Overdenture: DR Balendra Pratap Singh Assistant Professor Department of Prosthodontics

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OVERDENTURE

Dr Balendra Pratap Singh


Assistant Professor
Department of Prosthodontics
• The continuous pattern of alveolar bone loss, once teeth have
been removed have been well documented by researchers.

• Bone resorption is so predictable in most patients that every effort


should be made to preserve root & alveolar bone.
• Also the transition from dentulous to suddenly becoming
edentulous & wearing dentures is often traumatic psychological
experience for patients.

• Many times, patient feels that he has lost his sense of taste, smell
& tactile discrimination.

• Covering the hard palate & other tissues blocks vast regions of
nerve receptors that respond to pain, pressure.
• However the use of tooth- supported overdentures provides
retention of alveolar bone, makes possible a high degree of
tactile discrimination & strongly strengthens the psychologic
factors of the patient.
• DEFINITION: (According to GPT-8) it is a removable partial
denture or complete denture that covers & rest on one or more
remaining natural teeth, the roots of natural teeth, or dental implant.
SYNONYMS
1. overlay denture ( CRUM & ROONEY)
2. overlay prosthesis
3. telescope denture ( PEREL)
4. biologic denture
5. superimposed prosthesis
RATIONALE
1.To maintain the sensory input from the PDL
receptors:
• Sensitivity of the anterior teeth-
• The roots of the teeth offer more discrete discriminatory input than
does the oral mucosa.
• Dimensional perception-
• Means the discrimination of different thickness of objects between the
occlusal surfaces of teeth.

• Kawamura & Wantanabe [ 1960 ] found that patient’s with natural dentition
could discriminate differences at the 2mm range better than those with
artificial denture.
• Canine response-
• Corbin & Harisson [ 1940 ] found in their studies that canine were most
sensitive oral structures.
• Kruger et al [ 1962 ] said that the canines had more neurons than any
other teeth.

These results lend support to their retention for


overdentures.
• Directional sensitivity-
• Kruger & Michael [ 1962 ] reported that teeth had excellent directional
sensitivity.
• It appears there are specific sensory Nerve endings for various kinds of
force, that is lingual force or buccal force.
2.To increase masticatory performance:
• Rissin et al [ 1971] found that the overdenture patients had a chewing
efficiency 1/3 higher than the complete denture patients.
3.To preserve the alveolar bone:
• Even after fabrication of a CD alveolar bone resorption continues- this
may be because mucosal receptors under conventional dentures during
mastication are unable to warn against occlusal overloading.
ADVANTAGES
Preservation of alveolar bone-
• Preserving the teeth retains not only the alveolar bone surrounding the
teeth but also preserves the bone adjacent to the teeth.
• The roots of the teeth provide tensile stimulation to residual alveolar
ridge. This type of stimulation is conductive to bone repair &
maintenance.
Preservation of proprioception-
• Most of the sensory inputs from the receptors in the PDL are
proprioceptive signals.
• Periodontal receptors are largely responsible for the ability of the
mandible to close directly into intercuspal position without
interferences.
Support-
• The natural tooth stops of an overdenture provide for a static, stable
base unparalleled by any conventional denture.
• A stable base such as this improves occlusion by more accurate jaw
relation records.
Retention-
• Relief of some areas like bony protuberance or pronounced tissue
adjacent to the teeth break the seal but the use of attachment or soft
liners overcome this problem.
A simple approach to patient in following cases-
-Cleft palate
-Partial anodontia
-Microdontia
-Amelogenesis imperfecta
Partial anodontia
microdontia

Amelogenesis imperfecta
Patient acceptance-
• Pt’s are most receptive & appreciative of this type of treatment because
they experience a striking improvement in function & esthetics while
still maintaining some of their own teeth.
Convertibility-
• This concept is designed so that if for some reason the overlaid teeth
must be extracted, the overdenture can be readily be converted to a
conventional denture by blocking the abutment indentations or
relining & rebasing.
Other advantages
• Horizontal & torqueing forces are minimized.
• Fewer post insertion problems as compared to conventional dentures
• Its application is virtually unlimited & depends on dentists skill &
judgement.
DISADVANTAGES-
• More expensive because of endodontic treatment & subsequent
restoration of teeth with alloys or gold.
• Frequently need periodontal therapy. This entails a rigid &
frequent recall appointment protocol.
• Bulkier than FPD or RPD.
• If pt. does not keep the overdenture & teeth clean, caries & periodontal
disease may progress.
• Secondary caries under the margin of the copings.
• Available interarch space is sometimes inadequate & may require
extensive abutment & design modification to expedite treatment.
• Bony undercuts-
especially those found buccally to the abutment teeth may pose
problem in regard to close approximation of denture base in this area.
• Overcontouring-
at times it is necessary to excessily block existing tissue undercuts. This
will lead to overcontouring.
• Undercontouring-
because of limited path of insertion & presence of bony undercut some
times its necessary to underextend the denture border.
INDICATIONS:
• Presence of few healthy teeth in oral cavity.
• Pt. with badly attrited down teeth.
• Pt. with congenital or acquired intraoral defect of cleft palate,
oligodontia, microdontia & cliedocranial dysostosis.
• Pt. with poor prognosis for complete denture like high palatal vault &
steep ridge slope.
CONTRAINDICATIONS:
• When another line of treatment promises to give superior results.
• It is contraindicated in pt. who cannot maintain good oral hygiene to keep
abutment teeth & its periodontal tissue healthy.
• Teeth or tooth in which periodontal or endodontic treatment is
contraindicated.
In the mouth the attachments can be placed in either a sound
natural tooth following root canal therapy for better retention
OR
They are place into a dental implant
TOOTH SUPPORTED
OVERDENTURES
ONLAY DENTURES
• When a component of a partial denture extends to cover the greater
portion of the occlusal or incisal surface of the tooth it is called an
onlay denture.
• The onlay may cover one, many or all the teeth in the dental arch.
• An onlay denture is one which is designed to alter the shape & height
of the occlusal surface of the teeth over which it fits.
• They are made of –
- acrylic resin
- Gold
- Cr-Co alloy
IMMEDIATE OVERDENTURE
• An immediate overdenture is an overdenture constructed for insertion
immediately after removal of natural teeth
• ADVANTAGES:
• Immediate overdenture have additional advantage since minimal
discomfort & interference with function .
• SELECTION OF ABUTMENT TEETH:
• The factors governing the selection of abutment teeth are:
• Periodontal status
• Caries index
• Potential for endodontic treatment
• Location & number of teeth: teeth should be retained in areas of anticipated bone loss.
since bone loss is most rapid in anterior portion of the edentulous mandible, priority is
given to the retention of the mandibular canine.
• Ideally four teeth, one canine & one molar or premolar on each side of
the mandibular arch is retained.
• Contiguous teeth generally are not retained, because of retaining
adjacent teeth, inflammation of interdental papilla occurs more
rapidly.
PRERATION OF ABUTMENT TEETH:

• PERIODONTAL CONSIDERATION:
• all periodontal disease should be treated to provide healthy
environment for abutment teeth.
• Underlying osseous defect should be removed for proper support of
abutment teeth.
• ENDODONTIC CONSIDERATION:
• Most of the teeth will require endodontic therapy, the endodontic
prognosis must be considered.
• Some patient have advanced pulpal recession with extensive
tooth wear, which allows for coronal reduction without the need
for endodontic treatment.
• Endodontic implants are also used for better support & stability.
• TOOTH PRERARATION:
• After endodontic therapy the tooth can be reduced to convex contour
upto 1-2mm above the gingival margin.
• RESTORATIVE CONSIDERATION:
• After tooth reduction silver amalgam is placed in the access to root
canal & dentin.
• Amalgam should be highly polished that allow minimum accumulation
of plaque & can be easily cleaned to prevent caries of abutment teeth.
• ABUTMENT COPING:
• Coping is indicated when previous caries or restoration extends
below the level of gingival margin.
• Coping is also indicated when natural teeth are present in
opposing arch, severe abrasion.
• Coping contour are rounded to provide ball & socket contact
between coping & overdenture.
Variations in abutments*-

1. Cast post & tall core [3- 5 mm]


2. Cast post & short core [ 2-3 mm]
3. Amalgam in prepared tooth [ 1-2 mm]

*[JPD 1975, 34,135- 40]


cast post with tall core-

3-5mm
Cast post & short core

2-3mm
Amalgam in prepared tooth
1-2mm

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