SINGLE COMPLETE DENTURE .pptx

A single complete denture refers to a full arch prosthesis designed to replace all missing teeth in either the maxillary or mandibular jaw, while the opposing arch may have natural teeth or another prosthetic appliance. This type of denture plays a crucial role in restoring aesthetics, speech, and function in patients with edentulism in one arch. However, achieving a balanced and harmonious occlusion can be challenging due to differences in force distribution and wear between the denture and natural teeth. Careful attention to factors such as occlusal scheme, denture base stability, and patient adaptation is essential for the success of single complete dentures.

1. SINGLE COMPLETE DENTURE : A REVIEW DR. SATVIKA PRASAD MDS DEPT. OF PROSTHODONTICS MMCDSR

2. Introduction Definition Indication Classification Maxillary single denture Mandibular single denture Combination syndrome Review Conclusion CONTENTS

3. The single complete denture opposing all or some of the natural dentition is not an uncommon occurrence Incidence of tooth loss: maxillary > mandibular The primary consideration for a single complete denture is preservation. By opposing the natural teeth, the magnitude of force transmitted to the denture is high, which could lead to more difficulties, e.g - loss of ridge INTRODUCTION

4. A single complete denture is a complete denture that occludes against some or all natural teeth, a fixed restoration, or a previously constructed removable partial denture or a complete denture DEFINITION

5. INDICATION Single complete denture may be desirable when it is to oppose -

6. DISADVANTAGES Heavy occlusal forces, due to opposing natural teeth. {3 times than that of conventional CD; i.e 22lb} The high occlusal forces from the opposing natural teeth, which results in advanced bone loss of ridges. Supra- eruption of the opposing natural teeth produces an inharmonious occlusal plane. Mesial drifting of the opposing natural teeth produce inharmonious occlusal plane. Midline fracture of the denture due to heavy forces. JR extremes which make it difficult to arrange artificial teeth for the denture along the line of support. Excessively displaceable denture- bearing tissue (flabby ridges)

7. Carl F. Driscoll proposed a classification system that simplify the identification & treatment of patients Class I Class II Class III Class IV Class V

8. MAXILLARY SINGLE COMPLETE DENTURE

9. Diagnosis & treatment planning Edentulous arch – evaluated similar to any complete edentulous situation Dentulous arch – teeth are evaluated for following Number of teeth present Position and condition of teeth to assess, endodontic, restorative and periodontal condition

10. METHODS OF MOUTH PREPARATION Swenson’s technique Yurkstas technique Bruce technique Boucher’s technique Han Kuang Tan’s technique

11. SWENSON’S TECHNIQUE Upper and lower casts are mounted on the articulator. The upper denture is constructed. If the lower natural teeth interfere with the placement of the denture teeth, they are adjusted on the cast and the area is marked with a pencil. The natural teeth are then modified using the marked diagnostic cast as a guide. This technique is simple but time consuming.

12. YURKASTA’S TECHNIQUE Use of a commercially available U shaped metal occlusal template that is slightly convex on the lower surface, is placed on the occlusal surfaces of the remaining natural teeth and cusps to be adjusted are identified Stone cast is modification to a more acceptable occlusal relationship and the modifications are marked with a pencil and necessary alterations are done on natural teeth This template is often an aid in detecting minor deviations in the occlusal scheme

13. BRUCE’S TECHNIQUE Maxillary and mandibular casts are mounted at an acceptable VD with a CR record. Necessary modifications are made on the stone cast. Acrylic resin template fabricated on the altered stone cast The natural teeth are modified accordingly till the template seats properly

14. BOUCHER’S TECHNIQUE Artificial teeth are arranged on the maxillary edentulous cast in CO establishing occlusal plane, after maxillary and mandibular casts are mounted at an acceptable VD with a CR record The porcelain teeth are moved over the mandibular teeth in stone and occlusal interferences are ground by the porcelain teeth The ground areas are marked on the cast, and the natural teeth altered using this as a guide

15. HAN KUANG TAN TECHNIQUE Make a vacuum formed clear template over the cast which is 2mm thick Mount the mandibular cast and arrange the maxillary teeth Grind both the denture teeth and natural stone teeth on the mandibular cast to achieve best articulation possible. Voids are seen on the prepared areas of the template The template is cut over the prepared areas which will create openings in the prepared areas, when it is seated in the patient’s mouth The natural teeth are grind using it as a template

16. IMPRESSIONS AND JAW RELATIONS For edentulous arch, the condition of the residual ridge and philosophies of complete denture impression make dictate the method to be used. For dentulous arch, irreversible hydrocolloid material is used, following occlusal plane correction if needed. Jaw relations are recorded using the techniques, which is for complete

17. TEETH SELECTION Various materials of tooth forms are available to oppose natural teeth :- PORCELAIN ACRYLIC RESIN GOLD OCCLUSALS ACRYLIC RESIN WITH AMALGAM STOPS INTERPENETRATING RESIN (IPN)

18. PORCELAIN

19. ACRYLIC RESIN

20. GOLD OCCLUSALS Denture with acrylic resin teeth are worn out by patients for few weeks. Occlusal index of the denture is made. Occlusal surface of posterior teeth reduced by 1 mm. Wax pattern is prepared and verified with the help of occlusal index and casting is done.

21. ACRYLIC RESIN WITH AMALGAM STOPS Recommended by WINKLER After the acrylic teeth have been balanced, occlusal preparations are made in the acrylic teeth, extending to include as much of the articulating paper tracing as possible. Amalgam is condensed into the preparations and eccentric movements are made. Thus , centric holding area and some of the excrusions are recorded in amalgam by the articulator

22. INTERPENETRATING RESIN (IPN) To minimize disadvantages of acrylic resin and porcelain teeth and enhance certain qualities in each, evolution of IPN occurred. It consists of an unfilled highly cross – linked , interpenetrating polymer network Has a good wear resistance

23. Balanced setting The following methods are used to achieve eccentric balance ARTICULATOR EQUILIBRATION METHOD Most commonly used as it is similar to obtaining balance with conventional complete dentures. Used when denture bases are not stable and neuro -muscular control of the patient is poor. After mounting the casts, teeth are arranged in centric occlusion. It has to be decided if the lower buccal or lingual cusp is the centric holding cusp depending on the relationship of the upper arch During try-in, eccentric records are obtained to adjust the condylar settings on the articulator and teeth arranged in eccentric balance. The cusps are modified depending on the centric holding cusp

24. FUNCTIONAL CHEW IN TECHNIQUE Most accurate method of recording occlusal patterns Record bases should have good stability Patient should have good neuromuscular control. Following techniques are suggested- Stansbury’s technique Vig’s technique Sharry technique Rudd’s technique

25. Stansbury’s technique This was the first functional chew-in technique Compound maxillary occlusal rim is trimmed buccally and lingually so that occlusion is free in lateral excursions. Carding wax is added buccally and lingually and the patient is instructed to perform eccentric chewing movements. Carding wax gets functionally moulded , whereas the compound rim in the central fossa maintains the vertical dimension.

26. Vig’s technique It is similar to Stansbury's technique, except that a fin of acrylic resin is maintained at the vertical dimension instead of the compound rim Uses softened wax rim in increased vertical dimension. Eccentric chewing movements are made such that wax is abraded generating the final paths of the lower cusps. It is continued until the correct vertical dimensions are achieved Sharry technique Carding wax

27. Rudd’s technique This technique is similar to Stansbury's technique Uses a combination of baseplate wax and red counter wax instead of carding wax to make eccentric registration. But suggests using two maxillary bases, one for to recording the generated path and the other for setting the teeth. It decreases the number of appointments.

28. MANDIBULAR SINGLE DENTURE

29. Causes Irradiation therapy Trauma Greater challenge than maxillary single denture due to the following Difficult to stabilize lower denture Mandible is the movable member Proximity to tongue More resorption than maxilla Limited availability of good quality mucosa

30. Osseointegrated implants supported prosthesis is best in this situation. If patient cannot afford, conventional single denture is made, where the procedure is similar to that described for maxilla. Patient should be educated about the potential problems. Some clinicians recommend use of resilient liners in this situation to prevent soreness. Complications of single complete denture: Combination syndrome Wear of natural teeth Fracture of denture

31. COMBINATION SYNDROME (ELLSWORTH KELLY) The characteristic features of complete edentulous maxilla with opposed partial edentulous mandible, leading to loss of bone in the anterior maxillary region, overgrowth of the tuberosity area, papillary hyperplasia of the hard palatal mucosa, supraeruption of the lower anterior teeth, and loss of bone in the mandibular posterior region. This is also known as anterior hyperfunction syndrome. -GPT 9

32. SEQUENCE OF COMBINATION SYNDROME

33. TREATMENT PLANNING Systemic and dental considerations

34. PREVENTION RATIONALE Prevention of rapid resorption of bone under the removable prosthesis Prevention of excessive load in the anterior region Providing stable occlusion Allowing anterior teeth only for phonetics and aesthetics Education of the patient 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

35. Management Kelly advocated surgical excision of the maxillary tuberosity fibrous growth to establish proper occlusion Frequent recalls visits 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 Schumitt advocated construction of lower removable partial denture first and then to construct the upper complete denture

36. CASE REPORTS

37. Management of Syndrome Case with Metal Reinforced Maxillary Complete Denture and Mandibular Teeth supported Overdenture Buzayan MM, Sivakumar I, Choudhary S, Tawfiq O, Mahdey HM, Mahmood WA. iMedPub Journals.

38. A 73 years old woman reported to the Department of prosthodontics, requested for new upper and lower prostheses. She had a history of very loose upper and lower dentures Intraoral examination showed that she was completely edentulous on the upper arch, with moderate bone resorption͘ The maxillary tuberosities were both enlarged, and she was partially dentate on the lower arch with spacing and over erupted remaining anterior teeth

39. The treatment plan was decided to fabricate a metal reinforced maxillary complete denture and metal reinforced mandibular overdenture utilizing 32, 31, 41, and 42 as long coping (thimble) abutments Primary impressions of the maxillary and mandibular arches were taken with alginate impression material. The lower anterior teeth were prepared on the cast to simulate the assumed size. After confirming that there would be enough space for the planned type of the overdenture abutments, teeth preparations of 42, 41, 31 and 32 was carried out to receive metal coping, providing more reduction on the labial surface of the teeth. secondary impression was made using silicon medium body

40. Construction of an interim overdenture using the existing lower prosthesis: The current lower removable partial denture was picked up with an alginate impression (Figure 5), and poured in stone, to modify it into interim overdenture by adding artificial acrylic teeth to it. And it was issued to the patient on the same day of the teeth preparation

41. Cementation of the long metal copings: The metal coping was tried on the teeth and cemented permanently using Poly F cement. Subsequently, the intaglio surface of the interim overdenture was adjusted to remove any interference with the cemented copings (Figure 6). Using a spaced custom tray, new secondary impressions were made for the lower and upper arches using addition silicone medium body

42. Issuing the final prosthesis The conventional way of the metal reinforced removable prostheses construction and fabrication was followed. At insertion stage, the intaglio surface of the mandibular overdenture around the abutments was relined using side-chair hard relining material to increase the intimate contact between the prostheses and the abutments (Figures 7 and 8).

43. Discussion Using this approach in the management of the combination syndrome, will increase the stability, retention and will provide better support for the prostheses, this, in turn, will interfere with the combination syndrome mechanism and prevent further destructive changes from occurring For the maxillary arch, these prosthetic managements can be followed by either; Implant-supported fixed denture prosthesis, Implant supported over dentures, or Metal reinforced maxillary complete denture

44. The Single Complete Denture – A Case Report Radke UM, Gundawar SM, Banarjee RS, Paldiwal AS. The Single Complete Denture–A Case Report. International Journal of Clinical Dental Science. 2012 Jan 7;3(1).

45. A 70 year old female patient reported to the Department of Prosthetic Dentistry of V.S.P.M.’s Dental College And Research Centre, Nagpur with the chief complaint of repeated fracture of maxillary denture and for replacing the missing lower anterior teeth

46. Irreversible hydrocolloid Impression compound To check inter-arch distance

47. Master cast was duplicated. On the working cast of maxillary edentulous arch, the pattern of the metal frame work was adapted. The pattern of the metal base was kept short of posterior palatal seal area for ease to relieve the area if required

48. The lower natural teeth impression was made in an irreversible hydrocolloid impression material. On this impression the vacuum-formed clear template ( Biostar ) with 0.02 inch thick was adapted. Template was removed from the cast. The maxillary and mandibular casts were mounted in centric relation Maxillary teeth were arranged according to the contour of the maxillary occlusion rim and aligned the occlusal surface, in a compensating curve to facilitate the development of occlusal balance In the course of arranging teeth, the denture teeth were grinded judiciously to achieve the best possible articulation with the natural stone teeth on mandibular cast.

49. tooth preparation was done for 33 and 44. (Fig.10) The impressions of prepared tooth was made in elastomeric impression material putty and light body impression material and poured in die stone The provisionals were fabricated and cemented with temporary zinc oxide non-eugenol cement For the fabrication of metal occlusal the posterior teeth were removed from the teeth arrangement and putty index of the teeth was made

50. The occlusal third of the putty index was filled with inlay wax. The patterns were removed and custom made hooks were incorporated onto the waxed occlusals for retention of metal with the heat cure resin These patterns were invested, casted, finished and polished The metal occlusals were again placed in the putty index and modeling wax was poured into it till the cervical portion. The wax was allowed to set and solidify following to which the metal occlusals with the attached wax patterns were retrieved from the putty index and were flasked for incorporating tooth colored material. The regular procedure of dewaxing, followed by packing of heat cure tooth colored material and curing was done The custom made teeth with metal occlusals were then again placed in the jaw relation

51. Try in was carried out and denture was processed in usual manner

52. DISCUSSION Advantages: Very rigid. High thermal conductivity. Very stable form. High abrasion resistance. Less porous than acrylic and therefore easier to clean. Disadvantages 1. More difficult to adjust tissue surface 2. More difficult to reline the metal tissue surface. 3. Metal not esthetic. 4. Possibility of allergy 5. Weight Many patients become edentulous in one arch while retaining some or all of their natural teeth, in the opposing arch. Several difficulties are encountered in providing a successful, single complete denture treatment. Metal bases for complete dentures have been used successfully and provide many advantages over the more commonly used acrylic resin

53. INDICATIONS: 1. A tooth supported edentulous space where further bone resorption is not anticipated. 2. When a facing, tube tooth, metal pontic , or metal reinforced denture tooth is to be used. 3. A tooth-tissue supported edentulous space when the “ floating denture base ” concept is being used. CONTRAINDICATIONS: Tooth-tissue supported edentulous space. Tooth supported edentulous space where bone resorption is expected.

54. Fabrication of maxillary single complete denture in a patient with deranged mandibular occlusal plane:A case report Foong KW, Patil PG. Fabrication of maxillary single complete denture in a patient with deranged mandibular occlusal plane: A case report. The Saudi dental journal. 2019 Jan 1;31(1):148-54. Pravinkumar G. Patil

55. A 73-year-old female patient presented in March 2017 with a concern of missing upper teeth and reduced height of lower teeth

56. Technique to fabricate the OPT ( Occlusal Plane Template) A volleyball with a circumference of 65–67 cm and diameter of approximately 20.7 cm (8.1 in.) was procured. These dimensions were closely matching to the Monson’s sphere which has a diameter of 8” A single thickness modelling wax sheet was made into a circle to prepare a wax-box of approximately 10 cm in diameter and type III gypsum dental stone was poured into it The concave stone-form was then trimmed to appropriate size to ensure that it fits easily into the vacuum former machine A 1.5 mm thick, hard, thermoplastic sheet was used to adapt onto the stone-form in the machine to fabricate the OPT After cooling, the occlusal template was removed from the vacuum former and trimmed into a horseshoe shape of suitable size to fit the average dental arch

57. Use of OPT To evaluate and correct the occlusal plane with composite restorations, the OPT was placed on the primary cast and interfering cusps and amount of reduction required were identified Since the amount of reduction needed was minimal and within the enamel, selective grinding procedure was carried out. Before the mock-grinding procedure, the 4 points were identified namely disto-buccal cusp-tips of 36 and 46 and the cusp-tips of 33 and 43 . A thin layer of a quick setting adhesive glue was applied on these 4 cusps to protect them from accidental wearing off during grinding procedure as these 4 points were the part of the Monson’s sphere. The step by step mock grinding was performed on the primary cast with the help of the OPT

58. Refinement of occlusion Since the mandibular anterior teeth were severely attrited , they needed to be built up with composite resin to maintain the normal occlusal plane Putty impression of the wax-up was taken and cusps which require selective grinding were marked on the cast Putty guide was placed lingually Teeth to be restored with the composite were beveled to allow more surface area for bonding and for better aesthetics

59. The OPT was placed intra-orally and any interfering cusps or incisal edges were visualized and trimmed accordingly All restored teeth were occlusally refined using fine grit diamond point inclined lingually until the OPT touches to almost all cusp tips and incisal edges

60. Fabrication of maxillary denture Maxillary primary impression, final impression, maxillamandibular relationship records (Fig. 6), teeth arrangement and try in was carried out in a conventional manner. Denture was then processed, finished and polished. Occlusal refinement of denture was again carried out on the articulator before the denture issue appointment A harmonious balanced occlusion was achieved (Fig. 7). The maxillary complete denture was then issued and patient is recalled at suitable time for review. (Fig. 8A,8B)

61. Discussion The use of OPT aids the clinician in the development of a harmonious occlusal plane from a deranged one. The OPT can be used during pre-treatment and planning stages on a stone-cast as well as used during treatment directly intra-orally

62. SINGLE COMPLETE DENTURE IN MANDIBULAR ARCH OPPOSING NATURAL DENTITION – A CASE REPORT Kaira LS, Singh R. Single complete denture in mandibular arch opposing Natural dentition–a case report. Journal of Health and Allied Sciences NU. 2013 Mar;3(01):72-5.

63. A 43 year old male reported to the Department of Prosthetic Dentistry with a chief complaint of completely edentulous mandibular arch

64. Impression of the upper natural teeth was made with a irreversible hydrocolloid impression material. Preliminary impressions of the edentulous mandible was made with a viscous mixture of two varieties of softened impression compound (3 parts impression compound + 7 parts greenstick compound) [McCord's Technique] Border moulding was done and secondary impression was made with medium body The jaw relations were recorded. Face Bow transfer and jaw relations were then verified and secured in a semi adjustable articulator for teeth arrangement A trial of waxed up mandibular denture was made followed by acrylization of the complete denture with heat polymerizing acrylic resin

65. Discussion Mandibular denture bases may encounter tissue changes of the residual ridge followed by discomfort, occlusal problems and fracture of denture base The midline fracture in a denture is often a result of flexural fatigue. Though Poly Methyl Metha Acrylate denture bases have good mechanical, biological and esthetic properties, the impact and fatigue strength of PMMA are not entirely satisfactory ,thus may fail when there is excessive parafunctional and / or functional forces . Cobalt chromium bases in mandibular denture reduces functional deformation and thrust to the supporting tissues occurring in the anterior part of mandible . Besides rigidity and fracture resistance these metal bases have several other advantages like excellent strength to volume ratio, good adaptation to the supporting tissues, enhanced plaque control, high thermal conductivity, very little dimensional changes in time through fluid absorption

66. Problems of single denture: Greater magnitude of forces, lead to change in the underlying bone, the denture will compromised. Occlusal form of the remaining natural teeth, this occlusal form dictates occlusal form of the denture teeth which might be un suitable for denture. Occlusal scheme causing more horizontal forces. These factors causes occurrence of: Single denture syndrome. Damage of mucosa. Ridge resorption.

67. Conclusion The single complete denture opposing natural or restored arches is a greater challenge than conventional complete denture for the clinician. This is mainly due to the difference in support mechanisms of the natural and artificial teeth. The problems must be recognized and appropriate treatment should be provided to ensure a stable and comfortable prosthesis, which will preserve the supporting tissues. The patient should also be educated regarding the uniqueness of this treatment modality.

68. References Hobrink J, Zarb GA, Bolender CL, Eckert S, Jacob R, Fenton A, Mericske -Stern R. Prosthodontic treatment for edentulous patients: complete dentures and implant-supported prostheses. Elsevier Health Sciences; 2003 Sep 17. Buzayan MM, Sivakumar I, Choudhary S, Tawfiq O, Mahdey HM, Mahmood WA. iMedPub Journals Foong KW, Patil PG. Fabrication of maxillary single complete denture in a patient with deranged mandibular occlusal plane: A case report. The Saudi dental journal. 2019 Jan 1;31(1):148-54. Pravinkumar G. Patil Radke UM, Gundawar SM, Banarjee RS, Paldiwal AS. The Single Complete Denture–A Case Report. International Journal of Clinical Dental Science. 2012 Jan 7;3(1). Kaira LS, Singh R. Single complete denture in mandibular arch opposing Natural dentition–a case report. Journal of Health and Allied Sciences NU. 2013 Mar;3(01):72-5. Driscoll CF, Masri RM. Single maxillary complete denture. Dental Clinics. 2004 Jul 1;48(3):567-83.