This hyperplastic tissue does not support the denture base and usually it
folds forwards forming a characteritic deep fold/ crease anteriorly
Lower anterior teeth also migrate upwards, upper anterior teeth disappear
beneath the lip, and both dentures migrate downwards in the posterior
region
Excessive bony resorption under the lower removable partial denture and
often papillary hyperplasia develops in the palate
Treatment:
1. Mandibular removable partial denture should provide positive
occlusal support from remaining natural teeth and have maximum
coverage of basal seat beneath distal extension bases.
2. Design should be rigid providing maximum stability and minimising
excessive stress on the remaining teeth.
3. Occlusal scheme should be of proper vertical and centric relation.
4. Anterior teeth be used for cosmetic and phonetic purposes only.
5. Posterior teeth in balanced occlusion.
3) Mental trauma:
The loss of teeth is a traumatic experience for some patients and
they may even get depressed. Hence, in such patients who have lost their
mandibular teeth, the removal of maxillary teeth may be even more
traumatic. Thus, the necessity for retaining the maxillary teeth in spite of
the potential long term side effects.
In some, patient education and psychiatric help may help to counter
the situation.
Diagnosis:
- Bone morphology of the residual ridge
- Maxillo-mandibular relationship.
Amount of resorption can be classified as,
Class I Pattern: Approximately 2/3rd of amount of alveolar bone present.
Class II Pattern: Approximately 1/3rd 2/3rd of alveolar bone present.
Class III Pattern: Approximately 1/3rd or less of alveolar bone present.
Recommendations for retention of remaining maxillary teeth when
opposing an edentulous mandible.
Resorption
Pattern
Orthognathic
angle class I
Retorgnathic
class II
Class I
Consider
Consider
Class II
Consider
under
special cases
Consider
special case
Class III
Do not retain
Do not retain
Prognathic
class III
Strongly consider
in
Consider
Do not retain
In such situations, it has often been said that the patients are better
off with all their teeth extracted. A useful analogy can be presented, i.e.
the force concentration encountered when a small hammer is swing
against a large anvil. Here, a small hammer (mandible), the dentate
maxilla (large anvil). The arm holding the hammer is vulnerable (as the
mandible) and the force generated can only lead to denture dislodgement
and/or tissue trauma. However, it is not always possible to convince the
patient for the extractions of the restored maxillary teeth.
Indications for a mandibular complete denture:
1. Class III geno relations where the size and form of residual ridge is
adequate to resist forces from natural teeth.
2. In case of cleft palate patients, maxillary teeth are retained to help
maintain a prosthetic restoration.
3. Mental trauma where a mandibular teeth are already lost, patient
may not be able to tolerate the additional loss of maxillary teeth
(psychological complications).
10
References
1. JJ Sharry, Complete Denture Prosthodontics, 3 rd Edition, Blakinston
Publication.
2. Arthur Rahn, Syllabus of Complete Dentures, 4th Edition, BC Decker.
3. Sheldon Winkler, Essentials of Complete Denture Prosthodontics, 2nd
Edition, AITBS Publishers.
4. Zarb, Bolender, Prossthodontic Treatment forEdentulous patients, 12 th
Edition, Elsevier.
5. Ejvind Budtz-Jorgensen, Dr Odont, Prosthodontics for the Elderly
Diagnosis & Treatment, Quintessence Books.
6. Stansbury, C. B.: Single denture construction against a non-modified
natural dentition. J Prosthet Dent 1951:1;692-699.
7. Ellinger CW, Rayson JH, Henderson D. Single complete dentures. J
Prosthet Dent 1971;26:4-10.
8. Bruce RW. Complete dentures opposing natural teeth. J Prosthet Dent
1971;26:448-55.
9. Rudd KD, Morrow RM. Occlusion and the single denture. J Prosthet Dent
1973;30:4-I0.
10.Wallace DH. The use of gold occlusal surfaces in complete and partial
dentures. J Prosthet Dent 1964;14:326-33 .
11.Beyli MS, van Fraunhofer JA. An analysis of causes of fracture of acrylic
resin dentures. J Prosthet Dent 1981:46:238-41.
12.Schneider RL. Diagnosing functional complete denture fractures. J
Prosthet Dent 1985;54:809-14.
13.Han-Kuang Tan. A preparation guide for modifying the mandibular teeth
before making a maxillary single complete denture. J Prosthet Dent
1997;77:321-322.
14.Carl F .Driscoll, Radi M. Masri. Single maxillary complete denture. Dent Clin N
Am 2004;48:567-583
15.Nishtha Madan, Kusum Datta. Combination syndrome. J Ind Prosthet Soc
2008;8: 10-13.
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