Single complete denture/ academy laser dentistry

SINGLE COMPLETESINGLE COMPLETE
DENTUREDENTURE
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
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CONTENTSCONTENTS
1)1) INTRODUCTION.INTRODUCTION.
2)2) PROBLEM WITH SINGLE COMPLETE DENTURE.PROBLEM WITH SINGLE COMPLETE DENTURE.
3)3) COMMON OCCLUSAL DISHARMONIES ANDCOMMON OCCLUSAL DISHARMONIES AND
WAYS TO ADJUST THEM.WAYS TO ADJUST THEM.
4)4) SINGLE COMPLETE DENTURE OPPOSINGSINGLE COMPLETE DENTURE OPPOSING
A)A) NATURAL TEETH.NATURAL TEETH.

B)B) RPDRPD
C) FPDC) FPD
D) EXISTING COMPLETE DENTURED) EXISTING COMPLETE DENTURE
E) IMPLANT SUPPORTEDE) IMPLANT SUPPORTED
PROSTHESIS.PROSTHESIS.
5) METHODS TO ACHIEVE5) METHODS TO ACHIEVE
BALANCED OCCLUSIONBALANCED OCCLUSION

6) CINICAL PROCEDURE OF MAKING6) CINICAL PROCEDURE OF MAKING
SINGLE COMPLETE DENTURE.SINGLE COMPLETE DENTURE.
7) OCCLUSAL MATERIALS FOR SINGLE7) OCCLUSAL MATERIALS FOR SINGLE
COMPLETE DENTURESCOMPLETE DENTURES
8) SUMMARY8) SUMMARY
9) CONCLUSION9) CONCLUSION
10) REFERENCES10) REFERENCES

INTRODUCTIONINTRODUCTION
Many patients become edentulous in one archMany patients become edentulous in one arch
while retaining some or all of their natural teethwhile retaining some or all of their natural teeth
in the opposing arch. In this situation a singlein the opposing arch. In this situation a single
complete denture is fabricated.complete denture is fabricated.

A single complete denture may be desirableA single complete denture may be desirable
when it is to oppose any one of them:when it is to oppose any one of them:
1.1. Natural teeth that are sufficient in number notNatural teeth that are sufficient in number not
to necessitate a fixed or removable partialto necessitate a fixed or removable partial
denture.denture.
2. A partially edentulous arch in which missing2. A partially edentulous arch in which missing
teeth have been or will be replaced by RPD.teeth have been or will be replaced by RPD.

3. A partially edentulous arch in which missing3. A partially edentulous arch in which missing
teeth have been or will be replaced by FPD.teeth have been or will be replaced by FPD.
4. An existing Complete denture.4. An existing Complete denture.
5. Implant supported Complete denture.5. Implant supported Complete denture.

Dentist faces many difficulties in rehabilitatingDentist faces many difficulties in rehabilitating
the patients with this clinical pattern.the patients with this clinical pattern.
Malposed, tipped, or supraerupted teeth make itMalposed, tipped, or supraerupted teeth make it
difficult to achieve a harmonious balanceddifficult to achieve a harmonious balanced
occlusion and also interfere in proper placementocclusion and also interfere in proper placement
of artificial teeth to achieve adequate esthetics.of artificial teeth to achieve adequate esthetics.
As a result of unfavorable occlusalAs a result of unfavorable occlusal
relationships there is a tendency of denture torelationships there is a tendency of denture to
get displaced, causing soreness, mucosalget displaced, causing soreness, mucosal
changes and ultimately ridge resorption.changes and ultimately ridge resorption.

PROBLEM WITH SINGLEPROBLEM WITH SINGLE
COMPLETE DENTURECOMPLETE DENTURE

1.1.
Greater magnitude of forcesGreater magnitude of forces
Changes in the underlying boneChanges in the underlying bone
Denture in the long term will beDenture in the long term will be
compromised.compromised.

2.2. Related to occlusal form of the remainingRelated to occlusal form of the remaining
natural teeth:natural teeth:
This occlusal form dictates occlusal form of theThis occlusal form dictates occlusal form of the
denturedenture  might be unsuitable for the denture.might be unsuitable for the denture.

Supraerupted Tilted teeth

Occlusal scheme causingOcclusal scheme causing
more horizontal forcesmore horizontal forces

These factors causes occurrence of “These factors causes occurrence of “ SingleSingle
denture syndromedenture syndrome””
- loose or tilting denture- loose or tilting denture
-damage of mucosa-damage of mucosa
- ridge resorption.- ridge resorption.

COMMON OCCLUSALCOMMON OCCLUSAL
DISHARMONIES AND WAYSDISHARMONIES AND WAYS
TO ADJUST THEMTO ADJUST THEM

1. Tilted molars
with distal
halves
supraerupted

Steeply inclined
occlusal
surfaces
tend to drive
denture forward
when brought
into centric occlusion.

Only contact is on the distal half of lower molar in
protrusive and lateral excursions
Denture easily dislodged during functional
movements.

ADJUSTMENTS FOR TILTEDADJUSTMENTS FOR TILTED
MOLARSMOLARS
A)A)
If molars are notIf molars are not
severely tiltedseverely tilted
can be reshaped bycan be reshaped by
selective grinding.selective grinding.

B)B) If more toothIf more tooth
structure is neededstructure is needed
to be removedto be removed
Restore with crown orRestore with crown or
FPD.FPD.

C)C) If large space existIf large space exist
mesial to tilted molarmesial to tilted molar
RPD restoring the mesialRPD restoring the mesial
half of the molars,half of the molars,
lower the distal cuspslower the distal cusps
(mesial half onlay(mesial half onlay
mesial rest .)mesial rest .)

D)D) OrthodonticOrthodontic
repositioningrepositioning
of tilted molarof tilted molar
E)E) If severely tilted andIf severely tilted and
supraeruptedsupraerupted
ExtractionExtraction

2.2. Natural lower cuspids andNatural lower cuspids and
incisors are supraeruptedincisors are supraerupted

SelectiveSelective
grindinggrinding

Cuspid region, occlusal adjustment should aim atCuspid region, occlusal adjustment should aim at
providing a definite distal slope on the lowerproviding a definite distal slope on the lower
cuspid so as to allow space for free passage ofcuspid so as to allow space for free passage of
the upper artificial cuspid between the lowerthe upper artificial cuspid between the lower
cuspid and first premolar in lateral movements.cuspid and first premolar in lateral movements.

A)A) SINGLE COMPLETE DENTURE OPPOSINGSINGLE COMPLETE DENTURE OPPOSING
NATURAL TEETHNATURAL TEETH
1.1. Maxillary complete dentureMaxillary complete denture
opposing natural mandibularopposing natural mandibular
teeth.teeth.

PROBLEMSPROBLEMS
a)a) Malposed ,tipped and supraerupted teeth inMalposed ,tipped and supraerupted teeth in
lower arch and unfavorable plane oflower arch and unfavorable plane of
occlusion.occlusion.
b)b) Fixed position of mandibular anterior teethFixed position of mandibular anterior teeth
c)c) Problem of wear of teeth:Problem of wear of teeth:
i)i) Artificial teethArtificial teeth If acrylic is used.If acrylic is used.
ii)ii) Natural teethNatural teeth If porcelain is used.If porcelain is used.
d)d) Frequent fractures of dentureFrequent fractures of denture

Diagnostic procedures shouldDiagnostic procedures should
determine the following:determine the following:
1.If there are sufficient teeth in the mandibular1.If there are sufficient teeth in the mandibular
arch.arch.
According toAccording to SharrySharry: if there is class II jaw: if there is class II jaw
relation, a complete denture often may berelation, a complete denture often may be
constructed against lower anterior teeth andconstructed against lower anterior teeth and
premolars without replacing molars.premolars without replacing molars.
The lower premolars areThe lower premolars are far enough posteriorfar enough posterior
in relation to the maxillary ridge, that the forcesin relation to the maxillary ridge, that the forces
of occlusion are directed to theof occlusion are directed to the middle-posteriormiddle-posterior
part of the upper denture.part of the upper denture.www.indiandentalacademy.comwww.indiandentalacademy.com

Forces directed to Middle Posterior part of
Upper denture

But if class III jawBut if class III jaw
relationrelation situation issituation is
differentdifferent becausebecause
mandibular premolarsmandibular premolars
would apply occlusalwould apply occlusal
forces against theforces against the
anterior part of theanterior part of the
maxillary ridge.maxillary ridge.

Acc to WinklerAcc to Winkler: In any event, replacement of: In any event, replacement of
missing posterior teeth will enhance themissing posterior teeth will enhance the
retention and stability of the maxillary completeretention and stability of the maxillary complete
denture and help to distribute the functionaldenture and help to distribute the functional
forces more evenly on the residual maxillaryforces more evenly on the residual maxillary
ridge.ridge.

Ellinger et al (JPD 1971:26;6) :Ellinger et al (JPD 1971:26;6) :
A lower RPD should be indicated in all situations whenA lower RPD should be indicated in all situations when
all molarsall molars are missing.are missing.
• If upto first molar leftIf upto first molar left RPD may not be necessary.RPD may not be necessary.

• If one side uptoIf one side upto
premolars andpremolars and
others upto firstothers upto first
molarmolar RPD mayRPD may
not be necessary.not be necessary.
Missing molar beMissing molar be
replaced by areplaced by a
cantileveredcantilevered
premolar ponticpremolar pontic
having 2-3having 2-3
abutments.abutments.

2)2) Periodontal health of the remaining teeth isPeriodontal health of the remaining teeth is
acceptable.acceptable.
3)3) There are no missing teeth to be replaced.There are no missing teeth to be replaced.
4)4) position of mandibular anterior teeth.position of mandibular anterior teeth.

5)5) Condition of posterior teethCondition of posterior teeth
a)a) Irregular occlusal plane.Irregular occlusal plane.
b)b) Occlusal surface of natural teeth too largeOcclusal surface of natural teeth too large
bucco-lingually.bucco-lingually.
c) Occlusal form.c) Occlusal form.

Prior to any occlusal modifications of the naturalPrior to any occlusal modifications of the natural
teeth, maxillary and mandibular casts should beteeth, maxillary and mandibular casts should be
mounted on articulator.mounted on articulator.
Now whatever adjustments that may beNow whatever adjustments that may be
necessary can be planned.necessary can be planned.

Techniques to determine theTechniques to determine the
necessary tooth modificationsnecessary tooth modifications
prior to denture construction.prior to denture construction.

1)1) BY SWENSONBY SWENSON
Casts mounted on articulator using provisionalCasts mounted on articulator using provisional
CR at acceptable vertical dimension.CR at acceptable vertical dimension.
Maxillary record base made and teeth are setMaxillary record base made and teeth are set
If lower teeth interfere with placement of dentureIf lower teeth interfere with placement of denture
teethteeth adjusted on cast and areas markedadjusted on cast and areas markedwww.indiandentalacademy.comwww.indiandentalacademy.com

Areas to be
modified
are marked
with pencil
on the cast

Natural teeth modified accordinglyNatural teeth modified accordingly
New diagnostic cast of lower arch made andNew diagnostic cast of lower arch made and
mountedmounted
If more adjustments neededIf more adjustments needed  repeat therepeat the
procedure.procedure.
Tech.Tech. simplesimple butbut time consumingtime consuming..

2)2) BRUCEBRUCE (JPD 1971:26:448-455)(JPD 1971:26:448-455)
Advised reshaping natural teeth using a resinAdvised reshaping natural teeth using a resin
templatetemplate

Areas to be
modified are
marked with
pencil on
the cast

Clear acrylic resin
template is formed
over the corrected
cast

Initial modifications
done.
Template coated
with pressure
Indicating paste
and placed over
patients teeth.

Interferences can be
seen through the clear
template and can be
removed accordingly.
Process repeated
till template fits the
teeth perfectly
 Advantage: produces
accurate results.

3)3) BY YURKSTAS:BY YURKSTAS:
Advised useAdvised use
of a metalof a metal
‘‘U’ shapedU’ shaped
occlusalocclusal
templatetemplate

2.2. Mandibular complete dentureMandibular complete denture
opposing natural maxillaryopposing natural maxillary
teeth.teeth.

1)1) Preservation of residual alveolar ridge:Preservation of residual alveolar ridge:
a)a) Greater force exerted +smaller basal seatGreater force exerted +smaller basal seat
area.area. rapid loss of supporting bone fromrapid loss of supporting bone from
mandiblemandible  decreased retention and stability +decreased retention and stability +
frequent fractures of denturefrequent fractures of denture
Factors that must be evaluated before thisFactors that must be evaluated before this
treatment option is consideredtreatment option is considered

b) Mandible movable member of stomatognathicb) Mandible movable member of stomatognathic
systemsystem more difficult to stabilize the denture.more difficult to stabilize the denture.
c) Proximity to tongue.c) Proximity to tongue.
Therefore, considering preservation ofTherefore, considering preservation of
residual ridgeresidual ridge onlyonly as the main factor foras the main factor for
dictating the treatment plan of a completedictating the treatment plan of a complete
mandibular denture then this plan is totallymandibular denture then this plan is totally
contraindicated.contraindicated.

2.2. Necessity of retainingNecessity of retaining
maxillary teeth:maxillary teeth:
MaxillaryMaxillary
dentition maydentition may
be neededbe needed
to retainto retain
a prosthesis.a prosthesis.
3.3. Mental traumaMental trauma

B)B) SINGLE COMPLETESINGLE COMPLETE
DENTURE OPPOSINGDENTURE OPPOSING
REMOVABLE PARTIALREMOVABLE PARTIAL
DENTUREDENTURE

Ellinger et al (JPD 1971:26;6) :Ellinger et al (JPD 1971:26;6) :
A lower RPD should be indicated in all situationsA lower RPD should be indicated in all situations
when all molars are missing.when all molars are missing.
If upto first molar leftIf upto first molar left RPD may not beRPD may not be
necessary.necessary.
If one side upto premolars and others upto firstIf one side upto premolars and others upto first
molarmolar RPD may not be necessary.RPD may not be necessary.
Missing molar be replaced by a cantileveredMissing molar be replaced by a cantilevered
premolar pontic having 2-3 abutments.premolar pontic having 2-3 abutments.

Ellsworth KellyEllsworth Kelly (JPD1972:27;140)(JPD1972:27;140)
gave the term “gave the term “COMBINATION SYNDROMECOMBINATION SYNDROME” to” to
those changes that are seen in patients withthose changes that are seen in patients with
maxillary complete denture and a mandibularmaxillary complete denture and a mandibular
bilateral distal extension RPD.bilateral distal extension RPD.

Some characteristic changes in CombinationSome characteristic changes in Combination
syndrome( Anterior hyperfunction syndrome)syndrome( Anterior hyperfunction syndrome)
are:are:
i)i) Loss of bone from anterior part of the maxillaryLoss of bone from anterior part of the maxillary
ridge.ridge.
ii)ii) Overgrowth of the maxillary tuberosities.Overgrowth of the maxillary tuberosities.

iii)iii) Papillary hyperplasia in the hard palate.Papillary hyperplasia in the hard palate.
iv)iv) Extrusion of lower anteriors.Extrusion of lower anteriors.
v)v) Loss of bone under the lower partial dentureLoss of bone under the lower partial denture
base .base .

BY SAUNDER’S ET AL
(JPD 1979:41:124)

Sequence of changesSequence of changes
First change to occur?First change to occur?
Acc to Kelly et alAcc to Kelly et al (JPD1972:27;140)(JPD1972:27;140)  loss ofloss of
bone from the anterior part of the maxillary jaw.bone from the anterior part of the maxillary jaw.
Saunders et alSaunders et al ((JPD 1979:41:124)) bonebone
resorption under the mandibular partial dentureresorption under the mandibular partial denture
base.base.

Loss of bone from
anterior maxilla
Flabby hyperplastic
tissue
Characteristic deep
fold or crease

 Maxillary denture displaced anteriorly and superiorlyMaxillary denture displaced anteriorly and superiorly
 Tendency to develop epulis fissuratum associatedTendency to develop epulis fissuratum associated
with labial flange.with labial flange.
 Bone resorption also under mandibular DentureBone resorption also under mandibular Denture
base.base.
 Occlusal plane migrates up in anterior region andOcclusal plane migrates up in anterior region and
down in posterior region.down in posterior region.www.indiandentalacademy.comwww.indiandentalacademy.com

With posterior palatal sealWith posterior palatal seal
negative pressurenegative pressure
produced posteriorly.produced posteriorly.
Enlargement of tuberositiesEnlargement of tuberosities
&&
Papillary hyperplasia.Papillary hyperplasia.

 Lower anterior teethLower anterior teeth
migrate upward andmigrate upward and
periodontal changesperiodontal changes
occur.occur.
(change in occlusal(change in occlusal
planeplane encouragesencourages
protrusive occlusalprotrusive occlusal
contactcontact risk ofrisk of
extrusion andextrusion and
flaring of mandibularflaring of mandibular
anterior teeth)anterior teeth)

Maxillary anterior teethMaxillary anterior teeth
on the complete dentureon the complete denture
disappear underdisappear under
patients lips.patients lips.
Esthetics become poorEsthetics become poor

Loss of mandibular supportLoss of mandibular support
Gradual decrease of occlusal load posteriorly andGradual decrease of occlusal load posteriorly and
increased occlusal load anteriorlyincreased occlusal load anteriorly
Resorption of maxillary anterior ridgeResorption of maxillary anterior ridge

Ellsworth Kelly (JPD 1972:27;140) :Ellsworth Kelly (JPD 1972:27;140) :
3 yr study: all patients showed3 yr study: all patients showed
a)a)1-3 mm loss of ridge height in maxillary anterior1-3 mm loss of ridge height in maxillary anterior
regionregion
b)b) 1-2.5 mm increase in height of tuberosity1-2.5 mm increase in height of tuberosity
c)c) 1-1.5 mm extrusion of lower anteriors.1-1.5 mm extrusion of lower anteriors.

Saunders et al (JPD 1979;41:126)Saunders et al (JPD 1979;41:126)
Changes associated with combination syndromeChanges associated with combination syndrome
are not necessarily seen in all patients withare not necessarily seen in all patients with
maxillary complete denture and mandibularmaxillary complete denture and mandibular
distal extension RPD.distal extension RPD.

Prevention of combinationPrevention of combination
syndromesyndrome
Treatment planning to avoid this combination ofTreatment planning to avoid this combination of
prosthesis.prosthesis.
1)1) Try and retain weak posterior teeth by means ofTry and retain weak posterior teeth by means of
endodontic and periodontal therapies.endodontic and periodontal therapies.
2)2) Using lower anterior roots and givingUsing lower anterior roots and giving
overdenture.overdenture.
3)3) Giving bilateral balanced occlusion.Giving bilateral balanced occlusion.

Management of combinationManagement of combination
syndromesyndrome
• Diagnosis of cause and its correction.Diagnosis of cause and its correction.
• Use of Tissue conditionersUse of Tissue conditioners
• Surgical correction of changes in basal seatSurgical correction of changes in basal seat
(flabby tissues, papillary hyperplasia, enlarged(flabby tissues, papillary hyperplasia, enlarged
tuberosities.)tuberosities.)
• Restorative treatment of remaining teethRestorative treatment of remaining teeth

SINGLE COMPLETE DENTURESINGLE COMPLETE DENTURE
OPPOSING PARTIALLYOPPOSING PARTIALLY
EDENTULOUS ARCHEDENTULOUS ARCH
RESTORED WITH FPDRESTORED WITH FPD

Once fixed restoration is placed in a dental arch,Once fixed restoration is placed in a dental arch,
the restored arch can be thought of as a naturalthe restored arch can be thought of as a natural
teeth opposing a complete denture.teeth opposing a complete denture.
Placement of fixed restoration can correct manyPlacement of fixed restoration can correct many
occlusal disharmonies.occlusal disharmonies.
For example: tilted molarsFor example: tilted molars

Orthodontic
correction
and then
give FPD

Prepare tooth
to get proper
plane of
occlusion

Proximal half
crown

Cantilevered
premolar
pontic

Single complete dentureSingle complete denture
opposing an existing completeopposing an existing complete
denturedenture

11. Duration of the existing denture. Duration of the existing denture
2.2. Condition of the teeth:Condition of the teeth:
a)a) AppearanceAppearance
b)b) Alignment with regard to residualAlignment with regard to residual
ridge.ridge.

c) Is occlusal
plane
Desirable?

d) Occlusal surface
worn out

3.3. Condition of denture baseCondition of denture base
a)a) Accuracy of tissue adaptation and borderAccuracy of tissue adaptation and border
extensionextension
b)b) Any fracture repairsAny fracture repairs
c)c) Esthetic contouring and thickness adequate toEsthetic contouring and thickness adequate to
support the perioral structures.support the perioral structures.
d)d) Stability and retention.Stability and retention.

Single complete dentureSingle complete denture
opposing implant supportedopposing implant supported
prosthesisprosthesis

B.Jacobs et al(JPD 1993:70;135-140)B.Jacobs et al(JPD 1993:70;135-140)
Compared the anterior and posterior ridge resorptionCompared the anterior and posterior ridge resorption
in three group of patients with different mandibularin three group of patients with different mandibular
prosthetic constructions i.e.prosthetic constructions i.e.
i)i) Overdenture supported by two implantsOverdenture supported by two implants
ii)ii) Fixed prosthesis supported by 6 implantsFixed prosthesis supported by 6 implants
iii)iii) Complete denture.Complete denture.

Results indicatedResults indicated
1)1) A more pronounced annual bone resorption inA more pronounced annual bone resorption in
complete denture wearers compared to patientscomplete denture wearers compared to patients
with implant supported Overdentures.with implant supported Overdentures.

2)2) A limited but continuing bone resorptionA limited but continuing bone resorption
observed in patients with implant supportedobserved in patients with implant supported
overdentures.overdentures.
3)3) A slightly higher annual bone resorptionA slightly higher annual bone resorption
occurring in the implant supported fixedoccurring in the implant supported fixed
prosthesis group.prosthesis group.

Maxillary complete dentureMaxillary complete denture
opposing implant supportedopposing implant supported
overdentureoverdenture

Permits free
rotational
Movement
of denture
upon
Posterior
loading

Bone resorption in mandibular posterior regionBone resorption in mandibular posterior region
settling of denture base and loss of posteriorsettling of denture base and loss of posterior
contactscontacts
upward rotation of anterior mandibular dentureupward rotation of anterior mandibular denture
more forces on anterior maxilla supporting themore forces on anterior maxilla supporting the
maxillary denture.maxillary denture.

Barber et al (J OMFS 1990:48:1283-1287)Barber et al (J OMFS 1990:48:1283-1287)
Maxson et al (JPD 1990:63;554-558)Maxson et al (JPD 1990:63;554-558)
Sybille et al (IJP 1996:9:58-64):Sybille et al (IJP 1996:9:58-64):
Found that combination syndrome occurred in patientsFound that combination syndrome occurred in patients
with implant supported overdenture and maxillarywith implant supported overdenture and maxillary
conventional complete dentures.conventional complete dentures.

Maxillary completeMaxillary complete
denturedenture
opposing implantopposing implant
supported fixedsupported fixed
denturedenture

Opinion is divided over the functional forces borneOpinion is divided over the functional forces borne
by the maxillary complete denture opposingby the maxillary complete denture opposing
implant supported fixed denture.implant supported fixed denture.

 Stafford et alStafford et al ; found that loading forces did not; found that loading forces did not
increaseincrease
 Falk et al (JOMI 1989:44; 55-62)Falk et al (JOMI 1989:44; 55-62) found thefound the
loading forces to be comparable to those ofloading forces to be comparable to those of
partially restored natural dentitions, with greaterpartially restored natural dentitions, with greater
forces in the posterior region of the maxillaryforces in the posterior region of the maxillary
denture opposing cantilever units of the implantdenture opposing cantilever units of the implant
prosthesis.prosthesis.

Difference in opinion regarding the anteriorDifference in opinion regarding the anterior
maxillary bone loss under complete denturesmaxillary bone loss under complete dentures
opposing implant supported fixed prosthesis.opposing implant supported fixed prosthesis.

Jacobs et al (JPD 1993):Jacobs et al (JPD 1993): reported an increasereported an increase
annual bone loss maxillary anterior region.annual bone loss maxillary anterior region.
Henry et al (IJP 1999:12;492-497):Henry et al (IJP 1999:12;492-497): reported noreported no
anterior resorption and no occurrence ofanterior resorption and no occurrence of
condition like combination syndrome in thiscondition like combination syndrome in this
clinical state.clinical state.

METHODS TOMETHODS TO
ACHIEVE BALANCEDACHIEVE BALANCED
OCCLUSIONOCCLUSION

TWO TECHNIQUESTWO TECHNIQUES::
1)1) Those that dynamically equilibrate theThose that dynamically equilibrate the
occlusion by use ofocclusion by use of functionally generated pathfunctionally generated path
i.e.i.e. Functional chew in techniquesFunctional chew in techniques..
2)2) Those that statistically equilibrate the occlusionThose that statistically equilibrate the occlusion
by using an articulator programmed to simulateby using an articulator programmed to simulate
patients jaw movements.patients jaw movements.

Functionally generated pathFunctionally generated path
techniques / Functional chewtechniques / Functional chew
in techniques for singlein techniques for single
complete dentures.complete dentures.

Contraindications:Contraindications:
1)1) Record base not stable.Record base not stable.
2)2) Patients with poor neuromuscular control.Patients with poor neuromuscular control.

StansburyStansbury
(JPD 1951;1;692-699)(JPD 1951;1;692-699)
andand
Rudd and MorrowRudd and Morrow
(JPD 1973:30;4)(JPD 1973:30;4)

Cast mounted on articulator in CR at acceptableCast mounted on articulator in CR at acceptable
vertical dimension.vertical dimension.
Remove record base and occlusal rimRemove record base and occlusal rim adaptadapt
new base plate and fabricate occlusal rimsnew base plate and fabricate occlusal rims
made of compoundmade of compound

 (twice the normal width-atleast twice the width of(twice the normal width-atleast twice the width of
molar teeth)molar teeth)
 6 mm anterior to mandibular incisor,6 mm anterior to mandibular incisor,
 sufficient in height to receive an impression ofsufficient in height to receive an impression of
the central fossa of the lower teeth.the central fossa of the lower teeth.

Compound occlusal rim heatedCompound occlusal rim heated
Placed in articulatorPlaced in articulator closedclosed
Impression of fossae of all lower teeth recorded.Impression of fossae of all lower teeth recorded.

Occlusal rims trimmedOcclusal rims trimmed
B-L.B-L.
Compound extensionCompound extension
in the central fossa.in the central fossa.

Anterior regionAnterior region
trimmed till level oftrimmed till level of
indentation ofindentation of
incisors(2mm spaceincisors(2mm space
between rim andbetween rim and
mandibular anteriormandibular anterior
teeth)teeth)

Place in patients mouthPlace in patients mouth
Pt asked to make chewing slowlyPt asked to make chewing slowly
Excess compound wears offExcess compound wears off
Free action in lateral movement.Free action in lateral movement.

Record base removed fromRecord base removed from
patients mouth, soft waxpatients mouth, soft wax
(carding wax) added on(carding wax) added on
B-L sides.B-L sides.

Placed in patients mouthPlaced in patients mouth
Patient asked to perform eccentric chewingPatient asked to perform eccentric chewing
movementsmovements

Lower teeth cut theirLower teeth cut their
pathspaths
in the soft wax.in the soft wax.
Compound inCompound in
central fossa actcentral fossa act
as a guide toas a guide to
preserve cusp height.preserve cusp height.

Occlusal rim removedOcclusal rim removed  stonestone
poured into wax paths.poured into wax paths.
First mandibularFirst mandibular
cast is removedcast is removed
Maxillary occlusalMaxillary occlusal
rim with generatedrim with generated
occlusal paths and stone recordocclusal paths and stone record
is placed in articulatoris placed in articulator

Stone record is securedStone record is secured
to the lower member ofto the lower member of
the articulator withthe articulator with
plaster.plaster.

2 lower casts-first-duplicate of lower teeth,2 lower casts-first-duplicate of lower teeth,
second replica of generated path.second replica of generated path.
Original mandibular cast placed on articulatorOriginal mandibular cast placed on articulator
Maxillary teeth setting done (ant. teethMaxillary teeth setting done (ant. teeth acc. toacc. to
esthetics, post. teeth ground and adjusted toesthetics, post. teeth ground and adjusted to
CO.CO.

Checked in mouth for esthetics and centricChecked in mouth for esthetics and centric
occlusionocclusion
..
Denture processedDenture processed
Remounted.Remounted.
Any interference in centric occlusion checkedAny interference in centric occlusion checked
and correctedand corrected

will be established. Once correct in COwill be established. Once correct in CO removeremove
the lower castthe lower cast put chew-in mandibular castput chew-in mandibular cast
Interferences removedInterferences removed
Thus in CR and eccentric movement bilateralThus in CR and eccentric movement bilateral
balanced occlusionbalanced occlusion

By Robert G.VigBy Robert G.Vig
(JPD 1964;14:214-220)(JPD 1964;14:214-220)
Similar techniqueSimilar technique
like Stansbury butlike Stansbury but
he recommendedhe recommended
use of ause of a fin of resinfin of resin
placed into theplaced into the
central groovescentral grooves
instead of compound.instead of compound.
Maintains Vertical Dimension better.Maintains Vertical Dimension better.

Articulator EquilibrationArticulator Equilibration
TechniqueTechnique
Equilibrate the occlusion by using an articulatorEquilibrate the occlusion by using an articulator
programmed to simulate patients jawprogrammed to simulate patients jaw
movements.movements.

Indications:Indications:
• If denture base lacks stability.If denture base lacks stability.
• Patient unable to performPatient unable to perform
movements properly.movements properly.

Maxillary occlusal rims fabricatedMaxillary occlusal rims fabricated face bowface bow
transfer donetransfer done maxillary casts mounted onmaxillary casts mounted on
articulator.articulator.
Mandibular cast mounted on articulator usingMandibular cast mounted on articulator using
centric records at established vertical dimension.centric records at established vertical dimension.

Bucco-lingual position of the lower teeth and theirBucco-lingual position of the lower teeth and their
relation to maxillary arch is studied.relation to maxillary arch is studied.
Teeth arrangement done according to naturalTeeth arrangement done according to natural
teeth.teeth.
Interferences in centric and eccentric positions areInterferences in centric and eccentric positions are
removed by grinding the natural teeth andremoved by grinding the natural teeth and
artificial teeth until a bilateral balanced occlusionartificial teeth until a bilateral balanced occlusion
is achieved.is achieved. www.indiandentalacademy.comwww.indiandentalacademy.com

OCCLUSAL MATERIALS FOROCCLUSAL MATERIALS FOR
SINGLE COMPLETESINGLE COMPLETE
DENTURESDENTURES

a)a) Porcelain teeth:Porcelain teeth:
AdvantageAdvantage: minimal wearing, therefore vertical: minimal wearing, therefore vertical
dimension maintained.dimension maintained.
DisadvantageDisadvantage::
Rapid wearing of opposing naturalRapid wearing of opposing natural
teeth.teeth.
Occlusal adjustment of artificial teeth neededOcclusal adjustment of artificial teeth needed
porcelain becomes weak.porcelain becomes weak.

b)b) Acrylic resin teeth:Acrylic resin teeth:
Advantage:Advantage:
No wear of opposing teethNo wear of opposing teeth
Easy to do occlusal adjustments.Easy to do occlusal adjustments.
Disadvantage:Disadvantage:
Wears off easilyWears off easily loss of vertical dimension andloss of vertical dimension and
change in centric occlusion.change in centric occlusion.

c)c) Gold occlusalsGold occlusals
ConsideredConsidered best materialbest material to opposeto oppose
natural teeth. Minimum wear.natural teeth. Minimum wear.
Disadvantage:Disadvantage:
ExpensiveExpensive
Time consuming.Time consuming.

Schultz (JPD 1951:1:38-48)Schultz (JPD 1951:1:38-48)
• Showed that the chewing efficiency of acrylicShowed that the chewing efficiency of acrylic
resin teeth was 26-35% less than that ofresin teeth was 26-35% less than that of
porcelain teeth.porcelain teeth.
• Chewing efficiency of acrylic resin teeth withChewing efficiency of acrylic resin teeth with
gold occlusal surface is equal to that of porcelaingold occlusal surface is equal to that of porcelain
teeth.teeth.

Technique of fabrication ofTechnique of fabrication of
gold occlusalsgold occlusals
(JPD 1964:14;326-333)(JPD 1964:14;326-333)

Dentures made in usual manner usingDentures made in usual manner using
acrylic resin posterior teeth.acrylic resin posterior teeth.
Remounted on articulator-occlusalRemounted on articulator-occlusal
disharmonies removed by selectivedisharmonies removed by selective
GrindingGrinding
Denture finished and patient is allowedDenture finished and patient is allowed
to wear them for 3-4 weeksto wear them for 3-4 weekswww.indiandentalacademy.comwww.indiandentalacademy.com

With dentures in mouthWith dentures in mouth 
impression made with irreversibleimpression made with irreversible
hydrocolloidhydrocolloid
Denture in impressionDenture in impression applyapply
petroleum jellypetroleum jelly dental stonedental stone
poured into the denture.poured into the denture.

Buccal and palatal
surfaces covered
with modeling clay
All undercuts blocked
Lingually- 2mm short of
occlusal surface
Labially-1mm short www.indiandentalacademy.comwww.indiandentalacademy.com

Stone counter
dies poured

Grooves cut A-P
3mm wide
and
3mm deep.
Hole approximately
2mm depth
made in centre
of each tooth

Counter die

Final wax pattern
Sprue
attached

Castings cemented

d)d) Acrylic resin teeth with amalgam stopsAcrylic resin teeth with amalgam stops (JPD(JPD
1979:41:16-20)1979:41:16-20)
Advantage:Advantage:
• Reduces occlusal wear of resin teeth.Reduces occlusal wear of resin teeth.
• Less expensive than goldLess expensive than gold
• Facilitates the final stages of occlusal adjustment.Facilitates the final stages of occlusal adjustment.

Occlusal preparation
in acrylic teeth
Amalgam condensed

Centric holding
areas as well as
excursions are
recorded in
amalgam

CLINICAL PROCEDURE OFCLINICAL PROCEDURE OF
FABRICATINGFABRICATING
A MAXILLARYA MAXILLARY
COMPLETECOMPLETE
DENTURE OPPOSINGDENTURE OPPOSING
A MANDIBULAR NATURALA MANDIBULAR NATURAL
TEETHTEETH

 Proper diagnosis related to:Proper diagnosis related to:
 Periodontal health of the remaining teethPeriodontal health of the remaining teeth
 If any missing teeth to be replaced.If any missing teeth to be replaced.
 Tooth modifications needed.Tooth modifications needed.

 Impression of lower teethImpression of lower teeth  cast obtainedcast obtained
 Maxillary archMaxillary arch
Secondary impressionSecondary impression master cast obtainedmaster cast obtained
occlusal rim fabricatedocclusal rim fabricated contoured for adequate lipcontoured for adequate lip
support.support.
 Using face bow mount the maxillary cast on theUsing face bow mount the maxillary cast on the
articulatorarticulator  mount mandibular cast using centricmount mandibular cast using centric
records at correct VDrecords at correct VD

 Set teeth and achieve a balanced occlusion bySet teeth and achieve a balanced occlusion by
selective grinding.selective grinding.
 If gold restorations needed on the teeth, modifyIf gold restorations needed on the teeth, modify
the teeth.the teeth.

 If FPD neededIf FPD needed  do thedo the
tooth preparation beforetooth preparation before
making impression.making impression.
 Wax patterns areWax patterns are
carved to conform to thecarved to conform to the
existing occlusion ofexisting occlusion of
maxillary denture.maxillary denture.

CONCLUSIONCONCLUSION
The problems involved in providing comfort,The problems involved in providing comfort,
function, proper esthetics and retention is a vigorousfunction, proper esthetics and retention is a vigorous
challenge for practising dentist. The damage to thechallenge for practising dentist. The damage to the
edentulous ridge and inability to wear the dentureedentulous ridge and inability to wear the denture
may be avoided by good prosthetic treatment whichmay be avoided by good prosthetic treatment which
include adequate denture base, correct jaw relationinclude adequate denture base, correct jaw relation
record and proper occlusion.record and proper occlusion.

REFERENCESREFERENCES
1.Stansbury C B. Single denture construction1.Stansbury C B. Single denture construction
against a non-modifiednatural dentition.against a non-modifiednatural dentition. J ProsthetJ Prosthet
DentDent 1951;1951; 11: 692-699.: 692-699.
2.Meyer: Generated path technique :JPD 1957:72.Meyer: Generated path technique :JPD 1957:7
354.354.
3.Vig R G. A modified chew in and functional3.Vig R G. A modified chew in and functional
impression technique.impression technique. J.Prosthet DentJ.Prosthet Dent 1964;1964; 1414::
214-220.214-220.
4.Bruce: CD opposing natural teeth:JPD4.Bruce: CD opposing natural teeth:JPD
1971:26;5:448.1971:26;5:448.

 5.Ellinger:Single complete denture:JPD5.Ellinger:Single complete denture:JPD
1971:26:4-101971:26:4-10
 6.Kelly E. Changes caused by a mandibular6.Kelly E. Changes caused by a mandibular
removable partial denture opposing a maxillaryremovable partial denture opposing a maxillary
complete denture.complete denture. J Prosthet DentJ Prosthet Dent 1972;1972; 2727::
140-150.140-150.
7.Rudd and Morrow: occlusion and single7.Rudd and Morrow: occlusion and single
denture:jpd1973;31:4denture:jpd1973;31:4

8.Saunders T R, Gillis R E, Desjardins R P. The8.Saunders T R, Gillis R E, Desjardins R P. The
maxillary complete denture opposing themaxillary complete denture opposing the
mandibular bilateral distal-extension partialmandibular bilateral distal-extension partial
denture.Treatment considerations.denture.Treatment considerations. J ProsthetJ Prosthet
DentDent 1979 ;1979 ;4141: 124-128.: 124-128.
9.Schmitt ;combination syndrome :treatment9.Schmitt ;combination syndrome :treatment
approach :JPD 1985:54:664approach :JPD 1985:54:664
10.Shen:prevalance of Combination syndrome10.Shen:prevalance of Combination syndrome
among denture wearers: JPD 1989:62;642among denture wearers: JPD 1989:62;642
11.Maxillary bone resorption in patients with11.Maxillary bone resorption in patients with
mandibular implant supported OD or fixedmandibular implant supported OD or fixed
prosthesis.:JPd 1993:70:135-140)prosthesis.:JPd 1993:70:135-140)

 13.Yair Langer13.Yair Langer :Modalities of Treatment for the:Modalities of Treatment for the
Combination Syndrome :Combination Syndrome :J Prosthod 1995;4:76-J Prosthod 1995;4:76-
8181
 14.CS in relation to osseointegrated implant14.CS in relation to osseointegrated implant
supported OD :IJP 1996:9;58-64supported OD :IJP 1996:9;58-64
 15.Maxillary changes under CD opposing15.Maxillary changes under CD opposing
mandibular implant supported fixed prosthesis:mandibular implant supported fixed prosthesis:
IJP 1999:12;492IJP 1999:12;492
 16.combination syndrome: a literature16.combination syndrome: a literature
review:Jpd 2003:90:270-275review:Jpd 2003:90:270-275
12.Maxillary CD opposing osseointegrated12.Maxillary CD opposing osseointegrated
mandibular prosthesis:IJP1993:6;446-450mandibular prosthesis:IJP1993:6;446-450

 17.Essentials of complete denture17.Essentials of complete denture
prosthodontics:winkler:2prosthodontics:winkler:2ndnd
edtedt
 18.Text book of complete denture :518.Text book of complete denture :5thth
edt:Heartwell.edt:Heartwell.
 19.Prosthodontic treatment for edentulous19.Prosthodontic treatment for edentulous
patients:12patients:12thth
edt:Zarbedt:Zarb

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