Case Report

The removable occlusal overlay splint in the management

of tooth wear
Bilquis J. Ghadiali, S. A. Gangadhar, Kamal Shigli
Department of Prosthodontics, K.L.E.S’s Institute of Dental Sciences, Belgaum, Karnataka, India

For correspondence
Dr. Bilquis J. Ghadiali, GN-7, 3rd Floor, Akkamahadevi International Girls Hostel, J.N.M.C Campus, Nehru Nagar, Belgaum - 590 010,
Karnataka, India. E-mail: bilquis82@hotmail.com

The reconstruction of an extremely worn dentition is difÞcult and represents a challenge due to the minimal tooth structure
that remains. These patients often exhibit the loss of the vertical dimension of occlusion and esthetic problems. Moreover,
the problems associated with the maxillary complete denture opposing the natural teeth have to be taken into consideration.
Occlusal problems and fracture of the denture bases account for most of these structural difÞculties. These may result
from the occlusal stresses on the denture and underlying tissues from the opposing teeth and musculature, the position of
mandibular teeth and ßexure of the denture bases. The current article describes the prosthodontic rehabilitation of a patient
who reported with a completely edentulous maxillary arch and mandibular teeth with an uneven occlusal plane. Following
a thorough examination, a glass-Þber-reinforced maxillary complete denture and a mandibular removable overlay occlusal
splint was planned.
Key words: Maxillary single complete denture, occlusal overlay splint, tooth wear

INTRODUCTION underlying edentulous tissues from the teeth and

musculature accustomed to the opposing natural
The extremely worn dentition is a difficult condition dentition,
to treat due to the limited tooth structure that remains. 2. the position of the mandibular teeth, which may
These patients often exhibit the loss of the vertical not be properly aligned for the achievement of
dimension of occlusion and esthetic problems. When bilateral balance for stability,
ideally treated, the remaining teeth may require crown 3. the change in the occlusal plane due to extrusion,
lengthening, endodontic therapy, post cores and full rotation and migration and
crown coverage. Financial constraints or other priorities 4. the flexure of the denture bases.[4]
often restrict one from choosing the most desirable
treatment.[1] CASE REPORT
The overlay removable partial denture is a prosthesis
that covers and is partially supported by natural A 52-year-old male patient reported to the Department
teeth, tooth roots or dental implants; further it is an of Prosthodontics, K.L.E.S’s Institute of Dental Sciences,
effective method for treating a patient with a severely Belgaum, for prosthodontic rehabilitation.
worn dentition.[2] The chief complaint of the patient was the inability
Another challenge faced is to provide comfort, to chew food and improper speech. His main concern
function, proper esthetics and retention for the was to improve these functions.
maxillary complete denture of the patient with the No significant systemic findings were elucidated.
natural opposing dentition. Sharry summarized the Clinical examination revealed an edentulous maxillary
problem when he stated that, “Single dentures represent ridge and a full complement of mandibular teeth.
a vigorous challenge to the practicing dentist. In no The mandibular teeth showed excessive occlusive
other complete denture treatment are there so many wear, questionable pulpal involvement and cervical
factors that tend to negate the forces of retention and erosions and/or abrasion. Further, the mandibular
stability.”[3] posterior teeth demonstrated an uneven occlusal
Occlusal problems and fracture of the denture bases plane [Figure 1].
account for most of these structural difficulties and Radiographic evaluation displayed no periapical
these may result from one or all of the following: involvement and no caries was evident.
1. occlusal stresses on the maxillary denture and the Periodontal examination revealed tissues to be healthy

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around the remaining natural teeth except for the right to the desired level of modification. This created
mandibular first molar that showed gingival recession openings on the occlusal and incisal surfaces of
and the loss of attached gingiva. Pocket depths were the template to indicate the position of the tooth
within the normal limits and no incidence of mobility structure before they were modified. The margins of
was observed. the openings indicated the extent of tooth reduction,
i.e, when the template was seated in the mouth,
Prosthodontic evaluation the natural teeth would protrude through these
The maxillary ridge was adequate to retain a complete openings [Figure 2].
denture and also the bone quality was found to be This template was then placed in the mouth and
good. The maxillary tuberosities displayed adequate the mandibular teeth were reduced till the margins
space for the denture base and did not necessitate of the openings on the template.
any preprosthetic surgery. No loss was observed in 4. After the planned amount of odontoplasty was
the vertical dimension of occlusion; this would have performed, sharp margins were rounded and
otherwise necessitated splint therapy to increase the polished and final impressions were made. Maxillary
vertical dimension. arch with zinc oxide eugenol (DPI Impression paste;
Evaluation of temporomandibular joint: This Bombay Burma trading Corp, Ltd., Mumbai, India)
demonstrated no evidences of clicking, joint pain, and mandibular arch with irreversible hydrocolloid
limitation on the range of motion or tenderness of impression material (Alginoplast; Heraeus Kulzer,
the muscles of mastication. South Bend, India).Wax occlusal rims were then
After complete evaluation, the treatment planned fabricated on the master cast.
was a maxillary complete denture and a mandibular 5. The vertical dimension was determined. Then the
removable occlusal overlay splint with the elimination maxillary and mandibular casts were mounted on a
of periodontal surgery and root canal therapy. An semiadjustable articulator (Hanau series H2; Water
informed consent was obtained from the patient. Pik, Fort Collins, USA), by using a face-bow record
This option met the stated objectives with regard and a centric relation record was established.
to the patient; it was financially affordable, required 6. Then, the maxillary teeth arrangement was first
less chair side time and provided the patient the carried out based on a normal compensating curve
opportunity to later select other options when he was and not according to the uneven occlusal plane.
more financially and emotionally ready. 7. Subsequently, the wax-up of mandibular anterior
teeth was carried out. The incisal guidance was
Procedure adjusted accordingly and the protrusive contacts
1. The maxilary primary impression was made using were established.
impression compound (Pyrex; Pyrex Polykem, 8. The mandibular posterior teeth were then waxed-
Roorkee, India) and the mandibular impression was up in occlusion with the maxillary posterior teeth
made using an irreversible hydrocolloid (Alginoplast; [Figure 3]. This arrangement ensured a uniform
Heraeus Kulzer, South Bend, India) and diagnostic and harmonious occlusal plane. Balancing contacts
casts (Type III Dental stone; Goldstone, Asian were achieved bilaterally [Figure 4].
Chemicals, Gujarat, India) were fabricated. 9. For wax try-in purpose, a putty index (Aquasil;
2. Bite was recorded for diagnostic mounting. Soft putty, Dentsply, Germany) was made of the
3. The mandibular teeth displayed uneven and sharp mandibular diagnostic wax-up. A duplicate cast
cusps, few of which were traumatizing the tongue. with block out was fabricated. Self-cure clear acrylic
Thus, tooth alteration was planned for these sharp resin (DPI RR Cold cure; Bombay Burma Trading
cusps on the diagnostic casts. Corp, Ltd., Mumbai, India) was then placed in
A preparation guide was created that allowed the this index and placed over the cast.The temporary
planned amount of odontoplasty to be transferred removable occlusal overlay splint was obtained,
accurately and conveniently from the cast to which was used for try-in.
the mouth.[5] A uniform, clear, self-cure acrylic 10. After the try-in stage, the maxillary and mandibular
template was fabricated over the occlusal surface casts with wax-up were flasked.
of the mandibular teeth on the cast. The cusps 11. The midpalatal region and the region palatal to the
to be modified were marked on the cast with a incisors in the maxillary denture were reinforced
contrasting colored pencil. with E-glass fibers (Fiberglass Corporation, USA),
This clear acrylic template was then placed over using the split cast technique and the denture was
the unmodified cast. The colored contrasting marks packed with fiber-reinforced heat-cured acrylic resin
can be observed through the template. An acrylic (Lucitone 199; Dentsply, York Division).
trimming bur was then used to simultaneously trim 12. The mandibular splint was packed with heat-cured
both the template as well as the sharp cusps up clear acrylic resin (DPI Heat cure; Bombay Burma

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Figure 1: Preoperative view showing excessive occlusal wear and an

uneven occlusal plane of the mandibular teeth Figure 4: Final wax-up in occlusion with maxillary teeth

Figure 5: Finished dentures

Figure 2: Preparation guide placed in the mouth

Figure 6: Postoperative view with the splint in place

laboratory remount.
14. The dentures were then finished, polished [Figure
Figure 3: Mandibular teeth wax-up 5] and inserted in the mouth with minor occlusal
adjustments with the help of a clinical remount
[Figure 6].
Trading Corp, Ltd., Mumbai, India). 15. Oral hygiene and care instructions were
13. After processing, the dentures were retrieved administered.
and necessary corrections were made during the 16. Post insertion adjustments were minor, which

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were completed. incidence of the midline fracture of denture bases:

1. Recontouring/crowning the natural teeth to obtain
Follow up: On a recall visit, the patient expressed an occlusal plane favorable to maxillary denture
his satisfaction with the prosthesis. with a balanced occlusal scheme.
2. In patients with high frenal attachments, frenectomy
DISCUSSION is recommended as high attachment results in a
weak point and/or potential fracture line.
The reconstruction of a severely worn dentition is 3. A bilateral balance occlusal scheme is ideal for
a very complex and difficult problem, which poses a maxillary denture stability.
real challenge to the dentist. The best treatment for 4. A shallow incisal guidance, which is esthetically
any wear depends on its early recognition, but this is and phonetically acceptable, should be obtained.
an ideal condition that is difficult to achieve.[6] 5. An ideal posterior occlusal form should be
It is important to perform a comprehensive examination buccolingually narrow with the shallow cusp
to determine the cause of the problem, evaluate the height.
diagnostic data that includes a temporomandibular 6. Maximum physiologic extension of the denture
screening and determine the vertical dimension of base for increased tissue coverage through proper
occlusion so that the patient can be categorized into border molding and impression technique is
one of the following categories: recommended.[8]
1. Excessive wear with loss of VDO. 7. Use of high-strength polymers, i.e., impact resistant
2. Excessive wear without loss of VDO. materials, reduces the tendency to fracture.
3. Excessive wear without loss of VDO, but with 8. Also fiber reinforcement of the palate that is
limited space.[7] particularly palatal to the incisors in the anterior
Different treatment options should be presented to part of the palate, as performed in this case with
the patient with the time commitments, costs and the E-glass fibers, decreases the tendency to fracture.
advantages and disadvantages of each option. 9. Maintaining the denture base thickness at a
Various treatment options include: minimum of 2 mm and the use of metal bases
1. Bite guard to determine desired VDO. provides rigidity.[9]
2. Free gingival grafts and periodontal surgery in 10. Cast gold occlusal surfaces will not wear excessively
cases of recession and lack of attached gingiva. and minimize abrasion.[10]
3. Endodontic treatment of all the teeth with 11. Finally, a good processing technique reduces or
questionable pulpal involvement or insufficient eliminates residual stresses within the denture.
crown length.
4. Cast post and core on endodontically treated SUMMARY
teeth.
5. Porcelain fused to metal crowns on all the teeth Situations in which there is excessive wearing of teeth
restoring them to a height in harmony with the require a comprehensive examination and screening.
newly established VDO. Different treatment options should be presented to the
6. Maxillary complete denture with porcelain teeth patient with the time commitments, costs along with
or hardened acrylic resin teeth.[1] the corresponding advantages and disadvantages. In
Another factor to be considered, are the problems an occlusal wear situation for a patient with limited
associated with the maxillary complete denture opposing finances, the use of a removable occlusal overlay splint
the natural teeth. One of the most common prosthodontic with a single maxillary complete denture reinforced
failures encountered is the fracture at the midline and with glass fibers was suggested as an alternative
the failure of a single maxillary denture. treatment.
Maxillary denture midline fracture has been related to
the deformation of the denture base while functioning, REFERENCES
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Source of Support: Nil, Conflict of Interest: None declared.
8. Farmer JB. Preventive prosthodontics: Maxillary denture

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