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Case Report

Four and two tooth supportedConventional over denture:

Two case reports
Veena S Prakash, G Shivaprakash1, Samrat Hegde2, Nagarajappa3

Departments of Prosthodontics, 1Orthodontics, and 2Endodontics, College of Dental Sciences, Davangere, 3Department of Oral and
Maxillofacial Surgery, SJM Dental College, Chitradurga, Karnataka, India

Address for correspondence: Dr.Veena S Prakash, Department of Prosthodontics, College of Dental Sciences, Davangere577004,
Karnataka, India. Email:drveena30@gmail.com

Abstract

The mastication, phonation and esthetics: The trident factors are very important and should be given due
consideration when any dental procedure is initiated to achieve the successful outcome of treatment. The
prosthetic management of edentulous patient has long been a major challenge for dentistry. For well over
a century, complete maxillary and mandibular denture have been the traditional standard of care. However,
most of the patients report significantly more problems adapting to their mandibular denture due to a lack of
comfort(e.g.,they suffer from an increase in pain and soreness), retention, stability and inability to chew and
eat. Recent scientific studies carried out over the past decade have determined that the benefits of a mandibular
two implant over denture/coping retained are sufficient to propose the two implant over denture - rather than
conventional denture as the first treatment option. This in the prosthodontics literature has led to shift in
therapeutic philosophy regarding restoration of the edentulous patient. This article presents four and two tooth
supported conventional over denture-two case reports.
Key words: Implant, over denture, prosthesis

INTRODUCTION the preservation of alveolar bone.

Rissin etal. in 1978 compared masticatory performance Rationale for over denture concept
in patients with natural dentition, complete denture and Extraction of all natural dentition and replacement
over denture. They found that the over denture patients with complete denture is not the most desirable
had a chewing efficiency onethird higher than the treatment
complete denture patients. Preventive prosthodontics emphasizes the
importance of any procedure that can delay or
Crown and Rooney 1975 in their study found that eliminate further prosthodontic problems
retention of mandibular canine for over denture led to The over denture is a logical method for a dentist to
use in preventive prosthodontics.
Access this article online
Indications
Quick Response Code:
Website: 1. For patients who face the loss of remaining natural
www.ijohsjournal.org adult dentition. Therefore, younger the patient
greater the indication
DOI: 2. Patents with badly worn out dentition
10.4103/2231-6027.122134 3. Cleft palate cases
4. For congenital anomalies like microdontia, in
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Prakash, etal.: Four and two tooth supportedConventional over denture: Two case reports
selected partial anodontia cases.[1] Amelogenesis
imperfecta and dentinogenesis imperfecta
5. Denture for patients with maxillofacial trauma.
Contra indications
Uncooperative and under motivated patients
Mentally and physically handicapped patients for
whom good oral hygiene is difficult to maintain
When a patient cannot afford.
GENERAL CONSIDERATIONS DURING
DIAGNOSIS AND TREATMENT PLANNING
Periodontal consideration
Periodontal inflammation, pocket formation, bony
defect and poor zone of attached gingiva must be
eliminated before starting treatment.[2,3]
An important periodontal requisite with over denture
abutment is adequate zone of attached gingiva. This can
be accomplished through periodontal surgery(Utilizing
either a free gingival graft or apically repositioning a
split thickness flap).
Endodontic consideration
There are advantages of treating the abutment
endodontically. Few to mention include:
1. The crown root ratio can be made more favorable
2. Clinical crown reduction provides interocclusal
clearance for placement of artificial teeth
3. For securing attachments.
TYPES OF OVER DENTURES
Immediate over denture is constructed for insertion
immediately after the removal of some natural teeth.
Transitional over denture is obtained by converting an
existing removable partial denture to over denture.
Heartwells classification[4]
Based on the method of abutment preparation:
1. Coping
2. Noncopingwith simple tooth modification
3. Attachments
4. Submerged vital roots: Effective in preserving
alveolar bone
Coping
Short coping 23mm long and normally require
endodontic therapy
Long coping 58 mm long, an attempt is made
to circumvent endodontic therapy by conservative
reduction.
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Abutment with attachment
Most of the attachments are secured to the abutment by
a cast coping. Objective of attachment is to improve the
retention of denture.[5]
Treatment procedure
1. Includes:
Endodontic treatment, periodontal consideration,
caries management, location and distribution of
abutment, economy
Already endo and perio considerations are
discussed.
2. Caries management:
Frequent recall checkup and treatment of
abutment with periodic fluoride application.
Location of abutment teeth
Two teeth in each quadrant present an ideal situation.[6] E.g.
1. Cuspids, second premolars or second molars in each
quadrant
2. Mandibular cuspids are most often utilized since
they are usually the last teeth to be lost
3. Mandibular incisors can be used as over denture
abutments if mandibular arch is intact.
Clinical procedure:(For tooth supported over denture)
1. Surgical removal of teeth with poor prognosis
2. Periodontal treatment
3. Endodontic treatment of abutment teeth
4. Crown reduction of abutments
5. Fluoride application over prepared teeth
6. Impressions and subsequent procedures are similar
to conventional complete denture
7. On the tissue surface of the denture, the areas
adjacent to gsingival margin should be trimmed or
relieved to avoid impingement and later use resilient
liner.
Implant supported over denture
Some patients will not be able to wear their dentures
irrespective of its perfect contours. These patients are
termed as Maladaptive. The implantsupported
denture can be designed for these patients.
CASE REPORTS
Case 1
A 51yearold female patient with a poor prognosis of the
teeth present reported with a chief complaint of inability
to chew and wanted to improve her esthetics.
After evaluation of the patient, it was decided to
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Prakash, etal.: Four and two tooth supportedConventional over denture: Two case reports

extract all the teeth remaining in the maxillary arch. Case 2

In the mandibular arch as the patient gave a history of
extraction, a decade with regard to mandibular posteriors,
the lower ridge was poor. Hence, it was decided to
retain mandibular canines and first premolars, proceed
with intentional root canal treatment (RCT) followed
by coping to the four teeth. Maxillary conventional
and mandibular over denture was planned to reduce
the impact on the bone by conventional denture in
lower and also to improve the retention and stability.
After taking consent, the same treatment protocol was
followed[Figure1aj].
A 48yearold female patient reported with a chief
complaint of protruding upper front teeth and inability
to chew and wanted to improve her esthetics.
After evaluation of the patient, it was decided to
extract all the teeth remaining in the maxillary arch.
In the mandibular arch as the patient gave a history of
extraction, a decade with regard to mandibular posteriors
because of poor periodontal support, the mandibular ridge
was poor. Hence, it was decided to retain mandibular
first premolars, proceed with intentional RCT followed
by coping to the two teeth. Maxillary conventional and

a b c

b c d

e f

e f

g h
g h i

i j
Figure1: (a) Case 1: Pretreatment orthopantomogram. (b-d) Case
1: Intra oral maxillary, mandibular before coping insertion, copings
ready for cementation. (eh) Case 1: Mandibular canine and first
premolars endodontically treated, copings cemented. (i-j) Case 1:
Post-treatment intra and extra oral
j k
Figure 2: (a-c) Case 2: Pretreatment Extra oral & Intra oral. (d)Case
2: Pretreatment orthopantomogram. (e-f) Case 2: Pre-treatment
frontal first premolars after endodontic treatment. (g-i)Case 2:
Pre-treatment maxillary, mandibular before and after coping
cementation. (j-k) Case 2: Post-treatment intra oral and extra oral

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Prakash, etal.: Four and two tooth supportedConventional over denture: Two case reports
mandibular over denture was planned to reduce the
impact on the bone by conventional denture in mandible
and also to improve retention and stability.
During the extraction procedure as the patient had skeletal
class II with severe premaxillary excess alveoloplasty
was done in the anterior segment along with extraction.
After taking consentthe same treatment protocol was
followed [Figure2ak].
Advantages of conventional over denture:
Feels more like having teeth
More retention in many cases
Helps to reduce shrinkage of surrounding alveolar bone
Reduces pressure on portions of the alveolar ridge
Positive psychological advantage of still having teeth.
Disadvantages of conventional over denture:
Scrupulous oral hygiene is essential in order to
prevent decay and periodontal disease
The over denture may appear bulkier than
conventional denture
Frequent maintenance examinations are necessary
In general, this is a more expensive approach than
conventional denture.
CONCLUSION
The over denture has innumerable advantages and
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applications compared with conventional complete
denture. The success depends upon proper case selection
with critical monitoring of various steps involved.
Prosthodontic rehabilitation of cases like partial
anodontia not only improves function and esthetics
dramatically, but also psychologically boosts the
morale of the patients more so when the individual is
of younger age.
REFERENCES
1. MehtaSS. Prosthodontic rehabilitation of a case of partial
anodontia A case report. J Indian Prosthodont Soc
2001;1:35.
2. Brewer, MorrowRM. Over Dentures. 2nded. St. Louis: Mosby;
2nd ed. 1980.
3. Nallaswamy D. Text Book of Prosthodontics. Jaypee; 2005.
p.25962.
4. Hartwell CM Jr, RahnAO. Syllabus of Complete Denture. 4thed.
Philadelphia: Lee and Febiger; 1986.
5. P rieskel HW. Precision Attachments in Prosthodontics
over Denture and Telescopic Prosthesis. Vol. 2. Chicago:
Quintessence International; 1985.
6. GalagaliG. Ectodermal dysplasia and its prosthetic rehabilitation
with over dentureA case report. J Indian Prosthodont Soc
2000;11:424.
How to cite this article: Prakash VS, Shivaprakash G, Hegde S,
N. Four and two tooth supported - Conventional over denture: Two
case reports. Int J Oral Health Sci 2013;3:61-4.
Source of Support: Nil, Conflict of Interest: None declared.
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