Overdentures-a Case Report |
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OVERDENTURES- A REVIEW WITH CASE REPORT
Introduction
The concept of overdentures is far from new. Its almost 150 yrs back when ledger (1856) encouraged the idea of leaving roots of natural teeth to support a complete denture. A treatment alternative that has been beneficial to patients who still preserve a small number of healthy natural teeth is an overdenture.
ADVANTAGES 1. Retained propioception by mans of PDL. 2. Reduced loading of residual alveolar ridge. 3. Increase chewing efficiency. 4. Increased retention and stability. 5. Esthetic excellence. 6. Open palate design possible. 7. Less trauma to supporting structures. 8. Transitional or training dentures. 9. Reversibility. 10. Ease in maintenance and cleaning.
DISAVANTAGES Caries susceptibility. Periodontal breakdown of abutment teeth. Over contour. Encroachment of inter-occlusal space. Cost. Additional patient responsibilities.
INDICATIONS Patient with poor prognosis for complete denture.(high palatal vault, poorly defined sublingual space) Congenital and Acquired defects. When pronounced vertical overlap of anterior teeth required. Teeth with questionable prognosis. Unilateral over denture. Single denture opposing Natural Anterior teeth.
CONTRAINDIACTIONS Patient co-operation. Cost and time factor. Periodontally hopeless teeth. High caries index. Severe bony undercuts. Over contouring (muscle imbalance).
TYPES OF OVERDENTURES Immediate over dentures. Transitional over dentures.
Remote over dentures.
ABUTMENT SELECTION
As a general rule , if patient presents with 4-5 less retainable teeth in an arch , over denture should be considered. The abutments should be evaluated for: Periodontal status. Caries activity. Potential for endo-dontic treatment. Positional consideration. Abutment number and distribution. Space between abutments. Number of teeth available. Design of prosthesis.
Important Note: Four widely separated abutments provide ideal support and stability for an overdenture. Three abutments two canines and a second premolar can be used. A Canine and Premolar on same side for unilateral support is less desirable. Two canines and Premolars are preferred to molars. Two canines are abutments patterns most frequently used. If only two abutments teeth are available they should be situated bilaterally.
OVERDENTURE DESIGNS
There are three basic designs : Bare root over denture. Telescopic over denture. Attachment fixation over denture.CASE - REPORT
A Patient named : Mrs. kamala devi of age 55 yrs reported to the GOVT. DENTAL COLLEGE, ROHTAK, Deptt. Of PROSTHODONTICS in the month of December 2007. She came with a chief complaint of difficulty in eating food.
MEDICAL AND DENTAL HISTORY - not relevant.
EXAMINATION:
Extra-oral: facial symmetry
Intra-oral: upper edentulous arch and lower edentulous with three teeth remaining.
Periodontal examination: lower teeth which were to be used as abutments were periodontally sound. There was generalized attrition of upper teeth. Otherwise periodontal status was satisfactory.
Radiographic examination: No pathology seen around the remaining teeth, little horizontal bone loss around these teeth, localized gingival recession. The remaining teeth were considered favorable as abutments for over-denture.
The teeth which were considered as abutments were consulted for endodontic treatment in the Deptt. Of ENDONTICS, GOVT. DENTAL COLLEGE ROHTAK. They were root cananled photo of rc
FABRICATION
EXAMINATION AND DIAGNOSIS
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ABUTMENT SELECTION
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TREATEMENT PLANNING
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ABUTMENT PREPARATION
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IMPRESSIONS WITH ADDITION SILICONE
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CEMENT THE COPINGS ONTO THE ABUTMENTS
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PRIMARY IMPRESSION OF CEMENTED COPINGS WITH REVERSIBLE HYDROCOLLOID
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FINAL IMPRESSION MADE WITH ZINC OXIDE EUGENOL PASTE
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JAW RELATIONS RECOREDED
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TEETH ADJUSTMENT AND ARRANGEMENT DONE & WAX TRY IS COMPLETED
CURING OF OVER DENTURE - WITH FIBRE REINFORCED HEAT CURE DENTURE BASE RESIN. ?
OVER-DENTURE IS INSETERED, OCCLUSION IS ADJUSTED, AND INTSRUCTIONS ARE GIVEN TO PATIENTS ABOUT MAINTIANENANCE OF DENTURE ?
RECALL AFTER 48 HRS FOR FOOLW UPAND OCCLUSAL ADJUSTMENTS ?
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