Liquid supported denture-management of flabby ridges
A 52 year old female patient reported to K. V. G. dental college and hospital for replacement of missing teeth. The patient had a history of wearing a maxillary complete denture for 4 years. Her chief complaint was the poor fit of the denture and it felt loose while eating. She was also using denture adhesive. Missing mandibular teeth were not replaced by any prosthetic treatment. By intraoral examination, a completely edentulous maxillary arch with flabby tissue existing in the anterior region [] and a partially edentulous mandibular arch (Kennedy's Class II) were observed.\nKeeping the various challenges associated with the case, clinical steps and treatment plan was modified to suit the patient's need. It was decided to give a maxillary complete denture (liquid supported) opposing a mandibular cast partial denture.\nPrimary impressions were made with irreversible hydrocolloid (Zelgan 2002; Dentsply DeTrey GmbH, Konstanz, Germany). On the maxillary cast, a special tray was made. Border molding was performed by using low fusing impression compound (DPI pinnacle tracing sticks, Dental products of India)) and medium body addition silicone wash impression (Aquasil, Dentsply/caulk) was made. The flabby tissue was marked in the mouth and transferred on the tray. This area on the tray was cut to form a window to expose the flabby tissue. It was recorded in rest position by injecting light body addition silicone material (Aquasil, Dentsply/caulk). Jaw relation record and trial of waxed up denture was done by conventional method.\nFor the mandibular impressions, a cast framework replacing the missing teeth was fabricated, tried and adjusted. An altered cast impression technique was used to get the master cast. Jaw relations were recorded. Face bow transfer was made and casts were mounted. Teeth were set and the try in procedure of the waxed denture was done.\nThe upper denture design was modified to make a liquid supported denture. Lower cast partial denture was acrylised using conventional procedure.\nVacuum heat pressed polyethylene sheet (Biostar vacuum forming machine, Scheu-dental, Germany) of 1.5 mm thickness was adapted on the master cast. The sheet was cut 2 mm short of the sulcus and was not extended in the posterior palatal seal area []. Now denture was acrylised using heat cure resin along with sheet. Finishing and polishing of the denture was done and its checked in patient's mouth for retention, stability, support and border extension. Patient was asked to wear the denture for at least of two weeks so she can get adjusted to new denture. At recall appointment, the 1.5 mm thick sheet which was used as a spacer was removed from the denture. Due to removal of the sheet crevices were formed all along the denture borders. These crevices were helpful in final placement of 0.5 mm thick sheet. An addition silicone putty impression was made of the tissue surface of the denture and cast was made of it. This was done to record the exact junction of the sheet to the denture. On this cast a 0.5 mm thick polyethylene sheet was vacuum pressed which was used in place of 1.5 mm thick sheet creating a 1 mm space. The borders of the 0.5 mm thick sheet were placed in the crevice formed due to removal of 1.5 mm thick sheet. Cyanoacrylate adhesive and autopolymerizing acrylic resin were used to seal the borders and prevent escape of liquid []. Glycerine was filled in this space by making two holes in the buccal flange area of the denture and injecting it through these holes and checking the vertical dimensions simultaneously. The holes were sealed using self-cure acrylic resin. Finally the upper liquid supported denture was delivered []. Denture care instructions were given to the patient. Patient was told to clean the tissue surface using soft brush and recalled for follow up.