- Email: [email protected]
Construction of an artificial saliva reservoir in an existing maxillary denture
SHEN AND
13. 14. 15. 16. 17.
18.
19.
20. 21.
22.
interpositional and onlay grafting for treatment of mandibular bony deficiency in the edentulous patient. J Oral Maxillofac Surg 40:353, 1982. Mellonig J, Bower GM, Bailey RC: Comparison of bone graft materials. Parts I and II. J Periodontol 52291, 1981. Topazian R, Hammer W, Boucher L, Hubert S: Use of alloplastics for ridge augmentation. J Oral Surg 29:792, 1971. Laskin D: State of the art alveolar ridge augmentation. Comp Cont Ed Dent 2(Suppl):46, 1982. Jarcho M: Calcium phosphate ceramic as hard tissue prosthetics. Clin Orthop 157:259, 1981. Change CS, Matukas VJ, Lemons JE: Histological study of hydroxyapatite as an implant material for mandibular augmentation J Oral Maxillofac Surg 41:729, 1983. Frame JW, Brady C, Brown R: Augmentation of the edentulous mandible using bone and hydroxyapatite. A comparative study in dogs. Jnt J Oral Surg lO(Supp1 1):88, 1981. Nery EB, Pflughoeft F, Lynch K, Rooney GE: Functional loading of bioceramic augmentated alveolar ridge: A pilot study. J PROSTHETDENT 45338, 1980. Cranin N: Review of clinical experiences. Comp Cont Ed Dent 2(Suppl):71, 1982. Kent JN, Quinn JH, Zide, MF, Finger IM, Jarcho M, Sanford RS: Correction of alveolar ridge deliciences with nonresorbable hydroxyapatite. J Am Dent Assoc 105:993, 1982. Kent JN, Quinn J, Zide M, Guerra L, Boyne P: Alveolar ridge augmentation using nonresorable hydroxyapatite with or without autogenous cancellous bone. J Oral Maxillofac Surg 41:629, 1983.
Coristruction of an artificial existing maxillary denture A. V&ink,
D.D.S., Ph.D.,* M. C. Huisman,**
23.
24.
25. 26. 27. 28.
29.
30.
GONGLOFF
Larsen HD, Finger IM, Guerra LR, Kent JN: Prosthodontic management of the hydroxyapatite denture patient. J PROSTHET DENT 49461, 1983. Piecuch JF, Fedorka N: Results of soft tissue surgery over implanted replamineform hydroxyapatite. J Oral Maxillofac Surg 41:801, 1983. Lund B: Review of clinical experience. Comp Cont Ed Dent 2(Suppl):75, 1982. Waite D: Review of clinical experiences. Comp Cont Ed Dent 2(Suppl):573, 1982. Eevore DT: Collagen heterografts for bone replacement. J Oral Surg 36:609, 1973. Grello HC, Grass J: Thermal reconstruction of collagen form solution and the response to its heterologus implantation. J Surg Res 269, 1962. Harvey WK, Pincock, JL, Lemons JE: Evaluation of a subcutaneously implanted hydroxyapatite-Aviten mixture in rabbits. J Oral Maxillofac Surg 43:277, 1985. Kaban LB, Blowacki J: Induced osteogenesis in the repair of experimental defects in rats. J Dent Res 60:1356, 1981.
Reprint requests to: DR. R. K. GONCLOFF DENTAL SERVICE(160) VETERANSADMINISTRATIONMEDICAL CENTER 4150 CLEMENT ST. SAN FRANCISCO,CA 94121
saliva reservoir in an and FL J. ‘s-Gravenmade, Ph.D.***
University of Groningen and University Hospital, Groningen, The Netherlands
A
rtificial saliva reservoirs within removable prostheses have been suggested for patients with xerostomia.‘-4 The cost of constructing a new denture with such a reservoir can be a factor in suggesting its use. This article will describe a technique for providing an existing maxillary denture with a reservoir.
Sponsored by the Koningin Wilhelmina Fonds (Netherlands Cancer Foundation) project No. 83-20. *Dentist, Department of Oral and Maxillofacial Surgery, University Hospital. **Dental Technician, Dental Laboratory, University of Groningen. ***Professor of Oral Biochemistry, Laboratory for Materia Technica, University of Groningen.
70
TECHNIQUE The existing maxillary denture must have an acceptable or easily modified vertical dimension, centric relation, and esthetics. 1. Remove all acrylic resin undercuts from the internal surface of the denture, reestablish the borders and the posterior palatal seal with impression compound (soft green, Kerr/Sybron, Base& Switzerland, or Romulus, Mich.), and place an impression adhesive on the appropriate surfaces. 2. Make a final impression with a material of choice. Zinc oxide-eugenol impression pastes should not be used in patients with xerostomia because of its irritating effect on the dry, vulnerable oral mucosa.
JULY 1986
VOLUME
56
NUMBER
I
CONSTRUCTION
OF ARTIFICIAL
SALIVA
RESERVOIR
Fig. 1. Palatal surface of trial denture is thickened soft beeswax.
with
3. Thicken the palatal surface of the denture with soft beeswax (Cavex soft wax, Keur & Sneltjes, Haarlem, The Netherlands). Mold the wax so that oral function, especially speech, is not disturbed. Normal speech should be acceptable, although rapid speech will be difficult (Fig. 1). The wax thickening should increase the volume of the denture by approximately 9 ml (immerse the denture in a calibrated glass of water) to obtain a reservoir with a sufficient volume. 4. Cover the beeswax with a thin film of modeling wax (Cavex modeling wax normal, Keur & Sneltjes) to prevent it from sticking to the mold. 5. Pour a cast in plaster and key it (Fig. 2). 6. Lightly lubricate the superior surface of the cast with waterglass (Waterglas, Onderlinge Pharmaceutische Groothandel, Utrecht, The Netherlands) and cover it with a layer of plaster to form the nonfitting surface of the mold (Fig. 3). 7. Separate the nonfitting surface of the mold and remove the beeswax. 8. Fill the space created by the beeswax with Optosil (Optosil Bayer Dental, Leverkusen, West Germany) and replace the nonfitting surface of the mold. Remove the excess Optosil (Fig. 4). 9. Shorten the borders of the denture and remove the palatal part (Fig. 5). 10. With sticky wax (Model Cement Associated Dental Products Ltd, Purton, England) secure the teeth and the remaining base material to the nonfitting surface of the mold (Fig. 6). 11. Wax the proper denture extension with baseplate wax (Cavex modeling wax normal, Keur & Sneltjes). Space for the Optosil spacer must be maintained (Figs. 7 and 8). 12. Invest the denture, remove the Optosil, and boil out the wax.
THE JOURNAL
OF PROSTHETIC
DENTISTRY
Fig. 2. A keyed cast is rna3(\
Fig. 3. Upper half of mold is formed.
13. Construct a chrome-cobalt palatal plate on a duplicate cast. The metal base should cover the palate and terminate 5 mm anterior to the posterior extension. The metal base should be 0.45 mm thick at the center and 1 mm thick where it joins the acrylic resin base (Fig. 9). To snap .the metal and acrylic resin segments together, but permit their separation, the thickening at the border of the metal base must be undercut to 4 degrees maximum (Fig. 15). Leakage at the junction does not occur because of the border seal and the rheological properties of the saliva substitute. Place two filling holes (1.5 mm in diameter) in the metal base, one anterior and one posterior at the midline. 14. Adapt a shellac baseplate to the upper half of the flask that holds the teeth (Figs. 10 and 11) and glue the metal palate to the flasked cast. 15. Cover both halves of the flask with polythene foil (Biodent K 8~ B plus, DeTrey, Wiesbaden. West
71
VISSINK,
HUISMAN,
AND
‘S-GRAVENMADE
Fig. 4. Beeswax is replaced by Optosil.
Fig. 5. Vestibular borders of denture are shortened palatal part is removed.
Fig. 6. Teeth and remaining base material to the nonfitting Burface of mold. 72
and Fig. 7. Denture
is completely
waxed for reline.
are secured Fig. 8. Optosil JULY 1986
is replaced. VOLUME
56
NUMBER
1
CONSTRUCTION
OF ARTIFICIAL
Fig. 9. Chrome-cobalt
SALIVA
RESERVOIR
Fig. 12. Remaining sil.
space in flask is filled with
Fig. 13. Peripheral
parts of Optosil
Opto-
base in place on cast.
small piece of tinfoil
are removed,
A
is glued to Optosil, which is
secured to metal base.
Fig. 10. Palatal part of upper with a shellac baseplate.
half of flask is covered
Fig. 14. Optosil
Fig. 11. Diagram of two holes of mold showing position of old denture, shellac baseplate, and metal base.
Germany) and fill the remaining space with Optosil (Fig. 12). The amount of Optosil is less than that used in step No. 8 because the shellac baseplate allows for the acrylic resin covering of the oral side of the reservoir. THE JOURNAL
OF PROSTHETIC
DENTISTRY
and tinfoil
are glued to metal base.
16. Remove excess Optosil so that 2 mm of the outline of the chrome-cobalt baseplate is free (Fig. 13). 17. Glue the Optosil to the metal base and glue a small round piece of tinfoil to the Optosil (Figs. 13 and 14). The tintoil creates an area for the valve (see step 20). 18. Pack acrylic resin into the flask and cure in the usual manner. 19. Unsnap the metal base and remove the filler and the tinfoil from the denture (Fig. 1.5). 73
VISSINK,
Fig. 15. Denture is deflasked. Optosil, al base are removed.
tinfoil,
HUISMAN,
AND
‘S-GRAVENMADE
and metFig. 17. Cross-section
of finished
denture.
Fig. 16. Area created by tinfoil is covered with a latex membrane. Reservoir can be increased by peripheral extension.
20. Place a hole in the middle of the acrylic resin that covered the tinfoil. Cover the opening with a latex membrane (Penrose drain, Argyle, Tullamore, Ireland) (Fig. 16). The membrane is secured to the acrylic resin with cyanoacrylate glue (Renfert, Singen, West Germany). Punch a hole in the membrane. 21. Snap the metal base to position (Figs. 16 and 17). 22. The reservoir can be filled with a syringe (Fig. 18). The patient can moisten the oral cavity by sucking some artificial saliva out of the reservoir.
Fig. 18. Reservoir can be filled by means of a syringe with an injection needle.
2. 3.
SUMMARY A technique is presented for the construction of an artificial saliva reservoir in an existing denture. Compared with the construction of a new reservoir denture, adapting an existing denture can reduce the cost by approximately two thirds. REFERENCES 1. Covington JS, Slagle WF, Disney AL: Complete denture salivary fluid reservoirs: A novel approach to xerostomia relief. J Dent Res 64(Special issue):242, 1985.
74
4.
Toljanic JA, Zucuskie TG: Use of a palatal reservoir in denture patients with xerostomia. J PROSTHET DENT 52540, 1984. Vergo TJ, Kadish SP: Dentures as artificial saliva reservoirs in irradiated edentulous patients with xerostomia: A pilot study. Oral Surg 51:229, 1981. Vissink A, ‘s-Gravenmade EJ, Panders AK, Olthof A, Vermey A, Huisman MC, Visch LL: Artificial saliva reservoirs. J PROSTHET DENT 52710, 1984.
Reprint requests to: DR. A. VISSINK DEPARTMENT OF ORAL AND MAXILLOFACIAL ANT. DEUSINGLAAN 1 9713 AV GRONINGEN THE NETHERLANDS
JULY 1986
SURGERY
VOLUME
56
NUMBER
1
13. 14. 15. 16. 17.
18.
19.
20. 21.
22.
interpositional and onlay grafting for treatment of mandibular bony deficiency in the edentulous patient. J Oral Maxillofac Surg 40:353, 1982. Mellonig J, Bower GM, Bailey RC: Comparison of bone graft materials. Parts I and II. J Periodontol 52291, 1981. Topazian R, Hammer W, Boucher L, Hubert S: Use of alloplastics for ridge augmentation. J Oral Surg 29:792, 1971. Laskin D: State of the art alveolar ridge augmentation. Comp Cont Ed Dent 2(Suppl):46, 1982. Jarcho M: Calcium phosphate ceramic as hard tissue prosthetics. Clin Orthop 157:259, 1981. Change CS, Matukas VJ, Lemons JE: Histological study of hydroxyapatite as an implant material for mandibular augmentation J Oral Maxillofac Surg 41:729, 1983. Frame JW, Brady C, Brown R: Augmentation of the edentulous mandible using bone and hydroxyapatite. A comparative study in dogs. Jnt J Oral Surg lO(Supp1 1):88, 1981. Nery EB, Pflughoeft F, Lynch K, Rooney GE: Functional loading of bioceramic augmentated alveolar ridge: A pilot study. J PROSTHETDENT 45338, 1980. Cranin N: Review of clinical experiences. Comp Cont Ed Dent 2(Suppl):71, 1982. Kent JN, Quinn JH, Zide, MF, Finger IM, Jarcho M, Sanford RS: Correction of alveolar ridge deliciences with nonresorbable hydroxyapatite. J Am Dent Assoc 105:993, 1982. Kent JN, Quinn J, Zide M, Guerra L, Boyne P: Alveolar ridge augmentation using nonresorable hydroxyapatite with or without autogenous cancellous bone. J Oral Maxillofac Surg 41:629, 1983.
Coristruction of an artificial existing maxillary denture A. V&ink,
D.D.S., Ph.D.,* M. C. Huisman,**
23.
24.
25. 26. 27. 28.
29.
30.
GONGLOFF
Larsen HD, Finger IM, Guerra LR, Kent JN: Prosthodontic management of the hydroxyapatite denture patient. J PROSTHET DENT 49461, 1983. Piecuch JF, Fedorka N: Results of soft tissue surgery over implanted replamineform hydroxyapatite. J Oral Maxillofac Surg 41:801, 1983. Lund B: Review of clinical experience. Comp Cont Ed Dent 2(Suppl):75, 1982. Waite D: Review of clinical experiences. Comp Cont Ed Dent 2(Suppl):573, 1982. Eevore DT: Collagen heterografts for bone replacement. J Oral Surg 36:609, 1973. Grello HC, Grass J: Thermal reconstruction of collagen form solution and the response to its heterologus implantation. J Surg Res 269, 1962. Harvey WK, Pincock, JL, Lemons JE: Evaluation of a subcutaneously implanted hydroxyapatite-Aviten mixture in rabbits. J Oral Maxillofac Surg 43:277, 1985. Kaban LB, Blowacki J: Induced osteogenesis in the repair of experimental defects in rats. J Dent Res 60:1356, 1981.
Reprint requests to: DR. R. K. GONCLOFF DENTAL SERVICE(160) VETERANSADMINISTRATIONMEDICAL CENTER 4150 CLEMENT ST. SAN FRANCISCO,CA 94121
saliva reservoir in an and FL J. ‘s-Gravenmade, Ph.D.***
University of Groningen and University Hospital, Groningen, The Netherlands
A
rtificial saliva reservoirs within removable prostheses have been suggested for patients with xerostomia.‘-4 The cost of constructing a new denture with such a reservoir can be a factor in suggesting its use. This article will describe a technique for providing an existing maxillary denture with a reservoir.
Sponsored by the Koningin Wilhelmina Fonds (Netherlands Cancer Foundation) project No. 83-20. *Dentist, Department of Oral and Maxillofacial Surgery, University Hospital. **Dental Technician, Dental Laboratory, University of Groningen. ***Professor of Oral Biochemistry, Laboratory for Materia Technica, University of Groningen.
70
TECHNIQUE The existing maxillary denture must have an acceptable or easily modified vertical dimension, centric relation, and esthetics. 1. Remove all acrylic resin undercuts from the internal surface of the denture, reestablish the borders and the posterior palatal seal with impression compound (soft green, Kerr/Sybron, Base& Switzerland, or Romulus, Mich.), and place an impression adhesive on the appropriate surfaces. 2. Make a final impression with a material of choice. Zinc oxide-eugenol impression pastes should not be used in patients with xerostomia because of its irritating effect on the dry, vulnerable oral mucosa.
JULY 1986
VOLUME
56
NUMBER
I
CONSTRUCTION
OF ARTIFICIAL
SALIVA
RESERVOIR
Fig. 1. Palatal surface of trial denture is thickened soft beeswax.
with
3. Thicken the palatal surface of the denture with soft beeswax (Cavex soft wax, Keur & Sneltjes, Haarlem, The Netherlands). Mold the wax so that oral function, especially speech, is not disturbed. Normal speech should be acceptable, although rapid speech will be difficult (Fig. 1). The wax thickening should increase the volume of the denture by approximately 9 ml (immerse the denture in a calibrated glass of water) to obtain a reservoir with a sufficient volume. 4. Cover the beeswax with a thin film of modeling wax (Cavex modeling wax normal, Keur & Sneltjes) to prevent it from sticking to the mold. 5. Pour a cast in plaster and key it (Fig. 2). 6. Lightly lubricate the superior surface of the cast with waterglass (Waterglas, Onderlinge Pharmaceutische Groothandel, Utrecht, The Netherlands) and cover it with a layer of plaster to form the nonfitting surface of the mold (Fig. 3). 7. Separate the nonfitting surface of the mold and remove the beeswax. 8. Fill the space created by the beeswax with Optosil (Optosil Bayer Dental, Leverkusen, West Germany) and replace the nonfitting surface of the mold. Remove the excess Optosil (Fig. 4). 9. Shorten the borders of the denture and remove the palatal part (Fig. 5). 10. With sticky wax (Model Cement Associated Dental Products Ltd, Purton, England) secure the teeth and the remaining base material to the nonfitting surface of the mold (Fig. 6). 11. Wax the proper denture extension with baseplate wax (Cavex modeling wax normal, Keur & Sneltjes). Space for the Optosil spacer must be maintained (Figs. 7 and 8). 12. Invest the denture, remove the Optosil, and boil out the wax.
THE JOURNAL
OF PROSTHETIC
DENTISTRY
Fig. 2. A keyed cast is rna3(\
Fig. 3. Upper half of mold is formed.
13. Construct a chrome-cobalt palatal plate on a duplicate cast. The metal base should cover the palate and terminate 5 mm anterior to the posterior extension. The metal base should be 0.45 mm thick at the center and 1 mm thick where it joins the acrylic resin base (Fig. 9). To snap .the metal and acrylic resin segments together, but permit their separation, the thickening at the border of the metal base must be undercut to 4 degrees maximum (Fig. 15). Leakage at the junction does not occur because of the border seal and the rheological properties of the saliva substitute. Place two filling holes (1.5 mm in diameter) in the metal base, one anterior and one posterior at the midline. 14. Adapt a shellac baseplate to the upper half of the flask that holds the teeth (Figs. 10 and 11) and glue the metal palate to the flasked cast. 15. Cover both halves of the flask with polythene foil (Biodent K 8~ B plus, DeTrey, Wiesbaden. West
71
VISSINK,
HUISMAN,
AND
‘S-GRAVENMADE
Fig. 4. Beeswax is replaced by Optosil.
Fig. 5. Vestibular borders of denture are shortened palatal part is removed.
Fig. 6. Teeth and remaining base material to the nonfitting Burface of mold. 72
and Fig. 7. Denture
is completely
waxed for reline.
are secured Fig. 8. Optosil JULY 1986
is replaced. VOLUME
56
NUMBER
1
CONSTRUCTION
OF ARTIFICIAL
Fig. 9. Chrome-cobalt
SALIVA
RESERVOIR
Fig. 12. Remaining sil.
space in flask is filled with
Fig. 13. Peripheral
parts of Optosil
Opto-
base in place on cast.
small piece of tinfoil
are removed,
A
is glued to Optosil, which is
secured to metal base.
Fig. 10. Palatal part of upper with a shellac baseplate.
half of flask is covered
Fig. 14. Optosil
Fig. 11. Diagram of two holes of mold showing position of old denture, shellac baseplate, and metal base.
Germany) and fill the remaining space with Optosil (Fig. 12). The amount of Optosil is less than that used in step No. 8 because the shellac baseplate allows for the acrylic resin covering of the oral side of the reservoir. THE JOURNAL
OF PROSTHETIC
DENTISTRY
and tinfoil
are glued to metal base.
16. Remove excess Optosil so that 2 mm of the outline of the chrome-cobalt baseplate is free (Fig. 13). 17. Glue the Optosil to the metal base and glue a small round piece of tinfoil to the Optosil (Figs. 13 and 14). The tintoil creates an area for the valve (see step 20). 18. Pack acrylic resin into the flask and cure in the usual manner. 19. Unsnap the metal base and remove the filler and the tinfoil from the denture (Fig. 1.5). 73
VISSINK,
Fig. 15. Denture is deflasked. Optosil, al base are removed.
tinfoil,
HUISMAN,
AND
‘S-GRAVENMADE
and metFig. 17. Cross-section
of finished
denture.
Fig. 16. Area created by tinfoil is covered with a latex membrane. Reservoir can be increased by peripheral extension.
20. Place a hole in the middle of the acrylic resin that covered the tinfoil. Cover the opening with a latex membrane (Penrose drain, Argyle, Tullamore, Ireland) (Fig. 16). The membrane is secured to the acrylic resin with cyanoacrylate glue (Renfert, Singen, West Germany). Punch a hole in the membrane. 21. Snap the metal base to position (Figs. 16 and 17). 22. The reservoir can be filled with a syringe (Fig. 18). The patient can moisten the oral cavity by sucking some artificial saliva out of the reservoir.
Fig. 18. Reservoir can be filled by means of a syringe with an injection needle.
2. 3.
SUMMARY A technique is presented for the construction of an artificial saliva reservoir in an existing denture. Compared with the construction of a new reservoir denture, adapting an existing denture can reduce the cost by approximately two thirds. REFERENCES 1. Covington JS, Slagle WF, Disney AL: Complete denture salivary fluid reservoirs: A novel approach to xerostomia relief. J Dent Res 64(Special issue):242, 1985.
74
4.
Toljanic JA, Zucuskie TG: Use of a palatal reservoir in denture patients with xerostomia. J PROSTHET DENT 52540, 1984. Vergo TJ, Kadish SP: Dentures as artificial saliva reservoirs in irradiated edentulous patients with xerostomia: A pilot study. Oral Surg 51:229, 1981. Vissink A, ‘s-Gravenmade EJ, Panders AK, Olthof A, Vermey A, Huisman MC, Visch LL: Artificial saliva reservoirs. J PROSTHET DENT 52710, 1984.
Reprint requests to: DR. A. VISSINK DEPARTMENT OF ORAL AND MAXILLOFACIAL ANT. DEUSINGLAAN 1 9713 AV GRONINGEN THE NETHERLANDS
JULY 1986
SURGERY
VOLUME
56
NUMBER
1