Over-dentures

Department of Prosthodontics
Prosthodontics Deptt

Peshawar Dental College

Peshawar
Khyber College of Dentistry Peshawar
Outline:
Definition.
Rationale.
Tooth Supported Over-dentures.
Indications.
Contraindications.
Advantages.
Disadvantages.
Classification.
Treatment Planning.
Procedures.
Implant Supported Over-dentures.
Summary.
Definition:
Removable partial or complete denture that
covers & rests on one or more remaining
natural teeth, roots of teeth, & / or dental
implants. Also called:
Tooth-supported dentures
Telescopic dentures.
Hybrid dentures.
Onlay / Overlay dentures.
Super-imposed prostheses.
 Definition:

Over-Dentures constructed in:

Acrylic Resin.
Gold Alloys & Acrylic Resin.
Chrome Cobalt Alloys & Acrylic Resin.
Rationale For Over-Dentures:

The roots of the teeth offer the best available

support for occlusal forces.
Accelerated rate of bone resorption is
prevented.
Teeth maintained as part of the residual ridge:
- denture has more support than a conventional
denture.
 Rationale For Over-dentures:

Pts' manipulative skills in handling the denture:

- periodontal membrane is also preserved along
with the preserved teeth. thus proprioceptive
impulses, part of myofacial complex is retained.
Indications
1. Patient with badly worn down teeth.
2. Pt. with few natural remaining teeth.
3. Poor prognosis for routine complete denture.
4. Congenital or acquired intraoral defects.
5. Abnormalities in jaw size & position.
6. Mandibular arch where loss of alveolar bone
is more rapid.
 Indications
7. Post traumatic or post surgical cases.
8. Severe loss of OVD with few natural teeth.
9. Young patients.
10. Cleft palate causing large free-way space.
11. Need for use of attachments in dentures:
- Xerostomia & Sialorrhoea .
- Exagerrated gag reflex.
Few remaining teeth
Badly worn teeth

Congenital anomalies
Contraindications
1. High caries index.
2. Poor oral hygiene.
3. Poor prognosis of abutment.
4. Reduced inter-arch space.
5. Undercut ridges.
6. Insufficient attached gingiva.
7. Endo & perio treatment not possible or
feasible.
Advantages
1.Preservation
Preservation of alveolar bone.
2.Proprioception
Proprioception & perception maintenance. i.e. preservation of sensory input from perio- receptors.
3.Better
Better cosmetic results.
4.Relieves
Relieves deep or traumatic bite.
 Advantages

5. Improve masticatory efficiency in a case where: :

- lower molars occlude palatal, making chewing impossible.
- lateral movements of mandible are limited due to locking of mandible in CO.
6.Relieve trauma to TMJ & arthroses due to regression of condyl.
7.No feeling of being edentulous.
 Advantages

8.Enhanced
Enhanced denture retention & sometimes added with retentive device or attachment like
Dolder bar & Clip or Gerber attachment.
9.Support:
Support: Natural tooth stops of an over denture provide for static stable base unparallel
by any conventional denture.
10.
A simple approach to the problem patient.
 Advantages

11.
Periodontal maintenance.
12.
Patient’s acceptance.
13.
Harmony of arch form.
14.
Convertibility.
Disadvantages
1. Caries susceptibility.
2. Bony undercuts limiting POI.
3. Over / Under contoured denture base.
4. Encroachment of inter occlusal distance.
5. Esthetics.
 Disadvantages
6. Periodontal breakdown of abutment teeth.
7. May cause attrition of teeth.
8. Meticulous oral hygiene is required.
9. Time consuming.
10. Require special material .
Classification:
Based on Abutment Prep Design:
1. Abutment without coping:
- with endodontic treatment.
- without endodontic treatment.
2. Abutment with coping:
- with endodontic treatment.
- without endodontic treatment.
3. Abutment with precision attachments.


 BASED ON TYPE OF OVER-DENTURE

Immediate OD.
Transitional / Interrupt OD.
Definitive / Permanent OD.
Non Coping Abutments OD:
Abutments reduced to a coronal height of 2 to 3 mm. and then
contoured to a convex or dome shaped surface.
Most teeth require endodontic therapy and in final step are prepared
conservatively to receive an amalgam or composite type
restoration.

Case for non

coping type
abutment OD
(Before Treatment).
ABUTMENTS WITH METAL COPINGS:
Cast metal coping with a dome shaped surface & a
chamfer finish- line at the gingival margin are fabricated
and cemented.
Types of copings : short coping or long coping

Short coping prepared on Tooth to receive Over denture

Short Cast Copings:
Tooth reduced to 2-3 mm and normally require
endodontic therapy b/c the required coronal root
reduction would expose the pulp.
LONG CAST COPING
Attached to cast coping is a post filled to the
canal therefore canals should be obturated with
soft gutta-purcha like material rather than with
metal points.
 Cast Copings:

Long cast copings :

Normally 5-8 mm long, conservative reduction of coronal
tooth structure is done.
The end result is long ellipsoidal shaped coronal coping
and a larger crown root LONG
ratio. CAST COPING
Consequently, long cast coping require a greater level of
osseous support.
Abutment With Precision Attachment:
PA secured to abutment by a cast coping.
Objective: To improve fixation / or retention of denture base.
Disadvantage: Drastic reduction in crown root ratio & where
indicated periodontal & endodontic therapy is required.
Teeth
prepared to
receive coping
Attachment

Cast metal coping

Tooth prep to receive PA & provide retention:
Teeth with clinical crown prepared to give positive
retention when bars are attached to copings
covering the prepared clinical crowns.
PAs:
 Ball & Socket Anchor.
• Gerber attachment.
• CEKA Anchor.
• Stud Attachment.
• Dalbo Attachment.
• Zest Anchor.
• Rotherman Attachment.
• Introfix Attachment.
………………
 PAs:
• Schubiger Attachment.
• Quinlivan Attachment.
• Magnets.
• Bar Attachment.
• Baker Clip.
• Ackerman Clip.
• Dolder / Hader Bar.
Submerged Vital Roots
Submerged vital root as overdenture abutment is
still in experimental stage.
Therefore can not be recommended.
 Submerged Vital Roots
The method is innovative.
An attempt to obviate the basic problems like
caries, gingivitis, periodontitis, need for
endodontic therapy associated with
conventional over denture abutments.
 Submerged Vital Roots

Vital roots are selected & reduced to 2 mm. below

the crestal bone & then covered by muco-
periosteal flap.

Major post operative problems are:

- development of dehiscences over retained
roots.
- Pulp pathologies.
Submerged root copings Root copings placed
on teeth

Denture prepared and placed

Treatmet Planning
Selecting Abutment Teeth :
- Ideally tooth should:
- exhibit minimal mobility.
- have acceptable bone support.
- be amenable to periodontal therapy.
- have no contraindications for RCT.
 Selection Of Abutment Teeth : -

Isolated teeth preferred to several adjacent teeth.

Two teeth in each quadrant present an ideal
situation in which stress is distributed over a
rectangular area.
Tripod is the next most favorable form for support
& stability.
Canine-longest root-more proprioception.
Molar-multi-rooted tooth the next preferable.
 Treatmet Planning
Abutment Selection:

Preserve teeth that are already endo treated.

Choose teeth surrounded by healthy peridontium.
Preparatory Treatment

Sequence Of Treatment:

Construct an immediate
treatment claspless
RPD.
Make a cast from alginate
impression.
RPD replaces missing
and hopeless teeth for
esthetic reason and
will retain JRs.
Preparatory Treatment

Sequence Of Treatment:

Remove hopeless teeth

and insert the RPD.

During the healing period,

institute the
periodontic &
endodontic treatment.
Tooth Prep for minimal retention:

Remove sufficient tooth

structure to provide
favorable root to crown
ratio to allow insertion of
OD in an acceptable
esthetic position & in
Tooth preparation done and
favorable occlusal
tray prepared for impression relation with antagonist
teeth.
 Tooth Prep for minimal retention:

Reduce the crown length

up to 2 mm above the
gingival crest or a
chamfer type subgingival
margin.
Taper the prep in OG
Tooth preparation done and direction.
tray prepared for impression
 Tooth Prep for minimal retention:

The finished tooth with cast

coping is male member
of OD. The female
member is part of
denture base.
Tooth preparation done and
tray prepared for impression
Coping Fabrication:

 Make an accurate
impression of the
abutment and pour die.
 Lay-down the wax pattern.
Place concavity in the
occlusal surface of the
pattern using a wax
carver.
 Coping Fabrication:

 Cast the coping using a

hard type of class-III Au-
alloy.
 Cement the polished
coping to the tooth.
 Instruct the pt. in home
care of abutment tooth.
Impression For OD:
Follows the same technique used in constructing a
conventional complete denture.
- Preliminary impression.
- Final impression.
Record Bases & Occlusal Rims
The only difference in construction of record bases for tooth supported denture
and conventional denture is incorporation of metal bearing in record
base.

Record base

Recording MMRs
A face bow transfer is used to relate the maxillary cast to the
articulator.
Jaw relations and arrangement of teeth for phonetics are verified
at the time of try in.
Tooth Selection:
Artificial acrylic teeth placed over the abutment teeth .
When teeth in opposing arch have:
i) Gold occlusal surfaces ---- occlusal surfaces of artificial teeth
should be either gold or acrylic resin, preferably gold.
ii) teeth restored with porcelain -- Porcelain artificial teeth preferred.
iii) Natural teeth ---- Porcelain artificial teeth not preferred.
Setting The Artificial Teeth
Setting Acrylic Resin Tooth Over the Abutment
Requires:
1. Removing the acrylic resin record base to expose
abutment.
2. Retrieving the metal bearing from record base and
repositioning it in concavity by sealing the bearing to
abutment tooth, at the margins with sticky wax.
3. Hollowing the acrylic tooth with a bur until it is
properly positioned and the occlusion is adjusted.
4. Sealing the bearing to acrylic tooth with sticky wax.
5. Arranging the remainder of tooth in maximum
occlusion
6. Contouring the wax for try in appointment.
Trying-in the Denture:
 Verify JRs.
 Make eccentric JR records and adjust the articulator.
 Assure esthetic acceptability by the patient.
 Verify phonetic acceptability.

Laboratory Procedures
• Contouring in wax.
• Flasking.
• De-waxing.
• Packing mould with resin.
• Curing & Finishing.
Fitting OD:

 Review instruction in
denture use and care.
OD in mouth
 Use pressure disclosing
paste to locate contacts
between female and
male members.

After insertion
Fitting OD:
 Evaluate the tissue side
of denture base and
borders for pressure
areas & over extensions.
 Perfect the occlusion by
remounting & selective OD in mouth
grinding.
 Place pt. on recall visit
(every 4 months ).

After insertion
Implant Supported Over denture:

Indications:

1. Patients' wish and desire.

2. Systemic health to permit minor oral surgery.
3. Sufficient bone quantity to accommodate prescribed implant
dimensions.
4. Patient willingness to maintain oral status.
Implant Supported Over denture:
Contraindications:
1. Residual ridge dimensions unable to accommodate
preferred implant dimensions.
2. Communication with patient is not possible.
3. Patient has history of substance abuse.
4. General health conditions precludes.
5. Local anesthesia vasoconstrictor contraindicated.
6. Immunosuppressive therapy, prolonged intake of
antibiotics or corticosteroids or brittle metabolic disease
history.
Treatment Planning
OBJECTIVES :
o To determine the optimum location & number of
implants in the context of the morphological aspect of
the residual ridge.
o To design a favorable distribution for occlusal stresses
on the implant and prosthesis bearing tissues.
o To avoid discrepancies among the design of the
denture, the implant location, & the denture’s retentive
devices.
o To ensure an optimal esthetic result and hygiene
protocol
Step by step prosthodontic procedures:
Preliminary impression with irreversible
hydrocolloid for custom tray fabrication
(openings over implant’s location).
Abutment component selected (may include
additional prosthetic copings).
Mounting of copings.
Full arch or two- stage impression with custom
tray (master cast with implant analogues, wax
occlusal rims.
 Step by step prostho procedures:

Jaw relation records.

Tooth selection (laboratory–mounting the cast in
articulator, preliminary tooth set-up).
Verification of occlusion records.
Esthetic & functional assessment of tooth set-up
with the pt.
Indexing of set-ups to allow for optimal bar design
(corrections as determined in try-in appointment;
bar fabrication).
 Step by step procedures
Complete try-in, obtain consent of the pt.
Try in for bar assembly (laboratory – final
corrections, preparation for processing the
denture; assembly of clip/bar components).
Processing the denture.
Occlusal equilibration on articulator to rectify
processing errors delivery of OD to the patient.
Instruction about handling of the dentures
Cleaning instructions for implants, retention
devices, dentures.
Summary:

 Over denture is an excellent viable treatment

alternatives.

 Emphasis must be placed on:

– Proper patient selection,.
– Pt. motivation.
– Basic prosthodontic principles.
– Detail program of home care instructions.
– Frequent recall visits.
 Summary:

 Over denture is an outstanding mode of

treatment.
 The teeth that are used for the maintenance of
health. A breakdown in their structure or a
breakdown in their periodontal support
immediately negates an overdenture concept.
 Summary:

If we are to succeed, we
must control the factors
that jeopardize the success.
THANK
You