single complete dentures/ fixed orthodontics courses
DESCRIPTION
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.TRANSCRIPT
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SINGLE COMPLETE DENTURE
PROSTHESISINDIAN DENTAL ACADEMY
Leader in continuing dental education www.indiandentalacademy.com
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Definit ion
Making of a maxil lary and mandibular complete denture as distinguished from a set of complete dentures (GPT-7)
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ObjectivesThe primary consideration for continued
denture success with a single conventional complete denture is the preservation of that which remains.
Advantages
The single denture wearer is usually younger and more adaptable, ridges usually well formed and often exhibit a desirable degree of tissue resiliency. Rarely are there signs of chronic irritation, hypertrophy, or marked resorption.
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PROBLEMSThose prosthesis designed to articulate
and to function with a previously existing occlusal scheme, whether it be natural or artificial, are usually more complex than those encountered with complete maxillary and mandibular denture prosthesis.
The methods used, the difficulties experienced, the treatment plan, and the prognosis differ in different clinical situations. It is therefore desirable to consider the various clinical combinations separately.
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CLINICAL SITUATIONS WHERE FABRICATION OF SINGLE DENTURE IS CONSIDERED
• Natural teeth that are sufficient in number not to necessitate a fixed or removable partial dentures in the opposing arch.
• A partially edentulous arch in which the missing teeth have been or will be replaced by a fixed partial denture.
• A partially edentulous arch in which the missing teeth have been or will be replaced by a removable partial denture.
• An existing complete denture.www.indiandentalacademy.com
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DIAGNOSIS AND TREATMENT PLANNING
The basic diagnostic procedures are same to that of completely edentulous patients.
The characteristics of a physiological occlusion are frequently encountered in fully dentate mouths. They also can be almost invariably achieved when treating completely edentulous patients.
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However, when only one arch is edentulous, tooth positions in the dentate arch may preclude such objectives being reached. Unfavorable force distributions may then cause adverse tissue changes that compromise optimum function. It is therefore important to identify such clinical changes and to correct them.
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These changes include : (1) Extensive morphological changes in
denture foundation that can result in arch relationship or occlusal plane discrepancies.
(2) Jaw relationship extremes.
(3)Excessively displaceable denture bearing tissues.
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A thorough analysis of the remaining teeth and the role they play in the resolution of forces during function should be a primary consideration. Many dentists fail to take advantage of the possibility of modifying the existing occlusal characteristics so that they will tend to seat and stabilize the prosthesis rather than tend to dislodge it. Before one proceeds with the single denture, there are many factors to be considered in evaluating the teeth in the opposite arch.
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In evaluating the natural dentition the following should be checked:
1. Uneven alignment of teeth
Tipping, extrusion, rotation, etc. One often observes the extrusion of teeth due to loss of an antagonist. This disrupts the occlusal harmony These teeth may be brought back to correspond to the desired occlusal plane with judicious selective grinding or by orthodontic movement.
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In more severe instances extractions may be indicated if the tooth occupies excessive interarch space so as to interfere with the denture base itself. Extreme care must be exercised to ensure that there are 2 to 3 mm of anteroposterior freedom before the inclined plane is engaged.
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2.Character of the occlusal surfacesNatural teeth often exhibit varying steepness of the cusps and/ or associated abrasion and wear.
A change in the faciolingual diameter of the tooth occurs with wear or cusp height reduction. Appropriate changes must be made on the buccal and lingual contours of the teeth to keep the same functional width of the occlusal surfaces. Both the centralization of forces and the elimination of excursive interferences is accomplished by this relatively simple modification.
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3.Cross-bite relationships
A narrow maxilla in conjunction with a broad mandible adds complications to the prognosis of the complete denture. It is recommended that the posterior teeth be set so that the entire tooth is within the periphery of the denture base. In this instance it is well to consider articulating the teeth in crossbite relationship
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4. Number and position of opposing teeth
The stability of the upper denture during function is almost directly proportional to the number of posterior teeth which occlude. Construction of maxillary complete denture prosthesis against six anterior teeth is definitely contraindicated. In such a case destruction of the residual ridge is almost inevitable, and the patient also develops undesirable masticatory habits that are difficult to break. Therefore it is essential that a posterior occlusion be provided for proper function.
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When only the molars are missing and the bicuspids remain, it is sometimes possible to construct a functional denture without the aid of a removable partial lower denture. The anteroposterior position of the mandibular teeth in relation to the maxillary ridge should be considered
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Mandibular Denture to Oppose Natural Maxil lary Teeth
Although the mandibular arch is seldom the edentulous one, it usually happens as a result of surgical or accidental trauma.
An example of surgical trauma is the removal of the mandibular teeth for persons who are to undergo irradiation therapy for a tumor.
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Three factors in particular' must be carefully evaluated :
Preservation of the residual alveolar ridge
Necessity for retaining maxillary teeth
Mental trauma
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Single Complete Maxil lary Denture to Oppose Natural Mandibular Teeth
More frequently encountered than the singular mandibular denture is the single maxillary denture.
The diagnostic procedures should determine that there are sufficient teeth in the mandibular arch, periodontal health is acceptable, and there are no missing teeth to be replaced.
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The number of mandibular teeth considered sufficient should include the first molars in jaws that have a Class I or Class III relation. In Class II related jaws, the anterior teeth and premolars bilaterally may suffice. When these conditions are met, it would appear that one could proceed.
The occlusal forms of the natural teeth usually act as the guide in selecting the occlusal form for the maxillary posterior teeth. In most situations this would be a cusp tooth however, if the natural teeth are abraded and are not restored prior to treatment, the monoplane form may be the choice for the occlusal surfaces of posterior teeth.
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Some times the positions of the mandibular anterior teeth will not allow the maxillary anterior teeth to be positioned in an esthetically acceptable manner or for balanced occlusion. This problem may be resolved as follows :
1. Reposition the natural teeth with orthodontic procedures.
2. Alter the clinical crowns of the teeth by grinding or with restorations.
3. Accept balanced occlusion with the jaws in centric relation and not in the eccentric positions.
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Single Complete Maxil lary Denture to Opposing Natural Mandibular Teeth with fixed prosthesis
The problems presented are usually in the diagnostic procedures related to the existing restorations.
When the restorations are acceptable, one must then decide what occlusal concept will be pursued. The same principles of occlusion that apply to complete dentures apply to the single complete denture.
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Complete maxil lary denture to oppose a partially edentulous arch and a removable partial denture
The most frequently encountered situation for a single complete denture is opposite a partially edentulous arch in which the missing teeth have been or will be replaced with a removable partial denture.
The partial denture must meet the requirements of 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.
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Single Complete Denture to Oppose an Existing Complete Denture
Analysis of the following five questions should be done before proceeding:
1. How long has the existing denture been in use?
2. Was the denture an immediate insertion at the time of tooth removal?
3. Does the denture meet the requirements of an acceptable denture?
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4. Has the denture opposed another complete denture, a partially edentulous arch that supported a removable partial denture, a restored natural teeth, a fixed partial denture, or natural teeth in which no restorations have been placed?
5. Is the operator satisfied to institute complete denture procedures utilizing the existing denture?
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A SUGGESTED CLINICAL AND LABORATORY PROCEDURE
Case history, Intra-oral examination
All operative, periodontal, and surgical procedures
Study cast to be secured on an articulator to visualize Inter-arch space, Arch relation and
Occlusal planewww.indiandentalacademy.com
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Occlusal discrepancies in the natural teeth are judiciously equilibrated on the cast and marked.
Procedure is duplicated in the mouth
All ground enamel surfaces should be polished
If sensitivity is encountered, it can be readily handled with local application of sodium fluoride
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Impression procedure is carried out considering the clinical situations.
Face bow record is transferred and maxillary cast is secured on the upper member of the articulator.
Centric jaw relation is made in wax or fast setting plaster and mandibular cast is mounted on the lower member of the articulator.
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FIVE ELEMENTS TO BE CONSIDERED TO OBTAIN BALANCE OCCLUSION
Condylar guidance (CG)
Incisal guidance (IG)
Compensating curve (CC)
Cusp height (CH)
Occlusal plane (OP)
CG + IG = CC + CH + OPwww.indiandentalacademy.com
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When fabricating complete maxillary and mandibular denture, the dentist has control over incisal guidance, compensating curve, cusp height and occlusal plane.
In case of single complete denture control of these elements is limited.
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SELECTION OF ARTIFICIAL TEETHWhen the occlusal surfaces of the teeth
and fixed prosthesis are made of porcelain, the artificial teeth of choice are porcelain or acrylic resin.
When the occlusal surfaces are mixed enamel and gold or gold alone, the occlusal surfaces of the artificial teeth are preferably gold. However, acrylic resin teeth are acceptable.
Acrylic resin teeth are selected opposing a prosthesis with acrylic resin teeth www.indiandentalacademy.com
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PRECAUTIONS IN TEETH ARRANGEMENT
Deep vertical overbite be avoided in the anterior region, which results in less stress on the anterior teeth and thereby lends increased stability to the completed denture.
Increasing the horizontal overjet is one method of reducing the incisal guide angle.
It is essential that there be no locking in the anterior segment. www.indiandentalacademy.com
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Broad surface contacts on steep inclined planes must be avoided.
If the opposing teeth have relatively shallow cusps, then relatively shallow (20o) artificial teeth are selected to articulate with them, with steep cusps, 33o teeth are used, and with flat occlusal surfaces, zero degree teeth are selected.
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