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Table of Contents   
SHORT COMMUNICATION  
Year : 2011  |  Volume : 22  |  Issue : 2  |  Page : 359-361
Overdenture with accesspost system: A clinical report


1 Department of Prosthodontics and Crown & Bridge, Melaka Manipal Medical College, Manipal University, Karnataka, India
2 Department of Prosthodontics, Manipal College of Dental Sciences, Manipal University, Karnataka, India

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Date of Submission05-Jan-2010
Date of Decision03-May-2010
Date of Acceptance10-Nov-2010
Date of Web Publication27-Aug-2011
 

   Abstract 

A patient presented with an unfavorable distribution of teeth in the arch which precluded treatment with a removable partial denture. The unique pattern of partial edentulism was treated with an overdenture restoration using accesspost system. The final restoration was stable, well retained and esthetic, serving as a conservative approach to root preservation.

Keywords: Accesspost system, female nylon cap, tooth borne overdenture

How to cite this article:
Jain DC, Hegde V, Aparna I N, Dhanasekar B. Overdenture with accesspost system: A clinical report. Indian J Dent Res 2011;22:359-61

How to cite this URL:
Jain DC, Hegde V, Aparna I N, Dhanasekar B. Overdenture with accesspost system: A clinical report. Indian J Dent Res [serial online] 2011 [cited 2014 Dec 29];22:359-61. Available from: http://www.ijdr.in/text.asp?2011/22/2/359/84306
It is often possible to provide a functional, esthetic and comfortable treatment outcome through a variety of modalities. A conservative approach to root preservation is a valid and practical measure in preventive prosthodontics. There is no better example of such an effort other than overdentures.

Bone maintenance is the most significant advantage of a tooth borne overdenture because the maintenance of bone volume and vertical height can produce increased prosthesis retention and stability. It also gives patients better function and control because of presence of nerve receptors in the root. [1]


   Case Report Top


A healthy, 60 year old man with few remaining natural teeth presented at our prosthodontic service for evaluation. The patient's chief complaint pertained to the lack of function and esthetic deficiency. Clinical examination showed completely edentulous maxillary arch and partially edentulous mandibular arch. The periodontal findings were significant with moderate amount of deposits and stains being present along with gingival recession but no pocket formation. The teeth missing in the lower arch were 36, 37, 44, 45, 46 and 47. The patient related a history of tooth loss as a result of decay, mobility and unavailability of care earlier in life. 43 was severely decayed with a probable pulpal involvement. 31, 32, 33, 41, 42, 43 were grade 1 mobile, while 34 and 35 were grade 2 mobile. His home oral hygiene regimen on presentation was poor [Figure 1].
Figure 1: Preoperative intraoral view

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The existing teeth exhibited severe proclination and spacing; a lower removable partial denture (RPD) could not reasonably provide function or normal appearance. It was concluded that mandibular canines and left 3 rd molar had suitable periodontal support and can serve as abutments for an accesspost overdenture, thus providing ample stability and retention. Diagnostic mounting revealed ample interarch space for the necessary components and an esthetic, functional placement of acrylic denture teeth. The treatment plan was divided into phases, with phase 1 involving extraction of 31, 32, 34, 35, 41 and 42. In phase 2, the mandibular canines and left 3 rd molar were treated endodontically. In phase 3, prosthodontic care was rendered. Post space preparation was done which was then fitted with accessposts [Figure 2]. Hemispherical copings were cast for cementation along with the accesspost using composite resin cement [Figure 3].
Figure 2: Post space preparation

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Figure 3: Accesspost with copings

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Border molding was done, secondary impressions were made and master casts were obtained. Following the jaw relation recording, a face bow transfer was made and the cast mounted on a semiadjustable articulator (Hanau wide vue). Gothic arch tracing was obtained and interocclusal records were made. The horizontal and lateral condylar guidances were set, upper and lower anteriors arranged and the incisal guidance was adjusted. The posterior teeth were set in a balanced occlusion, thus ensuring even pressure in all parts of the arch while maintaining stability of the denture. The trial denture was then tried in the mouth, vertical dimension verified, centric and eccentric contacts were evaluated. The facial and functional harmony was studied and patient's approval obtained.

The dentures were then waxed and flasked for processing. After curing, laboratory remounting and selective grinding was done. Finally, the dentures were finished and polished. The female cap was then attached chairside to the intaglio surface of the lower denture using autopolymerizing acrylic resin. For this purpose, a rubber band was used to cover the height of contour of the head (to avoid locking) and the nylon cap was placed on the ball of the post.

Once the nylon caps were picked up, rubber bands were removed, and flash trimmed. The denture was adjusted and equilibrated and the patient was released to wear the denture [Figure 4]. Post insertion instructions were given along with a recall appointment. The following day, the mouth was observed for sore areas and final occlusal adjustments were made.
Figure 4: Postoperative intraoral view

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The designed prosthesis served as an esthetic and functional solution in the management of this patient [Figure 5] and [Figure 6].
Figure 5: Preoperative facial view

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Figure 6: Postoperative facial view

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   Discussion Top


Preventive prosthodontics emphasizes the importance of any procedure that can delay or eliminate future problems. The basic overdenture concept requires preservation of residual hard and soft tissues. Tallgren (1972) concluded that anterior mandible height resorbed four times faster than maxillary process with conventional dentures. [2] Crum and Runey (1975) in a 5-year study found that retention of mandibular canines for overdentures led to preservation of alveolar bone. [3] Further, Rissin et al. found that overdenture patients had a chewing efficiency which was one-third higher than that of complete denture wearers. [4]

The success of the overdenture treatment depends upon the proper attachment selection for the particular case. Attachment selection is based on available buccolingual and interarch space, amount of bone support opposing dentition, clinical experience, personal preferences, maintenance problems and cost. [5] Accessposts 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 socket attachment of accesspost 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 nylon cap provides 3-5 pounds of retention. The technical work required is minimal and can be carried out at chairside, thus making it cost effective. Accesspost overdenture is superior to any other passive overdenture because flange and second tier dissipate functional stresses and prevents "bottoming out" eliminating the high apical stresses under function common to other passive posts. [6]


   Conclusion Top


The concept of overdentures, though not a complete answer, provides a positive means of delaying the process of resorption of denture foundation. Although it is a feasible alternative, it is not often used to its full potential. Careful case selection and abutment preparation as well as periodic recall are the key to successful overdenture rehabilitation.


   Acknowledgment Top


The authors wish to thank Dr. Shobha Tandon, Dean, Manipal College of Dental Sciences, Manipal University, for her benevolent attitude, invaluable guidance, constant support, encouragement and tremendous patience.

 
   References Top

1.David R. Burns. The mandibular complete overdenture. Dent Clin North Am 2004;48:603-23.   Back to cited text no. 1
    
2.Tallgren A. The continuing reduction of the residual alveolar ridges in complete denture wearers: a mixed longitudinal study covering 25 years. J Prosthet Dent 1972;27:120-32.  Back to cited text no. 2
[PUBMED]    
3.Crum RJ, Rooney GE. Alveolar bone loss in overdentures: a 5 year study. J Prosthet Dent 1978;40:610-3.  Back to cited text no. 3
    
4.Rissin L, House JE, Manly RS, Kapur KK. Clinical comparison of masticatory performance and electromyographic activity of patients with complete dentures, overdentures and natural teeth. J Prosthet Dent 1978;39:508-11.  Back to cited text no. 4
[PUBMED]    
5.Ivy SS, Robert MM. Overdentures- principle and procedures. Dent Clin North Am 1996;40:169-93.  Back to cited text no. 5
    
6.Cohen BI, Pagnillo MK, Condos S, Deutsch AS. Comparative study of two precision overdenture attachment designs. J Prosthet Dent 1996;76:145-52.  Back to cited text no. 6
    

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Correspondence Address:
Deepti C Jain
Department of Prosthodontics and Crown & Bridge, Melaka Manipal Medical College, Manipal University, Karnataka
India
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DOI: 10.4103/0970-9290.84306

PMID: 21891915

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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    Abstract
   Case Report
   Discussion
   Conclusion
   Acknowledgment
    References
    Article Figures

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