SINGLE COMPLETE DENTURE

INTRODUCTION

• Maxillary single complete denture opposing mandibular natural

dentition is common

• Mandibular canines are four times more commonly retained

compared to other teeth

• Malposed , tipped, or super erupted teeth of the opposing arch

difficulty in achieving harmonious balanced occlusion.
• Fixed position of mandibular anterior teeth  difficulty in positioning
of maxillary anterior teeth
DIAGNOSIS AND TREATMENT
PLANNING
• Preservation of that which remains

Salient occulsal biomechanics consideration:

Acceptable interocclusal distance
Stable jaw relationship with bilateral tooth contacts in CR
Axially directed forces
Multidirectional freedom of tooth contact throughout a small range
of mandibular movement.
Unfavorable force distributions may cause adverse tissue changes that
compromise optimum function
Extensive morphologic changes in denture foundation
Jaw relationship extremes
Excessively displaceable tissues
Combination syndrome

• Specific oral destructive changes are often seen in patients with a

maxillary complete denture and a mandibular distal extension partial
denture. These changes have been referred to as the 'Combination
Syndrome'
Combination syndrome
• Clinical changes

Ellsworth Kelly was the first person to use the term 'Combination Syndrome'.
• He described five signs or symptoms that commonly occurred in this situation
• They include:

1. Loss of bone from the anterior part of the maxillary ridge.

2. Overgrowth of the tuberosities.

3. Papillary hyperplasia in the hard palate.

4. Extrusion of the lower anterior teeth.

5. The loss of bone under the partial denture bases.

Signs &symptoms of combination
syndrome
Pathogenesis
• Saunders et later described six additional signs associated with the
syndrome

• They include:

1. Loss of vertical dimension of occlusion.

2. Occlusal plane discrepancy.

3. Anterior spatial repositioning of the mandible.

4. Poor adaptation of the prostheses.

5. Epulis fissuratum.

6. Periodontal changes.
Prevention of combination syndrome

• Avoid combination of complete maxillary dentures opposing class I

mandibular RPD.

• Retaining weak posterior teeth as abutments by means of

endodontic and periodontic techniques.

• An overdenture on the lower teeth.

CLINICAL & LAB PROCEDURES
• Final maxillary and mandibular impressions made
• Maxillary cast mounted on the articulator using a facebow
• Mandibular cast mounted using centric interocclusal record
• Using eccentric records the condylar guidance is adjusted
• Teeth are arranged with proper inclination and overlap
TECHNIQUES FOR TOOTH
MODIFICATION
SWENSON (1964)
Casts are mounted on the articulator
Maxillary record base is made and denture teeth are set
If the lower natural teeth interfere, they are adjusted and those
areas are marked with pencil
Then, the natural teeth are modified using this marked cast as a
guide.
YURKSTAS (1968)
Metal U – shaped occlusal template, slightly convex
BRUCE (1971)
A clear acrylic resin template is fabricated
Inner surface of the template is coated with pressure indicating paste
and placed over the teeth
Interferences are identified and removed
BOUCHER (1975)
Maxillary porcelain teeth are used
If the natural teeth prevent balancing, the interferences are removed by
the movement of porcelain teeth
The areas to be reshaped are marked and used as a guide
COMMON OCCLUSAL DISHARMONIES
How to correct?
Stephens method
– reduce the distal
half of the last
molar flat
Prepare the tooth
and place onlay or
fixed partial
dentures
Orthodontic
correction
METHODS TO ACHIEVE BALANCED
OCCLUSION
Two categories:
Those that dynamically equilibrate the occlusion by the use of a
functionally generated path
Those that functionally equilibrate the occlusion using an articulator
programmed to simulate patients jaw movements
FUNCTIONAL CHEW-IN TECHNIQUE
Most accurate method for recording occlusal patterns
CONTRAINDICATIONS
Unstable record bases
Poor neuromuscular control
Poor mental competence

Stransbury (1928)
Compound maxillary occlusal rim trimmed bucally and lingually
• Carding wax is then added to the rim and the patient is instructed to
perform eccentric movements.

• The carding wax is slowly molded to the functional movements.

• The generated occlusal rim is removed from the mouth and stone is
poured into wax paths of the cusps
• The upper cast with the rim is fastened to the articulator

• Denture teeth are set in relation to patients lower cast

• Lower cast is removed and FGP is then secured

• All interfering spots are removed in centric and in eccentric movements

ARTICULATOR EQUILIBRATION
TECHNIQUE
• The upper and lower cast is mounted on the articulator
• The buccal lingual positioning of the teeth are studied

To articulate the central fossa of the denture teeth to the lower

buccal or lingual cusps
• At wax try in eccentric records are made and the condylar inclinations
are set
• Denture is processed
• Again mounted in relation to the lower cast
• The centric holding cusps are reestablished by selective grinding
• To avoid accidental removal of the contacts two colors of articulating
paper is used
one to mark centric contacts
one to mark eccentric contacts
• The eccentric contacts are ground until a relatively continuous area of
contact is noted on the buccal and lingual cuspal inclines
• The end result is harmonious balanced occlusion that allows freedom in
lateral excursions while maintaining maximum bilateral contacts in
functional and parafunctional activites.
POTENTIAL ADVERSE TREATMENT
OUTCOMES
Natural tooth wear
Maxillary porcelain denture teeth causes wear of the opposing natural
teeth
Best strategy is to employ new generation acrylic /composite resin
denture teeth
Denture fracture
Specific conditions that cause fracture are
heavy anterior occlusal contact
deep labial frenal notches
 High occlusal forces due strong mandibular elevator musculature
MANDIBULAR SINGLE COMPLETE DENTURE

• Compounded with finding of sever residual ridge resorption

• Limited quality of mucosa
• Greater impact of occlusal forces from maxillary arch

The use of endosseous implants to provide retention and support for

mandibular complete denture and to retard residual bone resorption.
CONCLUSION

• The patient requiring a single complete denture challenges the clinician

even more than the completely edentulous patients
• This is because of the biomechanical differences in the supporting
tissues of the opposing arches.