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SRM University Journal of Dental Sciences

Volume 1, Issue 3, October - Decembret 2010

Case Report

Hollow mandibular complete denture - A case report
N Kalavathy, M Mitha Shetty, Premnath, Karuna Pawashe, RKV Patel
Department of Prosthodontics, DAPM RV Dental College, Bangalore Department of Prosthodontics, Rajiv Gandhi Dental College, Bangalore
Address for correspondence Dr. N. Kalavathy Department of Prosthodontics DAPM RV Dental College Bangalore Email: drkalavathy@gmail.com

Abstract The severely atrophied jaw can have various treatment options. The treatment option involved in this article is hollowing the denture so as to reduce the weight of the denture, thereby enhancing stability and retention, reducing the further resorption of the jaws. This article describes an alternative method for the fabrication of hollow mandibular complete denture. It incorporates fabrication of clear, vacuum form shim ensure that there is adequate room for resin and teeth.
Keywords: Severely resorbed ridge, shim, hollow

mandibular complete denture

Introduction
For more than 150 years, it was believed that the weight of the lower denture contributes to both retention and stability. However, studies have shown that retention and stability can be achieved by improving the fit of the denture bases rather than addition of extra weight to the dentures and also the weight of the lower denture may not affect its retention and 1,2,3,4 stability. “No step in denture construction should be stopped short of perfection yet many dentures are worn which have, imperfections built into them provided they have peripheral seal sufficient to hold them in place”. Various studies have shown that both retention and stability can be achieved even with reduced weight of the denture in severely resorbed ridges by improving the quality of impression , thereby achieving a good peripheral seal.

almost 10 years and the problem (fractured denture) with the current denture was since a week.

Figure 1: Intra oral view of the mandibular arch On intra-oral examination revealed an U-shaped palatal vault and severely resorbed mandibular ridge. The treatment plan decided for the patient was the fabrication of a hollow complete mandibular denture.

Case Report
A 75-year-old female patient reported to the department of Prosthodontics, with a chief complaint of fractured lower denture and desired the replacement of the same. Her history revealed that, she was an old denture wearer for

Procedure for fabrication
1. Maxillary and mandibular impression was made followed by border moulding and final impression with zinc oxide eugenol impression paste.

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processed a shim of acrylic resin over the residual ridge and used a spacer . Problems that are likely to be faced may be due to narrower and more constricted residual ridge as the resorption 244 Streamdent. silicone putty or modelling clay during the laboratory procedures which are removed later to provide a hollow denture base. Dewaxing and processing of set 2 (base and counter 2) was done to obtain a heat cured acrylic shim (1mm thick) 12. The trial denture was duplicated with irreversible hydrocolloid and poured in dental stone 5. The advantages of hollow dentures are reduction in the excessive weight of the acrylic resin.3” thermoplastic sheet 6. Heat cure acrylic shim was positioned accurately over the permanent denture base using the clear template fabricated previously on the trial denture inorder to ensure that there is adequate space between the resin and the teeth 13. a heavy denture whether maxillary or mandibular is likely to cause poor denture bearing ability. The care of severely resorbed ridges is mainly taken care by broad area coverage within functional limits. when we look into the history of bulkier prosthesis reduction in prosthesis weight also have been tried by making the denture hollow. cellophane wrapped asbestos. Both the halves were separated without boil out. 3. stability and support for the complete denture. Holt . 2010 .1 In general. A wax shim (2 sheet thickness) was adapted over the ridge lap surfaces of denture teeth (counter 1) and flasking was done by placing the base 2 over counter1 9. Even though it is suggested that gravity and the adiitional weight to the mandibular complete denture may aid in prosthetic retention. Two split dental flasks with interchangeable counters were used for processing 7. decreased bucco lingual width of the teeth. Almost a similar technique with necessary modifications was followed for the clinical procedure which is likely to have reduced the weight of the denture by 25% 3.Hollow mandibular complete denture . finally finished and polished 17. Trial denture was flasked and dewaxed in the conventional manner using base 1 and counter 1 8.3. which is problem with the conventional (heavy) mandibular denture. an adequate seal is confirmed. The denture base and acrylic shim were then sealed at the borders using self cure acrylic resin to make a hollow denture base 14. avoidance of inclined planes. The maxilla-mandibular relationship was recorded using occlusal rims on permanent denture base and transferred to the articulator and the artificial teeth were arranged.A case report N Kalavathy et al 2. modifying the impression technique. progresses. etc. The hollow denture base was then immersed in water to ensure a proper seal 15. use of magnets . improved tooth form. if no air bubbles are evident. Heat cure acrylic resin was packed and processed in the conventional manner. resulting in the lighter The special steps taken for the fabrication were as follows: 4. provision for adequate tongue room . 1(3). counter2 was poured 11. Discussion Extreme resorption of the ridge whether maxilla or mandible will lead to a reduced denture bearing area which in turn will affect retention. decreased number of teeth. it is not an universally accepted one. The hollow cavity seal was verified by immersing the denture in water. To increase the retention and stability of heavy prosthesis. Such weight reduction approaches have been achieved using a solid 3-dimensional spacer including dental stone. adequate interocclusal distance apart from a hollow denture base. Extensive volume of the denture base material in prosthesis provided to patients with large maxillofacial defects or severe residual ridge resorption is always a challenge to prosthodontists. use of implants . The original counter1 was reseated on the base1 and verified for complete closure of the flask 16. Try in procedure was done. An added advantage with a hollow mandibular denture is a comparable increase in retention and stability that can be achieved. causing reduced supporting tissue with larger restorative space between maxillary and mandibular residual ridges. preservation of the existing residual alveolar ridge is possible. One sheet thickness was removed from base 2 10.either by making a hollow mandibular denture or by altering the plane of occlusion to some extent. many methods have been tried like utilising the undercuts . Apart from this.6-18 There are studies in which it is proved that. by reducing the weight of the mandibular denture . A clear template of the duplicated stone cast was made using a 0. With the wax shim (one sheet thickness) placed on the base of the second flask.

Base 2 (Removal of 1 sheet thickness wax) Impression of the trial denture Duplicated stone cas Counter 1 (With dewaxed teeth) Duplicated stone cast with thermoplastic sheet Clear acrylic template Base 2 Base 2 and counter 2 (Dewaxing of 1 sheet thickness was followed by processing) Base 1 and counter 1 Base 2 and counter 2 Acrylic shim (processed acrylic shim) Base 1 with trial denture Base 1 and counter 1 (Dewaxing done with permanent denture base and teeth in place) Base 1(occlusal view) Base 1(side view) (Clear acrylic template tried over the acrylic shim) Counter 1 Counter 1 (Adaptation of 2 sheet thickness wax on dewaxed teeth) Base 1 (acrylic shim sealed with permanent denture base using self cure acrylic resin) Streamdent. 2010 245 .A case report N Kalavathy et al prosthesis.Hollow mandibular complete denture . decreases the load on the residual alveolar ridge making the patient comfortable. 1(3).

David C. The hollow denture: An alternative treatment for atrophic maxillae. September 2006. LaDeane Fattore. J Prosthet Dent 1983. 2. 9. p. 8. 246 Streamdent.5:413-32. A light-cured interim obturator prosthesis. Louis Fine. J Prosthet Dent 1984. 13357. Browning JD. April 1981. J Prosthet Dent 1969. Worley JL. Edmonds.80:129-32. Michael o'Sullivan. Construction of a denture with hollow 17. Base 1 and counter 1 (showing the hollow denture in place with dewaxed teeth) 7. 2010 . Quintessence Dent Technol 1983. Chalian VA. Robert J. Jhanji A. lid.A case report N Kalavathy et al 3. Buckner H. ridge augmentation. Rothenberger S. J. David R. modifying the type of denture also may be better accepted by patients. Ackerman AJ. editors. Standish SM. 15.April 1988. January 1971. 9:591-594. 11. J. the best way is to rehabilitate them with conventional complete dentures. Final processed hollow denture 12. Maxillofacial prosthetics: multidisciplinary practice. A hollow complete denture for severely resorbed mandibular ridge. Hence. Hence. 16. Even though.7:13-4. 31: 95-99. McAndrew KS. many a times the patients who comes with such a problem are geriatric patients with many systemic illness. The hollow bulb obturator: its fabrication using one denture flask. Prosthet. Prosthe. A hollow complete lower denture . Prosthet. Rahn AO. Cagna. Prosthet. J Prosthet Dent 1957. 5. Aclinical report. Elliott DJ.5: 514-516. 95.50:227-9. Gardner LK. and soft acrylic lining. J Prosthet Dent 1998. 6. Apart . Nidiffer TJ. 1971. and soft acrylic lining J. Simplified technique for the fabrication of a hollow obturator prosthesis using vinyl polysiloxane. Louis: Elsevier. An innovative investment method for the fabrication of a closed hollow obturator prosthesis. J Proshet Dent 1990. implant retained over-dentures.52:8915. p. Fabrication of one-piece hollow obturators. 1970. from modifying the impression technique to get maximum denture bearing area. Kinderknecht J. Brown KE. 14. the choice of rehabilitation can be overdentures.4: 452-45. J Prosthet Dent 1991. St.7:12634. 4. Shipman TH. Minsley GE. Baltimore: Williams & Wilkins. Standish SM. 1(3).Hollow mandibular complete denture . DaBreo EL. Construction of a denture with hollow obturator. Fabrication of a hollow obturator with fluid resin. The hollow maxillary complete denture: a modified technique.66:136-8. loose denture weight for healthy and comfortable living. Hollow bulb obturator for acquired palatal openings.Dent. In: Chalian VA. Conclusion Rehabilitation of severely resorbed ridges is a challenge to the prosthodontist. Boucher LJ. Horst Buckner. Holt Jr.31:95-9. 10. References 1. J.66:602. Intraoral prosthetics. 13. 21:97-103. Prosthetic management of oral and facial defects following cancer surgery. Dent.6:157-161.63:371-3. obturator. Dent. 18. J Prosthet Dent 1974. Drane JB. The journal of Indian prosthodontic society. Aruna Bhat. Parr GR. Drane JB. A method for controlling the thickness of hollow obturator prostheses. Dent. Stevens ST. Rahn AO. J Prosthet Dent 1955. Fabrication of a hollow-bulb obturator. Cronin. Maxillofacial prosthetics: principles and concepts. Kniejski ME. etc. J Prosthet Dent 1991. lid. Raleigh A. june 2004. Nancy Hansen.