65839619 supradentalne proteze indikacije kontraindikacije tretman

8/12/2019 65839619 Supradentalne Proteze Indikacije Kontraindikacije Tretman

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OVERDENTURESOVERDENTURES

Indications, Contraindication andIndications, Contraindication and

Treatment ProcedureTreatment Procedure


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INTRODUCTIONINTRODUCTION

DEFINITIONSDEFINITIONSDEVELOPMENTDEVELOPMENT

RATIONALERATIONALE

CLASSIFICATIONCLASSIFICATION

ADVANTAGESADVANTAGES

INDICATIONSINDICATIONS

CONTRAINDICATIONCONTRAINDICATION

TREATMENT PROCEDURETREATMENT PROCEDURECONCLUSIONCONCLUSION

IMPLANT OVERDENTUREIMPLANT OVERDENTURE


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INTRODUCTIONINTRODUCTION

Overdenture, a complete orOverdenture, a complete orpartial prosthesis constructedpartial prosthesis constructedover existing teeth or rootover existing teeth or rootstructure, is not a new concept instructure, is not a new concept ina technical approach to aa technical approach to a

prosthetic problemprosthetic problem Indeed its use dates back overIndeed its use dates back over

100 yrs and it is one that has100 yrs and it is one that hasbecome increasingly morebecome increasingly morepopular since the emphasis ofpopular since the emphasis of

prevention in dentistryprevention in dentistry Preventive prosthodonticsPreventive prosthodontics

emphasizes the importance ofemphasizes the importance ofany procedure that can delay orany procedure that can delay oreliminate future prosthodonticeliminate future prosthodonticproblemsproblems


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DEFINITIONSDEFINITIONS

removable partial denture or complete denture removable partial denture or complete denturethat covers and rests on one or more remainingthat covers and rests on one or more remainingnatural teeth, the roots of natural teeth and!ornatural teeth, the roots of natural teeth and!ordental implantsdental implants

prosthesis that covers and is partially prosthesis that covers and is partiallysupported by natural teeth, natural tooth, rootssupported by natural teeth, natural tooth, rootsand!or dental implantsand!or dental implants

lso called as overlay dentures ! overlaylso called as overlay dentures ! overlay

prosthesis ! superimposed prosthesisprosthesis ! superimposed prosthesis GPT 8thed


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n overdenture is a denture that may ben overdenture is a denture that may be

supported by soft tissue, bone, the root of asupported by soft tissue, bone, the root of atooth, or a modified toothtooth, or a modified tooth

lso called as biologic denture, telescopeslso called as biologic denture, telescopes

denturedenture"eartwell


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DEVELOPMENTDEVELOPMENT

#he idea of leaving roots of natural teeth to support an#he idea of leaving roots of natural teeth to support anoverdenture is far from new$ even in 1%&', (edger hadoverdenture is far from new$ even in 1%&', (edger haddescribed a prosthesis resembling an overdenture whichdescribed a prosthesis resembling an overdenture whichwas referred to as )plates covering fangs* and this becamewas referred to as )plates covering fangs* and this becamethe title of a paper published by tkinson & yr laterthe title of a paper published by tkinson & yr later

In 1%'1, conference in +onneccticut produced increaseIn 1%'1, conference in +onneccticut produced increaseawareness of the value such roots might play inawareness of the value such roots might play insupporting a covering denturesupporting a covering denture

vans by 1%%% described a method of using roots actuallyvans by 1%%% described a method of using roots actuallyto retain restorationsto retain restorations

ssig in 1%-' and Peeso around the same timessig in 1%-' and Peeso around the same timeprescribed a telescoic.like copingprescribed a telescoic.like coping

/illiam "unter mentioned the necessity to devitalize most/illiam "unter mentioned the necessity to devitalize mostof the roots employed for prosthesisof the roots employed for prosthesis


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In 1-' and 1-'- #alligren showed that over a yr periodIn 1-' and 1-'- #alligren showed that over a yr periodthe reduction of anterior ridge height of the mandible is the reduction of anterior ridge height of the mandible is times than that of the maxillary edentulous ridge2 #hesetimes than that of the maxillary edentulous ridge2 #hese

findings were corrobrated by twod and +oy 31-45findings were corrobrated by twod and +oy 31-45 +rum and 6ooney31-%5 reported a yr study and claimed+rum and 6ooney31-%5 reported a yr study and claimed

that the retention of mandibular canines of overdenturesthat the retention of mandibular canines of overdentureshelped preserve the remaining edentulous ridgehelped preserve the remaining edentulous ridge

In 1-%' a study reported on 17- implants placed in theIn 1-%' a study reported on 17- implants placed in themandibular symphysis of % patients2 #he implants weremandibular symphysis of % patients2 #he implants wereloaded immediately and restored with bars and overdentureloaded immediately and restored with bars and overdenturewith clips as retention and overall success rate was -8with clips as retention and overall success rate was -8

9otansky 31--75 publlished a survey of patients suffering9otansky 31--75 publlished a survey of patients sufferingfrom mandibular alveolar ridge atrophy who had beenfrom mandibular alveolar ridge atrophy who had been

treated with overdentures supported by ball attachments andtreated with overdentures supported by ball attachments andthe success rates of the individual implants -8 and of thethe success rates of the individual implants -8 and of thedentures were1008dentures were1008


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RATIONALERATIONALE

It maintains teeth as part of the residua rid!eIt maintains teeth as part of the residua rid!e #his gives#his givesthe patient a denture that has far more support than anythe patient a denture that has far more support than anyconventional appliance2conventional appliance2

A decrease in the rate of resorptionA decrease in the rate of resorption lveolar bone existslveolar bone exists

as a support for teeth2 If the teeth are removed the alveolaras a support for teeth2 If the teeth are removed the alveolarprocess begins a rate of resorption consistent with the length ofprocess begins a rate of resorption consistent with the length oftime the teeth have been missing 2:y retaining the mandibulartime the teeth have been missing 2:y retaining the mandibularcanines in the use of an over.denture, the resorption of thecanines in the use of an over.denture, the resorption of thealveolar bone surrounding the teeth was reduced by eightalveolar bone surrounding the teeth was reduced by eighttimes2times2

It aso heps in an increase in the patients manipuati"eIt aso heps in an increase in the patients manipuati"es#is in handin! the dentures#is in handin! the denture with the preservation of thewith the preservation of theteeth for an over.denture there is also the preservation of theteeth for an over.denture there is also the preservation of theperiodontal membrane that surrounds these teeth2 #hisperiodontal membrane that surrounds these teeth2 #hispreserves the proprioceptive impulses supplied by thepreserves the proprioceptive impulses supplied by the

periodontal membrane22periodontal membrane22


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RE$UIRE%ENTSRE$UIRE%ENTS

%aintenance of heath%aintenance of heath the most important aspect of thethe most important aspect of theover.denture is the maintenance of the health of the underlyingover.denture is the maintenance of the health of the underlyingtooth structures without which the over.denture cannot sustain2tooth structures without which the over.denture cannot sustain2

Reduction in cro&n'to'root ratioReduction in cro&n'to'root ratio #he reduction of the crown#he reduction of the crownhas an immediately favourable effect on tooth mobility becausehas an immediately favourable effect on tooth mobility becauseof the decrease in the length of the lever arm delivering theof the decrease in the length of the lever arm delivering the

tor;ue to the mobile tooth2tor;ue to the mobile tooth2 (asa seat tissue(asa seat tissue well fitting basal seat is essential to well fitting basal seat is essential to

distribute the load over as wide an area as possible2distribute the load over as wide an area as possible2 Simpicit) of constructionSimpicit) of construction #he appliance should be#he appliance should be

relatively simple to construct and maintain2relatively simple to construct and maintain2

Ease of manipuationEase of manipuation fre;uently with the use of retainingfre;uently with the use of retainingdevices the over.denture becomes a struggle for the patient todevices the over.denture becomes a struggle for the patient toinsert and remove2 #his should not be the case because aninsert and remove2 #his should not be the case because anunwanted force could seriously damage the base or theunwanted force could seriously damage the base or theabutment tooth therefore the design should be kept simple toabutment tooth therefore the design should be kept simple to

avoid such problems2avoid such problems2


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I


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In class III tongue positionIn class III tongue position Anife edged ridge that will provide inade;uate support2Anife edged ridge that will provide inade;uate support2 /hen pronounced vertical overlap of the anterior teeth is/hen pronounced vertical overlap of the anterior teeth is

re;uired to produce good esthetic results2re;uired to produce good esthetic results2 Bnilateral over denture can be given to provide a goodBnilateral over denture can be given to provide a good

function and esthetics a large amount of bone and soft tissuefunction and esthetics a large amount of bone and soft tissuehave been lost on one side of the arch2have been lost on one side of the arch2

Patients with badly worn out teeth2Patients with badly worn out teeth2 /hen complete denture will be opposed by retained/hen complete denture will be opposed by retained

mandibular anterior teeth preventing 3combination syndrome52mandibular anterior teeth preventing 3combination syndrome52

#herapeutics in the form of insitu irradiation 3Cobermott D#herapeutics in the form of insitu irradiation 3Cobermott D6osenberg 31-'756osenberg 31-'75


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+O


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+ontra indications for using periodontally involved teeth2+ontra indications for using periodontally involved teeth2

+lass III mobility due to the loss of alveolar bone that connot be+lass III mobility due to the loss of alveolar bone that connot becorrected2corrected2

=oft tissue and osseous defects which are not correctable by=oft tissue and osseous defects which are not correctable bysurgery2surgery2

@ailure to establish a sufficient zone of attached gingiva by@ailure to establish a sufficient zone of attached gingiva bymucogingival or grafting procedure2mucogingival or grafting procedure2

xcessive reduction of the adEacent residual alveolar ridge as axcessive reduction of the adEacent residual alveolar ridge as aresult of elimination of osseous defects for the establishment ofresult of elimination of osseous defects for the establishment ofnormal architecture2normal architecture2


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+ontra indications for ndodontic #reatment>+ontra indications for ndodontic #reatment>

Fertical fracture of the root 3or5 roots2Fertical fracture of the root 3or5 roots2 Cechanical perforation of the root canal2Cechanical perforation of the root canal2 Internal resorption that has perforated through the side of theInternal resorption that has perforated through the side of the

root2root2 :roken instrument in the root canal2:roken instrument in the root canal2

"orizontal fracture of the root below the bony crest2"orizontal fracture of the root below the bony crest2 #eeth that are grossly malposed will be difficult to use#eeth that are grossly malposed will be difficult to use

especially posterior teeth that are tilted more than 4&G2especially posterior teeth that are tilted more than 4&G2 =ingle rooted teeth with only one canal that is easily=ingle rooted teeth with only one canal that is easily

negotiable are the best candidates although multirooted teethnegotiable are the best candidates although multirooted teethcan also be used2 4 to week interval before commencingcan also be used2 4 to week interval before commencingfurther treatment on the tooth is helpful to determinefurther treatment on the tooth is helpful to determineendodontic complication if any2endodontic complication if any2


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ADVANTA1ESADVANTA1ES

Apart from theApart from thePreservation of alveolar bone and preservationPreservation of alveolar bone and preservationof proprioceptive response, it also provides =upport andof proprioceptive response, it also provides =upport andretention2retention2

It is also a simple approach to the compromised patients withIt is also a simple approach to the compromised patients with

+left palate+left palate

Partial anodontiaPartial anodontiaCicrodontiaCicrodontia

Patient acceptance H they experience a striking improvement inPatient acceptance H they experience a striking improvement infunction and esthetics while still maintaining some of their ownfunction and esthetics while still maintaining some of their ownteethteeth


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Caintenance of arch formsCaintenance of arch forms

+onvertibility H the over denture is designed in such a way that+onvertibility H the over denture is designed in such a way thatif for some reason the remaining teeth or root stumps has toif for some reason the remaining teeth or root stumps has tobe extracted the over.denture can be readily converted tobe extracted the over.denture can be readily converted toaccept the alteration2accept the alteration2

+ost H the initial cost may be a little higher but when compared+ost H the initial cost may be a little higher but when comparedover a period of time the low percentage of remakes and theover a period of time the low percentage of remakes and thealternative treatment of extensive fixed and removablealternative treatment of extensive fixed and removableprosthesis, the cost of an over.denture is favorableprosthesis, the cost of an over.denture is favorable

ase in construction and maintenance2ase in construction and maintenance2

(ower cost when compared to 62P292(ower cost when compared to 62P292


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DISADVANTA1ESDISADVANTA1ES

Over denture treatment is more expensive thanOver denture treatment is more expensive thanconventional denture because of periodontal andconventional denture because of periodontal andendodontic therapy and the subse;uent restoration ofendodontic therapy and the subse;uent restoration ofteeth with gold coping2teeth with gold coping2

:ulkier than @2P292 3or5 62P292:ulkier than @2P292 3or5 62P292

If oral hygiene is not maintained properly, patient*sIf oral hygiene is not maintained properly, patient*ssusceptible tosusceptible to cariescariesandand periodonta diseaseperiodonta disease

:ony under cuts may cause either over contouring or:ony under cuts may cause either over contouring orunder containing of the denture2under containing of the denture2

ncroachment of inter occlusal distance2ncroachment of inter occlusal distance2 sthetics2sthetics2

In many cases, owing to lack of available spaceIn many cases, owing to lack of available spacesections of the over denture base are ;uite thin2 If metalsections of the over denture base are ;uite thin2 If metalreinforcement is not used, fracture of the base andreinforcement is not used, fracture of the base and

prosthetic teeth is common2prosthetic teeth is common2


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T&o ma+or !roups of patients &ho -enefit from the o"er'T&o ma+or !roups of patients &ho -enefit from the o"er'dentures are*dentures are*

1roup 41roup 4 +omprises patients with few remaining teeth that may be+omprises patients with few remaining teeth that may be

healthy or with reversible periodontal disease, that arehealthy or with reversible periodontal disease, that arecoronally intact or malpositioned or morphologicallycoronally intact or malpositioned or morphologicallycompromised2compromised2

:efore commencing the treatment carry out:efore commencing the treatment carry out nalysis of articulated diagnostic casts which helps tonalysis of articulated diagnostic casts which helps to

determine the potential abutment teeth*s restorative anddetermine the potential abutment teeth*s restorative andndodontic re;uirements in the context of the proposed over.ndodontic re;uirements in the context of the proposed over.denture design2denture design2

@ull mouth radiographs@ull mouth radiographs

1roup II1roup II 9iagnosed with so called multilated or severely9iagnosed with so called multilated or severely

compromised dentitions2 #hese patients appear to be headingcompromised dentitions2 #hese patients appear to be headingin an edentulous direction2in an edentulous direction2


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Accordin! toAccordin! to 5AROLD5AROLD

T)pes of o"er'dentures areT)pes of o"er'dentures are

TransitionaTransitiona

#he #ransitional over denture consists of a modification of#he #ransitional over denture consists of a modification ofthe partial denture which the patient is already wearing, tothe partial denture which the patient is already wearing, toreplace further lost teeth or to cover the roots of over.denturereplace further lost teeth or to cover the roots of over.dentureabutments once the teeth have been cut down2abutments once the teeth have been cut down2

Trainin! denturesTrainin! dentures

=trictly speaking, these are not over.dentures, but they do=trictly speaking, these are not over.dentures, but they dohave many applications in over.denture techni;ues2 =uchhave many applications in over.denture techni;ues2 =uchdentures are commonly employed to replace hopeless posteriordentures are commonly employed to replace hopeless posteriorteeth once they have been extracted2teeth once they have been extracted2

Immediate'repacement o"er'denturesImmediate'repacement o"er'dentures

#hey are constructed before the last remaining teeth are#hey are constructed before the last remaining teeth areextracted and the over.denture abutments prepared2 trainingextracted and the over.denture abutments prepared2 trainingdenture is often converted to an immediate replacement overdenture is often converted to an immediate replacement overdenture that may with Eudicious relining be employed for severaldenture that may with Eudicious relining be employed for severalmonths or years2 ven when they are replaced such prosthesismonths or years2 ven when they are replaced such prosthesismay serve as spare dentures later onmay serve as spare dentures later on


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Definiti"e prosthesesDefiniti"e prostheses Bsually constructed at least ' months following extraction ofBsually constructed at least ' months following extraction of

the last teeth and the preparation of the over denture abutmentsthe last teeth and the preparation of the over denture abutments

O"er'dentures on impantsO"er'dentures on impants

Over dentures supported by implants are comparatively newOver dentures supported by implants are comparatively newarrivals on the prosthodontic scene2arrivals on the prosthodontic scene2

+ompared with an implant supported fixed partial denture an+ompared with an implant supported fixed partial denture animplant supported over.denture re;uiresimplant supported over.denture re;uires

(ess support(ess support Offers more flexibilityOffers more flexibility

=eldom causes speech difficulties=eldom causes speech difficulties nd is more economicalnd is more economical On the other hand, many workers have reported complicationsOn the other hand, many workers have reported complications

with maintenance therapy2 It has become apparent that implantswith maintenance therapy2 It has become apparent that implantsare particularly susceptible to overload, and especially to forcesare particularly susceptible to overload, and especially to forcesthat are non axial2that are non axial2

+onstruction of an over.denture supported by+onstruction of an over.denture supported by bothbothroots androots andimplant is normally ill.advisedimplant is normally ill.advised


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CLASSIFICATIONCLASSIFICATION

(road) cassified into(road) cassified into

Tooth'supported dentureTooth'supported denture

Impant Supported O"er DentureImpant Supported O"er Denture


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5eart&e6s cassification of tooth supported5eart&e6s cassification of tooth supported

denturedenture

:ased on the method of abutment:ased on the method of abutmentpreparation2preparation2

=imple tooth modification and=imple tooth modification andreductionreduction

#ooth reduction and coping#ooth reduction and coping ndodontic treatment and amalgamndodontic treatment and amalgam

plug ! compositeplug ! composite

ndodontic treatment and copingndodontic treatment and coping

ndodontic therapy with cast copingndodontic therapy with cast coping

utilizing some form of ttachmentsutilizing some form of ttachments =ubmerged vital roots2=ubmerged vital roots2

Copin! AttachmentsCopin! Attachments


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=imple tooth modification and reduction=imple tooth modification and reduction In this procedure remaining teeth are merely reshaped toIn this procedure remaining teeth are merely reshaped to

eliminate undercuts D reduced in vertical height to createeliminate undercuts D reduced in vertical height to create

more interoccusal spacemore interoccusal space #he results of this techni;ue in patients with microdontia#he results of this techni;ue in patients with microdontia

or partial anodontia are strikingor partial anodontia are striking

ndodontic treatment and amalgam plug! compositendodontic treatment and amalgam plug! composite

/idely used/idely used Indicated when there is normal coronal height to the teethIndicated when there is normal coronal height to the teeth

D normal interocclusal distance with little or no verticalD normal interocclusal distance with little or no verticaldimension lossdimension loss

In cases to create space without opening of verticalIn cases to create space without opening of verticaldimension, endodontic procedure performed, toothdimension, endodontic procedure performed, toothsectioned at the gingival margin or slightly above above itsectioned at the gingival margin or slightly above above it3 1.4 mm5 D the remaining dentin smoothened D polished3 1.4 mm5 D the remaining dentin smoothened D polishedthoroughly with amalgam! compositethoroughly with amalgam! composite


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butment with cast coping > +ast metal coping with a dome shapedbutment with cast coping > +ast metal coping with a dome shapedsurface and chamfer finish line at the gingival margin aresurface and chamfer finish line at the gingival margin are

fabricated and cemented2 #here are 4 distinct types of copings >fabricated and cemented2 #here are 4 distinct types of copings > 12 #he short coping, 42 #he long coping12 #he short coping, 42 #he long coping #he short coping > #hese are 4 to 7mm long and normally re;uire#he short coping > #hese are 4 to 7mm long and normally re;uire

endodontic therapy since the re;uired coronal tooth reductionendodontic therapy since the re;uired coronal tooth reductionwould expose the pulp2 ttached to the coping is a post, fitted towould expose the pulp2 ttached to the coping is a post, fitted to

the canals2 @or this reason canals should be obturated with softthe canals2 @or this reason canals should be obturated with softutta.Percha rather than metal points2utta.Percha rather than metal points2 (ong coping > #hese are normally & to %mm long2 n attempt is(ong coping > #hese are normally & to %mm long2 n attempt is

made to circumvent endodontic therapy by a conservativemade to circumvent endodontic therapy by a conservativereduction with a cellsopidal shaped coronal coping and anreduction with a cellsopidal shaped coronal coping and an

increased crown root ratio which re;uire greater level of osseousincreased crown root ratio which re;uire greater level of osseoussupport2 de;uate inter occlusal distance must exist to allow forsupport2 de;uate inter occlusal distance must exist to allow forencroaching on the available inter ridge space or a visualizationencroaching on the available inter ridge space or a visualizationof vertical dimension is liable to occur with poor esthetics andof vertical dimension is liable to occur with poor esthetics andfailure because of patient intolerancefailure because of patient intolerance


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butments with ttachments>butments with ttachments> Cost attachments are secured to the abutment by a cast coping2 #heCost attachments are secured to the abutment by a cast coping2 #he

obEective of any attachment is to improve retention of the denture base2obEective of any attachment is to improve retention of the denture base2:ecause of the factors like time, cost and risks the procedure should:ecause of the factors like time, cost and risks the procedure shouldreserved for patient with a favourable prognosis2 #he attachment does notreserved for patient with a favourable prognosis2 #he attachment does notreduce the crown root ratio significantly as does the cast coping2 "ere thereduce the crown root ratio significantly as does the cast coping2 "ere thelow caries index proper home care2 Periodontal health and inter ridgelow caries index proper home care2 Periodontal health and inter ridgedistance are absolutely necessary2distance are absolutely necessary2

=ubmerged vital roots > #his is of current research interest, it attempts to=ubmerged vital roots > #his is of current research interest, it attempts toobviate some basic problem associated with the more conventional overobviate some basic problem associated with the more conventional over

denture abutments2 In these cases selected vital roots are transected anddenture abutments2 In these cases selected vital roots are transected andreduced to 4mm below the crestal bone and then covered byreduced to 4mm below the crestal bone and then covered bymucoperiosteal flap2mucoperiosteal flap2

#he maEor problem associated are development of dehiscences and pulpal#he maEor problem associated are development of dehiscences and pulpalpathosis2 /hen this is done several advantages of the over denture arepathosis2 /hen this is done several advantages of the over denture arelost2lost2

=upport from direct contact of the denture base to the abutment tooth2=upport from direct contact of the denture base to the abutment tooth2 ttempts to gain retention fom the teeth through some form of attachment isttempts to gain retention fom the teeth through some form of attachment is

no longer possible2no longer possible2 #he loss of proprioception2#he loss of proprioception2


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(ocation and distribution of abutment >(ocation and distribution of abutment > Preference for anterior over posterior teeth therefore the alveolarPreference for anterior over posterior teeth therefore the alveolar

ridge appears to be more vulnerable to reduction than theridge appears to be more vulnerable to reduction than the

posterior alveolar ridge2posterior alveolar ridge2 #wo teeth in each ;uadrant presents an ideal situation in which#wo teeth in each ;uadrant presents an ideal situation in whichstress is distributed, over a rectangular area2 g > +uspid 4ndstress is distributed, over a rectangular area2 g > +uspid 4ndpremolar and!or 4nd molar in each ;uadrant2premolar and!or 4nd molar in each ;uadrant2

#he tripod is the next most favourable form for support and#he tripod is the next most favourable form for support and

stability2stability2 #he use of two teeth in each arch or one tooth in one arch has#he use of two teeth in each arch or one tooth in one arch hasmet with satisfactory results2met with satisfactory results2

Carrow recommends that it is better to use isolated teeth asCarrow recommends that it is better to use isolated teeth asabutments rather than adEacent teeth because they return to aabutments rather than adEacent teeth because they return to a

state of good health more readily and are easier for the patinet tostate of good health more readily and are easier for the patinet tomaintain hygiene2maintain hygiene2 #he upper anterior teeth should be retained if opposed by natural#he upper anterior teeth should be retained if opposed by natural

lower anterior teeth to prevent the destruction of the anteriorlower anterior teeth to prevent the destruction of the anteriorridge when utilized in a maxillary over denture2ridge when utilized in a maxillary over denture2

Candibular cuspids are most often utilized since they are usuallyCandibular cuspids are most often utilized since they are usuallythe last tooth to be lostthe last tooth to be lost


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Over 9enture ttachmentsOver 9enture ttachments

nn attachmentattachmentis a mechanical device for the fixation, retention andis a mechanical device for the fixation, retention andstabilization of a dental prosthesesstabilization of a dental prostheses

ttachments +lassification2ttachments +lassification2 ccording to shape, design and primary area of use2ccording to shape, design and primary area of use2

+oronal+oronal>> Intra coronalIntra coronal

xtra coronalxtra coronal.6esilient2.6esilient2

. #elescope stud attachments#elescope stud attachments :ar attachments:ar attachments

.:ar Joints.:ar Joints

.:ar Bnits.:ar Bnits


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ccessory > uxiliary attachmentsccessory > uxiliary attachments =crew units2=crew units2 Pawl connectors2Pawl connectors2 :olts2:olts2 =tabilizers ! balancers2=tabilizers ! balancers2 InterlocksInterlocks

Pins!screws2Pins!screws2 6ests26ests2

CagnetsCagnets >> Permanent magent2Permanent magent2

Induced magnet2Induced magnet2 Open field2Open field2 +losed field+losed field

xtra +oronalxtra +oronal IntraIntra


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xtra +oronalxtra +oronal IntraIntra erber attachmentserber attachments Kest nchorKest nchor

9albo attachment9albo attachment

+eka attachment+eka attachment 6othermann attachment6othermann attachment

Infrofix attachmentInfrofix attachment

=chubiger attachment=chubiger attachment

Luinlican attachmentLuinlican attachment

#he compact unit 3Priska5#he compact unit 3Priska5

:attesti units:attesti units

+onod unit+onod unit

:aer and @ah units:aer and @ah units

Aurer stud attachmentAurer stud attachment


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#here are a few systems which work in the reverse2 eg2#here are a few systems which work in the reverse2 eg2Kest nchor2 few studs are anteriorly rigid 3because theKest nchor2 few studs are anteriorly rigid 3because thesize makes it difficult to prevent a small amount ofsize makes it difficult to prevent a small amount ofmovement between the two components52 In somemovement between the two components52 In somesprings are specifically incorporated to allow a controlledsprings are specifically incorporated to allow a controlled

degree of movement2degree of movement2dvantages >dvantages >

6etention, stability and support26etention, stability and support2 positive lock of certain units can maintain the border positive lock of certain units can maintain the border

seal of the dentureseal of the denture


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A recent a- stud) -) Tha)er and Caputo 7489:; empo)edA recent a- stud) -) Tha)er and Caputo 7489:; empo)edphoto'eastic stress ana)sis* The) found that forcesphoto'eastic stress ana)sis* The) found that forcesappied to a Doder -ar &ere reso"ed in an apicaappied to a Doder -ar &ere reso"ed in an apicadirection &here as stud attachments en!a!in! the do&edirection &here as stud attachments en!a!in! the do&eretained diaphra!m mi!ht produce tippin! potentias*retained diaphra!m mi!ht produce tippin! potentias*

Le"era!e effect upon the root has aso an effect onLe"era!e effect upon the root has aso an effect onattachment seection* %outh preparation, ease of re-asin!attachment seection* %outh preparation, ease of re-asin!and repair procedures aso determine the t)pe of studand repair procedures aso determine the t)pe of stud

attachment*attachment* The num-er of stud attachment /The num-er of stud attachment / One stud attachment on each side of the arch &i usua)One stud attachment on each side of the arch &i usua)

suffice other remainin! roots can -e co"ered &ith simpesuffice other remainin! roots can -e co"ered &ith simpecopin!s* Increased num-er of attachments in a denturecopin!s* Increased num-er of attachments in a denture

does not produce a correspondin! impro"ement indoes not produce a correspondin! impro"ement inretention*retention*


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POPULAR ATTAC5%ENT Smm hi!h &ithspherica shape mae section,spherica shape mae section,

eas) to cean* The fin!ers of theeas) to cean* The fin!ers of thesoc#et are surrounded -) n)onsoc#et are surrounded -) n)onrin!s that simpifies ad+ustmentsrin!s that simpifies ad+ustments

Ad+ustments are simpe to carr)Ad+ustments are simpe to carr)out* Retention can -e increasedout* Retention can -e increased-) aterin! free ends of ameae-) aterin! free ends of ameae

Ad+uncts /Ad+uncts /

Ad+ustin! toos / Ti!htenin!Ad+ustin! toos / Ti!htenin!de"ice* Compimentar) too*de"ice* Compimentar) too*De"ice to repace n)on see"e*De"ice to repace n)on see"e*Reocatin! do&e for re-asin!Reocatin! do&e for re-asin!impressionimpression


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1er-er Attachments1er-er Attachments//


37/84

11

Resiient that ao&s "ertica mo"ementResiient that ao&s "ertica mo"ement

Ri!id attachment 7popuar;*Ri!id attachment 7popuar;* Retention of -oth t)pes of 1er-erRetention of -oth t)pes of 1er-er

attachment is o-tained -) aattachment is o-tained -) aretainin! sprin! in the femae unitretainin! sprin! in the femae uniten!a!in! a periphera !roo"e in theen!a!in! a periphera !roo"e in themae section* The sprin! cip ma) -emae section* The sprin! cip ma) -eremo"ed for ad+ustment -)remo"ed for ad+ustment -)unscre&in!* The -ase of the femaeunscre&in!* The -ase of the femae

unit usin! the specia instrumentunit usin! the specia instrumentpro"idedpro"ided

(oth t)pes of mae unit scre&ed on(oth t)pes of mae unit scre&ed onto their soderin! -ase andto their soderin! -ase andpre"ented from unscre&in! &ith apre"ented from unscre&in! &ith a

itte resin cement* The) ma) -eitte resin cement* The) ma) -eunscre&ed in the mouth &ith aunscre&ed in the mouth &ith aheated scre& dri"er* Lea"in!heated scre& dri"er* Lea"in!e3posed a scre& thread pro+ectin!e3posed a scre& thread pro+ectin!from the -ase of the attachmentfrom the -ase of the attachment


38/84

1er-er pointed out that if t&o or more teeth &ere1er-er pointed out that if t&o or more teeth &ere

used, the most dista attachment shoud ao& moreused, the most dista attachment shoud ao& more

"ertica pa) than the anterior ones, as it is i#e) that"ertica pa) than the anterior ones, as it is i#e) that

!reater dispacin! force &oud -e appied to the moar!reater dispacin! force &oud -e appied to the moar

surfaces of the prosthesissurfaces of the prosthesis


39/84

Ce#a S)stemCe#a S)stem

T&o t)pesT&o t)pes Ri!idRi!id

Resiient*Resiient* Ri!id and Resiient desi!ns share aRi!id and Resiient desi!ns share a

common -ase*common -ase* (ut the Ce#a e3tracorona units are(ut the Ce#a e3tracorona units are

not identica*not identica*

Therefore it is not possi-e toTherefore it is not possi-e tochan!e resiient for ri!idchan!e resiient for ri!idconstructions mere) -) chan!in!,constructions mere) -) chan!in!,the retention portions*the retention portions*

The "ertica tra"e ao&ed -) theThe "ertica tra"e ao&ed -) the

resiient stud unit is :*>mm* theresiient stud unit is :*>mm* theretention pin or mae section isretention pin or mae section isscre&ed on to the -ase rin! has ascre&ed on to the -ase rin! has arounded shape &ider at top spitrounded shape &ider at top spit"ertica) into > sections &hich are"ertica) into > sections &hich arefe3i-e capa-e of -ein!fe3i-e capa-e of -ein!compressedcompressed


40/84

Anciiar) instruments /Anciiar) instruments /

MLocatin! de"iceLocatin! de"iceMAd+ustments de"iceAd+ustments de"iceMChan!in! attachmentsChan!in! attachmentsMRepair and re-asin! de"iceRepair and re-asin! de"ice

MLimitin! factor is the "erticaLimitin! factor is the "erticaspace reuired -) the unitspace reuired -) the unit

resutin! in mm "erticaresutin! in mm "ertica

space reuirement for thespace reuirement for the

attachment componentsattachment components

ith ll tt h t t ith ll tt h t t


41/84

s with all attachments systemss with all attachments systemstheir alignment with each othertheir alignment with each otherand the path of insertion of theand the path of insertion of theprosthesis must be planned2prosthesis must be planned2

#he attachment base is soldered#he attachment base is solderedto the prepared flat surface ofto the prepared flat surface ofthe coping2 #he spring pin orthe coping2 #he spring pin ormale section may be removedmale section may be removedfrom its base, so this allowsfrom its base, so this allows

considerable versatility, sinceconsiderable versatility, sincebreakage of the pin is easilybreakage of the pin is easilysolved by removing it andsolved by removing it andreplacing it with another unit2replacing it with another unit2

#his is done by a special tool#his is done by a special toolprovided with which the springprovided with which the spring

pin is unscrewed2 /hile thepin is unscrewed2 /hile theother end of the special tool mayother end of the special tool maybe used to increase the retentionbe used to increase the retentionby means of the wedge shapeby means of the wedge shapeinstrumentinstrument

Ce#aCe#a

specia toospecia too


42/84

IntrofixIntrofix is a solid tall cylinderis a solid tall cylinder

attachment that can be usedattachment that can be used

for fixed removable bridgefor fixed removable bridge

work as well as forwork as well as for

overdenturesoverdenturesIt consists of 7 partsIt consists of 7 parts

solder bar solder bar

replaceable and adEustable replaceable and adEustable

male friction partmale friction part

female cylindrical housing female cylindrical housing

IntrofixIntrofix


43/84

dvantagesdvantages 9isadvantages9isadvantages

=imple to use=imple to use +omponents are+omponents are

replaceable andreplaceable andinterchangeable with theinterchangeable with thesolder base of the ancrofixsolder base of the ancrofix

3resilient type53resilient type5

#he attachment provides#he attachment providesgood seating and retentiongood seating and retention

+an be used in+an be used in

combination with resilientcombination with resilientattachmentsattachments

=ervice life is indefinite=ervice life is indefinite

Paralleling necessaryParalleling necessary Processed in theProcessed in the

laboratorylaboratory

#or;ue potential is#or;ue potential is

maximum if denturesmaximum if denturesbase is not adaptedbase is not adaptedproperlyproperly

IntrofixIntrofix


44/84

=chubiger=chubiger +onsists of a short screw+onsists of a short screw

37mm in diameter5 block for37mm in diameter5 block forbar fixation a larger 3724mm5bar fixation a larger 3724mm5one for fixed removableone for fixed removablebridge work and an individualbridge work and an individualcap core system2cap core system2

Over denture attachmentsOver denture attachmentshas 7 parts2has 7 parts2

=older base common to the=older base common to theerber2erber2

sleeve in ceramic metal2 sleeve in ceramic metal2

cap nut2 cap nut2 Overall height is 42%mmOverall height is 42%mm :ar is soldered to the sleeve:ar is soldered to the sleeve


45/84

=chubiger=chubiger


llows complete flexibilityllows complete flexibility

Provides for bar fixation2Provides for bar fixation2

Permits conversation fromPermits conversation frombar to individual studbar to individual studfixationfixation

:ulk:ulk

3erber5 Paralleling is3erber5 Paralleling isnecessarynecessary

+omplex and expensive2+omplex and expensive2


46/84

Rothermann UnitRothermann Unit Ri!id 7ess hei!ht 4mm;*Ri!id 7ess hei!ht 4mm;* Resiient 7more hei!ht 4*mm;*Resiient 7more hei!ht 4*mm;*

Ad"anta!es / Reuires itte "erticaAd"anta!es / Reuires itte "erticaspace and toerance for imitedspace and toerance for imitedmisai!nment of attachments*misai!nment of attachments*

It is a -utton shaped attachment &ith theIt is a -utton shaped attachment &ith themae unit incorporatin! a !roo"e ofmae unit incorporatin! a !roo"e ofune"en depth*une"en depth*

The cip of the femae section sides o"erThe cip of the femae section sides o"erthe tapered upper ed!e of the mae* .iththe tapered upper ed!e of the mae* .iththe free ends of the femae en!a!in! thethe free ends of the femae en!a!in! thedeepest retainin! !roo"e*deepest retainin! !roo"e*

The femae cip is desi!ned to -eThe femae cip is desi!ned to -eretained &ith acr)ic resin*retained &ith acr)ic resin*

A modified "ersion of the cip is no&A modified "ersion of the cip is no&a"aia-e &ith ta!!in! that runs at ri!hta"aia-e &ith ta!!in! that runs at ri!htan!es to the ori!ina desi!n* Apart froman!es to the ori!ina desi!n* Apart fromthe minima "ertica space reuirementthe minima "ertica space reuirementan additiona ad"anta!eis the toerancean additiona ad"anta!eis the toerancefor imited misai!nment of attachmentfor imited misai!nment of attachment

6II9

6=I(I


47/84

O H ring system ! :all attachmentO H ring system ! :all attachment

O ? rin! are dou!hnut shaped,O ? rin! are dou!hnut shaped,

s)nthetic po)mer that posses thes)nthetic po)mer that posses thea-iit) to -end &ith resistance thena-iit) to -end &ith resistance then

return to their appro3imate positionreturn to their appro3imate position

The O rin! attaches to post &ith aThe O rin! attaches to post &ith a

!roo"e or undercut area caed the!roo"e or undercut area caed the

interna ca"it) of the meta or pasticinterna ca"it) of the meta or pastic

encapsuator, &hich permits eas)encapsuator, &hich permits eas)

repacement of rin! after &earin! orrepacement of rin! after &earin! or

dama!e for the rin!dama!e for the rin!

The O rin! reuires 'mm hei!ht, theThe O rin! reuires 'mm hei!ht, the

!reatest of an) attachments!reatest of an) attachments

O rin! post usua) made of machinedO rin! post usua) made of machinedtitanium ao) or cast in precioustitanium ao) or cast in precious

metameta

Post has a head* (od) nec#* ThePost has a head* (od) nec#* The

-od) of post is connected to the-od) of post is connected to the

impant a-utment or superstructureimpant a-utment or superstructure

-ar-ar


48/84

O H ring systemO H ring system

ADVANTA1EADVANTA1E

Ease in chan!in! the attachmentEase in chan!in! the attachment

.ide ran!e of mo"ement.ide ran!e of mo"ement

Lo& costLo& cost

Different de!ree of retentionDifferent de!ree of retention Possi-e eimination of time cost of a superstructure for thePossi-e eimination of time cost of a superstructure for the

prosthesisprosthesis


49/84

INTRA RADICULAR STUD TTAC5%ENTSINTRA RADICULAR STUD TTAC5%ENTS The ad"anta!es of this s)stem ies in costThe ad"anta!es of this s)stem ies in cost

and space reuirements* The) do notand space reuirements* The) do notreuire precious meta copin! do&e norreuire precious meta copin! do&e nor

specia a-orator) procedures* The) arespecia a-orator) procedures* The) arereati"e) simpe and uic#*reati"e) simpe and uic#*

est Anchor s)stemest Anchor s)stem// It deri"es its retention from &ithin the rootIt deri"es its retention from &ithin the root A post preparation is made &ithin the rootA post preparation is made &ithin the root

a femae see"e is cemented to pace a femae see"e is cemented to pace

A mae eement that is n)on post a -aA mae eement that is n)on post a -ahead that is incorporated in the denturehead that is incorporated in the denture-ase and pro+ects do&n&ards, en!a!in! a-ase and pro+ects do&n&ards, en!a!in! arecess in the root preparation, further therecess in the root preparation, further theoads are appied at a point* That is &eoads are appied at a point* That is &eapica to the !in!i"a mar!in of the root*apica to the !in!i"a mar!in of the root*

A "ariet) of a-utments ma) -e empo)edA "ariet) of a-utments ma) -e empo)edincudin! hemisected moar roots* @ si0esincudin! hemisected moar roots* @ si0esof 0est anchor are a"aia-e dependin! onof 0est anchor are a"aia-e dependin! onthe root en!th and diameter*the root en!th and diameter*

The s)stems has -een e3tensi"e) refinedThe s)stems has -een e3tensi"e) refinedo"er the )ears and a comprehensi"e #it iso"er the )ears and a comprehensi"e #it is

no& a"aia-eno& a"aia-e


50/84

#he vertical space re;uirements are the#he vertical space re;uirements are thesame as 6othermann unitsame as 6othermann unit

9F


51/84

DISADVANTA1ESDISADVANTA1ES Since no castin! or copin! usua) made,Since no castin! or copin! usua) made,

the root or cana itsef suscepti-ie tothe root or cana itsef suscepti-ie tocariescaries

The n)on studs ma) -ent or e"en fracture,The n)on studs ma) -ent or e"en fracture,pre"entin! seatin! of the appiance,pre"entin! seatin! of the appiance,especia) if se"era are -ein! used thusespecia) if se"era are -ein! used thusreuire freuent reca "istsreuire freuent reca "ists

Vertica fracture of the rootVertica fracture of the rootINDICATIONINDICATION

Idea for use in an interim o"erdentureIdea for use in an interim o"erdenture


52/84


53/84

(ar Attachments(ar Attachments

The -ar attachments hep in spintin! of the a-utmentThe -ar attachments hep in spintin! of the a-utmentteeth, retention and support of the appiance* Theteeth, retention and support of the appiance* Theinter occusa space a"aia-iit) has aread) -eeninter occusa space a"aia-iit) has aread) -eenemphasi0ed*emphasi0ed*

(ar attachments are cassified into t&o t)pes -ar(ar attachments are cassified into t&o t)pes -ar

units and -ar +oints*units and -ar +oints* (ar unit has a ri!id fi3ation &here there is no(ar unit has a ri!id fi3ation &here there is no

mo"ement -et&een the -ar and o"er)in! see"e andmo"ement -et&een the -ar and o"er)in! see"e andcan -e cassified as tooth -orn*can -e cassified as tooth -orn*

(ar +oints permits rotationa mo"ement -et&een(ar +oints permits rotationa mo"ement -et&een

see"e and -ar and deri"es more or residua rid!esee"e and -ar and deri"es more or residua rid!esupport*support*


54/84

T)pes of (ar Attachments /T)pes of (ar Attachments /

5ader (ar*5ader (ar* Doder -ar attachment*Doder -ar attachment* (a#er cips*(a#er cips*

Ac#erman cips andAc#erman cips and C*%* cipC*%* cip

5ADER (AR ATTAC5%ENT5ADER (AR ATTAC5%ENT


55/84

5ADER (AR ATTAC5%ENT5ADER (AR ATTAC5%ENT Can ser"e as a -ar +oint or a -ar unit*Can ser"e as a -ar +oint or a -ar unit* Can -e used as a stud attachment and aCan -e used as a stud attachment and a

-ar attachment*-ar attachment* Consists of preformed pastic -ars andConsists of preformed pastic -ars andcipscips

5emet 5ader de"eoped the 5ader -ar 5emet 5ader de"eoped the 5ader -ar rider s)stem in the ate 48F:6srider s)stem in the ate 48F:6s

Its present form has -een in use forIts present form has -een in use foramost 2: )rsamost 2: )rs En!ish, Donne Stau-i modified theEn!ish, Donne Stau-i modified the

s)stem in 488@ to form the 5ader EDSs)stem in 488@ to form the 5ader EDSs)stems)stem

The EDS 5ader s)stem is on) 2mm hi!h,The EDS 5ader s)stem is on) 2mm hi!h,&hereas the ori!ina &as 9*2mm in hei!ht&hereas the ori!ina &as 9*2mm in hei!ht


56/84

#he clips have 7 different retention#he clips have 7 different retentionstrengths D a 40strengths D a 40 00clip rotation whichclip rotation whichgreatly improves the flexibility of thegreatly improves the flexibility of the

system for a range of patient needs orsystem for a range of patient needs ordesiredesire #he clip rotation compensates for the#he clip rotation compensates for the

resilence of the tissue which is usuallyresilence of the tissue which is usually02& H 1 mm in the mandible02& H 1 mm in the mandible

#he standard or 9= "ader bar has a#he standard or 9= "ader bar has around superior aspect D an apronround superior aspect D an aprontoward the tissue below which acts astoward the tissue below which acts asa stiffener to improve the strength ofa stiffener to improve the strength ofthe bar D limit its flexibilitythe bar D limit its flexibility

6ound bar designs flexes in relation to6ound bar designs flexes in relation to?? i2e2, bar twice as long flexesi2e2, bar twice as long flexes4?4?4?4N 1' times more4?4?4?4N 1' times more


57/84

@abrication >@abrication >

#he plastic bar is attached to the wax copings#he plastic bar is attached to the wax copingsand is cast with the coping2and is cast with the coping2

Plastic clip is embedded in the denture forPlastic clip is embedded in the denture forretention2retention2

:ut metal clip offers more retention than the:ut metal clip offers more retention than theplastic2 Plastic clip wears off rapidly2 @or moreplastic2 Plastic clip wears off rapidly2 @or more

retention additional clips can be added andretention additional clips can be added andtension of the metal clip can be increasedtension of the metal clip can be increased


58/84

"ader :ar"ader :ar>>

#he total height of the#he total height of the

"ader bar and clip"ader bar and clip

assembly is as low as assembly is as low as

mmmm


59/84


:ars can be fabricated in:ars can be fabricated inany alloy2any alloy2

6etention can be improved6etention can be improvedby patient or dentist2by patient or dentist2

@or more retention metal@or more retention metalclip can be used2clip can be used2

ssembly techni;ue isssembly techni;ue issimple2simple2

+apability to follow+apability to followgingival contours2gingival contours2

6ider is too bulky6ider is too bulkyocclusogingivally2occlusogingivally2

@or additional retention@or additional retentionmore metal clips should bemore metal clips should be

addedadded

Doder (arDoder (ar


60/84

5as -ar unit and -ar +oint5as -ar unit and -ar +oint Preformed -ars are a"aia-e forPreformed -ars are a"aia-e for

-ar units*-ar units* Shape of the -ar, has paraeShape of the -ar, has parae

sides &ith a rounded top*sides &ith a rounded top* Retention is -) means ofRetention is -) means of

frictiona fit*frictiona fit* Non resiient attachment*Non resiient attachment* =a-rication /=a-rication /

The preformed -ars areThe preformed -ars aresodered to the copin!s and thesodered to the copin!s and thesee"e is em-edded in thesee"e is em-edded in theacr)ic o"er denture*acr)ic o"er denture*

Ad"anta!es /Ad"anta!es / A"aia-iit) of t&o differentA"aia-iit) of t&o different

hei!hts 4*>F mm and 2*Fmm*hei!hts 4*>F mm and 2*Fmm* Rider and -ar are a"aia-e inRider and -ar are a"aia-e in

an) en!ths*an) en!ths* Spacer ao&s "ertica andSpacer ao&s "ertica and

rotationa mo"ement*rotationa mo"ement* Crossection throu!h pear shapedDo-er -ar retainin! see"e

incorporated into impression

surface of o&er denture


61/84


62/84

:aker +lip:aker +lip

+onsists of )B* shaped clip designed to fit over a round wire2 14+onsists of )B* shaped clip designed to fit over a round wire2 14and 1 roung gauge wire are used2 #hese wires are soldered toand 1 roung gauge wire are used2 #hese wires are soldered tothe copings2 +lip is positioned over the wire and is attached tothe copings2 +lip is positioned over the wire and is attached tothe over denture with cold cure resin2the over denture with cold cure resin2

:aker +lip >:aker +lip >

dvantages >dvantages >

dEustable and provides rotational movement2dEustable and provides rotational movement2

6eadily available26eadily available2

9isadvantages >9isadvantages >


63/84

#hese are bar Eoints2#hese are bar Eoints2

:oth are similar in designs2:oth are similar in designs2

+onsists of a rounded bar and clip,+onsists of a rounded bar and clip,where the clip fits over the bar2where the clip fits over the bar2

#he slip has retention wings for the#he slip has retention wings for theeasy engagement into the acrylics2easy engagement into the acrylics2

llows vertical and rotationalllows vertical and rotationalmovement because of fixation2movement because of fixation2

Provides an excellent retention forProvides an excellent retention for

overdenture when bar Eoint systemoverdenture when bar Eoint systemis used2is used2

dvantages >dvantages >

6ider is provided with retention26ider is provided with retention2

=paces provides resiliences and=paces provides resiliences and

rotation 3or5 rotation alone if therotation 3or5 rotation alone if theshim is not used2shim is not used2


#he basis can be only 12-mm in#he basis can be only 12-mm indiameterdiameter

C i 9 6 iC ti 9 t 6 t ti


64/84

Cagnetic 9enture 6etentionCagnetic 9enture 6etention #hese have been in existance#hese have been in existance

since 1-702since 1-702

#hey can be divided into groups2#hey can be divided into groups2#hose depending on the mutual#hose depending on the mutual

repulsion of like magnetic poles2repulsion of like magnetic poles2e2g22 @riedman magnetice2g22 @riedman magneticstabilizers52stabilizers52

9isadvantages >9isadvantages > (ess retentive when most needed(ess retentive when most needed

3when Eaws are part53when Eaws are part5 +ontinued resorbtion2+ontinued resorbtion2

#hose depending on the mutual#hose depending on the mutual

attraction unlike poles2attraction unlike poles2 9isadvantages > One continuous9isadvantages > One continuous

attracting forces could cause theattracting forces could cause theembedded bar magnets to moveembedded bar magnets to movethrough the bone, corrrode thethrough the bone, corrrode the

soft tissues and becomesoft tissues and become


65/84

In order to know about magnetic over denture the fieldIn order to know about magnetic over denture the field

strength and magnetic permanence are 4 terms which re;uirestrength and magnetic permanence are 4 terms which re;uire

clear understanding2 @or dental use a high magnetic fieldclear understanding2 @or dental use a high magnetic fieldstrength is desirable as this will provide stronger retention2strength is desirable as this will provide stronger retention2

"igh permanence is essential for 315 it ensures magnet will be"igh permanence is essential for 315 it ensures magnet will be

less likely to lose its magnetism2 345 small magnet can beless likely to lose its magnetism2 345 small magnet can be

made without the north pole demagnetising the south pole2made without the north pole demagnetising the south pole2

Bntil 1-0 magnets for dental purpose were either lnico 3l,Bntil 1-0 magnets for dental purpose were either lnico 3l,

+o,


66/84



67/84

=mall root surface of some supporting root limit the=mall root surface of some supporting root limit thesize of magnet that can be inserted and limit retention2size of magnet that can be inserted and limit retention2

#he magnet alloy can corrode and fracture in the#he magnet alloy can corrode and fracture in themouth2mouth2

n avoidable magnetic field surrounds both the intran avoidable magnetic field surrounds both the intraradicular and denture magnets2radicular and denture magnets2

#hese disadvantage was over come by replacement of#hese disadvantage was over come by replacement ofone magnet with a magnetisable low intrinsic alloy,one magnet with a magnetisable low intrinsic alloy,without significant loss of retention2 casting alloywithout significant loss of retention2 casting alloybased on palladium, cobalt and nickle is cast as rootbased on palladium, cobalt and nickle is cast as root

cap and dowel and fitted to the supporting root2 #hecap and dowel and fitted to the supporting root2 #hecasting because of its magnetic coercivity becomes acasting because of its magnetic coercivity becomes astrong induced magnet and retains the denture like anstrong induced magnet and retains the denture like anintraradicular permanent magnet2intraradicular permanent magnet2


68/84

:iological ffects of +obalt!=amarium Cagnets >:iological ffects of +obalt!=amarium Cagnets > #here are two ways in which +o!=a magnets could have an#here are two ways in which +o!=a magnets could have an

effect on tissues>effect on tissues>

Physical effect because of the presence of magnetic fieldPhysical effect because of the presence of magnetic fieldgradient2gradient2

+hemical effect due to wear or corrosion products of alloy2+hemical effect due to wear or corrosion products of alloy2 :ehrman 31-'05 in his study concluded that magnetic is:ehrman 31-'05 in his study concluded that magnetic is

completely innocuous to tissues2 =imilar conclusions werecompletely innocuous to tissues2 =imilar conclusions werereached by #oto and +houkas2reached by #oto and +houkas2 #sutsui and his colleagues 31--5 found alloy to be innocuous in#sutsui and his colleagues 31--5 found alloy to be innocuous in

tissue culture test due to corrosion resistance2 #he wear rate oftissue culture test due to corrosion resistance2 #he wear rate ofunprotected faces of magnets used for over denture retentionunprotected faces of magnets used for over denture retentionhas been found to be less than 1mm!s;mm!year2 3illingshas been found to be less than 1mm!s;mm!year2 3illings1-%52 #his is several orders of magnitude less than the1-%52 #his is several orders of magnitude less than therecommended maximum ingestion levels for cobalt andrecommended maximum ingestion levels for cobalt andsamariumsamarium


69/84

#he external magnetic field can be virtually eliminated by#he external magnetic field can be virtually eliminated by

arranging paired magnets in a modified horse shoearranging paired magnets in a modified horse shoeconfiguration by which the retentive effect is almostconfiguration by which the retentive effect is almostdoubled2doubled2

#he explanation of this apparently anomalous doubling#he explanation of this apparently anomalous doublingeffect is that in the open configurations the north andeffect is that in the open configurations the north and

south pole facing each other contribute to the retention,south pole facing each other contribute to the retention,but the remaining =outh and


70/84

+omparison of magnetic retention and precision attachments+omparison of magnetic retention and precision attachments

=implicity2=implicity2

(ow cost2(ow cost2

=elf adEusting 3Orthodontic tooth movement for passing contact52=elf adEusting 3Orthodontic tooth movement for passing contact52

6eusable26eusable2

Inherent stress breaking2Inherent stress breaking2

6eseating after denture displacement26eseating after denture displacement2

@reedom of lateral and rotational denture movement2@reedom of lateral and rotational denture movement2

(ow potential for trauma to supporting roots2(ow potential for trauma to supporting roots2

ase of denture relining2ase of denture relining2


71/84

=B:C69 FI#( 6OO#= > #his is of current research=B:C69 FI#( 6OO#= > #his is of current researchinterest, it attempts to obviate some basic probleminterest, it attempts to obviate some basic problemassociated with the more conventional over dentureassociated with the more conventional over dentureabutments2 In these cases selected vital roots areabutments2 In these cases selected vital roots aretransected and reduced to 4mm below the crestal bonetransected and reduced to 4mm below the crestal boneand then covered by mucoperiosteal flap2and then covered by mucoperiosteal flap2

#he maEor problem associated are development of#he maEor problem associated are development of

dehiscences and pulpal pathosis2dehiscences and pulpal pathosis2/hen this is done several advantages of the over denture/hen this is done several advantages of the over dentureare lost2are lost2

=upport from direct contact of the denture base to the=upport from direct contact of the denture base to theabutment tooth2abutment tooth2

ttempts to gain retention form the teeth through somettempts to gain retention form the teeth through someform of attachment is no longer possibleform of attachment is no longer possible

+linical use of submerged vital roots as overdenture+linical use of submerged vital roots as overdentureabuments has yet not been successfulabuments has yet not been successful

Teescopic prosthesisTeescopic prosthesis


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Teescopic prosthesisTeescopic prosthesis Cinimum taper of copings is advised for best retention 3lessCinimum taper of copings is advised for best retention 3less

than & degrees of possible52 de;uate height of the axial wallsthan & degrees of possible52 de;uate height of the axial walls3at least mm53at least mm5

butments for telescopic prosthesis will be covered by twobutments for telescopic prosthesis will be covered by twolayers of metal while facial surfaces may re;uire facings aslayers of metal while facial surfaces may re;uire facings aswell2well2

#he poorly executed abutment preparations result in thin inner#he poorly executed abutment preparations result in thin innercoping that becomes perforated after a period of use also itcoping that becomes perforated after a period of use also itproduces a bulky and unsightly prosthesis2produces a bulky and unsightly prosthesis2

Occlusal reduction 4 H 7mm is minimum re;uirementOcclusal reduction 4 H 7mm is minimum re;uirement Carked reduction in restoration observed once the taperCarked reduction in restoration observed once the taper

increases beyond ' degreesincreases beyond ' degrees

+hamfer finish line is ideal+hamfer finish line is ideal Faluable in cleft palate patientFaluable in cleft palate patient #he removable section of the prosthesis re;uires e;ual care in#he removable section of the prosthesis re;uires e;ual care in

its planning as it is removable it re;uires sufficient strength toits planning as it is removable it re;uires sufficient strength towithstand handling by the patient2withstand handling by the patient2


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Treatment pannin!Treatment pannin!//The seuence and technica procedures of preparator)The seuence and technica procedures of preparator)

treatment remains the same for a #inds of tooth supportedtreatment remains the same for a #inds of tooth supporteddenturesdentures

The on) difference is in the desi!n of the a-utment teethThe on) difference is in the desi!n of the a-utment teeth

The foo&in! seuence can -e used as a !enera !uide -utThe foo&in! seuence can -e used as a !enera !uide -utnot necessari) in a situationsnot necessari) in a situations

Construct an immediate R3 caspess denture cast fromConstruct an immediate R3 caspess denture cast fromirre"ersi-e h)drocooid impressionirre"ersi-e h)drocooid impression

Remo"e the hopeess teeth insert the remo"a-e prosthesisRemo"e the hopeess teeth insert the remo"a-e prosthesis

Durin! heain! period institute the periodonta and endodonticDurin! heain! period institute the periodonta and endodontic

treatmenttreatment


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GG Copin! fa-ricationCopin! fa-rication


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GGCopin! fa-ricationCopin! fa-rication %a#e an accurate impression of the a-utment and%a#e an accurate impression of the a-utment and

pour a diepour a die

Car"e the &a3 pattern and pace the conca"it) inCar"e the &a3 pattern and pace the conca"it) inthe occusa surfacethe occusa surface Cast the copin!, and cement the poished copin!

to the tooth

GGDenture fa-ricationDenture fa-ricationPrimar) ImpressionPrimar) Impression ma#in!=ina impression ma#in!Record -ases and occusa rims prepared ' The on)

difference is the incorporation of the meta -earin! inthe record -ase* App) one thic#ness of -asepate&a3 to the a-utment ea"in! the occusa surfacee3posed* Seat the -earin! in the conca"it) sea it inpace &ith &a3* Construct the record -ase ofacti"ated acr)ic resin usin! sprin#e on techniue*Attach &a3 occusa rims to the -ase


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M Record ma3iomandi-uar reationM Tr)in! in the teeth La-orator) procedureM Contour the &a3M =as# the dentureM Eiminate the &a3

M At this step remo"e the meta -earin!s from theacr)ic resin tooth ceaned &ith -oiin! &ater dried

M The cast ao&ed to dr) and a-utment e3cept theconca"it) are painted &ith tin foi su-situte

M The meta -earin! seated in conca"it) and acopin! of acti"ated acr)ic resin &ith crossin#edmonomer made, usin! the sprin#e on techniue


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+linical experience supports the recommendation of at+linical experience supports the recommendation of atleast one abutment!;uadrant and the retained teethleast one abutment!;uadrant and the retained teethshould be preferably not be the adEacent ones, or thereshould be preferably not be the adEacent ones, or thereshould be several millimeters of space between theshould be several millimeters of space between thereduced tooth forms2reduced tooth forms2

Candibular canines are most often utilized because theyCandibular canines are most often utilized because theyare usually the last teeth to be lost2 If only a single toothare usually the last teeth to be lost2 If only a single tooth

remains this also should be retained as one tooth forremains this also should be retained as one tooth forsupport and bone preservation is better than none2support and bone preservation is better than none2

/hen +anines and premolars are present, it is better to/hen +anines and premolars are present, it is better tomaintain the canines and second premolars as this willmaintain the canines and second premolars as this willgive better support and also allows for more favorable oralgive better support and also allows for more favorable oral

hygiene2hygiene2

I%PLANT OVERDENTURE


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Patients who beneit !o""andib#$a! O%e!dent#!es

re usually elderly 3'& to%0 years5

re edentulous in themaxilla and mandible

"ave worn completedentures for many years

re uncomfortable with acomplete mandibulardenture

9emand stabilization ofdenture

If not yet edentulous, theyexhibit extremely reducedresidual dentition that cannotbe maintained

Patients who beneit !o" "a&i

O%e!dent#!esM re in the younger segment Of

older patients 3&0 to '0 years5

M "ave no experience with

maxillary removable prosthesis

M xhibit hopeless residual

maxiliary dentition

M re fearful of becoming

edentulous

"ave high esthetic demandsM "ave natural teeth or fixed

mandible

M 9esire fixed reconstruction

I


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Cinimum anterior bone loss$ prevents bone loss Improved esthetics Improved stability 3reduces or eliminates prosthesis movement5

Improved occlusion 3reproducible centric relation occlusion5 9ecrease in soft tissue abrasions Improved chewing efficiency and force Increased occlusal efficiency

Improved retention Improved support Improved speech 6educed prosthesis size 3eliminates palate flanges5

Improved maxillofacial prostheses

Impant O"erdenture Ad"anta!es

Impant O"erdenture Disad"anta!es


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Impant O"erdenture Disad"anta!es

butment crown height space re;uiredbutment crown height space re;uired

(ong term maintainence(ong term maintainence

@ood impaction@ood impaction

+ontinued posterior bone loss+ontinued posterior bone loss

G#ide$ines o! Mandib#$a! O%e!dent#!e


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G#ide$ines o! Mandib#$a! O%e!dent#!e

Fab!i'ation

#wo intraforaminal implants3approximately mm in diameter and aminimum of % mm in length5 arereccommended

#he distance between the implantsshould be1& to 4& mm, depending on

the size D curvature of the anteriorarch2 #he implant can be splinted with aclip.bar 3resilient retention5 or a B.shaped bar 3rigid retention as well assingle anchors, such ball attachments2

#hree or four implants are

recommended when implants ofreduced length or diameter are used2 Inthis case distance between the implantsshould be 14 H 1& mm to allow for areasonable length of the bar segments

G#ide$ines o! Ma&i$$ai( O%e!dent#!e


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Fab!i'ation

A minimum of four impants e"en)distri-uted o"er the anterior arch ispreferred*

Standard si0e and reduced'diameterimpants can -e used in the same arch*A spintin! -ar 7prefera-) ri!id; isrecommended, athou!h -a anchorscan -e used for temporar) adaptation,

Retention &ith -a anchors ma) not -eadeuate in e"er) situation due todi"er!ent impant a3es*

It is su!!ested that the denture -ase -ereinforced &ith a cast meta frame&or#Hthis increases the initia cost, -ut it

ma) reduce maintenance costs sincefractures and other compications can-e a"oided

Specia anatomic situations, such ascon!enita defects, reuire indi"iduafa-rication of ma3iar) prostheses


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CONCLUSIONCONCLUSION

Over dentures are both versatile andOver dentures are both versatile and

valuable method of treatment with evervaluable method of treatment with ever

increasing applications, but it is importantincreasing applications, but it is importantto visualize the final result at the treatmentto visualize the final result at the treatment

planning stage itself for ensuring aplanning stage itself for ensuring a

successful treatment2successful treatment2

65839619 supradentalne proteze indikacije kontraindikacije tretman

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