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Description : Check out this medical presentation on Dental Acrylic Resin, which is titled "Single complete denture", to know about single complete denture, problems associated with single complete denture, diagnosis and treatment planning, and various combinations of single complete denture.

Tags : Dental Acrylic Resin, Single complete denture, diagnosis, treatment

Published on : Jul 01, 2021 | Views : 3825 | Downloads : 9

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Single complete denture
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CONTENTS Introduction Definition Problems associated with single complete denture Diagnosis and treatment planning Various combinations of single complete denture
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Common occlusal disharmonies Methods used to achieve harmonious balanced occlusion Occlusal materials for single complete denture Changes caused by RPD opposing maxillary complete denture Conclusion References
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INTRODUCTION : The single complete denture opposing all or some of the natural dentition is not an uncommon occurrence. Causes for the loss of teeth from the dental arches like periodontal problems, dental caries and trauma. The incidence of tooth loss is more in maxillary arch compared to mandibular arch The single complete denture should be given for reasons like mastication and esthetics.
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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 primary consideration for continued denture success with a single conventional complete denture is the preservation of that which remains
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Indications Remaining Natural teeth are in good periodontal health. A partially edentulous arch in which the missing teeth have been or will be replaced by a removable partial denture. An existing single complete denture
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Diagnosis and treatment planning: The commonly sited long term goal in Prosthodontics is the preservation of that which remains. This demands an appreciation of occlusal mechanics.
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Problems: 1. Occlusal forces 2. Occlusal form of the natural teeth 3. Support for the denture base 4. Inter maxillary relations:
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1. Occlusal forces These forces have been recorded as high as 198 lbs on a single molar tooth. This is in contrast with the forces which a complete denture - 26 lbs
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2. Occlusal form of the natural teeth The occlusal form of the remaining natural teeth will dictate the occlusion of the denture The natural teeth may be supra erupted or tilted and there cusps may be high and sharp. Denture will constantly be thrust or dragged horizontally on the ridge.
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3. Support for the denture base: Denture base should have the maximum extension within the functional anatomic limits Lower complete denture opposing upper natural teeth should be normally avoided.
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4. Inter maxillary relations: When upper complete denture is being made to occlude with lower natural teeth, an error may be made in recording the vertical dimension The labio- lingual thickness of the wax rim, will usually not allow the lower incisor to close beyond the occlusal surface Increased vertical dimension may be recorded
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Occlusal problems and fracture of denture base account for structured difficulties and may result from one or all of the following. Occlusal stress on the maxillary denture and the underlying edentulous tissue from teeth and musculature accustomed to opposing natural dentition. The position of the mandibular teeth which may not be properly aligned for the achievement of bilateral balance for stability. Flexure of the denture base
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COMBINATIONS: Upper single complete denture opposing complete set of lower natural teeth. Lower single complete denture opposing complete set of upper natural teeth. Single complete denture opposing natural teeth with a removable partial denture. A single complete denture opposing natural teeth with a fixed partial denture. A single complete denture opposing an already existing complete denture
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Single complete denture (Maxillary) to oppose natural mandibular teeth: More frequently encountered than the single mandibular denture The occlusal forms of the natural teeth act as a guide in selecting the occlusal form for the maxillary posterior teeth However if the natural teeth are abraded monoplane form may be the choice
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Some times the position of mandibular teeth will not allow the maxillary anterior teeth to be positioned in an esthetically acceptable manner or for balanced occlusion.
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This problem may be solved as follows. Reposition of the natural teeth with orthodontic procedures Alter the clinical crowns of the teeth by grinding or with restoration. Accept balanced occlusion with the jaws in the terminal relation and not in the eccentric position
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The mandibular arch may present two planes of occlusion, An anterior plane and A posterior plane The posterior teeth have extruded and inter ridge space would be less.
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To prepare this mouth it requires extensive restorative procedures in mandibular arch and possibly surgery in the maxillary 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.
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Mandibular denture to oppose natural maxillary teeth: It usually happens as a result of either surgical or accidental trauma i.e. irradiation or accident or gunshot. Three factors in particular must be carefully evaluated. Preservation of the residual alveolar ridge Necessity for retaining maxillary teeth Mental trauma
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Preservation of the residual alveolar ridge The force of jaw closure with natural teeth is greater than that with complete denture and greater the force the more the pressure which a contributing factor to bone resorption
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Necessity for 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.
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Mental trauma A mental state exists when the patient loses the mandibular teeth, removal of the remaining maxillary teeth may be more than he or she can endure mentally.
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Complete maxillary denture to oppose a partially edentulous mandibular arch with fixed or removable 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.
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When there is a removable partial denture, it must be evaluated critically. The occlusal plane Tooth arrangement for occlusion Esthetics and material composition of the teeth Treatment plan is or should be formulated for both arches at the same time
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Single complete denture to oppose an existing complete 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.
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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.
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COMMON OCCLUSAL DISHARMONIES The most common occlusal adjustments involve the anterior teeth and the last molar Frequently natural lower incisors and cuspids are very long and there should be ground as much as is practicable If the molars are not severely lilted they may be reshaped by selective grinding Stephen’s recommends that the distal half of the occlusal surface should be ground flat and the denture teeth set to occlude with only that area, leaving mesial cusps out of contact.
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The ideal treatment is to restore the tilted molar with cast gold crowns, onlays or fixed bridge if a large edentulous space exists mesial to the molars. If a large space does exist mesial to the tilted molars another alternative treatment is to design a removable partial denture that would restore the mesial half of the molar.
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If the molar are severely tilted forward and supraerupted the modification is not possible, extraction is necessary. Another disharmony exists when insufficient mandibular teeth are left to occlude with a complete maxillary denture
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Methods used to achieve harmonious balanced occlusion: Many techniques have been described but all of them basically fall into two categories. Functional chew in techniques: Articulator equilibration technique:
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Functional chew in techniques: Stransbury described the first functional chew in technique in 1928 He suggested using a compound maxillary occlusal rim trimmed buccally and lingually so that the occlusion is free in lateral excursions. Carding wax is then added to the compound rim and the patient is instructed to perform eccentric chew movements.
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The carding wax as slowly molded to the functional movements while the compound in the central fossa act as a guide to preserve the vertical dimension. The generate occlusal rim is now removed from the mouth and stone is vibrated into the wax paths of the cusps and without separating them both are mounted on the articulator The denture teeth are set according to the lower cast of the patients teeth
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After the esthetics has been approved at the try-in, the lower cast is removed and lower chew in record is secured to the articulator All interfering spots are carefully ground until the incisal guide pin prevents further closure. Thus in centric and eccentric movements maximum bilateral balanced occlusion will have been established.
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VIG described as similar technique in which he recommended the use of a fin of resin placed into the central grooves of the lower posterior teeth, instead of using compound as mentioned by starsbury. The resin fin maintains the vertical dimension and also helps diagnostically locate interfering lower cusps In eccentric movements the lower cusp tips are ground until equal contacts occur between the teeth and the resin
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The fin is then built up using a soft wax and a functional path is generated. Sharry’s technique Lateral and protrusive chewing movements are made so that the wax is abraded generating the functional paths of the lower cusps. This is continued until the correct vertical dimension has been established.
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Rudd suggests a technique similar to starsbury’s A thickness of recording matrix made up of 3 sheets of medium and pink base plate wax and two sheets of red counter wax in added to the buccal and lingual surface of this compound rim.
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Articulator equilibration technique: If the denture bases lack stability or if the patient is physically unable to perform a chew in record the articulator equilibration method is preferred First the upper cast is mounted on the articulator using a face bow with an orbital pointer The lower cast is related to the upper by a centric inter occlusal record at an acceptable vertical dimension.
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If the denture teeth apex to be placed too far to buccal when articulated with the lower buccal cusp, they are rest to oppose the lingual cusps. Once the holding cusps have been selected the inclines of the remaining cusps are reduced and vice-versa This allows for a cusp to fossa relationship between the upper and lower teeth in centric .
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At the time of wax try in eccentric records are made and the condylar inclinations are set on the articulator The upper posterior teeth are arranged to be as close to being balanced as is possible at this time. After the denture has been processed it is again related to the mounted lower cast with a new centric intra-occlusal record.
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The condylar inclinations previously determined are reset on the articulator. Once the centric holding cusps are established by selective grinding, eccentric balance is achieved. This is simply accomplished by selectively grinding the interfering buccal and lingual cuspal inclines of the upper teeth. Once the centric contacts have been established it is advisable to use two colors of articulating paper. One colour to mark the centric contacts and other to mark the eccentric contacts.
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The eccentric contacts are selectively ground until a relatively continuous area of contact is noted on the buccal and lingual cuspal inclines of the upper teeth.
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Types of teeth: The most important aspects are to transmit the occlusal forces vertically. Non – anatomic teeth Anatomic teeth
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Non – anatomic teeth If 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. These teeth have flat occlusal surfaces with fissures and spillways carved into them which help to provide an effective masticating surface.
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Anatomic teeth: If the cuspal form of the lower teeth has been retained anatomic teeth can be used These should be arranged with a cusp to fossa relation. A 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
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Artificial tooth materials The materials available for occlusal posterior tooth forms are Porcelain Acrylic teeth Gold Acrylic resin with amalgam stop IPN
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Porcelain teeth wear slowly therefore the occlusal vertical dimension is maintained however they are predisposed to fracture and chipping when opposed by natural teeth and are more difficult to equilibrate. Also they cause rapid wear of opposing natural teeth. Porcelain teeth:
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Acrylic resin teeth Since acrylic resin teeth cause no wear of the opposing natural teeth they are the easiest to equilibrate They are the teeth of choice. The major disadvantage of resin teeth is there wear, which result in loss of vertical dimension
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Gold occlusal: 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 then 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.
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Acrylic resin with amalgam stops: This method is 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.
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This material consist of an unfilled, highly cross linked inter penetrating polymer network. A three year clinical study by ogle and his colleagues, has determined the wear of new material to be significantly less when compared to acrylic resin teeth. Inter penetrating polymer net work (IPN)
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Changes caused by mandibular removable partial denture apposing maxillary complete denture: Another problem is combination syndrome. The syndrome is characterized by Maxillary anterior ridge resorption Palatal papillary hyperplasia Enlargement of maxillary tuberosities Supra eruption of lower anterior teeth Resorption of mandibular posterior ridge
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CONCLUSION: The problems involved in providing comport, function, proper esthetics and retention is a vigorous challenge for practicing dentist. The damage to the edentulous ridge and inability to wear the denture may be avoided by good prosthetic treatment which includes adequate denture base, correct jaw relation record and proper occlusion.
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REFERENCES : Prosthodontic treatment for edentulous patients - Boucher Essentials of complete denture Prosthodontics – 2nd edn. Sheldon Winkler Syllabus of complete denture – Heartwell Complete denture Prosthodontics – Sharry Changes caused by a mandibular RPD opposing a maxillary C.D. – Ellsworth Kelly J. Prosthet. D. 27; 140-150: 1972. Single complete denture – Charles W. Ellinger J. Prosthetic. D. 26 ; 4-10 : 1971.
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CD’s opposing natural teeth - Robert W. Bruce JPD 26; 448 –55: 1971. Occlusion and single denture – Kenneth D. Rudd JPD 30; 4-10: 1973. The maxillary CD opposing natural teeth: the problems and some solutions – Alex Koper JPD 57; 704 –07: 1987. The maxillary CD opposing mandibular bilateral distal extension partial denture – Sounder RT JVD 41(2); 124-28: 1979. Diagnosing functional CD fractures – Schineder L. Robert 54; 804-14: 1985.