|Year : 2019 | Volume
| Issue : 1 | Page : 41-45
Root-supported overdenture as a prosthetic alternative for patients undergoing the transitional phase from partial to complete edentulism
Rodolfo Bruniera Anchieta1, Isis Almela Endo Hoshino2, Amilcar Chagas Freitas Júnior3, Erika Oliveira de Almeida4, Eduardo Passos Rocha5, Wirley Gonçalves Assunção5
1 Department of Restorative Dentistry, Univ Estadual Paulista, Araçatuba; Department Unipos-Dentistry, Centro Universitário do Norte Paulista, UNORP, São José do Rio Preto, São Paulo, Brazil
2 Department of Restorative Dentistry, Univ Estadual Paulista, Araçatuba, Brazil
3 Post-Graduation Program in Dental Prosthodontics, Innovation School, Natal, RN, Brazil
4 Department of Dentistry, Universidade Federal do Rio Grande do Norte, UFRN, Natal, São Paulo, Brazil
5 Department of Dental Materials and Prosthodontics, Univ Estadual Paulista, Araçatuba, Brazil
|Date of Web Publication||17-Jun-2019|
Dr. Rodolfo Bruniera Anchieta
Department of Restorative Dentistry, Sao Paulo State University, Univ Estadual Paulista, Araçatuba, SP 16015-050
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The objecitve of present article, is show through a clinical case the importance of preserving te remaining teeth in oral rehabilitation of elderly people, durinf the transitional phase from partial to complete edentulism. After careful planning, prosthetic rehabilitation was developed with the use of the remaining teeth that had excellent bone and periodontal implantation. In addition to root-supported overdenture provide better retention, stability, and comfort when compared to conventional full dentures, also help in the preservation of the alveolar ridge in the long term. The maintenance of the remaining roots for fabrication of overdentures allows future treatment with osseointegrated implants without the need for invasive surgical procedures for reconstruction.
Keywords: Complete edentulism, preservation of the alveolar, root-supported overdenture
|How to cite this article:|
Anchieta RB, Endo Hoshino IA, Freitas Júnior AC, de Almeida EO, Rocha EP, Assunção WG. Root-supported overdenture as a prosthetic alternative for patients undergoing the transitional phase from partial to complete edentulism. J Dent Implant 2019;9:41-5
|How to cite this URL:|
Anchieta RB, Endo Hoshino IA, Freitas Júnior AC, de Almeida EO, Rocha EP, Assunção WG. Root-supported overdenture as a prosthetic alternative for patients undergoing the transitional phase from partial to complete edentulism. J Dent Implant [serial online] 2019 [cited 2020 Jan 24];9:41-5. Available from: http://www.jdionline.org/text.asp?2019/9/1/41/260452
| Introduction|| |
Before implants became a regular prosthetic therapy, remaining roots were maintained and used to prevent residual ridge resorption and discomfort with complete dentures., However, the treatment with implants has raised a question about the fabrication of root-supported overdentures since some studies indicate limited prognosis for remaining roots because of their greater susceptibility to caries and periodontal problems., On the other hand, another study showed that periodontally healthy teeth present better survival rate than implants.,
Hence, the maintenance of teeth or roots for fabrication of overdentures has been requested mainly by elderly since this population usually presents systemic disorders or limited financial support that may preclude the treatment with osseointegrated implants.,, In this context, Brkovic-Popovic et al. demonstrated no significant ridge resorption surrounding the abutments in patients wearing root-supported overdentures.,,
According to this, the aim of this study was to present the importance of preserving the remaining teeth in patients during the transitional phase from partial to complete edentulism through preservation of the alveolar ridge after a 3-year follow-up in an elderly patient.
| Case Report|| |
A 62-year-old female patient attended the dental clinic, complaining about the esthetics and retention of the maxillary and mandibular dentures. The clinical examination revealed that the mandibular arch featured a Kennedy Class I with the right canine to the left canine and a removable partial denture with clips broken. The maxilla (Kennedy Class II subdivision 2) was rehabilitated with a provisional removable partial denture [Figure 1] and [Figure 2].
|Figure 1: Initial aspect of the patient showing maxillary alveolar ridge with the remaining roots (canine, second premolar, and first molar of the opposite hemiarch)|
Click here to view
|Figure 2: Mandibular removable partial denture with the left circumferential clasp broken. Maxillary provisional removable partial denture|
Click here to view
The patient also presented reduced interocclusal distance [Figure 3] and three endodontically treated maxillary roots restored with amalgam (right canine, right second premolar, and left first molar). The planning was based on the patient's expectations, oral characteristic, and financial limitations.
|Figure 3: Lateral view showing unsatisfactory space for insertion of attachment system|
Click here to view
It was suggested fabrication of a mandibular removable partial denture and a maxillary overdenture with metallic caps on the roots. The maxillary root-supported overdenture was chosen as a treatment alternative due to the limited economic status of the patient, which avoids the therapy with dental implants and implant-supported prostheses. The metallic caps were selected based on the reduced interocclusal distance, counterindicating the use of attachment systems.
After the approval of the treatment planning by the patient, the mandibular study cast was obtained by impression with alginate (Hydrogum, Zhermack SpA Polesine Badia, Italy). The root canals were prepared with Largo drills and the remaining roots were prepared with diamond burs. Thereafter, the impression of the maxillary arch and root canals was made with polyvinyl siloxane (Express, 3M/ESPE, St. Paul, Minnesota, USA) to obtain the metallic caps.
The metallic caps were cemented with zinc phosphate cement (ESP Durelon, Seefeld, Germany) [Figure 4] and a new impression of the maxillary arch was conducted. Then, the casts were mounted in a semiadjustable articulator after interocclusal record [Figure 5].
|Figure 4: Maxillary alveolar ridge with the remaining roots (canine, second premolar, and first molar of the opposite hemiarch) covered with metallic caps|
Click here to view
The artificial teeth were mounted on both prostheses [Figure 6] and clinical trials were carried out to evaluate esthetics and patient's comfort with the new vertical dimension of occlusion.
After clinical evaluation and approval by the patient, the dentures were processed. The resin base and occlusal surfaces of both dentures were adjusted to establish the bilateral balanced occlusion.
The patient returned for adjustments after every 15 days until the 3rd month following the dentures insertion [Figure 7] and [Figure 8]. After a 3-year follow-up, the prostheses were appropriate and the maxillary ridge presented no clinical sign of bone resorption [Figure 9].
|Figure 7: Initial aspect after the installation of maxillary overdenture|
Click here to view
|Figure 8: Occlusal view of the maxillary prosthesis showing the space in the acrylic resin base for the metal caps|
Click here to view
|Figure 9: Occlusal view of the remaining alveolar ridge after 3 years of overdenture insertion|
Click here to view
| Discussion|| |
For more than 100 years, conventional dentures were the only available treatment for edentulism., This conventional treatment relies on the retention and support provided by the remaining alveolar ridge.
The success of treatment with conventional complete dentures is variable and depends on the patient's capacity to overcome the limitations of complete dentures through an adaptive process.,,
The treatment with overdentures improves stability, retention, bite force, chewing efficiency, and oral health that may be associated with the quality of life in patients with severe problems for adapting with conventional dentures.,,,,
According to this, the maintenance of remaining roots prevents alveolar bone resorption, improves load transmission from the prosthesis to alveolar bone, maintains sensory feedback, and improves dentures stability.
In general, the higher the number of roots used to support the dentures, the greater the potential for success with overdentures.,, Similarly, the higher number of roots increases the sensory feedback of the patient. This results from the maintenance of the sensorial receptors of the periodontal ligament. Receptors of the periodontal ligament in dentate subjects contribute to the coordination of motor activity when chewing since objects of minimal thickness (<20 μm) are detected.,
The maintenance of only three roots [Figure 9] and [Figure 10] was enough to significantly increase the stability of a maxillary complete denture even without attachment systems on the roots due to unsatisfactory intermaxillary space.
|Figure 10: The remaining teeth are distributed in a polygonal configuration (triangle) of stabilization|
Click here to view
In addition, it was possible to preserve the volume and architecture of the alveolar ridge after 3 years of insertion of the root-supported overdenture. This fact is important mainly when rehabilitation with osseointegrated implants can be planned in the future.
Sometimes, this treatment only retards the condition of the partially dentate patient to the situation of complete edentulism. This is suggested since many studies have reported a limited prognostic for this treatment due to problems as caries, periodontal disease, and fracture of abutment teeth.,
However, caries was only a minor problem in this kind of treatment, as it could be completely inhibited through use of a daily application of chlorhexidine-fluoride gel and other problems could be controlled with periodical visits to the dentist.
Nevertheless, if all options for control of root-supported overdentures will not be efficient for its function, other prosthetic alternatives with adequate prognostic may be indicated, such as conventional complete denture or implant-supported/retained denture since the roots tend to preserve the alveolar ridge and minimize the resorption.,,,,
| Conclusions|| |
The roots maintenance for fabrication of overdentures is a low-cost and feasible alternative that improves the patients' quality of life. The preservation of the alveolar ridge resultant from maintenance of the remaining roots increased prosthesis support and stability and patient's comfort.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Fure S. Ten-year incidence of tooth loss and dental caries in elderly Swedish individuals. Caries Res 2003;37:462-9.
Kaufmann R, Friedli M, Hug S, Mericske-Stern R. Removable dentures with implant support in strategic positions followed for up to 8 years. Int J Prosthodont 2009;22:233-41.
Hug S, Mantokoudis D, Mericske-Stern R. Clinical evaluation of 3 overdenture concepts with tooth roots and implants: 2-year results. Int J Prosthodont 2006;19:236-43.
Bahrami G, Vaeth M, Kirkevang LL, Wenzel A, Isidor F. Risk factors for tooth loss in an adult population: A radiographic study. J Clin Periodontol 2008;35:1059-65.
Holm-Pedersen P, Lang NP, Müller F. What are the longevities of teeth and oral implants? Clin Oral Implants Res 2007;18 Suppl 3:15-9.
Sapir S, Kalter A, Sapir MR. Decoronation of an ankylosed permanent incisor: Alveolar ridge preservation and rehabilitation by an implant supported porcelain crown. Dent Traumatol 2009;25:346-9.
Scully C, Ettinger RL. The influence of systemic diseases on oral health care in older adults. J Am Dent Assoc. 2007 Sep 1;138:S7-14.
Stanford CM. Dental implants: a role in geriatric dentistry for the general practice?. J Am Dent Assoc. 2007 Sep 1;138:S34-40.
Brkovic-Popovic S, Stanisic-Sinobad D, Postic SD, Djukanovic D. Radiographic changes in alveolar bone height on overdenture abutments: A longitudinal study. Gerodontology 2008;25:118-223.
Becker CM, Kaiser DA. Overdenture abutments for fixed partial dentures. J Prosthet Dent 2000;84:366-9.
Avlund K, Holm-Pedersen P, Morse DE, Viitanen M, Winblad B. Tooth loss and caries prevalence in very old Swedish people: The relationship to cognitive function and functional ability. Gerodontology 2004;21:17-26.
Ferreira RC, de Magalhães CS, Moreira AN. Tooth loss, denture wearing and associated factors among an elderly institutionalised Brazilian population. Gerodontology 2008;25:168-78.
Awad MA, Lund JP, Dufresne E, Feine JS. Comparing the efficacy of mandibular implant-retained overdentures and conventional dentures among middle-aged edentulous patients: Satisfaction and functional assessment. Int J Prosthodont 2003;16:117-22.
Thomason JM, Lund JP, Chehade A, Feine JS. Patient satisfaction with mandibular implant overdentures and conventional dentures 6 months after delivery. Int J Prosthodont 2003;16:467-73.
Schuch C, de Moraes AP, Sarkis-Onofre R, Pereira-Cenci T, Boscato N. An alternative method for the fabrication of a root-supported overdenture: A clinical report. J Prosthet Dent 2013;109:1-4.
Carlsson GE. Clinical morbidity and sequelae of treatment with complete dentures. J Prosthet Dent 1998;79:17-23.
van Waas MA. The influence of psychologic factors on patient satisfaction with complete dentures. J Prosthet Dent 1990;63:545-8.
Assunção WG, Barão VA, Delben JA, Gomes EA, Tabata LF. A comparison of patient satisfaction between treatment with conventional complete dentures and overdentures in the elderly: A literature review. Gerodontology 2010;27:154-62.
Pera P, Bassi F, Schierano G, Appendino P, Preti G. Implant anchored complete mandibular denture: Evaluation of masticatory efficiency, oral function and degree of satisfaction. J Oral Rehabil 1998;25:462-7.
Fontijn-Tekamp FA, Slagter AP, van't Hof MA, Geertman ME, Kalk W. Bite forces with mandibular implant-retained overdentures. J Dent Res 1998;77:1832-9.
Assunção WG, Zardo GG, Delben JA, Barão VA. Comparing the efficacy of mandibular implant-retained overdentures and conventional dentures among elderly edentulous patients: Satisfaction and quality of life. Gerodontology 2007;24:235-8.
Awad MA, Lund JP, Shapiro SH, Locker D, Klemetti E, Chehade A, et al.
Oral health status and treatment satisfaction with mandibular implant overdentures and conventional dentures: A randomized clinical trial in a senior population. Int J Prosthodont 2003;16:390-6.
Fontijn-Tekamp FA, van 't Hof MA, Slagter AP, van Waas MA. The state of dentition in relation to nutrition in elderly Europeans in the SENECA study of 1993. Eur J Clin Nutr 1996;50 Suppl 2:S117-22.
MacEntee MI, Hole R, Stolar E. The significance of the mouth in old age. Soc Sci Med 1997;45:1449-58.
Haritha M, Reddy DM. Root supported overdentures-case report. J N J Dent Assoc 2015;86:22-3.
Al-Zubeidi MI, Payne AG. Mandibular overdentures: A review of treatment philosophy and prosthodontic maintenance. N Z Dent J 2007;103:88-97.
Mericske EA, Mericske-Stern R. Overdenture abutments and reduced periodontium in elderly patients. A retrospective study. Schweiz Monatsschr Zahnmed 1993;103:1245-51.
Renner RP. The overdenture concept. Dent Clin North Am 1990;34:593-606.
Walters RA. Design, preparation, and maintenance of overdenture abutments. Dent Clin North Am 1990;34:631-44.
Mericske-Stern R, Hofmann J, Wedig A, Geering AH.In vivo
measurements of maximal occlusal force and minimal pressure threshold on overdentures supported by implants or natural roots: A comparative study, part 1. Int J Oral Maxillofac Implants 1993;8:641-9.
Jacobs R, van Steenberghe D. Comparative evaluation of the oral tactile function by means of teeth or implant-supported prostheses. Clin Oral Implants Res 1991;2:75-80.
Krennmair G, Krainhöfner M, Waldenberger O, Piehslinger E. Dental implants as strategic supplementary abutments for implant-tooth-supported telescopic crown-retained maxillary dentures: A retrospective follow-up study for up to 9 years. Int J Prosthodont 2007;20:617-22.
Carlsson GE. Implant and root supported overdentures – A literature review and some data on bone loss in edentulous jaws. J Adv Prosthodont 2014;6:245-52.
Budtz-Jörgensen E. Prognosis of overdenture abutments in elderly patients with controlled oral hygiene. A 5 year study. J Oral Rehabil 1995;22:3-8.
Mericske-Stern R. Overdentures with roots or implants for elderly patients: A comparison. J Prosthet Dent 1994;72:543-50.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]