Single complete denture

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
Reasonsfor 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 completedenture.

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.Heavyocclusalforces,duetoopposingnatural
teeth.(3timesthatofconventionalCDie.22lb)
2.Thehighocclusalforcesfromtheopposing
naturalteeth,whichresultsinadvancedbone
lossofridges.
3.Supra-eruptionoftheopposingnaturalteeth
producesanunharmoniousocclusalplane.
4.Mesial drifting of the opposing natural teeth
produce unharmonious occlusal plane.
5.Midline fracture of the denture due to heavy
forces

8. ClassI–Patientforwhomminorornotoothreductionisneededto
obtainbalance.
ClassII–Patientforwhomminoradditionstotheheightofthe
teethareneededtoobtainbalance.
ClassIII–Patientforwhombothreductionandadditionstothe
teetharerequiredtoobtainbalance.Thetreatmentofthesepatient
involveschangeintheverticaldimensionofocclusion.
ClassIV–Patientwhopresentswithocclusaldiscrepanciesthat
requireadditiontothewidthoftheoccludingsurface.
ClassV–Patientwhopresentswithcombinationsyndrome.

9. Functional chew intechniques
Stansburytechnique(1928)
Vig'stechnique(1964)
Sharrytechnique
Ruddtechnique
Articulator equilibrationtechniques

10. Compound occlusal rim trimmed buccallyand lingually
so that occlusion is free in lateralexcursions
Carding wax added buccallyand linguallyand patient
instructed to perform chewingmovements
Carding wax gets functionally molded whereas the
compound rim in the central fossamaintains theVD.
The generated occlusal rim is removed from the mouth
and stone is vibrated intothe 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 onthe lower cast
After esthetics approved at try in, lower cast chew in record
is secured and allthe interfering spots are ground.
Thus in centric and eccentric movements balanced
occlusion isestablished.

13. Anterior teeth are set chairside.
Wax occlusal rims posterior to the cuspidsareremoved.
Acrylic resin is added and firmly pressed against the occlusal
surface of the teeth onthe opposing cast.
When set, acrylic resin is trimmed so as to leave only a fin of
resin falling into thecentral grooves of the opposing
posterior teeth to maintain the verticaldimension.
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 pathis
recorded.
The teeth are then set against the recorded chew in cast and
interferences are ground toobtainharmonious occlusion

14. A Modified Chew-in And Functional ImpressionTechnique, Robert G Vig.;JProsthetDent1964

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

16. Suggests a technique similar toStansbury's
But suggests using two maxillary bases, one for
recording the generated path and theother for setting
theteeth
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
interocclusalrecord at an acceptableVD.
The bucco-lingual position of the teeth and their relation
to the upper arch is studied.
Cusp-fossarelationship of the teeth isessential.
At the time of wax try-in, eccentric records made and
condylarinclinations are set and posterior teeth are now
balanced.

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

20. Swenson’stechnique
Yurkstasmethod
Bruce method
Bouchermethod
Han KuangTan’s technique

21. Maxillary and mandibular cast aremounted
A maxillary denture teeth areset.
Lower interfering teeth are adjusted on the cast and
area is marked with apencil.
The natural teeth are modified using marked
diagnostic cast as aguide.
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 tryin.

23. U shaped metal occlusal template that is slightly
convex on the lowersurface.
When placed on occlusal surfaces of remainingteeth,
cusps to be adjusted areidentified.
Stone cast is modified to a more acceptable occlusal
relationship and areas reduced are identified by
marking with apencil.
Cast is then used as a guide for modifying natural
teeth.

25. The casts are mounted and the necessary modifications
are made on the stonecast.
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 balancingcontacts.
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 thecast.
The occlusion is refined in the right and left lateralexcursive
movements until a harmonious balance isachieved.

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

30. Porcelainteeth
Acrylic resinteeth
Gold Occlusal
Acrylic resin with amalgamstops
IPN resin (Inter-penetrating PolymerNetwork)

31. Wear very slowly -occlusal vertical dimension is
maintained.
Predisposed to chipping andfracture
More difficult to equilibrate, since their surfacesdo not
mark well with articulatingpaper.
Cause rapid wear of opposing naturalteeth.
Contraindicated with acrylic resin posteriorsand
bruxism

32. Cause no wear of opposing naturalteeth.
Contraindicated inbruxers
Wear -results in loss of vertical dimension

33. Best material to oppose naturalteeth
Denture with acrylic resin teeth worn bypatient for
fewweeks
Occlusal index of thedenture ismade
Occlusal surface of posterior teeth reducedby 1mm
Wax pattern is prepared and verified with the help
of occlusal index and casting is done.

34. Amalgam inserts reduce occlusalwear
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 thearticulating paper tracing as is
possible.
Amalgam is condensed into preparationsand eccentric
movements aremade.

35. To minimize disadvantages of acrylic resin and
porcelain teeth and enhance certain qualitiesin each.
Consists of an unfilled, highlycross-linked,
interpenetrating polymernetwork.
Wear significantlyless

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, supraeruptionof the mandibular
anterior teeth, and loss of alveolar bone andridge height
beneath the mandibular removable partial denture bases; syn,
anterior hyperfunctionsyndrome (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 verticaldimensionof occlusion
2.Occlusal planediscrepancy
3.Anterior spatial repositioning of themandible
4.Poor adaptability of the prosthesis
5.Epulisfissuratum
6.Periodontal changes

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

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. Kellyadvocated surgical excision of the maxillary tuberosity
fibrous growth to establish proper occlusion.
Treating the combination syndrome requires recognition of the
factorsinvolved.
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
oSchumitt -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 J Prosthet
dent2017

44. Due to biomechanical differences in the supporting tissues
foropposingarchesthepatientrequiringsingledenture
opposinganatural
challengingjobfor
orrestoreddentitionfacesa
thedentistthusthetreatment
planningandtheprosthesistobegivenshouldbe
evaluatedandcorrectedtoprovideastableprosthesis
havingstablefunctionalrelationshipsthuscontrollingthe
resorptionanddiscomforttothepatient.

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. •HeartwellCm, RohnAo(2002) Tooth Selection. In:
Textbook Of Complete Dentures, 5th Ed. BcDecker, Pp
305–319
•ZarbGa, BolenderCl, Hickey Jc, CarlssonGe(1998)
Selecting Artificial Teeth For The Edentulous Patient.
•Textbook On BouchersProsthodonticTreatment For The
Elderly, 10th Edn. Bi Publications PvtLtd, New Delhi, Pp
330–351
•Sharry–Complete dentureprosthodontics
•Sheldon Winkler –Essentials of complete denture
prosthodontics.

47. Single Maxillary Complete Denture Carl F. Driscoll, Dmd*,
RadiM. Masri, Bds, Ms Dent ClinN Am 48 (2004)567–583
Kenneth D. Rudd, Robert M. Marrow –Occlusion and single
denture,JPD1973; Vol. 30(1):4-11.
Han KuangTan –Preparation guide for modifying the
mandibular teeth before making a maxillary single complete
denture, JPD 1997; 77:321-322.
L.KirkGardneretal–Usingatoothreductionguidefor
modifying natural teeth, JPD 1990; 63: 637-639.
Ricardo morandi;Implant-supported maxillary denture retained
by a telescopic abutment system: A clinical report:JPD2016
Luciolurosso;single arch digital removable complete denture
J Prosthetdent2017