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OVERDENTURE
PRESENTED BYDR SUNITA CHOUDHARY
MDS 2nd YEAR

OVERDENTURE

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Introduction
Definition
Aims and objective
Requirements of an overdenture
Classification
Advantages
Disadvantages
Indications
Contraindications
Selection and preparation of abutment teeth
Various techniques
Construction of overdenture
Post-insertion instruction
Problems
Errors
Implant supported overdenture
Conclusion

INTRODUCTION

It has been observed that losing all the teeth is one of the
worst tragedies in a persons life.

Now a days maximum number of people want to preserve their

natural teeth and they dont want to compromise their esthetic
as well as functional need when planning for a dental
prosthesis

Therefore, preventive prosthodontics has been adopted by

many dentists as it emphasizes the importance of any
procedure that can delay or eliminate further prosthodontic
problems. For this, overdenture is one of the logical methods
for the dentist to use in preventive prosthodontics.

DEFINITION

Overdenture is defined as a removable partial or complete denture that

covers and rests on one or more remaining natural teeth, roots, and/or
dental implants (GPT-8).

AIMS AND OBJECTIVE

Decrease rate of resorption of alveolar ridge.

Maintain proprioception by intact periodontal ligaments.

Increases the support

REQUIREMENTS OF AN OVERDENTURE
(a) Maintenance of health
Abutment teeth should be free of plaque.
Periodontal pocket should be checked around the abutment teeth and
should be corrected surgically or curettage.
Failure to do this may lead to loss of abutments

(b) Reduction in Crown Root Ratio

It decreases the leverage force acting on the tooth.
It provides required inter-occlusal gap.
(c) Endodontic Therapy

This is necessary as most abutments need extensive crown reduction and

the teeth in which this is done, pulp is likely to be exposed.

(d) Adaptation and Coverage of Denture Bearing Area

Denture base should be well adapted to prevent food accumulation and to

evenly distribute the force and maximum area coverage as much as
possible.

(e) Design of Denture

It should be easy to fabricate.

(f) Ease of Adaptability

Should leave easy path of insertion and removal.

CLASSIFICATION

1. Based on method of abutment

preparation.

Non-coping with or
Coping with or
without endodontic without endodontic
therapy
therapy

2. Based on type of overdenture

Immediate

Transitional

Remote

BASED ON METHOD OF ABUTMENT PREPARATION

1. (a) Non-coping Abutment with Endodontic Treatment
Endodontic therapy is required when there is lack of interocclusal
space.
Selected tooth abutments are reduced to a coronal height of 2-3 mm
above the crest of gingiva and then contoured to a dome shaped
surface.
The root canal access opening is restored with amalgam or
composite.
(b) Non-coping Abutment without Endodontic Treatment
This type is given only if there is sufficient interocclusal space.
For this type the pulp should have receded sufficiently so that the
reduced teeth are not sensitive.
Indications : In patients with severe attrition.

2. Coping Abutments
A coping is a thin covering over the abutment teeth for better
protection against caries.
Cast metal coping with dome shaped surface and finish lines at the
gingival margins are made and cemented.
(i) Coping with Endodontic Therapy
They are 2 3 mm long.
The coping is attached by means of a post in the root canal.
The canal should therefore be obturated with gutta-percha.
(ii) Coping without Endodontic Therapy
They are about 5 to 8 mm long and are given in an attempt to avoid
endodontic treatment.
They also require greater bone support.

COPING
SHORT COPING

2-3 mm

LONG COPING

5-8mm

BASED ON TYPES OF OVERDENTURE

(i) Immediate Overdenture
Immediate overdenture is constructed for insertion immediately
after extraction of some natural teeth.
(ii) Transitional Overdenture
Transitional overdenture is obtained by converting an existing
removable partial denture into an overdenture.
(iii) Remote Overdenture
Remote overdenture is constructed after the extraction of the
mutilated teeth, endodontic therapy, cast copings or any other
procedure.

TRANSITIONAL OVERDENTURE

REMOTE OVERDENTURE

ADVANTAGES
Preservation of residual alveolar ridge - because of wide and even stress
distribution. over
Hard tissue = tooth and bone.
Soft tissue = oral mucosa.
A recent study compares alveolar bone loss in patients with mandibular
overdentrues to that in with conventional mandibular dentures. By preserving
the mandibular canines.
Bone loss was evaluated in canine area using cephalometric radiographs.
It was reported, reduction of :
-

0.9mm - overdenture

1.8mm conventional denture

Preservation of proprioceptive response through intact periodontal ligament.

Improves retention, stability and support.

Horizontal torquing forces which are harmful to the underlying tissues are
minimized.

Excellent patient acceptance as he feels that he still has his own teeth.

Conversion to complete denture : Tissue coverage and border extensions are

usually the same. It is easy to compensate the loss of one or all of the retained
teeth, either the spaces can be filled in or the denture can be relined/rebase.

Open palate possible: the maxillary overdenture of many patients can be roofless
if necessary, especially when both anterior and posterior teeth are saved.

DISADVANTAGES

Caries and Periodontal Disease : If the patients does not keep

the retained roots or teeth and overdenture clean.

Multidisciplinary Approach : It consist

periodontic and prosthodontic treatment.

Time Consuming : It is time consuming because of various

endodontic, periodontic treatment and lab procedures.

Overdenture is bulkier.

Cannot be used in cases with reduced interarch space.

Esthetic may or may not be compromised due to overcontour

or undercontour.

of

endodontic,

INDICATIONS
1. Group I : Patients with few remaining teeth that may be healthy or
periodontally involved, with intact or grossly destroyed crown.
Group II : Patients with severely compromised dentition. Selective
extraction should be carried out after a thorough examination of the
patient.
2. In morphologically compromised dental arches where better support and
esthetics are required.
3. Patients with congenital or acquired intraoral defects.
These defects include:
-

Oligodontia

Microdontia

Cleft palate and lip

Here we can improve the function and esthetic by replacing with overdenture.

1 shows advanced, symptomatic teeth wear and pulpal recession in a patient

whose dentition showed considerable morphological changes and neglect.
2 and 3 show three maxillary anterior teeth were retained, and an overdenture
was constructed 4 shows some of the badly worn anterior mandibular teeth
were reduced/reshaped polished, and partially restored with a removable
partial denture of the overlay type.

(A) Oligodontia, patients smile (B) Intraoral view

(C) Profile without overdenture (D) Profile with overdenture

4. The younger the pt, the greater the indication for this treatment.
5. Geriatric pt who is mentally & physically able to undergo the
additional treatment procedure.

CONTRAINDICATIONS
1. When another line of treatment promises to give better results.
2. When patient cannot maintain abutment teeth and periodontal tissue,
which are already not in favorable condition.
3. Teeth/tooth where endodontic treatment is contraindicated.
4. When there is inadequate interocclusal space e.g.: Deep bite case.

SELECTION OF ABUTMENT TEETH

1.

Location of Abutment Teeth

The teeth are most useful in areas of maximum occlusal force and ridge
resorption potential. Abutments for overdenture opposed by a natural
dentition is selected because the masticatory loads on overdenture
opposing a complete denture is very less as compared to that against
natural dentition.
1. Canine as Abutment Teeth
Canine response - Kruger and Michen (1962), said that the canines
had most densely distributed neurons and has specific site in the
trigeminal nucleus for sensory information. Because of this, patients
can differentiate the smallest relative differences in force applied to
the teeth. So they are considered as the best abutments.
2. Premolar as Abutment Teeth
Mostly considered.
Present in the middle of ridge.
Equidistance from both buccal and lingual cortical plate.
3. Molars as abutment teeth : Because of bone loss in furcation area, less
desirable for abutment.

LOCATION OF ABUTMENT TEETH

4. Two canine and two second premolars are excellent combination for abutment
because the space between them provide proper gingival attachment around
both teeth.
5. As a anterior alveolar ridge resorbs easily under stress, anterior teeth are not
usually selected.
6. Maxillary incisors are used as abutment if mandibular arch is intact.
2. Endodontic and Prosthodontic Status
Anterior single rooted teeth are easier and less expensive to manage
endodontically.
Pulpal recession upto the extent of calcification has occurred endodontic
treatment avoided.
All abutment teeth should be obturated.
Access can be closed with a temporary cement/amalgam restoration.

Periodontal Condition of Abutment Teeth

1. Prospective abutment should have minimal mobility and have adequate
bone support.
2. It should be amenable to any indicated periodontal treatment.

The presence of severe adult

periodontal disease necessitated
extraction of selected teeth and
subgingival root planing of
retained overdenture abutments.

This figure after extraction of

compromised teeth. Endodontic
treatment and alloy restoration is
done of the abutments

Various Techniques
1.
2.
3.
4.
5.

Simple tooth modification and reduction.

Tooth reduction and cast coping.
Endodontic therapy with amalgam plug.
Endodontic therapy and cast coping.
Endodontic therapy and cast coping utilizing some form of attachment.
- Gerber attachment
- Zest anchor
- Dalbo attachment
- Magnets
- Ceka attachment
- Bar attachment

I. Simple Tooth Modification and Reduction

In this remaining teeth are merely reshaped

To eliminate undercuts

And

Are reduced in vertical height

INDICATION
Patients with severe abrasion
II. Tooth Reduction and Cast Copings
In this teeth are reduced

And

Coping is made on the teeth

III. Endodontic Therapy and Amalgam Plug

This is a very widely used approach.

Teeth are reduced drastically usually to the gingival level.

Endodontic therapy is must

after this

Tooth is reduced upto 1-2mm above / at the gingival margin.

Amalgam restoration is done

Remaining dentin is smoothed and polished thoroughly

IV. Endodontic Therapy and Cast Coping

It is similar to the last technique,

only exception is instead of

amalgam restoration, casting is placed in the root canal.

Endodontically treated canine with simple casting

V. Endodontic Therapy with Cast Coping Utilizing Some form of

Attachments
It is reserved for the patient in which improvement in retention and
stabilization is desired.
Following are some of the attachment.

Studs
Another form of direct retention for a removable
partial denture or overdenture is obtained by
using a stud that clips into a flexible ring
A metallic stud can be soldered to a post and
core and cemented into an abutment tooth
while the ring is contained within a cavity in the
denture base Egs: Ceka attachment and the
Gerber or Rotherman attachments

 The ring may be

adjusted to grip the
stud or the head of
the stud may have
two intersecting
slits to increase its
circumference, the
stud or the ring are
replaced when they
are no longer
resilient.

CEKA ATTACHMENT

ZEST ANCHOR

 The height of the stud should not interfere with

the arrangement of the artificial teeth on the
denture and when vertical space is small, the
Rotherman attachment, with a height of 1.6mm is
particularly useful

Rotherman attachment

Bars connected to cast metal crowns or

copings having flat upper surface to
support the prosthesis and parallel sides
help to stabilize it

The Ackerman bar may be bent to have

contour of the edentulous ridge, and several
short matrices rest on the bar to attach the
denture base
Oval cross-section has been used in the
Dolder bar to offer direct
retention to a resilient
matrix

BAR ATTACHMENT

CONSTRUCTION OF OVERDENTURE
1.

Coping the abutment

2.

Impression procedures

COPING THE ABUTMENT

Endodontically treated
mandibular right canine.

A diamond wheel to reduce the root

1 mm above the gingival crest and
shape the root reflecting the convex
contour of the residual ridge.

A Gates Glidden drill is guided to

remove the gutta-percha while
maintaining an apical seal of 4 mm
of gutta-percha.

The completed overdenture

post-coping

IMPRESSION PROCEDURES
Transitional Overdenture

Made from an existing removable partial denture, the patients own teeth
or both.

A removable partial denture is converted into an overdenture after

endodontic treatment of the abutment.
An alginate impression is made of the arch with the partial denture in place

Auto polymer resin of the proper shade is sifted into the abutment indentations
of the alginate impression

After saturation with monomer, the impression with the partial denture in place
is seated in the mouth

Before the resin is completely set, the impression is removed and placed in
water at 540 C until curing of the resin is completed

A stone cast is poured into the impression with the partial denture in place

The transitional overdenture is removed from the cast, polished and inserted

Occlusion is checked and necessary adjustments are made.

PREMOLAR AND CANINE REMAINING

RPD

IMPRESSION WITH
PARTIAL DENTURE

AUTO POLYMERISING RESIN OF

APPROPRIATE SHADE
PLACED INTO
ABUTMENT
INDENTATIONS

IMPRESSION WITH PARTIAL DENTURE

SEATED IN MOUTH-REMOVED

FLANGES ADDED WITH

AUTO POLYMERISING RESIN

PLACED IN MOUTH
AND CHECKED FOR OCCLUSION

IMMEDIATE OVER
DENTURE

DUAL IMPRESSION OF
THE ARCH TAKEN

OCCLUSAL RIMS

JAW RELATIONS

TEETH OF APPROPRIATE
MOLD SELECTED

ALL TEETH EXCEPT SERVICING

AS ABUTMENT ARE REPLACED
BY DENTURE TEETH

ABUTMENT TEETH ON
CAST ARE PREPARED

TEETH SHORTENED

AXIAL SURFACES
TAPERED

TEETH HOLLOWED WITH BUR

POSITIONED OVER
CAST PREPARATION

MARGIN AROUND EACH

ABUTMENT INDENTATION
IS SMOOTHENED

ABUTMENT TEETH REDUCED

REMAINING HOPLESS
ANTERIOR TEETH REMOVED

IMMEDIATE OVER DENTURE INSERTED

OCCLUSION CHECKED

Remote Overdenture
Remote overdenture is placed over healed ridges, usually after a
period of satisfactory experience with an interim overdenture.
They can be constructed with either resin or metal base.

POST-INSERTION INSTRUCTION
(A) Oral Hygiene Instruction

Soak the denture in the solution of clorox and calgon

brush ridge tissues with a soft toothbrush.

brush the denture thoroughly

(B) Care of Abutment Teeth

Soft, multitufted toothbrush is placed approximately at 45 0

angle and vibrating action is used to clean the abutment teeth
allowing the tips of the bristles to enter into the cervices.

Fluoridated tooth paste is used to prevent incidence of caries.

CARE OF
ABUTMENT
TEETH

(C) Patients are recalled at 3 months interval

To evaluate oral hygiene.

To evaluate the condition of the :

Copings
Retained teeth
Supportive tissues.

IMPLANT SUPPORTED OVERDENTURE

INCLUSION CRITERIA FOR IMPLANT PROSTHODONTIC TREATMENT
Patient desire for implant treatment.
Systemic health status, which permits a minor surgical procedure.
Bone availability.
Patient willingness and ability to maintain oral health status.
EXCLUSION CRITERIA FOR IMPLANT PROSTHODONTIC TREATMENT
Patients current prosthetic experience is an adaptive one.
Residual ridge dimensions do not accommodate preferred implant
dimensions.
Communication with patient is not possible because of his or her
compromised cognitive skills.
Local anesthesia with a vasoconstrictor is contraindicated.
Immunosuppressive therapy, prolonged intake of antibiotoics or
corticosteroids, or brittle metabolic disease history.

SPECIFIC OBJECTIVES OF TREATMENT PLANNING FOR A PATIENT

WITH IMPLANT SUPPORTED OVERDENTURE
To determine the optimum location and number of implants.
To design a favorable distribution for occlusal stresses on the implants
and the prostheses bearing tissues.
To ensure an optimal esthetic result and hygiene protocol.

TREATMENT PLANNING CONCERNS

Two major concerns of prosthodontic treatment are :
i. No. of implants prescribed and their location.
ii. Preferred denture retention devices.

NUMBER OF IMPLANTS PRESCRIBED AND THEIR LOCATION

Maxillary overdenture

Maxillary overdentures require placement of a minimum of 34 implants

which are usually joined with a connecting bar.

In maxillary ridges, short bar segments connecting multiple implants are

suggested because a segmented bar is more likely to follow a ridge
without encroaching on the palatal space.

MANDIBULAR OVERDENTURES
Appear to be adequately supported by two implants.
When the anterior mandibular ridge shows a slight curvature or a
straight line, a bar will connect the two implants on its shortest distance
and preferably parallel to the patients arbitrary hinge axis.
When a pronounced curvature of the mandibular ridge is encountered,
the placement of more than two implants is recommended.
Patients with advanced mandibular residual ridge resorption will only
accommodate shorter implant lengths, and consequently, more than
two implants must be placed.

In such situations, three or preferably four implants should be

prescribed to achieve sufficient intraosseous support.

Single Attachment
Easiest
Cost effective
Recommended when implants are placed underneath a patients
presently worn denture.
Bars
- For
Maxillary overdenture
Atrophic residual ridges in mandible.
Mandibles with > 2 implants.
- Rigid bar for
Short distal extension.
When intraoral defects are present.

PROSTHODONTIC PROTOCOL
Implant supported and implant retained complete dentures despite the
lack of periodontal ligament and its periodontal receptors, the ankylotic-like
osseointegrated attachment appears to provide adequate sensorimotor
feedback system through receptors in the oral mucosa, bone,
temporomandibular joint, and muscle spindles.
MAINTENANCE CARE
Main objective of regular recalls is to maintain the health of the oral tissues,
particularly the preimplant tissues, and to check the denture for :

Ongoing fit

Stability

Occlusion

Growth of hyperplastic soft tissue around implants can be rectified by :

Vigorous massage

Surgical trimming of excess tissue.

Adjustment appointments include :

Assessment of fit of the denture base to determine the need for relining.
A check of female attachment components (loose, broken, lost).
Wear and fear of any parts of abutment from contact with the denture base.

72

Although advances in methods and improved materials have

contributed to better treatment results, caries and periodontal
problems still remain significant threats to overdenture service
life. Emphasis must be placed on proper patient selection, patient
motivation, detailed program of home care instruction and
frequent recall. So it is necessary for the success of overdenture
to control the factors that jeopardize its success.

 Prothodontic Treatment for edentulous

patients-Zarb Bolender
Bouchers Prothodontic Treatment for
edentulous patients
Syllabus of complete dentures-Heartwell
DCNA complete dentures
Overdentures made Easy- A guide to
Implant and Root Supported ProsthesisHarold W Preiskel
Overdentures Allen A brewer, Robert M.
Marrow

 Essentials Of complete denture

prosthodontics-Winkler
Van Waas MAJ, Kalk W, Van zetter:
Treatment results with immediate
dentures J Prosthet 76:153-157,1996

Thank
you

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