Overdenture
Overdenture
Overdenture
INTRODUCTION:
2
DEFINITION:
G P T 1999,
4
History
The overdenture prosthesis constructed over
existing teeth or tooth structure is not a new
concept in a technical approach to a prosthodontic
problem. Its use dates back over 100 years.
In 1861, Barker reported on the proceedings of the
American Dental convention in New Haven,
Connecticut. Dr. Butler, Dr. Roberts, Dr. Atkinson,
Dr. Sutton and Dr. Hayes participated in a
symposium entitled – “Surgical preparation of the
mouth for artificial dentures – should the roots
would enable fabrication of complete dentures
superior to that obtained after extraction of all
roots. Hayes reported the results of fabricating a
complete denture over two roots in the maxillary
5 arches and 12 years later, they were still in place
Since that convention, many more than hundred
journal articles on the retention of roots/teeth to
support a complete denture have appeared.
In 1945, Black of Louisville, Kentucky provided
complete denture for a 14-year old girl with a
congenital absence of the permanent teeth. Four
maxillary and four mandibular teeth were retained
and crowns were fitted to the molars. In 1972, 27
years later the mandibular deciduous molars were
still intact supporting a complete mandibular
overdenture.
During the Second World War, many dentists in
a military service used overdentures in the treatment
of inadequate or mutilated dentitions. Boos reported
6
such a treatment in the July 1948 issue of the Dental
Digest.
In 1952, the article by Rehn advocated the
retention of a single front tooth for denture
support.
In 1958, Miller reported that retention of a
few teeth under complete dentures allowed the
weak teeth to regain healthy status. This
foresight was of prime importance in convincing
the profession that the overdenture was a
superior treatment modality. In 1969, Lord and
Teel reported 7 years of successful treatment
with overdentures.
7
The Gerber series of root cap attachments was
developed in 1954 and for 20 years, clinically
successful hybrid prosthesis have been fabricated
with the Gerber attachments.
As new materials and products such as plastic
tooth material, soft liners, fluorides were introduced,
the potential for this type of treatment increased
materially. Methods were simplified and at present
overdenture, treatment can be provided at a little
additional cost over the conventional complete
denture.
8
RATIONALE OF OVERDENTURES:
11
Kawamura (1964), Grossman (1964), and
Grossman and associates (1965) agreed that
the sensitivity in the anterior part of the mouth,
particularly the periodontal ligament of the
anterior teeth, tongue tip, and mucosa, was
acute.
There is a greater concentration of sensory
receptors in the anterior part of the mouth
(Kawamura, 1964), and these signals from the
periodontal and mucosal receptors are
important in controlling and determining biting
force.
12
2. DIMENSIONAL PERCEPTION:
13
3. CANINE RESPONSE:
14
4. DIRECTIONAL SENSITIVITY
16
6. PERCEPTION OF NONVITAL TEETH:
18
Advantages of overdentures
Equally effective and superior method of
treatment: In many situations, overdenture gives
better service than alternative methods of treatment,
especially in patients with congenital defects
(oligodontia, microdontia, cleft palate etc.) and for class
III patients with a prognathic jaw not amenable to
surgical an orthodontic treatment.
Maintenance problems:
• Copings may become loose
• Attachment wear, loss and breakage
•Alveolar ridge resorption
• Overdenture breakage
• Oral hygiene problems
28
Indications:
Younger the patient greater the indication
In situations where retention is difficult to
obtain
a. Xerostomia
b. Absence of alveolar residual ridge
c. Loss of maxilla or partial loss of
mandible
d. Congenital deformity (i.e. Cleft palate)
For patients with poor prognosis for complete
dentures
a. High palatal vault and ridge slope
b. Poorly defined sublingual fold space
c. In class III tongue patients
29
d. Knife edge ridge
When pronounced vertical overlap is required to
produce the desired esthetic result.
31
Contraindications for periodontally involved teeth
• Class III Mobility
• Uncorrectable soft tissue and osseous
defects
• Failure to establish sufficient zone of
attached gingiva
36
TREATMENT PLANNING:
The patient who has only few retainable natural
teeth may present difficult treatment questions for the
dentist. Johnston and associates (1965) stated that “a
bridge is indicated whenever there are properly
distributed and healthy teeth to serve as abutments,
provided these have suitable crown-root ratio and that
after radiographic, diagnostic cast and oral
examinations seem capable of sustaining the
additional load. When indicated, fixed partial dentures
are treatment of choice. A few retainable teeth
generally are scattered throughout the arch, and
invariably they are involved periodontally with
unfavorable crown-root ratios, the overdenture option
37 should be considered.
The treatment planning include evaluation of all
potential abutments for:
• Periodontal status
• Endodontic status
• Caries management
• Positional considerations
• Economics
38
PERIODONTAL STATUS:
39
Extreme oral neglect
Periodontal probing
40
Periodontal surgery
Splinting done
41
A common periodontal requisite with overdenture
abutment teeth is that an adequate zone of
attached gingival is mandatory. This can be
accomplished with periodontal surgery utilizing
either a free gingival graft or apically repositioning
split thickness flap. This results in a band of
attached gingiva adjacent to abutment tooth. It
should be understood that reduction of clinical
crown-root ratio will be favorable in reducing any
existing mobility.
42
ENDODONTIC CONSIDERATIONS:
43
CARIES MANAGEMENT:
44
POSITIONAL CONSIDERATIONS:
ECONOMICS:
Endodontic treatment, cast copings, attachments and
overdenture itself may workout expensive, so
economics of the patient should be considered.
47
Types of over dentures
I. Overdentures for congenital and acquired defects:
Many patients with congenital and acquired defects
cannot be treated successfully with orthodontic or
surgical therapy, nor can they be treated with
conventional procedures – either fixed or removable.
However there has been a high degree of success in
treating these patients with complete dentures over
their existing teeth. The congenital defects most
frequently treated with over dentures are:
Cleft palate
Microdontia
Oligodontia
Cleidocranial dystosis
Class III patients with prognathic mandible.
48
The acquired defects most frequently treated by this
usually results from accidents, disease or misuse.
Oligodontia
49
Class III Patient with missing teeth
50
Patient with eroded teeth
51
II. Transitional overdentures:
52
53
Advantages:
1. Less expensive
2. Smooth transition
3. Minimal interference with function and appearance
Disadvantages
1. Border extension, esthetics, occlusion, support and
stability of the R.P.D. often are inadequate,
particularly after many years of use, making
satisfactory conversion difficult.
2. Weaker overdenture
3. Therefore, the converted prosthesis is considered as
interim or temporary overdenture, to be replaced
54
after a suitable transitional period.
Conversion using patient’s teeth
The patient derives a tremendous psychological
boost by having his teeth removed, but leaving
with them still in his mouth; even through they are
in an overdentures. This is a more economical
method.
Pre op view
55
Posterior teeth arranged and
tooth to be retained is
prepared
56
Hollow ground Canines placed
57
Canines are reduced
58
1.Denture base ready 2. Stone matrix placed
3. Prepared teeth 4. Teeth joined
59
Completed Transitional overdenture
60
III. Immediate overdentures
An immediate overdenture is an overdenture
constructed for insertion immediately after the removal
of natural teeth. It may be used as an interim
prosthesis. The immediate overdenture enables a
dentist to use a simplified construction technique that
allows flexibility in planning treatments as requirements
change. Many times with good oral hygiene and
regular professional supervision an immediate
overdenture may have a long life. Sometimes, it can
be a prognostic aid before a more comprehensive
overdenture procedure. If prognosis is poor and
response to treatment is poor and immediate denture
can be converted into a serviceable complete denture.
61
Impression tech no 1
62
Impression tech no 2
63
Impression tech no 3
64
Impression is examined
65
Occlusal records made
66
Casts secured on the articulator
67
Replacement teeth are
positioned
68
Canine Prepared
69
Resin tooth is hollow ground and placed
70
Tooth indexing is done
72
Tooth colored acrylic resin is sifted in the hollow
tooth
Overdentures are ready
73
Canines prepared and
remaining teeth extracted
Overdentures placed
74
Disclosing wax is used
75
Tooth colored
autopolymerizing resin is
used for final seating of
the overdenture
76
IV. Remote overdentures
A remote overdenture is an overdenture other
than transitional or immediate. It is usually
constructed for insertion at sometime remote
from the removal of hopeless natural teeth.
The remote overdenture usually placed on well
healed ridges usually after a period of
satisfactory experience with an interim
overdenture which may be transitional or
immediate. Although remote overdentures can
be entirely constructed of resin, metal bases
are frequently used.
77
Metal base overdentures:
A metal base overdenture is complete denture
with a cast metal base that is supported and
stabilized by selected natural teeth with contours
that are modified for the purpose by preparation
and placement of copings.
78
Metal base Overdenture
79
V. Removable partial denture:
A superior removable partial overdenture can
be made for may patients by reducing some
of the remaining teeth coronally so that the
prosthesis can be fabricated over them.
82
DOWEL DESIGNS
83
1.CUSTOMIZED CAST DOWELS
85
3.PREFABRICATED METAL DOWELS
Heartwell:
I . Noncoping
II. Coping
III.Attachments
I. NONCOPING OVERDENTURES:
Selected abutments are reduced to a coronal
height of 2 to 3 mm and then contoured to a
convex or dome shaped surface. Most teeth
require endodontic therapy followed by amalgam
88
or composite restoration.
II.COPING OVERDENTURES:
Coping Types
A coping fitted to a prepared abutment is called a
primary coping. The sleeve, or coping, that fits
over this primary coping is referred to as a
secondary coping.
There are four basic types of primary copings:
1. Long copings (6-8 mm).
2. Medium copings (4-6mm).
3. Medium-short copings (2-4 mm).
4. Short copings (1-2 mm).
89
1. Long Copings (6-8 millimeters for vital teeth):
The long coping is an excellent restoration,
applicable to many overlay techniques. It may be
used simply to provide stability and retention under
a telescopic overdenture.
90
2. Medium Copings (4-6 millimeters for vital and
non-vital teeth):
Medium copings
92
With bar attachments To engage plunger
Studs cantilevered
93
3. Medium short copings (2-4 mm for nonvital
teeth):
Medium short copings are indicated for nonvital teeth;
where a more favorable crown root ratio is desired than that
possible with medium or long copings. This coping form
(and preparation) is indicated when: it is difficult to obtain
auxiliary retention of the coping on the abutment with a
dowel or parallel pins (the proximal walls of the preparation
should be very closely parallel for maximum frictional fit of
the coping); numerous neighboring abutments are to be
splinted, thus permitting better embrasure formation than
possible with very short copings; used with bar
attachments.
94
4. Short Copings (1-2 millimeters for non-vital
teeth):
Short copings are fabricated to conform to the
curvature of the alveolar ridge, with a very low profile.
They are indicated for maximum favorable crown-
root ratio. Such short copings are particularly suited
to various types of stud attachments, but may also be
used effectively with many forms of bar attachments.
95
The best possible coping for a specific abutment
depends on the amount of alveolar support, whether or
not the abutment is vital, and the function of the coping.
Coping Form and Portion of Root Supported by
Bone
112 or less 112 112 or more
Medium Copings
Medium Copings
(where pulp
Vital Long Copings
receded)
96
III. Overdenture with Attachments:
97
ATTACHMENTS FOR OVERDENTURES
98
BASIC PROSTHETIC DESIGN
99
Availability of the proprioceptive elements in the
attachment retained overdenture permits use of
gnathologic procedures and, in some instances,
anterior disclusion of the posterior teeth as well
as the relevant instrumentation desired. Use of
the attachment introduces another factor in basic
prosthetic design, that is, the demand for an
exact attachment prosthesis relationship. For
each type of attachment the demand differs,
depending on the availability or desirability of
resiliency and the overall adaptation of the
denture base over the soft and hard tissues of
the denture bearing area.
100
TOOTH PREPARATION
Tooth preparation varies with the type of support to be
provided. If there is sufficient tooth structure, that is,
3- to 8 mm of clinical crown for lateral stability of the
overdenture, there are several methods of preparation.
101
The coping is waxed to a minimal occlusal
thickness of 1 mm with the exception of the bulk of
the inlay seat.
102
TELESCOPE CROWNS:
The telescope crown is a prosthodontic retainer for a
fixed or removable prosthesis and usually consists of the
conical preparations with a like casting and a secondary
telescope casting that is embedded in a prosthesis or is
an abutment or crown itself. It is a system used to
stabilize an overdenture where 4 mm or more of clinical
crown is available. The advantage of the telescope
crown or telescope preparation over the standard
overdenture is the increased stabilization and retention of
the denture while using remaining vital or nonvital teeth
without dowels or screws.
103
TELESCOPE OVERDENTURE:
104
Advantages:
1. Conserve the alveolar ridge
2. Provide support and often retention
3. Retains some natural proprioception
4. Emotionally accept the overdenture
5. Easy modification possible
6. Auxiliary retention devices can be added
7. Easy to master
8. Less expensive than attachment fixation
overdentures
Disadvantages:
1. Retention is fixed, and not variable
2. Retention must be modified frequently
3. The overdenture is bulky and less esthetic
4. Expensive than a conventional complete denture
105
A Telescopic Overdenture Treatment Procedure:
107
Preliminary endodontic
therapy was carried out
108
Hopeless tooth and roots
removed
Periodontal surgeries
carried out, interim
dentures are very
important at this stage
worn for 3 months
109
Tissues have healed and
matured final preparation of
tooth is done now
Copings cemented
113
A metal framework with
a horseshoe like major
connector was fabricated
on a refractory model
114
Completed overdenture
Secondary copings
115
A resin secondary coping of a telescoped
overdenture does have some advantages over a
metal secondary coping particularly where no
auxiliary retentive means are used. It is easier to
adjust the retention by adding autopolymerizing
resin to the previously relieved secondary
coping spaces and relining the coping spaces
directly in the mouth.
116
Relining and/or Rebasing
As the alveolar ridges resorb, the overdenture will begin
to rock and direct damaging lateral stresses to the
abutment teeth. Now the prosthesis must be adjusted for
a better fit by relining or rebasing. This is a simple
procedure and performed similar to any complete denture
relining or rebasing procedure:
1. Hollow out the secondary resin coping to provide
adequate room for the impression material; 2. Paint an
adhesive material on the denture base; 3. Load the tissue
area of the overdenture with an elastic impression
material; 4. Insert the overdenture in position and have
the patient close gently into occlusion as you muscle trim;
5. Now the overdenture is relined or rebased similar to
any complete denture technique and ready for use.
117
ATTACHMENTS:
Bar compared to stud fixation
The splinting of two or more teeth with a bar
produces stability similar to the rigid stud type
attachment when the overdenture is in place. The
question that arises immediately is: if the denture
base is so well developed that the bar serves only
as a fixation device, what is the difference in the
result of splinting obtained in the stud prosthesis
and in the bar prosthesis. Theoretically, there is no
difference, but the stud type allows independent
movement, and, if one tooth is especially weak, the
strong tooth can serve as the fulcrum point for
movement of the weaker tooth in the prosthesis.
118
With bar units and joints, many times the bar
splints in more than one plane. Instead of the
prosthesis moving one tooth, all or none move
under a functional load. With bar fixation, a
stronger and a weaker tooth can be splinted with
the result that the stronger tooth strengthens the
weaker tooth and the weaker tooth weakens the
stronger tooth. In making the overdenture; only the
stud, the bar, and some of the accessory
attachments are of interest.
119
ATTACHMENTS CAN BE CLASSIFIED
ACCORDING TO SHAPE, DESIGN,
AND PRIMARY AREA OF USE AS
FOLLOWS:
(Mensor)
Coronal
1. Intracoronal attachments
2. Extracoronal attachments
Radicular
3. Telescope stud attachments (pressure
buttons)
120
4. Bar attachments
a. Joints
Accessory
5. Auxiliary attachments
a. Screw units
b. Pawl connectors
c. Bolts
d. Stabilizers/balancers
e. Interlocks
f. Pins/screws
g. Rests
121
The various attachment systems have been organized in a
compendium known as the EM attachment selector, which
presents thirty points of information about each attachment
(Mensor, 1973). This selector and the EM gauge (Matsuo,
1970) provide a simple color code method of choosing
attachments from the mounted diagnostic casts.
122
STUD (PRESSURE BUTTON)
ATTACHMENTS:
Most of the stud-type attachments can be considered
to be "snap fasteners" and are the simplest in
concept. They can be resilient or non resilient.
123
RESILIENT STUDS
Resilient attachment systems are selected to perform
a compensatory service and to act as a safety valve
for any overload situation. No two resilient attachment
systems should oppose each other unless the
attachments in the maxillary prosthesis are locked out
of function, for the maxillary prosthesis receives
additional support from the palatal coverage. This
situation arises when two hybrid prostheses oppose
each other or a mandibular appliance opposes the
maxillary denture.
124
When the mandibular appliance opposes a natural
dentition, some provision should be made for
movement so that maximal tissue contact of the
denture base can be achieved under maximal load.
In the well developed denture base with careful
positioning of the attachments, the need for a
resilient system becomes questionable. No attempt
should be made at equilibrating or establishing
permanent records or relining procedures without
locking the resilient attachments out of function,
because the base would move and produce
incorrect markings of the interferences.
125
The retained root with an attachment offers
retention and positional or directional orientation
for the appliance. When there is either inadequate
technique or inability to develop a well fitting
denture base, the resilient attachment gives some
leeway to acceptance of the prosthesis by allowing
more base contact and support during function.
NONRESILIENT STUDS
The nonresilient stud attachments are used when
interocclusal space is limited. They should be used
when the teeth are stable or when the dentist does
not desire movement or potential movement of the
overdenture.
126
When to Use a Resilient Stud?
A resilient attachment permits the tissue to compress
slightly before any load is transmitted to the
abutment. It is usually preferred:
127
When to use a non Resilient stud Attachment ?
A non resilient attachment will not allow vertical
movement (however it may permit rotational
movement)
When no vertical movement is indicated.
When an all-tooth supported prosthesis is
desired.
When a tooth-tissue supported appliance is
desired.
With strong abutments having maximum bone
support (one-half or more).
When functioning against a resilient prosthesis
When a large, well-fitting denture base is possible.
When there is little interocclusal space
128
Opposite a complete denture.
Some Stud Attachments:
1. Dalla Bona
2. Intrafix
3. Ancrofix
4. Gerber
5. Gmur
6. Rotherman
7. Huser
8. Schubiger
9. Ceka
129
The Gerber Attachment
The Gerber stud system is a versatile stud attachment
used routinely. It consists of a male post soldered to
the coping and a retentive female secured within the
denture base of the overlay prostheses. The Gerber
attachment is furnished in two different types - a
resilient and non-resilient form.
130
Resilient Gerber Non resilient Gerber
The male post consists of two
parts - a threaded base,
which is soldered to the
diaphragm of a coping, and a
removable sleeve with a
retentive undercut
132
Step-by-Step Technique:
1. All treatments must start with a thorough oral
examination. This examination should include
patient history, visual examination, radiographs
and periodontal probe evaluation. Accurate study
casts mounted on an appropriate articulator are
also helpful.
2. A thorough oral prophylaxis and home care
instructions are completed before any other
treatment is performed.
3. Fabricate an interim overdenture on the diagnostic
casts for insertion after reduction of the clinical
crowns, endodontics, extractions and periodontal
surgery.
133
4. All the teeth are reduced to
one to two mm above the
gingiva
5. Endodontics is performed
6. Partial preparation of the teeth
7. Extraction of hopeless dentition
8. Hollow out recesses in the interim overdenture
9. Now that the teeth have been initially reduced, the
hopeless dentition removed, and the interim
overdenture ready for insertion, periodontal therapy can
be completed in a relaxed manner with relative patient
134
comfort.
10.Insert the interim overdenture with a soft relining material
11.After several weeks of healing, complete endodontics (if
not completed).
135
13.Master cast with
removable dies
14.Copings waxed on
individual dies shaped
to conform to the
alveolar ridges. Resin
dowels were used as
dowel patterns
136
15.Position the finished
castings on the cast (lock
them together with Duralay);
invest and solder them to
form a splinted substructure
16.Preliminary intraocclusal
relation records for a trial
set-up of denture teeth. The
anterior teeth are oriented
with a plaster core. This
helps to accurately position
the male attachment on the
137 copings
17.Position the male attachment on the coping. Consider
the following factors when determining the position of the
male posts:
- Is there sufficient vertical space?
- Place the posts over abutments with the
most bone support.
- Position the males slightly lingual. This provides
more room for the anterior denture teeth.
- Utilize abutments in different planes for maximum
retention, stability and support .
- The attachments must be parallel to each other and
to the path of insertion of the overdenture
138
18.Lock the cast on the
surveying table. Loosen the
male sleeves and Place in
the paralleling mandrel.
Find the most
advantageous position for
the posts. Tilt the surveying
table so that the studs will
be aligned to the path of
insertion of the prosthesis.
139
20. Male sleeve is being
removed
140
22.Screw the soldering cornal
onto the threaded base. It
acts as an extension arm
for the screw to aid in
soldering
141
24. Finished copings with
attachments assembled and
soldered, positioned on the
abutments
143
28.Place a small amount
of Vaseline inside
each female then
snap it (with its
copper shim) onto the
male
31.Take accurate
occlusal records and
mount the casts on an
appropriate articulator
for the denture setup
and denture is
fabricated
145
32.Females locked inside. All
excess plaster and resin is
removed. Use the female
screwdriver to disassemble
the female, remove the
copper shim and
reassemble. This activates
the attachment making it
resilient.
146
Cement the copings onto the roots and
insert the overdenture
147
Non-Resilient Gerber
148
Maintenance Consideration
Relining or Rebasing
Alveolar resorption will eventually cause the
denture to rock about the abutments. This rocking
will increase the rate of resorption; abutment
bone support will be continually lost. Such
destructive action may even cause dislodgement
of the copings, breakage of attachments, or even
the splitting of the abutment. The appliances
should be relined or rebased to eliminate these
stressful forces.
149
Procedure for relining
152
The set cast, with the overdenture, is
articulated to a special relining jig. The
relining or rebasing procedure is similar
to a conventional denture relining or
rebasing technique. Separate the
articulator and remove the cast from the
overdenture impression. The cast has
the transfer males in the same location
as in the mouth
157
Male is a solid stud, female
is a single component with
retentive lamellae. A clear
Teflon ring covers the
female lamellae
158
Cylindrical Dalla Bona
The cylindrical male post has parallel walls
without an undercut. The female lamella fits
snugly over the male posts, providing frictional
retention. A PVC ring fits around the female
lamellae. This aids in fabrication, and permits
the lamellae to flex. The cylindrical Dalla Bona
must be parallel; therefore, the male posts
must be assembled using a paralleling
mandrel and surveyor.
159
Spherical Dalla Bona
The spherical Dalla Bona is similar to the
cylindrical, but the male post is spherical. This
sphere provides a retentive undercut which is
engaged by the retentive lamellae of the
female. If a spacer is used during fabrication,
this attachment will be resilient; without the
spacer, it will be nonresilient.
160
Advantages
1. Their overall length varies between 3.3 millimeters
(cylindrical), to 3.7 millimeters (spherical), so it is
suitable for short interocclusal spaces.
2. It provides firm, definite retention.
3. It can be processed into the overdenture in the
laboratory or mounted in the mouth using
autopolymerizing resin.
4. It is less expensive than the Gerber.
5. Parallelism of the spherical Bona is less critical
than that of the cylindrical Bona.
161
Disadvantages
1. The retentive action of the female is very stiff and
difficult to adjust.
2. The collar that retains the female housing in the
prosthesis is too small. Therefore the female may
become loose with normal adjustments and use.
3. The males must be parallel, particularly in the
cylindrical form.
4. There may be some torquing and tipping of the
abutment.
162
Spherical Dalla Bona Treatment
Diagnosis, treatment and management using the
Dalla Bona are very similar to that described for the
Gerber.
Step by step procedure
164
To improve the soldering
procedure, cut a ditch in the
diaphragm of the coping.
This ditch aids the flow of
solder under the stud base
167
Block out all coping
undercuts with plaster
169
The Rotherman anchorage
has a short solid stud( non
resilient right, resilient left)
and a double armed clasp.
The clasp has bar for
retention within the denture
base
170
The male features a definite undercut on just one
side of the cylinder. A scribe line on the occlusal
indicates the position of maximum undercut. The
male must be soldered to the coping so that this line
(and the undercut below it) is positioned facially. This
way, the female's clasp arms will reach around from
lingual to engage the undercut and the bar like
retentive lug will fall in the lingual portion of the
denture. There it will not interfere with the tooth setup
and will be locked in thicker resin.
The Rotherman is the easiest of all attachments to
solder, for it comes with solder built into the center of
the male. The technician need only position the male
on the coping and then hold it in a flame until the
171 solder flows.
BAR ATTACHMENTS
As the name suggests, bar attachments consist of a
metal bar that splints two or more abutments and a
companion mechanism processed within the tissue
area of the overdenture. This mechanism snaps on
the bar to retain the prosthesis.
Bar attachments are available commercially in a
wide variety of forms or they can easily be "custom"
fabricated.
172
Types of Bar Attachments
Bar units
Bar joints
173
The Bar Unit
This bar has parallel walls providing rigid fixation
with frictional retention. It can be used for
retention with long, medium or short copings, but
only when the appliance is to be an all tooth
supported appliance (i.e. where no stressbroken
or rotational action is indicated). It is never used
when a bar joint is indicated (when rotational or
vertical action is necessary); however, a bar joint
can be used whenever a bar unit is indicated.
174
The Bar Joint
The action of this attachment provides rotational or
vertical movement. In other words, it is a stress
broken attachment. It has a rounded or semi
rounded contour so the retention clip and prosthesis
can rotate slightly during mastication.
175
The Dolder Bar
An ideal bar attachment is the Dolder bar. It is well
designed for splinting two or more abutments to
provide support, stability and retention for the
overdenture.
This bar attachment is manufactured in two forms
a bar joint and a bar unit. It is also available in two
different diameters and lengths.
176
Dolder bar joint
The pear shaped bar joint is designed to provide vertical and
rotational action so it is indicated where a stress-broken,
resilient attachment is desired. It can also be used as a bar
unit for an all tooth supported prosthesis by fabricating the
overdenture without planned vertical movement.
Dolder bar unit
The bar unit is in the form of
an inverted U with parallel
walls. It does not permit
rotational or vertical
movement; therefore it only
provides retention and
support, but maximizes the
masticatory load on the
177
abutments.
Typical Dolder bar Treatment:
Reduce the
endodontically treated
cuspids to one to two
millimeters above the
gingiva.
178
Diamond bur is used to
prepare the abutments with
a bevel or chamfer margin. X
indentation is made.
181
The copings are finished, but
are left with a short section of
the sprue on each casting
which will be removed later.
These retained sprue posts
aid in the assembly of the bar
to the copings for soldering
182
Cut the bar to fit between
the copings. The bar
should be positioned
slightly lingual
Method of modification
184
The metal spacer is
positioned over the bar and
the retentive shell is
snapped on the bar
securing the spacer.
185
Block out all undercuts
around the copings with
plaster and cover the
flanges of the retentive
shell
Consequence of
excessive block out
186
With a small brush,
sparingly paint a semidry
mix of auto polymerizing
acrylic resin (such as
Duralay) to cover the end
of the spacer and shell
Framework is constructed
and secured on the cast
187
Use the stone index to
reposition the anterior
teeth and complete the
denture set-up
189
Overdenture Function
Let us now consider the function of this
overdenture. Freedom for vertical movement,
provided by the auxiliary wire spacer and lead foil
covering the copings during fabrication, allows
approximately 0.5 to 1.0 millimeter of space for
movement during function
190
At rest, the overdenture sits
passively only on the
alveolar tissues. A space is
present between the bar-
coping assembly and the
shell tissue side of the
overdenture. There is
maximum retention now
since the clip engages the
bar undercut
Relining/Rebasing Technique
As the alveolar ridge resorbs, the overdenture
settles and rocks on the Dolder bar assembly.
These excessive masticatory loads direct
damaging torquing stresses to the abutments.
When this occurs, the following rebasing procedure
should be followed.
192
1. With a small round bur, carefully remove the acrylic around the
shell, and remove the shell. It will be used later.
2. Remove additional acrylic above the area of the copings and bar
using a straight handpiece with a number eight
bur. This additional space will accommodate the impression material.
3. Dry the denture and paint the tissue areas with an impression
adhesive.
4. Using the elastic impression material of your choice, take an
impression of the tissue bearing areas, copings and Dolder bar. The
patient should close gently into occlusion, as you muscle trim the
impression material. When a large space is present under the bar or
between the copings, it should be blocked out with soft wax or cement
prior to taking the impression. Otherwise, tearing away of the
impression material from these voids, when the impression is
removed, will distort and destroy the accuracy of fit when the
prosthesis is rebased.
193
5. The impression is
poured with model stone.
194
7. The overdenture is
removed from the cast
leaving a reproduction of
the soft tissue, the copings
and Dolder bar.
195
9. The cast is now treated as if you are fabricating a new
overdenture i. e,
197
The Hader Bar System
The Hader system is an excellent bar attachment.
Similar to the customized bar, the Hader system
consists of a plastic bar pattern with gingival
extension and small plastic clips that are
processed into the overdenture. This system has
some advantages over others; the plastic bar
pattern's gingival extension can be trimmed to
conform to the ridge. In addition, worn clips can be
easily replaced at chair side using a special
seating tool.
198
Components of the Hader system are (from left to
right).
• Plastic bar pattern (1.8 mm diameter, vertical height
5.7 mm).
• Plastic clips (5 mm long, 3 mm thick, 4 mm high).
• Modeling riders used in processing to create a slot
for the clips.
• Clip seating tool.
199
Hader Bar Technique
• Take an impression of the prepared abutments,
pour a cast and trim the dies as you would any
bar retained overdenture.
• Wax the coping pattern on the dies.
• Cut the bar pattern to fit between the coping
patterns.
• Heat the bar pattern and adapt it to the ridge
curvature.
• Trim the gingival portion of the bar pattern to fit
the alveolar ridge.
• Wax the plastic pattern directly to the coping
patterns for a single casting, or for greater
accuracy, cast separately and solder to the
200 copings
7. The completed
substructure pattern
is sprued, invested,
cast and finished.
8. Seat the
substructure on
the cast for
completion of the
overdenture
201
9. Position modeling
riders on the bar where
clips will attach. These
riders are removed
after the prosthesis is
fabricated, leaving a
preformed seat to
receive the plastic clips
for retention.
202
11.When the overdenture
is finished, remove the
modeling riders with
pliers or a sharp
instrument
206
SCREWS:
Schubiger Screw Attachment
An excellent screw attachment often used in
overdenture technique is the Schubiger. This
attachment is a very versatile screw-type
system, used with Gerber and bar combinations.
207
Plunger-Type Attachments
Auxiliary retention for an overlay prosthesis is
often desirable and it may be added to various
coping or bar systems. Plunger type units such
as the Ipsoclip, Presso-matic and IC attachments
can add additional retention
208
Review of literature
Paul A. Miller ( 1958) gave special
emphasis on preservation of tissues with
support of artificial teeth. The use of
teeth as support for dentures is aimed at
reducing the load on the osseous
portions of the denture bearing area and
minimize the process of resorption.
209
Dolder E. J. in 1961 advocated the bar joint
denture. The denture is adapted primarily to the
situation with which only a few teeth remain. The
basic construction procedures consist of
(1) Shortening and capping the residual teeth to
render the crown: root length ratio more
favorable and
(2) Splinting the abutments with a straight bar
affixed to the cemented copings which serves, at
the same time, as the bearing shaft for the
complete denture.
210
Robert J. Crum and R. J. Loiselle
(1972) in his review of literature reveal that
discrete sensitivity that exists in the separate
components of masticatory system. It also
demonstrates the necessity for total integration
of each component of the masticatory system
and signals the importance of preserving the
natural teeth.
211
Merrill C. Mensor (1973) advocated the use of
E M attachment selector which consists of 8.5
by 11 inch color coded selector cards. It is
compendium of attachments and connecting
units available through out the world and it
contains 30 points of information for each of
more than 105 different attachment systems,
this is a total of over 3000 points of information.
Each of the cards numbered to correspond with
5 attachment classifications.
212
Joseph T. Quinlivan (1974) said that retention is
a problem for overlay dentures over simple
copings when only two teeth remain. This is
particularly a problem when treating a
mandibular arch, which has a more limited
basal seat area. He advocated RCT of the
abutment teeth; pulp space to be enlarged with
a Gates Glidden drill and finally with a safe
sided para post drill. Then he advocated used
ball and socket type of attachment for
overdenture on the teeth reduced I mm above
the gingiva.
213
Wayne R. frantz (1975) described the
construction of tooth supported dentures where
the natural tooth was utilized and the acrylic
resin for denture base processed directly to the
prepared cast. He said that abutment teeth with
their coping may result in 3-5 mm above the
gingiva which causes undue stress and torque
on the teeth. He advocated natural teeth to be
reduced 1-2 mm above gingiva fill the pulp
chamber with amalgam and give a very high
polish and construct the denture.
214
A. B. Warren and A. A. caputo (1975)
conducted a study to determine and compare
the transfer of forces to the alveolar bone for
five different abutment designs for the tooth
supported dentures and concluded that there
was a direct relationship between the stability
and retention that each design provided and
the amount of stress and torque transferred
to the supporting structures. Attachments that
used parallelism or undercuts for retention
tend to produce the most severe stress
conditions in the supporting alveolus.
215
H H Thayer and A A Caputo (1977) provided the
following guidelines in the selection of specific
designs for overdenture abutments:
1. The Dolder bar, which exhibits more cross-arch
involvement than the Zest anchor, will share the
occlusal load across the arch, between the
abutments and the supporting structures.
2. The posterior edentulous regions will receive some
physiologic stimulation with the Dolder bar, for it
shares more stress here than the Zest anchor.
216
3. The forces on the Dolder bar produce stress
directed more apically than that from the Zest
anchor. Since this force is better tolerated, use
of the Dolder bar may be indicated for a short-
rooted tooth with less supporting bone.
4. The greater stress concentrated around the
abutment teeth by the Zest anchor makes use of
this design in a tooth that is periodontally sound
and has a long root structure well imbedded in
supporting bone seem logical.
217
Merrill C. Mensor (1978) said that when selecting
an attachment it is essential to consider the skill of
the dentist – laboratory teem as well as dexterity of
the patient and to use the easier system that will
still improve stabilization. He advocated the use of
E M gauge and E M attachment selector to reduce
confusion in selection attachments.
218
Robert J. Crum and George E. Rooney (1978)
conducted a 5 year clinical study to determine
the amount of bone loss in the anterior part of
the maxillae and the mandible in two groups of
patients: one group with complete maxillary
dentures and mandibular overdentures and
other group with complete maxillary and
mandibular dentures. The result show that group
–I demonstrated less alveolar bone reduction
than group –II.
219
H. H. Thayer and A. A. Caputo (1979)
concluded that
a) The more retentive tissue bar and extra
coronal attachments produces higher stress
concentrations
b) The Hader bar produced less torquing forces
c) The Ancrofix appeared to share the forces of
occlusion between the abutments and the
posterior edentulous regions.
220
Gary D.Derkson and Michael Macentee ( 1982)
conducted a study to observe the therapeutic
effect of 0.4% stannous fluoride gel on the
periodontium and the tooth structure of
overdenture abutments and they found that
0.4% stannous fluoride gel is an effective agent
in reducing the progress of gingivitis around
overdenture abutments.
221
Conclusion:
To conclude it would not be a repetition to say
that overdenture is a preventive dentistry
concept which has been brought into
Prosthodontics. The alveolar bone and its
overlying mucosa was never intended to
receive the full force of the complete denture.
Even though the technique resembles those of
complete dentures, there are important
differences. The prognosis of the restoration is
likely to be influenced by numerous factors
like:
222
1) Selection of patient
2) Treatment planning
3) Preparation of the mouth
4) Execution of the prosthodontic work
5) Maintenance
223
References
1. Brewer AA, Morrow RM: Overdentures, ed 2. St
Louis, CV Mosby, 1980.
2. Crum RJ, Rooney GE Jr: Alveolar bone loss in
overdentures: A 5-year study. J Prosthet Dent
1978;40:610-613.
3. DerksonGD, MacEntee MM: Effect of 0.4% stannous
fluoride gel on the gingival health of overdenture
abutments. J Prosthet Dent 1982; 48:23-26.
4. Ettinger RL, Taylor TD, Scandrett FR: Treatment
needs of overdenture patients in a longitudinal study:
Five-year results. J Prosthet Dent 1984;52:532-537.
5. Mensor MC Jr: Attachment fixation of the overdenture:
Part II. J Prosthet Dent 1978;39:16-20.
224
6. Quinlivan JT: An attachment for overlay dentures. J
Prosthet Dent 1974;32:256-261.
7. Thayer HH, Caputo AA: Occlusal force transmission by
overdenture attachments. J Prosthet Dent 1979;41:266-
271.
8. Thayer HH, Caputo AA: Effects of overdentures upon the
remaining oral structures. J Prosthet Dent 1977;37:374-
381.
9. Winkler .S . Essentials of complete denture
Prosthodontics, second edition,2000, 384-402.
10.Paul A. Millar: complete denture supported by natural
teeth. J Prosthet Dent 1958;8:924.
11.Dolder E. J: The bar joint mandibular dentures. J
Prosthet Dent 1961;11:689.
225
12.Wayne R Frantz: The use of natural teeth in
overdentures. J Prosthet Dent 1975;34:135-140.
13.A B Warren and Caputo: Load transfer to alveolar bone
as influenced by abutment designs for tooth supported
dentures. J Prosthet Dent 1975;33:137.
226
227