COPING AND BAR RETAINED TOOTH

SUPPORTED OVER DENTURE A

VIABLE OPTION TO PRESERVE THE

PROPRIOCEPTION AND RESIDUAL BONE-

CASE REPORT

JIDAM

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ABSTRACT

Prosthetic treatment with overdenture is a favoured treatment

modality for elderly patients with few remaining teeth and roots

that are maintained under the denture base to preserve the residual

ridge. The tooth supported overdenture provides the patient with a

greater stability of the denture and improved masticatory function

and esthetics. Retaining natural teeth as abutments for dentures

can considerably reduce the progress of residual ridge resorption.

Multiple abutments can be used to retain proprioception and

prevent further bone resorption. This clinical report describes two

cases that were successfully rehabilitated with tooth supported

overdentures with high retention and esthetics.

KEYWORDS :

Coping and Bar Retained Tooth-Supported

Over Denture, Residual Bone, Proprioception

JIDAM/Chennai/Volume:7/Issue:4/Pages 157 - 162/Oct-Dec 2020

163

Address for Correspondence:

Dr.S.C.Ahila, MDS.,

Reader, Department of Prosthodontics,

SRM Dental College, Ramapuram,

Chennai, India.

Mail Id: ahilasc@yahoo.co.in

Received

: 23.10.20

Accepted

: 03.12.20

Published

: 27.12.20

CASE REPORT

Dr. Suji Daviasigamani, Dr. Ahila Singaravel Chidambaranathan, Dr. Muthukumar Balasubramanium

Department of Prosthodontics. SRM Dental College,SRM University, Ramapuram, Chennai, India.

DOI:1.37841/jidam_2020_V7_I4_06

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Suji et al: Coping and Bar Retained Tooth-Supported Over Denture to preserve proprioception and residual bone

164

INTRODUCTION:

In the past, extraction of the entire dentition

followed by complete denture replacement used

to be promoted as an inexpensive and permanent

solution for oral health care. The treatment with

overdenture was accepted in the 1960’s, when a new

clinical procedure in the fields of periodontology

and endodontics was used. We can think of no other

better example of preventive dentistry than the use of

an overdenture.

1-4

According to DeVan’s golden statement:

“Perpetual  preservation  of  what  remains  is  more
important  than  the  meticulous  replacement”.
Complete  edentulism  deals  with  complete  denture
planning.

However, the complete denture patient

goes through a sequel of events like loss of discrete
tooth proprioception, progressive loss of alveolar
bone, transfer of all occlusal forces from the teeth to
the oral mucosa, and the most depressing sequel, the
loss of self-confidence.

Overdenture is a dental prosthesis that

covers  and  also  is  partially  supported  by  natural
teeth,  natural  teeth  roots,  or  dental  implants.
Tooth-supported  overdentures  have  various
advantages  over  conventional  complete  dentures
like  preservation  of  alveolar  bone,  preservation  of
periodontal  proprioception,  improved  retention,
stability  and  support,  enhanced  psychological
comfort,  and  increased  masticatory  efficiency.

But the tooth supported over denture has few
disadvantages like secondary caries on the abutment
tooth, need endodontic treatment in certain clinical
condition, sometimes need metal denture base to
prevent fracture at the abutment site, need additional
designing and laboratory work and expensive.

According

to Glossary of Prosthodontic

Terms (GPT 9), “Overdenture is a removable partial
or complete denture that covers and rests on one or
more remaining natural teeth, roots, and/or dental

implants; a dental prosthesis that covers and is
partially supported by natural teeth, tooth roots, and/
or dental implants. It is also called as overlay denture,
overlay prosthesis and superimposed prosthesis”.

Rehabilitation of the partially edentulous area

with tooth supported over denture gives comfort,
more rentention and psychological support to them.
Hence this technique was applied for two cases for
rehabilitation of partially edentulous spaces with
coping and bar retained over dentures.

CASE 1:

A 69 year old male patient reported to our

Department  of  Prosthodontics  with  a  complaint  of
missing teeth in the upper jaw and lower back tooth
region for the past 7 years. Extra-oral examination
revealed  unsupported  lip  and  cheek  musculature,
mild distortion of speech articulation and no loss in
vertical dimension. Intra-oral examination revealed
that  the  teeth  24  and  25  alone  were  present  in
maxillary arch while 35, 36, 37, and 46 were present
in  the  mandibular  arch  with  gingival  recession  in
45.  Also,  root  canal  treatment  was  performed  on
45(Fig.1).  The  various  treatment  options  available
for  this  patient’s  maxillary  arch  were  conventional
complete  denture,  implant  supported  overdenture
and tooth supported overdenture. The patient was not
willing for extraction of his remaining natural teeth
and wished to use tooth supported complete dentures,
and hence, the treatment was started after obtaining
an informed consent.

CLINICAL PROCEDURE:

Orthopantomogram of the patient was taken

to  evaluate  for  the  presence  of  any  pathologies.
(Fig.3). Root canal treatment (RCT) was performed
on  24  and  25  teeth,  and  subsequent  to  which,  an
impression of the maxillary and mandibular arches
were  made  with  Zelgan  Plus  alginate  impression
material  (Dentsply,  International,  INC.,  New York,

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Suji et al: Coping and Bar Retained Tooth-Supported Over Denture to preserve proprioception and residual bone

165

USA). The impression was then poured with dental
stone(Fig.2). The teeth preparation was done on 24 and
25 (Fig.4) and metal coping was fabricated through
conventional  casting  method  and  luted  with  glass-
ionomer  cement  (GC  Corporation,  Tokyo,  Japan)
(Fig.5).The  final  impression  was  then  made  with
poly  vinyl  siloxane  impression  material  (Aquasil,
Dentsply  Intl,  New  York,  PA)(Fig.6)  and  poured
using dental stone(Fig.7). The stabilized record bases
were  made  using  autopolymerized  PMMA  resin
(DPI, India) using sprinkle-on technique and occlusal
rims were fabricated with modelling wax and then,
jaw  relations  were  recorded.  Teeth  arrangement
(Premadent,Delhi,India)  was  done  in  conventional
manner (Fig.8) after which, wax try-in was done in
the patient’s mouth. After the laboratory procedure of
processing the dentures, the overdenture was placed
intra-orally  and  routine  postinsertion  instructions
were given and the patient was motivated to make
an effort to learn to adapt to the new dentures (Fig 9
&10). During the follow-up after a week, the patient
expressed satisfaction in mastication and phonetics.

CASE 2

A female patient of age 57 years, reported

to  the  Department  of  Prosthodontics,  SRM  Dental
College  and  Hospital  with  a  broken  lower  denture
at the left side canine area. Her major desire was to
improve  her  masticatory  function  while  retaining
remaining  natural  teeth.  Extra  oral  examination
revealed no loss of vertical dimension, unsupported
lip  and  cheek  musculature,  and  mild  distortion  of
speech  articulation.  Intraoral  examination  revealed
that the maxillary missing teeth were replaced with
a fixed partial denture in relation to 11,12,21,22,23
and a flexible removable partial denture in relation
to  14,15,16,17,25,26,27.  The  mandibular  metal
copings  were  missing  and  the  denture  thickness
was  inadequate.  The  patient  was  presented  with
different treatment options available which included
complete  dentures,  removable  partial  dentures,

and implant supported fixed partial dentures. The
patient was hesitant to undergo dental implants due
to the need for an additional surgery and extended
treatment duration as well as an increase in cost of
the procedure. Therefore, an effective treatment
plan was made to use a bar retained over denture to
prevent fracture of the denture.

CLINICAL PROCEDURE:

A custom tray was fabricated using

autopolymerized  PMMA  resin  (DPI,  India)    and
border-molding  done  with  low-fusing  modelling
plastic.  (DPI,  India)  The  final  impressions  were
made with polyvinyl siloxane putty and light body
impression  material  (Aquasil,  Dentsply  Intl,  New
York, PA) (Fig 11). Master casts were poured with
type-III  dental  stone.  The  bar  was  obtained  after
investing and casting in conventional manner (Fig.12)
and  try  in  was  done  to  check  the  fit  of  the  metal
framework. (Fig.12). Occlusal rims were fabricated
with  modeling  wax,  jaw  relations  were  registered,
and teeth arrangement (Premadent,Delhi,India) was
done in an articulator.Try-in was done in the patient’s
mouth(Fig.13). Final finishing, polishing, laboratory
remounting was done (Fig.14) and after the necessary
adjustments, the denture was  inserted. (Fig  15  and
16). The post insertion was reviewed and the patient
was completely satisfied ( Fig 17).

Fig 1 : Pre-operative intra oral view

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Suji et al: Coping and Bar Retained Tooth-Supported Over Denture to preserve proprioception and residual bone

168

Fig 16 : Denture placement

Fig 17 : Extra-oral view

DISCUSSION:

For elderly people with partially or completely

edentulous  arches,  different  treatment  options  can
be  provided.  Acrylic  complete  dentures,  teeth-
supported  and  implant-supported  overlay  dentures
are popular therapies. Maintaining the teeth that are
protected by these overlay denture abutments offer
efficient  restorative

solutions of natural dentition

as overdenture abutments (overlay denture) have
become an effective substitute for the removal of
residual dentition over the past few years.

Denture

retention which is assured by overdenture is important
to increase the quality of patient’s life as related to
oral health.

The remaining roots of the teeth, which are

not extracted and left in place, significantly reduce
bone loss. Retained teeth (roots) should preferably
be on both quadrants in the jaw.However, removal

of the portion of the teeth above the gingival margin
is required. Hence, most of the tooth crown is
removed to improve the crown-root ratio. This often
necessitates root canal therapy.

CONCLUSION:

Overdenture therapy presents a realistic

alternative to the patients who are not willing to extract
their remaining natural teeth. The technical simplicity,
the  usefulness  for  geriatric  patients,  the  increased
control  of  jaw  function  through  the  maintained
periodontal ligaments and psychological benefits are
the  advantages  of  an  overdenture.  Neuromuscular
mechanism,  the  articulation  of  temporomandibular
joint  and  the  denture’s  supporting  structures  are
biologically  maintained  in  a  much  better  way  by
teeth than by the mucoperiostium. Tooth supported
overdenture  is  psychologically  beneficial  as  the
patient does not need to undergo extraction.

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