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 Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 6  |  Issue : 2  |  Page : 84-87

A simple approach to hollow maxillary complete denture fabrication: An innovative technique


Department of Prosthodontics, Goa Dental College and Hospital, Bambolim, Goa, India

Date of Web Publication6-Dec-2017

Correspondence Address:
Dr. Kathleen Manuela D'souza
Department of Prosthodontics, Goa Dental College and Hospital, Rajiv Gandhi Complex, Bambolim - 403 202, Goa
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdas.jdas_23_17

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  Abstract 


A severely atrophic maxillary arch exhibits reduced denture bearing area and increased inter-ridge distance, thus, affecting retention of the complete denture. Such clinical situations necessitate the fabrication of a hollow complete denture to reduce the weight of the prosthesis and increase retention. This article describes a simple technique to fabricate a hollow maxillary complete denture using salt and thermoplastic poly (methyl methacrylate) sheet. The vacuum-formed thermoplastic matrix regulates the quantity of salt and determines its placement in the unpolymerized denture base material during the denture packing stage. The matrix lining the hollow cavity also aids to reinforce the hollow denture base.

Keywords: Hollow denture, lost salt technique, residual ridge resorption


How to cite this article:
D'souza KM, Aras MA. A simple approach to hollow maxillary complete denture fabrication: An innovative technique. J Dent Allied Sci 2017;6:84-7

How to cite this URL:
D'souza KM, Aras MA. A simple approach to hollow maxillary complete denture fabrication: An innovative technique. J Dent Allied Sci [serial online] 2017 [cited 2019 May 22];6:84-7. Available from: http://www.jdas.in/text.asp?2017/6/2/84/219974




  Introduction Top


Residual ridge resorption is a physiological process that affects the architecture of the alveolar ridges resulting in reduced denture bearing area and an altered inter-alveolar ridge space.[1],[2] This increased inter-ridge distance provides a large restorative space, resulting in a heavier maxillary complete denture due to the incorporation of a greater volume of denture base material. Consequently, decreased denture bearing area, increased the weight of the prosthesis and gravity can negatively affect the retention of the prosthesis.[3],[4],[5],[6]

The foregoing literature reports that hollow dentures[3],[4],[5],[6],[7] have been fabricated to decrease the volume of the denture base material. This article explicitly describes the procedure to fabricate a hollow maxillary complete denture using a vacuum-formed thermoplastic sheet and salt as a part of a management protocol for patients with severely resorbed maxillary alveolar ridge.


  Case Report Top


The maxillary complete denture was fabricated up to trial denture stage and was invested in a split dental flask in type II gypsum material (Kaldent; Kalabhai Karson, Mumbai, Maharashtra, India). Following the wax elimination, two sheets of wax (Modelling wax no. 2; The Hindustan dental products, Hyderabad, Telangana, India) were adapted on the definitive cast to create space for acrylic resin forming the intaglio surface, one covering the entire denture bearing area and the other covering only the residual alveolar ridge. Three tissue stops (4 mm × 2 mm) were carved in the incisive papilla and first molar regions to aid in the orientation of the spacer [Figure 1]. Similarly, two sheets of wax were adapted over the ridge lap surfaces of the denture teeth to create space for acrylic resin forming the polished surface, one extending till the border extensions and the other covering only the denture teeth [Figure 1].
Figure 1: Modelling wax adapted to definitive cast in the drag and to denture teeth in the cope

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Mixed Putty impression material (Aquasil soft putty/regular set; Dentsply DeTrey, Konstanz, Germany) was packed in the flask to form a silicone replica of the three-dimensional (3-D) spacer [Figure 2]. The concave and convex surfaces of the silicone spacer were duplicated separately using irreversible hydrocolloid impression material (Zelgan 2002; Dentsply India, Gurgaon, Haryana, India) to form die stone replicas (Kalrock; Kalabhai Karson, Mumbai, Maharashtra, India). Clear thermoplastic matrices were fabricated over the stone replicas using a 2 mm thick pressure molded poly (methyl methacrylate) (PMMA) thermoplastic sheet (Biocryl C; Scheu-Dental GmbH, Iserlohn, Germany) [Figure 2]. Lead strips (4 mm × 31 mm) were placed along the inner surface of the matrices to evaluate the thickness of the denture base material using radiographs. Both the matrices were approximated and fused together using auto-polymerizing acrylic resin (DPI-RR cold cure; Dental Products of India, Mumbai, Maharashtra, India) to form an encasement [Figure 3]. A small opening along the fusion joint allowed salt insertion into the encasement, which was later sealed using acrylic resin.
Figure 2: Putty replica of the three-dimensional spacer. Die stone replicas of the concave and convex side of the silicone putty. Trimmed clear thermoplastic matrices which are pressed over the die stone replicas

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Figure 3: Matrices approximated and fused to form the encasement for salt. Lead strips placed on the inner surface of the three-dimensional spacer

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Heat-polymerizing acrylic resin (DPI Heat cure denture base material; Dental Products of India, Mumbai, Maharashtra, India) was mixed according to manufacturer's instructions and packed in dough stage. The 3-D spacer was positioned in the dough by aligning the tissue stops on the intaglio surface of the spacer with their respective positions on the alveolar ridge. The flask was pressed under hydraulic press, clamped and a conventional polymerization cycle was adopted. The processed denture was retrieved and polished. An opening (2 mm × 4 mm) was made on the palatal aspect of the denture [Figure 4]. A water-air syringe was used to thoroughly flush out the salt and dry the hollow cavity. This opening was closed with acrylic resin.
Figure 4: Opening in the palatal aspect of the denture for salt removal

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Float test was conducted and the denture was weighed before (32.49 g) [Figure 5]a and [Figure 5]b and after (26.95 g) [Figure 5]c and [Figure 5]d salt removal, respectively.
Figure 5: (a) Processed denture sinks in water. (b) Weight of the denture before salt removal. (c) Hollow denture floats in water. (d) Weight of the denture after salt removal

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  Discussion Top


Literature reports various techniques for the fabrication of a hollow complete denture.[3],[4],[5],[6],[7] Few authors suggest processing the denture in parts around a 3-D spacer, which are then fused at the denture borders, following spacer removal.[6],[7] Nevertheless, additional laboratory steps were needed, and postinsertion adjustments could result in a perforation, leading to fluid seepage into the hollow cavity.[6],[7]

Other techniques involved incorporation of the spacer within the denture base to form the hollow cavity during processing.[4],[5],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17] However, this necessitated designing large openings in the cameo surface to facilitate spacer removal. Several spacer materials have been used, such as, gauze coated with addition silicone impression material,[5] ice,[8] asbestos,[9] silicone putty,[4],[10],[11],[12] dough of dental plaster and pumice,[13] dough of dental plaster-pumice and sugar syrup,[14] modeling clay,[15] thermocol,[16] and salt.[17] Aggarwal et al.[17] proposed the lost salt technique to overcome the following shortcomings encountered in the aforementioned techniques: (a) Extra laboratory steps for the fabrication of a special lid and (b) tedious retrieval of high viscosity materials such as putty and thermocol.

However, certain limitations were encountered in the lost salt technique, which included the inability to control the denture base thickness and incorporation of salt in the denture base due to the inability to control its placement and quantity.

Literature reports proneness of the maxillary complete denture to fracture in the midline due to high tensile and shear stresses in this region.[18] Furthermore, nonuniformity of the denture base thickness due to inability to gauge the overall thickness of the denture base resin and hollowing of the maxillary denture can increase its proneness to fracture.[11] Baloš et al. suggested the use of thermoformed PMMA material for the fabrication of complete maxillary dentures due to the improved fracture toughness and crack resistance of this material.[18] This technique addresses the above-mentioned limitation by incorporation of a thermoplastic sheet within the denture base to act as a reinforcing material.

Moreover, incorporation of the matrix acts as a scaffold to confine the salt, thus controlling its quantity and helps to prevent denture base porosities due to incorporation of salt.[15] In addition, three tissue stops were incorporated in the intaglio surface of the spacer to control the depth of resin on the intaglio surface of the denture.

Biocryl C is a clinically proven hard elastic sheet made of break resistant PMMA without residual monomer.[19] It exhibits good acrylic bonding and possesses highly consistent mechanical properties, according to the manufacturers' instructions. It is routinely used in orthodontics as a base-plate material.[19]

Salt was incorporated in the 3-D spacer so that it does not deform under pressure during compression molding process. Salt is highly water soluble and can be easily eliminated from the denture cavity.[17]

Float test revealed that the denture floats in the water following salt removal confirming the reduction of the overall density of the prosthesis.


  Conclusion Top


This technique describes the fabrication of a 3-D spacer, using a thermoplastic matrix and salt, which was incorporated within the denture base material during denture packing stage. This resulted in the fabrication of a hollow maxillary complete denture for a severely atrophic maxillary arch. Although the technique was effective, further research needs to be conducted to evaluate the efficacy of thermoplastic PMMA sheets incorporated within the denture base material.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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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. 9
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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. 10
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Radke U, Mundhe D. Hollow maxillary complete denture. J Indian Prosthodont Soc 2011;11:246-9.  Back to cited text no. 11
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Indrakumar HS, Amarnath GS, Shavi GR, Hariprasad A, Hilal SM, Anand M. A denture with hollow to make weight shallow: A case report with a new putty method. J Int Oral Health 2014;6:92-4.  Back to cited text no. 12
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Bhandari A, Singh SK, Suwal P, Parajuli PK, Manandhar A. Rehabilitation of severely resorbed maxilla with a hollow maxillary complete denture. Health Renaiss 2013;11:281-3.  Back to cited text no. 13
    
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Chaturvedi S, Verma AK, Ali M, Vadhwani P. Hollow maxillary denture: A simplified approach. Peoples J Sci Res 2012;5:47-50.  Back to cited text no. 14
    
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Gundawar S, Zamad A, Gundawar S. Light weight dentures: An innovative technique. Contemp Clin Dent 2014;5:134-7.  Back to cited text no. 15
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Kaira LS, Singh R, Jain M, Mishra R. Light weight hollow maxillary complete denture: A case series. J Orofac Sci 2012;4:143-47.  Back to cited text no. 16
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17.
Aggarwal H, Jurel SK, Singh RD, Chand P, Kumar P. Lost salt technique for severely resorbed alveolar ridges: An innovative approach. Contemp Clin Dent 2012;3:352-5.  Back to cited text no. 17
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18.
Baloš S, Milutinović M, Potran M, Vuletić J, Puškar T, Pepelnjak T. The mechanical properties of moulded and thermoformed denture resins. J Mech Eng 2015;61:138-45.  Back to cited text no. 18
    
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Kopperud HM, Kleven IS, Wellendorf H. Identification and quantification of leachable substances from polymer-based orthodontic base-plate materials. Eur J Orthod 2011;33:26-31.  Back to cited text no. 19
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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