HIGHLIGHTS

 DEFINITION
 RATIONALE
 TOOTH SUPPORTED OVER DENTURE
 INDICATIONS
 CONTRAINDICATIONS
 ADVANTAGES
 DISADVANTAGES
 CLASSIFICATION
 TREATMENT PLANNING
 PROCEDURE
 IMPLANT SUPPORTED OVER DENTURE
 SUMMARY.
 DEFINATION
 AN OVER DENTURE IS A REMOVABLE PARTIAL OR
COMPLETE DENTURE THAT COVERS & REST ON ONE OR
MORE REMAINING NATURAL TEETH, ROOTS, & / OR
DENTAL IMPLANTS.

ALSO CALLED AS : TOOTH SUPPORTED

TELESCOPIC
HYBRID
INLAY / ONLAY / OVERLAY DENTURES
SUPERIMPOSED PROSTHESIS
IT MAY BE CONSTRUCTED OF : ACRYLIC RESIN
GOLD
CHROME COBALT
 RATIONALE FOR OVER
DENTURE
 The roots of the tooth offers the best available
support for occlusal forces.
 Accelerated rate of bone 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 pt’s manipulative skills in handling the
denture. (here 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 teeth.
2. Pt. with few natural remaining teeth.
3. Poor prognosis for routine complete denture.
4. Congenital or acquired intra oral defects.
5. Abnormalities in jaw size and position.
6. Mandibular arch where loss of alv.bone is more rapid.
7. Edentulous maxilla opposed by natural dentition.
8. Post traumatic or post surgical cases.
9. Severe attrition and loss of vertical dimension.
10. Young patient.
11. Cleft palate causing large free way space.
12. Attachment may be indicated in case of xerostomia and sialorrhoea.
 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. Undercuts.
6. Sufficient attached gingiva not present.
7. Where endo and perio treatment can not be performed
satisfactorily.
1.
ADVANTAGES
Preservation of alv. bone.
2. Proprioception & perception maintenance. i.e. preservation of sensory input from perio- receptors.
3. Cosmetic results r excellent.
4. Relieves deep or traumatic bite.
5. Improve masticatory efficiency in :
a. case where lower molars occlude palatally, chewing is
impossible.
b. Case where lateral movements of mandible r limited due to
locking of mandible in centric occlusion.
6. Relieve trauma to TMJ & arthroses due to regression of condyle.
7. Stability :- enhanced stability due to elimination of ant. , post. , &
lat. Slippage & sliding.
8. Retention :- dentures r well retained & r sometimes added with retentive
device or attachment like --- dolder bar attachment
--- gerber jut attachment.
9. Support :- natural tooth stop of an over denture provide for static stable
base unparallel by any conventional denture.
10. A simple approach to the problem patient.
11. Periodontal maintenance.
12. Patient’s acceptance.
13. Harmony of arch form.
14. Convertibility.
 DISADVANTAGES
1. Caries susceptibility.
2. Bony undercuts. (due to limited path of insertion)
3. Over contour.
4. Under contour.
5. Encroachment of inter occlusal distance.
6. Esthetics.
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 & attach material.
 CLASSIFICATION
 ACCORDING TO METHOD OF ABUTMENT
PREPARATION (Along with contemporary clinical terminology)
1. NON COPING with endodontic treatment
without endodontictreatment
2. COPING
with endodontic treatment
without endodontic
treatment
3. ATTACHMENTS
 BASED ON TYPE OF OVER DENTURE

– IMMEDIATE
– TRANSITIONAL / INTERUPT DENTURE
– REMOTE / PERMANENT DENTURE
 NON COPING ABUTMENTS
 Selected tooth abutments are reduced to a coronal height of 2 to 3 mm. and
then contoured to a convex or dome shaped surface.
 Most teeth required endodontic therapy and in final step are prepared
conservatively to receive an amalgam or composite type restoration.

for non coping type abutment over dent

Before treatment
 ABUTMENTS WITH COPINGS
Cast metal coping with a dome shaped surface and a chamber
finish line at the gingival margin are fabricated and cemented.

Types of copings : short coping

long coping

Short coping prepared on

Tooth to receive Over denture
 SHORT CAST COPINGS
• Short copings are 2-3 mm and normally require
endodontic
therapy because the
required coronal root reduction would expose the
pulp.
• Attached to cast coping is a post filled to the canal
therefore canals should be obdurate with soft gutta-
LONG
purcha like material rather CAST
than COPING
with metal points.
 Long cast copings are 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 ratio.
 Consequently, long cast coping require a greater level of osseous
support.
 ABUTMENT WITH ATTACHMENTS
 Most attachments are secured to abutment by a cast coping.
 Objective of any attachment is to improve fixation / or
retention of denture base.
 Drastic reduction in crown root ratio and where indicated
periodontal and endodontic therapy is required.

Teeth prepared
to
receive coping
Attachment

Cast metal
coping
 TOOTH PRAPARATION TO
PROVIDE RETENTION
 Teeth with clinical crown can be prepared to give positive retention when bars are
attached to copings covering the prepared clinical crowns.

ATTECHMENTS :-
 The B and D anchor
• Gerber attachment
• The CEKA anchor
• Stud attachment
• Dalbo attachment
• Zest anchor
• Rotherman attachment
• Introfix attachment
• Schubiger attachment
• Quinlivan attachment
• Magnets
• Bar attachment
• Baker clip
• Ackerman clip and CM clip
• Dolder bar
 SUBMERGED VITAL ROOTS

 Submerged vital root as over denture abutment is still in

experimental stage therefore can not be recommended.

 The method is innovative attempt to obviate the basic

problems like caries, gingivitis, periodontitis, need for
endodontic therapy associated with conventional over
denture abutments.

 Here, selected vital roots are selected and reduced to 2

mm. below the crestal bone and then covered by
mucoperiosteal flap

 Major post operative problems are: development of

dehiscences over retained roots and pulpal pathologies.
Submerged root copings Root copings placed
on teeth

Denture prepared and placed

 TREATMET
PLANNING
1. SELECTION OF ABUTMENT TEETH : -

 Ideally tooth should present minimal mobility, have acceptable

bone support and be amenable to periodontal therapy.
 Isolated teeth are proffered to several adjacent teeth.
 Two teeth in each quadrant probably 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 tooth, r to be
preserved)
 Preserve teeth that are already endodontically treated.
 Choose teeth that are surrounded by healthy peridontium.
 2. PREPARATORY TREATMENT
FOLLOWING SEQUENCE OFT
TREATMENT CAN BE USED
AS A GENERAL GUIDE.

1. Construct an immediate
treatment clasp less denture
and make a cast from an
irreversible hydrocolloid
impression. It replaces
missing and hopelessly
involved teeth for esthetic
reason and retain jaw
relations.

2. Remove hopeless teeth and

insert the removable
prosthesis.

3. During the healing period,

institute the periodontic and
endodontic treatment.
3. TOOTH PREPARATION FOR MINIMAL RETENTION
 Remove sufficient tooth structure
to provide favorable root crown
ratio to allow insertion of artificial
replacement in an acceptable
esthetic position and in favorable
occlusal relation with teeth of
opposing arch.

 Reduce the crown length up to 2

mm above the gingival crest or
extend a chamber type margin
slightly beneath free gingival
margin.

 Taper the preparation in

Tooth preparation done and
tray prepared for impression
occlusogingival direction. The
finished tooth with cast coping is
male member of denture. The
female member is part of denture
base.
4. COPING FABRICATION
 If making a coping type attachment
fabrication is required.

 Make an accurate impression of the

abutment and pour a die.

 Carve the wax pattern. place the concavity

in the occlusal surface of the pattern using
a wax tool.

 Cast the coping using a hard type of class-

III gold.

 Cement the polished coping to the tooth.

 Instruct the pt. in home care of abutment
tooth.
 IMPRESSION FOR THE DENTURE
 Follows the same technique that is used in constructing a
conventional complete denture.

 PRELIMINARY IMPRESSION
 FINAL IMPRESSION
 RECORD BASES AND 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 MAXILLO MANDIBULAR

RELATIONS
• 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 teeth placed over the abutment teeth should be acrylic resin.
 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) Restored with porcelain --Porcelain artificial teeth are preferred.
iii) Natural teeth ---- porcelain artificial teeth are preffered.
 SETTING THE ARTIFICIAL
TEETH
 To set acrylic resin tooth over 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 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 maximum
occlusion
6. Contouring the wax for try in appointment.
 TRYING THE DENTURE
 Varify jaw relation records
 Make eccentric jaw relation records and adjust
the articulator.
 Assure esthetic acceptibility by the patient.
 Varify phonetic acceptibility.

LABORATORY
PROCEDURES
• CONTOUR THE WAX
• FLASK THE DENTURE
• ELIMINATE THE WAX
• PRAPARE RESIN
• PACKING
 DENTURE INSERTION
 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 Final try in
for pressure areas and
over extensions.
 Perfect the occlusion by
remounting and selective
grinding.
 Place pt. on recall system
(every 4 months ).
After insertion
 IMPLANT SUPPORTED
OVERDENTURE
 INDICATIONS :
I. PT. DESIRE FOR IMPLANT TREATMENT
II. SYSTEMIC HEALTH STATUS, WHICH PERMITS A MINOR SURGICAL
PROCEDURE
III. SUFFICIENT BONE QUANTITY TO ACCOMMODATE PRESCRIBED IMPLANT
DIMENTIONS
IV. PT. WILLINGNESS AND ABILITY TO MAINTAIN ORAL STATUS

CONTRAINDICATIONS :
I. RESIDUAL RIDGE DIMENTIONS DO NOT ACCOMMODATE PREFFERED
IMPLANT DIMENTIONS
II. COMMUNICATION WITH PT. IS NOT POSSIBLE
III. PT. HAS HISTORY OF SUBSTANCE ABUSE
IV. GENERAL HEALTH CONDITIONS PRECLUDEA MINOR SURGICAL
INTERVENTION
V. LOCAL ANAESTHESIA WITH VASOCONSTRICTER IS CONTRAINDICATED
VI. IMMUNOSUPPRESIVE THERAPY, PROLONGED INTAKE OF ANTIBIOTICS
OR CORTICOSTEROIDS, OR BRITTLE MEABOLIC 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 ( laboratory – custom try 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 pt.
 Indexing of setups to allow for optimal bar design ( corrections as determined in
try in appointment; bar fabrication )
 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 the dentures 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 principle & detail program of home
care instruction & frequent recall.
 The overdenture is an out standing mode of treatment. The teeth
that are used for the maintainance of health. A breakdown in their
structure or a breakdown in their periodontal support immediately
negates an overdenture concept.
 IF WE ARE TO SUCEED, WE MUST CONTROL THE FACTORS
THAT JEOPARADIZE SUCCESS.

 REFFRENCES :
BOUCHER
INTERNET [ BHAM .AC.UK.CAL ]
WINKLER