Overdenture sequelae: a nine-month report

Six patients who were treated with maxillary and/or mandibular overdentures were recalled at specified intervals and observed for a period of 9 months. All these patients received periodontal therapy prior to overdenture fabrication. “Relief” and “no relief” methods of the acrylic resin of the overdenture opposing the abutment roots and supporting tissues were studied. The evaluation of dental and periodontal health was made, and the gingival index, sulcus depth, gingival crevicular fluid flow, width of the attached gingiva, root mobility, and dental caries were recorded.The subgingival microflora was examined at different time intervals to correlate gingival health and microbial ecology with overdenture wear. No statistically significant changes were noted with regard to the sulcus depth and width of the attached gingiva. A statistically significant decrease in the gingival index and the gingival crevicular fluid flow was observed around all the abutment roots, while no mobility of the abutment roots or dental caries were detectable throughout the length of the study.The pretreatment subgingival microflora consisted of a variety of microbial species. Following periodontal therapy and at the time of insertion of the overdentures, only Veillonella, Actinomyces, Bacteroides, and Candida were present. However, at the last recall Bacteroides and Candida were eliminated, while Fusobacterium, Treponema, Selenomonas, and Streptococcus repopulated the gingival crevice. Nevertheless, clinical gingival health was maintained. Additional studies are planned to determine if the total number of organisms rather than the composition of the flora is the important determinant of health or disease of the gingival tissues around the abutment roots supporting overdentures.It can be concluded that irrespective of which abutment management technique is used, the periodontal health of the abutment roots can be successfully maintained by good plaque control by the patient and by frequent professional recall visits. This study is part of a continuing longitudinal study of the effects of overdentures on their supporting tissues.     

A 10-year report of a longitudinal recall of overdenture patients

Eighty-nine patients were evaluated longitudinally for a 10-year period to assess the periodontal health of overdenture abutments and the effectiveness of the overdenture treatment. Of the original group, 28 patients returned for the 10-year recall. Sixty-six of the 77 overdenture abutments were present. Seven of the 11 abutment teeth extractions were because of caries and four were the result of periodontal disease. Most of the abutments have progressively lost attached tissue. Other periodontal indices remained fairly constant. Most of the patients were satisfied with the treatment even though the periodontal assessment was less than ideal.     

Overdentures and the periodontium.

Several periodontal factors are critical to the prognosis of overdenture abutment teeth. This literature review outlines these factors and discusses the documented effects of long-term overdenture use on periodontal health. The efficacy of a professional periodontal maintenance program, which is coordinated with a home oral hygiene program, is related to the success of overdenture therapy.     

Salvaging terminal dentitions with convertible periodontal prostheses

An alternative to the complete denture, the transitional prosthesis, the overdenture, and some tooth-splinting clasped partial dentures has been presented. The convertible periodontal prosthesis has many of the advantages of the overdenture, but few of the disadvantages such as palatal coverage, the appearance of a denture, and the psychologic effect. Preliminary observations over a 7-year period indicate that the periodontal condition of the abutment teeth improves. A case for periodontal worthiness of this method of periodontal prosthesis can be made.     

下颌磁性附着体覆盖全口义齿基牙龈沟内细菌的研究

目的 :了解磁性附着体基牙龈下微生物组成与正常龈下微生物组成比的差异及卫生指导前后基牙龈下微生物数量及组成的改变。方法 :检测卫生指导前后磁性附着体患者基牙以及正常人群相对应牙位龈下检出可培养微生物总量及组成比的变化。结果 :下颌磁性附着体覆盖全口义齿基牙龈沟中 ,G-杆菌及牙周炎相关细菌 ,如放线菌和其它不产黑色素G-杆菌组成较正常牙周增多 ,组成比为 19.2 3 %± 7.5 9%和 11.61%± 9.89% ;在卫生指导前后 ,基牙牙周龈沟内细菌的总量有所下降 ,而细菌的组成比没有明显变化。结论 :戴用下颌磁性附着体覆盖全口义齿是牙周炎的易感人群 ,但正确的卫生指导对基牙牙周细菌的控制有一定的效果     

Treatment needs of overdenture patients in a longitudinal study: five-year results

This study evaluated the treatment needs of 44 overdenture patients who had worn their dentures for at least 5 years. There were 135 abutment teeth involved, 35 in the maxillae and 100 in the mandible. Recall rates varied from a low of 27.6% to a high of 73.7%. The attrition rate was 20.5% after 5 years. The caries rate varied from a low of 2.7% to a high of 20.6%, and periodontal treatment was required by 94% of the subjects after 5 years. Only 39.4% of the subjects required adjustments, repairs, relines, or remakes of their overdentures during this time. The study showed that the success of overdentures depended on maintaining oral hygiene at an adequate level and at least yearly recalls to maintain gingival health.     

覆盖义齿修复方式保留重度牙周病口内余留牙的远期效果

目的观察重度牙周病口腔内余留牙体部分切除后,以覆盖义齿方式保留的远期效果。方法 追踪检查2001～2006年内采用不同覆盖义齿方式保留下来的基牙141颗,临床检查覆盖义齿的基本使用状况,测定口腔内剩余牙炎症程度、牙松动度和咀嚼效能,进行对比分析。结果基牙牙龈炎症消退,牙周炎得到一定控制,松动度普遍有一定缓解,义齿咀嚼功能良好,其中疗效Ⅰ级109颗,Ⅱ级20颗,Ⅲ级12颗。结论选用适当的覆盖义齿方式保留重度牙周病的牙体远期疗效是肯定的。     

The role in masseter muscle activities of functionally elicited periodontal afferents from abutment teeth under overdentures

Five overdenture wearers with a small number of remaining natural teeth were selected to evaluate the effect of the afferent input from periodontal mechanoreceptors on masseter activity in man. As a control, a full denture wearer was included. The subjects were instructed to chew a piece of gum, and/or tap their teeth. Surface EMG from the bilateral masseter muscles were recorded and analysed. When functional pressure was applied, during chewing, to the abutment teeth as well as to mucosa through the denture base, masseter activities were encouraged. Following application of anaesthesia to the periodontal membrane of the abutments, masseter activities were reduced. The duration of the silent period (SP) appearing in the EMG burst following tooth tapping was significantly increased with root support compared to mucosal support only. With topical anaesthesia of the periodontal tissues, SP duration decreased significantly. In conclusion, it has become apparent that the pressure sensibility of abutment teeth bearing functional pressure under an overdenture base is capable of facilitating masseter activity, as one of the sources of oral sensory input during mastication.     

磁性附着体在单颌全口覆盖义齿中的5年临床效果观察

目的：研究磁性附着体在单颌全口覆盖义齿中的临床修复效果。方法：20例患者，单颌选择1-4个基牙放置磁性附着体制作全口覆盖义齿，其中上颌全口覆盖义齿患者5例，下颌全口覆盖义齿患者15例，共采用41个磁性附着体。在修复后1个月、3个月、6个月、1年、2年、3年、4年及至今5年分别进行回访复查，主要观察固位体周围牙龈的健康状况，基牙松动度，继发龋，义齿的固位，稳定性，咀嚼效率的变化及舒适度。对义齿咀嚼效率的变化及舒适度衡量主要依赖患者的直接主观感受。结果：患者对义齿的舒适性和稳定性均表示满意，3个基牙出现松动，2个基牙出现继发龋，1个磁体脱落，其余良好。结论：采用磁性附着体的单颌全口覆盖义齿可以提高义齿的舒适性和稳定性。     

Periodontal considerations of the removable partial overdenture

1. An overdenture, whether complete or partial, is an excellent mode of treatment in the mutilated dentition for the preservation of the residual ridge. 2. Selection of patients for an overdenture should be based on past history of dental neglect, the status of the teeth and their periodontium, including present oral hygiene status, and patient motivation. The patients with a history of dental neglect, poor oral hygiene, and lack of motivation in having the teeth and the periodontium restored to health as well as strict compliance to a home-care regimen and recall schedule are not good candidates for treatment with an overdenture. 3. The choice of teeth or roots to serve as overdenture abutments must include their periodontal evaluation, which should consist of a detailed periodontal examination, diagnosis, prognosis, and treatment when this is indicated, including chemical protection (fluoride gel) and an oral hygiene regimen tailored to individual needs. 4. The knowledge and expertise in the selection and implementation of appropriate periodontal treatment modalities is of paramount importance in restoring optimum periodontal health to the overdenture abutments before overdenture fabrication. 5. The maintenance phase of the overdenture abutments as well as of the existing natural teeth is of critical importance in the preservation of health of these abutments and teeth. This maintenance phase should consist of periodic recalls based on individual needs; a detailed periodontal evaluation, including patient's motivation and status of oral hygiene and denture hygiene; and detection of caries. If necessary, appropriate periodontal and/or restorative therapy should be performed, and oral hygiene measures reinforced. This will ensure longevity of both abutment teeth or roots and of the existing natural teeth resulting in a long-term success of an overdenture. 6. Because there is evidence of high incidence of periodontal disease and dental caries in overdenture wearers, and because this evidence is attributed mainly to lack of motivation and compliance of adequate oral hygiene as well as to frequency of recall visits, patients should be made aware of the importance of their role in the maintenance phase of treatment and in the factors that lead to ultimate success of overdenture therapy. 7. With (a) proper selection of the patient and the abutment teeth, (b) adequate periodontal and restorative health and treatment to ensure optimum health prior to RPOD construction, (c) a well-designed home-care regimen and frequency of recalls, and (d) proper execution of maintenance care, changes for long-term success of overdenture therapy will be much improved.     

下颌桩核基牙式全口覆盖义齿基牙牙周支持组织的应力分析

目的 :研究下颌桩核基牙式全口覆盖义齿基牙牙周支持组织的应力分布状况 ,为临床工作提供实验依据和指导。方法 :应用三维有限元应力分析法研究下颌尖牙桩核基牙式全口覆盖义齿基牙牙周支持组织的应力分布特点 ,计算基牙牙周膜、骨硬板的应力值并与自然基牙作对比分析。结果 :基牙远中受力较大。桩核的存在可降低基牙颈部远中及根尖区近中牙周膜的应力值 ,增大根中部远中、根下 1/2近中牙周膜的应力值。桩核可增大基牙颈部远中骨硬板的应力值但减小颈部以下骨硬板的应力值。结论 :基牙有向远中倾斜的趋势 ;桩核对基牙牙周膜及骨硬板的应力分布有一定影响 ;桩有减小根尖部应力的趋势。     

Implant treatment in resorbed edentulous upper jaws

Patients with resorbed edentulous upper jaws were arranged into 2 different groups, based on an overall assessment of bone resorption prior to implant surgery. Each group comprised 3.5 patients, all of whom received an overdenture after abutment connection. The patients in the group with the best bone situation were scheduled to receive a fixed prosthesis after 1 year provided that the clinical situation was stable. The overall cumulative implant and prosthesis treatment success rates were 77% and 85%, respectively, for a 3‐year follow‐up period. Nineteen of the patients in the best bone group received a fixed prosthesis after they had used the overdenture for 1 year. These patients exhibited a cumulative implant success rate of 97%. None of the fixed prostheses was lost. Implant failures and other clinical adjustments were frequent for the first year of follow‐up, but the number of problems diminished in the subsequent years.     

A two-year longitudinal study of the periodontal health status of overdenture patients

Eleven patients who were treated with maxillary or mandibular overdentures or both were recalled at 6-month intervals and studied for a period of 2 years A periodontist evaluated the periodontal health status of the abutment teeth at initial placement of the overdenture and at all subsequent recalls using standardized periodontal indices. Statistical comparisons of the data from initial examination to the 2-year recall were made to assess the periodontal health status of roots supporting overdentures.Periodic, regular recall of patients treated with overdentures is one of the most important factors in the maintenance of the integrity of the root stumps and attachment apparatus, particularly since the roots supporting mandibular overdentures are at greater risk periodontally than those supporting maxillary overdentures. Measurements of pocket depth and width of attached gingivae seem to be the most definitive criteria to determine the status of the attachment apparatus in overdenture patients. With frequent recall, overdentures appear to be a successful method of treatment.     

Marginal tissue response adjacent to Astra Dental Implants® supporting overdentures in the mandible. A 2‐year follow‐up study.

The aim of this study was to evaluate the marginal tissue response adjacent to implant supported overdentures. Twenty edentulous patients had 2 Astra Dental Implants® placed in the canine region of the lower jaw. New overdentures were retained by individual ball attachments in 11 patients and by a bar attachment in 9 patients. Periodontal registrations were recorded 0 months, 6 months, 12 months and 24 months after the overdentures were inserted. One of the 40 fixtures was lost at the stage of abutment connection. No fixtures were lost during the 2‐ to 4‐year observation period and no fixtures showed any periodontal signs of failure. At the 2‐year examination, no pocket depths adjacent to the implants exceeded 4 mm and no bone loss exceeded 3 mm. The mean annual bone loss was less than 0.2 mm during the first 2 years. The preliminary results from this limited study were promising and showed that two osseointegrated Astra Dental Implants® could successfully retain an overdenture in the lower jaw. However, long‐term observation is needed for a definate evaluation of this treatment concept.     

A 4-year clinical study on amalgam, resin composite and resin-modified glass ionomer cement restorations in overdenture abutments

Objective: To assess the performance of three different filling materials in overdenture abutment teeth.

Methods: In 49 patients amalgam, resin composite and resin-modified glass ionomer cement were used to seal the root canal orifices of 155 overdenture abutment teeth. After initial preparation of the cavities, the three restorative materials were randomly assigned to the abutment teeth using a number of balancing criteria. All patients were reviewed every six months and received the same preventive regimen. Survival was assessed at two levels: S_orig (survival of the restoration independent from eventual maintenance treatments) and S_comp (restorations survived even without maintenance treatments).

Results: The calculated overall survival percentage of the original restorations (S_orig) after four years was 63±6% (mean±SE). Calculation for the overall complete survival (S_comp) revealed a percentage survival of 57±6%. At both levels, the differences between the survivals of the investigated materials were not statistically significant (p-values>0.05). Two abutments were lost, severe caries was the reason for one extraction and another abutment tooth was extracted for periodontal reasons.

Conclusions: The results of this study did not point out a superior restorative material for the seal of root canal orifices of overdenture abutments. The distribution of failures over the patients indicates a certain patient dependency.     

冠外附着体义齿修复后基牙牙周状况的临床研究

目的评价冠外附着体义齿修复后基牙牙周的健康状况。方法选择20例下颌牙列末端游离缺损的患者,每个患者分别在附着体义齿修复前,修复后1个月、6个月和1年,4个不同时期测定远中基牙的牙龈指数和菌斑指数,并在附着体义齿修复前和修复1年后拍摄数码全口牙位曲面体层片,比较修复前后远中基牙的牙槽骨高度。结果修复前和修复1个月、6个月、1年后不同时期远中基牙菌斑指数的差异均无统计学意义;修复后1个月、6个月远中基牙牙龈指数和修复前的差异无统计学意义,修复1年后远中基牙的牙龈指数高于修复前（P<0.05）。同一个体修复前和修复1年后远中基牙远中侧的平均牙槽骨高度的差异无统计学意义（P>0.05）。结论冠外附着体义齿修复游离缺损时应注意维护基牙的牙周健康。     

A prospective study of Astra single tooth implants

A new design of single tooth implant (AstraTech, Mölndal Sweden) featuring a microthreaded conical neck and TiO blasttm surface was evaluated clinically and radiographically after 2 years in function. Fifteen patients (age range 16 to 48) with missing maxillary anterior teeth (6 central incisors, 8 laterals, 1 bicuspid) had 4,13 mm and 11,15 mm implants placed under local anaesthesia and left for a period of 6 months before exposure and abutment connection/crown fabrication. All patients were seen at 4 to 6 monthly intervals for hygienist maintenance. Radiographs using Rinn holders and a long cone technique were taken at the crown insertion and after 1 year (14 subjects) and 2 years (12 subjects). All implants were successfully integrated at stage 2, and no implants have been lost. The internal conical seal design of the abutment/implant interface facilitated connection and there were no cases of abutment screw loosening. No soft tissue problems were observed, and the gingival morphology/health was well maintained. One crown was recemented after 18 months in function, and 1 crown was replaced because of a fracture to the porcelain incisal edge. At crown insertion, the mean bone level was 0.46 to 0.48 mm apical to the top of the implant and there were no statistically significant changes in the bone level over the 2 years of the study. In conclusion, the single tooth Astra implants were highly successful and bone changes within the first 2 years of function were comparable with other systems reporting high long‐term success rates.     

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目的观察老年2型糖尿病患者全口磁性附着体覆盖义齿修复的临床效果。方法对2006年6月至2008年12月在山西医科大学第二医院口腔科进行全口磁性附着体覆盖义齿修复的老年2型糖尿病患者20例,检查并记录修复前、修复后1年、修复后2年的基牙菌斑指数、牙龈指数、牙周袋深度、牙槽骨高度和牙齿松动度,并进行统计学分析。结果覆盖全口义齿经3～4次修磨后均固位良好,组织无压痛,随访2年中所有覆盖基牙均无龋坏,牙周无脓肿,基牙菌斑指数、牙龈指数、牙周袋深度均有增加(P<0.05),牙槽骨高度变化不明显(P>0.05),牙齿松动度降低(P<0.05),患者反应良好。结论覆盖全口义齿可以免除拔牙的痛苦和等待创口愈合的时间,为老年2型糖尿病患者要求全口义齿修复提供了一个良好的选择。     

Effect of using soft liner on bone density around the abutments supporting complete lower overdenture.

The effect of lower acrylic overdentures lined with soft liner on bone density around the abutment was studied on 14 patients divided into two equal groups. Group I patients using lower acrylic overdenture lined with soft liner. The abutments selected in each patient were two canines and two posterior. Bone density was measured from periapical radiographs made at denture insertion and after one year of denture use, for each abutments, using an accurate densitometer. The results showed decrease in bone density in the crestal alveolar bone around the abutments through the one year study period. patient using superstructure lined with soft liner showed less bone density than those using acrylic overdenture. The results of these study reached the conclusion that the resiliency of soft liner reduces the load applied over the overdenture abutments and in turn reduces alveolar bone changes.     

下颌磁性附着体覆盖全口义齿的临床疗效观察

目的：调查磁性附着体覆盖全口义齿修复的临床效果。方法：对9例磁性附着体患进行义齿满意度问卷调查分析，并检查患基牙临床指征及牙周微生态的情况。结果：患对磁性附着体义齿固位稳定功能满意度最高；基牙的微生物组成与正常值相比有一定的变化，但戴牙前后基牙临床指标无明显变化。结论：适当的修复以及良好的口腔卫生条件下，下颌磁性附着体覆盖全口义齿是一种有效、可行的修复方式。