Overdentures

OVERDENTURES According to the glossary of prosthodontics terms, an overdenture is defined as “ a removable partial or complete denture that covers and rests on one or more remaining natural teeth, the roots of natural teeth and/or dental implants; a prosthesis that covers and is partially supported by natural teeth, natural tooth roots, and /or dental implants.” An overdenture has also been referred to as overlay denture, overlay prosthesis or superimposed prosthesis. The overdenture is not a new concept and its use dates back 100years. Today with the stress on preventive measures the use of overdentures has increased to the point where it is now a feasible alternative to most treatment plan outlines in the fabrication of prosthesis for patients with some remaining teeth. NEED FOR OVERDENTURE When patients present with badly broken down teeth, grossly involved periodontal condition, teeth were extracted that could have been retained under more favorable conditions. This led to the complete denture with all its pitfalls. The most common being progressive deterioration in the fit of the denture due to residual ridge resorption that progresses in some cases at a very alarming rate. The “dental cripple” thus presented with a denture that had no appreciable residual ridge and therefore very little support and retention. This is where overdentures can make a distinct difference. HISTORY The idea of leaving roots to support an overdenture is far from new. IN 1856 Ledger constructed plates that covered the teeth and he referred
26 Complete Denture and Implantology

Overdentures

the teeth to as fangs. In 1888 Evans described a method of using roots to retain restorations. In 1896 Essig described the telescope like coping after intentional devitalisation of the roots. Subsequently 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. Fortunately continental Europe did not share the enthusiasm of Hunter and associates. Miller published his classic article in 1958 where the retention of previously unusable teeth and their advantageous use in overdenture treatment was explained as a basic tenet in management. Before going on to the advantages of overdenture therapy we shall discuss the goals. There are three obvious but rather important goals. 1. It maintains teeth as part of residual ridge. This gives the patient a denture that has far more support than any conventional prosthesis. 2. There is a decrease in the rate of bone resorption. If the teeth are preserved then alveolar bone resorption is naturally retarded. A study by Crum and Crooney compares bone loss between patients with conventional dentures and overlay dentures. They concluded that by preserving the mandibular canines, the resorption rate is reduced 8 times. 3. The third goal achieved is an increase in the manipulative skills in handling the denture. With the preservation of teeth, the periodontal membrane is preserved and this maintains the Proprioceptive impulses from the tooth. The patient although wearing a complete denture retains that important sensitive ability to be aware of occlusal
27 Complete Denture and Implantology

Greater the vertical space occupied greater the stabilization.Effects on the edentulous ridge. closer to that of natural teeth. Cutting down teeth to mucosal level has a dramatic effect on the crown root ratio and also favors plaque control. TACTILE DISCRIMINATION Effective mastication requires tactile discrimination.Overdentures contact. The feedback mechanism goes far beyond the periodontal membrane.Improved tactile discrimination . EFFECT ON THE EDENTULOUS RIDGE Bone is constantly remodeled. ADVANTAGES OF AN OVERDENTURE 28 Complete Denture and Implantology .Improved stability and retention of the denture. Lord and Teel stated that teeth too weak for normal partial dentures may be suitable for overdentures. In 1967 Tallgren showed that over a 7 year period the reduction in height of the anterior ridge was 4 times greater than that of maxillary ridge. Implants have no periodontal membrane but have very high masticatory efficiency. A study by Pacer and Bowman confirmed that an overdenture patient possessed more typical sensory function. . . The only deterrent is the amount of space available. IMPROVED STABILITYAND RETENTION Vertical walls of the root provide additional stabilization. There are certain advantages of preserving roots like .Psychological benefits.

partial anodontia. • Bony undercuts: this can pose a problem as close adaptation of denture flange is not possible. • Poor esthetics: at times due to undercuts especially in the canine region one may have to excessively block out the region and this can lead to an overcontoured flange. cost effectiveness and convertibility are excellent. Friedline and Wical described a technique to block out a labial bony undercut using a soft tissue palatal graft. • Encroachment of vertical space: some cases have very little vertical space available to accommodate even the prepared roots. To avoid this proper case selection is vital and also proper preparation of the underlying teeth. DISADVANTAGES OF AN OVERDENTURE • Caries susceptibility: this is one of the most pressing problem confronting overdentures. • Extra support and retention. Meticulous home care. This is done with one of the many attachment devices available in the market. Retention is sufficient by overlaying the teeth but in some cases it is desirable to increase the retention.Overdentures • Preservation of alveolar bone. • Preservation of Proprioceptive response. Surgical intervention is not often possible because the bone involved is the supporting alveolar bone of the abutment. • Patients with congenital defects such as cleft palate. If one prefers to underextend this area then peripheral seal may be compromised. frequent recall and fluoride treatment has shown to decrease the incidence of caries. amelogenesis imperfecta etc can be treated. • Patient acceptance. The natural tooth stops provide for a static stable base. Attachments occupy more space and so there is always a spectrum of 29 Complete Denture and Implantology .

Proper oral hygiene maintenance is very important to prevent periodontal breakdown of teeth. These are. DIAGNOSIS. Dubious roots can be replaced with an implant though at an additional cost. In a 1 year study the failure due to fracture was found to be 25% which comes second to the periodontal failure and the fracture characteristically occurs through or immediately adjacent to the abutment teeth. • Other disadvantages include increased cost of treatment. In general there are two groups of patients who benefit from overdenture therapy. TREATMENT PLANNING AND CASE SELECTION One of the most valuable assets in treatment planning is the visualization of the end result before the treatment is actually begun. increased bulk of prosthesis and another point is that more load is applied compared to conventional dentures and at the same time the bases are thinner which can lead to frequent fractures of the denture base.Overdentures cases where overdentures are not feasible. The cases are straightforward when the patient presents with 2-3 roots but the situation is quite demanding when there is an arcade of hopeless teeth. Group 1: these are patients with few remaining teeth that may be healthy or periodontally involved. This failure was shown to occur 6-8 weeks after insertion prior to relining. • Periodontal breakdown of abutment teeth: periodontal problem may be principal cause of the patient needing overdenture therapy and so if one is not careful the preexisting disease may continue leading to eventual loss of the abutment. coronally intact or else morphologically 30 Complete Denture and Implantology . The option of the osseointegrated implant has broadened the horizon of overdenture therapy.

expense and time. The loss of teeth and the costly. time consuming restorative work is not in itself an indication for an overdenture. Possibility of fixed or removable partial dentures: If the remaining teeth are capable of supporting a fixed or removable 31 Complete Denture and Implantology . Special consideration should be given to patients in whom the overdenture will oppose a natural or restored natural dentition. certain syndromes affecting the branchial arches development which have dental manifestations too. Analysis of articulated diagnostic casts. Lesser number of patients present solely due to caries activity.Overdentures compromised. Treatment here is conceptually and technically straightforward. More commonly it’s a combination of caries and periodontal problem. their restorative and endodontic requirements. Typically an overdenture patient presents with multiple hopeless teeth and a long standing periodontal problem. full mouth radiographs and overall patient concerns will enable the dentist to determine potential abutment teeth. Some cases are those who have congenital or acquired defects as a result of disease or catastrophic face/jaw injuries. Selective extractions are carried out and keeping those roots or teeth with good alveolar support. Generally speaking the treatment decision is often defined by the complexity. One must evaluate many factors like. Group 2: this group comprises patients who are diagnosed with a mutilated or severely compromised dentition. Some congenital defects that can present as overdenture cases are partial anodontia which in turn can occur in an isolated fashion or in conjunction with certain ectodermal dysplasias. These groups have been defined by Boucher.

Following endodontics a 2-4 week interval is desired before commencing further treatment on the tooth to make sure there are no endodontic complications. so overdentures do play a major role in treating young patients with mutilated dentition. then that should be the primary mode of treatment. location of the abutments. Esthetics and vertical height requirements dictate sufficient abutment reduction. At least 6mm of bone support is 32 Complete Denture and Implantology . PERIODONTAL STATUS It is axiomatic that a tooth with hopeless periodontal prognosis not be selected as an overdenture abutment. Abutment selection: There are many factors to be considered in abutment selection like endodontic status.Overdentures prosthesis. We shall discuss each in detail. and number of abutments. This may be due to the fact that secondary dentine does not form an absolute seal. Yearly radiographs are necessary if vital teeth are used as overdenture abutments.8%). Ideally patients with single rooted teeth and a single canal are the best candidates although multirooted teeth can also be used. 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. ENDODONTIC STATUS A tooth must more often than not be treated endodontically to allow enough reduction of the crowns. periodontal status. Vital teeth and even those having abundant secondary dentine are not very desirable abutments. Patient age: Extractions are to be avoided in a young patient as far as possible.

This prevents excessive bone loss from the anterior maxillary ridge.Overdentures needed to retain a tooth as an overdenture abutment. Teeth are most useful in areas of maximum occlusal forces and ridge resorption potential. pockets. The location of the remaining teeth is important in terms of support for the overdenture and preservation of the alveolar bone. Preservation of upper anterior teeth is especially important if the denture opposes natural teeth in the anterior mandible. Attached gingiva thickness adds to the favorable prognosis of the tooth. bony defects. and a poor zone of attached gingiva must all be eliminated before commencing treatment. Toolson and Smith on basis of their study emphasized the importance of a good periodontal work up of the potential abutments followed by frequent recall and proper regimen of home care. Four widely separated abutments provide ideal stability and retention. Abutment location and number A general rule is that if the patient presents with more than 4 retainable teeth in an arch that are periodontally sound some other treatment modality should be considered first. the mandibular arch abutment strength should be equal or greater than the maxillary arch. so canines and premolars are important teeth to preserve in this area. Inflammation. Exceptions to this rule do occur based on individual cases and patient desires. Attached gingiva can also be created through periodontal surgery. A common periodontal problem is lack of adequate attached gingiva. According to a study the canines are the most frequently used abutments. Bone support is assessed in terms of vertical height though it is not very reliable. When one goes for overdentures in both arches. in 70% of cases. The anterior mandible is very susceptible to change. 33 Complete Denture and Implantology .

noncoping and attachment overdentures. Connecting or splinting root surfaces has many advantages. The reasons for not selecting adjacent roots are. The most important advantage being that the inclined loads are resolved to more axial loads. removal of the weaker root is a good option. The connectors have to be swept upward from the gingiva which can complicate lab procedures too. • Hygiene maintenance becomes a definite problem. When interradicular space is restricted. transitional and remote. CLASSIFICATION OF OVERDENTURES Many authors have put forward differing classifications. Space between abutments: Adjacent roots are better avoided due to many reasons. This arrangement provides an excellent tripod effect and is especially effective when opposing natural dentition. • They do not provide more support and stability than one abutment. He classified overdentures into 34 Complete Denture and Implantology . Heartwell classified overdentures on basis of abutment preparation.Overdentures Another favorable arrangement is the use of maxillary canines and a central incisor. as coping. Yet another classification is put forward by Prieskel. Morrow and Brewer classified overdentures into immediate. A few are presented below. • This tends to increase the bulk of the denture and also makes it difficult to position the teeth correctly. horizontal or rotational forces (Thayer and Caputo 1980). There is also a marked resistance to lateral.

PREPARATORY PHASE OF OVERDENTURE THERAPY Lack of planning can cause a great deal of frustration and embarrassment. .Immediate overdentures usually require relining after 6-8 weeks.Definitive overdenture. Modern society makes it unacceptable to leave a patient without anterior teeth during the lengthy phase of denture treatment.Transitional overdentures.Immediate overdentures. Often it is advisable to maintain occluding hopeless premolars to serve as temporary maintainers of vertical dimension. According to Brewer and Morrow remote overdentures are those constructed for placement at some time remote usually a year or two from the removal of the last hopeless tooth. . These are removed when the prosthesis is delivered along with the anterior teeth. Most patients are given immediate or transitional overdentures prior to the remote one. .Overdentures .Hopeless posterior teeth should be extracted as soon as possible and preferably 6 weeks before prosthodontics treatment. . This phase can also be called the transitional phase of overdenture therapy.Occasionally a minor periodontal procedure might be postponed 5-6 weeks following overdenture delivery.Training overdentures. . . The 35 Complete Denture and Implantology . The ridges should be matured and gingival margins firmly established before treatment starts. According to Prieskel definitive prosthesis are usually constructed 6 months following extraction of last teeth and preparation of overdenture abutments.

The transitional phase is considerably simplified if the patient is already wearing a partial denture. periodontal problems and endodontic problems. After a year however a remote overdenture or a definitive prosthesis is recommended. Moreover attachment devices are specially indicated in cases where retention is difficult to obtain e. definitive treatment is contemplated. Submerged vital roots: This method is an innovative attempt to obviate some of the basic problems associate with overdenture abutments which include caries. . Another problem is the development of dehiscences over the roots and pulpal pathosis. 36 Complete Denture and Implantology . Once the transitional phase of overdenture therapy is over.g. the soft tissues should be stable. First of all retention is not increased appreciably and one also loses the stability provided by the vertical walls of the abutment. The selected roots are transected and reduced to 2mm below the crestal bone and then covered with a mucoperiosteal flap. There are a lot of disadvantages to this technique.Reduction of tuberosity or frenectomy can be carried out at this stage. . Adding flanges to partial dentures or a complete palate to an upper partial denture is an effective and rapid way of producing a transitional prosthesis. abutments prepared and modes of attachment devices to be used finalized. This is begun only after all the preparatory treatment is completed.Overdentures patient can wear immediate overdentures from several months to years. Before going on to this phase of treatment we shall see one other option in regards to the abutment.Endodontic treatment should be carried out during the initial healing phase of posterior tooth sockets.

Overdentures xerostomia or sialorrhea. loss of maxilla or partial loss of mandible and congenital deformities especially cleft palate. Oral hygiene must be optimal for this technique. • Simple tooth modification and reduction: remaining teeth are merely shaped to eliminate undercuts and reduced in vertical height to create more interridge distance. Use of attachments: stability and retention is quite good when attachments are used. The vital pulps of the teeth should have receded sufficiently for this technique. This approach occupies the least amount of space and also prevents thinning of denture base. 3. This approach occupies the maximum space buccolingually and vertically. Thimble shaped coping: this usually forms the inner layer of a telescopic prosthesis. 2. 1. The problem lies in the fact that repair and rebasing become complicated procedures. The drawback is that it offers very little extra stability and retention. It should be appreciated that any projection from the root surface is a corresponding depression in the denture base which can weaken it. ABUTMENT PREPARATION The vertical space available is the main consideration in overdenture abutment preparation. Another way of describing abutment preparation is as follows. Space requirements are intermediate compared to the other two approaches. It is often used in partial anodontic cases and in 37 Complete Denture and Implantology . absence of edentulous ridge in edentulous cases. There are three basic approaches to abutment preparation. Preparation of root surface just above mucosal level: there are 2 variants of this approach. one is leaving a bare root face and the other is using a dome shaped coping.

• Endodontic therapy and amalgam plug: after endodontic therapy the tooth is sectioned at the gingival margin or slightly above it(2-3mm) and an amalgam restoration is placed into the exposed root canal.Overdentures cases where there is severe abrasion of teeth. • Tooth reduction and cast coping: a casting is sometimes used to counter sensitivity or as a means of caries control. but if home care is not ideal caries can occur. The drawback is that the tooth may require endodontics later on and sufficient vertical height is required. This approach is used in those cases where vertical space is limited and caries index is also quite low. Here low caries index. The reason is that the margins are exposed and are difficult to finish properly. The attachment does 38 Complete Denture and Implantology . This approach is used in patients who are prone to caries. • Endodontic therapy with cast coping utilizing some form of attachment This approach is reserved for those cases where not only stability but significant improvement in retention is also desired. The casting is made to a shallow dome shape with the margins slightly supragingival. proper home care and periodontal health are absolute. Sufficient interocclusal distance is desired. • Endodontic therapy and cast coping: the procedure and indications are the same as in the previous technique except that a casting is placed instead of an amalgam restoration. The abutment teeth require adequate bone support because of the added stress that the attachment brings to the tooth. The remaining dentine is smoothed and polished leaving a surface that will accumulate minimum plaque and can be easily cleaned. One advantage is that there is very little abutment preparation and hence it is quite reversible.

This technique was developed by Lord and Teel in 1969.It is the ideal solution when immediate dentures are provided. As mentioned earlier space requirements are small and strength is unaffected. .It is the best solution when questionable teeth have to be evaluated prior to definitive therapy.It is the simplest. It also should not oppose another bare root face as dentine to dentine contact produces a very high degree of wear. . BARE ROOT FACE An irregularly shaped root surface should never be left behind. The canal opening is either obturated with glass ionomer or amalgam. It should not be used on a long term basis especially when it opposes natural teeth as it increases the incidence of vertical root fracture. The casting therefore requires additional retention which is provided by lengthening the post into the canal or by adding pins to the casting. PRECIOUS METAL COPING Operator has considerable scope in designing contours and establishing them. . The number and distribution of roots together with the adaptation of the denture base to root contributes to stability. Precious metal copings were once advocated for immediate insertion prosthesis but considering the rapid tissue changes that occur it is best to wait 3 months after extraction 39 Complete Denture and Implantology .Overdentures not reduce the crown/root ratio as much as the other approaches. Single unconnected copings are preferred and only in cases where mechanical requirements are of importance are connections preferred. There are certain contraindications. cheapest and least space consuming option. As mentioned earlier this technique has a few advantages.

Overdentures of other teeth before embarking on definitive prosthesis. Most of them are designed to be used with engine driven 40 Complete Denture and Implantology . The simplicity of the method is deceptive and is actually quite clinically demanding. Using reamers and waxing the dowel and coping directly have been used with good results for years. Plaque control requirements dictate that copings shouldn’t be overcontoured or bulbous. A relatively short dowel. Prefabricated systems or the so called matched reamer dowel systems are convenient to employ and more commonly used when canals are circular. minimum gold thickness of 1. The minimum requirements are an antirotation slot. Preparation for dome shaped casting: Dome shaped castings resist vertical loads well but they should resist lateral loads too. It requires extensive removal of dentine but is useful in canals that are irregularly or unusually shaped. A chamfer finish line is advocated around the preparation. In most of the cases lack of vertical space necessitates the root surface to be cut down to just above gingival level. Preparation for attachments: The occlusal surface is similar to the dome shaped coping but the centre of occlusal surface is hollowed out to increase the strength of the dowel/diaphragm junction and also to reduce the space requirements of the attachment. 4-5mm will suffice. The antirotation slot becomes more important and the length of the dowel into the canal needs to be longer. Moreover mechanical properties of cast metal are inferior to those of wrought metals in prefabricated systems.5mm over the occlusal surface without which there is a high chance of perforation. Any projection above the level of mucosa can be accommodated only by hollowing out a corresponding volume from the impression surface of the denture. at least 10mm.

They can provide additional stability. Anatomical considerations demand flange reduction. ATTACHMENTS These provide increased mechanical retention and stabilization. The most important stabilizing component is the prosthesis itself. Selection of the type of attachment is based upon available buccolingual and interarch space. Prefabricated attachments are versatile and provide considerable retention and stability. The ideal overdenture has inherent stability and retention. Unfortunately the ideal situation does not always apply. Retention systems supply this extra retention. Retaining components have to be rigid otherwise they deform or break during function. Retention by means of using attachments is usually not required in maxillary overdentures as normal flange extensions are possible. open palate etc. clinical experience.Overdentures reamers. We shall discuss some of the commonly used attachment systems in the following section. the additional retention systems serve mainly an auxiliary role. since their size makes it 41 Complete Denture and Implantology . As mentioned earlier their space requirement falls between thimble shape copings and dome shaped coping. Few stud attachments are entirely rigid. A variety of attachments are available ranging from the traditional mechanical units to magnetic retention systems. Stud attachments: Stud devices are among the simplest of all attachments. preferences and cost. retention and support and at the same time the positive lock of certain units can maintain the border seal of the denture. All this becomes very critical when interocclusal space is limited. which place additional demands on retention.

There are two types of stud attachments. . more buccolingual space is available for the denture teeth. It should be appreciated that these units must be surrounded by a reasonable thickness of acrylic resin. Intraradicular studs differ in the fact that alignment is determined by the roots and any divergence will lead to rapid wear of the male units although replacement is quite straightforward.Overdentures difficult to prevent a small amount of movement between two components. Another advantage is that no other casting is required and the female component can be simply placed into a receptacle on the root. . Selection of stud attachments: There are a wide variety of stud attachments in the market. The disadvantage is that the receptacle in the root is likely to require extensive finishing as it is unlikely to match the contours of the root and also requires extensive removal of dentine. but the mechanical ingenuity of the attachment occupies a secondary role compared to proper treatment planning and execution. Extraradicular attachments represent a large and versatile group. The lower the level of attachment. 42 Complete Denture and Implantology . Assessment of the vertical space is the most important step.Extraradicular in which the male element projects from the root surface of the preparation or implant.Intraradicular. in which the male element forms part of the denture base and engages a specially produced depression within the root contour of the implant. Whenever vertical space is limited consideration should be given to a less space consuming attachment such as bar retainer. These are available in a variety of sizes and range from 0-rings to pillar shaped projections. Space requirements of intraradicular studs are similar to the smallest extraradicular studs.

One stud attachment on either side of the arch will suffice. it may contribute to improved stability. it should be in line with the path of insertion of the denture. Bar attachments also demand more oral hygiene maintenance from the patients. Dalbo series. They have been well tried. A divergence of 10 degree can be tolerated. Zest anchor system etc. Two stud attachments on adjacent roots are unnecessary as it would complicate hygiene measures and also weaken the denture base. the remaining roots can be covered by simple copings. Significant divergence of roots or implants should be considered a contra indication for this approach. but leads to a weaker structure. Increasing the number of attachments does not necessarily increase retention. However connecting the copings will enable them to withstand rotational loads and also resolve inclined forces in a more axial direction. Alignment of stud attachments: The attachments should be aligned to each other. single sleeve and multiple 43 Complete Denture and Implantology .Overdentures Some of the commonly available stud systems are microfix. BAR ATTACHMENTS: This is one of the more popular class of attachments. tested and popular stabilizers and retainers for overdentures. Bar joints: Bar joints are divided into two types. The ball and socket type retainer is the most popular. The bulk of bar and related structures raises several problems. ceka revax extra and Intraradicular systems. Gerber units. Vertical and buccolingual space requirements limit their applications.

M. Multiple sleeve bar joints have short retaining clips or sleeves and this feature allows the bar to follow the curvature of the ridge. Ackermann and others have proposed modifications to the original design.Overdentures sleeve bar joints. Most of the systems are similar except for differences in sleeve design and use of spacers. These were first introduced in 1913 by Gilmore. Sleeves can be placed at sites with the greatest amount of space. bar has sleeves with retention tags in its own long axis. The sleeves are made of resin and these can be very easily replaced and also the sleeve rests directly on the bar without an intervening spacer unlike the other systems. Single sleeve bar joints are best represented by the Dolder bar joint. the sleeves have retention tags which project in a buccolingual direction whereas the C. Magnetic retention systems: These have been in use for the last 60 years. The versatility afforded by these bars are considerable and used extensively with implant supported overdentures. The Hader bar has a very ingenious design. A single sleeve bar cannot follow the curvature of the ridge and so used in square shaped arches. Until 1970 the 44 Complete Denture and Implantology . This bar is produced from wrought wire. In the Ackermann system. In case of implants the length of the span must be taken into account and failure to achieve rigidity at the abutment connection site can lead to loosening of the implant. An open sided sleeve is built into the impression surface of the denture and engages the bar when the denture is inserted. pear shaped in cross section and running just in contact with the oral mucosa between the abutments.

Pioneering work was led by Gillings in the University of Sydney. Another rare earth alloy which has potential is the Iron-Neodymium-Boron alloys. These alloys can produce smaller magnets with equal if not greater field strength. The introduction of rare earth alloys with a high magnetic field strength and high coercivity allowed production of magnets not much larger than stud retainers. Disadvantages: The magnetic alloys are susceptible to corrosion in the oral environment. Advantages with these systems are that path of insertion is not very important and so debilitated and arthritic patients can effectively use it. The earlier systems were open field in nature which meant that living tissues were exposed to magnetic fields. an alloy containing aluminum. The lab procedures are far less demanding compared to the other attachment systems.Overdentures magnets used were made of a cobalt platinum alloy or Alnico. This keeper is a ferromagnetic material like stainless steel or a high Platinum alloy. Both these alloys produced disk magnets that worked quite well in paired attraction for multi component maxillofacial prosthodontics. The corrosion of the magnet leads to dramatic drop in 45 Complete Denture and Implantology . cobalt and nickel. Gillings pioneered the closed field systems where magnets in the denture base abutted a keeper on the root face. This ensured that the magnetic fields were restricted to the local area. He developed a split pole assembly using Cobalt samarium alloys. They demonstrated a high magnetic field strength but their intrinsic coercivity was low which meant that they couldn’t be reduced to a size which could be used in overdentures. The size reduction allowed sandwich designs to come up in which one magnet is placed between two ferromagnetic plates and this occupies far less space.

Overdentures retention. So basically there are two types of implant overdentures depending on their mode of support. have been developed which can slow down the corrosion. One thing was that whatever protection was offered had to be in very thin layer so that magnetic field strength was unaffected and also the covering did not impinge on the space requirements. In 1989 Misch reported 5 prosthetic options in implant dentistry. Studies have shown that chewing efficiency is improved significantly compared to conventional complete dentures and bone loss is also reported to be minimal. The implant retained and tissue borne type relies primarily on the residual ridge for support. This continues to be a problem and is the area of considerable research. IMPLANT OVERDENTURES With the advent of dental implants. The differences between attachment of tooth to the bone and 46 Complete Denture and Implantology . polymers etc. Implant retained and implant borne dentures do not require peripheral seal but the periphery of the denture should rest on soft tissue to prevent food accumulation beneath the denture. Various techniques of preventing this undesirable phenomenon were devised. RP-4 is a removable prosthesis supported by implants alone. The first three are fixed restorations and the last two are removable prosthesis. RP-5 is a removable prosthesis supported by both soft tissue and implant. It is really useful in the mandibular arch as it helps preserve the residual ridge and also increase the retention and stability of the prosthesis. the benefits and advantages of using an overdenture has become a reality for edentulous patients. Various corrosion resistant sleeves of metals.

The choice of an implant overdenture depends on patient desires. This is often impossible when more than two implants are placed. The alternative is to go for a subperiosteal or transosseous system. Two implants are the minimum required for this type of prosthesis. Patients with tapered mandibular arch are not good candidates for the 2 implant bar and clip system because tissue space is encroached upon. This difference influences the design of the support system. availability and location as well as quantity of bone. A variety of implant types have been used to support overdentures which include endosseous through transosseous and subperiosteal of which the root form or endosseous variety is the most popular. A bar and clip mechanism is the most commonly used attachment system because it also provides a stress breaking action when the posterior portion is loaded. amount of interarch space. In cases of severely resorbed mandibles. the area of the bar to which the clip attaches should be in the symphysis region. endosseous implants can be place only after grafting is completed and a period of 6-9 months have elapsed after grafting. These implants can be left individually or splinted together for better biomechanics. For the bar and clip mechanism to be stress breaking in nature. The type of 47 Complete Denture and Implantology .Overdentures implant to the bone explains the difference between conventional and implant overdentures. In maxilla bar and clip attachments are usually not used. A bar length of 12-15mm is desirable in mandibular tissue borne overdentures. TISSUE BORNE OVERDENTURES Implants are generally placed in the anterior part of the mandibular or maxillary arch. manual dexterity of the patient and financial considerations. be parallel to the hinge axis and perpendicular to the mid sagittal plane. opposing occlusion. It should also be in a straight line.

milled bars and spark erosion attachments.Type of overdenture fabricated. to provide a firm union of prosthesis to the superstructure. 48 Complete Denture and Implantology . If the implants are short and placed in poor quality bone splinting helps. Others like ERA. .Location of implants on the ridge. IMPLANT BORNE OVERDENTURES These dentures rely on the implants to bear the entire occlusal load. This prosthesis requires a minimum of 4implants in the mandible and 6-8 in the maxilla. o-rings do not provide enough security and rigidity. Attachments Selection of a specific attachment for an implant overdenture depends on the following. . It is very important to avoid cantilevers in the maxilla. Some authors say that attachments placed directly over the implant bodies without splinting does not place detrimental forces on the implant. Firmer the connection of superstructure to the prosthesis. It is necessary to space the implants in order to ensure clips of adequate length (5-6mm). . Splinting: It is controversial as to whether splinting is good in all cases.Overdentures attachment depends on the number and location of implants used. more difficult it is for the patient to manage.The condition of the residual alveolar ridge. Swiss anchor. The firmer the connection of the superstructure on the implants. latch types. As mentioned earlier bars and clips are the most popular attachment devices. a variety of attachments have been developed like slant lock. more precise the tooth contacts can be in centric and eccentric movements because movement due to tissue resiliency ceases to be a factor.

bilateral. even contacts in centric and eccentric positions.Overdentures . In an edentulous patient the arch with the implants becomes the dominant arch in terms of occlusion. Mosby Inc 1999. • Carl Misch: Contemporary Implant Dentistry 2nd Ed. . As a general rule. The occlusion for the tissue borne overdentures should include multiple. Nowlin T P: Occlusion DCNA Vol 39 1995 49 Complete Denture and Implantology . Bolender C L. DCNA Vol 40 1996.Dexterity of the patient. • Nelson S J.Psychosocial needs of the patient. Mosby Inc 1997. more difficult it is to repair and maintain. Heartwell C M: Textbook of complete dentures 5th Ed • Sheldon Winkler: Essentials of complete denture prosthodontics 2nd Ed.Length of implant used. • Rahn A O. . Ishiyaku Euro America Inc 1996. • Engelmeir R L: Complete dentures. References • Zarb G A. Carlsson G E : Bouchers Prosthodontic treatment for edentulous patients 11th Ed. more complicated and sophisticated the attachment. .Relative need for stability and retention.

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