|Year : 2015 | Volume
| Issue : 2 | Page : 117-120
Design modification in overdentures with precision attachments in a case of reduced vertical dimension
Anuj Wangoo, Sakshi Malhotra, Ramanpreet Singh, Yashendra
Department of Prosthodontics, Luxmi Bai Dental College, Patiala, Punjab, India
|Date of Web Publication||2-Mar-2016|
Department of Prosthodontics, Luxmi Bai Dental College, Patiala, Punjab
Source of Support: None, Conflict of Interest: None
Overdentures is a preferred treatment option in patients who have to go for extraction of the remaining teeth for fabrication of complete dentures. The teeth which are preserved, play a vital role by improvement of crown root ratio, provide proprioception, decrease the rate of resorption, and improve support to the denture. Rehabilitation using overdentures is a widely accepted preventive approach due to its ease of fabrication and the successful prognosis. An over denture is a preventive prosthodontic concept with a multidisciplinary approach involving periodontic, endodontic, and prosthodontic intervention. An overdenture improves retention, stability, maintains proprioception, prevents residual ridge resorption, and improves patient satisfaction. This is a case report of a patient with few remaining teeth, successfully treated with Preci-Sagix (Ceka attachments Preci-line, Belgium) overdenture attachments.
Keywords: Overdenture, precision attachments, reduced vertical height
|How to cite this article:|
Wangoo A, Malhotra S, Singh R, Yashendra. Design modification in overdentures with precision attachments in a case of reduced vertical dimension. Saint Int Dent J 2015;1:117-20
|How to cite this URL:|
Wangoo A, Malhotra S, Singh R, Yashendra. Design modification in overdentures with precision attachments in a case of reduced vertical dimension. Saint Int Dent J [serial online] 2015 [cited 2020 Apr 1];1:117-20. Available from: http://www.sidj.org/text.asp?2015/1/2/117/177946
An overdenture is defined as any removable dental prosthesis that covers and rests on one or more remaining natural teeth, the roots of natural teeth, and/or dental implants; a dental prosthesis that covers and is partially supported by natural teeth, natural tooth roots, and/or dental implants.  Various terms have been used to describe this treatment modality: Overlay denture, telescoped dentures, tooth-supported dentures, hybrid prosthesis, crown and sleeve prosthesis, and the superimposing dentures. 
Today, with more attention on preventive measures in prosthodontics, the use of overdenture has increased to the point where it is now a feasible alternative to most treatment plan outlines in the construction of prosthesis for patients with some remaining teeth or even roots.  Two physiologic tenets related to this therapy: The first concerns the continued preservation of alveolar bone around retained teeth,  second relates to the continuing presence of periodontal sensory mechanisms  that guide and monitor gnathodynamic functions. Overdentures help to partly overcome many of the problems posed by conventional complete dentures such as progressive bone loss, poor stability and retention, loss of periodontal proprioception, and low masticatory efficiency. 
Tooth-supported overdenture is a viable and time-tested alternative technique for those who do not want or cannot afford implants. Overdentures are stabilized using attachment components such as bar and clips, balls, or magnets.
An estimated interarch space of 12-14 mm is needed for the overdenture and attachment components. Patients with well-formed alveolar ridges may not have sufficient interarch space to use an overdenture. , This clinical report describes prosthodontic rehabilitation of lower arch using tooth-supported Preci-Sagix (Ceka attachments Preci-line, Belgium) overdenture system with mesially placed stud attachment coping design as a means of addressing the limited interarch space situation.
| Case Report|| |
A 35-year-old female patient reported to the Department of Prosthodontics, Luxmi Bai Dental College, Patiala, with a chief complaint of difficulty in chewing and concerns of appearance due to missing teeth. Her medical history was noncontributory. On extraoral examination, she had a convex profile. On intraoral examination, she had completely edentulous favorable maxillary arch and moderately favorable mandibular arch with retained 33, 34, and 43 [Figure 1]. A routine clinical and radiographic evaluation was followed. Considering the patient's chief complaint, background, and condition of the oral cavity, definitive treatment plan included fabrication of a complete maxillary denture and a mandibular tooth-retained overdenture.
Diagnostic impressions were made using irreversible hydrocolloid impression material (Vignette Chromatic, Dentsply) and poured in type III dental stone (Kalstone, Kalabhai). Jaw relations were done on diagnostic mounting to assess the amount of space available for attachment and found to be insufficient. Hence, conventional stud attachment design was modified by fabricating custom-made Preci-Sagix attachments with mesially placed stud attachments which occupy less vertical space.
Intentional root canal treatment with 33, 34, and 43.
Maxillary arch-custom trays were fabricated on the preliminary cast using self-cure acrylic resin (Rapid Repair, Dentsply) tray material. Maxillary border molding using low fusing impression compound (green stick) (DPI Pinnacle Tracing Sticks) and final impression was made using zinc oxide eugenol impression material (DPI Impression Paste).
Mandibular arch-abutment teeth 33, 34, and 43 were prepared [Figure 2] to receive cast copings and the impression was made using putty and light-body addition silicon (AFFINIS™, Coltθne/Whaledent AG). Custom-made mesial stud attachment castings with cobalt chromium alloy were tried in patient's mouth and cemented with GIC (KETAC™ CEM, 3M ESPE, St. Paul, USA) [Figure 3]. Alginate impression was made and poured in type III dental stone. Full wax spacer was adapted, and custom tray was fabricated. Mandibular border molding using low fusing impression compound (green stick) (DPI Pinnacle Tracing Sticks) and final impressions were made in light-body addition silicone (AFFINIS, Coltθne/Whaledent AG). Master cast was poured in type IV dental stone (Kalrock, Kalabhai). Overdenture was fabricated by following the steps of the conventional complete denture [Figure 4] and [Figure 5]. Dentures were evaluated intraorally for retention, stability, support, occlusion, and esthetic.
The female component of Ceka Preci-Sagix is available in three different colors, i.e., white (less retention), yellow (normal retention), and red (increased retention).  The yellow female components were incorporated in the denture with the black fixing tool and held with the chairside rapid repair resin [Figure 6]. The denture was inserted and occlusal equilibrations were carried out. Postinsertion instructions were given [Figure 7] and [Figure 8]. A follow-up of 6 months reveals patient with healthy mucosa and successful rehabilitation using attachments.
| Discussion|| |
The phenomenon of residual ridge resorption following the removal of teeth has been well observed and documented in literature.  While the bone loss following the removal of teeth is stated to be rapid, progressive, irreversible, and inevitable; it is equally well observed that bone is maintained around standing teeth and implants.  Crum and Rooney studied and estimated the reduction in the height of the anterior part of the mandible in patients wearing complete upper and lower dentures as amounted to 5.2 mm, as compared with 0.6 mm for the overdenture patients over a period of 5 years. This represents 8 times more loss in the patients with complete dentures.  The teeth which are too weak to support a fixed partial denture and which are considered unsuitable to support a removable partial denture can often be usefully conserved and suitably modified to act as abutments for overdentures. Bar attachments compared to stud attachments require more amount of interocclusal space, it is unesthetic due to the bulkier denture base, and anterior teeth arrangement is difficult.  Due to these reasons, in this case, stud attachment was used. However, in marginal situations with inadequate vertical space or where bone support of the roots is minimal, a short dome-shaped coping is the recommended root preparation.  In this case, canines were used as abutments as they are the most important proprioceptive organs, the shape, position, and larger root length; larger periodontal attachment area makes them ideal abutments.  The reinforcement of the denture base with metal mesh was done not only to prevent fracture, but also to improve functional rigidity for occlusal stability and to distribute occlusal stress to the underlying denture- bearing areas as uniformly as possible.
| Conclusion|| |
An overdenture is a preventive prosthodontic concept with a multidisciplinary approach involving periodontic, endodontic, and prosthodontic intervention. In this case report, a patient with few remaining teeth was successfully treated with Preci-Sagix (Ceka attachments Preci-line, Belgium) overdenture attachments. In this case, mesially placed stud attachment overdenture coping design was used. The female component of Ceka Preci-Sagix is available in three different colors, i.e., white (less retention), yellow (normal retention), and red (increased retention). It is incorporated in denture which provides adequate retention to the final prosthesis. An overdenture improves retention, stability, maintains proprioception, prevents residual ridge resorption, and improves patient satisfaction.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
The academy of prosthodontics. The glossary of prosthodontic terms. J Prosthet Dent 2005;94:10-92.
Henking JP. Overdentures. J Dent 1982;10:217-25.
Winkler S. Essentials of Complete Denture Prosthodontics. 2 nd
ed.. New Delhi: AITBS Publishers; 2009.
Prince IB. Conservation of the supportive mechanism. J Prosthet Dent 196515:327-38.
Yalisove IL. Crown and sleeve-coping retainers for removable partial prosthesis. J Prosthet Dent 1966;16:1069-85.
Reitz PV, Weiner MG, Levin B. An overdenture survey: Preliminary report. J Prosthet Dent 1977;37:246-58.
Pasciuta M, Grossmann Y, Finger IM. A prosthetic solution to restoring the edentulous mandible with limited interarch space using an implant-tissue-supported overdenture: A clinical report. J Prosthet Dent 2005;93:116-20.
Low-profile attachments for implant-retained overdenture. Dent Abstr 2005;50:343-5. Reprinted from: Pasciuta M, Grossmann Y, Finger IM: A prosthetic solution to restoring the edentulous mandible with limited interarch space using an implant-tissue-supported overdenture: A clinical report. J Prosthet Dent 2005;93:116-120.
Toolson LB, Smith DE. A 2-year longitudinal study of overdenture patients. Part I: Incidence and control of caries on overdenture abutments. J Prosthet Dent 1978;40:486-91.
Tallgren A. The continuing reduction of the residual alveolar ridges in complete denture wearers: A mixed-longitudinal study covering 25 years. J Prosthet Dent 1972;27:120-32.
Crum RJ, Rooney GE Jr. Alveolar bone loss in overdentures: A 5-year study. J Prosthet Dent 1978;40:610-3.
Alsabeeha NH, Payne AG, Swain MV. Attachment systems for mandibular two-implant overdentures: A review of in vitro
investigations on retention and wear features. Int J Prosthodont 2009;22:429-40.
Preiskel HW. Overdentures Made Easy: A Guide to Implant and Root Supported Prostheses Preiskel, Harold W. London: Quintessence Pub Co. 1996.
Epstein DD, Epstein PL, Cohen BI, Pagnillo MK. Comparison of the retentive properties of six prefabricated post overdenture attachment systems. J Prosthet Dent 1999;82:579-84.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]