SREE BALAJI DENTAL

COLLEGE AND HOSPITAL

SINGLE COMPLETE
DENTURE

Submitted by: Dawn Meera Bose

Final Year B.D.S.
SRI BALAJI DENTAL COLLEGE AND HOSPITAL

DEPARTMENTOF PROSTHODONTICS
CERTIFICATE

This is to certify mr/miss………………………………….

has satisfactorily completed the project work prescribed by
THE BHARATH INSTITUTE OF HIGHER EDUCATION AND
RESEARCH INSTITUTE,Deemed university for final year
BDS course during the period 2006-2007.

University register no:………………..

Place:
Date

Guided by :

Dr. BHOOMINATHAN MDS HEAD OF THE DEPARTMENT

Prof. Dept. Of Prosthodontics. Department of Prosthodontics
 SINGLE COMPLETE DENTURE

CONTENTS

S No. INDEX Pg No.

1. INTRODUCTION 1

2. CLASSIFICATION 2

3. INDICATIONS 3

4. DISADVANTAGES 4

5. DIAGNOSIS AND TREATMENT

PLANNING 5

6. OCCLUSAL MODIFICATION 7

7. MAXILLARY COMPLETE DENTURE

OPPOSING A COMPLETE MANDIBULAR 11
NATURAL DENTITION

8. MAXILLARY COMPLETE DENTURE

OPPOSING A MANDIBULAR PARTIAL
DENTURE 12

9. MANDIBULAR SINGLE DENTURES 20

 (1)

INTRODUCTION

In this we consider a patient with single edentulous arch. The

prevalence of the condition where one edentulous arch opposes a natural

or restored dentition is quite common. It has been estimated that for some

patient population the mandibular cannines are retained four times longer

than other teeth followed by mandibular incisions. This indicates the

maxillary arch exhibits earlier tooth loss, however the reasons are unclear

but influenced by a combination of factors.

It is important that the clinician appreciate the oral conditions that may

predispose these patients to complications following treatment with

convectional complete dentures.

 (2)

CLASSIFICATION

SINGLE COMPLETE DENTURES:

 MAXILLARY COMPLETE DENTURE OPPOSING A

MANDIBULAR NATURAL DENTITION

 MAXILLARY COMPLETE DENTURE OPPOSING A

MANDIBULAR PARTIAL DENTURE

 MANDIBULAR COMPLETE DENTURE OPPOSING A

MAXILLARY NATURAL DENTITION

 MANDIBULAR COMPLETE DENTURE OPPOSING A

MAXILLARY PARTIAL DENTURE
 (3)

INDICATIONS

 In patients with discrepancies in jaw size who require a complete

denture, it is advisable to retain teeth in mandible.

 In patients with inoperable cleft or perforated palates, it is advisable to

retain teeth in maxillary arch. This is because the convectional

maxillary complete denture would be a failure due to absence of

peripheral seal.
 (4)

DISADVANTAGES

 Malposed, tipped or supra-errupted teeth in lower arch with interfear

with balanced occlusion. The imbalance may produce soreness

mucosal changes and ridge resorption in maxilla and the maxillary

denture will tend to get displaced.

 As the lower anteriors are present in a fixed position it is difficult to

obtain esthetic teeth arrangement.

 Use of acrylic teeth opposing natural teeth will produce abrasion of the

acrylic teeth where as use of porcelin teeth opposing natural teeth will

produce abrasion of natural teeth.

 (5)

DIAGNOSIS AND TREATMENT PLANNING

When only one arch is edentulous tooth positions in the dentate arch

may preclude occlusal biomechanics being reached.

Unfavorable force distributions may then cause adverse tissue

changes that compromise optimum function. It is therefore, important to

identify such clinical changes and correct them.

These changes includes:

 Extensive morphological changes in denture formation that can result

in arch relationship or occlusal plane discrepancies.

 Jaw relationship extremes or

 Excessively displaceable denture bearing tissue.

 Extensive morphological change occurring following extraction of teeth

creates horizontal discrepancy between arches anteriorly and

(6)

 posteriorly and makes it difficult to direct occlusal forces to the denture

bearing surfaces.

This can be corrected by placing the tooth in a reverse

horizontal overlap or cross bite arrangements. However, such

correction is not possible for anterior discrepancy due to esthetic

impact on max lip of such a tooth position.

 Extremes of jaw relationship also makes if very difficult to place the

denture teeth in a position that allows the denture bearing area to be

in line with occlusal support.

This can be corrected by placing the posterior teeth in an reverse

horizontal overlap or crossbite relationship.

 Conditions in opposing arch specially irregular occlusal plane can

dispose problems to patient with single complete denture.

 Selective grinding of tooth can be done as a treatment procedure.

 (7)

OCCLUSAL MODIFICATION

Occlusal modification of the remaining natural teeth is usually required

prior to the construction of single complete denture. It is a preprosthetic
procedure where occlusal discrepancies in natural teeth are corrected. If
can be done in one of the following methods:

SWENSON TECHNIQUE:

A tentative teeth arrangements is done using a diagnostic caste the

occlusal discrepancies are marked and reduction is done in patients
mouth.
YURKSTAS TECHNIQUE;

(8)

A ‘U” shaped slightly convex metal plate is positioned over natural

teeth and the occlusal discrepancies are recorded.

These discrepancies are reduced in diagnostic cast. The reduced cast

is used as guide to reduce the natural tooth.

BRUCE TECHNIQUE;

The occlusal discrepancies are arbitorly reduced in diagnostic cast. An

acrylic resin template is made over reduced cast. The natural teeth are

reduced till acrylic plate sets properly against them.

 (9)

BOUCHER ET AL TECHNIQUE;

The cast are articulated using a tentative jaw relation. Artificial porcelin

teeth are set on edentulous cast and this arrangement is made to more

against the teeth of opposing cast. As porcelin is hard it will abrade

 against the occlusal discrepancies. The denture is processed and

(10)

finished During insertion the abraded opposing cast is used

. as a guide to reduce the occlusal discrepancies of natural

teeth in patients mouth.

 (11)

MAXILLARY COMPLETE DENTURE OPPOSING A COMPLETE

MANDIBULAR NATURAL DENTITION;

These dentures are maxillary complete dentures opposing a complete

set of mandibular natural teeth.

Gross occlusal discrepancies are common and require occlusal

adjustments and orthodontic correction.

Some important points to be considered during the construction of

these dentures are:

 The morphology of natural teeth will determine the selection of

the artificial teeth.

Eg,. The size and shade of artificial teeth should match the

natural teeth

 If mandibular teeth are attriated, 0° or cuspless teeth are

preferred.

 It mandibular teeth are not attriated, anatomic teeth are

preferred.
 (12)

MAXILLARY COMPLETE DENTURE OPPOSING A MANDIBULAR

PARTIAL DENTURE

These dentures are clinically very significant due to their complications.

Teeth selection is very important in fabrication of the denture.

Artificial teeth for these dentures are selected based on following

factors;

Porcelin teeth - if opposing partial denture has porcelin

teeth.

Acrylic teeth - If opposing natural teeth have gold or metal

crowns.

Acrylic teeth - If opposing natural teeth or partial denture

with artificial acrylic teeth.

COMPLICATIONS;

 Combination Syndrome

 Wear of natural teeth

  Fracture of denture

(13)

COMBINATION SYNDROME;

INTRODUCTION:

It was identified by Kelly in 1972 in patients wearing a maxillary complete

denture opposing a mandibular distal extension denture base.

PATHOGENESIS:

This syndrome progresses in a sequalae / sequential manner. Progress of

disease can occur in any one of following sequence.

SEQUENCE I

Patient tend to concentrate the occlusal load on remaining natural teeth i.e.

mandibular anterior for proprioception.

This more force acting on anterior portion of maxillary denture.

Increased resorption of anterior part of maxilla, replaced by flabby tissue

occlusal plane gets tilted anteriorly upwards and posteriorly downwards due to

lack of anterior support.

Labial flange will displace and irritate labial vestibule – formation of epulis

fissuratum.
 (14)

Posteriorly there will be fibrous overgrowth of the tissues in the maxillary

tuberosity.

Shift of occlusal plane posteriorly downwards produced resorption in

mandibular distal extension denture bearing area.

Due to tilt of occulsal plane mandibular shift anteriorly during occlusion.

Retension and stability of denture decreased. Vertical dimension of occlusion

also decreased.

Tilt in the occlusal plane disoccludes the lower anteriors causing them to

supra-errupt.

Supra-errupt anteriors increase the amount of force acting on the anterior part

of the complete denture and thus the viscious cycle continues.

 (15)

A. Excessive load on anterior region of complete denture

B. Ridge resorption in maximum anterior region epulis fissuratom is

formed in maxillary labial sulcus.

C. Downward movement of posterior plane of occusal producing

excessive resorption of mandibular posterior region.

D. Downward titling of occlusal plane in posterior region produces

anterior open bite causing supra-erruption of lower anteriror. This

again increase load on anterior region producing a vicious cycle.

 (16)

SEQUENCE II

Gradual resorption of the distal extension residual ridge in the mandible.

Tilting of the occlusal plane posteriorly downwards and anteriorly upwards.

Rest of the cycle occurs similar to sequence I.

Combination syndrome should be identified at an early stage and prevented.

Planning over dentures and designing implant supported dentures are some

of the methods to prevent combination syndrome.

(17)
 (18)

A. Ridge resorption in mandibular edentulous area.

B. Downward movement of the posterior part of the maxillary denture

and formation of flabby tissue.

C. Supra erruption of lower anterior.

D. Increased load in mandibular anterior region of complete denture.

E. Resorption in anterior portion of maxillary ridge and formation of

flabby tissue.
 (19)

WEAR OF NATURAL TEETH:

When porcelin teeth are used, severe abrasion of the opposing natural

teeth will occur.

Thus proper selection of tooth material is important.

Care to be taken to avoid occlusal discrepancies.

DENTURE FRACTURE:

This condition is common in cases with single complete denture, as the

denture with receive excessive load from the natural teeth;

 Excessive anterior occlusal load.

 Deep labial frenal notches.

  High occlusal load due to excessive action of messeter.

(20)

PRECAUTIONS

 Check the occlusion.

 Maintain adequate thickness of the denture base.

 Do not deepen the labial notch.

MANDIBULAR SINGLE DENTURE

Mandibular single dentures can either be opposing a fully dentuluos

maxilla or a maxillar partial denture.

There is severe ridge resorption of edentulous mandible. Due to two reasons.

 (21)

 Constant movement of tongue add forces on the residual ridge

increasing the amount of resorption.

 Amount of firmly attached mucosa to the denture bearing area is less in

mandible than in maxilla.

This condition can be best treated using endosseous implants after

through evaluation of the patients.

When clinician is unable to provide the option of endosseous implants,

then treatment using single complete denture is provided. However

many clinicans believe that use of resilient liner in mandibular denture

is beneficial. With such a procedure the dentist attempts to provide

stress reducing element in the denture base to resist the forces of

functional and Para-functional loads.

(22)