Case reports ivitíi cCinicaC tecíiniques AnnaCs andEssences of (Dentistry

doi:10.5368/aedj.2011.3.1.2.1

SAVING ONE IS BETTER THAN NONE- TECHNIQUE FOR CU-SIL LIKE DENTURE-A CASE REPORT

^Meenakshi Khandelwal ^ Reader

^ Senior LecturerVikas punia

'^ Department of Prosthodontics, Darshan Dental College and Hospital, Udaipur, Rajasthan, India

ABSTRACTThe prime focus of present day Dentistry is on preservation of teeth, thereby preserving alveolar ridge integrity

and proprioceptive abilitv of periodontium. It also has positive psvchologic effect on patient. Transitional dentures serve asone of the treatment option for patients presenting with very few remaining teeth, in compromised condition. A relativelynewer type of transitional dentures is Cu-Sil dentures. A Cu-Sil denture is essentially a complete denture with holes linedwith a rubber gasket, allowinq the remaining natural teeth to protrude through. Cu-Sil dentures require specialarmamentarium and material for their processing. This case report presents an alternative technique to fabricate Cu-Sil likedentures in normal dental set-up as a lab procedure or ehairside procedure using commonly available long term soft liners.

KEY WORDS: Cu-Sii Denture, Cu-Sil like Denture, Transitional Denture.

INTRODUCTION

Dentistry have long reeognized the differeneethat the presence of teeth makes to preservation ofalveolar ridge integrity. Therefore the prime focus ofpresent day Dentistry is on preservation of teethand periodontium. Some of the consequences oftotal loss of teeth followed by complete denturewearing include psyehologieal trauma, laek ofstability, laek of retention, residual ridge résorption,undermined esthetie appearanee, eompromisedmastieatory funetion ete. '̂̂ '̂ The preservation ofeven a single healthy tooth in the oral cavity canstabilize an otherwise unstable denture.

Various researchers including Crum andRooney'' and Van Waas et al^ have eoneluded intheir studies that there is relatively far lessrésorption of alveolar bone when some teeth arepresent as eompared to alveolar résorption found inedentulous patients. Another advantage ofpreserving natural teeth is maintenanee ofproprioeeptive ability of periodontium. It also haspositive psyehologle effeet on patient.

The treatment options for patients having veryfew teeth remaining ineludes overdentures ortransitional dentures or immediate denturesfollowing eomplete extraetions.^ Overdentures

cannot serve a solution for all such cases becauseof contraindications, need for prerequisite treatment,poor positioning of remaining teeth, requirement ofmore patient visits and economic reasons.'^^ Mostof the patients defer getting all their teeth extractedas it has a mutilating effeet on their psychology.Thus transitional dentures serve as treatment optionfor many of such patients. A relatively newer type oftransitional dentures is Cu-Sil dentures.

A Ci>Sil denture is essentially a completedenture with holes allowing the remaining naturalteeth to protrude through. Normally the key to retaina complete denture is the suction that is obtained byintimate contact of denture to tissues and adequateperipheral seal. A hole allowing a tooth to protrudethrough disturbs the peripheral seal and breaks thesuction. The Cu-Sil denture is unique because thehole that surround the natural teeth are lined with arubber gasket which snugly holds the teeth whileallowing a natural suction to form under the denturein addition to the meehanieal stability offered byimmobility of natural teeth. Even a single remainingteeth increases the stability of denture severaltimes. But fabrieation of Cu-Sil dentures requiresspeeial armamentarium and material whieh makes itteehnique sensitive, time eonsuming and expensive.

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Case reports wit/i cdnicaC techniques AnnaCs and'Essences of (Dentistry

Fig.1. Preoperative view showing teeth inocclusion

Fig. 3. Trial closure for maxillary denturebeing done

Fig.5. Tissue surface of maxillary denture withholes for remaining teeth lined by acrylic

based soft liner

Fig .2. Putty adapted around cervical regionof remaining teeth on maxillary cast

Fig.4. Adaptation of acrylic based long termsoft liner around remaining teeth

Fig. 6. Postoperative view in occlusion showingmaxillary Cu-Sil like denture and mandibular

RPD in place

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Case reports ivith cdnicaC techniques AnnaCs andEssences of (Dentistry

Here we are reporting the management of acase of a 48 year old male patient with mandibularkennedys class I mod.1 partially edentulous archand maxillary three teeth remaining. An alternativetechnique to fabricate Cu-Sil like dentures in normaldental set-up as a lab procedure or chairsideprocedure using commonly available long term softliners is described.

Case report

A 48 year old male patient reported to thedepartment of Prosthodontics, Darshan DentalCollege and Hospital, Udaipur, for replacement ofmissing teeth. Dental history revealed that themissing teeth were extracted due to periodontalreasons. The patient had already undergoneperiodontal therapy for remaining teeth. Systemichistory revealed no significant finding. A preliminaryexamination revealed mandibular kennedy's class Imod 1 partially edentulous arch with missing mod 137,41,44,46,47. In maxillary arch only three teethwere remaining; that were 14,23,25 (Fig.1). All theteeth were afteeted periodontally by generalizedreeession. Mandibular anterior teeth were supra-erupted and had grade II mobility. Mobility of allother teeth was grade I. Oral hygiene was fair.Extraoral examination showed no significant finding.Radiographie examination revealed generalizedbone loss of all teeth upto middle third of root.

Because of compromised state of existing teeth;a definitive treatment plan could not be worked outfor this patient. Thus it was decided to fabricate atreatment partial denture for the mandibular archand a transitional denture for maxillary arch.Transitional RPD in maxillary arch could not befabricated due to drifting of remaining teeth andundesirable undercuts. Thus it was decided tofabricate a Cu-Sil like denture (complete denturewith holes for remaining teeth) for maxillary archwith a difterent technique.

Procedure

Diagnostic impressions were made withirreversible hydrocolloid. Custom trays werefabricated with autopolymerizing acrylic resin.Mandibular final impression was made by pick upimpression technique. Maxillary final impressionwas made by Campagna's technique^ used forimmediate denture impressions. This technique

provides advantage of recording the limitingstruetures as for eomplete denture impressions. Jawrelation recording and try-in procedure wasexecuted in routine manner. Wax-up andprocessing for mandibular removable partial denturewas done.

Wax-up for maxillary cusil-like denture wasdone similar to wax-up of complete dentureextending upto all limiting structures and aroundteeth that were present.

Processing of maxillary denture:

Maxillary cusil-like denture can be fabricatedusing the following materials-

1. Acrylic based long term soft liners2. Silicone based long term soft liners

Teclinique 1

This is used for acrylic based soft liners.Wax-up around the remaining teeth in maxillary castwas made thick. Flasking and wax elimination wasperformed. After wax elimination, around theremaining teeth on the maxillary cast an inertmaterial like putty or hard wax was adapted nearthe cervical region, in adequate thickness(Flg.2).Separating media was applied on both parts ofmould, packed with acrylic resin and trial closurewas done with putty placed around remaining teethon the cast (Fig.3). The placement of putty aroundteeth provided space for soft liner material. Aftertrial closure putty index was removed from theteeth. Freshly mixed acrylic based long term softliner (Permasoft soft denture liner, Dentsply India)was adapted around the remaining teeth on the castto occupy space created by removal of putty index(Fig.4). Flask was closed and curing done. Thedenture retrieved after deflasking was a completedenture having holes for natural teeth lined by softliner (Fig.5). It was finished, polished and insertedin the patient (Fig.6).

Technique-2

It is a chairside procedure used for siliconebased soft liners. The maxillary trial denture wasprocessed by normal procedure of flasking andproeessing. After the denture was finished andpolished, the spaee in the denture for remainingteeth was widened to give elearanee of 4-5 mm.

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Case reports witfi cCinicaC techniques AnnaCs andEssences of (Dentistry

Flg.7. Space created in denture for chairside procedure Fig.8. Finished maxillary denture with sillcone basedlong term soft liner around remaining teeth

around the teeth (Fig.7). Silicon adhesive wasapplied to denture. Denture was inserted in patient'smouth and held in position. Silicone soft liner baseand catalyst (Ufi Gel, Voco, Cuxhaven Germany)were mixed and adapted to occupy space betweendenture and natural teeth. After sefting of thematerial denture was removed, trimmed andfinished with silicone finishing agents (Fig.8).Silicone glaze was applied for polishing and dentureinserted in patient's mouth.

Post insertion instructions were same as forany removable prosthesis. As there are chances offungal growth on the soft liner material, special carehas to be taken regarding maintenance of excellentoral and denture hygiene. Use of denture cleanserswith antimicrobial agents can be recommended.

Discussion

Cu-Sil like dentures are designed to preservethe remaining natural teeth and thus the alveolarbone. They have a dramatic effect on retention andstability of dentures. In addition to this it gives thepatient psychologic satisfaction of retaining thenatural teeth as they were, i.e. without anymodification. Vertical dimension and proprioceptionis maintained by retained natural teeth. Attachmentdevices are avoided entirely.

This treatment modality does not require anytooth preparation and extra patient visit. It can beprocessed with routine steps or as a chairsideprocedure, and does not require any special

armamentarium and material as Cu-Sil dentures. Italso has economic advantage over Cu-Sil dentures.Future add-ons and relines are possible. If a tooth islost in future, existing denture can be modified tooccupy its place.

These dentures are to be used in cases whenthe natural teeth are poorly distributed across thedental arch or when the remaining natural teeth arelikely to be lost. They serve as a solution for singlestanding or isolated teeth present in dental arch.They are not indicated for patients with largenumber of teeth evenly distributed across the dentalarch. They should be avoided in patients with heavybite and habit of bruxism.

These dentures are associated with somedisadvantages. The functional duration of elasticmaterial used is short. It needs frequent corrections.Entire gingival margin of remaining teeth is coveredleading to plaque accumulation.

CONCLUSION

Cu-Sil like dentures serve as a viable treatmentalternative for patients with very few remainingteeth. They rest on the soft tissues while provide asnug fit over existing, healthy tooth structures. Anelastic gasket seals itself around the cervical part ofeach tooth, thereby providing a stable and healthyfit. It promotes healthy stimulation to maintainalveolar bone. Retention is improved, attachmentdevices are avoided, vertical dimension and

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proprioception are maintained. Factors to beconsidered during treatment planning includenumber of teeth present, their distribution across thearch, periodontal status and undercuts.

References

1. Zarb-Bolender: Prosthodontic treatment foredentulous patients, 12'^ ed. Mosby.6-23,160-176,190-208

2. Sheldon Winkler: Essentials of completedenture prosthodontics, 2"" ed.lshiyakuEuroAmerica Inc.U.S.A. 22-34,384^02

3. George A. Zarb, Charles L. Bolender, JudsonC. Hickey, Gunnar E. Carlsson. Boucher'sProsthodontic treatment for edentulous patients,lO'^'ed. Mosby.71-99

4. Crum RJ, Rooney GE Jr: Alveolar bone loss inoverdentures- a 5 year study. J Pros Dent1978;40:610-13.

5. Van Waas MAJ, Jonkman REG, Kalk W et al:Difterences two years after tooth extraction inmandibular bone reduction in patients treatedwith immediate overdentures or with immediatecomplete dentures. J Dent Res 1993;72: 1001-1004.

6. Ivy S. Schwartz and Robert M. Morrow:Overdentures- Principles and Procedures. TheDental Clinics of North America 1996: 40-1:169-94.

7. Richard R. Seals, Jr, William A. Kuebkar andKenneth L. Stewart: Immediate CompleteDentures. The Dental Clinics of North America1996:40-1:151-67.

Corresponding Author

Dr.Meenakshi Khandelwalc/o Mr. O.P. Gupta

978, Gyan Nagar, Sec-4, Hiran Magri,Udaipur (Raj) 313002

Phone-9461546500, 9214179643e-mail- monakhandfilwalrg)rediftmail.com

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