1 single complete denture /dental courses


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1 single complete denture /dental courses

  1. 1. SINGLE COMPLETE DENTURE INDIAN DENTAL ACADEMY Leader in continuing Dental Education www.indiandentalacademy.com
  4. 4. Introduction • The primary consideration for continued denture success with a single conventional complete denture is the preservation of that which remains. • Many difficulties confront the dentist rehabilitating the patient……. • Unfavourable occlusal relationship exist that results……. • Various measures….. www.indiandentalacademy.com
  5. 5. • A single complete denture opposing any one of the following: 1. Natural teeth that are sufficient in number not to necessitate a fixed or removable partial denture. 2. A partially edentulous arch in which the missing teeth have been or will be replaced by a fixed partial denture. 3. A partially edentulous arch in which the missing teeth have been or will be replaced by a removable partial denture. 4. An existing complete denture.www.indiandentalacademy.com
  6. 6. Diagnosis & Treatment Planning • The commonly seated long term goal in prosthodontics is the preservation of what which remains. • Prior to any occlusal modifications of the natural teeth. – First make final impression and mount the cast. – Mount diagnostic cast using provisional centric interocclusal record. – Eccentric records are made and articulator is programmed. – Whatever adjustments that may be necessary be properly planned.www.indiandentalacademy.com
  7. 7. Classification • This classification system can simplify the identification and treatment of the patient. – Class I – Patient from whom minor or no tooth reduction is all that is needed to obtain balance. – Class II – Patient from whom minor additions to the height of the teeth are needed to obtain balance. – Class III – Patient for whom both reduction and additions to the teeth are required to obtain balance. – The treatment of these patient involves change in the vertical dimension of occlusion. – Class IV – Patient who presents with occlusal discrepancies that require addition to the width of the occluding surface. – Class V – Patient who presents with combination syndrome. www.indiandentalacademy.com
  8. 8. Tooth modification techniques • Most natural dentitions do not exhibit any degree of bilateral occlusal balance. • Several techniques prior to denture construction are as follows: – Swenson’s technique – Yurkstas method – Bruce method – Boucher method – L. Klirk Gardner et al (1990) – Han-Kuang Tan (1997)www.indiandentalacademy.com
  9. 9. Swenson’s method • The maxillary mandibular cast are mounted on articulator. • A maxillary base is made and denture teeth are set. • Lower interfering teeth are adjusted on the cast and area is marked with a pencil. • The natural teeth are modified using marked diagnostic cast. • After the occlusal modifications new diagnostic cast of the lower arch is made and mounted on the articulator. www.indiandentalacademy.com
  10. 10. Yurkstas method • Method involves the use of a metal U-shaped occlusal template. • Cusps to be adjusted are identified. • The stone cast is modified. www.indiandentalacademy.com
  11. 11. Bruce method • The lower diagnostic cast is mounted necessary modifications are made on the stone cast. • A clear acrylic resin template is fabricated on the stone cast. • Interferences are noted through template and are reviewed by reshaping the occlusal anatomy until the template seats properly. www.indiandentalacademy.com
  12. 12. Boucher’s method • His technique involves making the natural teeth fit to the established plane and inclines of the maxillary porcelain teeth. • First, the cast are mounted. • Maxillary artificial teeth are arranged. • If the natural teeth prevents this balancing the interferences are removed by movement of maxillary porcelain teeth over the mandibular stone teeth. • The denture is processed and area to be reshaped are noted. • The occlusion is refined using arch shaped baseplate wax. www.indiandentalacademy.com
  13. 13. L Kirk Gardner et al (1990) • A simplified method of transferring diagnostic odontoplastic information from the cast to the patient. www.indiandentalacademy.com
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  15. 15. Han-Kuang Tan (1997) • Make a clear template over the mandibular cast with .02“ thick. • Mount the maxillary mandibular cast. • Arrange maxillary teeth. • Grind both the denture teeth and natural stone teeth on the mandibular cast to achieve best possible articulation. www.indiandentalacademy.com
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  18. 18. Methods used to achieve harmonious balanced occlusion Basically two types: 1. Those that dynamically equilibrate the occlusion by the use of a functionally generated path. 2. Those that statistically equilibrate the occlusion using an articulator. Functionally generated chew in technique: Indications: – Restoration of an edentulous arch that is opposed by natural teeth. Contraindications: – The desired jaw movements and necessary record base stability are not possible – The denture space is inadequate. – Physical and mental condition of the patient seriously compromise effective cooperation. www.indiandentalacademy.com
  19. 19. Stansbury (1951) • He suggested using compound maxillary rim for functionally generated chew-in technique. • The compound maxillary rim trimmed buccally and lingually… • Carding wax is then added. • The patient is asked to do mandibular movement. • The carding wax get moulded to the functional movements. • The stone is vibrated into the wax path of the cusps. • The denture teeth are first set to the lower cast. • After try-in is approved lower cast will be removed and the lower chewing cast will be secured to the articulator. • All interfering spots are carefully grounded. • Thus maximum bilateral balanced occlusion will be achieved. www.indiandentalacademy.com
  20. 20. Kenneth D. Rudd and Robert M. Morrow (1973) • Appointment I: – Impressions are made – Two resin base plates are constructed on the maxillary cast. • Appointment II: – A tentative jaw relation record. – Denture teeth are selected and positioned with the patient present, the setup is completed for try-in. – The duplicate denture base plate is placed on the cast and the modelling plastic is warmed and the articulator is closed. www.indiandentalacademy.com
  21. 21. – The posterior quadrant of the occlusal rim are trimmed. – With the modelling plastic occlusion in position divider are used to make vertical dimension reference measurement. • Appointment III: – The waxed denture is inserted and subjected to the usual check. – Recording wax for the functionally generated path procedure is added to the occlusion rim. – The patient is asked to do mandibular movements. www.indiandentalacademy.com
  22. 22. • Stone core: – The generated wax path is carefully boxed and stone is poured. – The upper denture teeth are set or ground to fit the generated path as recorded in the stone core. www.indiandentalacademy.com
  23. 23. Robert G. Vig (1964) • Upper and lower impressions are made. • Registration and mounting: • Preparing the chewing apparatus: – The wax occlusion rim posterior to cuspid are removed. – Dough stage resin is placed on denture base and the articulator is closed. • Cusp and sulcus analysis: – The patient is directed to make a lateral excursions…. – The tooth must be ground until an equal contacts occurs between the teeth and plastic. – If most of the buccal cusps contacts the maxillary fin, but few do not, the fin must be lengthened…… – The fin is build-up with Tenex wax.www.indiandentalacademy.com
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  25. 25. • The functional impression and chew-in: – Tissue conditioning resin is added to the impression side and base is seated in the mouth. – The patient is dismissed for a period of ½ hour. – After ½ hour patient is given thin slice of fruits…. – The chewing pattern and impression surface are examined. – The base is inserted again and the patient is dismissed until the following morning. www.indiandentalacademy.com
  26. 26. • Forming the stone chew-in record: – The master cast is carefully poured into the impression. – Dental stone is carefully poured into the chew-in record. • Articulator mounting: – The cast recording base chew-in record and the counter cast are mounted on the articulator. – The teeth are ground until the vertical stop articulator is seated and both cusps and contact. www.indiandentalacademy.com
  27. 27. • Sharry: – Mentions a simple technique of using maxillary rim of softened wax. – Lateral protrusive chewing movements are made so that the wax is abraded. – Generating functional path of the lower cusps. – This is continued until the correct vertical dimension has been established. www.indiandentalacademy.com
  28. 28. Articulator Equilibration Technique • Indications: – The denture base lacks stability. – If the patient is physically unable to form a chew-in record. 1. Upper cast is mounted on articulator using face bow. 2. Lower cast is related using interocclusal record. 3. Buccal lingual position of lower teeth and their relation to the upper arch is studied and decision is taken…... 4. Once the holding cusp have been selected the inclines of remaining cusps are reduced.www.indiandentalacademy.com
  29. 29. – At the time of wax try-in eccentric records are made and set on the articulator. – The upper posterior teeth are arranged as close to being balanced as possible at this time. – The denture is processed again related to the articulator. – Eccentric balance is achieved by grinding the interfering buccal and lingual inclines of upper teeth. – If any lower cusp make contacts the interferences are removed. www.indiandentalacademy.com
  30. 30. The combination syndrome • Complete denture opposing partial lower denture: – Ellsworth Kelly 2003 – A destructive change seen in the patient with maxillary complete denture and a mandibular bilateral distal-extension partial denture. – Kelly refers to a combination syndrome which consist of www.indiandentalacademy.com
  31. 31. – The anterior part of the maxilla is the weakest part of the upper arch to resist stress. – The hyperplastic tissue does not support the denture base. – The bone in ridge height are lost anteriorly, the posterior ridge becomes larger with the development of enlarge tuberosities. – Migrates up in the anterior and down in the back. – After some time the natural anterior teeth migrates upward. www.indiandentalacademy.com
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  33. 33. • Mechanics: – The resorption of bone in the anterior region initiates the change. – The maxillary denture moves up in the anterior region and down in the posterior region in function... – Vertical dimension is likely to be decreased and the occlusal plane gradually becomes lower posterior. – The change in the occlusal plane encourages protrusive occlusal contacts with a risk of extrusion and flaring of the mandibular anterior teeth and associated periodontal change.www.indiandentalacademy.com
  34. 34. – With the PPS a negative pressure is produced. – This negative pressure may account for the enlarge tuberosities and the papillary hyperplasia. • Prevention of the combination syndrome: Systemic Dental Considerations: – A complete review of the patient’s medical and dental history is essential. – Stahl and associates have stated that patients with systemic disease shows increased amount of bone resorption and compared to the healthy patients. – Clinical radiographic evaluation of both hard and soft tissues is an essential preliminary step in treating these patients. www.indiandentalacademy.com
  35. 35. • Kelly’s advocate to retain weak posterior teeth as abutments by means of endodontic and prosthodontic treatment. • Endosseous endodontic implants: • An overlay denture on the lower may avoid the combination syndrome from developing. • Treatment planning: – Initially treatment must concentrate on periodontal and restorative needs of remaining teeth. – Direct and indirect components of retention must be considered in their ability to place additional stress on the natural teeth. – Maximal extension, border seal, and tissue detail to ensure retention. – No incisal contact of the anterior teeth. – Balanced occlusion should be developed. www.indiandentalacademy.com
  36. 36. Single complete denture opposing existing complete denture • The decision to construct a single complete denture can be analyzed by following questions. – How long has the existing denture. – Was the denture an immediate insertion at the time of tooth removal. – Has the denture opposed another complete denture, a partially edentulous arch. – Does the posterior teeth form coincide with the physiology of the operator concept of occlusion. – If not, is there sufficient tooth remaining to allow selective grinding procedure for alterations.www.indiandentalacademy.com
  37. 37. Mandibular Single denture • The mandibular single denture poses an even greater challenge to the clinician. – The situation often compounded by residual ridge resorption of the edentulous mandible which makes conventional treatment nearly impossible. – Disadvantages: limited quantity of the mucosa, the amount of denture border against the moveable mucosa. – The impact of occlusal forces from the moving mandible contacting the static dentate maxillary arch. www.indiandentalacademy.com
  38. 38. • Eugene J. Tillman (1961) – Had given the fundamental specification for denture construction. – The specifications are: • Understanding and proper execution of the requirements inherent in a successful complete lower denture impression technique. • A correct registration and recording of centric relation at a accurately determined vertical dimension of occlusion. • A correctly formulated scheme of occlusion. – Use of endoosseous dental implants to provide retention and support for the mandibular complete denture and to retard residual bone resorption. www.indiandentalacademy.com
  39. 39. Rationale for implants in the single complete denture • The changes in the denture supporting tissues is variable but inevitable. • The major tissue change is an irreversible bone loss resulting from both local and systemic effects. • Such morphologic changes in the denture bearing foundation can lead to difficult functional stability. • Need to improve the denture foundation to ensure better functional stability. • Dental implants allows both enhanced function and a reduction in the irreversible bone loss that leads to the instability. www.indiandentalacademy.com
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  41. 41. Occlusal materials for the single complete denture • Porcelain teeth: – These teeth wear very slowly and therefore maintains a vertical dimension. – They are predisposed to fracture and chipping. – More difficult to equilibrate. – Causes rapid wear of opposing natural teeth. • Acrylic resin teeth: – Acrylic resin teeth causes no wear of the opposing natural teeth. – They are easy to equilibrate. – The major disadvantage of the resin teeth is their wear. www.indiandentalacademy.com
  42. 42. • Gold occlusals: – Occlusals are considered the best material to oppose natural teeth. – Their expenses and time involved in their fabrication make them impractical for most patient. • Acrylic resin with amalgam stops: – The amalgam stop appears to reduce the occlusal wear. – After the acrylic teeth have been balanced occlusal preparations are made in the acrylic teeth. – Amalgam is condensed into the preparation. • IPN resin: – This was developed to minimize the disadvantages of acrylic resin teeth and porcelain teeth. – The material consists of an unfilled, highly cross linked interpenetrating polymer network. www.indiandentalacademy.com
  43. 43. Summary & Conclusion • The decision to make a single complete denture cannot be considered lightly. • Carefully observation and recording of all diagnostic information must be considered before a decision is reached to construct a single complete denture. • Certain conditions must be evaluated and corrected early in treatment to provide for a more stable prosthesis. • The unique biomechanical features of the patient with a single denture should be emphasized and method for controlling denture tooth and opposing to position to maximum stable functional relationship. www.indiandentalacademy.com
  44. 44. References • Zarb Bolender – Prosthodontic treatment of edentulous patients. • Hartwell – Text book of complete denture. • Sharry – Complete denture prosthodontics • Sheldon Winkler – Essentials of complete denture prosthodontics. • Ellsworth Kelly – Changes caused by a mandibular removable partial denture opposing a maxillary complete denture, JPD 2003; Vol.90(3): 213-219. • Kenneth D. Rudd, Robert M. Marrow – Occlusion and single denture, JPD 1973; Vol. 30(1): 4-11. • Robert G. Vig – A modified chewing and functional impression technique, JPD 1964; Vol. 14(2).www.indiandentalacademy.com
  45. 45. • Timothy R. Sauders, Robert E. Gillis and Ronald P. Desjarclins – The maxillary complete denture opposing the mandibular bilateral distal extension partial denture treatment considerations, JPD 1979; Vol41(2): 124-128. • Han Kuang Tan – Preparation guide for modifying the mandibular teeth before making a maxillary single complete denture, JPD 1997; 77: 321-322. • L. Kirk Gardner et al – Usinga tooth reduction guide for modifying natural teeth, JPD 1990; 63: 637-639. • Eugene J. Tillman – Removable partial upper and complete lower denture, JPD 1961; 11(6): 1098-1105. • Carl B. Stansbury – Single denture construction against a non modified natural dentition, JPD 1951; 1(6): 692-699.www.indiandentalacademy.com
  46. 46. THANK YOUwww.indiandentalacademy.com