Oral rehabilitation through preventive approach: Overdenture and fenestrated denture

Oral rehabilitation through preventive approach: Overdenture and fenestrated denture ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)Case Report Oral rehabilitation through preventiveapproach: Overdenture and fenestrated dentureManu Rathee1, Priyanka Boora2, Poonam Malik3*1Senior Professor and Head of Department, 2PG Student, 3MDS ProsthodonticsDepartment of Prosthodontics, Post Graduate Institute of Dental Sciences (PGIDS), Pt. B.D. SharmaUniversity of Health Sciences, Rohtak, Haryana, India*Corresponding author email: [email protected] to cite this article: Manu Rathee, Priyanka Boora, Poonam Malik. Oral rehabilitation throughpreventive approach: Overdenture and fenestrated denture. IAIM, 2015; 2(3): 169-174.Available online at www.iaimjournal.comReceived on: 08-02-2015 Accepted on: 23-02-2015AbstractAchieving excellence in aesthetics and preservation of remaining structure is the ultimate goal inpreventive prosthodontic. Overdenture is a conservative and preventive approach and is essentiallya preventive prosthodontic concept as it endeavours to preserve remaining teeth and thus found tobe eminently suitable for treating patients with few remaining natural teeth. This case reportdiscusses the merits of using selectively retained roots and abutments to minimize alveolar ridgeresorption underneath the complete denture fabricated as maxillary overdenture and mandibularfenestrated denture.Key wordsOverdenture, Residual ridge resorption, Proprioception.Introduction idealised state of oral being [1]. Preventive prosthodontics emphasizes on the importanceDespite of all preventive measures, edentulism of any procedure that prevents or delays futureis still a major health problem and may leads to prosthodontic problems and overdenture ischanges in most of the domains i.e. it not only based on this preservative approach [2]. Thisaffects oral functions but also affects social life case report discusses the merits of usingand day to day activities and hence affects selectively retained roots and abutments tooverall quality of life .Therefore every effort minimize alveolar ridge resorption underneathshould be made to prevent tooth loss and to the complete denture fabricated as maxillarypreserve any remaining tooth and efforts should and mandibular overdenture.be directed to returning an individual to anInternational Archives of Integrated Medicine, Vol. 2, Issue 3, March, 2015. Page 169Copy right © 2015, IAIM, All Rights Reserved.

Oral rehabilitation through preventive approach: Overdenture and fenestrated denture ISSN: 2394-0026 (P)Case report ISSN: 2394-0034 (O) mandibular arch. Followed by that, diagnosticA 65 years old female patient reported to the mounting was done to find the requiredDepartment of Prosthodontics and Crown and adequate inter arch space. The treatment planBridge, Post Graduate Institute of Dental was divided into two phases.Sciences, Rohtak. Patient’s chief complaint wasdifficulty in chewing and also complaints of • Phase - I: Restoration of caries andunpleasant appearance. (Photo - 1) endodontic treatment of all remaining maxillary teeth following oral prophylaxis.Photo – 1: Intraoral preoperative. • Phase - II: Prosthodontic rehabilitation. Photo – 2: OPG.Intraoral examination revealed presence of left Phase – I: Endodontic treatment and orallateral incisor, canine and first premolar and prophylaxisright first premolar and second molar in Firstly oral prophylaxis was carried out. Then,maxillary arch and right side canine only in the restoration of the cervical caries was done.mandibular arch. Clinically, grade one mobility Following that, endodontic treatment was donewas found in maxillary right second molar. for remaining teeth in maxillary and mandibularPeriodontal findings were significant with arch. (Photo - 3)calculus and gingival recession, with no pocketformation. Also cervical caries were present in Photo – 3: Intra oral view after endodonticmaxillary left canine. treatment.Diagnostic full mouth X-ray i.e. OPG (Photo - 2)revealed bone loss around teeth, treatmentoptions were discussed with the patient. Afterconsidering the invasiveness, time and financialaspects, it was decided to give tooth supportedoverdenture in maxilla and fenestrated denturein mandible.Clinical procedure Page 170Diagnostic impressions were made usingirreversible hydrocolloid for the maxillary andInternational Archives of Integrated Medicine, Vol. 2, Issue 3, March, 2015.Copy right © 2015, IAIM, All Rights Reserved.

Oral rehabilitation through preventive approach: Overdenture and fenestrated denture ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)Phase II Prosthodontic rehabilitation surfaces and various movements like puckering,Metal coping fabrication smiling and mouth opening were done. PuttyThe endodontically treated maxillary and index was made. Then light body was removedmandibular teeth were prepared dome shape from the labial and buccal surfaces of denturepreparation with chamfer finish line for the and then putty index was re seated and wax wasfabrication of coping over them. Impressions added into the gap created after removal of lightwere made with irreversible hydrocolloid and body. Then prosthesis was acrylised in heatcasting was done after die fabrication and polymerising resin with unaltered contoursfabrication of wax pattern. Coping was recorded previously.fabricated, polished and cemented using Glassionomer luting agent. (Photo - 4) After finishing and polishing denture insertion was done. The denture provides patient withPhoto – 4: Copings in patient’s mouth after improved facial appearance, stability andcementation eith GIC. retention during function. (Photo - 5, Photo - 6) Patient was educated and instructed about oral hygiene measures. Patient recalled after 24 hours and then recalled for future visits. Patient reported with satisfaction with her denture. Photo – 5: Maxillary and mandibular finished dentures.Prosthesis fabricationThen primary impressions were made withadditional silicone with the coping cemented.Following custom tray were fabricated using self Mandibular Maxillarycured acrylic resins, border molding for maxillaryand mandibular arch was done using the low Page 171fusing green-stick impression compound andsecondary impression were made using zincoxide eugenol paste. Then the Temporarydenture bases were fabricated on master cast.Jaw relation recording was done. Casts mountedand teeth arrangement done. Followed by try in- During try in waxed dentures were checked inpatient’s mouth for esthetics, phonetics andocclusion. Then wax was removed from thelabial and buccal surfaces of trial denturesleaving only sufficient wax to support teeth. PVSlight body was placed on labial and buccalInternational Archives of Integrated Medicine, Vol. 2, Issue 3, March, 2015.Copy right © 2015, IAIM, All Rights Reserved.

Oral rehabilitation through preventive approach: Overdenture and fenestrated denture ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)Photo – 6: Pre-operative view and post- leads to serious prosthodontic problem andoperative view. cause difficulties both for the patient and the dentist in the management of complete denture [6, 7, 8, 9]. Thus over denture accomplishes three major goals - it improves retention and support, decrease rate of resorption of alveolar Pre-operative ridge, increase in patients manipulative skills and enhances patients’ denture coordination. Post-operative Tooth supported or Implant supported overdentures thus holds a new hope forDiscussion completely edentulous patients. ImplantPeriodontal ligament maintains the structure of supported overdentures though are the latestalveolar ridge. Removal of teeth removes PDL advancements but they also have someand its organizational influence on surrounding disadvantages like time and expense and alsoalveolar bone integrity and thus increase rate of implants do not restore neuromuscularresidual ridge resorption [3, 4]. A study by Crum pathways therefore every efforts should beand Rooney compares bone loss in patients made to preserve remaining teeth and practisewearing conventional denture and overdenture preventive dentistry by the use of overdenture.and found that bone loss is more in patients In a study by Renner, et al. 50% of the rootswith conventional denture [5]. Various studies that were used for overdenture remainshave shown that there is a continuous immobile and 25% of the roots which wereresorption of residual alveolar ridge in initially mobile becomes less mobile and 25%completely edentulous patient with complete roots which were initially mobile becomesdenture and this continuous resorption may immobile this is probably because of decreased crown: root ratio [10]. Most common problem encountered in overdenture is caries and gingivitis around abutment teeth [1]. NaF gel and 4% SnF2 is effective in reducing caries and gingivitis around overdenture abutments [11, 12]. Chewing efficiency of overdenture patient is higher than that of conventional denture wearer [13, 14]. Various studies have shown that satisfaction and acceptance level of patient with overdenture is superior when compared with conventional denture and these patients accustomed to their prosthesis within shorter span of period [15, 16]. Overdenture overcomes many problems encountered by complete denture patients or conventional denture patients like progressive bone loss, poor retention and stability, low masticatory performance, loss of proprioception and therefore act as a panacea for complete dentureInternational Archives of Integrated Medicine, Vol. 2, Issue 3, March, 2015. Page 172Copy right © 2015, IAIM, All Rights Reserved.

Oral rehabilitation through preventive approach: Overdenture and fenestrated denture ISSN: 2394-0026 (P) ISSN: 2394-0034 (O)patients [17]. Though use of implant is also 6. Rahn A, Heartwell C. Textbook ofbecoming very popular in order to overcome Complete Dentures, 5th edition. WBvarious conventional complete denture Saunders Co., Philadelphia, 1993.problems, however because of economic 7. Charles A. Dodge. Prevention ofconstrains or considering the economic norms complete denture problems by the useand also because of lack of awareness patients of overdentures. J Prosthet. Dent, 1973;usually cannot go for such procedures and 30(4): 403-411.therefore in such patient overdenture acts as a 8. The mandibular complete overdenture.troubleshoot for patients with very few Burns DR Dental Clinics of Northremaining teeth and this conservative approach America, 2004; 48(3): 603-23.is still valid. Overdenture is essentially a 9. Tallgren A. The continuing reduction ofpreventive prosthodontic concept, as it the residual alveolar ridge in completeendeavours to conserves or preserve the denture wearers. A mixed-longitudinalremaining few teeth or roots and thus study covering 25 years. J Prosthetconsidered as a conservative and preventive Dent., 1972; 27: 120–132.approach. 10. Renner R, Gomes B, Shakun M, Baer P, Davis R, Camp P. Four-year longitudinalConclusion study of the periodontal health status of overdenture patients. The Journal ofOverdenture though not a new concept it is Prosthetic Dentistry, 1984; 51(5): 593-8.conservative and preventive approach. It is 11. Derkson GD, MacEntee MM. Effect oftechnique sensitive procedure but with proper 0.4% stannous fluoride gel on thepatient selection and proper home care gingival health of overdenturemeasures by the patient it can become an abutments. J Prosthet Dent, 1982; 48:outstanding mode of treatment in patients with 23-26.few remaining teeth or roots. 12. Toolson L.B., Smith D.E. A five-yearReferences longitudinal study of patients treated with overdentures. J Prosthet Dent., 1. Winkler S. Essentials of complete 1983; 49: 749-756. denture Prosthodontics, 2nd edition, 13. Rissin L, House JE, Manly RS, Kapur KK. 2000, p. 384-402. Clinical comparison of masticatory performance and electromyographic 2. Jack l. Kabcenell. Tooth supported activity of patients with complete dentures. J Prosthet Dent, 1971; 26(3): dentures, overdentures, and natural 251-257. teeth. J Prosthet Dent., 1978; 39(5): 508- 511. 3. Emami E, De Souza RF, Kabawat 14. Fontijn-Tekamp, A. P. Slagter, A. van der M, Feine JS. The Impact of Edentulism Bilt, et al. Biting and chewing in on Oral and General Health. overdentures, full dentures, and natural International Journal of Dentistry, 2013. dentitions. Journal of Dental Research, 2000; 79(7): 1519–1524. 4. Glossary of prosthodontic terms. Journal 15. Hatim NA, Mohammed ST. Solving of Prosthetic Dentistry; 94(1): 10- 92. Complete Denture Problems by the Use 5. Crum RJ, Rooney GE Jr. Alveolar bone loss in overdentures: A 5-year study. J Prosthet Dent., 1978; 40(6): 610-3.International Archives of Integrated Medicine, Vol. 2, Issue 3, March, 2015. Page 173Copy right © 2015, IAIM, All Rights Reserved.

Oral rehabilitation through preventive approach: Overdenture and fenestrated denture ISSN: 2394-0026 (P)of Overdenture: Clinical Case Report. Al– ISSN: 2394-0034 (O) preventive prosthodontics. J ProsthetRafidain Dent J., 2011; 11(2): 238-243. Dent., 1969; 21: 513-522.16. Brill N. Adaptation and the hybridprosthesis. J Prosthet Dent., 1955; 5(6):811-824.17. Morrow R.M., et al. Tooth-supportedcomplete dentures: An approach toSource of support: Nil Conflict of interest: None declared.International Archives of Integrated Medicine, Vol. 2, Issue 3, March, 2015. Page 174Copy right © 2015, IAIM, All Rights Reserved.