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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Functionally Generated Amalgam Stops for Single Complete Denture: A Case Report</title><author><name sortKey="Patil, Pravinkumar G" sort="Patil, Pravinkumar G" uniqKey="Patil P" first="Pravinkumar G." last="Patil">Pravinkumar G. Patil</name><affiliation><nlm:aff id="AF0001">Lecturer, Department of Prosthodontics, Government Dental College and Hospital, Nagpur, India</nlm:aff></affiliation></author><author><name sortKey="Parkhedkar, Rambhau D" sort="Parkhedkar, Rambhau D" uniqKey="Parkhedkar R" first="Rambhau D." last="Parkhedkar">Rambhau D. Parkhedkar</name><affiliation><nlm:aff id="AF0002">Professor, Department of Prosthodontics, Government Dental College and Hospital, Nagpur, India</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21528030</idno><idno type="pmc">3075452</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075452</idno><idno type="RBID">PMC:3075452</idno><date when="2009">2009</date><idno type="wicri:Area/Pmc/Corpus">001C60</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001C60</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Functionally Generated Amalgam Stops for Single Complete Denture: A Case Report</title><author><name sortKey="Patil, Pravinkumar G" sort="Patil, Pravinkumar G" uniqKey="Patil P" first="Pravinkumar G." last="Patil">Pravinkumar G. Patil</name><affiliation><nlm:aff id="AF0001">Lecturer, Department of Prosthodontics, Government Dental College and Hospital, Nagpur, India</nlm:aff></affiliation></author><author><name sortKey="Parkhedkar, Rambhau D" sort="Parkhedkar, Rambhau D" uniqKey="Parkhedkar R" first="Rambhau D." last="Parkhedkar">Rambhau D. Parkhedkar</name><affiliation><nlm:aff id="AF0002">Professor, Department of Prosthodontics, Government Dental College and Hospital, Nagpur, India</nlm:aff></affiliation></author></analytic><series><title level="j">Dental Research Journal</title><idno type="ISSN">1735-3327</idno><idno type="eISSN">2008-0255</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Single complete denture opposing natural dentition is a common occurrence in clinical practice. This article reports a case of a single complete denture with a technique of occlusal refinement by functionally generated amalgam stops condensed in prepared resin teeth after initial balancing of the denture with semi-adjustable articulator. This technique provides intimacy of contact in all excursions by carving the amalgam in plastic stage. Amalgam stops improve the efficiency of the resin teeth. Dentures fabricated using this technique require fewer and simpler post-insertion adjustments.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Winkler, S" uniqKey="Winkler S">S Winkler</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="French, Fa" uniqKey="French F">FA French</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kurth, Le" uniqKey="Kurth L">LE Kurth</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ortman, Hr" uniqKey="Ortman H">HR Ortman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stansbury, Cb" uniqKey="Stansbury C">CB Stansbury</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vig, Rg" uniqKey="Vig R">RG Vig</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rudd, Kd" uniqKey="Rudd K">KD Rudd</name></author><author><name sortKey="Morrow, Rm" uniqKey="Morrow R">RM Morrow</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lauciello, Fr" uniqKey="Lauciello F">FR Lauciello</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sowter, Jb" uniqKey="Sowter J">JB Sowter</name></author><author><name sortKey="Bass, Re" uniqKey="Bass R">RE Bass</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Roberson, Tm" uniqKey="Roberson T">TM Roberson</name></author><author><name sortKey="Heymann, Ho" uniqKey="Heymann H">HO Heymann</name></author><author><name sortKey="Swift, Ej" uniqKey="Swift E">EJ Swift</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schuyler, Ch" uniqKey="Schuyler C">CH Schuyler</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hobo, S" uniqKey="Hobo S">S Hobo</name></author><author><name sortKey="Shillingburg, Ht" uniqKey="Shillingburg H">HT Shillingburg</name></author><author><name sortKey="Whitsett, Ld" uniqKey="Whitsett L">LD Whitsett</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Dent Res J (Isfahan)</journal-id><journal-id journal-id-type="publisher-id">DRJ</journal-id><journal-title-group><journal-title>Dental Research Journal</journal-title></journal-title-group><issn pub-type="ppub">1735-3327</issn><issn pub-type="epub">2008-0255</issn><publisher><publisher-name>Medknow Publications</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21528030</article-id><article-id pub-id-type="pmc">3075452</article-id><article-id pub-id-type="publisher-id">DRJ-6-51</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Functionally Generated Amalgam Stops for Single Complete Denture: A Case Report</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Patil</surname><given-names>Pravinkumar G.</given-names></name><xref ref-type="aff" rid="AF0001">*</xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Parkhedkar</surname><given-names>Rambhau D.</given-names></name><xref ref-type="aff" rid="AF0002">**</xref></contrib></contrib-group><aff id="AF0001"><label>*</label>Lecturer, Department of Prosthodontics, Government Dental College and Hospital, Nagpur, India</aff><aff id="AF0002"><label>**</label>Professor, Department of Prosthodontics, Government Dental College and Hospital, Nagpur, India</aff><author-notes><corresp id="cor1">Correspondence to: Pravinkumar G. Patil, Department of Prosthodontics, Government Dental College and Hospital, GMC Campus, Medical Square, Nagpur (Maharashtra) 440003, India. E-mail: <email xlink:href="pravinandsmita@yahoo.co">pravinandsmita@yahoo.co</email></corresp></author-notes><pub-date pub-type="ppub"><season>Spring</season><year>2009</year></pub-date><volume>6</volume><issue>1</issue><fpage>51</fpage><lpage>54</lpage><history><date date-type="received"><month>12</month><year>2008</year></date><date date-type="accepted"><month>2</month><year>2009</year></date></history><permissions><copyright-statement>© Dental Research Journal</copyright-statement><copyright-year>2009</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0/"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Single complete denture opposing natural dentition is a common occurrence in clinical practice. This article reports a case of a single complete denture with a technique of occlusal refinement by functionally generated amalgam stops condensed in prepared resin teeth after initial balancing of the denture with semi-adjustable articulator. This technique provides intimacy of contact in all excursions by carving the amalgam in plastic stage. Amalgam stops improve the efficiency of the resin teeth. Dentures fabricated using this technique require fewer and simpler post-insertion adjustments.</p></abstract><kwd-group><kwd>Amalgam</kwd><kwd>balanced dental occlusion</kwd><kwd>complete denture</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="sec1-1"><title>Introduction</title><p>Single complete denture (SCD) opposing natural dentition is a common occurrence in clinical practice. Malposed, tipped or supraerupted teeth in the opposing arch is a perplexing problem in achieving a harmonious balanced occlusion in SCD patients.<xref ref-type="bibr" rid="CIT1">1</xref> Balanced occlusion is a bilateral, simultaneous, anterior, and posterior occlusal contact of teeth in centric and eccentric positions.<xref ref-type="bibr" rid="CIT2">2</xref> It is developed for stability of denture bases in relation to supporting structures during functional and parafunctional movements.<xref ref-type="bibr" rid="CIT3">3</xref>–<xref ref-type="bibr" rid="CIT5">5</xref> Lack of occlusal balance may lead to denture instability, mucosal soreness, tissue changes and accelerated ridge resorption. Various techniques have been described to achieve a balanced occlusion in SCD patients.<xref ref-type="bibr" rid="CIT1">1</xref><xref ref-type="bibr" rid="CIT6">6</xref>–<xref ref-type="bibr" rid="CIT9">9</xref> It falls into two categories as follows: 1) those that dynamically equilibrate the occlusion by the use of a functionally generated path and 2) those that statistically equilibrate the occlusion using an articulator programmed to simulate the patient’s jaw movement. The functionally generated chewin techniques seem to provide the most accurate method of recording occlusal patterns.<xref ref-type="bibr" rid="CIT1">1</xref> Another problem with SCD is attrition of denture teeth if resin teeth are used and attrition of natural teeth if porcelain is used. In this situation, gold occlusals, interpenetrating polymer network (IPN) and resin teeth with amalgam stops have been tried as occlusal posterior tooth forms.<xref ref-type="bibr" rid="CIT1">1</xref><xref ref-type="bibr" rid="CIT9">9</xref> Amalgam stops wear less and cause less wear of opposing natural teeth.<xref ref-type="bibr" rid="CIT10">10</xref> Amalgam is less expensive than porcelain, IPN or gold occlusals. Also, amalgam stops have been described as improving the efficiency of the resin teeth.<xref ref-type="bibr" rid="CIT10">10</xref> This article describes a technique of occlusal refinement by functionally generated amalgam stops after initial balancing of SCD with articulator generated pathway.</p></sec><sec sec-type="cases" id="sec1-2"><title>Case Report</title><p>A 65 year-old male patient was presented in the department of prosthodontics with a completely edentulous mandibular arch and completely dentulous maxillary arch. A SCD was fabricated in the usual manner.<xref ref-type="bibr" rid="CIT1">1</xref> A balanced occlusion was achieved with acrylic resin teeth (Acryrock, Ruthinium Group Dental Manufacturing, Badia Polesine, Italy) using semi-adjustable articulator (<xref ref-type="fig" rid="F0001">Figure 1</xref>).<xref ref-type="bibr" rid="CIT1">1</xref><xref ref-type="bibr" rid="CIT9">9</xref> At the denture delivery appointment, a new centric relation interocclusal record was made and occlusal adjustments were carried out by remounting the processed SCD on the semi-adjustable articulator. Occlusal equilibration was also achieved in patient’s mouth by selective grinding procedure. Centric as well as eccentric occlusal contacts were marked intraorally with the help of articulating paper by asking the patient to perform all functional jaw movements (<xref ref-type="fig" rid="F0002">Figure 2</xref>). Occlusal preparations (1.5-2 mm in depth) were carried out in premolar and molar denture teeth, using inverted cone diamond bur extending to include as much of the articulating paper tracing as possible and sparing thin borders of the tracing areas to maintain vertical dimension (<xref ref-type="fig" rid="F0003">Figure 3</xref>). A mix of amalgam was triturated according to the manufacturer’s directions. Amalgam was then condensed into the occlusal preparations with the help of amalgam condenser. Preparation should be overpacked 1 mm or more using heavy pressure to ensure margins completely covered with well-condensed amalgam.<xref ref-type="bibr" rid="CIT11">11</xref> Denture was placed into patient’s mouth and the patient was directed to close with tapping action on the teeth in centric relation and to perform all eccentric movements in order to carve the condensed amalgam (<xref ref-type="fig" rid="F0004">Figure 4</xref>). In this situation, the vertical relation at occlusion was maintained by unprepared borders of tracing areas. Excess amalgam removed with the help of high volume evacuator. Patient was instructed to continue all functional movements of the jaw until initial setting of the amalgam occurred. Excess amalgam was removed again and occlusal pattern was examined for deficient margins. The denture was delivered (<xref ref-type="fig" rid="F0005">Figure 5</xref>) and postinsertion instructions were given. The patient was recalled after 24 hours. Amalgam stops were polished by an amalgam polishing kit.<xref ref-type="bibr" rid="CIT11">11</xref> The patient was followed up at periodic recall appointments and the last recall visit was after 2 years. The amalgam occlusal stops had a highly smooth and shiny surface (<xref ref-type="fig" rid="F0006">Figure 6</xref>). There was no noticeable clinical evidence of enamel wear of opposing natural teeth. The loss of vertical dimension was clinically insignificant. The patient used the denture with great functional comfort for 2 years (<xref ref-type="fig" rid="F0007">Figure 7</xref>).</p><fig id="F0001" position="float"><label>Figure 1</label><caption><p>Use of programmed articulator to achieve balanced occlusion with mandibular trial SCD.</p></caption><graphic xlink:href="DRJ-6-51-g001"></graphic></fig><fig id="F0002" position="float"><label>Figure 2</label><caption><p>Marking centric and eccentric records</p></caption><graphic xlink:href="DRJ-6-51-g002"></graphic></fig><fig id="F0003" position="float"><label>Figure 3</label><caption><p>Occlusal preparations (note borders of the tracing areas are spared)</p></caption><graphic xlink:href="DRJ-6-51-g003"></graphic></fig><fig id="F0004" position="float"><label>Figure 4</label><caption><p>Final functionally generated occlusal pattern developed in amalgam</p></caption><graphic xlink:href="DRJ-6-51-g004"></graphic></fig><fig id="F0005" position="float"><label>Figure 5</label><caption><p>Single complete denture in use</p></caption><graphic xlink:href="DRJ-6-51-g005"></graphic></fig><fig id="F0006" position="float"><label>Figure 6</label><caption><p>Occlusal view of the SCD after two years.</p></caption><graphic xlink:href="DRJ-6-51-g006"></graphic></fig><fig id="F0007" position="float"><label>Figure 7</label><caption><p>Final functionally generated occlusal pattern developed in amalgam</p></caption><graphic xlink:href="DRJ-6-51-g007"></graphic></fig></sec><sec sec-type="discussion" id="sec1-3"><title>Discussion</title><p>The major disadvantage of acrylic teeth used in SCD opposing natural dentition is rapid wear on occlusal surfaces. This affects the vertical dimension of occlusion and tooth relationships, and results in increased horizontal stresses and their associated sequelae.<xref ref-type="bibr" rid="CIT12">12</xref> The rate of wear also depends on the patient’s functional and parafunctional habits. Inserting amalgam stops into the resin occlusal surfaces slows down and controls this wear.<xref ref-type="bibr" rid="CIT1">1</xref><xref ref-type="bibr" rid="CIT9">9</xref><xref ref-type="bibr" rid="CIT10">10</xref></p><p>This article describes a case report of a SCD patient with a technique of occlusal refinement by functionally generated amalgam stops condensed in prepared resin teeth after initial balancing of the denture with semi-adjustable articulator. The amalgam stops can be carved either on the programmed articulator or directly in the patient’s mouth. The amalgam stops generated on the programmed articulator are carved according to the articulator movements guided by condylar and incisal guidance. The programmed articulator cannot perfectly copy patient’s mandibular movements as there may be a positive or negative error in the articulator adjustment.<xref ref-type="bibr" rid="CIT13">13</xref> Also, one or more mechanical limitations of the articulators like straight condylar path, fixed intercondylar distance, mechanical incisal guide table, or accuracy and stability of eccentric records prevent exact simulation of mandibular movements.<xref ref-type="bibr" rid="CIT13">13</xref> Hence, the balanced occlusion (achieved with articulator-generated amalgam stops) ultimately needed to be refined in patient’s mouth by selective grinding procedure in the end. The functionally generated path technique described in this article carves the amalgam in plastic stage directly in the patient’s mouth. Thus, the intimacy of contact in all excursion is possible and need not to be refined by selective grinding procedure (which is required in articulator generated path technique). TThis technique is less time consuming and more accurate than articulator-generated amalgam stop technique. But, if the denture bases do not have intraoral stability or if the patient is physically unable to form a chew-in record, the articulator-generated path technique will be preferred. The occlusion developed with a functionally generated amalgam stop technique provides a simple and inexpensive procedure to establish a balanced occlusion with extended wear capabilities. The functionally generated path in amalgam insert is in harmony with the patient’s mandibular movements and is an exceptionally smooth, efficient and comfortable balanced occlusion. Dentures fabricated using this technique require fewer and simpler postinsertion adjustments. The only disadvantage using amalgam stops (either articulator or functionally generated) is their esthetic unacceptance.</p></sec></body><back><ack><p>Authors wish to thank Dr. Smita P. Patil and Dr. Rahul S. 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id="CIT13"><label>13</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hobo</surname><given-names>S</given-names></name><name><surname>Shillingburg</surname><given-names>HT</given-names><suffix>Jr</suffix></name><name><surname>Whitsett</surname><given-names>LD</given-names></name></person-group><article-title>Articulator selection for restorative dentistry</article-title><source>J Prosthet Dent</source><year>1976</year><volume>36</volume><issue>1</issue><fpage>35</fpage><lpage>43</lpage><pub-id pub-id-type="pmid">787498</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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