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Single Complete Denture Final
Single Complete Denture Final
The single complete denture opposing all or some of the natural dentition is not an
uncommon occurrence. There are several causes for the loss of teeth from the dental
arches like periodontal problems, dental caries and trauma.
The incidence of tooth loss is more in maxillary arch compared to mandibular arch,
most of the single complete denture cases are edentulous maxilla opposing mandibular
natural teeth.
The single complete denture should be given for many reasons like mastication and
esthetics. Several difficulties are encountered in providing a successful single complete
denture treatment. Regrettably this service is envisioned as only half as difficult and time
consuming as the fabrication of opposing complete dentures.
DEFINITION:
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.
The primary consideration for continued denture success with a single
conventional complete denture is the preservation of that which remains.
A single complete denture may be desirable when it is to oppose any one of the
following:
o Natural teeth that are sufficient in number not to necessitate a fixed or removable
partial denture.
o A partially edentulous arch in which the messing teeth have been or will be
replaced by a fixed partial denture.
o A partially edentulous arch in which the missing teeth have been or will be
replaced by a removable partial denture.
o An existing complete denture
In the first situation the maxillary arch is usually the edentulous arch. Among the
reason for this occurrence is that a maxillary compete denture is more stable, easier to
retain in position and tolerated better by patients than a mandibular denture. Therefore
many are less reluctant to allow the loss of the maxillary teeth and at times insist upon
their removal.
PROBLEMS
1. Occlusal forces :
The firmness and rigidity with which the natural teeth are retained in the bone
and the magnitude of forces they can resist or deliver without any discomfort or
displacement. These forces has been recorded as high as198 lbs on a single molar
tooth.
This is in contrast with the forces which a complete denture, resting simply on the
delicate mucosa of the ridge can resist or deliver. This force has been established
as being a maximum static load of 26 lbs (Anderson and stores – 1966)
Clearly these forces by natural teeth will cause damage to the soft and hard
tissues under the denture.
When one considers the great magnitude of forces involved, the unsuitability of
the denture foundation to resist them, particularly due to unfavorable occlusal
relationships, there is occurrence of what is described by Sharry as the “Single
denture syndrome”. The patient complains of a loose or tilting denture.
Examination reveals damage to the mucosa and ridge resorption. Relining
temporarily cures the complaint but the cycle of trauma, resorption and looseness
continues.
Several techniques have been described in the literature where by the necessary
tooth modification are determined prior to denture construction.
1) In the method described by Swenson,
The maxillary and mandibular cast are mounted on the articulator using a provisional
centric relation record at an acceptable vertical dimension. After the maxillary teeth are
set the lower natural teeth interfering with the placement of denture teeth are adjusted on
the cast and the area is marked with pencil. The natural teeth are modified using the
marked diagnostic cast as a guide. After the occlusal modification have been completed a
new diagnostic cast of lower arch is made and mounted on the articulator. If more
adjustments are necessary the procedure is repeated. Once the occlusal modification
appear to be sufficient should be prepared for try in. This technique is simple but time
consuming.
COMBINATIONS
1) Upper single complete denture opposing complete set of lower natural teeth.
2) Lower single complete denture opposing complete set of upper natural teeth.
3) Single complete denture opposing natural teeth with a removable partial denture.
4) A single complete denture opposing natural teeth with a fixed partial denture.
5) A single complete denture opposing an already existing complete denture.
3) Mental trauma :
Some person become depressed with the loss of teeth. This depression may lead to more
complicated psychological problems. If this mental state exists when the patient loses the
mandibular teeth, removal of the remaining maxillary teeth maybe more than he or she
can endure mentally.
Even though the potential for the destruction of the mandibular residual ridge is
great, the necessity for retaining maxillary teeth for retentive purpose and the mental
trauma created by the loss of the mandibular teeth may be the deciding factors for
prescribing a complete mandibular denture to oppose natural maxillary teeth.
One circumstance in which a lower complete denture opposing upper natural
teeth is acceptable is for the patient with a class III jaw relationship. If the mandible is
larger than normal the size and form of the supporting tissue may be adequate to resist
the forces from upper natural teeth.
Proper diagnosis has to be done for a lower single complete denture against upper
natured teeth.
Evical and swoop- developed useful system to determine and classify the amount of
mandibular resorption. By measuring the distance from the inferior border of the mental
foramen and multiplying by three. A reliable estimation of orginal height of the alveolar
ridge can be obtained from this. The amount of resorption can be calculated and
classified into three patterns.
Class I- approximately 2/3rd of the mandibular alveolar bone is present.
Class II- approximately ½ - 2/3rd of bone is present
Class III- approximately 1/3rd or less than that
Depending on the maxillary and mandibular jaw relationship as well as the
resorption pattern a decision can be made concerning the retention of the remaining
natural maxillary teeth.
The above table should be used only as a guide other factors such as patient’s age and
general health, dental and medical history and emotional condition must be taken into
consideration.
The patient must be made aware of proper tongue position, necessary oral
hygienic procedures and the problems involved with retention and stability of the
prosthesis.
Patient should be made aware of importance of bilateral chewing.
Necessary adjustments in the natural teeth should be made to get an acceptable
plane of occlusion and to direct the occlusal force vertically.
Resilient liner are often very useful because of there stress breaking or stress
reducing properties may compensate for imbalance in areas subjected to
functional and parefunctional pressure.
The mandibular denture is constantly monitered and soft liner replaced when it
has lost its resiliency. The occlusion must be carefully checked at each recall
appointment.
2)Sharry mentions a simple technique of using a maxillary rim of softened wax. Lateral
and protrusive chewing movements are made so that the wax is abraded generating the
functional paths of the lower cusps. This is continued until the correct vertical dimension
has been established.
Rudd suggests a technique similar to starsbury’s. A compound maxillary rim is
formed much the same way. A thickness of recording matrix made up of 3 sheets of
medium and pink base plate wax and two sheets of red counter wax in added to the
buccal and lingual surface of this compound rim. He also suggests using two maxillary
bases, one for recording the generated path and the other for setting the teeth. The
advantage of this is to reduce the number of appointments necessary for the construction
of the upper denture.
Types of teeth :
(Occlusal materials for the single complete denture)
The most important aspects is to transmit the occlusal forces vertically. This can be
provided with anatomic and non anatomic teeth.
Non – anatomic teeth :
If the cusps of the natural teeth have been reduced either naturally or artificially to such a
degree that their occlusal surface are fairly flat, then non anatomic teeth maybe used on
the denture.
These teeth have flat occlusal surfaces with fissures and spillways carved into
them which help to provide an effective masticating surface. Setting them against fairly
flat lower teeth reduces the tendency for inclined planes to contact in centric occlusion
and as a result, occlusal forces are more likely transmitted vertically only. Non anatomic
teeth do not provide balanced occlusion in lateral position but a free articulation is
usually obtainable.
Anatomic teeth:
If the cuspal form of the lower teeth has been retained anatomic teeth can be used. These
should be arranged with a cusp to fossa relation.
As the artificial teeth are usually smaller mesio-distally than their natural
predecessors. Proper inter digitations should not be sacrificed simply to close the spaces
because this would result in inclined plane contacts which could shift denture
horizontally. A small space distal to the cuspid looks quite natural in a upper denture,
spaces between the posterior teeth provide extra channel for the escape of food from the
occlusal surfaces.
Gold occlusal :
The best material for an artificial occlusion opposing the natural teeth is gold. A
technique described by wallace in 1964, the denture is processed with acrylic resin teeth
and is worn by t he patient for a weeks until all occlusal adjustments have been made an
occlusal index of hard stone is made of the denture teeth and is extended on to the
denture base posteriorly. The occlusal surfaces of the posterior denture teeth are then
reduced by about 1mm and a central channel is cut posteriorly along them. The occlusal
index is lubricated and repositioned firmly on the incisors and on the denture base
posteriorly and inlay wax is flowed between and the teeth. The wax patterns are cast in
gold and cemented with self cure acrylic resin. However their expense and the time
involved in their fabrication make them impractical for most patients.
2)Denture fracture
Heavy anterior occlusal contact, deep labial freni notches and high
occlusal forces due to strong mandibular elevator musculature
Carefully planned occlusion, adequate denture base thickness are
necessary to prevent fracture
Still if the fracture potential is high, cast metal base is the best option
CONCLUSION :
The problems involved in providing comport, function, proper esthetics and
retention is a vigorous challenge for practising dentist. The damage to the edentulous
ridge and inability to wear the denture may be avoided by good prosthetic treatment
which include adequate denture base, correct jaw relation record and proper occlusion.