AN ALTERNATIVE METHOD FOR THE

FABRICATION OF A ROOT SUPPORTED

OVERDENTURE-A CLINICAL REPORT.

Schuch.C,pinheiro.A,Sarkis-Onofre.R,perreira-Cenci.T,Boscato.N.

J Prosthet Dent 2013;109:1-4)
INTRODUCTION-

The elderly population is rapidly increasing, as is their need for
dental treatment. Considering the number of partially or
completely edentulous patients, various types of treatment
may be indicated, including conventional complete dentures
and both tooth-supported and implant-supported overdentures.

Tooth-supported overdentures can be retained with attachments
and can improve both retention and stability while
simultaneously reducing alveolar bone resorption.

.

They may also be more cost-effective and maintain more dental
proprioception than implant supported overdentures.
However, excellent home oral health care with
professional assistance is needed to prevent failures




The preservation of supporting teeth for overdenture abutments
provides an efficient prosthetic treatment.
However, tooth preservation requires proper diagnosis and
planning to ensure acceptable long-term performance, with the
remaining roots used to maintain sufficient bone height and
periodontal support
OVERDENTURES
DEFINITION
According to GPT 8
A removable partial denture or complete denture that covers
and rests on one or more remaining natural teeth, the roots of
natural teeth and /or dental implants.

Various terms have been used to describe this treatment
modality:-
Overlay denture
Telescoped dentures
Tooth supported dentures
Hybrid prosthesis
Crown and sleeve prosthesis
Biologic prosthesis
Super imposing dentures.


GOALS
Maintains teeth as part of residual ridge support
and retention. Denture withstands increased occlusal
load without movement.
Decrease in rate of resorption
Increase in patients manipulative skills in handling
denture
According to a study by CRUM and ROONEY- by
retaining mandibular canines and its use in
overdentures- resorption decreased by 8 times

Indications
-In situations where retention is difficult to obtain.
a. Xerostomia
b. Absence of alveolar residual ridge
c. Loss of maxilla or partial loss of mandible
-Congenital deformity (i.e. Cleft palate)
-For patients with poor prognosis for complete dentures
a. High palatal vault and ridge slope
b. Poorly defined sublingual fold space
c. Knife edge ridge

o Unilateral overdenture can be given to provide good
function and esthetics when a large amount bone and
soft tissues have been lost on one side of the arch

o Patient with badly worn out teeth.

o When complete denture will be opposed by retained
mandibular anterior teeth preventing combination
syndrome.

CLASSIFICATION
Based on period of insertion:
Immediate
Transitional
Remote
Design:
Bare root overdenture
Telescopic
Attachment fixation overdenture
Implant supported
Method of support:
Natural teeth/ root
Implant
Submerged root
Method of retention:
Natural teeth (Frictional resistance)
Magnetic
Attachments
Area covered:
Complete overdenture
Partial overdenture
According to abutment preparation and coping:
Short coping
Long coping

Attachments may connect either individual teeth or splinted
teeth to the prosthesis.
Various designs of overdenture attachments are available,
including bar and clip, ball and O-ring, ERA (Sterngold Dental,
LLC, Attleboro, Mass), and magnet attachments.

The selection of the most appropriate system depends on the
number, distance, and location of the remaining natural teeth.

Among these attachments, the ball attachment system is
considered an appropriate, resilient mechanical attachment.


Another treatment option, known as a telescopic crown, short-
coping, or long-coping, covering the remaining roots with
metal.
Attachment selection should be determined after the analysis of
the occlusal vertical dimension and each tooths vertical bone
height.
The preservation of teeth to support an attachment-retained
overdenture is an appropriate and stable alternative to
extractions and complete dentures.
Locating procedures before denture construction:
1.all in one procedure.





2.Completing metal work of the root preparation and
luting them in place before making an overall
impression.





3.Completing metal frame work for abutment
preparations and placing them without a luting agent.
These restorations are removed or subsequently placed
in an overall locating impression.


4.Transfer coping technique.
These are particularly relevant to osseointegration
procedures.


This clinical report discusses a method for fabricating
an overdenture based on a combination of direct and
indirect impression techniques.
CLINICAL REPORT
A 62-year-old man in good general health presented with poor
esthetics and masticatory function to the private dental school,
Meridional Study Centre, Uning, Brazil.

The clinical examination revealed several periodontally
compromised teeth and the loss of occlusal vertical
dimension.

The mandibular central and lateral incisors, mandibular canines,
and mandibular first and second molars were in poor
periodontal condition and exhibited caries .

.
The patient wore a complete maxillary denture, which was also
in poor condition and required both maxillary and mandibular
arch rehabilitation

Radiographs were made, diagnostic casts were articulated at the
anticipated occlusal vertical dimension, and the treatment was
carefully planned.
Several treatment options were offered to the patient, and a
new complete maxillary denture with a root-supported
mandibular overdenture was selected.
The remaining mandibular canine roots presented adequate bone
and periodontal support, and the mandibular second molars
presented reasonable bone height and periodontal support.

The ability to accommodate abutment copings was assessed, and
ball attachments were selected for the canine roots and short
copings with metal coverage for the molars.

Endodontic treatment was performed and abutment teeth were
prepared to create adequate space for the overlying
denture.

The teeth were reduced to 0.5 to 1.0 mm above the alveolar
ridge, and the roots were rounded to a dome-shaped contour.
The preservation of the teeth to be used as retentive attachments
to support an overdenture is a short term, effective procedure
when implant therapy is not performed.
The patients remaining roots provided only reasonable bone
height and periodontal support.
The bone height and periodontal support of the remaining roots
determined which attachments could be used.
The limited bone height indicated the use of a short coping with
metal coverage that improved the crow nto-root ratio, thereby
decreasing the mobility of the abutment teeth supporting an
overdenture.

The use of ball attachments required greater bone height and
was limited because of the difficulty in obtaining the
intraradicular retention of the cast post and in achieving
parallelism between the ball attachments.
Both retention and parallelism increase the attachments
longevity and prevent premature failure of the overdenture.
A combination of direct and indirect impression techniques was
used, and the root canals were prepared to receive posts.
The posts were made of acrylic resin (Duralay; Reliance Dental
Mfg Co, Chicago, Ill) with retention at their cervical ends .


With the posts in position, vinyl polysiloxane
(Dentsply Brazil, Petrpolis, Brazil) was placed
around the posts, followed by the impression with
irreversible hydrocolloid (Hydrogum;
Zhermach SpA, Badia Polesine, Italy) .






The impressions were poured in Type III gypsum
(Microstone; Whip Mix Corp, Louisville, Ky).
The post was inserted into the cast and used for intraradicular
attachment waxing to avoid any loss of the length and
diameter of the attachment.
As the ball attachments (SternGold-ImplaMed, Attleboro, Mass)
were castable plastic patterns and therefore had to be
positioned parallel to the post and well adapted, another
indirect impression was made with vinyl polysiloxane to
obtain the necessary cast.

This method is proposed as an alternative for manufacturing an
overdenture, with the precision of direct molding of the post
space derived from an indirect impression to create a cast that
will be used to obtain parallelism between the attachments .






The parallelism between ball attachments in the definitive cast
was obtained by using a surveyor (Bioart, So Paulo,Brazil),
and the attachment thickness was evaluated (0.4 mm).
Posts were cast in a Ni-Cr-Ti metal (Tilite; Talladium Inc,
Valencia, Calif ).
The short copings with metal coverage for the molars and the
ball attachments for the canines were fitted, adjusted, and
cemented with zinc phosphate cement (LS; Vigodent SA, Rio
de Janeiro,Brazil) .

Once the copings were cemented the overdentures were
fabricated with a conventional technique.
The mandibular overdenture was adjusted to create adequate
space for the retentive component.
A mixture of red and transparent acrylic resin (Duralay;
Reliance Dental Mfg Co) was prepared and used to relate the
attachment to the overdenture, intraorally.
The overdenture was positioned, and the patient was maintained
in the maximum intercuspal position.

The acrylic resin was removed from around the attachments
before it polymerized completely.
Next, the overdenture was repositioned until complete
polymerization had occurred.
Voids and irregularities were filled with additional
autopolymerizing acrylic resin.The overdenture was then
cleaned,polished, and reinserted .

The patient was instructed to comply with an oral hygiene
program that included the use of fluoridated toothpaste and a
6-month recall schedule.
At 4-year follow-up, both clinical and radiographic exams were
performed, and the patients satisfaction was assessed.

SUMMARY-




An alternative technique was proposed for making post space
impressions that maintain both the precision of direct
impressions and the parallelism between the attachments
obtained with an indirect impression when fabricating a root-
supported overdenture.
REFERENCES-
1.AN ALTERNATIVE METHOD FOR THE
FABRICATION OF A ROOT SUPPORTED
OVERDENTURE-A CLINICAL REPORT.
Schuch.C,pinheiro.A,Sarkis-Onofre.R,perreira-
Cenci.T,Boscato.N. J Prosthet Dent 2013;109:1-4

2.Overdentures made easy- Harold Prieskal

3.Treatment plan for edentulous mandible .BDJ 2006

4.Crum RJ, Rooney GE. Alveolar bone loss in
overdentures: A 5- year study. J Prosthet Dent
1978;40:610

5.Mensor MC Jr. Classification and selection of
attachments. J Prosthet Dent 1973;20:494.
6.Guyer SE. Selectively retained vital roots for partial
support of overdentures: A patient report. J Prosthet
Dent 1975;33:258




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