single denture pdf - Dr.Munia

Dr. Monia MN Kandil

Single Upper Dentures

Opposing:

Single Lower Dentures

Opposing:

Upper Natural Dentition

Natural dentition

Partial lower denture

Over load on the Single Denture

How To Overcome These Problems

Applying

the principles of CD

construction

Maximum

base

extension

within functional anatomical limits.

Reduction

of the forces

to which the

denture is subject 

Occlusal

Adjustment and Tooth Modification 

Balance occlusion

Occlusal Plane Discrepancies

Tooth Reduction Protocol

• Confirm pulpal maturity (X-rays, EPT)

• No anesthesia

• Begin with teeth requiring most reduction

Preparing Plane of

Occlusion

Individual Tooth

Modifications

•Sharp Unworn
Cusps 

Reduce

cuspal inclination.

•Heavily Abraded
Teeth 

Reduce Bu-Li

width.

Tooth modifications and

occlusal adjustment

I- Swenson’s Technique

II- Bruce Technique

III- Yurkstas’ Technique

IV- Boucher’s Technique

V- Custom Template-Resin

Techniques

Swenson’s Technique

• Denture teeth are set and

when the natural teeth

interfere with placement of

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.

Bruce Technique

The  Modifications  are
made on the stone cast.
A  clear  acrylic  resin
template  is  fabricated
over the modified stone
cast  &  with  pressure
indicated  past  on  the
internal  surface  of  it  ,
the  unfavorable  areas
are  shown    remove
them.

The interferences are removed by

maxillary porcelain teeth

movement of the

over the mandibular stone teeth.

Prematurity's 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.

Boucher Technique

The use of a metal U-shaped occlusal

template that is slightly convex on the

lower surface is placed on the occlusal

surfaces of the remaining teeth.

20° Template

Yurkstas Technique

Custom Template – Resin

Techniques

I - Statically equilibrated occlusion using a

programmed articulator to stimulate the
patient’s mandibular movements.

a- Articulator equilibrated technique.

b- Articulator generated path technique.

II - Dynamically equilibrated occlusion by the

use of functional generated path technique

(Functional chew-in techniques)

Methods Used To Achieve

Balance Articulation:

Statically equilibrated occlusion

a- Articulator equilibrated technique.

Statically equilibrated occlusion

b- Articulator generated path technique

before

after

By  using  a  cavity  preparation  in  the  occlusal  surface  of
artificial teeth, like Class I. filled with amalgam like material,
that  altered  according  to  articulator  functional  movements
which  simulate  the  chewing  action  of  human  ,  as  much  as
possible.

Dynamically equilibrated occlusion:

Functional generated path technique

(Stansbury, 1928)

•An upper bit-rim of compound (preserve VD),  that
trimmed  buccaly  &  lingually  for  lat.  freedom
movements,  covers  with  Carding  wax    that
molded

inside

patient’s mouth (developing

functional occlusion path).
•Pouring  the  Carding  wax  with  stone  give  us  a
model  represent  the  functional  path  of  lower
natural teeth.
•Arranged upper teeth first related to conventional
lower teeth, then to the lower model represents the
“functionally generated occlusion”.

Functional generated path technique

(Stansbury, 1928)

Artificial Tooth Material

• Plastic (acrylic , cross linked resin )
• Porcelain
• Metal (casted)
• Acrylic with

gold occlusal surface,

malgam stoppers.

1- Porcelain teeth

2- Acrylic resin teeth

3- Acrylic resin with gold occlusal

surfaces

4- Acrylic resin with amalgam

stops

5- Cross-linked resin

Implant Assisted Overlay Maxillary

Dentures Against lower natural teeth

Occlusion is

bilateral balance

in such

patients

Single denture opposing

distal extension RPD

Difficulties of Maxillary Single

Denture Against Free Exten. Partial

Mandible

Occlusal

discrepancies

Excessive load

Combination

syndrome

Denture

fracture

Teeth abrasion

Esthetic

limitation

Combination Syndrome

A specific pattern of resorption

when anterior mandibular teeth

are retained and are opposed by

a complete maxillary denture.

The premaxilla undergoes severe

resorption

and

usually

accompanied by the development

of fibrous hyperplasia of the

maxillary tuberosity.

When mandibular anterior teeth remain, patient will

attempt to function in protrusive relationship top sense

feeling of mastication

Combination Syndrome

As bone is resorbed from maxillary anterior

ridge, denture will tip upward anteriorly and

downward posteriorly  V. D. O. will begin to

decrease

The change in the

angulation of the

occlusal plane

may contribute

to the loss of

support for the

remaining

natural teeth or

precipitate

periodontal

changes.

The irritated labio-buccal flange of the denture can

be develop

Epulis Fissuratum

, and associated

with overgrowth of fibrous tissue covering the

maxillary tuberosities.

The Combination Syndrome is a

Result of Three Main Factors

• The great magnitude of forces

involved.

• The unsuitability of the denture

foundation to resist them.

• Particularly

unfavorable

occlusal

relationship.

1- With some

careful grinding

of the canines

we can produce

a bilateral

balanced

occlusion

Single denture opposing

distal extension RPD

2- Occlusal rests

have been used to

idealize the

occlusal plane.

balancing ramp

are compatible

and bilateral

balance is

maintained.

Single denture opposing

distal extension RPD

Osseointegrated Implants Overlay

Denture against Lower Partial Arch

3- Implant is recommended, they prevent tipping of

the denture anteriorly and provide additional

retention and stability. The occlusion should still be

designed to provide bilateral balance. Otherwise,

the excessive tipping forces and lateral loads will

lead to an excessively high implant loss rate.

Note:

Resilient attachments

on the distal sides of the bar
bilaterally, are preferred.

Osseointegrated Implants Overlay Denture

against Lower Partial Arch

Edentulous Mandible Opposing

Dentate Maxilla

Difficulties:

1. Excessive load

2. Occlusal problems

3. Fracture

4. Tooth wear

5. Tissue abuse

6. Minimal denture foundation area

A lower complete denture

opposing upper natural teeth

should be

avoided

. A lower

complete denture opposing upper

natural teeth is

acceptable

for

patients with class III jaw relation.

and for a patient with cleft palate.

Edentulous Mandible Opposing

Dentate Maxilla

Edentulous Mandible Opposing Dentate

Maxilla

Lower single dentures are contraindicated

because they cause severe resorption as seen in

this patient. In past years many prosthodontists

recommended extraction of the remaining

maxillary teeth. Today other options are

available.

• Maximize denture base coverage
• Minimized occlusal forces
• Preprosthetic surgery
• Retention of key roots
• Use of osseointegrated implants
• Temporary soft liners replaced on a regular

basis

• Permanent soft liners

Options other than extraction of maxillary dentition For

Preservation of the Residual Alveolar Ridge

Edentulous Mandible Opposing Dentate Maxilla

You could…..

Lower Ridge Augmentation is

done, if the lower R.R. was so

resorbed.

Retained Roots can Used to Support

Over Denture

Osseo-integrated

Implants

Opposing

Dentate

Maxilla

This  type  of  prosthesis  stops  the  process  of
resorption of the mandible.  It is therefore the
most  desirable  method  for  restoring  the
edentulous mandible that opposes a fully dentate
maxilla.