OVERDENTURES

OVERDENTURES
Indications, Contraindication and
Indications, Contraindication and
Treatment Procedure
Treatment Procedure
INTRODUCTION
INTRODUCTION
DEFINITIONS
DEFINITIONS
DEVELOPMENT
DEVELOPMENT
RATIONALE
RATIONALE
CLASSIFICATION
CLASSIFICATION
ADVANTAGES
ADVANTAGES
INDICATIONS
INDICATIONS
CONTRAINDICATION
CONTRAINDICATION
TREATMENT PROCEDURE
TREATMENT PROCEDURE
CONCLUSION
CONCLUSION
IMPLANT OVERDENTURE
IMPLANT OVERDENTURE
INTRODUCTION
INTRODUCTION

Overdenture, a complete or Overdenture, a complete or

partial prosthesis constructed partial prosthesis constructed
over existing teeth or root over existing teeth or root
structure, is not a new concept in structure, is not a new concept in
a technical approach to a a technical approach to a
prosthetic problem prosthetic problem

Indeed its use dates back over Indeed its use dates back over
100 yrs and it is one that has 100 yrs and it is one that has
become increasingly more become increasingly more
popular since the emphasis of popular since the emphasis of
prevention in dentistry prevention in dentistry

Preventive prosthodontics Preventive prosthodontics

emphasizes the importance of emphasizes the importance of
any procedure that can delay or any procedure that can delay or
eliminate future prosthodontic eliminate future prosthodontic
problems problems
DEFINITIONS
DEFINITIONS

removable partial denture or complete denture

removable partial denture or complete denture
that covers and rests on one or more remaining
that covers and rests on one or more remaining
natural teeth, the roots of natural teeth and!or
natural teeth, the roots of natural teeth and!or
dental implants
dental implants

prosthesis that covers and is partially

prosthesis that covers and is partially
supported by natural teeth, natural tooth, roots
supported by natural teeth, natural tooth, roots
and!or dental implants
and!or dental implants

lso called as overlay dentures ! overlay

lso called as overlay dentures ! overlay
prosthesis ! superimposed prosthesis
prosthesis ! superimposed prosthesis
GPT 8
th
ed

n overdenture is a denture that may be

n overdenture is a denture that may be
supported by soft tissue, bone, the root of a
supported by soft tissue, bone, the root of a
tooth, or a modified tooth
tooth, or a modified tooth

lso called as biologic denture, telescopes

lso called as biologic denture, telescopes
denture
denture

"eartwell
DEVELOPMENT
DEVELOPMENT

#he idea of leaving roots of natural teeth to support an #he idea of leaving roots of natural teeth to support an
overdenture is far from new$ even in 1%&', (edger had overdenture is far from new$ even in 1%&', (edger had
described a prosthesis resembling an overdenture which described a prosthesis resembling an overdenture which
was referred to as )plates covering fangs* and this became was referred to as )plates covering fangs* and this became
the title of a paper published by tkinson & yr later the title of a paper published by tkinson & yr later

In 1%'1, conference in +onneccticut produced increase In 1%'1, conference in +onneccticut produced increase
awareness of the value such roots might play in awareness of the value such roots might play in
supporting a covering denture supporting a covering denture

,vans by 1%%% described a method of using roots actually ,vans by 1%%% described a method of using roots actually
to retain restorations to retain restorations

,ssig in 1%-' and Peeso around the same time ,ssig in 1%-' and Peeso around the same time
prescribed a telescoic.like coping prescribed a telescoic.like coping

/illiam "unter mentioned the necessity to devitalize most /illiam "unter mentioned the necessity to devitalize most
of the roots employed for prosthesis of the roots employed for prosthesis

In 1-'0 and 1-'- #alligren showed that over a 0 yr period In 1-'0 and 1-'- #alligren showed that over a 0 yr period
the reduction of anterior ridge height of the mandible is 1 the reduction of anterior ridge height of the mandible is 1
times than that of the maxillary edentulous ridge2 #hese times than that of the maxillary edentulous ridge2 #hese
findings were corrobrated by twod and +oy 31-045 findings were corrobrated by twod and +oy 31-045

+rum and 6ooney31-0%5 reported a 1 yr study and claimed +rum and 6ooney31-0%5 reported a 1 yr study and claimed
that the retention of mandibular canines of overdentures that the retention of mandibular canines of overdentures
helped preserve the remaining edentulous ridge helped preserve the remaining edentulous ridge

In 1-%' a study reported on 107- implants placed in the In 1-%' a study reported on 107- implants placed in the
mandibular symphysis of 1%1 patients2 #he implants were mandibular symphysis of 1%1 patients2 #he implants were
loaded immediately and restored with bars and overdenture loaded immediately and restored with bars and overdenture
with clips as retention and overall success rate was -18 with clips as retention and overall success rate was -18

9otansky 31--75 publlished a survey of patients suffering 9otansky 31--75 publlished a survey of patients suffering
from mandibular alveolar ridge atrophy who had been from mandibular alveolar ridge atrophy who had been
treated with overdentures supported by ball attachments and treated with overdentures supported by ball attachments and
the success rates of the individual implants -08 and of the the success rates of the individual implants -08 and of the
dentures were1008 dentures were1008
RATIONALE
RATIONALE

It maintains teeth as part of the residua rid!e It maintains teeth as part of the residua rid!e #his gives #his gives
the patient a denture that has far more support than any the patient a denture that has far more support than any
conventional appliance2 conventional appliance2

A decrease in the rate of resorption A decrease in the rate of resorption lveolar bone exists lveolar bone exists
as a support for teeth2 If the teeth are removed the alveolar as a support for teeth2 If the teeth are removed the alveolar
process begins a rate of resorption consistent with the length of process begins a rate of resorption consistent with the length of
time the teeth have been missing 2:y retaining the mandibular time the teeth have been missing 2:y retaining the mandibular
canines in the use of an over.denture, the resorption of the canines in the use of an over.denture, the resorption of the
alveolar bone surrounding the teeth was reduced by eight alveolar bone surrounding the teeth was reduced by eight
times2 times2

It aso heps in an increase in the patients manipuati"e It aso heps in an increase in the patients manipuati"e
s#is in handin! the denture s#is in handin! the denture with the preservation of the with the preservation of the
teeth for an over.denture there is also the preservation of the teeth for an over.denture there is also the preservation of the
periodontal membrane that surrounds these teeth2 #his periodontal membrane that surrounds these teeth2 #his
preserves the proprioceptive impulses supplied by the preserves the proprioceptive impulses supplied by the
periodontal membrane22 periodontal membrane22
RE$UIRE%ENTS
RE$UIRE%ENTS

%aintenance of heath %aintenance of heath the most important aspect of the the most important aspect of the
over.denture is the maintenance of the health of the underlying over.denture is the maintenance of the health of the underlying
tooth structures without which the over.denture cannot sustain2 tooth structures without which the over.denture cannot sustain2

Reduction in cro&n'to'root ratio Reduction in cro&n'to'root ratio #he reduction of the crown #he reduction of the crown
has an immediately favourable effect on tooth mobility because has an immediately favourable effect on tooth mobility because
of the decrease in the length of the lever arm delivering the of the decrease in the length of the lever arm delivering the
tor;ue to the mobile tooth2 tor;ue to the mobile tooth2

(asa seat tissue (asa seat tissue well fitting basal seat is essential to well fitting basal seat is essential to
distribute the load over as wide an area as possible2 distribute the load over as wide an area as possible2

Simpicit) of construction Simpicit) of construction #he appliance should be #he appliance should be
relatively simple to construct and maintain2 relatively simple to construct and maintain2

Ease of manipuation Ease of manipuation fre;uently with the use of retaining fre;uently with the use of retaining
devices the over.denture becomes a struggle for the patient to devices the over.denture becomes a struggle for the patient to
insert and remove2 #his should not be the case because an insert and remove2 #his should not be the case because an
unwanted force could seriously damage the base or the unwanted force could seriously damage the base or the
abutment tooth therefore the design should be kept simple to abutment tooth therefore the design should be kept simple to
avoid such problems2 avoid such problems2
I<9I+#IO<=
I<9I+#IO<=

It should be considered for patients who face the loss of the It should be considered for patients who face the loss of the
remaining natural adult dentition2 #herefore younger the remaining natural adult dentition2 #herefore younger the
patient greater the indication2 patient greater the indication2

In cases where the retention is difficult to obtain such as> In cases where the retention is difficult to obtain such as>

?erostomia or sialorrhea ?erostomia or sialorrhea

bsence of alveolar residual ridge bsence of alveolar residual ridge

(oss of maxilla and partial loss of mandible (oss of maxilla and partial loss of mandible

congenital deformity eg cleft palate congenital deformity eg cleft palate

@or patients with a poor prognosis for complete dentures2 @or patients with a poor prognosis for complete dentures2

"igh palatal vault and ridge slope "igh palatal vault and ridge slope

Poorly defined sublingual fold space Poorly defined sublingual fold space

Posterior Open occlusal relationship in cases of for eg2, Posterior Open occlusal relationship in cases of for eg2,
cleidocranial dysplasia, hpothyroidism, hypoparathyroidism cleidocranial dysplasia, hpothyroidism, hypoparathyroidism
' '

In class III tongue position In class III tongue position

Anife edged ridge that will provide inade;uate support2 Anife edged ridge that will provide inade;uate support2

/hen pronounced vertical overlap of the anterior teeth is /hen pronounced vertical overlap of the anterior teeth is
re;uired to produce good esthetic results2 re;uired to produce good esthetic results2

Bnilateral over denture can be given to provide a good Bnilateral over denture can be given to provide a good
function and esthetics a large amount of bone and soft tissue function and esthetics a large amount of bone and soft tissue
have been lost on one side of the arch2 have been lost on one side of the arch2

Patients with badly worn out teeth2 Patients with badly worn out teeth2

/hen complete denture will be opposed by retained /hen complete denture will be opposed by retained
mandibular anterior teeth preventing 3combination syndrome52 mandibular anterior teeth preventing 3combination syndrome52

#herapeutics in the form of insitu irradiation 3Cobermott D #herapeutics in the form of insitu irradiation 3Cobermott D
6osenberg 31-'75 6osenberg 31-'75
+O<#6I<9I+#IO<=
+O<#6I<9I+#IO<=

Un co'operati"e and under moti"ated patients &ho insists on Un co'operati"e and under moti"ated patients &ho insists on
remo"a of his remainin! teeth* An) indication of patient &ho &i remo"a of his remainin! teeth* An) indication of patient &ho &i
not co'operate in ora h)!iene and re!uar office procedures, reca not co'operate in ora h)!iene and re!uar office procedures, reca
for ad+ustments &hich is re,uired to maintain the remainin! teeth for ad+ustments &hich is re,uired to maintain the remainin! teeth
and the supportin! tissue in a state of heath* and the supportin! tissue in a state of heath*

Ps)choo!ica) some patients cannot accept an) t)pe of Ps)choo!ica) some patients cannot accept an) t)pe of
remo"a-e denture* remo"a-e denture*

%enta) and ph)sica) handicapped patients for &hom pa,ue %enta) and ph)sica) handicapped patients for &hom pa,ue
contro and !ood ora h)!iene are difficut* contro and !ood ora h)!iene are difficut*

.hen a patient cannot economica) afford* .hen a patient cannot economica) afford*

Periodonta Consideration/ Periodonta Consideration/

Periodonta infammation, poc#et formation, -on) defects, and Periodonta infammation, poc#et formation, -on) defects, and
poor 0one of attached !in!i"a must a -e eiminated -efore poor 0one of attached !in!i"a must a -e eiminated -efore
commencin! the treatment* The deeterious effect of the o"er commencin! the treatment* The deeterious effect of the o"er
denture on the periodontium can -e minimi0ed of the o"er denture denture on the periodontium can -e minimi0ed of the o"er denture
on the periodontium can -e minimi0ed if one -e!ins &ith an on the periodontium can -e minimi0ed if one -e!ins &ith an
optium state and the patient foo&s a meticuous home care optium state and the patient foo&s a meticuous home care
pro!ramme &ith fre,uent reca* pro!ramme &ith fre,uent reca*
+ontra indications for using periodontally involved teeth2 +ontra indications for using periodontally involved teeth2

+lass III mobility due to the loss of alveolar bone that connot be +lass III mobility due to the loss of alveolar bone that connot be
corrected2 corrected2

=oft tissue and osseous defects which are not correctable by =oft tissue and osseous defects which are not correctable by
surgery2 surgery2

@ailure to establish a sufficient zone of attached gingiva by @ailure to establish a sufficient zone of attached gingiva by
mucogingival or grafting procedure2 mucogingival or grafting procedure2

,xcessive reduction of the adEacent residual alveolar ridge as a ,xcessive reduction of the adEacent residual alveolar ridge as a
result of elimination of osseous defects for the establishment of result of elimination of osseous defects for the establishment of
normal architecture2 normal architecture2
+ontra indications for ,ndodontic #reatment> +ontra indications for ,ndodontic #reatment>

Fertical fracture of the root 3or5 roots2 Fertical fracture of the root 3or5 roots2

Cechanical perforation of the root canal2 Cechanical perforation of the root canal2

Internal resorption that has perforated through the side of the Internal resorption that has perforated through the side of the
root2 root2

:roken instrument in the root canal2 :roken instrument in the root canal2

"orizontal fracture of the root below the bony crest2 "orizontal fracture of the root below the bony crest2

#eeth that are grossly malposed will be difficult to use #eeth that are grossly malposed will be difficult to use
especially posterior teeth that are tilted more than 4&G2 especially posterior teeth that are tilted more than 4&G2

=ingle rooted teeth with only one canal that is easily =ingle rooted teeth with only one canal that is easily
negotiable are the best candidates although multirooted teeth negotiable are the best candidates although multirooted teeth
can also be used2 4 to 1 week interval before commencing can also be used2 4 to 1 week interval before commencing
further treatment on the tooth is helpful to determine further treatment on the tooth is helpful to determine
endodontic complication if any2 endodontic complication if any2
ADVANTA1ES
ADVANTA1ES

Apart from the Apart from the Preservation of alveolar bone and preservation Preservation of alveolar bone and preservation
of proprioceptive response, it also provides =upport and of proprioceptive response, it also provides =upport and
retention2 retention2

It is also a simple approach to the compromised patients with It is also a simple approach to the compromised patients with
+left palate +left palate
Partial anodontia Partial anodontia
Cicrodontia Cicrodontia

Patient acceptance H they experience a striking improvement in Patient acceptance H they experience a striking improvement in
function and esthetics while still maintaining some of their own function and esthetics while still maintaining some of their own
teeth teeth

Caintenance of arch forms Caintenance of arch forms

+onvertibility H the over denture is designed in such a way that +onvertibility H the over denture is designed in such a way that
if for some reason the remaining teeth or root stumps has to if for some reason the remaining teeth or root stumps has to
be extracted the over.denture can be readily converted to be extracted the over.denture can be readily converted to
accept the alteration2 accept the alteration2

+ost H the initial cost may be a little higher but when compared +ost H the initial cost may be a little higher but when compared
over a period of time the low percentage of remakes and the over a period of time the low percentage of remakes and the
alternative treatment of extensive fixed and removable alternative treatment of extensive fixed and removable
prosthesis, the cost of an over.denture is favorable prosthesis, the cost of an over.denture is favorable

,ase in construction and maintenance2 ,ase in construction and maintenance2

(ower cost when compared to 62P292 (ower cost when compared to 62P292
DISADVANTA1ES
DISADVANTA1ES

Over denture treatment is more expensive than Over denture treatment is more expensive than
conventional denture because of periodontal and conventional denture because of periodontal and
endodontic therapy and the subse;uent restoration of endodontic therapy and the subse;uent restoration of
teeth with gold coping2 teeth with gold coping2

:ulkier than @2P292 3or5 62P292 :ulkier than @2P292 3or5 62P292

If oral hygiene is not maintained properly, patient*s If oral hygiene is not maintained properly, patient*s
susceptible to susceptible to caries caries and and periodonta disease periodonta disease

:ony under cuts may cause either over contouring or :ony under cuts may cause either over contouring or
under containing of the denture2 under containing of the denture2

,ncroachment of inter occlusal distance2 ,ncroachment of inter occlusal distance2

,sthetics2 ,sthetics2

In many cases, owing to lack of available space In many cases, owing to lack of available space
sections of the over denture base are ;uite thin2 If metal sections of the over denture base are ;uite thin2 If metal
reinforcement is not used, fracture of the base and reinforcement is not used, fracture of the base and
prosthetic teeth is common2 prosthetic teeth is common2
Criteria for Patient seection
Criteria for Patient seection

Patients &ho are ps)choo!ica) accepta-e as CD patients Patients &ho are ps)choo!ica) accepta-e as CD patients
can -e candidates for su-mucosa "ita root retention* can -e candidates for su-mucosa "ita root retention*

Shoud ha"e a norma response to accepted cinica "itait) Shoud ha"e a norma response to accepted cinica "itait)
test* test*

Shoud sho& at east 2mm of a"eoar -one support on Shoud sho& at east 2mm of a"eoar -one support on
radio!raphic e3amination* radio!raphic e3amination*

Shoud -e ocated &ithin the area of the a"eoar rid!es Shoud -e ocated &ithin the area of the a"eoar rid!es
most affected -) rid!e resorption foo&in! tooth remo"a* most affected -) rid!e resorption foo&in! tooth remo"a*
T&o ma+or !roups of patients &ho -enefit from the o"er' T&o ma+or !roups of patients &ho -enefit from the o"er'
dentures are* dentures are*
1roup 4 1roup 4

+omprises patients with few remaining teeth that may be +omprises patients with few remaining teeth that may be
healthy or with reversible periodontal disease, that are healthy or with reversible periodontal disease, that are
coronally intact or malpositioned or morphologically coronally intact or malpositioned or morphologically
compromised2 compromised2

:efore commencing the treatment carry out :efore commencing the treatment carry out

nalysis of articulated diagnostic casts which helps to nalysis of articulated diagnostic casts which helps to
determine the potential abutment teeth*s restorative and determine the potential abutment teeth*s restorative and
,ndodontic re;uirements in the context of the proposed over. ,ndodontic re;uirements in the context of the proposed over.
denture design2 denture design2

@ull mouth radiographs @ull mouth radiographs

1roup II 1roup II

9iagnosed with so called multilated or severely 9iagnosed with so called multilated or severely
compromised dentitions2 #hese patients appear to be heading compromised dentitions2 #hese patients appear to be heading
in an edentulous direction2 in an edentulous direction2
Accordin! to Accordin! to 5AROLD 5AROLD
T)pes of o"er'dentures are T)pes of o"er'dentures are
Transitiona Transitiona

#he #ransitional over denture consists of a modification of #he #ransitional over denture consists of a modification of
the partial denture which the patient is already wearing, to the partial denture which the patient is already wearing, to
replace further lost teeth or to cover the roots of over.denture replace further lost teeth or to cover the roots of over.denture
abutments once the teeth have been cut down2 abutments once the teeth have been cut down2
Trainin! dentures Trainin! dentures

=trictly speaking, these are not over.dentures, but they do =trictly speaking, these are not over.dentures, but they do
have many applications in over.denture techni;ues2 =uch have many applications in over.denture techni;ues2 =uch
dentures are commonly employed to replace hopeless posterior dentures are commonly employed to replace hopeless posterior
teeth once they have been extracted2 teeth once they have been extracted2
Immediate'repacement o"er'dentures Immediate'repacement o"er'dentures

#hey are constructed before the last remaining teeth are #hey are constructed before the last remaining teeth are
extracted and the over.denture abutments prepared2 training extracted and the over.denture abutments prepared2 training
denture is often converted to an immediate replacement over denture is often converted to an immediate replacement over
denture that may with Eudicious relining be employed for several denture that may with Eudicious relining be employed for several
months or years2 ,ven when they are replaced such prosthesis months or years2 ,ven when they are replaced such prosthesis
may serve as spare dentures later on may serve as spare dentures later on
Definiti"e prostheses Definiti"e prostheses

Bsually constructed at least ' months following extraction of Bsually constructed at least ' months following extraction of
the last teeth and the preparation of the over denture abutments the last teeth and the preparation of the over denture abutments
O"er'dentures on impants O"er'dentures on impants

Over dentures supported by implants are comparatively new Over dentures supported by implants are comparatively new
arrivals on the prosthodontic scene2 arrivals on the prosthodontic scene2

+ompared with an implant supported fixed partial denture an +ompared with an implant supported fixed partial denture an
implant supported over.denture re;uires implant supported over.denture re;uires

(ess support (ess support

Offers more flexibility Offers more flexibility

=eldom causes speech difficulties =eldom causes speech difficulties

nd is more economical nd is more economical

On the other hand, many workers have reported complications On the other hand, many workers have reported complications
with maintenance therapy2 It has become apparent that implants with maintenance therapy2 It has become apparent that implants
are particularly susceptible to overload, and especially to forces are particularly susceptible to overload, and especially to forces
that are non axial2 that are non axial2

+onstruction of an over.denture supported by +onstruction of an over.denture supported by both both roots and roots and
implant is normally ill.advised implant is normally ill.advised
CLASSIFICATION
CLASSIFICATION
(road) cassified into (road) cassified into

Tooth'supported denture Tooth'supported denture

Impant Supported O"er Denture Impant Supported O"er Denture

5eart&e6s cassification of tooth supported
5eart&e6s cassification of tooth supported
denture
denture

:ased on the method of abutment :ased on the method of abutment
preparation2 preparation2

=imple tooth modification and =imple tooth modification and

reduction reduction

#ooth reduction and coping #ooth reduction and coping

,ndodontic treatment and amalgam ,ndodontic treatment and amalgam

plug ! composite plug ! composite

,ndodontic treatment and coping ,ndodontic treatment and coping

,ndodontic therapy with cast coping ,ndodontic therapy with cast coping
utilizing some form of ttachments utilizing some form of ttachments

=ubmerged vital roots2 =ubmerged vital roots2

Copin! Attachments Copin! Attachments
=imple tooth modification and reduction =imple tooth modification and reduction

In this procedure remaining teeth are merely reshaped to In this procedure remaining teeth are merely reshaped to
eliminate undercuts D reduced in vertical height to create eliminate undercuts D reduced in vertical height to create
more interoccusal space more interoccusal space

#he results of this techni;ue in patients with microdontia #he results of this techni;ue in patients with microdontia
or partial anodontia are striking or partial anodontia are striking
,ndodontic treatment and amalgam plug! composite ,ndodontic treatment and amalgam plug! composite

/idely used /idely used

Indicated when there is normal coronal height to the teeth Indicated when there is normal coronal height to the teeth
D normal interocclusal distance with little or no vertical D normal interocclusal distance with little or no vertical
dimension loss dimension loss

In cases to create space without opening of vertical In cases to create space without opening of vertical
dimension, endodontic procedure performed, tooth dimension, endodontic procedure performed, tooth
sectioned at the gingival margin or slightly above above it sectioned at the gingival margin or slightly above above it
3 1.4 mm5 D the remaining dentin smoothened D polished 3 1.4 mm5 D the remaining dentin smoothened D polished
thoroughly with amalgam! composite thoroughly with amalgam! composite
butment with cast coping > +ast metal coping with a dome shaped butment with cast coping > +ast metal coping with a dome shaped
surface and chamfer finish line at the gingival margin are surface and chamfer finish line at the gingival margin are
fabricated and cemented2 #here are 4 distinct types of copings > fabricated and cemented2 #here are 4 distinct types of copings >

12 #he short coping, 42 #he long coping 12 #he short coping, 42 #he long coping

#he short coping > #hese are 4 to 7mm long and normally re;uire #he short coping > #hese are 4 to 7mm long and normally re;uire
endodontic therapy since the re;uired coronal tooth reduction endodontic therapy since the re;uired coronal tooth reduction
would expose the pulp2 ttached to the coping is a post, fitted to would expose the pulp2 ttached to the coping is a post, fitted to
the canals2 @or this reason canals should be obturated with soft the canals2 @or this reason canals should be obturated with soft
Iutta.Percha rather than metal points2 Iutta.Percha rather than metal points2

(ong coping > #hese are normally & to %mm long2 n attempt is (ong coping > #hese are normally & to %mm long2 n attempt is
made to circumvent endodontic therapy by a conservative made to circumvent endodontic therapy by a conservative
reduction with a cellsopidal shaped coronal coping and an reduction with a cellsopidal shaped coronal coping and an
increased crown root ratio which re;uire greater level of osseous increased crown root ratio which re;uire greater level of osseous
support2 de;uate inter occlusal distance must exist to allow for support2 de;uate inter occlusal distance must exist to allow for
encroaching on the available inter ridge space or a visualization encroaching on the available inter ridge space or a visualization
of vertical dimension is liable to occur with poor esthetics and of vertical dimension is liable to occur with poor esthetics and
failure because of patient intolerance failure because of patient intolerance
butments with ttachments> butments with ttachments>

Cost attachments are secured to the abutment by a cast coping2 #he Cost attachments are secured to the abutment by a cast coping2 #he
obEective of any attachment is to improve retention of the denture base2 obEective of any attachment is to improve retention of the denture base2
:ecause of the factors like time, cost and risks the procedure should :ecause of the factors like time, cost and risks the procedure should
reserved for patient with a favourable prognosis2 #he attachment does not reserved for patient with a favourable prognosis2 #he attachment does not
reduce the crown root ratio significantly as does the cast coping2 "ere the reduce the crown root ratio significantly as does the cast coping2 "ere the
low caries index proper home care2 Periodontal health and inter ridge low caries index proper home care2 Periodontal health and inter ridge
distance are absolutely necessary2 distance are absolutely necessary2
=ubmerged vital roots > #his is of current research interest, it attempts to =ubmerged vital roots > #his is of current research interest, it attempts to
obviate some basic problem associated with the more conventional over obviate some basic problem associated with the more conventional over
denture abutments2 In these cases selected vital roots are transected and denture abutments2 In these cases selected vital roots are transected and
reduced to 4mm below the crestal bone and then covered by reduced to 4mm below the crestal bone and then covered by
mucoperiosteal flap2 mucoperiosteal flap2

#he maEor problem associated are development of dehiscences and pulpal #he maEor problem associated are development of dehiscences and pulpal
pathosis2 /hen this is done several advantages of the over denture are pathosis2 /hen this is done several advantages of the over denture are
lost2 lost2

=upport from direct contact of the denture base to the abutment tooth2 =upport from direct contact of the denture base to the abutment tooth2

ttempts to gain retention fom the teeth through some form of attachment is ttempts to gain retention fom the teeth through some form of attachment is
no longer possible2 no longer possible2

#he loss of proprioception2 #he loss of proprioception2

(ocation and distribution of abutment > (ocation and distribution of abutment >

Preference for anterior over posterior teeth therefore the alveolar Preference for anterior over posterior teeth therefore the alveolar
ridge appears to be more vulnerable to reduction than the ridge appears to be more vulnerable to reduction than the
posterior alveolar ridge2 posterior alveolar ridge2

#wo teeth in each ;uadrant presents an ideal situation in which #wo teeth in each ;uadrant presents an ideal situation in which
stress is distributed, over a rectangular area2 ,g > +uspid 4nd stress is distributed, over a rectangular area2 ,g > +uspid 4nd
premolar and!or 4nd molar in each ;uadrant2 premolar and!or 4nd molar in each ;uadrant2

#he tripod is the next most favourable form for support and #he tripod is the next most favourable form for support and
stability2 stability2

#he use of two teeth in each arch or one tooth in one arch has #he use of two teeth in each arch or one tooth in one arch has
met with satisfactory results2 met with satisfactory results2

Carrow recommends that it is better to use isolated teeth as Carrow recommends that it is better to use isolated teeth as
abutments rather than adEacent teeth because they return to a abutments rather than adEacent teeth because they return to a
state of good health more readily and are easier for the patinet to state of good health more readily and are easier for the patinet to
maintain hygiene2 maintain hygiene2

#he upper anterior teeth should be retained if opposed by natural #he upper anterior teeth should be retained if opposed by natural
lower anterior teeth to prevent the destruction of the anterior lower anterior teeth to prevent the destruction of the anterior
ridge when utilized in a maxillary over denture2 ridge when utilized in a maxillary over denture2

Candibular cuspids are most often utilized since they are usually Candibular cuspids are most often utilized since they are usually
the last tooth to be lost the last tooth to be lost
Over 9enture ttachments Over 9enture ttachments
n n attachment attachment is a mechanical device for the fixation, retention and is a mechanical device for the fixation, retention and
stabilization of a dental prostheses stabilization of a dental prostheses
ttachments +lassification2 ttachments +lassification2

ccording to shape, design and primary area of use2 ccording to shape, design and primary area of use2
+oronal +oronal > >

Intra coronal Intra coronal

,xtra coronal ,xtra coronal

.6esilient2 .6esilient2
.<on resilient .<on resilient
6adicular 6adicular > >

#elescope stud attachments #elescope stud attachments

:ar attachments :ar attachments

.:ar Joints .:ar Joints
.:ar Bnits .:ar Bnits
ccessory > uxiliary attachments ccessory > uxiliary attachments

=crew units2 =crew units2

Pawl connectors2 Pawl connectors2

:olts2 :olts2

=tabilizers ! balancers2 =tabilizers ! balancers2

Interlocks Interlocks

Pins!screws2 Pins!screws2

6ests2 6ests2
Cagnets Cagnets > >

Permanent magent2 Permanent magent2

Induced magnet2 Induced magnet2

Open field2 Open field2

+losed field +losed field

,xtra +oronal
,xtra +oronal
Intra
Intra

Ierber attachments
Ierber attachments
Kest nchor
Kest nchor

9albo attachment
9albo attachment

+eka attachment
+eka attachment

6othermann attachment
6othermann attachment

Infrofix attachment
Infrofix attachment

=chubiger attachment
=chubiger attachment

Luinlican attachment
Luinlican attachment

#he compact unit 3Priska5

#he compact unit 3Priska5

:attesti units
:attesti units

+onod unit
+onod unit

:aer and @ah units

:aer and @ah units

Aurer stud attachment

Aurer stud attachment

mounted diagnostic casts is an important aid to check mounted diagnostic casts is an important aid to check
the space available before an attachment is selected2 the space available before an attachment is selected2

Cost of the stud types can be considered to be snap Cost of the stud types can be considered to be snap
fasteners2 fasteners2

=tud devices are simplest among all attachments2 =tud devices are simplest among all attachments2

#he male part of the unit consists of a stud shaped #he male part of the unit consists of a stud shaped
proEection soldered to the diaphragm of a dowel retained proEection soldered to the diaphragm of a dowel retained
restoration2 restoration2

#he female part fits over the male unit and is embedded #he female part fits over the male unit and is embedded
within the denture base of the prosthesis2 within the denture base of the prosthesis2

#here are a few systems which work in the reverse2 eg2 #here are a few systems which work in the reverse2 eg2
Kest nchor2 few studs are anteriorly rigid 3because the Kest nchor2 few studs are anteriorly rigid 3because the
size makes it difficult to prevent a small amount of size makes it difficult to prevent a small amount of
movement between the two components52 In some movement between the two components52 In some
springs are specifically incorporated to allow a controlled springs are specifically incorporated to allow a controlled
degree of movement2 degree of movement2
dvantages > dvantages >

6etention, stability and support2 6etention, stability and support2

positive lock of certain units can maintain the border positive lock of certain units can maintain the border
seal of the denture seal of the denture
=election of attachments > =election of attachments >

#he success of prosthesis usually depends on careful treatment #he success of prosthesis usually depends on careful treatment
planning and attention to the prosthodontic problems2 #he planning and attention to the prosthodontic problems2 #he
mechanical ingenuity of the attachment is important, but must mechanical ingenuity of the attachment is important, but must
take second place2 #he shape and size of the units is normally take second place2 #he shape and size of the units is normally
the over riding consideration although the auxiliary devices that the over riding consideration although the auxiliary devices that
accompany the attachment must influence the choice2 accompany the attachment must influence the choice2

+orrect vertical space assessment must be taken care of2 ,xtra +orrect vertical space assessment must be taken care of2 ,xtra
radicular stud attachments are relatively strong and can often radicular stud attachments are relatively strong and can often
provide more effective retention than their interradicular counter provide more effective retention than their interradicular counter
parts2 (arger attachments are generally stronger than smaller parts2 (arger attachments are generally stronger than smaller
ones and less prone to wear2 9ebate still continues as to whether ones and less prone to wear2 9ebate still continues as to whether
or not the comparatively rigid units should be selected as or not the comparatively rigid units should be selected as
opposed to those that allow movement2 opposed to those that allow movement2

Censor 31-%05 auotiny work by @enner, "erber and Cabiemann Censor 31-%05 auotiny work by @enner, "erber and Cabiemann
31-&05 has claimed rigid or cylindrical stud attachments produce 31-&05 has claimed rigid or cylindrical stud attachments produce
no tipping action on the root2 :all and socket designs are stated no tipping action on the root2 :all and socket designs are stated
to produce 1 times as much tipping potential to produce 1 times as much tipping potential

A recent a- stud) -) Tha)er and Caputo 7489:; empo)ed A recent a- stud) -) Tha)er and Caputo 7489:; empo)ed
photo'eastic stress ana)sis* The) found that forces photo'eastic stress ana)sis* The) found that forces
appied to a Doder -ar &ere reso"ed in an apica appied to a Doder -ar &ere reso"ed in an apica
direction &here as stud attachments en!a!in! the do&e direction &here as stud attachments en!a!in! the do&e
retained diaphra!m mi!ht produce tippin! potentias* retained diaphra!m mi!ht produce tippin! potentias*

Le"era!e effect upon the root has aso an effect on Le"era!e effect upon the root has aso an effect on
attachment seection* %outh preparation, ease of re-asin! attachment seection* %outh preparation, ease of re-asin!
and repair procedures aso determine the t)pe of stud and repair procedures aso determine the t)pe of stud
attachment* attachment*

The num-er of stud attachment / The num-er of stud attachment /

One stud attachment on each side of the arch &i usua) One stud attachment on each side of the arch &i usua)
suffice other remainin! roots can -e co"ered &ith simpe suffice other remainin! roots can -e co"ered &ith simpe
copin!s* Increased num-er of attachments in a denture copin!s* Increased num-er of attachments in a denture
does not produce a correspondin! impro"ement in does not produce a correspondin! impro"ement in
retention* retention*
POPULAR ATTAC5%ENT S<STE% POPULAR ATTAC5%ENT S<STE%
Da-o Stud Unit Da-o Stud Unit

(a and Soc#et (a and Soc#et

Ri!id Da-o Ri!id Da-o

E3treme) popuar of the desi!n E3treme) popuar of the desi!n

series, stren!th, time tested series, stren!th, time tested

=eatures / >mm hi!h &ith =eatures / >mm hi!h &ith

spherica shape mae section, spherica shape mae section,
eas) to cean* The fin!ers of the eas) to cean* The fin!ers of the
soc#et are surrounded -) n)on soc#et are surrounded -) n)on
rin!s that simpifies ad+ustments rin!s that simpifies ad+ustments

Ad+ustments are simpe to carr) Ad+ustments are simpe to carr)

out* Retention can -e increased out* Retention can -e increased
-) aterin! free ends of ameae -) aterin! free ends of ameae

Ad+uncts / Ad+uncts /
Ad+ustin! toos / Ti!htenin! Ad+ustin! toos / Ti!htenin!
de"ice* Compimentar) too* de"ice* Compimentar) too*
De"ice to repace n)on see"e* De"ice to repace n)on see"e*
Reocatin! do&e for re-asin! Reocatin! do&e for re-asin!
impression impression

The compact unit / The compact unit /

5ei!ht ? @*9A mm 5ei!ht ? @*9A mm

Diameter of retention #no- is @*8mm Diameter of retention #no- is @*8mm

Di"er!ence of 4:B-et&een the ai!nment of @ Di"er!ence of 4:B-et&een the ai!nment of @

attachment ma) -e permitted &ithout causin! attachment ma) -e permitted &ithout causin!
increased &ear of mae section* It &as de"eoped increased &ear of mae section* It &as de"eoped
from the ancrofi3 from the ancrofi3
1er-er Attachments 1er-er Attachments / /
Resiient that ao&s "ertica mo"ement Resiient that ao&s "ertica mo"ement
Ri!id attachment 7popuar;* Ri!id attachment 7popuar;*

Retention of -oth t)pes of 1er-er Retention of -oth t)pes of 1er-er

attachment is o-tained -) a attachment is o-tained -) a
retainin! sprin! in the femae unit retainin! sprin! in the femae unit
en!a!in! a periphera !roo"e in the en!a!in! a periphera !roo"e in the
mae section* The sprin! cip ma) -e mae section* The sprin! cip ma) -e
remo"ed for ad+ustment -) remo"ed for ad+ustment -)
unscre&in!* The -ase of the femae unscre&in!* The -ase of the femae
unit usin! the specia instrument unit usin! the specia instrument
pro"ided pro"ided

(oth t)pes of mae unit scre&ed on (oth t)pes of mae unit scre&ed on
to their soderin! -ase and to their soderin! -ase and
pre"ented from unscre&in! &ith a pre"ented from unscre&in! &ith a
itte resin cement* The) ma) -e itte resin cement* The) ma) -e
unscre&ed in the mouth &ith a unscre&ed in the mouth &ith a
heated scre& dri"er* Lea"in! heated scre& dri"er* Lea"in!
e3posed a scre& thread pro+ectin! e3posed a scre& thread pro+ectin!
from the -ase of the attachment from the -ase of the attachment

1er-er pointed out that if t&o or more teeth &ere 1er-er pointed out that if t&o or more teeth &ere
used, the most dista attachment shoud ao& more used, the most dista attachment shoud ao& more
"ertica pa) than the anterior ones, as it is i#e) that "ertica pa) than the anterior ones, as it is i#e) that
!reater dispacin! force &oud -e appied to the moar !reater dispacin! force &oud -e appied to the moar
surfaces of the prosthesis surfaces of the prosthesis
Ce#a S)stem Ce#a S)stem
T&o t)pes T&o t)pes

Ri!id Ri!id

Resiient* Resiient*

Ri!id and Resiient desi!ns share a Ri!id and Resiient desi!ns share a
common -ase* common -ase*

(ut the Ce#a e3tracorona units are (ut the Ce#a e3tracorona units are
not identica* not identica*

Therefore it is not possi-e to Therefore it is not possi-e to

chan!e resiient for ri!id chan!e resiient for ri!id
constructions mere) -) chan!in!, constructions mere) -) chan!in!,
the retention portions* the retention portions*

The "ertica tra"e ao&ed -) the The "ertica tra"e ao&ed -) the
resiient stud unit is :*>mm* the resiient stud unit is :*>mm* the
retention pin or mae section is retention pin or mae section is
scre&ed on to the -ase rin! C has a scre&ed on to the -ase rin! C has a
rounded shape &ider at top C spit rounded shape &ider at top C spit
"ertica) into > sections &hich are "ertica) into > sections &hich are
fe3i-e C capa-e of -ein! fe3i-e C capa-e of -ein!
compressed compressed
Anciiar) instruments / Anciiar) instruments /
M
Locatin! de"ice Locatin! de"ice
M
Ad+ustments de"ice Ad+ustments de"ice
M
Chan!in! attachments Chan!in! attachments
M
Repair and re-asin! de"ice Repair and re-asin! de"ice
M
Limitin! factor is the "ertica Limitin! factor is the "ertica
space re,uired -) the unit space re,uired -) the unit
resutin! in Amm "ertica resutin! in Amm "ertica
space re,uirement for the space re,uirement for the
attachment components attachment components

s with all attachments systems s with all attachments systems

their alignment with each other their alignment with each other
and the path of insertion of the and the path of insertion of the
prosthesis must be planned2 prosthesis must be planned2

#he attachment base is soldered #he attachment base is soldered

to the prepared flat surface of to the prepared flat surface of
the coping2 #he spring pin or the coping2 #he spring pin or
male section may be removed male section may be removed
from its base, so this allows from its base, so this allows
considerable versatility, since considerable versatility, since
breakage of the pin is easily breakage of the pin is easily
solved by removing it and solved by removing it and
replacing it with another unit2 replacing it with another unit2

#his is done by a special tool #his is done by a special tool

provided with which the spring provided with which the spring
pin is unscrewed2 /hile the pin is unscrewed2 /hile the
other end of the special tool may other end of the special tool may
be used to increase the retention be used to increase the retention
by means of the wedge shape by means of the wedge shape
instrument instrument
Ce#a Ce#a
specia too specia too

Introfix Introfix is a solid tall cylinder is a solid tall cylinder

attachment that can be used attachment that can be used
for fixed removable bridge for fixed removable bridge
work as well as for work as well as for
overdentures overdentures
It consists of 7 parts It consists of 7 parts

solder bar solder bar

replaceable and adEustable replaceable and adEustable

male friction part male friction part

female cylindrical housing female cylindrical housing

Introfix Introfix
dvantages dvantages
9isadvantages
9isadvantages

=imple to use =imple to use

+omponents are +omponents are

replaceable and replaceable and
interchangeable with the interchangeable with the
solder base of the ancrofix solder base of the ancrofix
3resilient type5 3resilient type5
#he attachment provides #he attachment provides
good seating and retention good seating and retention
+an be used in +an be used in
combination with resilient combination with resilient
attachments attachments

=ervice life is indefinite =ervice life is indefinite

Paralleling necessary
Paralleling necessary

Processed in the
Processed in the
laboratory
laboratory

#or;ue potential is
#or;ue potential is
maximum if dentures
maximum if dentures
base is not adapted
base is not adapted
properly
properly
Introfix Introfix
=chubiger =chubiger

+onsists of a short screw +onsists of a short screw

37mm in diameter5 block for 37mm in diameter5 block for
bar fixation a larger 3724mm5 bar fixation a larger 3724mm5
one for fixed removable one for fixed removable
bridge work and an individual bridge work and an individual
cap core system2 cap core system2

Over denture attachments Over denture attachments

has 7 parts2 has 7 parts2

=older base common to the =older base common to the

Ierber2 Ierber2

sleeve in ceramic metal2 sleeve in ceramic metal2

cap nut2 cap nut2

Overall height is 42%mm Overall height is 42%mm

:ar is soldered to the sleeve :ar is soldered to the sleeve

=chubiger =chubiger
dvantages dvantages
9isadvantages
9isadvantages

llows complete flexibility llows complete flexibility

Provides for bar fixation2 Provides for bar fixation2

Permits conversation from Permits conversation from

bar to individual stud bar to individual stud
fixation fixation

:ulk
:ulk

3Ierber5 Paralleling is 3Ierber5 Paralleling is

necessary necessary

+omplex and expensive2 +omplex and expensive2

Rothermann Unit Rothermann Unit

Ri!id 7ess hei!ht 4mm;* Ri!id 7ess hei!ht 4mm;*

Resiient 7more hei!ht 4*Dmm;* Resiient 7more hei!ht 4*Dmm;*

Ad"anta!es / Re,uires itte "ertica Ad"anta!es / Re,uires itte "ertica

space and toerance for imited space and toerance for imited
misai!nment of attachments* misai!nment of attachments*

It is a -utton shaped attachment &ith the It is a -utton shaped attachment &ith the
mae unit incorporatin! a !roo"e of mae unit incorporatin! a !roo"e of
une"en depth* une"en depth*

The cip of the femae section sides o"er The cip of the femae section sides o"er
the tapered upper ed!e of the mae* .ith the tapered upper ed!e of the mae* .ith
the free ends of the femae en!a!in! the the free ends of the femae en!a!in! the
deepest retainin! !roo"e* deepest retainin! !roo"e*

The femae cip is desi!ned to -e The femae cip is desi!ned to -e

retained &ith acr)ic resin* retained &ith acr)ic resin*

A modified "ersion of the cip is no& A modified "ersion of the cip is no&
a"aia-e &ith ta!!in! that runs at ri!ht a"aia-e &ith ta!!in! that runs at ri!ht
an!es to the ori!ina desi!n* Apart from an!es to the ori!ina desi!n* Apart from
the minima "ertica space re,uirement the minima "ertica space re,uirement
an additiona ad"anta!eis the toerance an additiona ad"anta!eis the toerance
for imited misai!nment of attachment for imited misai!nment of attachment
6III9
6,=I(I,<#
6III9 I< P(+,
O H ring system ! :all attachment
O H ring system ! :all attachment

O ? rin! are dou!hnut shaped, O ? rin! are dou!hnut shaped,

s)nthetic po)mer that posses the s)nthetic po)mer that posses the
a-iit) to -end &ith resistance C then a-iit) to -end &ith resistance C then
return to their appro3imate position return to their appro3imate position

The O rin! attaches to post &ith a The O rin! attaches to post &ith a
!roo"e or undercut area caed the !roo"e or undercut area caed the
interna ca"it) of the meta or pastic interna ca"it) of the meta or pastic
encapsuator, &hich permits eas) encapsuator, &hich permits eas)
repacement of rin! after &earin! or repacement of rin! after &earin! or
dama!e for the rin! dama!e for the rin!

The O rin! re,uires A'Dmm hei!ht, the The O rin! re,uires A'Dmm hei!ht, the
!reatest of an) attachments !reatest of an) attachments

O rin! post usua) made of machined O rin! post usua) made of machined
titanium ao) or cast in precious titanium ao) or cast in precious
meta meta

Post has a head* (od) C nec#* The Post has a head* (od) C nec#* The
-od) of post is connected to the -od) of post is connected to the
impant a-utment or superstructure impant a-utment or superstructure
-ar -ar
O H ring system
O H ring system
ADVANTA1E ADVANTA1E

Ease in chan!in! the attachment Ease in chan!in! the attachment

.ide ran!e of mo"ement .ide ran!e of mo"ement

Lo& cost Lo& cost

Different de!ree of retention Different de!ree of retention

Possi-e eimination of time C cost of a superstructure for the Possi-e eimination of time C cost of a superstructure for the
prosthesis prosthesis
INTRA RADICULAR STUD TTAC5%ENTS INTRA RADICULAR STUD TTAC5%ENTS

The ad"anta!es of this s)stem ies in cost The ad"anta!es of this s)stem ies in cost
and space re,uirements* The) do not and space re,uirements* The) do not
re,uire precious meta copin! do&e nor re,uire precious meta copin! do&e nor
specia a-orator) procedures* The) are specia a-orator) procedures* The) are
reati"e) simpe and ,uic#* reati"e) simpe and ,uic#*
Eest Anchor s)stem Eest Anchor s)stem / /

It deri"es its retention from &ithin the root It deri"es its retention from &ithin the root

A post preparation is made &ithin the root A post preparation is made &ithin the root
C a femae see"e is cemented to pace C a femae see"e is cemented to pace

A mae eement that is n)on post C a -a A mae eement that is n)on post C a -a
head that is incorporated in the denture head that is incorporated in the denture
-ase and pro+ects do&n&ards, en!a!in! a -ase and pro+ects do&n&ards, en!a!in! a
recess in the root preparation, further the recess in the root preparation, further the
oads are appied at a point* That is &e oads are appied at a point* That is &e
apica to the !in!i"a mar!in of the root* apica to the !in!i"a mar!in of the root*

A "ariet) of a-utments ma) -e empo)ed A "ariet) of a-utments ma) -e empo)ed

incudin! hemisected moar roots* @ si0es incudin! hemisected moar roots* @ si0es
of 0est anchor are a"aia-e dependin! on of 0est anchor are a"aia-e dependin! on
the root en!th and diameter* the root en!th and diameter*

The s)stems has -een e3tensi"e) refined The s)stems has -een e3tensi"e) refined
o"er the )ears and a comprehensi"e #it is o"er the )ears and a comprehensi"e #it is
no& a"aia-e no& a"aia-e

#he vertical space re;uirements are the #he vertical space re;uirements are the
same as 6othermann unit same as 6othermann unit

9F<#I,= 9F<#I,=

ttachment is within the root structure, ttachment is within the root structure,
thus It overcomes any space problem thus It overcomes any space problem

(everage on the abutment tooth is (everage on the abutment tooth is

negligible as point of attachment is well negligible as point of attachment is well
below alveolar bone level below alveolar bone level

=imple D attachment procedure can be =imple D attachment procedure can be

performed ;uickly at chair side performed ;uickly at chair side

If more than one toot is used parallelism If more than one toot is used parallelism
is not necessary because of the is not necessary because of the
flexibility of the nylon male flexibility of the nylon male
Eest s)stem, sho&in!
n)on mae
component pro+ectin!
from the denture C
femae component
cemented into the root
DISADVANTA1ES DISADVANTA1ES

Since no castin! or copin! usua) made,

Since no castin! or copin! usua) made,
the root or cana itsef suscepti-ie to
the root or cana itsef suscepti-ie to
caries
caries

The n)on studs ma) -ent or e"en fracture,

The n)on studs ma) -ent or e"en fracture,
pre"entin! seatin! of the appiance,
pre"entin! seatin! of the appiance,
especia) if se"era are -ein! used thus
especia) if se"era are -ein! used thus
re,uire fre,uent reca "ists
re,uire fre,uent reca "ists

Vertica fracture of the root

Vertica fracture of the root
INDICATION INDICATION

Idea for use in an interim o"erdenture
Idea for use in an interim o"erdenture
(ar compared to Stud =i3ation (ar compared to Stud =i3ation / /

Spintin! of t&o or more teeth &ith a -ar produces Spintin! of t&o or more teeth &ith a -ar produces
sta-iit) simiar to the ri!id stud t)pe attachment &hen sta-iit) simiar to the ri!id stud t)pe attachment &hen
the o"erdenture is in pace* (ut the stud) t)pe ao& the o"erdenture is in pace* (ut the stud) t)pe ao&
independent mo"ement* independent mo"ement*

If one tooth is &ea# the stron! tooth can ser"e as the If one tooth is &ea# the stron! tooth can ser"e as the
fucrum point for mo"ement of the &ea#er tooth in the fucrum point for mo"ement of the &ea#er tooth in the
prosthesis* .ith -ar fi3ation, a stron!er and a &ea#er prosthesis* .ith -ar fi3ation, a stron!er and a &ea#er
tooth can -e spinted &ith the resut that the stron!er tooth can -e spinted &ith the resut that the stron!er
tooth stren!thens the &ea#er tooth and the &ea#er tooth tooth stren!thens the &ea#er tooth and the &ea#er tooth
&ea#ens the stron!er tooth &ea#ens the stron!er tooth
(ar Attachments
(ar Attachments

The -ar attachments hep in spintin! of the a-utment The -ar attachments hep in spintin! of the a-utment
teeth, retention and support of the appiance* The teeth, retention and support of the appiance* The
inter occusa space a"aia-iit) has aread) -een inter occusa space a"aia-iit) has aread) -een
emphasi0ed* emphasi0ed*

(ar attachments are cassified into t&o t)pes -ar (ar attachments are cassified into t&o t)pes -ar
units and -ar +oints* units and -ar +oints*

(ar unit has a ri!id fi3ation &here there is no (ar unit has a ri!id fi3ation &here there is no
mo"ement -et&een the -ar and o"er)in! see"e and mo"ement -et&een the -ar and o"er)in! see"e and
can -e cassified as tooth -orn* can -e cassified as tooth -orn*

(ar +oints permits rotationa mo"ement -et&een (ar +oints permits rotationa mo"ement -et&een
see"e and -ar and deri"es more or residua rid!e see"e and -ar and deri"es more or residua rid!e
support* support*
T)pes of (ar Attachments /
T)pes of (ar Attachments /

5ader (ar*
5ader (ar*

Doder -ar attachment*

Doder -ar attachment*

(a#er cips*
(a#er cips*

Ac#erman cips and

Ac#erman cips and

C*%* cip
C*%* cip


5ADER (AR ATTAC5%ENT 5ADER (AR ATTAC5%ENT

Can ser"e as a -ar +oint or a -ar unit* Can ser"e as a -ar +oint or a -ar unit*

Can -e used as a stud attachment and a Can -e used as a stud attachment and a
-ar attachment* -ar attachment*

Consists of preformed pastic -ars and Consists of preformed pastic -ars and
cips cips

5emet 5ader de"eoped the 5ader -ar C 5emet 5ader de"eoped the 5ader -ar C
rider s)stem in the ate 48F:6s rider s)stem in the ate 48F:6s

Its present form has -een in use for Its present form has -een in use for
amost 2: )rs amost 2: )rs

En!ish, Donne C Stau-i modified the En!ish, Donne C Stau-i modified the
s)stem in 488@ to form the 5ader EDS s)stem in 488@ to form the 5ader EDS
s)stem s)stem

The EDS 5ader s)stem is on) 2mm hi!h, The EDS 5ader s)stem is on) 2mm hi!h,
&hereas the ori!ina &as 9*2mm in hei!ht &hereas the ori!ina &as 9*2mm in hei!ht

#he clips have 7 different retention #he clips have 7 different retention
strengths D a 40 strengths D a 40
0 0
clip rotation which clip rotation which
greatly improves the flexibility of the greatly improves the flexibility of the
system for a range of patient needs or system for a range of patient needs or
desire desire

#he clip rotation compensates for the #he clip rotation compensates for the
resilence of the tissue which is usually resilence of the tissue which is usually
02& H 1 mm in the mandible 02& H 1 mm in the mandible

#he standard or ,9= "ader bar has a #he standard or ,9= "ader bar has a
round superior aspect D an apron round superior aspect D an apron
toward the tissue below which acts as toward the tissue below which acts as
a stiffener to improve the strength of a stiffener to improve the strength of
the bar D limit its flexibility the bar D limit its flexibility

6ound bar designs flexes in relation to 6ound bar designs flexes in relation to
? ?
1 1
i2e2, bar twice as long flexes i2e2, bar twice as long flexes
4?4?4?4N 1' times more 4?4?4?4N 1' times more
@abrication >
@abrication >

#he plastic bar is attached to the wax copings

#he plastic bar is attached to the wax copings
and is cast with the coping2
and is cast with the coping2

Plastic clip is embedded in the denture for

Plastic clip is embedded in the denture for
retention2
retention2

:ut metal clip offers more retention than the

:ut metal clip offers more retention than the
plastic2 Plastic clip wears off rapidly2 @or more
plastic2 Plastic clip wears off rapidly2 @or more
retention additional clips can be added and
retention additional clips can be added and
tension of the metal clip can be increased
tension of the metal clip can be increased
"ader :ar "ader :ar > >
#he total height of the #he total height of the
"ader bar and clip "ader bar and clip
assembly is as low as 1 assembly is as low as 1
mm mm
dvantages dvantages
9isadvantages
9isadvantages

:ars can be fabricated in :ars can be fabricated in

any alloy2 any alloy2

6etention can be improved 6etention can be improved

by patient or dentist2 by patient or dentist2

@or more retention metal @or more retention metal

clip can be used2 clip can be used2

ssembly techni;ue is ssembly techni;ue is

simple2 simple2

+apability to follow +apability to follow

gingival contours2 gingival contours2

6ider is too bulky 6ider is too bulky

occlusogingivally2 occlusogingivally2

@or additional retention @or additional retention

more metal clips should be more metal clips should be
added added
Doder (ar Doder (ar

5as -ar unit and -ar +oint 5as -ar unit and -ar +oint

Preformed -ars are a"aia-e for Preformed -ars are a"aia-e for
-ar units* -ar units*

Shape of the -ar, has parae Shape of the -ar, has parae
sides &ith a rounded top* sides &ith a rounded top*

Retention is -) means of Retention is -) means of

frictiona fit* frictiona fit*

Non resiient attachment* Non resiient attachment*

=a-rication / =a-rication /

The preformed -ars are The preformed -ars are

sodered to the copin!s and the sodered to the copin!s and the
see"e is em-edded in the see"e is em-edded in the
acr)ic o"er denture* acr)ic o"er denture*

Ad"anta!es / Ad"anta!es /

A"aia-iit) of t&o different A"aia-iit) of t&o different

hei!hts 4*>FA mm and 2*Fmm* hei!hts 4*>FA mm and 2*Fmm*

Rider and -ar are a"aia-e in Rider and -ar are a"aia-e in
an) en!ths* an) en!ths*

Spacer ao&s "ertica and Spacer ao&s "ertica and

rotationa mo"ement* rotationa mo"ement*
Crossection throu!h pear shaped
Do-er -ar C retainin! see"e
incorporated into impression
surface of o&er denture

9isadvantages > 9isadvantages >

#oo bulky even in #oo bulky even in

microsize 3faciolingually52 microsize 3faciolingually52

,xpensive and re;uires ,xpensive and re;uires

exceptional skill for its exceptional skill for its
use2 use2

llows vertical and llows vertical and

rotational movement rotational movement
because of the resilient because of the resilient
attachment2 attachment2

+ontouring the bar Eoint is +ontouring the bar Eoint is

difficult2 difficult2

:ulky and difficult to use :ulky and difficult to use

because of esthetic because of esthetic
considerations considerations
:aker +lip :aker +lip

+onsists of )B* shaped clip designed to fit over a round wire2 14 +onsists of )B* shaped clip designed to fit over a round wire2 14
and 11 roung gauge wire are used2 #hese wires are soldered to and 11 roung gauge wire are used2 #hese wires are soldered to
the copings2 +lip is positioned over the wire and is attached to the copings2 +lip is positioned over the wire and is attached to
the over denture with cold cure resin2 the over denture with cold cure resin2

:aker +lip > :aker +lip >

dvantages > dvantages >

dEustable and provides rotational movement2 dEustable and provides rotational movement2

6eadily available2 6eadily available2

9isadvantages > 9isadvantages >

<o retention for the clips2 <o retention for the clips2

=oldering the retentive loops reduces the elasticity of the clip2 =oldering the retentive loops reduces the elasticity of the clip2
ckerman and +2C2 +lip ckerman and +2C2 +lip

#hese are bar Eoints2 #hese are bar Eoints2

:oth are similar in designs2 :oth are similar in designs2

+onsists of a rounded bar and clip, +onsists of a rounded bar and clip,
where the clip fits over the bar2 where the clip fits over the bar2

#he slip has retention wings for the #he slip has retention wings for the
easy engagement into the acrylics2 easy engagement into the acrylics2

llows vertical and rotational llows vertical and rotational

movement because of fixation2 movement because of fixation2

Provides an excellent retention for Provides an excellent retention for

overdenture when bar Eoint system overdenture when bar Eoint system
is used2 is used2

dvantages > dvantages >

6ider is provided with retention2 6ider is provided with retention2

=paces provides resiliences and =paces provides resiliences and

rotation 3or5 rotation alone if the rotation 3or5 rotation alone if the
shim is not used2 shim is not used2

9isadvantages > 9isadvantages >

#he basis can be only 12-mm in #he basis can be only 12-mm in
diameter diameter
Cagnetic 9enture 6etention Cagnetic 9enture 6etention

#hese have been in existance #hese have been in existance

since 1-702 since 1-702

#hey can be divided into groups2 #hey can be divided into groups2
#hose depending on the mutual #hose depending on the mutual
repulsion of like magnetic poles2 repulsion of like magnetic poles2
e2g22 @riedman magnetic e2g22 @riedman magnetic
stabilizers52 stabilizers52

9isadvantages > 9isadvantages >

(ess retentive when most needed (ess retentive when most needed
3when Eaws are part5 3when Eaws are part5

+ontinued resorbtion2 +ontinued resorbtion2

#hose depending on the mutual #hose depending on the mutual
attraction unlike poles2 attraction unlike poles2

9isadvantages > One continuous 9isadvantages > One continuous

attracting forces could cause the attracting forces could cause the
embedded bar magnets to move embedded bar magnets to move
through the bone, corrrode the through the bone, corrrode the
soft tissues and become soft tissues and become
exfoliated exfoliated

In order to know about magnetic over denture the field In order to know about magnetic over denture the field
strength and magnetic permanence are 4 terms which re;uire strength and magnetic permanence are 4 terms which re;uire
clear understanding2 @or dental use a high magnetic field clear understanding2 @or dental use a high magnetic field
strength is desirable as this will provide stronger retention2 strength is desirable as this will provide stronger retention2
"igh permanence is essential for 315 it ensures magnet will be "igh permanence is essential for 315 it ensures magnet will be
less likely to lose its magnetism2 345 small magnet can be less likely to lose its magnetism2 345 small magnet can be
made without the north pole demagnetising the south pole2 made without the north pole demagnetising the south pole2

Bntil 1-00 magnets for dental purpose were either lnico 3l, Bntil 1-00 magnets for dental purpose were either lnico 3l,
+o, <i5 or +o!Pt magnets both alloys have magnetic field +o, <i5 or +o!Pt magnets both alloys have magnetic field
strength2 :ut their permanence is such that there is a lower strength2 :ut their permanence is such that there is a lower
limit to their physical size and they cannot be made as small limit to their physical size and they cannot be made as small
as a tooth and have high field strength2 as a tooth and have high field strength2

#his limitation was eliminated by the discovery of the rare #his limitation was eliminated by the discovery of the rare
earth cobalt 36,+5 magnet alloys2 6,+ alloys have & to earth cobalt 36,+5 magnet alloys2 6,+ alloys have & to
10 times field strength2 #he common composition being 10 times field strength2 #he common composition being
cobalt!samarium 3+o=m52 #hey were introduced to cobalt!samarium 3+o=m52 #hey were introduced to
prosthodontics for retention by Iillings in 1-002 prosthodontics for retention by Iillings in 1-002

In one approach magnets are attached to the supporting In one approach magnets are attached to the supporting
flush with the root faces2 =imilar but opposite polarity flush with the root faces2 =imilar but opposite polarity
provides retention in the range of 1&0.100 gms!magnet provides retention in the range of 1&0.100 gms!magnet
pair2 9enture base!root face separation of as much as pair2 9enture base!root face separation of as much as
7mm2 #here is no path of insertion restriction 7mm2 #here is no path of insertion restriction
9isadvantages >
9isadvantages >

=mall root surface of some supporting root limit the

=mall root surface of some supporting root limit the
size of magnet that can be inserted and limit retention2
size of magnet that can be inserted and limit retention2

#he magnet alloy can corrode and fracture in the

#he magnet alloy can corrode and fracture in the
mouth2
mouth2

n avoidable magnetic field surrounds both the intra

n avoidable magnetic field surrounds both the intra
radicular and denture magnets2
radicular and denture magnets2

#hese disadvantage was over come by replacement of

#hese disadvantage was over come by replacement of
one magnet with a magnetisable low intrinsic alloy,
one magnet with a magnetisable low intrinsic alloy,
without significant loss of retention2 casting alloy
without significant loss of retention2 casting alloy
based on palladium, cobalt and nickle is cast as root
based on palladium, cobalt and nickle is cast as root
cap and dowel and fitted to the supporting root2 #he
cap and dowel and fitted to the supporting root2 #he
casting because of its magnetic coercivity becomes a
casting because of its magnetic coercivity becomes a
strong induced magnet and retains the denture like an
strong induced magnet and retains the denture like an
intraradicular permanent magnet2
intraradicular permanent magnet2

:iological ,ffects of +obalt!=amarium Cagnets > :iological ,ffects of +obalt!=amarium Cagnets >

#here are two ways in which +o!=a magnets could have an #here are two ways in which +o!=a magnets could have an
effect on tissues> effect on tissues>

Physical effect because of the presence of magnetic field Physical effect because of the presence of magnetic field
gradient2 gradient2

+hemical effect due to wear or corrosion products of alloy2 +hemical effect due to wear or corrosion products of alloy2

:ehrman 31-'05 in his study concluded that magnetic is :ehrman 31-'05 in his study concluded that magnetic is
completely innocuous to tissues2 =imilar conclusions were completely innocuous to tissues2 =imilar conclusions were
reached by #oto and +houkas2 reached by #oto and +houkas2

#sutsui and his colleagues 31-0-5 found alloy to be innocuous in #sutsui and his colleagues 31-0-5 found alloy to be innocuous in
tissue culture test due to corrosion resistance2 #he wear rate of tissue culture test due to corrosion resistance2 #he wear rate of
unprotected faces of magnets used for over denture retention unprotected faces of magnets used for over denture retention
has been found to be less than 1mm!s;mm!year2 3Iillings has been found to be less than 1mm!s;mm!year2 3Iillings
1-0%52 #his is several orders of magnitude less than the 1-0%52 #his is several orders of magnitude less than the
recommended maximum ingestion levels for cobalt and recommended maximum ingestion levels for cobalt and
samarium samarium

#he external magnetic field can be virtually eliminated by #he external magnetic field can be virtually eliminated by
arranging paired magnets in a modified horse shoe arranging paired magnets in a modified horse shoe
configuration by which the retentive effect is almost configuration by which the retentive effect is almost
doubled2 doubled2

#he explanation of this apparently anomalous doubling #he explanation of this apparently anomalous doubling
effect is that in the open configurations the north and effect is that in the open configurations the north and
south pole facing each other contribute to the retention, south pole facing each other contribute to the retention,
but the remaining =outh and <orth poles do not and their but the remaining =outh and <orth poles do not and their
potential retentive effect is thus wasted2 /here as all the potential retentive effect is thus wasted2 /here as all the
available magnetic field is used in no closed configuration2 available magnetic field is used in no closed configuration2
:oth the open and closed field denture retention system :oth the open and closed field denture retention system
are in current use2 are in current use2
+omparison of magnetic retention and precision attachments +omparison of magnetic retention and precision attachments

=implicity2 =implicity2

(ow cost2 (ow cost2

=elf adEusting 3Orthodontic tooth movement for passing contact52 =elf adEusting 3Orthodontic tooth movement for passing contact52

6eusable2 6eusable2

Inherent stress breaking2 Inherent stress breaking2

6eseating after denture displacement2 6eseating after denture displacement2

@reedom of lateral and rotational denture movement2 @reedom of lateral and rotational denture movement2

(ow potential for trauma to supporting roots2 (ow potential for trauma to supporting roots2

,ase of denture relining2 ,ase of denture relining2

<o special accessories are re;uired2 <o special accessories are re;uired2

"eight of denture retention element is less than many precision "eight of denture retention element is less than many precision
attachments attachments
=B:C,6I,9 FI#( 6OO#= > #his is of current research =B:C,6I,9 FI#( 6OO#= > #his is of current research
interest, it attempts to obviate some basic problem interest, it attempts to obviate some basic problem
associated with the more conventional over denture associated with the more conventional over denture
abutments2 In these cases selected vital roots are abutments2 In these cases selected vital roots are
transected and reduced to 4mm below the crestal bone transected and reduced to 4mm below the crestal bone
and then covered by mucoperiosteal flap2 and then covered by mucoperiosteal flap2

#he maEor problem associated are development of #he maEor problem associated are development of
dehiscences and pulpal pathosis2 dehiscences and pulpal pathosis2
/hen this is done several advantages of the over denture /hen this is done several advantages of the over denture
are lost2 are lost2

=upport from direct contact of the denture base to the =upport from direct contact of the denture base to the
abutment tooth2 abutment tooth2

ttempts to gain retention form the teeth through some ttempts to gain retention form the teeth through some
form of attachment is no longer possible form of attachment is no longer possible

+linical use of submerged vital roots as overdenture +linical use of submerged vital roots as overdenture
abuments has yet not been successful abuments has yet not been successful
Teescopic prosthesis Teescopic prosthesis

Cinimum taper of copings is advised for best retention 3less Cinimum taper of copings is advised for best retention 3less
than & degrees of possible52 de;uate height of the axial walls than & degrees of possible52 de;uate height of the axial walls
3at least 1mm5 3at least 1mm5

butments for telescopic prosthesis will be covered by two butments for telescopic prosthesis will be covered by two
layers of metal while facial surfaces may re;uire facings as layers of metal while facial surfaces may re;uire facings as
well2 well2

#he poorly executed abutment preparations result in thin inner #he poorly executed abutment preparations result in thin inner
coping that becomes perforated after a period of use also it coping that becomes perforated after a period of use also it
produces a bulky and unsightly prosthesis2 produces a bulky and unsightly prosthesis2

Occlusal reduction 4 H 7mm is minimum re;uirement Occlusal reduction 4 H 7mm is minimum re;uirement

Carked reduction in restoration observed once the taper Carked reduction in restoration observed once the taper
increases beyond ' degrees increases beyond ' degrees

+hamfer finish line is ideal +hamfer finish line is ideal

Faluable in cleft palate patient Faluable in cleft palate patient

#he removable section of the prosthesis re;uires e;ual care in #he removable section of the prosthesis re;uires e;ual care in
its planning as it is removable it re;uires sufficient strength to its planning as it is removable it re;uires sufficient strength to
withstand handling by the patient2 withstand handling by the patient2
Treatment pannin!
Treatment pannin! / /
The se,uence and technica procedures of preparator) The se,uence and technica procedures of preparator)
treatment remains the same for a #inds of tooth supported treatment remains the same for a #inds of tooth supported
dentures dentures
The on) difference is in the desi!n of the a-utment teeth The on) difference is in the desi!n of the a-utment teeth
The foo&in! se,uence can -e used as a !enera !uide -ut The foo&in! se,uence can -e used as a !enera !uide -ut
not necessari) in a situations not necessari) in a situations
Construct an immediate R3 caspess denture C cast from Construct an immediate R3 caspess denture C cast from
irre"ersi-e h)drocooid impression irre"ersi-e h)drocooid impression
Remo"e the hopeess teeth C insert the remo"a-e prosthesis Remo"e the hopeess teeth C insert the remo"a-e prosthesis
Durin! heain! period institute the periodonta and endodontic Durin! heain! period institute the periodonta and endodontic
treatment treatment

PREPARATION O= RETAINED TEET5 PREPARATION O= RETAINED TEET5
G GTooth preparation for minima retention Tooth preparation for minima retention
Sufficient tooth structure is remo"ed to pro"ide fa"ora-e Sufficient tooth structure is remo"ed to pro"ide fa"ora-e
root cro&n ratio to ao& the insertion of the artificia root cro&n ratio to ao& the insertion of the artificia
prosthesis in an accepta-e esthetic position C in a prosthesis in an accepta-e esthetic position C in a
fa"ora-e occusa reation &ith the teeth of opposin! fa"ora-e occusa reation &ith the teeth of opposin!
arch arch
E3tend a chamfer t)pe mar!in si!ht) -eneath the free E3tend a chamfer t)pe mar!in si!ht) -eneath the free
!in!i"a mar!in !in!i"a mar!in
Taper the preparation in occuso!in!i"a direction Taper the preparation in occuso!in!i"a direction
The finished tooth &ith attached copin! is the mae mem-er The finished tooth &ith attached copin! is the mae mem-er
of the denture C the femae mem-er is a part of the of the denture C the femae mem-er is a part of the
denture -ase denture -ase
The occusa or incisin! surface must -e a dimension The occusa or incisin! surface must -e a dimension
suita-e to pro"ide an area for pacin! of a conca"it) in suita-e to pro"ide an area for pacin! of a conca"it) in
the copin! to accommodate CoCr -earin! &ith radius of the copin! to accommodate CoCr -earin! &ith radius of
the conca"it) si!ht) more than the radius of cur"ature the conca"it) si!ht) more than the radius of cur"ature
of the -earin! of the -earin!
G G Copin! fa-rication Copin! fa-rication

%a#e an accurate impression of the a-utment and %a#e an accurate impression of the a-utment and
pour a die pour a die

Car"e the &a3 pattern and pace the conca"it) in Car"e the &a3 pattern and pace the conca"it) in
the occusa surface the occusa surface

Cast the copin!, and cement the poished copin!

to the tooth
G GDenture fa-rication Denture fa-rication
Primar) Impression Primar) Impression ma#in!
=ina impression ma#in!
Record -ases and occusa rims prepared ' The on)
difference is the incorporation of the meta -earin! in
the record -ase* App) one thic#ness of -asepate
&a3 to the a-utment ea"in! the occusa surface
e3posed* Seat the -earin! in the conca"it) C sea it in
pace &ith &a3* Construct the record -ase of
acti"ated acr)ic resin usin! sprin#e on techni,ue*
Attach &a3 occusa rims to the -ase
M Record ma3iomandi-uar reation
M Tr)in! in the teeth
La-orator) procedure
M Contour the &a3
M =as# the denture
M Eiminate the &a3
M At this step remo"e the meta -earin!s from the
acr)ic resin tooth ceaned &ith -oiin! &ater C
dried
M The cast ao&ed to dr) and a-utment e3cept the
conca"it) are painted &ith tin foi su-situte
M The meta -earin! seated in conca"it) and a
copin! of acti"ated acr)ic resin &ith crossin#ed
monomer made, usin! the sprin#e on techni,ue
M The procedure ensures the correct positionin! of the
-earin! C ao& tria pac#in! of the heat cured acr)ic
resin denture -ase
M .hie the resin is in dou!h sta!e the copin! &ith
-earin! is hed secure) in pace C sma amount of
dou!h pressed around the !in!i"a surface of the
copin! and pac#in! competed
M After denture processed, remount procedure for
occusa errors competed
M Denture finished and poished

+linical experience supports the recommendation of at +linical experience supports the recommendation of at
least one abutment!;uadrant and the retained teeth least one abutment!;uadrant and the retained teeth
should be preferably not be the adEacent ones, or there should be preferably not be the adEacent ones, or there
should be several millimeters of space between the should be several millimeters of space between the
reduced tooth forms2 reduced tooth forms2

Candibular canines are most often utilized because they Candibular canines are most often utilized because they
are usually the last teeth to be lost2 If only a single tooth are usually the last teeth to be lost2 If only a single tooth
remains this also should be retained as one tooth for remains this also should be retained as one tooth for
support and bone preservation is better than none2 support and bone preservation is better than none2

/hen +anines and premolars are present, it is better to /hen +anines and premolars are present, it is better to
maintain the canines and second premolars as this will maintain the canines and second premolars as this will
give better support and also allows for more favorable oral give better support and also allows for more favorable oral
hygiene2 hygiene2
Patients who beneit !o"
"andib#$a! O%e!dent#!es

re usually elderly 3'& to

%0O years5

re edentulous in the
maxilla and mandible

"ave worn complete

dentures for many years

re uncomfortable with a
complete mandibular
denture

9emand stabilization of
denture

If not yet edentulous, they

exhibit extremely reduced
residual dentition that cannot
be maintained

Patients who beneit !o" "a&i
O%e!dent#!es
M re in the younger segment Of
older patients 3&0 to '0 years5
M "ave no experience with
maxillary removable prosthesis
M ,xhibit hopeless residual
maxiliary dentition
M re fearful of becoming
edentulous
"ave high esthetic demands
M "ave natural teeth or fixed
mandible
M 9esire fixed reconstruction
I%PLANT OVERDENTURE
I<9I+#IO<=

Cinimum anterior bone loss$ prevents bone loss

Improved esthetics

Improved stability 3reduces or eliminates prosthesis

movement5

Improved occlusion 3reproducible centric relation

occlusion5

9ecrease in soft tissue abrasions

Improved chewing efficiency and force

Increased occlusal efficiency

Improved retention

Improved support

Improved speech

6educed prosthesis size 3eliminates palate flanges5

Improved maxillofacial prostheses

Impant O"erdenture Ad"anta!es
Impant O"erdenture Disad"anta!es

butment crown height space re;uired

butment crown height space re;uired

(ong term maintainence

(ong term maintainence

@ood impaction
@ood impaction

+ontinued posterior bone loss

+ontinued posterior bone loss
G#ide$ines o! Mandib#$a! O%e!dent#!e
Fab!i'ation

#wo intraforaminal implants

3approximately 1 mm in diameter and a
minimum of % mm in length5 are
reccommended
#he distance between the implants
should be1& to 4& mm, depending on
the size D curvature of the anterior
arch2 #he implant can be splinted with a
clip.bar 3resilient retention5 or a B.
shaped bar 3rigid retention as well as
single anchors, such ball attachments2
#hree or four implants are
recommended when implants of
reduced length or diameter are used2 In
this case distance between the implants
should be 14 H 1& mm to allow for a
reasonable length of the bar segments
G#ide$ines o! Ma&i$$ai( O%e!dent#!e
Fab!i'ation
A minimum of four impants e"en)
distri-uted o"er the anterior arch is
preferred*
Standard si0e and reduced'diameter
impants can -e used in the same arch*
A spintin! -ar 7prefera-) ri!id; is
recommended, athou!h -a anchors
can -e used for temporar) adaptation,
Retention &ith -a anchors ma) not -e
ade,uate in e"er) situation due to
di"er!ent impant a3es*
It is su!!ested that the denture -ase -e
reinforced &ith a cast meta frame&or#H
this increases the initia cost, -ut it
ma) reduce maintenance costs since
fractures and other compications can
-e a"oided
Specia anatomic situations, such as
con!enita defects, re,uire indi"idua
fa-rication of ma3iar) prostheses
CONCLUSION
CONCLUSION

Over dentures are both versatile and

Over dentures are both versatile and
valuable method of treatment with ever
valuable method of treatment with ever
increasing applications, but it is important
increasing applications, but it is important
to visualize the final result at the treatment
to visualize the final result at the treatment
planning stage itself for ensuring a
planning stage itself for ensuring a
successful treatment2
successful treatment2