Prosthodontics
P rosthodontics
A CASE REPORT ON MANDIBULAR TELESCOPIC OVERLAY
DENTURE: A PREVENTIVE PROSTHODONTIC APPROACH
Dr. Nirban Mitra Dr. Naima Ahmed Dr. Anand Rajapur
P.G. Student Assistant Professor Professor
ACKNOWLEDGEMENT
We would take immense pleasure to acknowledge Dr. Vivek Thomas sir,
prof & hod, dept. of Prosthodontics, who always encouraged, supported
and believed in us. Would also heartfully thank Dr. Vishwas Chaugule sir,
prof & hod, dept. of Pedodontics without whose continuous guidance this
article could not have been completed. would also thank from deep beneath
my heart Dr. Manesh Lahori sir; prof & hod, dept. of Prosthodontics for his
gratitude and belief in us and provide a platform.
INTRODUCTION
Preventive Prosthodontics emphasizes the importance of any procedure that
can delay or eliminate future problems. Tooth-supported overdenture offers
a lot of advantages like better retention, stability, proprioception, support,
maintenance of alveolar bone and psychological aspect of retaining teeth.
There are two physiologic benefits related to overdenture therapy: the first
concerns the continued preservation of alveolar bone around the retained
teeth1 while the second relates to the continuing presence of periodontal
sensory mechanisms2 that guide and monitor gnathodynamic functions.
According to GPT 8, a telescopic denture is also called as an overdenture,
which is defined as any removable dental prosthesis that covers and rests on
one or more of the remaining natural teeth, on the roots of the natural teeth,
and/or on the dental implants. It is also called as overlay denture, overlay
prosthesis, and superimposed prosthesis. Although first described by Starr in
1886, telescopic copings were initially introduced as retainers for removable
partial dentures (RPD) at the beginning of the 20th century.3 Because of
its resemblance to the collapsible optical telescope, this system of double
crowns, which can be fitted into each other, became known as the telescopic
denture.4
The advantages of overlay dentures include better occlusal awareness, biting
force, neuromuscular control and immense psychological support for patients.
10 GUIDENT | Your Guide on the path of Dentistry
July 2016
A Case Report
Department of Prosthodontics
Vyas Dental College & Hospital, Jodhpur, Rajasthan, India.
The philosophy of Preventive Prosthodontics pertaining
to overdenture therapy has long term advantage, by
preserving the proprioception and thereby residual
alveolar ridge. It is a versatile and successful means of
achieving longterm restoration of a partially edentulous
jaw. Telescopic dentures consist of primary coping to
be cemented to abutment and a secondary coping which
is attached to the cast partial superstructure. These
copings are advantageous for to eliminate undesirable
undercut, protect the abutment from dental caries
and also provide retention and stabilization of the
secondary coping. An impression made for casting the
primary coping following abutment preparation. After
evaluation of parallelism these copings were cemented
on the abutments. A final impression was made and wax
pattern fabricated for cast partial framework. After
checking its fit and tryin of the occlusion, esthetics it
was processed and veneer was applied to the secondary
copings. Telescopic overlay denture may be considered
as preventive prosthodontic option, combining good
retentive and better occlusal awareness, biting force,
neuromuscular control and immense psychological
support for patients.
KEYWORDS: Telescopic denture, overlay denture,
preventive prosthodontics
 July 2016
Prosthodontics
P
It is often possible to provide a functional, retentive and esthetic treatment
rosthodontics
outcome through a variety of modalities.5
This clinical report describes a treatment modality emphasizing on preventive
prosthodonticapproach towards management of a patient with few remaining
natural teeth by using telescopic overlay denture in mandibular arch.

CASE REPORT
A 65 year old male patient reported to the department of Prosthodontics,
Vyas Dental College and Hospital, Jodhpur with a chief complaint of
difficulty in mastication due to partial mandibular edentulism. He
desired replacement of missing teeth so that function can be restored.
Clinical and radiographic examination revealed partially edentulous
Figure 2: Impression for fabrication of primary copings
mandibular arch. Teeth present were 34, 38, 44, 45,48 and 42 as
root stump (Figure 1). The teeth were periodontally sound, with no
mobility. The edentulous span had favorable ridge with firmly attached
keratinized mucosa.

Figure 1: Pre-operative intraoral view

Diagnostic casts were prepared via alginate impressions (Zelgan, Dentsply,

Figure 3: Surveying the primary copings
Mumbai, India). The casts were articulated in semi adjustable articulator
(Hanau Wide-VueArcon Articulator, Whipmix Corporation) using centric
relation record and a face-bow transfer (Quick mount Facebow) to evaluate
inter arch space and the vertical dimension of occlusion. There was
sufficient interarch space for the copings, the denture base and the teeth
arrangement. It was decided to fabricate a mandibular telescopic overlay
denture.
After taking consent from patient, he was sent for oral prophylaxis and
endodontic therapy of the remaining teeth. After assessing endodontic
therapy, tooth preparation was done to receive telescopic crowns by
placing chamfer finish line subgingivally. Since all the teeth were tilted with
undesirable undercuts which was then planned to eliminate using crowns
after surveying. After the preparation of the abutments, the impression
was made by using a polyvinyl siloxane elastomeric impression material
(putty and light body) (Reprosil, Dentsply Caulk, Milford, USA) by a double
step putty wash technique (Figure 2). The impression was poured into a die Figure 4: Intraoral view of the cemented primary copings
material (Kalrock, Kalabhai, Mumbai, India) to obtain the cast, on which the
primary copings were fabricated after surveying the copings for eliminating An over impression was made using the medium viscosity addition silicone
the undesirable undercuts (Figure 3). The fit of the primary coping were impression material and the second master model was made. This model
evaluated in the patients mouth, after which they were cemented on the would be used for fabrication of the cast partial superstructure. Bite
abutments with glass ionomer cement (Type I; GC Fuji) (Figure 4). registration (ImprintTM Bite, 3M ESPE, Germany) was repeated and the

Your Guide on the path of Dentistry | GUIDENT 11

Prosthodontics
P rosthodontics
models were mounted on a semiadjustable articulator using the same face
bow record. In the laboratory, the copings on the second master model
were milled. The second master model was duplicated (Polyflex duplicating
material, DenstplyAustenal, USA) and the refractory model was prepared.
The cast partial framework was waxed up (MAARC Pattern/Inlay, Shiva
products, Mumbai, India), which was then cast using a base metal alloy
(cobaltchrome) (Wironium, BEGO USA) with the secondary coping overlay
of the primary coping. After evaluating the fit of the framework in the mouth
(Figure 5), a wax rim (Rolex, Ashoo Sons, New Delhi, India) was prepared on
the framework and acrylic teeth (Premadent, Dr. Jagdishlalsethi, Delhi) were
set with the same shade as that of maxillary fixed dental prosthesis. After
verification of esthetics, function, phonetics and occlusion the mandibular
denture was processed using heat-cure acrylic resin (Trevalon-HI, Dentsply,
Germany). Retention of the denture was finally provided by the friction
between the parallel surfaces of the primary and secondary copings (Figure
6). The completed prostheses were re-evaluated for function, esthetics, and
phonetics.A veneering material (Artglass; HeraeusKulzer) was applied and
then light-polymerized on the facial aspect of the mandibular framework after
matching the shade with acrylic teeth. Occlusion was evaluated and adjusted
(Figure 7). Postoperative instructions on how to insert the prostheses and also
was provided with instruction on adequate oral hygiene maintenance. After
minor adjustments during post insertion visits, the patient was recalled for 6
monthsfollow-up. Minor post-insertion adjustments were performed.
Figure 5: Intraoral evaluation of cast partial superstructure with
secondary copings
Figure 6: Intaglio surface of the processed overlay denture
12 GUIDENT | Your Guide on the path of Dentistry
July 2016
Figure 7: Post-operative intraoral view
DISCUSSION
Proper diagnosis and strategic treatment planning play a crucial role in
management of complex cases. Residual ridge resorption (RRR) following
removal of teeth has been well observed and documented in literature.6
While the bone loss following the removal of teeth is stated to be rapid,
progressive, irreversible and inevitable, it is equally well observed that bone
is maintained around standing teeth and implants.7,8 Over denture therapy
constitutes essentially a preventive Prosthodontics concept as it endeavors
to preserve the few remaining teeth and the supporting structures.1,2 In
this situation, a total of 5 abutments for telescopic copings were used to
support the overdenture, thus creating a quadrilateral configuration. It has
been reported that at least two abutment teeth should be splinted when
attachment prostheses are used to make the stress patterns more favorable.
This option was thought to have a better prognosis for the remaining teeth
as well as to have a more retentive prosthesis.9 The recommended alloys for
fabrication of copings are the high noble (ADA Type IV). AgAuPd alloys have
better precision and better retention, but are technique sensitive and costly.
Base metal alloys (CrCo) can also be used because they have low thermal
conductivity, thus the patient does not experience unpleasant thermal
sensation caused by excessive tooth preparation10 and is economical.
The advantages of telescopic overlay dentures are that it creates a common
path of insertion, easy to perform routine oral hygiene,rigid splinting action,
proprioceptive responses, distribution of stresses to the abutment teeth and
it is psychologically well-tolerated by patients. The disadvantages include
increased cost, complex laboratory procedures, increased number of dental
appointments, difficulty in achieving esthetics11-13 and finally, veneer material
fracture, debonding, discoloration, and wear are the possible complications.14
CONCLUSION
Telescopic overlay denture may be considered as preventive prosthodontic
option, combining good retentive and stabilizing properties with a
splinting action. Apart from the splinting of the abutment teeth with
the telescopic system, the gingival tissues are easily accessible around
the entire marginal circumference of the abutment, thus permitting easy
home care and oral hygiene. However, correctly implemented plaque
control is fundamental in the prevention of recurrence of gingivitis. Also,
the rate of the residual ridge resorption decreases because of the transfer
of compressive forces into the tensile forces by the periodontal ligament and
better stress distribution.
References are available on request
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