SEMINAR TOPIC

PREVENTIVE
PROSTHODONTICS IN
COMPLETE DENTURE
CONTENTS

1. DEFINITION

2. GOALS OF PREVENTIVE PROSTHODONTICS

3. OBJECTIVES

4. PREVENTIVE PROSTHODONTICS IN COMPLETE DENTURE

5. OCCLUSAL SCHEMES

6. OVER DENTURES

7. ATTACHEMENTS IN OVERDENTURES

8. TYPE OF OVER DENTURES

9. IMMEDIATE DENTURES

10. SINGLE COMPLETE DENTUREs

11. IMPLANT OVERDENTURES

12. CONCLUSION

13. REFERENCES
INTRODUCTION

Prosthetic dentistry is one of the fundamental pillars of dentistry. The most effective

prosthetic prophylaxis could be the prevention of causes leading to tooth extractions.

As a dentist our main aim should be prevention, which not only includes prevention

of caries or periodontal disease but also prevention of residual alveolar bone loss after

teeth are extracted. Modern treatment options improve the overall prognosis of the

stomatognathic system and the quality of life of the affected patients significantly.

Preventive prosthodontics emphasizes the importance of any procedure that can delay

or eliminate future prosthodontic problems. Preventive prosthodontics refers to

prosthodontic practices that help prevention of the factors adversely affecting the

orodento-facial tissues and structures including, the tooth supporting structures such

as periodontium, alveolar bone, basal bone and surrounding Musculo skeletal

structures like muscles of mastication, salivary glands and the tissues in the head and

neck region. The loss of several teeth need not be an immediate threat to the function

of whole dentition, but it can initiate serious problems related to oro-facial region and

well being of the patient. In this perspective prosthetic dentistry is a valuable tool with

high therapeutical and preventive character.

Preventive dentistry is defined as procedures employed in practice of dentistry and

community dental health programs, which prevent the occurrence of oral diseases and

oral abnormalities.

Preventive prosthodontics emphasizes the importance of any procedure that can delay

or eliminate future prosthodontic problem.

GOALS OF PREVENTIVE PROSTHODONTICS:

1. To delay the residual ridge resorption

2. Preservation of followed in complete denture fabrication as well as fabrication of

partial dentures whether removable or fixed.

3. Assess the need for early prosthodontic replacement of lost tooth / teeth.

4. Select treatment in consultation with patient and implement it judiciously.

5. Design prostheses not interfering with normal oro-dental hygiene procedures.

6. Act as team leader, guide colleagues & help prevention of future prosthodontic

problems

Plan to preserve what already exists than replacing what is missing. Preventive Dentistry is a

philosophy of dentistry, it comprises the various procedures used by dentists, dental

hygienists, nurses. It consists of prevention of

1- Initiation of diseases (Primary prevention)

3- Loss of function (Tertiary prevention)

OBJECTIVES

1. Patients education and motivation

2. Selecting evidenced based management option / prosthetic type and design to maintain

remaining teeth and their supporting tissues in healthy state.

3. Prostheses for preventing, stabilizing and controlling the progression of specific dento-

orofacial conditions.

4. Special preventive prostheses for head and neck cancer (HNC) patients including

preventive prostheses and radiation stents and carriers.

PREVENTIVE PROSTHODONTICS IN COMPLETE DENTURE

When the teeth are completely absent in any one of the arch, the fabrication of a single

complete denture is highly recommended to prevent the contact of the teeth and alveolar

ridge, to restore function, vertical dimension, esthetics and prevent the development of

parafunctional habits. The complete dentures are provided for edentulous patients (edentulous

in both jaws) to rehabilitate them by restoring the function form and aesthetics and general

health of the patients. The complete dentures are provided with various occlusal schemes

such as balanced occlusion, lingualized occlusion, neutrocentric concept and others

depending upon the condition of the patients.

Barker (1861) reported first use of Overdentures to the American Dental Convention. An

overdenture is a removable dental prosthesis that covers and rests on one or more remaining

natural teeth, the roots of natural teeth, and on dental implants.

The implants or modified natural teeth provide for additional support, stability; and retention

of the overdenture than the edentulous ridges alone can provide.

This is particularly advantageous in the mandibular arch, where edentulous ridges may

resorb at a rate four times greater than that of the maxillary arch. It is also known as Hybrid

dentures or tooth-supported complete dentures.

Retaining natural teeth as abutments for dentures can considerably reduce the progress of

residual ridge resorption. Multiple abutments can be used for this purpose.

Indications for Overdentures:

1. For better support and aesthetics in morphologically compromised dental arches.

2. Cleft palate cases

3. Dentures for patients with maxillofacial trauma.

4. Patients with worn-out dentition

5. For congenital anomalies like microdontia, amelogenesis imperfecta, dentinogenesis

imperfecta and partial anodontia.

6. Patients with abnormal jaw size and position where orthognathic surgery is

contraindicated.
This treatment is usually indicated for:

Group l: Patients with few remaining teeth that may be healthy or periodontally involved,

with intact or grossly destroyed crowns.

Group 2: Patients with severely compromised dentition. Selective extraction should be

carried out after a thorough examination of the patient.

General Considerations during Diagnosis and Treatment Planning for an Overdenture:

Maintenance of Periodontal Health: Once an overdenture is planned and constructed, it is

the duty of the patient to maintain his teeth free from plaque. The dentist should check for

pocket formation around the abutments. Failure to do this may lead to the loss of an

abutment.

Reduction in Crown-root Ratio: Reduction in crown size during abutment preparation can

be beneficial for the tooth, as it reduces the crown-root ratio and decreases the leverage forces

acting on the tooth.

Success of Endodontic Therapy: Endodontic therapy may be necessary for most abutment

teeth because they need extensive crown reduction. A two-to-four week interval should be

provided after completion of endodontic therapy in order to determine its success before

starting further treatment.

Adaptation and Coverage of Denture-Bearing Area: The denture base should be well

adapted to the soft tissues in order to prevent accumulation of food debris and to evenly

distribute the forces acting on the denture.

Design of the Denture: As the denture base for overdentures are thin, they have to be

reinforced with metal. At the same time they should be easy to fabricate and maintain.
Ease of Use: The patient should be able to easily insert and remove the denture without any

harm to the denture base or the abutment tooth.

Advantages of Overdentures:

1. Maintains the integrity of the residual ridge.

2. Improves the retention and stability of the denture.

3. Improved proprioception leads to better neuromuscular control. This helps in regulating the

biting force over the denture.

4. Psychological effect on the patient as extraction can be avoided.

5. It can almost be used universally.

6. Even if there is abutment failure, the abutments can be extracted and the overdenture can

be relined and used as a conventional complete denture.

Disadvantages of Overdentures:

1. Nutritional counselling, oral hygiene measures and fluoride application should be carried

out periodically.

2. High incidence of caries and periodontal disease around the over denture abutments.

3. Frequent reviews are needed to verify the health of the supporting tissues of the

overdenture abutments.

4. More expensive than conventional dentures because: a- Endodontic therapy and coronal

restorations may be needed for certain overdenture abutments. b- Most cases need a cast

metal denture base, as acrylic is weaker. c- Additional designing and laboratory work is

needed.
 5. Cannot be used in cases with reduced interarch space, bony undercuts adjacent to the

abutments, etc.

6. Improper maintenance of the overdenture may lead to periodontal breakdown of the

overdenture abutments and the patient may lose all his remaining teeth.

ABUTMENT SELECTION

The choice and number of abutments are determined by a combination of load-bearing ability

of the abutment teeth plus the forces and stresses to which these will be subjected .The

number of roots, their shape, length, alignment and bone height has a direct relation to the

load bearing capacity of teeth. The shorter,more tapered the root and lower the bone level, the

less satisfactory the tooth will be as an abutment.

Evaluate the abudments for:

1. Periodontal status

2. Caries susceptibility

3. Potential for endodontic treatment

4. Positional considerations

LOCATION OF ABUTMENT TOOTH – Positional considerations of abutment tooth in the

arch and its position should be between the buccal and lingual cortical plates which are areas

of maximum force and ridge resorption potential . Best choice of +abutment is canines

and premolars . In maxillary arch, incisors are used at least one tooth per quadrant but ideal is

two teeth per quadrant. The stress is distributed over a rectangular area. A tripod approach can

also be used. Most commonly used teeth in the mandible for abutment is canine.
OVERDENTURE ABUTMENT MANAGEMENT

1. Non coping preparation

2. Coping preparation

3. Attachments

NON COPING ABUTMENTS Selected tooth abutment are reduced to a coronal height of 2

to 3mm, the crown is contoured to a convex or dome shape the tooth is endodontically treated

and filled with amalgam or composite restoration

COPING PREPARATION A coping is a cover for the exposed tooth surface and cast metal

copings with a dome shaped surface and a chamfer finish line at the gingival margin is

prepared Short copings: 2‐3mm long, RCT done, Copings are with a post, canals filled with

GP Long copings: 5to 8mm long, RCT is not a must, Copings are long

ATTACHMENTS IN OVERDENTURES Attachments are small precision devices which

are incorporated to provide some additional benefits like retention and support, more

retention can be gained by lengthening the post and the use of pins. It consists of two units: 1.

Male 2.female

REQUIREMENTS FOR THE ATTACHMENTS

 The patients should have a low caries index

 Perform proper home care

 Sound periodontal health

 Abutment teeth with proper bone support

 Added time

 May cause increased stress on the tooth

 More difficult to construct Ÿ Requires careful manipulation by the patients.

(Therefore is not of use for the mentally and physically handicapped )

 More expensive

 Reconstruction in the case of damage is difficult Added risk to the abutment due to

caries and periodontal disease if poor oral hygiene is performed by the patient

STUD ATTACHMENTS

Consists of a female part which is frictionally retained over the male stud and

incorporated into the denture resin either by means of a transfer coping system and the

creation of a master cast incorporating a replica of the attachment or directly in the mouth

using self-cured or light-polymerized resin. The stud attachments are classified according

to function into resilient and non-resilient attachments. Resilient attachments permit some

tissue ward vertical and rotational movements, thus protecting the underlying abutments

or implants against overload. However, resilient attachments usually require a large space

and might cause posterior mandibular resorption with the vertical movement of the

denture. On the other hand, the non-resilient type does not permit any movement of the

overdenture during function and were commonly employed when the interocclusal space

was limited

One of the main advantages of stud attachments is the ability of its use in cases with V-

shaped arches where the straight connection between the implants can affect the tongue

space
GERBER ATTACHMENT: This attachment is of two types: Rigid attachment: That

does not allow the movement of the base Rigid type: It is most popular and widely used it

consists of male post threaded on to a screw attached to a soldered base and female

housing part contain spring and ring. Both the types are easily replaceable

DALBO ATTACHMENT It is rigid, resilient or the stress breaker type. Male part is

soldered to the tooth and the housing to the base.

Dalbo Attachment The rigid type has a cylindrical male unit with a rounded head ,the

resilient type is the smallest and the most commonly used sphere shaped male unit which

allows rotational and vertical movements of female around male.

CEKA ATTACHMENT In this type of attachment the male part affixed to the tooth and

has a rounded shape wider at the top and split vertically into 4 sections. They are flexible

and can be compressed the female housing fits over this

The attachment can also be constructed with a different type of retention male component

that has a space between the parts to allow both rotational and vertical movements

ZEST ANCHOR Ideal for interim overdenture

It derives its retention from the root a post preparation is made within the root and the

female sleeve is cemented into place the male portion consists of a nylon post and a ball

head attachment to the overdenture as a chair side procedure and the post is placed in the

sleeve and the overdenture is placed over it with a self cure resin.

ADVANTAGES: Overcomes any space problem because attachment is within root

structure. Leverage to the abutment tooth is negligible since point of attachment is below

alveolar bone level.

preventing seating To correct this frequent recall visits are necessary When eating foods

without the OD can cause food to stagnate in the female part

ROTHERMAN ATTACHMENT This attachment is of two types : resilient and non

resilient Resilient allows both vertical and rotational movement..The male part consists of

a groove deeper at one end than the other, it easily attaches to the coping with free hand

soldering. The housing contains a 'C' shaped ring the ends of which fit in the deepest part

of the retaining groove. Rortherman Eccenrtric Attachment

INTROFIX ATTACHMENT Stud attachment composed of a solder base an adjustable

split male post and a female housing. The design is simple and provides frictional

attachment between the two parts. The male stud has a longitudinal split that can be

attached to provide more or less retention. It is replaceable as it is screwed to the solder

base . The lengthy stud can produce a torque potential so it is used in only totally tooth

supported system or OD with excellent support.

OTHER ATTACHMENTS The other attachments of importance: (as shown in fig 20)

Fig: 20 Parts of Attachment – Schubiger attachment – Ancrofix attachment – Quinlivan

attachment

BAR ATTACHMENTS The bar attachment consists of a metallic bar that splints two or

more implants or natural teeth spanning the edentulous ridge between them and a sleeve

(suprastructure) incorporated in the overdenture which clips over the original bar to retain

the denture. The bar attachments are available in wide variety of forms, Different Bar

Attachments They could be prefabricated or custom made. There are two basic types

based on the shape and the action performed: Bar joint that permit some degree of

rotation or resilient movement between the two components. Spacers should be provided
to ensure a small gap between the sleeve and the bar during processing. Bar joints are

subdivided into two types: Single sleeve and multiple sleeves; the single sleeve has to run

straight without allowing the antero-posterior curvature of the arch, so it is used in square

arches. On the other hand, the multiple sleeves can follow the curvature of the arch. It

also enables the use of more than one clip. Bar units that provide rigid fixation of the

overdenture allowing no movement between the sleeve and the bar. The prefabricated

bars are preferred to milled bars as they are less expensive and more solid with an equal

cross section. Prefabricated bars are either round, ovoid, or rectangular (U-shaped).

Round bars offer more denture rotation than rectangular bars, so produce less torque on

implants. However, Round bars require more frequent clip activation than U-shaped bars.

Therefore, oval or U-shaped bar are preferred when using two implants. The bar and clip

attachments are probably the most widely used attachments for implant tissue supported

overdentures as they offer greater mechanical stability and more wear resistance than

attachments. In addition, short distal extensions from rigid bars can be achieved which

contribute to the stabilization and prevent shifting of the denture. The assumed advantage

of bar attachment is the better transmission of forces between the implants due to the

primary splinting effect, load sharing, better retention, and the least post insertion

maintenance

MAGNET Magnetic retention is a popular method of attaching the removable prosthesis

to either retained roots or osseointegrated implants. The magnet is usually cylindrical or

dome-shaped attached to the fitting surface of the acrylic resin base of the overdenture.

The magnetic keeper is casted to a metal coping and cemented to root surface or screwed

over the implant fixture. The magnet system used for overdenture retention incorporates

the magnet into the overdenture which is a neodymium-iron-boron alloy or a cobalt-

samarium alloy. The second part of the magnetic system is the ferromagnetic keeper
which is screwed into the implants. The retention force of magnet attachments in implant

retained mandibular overdenture treatment is markedly less than the retention force of

ball and bar/clip attachments. The immediate loading of magnetic attachment retained

mandibular implant overdentures is considered as a viable treatment option in cases of the

complete edentulous patient that increase retention and stability of conventional dentures.

BASED ON TYPE OF OVER DENTURE

Immediate over denture : Constructed prior to preparation and ready for insertion after

preparation & reduction . It enhances patients ability and adaptability to wear dentures.

Interim over denture : Used for patients in transition or preparation phase until

permanent overdentureis constructed . Patient old partial denture can be modified and

used by extending the denture and by adding new artificial teeth using self cure acrylic

resin.

Remote or Definitive over denture : Conventional complete over denture is constructed

over one or more abutment teeth. Could be made entirely of acrylic resin or in

conjunction with metal bases.

Immediate Denture If the dentition is very compromised and indicated for total

extraction, then immediate dentures are planned to promote better healing (immediate

dentures act as surgical stents), protect the blood clot and aid early healing and promote

better ridge form. The immediate dentures apply functional forces within the

physiological limit results in an edentulous ridge with better form and more resilient soft
tissue covering. Immediate dentures also prevent the facial musculature from collapsing,

provide a guide for the vertical dimension, esthetic, easy adaptation to the dentures and

provide psychological comfort.

Single Complete Denture/Complete Denture When the teeth are completely absent in

any one of the arch, the fabrication of a single complete denture is highly recommended

to prevent the contact of the teeth and alveolar ridge, to restore function, vertical

dimension, esthetics and prevent the development of parafunctional habits.The complete

dentures are provided for edentulous patients (edentulous in both jaws) to rehabilitate

them by restoring the function form and aesthetics and general health of the patients. The

complete dentures are provided with various occlusal schemes such as balanced

occlusion, lingualized occlusion, neutrocentric concept and others depending upon the

condition of the patients.

IMPLANT SUPPORTED OVERDENTURES

INDICATIONS OF IMPLANT SUPPORTED OVERDENTURE:

 Severe morphological compromise of denture supporting areas that significantly

undermine denture retention.

 Poor muscular coordination

 Low tolerance of mucosal tissues.

 Recurrent instability of prosthesis

 Active and hyperactive gag reflexes

CONTRAINDICATIONS OF IMPLANT SUPPORTED OVERDENTURES:

 Severe renal disorder

 Treatment resistant diabetes

 Generalized secondary osteoporosis

 Radiotherapy in progress

 Hormonal deficiency

 Chronic alcoholism

 Heavy smoking habits

ADVANTAGES :

 Minimal anterior bone loss

 Improved esthetics

 Improved stability

 Improved occlusion

 Decreased soft tissue abrasions

 Improved chewing efficiency

 Improved retention, support, speech

 Decreased prosthesis size

DISADVANTAGES:

 Requires proper plaque control and denture hygiene

 More load to prosthesis

 Lack of insufficient interarch space makes overdenture fabrication more difficult.

Diagnosis & Treatment Planning

The two most significant decisions for successful implant overdentures are selecting the

proper type of patient and establishing a careful mode of treatment that will satisfy both

the patient and the prosthodontist. For this, a thorough examination and accurate

diagnosis are prerequisites. A clinical examination, medical and dental history, a

panoramic radiograph and a mounted casts are required to plan a treatment. The medical

and dental history are used to identify patients where implant failure is more likely to

occur so a thorough assessment of the risks/ benefits of the treatment can be made. This

information helps for the selection of case and also to identify patients where implant

treatment is contraindicated. The clinical examination and radiographic information are

used to evaluate bone health, bone quality and occlusocervical bone dimensions.

PROSTHETIC OPTIONS IN IMPLANT DENTISTRY:

In completely edentulous patient’s some patients have a strong psychological need to

have a fixed prosthesis as similar to natural teeth as possible. In 1989, Misch reported five

prosthetic options available in implant dentistry.

Mandibular implant overdenture options:

International consensus has found that two implants in the inter-foramina area should be

the first choice for standard care of the edentulous patients. However, because of the

treatment costs of this standard implant therapy, many patients cannot afford treatment

with multiple implants or are not willing to accept necessary bone augmentation

procedures. Multiple clinical trials have shown that single median implant can retain

mandibular overdenture well showing a satisfactory result, also lowered the component

cost and treatment time.

Limited treatment options are available in maxilla for implant overdentures. The primary

reason being an uneven resorptive pattern of the alveolar bone in maxilla, which makes it

difficult to place implants parallel to one another. If implant are not placed parallel, it

results in a fracture of prosthetic components. Independent implants are not an option,

because of the bone quality and direction of forces which again jeopardize the treatment

outcome.
Maxillary Implant Overdenture Option 1

The first treatment option for a completely edentulous maxilla has four to six implants, of

which at least three are positioned in the premaxilla. Implant number and location are

more important than implant size, but the implant should be at least 9 mm in length and

3.5 mm in body diameter. The key implants are positioned in the bilateral canine regions.

When possible, at least one central incisor position is suggested. Other secondary

implants may be placed in the first premolar region. When an implant cannot be placed in

at least one central incisal position, the incisive foramen may be considered for implant

insertion. Another alternative is the use of bilateral lateral incisor implants. In this option,

because of the reduced A-P spread, two implants are planned in the anterior region. In

these conditions, the dentate arch form should be square to ovoid. When the lateral incisor

is the anterior most implant site and force factors are greater, the premolar position may

also be used (along with the canine) to improve the A-P spread and increase the implant

number.

Maxillary Implant Overdenture Option 2

In the second option for a maxillary IOD, seven to 10 implants support a RP-4

restoration, which is rigid during function. This option is the most common treatment

because it maintains greater bone volume and provides improved security and confidence

to the patient. Many patients desire a fixed restoration in the maxilla. However, the loss of

bone in the premaxilla requires a bone graft or a labial flange for lip support. Grafts for

the entire premaxilla may require the iliac crest as a donor site because larger volumes of

bone are required for the FP. Combined factors such as patient fear of treatment and lack

of advanced training of the doctor are often the determining factors motivating the choice

for a maxillary overdenture.

Prosthesis movement can occur in one to six directions: occlusal, gingival, facial, lingual,

mesial and distal.

Attachment Systems:

Different types of attachment systems available are:

1) Stud attachments

2) Clip and bar

3) Magnets

4) Telescopic copings

STUD ATTACHMENTS:

Stud attachments consisted of a female part which is frictionally retained over the male

stud and incorporated into the denture resin either by the means of a transfer coping

system and the creation of a master cast incorporating a replica of the attachment or

directly in the mouth using self- cured or light polymerized resin . The stud attachments

are classified according to function into resilient and non- resilient attachments. One of

the main advantages of stud attachments is the ability of its use in cases with V-shaped

arches where straight connection between the implants can affect the tongue space.

BALL AND RING ATTACHMENTS :

into the implant, where as the female part is incorporated in the fitting surface of the

denture. The female part may be one of the following types:

(a) The O-ring in which the retentive element a few weeks.

(b) A metal part as in Dalbo system. This permits less resilience however the retentive

forces are almost twice those obtained with the O-ring system.

(c) A spherical metal anchor in which the female part contains a spring. These

attachments have advantage of being resilient and easily activated.

Ball attachments are among the simplest of all stud attachments widely used

because of their low cost, ease of handling, minimal chair side time requirements and

their possible applications with both root and implant-supported prosthesis. For

unsplinted implants, the most common attachment used is the ball attachment. This

attachment system is a practical, effective, and relatively low cost prosthetic option. Ball

attachments were claimed to be less costly, less technique sensitive and easier to clean

than bar attachments. Moreover, the potential for mucosal hyperplasia was more reduced

with a ball attachments.

LOCATOR ATTACHMENT:

It was conceived by R and D specialist Scott Mullaly of Zest Anchors, LLC in the year

2000. The Locator was designed for ease of insertion and removal, dual retention, a low

vertical profile and a unique ability to pivot, thus increasing its resiliency and tolerance

for implant divergency. The Locator Attachment is designed to reduce the height of

attachment and abutment. With a total attachment height of only 3.17mm (male plus 1mm

collar abutment), the Locator attachment saves a minimum of 1.68mm to 3.05mm of

male attachment allows to restore a non-parallel implants with up to 20 degrees of

angulation. This calculates to an extensive 40 degrees of divergence between two

implants. Dual retention, pivoting action provides resiliency to maximize stability and

longevity.

BAR AND CLIP ATTACHMENTS:

1) Bar attachments can be classified by their cross-sectional shape as:

 Round

 Egg-shaped

 Parallel- sided U-shaped

2) Bar and clip type attachments are mainly of two types-

 Bar joint (resilient)

single sleeve

multiple sleeves

 Bar unit (nonresilient)

Bars that are resilient, providing vertical resiliency, hinge resiliency or both, are termed as

bar joints. Bars that are non-resilient are termed as bar units.

Bar attachments can be prefabricated from type- IV gold. Other types of bars come in

castable, pre-milled plastic patterns.

Examples of castable bars are:

 Round bar
 Plastic Dolder bar

 EDS bar

 Hader bar

Bar clips or riders are available in different materials and configurations. metal clips and

riders are fully adjustable. Plastic Hader/ EDS clips are non-adjustable, can be replaced at

chair side.

Advantages of metal clips-

 Metal clips have more wear resistance compared to plastic clips

 Metal clips can be used with smaller bar dimensions

Disadvantages of metal clips-

 Replacement is difficult as compared to plastic clips. To replace a metal clip, it

has to be cut of the denture base with a bur.

 Metal clips require chair side pickup with self-cure acrylic.

HADER BAR:

Hader bar is classified as hinge resilient attachment and it provides mechanical snap

retention. In 1973, Helmut Hader, master technician and dental manufacturer, developed a

unique attachment system that even today is mainly known in the USA as the Hader bar

or the Hader vertical. The Hader bar is a semi- precision bar attachment that provides

hinge movement as long as a single Hader bar has been utilized in the attachment

assembly design. This function of this bar is based on the mechanical snap-retention

concept.

DOLDER BAR:
Dolder bar is a prefabricated precision bar attachment.

Dolder bar comes in two forms:

 Rigid form is U-shaped with parallel walls, called as bar unit.

 Resilient form is egg-shaped in cross-section and provides both vertical and

hinge resiliency

MAGNETIC ATTACHMENTS:

Magnets which are commonly used in dentistry are made up of mainly aluminium-nickel

cobalt metals. They are classified as universally resilient attachments as they allow all the

movements of the prosthesis. These are not very successful to provide retention, because

the magnetic forces of attraction generated to provide retention were weaker as compared

to retention provided by mechanical attachments like ball and bar attachments. Another

problem associated with magnetic attachments is corrosion in saliva on long term use. To

overcome this problem, newer generation magnets are developed which are made up of

rare earth elements such as samarium and neodymium. These have improved properties as

compared to conventional magnets.

TELESCOPIC ATTACHMENTS:

Telescopic crowns are also known as a double crown, crown and sleeve coping (CSC).

These crowns consist of an inner or primary telescopic coping, permanently cemented to

an abutment, and a congruent detachable outer or secondary telescopic crown, rigidly

connected to a detachable prosthesis . The use of telescopic retainers has been expanded

to include implant retained prostheses to make use of their enormous advantages. These

retainers provide excellent retention resulting from frictional fit between the crown and
the sleeve. They also provide better force distribution due to the circumferential relation

of the outer crown to the abutment which make axial transfer of occlusal load that

produce less rotational torque on the abutment. According to wall desig telescopic

retainers can be classified into parallel sided crowns, tapered (conical shaped) crowns and

crowns with additional attachments. Telescopic retained restoration has the advantage of

the ease of removability. This encourages the patient for repeated cleaning and

maintenance purposes.

COMPLICATIONS:

 Procedural complications do occur during the fabrication phase of prosthodontic

treatment following abutment connection

 Following the placement of completed prosthesis, the loss of implant anchorage or soft

tissue or mechanical complications may also occur.

 Loss of anchorage is a result of contamination, surgical trauma and prosthesis

overload.

MAINTANANCE:

 Metal scalers should be avoided. Use nylon, plastic, carbon, or resin scalers

designed specifically for cleaning around implant.

 Recall should be minimally every 3 months for the first 2 years. Depending on the

situation, recalls may be alternated between practices.

 Ultrasonic and sonic scalers should be avoided.

 A rubber cap with tooth paste, fine polishing paste, implant polishing paste, or
tinoxide is recommended.

 Mobility should be checked at every visit if possible.

 Occlusion should be evaluated to detect and correct possible traumatic or abnormal

occlusal contacts of relationships.

 Plaque, calculus, and bleeding indices should be assessed at every visit.

 Oral hygiene instructions should be assessed and reinforced or corrected at every

hygiene maintenance appointment.

 Radiographs should be taken using the paralleling technique to avoid image distortion

CONCLUSION

Though prosthodontics has evolved highly as a specialized field in replacement of

missing teeth and adjacent soft and hard oral tissues; the cooperation with other aspects of

dentistry, especially preventive cannot be ignored. Meeting the expectations of an ever

increasing elderly population with quite rightly youthful outlooks of both function and

esthetics is demanding. The loss of several teeth doesn't have to be an immediate threat to

the function of the whole dentition, but it can initiate serious problems related to the

whole orofacial region, psychics and the wellbeing of the patient. From this point of view

prosthetic dentistry is a valuable tool with high therapeutical and preventive character.
REFERENCES

1. PREVENTIVE PROSTHODONTICS BY Nishath ayesha

2. Preventive aspect of prosthodontics: An overview by Rina Singh, Jagjit Singh et al

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