Complete Denture Prosthodontics: Treatment and Problem Solving

284 Pages·2018·66.57 MB·English

by  Yasemin K. Özkan

Yasemin K. Özkan
Editor
Complete Denture
Prosthodontics
Treatment and Problem Solving
123
Complete Denture Prosthodontics
Yasemin K. Özkan
Editor
Complete Denture
Prosthodontics
Treatment and Problem Solving
Editor
Yasemin K. Özkan
Faculty of Dentistry, Department of Prosthodontics
Marmara University
Istanbul
Turkey
This work has been first published in 2017 by Quintessence Yayıncılık, Turkey with the following title:
Tam protezler: problemler ve çözüm yolları
ISBN 978-3-319-69016-2 ISBN 978-3-319-69017-9 (eBook)
https://doi.org/10.1007/978-3-319-69017-9
Library of Congress Control Number: 2018959420
© Springer International Publishing AG, part of Springer Nature 2018
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Contents
Part I T ooth Arrangement and Try-in
1 Anterior Tooth Selection and Arrangement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Buket Evren and Yasemin K. Özkan
2 Posterior Tooth Selection and Arrangement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Buket Evren and Yasemin K. Özkan
3 Evaluation of Try-In Stage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Yasemin K. Özkan, Yılmaz Umut Aslan, and Buket Evren
4 The Remounting Process: Adjustment of Dentures
on the Articulator and in Mouth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105
Zeliha Şanıvar, Şükrü Can Akmansoy, Seda Keban, and Yasemin K. Özkan
Part II P ost Insertion Problems
5 Post Insertion Problems in Complete Dentures . . . . . . . . . . . . . . . . . . . . . . . . . . . .145
Yasemin K. Özkan
6 Long-Term Problems with Complete Dentures . . . . . . . . . . . . . . . . . . . . . . . . . . . .197
Yasemin K. Özkan
Part III Stress-Reducing Materials for Complete Dentures
7 Tissue Conditioner Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .213
Erkut Kahramanoğlu and Yasemin K. Özkan
8 Clinical Applications of Soft Lining Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . .223
Ceren Küçük and Yasemin K. Özkan
Part IV D ifferent Techniques for Problem Cases
9 Single Complete Dentures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .243
Coşkun Yıldız and Yasemin K. Özkan
10 Duplicate (Copy) Dentures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .271
Yasemin K. Özkan, Yılmaz Umut Aslan, and Ender Kazazoğlu
11 Managing the Edentulous Dry Mouth: Reservoir Complete Denture . . . . . . . . . .281
Yasemin K. Özkan
v
Part I
Tooth Arrangement and Try-in
Anterior Tooth Selection 1
and Arrangement
Buket Evren and Yasemin K. Özkan
1.1 Anterior Tooth Selection The photographs of the natural teeth of the patients or the
and Arrangement previous dentures can be asked for tooth arrangements. If the
materials are not enough or absent, clinically proven anterior
In order to construct esthetic dentures, in spite of a lot of tooth arrangement rules should be applied.
guidance, there are still many questions regarding the esthet- Some of the rules among the embryogenetic principles of
ics of anterior portion of complete dentures. This guidance Gerber (1960) are based on the concept of developmental
includes esthetic arrangements, subjective experiences, physiology. The principles of Gerber indicate that facial
physiological theories, anatomical-morphological differ- structure should be reflected by the maxillary anterior teeth.
ences, and statistical comparisons. The dentist should obey Even though the morphometric principles lying under these
the precise rules for each specific case while considering the rules are scientifically undefined, considering this can pro-
general status and expectations of the patient. In this chapter, vide a satisfying esthetics of the complete dentures.
some general principles are explained about anterior tooth If facial asymmetry or deformity is present, both anterior
selection and tooth arrangement. and posterior teeth are arranged not considering the general
Tooth arrangement in complete dentures should fulfill the rules but considering the patient. The aim is to arrange the
requirements of Gerber (1979): teeth as close as possible and to ensure that the visibility of
facial deformity is minimal.
• Complete dentures should restore the facial expression
individually and naturally.
• Complete dentures should preserve the remaining tissues 1.1.1 Patient Evaluation: For Whom
and structures of the system. the Prosthesis Is Constructed?
• Complete dentures should provide sufficient mastication
function and proper phonation. The first and the most important factor that should be consid-
ered in anterior tooth selection and arrangement is for whom
The facial expression of a person is composed of several the prosthesis is constructed. Only after this factor is under-
dynamic and static components. Anterior teeth have direct stood can the size, shape, color, and material of the teeth be
effects on facial expression, facial ratios (vertical height), evaluated. By considering all these factors, we can achieve
and extraoral appearance of the patients and at the same time the natural and satisfying appearance that we try to have.
support the soft tissues of the face. Although hard and soft One of the best ways to have patient satisfaction is to
tissues guide edentulous oral cavity, they do not give suffi- include the patient in teeth selection and arrangement stages.
cient information about the location and shape of the lost How can we achieve this? If the patient is already a denture
teeth. Some artistic skill is also needed to have a satisfying user, he should be asked about the things he likes and dis-
restoration. likes about his dentures. What kinds of alterations does he
want? In order to have sufficient time to think about the sub-
ject seriously, the dentist should begin asking these questions
in the first appointment. If it would be the first complete den-
tures he will wear, probably some natural teeth will be
B. Evren · Y. K. Özkan (*) extracted. These remaining teeth can be useful for the new
Faculty of Dentistry, Department of Prosthodontics,
dentures. Perhaps there are some spaces, grooves, and prom-
Marmara University, Istanbul, Turkey
e-mail: [email protected] inences on the remaining teeth which the patient wishes to
© Springer International Publishing AG, part of Springer Nature 2018 3
Y. K. Özkan (ed.), Complete Denture Prosthodontics, https://doi.org/10.1007/978-3-319-69017-9_1
4 B. Evren and Y. K. Özkan
have on the new dentures. It may be beneficial to have an the use of qualified materials, he forms a copy of life. The
impression of the teeth before extraction. Old photographs patient who fits this appearance is sophisticated, intelligent,
showing the position of anterior teeth of the patient are also and conscious.
helpful. Our aim is to have as much information as possible
to have a denture with a natural appearance and to be accept- 1.1.2.2 Ideal Appearance
able by the patient. Most of the patients are not aware of the good points of
Nevertheless, we do not want to show the sample teeth natural appearance, and they want their teeth to reflect the
to the patient and we do not want him/her to make his own ideal appearance in magazines and advertisements. These
choice. To see the variations will confuse him/her. The first kinds of prosthesis could be fabricated with teeth in each
opportunity for the patient to see the teeth arrangement will shape, form, and color harmonious with the characteristics
be after the teeth are arranged on the wax rims and approved of the patient. The arrangements that usually please this
by the dentist. Selection of the anterior teeth should always group of patients give better results in patients with young
be performed together with the patient and the dentist. characteristic features and normal intermaxillary
Dentists’ concerns are important as much as the patients’ relationship.
wishes and thoughts. Because of their experience, dentists Problems arise when there are differences in the inter-
have a large influence on their patients. Therefore, accord- maxillary relationship. Although it does not fit the patient’s
ing to some authorities, trying to affect the patients should own esthetic criteria, the essential tooth arrangement is
be prevented. Compared to the other stages of the treat- established for the stability of the prosthesis. If a patient with
ment, it is important to maintain a sincere relationship dur- a Class III intermaxillary relationship wants to have a normal
ing the decision stage. Studies show that patients, who were inclination with his anterior maxillary and mandibular teeth,
allowed to make choices on esthetic properties of their he will accept an unstable prosthesis, and a patient with a
prostheses, showed faster adaptation to their prostheses. Class II relationship will observe that to have a normal rela-
Also, many studies indicated that satisfying patients on tionship, the mandibular incisors will be repositioned
esthetical terms shortens the adaptation time for their new (Fig. 1.1a, b).
prostheses. The patients who adopt the ideal appearance only think
Ideas from relatives (family members and friends) should about the general appearance; they are not interested in the
also be considered together with the patients’ own choice. details. These kinds of patients can be in different ages but
Evaluating teeth samples on patients makes selecting ante- mostly they are easily satisfied. Usually, they are worried
rior teeth easier and also allows choosing the morphology about the harmony between the color, size, and relationship
and shade of teeth. of the teeth and their own characteristics. On the other hand,
The sample table does not provide a three-dimensional they talk about their doubts at the try-in stage if their opinion
view. Therefore, sample models are used for teeth arrange- is asked.
ment to provide the three-dimensional view for both dentists
and patients. Patients, who are incompatible during anterior 1.1.2.3 Preferred Appearance
teeth arrangement, blame their dentist afterward because of Many studies indicate that most of the patients are not aware
the esthetical outcomes and usually cause problems about of the slight differences in dental anatomy unless their atten-
their prostheses. tion is attracted. The patients usually want to have properly
aligned tooth arrangements as the orthodontists obtained or
they want to have small white teeth. For some of these types
1.1.2 Tooth Selection of patients, the shape, color, and size of teeth are not impor-
tant, but the teeth should provide the soft tissue support and
Tooth selection stage is very important to determine the therefore be placed in a proper position. These kinds of
appearance of the patient. Each patient has a different good patients emphasize their wishes when they first visit the den-
appearance concept but it is necessary to provide a standard. tal office. How wishes will suitably meet with tissue toler-
Good appearance is classified into three different types. This ance should be explained by the dentist. The other part of this
can be beneficial to please the willing patients. group is biased about how their teeth will be arranged in real-
ity. They spent most of their time providing the accurate
1.1.2.1 Natural Appearance shape, color, and intermaxillary relationship of teeth, but a
For natural appearance, the dentist, with his dental anatomy fully harmonious treatment is not important. The patients in
experience and knowledge of aging process effect, decides this group can be easily defined. Either their old dentures are
the most suitable denture. The denture is the product of his apparently inaccurate (golden teeth or unnatural diastemas)
experience. Depending on the patients’ age, he reflects the or they exhibit their own wishes in details when selecting
wear and discoloration of teeth. With his own experience and teeth.
1 Anterior Tooth Selection and Arrangement 5
Fig. 1.1 (a, b) The position
a
of incisor teeth in Class 1,
Class 2, and Class 3 patients
CLASS I CLASS II CLASS III
b
CLASS I
CLASS II CLASS III
For these kinds of patient’s, tooth selection is usually anxious about their appearance. Therefore, they define their
simple and little problem is observed. If any problem displeasure on other features of denture design.
occurs, it is difficult to diagnose, and the depressed displea- In order to avoid problems, the dentist should be ready
sure of the patient cannot be expressed until he wears the for the situations that he does not have any authority and if
denture. Even, some patients do not want to be definite possible he should be in direct relation with the patient
about their complaints, as they do not want to be known as during decision. The aim of this kind of approach is to
6 B. Evren and Y. K. Özkan
have the best results. Furthermore, the dentist should have 1.1.4 Anterior Tooth Selection
some materials such as models and pages from magazines.
The photographs of the previous successful patient can There are four main subjects in anterior tooth selection:
also be useful. The dentist should explain the reasons of
the applications, and in a short time, he should determine 1. Tooth size
the best appearance that the patient is satisfied. Another 2. Tooth shape
useful strategy is to ask the opinions of the relatives of the 3. Tooth color
patients. Many elderly patients come to the office with 4. Tooth material
their children who give them physical and psychological
support. Both the patients and their children are satisfied
with the shape and arrangement of the teeth, and they are 1.1.4.1 Tooth Size
persuaded that the aim of our demands is to have the best If the patient did not explain any tooth size, selection of teeth
possible results. It is difficult to satisfy patients as they according to the size of the patient is the easiest approach. A
become older. pair of compasses can be used to measure the width of all
anterior artificial teeth. In the west European population, the
sum of the mean width of maxillary anterior six teeth is
1.1.3 Topographic and Functional 46 mm. In order to provide harmony, for a medium-sized
Adjustments in Anterior Teeth male patient, the width of anterior teeth should be 46 mm;
Arrangement for a large-sized male, it should be 48 mm; and for a small-
sized male, it should be 44 mm.
If functional demands are met, the location of artificial teeth Although there is no evidence that the teeth of females are
in complete dentures should be in the same place that the smaller than the teeth of males, the mean size of women
natural dentition was in the past. During the arrangement of teeth is less, and to have harmony, during teeth selection,
artificial teeth, the upper and lower anterior teeth should not 2 mm less teeth size can be chosen in each size (large,
have any contact in centric relation. A distance of 1 mm medium, small). When this system is used, the patient can
achieves “slight freedom” during protrusive movement think that the selected teeth are large for him. To confirm the
before contact with the upper teeth. Anterior teeth are gener- selection, comparisons can be made by preparing models
ally located with a maximum incisal guidance angle of 15 with natural dentition.
degrees (Fig. 1.2). The proper vertical and horizontal over- Another method for anterior teeth selection is to mark the
laps of maxillary and mandibular teeth should be obtained corners of the mouth on wax rims. By measuring the distance
necessarily. Another criterion for the topographical place- between the corners of the mouth on wax rims, the overall
ment of anterior teeth is to provide proper space for the soft width of six anterior teeth can be achieved. Some anatomical
tissue profile of the face and the tongue as indicated by Sir measurements for teeth selection are as follows:
Wilfred Fish (1936)
1. The vertical lines drawn from the edges of the nose passes
from the midline of the canine surfaces (Figs. 1.3–1.5).
2. The sum of the mesiodistal width of the first central inci-
sors is equal to the width of the philtrum (Figs. 1.4 and
1.6).
Incisal guidance
angle 3. The distance between the commissures of the mouth on
wax rims is equal to the overall width of anterior teeth
(Figs. 1.7 and 1.8).
Overbite 4. The sum of the mesiodistal width of the anterior teeth is
close to 1/3 of the distance between zygomas (Fig. 1.9).
5. The mesiodistal width of one central incisor is equal to
1/16 of the distance between zygomas (Fig. 1.10).
Alternatively, by measuring the distance between the ala
Overjet of the nose, the distance between the midlines of the canines
can be predicted.
The size of teeth is also related to the size of the dental
arch and the interarch distance. The easiest method to deter-
Fig. 1.2 Maximum incisal guidance angle is generally 15 ° in the ideal
arrangement of anterior teeth mine the teeth size is determining on the stone model. These