Single Complete Denture

Seminar by:
Dr. Shresht Khandpur
• To find a patient who has become entirely edentulous in
one arch is not uncommon

• Neither is it uncommon to find that the successful

rehabilitation of such a patient with a complete denture is
often very difficult and occasionally impossible

TWO REASONS
1. The existing teeth
2. The absence of teeth
 Oh my god!!!

The single denture

syndrome
Patient complains/outcomes
• Loose fitting denture
• Damage to the mucosa
• Ridge resorption
• Patient dissatisfied
Solution lies in the fact :

• Full use of the factors which favour success with

no procedural errors

• The forces to which the denture is subject must be

reduced as much as possible by appropriate mouth

preparation
Diagnosis and treatment planning

Modifying occlusal pattern

Common occlusal disharmonies and their

troubleshooting

Achieving harmonious occlusal balance

Mandibular complete denture

Rationale for implants in single dentures

Occlusal materials for single dentures

Potential complications of single dentures

Summary and Conclusion

References
Diagnosis
and
Treatment Planning
 A single complete denture can oppose any one
of the following:
1. Natural teeth that are sufficient in number not to
necessitate a fixed or removable partial denture.

2. A partially edentulous arch in which the missing teeth

have been or will be replaced by a fixed partial denture.

3. A partially edentulous arch in which the missing teeth

have been or will be replaced by a removable partial
denture.

4. An existing complete denture.

• Thorough clinical examination
– Forces : supporting mucosa, sub-mucosa, periosteum and bone

– Maximum extension of the denture base for a better

distribution of forces

• Master impressions and mounting the cast with a facebow

record

• Mounting the lower cast with a provisional centric record

made at an acceptable vertical dimension

Pre-determining the amount of occlusal adjustments necessary prior

to denture construction
 Carl F. Driscoll and Radi M. Masri* proposed a classification system that
could simplify the identification and treatment of those patients

• Class I – Patient for whom minor or no tooth reduction is all that is

needed to obtain balance.

• Class II – Patient for whom minor additions to the height of the

teeth are needed to obtain balance.

• Class III – Patient for whom both reduction and additions to the
teeth are required to obtain balance. The treatment of these
patient involves change in the vertical dimension of occlusion.

• Class IV – Patient who presents with occlusal discrepancies that

require addition to the width of the occluding surface.

• Class V – Patient who presents with combination syndrome.

*DCNA, July 2004: Vol 48; No.3

Modifying Occlusal Pattern
• Several techniques to modify the existing occlusal
pattern prior to denture construction have been suggested:

– Swenson’s technique

– Yurkstas method

– Bruce method

– Boucher method

– L. Klirk Gardner’s technique

– Han Kuang Tan’s technique

– The use of Broadrick’s Flag

 Swenson’s method (1964)
 The maxillary and mandibular cast are mounted on articulator using
provisional centric record.
 A maxillary denture teeth are set.
 Lower interfering teeth are adjusted on the cast and area is marked
with a pencil.
 The natural teeth are modified using marked diagnostic cast as a
guide.
 After the occlusal modifications new impressions are made of the
lower arch and mounted on the articulator.
 The artificial teeth are then checked and modifications done for the
final try in.
 Yurkstas method (1968)
 Method involves the use of a metal U-shaped occlusal template
which is slightly convex on the lower side.
 The template is placed on the lower cast and the cusps to be
adjusted are identified.
 The stone cast is modified to an acceptable occlusal
relationship and the areas are marked with a pencil.
 This cast is then used as a guide to

modify natural teeth

 Bruce method (1971)
 The casts are mounted and the necessary modifications are
made on the stone cast.
 A clear acrylic resin template is fabricated on the modified
stone cast.
 The inner surface of template is coated with pressure indicating
paste and the interferences are noted through template.
 The desired modifications are done till the template seats
properly.
 Boucher’s method (1975)
 His technique involves making the natural teeth fit to the
established plane and inclines of the maxillary porcelain teeth.
 First, the cast are mounted and the artificial teeth are arranged
to the best possible balancing contacts.
 If the natural teeth prevent balancing, the interferences are
removed by movement of maxillary porcelain teeth over the
mandibular stone teeth.
 The denture is processed and area to be reshaped are noted
on the cast.
 The natural teeth are ground at the areas marked on the cast.
 The occlusion is refined in the right and left lateral excursive
movements until a harmonious balance is achieved.
 L Kirk Gardner et al (1990)

 A simplified method of transferring diagnostic odontoplastic

information from the cast to the patient.
 Han-Kuang Tan (1997)

 Make a vacuum formed clear template over the cast with Sta-Vac sheet
0.02 inch thick
 The casts are mounted on the articulator and the maxillary teeth are
arranged. Judicious grinding of the denture teeth and the natural stone
teeth on the cast should be carried out.
 The modified cusps are marked and the template is re-seated. Voids are
seen at the prepared areas.
 The template is cut over the prepared areas which will create openings
in the prepared areas when it is seated in the patients mouth.
 The natural teeth are reduced using this a s a guide.
 The Broadrick Occlusal Plane Analyser
(Teledyne Water Pik)
 Used for analyzing the Curves of Spee and Wilson to develop an
acceptable curve of occlusion.
 Consists of:
 Card index with thumb screw
 Bow compass with graphite leads
 Scribing knife
 Plastic record cards

 Maxillary cast mounted with face bow and mandibular cast in centric
relation.
 The card index is attached to the upper member of the articulator in the
keyway portion straddling the incisal pin attached by a thumbscrew from
under side instead of the orbitale indicator.
 Card index

Scribing knife

Plastic cards

Bow compass

The Broadrick Occlusal Plane Analyzer

 The plastic cards are attached on the card index
 The Anterior survey point (disto incisal of cuspid) and the Posterior survey
point (disto buccal cusp of the last molar/condylar element of the articulator)
are selected and the arcs are drawn on the plastic card with the bow
compass with 4 inch radius. {In accordance with the Monson’s theory }
 Thereafter, the compass is placed on the intersection of the arcs and the
curve is evaluated. Importantly, the center of curve may be varied to achieve
the desired occlusal scheme but it should lie only on the long arc drawn from
the ASP.
 The desired curve is marked on the lower cast, mock preparation done and
then transferred on to the patients mouth with help of a template.
 The radii may be altered according to the skeletal relationship. For eg 3 3/4
inch radius for class II and 5 inch for class III relation.
 Common Occlusal Disharmonies

• Completely edentulous maxilla opposing mandibular natural teeth

with missing first molars or second pre-molars or both.
– Tilting of the distal molars and distal halves supra-erupted

– No occlusion in the protrusive and lateral excursions

– Easy dislodgement of during functional movements

• Insufficient mandibular teeth left to occlude with the maxillary

complete denture.
 Troubleshooting

• Reshaping by selective grinding if not severely tilted.

– The distal half of the tooth should be ground flat and the
denture teeth should be set to contact only that area, leaving
mesial cusps out of contact (Stephens).

• If moderate reduction is needed then cast gold crowns,

onlays or a fixed partial denture
– According to Brehend “in relation to the ideal occlusal plane, the
mesial cusps are usually too low and the distal cusps too high.
Thus the distal portion of the occlusal surface requires severe
reduction while the mesial portion may be left untouched.”
Brehend’s Technique
• If a large space exists mesial to the tilted molars,
designing of a removable partial denture can be done. The
mesial half can be restored with an onlay mesial rest and
lowering the distal half to achieve an acceptable occlusal
form.
• Another possible treatment plan would be orthodontic
repositioning of the tilted teeth. It would negate the need for
crowns but still some occlusal modifications may be required.

• Finally, if there is a severe tilt or supra-eruption and

modification is not possible then extraction is necessary.
If insufficient mandibular teeth are present opposing a

Maxillary Complete denture

• Although tolerable this may lead to loss of maxillary anterior ridge

with hyperplastic tissue changes.

• When all the molars are missing, removable partial denture

indicated.

• If teeth from the first molar to first molar remain then no partial
denture is needed except in a class II situation which will allow an
even distribution of stresses on the residual
maxillary ridge.
Achieving Harmonious

Occlusal Balance
 The various techniques fall in two categories

Those which dynamically Those which statistically

equilibrate occlusion equilibrate occlusion using a
using a Functionally Articulator programmed to
Generated Path simulate patients jaw
movements.
Functionally Generated Chew-in
Technique

These techniques do seem to provide the most

accurate method of recording occlusal pattern.
However,
Contraindications:
 The desired jaw movements and necessary record base
stability are not possible
 The denture space is inadequate.
 Physical and mental condition of the patient seriously
compromise effective cooperation.
 Stansbury (1951)
 He suggested using compound maxillary rim for
functionally generated chew-in technique.
 The compound maxillary rim trimmed buccally and
lingually
 Carding wax is added to the rim.
 The patient is asked to do eccentric chewing movements.
 The carding wax gets molded to the functional movements
and while compound in the central fossa prevents the loss
in vertical dimension.
 The stone is vibrated into the wax path of the cusps.
 The denture teeth are first arranged according to the
lower cast.
 After try-in is approved lower cast is removed and the
lower chewing cast is secured to the articulator.
 All interfering spots are carefully grounded.
 Thus maximum bilateral balanced occlusion will be
achieved.
 Vig’s technique (Robert G. Vig 1961)

 Preliminary impressions and base

 Upper and lower impressions are made, casts poured and denture base
fabricated with cold cure resin.

 Registration and mounting

 Centric relation at acceptable vertical dimension recorded
 Anterior teeth are arranged

 Preparing the chewing apparatus:

 The wax occlusion rim posterior to cuspid is removed.
 Resin in dough stage is placed on denture base and the articulator is
closed to press the resin against the occlusal surface.
 When set, the resin is trimmed so as to leave only a fin of resin in contact
with the central grooves of lower posterior teeth.
 Cusp and Sulcus analysis:
 The patient is directed to make a lateral excursions to bring tips
of the mandibular cusps in contact with the fin
 If most of the teeth do not contact the fin on lateral excursions
then the teeth must be ground until an equal contacts occurs
between the teeth and plastic.
 If most of the buccal cusps contacts the maxillary fin, but few do
not, the fin must be lengthened by deepening the central fossae
of teeth and building the fin with cold cure resin.
 Even contacts are achieved on both sides of arch.
 Holes about 1/4th inch apart are drilled and filled with sticky wax.
 The fin is then built up with wax according to the width of the
opposing tooth.
 Functional impression and Chew-in
 Tissue conditioning resin is added to the impression side and
base is seated in the mouth.
 After ½ hour patient is given thin slice of fruits like banana and
asked to chew normal pattern followed by vigorous chewing.
 The chewing pattern and impression surface are examined.
 If few areas expose : the resin is trimmed and relined
 If borders are exposed : resin is trimmed and relined
 If border unsupported : build with resin and reline
 The wax on the occlusal surface is rebuilt and the base is inserted
in patients mouth with instructions not to consume solid or hot
foods and to wear base all night.
 Forming the stone chew-in record
 Master cast poured without boxing
 Record is obtained for the waxed chew in
 The cast, record base, chew-in record and counter cast are
mounted on the articulator

 Arranging the posterior teeth

 The teeth are arranged according to the occlusal scheme
of the mandibular teeth and all the interferences in the
lateral excursive movements are removed with the help of
the chew-in record.
 Rationale of the technique
 Creates cuspal harmony in the non-functional glides
 Patients with limited motion, unusual patterns of masticatory
movements, persistent bruxism and other atypical situations can
be accommodated
 Functional impression is a reasonable and logical procedure as the
borders will be extended to the distance permitted by the
functional movements

 Contraindicated if the mucosa is so resilient that it can

allow shifting of the record base during the chew-in
phase.
 Kenneth D. Rudd and Robert M. Morrow (1973)

 Appointment I:
 Impressions are made
 Two resin base plates are constructed on the maxillary
cast.
 Appointment II:
 A tentative jaw relation record.
 Denture teeth are selected and positioned with the patient
present, the setup is completed for try-in.
 The duplicate denture base plate is placed on the cast and
the modelling plastic is warmed and the articulator is
closed.
  The posterior quadrant of the occlusal rim are trimmed.
 With the modelling plastic in occlusion position, a divider is used
to make vertical dimension reference measurement.

Appointment III:
• The waxed denture is inserted
and subjected to the usual
check.
• Recording wax for the
functionally generated path
procedure is added to the
occlusion rim.
• The patient is asked to do
mandibular movements.
Stone core:
 The generated wax path is carefully
boxed and stone is poured.
 The upper denture teeth are set or
ground to fit the generated path as
recorded in the stone core.
 Sharry(1968)

 Mentions a simple technique of using maxillary rim of

softened wax.
 Lateral protrusive chewing movements are made so
that the wax is abraded.
 Generating functional path of the lower cusps.
 This is continued until the correct vertical dimension
has been established.
Articulator Equilibration Technique

Indications:

 The denture base lacks stability.

 If the patient is physically unable
to form a chew-in record.
1. Upper cast is mounted on articulator using face bow.

2. Lower cast is related using inter-occlusal record.

3. Buccal lingual position of lower teeth and their relation

to the upper arch is studied and decision is taken
whether to articulate the denture teeth lower buccal
cusps or the lingual cusps.

4. Once the holding cusp have been selected the inclines

of remaining cusps are reduced.
The selection of the holding cusps depends according
to the lower occlusal scheme
 At the time of wax try-in eccentric records are made and
set on the articulator.
 The upper posterior teeth are arranged as close to being
balanced as possible at this time.
 The denture is processed again related to the articulator.
 Eccentric balance is achieved by grinding the interfering
buccal and lingual inclines of upper teeth.
 If any lower cusp make contacts the interferences are
removed.
Mandibular Single
Denture

To be or not to
be????
“The mandibular complete denture is an absolute
contraindication considering the underlying tissues
and their response to the occlusal stresses is not a
favourable one. The treatment plan can however
be carried out if a few roots are retained or by
placement of implants.”
 The mandibular single denture poses an even greater challenge to the
clinician.
 Severe residual ridge resorption of the edentulous mandible
makes conventional treatment nearly impossible.
 Relatively small area for support, limited quantity of the mucosa
often compound the problems.
 The impact of occlusal forces from the moving mandible
contacting the static dentate maxillary arch.
 Circumstances where a mandibular complete denture can be
given are:

1. Class III jaw relationship : the mandible is larger than normal and the
size and form of supporting tissues may be adequate to resist the
forces from opposing teeth.

2. Cleft palate patients : if the cleft is not entirely closed, retention of

upper denture may be difficult. Even if the cleft is closed, the denture
bearing area is too small and poorly formed .
 Eugene J. Tillman (1961)
 Had given the fundamental specification for denture construction.
 The specifications are:
 Understanding and proper execution of the requirements inherent in a
successful complete lower denture impression technique.
 A correct registration and recording of centric relation at a accurately
determined vertical dimension of occlusion.
 A correctly formulated scheme of occlusion.

 Use of endosseous dental implants to provide retention and support

for the mandibular complete denture and to retard residual bone
resorption.
 Single complete denture opposing existing complete
denture

 The decision to construct a single complete denture can be analyzed by

following questions.
 How long has the existing denture.
 Was the denture an immediate insertion at the time of tooth removal.
 Has the denture opposed another complete denture, a partially edentulous
arch.
 Does the posterior teeth form coincide with the physiology of the operator
concept of occlusion.
 If not, is there sufficient tooth remaining to allow selective grinding
procedure for alterations.
Rationale for Implants
in
Single Dentures
The single denture often leads to major tissue change like an irreversible bone
loss resulting from both local and systemic effects.

Such morphologic changes in the denture bearing foundation can lead to difficult
functional stability.

Even patients who demonstrate remarkable skill in manipulating the challenges of

such a prosthesis need to improve a foundation to ensure long term better
functional stability

Dental implants allows both enhanced function and a reduction in the irreversible
bone loss that leads to the instability.

With the use of implants we have

Preservation of the existing tissues especially bone

Better stress distribution pattern

Enhanced Stability
Occlusal materials
For
Single Denture
 Porcelain teeth:
 These teeth wear very slowly and therefore maintains a vertical
dimension.
 They are predisposed to fracture and chipping.
 More difficult to equilibrate.
 Causes rapid wear of opposing natural teeth.

 Acrylic resin teeth:

 Acrylic resin teeth causes no wear of the opposing natural teeth.
 They are easy to equilibrate.
 The major disadvantage of the resin teeth is their wear.
 Gold occlusals:
 Are considered the best material to oppose natural teeth.
 Their expenses and time involved in their fabrication make them
impractical for most patient.

 Acrylic resin with amalgam stops:

 The amalgam stop appears to reduce the occlusal wear.
 After the acrylic teeth have been balanced occlusal preparations are
made in the acrylic teeth.
 Amalgam is condensed into the preparation.
 IPN resin (Inter-penetrating Polymer Network):
 This was developed to minimize the disadvantages of acrylic
resin teeth and porcelain teeth.
 The material consists of an unfilled, highly cross linked
interpenetrating polymer network.
 Potential complications
of a
Single Complete Denture
Two most common adverse sequelae include
Natural tooth wear
 Use of porcelain teeth can lead to rapid wear of opposing natural
dentition.
 Best is to use acrylic resin denture teeth in conjunction with periodic
examination

Denture fracture
 Heavy anterior occlusal contact, deep labial freni notches and high
occlusal forces due to strong mandibular elevator musculature
 Carefully planned occlusion, adequate denture base thickness are
necessary to prevent fracture
 Still if the fracture potential is high, cast metal base is the best option
 Combination Syndrome (Ellsworth Kelly)
Seen in patients with completely edentulous maxilla and class I
partially edentulous mandible

Formation of hyperplastic tissue does not support the denture base in the
anterior maxilla.

The bone in ridge height are lost anteriorly, the posterior ridge becomes
larger enlarged tuberosities.

Supra-eruption of the mandibular anteriors.

Summary
and
Conclusion
 Single Complete Denture

Understanding the need and the

importance of implants in
Patient assessment achieving long term success and
and Evaluation enhanced functional stability of
the tissues

Achieving harmonious
Treatment plan for a
balanced occlusion by
long term success
functional of the
articulator equilibration
techniques

Assessment of
occlusion and its Strict clinical protocol
reorganization as per to be followed without
the indications any procedural errors
 References
 Zarb Bolender – Prosthodontic treatment of edentulous patients.
 Hartwell – Text book of complete denture.
 Sharry – Complete denture prosthodontics
 Sheldon Winkler – Essentials of complete denture
prosthodontics.
 Ellsworth Kelly – Changes caused by a mandibular removable
partial denture opposing a maxillary complete denture, JPD
2003; Vol.90(3): 213-219.
 Kenneth D. Rudd, Robert M. Marrow – Occlusion and single
denture, JPD 1973; Vol. 30(1): 4-11.
 Robert G. Vig – A modified chewing and functional impression
technique, JPD 1964; Vol. 14(2).
 Timothy R. Sauders, Robert E. Gillis and Ronald P. Desjarclins –
The maxillary complete denture opposing the mandibular
bilateral distal extension partial denture treatment
considerations, JPD 1979; Vol41(2): 124-128.
 Han Kuang Tan – Preparation guide for modifying the
mandibular teeth before making a maxillary single complete
denture, JPD 1997; 77: 321-322.
 L. Kirk Gardner et al – Using a tooth reduction guide for
modifying natural teeth, JPD 1990; 63: 637-639.
 Eugene J. Tillman – Removable partial upper and complete
lower denture, JPD 1961; 11(6): 1098-1105.
 Carl B. Stansbury – Single denture construction against a non
modified natural dentition, JPD 1951; 1(6): 692-699.