Prosthodontics

P rosthodontics Feb 2016

ACCESS TO BETTER DENTURES

A CASE REPORT
Department of Prosthodontics
Dr. D.Y. Patil Dental College And Hospital, Nerul, Navi Mumbai, India.
Dr. Rubina Tabassum Dr. Shetty Omkar Dr. Furia Vinit Chandrakant
Professor H.O.D P. G. Student

INTRODUCTION
Complete edentulism can substantially affect oral and general health as well
as overall quality of life.1-3 Patient satisfaction with dentures is influenced
by various factors including denture quality, the available denture bearing
area, the quality of dentistpatient interaction, previous experience with Preservation of alveolar bone is the main aim of
dentures, patients personality and psychologic well-being.4,5 Replacing the conventional tooth-retained overdenture. Preservation
lost tissues by means of complete dentures is challenging both for the dentist
of teeth for overdenture can improve retention and
and the patient.6 Nevertheless, some people do not succeed in acquiring new
skills with their dentures and thus suffer psychologically because of impaired
stability. In this case report, partial edentulous patient
function, comfort, self-image and social interaction. was treated with a tooth supported overdenture using
Access Post System. The final prosthesis was, well
Mandibular complete overdenture treatment is an effective and versatile
retained, stable and aesthetic, serving as a conservative
means of restoring missing teeth and improving facial contours and is
increasingly gaining popularity. As dentistry is experiencing a paradigm shift,
approach to root preservation.
in which mandibular implant overdenture treatment may become the new Keywords: Access Post System; Overdenture;
standard of care for the treatment of the edentulous mandible.Dentist are Retention; Stability.
looking for simplified treatments which are cost-effective alternatives to more
complex and expensive implant-prosthodontic procedures.7 Maintenance of
the residual alveolar bone is the most significant advantage of a tooth borne
CASE REPORT
overdenture as the bone volume and vertical height can help in increased
prosthetic retention and stability.It also gives patient better function and A 40 years old female patient reported to the department of Prosthodontics
control because of intact proprioception.7 at Dr. D.Y.Patil Dental College and Hospital with the chief complaint of all the
teeth missing in the upper arch and few remaining natural teeth in the lower
The shortened crown improves the crown-to-root ratio, thereby decreasing
arch along withdifficulty in chewing.
the mobility of the abutment teeth under an overdenture.In a 4-year-study,
Renner and his co-workers8 showed that 50% of roots, used as overdenture Clinical examination revealed completely edentulous maxillary arch and
abutments remained immobile. In addition, 25% of roots that were initially partially edentulous mandibular arch. Periodontal findings were significant
mobile became less mobile.The use of attachments can redirect occlusal with moderate amount of calculus and stains present along with gingival
forces away from weak supporting abutments and onto soft tissue.They act recession but no pocket formation. Teeth present in lower arch were 33 and
as shock absorbers as well as provides superior retention. Attachments are 43. Loss of teeth had occurred due to decay, mobility and lack of oral hygiene
often used in overdenture. This article reports a conservative approach of practice in earlier life. (FIG.1)
root preservation followed by replacement of missing teeth using Access post As remaining teeth were periodontally compromised, removable partial
attachment with mandibular overdenture.8 denture would not restore function and aesthetics to optimum function.

14 GUIDENT | Your Guide on the path of Dentistry

 Feb 2016

It was concluded that mandibular canines could serve as abutments for

Prosthodontics
P rosthodontics
an overdenture thus providing required retention and stability. Diagnostic
mounting revealed adequate interarch distance for necessary overdenture
components and esthetic and functional placement of artificial acrylic teeth.
Treatment plan was divided into two phases: Phase 1:Preprosthetic phase,
Phase 2: Prosthetic phase.
1. Preprosthetic phase: Endodontic treatment of 33,43 and oral prophylaxis
management of them was done.
2. Prosthetic phase: The mandibular canines were prepared followed by
primary impression made in irreversible hydrocolloid (Imprint,DPI). Final
impression was made in a special tray after border molding with low fusing
compound (Greenstick,DPI) and wash impression with zinc oxide eugenol
impression paste (DPI). Master cast was obtained. Orientation relation was
recorded and transferred on a semiadjustable articulator. Lower cast was
Fig. 2 : Access Post In Place With The Rubber And Nylon Caps
mounted using centric relation record.
Following teeth arrangement try-in was done, vertical dimension verified and
centric and eccentric contacts were evaluated. Facial and functional harmony
was studied and patients approval was obtained. Final denture processing
was done. After lab remounting and selective grinding, the final dentures
were finished and polished.
Post space preparation was carried out and Access Post was then cemented
using zinc phosphate cement. The female cap was then attached chair-side
to the denture using auto polymerizing acrylic resin (FIG.2). For this pur-pose,
rubber bands were used to cover the height of contour of the head and the
nylon cap was placed on the ball of the post. Once the nylon cap was picked
up, rubber bands were removed and flash trimmed. The denture was adjusted
and equilibrated (FIG.3).
Post insertion instructions were given along with recall appointment. The
following day mouth was inspected for any sore areas and final corrections Fig. 3: Post-Operavtive Intra-Oral View
were made. The designed prosthesis served as an aesthetic and functional
solution in the management of this patient.
DISCUSSION
Overdenture treatment is a notion which precludes the preventability of
floating plastic in edentulous mouth. It is a sensible and prudent approach
by the prosthodontist that has mitigated much of the time dependent risk
inherent in complete denture service. Retention and Stability are enhanced,
residual ridge resorption retarded and patient mediated responses are much
improved. The overdenture merits are many, the patients chewing efficiency
is one-third higher than that of complete denture wearers.The use of teeth as
overdenture abutments is beneficial to patients especially from the psycho-
logical aspect of patients losing teeth which cannot be underestimated and
this has been well documented. Even after knowing the merits,Tooth-borne
over denture attachment therapy is a treatment option rarely chosen in
todays aggressive marketing of implant treatment.8,9
The success of the overdenture treatment depends upon the proper
attachment selection for a particular case. Attachment selection is based
Fig.1: Pre-Operative Intra-Oral View
on available buccolingual and inter arch space, amount of bone support,
opposing dentition, clinical experience, personal preferences, maintenance
problems and cost.9,10

Your Guide on the path of Dentistry | GUIDENT 15

Prosthodontics
P rosthodontics
Access posts are stud attachments that work well with overdentures, as
they are the simplest of all. They occupy a small vertical space and the male
units on the different roots do not require parallelism. The ball and socket
attachment of Access post allows rotation of the denture attachment. Small
head of the attachment limits the amount of material that has to be removed
from the denture. The nylon cap provides 3-5 pounds of retention.10 Thus this
concept is cost effective.
CONCLUSION
In conclusion to obtain successful overdenture rehabilitation the dentists
must be careful during case selection and abutment preparation and a proper
periodic follow-up.
REFERENCES
1. Marcus PA, Joshi A, Jones JA, Morgano SM. Complete edentulism
and denture use for elders in New England. The Journal of prosthetic
dentistry.1996;76(3):260-6.
2. Gift H, Redford M. Oral health and the quality of life. Clinics in geriatric
medicine. 1992;8(3):673.
3. Baran , Ergn G, Semiz M. Socio-demographic and economic factors affecting
the acceptance of removable dentures. European journal of dentistry.
2007;1(2):104.
16 GUIDENT | Your Guide on the path of Dentistry
4.
Feb 2016
Boerrigter E, Geertman M, Van Oort R, Bouma J, Raghoebar G, Van Waas
M, et al. Patient satisfaction with implant-retained mandibular overdentures.
A comparison with new complete dentures not retained by implantsa
multicentre randomized clinical trial. British Journal of Oral and Maxillofacial
Surgery. 1995;33(5):282-8.
5. Naert I, Gizani S, Vuylsteke M, Van Steenberghe D. A 5year prospective
randomized clinical trial on the influence of splinted and unsplinted oral implants
retaining a mandibular overdenture: prosthetic aspects and patient satisfaction.
Journal of oral rehabilitation. 1999;26(3):195-202.
6. Zarb GA. Oral motor patterns and their relation to oral prostheses. The
Journal of prosthetic dentistry. 1982;47(5):472.
7. Burns DR. The mandibular complete overdenture.Dental Clinics of North
America. 2004;48(3):603.
8. Renner R, Gomes B, Shakun M, Baer P, Davis R, Camp P. Four-year longitudinal
study of the periodontal health status of overdenture patients. The Journal of
Prosthetic Dentistry. 1984;51(5):593-8.
9. Preiskel HW. Overdentures Made Easy- A guide to implant and root supported
prosthesis. 2nd ed.
10. Catalogue of Prime Dental Products Pvt. Ltd.
Copyright of Guident is the property of Ivory India and its content may not be copied or
emailed to multiple sites or posted to a listserv without the copyright holder's express written
permission. However, users may print, download, or email articles for individual use.