International J.

of Healthcare and Biomedical Research, Volume: 2, Issue:2, January 2014 , Pages 123-131

Review article:

Unconventional complete dentures: Innovative approach in

prosthodontics
1Dr. Rupal J Shah ,2 Pravin Parmar

1 Professor and Head of Department, Department of Prosthetic Dentistry, Government Dental College & Hospital,
Ahmedabad, Gujarat, India
2 Postgraduate student, Department of Prosthetic Dentistry, Government Dental College & Hospital, Ahmedabad, Gujarat,
India
Corresponding author: Email id: shahrupal1365@gmail.com

Abstract:
Routine complications faced by the dentist include atrophic ridge, microstomia, flabby tissue, xerostomia , bony exostosis,
labially inclined premaxilla, esthetic demand, bruxism, systemic disorders, patient’s demand for duplicating dentures,etc.
Management of these difficulties can be done by proper incorporating of suitable materials and advanced techniques. This
article describes the unconventional approaches to various modalities so as to provide ultimate satisfaction for the patient.
Keywords: complete dentures

Introduction stomia, bony exostosis, labially inclined premaxilla,

Transforming conventional into unconventional ap- esthetic demand, bruxism, systemic disorders,
proach is a characteristic feature of evergrowing patient’s demand for duplicating dentures,etc.
prosthodontic branch. The increasing demand of Management of these difficulties can be done by
patients and revolutionary thought of prosthodontists proper incorporating of suitable materials and
have led to the outcome of the special, i.e the advanced techniques.
unconventional approach for fabricating complete The conventional approach may not fulfill the five
dentures. Complete dentures made in conventional basic principles of complete denture like rete-
manner proves satisfactory in most of the patients, ntion,stability,support ,esthetics and preservation of
but in compromised patients conventional method supporting structures which are of utmost importance
brings with it certain disadvantages. So starring new for the complete satisfaction of the patient. Hence,it
techniques based on same old fundamentals of is never too late to introduce the unconventional
prosthodontia is known as the unconventional route. This article has described a simple, effective
complete dentures, a manifestation of new vision in and noninvasive treatment alternative to the classical
prosthesis construction. conventional technique in a completely edentulous
Routine complications faced by the dentist include patient.
atrophic ridge, microstomia, flabby tissue, xero-

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Following table describes routine complication and proposed technique

Routine complication Proposed technique

Flabby tissue Pressure less technique1
Liquid supported complete denture2
Microstomia Sectional impression3
Xerostomia Split denture technique4
Bruxism, repeated denture fractures. Metal reinforced denture base5

Labially inclined premaxilla Modified flange technique6

Large maxillofacial defect or atrophic ridge Hollow denture7
Esthetic demand Characterization8
Social or professional consideration Immediate denture9
Slumped or hollow cheeks Customized attachments retained cheek plumper prosthesis10

Tuberosity undercut,Consistent denture fracture Flexible denture11

Patients demand for replicating denture Dolly (duplicate) denture12
Lack of retention Denture with mechanical retentive components13

Table 1: Routine complications and their proposed techniques

1. COMPLETE DENTURE FOR PATIENT worn & will tend to lift the denture when the teeth are
WITH FLABBY TISSUE : not in contact.13
One of the common difficulties challenging the Watson described the 'window' impression technique
dentist is the mobile fibrous tissue in maxillary ridge. where a custom tray is made with a window or
This is termed as “flabby” or “soft hyperplastic” opening over the (usually anterior) flabby tissues.
tissue. This can be explained as a sequeale to tooth (figure 1 & 2) A muco-compressive impr-ession is
loss i.e residual alveolar ridge resorbs and is replaced first made of the normal tissues using the custom
by mobile fibrous tissue. The problems associated tray with zinc-oxide and eugenol. A low viscosity
with the flabby ridge are compromised retention mix of 'plaster of Paris' is then painted onto the
/stability of the maxillary complete denture and lack flabby tissues through the window .14Kelly in 1972
of posterior interocclusal space.1 Fibrous tissues are coined the term “combination syndrome” and
easily displaced labially, buccally, or lingually & described changes caused by mandibular removable
they do not supply stability or support for dentures. partial denture opposing maxillary complete
15
They must not be displaced when impressions are denture.
made since they will be painful when the dentures are

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Management of flabby tissue: 3. LIQUID SUPPORTED DENTURE

Technique employed should be such that it displaces
fibrous tissue as least as possible during impression.
Primary impression should be recorded by a
mucostatic impression technique. Secondary
impression should be “selective pressure” providing
relief to the flabby tissue.1
2. SECTIONAL COMPLETE DENTURE FOR
MICROSTOMIA
Figure 3: sectional impression technique
Oral submucous fibrosis, an insidious chronic
disease and a precancerous condition, affecting any Conventional complete denture lacks retention and
part of the oral cavity and sometimes the pharynx stability in patients with fibrous hyperplastic tissue.
is caused by prolonged use of tobacco, arecanut, Several techniques have been employed for mana-
spices ,etc. The fibrosis involves the lamina ging such cases. One of those techniques is to
propria and the submucosa and may often extend provide flexible tissue surface in complete
into the underlying musculature resulting in the denture.liquid supported denture,with its flexible
deposition of dense fibrous bands giving rise to tissue surface is the available option.2
the limited mouth opening which is a hallmark of
this disorder.3
Microstomia is defined as an abnormally small oral
opening, caused by scleroderma, oral submucous
fibrosis, sequeale of burns, surgical resection of facial
and oral neoplasms and temporomandibular joint
disorders. Since they have a limited mouth
opening , conventional method is difficult and (figure 4) Liquid supported denture is based on the
challenging. Hence it is necessary to modify theory that when the force applied on the denture is
3
technique. For facilitating easy insertion and absent, the base assumes its preshaped form that is
removal of the impression tray, sectional impression the one during processing.2 The principle of this
technique is advised i.e tray should be cut into two design was that a liquid-supported denture is flexible
section.3(figure 3) Final impressions were made with and continuously adapts itself to the mucosa.
non-Eugenol impression material as Eugenol However, it is also rigid enough to support the teeth
would cause burning sensation to the patient. during actual use. Thus, the denture base is covered
with a close-fitting flexible foil to keep a thin film of
liquid in its place.2 (table 2)

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Polythene sheet biocompatibility, no dimensional changes in time

through fluids absorption and no interferences with
Liquid(glycerine)
phonation.The fracture of acrylic resin denture is an
Denture base unresolved problem in removable prosthodontics17.
Denture teeth Midline fracture of an acrylic denture base results
from flexural fatigue failure, acrylic deformation of
Table 2) Layers in liquid supported denture the base during function, sharp changes in
The foil remains in the resting position in the absence contour,pin holes and residual processing stresses
of forces acting as a soft liner and when the dentures Various approaches such as use of metal bases, wires,
are in use,masticatory loads are distributed in all bars, & high impact acrylic resin reduces the
directions by the liquid resulting in even stress incidence of midline fracture13.
distribution. This helps in long-term preservation of
bone and soft tissues.Apart from the combined
benefits of tissue conditioners and soft liners, load
from biting forces and even bruxism, will be
distributed over a larger surface (Chase, 1961).
Advantages of liquid supported denture include
good base adaptation to the modified form of mucosa
due to hydrodynamics of the liquid improving Figure 5(a): cameo surface of
support, retention and stability, optimal stress metal based denture
distribution of masticatory forces over a larger area
which reduces tissue overloading ,prevention of
soreness and increased comfort level and patient
acceptance.
4. METAL BASE DENTURE
Routine Poly methyl methacrylate (PMMA) denture
bases have good mechanical, biological and aesthetic
properties. But, they may fail because of excessive
para functional and/or functional forces (in cases of Figure 5(b): intaglio surface

bruxism and/or complete dentures opposing natural

mandibular teeth). Metal based denture can be used INDICATIONS include deep palatal vault, prominent
to strengthen the denture bases17. (figure 5.a, b). residual ridges, when additional strength is needed
These thin metallic bases have several advantages, because stresses are concentrated over small parts of
besides rigidity and fracture resistance, like: excellent denture, shallow flat palates and mentally
strength to volume ratio, good adaptation to the compromised patients who may drop their
12
supporting tissues, enhanced control of denture denture .Materials used for metal denture base are
plaque, high thermal conductivity, high Cr-Co –(most retentive), Al, Ni – Cr, Titanium,
Gold.13

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5. HOLLOW DENTURE changes in the patient’s appearance that can occur

when natural teeth are removed.9 Post extraction
complications are reduced with these dentures as they
have therapeutic and prophylactic effect. It prevents
bleeding, protects the wound against trauma, prevents
the entrance of food and liquid into the wound,
protects blood clots and accelerates healing and
enables a more correct formation of the residual
ridge.13

Figure 6: hollow maxillary complete denture Disadvantages may be listed as increased visits for
patient,traumatic procedure,complex clinical and
For the patients with poor resorbed residual ridge or laboratory procedures and variation in bone and soft
large maxillofacial defect,the conventional denture tissue change lead to compromised retention,rebasing
fabricated proves to be both bulkier and heavier and required and anterior try in not possible so esthetic
so compromises retention and stability of the compromised.13
prosthesis. Reduction in the residual ridge height 7.MODIFIED FLANGE COMPLETE DENTURE
leads to increased inter arch space which ultimately Complete denture fabrication proves to be
increase the amount of denture base material in the challenging when the ideal requirements of both hard
denture making it less retentive.With the aim to and soft tissues are not fulfilled.Surgical procedures
reduce the weight, care should be taken to exclude i.e preprosthetic treatment need to be implemented
the denture base from the planned hollow cavity of with a view to fulfill patient satisfaction after
the prosthesis.(figure 6).Materials utilized for this complete denture fabrication. One of the conditions
purpose included a solid three dimensional spacer affecting the denture insertion and esthetics is labially
including dental stone (Ackermen, 1955), cellophane, inclined premaxilla and associated undercut.6(figure
wrapped asbestos (Worley & Kniejski, 1983), 7)
silicone putty (Holt, 1981) or modelling clay Esthetic principle was compromised with the
17
(DaBreo, 1990) during laboratory processing. . A complete denture fabricated by conventional
maxillary hollow denture can offer solution for this approach because of the excessive fullness by thick
situation as hollow dentures will be of lesser weight labial flange. Preprosthetic surgery might reduce the
compared to that of normal dentures. foundation for denture support. To cope up with this
6. IMMEDIATE DENTURE difficulties,modification is required in complete
Immediate denture is defined as a removable dental denture fabrication i.e it is a non surgical procedure
prosthesis fabricated for placement immediately to give modified labial flange so as to improve
9
following the removal of natural tooth or teeth. esthetics.6 (figure 8)
Advantages of Immediate denture includes avoiding
the embarrassment of appearing in the public without
teeth. Also, immediate dentures can minimize

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9. CHEEK PLUMPER PROSTHESIS

Figure 7:labially inclined premaxilla

and associated undercut

Figure 10: cheek plumper prosthesis

Esthetic factor not only confined to teeth but also to

be considered for facial appearance.Facial esthetic
Figure 8: modified labial flange
complete denture may be compromised due to lack of support from the
internal structures,i.e teeth, ridge, denture,etc.This
8. CHARACTERIZATION IN COMPLETE results in slumped or hollow cheek proving
10
DENTURE detrimental to facial esthetics. Cheek plumper help
Complete denture may not resemble the previous to enhance facial appearance by supporting the
anatomic morphology of teeth or oral mucosa. Many slumped cheeks. It is attached to complete denture by
patients demand more natural like appearance of customized attachments or magnets. A Conventional
complete denture such as spacing between inci-sor, cheek plumper would be a part of the complete
fractured incisal edge,stained teeth,proclined pro- maxillary denture prosthesis forming single unit
file,etc. So special considerations should be empl- prosthesis with extensions on either side in the region
oyed in modification of denture base and teeth. This of the polished buccal surfaces of the denture and are
modifications are called “characterization”. Complete continuous with the rest of the denture.12
denture can be characterized by two basic methods. Indications of such prosthesis are to provide a
1.Characterization by selection, arrangement and youthful appearance in patients with hollow cheeks
modification of artificial teeth. and to restore esthetics in patient with Maxillofacial
8
2. Characterization by tinting the denture bases. defect,12
Drawbacks associated with cheek plumper prosthesis
include excessive weight added to the upper denture
thus compromising retention, interference with
masseter muscle and the coronoid process of the
mandible and so difficulty in chewing, difficulty in
insertion and removal.12

Figure 9: characterized complete denture

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10. FLEXIBLE DENTURE Absolute bioadaptability is because the material is

free of harmful chemicals [monomer] and metal,
these being the principle causes of allergic reactions
in conventional denture materials.
Temporary dentures are recommended by dentists
during therapeutic episodes. After surgical
reconstruction of the upper jaw, there is a need to
accommodate the patient during the period between
surgery and the fabrication of a final dental appliance.
Figure 11: flexible complete denture
For this purpose, a flexible denture offers a great
Undercut is considered to be an aid for retention but solution that allows the patient to recommence da.ily
that’s only in case of unilateral one. Severe unilateral activities. Midline fracture of complete dentures has
or bilateral undercuts are frequently encountered and been reported to be the second most common type of
instead of enhancing retention interfere with the path fracture in denture prosthesis. Flexible denture
of insertion and removal of complete denture. material has been reported to have therapeutic
Conventional management techniques include advantage in overcoming midline denture fractures.
modification in denture bearing area,denture base Flexible dentures form an excellent alternative to
adaptation and relining . traditional hard fitting denture.
Flexible denture base material is nylon-based Material being soft and strong can be made thinner
thermoplastic resin. They have shown several and are light in weight compared to conventional
advantages over the traditional rigid acrylic denture dentures that promotes better adaptation of the tongue
bases. The translucency of the material picks up and cheek to the denture base. These dentures absorb
underlying tissue tones, making it almost impossible small amounts of water to make the denture more soft
20
to detect in the mouth. Some of the commercially tissue compatible. Due to their ability of excellent
available products are Valplast, Duraflex, Flexite, mouldability, light weight to density ratio and high
Proflex, Lucitone, Impak where as valplast and thermal strength, flexible dentures have been proven
lucitone are monomer free. Flexible denture material as an excellent treatment option for complete and
is so strong that it can be made very thin, which partial edentulism. However,careful case selection
makes it comfortable to wear and esthetically and clinical judgment is required to use flexible
pleasing. (figure 11). As the flexible dentures are dentures in appropriate situations in order to obtain a
fabricated using advanced and improved technique, successful treatment outcome.
they exhibit better accuracy compared to 11. DOLLY (DUPLICATE) DENTURE
conventional techniques. Being flexible , the denture Many complete denture patients ask the dentist to
adapts well in the undesired bony areas. The amount provide them with two sets of dentures instead of
of adjustment required at time of denture insertion is one. They cannot face the embarrassment of
greatly reduced. Also, this reduces post-insertion being without a denture, even for a short period
complaints of denture-induced trauma [ulceration]. of time, in case of denture fracture or in case of

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any technical procedure.esthetics of previous The various mechanical factors which aid in retention
denture can be duplicated by this technique restoring are retentive springs, magnetic forces , suction cham-
12
the previous appearance of the patient. bers and suction discs ,etc22.In the past Suction
12. DENTURE WITH MECHANICAL chambers in the maxillary dentures were used to aid
RETENTIVE COMPONENTS in retention. The suction chamber creates a negative
pressure ,which aids in retention. They are avoided
now due to their potency of creating palatal
hyperplasia.(figure 12) Intramucosal magnets aid in
increasing retention of highly resorbed ridges. (figure
13).
Conclusion
Correct treatment starts with correct
diagnosis and correct treatment planning. Correct
diagnosis and appropriate treatment plan must be
implemented so as to achieve utmost patient
satisfaction.This article gives us precise knowledge
of appropriate use of both materials and techniques
with a view to accomplish the various prosthetic
needs of patient.

Figure 12: Site for suction disc Figure 13: Magnets in lower denture
on palatal surface of maxillary for retention
complete denture

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Date of submission: 29 October 2013 Date of Provisional acceptance: 12 November 2013

Date of Final acceptance: 24 December 2013 Date of Publication: 05 January 2014
Source of support: Nil; Conflict of Interest: Nil

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