Overdenture

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Overdenture resting on implants on a plastic model Implant overdenture model.jpg
Overdenture resting on implants on a plastic model

Overdenture is any removable dental prosthesis that covers and rests on one or more remaining natural teeth, the roots of natural teeth, and/or dental implants. [1] It is one of the most practical measures used in preventive dentistry. Overdentures can be either tooth supported (conventional / immediate) or implant supported. It is found to help in the preservation of alveolar bone and delay the process of complete edentulism. [2]

Contents

An overdenture is a denture, the base of which covers one or more teeth, prepared roots or implants. [3]

An overdenture is usually used for elderly patients that have lost some teeth but not all, rendering them suitable for a set of full dentures. [4] The overdenture is not rigid in the mouth; it is removable. [4]

An advantage of overdentures compared to full dentures is that the roots left in the maxilla (upper jaw) help preserve bone of the upper jaw, preventing bone resorption. [4] Another advantage is that the sensory aspect is improved. [4] The nerves in the roots are still present therefore sensation is improved greatly. [4]

The gums around the teeth must be relatively healthy for an overdenture to not cause any further problems. [4]

A maxillary overdenture may be supported by implants. [5] Even though there is no solid evidence to prove how many implants would be ideal to stabilise an overdenture, the most common number of implants used to stabilise a maxillary denture is 4. [5]

For a mandibular overdenture, support was better given by 2 implants than it was when only one implant was present. [5] The patient could also chew much better and was overall more pleased with the overdenture. [5]

At first, chewing capabilities are reduced however within 12 months of fitting the overdenture, the chewing cycle improves. [6] [7]

Alternative Terminologies

Types

Overdentures can be classified into 2 categories, depending on the types of abutment providing support: [8]

Types of Abutment

Tooth-supported

This type of overdenture overlies natural tooth structures. Frequently, elective root canal treatment and coronal modification are carried out on the teeth that are used as abutments. This means that the pulpal tissues and crowns of the natural teeth are removed, followed by contouring of the tooth structure above the gum. This allows even distribution of occlusal stress onto the abutment teeth and soft tissues. [4] Other than that, retention of natural teeth in the jaw helps preserve bone by delaying the process of bone resorption in the jaw. [9]

Selection of abutment teeth depends on a few factors including:

To provide adequate support, there should be one abutment tooth per quadrant and the abutment should ideally be a canine.

The teeth selected to provide support should be healthy i.e. not decayed and no/ manageable gum disease, thus ensuring long term retention in the jaw.

Most of the time, the crown of the abutment teeth has to be removed to allow space for placement of overdenture without interfering the bite. Therefore, the pulp has to be removed. If the root canals of the abutment teeth are obliterated, endodontic treatment is not required. Teeth with non-negotiable root canals should not be selected as abutments.

Implant-supported

Edentulous patients with sufficient amount of bony ridge on their jaws can opt for implant supported overdenture. [4] This type of over denture gains support from both the dental implants and intraoral tissues. Having implant-supported overdenture provides better stability of prosthesis and reduce bone resorption. [10] However, a conventional complete denture can be considered as an alternative due to less treatment time needed. [11]

Types of Attachment System

Overdentures can be further classified according to the types of attachment system used. [12] The attachment systems function to enhance retention and stability of the overdenture. [13] Currently there isn't enough evidence to advocate a particular system and hence technical aspects are the main consideration when choosing it. [13]

Stud attachments

This is the oldest system available and consists of a male (stud) and female (housing) component. [12] It connects the over denture to the individual abutment. [14]

Examples of stud attachments include:

Bars and clips

Bars function to connect the over denture to the splinted abutments. [12] A clip or sleeve is then placed over the bar to hold the overdenture in place.[ citation needed ] Depending on their resiliency, bars can be made either a bar joint (resilient) or a bar unit (non-resilient/ rigid). Overall, this is the most popular attachment system due to its ability to stabilise overdenture and relatively higher wear resistance.[ citation needed ]

Magnets

This system consists of a magnet incorporated on the fitting surface of the overdenture and the magnet keeper fixed to the implant abutments.[ citation needed ] It is considered to be resilient and less retentive than the ball attachment, allowing movement of overdenture. [12]

Telescopic

This system is more commonly used in overdentures supported by natural teeth rather than implants. [12] It consists of a primary coping cemented to the abutments and a secondary coping, which is incorporated on the overdenture, to fit over the primary coping. [15] Hence, it is also known as double crown, a crown and sleeve coping or Konuskrone. [15]

Indications

Retention and Stability

- If prescribing a removable prosthesis and there is limited remaining firm teeth in the dentition an overdenture may aid in retention and stability compared to that of a conventional removable prosthesis. [2]

Preventative Dentistry

- The use of an overdenture delays the process of leaving the patient completely edentulous and assists in the preservation of bone. [2]

- As a main priority for many dentists and patients, preventative dentistry is a reason for prescribing an overdenture as it retains the natural teeth for longer. [16]

Patient Anatomy

- Overdentures can be useful for patients with a severe ridge defect or bone resorption. [17]

- Patients who have unfavourable tongue positions and muscle attachment for a conventional removable prosthesis could find that an overdenture has increased retention and stability. [16]

- If the patient has a superficially placed mental nerve, then the preferential choice of treatment may be to leave certain teeth in place in order to prevent damage to the nerve and prescribe an overdenture for any aesthetic needs. [17]

Protection of Root Canal Filling

- An overdenture can be prescribed for a patient who has just had a root canal treatment completed to protect the coronal seal of the tooth if they are waiting to have fixed prosthodontics carried out on the tooth.

Advantages

There are numerous advantages of overdentures when compared to conventional full or partial removable prosthesis. Overdentures can be supported and retained by natural roots left in situ or by dental implants. Implant retained dentures may be fixed or removable and are an option for the completely edentulous patient.  They offer the benefits that a root supported overdenture provides.

Proprioception

When roots are retained and used for overdentures, preservation of the periodontal membrane maintains proprioceptive impulses so the patient is aware of occlusal contacts and can control occlusal forces as they did with natural teeth. [18] Loss of proprioception is something which patients can struggle with accepting.

Bone Resorption

When teeth and roots are extracted, bone resorption ensues. This is greatest in the mandible and can be minimised by retaining roots.  Mandibular bone loss was examined by Crum and Rooney 1978 in patients with immediate complete dentures and in those with immediate overdentures on two lower canines. They found over the five years after placement 0.6mm bone loss in the overdenture group and 5.2 mm in the immediate complete dentures in the anterior part of the mandible. This reduction in bone loss enables increased stability and retention of the overdenture which has psychological and functional advantages for the patient. [19] Preservation of the alveolar ridge, especially with a lower prosthesis may improve patients comfort, chewing, phonetics and aesthetics allowing a better quality of life. A fixed implant retained denture is completely implant supported therefore further alveolar ridge resorption is avoided, unlike with a tissue supported prosthesis. An improvement in soft tissue health can also be seen.

Complications

There are a number of complications that can arise once overdentures are fitted in the mouth. These can range from post insertion tissue changes to fracture of the prosthesis.

Damage to Periodontal Tissues

The most common reason for changes within the periodontal tissues is the lack of adequate oral hygiene. [20] Plaque build up around overdenture abutments or precision attachments can lead to inflammation and hyperplasia of the gingiva. This can present as painful, red and swollen tissues, especially at the gingival margin. As a result, gingival recession may occur leading to exposure of the root surfaces to the oral environment. A study which looked at patients wearing overdentures found that the rate of tooth loss was in the order of 20% and was most commonly due to periodontal disease. Many of these failures could have been prevented with better oral hygiene methods. [21]

Tooth Decay

Any remaining tooth structure within the oral cavity is subject to developing caries and is often the result of lack of topical fluoride application, poor diet and poor oral hygiene. Caries can be found at the root face or root surface where gingival recession has occurred. [20] It is important to encourage patients to use a fluoride containing toothpaste over the denture abutments to minimise tooth surface loss and risk further infection.

Bone Resorption

Another tissue change that can result from wearing an overdenture is resorption of the alveolar bone. Although retention of a root prevents the alveolar bone from resorbing, at a distant site from the overdenture abutment the bone is susceptible to gradual resorption. This could lead to instability of the denture and uneven loading over time. [20] There is then a potential for the denture to irritate the mucosa due to repeated movement against the tissues.

Denture Stomatitis

Denture stomatitis is a common problem in full and partial denture wearers, and so can also be seen in patients wearing overdentures. It is an example of a yeast infection [22] and can arise due to various factors, for example poor oral hygiene, hyposalivation and poor diet. Common signs include ulcers, red and white patches or both. [23] It is important to encourage good denture hygiene methods and it may be necessary to provide a new denture.

Fractured Prosthesis

As well as damage to intra-oral tissues there is also a possibility of fracture of the prosthesis itself. Overdentures retained by attachments have been found to be more likely to fracture. [20] A study looking at implant retained mandibular overdentures compared the risk of fracture between one implant retained denture and two. The results showed that the incidence of denture base fracture was not significantly different between the presence of one or two implants but when a fracture did occur it was found to be in areas around the implants. [24]

Research & evidence

A 10-year observational period found that implants which supported overdentures in the mandible had a survival rate ranging from 91.7% to 100%. [25] Furthermore, implant survival rates with respect to their attachment system were found to be best for the ball type attachment which was an average of 95.8 - 97.5%, followed by the bar and magnet ranging from 96.2 - 100% , and 91.7% respectively. [25]

Related Research Articles

<span class="mw-page-title-main">Dentist</span> Health care occupations caring for the mouth and teeth

A dentist, also known as a dental surgeon, is a health care professional who specializes in dentistry, the branch of medicine focused on the teeth, gums, and mouth. The dentist's supporting team aids in providing oral health services. The dental team includes dental assistants, dental hygienists, dental technicians, and sometimes dental therapists.

<span class="mw-page-title-main">Dentures</span> Prosthetic devices constructed to replace missing teeth

Dentures are prosthetic devices constructed to replace missing teeth, supported by the surrounding soft and hard tissues of the oral cavity. Conventional dentures are removable. However, there are many denture designs, some of which rely on bonding or clasping onto teeth or dental implants. There are two main categories of dentures, the distinction being whether they fit onto the mandibular arch or on the maxillary arch.

<span class="mw-page-title-main">Bridge (dentistry)</span> Dental restoration for missing teeth

A bridge is a fixed dental restoration used to replace one or more missing teeth by joining an artificial tooth definitively to adjacent teeth or dental implants.

<span class="mw-page-title-main">Dental technician</span> Technician working on dental appliances

A dental technician is a member of the dental team who, upon prescription from a dental clinician, constructs custom-made restorative and dental appliances.

<span class="mw-page-title-main">Dental implant</span> Surgical component that interfaces with the bone of the jaw

A dental implant is a prosthesis that interfaces with the bone of the jaw or skull to support a dental prosthesis such as a crown, bridge, denture, or facial prosthesis or to act as an orthodontic anchor. The basis for modern dental implants is a biological process called osseointegration, in which materials such as titanium or zirconia form an intimate bond to the bone. The implant fixture is first placed so that it is likely to osseointegrate, then a dental prosthetic is added. A variable amount of healing time is required for osseointegration before either the dental prosthetic is attached to the implant or an abutment is placed which will hold a dental prosthetic or crown.

A removable partial denture (RPD) is a denture for a partially edentulous patient who desires to have replacement teeth for functional or aesthetic reasons and who cannot have a bridge for any reason, such as a lack of required teeth to serve as support for a bridge or financial limitations.

<span class="mw-page-title-main">Alveolar process</span> Region of jaw bones containing tooth sockets

The alveolar process is the portion of bone containing the tooth sockets on the jaw bones. The alveolar process is covered by gums within the mouth, terminating roughly along the line of the mandibular canal. Partially comprising compact bone, it is penetrated by many small openings for blood vessels and connective fibres.

<span class="mw-page-title-main">Toothlessness</span> Lacking teeth

Toothlessness or edentulism is the condition of having no teeth. In organisms that naturally have teeth, it is the result of tooth loss. Organisms that never possessed teeth can also be described as edentulous. Examples are the members of the former zoological classification order of Edentata, which included anteaters and sloths, as they possess no anterior teeth and no or poorly developed posterior teeth.

<span class="mw-page-title-main">Denturist</span>

A denturist in the United States and Canada, clinical dental technologist in the United Kingdom and Ireland, dental prosthetist in Australia, or a clinical dental technician in New Zealand is a member of the oral health care team and role as primary oral health care provider who provides an oral health examination, planning treatment, takes impressions of the surrounding oral tissues, constructs and delivers removable oral prosthesis treatment directly to the patient.

Fixed prosthodontics is the branch of prosthodontics that focuses on dental prostheses that are permanently affixed (fixed). Crowns, bridges, inlays, onlays, and veneers are some examples of indirect dental restorations. Prosthodontists are dentists who have completed training in this specialty that has been recognized by academic institutes. Fixed prosthodontics can be used to reconstruct single or many teeth, spanning tooth loss areas. The main advantages of fixed prosthodontics over direct restorations are improved strength in big restorations and the possibility to build an aesthetic-looking tooth. The concepts utilised to select the suitable repair, as with any dental restoration, include consideration of the materials to be used, the level of tooth destruction, the orientation and placement of the tooth, and the condition of neighboring teeth.

<span class="mw-page-title-main">Crown lengthening</span> Dental procedure

Crown lengthening is a surgical procedure performed by a dentist, or more frequently a periodontist, where more tooth is exposed by removing some of the gingival margin (gum) and supporting bone. Crown lengthening can also be achieved orthodontically by extruding the tooth.

In dentistry, Ante's law is a postulate about crown-to-root ratio put forth by Irwin H. Ante in a thesis paper he wrote in 1926.

In dentistry, overeruption is the physiological movement of a tooth lacking an opposing partner in the dental occlusion. Because of the lack of opposing force and the natural eruptive potential of the tooth there is a tendency for the tooth to erupt out of the line of the occlusion.

In dentistry, an abutment is a connecting element. This is used in the context of a fixed bridge, partial removable dentures and in implants. The implant fixture is the screw-like component that is osseointegrated.

<span class="mw-page-title-main">All-on-4</span> A prosthodontics procedure

The term All-on-4, also known as All-on-Four and All-in-Four, refers to 'all' teeth being supported 'on four' dental implants, a prosthodontics procedure for total rehabilitation of the edentulous (toothless) patient, or for patients with badly broken down teeth, decayed teeth, or compromised teeth due to gum disease. It consists of the rehabilitation of either edentulous or dentate maxilla and / or mandible with fixed prosthesis by placing four implants in the anterior maxilla, where bone density is higher. The four implants support a fixed prosthesis with 10 to 14 teeth, and it is placed immediately, typically within 24 hours of surgery.

In dentistry, the neutral zone refers to that space in the oral cavity where the forces exerted by the musculature of the tongue are equal and balanced with the forces exerted by the buccinator muscle of the cheek laterally and the orbicularis oris muscle anteriorly.

Alveoloplasty is a surgical pre-prosthetic procedure performed to facilitate removal of teeth, and smoothen or reshape the jawbone for prosthetic and cosmetic purposes. In this procedure, the bony edges of the alveolar ridge and its surrounding structures is made smooth, redesigned or recontoured so that a well-fitting, comfortable, and esthetic prosthesis may be fabricated or implants may be surgically inserted. This pre-prosthetic surgery which may include bone grafting prepares the mouth to receive a prosthesis or implants by improving the condition and quality of the supporting structures so they can provide support, better retention and stability to the prosthesis.

A complete denture is a removable appliance used when all teeth within a jaw have been lost and need to be prosthetically replaced. In contrast to a partial denture, a complete denture is constructed when there are no more teeth left in an arch; hence, it is an exclusively tissue-supported prosthesis. A complete denture can be opposed by natural dentition, a partial or complete denture, fixed appliances or, sometimes, soft tissues.

Occlusion according to The Glossary of Prosthodontic Terms Ninth Edition is defined as "the static relationship between the incising or masticating surfaces of the maxillary or mandibular teeth or tooth analogues".

Full arch restoration in dentistry refers to the comprehensive reconstruction or rehabilitation of an entire dental arch, which can include all teeth in the upper or lower jaw. This procedure is also known as full mouth reconstruction or full mouth rehabilitation.

References

  1. ↑ "Glossary of Prosthodontics". The Journal of Prosthetic Dentistry. 117 (5): C1–e105. May 2017. doi: 10.1016/j.prosdent.2016.12.001 . hdl:2027/mdp.39015007410742. PMID   28418832.
  2. 1 2 3 Samra, RupandeepKaur; Bhide, ShreenivasVasant; Goyal, Chhavi; Kaur, Taranjit (2015). "Tooth supported overdenture: A concept overshadowed but not yet forgotten!". Journal of Oral Research and Review. 7 (1): 16. doi: 10.4103/2249-4987.160172 .
  3. ↑ Guidelines in prosthetic and implant dentistry. Ogden, Alan., British Society for the Study of Prosthetic Dentistry. London: Quintessence Pub. for British Society for the Study of Prosthetic Dentistry. 1996. ISBN   978-1850970439. OCLC   37156780.{{cite book}}: CS1 maint: others (link)[ page needed ]
  4. 1 2 3 4 5 6 7 8 Bansal, Siddharth; Aras, Meena A.; Chitre, Vidya (December 2014). "Tooth Supported Overdenture Retained with Custom Attachments: A Case Report". The Journal of Indian Prosthodontic Society. 14 (S1): 283–286. doi:10.1007/s13191-013-0340-0. PMC   4502008 . PMID   26199532.
  5. 1 2 3 4 Di Francesco, Fabrizio; De Marco, Gennaro; Gironi Carnevale, Ugo Antonello; Lanza, Michele; Lanza, Alessandro (January 2019). "The number of implants required to support a maxillary overdenture: a systematic review and meta-analysis". Journal of Prosthodontic Research. 63 (1): 15–24. doi:10.1016/j.jpor.2018.08.006. PMID   30269880.
  6. ↑ Nogueira, Túlio E.; Schimmel, Martin; Leles, Cláudio R. (March 2019). "Changes in masticatory performance of edentulous patients treated with single-implant mandibular overdentures and conventional complete dentures". Journal of Oral Rehabilitation. 46 (3): 268–273. doi:10.1111/joor.12744. PMID   30387869. S2CID   53784442.
  7. ↑ "Proteza fixa pe implanturi" . Retrieved 18 June 2023.
  8. ↑ Locator Implants
  9. ↑ Samra, RupandeepKaur; Bhide, ShreenivasVasant; Goyal, Chhavi; Kaur, Taranjit (2015). "Tooth supported overdenture: A concept overshadowed but not yet forgotten!". Journal of Oral Research and Review. 7 (1): 16. doi: 10.4103/2249-4987.160172 .
  10. ↑ Lambade, Dipti; Lambade, Pravin; Gundawar, Sham (May 2014). "Implant Supported Mandibular Overdenture: A Viable Treatment Option for Edentulous Mandible". Journal of Clinical and Diagnostic Research. 8 (5): ZD04–ZD06. doi:10.7860/JCDR/2014/7711.4332. PMC   4080073 . PMID   24995252.
  11. ↑ Visser, Anita; Meijer, Henny J. A.; Raghoebar, Gerry M.; Vissink, Arjan (2006). "Implant-retained mandibular overdentures versus conventional dentures: 10 years of care and aftercare". The International Journal of Prosthodontics. 19 (3): 271–278. PMID   16752625.
  12. 1 2 3 4 5 6 7 Prasad, DKrishna; Prasad, DAnupama; Buch, Manan (2014). "Selection of attachment systems in fabricating an implant supported overdenture". Journal of Dental Implants. 4 (2): 176. doi: 10.4103/0974-6781.140905 .
  13. 1 2 Daou, Elie E. (April 2013). "Stud attachments for the mandibular implant-retained overdentures: Prosthetic complications. A literature review". The Saudi Dental Journal. 25 (2): 53–60. doi:10.1016/j.sdentj.2012.12.003. PMC   3723078 . PMID   23960557.
  14. 1 2 3 Guttal, Satyabodh S; Tavargeri, Anand K; Nadiger, Ramesh K; Thakur, Srinath L (July 2011). "Use of an Implant O-Ring Attachment for the Tooth Supported Mandibular Overdenture: A Clinical Report". European Journal of Dentistry. 5 (3): 331–336. doi:10.1055/s-0039-1698900. PMC   3137448 . PMID   21769276.
  15. 1 2 Shruthi, C. S.; Poojya, R.; Ram, Swati (March 2017). "Telescopic Overdenture: A Case Report". International Journal of Biomedical Science. 13 (1): 43–47. doi:10.59566/IJBS.2017.13043. PMC   5422644 . PMID   28533736.
  16. 1 2 "Root attachments as an option for overdentures" (PDF).[ full citation needed ]
  17. 1 2 Bansal, Siddharth; Aras, Meena A; Chitre, Vidya (2014-01-01). "Guidelines for treatment planning of mandibular implant overdenture". Journal of Dental Implants. 4 (1): 86. doi: 10.4103/0974-6781.131014 .
  18. ↑ Rathee, Manu & Bhoria, Mohaneesh & Singla, Shefali & Malik, Poonam. (2014). "Proprioception for Prevention and Preservation". ResearchGate. Retrieved 23 November 2018.{{cite web}}: CS1 maint: multiple names: authors list (link)
  19. ↑ Ettinger, Ronald L (1 March 2014). "Do Root Supported Overdentures Have a Good Prognosis in General Dental Practice?". Oral Health. Retrieved 23 November 2018.
  20. 1 2 3 4 Basker, R., & British Dental Association. (1993). Overdentures in general dental practice (3rd ed.). London: British Dental Association. ISBN   978-0904588422.{{cite book}}: CS1 maint: multiple names: authors list (link)[ page needed ]
  21. ↑ Ettinger, RL; Qian, F (June 2004). "Abutment tooth loss in patients with overdentures". Journal of the American Dental Association. 135 (6): 739–46, quiz 795–6. doi:10.14219/jada.archive.2004.0300. PMID   15270156.
  22. ↑ "Denture stomatitis". Oral Health Foundation. Retrieved 2018-11-22.
  23. ↑ Scully, Crispian (2013). "Denture-related stomatitis". Oral and Maxillofacial Medicine. pp. 264–267. doi:10.1016/B978-0-7020-4948-4.00040-4. ISBN   978-0-7020-4948-4.
  24. ↑ "Editorial Board". The Journal of Prosthetic Dentistry. 103 (2): A2. February 2010. doi:10.1016/s0022-3913(10)00005-3.
  25. 1 2 Kim, Ha-Young; Lee, Jeong-Yol; Shin, Sang-Wan; Bryant, S. Ross (2012). "Attachment systems for mandibular implant overdentures: a systematic review". The Journal of Advanced Prosthodontics. 4 (4): 197–203. doi:10.4047/jap.2012.4.4.197. PMC   3517957 . PMID   23236571.
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