International Journal of Applied Dental Sciences 2020; 6(2): 37-42

ISSN Print: 2394-7489

ISSN Online: 2394-7497
IJADS 2020; 6(2): 37-42 Save the bone the overdenture way: A case series
© 2020 IJADS
www.oraljournal.com
Received: 24-02-2020 Dr. Ankita Chitnis, Dr. Gaurang Mistry, Dr. Padmapriya Puppala, Dr.
Accepted: 28-03-2020
Omkar Shetty, Dr. Ashwini Kini and Dr. Kunal Mehta
Dr. Ankita Chitnis
D Y Patil Deemed to be
Abstract
University School of Dentistry, Dentistry revolves around maintaining the health of the oral tissues and preserving the integrity of the
Nerul, Navi Mumbai, dentition. The branch of prosthodontics aims at preserving what remains rather than meticulously
Maharashtra, India replacing what is lost. This dictum by M. M. Devan has led to development of various treatment
modalities which involve salvaging as many teeth as possible and preserving all associated structures.
Dr. Gaurang Mistry One of these include the concept of overdentures. It deals with providing a prosthesis to a patient by
D Y Patil Deemed to be using maximum support from the tissue, bone and the remaining teeth. This article is a case series
University School of Dentistry, discussing rehabilitation of patients by using various types of overdenture techniques.
Nerul, Navi Mumbai,
Maharashtra, India Keywords: overdentures, implants, bar attachment, ball attachment
Dr. Padmapriya Puppala
D Y Patil Deemed to be Introduction
University School of Dentistry, According to the FDI, oral disease affects 3.9 billion people worldwide, with untreated tooth
Nerul, Navi Mumbai, decay (dental caries) impacting almost half of the world’s population (44%), making it the
Maharashtra, India most prevalent of all the 291 conditions included in the Global Burden of Disease Study.
Globally, about 30% of people aged 65–74 years have no natural teeth, a burden expected to
Dr. Omkar Shetty
D Y Patil Deemed to be increase in the light of ageing populations [1]. Considering these statistics, a large number of
University School of Dentistry, older people have seen to be left with few or no teeth which may or may not be strong enough
Nerul, Navi Mumbai, to provide support to a removable prosthesis.
Maharashtra, India In 1856, Ledger encouraged the dental profession to leave ‘stumps’ under artificial teeth.
Atkinson (1861) in his article on ‘Plates over Fangs’ also gave similar advice. During World
Dr. Ashwini Kini
D Y Patil Deemed to be War II, many dentists in the military service used overdentures in the treatment of inadequate
University School of Dentistry, or mutilated dentitions. Boos (1948), Miller (1958), Lord and Tee1 (1969, 1974), Reitz et al.
Nerul, Navi Mumbai, (1977) and Welker et al. (1978) have all reported successful treatment with overdentures.[2]
Maharashtra, India According to the Glossary of Prosthodontics, and overdenture is defined as any removable
dental prosthesis that covers and rests on one or more remaining natural teeth, the roots of
Dr. Kunal Mehta
D Y Patil Deemed to be natural teeth, and/or dental implants; a dental prosthesis that covers and is partially supported
University School of Dentistry, by natural teeth, natural tooth roots, and/or dental implants.
Nerul, Navi Mumbai,
Maharashtra, India Rationale for retaining teeth or roots
Retention of roots and teeth for overdentures offers the patient several advantages from (a) a
functional and (b) a physiological standpoint.
From the functional standpoint the benefits are good retention and stability. Support from the
remaining roots helps to protect the residual ridge from force placed on the denture. The
retained roots also offer assistance in stabilizing the denture as it resists lateral displacing
forces.
From the physiological viewpoint, it is worth considering if the retention of teeth might
conceivably offer the advantages of the preservation of the proprioceptive mechanisms
associated with the periodontal membrane of natural teeth and reduced ridge resorption [2].
Corresponding Author: Overdentures can be classified based on the vertical space available [3]:
Dr. Ankita Chitnis
D Y Patil Deemed to be  Class I arch: available vertical restorative space equal to or greater than 15 mm.
University School of Dentistry,  Class II arch: available vertical restorative space of 12 to14 mm.
Nerul, Navi Mumbai,
Maharashtra, India

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 Class III arch: available vertical restorative space of 9 to Disadvantages of overdentures

11 mm.  Meticulous oral hygiene is required to prevent caries and
 Class IV arch: vertical restorative space less than 9 mm. periodontal disease.
 The over-denture tends to be bulkier and overcontoured.
They are also dependent on the kind of attachments used.  There is encroachment of inter-occlusal distance.
According to retentive means the attachments can be  This treatment modality is an expensive approach with
classified into: frequent recall check-ups of the patient than a
 frictional conventional removable complete denture [11].
 mechanical
 frictional and mechanical Overdenture treatment options are boundless and there are
 magnetic attachments [4]. innumerable options to choose from for different cases. In this
paper three cases are presented where overdenture with
Depending on the method of fabrication of attachments: different attachments was given as prefabricated nylon cap
 machine milling an alloy or precision attachments post system, bar and single piece ball attachment overdenture.
 custom casted from plastic patterns or semi precision Each case was differently selected on the base of number of
attachments.[5, 6] abutment teeth present, their alignment, available bone width
These attachments further include stud, bar, magnets, and and intra-arch space present.
telescopic attachments.
Case reports
Advantages of overdentures [7, 8, 9, 10] Case 1
 Preservation of alveolar bone A 65-year-old patient reported to the Department of
 Proprioception Prosthodontics with a chief complaint of ill-fitting dentures.
 Enhanced stability and retention On examination, it was observed that the maxillary and
 Maintenance of vertical dimension of occlusion. mandibular arch was partially edentulous with root pieces
 Psychological benefit of having patient’s own teeth. present in the canine region which were endodontically
 It is also useful for patients with congenital defects such treated and submerged under the denture. [Fig.1] No mobility
as oligodontia, cleft palate, cleidocranial dystosis and and periapical pathology was noticed in the clinical and
class III occlusion. radiographical examination. The patient wanted a prosthesis
 Overdenture can be easily converted to complete denture with good retention as compared to her previous dentures.
over a period of time.

Fig 1: Pre-operative pictures

Treatment Plan phonetics, vertical and centric relation and finally esthetics.
A tentative jaw relation of the diagnostic casts was done to Vertical dimension was verified and centric and eccentric
assess the inter-arch space. It was found to be sufficient for an contacts checked. Patient's approval was taken, and the curing
overdenture with intra-radicular ball attachments. of the final denture was done in heat-cure acrylic resin. The
Primary impressions for the maxillary arch and mandibular root pieces with 13, 23, 33, 43 were prepared to accept a
arches were made with Alginate irreversible hydrocolloid. prefabricated post with a ball attachment (EDS AccessPost
The impressions were poured and special trays were Overdenture). The intraradicular posts were cemented using
fabricated with self-cure acrylic resin. Border molding was resin modified glass ionomer cement, the denture was
done for both the arches with low fusing impression relieved in this area, delivered to the patient and post insertion
compound and final impression was made with light body instructions were given. [Fig. 3, 4] After a period of 24 hours,
elastomeric impression material. [Fig. 2] Following this, the nylon caps were picked up in the maxillary and
maxillomandibular relations were recorded and transferred mandibular dentures with the help of autopolymerizing resin.
onto the semi-adjustable articulator with the help of face-bow. [Fig. 5]
Teeth setting was done, evaluated in the patient's mouth for

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Fig. 2: Final impression

Fig. 3: Processed denture

Fig. 4: Cementation of prefabricated post with a ball attachment

Fig. 5: Nylon caps picked up in the dentures.

Case 2 examination, it was observed that the maxillary arch was

A 70-year-old patient reported to the Department of completely edentulous and mandibular arch was partially
Prosthodontics with a chief complaint of missing teeth. On edentulous with canines present which exhibited Grade III
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mobility. The patient wanted a prosthesis with good retention and primary impressions for the maxillary arch and
and ease of handling. mandibular arches were made with Alginate irreversible
hydrocolloid. After border molding and final impressions
Treatment Plan were made [Fig. 6], jaw relations were recorded and a trial
A tentative jaw relation of the diagnostic casts was done to denture was fabricated and evaluated in the patient's mouth
assess the inter-arch space. It was found to be sufficient for an for phonetics, vertical and centric relation and finally
overdenture with ball attachments. The canines were extracted esthetics. After

Fig. 6: Final impression

Fig. 7: Processed denture

the denture was fabricated, [Fig. 7] it was duplicated and used

as a stent to plan the placement of two ball head single piece
implants in the canine region. The implants were placed and
the denture was relieved and religned with a soft lining
material. After a period of three months, the implants were
evaluated for osseointegration. [Fig. 8] A metal housing was
picked up along with an O-ring in the denture using an
autopolymerizing resin. [Fig. 9]

Fig. 9: A metal housing picked up along with an O-ring in the

denture

Case 3
A 48-year-old patient reported to the Department of
Prosthodontics with a chief complaint of missing teeth. On
examination, it was observed that the maxillary arch was
completely edentulous and mandibular arch had two implants
placed with a bar attachment present. [Fig.10]

Fig. 8: Single piece implants with ball head attachments placed Treatment plan
After border molding and final impressions were made, jaw
relations were recorded and a trial denture was fabricated and
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evaluated in the patient's mouth for phonetics, vertical and 2. The health of the individual.
centric relation and finally esthetics. After fabrication of the 3. The amount of trauma to which the structures are
denture, [Fig. 11] plastic retentive clips were picked up in the subjected.
mandibular denture using autopolymerizing resin. [Fig. 12]
Overdenture helps reduce resorption of surrounding bone and
reduces pressure on the alveolar ridge. It helps in maintaining
proprioception, directional sensitivity, dimensional
discrimination, canine response and tactile sensitivity.[14]
Rissin et al. in 1978 compared masticatory performance in
patients with natural dentition, complete denture and over
denture. They found that the over-denture patients had a
chewing efficiency one-third higher than the complete denture
patients [15].
Overdenture with attachments can redirect occlusal forces
away from weak supporting abutments and onto a soft tissue
or redirect occlusal forces toward stronger abutments thereby
resulting in superior retention.[16] Attachments are often used
in overdenture construction by either connecting the
Fig. 10: bar attachment on implants attachments to cast abutment copings or intra-radicularly.
For the first case, access posts were chosen. Access posts
occupy a small vertical space and the male units on the
different roots do not require parallelism. [17] The ball and
socket attachment of Access post allows rotation of the
denture attachment. Small head of the attachment limits the
amount of material that has to be removed from the denture
and thus the strength of the denture is not jeopardized. The
technical work can be carried out easily chairside [18, 19, 20].
A similar principle works in the second case where single
piece ball head implants were placed in order to enhance the
retention of the denture. For the third case, there was
sufficient inter-arch space, so the use of the customized bar
joint with snugly fitting plastic sleeve offers increased
stability and retention. As the bar is close to the alveolar bone,
forces of mastication exert much less leverage to the implants.
Fig. 11: Processed final denture The bar joint offers slight vertical and rotational movement of
the denture as well as a stress breaker action. Bar exhibits
more cross-arch involvement and allows occlusal forces to be
shared between the abutments. [21] Since there was adequate
inter arch space, so the thickness of the acrylic denture over
the copings and bar assembly was not compromised.
Customized Bar assembly calls for perfection both at the
dentist and technician level, so it is challenging to execute,
but the results are worth the effort.
In cases with limited interarch space, reinforcement of the
denture base with metal framework adjacent to the top of the
coping would be effective in reducing overdenture fracture
due to reduced thickness of acrylic resin because of the
bulkiness of the bar assembly. [22] Thus stress is reduced in the
midline of the overdenture and around the copings, functional
Fig. 12: Retentive clips in the final denture rigidity was improved. Occlusal stress to the underlying
denture-bearing areas gets distributed evenly.
Discussion The success of the overdenture treatment depends upon the
The idea of losing all teeth can be very disturbing for a proper attachment selection for the particular case. Various
patient. It has a psychological effect on the patient’s well- factors for attachment selection include available
being and appearance. In such conditions, the option of buccolingual and inter arch space, the amount of bone
overdentures as a preventive prosthodontic treatment modality support, opposing dentition, clinical experience, personal
should be considered because of its innumerable advantages. preferences, maintenance problems, cost and most important
Crum and Rooney [12] observed that an average loss of 0.6 being patient's motivation. The decision must first be made to
mm of vertical bone occurs in the anterior part of the retain the teeth or location of the implants as overdenture
mandible of overdenture patients through cephalometric abutments and then the attachments should be planned. The
radiographs as opposed to 5.2 mm loss in complete denture attitude of the patient to the treatment should be assessed.
patients in a 5 years study. Only those who understand the limitations and benefits of
Miller [13] showed through his study that alveolar bone attachments should be treated with attachment retained
resorption depends upon three variables: overdentures. Hence, patient selection is critical to the success
1. The character of the bone. of the treatment.
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Conclusion of an implant o-ring attachment for the tooth supported
The concept of overdentures has been around for a century. It mandibular overdenture: A clinical report. Eur J Dent,
has allowed for preservation of teeth till their very “last 2011; 5:331-6.
breath”. With the advent of implant technology, implant 20. Cohen BI, Pagnillo M, Condos S, Deutsch AS.
supported overdentures have become a go-to procedure for Comparative study of two precision overdenture
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