Section 41- Overdentures

Handout Abstracts 001. Miller, P. A. Complete dentures supported by natural teeth. Prosthet !ent "#$%4-$%", 1$&$. 00%. Morro', (. M., et al. )ooth-supported complete dentures# An approach to preventive prosthodontics. Prosthet !ent %1#&1*-&%%, 1$+$. 00*. Morro', (. M., et al. ,mmediate interim tooth-supported complete dentures. Prosthet !ent *0#+$&--00, 1$-*. 004. !od.e, C. A. Prevention o/ complete denture problems by the use o/ overdentures. Prosthet !ent *0#40*-411, 1$-*. 00&. )hayer, 0. 0. Overdentures and the periodontium. !C1A %4#*+$-*--, 1$"0. 00+. Crum, (. . and (ooney, 2. 3. Alveolar bone loss in overdentures - & year study. Prosthet !ent 40#+10-+1*, 1$-". 00-. !er4son, 2. !. and Mac3ntee, M. M. 3//ect o/ 0.45 stannous /luoride .el on the .in.ival health o/ overdenture abutments. Prosthet !ent 4"#%*-%+, 1$"%. 00". )oolson, 6. 7. and Smith, !. 3. A /ive-year lon.itudinal study o/ patients treated 'ith overdentures. Prosthet !ent 4$#-4$--&+, 1$"*. 00$. 8llo, C. A. and (enner, (. P. !esi.n considerations /or a removable partial overdenture. Compend Contin 3duc !ent &#1&-1$, 1$"4. 010. Casey, !, M. and 6auciello, 9. (. A revie' o/ the submer.ed root concept. Prosthet !ent 4*#1%"-1*%, 1$"0. Section 41: Overdentures (Handout) Definitions Overdenture# a removable partial or complete denture that covers and rests on one or more remainin. natural teeth, roots, and:or dental implants; a prosthesis that covers and is partially supported by natural teeth, tooth roots, and:or dental implants-called also overlay denture, overlay prosthesis, superimposed, prosthesis. Indications and contraindications <Morro'=

,ndications# - 'hen a patient has /our or less retainable teeth in an arch - as a practical measure in preventive dentistry - 'ith bene/it the /ollo'in. patients# malrelated rid.e cases; those /acin. the loss o/ teeth in one arch 'hile the other is dentulous; patients 'ith un/avorable ton.ue positions, muscle attachments, residual rid.es; and di//icult stablility:retention cases. Contraindications# - the patient 'ho cannot be motivated to the desired level o/ oral hy.iene - systemic complications - inade>uate interarch distance Advantages and disadvantages <Morro', !od.e, Crum, )hayer, Miller, )oolson= 1. Advanta.es# a. preservation o/ alveolar bone <Crum# "? more bone loss over & years 'ith conventional dentures=. <At'ood @ )all.ren= C! 'earers su//ered irreversible bone loss especially in the /irst year at the rate in the mandible bein. /our times that in the ma?illa. <Miller= alveolar bone resorption is dependent upon three variables 'hich are# 1= the character o/ the bone, %= the health o/ the individual, *= and the amount o/ trauma to 'hich the structures are subAected. b. proprioception is maintained <)hayer=. Aids in directional sensitivity; dimensional discrimination; canine response; tactile sensitivity. 6it revie'# <Manly= av.. threshold o/ sensitivity to a load 'as ten times as .reat in denture 'earers as in dentulous patients. <6oiselle= discrimination 'as better in overdenture patients and that anterior teeth 'ere more sensitive than the posterior teeth. c. 2reatly enhanced stability <!od.e= d. positive retention e. B!O in maintained /. C( is easily recorded and preserved .. 6ip and /ace support h. Cuspid protection i. Psycholo.ical bene/its C security C patient still has his teeth A. Mastication 4. Poste?traction com/ort l. Positive support and com/ort 8se o/ attachments C !od.e discusses the advanta.es and disadvanta.es o/ the 2erber, (othermann, and the 7a4er clip attachments. Gerber 696 C Stud type, matri?, patri?, resilient and non-resilient desi.ns

Advanta.es# - (esiliency compatible 'ith tissue displacement under the denture. - Patri? and matri? sections are replaceable - Provides e?cellent support, stability, and retention

!isadvanta.es# - Considerable space or hei.ht is re>uired. !i//icult to use in a short interocclusal situation - Complicated to place, must be positioned 'ith a surveyor on a cast. A precision pic4up impression o/ the copin.s in the mouth is re>uired, and the /emale unit must be laboratory processed to the denture. - ,t is relatively e?pensive due to the above precision procedures and the ori.inal cost o/ the attachments. - Plastic teeth must be used and they tend to 'ear e?cessively. - Sometimes, the attachment must be placed lin.ual to the abutment tooth, 'hich in turn must be placed into the vestibule. - Cleansin. o/ the matri? may present a problem. - Some tor>ue is applied to the root due to the hei.ht o/ the attachment.

Rot er!ann C short stud 'ith a retainin. .roove. (etention provided by a C-shaped rin. desi.ned so that the /ree ends o/ the clip en.a.e the deepest portion o/ the retainin. .roove. )he stud comes 'ith a central core o/ solder /or easy attachment to the copin.

Advanta.es# - Shorter than the 2erber and can be placed in close-bite situations. - !irection o/ insertion is not important. Strict parallelism is not re>uired. - Attachment o/ stud to copin. can be done over a 7unsen burner. - )he /emale clip can be cold-cured 'ith a pic4up procedure. !isadvanta.es# - )oo bul4y /or many situations and a plastic overtooth is re>uired. - ,t is a'4'ard to position the C clip /or pic4up in the denture. - ,t is easy to loc4 the arms o/ the clip in acrylic resin. - )here is no lead-in as the patient attempts to seat the denture. - 9re>uent adAustment may be necessary and are di//icult to per/orm. - 7rea4a.e has been a problem.

" e #a$er c%i& C Small 8-shaped clip desi.ned to snap over a piece o/ round 'ire.

Advanta.es# - Bery small. Can use a porcelain overtooth. - )he desi.n is simple. - Parallelism is not a /actor. - ,t is easily constructed. - )he cost is minimal !isadvanta.e# i/ the clip becomes 'orn or bro4en, it has to be cut out o/ the denture rather than simply unscre'ed.

4' Abut!ent teet se%ection and &re&aration <Morro', Miller, )hayer, 8llo= <Morro'= 3valuation /rom /our standpoints#

- Periodontal status# mobility o/ the abutment tooth can be reduced by improvin. the cro'n#root ratio, poc4ets can be sur.ically corrected. - Caries# lesions must be restorable - Position# optimal abutment distribution /or one arch typi/ied by t'o cuspid and t'o second molar abutment. )his rectan.ular distribution provides /or ma?imum stability and support o/ the restoration. - 3ndodontics /acilitates correction o/ un/avorable clinical situations, i.e. cro'n#root ratios, esthetics, malpositioned teeth, latitude in the preparation o/ the teeth, and correction o/ un/avorable tilt and contours in abutments may be enhanced by endodontics.

Preparations should be tapered to'ard the incisal or occlusal sur/ace. )his 'ill permit development o/ copin. contours 'hich terminate in a rounded occlusal sur/ace as advocated by Miller. Cham/er-type mar.ins should e?tent Aust beneath the .in.ival mar.in and should be de/inite enou.h to permit accurate carvin. o/ the 'a? pattern. (' "issue &re&aration <Morro', )hayer, Casey= - periodontal preparation. )he amount o/ attached .in.iva is by /ar the most important consideration and it must be .reater than 1 mm. )estin. o/ the tissue is done by probin. the sulcular area and observin. i/ bleedin. occurs. ,/ li.ht in/lammation is present oral hy.iene must be improved or the Done o/ attached .in.iva must be increased throu.h .ra/tin. - submusosal vital root retention. <Casey and 6auciello= C 0istorical revie' o/ the /irst root submersions in humans. )he primary .oal 'as to .ain periodontal attachment. ,n situations 'here the conventional overdenture approach is not advisable <poor oral hy.iene, periodontitis, caries, economics, etc.= the vital root submersion procedures may be a viable alternative. Advanta.e# retained root and retardin. the resorption o/ bone. !isadvanta.e# possible loss o/ vestibular depth due to the sur.ical techni>ue. 6' "ec nica% consideration <Morro'= - ,mmediate interim overdenture C a conservative approach 'hich enables the dentist to implement a tooth-supported complete denture on a .raduated basis, providin. /le?ibility in plannin. treatment to meet the chan.in. re>uirements. An interim tooth-supported denture can be converted to a more de/initive prosthesis /ollo'in. a /avorable response to treatment, maintained as is /or a poor pro.nosis, or converted to a conventional complete denture. - Metal-based overdentures o//er several advanta.es, includin. stren.th, 'hich minimiDes postinsertion brea4a.e. )hey are indicated /or those patients 'hose previous denture e?perience includes recurrent /ailure due to brea4a.e. - )he metal base should be short o/ the re/lection o/ the cast because all borders are /inished in acrylic resin. Chrome-cobalt alloys /or ma?illary cases, and type ,B .old /or mandibular ones <adds 'ei.ht=. Contact 'ith the copin.s should be at the incisal 1:* only. Chec4 'ith disclosin. 'a?. - 9rom )hayerEs article# Farren and Caputo <1$-&= compared stresses on teeth restored 'ith amal.am, cast do'el post and copin.s, tapered cast .old copin.s, bischo/-dosenbach

attachments and ce4a attachments# the amal.am restored teeth displayed the least amount o/ stress. )' *aintenance - 9luoride application - )oolson study# 1a9 .el is an e//ective means to prevent recurrent caries on the retained overdenture abutments. )he periodontal health, 'hile not optimal, 'as not responsible /or the loss o/ a si.ni/icant number o/ abutments. 0o'ever, there 'as a si.ni/icant loss o/ attached tissue bet'een the %- and &-year recall. )he satis/action o/ the patients 'ith overdentures remained hi.h. )he >uality o/ the retention and support 'as also maintained. )his study emphasiDed the importance o/ a thorou.h periodontal evaluation o/ potential overdenture abutments. 9inally, the patient should be motivated to properly maintain the retained teeth 'ith home care and understand the importance o/ periodic /ollo'-up care by the dentist. - 7ene/its o/ /luoride - <!er4son= 0.45 Sn9% is an e//ective a.ent in reducin. the pro.ress o/ .in.ivitis around overdenture abutments + Abstracts , 41+--1' *i%%er. /' A' 0o!&%ete dentures su&&orted b1 natura% teet ' 2 /rost et Dent 3:944+ 943. 19(9' Purpose# G)his article is 'ritten in 1$&$.G ,t discusses that there are a lar.e number o/ youn. people bet'een 1"-*0 'ho are edentulous, and that one out o/ every /ive Americans has lost all o/ his teeth by the a.e o/ 40. At the a.e o/ &0, the ratio is % out o/ &, and at the a.e o/ -0, % out o/ 4. !iscussion# 3atin. to the elderly people is considered the one recreation /rom 'hich even the bedridden patient can derive .reat pleasure i/ he or she has the G'ear 'ith allG 'ith 'hich to participate. ,t is inevitable that resorption occurs 'hen teeth are removed. )he rate o/ resorption depends on three thin.s. )he character o/ bone, the health o/ the individual and the amount that traumas are subAected to. )en years o/ clinical investi.ation sho' that 'ea4 teeth used as support /or denture prosthesis not only remain in position but that a number have re.ain a healthier status. Methods @ Materials# )he remainin. teeth are prepared as /ull cro'n covera.e 'ith a shoulder type preparation. )he shoulder provides space /or a porcelain or a plastic labial insert in the thimble portion o/ the prostheses and ma4es an oversiDed lin.ual sur/ace unnecessary. )here is one important di//erence in preparation C the normally /lattened occlusal portion o/ the abutment teeth should be rounded or parabolic in /orm. Such a preparation permits the stresses o/ occlusion to be directed alon. the lon. a?es o/ the abutment teeth allo's /or some movement o/ the denture. )he abutment tooth plays no part in the retention o/ the denture; it acts as a stabiliDer. 9rictional retention is not 'anted; usin. the teeth /or more than support o/ the denture 'ill shorten their li/e. (etention o/ the denture is by inter/acial adhesion bet'een the tissue side o/ the denture and the mucosa. )hin 'all <%+ .au.e= castin.s <copin.s= are made to cover the prepared abutment teeth and cemented to place. All e?posed tooth sur/aces should be covered in an e//ort to prevent /uture carious lesions /rom developin.. A/ter approval o/ the try-in, the thimbles are removed /rom the 'a? denture and cemented to

the master cast. ,t is important that the thimbles be /i?ed to the master cast durin. /abrication procedures to prevent seepa.e o/ resin into the inside o/ the thimbles. A malrelation o/ the thimbles to the abutment teeth and the /inished denture 'ill result i/ this step is ne.lected. Summary# (etainin. teeth permit the stresses o/ occlusion to be borne partially by the teeth, thus reducin. the abuse, 'hich the alveolar process and the mucoperiosteum under.o 'hen dentures are 'orn. 7y reducin. the trauma to the mucosal tissues, it is reasonable to e?pect that resorption o/ the alveolar process 'ill be lessened. 41+--4' *orro5. R' *'. et a%' "oot +su&&orted co!&%ete dentures: An a&&roac to &reventive &rost odontics' 2 /rost et Dent 41:(16+(44. 1969' Purpose# )his article is a techni>ue article. ,t discusses the use/ulness o/ utiliDin. abutment teeth in the support o/ complete dentures. 7y maintainin. teeth the alveolar rid.e is less li4ely to resorb. 0i.hli.hts# ,. Advanta.es o/ )ooth Supported !entures. 1. So/t tissue o/ residual rid.e receives less abuse since abutment teeth provide support. %. More horiDontal stability. *. ,ncreased vertical stability. 4. 3?cellent patient acceptance. &. 1atural teeth unacceptable /or conventional dental use are acceptable /or tooth supported dentures. ,,. ,ndications and Contraindications to the )ooth Supported !enture. A. ,ndications 1. Fhen patient presents 'ith 4 or less retainable teeth. %. Patient presents 'ith mali.ned rid.es. *. Stability and:or retention o/ conventional dentures 'ill be a problem. 4. 8n/avorable ton.ue position, muscle attachments, and residual rid.es. &. !entulous arch opposin. a potentially edentulous arch. 7. Contraindications 1. Patient not motivated to maintain .ood oral hy.iene. %. Patient has numerous systemic problems. *. ,nade>uate interarch distance. ,,,. Steps in Construction o/ )ooth Supported !enture. 1. Selection and preparation o/ abutments. A /our step process. a. 3valuate the periodontal status o/ proposed abutments. %. Mobility# evaluate cro'n# root ratio *. Consider periodontal sur.ery /or poc4et elimination. 4. Abutment preparations should taper to'ard the occlusal or incisal sur/ace. &. Cham/er mar.ins are placed Aust belo' the .in.iva. a. 3valuate /or caries. b. Position o/ abutments and their relationship to each other. +. Optimal abutment distribution# % canines and % second molars per arch. -. (ectan.ular distribution provides the best stability. ". A sin.le abutment may be used. $. Appro?imatin. abutments ma4e cleanin. di//icult there/ore avoid appro?imatin. abutments.

a. 3ndodontics 10. (estoration o/ abutment<s= 'ith .old copin.s. 11. Metal base complete denture inserted over the abutments. a. Provides an accurate base upon 'hich Aa' relations can be made. b. Provides a precise adaptation o/ the abutment copin.s to the metal denture base ,B. Postinsertion instructions 1. remove dentures each ni.ht %. 7rush dentures a/ter each meal 'ith a so/t toothbrush. 41+--6' *orro5. R' *'. et a%' I!!ediate interi! toot +su&&orted co!&%ete dentures' 2 /rost et Dent 6-:69(+)--. 19)6' See section %+ C ,mmediate !entures /or this abstract 41+--4' Dodge. 0' /revention of co!&%ete denture &rob%e!s b1 use of overdentures' 2 /rost et Dent 6-:4-6+411. 19)6' (etainin. roots o/ selected 4ey teeth has demonstrated advanta.es over the use o/ complete dentures# 1. 2reatly enhanced stability. Anterior-posterior and lateral slippin. and slidin. are eliminated. - Positive retention. Periodontal bone remains relatively intact. )all.ren has reported that the anterior mandibular rid.e resorption may be as much as /our times that 'hich occurs in the ma?illa. - Proprioception. Provides an a'areness o/ Aa'-space relationships. ,t is impaired, i/ not lost entirely 'hen the teeth are e?tracted. - Bertical dimension loss o/ bone is avoided. - 6ip and /ace support. )eeth do not disappear /rom vie' due to alveolar resorption. - Psycholo.ical bene/its. As lon. as the roots are preserved, the patient e?periences a sense o/ security and a /eelin. that he still has his teeth. - Ability to masticate /ood seems to be better. - Poste?traction com/ort. )he common denture sore spots that o/ten /ollo' total e?traction are .reatly diminished, because the immediate denture is restin. on solid supports durin. this postoperative period. )ypes o/ attachments# 1. )he 2erber attachment# A stud type o/ unit, consistin. o/ male and /emale sections, and it is available in resilient <containin. a replaceable rin.=, and nonresilient desi.ns. Advanta.es - Can readily replace male or /emale attachments by unscre'in. the 'orn unit. !isadvanta.es - ,t must be positioned 'ith a parallelin. instrument or surveyor on a cast. (e>uires considerable interocclusal distance. Some tor>ue is applied to the root due to the hei.ht o/ the attachment. )he (otherman attachment# A short stud 'ith a retainin. .roove. (etention is provided by a Cshaped rin. or clasp desi.ned so that the /ree ends o/ the clip en.a.e the deepest portion o/ the retainin. .roove. )he stud comes 'ith a central core o/ solder /or easy attachment to the copin..

Advanta.es - Strict parallelism is not essential. !isadvanta.es - )o bul4y /or many situations. AdAustments are di//icult. 7rea4a.e is a problem. )he 7a4er clip attachment# A small 8 - shaped clip desi.ned to snap over a piece o/ round 'ire. Advanta.es - ,t is very small. Parallelism is not a /actor. Cost is minimal. ,t is easy to clean. !isadvanta.es - ,/ the clip 'orn or bro4en, it has to be cut out o/ the denture rather than simply unscre'ed. (etention o/ roots ma4es possible a denture 'hich provides support, retention, stability, and com/ort superior to that o/ a complete denture. 41+--(' " a1er. H' H' Overdentures and t e &eriodontiu!' D07A 44:669+6)). 193-' !iscussion# Preservin. the teeth or the roots preserves the periodontal li.ament. )he periodontal li.ament supports the tooth, provides proprioception in directional sensitivity, dimensional discrimination, tactile sensitivity to load, and canine response. Manly et al /ound the avera.e tactile sensitivity to load threshold /or denture 'earers 'as 10 times that o/ natural teeth. Pacer and 7o'man /ound that patients 'ith overdentures 'ere better able to discriminate occlusal /orces. Hru.er and Michel /ound that canines possessed a .reater number o/ neurons than any other teeth. Ha'amura /ound that the anterior portion 'ere more sensitive than the posterior portion o/ the mouth. Crum and (ooney sho'ed that conventional denture patients had " times more loss o/ mandibular alveolar bone than those 'ith mandibular overdentures. At'ood and )all.ren /ound that mandibular alveolar bone loss rate 'as 4 times more than in the ma?illa. Carlsson /ound reduced stress /rom the use o/ a tissue bar <!older 7ar= in partial dentures compared to conventional (P!. 6an. and 6o'e states that %mm o/ 4eratiniDed tissue and 1mm o/ attached tissue 'ere needed to maintain .in.ival health. )hree si.ns to assess the >uality and >uantity o/ the .in.iva are# 1. Ade>uate 'idth o/ attached tissue. %. 7leedin. on probin.. *. 9ree .in.ival mar.in is mobile. ,n 1$-&, Farren and Caputo /ound the desi.n o/ an amal.am-restored tooth displayed the least amount o/ stress in a photoelastic study. ,n 1$--, )hayer and Caputo /ound the !older 7ar e?hibited more cross-arch involvement than the Iest anchor and allo'ed occlusal /orces to be shared bet'een the abutments. ,n 1$-$, )hayer and Caputo /ound the 0ader 7ar e?hibited more apical /orce than the !older 7ar and less tor>uin. /orce than the Hin.-connector. All tissue bars e?erted more stress on the contralateral side o/ the arch than did the stud and conventional desi.ns. )his indicated the tissue bar shared the occlusal /orces contralaterally and protected the periodontium more e>uitably. Patients must clean all e?posed dentin and use 0.45 stannous /luoride daily. 41+--6' 0ru! R28 Roone1 G9 2r' A%veo%ar bone %oss in overdentures: a (+1ear stud1' 2 /rost et Dent 4-(6):61-+6. 19)3' Purpose# )o demonstrate less alveolar bone reduction in patients 'ith complete ma?illary and mandibular overdentures compared to patients 'ith ma?illary complete dentures and mandibular complete dentures. Materials and Methods# 1+ men a.ed 4+-+- 'ho had all their natural teeth re-e?traction 'ere

studied /or & years a/ter e?traction. )'o .roups o/ ei.ht men, each had 1=pre-e?traction %=* 'ee4s a/ter e?traction and *=1 year post e?traction cephalometric radio.raphs. 3i.ht <.roup 1= 'ere treated 'ith complete ma?illary dentures over mandibular overdentures and ei.ht <.roup %= 'ere treated 'ith ma?illary and mandibular complete dentures. Overdenture teeth had root canal treatments and 'ere reduced 1.& mm above .in.ival line 'ith access sealed 'ith amal.am. Seven radio.raphs 'ere made /or each patient and casts 'ere made /or analysis at the same time intervals as the radio.raphs. (esults# A &-year clinical study sho'ed that patients treated 'ith complete ma?illary dentures and mandibular overdentures demonstrated less vertical alveolar bone reduction than patients 'ith complete ma?illary and mandibular dentures. Patients in the control .roup e?hibited a mean vertical loss o/ &.%mm o/ alveolar bone in the anterior part o/ the mandible and a mean vertical loss o/ 1.-mm in the anterior part o/ the ma?illae. )he reduction in hei.ht o/ the anterior part o/ the mandible /or the overdenture .roup 'as 0.+ mm, 'hich represents ei.ht times more bone loss in the patients 'ith complete dentures. )he bone loss in the ma?illary process 'as similar in both .roups. 41+--)' Der$son GD. and *ac9ntee. **' 9ffect of -'4: stannous f%uoride ge% on t e gingiva% ea%t of overdenture abut!ents' 2 /rost et Dent 43: 46+46. 1934' Purpose# )o observe the therapeutic e//ects o/ a o.45 Sn9% .el on the periodontium and tooth structure o/ overdenture abutments. Materials and Methods# )his study the involved the participation o/ 1- patients# Abutment teeth 'ere prepared and dentures /itted accordin. to techni>ue described by 6ord and )eel. All patients 'ore their dentures com/ortably durin. the day and removed them at ni.ht. A double-blind crossover e?perimental desi.n 'as used, a/ter the initial e?am, i.e. 2roup A used 0.45 Sn9% .el ? + months and 2roup 7 used applied a similar but non/luoridated .el. )hen a second e?amination 'as per/ormed and the .els 'ere e?chan.ed 'ith both .roups applyin. the alternative .el /or another + months. )he /inal oral e?ams 'ere per/ormed a/ter 1 year /rom the start o/ the study. )he disease activity 'as measured by one practitioner 'ho evaluated, crevicular /luid production, .in.ival poc4et depth, 'idth o/ attached .in.iva, .in.ival in/lammation, pla>ue accumulation, and resistance o/ tooth sur/aces to probin.. (esults# Only 1% o/ the patients completed the study. )he data 'as collected /rom a total o/ *4 teeth evaluated /rom these patients. 3ach patient had bet'een t'o and /our abutment teeth. Overall results sho'ed that a/ter a + month application o/ the 0.45 Sn9% .el the there 'as a si.ni/icant improvement <i.e. the there 'as a reduction in /luid= o/ the crevicular /luid measurement <C9M= scores and in the .in.ival inde? <2,= scores than obtained 'ith the non/luoridated .el. )he other variables, pla>ue inde?, poc4et depth, attached .in.iva, or caries 'ere not altered si.ni/icantly. Conclusions# )his study sho'ed that the 0.45 Sn9% .el 'as an e//ective a.ent in reducin. the pro.ress o/ .in.ivitis around overdenture abutments. 41+--3' "oo%son. ;' #' and S!it . D' 9' A five+1ear %ongitudina% stud1 of &atients treated 5it overdentures' 2 /rost et Dent 49:)49+)(6. 1936'

Problem# Overdentures have been documented by several authors to be associated 'ith periodontal disease and recurrent caries because o/ teeth are retained under a denture. Purpose# )o study the lon.itudinal chan.es that occurred 'ith patients 'ho have 'orn an overdenture /or a &-year period. )he e//ectiveness o/ /luoride to prevent caries, the periodontal health o/ the abutments, alon. 'ith problems 'ith the prosthesis and patients satis/action 'ere all assessed. Materials and Methods# &4 o/ "$ patients <%$ 'omen and %& men= returned /or the &-year recall. 1** overdenture abutments 'ere e?amined. Areas o/ interest included# <1= patient satis/action 'ith prosthesis, <%= periodontal health o/ overdenture abutments, <*= e//ectiveness o/ /luoride .el to control caries, <4= >uality o/ retention, stability, and occlusion o/ the dentures. (esults# Fluoride. 1+ o/ &4 patients 'ere usin. neutral p0 1a9 .el daily. *& o/ *+ teeth had no caries. )he .roup not usin. /luoride had $4 teeth, o/ 'hich %0 had caries. Periodontal health of abutments. Attached tissue decreased si.ni/icantly bet'een the %- and &year recall e?aminations. )he pla>ue inde? scores 'ere not elevated. 9luoride use raised the pla>ue score. Patient satisfaction, support, retention, and occlusion of the dentures. Patient !enture Satis/action Juestionnaire Scores remained at very acceptable levels, alon. 'ith the evaluation /or support, retention and occlusion o/ the dentures. Conclusion# 9luoride .el is an e//ective means to prevent recurrent caries on the retained overdenture abutments. )he periodontal health, 'hile not optimal, 'as not responsible /or the loss o/ a si.ni/icant number o/ abutments. 0o'ever, there 'as a si.ni/icant loss o/ attached tissue bet'een the %- and &-year recall. )he satis/action o/ the patients 'ith overdentures remained hi.h. )he >uality o/ the retention and support 'as also maintained. )his study emphasiDed the importance o/ a thorou.h periodontal evaluation o/ potential overdenture abutments. 9inally, the patient should be motivated to properly maintain the retained teeth 'ith home care and understand the importance o/ periodic /ollo'-up care by the dentist. 41+--9' <%%o. 0'A'. and Renner. R'/' Design considerations for a re!ovab%e &artia% overdenture' 0o!&end 0ontin 9duc Dent (:1(+19. 1934' Purpose# )o e?amine the desi.n criteria /or success/ul removable partial overdentures. SubAect# )heoretical desi.ns o/ a Hennedy Class , (P! incorporatin. an abutment root /or use in a removable partial overdenture. Methods and materials# Selection o/ abutments should consider 1=periodontal status, %= morpholo.y o/ the root canal system, *= a?ial inclination o/ root, 4= root len.th, and &= dental arch position. )he use o/ an overdenture abutment can e//ect chan.es in /ulcrums and shi/t the a?is o/ rotation /or the (P!. )he Hennedy Class , (P! can e//ectively be converted to a Hennedy Class ,, or ,,, dependin. upon the number and location o/ overdenture abutments selected. ,ntracoronal attachments may be utiliDed, but must provide the proper path o/ insertion in relation to the desi.n o/ direct retainers <clasps= to avoid lateral displacement durin. insertion:removal. (esults# 8se o/ partial overdenture abutment can help preserve alveolar bone, and help absorb occlusal /orces that other'ise 'ould be /ully dissipated throu.h so/t tissue into bone. Proper case selection and desi.n criteria are essential /or success. Conclusion# Althou.h the application o/ overdenture techni>ues to (P!s may be clinically

appropriate in a relatively small number o/ cases, such treatment can be a practical alternative to conventional therapy. 41+-1-' 0ase1. D. *' and ;aucie%%o. =' R' A revie5 of t e sub!erged root conce&t' 2 /rost et Dent 46:143+164. 193-' Purpose# )he purpose o/ this article is to describe the historical evolution o/ the submer.ed root concept and to chronolo.ically revie' the available literature on this subAect. !iscussion# Over the years there have been many reports sho'in. that roots 'hich 'ere /ractured and le/t behind durin. e?tractions may be retained in the alveolar bone 'ith no evidence o/ pathosis. ,n /act, most retained roots have been sho'n to actually remain vital. ,n 1$4% 7evelander studied the histolo.ical tissue reactions to e?perimental root /racture in do.s. ,n 1$4- 2lic4man and associates histolo.ically described the healin. o/ poste?traction 'ound 'ith the presence o/ retained root remnants in rats. )hey reported that in some rats pulp vitality 'as retained in roots that 'ere deep. ,n 1$&$ Simpson e?amined a number o/ retained roots in humans and su..ested that root /ra.ments, 'hich 'ere ori.inally una//ected, could be sa/ely le/t in position. ,n 1$+0 0elsham reported on a clinical supply o/ %000 patients re/erred /or removal o/ retained roots that a small percenta.e o/ retained roots caused symptoms an any demonstrable patholo.ic chan.es. ,n 1$-* 0erd reported on %%" retained roots removed /rom 1-1 patients. 0e /ound 1+* o/ these roots to have vital pulp tissue 'ith no in/lammation. )he /irst published report o/ intentional root submersion 'as by 7Aorn in 1$+1. 7Aorn e?cluded epithelial do'n.ro'th by severin. the ma?illary canine cro'ns on Ga number o/ do.sG on 'hom he had sur.ically produced labial periodontal de/ects + months prior. (esults 'ere not totally clear. ,n 1$+& 7Aorn and associates e?tended his previous study to humans. 0e cut o// the cro'n o/ the tooth at the .in.ival mar.in leavin. several millimeters o/ tooth structure above the alveolar crest. )he primary .oal o/ this study 'as to .ain periodontal reattachment not to submer.e roots inde/initely. 1evertheless, this is considered the /irst report o/ root submersion in humans. ,n 1$+" and 1$+$ 6am and Poon investi.ated the possibility o/ implantin. cold-cure acrylic resin roots. (esults sho'ed the rate and the amount o/ bone chan.e 'ere minimiDed in the re.ion o/ the implanted resin roots. Accordin. to Poe and associates in 1$-0 0o'ell reported a clinical study o/ submer.ed endodontically treated roots, some o/ 'hich had been under observation /or more than 10 years. 0o'ellEs purpose 'as an attempt to preserve alveolar bone. 0e claimed there 'as no apparent loss o/ bone in this lon.-term study and appears to be the /irst to utiliDe this techni>ue /or bone preservation under complete dentures. ,n 1$-1 Poe and associates /irst reported a study on vital root retention in do.s. 0istolo.ic e?amination sho'ed that the vitality o/ the root stumps 'as maintained in all do.s, and no evidence o/ periapical patholo.y 'as present. ,n 1$-% 6am reported on the use o/ acrylic resin, plaster o/ Paris, e?tracted teeth /illed 'ith amal.am. )here 'as de/inite delayed or altered resorption patterns, compared to the control sites over periods up to 4 years. ,n 1$-% 2os4a and Bandra4e reported on a sin.le human subAect havin. three endodontically treated roots submer.ed /or a period o/ % years. 1o evidence o/ either o/ systemic reAection 'ere noted. ,n 1$-4 ohnson and associates reported on vital root submersion in mon4eys. 1o periapical patholo.y 'as observed. ,n 1$-4 Fhita4er and Shan4le /ound hi.her success rate in the vital roots <1% o/ 1$= than in the endodontically treated roots <* o/ 1-=. )he success/ully submer.ed endodontically treated roots 'ere associated 'ith mild pericoronal in/lammatory response. )his reaction 'as totally absent in all the success/ul vital submersions.

,n 1$-* Sander discussed the advanta.es o/ root retention /or the maintenance o/ alveolar bone. 0e cited the main disadvanta.e o/ root submersion as the e//ect o/ the reduction in hei.ht o/ the vestibule. ,n 1$-4 Simon and Himura e?tracted endodontically treated and reimplanted *0 roots in ei.ht patients. Many roots 'ere sho'in. si.ns o/ resorption, althou.h clinically some o/ the patients appeared to be maintainin. alveolar bone. ,n 1$-4 article 6evin and associates /elt that retention o/ roots in a vital state mi.ht not be the method o/ choice in human. ,n 1$-& Simon and Himura histolo.ically e?amined si? roots /rom t'o patients. )he roots had been submer.ed %% and *0 months previously. )he results sho'ed root resorption and areas o/ an4ylosis present in all roots. ,n 1$-& 2uver reported t'o vital roots submer.ed in a human. A/ter %- months, three teeth remained normal radio.raphically and clinically, and they maintained the alveolar rid.e contour. )his 'as the /irst reported vital root submersion in humans. ,n 1$-+ Plata reported on a histolo.ic study o/ the re.eneration o/ alveolar bone over submer.ed vital roots in the do.. ,n ei.ht o/ the 1% roots there 'as complete bone covera.e a/ter 1% 'ee4s 'ith the pulp retainin. its vitality in all roots. ,n 1$-- Coo4 and association per/ormed a study similar to 7AornEs 1$+& study, e?cept that the submer.ed teeth 'ere vital. Pulpal tissues associated 'ith submer.ed roots appeared vital 'ithout si.ni/icant de.enerative or in/lammatory. (esults coronal over.ro'th, no periapical in/lammation, no pericoronal in/lammation 'as /ound. ,n the second part o/ their study, 2ound and associates e?tracted 1+ roots a/ter endodontic therapy and sectioned and contoured to % to * mm belo' the alveolar crest. ,n 1$-" Fel4er and associates reported on 1% roots submer.ed in si? patients. 3i.ht 'ere vital and /our nonvital. !entures had been 'orn over the roots /or periods up to &1months. All patients had been termed clinically success/ul. Conclusion# )he obvious need to preserve alveolar bone /or complete dentures has led to the overdenture concept. Studies revie'ed indicate that nonin/ected vital roots completely submer.ed 'ithin the alveolus may be an e?pedient and ine?pensive 'ay o/ preservin. alveolar bone /or the support o/ complete or removable partial dentures. )he main disadvanta.e 'as the loss o/ vestibular depth due to the sur.ical techni>ue that is involved.