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Single maxillary denture /invisible aligners

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  • 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com
  • 2. INTRODUCTIONINTRODUCTION The single complete denture opposing all or some of the natural dentition is not an uncommon occurrence. Causes for the loss of teeth from the dental arches like periodontal problems, dental caries and trauma. The incidence of tooth loss is more in maxillary arch compared to mandibular arch The single complete denture should be fabricated for reasons like mastication and esthetics. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 3. DEFINITIONDEFINITION Single complete denture isa prosthesiswhichSingle complete denture isa prosthesiswhich replacesthe lost natural teeth and itsassociatedreplacesthe lost natural teeth and itsassociated structuresfunctionally and esthetically asa singlestructuresfunctionally and esthetically asa single unit which opposesall or some of the naturalunit which opposesall or some of the natural teeth.teeth. The primary consideration for continued denture success with a single conventional complete denture is the preservation of that which remains. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 4. SINGLE EDENTULOUS ARCHSINGLE EDENTULOUS ARCH Prevalence of the condition where edentulousPrevalence of the condition where edentulous arch opposes a natural or restored dentition isarch opposes a natural or restored dentition is quite commonquite common.. The reason for the loss of the maxillary teeth prior to the mandibular teeth are unclear and are influenced by a combination of factors. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 5. COMBINATIONSCOMBINATIONS Upper single complete denture opposing complete set ofUpper single complete denture opposing complete set of lower natural teeth.lower natural teeth. Lower single complete denture opposing complete set ofLower single complete denture opposing complete set of upper natural teeth.upper natural teeth. Single complete denture opposing natural teeth with aSingle complete denture opposing natural teeth with a removable partial denture.removable partial denture. A single complete denture opposing natural teeth with aA single complete denture opposing natural teeth with a fixed partial denture.fixed partial denture. A single complete denture opposing an already existingA single complete denture opposing an already existing complete denturecomplete denture www.indiandentalacademy.comwww.indiandentalacademy.com
  • 6. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 7. Successful complete denture use by patients depends on many variables. but three factors stand out in terms of functional success: Retention Stability Support www.indiandentalacademy.comwww.indiandentalacademy.com
  • 8. RetentionRetention - the quality inherent in the prosthesis- the quality inherent in the prosthesis acting to resist theacting to resist the forcesforces of dislodgmentof dislodgment alongalong the path of placement.the path of placement. StabilityStability - the quality of a prosthesis to be firm,- the quality of a prosthesis to be firm, steady, or constant, to resist displacement bysteady, or constant, to resist displacement by functional horizontal or rotational stresses.functional horizontal or rotational stresses. SupportSupport - the- the foundation areafoundation area on which a dentalon which a dental prosthesis rests.prosthesis rests. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 9. Of the three, it generally is agreed thatOf the three, it generally is agreed that stabilitystability is theis the most importantmost important factor.factor. Occlusion that is not balanced in excursiveOcclusion that is not balanced in excursive movements will create instability of themovements will create instability of the denture, loss of retention, and, eventually,denture, loss of retention, and, eventually, frustration to the patient.frustration to the patient. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 10. In addition, when a dentate arch opposesIn addition, when a dentate arch opposes an edentulous arch, thean edentulous arch, the edentulous archedentulous arch isis usuallyusually adversely affectedadversely affected because of thebecause of the forces generated.forces generated. Koper believes thatKoper believes that occlusal problemsocclusal problems andand denture-base fracturesdenture-base fractures seen in the singleseen in the single complete denture are the result of one orcomplete denture are the result of one or all of the following:all of the following: www.indiandentalacademy.comwww.indiandentalacademy.com
  • 11. 1.1. Occlusal stressOcclusal stress on the maxillary denture andon the maxillary denture and the underlying edentulous tissue from teeth andthe underlying edentulous tissue from teeth and musculature accustomed to opposing naturalmusculature accustomed to opposing natural teeth.teeth. 2. The2. The position of the mandibular teethposition of the mandibular teeth, which, which may not be properly aligned for the bilateralmay not be properly aligned for the bilateral balance needed for stability.balance needed for stability. 3. Flexure of the denture base. The3. Flexure of the denture base. The use of a metaluse of a metal base to help prevent denture-base fracturebase to help prevent denture-base fracture.. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 12. The fabrication of a single completeThe fabrication of a single complete denture, however, is often overlooked indenture, however, is often overlooked in educational courses and requires aeducational courses and requires a complete understanding of the factorscomplete understanding of the factors involved in obtaining bilateral balance.involved in obtaining bilateral balance. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 13. Theilemann simplified Hanau’s QuintTheilemann simplified Hanau’s Quint making it easier to understand how tomaking it easier to understand how to obtain balance and therefore stability.obtain balance and therefore stability. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 14. Condylar guidance Incisal guidance Compensatory curve Orientation of occlusal plane Theilemann Formula CG *IG = CI*CC*OP Functional movements Cuspal inclination www.indiandentalacademy.com
  • 15. Equilibrium or balance is achieved when the five elements are in harmony A change in any of the five elements requires changes in at least one of the remaining four elements. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 16. For example, if the incisal guidance is increased either a decrease in the condylar guidance or an increase in the compensating curve, cusp height, or occlusal plane must occur to maintain balance. Because the condylar guidance cannot change without surgical intervention, one or more of the three elements to the right of the equation must be adjusted. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 17. ConverselyConversely, if there is an increase in the cusp, if there is an increase in the cusp height there must be either a decrease in theheight there must be either a decrease in the compensating curve or the occlusal plane or ancompensating curve or the occlusal plane or an increase in the incisal guidance.increase in the incisal guidance. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 18. When the dentist is faced with fabricating only a single denture. however, control of these elements is limited and may adversely affect the attainment of bilateral balance. * Situations. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 19. If there is an existing denture , the dentistIf there is an existing denture , the dentist shouldshould modify the existing denturemodify the existing denture at theat the same time to allow greater control andsame time to allow greater control and flexibility in obtaining balance.flexibility in obtaining balance. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 20. The maxillary arch usually is the first arch to become edentulous. The position of the remaining natural teeth in these examples may create interferences in excursive movements of the single complete denture and create instability that would not be a problem in a patient with natural dentition in both arches and with anterior guidance correcting these interferences may be as simple as an occlusal adjustment or as severe as extraction of the offending tooth. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 21. This article discusses various nonextractive or nonorthodontic treatment modalities that may be used with various patients to achieve a balanced occlusion and to improve the stability of the single denture opposing natural teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 22. Occlusal discrepancies The proposed changes to occlusal discrepancies are best planned ahead of time in the dental laboratory on properly articulated casts to prevent unnecessary and irreversible alterations to the dentition. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 23. Making adjustments to the dentures after fabrication is not advisable because changes to the arrangement of the denture teeth are no longer possible. Patients also may view these postdelivery adjustments as an attempt to make the natural teeth fit a poorly made denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 24. Tooth selection Anatomic teeth usually are chosen in the single complete denture to enhance esthetics. The decision as to which cusped tooth to choose is based on evaluation of the condylar guidance and incisal guidance and therefore is selected after anterior tooth setup. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 25. In patients who present with a full dentition on the mandible, the condylar guidance, occlusal plane, and compensating curve are already pre-set, so the only variables that the dentist can easily control are the incisal guidance and the cusp height .The incisal guidance can be evaluated with esthetics and phonetics. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 26. In patients withIn patients with flat occlusal tablesflat occlusal tables teeth canteeth can bebe reshaped or non-anatomic teethreshaped or non-anatomic teeth may bemay be chosen.chosen. Plastic teethPlastic teeth are chosen overare chosen over porcelain teeth because theporcelain teeth because the amount ofamount of adjustmentadjustment that is sometimes required maythat is sometimes required may weakenweaken the porcelain teeth and make themthe porcelain teeth and make them unableunable to withstand the occlusal forces fromto withstand the occlusal forces from the natural teeth.the natural teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 27. ClassificationClassification The followingThe following proposed classificationproposed classification system cansystem can simplify the identification and treatment of thesesimplify the identification and treatment of these patients.patients. Class 1Class 1: patients for whom minor, or no, tooth: patients for whom minor, or no, tooth reduction is all that is needed to obtain balance.reduction is all that is needed to obtain balance. Class 2Class 2: patients for whom minor additions to the: patients for whom minor additions to the teeth are needed to obtain balance.teeth are needed to obtain balance. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 28. Class 3Class 3: patients whom both reductions and: patients whom both reductions and additions to teeth are required to obtain balance.additions to teeth are required to obtain balance. The treatment of these patients usually involves aThe treatment of these patients usually involves a change in vertical dimensionchange in vertical dimension of occlusion.of occlusion. Class 4Class 4: patients who present with occlusal: patients who present with occlusal discrepancies that require addition to thediscrepancies that require addition to the width ofwidth of the occluding surface.the occluding surface. Class 5Class 5: patients who present with: patients who present with combinationcombination syndrome.syndrome. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 29. Class 1Class 1 Class I includes patients for whom occlusalClass I includes patients for whom occlusal adjustments are made to the existing dentition toadjustments are made to the existing dentition to achieve balance in all excursive movements.achieve balance in all excursive movements. TwoTwo methods can be used in the laboratory to evaluatemethods can be used in the laboratory to evaluate the changes that must he made to the teeth. Thethe changes that must he made to the teeth. The first methodfirst method is more accurate and time consumingis more accurate and time consuming but is better suited for the inexperiencedbut is better suited for the inexperienced practitioner.practitioner. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 30. TheThe secondsecond is not as precise and should beis not as precise and should be reserved for the experienced clinician.reserved for the experienced clinician. TheThe first methodfirst method, described by, described by SwensonSwenson isis performed with casts articulated at theperformed with casts articulated at the correct vertical dimension and with maxillarycorrect vertical dimension and with maxillary teeth set. one at a time, to an ideal setup.teeth set. one at a time, to an ideal setup. As interferences arise, the opposing teethAs interferences arise, the opposing teeth on the cast are adjusted to allow for theon the cast are adjusted to allow for the ideal maxillary tooth positioning.ideal maxillary tooth positioning. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 31. The adjustments areThe adjustments are marked on the cast,marked on the cast, and the same adjustments are made in theand the same adjustments are made in the mouth at the time of delivery of the maxillarymouth at the time of delivery of the maxillary denture. In this manner,denture. In this manner, changes are morechanges are more precise and less arbitraryprecise and less arbitrary, and proposed, and proposed adjustments can be evaluated ahead of timeadjustments can be evaluated ahead of time rather than clinically, when it may be foundrather than clinically, when it may be found that proposed changes are not feasible.that proposed changes are not feasible. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 32. TheThe second methodsecond method, described by, described by YurkstasYurkstas,, involves the use of ainvolves the use of a curved U-shapedcurved U-shaped occlusal metal templateocclusal metal template that is positioned onthat is positioned on the incisal edges and cusp tips of the caststhe incisal edges and cusp tips of the casts to identify potential interferences or areasto identify potential interferences or areas that are below the occlusal plane andthat are below the occlusal plane and require buildup of some sort.require buildup of some sort. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 33. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 34. These areas are adjusted to conform to theThese areas are adjusted to conform to the curve of the template and then the denturecurve of the template and then the denture teeth are set against this plane.teeth are set against this plane. This method isThis method is quickerquicker but morebut more arbitraryarbitrary and more prone to error.and more prone to error. TheThe correct occlusal templatecorrect occlusal template should beshould be selected after the condylar guidance andselected after the condylar guidance and incisal guidance are determined to allow forincisal guidance are determined to allow for easier balance.easier balance. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 35. Preoperative right lateral view of protrusive movement Preoperative left lateral view of protrusive movement Postoperative frontal view of right laterotrusive movement showing balanced occlusionwww.indiandentalacademy.comwww.indiandentalacademy.com
  • 36. AboveAbove figurefigure shows the interferences andshows the interferences and potential for dislodgement and the balancepotential for dislodgement and the balance attained after selected reduction of theattained after selected reduction of the mandibular teeth.mandibular teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 37. Class 2Class 2 Class 2 includes patients for whom minorClass 2 includes patients for whom minor additions to theadditions to the height of the teethheight of the teeth are needed toare needed to obtain bilateral balance. This situation may occurobtain bilateral balance. This situation may occur when there has been loss of tooth structurewhen there has been loss of tooth structure because ofbecause of trauma or decaytrauma or decay or when there hasor when there has beenbeen isolated supraeruptionisolated supraeruption in areas without thein areas without the loss of vertical dimension. Anloss of vertical dimension. An exampleexample is a patientis a patient who presented for new maxillary denture and awho presented for new maxillary denture and a new mandibular swing lock removable partialnew mandibular swing lock removable partial denture.denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 38. The patient was referred for treatment afterThe patient was referred for treatment after the general dentist had placed crowns onthe general dentist had placed crowns on teeth #2l and #22. Upon establishment ofteeth #2l and #22. Upon establishment of the occlusal wax rim to register the properthe occlusal wax rim to register the proper occlusal plane relative to incisal show andocclusal plane relative to incisal show and lip support, it became evident that there waslip support, it became evident that there was a discrepancy in the height of thea discrepancy in the height of the mandibular anterior teeth.mandibular anterior teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 39. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 40. The patient refused to have the crownsThe patient refused to have the crowns remade to the proper dimensions. Anremade to the proper dimensions. An anterior try-inanterior try-in was performed to confirm thewas performed to confirm the correct esthetic and phonetic positioning.correct esthetic and phonetic positioning. During the placement of the posterior teeth,During the placement of the posterior teeth, additions to the natural mandibular teethadditions to the natural mandibular teeth were required to maintain contact in thewere required to maintain contact in the protrusive excursion.protrusive excursion. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 41. WaxWax was added to the articulatedwas added to the articulated mandibular cast to allow correct setting ofmandibular cast to allow correct setting of the posterior teeth with balance in allthe posterior teeth with balance in all excursions. To transfer this correction to theexcursions. To transfer this correction to the patient, the mandibular cast, with the waxpatient, the mandibular cast, with the wax added, was duplicated, and a 0020-inchadded, was duplicated, and a 0020-inch vacuum-pressed sheet was fabricated.vacuum-pressed sheet was fabricated. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 42. This sheet was used on the day of delivery toThis sheet was used on the day of delivery to act as a template to the placement ofact as a template to the placement of composite resincomposite resin to the natural teeth to createto the natural teeth to create the balanced occlusion that was developedthe balanced occlusion that was developed in the dental laboratory.in the dental laboratory. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 43. Vaccum-formed template in place before teeth buildup www.indiandentalacademy.comwww.indiandentalacademy.com
  • 44. SlitsSlits were placed through the vacuum-were placed through the vacuum- formed templateformed template interproximallyinterproximally to preventto prevent bonding of the composite resin to thebonding of the composite resin to the adjacent tooth and to allow the patient toadjacent tooth and to allow the patient to floss normally.floss normally. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 45. Final resultFinal result Anterior teeth built up in composite resin to permit balance in protrusion www.indiandentalacademy.comwww.indiandentalacademy.com
  • 46. Class 3Class 3 Class 3 includes patients for whom bothClass 3 includes patients for whom both reductions and additionsreductions and additions to teeth areto teeth are required to obtain balance. These patientsrequired to obtain balance. These patients often require restoration of theoften require restoration of the verticalvertical dimension of occlusion.dimension of occlusion. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 47. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 48. Patient who wasPatient who was edentulous in theedentulous in the maxillary archmaxillary arch andand dentate on thedentate on the mandiblemandible, The patient had poor oral, The patient had poor oral hygiene, caries, a history of fracturedhygiene, caries, a history of fractured denture teeth, perforations of crowns,denture teeth, perforations of crowns, large restorations, loss of verticallarge restorations, loss of vertical dimension. supraeruption of thedimension. supraeruption of the mandibular anterior teeth, inverse smilemandibular anterior teeth, inverse smile line, and poor self esteem.line, and poor self esteem. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 49. Instruction in oral hygiene was provided,Instruction in oral hygiene was provided, andand basic restorative needsbasic restorative needs were addressedwere addressed accordingly. The maxillary arch was borderaccordingly. The maxillary arch was border molded, impressed, and mounted on anmolded, impressed, and mounted on an articulator by the use of a face bow. Thearticulator by the use of a face bow. The wax occlusal rim was idealized with no inputwax occlusal rim was idealized with no input from the position of the mandibular teeth.from the position of the mandibular teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 50. Frontal view of the proposed maxillary setup www.indiandentalacademy.comwww.indiandentalacademy.com
  • 51. The result is demonstrated in the previous figure,The result is demonstrated in the previous figure, thethe lack of a natural smilelack of a natural smile is evident. With theis evident. With the maxillary teeth in the ideal position, themaxillary teeth in the ideal position, the verticalvertical dimension of occlusion was increased 4 mmdimension of occlusion was increased 4 mm fromfrom the correct location determined by the physiologicthe correct location determined by the physiologic rest position andrest position and 8 mm greater than at8 mm greater than at presentationpresentation. Using a. Using a second occlusal rimsecond occlusal rim, an, an interocclusal record was made at the correctinterocclusal record was made at the correct vertical dimension of occlusion and the mandibularvertical dimension of occlusion and the mandibular cast was articulated.cast was articulated. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 52. Once articulated, the maxillary cast with theOnce articulated, the maxillary cast with the ideal setup was placed back on theideal setup was placed back on the articulator, and aarticulator, and a 4-mm discrepancy4-mm discrepancy waswas noted in the anterior because of thenoted in the anterior because of the supraeruption of the mandibular anteriorsupraeruption of the mandibular anterior teeth. Before any adjustment of theteeth. Before any adjustment of the mandibular anterior teeth, a 0.020-inchmandibular anterior teeth, a 0.020-inch vacuum-formed template was fabricatedvacuum-formed template was fabricated over the mandibular cast.over the mandibular cast. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 53. Adjustments to the mandibular cast were made and marked in red.Adjustments to the mandibular cast were made and marked in red. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 54. The patient was advised of the possibleThe patient was advised of the possible need for endodontic treatments of theseneed for endodontic treatments of these teeth before any intraoral modifications.teeth before any intraoral modifications. After the mandibular anterior teeth wereAfter the mandibular anterior teeth were adjusted to a the correct verticaladjusted to a the correct vertical dimension to be established, there was nodimension to be established, there was no tooth contact in the posterior.tooth contact in the posterior. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 55. A mandibular occlusal device was fabricatedA mandibular occlusal device was fabricated for delivery at the time of maxillary denturefor delivery at the time of maxillary denture insertion and adjustment of the mandibularinsertion and adjustment of the mandibular anterior teeth. The vacuum-formed templateanterior teeth. The vacuum-formed template was trimmed with a scalpel to the level ofwas trimmed with a scalpel to the level of the teeth modifications so that the amount ofthe teeth modifications so that the amount of reduction of the mandibular teeth wasreduction of the mandibular teeth was clearly evident at the time of intraoralclearly evident at the time of intraoral modifications.modifications. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 56. The maxillary denture was inserted, andThe maxillary denture was inserted, and the mandibular teeth were adjusted to thethe mandibular teeth were adjusted to the proper corrected vertical dimension usingproper corrected vertical dimension using thethe modified vacuum-formed stentmodified vacuum-formed stent.. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 57. Vaccum-formed template in place before adjustments Vaccum-formed template in place after adjustments www.indiandentalacademy.comwww.indiandentalacademy.com
  • 58. A mandibular occlusal device that maintained posterior contact was also inserted. After insertion of maxillary complete denture, Reduction of the mandibular anterior teeth And insertion of occlusal device. Occlusal view of occlusal device www.indiandentalacademy.comwww.indiandentalacademy.com
  • 59. The patient was seen on follow-up toThe patient was seen on follow-up to evaluate the changes in vertical dimensionevaluate the changes in vertical dimension and the effect on esthetics and phonetics.and the effect on esthetics and phonetics. The patient exhibited no adverse signs orThe patient exhibited no adverse signs or symptoms from the changes. so treatmentsymptoms from the changes. so treatment proceeded with the restoration of theproceeded with the restoration of the mandibular posterior teeth. All posteriormandibular posterior teeth. All posterior teeth were restored withteeth were restored with gold occlusalgold occlusal surfaces.surfaces. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 60. Occlusal view of mandibular crowns www.indiandentalacademy.comwww.indiandentalacademy.com
  • 61. The maxillary posterior denture teeth wereThe maxillary posterior denture teeth were then modified using thethen modified using the chew-in orchew-in or functionally generated wax technique tofunctionally generated wax technique to obtain gold occlusal surfacesobtain gold occlusal surfaces to register andto register and maintain the balanced occlusion better in allmaintain the balanced occlusion better in all excursive movements.excursive movements. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 62. Functionally generated wax pattern Occlusals in wax ready for spruing Gold occlusalswww.indiandentalacademy.comwww.indiandentalacademy.com
  • 63. The final photographs show a moreThe final photographs show a more natural smilenatural smile and a far more estheticand a far more esthetic result. The attention to detail in preservingresult. The attention to detail in preserving the balance in excursive movements givesthe balance in excursive movements gives thesethese restorations a good long prognosisrestorations a good long prognosis.. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 64. Completed prostheses, facial view Completed prostheses, frontal view www.indiandentalacademy.comwww.indiandentalacademy.com
  • 65. Class 4Class 4 Class 4 includes patients whose occlusalClass 4 includes patients whose occlusal discrepancies require addition to thediscrepancies require addition to the width of thewidth of the occluding surfaceoccluding surface. These patients typically have all. These patients typically have all Angle’s class 2 malocclusionAngle’s class 2 malocclusion, and present with, and present with constricted arches resulting in a posterior crossconstricted arches resulting in a posterior cross bite or a with abite or a with a Brodie biteBrodie bite in which thein which the entireentire mandibular dentition is lingual to the palatalmandibular dentition is lingual to the palatal surfaces of the maxillary teeth.surfaces of the maxillary teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 66. Frontal view of waxup Occlusal view of waxup Occlusal view of mandibular waxup www.indiandentalacademy.comwww.indiandentalacademy.com
  • 67. Above figures showed a patient whoAbove figures showed a patient who exhibited a Brodie bite and who needed anexhibited a Brodie bite and who needed an immediate maxillary denture and animmediate maxillary denture and an immediate interim mandibular partialimmediate interim mandibular partial denture. The maxillary teeth were placed indenture. The maxillary teeth were placed in the most pleasing esthetic position, withthe most pleasing esthetic position, with care taken not to divert from the neutralcare taken not to divert from the neutral zone. The occlusal surfaces were widenedzone. The occlusal surfaces were widened with wax to obtain balanced contacts in allwith wax to obtain balanced contacts in all movements.movements. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 68. An additional row of teeth is an alternativeAn additional row of teeth is an alternative method of treatment but is more expensivemethod of treatment but is more expensive thanthan building up the contacts in waxbuilding up the contacts in wax andand eventually in denture base material.eventually in denture base material. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 69. Class 5Class 5 KellyKelly describeddescribed combination syndromecombination syndrome as aas a situation that exhibitssituation that exhibits  Bone loss in the maxillary anteriorBone loss in the maxillary anterior  Overgrowth of the tuberositiesOvergrowth of the tuberosities  Papillary hyperplasiaPapillary hyperplasia  Extrusion of the mandibular anterior teethExtrusion of the mandibular anterior teeth  Loss of bone in the mandibular posteriorLoss of bone in the mandibular posterior in patients who have a maxillary complete denturein patients who have a maxillary complete denture opposing mandibular anterior teeth.opposing mandibular anterior teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 70. SaundersSaunders addedadded six additional factorssix additional factors to includeto include periodontal changesperiodontal changes loss of vertical dimensionloss of vertical dimension occlusal plane discrepancyocclusal plane discrepancy poor prosthesis adaptationpoor prosthesis adaptation epulis fissuratumepulis fissuratum anterior repositioning of the mandible.anterior repositioning of the mandible. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 71. Although the combination syndrome is not found inAlthough the combination syndrome is not found in every patient who has a maxillary complete dentureevery patient who has a maxillary complete denture opposing a Kennedy class I removable partialopposing a Kennedy class I removable partial denture, one should be aware of thedenture, one should be aware of the importanceimportance ofof equally distributed occlusal contacts between theequally distributed occlusal contacts between the maxillary denture and the mandibular natural teethmaxillary denture and the mandibular natural teeth and the removable partial denture.and the removable partial denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 72. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 73. AboveAbove figuresfigures shows the treatment of ashows the treatment of a patient who was edentulous on the maxillarypatient who was edentulous on the maxillary arch for more than 20 years. Although aarch for more than 20 years. Although a mandibular removable partial denture wasmandibular removable partial denture was initially fabricated, the patient admits to notinitially fabricated, the patient admits to not wearing it very long. A clear resin duplicatewearing it very long. A clear resin duplicate was made of the maxillary denture and waswas made of the maxillary denture and was used to articulate the casts.used to articulate the casts. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 74. Articulated clear duplicate maxillary denture www.indiandentalacademy.comwww.indiandentalacademy.com
  • 75. The articulated casts clearly show that there is not enough space to fabricate the correct occlusal plane for the denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 76. With the mandibular incisor teeth and theWith the mandibular incisor teeth and the retromolar pads serving as guides, the castretromolar pads serving as guides, the cast was adjusted in the tuberosities region.was adjusted in the tuberosities region. FortunatelyFortunately, the sinuses were superiorly, the sinuses were superiorly placed and would not be exposed duringplaced and would not be exposed during the surgical reduction of the tuberosity.the surgical reduction of the tuberosity. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 77. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 78. AA clear surgical stentclear surgical stent was fabricated to assistwas fabricated to assist the oral and maxillofacial surgeon in thethe oral and maxillofacial surgeon in the amount of tuberosity reduction and delivery ofamount of tuberosity reduction and delivery of the maxillary denture. Anthe maxillary denture. An interim mandibularinterim mandibular removable dentureremovable denture was delivered at the samewas delivered at the same visit to maintain maximum occlusal contactsvisit to maintain maximum occlusal contacts and to provide balance in all excursiveand to provide balance in all excursive movements.movements. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 79. Frontal view of completed prostheses www.indiandentalacademy.comwww.indiandentalacademy.com
  • 80. After an appropriate healing period, aAfter an appropriate healing period, a new complete maxillary denturenew complete maxillary denture and aand a cast metal-resin removable partialcast metal-resin removable partial denture were fabricated.denture were fabricated. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 81. SummarySummary The single maxillary denture is a complex prosthesisThe single maxillary denture is a complex prosthesis that requires a complete understanding of thethat requires a complete understanding of the basics of denture occlusion. Theilemann’s formulabasics of denture occlusion. Theilemann’s formula must be applied to each individual patient andmust be applied to each individual patient and appropriate treatment must be taken to assureappropriate treatment must be taken to assure complete balance in all excursive movements.complete balance in all excursive movements. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 82. The basic principles of retention, stability,The basic principles of retention, stability, and support should not to be taken forand support should not to be taken for granted, and steps must be completed sogranted, and steps must be completed so that all components are working inthat all components are working in harmony for success of the maxillaryharmony for success of the maxillary denture.denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 83. Treatment of various patients has beenTreatment of various patients has been illustrated to allow the reader to comprehendillustrated to allow the reader to comprehend better the modalities that can be employedbetter the modalities that can be employed for preparing the oral environment beforefor preparing the oral environment before denture insertion thereby ensuring betterdenture insertion thereby ensuring better success in treating these classes ofsuccess in treating these classes of patients.patients. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 84. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 85. Charles W. Ellinger et al J Prosthet Dent 1971,Vol 26,no 1,Pg 4-10 Various combinations The artificial teeth arrangement in a harmonious relation to the mandibular teeth Summary: The development of a harmonious occlusion is most critical to the success of a single complete denture treatment. Achieving this desirable characteristic is usually much mare difficult than arranging Artificial teeth for opposing complete denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 86. THE MAXILLARY COMPLETE DENTURETHE MAXILLARY COMPLETE DENTURE OPPOSING NATURALTEETH:OPPOSING NATURALTEETH: PROBLEMS AND SOME SOLUTIONSPROBLEMS AND SOME SOLUTIONS Alex KoperAlex Koper J Prosthet Dent 1987 Vol 57, No 6,Pg 704-707.J Prosthet Dent 1987 Vol 57, No 6,Pg 704-707. The problems involved in providing comfort, function, proper esthetics and retention for the maxillary completer denture patient with natural opposing dentition may be challenging. Careful attention of the patient is important. It provides the new complete denture patient the opportunity to adapt to a complete denture and allows the dentist to evaluate his patient physically and emotionally before fabrication of the final complete denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 87. THE MAXILLARY COMPLETE DENTURE OPPOSING THETHE MAXILLARY COMPLETE DENTURE OPPOSING THE MANDIBULAR BILATERAL DISTAL-EXTENSION PARTIALMANDIBULAR BILATERAL DISTAL-EXTENSION PARTIAL DENTURE: TREATMENT CONSIDERATIONSDENTURE: TREATMENT CONSIDERATIONS TIMOTHY et alTIMOTHY et al J Prosthet Dent 1979, VolJ Prosthet Dent 1979, Vol 41,Pg 124-12841,Pg 124-128 The dentist should approach the treatment of the complete maxillaryThe dentist should approach the treatment of the complete maxillary denture opposing the mandibular bilateral distal extension partialdenture opposing the mandibular bilateral distal extension partial denture cautiously ,and the institution of correct treatment initiativesdenture cautiously ,and the institution of correct treatment initiatives is essential.is essential. Every patient must be aware from the outset that the longestEvery patient must be aware from the outset that the longest possible life of any prosthesis with the least harm to the remainingpossible life of any prosthesis with the least harm to the remaining tissues can only be ensured by regular recall and maintenance caretissues can only be ensured by regular recall and maintenance care www.indiandentalacademy.comwww.indiandentalacademy.com
  • 88. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 89. REFERENCESREFERENCES Jacobson TE, Krol AJ.Jacobson TE, Krol AJ. A contemporary review of theA contemporary review of the factors involved in complete denture retention, stability,factors involved in complete denture retention, stability, and support. Part I: retentionand support. Part I: retention J Prosthet Dent 1983:49(l):5-15.J Prosthet Dent 1983:49(l):5-15. Jacobson TE. Krol AJ.Jacobson TE. Krol AJ. A contemporary review of theA contemporary review of the factors involved in complete dentures. Part II : stability.factors involved in complete dentures. Part II : stability. J Prosthet Dent l983;49(2):165-72J Prosthet Dent l983;49(2):165-72.. Jacobson TE. KroI AJ.Jacobson TE. KroI AJ. A contemporary review of theA contemporary review of the factors involved in complete dentures. Par III support.factors involved in complete dentures. Par III support. J Prosthet Dent l983;49(3):306-l 3.J Prosthet Dent l983;49(3):306-l 3. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 90. The glossary of Prosthodontic terms.The glossary of Prosthodontic terms. J Prosthet Dent 2005.J Prosthet Dent 2005. Complete denture occlusion.Complete denture occlusion. Dent Clin North AmDent Clin North Am 1977:21(2):299-320.1977:21(2):299-320. Stephens AP.Stephens AP. The single complete denture. : Sharry L.The single complete denture. : Sharry L. Complete denture prosthodontics.Complete denture prosthodontics. Koper A.Koper A. The maxillary complete denture opposing naturalThe maxillary complete denture opposing natural teeth: problems and some solutions.teeth: problems and some solutions. J Prosthet Dent 1987;57(6):704-707J Prosthet Dent 1987;57(6):704-707 Ellinger CW, Rayson JH, Henderson D.Ellinger CW, Rayson JH, Henderson D. Single completeSingle complete dentures.dentures. J Prosthet Dent 1971 26(l):4-l0.J Prosthet Dent 1971 26(l):4-l0. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 91. Kelly.Kelly. Changes caused by a mandibular r removable partialChanges caused by a mandibular r removable partial denture opposing a maxillary complete denturedenture opposing a maxillary complete denture J Prosthet Dent 1972:27(2):140-50J Prosthet Dent 1972:27(2):140-50 Tan HK.Tan HK. A preparation guide for modifying the mandibularA preparation guide for modifying the mandibular teeth before making a maxillary single complete denture.teeth before making a maxillary single complete denture. J Prosthet Dent 1997;77(3):321-2.J Prosthet Dent 1997;77(3):321-2. Saunders TR. Gillis RE, Desjardins RPSaunders TR. Gillis RE, Desjardins RP. The maxillary. The maxillary complete denture opposing the mandibular bilateralcomplete denture opposing the mandibular bilateral distal-extension partial denture: treatment considerations.distal-extension partial denture: treatment considerations. J Prosthet Dent 1979:41(2):124 -128.J Prosthet Dent 1979:41(2):124 -128. www.indiandentalacademy.comwww.indiandentalacademy.com
  • 92. Zarb GA, Bolender C, Hickey JC, Carlsson GE.Zarb GA, Bolender C, Hickey JC, Carlsson GE. SingleSingle complete dentures opposing natural teeth. : Boucher’scomplete dentures opposing natural teeth. : Boucher’s Prosthodontic treatment for edentulous patients.Prosthodontic treatment for edentulous patients. Heartwell CM, Rahn A.Heartwell CM, Rahn A. The single complete denture :The single complete denture : Syllabus of complete dentures.Syllabus of complete dentures. www.indiandentalacademy.comwww.indiandentalacademy.com
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  • 113. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com