|
 
 |
| CASE REPORT |
|
| Year : 2013 | Volume
: 3
| Issue : 2 | Page : 121-124 |
|
Telescopic denture a treatment modalitity of preventive prosthodontics
Laxman Singh Kaira1, Rakesh Mishra2
1 Department of Dentistry, Veer Chandra Singh Garhwali Government Medical Sciences and Research Institute, Srinagar Garhwal, Uttrakhand, India
2 Department of Prosthodontics, Darshan Dental College and Hospital, Udaipur, Rajasthan, India
| Date of Web Publication | 4-Jul-2014 |
Correspondence Address:
Laxman Singh Kaira
Department of Dentistry, Veer Chandra Singh Garhwali Government Medical Sciences and Research Institute, Srinagar Garhwal, Uttrakhand
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2231-6027.135991
"It is more important to preserve what already exists than to replace what is missing," as stated by M.M. Devan has never been challenged or disapproved. In situations with few remaining natural teeth, prosthodontists are posed with a dilemma for the treatment options. In such cases, overdenture therapy has been proven to be advantageous. Bearing in mind the philosophy of preventive prosthodontics, overdenture therapy has a long-term advantage by preserving the proprioception and thereby residual alveolar ridge. This clinical report describes the prosthodontic rehabilitation a patient with few remaining mandibular natural teeth by telescopic mandibular overdenture for added advantages like better retention, stability, support and psychological benefits of the patient. Keywords: Preventive prosthodontics, primary coping, secondary coping, telescopic overlay denture
How to cite this article:
Kaira LS, Mishra R. Telescopic denture a treatment modalitity of preventive prosthodontics. Int J Oral Health Sci 2013;3:121-4 |
| Introduction | |  |
Preventive prosthodontics emphasizes the importance of any procedure that can delay or eliminate future problems. Retention of teeth and roots of one or more teeth for overdenture offers the patient a lot of advantages like better retention, stability, proprioception, support, maintenance of alveolar bone and psychological aspect of retaining teeth. The use of tooth-supported overdenture is a common form of treatment. There are two physiologic tenets related to overdenture therapy: The first concerns the continued preservation of alveolar bone around the retained teeth while the second relates to the continuing presence of periodontal sensory mechanisms that guide and monitor gnathodynamic functions. [1],[2]
A telescopic denture is a prosthesis that consists of a primary coping that is cemented to the abutments in a patient's mouth and a secondary coping that is attached to the prosthesis and fits on the primary coping. It thereby increases the retention and stability of the prosthesis. According to Glossary of prosthodontic terms, a telescopic denture is also called as an overdenture, which is defined as any removable dental prosthesis that covers and rests on one or more of the remaining natural teeth, on the roots of the natural teeth and/or on the dental implants. It is also called as overlay denture, overlay prosthesis and superimposed prosthesis.
Telescopic crowns were initially introduced as retainers for the removable partial dentures at the beginning of the 20 th century. They were also known as a double crown, a crown and sleeve coping or as Konuskrone, a German term that describes a cone-shaped design. These crowns are an effective means for retaining the Removable partial dentures and dentures. They transfer forces along the long axis of the abutment teeth and provide guidance, support and protection from the movements that dislodge the denture. [3]
The double crown systems are usually distinguished from each other by their differing retention mechanisms. There are three different types of double crown systems. These are telescopic crowns, which achieve retention by using friction, and conical crowns or tapered telescope crowns, which exhibit friction only when they are completely seated by using a "wedging effect." The magnitude of the wedging effect is mainly determined by the convergence angle of the inner crown: The smaller the convergence angle, the greater is the retentive force. The double crown with a clearance fit (also referred to as a hybrid telescope or a hybrid double crown) exhibits no friction or wedging during its insertion or removal. The retention is achieved by using additional attachments or functional molded denture borders. [4]
This clinical report describes the prosthodontic management of a patient with few remaining mandibular teeth by using the telescopic mandibular overdenture.
| Case Report | | |
A 60-year-old female patient reported to the Department of Prosthodontics, Crown and Bridge and Implantology with the chief complaint of difficulty in chewing and dissatisfaction with her present dentures [Figure 1]a. The patient gave a history of loss of teeth since 3 years due to caries and gum problems. On extra-oral examination, the patient had a convex profile and Temporomandibular joint was normal. On intraoral examination, the maxillary arch was completely edentulous with underextended complete denture and remaining teeth present in the mandibular arch were 32 33 37 41 42 43 44 45 47, which supported a dislodged removal partial denture. The edentulous span had favorable ridge with firmly attached keratinized mucosa with respect to both arches. Clinical and radiographic examination revealed grade III mobility and severe bone loss, respectively, with respect to 32 37 41 42 43 47 and were extracted [Figure 1]b and c. Diagnostic impressions were made and diagnostic mounting was performed to evaluate the interarch space and different possible treatment modalities. All treatment options were presented and discussed with the patient, including total extraction and conventional denture, implant-supported denture, telescopic complete denture with lower arch and conventional or implant-supported overdenture with upper arch after considering the financial aspects and amount of time the patient elected to have conventional upper complete denture and telescopic lower complete denture. After taking consent from the patient, oral prophylaxis, root planning and endodontic treatment of abutment teeth, i.e. 33, 44 and 45 were carried out, emphasizing oral hygiene instructions and maintenance [Figure 1]c. After assessing endodontic therapy, tooth preparation was done for receiving primary copings to 33 and 44 and 45. Impressions were made by the putty reline technique. The wax pattern was invested, cast, finished and modified on surveyor for parallelism, the metal crowns were cast using Co-Cr and returned to the surveyor to be resurveyed for the final path of insertion. Finally, the castings were polished and cemented in the patients' mouth [Figure 2]. Alginate impression for lower arch and conventional impression with impression compound for upperarch was made and custom tray was fabricated. Border moulding was performed in a conventional manner and final impressions were made by medium body impression material and zinc oxide impression paste for mandibular and maxillary arch, respectively, and master cast was poured. The lower master cast was blocked out and duplicated. After duplication, the refractory cast was obtained and the cast metal framework was waxed up with secondary coverage of the 33 44 45 abutments. The framework was cast in Co-Cr alloy. After trimming and polishing, it was fitted on to the master cast [Figure 3]a. The framework was tried in the patient's mouth for final fit [Figure 3]b. The jaw relation record was made with occlusal rims on the framework and maxillary record base. Wax try in was done in the patients mouth and patients' approval was taken. Acrylization of the framework was done using heat cure acrylic resin and maxillary denture was reinforced with metallic shim for increasing the strength [Figure 4]. Lab remounting of the denture was done and lower telescopic denture and upper complete denture was delivered to the patient. The patient reported with satisfactory fit and ease of use [Figure 5] and [Figure 6]. | Figure 1: (a and b) Pre-treatment extraoral and radiographic photograph(c) Post-extraction and endodontic treatment radiograph
Click here to view |
| Discussion | | |
It is a documented fact that after the loss of the teeth, the residual alveolar ridge undergoes rapid loss in all dimensions. The residual ridge resorption (RRR) is stated to be rapid, progressive, irreversible and inevitable, and has been well observed and documented in the literature. [5],[6] It is equally well observed that bone is maintained around long-standing teeth and implants. Retaining teeth as overdenture abutments seems to slow the rate of alveolar resorption. [7],[8] The physiologic objective is to provide for the tensile stimulation of as many of the oblique periodontal fibers as possible and the end result is the deposition of more bundle bone followed by concomitant decrease in abutment mobility.
The telescopic overdenture system used in this case in mandibular arch revealed a long-lasting usefulness in the prosthetic treatment of the patient with reduced dentition. Similar clinical observations were also described in reports made by other authors. [9] Many authors have also observed positive results of prosthetic treatment with telescopic dentures in patients with reduced dentition. [10] There are many advantages of telescopic crowns, like axial load of the tooth and full covering of the abutment (on the contrary to clasps), which may reduce the tilting forces with their negative influence on the abutment supporting tissues. The axial forces stimulate periodontal tissues and alveolar bone. They also provide indirect splinting influence, easy oral hygiene maintenance and easy ways of repair. [3]
Careful assessment of the interarch space is very important for the successful fabrication of the telescopic dentures. Sufficient space must be present to accommodate the primary and secondary copings to have a sufficient denture base thickness to avoid fracture, space for the arrangement of the teeth to fulfill the esthetic requirements and to have an interocclusal gap. The space consideration usually requires the devitalization of the abutments. The selected abutments should be periodontally sound with adequate bone support and no/minimal mobility. There should be at least one healthy abutment in each quadrant. An even distribution of the abutment in each quadrant of the arch is preferable for better stress distribution and for increased retention and stability of the prosthesis. The interocclusal gap/interarch distance should be ≥10 mm in order to have sufficient space for the copings, denture base, teeth placement and adequate closest speaking space. [11]
It has been found that telescopic dentures have better retention, stability, support and chewing efficiency as compared with the conventional complete dentures and also there is a decrease in the rate of the residual ridge resorption because of proprioception, better stress distribution and the transfer of compressive forces into the tensile forces by the periodontal ligament, which effects the rate of bone remodeling. A clinical study that was conducted by Bergman et al. on conical crown-retained dentures concluded that most of the patients were very satisfied with the restorations, both functionally and esthetically, and it found their chewing comfort to be better after the treatment with the conical crown-retained dentures. [12]
As the overdenture status of the prosthesis and its benefits to the patient depend solely on the continued retention of the underlying abutments, it becomes obligatory to periodically monitor their health and institute necessary steps to prolong their useful span. Herein lies the importance of periodical recall and review and patient motivation that makes overdenture therapy a continued service. Although there are increased costs and appointments associated with this technique, they are however justified because overdentures are a superior health service compared with the standard complete denture. [13]
| References | | |
| 1. | Prince IB. Conservation of the supporting mechanism. J Prosthet Dent 1965;15:327-38. 
|
| 2. | Yalisove IL. Crown and sleeve-coping retainers for removable partial prosthesis. J Prosthet Dent 1966;16:1069-85.
|
| 3. | Langer Y, Langer A. Tooth-supported telescopic prostheses in compromised dentitions: A clinical report. J Prosthet Dent 2000;84:129-32.
|
| 4. | Wenz HJ, Lehmann KM. A telescopic crown concept for the restoration of the partially endentulous arch: The Marburg double crown system. Int J Prosthodont1998;11:541-50.
|
| 5. | Toolson LB, Smith DE. A 2-year longitudinal study of overdenture patients. Part 1: Incidence and control of caries on overdenture abutments. J Prosthet Dent 1978;40:486-91.
|
| 6. | Atwood DA. Reduction of residual ridges: A major oral disease entity. J Prosthet Dent 1971;26:266-79.
|
| 7. | Tallgren A. The continuing reduction of the residual alveolar rides in complete denture wearers: A mixed-longitudnal study covering 25 years. J Prosthet Dent 1972;27:120-32.
|
| 8. | Lord JL, Teel S.The overdenture: Patient selection, use of copings, and follow-up evaluation. JProsthet Dent 1974;32:41-51.
|
| 9. | Sharry JJ. Complete Denture Prosthodontics. 3 rd ed. US: McGraw-Hill Inc; 1974. p. 310-19.
|
| 10. | Hou GL, Tsai CC, Weisgold AS. Periodontal and prosthetic therapy in severely advanced periodontitis by use of the crown sleeve coping telescope denture. A longitudinal case report. Aust Dent J 1997;42:169-74.
|
| 11. | Preiskel HW. OverdentureMade Easy: A Guide to Implant and Root Supported Prostheses. London: Quintessence Publishing Co Ltd; 1996. p. 61.
|
| 12. | Bergman B, Ericson A, Molin M. Long-term clinical results aftertreatment with conical crown-retained dentures. Int J Prosthodont1996;9:533-8.
|
| 13. | Bolender CL, Zarb GA, Carlsson GE. Boucher′s Prosthodontics Treatment for Edentulous Patients. 11 th ed. St.Louis: Mosby Year Book; 1997. p. 46-7.
|
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
|
Search Pubmed for