8660  Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No.

Over-Dentures and Attachments: A Review of Literature

Rasmita Kumari Samantaray1, Krishna Nanda1, Debashish Sahoo1

1
Post Graduate Trainees, Department of Prosthodontics and Crown & Bridge, Institute Of Dental Sciences,
Siksha O Anusandhan (Deemed to be Univerisity), Bhubaneswar, Odisha, India

Abstract
Tooth-retained overdentures are a simple and cost-effective treatment than the implant-supported
overdentures. When few teeth are present which are periodontally strong can be used as abutments for
overdenture fabrication. This helps in the retention and stability of the final prosthesis. The extraction of
teeth results in bone resorption, so preserving them as an abutment can not only provide retention and
stability to the denture but also prevents bone loss and provide proprioception. Above all, “it gives the
patient the satisfaction of having prosthesis with his natural teeth still present”.

Keywords:  Tooth Supported Denture,Implant Retained Denture,Overlay Prosthesis.

Introduction conventional complete dentures, while there was an

insignificant difference in comparative masticatory
An Overdenture is a “dental prosthesis that covers
efficiency between tooth-supported overdentures and
the natural tooth and or is partially supported by natural
implant-supported overdentures”2.
teeth, natural tooth roots or dental implants”. According
to GPT 10, “overdenture is a partial or complete denture Crown and Rooney 1975 in their study found that
that covers and rests on one or more remaining natural “retention of mandibular canine for overdenture led to
teeth, roots and/or dental implants; a dental prosthesis preservation of alveolar bone”2.
that covers and is partially supported by natural teeth,
tooth roots, and/or dental implants”. It is also called as Indications for Overdentures:1
“overlay denture, overlay prosthesis and superimposed 1. For better support in morphologically compromised
prosthesis.16 dental arches.
Preventive prosthodontics “emphasizes the 2. Cleft palate cases and congenital anomaly cases
importance of any procedure that can delay or eliminate like microdontia, amelogenesis imperfecta,
future prosthodontic problems and overdenture is an dentinogenesis imperfecta, and partial anodontia.
important part of the preventive treatment modality”.
3. Dentures patients with maxillofacial trauma.
De-Van’s golden statement: “Perpetual preservation
of what remains is more important than the meticulous 4. Patients with worn-out dentition.
replacement of what is missing” still rings true7. 5. Patients with abnormal jaw size and position where
Tooth supported overdentures have various orthognathic surgery is contraindicated.
advantages over conventional complete dentures such as General Considerations during Diagnosis and
maintenance of alveolar bone maintenance, periodontal Treatment Planning for an Over-Denture1,2,4:
proprioception is preserved, improves retention,
stability and support,enhances psychological comfort 1. Maintenance of Periodontal Health: Once an
and increased mastication efficacy.4 overdenture is planned and constructed, the patient
must maintain his teeth free from plaque. The
Chen et al. “observed that the patients treated with dentist should check for pocket formation around
tooth-supported overdentures had significantly more the abutments periodically and failing may lead to
comparative masticatory efficiency than those with the loss of abutment tooth.
 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4  8661
2. Reduction in Crown-root Ratio: Reduction in the supporting tissues of the overdenture abutments
crown size during preparation can be beneficial for and Improper maintenance of the overdenture may
the tooth, as it “reduces the crown-root ratio” and lead to periodontal breakdown of the overdenture
“decreases the leverage forces acting on the tooth”. abutments and the patient may lose all his remaining
teeth.
3. Success of Endodontic Therapy: Endodontic therapy
may be necessary for most abutment teeth because 4. More costly than conventional dentures because:
they need extensive crown reduction. A two-to-four
(a) Root canal therapy and coronal restorations may
week interval should be provided after completion
be needed for certain overdenture abutments.
of root canal therapy to determine the success.
(b) Most cases need a cast metal denture base, as
4. Number of overdenture abutment teeth: “Two
acrylic is weaker.
Abutments On Opposing Sides Of The Arch
Particularly In The Canine Regions Will Provide 5. Additional designing and laboratory work is needed.
Excellent Results”. Four Widely separated 6. Cannot be used in cases with reduced interarch
Abutments Are Even Better. space, bony undercuts adjacent to the abutments,
5. Adaptation and Coverage of Denture-Bearing Area: etc.
The denture base should be well adapted to the soft Abutment Preparation1: The preparation of
tissues to prevent accumulation of food debris and abutment teeth is one of the keys to the construction
to evenly distribute the force acting on the denture. of overdenture. Assuming the periodontal status to be
6. Design of the Denture: As the denture base for good, the operator has three choices:-
overdentures are thin, they have to be reinforced
1. Preparation just above the mucosal level.
with metal. At the same time they should be easy to
fabricate and maintain. • The bare root face approach.
7. Ease of Use: The patient should be able to easily • The dome-shaped gold coping.
insert and remove the denture without any harm to
2. The use of attachments.
the denture base or the abutment tooth.
3. The thimble-shaped coping.
Advantages of Overdentures:3
The Bare Root Face Approach1: The occlusal
1. Maintains the integrity of the ridge.
section is obturated with glass ionomer or silver
2. Improves the “retention and stability” of the denture. amalgam. It is normally employed for immediate
insertion prosthesis. On later stages coping can be given
3. Improved proprioception leads to better
the crown of abutment is reduced to a height of 2-3 mm.
neuromuscular control. This helps in regulating the
the abutment tooth is endodontically treated the occlusal
biting force over the denture.
surface is to be contoured to smooth or polished dome-
4. The psychological effect on the patient as extraction shaped surface. This will minimize lateral occlusal
can be avoided. stress. It offers following advantages-
5. If there is abutment failure, the abutments can be 1. “It is the simplest,cheapest and least space-
extracted and the overdenture can be relined and consuming”.
used as a conventional complete denture.
2. “It is ideal during maturation of edentulous ridge”of
Disadvantages of Overdentures:2 a recently extracted case.
1. Nutritional counseling, oral hygiene measures, 3. It should be replaced by an coping with precious or
and fluoride application should be carried out semi-precious metal otherwise there is a chance of
periodically. vertical longitudinal root fracture.
2. “High incidence of caries and periodontal disease 4. Contraindications:
around the overdenture abutments”.
5. It should not be used for a long period where a
3. Frequent reviews are needed to verify the health of natural tooth is opposing the overdenture.
8662  Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4
6. Leaving it as such may lead to longitudinal root Based on the method of abutment preparation:
fracture.
1. Coping
The Dome Shaped Copings1: The Abutment Tooth
2. Noncoping – with simple tooth modification
Is root canal Treated And Reduced To A Height Of
2-3mm and Post Space Is Created. Dome Shaped Cast 3. Attachments
Metal Copings 2-3 Mm In Height With Chamfer Finish 4. Submerged vital roots: Effective in preserving
Line And Post Are Fabricated And Cemented. Coping alveolar bone
Should Be Atleast 1 Mm Thick To Withstand Occlusal
Forces. Based on length of coping:
1. “Short coping – 23 mm long and normally require
Thimble shaped coping1: These are 5-8mm in
endodontic therapy”.
height and need considerable space. These copings
can be used to support the telescopic crown to enhance 2. “Long coping – 58 mm long, an attempt is made
retention. The chamfer finish line is given in the prepared to circumvent endodontic therapy by conservative
abutment. reduction”.

Basic Principles to be followed1,5: The abutment Abutment with attachment–“Most of the attachments
teeth must be surrounded with healthy periodontal tissue. are secured to the abutment by a cast coping. The
objective of attachment is to improve the retention of
1. Maximum reduction of the crown to attain a better denture”.
crown-root ratio and avoid interference during the
placement of artificial teeth. Endodontic therapy Attachments Used In tooth/root/Implant
may be done if needed. A simple tooth preparation supported Overdenture:
without any internal attachments can be done in a
Definition: “A mechanical device for the fixation,
single visit. This can be done for elderly patients and
retention and stabilization of a prosthesis,a retainer
medically compromised patients. It is less expensive
consisting of a metal receptacle and a closely fitting part;
than copings.
the former (the female matrix component) is usually
2. Gold copings or crowns and sleeve coping retainers contained within the normal or expanded contours of
can be given for grossly destructed abutments after the crown of the abutment tooth and the latter (the male
assessing the patient’s susceptibility to caries. Gold matrix component), is attached to a pontic or the denture
or metal coping can be prepared with posts and framework”.16
retentive pins after evaluating the amount of tooth
structure above the gingival attachment. The attachments used for overdenture can be
classified as1,9:
3. Attachments are added to the cast copings for
additional retention. These attachments may be Stud attachment
resilient or non-resilient types.
Bar attachments
4. Regular reviews and periodontal evaluation of
abutment teeth should be done. Magnetic attachments

Types of Overdenture:1 Requirements of Attachments:

Two types: • Patients should have a low caries index.

• Sound periodontal health.
Tooth supported overdenture
• The vertical space should be sufficient enough to
Implant-supported overdenture accommodate the attachment and denture teeth.
Heartwell’s classification for tooth-supported Disadvantages of Attachments:
overdenture
• Time-consuming and expensive.
• Difficulty in construction as well as repair is difficult.
 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4  8663
• Require careful use by the Patient. So not Rotherman System-
recommended for mentally and physically
handicapped patients. • The male part consists of a groove.

Stud attachment1,9,15: • The female part is c shaped ring that fits in the
deeper part of retaining groove.
It is the simplest of all types of attachments.
• The attachment looks like a press button with a
Stud attachments can be divided into two groups: groove.
• The female unit is clip with open end.
1. The Extra Radicular: “The Stud” (Male part)
usually attached to metal coping cemented over Locator attachment-
the prepared abutment and it projects from the
root surface of the preparation. The female part • The locator attachment system is an attachment
is attached to the denture. Attachment of male system with a self-aligning feature and has dual
component to female component provides retention. retention (inner and outer).
The male parts are available as: • Locator attachments come in different colors (white,
a. Prefabricated Metal Posts-Cemented Directly To pink and blue)
The Root. • “Extended range attachments, which can be used to
b. Prefabricated Resin Patterns- Which Is Cast And correct implant angulation up to 20 degrees they are
Cemented To The Root. offered in green, which has standard retention, and
red, which has extra-light retention”.
The female component is also termed as retentive
anchor and made in metal or plastic and is in the form Gerber Attachment: Readily replaced male or
of an o ring or matrix. Eg-CEKA, ORS-OD, DALBOS, female attachment Which can be replaced if they are
SERIES, GERBER, LOCATOR ATTACHMENT AND worn out.
ROTHERMAN. The spring-clip of the female part engages in the
Ceka Attachment: peripheral groove in the male.

The male part is round and composed of titanium. Other extraarticular attachment systems used
are:
The female part is replaceable plastic part that is
flexible And compressible. (a) The Ancro fix attachment
(b) The Introfix attachment
O Ring Series System: O-rings are “doughnut-
shaped, synthetic polymer gaskets that possess the (c) Quinlivan attachment
ability to bend with resistance and then return to their (d) Schubiger Attachment
approximate original shape”.
2. The Intra Radicular Attachment: “The Stud”(Male
Parts of an O-Ring Attachment-metal encapsulator,o element) forms part of the denture base and engages
ring post, and o ring which is available in 3 different a specially produced depression(housing or female
sizes. part) within the root contour. This attachment is
indicated in situations with reduced interocclusal
Dalbos Series Attachment System:
space.
• It is the most popular stud attachment with a long
Eg-Logic,Zest attachment,ERA attachment
life.
• It is available in two designs- ball and socket dalbo Zest Anchor System:
& rigid dalbo. The female sleeve is cemented in the post space.
• It is available in spherical and cylindrical forms.
Male portion consists of nylon.
• The ball and socket dalbo is the smallest of 4mm
height and easy to clean and maintain. ERA system: Resilient attachment system with
8664  Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4
color-coding resin unit providing various degrees of Dolder Bar:
retention.
It is named after swiss prosthodontist Eugene j
Universal hinge with vertical movement. dolder.

Metal jacket which holds the male attachments. The bar is straight and is rounded at the top. The
Sleeves that fit over the bargain retention by friction
Bar Attachment: It consists of a bar spanning only.
an edentulous area joining copings on the roots of the
abutment teeth on either side of the arch. The bar is available in various sizes and when cross-
sectionally viewed appears to be pear-shaped. The clip
Sleeves and clips placed in the denture attach to the which is fitted in the denture base allows some rotational
bar when the denture is inserted,providing retention. movement.
The bar splints the abutment teeth and thus It is available in sizes in diameter of 1.6 and 2.2 mm.
distributes the forces.
Ackermann and CM bar
This type of bar attachment requires vertical and
buccolingual space. These bars are round when viewed in cross-section.

Oral hygiene maintenance is very much essential As they are round they offer some resiliency and can
otherwise may lead to abutment loss. be bent in all directions.

It can be a bar joint or bar unit. A short extension of 5 mm is carried behind the most
distal root and the sleeve is positioned on this section.
Depending on the number it can be a single bar or
multiple bars. Sleeves or clips are made up of gold.

Depending on movement it can be a bar unit that Available in 1.8 mm diameter in plastic and gold.
provides no movement and is made up of solid rigid
material or bar joint which permits rotational movement The CM bar is available in a 1.9 mm diameter and
between bar and sleeve and thus made up of resilient used in long-span cases.
material. Magnetic Attachments1,3,8
Hader Bar: Magnetic attachment consists of keeper and denture
It is named after the swiss tool and die technician retention element.
“Helmut hader”. The keeper is made up of stainless steel and is
It is a rigid bar connecting two or more attachments. cemented to the abutment teeth.

When viewed from the cross-section it appears a The “denture retention element” consists of”
keyhole consisting of a rectangular bar with a rounded paired,cylindrical magnets” made of cobalt-samarium
superior ridge that creates a retentive undercut for the with opposite poles placed adjacent to each other.
female clip within the removable prosthesis. One end in the denture with knurled housing which
The bar provides mechanical retention and the round fits into the denture and other ends which is smooth fits
part makes the bar resilient type and thus some amount on the keeper.
of movement is seen in this attachment. The retention principle is due to the mutual attraction
The sleeves which are available commercially in of unlike poles.during dislodging forces, the magnetic
plastic form can be cast and converted to metal if extra forces reseat the denture.
retention is required. Advantages of magnetic attachment: No path of
insertion, No specialized casting or instruments required,
No paralleling of abutment.
 Indian Journal of Forensic Medicine & Toxicology, October-December 2020, Vol. 14, No. 4  8665
Automatic reseating, Ease of repair and relining, International Journal of Oral & Maxillofacial
Minimum forces are transmitted to roots. Implants. 1998 Mar 1;13(2).
5. Nallaswamy D:Textbook of prosthodontics. JP
Disadvantages: Alloy and corrode and fracture
Medical Ltd; 2017 Sep 30.
leading to loss of magnetism with loss of retention and
thus need for constant replacement. 6. Fontijn-Tekamp FA, Slagter AP, Van Der Bilt A,
Van’T Hof MA, Witter DJ, Kalk W, Jansen JA:
Discussion Biting and chewing in overdentures, full dentures,
and natural dentitions. Journal of dental research.
Tooth & implant-supported over-dentures are a
2000 Jul;79(7):1519-24.
“step in the direction of preventive prosthodontics”.
They Preserve the residual ridge, provide support and 7. Mehta S, Kumar M, Bansal A, Batra R, Sharma C,
stabilization to the denture base, and thus gives the Verma S:Prosthodontic Rehabilitation of a Case with
patient a sense of security in knowing that teeth aid Overlay Denture: A Case Report. Dental Journal of
in support of their prosthesis. The maxillary overlay Advance Studies. 2018 Dec;6(02/03):134-6.
denture is of great value when it opposes remaining 8. Kumari S, Banerjee S, Varshney N, Kumar S,
mandibular anterior teeth because it aids in conserving Kumar M, Issar G:A Full Mouth Rehabilitation
the ridge against resorption from “masticatory stress”4’. with Maxillary Immediate Denture & Mandibular
The greatest difficulty is the use of attachmentsbecause Tooth Supported Magnet Retained Over-denture:
of their “complex design”. A thorough understanding of A Case Report. International Journal of Research
the case and knowledge about the various attachments and Reports in Dentistry. 2019 Mar 12:1-5.
and its applications and limitations is a must to apply 9. Hartwell CM Jr, Rahn AO:Syllabus of Complete
clinically. Denture-4 the ed-Philadelphia: Lee and Febiger,
1986.
Conclusion 10. Crum RJ, Rooney Jr GE: Alveolar bone loss
Overdenture helps reduce shrinkage of surrounding in overdentures: a 5-year study. The Journal of
bone and reduces pressure on the alveolar ridge. In prosthetic dentistry. 1978 Dec 1;40(6):610-3.
the case of an overdenture prosthesis, “proprioception 11. Sadowsky SJ. Mandibular implant-retained
is maintained” there is the presence of “directional overdentures: A literature review. The Journal of
sensitivity; dimensional discrimination; canine response prosthetic dentistry. 2001 Nov 1;86(5):468-73.
and tactile sensitivity”1,14.
12. Awad MA, Lund JP, Shapiro SH, Locker D,
Funding Statement: None Klemetti E, Chehade A, Savard A, Feine JS:Oral
health status and treatment satisfaction with
Conflict of Interest: None mandibular implant overdentures and conventional
dentures: a randomized clinical trial in a senior
Ethical Permission: Approved
population. International Journal of Prosthodontics.
2003 Jul 1;16(4).
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