Single complete dentures (2)/ orthodontic assistant training

SINGLE
COMPLETE
DENTURE
PROSTHESISINDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.comwww.indiandentalacademy.com

Definition
Making of a maxillary and
mandibular complete denture as
distinguished from a set of complete
dentures (GPT-7)
www.indiandentalacademy.com

Objectives
The primary consideration for continued
denture success with a single conventional
complete denture is the preservation of
that which remains.
Advantages
The single denture wearer is usually
younger and more adaptable, ridges usually
well formed and often exhibit a desirable
degree of tissue resiliency. Rarely are there
signs of chronic irritation, hypertrophy, or
marked resorption.

PROBLEMS
Those prosthesis designed to articulate
and to function with a previously existing
occlusal scheme, whether it be natural or
artificial, are usually more complex than those
encountered with complete maxillary and
mandibular denture prosthesis.
The methods used, the difficulties
experienced, the treatment plan, and the
prognosis differ in different clinical situations. It
is therefore desirable to consider the various
clinical combinations separately.

CLINICAL SITUATIONS WHERE
FABRICATION OF SINGLE
DENTURE IS CONSIDERED
• Natural teeth that are sufficient in number not
to necessitate a fixed or removable partial
dentures in the opposing arch.
• A partially edentulous arch in which the
missing teeth have been or will be replaced by
a fixed partial denture.
• A partially edentulous arch in which the
missing teeth have been or will be replaced by
a removable partial denture.
• An existing complete denture.

DIAGNOSIS AND TREATMENT
PLANNING
The basic diagnostic procedures are
same to that of completely edentulous
patients.
The characteristics of a physiological
occlusion are frequently encountered in fully
dentate mouths. They also can be almost
invariably achieved when treating completely
edentulous patients.

However, when only one arch is
edentulous, tooth positions in the dentate
arch may preclude such objectives 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 to correct them.

These changes include :
(1) Extensive morphological changes in
denture foundation that can result in arch
relationship or occlusal plane
discrepancies.
(2) Jaw relationship extremes.
(3)Excessively displaceable denture bearing
tissues.

A thorough analysis of the remaining
teeth and the role they play in the resolution
of forces during function should be a primary
consideration. Many dentists fail to take
advantage of the possibility of modifying the
existing occlusal characteristics so that they
will tend to seat and stabilize the prosthesis
rather than tend to dislodge it. Before one
proceeds with the single denture, there are
many factors to be considered in evaluating
the teeth in the opposite arch.

In evaluating the natural dentition
the following should be checked:
1. Uneven alignment of teeth
Tipping, extrusion, rotation, etc. One
often observes the extrusion of teeth due to
loss of an antagonist. This disrupts the
occlusal harmony These teeth may be
brought back to correspond to the desired
occlusal plane with judicious selective
grinding or by orthodontic movement.

In more severe instances extractions
may be indicated if the tooth occupies
excessive interarch space so as to interfere
with the denture base itself. Extreme care
must be exercised to ensure that there are 2
to 3 mm of anteroposterior freedom before
the inclined plane is engaged.

2.Character of the occlusal
surfacesNatural teeth often exhibit varying
steepness of the cusps and/ or associated
abrasion and wear.
A change in the faciolingual diameter of
the tooth occurs with wear or cusp height
reduction. Appropriate changes must be
made on the buccal and lingual contours of
the teeth to keep the same functional width of
the occlusal surfaces. Both the centralization
of forces and the elimination of excursive
interferences is accomplished by this
relatively simple modification.

3.Cross-bite relationships
A narrow maxilla in conjunction with a
broad mandible adds complications to the
prognosis of the complete denture. It is
recommended that the posterior teeth be set
so that the entire tooth is within the periphery
of the denture base. In this instance it is well to
consider articulating the teeth in crossbite
relationship

4. Number and position of opposing teeth
The stability of the upper denture during
function is almost directly proportional to the
number of posterior teeth which occlude.
Construction of maxillary complete denture
prosthesis against six anterior teeth is definitely
contraindicated. In such a case destruction of
the residual ridge is almost inevitable, and the
patient also develops undesirable masticatory
habits that are difficult to break. Therefore it is
essential that a posterior occlusion be provided
for proper function.

When only the molars are missing and
the bicuspids remain, it is sometimes possible
to construct a functional denture without the
aid of a removable partial lower denture. The
anteroposterior position of the mandibular
teeth in relation to the maxillary ridge should
be considered

Mandibular Denture to Oppose
Natural Maxillary Teeth
Although the mandibular arch is seldom
the edentulous one, it usually happens as a
result of surgical or accidental trauma.
An example of surgical trauma is the
removal of the mandibular teeth for persons
who are to undergo irradiation therapy for a
tumor.

Three factors in particular' must be carefully
evaluated :
 Preservation of the residual alveolar ridge
 Necessity for retaining maxillary teeth
 Mental trauma

Single Complete Maxillary
Denture to Oppose Natural
Mandibular Teeth
More frequently encountered than the
singular mandibular denture is the single
maxillary denture.
The diagnostic procedures should
determine that there are sufficient teeth in
the mandibular arch, periodontal health is
acceptable, and there are no missing teeth to
be replaced.

The number of mandibular teeth
considered sufficient should include the first
molars in jaws that have a Class I or Class III
relation. In Class II related jaws, the anterior
teeth and premolars bilaterally may suffice.
When these conditions are met, it would appear
that one could proceed.
The occlusal forms of the natural teeth
usually act as the guide in selecting the occlusal
form for the maxillary posterior teeth. In most
situations this would be a cusp tooth however, if
the natural teeth are abraded and are not
restored prior to treatment, the monoplane form
may be the choice for the occlusal surfaces of
posterior teeth.

Some times the positions of the
mandibular anterior teeth will not allow the
maxillary anterior teeth to be positioned in an
esthetically acceptable manner or for
balanced occlusion. This problem may be
resolved as follows :
1. Reposition the natural teeth with
orthodontic procedures.
2. Alter the clinical crowns of the teeth by
grinding or with restorations.
3. Accept balanced occlusion with the jaws in
centric relation and not in the eccentric
positions. www.indiandentalacademy.com

Single Complete Maxillary
Denture to Opposing Natural
Mandibular Teeth with fixed
prosthesis
The problems presented are
usually in the diagnostic procedures
related to the existing restorations.
When the restorations are
acceptable, one must then decide what
occlusal concept will be pursued. The
same principles of occlusion that apply
to complete dentures apply to the singlewww.indiandentalacademy.com

Complete maxillary denture to
oppose a partially edentulous arch
and a removable partial denture
The most frequently encountered
situation for a single complete denture is
opposite a partially edentulous arch in which
the missing teeth have been or will be replaced
with a removable partial denture.
The partial denture must meet the
requirements of 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.

Single Complete Denture to
Oppose an Existing Complete
Denture
Analysis of the following five questions
should be done before proceeding:
1. How long has the existing denture been in
use?
2. Was the denture an immediate insertion at
the time of tooth removal?
3. Does the denture meet the requirements of
an acceptable denture?

4. Has the denture opposed another
complete denture, a partially edentulous arch
that supported a removable partial denture, a
restored natural teeth, a fixed partial denture,
or natural teeth in which no restorations have
been placed?
5. Is the operator satisfied to institute
complete denture procedures utilizing the
existing denture?

A SUGGESTED CLINICAL AND
LABORATORY PROCEDURE
Case history, Intra-oral examination
All operative, periodontal, and surgical procedures
Study cast to be secured on an articulator to
visualize Inter-arch space, Arch relation and
Occlusal plane

Occlusal discrepancies in the natural teeth are
judiciously equilibrated on the cast and marked.
Procedure is duplicated in the mouth
All ground enamel surfaces should be polished
If sensitivity is encountered, it can be readily
handled with local application of sodium fluoride
pastewww.indiandentalacademy.com

Impression procedure is carried out
considering the clinical situations.
Face bow record is transferred and
maxillary cast is secured on the upper
member of the articulator.
Centric jaw relation is made in wax or
fast setting plaster and mandibular cast is
mounted on the lower member of the
articulator.

FIVE ELEMENTS TO BE CONSIDERED TO
OBTAIN BALANCE OCCLUSION
Condylar guidance (CG)
Incisal guidance (IG)
Compensating curve (CC)
Cusp height (CH)
Occlusal plane (OP)
CG + IG = CC + CH + OP

When fabricating complete maxillary
and mandibular denture, the dentist has
control over incisal guidance, compensating
curve, cusp height and occlusal plane.
In case of single complete denture
control of these elements is limited.

SELECTION OF ARTIFICIAL TEETH
When the occlusal surfaces of the teeth
and fixed prosthesis are made of porcelain,
the artificial teeth of choice are porcelain or
acrylic resin.
When the occlusal surfaces are mixed
enamel and gold or gold alone, the occlusal
surfaces of the artificial teeth are preferably
gold. However, acrylic resin teeth are
acceptable.
Acrylic resin teeth are selected
opposing a prosthesis with acrylic resin teeth

PRECAUTIONS IN TEETH
ARRANGEMENT
Deep vertical overbite be avoided in the
anterior region, which results in less stress on
the anterior teeth and thereby lends increased
stability to the completed denture.
Increasing the horizontal overjet is one
method of reducing the incisal guide angle.
It is essential that there be no locking in the
anterior segment.www.indiandentalacademy.com

Broad surface contacts on steep inclined
planes must be avoided.
If the opposing teeth have relatively
shallow cusps, then relatively shallow (20o
)
artificial teeth are selected to articulate with
them, with steep cusps, 33o
teeth are used,
and with flat occlusal surfaces, zero degree
teeth are selected.

Single complete dentures (2)/ orthodontic assistant training

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