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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 60-62

Regaining esthetics with unconventional complete denture: Clinical case series


Department of Prosthodontics and Crown and Bridge, Christian Dental College, CMC, Ludhiana, Punjab, India

Date of Web Publication12-Jan-2018

Correspondence Address:
Surbhi Mehdiratta
Department of Prosthodontics and Crown and Bridge, Christian Dental College, Brown Road, CMC, Ludhiana - 141 008, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_46_17

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  Abstract 


Prosthodontic rehabilitation of edentulous patients can be the most satisfying if treatment can restore patient's function with superior esthetics. Conventional complete denture fabrication in patients with labially inclined premaxilla and maxillary labial undercuts is complicated due to the need for surgical correction. Failure to undergo surgical intervention results in complete dentures with compromised esthetics which could have long-term undesirable psychological bearing on edentulous patients. This article describes nonsurgical treatment modalities for proclined premaxilla in completely edentulous patients to achieve comprehensive rehabilitation with highest regard to esthetics.

Keywords: Nonsurgical, proclined premaxilla, prosthodontic rehabilitation


How to cite this article:
Daniel AY, Mehdiratta S, Talwar H, Daniel S. Regaining esthetics with unconventional complete denture: Clinical case series. CHRISMED J Health Res 2018;5:60-2

How to cite this URL:
Daniel AY, Mehdiratta S, Talwar H, Daniel S. Regaining esthetics with unconventional complete denture: Clinical case series. CHRISMED J Health Res [serial online] 2018 [cited 2020 Jul 3];5:60-2. Available from: http://www.cjhr.org/text.asp?2018/5/1/60/223119




  Introduction Top


Complete denture fabrication proves to be challenging when the ideal requirements of both hard and soft tissues are not fulfilled. One of the conditions affecting the denture fabrication and its esthetics is a labially proclined maxilla and associated undercut. Extremely prominent ridge is more commonly seen in maxilla than in mandible owing to differential resorption pattern. Overall goals of reconstructive, preprosthetic surgery are to provide an environment for prosthesis that would restore function, be stable, aid retention, preserve associated structures, and satisfy esthetics.[1] Removal of the minimum amount of bone necessary to eliminate the undercut, whereas at the same time, avoiding the loss of bony cortical plate can be done for such conditions to improve the environment for the denture construction.[2] However, use of surgical treatment is not always feasible owing to lack of patient motivation to undergo an invasive procedure,[3],[4] financial and systemic health constraints. In such cases, unconventional way of denture fabrication can be undertaken for the best results.[5],[6]

The aim of this article is to present case reports, in which satisfactory denture esthetics and function has been attained in a noninvasive manner in patients having proclined anterior maxillary ridge and associated undercut.


  Clinical Case Reports Top


Case 1

A 45-year-old completely edentulous female patient reported to the department of prosthodontics and crown and bridge requesting fabrication of a set of dentures. The patient had been edentulous for the past 6 months. On extraoral examination, the patient had an ovoid face, class 2 profile, normal muscle tone, and short lip length. Intraoral examination showed that the patient had a U-shaped arch with prominent maxillary residual ridge accompanying a severe anterior labial undercut.

Case 2

A 60-year-old female patient reported to the department of prosthodontics and crown and bridge, with a complaint of poor esthetics of the maxillary denture and wanted a new set of dentures. The patient had been wearing the denture for the past 6 months but was not satisfied with the esthetics and described her appearance as “monkey-like” on wearing the prosthesis. She further specified her inability to close the lips. On extraoral examination, it was found that the patient had a convex profile that got accentuated on wearing the prosthesis. The patient had an ovoid tapering face, class 2 profile, and a short lip length. Intraoral examination showed that the patient had a U-shaped arch with proclined anterior maxillary ridge and an accompanying severe labial undercut. The patient was not willing for surgical correction; hence, a complete denture with modified flanges was planned.

Technique for case 1 and 2

Steps of conventional denture fabrication were followed up to the stage of wax try-in. During wax-up, the labial flange was completely removed from canine-to-canine leaving two acrylic spikes extending anteriorly from the distal side enabling in retention by engaging the undercut. Variations of acrylic extensions accounting for the need of retention based on undercut extension were done in the above cases [Figure 1] and [Figure 2].
Figure 1: (a) Intraoral view of maxillary ridge showing proclined premaxilla (b) Flangeless maxillary denture with acrylic spikes (c) intraoral view (d) patient wearing maxillary denture with satisfactory lip fullness

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Figure 2: (a) Maxillary denture with labial flange completely removed leaving two acrylic wings (b) intraoral view of patient wearing flangeless denture (c and d) extraoral view of patient showing excellent esthetics

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Case 3

A 60-year-old male patient, edentulous for the past 1 year reported to the department of prosthodontics and crown and bridge for a set of dentures. On extraoral examination, the patient had an ovoid tapering face and class 2 profile. Intraoral examination revealed that the patient had a U-shaped ovoid arch with proclined premaxilla.

Technique

Case 3 involved removing the entire acrylic extensions and use of stainless steel to engage the labial undercut. Tip of wire was covered with acrylic tags to avoid mucosal impingement [Figure 3].
Figure 3: Intraoral view of denture with stainless steel wire extensions aiding in retention

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Subsequently, wax-up of maxillary and mandibular dentures was done in all cases in the usual manner. Denture insertion was done after careful processing, finishing, and polishing. Acrylic spikes/wings and stainless steel extensions in finished complete denture provided adequate retention of prosthesis on insertion.


  Discussion Top


In the case reports discussed above, labially proclined maxilla and the accompanying bony undercut proved to be the major cause of unesthetic appearance. Thus, there was a risk of excessive fullness associated with a planned conventional complete denture. Modification of the labial flanges of the maxillary denture was contemplated, as the patients were reluctant for surgical correction of proclined maxilla with alveoloplasty. In addition, alveoloplasty should be performed only when there is a definite indication for the procedure as this procedure affects the quantity of denture foundation and therefore denture stability.[7] It may result in a narrowed crest in alveolar ridge area leading to a less desirable area of support and an area that may resorb more rapidly. Therefore, labial flange modification proved to be the most simple, effective, and noninvasive treatment alternative to the conventional technique of denture fabrication in these patients. Any modifications to conventional dentures would involve reduction of labial fullness by restraining denture base over proclined premaxilla without compromising on denture retention.[7],[8] Nonsurgical techniques were opted in all the three case reports so that upper lip comes in direct contact with the mucosa, thereby minimizing the risk of enhanced fullness caused by denture flanges.

In the first two case reports, at the time of wax-up, two wax extensions were made in labial sulcus in the region of the canine. These “acrylic spikes or wings”[9],[10] served as mechanical retentive aid in the final processed denture. The advantage of the technique was that acrylic spikes engaging the bony undercut provided acceptable retention and fulfilled the desires for better esthetics by minimizing denture flange in this region. The limitations associated with acrylic spikes or wings were impingement of mucosa and risk of fracture which necessitated appropriate thickness of acrylic. The shortcomings of acrylic spikes were overcome in the third case by incorporating stainless steel wire extensions with acrylic tags which reduced the impingement of mucosa and need for sufficient acrylic thickness providing superior retention owing to elasticity of wire.


  Conclusion Top


Preprosthetic surgery helps in recontouring the ridges to receive prosthesis in a better way, but attainment of patient's consent is the major impediment for the same. Nonsurgical procedures can thus be utilized for the fabrication of prosthesis as they are noninvasive, provide better acceptance, and ultimate satisfaction for the patient.

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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Terry BC, Zarb GA. Report on the 4th international congress on preprosthetic surgery, Palm Springs, USA, 18-20 April, 1991. Int J Oral Maxillofac Surg 1991;20:314-6.  Back to cited text no. 1
[PUBMED]    
2.
Lawson WA. Objectives of pre-prosthetic surgery. Br J Oral Surg 1972;10:175-88.  Back to cited text no. 2
[PUBMED]    
3.
Hillerup S. Preprosthetic surgery in the elderly. J Prosthet Dent 1994;72:551-8.  Back to cited text no. 3
[PUBMED]    
4.
Keni Nandita N, Aras Meena A. Modified flange complete denture for labially inclined premaxilla. IJDA 2010;2:1-3.  Back to cited text no. 4
    
5.
Shah RJ, Parmar P. Unconventional complete dentures: Innovative approach in prosthodontics. Int J Health Biomed Res 2014;2:123-31.  Back to cited text no. 5
    
6.
Olvera N, Jones JD. Alternatives to traditional complete dentures. Dent Clin North Am 2014;58:91-102.  Back to cited text no. 6
[PUBMED]    
7.
Ogle RE. Preprosthetic surgery. Dent Clin North Am 1977;21:219-36.  Back to cited text no. 7
[PUBMED]    
8.
Basker RM, Davenport JC, Tomlin RH. Prosthetic Treatment of the Edentulous Patient. 3rd ed. London: Macmillan; 1992.  Back to cited text no. 8
    
9.
Rahn AO, Ivanhoe JR, Plummer KD. Textbook of Complete Dentures. 6th ed. Philadelphia: Williams and Wilkins, Media; 2009.  Back to cited text no. 9
    
10.
Zarb GA, Bolender CL, Carlsson GE. Boucher's Prosthodontic Treatment for Edentulous Patients. 11th ed. St. Louis (MO): Mosby; 1985.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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Introduction
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