|Year : 2017 | Volume
| Issue : 3 | Page : 126-131
Akshayalingam Meenakshi, N Sangeetha Meena, Vinay Bharti, S Suganthapriya
Department of Prosthodontics, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
|Date of Web Publication||18-Sep-2017|
Department of Prosthodontics, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu
Although complete dentures cannot be considered as a substitute for, natural teeth, they have been and remain, the staple treatment for edentulous patients. Most of them appear to have benefited from complete denture treatment and report satisfactory oral and masticatory function with their use. Not every case of edentulism, either complete or partial, can be treated with conventional methods of denture fabrication. There is a need for slight modification in impression procedure or designing of the prosthesis to achieve best results in case of compromised conditions. This article intends to highlight clinically relevant modifications of complete denture prosthesis that can be kept in mind, when such cases may be encountered in daily practice.
Keywords: Complete dentures, dentures for compromised conditions, modified dentures, modified prostheses
|How to cite this article:|
Meenakshi A, Meena N S, Bharti V, Suganthapriya S. Special dentures. SRM J Res Dent Sci 2017;8:126-31
| Introduction|| |
The conventional complete denture is a removable dental prosthesis that replaces the entire dentition and associated structures of maxillae or mandible (GPT-8).
In spite of excellent professional skills, techniques, and humanitarian concern, many edentulous patients are mal adaptive to complete denture prosthesis.
The increasing demand of patients and revolutionary thoughts of prosthodontists have led to the outcome of the special, that is, the unconventional approach for fabricating the complete dentures. The unconventional complete dentures follow new techniques based on same old fundamentals of prosthodontia. Complete dentures made in conventional manner prove satisfactory in most of the patients, but in compromised patients, conventional methods bring with it certain disadvantages. The conventional approach may not fulfill the five basic principles of complete denture such as stability, support, retention, esthetics, preservation of tissues which are of prime concern for the complete satisfaction of the patient.
Routine complications faced by the dentist include atrophic ridge, flabby tissue, microstomia, xerostomia, bruxism, labially inclined premaxilla, esthetic demand, and patients demand for duplicating dentures.
Management of these difficulties can be done by proper incorporation of suitable materials and modified techniques. This article has reviewed some of the simple, noninvasive, effective, and alternative treatment to classical conventional technique in completely edentulous patients.
| Hollow Dentures|| |
Severely atrophic ridges provide decreased retention, support, stability, and pose clinical challenge to the success of complete denture prostheses. Extreme ridge resorption also increases the interridge distance. Restoration of the vertical dimension and esthetics does demand increased height of the prosthesis and in turn leads to an increase in prosthesis weight. Reducing the weight of the denture by making it hollow enhances stability and retention, reduces further resorption of the jaw, thereby favoring the prognosis of the denture. Several techniques have been described in literature for creating hollow cavities in dentures and obturators. For the first time, a technique using two split denture flasks for the fabrication of hollow denture was described by Holt. It reduced the acrylic denture weight as much as 25%. Fattore et al. used a variation of the double flask technique for obturator fabrication. Various techniques have been described in literature for the fabrication of hollow cavity of the prosthesis. Materials used for this purpose included a solid three dimensional spacer including dental stone (Ackremann, 1955), cellophane wrapped asbestos (Worley and Kniejski, 1983), silicone putty (Holt, 1981), and modelling clay (Dabrea, 1990) for laboratory processing procedures [Figure 1].
| Liquid Supported Dentures|| |
Resorption of alveolar ridges is a dynamic process. It is a continuous process with varying rates in individuals at different times. Due to the residual ridge resorption, complete denture prosthesis seldom remains in close adaptation to underlying soft tissues, causing tissue irritation, and alteration in the underlying mucosa.
Fluid retained denture or liquid supported denture is a unique design for denture fabrication in cases where surgical removal of the flabby tissue and implant retained prosthesis cannot be planned. These dentures incorporate both plastic and elastic properties, acting as a soft liner at rest to prevent tissue soreness. Devan's dictum holds true in fluid supported denture cases as it provides long-term preservation of soft and hard tissues. The theory behind liquid supported dentures is when forces applied on dentures are absent, the base assumed its preshaped form that is the one while processing. In resting condition, the foil acts as a soft liner, while in use masticatory loads get distributed in all directions by the liquid resulting in even stress distribution.
- Thickness of the denture base must be at least 3 mm
- At the junction of foil and denture surface, hermetic seal should be maintained
- Postinsertion instructions given, denture hygiene emphasized
- Periodic review necessary to check for liquid leakage
- Preservation of the dental stone model is necessary so that when the sheet gets damaged, the model can be used for remaking if the sheet [Figure 2].
| Cheek Plumpers|| |
Prosthodontic rehabilitation does not mean to simply replace the missing teeth, but also restore the facial support. Cheeks are an important part of facial esthetics due to their extreme visibility. The support provided by the teeth, the ridges, or the dentures determine the form of the cheeks. Factors such as extraction of molars, thinning of tissues due to aging or weight loss may lead to concavities or hollowing of cheeks (sunken cheeks). This can make a person older and hence have a negative impact on the patient. This can be achieved using cheek plumpers or cheek lifting appliances. It may be a single piece prosthesis or detachable plumper prosthesis. Customized attachments or magnets can be used to retain the cheek plumpers. Drawbacks include excessive weight added to upper denture leads to compromised retention, interference in masseter muscle and coronoid process of mandible, difficulty in chewing, insertion, and removal of the prosthesis [Figure 3].
| Sectional Dentures|| |
Prosthetic rehabilitation of microstomia patients presents difficulties at all stages as the maximal oral opening is smaller than the size of a complete denture. Such condition may often result from the surgical treatment of orofacial cancer, cleft lip, trauma, burns, Plummer–Vinson syndrome or scleroderma. Oral submucous fibrosis precancerous condition caused by prolonged use of tobacco, areca nut, spices, etc., affects any part of oral cavity sometimes the pharynx. The fibrosis involves the lamina propria and the sub–mucosa and may often extend into the underlying musculature causing deposition of dense fibrous bands, resulting in minimal mouth opening microstomia frequently leads to several incapacitating sequelae such as the inability to masticate, speech problems, impaired oral hygiene or dental care, and psychological problems secondary to facial disfigurement.
Sectional impression trays and sectional dentures have been fabricated using recesses, orthodontic screws, Lego blocks (LEGO Systems Inc., Enfield, CT, USA), dowel plug holes and a screw joint for rigid connection, locking levers, and hinge attachments. Interlocking tray segments and flexible impression trays with silicone putty are also used  [Figure 4]a and [Figure 4]b.
|Figure 4: (a) Collapsed maxillary hinged. (b) Mandibular sectional and hinged complete denture with anterior removable partial denture|
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| Dentures With Salivary Reservoirs|| |
Xerostomia is a subjective feeling of dryness in the mouth, referred to as reduced salivary flow. When flow of saliva decreases to almost half the normal unstimulated rate of around 0.3 ml/min, those individuals are said to have dry mouth. In mild xerostomic cases, gustatory stimulation of salivary glands by mastication of sugar-free chewing gums or lozenges is helpful. In severe cases, salivary substitutes are used.
Xerostomia is a common patient complaint that has many possible causes such as anxiety, Sjogren's syndrome, salivary gland disease, medication-related side effects, head and neck radiation sequelae, and general medical conditions such as diabetes mellitus. Patients suffering from xerostomia may complain of not only a dry mouth but also of difficulty in normal oral and oropharyngeal functions including eating, speaking, and swallowing. Extreme discomfort in wearing dentures is a common complaint. The incorporation of salivary reservoirs in dentures deliver the artificial salivary substitutes constantly into patient's mouth without affecting the normal routine. Drawbacks include incorporation of salivary reservoir makes the denture base weak, sufficient vertical dimension, sufficient denture thickness, and adequate manual dexterity to remove and fix the lid of the reservoir are necessary. Care should be taken to clean the holes present in the reservoir which lodges microorganisms. Repair and relining is difficult [Figure 5].
| Immediate Dentures|| |
Today's uncertain economic climate coupled with the larger aging population has produced a surge in demand for immediate complete dentures. There are two methods, one is to use the immediate denture as an interim or provisional prosthesis and the other is to treat the immediate complete denture as the definitive prosthesis and then reline after surgical healing and ridge resorption  [Figure 6].
Types of immediate dentures
According to Fenn,
- With anterior teeth socketed (open flange design)
- Labial flange without alveolectomy
- Labial flange with alveolectomy
- Labial flange with alveolotomy (incision).
According to Boucher,
- Conventional/classic immediate dentures
- Interim/transitional/nontraditional immediate dentures.
With these dentures, it is very common to decrease labial flare, straighten teeth, and increase vertical dimension, thus improving a patient's esthetic smile immediately on insertion of the prosthesis, especially in socially active persons. The clinician and technician have the opportunity to improve the existing anterior esthetics with posterior function while still meeting a patient's financial expectations or restrictions.
| Characterized Dentures|| |
Denture characterization is a modification of the form and color of the denture base and teeth to produce a more lifelike appearance [Figure 7].
The complete denture may not resemble the previous anatomic morphology of teeth or oral mucosa. Many patients demand more natural like the appearance of complete dentures such as spacing between incisor, fractured incisal edge, stained teeth, and proclined profile. Hence, special considerations should be employed in the modification of denture base and teeth. This modifications are called “characterization.”
The complete denture can be characterized by two basic methods:
- Characterization by selection, arrangement, and modification of artificial teeth
- Characterization by tinting the denture bases.
- For patients demanding for enhanced esthetics
- High smile line
- Socially active
- Stage performers.
| Duplicate Dentures|| |
These dentures are made as either exact replica of the previous denture or with slight modification in denture of satisfactory service. For physically and psychologically impaired patients, who are not able to adapt to new dentures. Most of the completely edentulous patients opt for two sets of dentures because for them it is very much embarrassing to be without a denture for a short period in case of denture fracture or during technical procedures.
- Patients asking for a spare set of dentures
- Patients treated with immediate dentures that require replacement
- Patients with worn dentition but satisfied with the fitting of an old denture.
| Modified Flange Complete Denture|| |
Complete denture fabrication proves to be challenging when the ideal requirements of both hard and soft tissues are not fulfilled. Surgical procedures, i.e., preprosthetic treatment need to be implemented with a view to fulfill patient satisfaction after complete denture fabrication. Residual ridge anatomy of different patients shows different contour and forms of residual ridges that may range from severe resorption to well-formed to bulky ridges. The usual pattern of resorption in maxilla is upward and inward, whereas in mandible it follows outward and downward direction. This leads to small maxilla and large mandible. However, in some cases, maxilla is overdeveloped, irrespective of resorption. This may be due to the developmental or pathological reasons. This could be accentuated by minimum bone resorption and expansion of labial plate during extraction. One of the conditions affecting the denture insertion and esthetics is labially inclined premaxilla and associated undercut. Esthetic principle will be compromised with the complete denture if it is fabricated by conventional approach because of the excessive fullness by thick labial flange. Preprosthetic surgery might reduce the foundation for denture support. To cope up with this difficulties, the modification is required in complete denture fabrication, i.e., it is a nonsurgical procedure to give modified labial flange so as to improve esthetics [Figure 8].
| Labeled Dentures|| |
Denture labeling was introduced in prosthetic dentistry due to the necessity of forensic experts. The importance of denture identification was brought into focus by Dr. Robert H Griffiths during his tenure as a president of the American dental association.
Lamb published a simple method for permanent identification of dentures. Ling suggested a computer-printer micro labeling system. Coss and Wolfaardt (1995) mentioned a denture identification system where a labeling machine was used to print a label on 9 mm or 12 mm tape. The label was inserted into the lingual flange of mandibular denture and posterolaterally in the palate buccal to the tuberosity of maxillary denture [Figure 9].
|Figure 9: Tin foil with patient details embossed on processed complete dentures|
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Five requirements of marking dentures were suggested by Kruger–Monson. They are as follows
- Strength of the prosthesis must not be jeopardised
- Fabrication should be easy and inexpensive
- Identification system should be efficient
- Markings should be durable and visible
- Markings should withstand fire and humidity.
These type of dentures are fabricated with some markings that may be written name of the patient, a photograph, barcode or metal strip, a microchip with patient details for the purpose of identification. Different types of surface markings are scribing, engraving, and embossing.
Several inclusion methods are as follows
- Denture bar coding
- Paper strip method
- Lenticular card method
- ID band method
- T bar method
- Laser etching
- Electronic microchips
- Photographic methods
- Radio-frequency identification tags
- Incorporation of lead foil
- Incorporation of SIM card.
For forensic purpose and identification of patients in mass disasters or road side accidents when patient is unable to communicate.
- Easy and quick method for identification
- These dentures are useful in medicolegal investigation
- They are helpful in identification of dentures where in family there are multiple denture wearers.
| Conclusion|| |
The correct diagnosis helps us in planning perfect treatment. Perfect treatment plan helps us in fabricating the suitable prosthesis, thereby the patient satisfaction. Meeting patients' expectations by giving importance to their demands is the most important criteria for success. This will have a positive effect on patient's self-esteem. Each complete denture patient should be evaluated individually, and the dentist should strive to make the complete denture unique to that person. This article helps in reviewing the conditions and modified techniques followed to satisfy the needs of the patient. Even though meta-analysis data and follow-up studies are minimal regarding these unconventional dentures, we deliver these special dentures in our routine practice for better patient compliance. Critical part of these special dentures is their maintenance phase. In our department, we deliver these special dentures based on the demands of different clinical situations, and the patient compliance is good.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
O'Sullivan M, Hansen N, Cronin RJ, Cagna DR. The hollow maxillary complete denture: A modified technique. J Prosthet Dent 2004;91:591-4.
Holt RA Jr. A hollow complete lower denture. J Prosthet Dent 1981;45:452-4.
Fattore LD, Fine L, Edmonds DC. The hollow denture: An alternative treatment for atrophic maxillae. J Prosthet Dent 1988;59:514-6.
Davidson CL, Boere G. Liquid-supported dentures. Part I: Theoretical and technical considerations. J Prosthet Dent 1990;63:303-6.[Pubmed]. Skinner's Science of Dental Materials. 9th
ed. Philadelphia: WB Saunders; 1991. p. 177-213.
McCord JF, Tyson KW, Blair IS. A sectional complete denture for a patient with microstomia. J Prosthet Dent 1989;61:645-7.
Mendoza AR, Tomlinson MJ. The split denture: A new technique for artificial saliva reservoirs in mandibular dentures. Aust Dent J 2003;48:190-4.
Sharry JJ. Immediate dentures. In: Complete Denture Prosthodontics. St. Louis: McGraw-Hill; 1974.
Klein IE. Immediate denture prosthesis. J Prosthet Dent 1960;10:14-24.
Jagadeesh KN, Ravikumar N, Kashinath KR. “Flangeless cast partial denture” – A simplified approach for a better emergence profile with improved masticatory efficiency. J Dent Sci Res 2009;1:50-4.
Richmond R, Pretty IA. Contemporary methods of labeling dental prostheses – A review of the literature. J Forensic Sci 2006;51:1120-6.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]