OVER DENTURES HYBRIDS

Tooth supported complete dentures

Definition

Introduction

History

Indications, contraindications

Rationale for over dentures

Examination, diagnosis treat planning prognosis

Periodontal considerations

Endodontic considerations

Types classification (depending on the method of

abutment preparation) coping abutments attachment
a. Overdentures for congenital and acquired defects
b. Transitional overdentures
c. Immediate overdentures

d. Remote overdentures
e. Crown-sleeve coping prosthesis

Centric relation check points

Post insertion instructions and complications

Denture problems

Advantages and disadvantages

Definition
An overdenture is a complete or a partial denture
supported by mucoperiosteum and prepared teeth.
A tooth

supported

complete

denture

is

dental

prosthesis that replaces the lost or missing natural

dentin and associated structures of the maxillae and/or
mandible and receives partial support and stability from
one or more modified natural teeth.
A removable partial denture or complete denture that
covers and rests on one or more remaining natural teeth,

the roots of natural teeth and/or dental implants (GPT

7).
Introduction
Prevention is better than cure this phase is heard
time and again in a medical and dental profession.
I can think of no other better example of preventive
dentistry than the use of an OVER DENTURE.
Indications
Denture opposed by natural teeth or a removable partial
denture, because able resist increased occlusal forces
exerted by opposing natural teeth.
Patients with congenital or acquired defects.
Patient with few teeth remaining and it is understood
that patient will have difficulty in adapting to complete
dentures (e.g.) Parkinsons disease.

 When remaining teeth are considered unsuitable as

partial

denture

abutments

because

of

position,

angualtion and state of crowns.

When the prognosis of the teeth because of mobility is
poor. This mobility can be decreased in the crown root
ratio.
In cases of tooth surface loss due to attrition, abrasion
or erosion may be used as abutment for over dentures.
For patient with poor prognosis for complete dentures.
- Palatal vault is high and ridges slope
- Mandible has a poorly defined sublingual fold,
floor of mouth drapes
Contraindications
Patient who lack motivation
Teeth

that

cannot

be

saved

by

periodontal

and

endodontical therapy.
Remaining natural teeth are adequate to restore dental
arch with fixed or removable partial dentures.

Rationale for retention of teeth for over dentures concept

Before I talk about proprioception I would add a note
on receptors which are responsible for this receptor is a
nerve terminal that responds to stimuli.
Receptors are classified (Ramford and Ash)
Exteroreceptors affected by changes in external
environment (stimuli, temperature, vision, hearing)
Interoreceptors respond to the changes in the visera
(Hinger, visceral pain, thirst)
Proprioreceptors concerned with sense position and
movements of body and its parts (ligaments, muscles,
tendons.
Proprioception (GPT 7)
Definition
The reception of stimulation of sensory nerve terminals
within the tissues of the body that give information
concerning movements and the position of the body.

Sensory input from periodontal receptors

Sensitivity of anterior teeth
The minimal threshould for detection of load was 1gm
on the incisal surface of anterior teeth (axial direction)
and 8 to 10gm on the occlusal surfaces of molars, but in
individual wearing dentures it was 53gm to 125gm.
Important in determining bitting force (mucosa, tip of
tongue and anterior teeth come of receptors greater).
Dimensional perception
Discrimination of different thickness of objects between
occlusal surfaces of the teeth.
Patient with matural teeth can discriminate differences
at 2mm range better than those with artificial dentures.
Canine response
Canines had more neurons than any other teeth Corbin
and Harrison (1940) found that the canines were the
most sensitive in studies of cats.
Directional sensitivity

Jerge (1963) said that the receptors were arranged in

such a way as to respond to pressure regardless of the
direction.
Muscle changes after matural tooth contacts Schaerer
(1967), Brenman (1968) have found that the periodontal
receptors are related to activity of the masticatory
muscles. Jerge (1965) said that they are involved in the
cyclic jaw movements during mastication.
Proprioception and salivary secretion
Kapur

and

Collister

(1970)

said

that

periodontal

receptors played an indirect role in the masticatory

salivary reflex by regulating the range and type of
masticatory stroke.
In

denture

wearers

there

is

impairment

of

the

mechanism of regulating parotid gland stimulation

during mastication.
Tooth mobility in reduced teeth

Reduction will improve crown root ration and reduce

the mobility of retained. The mobility is reduced from
100% to 60%.

Alveolar bone preservation in over dentures

The alveolar bone loss in anterior part of mandible in
overdenture wearers was 0.6mm and in the case of
conventional dentures in 5.2mm almost 8 times more.
EXAMINATION,

DIAGNOSIS,

PLANNING AND PROGNOSIS

1. History
Medical history
Debilating diseases
- Diabetes
- Hypertension
- HIV, Hepatitis B
Psychiatric disorders
Dental history

TREATMENT

Past

dental

experience,

influence

is

attitudes

motivation, expectation.
Reasons for loss of tooth
Pre treatment records
Photographs
Casts
Profile registrations
Cephalometric radiographs

Examination
Visual examination for any pathologic changes
Rigital examination
- Sharp mylohyoid ridges
- Exoteses
- Disposable tuberosity tissues
- Undercut areas
Dental examination
Any resin, caries, occlusion, denture space, habits

Inflammation recession, attached gingiva, pockets,

bony deformitive
- Periodontal examination
- Radiographic examination IOPA, OPG
Diagnosis
The propectine power denture patients have chronic
generalized periodontitis, congenital deformities, or loss of
teeth due to trauma.
Treatment planning
Over dentures is considered as treatment of choice if
four or fewer retainable teeth are present, which are mobile,
improper crown root ration, where removable partial denture
and fixed partial denture are not recommended.
Abutment selection
Evaluation of abutment teeth should be evaluated
carefully from view points.

1. Periodontal status minimal mobility, acceptable bone

support, adequate band of attached gingiva.
2. Caries activity minimal or no caries activity.
3. Potential

for

endodontic

treatment

successful

endodontic treatment contributes abutment tooth and

replacement with one of the similar size and shape.
Crown root ratios improved after endodontic treatment.
4. Positional considerations teeth should be retained
where the occlusal force on the residual ridges has the
greatest destructive potential. Ideally two canines and
two premolars area act as keystone of the arch. Two
canines and a central incisor tripod of heavy
technique. Angulation of the tooth should considered.
The root should be perpendicular to direction of
occlusal forces.
5. Path of insertion tooth that is retained causes an
undercut in the labial contour of the ridge that would
not persist in case the tooth is removed. The retention
of premolar or incisors may protect the out part of the

arch or relief can be given or the borders can be under

extended.
Periodontal considerations for an overdenture patient
Presence of healthy teeth in the mouth is essential for
maintaining the alveolar ridge.
Canines are the most favorable teeth in the arch as they
have a larger surface area for attaching the periodontal
fillers.
Osseous defects are usually not found in amount portion
of the jaws since the cortical plate and alveolar housing
often are fused without any spongy bone.
Periodontal therapy
Includes elimination of periodontal pocket increase the
jone of attached gingiva, increase depth of the vestibule
and correction of any osseous defects. Maintenance of
abutment teeth with good oral hygiene procedures.
Complications

 Irritation from the denture base, pressure atrophy due to

inadequate inlay relief of the overdenture
Poor oral hygiene
Periodontal abscess

Endodonitc considerations
Endodontic treatment is a must for teeth with mobility
as the crown-root ration cannot improved.
The important to select abutment with the single root
canal.
One visit endodontic therapy that is usually followed,
increase of periapical infection it is contraindicated.
Endodontic implants
It is used to stabilize teeth with extremely short roots or
excessive

bone

loss.

Special

instruments

intraosseous bone drills.

Procedure use of rubber dam, anesthesia

40mm

 Removal of the incisal third to half of clinical crown to

allow access to pulp chamber and root canal.
Preparation is to 2-3mm beyond the apex (minimum
size no 60 Reamer)
Bone is prepared with no 60 file 5-10mm beyond the
apex.
Implant is cemented with help of root canal sealer.

Contraindications
Periodontal pocket extends to the apex of involved
tooth.
Less than 2mm of bone support remains around the
root.
Anatomic structures like the maxillary sinus, mares,
mandibular canal and mental foramen cannot be avoided
by the implant.
When the tooth is included in such a manner that
implant would penetrate the cortical plate.
Overdentures for congenital and acquired defects

Many patients with congenital and acquired defects

cannot be treated successfully by orthodontic therapy or
surgical intervention.
Congenital defects
The cleft palate
Oligodontia
Microdontia
Dentiongenesis imperfecta
Acquired defects
Accidents
Misuse
Oral cancer
Procedure
Impressions are made of both the arches using stock
trays and irreversible hydrocolloid.
The cast placed on the surveyor to determine the path of
insertion.
Undesirable undercuts are blocked out.

 Base plates are made using autopolymerizing resin by

sprinkle on method.
Maxillomandibular relationship record made by tactile
method.
The teeth of proper mold and shade are selected and
ground on the lingual aspect to overlay the existing
teeth.
The

dentures

are

waxed

and

processed

in

the

conventional manner.
Transitional overdentures (Interim over denture)
It made from an existing removable partial denture, the
patients own teeth or both.
An existing removable partial denture is most common
indication for an interim over denture.
Procedure
Endodontic therapy is completed before modifying teeth
or the removable partial denture.

 Evaluate the existing removable partial denture and

natural crowns to ensure that they have adequate
strength.
Make an index that relates all crowns to the occlusal
surface of the removable partial denture.
Chair side procedures
Prepare the retained teeth. Remove each crown in on
piece and save it.
Make an alginate important with removable partial
denture in the mouth.
Laboratory procedures
Remove the roots of extracted teeth and prepared
retention

holes

in

the

crown

that

they

can

be

mechanically retained.
Cut off the stone teeth on the cast and relate the
removable partial denture to the cast add the necessary
teeth using the occlusal index by sprinkle on method.
Post insertion care
Oral hygiene instruction

 Regular visits for maintenance

Advantages
Less costly
Patient experience with overdenture usually allows
smooth transition to over denture status.

Disadvantages
Border extension, esthetics, occlusion, support and
stability of removable partial denture are unsatisfactory
often many years of use.
Use autopolymer resin results in weaker over denture.
Immediate overdentures
An

immediate

over

denture

is

an

over

denture

constructed for insertion immediately after the removal of

natural teeth.
Abutment selection

 Pretreatment recordedmeasurement made from the

gingival margin of an abutment to the tooth in the
opposing arch when the jaws are closed.
Treatment planning
If the arch contains large number of hopeless teeth, the
post hopeless teeth are removed in increments at least 6
weeks are allowed for healing before imp. Hopeless anterior
teeth are retained for esthetic prerequisite endodontic and
periodontic treatment can be completed in healing period.
Impressions
1 s t method
Algimate implant is made. Cast is poured custom tray
is constructed on the cast over the teeth and residual ridges.
It used in making final imp with alginate or rubber base.
2 nd method
Custom tray is fabricated on the edentulous portion of
cast, border moulded imp made with Zinc oxide eugenol.
This imp replaced in mouth and alginate irreversible
hydrocolloid imp made.

 Jaw relations not enough teeth present for orienting

casts base plates are fabricated to facilitate jaw
relationships.
Selecting and positioning of teeth by removing one
teeth on the cast and substituting the corresponding the
replacement for compression all teeth are removed
except the abutment.
Abutment is prepared on the cast to 3-4mm in height
and axial surfaces are tapered.
The reduction in the cast should be more than that
anticipated tooth.
Waxing and flasking conventional denture
Finishing and polishing
Placing the over denture
Abutment preparation it is made smaller than that
made on cast for easy placement of the over denture.
Amalgam restoration are placed in occlusal or insical
surface to seal the root canal.

 Fluoride application 2-1minture application of APF

gel followed, 2-1minute application of 0.4% stannous
fluoride.
Surgical

procedures

extension,

frecnectomy,

tuberosity, reduction, undercut correction etc., - sutures

placed.
Insertion

of

overdentures

provides

excellent

protection for surgery side sutures removed in 3 5

days.
Adapting overdentures to abutment
Abutment teeth should be polished before adapting the
over dentures.
Definite circumferential margin is made around each
indentations.
Autopolymerizing resin is placed in the abutment
indention the abutment is well lubricated and vent is
placed for the excess to flow out and the denture is

placed in the mouth until initial set then placed in warm

water.
Post insertion care
Oral hygiene instruction
Bubble gum therapy after a week 30-60 minutes a
day over denture hygiene.
Advantages
It provides ample opportunity to evaluate the response
of the abutments and supporting tissues.
Disadvantages
Made form conventional denture resins are not as
strong as metal castings prone to breakage.
Remote over dentures
Remote overdentures are placed over well healed
residual ridges, usually after a period of satisfactory
experience with an interim overdenture.
Metal bases are frequently used.
Abutment copings

Preparation of teeth to serve as abutments results in

exposure of considerable amount of dentin. Coping provides
some protection against caries. Copings also pressure
abutment contours which can be modified.
Improper brushing
Bruxisim

Preparation of abutment
The incisal or occlusal surface of coping is convex
(Miller 1958).
Provides a rounded contact between coping and metal
base.
Endodontic,

periodontic

and

surgical

procedures

completed before preparation.

The clinical crown should be reduced 2.3mm above
gingival margin.
Sufficient reduction allows placement of an artificial
tooth similar in size and shape of natural tooth.
Long gingival level placed at gingival crevice.

 Short dowel is placed in prepared root and for retention

(57mm)
A parallel tapered groove is placed on the buccal or
lingual

surface

of

canal

preparation

to

contour

rotational force.
The entrance of canal preparation is beveled to
eliminate sharp edges.
Wax patterns
Contour of coping is described as Hemispheric
rounded occlusally and incisally. Wax on occlusal surface
and incisal surface in copings are prepared with type III
gold.
Impressions (broader molding and rubber base) are
made with newly prepared coping.
Tooth selection and positioning
The resin teeth for the abutment are selected hollowed
with a bur and positioned over the abutments.

 Opaquing the metal base pink color to part of denture

base to covered by base resin.
The

metal

base

cemented

to

the

cast

jined

oxyphosphate. Packing the over denture and finishing

and polishing.
Advantages
Inherently stronger
Resist

dimensional

changes

associated

with

polymerization of denture resins.

Metal base is excellent for jaw relation procedures.
Dentures supporting tissues respond more favorably.
Disadvantages
Relining presents more technical problems
More time consuming additional laboratory and
clinical procedures
JAW RELATION RECORDS
Functionally generated path technique (Meyer, 1959)
Maxillary dentures opposed by natural dentin.

 The opposing arch is restored first with fixed or

removable partial denture.
Making the compound rim
The black imp compound, is used to form occlusal rim.
The compound rim sealed to resin base plate to prevent
separation.
The compound rim softened by flaming.
The mandible stone teeth lubricated and articulator
closed to form distinct indentations.
The compound rim cooled, remove the compound on
each side of the ridge formed by the central fossa.
Compound removed on the anterior position (1 2mm).

Recording cuspal path

After cuspal path wax added to compound rim, patient
asked instructed to execute centric closures, as well as
protrusive, right and left lateral movements.
Procedures condt until smooth cuspal path is exhibited.
Pouring the path.

 The base plate and path rinsed thoroughly in cool water,

placed on cast, sealed with wax and remounted in
articulator.
Then cuspal path is boxed stone poured and mounted to
lower low of the articulator.
Adapting denture teeth to the core
The waxed denture teeth is replaced on the cast and
adapted to the core by using thin articulator stripe as an
indicator.
Over dentures constructed by this technique exhibit
excellent functional harmony.
Centric check point procedure
Effective method to verify accuracy of jaw relation
records (Brewer 1963). Technique is predicted only in case
of stable, well adapted base plates.
Procedure
Casts mounted on articulator in centric relation.

 The centric check points are attached to the base plates

by removing all traces of occlusion rim.
Set of centric check points consists of
- three short point
- three long points
- three med points
- three short cups
- three long cups
- wrench
Centric check point is assembled with long cup onto the
short point. The long point is screwed into the float end
of the long cup med point is used if the inter arch space
is nor sufficient.
One is placed in the midline and other in the molar
area. They are slanted slightly toward so that the points
are in line with arch of closure.

 Short point is attached to max base plate long point to

mand base plate with imp compound.
Each cup is then rotated with wrench until the short
point is freed articulator opened each cup rotated off.
Then base plate is removed from the articulator and
placed in the patient mouth and centric relation is
checked if the tips of the point should coincide it is
certain that the mandible is in centric relation.
Post insertion care
Oral hygiene instructions
Chair side advice is soon forgotten written instruction
best. Remove the denture before the retire at nite.
Recommended 1968 academy of denture prosthetics.
Readymade fluoride gel carrier.
Disclosing tablets
Care of abutment
Patients who lack agility.
Child tooth brush easy to gain assess

 Soft webless rubber polishing cup

Over denture hygiene
Removing after each meal with soft brush and ordinary
hand soap.
At nite removed and kept in denture cleansing solution.
Small ultrasonic denture cleaner available.
Complications
1. Caries because of recession
2. Inadequate

oral

hygiene

symptoms

of

severe

periodontal disease will be present.

3. Lack of regular examination More imp in overdenture
patient than in any other phase of prosthodontics.
4. Break age weak because of indutations
5. Incorrect abutment tooth high insufficiently reduced
mobility and discomfort evident, over reduced less
stability, proliferation of soft tissue.
Advantages
Equally effective or superior method of treatment.

- Better

service

than

alternative

method

of

treatment.
- Useful in patient congenital abnormalities and
class III not amenable to surgical or orthodontic
procedure.
- Restore occlusion and improve esthetics by proper
positioning.
- Patient has few remaining teeth which adequately
supported by bone.
Simplicity of construction.
- Some conventional CP
Ease of maintenance
Stability comparable to fixed partial denture
Retention Because better stability
Open palate possible
Excellent patient acceptance Because knowledge that
he still has his own teeth.

 Less trauma to supporting tissues Avoid resorption as

CP
Stabilization of existing structures as no resorption
vertical dimensions and lip and face maintained.