OVERDENTURE

Dr. Talib Amin

GDC Srinagar
  Introduction
• Extraction of teeth is followed by continuous ridge
resorption and poor denture foundation

• Loss of periodontal receptors responsible for proper

masticatory function and accurate jaw movements.

• Retention of few remaining teeth will preserve

alveolar bone and preserve periodontal receptors.
  Definition
A removable partial denture or complete denture
that covers & rests on one or more remaining
natural teeth, the roots of natural teeth, &/or
dental implants.
GPT 8
•Tooth supported denture
•Overlay denture/ Onlay denture/ Inlay denture
• Telescopic denture
• Superimposed prosthesis
• Hybrid denture
•Biological denture
•Coping prosthesis
RATIONALE FOR OVER DENTURE
(LOGICAL BASIS)
o The roots of the tooth offers the best available
support for occlusal forces.

o Accelerated rate of bone resorption is prevented.

o It increases pt’s manipulative skills in

handling the denture. (periodontal membrane
is preserved ,thus proprioceptive impulses, part of
myo-facial complex are retained.)
 Occlusal forces are transmitted on
oblique fibres and dissipated as tension
resulting in osteoblastic respose

Heartwell 4th Ed page 503

• LEDGER (1856)prescribed a prosthesis
resembling an over denture. His restorations
were referred to as plates covering fangs
(teeth)
• EVANS(1888) described a method for using
roots to retain restorations after intentional
devitalisation of the roots.

• ESSIG(1896) described a telescopic‐like

coping
• 1906–WILLIAM HUNTER put forward his focal
sepsis theory and this dealt a great blow to the
overdenture mode of treatment.
The main point of contention was that the
exposed roots act as foci of infection.

• 1916‐PEESO was employing removable

telescopic crowns. Later on, the bar type of
construction was developed.
• MILLER (1958 ) published his classic article
where the retention of previously unusable
teeth and their advantageous use in
overdenture treatment was explained as a
basic tenet in management.

• Prieskal(1968)described various
commercially available overdenture
attachments

Preiskel HW. Prefabricated attachments for compete overlay dentures.

Br Dent J 1967;123:161.
ADVANTAGES
• Ridge preservation
• Proprioception
• Superior patients acceptance
• Open palate possible
• Definitive vertical stop for denture base
• Support, stability and retention are improved
• Less trauma to supporting tissues
• Fever post insertion problems than conventional
complete denture
• Conversion to complete denture
• Increased biting force (Pacer FJ, Bowman DC. Occlusal force
discrimination bydenture patients. J Prosthet Dent 1975;33:602–9)
• Physiological Advantage
DISADVANTAGES
 Caries susceptibility.
 Periodontal disease around
abutments
 Bony undercuts. (due to limited
path of insertion)
 Encroachment of inter occlusal
distance.
 Meticulous oral hygiene is
required.
 Time consuming.
 Technique sensitive.
INDICATIONS
 Patient with badly worn teeth.
 Pt. with few natural remaining teeth.
 Poor prognosis for routine complete denture.
 Congenital or acquired intra oral defects.
 Mandibular arch where loss of bone is more rapid
 Edentulous maxilla opposing intact mandibular
dentition.
 Post traumatic or post surgical cases.
 Severe attrition and loss of vertical dimension.
 Young patient.
 Cleft palate causing large free way space.
 Hypodontia
 Tooth wear cases
CONTRAINDICATIONS
 High caries index.
 Poor oral hygiene.
 Poor prognosis of abutment.
 Reduced inter-arch space.
 Undercuts.
 Sufficient attached gingiva not present.
 Where endo and perio treatment can not be
performed satisfactorily.
 Grade III mobility
Classification
 ACCORDING TO METHOD OF
ABUTMENT PREPARATION
(Heartwell)
 OVERDENTURE

Tooth supported Implant supported

Non Coping Coping Attachments

Short Long

Stud
Bar
Magnets
 BASED ON TYPE OF OVER DENTURE
(Brewer and Morrow)

IMMEDIATE

TRANSITIONAL /
INTERUPT DENTURE

REMOTE /
PERMANENT
DENTURE
  Immediate over denture
• Constructed prior to preparation & ready for
insertion after preparation & reduction

• It enhances patients ability and adaptability

to wear dentures
  Interim over denture
• Used for patients in transition or preparation
phase until permanent overdenture
constructed

• Patient old partial denture can be modified &

used by extending the denture and add new
artificial teeth using self cure acrylic resin
  Remote or Definitive over denture

• Conventional complete over denture

constructed over one or more abutment teeth

• Could be made entirely of acrylic resin or in

conjunction with metal bases
 NON COPING ABUTMENTS
Selected tooth abutments are reduced to a
coronal height of 2 to 3 mm. and then
contoured to a convex or dome shaped surface.

Most teeth required endodontic therapy and

in final step are prepared conservatively to
receive an amalgam or composite type
restoration.
  Advantages
• Least expensive option

• More amenable to treatment, retreatment and

modification in contingency situations

• Greater degree of flexibility in formulating

treatment plan
 ABUTMENTS WITH COPINGS
• Coping is a cover for the exposed tooth surface
• Cast metal coping with a dome shaped surface
and a chamber finish line at the gingival
margin are fabricated and cemented.

 Short coping
 Long coping
 SHORT CAST COPINGS

• Short copings are 2-3 mm and normally

require endodontic therapy because the
required coronal root reduction would expose
the pulp.
 Long cast coping
Long cast copings are normally 5-8 mm
long, conservative reduction of coronal tooth
structure is done.

The end result is long ellipsoidal shaped

coronal coping and a larger crown root ratio.

 Consequently, long cast coping require a

greater level of osseous support.
ABUTMENT WITH ATTACHMENTS
 Attachments are small precision devices.

 Objective is to improve retention of denture base.

 Most attachments are secured to abutment by a

cast coping.

 Consists of two parts

o Male
o Female
 Requirements for the Attachments
Patients should have a low caries index.

Perform proper home care

Sound periodontal health

Proper bone support

 Disadvantages of attachments
Added time
Expensive
Difficult to construct
Repair is difficult
Requires careful manipulation by the
patient, not recommended for mentally and
physically handicapped
Rigid attachment
• Doesn’t allow movement of denture base
• Provide adequate retention
• May induce more torque on abutment

Resilient attachment
• Allows some control of movements
• Induces less torque on abutments
 1. Stud attachment
 simplest of all attachments
Consists of two parts
• The stud(male component) usually attached
to metal coping cemented over prepared
abutment
• Housing (female component) embedded in
the fitting surface of over denture
 Extra radicular stud attachment
 Male element projects from the root surface

 The stud is attached to the metal coping

cemented over the prepared abutment, while the
housing is embedded in the fitting surface of
denture.

• Gerber
• Ceka
• Rotherman
  Gerber anchor
• Readily replace able male or female
attachments by unscrewing the worn unit.
  Rothermann attachment
• Male part consists of groove

• Female part (housing) consists of C shaped

ring which fits in deeper part of retaining
groove
  Ceka attachment
• Male part round with cementable titanium
post
• Female part in titanium alloy with
replaceable plastic part that is flexible and
compressible (split vertically into four
sections )
  Other attachments of importance

Ancrofix attachment

Introfix attachment

Schubiger attachment

Quinlivan attachmentr
 Intra radicular stud attachment
 The stud is attached to the fitting surface
of the denture and the housing is
incorporated in the abutment.

• Zest Anchor
  Zest anchor system
• Female sleeve is cemented in post space made
within the root

• Male portion consists of nylon

Advantage Disadvantage
• The attachments should be aligned to each
other

• Should be in line with the path of insertion

of the denture.

• A divergence of 10 degree can be tolerated

• Significant divergence of roots or implants

should be considered a contra indication for
this approach.
• One stud attachment on either side of the arch
will suffice; the remaining roots can be covered
by simple copings.

• Increasing the number of attachments does not

necessarily increase retention; it may
contribute to improved stability, but leads to a
weaker structure.

• Two stud attachments on adjacent roots are

unnecessary as it would complicate hygiene
measures and also weaken the denture base
 Bar attachments
o A bar contoured to connect abutment teeth
together, run parallel & overlie residual ridge

o Preformed metal or plastic.

The purpose of using bars are:

• Splinting of abutment teeth
• Retention and support of prosthetic appliance
o Spreads loading
o Soldered to copings

 Increased torque
 Plaque control difficult
 Relining complicated
• The bulk of bar and related structures raises
several problems.

• Vertical and buccolingual space

requirements limit their applications.

• Bar attachments also demand more oral

hygiene maintenance from the patients.
 Bar units
o Rigid type

o No movement between bar and sleeve

o Transmits occlusal stresses totally to

abutments

o Thus Tooth born

 Bar joints
o Resilient
o Allow some movement of rotational type
between bar and sleeve.
o Utilize support both from residual ridge
and abutment
o Thus tooth tissue born
 Bar attachments of importance
• Haden bar

• Dolber bar

• Baker clip

• Ackerman clip and CM clip

• King connector
  Magnetic attachment

o Detachable keeper element

• Made of stainless steel that is fixed to abutment
teeth by
 Cementing
 Screwing
o Denture retention element
• Has paired, cylindrical Co- Sm magnets
axially magnetized and arranged with their
opposite poles adjacent
• Small, strong mini magnets

• One of poles cemented in the prepared cavity

in endodontically treated abutment and the
other attached to denture base.
DIAGNOSIS, TREATMENT
PLANNING AND CASE
SELECTION
 No Diagnosis
No Treatment

If you don’t know where you go,

you never get lost
History
Examination
 Articulated diagnostic casts
Full mouth radiographs
Overall patient concerns
 Possibility of fixed or removable
partial dentures:

• If the remaining teeth are capable of

supporting a fixed or removable prosthesis,
then that should be the primary mode of
treatment.
 Patient age
• Extractions are to be avoided in a young
patient as far as possible, so overdenture do
play a major role in treating young patients
with mutilated dentition.
Factors influencing selection
of abutment teeth

• Periodontal status
• Mobility
• Location
• Endodontic considerations
• Cost
Periodontal & Mobility status

• Ideally tooth should present minimal

mobility, have acceptable bone support and be
responsive to periodontal therapy.

• Circumferential band of attached gingiva is

an absolute necessity.

• Compromised teeth with good treatment

prognosis are suitable candidates even when
horizontal bone loss is present
• Slight tooth mobility with horizontal bone
loss is not contraindicated as decrease in C-
R ratio required for abutment preparation
improves mobility.

Reduces the length of the lever arm

• Vertical bone loss particularly accompanied

by Class II or III mobility excludes tooth
selection.
 Abutment location
• Ideal: Two teeth per quadrant (stress is
distributed over a rectangular area)

• Tripod is next most favorable form for

support and stability.

• Clinical experience recommends at least one

tooth per quadrant.
• Isolated teeth are preferred to several adjacent
teeth as inter dental areas are difficult to
clean and susceptible to gingivitis.
Robert M. Morrow, Colonel , Ret. USAFDC, Virginia, 1970
• Anterior mandibular ridge is most
vulnerable to time dependent RRR

• Canines and premolars are regarded as best

overdenture abutments
• In maxilla central incisors are ideal
as overdenture abutments( Protects
pre maxilla)

• Canines are next (Longest Root)

• Lateral incisors(widely spaced,

facilitating plaque control)
 Endodontic Status
• Preserve teeth that are already
endodontically treated.

• Usually anterior teeth are preferred as they are

easier to prepare and economical too.

• Whenever pulpal recession to the extent of

calcification has occurred , endodontic
treatment usually can be avoided.
• Ettinger in 1990 showed that the most
common cause of abutment failure was vital
teeth developing periapical lesions as a result
of pulpal necrosis ( 53.8%).
 According to Zarb 13 th edition
• After 5-6years, about 10% of abutment teeth
supporting overdentures were lost

Periodontal disease 70%

Caries 25%
Endo complications 5%
• Patient is motivated to maintain adequate
oral hygiene to prevent abutment loss.

• Patients must clean all exposed dentin and

use 0.4% stannous fluoride daily.
Thayer, H. H. Overdenture and the periodontium. DCNA 24:369-377, 1980.
 PREPARATORY TREATMENT
FOLLOWING SEQUENCE OFT TREATMENT CAN BE USED AS A
GENERAL GUIDE BUT MAY NOT BE SPECIFICALLY APPLICABLE
TO ALL PATIENTS:

1. Construct an immediate treatment clasp less

denture. It replaces missing and hopelessly
involved teeth for esthetic reason and retain jaw
relations.

2. Remove hopeless teeth and insert the removable

prosthesis.

3. During the healing period, institute the

periodontic and endodontic treatment.
 TOOTH PREPARATION
• Remove sufficient tooth structure to provide
favorable root crown ratio.

• Reduce the crown length up to 2 mm above the

gingival crest or extend a chamber type margin
slightly beneath free gingival margin.

• Taper the preparation in occlusogingival

direction.
• Consequently optimal abutment preparation
is achieved that has following features:
• Simple
• Short
• Convex
• Dome shaped
• Chamfer finish line
The finished tooth with cast coping is male
member of denture. The female member is
part of denture base.
• As a cost containment method, use of cast
coping has been largely eclipsed by composite
and alloy restoration with or without
adjunctive inter radicular attachments
 COPING FABRICATION
• Make an accurate impression
of the abutment and pour a
die.

• Carve the wax pattern.

• Cast the coping

• Cement the polished coping to

the tooth.

• Instruct the pt. in home care

of abutment tooth.
 IMPRESSION FOR THE DENTURE
• Follows the same technique that is used in constructing a
conventional complete denture.

• PRELIMINARY IMPRESSION
• BORDER MOLDING
• FINAL IMPRESSION
 RECORD BASES AND OCCLUSAL RIMS

RECORDING MAXILLO MANDIBULAR RELATIONS

• A face bow transfer is used to relate the maxillary cast to the
articulator.
• Jaw relations and arrangement of teeth for phonetics are
verified at the time of try in.
 TOOTH SELECTION
• Artificial teeth placed over the abutment teeth
should be acrylic resin.
• When teeth in opposing arch have
i) Gold occlusal surfaces ---- occlusal surfaces of
artificial teeth should be either gold or acrylic
resin, preferably gold.
ii) Restored with porcelain --Porcelain artificial
teeth are preferred.
iii) Natural teeth ---- Gold occlusals are preferred,
otherwise acrylic
 TRYING THE DENTURE
• Verify jaw relation records
• Make eccentric jaw relation records and adjust the
articulator.
• Assure esthetic acceptability by the patient.
• Verify phonetic acceptability.

LABORATORY PROCEDURES
• CONTOUR THE WAX
• FLASK THE DENTURE
• ELIMINATE THE WAX
• PRAPARE RESIN
• PACKING
• RELIEF FOR MARGINAL GINGIVA
 DENTURE INSERTION
• Review instruction in
denture use and care.
• Use pressure disclosing paste
to locate contacts between
female and male members.
• Evaluate the tissue side of Final try in
denture base and borders for
pressure areas and over
extensions.
• Perfect the occlusion by
remounting and selective
grinding.
• Place pt. on recall system
After insertion
 SUBMERGED VITAL ROOTS
 Selected vital roots are selected and reduced to 2
mm. below the crestal bone and then covered by
mucoperiosteal flap

 Still in experimental stage.

 The method is innovative attempt to obviate the

basic problems like caries, gingivitis,
periodontitis

 Major post operative problems are: development of

dehiscences over retained roots and pulpal
pathologies.
Implant supported Over denture
The minimum acceptable standard of care for
the treatment of the edentulous mandible
should be the provision of interforaminal osseo-
integrated dental implants to support and
retain the complete lower denture.

Quintessence International, volume 34, Number 1, 2003

 Why implant OD and not Full arch
Fixed Implant Prosthesis
• Lesser Implants

• Less cost

• Previous Denture wearer

• Denture is less complicated than Implant Fixed

Prosthesis

• Overall esthetic objectives can be addressed and

achieved with greater ease
 Inclusion Criteria for Implant
Placement
• PT. DESIRE FOR IMPLANT TREATMENT
• SYSTEMIC HEALTH STATUS, WHICH
PERMITS A MINOR SURGICAL
PROCEDURE
• SUFFICIENT BONE QUANTITY TO
ACCOMMODATE PRESCRIBED IMPLANT
DIMENTIONS
• PT. WILLINGNESS AND ABILITY TO
MAINTAIN ORAL STATUS

Prosthodontic Treatment for edentulous Patients

Zarb 13th edition Pg 331
 Exclusion Criteria for Implant
Placement
o RESIDUAL RIDGE DIMENTIONS DO NOT ACCOMMODATE
PREFFERED IMPLANT DIMENTIONS
o COMMUNICATION WITH PT. IS NOT POSSIBLE
o PT. HAS HISTORY OF SUBSTANCE ABUSE
o GENERAL HEALTH CONDITIONS PRECLUDEA MINOR
SURGICAL INTERVENTION
o LOCAL ANAESTHESIA WITH VASOCONSTRICTER IS
CONTRAINDICATED
o IMMUNOSUPPRESIVE THERAPY, PROLONGED INTAKE
OF ANTIBIOTICS OR CORTICOSTEROIDS, OR BRITTLE
MEABOLIC DISEASE HISTORY
Prosthodontic Treatment for edentulous Patients
Zarb 13th edition Pg 331
 TREATMENT

FOR A PATIENT WITH IMLANT OVERDENTURE

 Treatment Planning concerns for patient
with Implant supported Overdenture

• Number of Implants and their location

• Preferred denture retention devices- The Attachment

Systems
 Maxilla
• 4- 6 Implants and infrequently connected
using a bar.
• Implant length preferably 10mm or longer.
 Mandible
• 2 un-splinted implants with a selected
attachment method (current & most frequent)
between canine and lateral incisor.
• 12 mm inter implant distance required
• When shorter implants are used more number of
implants can be placed
A healing period of 3-4 months for
mandibular implants and 6 months for
maxillary implants ( conventionally
loading) has been traditionally observed.
• Selection of a specific attachment for an implant
overdenture depends on the following;
• - Type of overdenture fabricated.
• - Location of implants on the ridge.
• - The condition of the residual alveolar ridge.
• - Dexterity of the patient.
• - Psychosocial needs of the patient.
• - Relative need for stability and retention.
• - Length of implant used.
As a general rule, more complicated and
sophisticated the attachment, more difficult it is to
repair and maintain.
 ATTACHMENTS
• FEMALE PORTION -PROSTHESIS
• MALE PORTION –IMPLANTS
• Ball Attachments
O-ring System
Locator System
• Bar & Clip Attachments
CM Bar & Rider/Ackermann Clips
Dolder Bar System
Häder Bar System/EDS System
• Over denture is an excellent viable treatment
alternatives.

• Emphasis must be placed on proper patient

selection, pt. motivation, basic prosthodontic
principle & detail program of home care
instruction & frequent recall.

• The overdenture is an out standing mode of

treatment. Breakdown in tooth structure or a
breakdown in their periodontal support
immediately negates an overdenture concept.

 IF WE ARE TO SUCEED, WE MUST CONTROL THE

FACTORS THAT JEOPARADIZE SUCCESS.
REFERENCES
• Essentials of complete denture prosthodontics –
Sheldon Winkler 2ndedition
• Prosthodontic treatment for edentulous patients
–Zarb-Bolender 12thedition
• Complete denture prosthodontics –John J. Sharry
• Syllabus of complete dentures –Charles M.
Heartwell & Arthur O. Rahn 4thedition
• Dental Implant Prosthetics –Carl E . Misch
• Articles from different journals mentioned
earlier