Over dentures and its attachment

Over dentures and its attachment

1. TOOTH SUPPORTED OVER DENTURES AND ITS ATTACHMENT Presented by, Dr. Chaithra Prabhu B 2nd year PG Department of Prosthodontics VSDC 84

2. CONTENTS Introduction Definition History Goals Requirements of overdenture Advantages and Disadvantages Indications and Contraindications Classifications Treatment Planning and procedures Attachments Over denture maintenance Conclusion

3. INTRODUCTION Presence of teeth helps maintain the residual alveolar ridge. For this reason an approach has been espoused to retain the roots of natural teeth beneath a complete denture. Zarb GA, Hobkirk J, Eckert S, Jacob R. Prosthodontic treatment for edentulous patients-e-book: complete dentures and implant-supported prostheses. Elsevier Health Sciences; 2013 Nov 21.

4. DEFINITION Any removable dental prosthesis that covers and rests on one or more remaining natural teeth, the roots of natural teeth, and/or dental implants. -GPT 9 Removable prosthesis that covers the entire occlusal surface of a root or an implant -Preiskel

5. SYNONYMS Overlay denture Telescopic denture Biologic denture Superimposed denture Overlay prosthesis Hybrid denture Coping prosthesis Heartwell CM, Rahn AO. Syllabus of complete dentures. Lea & Febiger; 1986. Modalavalasa HK, Shankar YR, Kumar PS, Kumar TS. A Novel Overdenture Telescopic Prosthesis. Journal of Orofacial Research. 2015:56-60.

6. HISTORY 1856- Ledger had described a prosthesis resembling an overdenture. 1861- Increased awareness regarding overdentures. 1888- Evans described a method of using roots actually to retain restorations. 1896- Essig prescribed a telescopic like coping. - Peeso - removable telescopic prosthesis. 1913- Dr.Gilmore constructed Bar type attachment for overdenture. Preiskel HW. Overdentures made easy: a guide to implant and root supported prostheses. Quintessence Publishing Company; 1996.

7. GOALS Maintains teeth as a part of residual ridge. Decrease in the rate of alveolar resorption. An increase in the patient's manipulative skills in handelling the denture. Enables to withstand greater force without movement. A study conducted by Crum & Rooney showed that the resorption of alveolar bone surrounding these teeth was reduced by EIGHT TIMES . Preservation of proprioceptive impulses. Control the force of occlusion. Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

8. REQUIREMENTS Maintenance of health of underlying tooth structure. Reduction in crown- to-root ratio. Basal seat tissue Simplicity of construction Ease of manipulation Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

9. ADVANTAGES Preservation of alveolar bone Preservation of proprioceptive response Support Retention Periodontal maintenance Patient acceptance Convertibilty Harmony of arch form Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

10. DISADVANTAGES Caries susceptibility Periodontal breakdown of the abutment teeth Bony undercuts Overcontour Undercontour Encroachment of the interocclusal distance Esthetics Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

11. TYPES OF OVERDENTURES Transitional overdenture Training overdenture Immediate replacement overdenture Definitive prosthesis Preiskel HW. Overdentures made easy: a guide to implant and root supported prostheses. Quintessence Publishing Company; 1996.

12. Transitional overdenture The transitional overdenture consists of a modification of this partial denture to replace further lost teeth or to cover the roots of overdenture abutments once the teeth have been cut down. Preiskel HW. Overdentures made easy: a guide to implant and root supported prostheses. Quintessence Publishing Company; 1996.

13. Training dentures These are not overdentures But they do have many applications in overdenlure techniques. Such dentures are commonly employed to replace hopeless posterior teeth once they have been extracted They serve as a replacement to allow the patient to accommodate to the replaced posterior dentition Preiskel HW. Overdentures made easy: a guide to implant and root supported prostheses. Quintessence Publishing Company; 1996.

14. Immediate overdenture An overdenture constructed for placement immediately after removal of the last hopeless teeth Preiskel HW. Overdentures made easy: a guide to implant and root supported prostheses. Quintessence Publishing Company; 1996.

15. Khanna TS, Gurav SV, Ram SM, Nandeeshwar DB. Immediate overdenture. Journal of Contemporary Dentistry. 2012 Sep;2(3):101-5.

16. Khanna TS, Gurav SV, Ram SM, Nandeeshwar DB. Immediate overdenture. Journal of Contemporary Dentistry. 2012 Sep;2(3):101-5.

17. A Randomized Control Trail on 74 patients Region Bone reduction IOD ICD Canine region 0.9mm 1.8mm Posterior region 0.7mm 1.9mm Conclusion: Retention of roots of canines beneath a mandibular denture in immediate denture patients, even when they were in poor condition, reduced the collapse ofthe alveolar processes in all regions of the mandible. J Dent Res 72(6):1001-1004, June, 1993

18. Definitive prosthesis These are usually restored at least 6 months following extraction of the last teeth and the preparation of the overdenture abutments. matured edentulous ridge & firmly attached marginal gingiva may involve metal base. Preiskel HW. Overdentures made easy: a guide to implant and root supported prostheses. Quintessence Publishing Company; 1996.

19. Diagnosis and treatment planning and procedure

20. PATIENT SELECTION Possibilty of fixed or removable partial dentures. If the remaining natural teeeth are capable of supporting a FPD / RPD Endodontic therapy Good endodontic prognosis Single rooted teeth with single canals – best candidates 2-4 week interval Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

21. Periodontal condition Critical step optimum periodontal health inflammation,pocket formation, poor zone of attached gingiva must all be eliminated Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

22. Caries activity Ideally teeth with minimal or no carious involvement should be selected . Economic consideration already endodontically treated teeth selected as abutment teeth Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

23. SELECTION OF ABUTMENTS Heartwell CM, Rahn AO. Syllabus of complete dentures. Lea & Febiger; 1986.

24. Periodontal consideration Minimal mobility Acceptable bone support Be amennable to periodontal therapy. Periodontal pockets of 4-5mm require periodontal therapy. there must be a minimum of 3-4mm attached gingiva. Do not condemn a tooth only on the basis of its mobility Heartwell CM, Rahn AO. Syllabus of complete dentures. Lea & Febiger; 1986 Richardson GD, Levin B. Complete Denture Prosthodontics: A Manual for Clinical Procedures. Department of Removable Prosthodontics, University of Southern California, School of Dentistry; 1981..

25. Endodontic consideration Should have good endodontic prognosis Advantages of endodontic treatment C/R ratio can be made more favarable More favorable interocclusal distance Heartwell CM, Rahn AO. Syllabus of complete dentures. Lea & Febiger; 1986.

26. Number of abutment teeth Quadrilateral configuration Tripodal configuration Heartwell CM, Rahn AO. Syllabus of complete dentures. Lea & Febiger; 1986.

27. CANINES ARE THEABUTMENT OF CHOICE

28. The teeth that are used most often are maxillary and mandibular canines. After the canines, the most useful teeth inorder are: (1) molars and bicuspids, (2) maxillary central incisors, (3) maxillary lateral incisors, and (4) mandibular incisors Richardson GD, Levin B. Complete Denture Prosthodontics: A Manual for Clinical Procedures. Department of Removable Prosthodontics, University of Southern California, School of Dentistry; 1981.

29. The amount of space between abutment teeth Robert M Morrow recomends that abutments should not be approximating difficulty for oral hygine maintanence margiinal gingivitis in inter proximal areas Heartwell CM, Rahn AO. Syllabus of complete dentures. Lea & Febiger; 1986.

30. Location of abutment Maximum occlusal force Maximum ridge resorption potential Anterior aspect of mandibular residual ridge – (most susceptible to change) – canines and premolars Preservation of the lower teeth and alveolar process is more important – difficulties encountered in the complete denture. Mandibular canines – most often utilized Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

31. Reasons for loss of abutments .Tada S, Allen PF, Ikebe K, Zheng H, Shintani A, Maeda Y. The impact of the crown-root ratio on survival of abutment teeth for dentures. Journal of dental research. 2015 Sep;94(9_suppl):220S-5S.

32. CONTRAINDICATIONS Economical condition Mentally and physically handicapped. Most specific contraindications are- the diagnostic findings related to Periodontal and endodontic procedures Grade III mobility Soft tissue and osseous defect not correctable by periodontal surgery Failure to establish a sufficient zone of attached gingiva by mucogingival graft procedures Excessive reduction of the adjacent residual alveolar ridge as a result of result elimination of osseous defects and the establishment of normal architecture Patients who will not keep the retained teeth free of plague. Vertical fracture of the root or roots. Mechanical perforation of the root. Internal resorption that has perforated through the side of the root. Broken instrument in the root canal. Horizontal fracture of the root below the bony crest Heartwell CM, Rahn AO. Syllabus of complete dentures. Lea & Febiger; 1986.

33. INDICATIONS Younger patients who faces loss of teeth Geriatric patients CD opposed by retained madibular anterior teeth Attachments are particularly indicated xerostomia absence of residual alveloar ridge in edentulous area loss of a maxilla or partial loss of a mandible congenital deformity ( cleft palate ) Heartwell CM, Rahn AO. Syllabus of complete dentures. Lea & Febiger; 1986.

34. ABUTMENT PREPARATION Based on the method of abutment preparation Non Coping Abutments Abutment w ith Coping Abutment w ith a ttachments Submerged Vital Roots Simple tooth modofication & reduction Tooth reduction & cast copings endodontic therapy with amalgam plug Endodontic therapy and cast copings Endodontic therapy and cast copings utilising some form of attachment Heartwell CM, Rahn AO. Syllabus of complete dentures. Lea & Febiger; 1986. Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

35. SIMPLE TOOTH MODIFICATION AND REDUCTION Reshaped or Contoured to convex or dome shaped surface to eliminate the undercuts and reduce vertical height to create more inter-ridge space for the overdentures . Abutments reduced to coronal height of 2-3mm Good oral hygiene with a low caries index is a must Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

36. Indications Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. partially anadontic patients patients with severe abrasion

37. TOOTH REDUCTION WITH CAST COPING A butment teeth are reduced and a cast coping is made on the teeth in preparation for overdenture for sensitivity or caries control Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. Requirement of abutments

38. ENDODONTIC THERAPY AND AMALGAM PLUG Indications Normal coronal height of the tooth Normal interocclusal distance After Endodontic therapy Tooth is sectioned at the gingival margin or slightly above it (1-2mm) Amalgam restoration is placed into the exposed root canal Precautions: Caries index to be kept low – home care must be excellent Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

39. ENDODONTIC THERAPY AND CAST COPING Endodontic therapy is completed Casting is placed on the tooth (caries control) Casting is a shallow dome shaped Margin – supragingival Retention – short post placed in the canal – post is kept short for easy retrieval if caries develops Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

40. SHORT COPING AND LONG COPING Short Cast Coping : 2-3 mm long Require endodontic therapy because the coronal root reduction would expose the pulp. Attached to cast coping is a post fitted to the canal. Heartwell CM, Rahn AO. Syllabus of complete dentures. Lea & Febiger; 1986.

41. Long Cast Coping : 5-8 mm long Endodontic therapy is eliminated by a conservative reduction of coronal tooth structure. Long ellipsoid shaped coronal coping. Larger crown – root ratio. Require greater level of osseous support Heartwell CM, Rahn AO. Syllabus of complete dentures. Lea & Febiger; 1986.

42. Endodontic Therapy with cast coping utilizing some form of attachment Indications Significant improvement in retention is required. Loss of maxilla or partial loss of mandible Congenital deformity especially Cleft Palate Heartwell CM, Rahn AO. Syllabus of complete dentures. Lea & Febiger; 1986.

43. Attachments are secured to the abutment by cast coping. The objective of any attachment is to improve retention of the denture base . Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. ABUTMENTS WITH ATTACHMENTS :

44. SUBMERGED VITAL ROOTS This is of current research interest. It attempts to obviate some basic problem associated with the more conventional over denture abutments. Selected vital roots are transacted and reduced to 2mm below the crestal bone and then covered by a mucoperiosteal flap. 2 major postoperative problems: dehiscence and pulpal pathosis Heartwell CM, Rahn AO. Syllabus of complete dentures. Lea & Febiger; 1986.

45. ATTACHMENTS

46. ATTACHMENTS In the making of an overdenture only the stud, the bar, and some of the accessory attachments are of interest. Mensor Jr MC. Classification and selection of attachments. The Journal of prosthetic dentistry. 1973 May 1;29(5):494-7.

47. Stud Attachments Gerber attachments Dalbo attachment Ceka attachment Schubiger attachment Quinlivan attachment Rothermann attachment Infrofix attachmen t Bar attachments Hader Bar Dolder Bar Baker Clip Ackerman Clip and CM Clip Intracoronal attachments Zest anchor Extracoronal attachments Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. Mensor Jr MC. Classification and selection of attachments. The Journal of prosthetic dentistry. 1973 May 1;29(5):494-7.

48. STUD ATTACHMENT Stud attachment Male stud type Soldered to the base Base – coping covering the prepared root stump, usually with a post extending into an endodontically treated tooth Female stud type Embedded in the acrylic of overdenture OR Soldered to the substructure in the overdenture Rigidly attached to male - Non resilient attachment Designed with a spring load to provide for a controlled movement - R esilient attachment Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. PRESSURE BUTTONS / SNAP FAST

49. Gerber attachment Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

50. Rigid Gerber button – P opular and widely used. Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. Advantages Disadvantages All components are interchangeable and replaceable. Expensive Solid fixation and minimal torque Retention is internal and replaceable. If denture base is not adapted adequately, the attachment can place torque on the tooth . Housing can be picked up in the mouth with resin A mandrel is required to parallel the attachments when more than one is required Soldering base Male post Female housing

51. Resilient Gerber Most sophisticated stud attachment- mechanical resiliency under 20g load and requires 2 lbs of force to disengage the locking spring Spring loaded,vertically loaded- height of 4.7mm Easiest to use – once technique is learned. Vertical movement – less torque Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. Advantages Disadvantages Soldering base is interchangeable. Bulky attachment – take up the space All parts are replaceable , making service life indefinite. Complex – requires skill Spring loaded allows base to adapt under function. Control after every 4 months – replacement of spring . The attachment housing can be picked up in the mouth with resin. Torque – if denture base not adapted properly

52. Dalbo attachment

53. Ceka attachment Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. Male portion is fixed to the tooth & has round shaped wider at the top that splits vertically into 4 sections ----- flexible over this fits the female housing or the ring

54. Zest Anchor Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. Female Sleeve Male nylon post with ball head Derives its retention from within the root . Post preparation is done – female sleeve is cemented in place. Male – nylon post and a ball head Retention – ball head snapping into the undercut of female sleeve

55. Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. Advantages Disadvantages No space problem – attachment is within the root No casting or coping is made – root and canal are susceptible to caries Leverage on the tooth is minimal – point of attachment is well below the alveolar bone level. Nylon studs can be bent – preventing seating of the applicance – if several are used.

56. Attachment procedure is simple and done chair side Food debris in female housing – attempts at eating without the denture. More than one teeth – parallelism not necessary – flexibility of nylon head Although a successful attachment to use because of many disadvantages used as a temporaray from of fixation for interim overdentures . Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

57. Rothermann attachment There are two types consists of short stud with a deeper groove at one end retaining C ring Requires very little space no need be parallel because of short height male unit easy to attach to the coping-----free hand soldering female clip----self cure Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

58. Quinlivan attachment Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. Female housing O-ring Male component : prefabricated resin ball incorporated within the wax up of post. Female component : Prefabricated resin cap with‘O ’ ring. Retention – O rubber ring inside the female that is secured by small lip at the orifice of the female cap Height - 3mm Ball shaped resin male post

59. Advantages Easily and economically fabricated . H ousi ng is free to rotate in all directions . So minimum torque to the tooth. Retention is satisfactory . Height is less –less space constraints. Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

60. Schubiger attachment Permanent form of fixation using screw system that connects anchor teeth to bar joint and bar unit. Consists of : 1. A soldered base with a screw - interchangeable with Gerber post attachment. 2. A ceramic metal sleeve to which a bar unit can be soldered 3. Screw lock nut to receive the sleeve

61. Schubiger attachment Indications For bar attachment on teeth with divergent roots. Advantage: Convertibility with weak abutment teeth. If one or more of the teeth are lost , the bar attachment is un screwed, leaving the solder base which is common to Gerber stud unit. Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

62. Introfix attachment Tall stud attachment Because of its length, it has much torque potential on the abutment tooth and therefore should be used only on totally tooth supported overdentures or on an overdenture that has an other wise excellent support Female housing Male retention cylinder Split post Solder base

63. Introfix attachment Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. Advantages Disadvantages Simple to use Paralleling device – if additional attachments used Components are replaceable Solder base – common to Ancrofix anchor Torque potential maximum – if denture base not adapted properly Good seating and retention Can be used in combination with resilient attachments Service life is indefinite Ideal for overdenture with quadrilateral support

64. Ancrofix attachment Resilient attachment Overall height – 3.2mm Teflon ring – allow lamellae to function in resin Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. Advantages Allows rotational movement Components- replaceable Retention – easily adjusted Attachment system – simple and inexpensive

65. Magnets Consists of a detachable keeper element made of stainless steel fixed to the abutment tooth. Denture retentive element has Paired, Cylindrical , Cobalt –samarium Axially magnetized magnets with their opposite poles adjacent. Flat magnet faces are covered on one end by the attached stainless steel keeper and on the other end by thin stainless steel plates Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

66. Advantages Straightforward , inexpensive technique No significant external magnetic field associated with the retentive units No residual magnetic field when the denture is removed. Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

67. Mandibular Overdenture Retained by Magnetic Assembly: A Clinical tip Mandibular Overdenture Retained by Magnetic Assembly: A Clinical tip
Purwar Anupam,  G. N. Anandakrishna, Shetty Vibha, Janya Suma, and Khanna Shally J Indian Prosthodont Soc. 2014 Dec; 14(Suppl 1): 328–333. Pre-operative upper and lower arch (mandibular teeth were endodontically treated) Postspace preparations, gingival retraction and impressions of posts Polysiloxane impression of abutment teeth and posts

68. Mandibular Overdenture Retained by Magnetic Assembly: A Clinical tip Mandibular Overdenture Retained by Magnetic Assembly: A Clinical tip
Purwar Anupam,  G. N. Anandakrishna, Shetty Vibha, Janya Suma, and Khanna Shally J Indian Prosthodont Soc. 2014 Dec; 14(Suppl 1): 328–333. Definitive cast Keepers were placed and wax-up was done for casting along with post Keepers along with post were cemented with resin cement

69. Mandibular Overdenture Retained by Magnetic Assembly: A Clinical tip Mandibular Overdenture Retained by Magnetic Assembly: A Clinical tip
Purwar Anupam,  G. N. Anandakrishna, Shetty Vibha, Janya Suma, and Khanna Shally J Indian Prosthodont Soc. 2014 Dec; 14(Suppl 1): 328–333. Border molding and functional impression Gypsum dummy (above  dark line ) was fabricated on the top of the keepers attractive surface of the cast Magnets were attached in lower denture with the help of self-cure resin in patient’s mouth

70. Bar attachments Purpose is to splint the abutment teeth Retention and support of the prosthetic appliance. Rigid fixation. No movement Classified as tooth- borne. Permit rotational movement utilizing more of residual ridge for support Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

71. Hader Bar Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988. Can be used as a bar attachment /stud attachment/ bar joint / bar unit . Consists of preformed plastic bars and clips. Plastic bar – attached to coping wax up and is cast Plastic clip – embedded in denture Advantages : Can be adjusted to any length before casting ( bar / stud ) Disadvantages: Bulky

72. Dolder Bar preformed bar can only approach a close adaptation to the ridge contour as it must remain parallel to the ridge. soldered to the copings of abutment teeth, spacer present to provide resiliency Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

73. Dolder Bar

74. Baker Clip Small U shaped clip designed to fit over a round wire. 2 sizes -----------11 and 14 gauge. Wire is soldered to post copings. Clip is placed on the wire and picked up in the resin. Advantages: Simplicity Low cost Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

75. Ackerman clip and CM Clip Similar to Baker’s Clip. Difference : Retention wings on the clip for easy engagement into the acrylic of over denture. Also contain spacer – clip does not rest directly on the bar – providing vertical and rotational movement. Advantages: Small size Ease of fabrication Excellent choice for overdenture retention when a bar joint system is indicated Winkler S, editor. Essentials of complete denture prosthodontics. Year Book Medical Pub; 1988.

76. STUDD v/s BAR Splinting of two or more teeth with bar produces stability similar to the rigid stud type attachment Stud type attachment allows independent movement – if one tooth especially weak then the strong tooth acts as a fulcrum point for movement of the weaker teeth in the prosthesis Bar units and joints splints in more than one plane- all or none move With bar fixation, stronger and weaker tooth splinted together- stronger tooth strengthens the weaker tooth and weaker tooth strengthens a stronger tooth.

77. Photoelastic stress analysis of overdenture attachments AIM : To study the load transfer characteristics of 1) conventional endodontically treated tooth supported OD . 2) Stud attachment : Ceke , Zest, Rotherman , Gerber, Ancrofix 3) Bar attachment : Hader bar, Dolder bar , Kings connector. Results : The best design for uniform distribution, of occlusal forces to the remaining structures was the conventional design , particularly the amalgam restored abutment. This design, however; provided less effective retention and stability than the other designs. In the, group of stud type attachments studied, the Ancrofix transferred stress in a more favorable manner to the remaining structures in the oral cavity when compared to the other stud attachments. Photoelastic stress analysis of overdenture attachments. The Journal of prosthetic dentistry. 1980 Jun 1;43(6):611-7.

78. The Hader Bar provided more desirable effects to the abutments and remaining structures than did the other tissue bars. The major objective in the choice of an overdenture attachment should be the consideration of how the stress is transferred from these tachments through the abutments and other structures, not the retention and stability. Photoelastic stress analysis of overdenture attachments. The Journal of prosthetic dentistry. 1980 Jun 1;43(6):611-7.

79. OVERDENTURE MAINTENANCE ORAL HYGIENE : Regular cleaning of teeth and mucosa after each meal CARE OF DENTURES: Soft bristels brush with mild soap water cleaning the dentures after every meal soaking in water when not in mouth Richardson GD, Levin B. Complete Denture Prosthodontics: A Manual for Clinical Procedures. Department of Removable Prosthodontics, University of Southern California, School of Dentistry; 1981..

80. CARIES PREVENTION: Application of fluoride gel Shannon & Cronin advocatesd the use of 0.4% SnF2 gel application REGULAR FOLLOW UPS Richardson GD, Levin B. Complete Denture Prosthodontics: A Manual for Clinical Procedures. Department of Removable Prosthodontics, University of Southern California, School of Dentistry; 1981..

81. Conclusion Overdentures provide substantial benefit to the patient in terms of ridge preservation and retention. Patient should be educated regarding the provisional nature of the treatment and the inevitable need to progress to conventional complete dentures. Abutment selection is vitally important in success of this treatment modality, though cost is a deterrent, especially while using attachments .