SRM University Journal of Dental Sciences

Volume 1, Issue 3, October - Decembret 2010

Case Report

Hollow mandibular complete denture - A case report

N Kalavathy, M Mitha Shetty, Premnath, Karuna Pawashe, RKV Patel
Department of Prosthodontics, DAPM RV Dental College, Bangalore Department of Prosthodontics, Rajiv Gandhi Dental College, Bangalore
Address for correspondence Dr. N. Kalavathy Department of Prosthodontics DAPM RV Dental College Bangalore Email: drkalavathy@gmail.com

Abstract The severely atrophied jaw can have various treatment options. The treatment option involved in this article is hollowing the denture so as to reduce the weight of the denture, thereby enhancing stability and retention, reducing the further resorption of the jaws. This article describes an alternative method for the fabrication of hollow mandibular complete denture. It incorporates fabrication of clear, vacuum form shim ensure that there is adequate room for resin and teeth.
Keywords: Severely resorbed ridge, shim, hollow

mandibular complete denture

Introduction
For more than 150 years, it was believed that the weight of the lower denture contributes to both retention and stability. However, studies have shown that retention and stability can be achieved by improving the fit of the denture bases rather than addition of extra weight to the dentures and also the weight of the lower denture may not affect its retention and 1,2,3,4 stability. No step in denture construction should be stopped short of perfection yet many dentures are worn which have, imperfections built into them provided they have peripheral seal sufficient to hold them in place. Various studies have shown that both retention and stability can be achieved even with reduced weight of the denture in severely resorbed ridges by improving the quality of impression , thereby achieving a good peripheral seal.

almost 10 years and the problem (fractured denture) with the current denture was since a week.

Figure 1: Intra oral view of the mandibular arch On intra-oral examination revealed an U-shaped palatal vault and severely resorbed mandibular ridge. The treatment plan decided for the patient was the fabrication of a hollow complete mandibular denture.

Case Report
A 75-year-old female patient reported to the department of Prosthodontics, with a chief complaint of fractured lower denture and desired the replacement of the same. Her history revealed that, she was an old denture wearer for

Procedure for fabrication

1. Maxillary and mandibular impression was made followed by border moulding and final impression with zinc oxide eugenol impression paste.

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2.

3.

The maxilla-mandibular relationship was recorded using occlusal rims on permanent denture base and transferred to the articulator and the artificial teeth were arranged. Try in procedure was done.

progresses, causing reduced supporting tissue with larger restorative space between maxillary and mandibular residual ridges.1 In general, a heavy denture whether maxillary or mandibular is likely to cause poor denture bearing ability. Even though it is suggested that gravity and the adiitional weight to the mandibular complete denture may aid in prosthetic retention, it is not an universally accepted one. Extensive volume of the denture base material in prosthesis provided to patients with large maxillofacial defects or severe residual ridge resorption is always a challenge to prosthodontists. To increase the retention and stability of heavy prosthesis, many methods have been tried like utilising the undercuts , modifying the impression technique, use of magnets , use of implants , etc. Apart from this, when we look into the history of bulkier prosthesis reduction in prosthesis weight also have been tried by making the denture hollow. Such weight reduction approaches have been achieved using a solid 3-dimensional spacer including dental stone, cellophane wrapped asbestos, silicone putty or modelling clay during the laboratory procedures which are removed later to provide a hollow denture base.3,6-18 There are studies in which it is proved that, by reducing the weight of the mandibular denture ,either by making a hollow mandibular denture or by altering the plane of occlusion to some extent, preservation of the existing residual alveolar ridge is possible. An added advantage with a hollow mandibular denture is a comparable increase in retention and stability that can be achieved, which is problem with the conventional (heavy) mandibular denture. Holt , processed a shim of acrylic resin over the residual ridge and used a spacer . Almost a similar technique with necessary modifications was followed for the clinical procedure which is likely to have reduced the weight of the denture by 25% 3. The care of severely resorbed ridges is mainly taken care by broad area coverage within functional limits, decreased number of teeth, decreased bucco lingual width of the teeth, improved tooth form, avoidance of inclined planes, provision for adequate tongue room , adequate interocclusal distance apart from a hollow denture base. The advantages of hollow dentures are reduction in the excessive weight of the acrylic resin, resulting in the lighter

The special steps taken for the fabrication were as follows: 4. The trial denture was duplicated with irreversible hydrocolloid and poured in dental stone 5. A clear template of the duplicated stone cast was made using a 0.3 thermoplastic sheet 6. Two split dental flasks with interchangeable counters were used for processing 7. Trial denture was flasked and dewaxed in the conventional manner using base 1 and counter 1 8. A wax shim (2 sheet thickness) was adapted over the ridge lap surfaces of denture teeth (counter 1) and flasking was done by placing the base 2 over counter1 9. Both the halves were separated without boil out. One sheet thickness was removed from base 2 10. With the wax shim (one sheet thickness) placed on the base of the second flask, counter2 was poured 11. Dewaxing and processing of set 2 (base and counter 2) was done to obtain a heat cured acrylic shim (1mm thick) 12. Heat cure acrylic shim was positioned accurately over the permanent denture base using the clear template fabricated previously on the trial denture inorder to ensure that there is adequate space between the resin and the teeth 13. The denture base and acrylic shim were then sealed at the borders using self cure acrylic resin to make a hollow denture base 14. The hollow denture base was then immersed in water to ensure a proper seal 15. The original counter1 was reseated on the base1 and verified for complete closure of the flask 16. Heat cure acrylic resin was packed and processed in the conventional manner, finally finished and polished 17. The hollow cavity seal was verified by immersing the denture in water, if no air bubbles are evident, an adequate seal is confirmed.

Discussion
Extreme resorption of the ridge whether maxilla or mandible will lead to a reduced denture bearing area which in turn will affect retention, stability and support for the complete denture. Problems that are likely to be faced may be due to narrower and more constricted residual ridge as the resorption

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prosthesis, decreases the load on the residual alveolar ridge making the patient comfortable.

Base 2 (Removal of 1 sheet thickness wax) Impression of the trial denture Duplicated stone cas

Counter 1 (With dewaxed teeth)

Duplicated stone cast with thermoplastic sheet

Clear acrylic template Base 2

Base 2 and counter 2 (Dewaxing of 1 sheet thickness was followed by processing) Base 1 and counter 1 Base 2 and counter 2

Acrylic shim (processed acrylic shim)

Base 1 with trial denture

Base 1 and counter 1 (Dewaxing done with permanent denture base and teeth in place)

Base 1(occlusal view) Base 1(side view) (Clear acrylic template tried over the acrylic shim)

Counter 1 Counter 1 (Adaptation of 2 sheet thickness wax on dewaxed teeth)

Base 1 (acrylic shim sealed with permanent denture base using self cure acrylic resin)

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3. 4.

5.

6. Base 1 and counter 1 (showing the hollow denture in place with dewaxed teeth) 7.

8.

9.

10.

11. Final processed hollow denture

12.

Conclusion
Rehabilitation of severely resorbed ridges is a challenge to the prosthodontist. Even though, the choice of rehabilitation can be overdentures, implant retained over-dentures, ridge augmentation, etc, many a times the patients who comes with such a problem are geriatric patients with many systemic illness. Hence, the best way is to rehabilitate them with conventional complete dentures. Apart , from modifying the impression technique to get maximum denture bearing area, modifying the type of denture also may be better accepted by patients. Hence, loose denture weight for healthy and comfortable living. 13.

14.

15.

16.

References
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18.

2.

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