Single maxillary denture /invisible aligners

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INTRODUCTIONINTRODUCTION
The single complete denture opposing all or some of the
natural dentition is not an uncommon occurrence.
Causes for the loss of teeth from the dental arches like
periodontal problems, dental caries and trauma.
The incidence of tooth loss is more in maxillary arch
compared to mandibular arch
The single complete denture should be fabricated for
reasons like mastication and esthetics.

DEFINITIONDEFINITION
Single complete denture isa prosthesiswhichSingle complete denture isa prosthesiswhich
replacesthe lost natural teeth and itsassociatedreplacesthe lost natural teeth and itsassociated
structuresfunctionally and esthetically asa singlestructuresfunctionally and esthetically asa single
unit which opposesall or some of the naturalunit which opposesall or some of the natural
teeth.teeth.
The primary consideration for continued denture
success with a single conventional complete
denture is the preservation of that which remains.

SINGLE EDENTULOUS ARCHSINGLE EDENTULOUS ARCH
Prevalence of the condition where edentulousPrevalence of the condition where edentulous
arch opposes a natural or restored dentition isarch opposes a natural or restored dentition is
quite commonquite common..
The reason for the loss of the maxillary teeth
prior to the mandibular teeth are unclear and
are influenced by a combination of factors.

COMBINATIONSCOMBINATIONS
Upper single complete denture opposing complete set ofUpper single complete denture opposing complete set of
lower natural teeth.lower natural teeth.
Lower single complete denture opposing complete set ofLower single complete denture opposing complete set of
upper natural teeth.upper natural teeth.
Single complete denture opposing natural teeth with aSingle complete denture opposing natural teeth with a
removable partial denture.removable partial denture.
A single complete denture opposing natural teeth with aA single complete denture opposing natural teeth with a
fixed partial denture.fixed partial denture.
A single complete denture opposing an already existingA single complete denture opposing an already existing
complete denturecomplete denture

Successful complete denture use by
patients depends on many variables. but
three factors stand out in terms of
functional success:
Retention
Stability
Support

RetentionRetention - the quality inherent in the prosthesis- the quality inherent in the prosthesis
acting to resist theacting to resist the forcesforces of dislodgmentof dislodgment alongalong
the path of placement.the path of placement.
StabilityStability - the quality of a prosthesis to be firm,- the quality of a prosthesis to be firm,
steady, or constant, to resist displacement bysteady, or constant, to resist displacement by
functional horizontal or rotational stresses.functional horizontal or rotational stresses.
SupportSupport - the- the foundation areafoundation area on which a dentalon which a dental
prosthesis rests.prosthesis rests.

Of the three, it generally is agreed thatOf the three, it generally is agreed that
stabilitystability is theis the most importantmost important factor.factor.
Occlusion that is not balanced in excursiveOcclusion that is not balanced in excursive
movements will create instability of themovements will create instability of the
denture, loss of retention, and, eventually,denture, loss of retention, and, eventually,
frustration to the patient.frustration to the patient.

In addition, when a dentate arch opposesIn addition, when a dentate arch opposes
an edentulous arch, thean edentulous arch, the edentulous archedentulous arch isis
usuallyusually adversely affectedadversely affected because of thebecause of the
forces generated.forces generated.
Koper believes thatKoper believes that occlusal problemsocclusal problems andand
denture-base fracturesdenture-base fractures seen in the singleseen in the single
complete denture are the result of one orcomplete denture are the result of one or
all of the following:all of the following:

1.1. Occlusal stressOcclusal stress on the maxillary denture andon the maxillary denture and
the underlying edentulous tissue from teeth andthe underlying edentulous tissue from teeth and
musculature accustomed to opposing naturalmusculature accustomed to opposing natural
teeth.teeth.
2. The2. The position of the mandibular teethposition of the mandibular teeth, which, which
may not be properly aligned for the bilateralmay not be properly aligned for the bilateral
balance needed for stability.balance needed for stability.
3. Flexure of the denture base. The3. Flexure of the denture base. The use of a metaluse of a metal
base to help prevent denture-base fracturebase to help prevent denture-base fracture..

The fabrication of a single completeThe fabrication of a single complete
denture, however, is often overlooked indenture, however, is often overlooked in
educational courses and requires aeducational courses and requires a
complete understanding of the factorscomplete understanding of the factors
involved in obtaining bilateral balance.involved in obtaining bilateral balance.

Theilemann simplified Hanau’s QuintTheilemann simplified Hanau’s Quint
making it easier to understand how tomaking it easier to understand how to
obtain balance and therefore stability.obtain balance and therefore stability.

Condylar guidance
Incisal guidance
Compensatory curve Orientation of occlusal
plane
Theilemann Formula CG *IG = CI*CC*OP
Functional
movements
Cuspal inclination

Equilibrium or balance is achieved when
the five elements are in harmony
A change in any of the five elements
requires changes in at least one of the
remaining four elements.

For example, if the incisal guidance is increased
either a decrease in the condylar guidance or an
increase in the compensating curve, cusp height,
or occlusal plane must occur to maintain balance.
Because the condylar guidance cannot change
without surgical intervention, one or more of the
three elements to the right of the equation must
be adjusted.

ConverselyConversely, if there is an increase in the cusp, if there is an increase in the cusp
height there must be either a decrease in theheight there must be either a decrease in the
compensating curve or the occlusal plane or ancompensating curve or the occlusal plane or an
increase in the incisal guidance.increase in the incisal guidance.

When the dentist is faced with fabricating
only a single denture. however, control of
these elements is limited and may
adversely affect the attainment of bilateral
balance.
* Situations.

If there is an existing denture , the dentistIf there is an existing denture , the dentist
shouldshould modify the existing denturemodify the existing denture at theat the
same time to allow greater control andsame time to allow greater control and
flexibility in obtaining balance.flexibility in obtaining balance.

The maxillary arch usually is the first arch to
become edentulous.
The position of the remaining natural teeth in
these examples may create interferences in
excursive movements of the single complete
denture and create instability that would not be a
problem in a patient with natural dentition in both
arches and with anterior guidance correcting
these interferences may be as simple as an
occlusal adjustment or as severe as extraction
of the offending tooth.

This article discusses various
nonextractive or nonorthodontic treatment
modalities that may be used with various
patients to achieve a balanced occlusion
and to improve the stability of the single
denture opposing natural teeth.

Occlusal discrepancies
The proposed changes to occlusal discrepancies
are best planned ahead of time in the dental
laboratory on properly articulated casts to
prevent unnecessary and irreversible alterations
to the dentition.

Making adjustments to the dentures after
fabrication is not advisable because changes to
the arrangement of the denture teeth are no
longer possible. Patients also may view these
postdelivery adjustments as an attempt to
make the natural teeth fit a poorly made denture.

Tooth selection
Anatomic teeth usually are chosen in the single
complete denture to enhance esthetics. The
decision as to which cusped tooth to choose is
based on evaluation of the condylar guidance and
incisal guidance and therefore is selected after
anterior tooth setup.

In patients who present with a full dentition
on the mandible, the condylar guidance,
occlusal plane, and compensating curve are
already pre-set, so the only variables that
the dentist can easily control are the incisal
guidance and the cusp height .The incisal
guidance can be evaluated with esthetics
and phonetics.

In patients withIn patients with flat occlusal tablesflat occlusal tables teeth canteeth can
bebe reshaped or non-anatomic teethreshaped or non-anatomic teeth may bemay be
chosen.chosen. Plastic teethPlastic teeth are chosen overare chosen over
porcelain teeth because theporcelain teeth because the amount ofamount of
adjustmentadjustment that is sometimes required maythat is sometimes required may
weakenweaken the porcelain teeth and make themthe porcelain teeth and make them
unableunable to withstand the occlusal forces fromto withstand the occlusal forces from
the natural teeth.the natural teeth.

ClassificationClassification
The followingThe following proposed classificationproposed classification system cansystem can
simplify the identification and treatment of thesesimplify the identification and treatment of these
patients.patients.
Class 1Class 1: patients for whom minor, or no, tooth: patients for whom minor, or no, tooth
reduction is all that is needed to obtain balance.reduction is all that is needed to obtain balance.
Class 2Class 2: patients for whom minor additions to the: patients for whom minor additions to the
teeth are needed to obtain balance.teeth are needed to obtain balance.

Class 3Class 3: patients whom both reductions and: patients whom both reductions and
additions to teeth are required to obtain balance.additions to teeth are required to obtain balance.
The treatment of these patients usually involves aThe treatment of these patients usually involves a
change in vertical dimensionchange in vertical dimension of occlusion.of occlusion.
Class 4Class 4: patients who present with occlusal: patients who present with occlusal
discrepancies that require addition to thediscrepancies that require addition to the width ofwidth of
the occluding surface.the occluding surface.
Class 5Class 5: patients who present with: patients who present with combinationcombination
syndrome.syndrome.

Class 1Class 1
Class I includes patients for whom occlusalClass I includes patients for whom occlusal
adjustments are made to the existing dentition toadjustments are made to the existing dentition to
achieve balance in all excursive movements.achieve balance in all excursive movements. TwoTwo
methods can be used in the laboratory to evaluatemethods can be used in the laboratory to evaluate
the changes that must he made to the teeth. Thethe changes that must he made to the teeth. The
first methodfirst method is more accurate and time consumingis more accurate and time consuming
but is better suited for the inexperiencedbut is better suited for the inexperienced
practitioner.practitioner.

TheThe secondsecond is not as precise and should beis not as precise and should be
reserved for the experienced clinician.reserved for the experienced clinician.
TheThe first methodfirst method, described by, described by SwensonSwenson isis
performed with casts articulated at theperformed with casts articulated at the
correct vertical dimension and with maxillarycorrect vertical dimension and with maxillary
teeth set. one at a time, to an ideal setup.teeth set. one at a time, to an ideal setup.
As interferences arise, the opposing teethAs interferences arise, the opposing teeth
on the cast are adjusted to allow for theon the cast are adjusted to allow for the
ideal maxillary tooth positioning.ideal maxillary tooth positioning.

The adjustments areThe adjustments are marked on the cast,marked on the cast,
and the same adjustments are made in theand the same adjustments are made in the
mouth at the time of delivery of the maxillarymouth at the time of delivery of the maxillary
denture. In this manner,denture. In this manner, changes are morechanges are more
precise and less arbitraryprecise and less arbitrary, and proposed, and proposed
adjustments can be evaluated ahead of timeadjustments can be evaluated ahead of time
rather than clinically, when it may be foundrather than clinically, when it may be found
that proposed changes are not feasible.that proposed changes are not feasible.

TheThe second methodsecond method, described by, described by YurkstasYurkstas,,
involves the use of ainvolves the use of a curved U-shapedcurved U-shaped
occlusal metal templateocclusal metal template that is positioned onthat is positioned on
the incisal edges and cusp tips of the caststhe incisal edges and cusp tips of the casts
to identify potential interferences or areasto identify potential interferences or areas
that are below the occlusal plane andthat are below the occlusal plane and
require buildup of some sort.require buildup of some sort.

These areas are adjusted to conform to theThese areas are adjusted to conform to the
curve of the template and then the denturecurve of the template and then the denture
teeth are set against this plane.teeth are set against this plane.
This method isThis method is quickerquicker but morebut more arbitraryarbitrary
and more prone to error.and more prone to error.
TheThe correct occlusal templatecorrect occlusal template should beshould be
selected after the condylar guidance andselected after the condylar guidance and
incisal guidance are determined to allow forincisal guidance are determined to allow for
easier balance.easier balance.

Preoperative right lateral view
of protrusive movement
Preoperative left lateral view
of protrusive movement
Postoperative frontal view of right laterotrusive movement
showing balanced occlusionwww.indiandentalacademy.comwww.indiandentalacademy.com

AboveAbove figurefigure shows the interferences andshows the interferences and
potential for dislodgement and the balancepotential for dislodgement and the balance
attained after selected reduction of theattained after selected reduction of the
mandibular teeth.mandibular teeth.

Class 2Class 2
Class 2 includes patients for whom minorClass 2 includes patients for whom minor
additions to theadditions to the height of the teethheight of the teeth are needed toare needed to
obtain bilateral balance. This situation may occurobtain bilateral balance. This situation may occur
when there has been loss of tooth structurewhen there has been loss of tooth structure
because ofbecause of trauma or decaytrauma or decay or when there hasor when there has
beenbeen isolated supraeruptionisolated supraeruption in areas without thein areas without the
loss of vertical dimension. Anloss of vertical dimension. An exampleexample is a patientis a patient
who presented for new maxillary denture and awho presented for new maxillary denture and a
new mandibular swing lock removable partialnew mandibular swing lock removable partial
denture.denture.

The patient was referred for treatment afterThe patient was referred for treatment after
the general dentist had placed crowns onthe general dentist had placed crowns on
teeth #2l and #22. Upon establishment ofteeth #2l and #22. Upon establishment of
the occlusal wax rim to register the properthe occlusal wax rim to register the proper
occlusal plane relative to incisal show andocclusal plane relative to incisal show and
lip support, it became evident that there waslip support, it became evident that there was
a discrepancy in the height of thea discrepancy in the height of the
mandibular anterior teeth.mandibular anterior teeth.

The patient refused to have the crownsThe patient refused to have the crowns
remade to the proper dimensions. Anremade to the proper dimensions. An
anterior try-inanterior try-in was performed to confirm thewas performed to confirm the
correct esthetic and phonetic positioning.correct esthetic and phonetic positioning.
During the placement of the posterior teeth,During the placement of the posterior teeth,
additions to the natural mandibular teethadditions to the natural mandibular teeth
were required to maintain contact in thewere required to maintain contact in the
protrusive excursion.protrusive excursion.

WaxWax was added to the articulatedwas added to the articulated
mandibular cast to allow correct setting ofmandibular cast to allow correct setting of
the posterior teeth with balance in allthe posterior teeth with balance in all
excursions. To transfer this correction to theexcursions. To transfer this correction to the
patient, the mandibular cast, with the waxpatient, the mandibular cast, with the wax
added, was duplicated, and a 0020-inchadded, was duplicated, and a 0020-inch
vacuum-pressed sheet was fabricated.vacuum-pressed sheet was fabricated.

This sheet was used on the day of delivery toThis sheet was used on the day of delivery to
act as a template to the placement ofact as a template to the placement of
composite resincomposite resin to the natural teeth to createto the natural teeth to create
the balanced occlusion that was developedthe balanced occlusion that was developed
in the dental laboratory.in the dental laboratory.

Vaccum-formed template in place before teeth buildup

SlitsSlits were placed through the vacuum-were placed through the vacuum-
formed templateformed template interproximallyinterproximally to preventto prevent
bonding of the composite resin to thebonding of the composite resin to the
adjacent tooth and to allow the patient toadjacent tooth and to allow the patient to
floss normally.floss normally.

Final resultFinal result
Anterior teeth built up in composite resin to permit balance in protrusion

Class 3Class 3
Class 3 includes patients for whom bothClass 3 includes patients for whom both
reductions and additionsreductions and additions to teeth areto teeth are
required to obtain balance. These patientsrequired to obtain balance. These patients
often require restoration of theoften require restoration of the verticalvertical
dimension of occlusion.dimension of occlusion.

Patient who wasPatient who was edentulous in theedentulous in the
maxillary archmaxillary arch andand dentate on thedentate on the
mandiblemandible, The patient had poor oral, The patient had poor oral
hygiene, caries, a history of fracturedhygiene, caries, a history of fractured
denture teeth, perforations of crowns,denture teeth, perforations of crowns,
large restorations, loss of verticallarge restorations, loss of vertical
dimension. supraeruption of thedimension. supraeruption of the
mandibular anterior teeth, inverse smilemandibular anterior teeth, inverse smile
line, and poor self esteem.line, and poor self esteem.

Instruction in oral hygiene was provided,Instruction in oral hygiene was provided,
andand basic restorative needsbasic restorative needs were addressedwere addressed
accordingly. The maxillary arch was borderaccordingly. The maxillary arch was border
molded, impressed, and mounted on anmolded, impressed, and mounted on an
articulator by the use of a face bow. Thearticulator by the use of a face bow. The
wax occlusal rim was idealized with no inputwax occlusal rim was idealized with no input
from the position of the mandibular teeth.from the position of the mandibular teeth.

Frontal view of the proposed maxillary setup

The result is demonstrated in the previous figure,The result is demonstrated in the previous figure,
thethe lack of a natural smilelack of a natural smile is evident. With theis evident. With the
maxillary teeth in the ideal position, themaxillary teeth in the ideal position, the verticalvertical
dimension of occlusion was increased 4 mmdimension of occlusion was increased 4 mm fromfrom
the correct location determined by the physiologicthe correct location determined by the physiologic
rest position andrest position and 8 mm greater than at8 mm greater than at
presentationpresentation. Using a. Using a second occlusal rimsecond occlusal rim, an, an
interocclusal record was made at the correctinterocclusal record was made at the correct
vertical dimension of occlusion and the mandibularvertical dimension of occlusion and the mandibular
cast was articulated.cast was articulated.

Once articulated, the maxillary cast with theOnce articulated, the maxillary cast with the
ideal setup was placed back on theideal setup was placed back on the
articulator, and aarticulator, and a 4-mm discrepancy4-mm discrepancy waswas
noted in the anterior because of thenoted in the anterior because of the
supraeruption of the mandibular anteriorsupraeruption of the mandibular anterior
teeth. Before any adjustment of theteeth. Before any adjustment of the
mandibular anterior teeth, a 0.020-inchmandibular anterior teeth, a 0.020-inch
vacuum-formed template was fabricatedvacuum-formed template was fabricated
over the mandibular cast.over the mandibular cast.

Adjustments to the mandibular cast were made and marked in red.Adjustments to the mandibular cast were made and marked in red.

The patient was advised of the possibleThe patient was advised of the possible
need for endodontic treatments of theseneed for endodontic treatments of these
teeth before any intraoral modifications.teeth before any intraoral modifications.
After the mandibular anterior teeth wereAfter the mandibular anterior teeth were
adjusted to a the correct verticaladjusted to a the correct vertical
dimension to be established, there was nodimension to be established, there was no
tooth contact in the posterior.tooth contact in the posterior.

A mandibular occlusal device was fabricatedA mandibular occlusal device was fabricated
for delivery at the time of maxillary denturefor delivery at the time of maxillary denture
insertion and adjustment of the mandibularinsertion and adjustment of the mandibular
anterior teeth. The vacuum-formed templateanterior teeth. The vacuum-formed template
was trimmed with a scalpel to the level ofwas trimmed with a scalpel to the level of
the teeth modifications so that the amount ofthe teeth modifications so that the amount of
reduction of the mandibular teeth wasreduction of the mandibular teeth was
clearly evident at the time of intraoralclearly evident at the time of intraoral
modifications.modifications.

The maxillary denture was inserted, andThe maxillary denture was inserted, and
the mandibular teeth were adjusted to thethe mandibular teeth were adjusted to the
proper corrected vertical dimension usingproper corrected vertical dimension using
thethe modified vacuum-formed stentmodified vacuum-formed stent..

Vaccum-formed template in place
before adjustments
Vaccum-formed template in place
after adjustments

A mandibular occlusal device that maintained posterior
contact was also inserted.
After insertion of maxillary complete denture,
Reduction of the mandibular anterior teeth
And insertion of occlusal device.
Occlusal view of occlusal device

The patient was seen on follow-up toThe patient was seen on follow-up to
evaluate the changes in vertical dimensionevaluate the changes in vertical dimension
and the effect on esthetics and phonetics.and the effect on esthetics and phonetics.
The patient exhibited no adverse signs orThe patient exhibited no adverse signs or
symptoms from the changes. so treatmentsymptoms from the changes. so treatment
proceeded with the restoration of theproceeded with the restoration of the
mandibular posterior teeth. All posteriormandibular posterior teeth. All posterior
teeth were restored withteeth were restored with gold occlusalgold occlusal
surfaces.surfaces.

Occlusal view of mandibular crowns

The maxillary posterior denture teeth wereThe maxillary posterior denture teeth were
then modified using thethen modified using the chew-in orchew-in or
functionally generated wax technique tofunctionally generated wax technique to
obtain gold occlusal surfacesobtain gold occlusal surfaces to register andto register and
maintain the balanced occlusion better in allmaintain the balanced occlusion better in all
excursive movements.excursive movements.

Functionally generated wax pattern Occlusals in wax ready for spruing
Gold occlusalswww.indiandentalacademy.comwww.indiandentalacademy.com

The final photographs show a moreThe final photographs show a more
natural smilenatural smile and a far more estheticand a far more esthetic
result. The attention to detail in preservingresult. The attention to detail in preserving
the balance in excursive movements givesthe balance in excursive movements gives
thesethese restorations a good long prognosisrestorations a good long prognosis..

Completed prostheses, facial view
Completed prostheses, frontal view

Class 4Class 4
Class 4 includes patients whose occlusalClass 4 includes patients whose occlusal
discrepancies require addition to thediscrepancies require addition to the width of thewidth of the
occluding surfaceoccluding surface. These patients typically have all. These patients typically have all
Angle’s class 2 malocclusionAngle’s class 2 malocclusion, and present with, and present with
constricted arches resulting in a posterior crossconstricted arches resulting in a posterior cross
bite or a with abite or a with a Brodie biteBrodie bite in which thein which the entireentire
mandibular dentition is lingual to the palatalmandibular dentition is lingual to the palatal
surfaces of the maxillary teeth.surfaces of the maxillary teeth.

Frontal view of waxup
Occlusal view of
waxup
Occlusal view of mandibular waxup

Above figures showed a patient whoAbove figures showed a patient who
exhibited a Brodie bite and who needed anexhibited a Brodie bite and who needed an
immediate maxillary denture and animmediate maxillary denture and an
immediate interim mandibular partialimmediate interim mandibular partial
denture. The maxillary teeth were placed indenture. The maxillary teeth were placed in
the most pleasing esthetic position, withthe most pleasing esthetic position, with
care taken not to divert from the neutralcare taken not to divert from the neutral
zone. The occlusal surfaces were widenedzone. The occlusal surfaces were widened
with wax to obtain balanced contacts in allwith wax to obtain balanced contacts in all
movements.movements.

An additional row of teeth is an alternativeAn additional row of teeth is an alternative
method of treatment but is more expensivemethod of treatment but is more expensive
thanthan building up the contacts in waxbuilding up the contacts in wax andand
eventually in denture base material.eventually in denture base material.

Class 5Class 5
KellyKelly describeddescribed combination syndromecombination syndrome as aas a
situation that exhibitssituation that exhibits
 Bone loss in the maxillary anteriorBone loss in the maxillary anterior
 Overgrowth of the tuberositiesOvergrowth of the tuberosities
 Papillary hyperplasiaPapillary hyperplasia
 Extrusion of the mandibular anterior teethExtrusion of the mandibular anterior teeth
 Loss of bone in the mandibular posteriorLoss of bone in the mandibular posterior
in patients who have a maxillary complete denturein patients who have a maxillary complete denture
opposing mandibular anterior teeth.opposing mandibular anterior teeth.

SaundersSaunders addedadded six additional factorssix additional factors to includeto include
periodontal changesperiodontal changes
loss of vertical dimensionloss of vertical dimension
occlusal plane discrepancyocclusal plane discrepancy
poor prosthesis adaptationpoor prosthesis adaptation
epulis fissuratumepulis fissuratum
anterior repositioning of the mandible.anterior repositioning of the mandible.

Although the combination syndrome is not found inAlthough the combination syndrome is not found in
every patient who has a maxillary complete dentureevery patient who has a maxillary complete denture
opposing a Kennedy class I removable partialopposing a Kennedy class I removable partial
denture, one should be aware of thedenture, one should be aware of the importanceimportance ofof
equally distributed occlusal contacts between theequally distributed occlusal contacts between the
maxillary denture and the mandibular natural teethmaxillary denture and the mandibular natural teeth
and the removable partial denture.and the removable partial denture.

AboveAbove figuresfigures shows the treatment of ashows the treatment of a
patient who was edentulous on the maxillarypatient who was edentulous on the maxillary
arch for more than 20 years. Although aarch for more than 20 years. Although a
mandibular removable partial denture wasmandibular removable partial denture was
initially fabricated, the patient admits to notinitially fabricated, the patient admits to not
wearing it very long. A clear resin duplicatewearing it very long. A clear resin duplicate
was made of the maxillary denture and waswas made of the maxillary denture and was
used to articulate the casts.used to articulate the casts.

Articulated clear duplicate maxillary denture

The articulated casts clearly show that there is not
enough space to fabricate the correct occlusal plane for
the denture.

With the mandibular incisor teeth and theWith the mandibular incisor teeth and the
retromolar pads serving as guides, the castretromolar pads serving as guides, the cast
was adjusted in the tuberosities region.was adjusted in the tuberosities region.
FortunatelyFortunately, the sinuses were superiorly, the sinuses were superiorly
placed and would not be exposed duringplaced and would not be exposed during
the surgical reduction of the tuberosity.the surgical reduction of the tuberosity.

AA clear surgical stentclear surgical stent was fabricated to assistwas fabricated to assist
the oral and maxillofacial surgeon in thethe oral and maxillofacial surgeon in the
amount of tuberosity reduction and delivery ofamount of tuberosity reduction and delivery of
the maxillary denture. Anthe maxillary denture. An interim mandibularinterim mandibular
removable dentureremovable denture was delivered at the samewas delivered at the same
visit to maintain maximum occlusal contactsvisit to maintain maximum occlusal contacts
and to provide balance in all excursiveand to provide balance in all excursive
movements.movements.

Frontal view of completed prostheses

After an appropriate healing period, aAfter an appropriate healing period, a
new complete maxillary denturenew complete maxillary denture and aand a
cast metal-resin removable partialcast metal-resin removable partial
denture were fabricated.denture were fabricated.

SummarySummary
The single maxillary denture is a complex prosthesisThe single maxillary denture is a complex prosthesis
that requires a complete understanding of thethat requires a complete understanding of the
basics of denture occlusion. Theilemann’s formulabasics of denture occlusion. Theilemann’s formula
must be applied to each individual patient andmust be applied to each individual patient and
appropriate treatment must be taken to assureappropriate treatment must be taken to assure
complete balance in all excursive movements.complete balance in all excursive movements.

The basic principles of retention, stability,The basic principles of retention, stability,
and support should not to be taken forand support should not to be taken for
granted, and steps must be completed sogranted, and steps must be completed so
that all components are working inthat all components are working in
harmony for success of the maxillaryharmony for success of the maxillary
denture.denture.

Treatment of various patients has beenTreatment of various patients has been
illustrated to allow the reader to comprehendillustrated to allow the reader to comprehend
better the modalities that can be employedbetter the modalities that can be employed
for preparing the oral environment beforefor preparing the oral environment before
denture insertion thereby ensuring betterdenture insertion thereby ensuring better
success in treating these classes ofsuccess in treating these classes of
patients.patients.

Charles W. Ellinger et al
J Prosthet Dent 1971,Vol 26,no 1,Pg 4-10
Various combinations
The artificial teeth arrangement in a harmonious relation to the mandibular teeth
Summary: The development of a harmonious occlusion is most critical to the
success of a single complete denture treatment.
Achieving this desirable characteristic is usually much mare difficult than arranging
Artificial teeth for opposing complete denture.

THE MAXILLARY COMPLETE DENTURETHE MAXILLARY COMPLETE DENTURE
OPPOSING NATURALTEETH:OPPOSING NATURALTEETH:
PROBLEMS AND SOME SOLUTIONSPROBLEMS AND SOME SOLUTIONS
Alex KoperAlex Koper
J Prosthet Dent 1987 Vol 57, No 6,Pg 704-707.J Prosthet Dent 1987 Vol 57, No 6,Pg 704-707.
The problems involved in providing comfort, function, proper esthetics and retention
for the maxillary completer denture patient with natural opposing dentition may be
challenging.
Careful attention of the patient is important.
It provides the new complete denture patient the opportunity to adapt to a complete
denture and allows the dentist to evaluate his patient physically and emotionally
before fabrication of the final complete denture.

THE MAXILLARY COMPLETE DENTURE OPPOSING THETHE MAXILLARY COMPLETE DENTURE OPPOSING THE
MANDIBULAR BILATERAL DISTAL-EXTENSION PARTIALMANDIBULAR BILATERAL DISTAL-EXTENSION PARTIAL
DENTURE: TREATMENT CONSIDERATIONSDENTURE: TREATMENT CONSIDERATIONS
TIMOTHY et alTIMOTHY et al
J Prosthet Dent 1979, VolJ Prosthet Dent 1979, Vol 41,Pg 124-12841,Pg 124-128
The dentist should approach the treatment of the complete maxillaryThe dentist should approach the treatment of the complete maxillary
denture opposing the mandibular bilateral distal extension partialdenture opposing the mandibular bilateral distal extension partial
denture cautiously ,and the institution of correct treatment initiativesdenture cautiously ,and the institution of correct treatment initiatives
is essential.is essential.
Every patient must be aware from the outset that the longestEvery patient must be aware from the outset that the longest
possible life of any prosthesis with the least harm to the remainingpossible life of any prosthesis with the least harm to the remaining
tissues can only be ensured by regular recall and maintenance caretissues can only be ensured by regular recall and maintenance care

REFERENCESREFERENCES
Jacobson TE, Krol AJ.Jacobson TE, Krol AJ. A contemporary review of theA contemporary review of the
factors involved in complete denture retention, stability,factors involved in complete denture retention, stability,
and support. Part I: retentionand support. Part I: retention
J Prosthet Dent 1983:49(l):5-15.J Prosthet Dent 1983:49(l):5-15.
Jacobson TE. Krol AJ.Jacobson TE. Krol AJ. A contemporary review of theA contemporary review of the
factors involved in complete dentures. Part II : stability.factors involved in complete dentures. Part II : stability.
J Prosthet Dent l983;49(2):165-72J Prosthet Dent l983;49(2):165-72..
Jacobson TE. KroI AJ.Jacobson TE. KroI AJ. A contemporary review of theA contemporary review of the
factors involved in complete dentures. Par III support.factors involved in complete dentures. Par III support.
J Prosthet Dent l983;49(3):306-l 3.J Prosthet Dent l983;49(3):306-l 3.

The glossary of Prosthodontic terms.The glossary of Prosthodontic terms.
J Prosthet Dent 2005.J Prosthet Dent 2005.
Complete denture occlusion.Complete denture occlusion. Dent Clin North AmDent Clin North Am
1977:21(2):299-320.1977:21(2):299-320.
Stephens AP.Stephens AP. The single complete denture. : Sharry L.The single complete denture. : Sharry L.
Complete denture prosthodontics.Complete denture prosthodontics.
Koper A.Koper A. The maxillary complete denture opposing naturalThe maxillary complete denture opposing natural
teeth: problems and some solutions.teeth: problems and some solutions.
J Prosthet Dent 1987;57(6):704-707J Prosthet Dent 1987;57(6):704-707
Ellinger CW, Rayson JH, Henderson D.Ellinger CW, Rayson JH, Henderson D. Single completeSingle complete
dentures.dentures.
J Prosthet Dent 1971 26(l):4-l0.J Prosthet Dent 1971 26(l):4-l0.

Kelly.Kelly. Changes caused by a mandibular r removable partialChanges caused by a mandibular r removable partial
denture opposing a maxillary complete denturedenture opposing a maxillary complete denture
J Prosthet Dent 1972:27(2):140-50J Prosthet Dent 1972:27(2):140-50
Tan HK.Tan HK. A preparation guide for modifying the mandibularA preparation guide for modifying the mandibular
teeth before making a maxillary single complete denture.teeth before making a maxillary single complete denture.
J Prosthet Dent 1997;77(3):321-2.J Prosthet Dent 1997;77(3):321-2.
Saunders TR. Gillis RE, Desjardins RPSaunders TR. Gillis RE, Desjardins RP. The maxillary. The maxillary
complete denture opposing the mandibular bilateralcomplete denture opposing the mandibular bilateral
distal-extension partial denture: treatment considerations.distal-extension partial denture: treatment considerations.
J Prosthet Dent 1979:41(2):124 -128.J Prosthet Dent 1979:41(2):124 -128.

Zarb GA, Bolender C, Hickey JC, Carlsson GE.Zarb GA, Bolender C, Hickey JC, Carlsson GE. SingleSingle
complete dentures opposing natural teeth. : Boucher’scomplete dentures opposing natural teeth. : Boucher’s
Prosthodontic treatment for edentulous patients.Prosthodontic treatment for edentulous patients.
Heartwell CM, Rahn A.Heartwell CM, Rahn A. The single complete denture :The single complete denture :
Syllabus of complete dentures.Syllabus of complete dentures.

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