Podcast
Questions and Answers
What is a significant advantage of restoring a vital molar with a low-level thin coping?
What is a significant advantage of restoring a vital molar with a low-level thin coping?
Which type of preparation is specifically designed for devital teeth with bare root supports?
Which type of preparation is specifically designed for devital teeth with bare root supports?
What is the primary function of secondary copings in dental prosthetics?
What is the primary function of secondary copings in dental prosthetics?
Which criterion is NOT assessed when evaluating the success of an overdenture?
Which criterion is NOT assessed when evaluating the success of an overdenture?
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What is a common issue encountered during the placement of teeth on copings?
What is a common issue encountered during the placement of teeth on copings?
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What is a notable disadvantage of overdenture prosthesis?
What is a notable disadvantage of overdenture prosthesis?
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Which benefit of overdenture prosthesis specifically aids in the adaptation of patients?
Which benefit of overdenture prosthesis specifically aids in the adaptation of patients?
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What problem primarily occurs with patients using complete dentures over time?
What problem primarily occurs with patients using complete dentures over time?
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In the context of overdenture prosthesis, what does the term 'total Overdenture' refer to?
In the context of overdenture prosthesis, what does the term 'total Overdenture' refer to?
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What is a primary feature of overdenture treatment compared to complete dentures?
What is a primary feature of overdenture treatment compared to complete dentures?
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Which statement regarding overdenture prosthesis is true?
Which statement regarding overdenture prosthesis is true?
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What are the risks associated with the attachments used in overdenture prosthesis?
What are the risks associated with the attachments used in overdenture prosthesis?
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What is a significant advantage of using amalgam or composite restoration in dental procedures?
What is a significant advantage of using amalgam or composite restoration in dental procedures?
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In the context of coping, what determines whether a coping is classified as short or long?
In the context of coping, what determines whether a coping is classified as short or long?
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What is a primary disadvantage of using attachments in dental prostheses?
What is a primary disadvantage of using attachments in dental prostheses?
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Which of the following statements accurately defines rigid attachments?
Which of the following statements accurately defines rigid attachments?
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When preparing for treatment, which diagnostic method is NOT covered under clinical examination?
When preparing for treatment, which diagnostic method is NOT covered under clinical examination?
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What should be considered before starting a treatment plan for dental prosthetics?
What should be considered before starting a treatment plan for dental prosthetics?
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What is a characteristic of flexible attachments in dental applications?
What is a characteristic of flexible attachments in dental applications?
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What aspect of examination includes evaluating the condition of the antagonist dentition?
What aspect of examination includes evaluating the condition of the antagonist dentition?
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Which of the following is NOT a potential disadvantage of using attachments?
Which of the following is NOT a potential disadvantage of using attachments?
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How is the endodontic treatment related to the final stages of tooth preparation?
How is the endodontic treatment related to the final stages of tooth preparation?
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What characterizes an immediate overdenture?
What characterizes an immediate overdenture?
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Which situation would NOT be a contraindication for overdenture treatment?
Which situation would NOT be a contraindication for overdenture treatment?
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In which type of overdenture is a metal substructure commonly utilized?
In which type of overdenture is a metal substructure commonly utilized?
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What defines a teeth-supported overdenture?
What defines a teeth-supported overdenture?
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Which of the following is NOT a classification based on the type of support for overdentures?
Which of the following is NOT a classification based on the type of support for overdentures?
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For which case is an overdenture particularly advantageous?
For which case is an overdenture particularly advantageous?
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What is a primary consideration for selecting cases for overdentures?
What is a primary consideration for selecting cases for overdentures?
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What element is vital in the construction of supporting teeth without coping?
What element is vital in the construction of supporting teeth without coping?
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Which statement regarding contraindications for overdenture treatment is true?
Which statement regarding contraindications for overdenture treatment is true?
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What is the primary importance in evaluating the periodontal condition of supporting teeth?
What is the primary importance in evaluating the periodontal condition of supporting teeth?
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Why is preserving mandibular canines crucial for an overdenture?
Why is preserving mandibular canines crucial for an overdenture?
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What impact does a deep undercut in remaining teeth have on prosthesis design?
What impact does a deep undercut in remaining teeth have on prosthesis design?
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Which structure protects the maxillary edentulous crest during function?
Which structure protects the maxillary edentulous crest during function?
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For which situation is a single molar considered an effective abutment?
For which situation is a single molar considered an effective abutment?
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What is the critical factor in maintaining the occlusal vertical dimension created by dentures?
What is the critical factor in maintaining the occlusal vertical dimension created by dentures?
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What is a significant advantage of using single-canal teeth in endodontic treatments?
What is a significant advantage of using single-canal teeth in endodontic treatments?
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What should be ensured regarding the periodontal pocket depth for supporting teeth?
What should be ensured regarding the periodontal pocket depth for supporting teeth?
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Which arrangement of teeth provides a larger area of support?
Which arrangement of teeth provides a larger area of support?
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What is a direct consequence of not addressing undercuts when designing a prosthesis?
What is a direct consequence of not addressing undercuts when designing a prosthesis?
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Study Notes
Tooth-Supported Removable Dentures
- Tooth-supported removable dentures are a treatment option for edentulous patients.
- Complete dentures are the standard treatment, but they can result in loss of dental proprioception, progressive alveolar bone resorption, and transference of occlusal forces to the oral mucosa. This often leads to loss of self-confidence and oral function.
Overdenture
- Overdentures are removable dentures that support one or more teeth, teeth roots, or implants.
- They are used as a treatment alternative to complete dentures
- Using overdentures, horizontal forces and torque forces transmitted to the alveolar bone are decreased.
- Providing continuity of the proprioceptive response for the patient
- Improve patient psychological well-being with the presence of teeth
- Ease of conversion from overdenture to a total denture from loss of support teeth
- Increase the support, retention, and stability of the prosthesis, ultimately aiding the patient's adaptation to the prosthesis.
Overdenture Prosthesis Types
- Immediate overdenture: Prepared and attached before oral preparations (extractions, etc.) and delivered to the patient immediately afterward.
- Temporary overdenture: Used during a transitional or preparation phase before a permanent overdenture is completed. Extending and adding teeth to an existing partial denture.
- Permanent overdenture: The final prosthesis made after the clinical and laboratory stages. It can be made entirely of acrylic or have a metal substructure.
Overdenture Classification
- Construction Time: Immediate, Interim, Permanent
- Support Type: Teeth-supported, Implant-supported
- Coping Usage: No coping, Coping, Telescopic Attachment
- Base Material: Acrylic base, Metal base
Supporting Teeth without Coping
- Abutment teeth are shortened to 2-3mm coronal height.
- Teeth contoured into convex or dome shape.
- Endodontic treatment often necessary (e.g., root canal treatment).
- Teeth prepared for amalgam or composite restoration.
Supporting Teeth with Coping
- Coping is a cover for the exposed tooth surface.
- Cast metal coping with a dome-shaped surface and a chamfer finish line at the gingival margin.
- Coping types: Short and Long (requiring larger crown/root).
Supporting Teeth with Attachments
- Attachments are small, precise devices used to improve denture base retention.
- Most attachments are fixed to the abutment by casting coping.
- Attachments are typically two-part (male and female).
Advantages of Overdentures
- Cost-effective compared to other options
- Treatment can be adapted in emergencies.
- More flexibility when formulating treatment plan.
Disadvantages of Overdentures
- Increased time and cost compared to conventional prosthetics
- Complex construction
- More strenuous for patient for the building and repair of dentures
- Care needed from patient for maintenance
Rigid vs Flexible Attachments
- Rigid: Does not allow denture base movement, ensures adequate retention to prevent torque on abutment teeth.
- Flexible: Provides some control and induces less torque on abutment teeth.
Examination and Diagnosis
- Medical History: Includes the patient's general medical condition.
- Dental History: Includes the patient’s dental history.
- Clinical Examination: Assesses periodontal condition, endodontic evaluation, Caries activity, Bone support, number/position of supporting structures, axial slope of root form of supporting teeth, chewing load, and condition of the opposing dentition.
- Radiography: Includes panoramic and periapical radiographs.
Treatment Plan and Course
- Selecting and preparing support structures.
- Fabrication of copings
- Placing complete dentures on the restored support structures.
Periodontal Condition of Supporting Teeth
- Amount of supporting alveolar bone (critical for support, appropriate crown/root ratio, and resistance to incoming forces).
- Manageable periodontal pocket depth
- Sufficient attached gingiva
- Maintaining minimal pocket depth and adequate attached gingiva is vital for long-term tooth health.
Position of Supporting Teeth
- Teeth under high occlusal forces should be retained (e.g., canines and premolars) in both mandibular and maxillary arches to prevent resorption and maintain vertical dimension.
Path of Insertion
- Remaining teeth may have undercuts, especially in labial contours.
- Lingual undercuts can make insertion difficult.
- Reliefs must be made in areas of the prosthesis to avoid tissue damage.
- Undercut areas may be modified to allow access of the base.
Endodontic Evaluation
- Root canal treatment might be necessary to shorten clinical crown length to fit below the prosthesis, making single-canal teeth preferable.
- Exceptions considered with vital molars that can be restored with low-level thin coping without root canal treatment.
Preparation of Supporting Teeth
- Preparation types based on tooth vitality (vital or devital).
- Short, medium-short, medium, and long preparations for different types of copings.
Coping Types
- Primary copings: Designed to fit onto the prepared support.
- Secondary copings: Designed to sit on the primary coping.
- Different coping lengths (6-8mm, 4-6mm, 2-4mm, 1-2mm) for various preparations.
Preparation of Prostheses
- Impressions are taken with acrylic trays and elastomeric impression materials.
- A model is created.
- Temporary base plates and jaw relations are determined.
- Complete teeth alignment.
- Reductions may be made on the back of the teeth to be fitted.
- Prosthesis adapted to the patient’s mouth using pressure pastes.
Assessment Criteria for Overdenture Success
- Support, retention, and stability are assessed.
- Patient comfort and satisfaction are evaluated.
- Aesthetic, phonetic, and functional properties are considered.
- Occlusal contacts compatibility with mandibular movements is examined.
Periapical Tissue Evaluation
- Periapical tissue of support teeth needs evaluation.
- Health of the lamina dura is assessed—no infection should be present.
- History of root canal treatment might have an impact.
- If infection is present, it should have healed from root canal treatment for success.
Success Conditions of Supporting Teeth
- Presence or absence of caries in clinical crowns.
- Easy removal of denture.
- Closing of canal orifices.
- Proper support teeth utilization.
Long-Term Successful Overdenture Treatment
- Successful use determined by the patient's protection of supporting structures.
- Natural stimulation and cleaning can be reduced after prosthesis placement.
- Patient awareness of oral hygiene and prosthetic hygiene is crucial for long-term success.
Patient Hygiene Practices
- Patients advised to brush around supporting structures (using correct techniques).
- Interproximal brushes and floss usage encouraged.
- Soft-bristled brushes should be used for oral tissue brushing.
- Fluoride or chlorhexidine mouthwashes can be used (depending on the need).
- Prostheses should be cleaned and rinsed in a suitable cleaning solution every 2-3 weeks.
Example Cases
- Several case studies were discussed, illustrating different types of tooth-supported removable dentures.
References
- Several articles/studies cited to support the presented information.
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Description
This quiz covers tooth-supported removable dentures, focusing on overdentures as a treatment option for edentulous patients. It discusses their benefits over complete dentures, including improved patient wellbeing and reduced forces on the alveolar bone. Test your understanding of this important dental subject.