SRM Journal of Research in Dental Sciences

CASE REPORT
Year
: 2015  |  Volume : 6  |  Issue : 2  |  Page : 129--133

Tooth supported overdenture with stainless steel mesh reinforced


Angadi Kalyan Chakravarthy, Khaja Yousuf Sharif, M Mallikarjun, K Mahesh Babu, P Gautham 
 Department of Prosthodontics, Meghna Institute of Dental Sciences, Nizamabad, Telangana, India

Correspondence Address:
Khaja Yousuf Sharif
Department of Prosthodontics, Meghna Institute of Dental Sciences, Nizamabad, Telangana
India

Abstract

The overdenture is a removable prosthesis that is supported by both selectively retained teeth and the residual ridge or mucosa. It is a versatile and successful means of achieving long-term restoration of a partially edentulous jaw. Insertion and removal of the denture and routine oral hygiene are easy to perform. The beneficial results of this form of treatment can be considered for a wide variety of clinical applications for the severely advanced periodontitis case. This paper presents a case report on the prosthetic rehabilitation of a partially edentulous patient with a telescopic overdenture for the mandible and conventional complete denture for the maxilla.



How to cite this article:
Chakravarthy AK, Sharif KY, Mallikarjun M, Babu K M, Gautham P. Tooth supported overdenture with stainless steel mesh reinforced.SRM J Res Dent Sci 2015;6:129-133


How to cite this URL:
Chakravarthy AK, Sharif KY, Mallikarjun M, Babu K M, Gautham P. Tooth supported overdenture with stainless steel mesh reinforced. SRM J Res Dent Sci [serial online] 2015 [cited 2020 Sep 25 ];6:129-133
Available from: http://www.srmjrds.in/text.asp?2015/6/2/129/155477


Full Text

 INTRODUCTION



The loss of teeth is generally associated with esthetic, functional, psychological, and social impairment of the individual's life which may have a high impact of the patient's self-esteem and health. [1],[2] Periodontal disease and dental caries are indicated as main causes for the loss of teeth and are associated with cultural and social factors such as financial sources, educational level and the access to health services. [3],[4] In regards to the rehabilitation alternatives such as the use of dental implants, fixed prosthesis, removable partial or complete dentures, the overdenture rehabilitation is a viable and simple alternative and has been demonstrated to be efficient in these clinical situations. [5] In some situations, the dissatisfaction of the patient using conventional complete dentures/removable prosthesis is observed because of the instability of the prostheses. This instability is generated by prostheses movement over the soft tissue mainly in the mandibular arch. Thus, the preservation of roots are an effective way to improve prosthesis support and can be associated or not with retention systems. [6] A method to minimize these problems is the use of tooth supported complete denture. Root-supported overdentures have been fabricated to correct periodontal and/or occlusal collapse. Some teeth are maintained to:

Support and/or retain the prosthesis.Maximizing prosthesis stability.Preserving proprioception of the periodontal ligament.Reducing bone loss.Psychological benefits (like security-patient still has teeth).Improved mastication. [6],[7],[8]

The aim of this clinical case report was to present an oral rehabilitation of mandibular root-supported overdentures using a metal copings and metal mesh to prevent fracture of denture.

 CASE REPORT



A 55-year-old male patient with complete upper edentulous and partially lower edentulous condition reported to the Department of Prosthodontics with the chief complaint of replacing teeth. His major desire was to improve his masticatory function by retaining natural teeth.

Rosa (2012) stated that individuals rehabilitated with implants single crowns showed the greatest bite force and masticatory efficiency values compared to the other groups, the treatment using mandibular implant/tooth retained overdentures improved function compared to using conventional complete dentures.

History revealed that the patient was edentulous for the past 6 years and was wearing maxillary complete denture and lower removable partial denture since then. The general health status of the patient was quite satisfactory with no history of systemic disorders.

The intraoral examination revealed maxillary complete edentulous arch and partial edentulism in mandible. The teeth present were canines and premolars with sound periodontal and bone support. The ridge was low well-rounded in the maxillary arch, and uneven mandibular ridge is seen with sufficient inter arch space with an average mouth opening. The old existing dentures were compromised in retention and stability due to under extended borders along with severe occlusal wear. The patient was explained about other treatment modalities like removable partial denture, fixed partial denture and implant. As the economic status of the patient was poor, he cannot afford for fixed prosthesis. By considering his complaints about previous prosthesis that there is no retention and stability, we have planned for tooth supported overdenture. Therefore, new removable denture prosthesis was planned with a conventional complete denture for maxillary arch and an overdenture with retained teeth using metal copings and metal mesh for the mandibular arch to prevent fracture in denture [Figure 1].{Figure 1}

Clinical procedure

As the patient was not willing for extraction of his natural teeth and the final treatment option which patient selected was tooth supported overdenture, endodontic procedures were done in relation to 33, 34, 35, 43, 44, 45 as these teeth are used as abutments for the overdentures and were sectioned about 1 mm above the gingival margin. Intra-radicular postspace preparation was done for the abutment teeth sequentially with peeso reamers, and the wax pattern of the postspace is done by direct technique [Figure 2],[Figure 3] and [Figure 4]. The wax patterns were invested, burnt out, and casted to obtain metal copings. The metal copings along with post which were obtained after investing and casting are polished and cemented to teeth with glass ionomer cement (GC Corporation, Tokyo, Japan) [Figure 5] and [Figure 6].{Figure 2}{Figure 3}{Figure 4}{Figure 5}{Figure 6}

Preliminary impressions were made with impression compound using metal stock tray. Primary casts were poured with dental plaster and self-cure acrylic resin custom trays were constructed. Border-molding with low fusing modeling plastic (Dental Products of India [DPI] Tracing Stick, DPI, Mumbai, India), taking care to avoid overextension. Final impressions were made with polyvinyl siloxane light body impression material (DPI a division of the Bombay Burmah trading Corp. Ltd.). Master casts were poured with type III dental stone (Kalabhai, Mumbai, India). Stabilized record bases were made with self-cure acrylic (DPI, Mumbai, India) using the sprinkle-on technique and occlusion rims were fabricated with modeling wax. Wax rims were adjusted until tentative occlusal vertical dimensions were established, and jaw relations were recorded. Teeth were arranged in the usual manner. The wax set-up was tried in patient's mouth and was checked for esthetics, phonetics, occlusal vertical dimension, and occlusion. The maxillary and mandibular trial dentures were waxed up, flasked, and dewaxed. Heat cure acrylc resin was packed by placing metal mesh strips on buccal and lingual slopes of the mandibular ridge. Final finishing, polishing and laboratory remounting were done [Figure 7],[Figure 8],[Figure 9],[Figure 10],[Figure 11],[Figure 12] and [Figure 13].{Figure 7}{Figure 8}{Figure 9}{Figure 10}{Figure 11}{Figure 12}{Figure 13}

The patient was given routine postinsertion instructions and was motivated to make an effort to learn to adapt to the new dentures. Within a week, the patient expressed satisfaction in mastication and phonetics and his esthetic dilemma which was due to removable partial denture in the mandibular arch was reduced with the use of teeth retained overdenture.

 DISCUSSION



The literature reports that in the elderly population it is common to observe poor dentition, affected by periodontal disease and dental caries. In certain situations, the patient is limited to being rehabilitated with conventional complete dentures due to the fact that no other options are available. However, the use of select teeth in strategic positions can greatly improve the final treatment result in terms of overdenture stability and retention. [5]

This improvement is accomplished by utilization of roots to support, stabilize, and retain the overdenture. These alternatives offer the patient a more comfortable prosthesis, especially in the mandibular arch rehabilitation where achievement of functional requirements of the complete dentures with respect to retention, support, and stability are limited. [6]

Among possible roots to be used to support the overdenture, the canines and premolars are teeth that better exhibits characteristics associated with support. This occurs because of its large root with greater periodontal area for attachment and also due to its localization in the transition area between anterior and posterior teeth. [9]

By utilizing two canines and four premolars, it is shown that satisfactory retention was accomplished. Thus, this fact could have contributed to the patient's satisfaction in relation to retention and stability of the final prosthesis. Another advantage of this clinical case was the maintenance of the occlusal vertical dimension with relative accuracy by immediate denture utilization. Natural teeth utilization facilitates determination of centric relation. [10] It is important to emphasize that after dental extractions, it is necessary to have periodic relines done on the prostheses due to bone reabsorption to avoid movement.

Fenton and Hahn (1978), and by Toolson and Smith (1978), highlighted the problem of caries on abutment teeth and stressed the importance of sodium fluoride gel applied at regular intervals to decrease the activity of cariogenic microorganisms. Derkson and MacEntee (1982) showed that a 0.4% stannous fluoride gel had beneficial effects on the gingival health of overdenture abutments.

The most common problem associated with the mandibular overdentures is fracture in the midline area of the denture due to the absence of central and lateral incisors. So to increase the strength of denture, metal mesh is incorporated in the denture during packing of heat cure acrylic. [11] Reinforcement of acrylic denture base materials to improve the mechanical strength has been the focus of research for some time (Meng et al. 2005). Reinforcing agents in the form of cobalt-chromium wires (Uzun et al. 1999), metallic wires (Vojdani et al. 2006) have been added to PMMA matrix with considerable improvement in the strength.

The patient was instructed to comply with an oral hygiene program that included the use of fluoridated toothpaste and a 6-month recall schedule. At 1-year follow-up, both clinical and radiographic exams were performed, and patient's satisfaction was assessed. Consequently, there is a need for follow-up appointments to check the hygiene situation. Finally, one of the most important requirements to the success of overdentures is the patient's awareness of their need to improve oral hygiene of the remaining roots used for support and/or retention. [6]

 CONCLUSION



The root-supported overdenture is a better alternative for a treatment option to conventional dentures since the proprioception is maintained and improves stability and retention. It is necessary to have patient awareness about good oral hygiene to maintain the roots so that treatment remains satisfactory for a long time.

The overdenture is an outstanding mode of treatment. As Brewer and Fenton (1973) stated, "the application of this method of treatment is limited only by the imagination of the dentist," and in connection with that we must remember what Einstein once said, "imagination may be more important than knowledge."

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