Single Complete Denture Final

INTRODUCTION: The single complete denture opposing all or some of the natural dentition is not an uncommon occurrence. There are several causes for the loss of teeth from the dental arches like periodontal problems, dental caries and trauma. The incidence incidence of tooth loss is more in maxillary arch compared to mandibular mandibular arch, most of the single complete complete denture denture cases are edentulous edentulous maxilla opposing mandibular  mandibular  natural teeth. The single complete denture should be given for many reasons like mastication and esthetics. esthetics. Several difficultie difficultiess are encountered encountered in providing providing a successful successful single single complete complete denture treatment. Regrettably this service is envisioned as only half as difficult and time consuming as the fabrication of opposing complete dentures. DEFINITION: Single complete denture is a prosthesis which replaces the lost natural teeth and its associated structures functionally and esthetically as a single unit which opposes all or  some of the natural teeth. The The prim primar ary y cons consid ider erat atio ion n for for cont contin inue ued d dent dentur uree succ succes esss with with a sing single le conventional complete denture is the preservation of that which remains. A single single comp complet letee dent dentur uree may may be desi desirab rable le when when it is to oppo oppose se any one of the the following: o  atural teeth that are sufficient in number not to necessitate a fixed or removable r emovable o

 partial denture. A partially edentulous arch in which the messing teeth have been or will be

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replaced by a fixed partial denture. A partially edentulous arch in which the missing teeth have been or will be

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replaced by a removable partial denture. An existing complete denture

!n the first situation the maxillary arch is usually the edentulous arch. Among the reason for this occurrence is that a maxillary compete denture is more stable, easier to retain in position and tolerated better by patients than a mandibular denture. Therefore many are less reluctant to allow the loss of the maxillary teeth and at times insist upon their removal. Single edentulous arch : "revalence "revalence of the condition condition where edentulou edentulouss arch opposes a natural natural or restored dentition is #uite common. !t has been estimated that for some patient population the mand mandib ibul ular ar canin canines es are retai retaine ned d four four time timess long longer er than than othe otherr teet teeth h foll follow owed ed by mand mandib ibul ular ar inci inciso sors. rs. The The reaso reason n for for the the loss loss of the the maxi maxilla llary ry teeth teeth prio priorr to the the mandibular teeth are unclear and are influenced by a combination of factors. $ne ma%or  factor factor might might be the profess profession ion&s &s perceptio perception n of the ease of fabric fabricatio ation n of maxill maxillary ary dentures compared with mandibular ones and the comparative functional success of  maxillary versus mandibular complete denture.

There is a #ualitative and #uantitative difference between natural tooth and complete denture support. The difference is one of adaptability versus invaladaptability.

Diagnosis and treatment planning The commonly sited long term goal in prosthodontics is the preservation of that which remains. This demands an appreciation of occlusal mechanics. Carl F. Driscoll and Radi M. Masri  proposed a classification system that could simplify the identification and treatment of those patients: ' (lass ! ) "atient for whom minor or no tooth reduction is all that is needed to obtain balance. ' (lass !! ) "atient for whom minor additions to the height of the teeth are needed to obtain balance. ' (lass !!! ) "atient for whom both reduction and additions to the teeth are re#uired to obtain balance. The treatment of these patient involves change in the vertical dimension of occlusion. ' (lass !* ) "atient who presents with occlusal discrepancies that re#uire addition to the width of the occluding surface. ' (lass * ) "atient who presents with combination syndrome.

RO!"EMS #. Occlusal $orces :  The firmness and rigidity with which the natural teeth are retained in the bone

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and the magnitude of forces they can resist or deliver without any discomfort or  displacement. These forces has been recorded as high as+- lbs on a single molar  tooth. This is in contrast with the forces which a complete denture, resting simply on the

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delicate mucosa of the ridge can resist or deliver. This force has been established as being a maximum static load of / lbs 0Anderson and stores ) +//1 (learly these forces by natural teeth will cause damage to the soft and hard

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tissues under the denture.  2hen one considers the great magnitude of forces involved, the unsuitability of  the denture foundation to resist them, particularly due to unfavorable occlusal relationships, there is occurrence of what is described by Sharr% as the 3Single denture syndrome”. The patient complains of a loose or tilting denture. 4xamination reveals damage to the mucosa and ridge resorption. Relining temporarily cures the complaint but the cycle of trauma, resorption and looseness continues.

&. Occlusal $orm o$ the natural teeth  The occlusal form of the remaining natural teeth will dictate the occlusion of the 

denture. The natural teeth may be over erupted or tilted and there cusps may be high and sharp. As a result occlusion and articulation will involve contacting of the

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inclined planes of cusp in such a way that the denture will constantly be thrust or  dragged hori5ontally on the ridge. 6ecause of the unstability of the denture foundation to resist there unfavarourable forces, the occurrence of single complete denture syndrome is common. "atients complain of loose, tilting dentures and soreness of the tissues underlying the dentures. 4xamination reveals damage to the mucosa and ridge resorption.

'. Support $or the denture (ase :  !n a complete denture the occlusal force must be dissipated through the denture

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 base to the ridge. 7or this reason the denture base should have the maximum extension within the functional anatomic limits. So that the forces of occlusion  both vertical and hori5ontal will be distributed over the largest possible area of  supporting structures and force 8 unit area kept at minimum. !n the edentulous mandible the area of support available for the denture base is relatively small when compared to maxilla and also the mucosa is thin and delicate and the underlying bone is particularly prone to resorption. 7or these reasons the lower complete denture opposing upper natural teeth should be normally avoided.

). Inter ma*illar% relations :  The principles of recording inter maxillary relation remain unchanged for single 

complete denture. 6ut when an upper complete denture is being made to occlude with lower natural

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teeth, an error may be made in recording the vertical dimension, if the wax rim is trimmed to represent the incisal level of the upper anterior teeth and to be parallel with the ala tragus line as is done in conventional upper and lower complete denture construction. The labio9 lingual thickness of the wax rim, will usually not allow the lower 

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incisor to close beyond the occlusal surface of the wax rim although previously they occluded high on the lingual of the upper incisors. nless this fact is appreciated and allowed for an increased vertical dimension may be recorded. To avoid this the anterior this the anterior part of the wax rim should be trimmed

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in such a way that it should resemble labiolingual width of the upper anterior  teeth and should allow the lower anterior teeth to occlude above the occlusal  plane. $cclusal problems and fracture of denture base account for structured difficulties

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and may result from one or all of the following: +. $cclusal stress on the maxillary denture and the underlying edentulous tissue from teeth and musculature accustomed to opposing natural dentition. . The position of the mandibular teeth which may not be properly aligned for  the achievement of bilateral balance for stability. ;. 7lexure of the denture base Salient considerations include:

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Acceptable interocclusal distance

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Stable %aw relationship with bilateral tooth contact in retruded position.

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Stable tooth #uadrant relationships with axially directed forces

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