Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Archana Dambal

"Journal of clinical and diagnostic research is a welcome change in publishing practices. It aims to reach out to the grass-root level researchers who do not lack in experience, clinical material and ideas, but lack in their knowledge in English language and statistics. The journal achieves it's aim by supporting in these exact domains.
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Dr. Archana Dambal
Department of General Medicine,
Belgaum Institute of Medical Sciences,Belgaum, Karnataka,INDIA,
On 30 Nov 2018




Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Dentistry
Year : 2012 | Month : August | Volume : 6 | Issue : 6 | Page : 1112 - 1116

Telescopic Denture – A Treatment Modality for Minimizing the Conventional Removable Complete Denture Problems: A Case Report

Kunwarjeet Singh, Nidhi Gupta

1. Reader, Department of Prosthodontics and Dental Materials, Institute of Dental Studies and Technologies, Modinagar, Ghaziabad, Uttar Pradesh, India. 2. Reader, Department of Pedodontics and Preventive Dentistry, ITS Dental College, Greater Noida, Uttar Pradesh, India.

Correspondence Address :
Dr. Kunwarjeet Singh House No 609, First Floor, Sector-5, Vaishali Ghaziabad, Uttar Pradesh, India. Phone: 9911491242 E-mail: drkunwar@gmail.com

Abstract

Objective: The goal of this article was to describe the importance of saving the natural remaining teeth and the fabrication of telescopic dentures as an alternative to the conventional removable dentures, to minimize the complete denture problems.

Background: Telescopic dentures consist of an inner or primary telescopic coping which is permanently cemented to an abutment and an outer or secondary telescopic coping which is attached to the prosthesis. These copings protect the abutment from dental caries and thermal irritations and also provide retention and stabilization of the secondary coping. The secondary coping engages the primary copings to form a telescopic unit and it provides retention and stability to the prosthesis.

Materials and Methods: An impression was made with a polyvinyl siloxane elastomer after the preparation of the abutments and the primary copings were fabricated on the cast which was obtained from the impression. After evaluating the fit of the primary copings on the abutments, they were cemented with glass ionomer cement. An impression of the cemented primary copings was made for the fabrication of secondary copings with retention beads, which were attached to the prosthesis.

Conclusion: Telescopic overdentures have better retention and stability as compared to complete dentures, they improve the chewing efficiency and the comfort of the patient and they also decrease the alveolar bone resorption..

Keywords

Telescopic overdenture, Primary coping, Secondary coping, Double crown, Retention bead

How to cite this article :

Kunwarjeet Singh, Nidhi Gupta. TELESCOPIC DENTURE – A TREATMENT MODALITY FOR MINIMIZING THE CONVENTIONAL REMOVABLE COMPLETE DENTURE PROBLEMS: A CASE REPORT. Journal of Clinical and Diagnostic Research [serial online] 2012 August [cited: 2018 Dec 14 ]; 6:1112-1116. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2012&month=August&volume=6&issue=6&page=1112-1116&id=2351

INTRODUCTION
A telescopic denture is a prosthesis which consists of a primary coping which is cemented to the abutments in a patient’s mouth and a secondary coping which is attached to the prosthesis and which fits on the primary coping. It thereby increases the retention and stability of the prosthesis. According to GPT, 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.

Telescopic crowns were initially introduced as retainers for the removable partial dentures at the beginning of the 20th century. They were also known as a Double crown, a crown and sleeve coping or as Konuskrone, (1) a German term that described a cone shaped design. These crowns are an effective means for retaining the RPDs and dentures. They transfer forces along the ling axis of the abutment teeth and provide guidance, support and protection from the movements that dislodge the denture.

The double crown systems are usually distinguished from each other by their differing retention mechanisms (2). There are three different types of double crown systems. These are, telescopic crowns which-achieve retention by using friction, and conical crowns or tapered telescope crowns which exhibit friction only when they are completely seated by using a “wedging effect.” The magnitude of the wedging effect is mainly determined by the convergence angle of the inner crown: the smaller the convergence angle, the greater is the retentive force. The double crown with a clearance fit (also referred to as a hybrid telescope or a hybrid double crown) exhibits no friction or wedging during its insertion or removal. The retention is achieved by using additional attachments or functional molded denture borders.

The retention and the stability of the telescopic denture are directly related to the number and the distribution of the abutments along the dental arch and the taper of the wall of the primary coping. The tapered configuration of the contacting walls generates a compressive intersurface tension. The tension should be sufficiently strong enough to sustain the prosthesis in its place. An increase in the tapering of the coping walls reduces the retention between the copings. The smaller the degree of the taper, the greater is the frictional retention of the retainer. In case of the abutments with short clinical height, the walls should be kept parallel or the taper of the wall should be reduced (2-5º) to improve the retention. The taper of the walls of the primary coping can be adjusted to a predetermined angle, according to the special requirements of each patient.

The telescopic denture which was supported by the natural teeth gained significant popularity as an alternative to the conventional dentures during the 1970s and the 1980s. The retained teeth that support the overdentures, preserve the bone and they minimize the downward and forward settling of a denture, which otherwise occurs with alveolar bone resorption. The overdenture occlusion is maintained rather than shifting forward to simulate the appearance of a prognathic mandible.

The telescopic denture philosophy postulated a transfer of occlusal forces to the alveolar bone through the periodontal ligament of the retained roots. A proprioceptive feedback from the periodontal ligament prevents the occlusal overload and it consequently avoids the residual ridge resorption which is adjacent to the roots and the rest of the ridge, due to excessive forces. They also provide improved functions as compared to the conventional dentures, such as an improved biting force, chewing efficiency and even phonetics. The impairment of these functional parameters which are created by edentulism, reflects the significant role of the periodontal receptors for a sensory feedback and a discriminatory ability from the retained roots. Tooth loss results in loss of the proprioception mechanism that has been a part of the sensory programme throughout life

Case Report

CLINICAL CASE REPORT
A 52-years old male reported to our dental centre for a prosthetic evaluation. The patient had received a maxillary and mandibular anterior fixed partial denture and both the posterior arches were unrestored. The patient had the major complaints of difficulty in chewing due to the missing posterior teeth and poor aesthetics due to the poor designing of the fixed partial denture. After the removal of the FPD, the clinical and radiographic examination revealed that the maxillary and the mandibular right and left canines and the mandibular right premolar were present, with no periapical pathology. The teeth were periodontally sound, with no mobility. There was sufficient interarch space for the copings, the denture base and the teeth arrangement. It was decided to fabricate a maxillary telescopic denture and a mandibular bar supported overdenture. After the intentional root canal treatment of the abutments (Table/Fig 1), they were prepared with a tapered round end diamond rotary bur with a chamfer finish line for the primary coping (Table/Fig 2). The finish line had to be prepared subgingivally. The long abutments had to be prepared with tapered walls (2-5º) (Table/Fig 3) and the short abutments had to be prepared with parallel walls. After the preparation of the abutments, the impression was made by using a polyvinyl siloxane elastomeric impression material (putty and light body) by a double step putty wash technique. The impression was poured into a die material to obtain the cast, on which the primary copings were fabricated. The fit of the primary coping was evaluated in the patient’s mouth, after which they were cemented on the abutments with glass ionomer cement (Table/Fig 4). Another impression was made by a double step putty wash technique after the cementation of the primary copings, by using a custom acrylic resin tray to obtain a cast (Table/Fig 5) on which the secondary copings were fabricated (Table/Fig 6). The fit of the secondary copings over the primary copings was evaluated in the patient’s mouth. The secondary copings consisted of small metal projections which were known as retention beads, which helped in the mechanical interlocking of the secondary copings in the denture base. The frictional contact between the primary and secondary copings helped in the retention of the prosthesis. The secondary copings had to be placed on the master cast, it had to be covered with wax and the trial denture base had to be fabricated with chemically cured acrylic resins after applying separating media over the master cast. The placement of the wax over the secondary copings helped in the easy separation of the copings from the trial denture base at the time of the dewaxing. Occlusion rims were also fabricated over the trial denture base. Horizontal and vertical maxillomandibular records were obtained with the record bases and the occlusion rims and these were transferred to a semiadjustable articulator by using a face bow. The artificial teeth were selected and arranged on the record bases for a trial denture arrangement and they were evaluated intraorally for phonetics, aesthetics, occlusal vertical dimension and centric relation. A protrusive record was made, to set the articulator’s condylar elements and to achieve a balanced occlusal arrangement. After the wax up, the dentures were processed, finished, polished and delivered to the patient (Table/Fig 7). The patient was scheduled for follow-up visits every 3 months and he reported no complaints during the 2 years of follow-up.

Another patient with three remaining mandibular teeth (Table/Fig 8) was successfully rehabilitated by using a telescopic denture. (Table/Fig 9) shows the cemented primary copings over the abutments in the patient’s mouth. The walls of these short primary copings are almost parallel with the minimum taper for a better retention. (Table/Fig 10) shows the secondary copings inside the intaglio surface of the mandibular denture.

Discussion

Telescopic crowns have been used mainly in RPDs to connect dentures to the remaining dentition (3), but these can be used effectively to retain complete dentures which receive their support partly from the abutments and partly from the underlying residual tissues. Telescopic crowns have also been used successfully in RPDs and FPDs, supported by endosseous implants, in combination with the natural teeth, which includes the overdentures (4),(5). Telescopic crows can also be used as effective direct retainers for RPD (6). Their degree of retention can be planned to suit different situations by modifying their designs. The amount of intersurface friction depends on the configuration of the taper angle and the area of the surface contact. Telescopic crowns can also be used as indirect retainers to prevent the dislodgement of the distal extension base away from the edentulous ridge. The resistance to this movement is built-in in rigid telescope retainers with cylindrical or conical primary copings, which are designed with no free space between both the components. One of the main advantages of the telescopic retainers is that, being pericoronal devices, they transmit the occlusal forces in the direction of the long axes of the abutment teeth. This has proven to be the least damaging application force. The lateral forces exert traumatic pressure on the abutments. Careful assessment of the interarch space is very important for the successful fabrication of the telescopic dentures. Sufficient space must be present to accommodate the primary and secondary copings, to have a sufficient denture base thickness to avoid fracture, space for the arrangement of the teeth to fulfill the aesthetic requirements and to have an interocclusal gap. The space consideration usually requires the devitalization of the abutments (7). The selected abutments should be periodontally sound with adequate bone support and no/ minimal mobility. There should be at least one healthy abutment in each quadrant. An even distribution of the abutment in each quadrant of the arch is preferable for better stress distribution and for increased retention and stability of the prosthesis. The interocclusal gap/ interarch distance should be ≥ 10 mm, in order to have sufficient space for the copings, denture base, teeth placement and adequate closest speaking space. The contours and the degree of taper of the outer aspect of the primary coping determine the path of insertion and the amount of retention of the prosthesis. The retention varies inversely with the taper of the coping. Even copings of minimal taper (approximately 5 degrees) require a height of about 4mm to achieve a significant retention (3). The height and size of the inner coping also influence the retention. The essential requirements for the long service of the telescopic prosthesis are, to provide adequate height of the vertical walls (at least 4mm), sufficient thickness of the copings (never less than 0.7mm for each casting) and a taper of around 6º’s. Adaptation to the conventional removable complete dentures is a complex learning process. Patients who have originally adapted to wearing complete dentures may become maladaptive with time, due to the continual residual ridge resorption, intra oral physiological changes and the development of an altered muscle pattern. It has been found that the telescopic dentures which are supported by the roots of natural teeth have more predictable prosthodontic outcomes because of increased support, stability and retention and decrease in rate of the residual ridge resorption. Patients with natural teeth can masticate more effectively than when they are edentulous. This is due in part to their degree of accuracy in the functional jaw movements, which are possible with a better neuromuscular feedback mechanism from the periodontal ligaments. The proprioceptive nerve endings in the periodontal ligaments feed information into the neuromuscular mechanism. In the absence of teeth, this information is missing. By retaining the roots of some teeth, it may be possible to use this proprioceptive apparatus with complete dentures. If this is so, a higher degree of accuracy in the jaw movements and the masticatory performance could result. By this means, teeth that normally might have a very short life span can been retained for long periods of time. This can thus benefit the patients in their denture function. It has been found that telescopic dentures have better retention, stability, support and chewing efficiency as compared to the conventional complete dentures and also, there is a decrease in the rate of the residual ridge resorption because of proprioception, better stress distribution and the transfer of compressive forces into the tensile forces by the periodontal ligament, which effects rate of bone remodeling. A clinical study which was conducted by Bo Bergman et al on conical crown retained dentures, concluded that most of the patients were very satisfied with the restorations, both functionally and aesthetically and it found their chewing comfort to be better after the treatment with the conical crown-retained dentures (8). Complete denture fabrication for maladaptive elderly patients becomes difficult. Therefore, they are the group of patients who will benefit most with telescopic dentures. Overdentures which are supported and/or retained with a few remaining teeth or implants can be a predictable treatment that will fulfill most of the demands of the elderly denture patients.

Conclusion

Tooth-supported, removable over dentures with telescopic crowns may be considered as a good alternative to the conventional removable dentures, because they provide better retention, stability , support, stable occlusion, decrease in the forward sliding of the prosthesis and better control of the mandibular movements because of the proprioception feedback which increases the chewing efficiency and even phonetics, as compared to the conventional complete dentures. Also, the rate of the residual ridge resorption was decreased because of the transfer of compressive forces into the tensile forces by the periodontal ligament and better stress distribution.

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DOI and Others

Date of Submission: Jan 02, 2012
Date of Peer Review: Mar 02, 2012
Date of Acceptance: Apr 09, 2012
Date of Publishing: Aug 10, 2012

Financial OR OTHER COMPETING INTERESTS:
None.

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