SINGLE DENTURE

Dr Rakesh kumar yadav

Complications

Materials used

Methods to obtain balanced

occlusion

Tooth modification techniques

Disadvantages

Advantages

Contraindications

Indications

Classifications

Single denture

Introduction

Single complete denture is a prosthesis which replaces the lost natural teeth and its associated structures functionally and esthetically as a single unit which opposes all or some of the natural teeth.

single denture construction : The making of a maxillary or mandibular denture as distinguished from a set of complete dentures (GPT-1)

Mostly edentulous maxilla is seen.

Why they are difficult conditions?

Why single denture in maxilla are better then

single denture construction in mandible? Cases where a single denture in mandible are

relatively acceptable.Class III

Cleft palate patients

Types

SCD opposing natural teeth

SCD opposing a preexisting complete denture

SCD opposing a removable partial denture

SCD opposing an overdenture

SCD opposing an implant supported denture

Problems seen

• Heavy occlusal forces• Esthetics • Supraeruption• Mesial drifting• A mandibular single complete denture

opposing upper natural teeth is extremely complicated

• Combination syndrome• Occlusal wear

Indications

Inoperable tori cleft or perforated palates

Natural teeth that is sufficient in number

A partially edentulous arch replaced by a fixed

or removable partial denture.

Retrognathic mandible

Contraindications

Excessive loss of supporting bone

Reduced vertical dimension

Deranged occlusal plane

Flared out opposing teeth

Advantages

Maintains the vertical dimension

Maintains the occlusal plane

Maintains the residual ridge height

Maintain the esthetic appearance and function

for mastication, speech etc.

Disadvantages

Supraerupted teeth can reduce the space available, making setting of artificial teeth a laborious process.

A mandibular single complete denture opposing upper natural teeth is extremely complicated.

Combination syndrome. Occlusal wear Fixed position of lower anterior

Classification

Class l: Patients for whom minor, or no, tooth reduction is needed to obtain balance

Class 2: Patients for whom minor additions to the height of the

teeth are needed to obtain balance.

Class 3: Patients for whom both reductions and additions to teeth are required to obtain balance. The treatment of these patients usually involves a change in vertical dimension of occlusion.

Class 4: Patients who present with occlusal discrepancies that require addition to the width of the occluding surface.

Class 5: Patients who present with combination syndrome.

Tooth modification techniques

Swenson’s technique Yurkstas Method: Bruce’s Method: Boucher’s method :

Swenson’s technique

Maxillary base is made and denture teeth are set

Any interference adjusted on cast which acts as guide

Natural teeth are modified Teeth with modified occlusal surface is

mounted again Final try in

Yurkstas Method:1968

Metal U – shaped occlusal template, slightly convex on lower

surface

Bruce’s Method: Modifications on stone cast occlusal surfaces Clear acrylic resin template pressure indicating paste used

Boucher’s method : Cast mounted Maxillary porcelain teeth arranged Placed opposing mandibular stone cast Denture processed Comparison of natural teeth and altered

stone casts Natural teeth ground Base plate wax

Common occlusal problems?

Antreiors and premolars Severely tilted molars in centric and excursive

movements Ideal treatment for tilted molars?

onlays Cast gold crowns Bridge Rpd with crowning the teeth

Over bite and over jet

Natural teeth ?

Complete denture?

In single denture

Perfecting the Occlusal Plane

A. Orthodontic Means – Intrusion, Extrusion, Etc.

B. Placing Restorations – Crowns, Onlay Prosthesis

C. Occlusal Grinding – To Reshape The Teeth And to

Create a Suitable Occlusal Surface with low cusp

height.

Methods used to obtain a balanced occlusion

Teeth modified, final impression made, cast mounted

Two techniques Functional chew in techniques Articulator equilibration techniques

Functional chew-in techniques

Stansbury 1928 Intraorally Record base stability Good neuromuscular control Mental competence

Stansbury’s technique : Compound maxillary rim trimmed buccally

and lingually Carding wax used Perform eccentric movements till VD is

reached Occlusal rim removed stone is vibrated into

the generated pathways – positive stone cast of generated occlusion

Denture teeth set Try-in Lower cast removed replaced by lower chew-

in cast record Interfering spots ground.

Vig’s technique : Fin of resin placed contacting the central

fossae Helps to diagnostically locate the interfering

lower cusps In eccentric movements the lower cusp tips

are ground until equal contact occurs between teeth and resin

Fin then built up using a soft wax, and a functional path is recorded

Sharry’s technique:

Maxillary rim of softened wax is used

Lateral and protrusive chewing movements

are made –generating the functional paths of

the lower cusps

Continued until correct vertical dimension

Rudd’s technique :

Compound maxillary rim

Thickness of recording wax made up of three

sheets of medium hard pink base plate wax and

two sheets of red counter wax, is added to the

buccal and lingual surfaces of the compound rim.

Using two maxillary bases

Articulator equilibration techniques :

First upper cast is mounted using a face-bow

Lower cast related to upper at acceptable VD

Buccal-lingual position of lower teeth and their

relation to upper arch

Tipped and inclined natural teeth ?

Other cusp other then holding cusp is reduced

Wax try in

Condylar inclinations set in articulator

Denture processed

Remounted , eccentric balance achieved

Two colors of articulating paper to

differentiate

Occlusal materials for the single complete denture Porcelain teeth Acrylic resin teeth Acrylic resin with amalgam stops IPN resin Gold occlusals

Potential adverse treatment outcomes Natural tooth wear

Maxillary porcelain denture teeth Cast restorations less resistant New generation acrylic/composite resin denture

teeth are ideal. Denture fracture

Heavy anterior occlusal contact Deep labial frenal notches High occlusal forces due to excessive action of the

masseter

Single complete maxillary denture to oppose natural mandibular teeth

Frequently seen Sufficient teeth in mandibular arch, acceptable

periodontal health, no missing teeth Number of mandibular teeth considered

sufficient should include first molars

Alter the clinical crowns of the teeth by grinding or with restorations

Single Complete Maxillary Denture to Opposing Natural Mandibular Teeth with fixed prosthesis

When the restorations are acceptable

The same principles of occlusion that apply to

complete dentures apply to the single complete

denture

Material considerations

Complete maxillary denture to oppose a partially edentulous arch and a removable

partial denture

The occlusal plane, tooth arrangement for

occlusion, esthetics, and the material

composition of the teeth must be such that an

accepted complete denture can be

constructed to oppose it

When both planned together

Mandibular denture to oppose natural teeth

1. Preservation of Residual Ridge

2. Necessity for Retaining Maxillary teeth

3. Mental Trauma

 

Single Complete Denture to Oppose an Existing Complete Denture

Systematic approach

1. How long has the existing denture been in

used?

2. Was the denture an immediate insertion at

the time of tooth removal?

Gives us idea -bone resorption.

Use of pressure disclosing paste

3. Does the denture meet the requirements of an acceptable denture?

Tooth position,condition of polished surface,occlusal plane

4. Has the denture opposed another denture?

5. Is the operator satisfied to institute complete denture procedures utilizing the existing denture?

Complications of single complete maxillary denture opposing a mandibular partial denture

Combination syndrome Wear of the natural teeth Fracture of the denture

Combination syndrome

 Kelly E. Changes caused by a mandibular removable partial denture opposing a maxillary complete denture. J Prosthet Dent (1972) , 27:140-150..

By kelly E 1972

Sequence 2

Starts in mandible in distal extension area.

And continuous as in previous case

Five signs

anterior maxillary ridge resorption papillary hyperplasia in the hard palate maxillary tuberosity hypertrophy extrusion of the mandibular anterior teeth bone loss under the partial denture base

Saunders et al in 1979 added to the description of the combination syndrome by including destructive changes such as loss of occlusal vertical dimension, occlusal plane discrepancy, anterior spatial repositioning of the mandible, poor adaptation of the prostheses, epulis fissuratum and periodontal changes.

Saunders T et al ,The maxillary complete denture opposing the mandibular bilateral distal-extension partial denture: treatment considerations. J Prosthet Dent 1979;41(2):124-8.

Preventive Measures

Extraction of remaining anterior mandibular teeth – CD/CD.

Implants placed in the posterior region. Or Over dentures Maximum coverage of the distal extension ridges in RPD.

References

Winkler S, Essentials of complete Denture prosthodontics, 2nd edition, India ,AITBS Publishers , 1996, pp 417-426.

Bolender, Zarb G, Prosthodontic treatment for edentulous patients, India, 12th edition, Elsevier publications, 2004, pp 427- 436

Rahn A O and Heartwell C M, Textbook of complete dentures, 5th edition, U.S.A, Lea and Febiger Publications, 1993, pp 481- 492.

References

Sharry J J , Complete denture Prosthodontics, 3rd edition, Mc Graw Hill company, pp 310-319.

Manappallil J.J, Complete denture prosthodontics, 1st edition, India, Arya publishers, 2006 , pp 323-328

References

Deepak Nallaswamy, Textbook of Prosthodontics ,1st edition, India, Jaypee Publications, 2003, pp 250-254

Kelly E. Changes caused by a mandibular removable partial denture opposing a maxillary complete denture, J Prosthet Dent (1972) , 27:140-150.

Saunders et al,  The maxillary complete denture opposing the mandibular bilateral distal-extension partial denture: Treatment considerations.  J Prosthet Dent (1979) ,41:124-128.

References

Driscoll et al ,Single maxillary complete denture,Dent Clin N Am 48 (2004) 567–583