single complete denture
TRANSCRIPT
SREE BALAJI DENTAL COLLEGE AND HOSPITAL
SINGLE COMPLETE DENTURE
Submitted by: Dawn Meera Bose Final Year B.D.S.
SRI BALAJI DENTAL COLLEGE AND HOSPITAL
DEPARTMENTOF PROSTHODONTICSCERTIFICATE
This is to certify mr/miss………………………………….has satisfactorily completed the project work prescribed by THE BHARATH INSTITUTE OF HIGHER EDUCATION AND RESEARCH INSTITUTE,Deemed university for final year BDS course during the period 2006-2007.
University register no:………………..
Place:Date
Guided by :
Dr. BHOOMINATHAN MDS HEAD OF THE DEPARTMENTProf. Dept. Of Prosthodontics. Department of Prosthodontics
SINGLE COMPLETE DENTURE
CONTENTS
S No. INDEX Pg No.
1. INTRODUCTION 1
2. CLASSIFICATION 2 3. INDICATIONS 3
4. DISADVANTAGES 4
5. DIAGNOSIS AND TREATMENT PLANNING 5
6. OCCLUSAL MODIFICATION 7
7. MAXILLARY COMPLETE DENTURE OPPOSING A COMPLETE MANDIBULAR 11 NATURAL DENTITION
8. MAXILLARY COMPLETE DENTURE OPPOSING A MANDIBULAR PARTIAL DENTURE 12
9. MANDIBULAR SINGLE DENTURES 20
(1)
INTRODUCTION
In this we consider a patient with single edentulous arch. The
prevalence of the condition where one edentulous arch opposes a natural
or restored dentition is quite common. It has been estimated that for some
patient population the mandibular cannines are retained four times longer
than other teeth followed by mandibular incisions. This indicates the
maxillary arch exhibits earlier tooth loss, however the reasons are unclear
but influenced by a combination of factors.
It is important that the clinician appreciate the oral conditions that may
predispose these patients to complications following treatment with
convectional complete dentures.
(2)
CLASSIFICATION
SINGLE COMPLETE DENTURES:
MAXILLARY COMPLETE DENTURE OPPOSING A MANDIBULAR NATURAL DENTITION
MAXILLARY COMPLETE DENTURE OPPOSING A MANDIBULAR PARTIAL DENTURE
MANDIBULAR COMPLETE DENTURE OPPOSING A MAXILLARY NATURAL DENTITION
MANDIBULAR COMPLETE DENTURE OPPOSING A MAXILLARY PARTIAL DENTURE
(3)
INDICATIONS
In patients with discrepancies in jaw size who require a complete
denture, it is advisable to retain teeth in mandible.
In patients with inoperable cleft or perforated palates, it is advisable to
retain teeth in maxillary arch. This is because the convectional
maxillary complete denture would be a failure due to absence of
peripheral seal.
(4)
DISADVANTAGES
Malposed, tipped or supra-errupted teeth in lower arch with interfear
with balanced occlusion. The imbalance may produce soreness
mucosal changes and ridge resorption in maxilla and the maxillary
denture will tend to get displaced.
As the lower anteriors are present in a fixed position it is difficult to
obtain esthetic teeth arrangement.
Use of acrylic teeth opposing natural teeth will produce abrasion of the
acrylic teeth where as use of porcelin teeth opposing natural teeth will
produce abrasion of natural teeth.
(5)
DIAGNOSIS AND TREATMENT PLANNING
When only one arch is edentulous tooth positions in the dentate arch
may preclude occlusal biomechanics being reached.
Unfavorable force distributions may then cause adverse tissue
changes that compromise optimum function. It is therefore, important to
identify such clinical changes and correct them.
These changes includes:
Extensive morphological changes in denture formation that can result
in arch relationship or occlusal plane discrepancies.
Jaw relationship extremes or
Excessively displaceable denture bearing tissue.
Extensive morphological change occurring following extraction of teeth
creates horizontal discrepancy between arches anteriorly and
(6)
posteriorly and makes it difficult to direct occlusal forces to the denture
bearing surfaces.
This can be corrected by placing the tooth in a reverse
horizontal overlap or cross bite arrangements. However, such
correction is not possible for anterior discrepancy due to esthetic
impact on max lip of such a tooth position.
Extremes of jaw relationship also makes if very difficult to place the
denture teeth in a position that allows the denture bearing area to be
in line with occlusal support.
This can be corrected by placing the posterior teeth in an reverse
horizontal overlap or crossbite relationship.
Conditions in opposing arch specially irregular occlusal plane can
dispose problems to patient with single complete denture.
Selective grinding of tooth can be done as a treatment procedure.
(7)
OCCLUSAL MODIFICATION
Occlusal modification of the remaining natural teeth is usually required
prior to the construction of single complete denture. It is a preprosthetic
procedure where occlusal discrepancies in natural teeth are corrected. If
can be done in one of the following methods:
SWENSON TECHNIQUE:
A tentative teeth arrangements is done using a diagnostic caste the
occlusal discrepancies are marked and reduction is done in patients
mouth.
YURKSTAS TECHNIQUE;
(8)
A ‘U” shaped slightly convex metal plate is positioned over natural
teeth and the occlusal discrepancies are recorded.
These discrepancies are reduced in diagnostic cast. The reduced cast
is used as guide to reduce the natural tooth.
BRUCE TECHNIQUE;
The occlusal discrepancies are arbitorly reduced in diagnostic cast. An
acrylic resin template is made over reduced cast. The natural teeth are
reduced till acrylic plate sets properly against them.
(9)
BOUCHER ET AL TECHNIQUE;
The cast are articulated using a tentative jaw relation. Artificial porcelin
teeth are set on edentulous cast and this arrangement is made to more
against the teeth of opposing cast. As porcelin is hard it will abrade
against the occlusal discrepancies. The denture is processed and
(10)
finished During insertion the abraded opposing cast is used
. as a guide to reduce the occlusal discrepancies of natural
teeth in patients mouth.
(11)
MAXILLARY COMPLETE DENTURE OPPOSING A COMPLETE
MANDIBULAR NATURAL DENTITION;
These dentures are maxillary complete dentures opposing a complete
set of mandibular natural teeth.
Gross occlusal discrepancies are common and require occlusal
adjustments and orthodontic correction.
Some important points to be considered during the construction of
these dentures are:
The morphology of natural teeth will determine the selection of
the artificial teeth.
Eg,. The size and shade of artificial teeth should match the
natural teeth
If mandibular teeth are attriated, 0° or cuspless teeth are
preferred.
It mandibular teeth are not attriated, anatomic teeth are
preferred.
(12)
MAXILLARY COMPLETE DENTURE OPPOSING A MANDIBULAR
PARTIAL DENTURE
These dentures are clinically very significant due to their complications.
Teeth selection is very important in fabrication of the denture.
Artificial teeth for these dentures are selected based on following
factors;
Porcelin teeth - if opposing partial denture has porcelin
teeth.
Acrylic teeth - If opposing natural teeth have gold or metal
crowns.
Acrylic teeth - If opposing natural teeth or partial denture
with artificial acrylic teeth.
COMPLICATIONS;
Combination Syndrome
Wear of natural teeth
Fracture of denture
(13)
COMBINATION SYNDROME;
INTRODUCTION:
It was identified by Kelly in 1972 in patients wearing a maxillary complete
denture opposing a mandibular distal extension denture base.
PATHOGENESIS:
This syndrome progresses in a sequalae / sequential manner. Progress of
disease can occur in any one of following sequence.
SEQUENCE I
Patient tend to concentrate the occlusal load on remaining natural teeth i.e.
mandibular anterior for proprioception.
This more force acting on anterior portion of maxillary denture.
Increased resorption of anterior part of maxilla, replaced by flabby tissue
occlusal plane gets tilted anteriorly upwards and posteriorly downwards due to
lack of anterior support.
Labial flange will displace and irritate labial vestibule – formation of epulis
fissuratum.
(14)
Posteriorly there will be fibrous overgrowth of the tissues in the maxillary
tuberosity.
Shift of occlusal plane posteriorly downwards produced resorption in
mandibular distal extension denture bearing area.
Due to tilt of occulsal plane mandibular shift anteriorly during occlusion.
Retension and stability of denture decreased. Vertical dimension of occlusion
also decreased.
Tilt in the occlusal plane disoccludes the lower anteriors causing them to
supra-errupt.
Supra-errupt anteriors increase the amount of force acting on the anterior part
of the complete denture and thus the viscious cycle continues.
(15)
A. Excessive load on anterior region of complete denture
B. Ridge resorption in maximum anterior region epulis fissuratom is
formed in maxillary labial sulcus.
C. Downward movement of posterior plane of occusal producing
excessive resorption of mandibular posterior region.
D. Downward titling of occlusal plane in posterior region produces
anterior open bite causing supra-erruption of lower anteriror. This
again increase load on anterior region producing a vicious cycle.
(16)
SEQUENCE II
Gradual resorption of the distal extension residual ridge in the mandible.
Tilting of the occlusal plane posteriorly downwards and anteriorly upwards.
Rest of the cycle occurs similar to sequence I.
Combination syndrome should be identified at an early stage and prevented.
Planning over dentures and designing implant supported dentures are some
of the methods to prevent combination syndrome.
(17)
(18)
A. Ridge resorption in mandibular edentulous area.
B. Downward movement of the posterior part of the maxillary denture
and formation of flabby tissue.
C. Supra erruption of lower anterior.
D. Increased load in mandibular anterior region of complete denture.
E. Resorption in anterior portion of maxillary ridge and formation of
flabby tissue.
(19)
WEAR OF NATURAL TEETH:
When porcelin teeth are used, severe abrasion of the opposing natural
teeth will occur.
Thus proper selection of tooth material is important.
Care to be taken to avoid occlusal discrepancies.
DENTURE FRACTURE:
This condition is common in cases with single complete denture, as the
denture with receive excessive load from the natural teeth;
Excessive anterior occlusal load.
Deep labial frenal notches.
High occlusal load due to excessive action of messeter.
(20)
PRECAUTIONS
Check the occlusion.
Maintain adequate thickness of the denture base.
Do not deepen the labial notch.
MANDIBULAR SINGLE DENTURE
Mandibular single dentures can either be opposing a fully dentuluos
maxilla or a maxillar partial denture.
There is severe ridge resorption of edentulous mandible. Due to two reasons.
(21)
Constant movement of tongue add forces on the residual ridge
increasing the amount of resorption.
Amount of firmly attached mucosa to the denture bearing area is less in
mandible than in maxilla.
This condition can be best treated using endosseous implants after
through evaluation of the patients.
When clinician is unable to provide the option of endosseous implants,
then treatment using single complete denture is provided. However
many clinicans believe that use of resilient liner in mandibular denture
is beneficial. With such a procedure the dentist attempts to provide
stress reducing element in the denture base to resist the forces of
functional and Para-functional loads.
(22)