Case Report

Hollow Maxillary Denture: A Simplified Approach

Saurabh Chaturvedi, A.K. Verma, Mariyam Ali, Preeti Vadhvani
Department of Prosthodontics and Crown and Bridges, Career Post Graduate Institute of Dental Sciences and Hospital,
Lucknow-226060

(Received November, 2011) (Accepted July, 2012)

Abstract:
It is the dentist’s responsibility to fabricate a prosthesis incorporating stability, retention and support which
ultimately provide satisfaction to the patient. But in the critical conditions such as long lip length or severely resorbed
ridges with increased inter arch distance, the weight of a maxillary denture is often a dislodging factor. Hence, a light
weight denture is required for better retention. This article describes a case of completely edentulous patient successfully
rehabilitated with a hollow denture where a simplified technique of fabricating a light weight maxillary denture was used.

Key Words: Complete denture, hollow maxillary denture, inter ridge distance, light weight denture, residual
ridge resorption.

Introduction: wrapped asbestos (Worley & Kniejski, 1983), silicone

Extreme resorption of the maxillary denture putty (Holt, 1981) or modelling clay (DaBreo, 1990)
bearing area may lead to problems with prosthetic during laboratory processing to exclude denture base
rehabilitation. These may be due to narrower, more material from the planned hollow cavity of the
constricted residual ridge as resorption progresses, prosthesis.
decreased supporting tissues and a resultant large Holt (1981) processed a shim of indexed acrylic
restorative space between the maxillary and mandibular resin over the residual ridge and used a spacer which
residual ridge. Long lip length adds to this problem. was then removed and the two halves luted with auto
This may result in a heavy maxillary denture that may polymerized acrylic resin.
further compound the poor denture-bearing ability of Fattore et al (1988), used a variation of the
double flask technique for obturator fabrication by
the tissues and lead to decreased retention and
adding heat polymerized acrylic resin over the definitive
resistance (O’Sullivan et al, 2004).
cast and processing a minimal thickness of acrylic resin
The dentist should use his specialized training
around the teeth using different drag. Both portions of
and prosthetic abilities to overcome the above stated
resin were attached using a heat polymerized resin.
problems with simple techniques. To decrease the
O’Sullivan et al (2004) described a modified
leverage, reduction in the weight of the prosthesis would
be beneficial (Brown, 1969l; el Mahdy, 1969). It method for fabricating a hollow maxillary denture. A
improves the cantilever mechanics of suspension and clear matrix of the trial denture base was made. The
overtaxing of the remaining supporting structures. trial denture base was then invested in the conventional
In this case report, edentulous old male patient manner till the wax elimination. A 2mm heat polymerized
with increased inter-ridge distance and long lip length acrylic shim was made on the master cast, using a
was treated with a hollow maxillary denture, fabricated second flask. Silicone putty was placed over the shim
using Dental Plaster & Pumice (Prevest Denpro Ltd., and its thickness was estimated using a clear template.
Jammu)-Sugar syrup paste which is water soluble and The original flask with the teeth was then placed over
can be readily removed without any difficulty. the putty and the processing was done. The putty was
Various weight reduction approaches have later removed from the distal end of the denture and
been achieved using a solid three dimensional spacer, the openings were sealed with autopolymerizing resin.
including dental stone (Ackermen, 1955), cellophane The technique was useful in estimation of the
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spacer thickness, but removal of the putty was found
Co rrespo nding Author: Dr. Preeti Vadhva ni, Department of to be difficult especially from the anterior portion of
Prosthodontics, Career Post Graduate Institute of Dental Sciences the denture. Moreover, the openings made on the distal
& Hospital, Lucknow-226060
Phone No.: 07800722615
end had to be sufficiently large to retrieve the hard
E-mail : [email protected] putty.

People’s Journal of Scientific Research 47 Vol. 5(2), July 2012

Hollow Maxillary Denture: A Simplified Approach --------------------- S. Chaturvedi, A.K. Verma, M. Ali & P. Vadhvani

Case Report: were processed in the standard manner upto the wax
A 55year old male patient reported to the elimination stage (Fig. IIa). The maxillary trial denture
base was sealed (on the definitive cast) with the
Department of Prosthodontics with the chief complaint
modelling wax and a second flask was used to invest
of difficulty in chewing food and heaviness in his upper
the modelling wax till the wax elimination stage. The
denture. History revealed that patient was edentulous
cope (upper half of the flask/cavity side) was packed
for past 18 years and had used many sets of complete
and processed with heat polymerizing resin (Trevalon,
dentures. On examination, it was found that patient
Dentsply, Gurgaon). This permanent record base was
was dolicocephalic. Both maxillary and mandibular
left undisturbed on the master cast (Fig. IIb).
ridges were severely resorbed. His upper lip was long,
Dough of Dental Plaster-Pumice and Sugar
the inter-ridge distance was more than normal and
syrup was made and rolled. It was then placed over
vertical dimension of occlusion(VDO) and vertical
the heat cure record base (it acted as a spacer) (Fig.
dimension at rest (VDR) were more than average (Fig.
IIIa). To harmonise the space for heat cure resin, strips
I). The previous denture of the patient was heavy with
of modelling wax was placed on the ridge lap area of
attrited teeth and was under extended. Hence, it was
acrylic teeth including the buccal and palatal surface
decided to fabricate a new set of denture for the patient.
in the cope (Fig. IIIb). The two halves of the flask
The treatment options for complete denture available
were closed and then reopened. The thickness of the
to the patient were:
wax was then assessed with the help of the wax gauge
a. Implant supported complete denture
and necessary modifications were done(spacer material
b. Conventional Complete denture
was scraped wherever the wax was exposed or thinned
c. Hollow maxillary complete denture and conven-
out). This process was further repeated till the uniform
tional mandibular complete denture.
After analysing each available option, it was
decided to fabricate hollow maxillary complete denture.
The patient also approved of the treatment modality as
it was light in weight, inexpensive and non-surgical
procedure.

Fig. II: Interchangable flasks: (a) Dewaxed flask; (b)Permanent

Fig. I: Preoperative extraoral profile view. record base.

Technique:
Preliminary and final impressions were made
in conventional manner. At the time of jaw relation due
consideration was given to adjust maxillary occlusal
rims properly as to provide proper aesthetics to the
patient with long upper lip. Teeth were selected and
arranged in balanced occlusion and try-in was done
first for anterior teeth and then for posterior teeth.
For making the Maxillary denture hollow
Fig. III: (a) Dou gh of Dental Pla ster-Pumice & Suga r syru p;
interchangeable flasks were used. The trial dentures (b) Adapted gauged wax strip

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Hollow Maxillary Denture: A Simplified Approach --------------------- S. Chaturvedi, A.K. Verma, M. Ali & P. Vadhvani

thickness of the wax was achieved and thus ensured

uniform space of 1.5-2mm for the heat cure acrylic
resin.
Wax strip was then removed from the acrylic
teeth. The heat polymerizing resin was then mixed,
packed and processed for 7-8 hours (as per the
manufacturer ’s instructions). After curing, lab-
remounting was done and the processing errors were
corrected.
Two small openings were made with a bur into
the denture base distal to most posterior teeth to remove
Fig. V: Post operative Frontal view.
the spacer (Fig. IVa). The Dental Plaster- Pumice- -
Sugar syrup paste was then removed by scraping and duration treatment procedure and unwillingness for any
putting it in water (dough dissolves easily in water). kind of surgical procedure. Hence, the best way is to
The cavity was cleaned and disinfected. Later, these rehabilitate them with the conventional way. Apart,
openings were closed with the autopolymerizing resin from modifying the impression technique to get
(Trevalon,Dentsply,Gurgaon) in dough stage(Fig. IVb). maximum denture bearing area, modifying the type of
The dentures were then polished in usual manner. The denture may also be better accepted by the patient
sealing of the cavity was then verified by placing it in (Kalavathy et al, 2010).
water and checked for any bubbles(Fig. IVc). The In general, a conventional (heavy) denture
dentures were inserted in the patient’s mouth and whether maxillary or mandibular is likely to cause poor
instructions were given (Fig. V). denture bearing ability. Extensive volume of the denture
base material in prosthesis provided to patients with
large maxillofacial defects or severe residual ridge
resorption is always a challenge to prosthodontists. To
increase the retention and stability of heavy prosthesis,
many methods have been tried like utilising the
undercuts, modifying the impression technique, use of
magnets, use of implants, etc (Kalavathy et al, 2010).
The prosthodontic treatment plan chosen for this patient
was based on several findings noted during case history
and examination. Resorbed residual ridge (compounded
with long lip) length resulted in increased interridge
distance. If conventional maxillary denture was
constructed then it would have resulted in increased
weight of the maxillary denture that may result into
resorption of maxillary edentulous foundation at a higher
rate.
Reducing the weight of maxillary prosthesis,
however, has been shown to be beneficial when
Fig. IV: (a)Denture with open channels for spacer removal; (b) Sealed constructing prosthesis for rehabilitation of edentulous
channel; (c)Light weight hollow denture
patient. This can be achieved by making the maxillary
Discussion: denture hollow.
Rehabilitation of patient with severely resorbed The method in this case report has advantages
ridges and long lip length is a challenge to the dentist. over previously described techniques for the hollow
Even though, the choice for rehabilitation can be denture fabrication. Plaster-Pumice-Sugar syrup
implant supported overdenture, and ridge augmentation readily dissolves in water and can be easily removed,
but many a times the patient who come with such a unlike the tedious efforts made to remove putty from
problem are geriatric patients with systemic illness, the denture especially from the anterior region.
economic constrains, possess reluctance for a long Moreover, the openings made for spacer removal was

People’s Journal of Scientific Research 49 Vol. 5(2), July 2012

Hollow Maxillary Denture: A Simplified Approach --------------------- S. Chaturvedi, A.K. Verma, M. Ali & P. Vadhvani

also small compared to the openings made for the other

varieties of spacer used. The thickness of the resin Source of Support : Nil.
Conflict of Interest: None declared.
can be controlled by adapting an even thickness of wax
sheet all around after measuring it with wax gauge.
This will ultimately ensure even depth of resin to
prevent seepage and prevent deformation under
pressure of flask closure.
The advantages of hollow dentures are
reduction in the excessive weight of the acrylic resin,
resulting in the lighter prosthesis making the patient
more comfortable.

Summary:
Hollow maxillary denture is the best method
of rehabilitating the patient with severely resorbed ridge
and long lip length. It not only reduces the weight of
the denture but also the leverage action of the same.
This ultimately results in increased retention and stability
and upto some extent it is also possible to preserve the
existing residual alveolar ridge. This technique is simple
to execute and allows control of spacer thickness. Light
denture weight for healthy and comfortable living.

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People’s Journal of Scientific Research 50 Vol. 5(2), July 2012