Single- Complete- Denture PDF

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DENTISTRY NOTES (1). LEARNING THAT HELPS...

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SINGLE COMPLETE DENTURES - A single complete denture is a denture that occludes against some or all natural teeth, a fixed restoration, or a previously constructed removable partial denture or a complete denture. INDICATIONS A single complete denture may be desirable when it is to oppose any one of the following: ➢ Natural teeth that are sufficient in number not to necessitate a fixed or partial denture ➢ A partially edentulous arch in which missing teeth have been or will be replaced by a removable partial denture. ➢ An existing complete denture.

5. Tooth Wear 6. Tissue Abuse 7. Increased monitoring ✓ In the mandible, the limited denture bearing area will lead to advanced residual ridge resorption. For this reason, a lower complete denture opposing upper natural teeth should be avoided. A lower complete denture opposing upper natural teeth is acceptable for patients with class III jaw relation and for patients with cleft palate 2. SINGLE COMPLETE MAXILLARY DENTURE TO OPPOSE NATURAL MANDIBULAR TEETH

VARIOUS COMBINATIONS OF SINGLE COMPETE DENTURE 1. MANDIBULAR DENTURES TO OPPOSE NATURAL MAXILLARY TEETH

-most frequently encountered Problems: This situation occurs due to: 1. Surgical trauma 2. Accidental trauma • Greater challenge than maxillary single complete denture Difficulties: 1. Excessive load 2. Occlusal problems 3. Minimal Denture foundation Area 4 .Fracture

1. Malposed, tipped and supraerupeted teeth in lower arch and unfavorable plane of occlusion 2. Position of mandibular anterior teeth o

Reposition

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Alteration

According to Sharry: •

If there is class II jaw relation, a complete denture may be constructed against lower anterior teeth and premolars without replacing molars

Forces directed to middle posterior part of upper denture

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But if class III jaw relation situation is different because of mandibular premolars would apply occlusal forces against the anterior part of the maxillary ridge

Forces against the anterior part of the maxillary ridge

3. COMPLETE MAXILLARY DENTURE TO OPPOSE A PARTIALLY EDENTULOUS MANDIBULAR ARCH WITH FIXED 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. 4. COMPLETE MAXILLARY DENTURE TO OPPOSE A PARTIALLY EDENTULOUS ARCH AND A REMOVABLE PARTIAL DENTURE

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Remaining mandibular teeth should be in an acceptable state of dental health

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The partial denture should meet minimal acceptable requirements

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The occlusal plane, tooth arrangement for occlusion, esthetic and the material composition of the removable partial denture should be suitable to be opposed by a complete denture

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Factors that causes the occurrence of single denture syndrome ➢ loose or tilting denture ➢ Damage of mucosa ➢ Ridge resorption COMMON OCCLUSAL DISHARMONIES AND WAYS TO ADJUST THEM I. TILTED MOLARS WITH DISTAL HALVES SUPRA ERUPTED

It is always wise to construct both the removable ad complete denture at the same time.

5. SINGLE COMPLETE DENTURE OPPOSING AN EXISTING 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. ➢ 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. Problem associated with single complete denture ➢ Occlusal forces ➢ Occlusal form of the natural teeth ➢ Support of denture base ➢ Supraerupted & tilted teeth

ADJUST FOR THE TILTED MOLARS 1 If molars are not severely tilted - it can be reshaped by selective grinding

2. If more tooth structure is needed to be removed - restored with crown or fixed partial denture

DIAGNOSIS & TREATMENT PLANNING •

If large space exist mesial to tilted molar- rpd restoring the mesial half of the molars, lower the distal cusps ( mesial half onlay mesial rest or extended rest)

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Orthodontic repositioning of tilted molar

➢ The basic diagnostic procedures are same to that of completely edentulous patients. ➢ The characteristics of a physiological occlusion are frequently encountered in fully dentate mouths. They also can be almost invariably achieved when treating completely edentulous patients. ➢ When only one arch is edentulous, tooth positions in the dentate arch may preclude such objectives being reached. Unfavorable force distributions may then cause adverse tissue changes that compromise optimum function ➢ Edentulous arch: This is evaluated similar to any complete edentulous situation. ➢ Dentulous arch: The teeth are evaluated for the following: • Number of teeth present. • Position and condition of teeth to assess, endodontic, restorative and periodontal condition

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If severely tilted and supraerupted – extraction

Carl F. Driscoll proposed a classification system that simplify the identification and treatment of patients! •

Class I – Patient for whom minor or no tooth reduction is all that is needed to obtain balance.

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Class II – Patient for whom minor additions to the height of the teeth are needed to obtain balance.

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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.

II. Natural lower cuspids and incisors are supraerupted – selective grinding

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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.

YURKSTAS TECHNIQUE:

• TECHNIQUES TO DETERMINE THE NECESSARY TOOTH MODIFICATIONS PRIOR TO DENTURE CONSTRUCTION •

Swenson`s Technique

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Yursktas Technique

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Bruce Technique

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Boucher Technique

SWENSON'S TECHNIQUE:

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Uses a metal ‘U’ shaped occlusal template

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Placed on the occlusal surfaces of the remaining teeth and cusps are adjusted and identified. ʹ Stone cast is modified to a more acceptable occlusal relationship and the reduced areas are marked with a pencil.

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Necessary alterations done on the natural teeth using the cast as a guide.

• Mount maxillary and mandibular casts at an acceptable VD with a CR record. ʹ A maxillary base is made and denture teeth set. • If interferences are there, adjusted on the cast and mark with pencil. Natural teeth modified with this guide and a new diagnostic cast made and mounted on the articulator. • If this occlusal modification is sufficient, denture teeth are reset for trial. Disadvantages Time consuming if it needs several impressions and mountings before the occlusion is finalize.

BRUCE TECHNIQUE: •

The lower diagnostic cast is mounted with the upper with the proper CR record.

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Necessary modifications are made on the stone cast.

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Acrylic resin template is fabricated on the modified stone cast.

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Checked in the patient's mouth for interferences and the interferences are removed ʹ Process is repeated until the template seats properly.

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Initial modification done Template coated with Pressure indicating paste & placed over teeth:

Interferences can be seen through the clear template and can be removed accordingly. Process repeated till template fits the teeth perfectly:

Areas to be modified are marked with pencil on the cast:

Advantage: Produces accurate results

BOUCHER'S TECHNIQUE:

• Clear acrylic resin template is formed over the corrected cast:

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Casts are mounted on a programmed articulator.

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Artificial are arranged to obtain best possible balancing contacts.

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If a natural tooth prevents balancing, interferences are removed by moving porcelain teeth over the mandibular stone teeth. ʹ Areas to be ground are marked on the cast

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The denture is processed and will be used as a guide to modify natural opposing teeth.

METHODS TO ACHIEVE HARMONIOUS BALANCED OCCLUSION 1. Functional chew in techniques 2. Articulator equilibration techniques 1. !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 neuromuscular control. Mental competence to effectively cooperate FUNCTIONAL CHEW IN TECHNIQUE: a. Stansbury technique (1928) b. Vig's technique (1964) c. Sharry technique d. Rudd technique A. Stansbury Technique (1928) -For upper complete denture opposing lower natural teeth -Compound maxillary 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 to the lower member of the

articulator. The denture teeth are first set to the lower cast of the patient's teeth .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 maximus balanced occlusion is established. B. Vig's Technique (1964) Modified functional chew-in and impression technique. Anterior teeth are set chair side. Wax occlusal rims posterior to the cuspid teeth are removed. Acrylic cast. When set, acrylic resin is trimmed so as to leave only a fin of resin falling into the central grooves of the lower 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 with resilient liner on the tissue side final path is recorded. The teeth are then set against the recorded chew in cast and interferences are ground to obtain a smooth harmonious C. Sharry 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 VD is achieved

D. Rudd Technique 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 upper denture

Occlusal Plane Discrepancies

!2. ARTICULATOR EQUILIBRATION TECHNIQUES Upper cast mounted on the articulator using a face- bow with an orbitale pointer ʹ 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. After denture is processed, then centric holding cusps are achieved by selective grinding and then eccentric balance is achieved. However, perfectly balanced occlusion in all eccentric positions may not be possible in many cases when working with natural teeth in one arch.

PREPARING PLANE OF OCCLUSION Individual Tooth Modifications -

Sharp Unworn Cusps •

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Reduce cuspal inclination

Heavily Abraded Teeth •

Reduce Buccolingual width

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The occlusal plane discrepancy is readily apparent when denture teeth are properly arranged.

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This discrepancy can only be corrected by restorative means.

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