CLINICAL NOTE
Australian Dental Journal 2003;48:(3):190-194
The split denture: A new technique for artificial saliva
reservoirs in mandibular dentures
AR Mendoza,* MJ Tomlinson†
Abstract
Xerostomia is a relatively common complaint that
can make the wearing of dentures very
uncomfortable for affected individuals. To help
overcome this problem, a number of techniques have
been proposed for incorporating reservoirs,
containing salivary substitutes, into dentures. These
have had varying degrees of success. This paper
presents a case of a patient suffering from
xerostomia who was successfully treated with a new
form of reservoir denture. This new split-denture
technique resulted in a reservoir denture that
provided good lubrication of the oral tissues, was
easily cleaned by the wearer and was produced from
routine denture materials. Details of its design,
construction and other potential applications are
also presented.
Key words: Xerostomia, reservoir, split-denture.
(Accepted for publication 3 March 2003.)
INTRODUCTION
Xerostomia is a common patient complaint that has
many possible causes such as anxiety, Sjögren’s
Syndrome, salivary gland disease, medication-related
side effects, head and neck radiation sequelae and
general medical conditions such as diabetes mellitus.1-3
Patients suffering from xerostomia may complain of
not only a dry mouth, but also of difficulty in normal
oral and oropharyngeal functions including eating,
speaking and swallowing. Extreme discomfort in
wearing dentures is a common complaint.4,5
Depending upon the cause, a variety of treatment
options are available to the clinician. In medication
induced xerostomia, liaison with a patient’s general
medical practitioner to discuss the timing, dosage or a
change in medication may reduce the severity of the
problem. In such cases, measurement of a patient’s non-
stimulated salivary flow rates before and after altering
their medication may be useful in gauging the success of
*Senior Dentist, Gold Coast Health Service District, Queensland.
†Senior Dental Technician, Gold Coast Health Service District,
Queensland.
190
treatment. Alternatively, gustatory stimulation of the
salivary glands by mastication of sugar free chewing
gums or lozenges is helpful.6-9 In severe xerostomic
cases, saliva substitutes or salivary stimulants may be
utilized.10,11 Soft denture liners can also be used to
minimize patient discomfort. Often, a combination of
treatments may be required.
In cases where all treatment modalities have proven
unsuccessful, the incorporation into dentures of
reservoirs containing saliva substitute, has been
proposed.12,13 However, there have been intrinsic
difficulties with both cleanliness and variable patient
acceptance.
This paper presents a case where a reservoir denture
was used successfully in a patient where other
treatment modalities had failed. An alternative method
for constructing full, mandibular reservoir dentures is
presented. This method utilizes routine materials and
follows routine clinical stages during construction. This
reservoir denture splits into two sections – a clear
acrylic base section which contains the reservoirs and a
pink acrylic upper section which contains the denture
teeth. It provides constant salivary flow for the patient
and has the added advantage of allowing easy cleaning
of the reservoirs.
Case description
A 65-year-old edentulous female patient presented,
complaining of a dry mouth and severe discomfort
when wearing lower dentures. Her dental history
revealed that she had had numerous sets of maxillary
and mandibular dentures made in recent years but was
always unable to wear the lower denture due to
constant irritation. Her medical history indicated that
she was on a number of medications for asthma,
angina, increased blood pressure and non-insulin
dependant diabetes mellitus. These included Lasix
(Frusemide), Lanoxin (Digoxin), Adalat (Nifedipine),
Quinate (quinine sulphate), Minidiab (Glipizide),
Diabex (Metformin Hydrochloride), Ventolin
(Salbutamol) and Flixotide (Flucticasone Propionate).
On examination, her mouth was noted to be very dry
with areas of irritation associated with the lower
Australian Dental Journal 2003;48:3.
 b
Fig 1. To determine the height at which to make the clear acrylic base
section of the denture (length c), the height of the lower anterior teeth
plus approximately 3mm (length b), is subtracted from the overall
anterior height of the denture (length a). That is a-b=c.
denture. Her dentures were one year old and appeared
to be satisfactory. The patient already used a salivary
substitute (methyl cellulose) regularly and frequently
consumed water to help overcome the dryness and
discomfort.
After a number of unsuccessful adjustments to the
existing dentures, it was decided to construct a new set
of maxillary and mandibular dentures. During this
process, the patient’s general practitioner was also
contacted and the medications were reduced or altered
to try and reduce the xerostomia. Notwithstanding the
successful completion of these strategies, the patient
still suffered discomfort from her lower dentures. At
this stage the patient agreed to try a ‘split reservoir
denture’ to help alleviate her discomfort. The technique
used is outlined below.
Preparatory stages
Clinically, primary and secondary impressions were
taken in the normal manner. In the laboratory, a
duplicate of the secondary models was then made using
ExaflexTM (Exaflex, GC Dental Products Corporation,
Japan) impression paste material in a custom-made
tray. The duplicate models were then marked ‘Number
2 Models’.
Clinically the maxillomandibular relationship was
recorded with the mandible in a retruded position and
an acceptable freeway space. The models were then
articulated in the normal way and the teeth set up for
try in. Shorter teeth were used in the lower rim to allow
a deeper area for the future placement of reservoirs.
The wax dentures were then tried in clinically and
adjusted until aesthetics and the vertical and
anteroposterior jaw relations were satisfactory to both
patient and operator.
Using the ‘Number 2 models’ created after the
secondary impressions, and the wax dentures, a second
articulator was set up with identical maxillomandibular
relationships. This was set aside for later use.
Construction of the clear acrylic mandibular base
section
The height of the clear acrylic base section first had
to be determined. This was done by measuring the
anterior height of the mandibular wax denture (Fig 1).
Australian Dental Journal 2003;48:3.
Fig 2. The waxed up base section of the split denture, with parallel
Lego™ blocks in place.
Then the height of the lower anterior teeth was
measured and 3mm added on to allow for sufficient
acrylic under the teeth for strength (Fig 1). This height
was then subtracted from the height of the denture to
determine the height at which the base section needed
to be constructed (Fig 1).
The original wax dentures were then set aside and a
new mandibular wax base was constructed, on the
original articulator, to this base height. This base was
kept smooth, with the occlusal surface as flat as
possible and with clearly defined occlusal edges. Three
double-toothed LegoTM (LEGO, LEGO Korea Co Ltd,
Seoul, Korea) blocks were positioned in the wax. One
was positioned anteriorly and one was positioned in
each posterior region. These were placed exactly in the
centre of the wax base, kept parallel to each other and
waxed in such a way that only the ‘teeth’ of the lego
blocks were above the wax (Fig 2).
The rim was then waxed down to the model and
flasked in the normal manner. Because accuracy was
critical, vacuum mixed, hard stone was used. Once the
wax was boiled out, the Lego™ blocks were carefully
removed. After applying separating solution, the flask
was packed with clear, VertexTM (Vertex, Vertex Dental
BV, Zeist, Holland) rapid-curing denture acrylic. This
was heat processed as per manufacturer’s instructions
for 20 minutes and allowed to bench cool.
After processing, the clear acrylic base was deflasked.
Care was taken in polishing to ensure that the square,
occlusal edges were maintained.
Construction of the upper mandibular section
Using the second articulator with the ‘Number 2
models’, the wax upper denture was placed on the
upper model and the clear acrylic base placed on the
lower model. As this articulator records the same
maxillomandibular relationship as the original, the gap
between the upper denture and the lower base plate
should be the length of the teeth plus 3mm (Fig 3a).
The clear acrylic base was easily reseated on the
191
 b
a deflasking, the upper segment of the mandibular
b could be clearly visualized. Since the internal surfaces
Fig 3. The upper wax denture articulated against the base section of
the split denture. (a) The distance between the base section and the
upper denture should be the same as ‘length b’ from Fig 1. (b) The
upper denture is articulated against a duplicate of the base section.
original model as the patient’s mandibular ridge had
undergone extensive resorption, resulting in a flat,
undercut-free surface.
To allow the upper section of the mandibular denture
to be processed separately, it was waxed up on a
duplicate of the clear acrylic base. This duplicate was
formed by taking an Exaflex™ paste impression of its
occlusal surface in a custom-made tray and pouring it
up in stone. In order to articulate this stone duplicate in
the corresponding position to the clear acrylic base, a
wax squash bite was made on the articulator, between
the upper wax denture and the clear acrylic base. The
clear acrylic base was then removed and the stone
192
Fig 4. The upper section of the mandibular split denture, waxed up
and articulated.
duplicate placed in its position (Fig 3b). This was then
plastered into place.
The teeth were then set up and waxed into position
in the normal manner (Fig 4). The dentures were then
flasked and processed in pink, Vertex™ rapid-curing
denture acrylic as previously described. After careful
denture was attached to the lower segment for
polishing. The two sections should ‘click’ into place at
this point. All polishing was done with the segments
together to ensure a flush, smooth finish and no
damage to the edges. The result was a full lower
denture with a clear acrylic base and a removable, pink
acrylic upper section (Fig 5a-5c).
Denture issue and reservoir placement
The denture, still with no reservoirs, was now issued
to the patient and worn for a time to allow the patient
to adjust and complete any minor adjustments. Once
this was achieved, reservoirs were cut into the clear,
acrylic base of the denture. Because a clear acrylic was
used for the base section, the extent of the reservoirs
of the reservoirs cannot be polished, they were cut as
cleanly and smoothly as possible to facilitate easy
cleaning. One was placed in each posterior segment
(Fig 6a-6c). The reservoirs were made as large as
possible while maintaining sufficient thickness of the
denture walls for strength. A minimum thickness of
2mm was maintained for the reservoir walls.
Once the reservoirs were placed, a 0.5mm diameter
rose bur was used to drill a drainage hole from the
inferior aspect of the lingual flange of the denture into
the reservoirs (Fig 7). Drainage was tested by filling the
reservoirs with water, placing the denture on a paper
towel and checking that capillary action slowly drained
the chambers.
The split reservoir denture was now reissued to the
patient. Details on how to separate the two halves were
provided along with cleaning instructions. To clean the
reservoirs, the patient was instructed to flush out the
Australian Dental Journal 2003;48:3.

c The patient has now been successfully wearing the
Fig 5. The final mandibular split denture prior to reservoir placement:
(a) in one piece; (b) in two sections; and (c) in two sections showing
the matching lugs and holes.
reservoirs weekly with 1 per cent sodium hypochlorite
solution. Additionally, fine orthodontic wire was
provided to clean the drainage holes if they became
blocked. The patient was instructed to clean the
reservoirs daily with either a small bottlebrush or a cut
down toothbrush. The patient was also advised to
continue to use the same salivary substitute as different
brands varied in their viscosity and this would require
alteration to the diameter of the drainage holes. The
patient then attended for a number of follow-up
appointments to adjust the diameter of the drainage
holes to achieve the optimum flow levels. To enlarge the
holes, a larger diameter bur was used. To reduce the
Australian Dental Journal 2003;48:3.
a
c
Fig 6. The completed split denture with reservoirs placed: (a) in one
piece from posterior aspect; (b) in one piece from a lateral view; and
(c) the lower section with reservoirs filled with coloured liquid.
size of the holes, stainless steel orthodontic wire of the
appropriate diameter (e.g., 0.5mm) was placed into the
hole and cold cured acrylic placed around it. Once the
acrylic had set, the wire was removed. After a number
of visits, the patient was able to wear the denture
comfortably throughout the day and only needed to
refill the reservoirs twice per day.
dentures for over three years. The patient finds them
easy to use and clean and has found a great reduction
in her symptoms of xerostomia.
DISCUSSION
This split reservoir denture offers clinicians an
alternative method of treating patients suffering from
xerostomia where other treatment modalities may have
failed. While this paper presents treatment of a
medication and age related xerostomic patient, the split
reservoir denture also has potential applications in other
cases such as patients suffering post-radiation sequelae.
The advantage of this split denture technique over
previous reservoir dentures lies in the ready access to
the reservoirs, both by the patient and for professional
attention. It allows easy cleaning and adjustment of the
reservoirs as needed. The use of clear acrylic for the
193

Fig 7. A wire demonstrates the reservoir drainage hole in the inferior
aspect of the lingual flange.
base section permits the clinician to determine the best
size and position for placement of the reservoirs.
Additionally, it also enables the patient to clearly
visualize the levels of saliva substitute within the
chamber.
From a clinician’s perspective, the clinical stages during
construction are routine and require little additional
chair-side time. However, laboratory stages are time
consuming and precision is essential to ensure accurate
and smoothly fitting segments. Additionally, repairs and
relines of a split denture become more complex.
Case selection is also extremely important. Cutting
reservoirs into the denture weakens its structure, so
only cases with sufficient vertical dimension and
thickness are suitable for this technique. Further
research is required into the minimum thickness
required for the reservoir walls, to allow maximum
reservoir size but still maintain denture strength. Even
so, placement of reservoirs should be on a case by case
basis. If there is insufficient room to place reservoirs in
a posterior segment, there may be room to place a
reservoir anteriorly. Additionally, patients must have
the manual dexterity to separate and rejoin the two
segments of the split denture.
Another point to consider in case selection is that the
split-denture technique described involves reseating the
clear acrylic mandibular base on a duplicate of the
original model, prior to constructing the upper
mandibular section. Accurately reseating processed
dentures on models can be difficult if large undercuts
are present. To facilitate easy reseating of the processed
denture base, it is preferable to select cases with
minimal tissue undercuts.
Previous studies14,15 suggest that reservoirs in the
palatal aspect of maxillary dentures may also be useful
in treating xerostomia. This split denture technique has
the potential to be modified for use with maxillary
dentures as well. A further improvement to the
technique mentioned in this paper could be the use of
precision attachments in place of readily available
Lego® blocks. While these would possibly add to the
bulk and cost of the denture, they may prove more
reliable and wear resistant in the long term.
194
In summary, this paper reports a novel technique for
the construction of a mandibular denture incorporating
a saliva reservoir. Case selection is important but the
product has sufficient utility to be appropriate in a
number of areas of the prosthesis and with a range of
products. Further clinical trials are required but the
prototype has been eminently successful.
ACKNOWLEDGEMENTS
The assistance of Associate Professor Neil Savage
and Dr Leslie Jabbour is acknowledged. The authors
also wish to acknowledge the Queensland Department
of Health and the Gold Coast Health Service District
for the use of materials and facilities.
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Address for correspondence/reprints:
Dr AR Mendoza
C/- Nerang Dental Clinic, Earle Plaza
Cnr Price and White Streets
Nerang, Queensland 4211
Email: TonyMendoza@health.qld.gov.au
Australian Dental Journal 2003;48:3.