Single complete dentures

1. Single complete denture

2. CONTENTS
• Introduction
• Definition
• Single edentulous arch
• Problems associated with single complete
denture
• Diagnosis and treatment planning
• Various combinations of single complete
denture

3. • Common occlusal disharmonies
• Methods used to achieve harmonious
• balanced occlusion
• Occlusal materials for single complete denture
• Changes caused by RPD opposing maxillary
complete denture
• Conclusion
• References

4. INTRODUCTION :
• The single complete denture opposing all or
some of the natural dentition is not an uncommon
occurrence.
• Causes for the loss of teeth from the dental
arches like periodontal problems, dental caries
and trauma.
• The incidence of tooth loss is more in maxillary
arch compared to mandibular arch
The single complete denture should be given for
reasons like mastication and esthetics.

5. DEFINITION :
• Single complete denture is a prosthesis which
replaces the lost natural teeth and its
associated structures functionally and
esthetically as a single unit which opposes all
or some of the natural teeth.
The primary consideration for continued denture
success with a single conventional complete
denture is the preservation of that which remains

7. Indications
Natural teeth that are sufficient in number
not to necessitate a fixed or removable
partial denture.
A partially edentulous arch in which the
missing teeth have been or will be replaced
by a fixed partial denture.
A partially edentulous arch in which the
missing teeth have been or will be replaced
by a removable partial denture.
An existing complete denture

8. Single edentulous arch :
Prevalence of the condition where edentulous
arch opposes a natural or restored dentition is
quite common
The reason for the loss of the maxillary teeth
prior to the mandibular teeth are unclear and
are influenced by a combination of factors

9. Diagnosis and treatment planning:
• The commonly sited long term goal in
Prosthodontics is the preservation of that
which remains.
• This demands an appreciation of occlusal
mechanics.

10. Problems:
1. Occlusal forces
2. Occlusal form of the natural teeth
3. Support for the denture base
4. Inter maxillary relations:

12. 1. Occlusal forces
• These forces have been recorded as high as
198 lbs on a single molar tooth.
• This is in contrast with the forces which a
complete denture - 26 lbs

13. 2. Occlusal form of the natural
teeth
• The occlusal form of the remaining natural
teeth will dictate the occlusion of the
denture
• The natural teeth may be over erupted or
tilted and there cusps may be high and
sharp.
• Denture will constantly be thrust or
dragged horizontally on the ridge.

15. 3. Support for the denture base:
• Denture base should have the maximum
extension within the functional anatomic
limits
• Lower complete denture opposing upper
natural teeth should be normally avoided.

16. 4. Inter maxillary relations:
• When upper complete denture is being
made to occlude with lower natural teeth,
an error may be made in recording the
vertical dimension
• The labio- lingual thickness of the wax rim,
will usually not allow the lower incisor to
close beyond the occlusal surface
• Increased vertical dimension may be
recorded

17. Occlusal problems and fracture of denture base account for
structured difficulties and may result from one or all of the
following.
• Occlusal stress on the maxillary denture and the underlying
edentulous tissue from teeth and musculature accustomed to
opposing natural dentition.
• The position of the mandibular teeth which may not be
properly aligned for the achievement of bilateral balance for
stability.
• Flexure of the denture base

18. Salient consideration include
• Acceptable interocclusal distance
• Stable jaw relationship with bilateral tooth contact in
retruded position.
• Stable tooth quadrant relationships with axially directed
forces
• Multidirectional freedom of tooth contact throughout a
small range (with in 2 mm) of mandibular movements.

19. When only one arch is edentulous, tooth position in the
dentate arch may preclude such objectives being reached.
Unfavorable force distribution may then cause adverse
tissue changes that compromise optimum function like –
• Extensive morphological changes in denture foundation
• Extreme jaw relationships
• Excessively displaceable denture bearing tissue.

20. COMBINATIONS:
• Upper single complete denture opposing complete
set of lower natural teeth.
• Lower single complete denture opposing complete
set of upper natural teeth.
• Single complete denture opposing natural teeth
with a removable partial denture.
• A single complete denture opposing natural teeth
with a fixed partial denture.
• A single complete denture opposing an already
existing complete denture

21. Single complete denture (Maxillary) to
oppose natural mandibular teeth:
• More frequently encountered than the single
mandibular denture
• The occlusal forms of the natural teeth act as a
guide in selecting the occlusal form for the
maxillary posterior teeth
• However if the natural teeth are abraded
monoplane form may be the choice

23. • Some times the position of mandibular teeth will
not allow the maxillary anterior teeth to be
positioned in an esthetically acceptable manner
or for balanced occlusion.
• This problem may be solved as follows.
Reposition of the natural teeth with orthodontic
procedures

24. Alter the clinical crowns of the teeth by
grinding or with restoration.
Accept balanced occlusion with the jaws in
the terminal relation and not in the
eccentric position

25. • The mandibular arch may present two
planes of occlusion,
• An anterior plane and
• A posterior plane
The posterior teeth have extruded and inter
ridge space would be less.

26. • To prepare this mouth it requires extensive
restorative procedures in mandibular arch
and possibly surgery in the maxillary arch.
• To proceed with complete maxillary denture
procedures without first preparing the
environment into which the artificial teeth
will be placed is to invite trouble.

28. Mandibular denture to oppose
natural maxillary teeth:
• It usually happens as a result of either surgical or
accidental trauma i.e. irradiation or accident or
gunshot.
• Three factors in particular must be carefully
evaluated.
Preservation of the residual alveolar ridge
Necessity for retaining maxillary teeth
Mental trauma

29. Preservation of the residual alveolar
ridge
• The force of jaw closure with natural
teeth is greater than that with complete
denture and greater the force the more
the pressure which a contributing factor to
bone resorption
• One cannot guess that the force will be
minimal and tolerated with no deterioration
of the bone.

30. Necessity for retaining maxillary
teeth:
• The maxillary dentition may be needed to
retain prosthesis.
• This situation is usually associated with
congenital defects such as cleft palate or
stoma resulting from surgical or accidental
trauma.

31. Mental trauma
• A mental state exists when the patient loses the mandibular
teeth, removal of the remaining maxillary teeth may be more than
he or she can endure mentally.
• One circumstance in which a lower complete denture opposing
upper natural teeth is acceptable is for the patient with a class III
jaw relationship.

32. • wical and Swoope developed useful system to
determine and classify the amount of mandibular
resorption.
The amount of resorption can be calculated and
classified into three patterns.
• Class I approximately 2/3rd of the mandibular
alveolar bone is present.
• Class II approximately ½ - 2/3rd of bone is present
• Class III approximately 1/3rd or less than that

33. Recommendations for retention of the
remaining maxillary dentition when
opposing an edentulous mandible
Resorption
pattern
Angle class I II III
Class I
(Mild)
Consider Consider Strongly
Consider
Class II
(Moderate)
Consider Consider Consider
Class III
(Severe)
Do not retain Do not retain Do not
retain

34. Complete maxillary denture to oppose a
partially edentulous mandibular arch with
fixed or removable prosthesis :
• First it must be determined if the fixed restorations
are acceptable if they can be made acceptable or if
they must be rejected.
• When the restorations are acceptable one must
then decide what occlusal concept will be pursued
• Teeth in single complete denture are on a movable
base and even though they function against natural
teeth they will function as a unit.

35. When there is a removable partial denture, it
must be evaluated critically.
• The occlusal plane
• Tooth arrangement for occlusion
• Esthetics and material composition of the
teeth
Treatment plan is or should be formulated for
both arches at the same time

36. Single complete denture to oppose
an existing complete denture:
• In this situation this following factors
must be considered.
Duration of existing denture
Was the denture an immediate insertion at
the time of teeth removal
These two factors are directly related to the
extent of bone resorption.

37. Does the denture meet the requirements of an
acceptable denture?
Condition of opposing arch in relation to the
existing denture.
A most serious consideration is the fact that the
dentist assumes the responsibility for both
dentures as soon as he accepts the patient for
treatment of the single complete denture.

38. COMMON OCCLUSAL
DISHARMONIES
• The most common occlusal adjustments involve the anterior
teeth and the last molar
• Frequently natural lower incisors and cuspids are very long and
there should be ground as much as is practicable
• If the molars are not severely lilted they may be reshaped by
selective grinding
• Stephen’s recommends that the distal half of the occlusal surface
should be ground flat and the denture teeth set to occlude with
only that area, leaving mesial cusps out of contact.

40. • The ideal treatment is to restore the tilted
molar with cast gold crowns, onlays or
fixed bridge if a large edentulous space
exists mesial to the molars.
• If a large space does exist mesial to the
tilted molars another alternative treatment is
to design a removable partial denture that
would restore the mesial half of the molar.

42. • If the molar are severely tilted forward and
supraerupted the modification is not
possible, extraction is necessary.
• Another disharmony exists when
insufficient mandibular teeth are left to
occlude with a complete maxillary denture

43. Methods used to achieve
harmonious balanced occlusion:
Many techniques have been described but
all of them basically fall into two
categories.
Functional chew in techniques:
Articulator equilibration technique:

44. Functional chew in techniques:
• Stransbury described the first functional chew in
technique in 1928
• He suggested using a compound maxillary
occlusal rim trimmed buccally and lingually so
that the occlusion is free in lateral excursions.
• Carding wax is then added to the compound rim
and the patient is instructed to perform eccentric
chew movements.

45. • The carding wax as slowly molded to the
functional movements while the compound in the
central fossa act as a guide to preserve the vertical
dimension.
• The generate occlusal rim is now removed from
the mouth and stone is vibrated into the wax paths
of the cusps and without separating them both are
mounted on the articulator
• The denture teeth are set according to the lower
cast of the patients teeth

46. • After the esthetics has been approved at the try-in,
the lower cast is removed and lower chew in
record is secured to the articulator
• All interfering spots are carefully ground until the
incisal guide pin prevents further closure.
• Thus in centric and eccentric movements
maximum bilateral balanced occlusion will have
been established.

47. • VIG described as similar technique in which he
recommended the use of a fin of resin placed into
the central grooves of the lower posterior teeth,
instead of using compound as mentioned by
starsbury.
• The resin fin maintains the vertical dimension and
also helps diagnostically locate interfering lower
cusps
• In eccentric movements the lower cusp tips are
ground until equal contacts occur between the
teeth and the resin

49. • The fin is then built up using a soft wax and a
functional path is generated.
• Sharry’s technique
Lateral and protrusive chewing movements are made
so that the wax is abraded generating the functional
paths of the lower cusps.
This is continued until the correct vertical dimension
has been established.

50. • Rudd suggests a technique similar to
starsbury’s
• A thickness of recording matrix made up of
3 sheets of medium and pink base plate wax
and two sheets of red counter wax in added
to the buccal and lingual surface of this
compound rim.

51. Articulator equilibration
technique:
• If the denture bases lack stability or if the patient
is physically unable to perform a chew in record
the articulator equilibration method is preferred
• First the upper cast is mounted on the articulator
using a face bow with an orbital pointer
• The lower cast is related to the upper by a centric
inter occlusal record at an acceptable vertical
dimension.

53. • If the denture teeth apex to be placed too far to
buccal when articulated with the lower buccal
cusp, they are rest to oppose the lingual cusps.
• Once the holding cusps have been selected the
inclines of the remaining cusps are reduced and
vice-versa
• This allows for a cusp to fossa relationship
between the upper and lower teeth in centric .

55. • At the time of wax try in eccentric records are
made and the condylar inclinations are set on the
articulator
• The upper posterior teeth are arranged to be as
close to being balanced as is possible at this time.
• After the denture has been processed it is again
related to the mounted lower cast with a new
centric intra-occlusal record.

56. The condylar inclinations previously determined
are reset on the articulator.
Once the centric holding cusps are established by
selective grinding, eccentric balance is achieved.
This is simply accomplished by selectively
grinding the interfering buccal and lingual cuspal
inclines of the upper teeth.
Once the centric contacts have been established it
is advisable to use two colors of articulating paper.
One colour to mark the centric contacts and other
to mark the eccentric contacts.

57. • The eccentric contacts are selectively
ground until a relatively continuous area of
contact is noted on the buccal and lingual
cuspal inclines of the upper teeth.

58. Types of teeth:
The most important aspects are to transmit the
occlusal forces vertically.
• Non – anatomic teeth
• Anatomic teeth

59. Non – anatomic teeth
• If the cusps of the natural teeth have been reduced
either naturally or artificially to such a degree that
their occlusal surface are fairly flat, then non
anatomic teeth maybe used on the denture.
• These teeth have flat occlusal surfaces with
fissures and spillways carved into them which
help to provide an effective masticating surface.

60. Anatomic teeth:
• If the cuspal form of the lower teeth has been
retained anatomic teeth can be used
• These should be arranged with a cusp to fossa
relation.
• A small space distal to the cuspid looks quite
natural in an upper denture, spaces between the
posterior teeth provide extra channel for the
escape of food from the occlusal surfaces

61. Artificial tooth materials
• The materials available for occlusal
posterior tooth forms are
Porcelain
Acrylic teeth
Gold
Acrylic resin with amalgam stop
IPN

62. • Porcelain teeth wear slowly therefore the
occlusal vertical dimension is maintained
however they are predisposed to fracture and
chipping when opposed by natural teeth and are
more difficult to equilibrate.
• Also they cause rapid wear of opposing natural
teeth.
Porcelain teeth:

63. Acrylic resin teeth
• Since acrylic resin teeth cause no wear of the
opposing natural teeth they are the easiest to
equilibrate
• They are the teeth of choice.
• The major disadvantage of resin teeth is there
wear, which result in loss of vertical dimension

64. Gold occlusal:
• The best material for an artificial occlusion
opposing the natural teeth is gold
• A technique described by Wallace in 1964
• The occlusal surfaces of the posterior acrylic
denture teeth are then reduced by about 1mm and
a central channel is cut posteriorly along them
• The wax patterns are cast in gold and cemented
with self cure acrylic resin.

66. Acrylic resin with amalgam stops:
• This method is established by Frank R. Lauciello.
• After the acrylic teeth have been balanced,
occlusal preparation are made in the acrylic teeth,
extending it include as much of the articulating
paper tracing as is possible.
• Amalgam is condensed into the preparation and
the articulator is gently closed, going side to side
and back and forth until the incisal guide pin is
again flush with the guide table.

67. • This material consist of an unfilled,
highly cross linked inter penetrating
polymer network.
• A three year clinical study by ogle and his
colleagues, has determined the wear of new
material to be significantly less when
compared to acrylic resin teeth.
Inter penetrating polymer net work
(IPN)

68. Changes caused by mandibular removable
partial denture apposing maxillary
complete denture:
• Another problem is combination syndrome.
• The syndrome is characterized by
Maxillary anterior ridge resorption
Palatal papillary hyperplasia
Enlargement of maxillary tuberosities
Supra eruption of lower anterior teeth
Resorption of mandibular posterior ridge

69. CONCLUSION:
The problems involved in providing comport,
function, proper esthetics and retention is a
vigorous challenge for practicing dentist. The
damage to the edentulous ridge and inability to
wear the denture may be avoided by good
prosthetic treatment which includes adequate
denture base, correct jaw relation record and
proper occlusion.

70. REFERENCES :
• Prosthodontic treatment for edentulous patients - Boucher
• Essentials of complete denture Prosthodontics – 2nd edn.
Sheldon Winkler
• Syllabus of complete denture – Heartwell
• Complete denture Prosthodontics – Sharry
• Changes caused by a mandibular RPD opposing a
maxillary C.D. – Ellsworth Kelly J. Prosthet. D. 27; 140-
150: 1972.
• Single complete denture – Charles W. Ellinger J.
Prosthetic. D. 26 ; 4-10 : 1971.

71. • CD’s opposing natural teeth - Robert W. Bruce JPD 26;
448 –55: 1971.
• Occlusion and single denture – Kenneth D. Rudd JPD 30;
4-10: 1973.
• The maxillary CD opposing natural teeth: the problems
and some solutions – Alex Koper JPD 57; 704 –07: 1987.
• The maxillary CD opposing mandibular bilateral distal
extension partial denture – Sounder RT JVD 41(2); 124-
28: 1979.
• Diagnosing functional CD fractures – Schineder L. Robert
54; 804-14: 1985.