over dentures jan 2012

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:VERDENTURES :OUTLINE OF PRESENTATION .1 .DEFINITION

.2 .RATIONALE .3 .TOOTH SUPPORTED OVER DENTURE .4 .INDICATIONS .5 .CONTRAINDICATIONS

.6 .ADVANTAGES .7 .DISADVANTAGES .8 .CLASSIFICATION .9 .TREATMENT PLANNING .10 .PROCEDURE .11 .IMPLANT SUPPORTED OVER DENTURE .12 .SUMMARY

:VERDENTURERemovable partial or complete dentalprosthesis resting on one or more

, , & /natural teeth roots or dental implants by completely enclosing them.underneath its fitting surface

:YNONYMS

, , ,Tooth supported Telescopic Hybrid/ / ,Inlay Onlay Overlay Dentures.Superimposed Prosthesis:ay be Constructed of

- Acrylic resin or in combination , -with Gold Chrome,Cobalt - ’Ti vaAl Alloys

.Frameworks

:ATIONALE FOR MAKING OVERDENTURES The roots of the tooth offers the best

available support for .cclusal forces

Accelerated rate of one resorption is.prevented

It maintains the teeth as a part of the. (residual ridge ,so denture has far more

support than any other conventional.) appliance

It increases ’patient s manipulativeskills .in handling the denture

( Periodontal membrane is also preserved .along with the preserved teeth Thus

, proprioceptive impulses part of myofacial).complex is retained

.Patient feels not being edentulous

.1 .Patient with badly worn teeth

.2 .Patients with few natural teeth remaining.3 . When prognosis is poor for conventional CD

.4 .Congenital or acquired intra oral defects

.5 & .Abnormalities in jaw size position

.6 .Mandibular arch with more rapid loss of RRR

.7 Edentulous maxilla opposed by natural

.dentition.8 .Post traumatic or post surgical cases.9 &Severe attrition loss of vertical

.dimension.10 .Young patients

.Cleft palate causing large free way space.12 Attachment may be indicated in patients

suffering from xerostomia or sialorrhoea( / ).Palateless Flangeless Denture

.25 .Patients with exagerated gag reflex

.14 .Patients suffering from hypodontia

:NDICATIONS FOR OVERDENTURES

dly Worn Teeth

dly Worn Teeth ew Remaining Natural Teeth

ongenital Anomalies

.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 Where ndo and perio treatment can

.not be performed satisfactorily

:NTRAINDICATIONS

:DVANTAGES

.1 .Preservation of alveolar bone

.2 - & .Proprio ception perception maintenance. . -i e preservation of sensory input from perio.receptors

.3 .Cosmetic results are excellent

.4 .Relieves deep or traumatic bite

.5 :Improve masticatory efficiency in.a Cases where lower molars occlude palatally making .chewing difficult

.b Cases where lateral movements of mandible are limited due to locking of mandible in .centric occlusion

.6 & /Relieve TMJ trauma Arthroses b c of regression of .condyles

….( ):VANTAGES CONTD

. Stability enhanced due to elimination of, &anterior posterior

&lateral slippage sliding

.of denture. enture &is well retained sometimes added with

precision attachment retentive devices or attachment: & .like Dolder bar attachment other attachment

.1 :upport - natural tooth stop of an overdenture provide for static stable base unparallel by any.conventional denture

.10 A simple approach to avoid future problems of patient.having denture difficulties

.11 .Periodontal maintenance

.12 ’ .Patient s acceptance of prostheses is enhanced

.13 .Harmony of arch form restored

.14 &Easy Acceptability Convertibility to.Conventional CDs

.1 .Caries susceptibility increased

.2 . ( ).Bony undercuts limited POI

.3 .Over contoured prosthesis.4 .Under contoured prosthesis

.5 .Encroachment of inter occlusal distance

.6 / .Esthetics Bulky prosthesis

.7 .Periodontal breakdown of abutment teeth

.8 .May cause attrition of teeth.9 .Meticulous oral hygiene is required.10 .Time consuming.11 &Require special material attachment

.material

:ISADVANTAGES

CCORDING TO METHOD OF ABUTMENT:REPARATION

( Along with contemporary clinical ) terminology .1 :ABUTMENTS WITHOUT COPING

- .without endodontic treatment- with

.endodontic treatment .2 :ABUTMENTS WITH COPING

- .without endodontic treatment

- with endodontic.treatment

.3 :ATTACHMENTS RETAINED OVERDENTURES

:ASSIFICATION

:ASED ON TYPE OF OVER DENTUREØIMMEDIATE OD.ØTRANSITIONAL / INTERUPT OD.ØREMOTE / PERMANENT OD.ØIMPLANT RETAINED OD.

Selected tooth abutments are reduced to a coronal height of 2 t o 3 mm .

.Contoured to a convex or dome shaped surface

.Most teeth require endodontic therapy In final step such teeth are prepared conservatively to receive an

.amalgam or composite restoration

:BUTMENTS WITHOUT COPING

- ( ).Case for Non Coping Abutment Overdenture Before Treatment

BUTMENTS WITH COPINGS

Abutment tooth prepared to Receive a:Abutment tooth prepared to Receive a:

Cast metal coping with a dome shaped surface.Cast metal coping with a dome shaped surface.

Abutment has chamfer finish line at the gingival margin.Abutment has chamfer finish line at the gingival margin.Coping may be SHORT or LONG.Coping may be SHORT or LONG.

Coping fabricated and cemented over the prepared abutment in mouth.Coping fabricated and cemented over the prepared abutment in mouth.

SHORT CAST COPINGS (Root Coping)SHORT CAST COPINGS (Root Coping)-hort copings are 2 3 mm and normally require endodontic-hort copings are 2 3 mm and normally require endodontic

/ :herapy b c/ :herapy b c- he required coronal root reduction would expose the he required coronal root reduction would expose the.ulp.ulp

.ttached to cast coping is a post fitted to the canal.ttached to cast coping is a post fitted to the canal-oot canals should be obdurated with soft gutta purcha rather-oot canals should be obdurated with soft gutta purcha rather

.han with metal points.han with metal pointsLONG CAST COPINGS (Crown Coping):

Normally 5-8 mm long.

Conservative reduction of coronal tooth structure is done.The end result is long ellipsoidal shaped coronal coping.Prepared abutment has larger crown root ratio.

Long cast coping require a greater level of osseous support.

Most attachments are secured to abutment by a cast coping.Objective: To improve fixation / or retention of OD.

- Drastic reduction in crown root ratio results (Favourable).- Where indicated periodontal and endodontic therapy is required.

:UTMENTS WITH PRECISION ATTACHMENTS

Teeth prepared toTeeth prepared toreceive Copingreceive CopingAttachmentAttachment

Splinted CastSplinted CastMetal CopingMetal Coping

With Bar AttachmentWith Bar AttachmentMetal CopingMetal Coping

With BarWith Bar

Attachment fitted over theAttachment fitted over the

prepared abutmentsprepared abutments

:OOTH PREPARATION TO ENHANCE RETENTION:Prepared abutments with some clinical crown will give

- positive retention when a bar is attached to.their copings Cemented on them Bar also has a

.splinting effect

( ):RECISION ATTECHMENTS PAs.The B and D anchor

.Gerber attachment.The CEKA anchor.Stud attachment.Dalbo attachment

.Zest anchor .Rotherman attachment.Introfix attachment.Schubiger attachment.Quinlivan attachment

:agnets

- - .Rare Earth Cobalt samarium Miniature Magnets:ar Attachment Baker clip

&Ackerman clip CM clip/Dolder bar Hader Bar

:UBMERGED ROOTS AS OVERDENTURE ABUTMENTS

Submerged root as overdenture abutment is stillin experimental stage therefore can not be

.recommended

An innovative attempt to obviate the basic:problems like

- , , .caries gingivitis periodontitis- need for endodontic therapy associated

with .conventional OD abutments.Vital roots are selected

.Reduced to 2 mm below the crestal bone- .Covered by muco periosteal flap

:Major post operative problems are- development of dehiscences over retained.roots- .pulpal pathologies

Submerged root copingsSubmerged root copings Root copings placed on TeethRoot copings placed on Teeth

Denture prepared and placedDenture prepared and placed

:R E A T M E N T P L A N N I N G F O R O V E R D E N T U R E S E L E C T I O N O F T E E T H A S A B U T M E N T F O R O D s :

.Ideally tooth should present minimal mobility.Should have acceptable bone support

.Be amenable to periodontal therapy

.Isolated teeth are proffered 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 and

.stability

- - .Canine longest root more Proprioception- .Molars multirooted teeth are to be preserved

.Preserve teeth that are already endodontically treated

.Choose teeth that are surrounded by healthy peridontium

PREPARATORY TREATMENT:

SEQUENCE OF TREATMENT (AS A GENERALGUIDE):

-Construct an immediate treatment clasp less.denture

Make a cast from an irreversible hydrocolloid

.impression RPD replaces missing and hopelessly involved

.teeth

.Esthetic restored Jaw Relations Retained

Remove hopeless teeth and insert the removable.prosthesis

1., :During the healing period institute the

- .periodontic and endodontic treatment

TOOTH PREPARATION FOR MINIMAL RETENTION:Remove sufficient tooth structure to:- Provide favorable root-crown ratio:- Allow insertion of OD in an acceptable esthetic position.- Maintain favorable occlusal relation with teeth of opposing arch.

Reduce the crown length up to 2 mm above the gingival crest.or A chamber type margin slightly beneath FGM.

Incorporate Occlusal Convergence.

The finished tooth with cast coping is:- male member of denture.

The female member is part of:- denture base.

Tooth preparation done andTooth preparation done and

Special tray prepared forSpecial tray prepared forimpression.impression.

AST COPING:ABRICATION

.If making a coping type PA

Make an impression of the abutment.after its preparation

.Pour a die

.Carve the wax pattern

Place occlusal surface concavity in- .the pattern using a wax up

- -Cast the coping in Type III Au.alloy

.Cement the polished coping-Advise patient for home care of

.abutments

Short coping cemented onto prepared Tooth to receive OverdentureShort coping cemented onto prepared Tooth to receive Overdenture

:ROCEDURES FOR MAKING OVERDENTURES: :TEP 1 IMPRESSIONS

Same technique is used as when making a

:conventional CD-Preliminary Impression.-Final Impression.

: &TEP 2 RECORD BASES OCCLUSAL:IMS

The only difference in the making of

record bases for tooth supported&overdenture conventional denture is ncorporation of metal bearing in

.ecord base

RECORDING MMRs / TOOTH SET-UP & TRIAL:RECORDING MMRs / TOOTH SET-UP & TRIAL:•Record Vertical & Retruded Contact Position.Record Vertical & Retruded Contact Position.•A face bow transfer register is used to relate the maxillary cast to the articulator.A face bow transfer register is used to relate the maxillary cast to the articulator.• Jaw relations and arrangement of teeth for Esthetics & phonetics are verified atJaw relations and arrangement of teeth for Esthetics & phonetics are verified at

the time of try in.the time of try in.

:OOTH SELECTION Consider using acrylic resin denture teeth or their

- - :occlusal surfaces in Type III Au Alloy.1 . When natural teeth are in the opposing arch.2 When teeth in the opposing arch have been

restored with .Gold occlusal surfaces Gold Occlusal.surfaces preferred

Use porcelain teeth in OD if opposing arch has been.restored in porcelain

- :EETH SET UP o set acrylic resin tooth over abutment

:equires.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 resin tooth with an acrylic bur until it is properly positioned.and the occlusion is adjusted

.4 Sealing the bearing to acrylic resin tooth.with sticky wax

.5 Arranging the remainder of tooth in maximumocclusion

.6 - -Contouring the wax up denture for try in.appointment

- - :RY IN THE WAXED UP OD.Verify jaw relations

.Make eccentric jaw relation records

.Adjust the articulator Assure esthetic acceptability by the.patient

.Verify phonetic acceptability

LABORATORY PROCEDURES:LABORATORY PROCEDURES:

-- CONTOUR THE WAX.CONTOUR THE WAX.- FLASK THE DENTURE.- FLASK THE DENTURE.- DE-WAXING / ELIMINATE THE WAX.- DE-WAXING / ELIMINATE THE WAX.- PRAPARE RESIN MIX FOR PACKING.- PRAPARE RESIN MIX FOR PACKING.

- PROCESS / CURE OVERDENTURE.- PROCESS / CURE OVERDENTURE.

/ :NSERTING FITTING OVERDENTURE.Review instruction in denture use and care

:Use pressure disclosing paste to locate- .Contacts between female and male members

Evaluate the tissue side of denture base and:borders for- .Pressure areas and over extensions Perfect the occlusion by remounting and

.selective grinding

& .Give instruction for Oral Denture Hygiene Regular use of fluoride - /tooth paste varnish on.abutments

( ).Place patient on recall system every 4 months

-INAL TRY IN FTER INSERTION

- :MPLANT SUPPORTED OVERDENTURES:NDICATIONS

’ .Patients desire for implant treatment Systemic health status permitting minor surgical

.procedure Sufficient bone quantity to accommodate prescribed.implant dimentions

&Patient willing and able to maintain oral hygiene.health

CONTRAINDICATIONS : Residual ridge dimentions do not accommodate preffered

.implant dimentions.Communication with patient is not possible

.Patient has history of substance abuse

General health conditions preclude a minor surgical.intervention

Local anaesthesia with vasoconstricter is.contraindicated

,Immunosuppresive therapy prolonged intake of antibiotics

, .or corticosteroids or meabolic disease history

:REATMENT PLANNING:BJECTIVES

&To determine the optimum location number of implants in the context of the morphological aspect of the

.residual ridge

To design a favorable distribution for occlusal stresses.on the implant and prosthesis bearing tissues

,To avoid discrepancies among the design of the denture, & ’ .the implant location the denture s retentive devices

To ensure an optimal esthetic result and hygiene.protocol

:TEP BY STEP PROCEDURE Preliminary impression with irreversible hydrocolloid for custom

( –tray fabrication laboratory custom tray with 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 laboratory

, ).master cast with implant analogues wax occlusal rims

.Jaw relation records( –Tooth selection laboratory mounting the cast on the

, ).articulator preliminary tooth set up

.Verification of occlusion records& .Esthetic functional assessment of tooth set up with the patient

(Indexing of setups to allow for optimal bar design corrections as- ; ( ).determined in try in appointment bar fabrication

………Contd

- , .Complete try in obtain consent of the patient

- :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 the dentures to the patient

.Instruction about handling of the dentures

, &Cleaning instructions for implants retention devices.dentures

:UMMARY Overdenture is an excellent viable treatment.alternatives

:Emphasis must be placed on

- .Patient Selection- .Patient Motivation- .Following Basic Prosthodontic Principles- - .Detail Program of Home care Instruction- / .Frequent Recall Review Visits

.Overdenture is an outstanding mode of treatment The teeth that are used for the maintenance of health

.must be properly looked after

A breakdown in the Coronal Structure or breakdown in the Periodontal Support of abutments immediately negates the

.very concept of overdenture therapy

:T IS IMPORTANT TO CONTROL- .ACTORS THAT JEOPARADIZE THE SUCCESS

over dentures jan 2012

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