Technique to Fabricate Hollow Maxillary Complete Denture

Using 3D Printed Template

Rupal Jaydip Shah, MDS, Sanjay Balaji Lagdive, MDS, Abhay Hareshkumar Machchhar ,
Kalaiarasi Periyanan, & Sherin Cherian
Department of Prosthodontics, Government Dental College and Hospital, Ahmedabad, Gujarat 380016, India

Keywords
Dental SG resin; 3D printing; hollow space.
Correspondence
Abhay Hareshkumar Machchhar, 3,
Vivekanand society, B/h Old Railway Station,
Navagam Ghed, Jamnagar, Gujarat – 361008,
India. E-mail: abhaymachchhar@yahoo.com
The authors deny any conflicts of interest in
regards to this study.
Accepted February 13, 2020
Abstract
Severely resorbed residual alveolar ridges are a challenge in rehabilitation with re-
movable complete dentures. Increased interarch space may result in increased height
of maxillary and/or mandibular dentures with corresponding increase in weight, which
may compromise retention and resistance of the denture and ultimately, the success
of the removable prosthesis. There are many techniques and materials described for
reducing the weight of dentures. This article describes an innovative technique for
fabricating hollow maxillary dentures using a 3D printed hollow dental surgical guide
resin spacer. The double flask technique was used to construct the hollow denture and
was modified to incorporate the hollow spacer at the time of final closure of flasks.

doi: 10.1111/jopr.13153

Residual ridge resorption of the maxillary and mandibular jaws
encompasses multiple processes that affect the overall osseous
anatomy, making it less favorable for prosthodontic rehabil-
itation. As a consequence of significant ridge resorption, the
restorative space between the maxillary and mandibular ridges
becomes large.1
An excessively resorbed maxillary ridge is a challenge com-
promising retention and support necessary for a successful pros-
thesis. When this situation is coupled with a large restorative
space, the clinical prognosis becomes uncertain. The resultant
denture is often heavy and compounds the problems associ-
ated with retention and resistance of the maxillary denture.2
Various methods have been employed to manage heavy maxil-
lary complete dentures like, use of implants,3 magnets,4 intra-
mucosal inserts,5 suction disks, springs,6 modified impression
techniques,7 and lightweight dentures.1,8,9
Lightweight dentures are constructed by creating a hol-
low cavity within the denture’s body, by using a 3D spacer
to create a void. Such a hollow prosthesis lessens the vol-
ume of denture base material and overcomes difficulties as-
sociated with a heavy prosthesis. Single flask or double flask
techniques are commonly employed for constructing a hol-
low denture. Jhanji and Stevens10 described a technique which
utilizes a single flask to fabricate the hollow obturator us-
ing silicone putty. O’Sullivan2 also using a single flask tech-
nique, processed the hollow denture with the silicone putty
spacer and later created holes to retrieve the spacer material.
Holt Jr,11 Fattore,1 and Radke,8 used a double flask technique
in which the hollow denture was processed as two separate
parts, the tooth bearing portion and cameo surface as one, and
the intaglio surface as the other. Later, these two parts were
joined using auto-polymerizing or/heat polymerizing acrylic
resin.
Different materials like dental stone,12 cellophane-wrapped
asbestos,13 silicone putty,2,14 light-body coated gauze,9 salt,15
modelling clay,16 caramel,17 thermocol,18 and glycerine soap19
have been used as 3D spacers and are retrieved after processing
to produce a hollow cavity. A photopolymer resin (Dental SG
resin, Formlabs Inc, USA) containing methacrylic ester and
photoinitiator is specifically manufactured for printing 3D parts
for use as surgical guides among other applications.20
This article describes a technique using a digital workflow
to achieve a hollow cavity within maxillary dentures, by using
a 3-dimensionally printed dental SG resin template and double
flask technique. The main advantage of this method is that re-
trieval of the biocompatible spacer is not required after denture
processing.
Technique
1. Complete the clinical try-in procedure of waxed-up trial
denture. Invest and dewax the maxillary denture in the
conventional manner21 (Fig 1).
2. Use the double flask technique1,8,11 to fabricate a heat-
polymerized maxillary denture base (Meliodent Heat
cure, Kulzer, Germany) on the definitive maxillary cast.
While deflasking, do not separate the denture base from
the cast. Make indentations of approximately 0.5-1 mm
in depth and 5 mm in width on the processed denture
base with acrylic burs in the premolar and molar region

360 Journal of Prosthodontics 29 (2020) 360–363 

C 2020 by the American College of Prosthodontists
Shah et al 3D Printing Technology in Hollow Denture

on both sides for orientation of the 3D spacer, making

sure that the denture base is not perforated (Fig 2).
3. Adapt 2 layers of 1.2-mm-thick wax sheet (Y Dents Mod-
elling wax, MDM corporation, Delhi, India) onto the
labial, palatal, and acrylic binding surfaces of the teeth
present in the plaster mold embedded in the cope. Make
sure the wax is closely and uniformly adapted to the sur-
faces as it models the thickness of the resin that will be
obtained after processing, and also provides an outline
for the putty index (Fig 3).22
4. Manipulate vinyl polysiloxane putty (Speedex putty C-
silicone, Coltene, OH) according to manufacturer’s in- Figure 1 After dewaxing.
structions, mold it into a U shape, and place it over the
wax adapted on the teeth. Carefully close the flask, en-
suring rim to rim contact throughout.
5. Open the flask after the putty is set and trim the ex-
cess. Inspect for accurate adaptation of the putty index
by reassembling the dental flask with the spacer placed
inside. There must be no evident gap between the cope
and drag. Once verified, the putty index is used to make
the 3D spacer (Fig 4).
6. To obtain a 3D printed spacer, first, scan the index using
a 3D scanner (Shining 3D, Zhejiang, China) to generate a
digital (STL) file (Fig 5). Upload the STL file into Com-
puter Aided Design software (CAD software, Exocad,
Germany). Set design parameter of 1.25 mm wall thick-
ness to create a hollow space within the solid STL file
(this uniform wall thickness provides sufficient spacer
material to prevent fracture during flasking). Utilize this
modified file to print a 3D hollow spacer with dental SG
resin (Next Generation 3D Printers PVT LTD, Kottur,
Chennai) (Fig 6).
7. Autoclave the 3D printed hollow spacer.20 Orient it on
the previously fabricated denture base. This is made pos- Figure 2 Denture base fabricated and indentations placed for orientation
sible by utilizing the orientation indentations created at of 3D spacer.
premolar and molar region on both sides of the den-
ture base. Verify the placement by checking for stability
and adaptation to the denture base. Secure it in place
using cyanoacrylate (Fevikwik, Pidlite industries, India)
(Fig 7).
8. Remove the wax adapted in the cope. Apply 2 thin layers
of separating medium (DPI Heat Cure, Cold Mould Seal;
Dental Products of India) on all gypsum surfaces in the
cope and drag. Avoid applying on the acrylic surface of
the teeth and on the processed denture base.
9. Mix and pack heat cure acrylic resin (Meliodent Heat
cure, Kulzer, Germany) following manufacturer’s in-
structions. Ensure uniform closure of the flask parts to
prevent any increase in vertical dimension after process-
ing.
10. Process the denture by following conventional polymer-
ization cycle. After deflasking, finish and polish the
prosthesis. The resin spacer remains within the denture
(Fig 8).

Discussion
Figure 3 Two layers of modelling wax adapted on buccal, palatal and
The technique presented is simple and has advantages over acrylic binding surfaces of teeth.
other methods for fabrication of a hollow denture. The double

Journal of Prosthodontics 29 (2020) 360–363 

C 2020 by the American College of Prosthodontists 361
3D Printing Technology in Hollow Denture
Figure 4 Fabricated 3D putty spacer.
Figure 5 stl file image of hollow 3D spacer.
Figure 6 3D printed hollow spacer.
flask technique1,8,11 is technique-sensitive as the two flasks
used may not accurately fit, causing an inadvertent increase in
vertical dimension. Also, the junction of the two parts of the
denture may fracture, discolor or leak with time.9,17
362 Journal of Prosthodontics 29 (2020) 360–363 
Shah et al
Figure 7 3D printed spacer attached to denture base using cyanoacry-
late.
Figure 8 Hollow denture.
In single flask techniques,10 the various materials used for
creating a 3-dimensional space require retrieval after denture
fabrication to create a hollow space. The retrieval of some
materials used in the past has proved difficult particularly from
the anterior part of denture.18 Also, some methods used for
creating hollow 3D spacers with clear templates are much more
labor intensive.2
The benefit of using this technique is ease of handling the 3D
spacer as it is solid and fixed to the denture base and retrieval is
not required unlike other materials described previously.2,9,12-19
Also, there is no discoloration as seen in the double flask
technique.1,8,11
Disadvantages include cost and availability of 3D scanner,
3D printer and dental SG resin material. The required thickness
of dental SG resin limits the volume of space that can be created
within the prosthesis.
C 2020 by the American College of Prosthodontists
Shah et al
This technique is a modification of the conventional double
flask technique; two flask assemblies were used to obtain the
processed denture base. However, the rest of the procedure
was completed using a single flask. The processed denture
base on the definitive maxillary cast (drag) with the printed
spacer attached to it and the teeth containing portion (cope)
were flasked together as a single unit. Therefore, the resulting
denture was a single processed unit instead of 2 parts as would
result from a standard double flask technique. This helps to
overcome the occurrence of a vulnerable junction prone to
discoloration, breakage or leakage.
In this technique, two layers of base plate wax were adapted
onto the teeth contained in the cope.22 The vinylpolysiloxane
used to fabricate the 3D spacer does not bond to the acrylic, so
removal of the spacer index is easy.
The printed spacer is made of resin and chemically adheres to
the denture base. It is to be retained within the denture without
having to prepare any holes for the purpose of retrieval. It can
be autoclaved and is biocompatible,20 allowing the spacer to
remain within the denture posing no harm to the wearer. Care
was taken while placing the orientation indentation to encroach
only up to partial thickness of the denture base without any
perforation. This prevents any direct contact with the spacer.
The robust structure enables the resin spacer to withstand the
forces of compression applied during flasking. The 3D printed
spacer can also be used in the construction of hollow large sized
obturators to obtain the same benefits.
The difference in weight was measured by duplicating the
denture with the same tooth mold and material without a hollow
space. The weight of the hollow denture was 27.77 g and the
duplicated denture was 31.80 g, a 4 g reduction in weight. The
lighter weight prosthesis may be more comfortable to wear and
may reduce the forces acting on the residual alveolar ridge,
preserving the health of the underlying tissue.
Research is necessary concerning other materials that can be
3D printed and are able to resist fracture in reduced dimensions
than that of dental SG resin.
Acknowledgment
We would like to acknowledge Dr. Vijay Asrani (M.D.S., Oral
medicine, diagnosis and radiology) for his valuable contribution
to the entire process of 3D printing.
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