Single Complete Denture
Niaz Ahammed A
Contents
• Introduction
• Problems in single complete denture
• Diagnosis and treatment planning
-mouth preperations
-occlusal adjustments
• Modifying occlusal pattern
–
–
–
–
Swenson’s method
Yurkstas
Bruce method
Boucher’s method
• Achieving harmonious balance
– Functional chew in
– Articulator equilibriation
• Mandibular denture opposing natural maxillary
teeth
• Maxillary denture opposing RPD
• Maxillary denture opposing FPD
• Maxillary denture opposing CD
• Clinical procedures
• Occlusal materials
• Sequelae of single dentures
• Combination syndrome
Introduction
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
4.
An existing complete denture.
denture.
Problems in single complete denture
• High magnitude of forces that natural teeth
can exert on denture base
• Occlusal form of denture base-over eruption
or tilting and high or sharp cusps
Diagnosis and treatment planning
• Primary objective is to preserve the remaining
structures
• Factors to be considered are:
-Acceptable interocclusal records
-Stable jaw relationship with bilateral posterior
teeth contacts
-Forces directed along the long axis of the teeth
-Avoidance of adverse tooth contacts
Prosthetic treatment for edentulous patients; Zarb ,13thedition
Mouth preperation:
• Arch form in dentate jaw may not co ordinate
with the arrangement of denture teeth
• The remaining teeth may be tilted or supra
erupted
• The natural teeth can be ground or restored to
give a more suitable occluding surface and
grossly malpositioned teeth can be extracted or
orthodontically repositioned
Occlusal adjustments
• Natural lower cuspids and incisors are long
and often has to be ground
• Severely tilted and overerupted molars should
be considered for extraction
• If tilt is not extreme, distal half of occlusal
surface is ground flat and denture made to
contact with that area only
• Ideal treatment is to restore the tooth with
cast gold crown or onlay
• If there is a large edentulous space mesial to
the molar, a bridge or removable denture
should be inserted
Carl F. Driscoll and Radi M. Masri* proposed a classification system that could
simplify the identification and treatment of single denture 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
 Han Kuang Tan’s technique
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.
Complete denture prosthodontics: Sharry, 315
Yurkstas method (1968)
Method
involves the use
of a metal Ushaped 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.
*DCNA, July 2004: Vol 48; No.3
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
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.
Complete dentures opposing natural teeth: Bruce etal: JPD, November 1971
Boucher’s method
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.
Han-Kuang Tan
Make a vacuum formed clear
template over the cast with
Sta-Vac sheet 0.02 inch thick
The modified cusps are marked
and the template is re-seated.
Voids are seen at the prepared
areas.
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 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.
A preparation guide for modifying the mandibular teeth before making a
maxillary single complete denture Han- Kuang- Tang, JPD, 1997
Achieving Harmonious
Occlusal Balance
The various techniques fall in two categories
Those which dynamically
equilibrate occlusion using
a Functionally Generated
Path
Those which statistically
equilibrate occlusion using a
Articulator programmed to
simulate patients jaw
movements.
Functionally Generated Chew-in Technique
These techniques 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)
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.
Single denture construction against non-modified natural dentition: JPD,
November, 1951
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 to make a
stone cusp path record
and chewing cast
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.
Modified chew in tech- RG Vigg, JPD, April 1964
• 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
in contact 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 chewin 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
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:
Appointment
II:
• Impressions are made
• Two resin base plates are constructed on the maxillary
cast
• 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
Occlusion and single denture; Rudd , Morrow; JPD July, 1973
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.
Complete Denture Prosthodontics; Sharry 317
Articulator Equilibration Technique
Indications:
 The denture base lacks stability.
 If the patient is physically unable to form a chew-in record.
Essentials of complete denture prosthodontics 2nd ed, Sheldon Winkler, 421-24
Upper cast is mounted on
articulator using face bow.
Lower cast is related using interocclusal record.
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
with lower buccal cusps or the
lingual cusps.
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 and 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 other
than holding cusp the interferences are
removed.
• Mandibular Denture to Oppose Natural
Maxillary Teeth:
 Seldom this condition does occur.
 It usually happens as a result of surgical or accidental trauma.
 An example of surgical trauma is the removal of the mandibular
teeth for persons who have to undergo irradiation therapy for a
tumor.
Complicating factors for the single mandibular
complete denture opposing natural teeth
1.The denture supporting tissues for the mandibular complete denture is
relatively small compared to the maxillary supporting tissue.
2.The mucosa with tightly attached submucosa overlying the periostium
and bone of the lower residual ridge is thin.
3.For the above two reasons, the underlying bone is extremely prone to
resorption from occlusal forces of the natural teeth.
4. Impact of occlusal forces from moving mandible
Heartwell; syllabus of complete dentures, 488-89; Zarb;12th edition
There are two situations When a mandibular complete
denture, opposing upper natural teeth are accepted:
1.When the patient has a class III jaw relationship.
This occur when the mandible is larger than
normal or the maxilla is smaller than normal.
2.When the patient has a cleft palate,
Eugene tilman; removable partial upper and
lower complete dentures
( jpd,nov- dec, 1961)
• A posterior occlusion employing nonanatomic teeth aids in the stability
and reduces the displacing forces encountered in mandibular movements
during mastication.
• The lower anterior teeth must be arranged for esthetic appearance
• A plane of occlusion is constructed on the lower base beginning at the
height of the cusp of the lower cuspid and extending distally parallel with
the crest of the lower ridge
Single Complete Maxillary Denture to Oppose Natural
Mandibular Teeth
The diagnostic procedures should determine that;
i.
there are sufficient teeth in the mandibular arch,
ii.
periodontal health is acceptable, and
iii. there are no missing teeth to be replaced.
Syllabus of complete Dentures; Heartwell, pg- 490-92
Some times the positions of the mandibular anterior teeth will not allow
the maxillary anterior teeth to be positioned in an esthetically acceptable
manner or for balanced occlusion. This problem may be resolved as
follows:
1. Reposition the natural teeth with orthodontic procedures.
2. Alter the clinical crowns of the teeth by grinding or with restorations.
3. Accept balanced occlusion with the jaws in centric relation and not in the
eccentric positions.
• The occlusal forms of the natural teeth usually act as the guide in selecting
the occlusal form for the maxillary posterior teeth.
• In most situations this would be a cusp tooth
• But if the natural teeth are abraded and are not restored prior to treatment,
the monoplane form may be the choice for the occlusal surfaces of posterior
teeth.
• When the mandibular teeth are malposed or missing, selective grinding
procedures can be employed
• When occlusal surfaces have large food tables , they can be altered by
removing some enamel from buccal and lingual surfaces
Single Complete Maxillary Denture to Opposing
Natural Mandibular Teeth with fixed prosthesis
•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 existed previously
•The occlusion between the denture teeth and the fixed
restorations is harmonized on an articulator
Single complete dentures; Ellinger. JPD; Nov, 1951
Complete maxillary denture to oppose a partially edentulous arch and a
removable partial denture
 The most frequently encountered situation for a single complete denture
 Replacement of missing posterior teeth in lower arch will improve the
prognosis of upper denture
 But in class II jaw relation, lower anterior teeth and premolars is enough
Single complete dentures; Ellinger. JPD; Nov, 1951
• A complete upper denture should not be constructed to oppose only 6-8
lower natural anteriors, unless replaced by RPD
• If not loss of bone and formation of hyperplastic tissue can form in
anterior maxilla
• Lower RPD is usually indicated when all molars are missing
• If all teeth through the first molars are present RPD may not be indicated
• If all teeth through premolars on one side and molars on other side are
present, RPD may not be necessary
• In some cases missing molars may be restored with cantilever type of FPD
Clinical procedures for making complete
upper denture opposing natural or fixed
restoration- Ellinger etal- JPD, July,1971
• Make Impression of lower arch of irreversible
hydrocolloid and pour artificial stone
• Make Preliminary upper impression and final
impressions of upper arch made and pour the
cast
• Construct occlusion rim and contour it for
adequate lip support
• Use face bow and mount maxillary cast on
articulator
• Establish the VDO
• Make preliminary centric relation record
• Select artificial teeth and arrange them in
centric occlusion
• Make eccentric records and transfer it on to
the articulator
• Rearrange posterior teeth to obtain balanced
occlusion
• Alter occlusal surfaces of teeth on stone cast
to provide balanced occlusion and outlined
• After the teeth are recontoured, make
preperations for restorations that are planned
for fixed or removable prosthesis
• An impression is made and and mount cast on
articulator ,and carve the wax patterns to the
existing occlusion of denture teeth
• Place restoration in mouth and make final
impression
• Make a new centric relation record and
remount the lower cast
• Teeth are arranged in the most nearly ideal
balanced occlusion
• Perfectly balanced occlusion in all eccentric
positions may not be possible for every patient
when working with natural teeth
Single Complete Denture to Oppose an Existing
Complete Denture
• The existing denture should be satisfactory if it is used for
fabrication of single complete dentures




The teeth should be
Aligned with respect to residual alveolar ridge for mechanical
stability and masticatory efficiency
Have good appearance
Exhibit proper tissue support
Have cusp height suitable for the teeth of planned denture
Single complete dentures; Ellinger. JPD; Nov, 1951
The denture base should
 Have esthetic contour and thickness to support peri oral structures
 Be extended to utilize all available supporting tissues
 Be stable and retentive
Unfortunately, few dentures fulfill all these criteria and in such cases the
prognosis is poor
OCCLUSAL MATERIALS FOR SINGLE DENTURES
• Artificial Tooth Material
 Plastic
 Porcelain
 Metal
 Amalgam
 Cast gold occlusals
OCCLUSAL MATERIALS FOR SINGLE DENTURES
1)Porcelain teeth:
1.Wear slowly and vertical
dimension of occlusion is
maintained.
2.Cause fracture and chipping
when opposed to natural teeth
and are difficult to equilibrate.
3.Cause wear of natural teeth
2) Acrylic resin teeth :
1.Easy to equilibrate and cause
no wear of natural teeth
2.Disadvantages: These teeth
wear after a period of time and
cause loss in vertical dimension.
3) Acrylic resin with amalgam stops:
• Amalgam inserts reduce occlusal wear
• Less expensive and time consuming
Technique:After the acrylic teeth
have been balanced,
occlusal preparations
are made in the
acrylic teeth,
extending to include
as much of the
articulating paper
tracing as possible.
Amalgam is
condensed into these
preparations and
articulator is gently
closed, going side to
side, back and forth
until the incisal guide
plane is again flush
with the guide pin.
Articulator generated amalgam stops for cd, Lauciello, JPD, 1979
4) IPN Resin:
1.Consists of unfilled, highly
cross-linked,
interpenetrating polymer
network.
2. Wear is significantly less
as compared to acrylic resin.
5) Gold occlusals:
1.These are considered one of the
best materials to oppose natural
teeth though it is an expensive
and a time consuming process.
2.When one or more gold occlusal
surfaces are provided on either
side of the single complete
denture, they will stop the
abrasion between unlike materials
and protect the other teeth from
wear.
Use of gold occlusal surfaces in complete and
partial dentures-Wallace DH;JPD, 1964
• The denture is processed with acrylic resin teeth and all occlusal
adjustments are made
• Occlusal index or counter die is made of the denture teeth
• The occlusal surface of the posterior denture teeth is reduced by 1mm
• Occlusal index is used to make a wax pattern with inlay wax
• The wax patterns are cast and then cemented with selfcure acrylic resin
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
Prosthodontic ttm for edentulous patients; Zarb, 12th ed pg-432
Combination Syndrome
According to GPT8• “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 tuberosities,
 papillary hyperplasia of the hard palatal mucosa,
 extrusion of mandibular anterior teeth, and
 loss of alveolar bone and ridge height beneath the
mandibular removable partial denture bases,
Also called anterior” hyperfunction syndrome.”
Five changes constitute a Combination
syndrome
These are quite characteristic.
(1) loss of bone from the anterior part of the maxillary ridge,
(2) overgrowth of the tuberosities,
Changes caused by mandibular rpd opposing maxillary cd, Kelly E, JPD february,
(3) papillary hyperplasia in the hard palate,
(4) extrusion of the lower anterior teeth, and
(5) the loss of bone under the partial denture bases.
Saunders et al; stated that six other changes are
commonly associated with this clinical scenario:
 Loss of vertical dimension of occlusion
 Occlusal plane discrepancy
 Anterior spatial repositioning of the mandible
 Poor adaptation of the prostheses
 Epulis fissuratum
 Adverse periodontal changes
Kelly's Hypothesis
Bone resorption in the maxillary
anterior region initiates the
changes.
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.
Changes caused by mandibular rpd opposing maxillary cd, Kelly E, JPD february,
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.
Changes caused by mandibular rpd opposing maxillary cd, Kelly E, JPD february,
PREVENTION OF THE COMBINATION SYNDROME
 Treatment planning should avoid the necessity for such a combination.
 Eliminate the combination of complete upper dentures opposing Class
I lower partial dentures by retaining weak posterior teeth as abutments
by means of endodontic and periodontic techniques.
Combination syndrome, a treatment report : Schmitt, JPD, Nov, 1985
 Endosseous endodontic implants
 Amputation of one lower molar root to preserve the other as an
abutment
 An overlay denture on the lower
 Overlay dentures utilizing the lower tooth roots for stabilization
provide a complete denture occlusion.
Saunders et al; recommended that the essential objective of treatment
planning in these cases was
“ To provide an occlusal scheme that could best discourage excessive
occlusal pressures in the maxillary anterior region in both centric and
eccentric occlusal contacts”.
Summary