Complete dentures

Complete dentures opposing natural teeth

Robert W. Bruce, Captain (DC1 USN

I ‘. S. No7:nl Air Station, Alameda, Calil.

lhe d’Iagnostic and technical ingenuity of the dentist is challenged in providing

an adequate diagnosis, a prognosis, and a long-range treatment plan for patients
with an edentulous arch opposing natural teeth. Roucher’ described the use of ,t
complete maxillary denture opposed by natural mandibular teeth. He used wax to
locate occlusal disharmonies and made corrections by grinding the remaining
natural teeth. Meyer? and Stansbury” corrected the denture to harmonize with the
wmaining natural teeth. Schweitzt+ reconstructed the opposing natural terth to
achieve an acceptable occlusion.
Many dentists” feel that complete mandibular dentures are contraindicated whc~n
natural maxillary teeth remain. C!!inkal teswrrh may offer hope for these un-
fortunatr patkits.
i\ll dentists should try to save natural teeth as long as possible, but at the sanw
time they must be aware that the edentulous ridge may be destroyed by forcrs
exerted against the denture support (Fig. 1 ‘i liemakes and relines of complete
dcntuws, chronic soreness of soft tissues, srqcry, and residual bone loss are oftcrl
the rnd result of the best treatment efforts (I$. 2: . This condition is complicated
further by the factors predisposing thr loss of the teeth such as caries suswptibilit):
periodontal disease, destructive habits. and neglect of oral hygiene that may still be
presf~nt.

EVALUATING THE TREATMENT BY COMPLETE DENTURES OPPOSING NATURAL

TEETH
In an effort to evaluate various clinical nwthods used to treat partialI\, cdentuloux
patirnts~ records were kept OC twenty patients bf-twc.cn the ages of 19 and 55 for
\\-horn one complete dc=nture was constructed opposing natural teeth. All patients
were judged by their physician to be in good health before prosthodontic treatment
was started. Ekghtcen patients had edcntulolus maxillary ridges and two had edentu-
lous mandibular ridges. Each patient was considered carefully for oral conditions

The views expressed herein are those of the author and do not necessarily reflect the
views of the United States Navy or the Department of Defense.

448
Fig. 1. Soft tissue damage is due to a complete denture with no posterior occlusion on thr
left side and malocclusion on the right side.
Fig. 2. The porcelain posterior teeth on the comp!ete upper denture have destroyed the
natural teeth by attrition. Note the repairs of midline fractures.

that would indicate a method of treatment which would avoid excessive trauma to
the remaining ridge. Examples of the types of treatment used were preventive sur-
,gery, occlusal adjustment of the remaining teeth, use of different tooth forms, use
of acrylic resin teeth with cast gold occlusal surfaces, varying arrangements of teeth,
use of cast denture bases, use of tissue conditioners, use of semipermanent soft liners,
programs of oral tissue massage and oral hygiene, and psychiatric consultation.
Prosthodontic replacements were made as needed to complete the dentulous arch.
The treatment plan for each patient was continually evaluated for a period of two
450 Bruce

years. Only after every effort had been made to produce a successful denture would
any of the patient’s remaining teeth be extracted.

EVALUATING THE TREATMENT BY COMPLETE DENTURES OPPOSING NATURAL

TEETH
The treatment of the 20 patients can be summarized as follows:
1. Complete maxillary and mandibular dentures had to be constructed for 4 of
the 20 patients. Three patients had maxillary teeth and one had natural mandibular
teeth.
2. As treatment of the patients progressed, the natural teeth required correctioil
either by grinding or by prosthodontic replacements or both.
3. (:ast metal bases were of great value, and in some instances they were .i
necessity to strengthen the denture to prevent midline fractures.
4. The patients who were considered failures due to chronic traurna of the
residual ridge had either bruxing habits, heavy musculature, or a combination of
both. Unknown physiologic. factors combined with dietary, nutritional, or hereditary
factors may have been contributing complications.
5. One of the rnandibular complete dentures was considered successful after two
years.
6. Patients who developed the most trauma of the residual ridge were those with
excessive wear on either the denture teeth or the natural teeth.
7. Remaining natural second and third molars caused the dentures to slide
forward on the ridge, causing traurna and eventual destruction of the ridge. Extrac-
tion of these teeth seemed to improve this condition.

TECHNIQUE FOR CONSTRUCTING COMPLETE DENTURES OPPOSING NATURAL

TEETH
A technique was developed from the methods used on the patients whose treat-
ment was considered successful after two years. The important aspects of the various
procedures will be described.
Diagnosis. Oral radiographs, diagnostic casts, and a dental and medical history
are completed. The patient’s physician is consulted. The patient is studied 1.0
deterrnine his physiologic, anatomic, and psychologic makeup. A patient indicating
a lack of interest in a long-range treatment plan is not a good risk. A patient with
a history of bruxism or having heavily developed facial musculature is also a poor
prospect. These types of patients will destroy the supporting structures under the
denture.
Planning the occlusion. The natural teeth are carefully examined to determine
if simple reshaping can create a suitable occlusal surface or if the occlusal surfaces
rnust be reconstructed. Extruded or malposed teeth must be reshaped into a normal
occlusal plane position, or crowned, or extracted to create a usable occlusion. A
plan of occlusion with low cusp height should be created. Partially edentulous arches
should be restored with partial dentures.
Impression procedures. Impressions are made only after the edentulous ridge tis-
sue is in a healthy conditon.” Soft denture liners, as well as leaving the dentures out
of the mouth, may be necessary for tissue recovery.? The impression should cover
Volume 26 Complete dentures opposing natural teeth 451
Kumber 5

the maximum tissue surface possible within physiologic limits to gain the best sup-
port possible for the denture.8
Establishing the vertical dimension o/ occlusion. Whatever method or combina-
tion of methods are used, an adequate interocclusal distance must be established.
The use of facial measurements, phonetics, pm-extraction records, patients’ senses,
and swallowing are all helpful.
Articulator mounting. After the casts are mounted on the articulator and the
articulator adjusted, acrylic resin teeth are selected and tentatively arranged in wax
in order to observe the occlusion. The anterior teeth are positioned with as little
vertical overlap as possible but a horizontal overlap is desirable.
The artificial stone teeth of the opposing cast are carefully trimmed to develop
balancing contacts in all positions (Fig. 3 ) . Fixed restorations or removable partial
dentures that restore the occlusal surfaces on the occlusal plane are designed and
fabricated at this point in the treatment before the opposing complete denture is
made (Figs. 4 and 5) .
Reshaping the natural teeth using a resin template. The patient’s natural teeth
arc ground in a manner similar to the way in which the stone cast was trimmed.
Marks are made on the stone teeth with colored pencil to indicate the location of
the cuts on the natural teeth (Fig. 6).
A clear acrylic resin template is formed over the corrected cast (Fig. 7). The
inner surface of the template is coated with pressure-indicating paste.* The template
is placed over the patient’s teeth and rocked into the firmest position. Interferences
can be seen through the clear template and are recorded by the indicator paste
(Fig. 8.). The interferences are removed by grinding the proper teeth and the
process is repeated until the template fits the teeth perfectly. This method produces
an accurate result (Fig. 9).

CAST GOLD OCCLUSION

Gold occlusal surfaces are cast for the acrylic resin posterior teeth after the
denture has been finished and the occlusion perfected (Fig. 10) .9 The gold occlusal
surfaces will not wear excessively or cause abrasion of the occlusal surfaces of the
natural teeth. Patients who showed the most ridge destruction had excessively worn
either the denture teeth or the natural teeth.

FACTORS OF OCCLUSION
Occlusal forces should be directed vertically, posteriorly, and bilaterally equally.
Posterior teeth should not extend distally beyond the first molar. By leaving out the
second molar the stress on the ridge can be reduced and the tendency of the denture
to slide forward will be lessened, Second and third molars may be extracted to
develop this type of occlusion in some instances.

INITIAL PLACEMENT OF THE DENTURE

Pressure-indicator paste is used to locate pressure spots on the tissue surface of
the completed denture. New interocclusal records are made to remount the

*P. I. P., Mizzy, Inc., Clifton Forge, Va.

 J. I’msthet. Dent.
452 Bruce November, 1971

Fig. 3. An occlusal guide plane is used to evaluate the occlusal plane on the right side,
Fig. 4. A removable partial denture design is drawn on the master cast. An occlusal onla)
will be used to improve the occlusal plane.
Fig. 5. The removable partial denture produces an ideal occlusal plane for the upper corn-
plete denture.
Fig. 6. The parts to be ground and reshaped on the natural teeth arc indicated on the r.a\i
as a guide for the dentist.

mandibular denture, removable partial denture, or cast to the articulator. ‘I‘hc

articulator is adjusted and the occlusion is corrected on the articulator before placfx-
ment of the denture.
The patient is advised to leave the denture out when he sleeps or at least part
of every day.6 He is given oral hygiene and dietary instructions including techniques
for brushing and massaging of the residual ridge. Finally the patient is given an
appomtment for future observation of his mouth.
Postdelivery diet, nutrition, oral hygiene, and general health are determining
factors as to the prognosis of the patient and should be discussed and emphasized
zs%‘5”
A Complete dentures opposing natural teeth 453

Fig. 7. A clear acrylic resin template is formed over the reshaped cast. Cold-curing resins are
used to perfect the fit of the template.
Fig. 8. The resin template is used to locate imperfections in the occlusal plane after the
initial reshaping has been done.

at each appointment. Chewing gum, bruxing habits, and clenching of the teeth
should be discouraged. Psychiatric consultation is desirable if these habits are CXCCS-
sive.

DISCUSSION
Anatomic tooth forms that can be used to develop balanced occlusion with the
remaining natural teeth are not available. Therefore, the natural teeth should be
shaped to the best form possible to occlude with the artificial teeth that are com-
mercially available. The accuracy of this adjustment of the natural teeth can be
improved by use of the clear resin template for locating occlusal discrepancies.
Clinical observation indicated that patients with good occlusion had fewer post-
delivery problems.
Clinical impressions from the ‘20 patients studied indicate that they did not oc-
clude with as much force as they did previously when their opposing natural teeth
were present. Another clinical impression is that a large percentage of these patients
can be treated successfully when a long-range treatment plan is established and
carried out carefully by both the patient and the dentist.
Lastly, it became obvious after treating these patients that tissue conditioning,
oral surgery, restoration of natural arch form, and oral hygiene often are the secret
to success. These procedures should be employed during a diagnostic period to
prepare the patient. Patients with histories of failures with dentures often indicated
that new dentures had been fabricated without restoring soft tissues to health and
without restoring the opposing natural teeth.

SUMMARY
A technique for making complete dentures opposing natural teeth with emphasis
on diagnosis and continuous long-range observation of the patient has been
454 Bruce

Fig. 9. Exccflent occlusion can be developed by reshaping or rebuiIding the remdi~liug teeth.
Upper left, the centric occlusion; upper right. the protrusive occlusion; lower Icft, the : right
working occlusion; and lower right, the left working occlusion.
Fig. 10. The completed denture has a cast base for strength and stability aud <old ( wclusal
surfaces to prevent wear of the teeth.

presented. A method for reshaping the natur;tl teeth by usirlg a transpareni : resin
template was described.

References
1. Boucher, C. 0.: Swenson’s Complete Dentures, ed. 5, St. Louis, 1964, The Ct. V. Mosby
Company.
Volume 26 Complete dentures opposing natural teeth 455
Number 5

2. -vMeyer, F. S.: Building Full Upper or Lower Artificial Teeth to Opposing Natural Teeth,
Northwest Dent. J. 30: 112-115, 1951.
3. Stansbury, C. B.: Single Denture Construction Against a Nonmodified Natural Dentition,
J. PROSTIIET. DENT. 1: 692-699, 1951.
4. Schweitzer, J. M.: Restorative Dentistry, St. Louis, 1947, The C. V. Mosby Company,
pp. 435-445.
5. Academy of Denture Prosthetics: Principles, Concepts, and Practice of Prosthodontics,
J. PKOSTHET. DENT. 18: 182, 1968.
6. Lytle, R. B., Complete Denture Construction Based on a Study of the Deformation of the
Underlying Soft Tissue, J. PROSTHET. DENT. 9: 539-551, 1959.
7. Bruce, R. W.: Conditioning the Mouth for Dentures, Dent. Prog. 3: 262-266, 1963.
8. Roucher, C. 0.: A Critical Analysis of Mid-century Impression Techniques for Pull
Dentures, J. PROSTIIET. DXXT. 1: 4i2-491, 3951.
9. Wallace, D.: The Use of Gold <kclllsal Surfaces in Complete and Partial Dentures, J.
PROSTIIET. DENT. 14: 326-333, 1964.

DESTAL DRPAHTMENT
u. s. NAVAL AIR STATIOS
ALAMEIM, CAMP. 94501