OVER DENTURES

The dental profession has expanded the preventive dentistry concepts intor
prosthodontics to bring about the prescription called The Overdenture! "t is
further bytressed by he fact that the alveolr bone #ith its overling $ucose #as
never intended to receive the full force of a co$plete denture! So then% #hat is
an over denture!
i& ' co$plete or re$ovable partial denture that covers and rests onone $or
$ore re$aining natural teeth or roots!
()R&
ii& ' prosthesis that covers and is partially supported by natural teeh% tooth
roots or dental i$plants!
(OR&&
iii& ' prosthesis covering the occlusal surfaces of the teeth
(OR&
iv& The over lay of artificial teeth on the surface of natural teeth to i$prove
occlusion% arch fo$ and*or esthetics + super i$posed prosthesis!
S,NON,-S
(.& /iologic denture ( 0& 1ybrid denture (2& Telescopic denture (3& Overlay
denture (4& Onlay denture (5& Tooth supported dentures (6& Super i$posed
denture!
Rational for the over denture concept!
Extraction of all naturl dentition and replace$ent #ith a si$ple denture is not
the $ost desiable treat$ent! 7reventive prosthodontics e$phasi8es the
i$portance of any procedure that can delay or eli$inate further prosthodontics
proble$s! The over denture is a logical $ethod for the dental to use in
preventive prosthodonics!
The se9uelae after the extraction of all the teeth $a:e co$plete denture
progresively less effective! '$ong these se9uelae are
a& The loss of discrete teeth proprioception
b& The progressive loss alveolar bone
c& The transfer of all occlusal forces fro$ the teeth is the oral $ucosa!
;ro$ physiologic vie# point the roots provide not only periodonal liga$ent
support but also
a& Directional sensitivity
b& Tactile sensitivity to load
c& Di$ensional discri$ination
d& <apine response
e& 7roprioception and salivary secretion
f& Decreased perception in older individuals
-anly and associates observed that the $ean $ini$al threshold for detection
of load #as approxi$ately . g$! ;or the incisal surface of natural anterior
tooth in axial direction #here as it #as = to .) g$s on the occlusal surface of
the .
st
$olar! Of the eight denture #earers tested for ani$al load threshold to
forces applied to the occlusal surface of the .
st
pre$olar of the $andibular
denture% five #ere insensitive to a force of .04 g$ t#o reacted to =)g$! 'nd
one reacted to 4)g$! Therefore the average threshold for denture #earer #as
$ore than a hundred ti$es that for an anerior natural the! The retention o
natural teeth for an over denture preserves so$e of the sensory i$puts fro$ the
periodontal receptors #hich is $ore precise than that is obtained fro$ the oral
$ucosa!
>a#a$ura (.?53& @ross$an (.?53& and @ross$an and associates (.?54&
agreed that the sensitivity in the anterior part of the $outh% particulary the
periodontal liga$ent of the anterior teeh% tongue tip and $ucosa #as acute!
Nishiya$a and others discovered that patients Audge$ent of the loaded tooth in
locali8ing the sti$ulated tooth #as better a$ong anterior teeth than a$ong
posterior teeth! Though studies indicate that the natural anterior teeth exhibit
$ore sensitivity and discri$ination than posterior teeth% posterior teeth also
should be retained for over dentures #hen feasible!
"n co$paring the di$ensional perception% patients #ith natural dention could
discri$inate difference at the 0$$ range better than those #ith artificial
dentures! -anly and associates (.?40& graded 9uantities of calciu$ carbonate
suspended is bland pudding in various percentage! 'l$ost all patients #ith
natural dentition #ould detect 0!?B <a<oa or less #hile the $aAority of
denture patients re9uired $ore than ? C <a<o2 for detection! Those findings
e$phasi8ed the i$portance of conservative procedures and i$portance of the
retention of natural teeth!
Studies of canine response indicate that canine $ay be the $ost i$portant
propriceptive teeth #ith significant sensosry activity and land support to their
retention of over denture! So$e lateral forces are trans$itted by the over
denture is the supporting tooth! "t has been sho#n that teeth are $ore sensitive
to lateral forces than those in long axis 'lder (.?36& This finding reinforces
the i$portance of directional sensitivity!
>apar D <ollister (.?6)& in their stuides concluded that the periodontal
receptors played an indirect role in satisfactory salivary reflex by regulating the
range and type of the satisfactory stro:e! The $uscle activity deter$ined by
this $asticatory stro:e controlled the parotid gland secretion during
$astication! The $aAority of natural teeth used to support over denture are
devitalised and treated endodontically perceptual studies sho#ed that vital and
devitalised teeth have e9ual sensory input capabilities! Ranna$ found that
after re$oval of all but a s$all portion of the root and extre$ely light pressure
on the re$aining portion still gave a neural response!
7erceptive ability appears to decrease #ith age the Donald D 'ugust (.?6)&
found that he ability to identify for$s in the $outh re$ained stable in young
aduls and the decreased #ith age! Use of the over denture is an ate$pt to retain
every possible sensory ele$ent at the ti$e the patient $ay experience a
generali8ed decrease in sensory capacity! Rissin and coE#or:ers (.?6=&
co$pared $asticatory perfor$ance in patients #ith natural dentition!
<o$plete denture and over denture! They found that the over denture patients
had a che#ing efficiency one third higher than the co$plete denture patients!
<ru$ and Rooney (.?64& in a 4 years study found that the retention of
$andibular canines for over denture led to the preservation of alveolar bone
using! <o$paraive cephalo$etric radiographs and study costs they found an
average of !5 $$ vertical loss of alveolar bone in the anterior part of the
$andible in the over denture patients! The sa$e in cse of $andibular
conventional denture #as an average of 4!0$$ (or& = ti$es as $uch bone loss
as in patients #ith over denture! "t #as also observed tha the use of the over
denture preserved the alveolar boe bet#een canines in both height and #idth!
The over denture patient also exhibited less alveolar bone loss in the area
i$$ediately posterior to the canines! The study sho#ed the presence of roots
of the teeth in the alveolar bone #as i$portant for is preservation!
@O'F O; T1E R'T"ON'FEG
.& -aintains teeth as part of the residual ridge
0& Reduced rate o resorption
2& "ncreased in $anipulative s:ills of handing the dentures
"ND"<'T"ONS
"t $ay be of partial or co$plete type%
.& ;or patients #ho face the loss of the re$aining natural adult dentition!
Therefore younger the patient greater the indication!
0& <auses #here the retention is difficult to obtain!
a& Cerosto$ia or sialorrhea
b& 'bsence of alveolar residual ridge
c& Foss of $axilla and partial loss of $andible
d& cognetial defor$ity leg cleft palate
2& ;or patients #ith a poor prognosis for co$plete dentures!
a& 1igh palatal vault and ridge slope
b& 7oorly defined sublingual fold space
c& "n class """ tongue position
d& >nife edged ridge that #ill provide inade9uate support!
3& Hhen pronounced vertical overlap of the anterior teeth is re9uired to
produce good esthetic results!
4& !Unilateral over denture can be given to provide a good function and
esthetics a large a$oun of bone and soft tissue hve been lost on one side of
the arch!
5& 7atients #ith badly #orn out teeth!
6& Hhen co$plete denture #ill be opposed by retained $andibular anterior
teeth preventing (co$bination syndro$e&!
=& Thexapeutics in the for$ of insitu irradiation (-ober$ott D Rosenberg
(.?52&
<ONTR' "ND"<'T"ONS
a& Un coEoperative and under $otivated patients #ho insists on re$oval of his
re$aining teeth! 'ny indicaion of patient #ho #ill not coEoperate in oral
hygiene and regular office procedures% vecull for adAust$ents #hich is
re9uired to $aintain the re$aining teeth and the supporting tissue in a state
of health!
b& 7sychologically so$e patients cannot accept any type of re$ovable denture!
c& -enally and physically handicapped patiens for #ho$ pla9ue control and
good oral hygiene are difficult!
d& Hhen a patient canno econo$ically afford!
7eriodontal <onsiderationG
7eriodontal infla$$ation% poc:et for$ation% bony defecs% and poor 8one of
attached gingiva $ust all be eli$inated before co$$encing the treat$ent! The
deleterious effect of the over denture on the periodontiu$ can be $ini$i8ed of
the over denture on the periodontiu$ can be $ini$i8ed if one begins #ith an
optiu$ state and the patient follo#s a $eticulous ho$e care progra$$e #ith
fre9uent recall!
' co$$on periodontal re9uisite #ith over denture abut$ent teeth is that an
ade9uate 8one of atached gingiva is $andatory! This can be acco$plished
through periodontal surgery utili8ing either a free gingival graft or apically
repositioning a split thic:ness flap! This results in a band of attached gingiva
adAacent to the abut$ent tooth!
The ideal teeth thould present $ini$u$ $obility have acceptable bone support
and a$enable to periodontal therapy! "t should e understood that the reduction
of clinical cro#n root ratio #ill be favorable in reducing any existing $obility!
<ontra indications for using periodontally involved teeth!
i& <lass """ $obility due to the loss of alveolar bone at connot be corrected!
ii& Soft tissue and osseous defects #hich are not correctable by surgery!
iii& ;ailure to establish a sufficient 8one of attached gingiva by
$ucogingival or grafting procedure!
iv& Excessive reduction of the adAacent residual alveolar ridge as a result of
eli$ination of osseous defects for the establish$ent of nor$al
architecture!
Endodontic <onsideration
There are 2 $ain advantages of treating the abut$ent teeth endodontically!
i! The cro#n root ratio can be $ade $ore favourable!
ii! Reduction of the clinical cro#n provides an interocclusal distance $ore
favourable for the place$ent of the artificial tooth in an esthetically
acceptable position and in $ore favourable relation to the opposing
teeth!
<areful evaulation of the possibility of ;!7!D! of R!7!D! $ust be done! Since
there are $any disadvantages of an over denture that can be easily avoided if
;!7!D! of R!7!D! is utili8ed!
<ontra indications for Endodotnic Treat$entG
i! Vertical fracture of the root (or& roots!
ii! -echanical preparation of the root canal!
iii! "nternal resorption that has perforated through the side of the root!
iv! /ro:en instru$ent in the root canal!
v! 1ori8ontal fracture of the root belo# the bony crest!
Teeth that are grossly $alposed #ill be difficult to use especially posterior
teeth that are tilted $ore than 04I!
Single rooted teeth #ith only one canal that is easily negotiable are the best
candidates although $ultirooted teeth can also be used! '0 to 3 #ee: interval
before co$$encing further treat$ent on the tooth is helpful to deter$ine
endodontic co$plication if any!
Types of Over Denture
The type of overdenture depends pri$arily on the status of the patientJs
dentition at the start of treat$ent!
.! "$$ediate Over Denture G
'n i$$ediate over denture is constructed for insertion i$$ediately after the
re$oval of so$e natural teeth of #hich $any hopeless abut$ent teeth! 're%
treated and the over denture is inserted as an i$$ediate replace$ent! The
i$$ediate over denture $odified as re9uired! <an be #orn for several years
under favourable circu$stances!
""! Transitional over * 'dditive denture G
' Transitional over denture is obtained by converting an existing re$ovable
partial denture to over denture!
"""! Re$ote over denture G
' re$ove over denture is an over denture other than transitional or i$$ediate!
"t is usually constructed for insertion at so$e ti$e re$ote fro$ the re$oval
of hopeless! Natural teeth!
<lassificationG
1eart#elJs G
/ased on the $ethod of abut$ent preparation!
.! Non coping #ith si$ple tooth $odification #ith endodontic treat$ent
#ithout endodontic treat$ent!
0! <oping!
2! 'ttach$ents
3! Sub$erged vital roots!
.! Non coping G ('fter endodontic treat$ent selected abut$ents are reduced to
a coronal height of 0$$ to 2$$ and then contoured to a convex or do$e
shaped surface! -ost teeth re9uire endodontic therapy and the final step is
prepared conservatively to receive an a$alga$ or co$posite restoration!
Hithout endodontic therapy G The re$aining teeth are $erely reshaped to
eli$inate undercuts and reduce the vertical height if necessary to create $ore
interEridge space for the over denture! ;or these techni9ues to be possible% oral
hygiene $ust be ex9uisite #ith a lo# caries index! This techni9ue is often used
in partially anodontic patients of $ini$al preparation prior to final i$pression
#hich $a:es it totally reversible!
'but$ent #ith cast coping G <ast $etal coping #ith a do$e shaped surface and
cha$fer finish line at the gingival $argin are fabricated and ce$ented! There
are 0 distinct types of copings G
.! The short coping% 0! The long coping
The short coping G These are 0 to 2$$ long and nor$ally re9uire endodontic
therapy since the re9uired coronal tooth reduction #ould expose the pulp!
'ttached to the coping is a post% fitted to the canals! ;or this reason canals
should be obturated #ith soft @uttaE7ercha rather than $etal points!
Fong coping G These are nor$ally 4 to =$$ long! 'n atte$pt is $ade to
circu$vent endodontic therapy by a conservative reduction #ith a cellsopidal
shaped coronal coping and an increased cro#n root ration #hich re9uire greater
leve of osseous support! 'de9uate inter occlusal distance $ust exist to allo#
for encroaching on the available inter ridge space or a visuali8ation of vertical
di$ension is liable to occur #ith poor esthetics and failure because of patient
intolerance!
'but$ents #ith 'ttach$entsG
-ost attach$ents are secured to the abut$ent by a cast coping! The obAective
of any attach$ent is to i$prove retention of the denture base! /ecause of the
factors li:e ti$e% cost and ris:s the procedure should reserved for patient #ith a
favourable prognosis! The attach$ent does not reduce the cro#n root ratio
significantly as does the cast coping! 1ere the lo# caries index proper ho$e
care! 7eriodontal health and inter ridge distance are absolutely necessary!
Sub$erged vital roots G This is of current research interest% it atte$pts to
obviate so$e basic proble$ associated #ith the $ore conventional over
denture abut$ents! "n these cases selected vital roots are transected and
reduced to 0$$ belo# the crestal bone and then covered by $ucoperiosteal
flap!
The $aAor proble$ associated are develop$ent of dehiscences and pulpal
pathosis! "t is not reco$$ended as it is still in a state of infancy! Hhen this is
done several advantages of the over denture are lost!
.! Support fro$ direct contact of the denture base to the abut$ent tooth!
0! 'tte$pts to gain retention fo$ the teeth through so$e for$ of attach$ent is
no longer possible!
2! The loss of proprioception!
Treat$ent planning G
This includes G
.! Endodontic treat$ent!
0! 7eriodontal condition!
2! <aries $anage$ent!
3! Focation and distribution of abut$ent!
4! Econo$ics!
The .
st
and 0
nd
conditions have already been discussed!
<aries $anage$ent G The presence of high caries index and the situation that
#ill create a carious environ$ent are the devastating se9uelae to i$proper over
denture patient selection! <hoice of abut$ent is teeth% that have a healthy
clinical cro#n! <aries activity in a protected abut$ent is undesirable for
reasons other than the technical proble$s of restoration% an active caries
process can lead to a recurrence in protected abut$ent teeth or gingival to the
coping $argin!
;re9uent recall chec: up and treat$ent of the abut$ent #ith periodic fluoride
application to insure against any further brea: do#n! )!3 and Stannous ;luoride
gel is brooted on abut$ent teeth for . $inute once daily and expectorated!
Focation and distribution of abut$ent G
.! 7reference for anterior over posterior teeth therefore the alveolar ridge
appears to be $ore vulnerable to reduction than the posterior alveolar ridge!
0! T#o teeth in each 9uadrant presents an ideal situation in #hich stress is
distributed% over a rectangular area! Eg G <uspid 0
nd
pre$olar and*or 0
nd
$olar in each 9uadrant!
The tripod is the next $ost favourable for$ for support and stability!
The use of t#o teeth in each arch or one tooth in one arch has $et #ith
satisfactory results!
-arro# reco$$ends that it is better to use isolated teeth as abut$ents rather
than adAacent teeth because they return to a state of good health $ore readily
and are easier for the patinet to $aintain hygiene!
2! The upper anterior teeth should be retained if opposed by natural lo#er
anterior teeth to prevent the destruction of the anterior ridge #hen utili8ed
in a $axillary over denture!
3! -andibular cuspids are $ost often utili8ed since they are usually the last
tooth to be lost!
Hhen #e consider endodontics% especially on several teeth% the possibility of
casts coping% internal attach$ents and the over denture itself% the cost of this
$ode of treat$ent $ay #or: cut to be costly! Therefore #e should evaluate the
situation as it exists! The teeth that already have been endodontically treated%
teeth perhaps could be reduced #ithout endodontics% single rooted than
$ultirooted teeth% $ini$u$ nu$ber of teeth needed to achieve support and
bone preservation should be :ept to hold so that this for$ of treat$ent can be a
viable alternative to conventional co$plete denture!
'dvantge G
.! 7reservation of alveolar bone!
0! "$proved denture retention% stability and support!
2! 7rovides a vertical definite stop!
3! 7hysiological acceptances hence better patient coEoperation!
4! 7reservation of $asticatory proprioception!
5! ;e#er post insertion proble$s!
6! <onvertability!
=! 1ar$ony of arch for$!
?! "deal occlusion!
.)! Open palate possible!
..! Fess trau$a is supporing tooth!
.0! Esthetics!
.2! Ease in construction and $aintenance!
.3! Fo#e cost #hen co$pared to R!7!D!
Disadvantages G
.! Over denture treat$ent is $ore expensive than conventional denture
because of periodontal and endodontic therapy and the subse9uent
restoration of teeth #ith gold coping!
0! /ul:ier than ;!7!D! (or& R!7!D!
2! "f oral hygiene is not $aintained properly caries and periodontal disease
$ay still progress!
3! /ony under cuts $ay cause either over contouring or under containing of
the denture!
4! Encroach$ent of inter occlusal distance!
5! Esthetics!
6! "n $any cases% o#ing to lac: of available space sections of the over denture
base are 9uite thin! "f $etal reinforce$ent is not used% fracture of the base
and prosthetic teeth is co$$on!
'n over denture that fulfils all of its specific re9uire$ents $ust also fulfill
these re9uire$ents of any conventional denture! Therefore $atters such as
ade9uate tissue converage% proper extension% of bases% la# records!
1ar$onious occlusion and esthetics cannot be co$pensated because an over
denture is being contracted! ' sound prosthodontic approach to the appliance
$ust al#ays be carried out!
Over Denture 'ttach$ents
'ttach$ents <lassification!
"! 'ccording to shape% design and pri$ary area of use!
<oronal G
a! "ntra coronal!
b! Extra coronal
i! Resilient!
ii! Non resilient
Radicular G
a! Telescope stud attach$ents!
b! /ar attach$ents!
i! Koints
ii! Units
'ccessory G 'uxiliary attach$ents
a! Scre# units!
b! 7a#l connectors!
c! /olts!
d! Stabili8ers * balancers!
e! "nterloc:s
f! 7ins*scre#s!
g! Rests!
-agnets G
a! 7er$anent $agent!
b! "nduced $agnet!
c! "nduced $agnet!
d! Open field!
e! <#sent field!
Extra <oronal "ntra radicular
.! @erber attach$ents .! Lest 'nchor
0! Dalbo attach$ent!
2! <e:a attach$ent
3! Rother$ann attach$ent!
4! "nfrofix attach$ent!
5! Schubiger attach$ent!
6! Muinlican attach$ent!
=! The co$pact unit (7ris:a&
?! /attesti units!
.)! <onod unit!
..! /acer and ;ah units!
.0! The )E4) syste$
.2! 1o#$edics and "none units!
.3! Hhale donJt stud asse$bly!
.4! >urer stud attach$ent!
' $ounted diagnostic casts is an i$portant aid to chec: the space available
before an attach$ent is selected!
-ost of the stud types can be considered to be snap fasteners! Stud devices are
si$pletes a$ong all attach$ents! The $ale part of the unit consists of a stud
shaped proAection soldered to the diaphrag$ of a dovel retained restoration!
The fe$ale part fits over the $ale unit and is e$bedded #ithin the denture base
of the prosthesis! There are a fe# syste$s #hich #or: in the reverse! Eg! Lest
'nchor! ' fe# studs are anteriorly riged (because the si8e $a:es it difficult to
prevent a s$all a$ount of $ove$ent bet#een the t#o co$ponents&! "n so$e
springs are specifically incorporated to allo# a controlled degree of $ove$ent!
'dvantages G
Retention% stability and support!
' positive loc: of certain untis can $aintain the border seal of the denture!
Selection of attach$ents G
The success of prosthesis usually depends on careful treat$ent planning and
attention to the prosthodontic proble$s! The $echanical ingenuity of the
attah$ent is i$portant% but $ust ta:e second place! The shape and si8e of the
units is nor$ally the over riding consideration although the auxiliary devices
that acco$pany the attach$ent $ust influence the choice!
<orrect vertical space assess$ent $ust be ta:en care of! Extra radicular stud
attach$ents are relatively strong and can often provide $ore effective retention
than their interradicular counter parts! Farger attach$ents are generally
stronger than s$aller ones and less prone to #ear! Debate still continues as to
#hether or not the co$paratively rigid units should be selected as opposed to
those that allo# $ove$ent!
-ensor (.?=)& auotiny #or: by ;enner% 1erber and -abie$ann (.?4)& has
clai$ed rigid or cylindrical stud attach$ents produce no tipping action on the
root! /all and soc:et designs are stated to produce 3 ti$es as $uch tipping
potential!
' recent lab study by Thayer and <aputo (.?=)& e$ployed photoEelastic stress
analysis! They found that forces applied to a Dolder bar #ere resolved in an
apical direction #here as stud attach$ents engaging the do#el retained
diaphrag$ $ight produce tipping potentials!
Feverage effect upon the root has also an effect on attach$ent selection! -outh
preparation% ease of rebasing and repair procedures also deter$ine the type of
stud attach$ent!
The nu$ber of stud attach$ent G
One stud attach$ent on each side of the arch #ill usually suffice other
re$aining roots can be covered #ith si$ple copings! "ncreased nu$ber of
attach$ents in a denture does not produce a corresponding i$prove$ent in
retention!
7opular attach$ent syste$ G
'! Dalbo Stud Unit G
a! /all and Soc:et!
b! Rigid Dalbo
Extre$ely popular of the design series% neatness strength% ti$e tested!
;eatures G 3$$ high #ith spherical shape $ale section% easy to clean! The
fingers of the soc:et are surrounded by nylon rings! That si$plifies
adAust$ents! 'dAust$ents are si$ple to carry out! Retention can be increased
by altering free ends of la$ellae!
'dAuncts G
'dAusting tools G Tightening device! <o$pli$entary tool! Device to replace
nylon sleeve! Relocating do#el for rebasing i$pression!
/! The co$pact unit G
1eight + 0!=4 $$
Din of retention :nob is 0!?$$
Divergence of .)Ibet#een the align$ent of 0 attach$ent $ay be per$itted
#ithout causing increased #ear of $ale section! "t #as developed fro$ the
ancrofix!
<! @erber 'ttach$ents G That allo#s vertical $ovenet! Rigid attach$ent
(popular&!
Retention of both types of @erber attach$ent is obtained by a retaining spring
in the fe$ale unit engaging a peripheral groove in the $ale section! The spring
clip $ay be re$oved for adAust$ent by unscre#ing! The base of the fe$ale
unit using the special instru$ent provided! /oth types of $ale unit scre#ed on
to their soldering base and prevented fro$ unscre#ing #ith a little resin
ce$ent! They $ay be unscre#ed in the $outh #ith a heated scre# driver!
Feaving exposed a scre# thread proAecting fro$ the base of the attach$ent!
@erber pointed out that if t#o or $ore teeth #ere used% the $ost distal
attach$ent should allo# $ore vertical play than the anterior ones% as it is li:ely
that greater dispathc force #ould be applied to the $olar surfaces of the
prosthesis!
D! <e:a Syste$ G
.! Rigid
0! Resilient!
Rigid and Resilient designs share a co$$on base! /ut the <e:a extracoronal
units are not identical! Therefore it is not possible to change resilient for rigid
constructions $erely by changing% the retention portions! The vertical travel
allo#ed by the resilient stud unit is )!3$$! the retention pin or $ale section is
scre#ed on to the base ring!
'nciliary instru$ents G
a! Focating device!
b! 'dAust$ents device!
c! <hanging attach$ents!
d! Repair and rebasing device!
Fi$iting factor is the vertical space re9uired by the unit resulting in 4$$
vertical space re9uire$ent for the attach$ent co$ponents!
's #ith all attach$ents syste$s their align$ent #ith each other and the path of
insertion of the prosthesis $ust be planned! The attach$ent base is soldered to
the prepared flat surface of the coping! The spring pin or $ale section $ay be
re$oved fro$ its base% so this allo#s considerable versatility% since brea:age of
the pin is easily solved by re$oving it and replacing it #ith another unit! This
is done by a special tool provided #ith #hich the spring pin is unscre#ed!
Hhile the other end of the special tool $ay be used to increase the retention by
$eans of the #edge shape instru$ent!
Rebasing techni9ues are 9uite straight for#ard and there is a locating do#el
that engages the fe$ale section of the attach$ent before the i$pression is cast!
This re$ovable spring pin ($ale section& is particularly useful #hen a
duplicate denture is re9uired% as it saves intraoral locating procedures #hich are
difficult to carryout! The spring pins are unscre#ed and special locating
co$ponents #ith parallel sided tagging scre#ed do#n on the copings in the
$outh! The $aster i$pression #ill no# reproduce the parallel sided tagging! "n
the laboratory% identical co$ponents are slid into the i$pression leaving the
scre# threads proAecting! The du$$y scre# base is no# attached to the
co$ponents in the i$pression and the i$pression is poured! Thus #ithin the
$aster cast includes du$$y scre# based identical in every respect to those in
the $outh! Spring pins can no# be placed on the$ and the duplicate denture
constructed! On this cast #ith sure :no#ledge that is #ill fit accurately in the
$outh!
E!"ntrofix is a solid cylinder attach$ent that can be used for fixed re$ovable
bridge #or: as #ell as for overdentures! "t consists of 2 parts G
.! ' solder bar that is co$$on to the ancrofix!
0! ' replaceable and adAustable $ale friction part!
2! ' fe%aNe cylindrical housing!
'dvantages Disadvantages
.! Si$ple to use!
0! <o$ponents are replaceable and
interchangeable #ith the solder base
of the acrofix!
2! The attach$ent provides good
seating and retention!
3! <an be used in co$bination #ith
resilient attach$ents!
4! Service life is indefinite
.! 7aralleling necessary!
0! 7rocessed in the lab!
2! Tor9u$ potential is $axi$u$ if
dentures base is not adapted
properly!
E! Schubiger
<onsists of a short scre# bloc: for bar fixation a larger one for fixed re$ovable
bridge #or: and an individual cap core syste$!
Over denture attach$ents has 2 parts!
a! Solder base co$$on to the @erber!
b! ' sleeve in cera$ic $etal!
c! ' cap nut!
d! Overall height is 0!=$$!
'dvantages Disadvantages
.! 'llo#s co$plete flexibility
0! 7rovides for bar fixation!
2! 7er$its conversation fro$ bar to
individual stud fixation! (@erber&
7aralleling is necessary!
<o$plex and expensive!
;! Rother$ann Unit G
a! Rigid (less height .$$&!
b! Resilient ($ore height .!6$$&!
'dvantages G Re9uires little vertical space and tolerance for li$ited
$isalign$ent of attach$ents!
"t is a button shaped attach$ent #ith the $ale unit incorporating a groove of
uneven depth! The clip of the fe$ale section slides over the tapered upper edge
of the $ale! Hith the free ends of the fe$ale engaging the deepest retaining
groove! The fe$ale clip is designed to be retained #ith acrylic resin! '
$odified version of the clip is no# available #ith tagging that runs at right
angles to the original design! 'part fro$ the $ini$al vertical space
re9uire$ent an additional advantageis the tolerance for li$ited $isalign$ent of
attach$ent!
"ntra radicular stud attach$ents G
The advantages of this syste$ lies in cost and space re9uire$ents! They do not
re9uire precious $etal coping do#el nor special laboratory procedures! They
are relatively si$ple and 9uic:!
Lest 'nchor syste$ G
' nylon $ale ele$ent is incorporated in the denture base and proAects
do#n#ards% engaging a recess in the root preparation% further the loads are
applied at a point! That is #ell apical to the gingival $argin of the root! '
variety of abut$ents $ay be e$ployed including he$isected $olar roots! 0
si8es of 8est anchor are available depending on the root length and dia$eter!
The syste$s has been extensively refined over the years and a co$prehensive
:it is no# available! The vertical space re9uire$ents are the sa$e as
Rother$ann unit!
/ar co$pared to Stud ;ixation G
.! Splinting of t#o or $ore teeth #ith a bar produces stability si$ilar to the
rigid stud type attach$ent #hen the overdenture is in place! /ut the study
type allo# independent $ove$ent!
0! "f one tooth is #ea: the strong tooth can serve as the fulcru$ point for
$ove$ent of the #ea:er tooth in the prosthesis! Hith bar fixation% a
stronger and a #ea:er tooth can be splinted #ith the result that the stronger
tooth strengthens the #ea:er tooth and the #ea:er tooth #ea:ens the
stronger tooth!
/ar 'ttach$ents G
The bar attach$ents help in splinting of the abut$ent teeth% retention and
support of the appliance! The inter occlusal space availability has already been
e$phasi8ed! /ar attach$ents are classified into t#o types bar units and bar
Aoints! /ar unit has a rigid fixation #here there is no $ove$ent bet#een the bar
and overlying sleeve and can be classified as tooth born! /ar Aoints per$its
rotational $ove$ent bet#een sleeve and bar and derives $ore or residual ridge
support!
Types of /ar 'ttach$ents G
.! 1ader /ar!
0! Dolder bar attach$ent!
2! /a:er clips!
3! 'c:er$an clips and
4! <!-! clip
1ader /ar attach$ent G
- <an serve as a bar Aoint or a bar unit!
- <an be used as a stud attach$ent and a bar attach$ent!
- <onsists of prefor$ed plastic bars and clips!
;abrication G
The plastic bar is attached to the #ax copings and is cast #ith the coping!
7lastic clip is e$bedded in the denture for retention! /ut $etal clip offers $ore
retention than the plastic! 7lastic clip #ears off rapidly! ;or $ore retention
additional clips can be added and tension of the $etal clip can be increased!
1ader /ar G
'dvantages G
- /ars can be fabricated in any alloy!
- Retention can be replaced by patient or dentist!
- ;or $ore retention $etal clip can be used!
- 'sse$bly techni9ue is si$ple!
- <apability to follo# gingival contours!
Disadvantages G
- Rider is too bul:y occlusogingivally!
- Rider retention decreases rapidly!
- No tension adAust$ent! ;or additional retention $ore $etal clips
should be added!
Dolder /ar G
- 1as bar unit and bar Aoint
- 7refor$ed bars are available for bar units!
- Shape of the bar% has parallel sides #ith a rounded top!
- Retention is by $eans of frictional fit!
- Non resilient attach$ent!
;abrication G
The prefor$ed bars are soldered to the copings and the sleeve is e$bedded in
the acrylic over denture!
0!Dolder /ar G
'dvantages G
- 'vailability of t#o different heights .3!54 $$ and 2!5$$!
- Rider and bar are available in any lengths!
- Spacer allo#s vertical and rotational $ove$ent!
Disadvantages G
- Too bul:y even in $icrosi8e (faciolingually&!
- Expensive and re9uires exceptional s:ill for its use!
- 'llo#s vertical and rotational $ove$ent because of the resilient
attach$ent!
- <ontouring the bar Aoint is difficult!
/ul:y and difficult to use because of esthetic considerations!
/a:er <lip G
- <onsists of OUJ shaped clip designed to fit over a round #ire! .0 and .3
roung gauge #ire are used! These #ires are soldered to the copings! <lip is
positioned over the #ire and is attached to the over denture #ith cold cure
resin!
2! /a:er <lip G
'dvantages G
- 'dAustable and provides rotational $ove$ent!
- Readily available!
Disadvantages G
- No retention for the clips!
- Soldering the retentive loops reduces the elasticity of the clip!
'c:er$an and <!-! <lip G
- These are bar Aoints!
- /oth are si$ilar in designs!
- <onsists of a rounded bar and clip% #here the clip fits over the bar!
- The slip has retention #ings for the easy engage$ent into the acrylics!
- 'llo#s vertical and rotational $ove$ent because of fixation!
- 7rovides an excellent retention for overdenture #hen bar Aoint syste$ is
used!
'dvantages G
.! Rider is provided #ith retention!
0! Spaces provides resiliences and rotation (or& rotation alone if the shi$ is not
used!
Disadvantages G
The basis can be only .!?$$ in dia$eter!
-agnetic Denture Retention G
These have been in existance since .?2)! They can be divided into groups!
.! Those depending on the $utual repulsion of li:e $agnetic poles! Eg!
;ried$an $agnetic stabili8ers&!
Disadvantages G
a! Fess retentive #hen $ost needed (#hen Aa#s are part&
b! <ontinued resorbtion!
0! These depending on the $utual attraction unli:e poles!
Disadvantages G One continuous attracting forces could cause the e$bedded bar
$agnets to $ove through the bone% crode the soft tissues and beco$e
exfoliated!
"n order to :no# about $agnetic over denture the field strength and $agnetic
per$anence are 0 ter$s #hich re9uire clear understanding! ;or dental use a
high $agnetic field strength is desirable as this #ill provide stronger retention!
1igh per$anence is essential for (.& it ensures $agnet #ill be less li:ely to lose
its $agnetis$! (0& ' s$all $agnet can be $ade #ithout the north pole
de$agnetising the south pole!
Until .?6) $agnets for dental purpose #ere either 'lnico ('l% <o% Ni& or <o*7t
$agnets both alloys have $agnetic field strength! /ut their per$anence is such
that there is a lo#er li$it to their physical si8e and they cannot be $ade as
s$all as a tooth and have high field strength!
This li$itation #as eli$inated by the discovery of the rare earth cobalt (RE<&
$agnet alloys! RE< alloys have 4 to 3) ti$es field strength! The co$$on
co$position being cobalt*sa$ariu$ (<oS$&! They #ere introduced to
prosthodontics for retention by @illings in .?66!
"n one approach $agnets are attached to the supporting flush #ith the root
faces! Si$ilar but opposite polarity provides retention in the range of .4)E3))
g$s*$agnet pair! Denture base*root face separation of as $uch as 2$$! This is
no path of insertion retriction!
Disadvantages G
.! S$all root surface of so$e supporting root li$it the si8e of $agnet that can
be inserted and li$it retention!
0! The $agnet alloy can corrode and fracture in the $outh!
2! 'n avoidable $agnetic field surrounds both the intra radicular and denture
$agnets!
These disadvantage #as over co$e by replace$ent of one $agnet #ith a
$agnetisable lo# intrinsic coercivity alloy% #ithout significant loss of
retention! ' casting alloy based on palladiu$% cobalt and nic:le is cast as root
cap and do#el and fitted to the supporting root is inserted! The casting because
of its $agnetic coercivity beco$es a strong induced $agnet and retains the
denture li:e an intraradicular per$anent $agnet!
/iological Effects of <obalt*Sa$ariu$ -agnets G
There are t#o #ays in #hich <o*Sa $agnets could have an effect on tissuesG
.! 7hysical effect because of the presence of $agnetic field gradient!
0! <he$ical effect due to #ear or corrosion products of alloy!
/ehr$an (.?5)& in his study concluded that $agnetic is co$pletely innocuous
to tissues! Si$ilar conclusions #ere reached by Toto and <hou:as!
Tsutsui and his colleagues (.?6?& found alloy to be innocuous in tissue culture
test due to corrosion resistance! The #ear rate of unprotected faces of $agnets
used for over denture retention has been found to be less than
.$$*s9$$*year! (@illings .?6=&! This is several orders of $agnitude less than
the reco$$ended $axi$u$ ingestion levels for cobalt and sa$ariu$!
The external $agnetic field can be virtually eli$inated by arranging paired
$agnets is a $odified horse shoe configuration by #hich the retentive effect is
al$ost doubled! The explanation of this apparently ano$alous doubling effect
is that in the open configurations the north and south pole facing each other
contribute to the retention% but the re$aining South and North poles do not and
their potential retentive effect is thus #asted! Hhre as all the available
$agnetic field is used in no closed configuration! /oth the open and closed
field denture retention syste$ are in current use!
<o$parison of $agnetic retention and precision attach$ents!
'dvantages G
.! Si$plicity!
0! Fo# cost!
2! Self adAusting (Orthodontic tooth $ove$ent for passing contact&!
3! Reusable!
4! "nherent stress brea:ing!
5! Reseating after denture displace$ent!
6! ;reedo$ of lateral and rotational denture $ove$ent!
=! Fo# potential for trau$a to supporting roots!
?! Ease of denture relining!
.)! No special accessories are re9uired!
..! 1eight of denture retention ele$ent is less than $any precision
attach$ents!
"n a study conducted by Fo:e in (.?5)& the retention provided by a standard
$agnetic retention unit #as found to be co$parable to the :urer stud
attach$ent% but only about one 9uarter of the ce:a attach$ent and about .*6
th
that of bona buffer!
1o#ever $echanical attach$ent are subAected to #ear in service #here as
$agnets retention does not have any effect! <linically the retention i$proves
#ith ti$e probably as a result of closer contact bet#een retention ele$ent and
root face through orthodontic root $ove$ent and interface #ear!
The $agnetic syste$ provides retention of 4))g$ #ith 0 units! Hhich is
ade9uate in $ost cases and #ith $ore than 3 so$e patients have difficulty in
re$oving the denture!
The indicated bona buffer attach$ents $ay have $ore than 2!4 :g of retention
but this #ould provide excellent denture stabili8ing but could i$pose
unacceptable high stress to the supporting roots!
Sub$erged Vital Roots G
-any patients cannot change their oral hygiene habits to properly $aintain the
gingival sulcus or tooth surface! ;or these patients a $ethod of root retention
and ridge preservation not re9uiring tooth and oral tissue cleanliness $ay be
the treat$ent of choice!
@uyer and associates in .?6= said that sub$ucosal root retention is one $eans
of eli$inating oral hygiene obligations for patients #hile possibly delaying
residual ridge resorption!
The $aintenance of alveolar bone tissue has depended up on the presence of a
healthy root and periodontal liga$ent #ith the resultant tensional forces
delivered to the bone by to the teeth during $asticatory or parafunctional
$andibular $ove$ents! Tooth roots retained sub$ucosally see$s to be
si$ilarly effective in preserving alveolar bone! Though endodontically treated
teeth prior to burial are used recent investigations suggest sub$ucosal vital root
retention a feasable alternatives! Research results have proved that sectional
and buried teeth #ere co$patible #ith surrounding tissue and sho#ed no
pathology #ithin the pulpal tissues or tissues attached to the roots! The retained
root exhibited co$plete healing #ith for$ation of an osteoce$entoid plug over
the coronal surfaces of the root and a healthy viable pulp tissue!
.! Reduced cost!
0! Expeiditing the treat$ent!
2! 7reservation of R!R!
3! No $aintainance of any degree of oral hygiene around the re$aining teeth!
<riteria for 7atient Selection G
.! 7atients #ho are psychologically acceptable as <D patients can be
candidates for sub$ucosal vital root retention!
0! Should have a nor$al response to accepted clinical vitality test!
2! Should sho# at least 2$$ of alveolar bone support on radiographic
exa$ination!
3! Should be located #ithin the area of the alveolar ridges $ost affected by
ridge resorption follo#ing tooth re$oval!
Farge restorations that $ay create debris during cutting of cro#n and root
should be debrided and filled #ith a te$porary prior to surgery or re$oval of
the ti$e of surgery! 7rior to the $a:ing of the surgical incision! 'de9uate
healthy gingiva is re9uired to cover the roots to be sectioned! Fac: of gingival
tissue at the ti$e of surgery $ay creative tension on the soft tissue! Sutured
over the sub$erged roots and cause failure of the #ound edges to re$ain #ater
tight closure and heal by pri$ary intension presurgical periodontal sealing! Soft
tissue curettage and root planning are considered essential for rapid soft tissue
#ound healing and acceptance of the retained roots #ithin the alveolar ridge!
Su$$ary
To conclude it #ould not be a repetition to say that over denture is a preventive
dentistry concept #hich has been brought into prosthodontics% and the alveolar
bone #ith its overlying $ucosa #as never intended to receive the full force of
a co$plete denture! Even though the techni9ue rese$bleJs those of co$plete
denture% there are i$portant differences! The prognosis of the restoration is
li:ely to be influenced by nu$erous factors li:e .! Selection of patient! 0!
Treat$ent planning 2! 7reparation of the $outh! 3! Execution of the
prosthodontic #or: and 4! -aintenance% finally its reasonable to conclude that
the retention of a part of the natural dentition affords the overdenture patient
again in neuro$uscular perfor$ance there by having an edge over his
edentulous counter part!
References
.! Kohn K! Sharry G <o$plete Denture 7rosthodontics! Third edition% Ne#
,or:% -c@ra#E1ill /oo: <o!% .?63!
0! /re#er '!'! and Robert! -! -orro# G Over dentures! Second edition!
St!Fouis% The <!V! -osby co$pany!% .?=)!
2! Sheldon Hin:ler G Essentials of co$plete denture! 7hiladelphia H!/!
Saunders <o! .?66!
3! 1arold H! 7reis:el G 7recision 'ttach$ents in prosthodontics G Over
dentures and Telescopic prosthesis vol! 0! <hicag% Muintessence 7ublishing
<o!% "nc! .?=4!
4! Kudson <! 1ic:ey!% @eorge '! Larb% and <harls F! /olender G Syllabus of
co$plete dentures! Ninth edition% St! Fouis% The <!V! -osby <o$pany
.?=4!
5! <harles -! 1eart#ell% Kr!% and 'rthur O! Rahn G Syllabus of co$plete
denture! ;ourth edition! 7hiladelphia! Fea and ;ebiger .?=5!