Chairside technique for addition of teeth to an acrylic partial denture. A clinical report

Abstract

This article describes a chairside technique of addition of teeth to a patient's existing acrylic partial denture at the extraction appointment without the need for dental laboratory intervention. This maintains aesthetics, function, phonation, biologic integrity, patient confidence, and psychological well-being.

An immediate denture is any fixed or removable dental prosthesis fabricated for placement immediately after the removal of a natural tooth/teeth [1,2]. Immediate dentures have many advantages over conventional dentures including conservation of patient's integrity, aesthetics, functionality, soft tissue support and occlusion [2-4]. Immediate dentures require several visits with associated costs and the patient has a period of adjustment to the new prosthesis. This clinical report describes a simple and fast technique of chairside immediate tooth addition to an existing denture avoiding some of these issues.

A 65-year-old woman was referred for a pre-radiotherapy dental assessment for management of T2N0 oropharynx and base of tongue squamous cell carcinoma. After a comprehensive clinical and radiographic examination, it was decided that two maxillary teeth required extraction. The patient had a well-fitting maxillary acrylic partial denture as a removable replacement for her natual teeth [[1], [2]]. To facilitate prompt commencement of radiotherapy, a decision was made to extract these teeth and complete an immediate chairside addition of teeth to her existing acrylic partial denture (Fig. 1). Ethical approval was sought by the Dublin Dental University Hospital ethics board but was not required as it is a previously conducted treatment technique in the patient's best interest and did not involve experimental tools/medicine/materials. Written informed consent for this procedure was gained from the patient.

Fig. 1.

Pre-operative orthopantomogram.

1. Clinical report

1. The maxillary acrylic partial denture was placed in situ. If required, retention could be improved by clasp activation (if clasps present) or the use of a denture adhesive (Fig. 2A–C).

Fig. 2.

Baseline clinical presentation. A, Patient's existing maxillary acrylic partial denture. B, Partially dentate maxillary arch. C, Maxillary partial denture in situ.

2. An elastomeric impression was made by using a full arch stock tray with the denture in situ. Once set, the impression and denture were removed together and appropriately disinfected (Fig. 3).

Fig. 3.

Pick-up polyvinylsiloxane impression.

3. Any excess impression material between the denture and impression of the teeth requiring extraction was removed with a number 11 scalpel (Fig. 4A). It is advisable to retain impression material in the interproximal gingival area of teeth to be retained. This blocks undercuts and prevents acrylic from flowing into this area. Mechanical grooves were made on the denture's fitting surface adjacent to the planned addition site to enhance retention (Fig. 4B).

Fig. 4.

A, Removal of excess impression material with scalpel. B, Grooves added onto denture intaglio for mechanical retention of acrylic resin.

4. After tooth extraction, sponge plugs were inserted to protect the sockets and control healing. Adjacent teeth were lubricated with a smear of petroleum jelly (Fig. 5).

Fig. 5.

Post extraction of maxillary right second molar and left first premolar.

5. A tooth-colored self-cured acrylic resin (SNAP Self-Cure Acrylic, Parkell Inc.) was mixed and placed in areas of the extracted teeth and the retention grooves. The denture was wet with monomer before filling the tooth mold to the gingival margin level (Fig. 6A and B).

Fig. 6.

A, Tooth colored acrylic resin poured into indentation of extracted teeth. B, Close up showing acrylic resin in grooves on denture intaglio.

6. The denture and impression were inserted into the mouth to allow preliminary polymerization of the acrylic resin. It can also be allowed to set chairside, outside the mouth. Placing the denture in warm water expedites the polymerization process. Once polymerized, the denture was removed from the impression, finished, polished and re-fitted into the patient's mouth and occlusion adjusted (Fig. 7).

Fig. 7.

Denture with chairside tooth additions in-situ.

7. The patient was reviewed one week post operatively. She reported that the denture with additions was very comfortable (Fig. 8). Clinical examination showed satisfactory healing of the extraction sockets.

Fig. 8.

Denture with chairside tooth additions in-situ.

8. The patient was scheduled for definitive prosthesis fabrication three months after completion of her radiation therapy.

2. Discussion

Immediate tooth addition to a denture is an excellent treatment option. This technique makes use of materials and procedures routinely used in general practice. The patient avoids the inconvenience and embarrassment of being without a denture if it is sent to a dental laboratory. It is also particularly beneficial to head and neck cancer patients where treatment is time sensitive and their ability to return to the dental clinic is limited by their other hospital appointments and radiation and chemotherapeutic complications. In addition, the added teeth are the same shape as those extracted, and occlusal adjustments are minimal if needed. Patients adapt very easily to the additions.

Since Payne described his technique for transitional denture fabrication in 1964 [3], various techniques of immediate denture fabrication have been described with several modifications in the literature. The main drawback with conventional tooth addition techniques to an existing partial denture is the absence of the denture for the patient while the laboratory work is performed. While fabricating a new immediate denture is an option, there are financial costs, and the patient must then adapt to a newly fitted prosthesis during a highly stressful and potentially morbid stage in their life. This technique avoids such problems.

The technique described in this paper is very convenient for the patient with extraction and addition possible in one clinic visit. It is quick and patients adapt easily to their adjusted existing prosthesis avoiding having to adapt to a new denture base [4,5,[6], [7], [8], [9], [10], [11]]. It is a simple chairside procedure that completely eliminates the need for dental laboratory access, resulting in patient convenience, fewer clinic visits, and reduced cost [[6], [7], [8], [9], [10], [11]]. Although Devlin et al. [12] recognized the above obstacles in his described technique with a sectional impression, his technique lacked simplicity and needed access to a laboratory to finish the denture. Eliminating the laboratory step reduces both time and cost.

Similar to other addition methods used in the past [12], the described technique can accommodate a sectional impression tray that has better tolerance then a full-sized stock tray. This is particularly advantageous in patients with a hypersensitive gag reflex or limited mouth opening. An irreversible hydrocolloid may be used as a less expensive, faster setting impression material. The technique in this article provides immediate compression to a fresh extraction socket which helps to accelerate healing [7]. The risks of several post-extraction complications are reduced including alveolar osteitis and post extraction bleeding. This technique can also be adapted for addition of teeth to chrome frameworks.

This technique has some limitations. The planned tooth for addition ideally should have good contour, alignment and not cause occlusal interference. The technique described above cannot be used if the extracted tooth is not in direct proximity to the denture's acrylic. This would necessitate additional steps. Finally, this will not improve retention in a poorly retained denture.

3. Summary

In conclusion, the technique described in this paper overcomes many disadvantages of conventional techniques. It is simple, cost effective, time saving, and patients adapt easily to the addition. It uses the patient's existing denture and exactly matches the anatomy of the extracted teeth. There are less adjustments required, and it provides an immediate plug/protection to the fresh extraction site, hence accelerating healing. This was particularly beneficial for the pre radiotherapy patient who required timely extractions and benefited from immediate replacement of the extracted teeth.

Author contribution statement

Sittana Elfadil: performed the experiments and wrote the paper.

Ahmed Kahatab: analyzed and interpreted the data and wrote the paper.

Eabha Cronin: contributed reagents, materials, analysis tools or data and wrote the paper.

Aisling O'Mahony: conceived and designed the experiments.

Data availability statement

Data will be made available on request.

Declaration of competing interest

The manuscript has not been submitted to any other journal. We declare no conflict of interest. The manuscript has been read and approved by all authors.