1. Overdenture, Transitional Denture and Failing Dentition
Dr Norlela Yacob
BDS(Mal), MDSc (Dundee)(Prosthodontics)
9/9/2013

2. Lecture content: Definition : overdenture
Advantages and disadvantages of overdenture
Abutment issue
Types of Overdenture
Transitional denture
Failing dentition
Sequencing of treatment
Design aspect of transitional/immediate complete denture

3. Overdenture: Definition:
A denture which is fitted over teeth which usually had their natural crown reduced.
Objective:
to distribute stress concertration between retained teeth abutments and denture supporting tissues.
Special attachment may be fixed to the roots faces to provide mechanical retention for the denture

4. Indication: Major tooth wear to less severe tooth wear
Congenital tooth wear, hypodontia or cleft palate
Sequalae of maxillofacial trauma
Patient that heading in an edentulous direction (failing dentition)

5. Advantage of overdenture
Preservation of edentulous ridge form
-Especially for lower jaw
-It will provide support and promoting stability of denture
-Preserve labial undercut: better retention and stability
Minimize horizontal forces on abutment teeth

6. Advantages of overdenture
Improve appearance: more bone support, prevent labial and lip collapse.
Preservation of sensory input: better occlusal awareness, biting force and neuromuscular control from the periondontal tissue.
Allows scope of attachments. Eq; magnetic, telescopic crown, bar

7. Advantages of overdenture
Improvement of crown root ratio:
Due to tooth wear, the ratio become reduce.
Patient perception of “Natural Feeling” and prevent tooth extraction.

8. Disadvantages Root canal therapy: increase cost, long treatment
Limitation of space: may require design modification
Potentially fracture of denture base materials at thin/weak base
Risk for further disease on abutments: caries and periodontal disease
Periodontal attachment loss
Root face caries
May need additional or extra laboratory steps

9. Abutments: Issues of selection and protection from
Caries and periodontal disease

10. Abutment selection:
Periodontal and mobility status: health periodontal tissue. Slight mobility per se is not contraindication
Location: Canine and premolars are most vulnerable to reduce adverse force. At least one tooth per quadrant.
Endodontic and prosthodontics status.

12. Protection of abutments
Plaque control
denture wearing habits
Anti-microbial agent: chlorohexidine m/wash
Flouride gel application
Reduction of crown portion especially in root treated teeth
Endodotically treated teeth: leave it unprotected or protect with coping with alloy, composite, reshaped and polished with sandpaper disks.

13. Materials for restoring the root face
Amalgam
Composite resin
Glass Inomer cement
Post retained copings-keeper, telescopic crown
Full coverage of the root face
Attachment: precision attachment, stud attachment

14. Type of overdenture Directly over teeth-no reduction
Reduction of crowns without endodontics
Reduction of crown with endodontics
Attachment system
Implant supported denture

17. Transitional dentures
Is an aid to the transition from dentate to edentulous. It helps to restore existing edentulous areas.
It may be worn for short period of time before remaining natural teeth are extracted and denture are converted accordingly.
Example: spoon denture, interim denture, immediate denture, overdenture

18. Indications for transitional dentures
Immediate partial denture
Prolonged restorative treatment
Growing patient; children and teenagers
Failing dentition

19. Prolonged restorative treatment

20. FAILING DENTITION Pattern of Failing Dentition: Catastrophic failing
Slow failure- creeping towards edentulous arch

21. Catastrophic Failing Years of neglect Dietary/ saliva flow
Medical crises Eq: Diabetes,

22. Slow Failing
Patient need to understand the position and condition of failing dentition
Need more visits and costs

24. Treatment planning for the failing dentition
CONTROL OF PAIN first
Periodontal assessment: identify the prognosis of tooth (may need to retain or extraction).
Patient: must be fully informed and patient is aware and UNDERSTAND they have periodontal disease.
Extraction of painful, posterior teeth and roots
Periodontal stabilization-never/necessary?
Conservation: removable partial denture/crown/provisional denture (interim denture)/immediate denture

25. Decisions in treatment planning
Should we provide immediate dentures at all time?
Transitional denture: Immediate denture or interim dentures or complete clearance
Consider the history of patient

26. Decisions in treatment planning
What problem is the patient presenting with?
Is the patient in pain?
Previous denture wearing experience
Gagging: transitional denture
Is there an urgent need to extract the teeth.
Can teeth be added to an existing denture
Do we need new prostheses.
How many teeth should be removed at each stage?
Clearance of teeth without prosthetic replacement
Social disadvantages.
Loss of reference point for vertical and horizontal jaw relationship

27. Clearance with complete immediate denture
Often difficulties wearing especially the lower prosthesis.
More predictable way of preserving information on jaw relationship (vertival + horizontal) and tooth position.
Massive resorption- whole jaw resorption>loose dentures
Psychological effects

28. Sequencing of extraction
For case that creeping to edentulous arch

29. Phase 1
Remove posterior teeth initially and allow the ridges to heal (how many teeth you would extract?)
Leave the index teeth eq:1st premolar. Therefore, correct vertical dimension is remained.

30. Phase 2
Make partial acrylic denture. At this stage we call it transitional denture.
Let patient accustomed and adapt with the prostheses. 2-4 weeks.
If may require further extraction, interim denture could be considered.

31. Phase 3
Once patient comfortable with the denture convert it to complete immediate denture.

32. Phase 4
Replacement or rebasing After bone resportion has settled down

33. Transitional denture Advantages Disadvantages Simple and economic
Relatively atraumatic
Function and appearance maintained.
Can use information that remain eq: VD
Patient preference
Adaptation to dentures
Repeated additions to dentures may be socially inconvenient.
Problems from remaining teeth at any time
Difficulty constructing a functional and aesthetic denture
Position and distribution of remaining teeth unacceptable
Prolonged treatment

34. Immediate denture of failing denture
CONCLUSION:
Immediate denture of failing denture
Good communications skills is ESSENTIAL.
Inform patient of requirement for follow up.
Inform patient of requirement for definitive treatment at later stage.

35. References
Jepson, NJA. Removable Partial denture. Quintessentials of dental Practice. London ISBN
RM Basker, JC Davenport. Prosthetic treatment of the edentulous patient. 4th edi. Blackwell 2002.

36. Learning outcome: Describe overdenture and its type
Explain advantages and disadvantages of overdenture
Understand the management of abutment issue
Know the pattern of failing dentition
Know the management of failing dentition
Describe interim denture, transitional denture, and immediate denture

37. Thank you
Question, please…