Presentation on theme: "Overdenture, Transitional Denture and Failing Dentition"— Presentation transcript:
1Overdenture, Transitional Denture and Failing Dentition Dr Norlela YacobBDS(Mal), MDSc (Dundee)(Prosthodontics)9/9/2013
2Lecture content: Definition : overdenture Advantages and disadvantages of overdentureAbutment issueTypes of OverdentureTransitional dentureFailing dentitionSequencing of treatmentDesign aspect of transitional/immediate complete denture
3Overdenture: 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
4Indication: Major tooth wear to less severe tooth wear Congenital tooth wear, hypodontia or cleft palateSequalae of maxillofacial traumaPatient that heading in an edentulous direction (failing dentition)
5Advantage 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 stabilityMinimize horizontal forces on abutment teeth
6Advantages 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
7Advantages of overdenture Improvement of crown root ratio:Due to tooth wear, the ratio become reduce.Patient perception of “Natural Feeling” and prevent tooth extraction.
8Disadvantages Root canal therapy: increase cost, long treatment Limitation of space: may require design modificationPotentially fracture of denture base materials at thin/weak baseRisk for further disease on abutments: caries and periodontal diseasePeriodontal attachment lossRoot face cariesMay need additional or extra laboratory steps
9Abutments: Issues of selection and protection from Caries and periodontal disease
10Abutment selection:Periodontal and mobility status: health periodontal tissue. Slight mobility per se is not contraindicationLocation: Canine and premolars are most vulnerable to reduce adverse force. At least one tooth per quadrant.Endodontic and prosthodontics status.
12Protection of abutments Plaque controldenture wearing habitsAnti-microbial agent: chlorohexidine m/washFlouride gel applicationReduction of crown portion especially in root treated teethEndodotically treated teeth: leave it unprotected or protect with coping with alloy, composite, reshaped and polished with sandpaper disks.
13Materials for restoring the root face AmalgamComposite resinGlass Inomer cementPost retained copings-keeper, telescopic crownFull coverage of the root faceAttachment: precision attachment, stud attachment
14Type of overdenture Directly over teeth-no reduction Reduction of crowns without endodonticsReduction of crown with endodonticsAttachment systemImplant supported denture
17Transitional 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
18Indications for transitional dentures Immediate partial dentureProlonged restorative treatmentGrowing patient; children and teenagersFailing dentition
24Treatment planning for the failing dentition CONTROL OF PAIN firstPeriodontal 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 rootsPeriodontal stabilization-never/necessary?Conservation: removable partial denture/crown/provisional denture (interim denture)/immediate denture
25Decisions in treatment planning Should we provide immediate dentures at all time?Transitional denture: Immediate denture or interim dentures or complete clearanceConsider the history of patient
26Decisions in treatment planning What problem is the patient presenting with?Is the patient in pain?Previous denture wearing experienceGagging: transitional dentureIs there an urgent need to extract the teeth.Can teeth be added to an existing dentureDo we need new prostheses.How many teeth should be removed at each stage?Clearance of teeth without prosthetic replacementSocial disadvantages.Loss of reference point for vertical and horizontal jaw relationship
27Clearance 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 denturesPsychological effects
28Sequencing of extraction For case that creeping to edentulous arch
29Phase 1Remove 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.
30Phase 2Make 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.
31Phase 3Once patient comfortable with the denture convert it to complete immediate denture.
32Phase 4Replacement or rebasing After bone resportion has settled down
33Transitional denture Advantages Disadvantages Simple and economic Relatively atraumaticFunction and appearance maintained.Can use information that remain eq: VDPatient preferenceAdaptation to denturesRepeated additions to dentures may be socially inconvenient.Problems from remaining teeth at any timeDifficulty constructing a functional and aesthetic denturePosition and distribution of remaining teeth unacceptableProlonged treatment
34Immediate denture of failing denture CONCLUSION:Immediate denture of failing dentureGood communications skills is ESSENTIAL.Inform patient of requirement for follow up.Inform patient of requirement for definitive treatment at later stage.
35ReferencesJepson, NJA. Removable Partial denture. Quintessentials of dental Practice. London ISBNRM Basker, JC Davenport. Prosthetic treatment of the edentulous patient. 4th edi. Blackwell 2002.
36Learning outcome: Describe overdenture and its type Explain advantages and disadvantages of overdentureUnderstand the management of abutment issueKnow the pattern of failing dentitionKnow the management of failing dentitionDescribe interim denture, transitional denture, and immediate denture