{{Short description|An overview of overdenture use in dentistry}}
It is defined as, “a dental prosthesis that replaces the lost or missing natural dentition and associated structures of the maxilla and/or mandible and receives partial support and stability from one or more modified natural teeth”.
{{Use dmy dates|date=October 2023}}
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[[File:Implant overdenture model.jpg|thumb|An example of an implant-supported overdenture model.]]
An '''overdenture''' is a type of [[denture]] that is supported by and attached to either the [[alveolar ridge]] or [[dental implants]]. Overdentures are used to improve the stability and retention of dentures, providing better function and comfort for patients who have lost their natural teeth.
* For better support and aesthetics in morphologically compromised dental arches.
* Cleft palate cases.
* Dentures for patients with maxillo-facial trauma.
* Patients with worn-out dentition
* For congenital anomalies like microdontia, amelogenesis imperfecta, dentinogenesis imperfecta and partial anodontia.
* Patients with abnormal jaw size and position where orthognathic surgery is contraindicated.
This treatment is usually indicated for:
==Types of Overdentures==
# Group1: Patients with few remaining teeth that may be healthy or periodontally involved, with intact or grossly destroyed crowns.
Overdentures can be classified based on their support system:
# Group2: Patients with severely compromised dentition. Selective extraction should be carried out after a thorough examination of the patient.
=== Advantages ===
===Implant-Supported Overdentures===
* Maintains the integrity of the residual ridge.
Implant-supported overdentures are anchored by [[dental implants]] that are surgically placed into the jawbone. These implants provide a stable foundation for the overdenture, improving its retention and function. Implant-supported overdentures can be either fixed or removable, depending on the patient's needs and preferences.
* Improves the retention and stability of the denture.
* Improved proprioception leads to better neuromuscular control. This helps in regulating the biting force over the denture.
* Psychological effect on the patient as extraction can be avoided.
* It can almost be used universally.
* Even if there is abutment failure, the abutments can be extracted and the overdenture can be relined and used as a conventional complete denture.
=== Disadvantages ===
===Tooth-Supported Overdentures===
* Nutritional counselling, oral hygiene measures and fluoride application should be carried out periodically.
Tooth-supported overdentures use the remaining natural teeth as support. These teeth are often modified with attachments or copings to enhance the retention of the overdenture. This type of overdenture is beneficial for patients who still have some healthy teeth remaining.
* High incidence of caries and periodontal disease around the over denture abutments.
* Frequent reviews are needed to verify the health of the supporting tissues of the overdenture abutments.
* More expensive than conventional dentures because:
# Endodontic therapy and coronal restorations may be needed for certain overdenture abutments.
# Most cases need a cast metal denture base as acrylic is weaker.
# Additional designing and laboratory work is needed.
* Cannot be used in cases with reduced interarch space, bony undercuts adjacent to the abutments, etc.
* Improper maintenance of the overdenture may lead to periodontal breakdown of the overdenture abutments and the patient may lose all his remaining teeth.
=== Patient Selection ===
==Benefits of Overdentures==
==== ''Possibility of a Fixed or Removable Partial Denture'' ====
Overdentures offer several advantages over traditional dentures:
If the periodontal condition and position of the remaining teeth favour the use of a fixed partial denture or removable partial denture, then an overdenture should not be considered for that patient.
==== ''Condition of the Abutment Teeth'' ====
The crowns of teeth should be free from caries. There should be sufficient width of attached gingiva around the abutments. The abutment should be free from any periodontal disease.
==== ''Age of the Patient'' ====
Overdentures are always recommended for young patients because they have a favourable psychological effect.
=== Abutment Teeth Selection ===
* '''Improved Stability and Retention''': The use of implants or natural teeth provides a more secure fit, reducing the risk of the denture slipping or moving during use.
As the outcome of the treatment does not depend on the number of teeth retained, the dentist must evaluate the cost of treatment. That is he can preserve the ideal teeth and extract the remaining to reduce the cost of the prosthesis. The factors to be considered are:
* '''Preservation of Jawbone''': Implants help stimulate the jawbone, preventing bone resorption that typically occurs after tooth loss.
==== ''Periodontal Status'' ====
* '''Enhanced Comfort and Function''': Patients often experience better chewing efficiency and comfort with overdentures compared to conventional dentures.
* Periodontally-compromised teeth with horizontal bone loss have a better prognosis than the ones with vertical bone loss.
* '''Aesthetic Improvements''': Overdentures can be designed to look more natural, improving the patient's appearance and confidence.
* A favourable crown-root ratio should be present in cases with slight tooth mobility.
* A circumferential band of attached gingiva is an absolute necessity for an overdenture abutment.
==== ''Abutment Location'' ====
* Cuspids and bicuspids are frequently selected as overdenture abutments.
* As the anterior alveolar ridge resorbs easily under stress, anterior teeth are not usually selected.
* Maxillary incisors can be used as overdenture abutments, if the mandibular arch is intact.
* At least one tooth should be retained in a quadrant to maintain the health of the oral tissues.
* The number and location of the abutment teeth and the status of the opposing one should be evaluated during treatment planning.
==== ''Endodontic and Prosthodontic Status'' ====
* Usually anterior teeth (canines and premolars) are preferred as overdenture abutments as they are easier to prepare and economical too.
* When there is pulpal recession or calcifications along with extensive tooth wear, endodontic therapy can be avoided.
=== Basic Principles to be Followed ===
==Procedure for Overdenture Placement==
* The abutment teeth should be surrounded with healthy periodontal tissue.
The process of obtaining an overdenture involves several steps:
* Maximum reduction of the coronal portion should be done to attain a better crown-root ratio and avoid interference during placement of artificial teeth. Endodontic therapy may be done if needed.
* A simple tooth preparation without any internal attachments can be done in a single visit. This can be done for elderly patients and medically compromised patients. It is less expensive than copings.
* Treatment should be accompanied with fluoride gel application and other oral hygiene measures.
* Gold copings or crowns and sleeve coping retainers can be given for grossly destructed abutments after assessing the patient’s
susceptibility to caries. Gold coping can be prepared with posts and retentive pins after evaluating on the amount of tooth structure above the gingival
attachment.
* Attachments may be added to the cast copings for additional retention. These attachments may be resilient or non-resilient types.
* These additional components complicate the design and increase the cost of treatment.
=== Oral Hygiene Status ===
1. '''Initial Consultation and Assessment''': The dentist evaluates the patient's oral health, bone structure, and remaining teeth to determine the suitability of an overdenture.
* The patient should be motivated to maintain adequate oral hygiene, as poor oral hygiene can lead to the loss of the abutment.
2. '''Implant Placement (if applicable)''': For implant-supported overdentures, dental implants are surgically placed into the jawbone. Healing time is required for osseointegration.
* Regular reviews should be done to evaluate the oral hygiene and the oral health maintenance measures should be revised if needed.
3. '''Impression Taking''': Impressions of the mouth are taken to create a custom-fitted overdenture.
* Regular fluoride gel application is mandatory.
4. '''Fitting and Adjustment''': The overdenture is fitted and adjusted to ensure comfort and proper function.
5. '''Follow-Up Care''': Regular check-ups are necessary to monitor the health of the implants or supporting teeth and to make any necessary adjustments to the overdenture.
=== Clinical Procedure ===
==Challenges and Considerations==
* Surgical removal of teeth with hopeless prognosis.
While overdentures offer many benefits, there are also challenges and considerations:
* Periodontal treatment of the patient.
* Endodontic treatment of abutment teeth.
* Crown reduction of the abutment.
* Fluoride application over the prepared teeth.
* Copings are fabricated and cemented if needed.
* Impressions are made and the denture fabrication is similar to a conventional complete denture.
* On the tissue surface of the fabricated denture, the areas adjoining the gingival margins have to be trimmed/relieved in order to avoid impingement. This area is later lined with resilient liner to close the dead space between the gingiva and the denture.
=== IMPLANT-SUPPORTED OVERDENTURES ===
* '''Cost''': Implant-supported overdentures can be more expensive than traditional dentures due to the cost of implants and surgical procedures.
Implants are the latest trend in prosthodontia these days. Implants are used as a part of removable and fixed partial dentures. They play an important role in complete dentures too. Some patients will not be able to wear their dentures irrespective of its perfect contour. These patients are termed as “''Mal-adaptive''”. The implant-supported denture can be designed for these patients.
* '''Surgical Risks''': Implant placement involves surgery, which carries risks such as infection or implant failure.
* '''Maintenance''': Overdentures require regular maintenance and care to ensure their longevity and function.
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==Also see==
{{dictionary-stub1}}
* [[Denture]]
* [[Dental implant]]
* [[Prosthodontics]]
* [[Oral and maxillofacial surgery]]
{{Dental prosthetics}}
[[Category:Dentistry]]
[[Category:Dental prosthetics]]
Latest revision as of 03:00, 11 December 2024
An overview of overdenture use in dentistry
An example of an implant-supported overdenture model.
An overdenture is a type of denture that is supported by and attached to either the alveolar ridge or dental implants. Overdentures are used to improve the stability and retention of dentures, providing better function and comfort for patients who have lost their natural teeth.
Implant-supported overdentures are anchored by dental implants that are surgically placed into the jawbone. These implants provide a stable foundation for the overdenture, improving its retention and function. Implant-supported overdentures can be either fixed or removable, depending on the patient's needs and preferences.
Tooth-supported overdentures use the remaining natural teeth as support. These teeth are often modified with attachments or copings to enhance the retention of the overdenture. This type of overdenture is beneficial for patients who still have some healthy teeth remaining.
Overdentures offer several advantages over traditional dentures:
Improved Stability and Retention: The use of implants or natural teeth provides a more secure fit, reducing the risk of the denture slipping or moving during use.
Preservation of Jawbone: Implants help stimulate the jawbone, preventing bone resorption that typically occurs after tooth loss.
Enhanced Comfort and Function: Patients often experience better chewing efficiency and comfort with overdentures compared to conventional dentures.
Aesthetic Improvements: Overdentures can be designed to look more natural, improving the patient's appearance and confidence.
The process of obtaining an overdenture involves several steps:
1. Initial Consultation and Assessment: The dentist evaluates the patient's oral health, bone structure, and remaining teeth to determine the suitability of an overdenture.
2. Implant Placement (if applicable): For implant-supported overdentures, dental implants are surgically placed into the jawbone. Healing time is required for osseointegration.
3. Impression Taking: Impressions of the mouth are taken to create a custom-fitted overdenture.
4. Fitting and Adjustment: The overdenture is fitted and adjusted to ensure comfort and proper function.
5. Follow-Up Care: Regular check-ups are necessary to monitor the health of the implants or supporting teeth and to make any necessary adjustments to the overdenture.
