Overdenture

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OVERDENTURE ATTACHMENTSSHREY SURI1ST YEAR PROSTHODONTICS Options for Restoring Totally Edentulous Jaws

12 Mini-implants per arch with Snap-on Acrylic Bridge

Drill Sequence for 3.0 ScrewIndirect Implant

Pointed Drill to Initiate Osteotomy2.8/2.3 Step Drill for 3.0 Implant in Dense Bone2.3mm Drill for 3.0 Implant in Soft BoneCompare Imtek Mini-implants to ScrewDirect

Bar Overdenture on 4 ScrewIndirect 1-Piece Implants





Bar Overdenture on 4 ScrewIndirect ImplantsBar Overdenture on 4 ScrewIndirect 1-Piece Implants

Restoration of the Totally Edentulous Jaw with an Implant Supported Bar Overdenture on 5 ScrewInDirect Implants

5 S-InDirect One-piece Implants between Mental Foramen

5 S-InDirect Implants with Snap-on Comfort Caps

Open Tray Transfer Impression

Bar with Ball Attachments, Attached to Implants within 48 Hours

Bar Attached to Implants 6Mo PO

Fixed Detachable Bridge on 5 ScrewIndirect Implants




Teeth-in-a-Day on 7 ScrewIndirect Implants Dr. Peabody

Teeth-in-a-Day on 7 ScrewIndirect Implants

Teeth-in-a-Day on 7 ScrewIndirect Implants

Make Impression to Locate Position of Holes

Attach Titanium Copings and Seat Modified Denture

Cold Cure Denture to Titanium Copings

Screw-in Fixed-Detachable Restoration

Teeth-in-1Day with 5 ScrewIndirect Implants



CLASSIFICATION OF OVERDENTURES (based on method of abutment preparation) {Heartwell}

Non coping Coping Attachments

NONCOPING OVERDENTURESSelected abutments are reduced to a coronal height of 2 to 3 mm and then contoured to a convex or dome shaped surface. Most teeth require endodontic therapy followed by amalgam or composite restoration.

COPING OVERDENTURES

COPING OVERDENTURE

A coping fitted to a prepared abutment is called a primary coping. The sleeve or coping that fits over this primary coping is referred to as a secondary coping.

There are four basic types of primary copings

1. Long copings (6-8 mm).2. Medium copings (4-6mm).3. Medium-short copings (2-4 mm).4. Short copings (1-2 mm).

Long copings (6-8 mm)

Medium Copings (4-6 millimeters for vital and non-vital teeth)

Medium copingsAbutment preparations for medium copingsMedium short copings (2-4 mm for nonvital teeth)

Indicated for nonvital teeth; where a more favorable crown root ratio is desired than that possible with medium or long copingsShort Copings (1-2 millimeters for non-vital teeth)

They are indicated for maximum favorable crown-root ratioATTACHMENTS{CLASSIFICATION BY MENSOR} Resilient Non resilient Coronal Radicular Auxiliary

Coronal Intra coronal attachments Extra coronal attachmentsRadicular Telescope stud attachments Bar attachmentsAuxiliary attachments Screw units Pawl connectors Bolts Stabilizers/balancers Interlocks Pins/screws RestsSTUD ATTACHMENTS

They can be resilient or non resilient.

Resilient attachment permits the tissue to compress slightly before any load is transmitted to the abutment .

Indicated:

When there are only a few abutments. When abutments have minimal bone support. When functioning opposite natural dentition.

A non resilient attachment will not allow vertical movement (however it may permit rotational movement). Used : When no vertical movement is indicated. When an all-tooth supported prosthesis is desired. When a tooth-tissue supported appliance is desired. With strong abutments having maximum bone support .

Some Stud Attachments

Gerber attachmentDalbo attachmentCeka attachmentZest anchorRothermann attachmentIntrofix attachmentSchubiger attachmentQuinlivan attachmentThe Gerber Attachment

The Gerber stud system is a versatile stud attachment used routinely. It consists of a male post soldered to the coping and a retentive female secured within the denture base of the overlay prostheses. The Gerber attachment is furnished in two different types - a resilient and non-resilient form.

Dalbo attachment

RigidResilientStress broken

It is composed of the male unit attached to the tooth & the female housing embedded in the denture base.CEKA ATTACHMENT

MALE{affixed to tooth} has a rounded shape wider at top & split vertically into 4 sections.Over this fits a female housing or ring.

It allows some vertical play & rotational movement of the base.

Recent advances in CEKA

The Ceka Revax The new Ceka Revax (M2) is the smallest fully adjustable and serviceable stud attachment system.

The small size allows for usage when space is at a premium--ideal for close bite situations. Space requirements for the Revax (M2) are 3.8mm in height 3.4mm in diameter. Its advised to allow approximately 4.8 mm of vertical space for the attachment, acrylic resin, and teeth. the Ceka requires 0.45 mm more vertical clearance. When space is available, select the traditional M3 Ceka as it is stronger and easier to service.

ZEST ANCHOR{ Intraradicular} Post preparation is made in root & female sleeve is cemented.

The male portion is a nylon post & a ball head that is attached to Overdenture as a chair side procedure.

Advantages:No space problemsLeverage on abutment tooth negligibleQuick & needs no casting

Advancements allow the male to freely rotate and move within the housing or denture cap, the wide band on the male allows for increased retention and reduced wear (less bending and breakage)the female has a titanium coating for hardness and a smoother internal surface

New Zest Anchor Advanced Generation (ZAAG)The female may be used with a cast coping or directly placed into a root.

There are two sizes regular (4.0 mm height, 3.8 mm width) mini (2.3 mm height, 3.3 mm width)

QUINLIVAN ATTACHMENT

Consists of a prefabricated resin ball - incorporated with the wax up of post & coping.

A resin female housing is attached to the Overdenture with cold cure resin.

Retention is gained by an O rubber ring inside the female that is secured by a small lip at the orifice of the female cap.Advantages:Free to rotate in all directionsEasily fabricated & replaceableEconomical

Disadvantages:Wear & possible fracture of resin housing if much grinding was originally done to fit the limited space.

shiner magnet

no path of insertion for patients with limited dexterity limited servicing requirements for the operator up to 24 of rotation per abutment for non-parallel abutments prosthesis may engage undercuts for increased stability

OSO Post

simple techniques low cost a pressure relief system for seating the ability to be used in combination with splinting bars, processing jigs that allow dentists to cement the crowns at time of try in and provide simple repair or replacement of the removable prosthesis.

The OSO is maintenance free...there is nothing to repair except the O-ring, which may be replaced in minutes.

The overdenture system in prefabricated Vitallium posts are available in 0, 5, 10, 15, and 20 degrees.

The new Sphero Flex Post system is an endodontic post rotating ball attachment that corrects misalignment in any plane up to 15 degrees. The advantages of this self paralleling system are -the freedom of movement (resiliency) that protects weak abutments -the biocompatibility of titanium -the small size of the sphere (2.5 mm). SPHERO POST

The female may be seated in the prosthesis, or incorporated in to a cast frame. The posts are available in three lengths-- 6.75 mm, 8.40 mm, and 9.75 mm. The 2 degree tapered reamer is used to refine the canal. This system can also be used with a cast coping.

BAR ATTACHMENTS

The purpose is splinting of the abutment teeth and retention & support of the prosthetic appliance.Types of Bar Attachments Bar units

Bar joints

Various bar attachments are

Hader bar Dolder bar Baker clip Ackerman clip CM ClipHADER BAR:

Consists of preformed plastic bars & clips.

The plastic bar is attached to the copingwax up & is cast with the copings.

The plastic clips can be embedded in denture base to gain retention

BAKERS CLIP

U shaped clip designed to fit over round wire.2 sizes of wire are available:11 gauge14 gauge

The wire is soldered to post copings. The clip is attached to denture base.

ACKERMAN CLIP & CM CLIPTREATMENT PLANNING

This includes Periodontal considerations Endodontic treatment Caries Management Location and Distribution of forces Economics

PERIODONTAL CONSIDERATION

Periodontal inflammation

Pocket formation

Bony defects and poor zone of attached gingiva must all be eliminated before commencement of the treatment

A common periodontal requisite with over denture abutment teeth is that an adequate zone of attached gingiva is mandatory

ENDODONTIC CONSIDERATIONAdvantages The crown root ratio can be made more favorable.

Reduction of the clinical crown provides an interocclusal distance more favorable for the placement of the artificial tooth in an esthetically acceptable position and in more favorable relation to the opposing teeth. Contra indications for endodontic treatment Vertical fracture of the root or roots. Mechanical perforation of the root canal. Broken instrument in the root canal. Horizontal fracture of the root below the bony crest. Posterior teeth that are tilted more than 25 degrees.

LOCATION AND DISTRIBUTION OF ABUTMENT

Two canines & two premolars abutments are the most common pattern for four abutments.

Three abutments, two canines & a second premolar can be used where fourth abutment is unavailable

CARIES MANAGEMENT

The presence of high caries index and the situation that will create a carious environment are the devastating sequelae to improper over denture patient selection.

Choice of abutment is a tooth that have a healthy clinical crown.

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Frequent recall check up and treatment of the abutment with periodic fluoride application to ensure against any further break down.

ECONOMICS Endodontic treatment, cast copings, attachments and Overdenture itself may workout expensive so economics of the patient should be considered.

Implant-Supported

Overdenture

A Solution For all Missing Teeth

Dental implants can be used to support a specially designed denture, known as an Overdenture.

ADVANTAGES minimum bone lossimproved stabilityimproved occlusionimproved speech, retention, support

THESE ARE ESPECIALLY ADVANTAGEOUS FOR THE LOWER ARCH, WHERE RETENTION OF DENTURES IS OFTEN A PROBLEMImplant-supported Overdenture may be supported by two to six implants.

There are two types of implant-supported dentures: bar-retained

ball-retainedBar-retained dentures A thin metal bar that follows the curve of jaw , is attached to two to five implants.

Clips or other types of attachments are fitted to the bar ,the denture, or to both. The denture fits over the bar and is securely clipped into place by the attachments.

Ball-retained dentures (stud-attachment dentures) Each implant that has been placed in the jawbone holds a metal attachment that fits into another attachment on the denture. In most cases, the attachments on the implants are ball-shaped ("male" attachments), and they fit into sockets ("female" attachments) on the denture

Impression making for Overdenture

CUSTOM TRAY FABRICATIONTISSUE BORNE SIDE OF TRAY SCREW FINAL TITANIUM ABUTMENTS INTO PLACE IN ROOT FORM IMPLANTSTRANSFER COPINGS

SCREW EACH TRANSFER COPING TIGHTLY INTO ITS MATCHING ABUTMENTSBORDER MOULDING IN MOUTHFINAL IMPRESSION RECORDS ALL TISSUES & TRANSFER COPINGSEACH TRANSFER COPING IS REMOVED FROM ABUTMENT & SCREWED INTO A PROSTHETIC IMPLANT ANALOGUE

PLACE ABUTMENT ANALOGS INTO THEIR IMPLANT MATES ON WORKING CASTPROCESS BASE PLATE ON CASTWAX RIM BUILT ON BASE PLATE FOR CR & VDSET TEETH IN WAX ON IDEAL PLANEVIEW ABUTMENT FROM ABOVE IN THEIR ACCURATE RELATION TO DENTURE BASEFOLLOW UP CARE Home care recommendations:Brushing with soft bristleBubble gum physiotherapyDaily application of 0.4% SnF2 gel using Overdenture as a carrier.

FlossPerio aidsRubber tips should be used which guarantee that all plaque accumulation is removed from tooth surface & sulcus. 0.12% chlorhexidine gluconate mouth wash

The dentist should recall regularly.Initial 2 minute treatment with 1.23% APF gel followed by 0.4% stannous fluoride gel for 2 minute.

Failures of Overdenture ABUTMENT FAILUREAbutment caries is a problem , the effects can be managed by restoration & improved oral hygiene efforts.Abutment failures -an exacerbation of periodontal disease ( more common cause)

OVERDENTURE BREAKAGE

Fracture characteristically were through or immediately adjacent to abutment teeth & often occurred 6-8 weeks postinsertion just before relining.Contributing factors:Residual ridge changes secondary to healing Additional load transference to abutmentsChanges: Use of resin denture teeth.Grooves placed in ridge laps of resin teeth - provide additional bonding area for denture base resin & to increase the strength & rigidity of OverdentureHigh impact denture base resins were used for immediate OverdenturesCONCLUSION

OVERDENTURE is a preventive dentistry concept which has been brought into prosthodontics. Even though the technique resembles that of complete denture there are important differences. The prognosis of the restoration is likely to be influenced by numerous factors like :Selection of patientTreatment planningPreparation of mouthPatient home carereferences-Sheldon Winkler-Essentials of complete denture prosthodontics, second edition-Zarb-Bolender-Prosthodontic treatment for edentulous patients, twelfth edition-Charles M. Heartwell Jr, Arthur O.Rahn- Syllabus of complete dentures, fifth editionThe dental clinics of north America- complete dentures Vol. 40, No. 1, Jan 1996. Pg 169-194. An attachment of overlay denture. JPD 1974 ;32: 3, 256-261.

Alveolar bone loss in Overdenture: a 5 year study. JPD 1978;40:6, 610-613. Effect of 0.4% stannous fluoride gel on the gingival health of overdenture abutments JPD 1982; 48:23-26.Classification & selection of attachments. JPD 1973: 20; 494.Attachment fixation of the Overdenture. JPD 1978;39: 1, 16-19.

DCNA 2004: removable prosthodontics;586-613Atlas of oral Implantology A. Norman CraninContemporary Implant Dentistry Carl E. Misch

Overdenture

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