SINGLE COMPLETE

DENTURE

Kalyani Jankar
Final year
20
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.
Disadvantages :
• Extensive morphological changes in denture foundation.
• Jaw relationship extremes which make it difficult to arrange
artificial teeth for the denture along the line of support.
• Excessively displaceable denture-bearing tissue [flabby
ridges]
Indications :
• Natural teeth sufficient in numbers not to necessitate a fixed or
removable partial denture.
• A partially edentulous arch in which the missing teeth have
been or will be replaced by the fixed partial denture.
• A partial edentulous arch in which the missing teeth have been
or will be replaced by a removable partial denture.
• An existing complete denture.
MAXILLARY SINGLE COMPLETE
DENTURE
1. Diagnosis and treatment plan :
Edentulous arch – This is evaluated similar to any complete
edentulous situation.
Dentulous arch –
 Number of teeth present.
 Position and condition of teeth to assess, endodontic,
restorative and periodontal condition
2. Mouth Preparation :
A part from treating the natural teeth, the occlusal plane is
assessed and corrected by selective grinding to achieve a
harmonious occlusion with the artificial teeth.
Occlusal plane correction :
Indications –
• Malposed teeth
• Severely tipped teeth
• Supra erupted teeth
• Irregular occlusal plane
• Less space for teeth
Methods :

 SWENSONS TECHNIQUE –

• Maxillary and mandibular casts are mounted at an acceptable

VD with a CR record.
• The teeth are arranged and the occlusal discrepancies are
corrected and marked with pencil on the diagnostic cast.
• With this as a guide, the natural teeth are modified
 YURKSTAS TECHNIQUE –

• A U-shaped metallic occlusal template, which 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 .
• The stone cast is modified to a more acceptable occlusal
relationship and the modifications are marked with a pencil.
• Necessary alterations are done on the natural teeth using this
as a guide.
 BRUCE 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 stone. [altered]
• The natural teeth are modified accordingly till the template
seats properly.
 BOUCHERS TECHNIQUE –

• Artificial porcelain teeth are arranged on the maxillary

edentulous cast in centric occlusion 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 grounded by the porcelain
teeth.
• The ground areas are marked on the cast, and the natural teeth
altered using this as a guide.
3. Impressions and Jaw relations :

• For the edentulous arch, thee condition of the residual ridge

and philosophies of complete denture impression making
dictate the method used .
• For the dentulous arch, impressions are made with irreversible
hydrocolloid, following occlusal plane correction if needed.
• Jaw relations are recorded using the techniques described for
complete dentures – vertical dimensions of occlusion is
recorded using niswonger method and a static registration is
used to record the centric relation.
4. Teeth selection :
Materials available for occlusal posterior tooth forms to oppose
natural teeth are as follows,
 Porcelain –
- Advantages :
Maintains vertical dimensions.
Wears very slowly.
- Disadvantages :
Fracture, wearing and chipping of natural teeth.
Difficult to equilibrate.
Cannot be used when inter-occlusal distance is less.
 Acrylic resin –
- Advantages :
Does don’t wear opposing natural teeth.
Easy to equilibrate.
-Disadvantages :
Loss of vertical dimensions.
Poor wear resistance.
 Gold occlusals –
-Advantages :
Best to oppose natural teeth.
- Disadvantages :
More time consuming and expensive.
 Acrylic resin with amalgam stops –
- Recommended by Winkler.
- After the acrylic teeth have been balanced, occlusal preparation
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 the
centric holding area and some of the excursions are recorded in
amalgam by the articulator .
- Has better wear resistance than acrylic.
 Interpenetrating [IPN] resin –
- Consists of an unfilled highly cross-linked, interpenetrating
polymer network.
- Has good wear resistance.
5. Balanced setting :
The following methods are used to achieve eccentric balance,
 Functional chew – in technique –
Most accurate method of recording occlusal patterns.
Record bases should have good stability.
Patient should have good neuromuscular control.
The following techniques are suggested:
a. Stansbury’s technique [1928]
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 dimensions.
-Stone is vibrated onto the wax record occlusally, and the stone
record is secured to the lower member of the articulator.
- The denture teeth are first arranged to the lower cast of the patient.
- After the aesthetics is approved at the try in, the stone record of lower is
secured and balance in eccentric postions is obtained.
b. Vig’s technique[1964]
- It is similar to stansbury’s technique, except that a fin of acrylic resin is
maintained at the vertical dimensions instead of the compound rim.

c. Sharry technique
-Uses softened wax rim in increased vertical dimensions
- Eccentric chewing movements are made such that wax is abraded generating
the final paths of the lower cusps.
- It is continued until the correct VD is achieved.
d. Rudd’s technique
- This technique is similar to stansbury’s technique.
- Uses combination of baseplate wax and red counter wax
instead of carding wax to make eccentric registration.
- But suggests using two maxillary bases, one for recording
generated path and the other for setting the teeth. It decreases
the number of appointments.
 Articulator equilibration method-
- Most common used as it is similar to obtaining balance with
the conventional CD.
- Used when denture bases are not stable and neuromuscular
control of the patient is poor.
- After the 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 upon the relationship of the
upper arch.
- During the try in, eccentric records are obtained to adjust the
condylar settings on the articulator and the teeth are arranged
in eccentric balance. The cusps are modified depending on the
centric holding cusp.
6. Try-in, Insertion, Recall and Maintenance :
This procedures are similar to conventional CD.
 MANDIBULAR SINGLE
COMPLETE DENTURE
• CAUSES :
- Irradiation therapy.
- Trauma.
• Greater challenge than maxillary single denture due to the following:
- Difficult to stabilize lower denture.
- Mandible is movable member.
- Proximity of tongue.
- More resorption than maxilla.
- Limited availability of good quality mucosa.
• Osseo-integrated implants supported prosthesis is best in this
situation.
• If patient cannot afford, conventional single denture is made,
where the procedure is same as maxilla. Patient should be
educated about potential problems.
• Some clinicians recommend use of resilient liners in this
situation to prevent soreness.
 COMPLICATIONS OF SINGLE
COMPLETE DENTURE
1. Combination syndrome
2. Wear of natural teeth
3. Fracture of denture
 COMBINATION SYNDROME
• Definition: [KELLY in 1972]
The characteristic features that occur when an edentulous maxilla
is opposed by natural mandibular anterior teeth, including loss of
bone from the anterior portion of the maxillary ridge, overgrowth
of the tuber-osities, papillary hyperplasia of the hard palate’s
mucosa, extrusion of the lower anterior teeth and loss of alveolar
bone and ridge height beneath the mandibular removable dental
prosthesis bases – also called anterior hyperplasia function
syndrome [GPT8]
 Features :
• Loss of bone in anterior maxilla with subsequent replacement
by flabby fibrous tissue.
• Down growth of the tuberosities.
• Papillary hyperplasia of hard palate.
• Supraeruption of lower anterior teeth.
• Bone loss under the lower distal extension removable
prosthesis.
 Saunders et al. [1978] added six more features-
• Loss of vertical dimensions
• Occlusal plane discrepency.
• Anterior spatial repositioning of the mandible .
• Loss of stability and refabrication of the existing dentures.
• Epulis fissuratum
• Periodontal problems of the remaining teeth.
 Sequence :
 TREATMENT PLANNING
-SYSTEMIC FACTORS:
Diabetes and osteoporosis increase the rate of resorption of the
bone.
-DENTAL FACTORS :
• In case of class III jaw relationships there will be increased
pressure in the anterior maxilla.
• When lower anteriors are retained for long time, the patient is
accustomed to biting in the anterior region .
• Presence of parafunctional habits increases bone resorption.
• Type of occlusal scheme also has direct effect on the
development of the syndrome.
- RATIONALE:
• Prevention of rapid resorption of the bone under the lower
removable prosthesis by increasing stability through
extensions up to retromolar pad.
• Prevention of excessive load in the anterior region by
providing a stable occlusal scheme.
-posterior occlusion free of interfering contacts during centric
and eccentric movements.
- Minimum contact in the anterior region even in protrusive
movements.
- Anterior teeth to be used only for phonetics and aesthetics.
- Education of the patient.
-PREVENTION :
• Retaining weaker posterior teeth by using combined
endodontic and periodontal technique.
• Fabricating a fixed prosthesis in the lower posterior region
using endosseous implants.
• Planning for tooth supported overdenture in the lower arch.
• Regular recall visits and checks with frequent relining to
compensate for the resorption especially in the lower distal
extension prosthesis.