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Maxillary overlay removable partial dentures for the restoration of worn teeth

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 Continuing Education 1

Maxillary Overlay
Removable Partial
Dentures for the
Restoration of
Worn Teeth
By Júlio Fonseca, DMD; Pedro Nicolau, DMD, PhD;
and Tony Daher, DDS, MSEd

Learning Objectives abstract

• list the various classifications of

tooth surface loss. Prolonged tooth maintenance by a more aged population
• explain the changes that take place considerably increases the probability of dentists having to
in the relationship of teeth as treat patients with high levels of tooth wear. Pathological
they wear. tooth wear, caused primarily by parafunction, seems to
• understand the use of maxillary be a growing problem that affects a large number of adult
overlay removable partial dentures patients. The clinical report presents a case of a partially
(ORPDs) in the treatment of edentulous patient with an elevated degree of wear in
patients with severe tooth wear.
the upper jaw caused by attrition and erosion, rehabili-
tated with a maxillary overlay removable partial denture
(ORPD) consisting of a chrome-cobalt (Cr-Co) framework
with anterior acrylic resin veneers, posterior cast overlays,
and acrylic resin denture bases. Removable partial pros-
thesis is a treatment alternative when teeth are found to be
severely worn or when the patient needs a simple and eco-
nomical option. Because economics is a conditional factor
of the treatment, the clinician should present different
treatment alternatives to the patient, in which the overlay
prosthesis can be considered.

12 compendium April 2011 Volume 32, Number 3

 Continuing Education 1
T
ooth wear is commonly found in every den-
tition and may have physiologic or patho-
logic causes. 1-3 Pathological tooth wear is
becoming more evident today, with an
aging population who is retaining their
natural teeth for significantly longer. 2,4
When tooth wear occurs as a natural physiological process,
the average wear rates on occlusal contact areas were estimated
to be 29 µm per year for molars and 15 µm per year for premo-
lars.5 Tooth wear is considered excessive or pathologic when the
normal rate of wear is accelerated by endogenous or exogenous
factors2 and the degree of wear exceeds the level expected at any
particular age.1,6 Tooth wear caused by parafunction is estimated
to progress 3 times faster than physiological wear.2 Tooth surface
loss (TSL) has been classified as the following types: (1) erosion:
loss of tooth surface by chemical processes not involving bacterial
action; (2) attrition: tooth structure loss by wear of tooth or resto-
ration surface caused by tooth-to-tooth contact during functional
or parafunctional activity of the teeth; and (3) abrasion: loss of
tooth surface caused by the frictional action of a foreign substance
on the teeth (other than tooth-to-tooth contact), such as that
caused by toothbrushing. Another classification divides tooth
wear into two categories: mechanical wear caused by attrition
or abrasion, and chemical wear caused by erosion.1,2,7
A differential diagnosis is not always possible because in many
situations there is an occurring combination of these process-
es1,2 although one is likely to predominate.8 Patients often seek
help for problems of pain, altered function, and compromised
appearance.8 Etiologic factors include bruxism, harmful oral
habits, diet with excessive intake of citrus fruits or beverages
with a low pH, eating disorders, gastroesophageal reflux disease,
environmental and salivary factors as in xerostomic patients,
and congenital anomalies such as amelogenesis imperfecta and
dentinogenesis imperfecta.1-3
Several changes take place in the relationship of the teeth as
they wear: Flat occlusal contacts create lack of stability, reduced
clinical crown height, and the exposure of large areas of dentin
that may limit the use of conservative adhesive techniques.9 This
creates many difficulties for the restorative dentist, who may have
to compromise the form of the restorations, their occlusal rela-
tionships, and the stability of the occlusion. Adequate retention
and resistance forms for fixed prostheses are also difficult.6,9,10
In situations where tooth tissue loss has occurred and the occlu-
sal vertical dimension (OVD) is still acceptable without the need
be increased (compensated tooth surface loss [TSL] by continu-
ous tooth eruption and alveolar bone growth2), treatment options
may include periodontal surgery to gain clinical crown length,
orthodontic movement with limited intrusion, surgical reposi-
tioning of a segment of teeth with its supporting alveolar bone,
and placement of crowns and fixed partial dentures (FPDs).1,2
14 compendium April 2011
In situations where tooth wear exceeds compensatory mecha-
nisms (non-compensated TSL11), loss of OVD will occur.2 With non-
compensated TSL, the collapse of the anterior lower facial height
needs an increase in the vertical dimension to restore the subjects
to their presumed original OVD before TSL took place.11 This will
create the interocclusal space required to accommodate the restor-
ative material. Because the tooth structure is already worn, avoiding
further tooth reduction to create space is highly desirable.12
The space required can be obtained by an overall increase in
OVD. This allows the opportunity to restore the teeth and to re-
establish esthetic and occlusal stability.8,12 Determining the OVD
can be achieved through several methods such as phonetics, interoc-
clusal distance, swallowing, and esthetics.1,2 A correct determination
of the OVD and an appropriate jaw relationship form the basis of
treatment whether this employs fixed or removable prostheses.11
Long-term observations have confirmed that, for the majority of
patients, moderate alterations to the OVD may be well-tolerated.1
It is commonly believed that changes of OVD should be conserva-
tive and that a carefully monitored trial period with an interim
prosthesis is desirable.1 Transitional removable partial dentures
(RPDs) at the desired OVD, acrylic splints, or provisional restora-
tions are several techniques that can be used.13 Because treatments
may be costly and time-consuming, it is preferable to use a pros-
thesis that does not permanently change the dentition during the
assessment period.1,10 The obtained position can be used for the
definitive rehabilitation, and the final treatment option is depen-
dent on the condition of the patient’s remaining teeth.
In situations where loss of OVD has occurred because of non-
compensated TSL,11 the overlay removable partial denture (ORPD)
may be a definitive treatment option.2 This treatment consists
of a prosthesis that covers and is partially supported by natural
teeth, tooth roots, or dental implants and is an effective method
of treating a patient with severely worn dentition.14,15 This treat-
ment option has been suggested to be reversible and cost-effective
for patients with congenital or acquired anomalies, with the final
outcome pleasing to the patient.2,14 The following case report de-
scribes the use of maxillary ORPDs consisting of a chrome-cobalt
(Cr-Co) framework with anterior acrylic resin veneers, posterior
cast overlays, and acrylic resin denture bases in the treatment of
a patient with severe tooth wear caused by attrition and erosion.
Case Report
A 51-year-old man was referred for prosthodontic and occlusal
rehabilitation to the postgraduate clinic of the Faculty of Dental
Medicine at the University of Coimbra, Portugal. His chief com-
plaint was chewing difficulty and poor esthetics (“small teeth”).
His medical and dental histories were recorded, and a complete
series of radiographs were made. There was no medical or dental
history that contraindicated dental treatment.
Volume 32, Number 3
 Initial examination revealed a partial edentulous patient with
extensive wear of the maxillary anterior teeth and moderate wear
in the mandibular teeth (Figure 1 through Figure 7). The patient’s
maxillary and mandibular RPDs also showed excessive wear and
multiple signs of fractures (Figure 2 and Figure 3). The patient
had been wearing a mandibular nightguard for 8 years.
Fig 1. Fig 2.
An extensive evaluation was performed that included intraoral
and extraoral examinations of the teeth and supporting structures
and an examination of the existing prostheses.10 Palpation of the
temporomandibular joints and muscles of mastication revealed
no evidence of joint sounds and/or tenderness. The mandibular
range of motion was within normal limits.
A history of bruxing and consumption of acidic and carbonated
drinks were reported. The clinical examination revealed severe
tooth wear extending to the cervical level of the palatal surfaces of
the maxillary teeth in some areas. Therefore, TSL was diagnosed
as being caused by a combination of attrition and erosion.
Clinical determination of the OVD was achieved using sev-
eral methods such as facial measurements and esthetics.10 This
distance varies between persons in a range of 2 mm to 4 mm.
Fig 3.
Phonetics were used to also determine the optimal position of the
maxillary central incisor edges, with the incisors lightly touching
the junction of the wet and dry border of the lower lip during Fig 1. Intraoral anterior view of the patient presenting a severely worn
maxillary dentition and loss of OVD. Fig 2. Intraoral occlusal view of max-
pronunciation of fricative sounds. Patient preferences and facial illary dentition with the existing removable prosthesis presenting exces-
appearance were also evaluated. After careful assessment, an in- sive signs of wear. Fig 3. Intraoral occlusal view of mandibular dentition
terocclusal space of 7 mm was determined. The increase needed in with the existing removable prosthesis presenting excessive signs of wear.

the actual OVD was 4 mm, thereby leaving 3 mm of interocclusal

space. Investigation of the patient’s maxillo–mandibular relation-
ship revealed an edge-to-edge tooth relationship in intercuspa-
tion position (ICP). A functional convenience position had been
assumed. Preliminary impressions were made. The diagnostic
casts were mounted on a semi-adjustable articulator using an
interocclusal relation record with a bite registration material at
the presumed final OVD and an average mounting technique.
During the following visit, several treatment options ranging
from composite resin restorations to endodontic therapy to fixed
restorations were discussed with the patient. After considering
the options as well as the life expectancy of FPDs, the amount of
time necessary, and patient’s financial constraints, the patient
elected to have ORPDs.
The design of the final maxillary overlay Cr-Co framework
included metal occlusal surfaces on the anterior teeth and left
second maxillary molar, a telescopic crown on the right maxillary
third molar, circumferential clasps on the canines and left second
molar, and a palatal strap as a major connector. Metal occlusal
surfaces on the incisive teeth were provided with retention beads
for an acrylic resin veneer material in the facial aspect of the
incisors, and the tip of the canines were restored with composite
resin to avoid further tooth surface preparation and to maintain
maximum proprioception.
The prosthetic treatment began with diagnostic wax patterns of
the maxillary teeth to restore the OVD and the plane of occlusion
(Figure 8 through Figure 10). The proportions of the maxillary
anterior teeth were corrected based on anatomic landmarks and
averaged values. In addition, the diagnostic wax patterns correct-
ed the maxillary–mandibular relation from edge-to-edge to Class
I relationship in order to achieve a stable rehabilitation position.
The diagnostic cast of the wax patterns was duplicated using ir-
reversible hydrocolloid and then poured in dental stone, and 1-mm
thick thermal-vacuumed forming material was formed over the cast.
The upper acrylic partial denture of the patient was then modi-
fied using the vacuum-formed template as follows: The occlusal
surfaces of the patient’s teeth were lubricated with Vaseline.
Retentive grooves were created on the interim prosthesis, which
was then filled with autopolymerizing acrylic resin and inserted
into the mouth. After polymerization, the template and prosthesis
were removed, the excess bulk of the acrylic was trimmed, and
the prosthesis was polished. After insertion, the occlusion was
adjusted for canine guidance. This allowed for assessment of the
patient’s tolerance and acceptance of the restored OVD, testing
of the occlusion, and evaluation of phonetics and esthetics before
making the definitive prosthesis.

www.dentalaegis.com/cced April 2011 compendium 15

 Continuing Education 1
Fig 4.
Fig 4. Intraoral occlusal view of maxillary dentition presenting exces-
sive signs of wear. Fig 5. Intraoral occlusal view of mandibular denti-
tion presenting excessive signs of wear. Fig 6. Lateral right view.
Fig 7. Lateral left view.
The interim prosthesis was designed to offer bilateral and simulta-
neous contact of all posterior teeth and a slight contact of the anterior
teeth in centric occlusion, incisal guidance in protrusive movement,
and canine guidance in laterotrusive movements. The interim pros-
thesis was delivered to the patient and was worn for approximately
7 weeks, during which occlusal adjustments were made and occlu-
sion was modified on the basis of phonetic and esthetic principles,
as well as patient comfort and ease of function. The patient was also
evaluated for excessive signs of wear on the prosthesis, symptoms
of temporomandibular dysfunction, and muscle tenderness. The
prosthesis was well-tolerated and maintained by the patient with no
adverse effect on phonetics, and no repairs were necessary.
After 2 weeks using the interim prosthesis, a periodontal exam-
ination revealed the presence of gingival marginal inflammation
on the palatal aspect of the anterior teeth. Small composite resin
restorations were then made to create a supragingival margin and
the necessary relief on the interim prosthesis. After 1 week, the
examination revealed only a smaller gingival marginal inflam-
mation, with no patient discomfort.
The absence of pain in the masticatory muscles and the im-
provement in mastication, speech, and facial esthetics confirmed
the patient’s tolerance to the new mandibular interim prosthesis.
The interocclusal space was determined to be 4 mm at the end
of the assessment period. On the basis of these observations it
was decided to undertake the definitive oral rehabilitation at the
newly established OVD using the interim prosthesis as a guide.
Facial reduction of enamel surface on the maxillary incisive
was required to accommodate the acrylic resin veneers, which
would be bonded to the ORPD framework. Dentin exposure areas
of the teeth were treated with dentin bonding agents and fluoride
applications (Figure 11).
16 compendium April 2011
Fig 5. Fig 6.
Fig 7.
The interim prosthesis was relined with autopolymerizing
acrylic resin. During a subsequent appointment, the process was
repeated for the maxillary right third molar, which was prepared
for a telescopic crown. On each of these appointments, the relin-
ing of the interim prosthesis maintained the established OVD.
Rest preparations were not needed because the entire occlusal
surface of the teeth served as rest seats under the cast framework.
Only sharp edges of the abutment teeth were rounded and pol-
ished. After preparations were completed, final silicone impres-
sions were made using standard trays customized with putty
silicone and a wash impression with a low-viscosity silicone. They
were poured in type IV dental stone to obtain a final cast. The
mandibular impression picked up the existing RPD for correction
of a clasp fracture and to replace the acrylic teeth that showed
excessive wear and an inadequate curve of Spee.
Using an earbow record and the patient interim prosthesis as a
centric occlusion record at the newly established OVD, the final
casts were mounted on a semi-adjustable articulator. Condylar
and side-shift angles were determined with the use of protrusive
and lateral bite records. A customized anterior incisal guidance
table was also established using autopolymerizing acrylic resin.
The casts were surveyed to determine the most suitable path
of insertion for the definitive prosthesis. The posterior occlusal
surfaces were waxed, and wax patterns were used for clasps and
denture base connectors. Retentions were placed on the surfaces
of the anterior portion of the framework to support acrylic ve-
neers. The wax patterns were casted in a chrome-cobalt alloy
(Figure 12).
The framework was evaluated intraorally for fit, occlusion,
retention, and stability (Figure 13 through Figure 15). With the
framework in position, a new maxillo–mandibular relationship
Volume 32, Number 3
record was made with a silicone-based interocclusal record mate-
rial, and the definitive casts were remounted on the articulator.
The framework was returned to the laboratory, and acrylic resin
veneers were applied in the esthetic zone and posterior artificial
acrylic resin teeth were placed on the framework. The artificial
teeth were arranged and tried in to verify esthetics and jaw re-
lation records and to obtain the patient’s approval before final
processing. The junction between the maxillary natural teeth
and the overlay prosthesis was not noticeable during normal
speech and function.
The prosthesis was then processed with heat-polymerized
acrylic resin. After deflasking procedures, the occlusion was
adjusted and the prosthesis was finished and polished. At the next
visit, the ORPDs were inserted with minor occlusal adjustments,
and the canines were then restored with bonded composite resin
(Figure 16 and Figure 17). Postoperative instructions on how to
properly insert and clean the prosthesis were provided. These
included oral hygiene, the application of sodium fluoride neutral
mineral gel, and dietary counseling for caries and erosion pre-
vention. The patient also was instructed to remove the dentures
at night and to clean the ORPDs with a non-abrasive paste and
soft-bristled brush. At night the patient was instructed to wear
Fig 8.
Fig 9.
www.dentalaegis.com/cced
a maxillary nightguard (Figure 18). Four post-insertion visits (2
days, 1 week, 2 weeks, 4 weeks) were needed for minor prosthe-
sis adjustments, and the patient was then placed on a 6-month
continuous care schedule. During a 48-month follow-up period
the only major problem was the fracture of the tip of the right
canine, which was easily repaired with resin composite. Small
marginal gingival inflammation on the maxillary incisors was
also noticed and easily managed. No further wear was noticed
on the mandibular teeth.
Discussion
The treatment used in this case is a relatively non-invasive, con-
servative, and cost-effective solution that allowed an esthetic and
functional rehabilitation.1,16 This technique can be useful as an
interim measure and allows for the possibility of more involved
and complex procedures in the form of conventional crowns to
be considered at a later time.12
Several disadvantages are associated with ORPDs such as com-
plaints related to compromised esthetics when the dentures are
removed,2 and oral comfort.16 Overlay treatment may be related
to caries and progression of periodontal disease adjacent to the
Fig 10.
Fig 11.
Fig 8. Lateral right view on the diagnostic casts mounted on a semi-
adjustable articulator at the selected OVD. Fig 9. Anterior view of the
diagnostic wax patterns made on the maxillary anterior teeth and on
the acrylic partial denture. Fig 10. The interim prosthesis adjusted for
canine guidance. Fig 11. Tooth preparations. Anterior view.
April 2011 compendium 17
 Continuing Education 1

abutments even if preventive measures are introduced;16 however,

these problems are mainly a result of poor oral hygiene.2 Veneer
material fracture, debonding, discoloration, wear, and patient dis-
satisfaction with a removable prosthesis are also possible com-
plications of ORPD therapy.2,14 To improve denture retention and
patient comfort, the abutments may be provided with attachments
or conical crowns if the patient is able to maintain satisfactory
oral hygiene.16
Fig 12. Fig 13.
Other risks of treatment with RPDs are mechanical failures
such as fractures of major or minor connectors, as well as oc-
clusal rests, deformation or fracture of retentive clasps, and in-
flammation of the underlying mucosa from traumatic irritation.
Furthermore, the resorption of the residual ridge below the distal
extension and wear of the denture teeth may result in a desta-
bilization of the occlusion.16 Such risks could be minimized, to
some extent, by a careful design of the framework with adequate
dimensions and by using distal abutment or implants and institut-
ing regular recalls to anticipate changes or problems.17
Caries secondary to the prosthesis insertion and periodontal
problems are the main cause of loss of abutments.16 The wear-
ing of a close-fitting denture can affect the progression of peri-
odontal disease, accentuating the accumulation/formation of
plaque and bacterial colonization (and increasing its pathoge-
nicity).16 Overdenture abutment caries is rarely the reason for
tooth extraction considering that it normally could be treated
with conventional conservative techniques. The placement of
copings with subgingivally located margins is also an additional
caries preventive measure.18 In this specific case those copings
were not used because of financial limitations, but the authors
recognize their advantage in controlling caries and abutment
wear.16 The preparation’s margins were located just gingivally,
and the palatal margin of the anterior tooth was restored with
Fig 14.
direct acid-etch retained composite resin to minimize gingival
inflammation.12,16 When the loss of abutments is inevitable, the
consequences are usually readily overcome by re-adaptation of
the denture or replacement of the natural tooth by an implant.16
Periodontal health and a reduced risk of caries can be maintained
by rigorous oral hygiene measures, daily application of a fluoride
or chlorhexidine gel, and by removing the dentures overnight.17
Several authors have stressed that good patient cooperation and
regular recalls are of major importance in reducing potential prob-
Fig 15. Fig 16. lems compared with the minor impact of the concept and design of
the dentures.19 In a study performed by Ettinger et al20 the rate of
Fig 12. Maxillary prosthesis framework. Fig 13. Maxillary prosthesis subsequent periapical pathosis in overdenture abutments due to
framework try-in. Anterior view. Fig 14. Maxillary prosthesis frame- pulp necrosis or endodontic-associated problems was only 3.8%.
work try-in. Telescopic crown on the right molar. Fig 15. Maxillary
The clinician should be aware of potential pulp micro-exposures
prosthesis framework try-in. Metal occlusal surfaces on the left molar.
Fig 16. Anterior, lateral right, and left view of the maxillary prosthesis when using vital teeth as abutments and should use a restorative
teeth try-in. material to seal the exposed tubules.20 In this clinical case, dentin
exposure was managed with a thorough maintenance program that
included patient and/or professional application fluoride mouth

18 compendium April 2011 Volume 32, Number 3

rinses and varnishes and the use of dentin bonding agents. An
average interval between radiographs is typically 6 to 24 months,
but they can be taken at any interval when they will aid either in
monitoring or early diagnosis of periapical pathosis.
As in this case, when a patient exhibits parafunctional activity,
it becomes increasingly important that there are enough opposing
posterior teeth to provide stable ICP contacts so that the forces
produced during parafunction are distributed over a wide area
and in the teeth-long axis direction.6 An adequate anterior guid-
ance will reduce the potentially harmful lateral forces produced
by bruxing on interferences between posterior teeth. Canine
guidance in lateral excursion and incisal guidance in protrusion Fig 17.
discludes the posterior teeth as soon as the mandible moves from
ICP and reduces the number of tooth contacts occurring outside
ICP.21 There is some evidence that this alters the proprioceptive
feedback to the central nervous system, which in turn reduces the
level of activity in the masticatory muscles.22 Besides, in terms of
laboratory and clinical prosthetic convenience, it is much easier
to produce restorations in the presence of an adequately steep,
immediate disclusion provided by a small number of teeth near
the front of the mouth. When the lower dentition produces a
satisfactory occlusal plane and stable ICP contacts there is no
need for lower rehabilitation to complement the upper denture
unless there are specific esthetic reasons.11
The etiology of parafunction is largely stress-related. It is likely Fig 18.
that patients will continue to brux and clench after restoration
of the worn teeth. Patients who are prone to nocturnal bruxism Fig 17. Details of the maxillary prosthesis finished after the recon-
should wear occlusal guards at night. This may reduce their para- struction of the canines. Fig 18. The nightguard.
functional activity and will prevent damage to teeth and new res-
torations. It is important to motivate patients to wear their night-
guards by stressing the long-term consequences of failing to do so. with composite or porcelain veneers, in this patient acrylic veneers
This should be made clear to the patient before treatment begins.3,6 were applied to the framework. There are several clinical cases
To prevent framework failures and distribute the occlusal described where acrylic or porcelain veneers were used.2,14,15
forces, the dentures should be designed with rigid major and Porcelain veneers are more color-stable than acrylic;23,24 how-
minor connectors, reciprocating clasp arms, and occlusal rests. ever, their low deformation at the yield point indicates that por-
The choice of denture base material will depend on various celain may be more suitable for rigid areas of a removable partial
factors including the opposing materials and whether coverage denture.25 Porcelain veneers are more expensive and more difficult
is mainly on hard or soft tissue. A well-supported and resistant to produce and repair than acrylic. Acrylic resin teeth veneers for
denture is of primary importance. The definitive upper denture RPDs have reasonably good esthetics, can be easily repaired, and
will benefit from a metal construction if the splint has shown signs are compatible with most dental alloys. In addition to relatively
of excessive wear resulting in breakage.11 The final prosthesis can pleasing esthetics, an acrylic prosthesis is inexpensive, not time-
be veneered over almost its entire occlusal surface with Cr-Co, consuming, and simple to produce. The retention of the resin to
which will strengthen the appliance and increase its longevity. the metal is mainly mechanical. Acrylic resin teeth veneers are
Long-term wear resistance is essential because of the tremen- more sensitive to microleakage and are less color-stable than
dous occlusal stresses that take place during normal mastication. porcelain veneers.23,24 They also are less wear-resistant26 and even-
However, when using Cr-Co, attention must be paid to the prob- tually require repair or replacement. But with its high compres-
ability that the opposing arch may suffer accelerated wear.11 In this sive load and yield strength, acrylic resin presents the physical
case, metal occlusal surfaces on the incisive teeth were provided properties that makes it the material of choice for veneering the
with retention beads for a veneering material on the facial aspect. more flexible areas of overlay dentures that may flex in function,
Although the esthetic zone in the ORPD can be fabricated either as in the anterior area of a bruxing patient.25,26

www.dentalaegis.com/cced April 2011 compendium 19

 Continuing Education 1
Conclusion
In analyzing the literature, it can be concluded that the dental
profession has seemingly not reached a consensus on the action
needed in cases of tooth surface loss, but it agrees that a preven-
tive regimen, as well as an early diagnosis of tooth surface loss,
is preferable to restoration.
Removable prostheses may be the treatment of choice for some
individuals, particularly when the time and cost of fixed restora-
tions are considered. This clinical report demonstrated that the
use of ORPDs can be a viable, relatively inexpensive, conser-
vative, and non-invasive treatment choice for a patient with a
severely worn dentition who expressed concerns over treatment
longevity, invasiveness, cost, and long-term maintenance.
Every tooth replacement should be preceded by a careful
evaluation of the existing dental and functional situation of
the individual patient and the risks, benefits, and costs of any
relevant prosthetic treatment. The conversion of existing pros-
theses into onlay provisional dentures has been presented. With
this method of assessing a patient’s tolerance to restoration of
the occlusal vertical dimension, esthetics and function can be
established and acceptability can be evaluated before perma-
nent changes are made to the natural dentition. Any treatment
option contemplated should be coupled with an overall preven-
tive approach and a rigorous maintenance program. In well-
controlled cases, biological failures through caries, periodontal
disease, and endodontic problems will be rare and generally can
be easily managed.
about the authors
Júlio Fonseca, DMD
Assistant Professor
Department of Occlusion, Faculty of Dental Medicine
University of Coimbra
Coimbra, Portugal
Pedro Nicolau, DMD, PhD
Professor
Department of Prosthodontics, Faculty of Dental Medicine
University of Coimbra
Coimbra, Portugal
Tony Daher, DDS, MSEd
Associate Professor
Department of Restorative Dentistry, School of Dentistry
Loma Linda University
Loma Linda, California
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15. Pavarina AC, Machado AL, Vergani CE, Giampaolo ET. Overlay
removable partial dentures for a patient with ectodermal dysplasia:
a clinical report. J Prosthet Dent. 2001;86(6):574-577.
16. Budtz-Jorgensen E. Restoration of the partially edentulous mouth—
a comparison of overdentures, removable partial dentures, fixed partial
dentures and implant treatment. J Dent. 1996;24(4):237-244.
17. Bergman B, Hugoson A, Olsson CO. Caries, periodontal and
prosthetic findings in patients with removable partial dentures: a
ten-year longitudinal study. J Prosthet Dent. 1982;48(5):506-514.
18. Molin M, Bergman B, Ericson A. A clinical evaluation of conical
crown retained dentures. J Prosthet Dent. 1993;70(3):251-256.
19. Keltjens HM, Schaeken MJ, van der Hoeven JS, Hendriks JC. Ef-
fects of chlorhexidine gel on periodontal health of abutment teeth in
patients with overdentures. Clin Oral Implants Res. 1991;2(2):71-74.
20. Ettinger RL, Krell K. Endodontic problems in an overdenture
population. J Prosthet Dent. 1988;59(4):459-462.
21. McIntyre F. Restoring esthetics and anterior guidance in worn
anterior teeth. A conservative multidisciplinary approach. J Am Dent
Assoc. 2000;131(9):1279-1283.
22. Wiskott HW, Belser UC. A rationale for a simplified occlusal de-
sign in restorative dentistry: historical review and clinical guidelines.
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23. Marei MK, el-Shimy A. Restoration of inadequate occlusal face
height by using resin bonded to etched metal removable prosthesis.
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24. Lakatos S, Rominu M, Negrutiu M, Florita Z. The microleakage
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25. Rominu M, Lakatos S, Florita Z, Negrutiu M. Investigation of
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1999;27(5):367-372.
Volume 32, Number 3
 Continuing Education 1 Quiz 1

Maxillary Overlay Removable Partial Dentures

for the Restoration of Worn Teeth
By Júlio Fonseca, DMD; Pedro Nicolau, DMD, PhD; and Tony Daher, DDS, MSEd

This article provides 2 hours of CE credit from AEGIS Publications, LLC. Record your answers on the enclosed answer sheet or submit them on a
separate sheet of paper. You may also phone your answers in to (215) 504-1275 x 207 or fax them to (215) 504-1502 or log on to www.dentalaegis.com/
cced and click on “Continuing Education.” Be sure to include your name, address, telephone number, and last 4 digits of your Social Security number.

1. When tooth wear occurs as a natural physiological process, the 6. Periodontal health and a reduced risk of caries can be main-
average wear rates on occlusal contact areas were estimated tained by:
to be how much per year for molars? A. rigorous oral hygiene measures.
A. 0.29 µm B. daily application of a fluoride or chlorhexidine gel.
B. 0.15 µm C. removing the dentures overnight.
C. 15 µm D. all of the above
D. 29 µm.
7. The rate of subsequent periapical pathosis in overdenture
2. Compared to physiological wear, tooth wear caused by para- abutments due to pulp necrosis or endodontic-associated
function is estimated to progress: problems was:
A. 10 times slower. A. 3.8%.
B. 5 times slower. B. 8.3%.
C. approximately the same. C. 13.8%.
D. 3 times faster. D. 18.3%.

3. In situations where tooth wear exceeds compensatory mecha- 8. When a patient exhibits parafunctional activity, it becomes
nisms (non-compensated TSL): increasingly important that:
A. loss of OVD will occur. A. there are enough opposing posterior teeth to provide stable
B. there is TMJ pain reported. ICP contacts.
C. there is always periodontal pocketing observed. B. the forces produced during parafunction are distributed
D. endodontic treatment will be required. over a wide area and in the teeth-long axis direction.
C. the forces produced during parafunction are distributed in
4. Long-term observations have confirmed that, for the majority the teeth-long axis direction.
of patients, what kind of alterations to the OVD may be
D. all of the above
well-tolerated?
A. small
9. The etiology of parafunction is largely:
B. moderate
A. caries-related.
C. large
B. stress-related.
D. uni-dimensional
C. psychosomatically related.
D. genetically related.
5. Overlay treatment may be related to caries and progression of
periodontal disease adjacent to the abutments even if preve-
tive measures are introduced; however, these problems are 10. When using Cr-Co, attention must be paid to the probability
mainly a result of: that the:
A. inadequate clasp retention. A. patient will complain of a unusual taste.
B. lack of cuspid rise disclusion. B. patient will discontinue proper oral hygiene.
C. poor oral hygiene. C. opposing arch may suffer accelerated wear.
D. salivary fluid entrapment under the partial. D. casting will deform over time.

The deadline for submission of quizzes is 24 months after the date of publication. Par-
ticipants must attain a score of 70% on each quiz to receive credit. Participants receiving
a failing grade on any exam will be notified and permitted to take one re-examination.
Participants will receive an annual report documenting their accumulated credits, and
AEGIS Publications, LLC, is an ADA CERP Recognized Provider. ADA
CERP is a service of the American Dental Association to assist dental
professionals in identifying quality providers of continuing dental
education. ADA CERP does not approve or endorse individual courses
Program Approval for
or instructors, nor does it imply acceptance of credit hours by boards of Continuing Education

dentistry. Concerns or complaints about a CE provider may be directed Approved PACE Program Provider

are urged to contact their own state registry boards for special CE requirements. to the provider or to ADA CERP at www.ada. org/goto/cerp.
FAGD/MAGD Approved
7/18/1990 to 12/31/2012

www.dentalaegis.com/cced April 2011 compendium 21

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