The dental profession has expanded the preventive dentistry concepts intor
prosthodontics to bring about the prescription called The Overdenture! "t is
further bytressed by he fact that the alveolr bone #ith its overling $ucose #as
never intended to receive the full force of a co$plete denture! So then% #hat is
an over denture!
i& ' co$plete or re$ovable partial denture that covers and rests onone $or
$ore re$aining natural teeth or roots!
()R&
ii& ' prosthesis that covers and is partially supported by natural teeh% tooth
roots or dental i$plants!
(OR&&
iii& ' prosthesis covering the occlusal surfaces of the teeth
(OR&
iv& The over lay of artificial teeth on the surface of natural teeth to i$prove
occlusion% arch fo$ and*or esthetics + super i$posed prosthesis!
S,NON,-S
(.& /iologic denture ( 0& 1ybrid denture (2& Telescopic denture (3& Overlay
denture (4& Onlay denture (5& Tooth supported dentures (6& Super i$posed
denture!
Rational for the over denture concept!
Extraction of all naturl dentition and replace$ent #ith a si$ple denture is not
the $ost desiable treat$ent! 7reventive prosthodontics e$phasi8es the
i$portance of any procedure that can delay or eli$inate further prosthodontics
proble$s! The over denture is a logical $ethod for the dental to use in
preventive prosthodonics!
The se9uelae after the extraction of all the teeth $a:e co$plete denture
progresively less effective! '$ong these se9uelae are
a& The loss of discrete teeth proprioception
b& The progressive loss alveolar bone
c& The transfer of all occlusal forces fro$ the teeth is the oral $ucosa!
;ro$ physiologic vie# point the roots provide not only periodonal liga$ent
support but also
a& Directional sensitivity
b& Tactile sensitivity to load
c& Di$ensional discri$ination
d& <apine response
e& 7roprioception and salivary secretion
f& Decreased perception in older individuals
-anly and associates observed that the $ean $ini$al threshold for detection
of load #as approxi$ately . g$! ;or the incisal surface of natural anterior
tooth in axial direction #here as it #as = to .) g$s on the occlusal surface of
the .
st
$olar! Of the eight denture #earers tested for ani$al load threshold to
forces applied to the occlusal surface of the .
st
pre$olar of the $andibular
denture% five #ere insensitive to a force of .04 g$ t#o reacted to =)g$! 'nd
one reacted to 4)g$! Therefore the average threshold for denture #earer #as
$ore than a hundred ti$es that for an anerior natural the! The retention o
natural teeth for an over denture preserves so$e of the sensory i$puts fro$ the
periodontal receptors #hich is $ore precise than that is obtained fro$ the oral
$ucosa!
>a#a$ura (.?53& @ross$an (.?53& and @ross$an and associates (.?54&
agreed that the sensitivity in the anterior part of the $outh% particulary the
periodontal liga$ent of the anterior teeh% tongue tip and $ucosa #as acute!
Nishiya$a and others discovered that patients Audge$ent of the loaded tooth in
locali8ing the sti$ulated tooth #as better a$ong anterior teeth than a$ong
posterior teeth! Though studies indicate that the natural anterior teeth exhibit
$ore sensitivity and discri$ination than posterior teeth% posterior teeth also
should be retained for over dentures #hen feasible!
"n co$paring the di$ensional perception% patients #ith natural dention could
discri$inate difference at the 0$$ range better than those #ith artificial
dentures! -anly and associates (.?40& graded 9uantities of calciu$ carbonate
suspended is bland pudding in various percentage! 'l$ost all patients #ith
natural dentition #ould detect 0!?B <a<oa or less #hile the $aAority of
denture patients re9uired $ore than ? C <a<o2 for detection! Those findings
e$phasi8ed the i$portance of conservative procedures and i$portance of the
retention of natural teeth!
Studies of canine response indicate that canine $ay be the $ost i$portant
propriceptive teeth #ith significant sensosry activity and land support to their
retention of over denture! So$e lateral forces are trans$itted by the over
denture is the supporting tooth! "t has been sho#n that teeth are $ore sensitive
to lateral forces than those in long axis 'lder (.?36& This finding reinforces
the i$portance of directional sensitivity!
>apar D <ollister (.?6)& in their stuides concluded that the periodontal
receptors played an indirect role in satisfactory salivary reflex by regulating the
range and type of the satisfactory stro:e! The $uscle activity deter$ined by
this $asticatory stro:e controlled the parotid gland secretion during
$astication! The $aAority of natural teeth used to support over denture are
devitalised and treated endodontically perceptual studies sho#ed that vital and
devitalised teeth have e9ual sensory input capabilities! Ranna$ found that
after re$oval of all but a s$all portion of the root and extre$ely light pressure
on the re$aining portion still gave a neural response!
7erceptive ability appears to decrease #ith age the Donald D 'ugust (.?6)&
found that he ability to identify for$s in the $outh re$ained stable in young
aduls and the decreased #ith age! Use of the over denture is an ate$pt to retain
every possible sensory ele$ent at the ti$e the patient $ay experience a
generali8ed decrease in sensory capacity! Rissin and coE#or:ers (.?6=&
co$pared $asticatory perfor$ance in patients #ith natural dentition!
<o$plete denture and over denture! They found that the over denture patients
had a che#ing efficiency one third higher than the co$plete denture patients!
<ru$ and Rooney (.?64& in a 4 years study found that the retention of
$andibular canines for over denture led to the preservation of alveolar bone
using! <o$paraive cephalo$etric radiographs and study costs they found an
average of !5 $$ vertical loss of alveolar bone in the anterior part of the
$andible in the over denture patients! The sa$e in cse of $andibular
conventional denture #as an average of 4!0$$ (or& = ti$es as $uch bone loss
as in patients #ith over denture! "t #as also observed tha the use of the over
denture preserved the alveolar boe bet#een canines in both height and #idth!
The over denture patient also exhibited less alveolar bone loss in the area
i$$ediately posterior to the canines! The study sho#ed the presence of roots
of the teeth in the alveolar bone #as i$portant for is preservation!
@O'F O; T1E R'T"ON'FEG
.& -aintains teeth as part of the residual ridge
0& Reduced rate o resorption
2& "ncreased in $anipulative s:ills of handing the dentures
"ND"<'T"ONS
"t $ay be of partial or co$plete type%
.& ;or patients #ho face the loss of the re$aining natural adult dentition!
Therefore younger the patient greater the indication!
0& <auses #here the retention is difficult to obtain!
a& Cerosto$ia or sialorrhea
b& 'bsence of alveolar residual ridge
c& Foss of $axilla and partial loss of $andible
d& cognetial defor$ity leg cleft palate
2& ;or patients #ith a poor prognosis for co$plete dentures!
a& 1igh palatal vault and ridge slope
b& 7oorly defined sublingual fold space
c& "n class """ tongue position
d& >nife edged ridge that #ill provide inade9uate support!
3& Hhen pronounced vertical overlap of the anterior teeth is re9uired to
produce good esthetic results!
4& !Unilateral over denture can be given to provide a good function and
esthetics a large a$oun of bone and soft tissue hve been lost on one side of
the arch!
5& 7atients #ith badly #orn out teeth!
6& Hhen co$plete denture #ill be opposed by retained $andibular anterior
teeth preventing (co$bination syndro$e&!
=& Thexapeutics in the for$ of insitu irradiation (-ober$ott D Rosenberg
(.?52&
<ONTR' "ND"<'T"ONS
a& Un coEoperative and under $otivated patients #ho insists on re$oval of his
re$aining teeth! 'ny indicaion of patient #ho #ill not coEoperate in oral
hygiene and regular office procedures% vecull for adAust$ents #hich is
re9uired to $aintain the re$aining teeth and the supporting tissue in a state
of health!
b& 7sychologically so$e patients cannot accept any type of re$ovable denture!
c& -enally and physically handicapped patiens for #ho$ pla9ue control and
good oral hygiene are difficult!
d& Hhen a patient canno econo$ically afford!
7eriodontal <onsiderationG
7eriodontal infla$$ation% poc:et for$ation% bony defecs% and poor 8one of
attached gingiva $ust all be eli$inated before co$$encing the treat$ent! The
deleterious effect of the over denture on the periodontiu$ can be $ini$i8ed of
the over denture on the periodontiu$ can be $ini$i8ed if one begins #ith an
optiu$ state and the patient follo#s a $eticulous ho$e care progra$$e #ith
fre9uent recall!
' co$$on periodontal re9uisite #ith over denture abut$ent teeth is that an
ade9uate 8one of atached gingiva is $andatory! This can be acco$plished
through periodontal surgery utili8ing either a free gingival graft or apically
repositioning a split thic:ness flap! This results in a band of attached gingiva
adAacent to the abut$ent tooth!
The ideal teeth thould present $ini$u$ $obility have acceptable bone support
and a$enable to periodontal therapy! "t should e understood that the reduction
of clinical cro#n root ratio #ill be favorable in reducing any existing $obility!
<ontra indications for using periodontally involved teeth!
i& <lass """ $obility due to the loss of alveolar bone at connot be corrected!
ii& Soft tissue and osseous defects #hich are not correctable by surgery!
iii& ;ailure to establish a sufficient 8one of attached gingiva by
$ucogingival or grafting procedure!
iv& Excessive reduction of the adAacent residual alveolar ridge as a result of
eli$ination of osseous defects for the establish$ent of nor$al
architecture!
Endodontic <onsideration
There are 2 $ain advantages of treating the abut$ent teeth endodontically!
i! The cro#n root ratio can be $ade $ore favourable!
ii! Reduction of the clinical cro#n provides an interocclusal distance $ore
favourable for the place$ent of the artificial tooth in an esthetically
acceptable position and in $ore favourable relation to the opposing
teeth!
<areful evaulation of the possibility of ;!7!D! of R!7!D! $ust be done! Since
there are $any disadvantages of an over denture that can be easily avoided if
;!7!D! of R!7!D! is utili8ed!
<ontra indications for Endodotnic Treat$entG
i! Vertical fracture of the root (or& roots!
ii! -echanical preparation of the root canal!
iii! "nternal resorption that has perforated through the side of the root!
iv! /ro:en instru$ent in the root canal!
v! 1ori8ontal fracture of the root belo# the bony crest!
Teeth that are grossly $alposed #ill be difficult to use especially posterior
teeth that are tilted $ore than 04I!
Single rooted teeth #ith only one canal that is easily negotiable are the best
candidates although $ultirooted teeth can also be used! '0 to 3 #ee: interval
before co$$encing further treat$ent on the tooth is helpful to deter$ine
endodontic co$plication if any!
Types of Over Denture
The type of overdenture depends pri$arily on the status of the patientJs
dentition at the start of treat$ent!
.! "$$ediate Over Denture G
'n i$$ediate over denture is constructed for insertion i$$ediately after the
re$oval of so$e natural teeth of #hich $any hopeless abut$ent teeth! 're%
treated and the over denture is inserted as an i$$ediate replace$ent! The
i$$ediate over denture $odified as re9uired! <an be #orn for several years
under favourable circu$stances!
""! Transitional over * 'dditive denture G
' Transitional over denture is obtained by converting an existing re$ovable
partial denture to over denture!
"""! Re$ote over denture G
' re$ove over denture is an over denture other than transitional or i$$ediate!
"t is usually constructed for insertion at so$e ti$e re$ote fro$ the re$oval
of hopeless! Natural teeth!
<lassificationG
1eart#elJs G
/ased on the $ethod of abut$ent preparation!
.! Non coping #ith si$ple tooth $odification #ith endodontic treat$ent
#ithout endodontic treat$ent!
0! <oping!
2! 'ttach$ents
3! Sub$erged vital roots!
.! Non coping G ('fter endodontic treat$ent selected abut$ents are reduced to
a coronal height of 0$$ to 2$$ and then contoured to a convex or do$e
shaped surface! -ost teeth re9uire endodontic therapy and the final step is
prepared conservatively to receive an a$alga$ or co$posite restoration!
Hithout endodontic therapy G The re$aining teeth are $erely reshaped to
eli$inate undercuts and reduce the vertical height if necessary to create $ore
interEridge space for the over denture! ;or these techni9ues to be possible% oral
hygiene $ust be ex9uisite #ith a lo# caries index! This techni9ue is often used
in partially anodontic patients of $ini$al preparation prior to final i$pression
#hich $a:es it totally reversible!
'but$ent #ith cast coping G <ast $etal coping #ith a do$e shaped surface and
cha$fer finish line at the gingival $argin are fabricated and ce$ented! There
are 0 distinct types of copings G
.! The short coping% 0! The long coping
The short coping G These are 0 to 2$$ long and nor$ally re9uire endodontic
therapy since the re9uired coronal tooth reduction #ould expose the pulp!
'ttached to the coping is a post% fitted to the canals! ;or this reason canals
should be obturated #ith soft @uttaE7ercha rather than $etal points!
Fong coping G These are nor$ally 4 to =$$ long! 'n atte$pt is $ade to
circu$vent endodontic therapy by a conservative reduction #ith a cellsopidal
shaped coronal coping and an increased cro#n root ration #hich re9uire greater
leve of osseous support! 'de9uate inter occlusal distance $ust exist to allo#
for encroaching on the available inter ridge space or a visuali8ation of vertical
di$ension is liable to occur #ith poor esthetics and failure because of patient
intolerance!
'but$ents #ith 'ttach$entsG
-ost attach$ents are secured to the abut$ent by a cast coping! The obAective
of any attach$ent is to i$prove retention of the denture base! /ecause of the
factors li:e ti$e% cost and ris:s the procedure should reserved for patient #ith a
favourable prognosis! The attach$ent does not reduce the cro#n root ratio
significantly as does the cast coping! 1ere the lo# caries index proper ho$e
care! 7eriodontal health and inter ridge distance are absolutely necessary!
Sub$erged vital roots G This is of current research interest% it atte$pts to
obviate so$e basic proble$ associated #ith the $ore conventional over
denture abut$ents! "n these cases selected vital roots are transected and
reduced to 0$$ belo# the crestal bone and then covered by $ucoperiosteal
flap!
The $aAor proble$ associated are develop$ent of dehiscences and pulpal
pathosis! "t is not reco$$ended as it is still in a state of infancy! Hhen this is
done several advantages of the over denture are lost!
.! Support fro$ direct contact of the denture base to the abut$ent tooth!
0! 'tte$pts to gain retention fo$ the teeth through so$e for$ of attach$ent is
no longer possible!
2! The loss of proprioception!
Treat$ent planning G
This includes G
.! Endodontic treat$ent!
0! 7eriodontal condition!
2! <aries $anage$ent!
3! Focation and distribution of abut$ent!
4! Econo$ics!
The .
st
and 0
nd
conditions have already been discussed!
<aries $anage$ent G The presence of high caries index and the situation that
#ill create a carious environ$ent are the devastating se9uelae to i$proper over
denture patient selection! <hoice of abut$ent is teeth% that have a healthy
clinical cro#n! <aries activity in a protected abut$ent is undesirable for
reasons other than the technical proble$s of restoration% an active caries
process can lead to a recurrence in protected abut$ent teeth or gingival to the
coping $argin!
;re9uent recall chec: up and treat$ent of the abut$ent #ith periodic fluoride
application to insure against any further brea: do#n! )!3 and Stannous ;luoride
gel is brooted on abut$ent teeth for . $inute once daily and expectorated!
Focation and distribution of abut$ent G
.! 7reference for anterior over posterior teeth therefore the alveolar ridge
appears to be $ore vulnerable to reduction than the posterior alveolar ridge!
0! T#o teeth in each 9uadrant presents an ideal situation in #hich stress is
distributed% over a rectangular area! Eg G <uspid 0
nd
pre$olar and*or 0
nd
$olar in each 9uadrant!
The tripod is the next $ost favourable for$ for support and stability!
The use of t#o teeth in each arch or one tooth in one arch has $et #ith
satisfactory results!
-arro# reco$$ends that it is better to use isolated teeth as abut$ents rather
than adAacent teeth because they return to a state of good health $ore readily
and are easier for the patinet to $aintain hygiene!
2! The upper anterior teeth should be retained if opposed by natural lo#er
anterior teeth to prevent the destruction of the anterior ridge #hen utili8ed
in a $axillary over denture!
3! -andibular cuspids are $ost often utili8ed since they are usually the last
tooth to be lost!
Hhen #e consider endodontics% especially on several teeth% the possibility of
casts coping% internal attach$ents and the over denture itself% the cost of this
$ode of treat$ent $ay #or: cut to be costly! Therefore #e should evaluate the
situation as it exists! The teeth that already have been endodontically treated%
teeth perhaps could be reduced #ithout endodontics% single rooted than
$ultirooted teeth% $ini$u$ nu$ber of teeth needed to achieve support and
bone preservation should be :ept to hold so that this for$ of treat$ent can be a
viable alternative to conventional co$plete denture!
'dvantge G
.! 7reservation of alveolar bone!
0! "$proved denture retention% stability and support!
2! 7rovides a vertical definite stop!
3! 7hysiological acceptances hence better patient coEoperation!
4! 7reservation of $asticatory proprioception!
5! ;e#er post insertion proble$s!
6! <onvertability!
=! 1ar$ony of arch for$!
?! "deal occlusion!
.)! Open palate possible!
..! Fess trau$a is supporing tooth!
.0! Esthetics!
.2! Ease in construction and $aintenance!
.3! Fo#e cost #hen co$pared to R!7!D!
Disadvantages G
.! Over denture treat$ent is $ore expensive than conventional denture
because of periodontal and endodontic therapy and the subse9uent
restoration of teeth #ith gold coping!
0! /ul:ier than ;!7!D! (or& R!7!D!
2! "f oral hygiene is not $aintained properly caries and periodontal disease
$ay still progress!
3! /ony under cuts $ay cause either over contouring or under containing of
the denture!
4! Encroach$ent of inter occlusal distance!
5! Esthetics!
6! "n $any cases% o#ing to lac: of available space sections of the over denture
base are 9uite thin! "f $etal reinforce$ent is not used% fracture of the base
and prosthetic teeth is co$$on!
'n over denture that fulfils all of its specific re9uire$ents $ust also fulfill
these re9uire$ents of any conventional denture! Therefore $atters such as
ade9uate tissue converage% proper extension% of bases% la# records!
1ar$onious occlusion and esthetics cannot be co$pensated because an over
denture is being contracted! ' sound prosthodontic approach to the appliance
$ust al#ays be carried out!
Over Denture 'ttach$ents
'ttach$ents <lassification!
"! 'ccording to shape% design and pri$ary area of use!
<oronal G
a! "ntra coronal!
b! Extra coronal
i! Resilient!
ii! Non resilient
Radicular G
a! Telescope stud attach$ents!
b! /ar attach$ents!
i! Koints
ii! Units
'ccessory G 'uxiliary attach$ents
a! Scre# units!
b! 7a#l connectors!
c! /olts!
d! Stabili8ers * balancers!
e! "nterloc:s
f! 7ins*scre#s!
g! Rests!
-agnets G
a! 7er$anent $agent!
b! "nduced $agnet!
c! "nduced $agnet!
d! Open field!
e! <#sent field!
Extra <oronal "ntra radicular
.! @erber attach$ents .! Lest 'nchor
0! Dalbo attach$ent!
2! <e:a attach$ent
3! Rother$ann attach$ent!
4! "nfrofix attach$ent!
5! Schubiger attach$ent!
6! Muinlican attach$ent!
=! The co$pact unit (7ris:a&
?! /attesti units!
.)! <onod unit!
..! /acer and ;ah units!
.0! The )E4) syste$
.2! 1o#$edics and "none units!
.3! Hhale donJt stud asse$bly!
.4! >urer stud attach$ent!
' $ounted diagnostic casts is an i$portant aid to chec: the space available
before an attach$ent is selected!
-ost of the stud types can be considered to be snap fasteners! Stud devices are
si$pletes a$ong all attach$ents! The $ale part of the unit consists of a stud
shaped proAection soldered to the diaphrag$ of a dovel retained restoration!
The fe$ale part fits over the $ale unit and is e$bedded #ithin the denture base
of the prosthesis! There are a fe# syste$s #hich #or: in the reverse! Eg! Lest
'nchor! ' fe# studs are anteriorly riged (because the si8e $a:es it difficult to
prevent a s$all a$ount of $ove$ent bet#een the t#o co$ponents&! "n so$e
springs are specifically incorporated to allo# a controlled degree of $ove$ent!
'dvantages G
Retention% stability and support!
' positive loc: of certain untis can $aintain the border seal of the denture!
Selection of attach$ents G
The success of prosthesis usually depends on careful treat$ent planning and
attention to the prosthodontic proble$s! The $echanical ingenuity of the
attah$ent is i$portant% but $ust ta:e second place! The shape and si8e of the
units is nor$ally the over riding consideration although the auxiliary devices
that acco$pany the attach$ent $ust influence the choice!
<orrect vertical space assess$ent $ust be ta:en care of! Extra radicular stud
attach$ents are relatively strong and can often provide $ore effective retention
than their interradicular counter parts! Farger attach$ents are generally
stronger than s$aller ones and less prone to #ear! Debate still continues as to
#hether or not the co$paratively rigid units should be selected as opposed to
those that allo# $ove$ent!
-ensor (.?=)& auotiny #or: by ;enner% 1erber and -abie$ann (.?4)& has
clai$ed rigid or cylindrical stud attach$ents produce no tipping action on the
root! /all and soc:et designs are stated to produce 3 ti$es as $uch tipping
potential!
' recent lab study by Thayer and <aputo (.?=)& e$ployed photoEelastic stress
analysis! They found that forces applied to a Dolder bar #ere resolved in an
apical direction #here as stud attach$ents engaging the do#el retained
diaphrag$ $ight produce tipping potentials!
Feverage effect upon the root has also an effect on attach$ent selection! -outh
preparation% ease of rebasing and repair procedures also deter$ine the type of
stud attach$ent!
The nu$ber of stud attach$ent G
One stud attach$ent on each side of the arch #ill usually suffice other
re$aining roots can be covered #ith si$ple copings! "ncreased nu$ber of
attach$ents in a denture does not produce a corresponding i$prove$ent in
retention!
7opular attach$ent syste$ G
'! Dalbo Stud Unit G
a! /all and Soc:et!
b! Rigid Dalbo
Extre$ely popular of the design series% neatness strength% ti$e tested!
;eatures G 3$$ high #ith spherical shape $ale section% easy to clean! The
fingers of the soc:et are surrounded by nylon rings! That si$plifies
adAust$ents! 'dAust$ents are si$ple to carry out! Retention can be increased
by altering free ends of la$ellae!
'dAuncts G
'dAusting tools G Tightening device! <o$pli$entary tool! Device to replace
nylon sleeve! Relocating do#el for rebasing i$pression!
/! The co$pact unit G
1eight + 0!=4 $$
Din of retention :nob is 0!?$$
Divergence of .)Ibet#een the align$ent of 0 attach$ent $ay be per$itted
#ithout causing increased #ear of $ale section! "t #as developed fro$ the
ancrofix!
<! @erber 'ttach$ents G That allo#s vertical $ovenet! Rigid attach$ent
(popular&!
Retention of both types of @erber attach$ent is obtained by a retaining spring
in the fe$ale unit engaging a peripheral groove in the $ale section! The spring
clip $ay be re$oved for adAust$ent by unscre#ing! The base of the fe$ale
unit using the special instru$ent provided! /oth types of $ale unit scre#ed on
to their soldering base and prevented fro$ unscre#ing #ith a little resin
ce$ent! They $ay be unscre#ed in the $outh #ith a heated scre# driver!
Feaving exposed a scre# thread proAecting fro$ the base of the attach$ent!
@erber pointed out that if t#o or $ore teeth #ere used% the $ost distal
attach$ent should allo# $ore vertical play than the anterior ones% as it is li:ely
that greater dispathc force #ould be applied to the $olar surfaces of the
prosthesis!
D! <e:a Syste$ G
.! Rigid
0! Resilient!
Rigid and Resilient designs share a co$$on base! /ut the <e:a extracoronal
units are not identical! Therefore it is not possible to change resilient for rigid
constructions $erely by changing% the retention portions! The vertical travel
allo#ed by the resilient stud unit is )!3$$! the retention pin or $ale section is
scre#ed on to the base ring!
'nciliary instru$ents G
a! Focating device!
b! 'dAust$ents device!
c! <hanging attach$ents!
d! Repair and rebasing device!
Fi$iting factor is the vertical space re9uired by the unit resulting in 4$$
vertical space re9uire$ent for the attach$ent co$ponents!
's #ith all attach$ents syste$s their align$ent #ith each other and the path of
insertion of the prosthesis $ust be planned! The attach$ent base is soldered to
the prepared flat surface of the coping! The spring pin or $ale section $ay be
re$oved fro$ its base% so this allo#s considerable versatility% since brea:age of
the pin is easily solved by re$oving it and replacing it #ith another unit! This
is done by a special tool provided #ith #hich the spring pin is unscre#ed!
Hhile the other end of the special tool $ay be used to increase the retention by
$eans of the #edge shape instru$ent!
Rebasing techni9ues are 9uite straight for#ard and there is a locating do#el
that engages the fe$ale section of the attach$ent before the i$pression is cast!
This re$ovable spring pin ($ale section& is particularly useful #hen a
duplicate denture is re9uired% as it saves intraoral locating procedures #hich are
difficult to carryout! The spring pins are unscre#ed and special locating
co$ponents #ith parallel sided tagging scre#ed do#n on the copings in the
$outh! The $aster i$pression #ill no# reproduce the parallel sided tagging! "n
the laboratory% identical co$ponents are slid into the i$pression leaving the
scre# threads proAecting! The du$$y scre# base is no# attached to the
co$ponents in the i$pression and the i$pression is poured! Thus #ithin the
$aster cast includes du$$y scre# based identical in every respect to those in
the $outh! Spring pins can no# be placed on the$ and the duplicate denture
constructed! On this cast #ith sure :no#ledge that is #ill fit accurately in the
$outh!
E!"ntrofix is a solid cylinder attach$ent that can be used for fixed re$ovable
bridge #or: as #ell as for overdentures! "t consists of 2 parts G
.! ' solder bar that is co$$on to the ancrofix!
0! ' replaceable and adAustable $ale friction part!
2! ' fe%aNe cylindrical housing!
'dvantages Disadvantages
.! Si$ple to use!
0! <o$ponents are replaceable and
interchangeable #ith the solder base
of the acrofix!
2! The attach$ent provides good
seating and retention!
3! <an be used in co$bination #ith
resilient attach$ents!
4! Service life is indefinite
.! 7aralleling necessary!
0! 7rocessed in the lab!
2! Tor9u$ potential is $axi$u$ if
dentures base is not adapted
properly!
E! Schubiger
<onsists of a short scre# bloc: for bar fixation a larger one for fixed re$ovable
bridge #or: and an individual cap core syste$!
Over denture attach$ents has 2 parts!
a! Solder base co$$on to the @erber!
b! ' sleeve in cera$ic $etal!
c! ' cap nut!
d! Overall height is 0!=$$!
'dvantages Disadvantages
.! 'llo#s co$plete flexibility
0! 7rovides for bar fixation!
2! 7er$its conversation fro$ bar to
individual stud fixation! (@erber&
7aralleling is necessary!
<o$plex and expensive!
;! Rother$ann Unit G
a! Rigid (less height .$$&!
b! Resilient ($ore height .!6$$&!
'dvantages G Re9uires little vertical space and tolerance for li$ited
$isalign$ent of attach$ents!
"t is a button shaped attach$ent #ith the $ale unit incorporating a groove of
uneven depth! The clip of the fe$ale section slides over the tapered upper edge
of the $ale! Hith the free ends of the fe$ale engaging the deepest retaining
groove! The fe$ale clip is designed to be retained #ith acrylic resin! '
$odified version of the clip is no# available #ith tagging that runs at right
angles to the original design! 'part fro$ the $ini$al vertical space
re9uire$ent an additional advantageis the tolerance for li$ited $isalign$ent of
attach$ent!
"ntra radicular stud attach$ents G
The advantages of this syste$ lies in cost and space re9uire$ents! They do not
re9uire precious $etal coping do#el nor special laboratory procedures! They
are relatively si$ple and 9uic:!
Lest 'nchor syste$ G
' nylon $ale ele$ent is incorporated in the denture base and proAects
do#n#ards% engaging a recess in the root preparation% further the loads are
applied at a point! That is #ell apical to the gingival $argin of the root! '
variety of abut$ents $ay be e$ployed including he$isected $olar roots! 0
si8es of 8est anchor are available depending on the root length and dia$eter!
The syste$s has been extensively refined over the years and a co$prehensive
:it is no# available! The vertical space re9uire$ents are the sa$e as
Rother$ann unit!
/ar co$pared to Stud ;ixation G
.! Splinting of t#o or $ore teeth #ith a bar produces stability si$ilar to the
rigid stud type attach$ent #hen the overdenture is in place! /ut the study
type allo# independent $ove$ent!
0! "f one tooth is #ea: the strong tooth can serve as the fulcru$ point for
$ove$ent of the #ea:er tooth in the prosthesis! Hith bar fixation% a
stronger and a #ea:er tooth can be splinted #ith the result that the stronger
tooth strengthens the #ea:er tooth and the #ea:er tooth #ea:ens the
stronger tooth!
/ar 'ttach$ents G
The bar attach$ents help in splinting of the abut$ent teeth% retention and
support of the appliance! The inter occlusal space availability has already been
e$phasi8ed! /ar attach$ents are classified into t#o types bar units and bar
Aoints! /ar unit has a rigid fixation #here there is no $ove$ent bet#een the bar
and overlying sleeve and can be classified as tooth born! /ar Aoints per$its
rotational $ove$ent bet#een sleeve and bar and derives $ore or residual ridge
support!
Types of /ar 'ttach$ents G
.! 1ader /ar!
0! Dolder bar attach$ent!
2! /a:er clips!
3! 'c:er$an clips and
4! <!-! clip
1ader /ar attach$ent G
- <an serve as a bar Aoint or a bar unit!
- <an be used as a stud attach$ent and a bar attach$ent!
- <onsists of prefor$ed plastic bars and clips!
;abrication G
The plastic bar is attached to the #ax copings and is cast #ith the coping!
7lastic clip is e$bedded in the denture for retention! /ut $etal clip offers $ore
retention than the plastic! 7lastic clip #ears off rapidly! ;or $ore retention
additional clips can be added and tension of the $etal clip can be increased!
1ader /ar G
'dvantages G
- /ars can be fabricated in any alloy!
- Retention can be replaced by patient or dentist!
- ;or $ore retention $etal clip can be used!
- 'sse$bly techni9ue is si$ple!
- <apability to follo# gingival contours!
Disadvantages G
- Rider is too bul:y occlusogingivally!
- Rider retention decreases rapidly!
- No tension adAust$ent! ;or additional retention $ore $etal clips
should be added!
Dolder /ar G
- 1as bar unit and bar Aoint
- 7refor$ed bars are available for bar units!
- Shape of the bar% has parallel sides #ith a rounded top!
- Retention is by $eans of frictional fit!
- Non resilient attach$ent!
;abrication G
The prefor$ed bars are soldered to the copings and the sleeve is e$bedded in
the acrylic over denture!
0!Dolder /ar G
'dvantages G
- 'vailability of t#o different heights .3!54 $$ and 2!5$$!
- Rider and bar are available in any lengths!
- Spacer allo#s vertical and rotational $ove$ent!
Disadvantages G
- Too bul:y even in $icrosi8e (faciolingually&!
- Expensive and re9uires exceptional s:ill for its use!
- 'llo#s vertical and rotational $ove$ent because of the resilient
attach$ent!
- <ontouring the bar Aoint is difficult!
/ul:y and difficult to use because of esthetic considerations!
/a:er <lip G
- <onsists of OUJ shaped clip designed to fit over a round #ire! .0 and .3
roung gauge #ire are used! These #ires are soldered to the copings! <lip is
positioned over the #ire and is attached to the over denture #ith cold cure
resin!
2! /a:er <lip G
'dvantages G
- 'dAustable and provides rotational $ove$ent!
- Readily available!
Disadvantages G
- No retention for the clips!
- Soldering the retentive loops reduces the elasticity of the clip!
'c:er$an and <!-! <lip G
- These are bar Aoints!
- /oth are si$ilar in designs!
- <onsists of a rounded bar and clip% #here the clip fits over the bar!
- The slip has retention #ings for the easy engage$ent into the acrylics!
- 'llo#s vertical and rotational $ove$ent because of fixation!
- 7rovides an excellent retention for overdenture #hen bar Aoint syste$ is
used!
'dvantages G
.! Rider is provided #ith retention!
0! Spaces provides resiliences and rotation (or& rotation alone if the shi$ is not
used!
Disadvantages G
The basis can be only .!?$$ in dia$eter!
-agnetic Denture Retention G
These have been in existance since .?2)! They can be divided into groups!
.! Those depending on the $utual repulsion of li:e $agnetic poles! Eg!
;ried$an $agnetic stabili8ers&!
Disadvantages G
a! Fess retentive #hen $ost needed (#hen Aa#s are part&
b! <ontinued resorbtion!
0! These depending on the $utual attraction unli:e poles!
Disadvantages G One continuous attracting forces could cause the e$bedded bar
$agnets to $ove through the bone% crode the soft tissues and beco$e
exfoliated!
"n order to :no# about $agnetic over denture the field strength and $agnetic
per$anence are 0 ter$s #hich re9uire clear understanding! ;or dental use a
high $agnetic field strength is desirable as this #ill provide stronger retention!
1igh per$anence is essential for (.& it ensures $agnet #ill be less li:ely to lose
its $agnetis$! (0& ' s$all $agnet can be $ade #ithout the north pole
de$agnetising the south pole!
Until .?6) $agnets for dental purpose #ere either 'lnico ('l% <o% Ni& or <o*7t
$agnets both alloys have $agnetic field strength! /ut their per$anence is such
that there is a lo#er li$it to their physical si8e and they cannot be $ade as
s$all as a tooth and have high field strength!
This li$itation #as eli$inated by the discovery of the rare earth cobalt (RE<&
$agnet alloys! RE< alloys have 4 to 3) ti$es field strength! The co$$on
co$position being cobalt*sa$ariu$ (<oS$&! They #ere introduced to
prosthodontics for retention by @illings in .?66!
"n one approach $agnets are attached to the supporting flush #ith the root
faces! Si$ilar but opposite polarity provides retention in the range of .4)E3))
g$s*$agnet pair! Denture base*root face separation of as $uch as 2$$! This is
no path of insertion retriction!
Disadvantages G
.! S$all root surface of so$e supporting root li$it the si8e of $agnet that can
be inserted and li$it retention!
0! The $agnet alloy can corrode and fracture in the $outh!
2! 'n avoidable $agnetic field surrounds both the intra radicular and denture
$agnets!
These disadvantage #as over co$e by replace$ent of one $agnet #ith a
$agnetisable lo# intrinsic coercivity alloy% #ithout significant loss of
retention! ' casting alloy based on palladiu$% cobalt and nic:le is cast as root
cap and do#el and fitted to the supporting root is inserted! The casting because
of its $agnetic coercivity beco$es a strong induced $agnet and retains the
denture li:e an intraradicular per$anent $agnet!
/iological Effects of <obalt*Sa$ariu$ -agnets G
There are t#o #ays in #hich <o*Sa $agnets could have an effect on tissuesG
.! 7hysical effect because of the presence of $agnetic field gradient!
0! <he$ical effect due to #ear or corrosion products of alloy!
/ehr$an (.?5)& in his study concluded that $agnetic is co$pletely innocuous
to tissues! Si$ilar conclusions #ere reached by Toto and <hou:as!
Tsutsui and his colleagues (.?6?& found alloy to be innocuous in tissue culture
test due to corrosion resistance! The #ear rate of unprotected faces of $agnets
used for over denture retention has been found to be less than
.$$*s9$$*year! (@illings .?6=&! This is several orders of $agnitude less than
the reco$$ended $axi$u$ ingestion levels for cobalt and sa$ariu$!
The external $agnetic field can be virtually eli$inated by arranging paired
$agnets is a $odified horse shoe configuration by #hich the retentive effect is
al$ost doubled! The explanation of this apparently ano$alous doubling effect
is that in the open configurations the north and south pole facing each other
contribute to the retention% but the re$aining South and North poles do not and
their potential retentive effect is thus #asted! Hhre as all the available
$agnetic field is used in no closed configuration! /oth the open and closed
field denture retention syste$ are in current use!
<o$parison of $agnetic retention and precision attach$ents!
'dvantages G
.! Si$plicity!
0! Fo# cost!
2! Self adAusting (Orthodontic tooth $ove$ent for passing contact&!
3! Reusable!
4! "nherent stress brea:ing!
5! Reseating after denture displace$ent!
6! ;reedo$ of lateral and rotational denture $ove$ent!
=! Fo# potential for trau$a to supporting roots!
?! Ease of denture relining!
.)! No special accessories are re9uired!
..! 1eight of denture retention ele$ent is less than $any precision
attach$ents!
"n a study conducted by Fo:e in (.?5)& the retention provided by a standard
$agnetic retention unit #as found to be co$parable to the :urer stud
attach$ent% but only about one 9uarter of the ce:a attach$ent and about .*6
th
that of bona buffer!
1o#ever $echanical attach$ent are subAected to #ear in service #here as
$agnets retention does not have any effect! <linically the retention i$proves
#ith ti$e probably as a result of closer contact bet#een retention ele$ent and
root face through orthodontic root $ove$ent and interface #ear!
The $agnetic syste$ provides retention of 4))g$ #ith 0 units! Hhich is
ade9uate in $ost cases and #ith $ore than 3 so$e patients have difficulty in
re$oving the denture!
The indicated bona buffer attach$ents $ay have $ore than 2!4 :g of retention
but this #ould provide excellent denture stabili8ing but could i$pose
unacceptable high stress to the supporting roots!
Sub$erged Vital Roots G
-any patients cannot change their oral hygiene habits to properly $aintain the
gingival sulcus or tooth surface! ;or these patients a $ethod of root retention
and ridge preservation not re9uiring tooth and oral tissue cleanliness $ay be
the treat$ent of choice!
@uyer and associates in .?6= said that sub$ucosal root retention is one $eans
of eli$inating oral hygiene obligations for patients #hile possibly delaying
residual ridge resorption!
The $aintenance of alveolar bone tissue has depended up on the presence of a
healthy root and periodontal liga$ent #ith the resultant tensional forces
delivered to the bone by to the teeth during $asticatory or parafunctional
$andibular $ove$ents! Tooth roots retained sub$ucosally see$s to be
si$ilarly effective in preserving alveolar bone! Though endodontically treated
teeth prior to burial are used recent investigations suggest sub$ucosal vital root
retention a feasable alternatives! Research results have proved that sectional
and buried teeth #ere co$patible #ith surrounding tissue and sho#ed no
pathology #ithin the pulpal tissues or tissues attached to the roots! The retained
root exhibited co$plete healing #ith for$ation of an osteoce$entoid plug over
the coronal surfaces of the root and a healthy viable pulp tissue!
.! Reduced cost!
0! Expeiditing the treat$ent!
2! 7reservation of R!R!
3! No $aintainance of any degree of oral hygiene around the re$aining teeth!
<riteria for 7atient Selection G
.! 7atients #ho are psychologically acceptable as <D patients can be
candidates for sub$ucosal vital root retention!
0! Should have a nor$al response to accepted clinical vitality test!
2! Should sho# at least 2$$ of alveolar bone support on radiographic
exa$ination!
3! Should be located #ithin the area of the alveolar ridges $ost affected by
ridge resorption follo#ing tooth re$oval!
Farge restorations that $ay create debris during cutting of cro#n and root
should be debrided and filled #ith a te$porary prior to surgery or re$oval of
the ti$e of surgery! 7rior to the $a:ing of the surgical incision! 'de9uate
healthy gingiva is re9uired to cover the roots to be sectioned! Fac: of gingival
tissue at the ti$e of surgery $ay creative tension on the soft tissue! Sutured
over the sub$erged roots and cause failure of the #ound edges to re$ain #ater
tight closure and heal by pri$ary intension presurgical periodontal sealing! Soft
tissue curettage and root planning are considered essential for rapid soft tissue
#ound healing and acceptance of the retained roots #ithin the alveolar ridge!
Su$$ary
To conclude it #ould not be a repetition to say that over denture is a preventive
dentistry concept #hich has been brought into prosthodontics% and the alveolar
bone #ith its overlying $ucosa #as never intended to receive the full force of
a co$plete denture! Even though the techni9ue rese$bleJs those of co$plete
denture% there are i$portant differences! The prognosis of the restoration is
li:ely to be influenced by nu$erous factors li:e .! Selection of patient! 0!
Treat$ent planning 2! 7reparation of the $outh! 3! Execution of the
prosthodontic #or: and 4! -aintenance% finally its reasonable to conclude that
the retention of a part of the natural dentition affords the overdenture patient
again in neuro$uscular perfor$ance there by having an edge over his
edentulous counter part!
References
.! Kohn K! Sharry G <o$plete Denture 7rosthodontics! Third edition% Ne#
,or:% -c@ra#E1ill /oo: <o!% .?63!
0! /re#er '!'! and Robert! -! -orro# G Over dentures! Second edition!
St!Fouis% The <!V! -osby co$pany!% .?=)!
2! Sheldon Hin:ler G Essentials of co$plete denture! 7hiladelphia H!/!
Saunders <o! .?66!
3! 1arold H! 7reis:el G 7recision 'ttach$ents in prosthodontics G Over
dentures and Telescopic prosthesis vol! 0! <hicag% Muintessence 7ublishing
<o!% "nc! .?=4!
4! Kudson <! 1ic:ey!% @eorge '! Larb% and <harls F! /olender G Syllabus of
co$plete dentures! Ninth edition% St! Fouis% The <!V! -osby <o$pany
.?=4!
5! <harles -! 1eart#ell% Kr!% and 'rthur O! Rahn G Syllabus of co$plete
denture! ;ourth edition! 7hiladelphia! Fea and ;ebiger .?=5!