The hollow maxillary complete denture: A modied technique

Michael OSullivan, BDentSci, MSc, PhD,a Nancy Hansen, CDT,b Robert J. Cronin, DDS, MS,c and David 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. It incorporates a clear, pressure-formed matrix of the trial denture external contours to facilitate the fabrication of a silicone putty cavity form. This cavity form ensures the appropriate dimensions of both the denture base acrylic resin for structural integrity and the denture base cavity for optimal weight reduction. (J Prosthet Dent 2004;91:591-4.)

xtreme resorption of the maxillary denture-bearing area may lead to problems with prosthetic rehabilitation. These may be due to a narrower, more constricted residual ridge as resorption progresses, decreased supporting tissues, and a resultant large restorative space between the maxillary residual ridge and opposing mandibular teeth. The latter may result in a heavy maxillary complete denture that may compound the poor denture-bearing ability of the tissues and lead to decreased retention and resistance. Although not universally accepted,1 it has been suggested that gravity and the addition of weight to the mandibular complete denture may aid in prosthesis retention.2,3 Reducing the weight of a maxillary prosthesis, however, has been shown to be benecial when constructing an obturator for the restoration of a large maxillofacial defect.4,5 Given the extensive volume of the denture base material in prostheses provided to patients with large maxillofacial defects or severe residual ridge resorption, reduction in prosthesis weight may be achieved by making the denture base hollow. Historically, weight reduction approaches have been achieved using a solid 3-dimensional spacer, including dental stone,4-14 cellophane wrapped asbestos,15 silicone putty,16,17 or modelling clay18,19 during laboratory processing to exclude denture base material from the planned hollow cavity of the prosthesis. Multiple and separate pieces of the prosthesis are polymerized around a 3-dimensional spacer. Following the initial polymerization process, the solid spacer is removed. Individual pieces of the prosthesis are then joined using autopolymerizing acrylic resin repair techniques. Fattore et al12 used a variation of a double ask technique for obturator fabrication20 by adding heatpolymerizing acrylic resin over the denitive cast and processing a minimal thickness of acrylic resin around the teeth using a different drag. Both portions of resin
a

Fig. 1. Trial maxillary denture sealed to indexed denitive cast.

were then attached using heat-polymerized resin. Holt18 processed a shim of acrylic resin over the residual ridge and used a spacer (Insta-mold; Nobilium, Albany, NY). The resin was indexed and the second half of the denture processed against the spacer and shim. The spacer was then removed and the 2 halves luted with autopolymerized acrylic resin using the indices to facilitate positioning. The primary disadvantage of such techniques is that the junction between the 2 previously polymerized portions of the denture occurs at the borders of the denture. This is a long junction with an increased risk of seepage of uid into the denture cavity. Furthermore, this junction is a common site for postinsertion adjustment increasing the risk of leakage. A further disadvantage is that it is difcult to gauge resin thickness in the cope area. This article describes a technique for fabrication of a hollow maxillary complete denture using silicone putty to develop a cavity within the denture base.

TECHNIQUE
1. Make a denitive impression of the maxillary residual ridge and fabricate the denture to the trial denture stage. 2. Index the land area of the cast using a conical bur (416/060; JOTA AG, Switzerland) and seal the trial
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Fellow, Department of Prosthodontics. b Medical Sculptor and Maxillofacial Laboratory Technician, Department of Prosthodontics. c Professor, Department of Prosthodontics. d Associate Professor, Department of Prosthodontics.

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

Fig. 3. A, Clear matrix of trial denture adapted to indexed denitive cast with acrylic intaglio portion still attached to cast. Acrylic thickness may be estimated using endodontic le and rubber stop. B, Lateral view of clear matrix with endodontic le 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 denitive cast to visualize possible acrylic thickness around trimmed vinyl polysiloxane putty.

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

3. 4.

5.

6.

7.

denture to the denitive cast (Fig 1). Duplicate the trial denture in reversible hydrocolloid (Nobiloid; Nobilium) and pour the impression in dental stone (Microstone; Whip Mix, Louisville, Ky). Make a clear template of the stone cast using a 0.3-mm thermoplastic sheet (Biocryl; Great Lakes Orthodontic, Tonawanda, NY). Process the trial denture in the standard manner through the wax elimination stage.21 Adapt 2 layers of baseplate wax (Anutex; Kemdent, Wiltshire, UK) to the denitive cast in the drag, conforming to the border extensions (Fig 2, A). Use a second ask to invest the baseplate wax and again complete the wax elimination process (Fig 2, B). Pack the cope and second drag with heat-polymerized acrylic resin (Lucitone 199; Dentsply, York, Pa) and process. Separate the cope, with the polymerized acrylic resin still attached, from the drag. Place the clear matrix on the denitive cast using the indices in the land area as seating guides (Fig 3, A). Use an endodontic le with a rubber stop to measure the space between the matrix and the processed resin (Fig. 3, B). Mix and adapt vinyl polysiloxane putty (Reprosil; Dentsply Caulk, Milford, Del) to the bur-roughened acrylic resin and shape to the approximate contours of the matrix (Fig 4, A). Shape the polymerized putty with a bur (H251E; Brasseler USA, Savannah, Ga) to leave 2-3 mm of space between the putty and matrix. Provide an additional 1-mm space over the tooth portion of the denture (Fig 4, B). Fix the putty to the acrylic resin using cyanoacrylate (Superglue; Pacer Technology, Rancho Cucamonga, Calif ). Reseat the original cope on the drag and verify complete closure of the ask. Mix, pack, and polymerize the acrylic resin. Verify adequate thickness of resin around the teeth at the packing stage using a periodontal probe. Recover the processed denture in the usual manner.21

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

8. Remount the denture on an articulator and adjust the occlusion as necessary. Cut 2 openings with a bur (H251E; Brasseler USA) into the denture base distal to the most posterior teeth. Remove the silicone putty by scraping with a sharp instrument. Widen the openings as necessary, laterally, to facilitate access (Fig 5, A). Remove the putty and fabricate 2 covers using clear autopolymerizing resin (Great Lakes Splint Resin Acrylic #040-008, Great Lakes Orthodontic) (Fig 5, B). Clean and disinfect the cavity (Cidex OPA, Advanced Sterilization Products, Johnson & Johnson Medical, Skipton, UK). Attach the clear resin covers by bonding them into position (Fig 6) using autopolymerizing resin (Great Lakes Orthodontic) or light-polymerizing gel (Triad gel; Dentsply). 9. Polish the denture in the usual manner.21 Verify that the cavity is sealed by immersing the denture in water. If no bubbles are evident, an adequate seal is conrmed.
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DISCUSSION
The method described has advantages over previously described techniques for hollow denture fabrication.12,16 Leakage and difculty in gauging resin thickness are problems inherent in previously described techniques.4-19 The procedures described in this article overcome these problems. Heat-polymerizing 1 portion of the denture against polymerized resin may reduce leakage at the junction of the 2 portions of the denture. The small window in the cameo surface facilitates recovery of the spacer in an area that is not commonly adjusted after denture insertion and has a small margin along which leakage could occur. The clear resin window allows for verication of the integrity of the denture at patient recall. The thickness of resin can be controlled through the use of the putty and clear matrix, ensuring an even depth of resin to prevent seepage and prevent deformation under pressure of ask closure. Additional verication of adequate acrylic resin thickness may be achieved at the packing stage using a periodontal probe, allowing recontouring of the putty at that time if required. Silicone putty is used as a spacer because of previously described advantages,17 including its stability, its ability to be carved, and the fact that it does not adhere to acrylic resin. The cyanoacrylate bond between the resin and the putty may be easily removed.

SUMMARY
A technique for fabricating a hollow maxillary denture is described. The technique uses a clear matrix of the trial denture to facilitate shaping of a silicone putty spacer to ensure an even thickness of acrylic to resist deformation and prevent seepage of saliva into the cavity.
REFERENCES
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4. el Mahdy AS. Processing a hollow obturator. J Prosthet Dent 1969;22: 682-6. 5. Brown KE. Fabrication of a hollow-bulb obturator. J Prosthet Dent 1969; 21:97-103. 6. Ackerman AJ. Prosthetic management of oral and facial defects following cancer surgery. J Prosthet Dent 1955;5:413-32. 7. Nidiffer TJ, Shipman TH. Hollow bulb obturator for acquired palatal openings. J Prosthet Dent 1957;7:126-34. 8. Rahn AO, Boucher LJ. Maxillofacial prosthetics: principles and concepts. St. Louis: Elsevier; 1970. p. 95. 9. Chalian VA, Drane JB, Standish SM. Intraoral prosthetics. In: Chalian VA, Drane JB, Standish SM, editors. Maxillofacial prosthetics: multidisciplinary practice. Baltimore: Williams & Wilkins; 1971. p. 133-57. 10. Buckner H. Construction of a denture with hollow obturator, lid, and soft acrylic lining. J Prosthet Dent 1974;31:95-9. 11. Browning JD, Kinderknecht J. Fabrication of a hollow obturator with uid resin. J Prosthet Dent 1984;52:891-5. 12. Fattore LD, Fine L, Edmonds DC. The hollow denture: an alternative treatment for atrophic maxillae. J Prosthet Dent 1988;59:514-6. 13. Gardner LK, Parr GR, Rahn AO. Simplied technique for the fabrication of a hollow obturator prosthesis using vinyl polysiloxane. J Prosthet Dent 1991;66:60-2. 14. McAndrew KS, Rothenberger S, Minsley GE. An innovative investment method for the fabrication of a closed hollow obturator prosthesis. J Prosthet Dent 1998;80:129-32. 15. Worley JL, Kniejski ME. A method for controlling the thickness of hollow obturator prostheses. J Prosthet Dent 1983;50:227-9. 16. Holt RA Jr. A hollow complete lower denture. J Prosthet Dent 1981;45: 452-4. 17. Jhanji A, Stevens ST. Fabrication of one-piece hollow obturators. J Prosthet Dent 1991;66:136-8. 18. Elliott DJ. The hollow bulb obturator: its fabrication using one denture ask. Quintessence Dent Technol 1983;7:13-4. 19. DaBreo EL. A light-cured interim obturator prosthesis. A clinical report. J Proshet Dent 1990;63:371-3. 20. Chalian VA, Barnett MO. A new technique for constructing a one-piece hollow obturator after partial maxillectomy. J Prosthet Dent 1972;28: 448-53. 21. Morrow RM, Rudd KD, Rhoads JE, editors. Dental laboratory procedures: complete dentures. Vol 1. 2nd ed. St. Louis: Mosby; 1985. p. 312-24. Reprint requests to: DR. MICHAEL OSULLIVAN 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 2004 by The Editorial Council of The Journal of Prosthetic Dentistry

doi:10.1016/j.prosdent.2004.03.021

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