Single complete dentures

SINGLE COMPLETE DENTURES
PAAVANA
III MDS

CONTENTS
INTRODUCTION
DEFINITION
INDICATIONS
DIAGNOSIS AND TREATMENT PLANNING
PROBLEMS ASSOCIATED WITH SINGLE COMPLETE DENTURE
COMMON OCCLUSAL DISHARMONIES AND WAYS TO CORRECT THEM
MODIFYING OCCLUSAL PATTERNS
CLASSIFICATION FOR IDENTIFICATION AND TREATMENT OF PATIENTS
TREATMENT PLANNING BASED ON CLINICAL SITUATIONS
2

CONTENTS
METHODS USED TO ACHIEVE HARMONIOUS BALANCED OCCLUSION
TEETH SELECTION
OCCLUSAL MATERIALS
ADVERSE SEQUELE TO SCD TREATMENT
REVIEW OF LITERATURE
CONCLUSION
REFERENCES
3

INTRODUCTION
The prevalence of the condition in which one arch is edentulous
opposing a natural or restored dentition is common.
This situation occurs most often when the maxillary teeth are lost and
the mandibular arch is maintained with some or all natural teeth.
4
Prosthodontic treatment for edentulous patients – Boucher 12th edition .Pg-427

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 making of a maxillary or mandibular denture as distinguished
from a set of complete dentures (GPT-9).
5

INDICATIONS
A single complete denture may be desirable when it is to oppose any
one of the following
6
Textbook of complete
denture – Heartwell
5th edition.pg 481
Natural teeth sufficient in numbers which do not necessitate a fixed
or removable partial denture.
A partially edentulous arch in which the missing teeth have been
or will be replaced by the 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 or Implant supported complete
denture.

DIAGNOSIS AND TREATMENT PLANNING
 Diagnosis consists of planned observations to determine and evaluate the existing
conditions, which lead to decision making based on the condition observed.
 The commonly sited long term goal in Prosthodontics is the Preservation of that
which remains.
7
Prosthodontic treatment for edentulous patients – Boucher 12th edition .page-298

DIAGNOSIS AND TREATMENT PLANNING
 For proper diagnosis and treatment planning - evaluate
 Edentulous arch - frenii, sulcus, palate, mucosa, ridge, undercuts, tongue,
lips, TMJ, mouth opening.
 Dentulous arch - number of teeth present, position of teeth, condition of
teeth, endodontic considerations, restorative consideration, condition of
existing restoration and periodontal condition
 Deciding whether to extract remaining teeth depends on
oGeneral health of the patient
oAge of the patient
oTooth mobility
oPresence of infection
8
Prosthodontic treatment for edentulous patients – Boucher 12th edition .page 57-74

PROBLEMS
9
Essentials of complete denture
Prosthodontics – 2nd edition.
Sheldon Winkler .page-417
Malposed, tipped or
supraerupted teeth
Presence of lower
anteriors in a fixed
position
Occlusal forces Occlusal wear
Occlusal form of the
natural teeth
Support for the
denture base
Occlual plane
Intermaxillary
relations
A mandibular single
complete denture
opposing upper
natural teeth
The upper single
complete denture
opposing lower
natural anterior
teeth.
Fracture of the
single complete
denture

COMMON OCCLUSAL DISHARMONIES AND
WAYS TO ADJUST THEM
 Tilted molars with distal halves supraerupted
 Steeply inclined occlusal surfaces tend to drive denture forward when brought into
centric occlusion.
 Only contact is on the distal half of lower molar in protrusive and lateral movement.
Denture easily dislodged during functional movements.
10
Essentials of complete denture Prosthodontics – 2nd edition. Sheldon Winkler .page-419

 ADJUSTMENT:
oIf molars are not severely tilted it can be reshaped by
selective grinding.
oStephen’s recommends that in this situation the 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.
oIf more tooth structure is needed to be removed -Restore
with crown or FPD. Described by Behrend.
11

oIf large space exist mesial to tilted molar - RPD restoring the mesial half of the
molars, by lowering the distal cusps and restoring mesial cusps using an onlay
mesial rest.
oOrthodontic repositioning of tilted molar
oIf severely tilted and supraerupted- Extraction
12

Natural lower cuspids and incisors are supraerupted- Selective grinding.
Cuspid region, occlusal adjustment should aim at providing a definite distal slope on
the lower cuspid so as to allow space for free passage of the upper artificial cuspid
between the lower cuspid and first premolar in lateral movements.
13
Schneider RL. Diagnosing functional complete
denture fractures. J Prosthet Dent . 1985 Dec
1;54(6):810

MODIFYING OCCLUSAL PATTERNS
 Several techniques to modify the existing occlusal pattern prior to denture
construction have been suggested:
1. Swenson’s technique
2. Yurkstas method
3. Bruce method
4. Boucher method
5. Han Kuang Tan’s technique
6. L. Klirk Gardner’s technique
7. Broadrick occlusal plane analyser
8. Custom made occlusal plane template
14

SWENSON’S TECHNIQUE (1964)
 The maxillary and mandibular cast are mounted on articulator using provisional
centric record and maxillary denture teeth are set.
 Lower interfering teeth are adjusted on the cast and area is marked with a pencil.
15

SWENSON’S TECHNIQUE
 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.
Disadvantages:
Time consuming if it needs several impressions and mountings before the occlusion
is finalized
16

YURKSTA’S METHOD (1968)
 Method involves the use of a metal U-shaped occlusal template which is slightly
convex on the lower side.
 The template is placed on the lower cast and the cusps to be adjusted are
identified.
 The stone cast is modified to an acceptable occlusal relationship and the areas are
marked with a pencil.
 This cast is then used as a guide to modify natural teeth
17
Essentials of complete denture Prosthodontics – 2nd edition. Sheldon Winkler .page-
418

18
Complete denture Prosthodontics – Sharry 3rd edition.pg 274-275

BRUCE METHOD (1971)
 Areas to be modified are marked with a pencil
on the cast.
19
Bruce RW. Complete dentures opposing natural teeth. J Prosthet Dent . 1971 Nov 1;26(5):448-
55

 Clear acrylic resin template is formed over the
corrected cast
 Template coated with pressure indicating paste and
placed over patients teeth.
20
55

BRUCE’S METHOD
 Interferences can be seen through the clear template and can be removed
accordingly.
 Process repeated till template fits the teeth perfectly
Advantage:
Produces accurate results.
21
55

 His technique involves making the 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.
22

 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.
23

HAN-KUANG TAN (1997)
24
Tan, H.-K. . A preparation guide for modifying the mandibular teeth before making a maxillary single complete denture. (J Prosthet Dent 1997;77:321-2.

25
Tan, H.-K. . A preparation guide for modifying the mandibular teeth before making a maxillary single complete denture. (J Prosthet Dent 1997;77:321-2.

26
Tan, H.-K. . A preparation guide for modifying the mandibular teeth before making a
maxillary single complete denture. (J Prosthet Dent 1997;77:321-2.

L. Klirk Gardner’s technique
27
Gardner, L. K., Rahn, A. O., Parr,
G. R., & Richardson, D. W.
(1990). Using a tooth-reduction
guide for modifying natural teeth. J
PROSTHET DENT 1990; 63: 637-
9.)

28
Gardner, L. K., Rahn, A. O.,
Parr, G. R., & Richardson,
D. W. (1990). Using a tooth-
reduction guide for
modifying natural teeth. J
PROSTHET DENT 1990;
63: 637-9.)

BROADRICK OCCLUSAL PLANE ANALYSER
Hanau™ Broadrick Occlusal Plane Analyzer

Customised broadwick occlusal plane analyser
Manvi S, Miglani S, Rajeswari CL, Srivatsa G, Arora S. Occlusal plane determination using custom made broadrick occlusal plane analyser: A case control study. ISRN dentistry.
2012;2012.

Gupta R, Luthra RP, Sheth HH. Broadrick’s occlusal plane analyzer: A review. Int. J. Appl. Dent. Sci.. 2019;5(1):95-8.

Manvi S, Miglani S, Rajeswari CL, Srivatsa G, Arora S. Occlusal plane determination using custom made broadrick occlusal plane analyser: A case control study. ISRN
dentistry. 2012;2012.

Custom made occlusal plane template
35
Polymer ball of 8 inches diameter with poured Type III
gypsum material
Concave stone-form
Muley BY, Patil PG, Khalikar AN, Puri SB. A simple technique to fabricate custom made occlusal plane template. J Indian Prosthodont Soc. 2014 Dec 1;14(1):334-6

36
Concave stone-form placed in heat and
pressure molding machine
Adapted PMMA plate on concave stone-form

37
Finished occlusal plane template (OPT) on concave
stoneform.
OPT in use

Classification for identification and treatment of patients
requiring single dentures
Class 1
• Patients for whom minor, or no, tooth reduction is all that is needed to obtain balance
Class 2
• Patients for whom minor additions to the height of the teeth are needed to obtain balance
Class 3
• Patients for whom both reductions and additions to the teeth are required to obtain balance. The treatment of
these patients usually involves a change in vertical dimension of occlusion
Class 4:
• Patients who present with occlusal discrepancies that require addition to the width of the occluding surface
Class 5
• Patients who present with combination syndrome as described by Kelly
39
Proposed by Carl F. Driscoll and Radi M. Masri
Driscoll, C. F., & Masri, R. M. (2004). Single maxillary complete denture. Dent Clin N Am, 48(3), 567–583

 Treatment planning for the patient depends upon the clinical situation he/she
presents. It may be:
1. Upper single complete denture opposing complete set of lower natural
teeth.
2. Lower single complete denture opposing complete set of upper natural
teeth.
3. Single complete denture opposing natural teeth with a removable partial
denture.
4. A single complete denture opposing natural teeth with a fixed partial
denture.
5. A single complete denture opposing an already existing complete denture
6. Single complete denture opposing implant supported prosthesis
40
Ellinger CW, Rayson JH, Henderson D. Single complete dentures. J Prosthet Dent . 1971 Jul 1;26(1):4-10

Single complete denture (Maxillary) to oppose
natural mandibular teeth:
 More frequently encountered
 The diagnostic procedures should determine that there are sufficient teeth in the mandibular
arch, periodontal health is acceptable, and there are no missing teeth to be replaced.
 The occlusal forms of the natural teeth usually act as the guide in selecting the occlusal form
for the maxillary posterior
41
Textbook of complete denture – Heartwell 5th edition.pg-484-486

 The mandibular arch may present two planes of occlusion,
An anterior plane from canine to canine and
A much lower posterior plane
 If the posterior teeth are extruded the inter ridge space would be less.
 To prepare this mouth it requires extensive restorative procedures in mandibular
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.
42

This problem may be solved as follows.
oReposition of the natural teeth with orthodontic procedures
oAlter the clinical crowns of the teeth by grinding or with restoration.
oAccept balanced occlusion with the jaws in the terminal relation and not in the
eccentric position
43

Mandibular complete denture to oppose maxillary
natural teeth:
 Although the mandibular arch is seldom the edentulous one, this condition does
occur.
 It usually happens as a result of either surgical or accidental trauma i.e. irradiation
or accident or gunshot
44
Ellinger CW, Rayson JH, Henderson D. Single complete dentures. J Prosthet Dent .
1971 Jul 1;26(1):5

 Three factors in particular must be carefully evaluated.
45
Preservation
of the
residual
alveolar
ridge
Necessity
for retaining
maxillary
teeth
Mental
trauma

Preservation of residual alveolar ridge
 Force of jaw closure is greater with opposing natural teeth than with complete
denture. Greater the force, the more the pressure, and pressure contributes to
bone resorption.
 Stability of mandibular denture is very difficult due to tongue movements, denture
movement will increase the pressure and stress on the mucosa and bone, which is
detrimental to comfort and preservation
 Minimal availability of mucosa with tightly attached submucosa will lead to stress
concentration. So ultimately tissues become not tolerable to dentures.
46

Necessity of 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.
 The primary considerations for these patients are:
oTo speak clearly
oTo swallow food and fluids without passing in to nasal cavity.
47

Mental trauma
 The loss of teeth is such a traumatic mental experience for some persons that they
become depressed. Their depression may lead to more complicated psychological
problems.
 If this mental state exists when the patient losses his mandibular teeth, the removal
of the remaining maxillary teeth may be more than he or she can endure mentally.
48

Complete maxillary denture to oppose a
partially edentulous mandibular arch with
fixed prosthesis
 The following points must be evaluated for the proper diagnosis and
treatment planning:
oIt must be determined whether fixed restorations are acceptable, can be
made acceptable or should be rejected.
oIf any fixed partial denture is acceptable,
1. Then the same principles of occlusion that are applied to complete
dentures should be applied to single complete dentures.
2. The teeth in a single complete denture are on a movable base and even
though they function against natural teeth they will function as a unit.
3. Composition of the artificial teeth to be used.
49

oIf the fixed partial dentures have
1. Porcelain occlusals then  porcelain / acrylic resin teeth
2. Mixed enamel and gold or gold alone gold / acrylic resin teeth
50

Complete maxillary denture to oppose a partially
edentulous mandibular arch with a removable partial
denture
 The most common single denture situation
 Replacement of missing posterior teeth in the lower arch will almost always
improve the prognosis for the upper denture.
 However, a removable partial denture is not always indicated to oppose the
complete denture even when some or all of the molars are missing.
51
Ellinger CW, Rayson JH, Henderson D. Single complete dentures. J Prosthet Dent . 1971 Jul 1;26(1):6

 Sharry’ states that in a Class II jaw relationship a complete upper denture often
may be constructed against lower anterior teeth and the premolars without
replacing the molars. In this situation, the lower premolars are far enough posterior
in relation to the maxillary residual ridge that the forces of occlusion are directed to
the middle-posterior part of the upper denture.

52

 If this same patient presented a similar condition but in a Class III jaw relation, the
clinical situation would be different because the mandibular prcmolars would apply
occlusal forces against he anterior part of the maxillary residual ridge.
53

 A lower removable partial denture is usually indicated in all situations when all
molars arc missing.
 When the removable partial denture is to be supplied, there should be no particular
problem related to the complete denture construction, since the treatment plan is or
should be formulated for both arches at the same time
54
Textbook of complete denture – Heartwell 5th edition.pg-489

Single complete denture to oppose an
existing complete denture:
 The decision to construct a single complete denture against an existing complete
denture can be approached in a systematic manner by answering and analyzing
the following five questions
55
1.long has the existing denture
been in use?
2 . Was the denture an immediate
insertion
at the time of tooth removal?
3.Does the denture meet the
requirements
of an acceptable denture?
4. Has the denture opposed
another complete denture, a
partially edentulous arch that
supported a removable partial
denture, restored natural teeth, a
fixed partial denture or natural
teeth in which no restorations
have been placed?
5. Is the operator satisfied to
institute complete denture
procedures utilizing the existing
denture?

Single complete denture opposing implant
supported prosthesis
With the use of implants we have
 Preservation of the existing tissues especially bone
 Better stress distribution pattern
 Enhanced Stability
It prevents
 Bone resorption in mandibular posterior region
 Settling of denture base and loss of posterior contacts
 Upward rotation of anterior mandibular denture
 More forces on anterior maxilla supporting the maxillary denture.
56

METHODS USED TO ACHIEVE
HARMONIOUS BALANCED OCCLUSION:
 The techniques to achieve this are broadly divided into two categories.
1. Those that dynamically equilibrate the occlusion by use of functionally
generated path i.e. Functional chew in techniques.
2. Those that statistically equilibrate the occlusion by using an articulator
programmed to simulate patients jaw movements. i.e Articulated
equilibriation technique.
57
Essentials of complete denture Prosthodontics – 2nd edition. Sheldon Winkler.pg-420

FUNCTIONAL CHEW IN TECHNIQUE
 Most accurate method of recording occlusal patterns
 To obtain functional chew in technique
Record bases should have good stability.
Patient should have good neuro-muscular control
Mental competence to effectively co-operate
58

Stansbury (1928)
 First functional chew in technique for upper complete denture opposing lower
natural teeth.
 .
59
• Compound maxillary rim trimmed buccally and lingually.
• Carding wax is then added to the compound rim, and the patient is instructed to
perform eccentric chewing movement.
• The carding wax is slowly molded to the functional movements, while the
compound in the central fossa acts as a guide to preserve the vertical dimension
Essentials of complete denture Prosthodontics – 2nd edition. Sheldon Winkler.pg-420 -421

61
• The generated occlusion rim is now removed from the mouth, and stone
is vibrated into the wax paths of the cusps.
• The upper cast is again fastened to the articulator with the generated
occlusion rim and the stone cusp path record is secured to the lower
member of the articulator with plaster. .
• We now have the upper cast mounted on the articulator and two lower
casts. One is a duplicate of the lower teeth and the other is a replica of
the generated path.
• The denture teeth are first set to the lower cast of the patient’s teeth. After
the esthetics have been approved at the try-in, the lower cast is removed
and the lower chew-in cast record is then secured to the articulator
Essentials of complete denture Prosthodontics – 2nd edition. Sheldon Winkler.pg-420 -421

Vig’s technique
 By Robert G. Vig
 Modified functional chew-in.
 Similar technique to Stansbury
 The use of a fin of resin placed into the central grooves of the
lower posterior teeth, instead of using compound as mentioned
by Stansbury .
 In eccentric movements the lower cusp tips are ground until
equal contact occurs between the teeth and resin.
 The fin is then built up using a soft wax, and a functional path is
recorded
62

Sharry’s technique
 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 vertical dimension is achieved.
63
Essentials of complete denture
Prosthodontics – 2nd edition. Sheldon
Winkler.pg-421

Rudd’s Technique
 Suggests a technique similar to Stansbury's.
 A compound maxillary rim is formed much the same way.
 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
 Suggests using two maxillary bases, one for recording the generated path and the
other for setting the teeth.
 Advantage –
oDecreases the number of appointments necessary for the construction of the upper
denture.
64

ARTICULATOR EQUILIBRATION
TECHNIQUE
 Indications-
oWhen denture bases are not stable
oNeuro-muscular control of the patient is poor
65
Essentials of complete denture Prosthodontics – 2nd edition. Sheldon Winkler.pg-421-423

 Procedure-
oFirst the upper cast is mounted on the articulator using a face bow with an orbital
pointer
oThe lower cast is related to the upper cast by a centric interocclusal record at an
acceptable vertical dimension.
oIf the denture teeth appear to be placed too far buccally when articulated with the
lower buccal cusp, they are reset to oppose the lower lingual cusps.
oIf the denture teeth appear to be placed too far lingually when articulated with the
lower lingual cusps, they are reset to oppose the lower buccal cusps.
oOnce the holding cusps have been selected, the inclines of the remaining cusps
are reduced and vice-versa.
oThis allows for a cusp to fossa relationship between the upper and lower teeth in
centric.
oAt the time of wax try in, eccentric records are made and the condylar inclinations
are set on the articulator.
66

67

68

TEETH SELECTION FOR SINGLE
COMPLETE DENTURE
 Selecting the right material for the teeth is important because of the peculiar nature
of the single complete denture. The occlusal surface should not wear too fast nor
should it damage the natural teeth. The most important aspects are to transmit the
occlusal forces vertically.
 Types of teeth:
Non – anatomic teeth
Anatomic teeth
69

Teeth selection
 Non-anatomic teeth:
oIf 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.
oThese teeth have flat occlusal surfaces with fissures and spillways carved into
them which help to provide an effective masticating surface.
70

Teeth selection
 Anatomic teeth:
oIf the cuspal form of the lower teeth has been retained anatomic teeth can be used
oThese should be arranged with a cusp to fossa relation.
oA 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.
71
30
°

OCCLUSAL MATERIALS FOR SINGLE
COMPLETE DENTURES
The materials available for occlusal posterior tooth forms are:-
 Porcelain teeth
 Acrylic resin teeth
 Gold occlusals
 Acrylic resin teeth with amalgam stops
 IPN (interpenetrating polymer network) resin
72

Porcelain
73
Advantage:
Porcelain teeth wear slowly therefore the
vertical dimension is maintained.
Disadvantage:
They are predisposed to fracture and
chipping when opposed by natural teeth
and are difficult to equilibrate.
Can cause rapid wear of natural teeth
If Occlusal adjustment of artificial teeth
are needed porcelain becomes weak.
Cannot be used in decreased inter-
occlusal distance.
They are difficult to grind and polish.

Acrylic resin 74
Advantage:
Since acrylic resin teeth cause no
wear of the opposing natural teeth
they are the easiest to equilibrate.
Easy to do occlusal adjustments. Disadvantage:
Resin teeth wear which result in loss of
vertical dimension and change in centric
occlusion.

Gold occlusals
 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 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.
 Disadvantages-Although gold occlusals are considered the best material to oppose
natural teeth, their expense and the time involved in their fabrication make them
impractical for most patients.
75

Acrylic resin teeth with
amalgam stops
 This method was 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.
76

 Advantage:
oReduces occlusal wear of resin teeth.
oLess expensive than gold
oFacilitates the final stages of occlusal adjustment.
oLess time consuming
77

Inter penetrating polymer network (IPN)
 Developed to minimize the disadvantages of acrylic resin and porcelain teeth and
enhance certain qualities in each.
 This material consist of an unfilled, highly cross linked inter penetrating polymer
network.
 A three year clinical study by Ogle et al, has determined the wear of this material to
be significantly less when compared to acrylic resin teeth.
78

ADVERSE SEQUELE TO SCD TREATMENT
79
POTENTIAL
ADVERSE
TREATMENT
OUTCOMES
. Kelly’s
combination
syndrome
. Denture
fracture
Tooth wear

Combination syndrome
 It was identified by Kelly in 1972 in patients wearing a maxillary complete denture
opposing a mandibular distal extension prosthesis.
80
Textbook of prosthodontics – Deepak Nallaswamy. 2nd edition.pg-324

DEFINITION
 A series of destructive changes occurring in the jaws of the patients wearing a
complete maxillary denture opposed by mandibular natural teeth as well as distal
extension partial denture (Kennedy Class I).
 “The characteristic features that occur when an edentulous maxilla is opposed by
natural mandibular anterior teeth, includes loss of bone from the anterior portion of the
maxillary ridge, overgrowth of the tuberosities, papillary hyperplasia of the hard palate’s
mucosa, extrusion of the lower anterior teeth, loss of alveolar bone and ridge height
beneath the mandibular RPD bases. It is also called ‘Anterior Hyperfunction Syndrome’
GPT - 9
81

Kelly et al put forward 5 features of
combination syndrome:
82
Palmqvist S, Carlsson GE. The combination
syndrome: a literature review. J Prosthet Dent .
2003 Sep 1;90(3):270-5

Saunders et al later described six additional
signs associated with the syndrome
83
Saunders TR, Gillis RE, Desjardins
RP. The maxillary complete denture
opposing the mandibular bilateral
distal-extension partial denture:
treatment considerations. J Prosthet
Dent . 1979 Feb 1;41(2):124-8

Pathogenesis
oIt progresses in a sequential manner. The group of complications which represent
as a syndrome are interlinked to one another. The progress of the disease can
occur in any one of the sequences.
84
Textbook of prosthodontics – Deepak Nallaswamy. 2nd edition.pg-325

 Sequence 1
85
Textbook of prosthodontics –
Deepak Nallaswamy. 2nd
edition.pg-326

 Sequence 2
86
Textbook of prosthodontics –
Deepak Nallaswamy. 2nd
edition.pg-327

Systemic and dental considerations
 Review medical, dental history.
 Thorough clinical and radiographic evaluation of both hard and soft tissues associated
with prosthesis wear.
 Resolution of any inflammation, if present.
 Evaluation of patient’s caries susceptibility, periodontal status and oral hygiene.
 Factors to be considered in tooth to be used as abutment. (Tooth vitality, morphologic
changes, number of roots, bony support, mobility, crown-root ratio, presence and
position of existing restorations, position of teeth in the arch, the availability of
retention and guide planes.)
87
Madan N, Datta K. Combination syndrome. J Indian Prosthodont So. 2006 Jan 1;6(1):10

 Kelly said that before proceeding with the prosthetic treatment, gross changes that
have already taken place should be surgically treated. These include conditions
like:
 Flabby (hyperplastic) tissue
 Papillary hyperplasia
 Enlarged tuberosities
 Lower partial denture base should be fully extended and shouldcover retromolar
pad and buccal shelf area
88

Rationale
oPrevention of rapid resorption of the bone under the removable prosthesis.
oPrevention of excessive load in the anterior region
oProviding stable occlusal scheme
oAllowing anterior teeth only for phonetics and esthetics
oEducate the patient.
89

Treatment
planning
Prevention Management
90

Prevention
oRetain weaker posterior teeth by using combined endodontic and periodontal
techniques.
oEndosseous implants are used in the posterior mandibular region
oAn overlay denture on the lower may avoid the combination syndrome
91

Mangement
1.. Modifications in
removable partial
denture and complete
dentures
• Kelly - advocated
covering of retromolar
pad to have stability of
the lower removable
partial denture.
• Schumitt - advocated
construction of lower
removable partial
denture first and then to
construct the upper
complete denture.
2. Choice of occlusion
• Anterior teeth only for
esthetics and phonetics.
• Posterior occlusion free
of supra contacts during
centric and all eccentric
positions.
• During protrusive
movement, there should
be minimum contact in
the anterior region, when
posterior teeth are in
contact
3 .Overdentures
• Lower anterior teeth are
treated endodontically
and their height is
reduced.
• This can be used for
proprioceptive sensation
of the lower jaw and
prevents resorption of
the underlying bone.
92
Madan N, Datta K.
Combination
syndrome. J Indian
Prosthodont So.
2006 Jan 1;6(1):10

4. Implant - supported prosthesis
• Implants in the posterior region of the
mandible to decrease the residual ridge
resorption
5.Surgical consideration
• 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.
93

Denture fracture
 Denture fracture is common in cases with single complete
dentures because the denture will receive excessive load
from the natural teeth.
 Precepitating factors:
Uneven or deflective occlusal contacts will deform the
denture base and create lines of fatigue that result in
complete denture base fracture.
Improper occlusal plane.
Excessive anterior occlusal load
Broad labial frenal notches
Soft and hard tissue undercuts.
94
Schneider RL. Diagnosing functional complete denture fractures. J Prosthet Dent . 1985 Dec 1;54(6):809-14

 Precautions:
oCheck for the occlusion
oMaintain adequate thickness of the denture base
oNever deepen the labial notch
oFor cases with high fracture potential, use a cast metal
denture base. The metal used can be Type IV gold
alloy or base metal alloy.
95
Schneider RL. Diagnosing functional complete denture fractures. J Prosthet Dent . 1985 Dec 1;54(6):809-14

Wear of the natural teeth
 Use of porcelain material opposing the natural teeth will wear away the tooth
structure.
 Hence proper selection of the tooth material is very important.
 Care should be taken to avoid any occlusal discrepancies.
96

Single complete denture - A corrective
prosthodontics : A clinical report
SHROFF S, VIKHE DM, LAGDIVE S, LAGDIVE S. International J. of Healthcare and Biomedical
Research. 2016 Jul;4(04):104-7.
98
This case report shows the removal of interferences in Single maxillary complete
denture by Han-Kuang Tan technique.

CASE REPORT
pre-operative extraoral
Master cast
Master cast
99

lower cast with vacuum formed sheet occlusion on right side.
100

interferences marked on cast
interferences removed on the sheet
vacuum formed sheet placed on
natural teeth to remove interferences
intraorally
101

Final characterized upper denture
Prosthesis intraorally.
Try - In of waxed and carved dentures.
102

Fabrication of Single Complete Denture Using
Customized BOPA
Vijender et al., J Oral Hyg Health 2017,
 Proper occlusal plane is an essential consideration to fabricate single complete maxillary
denture.
 This case report aims to determine the appropriate occlusal curve for individual patients
and to compare the deviation of the clinical occlusal curve with the ideal ones, using
fabricated customized BOPA (Broadrick occlusal plane analyzer).
103

An arc was scribed on the flag.
105

Line was scribed on other side of the cast.
Fabrication of vacuum form sheet template was done by adapting
over mandibular cast.
106

After that it was trimmed with a sharp knife
up to the marked plane.
Dentures processed.
Dentures inserted in patient’s mouth.
107

CONCLUSION
 Fabrication of complete denture is easier than fabrication of single complete denture.
 This article describes use of customized Broderick Flag and a vacuum form sheet template. Use
of these two devices helped to achieve following goals:
1. Establishing of occlusal plane.
2. Proper reduction of natural teeth.
3. Allows guided intraoral reduction.
4. It eliminates arbitrary grinding.
5. Thus the procedure minimizes guesswork and it provides more favorable occlusal plane.
108

Modified Functionally Generated Path
Technique to Develop Occlusal Scheme in
Single Complete Denture
Agarwal A, Nair C, Singhal MK, Upadhyay P. 2019 Mar 1;30(2):310.
 The current article represents a technique for a patient who was rehabilitated with a
maxillary complete denture, and a harmonious occlusion was achieved between the
complete denture and the mandibular natural dentition.
109

CASE REPORT
A 42-year-old male patient reported to the Department of Prosthodontics,
Institute of Dental Sciences, Bareilly, seeking replacement of missing
upper teeth.
110

Primary impression made with impression compound Functional chew in record
PROCEDURE 111

Postoperative view of inserted denture
Denture remounted against stone core
112

Functionally generated path prosthesis in occlusion (right side) Functionally generated path prosthesis in occlusion (left side)
113

CONCLUSION
 The FGP technique is indicated for complete denture opposed by natural or
reconstructed teeth.
 Harmoniously balanced occlusion between the maxillary complete denture and the
mandibular natural dentition by modifying Meyer’s FGP technique can be easily
attained.
 If the FGP technique is carefully recorded, only minimal occlusal adjustments will
be required during denture insertion, which is a major advantage over the
conventional technique.
114

Functionally generated amalgam stops for
single complete denture: a case report
 Prasad T, Lahari M, Chalapathi M, Harika Y. Annals & Essences of Dentistry. 2014
Jul 1;6(3).
115

116
completely edentulous maxillary arch
and partially dentulous mandibular arch
A balanced occlusion was achieved using
semi-adjustable articulator

117
Remounting the processed SCD on the
semiadjustable articulator
Marked intraorally with the help of articulating
paper

118
Occlusal preparations
Amalgam was then condensed into theocclusal
preparations
Denture was placed into patient’s mouth
Centric and all eccentric
movements arecarved in
the condensed amalgam

119
The denture was delivered Extraoral Photograph of the patient

CONCLUSION
 The decision to make a single complete denture cannot be considered lightly.
 The procedure is not one that takes half as much time and effort as one would
devote to complete dentures.
 Careful observation and recording of all diagnostic information must be considered
before a decision is reached to construct a single complete denture.
120

REFERENCES
 Prosthodontic treatment for edentulous patients – Boucher 12th edition
 Essentials of complete denture Prosthodontics – 2nd edition. Sheldon Winkler
 Textbook of complete denture – Heartwell 5th edition
 Complete denture Prosthodontics – Sharry 3rd edition
 Textbook of prosthodontics – Deepak Nallaswamy. 2nd edition
 Ellinger CW, Rayson JH, Henderson D. Single complete dentures. J Prosthet Dent
. 1971 Jul 1;26(1):4-10.
 Schneider RL. Diagnosing functional complete denture fractures. J Prosthet Dent .
1985 Dec 1;54(6):809-14.
 Bruce RW. Complete dentures opposing natural teeth. J Prosthet Dent . 1971 Nov
1;26(5):448-55
 Tan, H.-K. . A preparation guide for modifying the mandibular teeth before making a
maxillary single complete denture. J Prosthet Dent 1997;77:321-2.
 Gardner, L. K., Rahn, A. O., Parr, G. R., & Richardson, D. W. (1990). Using a tooth-
reduction guide for modifying natural teeth. J Prosthet Dent 1990; 63: 637-9.
121

REFERENCES
 Gupta R, Luthra RP, Sheth HH. Broadrick’s occlusal plane analyzer: A review. Int. J.
Appl. Dent. Sci.. 2019;5(1):95-8.
 Manvi S, Miglani S, Rajeswari CL, Srivatsa G, Arora S. Occlusal plane determination
using custom made broadrick occlusal plane analyser: A case control study. ISRN
dentistry. 2012;
 Muley BY, Patil PG, Khalikar AN, Puri SB. A simple technique to fabricate custom made
occlusal plane template. J Indian Prosthodont Soc. 2014 Dec 1;14(1):334-6.
 Driscoll, C. F., & Masri, R. M. (2004). Single maxillary complete denture. Dent Clin N
Am, 48(3), 567–583.
 Saunders TR, Gillis RE, Desjardins RP. The maxillary complete denture opposing the
mandibular bilateral distal-extension partial denture: treatment considerations. J
Prosthet Dent . 1979 Feb 1;41(2):124-8.
 Palmqvist S, Carlsson GE. The combination syndrome: a literature review. J Prosthet
Dent . 2003 Sep 1;90(3):270-5
 Madan N, Datta K. Combination syndrome. J Indian Prosthodont So. 2006 Jan
1;6(1):10.
122

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