|Year : 2018 | Volume
| Issue : 2 | Page : 60-62
Hollow complete denture for resorbed ridges
U Krishna Kumar1, Sanjay Murgod2
1 Department of Prosthodontics Including Crown and Bridge and Implantology, Rajarajeswari Dental College, Bengaluru, Karnataka, India
2 Department of Oral Pathology, Rajarajeswari Dental College, Bengaluru, Karnataka, India
|Date of Web Publication||18-Dec-2018|
U Krishna Kumar
Department of Prosthodontics Including Crown and Bridge and Implantology, Rajarajeswari Dental College, No 14, Ramohally Cross, Kumbalgodu, Mysore Road, Bengaluru - 560 074, Karnataka
Source of Support: None, Conflict of Interest: None
The severely resorbed maxillary and mandibular edentulous arches that are narrow and constricted with increased inter-arch space provide decreased support, retention, and stability and pose a clinical challenge to the success of complete denture prostheses. The consequent weight of the processed complete denture only compromises them further. This article highlights a technique for the fabrication of a hollow maxillary complete denture in situation where there is excessive resorption of the maxillary residual alveolar ridge and thereby greatly reducing the weight of an exceptionally heavy maxillary denture. Weight of a denture may be a contributing factor to the successful resolution of a patient's problem; the hollow denture can be considered as one of the treatment modalities.
Keywords: Hollow dentures, lightweight, ridge resorption
|How to cite this article:|
Kumar U K, Murgod S. Hollow complete denture for resorbed ridges. Int J Oral Health Sci 2018;8:60-2
| Introduction|| |
Residual ridge resorption is the physiological process of reduction in size of the bony ridge under the mucoperiosteum. The resorption occurs at a faster rate in mandibular arch as compared to the maxillary arch, but severely atrophic maxillae with large interridge distance often pose a clinical challenge during fabrication of a successful maxillary complete denture. In addition to this increased interridge distance often results in heavy maxillary complete denture that further reduces the retention of the prosthesis. Reducing the weight of a maxillary prosthesis has been shown to be beneficial when constructing an obturator for the restoration of a large maxillofacial defect., It has also been proved that prosthesis weight can be reduced by making the denture base hollow.
Different approaches like using a solid 3-dimensional spacer, including dental stone,,,,,, silicone putty,, modeling clay,, or cellophane wrapped asbestos, thermocol have been used during laboratory processing to exclude denture base material from the planned hollow cavity of the prosthesis. Holt processed a shim of acrylic resin over the residual ridge and used a spacer. The resin was indexed and the second half of the denture processed against the spacer and shim. The spacer was then removed and the two halves luted with autopolymerized acrylic resin using the indices to facilitate positioning. The primary disadvantage of such techniques is that the junction between the two previously polymerized portions of the denture occurs at the borders of the denture. This is a long junction with an increased risk of seepage of fluid into the denture cavity increasing the risk of leakage. Fattore et al. used a variation of the double-flask technique for obturator fabrication by adding heat polymerizing acrylic resin over the definitive cast and processing a minimal thickness of acrylic resin around the teeth using a different drag. Both portions of resin were attached using a heat polymerized resin.
Kaira et al., 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 the 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.
| Case Report|| |
A 46-year-old male patient reported to the department of prosthodontics with a chief complaint of looseness of both upper and lower dentures and desired the replacement of the same. The intraoral examination revealed a narrow and constricted U-shaped flat palatal vault and severely resorbed maxillary and mandibular ridges. The treatment plan decided for the patient was the fabrication of a hollow maxillary complete denture.
Preliminary impressions of the edentulous maxilla and mandible were made with impression compound. The impressions were washed and poured with the dental plaster. The custom tray was prepared with autopolymerizing acrylic resin. Border molding was performed with greenstick and final impression [Figure 1] with zinc oxide eugenol impression. Occlusal rims were fabricated using modeling wax record. The maxilla-mandibular relationship was recorded and transferred to the articulator; artificial teeth were arranged. Try in procedure was done. Trial denture bases were reinserted into the patient's mouth and the patient was instructed to perform various orofacial movements so as to record the polished surface of the denture in harmony with the orofacial musculature. After the try in procedure, carving and festooning of wax was done and dentures were made ready for processing. The mandibular denture was processed using the conventional procedure.
The maxillary trial denture was flasked and dewaxed in the conventional manner. Half of the heat cure in dough stage was positioned accurately over the dewaxed mold and then salt crystals [Figure 2] were placed over it. Above that, the remaining heat cure resin was packed and cured at 74°C for 7–8 h. Processed denture was retrieved, and three holes were made in the tissue surface. 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. The hollow cavity seal was verified by immersing the denture in water; if no air bubbles are evident, an adequate seal is confirmed. The dentures were inserted in the patient's mouth [Figure 3], and instructions regarding care, hygiene, and maintenance were given. Preinsertion occlusal corrections were made, and the denture was inserted in the patient's mouth.
The method described has advantages as 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. There are studies in which it is proved that, by reducing the weight of the denture, either by making a hollow denture or by altering the plane of occlusion to some extent, preservation of the existing residual alveolar ridge is possible. An added advantage with a hollow denture is a comparable increase in retention and stability that can be achieved. 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.
| Conclusion|| |
Rehabilitation of severely resorbed ridges is a challenge to the prosthodontist due to retention, stability, and support factors. Even though the choice of rehabilitation can be overdentures, implant retained overdentures, ridge augmentation, etc., many a times the patients who come with such a problem are geriatric patients with many systemic illnesses. One of the best ways is to rehabilitate them with lightweight conventional complete dentures. A simplified technique of fabricating hollow denture using salt crystals as spacer was found to be effective and satisfactory for patients.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]