Prong maxillary complete denture for better facial aesthetic: A case report

Denture teeth and denture ﬂange are two very important aspects of a complete denture. For aesthetic purpose while fabricating the complete denture prosthesis, restoring the labial fullness is a sensitive procedure. There are some clinical situations where the labial ﬂange gives poor facial aesthetics. It is more occur in proclined maxillary anterior ridge or thick labial cortical plate with severe labial undercut. In this article we are presenting a case with thick labial cortical plates and severe labial undercut. So, we have modiﬁed the complete denture and delivered a prong (ﬂangeless) denture to give more aesthetic appearance to the patient. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.


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. An excessively prominent ridge more commonly present in maxilla than mandible. 1 Its very challenging to fabricate the complete denture when the ideal biological consideration of both hard and soft tissues are not fullfilled. 2 Labially proclined maxilla with associated undercut is the most common condition that effects the esthetics and fabrication of complete denture. 3 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. 4 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. 5 In those cases we can add some modifications in dentures which is also called unconventional complete dentures .This case report presents a non-surgical procedure of complete denture fabrication and producing an esthetic appearance in proclined maxillary anterior ridge with severe labial undercut with the help of prong (flangeless) denture.Many authors have referred to this as "gum fit dentures" and "ridge grip esthetic prosthesis". 6,7

Case Report
A fifty-six years old male patient came to the Department of Prosthodontics and Crown and Bridge, Himachal Dental College, Sundernagar with the chief complaint of missing teeth. He had been edentulous for last one year. Patient had history of smoking for last twenty-five years and had quit smoking one year back. This patient had tapered face with normal muscle tone and adequate lip length (Figure 1), as found on extraoral examination. An U-shaped maxillary arch with severe labial undercut on intraoral examination ( Figure 2).  Surgical procedures like alveoloplasty and implant supported overdentures were explained to the patient, but the patient was not ready for any of the surgical treatment. A flangeless maxillary denture with conventional mandibular denture was planned and patient was explained about the problems with conventional denture. Impression compound was used to take the primary impression ( Figure 3). Casts were poured in plaster of paris. After that special trays were fabricated and border moulding was done with green stick compound and secondary impressions were made (Figure 4). After making master casts, temporary base and occlusal rims were fabricated. Jaw relations were done same as in conventional dentures and then mounted on articulator and teeth arrangement was done.
After try in during wax-up the labial flange was removed from canine-to-canine region leaving two acrylic spikes extending anteriorly from distal sides ( Figure 5). Putty addition silicon impression material was placed on the labial flange and dewaxing was done ( Figure 6) Packing and curing of heat cure acrylic resin was done. After polishing the prong (flangeless) denture was delivered to the patient (Figure 7).
Follow up of the patient was done following 24 hours, one week and one month after post-insertion. Patient was having no complaints regarding the denture and completely satisfied with the prong denture ( Figure 8). Post insertion instructions were given to the patient.

Discussion
The flangeless maxillary denture technique is a method to preview the aesthetic results, certain situations demand the same design to be incorporated in the final denture. 8,9 These dentures have different names like wing denture, ridge grip, gum fit. 10,11    In some cases prominent modiolus is also altered, mainly medially (inwards and posteriorly). Upon combination with hypertonic maxillary lips, the vestibule space constantly shrinks unless the labial cortical plate does not undergo significant resorption. 12,13 If a conventional denture would have been fabricated, it would add to severe labial fullness and an unaesthetic appearance. The excessive bulky labial flange would have also lead to interference with the phonetics. 14 Another modification as given in the literature is "Wing denture". Here the labial flange is sectioned in the labial frenum region and two wings appear from either side to allow space for the labial frenum. 15,16

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. They are successful in giving the satisfactory aesthetics and better patient acceptance. 17 The obliteration of labial vestibule impacts complete denture fabrication. Hypertonic maxillary lip and overactive modiolus obliterates the labial vestibule. Above two parameters should be included in routine patient data collection, while examining the complete edentulous patients. 18 Our clinical report describes the fabrication of an economical, quick and easy method of fabrication of a prong denture for rehabilitation of proclined maxillary ridge with presence of labial undercut. Nonsurgical procedures can thus be utilized for the fabrication of the prosthesis as they are non-invasive, provides good acceptance, and ultimate satisfaction to the patient. The prong dentures are convenient in terms of insertion, removal and function for the edentulous patient. 19,20

Conflicts of Interest
All contributing authors declare no conflicts of interest.

Source of Funding
None.