dr. isha saxena Institute of Dental Sciences, Bareilly

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3. Contents
• Introduction
• Definition
• Indication
• Diagnosis and treatment planning
• Various combination of single complete denture
• Problems associated with single complete
denture
• Common occlusal disharmonies & ways to adjust
them
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4. • Mouth preparation
• Methods to achieve balanced/ harmonious
occlusion.
• Teeth selection
• Adverse outcomes
• Conclusion
• References
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5. Introduction
• The single complete denture opposing all or some
of the natural dentition is not an uncommon
occurrence.
• Many patients become edentulous in one arch
while retaining some or all of their natural teeth in
the opposing arch.
• In this situation a single complete denture is
fabricated.
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6. • A single complete denture may occlude against:
 Some or all natural teeth
 fixed restoration
Previously constructed RPD or a complete denture.
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7. Definition
• “The making of maxillary or mandibular denture
as distinguished from a set of complete
denture.” –GPT 1
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8. Maxillary single dentures
• More common
• Maxillary teeth are lost earlier than their
mandibular antagonists.
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9. Mandibular single denture
Must be avoided whenever possible.
Because in mandible the area of support available is
relatively small to resist the forces of opposing natural
teeth.
• Due to heavy occlusal forces- severe ridge resorption.
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10. • Stress reduction should be used.
-processed resilient dentures.
-over denture
-implant retained dentures.
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11. Reasons of difficulty
• FORCE:
• The magnitude of force that natural dentition
can resist or deliver without discomfort
• Than the force a complete denture resting on
delicate mucosa can resist.
is much higher
198 lbs
26lbs
By Anderson & Storer (1966)
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12. • Heavy occlusal forces due to opposing natural
teeth.(3 times higher than conventional CD)
• These high magnitude of forces on denture
foundation results in
Loose tilting dentures, damage to mucosa .
Results in advanced bone loss of ridges
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13. • OCCLUSAL FORM:
• Occlusal form of natural dentition is unsuitable
for the denture.
• Natural dentition may have sharp or high cusps
• Malposed , tipped or supra-erupted teeth in
the lower arch makes it difficult to achieve a
harmonious balanced occlusion.
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14. • Supra eruption & mesial drifting of opposing natural
teeth produce unharmonious occlusal plane.
• As a result, unfavourable occlusal relationships exists
which tends to displace the maxillary denture
- Causing soreness, mucosal changes and ultimately
ridge resorption.
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15. Problems with single complete
denture
• Midline fracture of denture
• Greater magnitude of forces
• Dislodgement of denture
• Changes in the underlying bone
• Wearing of natural teeth
• Difficulty to obtain occlusal balance.
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16. To overcome these
problems
Establishment of inter occlusal distance
Creation of bilateral posterior contacts
Avoidance of adverse tooth contacts
Directing forces along the long axis of prosthesis
Forces to which denture is subjected must be reduced
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17. 17
IN CASE OF MIDLINE
FEACTURE OF DENTURE
BASE:
The denture base is
reinforced using co-cr
mesh – by embedding it in
PMMA resin

18. DIAGNOSIS AND TREATMENT
PLANNING
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19. • For proper diagnosis and treatment planning-
evaluate-
• Edentulous arch: freni , sulcus , palate,
mucosa, ridge undercuts .
• Dentulous arch: no of teeth, position of teeth,
restorative & periodontal condition of existing
dentition.
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20. Carl F. Driscoll classification for
identification and treatment of
patients.
• Class I: Patients for whom minor or no tooth
reduction is needed to obtain balance.
• Class II: patients for whom minor additions to the
height of the teeth are needed to obtain
balance
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21. • Class III : Patients for whom both reduction and
addition are required to obtain
balance. The treatment of these
patients involves changes in the VDO.
• Class IV: Patients who represents occlusal
discrepancies that require addition to
the width of the occluding surface.
• class V : Patients who presents with
combination syndrome.
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22. Different clinical scenarios
• A single complete denture is desirable . When it is to
oppose any one of them:
1. Natural teeth
2. Partially edentulous arch – missing teeth replaced by RPD
3. Partially edentulous arch – missing teeth replaced by FPD
4. Existing complete denture
5. Implant supported complete denture
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23. COMMON OCCLUSAL
DISHARMONIES
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(A) If denture teeth are set to the unaltered inclinations of lower natural
teeth, an unfavourable occlusal plane will result
(B) In lateral excursions most teeth will disocclude because of severe
inclinations of posterior teeth. If the denture teeth are set according to
tipped natural teeth.

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28. OCCLUSAL MODIFICATIONS OF
NATURAL TEETH
Prior to denture construction
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29. Techniques to modify the existing occlusal
pattern prior to denture construction
• Swenson’s technique
• Yurkstas method
• Bruce method
• Bouchers method
• Han kuang tan’s technique
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30. Swenson’s method (1964)
• Maxillary and mandibular cast are mounted on
articulator (using a provisional CR record )
• Maxillary denture teeth are set.
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31. • Lower interfering teeth are adjusted on the
cast and area is marked with a pencil
•Natural teeth are modified using
marked diagnostic cast as a guide.
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32. • After occlusal modifications new diagnostic
cast of the lower arch is made and mounted
on the articulator.
• If more adjustments are needed the
procedure is repeated.
• Artificial teeth are then checked and
modifications are done for the final try in
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33. • Disadvantage:
• This technique is simple but time consuming if
several impressions and mountings are to be
made.
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34. Yurkstas method (1968)
• Involves the use of a U shaped metal occlusal
template that is slightly convex on the lower
surface.
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35. •When placed on the occlusal
surface of the remaining
teeth, Cusps to be adjusted
are identified.
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36. • Stone cast is modified to a more acceptable
occlusal relationship and areas reduced are
identified by marking with a pencil
• Cast is then used as a guide for modifying
natural teeth.
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37. Bruce method (1971)
• The casts are mounted and the necessary
modifications are made on the stone casts.
• A clear acrylic resin template is fabricated on
the modified stone cast.
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38. • Inner surface of template is
coated with pressure
indicating paste and the
interferences are noted
through the template.
• Desired modifications are
done on natural teeth till the
template seats properly.
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39. Boucher’s method
• It involves making natural teeth fit into the
established plane and inclines of the maxillary
porcelain teeth.
• First, the casts are mounted and artificial
teeth are arranged to the best possible
balancing contacts.
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40. • If natural teeth prevent balancing , the
interferences are removed by movement of
maxillary porcelain teeth over the mandibular
stone teeth.
• Denture is processed and area to be reshaped
are noted on the cast.
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41. • Natural teeth are ground at the areas marked
on the cast.
• The occlusion is refined in the right left lateral
excursive movements until a harmonious
balance is achieved.
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42. Han – kuang Tan (1997)
• a vacuum formed clear template is made over
the cast with Sta-Vac sheet resin material
(0.02)inch thick.
• Cut the template at the level of gingival margin
around the entire cast to facilitate removal.
• Remove the template from the cast
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43. • Mount the maxillary and mandibular casts in
CR with a good jaw relation record.
• Arrange the maxillary teeth according to the
contour of the maxillary occlusion rim
• In the course of setting teeth, judiciously grind
both the denture teeth and the natural stone
teeth on the mandibular cast to achieve the
best possible articulation
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45. 45

46. Methods to achieve harmonious
balanced occlusion
Functional chew in techniques
• Stansbury technique
• Vig’s technique
• Sharry technique
• Rudd technique
Articulator equilibriation techniques
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47. 47

48. Stansbury technique (1928)
• Compound occlusal rim trimmed
buccally and lingually so that
occlusion is free in lateral
excursion.
• Carding wax is added buccally and
lingually and patient instructed to
perform chewing movements.
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Impression compound
occlusal rims

49. • Carding wax gets functionally molded whereas
compound rims in the central fossa maintains the
VD.
• The generated occlusal rim is removed from the
mouth and stone is vibrated into the wax path of the
cusps
• The record is secured and used as a occlusal guide on
the articulator.
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50. • Denture teeth are first set on the lower cast
• After esthetics approved at try in , lower cast chew-in
record is secured and all the interfering spots are ground.
• Thus in centric and eccentric movements balanced
occlusion is established.
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51. Vig’s technique (1964)
• Anterior teeth are set chair side.
• Wax occlusal rims posterior to cuspids are
removed.
• Acrylic resin is added and firmly pressed
against the occlusal surface of teeth on the
opposing cast
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52. 52
•When set, acrylic resin is trimmed so as to leave only a
fin of resin falling into the central grooves of the
opposing posterior teeth to maintain VD
•The base is the inserted into the mouth for cusp and
sulcus analysis.

53. • The fin is then build up with a soft wax and
final path is recorded
• The teeth are then set against the recorded
chew in cast and interferences are ground to
obtain harmonious occlusion
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54. Sharry technique
• Simple technique of using maxillary rim of
softened wax
• Lateral and porotrusive chewing movements
are made so that wax is abraded generating
the final paths of the lower cusps.
• Continued untill correct VD is achieved.
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55. Rudd technique
• Suggests a technique similar to Stansbury’s
• But suggests using 2 maxillary bases , one for
recording the generated path and for setting
the teeth.
• Advantage:
• Decreases number of appointments necessary
for the construction of the denture.
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56. Articulator equilibration technique
o Used- when denture base lack stability
when patient is unable to perform chew-in
record.
• Upper cast is mounted on the articulator using a
facebow transfer.
• Lower cast is related to upper cast by a centric
inter-occlusal record at an acceptable VD.
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57. • The bucco-lingual position of the teeth an
their relation to the upper arch is studied.
• Cusp-fossa relationship of the teeth is
essential
• At the time of wax try in , eccentric records
are made and condylar inclinations are set
and posterior teeth are now balanced.
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58. 58
L
L
B
B

59. 59
B B

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B L

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62. • Disadvantage:
• Perfectly balanced occlusion in all eccentric
positions may not be possible in many cases
when working with natural teeth in one arch.
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63. Various teeth material used
• Porcelain teeth
• acrylic teeth
• Gold occlusal
• Acrylic resin with amalgam stops
• IPN resin (inter-penetrating polymer network)
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64. • Tooth selection
• Anatomic teeth usually are chosen in the single complete
denture to enhance esthetics
• The decision as to which cusped tooth to choose is based
on evaluation of the condylar guidance and incisal
guidance and therefore is selected after anterior tooth
setup
• The cusp height can be chosen by following methods:
• cusp height is equal to the sum of condylar guidance
and incisal guidance divided by two, or
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65. • In patients with flat occlusal tables, non-
anatomic teeth maybe chosen
• Plastic teeth are chosen over porcelain teeth
because the amount of adjustment that is
sometimes required may weaken the
porcelain teeth
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66. Porcelain teeth
• Wear very slowly - occlusal VD is maintained
• Predisposed to chipping and fractutre
• More difficult to equilibriate, since their surfaces do not
mark well with the articulating paper.
• Cause rapid wear of opposing natural teeth.
• Contraindicated with acrylic resin posteriors and bruxism.
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67. Acrylic resin teeth
• Cause no wear of opposing natural teeth.
• Contraindicated in bruxers
• Wear-results in loss of vertical dimension.
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68. Gold Occlusals
• Best material to oppose natural teeth
• Denture with acrylic resin teeth worn by
the patient for few weeks
• Occlusal index of the denture is made
• Occlusal surface of posterior teeth
reduced by 1 mm
• Wax pattern is prepared and verified with
the help of occlusal index and casting is
done 68

69. Acrylic resin with amalgam stops
• Amalgam inserts reduce occlusal wear
• Technique is simple, less time consuming , less
expensive.
• After acrylic teeth have been arranged, occlusal
preparations are made in acrylic teeth, extending
to include as much of the articulator paper
tracing as is possible.
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70. Fig1: Eccentric balancing contacts are
established by selective grinding
Fig2:Occlusal preparations are made in the
posterior denture teeth.
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71. 71
Fig3 :Amalgam is condensed into preparations and eccentric
movements are made.

72. IPN Resin
• To minimise disadvantage of acrylic resin and
porcelain teeth and enhance certain qualities of each
• These teeth consist of am unfilled, highly-crossed
linked- inter penetrating polymer network.
• Wear significantly less
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73. COMBINATION SYNDROME
&
ASSOCIATED CHANGES.
Kelly’s syndrome
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74. Combination syndrome
• It is a dental condition that is commonly seen in
patients with a completely edentulous maxilla and
partially edentulous mandible with preserved
anterior teeth.
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75. Maxillary
complete
denture
Mandibular
distal
extension
denture
Oral
destructive
changes
75
Combination
syndrome

76. • Clinical features:
 Loss of bone from maxillary anterior
edentulous ridge.
 Down growth of maxillary tuberosities
 Papillary hyperplasia of the tissues of
hard palate
 Extrusion of lower anterior teeth
 Loss of bone beneath the removable
partial denture bases
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77. Mechanism of pathogenesis
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Due to resorption of anterior maxilla
A negative pressure develops
within maxillary denture.
Anterior ridge is driven upwards
by anterior occlusal load
Tuberosity is pulled downwards
Tuberosity enlargement
Upward tipping of the
anterior portion of
maxillary denture
Downward movement
of posterior portion of
denture

78. 78
Occlusal plane
Moves upwards
in the anterior
region
Downwards in
the posterior
region
This will reduce
antagonistic force on
the mandibular
anteriors
Functional load cause
stresses on mandibular
distal extension
Cause resorption of
mandibular posterior
ridge
Cause supra-eruption
/ extrusion of lower
anteriors
result

79. (Associated changes)
 Loss of VDO
 Occlusal plane discrepancy
 Anterior resorption of maxilla
 Epulis fissuratum
 Poor adaptation of the prosthesis
 Periodontal changes
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Result

80. 80
 labial flange of the denture produces a low grade irritation
in the surrounding soft tissues, resulting in the development
of epulis fissuratum
 Causes an associated overgrowth of fibrous tissue covering
the maxillary tuberosities.

81. Tolstunov classification of combination
syndrome
• Class I:
• Maxilla: completely edentulous alveolar ridge.
• Mandible:
• M1: partially edentulous ridge with preserved
anterior teeth.
• M2: stable “fixed” full dentition (natural/ implant
supported)
• M3: partially edentulous ridge with preserved teeth
in anterior and one posterior region.
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82. • Class II:
• Maxilla: partially edentulous alveolar ridge:
with edentulous & atrophic anterior ridge
teeth present in both posterior regions.
• Mandible: same as class I
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83. • Class III:
• Maxilla: edentulous alveolar ridge with teeth
present in one posterior region only.
edentulous & atrophic posterior region.
• Mandible: same as class 1
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84. • Prevention:
• Avoid combination of maxillary dentures with
mandibular distal extension dentures.
• Treatment plan:
• When planning treatment for patients with
edentulous maxilla & partially edentulous mandible
Risk of development of combination syndrome must
be recognised
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85. • Saunders et al, (1979) :
Suggested that an occlusal scheme should be
developed that-
 Reduces excessive occlusal pressure in maxillary
anterior region.
 Lower partial denture base should be fully extended
& should cover retromolar pad & buccal shelf area.
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86. • Kelly: suggested that
Before proceeding with prosthetic treatment-
Surgical correction of:
 Flabby (hyperplastic) tiussue
 Papillary hyperplasia
 Enlarged tuberosities
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87. Treatment approaches:
(Stephen m. Schmitt 1985)
• In an attempt to minimize destructive changes:
• In patients with risk of developing of combination syndrome
• The prosthesis should be made in 2 stages:
1. Mandibular RPD
2. And for maxilla use:
-acrylic resin teeth- anterior
- Cast gold occlusal- for replacing posterior teeth
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88. • In patients who already have combination
syndrome:
• Maxilla: stabilization of maxillary arch :
Augmentation with resorbable hydroxyapatite
Maxillary osseointegrated implants.
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89. • Mandible:
• Mandibular overdenture
• Madibular implant over dentures
• Implant supported fixed prosthesis
• Wennerberg et al(2001)- reported excellent results
with mandibular implant supported fixed prosthesis.
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90. Summary
• Restoring a patient with single denture opposing
natural / restored dentition is challenging to dentist.
• This is due to biomechanical differences in tissues of
opposing arches.
• So proper evaluation & correction of existing factors
is necessary to give a more stable prosthesis.
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91. references
• Sheldon Winkler- Essentials of complete
denmture.
• Sharry- complete denture prosthodontics.
• Textbook of bouchers –
Prosthodontictreatment for the elderly-12th
edition
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