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Single Complete Denture

SDS 421

Rahn, A; Heartwell, C: Text book of complete dentures.


5th ed. Pages 481 491. 1993
Sharry, JJ: Complete Denture Prosthodontics.
5th ed. Pages 310 319. 1974

Edentulous Maxilla Vs Class I Mandibular Arch

General Considerations in Construction & Delivery


The main problem in treating
patients who need a CD to occlude with
a natural dentition (without any restoration or
restored with a partial prosthesis FPD or RPD)

is that the natural teeth can transmit


large forces to a denture whose
supporting structures are unable to
resist them adequately. ,,,,

Thus damage to the edentulous ridge or inability to wear


the denture may easily occur.

To avoid these sequelae, the basic ingredients of good prosthetic


treatment an adequate denture base, correct jaw relations, good
occlusion, and free articulation must be provided.

Single Complete Denture Syndrome


Definition
the characteristic features that occur when an edentulous
maxilla is opposed by natural mandibular anterior teeth, including
loss of bone from anterior portion of the maxillary ridge, overgrowth
of the tuberosities, papillary hyperplasia of the hard palatal mucosa,
extrusion of mandibular anterior teeth, and the loss of alveolar bone
and height beneath the mandibular removable partial denture
bases, also called an anterior hyperfunction syndrome.
The Glossary of Prosthodontic Terms, 1999

Single Complete Denture Syndrome


Characteristics
1. Loss of bone from anterior portion of the maxillary ridge
2. Overgrowth or enlargement of the maxillary tuberosities
3. Papillary hyperplasia of the hard palatal mucosa
4. Extrusion of the mandibular anterior teeth
and
5. Loss of alveolar bone and height beneath the mandibular
removable partial denture bases.

Loss of bone from anterior portion of the maxillary ridge

Overgrowth or enlargement of the maxillary tuberosities

Papillary hyperplasia of the hard palatal mucosa

Extrusion of the mandibular anterior teeth

Single Complete Denture Syndrome


Preventive Measures
Preventing the degenerative changes produced by a maxillary
complete denture opposed by a class I mandibular RPD is by
treatment planning to avoid this combination of prostheses - causing
combination syndrome. The options are,
1. Extraction of remaining anterior mandibular teeth CD/CD.
2. Retain the week posterior teeth as abutments by means of
endodontic treatment and periodontic recalls.
3. Overlay dentures in the mandible.
4. Implants placed in the posterior region.
5. Maximum coverage of the distal extension ridges in RPD.

Retained roots can be used as OD abutments that will preserve the


alveolar ridge hence prevent the SCD Syndrome

Application of basic prosthetic principles maximum area of coverage


proper OP orientation and balanced occlusion ensure preservation of
the alveolar bone prevention of SCD syndrome

An attempt to equalize the support gained from the teeth and the ridge
by altered cast impression, will minimize denture rotation
preservation of the alveolar ridge.

Minimizing Occlusal Forces on the Denture Foundation


There are two reasons for the difficulty associated with the provision of
a successful complete denture for these patients.
1. The biting forces applied by the natural teeth are very high
(198 lb by a natural molar tooth Vs 26 lbs by a CD).
2. Disrupted occlusal plane of the remaining natural teeth
applies horizontally directed forces to the opposing denture.
Solution
1. Maximum denture base extension and precise jaw relation
records with proper articulation of the teeth.
2. Reduce the magnitude of damaging forces by correcting the
occlusal plane orientation occlusal grinding, extraction and
restoration of the tilted or over-erupted teeth.

Single Mandibular Complete Denture


The Complicating Factors
Very rarely the mandibular arch is the edentulous one. It usually
happens due to surgical or accidental trauma, i.e., radiation
therapy of the jaw, fall, vehicle accident or gunshot. Three factors
should be considered while treating such patients.
1. Preservation of Residual Ridge: Opposing natural teeth would apply
greater force and tongue activity can lead to denture movement hence
rate of bone resorption could be high.

2. Necessity for Retaining Maxillary teeth: These may be needed to retain


a prosthesis, e.g., cleft palate, or these may be esthetically attractive and
periodontally healthy.

3. Mental Trauma: Loss of mandibular teeth is already traumatic to the patient


and advising the removal of remaining maxillary teeth will undoubtedly be
traumatic that may lead to depression.

Single Mandibular Complete Denture


The Favorable Situations
Occasionally, constructing a single mandibular complete denture is not
potentially harmful, e.g.,
1. When the maxillary arch has already been restored with a complete
denture.
2. When all the maxillary posterior teeth are also missing and the
patient needs a bilateral distal extension maxillary RPD. The biting
forces applied by the RPD will be lass is magnitude.
3. Very old and frail patient the biting forces applied by the natural
teeth would be small, hence less damage to the mandible.

Single Mandibular Complete Denture

Various Combinations for Constructing a SCD


Opposed by: Natural dentition, FPDs .

Various Combinations for Constructing a SCD


Opposed by: Class I or II RPD, or an existing CD

Special considerations for obtaining the

Impression
Maximum tissue surface coverage is
essential.
Special impression technique for
recording the impression of flabby
ridge without displacement.

Impression can be obtained with impression plaster that will cause


minimal tissue displacement of the flabby ridge.

Two stage Impression Technique


Special design of custom tray - window for the flabby ridge

After completing border molding & impression of the firm tissues,


impression plaster is painted with a soft brush to record the flabby ridge
without displacement.

Two stage Impression can be obtained with a combination of silicon


impression material and impression plaster.

Special considerations for recording the

Maxillo-mandibular relations
The basic principles of recording vertical and centric jaw relations for
edentulous patients must be followed. Following two difficulties can
be met with while constructing a single complete denture,
1. An error may be made while recording the OVD if the upper wax rim
is trimmed to represent the incisal level below the upper lip and
parallel to the ala tragal line.
The labio-lingual thickness of the wax rim
may have to be reduced to accommodate
the lower natural teeth behind the upper
wax rim.

2. If a gothic arch tracing is to be used for recoding the centric relation,


then attaching the recording plate to mandibular natural teeth could
pose a problem.

Alternate methods of recording CR (check bites) can be used


to avoid this difficulty.

Modifying the Opposing Occlusion


Indications
Not infrequently, the opposing dentition of the mandibular arch (natural
teeth or prosthetically restored teeth with RPD & FPD) has to be
modified prior to the fabrication of a maxillary complete denture.
1. Malposed or tilted mandibular posterior teeth.
2. Over-erupted mandibular anterior teeth.
3. Over-erupted mandibular posterior teeth.

These conditions will result in an irregular occlusal plane that


will result in unacceptable occlusal function and esthetics.
4. Too large occlusal table (bucco-lingual width) of the natural
teeth may have to be narrowed by grinding of the buccal &
lingual surfaces to accommodate the denture teeth.

Modifying the Opposing Occlusion by grinding the incisal edges.

The aim of grinding the opposing natural teeth is to establish


a regular occlusal plane.

Perfecting the Occlusal Plane


An irregular occlusal plane of the opposing natural / artificial
teeth (picket fence arrangement) is unacceptable, hence their
irregularity must be altered by,
a. orthodontic means intrusion, extrusion, etc.
b. placing restorations crowns, onlay prosthesis, etc.
c. occlusal grinding to reshape the teeth and to create a
suitable occlusal surface with low cusp height.
If this correction is not made, the finished prosthesis may have
balanced contact of teeth in centric relation position only and not in
the eccentric occlusion hence lack of stability will result.

Perfecting the Occlusal Plane

Occlusal Adjustment
1st Method

Pre-requisite to any occlusal grinding of the natural teeth is


mounted study casts. In the event of edentulous maxilla, a metal
occlusal template can be placed on the occlusal surface of the
mandibular study cast to evaluate the existing occlusal plane.

This curved template when positioned on the cast will guide the
operator for determining the areas and the amount of occlusal
grinding needed on all the teeth (natural and artificial, if present).

The cast tooth surfaces are painted with a spray paint before grinding
the altered areas become unpainted after grinding and serve as a
guide for intra oral adjustment. The template is then sterilized and
used as a guide in the oral procedures.

Occlusal Adjustment
2nd Method
This method is time consuming but accurate and enables one
(specially the beginner) to appreciate why these adjustments are
necessary. It also gives immediate picture of the improvements
made.
1. Proceed to the stage of recording CR record and mount the casts.
2. Start the set up of the artificial teeth as the interferences in the natural
occlusion become apparent, they are adjusted on the cast and marked with
a pencil for future reference.
3. Once a favorable occlusion has been achieved on the articulator, similar
adjustments are carried out on the natural teeth intra-orally using markings
on the cast and the denture set up as a guide.

Although due to the presence of restorations and sensitive dentine


areas, it is not always possible to carry out all the adjustments
needed, a substantial amount can usually be done.

Mesially tilted Opposing last Molar tooth


The over-erupted or mesially tilted remaining molar teeth are a hazard
to the success of a denture as the steeply inclined occlusal surface
would tend to drive the opposing denture forward in CO as well as in
eccentric occlusions.

Mesially tilted Opposing last Molar tooth


Solutions to the Problem
Moderate tilt: Grinding the distal half of the occlusal surface flat and
denture tooth to contact that area only with no contact
on the mesial cusps.

Mesially tilted Opposing last Molar tooth

Solutions to the Problem


Extreme tilt:
Extraction of the tilted molar tooth
Endodontics and restoration with a cast crown or onlay
(the surveyed crown).
Flattening the distal cusp by grinding and building the
mesial cusps by overlay rest of the RPD framework.

A case report of Onlay rest with partial OD RPD.

Establishing the Vertical & Horizontal overlap


Natural Anterior Teeth often have a large overbite and small overjet.
This is tolerable because of the teeth being firmly held in the bone.

In Complete Dentures, this arrangement results in excessive forces


applied to the anterior ridge, hence rapid resorption can occur.
Therefore, in CD construction minimal OB and substantial OJ is
normally provided.

Establishing the Vertical & Horizontal overlap


In the presence of mandibular anterior teeth, this articulation is difficult
to achieve as the lower incisal edges were positioned high on the
cingula of the upper anterior teeth before extraction. Therefore,
1. Raise the level of upper teeth and grind the incisal edges of the lower.
2. Do not set the upper teeth too far palatally use the biometric guides.
3. Grind the labio-incisal surfaces of the lower teeth and the palato-incisal
surfaces of the upper teeth to gain more OJ.

Establishing the Vertical & Horizontal overlap


Natural anterior teeth must not contact the opposing complete denture
in CR and during Eccentric movements.

Occlusal Requirements of a SCD

The setting of the posterior teeth must ensure that the opposing
inclined planes do not contact as the jaw closes into CO. Only those
surfaces of opposing teeth should contact which transmit occlusal
forces vertically.

Occlusal Requirements of a SCD


This arrangement can be provided with the use of both non-anatomic
or anatomic teeth.
Non Anatomic Teeth are selected if the natural posterior teeth have flat cusps
due to attrition. Balanced occlusion may not be achievable however, free
articulation must be obtained.

Occlusal Requirements of a SCD


Non-anatomic teeth cusp to fossa set-up

Occlusal Requirements of a SCD


Anatomic Teeth are selected if the cuspal

form of the natural teeth has been


retained. These should be arranged with
good intercuspation in CO (cusp-fossa
relation).

As the artificial teeth are usually smaller


mesio-distally than the natural teeth,
small spaces may have to be left
between them for proper inter-cuspation.
Similarly, artificial teeth may need grinding of
the cuspal inclines to accommodate for
the much larger bucco-linguial width of
the natural teeth.

Artificial Posterior Teeth Materials


Porcelain Teeth
The amount of occlusal grinding necessary to permit artificial teeth to occlude
with the natural teeth often precludes the use of porcelain teeth. Week porcelain
teeth will fracture or chip easily.

Artificial Posterior Teeth Materials


Acrylic resin Teeth
These are more suitable to occlude with the natural teeth. Wear of their surfaces
can be prevented by using good quality cross linked copolymer resin teeth or by
placing occlusal amalgam restorations in the denture teeth.

Artificial Posterior Teeth Materials


Gold Occlusals
Gold is the best material to occlude with the natural dentition. A number of
methods are available to the technicians to construct these gold occlusal
surfaces in the denture teeth.

Placement (insertion) Visit


This visit carries the same importance as for constructing a set of
complete dentures. Following procedures must be meticulously
performed,

PIP adjustment: To establish even contact of the denture fitting

surface to the supporting mucosa. The contact of posterior palatal


seal area should be carefully evaluated.

Placement (insertion) Visit


Occlusal adjustment
This can best be achieved with the help of clinical remount procedure. A
balanced occlusion in both CO and Eccentric relations, with free articulation of
the teeth must be provided.

Placement (insertion) Visit


Home Care Instructions
Patient must understand the importance of leaving the denture out while
sleeping, especially to avoid the detrimental forces of bruxism while sleeping.
Oral hygiene measures for the denture and the natural teeth must be reinforced.