This document provides information about fabricating a single complete denture opposing natural teeth. It discusses common occlusal issues that can arise in these cases such as tilted molars and how to address them. Methods for achieving balanced occlusion are described, including functional chewing techniques and articulator-based equilibration. The document also covers occlusal modification of natural teeth, materials used for the denture occlusal surfaces, and combination syndrome.

1. SINGLE COMPLETE
DENTURE
Presented by,
Dr ANJU D
II MDS
1

2. CONTENTS
 Introduction
 Different clinical scenarios
 Common occlusal disharmonies and adjustment.
 Methods used to achieve a harmonious balanced
occlusion
 Occlusal modification
 Occlusal materials for the single denture
 Combination syndrome
 Conclusion
 References
2

3. INTRODUCTION
3

4. •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.
4

5. PROBLEM WITH SINGLE COMPLETE
DENTURE
5

6. 6
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

7. COMMON OCCLUSAL DISHARMONIES
7

8. •Different Clinical Scenarios:
1. Natural teeth that are sufficient in number not to
necessitate a fixed or removable partial denture.
2. A partially edentulous arch in which missing teeth
have been or will be replaced by RPD.
3. A partially edentulous arch in which missing teeth
have been or will be replaced by FPD.
4. An existing Complete denture.
8

9. 9
• Completely edentulous maxillary arch
opposing a mandibular complement
of natural teeth with missing first
molars, or second premolars, or both.
• Remaining molars are severely inclined
mesially and their distal halves supra erupted .
• This results in maxillary denture being easily
dislodged during functional movements.

10. 10
If molars are not severely tilted - reshaped by
selective grinding.
• Stephens - in this situation distal half of the
occlusal surface should be ground flat and the
denture teeth set to occlude only with that area,
leaving the mesial cusps out of contact - prevent
contact of denture teeth on an inclined plane.

11. 11
When more than a moderate amount of tooth
reduction is found necessary
• Restore the tilted molars with cast gold crowns,
onlays, or a fixed bridge if a large edentulous
space exists mesial to the molars.
• If a tooth supra erupted beyond restoration -
should be extracted.

12. 12
If a large space does exist
mesial to the tilted molars
• RPD restore mesial half of molars.
• By lowering distal cusps and restoring
mesial cusps using an onlay mesial
rest, occlusal surface may be restored
to an acceptable form.

13. 13
When insufficient
mandibular teeth are
left to occlude with a
complete maxillary
denture
- Loss of maxillary
anterior alveolar ridge
along with
hyperplastic tissue
changes.
• When all molars are
missing
RPD is indicated.

14. 14
METHODS USED TO ACHIEVE A
HARMONIOUS BALANCED
OCCLUSION

15. 15
Those that dynamically equilibrate
occlusion by use of a functionally
generated path
Those that statically equilibrate occlusion
using an articulator programmed to
simulate patient’s jaw movement.

16. 16
Functional Chew-in Techniques
• Stansbury described first functional chew in
technique (1928) for an upper complete denture
opposing lower natural teeth.
• He suggested using a compound maxillary rim
trimmed buccally and lingually so that the occlusion
is free in lateral excursions.
• Carding wax is then added to the compound rim, and
patient is instructed to perform eccentric chewing
movements

17. 17
Carding wax molded to functional movements,
while compound in central fossa acts as a guide
to preserve vertical dimension.
Generated occlusion rim is removed from mouth
Stone is vibrated into wax paths of cusps.
Upper cast is again fastened to the articulator
with generated occlusion rim and stone cusp
path record.
Stone cusp path record is secured to lower
member of articulator with plaster.

18. 18
Denture teeth first set to the original lower
cast.
After esthetics have been approved at the try-in,
lower cast removed and lower chew-in cast
record is then secured to articulator.
All interfering spots are ground until
incisal guide pin prevents further closure.

19. 19
Vig’s technique
• Use of a fin of resin placed into central
grooves of lower posterior teeth, instead of
using compound.
• Resin fin maintains vertical dimension and
helps to locate the interfering lower cusps.
• In eccentric movements lower cusp tips are
ground until equal contact occurs between
teeth and resin.
• Fin is then built up using a soft wax, and a
functional path is recorded.

20. 20
• Use a maxillary rim of softened
wax.
• Lateral and protrusive chewing
movements are made so that the
wax is abraded, generating
functional paths of the lower
cusps.
• This is continued until correct
vertical dimension has been
established.
Sharry’s technique

21. 21
. A compound maxillary rim is formed.
• A thickness of recording matrix, made up of three
sheets of medium -hard pink baseplate wax and
two sheets of red counter wax, is added to the
buccal and lingual surfaces of the compound rim.
• Wax path is boxed, and minimal-expansion
artificial stone is poured in it. This forms the
generated-path stone core.
• Two maxillary bases, one for recording generated
path and other for setting teeth.
Rudd
Technique

22. 22
• Upper cast is mounted on an
articulator using facebow.
• Lower cast related to upper by a
centric interocclusal record at an
acceptable VD.
• Buccal-lingual position of lower
teeth and their relation to the
upper arch is studied
Articulator
Equilibration
Techniques

23. 23
• If denture teeth appear to be placed too far to the buccal
when articulated with lower buccal cusps, they are reset to
oppose the lower lingual cusps

24. 24
• If the denture teeth appear to be placed too far lingually
when articulated with lower lingual cusps, they are reset to
oppose lower buccal cusps

25. 25
• Once holding cusps have been selected, inclines of
remaining cusps are reduced.

26. 26

27. OCCLUSAL MODIFICATION
27

28. 28
• Maxillary and mandibular casts mounted on articulator,
using a provisional centric relation record at an
acceptable vertical dimension.
• A maxillary base made and denture teeth are set.
• If lower natural teeth interfere with placement of
denture teeth - adjusted on the cast and area marked
with a pencil.
Swenson’s method

29. 29
• Natural teeth modified using marked diagnostic cast as
a guide.
• Occlusal modifications are completed, a new diagnostic
cast of lower arch is made and mounted on the
articulator.
• Denture teeth reset for try-in.
• Simple, but time consuming if several impressions and
mountings must be made.

30. 30
• U shaped metal occlusal template that is slightly convex
on the lower surface.
• When placed on occlusal surfaces of remaining teeth,
cusps to be adjusted are identified.
• 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.
Yurkstas method

31. 31
• Lower diagnostic cast is mounted as in previous
procedures.
• Necessary modifications are made on stone cast occlusal
surfaces.
Bruce method

32. 32
• A clear acrylic resin template fabricated over
modified stone cast
• Inner surface of template coated with pressure
indicating paste and placed over patient’s natural
teeth.
• Interferences are readily noted through template
and are removed by reshaping occlusal anatomy.
• Process repeated until template seats properly.

33. 33
Involves making natural teeth fit to established plane and
inclines of maxillary porcelain teeth.
First casts are mounted on a programmed articulator.
Maxillary artificial teeth arranged to obtain best possible
occlusal balancing contacts.
Boucher’s method

34. 34
Interferences removed by movement of maxillary
porcelain teeth over mandibular stone teeth.
Ground areas marked on cast and natural teeth altered
using this as guide

35. 35
OCCLUSAL MATERIALS FOR
SINGLE DENTURE

36. 36
• Wear very slowly - occlusal vertical dimension is
maintained.
• Predisposed to chipping and fracture
• More difficult to equilibrate, since their surfaces do
not mark well with articulating paper.
• Cause rapid wear of opposing natural teeth.
• Contraindicated with acrylic resin posteriors and
bruxism
Porcelain Teeth

37. 37
Acrylic Resin Teeth
• Cause no wear of opposing natural teeth.
• Contraindicated in bruxers
• Wear - results in loss of vertical dimension.

38. 38
Gold Occlusals
• Best material to oppose natural teeth
Technique described by Wallace 1964
 Denture with acrylic resin teeth worn by patient
for few weeks
 Occlusal index of hard stone of teeth and
denture made
 Occlusal surface of posterior teeth reduced by
1mm

39. 39
 Central channel is cut antero – posteriorly
 Inlay wax is flowed on the channels
 Wax pattern is cast in gold ; cemented with self
cure acrylic resin

40. 40
Acrylic Resin with Amalgam Stops
• Amalgam inserts reduce occlusal wear
• Technique is simple, less time consuming ,
expensive.
• After acrylic teeth have been balanced , occlusal
preparations are made in acrylic teeth,
extending to include as much of the articulating
paper tracing as is possible.

41. 41
• Amalgam is condensed into preparations and
eccentric movements are made.
• Thus centric holding area as well as some of the
excursions are recorded in amalgam by
articulator that has been programmed to closely
simulate patient’s jaw movements.

42. 42
IPN Resin
• To minimize disadvantages of acrylic resin and
porcelain teeth and enhance certain qualities in
each.
• Consists of an unfilled, highly cross-linked,
interpenetrating polymer network.
• Wear significantly less

43. 43
COMBINATION SYNDROME

44. 44
Combination syndrome :
The characteristic features that occur when an edentulous
maxillae is opposed by natural mandibular anterior teeth and
a mandibular bilateral extension-base removable partial
denture, including loss of bone from the anterior portion of
the maxillary ridge, hyperplasia of the tuberosities, papillary
hyperplasia of the hard palate’s mucosa, supraeruption of the
mandibular anterior teeth, and loss of alveolar bone and ridge
height beneath the mandibular removable partial denture
bases; syn, anterior hyperfunction syndrome
GPT-9

45. 45
• Ellsworth Kelly (JPD1972:27;140) gave the term
COMBINATION SYNDROME to those changes that are
seen in patients with maxillary complete denture and a
mandibular bilateral distal extension RPD.

47. SEQUENCE OF CHANGES
47

48. 48
First change to occur
• Acc to Kelly et al (JPD1972:27;140) - loss of bone from
the anterior part of the maxillary jaw.
• Saunders et al (JPD 1979:41:124) - bone resorption
under the mandibular partial denture base.

49. 49
Characteristic deep fold or crease
Flabby hyperplastic tissue
Loss of bone from anterior maxilla

50. 50
Occlusal plane migrates up in anterior region
and down in posterior region.
Bone resorption under mandibular denture
base
Tendency to develop epulis fissuratum
associated with labial flange.
Maxillary denture displaced anteriorly and
superiorly

51. 51
Enlargement of tuberosities & Papillary
hyperplasia.
With posterior palatal seal negative pressure
produced posteriorly.

52. 52
• extrusion and flaring of mandibular anterior
teeth
• change in occlusal plane

53. 53
Resorption of maxillary anterior ridge
Gradual decrease of occlusal load posteriorly
and increased occlusal load anteriorly.
Loss of mandibular support

54. 54

55. 55
Ellsworth Kelly (JPD 1972:27;140) :
3 yr study: all patients showed
a)1-3 mm loss of ridge height in maxillary anterior
region
b)1-2.5 mm increase in height of tuberosity
c)1-1.5 mm extrusion of lower anteriors.

56. 56
Kay Shen et al (JPD 1989;62:642-644)did a study in 150
complete denture wearers and found a prevalence of
symptoms of combination syndrome in 24% of patients
who had mandibular anterior teeth opposing complete
maxillary denture.This rate did not differ significantly
between patients who do and do not wear mandibular
RPD.

57. 57
Saunders et al (JPD 1979;41:126)
Changes associated with combination syndrome are
not
necessarily seen in all patients with maxillary complete
denture and mandibular distal extension RPD.

58. 58
Classification of combination syndrome
COMBINATIONSYNDROME:CLASSIFICATIONAND CASEREPORT Len Tolstunov:Journal of Oral ImplantologyVol.
XXXIII/No. Three/2007

59. 59
COMBINATIONSYNDROME:CLASSIFICATIONAND CASEREPORT Len Tolstunov:Journal of Oral
ImplantologyVol. XXXIII/No. Three/2007

60. 60

61. 61

62. Management
 Avoiding extraction of lower anterior teeth and
retaining weak posterior teeth as abutments by
means of endodontic and periodontic technique
 Over denture for retaining the roots of anterior
mandibular teeth
 Commodious coverage of basal seat area
“shortened dental arch” concept.
62

63.  Surgical options for flabby hyperplastic tissue ,
papillary hyperplasia
 Correction of premaxillary bone atrophy with
bone grafting
 Implants retained and implant supported
prostheses
63

64. 64
Saunders et al in 1979 stated that, the basic treatment
objectives in treating these patients is to develop an
occlusal scheme that discourages excessive occlusal
pressure in maxillary anterior regions in both centric
and eccentric positions

65. 65
specic objectives:-
• Mandibular R.P.D should provide positive
occlusal support ,have maximum coverage of
basal seat beneath distal extension bases.
• The design should be rigid and should
provide maximum stability while minimizing
excessive stress on remaining teeth.
• The occlusal scheme should be at a proper
vertical and centric relation position.
• Anterior teeth should be used for cosmetic
and phonetic purpose only.
• Posterior teeth should be in balanced
occlusion. Patient education and frequent
recall and maintainance care are essential

66. 66
Stephen M. Schmitt, 1985 described a treatment
approach that attempted to minimize the destructive
changes by using the treatment objectives of
Saunders et al.
Yair Langer et al described an approach in which
maxillary impression is made in a specially
designed tray using a combination of elastomeric
impression material and impression plaster without
distorting the anterior residual ridge.

67. 67
Type of teeth
Non anatomic teeth
Indications :Flat natural teeth
•Occlusal forces are transmitted vertically only.
•Donot provide balanced occlusion in lateral positions
•Free articulation is attainable

68. 68
Anatomic teeth
•Indication : If cuspal form of lower teeth retained
•Narrower than natural predecessor
•There should be a cusp tip to fossa relation.
•Molars should not be placed ore buccally – crossbite is
preferred

69. CONCLUSION
69

70. REFERENCES
 Essentials of complete denture prosthodontics – Sheldon
Winkler.
 Syllabus of complete dentures – Heartwell.
 Complete denture Prosthodontics – Sharry
 Vig R G. A modified chew in and functional impression
technique. J. Prosthet Dent 1964;14 : 214-220.
 Use of gold occlusal surface in complete and partial dentures:
JPD 1964:14;326.
 Bruce: CD opposing natural teeth:JPD 1971:26;5:448
 Ellinger:Single complete denture:JPD 1971 ; 26; 4-10
 Kelly E. Changes caused by a mandibular removable partial
denture opposing a maxillary complete denture. J Prosthet Dent
1972; 27: 140-150
70

71. 71
•Saunders T R, Gillis R E. The maxillary complete denture
opposing the mandibular bilateral distal-extension partial
denture.Treatment considerations. JPD 1979 ;41: 124-128.
•Schmitt ;combination syndrome treatment appoach:JPD
1985:54:664
•Yair Langer: Modalities of Treatment for combination
Syndrome : JPD 1995;4:76-81
•Combination syndrome: a literature review: JPD
2003:90:270-275

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