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OVERDENTURE

Presented by:
Dr. Ranjeet Kumar Chaudhary
2nd Year PG
Dept. Of Prosthodontics
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OVERDENTURE

Presented by:
Dr.Ranjeet Kumar Chaudhary
2nd Year PG
Dept. Of Prosthodontics
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OVERDENTURE
• An over denture any removal dental prosthesis that
covers and rest on one or more remaining natural
teeth, the roots of natural teeth, and/ or dental
implants.- GPT 9

• A tooth-supported complete denture is a dental

prosthesis that replaces the lost or missing natural
dentition and associated structures of the maxillae
and/ or mandible and receives partial support and
stability from one or more modified natural teeth.
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GOALS:
• First, it maintains teeth as part of the residual ridge. This
gives the patient a denture that has far more support than
any conventional appliance. This gives the patient a denture
that has far more support than any conventional appliance.
Instead of soft, movable mucous membrane, the denture
literally sits on teeth “pilings” enabling the denture to
withstand a much greater occlusal load without movement.
• The second goal achieved by the over denture is a
decreased in the rate of resorption. Alveolar bone exist as a
support for teeth
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• The third goal achieved by the overdenture is an increase in

the patient’s manipulative skills in handling the denture.
With the preservation of the teeth for an overdenture, there is
also the preservation of the periodontal membrane that
surround these teeth. This preserve the proprioceptive
impulse supplied by the periodontal membrane.
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Classification
• Noncoping Abutments: Selected root abutments are
reduced to a coronal height of 2 to 3 mm and then
contoured to a convex or dome-shaped surface.
• Abutments With Copings: Cast metal coping with a
dome-shaped surface and a chamfer finish line at the
gingival margin are fabricated and cemented
• Abutments With Attachments: Most attachments
are secured to the abutment by a cast coping.
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Requirement of an Overdenture
• 1. Maintance of health:
• 2.Reduction in crown-to-root ratio- reduction of the crown
has an immediately favorable effect on the tooth mobility
because decrease in the length of the lever arm delivering the
torque to the mobile tooth, tooth mobility has lessened under
long- term overdenture use, provide that the periodontal health
has been maintained.
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• 3. Basal seat tissue- The tissue covering the remaining

basal area should be treated and expected to respond quite
similarly to the tissue under a complete or partial denture base.
A well fitting base is essential to distribute the load over as
wide as an area as possible and tissue contact is also necessary
to prevent food and plaque accumulation under base.
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• 4. Simplicity of construction- The appliance should be

relatively simple to construct and maintain. In some case , due
to lack of available space, section of over denture bases are
quiet thin. If metal reinforcement is not used, fracture of the
base and prosthetics teeth is common, so the over denture then
constructed.
• 5. Ease of manipulation-
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Advantages of an overdenture
• 1. Preservation of alveolar bone: Preserving the teeth
retains not only the alveolar bone supporting the teeth but also
the alveolar bone adjacent to the teeth.
• 2. Preservation of proprioceptive response: The
existence of periodontal membrane under overdenture gives
the patient a sense of discrimination not possible with
conventional dentures.
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• 3. Support: The natural tooth stop of an overdenture

provide for static, stable, base unparalleled by any
conventional denture. Stable base such as this improve
occlusion by more accurate jaw records and improves
patient comfort by drastically reducing the trauma of a
denture to the supporting tissue and reduce the no. of post
insertion adjustments.
• 4. Retention: Retention is usually sufficient merely by
overlaying the teeth. Retention is increased in some
individual by several attachment device available on the
market today or by lining the over denture with one of the
resilient liners.
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• 5. A simple approach to the problem patient: In the

past with congenital defects, such as cleft palate, partial
anodontia, microdontia, amelogenesis imperfecta and so on,
posed a rather detailed, lengthy and expensive mode of
treatment become possible.
• 6. Periodontal maintance: Because the abutment teeth
are easily accessible and because any form of splinting seldom
is involved, the patient is able to undertake a vigorous home
care program to maintain the peridontium in an optimum state
of health
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• 7. Patient acceptance: Patients are most receptive to and

appreciative of this treatment because they experience a
striking improvement in function and esthetics while still
maintaining some of their own teeth.
• Psychologic scarring some patient incur because of the loss of
all their natural teeth, somehow, the thought of retaining at
least the root structure and some coronal portion of the natural
teeth is emotionally uplifting to many people.
• 8. Convertibility: The over denture concept is designed so
that if some reason overlaid teeth must be extracted, the over
denture can readily be converted to accept the alternation.
Even if all the teeth must be lost, the over denture, because of
its basic complete denture design can easily relined or rebased
into a conventional complete denture.
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Disadvantages of overdenture
• 1. Caries Susceptability (Incipent carious): Carious
breakdown of overlaid teeth following the endodontics and the
teeth that have had been casting placed.
Fluoride treatment of over denture abutment markedly slow
the carious process. Use of Sodium fluoride and stannous
fluoride have been effective in reducing carious incidence.
2. Bony undercuts: Because of limited path of insertion of
these appliance, bony undercuts, especially those found
adjacent to the overlaid teeth have posed a problem in regard
close approximation of the denture flange to the underlying
tissue .
Block out undercuts, resulting in a denture flange that is placed
away from tissue, creating a food trap, and elimination any
possibility of peripheral seal,
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• 3. Overcontour: Because of undercuts it is difficult to

properly contour the denture base for optimum function.
Excessive block out of existing undercuts leads to poorly
contoured base, resulting in improper lip fullness that disturb
its natural drape and leads to difficult in patient acceptance.
• An overcontoured flanges does not interact well with the
facial musculature, support and retention of the denture is
sacrificed when this situtaion prevails.
• 4. Undercontour: Because of the limited path of insertion
and the presence of bony undercuts, at time it may be
necessary to understand a denture border in order for the
denture to go to place.
• Therefore important denture extension areas such as the
retromylohyoid space on the mandible and the postmalar
pocket on the maxilla may not be fully utilized in the denture
periphery, sacrifing their desirable qualities.
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• 5. Enchorment of the interocclusal distance: When

an overdenture is made , especially one with some form of
internal attachment, the available interocclusal distance of a
standard denture usually cannot be compromised and so a
struggle ensues to place all of the overdenture within its proper
dimension.
• The placement of an attachment, the artificial tooth, and
necessary acrylic to retain the attachment and tooth over the
natural tooth is an exercise in selection and grinding to achieve
the proper form within the parameter of available interridge
distance.
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• 6. Esthetics: An overcontoured flange that disturb the

natural drape of the lip, a foreshortened flange that end at the
height of contour of a bony undercut, a compensated occlusal
plane in light of space problem. Or an over bulked denture in
general resulting from insufficient space for attachment and
tooth replacement do little for esthetics, if the problem is
severe enough, may indeed contraindicate an overdenture.
• 7. Periodontal breakdown of an abutment teeth:
Plaque accumulation, inflammation, pocket formation, loss of
supporting bone, and decrease in attached gingiva are all
potential sequelae that may occur if the overdenture patient is
not maintained properly.
• Fluoride therapy not only reduces caries activity but also
reduces the gingival inflammation by reducing bacterial
colonization in dental plaque both in the qualitative and
quantitative manner.
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Patient Selection
• 1. Possibility of fixed or removable partial denture:
If the remaining natural teeth are capable of supporting a fixed or
removable appliance, then this form of treatment must be
considered the primary plan of treatment.
• 2. Endodontic therapy:
Because a tooth usually must be treated endodontically to allow for
sufficient reduction of the clinical crown, It must be ascertained that
successful endodontic can be performed. Single rooted teeth and
multirooted teeth is used
• 3. Periodontal condition of abutment teeth:
Inflammation, pocket formation, bony defects and a poor zone of
attached gingiva must all be eliminated before commencing
treatment.
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• Common periodontal problem found with over denture

abutment teeth is that an adequate zone of attached gingiva is
needed but not present. This can reflect through periodontal
surgery utilizing either a free gingival graft or apically
repositioning a split thickness flap.
• 4. Caries: If abutment teeth are prone to caries then
endodontic treatment or covered with casting can done.
• 5. Young patient: A young patient who faces the loss of
his teeth can become the so-called “ dental Cripple” at very
young age, therefore overdenture therapy, with its
maintenance of the teeth and supporting bone, should always
be consider over extraction of teeth.
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• 6. Location of abutment Teeth: Teeth are most useful in

areas of maximum occlusal force and ridge resorption
potential. The anterior aspect of the residual ridge, especially
that of mandible, is very susceptibility to change, so canine
and premolar are valuable teeth to preserve in this area. Upper
anterior teeth that oppose natural lower teeth prevent the
destruction of the anterior maxillary ridge when utilized in a
maxillary overdenture.
• If the canine and premolar are present, it is better to maintain
canine and the 2nd premolar rather then the canine and 1st
premolar, this give better support and also favorable hygiene.
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Various Techniqes
Following are the Technique:
• 1. Simple tooth modification and reduction
• 2. Tooth reduction and cast coping
• 3. Endodontic therapy and amalgam plug
• 4. Endodontic therapy and cast coping
• 5. Endodontic therapy with Cast coping utilizing
some form of attachments
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• 1. Simple tooth Modification and reduction:

Teeth are reshaped to eliminate undercuts and
reduced in vertical height, if necessary to create
more interridge space for overdenture and
reduced teeth will not sensitive to oral
environment including the contact of
overdenture.
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• 2. Tooth Reduction and Cast Coping:

Teeth are reduced and casting is made on the teeth in
preparation for the overdenture, this is necessary
because of sensitivity or as a caries control.
Endodontic is not done in these teeth, so the
possibility of sensitivity certainly exist, this approach
is possible only when the teeth have an adequate
bony support and a good prognosis, because of this
method minimum reduction in crown to root ratio.
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3. Endodontic Therapy and Amalgam Plug:

It is indicated when there is normal coronal height to the teeth and
normal interocclusal distance with little or no loss of vertical
dimension. To create a enough space for overdenture without
opening the vertical dimension, the teeth must be drastically
reduced, up to the gingival level, so endodontic therapy is almost
necessary.

After endodontic therapy is completed, the tooth is sectioned at the

gingival margin or slightly above it (1 to 2 mm) and an amalgam
restoration is placed into the exposed root canal.

The remaining dentin is smoothened and polished thoroughly with

the amalgam, leaving a surface that will accumulate a minimum of
plaque and that can be easily cleaned.

To successful the caries index should be low and home care must
be excellent to ensure against recurrent decay and periodontal
condition has been corrected.
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• 4. Endodontic Therapy And Cast Coping: A

casting is placed on endodontically treated tooth instead of
placing a simple amalgam restoration in the root canal. The
casting is used because of fear of recurrent decay on the
exposed dentin when there is history of carious involvement.
The margins of casting. Which are usually placed on
cementum and are very difficult to finish properly are prone to
break down.
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5. Endodontic therapy with Cast coping

utilizing some form of attachments
1. STUD ATTACHMENT
Male stud –soldered to the base which
is a coping covering the prepared
tooth stump
• Female housing –this is embedded in
the acrylic of the OD or it is soldered
to substructure in the OD
• Male and female attachments may be
either resilient or non resilient
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Gerber attachment

• Two Type
• 1) Rigid- This not allow for movement of
base. It consist of male post threaded onto
screw attached to a soldering base and a
female overall housing containing a
retention spring and ring. The retention is
gained by the spring clip in the female
housing engaging a groove in the male
section. Expensive, Torque on the tooth if
the, base moves due to improper ,impression
or reduced adaptability.
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• 2) Resilient- The attachment with

vertical movement impart less torque,
complex in its design and construction.
Its attachment has a soldering base and
different male retention post. Housing
contains a mounting ring, bushing, and
a retention ring with a ring assembly
that enables the attachment moves in a
vertical direction. Thus enables the
appliance to utilize more of residual
ridge support.
• Advantages: Easy replaceable, male
units can be removed by unscrewing the
threads and other attachment can be
fixed
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Ceka Attachment
Male part affixed to the tooth and has
a rounded shape wider at the top
and split vertically into 4 sections.
They are flexible and can be
compressed

• Female housing fits over this

• The attachment can also be
constructed with a different type of
retention male that has a space
between the parts to allow both
rotational and vertical movements
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Zest Anchor

. Ideal for interim overdenture

• Derives its retention from within the root
• A post preparation is made within the root
and the female sleeve is cemented into place
• Male portion consists of a nylon post and a
ball head attachment to the overdenture as a
chair side procedure.

• The post is placed in the sleeve and the

overdenture is placed over it with a self cure
resin places in recess to accept the male.
• Its retention to the tooth is gained by the ball
head snapping into the undercut in the
female sleeve.
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ADVANTAGES:
1) Overcomes any space problem
2) Leverage to the abutment tooth is reduced
3) Attachment procedure is simple
4) Parallelism is not necessary if more than one tooth is used due
to the flexibility of the nylon
DISADVANTAGES:
1) Caries susceptibility as no coping placed
2) Nylon stud can bend preventing seating
3) To correct this frequent recall visits are necessary
4) When eating foods without the OD can cause food to stagnate
in the female part
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Rotherman Attachment
2 Types : resilient and non -
resilient
• Resilient allows both vertical
and rotational movement
• The male part consists of a
groove deeper at one end than
the other
• The housing contains a ‘C’
shaped ring the ends of which
fit in the deepest part of the
retaining groove
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Advantages: no need for parallelism when >1 copings are

used
• Attachment is easy

• Disadvantages: Due to lingual bulk, the denture is thin and

this leads to denture fracture
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Introfix attachment
Tall stud attachment composed of a solder base an adjustable split male
post and a female housing.
•Design is simple and provides frictional attachment between the two
parts:
•Male stud has a longitudinal split that can be attached to provide more
or less retention .
•This is replaceable as it is screwed to the solder base
•The lengthy stud can produce a torque potential
•So used in only a totally tooth supported system or OD with excellent
support.
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Introfix attachment
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So used in only a totally tooth supported system or OD with
excellent support.
• It is interchangeability with the ancrofix system and has a solder
base, replaceable retention head, a female housing with four
lamellae for retention and a Teflon ring that allows for the
movement of the lamellae.
• Ancrofix system is a resilient type of attachment that can allow for
rotational movement or become fixed by a simple adjustment of
male post.
• The torque potential of the introfix attachment can be eliminated
by exchanging the solder base of introfix system with that of the
ancrofix system.
• Disadvantage of the ancrofix attachment is its difficulty in setting
up if more then attachment is used.
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Schubiger Attachment
• This attachment is permanent form of
fixation using a screw system that connect
anchor teeth to bar joints and bar units.
• It consist of a solder base with a screw that
can retain and is interchangeably with a
Gerber post attachment, ceramic metal
sleeve to which a bar unit may be soldered,
and lock nut with screw recess used to
secure the sleeve.
• Indicated for a bar attachment on teeth with
divergent root and a paralleling mandrel
must be used to align the threaded stud so
that metal sleeves will go to place.
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Quinlivan attachment
• This attachment consists of a prefabricated resin
ball that is incorporated with the wax-up of post
coping. The completed casting is then cemented
into the endodontically treated tooth.
• A resin female housing is attached to the
overdenture with cold-cure resin.
• Retention is gained by an O rubber ring inside the
female that is secured by a small lip at the orifice
of female Cap.
• Advantages of this attachment that O ring can
easily be replaced if retention lessens because of
fatigue of the rubber ring, the housing is free to
rotate in all direction, resulting in minimum torque
to the tooth and retention is quiet satisfactory.
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Magnets
Detachable keeper element: made of stainless steel that is
fixed to the abutment teeth
This can be done by :
▫ Cementing in a preformed keeper after preparation of the
tooth
▫ Screwing in a preformed keeper
▫ Casting a root cap and dowel keeper and cementing that to
place
Denture retention element has a paired, cylindrical
Co‐Samarium magnets axially magnetized and arranged
with their opposite poles adjacent.
The flat magnets, faces are covered on one end by the
attached stainless steel keeper and on the other end by
thin stainless steel plates.
The plates protect the exposed magnet faces against wear
and corrosion in the mouth.
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• The denture retention is cured into the overdenture and gives

the overdenture a retentive force of approximately 250 g.
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Bar Attachment
• The purpose of bar attachments are splinting of the abutment
of the abutment teeth and retention and support of the
prosthetics appliance.
• Two type of bar attachment
• A) Bar units- have rigid fixation where there is no movement
between the bar and overlying sleeve and classified as tooth-
borne
• B) Bar Joints- Permit rotational movement between sleeve and
bar, utilizing more of the residual ridge for support
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Hader Bar
• This attachment can serve either as a bar join or a
bar unit and can be used as a stud attachment as
well as a bar attachment.
• It consist of preformed plastic bars and clips. The
plastic bar is attached to the coping wax-up and is
cast with the coping. The plastic clips can be
embedded in the denture base to gain retention.
• If more retention is desired, the plastic clip can be
transformed into a metal clip.
• The bar and clip attachment is bulky and care must
be excerised in its placement to allow for space to
set teeth.
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Dolder Bar
• This attachment is supplied as both a bar
unit and bar joint. The bar unit consist of a
preformed bar that is soldered to copings
on the abutment teeth.

• The bar is preformed it can only approach

a close adaptation to the ridge contour
because it must be remain in straight line.
The shape of the bar has parallel sides with
a rounded top and to fit sleeves is
embedded in the acrylic overdenture and
retention is due to frictional fit.
. This Doldar bar joint is also soldered to the
coping of abutment teeth and also can use
Schubiger system if problem of parallelism
arise.
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Baker clip

• This joint attachment consist of a small U- shaped clip

designed to fit over a round wire.
• Two size available- 11 and 14 gauge, to be used with either a
preformed or cast wire of the same gauge.
• The clip simply is placed on the wire that has been soldered to
the post copings. It has been picked up into the denture with
cold-cure resin. Means attachment of the clip to the resin is not
provided, so a retentive in the acrylic. If the clip becomes
worn or broken, the involved clip can be ground out of the
denture base and a new one inserted.
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Ackerman clip and CM

• Both are similar in design
• Consist of round bar soldered to
the post copings and clip that fits
over the bar similar to the Baker
clip.
• Equipped with retention wings on
the clip for easy engagement in to
the acrylic of the overdenture and
also supply a spacer so that the
clip does not rest directly on the
bar, providing for vertical and
rotational movement.
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Combination syndrome
Combination Syndrome defined as: “the characteristic
features that occur when an edentulous maxilla is opposed by
natural mandibular anterior teeth, including loss of bone from
the anterior portion of the maxillary ridge, overgrowth of the
tuberosities, papillary hyperplasia of the hard palatal mucosa,
extrusion of mandibular anterior teeth and loss of alveolar
bone and ridge height beneath the mandibular removable
partial denture bases, also called anterior hyperfunction
syndrome.”-GPT
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Ellsworth Kelly was the first person to use the term ‘Combination
Syndrome’. Kelly originally described Combination Syndrome in
a sample of patients with complete maxillary dentures, opposing
natural mandibular teeth and a distal extension RPD.

Five Sign Given by Kelly

1. Loss of bone from the anterior part of the maxillary ridge.
2. Overgrowth of the tuberosities.
3. Papillary hyperplasia in the hard palate.
4. Extrusion of the lower anterior teeth.
5. The loss of bone under the partial denture bases
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Patient with edentulous maxillae and remaining mandibular

anterior teeth
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Pathogenesis
According to Kelly, the early loss of bone from the anterior part of the
maxillary jaw is the key to the other changes of the combination
syndrome.
With the anterior loss of bone, flabby hyperplastic connective tissue
makes up the anterior part of the ridge. This does not support the
denture base and may fold forward with the formation of epulis
fissuratum in the maxillary labial sulcus.
The posterior residual ridge becomes larger with the development of
enlarged fibrous tuberosities. With these changes, the occlusal plane
migrates up in the anterior region and down in the back. After a time,
the natural lower anterior teeth migrate upward, the anterior teeth on the
complete denture disappear under the patients lips and both dentures
migrate downward in the posterior region
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The aesthetics are poor, with the patient showing none of the upper
anterior teeth and too much of the lower anterior teeth and the occlusal
plane drops down to expose the upper posterior teeth
Excessive bony resorption under the lower removable partial denture
bases occurs to permit these changes and inflammatory papillary
hyperplasia often develops in the palate.
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MECHANICS WHICH PRODUCE THE

COMBINATION SYNDROME
Kelly’s theory suggests that negative pressure within the maxillary
denture pulls the tuberosities down, as the anterior ridge is driven
upward by the anterior occlusion. The functional load will then direct
stress to the mandibular distal extension and cause bony resorption of the
posterior mandibular ridge.

The upward tipping movement of the anterior portion of the maxillary

denture and the simultaneous downward movement of the posterior
portion, will decrease antagonistic forces on the mandibular anterior
teeth and lead to their supraeruption.
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Eventually an occlusal plane discrepancy will occur and the patient

may have a loss of vertical dimension of occlusion. In addition, the
chronic stress and movement of the denture will often result in an
ill-fitting prosthesis and contribute to the formation of palatal
papillary hyperplasia.

Prevention of combination syndrome

1. Avoid combination of complete maxillary dentures opposing
class I mandibular RPD.
2. Retaining weak posterior teeth as abutments by means of
endodontic and periodontic techniques.
3. An overdenture on the lower teeth.
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REFERENCES:
1)John J Sharry;Complete denture Prosthodontics, 3rd
edition
2) Sheldon Winkler; Essential of complete denture
Prosthodontics;2nd & 3rd edition;
3) Arthur O Rahn,C.M.Heartwell;syllabus of complete
dentures
4) G.A.Zarb etal;Boucher's Prosthodontic treatment for
edentulous patients;XI