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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 7  |  Issue : 3  |  Page : 190-193

Use of natural anterior maxillary teeth in immediate removable partial denture: An old technique revisited


1 Department of Dentistry, FH Medical College, Tundla, Firozabad, Uttar Pradesh, India
2 Department of Prosthodontics and Dental Material Sciences, F. O. D. S, K. G. Medical University, Lucknow, Uttar Pradesh, India
3 Department of Oral Pathology, IDST, Modinagar, Ghaziabad, Uttar Pradesh, India

Date of Web Publication22-Aug-2016

Correspondence Address:
Varun Baslas
305 Aparna Garden, Vijay Nagar, Agra, Uttar Pradesh
India
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DOI: 10.4103/0976-433X.188809

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  Abstract 

Maxillary anterior teeth play an important role in esthetics, speech, smile, and self-esteem of an individual. Although a clinician can restore missing teeth with artificial teeth, the importance of natural teeth in patient's overall personality cannot be ignored. The present article elucidates a technique for fabrication of immediate removable partial denture prosthesis using natural teeth to enhance esthetics and confidence of the patient.

Keywords: Extracted teeth, immediate denture, natural teeth


How to cite this article:
Baslas V, Kaur S, Yadav R, Aggarwal H, Ehtisham M. Use of natural anterior maxillary teeth in immediate removable partial denture: An old technique revisited. SRM J Res Dent Sci 2016;7:190-3

How to cite this URL:
Baslas V, Kaur S, Yadav R, Aggarwal H, Ehtisham M. Use of natural anterior maxillary teeth in immediate removable partial denture: An old technique revisited. SRM J Res Dent Sci [serial online] 2016 [cited 2021 Jan 15];7:190-3. Available from: https://www.srmjrds.in/text.asp?2016/7/3/190/188809


  Introduction Top


Maxillary central incisors dominate the physical appearance and add to the smile, esthetics and self-esteem of an individual. Developments in restorative materials (resin based with tooth colored fiber posts), placement techniques, preparation designs (conservative), and adhesive protocols allow clinicians to restore fractured teeth. If the original tooth fragment is retained following fracture, the natural tooth structures can be reattached using adhesive protocols to ensure reliable strength, durability, and esthetics.[1],[2],[3] Tooth fractured at the cervical margin can also be reattached successfully.[4]

Extracted anterior tooth crown is also used as a temporary restoration after the implant surgery until a definitive prosthesis is fabricated.[5] When extracted tooth is used as a temporary, it provides for a very biocompatible restoration that preserves the original gingival contour and architecture in implant cases. In addition to the above uses of natural teeth, they can also be used for the prosthetic rehabilitation in partially edentulous patients.

An immediate denture is defined as a complete or removable partial denture fabricated for placement immediately after the removal of natural teeth.[6] Immediate dentures allow patients to continue their social and business activities without being in an edentulous and embarrassing situation. This advantage may be very demanding and challenging, as the selection of artificial teeth cannot be observed at the try-in appointment, and the patient has to depend on the clinician for its fulfillment. However, if patient's own natural teeth can be attached to his immediate denture, the clinician can easily overcome his expectations, thereby increasing his self-esteem and morale.

The present article describes fabrication of an immediate removable partial denture using patient's own natural teeth to enhance esthetics and comfort to the patient.


  Case Report Top


A patient aged 24 years reported to the Department of Prosthodontics with a chief complaint of unesthetic appearance of face due to forwardly placed upper front teeth. Intraoral examination revealed severely proclined upper central incisors having an overjet of 13 mm and missing right lateral incisor. Orthodontic treatment was contraindicated due to poor periodontal condition. Bone loss around the abutments contraindicated the restoration with fixed partial denture. The patient was advised for implant retained prosthesis, but the patient was reluctant to go through surgical procedures. Therefore, an immediate removable partial denture was planned. There were distinguishable hypocalcification marks on both the central incisors [Figure 1]. The patient requested to replicate them in the artificial teeth as he was often identified by them among his colleagues. Both the central incisors were healthy (enamel and dentin were intact, and there were no signs of attrition or abrasion) and in good physical shape. So, a decision to extract them atraumatically and use them for immediate denture was taken.
Figure 1: Pre treatment lateral view. Note the hypocalcification marks on central incisors

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Procedure

  1. Irreversible hydrocolloid impressions of maxillary and mandibular dentition were made according to the conventional technique and poured in dental stone. Maxillary cast was duplicated.
  2. Casts were mounted on the articulator. Both the central incisors were grounded off and socketing was done [Figure 2]a.
  3. Acrylic right lateral incisor of appropriate shade was selected and set up in wax on the duplicate maxillary cast while maintaining the plane of occlusion and keeping in mind the esthetic zone and smile line of the patient.
  4. A removable partial denture of heat polymerized acrylic resin containing right lateral incisor and with the provision of space for two central incisors was fabricated using the duplicate cast according to the conventional technique. It was placed on the maxillary cast on the articulator.
  5. The patient was seated upright, and local infiltration was given in the central incisor region. Both the central incisors were extracted atraumatically. Buccal and lingual cortical plates were compressed to minimize hemorrhage [Figure 3].
  6. Both the central incisors were thoroughly washed under running water to remove any granulation tissue or blood. Then they were disinfected in 2% gluteraldehyde solution.
  7. The roots were removed 1 mm below the cemento-enamel junction toward root apex with a separating or cutting disc. Cuts approximately 1mm deep were made on the mesial and distal surfaces of each tooth just apical to the cemento-enamel junction to aid in retention of teeth in the denture base material [Figure 4].
  8. The pulpal tissue of each tooth was removed with ano.4 round bur. The vacated pulpal space was filled with clear autopolymerizing acrylic resin to provide strength to the remaining tooth structure while aiding in retention to the denture base material [Figure 4].
  9. Both the central incisors were then set and cured at the appropriate position maintaining a 4 mm of normal overjet on the processed partial denture using pink veined autopolymerizing acrylic resin according to the plane of occlusion and esthetics [Figure 2]b].
  10. Immediate partial denture was rinsed in disinfectant solution and placed in the patient's mouth.
  11. The patient was given instructions for the immediate denture care and recalled on the next day to evaluate any basal seat error or for occlusal adjustment [Figure 5]. The patient was very pleased with his appearance at subsequent visits [Figure 6].
Figure 2: (a and b) Mounted casts showing alignment of upper and lower incisors

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Figure 3: Immediate post extraction photograph

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Figure 4: Extracted crowns with filled pulp chambers and cuts on proximal surfaces

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Figure 5: Post treatment view

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Figure 6: Pre and post treatment photographs of the patient

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  Discussion Top


Porcelain and acrylic teeth are available in a large variety of molds and shades. With these and available stains and materials, the clinician can duplicate or obtain any desired contour, hue, or imperfection in artificial teeth. Therefore, to suggest, the use of natural teeth in partial dentures may seem a step backward. However, this procedure provides improvement in esthetics that, in certain instances, may be appropriate and demanding, as in our case.

The present article describes a technique for the fabrication of an immediate removable partial denture using patient's own natural teeth that have added advantages over conventional partial dentures. Maxillary anterior teeth primarily are important for esthetics and speech. Using patient's own upper anterior teeth not only enhanced his morale and self-esteem, but also gave him the feeling of comfort, uniqueness, and improved esthetics. This conservative approach maintained the extracted teeth in their own biological environment. The patient could continue with his routine social activities from the very next day.

The greatest precaution for such dentures is that they must be kept in water while not in the mouth. The present patient was recalled every 3 months for 2 years. Initially, the patient had difficulty in denture care as the natural teeth retain their shade and vital appearance when kept moist. If allowed to dry, the natural teeth lose their vital appearance and hue but these characteristics return when moisture is restored.[7] During the last visit, the removable denture was found in good condition, and natural teeth retained their vital appearance. The expected longevity of such denture can be enhanced by proper care.

No complaints of undesirable odors or taste were reported by the patient. There were no complaints of decay, breakage, or loss of teeth also.

Lower anterior teeth cannot be used in this way, because first, the size of lower anterior teeth in the cervical region would not permit adequate retention and second, the removal of the pulpal tissue may cause undue weakening of the teeth.[8] Furthermore, this technique cannot be used for posterior teeth as replacement of their relatively large pulpal tissue with autopolymerizing resin would not be able to bear masticatory loads for long. It is also contraindicated in mouth breathers (natural teeth lose their vital appearance and hue due to dryness and acrylic resin may shrink), bruxers (biting forces are more than normal) and patients with neuromuscular disorders.


  Summary Top


A technique for using natural upper anterior teeth for the fabrication of immediate partial denture has been described. Natural teeth will retain their hue and strength for a sufficient period to make their use practical in some instances. Besides being a conservative approach, this technique has an added advantage of increasing the patient's compliance toward wearing dentures while enhancing esthetics. This is particularly useful in geriatric patients and conditions where implant placement or other surgical inventions are not recommended.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Terry DA. Adhesive reattachment of a tooth fragment: The biological restoration. Pract Proced Aesthet Dent 2003;15:403-9.  Back to cited text no. 1
    
2.
Zorba YO, Ozcan E. Reattachment of coronal fragment using fiber-reinforced post: A case report. Eur J Dent 2007;1:174-8.  Back to cited text no. 2
    
3.
Macedo GV, Diaz PI, De O Fernandes CA, Ritter AV. Reattachment of anterior teeth fragments: A conservative approach. J Esthet Restor Dent 2008;20:5-18.  Back to cited text no. 3
    
4.
Kumar AS, Jyothi KN. Reattachment of fractured tooth using self etching adhesive and esthetic fiber post. J Dent Sci Res 2010;1: 75-83.  Back to cited text no. 4
    
5.
Wasserstein J. Guided Dental Implant Surgery Using the Extracted Tooth Crown as a Temporary Restoration. Available from: . [Last updated on 2010 Dec 02].  Back to cited text no. 5
    
6.
Soni A. Trial anterior artificial tooth arrangement for an immediate denture patient: A clinical report. J Prosthet Dent 2000;84:260-3.  Back to cited text no. 6
    
7.
Boucher CO. Swenson's Complete Dentures. 5th ed. St. Louis: The C.V. Mosby Company; 1964. p. 669-702.  Back to cited text no. 7
    
8.
Hayward DE. Use of natural upper anterior teeth in complete dentures. J Prosthet Dent 1968;19:359-63.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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