Single complete denture /dentistry studies

SINGLE COMPLETESINGLE COMPLETE
DENTUREDENTURE
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com

CONTENTSCONTENTS

1)1) INTRODUCTIONINTRODUCTION
2)2) PROBLEM WITH SINGLE COMPLETEPROBLEM WITH SINGLE COMPLETE
DENTURE.DENTURE.
3)3) COMMON OCCLUSALCOMMON OCCLUSAL
DISHARMONIES AND WAYS TODISHARMONIES AND WAYS TO
ADJUST THEM.ADJUST THEM.
4)4) SINGLE COMPLETE DENTURESINGLE COMPLETE DENTURE
OPPOSINGOPPOSING
A)A) NATURAL TEETHNATURAL TEETH

B)B) RPDRPD
C) FPDC) FPD
D) EXISTING COMPLETE DENTURED) EXISTING COMPLETE DENTURE
E) IMPLANT SUPPORTEDE) IMPLANT SUPPORTED
PROSTHESIS.PROSTHESIS.
5) METHODS TO ACHIEVE5) METHODS TO ACHIEVE
BALANCED OCCLUSIONBALANCED OCCLUSIONwww.indiandentalacademy.comwww.indiandentalacademy.com

6) CINICAL PROCEDURE OF6) CINICAL PROCEDURE OF
MAKING SINGLE COMPLETEMAKING SINGLE COMPLETE
DENTURE.DENTURE.
7) OCCLUSAL MATERIALS FOR7) OCCLUSAL MATERIALS FOR
SINGLE COMPLETE DENTURESSINGLE COMPLETE DENTURES
8) SUMMARY8) SUMMARY
9) CONCLUSION9) CONCLUSION
10) REFERENCES10) REFERENCESwww.indiandentalacademy.comwww.indiandentalacademy.com

INTRODUCTIONINTRODUCTION

Many patients becomeMany patients become
edentulous in one arch whileedentulous in one arch while
retaining some or all of theirretaining some or all of their
natural teeth in the opposingnatural teeth in the opposing
arch. In this situation a singlearch. In this situation a single
complete denture is fabricated.complete denture is fabricated.

A single complete denture may beA single complete denture may be
desirable when it is to oppose anydesirable when it is to oppose any
one of them:one of them:
1. Natural teeth that are sufficient in1. Natural teeth that are sufficient in
number not to necessitate a fixed ornumber not to necessitate a fixed or
removable partial denture.removable partial denture.
2. A partially edentulous arch in which2. A partially edentulous arch in which
missing teeth have been or will bemissing teeth have been or will be
replaced by RPD.replaced by RPD.

3. A partially edentulous arch in3. A partially edentulous arch in
which missing teeth have been orwhich missing teeth have been or
will be replaced by FPD.will be replaced by FPD.
4. An existing Complete denture.4. An existing Complete denture.
5. Implant supported Complete5. Implant supported Complete
denture.denture.

Dentist faces many difficulties inDentist faces many difficulties in
rehabilitating the patients with thisrehabilitating the patients with this
clinical pattern.clinical pattern.
Malposed, tipped, or supraeruptedMalposed, tipped, or supraerupted
teeth make it difficult to achieve ateeth make it difficult to achieve a
harmonious balanced occlusion andharmonious balanced occlusion and
also interfere in proper placement ofalso interfere in proper placement of
artificial teeth to achieve adequateartificial teeth to achieve adequate
esthetics.esthetics.

As a result of unfavorable occlusalAs a result of unfavorable occlusal
relationships there is a tendencyrelationships there is a tendency
of denture to get displaced,of denture to get displaced,
causing soreness, mucosalcausing soreness, mucosal
changes and ultimately ridgechanges and ultimately ridge
resorption.resorption.

PROBLEM WITH SINGLEPROBLEM WITH SINGLE
COMPLETE DENTURECOMPLETE DENTURE

1.1.
Greater magnitude of forcesGreater magnitude of forces
Changes in the underlying boneChanges in the underlying bone
Denture in the long term will beDenture in the long term will be
compromised.compromised.www.indiandentalacademy.comwww.indiandentalacademy.com

2.2. Related to occlusal form of theRelated to occlusal form of the
remaining natural teeth:remaining natural teeth:
This occlusal form dictatesThis occlusal form dictates
occlusal form of the dentureocclusal form of the denture 
might be unsuitable for themight be unsuitable for the
denture.denture.

Supraerupted Tilted teeth

Occlusal scheme causingOcclusal scheme causing
more horizontal forcesmore horizontal forces

These factors causes occurrenceThese factors causes occurrence
of “of “ Single denture syndromeSingle denture syndrome””
- loose or tilting denture- loose or tilting denture
-damage of mucosa-damage of mucosa
- ridge resorption.- ridge resorption.

COMMON OCCLUSALCOMMON OCCLUSAL
DISHARMONIES AND WAYSDISHARMONIES AND WAYS
TO ADJUST THEMTO ADJUST THEM

1. Tilted molars
with distal
halves
supraerupted

Steeply inclined
occlusal
surfaces
tend to drive
denture forward
when brought
into centric
occlusion.

Only contact is on the distal half of
lower molar in protrusive and
lateral excursions
Denture easily dislodged during
functional movements.www.indiandentalacademy.comwww.indiandentalacademy.com

Adjustment for tilted molarAdjustment for tilted molar

A)A)
If molars areIf molars are
not severelynot severely
tiltedtilted
can becan be
reshaped byreshaped by
selectiveselective
grinding.grinding.

B)B) If more toothIf more tooth
structure isstructure is
needed to beneeded to be
removedremoved
Restore withRestore with
crown or FPD.crown or FPD.

C)C) If large spaceIf large space
exist mesial toexist mesial to
tilted molartilted molar
RPD restoring theRPD restoring the
mesial half of themesial half of the
molars, lower themolars, lower the
distal cuspsdistal cusps
(mesial half onlay(mesial half onlay
mesial rest ormesial rest or
extended rest)extended rest) www.indiandentalacademy.comwww.indiandentalacademy.com

D)D) OrthodonticOrthodontic
repositioningrepositioning
of tilted molarof tilted molar
E)E) If severely tilted and supraeruptedIf severely tilted and supraerupted
ExtractionExtraction

2.2. Natural lower cuspids andNatural lower cuspids and
incisors are supraeruptedincisors are supraerupted

SelectiveSelective
grindinggrinding

Cuspid region, occlusal adjustmentCuspid region, occlusal adjustment
should aim at providing a definiteshould aim at providing a definite
distal slope on the lower cuspiddistal slope on the lower cuspid
so as to allow space for freeso as to allow space for free
passage of the upper artificialpassage of the upper artificial
cuspid between the lower cuspidcuspid between the lower cuspid
and first premolar in lateraland first premolar in lateral
movements.movements.

A)A) SINGLE COMPLETESINGLE COMPLETE
DENTURE OPPOSINGDENTURE OPPOSING
NATURAL TEETHNATURAL TEETH

1.1. Maxillary complete dentureMaxillary complete denture
opposing natural mandibularopposing natural mandibular
teeth.teeth.

PROBLEMSPROBLEMS
a)a) Malposed ,tipped andMalposed ,tipped and
supraerupted teeth in lowersupraerupted teeth in lower
arch and unfavorable plane ofarch and unfavorable plane of
occlusion.occlusion.

b)b) Fixed position of mandibularFixed position of mandibular
anterior teethanterior teeth

c)c) Problem of wear of teeth:Problem of wear of teeth:
i)i) Artificial teethArtificial teeth If acrylic isIf acrylic is
used.used.
ii)ii) Natural teethNatural teeth If porcelain isIf porcelain is
used.used.
d)d) Frequent fractures of dentureFrequent fractures of denture

Diagnostic procedures shouldDiagnostic procedures should
determine the following:determine the following:

1)1) If there are sufficient teeth inIf there are sufficient teeth in
the mandibular arch.the mandibular arch.

According toAccording to SharrySharry: if there is class: if there is class
II jaw relation, a complete dentureII jaw relation, a complete denture
often may be constructed againstoften may be constructed against
lower anterior teeth and premolarslower anterior teeth and premolars
without replacing molars.without replacing molars.
The lower premolars areThe lower premolars are far enoughfar enough
posteriorposterior in relation to the maxillaryin relation to the maxillary
ridge, that the forces of occlusion areridge, that the forces of occlusion are
directed to thedirected to the middle-posteriormiddle-posterior partpart
of the upper denture.of the upper denture.

Forces directed to Middle Posterior
part of Upper denture

But if class III jaw relationBut if class III jaw relation
situation is differentsituation is different becausebecause
mandibular premolars wouldmandibular premolars would
apply occlusal forces against theapply occlusal forces against the
anterior part of the maxillary ridge.anterior part of the maxillary ridge.

Forces against the anteriorForces against the anterior
part of the maxillary ridgepart of the maxillary ridge

Acc to WinklerAcc to Winkler: In any event,: In any event,
replacement of missing posteriorreplacement of missing posterior
teeth will enhance the retentionteeth will enhance the retention
and stability of the maxillaryand stability of the maxillary
complete denture and help tocomplete denture and help to
distribute the functional forcesdistribute the functional forces
more evenly on the residualmore evenly on the residual
maxillary ridge.maxillary ridge.

Ellinger et al (JPD 1971:26;6) :Ellinger et al (JPD 1971:26;6) :
A lower RPD should be indicated in allA lower RPD should be indicated in all
situations whensituations when all molarsall molars areare
missing.missing.
• If upto first molar leftIf upto first molar left RPD may notRPD may not
be necessary.be necessary.

• If one side upto premolars andIf one side upto premolars and
others upto first molarothers upto first molar RPD mayRPD may
not be necessary.not be necessary.
Missing molar be replaced by aMissing molar be replaced by a
cantileveredcantilevered
premolar ponticpremolar pontic
having 2-3having 2-3
abutments.abutments.

2)2) Periodontal health of thePeriodontal health of the
remaining teeth is acceptable.remaining teeth is acceptable.
3)3) There are no missing teeth toThere are no missing teeth to
be replaced.be replaced.
4)4) position of mandibular anteriorposition of mandibular anterior
teeth.teeth.

5)5) Condition of posterior teethCondition of posterior teeth
a)a) Irregular occlusal plane, picketIrregular occlusal plane, picket
fence arrangementfence arrangement..
b)b) Occlusal form of natural teeth.Occlusal form of natural teeth.
c)c) Occlusal surface of natural teethOcclusal surface of natural teeth
too large bucco-lingually.too large bucco-lingually.

Prior to any occlusalPrior to any occlusal
modifications of the natural teeth,modifications of the natural teeth,
maxillary and mandibular castsmaxillary and mandibular casts
should be mounted on articulator.should be mounted on articulator.
Now whatever adjustments thatNow whatever adjustments that
may be necessary can bemay be necessary can be
planned.planned.

Techniques to determine theTechniques to determine the
necessary tooth modificationsnecessary tooth modifications
prior to denture construction.prior to denture construction.

1)1) BY SWENSONBY SWENSON
Casts mounted on articulator usingCasts mounted on articulator using
provisional CR at acceptable verticalprovisional CR at acceptable vertical
dimension.dimension.
Maxillary record base made and teethMaxillary record base made and teeth
are setare set
If lower teeth interfere with placementIf lower teeth interfere with placement
of denture teethof denture teeth adjusted on castadjusted on cast
and areas markedand areas marked

Areas to be
modified
are marked
with pencil
on the cast

Natural teeth modified accordinglyNatural teeth modified accordingly
New diagnostic cast of lower archNew diagnostic cast of lower arch
made and mountedmade and mounted
If more adjustments neededIf more adjustments needed  repeatrepeat
the procedure.the procedure.
Tech.Tech. simplesimple butbut time consumingtime consuming..

2)2) BRUCEBRUCE (JPD 1971:26:448-455)(JPD 1971:26:448-455)
Advised reshaping natural teethAdvised reshaping natural teeth
using a resin templateusing a resin template

Areas to be
modified are
marked with
pencil on
the cast

Clear acrylic resin
template is formed
over the corrected
cast

Initial modifications done.
Template coated
with pressure
Indicating paste
and placed over
patients teeth.

Interferences can be seen through
the clear template and can be
removed accordingly.
Process repeated
till template fits the
teeth perfectly
Advantage: produces accurate results.www.indiandentalacademy.comwww.indiandentalacademy.com

3)3) BY YURKSTAS:BY YURKSTAS:
Advised useAdvised use
of a metalof a metal
‘‘U’ shapedU’ shaped
occlusalocclusal
templatetemplate

2.2. Mandibular complete dentureMandibular complete denture
opposing natural maxillaryopposing natural maxillary
teeth.teeth.

Factors that must be evaluatedFactors that must be evaluated
before this treatment option isbefore this treatment option is
consideredconsidered

1)1) Preservation of residual alveolarPreservation of residual alveolar
ridge:ridge:
a)a) Greater force exerted +smallerGreater force exerted +smaller
basal seat area.basal seat area. rapid loss ofrapid loss of
supporting bone from mandiblesupporting bone from mandible
 decreased retention anddecreased retention and
stability + frequent fractures ofstability + frequent fractures of
denturedenture

b) Mandible movable member ofb) Mandible movable member of
stomatognathic systemstomatognathic system moremore
difficult to stabilize the denture.difficult to stabilize the denture.
c) Proximity to tongue.c) Proximity to tongue.

Therefore, consideringTherefore, considering
preservation of residual ridgepreservation of residual ridge onlyonly
as the main factor for dictating theas the main factor for dictating the
treatment plan of a completetreatment plan of a complete
mandibular denture then this planmandibular denture then this plan
is totally contraindicated.is totally contraindicated.

2.2. Necessity of retaining maxillaryNecessity of retaining maxillary
teeth:teeth:
MaxillaryMaxillary
dentition maydentition may
be neededbe needed
to retainto retain
a prosthesis.a prosthesis.

3.3. Mental traumaMental trauma
4.4. Health factorsHealth factors
Even though the potential for theEven though the potential for the
destruction of the mandibular residualdestruction of the mandibular residual
ridge is great, the necessity forridge is great, the necessity for
retaining maxillary teeth for retentiveretaining maxillary teeth for retentive
purposes and the mental traumapurposes and the mental trauma
created by the loss of the mandibularcreated by the loss of the mandibular
teeth may be the deciding factors forteeth may be the deciding factors for
fabricating a complete denture tofabricating a complete denture to
oppose natural maxillary teeth.oppose natural maxillary teeth.www.indiandentalacademy.comwww.indiandentalacademy.com

B)B) SINGLE COMPLETESINGLE COMPLETE
REMOVABLE PARTIALREMOVABLE PARTIAL
DENTUREDENTURE

Ellinger et al (JPD 1971:26;6) :Ellinger et al (JPD 1971:26;6) :
A lower RPD should be indicated in allA lower RPD should be indicated in all
situations when all molars aresituations when all molars are
missing.missing.
If upto first molar leftIf upto first molar left RPD may notRPD may not
be necessary.be necessary.
If one side upto premolars and othersIf one side upto premolars and others
upto first molarupto first molar RPD may not beRPD may not be
necessary.necessary.
Missing molar be replaced by aMissing molar be replaced by a
cantilevered premolar pontic havingcantilevered premolar pontic having
2-3 abutments.2-3 abutments.www.indiandentalacademy.comwww.indiandentalacademy.com

Ellsworth KellyEllsworth Kelly (JPD1972:27;140)(JPD1972:27;140)
gave the term “gave the term “COMBINATIONCOMBINATION
SYNDROMESYNDROME” to those changes” to those changes
that are seen in patients withthat are seen in patients with
maxillary complete denture and amaxillary complete denture and a
mandibular bilateral distalmandibular bilateral distal
extension RPD.extension RPD.

Some characteristic changes inSome characteristic changes in
Combination syndrome( AnteriorCombination syndrome( Anterior
hyperfunction syndrome) are:hyperfunction syndrome) are:
i)i) Loss of bone from anterior partLoss of bone from anterior part
of the maxillary ridge.of the maxillary ridge.
ii)ii) Overgrowth of the maxillaryOvergrowth of the maxillary
tuberosities.tuberosities.

iii)iii) Papillary hyperplasia in the hardPapillary hyperplasia in the hard
palate.palate.
iv)iv) Extrusion of lower anteriors.Extrusion of lower anteriors.
v)v) Loss of bone under the lowerLoss of bone under the lower
partial denture base .partial denture base .

BY SAUNDER’S ET AL
(JPD 1979:41:124)

Sequence of changesSequence of changes

First change to occur?First change to occur?
Acc to Kelly et alAcc to Kelly et al (JPD1972:27;140)(JPD1972:27;140)
 loss of bone from the anteriorloss of bone from the anterior
part of the maxillary jaw.part of the maxillary jaw.
Saunders et alSaunders et al ((JPD 1979:41:124))
bone resorption under thebone resorption under the
mandibular partial denture base.mandibular partial denture base.

Loss of bone
from anterior
maxilla
Flabby
hyperplastic
tissue
Characteristic
deep
fold or crease www.indiandentalacademy.comwww.indiandentalacademy.com

Maxillary denture displaced anteriorly andMaxillary denture displaced anteriorly and
superiorlysuperiorly
Tendency to develop epulis fissuratumTendency to develop epulis fissuratum
associated with labial flange.associated with labial flange.
Bone resorption also under mandibularBone resorption also under mandibular
Denture base.Denture base.
Occlusal plane migrates up in anteriorOcclusal plane migrates up in anterior
region and down in posterior region.region and down in posterior region.

With posterior palatalWith posterior palatal
seal negativeseal negative
pressure producedpressure produced
posteriorly.posteriorly.
Enlargement ofEnlargement of
tuberositiestuberosities
&&
PapillaryPapillary
hyperplasia.hyperplasia.

Lower anterior teeth migrateLower anterior teeth migrate
upward and periodontal changesupward and periodontal changes
occur.occur.
(change in occlusal(change in occlusal
planeplane encouragesencourages
protrusive occlusalprotrusive occlusal
contactcontact risk ofrisk of
extrusion andextrusion and
flaring of mandibular anterior teeth)flaring of mandibular anterior teeth)

Maxillary anteriorMaxillary anterior
teeth on theteeth on the
complete denturecomplete denture
disappear underdisappear under
patients lips.patients lips.
Esthetics becomeEsthetics become
poorpoor

Loss of mandibular supportLoss of mandibular support
Gradual decrease of occlusal loadGradual decrease of occlusal load
posteriorly and increased occlusalposteriorly and increased occlusal
load anteriorlyload anteriorly
Resorption of maxillary anteriorResorption of maxillary anterior
ridgeridge www.indiandentalacademy.comwww.indiandentalacademy.com

Ellsworth Kelly (JPD 1972:27;140) :Ellsworth Kelly (JPD 1972:27;140) :
3 yr study: all patients showed3 yr study: all patients showed
a)a)1-3 mm loss of ridge height in1-3 mm loss of ridge height in
maxillary anterior regionmaxillary anterior region
b)b) 1-2.5 mm increase in height of1-2.5 mm increase in height of
tuberositytuberosity
c)c) 1-1.5 mm extrusion of lower1-1.5 mm extrusion of lower
anteriors.anteriors.

Kay Shen et al (JPD 1989;62:642-644)Kay Shen et al (JPD 1989;62:642-644)
did a study in 150 complete denturedid a study in 150 complete denture
wearers and found a prevalence ofwearers and found a prevalence of
symptoms of combination syndrome insymptoms of combination syndrome in
24% of patients who had mandibular24% of patients who had mandibular
anterior teeth opposing completeanterior teeth opposing complete
maxillary denture.maxillary denture.
This rate did not differ significantlyThis rate did not differ significantly
between patients who do and donot wearbetween patients who do and donot wear
mandibular RPD.mandibular RPD.

Saunders et al (JPD 1979;41:126)Saunders et al (JPD 1979;41:126)
Changes associated withChanges associated with
combination syndrome are notcombination syndrome are not
necessarily seen in all patientsnecessarily seen in all patients
with maxillary complete denturewith maxillary complete denture
and mandibular distal extensionand mandibular distal extension
RPD.RPD.

Some clinical states, seem toSome clinical states, seem to
encourage development of thisencourage development of this
syndrome like:syndrome like:
i)i) AccentuatedAccentuated in patients within patients with
AngleAngle class IIIclass III jaw relations.jaw relations.
DecreasedDecreased tendency in patienttendency in patient
with anglewith angle class IIclass II situations.situations.

ii)ii) Patients whose mandibular posteriorPatients whose mandibular posterior
teeth have not been replaced andteeth have not been replaced and
who has functioned with only anteriorwho has functioned with only anterior
teeth for extended periods.teeth for extended periods.
iii)iii) Patients with parafunctional habits.Patients with parafunctional habits.

iv)iv) Type of occlusal schemeType of occlusal scheme
provided by dentist: deflectiveprovided by dentist: deflective
anterior contacts in centric andanterior contacts in centric and
eccentric positions (willeccentric positions (will
concentrate stress anteriorly) andconcentrate stress anteriorly) and
lack of occlusal balancelack of occlusal balance
posteriorly.posteriorly.

Prevention of combinationPrevention of combination
syndromesyndrome
Treatment planning to avoid thisTreatment planning to avoid this
combination of prosthesis.combination of prosthesis.
1)1) Try and retain weak posteriorTry and retain weak posterior
teeth by means of endodontic andteeth by means of endodontic and
periodontal therapies.periodontal therapies.

2)2) Using lower anterior roots andUsing lower anterior roots and
giving overdenture.giving overdenture.
3)3) Giving bilateral balancedGiving bilateral balanced
occlusion.occlusion.

Management of combinationManagement of combination
syndromesyndrome
• Diagnosis of cause and its correction.Diagnosis of cause and its correction.
• Use of Tissue conditionersUse of Tissue conditioners
• Surgical correction of changes inSurgical correction of changes in
basal seat (flabby tissues, papillarybasal seat (flabby tissues, papillary
hyperplasia, enlarged tuberosities.)hyperplasia, enlarged tuberosities.)
• Restorative treatment of remainingRestorative treatment of remaining
teethteeth

DENTUREDENTURE
PART IIPART II

1)1) INTRODUCTIONINTRODUCTION
2)2) PROBLEM WITH SINGLE COMPLETEPROBLEM WITH SINGLE COMPLETE
DENTURE.DENTURE.
3)3) COMMON OCCLUSALCOMMON OCCLUSAL
DISHARMONIES AND WAYS TODISHARMONIES AND WAYS TO
ADJUST THEM.ADJUST THEM.
OPPOSINGOPPOSING
• NATURAL TEETHNATURAL TEETH
• RPDRPD www.indiandentalacademy.comwww.indiandentalacademy.com

1)1) DEFINITIONSDEFINITIONS
2)2) REVIEW OF LITERATUREREVIEW OF LITERATURE
OPPOSING:OPPOSING:
A)A) FPDFPD
B)B) EXISTING COMPLETE DENTUREEXISTING COMPLETE DENTURE
C)C) IMPLANT SUPPORTEDIMPLANT SUPPORTED
PROSTHESIS.PROSTHESIS.

4)4) METHODS TO ACHIEVEMETHODS TO ACHIEVE
BALANCED OCCLUSIONBALANCED OCCLUSION
5)5) OCCLUSAL MATERIALS FOROCCLUSAL MATERIALS FOR
SINGLE COMPLETE DENTURESSINGLE COMPLETE DENTURES
6)6) STEPS IN FABRICATION OFSTEPS IN FABRICATION OF
SINGLE COMPLETE DENTURESINGLE COMPLETE DENTURE
OPPOSING NATURAL TEETH.OPPOSING NATURAL TEETH.

7)7) TREATMENT PLANNING FORTREATMENT PLANNING FOR
OPPOSING RPDOPPOSING RPD
8)8) SUMMARYSUMMARY
9)9) CONCLUSIONCONCLUSION
10)10) REFERENCESREFERENCESwww.indiandentalacademy.comwww.indiandentalacademy.com

DEFINITIONSDEFINITIONS

Combination syndrome / AnteriorCombination syndrome / Anterior
hyperfunction syndrome (GPT-7):hyperfunction syndrome (GPT-7):
The characteristic features thatThe characteristic features that
occur when an edentulous maxillaoccur when an edentulous maxilla
is opposed by natural mandibularis opposed by natural mandibular
anterior teeth, including loss ofanterior teeth, including loss of
bone from the anterior portion ofbone from the anterior portion of
the maxillary anterior ridge,the maxillary anterior ridge,
overgrowth of the tuberosities,overgrowth of the tuberosities,

papillary hyperplasia of the hardpapillary hyperplasia of the hard
palate’s mucosa, extrusion of thepalate’s mucosa, extrusion of the
lower anterior teeth, and loss oflower anterior teeth, and loss of
alveolar bone and ridge heightalveolar bone and ridge height
beneath the mandibularbeneath the mandibular
removable partial denture base.removable partial denture base.

BALANCED OCCLUSIONBALANCED OCCLUSION
(GPT-7)(GPT-7)
The bilateral, simultaneous, anterior,The bilateral, simultaneous, anterior,
and posterior occlusal contact ofand posterior occlusal contact of
teeth in centric and eccentricteeth in centric and eccentric
position.position.

SELECTIVE GRINDINGSELECTIVE GRINDING
The intentional alteration of theThe intentional alteration of the
occlusal surfaces of teeth toocclusal surfaces of teeth to
change their form.change their form.

REVIEW OF LITERATUREREVIEW OF LITERATURE

Schultz (JPD 1951:1:38-48)Schultz (JPD 1951:1:38-48)
• Showed that the chewingShowed that the chewing
efficiency of acrylic resin teethefficiency of acrylic resin teeth
was 26-35% less than that ofwas 26-35% less than that of
porcelain teeth.porcelain teeth.
• Chewing efficiency of acrylicChewing efficiency of acrylic
resin teeth with gold occlusalresin teeth with gold occlusal
surface is equal to that ofsurface is equal to that of
porcelain teeth.porcelain teeth.

Frederick S. Meyer (JPDFrederick S. Meyer (JPD
1957:7:354)1957:7:354) gave the functionallygave the functionally
generated path technique forgenerated path technique for
achieving a balanced occlusion .achieving a balanced occlusion .
Acc. to him the occlusal pathsAcc. to him the occlusal paths
generated on mechanicalgenerated on mechanical
articulators are different fromarticulators are different from
those generated in mouth.those generated in mouth.

Ellsworth Kelly(JPD 1972:27:2:140-Ellsworth Kelly(JPD 1972:27:2:140-
150)150)
Followed 6 patients wearing maxillaryFollowed 6 patients wearing maxillary
CD opposing mandibular DEB RPDCD opposing mandibular DEB RPD
over a period of 3 yeas and gave theover a period of 3 yeas and gave the
term Combination syndrome to theterm Combination syndrome to the
changes that have occurred in thesechanges that have occurred in these
patients.patients.
All patients showedAll patients showed
a)a)1-3 mm loss of ridge height in1-3 mm loss of ridge height in
maxillary anterior regionmaxillary anterior region

b)b) 1-2.5 mm increase in height of1-2.5 mm increase in height of
tuberositytuberosity
c)c) 1-1.5 mm extrusion of lower1-1.5 mm extrusion of lower
anteriors.anteriors.
Acc. to him, first change to occurAcc. to him, first change to occur
 loss of bone from the anteriorloss of bone from the anterior
part of the maxillary jaw.part of the maxillary jaw.

SAUNDERS et al
(JPD1979:41:124)
Further described the
combination syndrome, and
proposed that the first change toproposed that the first change to
occur is bone resorption underoccur is bone resorption under
the mandibular partial denturethe mandibular partial denture
base.base.

Changes associated with combinationChanges associated with combination
syndrome are not necessarily seensyndrome are not necessarily seen
in all patients with maxillaryin all patients with maxillary
complete denture and mandibularcomplete denture and mandibular
distal extension RPD. Some clinicaldistal extension RPD. Some clinical
states likestates like a)a) AngleAngle class IIIclass III jawjaw
relations,relations, b)b) parafunctional habits,parafunctional habits, c)c)
deflective anterior contacts indeflective anterior contacts in
centric and eccentric positions andcentric and eccentric positions and
d)d) lack of occlusal balancelack of occlusal balance
posteriorly tend to accentuate thisposteriorly tend to accentuate this
condition.condition. www.indiandentalacademy.comwww.indiandentalacademy.com

Saunders et al (J Prosthet Dent 1979 ;Saunders et al (J Prosthet Dent 1979 ;
41: 124-128.;)41: 124-128.;)recommended that therecommended that the
essential objective of treatmentessential objective of treatment
planning in cases with maxillaryplanning in cases with maxillary
single complete denture opposingsingle complete denture opposing
DEB RPD was “to provide anDEB RPD was “to provide an
occlusal scheme that could bestocclusal scheme that could best
discourage excessive occlusaldiscourage excessive occlusal
pressures in the maxillary anteriorpressures in the maxillary anterior
region in both centric and eccentricregion in both centric and eccentric
occlusal contacts”.occlusal contacts”.

Barber et al (JOMFS 1990:48:1283-Barber et al (JOMFS 1990:48:1283-
1287)1287)
Maxson et al (JPD 1990:63;554-558)Maxson et al (JPD 1990:63;554-558)
Sybille et al (IJP 1996:9:58-64):Sybille et al (IJP 1996:9:58-64):
Found that combination syndromeFound that combination syndrome
occurred in patients with implantoccurred in patients with implant
supported overdenture and maxillarysupported overdenture and maxillary
conventional complete dentures.conventional complete dentures.

B.Jacobs et al(JPD 1993:70;135-140)B.Jacobs et al(JPD 1993:70;135-140)
Compared the anterior and posteriorCompared the anterior and posterior
ridge resorption in three group ofridge resorption in three group of
patients with different mandibularpatients with different mandibular
prosthetic constructions i.e.prosthetic constructions i.e.
i)i) Overdenture supported by twoOverdenture supported by two
implantsimplants
ii)ii) Fixed prosthesis supported by 6Fixed prosthesis supported by 6
implantsimplants
iii)iii) Complete denture.Complete denture.

Results indicatedResults indicated
1)1) A more pronounced annualA more pronounced annual
bone resorption in completebone resorption in complete
denture wearers compared todenture wearers compared to
patients with implant supportedpatients with implant supported
Overdentures.Overdentures.

2)2) A limited but continuing boneA limited but continuing bone
resorption observed in patientsresorption observed in patients
with implant supportedwith implant supported
overdentures.overdentures.
3)3) A slightly higher annual boneA slightly higher annual bone
resorption occurring in the implantresorption occurring in the implant
supported fixed prosthesis group.supported fixed prosthesis group.

Sigvard Palmqvist et al (JPDSigvard Palmqvist et al (JPD
2003:90;270-275)2003:90;270-275) critically reviewedcritically reviewed
the literature regarding combinationthe literature regarding combination
syndrome and concluded that “thesyndrome and concluded that “the
combination syndrome does notcombination syndrome does not
meet the criteria to be accepted as ameet the criteria to be accepted as a
medical syndrome. The singlemedical syndrome. The single
features associated with thefeatures associated with the
combination syndrome exist but tocombination syndrome exist but to
what extent or in which combinationswhat extent or in which combinations
has not been clarified.”has not been clarified.”www.indiandentalacademy.comwww.indiandentalacademy.com

OPPOSING PARTIALLYOPPOSING PARTIALLY
EDENTULOUS ARCHEDENTULOUS ARCH
RESTORED WITH FPDRESTORED WITH FPD

Which material to be used forWhich material to be used for
artificial teeth.artificial teeth.
Once fixed restoration is placed inOnce fixed restoration is placed in
a dental arch, the restored archa dental arch, the restored arch
can be thought of as a naturalcan be thought of as a natural
teeth opposing a completeteeth opposing a complete
denturedenture

Placement of fixed restoration canPlacement of fixed restoration can
correct many occlusalcorrect many occlusal
disharmonies.disharmonies.
For example: tilted molarsFor example: tilted molars

Orthodontic
correction
and then
give FPD

Prepare tooth
to get proper
plane of
occlusion

Telescopic crownTelescopic crown
retainerretainer

Proximal half
crown
Nonrigid
connector

Cantilevered
premolar
pontic

Single complete dentureSingle complete denture
opposing an existing completeopposing an existing complete
denturedenture

11. Duration of the existing denture. Duration of the existing denture

2.2. Condition of the teeth:Condition of the teeth:
a)a) AppearanceAppearance
b)b) Alignment with regard toAlignment with regard to
residual ridge.residual ridge.

c) Is occlusal
plane
Desirable?

d) Occlusal surface
worn out

3.3. Condition of denture baseCondition of denture base
a)a) Accuracy of tissue adaptation andAccuracy of tissue adaptation and
border extensionborder extension
b)b) Any fracture repairsAny fracture repairs
c)c) Esthetic contouring and thicknessEsthetic contouring and thickness
adequate to support the perioraladequate to support the perioral
structures.structures.
d)d) Stability and retention.Stability and retention.

Single complete dentureSingle complete denture
opposing implant supportedopposing implant supported
prosthesisprosthesis

Maxillary complete dentureMaxillary complete denture
opposing implant supportedopposing implant supported
overdentureoverdenture

Permits free
rotational
Movement
of denture
upon
Posterior
loading

Bone resorption in mandibularBone resorption in mandibular
posterior regionposterior region
settling of denture base and loss ofsettling of denture base and loss of
posterior contactsposterior contacts
upward rotation of anterior mandibularupward rotation of anterior mandibular
denturedenture
more forces on anterior maxillamore forces on anterior maxilla
supporting the maxillary denture.supporting the maxillary denture.www.indiandentalacademy.comwww.indiandentalacademy.com

Barber et al (J OMFS 1990:48:1283-Barber et al (J OMFS 1990:48:1283-
1287)1287)
Maxson et al (JPD 1990:63;554-558)Maxson et al (JPD 1990:63;554-558)
Sybille et al (IJP 1996:9:58-64):Sybille et al (IJP 1996:9:58-64):
Found that combination syndromeFound that combination syndrome
occurred in patients with implantoccurred in patients with implant
supported overdenture and maxillarysupported overdenture and maxillary
conventional complete dentures.conventional complete dentures.

Maxillary completeMaxillary complete
denturedenture
opposing implantopposing implant
supported fixedsupported fixed
denturedenture

Opinion is divided over theOpinion is divided over the
functional forces borne by thefunctional forces borne by the
maxillary complete denturemaxillary complete denture
opposing implant supported fixedopposing implant supported fixed
denture.denture.

Stafford et alStafford et al ; found that loading; found that loading
forces did not increaseforces did not increase
Falk et al (JOMI 1989:44; 55-62)Falk et al (JOMI 1989:44; 55-62)
found the loading forces to befound the loading forces to be
comparable to those of partiallycomparable to those of partially
restored natural dentitions, withrestored natural dentitions, with
greater forces in the posteriorgreater forces in the posterior
region of the maxillary dentureregion of the maxillary denture
opposing cantilever units of theopposing cantilever units of the
implant prosthesis.implant prosthesis.www.indiandentalacademy.comwww.indiandentalacademy.com

Difference in opinion regardingDifference in opinion regarding
the anterior maxillary bone lossthe anterior maxillary bone loss
under complete denturesunder complete dentures
opposing implant supported fixedopposing implant supported fixed
prosthesis.prosthesis.

Jacobs et al (JPD 1993):Jacobs et al (JPD 1993): reportedreported
an increase annual bone lossan increase annual bone loss
maxillary anterior region.maxillary anterior region.
Henry et al (IJP 1999:12;492-497):Henry et al (IJP 1999:12;492-497):
reported no anterior resorptionreported no anterior resorption
and no occurrence of conditionand no occurrence of condition
like combination syndrome in thislike combination syndrome in this
clinical state.clinical state.

METHODS TOMETHODS TO
ACHIEVE BALANCEDACHIEVE BALANCED
OCCLUSIONOCCLUSION

TWO TECHNIQUESTWO TECHNIQUES::
1)1) Those that dynamicallyThose that dynamically
equilibrate the occlusion by useequilibrate the occlusion by use
ofof functionally generated pathfunctionally generated path
i.e.i.e. Functional chew inFunctional chew in
techniquestechniques..
2)2) Those that statisticallyThose that statistically
equilibrate the occlusion byequilibrate the occlusion by
using an articulator programmedusing an articulator programmed
to simulate patients jawto simulate patients jaw
movements.movements.www.indiandentalacademy.comwww.indiandentalacademy.com

Functionally generated pathFunctionally generated path
techniques / Functional chewtechniques / Functional chew
in techniques for singlein techniques for single
complete dentures.complete dentures.

Contraindications:Contraindications:
1)1) Record base not stable.Record base not stable.
2)2) Patients with poor neuromuscularPatients with poor neuromuscular
control.control.

StansburyStansbury
(JPD 1951;1;692-699)(JPD 1951;1;692-699)
andand
Rudd and MorrowRudd and Morrow
(JPD 1973:30;4)(JPD 1973:30;4)

Cast mounted on articulator in CRCast mounted on articulator in CR
at acceptable vertical dimension.at acceptable vertical dimension.
Remove record base and occlusalRemove record base and occlusal
rimrim adapt new base plate andadapt new base plate and
fabricate occlusal rims made offabricate occlusal rims made of
compoundcompound

(twice the normal width-atleast(twice the normal width-atleast
twice the width of molar teeth)twice the width of molar teeth)
 6 mm anterior to mandibular6 mm anterior to mandibular
incisor,incisor,
sufficient in height to receive ansufficient in height to receive an
impression of the central fossa ofimpression of the central fossa of
the lower teeth.the lower teeth.

Compound occlusal rim heatedCompound occlusal rim heated
Placed in articulatorPlaced in articulator closedclosed
Impression of fossae of all lowerImpression of fossae of all lower
teeth recorded.teeth recorded.

Occlusal rimsOcclusal rims
trimmed B-L.trimmed B-L.
CompoundCompound
extension inextension in
the centralthe central
fossa.fossa.

Anterior regionAnterior region
trimmed tilltrimmed till
level oflevel of
indentation ofindentation of
incisors(2mmincisors(2mm
space betweenspace between
rim andrim and
mandibularmandibular
anterior teeth)anterior teeth)

Place in patients mouthPlace in patients mouth
Pt asked to make chewing slowlyPt asked to make chewing slowly
Excess compound wears offExcess compound wears off
Free action in lateral movement.Free action in lateral movement.

Record baseRecord base
removed fromremoved from
patients mouth,patients mouth,
soft wax (cardingsoft wax (carding
wax) added onwax) added on
B-L sides.B-L sides.

Placed in patients mouthPlaced in patients mouth
Patient asked to perform eccentricPatient asked to perform eccentric
chewing movementschewing movements

Lower teeth cutLower teeth cut
their pathstheir paths
in the soft wax.in the soft wax.
Compound inCompound in
central fossa actcentral fossa act
as a guide toas a guide to
preserve cusppreserve cusp
height.height.

Occlusal rim removedOcclusal rim removed  stone pouredstone poured
into wax paths.into wax paths.
First mandibularFirst mandibular
cast is removedcast is removed
Maxillary occlusalMaxillary occlusal
rim with generatedrim with generated
occlusal paths and stone recordocclusal paths and stone record
is placed in articulatoris placed in articulatorwww.indiandentalacademy.comwww.indiandentalacademy.com

Stone record isStone record is
secured to thesecured to the
lower member oflower member of
the articulator withthe articulator with
plaster.plaster.

2 lower casts-first-duplicate of lower2 lower casts-first-duplicate of lower
teeth, second replica of generatedteeth, second replica of generated
path.path.
Original mandibular cast placed onOriginal mandibular cast placed on
articulatorarticulator
Maxillary teeth setting done (ant.Maxillary teeth setting done (ant.
teethteeth acc. to esthetics, post. teethacc. to esthetics, post. teeth
ground and adjusted to CO.ground and adjusted to CO.

Checked in mouth for esthetics andChecked in mouth for esthetics and
centric occlusioncentric occlusion
..
Denture processedDenture processed
Remounted.Remounted.
Any interference in centric occlusionAny interference in centric occlusion
checked and correctedchecked and corrected

Once correct in COOnce correct in CO remove theremove the
lower castlower cast put chew-in mandibularput chew-in mandibular
cast coat with prusssian bluecast coat with prusssian blue
Interferences removedInterferences removed
Thus in CR and eccentric movementThus in CR and eccentric movement
bilateral balanced occlusion will bebilateral balanced occlusion will be
established.established.

By Robert G.VigBy Robert G.Vig
(JPD 1964;14:214-220)(JPD 1964;14:214-220)
Similar techniqueSimilar technique
like Stansbury butlike Stansbury but
he recommendedhe recommended
use of ause of a fin of resinfin of resin
placed into theplaced into the
central groovescentral grooves
instead of compound.instead of compound.
Maintains Vertical Dimension better.Maintains Vertical Dimension better.www.indiandentalacademy.comwww.indiandentalacademy.com

Articulator EquilibrationArticulator Equilibration
TechniqueTechnique
Equilibrate the occlusion by usingEquilibrate the occlusion by using
an articulator programmed toan articulator programmed to
simulate patients jaw movements.simulate patients jaw movements.

Indications:Indications:
• If denture base lacks stability.If denture base lacks stability.
• Patient unable to performPatient unable to perform
movements properly.movements properly.

Maxillary occlusal rimsMaxillary occlusal rims
fabricatedfabricated face bow transferface bow transfer
donedone maxillary casts mountedmaxillary casts mounted
on articulator.on articulator.
Mandibular cast mounted onMandibular cast mounted on
articulator using centric andarticulator using centric and
eccentric records at establishedeccentric records at established
vertical dimension.vertical dimension.

Bucco-lingual position of the lowerBucco-lingual position of the lower
teeth and their relation to maxillaryteeth and their relation to maxillary
arch is studied.arch is studied.
Teeth arrangement done according toTeeth arrangement done according to
natural teeth.natural teeth.
Interferences in centric and eccentricInterferences in centric and eccentric
positions are removed by grindingpositions are removed by grinding
the natural teeth and artificial teeththe natural teeth and artificial teeth
until a bilateral balanced occlusion isuntil a bilateral balanced occlusion is
achieved.achieved. www.indiandentalacademy.comwww.indiandentalacademy.com

OCCLUSAL MATERIALS FOROCCLUSAL MATERIALS FOR
DENTURESDENTURES

a)a) Porcelain teeth:Porcelain teeth:
AdvantageAdvantage: minimal wearing, therefore: minimal wearing, therefore
vertical dimension maintained.vertical dimension maintained.
DisadvantageDisadvantage::
Rapid wearing of opposing naturalRapid wearing of opposing natural
teeth.teeth.
Occlusal adjustment of artificial teethOcclusal adjustment of artificial teeth
neededneeded porcelain becomes weak.porcelain becomes weak.www.indiandentalacademy.comwww.indiandentalacademy.com

b)b) Acrylic resin teeth:Acrylic resin teeth:
Advantage:Advantage:
No wear of opposing teethNo wear of opposing teeth
Easy to do occlusal adjustments.Easy to do occlusal adjustments.
Disadvantage:Disadvantage:
Wears off easilyWears off easily loss of verticalloss of vertical
dimension and change in centricdimension and change in centric
occlusion.occlusion. www.indiandentalacademy.comwww.indiandentalacademy.com

c)c) Gold occlusalsGold occlusals
ConsideredConsidered best materialbest material to opposeto oppose
natural teeth. Minimum wear.natural teeth. Minimum wear.
Disadvantage:Disadvantage:
ExpensiveExpensive
Time consuming.Time consuming.

Technique of fabrication ofTechnique of fabrication of
gold occlusalsgold occlusals
(JPD 1964:14;326-333)(JPD 1964:14;326-333)

Dentures made in usual manner usingDentures made in usual manner using
acrylic resin posterior teeth.acrylic resin posterior teeth.
Remounted on articulator-occlusalRemounted on articulator-occlusal
disharmonies removed by selectivedisharmonies removed by selective
GrindingGrinding
Denture finished and patient is allowedDenture finished and patient is allowed
to wear them for 3-4 weeksto wear them for 3-4 weekswww.indiandentalacademy.comwww.indiandentalacademy.com

With dentures in mouthWith dentures in mouth 
impression made with irreversibleimpression made with irreversible
hydrocolloidhydrocolloid
Denture in impressionDenture in impression applyapply
petroleum jellypetroleum jelly dental stonedental stone
poured into the denture.poured into the denture.

Buccal and palatal
surfaces covered
with modeling clay
All undercuts blocked
Lingually- 2mm short of
occlusal surface
Labially-1mm short www.indiandentalacademy.comwww.indiandentalacademy.com

Stone counter
dies poured

Preparation resembling three quarter
crown made on each tooth
1.5mm
2mm
1.5mm

Grooves cut A-P
3mm wide
and
3mm deep.
Hole approximately
2mm depth
made in centre
of each tooth

Counter die

Final wax pattern
Sprue
attached

Castings cemented

d)d) Acrylic resin teeth with amalgamAcrylic resin teeth with amalgam
stopsstops (JPD 1979:41:16-20)(JPD 1979:41:16-20)
Advantage:Advantage:
• Reduces occlusal wear of resin teeth.Reduces occlusal wear of resin teeth.
• Less expensive than goldLess expensive than gold
• Facilitates the final stages of occlusalFacilitates the final stages of occlusal
adjustment.adjustment.

Occlusal preparation
in acrylic teeth
Amalgam condensed

Centric holding
areas as well as
excursions are
recorded in
amalgam

CLINICAL PROCEDURE OFCLINICAL PROCEDURE OF
FABRICATINGFABRICATING
A MAXILLARYA MAXILLARY
COMPLETECOMPLETE
A MANDIBULAR NATURALA MANDIBULAR NATURAL
TEETHTEETH

 Maxillary and mandibular castsMaxillary and mandibular casts
obtained and are mounted in CR atobtained and are mounted in CR at
acceptable VD.acceptable VD.
 Proper diagnosis related to:Proper diagnosis related to:
 Periodontal health of thePeriodontal health of the
remaining teethremaining teeth
 If any missing teeth to be replaced.If any missing teeth to be replaced.
 Tooth modifications needed.Tooth modifications needed.

 Impression of lower teethImpression of lower teeth  castcast
obtainedobtained
 Maxillary archMaxillary arch
Secondary impressionSecondary impression master castmaster cast
obtainedobtained occlusal rim fabricatedocclusal rim fabricated
contoured for adequate lip support.contoured for adequate lip support.
 Using face bow mount the maxillary castUsing face bow mount the maxillary cast
on the articulatoron the articulator  mount mandibularmount mandibular
cast using centric and eccentric recordscast using centric and eccentric records
at correct VDat correct VD

 Set teeth and achieve a balancedSet teeth and achieve a balanced
occlusion by selective grinding.occlusion by selective grinding.
 If gold restorations needed on theIf gold restorations needed on the
teeth, modify the teeth.teeth, modify the teeth.

 If FPD neededIf FPD needed 
do the toothdo the tooth
preparation beforepreparation before
making impression.making impression.
 Wax patterns areWax patterns are
carved to conformcarved to conform
to the existingto the existing
occlusion ofocclusion of
maxillary denture.maxillary denture.

TREATMENT PLANNINGTREATMENT PLANNING
FOR PATIENT WITHFOR PATIENT WITH
EDENTULOUS MAXILLAEDENTULOUS MAXILLA
AND PARTIALLY EDENTULOUSAND PARTIALLY EDENTULOUS
MANDIBLEMANDIBLE

 1)1) Risk of development ofRisk of development of
combination syndrome should becombination syndrome should be
recognized.recognized.
 2)2) Basic objectiveBasic objective: occlusal scheme: occlusal scheme
that can discourage excessivethat can discourage excessive
occlusal pressure in maxillaryocclusal pressure in maxillary
anterior region in both centric andanterior region in both centric and
eccentric occlusal contacts:eccentric occlusal contacts:
Bilateral balanced occlusionBilateral balanced occlusionwww.indiandentalacademy.comwww.indiandentalacademy.com

3)3) Treatment must concentrate onTreatment must concentrate on
periodontal and restorative needsperiodontal and restorative needs
of remaining teethof remaining teeth

4) RPD Design4) RPD Design
• Maximal coverage of basal seatMaximal coverage of basal seat
beneath distal extension base withoutbeneath distal extension base without
encroaching movable tissues.encroaching movable tissues.
• Adequate fit of the denture baseAdequate fit of the denture base
• Design be rigid and provideDesign be rigid and provide
maximum stability.maximum stability.www.indiandentalacademy.comwww.indiandentalacademy.com

• Functional impression technique.Functional impression technique.
• Increasing the efficiency ofIncreasing the efficiency of
occlusal surface of artificial teeth.occlusal surface of artificial teeth.
• Narrowing the occlusal tableNarrowing the occlusal table
• Avoiding the use of stressAvoiding the use of stress
breakers.breakers.

5) Maxillary complete denture:5) Maxillary complete denture:
• Maximum extensionMaximum extension
• Adequate border sealAdequate border seal

6)6) Adequate vertical dimension andAdequate vertical dimension and
proper centric relation positionproper centric relation position
7)7) Anterior teeth in maxillary completeAnterior teeth in maxillary complete
denture be used for cosmeticdenture be used for cosmetic
purpose only. No incisal contact inpurpose only. No incisal contact in
centric occlusion and minimal contactcentric occlusion and minimal contact
in eccentric position.in eccentric position.
8)8) Patient education and frequentPatient education and frequent
recall and maintenance.recall and maintenance.

SUMMARYSUMMARY

CONCLUSIONCONCLUSION
The main problem in treatingThe main problem in treating
patients who need a completepatients who need a complete
denture to occlude with opposingdenture to occlude with opposing
natural teeth is that natural teeth cannatural teeth is that natural teeth can
transmit larger forces to a denturetransmit larger forces to a denture
whose supporting structures arewhose supporting structures are
unable to resist them. Thus damageunable to resist them. Thus damage
to the edentulous ridge can easilyto the edentulous ridge can easily
occur.occur.www.indiandentalacademy.comwww.indiandentalacademy.com

To avoid this sequeale, the basicTo avoid this sequeale, the basic
fundamentals of prosthodonticfundamentals of prosthodontic
treatment i.e. an adequatetreatment i.e. an adequate
denture base ,correct jawdenture base ,correct jaw
relations, bilateral balancedrelations, bilateral balanced
occlusion must be provided.occlusion must be provided.

REFERENCESREFERENCES

 Stansbury C B. Single dentureStansbury C B. Single denture
construction against a non-modifiedconstruction against a non-modified
natural dentition.natural dentition. J Prosthet DentJ Prosthet Dent 1951;1951;
11: 692-699.: 692-699.
 Meyer: Generated path techniqueMeyer: Generated path technique
:JPD 1957:7 354:JPD 1957:7 354
 Tillman E J. Removable partial upperTillman E J. Removable partial upper
and complete lower dentures.and complete lower dentures.
J.Prosthet DentJ.Prosthet Dent 1961;1961; 1111: 1097-1104.: 1097-1104.

 Vig R G. A modified chew in andVig R G. A modified chew in and
functional impression technique.functional impression technique. J.J.
Prosthet DentProsthet Dent 1964;1964; 1414: 214-220.: 214-220.
 Use of gold occlusal surface in completeUse of gold occlusal surface in complete
and partial dentures: JPD 1964:14;326and partial dentures: JPD 1964:14;326
 Bruce: CD opposing natural teeth:JPDBruce: CD opposing natural teeth:JPD
1971:26;5:4481971:26;5:448
 Ellinger:Single complete denture:JPDEllinger:Single complete denture:JPD
1971:26:4-101971:26:4-10

 Kelly E. Changes caused by a mandibularKelly E. Changes caused by a mandibular
removable partial denture opposing aremovable partial denture opposing a
maxillary complete denture.maxillary complete denture. J ProsthetJ Prosthet
DentDent 1972;1972; 2727: 140-150.: 140-150.
 Rudd and Morrow: occlusion and singleRudd and Morrow: occlusion and single
denture:jpd1973;31:4denture:jpd1973;31:4
 Mandibular posterior fixed partialMandibular posterior fixed partial
denture:JPD 1977:37:622denture:JPD 1977:37:622

Saunders T R, Gillis R E, DesjardinsSaunders T R, Gillis R E, Desjardins
R P. The maxillary complete dentureR P. The maxillary complete denture
opposing the mandibular bilateralopposing the mandibular bilateral
distal-extension partialdistal-extension partial
denture.Treatment considerations.denture.Treatment considerations. JJ
Prosthet DentProsthet Dent 1979 ;1979 ;4141: 124-128.: 124-128.
Lauciello:articulator generated stopsLauciello:articulator generated stops
for CD:jpd1979;41:16for CD:jpd1979;41:16
Schmitt ;combination syndromeSchmitt ;combination syndrome
:treatment appoach:JPD 1985:54:664:treatment appoach:JPD 1985:54:664www.indiandentalacademy.comwww.indiandentalacademy.com

Koper ;maxillary CD opposind naturalKoper ;maxillary CD opposind natural
teeth: problems and some solutuions:teeth: problems and some solutuions:
JPD 1987:57;704JPD 1987:57;704
Shen:prevalance ofShen:prevalance of CombinationCombination
syndrome among denture wearers:syndrome among denture wearers:
JPD 1989:62;642JPD 1989:62;642
Maxillary CD opposingMaxillary CD opposing
osseointegrated mandibularosseointegrated mandibular
prosthesis:IJP1993:6;446-450prosthesis:IJP1993:6;446-450
Maxillary bone resorption inMaxillary bone resorption in
patients with mandibular implantpatients with mandibular implant
supported OD or fixedsupported OD or fixed
prosthesis.:JPd 1993:70:135-140)prosthesis.:JPd 1993:70:135-140)www.indiandentalacademy.comwww.indiandentalacademy.com

 Yair LangerYair Langer ::Modalities of Treatment forModalities of Treatment for
the Combination Syndromethe Combination Syndrome ::J ProsthodJ Prosthod
1995;4:76-811995;4:76-81
 CS in relation toCS in relation to osseointegratedosseointegrated
implant supported OD :IJP 1996:9;58-64implant supported OD :IJP 1996:9;58-64
 Maxillary changes underMaxillary changes under CD opposingCD opposing
mandibular implant supported fixedmandibular implant supported fixed
prosthesis: IJP 1999:12;492prosthesis: IJP 1999:12;492
 combination syndrome: a literaturecombination syndrome: a literature
review:Jpd 2003:90:270-275review:Jpd 2003:90:270-275
 Philip W SmithPhilip W Smith ::Combination syndromeCombination syndrome
revisited: BDJ 2001; 2(3):96-101revisited: BDJ 2001; 2(3):96-101

 Complete denture prosthodontics:Complete denture prosthodontics:
Sharry: 3Sharry: 3rdrd
edtedt
Essentials of complete dentureEssentials of complete denture
prosthodontics:winkler:2prosthodontics:winkler:2ndnd
edtedt
Text book of complete denture :5Text book of complete denture :5thth
edt:Heartwell.edt:Heartwell.
 complete denture :Swenson:4complete denture :Swenson:4thth
edtedt

Removable partial prosthodontics:10Removable partial prosthodontics:10
edt:Mc Crackenedt:Mc Cracken
Prosthodontic treatment forProsthodontic treatment for
edentulous patients:12edentulous patients:12thth
edt:Zarbedt:Zarb

Combination syndrome / AnteriorCombination syndrome / Anterior
hyperfunction syndromehyperfunction syndrome (GPT-7):(GPT-7):
““The characteristic features that occurThe characteristic features that occur
when an edentulous maxilla is opposed bywhen an edentulous maxilla is opposed by
natural mandibular anterior teeth,natural mandibular anterior teeth,
including loss of bone from the anteriorincluding loss of bone from the anterior
portion of the maxillary anterior ridge,portion of the maxillary anterior ridge,
overgrowth of the tuberosities, papillaryovergrowth of the tuberosities, papillary
hyperplasia of the hard palate’s mucosa,hyperplasia of the hard palate’s mucosa,
extrusion of the lower anterior teeth, andextrusion of the lower anterior teeth, and
loss of alveolar bone and ridge heightloss of alveolar bone and ridge height
beneath the mandibular removable partialbeneath the mandibular removable partial
denture base.”denture base.”

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