INTERNATIONAL JOURNAL of BIOMEDICAL SCIENCE

CASE REPORT

Telescopic Overdenture: A Case Report

C. S. Shruthi1, R. Poojya2, Swati Ram3, Anupama4
1
Professor, Department of Prosthodontics, M R Ambedkar Dental College and Hospital, Bangalore, Karnataka, India; 2Reader,
Department of Prosthodontics, M R Ambedkar Dental College and Hospital, Bangalore, Karnataka, India; 3Post Graduate
Student, Department of Prosthodontics, M R Ambedkar Dental College and Hospital, Bangalore, Karnataka, India; 4Post
Graduate Student, Department of Prosthodontics, M R Ambedkar Dental College and Hospital, Bangalore, Karnataka, India

ABSTRACT

Patient: This report describes the case of a 68 year old female patient who presented with the chief com-
plaint of difficulty in chewing and poor aesthetics due to missing teeth. The patient was interested in saving
the remaining natural teeth and desired minimal tissue coverage from the prosthesis. After consideration
of all the factors involved, it was deemed advisable to resort to a palate free maxillary telescopic complete
denture and a mandibular removable partial denture.
Discussion: Considering the age of the patient and the cost involved, implant supported prosthesis was
ruled out as a treatment option for the patient. A telescopic denture was chosen as a favourable treatment
option since it overcomes many of the problems posed by conventional complete dentures like progressive
bone loss, lower stability and retention, loss of periodontal proprioception and low masticatory efficiency. It
also provides minimal tissue coverage and better distribution of forces. Evaluation of occlusion, esthetics,
phonetics and comfort after 24 hours, 1 week and 1 month of treatment showed that the patient was happy
with the prosthesis and was able to speak and chew well.
Conclusion: Telescopic overdentures have better retention and stability as compared to conventional
complete dentures. They improve the chewing efficiency, patient comfort and also decrease the alveolar
bone resorption. As such they are an excellent alternative to conventional complete denture treatment. (Int J
Biomed Sci 2017; 13 (1): 43-47)

Keywords: overdenture; telescopic denture; double crown; crown and sleeve coping; telescopic overlay denture

INTRODUCTION

M. M. Devan stated, “It is perpetual preservation of

what already exists and not the meticulous replacement of
Corresponding author: Dr. Swati Ram, M R Ambedkar Dental College what is missing”.
and Hospital, 1/36, Cline Road, Cooke Town, Bangalore-560005, Karna- When few teeth are remaining the options for replace-
taka, India. Tel: 9686416732; E-mail: [email protected].
Received December 1, 2016; Accepted January 15, 2017 ment are tooth or tissue supported dentures, conventional
Copyright: © 2017 C. S. Shruthi et al. This is an open-access article dis- fixed prosthesis or implant-supporting dentures. Dentures
tributed under the terms of the Creative Commons Attribution License are often unsatisfactory for patients because of the lack of
(http://creativecommons.org/licenses/by/2.5/), which permits unrestrict-
ed use, distribution, and reproduction in any medium, provided the origi- retention or excessive tissue coverage. Implants are often
nal author and source are credited. expensive and may require bone grafting for placement.

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 TELESCOPIC OVERDENTURE: A CASE REPORT

In other cases, there may not be enough teeth present to eration of all the factors involved, it was deemed advisable
support a fixed prosthesis. Furthermore, patients who have to resort to a palate free maxillary telescopic complete
lost teeth due to poor oral hygiene may suffer the same denture and a mandibular removable partial denture.
problems with implants or bridges. In such cases, a remov- Extraction of 35, 44 and 45 was done and the extraction
able prosthesis facilitates the maintenance of oral hygiene. sockets were allowed to heal (Figure 1). Primary impression
A telescopic denture is an excellent alternative to over- of the maxillary and mandibular arches were made using ir-
come all of the above mentioned problems (1). reversible hydrocolloid impression material and diagnostic
According to GPT, a telescopic denture is also called casts were made with Type III gypsum product. Endodon-
as an overdenture, which is defined as any removable den- tic treatment of the remaining teeth was done, to use them
tal prosthesis that covers and rests on one or more of the as abutments for the maxillary telescopic complete denture
remaining natural teeth, on the roots of the natural teeth, and mandibular removable partial denture (Figure 2 and
and/or on the dental implants (2). It is a prosthesis which Figure 3). Temporary denture bases and wax occlusal rims
consists of a primary coping which is cemented to the were fabricated on the diagnostic casts. The occlusal rims
abutments in a patient’s mouth and a secondary coping were used to determine the vertical dimension of occlusion
which is attached to the prosthesis which fits on the prima- and occlusal plane, prior to tooth preparation.
ry coping. Hence, it increases the retention and stability of In the maxillary arch, tooth preparation was done for 14,
the prosthesis. It is also called as overlay denture, overlay 17, 24 and 27 to receive primary copings. The occlusal rims
prosthesis and superimposed prosthesis (1, 3). acted as a guide for tooth preparation. After preparation of
Telescopic crowns were initially introduced as retain- the abutments, impression was made using polyvinyl silox-
ers for the removable partial dentures at the beginning of ane elastomeric impression material (putty and light body)
the 20th century. Also known as a Double crown, a crown by single step double mix technique. Primary copings were
and sleeve coping or as Konuskrone (4), a German term fabricated on the master cast obtained (Figure 4) and the fit
that described a cone shaped design, these crowns are an of the copings were evaluated in the patient’s mouth, after
effective means for retaining the RPDs and dentures. They
transfer forces along the long axes of the abutment teeth,
provide support and protection from the movements that
dislodge the denture (3).

OUTLINE OF THE CASE

A 68 year old female patient reported to the Depart-

ment of Prosthodontics, Crown & Bridge and Implantol-
ogy, M R Ambedkar Dental College and Hospital, Benga-
luru, with the chief complaint of difficulty in chewing and
poor aesthetics due to missing teeth. Figure 1. Pre-operative intraoral frontal view after extraction.
On intraoral examination, teeth present were 14, 17,
24, 27, 34, 35, 37, 44 and 45. 35, 44 and 45 were grossly
decayed showing grade II mobility. The other teeth were
grossly decayed but firm. The edentulous span had favour-
able ridge with firmly attached keratinized mucosa. Ra-
diographic examination of the remaining teeth revealed
that 35, 44 and 45 had poor bone support while 14, 17, 24,
27, 34 and 37 had good bone support.

Prosthetic Management
All the possible treatment options, including implant
therapy, were given to the patient. The patient was inter-
ested in saving the remaining natural teeth and desired Figure 2. Pre-operative intraoral view of the maxillary arch
minimal tissue coverage from the prosthesis. After consid- after endodontic treatment.

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 TELESCOPIC OVERDENTURE: A CASE REPORT

which they were cemented on the abutments with glass ion- molding and secondary impression. The metal framework
omer cement (Figure 5). Construction of the maxillary met- included the secondary copings for the telescopic denture.
al framework was done on the master cast, following border The framework was tried in the patient’s mouth and neces-
sary modifications were made (Figure 6).
In the mandibular arch, tooth preparation was done for
34 and 37 using the wax occlusal rims as a guide. Porce-
lain fused to metal crowns were fabricated cemented on
the prepared teeth using glass ionomer cement. Border
molding was done and secondary impression was made to
obtain the master cast.
Maxillomandibular relation was recorded with wax oc-
clusal rims on temporary denture bases fabricated on the
mandibular master cast and the maxillary metal framework.
Acrylic teeth were arranged and try-in was completed. Af-
ter evaluating occlusion, phonetics and aesthetics, the final
processing of the maxillary telescopic denture and man-
dibular removable partial denture was done. The prosthesis
was polished and placed (Figure 7). Occlusion was assessed
Figure 3. Pre-operative intraoral view of the mandibular arch
after endodontic treatment.

Figure 6. Metal framework with secondary copings ready for

try-in.
Figure 4. Primary metal copings.

Figure 7. Intraoral view of the finished and polished maxillary

Figure 5. Intraoral view of primary copings cemented on 14, telescopic overdenture and mandibular removable partial den-
17, 24 and 27. ture.

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 TELESCOPIC OVERDENTURE: A CASE REPORT

(Figure 8) and placement instructions were given. Post Owal et al found that 25% of RPDs fabricated were dis-
placement check up was done after 24 hours, 1 week and 1 carded during the first year due to unacceptable retention
month. The patient was happy with the prosthesis and was and stability of the prosthesis (5). This lack of retention
able to speak and chew well (Figure 9). The patient was in- and stability occurs because the residual alveolar ridge un-
structed to attend recall visits every 6 months. dergoes resorption in all directions following tooth loss
(6). The resorption is stated to be rapid, progressive, ir-
DISCUSSION reversible and inevitable and has been well observed and
documented in literature. It is equally well observed that
Considering the age of the patient and the cost involved, bone is maintained around standing teeth and implants.
implant supported prosthesis was ruled out as a treatment Since overdenture therapy endeavours to preserve the few
option for the patient. A telescopic denture was chosen as remaining natural teeth/tooth roots, it helps in the pres-
a favourable treatment option since it overcomes many of ervation of the alveolar ridge (7, 8). Robert J. Krum con-
the problems posed by conventional complete dentures ducted a study to determine the amount of vertical residual
like progressive bone loss, lower stability and retention, bone loss in the anterior part of the maxillae and man-
loss of periodontal proprioception and low masticatory ef- dible in two groups of patients: One with complete maxil-
ficiency. It also provides minimal tissue coverage and bet- lary dentures and mandibular overdentures and the other
ter distribution of forces. group with complete maxillary and mandibular conven-
tional dentures. It was concluded that patients treated with
complete maxillary dentures and mandibular overdentures
demonstrated less vertical alveolar bone reduction than
patients with complete maxillary and mandibular conven-
tional dentures (9).
Longitudinal follow-up studies of 5-10 years report
that conical crown-retained partial dentures have a lower
failure rate compared to those retained with clasps or pre-
cision attachments (6). Teeth which are too weak to sup-
port a fixed partial denture and are unsuitable to support
a removable partial denture can be conserved and suit-
ably modified to act as abutments under overdentures for
a good span of time (8). They provide tensile stimulation
of the oblique periodontal fibres which leads to deposi-
tion of more bundle bone followed by decrease in abut-
ment mobility. Telescopic prostheses are usually indicated
Figure 8. Right lateral view.
only for patients with multiple abutments distributed bilat-
erally along the dental arch. The abutment teeth provide
additional support to that supplied by the residual ridges.
Stability is enhanced by the vertical component of the re-
tained tooth/root. Proprioception through the periodontal
fibres, gives the patient a sense of discrimination to touch
and pressure, which is less with conventional complete
dentures (1, 4, 6, 10).
Telescopic crowns consist of a primary telescopic cop-
ing which is permanently cemented to an abutment and a
detachable secondary telescopic crown, rigidly connected
to a detachable prosthesis. Copings protect the abutment
from dental caries, thermal irritations and also provide re-
tention and stabilization of the secondary crown. The sec-
ondary crown engages the primary coping to form a tele-
Figure 9. Post-placement view of the patient. scopic unit and serves as an anchor for the remainder of

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 TELESCOPIC OVERDENTURE: A CASE REPORT

the prostheses. The tapered configuration of the contact- due to conversion of compressive forces into tensile and
ing walls generates a compressive inter-surface tension better stress distribution. Even with the increased use of
based on wedging action. Tapering of the coping walls implants for overdenture therapy, tooth/root supported
reduces retention between the unit elements. The smaller telescopic overdenture still remains an excellent treat-
the degree of the taper, the greater the frictional retention ment modality.
of the retainer. The average wall taper commonly has a
6-degree angle. The copings are milled to exact configura- CONFLICT OF INTEREST
tions of taper angles of the walls with each other to create
a common path of insertion for outer telescopic crowns of The authors declare that no conflicting interests exist.
a retrievable superstructure (3, 4).
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