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Overdentures with metal occlusion to maintain occlusal vertical dimension and prevent denture fracture
TWO UNIQUE
CLINICAL
APPLICATIONS
canine into an improved arch alignment. Because of a favorable occlusal relationship, it was decided to design a fixed partial denture by using etched-metal retainers with a cross-over configuration to cover and be attached to the labial surface of the canine and the lingual surface of the central incisor. The restorations were made and inserted in the mouth (Figs. 9 and 10). Reprint requeststo:
Fig. 10. Prosthetic restoration in place, labial view.
DR. THOMAS E. MILLER UNIVERSITYOF MARYLAND DENTAL SCHOOL BALTIMORE,MD 21201-1586
Overdentures with metal occlusion to maintain occlusal vertical dimension and prevent denture fracture A. Windchy, D.M.D.,” 2. Khan, D.D.S.,** and H. Fields, D.M.D.*** University of Louisville, Schoolof Dentistry, Louisville, Ky.
A
n overdenture is a complete or removable partial denture supported by retained teeth and/or roots that may or may not require preparation. Congenital defects such as cleft palate, oligodontia, cleidocranial dysostosis, and class III malocclusion are good indications for the use of overdentures. In these instances it is rarely necessary to reduce tooth crowns or cover them with gold copings. Dramatic improvement in esthetics and function is achieved by means of an overdenture for patients with badly abraded or eroded teeth.‘”
ADVANTAGES
OF OVERDENTURES
1. Abuse of the soft tissue of residual ridges is reduced because natural teeth are the primary support. 2. The denture is more stable both vertically and horizontally and thus improves masticatory function. 3. Natural teeth often not suitable for other types of restorations can be used in overdenture treatment. *Clinical Assistant Professor, Department of Prosthodontics. **Associate Professor and Director, Advanced Education Program in Prosthodontics, Department of Prosthodontics. ***Professor and Chairman, Department of Prosthodontics. THE JOURNAL
OF PROSTHETIC
DENTISTRY
Fig. 1. Patient with her first overdenture.
4. Patient acceptance of tooth-supported dentures is excellent.3 5. The denture can be altered as teeth may be lost.
DISADVANTAGES
OF OVERDENTURES
1. Abutment teeth are susceptible to caries if patients cannot be motivated to a level of good oral hygiene. 2. Wear between the denture base and the supporting teeth increases the possibility of breakage.4 11
WINDCHY,
Fig. 2. Patient with a class III malocclusion.
Fig. 3. Diagnostic casts mounted on articulator desired occlusal vertical dimension.
with
Fig. 4. A, Anatoline denture tooth with facial surface removed and retention beads applied. B, Denture base side of denture teeth with retentive holes prepared.
3. The denture base is often thin in the region of the supporting natural teeth and increases the possibility of fracture. Lord and TeeJ5 Frantz,6 and Guyer’ have described overdentures over roots with or without copings used as support for overdentures. APPLICATION
A woman 74 years of age was referred to the postgraduate prosthodontic clinic for a new maxillary complete overdenture. She said that she had been treated 12
AND FIELDS
Fig. 5. A, Cast metal teeth ready for opaquer and lightcure composite. B, Completed tooth with composite.
Fig. 6. Tooth arrangement ready for try-in.
CLINICAL
KHAN,
in wax in articulator
and
with two maxillary overdentures during the past 3 to 4 years but was dissatisfied with the esthetics. However, an overdenture provided some years previously had been esthetically, phonetically, and functionally satisfactory (Fig. 1). Becauseof a loss of vertical dimension caused by occlusal wear of the posterior teeth, the anterior segment of this denture received excessivewear from the natural mandibular anterior teeth. The anterior portion of the denture had fractured on three occasions and after repeated repairs the denture required replacement. The patient stated that she was a speech therapist and esthetics and function were important to her, especially because her patients were required to read her lips and observe her speech patterns. Examination of the patient revealed she had an angle class III malocclusion (Fig. 2). Fig. 3 illustrates the class III malocclusion of the patient on mounted diagnostic casts. A review indicated that the denture was necessary to maintain the occlusal vertical dimension and any loss through occlusal wear would increase the tendency for fracture of the anterior segment of the denture. The treatment selected was the construction of an overdenture using posterior teeth with metal occlusal surfaces.
JULY 1988
VOLUME
60
NUMBER
1
OVERDENTURES
WITH
METAL
OCCLUSION
Fig. 7. Wax try-in in mouth. Fig. 9. One half of flasked denture shows tissue side of metal denture teeth.
Fig. 8. After
boil-out, undercuts around teeth on master cast were blocked out with zinc phosphate cement. Fig. 10. Tissue-bearing side of finished overdenture.
PROCEDURE The casts were mounted in an articulator by using a facebow and an interocclusal centric jaw-relation record. Trubyte Anatoline (Dentsply International Inc., York, Pa.) posterior teeth were arranged, adjusted for occlusion, and tried in the patient’s mouth. The posterior dentire teeth were prepared for casting in the following manner: (1) The facial surface of each tooth was modified to provide space for retention beads, opaquer, and composite so that the final denture teeth could retain contours similar to those of the original teeth; (2) retention beads were applied to the buccal surfaces of the teeth (Fig. 4, A); and (3) retentive holes were placed on the ridge laps with a No. 35 inverted cone bur (Fig. 4, B) to provide mechanical locks for the denture base resin. The prepared denture teeth were invested, burned out, cast using Sterngold No. 66 (APM Sterngold, Stamford, Conn.) and finished (Fig. 5, A). An opaquer and light-cured resin was applied to the denture tooth (Fig. 5, B).
The denture teeth with metal occlusal surfaces were arranged in wax (Fig. 6) for the patient try-in. Centric jaw relation, occlusion, occlusal vertical dimension,
THE JOURNAL
OF PROSTHETIC
DENTISTRY
Fig. 11. Occlusal view of finished denture showing metal occlusal surfaces of teeth.
esthetics, and phonetics were verified. The patient expressed her satisfaction with the try-in (Fig. 7). Undercuts on the teeth of the master cast were blocked out with zinc phosphate cement to prevent any problems of insertion or removal of the denture (Fig. 8). The trial wax denture was invested and the wax removed (Fig. 9). The mold was packed with acrylic resin with careful
13
WINDCHY,
KHAN,
AND FIELDS
REFERENCES Brewer AA, Fenlon AH. The overdenture. Dent Clin North Am 1973;17:723-6. 2. Brewer AA, Morrow RN. Overdentures. 2nd ed. St Louis: The CV Mosby Co, 1980;89-99. 3. Morrow RN, Feldmann, EE, Rudd KD, Travillion HM. Tooth-supported complete dentures: an approach to preventive prosthodontics. J PROSTHET DENT 1969;21:513-22. 4. Morrow RN, Powell JM, Jameson WS, Jewson L, Rudd, KD. Tooth-supported complete dentures: description and clinical evaluation of a simplified technique. J PROSTHET DENT c 1969;22:414-24. 5. Lord JL, Tee1 S. The overdenture: patient selection, use of copings, and follow-up evaluation. J PROSTHET DENT 1974; 1.
Fig. 12. Finished denture in mouth.
32:41-51.
attention to the retentive holes on the denture base side of the teeth. The processing and finishing were completed by using standard laboratory procedures (Figs. 10 and 11). The maxillary overdenture with metal occlusal surfaces was found to satisfy requirements of the patient for esthetics and function and provided a stable occlusal vertical dimension that eliminated the problem of recurrent fracture of the anterior portion of the denture (Fig. 12).
Announcing
The JOURNAL
6.
Frantz WR. The use of natural teeth in overlay dentures. J PROSTHET DENT 1975;34: 135-40.
7.
Cuyer SE. Selectively retained vital roots for partial support of overdentures: a patient report. J PROSTHET DENT 1975;33:25863.
Reprint requests to: DR. ANN M. WINDCHY UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY LOUISVILLE. KY 40292
a section for clinical
OF PROSTHETIC DENTISTRY
reports
is pleasedto announcea new section-Clinical reports.
This section will contain reports of the clinical treatment procedures of a patient that will be of . . REPORT should be no longer than three to four special interest to our readers. A CLINICAL double-spaced, typewritten pages supplemented by no more than eight good-quality, descriptive color illustrations. CLINICAL REPORTS will be evaluated in the same manner as all other manuscripts that are submitted to the JOURNAL OF PROSTHETIC DENTISTRY for possiblepublication.
14
JULY 1988
VOLUME
60
NUMBER
I
CLINICAL
APPLICATIONS
canine into an improved arch alignment. Because of a favorable occlusal relationship, it was decided to design a fixed partial denture by using etched-metal retainers with a cross-over configuration to cover and be attached to the labial surface of the canine and the lingual surface of the central incisor. The restorations were made and inserted in the mouth (Figs. 9 and 10). Reprint requeststo:
Fig. 10. Prosthetic restoration in place, labial view.
DR. THOMAS E. MILLER UNIVERSITYOF MARYLAND DENTAL SCHOOL BALTIMORE,MD 21201-1586
Overdentures with metal occlusion to maintain occlusal vertical dimension and prevent denture fracture A. Windchy, D.M.D.,” 2. Khan, D.D.S.,** and H. Fields, D.M.D.*** University of Louisville, Schoolof Dentistry, Louisville, Ky.
A
n overdenture is a complete or removable partial denture supported by retained teeth and/or roots that may or may not require preparation. Congenital defects such as cleft palate, oligodontia, cleidocranial dysostosis, and class III malocclusion are good indications for the use of overdentures. In these instances it is rarely necessary to reduce tooth crowns or cover them with gold copings. Dramatic improvement in esthetics and function is achieved by means of an overdenture for patients with badly abraded or eroded teeth.‘”
ADVANTAGES
OF OVERDENTURES
1. Abuse of the soft tissue of residual ridges is reduced because natural teeth are the primary support. 2. The denture is more stable both vertically and horizontally and thus improves masticatory function. 3. Natural teeth often not suitable for other types of restorations can be used in overdenture treatment. *Clinical Assistant Professor, Department of Prosthodontics. **Associate Professor and Director, Advanced Education Program in Prosthodontics, Department of Prosthodontics. ***Professor and Chairman, Department of Prosthodontics. THE JOURNAL
OF PROSTHETIC
DENTISTRY
Fig. 1. Patient with her first overdenture.
4. Patient acceptance of tooth-supported dentures is excellent.3 5. The denture can be altered as teeth may be lost.
DISADVANTAGES
OF OVERDENTURES
1. Abutment teeth are susceptible to caries if patients cannot be motivated to a level of good oral hygiene. 2. Wear between the denture base and the supporting teeth increases the possibility of breakage.4 11
WINDCHY,
Fig. 2. Patient with a class III malocclusion.
Fig. 3. Diagnostic casts mounted on articulator desired occlusal vertical dimension.
with
Fig. 4. A, Anatoline denture tooth with facial surface removed and retention beads applied. B, Denture base side of denture teeth with retentive holes prepared.
3. The denture base is often thin in the region of the supporting natural teeth and increases the possibility of fracture. Lord and TeeJ5 Frantz,6 and Guyer’ have described overdentures over roots with or without copings used as support for overdentures. APPLICATION
A woman 74 years of age was referred to the postgraduate prosthodontic clinic for a new maxillary complete overdenture. She said that she had been treated 12
AND FIELDS
Fig. 5. A, Cast metal teeth ready for opaquer and lightcure composite. B, Completed tooth with composite.
Fig. 6. Tooth arrangement ready for try-in.
CLINICAL
KHAN,
in wax in articulator
and
with two maxillary overdentures during the past 3 to 4 years but was dissatisfied with the esthetics. However, an overdenture provided some years previously had been esthetically, phonetically, and functionally satisfactory (Fig. 1). Becauseof a loss of vertical dimension caused by occlusal wear of the posterior teeth, the anterior segment of this denture received excessivewear from the natural mandibular anterior teeth. The anterior portion of the denture had fractured on three occasions and after repeated repairs the denture required replacement. The patient stated that she was a speech therapist and esthetics and function were important to her, especially because her patients were required to read her lips and observe her speech patterns. Examination of the patient revealed she had an angle class III malocclusion (Fig. 2). Fig. 3 illustrates the class III malocclusion of the patient on mounted diagnostic casts. A review indicated that the denture was necessary to maintain the occlusal vertical dimension and any loss through occlusal wear would increase the tendency for fracture of the anterior segment of the denture. The treatment selected was the construction of an overdenture using posterior teeth with metal occlusal surfaces.
JULY 1988
VOLUME
60
NUMBER
1
OVERDENTURES
WITH
METAL
OCCLUSION
Fig. 7. Wax try-in in mouth. Fig. 9. One half of flasked denture shows tissue side of metal denture teeth.
Fig. 8. After
boil-out, undercuts around teeth on master cast were blocked out with zinc phosphate cement. Fig. 10. Tissue-bearing side of finished overdenture.
PROCEDURE The casts were mounted in an articulator by using a facebow and an interocclusal centric jaw-relation record. Trubyte Anatoline (Dentsply International Inc., York, Pa.) posterior teeth were arranged, adjusted for occlusion, and tried in the patient’s mouth. The posterior dentire teeth were prepared for casting in the following manner: (1) The facial surface of each tooth was modified to provide space for retention beads, opaquer, and composite so that the final denture teeth could retain contours similar to those of the original teeth; (2) retention beads were applied to the buccal surfaces of the teeth (Fig. 4, A); and (3) retentive holes were placed on the ridge laps with a No. 35 inverted cone bur (Fig. 4, B) to provide mechanical locks for the denture base resin. The prepared denture teeth were invested, burned out, cast using Sterngold No. 66 (APM Sterngold, Stamford, Conn.) and finished (Fig. 5, A). An opaquer and light-cured resin was applied to the denture tooth (Fig. 5, B).
The denture teeth with metal occlusal surfaces were arranged in wax (Fig. 6) for the patient try-in. Centric jaw relation, occlusion, occlusal vertical dimension,
THE JOURNAL
OF PROSTHETIC
DENTISTRY
Fig. 11. Occlusal view of finished denture showing metal occlusal surfaces of teeth.
esthetics, and phonetics were verified. The patient expressed her satisfaction with the try-in (Fig. 7). Undercuts on the teeth of the master cast were blocked out with zinc phosphate cement to prevent any problems of insertion or removal of the denture (Fig. 8). The trial wax denture was invested and the wax removed (Fig. 9). The mold was packed with acrylic resin with careful
13
WINDCHY,
KHAN,
AND FIELDS
REFERENCES Brewer AA, Fenlon AH. The overdenture. Dent Clin North Am 1973;17:723-6. 2. Brewer AA, Morrow RN. Overdentures. 2nd ed. St Louis: The CV Mosby Co, 1980;89-99. 3. Morrow RN, Feldmann, EE, Rudd KD, Travillion HM. Tooth-supported complete dentures: an approach to preventive prosthodontics. J PROSTHET DENT 1969;21:513-22. 4. Morrow RN, Powell JM, Jameson WS, Jewson L, Rudd, KD. Tooth-supported complete dentures: description and clinical evaluation of a simplified technique. J PROSTHET DENT c 1969;22:414-24. 5. Lord JL, Tee1 S. The overdenture: patient selection, use of copings, and follow-up evaluation. J PROSTHET DENT 1974; 1.
Fig. 12. Finished denture in mouth.
32:41-51.
attention to the retentive holes on the denture base side of the teeth. The processing and finishing were completed by using standard laboratory procedures (Figs. 10 and 11). The maxillary overdenture with metal occlusal surfaces was found to satisfy requirements of the patient for esthetics and function and provided a stable occlusal vertical dimension that eliminated the problem of recurrent fracture of the anterior portion of the denture (Fig. 12).
Announcing
The JOURNAL
6.
Frantz WR. The use of natural teeth in overlay dentures. J PROSTHET DENT 1975;34: 135-40.
7.
Cuyer SE. Selectively retained vital roots for partial support of overdentures: a patient report. J PROSTHET DENT 1975;33:25863.
Reprint requests to: DR. ANN M. WINDCHY UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY LOUISVILLE. KY 40292
a section for clinical
OF PROSTHETIC DENTISTRY
reports
is pleasedto announcea new section-Clinical reports.
This section will contain reports of the clinical treatment procedures of a patient that will be of . . REPORT should be no longer than three to four special interest to our readers. A CLINICAL double-spaced, typewritten pages supplemented by no more than eight good-quality, descriptive color illustrations. CLINICAL REPORTS will be evaluated in the same manner as all other manuscripts that are submitted to the JOURNAL OF PROSTHETIC DENTISTRY for possiblepublication.
14
JULY 1988
VOLUME
60
NUMBER
I