Overdentures2 / dental implant courses by Indian dental academy

TOOTH SUPPORTED OVERTOOTH SUPPORTED OVER
DENTUREDENTURE
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.comwww.indiandentalacademy.com

RATIONALERATIONALE

1.1.TO INCREASE PATIENTSTO INCREASE PATIENTS
MANIPULATIVE SKILLS INMANIPULATIVE SKILLS IN
HANDLING THE DENTUREHANDLING THE DENTURE

BY PRESERVING TEETHBY PRESERVING TEETH
PDL PRESERVEDPDL PRESERVED
PROPRIOCEPTIVEPROPRIOCEPTIVE
IMPULSES PRESERVEDIMPULSES PRESERVED

JERGE AND KAWAMURAJERGE AND KAWAMURA
(J. Physiology 1964)(J. Physiology 1964)

KAPUR AND COLLISTERKAPUR AND COLLISTER
(1970)(1970)
 RISSIN et alRISSIN et al
(JPD 1978:39;508-511)(JPD 1978:39;508-511)

2.2. TO DECREASE ALVEOLARTO DECREASE ALVEOLAR
BONE RESORPTIONBONE RESORPTION

WHY DOES ALVEOLARWHY DOES ALVEOLAR
BONE RESORPTION OCCURBONE RESORPTION OCCUR
UNDER CONVENTIONALUNDER CONVENTIONAL
DENTURES ?DENTURES ?

CRUM AND ROONEYCRUM AND ROONEY
( JPD 1978;40;610-613)( JPD 1978;40;610-613)

3.3. TO RETAIN THE TEETH AS ATO RETAIN THE TEETH AS A
PART OF ALVEOLAR BONEPART OF ALVEOLAR BONE
ADVANTAGE:ADVANTAGE:
 BETTER SUPPORTBETTER SUPPORT
 BETTER MASTICATORYBETTER MASTICATORY
FUNCTIONFUNCTION
 INCREASED RETENTION BYINCREASED RETENTION BY
USING ATTACHMENTSUSING ATTACHMENTSwww.indiandentalacademy.comwww.indiandentalacademy.com

ADVANTAGESADVANTAGES
1.1. PRESERVATION OFPRESERVATION OF
ALVEOLAR BONEALVEOLAR BONE
2.2. PRESERVATION OFPRESERVATION OF
PROPRIOCEPTIVEPROPRIOCEPTIVE
MECHANISMMECHANISM

3.3. BETTER SUPPORT ANDBETTER SUPPORT AND
STABILITYSTABILITY
4.4. INCREASED RETENTIONINCREASED RETENTION
5.5. PATIENTS ACCEPTANCEPATIENTS ACCEPTANCE

6.6. A SIMPLE APPROACH TOA SIMPLE APPROACH TO
PROBLEMATIC PATIENTPROBLEMATIC PATIENT
7.7. CONVERTIBILITYCONVERTIBILITY
8.8. POST INSERTIONPOST INSERTION
PROBLEMS ARE MINIMALPROBLEMS ARE MINIMAL

DISADVANTAGESDISADVANTAGES
1.1. CARIES SUSCEPTIBILITYCARIES SUSCEPTIBILITY
2.2. MORE EXPENSIVEMORE EXPENSIVE
3.3. ENCROACHMENT OF INTERENCROACHMENT OF INTER
OCCLUSAL DISTANCEOCCLUSAL DISTANCE

4.4. PRESENCE OF BONYPRESENCE OF BONY
UNDERCUTSUNDERCUTS

i)i) WE CAN BLOCK THESEWE CAN BLOCK THESE
UNDERCUTS AND RELIEFUNDERCUTS AND RELIEF
THAT AREATHAT AREA
(OVER CONTOURING)(OVER CONTOURING)

IMPROPER
LIP
FULLNESS

ii)ii) WE CAN PURPOSELYWE CAN PURPOSELY
SHORTEN THE DENTURESHORTEN THE DENTURE
FLANGE TO END IT AT THEFLANGE TO END IT AT THE
HEIGHT OF CONTOURHEIGHT OF CONTOUR
(UNDER CONTOURING)(UNDER CONTOURING)

DENTURE
FLANGE
SHORTENED

iii)iii) SURGICAL INTERVENTIONSURGICAL INTERVENTION
-USUALLY NOT POSSIBLE-USUALLY NOT POSSIBLE

5.5. FRACTURE OF THEFRACTURE OF THE
DENTURE BASEDENTURE BASE

INDICATIONSINDICATIONS
1.1. PATIENTS WITH POORPATIENTS WITH POOR
PROGNOSIS FORPROGNOSIS FOR
CONVENTIONALCONVENTIONAL
COMPLETE DENTURECOMPLETE DENTURE

 HIGH PALATAL VAULTHIGH PALATAL VAULT
 KNIFE EDGE RIDGEKNIFE EDGE RIDGE
 POORLY DEFINED SUBPOORLY DEFINED SUB
LINGUAL SPACE AND CLASSLINGUAL SPACE AND CLASS
III TONGUE POSITION.III TONGUE POSITION.

2.2. FEW NATURAL TEETHFEW NATURAL TEETH
REMAINING WHICH AREREMAINING WHICH ARE
BADLY TILTED OR AREBADLY TILTED OR ARE
UNSUITABLY SHAPEDUNSUITABLY SHAPED
3.3. PROGNOSIS OF THEPROGNOSIS OF THE
REMAINING TEETH POORREMAINING TEETH POOR

4.4. SEVERESEVERE
GENERALISEDGENERALISED
ATTRITION CASESATTRITION CASES

5.5.COMPLETE DENTURECOMPLETE DENTURE
OPPOSED BY NATURALOPPOSED BY NATURAL
DENTITION ESPECIALLYDENTITION ESPECIALLY
LOWER ANTERIOR TEETHLOWER ANTERIOR TEETH

CONTRAINDICATIONSCONTRAINDICATIONS
1.1. UNCOOPERATIVE ANDUNCOOPERATIVE AND
UNMOTIVATED PATIENTSUNMOTIVATED PATIENTS
2.2. ANY PATIENT WHO WILLANY PATIENT WHO WILL
NOT COOPERATE IN ORALNOT COOPERATE IN ORAL
HYGIENE AND REGULARHYGIENE AND REGULAR
OFFICE PROCEDURESOFFICE PROCEDURES

3.3. MENTALLY ANDMENTALLY AND
PHYSICALLYPHYSICALLY
HANDICAPPED PATIENTSHANDICAPPED PATIENTS
4.4. PATIENTS WHO CAN NOTPATIENTS WHO CAN NOT
AFFORD TREATMENT COSTAFFORD TREATMENT COST
5.5. INADEQUATE INTER ARCHINADEQUATE INTER ARCH
SPACESPACE

PATIENT SELECTIONPATIENT SELECTION
1.1. POSSIBILITY OF FIXED ORPOSSIBILITY OF FIXED OR
REMOVABLE PARTIALREMOVABLE PARTIAL
DENTUREDENTURE
2.2. CARIES STATUSCARIES STATUS
3.3. PATIENTS AGEPATIENTS AGE
4.4. ABUTMENT SELECTIONABUTMENT SELECTION

1.1. PERIODONTAL STATUSPERIODONTAL STATUS
2.2. ENDODONTIC STATUSENDODONTIC STATUS
3.3. CARIES STATUSCARIES STATUS
4.4. LOCATION AND NUMBERLOCATION AND NUMBER
OF ABUTMENTSOF ABUTMENTS
5.5. SPACE BETWEENSPACE BETWEEN
ABUTMENTSABUTMENTS

1. PERIODONTAL STATUS1. PERIODONTAL STATUS

PROSPECTIVE ABUTMENTSPROSPECTIVE ABUTMENTS
SHOULD HAVESHOULD HAVE::
1. MINIMUM MOBILITY1. MINIMUM MOBILITY

2.ADEQUATE
BONE
SUPPORT
ATLEAST
6 mm

3. SHOULD BE AMNEABLE3. SHOULD BE AMNEABLE
TO ANY INDICATEDTO ANY INDICATED
PERIODONTAL TREATMENTPERIODONTAL TREATMENT

TOOLSON AND SMITHTOOLSON AND SMITH
(JPD 1982:41:4-11) AND(JPD 1982:41:4-11) AND
( JPD 1983:49:749-756)( JPD 1983:49:749-756)
DID 2 YEAR AND 5 YEARDID 2 YEAR AND 5 YEAR
STUDY ON OVER DENTURESTUDY ON OVER DENTURE
PATIENTSPATIENTS

TWO YEAR STUDYTWO YEAR STUDY
SHOWED:SHOWED:
ELEVATED PLAQUEELEVATED PLAQUE
SCORES ON ABUTMENTSCORES ON ABUTMENT
TEETH BUT NOTEETH BUT NO
SIGNIFICANT DECREASE INSIGNIFICANT DECREASE IN
PERIODONTAL HEALTHPERIODONTAL HEALTH

FIVE YEARS STUDYFIVE YEARS STUDY
SHOWED THAT:SHOWED THAT:
 PERIDONTAL HEALTH WASPERIDONTAL HEALTH WAS
NOT AT AN OPTIMUMNOT AT AN OPTIMUM
LEVELLEVEL
 THERE WAS A LOSS OFTHERE WAS A LOSS OF
ATTACHED GINGIVAATTACHED GINGIVA
BETWEEN SECOND ANDBETWEEN SECOND AND
FIFTH YEAR OF FOLLOWFIFTH YEAR OF FOLLOWwww.indiandentalacademy.comwww.indiandentalacademy.com

CONTRAINDICATIONS OFCONTRAINDICATIONS OF
USING PERIODONTALLYUSING PERIODONTALLY
INVOLVED TEETH ARE:INVOLVED TEETH ARE:
1. GRADE THREE MOBILITY1. GRADE THREE MOBILITY

2. FAILURE TO ESTABLISH2. FAILURE TO ESTABLISH
ZONE OF ATTACHEDZONE OF ATTACHED
GINGIVA BY MUCOGINGIVA BY MUCO
-GINGIVAL SURGERIES-GINGIVAL SURGERIES
3. OSSEOUS DEFECTS3. OSSEOUS DEFECTS
WHICH CAN NOT BEWHICH CAN NOT BE
CORRECTED BY SURGERYCORRECTED BY SURGERY

2. ENDODONTIC STATUS2. ENDODONTIC STATUS

IDEALLY SINGLE ROOTEDIDEALLY SINGLE ROOTED
TEETH WITH A SINGLETEETH WITH A SINGLE
CANAL THAT CAN BECANAL THAT CAN BE
EASILY NEGOTIABLE AREEASILY NEGOTIABLE ARE
BEST CANDIDATESBEST CANDIDATES

ETTINGER R. et alETTINGER R. et al
(JPD 1984;52:532-537)(JPD 1984;52:532-537)

3. CARIES STATUS OF3. CARIES STATUS OF
ABUTMENTABUTMENT

4. ABUTMENT NUMBER AND4. ABUTMENT NUMBER AND
LOCATIONLOCATION

IF PATIENT PRESENTSIF PATIENT PRESENTS
WITH GREATER THAN 4WITH GREATER THAN 4
RETAINABLE TEETH IN ANRETAINABLE TEETH IN AN
ARCH THAT AREARCH THAT ARE
PERIODONTALLY SOUND -PERIODONTALLY SOUND -

LOCATION OF TEETH ISLOCATION OF TEETH IS
IMPORTANT FOR SUPPORTIMPORTANT FOR SUPPORT
OF OVER DENTURE ANDOF OVER DENTURE AND
PRESERVATION OF THEPRESERVATION OF THE
ALVEOLAR BONEALVEOLAR BONE

4 ABUTMENTS IN ONE ARCH

MAXILLARY CANINES AND CENTRAL
INCISOR-TRIPOD

IF THREE ABUTMENTS
(2 ON ONE SIDE OF ARCH)
CAN CAUSE UN BALANCE

IF ONLY 2 ABUTMENTS
TWO CANINES TWO PRE MOLARS

CANINES ARE USED MOSTCANINES ARE USED MOST
AS ABUTMENTSAS ABUTMENTS
CANINES>PRE MOLARS >CANINES>PRE MOLARS >
INCISORS>MOLARSINCISORS>MOLARS

5. SPACE BETWEEN5. SPACE BETWEEN
ABUTMENTSABUTMENTS

RESULTS ARE BETTER IFRESULTS ARE BETTER IF
ABUTMENTS ARE NOTABUTMENTS ARE NOT
APPROXIMATINGAPPROXIMATING
BECAUSE:BECAUSE:
1) THEY DO NOT PROVIDE1) THEY DO NOT PROVIDE
MORE SUPPORT ANDMORE SUPPORT AND
STABILITY THAN 1STABILITY THAN 1
ABUTMENTABUTMENT

2) MORE DIFFICULT FOR2) MORE DIFFICULT FOR
PATIENT TO KEEPPATIENT TO KEEP
ABUTMENTS CLEANABUTMENTS CLEAN
3) MAY MAKE TOOTH3) MAY MAKE TOOTH
POSITIONING ONPOSITIONING ON
OVERDENTURE MOREOVERDENTURE MORE
DIFFICULTDIFFICULTwww.indiandentalacademy.comwww.indiandentalacademy.com

TYPES OF OVER DENTURESTYPES OF OVER DENTURES
Depending primarily onDepending primarily on
the status of the patientsthe status of the patients
dentition at the start ofdentition at the start of
treatment (ALLEN A.treatment (ALLEN A.
BREWER ):BREWER ):

1.IMMEDIATE OVER1.IMMEDIATE OVER
DENTUREDENTURE
2. TRANSITION OVER2. TRANSITION OVER
DENTUREDENTURE
3.REMOTE / DEFINITIVE3.REMOTE / DEFINITIVE
OVER DENTUREOVER DENTURE

1. IMMEDIATE OVER1. IMMEDIATE OVER
DENTUREDENTURE

AN IMMEDIATE OVERAN IMMEDIATE OVER
DENTURE IS EASY TO USEDENTURE IS EASY TO USE
AND USES NOAND USES NO
SPECIALISED CASTINGSSPECIALISED CASTINGS

IT IS A RELIABLEIT IS A RELIABLE
PROGNOSTIC AID AND APROGNOSTIC AID AND A
PRE REQUISITE TO THEPRE REQUISITE TO THE
MORE SOPHISTICATEDMORE SOPHISTICATED
TECHNIQUETECHNIQUE

PROCEDUREPROCEDURE
SELECT TEETH TO BESELECT TEETH TO BE
RETAINED AS ABUTMENTSRETAINED AS ABUTMENTS
IF ARCH HAS LARGEIF ARCH HAS LARGE
NUMBER OF HOPELESSNUMBER OF HOPELESS
TEETH REMOVETEETH REMOVE
POSTERIOR HOPELESSPOSTERIOR HOPELESS
TEETH IN INCREMENTSTEETH IN INCREMENTS

HOPELESS ANTERIOR TEETHHOPELESS ANTERIOR TEETH
RETAINEDRETAINED
DURING HEALING PERIODDURING HEALING PERIOD
ENDODONTIC ANDENDODONTIC AND
PERIODONTAL TREATMENTPERIODONTAL TREATMENT
OF PROPOSED ABUTMENTS ISOF PROPOSED ABUTMENTS IS
DONEDONE
ORAL HYGIENE PROCEDURESORAL HYGIENE PROCEDURES
ARE EMPHASIZEDARE EMPHASIZED

DUAL IMPRESSION OF
THE ARCH TAKEN

OCCLUSAL RIMS JAW RELATIONS

SELECTING ANDSELECTING AND
POSITIONING TEETHPOSITIONING TEETH
METHOD BY LORD AND TEELMETHOD BY LORD AND TEEL
(DCNA 1969:13:871-881)(DCNA 1969:13:871-881)

TEETH OF APPROPRIATE
MOLD SELECTED

ALL TEETH EXCEPT SERVICING
AS ABUTMENT ARE REPLACED
BY DENTURE TEETH

ABUTMENT TEETH ON
CAST ARE PREPARED

TEETH SHORTENED AXIAL SURFACES
TAPERED

ABUTMENT HEIGHT MEASURED ON CAST

RESIN DENTURE TEETH SELECTED
(BEFORE PREPARATION)

TEETH HOLLOWED WITH BUR

POSITIONED OVER
CAST PREPARATION

MARGIN AROUND EACH
ABUTMENT INDENTATION
IS SMOOTHENED

ABUTMENT TEETH REDUCED

PREPARED TEETH TREATEDPREPARED TEETH TREATED
WITH APF GELWITH APF GEL
( 1 MIN - 2 APPLICATIONS)( 1 MIN - 2 APPLICATIONS)

REMAINING HOPLESS
ANTERIOR TEETH REMOVED

IMMEDIATE OVER DENTURE INSERTED
OCCLUSION CHECKED

ADAPTATION OF OVERADAPTATION OF OVER
DENTURE TO THEDENTURE TO THE
ABUTMENTABUTMENT

SMALL HOLE PLACED

TOOTH COLOURED ACRYLIC
RESIN PLACED

EXCEES
REMOVED
MARGINS
SMOOTHENED

RELININGRELINING

IF RESPONSE IS POORIF RESPONSE IS POOR
AND ORAL HYGIENEAND ORAL HYGIENE
INADEQUATEINADEQUATE

IF ABUTMENT FAILUREIF ABUTMENT FAILURE
IS SUREIS SURE

IF RESPONSE IS GOODIF RESPONSE IS GOOD

2.TRANSITIONAL OVER2.TRANSITIONAL OVER
DENTURE / ADDITIVEDENTURE / ADDITIVE
DENTUREDENTURE

ADVANTAGEADVANTAGE
1.LESS COSTLY1.LESS COSTLY
2. PATIENTS PREVIOUS2. PATIENTS PREVIOUS
EXPERIENCE WITH THEEXPERIENCE WITH THE
PARTIAL DENTUREPARTIAL DENTURE
PERMITS A SMOOTHPERMITS A SMOOTH
TRANSITION TO OVERTRANSITION TO OVER
DENTURE STATUSDENTURE STATUS

DISADVANTAGEDISADVANTAGE

CONVERSIONCONVERSION

PREMOLAR AND CANINE REMAINING
RPD

IMPRESSION WITH
PARTIAL DENTURE

AUTO POLYMERISING RESIN OF
APPROPRIATE SHADE
PLACED INTO
ABUTMENT
INDENTATIONS

IMPRESSION WITH PARTIAL DENTURE
SEATED IN MOUTH-REMOVED

FLANGES ADDED WITH
AUTO POLYMERISING RESIN

PLACED IN MOUTH
AND CHECKED FOR OCCLUSION

3.REMOTE / DEFINITIVE3.REMOTE / DEFINITIVE

IT IS USUALLYIT IS USUALLY
CONSTRUCTED FORCONSTRUCTED FOR
INSERTION AT SOME TIMEINSERTION AT SOME TIME
‘REMOTE’ FROM THE‘REMOTE’ FROM THE
REMOVAL OF HOPELESSREMOVAL OF HOPELESS
NATURAL TEETHNATURAL TEETH

1.NON COPING1.NON COPING
A) WITH ENDODONTICA) WITH ENDODONTIC
TREATMENTTREATMENT

NON COPING WITHNON COPING WITH
ENDODONTICENDODONTIC
TREATMENTTREATMENT

B) WITHOUTB) WITHOUT
ENDODONTICENDODONTIC
TREATMENTTREATMENT

2) COPING2) COPING
2 TYPES OF COPINGS:2 TYPES OF COPINGS:
A) SHORT COPINGA) SHORT COPING
B) LONG COPINGB) LONG COPING

A) SHORT COPINGA) SHORT COPING
2-3 mm long
(Dome shaped)
Require
Endo
treatmentwww.indiandentalacademy.comwww.indiandentalacademy.com

B) LONG COPINGB) LONG COPING
5-8mm long
(long ellipsoidal
shaped)

3. ABUTMENTS WITH3. ABUTMENTS WITH
ATTACHMENTSATTACHMENTS

ATTACHMENT

Part I endPart I end

ATTACHMENTS CAN BEATTACHMENTS CAN BE
CLASSIFIED AS :CLASSIFIED AS :
1.1. INTRA RADICULARINTRA RADICULAR
ATTACHMENTS:ATTACHMENTS:
( eg:Zest Anchor)( eg:Zest Anchor)
2.2. EXTRA RADICULAREXTRA RADICULAR
ATTACHMENTS:ATTACHMENTS:

A)A) STUD ATTACHMENTSSTUD ATTACHMENTS
(eg:Rothermann,(eg:Rothermann,
Dalbo, Bonaball)Dalbo, Bonaball)
B)B) BAR ATTACHMENTSBAR ATTACHMENTS
(eg:Dolder bar, Hader bar,(eg:Dolder bar, Hader bar,
Ackerman clip)Ackerman clip)
3.3. MAGNET ATTACHMENTSMAGNET ATTACHMENTS

INTRA RADICULARINTRA RADICULAR

ZEST ANCHORZEST ANCHOR

MALE POST
AND HEAD
(NYLON)
FEMALE
SLEEVE

ADVANTAGEADVANTAGE
1.1. Space problem is less.Space problem is less.
2.2. Minimal leverage on theMinimal leverage on the
abutment tooth.abutment tooth.
3.3. Attachment used without aAttachment used without a
Dowel or coping.Dowel or coping.www.indiandentalacademy.comwww.indiandentalacademy.com

4.4. Pick up in the denture withPick up in the denture with
resin is easy.resin is easy.
5.5. If more than one tooth isIf more than one tooth is
used parallelihg ofused parallelihg of
attachment is not necessary.attachment is not necessary.

1.1.No coping Root surfaceNo coping Root surface
exposed Susceptibleexposed Susceptible
to cariesto caries
2.2.Nylon male portion bendsNylon male portion bends
and breaks very easily.and breaks very easily.

3.3. When many Zest anchorsWhen many Zest anchors
used - male nylon portionused - male nylon portion
may bend - preventingmay bend - preventing
proper seating.proper seating.
4.4. If patient attempts eatingIf patient attempts eating
without denture - foodwithout denture - food
particles enters femaleparticles enters female
housing - very difficult tohousing - very difficult to
remove them.remove them.www.indiandentalacademy.comwww.indiandentalacademy.com

EXTRA RADICULAR STUDEXTRA RADICULAR STUD

MALE STUD
(Soldered to coping)
COPING
FEMALE HOUSING

FEMALE HOUSING
EMBEDDED INTO ACRYLIC

STUD ATTACHMENTS CANSTUD ATTACHMENTS CAN
BE :BE :
1)1) RESILIENT STUDSRESILIENT STUDS
2)2) NON-RESILIENT STUDSNON-RESILIENT STUDS

RESILIENT STUDSRESILIENT STUDS
Examples:Examples:
• Resilient GerberResilient Gerber
• Resilient CekaResilient Ceka
• Resilient RothermannResilient Rothermann
• BonnaballBonnaball
• Resilient Bonna cylinderResilient Bonna cylinder
• Resilient DalboResilient Dalbo
• AncrofixAncrofix www.indiandentalacademy.comwww.indiandentalacademy.com

NON-RESILIENT STUDSNON-RESILIENT STUDS
Examples:Examples:
• Non- Resilient GerberNon- Resilient Gerber
• Non-Resilient CekaNon-Resilient Ceka
• Non-Resilient RothermannNon-Resilient Rothermann
• IntrofixIntrofix
• Non-Resilient Bonna cylinderNon-Resilient Bonna cylinder
• Non-Resilient DalboNon-Resilient Dalbowww.indiandentalacademy.comwww.indiandentalacademy.com

GERBER ATTACHMANTGERBER ATTACHMANT
2 TYPES:2 TYPES:
A)A) Non resilient /GerberNon resilient /Gerber
cylinder.cylinder.
B)B) Resilient.Resilient.

NON RESILIENT GERBERNON RESILIENT GERBER
HOUSING
(Tent shaped)
RETENTION SPRING
CLIP
RETENTION RING
MALE POST
SOLDERING BASE
FEMALE
PARTS
MALE
PARTS

ADVANTAGEADVANTAGE
1.1. All components areAll components are
replaceable and solder basereplaceable and solder base
is interchangeable withis interchangeable with
resilient Gerber.resilient Gerber.

2.2. Solid fixation and minimalSolid fixation and minimal
torque on the tooth if thetorque on the tooth if the
denture base is adapteddenture base is adapted
adequately.adequately.
3.3. Fabrication is simple.Fabrication is simple.
4.4.Provides adequate retentionProvides adequate retention

1)1) Expensive.Expensive.
2)2) Attachment can place torqueAttachment can place torque
on the tooth if denture base ison the tooth if denture base is
not adapted adequately.not adapted adequately.
3)3) Mandrel is required to parallelMandrel is required to parallel
the attachments when morethe attachments when more
than one attachment is used.than one attachment is used.

RESILIENT GERBERRESILIENT GERBER

Consist of 9 parts.Consist of 9 parts.
Overall height is 4.7 mm.Overall height is 4.7 mm.
One of the mostOne of the most
sophisticated studsophisticated stud
attachment.attachment.

Most expensive studMost expensive stud
attachment.attachment.
Imparts less torque onImparts less torque on
abutment - allows denture toabutment - allows denture to
utilize more of the residualutilize more of the residual
ridge for support.ridge for support.

ADVANTAGEADVANTAGE
1)1) All components areAll components are
replaceable andreplaceable and
interchangeable solderinterchangeable solder
base.base.
2)2) Spring loaded resiliencySpring loaded resiliency
allows the base to adaptallows the base to adapt
under function.under function.

3)3) Resilient attachment can beResilient attachment can be
made non resilient bymade non resilient by
keeping a copper shimkeeping a copper shim
(0.4mm thick) in the female(0.4mm thick) in the female
housing.housing.

1.1.BulkyBulky
2.2. More complexMore complex
3.3. Resilient spring needs toResilient spring needs to
be changed every 4 months.be changed every 4 months.

4.4. Mandrel required forMandrel required for
paralleling if more than oneparalleling if more than one
attachment is used.attachment is used.
5.5. Expensive tool kit isExpensive tool kit is
required for servicing therequired for servicing the
unit.unit.

QUINLIVAN ATTACHMENTQUINLIVAN ATTACHMENT

PRE
FABRICATED
RESIN BALL
FEMALE HOUSING

DOME SHAPED
FEMALE
HOUSING
LIP FOR
‘O’ RING
MALE
PART

1.1. Overall height is 3mm-can beOverall height is 3mm-can be
used in limited space areas.used in limited space areas.
2.2. Can be used in divergentCan be used in divergent
abutments.abutments.
3.3. Provides good retention.Provides good retention.
4.4. Easy to use.Easy to use.

5.5. Provides fixation withProvides fixation with
rotational movement.rotational movement.
6.6. ‘O’ ring can be easily changed.‘O’ ring can be easily changed.

1.1. Male component, which isMale component, which is
cast, could have porosities.cast, could have porosities.
2.2. Wear of male portion.Wear of male portion.

DALBO ATTACHMENTDALBO ATTACHMENT

3 TYPES:3 TYPES:
1.1. RIGIDRIGID
2.2. RESILIENTRESILIENT
3.3. STRESS BROKEN.STRESS BROKEN.

i) RIGID DALBOi) RIGID DALBO
Has a cylindrical male unitHas a cylindrical male unit
with a round head that iswith a round head that is
attached to the tooth and aattached to the tooth and a
female housing imbeddedfemale housing imbedded
in denture.in denture.

ii) RESILIENT DALBOii) RESILIENT DALBO
Sphere shaped male unitSphere shaped male unit
which allow rotational andwhich allow rotational and
vertical movement of thevertical movement of the
female unit around it.female unit around it.
Smallest and most commonlySmallest and most commonly
used.used. www.indiandentalacademy.comwww.indiandentalacademy.com

iii) STRESS BROKEN DALBOiii) STRESS BROKEN DALBO
Similar in design to resilientSimilar in design to resilient
type but female housing istype but female housing is
longer and incorporates alonger and incorporates a
coil spring.coil spring.

CEKA ATTACHMENTCEKA ATTACHMENT
2 TYPES:2 TYPES:
A)A) RIGID TYPERIGID TYPE
B)B) RESILIENT TYPERESILIENT TYPE

SOLDER BASE
REMOVABLE STUD (MALE )
FEMALE HOUSING
(QUARTERED VERTICALLY
INTO FLEXIBLE
SECTIONS)

1)1) Allow for either rigid orAllow for either rigid or
resilient fixation.resilient fixation.
2)2) lamellae are adjustable andlamellae are adjustable and
male stud is removable.male stud is removable.
3)3) Servicing is easy.Servicing is easy.www.indiandentalacademy.comwww.indiandentalacademy.com

1. More height and bulk.1. More height and bulk.
2. Non resilient Ceka can produce2. Non resilient Ceka can produce
excessive torque on the teethexcessive torque on the teeth
unless overdenture base isunless overdenture base is
adapted correctly on residualadapted correctly on residual
ridge.ridge.

BONA BALL ANCHORBONA BALL ANCHOR
SOLDER BASE
SPHERE
LAMELLAE
PVC RING

1. Easy to use.1. Easy to use.
2. Lamellae can provide retention2. Lamellae can provide retention
adjustments and compensateadjustments and compensate
for wear of the metal ball.for wear of the metal ball.

1.1. Male component is notMale component is not
replaceable.replaceable.
2.2. A mandrel is required forA mandrel is required for
paralleling two or moreparalleling two or more
attachments.attachments.

BONA CYLINDER ANCHORBONA CYLINDER ANCHOR
2 TYPES:2 TYPES:
A)A) RESILIENT TYPERESILIENT TYPE
B)B) NON RESILIENT TYPENON RESILIENT TYPE

CYLINDRICAL
MALE POST
LAMELLAE (8)
PVC RING

1.1. Increase number of lamellaeIncrease number of lamellae
provides softer and moreprovides softer and more
precise retention.precise retention.
2.2. If 1 or 2 lamellae breakIf 1 or 2 lamellae break
retention in the housing is stillretention in the housing is still
adequateadequate
3.3. Easy to use.Easy to use.

1.1.Male component is notMale component is not
replaceable.replaceable.
2.2.Mandrel is required for parallelingMandrel is required for paralleling
when 2 or more attachments arewhen 2 or more attachments are
used.used.
3.3.Cylinder configuration canCylinder configuration can
produce some torque on the toothproduce some torque on the tooth
if the denture base is not adaptedif the denture base is not adapted
adequately.adequately. www.indiandentalacademy.comwww.indiandentalacademy.com

ROTHERMANN ATTACHMENTROTHERMANN ATTACHMENT
 Most popular attachment.Most popular attachment.
 Short stud attachment.Short stud attachment.
 2 types :2 types :
a)a) Resilient typeResilient type
b)b) Non resilient typeNon resilient type

ROTHERMANN NON RESILIENTROTHERMANN NON RESILIENT
MALE STUD
WITH SOLDER
CORE
PERFORATED ARM
C-RING
ORIENTATION
NOTCH

1)1) Attachment low in height.Attachment low in height.
2)2) Less lab timeLess lab time
3)3) Retention can be adjusted byRetention can be adjusted by
spreading the retention ring.spreading the retention ring.
4)4) Torque is minimum.Torque is minimum.

1)1) Lingual bulk present.Lingual bulk present.
2)2) No path in or guidance forNo path in or guidance for
seating the denture.seating the denture.

ROTHERMANN RESILIENTROTHERMANN RESILIENT
NON RESILIENT
(1.1 mm)
RESILIENT
(1.7 mm)

INTROFIX ATTACHMENTINTROFIX ATTACHMENT
FEMALE CYLINDRICAL
HOUSING
MALE PART
SOLDER BASE
WITH THREADS

1)1) Simple to use.Simple to use.
2)2) Components are replaceable.Components are replaceable.
3)3) Attachments provide goodAttachments provide good
seating and retention.seating and retention.

1)1) Require mandrel forRequire mandrel for
paralleling.paralleling.
2)2) Torque potential maximum ifTorque potential maximum if
denture base is not adapteddenture base is not adapted
adequately.adequately.

ANCROFIX ATTACHMENTANCROFIX ATTACHMENT
HOUSING WITH 4
LAMELLAE
TEFLON RING
SOLDER BASE
RETENTION HEAD

1)1) Allows rotational movements.Allows rotational movements.
2)2) Components can be replaced.Components can be replaced.
3)3) Retention can be easilyRetention can be easily
adjusted.adjusted.
4)4) Solder base is interchangeableSolder base is interchangeable
with the Introfix attachment.with the Introfix attachment.
5)5) Simple.Simple.

1)1) Paralleling mandrel required ifParalleling mandrel required if
greater than 1 attachment isgreater than 1 attachment is
used.used.
2)2) Can place torque on teeth.Can place torque on teeth.

BAR ATTACHMENTBAR ATTACHMENT
2 GROUPS:2 GROUPS:
A)A) BAR UNITBAR UNIT
B)B) BAR JOINTBAR JOINT

DOLDER BARDOLDER BAR
A)A) DOLDER BAR UNITDOLDER BAR UNIT
B)B) DOLDER BAR JOINTDOLDER BAR JOINT

RIDER CLIP
DOWEL
COPING
DOLDER
BAR

DOLDER BAR UNITDOLDER BAR UNIT
RIDER CLIP
CHURCH WINDOW
PROFILE (Parallel walls)
Retention mesh
Denture base

RIDER CLIP
RETENTION
MESH
BAR
(CHURCH
WINDOW
SHAPED)

DOLDER BAR JOINTDOLDER BAR JOINT
SPACE TO PROVIDE
RESILIENCY
RIDER
EGG SHAPED
PROFILE

ADVANTAGES OF DOLDER BARADVANTAGES OF DOLDER BAR
1.Bar and rider are available in1.Bar and rider are available in
two heights.two heights.
2.Rider and bar available in many2.Rider and bar available in many
lengths.lengths.
3.Bar can be bend and shaped to3.Bar can be bend and shaped to
any configuration.any configuration.

Dolder bar to be bent to
conform to ridge and rider
should fit straight section.

HADER BAR ATTACHMENTHADER BAR ATTACHMENT
PLASTIC RIDER
BAR
(KEY HOLE
SHAPED)

1.1. Bar can be fabricated inBar can be fabricated in
any alloy.any alloy.
2.2. If more retention is neededIf more retention is needed
metal riders can be used.metal riders can be used.

1.1. Riders are too bulky.Riders are too bulky.
2.2. Rider retention decreasesRider retention decreases
rapidly.rapidly.
3.3. No tension adjustment.No tension adjustment.

ACKERMANN BARACKERMANN BAR
ATTACHMENT AND CM CLIPATTACHMENT AND CM CLIP
ATTACHMENTATTACHMENT

RETENTION
WINGS
BAR
(ROUND)
(1.8-1.9 mm)
Rider

1.1. Increased retention in acrylicIncreased retention in acrylic
due to wings.due to wings.
2.2. Spacer provides resilience andSpacer provides resilience and
rotation (rotation alone ifrotation (rotation alone if
spacer not used).spacer not used).

Procedure of using Dolder barProcedure of using Dolder bar
Prepare the abutments with a common
path of insertion.
 Complete the cast of post copingsComplete the cast of post copings
 Try in post copings in the mouth,useTry in post copings in the mouth,use
temporary cement and fix ittemporary cement and fix it

 take a full arch impression
 Pour the model.
 Fab special tray, do border molding,removeFab special tray, do border molding,remove
the coping,reseat it on the tooth and takethe coping,reseat it on the tooth and take
pick up impression(place temporarypick up impression(place temporary
restoration on the tooth).restoration on the tooth).
 Prepare master cast
 Prepare occlusal rimsPrepare occlusal rims

Record the jaw relations, and
complete wax set-up and try-in in
the mouth
Return wax set-up to the masterReturn wax set-up to the master
cast. Make plaster or putty labial,cast. Make plaster or putty labial,
buccal, and occlusal keys orbuccal, and occlusal keys or
indexes. Remove the keys orindexes. Remove the keys or
indexes and the wax set-up fromindexes and the wax set-up from
the master castthe master cast

Cut the bar to the desired
length. Affix it to its
retainers with sticky wax
considering ridge contour
and according to the desired
path of insertion.

Affix retainers with
sticky wax

Invest the abutment retainers andInvest the abutment retainers and
bar in soldering investment.bar in soldering investment.

Reseat bar on master castReseat bar on master cast
Fit the sleevesleeve to length by cutting
between the weld points

Fill any space between the bar
and ridge with plaster and also
bring the plaster halfway up the
height of the female sleeve
creating space for function of
the attachment

Reposition the plaster keys
or indexes with teeth on the
master model. Prepare the
wax set-up of the prosthesis
for acrylic processing.
Invest, finish,www.indiandentalacademy.comwww.indiandentalacademy.com

Remove the
plaster after
polymerizatio
n. The
segments are
now free for
activating

Any retention
adjustment is
completed by
inserting a
small
instrument
between the
acrylic base
and clean
female sleevewww.indiandentalacademy.comwww.indiandentalacademy.com

MAGNET ATTACHMENTSMAGNET ATTACHMENTS

• Magnetic attachmentsMagnetic attachments
dissipate lateral forcesdissipate lateral forces
preventing them from beingpreventing them from being
transferred to the abutment .transferred to the abutment .
• PreviouslyPreviously- ALNICO or- ALNICO or
Cobalt-Platinum magnets.Cobalt-Platinum magnets.
• After 1977-After 1977- Cobalt –Cobalt –
Samarium and Neodymium –Samarium and Neodymium –
iron –boron type magnetsiron –boron type magnetswww.indiandentalacademy.comwww.indiandentalacademy.com

Qualities of magnets which areQualities of magnets which are
required in dentistry are:required in dentistry are:
a)a) Strong magnetic field.Strong magnetic field.
b)b) Magnetic permanence.Magnetic permanence.
c)c) Durability and compactness.Durability and compactness.

2 ways in which magnets can2 ways in which magnets can
effect tissues:effect tissues:
i)i) Physical effect.Physical effect.
ii)ii) Chemical effect.Chemical effect.

Roth (1968) , Becker (1963)-:Roth (1968) , Becker (1963)-:
Damaging tissue effects ofDamaging tissue effects of
magnetism were noted butmagnetism were noted but
only with magnetic fieldsonly with magnetic fields
considerably stronger thanconsiderably stronger than
those associated with thethose associated with the
dental use of magnets.dental use of magnets.

Lamb et al. ,Morin and Daniel:-Lamb et al. ,Morin and Daniel:-
the dental use of Cobalt-the dental use of Cobalt-
Somarium magnets is mostSomarium magnets is most
unlikely to cause any harm tounlikely to cause any harm to
tissues.tissues.

OPEN FIELD TYPE

CLOSED FIELD TYPE

ATTACHED KEEPER
PAIRED
MAGNETS
DETACHABLE KEEPERwww.indiandentalacademy.comwww.indiandentalacademy.com

CLINICAL PROCEDURESCLINICAL PROCEDURES

Three different procedures can beThree different procedures can be
used to fix the keeper elementused to fix the keeper element
(detachable keeper) to the root:-(detachable keeper) to the root:-
i)i) Keeper element can beKeeper element can be
cemented.cemented.
ii)ii) Can be held with self threadingCan be held with self threading
pins.pins.
iii)iii) A root cap and post casting canA root cap and post casting can
be made of magnetizable castingbe made of magnetizable casting
alloy.alloy. www.indiandentalacademy.comwww.indiandentalacademy.com

PROCEDURE FORPROCEDURE FOR
CEMENTED KEEPERCEMENTED KEEPER

Tooth anaesthesized-crownTooth anaesthesized-crown
removed(1-2 mm crown aboveremoved(1-2 mm crown above
gingiva) -endo treatment donegingiva) -endo treatment done

Wheel diamond used
to flatten the surface of tooth

Root canal penetrated
to depth of 3 mm
using small round bur

Straight fissure bur is used
to enlarge cavity in bucco-lingual
direction in oval shape

Inverted cone bur
used to give under
cuts

Keeper element tested in the cavity

Keeper element cemented

Tooth polished with pumiceTooth polished with pumice

SUB MUCOSAL VITALSUB MUCOSAL VITAL
ROOT RETENTIONROOT RETENTION

GARYER et al.GARYER et al.
(JPD1980:368-373)(JPD1980:368-373)

Internal bevel
incision given

Teeth
sectioned
0.5mm above
the crestal
Bone
(contoured
according
to existing
Residual
Ridge form)www.indiandentalacademy.comwww.indiandentalacademy.com

suturing

DENTURES RELINED WITHDENTURES RELINED WITH
TISSUE CONDITIONERS INTISSUE CONDITIONERS IN
AREAS OF SURGERY ANDAREAS OF SURGERY AND
PLACEDPLACED

4 weeks after surgery

1.1.REDUCED COSTREDUCED COST
2.2. PROSTHESIS CAN BEPROSTHESIS CAN BE
CONSTRUCTED EVEN IN BADCONSTRUCTED EVEN IN BAD
ORAL HYGIENE CONDITIONS.ORAL HYGIENE CONDITIONS.
3.3.PRESERVATION OFPRESERVATION OF
ALVEOLAR RIDGEALVEOLAR RIDGE

1.1.RETENTION NOTRETENTION NOT
INCREASEDINCREASED
APPRECIABLY AND ONEAPPRECIABLY AND ONE
LOOSES THE STABILITYLOOSES THE STABILITY
PROVIDED BY VERTICALPROVIDED BY VERTICAL
WALLS OF THEWALLS OF THE
ABUTMENT.ABUTMENT.

2.2.DEVELOPMENT OFDEVELOPMENT OF
DEHISCENSE OVER THEDEHISCENSE OVER THE
ROOTS AND PULPALROOTS AND PULPAL
PATHOSIS.PATHOSIS.
3.3.ATTEMPT TO GAINATTEMPT TO GAIN
RETENTION FROM THE TEETHRETENTION FROM THE TEETH
USING SOME FORM OFUSING SOME FORM OF
ATTACHMENT IS NO LONGERATTACHMENT IS NO LONGER
POSSIBLE.POSSIBLE. www.indiandentalacademy.comwww.indiandentalacademy.com

REMOVABLE PARTIAL OVERREMOVABLE PARTIAL OVER
DENTUREDENTURE
WE CAN CHANGE A FREEWE CAN CHANGE A FREE
SADDLE OR TOOTH TISSUESADDLE OR TOOTH TISSUE
SUPPORTED RPD INTO ASUPPORTED RPD INTO A
SIMPLE, TOOTH SUPPORTEDSIMPLE, TOOTH SUPPORTED
RPDRPD

Periodontally
compromised canine

SUMMARYSUMMARY

CONCLUSIONCONCLUSION

REFERRENCESREFERRENCES

Overdentures – Allen A.Overdentures – Allen A.
Brewer , 2Brewer , 2ndnd
edition .edition .
Essentials of completeEssentials of complete
denture Prosthodontics –denture Prosthodontics –
Winkler , 2Winkler , 2ndnd
edition .edition .
Textbook of completeTextbook of complete
dentures – C . M .Heatrwell ,dentures – C . M .Heatrwell ,
55thth
edition .edition .

Prosthdontic treatmemnt forProsthdontic treatmemnt for
edentulous patients – Boucher , 10edentulous patients – Boucher , 10thth
edition .edition .
Attachment fixation for overdenturesAttachment fixation for overdentures
– part 1 , M. C. Mensor , JPD 1977 ,– part 1 , M. C. Mensor , JPD 1977 ,
37; 366-373.37; 366-373.
Attachment fixation for overdenturesAttachment fixation for overdentures
– part 2 , M. C. Mensor , JPD 1978 ,– part 2 , M. C. Mensor , JPD 1978 ,
39; 16-2039; 16-20

Effects of OD on remaining oralEffects of OD on remaining oral
structures – H . H. Thayer , JPD 1977structures – H . H. Thayer , JPD 1977
, 37; 374-381., 37; 374-381.
A retentive attachments for OD – B .A retentive attachments for OD – B .
E. Stansbury ,JPD 1976 , 35; 228-230E. Stansbury ,JPD 1976 , 35; 228-230
Prevention of complete denturePrevention of complete denture
problems by use of OD- C .problems by use of OD- C .
A.Dodge ,JPD 1973 ,30;403-411A.Dodge ,JPD 1973 ,30;403-411www.indiandentalacademy.comwww.indiandentalacademy.com

Immediate interim tooth supportedImmediate interim tooth supported
CD – R . M. Morrow:JPDCD – R . M. Morrow:JPD
1973:30:695-7001973:30:695-700
USE OF ROOTS TO ESTABLISHUSE OF ROOTS TO ESTABLISH
FAVOURABLE RPD DESIGN:CASEFAVOURABLE RPD DESIGN:CASE
REPORTS: QUINT INT:1994:25:173-REPORTS: QUINT INT:1994:25:173-
176176
Root retained Ods:part I-Root retained Ods:part I-
Y.Langer:JPD 1991:66:784-789.Y.Langer:JPD 1991:66:784-789.

The bar joint mandibular denture :The bar joint mandibular denture :
:E.J.Dolder:JPD 1961:11:689-705:E.J.Dolder:JPD 1961:11:689-705
INVESTIGATION INTO FAILURE OFINVESTIGATION INTO FAILURE OF
DENTALDENTAL
MAGNETS:IJP:1991:12:249-254MAGNETS:IJP:1991:12:249-254
OVER DENTURE OVERSIGHTOVER DENTURE OVERSIGHT
:A.H.FENTON:DCNA 1979:23:117-:A.H.FENTON:DCNA 1979:23:117-
129129

Complete dentures supported byComplete dentures supported by
natural teeth: Paul l Miller:JPDnatural teeth: Paul l Miller:JPD
1958:8:924-9281958:8:924-928

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