0 Patient Assessment
- 0.1 Patient demand
- 0.2 Overarching considerations
- 0.3 Local history
- 0.4 Anatomical location
- 0.5 General patient history
- 0.6 Risk assessment & special high risk categories
  - 5.1 Risk assessment & special high risk categories
  - 5.2 age
  - 5.3 Compliance
  - 5.4 Smoking
  - 5.5 Drug abuse
  - 5.6 Recreational drugs and alcohol abuse
  - 5.7 Parafunctions
  - 5.8 Diabetes
  - 5.9 Osteoporosis
  - 5.10 Coagulation disorders and anticoagulant therapy
  - 5.11 Steroids
  - 5.12 Bisphosphonates
  - 5.13 BRONJ / ARONJ
  - 5.14 Radiotherapy
  - 5.15 Risk factors
1 Diagnostics
- 1.1 Clinical Assessment
  - 0.1 Lip line
  - 0.2 Mouth opening
  - 0.3 Vertical dimension
  - 0.4 Maxillo-mandibular relationship
  - 0.5 TMD
  - 0.6 Existing prosthesis
  - 0.7 Muco-gingival junction
  - 0.8 Hyposalivation and Xerostomia
- 1.2 Clinical findings
  - 1.1 Occlusion
  - 1.2 Alveolar atrophy and insufficiency
  - 1.3 Skeletal consequences of edentulism
  - 1.4 Head-neck cancer
- 1.3 Clinical diagnostic assessments
  - 2.1 Microbiology
  - 2.2 Salivary output
- 1.4 Diagnostic imaging
  - 3.1 Imaging overview
  - 3.2 Intraoral radiographs
  - 3.3 Panoramic
  - 3.4 CBCT
  - 3.5 CT
- 1.5 Diagnostic prosthodontic guides
  - 4.1 Prosthodontic guides overview
  - 4.2 Wax-up, arrangement, mock-up
  - 4.3 Splints and imaging for surgery
  - 4.4 Provisionals
2 Treatment Options
- 2.1 Mucosally-supported
  - 0.1 Mucosally supported - Overview and important considerations
  - 0.2 Complete denture
  - 0.3 Immediate denture
  - 0.4 Occlusal schemes
- 2.2 Implant-retained/supported, general
  - 1.1 Prosthodontic options overview
  - 1.2 Number of implants maxilla and mandible
  - 1.3 Time to function
  - 1.4 Submerged or non-submerged
  - 1.5 Soft tissue management
  - 1.6 Hard tissue management, mandible
  - 1.7 Hard tissue management, maxilla
  - 1.8 Need for grafting
  - 1.9 Healed vs fresh extraction socket
  - 1.10 Digital treatment planning protocols
    
    9.1 Digital treatment planning protocols, introduction
    
    9.2 Digital treatment planning protocols, NobelClinician
- 2.3 Implant prosthetics - removable
  - 2.1 Implant overdenture, overview
    
    0.1 Implant overdenture, introduction
    
    0.2 Overdenture retention devices, overview
  - 2.2 Secondary splinting
  - 2.3 Primary splinting
- 2.4 Implant prosthetics - fixed
  - 3.1 Fixed implant prosthesis, introduction
  - 3.2 Screw-retained restorations
    
    1.1 Screw-retained
    
    1.2 Implant-supported vs abutment-supported
  - 3.3 Cement-retained restorations
    
    2.1 Cement-retained
    
    2.2 Abutment materials
  - 3.4 Framework materials
    
    3.1 Framework materials
    
    3.2 Veneering with ceramic
    
    3.3 Veneering with Acrylic
- 2.5 Comprehensive treatment concepts
3 Treatment Procedures
- 3.1 Surgical
  - 0.1 Surgical considerations
    
    0.1 Anesthesia
    
    0.2 Peri-operative care
    
    0.3 Post-operative care
    
    0.4 Flap-or flapless
    
    0.5 Wound closure
    
    0.6 Intra-operative complications
    
    0.7 Guided vs non-guided
    
    0.8 Semi-guided surgery with prosthetic template
    
    0.9 Guided surgery with drill guides
  - 0.2 Surgical protocols - general
    
    1.1 Crestal incision
    
    1.2 Choice of implant
    
    1.3 Parallel implant placement
    
    1.4 Tapered implant placement
    
    1.5 Insertion torque
    
    1.6 Insertion height
    
    1.7 Implant angulation
  - 0.3 Surgical protocols - mandible
    
    2.1 Implant placement with open flap procedure - mandible
    
    2.2 Grafting, mandible
  - 0.4 Surgical protocols - maxilla
    
    3.1 Implant placement - maxilla
    
    3.2 Grafting, maxilla
    
    3.3 Sinus lifting
    
    3.4 Zygomatic implants
    
    3.5 Pterygoid implants
    
    3.6 Problems and complications in maxillary implant surgery
- 3.2 Removable prosthetics
  - 1.1 Complete dentures
    
    0.1 Complete denture clinical protocol
    
    0.2 Complete denture impressions
    
    0.3 Complete denture - maxillo-mandibular relations
    
    0.4 Complete denture trial placement
    
    0.5 Complete denture placement
    
    0.6 Complete denture post-placement
  - 1.2 Implant overdentures
    
    1.1 Overdenture clinical protocol
    
    1.2 Implant overdenture impressions
    
    1.3 Implant overdenture maxillo-mandibular relations
    
    1.4 Implant overdenture trial placement
    
    1.5 Implant overdenture placement
    
    1.6 Implant overdenture post-placement
- 3.3 Fixed prosthetics
  - 2.1 Fixed implant prosthesis clinical protocol
  - 2.2 Impressions
    
    1.1 Impressions - overview
    
    1.2 Splinted vs unsplinted impression copings
    
    1.3 Open versus closed tray
    
    1.4 Parallel vs non-parallel
  - 2.3 Maxillo-mandibular relations
  - 2.4 Trial placement
  - 2.5 Framework trial placement
  - 2.6 Placement
  - 2.7 Post-placement
4 Aftercare
- 4.1 Surgical aftercare
  - 0.1 Medication
  - 0.2 Post-operative soft tissue management
  - 0.3 Suture removal
  - 0.4 Post-surgical recommendations
- 4.2 Prosthetic aftercare
  - 1.1 Esthetic and function check
  - 1.2 Provisionals / temporary prosthesis
  - 1.3 Oral hygiene instructions
  - 1.4 Occlusal guard
- 4.3 Post-treatment complications and management
  - 2.1 Bleeding
  - 2.2 Soft tissue and hard tissue
  - 2.3 Patient compliance / recall
  - 2.4 Biologic complications
  - 2.5 Esthetic complications
- 4.4 Recall visits and logistics
  - 3.1 Recall visits - overview
  - 3.2 Patient expectations
  - 3.3 General health check
  - 3.4 Professional oral hygiene
  - 3.5 Implant overdenture maintenance
  - 3.6 Occlusion check
  - 3.7 Probing
  - 3.8 Inflammation, infection
    
    7.1 Inflammation and infection - overview
    
    7.2 Infection, microbiological diagnostics
  - 3.9 Radiological control

Treatment guidelines

Overdenture Clinical Protocol

Key points

The oral rehabilitation of edentulous patients is comprised of specific clinical techniques
Clinical objectives are best met by following a routine protocol
Restoration of soft tissue health is an important prerequisite for impression making

Overdenture clinical protocols

Successful oral rehabilitation of edentulous patients with removable prostheses demands careful adherence to a clinical protocol.

Clinical objectives are met by using a routine clinical protocol that includes most or all of the following steps:

Restoration of soft tissue health. Absence of a wide band of attached mucosa does not seem to adversely affect soft tissue health around implants. Gingival-mucosal grafting procedures are rarely prescribed. Irreversible hydrocolloid impressions in stock trays are made to produce required stone diagnostic casts.
Fabrication of custom impression trays and making of final impressions using elastomeric materials in conjunction with recording functional border extensions of the prosthesis. Definitive stone casts are then poured.
Fabrication and adjustment of wax occlusion rims to establish height of the occlusal plane, while establishing correct vertical dimension of occlusion, suitable smile and lip lines.
Registration of the maxillo-mandibular relation record and articulator mounting (with or without use of a face-bow).
Artificial teeth selection and their arrangement for a try-in of the provisional set-up
Clinical evaluation of the desired restoration of vertical and horizontal jaw dimensions, centric relation and overall esthetic outcomes.
Denture placement to include evaluation of patient comfort, function and esthetic appearance. Overdenture is related to attachments. Careful attention must be paid to denture base fit and extensions, functional elements of speech and mastication, occlusion, and appearance/soft tissue support.
Post-placement evaluation of patient comfort, function and esthetics. Adjustments are made as necessary.

Clinical topics

Treatment guidelines

Implant overdentures, introduction

Some patients present with soft and hard tissue defects that cannot be addressed by a fixed implant prosthesis when esthetics, phonetics and oral hygiene access are considered. In these patients who have struggled...

Treatment guidelines

Implant overdenture maxillo-mandibular relations

Accurate and repeatable recording of patient’s maxillo-mandibular relationships are essential for all types of oral rehabilitation. They provide essential clinical documentation that enables dentists and technicians to create...

Implant prosthetics

Treatment guidelines

Implant overdenture placement

Placement of a removable prosthesis requires attention to detail to cover all important clinical items such prosthesis fit, denture base extensions, esthetics, occlusion, patient comfort and post-insertion instructions. Implant overdentures may or may not...

Additional resources

Videos

Iven Klineberg: Is traditional complete denture therapy passé ?

Even though preventive and restorative efforts increase the retention of natural teeth considerably, the number of edentulous patients will grow due to the epidemiologic growth of the older patient group. Adequate treatment of edentulous patient remains a challenge and Dr Klineberg...

Implant prosthetics

Videos

Werner Zechner: Treatment concepts for edentulous patients over time

The lecture summarizes the development of implant-based treatment options for edentulous indications over time until the most up-to-date treatment techniques, like zygomatic implants, the All-on-4 technique, digital diagnostics and treatment planning and guided surgery procedures...

Videos

Saj Jivraj: Restorative considerations for the immediate loaded transitional prosthesis

The lecture highlights the importance of the restorative space to meet the requirements for esthetics, mechanics and biomechanical integrity. Dr Jivraj reviews the restorative considerations playing a role like tooth position, vertical restorative space, restoration contour and...

Videos

Stefan Holst: Prosthetic considerations for edentulous patients

The lecture reviews decision criteria for material selection and design options in edentulous restorations. From a clinical and patient expectation standpoint, removable and fixed restorations provide comparable long-term outcome. Removable restorations can offer advantages, such...

Videos

Egon Euwe: The esthetic upgrade for the edentulous patient

The lecture reviews the treatment plan and workflow for fixed prosthetic restorations of edentulous arches. The diagnostic planning before the implant surgery can be tested e.g. with provisional diagnostic dentures. Highlighting with a patient case, Dr Euwe explains how a screw...

Videos

Lambert Stumpel: Three tales of things done differently

Dr Stumpel presents three cases with edentulous and partially edentulous situations and gives insight in surprising tips and tricks how to improve precision of the guided surgery protocol and at the same time facilitate some of the intra- and extra-oral workflow steps and...

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Overdenture Clinical Protocol

Overdenture clinical protocols

Clinical topics

Related articles

Treatment guidelines

Implant overdentures, introduction

Treatment guidelines

Implant overdenture maxillo-mandibular relations

Treatment guidelines

Implant overdenture placement

Additional resources

Videos

Iven Klineberg: Is traditional complete denture therapy passé ?

Videos

Werner Zechner: Treatment concepts for edentulous patients over time

Videos

Saj Jivraj: Restorative considerations for the immediate loaded transitional prosthesis

Videos

Stefan Holst: Prosthetic considerations for edentulous patients

Videos

Egon Euwe: The esthetic upgrade for the edentulous patient

Videos

Lambert Stumpel: Three tales of things done differently

Questions