| Abstract|| |
A case report describing the rehabilitation of a patient presenting with partially edentulous arches and compromised abutment teeth has been described. The aim of this study was to restore function and esthetics and uplift the psychological status of the patient by fabrication of a fixed removable prosthesis using the existing abutment teeth as telescopic overdenture.
Keywords: Fixed removable, overdenture, telescopic
|How to cite this article:|
Verma M, Mutneja P, Gupta R, Gill S. Telescopic overdenture for oral rehabilitation of partially edentulous patient. Indian J Dent Res 2019;30:468-71
|How to cite this URL:|
Verma M, Mutneja P, Gupta R, Gill S. Telescopic overdenture for oral rehabilitation of partially edentulous patient. Indian J Dent Res [serial online] 2019 [cited 2019 Sep 18];30:468-71. Available from: http://www.ijdr.in/text.asp?2019/30/3/468/264129
| Introduction|| |
Partially edentulous mouths present as such dental cripples that can be treated with various treatment options for rehabilitation including both fixed and removable prosthesis. The periodontal status of abutment teeth present in such cases dictates the prognosis of the treatment option chosen., A limited number of available abutments and decreased crown-to-root ratio of the present teeth pose a great prosthetic challenge. Removable prosthodontics was the only answer to aforementioned cases before the advent of fixed removable prosthesis in the form of telescopic overdenture.
Telescopic overdenture refers to the application of interfacial surface tension and friction fit mechanism of retention through the use of double copings. The primary castings consist of full-coverage parallel-milled copings that are cemented to the prepared teeth. The superstructure metal framework is fabricated to fit on the primary copings, thus enhancing retention.,,,
The current case report describes rehabilitation of a partially dentate patient with less than optimum crown-to-root ratio of abutments in the upper arch. The ultimate aim was to uplift the functional ability, esthetics, and quality of life of the patient.
A 65-year-old male patient reported to the department of prosthodontics with the chief complaint of difficulty in eating and compromised esthetic appearance due to missing teeth. The patient had a history of chronic generalized periodontitis for which he had undergone treatment. Intraoral examination revealed 1, 2, 3, 4, 5, 9, 11, 12, 13, 15, 16, 17, 18, 19, 20, 29, 30, 31, and 32 teeth missing along with generalized gingival recession. Carious decay was evident in 3, 8, 10, 14, 22, 26, and 27 teeth [Figure 1] and [Figure 2]. Radiographic evaluation showed a generalized bone loss and less than optimum crown-to-root ratio of present abutment teeth in the upper arch. The plan of treatment was to fabricate telescopic overdenture for the upper arch and a cast partial removable prosthesis for the lower arch.
Preprosthetic mouth preparation was carried out including oral prophylaxis and root canal treatment of all teeth in the upper arch. Tooth preparation of the upper teeth was done to provide enough interocclusal clearance as to accommodate metal copings and ceramometal superstructure. Putty wash (Affinis, Coltene Whaledent, USA) impression of the upper arch was made, and die-cut model was fabricated in die stone (BEGO GmbH & Co., USA). Wax-up of primary copings with metal collar was done on the model using inlay wax (BEGO GmbH & Co., USA), and the patterns were surveyed to ensure parallelism of all the surfaces [Figure 3]. After casting, cementation of the primary copings was done using glass ionomer cement. Again, a putty-wash impression was made and a master model was fabricated in die stone. Block out of the master model was done using baseplate wax (Cavex, UK) and it was duplicated in refractory investment material (Wirovest, BEGO GmbH & Co, USA) using duplicating silicone (Wirosil, BEGO GmbH & Co, USA). After hardening of the refractory cast, wax-up of the superstructure metal framework was done and casting procedure carried out. Metal framework trial was seated in the mouth [Figure 4]. After confirmation of fit, ceramic layering (VITA Zahnfabrik, Germany) was done on the abutment copings [Figure 5]. For the pontic regions, acrylic teeth (Cosmo, Dentsply, USA) were set up in wax for trial. After confirmation of the trial, processing of the overdenture was carried out in heat-cured polymethylmethacrylate (PMMA) resin (Trevalon HI, Dentsply, USA) [Figure 6]. The prosthesis was tried in the mouth for fit, stability, retention, and esthetics [Figure 7] and [Figure 8].
Surveying of the diagnostic model was done and the design of cast partial denture was finalized. Rest seat required in 26 and 27 teeth was provided in the single-unit fixed dental prosthesis fabricated for the same at the wax-up stage. For the remaining abutments, mouth preparation was carried out followed by putty-wash impression of the lower arch. Surveying, block out, and duplication in refractory model were carried out in a similar way as that for the upper arch. Wax pattern was fabricated on the refractory model and casting procedure was carried out. After confirmation of fit of metal framework, acrylic pontic teeth were added, their trial was done, and acrylization was carried out in heat-cured PMMA resin in a similar way as for the upper arch.
Six-month follow-up showed no prosthetic complication and optimum patient satisfaction.
| Discussion|| |
Patients who present with multiple periodontally and endodontically compromised abutment teeth pose a great prosthodontic challenge. Opting for a fixed prosthodontic treatment for such patients does not ensure prognosis and longevity., However, apart from the cripples of removable prosthesis, compromised support and stability are added disadvantages to such treatment plan. Earlier, such patients were condemned to undergo complete mouth extraction and rehabilitation with complete dentures. Such treatment plan is too radical and in most circumstances not accepted well by the patients. Fabrication of fixed removable prosthesis combines advantages of both fixed and removable dental prosthesis.,, Undue leverage forces due to parafunction are avoided as the superstructure is removable. The rigid splinting action, support and retention provided by abutment teeth, and better distribution of forces are some of the advantages of such prosthesis. Furthermore, better prognosis of abutment teeth can be predicted due to improvement in the crown-to-root ratio, better hygiene maintenance, and reinforcement provided by the primary metal copings.,, Disadvantages associated with such prosthesis are the extra time, effort, and cost involved. Vertical space requirement is another limitation to plan treatment with such prosthesis. A minimum of 9-mm vertical space is required to accommodate the metal copings (1.5–2 mm) and ceramometal superstructure (3 mm) on the abutments prepared to an adequate height (4–5 mm). Furthermore, the procedure is technique sensitive. Satisfactory periodontal and endodontic statuses of abutment teeth dictate a fair prognosis with removable cast partial denture if the designing of components satisfies the mechanical requirements. In the current case, removable cast partial denture was fabricated to rehabilitate the lower arch because of the favorable prognosis of abutment teeth. However, telescopic overdenture prosthesis was fabricated for the upper arch due to the guarded prognosis of abutment teeth present.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Dr. Parul Mutneja
Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, P. G. Clinic, Second Floor, New Delhi - 110 002
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]