Single Complete Dentures PDF

# Single Complete Dentures ## Assoc. Prof. Dr. Simge Taşın **Single complete dentures** is a treatment concept applied in cases where only one jaw (upper/lower) is restored with a total prosthesis. * More frequently applied to the maxilla ### Opposite jaw dentition: 1. An arch with a sufficient...

# Single Complete Dentures ## Assoc. Prof. Dr. Simge Taşın **Single complete dentures** is a treatment concept applied in cases where only one jaw (upper/lower) is restored with a total prosthesis. * More frequently applied to the maxilla ### Opposite jaw dentition: 1. An arch with a sufficient number of natural teeth and fixed restorations NOT requiring another prosthesis. 2. Partially edentulous arch in which missing teeth are or will be replaced with removable partial dentures, fixed partial dentures or implant supported fixed prosthesis. 3. Mucosa-supported, tooth-supported or implant-supported, acceptable full denture. * **Complete dentures should restore lost function and aesthetics, while maintaining the continuity and integrity of the remaining tissues.** * **Although the success criteria of complete dentures vary according to the situation, there are three important factors that determine the functional success of the complete denture:** * stability * retention * support * **In the construction of both upper-lower complete dentures, the teeth are aligned according the desired occlusion.** * **There is nothing that restricts the dentist from achieving balanced occlusion.** * **This is often not possible in single complete dentures that occlude with natural teeth.** * **Therefore, the construction of a single complete denture can be much more complex than when both jaws are restored at the same time.** * **Natural teeth in the mouth have distinctive occlusions.** * **With tooth loss, bending, elongation and rotation movements may occur in the remaining teeth towards the extraction spaces.** * **These movements make it difficult to stabilize the occlusion.** * **The inability to balance the occlusion is the main reason that reduces the chance of success of single complete dentures.** * **These problems must be evaluated and adjusted at the planning stage.** * **If the prosthesis is fabricated without eliminating those problems, the natural teeth will apply horizontal forces exceeding the physiological limit of the single complete denture in the opposing jaw during the chewing function.** * **In addition, with the effect of periodontal receptors, natural teeth apply more force to the opposing single complete denture.** * **Result: traumatic occlusion** * **Maxillary single complete dentures are usually more successful compared to mandibular single complete dentures;** * **In the maxillary jaw, the area where the denture base sits is wider (chewing pressure per unit area)** * **The mandibular denture is limited by the more mobile structures that may adversely affect its stability.** ### Problems encountered in single full dentures * lack of stability * Damage to the mucosa and resorption of the alveolar bone * unsatisfactory function * Fractures in the denture base * Wear on artificial teeth or natural teeth in the opposing jaw, depending on the tooth material used in the denture ### Midline fractures are more common in maxillary total dentures for the following reasons: * Lack of relief in the median palatine suture region * Failure to achieve occlusal harmony * Compatible contacts in centric and eccentric movements * Arrangement of posterior teeth outside the crest * Concentration of occlusal contacts in buccal cusps * Insufficient thickness of the acrylic base (<2mm) * **Facing even one of those problems is enough to call the prosthesis unsuccessful.** * **But the most unfavorable: resorption in the alveolar bone** * **Because in this case, the principle of 'primarily preserving the continuity and integrity of the remaining tissues', which has a very important place in prosthetic treatment, would be contradicted.** ### Correct diagnosis and treatment planning are essential to overcome these problems. ## Patient examination for single complete dentures includes: * Examination of the edentulous jaw arch * Examination of the opposing jaw arch * Features of the denture base * occlusion * Types of artificial teeth ## Examination of the edentulous jaw arch * **Resorption degree and shape of the alveolar arch** * **If there is a sharp, knife-edge or uneven alveolar crest, it should be corrected (sores, pain)** * **If surgery is contraindicated, soft lining materials may be used.** ## Examination of the edentulous jaw arch * **The thickness and structure of the mucosa** * **The ideal mucosal thickness is 1.5 mm.** * **More subtle: irritation** * **Thicker and mobile: loss of stability** * Associated with direct alveolar bone resorption in long-term edentulous patients * It should be surgically removed, unless it will reduce the support area too much, it should be left. ## Examination of the edentulous jaw arch * **Frenulum, broad and extending to the top of the crest** * **The denture is notched for the frenulum to move freely and to prevent the prosthesis from being dislotched during function (a)** * **If the frenulum extends up to the crest, the prosthesis is weakened in this region and can break under pressure.** * **Solution: frenectomy** ## Examination of the edentulous jaw arch * **Toruses** * Small ones that cause no problems to the prosthethesis can be tolerated * Large ones should be surgically removed to avoid mucosal irritation and denture fracture from lever effect. ## Examination of the edentulous jaw arch * **Occlusal surfaces of teeth** * Natural teeth with high cusps; low chewing force, little eccentric movement * Worn teeth; high chewing force, excessive eccentric movement indicator *Reducing the slope of teeth with high tubercle inclination positively affects stability ## Examination of the edentulous jaw arch * **Occlusal surfaces of teeth** * The presence of excessively worn teeth in the opposing jaw will also adversely affect the stability of the denture. * Since the buccolingual distance of the worn teeth will increase, the occlusal surfaces should be restored to their former functional width by abrading the buccal and lingual surfaces first. ## Examination of the edentulous jaw arch * **Inter-occlusal relations of teeth** * Adversely affects the prognosis of a single complete denture * Posterior teeth aligning outside the crest causes harmful forces * The central fossae of the maxillary teeth can be brought in contact with the lingual cusps of the mandibular teeth to center the chewing forces, and the inclined buccal cusps of the mandibular teeth can be modified to increase stability. ## Features of the denture base * The denture base plate should be within physiological tolerance. It should cover the largest possible area (pressure per unit area ↓ ) * If there are toruses and bony prominences that cannot be surgically removed, these areas should be relieved (if not done; soft tissue irritation, fracture) * In the presence of a knife-edge crest or protruding anatomical structure, soft lining materials can be used (result of thinning of the base: fracture) * Occlusion should be rechecked after any repair * The use of reinforced base material may be advantageous ## occlusion * The most important cause for fracture of single complete dentures is incorrect arrangement of occlusion. * For maximum stabilization, bilateral balanced occlusion should be achieved during eccentric movements, with simultaneous bilateral contacts without premature contact in the posterior teeth. ## occlusion * The morphology of the teeth in the opposing arch should be considered in tooth selection. * If the tubercle inclination of natural teeth is low, teeth with approximately 20° tubercle inclination should be selected, and if the tubercle inclination of natural teeth is high, teeth with 33° tubercle inclination should be selected. * If the posterior teeth have a flat occlusal surface, teeth with 0° tubercle inclination should be selected. ## occlusion * Point contacts formed on shallower surfaces should be preferred instead of tight intercuspation with pointed and long cusps. * The incisal guidance angle should be close to 0. Therefore, creating a deep overbite should be avoided and a wide overjet should be made. * If this cannot be achieved and contact between anterior artificial teeth and natural teeth cannot be prevented in eccentric movements, chewing forces from the anterior region will cause rotation of the denture. * Chronic trauma causes resorption of the alveolar bone, in addition, the mucosa becomes hyperplastic. * This gives the clinical image: combination syndrome * Occurs in upper total- lower Kennedy 1 cases ## Combination syndrome (Dr. Kelly, 1972) * "Anterior Hyperfunction syndrome" * "Kelly syndrome" * Reasons; Excessive load concentrated in the maxillo-anterior region as a a result of fault prosthesis construction or the patient's failure to use the lower partial prosthesis. * Bone loss in the anterior area of the upper jaw overgrowth of tubercles * Hyperplasia of the palatal mucosa * Elongation of the lower front teeth * Loss of alveolar bone and ridge height under the lower partial denture base plate ## Combination syndrome (Dr. Kelly, 1972) * "Anterior Hyperfunction syndrome" * "Kelly syndrome" ## Prevention: * First of all, it is necessary to be aware of the syndrome. * Anterior teeth should not touch each other (appropriate overbite-overjet) * Porcelain teeth should not be used in maxillary anterior teeth and acrylic teeth in other regions (in seek of aesthetics) * Quick-wear, poor quality acrylic teeth should not be used in upper and lower edentulous lower Kennedy cases. * Routine check every 6 months ## Treatment: * Surgical removal of fibrous tissue if there is enough underlying bone tissue ## Types of teeth used in single complete dentures ### acrylic teeth * Mostly recommended material * absorbs forces * Reduces resorption in supporting tissues (varying with stiffness?) * It does not cause wear on natural teeth. * There may be vertical dimension loss due to wear. ### Porcelain * Wear resistant * No vertical dimension loss * May cause wear on natural teeth * There may be cracks and fractures. * Irreparable * Does not form chemical bonds with the base * Transmits chewing forces directly to supporting tissues ## Occlusally reinforced teeth * Amalgam applied to the occlusal surfaces of artificial teeth to prevent wear * Artificial teeth made under occlusal surfaces * The best strategy is to use new generation acrylic/composite resin denture teeth with periodic examinations. * This is the most practical approach considering the average life expectancy of a single complete denture ## Examination of the opposing natural tooth jaw arch * Malpositioned teeth may cause cusp conflict during function, causing the prosthesis to tip over. ## Examination of the opposing natural tooth jaw arch * L-L position of the lower teeth: ideally coinciding with the middle of the upper crest ridge. * The incisal edge and cusp tips of the lower teeth: irregularities can be corrected with minor abrasions. * Parallelism of the occlusal planes: If there is no parallelism, the force distribution will not be balanced and the prosthesis will not be stable. * Some procedures may be required to correct the inappropriate position or occlusal surfaces of natural teeth: * Teeth can be abraded * It should be done only for the removal of small irregularities and only at the enamel level. * Natural teeth can be restored (full crown, inlay, onlay) * Orthodontic treatment can be applied * Teeth that are highly possible to prevent prosthesis stability can be extracted. ## Analysis * Reported by Yurtstas (1962) * It is based on Monson's Galot Theory, which collects Spee and Wilson curves as a single whole. ## Class III cases * In cases where there is an underdeveloped fully, edentulous maxilla opposing a normally developed mandible, the fabrication of removable complete dentures becomes difficult. * The area where the upper denture is attached is narrow. * The stability of the denture may be adversely, affected, especially if we are trying to align the anterior teeth in Class I. * There may be pain in the crest of the ridge and in the lips. * Anterior teeth can be aligned in Class III position or edge to edge ## MANDIBULAR TOTAL DENTURE MADE AGAINST THE MAXILLARY NATURAL DENTITION: * In these cases, irregularities in the opposite arc should be adjusted. * It is very important to ensure balanced occlusion. * It is necessary to spread the prosthesis as wide as possible. * Necessary instructions should be given to the patient. * If possible, it may be advantageous to make an implant-supported overdenture prosthesis. ## REMOVABLE FULL DENTURE MADE AGAINST FIXED PARTIAL PROSTHESIS * First of all, for the maxilla; * anatomical size * functional impression * Then vertical dimension detection * Appropriate preparation * Metal try-in (anterior guidance and necessary abrasions in step 2) * Finishing * Final occlusal alignment ## SINGLE COMPLETYE DENTURE MADE OPPOSING AVAILABLE SINGLE COMPLETE PROSTHESIS AVAILABLE * It is easier and more reliable to make a lower and upper complete denture at the same time. * When the dentist accepts a patient who requests a new single complete denture to be made over an existing single complete denture, the risk is high as he assumes responsibility for both prostheses. ## The following conditions must be found in the old Single Denture, In order to start an opposing new Single Complete Denture 1. The teeth should be aligned correctly on the crest so that the stability of the prosthesis and chewing efficiency can be favorable. 2. The aesthetics of the teeth should be appropriate. 3. Tissue support should be sufficient. 4. The cusp heights of the teeth should be suitable for the teeth to be aligned in a single full denture to be made on the opposite jaw. 5. The denture base should be of appropriate thickness and aesthetics to adequately support the perioral tissues. 6. The denture base must cover all the supporting tissues. 7. The stabilization and retention of the denture should be good. ## CONCLUSION * One of the most important points in the construction of a single complete denture is the alignment of the occlusal plane. * Pre-prosthetic mouth preparation should not be skipped, necessary procedures should be done * Be aware of the options regarding the denture base and artificial teeth (material, production method, form) * The importance of regular check-ups should be emphasized. * If success is not achieved despite everything, implant supported options can be considered. ## RESOURCES * Textbook of COMPLETE DENTURES by Arthur O. Rahn John R. Ivanhoe Kevin D. Plummer * Complete Denture Prosthodontics: Planning and Decision-Making by Yasemin K. Özkan * Dişsiz Hastaların Protetik Tedavisi Klasik Tam Protezler by Prof. Dr. Senih CALIKKOCAOĞLU ## Hjalmar Munsterhjelm's 1883 Moonlit Night The image shows a painting of a moonlit night. A lone tree with a single branch stands on a rocky cliff. Beyond the tree, a lake stretches towards the horizon, reflecting the light of the moon and the clouds above. More trees are visible on the opposite shore, and the water is still and dark. The sky is a deep blue, with scattered white clouds lit by the moon. The painting is painted in a realistic style, with meticulous attention to detail. The overall effect is one of peace and tranquility.