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DR.NOOR ADDEEN ABO ARSHEED Clinical Lecturer and Specialist Prosthodontist

Head of LUC Dental Center

BDS, HD Prostho, MDS , DOI (Germany)

NBDE (USA) , FICOI (USA).

LINCOLN UNIVERSITY COLLEGE

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OVERDENTURES

Part (2)

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TREATMENT SEQUENCE FOR THE OVERDENTURE PATIENT

1. Examination, diagnosis and treatment planning. This includes oral

hygiene selection of abutment teeth, patient education and motivation, and

oral hygiene counseling

2. Referral for opinion from other specialists and completion of prerequisite

treatment

• Prerequisite oral surgery

• Prerequisite periodontics

• Prerequisite endodontics

3. Preparation and/or restoration of abutment teeth and fluoride therapy.

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TREATMENT SEQUENCE FOR THE OVERDENTURE PATIENT

4. Impression and fabrication of copings and cast metal bases (when

indicated).

5. Impression and construction of overdenture

6. Fixing of attachments (when indicated)

7. Delivery of overdenture and oral hygiene counseling.

8. Periodic recall with assessment of overdenture and abutment status.

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DETERMINING PATIENT MOTIVATION

The level of motivation is critical for the

potential overdenture patient. This is

because of the increased number of dental

appointments and the increased cost .

The Cost and the number of visits is

dependent on the amount of prerequisite

treatment( endodontic, periodontal, etc.)

patient requires. Cast copings and precision

attachments also increase the cost of the

treatment. Thus, it is important to discuss

the treatment plan and cost and obtain

consent before starting.

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ENDODONTIC THERAPY

lt is beneficial to treat the tooth

endodontically to allow for sufficient

reduction of the crown-root ratio. Therefore

it is important to determine if successful

endodontics can be done. Single rooted

teeth like canines with patent canals are

good candidates. However, multirooted

teeth may also be used

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PERIODONTAL

THERAPY

Periodontal therapy includes elimination of inflammation, pockets,

and bone defects .

The reduction of crown height considerably reduces mobility,

including grade 1, most grade 2 and sometimes even grade 3

mobility.

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REDUCING

THE CROWN HEIGHT

Once the periodontal treatment is initiated,

the crown height is reduced .and endodontic

treatment is initiated.

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FLUORIDE THERAPY

In cases where cast copings are not going

to be provided, the dentist must make sure

that the tooth structure is properly smoothed

and polished after the remodelling,

Secondary caries is a major cause for

concern in unprotected teeth. Research has

shown that regular fluoride application

during routine office visits, in addition to

regular home care, considerably reduce the

incidence of caries

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AMALGAM PLUG

Some operators place an amalgam

restoration into the coronal part of the root

canal after the endodontic therapy. The

tooth is sectioned slightly above the gingival

margin. Amalgam is condensed into the

exposed root canal. The amalgam

restoration along with the exposed tooth

structure is finished and polished.

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CONSTRUCTION OF COPINGS

After the successful completion of

endodontic and periodontal treatment, the

teeth are prepared to receive copings

Copings help protect the teeth from caries.

Copings may be either long or short. The

preferred finish line is usually a chamfer or

chisel edge. The coping may be retained by

means of a short post within the root canal

for teeth with insufficient coronal height.

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IMPRESSION AND CONSTRUCTION OFO

VERDENTURE

After the cementation of the copings , impressions are made for the

construction of the overdenture.

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Clinical overdenture case

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Case report

A 55-year-old male patient with complete upper edentulous and partially lower

edentulous condition reported to the Department of Prosthodontics with the

chief complaint of replacing teeth.

His major desire was to improve his masticatory function by retaining natural

teeth.

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Case report

History revealed that the patient was edentulous for the past 6 years and

was wearing maxillary complete denture and lower removable partial

denture since then.

The general health status of the patient was quite satisfactory with no

history of systemic disorders

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Case report

The intraoral examination revealed maxillary complete edentulous arch and

partial edentulism in mandible.

The teeth present were canines and premolars with sound periodontal and

bone support.

The ridge was well-rounded in the maxillary arch, and uneven mandibular

ridge is seen with sufficient inter arch space with an average mouth

opening.

The old existing dentures were compromised in retention and stability due to

under extended borders along with severe occlusal wear

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Case report

new removable denture prosthesis was planned with a conventional

complete denture for maxillary arch and an overdenture with retained teeth

using metal copings for the mandibular arch.

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Clinical procedure

As the patient was not willing for extraction of his natural teeth and the final

treatment option which patient selected was tooth supported overdenture,

endodontic procedures were done in relation to 33, 34, 35, 43, 44, 45 as these teeth

are used as abutments for the overdentures and were sectioned about 1 mm above

the gingival margin.

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Clinical procedure

. Intraradicular postspace preparation was done for the abutment teeth sequentially

with peeso reamers, and the wax pattern of the postspace is done by direct

technique

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Clinical procedure

The wax patterns were invested, burnt out, and casted to obtain metal copings.

The metal copings along with post which were obtained after investing and casting

are polished and cemented to teeth with glass ionomer cement

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Clinical procedure

Preliminary impressions were made with impression compound using metal stock

tray.

Primary casts were poured with dental plaster and self-cure acrylic resin custom

trays were constructed. Border-molding with impression compound type 1 was done

.

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Clinical procedure

Final impressions were made with polyvinyl siloxane light body impression material

Master casts were poured with type III dental stone

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Clinical procedure

Stabilized record bases were made with self-cure acrylic using the sprinkle-on

technique and occlusion rims were fabricated with modeling wax.

Wax rims were adjusted until tentative occlusal vertical dimensions were

established, and jaw relations were recorded.

Teeth were arranged in the usual manner. The wax set-up was tried in patient’s

mouth and was checked for esthetics, phonetics, occlusal vertical

dimension, and occlusion.

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Clinical procedure

The maxillary and mandibular trial dentures were waxed up, flasked, and dewaxed.

Heat cure acryilc resin was packed

Final finishing, polishing and laboratory remounting were done

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Clinical procedure

The patient was given routine postinsertion instructions and was motivated to make

an effort to learn to adapt to the new dentures.

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The overdenture is a very valuable option in the treatment of a patient with multiple

missing teeth.

Careful case selection and abutment preparation as well as periodic recall is the key to

a successful overdenture rehabilitation.

The patient should be made aware of the increased cost and the greater number of

appointments that may be required for the successful completion of the overdenture.

Emphasis should also be placed on rigorous oral hygiene protocol.

Summary

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