Dr Rakesh kumar yadav

Classifications

Tooth modification techniques

Indications Methods to obtain balanced occlusion Contraindications

Single denture
Materials used

Advantages

Complications Disadvantages

Single complete denture is a prosthesis which replaces the lost natural teeth and its associated structures functionally and esthetically as a single unit which opposes all or some of the natural teeth. single denture construction : The making of a maxillary or mandibular denture as distinguished from a set of complete dentures (GPT-1)

Mostly edentulous maxilla is seen. Why they are difficult conditions? Why single denture in maxilla are better then single denture construction in mandible?

Cases where a single denture in mandible are relatively acceptable.

Class III Cleft palate patients

SCD opposing natural teeth SCD opposing a preexisting complete denture SCD opposing a removable partial denture SCD opposing an overdenture SCD opposing an implant supported denture

Heavy occlusal forces Esthetics Supraeruption Mesial drifting A mandibular single complete denture opposing upper natural teeth is extremely complicated Combination syndrome Occlusal wear

Inoperable tori cleft or perforated palates Natural teeth that is sufficient in number A partially edentulous arch replaced by a fixed or removable partial denture.

Retrognathic mandible

Excessive loss of supporting bone Reduced vertical dimension Deranged occlusal plane Flared out opposing teeth

Maintains the vertical dimension Maintains the occlusal plane Maintains the residual ridge height Maintain the esthetic appearance and function for mastication, speech etc.

Supraerupted teeth can reduce the space available, making setting of artificial teeth a laborious process. A mandibular single complete denture opposing upper natural teeth is extremely complicated. Combination syndrome. Occlusal wear Fixed position of lower anterior

Class l: Patients for whom minor, or no, tooth reduction is needed to obtain balance Class 2: Patients for whom minor additions to the height of the teeth are needed to obtain balance. Class 3: Patients for whom both reductions and additions to teeth are required to obtain balance. The treatment of these patients usually involves a change in vertical dimension of occlusion. Class 4: Patients who present with occlusal discrepancies that require addition to the width of the occluding surface. Class 5: Patients who present with combination syndrome.

Swensons technique Yurkstas Method: Bruces Method: Bouchers method :

Maxillary base is made and denture teeth are set Any interference adjusted on cast which acts as guide Natural teeth are modified Teeth with modified occlusal surface is mounted again Final try in

Yurkstas Method:1968

Metal U shaped occlusal template, slightly convex on lower surface

Bruces Method: Modifications on stone cast occlusal surfaces Clear acrylic resin template pressure indicating paste used

Bouchers method : Cast mounted Maxillary porcelain teeth arranged Placed opposing mandibular stone cast Denture processed Comparison of natural teeth and altered stone casts Natural teeth ground Base plate wax

Antreiors and premolars Severely tilted molars in centric and excursive movements Ideal treatment for tilted molars?
onlays Cast gold crowns Bridge Rpd with crowning the teeth

Natural teeth ? Complete denture? In single denture

A. Orthodontic Means Intrusion, Extrusion, Etc.

B. Placing Restorations Crowns, Onlay Prosthesis C. Occlusal Grinding To Reshape The Teeth And to Create a Suitable Occlusal Surface with low cusp height.

Methods used to obtain a balanced occlusion

Teeth modified, final impression made, cast mounted Two techniques Functional chew in techniques Articulator equilibration techniques

Functional chew-in techniques Stansbury 1928 Intraorally Record base stability Good neuromuscular control Mental competence

Stansburys technique : Compound maxillary rim trimmed buccally and lingually Carding wax used Perform eccentric movements till VD is reached Occlusal rim removed stone is vibrated into the generated pathways positive stone cast of generated occlusion

Denture teeth set Try-in Lower cast removed replaced by lower chewin cast record Interfering spots ground.

Vigs technique : Fin of resin placed contacting the central fossae Helps to diagnostically locate the interfering lower cusps In eccentric movements the lower cusp tips are ground until equal contact occurs between teeth and resin Fin then built up using a soft wax, and a functional path is recorded

Sharrys technique:

Maxillary rim of softened wax is used Lateral and protrusive chewing movements are made generating the functional paths of the lower cusps

Continued until correct vertical dimension

Rudds technique :

Compound maxillary rim Thickness of recording wax made up of three sheets of medium hard pink base plate wax and two sheets of red counter wax, is added to the buccal and lingual surfaces of the compound rim.

Using two maxillary bases

Articulator equilibration techniques :

First upper cast is mounted using a face-bow Lower cast related to upper at acceptable VD Buccal-lingual position of lower teeth and their relation to upper arch

Tipped and inclined natural teeth ? Other cusp other then holding cusp is reduced

Wax try in Condylar inclinations set in articulator Denture processed Remounted , eccentric balance achieved Two colors of articulating paper to differentiate

Occlusal materials for the single complete denture Porcelain teeth Acrylic resin teeth Acrylic resin with amalgam stops IPN resin Gold occlusals

Potential adverse treatment outcomes Natural tooth wear Maxillary porcelain denture teeth Cast restorations less resistant New generation acrylic/composite resin denture teeth are ideal. Denture fracture Heavy anterior occlusal contact Deep labial frenal notches High occlusal forces due to excessive action of the masseter

Frequently seen Sufficient teeth in mandibular arch, acceptable periodontal health, no missing teeth Number of mandibular teeth considered sufficient should include first molars Alter the clinical crowns of the teeth by grinding or with restorations

When the restorations are acceptable The same principles of occlusion that apply to complete dentures apply to the single complete denture

Material considerations

The occlusal plane, tooth arrangement for occlusion, esthetics, and the material composition of the teeth must be such that an accepted complete denture can be constructed to oppose it

When both planned together

1. Preservation of Residual Ridge 2. Necessity for Retaining Maxillary teeth 3. Mental Trauma

Systematic approach 1. How long has the existing denture been in used?

2. Was the denture an immediate insertion at the time of tooth removal?

Gives us idea -bone resorption. Use of pressure disclosing paste

3. Does the denture meet the requirements of an acceptable denture?

Tooth position,condition of polished surface,occlusal plane

4. Has the denture opposed another denture? 5. Is the operator satisfied to institute complete denture procedures utilizing the existing denture?

Combination syndrome Wear of the natural teeth Fracture of the denture

By kelly E 1972

Kelly E. Changes caused by a mandibular removable partial denture opposing a maxillary complete denture. J Prosthet Dent (1972) , 27:140150..

Sequence 2 Starts in mandible in distal extension area. And continuous as in previous case

anterior maxillary ridge resorption papillary hyperplasia in the hard palate maxillary tuberosity hypertrophy extrusion of the mandibular anterior teeth bone loss under the partial denture base

Saunders et al in 1979 added to the description of the combination syndrome by including destructive changes such as loss of occlusal vertical dimension, occlusal plane discrepancy, anterior spatial repositioning of the mandible, poor adaptation of the prostheses, epulis fissuratum and periodontal changes.

Saunders T et al ,The maxillary complete denture opposing the mandibular bilateral distal-extension partial denture: treatment considerations. J Prosthet Dent 1979;41(2):124-8.

  

Extraction of remaining anterior mandibular teeth CD/CD. Implants placed in the posterior region. Or Over dentures Maximum coverage of the distal extension ridges in RPD.

Winkler S, Essentials of complete Denture prosthodontics, 2nd edition, India ,AITBS Publishers , 1996, pp 417-426. Bolender, Zarb G, Prosthodontic treatment for edentulous patients, India, 12th edition, Elsevier publications, 2004, pp 427- 436 Rahn A O and Heartwell C M, Textbook of complete dentures, 5th edition, U.S.A, Lea and Febiger Publications, 1993, pp 481- 492.

Sharry J J , Complete denture Prosthodontics, 3rd edition, Mc Graw Hill company, pp 310-319. Manappallil J.J, Complete denture prosthodontics, 1st edition, India, Arya publishers, 2006 , pp 323328

Deepak Nallaswamy, Textbook of Prosthodontics ,1st edition, India, Jaypee Publications, 2003, pp 250-254 Kelly E. Changes caused by a mandibular removable partial denture opposing a maxillary complete denture, J Prosthet Dent (1972) , 27:140-150. Saunders et al, The maxillary complete denture opposing the mandibular bilateral distal-extension partial denture: Treatment considerations. J Prosthet Dent (1979) ,41:124-128.

Driscoll et al ,Single maxillary complete denture,Dent Clin N Am 48 (2004) 567583