Table of Contents  
CASE REPORT
Year : 2012  |  Volume : 4  |  Issue : 2  |  Page : 143-147

Light weight hollow maxillary complete denture: A case series


1 Veer Chandra Singh Garhwali Government Medical Sciences and Research Institute, Srinagar Garhwal, Uttrakhand, India
2 Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
3 Department of Public Health Dentistry, Peoples Dental Academy, Bhopal, Madhya Pradesh, India
4 Department of Prosthodontics, Darshan Dental College, Udaipur, Rajasthan, India

Date of Web Publication17-Jan-2013

Correspondence Address:
Laxman Singh Kaira
House Nu 47A Vijay Colony, New Cantt Road, Dehradoon - 248 001, Uttrakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-8844.106216

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  Abstract 

Retention, stability and support are the basic principles on which the success of a complete denture relies on. The skill lies in applying these principles efficiently in critical situations. Residual ridge resorption occurs at a three times faster rate in mandibular arch than in the maxillary arch. The severely resorbed maxillary and mandibular edentulous arches that are narrow and constricted with increased interarch space provide decreased support, retention and stability. The consequent weight of the processed complete denture only compromises them further. The severely resorbed jaw can have various treatment options. Extreme resorption of the maxillary denture-bearing area may lead to problems with prosthetic rehabilitation. The advantage of a hollow maxillary or mandibular denture is the reduction of excessive weight of acrylic resin, which normally replaces lost alveolar ridge in the interridge space of the denture wearer. This clinical report describes two case reports of edentulous patients with resorbed ridges where a simplified technique of fabricating a light weight hollow maxillary complete denture was used for the preservation of denture bearing areas.

Keywords: Dental education, dental health, dental health promotion, tooth loss


How to cite this article:
Kaira LS, Singh R, Jain M, Mishra R. Light weight hollow maxillary complete denture: A case series. J Orofac Sci 2012;4:143-7

How to cite this URL:
Kaira LS, Singh R, Jain M, Mishra R. Light weight hollow maxillary complete denture: A case series. J Orofac Sci [serial online] 2012 [cited 2017 Jul 23];4:143-7. Available from: http://www.jofs.in/text.asp?2012/4/2/143/106216


  Introduction Top

"No step in denture construction should be stopped short of perfection yet many dentures are worn, which have imperfections built into them, provided they have peripheral seal sufficient to hold them in place". In the large maxillofacial defects and in severely resorbed edentulous ridges, there is a decreased denture bearing area for support, retention and stability. Increase interridge space compounds this problem. To decreased the leverage forces, reduction in the weight of the prosthesis was recommended and was also found to be beneficial. [1],[2] Different weight reduction approaches have been achieved using a solid 3 dimensional spacer, including dental stone, [1],[2],[3],[4],[5],[6] cellophane wrapped asbestos, [7] silicone putty [8] or modeling clay [9] have been used during laboratory processes to exclude denture base material from the planned hollow cavity of the prosthesis. Fattore et al.[10] 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 were attached using a heat polymerized resin.

Holt et al. [8] processed a shim of indexed acrylic resin over the residual ridge and used a spacer, which was then removed and the two halves luted with autopolymerized acrylic resin. The primary disadvantage of such technique is that the junction between the two previously polymerized portions of the denture occurs at the border of the denture, which increases risk of seepage of fluid into the denture cavity. Another disadvantage is that it is difficult to gauge resin thickness in the cope area.

O'Sullivan et al.[11] described a modified method for fabricating a hollow maxillary denture. A clear matrix of trail denture base was made. The trail 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 shim and the processing was done. The putty was later removed from the distal end of the denture and the opening was sealed with autopolymerizing resin. This case reports describes three technique for fabrication of a hollow maxillary complete denture in a patient with resorbed maxillary and mandibular ridges and increased interridge distance.


  Case Report Top


A 59-year-old male patient reported to the Department of Prosthetic Dentistry of Institute of Dental Sciences, Bareilly, Uttarpradesh for prosthetic rehabilitation of maxillary and mandibular edentulous ridges. Patient medical history was not significant. Past dental history revealed that patient was a denture wearer since 4 to 5 years, and the maxillary denture were loose. Intraoral examination revealed severely resorbed maxillary and mandibular edentulous ridges with increased interridge distance. Hence, hollow maxillary complete denture and conventional mandibular denture was planned for this patient.

Technique 1

  • Keeping in mind the strength of the denture, the distance from the teeth to 3 mm of the denture base was calculated. The rest of the denture base till the border was then calculated, therefore, the spacer would occupy the area between the shim of 2 mm thickness and the teeth with 3 mm of the denture base [Figure 1] and [Figure 2].
    Figure 1: Distance of teeth to 2 mm of wax

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    Figure 2: Distance of denture borders and wax

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  • Till the tryin stage the denture is fabricated in conventional manner.
  • The land area of the cast was indexed using a conical bur and the trail denture was sealed to the definitive cast.
  • The trail denture was duplicated in reversible hydrocolloid and poured in die stone.
  • A template of the duplicated trail denture was made by adapting 1 mm thermoplastic sheet on the recovered cast using vacuum heat-press machine [Figure 3].
    Figure 3: Clear template adaptation

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  • Two split denture flasks with interchangeable counters were used for processing.
  • The trial denture was then processed in the standard manner up to the wax elimination stage in base 1 counter 1 flask.
  • With the wax shim, 2 sheet thickness of base plate wax were adapted to the definitive cast in the drag, conforming to the border extensions. A second flask (counter 2) was used to pour this base plate wax and processed in the conventional manner using clear heat cure acrylic resin. After deflasking, the clear matrix was placed on the definitive cast (base 1) using the indices in the land area as seating guides. An endodontic file with the rubber stop was used to measure the space between the matrix and the processed base, in order to ensure that there is adequate space between the resin and the teeth [Figure 4].
    Figure 4: Placement of clear matrix over denture base with endodontic files

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  • Vinyl polysiloxane putty was mixed and adapted on the base 1 and shaped to the approximate contours of the matrix. The polymerized putty was shaped with a bur to leave 2 to 3 mm of space between denture base and matrix so that a hollow space is created. An additional, 1 mm space was provided over the tooth portion of the denture. The putty was fixed to the base using cynoanocrylate [Figure 5].
    Figure 5: Putty adaptation and placement of matrix with file checking space

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  • The original cope (counter 1) was reseated on the drag (base 1) and verified for a complete closure of the flask. Then acrylic resin was packed over the polyvinyl siloxane putty and processed. The processed denture was recovered in the usual manner.
  • After finishing the denture, two openings were cut with a bur into the denture base distal to the most posterior tooth. The silicone putty was removed using a sharp instrument and a thick orthodontic wire. The opening was widened as necessary, to facilitate the access. After complete removal of putty, two covers were fabricated using clear autopolymerizing resin. The clear resin cover was attached using autopolymerizing resin.
  • The denture was polished in usual manner and the seal was verified by immersing the denture in the water (air bubbles should not be evident after immersing the denture in the water) [Figure 6].
    Figure 6: Hollow denture floating in jar

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Technique 2

For the second patient with resorbed maxillary and mandibular ridges with increased interarch distance, was treated with a lightweight maxillary hollow denture, using thermocol, a common packing material, as spacer.

  • Two split denture flasks with interchangeable counters were used for the processing.
  • The trial denture base was invested and the processing was carried out till the wax elimination stage. Two layers of hard base plate wax over the definitive cast in the drag (base 1) conforming to the border extensions was added [Figure 7].
    Figure 7: Top half of the second split flask over the wax shimmed

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  • A second flask (counter 2) was used to invest the base plate wax till wax elimination stage and the cope (upper half of the flask or cavity side) was packed and processed with heat polymerizing resin.
  • The second flask (base 1) with the polymerized acrylic resin shim of 2 mm attached with the drag was separated. A denser thermocol was placed over the bur roughened acrylic shim along the ridge and luted with cyanoacrylate [Figure 8].
    Figure 8: Thermocol adaptation

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  • The spacer thickness is modified according to the calculation done above, leaving 3 mm from the teeth to the denture base.
  • The original cope (base 1) over the drag (counter 1) was reseated and complete closure of the flask was verified. The heat polymerizing resin was then mixed, packed and processed at 74°C for 7 to 8 h. Pre-insertion occlusal corrections were made and the denture was inserted in the patient mouth [Figure 9].
    Figure 9: Post-operative photograph

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  Discussion Top


The technique two has advantages over the first technique. Thermocol being a light weight material can be left in the denture without compromising the integrity of the denture, avoiding the tedious effort to remove the spacer material from the denture. The technique 1 overcomes the disadvantage of the older techniques. Problems with leakage and difficulty in gauging resin thickness are overcome. The small window in the cameo surface facilitates recovery of the spacer in an area that is not commonly adjusted after denture insertion and has a small margin along in which leakage can occur. The clear resin window allows vertification of the integrity of the denture at patient recall. The thickness of resin can be controlled through the use of putty and clear matrix, ensuring an even depth of resin to prevent seepage and prevent deformation under pressure of flask closure. In the first technique, silicone putty was used as a spacer because it is stable, it can be carved, and it does not adhere to acrylic resin. The cyanoacrylate bond between the resin and the putty can be easily removed. [11]

Advantages of technique 1

  • Reduce leakage at the junction of the two portions of the denture
  • Commonly used materials are used for its fabrication
  • Reduces weight of the prosthesis which in turn enhances retention.
Disadvantages

  • Time consuming procedure
  • Hollow denture is prone to fracture
  • Removal of putty from the cavity is difficult.
Precautions

  • There should be adequate thickness of the resin around the cavity
  • Seal around the window should be perfect and should be checked for any leakage
  • Denture care instructions should be given to the patients
  • Special instructions regarding handling of the denture should be given as the dentures are prone to fracture. [11]

  Conclusion Top


Hollow maxillary complete denture considerably reduces the weight of the prosthesis, which in turn prevents transmission of the detrimental forces, which would otherwise be transmitted from a conventional heavy prosthesis to the underlying tissue and bone. Thus, it helps to preserve underlying tissue and bone. Also, the clear matrix of the trial denture helps to facilitate the shaping of putty spacer to ensure even the thickness of acrylic to resist deformation and prevent seepage of saliva into the cavity. A simplified technique for fabricating light weight maxillary dentures using Thermocol as spacer and putty as a spacer that can be left in the denture without compromising denture strength has been described.

 
  References Top

1.el Mahdy AS. Processing a hollow obturator. J Prosthet Dent 1969;22:682-6.  Back to cited text no. 1
[PUBMED]    
2.Brown KE. Fabrication of a hollow-bulb obturator. J Prosthet Dent 1969;21:97-103.  Back to cited text no. 2
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3.Chalian VA, Drane JB, Standish SM. Intraoral prosthetics. In: Chalian VA, Drane JB, Standish SM, editors. Maxillofacial Prosthetics: multidisciplinary Practice. Baltimore: Williams and Wilkins; 1971. p. 133-57.  Back to cited text no. 3
    
4.Fattore LD, Fine L, Edmonds DC. The hollow denture: An alternative treatment for atrophic maxillae. J Prosthet Dent 1988;59:514-6.  Back to cited text no. 4
[PUBMED]    
5.Gardner LK, Parr GR, Rahn AO. Simplified technique for the fabrication of a hollow obturator prosthesis using vinyl polysiloxane. J Prosthet Dent 1991;66:60-2.  Back to cited text no. 5
[PUBMED]    
6.McAndrew KS, Rothenberger S, Minsley GE. 1997 Judson C. Hickey Scientific Writing Awards. An innovative investment method for the fabrication of a closed hollow obturator prosthesis. J Prosthet Dent 1998;80:129-32.  Back to cited text no. 6
    
7.Nidiffer TJ, Shipman TH. Hollow bulb obturator for acquired palatal openings. J Prosthet Dent 1957;7:126-34.  Back to cited text no. 7
    
8.Worley JL, Kniejski ME. A method for controlling the thickness of hollow obturator prostheses. J Prosthet Dent 1983;50:227-9.  Back to cited text no. 8
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9.Holt RA Jr. A hollow complete lower denture. J Prosthet Dent 1981;45:452-4.  Back to cited text no. 9
[PUBMED]    
10.Jhanji A, Stevens ST. Fabrication of one-piece hollow obturators. J Prosthet Dent 1991;66:136-8.  Back to cited text no. 10
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11.O'Sullivan M, Hansen N, Cronin RJ, Cagna DR. The hollow maxillary complete denture: A modified technique. J Prosthet Dent 2004;91:591-4.  Back to cited text no. 11
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]



 

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