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Conversion of a removable partial denture to a transitional complete denture: A clinical report
Conversion of a removable partial denture to a transitional complete denture: A clinical report June Sisson, DDS,a Kenneth Boberick, DMD,b and Sheldon Winkler, DDSc Department of Restorative Dentistry, Temple University School of Dentistry, Philadelphia, Pa A procedure is described for conversion of an existing removable partial denture into a complete denture using autopolymerizing tooth-colored acrylic resin, acrylic resin denture repair material, and a clear matrix template. The shape, color, and position of the lost natural teeth may be duplicated in the transitional denture, minimizing the psychological concerns of the patient regarding esthetics and social impact. Because the patient is never without teeth, an appropriate healing time can occur before fabrication of the definitive prosthesis. (J Prosthet Dent 2005;93:416-8.)
A
difficult challenge for the dentist and the patient is the transition from the dentate to the edentulous state.1 For many patients, the loss of their last remaining teeth and the transition from the partially dentate status to complete edentulism is a psychologically stressful experience.2 Problems frequently arise concerning esthetics and function because many patients are unwilling or unable to wait the long healing period (approximately 6-8 weeks) necessary before the insertion of definitive dentures. The use of immediate dentures may not be an acceptable solution because they present their own set of difficulties, including the emotional and psychological issues of unpredictable appearance because a wax trial insertion appointment cannot be accomplished, and the added physical stress of multiple extractions.3 Clinical procedures that could help transition the patient from a removable partial denture (RPD) to a complete denture would be welcome. There are many techniques for making interim dentures described in the literature. Goldfarb4 described a method for fabricating a transitional denture using silicone rubber molds. Abbott and Wongthai5 described a procedure for making an interim denture from an existing RPD. Broering and Gooch6 described a procedure that duplicated existing restorations and incorporated them in an immediate denture. Lonsbrough7 described a single-appointment method for converting a failing fixed partial denture into a complete interim overdenture. Other techniques for fabrication of interim dentures have also been presented in the literature.8-10 This article describes a method for converting an existing RPD into a transitional complete denture using autopolymerizing tooth-colored acrylic resin, acrylic resin denture repair material, and a clear matrix template. Using this technique, the shape, color, and position of lost natural teeth can be duplicated in the transitional
a
Assistant Professor. Associate Professor. c Professor. b
416 THE JOURNAL OF PROSTHETIC DENTISTRY
denture, minimizing the psychological concerns of the patient regarding esthetics and social impact. Maintaining satisfactory nutrition is important immediately after surgery and during the healing period. The use of a transitional denture can protect the surgical site and speed the healing process. With a transitional denture, the clinician can maintain the existing vertical dimension of occlusion. The clear acrylic template technique11 allows the clinician to make visual inspection during placement of the acrylic resin, and the matrix leaves a smooth acrylic surface. If the extractions are scheduled over more than 1 visit, the matrix can be used to add teeth and the adjacent flanges incrementally. Fabrication of the definitive prosthesis in the conventional manner will allow the clinician to make a more accurate final impression and arrange a trial insertion visit, providing for better esthetics and fit of the denture. Patients usually adjust more easily to a complete prosthesis following a period of transitional denture use.12 One obvious disadvantage of this technique is the use of acrylic resin intraorally, which may irritate the tissues.
CLINICAL REPORT A 49-year-old woman presented in good health to the private dental office of the senior author. After a radiographic and clinical examination, a treatment plan was developed that involved extraction of the remaining nonrestorable mandibular teeth and conversion of the existing mandibular RPD into a transitional complete denture. Other treatment plans considered included an immediate complete mandibular denture, extractions and denture fabrication after the residual ridge had healed, and an implant-supported prosthesis. Financial considerations prevented implant use. The patient selected the interim transitional denture because it fulfilled her esthetic needs while allowing for the definitive prosthesis to be made with a trial insertion visit. An irreversible hydrocolloid (Jeltrate; Dentsply International, York, Pa) impression was made of the mandibular arch with the patient’s existing RPD in place. A stone VOLUME 93 NUMBER 5
SISSON, BOBERICK, AND WINKLER
Fig. 1. Cast with wax flanges added.
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 2. Clear vacuum-formed matrix with RPD properly seated.
Fig. 3. Addition of tooth-colored acrylic replacing extracted teeth.
Fig. 4. Transitional prosthesis, with flanges added, finished and polished.
(Dentstone, Type III; Heraeus Kulzer, Armonk, NY) cast was made, and flanges were added to the labial and lingual areas of the cast using baseplate wax (Modern Pink No. 3; Heraeus Kulzer) (Fig. 1). An irreversible hydrocolloid impression was made of the modified cast, and a new cast was fabricated in stone. A clear acrylic resin template (Temporary Splint Material, 0.02 thickness; Buffalo Dental Manufacturing Co, Syosset, NY) was fabricated using a vacuum forming machine (Vacuum forming machine, 110 V; Zahn Dental, Melville, NY). The matrix was trimmed to extend just beyond the borders of the denture. The clear matrix was used to transform the RPD into the transitional complete denture during the surgery appointment. At the extraction visit, the patient’s RPD was modified by removing the clasps and roughening the acrylic, then placing undercuts to enhance the retention of the new flanges. The RPD was seated into the clear matrix and evaluated for accuracy of fit (Fig. 2). Tooth-colored acrylic resin (Jet tooth shade acrylic; Lang Dental, Wheeling, Ill) was placed into the clear matrix to repli-
cate the coronal areas of the extracted teeth. The acrylic resin was added just to the level of the gingival margins and allowed to polymerize (Fig. 3). The patient’s remaining teeth were extracted and denture repair acrylic resin (Self-curing denture repair acrylic, pink; Lang Dental) was added to the flange areas previously waxed onto the cast. When the repair resin reached a doughy consistency, the clear matrix containing the partial denture and repair acrylic was placed intraorally, and border molding was accomplished. The denture was removed from the mouth, placed in warm water, and the acrylic resin was allowed to completely polymerize. After the polymerization of the resin, the denture was removed from the clear matrix and then finished and polished conventionally13 (Fig. 4). The borders were well rounded, and undercuts on the intaglio surface were identified and removed. The denture was inserted and all necessary adjustments were made. Instructions were given to the patient regarding home care, and the patient was scheduled for a recall appointment within
MAY 2005
417
THE JOURNAL OF PROSTHETIC DENTISTRY
24 to 48 hours. Additional appointments were made during the first few weeks for additional correction, such as occlusal adjustment and relief of pressure areas. The fabrication of the definitive denture began after 8 weeks of healing.
SUMMARY The transitional denture is valuable, as it can be used to help patients adjust to the edentulous condition. A procedure was described for converting a removable partial denture into a complete denture. The clinician can provide the patient with a transitional denture during the healing period, addressing patient concerns regarding esthetics and function. Following the healing period, the clinician can fabricate the definitive prosthesis in the conventional manner, maintaining control over esthetics and fit. REFERENCES 1. Straus R, Sandifer JC, Hall DS, Haley JV. Behavioral factors and denture status. J Prosthet Dent 1977;37:264-73. 2. Mersel A, Babayof I, Berkey D, Mann J. Variables affecting denture satisfaction in Israeli elderly: a one-year follow up. Gerodontology 1995; 12:89-94. 3. Mersel A. Immediate or transitional complete dentures: gerodontic considerations. Int Dent J 2002;52:298-303. 4. Goldfarb G. A transitional denture technique using silicone rubber molds. J Prosthet Dent 1965;15:25-6. 5. Abbott FB, Wongthai P. Converting a removable partial denture to a complete interim denture. J Prosthet Dent 1983;49:852-5.
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SISSON, BOBERICK, AND WINKLER
6. Broering LF, Gooch WM. Existing restorations duplicated for an immediate denture. J Prosthet Dent 1982;47:336-7. 7. Lonsbrough RL. Conversion of a fixed partial denture to an interim removable partial denture: a clinical report. J Prosth Dent 1993;70:383-5. 8. Payne SH. The interim denture. In: Winkler S, editor. Essentials of complete denture prosthodontics. 2nd ed. St. Louis: Ishiyaku EuroAmerica; 1988. p. 375-83. 9. Swoope CC, Depew TE, Wisman LJ, Wands DH. Interim dentures. J Prosthet Dent 1974;32:604-12. 10. Burger H. Immediate transitional denture utilizing the natural dentition. Gen Dent 1980;28:34-7. 11. Shillingburg HT, Hobo SH, Whitsett LD, Jacobi R, Brackett SE. Fundamentals of fixed prosthodontics. 3rd ed. Chicago: Quintessence; 1997. p. 234-5. 12. Wagner AG, Monesmith MB. Transitional immediate complete dentures. Gen Dent 1991;39:200-2. 13. Sherman H. Denture insertion. In: Winkler S, editor. Essentials of complete denture prosthodontics. 2nd ed. St. Louis: Ishiyaku EuroAmerica; 1988. p. 318-30. Reprint requests to: DR JUNE SISSON DEPARTMENT OF RESTORATIVE DENTISTRY TEMPLE UNIVERSITY SCHOOL OF DENTISTRY 3223 N. BROAD ST. PHILADELPHIA, PA 19140 FAX: 215-707-2840 E-MAIL: [email protected] 0022-3913/$30.00 Copyright Ó 2005 by The Editorial Council of The Journal of Prosthetic Dentistry.
doi:10.1016/j.prosdent.2005.02.026
VOLUME 93 NUMBER 5
A
difficult challenge for the dentist and the patient is the transition from the dentate to the edentulous state.1 For many patients, the loss of their last remaining teeth and the transition from the partially dentate status to complete edentulism is a psychologically stressful experience.2 Problems frequently arise concerning esthetics and function because many patients are unwilling or unable to wait the long healing period (approximately 6-8 weeks) necessary before the insertion of definitive dentures. The use of immediate dentures may not be an acceptable solution because they present their own set of difficulties, including the emotional and psychological issues of unpredictable appearance because a wax trial insertion appointment cannot be accomplished, and the added physical stress of multiple extractions.3 Clinical procedures that could help transition the patient from a removable partial denture (RPD) to a complete denture would be welcome. There are many techniques for making interim dentures described in the literature. Goldfarb4 described a method for fabricating a transitional denture using silicone rubber molds. Abbott and Wongthai5 described a procedure for making an interim denture from an existing RPD. Broering and Gooch6 described a procedure that duplicated existing restorations and incorporated them in an immediate denture. Lonsbrough7 described a single-appointment method for converting a failing fixed partial denture into a complete interim overdenture. Other techniques for fabrication of interim dentures have also been presented in the literature.8-10 This article describes a method for converting an existing RPD into a transitional complete denture using autopolymerizing tooth-colored acrylic resin, acrylic resin denture repair material, and a clear matrix template. Using this technique, the shape, color, and position of lost natural teeth can be duplicated in the transitional
a
Assistant Professor. Associate Professor. c Professor. b
416 THE JOURNAL OF PROSTHETIC DENTISTRY
denture, minimizing the psychological concerns of the patient regarding esthetics and social impact. Maintaining satisfactory nutrition is important immediately after surgery and during the healing period. The use of a transitional denture can protect the surgical site and speed the healing process. With a transitional denture, the clinician can maintain the existing vertical dimension of occlusion. The clear acrylic template technique11 allows the clinician to make visual inspection during placement of the acrylic resin, and the matrix leaves a smooth acrylic surface. If the extractions are scheduled over more than 1 visit, the matrix can be used to add teeth and the adjacent flanges incrementally. Fabrication of the definitive prosthesis in the conventional manner will allow the clinician to make a more accurate final impression and arrange a trial insertion visit, providing for better esthetics and fit of the denture. Patients usually adjust more easily to a complete prosthesis following a period of transitional denture use.12 One obvious disadvantage of this technique is the use of acrylic resin intraorally, which may irritate the tissues.
CLINICAL REPORT A 49-year-old woman presented in good health to the private dental office of the senior author. After a radiographic and clinical examination, a treatment plan was developed that involved extraction of the remaining nonrestorable mandibular teeth and conversion of the existing mandibular RPD into a transitional complete denture. Other treatment plans considered included an immediate complete mandibular denture, extractions and denture fabrication after the residual ridge had healed, and an implant-supported prosthesis. Financial considerations prevented implant use. The patient selected the interim transitional denture because it fulfilled her esthetic needs while allowing for the definitive prosthesis to be made with a trial insertion visit. An irreversible hydrocolloid (Jeltrate; Dentsply International, York, Pa) impression was made of the mandibular arch with the patient’s existing RPD in place. A stone VOLUME 93 NUMBER 5
SISSON, BOBERICK, AND WINKLER
Fig. 1. Cast with wax flanges added.
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 2. Clear vacuum-formed matrix with RPD properly seated.
Fig. 3. Addition of tooth-colored acrylic replacing extracted teeth.
Fig. 4. Transitional prosthesis, with flanges added, finished and polished.
(Dentstone, Type III; Heraeus Kulzer, Armonk, NY) cast was made, and flanges were added to the labial and lingual areas of the cast using baseplate wax (Modern Pink No. 3; Heraeus Kulzer) (Fig. 1). An irreversible hydrocolloid impression was made of the modified cast, and a new cast was fabricated in stone. A clear acrylic resin template (Temporary Splint Material, 0.02 thickness; Buffalo Dental Manufacturing Co, Syosset, NY) was fabricated using a vacuum forming machine (Vacuum forming machine, 110 V; Zahn Dental, Melville, NY). The matrix was trimmed to extend just beyond the borders of the denture. The clear matrix was used to transform the RPD into the transitional complete denture during the surgery appointment. At the extraction visit, the patient’s RPD was modified by removing the clasps and roughening the acrylic, then placing undercuts to enhance the retention of the new flanges. The RPD was seated into the clear matrix and evaluated for accuracy of fit (Fig. 2). Tooth-colored acrylic resin (Jet tooth shade acrylic; Lang Dental, Wheeling, Ill) was placed into the clear matrix to repli-
cate the coronal areas of the extracted teeth. The acrylic resin was added just to the level of the gingival margins and allowed to polymerize (Fig. 3). The patient’s remaining teeth were extracted and denture repair acrylic resin (Self-curing denture repair acrylic, pink; Lang Dental) was added to the flange areas previously waxed onto the cast. When the repair resin reached a doughy consistency, the clear matrix containing the partial denture and repair acrylic was placed intraorally, and border molding was accomplished. The denture was removed from the mouth, placed in warm water, and the acrylic resin was allowed to completely polymerize. After the polymerization of the resin, the denture was removed from the clear matrix and then finished and polished conventionally13 (Fig. 4). The borders were well rounded, and undercuts on the intaglio surface were identified and removed. The denture was inserted and all necessary adjustments were made. Instructions were given to the patient regarding home care, and the patient was scheduled for a recall appointment within
MAY 2005
417
THE JOURNAL OF PROSTHETIC DENTISTRY
24 to 48 hours. Additional appointments were made during the first few weeks for additional correction, such as occlusal adjustment and relief of pressure areas. The fabrication of the definitive denture began after 8 weeks of healing.
SUMMARY The transitional denture is valuable, as it can be used to help patients adjust to the edentulous condition. A procedure was described for converting a removable partial denture into a complete denture. The clinician can provide the patient with a transitional denture during the healing period, addressing patient concerns regarding esthetics and function. Following the healing period, the clinician can fabricate the definitive prosthesis in the conventional manner, maintaining control over esthetics and fit. REFERENCES 1. Straus R, Sandifer JC, Hall DS, Haley JV. Behavioral factors and denture status. J Prosthet Dent 1977;37:264-73. 2. Mersel A, Babayof I, Berkey D, Mann J. Variables affecting denture satisfaction in Israeli elderly: a one-year follow up. Gerodontology 1995; 12:89-94. 3. Mersel A. Immediate or transitional complete dentures: gerodontic considerations. Int Dent J 2002;52:298-303. 4. Goldfarb G. A transitional denture technique using silicone rubber molds. J Prosthet Dent 1965;15:25-6. 5. Abbott FB, Wongthai P. Converting a removable partial denture to a complete interim denture. J Prosthet Dent 1983;49:852-5.
418
SISSON, BOBERICK, AND WINKLER
6. Broering LF, Gooch WM. Existing restorations duplicated for an immediate denture. J Prosthet Dent 1982;47:336-7. 7. Lonsbrough RL. Conversion of a fixed partial denture to an interim removable partial denture: a clinical report. J Prosth Dent 1993;70:383-5. 8. Payne SH. The interim denture. In: Winkler S, editor. Essentials of complete denture prosthodontics. 2nd ed. St. Louis: Ishiyaku EuroAmerica; 1988. p. 375-83. 9. Swoope CC, Depew TE, Wisman LJ, Wands DH. Interim dentures. J Prosthet Dent 1974;32:604-12. 10. Burger H. Immediate transitional denture utilizing the natural dentition. Gen Dent 1980;28:34-7. 11. Shillingburg HT, Hobo SH, Whitsett LD, Jacobi R, Brackett SE. Fundamentals of fixed prosthodontics. 3rd ed. Chicago: Quintessence; 1997. p. 234-5. 12. Wagner AG, Monesmith MB. Transitional immediate complete dentures. Gen Dent 1991;39:200-2. 13. Sherman H. Denture insertion. In: Winkler S, editor. Essentials of complete denture prosthodontics. 2nd ed. St. Louis: Ishiyaku EuroAmerica; 1988. p. 318-30. Reprint requests to: DR JUNE SISSON DEPARTMENT OF RESTORATIVE DENTISTRY TEMPLE UNIVERSITY SCHOOL OF DENTISTRY 3223 N. BROAD ST. PHILADELPHIA, PA 19140 FAX: 215-707-2840 E-MAIL: [email protected] 0022-3913/$30.00 Copyright Ó 2005 by The Editorial Council of The Journal of Prosthetic Dentistry.
doi:10.1016/j.prosdent.2005.02.026
VOLUME 93 NUMBER 5