pre maxilla

Evaluation of open-face maxillary
complete denture for patients

with prominent premaxilla:
a crossover study
Haitham A. Ismail1* , Muhammed B. El‑Danasory2 , Salma
Abolgheit3 and Ingy S. Soliman4
PRESENTED BY
Y. MANJUSHA
Dept. of prosthodontics and

crown and bridge
CONTENTS
1. INTRODUCTION
2. MATERIALS AND METHODS
3. RESULTS
4. DISCUSSION
5. CONCLUSION
6. REFERENCES
INTRODUCTION
SYNONYMS
Open-faced dentures,
gum fit dentures,
ridge grip aesthetic prosthesis
wing denture,
INTRODUCTION
• In prosthodontics during complete denture fabrication, we

have to come across different types of ridge anatomy.
• Ridge anatomy may differ from patient to patient from
massive ridges to severely resorbed ridges.
• Complete dentures gives more esthetic appearance if its labial
fullness is accurate.
• Its very challenging to fabricate the complete denture when
the ideal biological consideration of both hard and soft tissues
are not fullfilled.
• Labially proclined maxilla with associated undercut -
effects the esthetics and fabrication of complete denture.
• Sometimes prior to the construction of a complete denture

there are some abnormal conditions which can be corrected
by surgically, but that is not always possible.
• It is also essential to differentiate certain systemic

conditions or syndromes that incapacitate the individual
from using his surrounding musculature to aid in holding
the prosthesis.
• The open-face denture Conservative non-surgical
management for patients having prominent premaxilla. It
can preserve good facial esthetics by eliminating excessive
labial fullness.
• Muller Devan’s dictum (1952) has greatly stated that “The

preservation of that, which remains is more important and
not the meticulous replacement of what is lost”.
Preprosthetic alveoloplasty
Increases morbidity
use of resilient
design of open-
Not always feasible for the geriatrics. denture base
face dentures
materials
Compromise denture-supporting tissues.

allow extending the
denture flanges into
the undercuts
achieving maximum
retention
MATERIALS AND METHODS
• Prospective, Double-blinded, Randomized controlled clinical trial with a cross-over

design.
• 38 participants indicated for complete dentures were selected from those admitted to the
Department of Prosthodontics.
• Clinical procedures and possible complications were explained to the participants.

THE INCLUSION CRITERIA
Completely edentulous ridge with a healthy mucosa
A prominent premaxilla that provided adequate

support for the lips,
Skeletal Class I Angle’s maxillomandibular

relationship,
History of a previous denture with a complaint of

unsatisfying esthetics due to over supported lips.
EXCLUSION CRITERIA
Xerostomia
Presence of tempo-mandibular joint History of chemotherapy or

disorder, radiotherapy
Uncontrolled Parkinson’s
diabetes mellitus, disease,
Hypertension
Each participant - mandibular conventional denture
- a maxillary conventional denture,
- and a maxillary open-face denture.
• Conventional hard maxillary complete denture with
mandibular denture.
• For the open-face maxillary denture, the maxillary

cast with the trial denture was mounted on a dental
surveyor in the zero-tilt position guided by the
occlusal plane of the trial denture.
• The trial denture was removed and the areas of

undercut were delineated using the carbon marker.
• Then the maxillary cast with the trial denture was flasked.
• At the packing stage, a fold of tin foil was adapted on the cast to act as a
spacer then the hard heat cure acrylic resin was packed.
• After completing the trial closure, the flask was opened and the tin foil
was removed and the hard acrylic resin was cut away in the areas apical to
the survey line.
• A resilient denture base material was packed and the flask was closed for
curing.
• After deflasking, the dentures were finished and polished.

For the open-face maxillary denture, the labial flanges were windowed to uncover the prominent
area of the pre maxilla.
Group CD-OFD Group OFD-CD
• Open-face maxillary (OFD) and

• Conventional maxillary (CD) and conventional mandibular complete
mandibular complete dentures - dentures - 3months.
3months. • conventional denture (CD)- stored in
• OFD- stored in an incubator in a an incubator in a water bath at 37 ±
water bath at 37 ± 1°C. 1°C.
• washout period of 2 weeks. • washout period of 2 weeks.
• conventional maxillary denture was • open-face maxillary denture was

replaced by the open-face denture replaced by the conventional denture
(OFD)-3months. (CD)- 3months.
• The retention of the maxillary dentures and patient
satisfaction were evaluated at 1 day (20 min after
denture insertion), 1 month, and 3 months after
denture insertion.
• Retention - universal testing machine to exert a

vertical dislodging force on the maxillary denture.
• A stainless steel loop was attached to the geometric

centre of the maxillary denture by using an
autopolymerizing acrylic resin.
• The centre of the labial frenum (point A) and
the hamular notches (points B and C) were
located in the denture base.
• The distance halfway between points B and C

was measured, and the location was marked
on the posterior border of the denture base
(point D).
• Finally, half the distance between points A

and D was marked as the centre of the
denture base (point E)
• A force transmission device (FTD) was used to
transmit the dislodging vertical force from the
universal testing machine to the maxillary denture.
• The FTD is a split bar with a hook at an end to

engage the loop attached o the denture. The bar has
nuts for adjusting its length.
• A facebow was used to set the Frankfort plane of the patient
parallel to the floor. After orienting the participant to the
universal testing machine, it was set to exert a dislodging
force at a rate of 50 mm/min .
• The retention test was repeated 3 times for each denture and
the mean value was calculated.
RESULTS
DISCUSSION
• Null hypothesis - Dislodging force and retention was not rejected.

- Rejected regarding patient satisfaction with esthetic and comfort.
• Conventional and open-face denture dentures - close results regarding retention evaluation.
• Significant differences between them regarding esthetics and comfort favoring the OFD.
• The soft borders of the open-face dentures allowed them to easily engage mucosal undercuts
eliminating the need for relief.
Close fitting of the open-face dentures and completing the soft tissue drape by the upper lip may achieve a
peripheral seal compensating for the labial window.
A washout period of 2 weeks was found to be sufficient to eliminate the effect of the previous denture as
indicated by the presence of healthy mucosa which was free of inflammation, ulcerations, and indentations.
Aesthetics- Open-face denture eliminate excessive lip fullness providing a natural look- ing appearance unlike the
conventional denture.
Resilient denture base material for open-face dentures higher comfort.
The insignificant difference in patient perception of comfort after 3 months- continuous post-insertion
adjustments and the neuromuscular adaptation developed during the follow-up period.
• A 42-year old female patient visited the Department of Prosthodontics with a chief
complaint of missing teeth and wanting a replacement for the same.
CONCLUSION
• A prosthodontist should attempt to make the complete denture as unique and customized
as far as possible for each individual.
• Flangeless dentures give a simple and easy alternative for patients, not opting for surgical
options for the correction of over-contoured ridges.
• Satisfactory aesthetics and better patient acceptance.
• Nonsurgical procedures- utilized for the fabrication of the prosthesis > non-invasive,
provides good acceptance, and ultimate satisfaction to the patient.
• The prong dentures [FLANGELESS DENTURE] are convenient in terms of insertion,

removal and function for the edentulous patient.
Refernces
1. Lee DJ, Saponaro PC. Management of edentulous patients. Dent Clin North Am. 2019;63:249–61.
2. Balshi SF, Wolfnger GJ, Balshi TJ. Surgical planning and prosthesis con‑ struction using
computed tomography, CAD/CAM technology, and the internet for immediate loading of dental
implants. J Esthet Restor Dent. 2006;18:312–23.
3. Gómez-de Diego R, Mang-de la Rosa Mdel R, Romero-Pérez MJ, CutandoSoriano A, López-

Valverde-Centeno A. Indications and contraindications of dental implants in medically compromised
patients: update. Med Oral Patol Oral Cir Bucal. 2014;19:483–9.
4. Olvera N, Jones JD. Alternatives to traditional complete dentures. Dent Clin N Am. 2014;58:91–
102.

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Evaluation of open-face maxillary

complete denture for patients

Dept. of prosthodontics and

2. MATERIALS AND METHODS

gum fit dentures,

ridge grip aesthetic prosthesis

• In prosthodontics during complete denture fabrication, we

• Sometimes prior to the construction of a complete denture

• It is also essential to differentiate certain systemic

• Muller Devan’s dictum (1952) has greatly stated that “The

Compromise denture-supporting tissues.

• Prospective, Double-blinded, Randomized controlled clinical trial with a cross-over

• Clinical procedures and possible complications were explained to the participants.

Completely edentulous ridge with a healthy mucosa

A prominent premaxilla that provided adequate

Skeletal Class I Angle’s maxillomandibular

History of a previous denture with a complaint of

Presence of tempo-mandibular joint History of chemotherapy or

• For the open-face maxillary denture, the maxillary

• The trial denture was removed and the areas of

• After deflasking, the dentures were finished and polished.

• Open-face maxillary (OFD) and

• washout period of 2 weeks. • washout period of 2 weeks.

• conventional maxillary denture was • open-face maxillary denture was

• Retention - universal testing machine to exert a

• A stainless steel loop was attached to the geometric

• The distance halfway between points B and C

• Finally, half the distance between points A

• The FTD is a split bar with a hook at an end to

• Null hypothesis - Dislodging force and retention was not rejected.

Resilient denture base material for open-face dentures higher comfort.

• Satisfactory aesthetics and better patient acceptance.

• The prong dentures [FLANGELESS DENTURE] are convenient in terms of insertion,

3. Gómez-de Diego R, Mang-de la Rosa Mdel R, Romero-Pérez MJ, CutandoSoriano A, López-

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