|Year : 2013 | Volume
| Issue : 1 | Page : 61-64
Four and two tooth supported - Conventional over denture: Two case reports
Veena S Prakash1, G Shivaprakash2, Samrat Hegde3, Nagarajappa4
1 Department of Prosthodontics, College of Dental Sciences, Davangere, Karnataka, India
2 Department of Orthodontics, College of Dental Sciences, Davangere, Karnataka, India
3 Department of Endodontics, College of Dental Sciences, Davangere, Karnataka, India
4 Department of Oral and Maxillofacial Surgery, SJM Dental College, Chitradurga, Karnataka, India
|Date of Web Publication||26-Nov-2013|
Veena S Prakash
Department of Prosthodontics, College of Dental Sciences, Davangere - 577 004, Karnataka
Source of Support: None, Conflict of Interest: None
The mastication, phonation and esthetics: The trident factors are very important and should be given due consideration when any dental procedure is initiated to achieve the successful outcome of treatment. The prosthetic management of edentulous patient has long been a major challenge for dentistry. For well over a century, complete maxillary and mandibular denture have been the traditional standard of care. However, most of the patients report significantly more problems adapting to their mandibular denture due to a lack of comfort (e.g., they suffer from an increase in pain and soreness), retention, stability and inability to chew and eat. Recent scientific studies carried out over the past decade have determined that the benefits of a mandibular two implant over denture/coping retained are sufficient to propose the two implant over denture - rather than conventional denture - as the first treatment option. This in the prosthodontics literature has led to shift in therapeutic philosophy regarding restoration of the edentulous patient. This article presents four and two tooth supported conventional over denture - two case reports.
Keywords: Implant, over denture, prosthesis
|How to cite this article:|
Prakash VS, Shivaprakash G, Hegde S, Nagarajappa. Four and two tooth supported - Conventional over denture: Two case reports. Int J Oral Health Sci 2013;3:61-4
|How to cite this URL:|
Prakash VS, Shivaprakash G, Hegde S, Nagarajappa. Four and two tooth supported - Conventional over denture: Two case reports. Int J Oral Health Sci [serial online] 2013 [cited 2017 Mar 23];3:61-4. Available from: http://www.ijohsjournal.org/text.asp?2013/3/1/61/122134
| Introduction|| |
Rissin et al. in 1978 compared masticatory performance in patients with natural dentition, complete denture and over denture. They found that the over denture patients had a chewing efficiency one-third higher than the complete denture patients.
Crown and Rooney 1975 in their study found that retention of mandibular canine for over denture led to the preservation of alveolar bone.
Rationale for over denture concept
- Extraction of all natural dentition and replacement with complete denture is not the most desirable treatment
- Preventive prosthodontics emphasizes the importance of any procedure that can delay or eliminate further prosthodontic problems
- The over denture is a logical method for a dentist to use in preventive prosthodontics.
- For patients who face the loss of remaining natural adult dentition. Therefore, younger the patient greater the indication
- Patents with badly worn out dentition
- Cleft palate cases
- For congenital anomalies like microdontia, in selected partial anodontia cases.  Amelogenesis imperfecta and dentinogenesis imperfecta
- Denture for patients with maxillofacial trauma.
- Uncooperative and under motivated patients
- Mentally and physically handicapped patients for whom good oral hygiene is difficult to maintain
- When a patient cannot afford.
| General Considerations During Diagnosis and Treatment Planning|| |
An important periodontal requisite with over denture abutment is adequate zone of attached gingiva. This can be accomplished through periodontal surgery (Utilizing either a free gingival graft or apically repositioning a split thickness flap).
- Periodontal inflammation, pocket formation, bony defect and poor zone of attached gingiva must be eliminated before starting treatment. ,
- There are advantages of treating the abutment endodontically. Few to mention include:
- The crown root ratio can be made more favorable
- Clinical crown reduction provides interocclusal clearance for placement of artificial teeth
- For securing attachments.
| Types of Over Dentures|| |
Immediate over denture is constructed for insertion immediately after the removal of some natural teeth.
Transitional over denture is obtained by converting an existing removable partial denture to over denture.
Heartwell's classification 
Based on the method of abutment preparation:
- Non-coping - with simple tooth modification
- Submerged vital roots: Effective in preserving alveolar bone
Abutment with attachment
- Short coping - 2-3 mm long and normally require endodontic therapy
- Long coping - 5-8 mm long, an attempt is made to circumvent endodontic therapy by conservative reduction.
Most of the attachments are secured to the abutment by a cast coping. Objective of attachment is to improve the retention of denture. 
- Endodontic treatment, periodontal consideration, caries management, location and distribution of abutment, economy
- Already endo and perio considerations are discussed.
- Caries management:
- Frequent recall checkup and treatment of abutment with periodic fluoride application.
Location of abutment teeth
Two teeth in each quadrant present an ideal situation.  E.g.
Clinical procedure: (For tooth supported over denture)
- Cuspids, second premolars or second molars in each quadrant
- Mandibular cuspids are most often utilized since they are usually the last teeth to be lost
- Mandibular incisors can be used as over denture abutments if mandibular arch is intact.
Implant supported over denture
- Surgical removal of teeth with poor prognosis
- Periodontal treatment
- Endodontic treatment of abutment teeth
- Crown reduction of abutments
- Fluoride application over prepared teeth
- Impressions and subsequent procedures are similar to conventional complete denture
- On the tissue surface of the denture, the areas adjacent to gsingival margin should be trimmed or relieved to avoid impingement and later use resilient liner.
Some patients will not be able to wear their dentures irrespective of its perfect contours. These patients are termed as "Mal-adaptive." The implant-supported denture can be designed for these patients.
| Case Reports|| |
A 51-year-old female patient with a poor prognosis of the teeth present reported with a chief complaint of inability to chew and wanted to improve her esthetics.
After evaluation of the patient, it was decided to extract all the teeth remaining in the maxillary arch. In the mandibular arch as the patient gave a history of extraction, a decade with regard to mandibular posteriors, the lower ridge was poor. Hence, it was decided to retain mandibular canines and first premolars, proceed with intentional root canal treatment (RCT) followed by coping to the four teeth. Maxillary conventional and mandibular over denture was planned to reduce the impact on the bone by conventional denture in lower and also to improve the retention and stability. After taking consent, the same treatment protocol was followed [Figure 1]a-j.
|Figure 1: (a) Case 1: Pre-treatment orthopantomogram. (b-d) Case 1: Intra oral maxillary, mandibular before coping insertion, copings ready for cementation. (e-h) Case 1: Mandibular canine and first premolars endodontically treated, copings cemented. (i-j) Case 1: Post-treatment intra and extra oral|
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A 48-year-old female patient reported with a chief complaint of protruding upper front teeth and inability to chew and wanted to improve her esthetics.
After evaluation of the patient, it was decided to extract all the teeth remaining in the maxillary arch. In the mandibular arch as the patient gave a history of extraction, a decade with regard to mandibular posteriors because of poor periodontal support, the mandibular ridge was poor. Hence, it was decided to retain mandibular first premolars, proceed with intentional RCT followed by coping to the two teeth. Maxillary conventional and mandibular over denture was planned to reduce the impact on the bone by conventional denture in mandible and also to improve retention and stability.
During the extraction procedure as the patient had skeletal class II with severe premaxillary excess alveoloplasty was done in the anterior segment along with extraction. After taking consent - the same treatment protocol was followed [Figure 2]a-k.
|Figure 2: (a-c) Case 2: Pretreatment Extra oral & Intra oral. (d) Case 2: Pre-treatment orthopantomogram. (e-f) Case 2: Pre-treatment frontal first premolars after endodontic treatment. (g-i) Case 2: Pre-treatment maxillary, mandibular before and after coping cementation. (j-k) Case 2: Post-treatment intra oral and extra oral|
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Advantages of conventional over denture:
Disadvantages of conventional over denture:
- Feels more like having teeth
- More retention in many cases
- Helps to reduce shrinkage of surrounding alveolar bone
- Reduces pressure on portions of the alveolar ridge
- Positive psychological advantage of still having teeth.
- Scrupulous oral hygiene is essential in order to prevent decay and periodontal disease
- The over denture may appear bulkier than conventional denture
- Frequent maintenance examinations are necessary
- In general, this is a more expensive approach than conventional denture.
| Conclusion|| |
The over denture has innumerable advantages and applications compared with conventional complete denture. The success depends upon proper case selection with critical monitoring of various steps involved.
Prosthodontic rehabilitation of cases like partial anodontia not only improves function and esthetics dramatically, but also psychologically boosts the morale of the patients more so when the individual is of younger age.
| References|| |
|1.||Mehta SS. Prosthodontic rehabilitation of a case of partial anodontia - A case report. J Indian Prosthodont Soc 2001;1:3-5. |
|2.||Brewer, Morrow RM. Over Dentures. 2 nd ed. St. Louis: Mosby; 2 nd ed. 1980. |
|3.||Nallaswamy D. Text Book of Prosthodontics. Jaypee; 2005. p. 259-62. |
|4.||Hartwell CM Jr, Rahn AO. Syllabus of Complete Denture. 4 th ed. Philadelphia: Lee and Febiger; 1986. |
|5.||Prieskel HW. Precision Attachments in Prosthodontics over Denture and Telescopic Prosthesis. Vol. 2. Chicago: Quintessence International; 1985. |
|6.||Galagali G. Ectodermal dysplasia and its prosthetic rehabilitation with over denture-A case report. J Indian Prosthodont Soc 2000;11:42-4. |
[Figure 1], [Figure 2]