Dr.Bhavna Maheshwari1, Dr.Sonal Pamecha2, Dr.Maulik Barmeda1
Post-graduate Student,2 Professor,
Department of Prosthodontics, Crown & Bridge.,
Pacific dental College and hospital, Udaipur,India
Keywords :
Residual ridge resorption poses an ordeal for prosthetic rehabilitation using complete dentures due to decreased support, stability, and retention. Severe resorption also increases the interarch space between maxillary and mandibular atrophic ridges. Rehabilitation in such cases results in increased height and weight of the complete denture prosthesis further compromising its retention and stability. The unstable dentures overload the underlying hard and soft tissues exacerbating ridge resorption. So, to break this vicious cycle, the weight of the prosthesis needs to be reduced. Different techniques have been used and discussed for the fabrication of lightweight prosthesis in literature. This clinical report presents an innovative technique of fabricating a hollow maxillary complete denture in a patient with severely resorbed maxillary and mandibular ridges with increased interridge distance, using glycerine Soap.
Keywords :
Atrophic ridge, Increased inter-ridge distance, Lightweight prosthesis, Residual ridge resorption, Hollow denture, Innovative technique
CITATIONS :
Maheshwari.B, Pamesha.S, Barmeda.M. Fabrication of Hollow Denture using glycerine soap: Advantages, Precautions and Limitations-A Case Report. J Prosthodont Dent Mater 2022:3(2);67-74.
INTRODUCTION :
Successful rehabilitation of edentulous patients with complete denture prosthesis bank on the principles of retention, stability, and support. Effectuating these principles in severely resorbed ridges foist challenges to the clinicians
due to decreased supporting area. As Resorption progresses it results in increased inter-ridge distance. Rehabilitation using conventional complete dentures in such cases often results in a heavy prosthesis; this further compromises the
retention and stability of the prosthesis.1 Reducing the weight of a prosthesis during fabrication aids in improved retention and a better prognosis.2 Historically, weight reduction approaches have been achieved
using dental stone, cellophane-wrapped asbestos, silicone putty, modeling clay, or salt during laboratory processing to exclude denture base material from the planned hollow cavity of the prosthesis.2,3 Salt failed to sustain
pressures produced during flask closure resulting inadequate hollow cavity inside the prosthesis. The other techniques demand tedious retrieval of the three-dimensional spacer especially from the anterior region of the prosthesis between
the canines due to the curvature of the arch.4
This case report describes an innovative and simplified technique for the fabrication of a hollow maxillary complete denture for rehabilitating a patient with severely resorbed ridges and increased inter-ridge distance using glycerine
soap.
CASE REPORT:
A 55-year-old reported with an exophytic gingival growth around a bulky, over-contoured, faulty fixed prosthesis in anterior mandible. Upon biopsy, the lesion was diagnosed as well-differentiated squamous cell carcinoma. The patient underwent a peroral Central Segment Marginal Mandibulectomy with left elective neck dissection (levels I-IV) under general anesthesia. The remaining mandibular height was 26 mm which allowed primary placement of four dental implants (Straumann SP, SLactive, 4.1 X 8mm) in the interforaminal region of the native mandible, each achieving an acceptable torque of 30-35 Ncm. Post- implant surgery, a free-radial artery forearm flap (FRAFF) was placed in order to achieve a soft - tissue coverage. (Figure 1)
A 55-year male patient presented to the Department of Prosthodontics, with the chief complaint of missing teeth. He reported the loss of teeth due to mobility and is edentulous for eight years. He also presented old worn-off and
ill-fitting dentures. The patient gave no relevant medical history. Intra-oral examination revealed a completely edentulous maxillary and mandibular ridge with Atwood’s order V and Atwood’s order VI respectively.
Treatment options were planned and discussed with patients which included:.
1) Implant-supported Fixed prosthesis.
2) Implant-supported Overdenture.
3) Pre-prosthetic surgery i.e. vestibuloplasty followed by conventional complete denture.
4) Conventional complete dentures using the neutral zone technique..
The patient opted for the option of conventional complete denture prosthesis due to the cost and the surgical procedure involved in pre-prosthetic surgery and an implant- supported prosthesis.
Steps:
1. Phase I: 1st Clinical Appointment
Case History Recording and Primary Impression
A thorough case history was recorded and the primary impression was made using Impression Compound for the maxillary arch and Admixed compound for the mandibular arch.
2. Phase II: 1st Laboratory Procedure:
Impression was poured in dental plaster and the custom trays were fabricated using a Modified Boucher spacer design for the maxillary arch and without a spacer for the mandibular arch.
4. Phase IV: 2nd Laboratory Procedure:
Impression was Poured in Type IV Dental stone and the denture base and rims were fabricated. Two denture bases were fabricated for mandibular denture and in one of the denture bases, stapler pins were attached for retention of the admixed
compound while recording the neutral zone impression and rims on another for jaw relation.
5. Phase V: 3rd Clinical Appointment
Maxillo-mandibular relation was recorded and mounted on a mean value articulator. The admixed compound was attached to the denture base with stapler pins and was adjusted at the recorded vertical dimension. The patient was then asked to
make the movements to record the neutral zone.
6. Phase VI: 3rd Laboratory Procedure:
Teeth arrangement was done for the maxillary and mandibular arch. In the mandibular arch, the teeth were arranged in the recorded neutral zone area.
7. Phase VII: 4th Clinical Appointment
Try in
During the try-in, esthetics and phonetics were evaluated. Due to the increase in interarch space, the trial dentures demanded an increase in the height of the rims that in turn would increase the weight of the final prosthesis. To reduce
the weight of the prosthesis, it was decided to rehabilitate the patient with hollow dentures.
8. Phase VIII: 4th Laboratory Procedure
Steps in Fabricating hollow denture
xiv. The mandibular denture was processed using a conventional technique, finished, and polished.
Phase IX:5th Clinical Appointment
Denture Insertion
Denture insertion was done. Centric and vertical jaw relations were re-evaluated Aesthetics and phonetics were assessed. Patient satisfaction was obtained and post-insertion instructions were given.
Phase X: 6th Clinical Appointment
Follow up
The patient was recalled for follow-up after 1 week; No adjustments were needed and the patient was satisfied. The patient gave no history of unsatisfactory smell or any allergic reaction due to the use of glycerine soap.
DISCUSSION
Fabrication of hollow dentures using glycerine soap is a simple and innovative technology that gives the best results if accurate measurements and precautions are taken.
PRECAUTIONS;
1. Measuring the putty spacer accurately leaving 2 mm of space from all the sides for acrylic resin
2. Letting the soap set completely before packing: If packing is done before glycerine soap is completely set it will get displaced with the pressure and may lead to a solid denture or exposure of palatal surface due to inadequate space
available for resin
3. Ensuring by trial packing
LIMITATIONS:
1. Time-consuming
2. Technique sensitive: If the measurements for the glycerine soap spacer are inaccurate it will result in inadequate space for acrylic resin.
ADVANTAGES:
1. Better results
2. Reduces the weight of the prosthesis which in turn enhances retention.
3. The main advantage of using a glycerine soap spacer is its ability to sustain high curing temperatures (boiling point of glycerine 290°C) and also it doesn’t interfere with the polymerization of heat cure acrylic resin leaving no
residues inside the hollow cavity.
4 The soap spacer is eventually removed leaving behind a clean hollow cavity, any concern regarding its biocompatibility in the oral cavity is dismissed.[4] In prosthodontics everything is reversible. So, even if such errors occur they could
be corrected by following methods:
i. The putty spacer can be re-fabricated using the denture as a guide leaving 2 mm of space from the palatal aspect. Then, obtain the glycerine soap spacer from the putty spacer as before. Adaptation of modeling wax on the cast and
dewaxing by keeping the retrieved denture in the flask. After dewaxing the layer of acrylic to be adapted over the palatal aspect and re-packing to be done.
ii. Relining of the denture.
iii. Refabrication of hollow dentures using other techniques like the lost salt technique, putty spacer technique, or thermocol denture technique.
CONCLUSION
Fabrication of hollow dentures using glycerine soap is an easy but technique-sensitive method that ensures better results when all the steps are followed accurately.
REFERNECES:
1. Qanungo A, Aras MA, Chitre V, Mysore A, Da Costa GC. An Innovative and Simple Technique of Hollow Maxillary Complete Denture Fabrication. J Clin Diagn Res. 2016;10(8):ZD23-ZD25.
2. Radke U, Mundhe D. Hollow maxillary complete denture. J Indian Prosthodont Soc. 2011;11(4):246-249.
3. Kaira LS, Singh R, Jain M, Mishra R. Light weight hollow maxillary complete denture: A case series. J Orofac Sci 2012;4:143-7
4. Barman J, Rahman R, Bhattacherjee S. Fabrication of hollow maxillary complete denture: A simplified technique. Int J Oral Health Dent 2020;6(1):63-5