case reports - tooth supported over dentures

1. A Full Mouth Rehabilitation with Maxillary
Immediate Denture & Mandibular Tooth
Supported Magnet Retained Over-denture: A
Case Report
SONAM KUMARI , SAGNIK BANERJEE , NITISH VARSHNEY, SHALABH KUMAR, MANOJ
KUMAR AND GAURAV ISSAR
INTERNATIONAL JOURNAL OF RESEARCH AND REPORTS IN DENTISTRY
Journal club presentation
Presented by
Namitha AP
3RD YEAR MDS

2. Contents
 Introduction
 Clinical reports
 Discussion
 Conclusion
 Related articles
 References

3. Introduction
Tooth supported
overdentures
Non coping Coping
Short Long
Attachments
Studs Magnets Bar
The roots of the tooth offers the
best available support for
occlusal forces.
Accelerated rate of
bone resorption is
prevented
increases patient’s manipulative
skills in handling the denture.
periodontal
membrane is
preserved ,thus
proprioceptive
impulses, part of
myo-facial complex
are retained
Occlusal forces are transmitted on oblique fibres
and dissipated as tension resulting in osteoblastic
response

4. Case report
 Chief complaint of missing teeth in upper
back region and multiple missing teeth in
lower arch since 6 years.
 On intraoral examination -only maxillary
centrals and lateral was present with poor
periodontal support and mandibular 33,
34, 35, 44, 45 was present.
A 43 years old non-smoker, female patient

5.  Diagnostic impression was made and model was
poured in dental stone.
 On maxillary model mock surgery was done to prepare
the radiographic stent.
 Jaw relation was recorded to evaluate the prosthetic
space.
 Intraorally 33,35,43 abutment was prepared for coping
and 34 and 44 was prepared to receive magnet
attachment.
 Try in was done
 to check the aesthetics and phonetics of the patient,
denture was processed in heat cure acrylic resin.

6. On the day of
insertion
11,12,21,22
was extracted
bony undercut was removed with the help
of radiographic stent

7.  At the time of insertion maxillary denture
was relined by soft liner to avoid tissue
impingement.
 In mandibular arch post space was
prepared on abutment 34, 44 to receive
magnet attachment and luted with glass
ionomer cement

8.  Attachment incorporation was done by direct
technique.
 All magnets were kept on the top of keeper
so as to coincide with both central axes, and
autopolymerizing cure resin was filled into
the space left for magnetic assembly in the
impression surface of mandibular
overdenture.
 Patient was asked to occlude till curing of the
resin.
 Excess of resin was removed the occlusion
was checked to remove interceptive occlusal
contacts, and the denture was inserted

9. Discussion
 Attachment retained overdentures redirect occlusal forces away from the weak
supporting abutments or redirect the occlusal forces towards stronger abutment
thus improving the retention
 An overdenture with a magnetic attachment is useful in periodontally
compromised cases as it helps to dissipate the lateral stresses onto the abutment
teeth and improves the crown to root ratio.
 Dental magnetic assembly are available in various types and sizes.
 These systems, consisting of a magnet and a keeper, help in retaining removable
partial dentures and maxillofacial prostheses

10. TYPES OF MAGNETIC SYSTEM
 The magnetic system used to retain
dentures is usually an open-field or a
closed-field system.
 Closed-field systems work by eliminating
the external magnetic flux fields by
placing the magnetic components in a
series, called an assembly
ADVANTAGES OF MAGNET
RETAINED OVERDENTURES
 magnets can be easily incorporated into a denture
with simple clinical and technical procedures
 easily cleaned
 easily placed in patients (physically disabled or
neuromuscular compromised)
 automatic re-seating, and constant retention with
number of cycles
 patients with restricted inter-occlusal space and
challenging esthetic demands and can accommodate
a moderate divergence of alignment between two or
more abutments, and dissipate lateral functional
stresses

11. Conclusion
 This clinical report emphasizes the relevance of overdenture treatment option in
present day dentistry retained by magnetic assembly for better retention, stability
and support.
 Tooth supported overdenture retained by various attachments have shown better
results as compared to implant retained overdentures due to better
proprioception and have proven to be advantageous considering the time and
cost factors.

12. Insertion and removal effects of tooth supported
overdentures on retention strength and fatigue resistance
of attachment systems: An in vivo study
Sagar J. Abichandani, Neha Abichandani
 Semi-precision attachments require repeated replacements and servicing
in use, so it is important to understand the time frame of this wear and its
possible replacement for better patient compliance.
 This study was aimed to assess the retention strength and fatigue
resistance of Rhein OT caps and Ceka sagix attachment in the patients.

13. Those patients who had tooth supported overdentures
incorporating Sagix and Rhein attachments were shortlisted and classified
based on the time frame of denture insertion into 0, 1, 2, 3, and 4 years
 Grouping
study comprised five groups:
• 0 years – Tooth supported overdentures will be fabricated during the study
using the attachments
• 1 year – Tooth supported overdentures using attachments fabricated 1 year
ago
• 2 years – Tooth supported overdentures using attachments fabricated 2
years ago
• 3 years - Tooth supported overdentures using attachments fabricated 3
years ago
• 4 years – Tooth supported overdentures using attachments fabricated 4
years ago.

14. An indigenous retention tester equipment was fabricated and calibrated to measure
the force required to displace the overdenture giving the value of its retention which was
further compared with the value of retention strength of newly inserted overdentures
using both Sagix and Ceka attachment systems individually.

15. The values were noted and subjected to statistical analysis for evaluating the retention loss and development
of fatigue. Repeated measures of ANOVA were used which provided a statistically significant relation between
the retention values of both the attachment systems on tooth supported overdentures when compared with
the time period of its use in the oral cavity.

16. Conclusion
 It can be concluded that:
• Both Sagix and Rhein attachment systems showed adequate retention values up to
the first 2-3 years of usage in the oral cavity
• Fatigue of about 4 years of usage in the form of repeated insertion and removal did
cause subsequent reduction in the retention values but no subsequent fractures of
the component systems.

17. Comparative Evaluation of Root Supported Over-Denture
versus Root Supported Over-Denture with Precision
Attachment
Priyanka, Harsh Kumar
 This article is focused on the comparative evaluation of the two over denture techniques,
namely conventional root supported over-denture and root supported overdentures with
precision attachment
 A total of 38 patients were treated and evaluated over the period of 18 months.
 group B patients, the custom made ball attachments (male component) and orthodontic
separators (female component) were used as simple and very cost effective
• 19 patients who opted for conventional root supported overdenture.
Group A
• 19 patients who opted for root supported over-dentures with precision
attachment.
Group B

18.  Ball attachments were made 1 mm larger than the inner diameter of the separators
to maintain adequate frictional retention.
 Inner and outer diameter of the desired separator was 2.23 and 4.23 mm
respectively.
 When it was stretched and extended by 1 mm, the outer diameter became 5.23
mm and the amount of frictional force applied for retention by the separator on
the ball attachment was calculated with the help of a dontrix gauge.
 The amount of frictional retentive force provided by the prefabricated stud
attachments are in the range of 3.2–11 N.
 The force was more than the retentive force provided by these custom ball
abutments

19.  The entire treatment for patients of both groups was
completed in 2 months’ time.
 For first three months all patients were evaluated for every
15 days, and later a monthly follow up was made for
remaining 13 months.
 All the patients were asked a series of questions, and were
asked to evaluate the following statements depending on
their experience with the denture.
 Clinical examination various factors were evaluated for
every person; (a) stability, (b) retention, (c) phonetics and
(d) oral hygiene.
a) Esthetically
sound
(b) any discomfort
while chewing
(c) and discomfort
while speaking
(d) and problems
with removal or
insertion
(e)ease of cleaning
and maintenance

20. 26% 16%
11% 5% 37%
16%

21. CONCLUSIONS
 Root supported over-denture with precision attachment prosthesis are a simple
and a cost effective alternative treatment to prefabricated attachments for
enhancing the retention of tooth supported over-dentures.
 Also, the root supported over-denture with precision attachment are poor in
terms of oral hygiene when compared with tooth supported over-dentures.

22. Tooth supported Overdenture: Imperative treatment
modality: Root to basics
Dr. Gandhi Drashti and Dr. Sethuraman Rajesh
 This article describes a two case reports in which different attachment systems was
given to the partially edentulous patient which were successfully rehabilitated with
comprehensive treatment of maxillary and mandibular natural teeth supported
Overdenture with locator attachment (Zest Anchors) and stud and copings with
Intraradicular post.
 Individually case was differently selected on the basis of total number of abutment
teeth present, their position and intra-arch space present

23. CASE 1
 A 62-year-old female patient
 chief complaint of missing teeth and difficulty to
masticate the food.
 No abnormalities were detected on Extra oral and
intra oral examination.
 Periodontically weak Teeth were extracted after
bridge removal. 21,22,23,28,34,35, 45 were used as
over denture abutments

24.  The diagnostic impressions were
made using irreversible hydrocolloid
(DPI, Imprint) and diagnostic casts
were poured in type IIIs and were
mounted with a tentative jaw
relation on mean value articulator to
enable planning the final treatment.

25.  Root canal treatment of
21,22,23,28,34,35,45 was
done.
 Decoronation
21,22,23,28,34,35,45 was
done maintaining 1 mm of
tooth structure
supragingivally

26.  Preparation for the post was done i.r.t 35,
45: 4 mm short of the apical length using
grid markings.
 In 35 & 45, post space preparation was
done with the pilot drill to final drill in
recommended sequence
 After finishing the preparation with both
35 and 45, the teeth were cleaned with
0.2%.
 The stud attachments were then cemented
with resin cement.

27.  The copings were fabricated in dome
shaped 0n 21, 22, 23, 28, 34, using pattern
resin.
 extra pattern resin was trimmed off.
 The copings were further evaluated for fit
in the patients' mouth and lastly cemented
with glass ionomer cement
 Border moulding was done with low
fusing impression compound and final
impression was made with light bodied
polyvinyl siloxane for maxillary and
mandibular arches
 Final cast was poured using type 3 dental
stone.
 Diagnostic Jaw relations was recorded

28. Orientation jaw relation was recoded using Hanua
Spring Bow- Face bow and Gothic arch intra oral
tracing was done for evaluating centric relation.
inter occlusal records in centric and protrusion was
made using polyvinyl siloxane (Jet bite fast).

30. Case 2
 A 67-year-old female
 chief complaint of loosening of teeth and
difficulty to masticate the food.
 Periodontically weak teeth were removed
and 13,14,15,28,43 were used as
Overdenture abutments
 The diagnostic impressions were made
using irreversible hydrocolloid and
diagnostic casts were poured in type III and
were mounted with a tentative jaw relation
on mean value articulator to enable planning
the final treatment

31.  One week post-insertion, when patient was comfortable with both the dentures, space was created
in the mandibular denture in 13 and 43 regions to pick up the locator male assemblies in the
denture Locator male assemblies with black processing caps were placed into cemented female
assemblies in 13 and 43.
 These processing caps set up the vertical resiliency needed for the final male assembly.
 It was verified that the denture is seating perfectly on the maxillary tissue surface without any
interferences due to the locator attachments in 13 and 43.
 White processing sleeves were placed on the attachment which prevented blocking of the
attachment with auto-polymerizing acrylic resin while picking up the attachments.

32.  Auto-polymerizing acrylic resin was mixed with the Locator male assemblies with
black processing caps were placed into cemented females in 13 and 43 in dough
stage, and the denture was placed in mouth and patient was instructed to close
the teeth in centric occlusion.
 Minimum acrylic resin was used to prevent the excess flow of resin on intaglio
surface of the denture.
 Once the acrylic resin was completely set, excess acrylic was trimmed off. Denture
finishing and polishing was done and evaluated in the patient’s mouth for the
complete seating of the denture and occlusion

33. Determining the need of a coping and/or its
number/type in a tooth supported overdenture
Khurshid A Mattoo, Anchal Deep
 With the assistance of presenting two
different cases of overdenture and
immediate overdenture, they present a
clinical diagnostic method that will assist a
prosthodontist to determine whether
copings will be indicated or not while also
being able to decide among different
types of copings
Case 1
 Maxillary overdenture using short copings
and a mandibular immediate overdenture
 Female patient aged 47 years
 Intra oral examination revealed a kennedy class 1
modification 1 partial edentulous situation in the
maxillary arch and a kennedy class 2 modification 1
situation in the mandibular arch

34.  Treatment planned consented by the patient was a maxillary overdenture with
coping and a mandibular immediate overdenture without coping (amalgam plug).
 Endodontic treatment was done for all the required abutments irrespective of
using a coping or not.
 Direct technique for fabrication of coping pattern using duralay resin was
employed, followed by their casting,
 finishing and final cementation using zinc phosphate cement.

35.  Mandibular immediate overdenture fabrication
employed preparation of respective abutments
(followed by sealing with amalgam plugs) and
later extraction of planned teeth.
 surgical template made of clear acrylic was
designed for accomplishing a near accurate
preplanned osteoplasty.
 clinical and laboratory procedures for fabrication
of overdenture were done in the conventional
way.
 Dentures were inserted and the patient was given
instructions regarding its maintenance

36. CASE 2
 female 53 years Extra oral examination revealed presence of a long maxillary lip in
relation to the lower third of the face and also showed hypomobility
 Intra oral examination revealed a kennedy class 1 modification 1 partial
edentulous situation in the maxillary arch (Fig 1B) while the mandibular arch was
intact.
 The central incisors were supraerupted while the maxillary left premolar was
maintaining the vertical dimensions.

37.  Pre prosthetic treatment included oral
prophylaxis and endodontic treatment of
remaining maxillary teeth.
 Routine clinical and laboratory steps for
overdenture (short, coping) fabrication were
done.
 The short coping was designed to be
retained by a post within the roots (Fig 1C).
 After the casting of the copings was done,
they were cemented in place with zinc
phosphate cement

38. Discussion
• with or without endodontic treatment
A non coping overdenture
• 2- 3mm, endodontic treatment may or may not be
required
A short coping overdnture
• 5-8 mm long to eliminate the need of endodontic
treatment
A long coping overdenture
Bettter understanding of the
dynamic functional relation between the
incisal/occlusal plane and the inter arch
distance between residual alveolar ridge and
the relative position of the abutment tooth to
be used within this space
in a case of an overdenture
both teeth and residual alveolar ridges are
present.
This situation puzzles the mind and it is
imperative to focus on either the tooth or the
edentulous ridge at one time during a clinical
examination

39.  Since few teeth may be supraerupted in
such cases, the focus is mainly on the
natural tooth positions.
 The position of the tooth to be used as
abutment has been shown at three
different points, namely a, b, c.

40. When the incisal edge of a natural tooth is
at point a
 distance between the alveolar ridge and the incisal edge of that natural tooth is
decreased, but at the same time it increases the possibility of accommodating a
coping within the interarch distance
 It is preferable to place two copings in overdenture (one on the abutment tooth
and one within the denture), in such cases the amount of the available interarch
distance is critical because it is important to understand that placement of two
copings should not be at the expense of pushing the incisal plane towards the
mandibular arch ( impair esthetics)
 Determination of the amount of freeway space relative to the natural tooth
observed, is imperative to determine whether one should use a single coping or
one can accommodate two copings for a denture

41. At point B
 It is just above or near the anticipated incisal plane and is ideal since it creates
equal distance within the interarch distance and the anticipated incisal plane.
 increases the chances of increasing the possibility of vertical dimension alteration
if one uses two copings for an overdenture.
 whenever the existing incisal position of the natural tooth is close to the
anticipated incisal plane, a single coping overdenture is the safest choice
 Two physiological methods of determining vertical dimensions are necessary
during clinical examination.
 The swallowing threshold and the phonetic method.
 When both tests are conducted on the patient, and if the patient presents with
short timed contact during swallowing and/or some or little space during speech
one can accommodate two copings overdenture.

42. At point C
 The incisal plane is below the anticipated incisal
plane of the overdenture and placement of a
coping necessitates the need of endodontic
treatment.
 However, depending upon the available abutment
one can decide whether long coping is feasible, in
that case endodontic treatment is not needed.
 This situation is extremely difficult to determine
since one must also consider the age of the patient
(secondary dentin deposition).
 However, it requires minimal tooth preparation
within the enamel since the exposure of the
dentinal tubules would create the tissue of
sensitivity and patient will reject such treatment.
 The position of pulp in relation to the anticipated
incisal plane should be considered in such cases.
 The more the distance between the two, the less is
the need of the endodontic treatment.
 At the same time point c also represents supra
eruption of the tooth, which necessitates the need
of endodontic treatment followed by placement of
two copings.

43. Summary
 Clinical skill of decision making comes with close observation and deep
understanding of the various relations between various variables.
 In the case of a tooth supported overdenture the anticipated incisal plane, the
current tooth position and the interocclusal distance are three important variables
that need to be explored in the case of tooth supported overdentures

44. Customization of Attachments in Tooth Supported
Overdentures: Three Clinical Reports
Jyoti Devi, Poonam Goyal, Mahesh Verma, Rekha Gupta, Shubhra Gill
 In the current series of case reports, customization of tooth supported overdentures with different
attachments was done.
 Each case was selected differently on the basis of number and distance between the abutment
teeth present, their intra-arch alignment, and inter-arch space available.
 The fabrication of tooth supported overdentures with semiprecision attachments can improve the
longevity of prosthesis.
 Customization is also helpful for patients who cannot bear the cost of expensive attachments.
 Furthermore, there are situations where remaining dentin thickness is less to accommodate
postspace preparations required for prefabricated attachments.
Customization of attachments available is a viable alternative
for some patients in which prefabricated attachments cannot be placed or in which cost is a factor; to
improve the final outcome of the treatment

45.  Although clinical procedures done for tooth supported over denture in each case were
similar including:
1. Periodontal treatment of remaining teeth
2. Endodontic treatment/restoration of abutment teeth
3. Postspace preparation of abutment teeth
4. Tooth preparation and direct/indirect final impressions of abutments to receive copings
5. Cementation of copings
6. Final Impressions for denture fabrication
7. Subsequent procedures were similar to fabrication of conventional complete denture.

46. Case 1
45/M
11, 12, 21,
23, 33,
and 43
remaining
which
were
severely
worn out.
Maxillary
overdentures
- dome-shaped
and mandibular
overdentures
thimble-shaped
semiprecision
attachments were
planned
The preparation of the 33 was not ample which led to the repeated fracture of
denture at the same point.
Root canal treatments were completed for all teeth
Tooth preparations were modified with chamfer margins, and 3 mm of radicular
extensions with an anti-rotational groove were prepared in
33 and 43

47. Final impressions for
coping fabrication
were made using soft
putty and
light body elastomers
Four
dome-shaped
copings were
made for
maxillary arch
Two thimble-shaped
copings with customized
locator precision
attachments were made
for mandibular arch
A square hard plastic cuboid
container of
15 mm × 15 mm × 25 mm
dimensions was used for the
impression of locator
overdenture implant
attachment
Zest Anchors,using same
putty and light
body material
Wax patterns for
coping were
fabricated on
dies using
blueinlay wax
Two positive replicas free of
any voids or nodules of the
female component of locator
attachment were obtained using
self-cure acrylic resin

48.  Spruing was done away from the area where replica of female component of locator
attachment was attached to the blue inlay wax coping.
 The casting was done in the conventional manner using Co-Cr alloy and phosphate
bonded investment material
 Cementation of copings was done using luting Glass Ionomer Cement
 Dentures were then fabricated conventionally, with secondary impressions made using
elastomeric impression material
 Mesh was incorporated in the mandibular denture for providing additional strength to
acrylic.
 Finished and polished dentures were inserted, adjusted, and postinsertion instructions
were given.

49. Follow-up was done at intervals of 3
months for 1 year. At last, patient adapted
well to the dentures without any complaints
of sore mouth or breakage.
Male components of locator attachments were
attached to the denture using chairside pickup technique
with self-cure resin

50. Case 2
 A 47-year-old male reported with difficulty in chewing food due to loss of upper teeth.
 On examination, 11, 13, 21, 22, 23 teeth and a splinted fixed denture prosthesis (FDP) from 37 to
47 was present.
 Orthopantomogram revealed metallic prefabricated screw posts in 13 and 23 teeth.
 The patient rejected the option of replacement of his FDP and implants prosthesis in maxilla
because of the need for surgery, removal of natural teeth, the extended duration, and associated
expenses.
 Tooth supported overdentures with dome-shaped copings, and radicular extensions were
planned

51.  After removal of metallic prefabricated screw posts from 13
to 23 teeth with the help of scaler and artery forceps, roots of
the remaining teeth were assessed for any fracture or decay.
 Chamfer margins were made around the 13 and 23 teeth and
composite restorations were done in 11, 21, and 22.
 Root canals were thoroughly cleaned, shaped, and
anti-rotational grooves were placed to receive the
dome-shaped copings with radicular extensions into the
roots for added retention due to limited inter-arch space

52.  For an impression of postspace and fabrication of coping pattern
resin (supplied as powder and liquid) is used.
 Polycarbonate plastic posts were used for the direct impression of
postspace.
 Petroleum jelly was applied in the postspace before starting the
impression.
 Posts were dipped in liquid and powder was applied on the post
and placed in the canal to make the direct impression and taken out
when it is hardened.
 Once postspace impression is captured completely, resin is applied
on the prepared tooth surface to fabricate dome-shaped coping
directly in mouth
 Subsequent steps were similar to as discussed in case history 1

53. As the opposing dentition was having a porcelain
fused to metal multiple splinted FDP, high strength
cross-linked acrylic teeth were used.
Finished and polished dentures were inserted,
adjusted, and instructions were given.
The occlusal adjustment was done after 24 h.
A round micromotor carbide bur was used to make
holes of 2 mm diameter and 2 mm depth at the
centric stops which were filled with non γ2-amalgam
alloy

54.  Follow-up was done at intervals of 3 months for 1.5 years.
 The patient adjusted well to the dentures without any complaints of pain or
breakage of denture teeth, amalgam or of ceramic.
 Retention and stability of denture; and appearance of the patient was also
improved
 The patient was educated about the usage of interdental brush for the hygiene
maintenance of FDP.

55. Case 3
 A 50-year-old male reported with difficulty in chewing with only few teeth remaining.
 Intraoral examination revealed completely edentulous maxillary arch and mandibular arch with 33,
43, and 45 teeth abraded and worn out
 Maxillary complete denture and mandibular overdenture with semi-precision stud attachments on
dome copings with small root extensions 3 mm in length were planned.

56.  For mandibular overdenture, dome-shaped coping was planned with respect to 45
and semi-precision micro stud attachments in 33 and 43. Procedure for
customization was similar to as discussed in case history 2
 Postinsertion instructions were given and follow-up was done at intervals of 2
months for 1 year.
 Patient’s oral function improved with dentures without any complaints of difficulty
in chewing, sore mouth or loss of retention

58. Summary
 Customization of attachments can be a simple and cost-effective alternative
treatment to the use/modification of precision attachments for enhancing the
retention, stability and function of tooth supported overdentures.
 Although tooth supported overdentures have the risk of caries development,
periodontitis around abutments, and fracture of overdenture.
 But with proper patient selection, thorough treatment planning and modifications
in the denture like making use of amalgam stops, cross-linked teeth, metallic
mesh, radicular extensions; longevity and success of the attachment overdenture
prosthesis can be achieved

59. References
 Abichandani SJ, Abichandani N. Insertion and removal effects of tooth supported overdentures on
retention strength and fatigue resistance of attachment systems: An in vivo study. International
Dental & Medical Journal of Advanced Research. 2016;2015:2.
 Kumari S, Banerjee S, Varshney N, Kumar S, Kumar M, Issar G. A Full Mouth Rehabilitation with
Maxillary Immediate Denture & Mandibular Tooth Supported Magnet Retained Over-denture: A
Case Report. International Journal of Research and Reports in Dentistry. 2019 Mar 12:1-5.
 Kumar H. Comparative Evaluation of Root Supported Over-Denture versus Root Supported Over-
Denture with Precision Attachment. Journal of Advanced Medical and Dental Sciences Research.
2018 Dec 1;6(12):8-11.
 Mattoo KA, Deep A. Determining the need of a coping and/or its number/type in a tooth
supported overdenture. Journal of Advanced Medical and Dental Sciences Research. 2020 Oct
1;8(10):46-9.
 Drashti, Gandhi, and Sethuraman Rajesh. "Tooth supported Overdenture: Imperative treatment
modality: Root to basics." (2019).
 Devi J, Goyal P, Verma M, Gupta R, Gill S. Customization of attachments in tooth supported
overdentures: Three clinical reports. Indian J Dent Res 2019;30:810-5.