J

The hollow maxillary complete denture: A modified technique

Michael O’Sullivan, BDentSci, MSc, PhD,a Nancy Hansen, CDT,b Robert J. Cronin, DDS, MS,c andDavid R. Cagna, DMDd

Dental School, University of Texas Health Science Center at San Antonio, San Antonio, Tex

The severely atrophic maxilla poses a clinical challenge for fabrication of a successful complete denture.This article describes a novel method for fabrication of a hollow maxillary complete denture. Itincorporates a clear, pressure-formed matrix of the trial denture external contours to facilitate thefabrication of a silicone putty cavity form. This cavity form ensures the appropriate dimensions of boththe denture base acrylic resin for structural integrity and the denture base cavity for optimal weightreduction. (J Prosthet Dent 2004;91:591-4.)

Extreme resorption of the maxillary denture-bearingareamay lead to problemswith prosthetic rehabilitation.These may be due to a narrower, more constrictedresidual ridge as resorption progresses, decreasedsupporting tissues, and a resultant large restorativespace between the maxillary residual ridge and opposingmandibular teeth. The latter may result in a heavymaxillary complete denture that may compound thepoor denture-bearing ability of the tissues and lead todecreased retention and resistance.

Although not universally accepted,1 it has beensuggested that gravity and the addition of weight tothe mandibular complete denture may aid in prosthesisretention.2,3 Reducing the weight of a maxillary pros-thesis, however, has been shown to be beneficial whenconstructing an obturator for the restoration of a largemaxillofacial defect.4,5 Given the extensive volume ofthe denture base material in prostheses provided topatients with large maxillofacial defects or severeresidual ridge resorption, reduction in prosthesis weightmay be achieved by making the denture base hollow.Historically, weight reduction approaches have beenachieved using a solid 3-dimensional spacer, includingdental stone,4-14 cellophane wrapped asbestos,15 sili-cone putty,16,17 or modelling clay18,19 during labora-tory processing to exclude denture base material fromthe planned hollow cavity of the prosthesis.Multiple andseparate pieces of the prosthesis are polymerized arounda 3-dimensional spacer. Following the initial polymer-ization process, the solid spacer is removed. Individualpieces of the prosthesis are then joined using auto-polymerizing acrylic resin repair techniques.

Fattore et al12 used a variation of a double flasktechnique for obturator fabrication20 by adding heat-polymerizing acrylic resin over the definitive cast andprocessing a minimal thickness of acrylic resin aroundthe teeth using a different drag. Both portions of resin

aFellow, Department of Prosthodontics.bMedical Sculptor and Maxillofacial Laboratory Technician, De-

partment of Prosthodontics.cProfessor, Department of Prosthodontics.dAssociate Professor, Department of Prosthodontics.

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were then attached using heat-polymerized resin.Holt18 processed a shim of acrylic resin over the residualridge and used a spacer (Insta-mold; Nobilium, Albany,NY). The resin was indexed and the second half of thedenture processed against the spacer and shim. Thespacer was then removed and the 2 halves luted withautopolymerized acrylic resin using the indices tofacilitate positioning. The primary disadvantage of suchtechniques is that the junction between the 2 previouslypolymerized portions of the denture occurs at theborders of the denture. This is a long junction with anincreased risk of seepage of fluid into the denture cavity.Furthermore, this junction is a common site forpostinsertion adjustment increasing the risk of leakage.A further disadvantage is that it is difficult to gauge resinthickness in the cope area. This article describesa technique for fabrication of a hollow maxillarycomplete denture using silicone putty to develop a cavitywithin the denture base.

TECHNIQUE

1. Make a definitive impression of the maxillaryresidual ridge and fabricate the denture to the trialdenture stage.

2. Index the land area of the cast using a conical bur(416/060; JOTA AG, Switzerland) and seal the trial

Fig. 1. Trial maxillary denture sealed to indexed definitivecast.

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Fig. 2. A, Baseplate wax adapted to definitive cast. B, Second cope indexed to baseplate wax pattern in A.

Fig. 3. A, Clear matrix of trial denture adapted to indexed definitive cast with acrylic intaglio portion still attached to cast. Acrylicthickness may be estimated using endodontic file and rubber stop. B, Lateral view of clear matrix with endodontic file in place.

Fig. 4. A, Vinyl polysiloxane putty adapted to estimate outline of hollow portion of denture and secured with cyanoacrylate.B, Clear matrix placed on definitive cast to visualize possible acrylic thickness around trimmed vinyl polysiloxane putty.

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Fig. 5. A, Processed maxillary denture on definitive cast with openings prepared to facilitate removal of putty. B, Heat-polymerized clear acrylic resin covers for windows with handles to facilitate positioning.

denture to the definitive cast (Fig 1). Duplicate thetrial denture in reversible hydrocolloid (Nobiloid;Nobilium) and pour the impression in dental stone(Microstone; WhipMix, Louisville, Ky). Make a cleartemplate of the stone cast using a 0.3-mm thermo-plastic sheet (Biocryl; Great Lakes Orthodontic,Tonawanda, NY).

3. Process the trial denture in the standard mannerthrough the wax elimination stage.21

4. Adapt 2 layers of baseplate wax (Anutex; Kemdent,Wiltshire, UK) to the definitive cast in the drag,conforming to the border extensions (Fig 2, A). Usea second flask to invest the baseplate wax and againcomplete the wax elimination process (Fig 2, B). Packthecopeandseconddragwithheat-polymerizedacrylicresin (Lucitone 199; Dentsply, York, Pa) and process.

5. Separate the cope, with the polymerized acrylic resinstill attached, from the drag. Place the clear matrixon the definitive cast using the indices in the landarea as seating guides (Fig 3, A). Use an endodonticfile with a rubber stop to measure the space betweenthe matrix and the processed resin (Fig. 3, B).

6. Mix and adapt vinyl polysiloxane putty (Reprosil;Dentsply Caulk, Milford, Del) to the bur-roughenedacrylic resin and shape to the approximate contours ofthe matrix (Fig 4, A). Shape the polymerized puttywith a bur (H251E; Brasseler USA, Savannah, Ga) toleave 2-3 mm of space between the putty and matrix.Provide an additional 1-mm space over the toothportion of the denture (Fig 4, B). Fix the putty to theacrylic resin using cyanoacrylate (Superglue; PacerTechnology, Rancho Cucamonga, Calif ).

7. Reseat the original cope on the drag and verifycomplete closure of the flask. Mix, pack, andpolymerize the acrylic resin. Verify adequate thick-ness of resin around the teeth at the packing stageusing a periodontal probe. Recover the processeddenture in the usual manner.21

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8. Remount the denture on an articulator and adjust theocclusion as necessary. Cut 2 openings with a bur(H251E; Brasseler USA) into the denture base distalto the most posterior teeth. Remove the siliconeputty by scraping with a sharp instrument. Widen theopenings as necessary, laterally, to facilitate access(Fig 5, A). Remove the putty and fabricate 2 coversusing clear autopolymerizing resin (Great LakesSplint Resin Acrylic #040-008, Great Lakes Ortho-dontic) (Fig 5, B). Clean and disinfect the cavity(Cidex OPA, Advanced Sterilization Products, John-son & Johnson Medical, Skipton, UK). Attach theclear resin covers by bonding them into position (Fig6) using autopolymerizing resin (Great Lakes Or-thodontic) or light-polymerizing gel (Triad gel;Dentsply).

9. Polish the denture in the usual manner.21 Verify thatthe cavity is sealed by immersing the denture inwater. If no bubbles are evident, an adequate seal isconfirmed.

Fig. 6. Completed hollow maxillary denture with clear resinwindows bonded into position using autopolymerizing resin.

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DISCUSSION

The method described has advantages over pre-viously described techniques for hollow denture fabri-cation.12,16 Leakage and difficulty in gauging resinthickness are problems inherent in previously describedtechniques.4-19 The procedures described in this articleovercome these problems. Heat-polymerizing 1 portionof the denture against polymerized resin may reduceleakage at the junction of the 2 portions of the denture.The small window in the cameo surface facilitatesrecovery of the spacer in an area that is not commonlyadjusted after denture insertion and has a small marginalong which leakage could occur. The clear resinwindow allows for verification of the integrity of thedenture at patient recall. The thickness of resin can becontrolled through the use of the putty and clear matrix,ensuring an even depth of resin to prevent seepage andprevent deformation under pressure of flask closure.Additional verification of adequate acrylic resin thick-ness may be achieved at the packing stage usinga periodontal probe, allowing recontouring of the puttyat that time if required. Silicone putty is used as a spacerbecause of previously described advantages,17 includingits stability, its ability to be carved, and the fact that itdoes not adhere to acrylic resin. The cyanoacrylate bondbetween the resin and the putty may be easily removed.

SUMMARY

A technique for fabricating a hollow maxillarydenture is described. The technique uses a clear matrixof the trial denture to facilitate shaping of a silicone puttyspacer to ensure an even thickness of acrylic to resistdeformation and prevent seepage of saliva into thecavity.

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Reprint requests to:

DR. MICHAEL O’SULLIVAN

DEPARTMENT OF RESTORATIVE DENTISTRY & PERIODONTOLOGY

DUBLIN DENTAL SCHOOL & HOSPITAL

LINCOLN PLACE, DUBLIN 2

IRELAND

FAX: 353-1-6127297

E-MAIL: misullvn@dental.tcd.ie

0022-3913/$30.00

Copyright ª 2004 by The Editorial Council of The Journal of Prosthetic

Dentistry

doi:10.1016/j.prosdent.2004.03.021

VOLUME 91 NUMBER 6