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CASE REPORT<br />

<strong>Telescopic</strong> <strong>complete</strong> <strong>denture</strong>-<strong>with</strong> a <strong>custom</strong> <strong>mode</strong> stud attachment<br />

1 1 1 1<br />

Ravikumar , Raghavendra Prasad. S , K.R. Kashinath , Naveen B.H.<br />

1 Department of Prosthodontics<br />

Sri Siddhartha Dental College<br />

Tumkur.<br />

JOURNAL OF DENTAL SCIENCES AND RESEARCH<br />

Vol. 2, Issue 3, Pages 10-13<br />

ABSTRACT<br />

“It is more important to preserve what already exists than to replace what is missing” as stated<br />

by M.M.Devan has never been challenged or disapproved. As dentist our main aim should be<br />

prevention which not only includes prevention of caries and or periodontal disease but also<br />

prevention of residual alveolar bone loss after teeth are extracted. Unfortunately little progress<br />

has been made in this area. The resorption being progressive and irreversible and if allowed to<br />

proceed to excessive levels will jeopardize the ability to construct satisfactory removable<br />

prosthesis.<br />

It was due to this stated uncontrollable bone resorption that other techniques for alveolar bone<br />

maintenance were evaluated, over <strong>denture</strong>s being one of them.<br />

This is a clinical report which describes use of selectively retained teeth as abutments to<br />

minimize alveolar ridge resorption below the <strong>complete</strong> <strong>denture</strong>s.<br />

Key Words: telescopic <strong>denture</strong>, residual ridge resorption, stud attachment.<br />

Most common debilitating oral condition existing on a<br />

[1]<br />

routine level is edentulism, especially in the mandible .<br />

It remains one of the more challenging procedures in the<br />

dental practice to fabricate a <strong>complete</strong> mandibular<br />

<strong>denture</strong> offering patient comfort, function, and esthetic<br />

[2]<br />

harmony <strong>with</strong> retention and stability . In the past when<br />

patients presented themselves as candidates for a <strong>denture</strong><br />

<strong>with</strong> teeth that were badly broken down <strong>with</strong> periodontal<br />

involvement or <strong>with</strong>out the ability to financially support<br />

an extensive restorative treatment, those teeth were<br />

extracted that could have been retained under more<br />

favorable conditions which leads to severe residual ridge<br />

resorption. Over <strong>denture</strong>s helps to overcome this<br />

problem along <strong>with</strong> other problems posed by<br />

conventional <strong>complete</strong> <strong>denture</strong>s like poor stability,<br />

retention, loss of periodontal proprioception, low<br />

[3]<br />

masticatory efficiency, etc. Over <strong>denture</strong> therapy is<br />

essentially a preventive prosthodontic concept since it<br />

attempts to conserve the few remaining natural teeth.<br />

There are two physiologic tenets related to this therapy:<br />

the first concerns the continued preservation of alveolar<br />

[4]<br />

bone around the retained teeth while the second relates<br />

to the continuing presence of periodontal sensory<br />

mechanisms that guide and monitor gnathodynamic<br />

[5]<br />

functions . Removable <strong>denture</strong>s attached by means of<br />

telescopic anchors are regarded to be a good clinical<br />

solution. <strong>Telescopic</strong> crowns were initially introduced as<br />

retainers for removable partial <strong>denture</strong>s. (RPDs) These<br />

crowns consist of an inner or primary telescopic coping,<br />

permanently cemented to an abutment, and a congruent<br />

detachable outer or secondary telescopic crown, rigidly<br />

connected to a detachable prosthesis. Copings were<br />

designed to protect the abutment from dental caries and<br />

thermal irritations and also provided retention and<br />

stabilization of the secondary crown. The secondary<br />

crown engages the primary coping to form a telescopic<br />

unit and serves as an anchor for the remainder of the<br />

dentition.<br />

Synonyms<br />

Overlay <strong>denture</strong>, telescoped <strong>denture</strong>s, tooth supported<br />

<strong>denture</strong>s, hybrid prosthesis, crown and sleeve prosthesis,<br />

and the superimposing <strong>denture</strong>s.<br />

Address for correspondence:<br />

Dr. Ravikumar<br />

E-mail: drravi_kn@yahoo.com<br />

Access this article online<br />

Website: http://www.ssdctumkur.<strong>org</strong>/jdsr.php<br />

10<br />

Non plagiarized Content<br />

declaration provided by<br />

author<br />

Yes<br />

Case report<br />

A 60 year old male patient reported to the department of<br />

Prosthodontics, Crown &Bridge and Implantology <strong>with</strong>


Vol. 3, Issue 1, February 2012<br />

the chief complaint of difficulty in chewing and<br />

dissatisfaction <strong>with</strong> his speech. Patient gave history of<br />

loss of teeth since three years due to caries and gum<br />

problems. On extra-oral examination patient had a<br />

convex profile and TMJ was normal.<br />

Intra-oral examination revealed remaining 34, 35, 43 and<br />

45 teeth, <strong>with</strong> edentulous maxillary arch. The edentulous<br />

span had favorable ridge <strong>with</strong> firmly attached<br />

keratinized mucosa <strong>with</strong> respect to both arches. After<br />

clinical and radiographic evaluation, 43 have been<br />

extracted due to mobility and severe periodontitis. All<br />

treatment options were presented and discussed <strong>with</strong> the<br />

patient, including total extraction and conventional<br />

<strong>denture</strong>, cast partial <strong>denture</strong>, implant supported <strong>denture</strong>,<br />

telescopic <strong>complete</strong> <strong>denture</strong> <strong>with</strong> lower arch and<br />

conventional or implant supported over <strong>denture</strong> <strong>with</strong><br />

upper arch. After considering financial aspect, and<br />

amount of time the patient elected to have conventional<br />

upper <strong>complete</strong> <strong>denture</strong> and telescopic lower <strong>complete</strong><br />

<strong>denture</strong>. After taking consent from patient, oral<br />

prophylaxis, root planning and endodontic treatment of<br />

abutment teeth i.e 34, 35 and 45 were carried out,<br />

emphasizing oral hygiene instruction and maintenance.<br />

After assessing endodontic therapy, tooth preparation<br />

was done for receiving primary copings to 35 and 45.<br />

Impressions were made by putty reline technique. Wax<br />

pattern were invested, cast, finished and modified on<br />

surveyor for parallelism, castings were polished and<br />

cemented in patient mouth. (Fig-1) Post space was<br />

prepared and recorded to 34. (Fig-2a) Custom made cast<br />

dowel and stud were fabricated by using burnout post and<br />

cemented to 34. (Fig-2b)<br />

Border moulding and secondary impression were carried<br />

out and stud attachment was replicated <strong>with</strong> acrylic resin<br />

on the master cast. (Fig-3) Custom made female<br />

attachment analog to 34 and x-ray foil to primary coping<br />

were attached. Temporary <strong>denture</strong> bases and occlusal<br />

rims were fabricated upon this. Maxillomandibular<br />

relationship and teeth selection was done and definitive<br />

casts were mounted on semi-adjustable articulator. In the<br />

mean time secondary copings <strong>with</strong> interconnecting<br />

Fig 1. Primary copings cemented on 35 & 45<br />

Fig 2(a) : Cast showing Post Space<br />

Fig 2(b) : Custom made stud attachment on 34<br />

Fig 3 : Custom made acrylic resign stud<br />

attachment on master last<br />

11


Journal of Dental Sciences and Research<br />

lingual bar was fabricated on duplicated casts and<br />

evaluated intraorally for fit, retention, and stability.<br />

Artificial acrylic resin teeth were arranged in bilateral<br />

balanced occlusal scheme <strong>with</strong> wax patterns on the<br />

secondary copings. Porcelain firing was carried<br />

out on the resulted wax patterns shape. During<br />

try-in appointment windows were created on<br />

trial <strong>denture</strong> to pick-up secondary copings <strong>with</strong><br />

interconnecting bar by using putty index and placed on<br />

the master cast to ensure single path of insertion and<br />

removal as shown in the picture. (Fig-4a) Esthetics,<br />

phonetics, maxillomandibular relation, retention,<br />

stability etc all are checked during try-in appointment.<br />

Vertical slots were created on interconnecting bar for<br />

mechanical retention <strong>with</strong> heat cure acrylic resin.<br />

(Fig-4b) Dentures were finished and polished in<br />

conventional method, female component for the stud<br />

attachment was placed by direct method using<br />

autopolymerising resin and inserted. (Fig-5 and Fig-6)<br />

Occlusion was evaluated and adjusted, post operative<br />

instructions on how to insert and maintain the prostheses<br />

and also adequate oral hygiene maintenance were given.<br />

After minor adjustments during post insertion visits, the<br />

patient was placed on a six month recall visit.<br />

Discussion<br />

It is a documented fact that after the loss of the teeth the<br />

residual alveolar ridge undergoes rapid loss in all<br />

dimensions. The residual ridge resorption (RRR) is<br />

stated to be rapid, progressive, irreversible and<br />

inevitable and has been well observed and documented in<br />

[7,8]<br />

literature . It is equally well observed that bone is<br />

maintained around long standing teeth and implants.<br />

Retaining teeth as over <strong>denture</strong> abutments seems to slow<br />

[9,10]<br />

the rate of alveolar resorption . The physiologic<br />

objective is to provide for the tensile stimulation of as<br />

Fig 4(a) : Inter connecting bar and secondary Copings<br />

Fig 4(b) : Vertical slots on Inter connecting bar<br />

Fig. 5 : Female component on Intalgio sorface of<br />

<strong>denture</strong><br />

Fig 6 : Prosthesis - Intra Oral View<br />

12


Vol. 3, Issue 1, February 2012<br />

many of the oblique periodontal fibers as possible, the<br />

end result is the deposition of more bundle bone followed<br />

by concomitant decrease in abutment mobility.<br />

The support provided by the abutment teeth is in<br />

addition to that supplied by the residual ridges. The<br />

stability is enhanced by the vertical component of the<br />

retained tooth/root in the alveolar bone. The factors of<br />

border seal and tissue adaptation are more constant<br />

during function in over <strong>denture</strong>s than in conventional<br />

<strong>denture</strong>s, and retention is enhanced by the increased<br />

support and stability. An additional feature is<br />

proprioception through the periodontal fibers, over<br />

<strong>denture</strong>s gives a patient a sense of discrimination to touch<br />

and pressure, which is less possible by using<br />

[4, 6, 10]<br />

conventional <strong>complete</strong> <strong>denture</strong>s .<br />

There are many advantages of telescopic crowns like<br />

axial load of the tooth and full covering of the abutment<br />

(on the contrary to clasps), which may reduce tilting<br />

forces <strong>with</strong> their negative influence on abutment<br />

supporting tissues. The axial forces stimulate<br />

periodontal tissues and alveolar bone. They also provide<br />

indirect splinting influence, easy oral hygiene<br />

[6]<br />

maintenance and easy ways of repair . In this case the<br />

interconnecting lingual bar to the secondary copings and<br />

stud attachment ensures single path of insertion and<br />

removal, retention and stability to the lower <strong>denture</strong>.<br />

2. Epstein DD, Epstein PL, Cohen BI, Pagnillo MK:<br />

Comparision of the retentive properties of six prefabricated<br />

post over <strong>denture</strong> attachment systems. J Prosthet Dent 1999;<br />

82:579-84.<br />

3. Reitz PV, Weiner MG, Levin B: An over <strong>denture</strong> survey;<br />

Preliminary report. J Prosthet Dent 1977; 37:246-58.<br />

4. Prince IB. Conservation of the supporting mechanism.<br />

J Prosthet Dent 1965;15:327.<br />

5. Yalisove IL. Crown and sleeve coping retainers for removable<br />

partial prosthesis. J Prosthet Dent 1966;16:1069-85.<br />

6. Langer Y, Langer A. Tooth supported telescopic prostheses in<br />

compromised dentitions: A clinical report. J. Prosthet Dent.<br />

2000;84:129-32.<br />

7. Toolson LB, Smith DE. A two year longitudinal study of<br />

over<strong>denture</strong> patients, Part 1: Incidence and control of caries on<br />

over<strong>denture</strong> abutments. J Prosthet Dent 1978;40:486-91.<br />

8. Atwood DA: Reduction of residual ridges; A major oral<br />

disease entity. J Prosthet Dent 1971;26:266-279.<br />

9. Tallgren A. The continuing reduction of the residual alveolar<br />

rides in <strong>complete</strong> <strong>denture</strong> wearers: a mixed longitudnal study<br />

covering 25 years. J Prosthet Dent 1972;27:120-32.<br />

10. James L. Lord and Stephen Teel.: “The over<strong>denture</strong>: Patient<br />

selection, use of copings, and follow-up evaluation”.<br />

J. Prosthet. Dent., 1974; 32:41-51.<br />

As the over <strong>denture</strong> status of the prosthesis and its<br />

benefits to the patient depend solely on the continued<br />

retention of the underlying abutments, it becomes<br />

obligatory to periodically monitor their health and<br />

institute necessary steps to prolong their useful span.<br />

Here in lies the importance of periodical recall and<br />

review and patient motivation which makes over <strong>denture</strong><br />

therapy a continued service.<br />

Although there are increased costs and appointments<br />

associated <strong>with</strong> this technique are, however justified<br />

because over <strong>denture</strong>s are a superior health service<br />

[1]<br />

compared to the standard <strong>complete</strong> <strong>denture</strong> .<br />

Conclusion<br />

As the coming decade are opting for Branemark<br />

introduced 'third dentition of titanium roots' i.e implants,<br />

tooth / root supported over <strong>denture</strong> still remains excellent<br />

treatment modality, which is cost effective, if fabricated<br />

well <strong>with</strong> good clinical and laboratory Expertise,<br />

maintained <strong>with</strong> excellent care, then each telescopic over<br />

<strong>denture</strong> treatment can be a successful one.<br />

REFERENCES:<br />

1. Bolender C, Zarb G, Carisson G: Boucher's prosthodontic<br />

treatment for edentulous patients. 11th ed. St.Louis Mosby<br />

year book, 1997:46-47.<br />

13

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