Overdenture , Transitional Denture and Failing Dentition

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.

11. http://www.google.com.my/imgres?q=magnetic+denture&hl

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. 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 2004. ISBN 1850970750 • 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…