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Inconsiderate try in of Complete Denture Prosthesis – An Iatrogenic Failure

Article · September 2017

DOI: 10.18535/jmscr/v5i9.85

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DOI: https://dx.doi.org/10.18535/jmscr/v5i9.85

Inconsiderate try in of Complete Denture Prosthesis – An Iatrogenic Failure

Authors
Khurshid A Mattoo1*, Sarwar S2
1
*Assistant Professor, Dept of Prosthetic Dental Sciences, College of Dentistry, Jazan University, (KSA)
2
Senior Dental Technician, Subharti Dental college, Subharti University, India
* Corresponding Author
Khurshid A Mattoo
Email: [email protected]

Abstract
Very often in academic practice, students ignore, work approval by their respective supervisor. During complete
denture fabrication, denture trial is a clinical procedure that most of graduate students consider petite clinical
procedure, thereby neglecting many things that are to be clinically verified. An elderly female reported to the
department that she was not satisfied with the esthetics of the complete denture delivered to her. The female
patient was advised new complete denture fabrication which she rightly rejected. After evaluation of the vertical
and centric relation with current centric occlusion, it was decided that the same denture can be corrected. This
article describes a simple clinical technique to replace anterior teeth of the existing denture.
Keywords: artificial teeth, polymerization, articulator, complete denture, centric relation.

Introduction described. An outline of denture trial has also been

The denture trial is a three eyed clinical procedure tabled.
that needs to be verified by the dentist firstly,
followed by approval by the patient and then his Case report
close associate. The importance of perfection and A female patient aged 64 years, reported to the
verification of jaw relation records has been undergraduate OPD of the department of
emphasized in all textbooks.1-3 Therefore, even Prosthodontics with chief complaint of new denture
denture trial is a procedure where jaw relations have falling whenever she would speak. The complete
to be perfected. Only when one is sure after denture was delivered to her by an undergraduate
verification, he should proceed to the next step. student who had neglected the academic protocol
Denture trial is the last stage where modifications and delivered the denture after galloping through try
can be accommodated. Nevertheless, in academic in procedure. The patient was advised for remaking
practice, there are times when teachers are busy of a new denture which patient rejected as it was
with students and there are times when students difficult for her to go through the entire procedure
bypass the supervision. This article describes a case again. The patient was referred to the post graduate
report of an elderly female patient who received a clinic of the department, where after preliminary
complete denture prosthesis with flared anterior verification of vertical dimensions and centric
teeth. Emergency correction in such case is relation of the denture it was decided that an attempt

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will be made to replace the faulty proclined anterior lar anterior teeth were removed using an acrylic
teeth with a new one but the patient would receive trimmer. This was replaced by modelling wax
the denture after one day which she happily agreed. (Rolex, India). The profile contour of modelling
Medical, dental, social, drug and other histories wax was then re-established clinically on the
were non-contributory. This was the patient’s first patient. New teeth were then arranged in
denture and had lost remaining few teeth due to conventional manner (Fig 2 b,c). A denture trial was
mobility six months back. done (Outlined in Table 1) and after her approval
At the outset, the patient was asked to wear the the dentures were invested in a conventional way
existing complete denture (Fig 1a) and perform oral except one modification. The entire denture was
functions (Fig 1b). Maxillary anterior teeth were covered in plaster except the teeth that were
visible to the cervical margin and while smiling the attached to the denture with wax (Fig 2 d). Heat
denture would fall. All objectives of impression cure denture base acrylic (DPI-Heat cure, Dental
making were verified following which centric products of India Ltd, Mumbai, India) was then
relation and vertical dimensions were verified (Fig added in the area and after trial closure and bench
1c). Reasons for denture failure were proclined curing, the denture was processed using a long cycle
anterior teeth with excessive visibility (Fig1d). (100 degrees centigrade for 8 hours) for denture
Excess proclination activates orbicularis oris which processing. The denture was retrieved next day and
in turn pushes the denture backwards and finished and polished (Fig 2e). The patient was
downwards. informed about the drawbacks of double curing,
although long curing cycle was used to minimize
such drawbacks. The patient was satisfied with the
immediate correction that was offered to her.

Figure 1: Maxillary and mandibular denture

showing extreme visiblity, correct centric and
vertical and proclined anteriors
Figure 2: Clinical and laboratory procedure
Procedure involved in correction. (Refer text for details)
The dentures were checked for peripheral
Discussion
extensions, retention, stability, posterior palatal seal,
Over the years in various academic set ups, the
vertical dimensions and centric occlusion (relation
author has observed a decline in the quality of
with centric relation). A new centric relation record
denture trial procedures which is why it has
was made using bite registration paste (O-Bite,
prompted the author to use this case as a good
DMG-Germany) (Fig 2a). Denture with the new
opportunity to review this important clinical
interocclusal centric record was then mounted on an
procedure for this discussion. A brief outline is
articulator (mean value) similar like a clinical
given in table 1. Denture trial is a clinical
remount procedure. All the maxillary and mandibu-
procedure wherein the dentist needs to verify all
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aspects of the denture tooth set up i:e the Complete denture prosthesis is made up of heat cure
appearance, phonetics, occlusal relationships and denture acrylic resin and has been traditionally
patient comfort. Most authors recommend two trial repaired with different materials like self-cure and
appointments (anterior/posterior or initial/final) and heat cure denture base resins, light polymerized
one should practice the same. 1,3 resin (VLP) and microwave resins (MW).4-7
Among various complete denture failures, the Although auto cure acrylic resin is a commonly
failure in this case was iatrogenic and could have used repair material but in this case the repair was
been easily avoided with little patience and care. done using heat cure acrylic for better durability,
Most of the dental students, are supposed to arrange avoid mismatching and high strength.8 However, to
the teeth themselves under supervision at all times. minimize distortion due to reheating, a long curing
Doing laboratory work either at residence or by cycle of polymerization was used. In this case,
dental technicians snatches the learning opportunity. because the vertical dimensions and the centric were
Such academic practice is not advisable during correct the decision to replace anterior teeth was
learning, because while doing laboratory work, taken. In case, the vertical and centric would have
there is need of correction all the time. While not been correct then there are two options, either
arranging anterior teeth, if a single tooth is arranged remake the denture or use the present denture as a
outside the confines of the occlusal rims, then as special tray or a trial denture base.
arrangement progresses the error gets magnified. In
this case, this was the main reason of arranging Conclusion
proclined and flared teeth. Every clinical and laboratory procedure in
Table 1: An outline of complete denture try in fabrication of the complete denture prosthesis has
procedure its own significance and any error in one step leads
1) Preparation for denture trial
Verify teeth arrangement first on the articulator to failure of the entire prosthesis. Fortunately, in
Place an arrangement of teeth near the patient and observe Prosthodontics there are methods compensating
his reaction
Stimulate salivary secretion by placing mandibular denture, one’s errors, but in such cases the property of the
first, then place maxillary final prosthesis gets compromised.
2) General verification
Altered flange thickness due to wax up affects fullness
Rocking of trial denture Acknowledgements
3) The lower denture by itself
Peripheral outline – buccal, labial, lingual, posterior The efforts of the patient during fabrication of her
extension, over and under extension prosthesis that ultimately failed and her resolve to
Stability to occlusal stresses
Tongue space get it corrected is highly acknowledged.
Occlusal plane height
4) Upper denture by itself
Peripheral outline – buccal and labial, posterior palatal seal References
area 1. George A. Zarb. Prosthodontic treatment for
Stability to occlusal stress
Retention edentulous patients: complete dentures and
5) Both dentures together implant supported prosthesis, 12th Ed.
(a) Position of occlusion
(i) Horizontal relationship (canine and molar relation) Mosby. 366-68
(ii) Vertical dimension (occlusal face height/freeway space) 2. Sheldon Winkler. Essential of Complete
(b) Evenness of occlusal contact
6) Appearance Denture Prosthodontics. pp 38,63,90
(i) Centre line (midline of face and dental midline) 3. Heartwell C, Rahn AO. Syllabus of
(ii) Anterior plane (incisal plane)
(iii) Profile and lip form Complete Dentures. 4th ed.; Lea & Febiger:
(iv) Amount of tooth visible (low and high lip lines)
(vii) Phonetics (labial, labiodental and Linguodental,
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linguopalatal) 4. Faot F, Da Silva WJ, Da Rosa RS, Del Bel
(vii) Freeway space
7) Approval by the patient
Cury AA, Garcia RC (2009) Strength of
8) Approval (limited aspects) by close associate of patient denture base resins repaired with auto-and

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visible light-polymerized materials. J
Prosthodont 18(6): 496-502
5. Ng ET, Tan LH, Chew BS, Thean HP
(2004) Shear bond strength of
microwaveable acrylic resin for denture
repair. J Oral Rehabil 31 (8): 798-802.
6. Gad MM, Rahoma A, Al-Thobity AM,
ArRejaie AS (2016) Influence of
incorporation of ZrO nanoparticles on the
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(2004) Efficacy of conventional and
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J Oral Rehabil 31(11): 1130-1138.
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dentures:Rudd and Morrow, Mosby . pp
345,378

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