Description
This webinar focuses on mandibular overdentures in geriatric patients, comparing tooth-retained and implant-retained treatment options. It highlights age-related anatomical, functional, and systemic considerations that influence overdenture planning in elderly individuals. The session discusses advantages, limitations, and clinical indications of retaining natural teeth versus using dental implants for overdenture support. Emphasis is placed on patient comfort, masticatory efficiency, maintenance requirements, and long-term prognosis. Clinical decision-making based on bone quality, medical status, and cost-effectiveness will be explored. The webinar aims to help clinicians choose the most appropriate and predictable overdenture option for geriatric patients
Summary Listen
- The presenter discussed the high prevalence of edentulism in India, highlighting that a significant percentage of the population is completely or partially edentulous. They expressed concern about the trend of extracting all teeth and emphasized the importance of preserving teeth whenever possible. The main causes of edentulism include periodontal disease, dental caries, poor oral hygiene, tobacco use, and socioeconomic factors, a worldwide problem.
- Overdentures, removable prostheses supported by residual natural teeth, roots, or implants, are an effective alternative to complete dentures. Key benefits of overdentures include bone preservation, proprioception, and improved support, stability, and retention. They can be tooth-retained or implant-retained, with the latter potentially being immediately or conventionally loaded. Tooth-retained overdentures are particularly cost-effective.
- Tooth-retained overdentures improve retention and stability, maintain proprioception, and reduce alveolar bone resorption. Various attachment types exist, including header bars and clips, ball and o-ring attachments, castables, and magnetic attachments. Intra-radicular attachments such as the Seacup Rissline system, which requires specific drills, are commonly used.
- The presenter demonstrated a clinical procedure for placing intra-radicular attachments on retained canines, including measuring attachment length, trimming teeth, drilling receptacles, and cementing the attachments. They highlighted the importance of patient recall every six months to check for anterior-posterior rotation. The average lifespan of these attachments is around five to six years, after which implants may be considered.
- Implant-retained overdentures, now considered a standard of care, provide significant benefits over conventional complete dentures. These benefits include improved support, retention, psychological well-being, appearance, diet, and reduced bone loss. Immediate loading protocols, where the prosthesis is placed within 48 hours, can shorten treatment time.
- Success criteria for immediate overdentures include an insertion torque above 30, an ISQ value above 60, a minimum of two implants in the mandible or four in the maxilla, and a minimum implant length of 10 millimeters. While splinting was once considered necessary, unsplinted implants can be equally effective with sufficient insertion torque. Locator attachments are preferred over ball attachments for implant-retained overdentures.
- The presentation included case studies of immediate and conventional implant-retained overdentures, showcasing various techniques and attachment systems. The speaker discussed the importance of an exceptional dental lab and emphasized the pickup process for attachments in the mouth. Challenges associated with two-teeth retained overdentures include carries, super-eruption and attachment fractures.
- The presenter detailed a few cases, highlighting the utility of overdentures in maxillofacial reconstruction, particularly in cases involving ameloblastoma and cementifying fibroma. These cases often involve fibula free flaps for reconstruction, followed by implant placement and overdenture fabrication. The presentation showed the use of surgical guides and 3D planning for precise implant placement and reconstruction.
- In conclusion, overdentures significantly improve the quality of life for edentulous patients, particularly in the mandible where complete dentures often lack sufficient stability and retention. Overdentures are a predictable option and offer sufficient retention and stability with a minimum of two implants, while four implants provide added support. It is essential that the overdenture be passive and free from excessive lateral stresses to prevent bone loss and implant failure.
Sample Certificate
About the Speakers
Dr. P.C Jacob
Maxillofacial Prosthodontist and Chief Executive at Ora Care Clinic, Senior Consultant at Mazumdar Shaw Medical Center, Narayana Health and Aster CMI Hospital, Bangalore
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