Rooted or Replaced? Comparative Insights into Tooth- and Implant-Supported Overdentures with Case Series

Objective: This review aims to provide a comparative analysis of tooth-supported and implant-supported overdentures, focusing on clinical, biomechanical, functional, and patient-centred outcomes. In addition to summarizing current literature, the review integrates illustrative clinical case series to contextualize decision-making in prosthodontic practice. Methods: A comprehensive review of peer-reviewed literature was conducted, examining outcomes associated with both overdenture modalities. Clinical cases were selected to represent common scenarios encountered in prosthodontics and to demonstrate the practical application of treatment principles. These cases were evaluated alongside published evidence to highlight indications, techniques, and patient-centered considerations. Results: Implant-supported overdentures (ISODs) consistently demonstrated superior retention, masticatory efficiency, and patient satisfaction, particularly in cases of advanced ridge resorption. Tooth-supported overdentures (TSODs), on the other hand, preserved proprioception, maintained alveolar bone via retained roots, and served as a cost-effective, minimally invasive alternative. The included case series highlighted real-world scenarios where each modality was selected based on anatomical, systemic, and psychological factors. Attachment systems—ball, locator, bar, and magnets—were also discussed for their role in prosthetic function and maintenance. Conclusion: The integrated case series supports the conclusion that both TSODs and ISODs play vital roles in edentulous rehabilitation. While ISODs provide enhanced functional outcomes, TSODs remain valuable for medically compromised patients or those seeking non-surgical solutions. Treatment success hinges on individualized case selection, informed consent, and long-term maintenance protocols. This review emphasizes the necessity of a patient-specific, evidence-informed approach to overdenture therapy in modern prosthodontics.