Access to Better Dentures

INTRODUCTION

Complete edentulism can substantially affect oral and general health as well as overall quality of life.1-3Patient satis¬faction with dentures is influenced by various factors including denture quality, the available denture bearing area, the qual¬ity of dentist–patient interaction, previous experience with dentures, patient’s personality and psychologic well-being.4,5Replacing the lost tissues by means of complete dentures is challenging both for the dentist and the patient.6Never¬theless, some people do not succeed in acquiring new skills with their dentures and thus suffer psychologically because of impaired function, comfort, self-image and social interac¬tion.

Mandibular complete overdenture treatment is an effective and versatile means of restoring missing teeth and improving facial contours and is increasingly gaining popularity. As dentistry is experiencing a paradigm shift, in which mandibular im¬plant overdenture treatment may become the new standard of care for the treatment of the edentulous mandible.Dentist are looking for simplified treatments which are cost-effective alternatives to more complex and expensive implant-prostho¬dontic procedures.7 Maintenance of the residual alveolar bone is the most significant advantage of a tooth borne overdenture as the bone volume and vertical height can help in in¬creased prosthetic retention and stability.It also gives patient better function and control because of intact proprioception.7

The shortened crown improves the crown-to-root ratio, there¬by decreasing the mobility of the abutment teeth under an overdenture.In a 4-year-study, Renner and his co-workers8 showed that 50% of roots, used as overdenture abutments remained immobile. In addition, 25% of roots that were initially mobile became less mobile.The use of attachments can re-direct occlusal forces away from weak supporting abutments and onto soft tissue.They act as shock ab-sorbers as well as providessuperior re-tention.Attachments are often used in overdenture. This article reports a conservative approach of root preservation followed by replacement of missing teeth using Access post attachment with mandibular overdenture.8

CASE REPORT

A 40 years old female patientreported to the department of Prosthodontics at Dr.D.Y.Patil Dental College and Hospital with the chief complaint of all the teeth missing in the upper arch and few remaining natural teeth in the lower arch along withdifficulty in chewing.

Clin¬ical examination revealed completely edentulous maxillary arch and partially edentulous mandibular arch. Periodontal findings were significant with moderate amount of calculus and stains present along with gingival recession but no pock¬et formation. Teeth present in lower arch were 33 and 43. Loss of teeth had occurred due to decay, mobility and lack of oral hygiene practice in ear¬lier life. (FIG.1)

As remaining teeth were periodontally compromised, removable partial denture would not restore function and aesthetics to optimum function. It was concluded that mandibular canines could serve as abut¬ments for an overdenture thus providing required retention and stability. Diagnostic mounting revealed adequate inter¬arch distance for necessary overdenture components and esthetic and functional placement of artificial acrylic teeth.

Treatment plan was di¬vided into two phases: Phase 1:Preprosthetic phase, Phase 2: Prosthetic phase.

1. Preprosthetic phase: Endodontic treatment of 33,43 and oral prophylaxis management of them was done.

2. Prosthetic phase: The mandibular canines were pre¬pared followed by primary impression made in irreversible hydrocolloid (Imprint,DPI). Final impression was made in a special tray after bor¬der molding with low fusing compound(Greenstick,DPI) and wash impression with zinc oxide eugenol impression paste (DPI). Master cast was obtained. Orientation relation was recorded and transferred on a semiadjustable articulator. Lower cast was mounted using centric relation record.

Fol¬lowing teeth arrangement try-in was done, vertical dimension verified and centric and eccentric contacts were evaluated. Facial and functional harmony was studied and patient’s ap¬proval was obtained. Final dentureprocessing was done. After lab remounting and selective grind¬ing, the final dentures were finished and polished.

Post space preparation was carried out and Access Post was then cemented using zinc phosphate cement. The female cap was then attached chair-side to the denture using auto polymerizing acrylic resin (FIG.2). For this pur¬pose, rubber bands were used to cover the height of contour of the head and the nylon cap was placed on the ball of the post. Once the nylon cap was picked up, rubber bands were removed and flash trimmed. The denture was ad¬justed and equilibrated (FIG.3).

Post insertion instructions were given along with recall appointment. The following day mouth wasinspected for any sore areas and final corrections were made. The designed prosthesis served as an aesthetic and functional solution in the management of this patient.

Fig.1: Pre-Operative Intra-Oral View	Fig. 2 : Access Post In Place With The Rubber And Nylon Caps

Fig. 3: Post-Operavtive Intra-Oral View

DISCUSSION

Overdenture treatment is a notion which precludes the preventability of “floating plastic” in edentulous mouth. It is a sensible and prudent approach by the prosthodontist that has mitigated much of the time dependent risk inherent in complete denture service. Retention and Stability are enhanced, residual ridge resorption retarded and patient mediated responses are much improved.The overdenture merits are many, the pa¬tients chewing efficiency is one-third higher than that of complete denture wearers.The use of teeth as overdenture abutments is beneficial to patients especially from the psycho¬logical aspect of patients losing teeth which cannot be underestimated and this has been well documented.Even after knowing the merits,Tooth-borne overdenture attachment therapy is a treatment option rare¬ly chosen in today’s aggressive marketing of implant treat¬ment.8,9

The success of the overdenture treatment depends upon the proper attachment selection for a particular case. Attachment selection is based on available buccolingual and inter arch space, amount of bone support, opposing denti¬tion, clinical experience, personal preferences, maintenance problems and cost.9,10

Access posts are stud attachments that work well with overdentures, as they are the simplest of all. They occupy a small vertical space and the male units on the different roots do not require parallelism. The ball and sock¬et attachment of Access post allows rotation of the denture attachment. Small head of the attachment limits the amount of material that has to be removed from the denture.The ny¬lon cap provides 3-5 pounds of retention.10Thus this concept is cost effective.

CONCLUSION

In conclusion to obtain successful overdenture rehabilitation the dentists must be careful during case selection and abut¬ment preparation and a proper periodic follow-up.

REFERENCES