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CONTENTS
INTRODUCTION
CONCEPT AND RATIONALE
REVIEW OF LITERATURE
PROS AND CONS, INDICATIONS AND CONTRAINDICATIONS
CLASSIFICATION, OF OVERDENTURES AND ABUTMENTS
TREATMENT PLANNING
CLASSIFICATION, OF ATTACHMENTS
SPECIFIC CLINICAL PROCEDURES
SOME POPULAR ATTACHMENT SYSTEMS
SUMMARY AND CONCLUSION
BIBLIOGRAPHY
The dental profession has expanded the preventive dentistry concepts into
prosthodontics to bring about the prescription called "The Over denture". It is
further buttressed by the fact that the alveolar bone with its overlying mucosa
was never intended to receive the full force of a complete denture. So then, what
is an overdenture.
The sequelae after the extraction of all the teeth make complete denture
progressively less effective. Among these sequel are
a. The 'loss of discrete tooth. proprioception
b. The progressive 'loss of alveolar bone
c. The transfer of all occlusal forces from the teeth to the oral mucosa.
From physiologic view point the roots provide not only periodontal ligament
Support but also
Directional sensitivity
Tactile sensitivity to load
Dimensional discrimination'
Canine response
Proprioception and salivary secretion
Decreased perception in older individuals
REVIEW OF LITERATURE
GEORGE L . MARQUARD (1976):described a technique by using dolber bar
joint mandibular overdentures for non parallel abutment teeth.Two
techniques for attaching bar to the teeth with divergent root canals were
used:1.The schubiger screw system for those teeth with extremely divergent
canals.
2.The stutz pivots system for teeth with only slight diveregent root canals.
The use of bar joint offered periodontally involved teeth an improved crown –
root ratio and splinting of the teeth.As the bar was close to the bone, forces of
mastication exerted much less leverage to the teeth.finally the bar offered
slight vertical and rotational movementof the denture as well as a stress
breaker action.
HISTORY
The idea of leaving roots of natural teeth to support an overdenture is far from
new.
1856-Ledger described prosthesis resembling an overdenture and were referred
to as plates covering flanges.
1861-There was an increasing awareness of the value of such roots might play in
supporting denture .
1888-Evans described a method of using roots to retain restorations.
1. For patients who face the loss of the remaining natural adult dentition.
Therefore the younger the patient greater the indication.
2. Cases where the retention is difficult to Obtain.
– Xerostomia of sialorrhea
– Absence of alveolar residual ridge
– Loss of maxilla and partial loss of mandible
– Congenital deformity (eg : cleft palate)
– CONTRA INDICATIONS
– Convertibility
– Harmony of arch form
– Ideal occlusion
– Open palate possible
– Less trauma to supporting tooth
– Esthetics
– Ease in construction and maintanance
– Lower cost when compared to R.P.D.
DISADVANTAGES
The type of over denture depends primarily on the status of the patient's
dentition at the start of treatment.
– CLASSIFICATION
– HEARTWELL’S
Based on the method of abutment preparation
Cast metal coping with a dome shaped surface and chamfer finish line at the
gingival margin are fabricated and cemented. These are 2 distinct types of
copings
– 1.Short
– 2.Long
– The short coping: These are 2-3 mm long and normally require endodontic
therapy since the required coronal tooth reduction would expose the pulp. Attached
to the coping is a post fitted to the canals.
– Most attachments are secured to the abutment by cast coping. The objective
of any attachment is to improve retention of the denture base.
– Because of the factors like time, cost and risks the procedure should be
reserved for patient with a favourable prognosis. Here the low caries index, proper
home care, periodontal health and inter ridge distance are absolutely necessary.
TREATMENT PLANNING:
This includes
– Periodontal considerations
– Endodontic treatment
– Caries Management
– Location and Distribution of forces
– Economics
PERIODONTAL CONSIDERATION
– ENDODONTIC CONSIDERATION
3 main advantages
– The crown root ratio can be made more favourable.
– Reduction of the clinical crown provides an interocclusal distance more
favourable for the placement of the artificial tooth in an esthetically acceptable
position and in more favorable relation to the opposing teeth.
– For securing attachments.
– CARIES MANAGMENT :
– The presence of high caries index and the situation that will create a carious
environment are the devastating sequelae to improper over denture patient
selection.
– Choice of abutment is a tooth that have a healthy clinical crown.
– Caries activity in a protected environment is undesirable
– Frequent recall check up and treatment of the abutment with periodic
fluoride application to insure against any further break down.
The tripod is the next most favourable form for support and stabiliy
The use of two teeth in each arch or one arch has met with satisfactory
results.
Marrow recommends that it is better to use isolated teeth as abutments
rather than adjacent teeth because they return to a state of good health more
rapidly and are easier for patients to maintain hygiene.
– Advantages
– Retention, stability and support
– A positive lock of certain units can maintain the border seal of the denture.
– The success of a prosthesis usually depends on careful treatment planning
and attention to the prosthodontic problems. The mechanical integrity of the
attachment is important but must take second place. The shape and size of the,
units is normally the over riding consideration although the auxillialy devices that
accompany the attachment must influence the choice.Correct vertical space
assessment must be taken care of. Extraradicular stud attachments are relatively
strong and can often provide more effective retention than their intra radcular
counter parts
– 20
SINGLE ATTACHMENT
– Only one remaining tooth
– Diagonal position of abutment teeth
– Span too long to be bridged by bars
– Arches that are markedly V shaped
– BAR CONNECTORS
– periodontally weak abutments where
splinting is desirable
Roots that will acco
modate only short do
– wels
– offer greater mechan
ical stability and mor
e wear resistance
– IMMEDIATE OVERDENTURE
– DIRECT CONVERSION TO PROVISIONAL OVERDENTURE
– INDIRECT CONVERSION TO PROVISIONAL OVERDENTURE
IMPRESSION PROCEDURES::
TEETH ARRANGEMENT::
Overdentures being periodontally supported complete dentures, their occlusal form
therefore corresponds to that of complete denture.
Gerber Attachment :
That allows vertical movement. Rigid attachment (popular). Retention of both types
is obtained by a retaining spring in the female unit engaging a peripheral groove in the
male section. The spring clip may be removed for adjustment by unscrewing.
Ceka System :
1. Rigid 2. Resilient-
Rigid and Resilient designs share a common base. But the ceka extracoronal units
are not identical. Therefore it is not possible to change resilient for rigid constructions
merely by changing, the Retention portions. The vertical travel allowed by the resilient
stud unit is 0.4 mm: The retention pin. or male section is screwed on to the base ring.
Schubiger :
Consists of a short screw block for bar fixation a larger one for fixed removable
bridge work and an individual cap core system.
– a Solder base common to the Gerber
– b Sleeve in ceramic metal
– c. A cap nut
– d. Overall height is 2.8 mm.
The advantages of this system lies in cost and space requirements. They do not
require precious metal coping dowel nor special laboratory procedures. They are
relatively simple and quick.
Zestanchor system:
A nylon male element is incorporated in the denture base and projects down ward@
engagmg a recess in the root preparation. Further the loads are applied at a point that is
well apical to the gingival margin of the root. A variety of abutments may be employed
including hemi-sected molar roots. 2 sizes of zest anchor are available depending on the
root length and diameter.
Bar attachments:
The bar attachments help in splinting of the abutment teeth, retention and support of
the appliance. Bar attachments are classified into two types bar units and bar joints.
Bar unit has a rigid fixation where there is no movement between the bar and overlying
sleeve and can be classified as tooth born. Bar joints permits rotational movement
between sleeve and bar and derives more of residual ridge support.
Types of bar attachments are:
1. Hader bar
2. Dolder bar attachment
3.Bakres clips
4.Ackerrnan clips and
5. C.M.Clip.
This innovative method attempts to obviate some of the basic problems associated
with conventional over denture treatment like caries, gingivitis, periodontitis and need
for endodontic procedures. Here selected vital roots are transected and reduced to 2mm
below the crestal bone and then covered by a mucoperiosteal flap. Problems with this
technique include dehiscences,pulpal pathoses and lack of sensory discrimination.