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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 5  |  Issue : 1  |  Page : 51-54

Hollow maxillary denture: A new modified technique for improving retention in resorbed maxillary ridges


1 Department of Dentistry, Veer Chandra Sing Garhwali Government Medical Sciences and Research Institute, Srinagar, Pauri Garhwal, Uttarakhand, India
2 Private practionner, Srinagar garhwal, Uttrakhand, India

Date of Web Publication19-Mar-2014

Correspondence Address:
Laxman Singh Kaira
Type 2, House No. 4, Faculty Residence, Veer Chandra Sing Garhwali Government Medical Sciences and Research Institute Campus, Srinagar, Pauri Garhwal-246 174, Uttarakhand
India
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DOI: 10.4103/0976-433X.129074

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  Abstract 

The success of a complete denture relies on the principles of retention, stability, and support. The prosthodontist skill lies in applying these principles efficiently in critical situations. Severely resorbed maxillary edentulous ridges that are narrow and constricted with increased interridge space provide decreased support, retention, and stability. The consequent weight of the processed denture only compromises them further. This article describes a case report of an edentulous patient with resorbed ridges, where a simplified technique of fabricating a hollow maxillary complete denture was used for preservation of denture bearing areas.

Keywords: Dental health education, edentulous ridges, interridge space, maxillary resorbed ridges, retention, rehabilitation


How to cite this article:
Kaira LS, Dabral E. Hollow maxillary denture: A new modified technique for improving retention in resorbed maxillary ridges. SRM J Res Dent Sci 2014;5:51-4

How to cite this URL:
Kaira LS, Dabral E. Hollow maxillary denture: A new modified technique for improving retention in resorbed maxillary ridges. SRM J Res Dent Sci [serial online] 2014 [cited 2022 Jan 23];5:51-4. Available from: https://www.srmjrds.in/text.asp?2014/5/1/51/129074


  Introduction Top


It is obvious that in large maxillofacial defects and in severe resorption of the edentulous ridges, there is a decreased denture bearing area for retention, support, and stability. Increased interridge space compound this problem. To decrease the leverage, reduction in the weight of the prosthesis was recommended and was also found to be beneficial. Various weight reduction approaches have been achieved using a solid three-dimensional spacer, including dental stone, [1],[2],[3],[4],[5],[6] silicone putty, [7],[8] modelling clay, [9],[10] cellophane wrapped asbestos, [11] or thermocol, [12] during laboratory processing to exclude denture base material from the planned hollow cavity of the prosthesis.

Holt [7] processed a shim of indexed acrylic resin over the residual ridge and used a spacer which was then removed and the two halves luted with auto polymerized acrylic resin. The primary disadvantage of such technique is that the junction between the two previously polymerized portions of the denture occurs at the border of the denture, which increases risk of seepage of fluid into the denture cavity.

O'Sullivan et al., [8] described a modified method for fabricating a hollow maxillary denture. A clear matrix of the trial denture base was made. The trial denture base was then invested in the conventional manner till the wax elimination. A 2 mm heat polymerized acrylic resin shim was made on the master cast using a second flask. Silicone putty was placed over the shim and its thickness was estimated using the clear template. The original flask with the teeth was then placed over the putty and the shim and the processing was done. The putty was later removed from the distal end of the denture and the openings were sealed with autopolymerizing resin.

The technique was useful in estimation of the spacer thickness, but removal of putty was found to be difficult especially from the anterior portion of the denture.


  Case Report Top


A 55-year-old patient walked into the dental clinic with a chief complaint of replacing missing teeth. He had been edentulous for 10 years and had been wearing dentures for 7 years. On examination, he had severely resorbed ridges, the upper being narrow and constricted and with an interridge space of 36 mm [Figure 1]. Other clinical abnormalities were not seen. Treatment plan was explained to the patient and an informed consent was obtained. Ethical clearance was obtained from the ethical committee of Institute of Dental Sciences, Bareilly. Hence, hollow maxillary complete denture and conventional mandibular denture was planned for this patient.
Figure 1: Preoperative photograph

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Technique

The maxillary denture was fabricated up to the trial denture stage in the conventional manner. Keeping in mind the strength of the denture, the distance from the teeth to 3 mm of the denture base was calculated. The rest of the denture base till the border was then calculated; therefore, the spacer would occupy the area between the shim of 2 mm thickness and the teeth with 3 mm of the denture base [Figure 2] and [Figure 3]. The land area of the cast was indexed using a conical bur and the trail denture was sealed to the definitive cast. The trial denture was duplicated in reversible hydrocolloid and poured in dental stone. A template of the duplicated trial denture was made by adapting 0.5-mm thermoplastic sheet (Duran 0.5 × 125 mm, code 111; Libral Traders Pvt. Ltd., New Delhi.) on the recovered cast using vacuum heat-pressed machine (Biostar) [Figure 4]. The trial denture was then processed in the standard manner up to the wax elimination stage. Two layers of baseplate wax were adapted to the definitive cast in the drag, conforming to the border extensions. A second flask was used to invest this baseplate wax and processed in conventional manner. After deflasking, the clear matrix was placed on the definitive cast using the indices in the land area as seating guides. An endodontic file with a rubber stop was used to measure the space between the matrix and the processed basein order to ensure that there is adequate space between the resin and the teeth [Figure 5]. Half of the heat cure poly methylmethaacrylate (PMMA) (Trevalon, Dentsply India Pvt. Ltd., Gurgaon, India) in dough stage was positioned accurately over the dewaxed mould and then salt crystals were placed over it [Figure 6]. Above that, the remaining heat cure resin was packed and cured at 74°C for 7-8 h. Cured denture was retrieved and three holes were made in the thickest palatal area [Figure 7]. All the residual salt crystals were removed by flushing water with the high pressure syringe through the holes. After making sure that all the salt crystals have been removed, the escape holes were closed with autopolymerizing resin (Trevalon, Dentsply India Pvt. Ltd., Gurgaon, India). The hollow cavity seal was verified by immersing the denture in water, if no air bubbles are evident, an adequate seal is confirmed [Figure 8]. The dentures were inserted in the patient›s mouth [Figure 9] and instructions regarding care, hygiene, and maintenance were given. On 6-month follow-up, the patient reported that he was quite comfortable with the dentures and he had encountered no problems.
Figure 2: Distance from teeth to wax

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Figure 3: Distance from denture borders to wax

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Figure 4: Polyethylene sheet adaptation

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Figure 5: Endodontic instrument used to measure space between clear template and permanent denture base

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Figure 6: Salt crystals placement over heat cure resin

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Figure 7: Denture with three holes on the palatal surface

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Figure 8: Denture floating in water

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Figure 9: Post operative intraoral photograph

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  Discussion Top


Shetty et al., [12] used thermocol that being a light weight material can be left in the denture without compromising the integrity of the denture, avoiding the tedious effort to remove the spacer material from the denture are overcome. Problems with leakage and difficulty in gauging resin thickness. The small window in the cameo surface facilitates recovery of the spacer in an area that is not commonly adjusted after denture insertion and has a small margin along in which leakage can occur. Major lacunae in this technique is calculating accurately the width and height of thermocol. O'Sullivan et al., [8] advocated silicone putty as spacer because it is stable, it can be carved, and it does not adhere to acrylic resin. The cyanoacrylate bond between the resin and the putty can be easily. The technique was useful in estimation of the spacer thickness, but removal of putty was found to be difficult especially from the anterior portion of the denture. Moreover, the openings made from the distal end had to be sufficiently large to retrieve the hard putty. The salt crystals being heat labile melt during the curing procedure and thorough flushing after curing results in no crystals remaining in the denture thereby maintaining the integrity of the denture, avoiding the tedious effort to remove the spacer material from the denture. This technique of lost salt technique is simple to execute and utilizes a very cheap and easily available spacer material.

The advantages of hollow dentures are reduction in the excessive weight of the acrylic resin, resulting in the lighter prosthesis, and decreased load on the residual alveolar ridges thereby making the patient comfortable.

 
  References Top

1.el Mahdy AS. Processing a hollow obturator. J Prosthet Dent 1969;22:682-6.  Back to cited text no. 1
[PUBMED]    
2.Brown KE. Fabrication of a hollow-bulb obturator. J Prosthet Dent 1969;21:97-103.  Back to cited text no. 2
[PUBMED]    
3.Ackerman AJ. The prosthetic management of oral and facial defects following cancer surgery. J Prosthet Dent 1955;5:413-32.  Back to cited text no. 3
    
4.Nidiffer TJ, Shipman TH. Hollow bulb obturator for acquired palatal openings. J Prosthet Dent 1957;7:126-4.  Back to cited text no. 4
    
5.Rahn AO, Boucher LJ. Maxillofacial Prosthetics: Principals and Concepts. St. Louis: Elsevier; 1970. p. 95.  Back to cited text no. 5
    
6.Chalian VA, Barnett MO. A new technique for constructing a one-piece hollow obturator after partial maxillectomy. J Prosthet Dent 1972;28:448-53.  Back to cited text no. 6
[PUBMED]    
7.Holt RA Jr. A hollow complete lower denture. J Prosthet Dent 1981;45:452-4.  Back to cited text no. 7
[PUBMED]    
8.O′Sullivan M, Hansen N, Cronin RJ, Cagna DR. The hollow maxillary complete denture: A modified technique. J Prosthet Dent 2004;91:591-4.  Back to cited text no. 8
    
9.Jhanji A, Stevens ST. Fabrication of one-piece hollow obturators. J Prosthet Dent 1991;66:136-8.  Back to cited text no. 9
    
10.DaBreo EL. A light-cured interim obturator prosthesis. A clinical report. J Prosthet Dent 1990;63:371-3.  Back to cited text no. 10
[PUBMED]    
11.Elliott DJ. The hollow bulb obturator: Its fabrication using one denture flask. Quintessence Dent Technol 1983;7:13-4.  Back to cited text no. 11
[PUBMED]    
12.Shetty V, Gali S, Ravindran S. Light weight maxillary complete denture: A case report using a simplified technique with thermocol. J Interdiscip Dent 2011;1:45-8.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]



 

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