OVERDENTURE

THE SINGLE COMPLETE DENTURE

DEFINITION

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.

The construction of a single denture may be presented in a variety of dental

combinations. It could be constructed against:

- Natural teeth.
- Removable partial denture.
- A previously constructed complete denture.

The single complete maxillary denture opposing all or some of the mandibular
natural teeth is a very common clinical situation

PROBLEMS OF SINGLE DENTURE:

1. The firmness and rigidity in which the natural teeth are retained in the bone and
the magnitude of the force. (Excessive load from the natural teeth).

2. The occlusal form of the remaining natural teeth and the uneven occlusal plan
(“mutilated” dentition).

3. Single denture syndrome. This situation is the result of the displacement of the
maxillary denture due to unfavorable occlusal relationship as a result of
tipped, malposed or supererupted natural teeth. It is presented as mucosal
irritation and ridge resorption of the edentulous ridge.

4. Esthetic and phonetic problems due to the fixed positions of the mandibular teeth

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5. Artificial teeth selection. Acrylic teeth are abraded by natural teeth and porcelain
teeth abrade natural teeth.

6. Mandibular single denture.

HOW TO OVERCOME THESE PROBLEMS

The primary consideration for a continued success of a single complete

denture is the preservation of that which remains.

Proper diagnosis and full use of every factor, which favors success for this denture,

Applying the principles of complete denture construction:

• Lip support
• Minimal vertical overlap (Overbite)
• Balancing occlusion and free articulation.
• Avoid broad inclined planes.
Maximum base extension within functional anatomical limits (distributed forces
over the largest possible area of supporting structures and the force per unit area kept
at minimum.)

Reduction of the forces to which the denture is subjected

DIAGNOSIS AND TREATMENT PLANNING:

1- Complete case history is taken and oral examination is done.

2- Study upper and lower casts are obtained.
3- The upper cast is mounted on the articulator using a facebow.
4- The lower cast is mounted on the articulator using a provisional centric
interocclusal record at an acceptable vertical dimension.
5- Eccentric records are made and the condylar elements of the articulator are
adjusted.

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COMMON OCCLUSAL DISHARMONIES:

The remaining molars are often severely inclined mesially and then distal halves
super-erupted. If this situation is left unaltered there would be no occlusion in
protrusive and lateral excursions except for contact on the distal half of the lower
molar. This results in the maxillary denture being easily dislodged during functional
movements.

a) If the molars are not severely tilted they may be reshaped by selective
grinding.
b) When tooth reduction is found necessary, the ideal treatment is to restore the
tilted molars with cast gold crowns, onlays, or a fixed bridge if a large
edentulous space exists mesial to the molars.
c) 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 molars by using an onlay mesial rest (Fig 4-1).
d) If the molars are severely tilted forward and supererupted, and modification
is not possible, extraction is necessary.

Correction of inclined teeth

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METHODS USED FOR DETECTING OCCLUSAL MODIFICATIONS:

Several techniques could be used to determine occlusal modifications that are

necessary prior to denture construction:

I- 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 them modified using the marked diagnostic cast as a
guide. This technique is simple but time consuming.

The occlusal plane discrepancy is readily apparent when the denture teeth are
properly arranged. This discrepancy can only be corrected by restorative means.

II- Bruce Technique

Use of a clear acrylic resin template fabricated over the modified stone cast. The
inner surface of the template is coated with pressure indicating paste and placed
over the patient's natural teeth. The Modifications Are Made on the Stone Cast.
A Clear Acrylic Resin Template is Fabricated over the modified stone cast.

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III- Yurkstas’ Technique

Use of a commercially available U-shaped metal occlusal template that is slightly

convex on the lower surface. This template is often an aid in detecting minor
deviations in the occlusal scheme.

IV- Boucher’s Technique

The interferences are removed by movement of the maxillary porcelain teeth

over the mandibular stone teeth.

Prematurities are identified and removed by grinding the natural teeth. The
procedure is repeated for right and lateral excursions until a harmonious balanced
occlusion is established.

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METHODS USED FOR A HARMONIES BALANCED OCCLUSION:

In the construction of dentures to articulate with natural teeth, the

prosthodonticsts must provide a harmonious occlusal scheme free of interference in
any jaw relationship this will lead to a better retention and stability of the single
denture which will lead to least residual ridge damage.

Many techniques have been used to achieve a balanced occlusion of a

complete maxillary denture opposing natural teeth. They basically fall into two
categories:

1- Dynamic equilibration of occlusion by the use of a functionally generating

path.
2- Static equilibration of occlusion with an adjustable articulator.

Functional generating path

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MATERIALS FOR ARTIFICIAL POSTERIOR TEETH:

The materials available for occlusal posterior tooth forms are

1- Acrylic resin.
2- Porcelain.
3- Gold
4- Cast metal
5- Acrylic resin with amalgam stops.

Gold posterior teeth Cast metal posterior teeth

Acrylic teeth Porcelain Teeth

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Acrylic resin with amalgam stops

ESTHETICS OF MAXILLARY SINGLE DENTURE

The fixed positions of mandibular teeth limit the esthetic position of maxillary
anterior teeth. How to solve the esthetic problem?

1- To create enough horizontal overlap to allow freedom to balance in eccentric

movements.
2- Or to steeping the posterior cusp angles so that the posterior teeth will
disocclude the anterior teeth during eccentric movement.

MANDIBULAR SINGLE DENTURE:

The prognosis of a mandibular single denture against natural teeth is less
favorable than when the full upper denture is opposed by natural lower teeth . It
would be difficult to classify this case as clinically successful. This is due to:

1- Excessive resorption of lower ridge due to greater stresses per unit area
delivered to the mandibular ridge by the natural teeth.
2- Occlusal problems: The presence of natural teeth will present difficulties in
controlling the occlusal scheme.

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3- Minimal denture foundation area

4- Fracture.
5- Tooth wear.
6- Tissue abuse.

The alternative line of treatment plan for such patient could be either:

1- Extraction of remaining teeth and complete upper and lower denture are
constructed.
2- Ridge Augmentation
3- Preprosthetic surgery: e.g: Vestibuloplasty
4- Use of resilient denture liner in the mandibular denture.
5- Maximize denture base coverage.
6- Minimized occlusal forces.
7- Retention of key roots e.g: Overdenture
8- Use of implant supported fixed or removable overdenture prosthesis

Implant supported overdenture

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COMBINATION SYNDROME AND ASSOCIATED CHANGES

(Kelly’s Syndrome)
A Combination Syndrome by Kelly (1972): destructive problems, that may be
encountered as a result of long term use of a mandibular distal extension partial
denture against a complete maxillary denture.

This syndrome consists of:

1- Loss of bone from the maxillary anterior edentulous ridge.

2- Down growth of the maxillary tuberosities .
3- Papillary hyperplasia of the tissues of the hard palate.
4- Extrusion of the lower anterior teeth and,
5- Loss of bone beneath the removable partial denture bases.

Note: Advanced bone loss: premaxilla and posterior mandible

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Loss of anterior bone Down growth of maxillary tuberosity

Papillary hyperplasia of the hard palate Extrusion of lower anterior teeth

Loss of bone beneath the removable partial denture bases

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It usually has six associated changes:

1- Loss of vertical dimension of occlusion.

2- Occlusal plane discrepancy.
3- Anterior spatial resorption of the mandible.
4- Development of epulis fissuratum .
5- Poor adaptation of the prosthesis
6- Periodontal changes.

Loss of vertical dimension Occlusal plane discrepancy

Epulis fissuratum spatial resorption of the mandible

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The Combination Syndrome is a result of three main factors:

- The great magnitude of forces involved from lower anterior teeth.

- The unsuitability of the denture foundation to resist them
- The particularly unfavorable occlusal relationship.

The great magnitude of forces involved

Premaxilla anterior resorption

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