Single Complete Denture Techniques

SINGLE COMPLETE DENTURE
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

CONTENTS
• INTRODUCTION
• DIAGNOSIS AND TREATMENT PLANNING
• TOOTH MODIFICATION TECHNIQUES
• METHODS USED TO ACHIEVE A HARMONIOUS BALANCED
OCCLUSION
– FUNCTIONAL CHEW IN TECHNIQUE
a) Stansbury procedure
b) Vig
c) Rudd
d) Sharry
– ARTICULATOR EQUILIBRIUM TECHNIQUE

• COMBINATION SYNDROME
• LOWER SINGLE COMPLETE DENTURE
• SINGLE COMPLETE DENTURE OPPOSING AN EXISTING
COMPLETE DENTURE
• OCCLUSAL MATERIALS FOR THE SINGLE DENTURE
• SUMMARY AND CONCLUSION
• REFERENCES

Introduction
• The primary consideration for continued
denture success with a single conventional
complete denture is the preservation of that
which remains.
• Many difficulties confront the dentist
rehabilitating the patient…….
• Unfavourable occlusal relationship exist that
results…….
• Various measures…..

• A single complete denture opposing 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.www.indiandentalacademy.com

Diagnosis & Treatment Planning
• The commonly seated long term goal in
prosthodontics is the preservation of what
which remains.
• Prior to any occlusal modifications of the
natural teeth.
– First make final impression and mount the cast.
– Mount diagnostic cast using provisional centric
interocclusal record.
– Eccentric records are made and articulator is
programmed.
– Whatever adjustments that may be necessary be
properly planned.www.indiandentalacademy.com

Classification
• This classification system can simplify the
identification and treatment of the patient.
– Class I – Patient from whom minor or no tooth reduction is
all that is needed to obtain balance.
– Class II – Patient from 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.

Tooth modification techniques
• Most natural dentitions do not exhibit any
degree of bilateral occlusal balance.
• Several techniques prior to denture construction
are as follows:
– Swenson’s technique
– Yurkstas method
– Bruce method
– Boucher method
– L. Klirk Gardner et al (1990)
– Han-Kuang Tan (1997)www.indiandentalacademy.com

Swenson’s method
• The maxillary mandibular cast are mounted on
articulator.
• A maxillary base is made and 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.
• After the occlusal modifications new diagnostic cast of
the lower arch is made and mounted on the articulator.

Yurkstas method
• Method involves the use of a metal U-shaped
occlusal template.
• Cusps to be adjusted are identified.
• The stone cast is modified.

Bruce method
• The lower diagnostic cast is mounted necessary
modifications are made on the stone cast.
• A clear acrylic resin template is fabricated on
the stone cast.
• Interferences are noted through template and
are reviewed by reshaping the occlusal anatomy
until the template seats properly.

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.
• Maxillary artificial teeth are arranged.
• If the natural teeth prevents this 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.
• The occlusion is refined using arch shaped baseplate
wax.

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 clear template over the mandibular cast
with .02“ thick.
• Mount the maxillary mandibular cast.
• Arrange maxillary teeth.
• Grind both the denture teeth and natural stone
teeth on the mandibular cast to achieve best
possible articulation.

Methods used to achieve harmonious balanced
occlusion
Basically two types:
1. Those that dynamically equilibrate the occlusion by the use
of a functionally generated path.
2. Those that statistically equilibrate the occlusion using an
articulator.
Functionally generated chew in technique:
Indications:
– Restoration of an edentulous arch that is opposed by natural teeth.
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 then added.
• The patient is asked to do mandibular movement.
• The carding wax get moulded to the functional movements.
• The stone is vibrated into the wax path of the cusps.
• The denture teeth are first set to the lower cast.
• After try-in is approved lower cast will be removed and the
lower chewing cast will be secured to the articulator.
• All interfering spots are carefully grounded.
• Thus maximum bilateral balanced occlusion will be achieved.

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
occlusion in position divider are
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.

Robert G. Vig (1964)
• Upper and lower impressions are made.
• Registration and mounting:
• Preparing the chewing apparatus:
– The wax occlusion rim posterior to cuspid are removed.
– Dough stage resin is placed on denture base and the
articulator is closed.
• Cusp and sulcus analysis:
– The patient is directed to make a lateral excursions….
– The tooth 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……
– The fin is build-up with Tenex wax.www.indiandentalacademy.com

• The functional impression and chew-in:
– Tissue conditioning resin is added to the impression
side and base is seated in the mouth.
– The patient is dismissed for a period of ½ hour.
– After ½ hour patient is given thin slice of fruits….
– The chewing pattern and impression surface are
examined.
– The base is inserted again and the patient is
dismissed until the following morning.

• Forming the stone chew-in record:
– The master cast is carefully poured into the
impression.
– Dental stone is carefully poured into the chew-in
record.
• Articulator mounting:
– The cast recording base chew-in record and the
counter cast are mounted on the articulator.
– The teeth are ground until the vertical stop
articulator is seated and both cusps and contact.

• Sharry:
– 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
interocclusal record.
3. Buccal lingual position of lower
teeth and their relation to the
upper arch is studied and decision
is taken…...
4. Once the holding cusp have been
selected the inclines of remaining
cusps are reduced.www.indiandentalacademy.com

– 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.

The combination syndrome
• Complete denture opposing partial lower denture:
– Ellsworth Kelly 2003
– A destructive change seen in the patient with maxillary
complete denture and a mandibular bilateral distal-extension
partial denture.
– Kelly refers to a combination syndrome which consist of

– The anterior part of the
maxilla is the weakest part of
the upper arch to resist stress.
– The hyperplastic tissue does
not support the denture base.
– The bone in ridge height are
lost anteriorly, the posterior
ridge becomes larger with the
development of enlarge
tuberosities.
– Migrates up in the anterior and
down in the back.
– After some time the natural
anterior teeth migrates
upward.

• Mechanics:
– The resorption of bone in the
anterior region initiates the
change.
– The maxillary denture moves up
in the anterior region and down
in the posterior region in
function...
– Vertical dimension is likely to be
decreased and the occlusal plane
gradually becomes lower
posterior.
– The change in the occlusal plane
encourages protrusive occlusal
contacts with a risk of extrusion
and flaring of the mandibular
anterior teeth and associated
periodontal change.www.indiandentalacademy.com

– With the PPS a negative pressure is produced.
– This negative pressure may account for the enlarge
tuberosities and the papillary hyperplasia.
• Prevention of the combination syndrome:
Systemic Dental Considerations:
– A complete review of the patient’s medical and dental
history is essential.
– Stahl and associates have stated that patients with systemic
disease shows increased amount of bone resorption and
compared to the healthy patients.
– Clinical radiographic evaluation of both hard and soft tissues
is an essential preliminary step in treating these patients.

• Kelly’s advocate to retain weak posterior teeth as abutments by
means of endodontic and prosthodontic treatment.
• Endosseous endodontic implants:
• An overlay denture on the lower may avoid the combination
syndrome from developing.
• Treatment planning:
– Initially treatment must concentrate on periodontal and restorative needs
of remaining teeth.
– Direct and indirect components of retention must be considered in their
ability to place additional stress on the natural teeth.
– Maximal extension, border seal, and tissue detail to ensure retention.
– No incisal contact of the anterior teeth.
– Balanced occlusion should be developed.

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.www.indiandentalacademy.com

Mandibular Single denture
• The mandibular single denture poses an even
greater challenge to the clinician.
– The situation often compounded by residual ridge
resorption of the edentulous mandible which makes
conventional treatment nearly impossible.
– Disadvantages: limited quantity of the mucosa, the
amount of denture border against the moveable
mucosa.
– The impact of occlusal forces from the moving
mandible contacting the static dentate maxillary
arch.

• 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 endoosseous dental implants to provide retention and
support for the mandibular complete denture and to retard
residual bone resorption.

Rationale for implants in the single complete
denture
• The changes in the denture supporting tissues is
variable but inevitable.
• The major tissue change is 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.
• Need to improve the denture foundation to ensure
better functional stability.
• Dental implants allows both enhanced function and a
reduction in the irreversible bone loss that leads to the
instability.

Occlusal materials for the single
complete 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:
– 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:
– 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.

Summary & Conclusion
• The decision to make a single complete denture cannot
be considered lightly.
• Carefully observation and recording of all diagnostic
information must be considered before a decision is
reached to construct a single complete denture.
• Certain conditions must be evaluated and corrected
early in treatment to provide for a more stable
prosthesis.
• The unique biomechanical features of the patient with
a single denture should be emphasized and method for
controlling denture tooth and opposing to position to
maximum stable functional relationship.

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).www.indiandentalacademy.com

• 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 – Usinga 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.www.indiandentalacademy.com

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Single Complete Denture Techniques

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