Single Denture 11 [تم حفظه تلقائيا]

SINGLE
DENTURE
Majed alkhadher alameri
Researcher in prosthodontics department / faculty of dentistry kafr el sheikh university
Under supervision of DR. EMAN SABRY
 DEFINITION
 SINGLE DENTURE OPPOSING NATURAL TEETH
 SINGLE COMPLETE DENTURE OPPOSING
LOWER NATURAL DENTITION
 SINGLE COMPLETE DENTURE OPPOSING
UPPER NATURAL DENTITION 0UTLINES
 SINGLE COMPLETE DENTURE OPPOSING FIXED PARTIAL
DENTURES
 SINGLE COMPLETE DENTURE OPPOSING REMOVABLE
PARTIAL DENTURE
 COMBINATION SYNDROME
 SINGLE COMPLETE DENTURE OPPOSING AN EXISTING

COMPLETE DENTURE
 TECHNIQUE FOR CONSTRUCTING COMPLETE DENTURES
OPPOSING NATURAL TEETH
DEFINITION:
 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 .GPT9
Natural teeth.
Single
A removable Complete
Fixed
partial Maxillary restorations.
denture. Dentures
VS
An existing
complete
denture.
 SINGLE DENTURE
OPPOSING NATURAL
TEETH:
 The problems involved in providing, comfort, function, proper esthetics, and retention for the
Single denture patient with natural opposing dentition can be challenging.
 There are reasons for this difficulty:
1. Related to the firmness and rigidity with which the natural teeth are retained in the bone
even in the presence of severe periodontal disease , they can resist or deliver without
discomfort or displacement.
Clinical Complete Denture Prosthodontic - Moustafa Abd Elmeguid Hassaballa - (2010)

2. the denture will receive forces that exceed physiological tolerance limits
with a high lateral component from the natural dentition, This will cause
traumatic occlusion
Due to the excessive forces from natural dentition or fixed dentures leads to:
 Loss of denture stability.
 Undesirable movement of the denture.
 Fracture due to the bending forces.
 Excessive forces coming from anterior natural dentition lead to alveolar
bone resorption of the opposing edentulous crests, called the “mobile
ridge,” which makes denture fabrication difficult
Coşkun Yıldız and Yasemin K. Özkan Complete Denture Prosthodontics-Treatment and Problem
Solving
3. There may be teeth that are tilted mesially or distally because of an
extraction space; teeth that are overerupted and teeth that are
rotated or located in vestibular or lingual areas, due to orthodontic
anomalies.
4. The occlusal plane inclinations of the opposing dentition are

mostly inaccurate
Solving
5. Teeth may be malpositioned, and they can present
increased tubercle inclinations.
6. Natural teeth may be too wide buccolingually
Solving
TO OVERCOME THESE
PROBLEMS:
 The diagnosis and treatment plan is very important.
 Examination of patients:
A. Examination of the edentulous area.

B. Examination of the natural teeth on the antagonist dental arch.
C. Features of denture base.
D. Occlusion.
E. Types of artificial teeth.
Solving
A. EXAMINATION OF THE
EDENTULOUS RIDGE:
 1. Alveolar ridge:
 Because the alveolar ridge plays a great role in denture stability and retention, the
resorption amount of the alveolar ridge is very important for the prognosis of the SCD.
 Bone irregularities on the alveolar bone should be removed surgically, or soft lining
materials should be applied.
Solving
 2. Frenums:
 If these frenum are too long and wide, the area prepared for
the frenum on denture base will be too wide and will
eventually weaken the denture.
 In this case, especially if there is natural dentition on the
antagonist arch, the occlusal forces will be concentrated on this
particular area and will result in denture fractures.
 In such conditions, a frenectomy procedure is advised.
Solving
B. EXAMINATION OF THE NATURAL TEETH
ON THE ANTAGONIST DENTAL ARCH:
 1. Number and position of natural teeth:

 Play a significant role in the success of SCD opposing natural.
 When a SCD is fabricated opposing malpositioned teeth, the contact occurring during
functional movements will disturb stability.
 Teeth with positional anomalies should be moderated to obtain a bilateral balanced
occlusion, by trimming the overerupted teeth and restoring the teeth that cannot be treated
in any other way.
Solving
 2. Occlusal surface of natural teeth:
 While natural teeth having high tubercles indicate that the
patient has a low occlusal force and performs less eccentric
movements during function.
 Excessively abraded teeth show that the patient has high
occlusal force, performs wide lateral movements during function,
grinds abrasive nutrients, and performs parafunctional
movements.
Solving
 Prior to the production of the SCD, decreasing the tubercle height of
the teeth with high tubercles will positively affect the stabilization of
the denture.
 SCD applied to patients with excessively abraded teeth will have a
lower chance of success, because the buccolingual distance of the
abraded teeth will be increased as well
Solving
3. Crossbite relationship:
 Crossbite negatively affects the prognosis of a SCD.
 For a SCD that is going to be fabricated opposing a wide mandible with
natural dentition, the posterior teeth should be aligned peripherally from
the denture base but should never be on the denture border; otherwise,
harmful forces will emerge.
 To centralize the occlusal contacts in the event of crossbite, the central fossa
of maxillary teeth and lingual tubercles of mandibular teeth should be in
contact and the buccal tubercles modified to increase denture stability.
Solving
C. FEATURES OF DENTURE
BASE:
 As in conventional complete denture, should cover an area as wide as possible within the
limitations of physiological tolerance.
 If there is excessive resorption on the alveolar ridge, soft lining materials could be applied.
 Thus, both pressure on the alveolar ridge is decreased and denture base fractures are
prevented.
 Reinforced base materials could be also used to prevent denture fractures
Solving
D. OCCLUSION:
 In SCD, most important reason for denture fracture is the inaccurate
arrangement of the occlusion.
 The occlusion will create unstable pressures on denture and result in
denture base fractures.
 On account of this, during fabrication of the denture, occlusal
rearrangements and occlusal control should be done carefully.
 To obtain maximum denture stabilization in SCD, there should be
Lingualized occlusion when SCD opposing dentition.*
Solving
 For posterior artificial teeth selection with SCD, form and size of natural teeth on antagonist
arch should be kept in mind.
 If cuspal inclinations of natural teeth are low, teeth with approximately 20° cuspal
inclinations should be selected.*
 If cuspal inclinations of natural teeth are high, teeth with 33° cuspal inclination should be
selected. *
 If posterior teeth have a straight occlusal surface, then, teeth with 0° cuspal inclination
should be selected.*
Solving
 In SCD, incisal path inclination should be close to 0 degrees as long as the esthetic and
phonation allow.
 To obtain this:
1. Deep vertical overlap in the anterior region is avoided.

2. Horizontal overlap is increased.
 Decreasing incisal path inclination provides less stress on the anterior teeth, therefore,
increasing denture stability.
 Research showed that to improve denture stability, linear occlusion (i.E., Linear occlusion,
monoplane occlusion) could be used.
Solving
OCCLUSION CONCEPTS FOR
SINGLE COMPLETE DENTURE:
1. Bilateral balanced occlusion if can be obtained the natural teeth is
seldom situated in positions that allow cusp to fossa or cusp to embrasure
relation )mostly used when the opposing is denture or removable partial
denture).*
2. “An occlusal scheme that employs a multiplicity of point contacts, rather
than one that utilizes broad-surfaced contacts on inclined planes is
advocated.“
 The golden rule for this type of case “equal contacts in centric occlusion and
no interferences.”
The Single Complete Denture. In: Sharry JJ, editor. Complete Denture Prosthodontics. 3rd ed.
3. Lingualized occlusion:
 Kimoto et al. (2006) made a comparison between lingualized occlusion and bilateral balanced
occlusion and determined that patients who have lingualized occlusion were more satisfied
with their denture’s retention.
 However, no difference in mastication effectiveness was observed.
Kimoto S, Gunji A, Yamakawa A, Ajiro H, Kano K, Shinomiya M, Kawai Y, Kawara M, Kobayashi K. Prospective clinical trial comparing lingualized occlusion
to bilateral balanced occlusion in complete dentures: a pilot study. Int J Prosthodont. 2006;19:103–9.
4. Monoplane occlusion:
 Clough et al. (1983) made a comparison between lingualized
occlusion and monoplane occlusion.
 Thirty patients were asked to use a denture that had lingualized
occlusion and a denture that had monoplane occlusion; as a result,
67% of the patients stated that mastication effectiveness,
comfort, and esthetics were enhanced with the dentures that
had lingualized occlusion.
Clough HE, Knodle JM, Leeper SH, Pudwill ML, Taylor DT. A comparison of lingualized occlusion and monoplane occlusion in complete dentures. J Prosthet
Dent. 1983;50:176–9
E. TYPES OF ARTIFICIAL
TEETH:
1. Acrylic teeth:
 Acrylic teeth are the most commonly used type of artificial teeth in SCD.
 Advantages:
 They do not cause abrasion on natural teeth or absorb occlusal forces and cause less
resorption on the supporting tissues.
 Disadvantages:
 Abrasion in time and vertical height loss.
Solving
 Nowadays, the production of acrylic teeth with a higher quality and hardness has
eliminated these disadvantages.
 Because of the abrading nature of acrylic teeth, some researchers have advised the use of
ceramic teeth for second premolars and first molars on which occlusal forces concentrate.
Solving
2. Porcelain Teeth:
 Advantages:
1. Not abrading, and by this securing vertical height.

 Disadvantages:
1. They cause abrasion on natural teeth.

2. The occlusal forces on the teeth may cause a fracture of the palatal tubercles on the
upper arch and buccal tubercles on the lower arch.
3. They do not bond chemically to the denture base. Their retention to the denture base
is mechanical, and therefore, they may separate from denture base.
4. Porcelain teeth transfer occlusal forces directly to the underlying alveolar ridge
without absorbing them, therefore accelerating resorption on alveolar ridge.
Using porcelain teeth on SCD is not advised.
Solving
3. Teeth with modified occlusal surfaces:
 To prevent abrasion of the acrylic teeth used on SCD, cavities on top of occlusal surfaces of
these teeth can be prepared and filled with amalgam.
 With this method, it is possible to prevent vertical height loss.
 Disadvantage of this method:
Acrylic portion around amalgam filling wears in time.
Solving
4. gold occlusal surfaces.
 Schultz first recommended gold occlusal surfaced teeth in 1951.
 Gold, being a harder material, will prevent occlusal abrasion.
 The disadvantage is their cost.
Solving
SCD Opposing Natural
Dentition
1. SINGLE COMPLETE DENTURE OPPOSING
LOWER NATURAL DENTITION
 Single upper dentures opposing lower natural dentition

cases are most likely to be encountered in SCD opposing
natural dentition.
 These are the problems seen with these types of patients:
1. Irregulars in occlusal plane

2. Problems in recording intermaxillary relations
Solving
• IRREGULARS IN OCCLUSAL
PLANE:
 Since the occlusion of natural teeth is generally unsuitable, they need
to be modified in order to obtain a balanced occlusion.
 Tilted or overerupted teeth regarding the occlusal plane disrupt
occlusal harmony and create undesirable forces on the denture.
 It is necessary to decrease the Spee curve by reducing overeruption
of teeth via occlusal modifications.
 If there are rotated teeth, they should be recontoured (e.g., grinding,
crowning) to obtain their contact with plane surfaces.
Solving
 In some heavy cases, in which teeth are overerupted, touching the denture base or
decreasing the intermaxillary distance, the extraction of such a tooth may be considered
Solving
 The relation of the occlusal plane with antagonist supporting structures must be evaluated.
 If it is lower or higher than the midpoint of intermaxillary distance, it should be leveled
according to the upper or lower denture
Solving
 The relation of occlusal plane inclination against the antagonist arch must be evaluated.
 If there is even the slightest deviation on their parallelism, the stability of the denture
against occlusal forces will be problematic.
Solving
• PROBLEMS IN RECORDING
INTERMAXILLARY
RELATIONS:
 A problem occurs while arranging parallelism between the
upper wax rim and ala-tragus line because occlusal surfaces
of antagonist teeth determine the slope of the occlusal plane.
 If overbite is needed on the teeth that are to be aligned, in the
upper anterior region, the labiolingual thickness of the wax
rim prevents accurate recording of vertical height.
Solving
A. The artificial incisor has been set farther back and lower than its natural predecessor, thereby
providing a locked and potentially traumatic occlusion.
B. The overbite has been reduced by raising the tip of the lower incisor (high vertical dimension).
 The overjet has been increased by moving the upper incisor forward to its correct position and by
grinding the labioincisal surface of the lower incisor.
Solving
Evaluation of the model:
 Occlusal adjustment should be undertaken before the fabrication of
the SCD, as afterward it may be impossible to provide a harmony between
the natural dentition and artificial teeth.
 Thus, a diagnostic impression is made, a plaster model is obtained, and the
teeth are evaluated.
 A calotte is used to determine the occlusal irregularities (metallic
template)*
 Articulation paper is placed on top of the calotte, and the stained areas are
trimmed.
Solving
 Early contact points on the lower model determined with a calotte.
 Overerupted teeth are trimmed to a certain degree and brought to the same occlusal level with
other teeth and equalizing contact points.
Solving
 If tilting of the tooth is excessive, the grinding that will be done to fix this problem will be
excessive too, as it will expose the pulp and result in the loss of vitality.
 In this condition the needed procedure is not touching the distal tubercle and leaving it out
of occlusion.
Solving
 If there is an extreme disharmony of occlusion in the
second molar area, it is most probably because of an
early extraction of a molar.
 In this case, overerupted teeth are left out of the
occlusion, and the teeth arrangement is made
according to this.
 If there is a problem due to the reduced
intermaxillary distance, the second molar may be
extracted.
Solving
 The class III relation or mandibular prognathism can take shape in two ways:
1. Normally developed mandible opposing a less developed maxilla.

2. Normally developed maxilla opposing an excessively developed mandible.
 Prognoses on cases with less developed maxilla are generally worse because the denture
support area is less than a normal maxilla.
 Since denture stability and retention is directly related with the area that it covers, success
rates with these patients are low.
Solving
 With these cases, it is necessary to place anterior teeth in
the class III relation (upper anterior are palatal to lower
anterior), at best they need to be placed in an edge-to-
edge relation.
 Positioning the maxillary anterior teeth away from the
alveolar ridge will create problems:
Phonation difficulties.
Pain on the alveolar ridge.
Damage to the lips and cheeks due to permanent pressure.
Solving
 Patients generally have long lower anterior teeth.
 If the lower anterior are tilted labially, to increase overjet and decrease overbite at the same
time, the lower anterior labioincisal surfaces are grinded.
 In some cases, this grinding may not be enough, in which case the lower teeth should be
restored.
Solving
2. SINGLE COMPLETE
DENTURE OPPOSING UPPER
DENTITION
 Conventional dentures are contraindicated because they cause severe resorption.
 In past years many prosthodontists recommended extraction of the remaining maxillary teeth.
 Today other options are available.
Solving
• PROBLEMS WITH EDENTULOUS
MANDIBLE OPPOSING DENTATE
MAXILLA:
Having a narrower supporting tissue surface leads to:
 Excessive load.
 More susceptible to resorption.
 Denture base fracture.
 Tooth wear.
 Tissue abuse.
 It is acceptable for patients with class III jaw relation.
Solving
• OPTIONS FOR RESERVATION OF THE
RESIDUAL RIDGE:
 The lower denture base should cover the maximum area within the patient’s anatomical
and functional borders. This will help with the equal distribution of occlusal forces.
 A denture base extending bilaterally toward the retromylohyoid areas will increase its
retention.
 To increase denture stability and equalize occlusal force distribution, bilateral contacts
should be present both in centric relation and during functional movements.
Solving
 Soft lining materials should be used.
 Preprosthetic surgery (Ridge augmentation).
 Retention of key roots (Overdenture):
 Maintenance of bone and prevent compression of periosteum.
 Better retention and stability.
 Enhanced comfortability.
 Psychological aspects.
 Greater chewing power.
Solving
 Osseointegrated implants:
 The overdenture design can be mainly mucosally supported, a combined mucosa implant-
supported, or an implant-supported overdenture depending on the number and location of
the implants.
Wismeijer D, van Waas MA, Kalk W. Factors to consider in selecting an occlusal concept for patients with implants in the edentulous mandible. The Journal of
prosthetic dentistry. 1995 Oct 1;74(4):380-4.
 mucosally supported overdenture:
 The mainly mucosally supported overdenture is attached to two implants by
means of resilient stud attachments or magnets.
 It is indicated for patients who have a retention problem and when new
dentures without implants will not adequately solve the problem.
 In case of lower SCD opposing natural dentition, posterior occlusal loads,
however, must be borne by the retromolar pad, the buccal shelf and the
residual alveolar process.
 A carefully made border molded impression will make maximum use of
these support areas.
The implant-supported overdenture:
 Requires four to six implants placed in the anterior region of the mandible that are rigidly
connected by a bar superstructure.
 The overdenture is attached to the bar by clips and is thus implant supported.
Indications of implant supported overdenture:
 For patients with sensitive mucosa easily irritated by the pressure of a denture, for example,
when bone is resorbed and thus exposes the alveolar nerve or when a knife-edge ridge or
sharp mylohyoid projection is present.
 Patients with an extreme gag reflex. The overdenture is held in place during function and thus
does not trigger the gag reflex.
 When the opposing arch has natural teeth, this type of overdenture is also indicated for
reasons of stress distribution.
Single complete denture opposing fixed
partial dentures
 Once a fixed restoration is placed in a dental arch, the restored arch can be thought of as
natural teeth opposing a complete denture.
 The construction and placement of fixed restorations can correct many occlusal disharmonies
that may have existed previously.
 The occlusion between the denture teeth and the fixed restorations is harmonized on an
articulator while the patterns for the castings are being developed during try in stage.
Solving
 Upper occlusal rims should be prepared during the lower metal try-in* stage of fixed
restorations, if there is a case with lower fixed bridge and upper SCD.
 Following this stage, the anterior teeth arrangement and control should be made.
Solving
 After every tooth arrangement is completed, it is tried intraorally.
 Following these stages, the lower fixed bridge is checked intraorally, and the denture is then
ready for the finishing process.
Solving
 In the case, since each of the patient’s lower teeth was treated with fixed restorations, teeth
alignment was completed easily, and the overbite was not overly done.
 Cusp-cusp contact was easily achieved
Solving
Single complete denture opposing
removable partial denture
 Placing posterior teeth on RPD will positively affect the
prognosis of the SCD.
 If some or all of the posterior teeth are absenting at the opposing
arch of the SCD, a RPD may not always be indicated.
 For example, in the class i jaw relation, lower molar teeth may
not be involved in denture design, and a SCD contacting only
lower anterior and premolar teeth can be fabricated.
 In this case, lower premolar teeth will be able to administer the
occlusal forces that are directed to the mid-posterior region of
the SCD, and therefore a sufficient relation with upper dentures
posterior area will be achieved.
Solving
 If a patient in the same condition has a class III jaw relation,
since the occlusal forces applied by lower premolars will be
directed toward the anterior portion of the upper alveolar
ridge.
 It will be obligatory to treat the lower arch with a RPD.
 If mandibular premolar teeth can have a relation with the
complete dentures posterior area, a clinically successful
maxillary single complete denture can be fabricated
Solving
 In each case when all the molar teeth are absenting in the
mandible, the partial removable denture is indicated.
 The upper complete denture and lower partial denture should be
produced at the same time*, and optimal occlusion should be
obtained.
 If two molar teeth are absenting on one side and only the
second molar on the other.
 It may not be necessary to fabricate a removable partial denture.
In this situation, a cantilever bridge can be prepared for the
missing molar tooth.
Solving
Combination syndrome
 Combination syndrome is a dental condition that is commonly seen in patients with a
completely edentulous maxilla and partially edentulous mandible with preserved
anterior teeth.
Palmqvist S, Carlsson GE. The combination syndrome: a literature review. The Journal of prosthetic dentistry. 2003 Sep 1;90(3):270-5.
 Based on a literature review and the author’s experience with a variety of combination
syndrome patients (complete and partial maxillary and mandibular edentulous cases), a
clinically relevant classification of CS is proposed.
 Three classes and 10 modifications of CS are described.
 An anterior maxillary resorption resulting from the force of anterior mandibular teeth is the
key feature of this classification, and it is consistently present throughout all classes and all
modifications.
 Maxillary edentulous condition’ defines the class, ‘mandibular’ the modification within
the class.
Rajendran S, baburajan. Combination syndrome. Int J prosthodont restor dent 2012;2(4):156-160.

CLASSIFICATION OF
COMBINATION SYNDROME
SIGNS OF COMBINATION
SYNDROME:*
 Loss of bone from the anterior part of the maxillary ridge.
 Overgrowth of the tuberosities.
 Papillary hyperplasia in the hard palate.
 Extrusion of the lower anterior teeth.
 The loss of bone under the partial denture bases.
Kelly, E. (1972). Changes caused by a mandibular removable partial denture opposing a maxillary complete denture. The Journal of Prosthetic Dentistry,
27(2), 140–150. doi:10.1016/0022-3913(72)90190-4
Saunders et al. (1979) stated that the following six changes also occur over time:
(complication)*
 Loss of vertical height.
 Irregularities on the occlusal plane.
 Anterior positioning of the mandible.
 Loss of denture adaptation.
 Epulis fissuratum.
 Periodontal changes.
27(2), 140–150. doi:10.1016/0022-3913(72)90190-4
MECHANICS WHICH PRODUCE
COMBINATION SYNDROME:
 The patient has a tendency to condense occlusal load on the natural dentition.
 For example, for proprioception, the lower anterior teeth have a more forceful effect on the
anterior portion of the maxillary teeth.
 This portion of the ridge is composed of cancellous bone and is subject to fairly rapid
resorption if excessive force is placed against it.
 As ridge resorption occurs and progresses, the bony ridge is replaced by redundant soft tissue,
initiating the combination syndrome and associated changes.
27(2), 140–150. doi:10.1016/0022-3913(72)90190-4
 While bone is being lost in the anterior region in the upper jaw,
bony resorption also occurs under the mandibular partial
denture bases.
 The maxillary denture then moves up in the anterior region
and down in the posterior region in function (negative
pressure)*
 When mandibular anterior teeth remain, patient will attempt to function in protrusive
relationship to sense feeling of mastication.
27(2), 140–150. doi:10.1016/0022-3913(72)90190-4
 With the posterior palatal seal, a negative pressure is produced posterior to the fulcrum
line.
 This negative pressure may account for the enlarged tuberosities and the papillary
hyperplasia.
27(2), 140–150. doi:10.1016/0022-3913(72)90190-4
 As the settling of the maxillary anterior denture base occur the VDO. Will begin to
decrease.
 Depending on the increased resorption and decreased support in the anterior region, epulis
fissuratum occurs in the vestibular area of the denture.
 Because the labial flange of the denture produces a low grade irritation in the surrounding
soft tissues.
Solving
 Also, due to the loss of support in the anterior region,
occlusal loadings increase on the posterior region of
the denture, leading to resorption and occlusal
disharmony.
 The posterior portion moves downward, depending on
the severe resorption of the mandibular posterior region.
Coşkun Yıldız and Yasemin K. Özkan Complete Denture Prosthodontics-Treatment and Problem Solving
 Downward movement of the occlusal plane on the
posterior region causes the denture to move anteriorly,
thus overeruption of the natural teeth.
 Because of the ongoing excessive load on the anterior
portion, this vicious cycle continues.
 The change in the angulation of the occlusal plane may result in a protrusive or sliding contact
of the mandibular teeth with the denture, which can contribute to the loss of support for the
remaining natural teeth or precipitate periodontal changes.
PREVENTION OF COMBINATION SYNDROME FOR
DISTAL EXTENSION PARTIALLY EDENTULOUS
MANDIBLE:
 Combination syndrome should be determined in the early stages and
prevented.
 The spatial position of the mandibular anterior teeth is important to
the treatment plan.
 Teeth that are considerably supraerupted would require alteration by
shortening, crowning.
 If the incisal edges of the mandibular anterior teeth are compared with
the level of the resorbed posterior residual ridges, the teeth may be
mistakenly interpreted as being extruded.
 The level of the incisal edges of the mandibular anterior teeth should
be assessed in comparison to the proposed posterior occlusal plane.
Langer, Y., Laufer, B.-Z., & Cardash, H. S. (1995). Modalities of Treatment for the Combination Syndrome. Journal of Prosthodontics, 4(2), 76–81.
doi:10.1111/j.1532-849x.1995.tb00320.x
 The mandibular RPD supported anteriorly by rests
with a lingual plate as the major connector.
 The lingual plate delays the overeruption of the
mandibular teeth, preventing undesirable anterior
pressure on the anterior part of the maxillary denture.
 It also facilitates accurate positioning of the RPD
during relining procedures.
doi:10.1111/j.1532-849x.1995.tb00320.x
 Optimum fit of the denture base is achieved using the altered cast technique.
 Posteriorly, maximum support is obtained by extending the denture base to cover the
retromolar pad.
doi:10.1111/j.1532-849x.1995.tb00320.x
 Maximum occlusal support posteriorly with no contact anteriorly in centric occlusion and a
balanced articulation in eccentric movements further reduce pressure on the anterior
maxillary ridge.
doi:10.1111/j.1532-849x.1995.tb00320.x
 Despite the lingual plate, the mandibular anterior teeth may continue to erupt.
 In the absence of anterior tooth contact, overloading of the mandibular posterior ridge and
consequent rapid alveolar resorption may occur.
 Posterior occlusal contact must be maintained by frequent relining of the distal extension
denture base* to compensate for its resorption.
doi:10.1111/j.1532-849x.1995.tb00320.x
 A more predictable outcome can be expected by the use of the overdenture.
 This more radical approach is also required when mandibular anterior teeth have large
structural defects or a weakened periodontium and are unable. to withstand normal
occlusal loading.
 The teeth are treated endodontically and are reduced to the gingival level, and an
overdenture is constructed that is supported and retained by the roots of the residual teeth.
doi:10.1111/j.1532-849x.1995.tb00320.x
 In overdenture, all teeth in the mandibular jaw are, therefore, part of one restoration enabling
the occlusal load to be shared more evenly between the posterior edentulous ridge and
the remaining anterior roots.
doi:10.1111/j.1532-849x.1995.tb00320.x
 Additional retention for the mandibular denture may be provided by stud attachments
cemented to the retained roots.
 Support is maintained posteriorly by maximum tissue coverage.
doi:10.1111/j.1532-849x.1995.tb00320.x
 Implant-supported fixed prosthesis— in distal extension partially edentulous situations
in case there is adequate bone height and width, no anatomic structures that could
interfere with implant placement and visual inspection and palpation do not show presence
of any flabby excess tissue, bony ridges and sharp underlying osseous formations or
undercuts.
 Either an implant can be placed distal to the most posterior natural abutment and a fixed
prosthesis connecting the implant with the natural teeth can be fabricated.
 Or two or more implants can be placed posterior to the most distal natural tooth in order to
fabricate a completely implant-supported restoration.
Rajendran S, Baburajan. Combination Syndrome. Int J Prosthodont Restor Dent 2012;2(4):156-160.

 The maxillary impression is made in a specially designed tray using a combination of
elastomeric impression material and impression plaster without distorting the anterior residual
ridge.
doi:10.1111/j.1532-849x.1995.tb00320.x
 Planned extractions followed by immediate dentures.
 Or preservation of a few of the remaining teeth for the fabrication of overdenture prosthesis
with a metallic denture base for one arch are preferred treatment modalities.
Rajendran S, Baburajan. Combination Syndrome. Int J Prosthodont Restor Dent 2012;2(4):156-160.

MANAGEMENT OF
COMBINATION SYNDROME:
Non surgical management of old denture lesions (flappy ridge - epulis fissuratum -
papillary hyperplasia ):
 Denture removal, tissue rest and mucosal conditioning.
 Adjustment of tissue conditioner.

Surgical prosthetic correction:
 The change in facial aesthetics from the resulting combination syndrome is a challenge to
restore with traditional dentistry as the prosthetic solutions are limited, the age of the
patient is often a limitation and financial costs are of concern.
 The treatment time can be reduced to one surgical visit in many cases, with all treatment
completed in one week with follow-up visits needed approximately once a week for several
weeks.

 Pre-surgical/ prosthetic planning:
 Prostheses completed prior to surgery
 Surgical/ prosthetic phase:
 Maxillary grafting completed first, upper immediate denture ready for insertion.

 Extractions, alveoplasty and insertion of mandibular implants and healing abutments,
immediate lower denture and soft liner ready for insertion.
 Minimal invasive surgical technique allowing surgical correction and final implant connecting
bar impression the day of surgery.

Single complete denture opposing an existing
complete denture
 Instead of fabricating a SCD opposing an existing complete denture, fabricating a lower and
upper complete denture together is a safer and easier way.
 If the existing complete denture does not meet certain standards, a SCD should not be
fabricated for the antagonist arch.
These standards are:
 Having a good teeth arrangement on the existing denture to provide effective mastication
and denture stability.
 Having esthetically acceptable teeth.
 Having adequate tissue support.
 Having proper cusp heights harmonious with the SCD.
 Having sufficient esthetics and base thickness to support perioral structures.
 Having a denture base that covers all supporting structures.
 Having a good stability and retention.
Technique for Constructing Complete
Dentures Opposing Natural Teeth
TECHNIQUE FOR CONSTRUCTING
COMPLETE DENTURES OPPOSING
NATURAL TEETH
1. Proper diagnosis and mounting the diagnostic casts.
2. Occlusal adjustment and tooth modification
3. Final impression
4. Jaw relation
5. Face bow transfer
6. Artificial teeth adjustment
7. Try-in of waxed denture.
8. Denture insertion

1. PROPER DIAGNOSIS AND MOUNTING
THE DIAGNOSTIC CASTS.
 The initial interview with the patient is very important.
 A patient indicating a lack of interest in a long-range treatment plan is not a good risk.
 A patient with a history of bruxism or having heavily developed facial musculature is also a
poor prognosis.

 Upper and lower primary impressions are made and diagnostic
casts are obtained.
 It is recommended that the diagnostic casts be mounted in proper
centric relationship in order to accurately visualize the existing
interarch space, the arch relationships, the occlusal plane, the need
of preprosthetic surgery, and any other features that might
influence the treatment plan and prognosis.

2. OCCLUSAL ADJUSTMENT AND TOOTH
MODIFICATION
 Before one proceeds with the single denture, there are many factors to
be considered in evaluating the natural teeth in the opposite arch.
 The natural teeth are carefully examined to determine if simple
reshaping can create a suitable occlusal surface or if the occlusal
surfaces must be reconstructed
 Extruded or malposed teeth must be reshaped into a normal occlusal
plane position, or crowned, or extracted to create a usable occlusion.
 Planning such changes and assessing the improvement which will
result is best achieved by first making the changes experimentally on
a study cast and, if the desired improvement is achieved, then
carrying them out in the mouth.

OCCLUSAL ADJUSTMENT :
1. Swenson's Technique
2. Bruce Technique
3. Yurkstas Technique
4. Boucher's Technique
5. Tan technique
6. L. Kirk Gardner Technique
7. Digital
1. SWENSON’S TECHNIQUE:
 Set the maxillary teeth first on the articulator.
 If the mandibular stone teeth interfere with placement
of maxillary denture teeth, stone teeth are adjusted
and marked on the cast with pencil.
 The natural teeth are modified using the diagnostic
cast as a guide.
 Make an impression to modified teeth again, pour it
and mount of the resultant cast.
 Disadvantage: time consuming
Swenson O, Bill AH. Resection of the rectum and rectosigmoid with preservation of the sphincter for benign spastic lesions producing
megacolon: an experimental study. Surgery. 1948;24:212–20.
2. BRUCE TECHNIQUE:
 Primary Impression of the maxillary arch was recorded.
 Maxillary custom tray fabricated using conventional method and final impression was recorded.
 Teeth setting was done after jaw relation and articulation.
 Interfering cusps of lower stone teeth are modified ( grinding ) on the cast
Bruce RW Complete denture opposing natural teeth. J Prosthet Dent.1971; 26(5): 448-55.
 Interfering cusps of lower stone teeth are
modified ( grinding ) on the cast
 Make a clear acrylic resin template over the
modified cast.
 Coat the inner surface of template with
pressure indicating paste and place the template
over the natural teeth of the patient.
 Grind the teeth that make pressure areas on the
inner surface of template.
Bruce RW Complete denture opposing natural teeth. J Prosthet Dent.1971; 26(5): 448-55.
3. YURKSTAS TECHNIQUE:
 The use of a metal U-shaped occlusal template which have the shape of compensatory
curve, place convex surface on the occlusal surfaces of the lower remaining teeth (with
curvature 20 degree) *
 Mark the prominent cusps that touch the template with pencil.
 The stone cusps are reduced on the cast till all teeth touch the template.
 The marked area used as a guide.
Yurkstas A.A. Single dentures. In: Sharry J.J., editor. Complete Denture Prosthodontics. second ed. McGraw-Hill; New York: 1968. p. 300.
4. 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.
Heartwell CM, Rahn A. The single complete denture. In: Syllabus of complete dentures. Philadelphia: Lea and Febiger 1993, 481-91.
5. TAN TECHNIQUE:
 1. Make a vacuum-formed clear template over the mandibular cast with 0.02 inch thick
Sta-Vac sheet resin material. Cut the template at the level of gingival margin around the entire
cast to facilitate removal.
 2. Mount the maxillary and mandibular casts in centric relation with a good jaw relation
record.
 3. Arrange the maxillary teeth according to the contour of the maxillary occlusion rim
and align the occlusal surface in a compensating curve to facilitate the development of
occlusal balance.
 In the course of setting teeth, judiciously grind both the denture teeth and the natural
stone teeth on the mandibular cast to achieve the best possible articulation.
Tan, H.-K. (1997). A preparation guide for modifying the mandibular teeth before making a maxillary single complete denture. The Journal of Prosthetic Dentistry,
77(3)
 4. Mark the modified cusps on the mandibular casts with a contrasting colored pencil.
 Seat the clear template onto the mandibular cast that has now been modified. (Voids can be
seen through the template where cusps have been modified).
77(3)
 5. Cut the template to the level of the modified tooth surface with a sharp scalpel blade.
 This will create openings on the occlusal aspect of the template to indicate the position of
the tooth structure before they are modified.
 The margin of the openings indicates the extent of tooth reduction.
 When the template is seated in the mouth, the natural tceth will protrude through these
openings.
77(3)
 6. Mark the margin of the openings with a permanent marker of choice (The markings
indicate the exact amount of odontoplasty as planned on the articulator).
 7. Reduce the mandibular teeth to the margin of the openings on the template.
77(3)
Advantages:
 This procedure offers the convenience of having the preparation guide seated stably on
the teeth during the process of odontoplasty.
 Minimal thickness of the preparation guide allows the amount of planned tooth
reduction to be accurately indicated on the involved tooth surfaces.
 Low cost and ease of fabrication.
Disadvantages:
 If any, are limited to time and effort.
77(3)
6. L. KIRK GARDNER
TECHNIQUE:
 1. Perfect the occlusal plane on diagnostic casts by
using a template or any other desired method with a
sharp knife, stones, or burs.
 2. Paint the cast with a tinfoil substitute and allow it to
dry.
 3. Adapt autopolymerizing acrylic resin (dough stage)
to the facial surface of the modified teeth on the cast
and cut to the occlusal height of the altered teeth.
Gardner, L. K., Rahn, A. O., Parr, G. R., & Richardson, D. W. (1990). Using a tooth-reduction guide for modifying natural teeth. The Journal of Prosthetic Dentistry,
63(6), 637–639. doi:10.1016/0022
 4. Lubricate acrylic resin surfaces in the modified locations
with petroleum jelly and apply a second mix of acrylic resin
to make the lingual portion of the guide.
 5. After the acrylic resin is cured, remove the guide in two
pieces and smooth any rough surfaces.
Vinyl polysiloxane may also be used for the
construction of the reduction guide.
63(6), 637–639. doi:10.1016/0022
 6. Place the reduction guide in the patient’s mouth and accurately reshape the desired
teeth.
 7. Narrow, polish, and smooth the occlusal surfaces of the odontoplasty, further reduce the
teeth to receive crowns, and make temporary restorations.
63(6), 637–639. doi:10.1016/0022
7.DIGITAL TECHNIQUE:
Yang, Yang & Zhu, Xiaoming & Wang, Zixuan & Liu, Xiaoqiang & Tan, Jianguo & Wang, Yong. (2022). A digital workflow for single complete denture using a multi-
functional diagnostic denture. Journal of Dental Sciences. 18. 10.1016/j.jds.2022.09.015.
 A digital workflow for single complete denture restoration, to facilitate the clinical procedure
and promote balanced occlusion.
 The workflow comprises digital design and 3d-printing of a multi-functional diagnostic
denture to guide opposing natural teeth grinding, taking the final impression, and recording
the jaw relation and functional movement.
 Accurate modification of the opposing dentition and characterized artificial dentition both
promote final balanced occlusion.
 Overall, this proposed digital workflow is promising and highly efficient; however, long-
term clinical validation is necessary.
 (A) Intraoral scanning of the maxillary edentulous arch and opposing dentition with the
primary jaw relationship.
 (B) Design of the diagnostic denture.
 (C) Marking of the grinding surface of opposing teeth.
 (D) Tissue surface of the diagnostic denture.
 (E) Dentition and polishing surface of the DD.
 (F) Definitive impression of the edentulous arch
using the DD.
 (G) Modification of the opposing natural tooth with
the DD in place.
 (H) Assessment of occlusal contact using articulator
papers.
 (I)Mandibular dentition after tooth grinding and
polishing.
3. FINAL IMPRESSION
 After completion of all operative, periodontal and surgical
procedures, a final impression of dentulous arch is made.
 Final impressions of the edentulous ridge is made only after the
edentulous ridge tissue is in a healthy condition.
 Soft denture liners, as well as leaving the dentures out of the mouth
may be necessary for tissue recovery.
 The impression should cover the maximum tissue surface possible
within physiologic limits to gain the best support possible for the
dentures.

4. JAW RELATION
 A maxillary recording base with a wax occlusion rim is made
and trimmed in the patient's mouth until the correct vertical
dimension of occlusion is achieved.
 The labio-lingual thickness of the wax rim will usually not allow
the lower natural incisors to close beyond the occlusal surface of
the wax rim.
 To avoid this, the vertical dimension should be recorded without
reference to the incisal level or the occlusal plane of the upper
wax rim.
 The use of facial measurements, phonetics, preextraction
records, patient tactile sense, and swallowing are all helpful.

5. FACE BOW TRANSFER
 A face-bow registration is made to mount the maxillary cast on a simi-adjustable articulator,
and an accurate centric relation record is made at the correct vertical dimension of occlusion.
 The mandibular master cast is mounted on the articulator to occlude with the previously
mounted maxillary cast and base and the artificial teeth are selected to match the shade of the
lower natural teeth.

 Methods to achieve balanced articulation:
 Statically equilibrated occlusion using a programmed articulator to stimulate the patient’s
mandibular movements.
 Dynamically equilibrated occlusion by the use of functional generated path technique
(Functional chew-in techniques).
 FUNCTIONALLY
GENERATED PATH
TECHNIQUE:
 Stansbury, in his functional chew-in technique, mounted the maxillary and mandibular casts
on an articulator in centric relation at an acceptable vertical dimension.
 He then adapted a new base plate and fabricated the occlusal rim made of impression
compound on the edentulous cast.
 The compound occlusal rim was at least twice the width of the molar teeth and sufficient
in height to receive an impression of the central fosse of the lower teeth.
Upadhyay SR, Singh SV, Bhalla G, Kumar L, Singh BP. Modified functionally generated path technique for single complete denture against non-modified natural
dentition. J Oral Biol Craniofac Res. 2012 Jan-Apr;2(1):67-71. doi: 10.1016/S2212-4268(12)60016-5. PMID: 25756037; PMCID: PMC3941280.
 This occlusal rim was then heated and placed in the articulator to record the impression of
the fosse of all opposing teeth.
 The occlusal rim was then trimmed bucco-lingually so that only a fin of the compound
extending to the central fosse remained and the anterior region was trimmed till the level of
indentation of the incisors.
 Carding wax was then added on the bucco-lingual sides of the occlusal fin.
 The assembly was then placed in the patient’s mouth and the patient was asked to perform
eccentric chewing movements.
 The opposing teeth cut their path in the soft carding wax and the compound in the central
fosse acted as a guide to preserve the cusp height.
 A stone index was poured in this path.
 A modification was made in the original technique, described by Stansbury.
 The patient’s existing maxillary complete denture, was thoroughly examined and checked for
proper extensions, retention, stability, and vertical dimension.
 Carding wax was added to the full width and length of the occlusal surface of the denture
teeth.
 The entire assembly was inserted in the patient’s mouth.
 Patient was guided to first close into centric occlusion and the
indentations of the patient’s mandibular anterior teeth were recorded in
the carding wax.
 These indentations served as the future centric stops.
 Then, the patient was instructed to open the mouth and slowly
move the jaw to either right or left (about 5 mm) and slide the jaw
back into the centric position.
 This was repeated several times before accepting it as the final record.
 The wax indentations of the mandibular anterior teeth acted as a guide to close in the
centric position.
 This was done for both right and left lateral excursions. Similarly, the protrusive movement
was also recorded.
6. ARTIFICIAL TEETH
ADJUSTMENT
1. Acrylic teeth:
 Acrylic teeth are the most commonly used type of artificial teeth in SCD.
 Advantages:
 They do not cause abrasion on natural teeth or absorb occlusal forces and cause less
resorption on the supporting tissues.
 Disadvantages:
 Abrasion in time and vertical height loss.
 Nowadays, the production of acrylic teeth with a higher quality and hardness has
eliminated these disadvantages.
 Because of the abrading nature of acrylic teeth, some researchers have advised the use of
ceramic teeth for second premolars and first molars on which occlusal forces concentrate.
2. PORCELAIN TEETH:
 Advantages:
1. Not abrading, and by this securing vertical height.

 Disadvantages:
1. They cause abrasion on natural teeth.

2. The occlusal forces on the teeth may cause a fracture of the palatal tubercles on the
upper arch and buccal tubercles on the lower arch.
3. They do not bond chemically to the denture base. Their retention to the denture base
is mechanical, and therefore, they may separate from denture base.
4. Porcelain teeth transfer occlusal forces directly to the underlying alveolar ridge
without absorbing them, therefore accelerating resorption on alveolar ridge.
 Using porcelain teeth on SCD is not advised.
3. TEETH WITH MODIFIED OCCLUSAL
SURFACES:
 amalgam occlusal surfaces :
 To prevent abrasion of the acrylic teeth used on SCD, cavities on top of occlusal surfaces of these
teeth can be prepared and filled with amalgam.
 With this method, it is possible to prevent vertical height loss.
 Disadvantage of this method:
Acrylic portion around amalgam filling wears in time.

 gold occlusal surfaces :
 Another type of artificial tooth used in SCD.
 Schultz first recommended gold occlusal surfaced teeth in 1951.
 Gold, being a harder material, will prevent occlusal abrasion.
 The disadvantage is their cost.
7- TRY-IN
 At this time the dentist can verify maxillomandibular relationship and take new records if
necessary.
 He can evaluate tooth position, phonetics, denture stability, and retention.
 He has also an opportunity to determine if he has fulfilled all mechanical requirements of the
prosthetic appliance
 The trial denture is then returned to the laboratory to be waxed-up and the denture is
processed.
 The occlusion of the processed denture is corrected by laboratory remounting and selective
grinding.

8. DENTURE PLACEMENT
 The articulator is adjusted and the occlusion is corrected on the articulator before placement of
the denture
 Pressure-indicator paste is used to locate pressure spots on the tissue surface of the completed
denture.
 The patient is advised to leave the denture out when he sleeps or at least part of every day.
 He is given oral hygiene and dietary Instructions including techniques of brushing and
massaging of the residual ridge.
 Finally, the patient is given an appointment for future observation of his mouth.

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SINGLE

 SINGLE COMPLETE DENTURE OPPOSING AN EXISTING

 There are reasons for this difficulty:

Clinical Complete Denture Prosthodontic - Moustafa Abd Elmeguid Hassaballa - (2010)

4. The occlusal plane inclinations of the opposing dentition are

6. Natural teeth may be too wide buccolingually

A. Examination of the edentulous area.

 1. Number and position of natural teeth:

1. Deep vertical overlap in the anterior region is avoided.

1. Not abrading, and by this securing vertical height.

1. They cause abrasion on natural teeth.

Acrylic portion around amalgam filling wears in time.

 Single upper dentures opposing lower natural dentition

 These are the problems seen with these types of patients:

1. Irregulars in occlusal plane

1. Normally developed mandible opposing a less developed maxilla.

 It is acceptable for patients with class III jaw relation.

Rajendran S, baburajan. Combination syndrome. Int J prosthodont restor dent 2012;2(4):156-160.

Rajendran S, Baburajan. Combination Syndrome. Int J Prosthodont Restor Dent 2012;2(4):156-160.

Rajendran S, Baburajan. Combination Syndrome. Int J Prosthodont Restor Dent 2012;2(4):156-160.

Clinical Complete Denture Prosthodontic - Moustafa Abd Elmeguid Hassaballa - (2010)

Clinical Complete Denture Prosthodontic - Moustafa Abd Elmeguid Hassaballa - (2010)

Clinical Complete Denture Prosthodontic - Moustafa Abd Elmeguid Hassaballa - (2010)

Clinical Complete Denture Prosthodontic - Moustafa Abd Elmeguid Hassaballa - (2010)

Clinical Complete Denture Prosthodontic - Moustafa Abd Elmeguid Hassaballa - (2010)

Clinical Complete Denture Prosthodontic - Moustafa Abd Elmeguid Hassaballa - (2010)

Clinical Complete Denture Prosthodontic - Moustafa Abd Elmeguid Hassaballa - (2010)

Clinical Complete Denture Prosthodontic - Moustafa Abd Elmeguid Hassaballa - (2010)

Clinical Complete Denture Prosthodontic - Moustafa Abd Elmeguid Hassaballa - (2010)

Clinical Complete Denture Prosthodontic - Moustafa Abd Elmeguid Hassaballa - (2010)

Clinical Complete Denture Prosthodontic - Moustafa Abd Elmeguid Hassaballa - (2010)

1. Not abrading, and by this securing vertical height.

1. They cause abrasion on natural teeth.

Acrylic portion around amalgam filling wears in time.

Clinical Complete Denture Prosthodontic - Moustafa Abd Elmeguid Hassaballa - (2010)

Clinical Complete Denture Prosthodontic - Moustafa Abd Elmeguid Hassaballa - (2010)

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