Single Complete Denture vs. Natural Teeth
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Tim TimSingle Complete Denture vs. Natural Teeth
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Powered by AIBalanced occlusion in denture placement can be achieved through two primary methods: dynamic equilibration using a functionally generated path (FGP) and functional equilibration using an articulator programmed to simulate the patient's jaw movements. The functional chew-in technique is the most accurate for recording occlusal patterns but is contraindicated in cases of unstable bases or poor neuromuscular control. The articulator equilibration technique involves mounting casts, adjusting buccal and lingual positions, setting condylar inclinations, and selectively grinding for harmony in centric and eccentric movements. Both methods seek to maintain maximum bilateral contacts in functional activities, allowing freedom in lateral excursions .
The use of maxillary porcelain denture teeth can lead to wear of the opposing natural teeth due to their hardness. Additionally, conditions such as heavy anterior occlusal contact, deep labial frenal notches, and high occlusal forces can result in denture fractures. To circumvent these issues, it is recommended to use new generation acrylic or composite resin denture teeth, which are softer and reduce the wear on opposing natural teeth .
Swenson's technique involves mounting casts on an articulator, setting maxillary denture teeth, and marking areas of interference on the natural teeth for modification. Yurkstas recommended using a metal U-shaped occlusal template, while Bruce suggested a clear acrylic template coated with pressure-indicating paste to identify and remove interferences. These methods focus on achieving balanced occlusion by adjusting tooth positions and alleviating occlusal disharmonies .
Preventive strategies for Combination Syndrome include avoiding the combination of maxillary complete dentures with mandibular class I removable partial dentures (RPDs). Retaining weak posterior teeth using endodontic and periodontal techniques, or creating an overdenture on the lower teeth, are advisable strategies. These approaches help manage the adverse biomechanical forces and mitigate the syndrome's progression .
The primary challenge in providing a single complete denture, particularly when a maxillary denture is opposed by natural mandibular teeth, lies in the significant biomechanical differences in the supporting tissues of the upper and lower arches. The retention and stability are influenced by the fixed position of mandibular anterior teeth, the natural teeth's various malpositions, and potential super eruptions, which complicate achieving harmonious balanced occlusion. In addition, issues such as adverse occlusal forces from the remaining dentition and potential bone resorption in the opposing arch further exacerbate these challenges .
Articulator equilibration techniques guide the dental practitioner in simulating the patient's jaw movements, aiding in precise placement and adjustment of denture teeth. By evaluating buccal-lingual positioning and using eccentric records to set condylar inclinations, practitioners can ensure maximum bilateral contact during functional and parafunctional activities. Selective grinding of contacts in centric and eccentric movements is performed to ensure continuous contact, thus achieving a harmonious balanced occlusion .
Mandibular residual ridge resorption detrimentally affects denture stability due to the inadequate support from the residual ridge, leading to compromised denture retention. The resorption alters the fit of the denture, making it susceptible to occlusal forces, and increasingly unstable as the ridge resorbs further. Endosseous implants can counteract these effects by providing additional retention and support, thereby enhancing denture stability and functionality .
Mandibular single complete dentures present challenges including severe residual ridge resorption and limited quality of supporting mucosa due to greater occlusal forces from the maxillary arch. These factors contribute to difficulties in retention and stability. One proposed solution is the use of endosseous implants, which offer better retention and support, and help retard bone resorption, providing a more stable foundation for the mandibular dentures .
Combination Syndrome develops when a maxillary complete denture is used in conjunction with a mandibular distal extension partial denture, leading to specific oral changes. Clinically, Ellsworth Kelly identified signs such as loss of bone in the maxillary anterior ridge, overgrowth of tuberosities, papillary hyperplasia, extrusion of lower anterior teeth, and loss of bone under partial denture bases. Additional signs include loss of vertical occlusion dimension, occlusal plane discrepancy, anterior repositioning of the mandible, poor prostheses adaptation, epulis fissuratum, and periodontal changes .
The functional chew-in technique requires the patient to perform eccentric movements with a modified occlusal rim, allowing the carding wax to mold into the occlusal patterns. The wax path is then transposed to the stone to simulate jaw movements for setting denture teeth. Limitations arise from unstable record bases, poor neuromuscular control, or mental competence issues, making it unsuitable for certain patients despite its accuracy .