Dr Norlela YacobBDS(Mal), MDSc (Dundee)(Prosthodontics)

9/9/2013

Lecture content:Definition : overdentureAdvantages and disadvantages of overdentureAbutment issueTypes of OverdentureTransitional dentureFailing dentitionSequencing of treatmentDesign aspect of transitional/immediate

complete denture

Definition: A denture which is fitted over teeth which usually had their natural crown reduced.

Objective: to distribute stress concertration between retained teeth abutments and denture supporting tissues.

•Special attachment may be fixed to the roots faces to provide mechanical retention for the denture

Indication:Major tooth wear to less severe tooth wearCongenital tooth wear, hypodontia or cleft

palateSequalae of maxillofacial traumaPatient that heading in an edentulous

direction (failing dentition)

Advantage of overdenturePreservation of edentulous ridge form-Especially for lower jaw-It will provide support and promoting stability of

denture-Preserve labial undercut: better retention and

stabilityMinimize horizontal forces on abutment teeth

Advantages of overdentureImprove appearance: more bone support,

prevent labial and lip collapse. Preservation of sensory input: better occlusal

awareness, biting force and neuromuscular control from the periondontal tissue.

Allows scope of attachments. Eq; magnetic, telescopic crown, bar

Advantages of overdentureImprovement of crown root ratio:

Due to tooth wear, the ratio become reduce.

Patient perception of “Natural Feeling” and prevent tooth extraction.

DisadvantagesRoot canal therapy: increase cost, long treatment Limitation of space: may require design

modificationPotentially fracture of denture base materials at

thin/weak baseRisk for further disease on abutments: caries and

periodontal diseasePeriodontal attachment lossRoot face cariesMay need additional or extra laboratory steps

Issues of selection and protection fromCaries and periodontal disease

Abutment selection:Periodontal and mobility status: health

periodontal tissue. Slight mobility per se is not contraindication

Location: Canine and premolars are most vulnerable to reduce adverse force. At least one tooth per quadrant.

Endodontic and prosthodontics status.

http://www.google.com.my/imgres?q=magnetic+denture&hl

Protection of abutmentsPlaque controldenture wearing habitsAnti-microbial agent: chlorohexidine m/washFlouride gel applicationReduction of crown portion especially in root

treated teethEndodotically treated teeth: leave it

unprotected or protect with coping with alloy, composite, reshaped and polished with sandpaper disks.

Materials for restoring the root faceAmalgamComposite resinGlass Inomer cementPost retained copings-keeper, telescopic crownFull coverage of the root faceAttachment: precision attachment, stud

attachment

Directly over teeth-no reductionReduction of crowns without endodonticsReduction of crown with endodonticsAttachment system Implant supported denture

Is an aid to the transition from dentate to edentulous. It helps to restore existing edentulous areas.

It may be worn for short period of time before remaining natural teeth are extracted and denture are converted accordingly.

Example: spoon denture, interim denture, immediate denture, overdenture

Indications for transitional denturesImmediate partial dentureProlonged restorative treatmentGrowing patient; children and teenagersFailing dentition

Prolonged restorative treatment

Pattern of Failing Dentition:1.Catastrophic failing2.Slow failure- creeping towards edentulous arch

Catastrophic FailingYears of neglectDietary/ saliva flowMedical crises Eq: Diabetes,

Slow FailingPatient need to understand the position and

condition of failing dentitionNeed more visits and costs

Treatment planning for the failing dentitionCONTROL OF PAIN firstPeriodontal assessment: identify the prognosis of tooth (may

need to retain or extraction).Patient: must be fully informed and patient is aware and

UNDERSTAND they have periodontal disease.Extraction of painful, posterior teeth and rootsPeriodontal stabilization-never/necessary?Conservation: removable partial denture/crown/provisional

denture (interim denture)/immediate denture

Decisions in treatment planningShould we provide immediate dentures at all

time?

Transitional denture: Immediate denture or interim dentures or complete clearance

Consider the history of patient

Decisions in treatment planningWhat problem is the patient presenting with?Is the patient in pain?Previous denture wearing experienceGagging: transitional dentureIs there an urgent need to extract the teeth.Can teeth be added to an existing dentureDo we need new prostheses.How many teeth should be removed at each stage?Clearance of teeth without prosthetic replacementSocial disadvantages.Loss of reference point for vertical and horizontal

jaw relationship

Clearance with complete immediate dentureOften difficulties wearing especially the lower

prosthesis.More predictable way of preserving

information on jaw relationship (vertival + horizontal) and tooth position.

Massive resorption- whole jaw resorption>loose dentures

Psychological effects

For case that creeping to edentulous arch

Phase 1Remove posterior teeth initially and allow the

ridges to heal (how many teeth you would extract?)

Leave the index teeth eq:1st premolar. Therefore, correct vertical dimension is remained.

Phase 2

Make partial acrylic denture. At this stage we call it transitional denture.

Let patient accustomed and adapt with the prostheses. 2-4 weeks.

If may require further extraction, interim denture could be considered.

Phase 3

Once patient comfortable with the denture convert it to complete immediate denture.

Phase 4

Replacement or rebasing

After bone resportion has settled down

Transitional dentureAdvantages DisadvantagesSimple and economicRelatively atraumaticFunction and

appearance maintained.Can use information that

remain eq: VDPatient preferenceAdaptation to dentures

Repeated additions to dentures may be socially inconvenient.

Problems from remaining teeth at any time

Difficulty constructing a functional and aesthetic denture

Position and distribution of remaining teeth unacceptable

Prolonged treatment

Good communications skills is ESSENTIAL.Inform patient of requirement for follow up.Inform patient of requirement for definitive treatment at later stage.

CONCLUSION:

ReferencesJepson, NJA. Removable Partial denture.

Quintessentials of dental Practice. London 2004. ISBN 1850970750

RM Basker, JC Davenport. Prosthetic treatment of the edentulous patient. 4th edi. Blackwell 2002.

Learning outcome:Describe overdenture and its typeExplain advantages and disadvantages of

overdentureUnderstand the management of abutment

issueKnow the pattern of failing dentitionKnow the management of failing dentitionDescribe interim denture, transitional

denture, and immediate denture

Question, please…