SINGLE COMPLETESINGLE COMPLETE
DENTUREDENTURE
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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CONTENTSCONTENTS
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1)1) INTRODUCTIONINTRODUCTION
2)2) PROBLEM WITH SINGLE COMPLETEPROBLEM WITH SINGLE COMPLETE
DENTURE.DENTURE.
3)3) COMMON O...
B)B) RPDRPD
C) FPDC) FPD
D) EXISTING COMPLETE DENTURED) EXISTING COMPLETE DENTURE
E) IMPLANT SUPPORTEDE) IMPLANT SUPPORTED...
6) CINICAL PROCEDURE OF6) CINICAL PROCEDURE OF
MAKING SINGLE COMPLETEMAKING SINGLE COMPLETE
DENTURE.DENTURE.
7) OCCLUSAL M...
INTRODUCTIONINTRODUCTION
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Many patients becomeMany patients become
edentulous in one arch whileedentulous in one arch while
retaining some or all of...
A single complete denture may beA single complete denture may be
desirable when it is to oppose anydesirable when it is to...
3. A partially edentulous arch in3. A partially edentulous arch in
which missing teeth have been orwhich missing teeth hav...
Dentist faces many difficulties inDentist faces many difficulties in
rehabilitating the patients with thisrehabilitating t...
As a result of unfavorable occlusalAs a result of unfavorable occlusal
relationships there is a tendencyrelationships ther...
PROBLEM WITH SINGLEPROBLEM WITH SINGLE
COMPLETE DENTURECOMPLETE DENTURE
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1.1.
Greater magnitude of forcesGreater magnitude of forces
Changes in the underlying boneChanges in the underlying bone
D...
2.2. Related to occlusal form of theRelated to occlusal form of the
remaining natural teeth:remaining natural teeth:
This ...
Supraerupted Tilted teeth
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Occlusal scheme causingOcclusal scheme causing
more horizontal forcesmore horizontal forces
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These factors causes occurrenceThese factors causes occurrence
of “of “ Single denture syndromeSingle denture syndrome””
-...
COMMON OCCLUSALCOMMON OCCLUSAL
DISHARMONIES AND WAYSDISHARMONIES AND WAYS
TO ADJUST THEMTO ADJUST THEM
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1. Tilted molars
with distal
halves
supraerupted
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Steeply inclined
occlusal
surfaces
tend to drive
denture forward
when brought
into centric
occlusion.
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Only contact is on the distal half of
lower molar in protrusive and
lateral excursions
Denture easily dislodged during
fun...
Adjustment for tilted molarAdjustment for tilted molar
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A)A)
If molars areIf molars are
not severelynot severely
tiltedtilted
can becan be
reshaped byreshaped by
selectiveselecti...
B)B) If more toothIf more tooth
structure isstructure is
needed to beneeded to be
removedremoved
Restore withRestore with
...
C)C) If large spaceIf large space
exist mesial toexist mesial to
tilted molartilted molar
RPD restoring theRPD restoring t...
D)D) OrthodonticOrthodontic
repositioningrepositioning
of tilted molarof tilted molar
E)E) If severely tilted and supraeru...
2.2. Natural lower cuspids andNatural lower cuspids and
incisors are supraeruptedincisors are supraerupted
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SelectiveSelective
grindinggrinding
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Cuspid region, occlusal adjustmentCuspid region, occlusal adjustment
should aim at providing a definiteshould aim at provi...
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A)A) SINGLE COMPLETESINGLE COMPLETE
DENTURE OPPOSINGDENTURE OPPOSING
NATURAL TEETHNATURAL TEETH
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1.1. Maxillary complete dentureMaxillary complete denture
opposing natural mandibularopposing natural mandibular
teeth.tee...
PROBLEMSPROBLEMS
a)a) Malposed ,tipped andMalposed ,tipped and
supraerupted teeth in lowersupraerupted teeth in lower
arch...
b)b) Fixed position of mandibularFixed position of mandibular
anterior teethanterior teeth
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c)c) Problem of wear of teeth:Problem of wear of teeth:
i)i) Artificial teethArtificial teeth If acrylic isIf acrylic is...
Diagnostic procedures shouldDiagnostic procedures should
determine the following:determine the following:
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1)1) If there are sufficient teeth inIf there are sufficient teeth in
the mandibular arch.the mandibular arch.
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According toAccording to SharrySharry: if there is class: if there is class
II jaw relation, a complete dentureII jaw rel...
Forces directed to Middle Posterior
part of Upper denture
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But if class III jaw relationBut if class III jaw relation
situation is differentsituation is different becausebecause...
Forces against the anteriorForces against the anterior
part of the maxillary ridgepart of the maxillary ridge
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Acc to WinklerAcc to Winkler: In any event,: In any event,
replacement of missing posteriorreplacement of missing posterio...
Ellinger et al (JPD 1971:26;6) :Ellinger et al (JPD 1971:26;6) :
A lower RPD should be indicated in allA lower RPD should ...
• If one side upto premolars andIf one side upto premolars and
others upto first molarothers upto first molar RPD mayRPD...
2)2) Periodontal health of thePeriodontal health of the
remaining teeth is acceptable.remaining teeth is acceptable.
3)3) ...
5)5) Condition of posterior teethCondition of posterior teeth
a)a) Irregular occlusal plane, picketIrregular occlusal plan...
Prior to any occlusalPrior to any occlusal
modifications of the natural teeth,modifications of the natural teeth,
maxillar...
Techniques to determine theTechniques to determine the
necessary tooth modificationsnecessary tooth modifications
prior to...
1)1) BY SWENSONBY SWENSON
Casts mounted on articulator usingCasts mounted on articulator using
provisional CR at acceptabl...
Areas to be
modified
are marked
with pencil
on the cast
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Natural teeth modified accordinglyNatural teeth modified accordingly
New diagnostic cast of lower archNew diagnostic cast ...
2)2) BRUCEBRUCE (JPD 1971:26:448-455)(JPD 1971:26:448-455)
Advised reshaping natural teethAdvised reshaping natural teeth
...
Areas to be
modified are
marked with
pencil on
the cast
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Clear acrylic resin
template is formed
over the corrected
cast
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Initial modifications done.
Template coated
with pressure
Indicating paste
and placed over
patients teeth.
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Interferences can be seen through
the clear template and can be
removed accordingly.
Process repeated
till template fits t...
3)3) BY YURKSTAS:BY YURKSTAS:
Advised useAdvised use
of a metalof a metal
‘‘U’ shapedU’ shaped
occlusalocclusal
templatete...
2.2. Mandibular complete dentureMandibular complete denture
opposing natural maxillaryopposing natural maxillary
teeth.tee...
Factors that must be evaluatedFactors that must be evaluated
before this treatment option isbefore this treatment option i...
1)1) Preservation of residual alveolarPreservation of residual alveolar
ridge:ridge:
a)a) Greater force exerted +smallerGr...
b) Mandible movable member ofb) Mandible movable member of
stomatognathic systemstomatognathic system moremore
difficult...
Therefore, consideringTherefore, considering
preservation of residual ridgepreservation of residual ridge onlyonly
as the ...
2.2. Necessity of retaining maxillaryNecessity of retaining maxillary
teeth:teeth:
MaxillaryMaxillary
dentition maydentiti...
3.3. Mental traumaMental trauma
4.4. Health factorsHealth factors
Even though the potential for theEven though the potenti...
B)B) SINGLE COMPLETESINGLE COMPLETE
DENTURE OPPOSINGDENTURE OPPOSING
REMOVABLE PARTIALREMOVABLE PARTIAL
DENTUREDENTURE
www...
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Ellinger et al (JPD 1971:26;6) :Ellinger et al (JPD 1971:26;6) :
A lower RPD should be indicated in allA lower RPD should ...
Ellsworth KellyEllsworth Kelly (JPD1972:27;140)(JPD1972:27;140)
gave the term “gave the term “COMBINATIONCOMBINATION
SYNDR...
Some characteristic changes inSome characteristic changes in
Combination syndrome( AnteriorCombination syndrome( Anterior
...
iii)iii) Papillary hyperplasia in the hardPapillary hyperplasia in the hard
palate.palate.
iv)iv) Extrusion of lower anter...
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BY SAUNDER’S ET AL
(JPD 1979:41:124)
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Sequence of changesSequence of changes
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First change to occur?First change to occur?
Acc to Kelly et alAcc to Kelly et al (JPD1972:27;140)(JPD1972:27;140)
 loss...
Loss of bone
from anterior
maxilla
Flabby
hyperplastic
tissue
Characteristic
deep
fold or crease www.indiandentalacademy.c...
Maxillary denture displaced anteriorly andMaxillary denture displaced anteriorly and
superiorlysuperiorly
Tendency to de...
With posterior palatalWith posterior palatal
seal negativeseal negative
pressure producedpressure produced
posteriorly.pos...
Lower anterior teeth migrateLower anterior teeth migrate
upward and periodontal changesupward and periodontal changes
occ...
Maxillary anteriorMaxillary anterior
teeth on theteeth on the
complete denturecomplete denture
disappear underdisappear un...
Loss of mandibular supportLoss of mandibular support
Gradual decrease of occlusal loadGradual decrease of occlusal load
po...
Ellsworth Kelly (JPD 1972:27;140) :Ellsworth Kelly (JPD 1972:27;140) :
3 yr study: all patients showed3 yr study: all pati...
Kay Shen et al (JPD 1989;62:642-644)Kay Shen et al (JPD 1989;62:642-644)
did a study in 150 complete denturedid a study in...
Saunders et al (JPD 1979;41:126)Saunders et al (JPD 1979;41:126)
Changes associated withChanges associated with
combinatio...
Some clinical states, seem toSome clinical states, seem to
encourage development of thisencourage development of this
synd...
ii)ii) Patients whose mandibular posteriorPatients whose mandibular posterior
teeth have not been replaced andteeth have n...
iv)iv) Type of occlusal schemeType of occlusal scheme
provided by dentist: deflectiveprovided by dentist: deflective
anter...
Prevention of combinationPrevention of combination
syndromesyndrome
Treatment planning to avoid thisTreatment planning to ...
2)2) Using lower anterior roots andUsing lower anterior roots and
giving overdenture.giving overdenture.
3)3) Giving bilat...
Management of combinationManagement of combination
syndromesyndrome
• Diagnosis of cause and its correction.Diagnosis of c...
SINGLE COMPLETESINGLE COMPLETE
DENTUREDENTURE
PART IIPART II
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CONTENTSCONTENTS
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1)1) INTRODUCTIONINTRODUCTION
2)2) PROBLEM WITH SINGLE COMPLETEPROBLEM WITH SINGLE COMPLETE
DENTURE.DENTURE.
3)3) COMMON O...
1)1) DEFINITIONSDEFINITIONS
2)2) REVIEW OF LITERATUREREVIEW OF LITERATURE
3)3) SINGLE COMPLETE DENTURESINGLE COMPLETE DENT...
4)4) METHODS TO ACHIEVEMETHODS TO ACHIEVE
BALANCED OCCLUSIONBALANCED OCCLUSION
5)5) OCCLUSAL MATERIALS FOROCCLUSAL MATERIA...
7)7) TREATMENT PLANNING FORTREATMENT PLANNING FOR
SINGLE COMPLETE DENTURESINGLE COMPLETE DENTURE
OPPOSING RPDOPPOSING RPD
...
DEFINITIONSDEFINITIONS
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Combination syndrome / AnteriorCombination syndrome / Anterior
hyperfunction syndrome (GPT-7):hyperfunction syndrome (GPT-...
papillary hyperplasia of the hardpapillary hyperplasia of the hard
palate’s mucosa, extrusion of thepalate’s mucosa, extru...
BALANCED OCCLUSIONBALANCED OCCLUSION
(GPT-7)(GPT-7)
The bilateral, simultaneous, anterior,The bilateral, simultaneous, ant...
SELECTIVE GRINDINGSELECTIVE GRINDING
The intentional alteration of theThe intentional alteration of the
occlusal surfaces ...
REVIEW OF LITERATUREREVIEW OF LITERATURE
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Schultz (JPD 1951:1:38-48)Schultz (JPD 1951:1:38-48)
• Showed that the chewingShowed that the chewing
efficiency of acryli...
Frederick S. Meyer (JPDFrederick S. Meyer (JPD
1957:7:354)1957:7:354) gave the functionallygave the functionally
generated...
Ellsworth Kelly(JPD 1972:27:2:140-Ellsworth Kelly(JPD 1972:27:2:140-
150)150)
Followed 6 patients wearing maxillaryFollow...
b)b) 1-2.5 mm increase in height of1-2.5 mm increase in height of
tuberositytuberosity
c)c) 1-1.5 mm extrusion of lower1-1...
SAUNDERS et al
(JPD1979:41:124)
Further described the
combination syndrome, and
proposed that the first change toproposed...
Changes associated with combinationChanges associated with combination
syndrome are not necessarily seensyndrome are not n...
Saunders et al (J Prosthet Dent 1979 ;Saunders et al (J Prosthet Dent 1979 ;
41: 124-128.;)41: 124-128.;)recommended that ...
Kay Shen et al (JPD 1989;62:642-644)Kay Shen et al (JPD 1989;62:642-644)
did a study in 150 complete denturedid a study in...
Barber et al (JOMFS 1990:48:1283-Barber et al (JOMFS 1990:48:1283-
1287)1287)
Maxson et al (JPD 1990:63;554-558)Maxson et ...
B.Jacobs et al(JPD 1993:70;135-140)B.Jacobs et al(JPD 1993:70;135-140)
Compared the anterior and posteriorCompared the ant...
Results indicatedResults indicated
1)1) A more pronounced annualA more pronounced annual
bone resorption in completebone r...
2)2) A limited but continuing boneA limited but continuing bone
resorption observed in patientsresorption observed in pati...
Sigvard Palmqvist et al (JPDSigvard Palmqvist et al (JPD
2003:90;270-275)2003:90;270-275) critically reviewedcritically r...
SINGLE COMPLETE DENTURESINGLE COMPLETE DENTURE
OPPOSING PARTIALLYOPPOSING PARTIALLY
EDENTULOUS ARCHEDENTULOUS ARCH
RESTORE...
Which material to be used forWhich material to be used for
artificial teeth.artificial teeth.
Once fixed restoration is pl...
Placement of fixed restoration canPlacement of fixed restoration can
correct many occlusalcorrect many occlusal
disharmoni...
Orthodontic
correction
and then
give FPD
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Prepare tooth
to get proper
plane of
occlusion
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Telescopic crownTelescopic crown
retainerretainer
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Proximal half
crown
Nonrigid
connector
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Cantilevered
premolar
pontic
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Single complete dentureSingle complete denture
opposing an existing completeopposing an existing complete
denturedenture
w...
11. Duration of the existing denture. Duration of the existing denture
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2.2. Condition of the teeth:Condition of the teeth:
a)a) AppearanceAppearance
b)b) Alignment with regard toAlignment with ...
c) Is occlusal
plane
Desirable?
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d) Occlusal surface
worn out
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3.3. Condition of denture baseCondition of denture base
a)a) Accuracy of tissue adaptation andAccuracy of tissue adaptatio...
Single complete dentureSingle complete denture
opposing implant supportedopposing implant supported
prosthesisprosthesis
w...
B.Jacobs et al(JPD 1993:70;135-140)B.Jacobs et al(JPD 1993:70;135-140)
Compared the anterior and posteriorCompared the ant...
Results indicatedResults indicated
1)1) A more pronounced annualA more pronounced annual
bone resorption in completebone r...
2)2) A limited but continuing boneA limited but continuing bone
resorption observed in patientsresorption observed in pati...
Maxillary complete dentureMaxillary complete denture
opposing implant supportedopposing implant supported
overdentureoverd...
Permits free
rotational
Movement
of denture
upon
Posterior
loading
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Bone resorption in mandibularBone resorption in mandibular
posterior regionposterior region
settling of denture base and l...
Barber et al (J OMFS 1990:48:1283-Barber et al (J OMFS 1990:48:1283-
1287)1287)
Maxson et al (JPD 1990:63;554-558)Maxson e...
Maxillary completeMaxillary complete
denturedenture
opposing implantopposing implant
supported fixedsupported fixed
dentur...
Opinion is divided over theOpinion is divided over the
functional forces borne by thefunctional forces borne by the
maxill...
Stafford et alStafford et al ; found that loading; found that loading
forces did not increaseforces did not increase
Fal...
Difference in opinion regardingDifference in opinion regarding
the anterior maxillary bone lossthe anterior maxillary bone...
Jacobs et al (JPD 1993):Jacobs et al (JPD 1993): reportedreported
an increase annual bone lossan increase annual bone loss...
METHODS TOMETHODS TO
ACHIEVE BALANCEDACHIEVE BALANCED
OCCLUSIONOCCLUSION
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TWO TECHNIQUESTWO TECHNIQUES::
1)1) Those that dynamicallyThose that dynamically
equilibrate the occlusion by useequilibra...
Functionally generated pathFunctionally generated path
techniques / Functional chewtechniques / Functional chew
in techniq...
Contraindications:Contraindications:
1)1) Record base not stable.Record base not stable.
2)2) Patients with poor neuromusc...
StansburyStansbury
(JPD 1951;1;692-699)(JPD 1951;1;692-699)
andand
Rudd and MorrowRudd and Morrow
(JPD 1973:30;4)(JPD 1973...
Cast mounted on articulator in CRCast mounted on articulator in CR
at acceptable vertical dimension.at acceptable vertical...
(twice the normal width-atleast(twice the normal width-atleast
twice the width of molar teeth)twice the width of molar te...
Compound occlusal rim heatedCompound occlusal rim heated
Placed in articulatorPlaced in articulator closedclosed
Impress...
Occlusal rimsOcclusal rims
trimmed B-L.trimmed B-L.
CompoundCompound
extension inextension in
the centralthe central
fossa...
Anterior regionAnterior region
trimmed tilltrimmed till
level oflevel of
indentation ofindentation of
incisors(2mmincisors...
Place in patients mouthPlace in patients mouth
Pt asked to make chewing slowlyPt asked to make chewing slowly
Excess compo...
Record baseRecord base
removed fromremoved from
patients mouth,patients mouth,
soft wax (cardingsoft wax (carding
wax) add...
Placed in patients mouthPlaced in patients mouth
Patient asked to perform eccentricPatient asked to perform eccentric
chew...
Lower teeth cutLower teeth cut
their pathstheir paths
in the soft wax.in the soft wax.
Compound inCompound in
central foss...
Occlusal rim removedOcclusal rim removed  stone pouredstone poured
into wax paths.into wax paths.
First mandibularFirst ...
Stone record isStone record is
secured to thesecured to the
lower member oflower member of
the articulator withthe articul...
2 lower casts-first-duplicate of lower2 lower casts-first-duplicate of lower
teeth, second replica of generatedteeth, seco...
Checked in mouth for esthetics andChecked in mouth for esthetics and
centric occlusioncentric occlusion
..
Denture process...
Once correct in COOnce correct in CO remove theremove the
lower castlower cast put chew-in mandibularput chew-in mandi...
By Robert G.VigBy Robert G.Vig
(JPD 1964;14:214-220)(JPD 1964;14:214-220)
Similar techniqueSimilar technique
like Stansbur...
Articulator EquilibrationArticulator Equilibration
TechniqueTechnique
Equilibrate the occlusion by usingEquilibrate the oc...
Indications:Indications:
• If denture base lacks stability.If denture base lacks stability.
• Patient unable to performPat...
Maxillary occlusal rimsMaxillary occlusal rims
fabricatedfabricated face bow transferface bow transfer
donedone maxill...
Bucco-lingual position of the lowerBucco-lingual position of the lower
teeth and their relation to maxillaryteeth and thei...
OCCLUSAL MATERIALS FOROCCLUSAL MATERIALS FOR
SINGLE COMPLETESINGLE COMPLETE
DENTURESDENTURES
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a)a) Porcelain teeth:Porcelain teeth:
AdvantageAdvantage: minimal wearing, therefore: minimal wearing, therefore
vertical ...
b)b) Acrylic resin teeth:Acrylic resin teeth:
Advantage:Advantage:
No wear of opposing teethNo wear of opposing teeth
Easy...
c)c) Gold occlusalsGold occlusals
ConsideredConsidered best materialbest material to opposeto oppose
natural teeth. Minimu...
Schultz (JPD 1951:1:38-48)Schultz (JPD 1951:1:38-48)
• Showed that the chewingShowed that the chewing
efficiency of acryli...
Technique of fabrication ofTechnique of fabrication of
gold occlusalsgold occlusals
(JPD 1964:14;326-333)(JPD 1964:14;326-...
Dentures made in usual manner usingDentures made in usual manner using
acrylic resin posterior teeth.acrylic resin posteri...
With dentures in mouthWith dentures in mouth 
impression made with irreversibleimpression made with irreversible
hydroco...
Buccal and palatal
surfaces covered
with modeling clay
All undercuts blocked
Lingually- 2mm short of
occlusal surface
Labi...
Stone counter
dies poured
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Preparation resembling three quarter
crown made on each tooth
1.5mm
2mm
1.5mm
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Grooves cut A-P
3mm wide
and
3mm deep.
Hole approximately
2mm depth
made in centre
of each tooth
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Counter die
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Final wax pattern
Sprue
attached
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Castings cemented
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d)d) Acrylic resin teeth with amalgamAcrylic resin teeth with amalgam
stopsstops (JPD 1979:41:16-20)(JPD 1979:41:16-20)
Ad...
Occlusal preparation
in acrylic teeth
Amalgam condensed
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Centric holding
areas as well as
excursions are
recorded in
amalgam
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CLINICAL PROCEDURE OFCLINICAL PROCEDURE OF
FABRICATINGFABRICATING
A MAXILLARYA MAXILLARY
COMPLETECOMPLETE
DENTURE OPPOSING...
 Maxillary and mandibular castsMaxillary and mandibular casts
obtained and are mounted in CR atobtained and are mounted i...
 Impression of lower teethImpression of lower teeth  castcast
obtainedobtained
 Maxillary archMaxillary arch
Secondary...
 Set teeth and achieve a balancedSet teeth and achieve a balanced
occlusion by selective grinding.occlusion by selective ...
 If FPD neededIf FPD needed 
do the toothdo the tooth
preparation beforepreparation before
making impression.making imp...
TREATMENT PLANNINGTREATMENT PLANNING
FOR PATIENT WITHFOR PATIENT WITH
EDENTULOUS MAXILLAEDENTULOUS MAXILLA
AND PARTIALLY E...
 1)1) Risk of development ofRisk of development of
combination syndrome should becombination syndrome should be
recognize...
3)3) Treatment must concentrate onTreatment must concentrate on
periodontal and restorative needsperiodontal and restorati...
4) RPD Design4) RPD Design
• Maximal coverage of basal seatMaximal coverage of basal seat
beneath distal extension base wi...
• Functional impression technique.Functional impression technique.
• Increasing the efficiency ofIncreasing the efficiency...
5) Maxillary complete denture:5) Maxillary complete denture:
• Maximum extensionMaximum extension
• Adequate border sealAd...
6)6) Adequate vertical dimension andAdequate vertical dimension and
proper centric relation positionproper centric relatio...
SUMMARYSUMMARY
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CONCLUSIONCONCLUSION
The main problem in treatingThe main problem in treating
patients who need a completepatients who nee...
To avoid this sequeale, the basicTo avoid this sequeale, the basic
fundamentals of prosthodonticfundamentals of prosthodon...
REFERENCESREFERENCES
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 Stansbury C B. Single dentureStansbury C B. Single denture
construction against a non-modifiedconstruction against a non...
 Vig R G. A modified chew in andVig R G. A modified chew in and
functional impression technique.functional impression tec...
 Kelly E. Changes caused by a mandibularKelly E. Changes caused by a mandibular
removable partial denture opposing aremov...
Saunders T R, Gillis R E, DesjardinsSaunders T R, Gillis R E, Desjardins
R P. The maxillary complete dentureR P. The maxi...
Koper ;maxillary CD opposind naturalKoper ;maxillary CD opposind natural
teeth: problems and some solutuions:teeth: probl...
 Yair LangerYair Langer ::Modalities of Treatment forModalities of Treatment for
the Combination Syndromethe Combination ...
 Complete denture prosthodontics:Complete denture prosthodontics:
Sharry: 3Sharry: 3rdrd
edtedt
Essentials of complete d...
Removable partial prosthodontics:10Removable partial prosthodontics:10
edt:Mc Crackenedt:Mc Cracken
Prosthodontic treatm...
Combination syndrome / AnteriorCombination syndrome / Anterior
hyperfunction syndromehyperfunction syndrome (GPT-7):(GPT-7...
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Single complete denture /dentistry studies

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Single complete denture /dentistry studies

  1. 1. SINGLE COMPLETESINGLE COMPLETE DENTUREDENTURE INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com
  2. 2. CONTENTSCONTENTS www.indiandentalacademy.comwww.indiandentalacademy.com
  3. 3. 1)1) INTRODUCTIONINTRODUCTION 2)2) PROBLEM WITH SINGLE COMPLETEPROBLEM WITH SINGLE COMPLETE DENTURE.DENTURE. 3)3) COMMON OCCLUSALCOMMON OCCLUSAL DISHARMONIES AND WAYS TODISHARMONIES AND WAYS TO ADJUST THEM.ADJUST THEM. 4)4) SINGLE COMPLETE DENTURESINGLE COMPLETE DENTURE OPPOSINGOPPOSING A)A) NATURAL TEETHNATURAL TEETH www.indiandentalacademy.comwww.indiandentalacademy.com
  4. 4. B)B) RPDRPD C) FPDC) FPD D) EXISTING COMPLETE DENTURED) EXISTING COMPLETE DENTURE E) IMPLANT SUPPORTEDE) IMPLANT SUPPORTED PROSTHESIS.PROSTHESIS. 5) METHODS TO ACHIEVE5) METHODS TO ACHIEVE BALANCED OCCLUSIONBALANCED OCCLUSIONwww.indiandentalacademy.comwww.indiandentalacademy.com
  5. 5. 6) CINICAL PROCEDURE OF6) CINICAL PROCEDURE OF MAKING SINGLE COMPLETEMAKING SINGLE COMPLETE DENTURE.DENTURE. 7) OCCLUSAL MATERIALS FOR7) OCCLUSAL MATERIALS FOR SINGLE COMPLETE DENTURESSINGLE COMPLETE DENTURES 8) SUMMARY8) SUMMARY 9) CONCLUSION9) CONCLUSION 10) REFERENCES10) REFERENCESwww.indiandentalacademy.comwww.indiandentalacademy.com
  6. 6. INTRODUCTIONINTRODUCTION www.indiandentalacademy.comwww.indiandentalacademy.com
  7. 7. Many patients becomeMany patients become edentulous in one arch whileedentulous in one arch while retaining some or all of theirretaining some or all of their natural teeth in the opposingnatural teeth in the opposing arch. In this situation a singlearch. In this situation a single complete denture is fabricated.complete denture is fabricated. www.indiandentalacademy.comwww.indiandentalacademy.com
  8. 8. A single complete denture may beA single complete denture may be desirable when it is to oppose anydesirable when it is to oppose any one of them:one of them: 1. Natural teeth that are sufficient in1. Natural teeth that are sufficient in number not to necessitate a fixed ornumber not to necessitate a fixed or removable partial denture.removable partial denture. 2. A partially edentulous arch in which2. A partially edentulous arch in which missing teeth have been or will bemissing teeth have been or will be replaced by RPD.replaced by RPD. www.indiandentalacademy.comwww.indiandentalacademy.com
  9. 9. 3. A partially edentulous arch in3. A partially edentulous arch in which missing teeth have been orwhich missing teeth have been or will be replaced by FPD.will be replaced by FPD. 4. An existing Complete denture.4. An existing Complete denture. 5. Implant supported Complete5. Implant supported Complete denture.denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  10. 10. Dentist faces many difficulties inDentist faces many difficulties in rehabilitating the patients with thisrehabilitating the patients with this clinical pattern.clinical pattern. Malposed, tipped, or supraeruptedMalposed, tipped, or supraerupted teeth make it difficult to achieve ateeth make it difficult to achieve a harmonious balanced occlusion andharmonious balanced occlusion and also interfere in proper placement ofalso interfere in proper placement of artificial teeth to achieve adequateartificial teeth to achieve adequate esthetics.esthetics. www.indiandentalacademy.comwww.indiandentalacademy.com
  11. 11. As a result of unfavorable occlusalAs a result of unfavorable occlusal relationships there is a tendencyrelationships there is a tendency of denture to get displaced,of denture to get displaced, causing soreness, mucosalcausing soreness, mucosal changes and ultimately ridgechanges and ultimately ridge resorption.resorption. www.indiandentalacademy.comwww.indiandentalacademy.com
  12. 12. PROBLEM WITH SINGLEPROBLEM WITH SINGLE COMPLETE DENTURECOMPLETE DENTURE www.indiandentalacademy.comwww.indiandentalacademy.com
  13. 13. 1.1. Greater magnitude of forcesGreater magnitude of forces Changes in the underlying boneChanges in the underlying bone Denture in the long term will beDenture in the long term will be compromised.compromised.www.indiandentalacademy.comwww.indiandentalacademy.com
  14. 14. 2.2. Related to occlusal form of theRelated to occlusal form of the remaining natural teeth:remaining natural teeth: This occlusal form dictatesThis occlusal form dictates occlusal form of the dentureocclusal form of the denture  might be unsuitable for themight be unsuitable for the denture.denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  15. 15. Supraerupted Tilted teeth www.indiandentalacademy.comwww.indiandentalacademy.com
  16. 16. Occlusal scheme causingOcclusal scheme causing more horizontal forcesmore horizontal forces www.indiandentalacademy.comwww.indiandentalacademy.com
  17. 17. These factors causes occurrenceThese factors causes occurrence of “of “ Single denture syndromeSingle denture syndrome”” - loose or tilting denture- loose or tilting denture -damage of mucosa-damage of mucosa - ridge resorption.- ridge resorption. www.indiandentalacademy.comwww.indiandentalacademy.com
  18. 18. COMMON OCCLUSALCOMMON OCCLUSAL DISHARMONIES AND WAYSDISHARMONIES AND WAYS TO ADJUST THEMTO ADJUST THEM www.indiandentalacademy.comwww.indiandentalacademy.com
  19. 19. 1. Tilted molars with distal halves supraerupted www.indiandentalacademy.comwww.indiandentalacademy.com
  20. 20. Steeply inclined occlusal surfaces tend to drive denture forward when brought into centric occlusion. www.indiandentalacademy.comwww.indiandentalacademy.com
  21. 21. Only contact is on the distal half of lower molar in protrusive and lateral excursions Denture easily dislodged during functional movements.www.indiandentalacademy.comwww.indiandentalacademy.com
  22. 22. Adjustment for tilted molarAdjustment for tilted molar www.indiandentalacademy.comwww.indiandentalacademy.com
  23. 23. A)A) If molars areIf molars are not severelynot severely tiltedtilted can becan be reshaped byreshaped by selectiveselective grinding.grinding. www.indiandentalacademy.comwww.indiandentalacademy.com
  24. 24. B)B) If more toothIf more tooth structure isstructure is needed to beneeded to be removedremoved Restore withRestore with crown or FPD.crown or FPD. www.indiandentalacademy.comwww.indiandentalacademy.com
  25. 25. C)C) If large spaceIf large space exist mesial toexist mesial to tilted molartilted molar RPD restoring theRPD restoring the mesial half of themesial half of the molars, lower themolars, lower the distal cuspsdistal cusps (mesial half onlay(mesial half onlay mesial rest ormesial rest or extended rest)extended rest) www.indiandentalacademy.comwww.indiandentalacademy.com
  26. 26. D)D) OrthodonticOrthodontic repositioningrepositioning of tilted molarof tilted molar E)E) If severely tilted and supraeruptedIf severely tilted and supraerupted ExtractionExtraction www.indiandentalacademy.comwww.indiandentalacademy.com
  27. 27. 2.2. Natural lower cuspids andNatural lower cuspids and incisors are supraeruptedincisors are supraerupted www.indiandentalacademy.comwww.indiandentalacademy.com
  28. 28. SelectiveSelective grindinggrinding www.indiandentalacademy.comwww.indiandentalacademy.com
  29. 29. Cuspid region, occlusal adjustmentCuspid region, occlusal adjustment should aim at providing a definiteshould aim at providing a definite distal slope on the lower cuspiddistal slope on the lower cuspid so as to allow space for freeso as to allow space for free passage of the upper artificialpassage of the upper artificial cuspid between the lower cuspidcuspid between the lower cuspid and first premolar in lateraland first premolar in lateral movements.movements. www.indiandentalacademy.comwww.indiandentalacademy.com
  30. 30. www.indiandentalacademy.comwww.indiandentalacademy.com
  31. 31. A)A) SINGLE COMPLETESINGLE COMPLETE DENTURE OPPOSINGDENTURE OPPOSING NATURAL TEETHNATURAL TEETH www.indiandentalacademy.comwww.indiandentalacademy.com
  32. 32. 1.1. Maxillary complete dentureMaxillary complete denture opposing natural mandibularopposing natural mandibular teeth.teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  33. 33. PROBLEMSPROBLEMS a)a) Malposed ,tipped andMalposed ,tipped and supraerupted teeth in lowersupraerupted teeth in lower arch and unfavorable plane ofarch and unfavorable plane of occlusion.occlusion. www.indiandentalacademy.comwww.indiandentalacademy.com
  34. 34. b)b) Fixed position of mandibularFixed position of mandibular anterior teethanterior teeth www.indiandentalacademy.comwww.indiandentalacademy.com
  35. 35. c)c) Problem of wear of teeth:Problem of wear of teeth: i)i) Artificial teethArtificial teeth If acrylic isIf acrylic is used.used. ii)ii) Natural teethNatural teeth If porcelain isIf porcelain is used.used. d)d) Frequent fractures of dentureFrequent fractures of denture www.indiandentalacademy.comwww.indiandentalacademy.com
  36. 36. Diagnostic procedures shouldDiagnostic procedures should determine the following:determine the following: www.indiandentalacademy.comwww.indiandentalacademy.com
  37. 37. 1)1) If there are sufficient teeth inIf there are sufficient teeth in the mandibular arch.the mandibular arch. www.indiandentalacademy.comwww.indiandentalacademy.com
  38. 38. According toAccording to SharrySharry: if there is class: if there is class II jaw relation, a complete dentureII jaw relation, a complete denture often may be constructed againstoften may be constructed against lower anterior teeth and premolarslower anterior teeth and premolars without replacing molars.without replacing molars. The lower premolars areThe lower premolars are far enoughfar enough posteriorposterior in relation to the maxillaryin relation to the maxillary ridge, that the forces of occlusion areridge, that the forces of occlusion are directed to thedirected to the middle-posteriormiddle-posterior partpart of the upper denture.of the upper denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  39. 39. Forces directed to Middle Posterior part of Upper denture www.indiandentalacademy.comwww.indiandentalacademy.com
  40. 40. But if class III jaw relationBut if class III jaw relation situation is differentsituation is different becausebecause mandibular premolars wouldmandibular premolars would apply occlusal forces against theapply occlusal forces against the anterior part of the maxillary ridge.anterior part of the maxillary ridge. www.indiandentalacademy.comwww.indiandentalacademy.com
  41. 41. Forces against the anteriorForces against the anterior part of the maxillary ridgepart of the maxillary ridge www.indiandentalacademy.comwww.indiandentalacademy.com
  42. 42. Acc to WinklerAcc to Winkler: In any event,: In any event, replacement of missing posteriorreplacement of missing posterior teeth will enhance the retentionteeth will enhance the retention and stability of the maxillaryand stability of the maxillary complete denture and help tocomplete denture and help to distribute the functional forcesdistribute the functional forces more evenly on the residualmore evenly on the residual maxillary ridge.maxillary ridge. www.indiandentalacademy.comwww.indiandentalacademy.com
  43. 43. Ellinger et al (JPD 1971:26;6) :Ellinger et al (JPD 1971:26;6) : A lower RPD should be indicated in allA lower RPD should be indicated in all situations whensituations when all molarsall molars areare missing.missing. • If upto first molar leftIf upto first molar left RPD may notRPD may not be necessary.be necessary. www.indiandentalacademy.comwww.indiandentalacademy.com
  44. 44. • If one side upto premolars andIf one side upto premolars and others upto first molarothers upto first molar RPD mayRPD may not be necessary.not be necessary. Missing molar be replaced by aMissing molar be replaced by a cantileveredcantilevered premolar ponticpremolar pontic having 2-3having 2-3 abutments.abutments. www.indiandentalacademy.comwww.indiandentalacademy.com
  45. 45. 2)2) Periodontal health of thePeriodontal health of the remaining teeth is acceptable.remaining teeth is acceptable. 3)3) There are no missing teeth toThere are no missing teeth to be replaced.be replaced. 4)4) position of mandibular anteriorposition of mandibular anterior teeth.teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  46. 46. 5)5) Condition of posterior teethCondition of posterior teeth a)a) Irregular occlusal plane, picketIrregular occlusal plane, picket fence arrangementfence arrangement.. b)b) Occlusal form of natural teeth.Occlusal form of natural teeth. c)c) Occlusal surface of natural teethOcclusal surface of natural teeth too large bucco-lingually.too large bucco-lingually. www.indiandentalacademy.comwww.indiandentalacademy.com
  47. 47. Prior to any occlusalPrior to any occlusal modifications of the natural teeth,modifications of the natural teeth, maxillary and mandibular castsmaxillary and mandibular casts should be mounted on articulator.should be mounted on articulator. Now whatever adjustments thatNow whatever adjustments that may be necessary can bemay be necessary can be planned.planned. www.indiandentalacademy.comwww.indiandentalacademy.com
  48. 48. Techniques to determine theTechniques to determine the necessary tooth modificationsnecessary tooth modifications prior to denture construction.prior to denture construction. www.indiandentalacademy.comwww.indiandentalacademy.com
  49. 49. 1)1) BY SWENSONBY SWENSON Casts mounted on articulator usingCasts mounted on articulator using provisional CR at acceptable verticalprovisional CR at acceptable vertical dimension.dimension. Maxillary record base made and teethMaxillary record base made and teeth are setare set If lower teeth interfere with placementIf lower teeth interfere with placement of denture teethof denture teeth adjusted on castadjusted on cast and areas markedand areas marked www.indiandentalacademy.comwww.indiandentalacademy.com
  50. 50. Areas to be modified are marked with pencil on the cast www.indiandentalacademy.comwww.indiandentalacademy.com
  51. 51. Natural teeth modified accordinglyNatural teeth modified accordingly New diagnostic cast of lower archNew diagnostic cast of lower arch made and mountedmade and mounted If more adjustments neededIf more adjustments needed  repeatrepeat the procedure.the procedure. Tech.Tech. simplesimple butbut time consumingtime consuming.. www.indiandentalacademy.comwww.indiandentalacademy.com
  52. 52. 2)2) BRUCEBRUCE (JPD 1971:26:448-455)(JPD 1971:26:448-455) Advised reshaping natural teethAdvised reshaping natural teeth using a resin templateusing a resin template www.indiandentalacademy.comwww.indiandentalacademy.com
  53. 53. Areas to be modified are marked with pencil on the cast www.indiandentalacademy.comwww.indiandentalacademy.com
  54. 54. Clear acrylic resin template is formed over the corrected cast www.indiandentalacademy.comwww.indiandentalacademy.com
  55. 55. Initial modifications done. Template coated with pressure Indicating paste and placed over patients teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  56. 56. Interferences can be seen through the clear template and can be removed accordingly. Process repeated till template fits the teeth perfectly Advantage: produces accurate results.www.indiandentalacademy.comwww.indiandentalacademy.com
  57. 57. 3)3) BY YURKSTAS:BY YURKSTAS: Advised useAdvised use of a metalof a metal ‘‘U’ shapedU’ shaped occlusalocclusal templatetemplate www.indiandentalacademy.comwww.indiandentalacademy.com
  58. 58. 2.2. Mandibular complete dentureMandibular complete denture opposing natural maxillaryopposing natural maxillary teeth.teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  59. 59. Factors that must be evaluatedFactors that must be evaluated before this treatment option isbefore this treatment option is consideredconsidered www.indiandentalacademy.comwww.indiandentalacademy.com
  60. 60. 1)1) Preservation of residual alveolarPreservation of residual alveolar ridge:ridge: a)a) Greater force exerted +smallerGreater force exerted +smaller basal seat area.basal seat area. rapid loss ofrapid loss of supporting bone from mandiblesupporting bone from mandible  decreased retention anddecreased retention and stability + frequent fractures ofstability + frequent fractures of denturedenture www.indiandentalacademy.comwww.indiandentalacademy.com
  61. 61. b) Mandible movable member ofb) Mandible movable member of stomatognathic systemstomatognathic system moremore difficult to stabilize the denture.difficult to stabilize the denture. c) Proximity to tongue.c) Proximity to tongue. www.indiandentalacademy.comwww.indiandentalacademy.com
  62. 62. Therefore, consideringTherefore, considering preservation of residual ridgepreservation of residual ridge onlyonly as the main factor for dictating theas the main factor for dictating the treatment plan of a completetreatment plan of a complete mandibular denture then this planmandibular denture then this plan is totally contraindicated.is totally contraindicated. www.indiandentalacademy.comwww.indiandentalacademy.com
  63. 63. 2.2. Necessity of retaining maxillaryNecessity of retaining maxillary teeth:teeth: MaxillaryMaxillary dentition maydentition may be neededbe needed to retainto retain a prosthesis.a prosthesis. www.indiandentalacademy.comwww.indiandentalacademy.com
  64. 64. 3.3. Mental traumaMental trauma 4.4. Health factorsHealth factors Even though the potential for theEven though the potential for the destruction of the mandibular residualdestruction of the mandibular residual ridge is great, the necessity forridge is great, the necessity for retaining maxillary teeth for retentiveretaining maxillary teeth for retentive purposes and the mental traumapurposes and the mental trauma created by the loss of the mandibularcreated by the loss of the mandibular teeth may be the deciding factors forteeth may be the deciding factors for fabricating a complete denture tofabricating a complete denture to oppose natural maxillary teeth.oppose natural maxillary teeth.www.indiandentalacademy.comwww.indiandentalacademy.com
  65. 65. B)B) SINGLE COMPLETESINGLE COMPLETE DENTURE OPPOSINGDENTURE OPPOSING REMOVABLE PARTIALREMOVABLE PARTIAL DENTUREDENTURE www.indiandentalacademy.comwww.indiandentalacademy.com
  66. 66. www.indiandentalacademy.comwww.indiandentalacademy.com
  67. 67. Ellinger et al (JPD 1971:26;6) :Ellinger et al (JPD 1971:26;6) : A lower RPD should be indicated in allA lower RPD should be indicated in all situations when all molars aresituations when all molars are missing.missing. If upto first molar leftIf upto first molar left RPD may notRPD may not be necessary.be necessary. If one side upto premolars and othersIf one side upto premolars and others upto first molarupto first molar RPD may not beRPD may not be necessary.necessary. Missing molar be replaced by aMissing molar be replaced by a cantilevered premolar pontic havingcantilevered premolar pontic having 2-3 abutments.2-3 abutments.www.indiandentalacademy.comwww.indiandentalacademy.com
  68. 68. Ellsworth KellyEllsworth Kelly (JPD1972:27;140)(JPD1972:27;140) gave the term “gave the term “COMBINATIONCOMBINATION SYNDROMESYNDROME” to those changes” to those changes that are seen in patients withthat are seen in patients with maxillary complete denture and amaxillary complete denture and a mandibular bilateral distalmandibular bilateral distal extension RPD.extension RPD. www.indiandentalacademy.comwww.indiandentalacademy.com
  69. 69. Some characteristic changes inSome characteristic changes in Combination syndrome( AnteriorCombination syndrome( Anterior hyperfunction syndrome) are:hyperfunction syndrome) are: i)i) Loss of bone from anterior partLoss of bone from anterior part of the maxillary ridge.of the maxillary ridge. ii)ii) Overgrowth of the maxillaryOvergrowth of the maxillary tuberosities.tuberosities. www.indiandentalacademy.comwww.indiandentalacademy.com
  70. 70. iii)iii) Papillary hyperplasia in the hardPapillary hyperplasia in the hard palate.palate. iv)iv) Extrusion of lower anteriors.Extrusion of lower anteriors. v)v) Loss of bone under the lowerLoss of bone under the lower partial denture base .partial denture base . www.indiandentalacademy.comwww.indiandentalacademy.com
  71. 71. www.indiandentalacademy.comwww.indiandentalacademy.com
  72. 72. BY SAUNDER’S ET AL (JPD 1979:41:124) www.indiandentalacademy.comwww.indiandentalacademy.com
  73. 73. Sequence of changesSequence of changes www.indiandentalacademy.comwww.indiandentalacademy.com
  74. 74. First change to occur?First change to occur? Acc to Kelly et alAcc to Kelly et al (JPD1972:27;140)(JPD1972:27;140)  loss of bone from the anteriorloss of bone from the anterior part of the maxillary jaw.part of the maxillary jaw. Saunders et alSaunders et al ((JPD 1979:41:124)) bone resorption under thebone resorption under the mandibular partial denture base.mandibular partial denture base. www.indiandentalacademy.comwww.indiandentalacademy.com
  75. 75. Loss of bone from anterior maxilla Flabby hyperplastic tissue Characteristic deep fold or crease www.indiandentalacademy.comwww.indiandentalacademy.com
  76. 76. Maxillary denture displaced anteriorly andMaxillary denture displaced anteriorly and superiorlysuperiorly Tendency to develop epulis fissuratumTendency to develop epulis fissuratum associated with labial flange.associated with labial flange. Bone resorption also under mandibularBone resorption also under mandibular Denture base.Denture base. Occlusal plane migrates up in anteriorOcclusal plane migrates up in anterior region and down in posterior region.region and down in posterior region. www.indiandentalacademy.comwww.indiandentalacademy.com
  77. 77. With posterior palatalWith posterior palatal seal negativeseal negative pressure producedpressure produced posteriorly.posteriorly. Enlargement ofEnlargement of tuberositiestuberosities && PapillaryPapillary hyperplasia.hyperplasia. www.indiandentalacademy.comwww.indiandentalacademy.com
  78. 78. Lower anterior teeth migrateLower anterior teeth migrate upward and periodontal changesupward and periodontal changes occur.occur. (change in occlusal(change in occlusal planeplane encouragesencourages protrusive occlusalprotrusive occlusal contactcontact risk ofrisk of extrusion andextrusion and flaring of mandibular anterior teeth)flaring of mandibular anterior teeth) www.indiandentalacademy.comwww.indiandentalacademy.com
  79. 79. Maxillary anteriorMaxillary anterior teeth on theteeth on the complete denturecomplete denture disappear underdisappear under patients lips.patients lips. Esthetics becomeEsthetics become poorpoor www.indiandentalacademy.comwww.indiandentalacademy.com
  80. 80. Loss of mandibular supportLoss of mandibular support Gradual decrease of occlusal loadGradual decrease of occlusal load posteriorly and increased occlusalposteriorly and increased occlusal load anteriorlyload anteriorly Resorption of maxillary anteriorResorption of maxillary anterior ridgeridge www.indiandentalacademy.comwww.indiandentalacademy.com
  81. 81. Ellsworth Kelly (JPD 1972:27;140) :Ellsworth Kelly (JPD 1972:27;140) : 3 yr study: all patients showed3 yr study: all patients showed a)a)1-3 mm loss of ridge height in1-3 mm loss of ridge height in maxillary anterior regionmaxillary anterior region b)b) 1-2.5 mm increase in height of1-2.5 mm increase in height of tuberositytuberosity c)c) 1-1.5 mm extrusion of lower1-1.5 mm extrusion of lower anteriors.anteriors. www.indiandentalacademy.comwww.indiandentalacademy.com
  82. 82. Kay Shen et al (JPD 1989;62:642-644)Kay Shen et al (JPD 1989;62:642-644) did a study in 150 complete denturedid a study in 150 complete denture wearers and found a prevalence ofwearers and found a prevalence of symptoms of combination syndrome insymptoms of combination syndrome in 24% of patients who had mandibular24% of patients who had mandibular anterior teeth opposing completeanterior teeth opposing complete maxillary denture.maxillary denture. This rate did not differ significantlyThis rate did not differ significantly between patients who do and donot wearbetween patients who do and donot wear mandibular RPD.mandibular RPD. www.indiandentalacademy.comwww.indiandentalacademy.com
  83. 83. Saunders et al (JPD 1979;41:126)Saunders et al (JPD 1979;41:126) Changes associated withChanges associated with combination syndrome are notcombination syndrome are not necessarily seen in all patientsnecessarily seen in all patients with maxillary complete denturewith maxillary complete denture and mandibular distal extensionand mandibular distal extension RPD.RPD. www.indiandentalacademy.comwww.indiandentalacademy.com
  84. 84. Some clinical states, seem toSome clinical states, seem to encourage development of thisencourage development of this syndrome like:syndrome like: i)i) AccentuatedAccentuated in patients within patients with AngleAngle class IIIclass III jaw relations.jaw relations. DecreasedDecreased tendency in patienttendency in patient with anglewith angle class IIclass II situations.situations. www.indiandentalacademy.comwww.indiandentalacademy.com
  85. 85. ii)ii) Patients whose mandibular posteriorPatients whose mandibular posterior teeth have not been replaced andteeth have not been replaced and who has functioned with only anteriorwho has functioned with only anterior teeth for extended periods.teeth for extended periods. iii)iii) Patients with parafunctional habits.Patients with parafunctional habits. www.indiandentalacademy.comwww.indiandentalacademy.com
  86. 86. iv)iv) Type of occlusal schemeType of occlusal scheme provided by dentist: deflectiveprovided by dentist: deflective anterior contacts in centric andanterior contacts in centric and eccentric positions (willeccentric positions (will concentrate stress anteriorly) andconcentrate stress anteriorly) and lack of occlusal balancelack of occlusal balance posteriorly.posteriorly. www.indiandentalacademy.comwww.indiandentalacademy.com
  87. 87. Prevention of combinationPrevention of combination syndromesyndrome Treatment planning to avoid thisTreatment planning to avoid this combination of prosthesis.combination of prosthesis. 1)1) Try and retain weak posteriorTry and retain weak posterior teeth by means of endodontic andteeth by means of endodontic and periodontal therapies.periodontal therapies. www.indiandentalacademy.comwww.indiandentalacademy.com
  88. 88. 2)2) Using lower anterior roots andUsing lower anterior roots and giving overdenture.giving overdenture. 3)3) Giving bilateral balancedGiving bilateral balanced occlusion.occlusion. www.indiandentalacademy.comwww.indiandentalacademy.com
  89. 89. Management of combinationManagement of combination syndromesyndrome • Diagnosis of cause and its correction.Diagnosis of cause and its correction. • Use of Tissue conditionersUse of Tissue conditioners • Surgical correction of changes inSurgical correction of changes in basal seat (flabby tissues, papillarybasal seat (flabby tissues, papillary hyperplasia, enlarged tuberosities.)hyperplasia, enlarged tuberosities.) • Restorative treatment of remainingRestorative treatment of remaining teethteeth www.indiandentalacademy.comwww.indiandentalacademy.com
  90. 90. SINGLE COMPLETESINGLE COMPLETE DENTUREDENTURE PART IIPART II www.indiandentalacademy.comwww.indiandentalacademy.com
  91. 91. CONTENTSCONTENTS www.indiandentalacademy.comwww.indiandentalacademy.com
  92. 92. 1)1) INTRODUCTIONINTRODUCTION 2)2) PROBLEM WITH SINGLE COMPLETEPROBLEM WITH SINGLE COMPLETE DENTURE.DENTURE. 3)3) COMMON OCCLUSALCOMMON OCCLUSAL DISHARMONIES AND WAYS TODISHARMONIES AND WAYS TO ADJUST THEM.ADJUST THEM. 4)4) SINGLE COMPLETE DENTURESINGLE COMPLETE DENTURE OPPOSINGOPPOSING • NATURAL TEETHNATURAL TEETH • RPDRPD www.indiandentalacademy.comwww.indiandentalacademy.com
  93. 93. 1)1) DEFINITIONSDEFINITIONS 2)2) REVIEW OF LITERATUREREVIEW OF LITERATURE 3)3) SINGLE COMPLETE DENTURESINGLE COMPLETE DENTURE OPPOSING:OPPOSING: A)A) FPDFPD B)B) EXISTING COMPLETE DENTUREEXISTING COMPLETE DENTURE C)C) IMPLANT SUPPORTEDIMPLANT SUPPORTED PROSTHESIS.PROSTHESIS. www.indiandentalacademy.comwww.indiandentalacademy.com
  94. 94. 4)4) METHODS TO ACHIEVEMETHODS TO ACHIEVE BALANCED OCCLUSIONBALANCED OCCLUSION 5)5) OCCLUSAL MATERIALS FOROCCLUSAL MATERIALS FOR SINGLE COMPLETE DENTURESSINGLE COMPLETE DENTURES 6)6) STEPS IN FABRICATION OFSTEPS IN FABRICATION OF SINGLE COMPLETE DENTURESINGLE COMPLETE DENTURE OPPOSING NATURAL TEETH.OPPOSING NATURAL TEETH. www.indiandentalacademy.comwww.indiandentalacademy.com
  95. 95. 7)7) TREATMENT PLANNING FORTREATMENT PLANNING FOR SINGLE COMPLETE DENTURESINGLE COMPLETE DENTURE OPPOSING RPDOPPOSING RPD 8)8) SUMMARYSUMMARY 9)9) CONCLUSIONCONCLUSION 10)10) REFERENCESREFERENCESwww.indiandentalacademy.comwww.indiandentalacademy.com
  96. 96. DEFINITIONSDEFINITIONS www.indiandentalacademy.comwww.indiandentalacademy.com
  97. 97. Combination syndrome / AnteriorCombination syndrome / Anterior hyperfunction syndrome (GPT-7):hyperfunction syndrome (GPT-7): The characteristic features thatThe characteristic features that occur when an edentulous maxillaoccur when an edentulous maxilla is opposed by natural mandibularis opposed by natural mandibular anterior teeth, including loss ofanterior teeth, including loss of bone from the anterior portion ofbone from the anterior portion of the maxillary anterior ridge,the maxillary anterior ridge, overgrowth of the tuberosities,overgrowth of the tuberosities, www.indiandentalacademy.comwww.indiandentalacademy.com
  98. 98. papillary hyperplasia of the hardpapillary hyperplasia of the hard palate’s mucosa, extrusion of thepalate’s mucosa, extrusion of the lower anterior teeth, and loss oflower anterior teeth, and loss of alveolar bone and ridge heightalveolar bone and ridge height beneath the mandibularbeneath the mandibular removable partial denture base.removable partial denture base. www.indiandentalacademy.comwww.indiandentalacademy.com
  99. 99. BALANCED OCCLUSIONBALANCED OCCLUSION (GPT-7)(GPT-7) The bilateral, simultaneous, anterior,The bilateral, simultaneous, anterior, and posterior occlusal contact ofand posterior occlusal contact of teeth in centric and eccentricteeth in centric and eccentric position.position. www.indiandentalacademy.comwww.indiandentalacademy.com
  100. 100. SELECTIVE GRINDINGSELECTIVE GRINDING The intentional alteration of theThe intentional alteration of the occlusal surfaces of teeth toocclusal surfaces of teeth to change their form.change their form. www.indiandentalacademy.comwww.indiandentalacademy.com
  101. 101. REVIEW OF LITERATUREREVIEW OF LITERATURE www.indiandentalacademy.comwww.indiandentalacademy.com
  102. 102. Schultz (JPD 1951:1:38-48)Schultz (JPD 1951:1:38-48) • Showed that the chewingShowed that the chewing efficiency of acrylic resin teethefficiency of acrylic resin teeth was 26-35% less than that ofwas 26-35% less than that of porcelain teeth.porcelain teeth. • Chewing efficiency of acrylicChewing efficiency of acrylic resin teeth with gold occlusalresin teeth with gold occlusal surface is equal to that ofsurface is equal to that of porcelain teeth.porcelain teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  103. 103. Frederick S. Meyer (JPDFrederick S. Meyer (JPD 1957:7:354)1957:7:354) gave the functionallygave the functionally generated path technique forgenerated path technique for achieving a balanced occlusion .achieving a balanced occlusion . Acc. to him the occlusal pathsAcc. to him the occlusal paths generated on mechanicalgenerated on mechanical articulators are different fromarticulators are different from those generated in mouth.those generated in mouth. www.indiandentalacademy.comwww.indiandentalacademy.com
  104. 104. Ellsworth Kelly(JPD 1972:27:2:140-Ellsworth Kelly(JPD 1972:27:2:140- 150)150) Followed 6 patients wearing maxillaryFollowed 6 patients wearing maxillary CD opposing mandibular DEB RPDCD opposing mandibular DEB RPD over a period of 3 yeas and gave theover a period of 3 yeas and gave the term Combination syndrome to theterm Combination syndrome to the changes that have occurred in thesechanges that have occurred in these patients.patients. All patients showedAll patients showed a)a)1-3 mm loss of ridge height in1-3 mm loss of ridge height in maxillary anterior regionmaxillary anterior region www.indiandentalacademy.comwww.indiandentalacademy.com
  105. 105. b)b) 1-2.5 mm increase in height of1-2.5 mm increase in height of tuberositytuberosity c)c) 1-1.5 mm extrusion of lower1-1.5 mm extrusion of lower anteriors.anteriors. Acc. to him, first change to occurAcc. to him, first change to occur  loss of bone from the anteriorloss of bone from the anterior part of the maxillary jaw.part of the maxillary jaw. www.indiandentalacademy.comwww.indiandentalacademy.com
  106. 106. SAUNDERS et al (JPD1979:41:124) Further described the combination syndrome, and proposed that the first change toproposed that the first change to occur is bone resorption underoccur is bone resorption under the mandibular partial denturethe mandibular partial denture base.base. www.indiandentalacademy.comwww.indiandentalacademy.com
  107. 107. Changes associated with combinationChanges associated with combination syndrome are not necessarily seensyndrome are not necessarily seen in all patients with maxillaryin all patients with maxillary complete denture and mandibularcomplete denture and mandibular distal extension RPD. Some clinicaldistal extension RPD. Some clinical states likestates like a)a) AngleAngle class IIIclass III jawjaw relations,relations, b)b) parafunctional habits,parafunctional habits, c)c) deflective anterior contacts indeflective anterior contacts in centric and eccentric positions andcentric and eccentric positions and d)d) lack of occlusal balancelack of occlusal balance posteriorly tend to accentuate thisposteriorly tend to accentuate this condition.condition. www.indiandentalacademy.comwww.indiandentalacademy.com
  108. 108. Saunders et al (J Prosthet Dent 1979 ;Saunders et al (J Prosthet Dent 1979 ; 41: 124-128.;)41: 124-128.;)recommended that therecommended that the essential objective of treatmentessential objective of treatment planning in cases with maxillaryplanning in cases with maxillary single complete denture opposingsingle complete denture opposing DEB RPD was “to provide anDEB RPD was “to provide an occlusal scheme that could bestocclusal scheme that could best discourage excessive occlusaldiscourage excessive occlusal pressures in the maxillary anteriorpressures in the maxillary anterior region in both centric and eccentricregion in both centric and eccentric occlusal contacts”.occlusal contacts”. www.indiandentalacademy.comwww.indiandentalacademy.com
  109. 109. Kay Shen et al (JPD 1989;62:642-644)Kay Shen et al (JPD 1989;62:642-644) did a study in 150 complete denturedid a study in 150 complete denture wearers and found a prevalence ofwearers and found a prevalence of symptoms of combination syndrome insymptoms of combination syndrome in 24% of patients who had mandibular24% of patients who had mandibular anterior teeth opposing completeanterior teeth opposing complete maxillary denture.maxillary denture. This rate did not differ significantlyThis rate did not differ significantly between patients who do and donot wearbetween patients who do and donot wear mandibular RPD.mandibular RPD. www.indiandentalacademy.comwww.indiandentalacademy.com
  110. 110. Barber et al (JOMFS 1990:48:1283-Barber et al (JOMFS 1990:48:1283- 1287)1287) Maxson et al (JPD 1990:63;554-558)Maxson et al (JPD 1990:63;554-558) Sybille et al (IJP 1996:9:58-64):Sybille et al (IJP 1996:9:58-64): Found that combination syndromeFound that combination syndrome occurred in patients with implantoccurred in patients with implant supported overdenture and maxillarysupported overdenture and maxillary conventional complete dentures.conventional complete dentures. www.indiandentalacademy.comwww.indiandentalacademy.com
  111. 111. B.Jacobs et al(JPD 1993:70;135-140)B.Jacobs et al(JPD 1993:70;135-140) Compared the anterior and posteriorCompared the anterior and posterior ridge resorption in three group ofridge resorption in three group of patients with different mandibularpatients with different mandibular prosthetic constructions i.e.prosthetic constructions i.e. i)i) Overdenture supported by twoOverdenture supported by two implantsimplants ii)ii) Fixed prosthesis supported by 6Fixed prosthesis supported by 6 implantsimplants iii)iii) Complete denture.Complete denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  112. 112. Results indicatedResults indicated 1)1) A more pronounced annualA more pronounced annual bone resorption in completebone resorption in complete denture wearers compared todenture wearers compared to patients with implant supportedpatients with implant supported Overdentures.Overdentures. www.indiandentalacademy.comwww.indiandentalacademy.com
  113. 113. 2)2) A limited but continuing boneA limited but continuing bone resorption observed in patientsresorption observed in patients with implant supportedwith implant supported overdentures.overdentures. 3)3) A slightly higher annual boneA slightly higher annual bone resorption occurring in the implantresorption occurring in the implant supported fixed prosthesis group.supported fixed prosthesis group. www.indiandentalacademy.comwww.indiandentalacademy.com
  114. 114. Sigvard Palmqvist et al (JPDSigvard Palmqvist et al (JPD 2003:90;270-275)2003:90;270-275) critically reviewedcritically reviewed the literature regarding combinationthe literature regarding combination syndrome and concluded that “thesyndrome and concluded that “the combination syndrome does notcombination syndrome does not meet the criteria to be accepted as ameet the criteria to be accepted as a medical syndrome. The singlemedical syndrome. The single features associated with thefeatures associated with the combination syndrome exist but tocombination syndrome exist but to what extent or in which combinationswhat extent or in which combinations has not been clarified.”has not been clarified.”www.indiandentalacademy.comwww.indiandentalacademy.com
  115. 115. SINGLE COMPLETE DENTURESINGLE COMPLETE DENTURE OPPOSING PARTIALLYOPPOSING PARTIALLY EDENTULOUS ARCHEDENTULOUS ARCH RESTORED WITH FPDRESTORED WITH FPD www.indiandentalacademy.comwww.indiandentalacademy.com
  116. 116. Which material to be used forWhich material to be used for artificial teeth.artificial teeth. Once fixed restoration is placed inOnce fixed restoration is placed in a dental arch, the restored archa dental arch, the restored arch can be thought of as a naturalcan be thought of as a natural teeth opposing a completeteeth opposing a complete denturedenture www.indiandentalacademy.comwww.indiandentalacademy.com
  117. 117. Placement of fixed restoration canPlacement of fixed restoration can correct many occlusalcorrect many occlusal disharmonies.disharmonies. For example: tilted molarsFor example: tilted molars www.indiandentalacademy.comwww.indiandentalacademy.com
  118. 118. Orthodontic correction and then give FPD www.indiandentalacademy.comwww.indiandentalacademy.com
  119. 119. Prepare tooth to get proper plane of occlusion www.indiandentalacademy.comwww.indiandentalacademy.com
  120. 120. Telescopic crownTelescopic crown retainerretainer www.indiandentalacademy.comwww.indiandentalacademy.com
  121. 121. Proximal half crown Nonrigid connector www.indiandentalacademy.comwww.indiandentalacademy.com
  122. 122. Cantilevered premolar pontic www.indiandentalacademy.comwww.indiandentalacademy.com
  123. 123. Single complete dentureSingle complete denture opposing an existing completeopposing an existing complete denturedenture www.indiandentalacademy.comwww.indiandentalacademy.com
  124. 124. 11. Duration of the existing denture. Duration of the existing denture www.indiandentalacademy.comwww.indiandentalacademy.com
  125. 125. 2.2. Condition of the teeth:Condition of the teeth: a)a) AppearanceAppearance b)b) Alignment with regard toAlignment with regard to residual ridge.residual ridge. www.indiandentalacademy.comwww.indiandentalacademy.com
  126. 126. c) Is occlusal plane Desirable? www.indiandentalacademy.comwww.indiandentalacademy.com
  127. 127. d) Occlusal surface worn out www.indiandentalacademy.comwww.indiandentalacademy.com
  128. 128. 3.3. Condition of denture baseCondition of denture base a)a) Accuracy of tissue adaptation andAccuracy of tissue adaptation and border extensionborder extension b)b) Any fracture repairsAny fracture repairs c)c) Esthetic contouring and thicknessEsthetic contouring and thickness adequate to support the perioraladequate to support the perioral structures.structures. d)d) Stability and retention.Stability and retention. www.indiandentalacademy.comwww.indiandentalacademy.com
  129. 129. Single complete dentureSingle complete denture opposing implant supportedopposing implant supported prosthesisprosthesis www.indiandentalacademy.comwww.indiandentalacademy.com
  130. 130. B.Jacobs et al(JPD 1993:70;135-140)B.Jacobs et al(JPD 1993:70;135-140) Compared the anterior and posteriorCompared the anterior and posterior ridge resorption in three group ofridge resorption in three group of patients with different mandibularpatients with different mandibular prosthetic constructions i.e.prosthetic constructions i.e. i)i) Overdenture supported by twoOverdenture supported by two implantsimplants ii)ii) Fixed prosthesis supported by 6Fixed prosthesis supported by 6 implantsimplants iii)iii) Complete denture.Complete denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  131. 131. Results indicatedResults indicated 1)1) A more pronounced annualA more pronounced annual bone resorption in completebone resorption in complete denture wearers compared todenture wearers compared to patients with implant supportedpatients with implant supported Overdentures.Overdentures. www.indiandentalacademy.comwww.indiandentalacademy.com
  132. 132. 2)2) A limited but continuing boneA limited but continuing bone resorption observed in patientsresorption observed in patients with implant supportedwith implant supported overdentures.overdentures. 3)3) A slightly higher annual boneA slightly higher annual bone resorption occurring in the implantresorption occurring in the implant supported fixed prosthesis group.supported fixed prosthesis group. www.indiandentalacademy.comwww.indiandentalacademy.com
  133. 133. Maxillary complete dentureMaxillary complete denture opposing implant supportedopposing implant supported overdentureoverdenture www.indiandentalacademy.comwww.indiandentalacademy.com
  134. 134. Permits free rotational Movement of denture upon Posterior loading www.indiandentalacademy.comwww.indiandentalacademy.com
  135. 135. Bone resorption in mandibularBone resorption in mandibular posterior regionposterior region settling of denture base and loss ofsettling of denture base and loss of posterior contactsposterior contacts upward rotation of anterior mandibularupward rotation of anterior mandibular denturedenture more forces on anterior maxillamore forces on anterior maxilla supporting the maxillary denture.supporting the maxillary denture.www.indiandentalacademy.comwww.indiandentalacademy.com
  136. 136. Barber et al (J OMFS 1990:48:1283-Barber et al (J OMFS 1990:48:1283- 1287)1287) Maxson et al (JPD 1990:63;554-558)Maxson et al (JPD 1990:63;554-558) Sybille et al (IJP 1996:9:58-64):Sybille et al (IJP 1996:9:58-64): Found that combination syndromeFound that combination syndrome occurred in patients with implantoccurred in patients with implant supported overdenture and maxillarysupported overdenture and maxillary conventional complete dentures.conventional complete dentures. www.indiandentalacademy.comwww.indiandentalacademy.com
  137. 137. Maxillary completeMaxillary complete denturedenture opposing implantopposing implant supported fixedsupported fixed denturedenture www.indiandentalacademy.comwww.indiandentalacademy.com
  138. 138. Opinion is divided over theOpinion is divided over the functional forces borne by thefunctional forces borne by the maxillary complete denturemaxillary complete denture opposing implant supported fixedopposing implant supported fixed denture.denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  139. 139. Stafford et alStafford et al ; found that loading; found that loading forces did not increaseforces did not increase Falk et al (JOMI 1989:44; 55-62)Falk et al (JOMI 1989:44; 55-62) found the loading forces to befound the loading forces to be comparable to those of partiallycomparable to those of partially restored natural dentitions, withrestored natural dentitions, with greater forces in the posteriorgreater forces in the posterior region of the maxillary dentureregion of the maxillary denture opposing cantilever units of theopposing cantilever units of the implant prosthesis.implant prosthesis.www.indiandentalacademy.comwww.indiandentalacademy.com
  140. 140. Difference in opinion regardingDifference in opinion regarding the anterior maxillary bone lossthe anterior maxillary bone loss under complete denturesunder complete dentures opposing implant supported fixedopposing implant supported fixed prosthesis.prosthesis. www.indiandentalacademy.comwww.indiandentalacademy.com
  141. 141. Jacobs et al (JPD 1993):Jacobs et al (JPD 1993): reportedreported an increase annual bone lossan increase annual bone loss maxillary anterior region.maxillary anterior region. Henry et al (IJP 1999:12;492-497):Henry et al (IJP 1999:12;492-497): reported no anterior resorptionreported no anterior resorption and no occurrence of conditionand no occurrence of condition like combination syndrome in thislike combination syndrome in this clinical state.clinical state. www.indiandentalacademy.comwww.indiandentalacademy.com
  142. 142. METHODS TOMETHODS TO ACHIEVE BALANCEDACHIEVE BALANCED OCCLUSIONOCCLUSION www.indiandentalacademy.comwww.indiandentalacademy.com
  143. 143. TWO TECHNIQUESTWO TECHNIQUES:: 1)1) Those that dynamicallyThose that dynamically equilibrate the occlusion by useequilibrate the occlusion by use ofof functionally generated pathfunctionally generated path i.e.i.e. Functional chew inFunctional chew in techniquestechniques.. 2)2) Those that statisticallyThose that statistically equilibrate the occlusion byequilibrate the occlusion by using an articulator programmedusing an articulator programmed to simulate patients jawto simulate patients jaw movements.movements.www.indiandentalacademy.comwww.indiandentalacademy.com
  144. 144. Functionally generated pathFunctionally generated path techniques / Functional chewtechniques / Functional chew in techniques for singlein techniques for single complete dentures.complete dentures. www.indiandentalacademy.comwww.indiandentalacademy.com
  145. 145. Contraindications:Contraindications: 1)1) Record base not stable.Record base not stable. 2)2) Patients with poor neuromuscularPatients with poor neuromuscular control.control. www.indiandentalacademy.comwww.indiandentalacademy.com
  146. 146. StansburyStansbury (JPD 1951;1;692-699)(JPD 1951;1;692-699) andand Rudd and MorrowRudd and Morrow (JPD 1973:30;4)(JPD 1973:30;4) www.indiandentalacademy.comwww.indiandentalacademy.com
  147. 147. Cast mounted on articulator in CRCast mounted on articulator in CR at acceptable vertical dimension.at acceptable vertical dimension. Remove record base and occlusalRemove record base and occlusal rimrim adapt new base plate andadapt new base plate and fabricate occlusal rims made offabricate occlusal rims made of compoundcompound www.indiandentalacademy.comwww.indiandentalacademy.com
  148. 148. (twice the normal width-atleast(twice the normal width-atleast twice the width of molar teeth)twice the width of molar teeth)  6 mm anterior to mandibular6 mm anterior to mandibular incisor,incisor, sufficient in height to receive ansufficient in height to receive an impression of the central fossa ofimpression of the central fossa of the lower teeth.the lower teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  149. 149. Compound occlusal rim heatedCompound occlusal rim heated Placed in articulatorPlaced in articulator closedclosed Impression of fossae of all lowerImpression of fossae of all lower teeth recorded.teeth recorded. www.indiandentalacademy.comwww.indiandentalacademy.com
  150. 150. Occlusal rimsOcclusal rims trimmed B-L.trimmed B-L. CompoundCompound extension inextension in the centralthe central fossa.fossa. www.indiandentalacademy.comwww.indiandentalacademy.com
  151. 151. Anterior regionAnterior region trimmed tilltrimmed till level oflevel of indentation ofindentation of incisors(2mmincisors(2mm space betweenspace between rim andrim and mandibularmandibular anterior teeth)anterior teeth) www.indiandentalacademy.comwww.indiandentalacademy.com
  152. 152. Place in patients mouthPlace in patients mouth Pt asked to make chewing slowlyPt asked to make chewing slowly Excess compound wears offExcess compound wears off Free action in lateral movement.Free action in lateral movement. www.indiandentalacademy.comwww.indiandentalacademy.com
  153. 153. Record baseRecord base removed fromremoved from patients mouth,patients mouth, soft wax (cardingsoft wax (carding wax) added onwax) added on B-L sides.B-L sides. www.indiandentalacademy.comwww.indiandentalacademy.com
  154. 154. Placed in patients mouthPlaced in patients mouth Patient asked to perform eccentricPatient asked to perform eccentric chewing movementschewing movements www.indiandentalacademy.comwww.indiandentalacademy.com
  155. 155. Lower teeth cutLower teeth cut their pathstheir paths in the soft wax.in the soft wax. Compound inCompound in central fossa actcentral fossa act as a guide toas a guide to preserve cusppreserve cusp height.height. www.indiandentalacademy.comwww.indiandentalacademy.com
  156. 156. Occlusal rim removedOcclusal rim removed  stone pouredstone poured into wax paths.into wax paths. First mandibularFirst mandibular cast is removedcast is removed Maxillary occlusalMaxillary occlusal rim with generatedrim with generated occlusal paths and stone recordocclusal paths and stone record is placed in articulatoris placed in articulatorwww.indiandentalacademy.comwww.indiandentalacademy.com
  157. 157. Stone record isStone record is secured to thesecured to the lower member oflower member of the articulator withthe articulator with plaster.plaster. www.indiandentalacademy.comwww.indiandentalacademy.com
  158. 158. 2 lower casts-first-duplicate of lower2 lower casts-first-duplicate of lower teeth, second replica of generatedteeth, second replica of generated path.path. Original mandibular cast placed onOriginal mandibular cast placed on articulatorarticulator Maxillary teeth setting done (ant.Maxillary teeth setting done (ant. teethteeth acc. to esthetics, post. teethacc. to esthetics, post. teeth ground and adjusted to CO.ground and adjusted to CO. www.indiandentalacademy.comwww.indiandentalacademy.com
  159. 159. Checked in mouth for esthetics andChecked in mouth for esthetics and centric occlusioncentric occlusion .. Denture processedDenture processed Remounted.Remounted. Any interference in centric occlusionAny interference in centric occlusion checked and correctedchecked and corrected www.indiandentalacademy.comwww.indiandentalacademy.com
  160. 160. Once correct in COOnce correct in CO remove theremove the lower castlower cast put chew-in mandibularput chew-in mandibular cast coat with prusssian bluecast coat with prusssian blue Interferences removedInterferences removed Thus in CR and eccentric movementThus in CR and eccentric movement bilateral balanced occlusion will bebilateral balanced occlusion will be established.established. www.indiandentalacademy.comwww.indiandentalacademy.com
  161. 161. By Robert G.VigBy Robert G.Vig (JPD 1964;14:214-220)(JPD 1964;14:214-220) Similar techniqueSimilar technique like Stansbury butlike Stansbury but he recommendedhe recommended use of ause of a fin of resinfin of resin placed into theplaced into the central groovescentral grooves instead of compound.instead of compound. Maintains Vertical Dimension better.Maintains Vertical Dimension better.www.indiandentalacademy.comwww.indiandentalacademy.com
  162. 162. Articulator EquilibrationArticulator Equilibration TechniqueTechnique Equilibrate the occlusion by usingEquilibrate the occlusion by using an articulator programmed toan articulator programmed to simulate patients jaw movements.simulate patients jaw movements. www.indiandentalacademy.comwww.indiandentalacademy.com
  163. 163. Indications:Indications: • If denture base lacks stability.If denture base lacks stability. • Patient unable to performPatient unable to perform movements properly.movements properly. www.indiandentalacademy.comwww.indiandentalacademy.com
  164. 164. Maxillary occlusal rimsMaxillary occlusal rims fabricatedfabricated face bow transferface bow transfer donedone maxillary casts mountedmaxillary casts mounted on articulator.on articulator. Mandibular cast mounted onMandibular cast mounted on articulator using centric andarticulator using centric and eccentric records at establishedeccentric records at established vertical dimension.vertical dimension. www.indiandentalacademy.comwww.indiandentalacademy.com
  165. 165. Bucco-lingual position of the lowerBucco-lingual position of the lower teeth and their relation to maxillaryteeth and their relation to maxillary arch is studied.arch is studied. Teeth arrangement done according toTeeth arrangement done according to natural teeth.natural teeth. Interferences in centric and eccentricInterferences in centric and eccentric positions are removed by grindingpositions are removed by grinding the natural teeth and artificial teeththe natural teeth and artificial teeth until a bilateral balanced occlusion isuntil a bilateral balanced occlusion is achieved.achieved. www.indiandentalacademy.comwww.indiandentalacademy.com
  166. 166. OCCLUSAL MATERIALS FOROCCLUSAL MATERIALS FOR SINGLE COMPLETESINGLE COMPLETE DENTURESDENTURES www.indiandentalacademy.comwww.indiandentalacademy.com
  167. 167. a)a) Porcelain teeth:Porcelain teeth: AdvantageAdvantage: minimal wearing, therefore: minimal wearing, therefore vertical dimension maintained.vertical dimension maintained. DisadvantageDisadvantage:: Rapid wearing of opposing naturalRapid wearing of opposing natural teeth.teeth. Occlusal adjustment of artificial teethOcclusal adjustment of artificial teeth neededneeded porcelain becomes weak.porcelain becomes weak.www.indiandentalacademy.comwww.indiandentalacademy.com
  168. 168. b)b) Acrylic resin teeth:Acrylic resin teeth: Advantage:Advantage: No wear of opposing teethNo wear of opposing teeth Easy to do occlusal adjustments.Easy to do occlusal adjustments. Disadvantage:Disadvantage: Wears off easilyWears off easily loss of verticalloss of vertical dimension and change in centricdimension and change in centric occlusion.occlusion. www.indiandentalacademy.comwww.indiandentalacademy.com
  169. 169. c)c) Gold occlusalsGold occlusals ConsideredConsidered best materialbest material to opposeto oppose natural teeth. Minimum wear.natural teeth. Minimum wear. Disadvantage:Disadvantage: ExpensiveExpensive Time consuming.Time consuming. www.indiandentalacademy.comwww.indiandentalacademy.com
  170. 170. Schultz (JPD 1951:1:38-48)Schultz (JPD 1951:1:38-48) • Showed that the chewingShowed that the chewing efficiency of acrylic resin teethefficiency of acrylic resin teeth was 26-35% less than that ofwas 26-35% less than that of porcelain teeth.porcelain teeth. • Chewing efficiency of acrylicChewing efficiency of acrylic resin teeth with gold occlusalresin teeth with gold occlusal surface is equal to that ofsurface is equal to that of porcelain teeth.porcelain teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  171. 171. Technique of fabrication ofTechnique of fabrication of gold occlusalsgold occlusals (JPD 1964:14;326-333)(JPD 1964:14;326-333) www.indiandentalacademy.comwww.indiandentalacademy.com
  172. 172. Dentures made in usual manner usingDentures made in usual manner using acrylic resin posterior teeth.acrylic resin posterior teeth. Remounted on articulator-occlusalRemounted on articulator-occlusal disharmonies removed by selectivedisharmonies removed by selective GrindingGrinding Denture finished and patient is allowedDenture finished and patient is allowed to wear them for 3-4 weeksto wear them for 3-4 weekswww.indiandentalacademy.comwww.indiandentalacademy.com
  173. 173. With dentures in mouthWith dentures in mouth  impression made with irreversibleimpression made with irreversible hydrocolloidhydrocolloid Denture in impressionDenture in impression applyapply petroleum jellypetroleum jelly dental stonedental stone poured into the denture.poured into the denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  174. 174. Buccal and palatal surfaces covered with modeling clay All undercuts blocked Lingually- 2mm short of occlusal surface Labially-1mm short www.indiandentalacademy.comwww.indiandentalacademy.com
  175. 175. Stone counter dies poured www.indiandentalacademy.comwww.indiandentalacademy.com
  176. 176. Preparation resembling three quarter crown made on each tooth 1.5mm 2mm 1.5mm www.indiandentalacademy.comwww.indiandentalacademy.com
  177. 177. Grooves cut A-P 3mm wide and 3mm deep. Hole approximately 2mm depth made in centre of each tooth www.indiandentalacademy.comwww.indiandentalacademy.com
  178. 178. Counter die www.indiandentalacademy.comwww.indiandentalacademy.com
  179. 179. Final wax pattern Sprue attached www.indiandentalacademy.comwww.indiandentalacademy.com
  180. 180. Castings cemented www.indiandentalacademy.comwww.indiandentalacademy.com
  181. 181. d)d) Acrylic resin teeth with amalgamAcrylic resin teeth with amalgam stopsstops (JPD 1979:41:16-20)(JPD 1979:41:16-20) Advantage:Advantage: • Reduces occlusal wear of resin teeth.Reduces occlusal wear of resin teeth. • Less expensive than goldLess expensive than gold • Facilitates the final stages of occlusalFacilitates the final stages of occlusal adjustment.adjustment. www.indiandentalacademy.comwww.indiandentalacademy.com
  182. 182. Occlusal preparation in acrylic teeth Amalgam condensed www.indiandentalacademy.comwww.indiandentalacademy.com
  183. 183. Centric holding areas as well as excursions are recorded in amalgam www.indiandentalacademy.comwww.indiandentalacademy.com
  184. 184. CLINICAL PROCEDURE OFCLINICAL PROCEDURE OF FABRICATINGFABRICATING A MAXILLARYA MAXILLARY COMPLETECOMPLETE DENTURE OPPOSINGDENTURE OPPOSING A MANDIBULAR NATURALA MANDIBULAR NATURAL TEETHTEETH www.indiandentalacademy.comwww.indiandentalacademy.com
  185. 185.  Maxillary and mandibular castsMaxillary and mandibular casts obtained and are mounted in CR atobtained and are mounted in CR at acceptable VD.acceptable VD.  Proper diagnosis related to:Proper diagnosis related to:  Periodontal health of thePeriodontal health of the remaining teethremaining teeth  If any missing teeth to be replaced.If any missing teeth to be replaced.  Tooth modifications needed.Tooth modifications needed. www.indiandentalacademy.comwww.indiandentalacademy.com
  186. 186.  Impression of lower teethImpression of lower teeth  castcast obtainedobtained  Maxillary archMaxillary arch Secondary impressionSecondary impression master castmaster cast obtainedobtained occlusal rim fabricatedocclusal rim fabricated contoured for adequate lip support.contoured for adequate lip support.  Using face bow mount the maxillary castUsing face bow mount the maxillary cast on the articulatoron the articulator  mount mandibularmount mandibular cast using centric and eccentric recordscast using centric and eccentric records at correct VDat correct VD www.indiandentalacademy.comwww.indiandentalacademy.com
  187. 187.  Set teeth and achieve a balancedSet teeth and achieve a balanced occlusion by selective grinding.occlusion by selective grinding.  If gold restorations needed on theIf gold restorations needed on the teeth, modify the teeth.teeth, modify the teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  188. 188.  If FPD neededIf FPD needed  do the toothdo the tooth preparation beforepreparation before making impression.making impression.  Wax patterns areWax patterns are carved to conformcarved to conform to the existingto the existing occlusion ofocclusion of maxillary denture.maxillary denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  189. 189. TREATMENT PLANNINGTREATMENT PLANNING FOR PATIENT WITHFOR PATIENT WITH EDENTULOUS MAXILLAEDENTULOUS MAXILLA AND PARTIALLY EDENTULOUSAND PARTIALLY EDENTULOUS MANDIBLEMANDIBLE www.indiandentalacademy.comwww.indiandentalacademy.com
  190. 190.  1)1) Risk of development ofRisk of development of combination syndrome should becombination syndrome should be recognized.recognized.  2)2) Basic objectiveBasic objective: occlusal scheme: occlusal scheme that can discourage excessivethat can discourage excessive occlusal pressure in maxillaryocclusal pressure in maxillary anterior region in both centric andanterior region in both centric and eccentric occlusal contacts:eccentric occlusal contacts: Bilateral balanced occlusionBilateral balanced occlusionwww.indiandentalacademy.comwww.indiandentalacademy.com
  191. 191. 3)3) Treatment must concentrate onTreatment must concentrate on periodontal and restorative needsperiodontal and restorative needs of remaining teethof remaining teeth www.indiandentalacademy.comwww.indiandentalacademy.com
  192. 192. 4) RPD Design4) RPD Design • Maximal coverage of basal seatMaximal coverage of basal seat beneath distal extension base withoutbeneath distal extension base without encroaching movable tissues.encroaching movable tissues. • Adequate fit of the denture baseAdequate fit of the denture base • Design be rigid and provideDesign be rigid and provide maximum stability.maximum stability.www.indiandentalacademy.comwww.indiandentalacademy.com
  193. 193. • Functional impression technique.Functional impression technique. • Increasing the efficiency ofIncreasing the efficiency of occlusal surface of artificial teeth.occlusal surface of artificial teeth. • Narrowing the occlusal tableNarrowing the occlusal table • Avoiding the use of stressAvoiding the use of stress breakers.breakers. www.indiandentalacademy.comwww.indiandentalacademy.com
  194. 194. 5) Maxillary complete denture:5) Maxillary complete denture: • Maximum extensionMaximum extension • Adequate border sealAdequate border seal www.indiandentalacademy.comwww.indiandentalacademy.com
  195. 195. 6)6) Adequate vertical dimension andAdequate vertical dimension and proper centric relation positionproper centric relation position 7)7) Anterior teeth in maxillary completeAnterior teeth in maxillary complete denture be used for cosmeticdenture be used for cosmetic purpose only. No incisal contact inpurpose only. No incisal contact in centric occlusion and minimal contactcentric occlusion and minimal contact in eccentric position.in eccentric position. 8)8) Patient education and frequentPatient education and frequent recall and maintenance.recall and maintenance. www.indiandentalacademy.comwww.indiandentalacademy.com
  196. 196. SUMMARYSUMMARY www.indiandentalacademy.comwww.indiandentalacademy.com
  197. 197. CONCLUSIONCONCLUSION The main problem in treatingThe main problem in treating patients who need a completepatients who need a complete denture to occlude with opposingdenture to occlude with opposing natural teeth is that natural teeth cannatural teeth is that natural teeth can transmit larger forces to a denturetransmit larger forces to a denture whose supporting structures arewhose supporting structures are unable to resist them. Thus damageunable to resist them. Thus damage to the edentulous ridge can easilyto the edentulous ridge can easily occur.occur.www.indiandentalacademy.comwww.indiandentalacademy.com
  198. 198. To avoid this sequeale, the basicTo avoid this sequeale, the basic fundamentals of prosthodonticfundamentals of prosthodontic treatment i.e. an adequatetreatment i.e. an adequate denture base ,correct jawdenture base ,correct jaw relations, bilateral balancedrelations, bilateral balanced occlusion must be provided.occlusion must be provided. www.indiandentalacademy.comwww.indiandentalacademy.com
  199. 199. REFERENCESREFERENCES www.indiandentalacademy.comwww.indiandentalacademy.com
  200. 200.  Stansbury C B. Single dentureStansbury C B. Single denture construction against a non-modifiedconstruction against a non-modified natural dentition.natural dentition. J Prosthet DentJ Prosthet Dent 1951;1951; 11: 692-699.: 692-699.  Meyer: Generated path techniqueMeyer: Generated path technique :JPD 1957:7 354:JPD 1957:7 354  Tillman E J. Removable partial upperTillman E J. Removable partial upper and complete lower dentures.and complete lower dentures. J.Prosthet DentJ.Prosthet Dent 1961;1961; 1111: 1097-1104.: 1097-1104. www.indiandentalacademy.comwww.indiandentalacademy.com
  201. 201.  Vig R G. A modified chew in andVig R G. A modified chew in and functional impression technique.functional impression technique. J.J. Prosthet DentProsthet Dent 1964;1964; 1414: 214-220.: 214-220.  Use of gold occlusal surface in completeUse of gold occlusal surface in complete and partial dentures: JPD 1964:14;326and partial dentures: JPD 1964:14;326  Bruce: CD opposing natural teeth:JPDBruce: CD opposing natural teeth:JPD 1971:26;5:4481971:26;5:448  Ellinger:Single complete denture:JPDEllinger:Single complete denture:JPD 1971:26:4-101971:26:4-10 www.indiandentalacademy.comwww.indiandentalacademy.com
  202. 202.  Kelly E. Changes caused by a mandibularKelly E. Changes caused by a mandibular removable partial denture opposing aremovable partial denture opposing a maxillary complete denture.maxillary complete denture. J ProsthetJ Prosthet DentDent 1972;1972; 2727: 140-150.: 140-150.  Rudd and Morrow: occlusion and singleRudd and Morrow: occlusion and single denture:jpd1973;31:4denture:jpd1973;31:4  Mandibular posterior fixed partialMandibular posterior fixed partial denture:JPD 1977:37:622denture:JPD 1977:37:622 www.indiandentalacademy.comwww.indiandentalacademy.com
  203. 203. Saunders T R, Gillis R E, DesjardinsSaunders T R, Gillis R E, Desjardins R P. The maxillary complete dentureR P. The maxillary complete denture opposing the mandibular bilateralopposing the mandibular bilateral distal-extension partialdistal-extension partial denture.Treatment considerations.denture.Treatment considerations. JJ Prosthet DentProsthet Dent 1979 ;1979 ;4141: 124-128.: 124-128. Lauciello:articulator generated stopsLauciello:articulator generated stops for CD:jpd1979;41:16for CD:jpd1979;41:16 Schmitt ;combination syndromeSchmitt ;combination syndrome :treatment appoach:JPD 1985:54:664:treatment appoach:JPD 1985:54:664www.indiandentalacademy.comwww.indiandentalacademy.com
  204. 204. Koper ;maxillary CD opposind naturalKoper ;maxillary CD opposind natural teeth: problems and some solutuions:teeth: problems and some solutuions: JPD 1987:57;704JPD 1987:57;704 Shen:prevalance ofShen:prevalance of CombinationCombination syndrome among denture wearers:syndrome among denture wearers: JPD 1989:62;642JPD 1989:62;642 Maxillary CD opposingMaxillary CD opposing osseointegrated mandibularosseointegrated mandibular prosthesis:IJP1993:6;446-450prosthesis:IJP1993:6;446-450 Maxillary bone resorption inMaxillary bone resorption in patients with mandibular implantpatients with mandibular implant supported OD or fixedsupported OD or fixed prosthesis.:JPd 1993:70:135-140)prosthesis.:JPd 1993:70:135-140)www.indiandentalacademy.comwww.indiandentalacademy.com
  205. 205.  Yair LangerYair Langer ::Modalities of Treatment forModalities of Treatment for the Combination Syndromethe Combination Syndrome ::J ProsthodJ Prosthod 1995;4:76-811995;4:76-81  CS in relation toCS in relation to osseointegratedosseointegrated implant supported OD :IJP 1996:9;58-64implant supported OD :IJP 1996:9;58-64  Maxillary changes underMaxillary changes under CD opposingCD opposing mandibular implant supported fixedmandibular implant supported fixed prosthesis: IJP 1999:12;492prosthesis: IJP 1999:12;492  combination syndrome: a literaturecombination syndrome: a literature review:Jpd 2003:90:270-275review:Jpd 2003:90:270-275  Philip W SmithPhilip W Smith ::Combination syndromeCombination syndrome revisited: BDJ 2001; 2(3):96-101revisited: BDJ 2001; 2(3):96-101 www.indiandentalacademy.comwww.indiandentalacademy.com
  206. 206.  Complete denture prosthodontics:Complete denture prosthodontics: Sharry: 3Sharry: 3rdrd edtedt Essentials of complete dentureEssentials of complete denture prosthodontics:winkler:2prosthodontics:winkler:2ndnd edtedt Text book of complete denture :5Text book of complete denture :5thth edt:Heartwell.edt:Heartwell.  complete denture :Swenson:4complete denture :Swenson:4thth edtedt www.indiandentalacademy.comwww.indiandentalacademy.com
  207. 207. Removable partial prosthodontics:10Removable partial prosthodontics:10 edt:Mc Crackenedt:Mc Cracken Prosthodontic treatment forProsthodontic treatment for edentulous patients:12edentulous patients:12thth edt:Zarbedt:Zarb www.indiandentalacademy.comwww.indiandentalacademy.com
  208. 208. Combination syndrome / AnteriorCombination syndrome / Anterior hyperfunction syndromehyperfunction syndrome (GPT-7):(GPT-7): ““The characteristic features that occurThe characteristic features that occur when an edentulous maxilla is opposed bywhen an edentulous maxilla is opposed by natural mandibular anterior teeth,natural mandibular anterior teeth, including loss of bone from the anteriorincluding loss of bone from the anterior portion of the maxillary anterior ridge,portion of the maxillary anterior ridge, overgrowth of the tuberosities, papillaryovergrowth of the tuberosities, papillary hyperplasia of the hard palate’s mucosa,hyperplasia of the hard palate’s mucosa, extrusion of the lower anterior teeth, andextrusion of the lower anterior teeth, and loss of alveolar bone and ridge heightloss of alveolar bone and ridge height beneath the mandibular removable partialbeneath the mandibular removable partial denture base.”denture base.” www.indiandentalacademy.comwww.indiandentalacademy.com
  209. 209. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com

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