With increasing stress on preventive prosthodontics, the use of overdentures has reached a point where it is now a feasible alternative to most treatment plan outlines in the construction of a prosthesis for patients with remaining teeth

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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
Facebook.com/AboarsheedNasa

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OVERDENTURES
Part (2)

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TREATMENT SEQUENCE
FORTHE 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
FORTHE 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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ENDODONTICTHERAPY
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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FLUORIDETHERAPY
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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