A single complete denture is a complete denture that occludes against some or all of the natural teeth, a fixed restoration, or a previously constructed removable partial denture or a complete denture. Opposing natural teeth that are sufficient in number and do not necessitate a fixed or removable partial denture. Opposing a partially edentulous arch in which the missing teeth have been or will be replaced by a fixed partial denture. Opposing arch with an existing complete denture.

1. By- Dr. Prathamesh Fulsundar
(MDS- Prosthodontics)

2.  Introduction
 Different clinical scenarios
 Reasons for increased difficulty
 Diagnosis and Treatment planning
 Methods to achieve balanced occlusion
 Techniques for occlusal modification
 Various teeth materials used
 Combination Syndrome
 Recent advances
 Summary
 References

3.  A single complete denture is a complete denture that
occludes against some or all of the natural teeth, a fixed
restoration, or a previously constructed removable
partial denture or a complete denture.

4.  Opposing natural teeth that are sufficient
in number and do not necessitate a fixed
or removable partial denture.
 Opposing a partially edentulous arch in
which the missing teeth have been or will
be replaced by a fixed partial denture.
 Opposing arch with an existing complete
denture.

5. 1. Heavy occlusal forces, due to opposing natural
teeth. (3 times that of conventional CD ie.22lb)
2. The high occlusal forces from the opposing
natural teeth, which results in advanced bone
loss of ridges.
3. Supra-eruption of the opposing natural teeth
produces an unharmonious occlusal plane.
4. Mesial drifting of the opposing natural teeth
produce unharmonious occlusal plane.
5. Midline fracture of the denture due to heavy
forces

8.  Class I – Patient for whom minor or no tooth reduction is needed to
obtain balance.
 Class II – Patient for 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.

9. Functional chew in techniques
Stansbury technique (1928)
Vig's technique (1964)
Sharry technique
Rudd technique
Articulator equilibration techniques

10.  Compound occlusal rim trimmed buccally and lingually
so that occlusion is free in lateral excursions
 Carding wax added buccally and lingually and patient
instructed to perform chewing movements
 Carding wax gets functionally molded whereas the
compound rim 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 and
this record is secured and used as a occlusal guide on the
articulator

12.  The 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.

13.  Anterior teeth are set chair side.
 Wax occlusal rims posterior to the cuspids are removed.
 Acrylic resin is added and firmly pressed against the occlusal
surface of the teeth on the opposing cast.
 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 the vertical dimension.
 The base is then inserted into the mouth for cusp and sulcus
analysis.
 The fin is then built 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

14. A Modified Chew-inAnd Functional Impression Technique, RobertGVig.;JProsthet Dent1964

15.  Simple technique of using a maxillary rim of softened
wax
 Lateral and protrusive chewing movements are made
so that wax is abraded generating the final paths of
the lower cusps.
 Continued until the correct VD is achieved

16.  Suggests a technique similar to Stansbury's
 But suggests using two maxillary bases, one for
recording the generated path and the other for setting
the teeth
 Advantage - decreases the number of appointments
necessary for the construction of the denture.

17.  Upper cast mounted on the articulator using a face- bow
transfer.
 The lower cast is related to the upper by a centric
interocclusal record at an acceptable VD.
 The bucco-lingual position of the teeth and 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 made and
condylar inclinations are set and posterior teeth are now
balanced.

18. Disadvantage-
 Perfectly balanced occlusion in all eccentric positions may
not be possible in many cases when working with natural
teeth in one arch.

20.  Swenson’s technique
 Yurkstas method
 Bruce method
 Boucher method
 Han Kuang Tan’s technique

21.  Maxillary and mandibular cast are mounted
 A maxillary 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 as a guide.
 After the occlusal modifications new impressions are
made of the lower arch and mounted on the
articulator.
 The artificial teeth are then checked and modifications
done for the final try in.

23.  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.

25.  The casts are mounted and the necessary modifications
are made on the stone cast.
 A clear acrylic resin template is fabricated on the
modified stone cast.
 The inner surface of template is coated with pressure
indicating paste and the interferences are noted through
template.
 The desired modifications are done till the template seats
properly.

27.  It involves making natural teeth fit to the established plane
and inclines of the maxillary porcelain teeth.
 First, the cast are mounted and the artificial teeth are
arranged to the best possible balancing contacts.
 If the natural teeth prevent 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
on the cast.
 The natural teeth are ground at the areas marked on the cast.
 The occlusion is refined in the right and left lateral excursive
movements until a harmonious balance is achieved.

28.  Make a vacuum formed clear template over
the cast with Biostar sheet (2mm thick)

30.  Porcelain teeth
 Acrylic resin teeth
 Gold Occlusal
 Acrylic resin with amalgam stops
 IPN resin (Inter-penetrating Polymer Network)

31.  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

32.  Cause no wear of opposing natural teeth.
 Contraindicated in bruxers
 Wear - results in loss of vertical dimension

33.  Best material to oppose natural teeth
 Denture with acrylic resin teeth worn bypatient for
few weeks
 Occlusal index of the denture is made
 Occlusal surface of posterior teeth reduced by 1mm
 Wax pattern is prepared and verified with the help
of occlusal index and casting is done.

34.  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 articulating paper tracing as is
possible.
 Amalgam is condensed into preparations and eccentric
movements are made.

35.  To minimize disadvantages of acrylic resin and
porcelain teeth and enhance certain qualitiesin each.
 Consists of an unfilled, highly cross-linked,
interpenetrating polymer network.
 Wear significantly less

36. 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)

37.  Loss of bone in anterior maxilla and subsequent replacement with
flabby fibrous tissue
1. Down growth of the tuberosities
2. Papillary hyperplasia of the palate
3. Lower incisors supra eruption
4. Bone loss under the removable prostheses

38. Six additional signs associated with the syndrome
(Saunders et al)
1. Loss of vertical dimension of occlusion
2. Occlusal plane discrepancy
3. Anterior spatial repositioning of the mandible
4. Poor adaptability of the prosthesis
5. Epulis fissuratum
6. Periodontal changes

39.  Rationale:
 Prevention of rapid resorption of the bone under the
removable prosthesis
 Prevention of excessive load in the anterior region
 Providing stable occlusion
 Allowing anterior teeth only for phonetics and esthetics
 Education of the patient
 Treatment planning
 Treatment planning plays an important role in the
prevention and management of the combination syndrome.

40.  Retain weaker posterior teeth by using combined
endodontic and periodontic techniques.
 Endosseous endodontic implants are used in the posterior
mandibular region.
 An overlay denture on the lower may avoid the
combination syndrome.

41.  Kelly advocated surgical excision of the maxillary tuberosity
fibrous growth to establish proper occlusion.
 Treating the combination syndrome requires recognition of the
factors involved.
 Frequent recalls visits and check ups with frequent relining to
compensate for the resorption especially in the lower distal extension
prosthesis.
 Educating the patient about the possible outcome of the treatment
and better understanding of the syndrome so that patient cooperates
with the dentist
o Schumitt - advocated construction of lower removable partial
denture first and then to construct the upper complete denture .

42. Ricardo morandi;Implant-supported maxillary denture retained by a telescopic
abutment system: A clinical report:JPD 2016

43. Lucio lu rosso ;single arch digital removable complete denture JProsthet
dent 2017

44. Due to biomechanical differences in the supporting tissues
for opposing arches the patient requiring single denture
opposing a natural
challenging job for
or restored dentition faces a
the dentist thus the treatment
planning and the prosthesis to be given should be
evaluated and corrected to provide a stable prosthesis
having stable functional relationships thus controlling the
resorption and discomfort to the patient.

45. Patient assessment and
Evaluation
Treatment plan for a
long term success
Assessment of
occlusion and its
reorganization as per
the indications
Strict clinical protocol
to be followed without
any procedural errors
Achieving harmonious
balanced occlusion by
functional or the articulator
equilibration techniques
Understanding the need and the
importance of implants in
achieving long term success and
enhanced functional stability of the
tissues

46. •Heartwell Cm, Rohn Ao (2002) Tooth Selection. In:
Textbook Of Complete Dentures, 5th Ed. Bc Decker, Pp
305–319
•Zarb Ga, Bolender Cl, Hickey Jc, Carlsson Ge (1998)
Selecting Artificial Teeth For The Edentulous Patient.
•Textbook On Bouchers Prosthodontic Treatment For The
Elderly, 10th Edn. Bi Publications Pvt Ltd, New Delhi, Pp
330–351
•Sharry – Complete denture prosthodontics
•Sheldon Winkler – Essentials of complete denture
prosthodontics.

47.  Single Maxillary Complete Denture Carl F. Driscoll, Dmd*,
Radi M. Masri, Bds, Ms Dent Clin N Am 48 (2004) 567–583
 Kenneth D. Rudd, Robert M. Marrow – Occlusion and single
denture,JPD 1973; Vol. 30(1): 4-11.
 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 – Using a tooth reduction guide for
modifying natural teeth, JPD 1990; 63: 637-639.
 Ricardo morandi;Implant-supported maxillary denture retained
by a telescopic abutment system: A clinical report:JPD 2016
 Lucio lu rosso ;single arch digital removable complete denture
JProsthet dent 2017