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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 9  |  Issue : 3  |  Page : 198-201

Prosthetic management of resorbed ridges through fabrication of hollow denture using three-dimensional glycerin spacer and neutral zone technique


Department of Prosthodontics, Post Graduate Institute of Dental Sciences, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India

Date of Submission09-Oct-2022
Date of Acceptance01-Nov-2022
Date of Web Publication31-Dec-2022

Correspondence Address:
Dr. Sujata Chahal
Department of Prosthodontics, Post Graduate Institute of Dental Sciences, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjoralsci.sjoralsci_46_22

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  Abstract 


Residual ridge resorption leads to diminished retention, support, and stability of the prosthesis due to decrease in the denture supporting areas, decreased denture space, and increased leverage due to increase inter-ridge distance. The prosthetic rehabilitation of the severely resorbed ridges needs modification for the fabrication of a stable prosthesis. This clinical report describes the prosthetic management of resorbed ridges using modified impression technique, neutral zone technique, external impressions, and fabrication of a hollow denture using three-dimensional glycerin spacer to enhance the retention and stability of the prosthesis.

Keywords: Atrophic ridges, complete denture, hollow denture, neutral zone, residual ridge resorption


How to cite this article:
Rathee M, Chahal S, Jain P, Divakar S, Singh S, Tomar SS. Prosthetic management of resorbed ridges through fabrication of hollow denture using three-dimensional glycerin spacer and neutral zone technique. Saudi J Oral Sci 2022;9:198-201

How to cite this URL:
Rathee M, Chahal S, Jain P, Divakar S, Singh S, Tomar SS. Prosthetic management of resorbed ridges through fabrication of hollow denture using three-dimensional glycerin spacer and neutral zone technique. Saudi J Oral Sci [serial online] 2022 [cited 2023 Feb 6];9:198-201. Available from: https://www.saudijos.org/text.asp?2022/9/3/198/366533




  Introduction Top


Residual ridge resorption is an inevitable multifactorial process occurring after extraction of the teeth. Severe ridge resorption leads to a decrease in the denture supporting area, leading to compromised retention and stability of the prosthesis. The increase in the inter-ridge distance following ridge resorption places the occlusal surfaces of the teeth further away from the denture supporting area, thereby increasing the leverage.[1] Reducing the weight of the prosthesis in such situations has proven to be a beneficial aid in the retention of the prosthesis.[2] Following the resorption, neutral zone area also gets reduced necessitating the need to respect the muscular balance for the stability of the denture. The contours of the denture should be recorded more aptly in harmony with the muscular forces. Further, the polished surfaces of the denture must be modified according to the muscular balance to aid in the retention and stability of the denture. This clinical report describes the rehabilitation of maxillary and mandibular resorbed ridges using neutral zone technique followed by fabrication of the hollow maxillary denture.


  Case Report Top


A 60-year-old female reported with the chief complaint of loose upper and lower denture. Intraoral examination revealed low, well-rounded (Atwood Order V) completely edentulous upper and lower arches [Figure 1]a and [Figure 1]b. Various treatment options including conventional complete denture, preprosthetic surgery, implant retained prosthesis, and modified complete denture were advised to the patient. The patient opted for the modified complete denture as she was not willing for any surgical procedures. A consent form regarding the treatment protocol was obtained from the patient.
Figure 1: (a) Low, well-rounded maxillary ridge, (b) highly resorbed mandibular ridge, (c) primary impressions of the maxillary and mandibular arches, (d) all green technique for mandibular ridge, (e) final impression of the mandibular arch, (f) final impression of the maxillary arch

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Primary impressions of the maxillary and mandibular arches [Figure 1]c were made using irreversible hydrocolloid impression material (Algitex, DPI, Uttarakhand). Primary casts were obtained and special trays were fabricated. Border molding of maxillary arch was done using green stick material (DPI PINNACLE, Tracing Sticks, Mumbai) and of mandibular arch was done using all green technique [Figure 1]d. Final impressions of the maxillary and mandibular arches [Figure 1]e and [Figure 1]f were made using light body consistency addition silicone material (3M ESPE Express, USA). Master casts were obtained [Figure 2]a and [Figure 1]b and jaw relation was recorded [Figure 2]c. Facebow was recorded followed by mounting of the occlusal rims on the Hanau Wide Vue semiadjustable articulator [Figure 2]d. Another set of temporary denture bases were fabricated and a thin acrylic rim [Figure 2]e and [Figure 2]f was adapted on the temporary denture base at the established vertical dimension. Admix material was manipulated and placed on the second set of denture bases. The patient was instructed to perform various functional movements including swallowing, sucking, whistling, pursing lips, and pronouncing vowels to mold the material. Maxillary occlusal rim was placed in the mouth when performing movements for mandibular arch and mandibular rim when performing movements for the maxillary arch. The vertical dimension was reassessed while keeping both the molded denture bases intraorally [Figure 3]a. The putty index was fabricated around the molded material and teeth arrangement of both the arches was carried out using the index as the guide [Figure 3]b. Try-in was carried out [Figure 3]c and the external impressions were made [Figure 3]d using light body consistency addition silicone material (Avue, Light Body, Mumbai) by asking patient to perform various functional movements.
Figure 2: (a) Maxillary master cast, (b) mandibular master cast, (c) recording of jaw relation, (d) mounting of occlusal rims on semiadjustable articulator, (e) maxillary temporary denture base with thin acrylic rim to support the admix material, (f) mandibular denture base with acrylic rim

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Figure 3: (a) Molded bases following recording of neutral zone at the established vertical dimension, (b) teeth arrangement according to the putty index, (c) try-in stage, (d) external impressions using light body material, (e) duplication of trial denture using irreversible hydrocolloid impression material, (f) duplicated cast

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The maxillary trial denture was duplicated [Figure 3]e using irreversible hydrocolloid material (Algitex, DPI, Uttarakhand) and the duplicated cast was obtained [Figure 3]f. A 1mm thick transparent thermoplastic sheet (Bio-Art Sheet, India) was adapted on the duplicated cast [Figure 4]a using vacuum heat-pressed machine (Biostar). The template was checked for adaptation on the maxillary master cast [Figure 4]b. A 2-mm thick spacer was adapted on the maxillary cast [Figure 4]c and the teeth region in the template was blocked out using the modeling wax (MAARC Modelling Wax, Delhi) [Figure 4]d. The putty material (3M ESPE, Soft Putty, USA) was manipulated and placed between the spacer and the blocked out template. The putty spacer was retrieved [Figure 4]e and a glycerin soap (Pears, Hindustan Unilever Ltd., Mumbai, India) replica of the putty spacer was hand carved out [Figure 4]f.
Figure 4: (a) Template adapted over the duplicated cast, (b) adaptation of template on the maxillary master cast, (c) 2-mm thick spacer adapted on the maxillary cast, (d) teeth region in the template blocked out using the modeling wax, (e) retrieved putty spacer, (f) glycerin soap replica of the putty spacer

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Flasking and dewaxing was carried out in the conventional manner. Trial closure was carried out using the putty spacer [Figure 5]a, which was then retrieved [Figure 5]b and replaced by the soap spacer [Figure 5]c. Conventional curing was carried out and the dentures were finished and polished [Figure 5]d. Openings were made distal to the most posterior teeth and the denture was immersed in water for dissolution of soap. The glycerin soap was removed mechanically and the openings were sealed using autopolymerizing resin (DPI RR, Cold Cure, India). Float test was conducted and the seal of the maxillary denture was confirmed by its tendency to float on the water [Figure 5]e and [Figure 5]f. The weight of the prosthesis before and after removal of the glycerin soap was 25g and 20g, respectively [Figure 6]a and [Figure 6]b. The denture was inserted [Figure 6]c and the hygiene maintenance instructions were given. The patient was satisfied with the treatment [Figure 6]d, [Figure 6]e and [Figure 6]f.
Figure 5: (a) Trial closure carried out using the putty spacer, (b) Cavity formed following retrieval of the putty spacer, (c) placement of the soap spacer followed by conventional curing, (d) finished and polished dentures, (e) denture before removal of the glycerin spacer immersed in the water, (f) float test conducted to ensure adequate seal of the maxillary denture

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Figure 6: (a) Weight of the prosthesis before removal of the spacer, (b) Weight of the prosthesis on removal of the soap spacer, (c) Intraoral frontal view following insertion of the denture, (d) Prerehabilitative view, (e) Postrehabilitative view, (f) Smile view following insertion of the denture

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  Discussion Top


Residual ridge resorption leads to a decrease in the denture supporting area, hence compromising the retention and stability of the prosthesis. In this case report, all green technique was used to record the mandibular arch as the impression can be corrected readily and accurately determine the extent of the denture supporting area without distortion of the impression.[3] Neutral zone technique was used for both the maxillary and mandibular denture to allow the arrangement of teeth within the neutral zone. The balance between the oral and perioral muscular activity helps stabilize the denture rather than displacing the prosthesis.[4] The external impressions were made for both the dentures to functionally mold the polished surfaces of the prosthesis accommodating the muscles surrounding the denture and enhancing the stability of prosthesis.[5]

Excessive ridge resorption leads to increased inter-ridge distance which further causes increased height and weight of the prosthesis, leading to increased leverage and stresses in the denture supporting area. The reduced weight of the prosthesis achieved by hollowness of the denture aids in its increased retention and stability.[6],[7] Various literature has been cited in the past to achieve reduction in the weight of the maxillary denture using silicone putty, asbestos, thermocol, dough, dental stone, modeling clay, and salt.[8] The main disadvantage of these techniques is difficulty in the retrieval of the three dimensional spacer especially from the anterior region. The technique using salt has the issue to create a substantial pressure while closure of the flask resulting in inability to create a hollow cavity in the denture.

The technique described here uses a glycerin soap spacer as it can be retrieved easily due to the high content of glycerin and the high boiling point enables it to sustain the curing temperature. The added advantages of glycerin are that it does not leave any residue in the hollow cavity and does not interfere with the polymerization process.[9] The thermoplastic template replicated the external contours of the trial denture and ensures the uniform thickness of resin around the planned hollow cavity. The wax spacer on the master cast as well as the teeth block out was done to ensure uniform thickness of the three dimensional putty spacer which was later used to duplicate the glycerin spacer.

The small openings for the glycerin retrieval were chosen on the distal end of the most posterior teeth as it not commonly altered following the insertion and has a small margin for leakage. The float test further reinsured the adequate seal of the prosthesis. Following the removal of the glycerin spacer, the weight of the prosthesis was reduced by five grams leading to enhanced retention and stability of the prosthesis.


  Conclusion Top


The modified technique described in this case report aims to provide a noninvasive, effective, functional, and economic solution to rehabilitate the highly resorbed residual ridges. The neutral zone record and external impressions were made to respect the anatomy and functional movements of the oral and perioral musculature. The hollow maxillary denture lead to reduction in weight of the prosthesis and reducing the unfavorable forces exerted on the underlying tissues.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jain P, Rathee M. Stability in mandibular denture. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549861/. [Last updated on 2022 Jun 16].  Back to cited text no. 1
    
2.
Pande SS, Kambala SS, Revankar RP, Balwani TR. Thermocol-filled hollow complete denture. J Datta Meghe Inst Med Sci Univ 2020;15:320-2.  Back to cited text no. 2
  [Full text]  
3.
Yadav B, Jayna M, Yadav H, Suri S, Phogat S, Madan R. Comparison of different final impression techniques for management of resorbed mandibular ridge: A case report. Case Rep Dent 2014;2014:253731.  Back to cited text no. 3
    
4.
Chandra SS. Management of a severely resorbed mandibular ridge with the neutral zone technique. Contemp Clin Dent 2010;1:36-9.  Back to cited text no. 4
    
5.
Mustafa AZ. Effect of the lingual ledge of neutral zone impression on the retention and stability of mandibular complete denture in elders with atrophied alveolar ridge. Tanta Dent J 2015;12:111-8.  Back to cited text no. 5
    
6.
Deogade SC, Patel A, Mantri SS. An alternative technique for hollowing maxillary complete denture. J Indian Prosthodont Soc 2016;16:412-5.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
O'Sullivan M, Hansen N, Cronin RJ, Cagna DR. The hollow maxillary complete denture: A modified technique. J Prosthet Dent 2004;91:591-4.  Back to cited text no. 7
    
8.
Radke U, Mundhe D. Hollow maxillary complete denture. J Indian Prosthodont Soc 2011;11:246-9.  Back to cited text no. 8
    
9.
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:ZD23-5.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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