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3. OVERDENTURE – Denture over Teeth!
sangeetaporiya.sp
December 12, 2019
Dental Notes / Dentist
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TOOTH SUPPORTED OVERDENTURE
INTRODUCTION
It is considered that the presence of a tooth with a healthy periodontal ligament keeps a proper
alveolar ridge morphology. In contrast, a diseased and / or absence of periodontal ligament is
associated with certain residual ridge resorption. Because of this, contrary to the past where
extractions of remaining teeth with complete denture replacement used to be promoted as an
inexpensive and permanent solution for oral health care, nowadays, dentists try hard to maintain even
loose teeth with bone loss to stabilize, retain and support the removable dentures.
A tooth-supported overdenture may be defined as a removable prosthesis that covers and is partially
supported by natural teeth or natural tooth roots.
Overdentures are otherwise known as Biologic dentures, Hybrid dentures, Telescopic dentures,
Overlay dentures, Superimposed dentures.
Overdenture therapy is actually a complete rehabilitation drawing upon many phases of dentistry i.e.
Oral surgery, Periodontics, Endodontics, and Prosthodontics.
When an overdenture treatment is the method selected it does not simply involve making a denture to
fit over the roots. The success or failure of many overdentures depends on detailed differences in
design or fabrication. Failure to select the right abutment for each situation adds to the complexity of
the treatment.
HISTORY
In 1856 Ledger constructed plates that covered the teeth and he referred the teeth to as fangs.
In 1896 Essig described the telescope like coping after intentional devitalization of roots.
RATIONALE
A defect or non-integration of the proprioceptive input can result in poor function or pathologic
changes in the system.
Input from periodontal receptors forms a major part of inputs. They contain information about the
magnitude and direction of occlusal forces, size, and consistency of food bolus. It also monitors teeth
against overloading.
By preserving teeth, PDL is preserved, thus proprioceptive impulses are preserved.
Jerge and Kawamura (J. Physiology 1964, 1967), suggested that periodontal receptors are actively
involved in cyclic jaw movements during mastication. They suggested that the activity of specific
muscles or parts of muscles attached to the mandible is directed by receptors of teeth.
Kapur and Collister (1970) presumed that the periodontal receptors acted a significant indirect role in
the masticatory reflex by adapting the scale and nature of masticatory stroke.
Advantages are:
1) Better support
2)Better masticatory function
3)Increased retention by using attachments.
ADVANTAGES
1. Patients acceptance:
Patients are more receptive and appreciative to this treatment because they experience a
striking improvement in function and esthetics while still maintaining some of their own
teeth.
(Thought of retaining at least the root structure or some coronal portion of the natural
teeth is emotionally uplifting to many people).
2. A simple approach to problematic patient:
Patients with congenital defects like Cleft palate or defects arising from surgery or
trauma are often difficult to treat because of difficulty in getting support and
retention. Designing Overdentures with attachments can be a remedy in these situations.
3. Convertibility:
If some teeth are lost, denture can be readily converted to accept the alteration. Even if all
the teeth are lost, Overdenture can be relined in conventional complete dentures.
4. Post insertion problems are minimal.
5. Open palate is possible.
6. Ideal occlusion-because of minimal Relief.
DISADVANTAGES
1. Caries susceptibility:
Needs precise home care and fluoride applications.
2. More expensive:
More pricey than regular denture because of Endodontic treatment, periodontal treatment,
and high-priced attachments.
3. Encroachment of interocclusal distance:
4. Presence of bony undercuts:
Bony undercuts, particularly near the overlayed teeth, may create obstacles (in respect to
the intimate adaptation of denture flange to underlying tissues.)
A) We can block out these undercuts and free that area: OVER CONTOURING
This creates a denture flange that is spaced away from the tissue. This can:
a) Create food trap.
b) Decreases retention, since peripheral seal is broken.
c) Over contouring, leads to a poorly contoured base resulting in improper lip fullness, which is
difficult for patient to accept (poor esthetics).
Over contoured flange does not interact well with the facial musculature, thus decreasing the support
and retention of denture.
B) We can purposely shorten the denture flange to end it at the height of contour: UNDER
CONTOURING
There will be no peripheral seal, thus decreased retention, decreased stability, food entrapment and
poor esthetics.
C) Surgical intervention:
It is usually not possible, since the bone involved is the supporting alveolar process of the overlaid
tooth.
Freidline and Wical: described a technique to block out a bony labial undercut through the use of a
free soft tissue palatal graft. Added benefit is increased zone of attached gingiva and apical
positioning of soft tissue attachment.
1. Few natural teeth remaining which are badly tilted or are unsuitably shaped to provide
abutments for normal partial denture.
2. Prognosis of the remaining teeth poor: Over denture can serve as transitional denture prior
to the loss of the teeth, Endodontic Treatment, crown root ratio decrease and stabilized.
3. Severe generalized attrition cases.
4. Complete denture opposed by natural dentition especially lower anterior teeth:-
combination syndrome chances.
When a pronounced vertical overlap of the anterior teeth is required to produce a good esthetic
result:-necessary to retain few maxillary teeth for overdenture.
CONTRAINDICATIONS
Since Overdentures rely on abutment teeth for support and stability, hence these teeth must be in a
balanced state of periodontal health before the completion of the Overdenture.
Teeth with a hopeless periodontal prognosis should not be picked as abutments. Prospective
abutments should have:
i) Minimum mobility: Although mobility patterns are important in selecting abutments, improvement
in crown, root ratio – decreases apparent clinical mobility significantly.
ii) Adequate bone support: At least 6mm of bone support is needed to retain a tooth as an Over
Denture abutment.
iii) Should be amenable to any indicated periodontal treatment.:- Periodontal pockets, bony defects
be eliminated before commencing treatment.
Common problem is lack of adequate attached gingiva.
Attached gingiva:-
1.teeth periodontally involved
Toolson and smith (JPD 1982:41;4-11 and JPD 1983:49:749-756), did a 2 year and 5 year study on
OD patients.
2 year Study showed elevated plaque scores on abutment teeth but no significant decrease ion
periodontal health. They emphasized the importance of adequate follow up and continued
reinforcements of home care procedure.
5 year study showed that
a) Periodontal health was not at an optimum level. (Though still not responsible for loss of significant
number of teeth.)
b) There was a loss of attached gingiva between second and fifth year follow up.
Endodontic treatment is recommended for OD abutment as it allows enough reduction of the crowns
(as directed by esthetics and vertical height requirement)
Ideally single rooted teeth and a single canal that can be easily negotiable are best candidates.
(Although multi rooted teeth can also be used)
Vital teeth and even those having ample secondary dentine are not very acceptable abutments.
(Due to the fact that secondary dentine does not form an absolute seal, early radiographs are
necessary if vital teeth are used as OD abutments.)
to decrease the cost of treatment we should consider the teeth that have already been treated
endodontically. (Carefully evaluate – should not select wrong abutment).
C) Caries status of abutment
Ideally teeth with minimal caries or no varies involvement should be selected as abutments.
If caries present, evaluate if it can be easily removed and if we can create an environment that the
patient can maintain. (An active caries process can lead to recurrence of caries in unprotected
abutment teeth or gingival to coping margins, and thus can lead to failure of the OD).
If patient presents with >4 retainable teeth in an arch that are periodontally sound: some other
treatment modality (RPD, FPD) should be considered first. (Exception based on individual cases and
pt. desires).
Location of teeth is important for support of OD and preservation of the alveolar bone.
Anterior aspect of residual ridge, especially that of mandibular is very susceptible to change therefore
canines and premolars are valuable teeth to preserve in this area.
Preservation of upper anterior teeth is especially important if denture opposes natural teeth in the
anterior mandible. (Combination syndrome prevention, Prevent destruction of anterior maxillary
ridge).
If 4 abutments in one arch i.e. 2 canines and 2 second premolars – represent an ideal stress
distribution. This distribution provides maximum stability and support for the OD which is truly
tooth supported.
Another favorable arrangement-use of maxillary canines and a central incisor – provides a tripod
of support in the anterior jaw ; particularly effective when opposing natural dentition.
If 3 abutments – 2 on one side of the arch – can cause unbalance (generally patient had no difficulty)
1. They do not provide more support and stability than 1 abutment. (i.e. 1 canine and 1
premolar =canine (in regard to support)).
2. More difficult for patient to keep abutments clean.
3. May make tooth positioning on OD more difficult.
4. Connectors have to be cleared up from the gingiva which can hinder lab procedures.
TYPES OF OVER DENTURES
Depending primarily on the status of the patient’s dentition at the start of treatment. (According to
Brewer):
1. Immediate OD
2. Transitional / Additive OD
3. Remote/Definitive OD
Immediate Overdenture
An immediate overdenture is constructed for insertion immediately after the removal of some natural
teeth. The remaining natural teeth are treated and the overdenture is inserted as an immediate
replacement.
Construction of a definitive overdenture requires special attachments or castings over restored
abutments. These procedures are more time consuming and costly.
An immediate overdenture is easy to use and uses no specialized castings. So it can be used as an
interim prosthesis that allows the dentist, opportunity to evaluate the response of the abutments and
supporting tissues to an overdenture and to observe the oral hygiene.
It is reliable prognostic aid and a pre requisite to the more sophisticated technique.
If response is poor and failure of abutments is sure;the immediate overdenture can be converted to
conventional complete denture.
PROCEDURE
Hopeless anterior teeth retained for esthetics and function considerations until insertion of immediate
overdenture.
During healing period – Endodontic and periodontal treatment of proposed abutments is done.
(Endodontic treatment of all abutments, periodontal treatment to correct pocket depths, to recontour
supporting tissues.)
Oral hygiene procedures are emphasized.
After healing
Dual impression of the arch is taken:
Custom tray for edentulous area- border molding- impression with ZOE/rubber base- use alginate –
dual impression-poured in dental stone.
Adapt base plate –make occlusion rims-record jaw relations (centric jaw relation)
SELECTING AND POSITIONING TEETH (method by Lord and Teel, DCNA 1969;13;871-881):
If response is good:
(1.minimum crevicular depth, 2.absence of plaque on abutment, 3.minimum mobility of abutment,
4.excellent tissue color and tone):
More sophisticated overdenture can be considered.
Transitional / Additive Overdenture
ADVANTAGE
Inadequate occlusion
Inadequate border extension
Inadequate support and stability.
Therefore may make satisfactory conversion difficult.
CONVERSION
Remote/Definitive Overdenture
Overdenture Patient
Prerequisite Oral Surgery
Prerequisite Periodontics
Prerequisite Endodontics
Immediate Overdenture
Convert To Conventional Complete Denture
Continue Immediate Overdenture
Remote Overdenture
Exam. Diagnosis, Treatment Planning, Oral Hygiene Counselling
Remove Hopeless Teeth, Oral Hygiene Counselling
Abutment Supportive Treatment, Oral Hygiene Counselling
Abutment Endodontic Treatment
Oral Hygiene Counselling
Poor Oral Hygiene, Imminent Abutment Failure
Marginal Oral Hygiene And Overdenture Response
Excellent Oral Hygiene And Response To Immediate Overdenture
Copings, Metal Base Or Attachment Overdenture. Continue Immediate Overdenture
CLASSIFICATIONS
1. Transitional overdenture
2. Immediate overdenture
3. Remote / definitive overdenture
4. NON-COPING
A)WITH ENDODONTIC TREATMENT:
Widely used.
It is indicated when no enough space present for OD; so teeth have to be drastically
reduced.
Caries index should be low
Excellent home care is needed.
After Endodontic treatment, abutments are reduced to a coronal height of 2-3mm and then
contoured to convex or dome shaped surface. Amalgam or composite restoration is placed
into the exposed root canal.
Remaining dentine smoothened and polished, leaving surface that accumulates minimum
plaque and can be easily cleaned.
B)NON-COPING WITHOUT ENDODONTIC TREATMENT:
Remaining teeth are merely reshaped to eliminate undercuts and reduce vertical height (if necessary)
to create more inter ridge space for the OD.
Caries index should be low
Good oral hygiene is needed.
If teeth are reduced to any degree, the vital pulp must be receded sufficiently so that
reduced teeth are not sensitive (severe attrition).
Used in partially anodontic patients or in patients with severe attrition.
Minimal preparation which makes the procedure totally reversible.
1. COPING:
Cast metal coping with a dome-shaped surface and chamfer finish line at the gingival
margin (or slightly supra gingival) are fabricated and cemented.
2 types of copings:
a) Short copings
b) Long coping
a) Short copings:
2-3mm long and normally require Endodontic treatment (because the required coronal
tooth reduction would expose the pulp).
Attached to the casting is a post fitting to the canals.
Dome shaped:-Abutment is reduced in height and width (i.e. circumference)
Chamfer finish line.
b) Long coping:
5-8 mm long
An attempt is made to avoid Endodontic treatment by conservative reduction of coronal
tooth structure (but generally endodontic treatment recommended to avoid later failure)
Long ellipsoid shaped-minimal height reduction, taper-2-6 degrees
Larger crown root ratio, therefore, require greater level of osseous support.
Adequate inter occlusal distance should exist.
2. ABUTMENTS WITH ATTACHMENTS:
Objective of attachment is to improve retention of the denture base.
The attachment does not reduce the crown-root ratio significantly as does the cast coping,
so abutment need adequate bone support because of added stress.
Because of stresses on the attachment from the OD, more retention is needed in the
casting. This is done by using post (post and core).
Since, the attachment usually requires some form of the inter ridge distance, sufficient
space is necessary for its construction.
Because of added time, cost and risks the procedures should be reserved for patients with
favorable prognosis.
Occlusal surface is similar to dome shaped coping but the centre of occlusal surface is
hollowed out to increase the strength of the dowel/ diaphragm junction and also to
decrease the space requirements of the attachments.
Anti-rotation slot is important and the length of dowel in the canal needs to be at least
10mm.
OVERDENTURE ATTACHMENTS
OVER DENTURE ATTACHMENTS CAN BE CLASSIFIED AS:
Example-Zest anchor
-Derives its retention from with in the root.
-Post preparation is made with in the rest and a Female sleeve (Stainless steel) is cemented into the
root.
-Female portion is a nylon post and a ball head
-Female portion is attached to the Over Denture as a chairside procedure.
(Post is placed in a recess to accept this female part. Nylon post is placed in the sleeve and is picked
up in the denture resin).
-Retention gained by ball head snapping into the undercut in the female sleeve.
Advantage:
Most stud type attachments consist of a male Stud type that is soldered to the base
Base is a coping covering the prepared root stump usually having a post extending into the treated
root canal.
Fixation is attained by a female housing which is embedded in the acrylic of the OD.
Stud attachments can be:
1. Resilient studs
2. Non Resilient studs
RESILIENT STUDS
Examples:
Resilient Gerber
Resilient Ceka
Resilient Rothermann
Bonnaball
Resilient Bonna cylinder
Resilient Dalbo
Ancrofix
-Allow some movement of the denture base.
-Can be unidirectional or multidirectional.
-Used when there is an inability to develop a well fitting denture base.
Examples:
Non- Resilient Gerber
Non-Resilient Ceka
Non-Resilient Rothermann
Introfix
Non-Resilient Bonna cylinder
Non-Resilient Dalbo
Do not allow movement of Overdenture.
2 TYPES:
A) Non resilient /Gerber cylinder.
B) Resilient.(Allows vertical movement of base).
1. Solid fixation and minimal torque on the tooth if the denture base is adapted adequately.
2. Fabrication is simple.
3. Provides adequate retention.
Despite some disadvantage it is highly recommended.
Disadvantage:
1) Expensive.
2) Attachment can place torque on the tooth if denture base is not adapted adequately.
3) Mandrel is required to parallel the attachments when more than one
attachment is used.
B) RESILIENT GERBER
DISADVANTAGE
ADVANTAGES
3 TYPES:
1. RIGID
2. RESILIENT
3. STRESS BROKEN.
All are composed of male unit that is attached to the tooth and a female housing imbedded
in the denture base.
4. RIGID DALBO
Has a cylindrical male unit with a round head that is attached to the tooth and a female
housing imbedded in denture.
5. RESILIENT DALBO
Sphere shaped male unit which allow rotational and vertical movement ( made possible
because of a relieved space between the units) of the female unit around it.
Smallest and most commonly used.
1. STRESS BROKEN DALBO
Similar in design to resilient type but female housing is longer and incorporates a coil
spring.
Retention of all three types is provided by some what retentive arms of the Female unit
fitting over the undercut head of the male unit.
CEKA ATTACHMENT
2 TYPES:
A) RIGID TYPE
B) RESILIENT TYPE
Solder base with removable metal stud.
Male part is conical in shape and has a rounded top with increased diameter for retention.
Male portion is quartered vertically into 4 flexible sections to engage undersized female housing.
In resilient Ceka –space between female and male part-provides vertical and rotational movement.
Overall height is 4.1 mm-Resilient and 3.65 mm Non Resilient/Rigid.
ADVANTAGES
1) Allow for either rigid or resilient fixation.
2) Lamellae are adjustable and male stud is removable.
3) Servicing is easy.
DISADVANTAGES
ADVANTAGES
1. Easy to use.
2. Lamellae can provide retention adjustments and compensate for wear of the metal ball.
(Recommended for OD when rotation, resistance and fixation are desired.)
DISADVANTAGES
DISADVANTAGES
1) Lingual bulk present.
2) No path in or guidance for seating the denture.-so patient finds it difficult in properly placing the
appliance .Lack of a path and lack of thickness of acrylic due to lingual bulk leads to fracture of
denture.
ROTHERMANN RESILIENT
Overall height of male stud is increased. i.e. 1.7mm.
Attachment allows some vertical and rotational movement.
Recommended when space is limited, teeth are divergent and vertical as well as rotational movement
is desired in addition to fixation.
INTROFIX ATTACHMENT
Solid cylinder attachment.
Consist of three parts
DISADVANTAGE
1) Require mandrel for paralleling.
2) Torque potential maximum if denture base is not adapted adequately.
ANCROFIX ATTACHMENT
Resilient pressure button system.
4 parts
1. A solder base
2. A replaceable retention head
3. A housing with 4 lamellae that can be activated
4. A Teflon ring to allow lamellae to function in the resin.
-Height-3.2mm.
ADVANTAGES
1) Allows rotational movements.
2) Components can be replaced.
3) Retention can be easily adjusted.
4) Solder base is interchangeable with the Introfix attachment.
5) Simple.
DISADVANTAGES
1) Paralleling mandrel required if greater than 1 attachment is used.
2) Can place torque on teeth.
BAR ATTACHMENT
Divided into 2 groups
A) BAR UNIT B) BAR JOINT
Bar unit provides rigid fixation for the OD, whereas bar joints permit some degree of rotational or
resilient movement or both.
Primary function of bars are splinting the tooth and carrying appliance positionally.
When we select a bar it is desirable to select the largest possible size for space without affecting the
vertical relationship, occlusion or contour of the prosthesis.
DOLDER BAR
Try in post copings in the mouth take a full arch pick-up impression
Remove the keys or indexes and the wax set-up from the master cast
Fill any space between the bar and ridge with plaster and also bring the plaster halfway up the height
of the female sleeve creating space for function of the attachment
Reposition the plaster keys or indexes with teeth on the master model. Prepare the wax set-up of the
prosthesis for acrylic processingàInvest, finish
Remove the plaster after polymerization. The segments are now free for activating
Any retention improvement is achieved by embedding a tiny instrument between the acrylic base and
the absolute female sleeve.
ADVANTAGE
Bars can be fabricated in any alloy.
If more retention needed-metal riders can be used.
DISADVANTAGE
Riders are too bulky.
Rider retention decrease rapidly.
No tension adjustment.
(Plastic rider clips serves as good intermediate ‘training clips’ until metal riders can be substituted).
ADVANTAGE:
BAKER CLIP:
No retention wings (So solder wire for retention.).
14 gauge bar and 12 gauge bar.
Rest is same like CM Clip.
Not recommended since no retention.
MP CHANNELS :
Not recommended.
MAGNET ATTACHMENTS
In order to overcome the problems associated with mechanical attachments, efforts to employ
magnetic attachments were made. Magnetic attachments dissipate lateral forces preventing them
from being transferred to the abutment.
Previously magnets used for dental purpose were either ALNICO or Cobalt-Platinum magnets. But
their permanency was less and there was a lower limit to their physical size (They can not be made
too small and still retained a high field strength.).
After 1977 rare earth metal magnets Cobalt – Samarium and Neodymium –iron –boron type were
introduced. It became possible to produce magnets with small enough dimensions for dental
applications and still provide the necessary forces.( Shriner magnet system by Saco)
Qualities of magnets which are required in dentistry are:
a) Strong magnetic field.
b) Magnetic permanence.
c) Durability and compactness.
Lamb et al., Morin and Daniel:-The dental use of Cobalt-Somarium magnets is most unlikely to
cause any harm to tissues.
The first devices used were of an “open field type” (though safe but still if at all possible eliminate
magnetic field). In which 2 magnets were used once in the jaw and the other in the denture. In this
configuration, the magnets were unshielded and hence magnetic field was experienced in the oral
cavity.
Due to concerns about possible effects of magnetic fields on the tissues nowadays “closed field type”
systems are used.
In this system, a Ferromagnetic material like stainless steel or Pd-Co-Ni alloy, which is known as
Keeper is placed into the tooth rather than a magnet. Paired magnets are placed in the denture. In
this configuration (the magnetic field lines are shunted through the keeper as it is in the path of
minimum energy and hence) there is no magnetic field experienced in the oral cavity.
Attachments of this type are more efficient as both the north and south poles can be employed for
attachment to the keeper, as opposed to the Open field systems, where only one pole is used.
(Paralleling is unnecessary and attachment greatly reduces the load to the roots should the denture
move laterally or rotationally).
‘Saco’ magnetic ball slide attachment: Magnetic retention unit-developed at University of Sydney.
Paired magnet and attached keeper and detachable keeper (1.2mm thick)-magnet covered with 0.25
mm thin magnetizable alloy plates to prevent corrosion.
CLINICAL PROCEDURES
Three different procedures can be used to fix the keeper element (detachable keeper) to the root:-
i) Keeper element can be cemented into the oral cavity prepared into the root face.
ii) Can be held with self threading pins.
iii) A root cap and post casting can be made of magnetizable casting alloy.
PROCEDURE FOR CEMENTED KEEPER
Keeper element is an oval disk-5mm long, 3.2mm wide and 1.2mm thick. It has a flat upper side and
curved lower side (this face is inserted into the prepared cavity.).
Tooth anaesthetized
wheel diamond used to flatten the surface of tooth. (gingival trauma can be avoided by removing
diamond from edges.)(Root faces need not be coplanar or at right angles to the long axis of the
roots.)
Root canal penetrated to depth of approximately 3mm using small round bur-cavity then enlarged in
small increments using round burs in ascending sizes.
using straight tissue bur –enlarge cavity in Bucco-lingual direction into oval shape(keeper loosely fit,
depth of cavity approximately 1.5mm,walls parallel.).
Using inverted cone bur-undercuts given in buccolingual axio-pulpal line angles.-keeper can not be
cemented into the cavity. (parallel cavity walls and undercuts provide ample retention.)
Before cementation-keeper element tested in the cavity for ease of fit to ensure that it can be placed
with flat face level with flattened root face
For this, retention element is used as a magnetic handle and is gripped with tweezer. A small square
transparent matrix strip is placed between the retention element and keeper to provide separation.
cementation is done using resin cements (Matrix strip provides separation), excess cement removed.
then tooth polished with pumice.
Incorporate paired magnet and attached keeper in the denture. Two ways:- Chair side and Lab
(transfer coping technique).
Chair side
Keep retention elements in position
take impression
magnets in impression
remove magnets
pour cast
place denture, wait for cold cure to set(make hole in denture for excess to go out).
lab step
placed on magnet
cast poured
dewaxed
processed
Many patients can not change their oral hygiene habits to properly maintain the gingival sulcus or
tooth surface. For these patients a method of root retention and ridge preservation not requiring tooth
and oral tissue cleanliness may be the treatment of choice.
GARYER et al. (JPD1980:368-373) did a three year study on 10 patients –they retained 45 roots out
of that in 36 roots there was no pathosis).They concluded that sub mucosal vital root retention is one
means of eliminating oral hygiene problems while possibly delaying residual ridge resorption.
Existing restoration, gross decay etc removed from teeth to be sectioned. Marginal internal bevel
incision is given to remove diseased sulcular epithelium and leaving healthy gingival complex to
permit adequate tissue coverage. Following initial incision –deep sub periosteal dissection of
adjacent tissues done, thus freeing sufficient tissue for loose wound-edge approximation.
Teeth isolated sectioned 0.5mm above the crestal bone using high speed drill(bur)(large round bur
and copious fluid lavage is must)-pulpal tissue observed for bleeding patterns (diseased tissue-
profuse bleeding).final tissue coverage and suturing(horizontal mattress suture)
denture relined in areas of surgery and placed; all teeth are sectioned and contoured to existing
residual bony ridge form.
Retained root exhibited with complete formation of an osteocementoid plug over the coronal surface
of the root and a healthy viable pulp tissue.
ADVANTAGE
1).Reduced cost
2).Prosthesis can be constructed even in bad oral hygiene condition.
3).Preservation of alveolar ridge.
DISADVANTAGE
1). Retention not increased appreciably and also looses the stability provided by vertical walls of the
abutment.
2). Development of dehiscence over the roots and pulpal pathosis.
3).Attempts to gain retention from the teeth through some form of attachment are no longer possible.
OVERDENTURE PROBLEMS
1).Abutment loss:
a) Periodontal disease-most common cause-recall every three months.
b) Caries-next common.
c) Failure of Endodontic treatment-Rare.
2).Fracture of denture or perforation of denture: Inadequate reduction of abutment so denture thin in
that area.
3). Perforation of coping: At least 1mm thick on occlusal surface.
SUMMARY
Use of overdenture therapy has many advantages like decreased resorption, increased patients
manipulative skills in handling the denture and increased retention of denture. Caries susceptibility of
abutments, extra cost involvement in the treatment and frequent fracture of dentures are some of the
disadvantages of OD.
Proper case selection and abutment selection is an important factor for fabrication of successful OD.
Abutment tooth should be situated bilaterally for proper stress distribution.
Construction of a definitive OD requires special attachments or casting. These procedures are time
consuming so Immediate OD and transitional OD can be reliable prognostic aid and a prerequisite to
the more sophisticated technique.
Abutments can be with coping, without coping or with attachments.
Various stud and bar attachments have been described.
Magnets can be used as attachments in OD. They offer many advantage over the mechanical
attachments as they serve to dissipate lateral forces preventing them from being transferred to the
abutment.
CONCLUSION
Although improvements in methods and upgraded materials have offered to more approving
treatment outcomes, caries and periodontal problems still remain a warning to OD duty life.
In whatever circumstances this type of denture is prescribed unless the patient is prepared to put
considerable effort with effective plaque control and maintenances of better oral hygiene, the
advantage of this form of treatment will be short lived.