Prosthetic Management of Prominent Premaxilla with Flangeless Complete Denture: A Case Report

INTRODUCTION

One's social acceptance is determined by their face. The loss of teeth frequently causes a patient to experience severe psychological trauma and has an impact on their face appearance. There are some fundamental objectives to be accomplished for restoring facial attractiveness.¹ In a person with no teeth at all the form and shape of residual alveolar ridges can vary, ranging from heavily resorbed to widely massive ridges. When both soft and hard tissues are not taken into optimum biological consideration, making a complete denture might be difficult.² A labially proclined maxilla with the presence of an associated undercut is the problem most frequently compromising the aesthetics and construction of a complete denture. Extremely pronounced alveolar ridges with labial undercuts are more frequently found in the maxilla than the mandible as a result of differential resorption patterns of the remnant alveolar ridge.

One such condition is a proclined maxilla with an associated undercut. Surgery is required to reduce tissue undercuts that range in severity from mild to severe. Pre-prosthetic procedures, such as removing severe undercuts with the least amount of bone removal and preventing the loss of the bony cortical plate, are thought to be crucial in preparing the mouth for denture construction.^3,4,5 Due to patients' lack of motivation, it is not always possible to use reconstructive surgical treatment. The surgical rehabilitation is hampered by systemic disorders such as uncontrolled diabetes mellitus, hypertension, and cardiac conditions.⁶

This article aims to give case studies demonstrating a minimally invasive method of creating flangeless dentures for patients with a proclined anterior maxillary ridge and associated undercut.

CASE REPORT

The main complaint of a 62-year-old male patient who visited the prosthodontics department was that he had difficulty speaking and eating because of teeth that were missing and that he wanted to replace them. Extra oral examination revealed that the patient had a convex profile, an oval face with a tapering chin, and sufficient support and fullness in the maxillary lips (Fig. 1). The patient had a proclined anterior maxillary ridge, along with a severe labial undercut, according to an intraoral examination. (Fig 2).

TECHNIQUE

The primary impression of the maxillary and mandibular arches were made using impression compound. The primary cast (Dental Plaster Class II) was used to fabricate custom trays using DPI RR cold cure. Greenstick compound (DPI Pinnacle tracing sticks) was used for border molding, and light body polyvinyl siloxane was used for the final wash impression. Jaw relation was completed once the master cast (type III dental stone) was ready (Fig 3). The trimming of denture base in the labial prominence area result in direct contact between the lips and the ridge, which ultimately reduced the labial fullness.

Articulation was done and teeth setting were completed and try-in was done (Fig 4). Heat-cure acrylic resin was packed and curing done according to conventional procedures.

When the final flangeless denture was polished and tried in the patient's mouth for evaluation, occlusal corrections were made, the denture was delivered, and the patient was evaluated 24 hours, a week, and one month later for post-insertion visits. The patient was satisfied and had no significant complaints (Fig 5).

DISCUSSION

A thorough diagnosis is a crucial component of the ideal treatment strategy. A fantastic prosthesis can be achieved with the right course of treatment. Living up to patient expectations by giving consideration to their wishes is one of the clearest indicators of improvement. The anatomy of the residual ridge differs from patient to patient.⁷ Patients with excessively thick ridges frequently have poor facial aesthetics. The labial fullness is further harmed by the thickness of the labial flange, which leads to an unsightly maxillary denture. The preservation of face aesthetics is just as important as replacing lost teeth with prosthetics.

The replacement of a prosthetic is heavily influenced by facial and dental aesthetics. Any prosthesis must also have functional integrity in addition to aesthetic appeal. Soft liners are one of the more conservative ways to use undercuts without having to sacrifice them to surgical intervention.^8,9 The liners flexibility allows them to be quickly removed and inserted in severely undercut areas without causing tissue trauma, in addition to evenly distributing the functional load and preventing local stress concentrations. In the near future, surgical undercut removal will be less popular due to advancements in soft liners because they can last long.¹⁰

Hard tissue undercuts, which are obtained buccolingually and are the most prevalent mechanical means of retention in completely edentulous patients, have a detrimental effect on the retention of the prosthesis. One of the conventional non-surgical methods for preserving the ridge is a flangeless denture.

This has also been referred to as "ridge grip aesthetic prosthesis" and "gum fit dentures" by many authors.¹¹ This is referred to as a "wing denture" by some authors, where the labial flange is segmented in the labial frenum region and two wings appear from either side, leaving enough room for the labial frenum.^12,13

CONCLUSION

This clinical report outlines the creation of a flangeless denture using an affordable, quick, and simple method for the rehabilitation of a proclined maxillary ridge with labial undercut. Thus, nonsurgical techniques can be used to create the prostheses because they are noninvasive, offer better patient acceptance, and result in greater patient satisfaction. Regarding insertion, removal, and functionality, the patient found the flangeless denture to be convenient.

REFERENCES