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Managing the unstable mandibular complete denture – tooth placement and the polished surface Peter Clarke A Johanna Leven Callum C Youngson Dental Update 2024 43:7, 707-709.
Authors
PeterClarke
DCT in Restorative Dentistry, Liverpool University School of Dentistry, Pembroke Place, Liverpool L3 5PS, UK (pete.t.clarke@gmail.com)
Constructing satisfactory conventional mandibular complete dentures is often challenging in comparison to the upper counterpart partially due to differences in the anatomy of the denture-bearing area. This problem is exaggerated in the atrophic mandible, where supporting structures are frequently ill-defined and suboptimal in quality. Implant-retained prostheses offer well recognized benefits but are not always a feasible options, so conventional methods must be relied upon. The importance of impression quality and registration has been reviewed previously. This article aims to discuss the influence of tooth placement, the polished surfaces and the neutral zone on the success of lower dentures.
CPD/Clinical Relevance: This article highlights the importance that polished surface contouring and tooth prescription can have on the outcome of lower dentures. Techniques for assessing and recording the neutral zone are explained, along with alternative occlusal schemes.
Article
Almost every practising dentist will be aware of the problems and challenges that arise when trying to provide a mandibular complete denture successfully. In comparison to the upper arch, the anatomy is less favourable and the patient may have previously had a satisfactory upper denture paired with a number of unsuccessful lower counterparts. This is an all too common scenario and most of the emphasis of previous articles relates to the importance of impression techniques and jaw registration. This paper aims to discuss some of the elements surrounding the polished and occlusal surfaces when managing the less stable mandibular complete denture.
In 2009, it was recorded that 6% of the English population wore complete dentures1 and it has been estimated that a third have difficulty wearing mandibular dentures satisfactorily.2 This equates to approximately one million patients. In a number of these cases, the lower denture-bearing area is grossly resorbed with little height or width from which to gain stability or retention. Managing these patients can often be extremely difficult and the outcome is not always favourable. The literature surrounding the prognostic indicators of mandibular complete denture success has been reviewed in detail elsewhere, along with options and clinical tips to help overcome these issues.3,4
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