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OVER DENTURES

DEFINITION
Dentures which derive support from one
or
more abutment teeth by completely
enclosing them beneath the fitting
surface
i.e. dentures that covers the roots and
utilize them for support

The roots of teeth unsuitable for use as


abutment for a removable partial denture
may be employed
Loss of supporting bone causes the crown:
root to become increasingly unfavorable
A dramatic improvement in crown: root
ratio is achieved by reducing the crowns
to 1 or 2mm above the gingival margins,
which vastly reduces the lateral leverage
on the remaining root
May be complete or partial

ADVANTAGES

Preservation of remaining alveolar bone


around the retained roots

Greater retention and stability of the


denture

Sensory feedback from periodontal


membrane. The sensory and
propioceptive feedback from the
retained
periodontal membrane is of great
importance

It aids in pt`s recognition of


i.
Jaw position
ii.
Food texture
iii. Muscle force used in mastication
.
Greater masticatory force is possible
.
Retaining devices can be attached to
the remaining roots by means of a
post. The male attachment (patrices)
joins female counterpart (matrices)
within the body of the denture
.
Reduction of psychological trauma

DISADVANTAGES

More clinical time and expenses

Difficult time consuming endodontic


may be necessary

Patient must have good oral hygiene


otherwise the roots will be lost due to
carries and periodontal diseases

Increased labial or buccal fullness


around retained roots due to lack of
resorption

To avoid excessive bulk in region of


retained tooth, denture base may need
to be thinned, which increases the like
hood of #
Increased masticatory loads and often
smaller inter-ridge distance may
predispose to denture #. This problem
can be helped by using high impact
resins or metal alloys in the denture
More frequent maintenance visits

INDICATIONS
A complete denture opposed by natural
teeth b/c alignment of occlusal plane
can make occlusal balance difficult
Cleft lip palates
Hypodontia
Extreme attrition
Potentially difficult lower CD
Bruxists

PATIENT SELECTION
General health e.g. vavular diseases
adversely affects the prescription of
endodontic treatment
Cooperation of pt
Attitude of pt, especially regarding tooth
loss
Periodontal state of potential abutment
Sufficient inter-arch space, critical if
attachments are used

CHOOSING THE ABUTMENT TEETH


Ideally: bilateral, symmetrical with a
minimum of one tooth space b/w them
Order of preference: canines ,molars ,
premolars, incisors
Healthy attached gingiva, adequate
periodontal support (>1/2 root in bone),
and no or limited mobility
Is RCT required or not

PREPARATION OF ABUTMENT TEETH


Removal of undercuts
Preparation of crown for
thimble/telescopic gold coping
RCT, tooth cut to dome shape and
access cavity restored with amalgam
RCT and gold coping over root face
RCT and precision attachment (bar,
magnets, stud/anchor

CLINICAL METHODS
The retained tooth is root treated
If carries is unlikely to occur, the root
face is prepared so that 2mm projects
from the ging. margin and the root face
is left bare, apart from the restoration
required to seal off the root canal filling
If carries is likely, a coping is necessary,
(made of cast gold)
Often in older pts the root will not need
to be devitalized b/c of sec dentine

Two clinical methods are used


1) After abutments have been prepared
and stoned to ging. level, impression
are taken and denture made using
routine procedure
2) The teeth are root treated but not
stoned to the level of ging. The
denture are then made as for
immediate replacement.
. The clinician reduces the height of the
prospective abutment on the master
castto about 4mm above the gingiva.

On completion of the denture, the teeth


are reduced in the mouth and denture
fitted as accurately as possible.
Cold cure acrylic is then placed on the
fitting surface of the denture in the
recesses which corresponds to the
abutments
Venting holes having been cut right
through to the polished surfaces
When set the resin is trimmed away and
the final fit of the denture checked with
disclosing paste

MAINTAINENCE
Abutments are examined at 6 months
interval
Pt is instructed to brush over the
abutments twice a day. Topical fluoride
in the form of toothpaste should be
applied once a day using denture as
applicator
Denture must be kept clean. An interspace brush must be used to clean the
recesses on fitting surface
The denture should not be worn at night

THANK YOU