The dedicated retention ball hex driver was then used again to place high retention green ball attachments into the overdenture Figure A post-implant placement panoramic radiograph was taken Figure The patient was dismissed, appointed for a follow up, and allowed to heal while traveling. Definitive Mandibular Denture When the patient was financially ready to proceed with the treatment plan, closed-tray abutment level impression copings were seated, and an abutment level impression was made using a vinyl polysiloxane VPS impression material Honigum Pro [DMG America] Figure His lower final prosthesis Pala Digital Dentures was digitally designed with an occlusal scheme consistent with the maxillary removable provisional Snap-On Smile.
For the definitive overdenture, the decision was made to combine digital denture teeth Pala Digital Dentures with a titanium denture base framework Figure The dental laboratory team created a virtual wax-up and set and moved the proposed denture teeth according to that wax-up, and then proceeded to facilitate the CAM fabrication of the final mandibular overdenture. This meant only one patient appointment was necessary prior to delivery of the final implant overdenture, compared to the 5 or more appointments typically required for conventional dentures.
After seating the restoration, the patient was given hygiene instructions for proper maintenance and scheduled for a postoperative evaluation Figure In the future, the patient in this case will return for the extraction of his remaining maxillary teeth, the immediate placement of 6 implants, and immediate loading with a provisional PMMA digital denture attached with LOCATOR F-Tx abutments. Little is also a respected clinical researcher, focusing on implants and dental materials, as well as a consultant on emerging restorative techniques and materials. He can be reached via email at This email address is being protected from spambots.
Complete dentures are prone to a variety of displacing forces of differing magnitude as they are resting on oral mucosa and are in close proximity with tissues that are constantly changing due to the action of muscles. Consequently, for complete dentures to be retentive and stable, the retentive forces that hold the dentures in place must be greater than the ones aiming to displace it. Obtaining maximum stability and retention is one of the biggest challenges in full denture construction. Retention in removable prosthodontics can be defined as the resistance to vertical dislodgment  that can arise from either muscular forces or physical forces.
It can be gained from three different surfaces of the denture: . The peri-oral muscles muscles of the cheeks and lips can cause displacement of the dentures. Patients can, however, learn to control and coordinate their muscles so that the forces exerted are minimised or counter-acted to prevent such displacement.
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With age, the ability to learn new skills and acquire some level of neuromuscular control declines. Therefore, the "training" time-frame for patients to learn how to successfully use their new complete dentures is expected to be much longer for older patients. Many patients find the idea of wearing complete dentures very upsetting. It is, therefore, reasonable to consider different ways of transitioning into the edentate state in patients who have not yet lost all of their teeth but in which complete dentures will be required in the foreseeable future.
Alternatively, if the former is not possible, consideration should be given to whether roots of teeth can be retained in strategic locations in the maxilla or mandible to help with the stability of the prostheses. Teeth that can be restored despite a poor long-term prognosis may be retained to transition the patient into the edentulous state via a series of transitional partial dentures. It is important that the patient can maintain good plaque control during this period, as progression of periodontal disease will lead to further destruction of bone that will later become the foundation for denture support.
Complete dentures require some level of muscular control from the patient e. As patients age, the process of learning and memorising new skills as well as neuromuscular control i. An overdenture is a prosthesis that fits over retained roots or implants in the jaws. Compared to conventional complete dentures, it provides a greater level of stability and support for the prosthesis. The mandibular lower jaw has a significantly less surface area compared to the maxillary upper jaw, hence retention of a lower prosthesis is much more reduced.
Consequently, mandibular overdentures are much more commonly prescribed than maxillary ones, where the palate often provides enough support for the plate. Retaining two or three natural teeth as retained roots can greatly improve the retention and stability of a complete denture, especially if the roots are fitted with special precision attachments. The process involves decoronation removing the crown of the tooth and elective root canal treatment of the overdenture abutments.
For matters of simplicity for endodontic treatment provision, single rooted anterior teeth are preferred, with the exception of lower incisors as they lack sufficient root surface area. Alternatively, if treatment fails, the roots can be extracted and the overdenture can easily be converted into a conventional complete denture. Although an implant supported overdenture is not appropriate for the short-term transitioning stage into conventional complete dentures, it is an option that should be considered for the definitive treatment, given the higher stability and retention of such dentures.
When clearance of the dentition is the only viable treatment option, immediate dentures can be constructed prior to the extractions and fitted once the teeth have been removed, on the same appointment. Such dentures help restore masticatory chewing function and aesthetics whilst at the same time allowing a period for the soft tissues to heal and the bone levels to stabilise before constructing the definitive complete dentures.
In many circumstances patients will already have a set of dentures that will require replacing for various reasons e. Whether or not they are deemed satisfactory by the wearer or clinician, existing dentures can provide invaluable information for the construction of a new set .
If we are using the dentures for a long period of time, it would have undergone countless cycles of chewing and daily wear. The time taken for the repair depends on the severity of the damage. Broken dentures involving metal framework fractures are impossible for the lay person to repair. There are several anatomical structures that have the potential to cause displacement of the complete dentures. These are:. Similarly to all removable prosthesis, the first step in denture construction is to obtain accurate impressions of the soft tissues. Diagnosis and treatment plan of com Embed Size px.
Denture and Overdenture Complications
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Digital Denture Fabrication Process
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College of Dental Medicine | Course Descriptions | MUSC | Charleston, SC
No notes for slide. Diagnosis and treatment planning of edentulous patients 1. Above all, treating the patient instead of just constructing complete dentures for them. Lip support Lip thickness Lip length Determines the amount of basal seat available for denture foundation.