Overdentures in prosthodontic and implant dentistry

Overdentures in prosthodontic and implant dentistry

1. OVERDENTURE PRESENTED BY: DR. MAHENDRA DAVE 1

2. Contents Introduction Definition Synonyms History Indications Contraindications Classification Types of overdenture According to method of abutment preparation- Heartwell Non coping Coping 2

3. Attachment Attachment systems Magnetic denture retention Submerged vital roots Criteria for patient selection Treatment planning Implant supported overdenture Summary 3

4. Introduction 4

5. Physiologic basis of overdenture Sensory input from periodontal receptors Alveolar bone preservation Occlusal forces substantially increased Masticatory performance Tooth mobility greatly reduced 5

6. Definition Any removable dental prosthesis that covers and rests on one or more remaining natural teeth, the root of natural teeth or dental implant. or A prosthesis that covers and is partially supported by natural teeh , tooth roots or dental implants. GPT-8 6

7. An overdenture is a denture that may be supported by soft tissue, bone, the root of a tooth or a modified tooth. Winkler 7

8. Overdenture may be defined as a removable prosthesis that covers the entire occlusal surface of a root or implant. Preiskel 8

9. Synonyms Biologic denture Hybrid denture Telescopic denture Overlay denture Onlay denture Tooth supported dentures Super imposed denture. 9

10. History In 1856, Ledger has described a prosthesis resembling an overdenture. His restoration was referred to as “plates covering flanges” . 10

11. In 1988, Evans had described a method of using roots to retain restorations. 11

12. In 1896, Essig described telescopic like coping. 12

13. Peeso was employing removable telescopic prosthesis at around the same time. 13

14. Gilmore was looking for both denture retention and stability whereas Peeso (referenced in 1916) suggested that he was interested primarily in denture support. 14

15. The reasons for retaining the roots were not always specified but it is likely that denture retention and stability must have been uppermost in clinicians mind. 15

16. CLASSIFICATION 16

17. CLASSIFICATION Design of abutment: Bare abutment. Protected abutment : Short coping. Medium coping. Long coping. Coping with attachments. 17

18. CLASSIFICATION 18

19. CLASSIFICATION 19

20. CLASSIFICATION 20

21. INDICATIONS 1.Patients with a poor prognosis for complete dentures 2.Congenital defects: Cleft palate Oligodontia Microdontia Cleido cranial dysostosis Class III patients with prognathic mandible 21

22. 3. Acquired defects: Accidents Disease 4.Teeth with questionable prognosis 22

23. 6. In case where the retention is difficult to obtain . Xerostomia Absence of alveolar residual ridge Loss of maxilla or partial loss of mandible Congenital deformity e.g. Cleft palate 7. Knife edge ridge that will provide inadequate support. 8. Unilateral overdentures 23

24. CONTRAINDICATIONS OTHER METHOD SUPERIOR PATIENT COOPERATION 24

25. ADVANTAGES PRESERVATION OF ALVEOLAR BONE Crum and Rooney (1975) PRESERVATION OF PROPRIOCEPTIVE RESPONSE : SUPPORT STABILITY: RETENTION EQUALLY EFFECTIVE OR SUPERIOR METHOD OF TREATMENT 25

26. SIMPLICITY OF CONSTRUCTION STABILIZATION OF EXISTING STRUCTURE IDEAL OCCLUSION ESTHETIC EXCELLENCE OPEN PALATE POSSIBLE FAMILIAR PROCEDURES 26

27. LESS TRAUMA TO SUPPORTING STRUCTURES EXCELLENT PATIENT ACCEPTANCE CONVERSION TO COMPLETE DENTURE MINIMAL ADJUSTMENTS POSSIBILITY OF USING ATTACHMENTS OR SOFT LINERS 27

28. EASE OF MAINTENANCE EASE IN CLEANING 28

29. DISADVANTAGES CARIES SUSCEPTIBILITY PERIODONTAL BREAKDOWN OF THE ABUTMENT TEETH COST ADDITIONAL PATIENT RESPONSIBILITY 29

30. TYPES OF OVERDENTURES 30 DCNA vol 40: number 1: january 1996

31. TRANSITIONAL OVERDENTURE 31 A modified partial denture can be used as a Transitional Overdenture

32. ADVANTAGES Less costly Permits a smooth transition to overdenture status 32

33. DISADVANTAGES Border extension, Esthetics , Occlusion, Support and Stability of the removable partial denture often are inadequate. Use of autopolymerising resin. 33

34. PROCEDURE CONVERSION USING DENTURE TEETH Addition of teeth before extraction of hopeless teeth Endodontic treatment Alginate impression Preparation of abutment teeth Addition of autopolymerizing resin in indentations Place it in patients mouth Stone cast is poured Flanges are made Finishing and polishing 34

35. POST INSERTION CARE 35

36. IMMEDIATE OVERDENTURE 36 Immediate overdentures may be employed for the post-extraction period, and serve as a spare denture later on

37. ADVANTAGES Increased support and stability afforded by the natural teeth retained as abutments. Preserves residual ridge by retention of natural teeth. Receives favourable response from the patient. Minimal discomfort and interference with function. Construction is relatively simple. 37

38. DISADVANTAGES Are not sturdy as those reinforced with metal casting and are made prone to breakage . 38

39. Procedure 39

40. 40

41. 41

42. 42

43. Treatment sequence Overdenture patient diagnosis & t/t plan Prerequisite oral surgery Remove hopeless posterior teeth Prerequisite periodontics Abutment supportive t/t Prerequisite endodontic Abutment endodontic t/t Immediate over denture Marginal oral hygine & overdenture response Continue overdenture 43 Poor oral hygiene abutment failure Convert to conventional overdenture Excellent oral hygiene & overdenture response Remote overdenture copings, metal base or attachments

44. POST INSERTION CARE Soft bristle tooth brushes, disclosing tablets, dental floss and bubble gum therapy are used to maintain gingival health . 44

45. REMOTE OVERDENTURE 45 Remote Overdenture Constructed for placement at sometimes remote

46. ADVANTAGES Stronger and is less subject to breakage. Rigid; resist the dimensional changes The metal bases permit accurate jaw relation record. Reinforcement of the overdenture by a rigid cast metal base significantly postpones the need for relining.   46

47. DISADVANTAGES The additional clinical and laboratory procedures increase both time and cost of the treatment. Relining presents more difficulty with a metal denture base than with one constructed of a resin. The metal bases give poor esthetic effect. 47

48. Procedure 48

49. 49

50. 50

51. Classification of attachments CORONAL Intra coronal attachment Extra coronal attachments RADICULAR Telescope stud attachments Bar attachments Joints Units ACCESSORY Auxillary attachment Screw units Pawl Connectors Bolts Stabilisers or Balancers Interlocks Rests  51

52. Magnets Permanent Induced Open field Cwsent field 52

53. Extra coronal Intra coronal Gerber attachment Zest anchor Dalbo attachment Ceka attachment Rothermann attachment Infrofix attachment Schubiger attachment The compact unit ( priska ) Bacer and fah unit The 0-50 system 53

54. Stud attachments Simplest among all attachments Study by Thayer & Caputo 1980 Advantages 1. Retention, stability, support 2.Positive lock of certain unit can maintain the border seal of the denture 54 Female part Male part

55. 55

56. Popular stud attachments are: Dalbo stud unit: Ball and socket Rigid dalbo B. The compact unit 56 Extremely popular of design series, neatness, strength, time tested

57. Features Male part: 4mm high & spherical shaped Easy to clean Fingers of socket are surrounded by nylon rings(simplifies adjustment) Retention can be altered by free end of lamellae Adjusting tools: tightning device, complimentry tool, device to replace nylon sleeve, relocating dowel for rebasing impression. 57

58. Gerber attachments 58 Allows vertical movements, rigid attachment

59. 59

60. 60

61. Ceka system 61 Rigid Resilient

62. 62

63. Both share common base but extracoronal unit is not identical. Vertical travel allowed by the resilient stud is 0.3mm Anciliary instruments: Locating device Adjustment device Changing attachments Repair and rebasing device. The attachment base is soldered to the prepared flat surface of the coping 63

64. Introfix A solid cylinder attachment that can be used fixed removable bridge work as well as for overdenture……consists of 3 parts A solder bar A replaceable and adjustable male friction part A female cylindrical housing 64

65. 65

66. Advantages Simple to use Components are replaceable and interchangeable Attachment provides good seating and retention Can be used in combination with resilient attachments. Service life is indefinite. 66

67. Disadvantages Paralleling is necessary Processed in the lab Torque potential is maximum if denture base is not adapted properly. 67

68. Rothermann Unit Rigid (less height 1mm) Resilient (more height 1.7mm) 68

69. 69 Rigid Rigid in place Resilient

70. Advantages Requires little vertical space Tolerance for limited misalignment of attachments 70

71. Intraradicular stud attachments Advantage Cost Precious metal coping are not required Space requirement Simple and quick 71

72. 72

73. Zest anchor system 73

74. Nylon male element is incorporated in the denture base projects downwards, and engages a recess in the root prepration . 74

75. 75

76. Bar compared to stud fixation 76

77. Bar attachment Types of bar attachments hader bar dolder bar attachment baker clips ackerman clips C.M. clip 77

78. 78 The Dolder Bar Hader Bar Ackermann bar Bar Baker clip

79. Hader bar attachment Can serve as bar joint or bar unit Can be used as a stud attachment Consists of preformed plastic bars and clips 79

80. Advantages Bars can be fabricated in any alloy Retention can be replaced by patient or dentist For more retention metal clips can be used Assembly technique is simple Capability to follow gingival contour 80

81. Disadvantages Rider is too bulky occlusogingivally Rider retention decreases rapidly No tention adjustment For additional retention more clips should be added 81

82. Dolder bar Has bar unit and bar joint Preformed bar are available for bar units Shape of the bar, has parallel sides with a rounded top Retention is by means of frictional fit Non resilient attachment 82

83. ADVANTAGES: availability of two different heights 14.65 mm and 3.6 mm Rider and bar are available in any length Spacer allows vertical and rotational movement 83

84. DISADVANTAGES: too bulky even in microsize ( faciolingually ) Expensive and requires exceptional skill for its use Allow vertical and rotational movement because of the resilient attachment Contouring the bar joint is difficult 84

85. Baker clip 85

86. Advantages: Adjustable and provides rotational movements Readily available 86

87. Disadvantages: No retention for the clips Soldering the retentive loops reduces the elasticity of the clip. 87

88. Ackerman and C.M. clip These are bar joints Both are similar in designs Consists of a rounded bar and clip, clip fits on the bar Slip has retention wings for the easy engagement into acrylic Allows vertical & rotational movement because of fixation. 88

89. Advantages: Rider is provided with retention 89

90. 90

91. Magnetic 91

92. Advantages No specific path of insertion is required (good for limited dexterity patients) No abutment parallelism is required Soft tissue undercuts may be engaged Potentially pathologic lateral or rotating forces are basically eliminated providing maximum abutment protection 92

93. Until 1970 magnets were either Alnico or Co/Pt Both have magnetic field In 1977 Gillings introduced Rare Earth Cobalt (REC) Alloy composition was Co/ Sm ) 93

94. Biological effects of cobalt/samarium magnets Physical effects Biological effects 94

95. Implant supported overdenture INDICATIONS: A . Patient who benefit with mandibular overdenture: Are usually elderly (65 to 80+ years) Are edentulous in maxilla and mandible Have worn complete dentures for many years Are uncomfortable with a complete mandibular denture Demand stabilization of denture 95

96. B. Patient who benefit from maxillary denture Are in younger segment (50 to 60 years) Have no experience with maxillary removable prosthesis Exhibit hopeless residual maxillary dentition Are fearful of becoming edentulous 96

97. 97 When comparing the height of the Locator Attachment on the left with other commonly used implant attachments on the market, the Locator saves from 1.7mm to 3mm of interocclusal space required.

98. 98 Another advantage of the Locator Implant Attachment is its ability to accommodate angles up to 40 degrees between two divergent implants

99. 99 The self-aligning design of the Locator Attachment System helps guide the attachment into place on the abutment.

100. 100 Locator Replacement Males The Locator Core Tool (LOCCT2) consists of three pieces used throughout the restorative process: 1) Male Component Removal Tool 2) Male Component Seating Tool 3) Locator Abutment Driver

101. 101 Preparing the implant site for Locator Attachments Remove the healing components from the implants with the 1.25mmD Hex Tool. Ensure all bone and soft tissue are removed from the superior aspect of the implant for complete seating of the Locator Attachment.

102. Selecting the Locator Attachments 102 based on the tissue depth. Determine the tissue depth by measuring from the coronal rim of the implant body to the crest of the soft tissue in three or four areas

103. Seating the Locator Attachments 103 Insert the Locator Abutment into the implant and rotate into position using the Abutment Driver.

104. Tightening the Locator Attachments 104 Locator Torque Wrench Insert Driver with the Torque Wrench for tightening of the abutment.

105. Determining divergence and selecting Replacement Males 105 Attach the Parallel Posts to the abutments to determine the degree of divergence

106. The standard transfer procedure 106 Inject light-body impression material around the transfers in a “wash” technique and then record a full-arch impression with standard body material. The Locator Impression Coping is retained in the impression material.

107. Completing the standard transfer procedure 107 Insert the Abutment Analogs into the Impression Copings located within the impression material.

108. Processing the denture 108

109. Delivering the final prosthesis 109

110. 110

111. Advantages Minimum anterior bone loss Improved esthetics Improved stability Improved occlusion Decrease in soft tissue abrasion Improved chewing efficiency and force Improved retention, support, speech Improved maxillofacial prosthesis 111

112. Disadvantages Abutment crown height space required Long term maintenance Food impaction Continued posterior bone loss 112

113. Conclusion Alveolar bone with its overlying mucosa was never intended to receive the full force of a complete denture. Finally it is reasonable to conclude that the retention of a part of a natural dentition affords the overdenture patient again in neuromuscular performance there by having an edge over his edentulous counter part 113

114. REFERENCES Zarb Bolender`s prosthodontic treatment for edentulous patients. Charles M. Heartwell`s syllabus of complete dentures. Harold W. Preiskel`s syllabus of overdenture. An alternative method for the fabrication of a root-supported overdenture: A clinical report. J Prosthet Dent 2013;109:1-4 Prosthodontic Rehabilitation using Attachment Retained Overdenture- Case Reports Dr. Deshraj jain1, Dr. Alka Gupta2 IOSR Journal of Dental and Medical Sciences Volume 14, Issue 8 Ver. II (Aug. 2015) Over denture with access post system: a case report Neha Gupta, Dhawal Goyal, Manoj Agarwal, I N T E R N AT I O N A L J O U R N A L O F D E N TA L C L I N I C S | 2 0 1 2 Volume 4 I s s u e 2 114

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