excessive inter ridge space case

Journal of Interdisciplinary Dentistry / Jan-Jun 2011 / Vol-1 / Issue-1 45

I t is obvious that in large maxillofacial defects and in severe resorption of the edentulous

ridges, there is a decreased denture bearing area for support, retention and stability. Increased interridge space compounds this problem. To decrease the leverage, reduction in the weight of the prosthesis was recommended and was also found to be beneficial. [1,2] Various weight reduction approaches have been achieved using a solid three-dimensional spacer, including dental stone,[1-6] cellophane wrapped asbestos,[7] silicone putty[8] or modeling clay[9] during laboratory processing to exclude denture base material from the planned hollow cavity of the prosthesis.

Holt et al,[8] 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.

Fattore et al,[10] used a variation of the double flask technique for obturator fabrication by adding

heat polymerizing acrylic resin over the definitive cast and processing a minimal thickness of acrylic resin around the teeth using a dif ferent drag. Both portions of resin were attached using a heat polymerized resin.

O’Sullivan et al,[11] described a modified method for fabricating a hollow maxillary denture. A clear matrix of the trial denture base was made. The trial denture base was then invested in the conventional manner till the wax elimination. A 2 mm heat polymerized acrylic resin shim was made on the master cast using a second flask. Silicone putty was placed over the shim and its thickness was estimated using the clear template. The original flask with the teeth was then placed over the putty and the shim and the processing was done. The putty was later removed from the distal end of the denture and the openings were sealed with auto polymerizing resin.

The technique was useful in estimation of the spacer thickness, but removal of putty was found to be difficult especially from the anterior portion of the denture. Moreover, the openings made from the distal end had to be sufficiently large to retrieve the hard putty. In this case report, a 45-year-old edentulous male patient with increased interridge distance was treated with a light weight maxillary denture, using thermocol, a common packing material, as spacer.

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DOI: 10.4103/2229-5194.77208

Cas

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t Light weight maxillary complete denture: A case report using a simplified technique with thermocolVibha Shetty, Sivaranjani Gali, Smitha Ravindran

Department of Prosthodontics, M S Ramaiah Dental College And Hospital, Bangalore, Karnataka, India

Address for correspondence: Dr. Sivaranjani Gali, E-mail: [email protected]

ABSTRACT

The success of a complete denture relies on the principles of retention, stability and support. The prosthodontist’s skill lies in applying these principles efficiently in critical situations. Severely resorbed maxillary edentulous ridges that are narrow and constricted with increased inter ridge space provide decreased support, retention and stability. The consequent weight of the processed denture only compromises them further. This article describes a case report of an edentulous patient with resorbed ridges where a simplified technique of fabricating a light weight maxillary complete denture was used for preservation of denture bearing areas.

Key words: Complete dentures, hollow maxillary denture, inter ridge distance, light weight dentures, residual ridge resorption

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Journal of Interdisciplinary Dentistry / Jan-Jun 2011 / Vol-1 / Issue-146

CASE REPORT

A 45-year-old patient walked into the dental clinic with a chief complaint of replacing missing teeth. He had been edentulous for 10 years and had been wearing dentures for 7 years. On examination, he had severely resorbed ridges, the upper being narrow and constricted and with an interridge space of 38 mm [Figure 1]. Other clinical abnormalities were not seen.

Because of narrow constricted ridges and increased interridge distance, a criss-cross teeth arrangement (with the lower right posterior teeth placed on the upper left posterior ridge and lower left posterior teeth placed on the upper right posterior ridge) was planned for better stability as the forces are directed better towards the ridges. A light weight maxillary complete denture was planned to counteract the lateral forces better and decrease leverage.

Technique

1. Keeping in mind the strength of the denture, the distance from the teeth to 3 mm of the denture

base was calculated. The rest of the denture base till the border was then calculated [Figures 2 and 3]. Therefore, the spacer would occupy the area between the shim of 2 mm thickness and teeth with 3 mm of the denture base.

2. The trial denture base was invested and processing carried out till the wax elimination stage. Two layers of hard base plate wax over the definitive cast in the drag (lower half of the flask or the cast side) conforming to the border extensions was added [Figure 4].

3. A second flask was used to invest the base plate wax till wax elimination stage and the cope (upper half of the flask or cavity side) was packed and processed with heat polymerizing resin [Figure 5].

4. The second cope with the polymerized acrylic resin shim of 2 mm attached with the drag was separated. A denser thermocol was placed over the bur roughened acrylic shim along the ridge and luted with cyanoacrylate [Figure 6].

5. The spacer thickness was modified according to the calculation done above, leaving 3 mm from the teeth to the denture base.

Figure 1: The casts mounted on the articulator with the interridge distance

Figure 3: Calculate the distance of 2 mm of denture base Figure 4: 2 mm of modeling wax on the definitive cast

Figure 2: Calculate the distance from teeth to 3 mm of denture base

Shetty, et al.: Light weight maxillary denture



Journal of Interdisciplinary Dentistry / Jan-Jun 2011 / Vol-1 / Issue-1 47

6. The original cope over the drag was reseated and complete closure of the flask was verified. The heat polymerizing resin was then mixed, packed and processed at 74oC for 7-8 h. Pre insertion occlusal corrections were made and the denture was inserted in the patient’s mouth [Figures 7 and 8].

DISCUSSION

The method described has advantages over the previously described techniques. Thermocol being a light weight material can be left in the denture without compromising the integrity of the denture, avoiding the tedious effort to remove the spacer material from the denture. Moreover, the small window in the cameo surface in the previous techniques has potential for leakage between the heat polymerized resin and auto polymerized resin portions. This technique is simple to execute and allows control of spacer thickness.

CONCLUSION

A simplified technique for fabricating light weight maxillary denture using thermocol as a spacer that can be left in the denture without compromising denture strength.

REFERENCES

1. el Mahdy AS. Processing a hollow obturator. J Prosthet Dent 1969;22:682-6.

2. Brown KE. Fabrication of a hollow bulb obturator. J Prosthet Dent 1969;21:97-103.

3. Ackermann AJ. Prosthetic management of oral and facial defects following cancer surgery. J Prosthet Dent 1955;5:413-32.

4. Nidiffer TJ, Shipman TH. Hollow bulb obturator for acquired palatal openings. J Prosthet Dent 1957;7:126-34.

5. Rahn AO, Boucher LJ. Maxillofacial prosthetics: Principles and concepts. St. Louis: Elsevier; 1970. p. 95.

6. Chalian VA, Drane JB, Standish SM. Intraoral prosthetics. In: Chalian VA, Drane JB, Standish SM, editors. Maxillofacial Prosthetics: Multidisciplinary Practice. Baltimore: Williams and Wilkins; 1971. p. 133-57.

7. Worley JL, Kneijski ME. A method for controlling the thickness of

Figure 5: Heat cured shim of denture base processed on the definitive cast Figure 6: Thermocol luted to the denture base

Figure 8: Denture inserted in the patient’s mouthFigure 7: Denture inserted in the patient’s mouth




Journal of Interdisciplinary Dentistry / Jan-Jun 2011 / Vol-1 / Issue-148

Source of Support: Nil, Conflict of Interest: None declared.

hollow obturator prosthesis. J Prosthet Dent 1983;50:227-9.

8. Holt RA Jr. A hollow complete lower denture. J Prosthet Dent 1981;45:452-4.

9. DaBreo EL. A light cured interim obturator prosthesis: A clinical report. J Prosthet Dent 1990;63:371-3.

10. Fattore LD, Fine L, Edmonds DC. The hollow denture: An alternative

treatment for atrophic maxillae. J Prosthet Dent 1988;59:514-6.11. O’Sullivan M, Hansen N, Cronin RJ, Cagna DR. The hollow

maxillary complete denture: A modified technique. J Prosthet Dent 2004;91:591-4.




excessive inter ridge space case

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