Overlay Lawrence Rockville,

dentures

for the cleft-palate

I. A. Rothenberg, Md.

patient

D.D.S., M.S.

Lh e overlay denture used as a prosthesis for cleft-palate patienb is also known as a tooth-supported denture, telescopic denture, hybrid prosthesis, overdenture,l superimposed prosthesis,** 3 and plumper. 4y 5 It can be described as a complete or removable partial denture consisting of an acrylic resin base with or without a cast metal framework.6 The prosthesis is fabricated over retained teeth and/or roots that may or may not be prepared and restored. ’ By providing proper occlusion and facial support, a dramatic improvement in esthetics and function is achieved with the preservation of remaining teeth and tissue. Overlay dentures may be classified as ( 1) mechanical, in which a clip-bar attachment is indicated when few teeth are present, or (2) nonmechanical when a suf&ient number of teeth are present for retention and stability of the prosthesis. Generally, candidates for overlay dentures are patients with acquired defects due to accidents, those with abraded and/or eroded teeth, and patients with congenital defects, which include (1) oligodontia, (2) c 1ei‘d ocranial dysostosis, (3) Class III malocclusion not amenable to surgical or orthodontic treatment, and (4) cleft palate. INDICATIONS

FOR OVERLAY

DENTURES

FOR CLEFT-PALATE

PATIENTS

The following is a list of cleft-palate patients who may need overlay dentures: ( 1) patients with resection of the premaxilla leading to a lack of vertical, lateral, and anteroposterior growth, (2) patients with a floating premaxilla in abnormal relationship, (3) patients exhibiting lip collapse and postoperative lip tightness and/or tenseness,* and (4) patients having few remaining teeth in abnormal or collapsed occlusal relationship.** 4 The complete overlay denture is indicated when a large anterior ridge defect associated with depression of the middle third of the face is present3 or when there is a bilateral cleft associated with constriction of the maxillae and lingual version of the cuspids. The entire anterior ridge is overlayed with both flange and artificial teeth extending from first molar to first molar. In unilateral cases, the overlay partial denture is indicated with the flange confined to the cleft side of the arch.5 This article was presented in partial degree in prosthodontics at Georgetown

fulfillment University.

of the requirements

for a Master

of Science

327

328

Rothenberg

J. Pro&et. March,

Dent. 1977

For the cleft-palate patient, retention of the overiay prosthesis may be a problem, but it can be achieved by the preservation of the remaining teeth. All carious and infected teeth should be restored. Roots, even if submerged below the gingiva, should be retained and treated with root canal therapy and restored by use of gold posts, crowns, and copings.’ METHODS

OF RETENTtON

Retention of the overlay denture is achieved by frictional resistance of denture acrylic resin to crowns,5 telescopic crowns with metal-to-metal contact,’ cervical undercuts on full crowns engaged by a silicone lining in the overlay denture,“, G and internal semiprecision attachments, such as the ( 1) Gerber 696 attachment,* (2) Rothermann attachment,* and (3) clip-bar attachment.?& With regard to tooth coverage, the gold coping is the method of choice.’ Some take a more conservative approach and recommend that copings be used only when tooth structure does not provide adequate support.” Others seldom reduce the clinical crowns for coping coverage by reasoning that it is an unnecessary, expensive, and irreversible treatment.* However, all agree on the necessity of meticulous daily removal of plaque and that all possible teeth should be saved for the retention of the prosthesis. The age of the patient is another factor which must be considered in the use of the overlay denture. Since the adult patient has completed growth and development and existing teeth will not undergo passive eruption, this type of prosthesis is not recommended for patients under 16 years of age. In addition, since crowns or inlays may be required, the adult patient usually has a lower caries susceptibility and minimal pulpal irritation requiring endodontic therapy.” The overlay denture consists of clasps, palatal extensions, and cast metal palatal bars covered by acrylic resin.2 Acrylic resin teeth’ are ground thin and set anterior to the remaining natural teeth to provide the proper vertical dimension, occlusion, and esthetics.4 Clasps are used for retention but must be designed to eliminate excessive torque on the abutment teeth. In addition to tooth surface, all available basetissue area should be covered to secure the maximum denture-bearing area.’ CONCLUStONS The advantages of the overlay denture are enhanced stability and positive retention of the prosthesis,7v 8 preservation of the residual ridge,‘? 8 restoration of vertical dimension2, ‘3 R,0 preservation of proprioceptionR support of the lip and face muscles,‘, ‘, ’ maintenance of centric relation,* psychologic benefits,*, Q improved mastication,” improved crown/root ratio of teeth that might otherwise have been lost,‘, 0 positive support and comfort,* and the restoration of the maxillary arch.2 The use of an overlay denture for the cleft-palate patient requires meticulous home care on the part of the patient but remains an excellent choice of treatment. The author would fessor of Prosthodontics, *APM-Sterngold, +Baker Dental,

like to express Georgetown

his thanks University,

San Mateo, Calif. Carteret, N. J.

to Dr. Hratch A. Abrahamian, for his assistance in preparing

Associate Prothis article.

Overlay

dentures

for

cleft-palate

patients

329

References 1. Brewer, A., and Fenton, A.: The Overdenture, Dent. Clin. North Am. 17: 723-746, 1973. 2. Adisman, I. K.: Cleft Palate Prosthetics, in Grabb, W. C., Rosenstein, S. W., and Bzoch, K. R.: Cleft Lip and Palate, Boston, 1971, Little, Brown & Company. 3. Chalian, V. A., Drane, J. B., and Standish, S. M.: Maxillofacial Prosthetics, Baltimore, 1972, The Williams & Wilkins Company. 4. Abrahamian, H.: Cleft Palate Prosthesis, Georgetown Dent. J. 32: 4-8, 1965. 5. Rahn, A. O., and Boucher, L. J.: Maxillofacial Prosthetics, Principles and Concepts, Philadelphia, 1970, W. B. Saunders Company, p. 188. Adverse Effects of Resilient Denture Liners in Overlay 6. Immekus, J. E., and Aramany, M.: Dentures, J. PROSTHET. DENT. 32: 178-181, 1974. 7. Brewer, A.: The Tooth-Supported Denture, J. PROSTHET. DENT. 30: 703-706, 1973. 8. Dodge, C. A.: Prevention of Complete Denture Problems By Use Of “Overdentures,” J. PROSTHET. DENT. 30: 403-411, 1973. 9. Lord, J. L., and Teel, S.: The Overdenture: Patient Selection, Use of Copings, and Followup Evaluation, J. PROSTKET. DENT. 32: 41-51, 1974. 10401

GROSVENOR

MD.

ROCKVILLE,

ARTICLES A review Donald

PL. 20852

TO APPEAR IN FUTURE

of psychogenic B. Mikami,

aspects

D.D.S.,

ISSUES

and treatment

of bruxism

M.Ed.

Anatomic and clinical evaluation of the relationship temporomandibular joint and occlusion Franc0

Mongini,

Evaluation Dorsey Michael

M.D.,

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of polymeric

I. Nicholls,

Panoramic Luc

A.

materials

Aliza

Rehany,

for maxillofacial

R. Glaser,

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Ph.D.,

prosthetics

Michael

Theoretical

considerations

in the examination

of edentulous

J. Tabacco,

D.D.S.,

Ph.D.

radiography

Perrelet,

A method

the

D.D.S.

J. Moore, D.D.S., Zorach G. Linebaugh, D.D.S.

The measurement

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D.M.D.,

of refacing D.M.D.,

Repair

technique

Joseph

T. Richardson,

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Stern,

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