Prosthodontics

P ROSTHODONTICS Dec 2015

ALTERNATIVES TO CONVENTIONAL
COMPLETE DENTURES

A Review
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Dr. Kavita Patil Dr Sunil Dhaded Dr. Subashani
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INTRODUCTION
A well-managed transition from what remains of the natural dentition to
totally artificial dentition carries a good level of success. Clinicians skills and
experience play a major role in designing and fabrication of the optimum
prosthodontic restoration. Selection of denture is equally important. Lack 5RGEKE CNVGTPCVKXGU VQ VTCFKVKQPCN EQORNGVG FGPVWTG
of treatment planning may lead to failure and loss of work time. As it is VJGTCR[ JCXG DGGP EQPVTQXGTUKCN DGECWUG QH VJG
said necessity is the mother of invention, so the alternative denture was
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introduced as necessary to overcome the drawbacks of the conventional
complete denture prosthesis and selecting alternatives as primary treatment
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for the edentulous patients, greatly enhancing the denture esthetics, retention OCMKPIEQORNGVGFGPVWTGUVJG[JCXGDGGPUWEEGUUHWNN[
and function, considering the socio-economic status and general health of the WUGF HQT VJG VTGCVOGPV QH VJG GFGPVWNQWU RCVKGPV
patient. #NVGTPCVKXGUUGTXGCUXCNWCDNGRTQUVJQFQPVKEVTGCVOGPV
QRVKQPU VJCV ITGCVN[ GPJCPEG FGPVWTG CGUVJGVKEU 
Types of alternative denture: HWPEVKQPUJQWNFDGEQPUKFGTGFHQTGFGPVWNQWURCVKGPVU
1. Flangeless denture 6JGXCTKQWUV[RGUQHCNVGTPCVGFGPVWTGYKVJVJGRWTRQUG
2. Palate less denture JCXGDGGPFKUEWUUGFHTQOVJGNKVGTCVWTGVQQXGTEQOGVJG
3. Liquid supported denture UJQTVHCNNQHEQPXGPVKQPCNFGPVWTGVJGTGD[RTQXKFKPIVJG
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4. Reservoir denture
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5. Over denture
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6. Characterized dentures
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7. Denture with cheek plumpers EJCTCEVGTK\GF FGPVWTGU FGPVWTG YKVJ EJGGM RNWORGTU
8. Hollow denture CPFJQNNQYFGPVWTG

FLANGELESS DENTURE
Presence of protruding trajectory before any tooth extraction in maxilla often
produce the appearance of a protruding upper lip. In these instances, where
there is existing lip support does not require additional flange thickness or
length to create the illusion of normalcy .Hence, denture base extension in to
buccal flange can distort the facial support and muscles of facial expression,
limit the function, and compromise esthetics. So the flangeless maxillary
complete denture is indicated in residual anterior mandible and premaxillae
are at 450 angle to meet the esthetic requirements and ideal support of the
upper lip.

26 GUIDENT | Your Guide on the path of Dentistry

 Dec 2015
Prosthodontics
Advantage of the modified flange is that by eliminating the labial flange,
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there is no distortion of desired aesthetic facial support. No additional surgical
intervention is required to remove osseous residual ridge.
Limitations of flangeless denture are that the retention of the denture is
compromised sometimes.1
PALATELESS DENTURE
Since traditional dentures were introduced, patients have struggled with the
problems posed by a covered soft palate. Normally, upper dentures cover
the top of the mouth so thoroughly that a persons ability to taste and
experience their food is diminished, not to mention hamper proper function.
Now, modern prosthetic dentistry has overcome this hurdle with palateless
dentures. These are upper dentures without a palate, which can improve
comfort and sense of taste.
Palateless dentures are any upper denture that has no plate covering the
upper palate, including dental implants, natural tooth-retained overdentures,
fixed/removable restorations, or even a conventional palateless denture with
a horseshoe shaped frame.
This type of denture is often recommended for patients with a highly sensitive
gag reflex who have trouble adjusting to the palate in a conventional denture.
LIQUID SUPPORTED DENTURE
ROSTHODONTICS
Liquid supported denture is based on the theory that when the force applied
on the denture is absent, the base assumes its preshaped form that is the
one during processing.A complete denture is designed so that the base is
covered with a preshaped, close fitting, flexible foil containing a thin film
of high-viscosity liquid. This technique allows continued adaptation and
eliminates the disadvantages of denture designs based on the application
of temporary tissue conditioners or soft liners. In contrast to the traditional
tissue conditioners and soft liners, the foil remains elastic and preserves the
plasticity of the liquid.2
A clinical study by Gert Boere et al showed that it is possible to make a
liquid-supported denture that in general fits and feels comfortable, has proper
retention, a slightly diminished masticatory function, and that can provide a
solution to some problematic prosthodontic situations.3
Fibrous ridges pose a prosthodontic challenge for the achievement of stable
and retentive dental prosthesis. The use of liquid supported denture can
further improve the patients acceptance due to more uniform distribution of
forces and due to the improved comfort level.
RESERVOIR DENTURE
Reservoir dentures are given in Xerostomia patients. Xerostomia is defined
as the dry mouth resulting from the reduced or absent salivary flow. Saliva
plays an important role in retention and comfort of denture. In patients
with extreme or prolonged dry mouth, substances that replace lost salivary
function and components can be used. These options include artificial saliva,
which humidifies the oral cavity, particularly protecting it from irritating
mechanical or chemical factors and infections
Saliva substitute has been used effectively to help dialysis patients control
water intake. It has also successfully aided psychiatric patients with
xerostomia caused by drug regimens. In many instances, a palatal reservoir
could be incorporated into a removable partial or complete maxillary denture
to act as a vehicle for delivery of saliva substitute.4
The major drawback of artificial saliva is that it must be mechanically
introduced into the oral cavity by the patient at regular intervals. Patients
object to carry a bottle of artificial saliva and would prefer a more convenient
saliva delivery system in the form of reservoir dentures or oral lubricating
devices. The reservoir dentures store the artificial saliva and thus keep the
oral cavity moist
Vergo and Kadish in 1981 developed an intraoral saliva reservoir in the
hollowed lingual flange of a mandibular denture. Their results were poor
Your Guide on the path of Dentistry | GUIDENT 27
Prosthodontics
P ROSTHODONTICS
because adequate cleansing of the denture was difficult, which prevented
Dec 2015

flow of the saliva substitute into the mouth.5

A reservoir is not suitable for all patients. The large size of the maxillary and
mandibular reservoirs is required to provide storage of an adequate volume
of saliva. Therefore, an adequate reservoir cannot be constructed for patients
who have only a slight resorption of the mandibular alveolar process or a
shallow palatal vault.6 Artificial or natural mucin protects the oral mucous
membrane.7 Artificial saliva that contains fluoride has potential for enamel
hardening.8,9 A continuous flow of calcium, phosphate, and fluoride ions
around the teeth may be an important factor in reducing rampant caries. The
oral microflora may also be changed by this continuous flow. Rehardening CHARACTERIZED DENTURES
of the teeth and the influence of saliva substitutes on oral flora are under
investigation. Denture characterization is modification of the form and color of the denture
base and teeth to produce a more lifelike appearance. As said by Frush and
Fisher, the environment of the teeth is as important as the tooth itself. Thus
the two elements that must be considered in denture esthetics are teeth and
their supporting denture base. Complete dentures must be esthetic as well
as functional13 Hardy stated that, To meet the esthetic needs of the denture
patient, we should make the (denture) teeth look like (the patients) natural
teeth.14

Complete denture can be characterized by two basic methods.

OVERDENTURE
Any removable dental prosthesis that covers and rests on one or more
remaining natural teeth, the roots of natural teeth, and/or dental implants.
Synonyms are Biologic denture, Hybrid denture, Telescopic denture, Overlay
denture, Onlay denture, Tooth supported dentures, Super imposed denture
Crum and Rooney (1975) in a 5 years study found that the retention of
mandibular canines for over denture led to the preservation of alveolar bone.10
Jerge showed that the periodontal receptors actively influences the cyclic
joint movements of mastication by influencing the muscles of mastication by
their proprioceptive feedback mechanism.11
Study by Pacer and Bowman compared occlusal force discrimination between
conventional and overdenture wearers and found that overdenture patient
possessed more typical sensory function, i.e., closer to natural teeth than a
complete denture patient in discriminating between occlusal forces.12
The advantages of overdentures include, preservation of alveolar
bone,proprioceptive response, provides additional support & retention to
the prostheses, increased masticatory ability, increased patient acceptance,
periodontal maintenance, Harmony of arch form and convertibility.
The overdentures can be tooth supported or the implant supported. The
support gained in implant supported overdentures is from the implants rather
than the natural teeth hence there are some differences between the two.
1. Characterization by selection, arrangement and modification of artificial teeth.
2. Characterization by tinting the denture bases.15
Characterization by selection: (arrangement and modification of artificial
teeth). The teeth can be modified to harmonize with the patients age, sex, and
personality to provide subjective unity. Fisher said that gender, personality,
and age can be used as guidelines for tooth selection, arrangement, and
characterization to enhance the natural appearance of the individual.16
Pound in 1951 incorporated the racial and individual colour peculiarities, of
the gingiva in artificial denture. He was the first to suggest a method of
tinting acrylic denture bases to simulate the gingival colour. Kemnitzer used a
combination of blue and brown stain to reproduce the melanotic pigmentation
of the gingiva.17
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Rehabilitating a patient with loss of teeth with dentures may result in
increased confidence and social interactions due to positive esthetic changes.18
However sometimes the denture flanges do not give adequate support to the
facial muscles.The external form of lips and cheeks are reliant on the internal
structure of their underlying support. When cheeks and lips are unsupported
muscles do not function properly and become weak. As a result skin wrinkles

28 GUIDENT | Your Guide on the path of Dentistry

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Prosthodontics
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and the lips and cheeks sag. In order to deal with the slumped tissue extra
support might be required.19 This is achieved with the help of cheek plumper,
also known as cheek lifting appliance which is basically a prosthesis to support
and plump the cheek providing a youthful appearance.20 A cheek plumper can
be of two types: Detachable and Un-detachable.
Lazzari described the fabrication of a maxillary removable partial denture for a
patient with unilateral facial paralysis. The purpose of design was to elevate
and support the upper lip and corner of the mouth.21
HOLLOW DENTURE
Extreme resorption of the maxillary denture-bearing area may lead to
problems with prosthetic rehabilitation. These may be due to a narrower,
more constricted residual ridge as resorption progresses, decreased supporting
tissues, and a resultant large restorative space between the maxillary residual
ridge and opposing mandibular teeth.22
It has been proved that prosthesis weight can be reduced by making the
denture base hollow. To decrease the leverage, reduction in the weight of
the prosthesis would be beneficial (Brown, 1969l; el Mahdy, 1969).23, 24
It improves the cantilever mechanics of suspension and overtaxing of the
remaining supporting structures.
This technique greatly reduces the weight of an exceptionally heavy maxillary
denture. Whenever weight of a denture may be a contributing factor to the
successful resolution of a patients problem, the hollow denture should be
considered.
Various weight reduction approaches have been achieved using a solid three
dimensional spacer, including dental stone (Ackermen, 1955),25 cellophane
wrapped asbestos (Worley & Kniejski, 1983), silicone putty (Holt, 1981)
or modelling clay (DaBreo, 1990) during laboratory processing to exclude
denture base material from the planned hollow cavity of the prosthesis.26
Holt (1981) processed a shim of indexed acrylic resin over the residual ridge
and used a spacer which was then removed and the two halves luted with
auto polymerized acrylic resin.26
Fattore et al (1988), used a variation of the double flask technique for
obturator fabrication by adding heat polymerized acrylic resin over the
definitive cast and processing a minimal thickness of acrylic resin around the
teeth using different drag. Both portions of resin were attached using a heat
polymerized resin.27
ROSTHODONTICS
OSullivan et al (2004)22 described a modified method for fabricating a hollow
maxillary denture. A clear matrix of the trial denture base was made. The
various techniques mentioned can be used depending on the treatment need
and considering the shortfalls of the techniques.
DISCUSSION
Loss of teeth, a part of normal aging can be restored with complete dentures.
But not in all cases the conventional dentures will provide the needed
satisfaction to the patient, and hence few modifications are adapted to
enhance the lifestyle and dental care of the elderly. With increasing age,
treatment modalities become increasingly challenging.
Although the flangeless complete denture is not used routinely, it has been
successfully used for the treatment of edentulous patients with existing
bone and lip support. The modified maxillary denture is a valuable treatment
modality that should be considered when treating selected edentulous
patients.1
Studies with overdentures have shown to preserve the alveolar bone in the
mandible as compared to the patients with complete dentures showing eight
times more loss. It may be hypothesized that the discrete proprioceptiveability
of the teeth under an overdenture acts to signal against a physiologic overload
of the system and thus prevents bone resorption. In the complete denture
patients, the proprioceptive ability of the mucosa is poor, and the constant
overloading may result in alveolar bone loss. The sensory feedback input of
the tooth may contribute to the preservation of alveolar bone in overdenture
patients, while the absence of tooth sensory feedback in complete denture
patients may contribute to alveolar bone destruction.10
Extreme resorption of the maxillary denture-bearing area may lead to
problems with prosthetic rehabilitation. Reducing the weight of a maxillary
prosthesis,however, has been shown to be beneficial when constructing
an obturator for the restoration of a large maxillofacial defect.4,5 Given the
extensive volume of the denture base material in prostheses provided to
patients with large maxillofacial defects or severe residual ridge resorption,
reduction in prosthesis weight may be achieved by making the denture base
hollow.22
Liquid supported denture will have optimal stress distribution during
masticatory functions. Load from biting forces and even bruxism will be
distributed over a far larger surface. Thus pressure spots and overloading of
the supporting tissues may be reduced. Vertically directed loads will also be
distributed in other directions by the liquid, which minimizes local stressing
of the supporting tissues. The spreading of the pressure might also reduce
Your Guide on the path of Dentistry | GUIDENT 29
Prosthodontics
P ROSTHODONTICS
problems at the mental foramen in a resorbed mandible and a long-term
advantage could be a slower and more even resorption of the residual ridge.2
Reservoir dentures are of very importance in patients with xerostomia. For
optimal physiologic activity and protection of the oral cavity, continuous
coating of the mucous membranes with natural or artificial saliva is necessary.
In patients with xerostomia this may involve application of artificial saliva
with a squeeze bottle or atomizer. As the retention of a saliva substitute in the
mouth is short, this method of application does not provide a continuous flow
of saliva. Artificial saliva administered by an intra-oral reservoir guarantees
continuous flow into the mouth. Application of artificial saliva with an
intraoral reservoir appears to be acceptable to patients who rejected applying
artificial saliva with a squeeze bottle or atomizer. Thus prosthesis reservoir is
easy to construct,is easy to refill,can be cleaned easily, contains an acceptable
amount of artificial saliva, and is an important factor in the relief of symptoms
associated with xerostomia.6
CONCLUSION
Prosthetic dentistry in this era provides a vast variety of options in materials
and techniques for the treatment planning by understanding the need of
the patients. Evidence based dentistry should be adapted for treatment.
The nuances of prosthetic dentistry provides a prosthodontist to modify,
adapt and provide a prosthesis depending on the patient oral & systemic
condition, patient expectation and there by providing a functional, esthetic
and psychological satisfaction for the patient.
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