Dr.

Mahmoud Ramadan I

Rem. Prosthodontics
502
Dr. Mahmoud Ramadan II

Overlay Denture
-:Advantages*
Superior method of treatment of certain cases as congenital defects.-1
.(E.g. (cleft palate, class III pt's& pt's have few remaining teeth
.Simplicity of construction: as those for conventional complete denture-2
Ease of maintenance: (repairs, alteration or refitting of over-denture)-3
.as those for conventional complete denture
.stability as in fixed& complete dentures ↑-4
.retention because, of ↑ stability of over-denture ↑-5
.esthetics: due to restoring bony defects & selection of teeth freely ↑-6
.Open (roofless) palate is possible when anterior& posterior are saved-7
.Reasonable cost: ↓ than fixed partial denture-8
.familiar procedure: no special training should be required-9
Ease in making measurements: the vertical dimension of occlusion-10
maintained with high degree of accuracy – stabilization of the recording
.bases
.Ideal occlusion: the occlusion is acceptable esthetically-11
Excellent pt. acceptance: because, loss of all teeth at an advanced age,-12
.more traumatic to the pt
.trauma to supporting structure: ↓ resorption of alveolar ridge ↓-13
Stabilisation& support of existing structures: vertical dimension of-14
.occlusion is maintained and lip& face support is maintained
.Minimal adjustment: because, of ↑ stability& support-15
Possibility of using attachments( ↑ retention )& soft liners( when it is-16
.( difficult to maintain a seal
Transitional (training) denture: for preparing to receive complete-17
.denture
Conversion to complete denture: loss of one or all retainable teeth-18
.corrected by relining& rebasing
.Reversibility-19
Ease of cleaning: being removable →easier to clean than fixed partial-20
.denture

-:Disadvantages*
.(expensive than conventional complete denture(endo- perio- surgery ↑-1
Dr. Mahmoud Ramadan III

.Bulker than fixed partial denture or removable partial denture-2

.Some prefer fixed partial dentures& don't like removable dentures-3
.Caries& periodontal diseases can progress in pt's with↓oral hygiene-4

-:Indications*
.Presence of few remaining teeth -1
.Pt's with only one root or tooth remaining -2
.Pt's with poor prognosis for complete dentures -3
.Pt's with class II & IV Angle classification -4
.Pt's with abnormal jaw size or bony defects -5
.(Pt's with congenital defects (cleft palate or microdontia -6
.(periodontal health of teeth (↓ crown-root ratio ↓ mobility ↓ -7

-:Contraindications*
.Poor oral hygiene -1
.(Low inter-arch space (can't accept the denture& the abutments -2
.Grade II mobility of teeth -3

Examination, Diagnosis, Treatment

planning& Prognosis
-:A)History & Records
-:I [ Medical history [
Dr. Mahmoud Ramadan IV

.ve ) correlation between emotional state& denture problems + ) →

.Debilitating medical or psychiatric disorders →
.Pt. ability to maintain an adequate level of oral hygiene →

-:II [ Dental history [

Past dental history gives information about previous experiences →
.which may influence his attitude, motivation& expectation
Why did the pt. loose teeth& what difficulties did he have with →
?replacements
Pt. should be formed about expectations within treatment capabilities →
.to avoid disappointment
Pt. with acceptable oral hygiene have much better over-denture →
.prognosis than those of bad oral hygiene

-:III [ Pretreatment records [

Accurate diagnostic casts mounted in a suitable articulator which -1
.supply information about the pt.& selection of the abutments
.Color transparences or photographs -2
.Cephalometric radiographs -3

-:B)Examination
-:Visual& Digital Examination ♥
-:a- Visual Examination
Lips, buccal Mucosal, gingiva, floor of the mouth, hard& soft palate →
.should be examined
.Possible pathologic changes should be evaluated →
Evaluation the response of supporting tissues to existing prosthesis, →
.such as inflammation or hyper plastic tissue

-:b- Digital Examination

Exostosis, sharp mylohyoid ridges, displaceable tuberosity tissue, →
displaceable tissues on the residual ridges, tissue undercut areas in need
.for surgical correction

-:Dental Examination ♥
.Carious lesions& defective restorations -1
Dr. Mahmoud Ramadan V

.Vitality tests -2
.Missing teeth -3
.Condition of replacements -4
.Occlusion -5
.Adequate denture space -6
.Clenching or Bruxism -7
.Abnormal tongue or lip habit -8
.Oral hygiene status -9
.Pt. denture cleaning methods -10

-:Periodontal Examination ♥
-:Diagnosis of →
.Signs& symptoms of chronic periodontal disease -1
.Generalized bone loss -2
.Increased periodontal pocket depth -3
.Hyper-mobility -4
.Crevicular& pocket depths as well as furcation should be probed -5
.Teeth with horizontal& Vertical displacement are poor choice -6
It is essential to evaluate the pt. oral hygiene in relation to the →
.periodontal status
Maintaining an adequate oral hygiene is important in achieving a →
.reasonable service life for the overlay denture

-:Radiographic Examination ♥
Individual periapical films supplemented by a panoramic radiograph →
-:should be adequate. Also we should observe
.Retained roots -1
.Impacted teeth -2
.Crown-Root ratio -3
.Carious lesions -4
.Status of previous endodontic treatment -5
.Radiolucent& radiopaque lesions of the jaw -6
.Status of periodontium -7

-:C) Treatment Planning

-:Indications for Fixed Partial Denture *
Dr. Mahmoud Ramadan VI

.Properly distributed& healthy teeth to serve as abutments -1

Teeth have suitable crown-root ratio after radiographs, diagnostic -2
.cast& oral examinations

-:Indications for Removable Partial Denture *

.Distal extension situations -1
.After recent extraction -2
.Long edentulous span -3
.Need for bilateral bracing -4
.Esthetics in anterior region -5
.Excessive loss of residual bone -6

-:Indications for Removable Complete Denture *

.Uncooperative& disinterested pt -1
.No retainable teeth are present -2

-:Indications for Overlay Denture *

.or fewer retainable teeth are present in an arch 4 -1
.Pt. loose teeth in one arch& the other remain dentulous -2
.Unfavorable tongue position or improper muscle attachment -3
Any situation in which stability& retention would be a very serious -4
.problem with complete denture

-:Types of Overdenture ♥
-:Immediate Overdenture (1
Constructed for insertion immediately after removal of some natural →
.teeth
.Used when pt. has many hopeless teeth →
The abutment teeth are selected, treated and then, Overdenture is →
.inserted
.This type is modified as required& can be worn for several years →

-:Transitional Overdenture (2
Obtained by converting an existing Removable Partial Denture to →
.Overdenture status

-:Remote Overdenture (3
Dr. Mahmoud Ramadan VII

Constructed for insertion at time remote from removal of hopeless →

.natural teeth
Complete or Partial Overdentures with metal or acrylic bases can be →
.fabricated

-:Abutment Selection ♥
-:The abutments should be evaluated from the view of points →
-:a) Periodontal Status
Teeth must have acceptable state of periodontal health prior to *
.completion of the Overdenture
-:Basis for selection →
.Acceptable state of periodontal health -1
.Use teeth that less than ideal -2
.Teeth with minimal mobility -3
.Adequate bone support -4
.Accept periodontal treatment -5
.Good crown-root ratio -6
-:b) Caries activity
Teeth with minimal or no caries involvement should be selected for →
.abutments
.Carious teeth can be selected after successful restorative procedure →
.Caries in unprotected abutments can lead to failure of the restoration →

-:c) Potential for Endodontic treatment

.Recommended for Overdenture abutments *
.It's advantages overcome it's disadvantages *
-:Successful Endodontic treatment contributes to →
.Esthetics: by allowing sufficient reduction of the abutment tooth -1
.Crown-root ratio: improved by crown reduction -2
Permits using of: tilted or malposed or hemi-sectioned teeth as -3
.abutments for Overdenture

-:d) Positional consideration

Overdentures should be considered with 4 or fewer retainable teeth →
.((which have less than ideal periodontal support
-:Depending on distribution *
-:abutments in one arch 4 ♥
Dr. Mahmoud Ramadan VIII

Represent an ideal stress distribution. E.g. (2 Canines& 2 second →

.(premolars
-:Factors affecting support in Overdenture →
.Number of the abutments -1
.Distribution of the abutments -2
.Position of the abutments -3

-:abutments in one arch 3 ♥

abutments are in one side of the arch& one is on the other side, will 2 →
.give unbalanced support
.canines& one central incisor (tripod), will give better distribution 2 →

-:abutments in one arch 2 ♥

Canines& premolars are selected more than any other type of teeth. →
-:Because, they are
.Amenable to endodontic treatment -1
.Adequate periodontal attachment area -2
.Strategic positions in the arch -3
.The 2 abutments should be situated bilaterally for optimum support →
Anterior positioning of the canines minimize the soft tissue loading in →
.anterior arch

-:Good results gained when abutments aren't approximating ♥

Canine& approximating premolar don't give much more support than -1
.one abutment
.Approximating abutments are difficult to clean -2
Approximating abutments make positioning of teeth in Overdenture -3
.more difficult

-:e) Occlusal consideration

It is essential to consider occlusion in selecting abutments for →
-:Overdenture
If an Overdenture is opposed by Removable Complete or Partial -1
Denture the forces will be less than if the Overdenture is opposed by
.intact natural dentition
Abutments for Overdentures opposed by a natural dentition should be -2
.selected to reflected the high need for support& stability
Dr. Mahmoud Ramadan IX

-:D)Prognosis
.Accurate examination& diagnosis affect prognosis of Overdenture -1
.Oral hygiene level of the pt -2
.Clinical& laboratory procedures -3
.Post-insertion service& maintenance -4