CLINICAL REPORTS
removable partial denture, which replaced
The telescoped overdenture:
advantages and limitations
G o n z a lo I. P a rd o , D D S
R o b e rt P. R e n n e r, D D S
A case is re p o rte d in which the
telescoped o v erd en tu re w as
chosen in ste a d of conventional
techn iq u es in tre a tm e n t o f a
p a tie n t’s m ax illary teeth. The
ad v a n ta g e s a n d d isa d v a n ta g e s of
this tech n iq u e a re discussed.
he telescoped overdenture as de­
scribed by Renner and Gottlieb1 is
one of the least frequently used over­
denture techniques. As opposed to a
conventional overdenture, which is
designed to cover endodontically
treated abutment teeth, the te le ­
scoped overdenture is designed to fit
over vital teeth, the crowns of which
have been prepared and protected
with cast metal copings. The bulki­
ness of the resulting prosthesis no
doubt helps to explain the reluctance
of many dentists to use this overden­
ture concept. Nevertheless, in certain
instances, this technique can offer
advantages over the more conven­
tional overdenture techniques, not
the least of which is the avoidance of
endodontic therapy on healthy teeth.
A case is reported in which a tele­
scoped overdenture was used.
Report of case
A 64-year-old white woman was referred
for treatment to the dental care center by a
932 ■ |ADA, Vol. 101, December 1980
the missing second premolars and molars.
The canines and first prem olars were
splinted and restored bilaterally with clin­
ically acceptable full-cast acrylic veneer
splints. Deep semiprecision rests were
present in the lingual interproximal em­
brasure between the canine and premolar
crown of each splint.
With the exception of the mandibular
central incisors, which had moderate gin­
gival recession and a one-plus mobility,
the periodontal condition of the remain­
ing teeth was within normal limits. The
private dentist. The patient had a history
maxillary incisors had pseudo pockets 3
of chronic dental problems, exacerbated
to 4 mm deep circum ferentially and a
by recent depressive episodes that devel­
one-plus mobility. There was facial gingi­
oped after the death of her husband. She
val recession on both maxillary molars,
was under the care of a physician for a
exposing the borders of the buccal furca
hypothyroid condition and had been re­
but not extending intraradicularly. A c­
ceiving tranquilizers for eight months.
cumulation of supragingival calculus was
Her medical history was otherwise non­
heavy on the mandibular anterior teeth,
contributory. The patient’s dental history
and moderate on the remaining teeth. Lit­
disclosed chronic problems, including an
tle caries was present. The patient was a
inability to masticate effectively, an audi­
moderate smoker, a fact that was consid­
ble clicking while eating; and severe dis­
ered contributory to her periodontal con­
comfort in the mandibular right quadrant
dition.
during mastication.
A large maxillary torus palatinus, con­
Examination of the maxilla showed two
sisting of four nodular masses covered
temporary fixed partial dentures of acrylic
with thin mucosa, was present on the
resin. One six-unit restoration extended
m axilla (Fig 2). The patient expressed
from the right central incisor to the right
strong resistance to the surgical removal
second molar, with the right central and
of the exostoses—which may help to ex­
lateral in cisors and m axillary second
plain the unsuccessful attempts by two
molar acting as abutments; the second res­
previous dentists to restore the maxillary
toration extended from the left central in­
arch with fixed partial prostheses.
cisor to the left second molar with those
The patient was eager to cooperate and
two teeth as the abutments (Fig 1). The
had a relaxed outlook toward therapy. The
cement seals on all five abutments had
entire treatment, including correction of
failed many times.
The mandibular arch had been restored
with an ill-fitting bilateral distal extension
F ig 2 ■ F r a m e w o r k -s e c o n d a ry im p re ss io n tr a y
F ig 1 ■ M a x illa r y a r c h w ith c o p in g s in p o s i­ a s s e m b ly b e fo re re a m in g a n d p e r fo r a tio n o f a n ­
tion s h o w s la r g e lo b u la te d to ru s p a la tin u s. t e r io r c o p in g a re a .

the m axillary p rep aration s, was co m ­
pleted without local anesthesia and with­
out pain. The lack of pain was, in part, at­
tributable to the advanced sclerosis of the
pulp chambers of the maxillary teeth.
Treatment plan
The major considerations in developing a
treatment plan were: resistance of the pa­
tient to surgical removal of the maxillary
torus; favorable distribution of remaining
maxillary teeth for placement of the over­
denture2; preservation of alveolar bone
and prevention of anterior hyperfunction
syndrome1,3,4; and avoidance of endodon­
tic therapy of the remaining m axillary
teeth.
The mandibular removable partial den­
ture was clinically unacceptable and was
scheduled to be replaced. The two man­
dibular canine-first premolar splints were
clinically acceptable and would be re­
tained as abutments for the new prosthe­
sis. Scaling and root planing were the
only other procedures required on the
mandibular arch. The mandibular pros­
thesis was of conventional design and
construction and will not be discussed
here.
The m axillary overd entu re was de­
signed after a careful survey of both the
maxillary residual ridge and the remain­
ing overdenture abutm ents.1,5'9 A dis­
crepancy in the path of insertion, noticed
during the survey, was correctable by
minimal reduction of the labial aspects of
the m axillary incisor preparations and
posed no danger of mechanical pulpal ex­
posures. The axial inclination of the mo­
lars was consistent with the planned path
of insertion but slight occlusal reduction
was needed to allow adequate clearance
for the restorative materials.
Treatment phase
A full arch mercaptan rubber impression
of the m axilla was made in an acrylic
resin custom tray. Individual die stone
dies were made from the first pouring and
a master working cast was fabricated from
the second pouring of the rubber impres­
sion. Thin tapered copings were waxed on
the individual dies, transferred to the mas­
ter cast, examined, altered to coincide with
the planned path of insertion, cast in type
3 gold, and individually fitted in the
mouth.
A chromium-cobalt framework was fab­
ricated on the maxillary master cast with
th e c a s t g o ld c o p in g s in p l a c e . A
horseshoe-shaped major connector, con­
nected at its posterior end by a bar, was
used to provide cross arch rigidity and to
circumvent the torus palatinus.
The design of the chrom iu m -cob alt
framework, as shown in the framework-
impression tray assembly (Fig 2), con­
sisted of thin metallic overlays in contact
with the molar copings (no relief) and a
retentive m eshwork over the denture-
bearing areas which circumvented the an­
terior teeth and copings. The resulting
framework provided for metal-to-metal
contact at the molar copings and acrylic
resin-to-metal contact at the incisor cop­
ings. Relief consisting of a double layer of
3 0 -g a u g e w ax w as p la c e d o v e r the
denture-bearing areas before fabrication of
the secondary impression tray.
The maxillary framework was fitted in
the mouth, and a corrected impression
(Fig 3) of the denture-bearing tissues was
made using mouth temperature wax in a
framework impression tray assembly (Fig
2).
In the area of the maxillary incisors, the
impression tray was heavily relieved and
perforated in the incisor region to allow
excess wax to escape. The cast gold cop­
ings were temporarily placed on the teeth.
A bead of mouth temperature wax was
added around the labial periphery of the
im pression tray and functional border
molding was accomplished by having the
patient make lip and cheek movements
while the impression tray was held in
place with firm finger pressure in the
palatal region.
Softened wax was then added to the
internal aspect of the entire impression
tray and the corrected im pression was
completed with successive temperings in
water heated to 120 F and reinsertion with
firm pressure. After each insertion, excess
w ax w as carefu lly trim m ed from the
internal aspect of the molar overlays and
from the finish line ringing the palatal pe­
riphery of the framework. Successive
tempering and reinsertion of the impres­
sion assembly were continued until ex­
cess wax no longer extruded over these
metal surfaces. At that point, the impres­
sion was again tempered, inserted with
firm finger pressure, and the patient was
instructed to go through muscle move­
ments. The completed impression was
chilled intraorally with cold water and
removed. The maxillary master cast was
poured directly into the impression as­
sembly.
A face bow transfer and a centric rela­
tion registration at an acceptable vertical
dimension were made using conventional
prosthodontic techniques, and the casts
w ere m ounted on an arcon dental ar­
ticulator.
Acrylic resin denture teeth of the ap­
propriate shade and mold were selected
for the m axillary overdenture. A crylic
resin denture teeth must be used because
of the extensive lingual hollow grinding
needed for esthetically acceptable place­
ment of the denture teeth over the incisor
copings. The additional technical effort
needed for the hollow grinding was partly
offset during the set-up phase because the
maxillary incisors provided an excellent
guide for placement. The molars, in turn,
acted as guides for orienting the posterior
arch segments. The value of these natural
tooth guides became increasingly appar-
Pardo-Renner : TELESCOPED OVERDENTURE ■933
CLINICAL REPORTS
F ig 3 ■ C o m p le te d s e c o n d a r y im p r e s s io n o f
m a x i l l a r y a r c h s h o w s c o p in g o v e r l a y s a n d
p a la t a l rin g d e sig n .
ent during the trial fittings as minimal
corrections were sufficient to achieve an
esthetically and functionally acceptable
result.
Both maxillary and mandibular pros-
theses w ere processed in h igh-im pact
heat-cured acrylic resin (Lucitone 199),
with the exception of the palatal acrylic
resin immediately overlying the maxillary
incisor copings, which was selectively re­
lieved and fenestrated in the manner de­
scribed by Mascola.6 At the time of inser­
tion, the vented areas were readapted with
cold-curing acrylic resin and allowed to
cure intraorally while the patient main­
tained moderate biting pressure. Without
this additional step, accurate placement of
the overdenture becomes problematical.
The cast gold copings were lubricated
with a lanolin ointment to prevent bond­
ing of the acrylic resin to the copings dur­
ing this procedure. Fenton and others5
noticed problems with the reseating of
com pletely preprocessed overdentures,
and attributed the difficulties to the loss
of detail in the cast or die during the pre­
processing boil-out. Such loss of detail, al­
though not as important when soft tissue
contacts are concerned, becomes of major
significance when contacts of denture to
hard tissue are involved.
Disadvantages
The telescoped overdenture has sev­
eral inherent disad vantages, w hich
generally prove preventable, co rrect­
ab le, or a c c e p ta b le u n d e r c e rta in
co n d itio n s . S ev eral of th e se w ere
evident in this case:
—Because of acrylic bulk in the an­
terio r reg io n , the p atien t had a
speech impediment that lasted sev­
eral days.
—Insufficient reduction in crown
height, especially in the anterior re­
gion, may result in esthetically unac­
ceptable exposure of denture base
material. This relatively frequent oc­
currence is evident behind the left
maxillary lateral incisor (Fig 4). The
problem is usually correctable and
CLINICAL REPORTS
causes m ore embarrassment than dis­
comfort. Aw areness of the potential
for the problem and careful planning
w ill su b stan tially red u ce the in c i­
dence.
— A c r y lic d e n tu re te e th , e x te n ­
sively hollow ground, m ust be used to
accom m odate the subjacent copings.
— An aggressive oral hygiene pro­
gram , including topical fluoride ap­
plications, is mandatory. The patient
was in structed in denture hygiene,
toothbrushing methods, and fluoride
application. One drop of topical fluo­
ride is placed in the denture depres­
sions overlying each retained tooth
coping, and the denture is used as a
topical application tray .10,11
— A dental surveyor m ust be used
to ensure a com m on path of insertion
between soft and hard tissue under­
cuts and cast copings.
934 ■JADA, Vol. 101, December 1980
Summary
The fabrication of a telescoped over-
denture has been described. Despite
th e lim ita tio n s of b u lk in e ss, th is
treatm ent modality can, in selected
cases, substantially simplify the ap­
proach to overdenture service. With
p roper pretreatm ent ed ucation and
p ostinsertion care, the possibilities
for success and acceptance by the pa­
tient are high.
T he com p leted p ro sth esis w as a
qualified su ccess. E sth etic ap p ear­
a n c e , o c c lu s io n , and fu n c tio n all
proved satisfactory, and the patient
accepted the prosthesis well. As the
prosthesis offers a potential for greater
longevity of service, it is well worth
the effort.
Drs. P ard o a n d R e n n e r are a ss o c ia te p ro fe s­
s o rs, d e p artm en t o f resto ra tiv e d e n tistry, S c h o o l
o f D e n tal M e d ic in e , S ta te U n iv e r s it y o f N e w
Y o rk . A d d r e ss req u e sts fo r re p rin ts to Dr. P ard o ,
D epartm en t o f R esto ra tiv e D e n tistry, S c h o o l of
D ental M e d ic in e , H ealth S c ie n c e s C en ter, S tate
U n iv e r s ity o f N e w Y o rk , S to n y B ro o k , 1 1 7 9 4 .
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D ent 2 6 (l):4 2 -4 6 , 19 7 8 .
1 0 . R e n n e r, R .P ., a n d K le in e r m a n , V . O ver-
d e n t u r e t e c h n i q u e s in t h e m a n a g e m e n t o f
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