In complete denture treatment, jaw relation record is an important step, even if the impression is well-taken, an improper jaw relation can result in a completely non-functional denture. Therefore, from the perspective of leading complete denture clinical practice to success, there is no doubt that jaw relation record are the most important steps. Despite its importance, it is a very challenging step and is considered a significant reason why young dentists struggle with complete dentures. In this paper, I would like to explain seven key points that should be noted to successfully perform jaw relation record in complete denture treatment.

Removable dentures are often the preferred prosthetic options for missing tooth in elderly patients who require nursing care. Prosthetic treatment of multiple tooth defects is expected to improve masticatory and swallowing functions. Alternatively, because dentures alone cannot improve polypharmacy or dementia-related dysphagia, it is essential to consider the treatment goal in a whole-body unit.

It is required to consider the balance between therapeutic and compensatory approaches according to the conditions of dementia and cerebrovascular disease, which are the causative diseases requiring nursing care. Additionally, it is necessary to consider the psychological and economic burden on the dependent elderly and their families. Finally, after the denture is produced, the author wants to propose rehabilitation to improve masticatory and articulatory functions, in addition to the instruction and adjustment for the denture.

In prosthetic treatment with dentures of home-visit dental care, we often experience difficulties in impression taking and maxillomandibular registration due to physical and mental problems and difficulty in communication among older adults requiring nursing care. Therefore, we focus on whether or not the open mouth state and the occlusal state can be maintained as criteria for intervention in denture treatment. In addition, it is thought that the success or failure of treatment can be greatly affected by communication with key persons and cooperation with other multi-professional occupations, as the treatment can be carried out smoothly by determining the timing of treatment and having a caregiver present.

In this paper, I will introduce cases of prosthetic treatment with dentures that I have experienced in home-visit dental care, and describe the setting of goals for prosthetic treatment for older adults requiring nursing care.

In prosthetic treatment for elderly patients requiring long-term care, especially when the patient has severe dementia, consent for treatment is often given by the family on behalf of the patient. There is a concern that the family’s wishes and the dentist’s sense of ethics may take precedence over the patient’s wishes, which should be given the highest priority. “Clinical ethics” is a practical science for making decisions from an ethical viewpoint in response to such conflicts, and it recommends that decisions be made with respect for the presumed intentions of the patient, with appropriate information and explanations provided to all important parties. The first step in this process is to communicate unbiased and correct information to the parties concerned. In this article, we consider how to provide ethically appropriate information and decision-making when providing prosthetic care to elderly patients who require long-term care.

Although implant treatments have become established today, the demand for complete dentures remains high due to financial reasons, difficulty of undergoing an operation because of systemic disorders, and so forth.

The number of notable cases of severe ridge resorption seems to be increasing year by year in the clinical field due to factors such as advances in periodontal disease treatment, delay in the age of developing edentulous jaw, and extension of average life span. In cases of severe ridge resorption, it tends to be difficult to achieve suction and stability of a complete denture when using the standard manufacturing method, as various conditions within the oral cavity deteriorate.

This article presents and explains the characteristics of such cases based on the author’s clinical observation of oral cavities in cases of severe mandibular ridge resorption with edentulous jaw, and discusses its treatment method.

Patient: A 65-year-old female visited our hospital complaining of difficulty and discomfort in chewing using removable partial dentures. Maxillary removable partial dentures with an occlusal ramp were delivered to the patient with small mandibular dental arch, scissors bite of the left premolars, and anterior deep bite to restore bilateral occlusal contacts through the denture base.

Discussion: Using an occlusal ramp to restore bilateral occlusal contact in centric occlusion improved rotational movement of the maxillary dentures and masticatory ability, resulting in high satisfaction of the patient.

Conclusion: Removable dentures with an occlusal ramp resulted in a satisfactory therapeutic effect for a patient with scissors bite and deep bite.

Patient: A 70-year-old man visited our hospital complaining of difficulty in mastication and pain due to serious periodontal disease and incompatibility of maxillary and mandibular dentures. The solution for serious periodontal disease was attaining primary stability by a cross-arch bridge. After periodontal treatment, a mandibular cross-arch bridge (), a maxillary complete denture, and a mandibular removable dental prosthesis were provided.

Discussion: After 3 years, no major problem was observed. However, periodontitis deteriorated because maintenance was suspended for one year due to the Covid-19 pandemic.

Conclusion: Thanks to appropriate primary stability, mandibular premolars were saved, and as a result, functional recovery, predictability and a high degree of satisfaction were achieved.

Patient: The patient was a 53-year-old female with the complaint of esthetic problems due to fracture and morphological defects of a fixed dental prosthesis in the maxillary anterior region. The maxillary right central incisor, which was the abutment of a fixed dental prosthesis, was affected by subgingival caries. Gingival recession had been caused by caries removal and tooth preparation. A porcelain-fused-to-metal bridge for (6)(5)4(3)(2)(1) | 12(3) was provided after orthodontic extrusion of the maxillary right central incisor.

Discussion: Four years after placing the porcelain-fused-to-metal bridge, no significant gingival recession was observed, and the patient was highly satisfied with the results.

Conclusion: The gingival morphology of the cervical region of the abutment tooth, which had undergone gingival recession due to caries removal and tooth preparation, was made as symmetrical as possible by orthodontic extrusion, and a highly esthetic dental prosthesis could be provided.

Patient: The patient was a 40-year-old male, with masticatory and esthetic disturbance due to caries on multiple teeth. A treatment denture was made, as many teeth as possible were preserved, and metal copings were attached. In the maxilla, a roofless overdenture was placed and a good prognosis was obtained.

Discussion: The root length of the remaining teeth was not sufficient for a crown prosthesis due to caries-related dentinal defects, so an overdenture was used to improve the crown-root ratio and to distribute the occlusal load to many teeth, which resulted in a good prognosis.

Conclusion: The use of multiple-tooth copings is useful in improving physical, functional, and psychological disabilities in dentistry in cases of roofless dentures.

Patient: A 31-year-old woman visited our hospital with the chief complaint of esthetic dissatisfaction after glossectomy and segmental mandibulectomy due to tongue cancer. Dysmasesis, dysphagia and dysarthria were also present due to loss of occlusal contact in the centric relation and decreased tongue movement. Rehabilitation was performed by wearing a denture for defective jaw and palatal augmentation prosthesis (PAP) with a functional form.

Discussion: Wearing the denture improved the esthetics, and the chewing cycle stabilized by acquiring occlusion. Rehabilitation by using PAP strengthened the tongue and suprahyoid muscles and led to increased tongue pressure and movement range.

Conclusion: The esthetic dissatisfaction and dysmasesis were improved by wearing a denture for defective jaw. Furthermore, rehabilitation using PAP also improved the dysmasesis, dysphagia and dysarthria caused by decreased tongue movement.

Patient: A 64-year-old woman visited the hospital complaining of pain due to anterior tooth movement, malocclusion, and esthetic problems. About a year earlier, she had begun to be concerned about movement of her left upper central incisor and felt pain when she came to the clinic. After periodontal and X-ray examinations, esthetic and masticatory disorder was diagnosed due to root fracture and periodontitis induced by occlusal trauma and occlusal abrasion. Therefore, raising the occlusal vertical dimension was planned to solve the esthetic and masticatory problems.

Discussion: Cephalometric analysis aided determination of the new occlusal vertical dimension, thus improving masticatory performance.

Conclusion: Cephalometric analysis effectively established the occlusal vertical dimension. The oral-related quality of life (OHIP-14) and masticatory performance were improved compared to the baseline.

Patient: A patient was a 65-year-old man who visited the hospital with the chief complaint of difficulty in eating. Bilateral maxillary molar defects and marked tooth attrition of the mandibular anterior and premolar region were observed. After preprosthetic treatment, the amount of vertical dimension increase, occlusion scheme, and occlusal plane were examined with a diagnostic wax-up to place an interim prosthesis. Then, occlusal reconstruction was performed with a fixed dental prosthesis and metal plate denture.

Discussion: It is considered that careful examination of the amount of vertical dimension increase with the interim prosthesis and reflecting the amount in the final prosthesis using the cross mount technique led to an increase in patient satisfaction and improvement in dental masticatory dysfunction.

Conclusion: Marked tooth attrition and teeth defects were treated by vertical dimension increase and occlusal reconstruction, which resulted in a good prognosis.

Patient: An 81-year-old woman presented with the complaint of masticatory dysfunction due to instability of the maxillary and maxillary complete dentures and pain during mastication. Masticatory dysfunction was diagnosed due to denture instability caused by deterioration of resilient denture liner and decreased occlusal vertical dimension caused by attrition of artificial teeth. Class II was identified by the JPS classification of symptoms. To transfer the present information of the existing dentures, the final denture was fabricated by making a duplicate treatment denture based on the existing denture.

Discussion: By using the duplicate denture, the form and function of the existing denture were transferred, and the patient’s complaint was resolved and quality of life was improved.

Conclusion: Masticatory dysfunction in an edentulous patient was improved by reflecting the information obtained from the treatment denture by using a duplicate denture in the fabrication of the final denture.

Patient: The patient was a 50-year-old female with the chief complaint of esthetic problems with tilted maxillary anterior teeth, discoloration, caries, and metal crowns on the premolars. Because there were many treatment sites, the treatment was divided into five blocks.

Discussion: The treatment was performed block by block, and the maximal intercuspal position deviation was minimized, leading to a good outcome. Furthermore, the esthetic satisfaction of the patient was high because of appropriate selection of the prosthetic material and the treatment plan based on consultation using a diagnostic wax-up and modification of the provisional restorations.

Conclusion: In this case, the esthetic disorder of the maxillary anterior teeth and right and left molars was treated in five blocks to maintain a stable maximal intercuspal position, and good esthetic restoration and progress were achieved.

Patient: A 74-year-old man visited our hospital because of chewing difficulties due to a mobile fixed partial denture in the maxillary right molar region and an ill-fitting removable partial denture. Occlusal reconstruction using a fixed dental prosthesis and a removable partial denture based on a diagnostic wax-up was performed for severe tooth wear.

Discussion: The vertical dimension at occlusion was decided based on a diagnostic wax-up, and a treatment denture was fabricated for the patient to increase the vertical dimension. Occlusal reconstruction was successful through the early placement of a stable denture, which appropriately restored the occlusion. Molar occlusion was established using a removable partial denture, suggesting that it is crucial to follow the changes in the alveolar ridge and the occlusal wear.

Conclusion: Occlusal reconstruction for a patient with severe attrition had a satisfactory therapeutic effect with improvement in subjective masticatory performance and oral health-related quality of life.

Patient: A 54-year-old woman visited our hospital with the chief complaints of difficulty in chewing and poor esthetic appearance. We observed loss of anterior occlusal contact due to tooth erosion and natural tooth discoloration. After oral examination, the woman was diagnosed with masticatory disorder due to tooth erosion and esthetic disorder due to tetracycline teeth. After establishing anterior guidance through provisional restoration, we undertook prosthodontic treatment using all-ceramic crowns and porcelain laminate veneers.

Discussion: Good outcomes were achieved by anterior guidance with a capsid protected occlusal scheme established in the final prosthetic appliance which was determined by using a provisional restoration.

Conclusion: Functional and esthetic restoration was successfully achieved in a patient exhibiting mastication and esthetic disorders.

Patient: A 74-year-old man in his seventies complained of missing anterior crowns, poor appearance, and difficulty in pronunciation and eating. Significant structure loss of the maxillary left central incisor had reached the subgingival region. Crown lengthening was performed as a preprosthetic treatment, followed by restoration.

Discussion: Crown lengthening was performed to get a ferrule effect and to recover supracrestal tissue attachment, taking into account the crown-root ratio. As a result, the remaining tooth structure could be fully used.

Conclusion: This case report describes the favorable clinical outcome of a patient with significant structure loss of the maxillary incisors by getting a ferrule effect to fully use the remaining tooth structure.

Patient: A 73-year-old female patient visited with a chief complaint of masticatory dysfunction due to denture mobility and pain in the upper molar gum caused by food impaction. The diagnosis was masticatory dysfunction due to ill-fitting denture and food impaction caused by diastema. A mandibular full denture was fabricated as a treatment denture and immediately loaded as an implant overdenture (IOD) in order to achieve denture retention and stability. Then, for the maxilla, connected full cast crowns were inserted for the molar and a partial denture was fabricated. For the mandible, an IOD was newly fabricated.

Discussion: By applying the IOD in the mandible, denture stability significantly improved immediately after the implant surgery and the patient’s masticatory function has improved.

Conclusion: IODs could be considered as a highly effective treatment option for cases in which it is difficult to achieve denture stability and retention due to severe atrophic ridge such as in the present case.

Patient: A 71-year-old edentulous woman with severe alveolar ridge resorption visited our hospital complaining of pain during mastication in the basal seat mucosa of her mandibular complete denture. An occlusal map was made to extract the area on the alveolar ridge where the artificial teeth could be arranged to establish unilateral occlusal balance in the fabrication of new dentures and the artificial teeth were arranged so that the occlusal contact point was obtained within the area.

Discussion: The chief complaint was improved and a good prognosis was obtained by using the occlusal map to arrange the positions of artificial teeth so as to achieve unilateral occlusal balance.

Conclusion: The occlusal map makes it possible to visualize the maxillomandibular residual ridge relationship as an image, which is useful for arranging artificial teeth in cases with anatomically difficult dentures.

Patient: The patient was a 57-year-old female who visited the clinic with a chief complaint of difficulty in chewing food due to missing maxillary left molars. Upon examination, tooth extrusion, a decrease in occlusal vertical dimension caused by reduced occlusal support, and a decrease in interocclusal space were observed. A cone crown telescopic denture was delivered for the maxilla after increasing the vertical dimension of occlusion.

Discussion: It is considered that the rigid support and connection, which are characteristics of cone crown telescopic dentures, significantly contributed to the acquisition of intraoral stability and the improvement of oral health-related quality of life.

Conclusion: A case with masticatory disturbance was successfully treated by prosthodontic treatment using a cone crown telescopic denture.

Patient: A 29-year-old woman visited our hospital with the chief complaint of esthetic dissatisfaction due to congenital multiple missing teeth. Prosthodontic treatment using an implant-supported prosthesis was planned and performed in view of ease of handling the denture and preservation of the natural dentition. The final restoration, which reflected the morphology of the provisional restoration adjusted for proximal interdental papilla reconstruction, was delivered.

Discussion: Prosthetic design was simplified by providing an implant-supported prosthesis while avoiding interventions on pulp and periodontal tissue caused by tooth preparation. Adjustment of the provisional restoration and application of a custom impression coping are considered to be important for acquiring a satisfactory esthetic outcome.

Conclusion: In the present case, occlusal function and an esthetically pleasing outcome were successfully obtained by applying an implant-supported fixed prosthesis.

Patient: The patient, a 70-year-old man, visited our hospital due to recurrence of a right maxillary osteosarcoma. The patient had underdone partial maxillectomy and was referred to our department for a denture for defective jaw. The palatal defect had perforated the nasal cavity and maxillary sinus. The case was diagnosed with mastication, articulation and esthetic disorders caused by the partial maxillectomy. His denture for defective jaw did not have enough retention, so we fabricated a new denture after repairing and adjusting his denture for defective jaw.

Discussion: The shape of the denture for defective jaw was based on the shape of the treatment denture. As a result, good esthetics and recovery of conversation and masticatory function were achieved, improving the patient’s QOL.

Conclusion: A long-term favorable outcome was achieved by functionally harmonizing the denture form with the perioral muscles.

Patient: An 85-year-old man was suffering from poor esthetics of his front teeth and difficulty chewing, caused by extensive tooth wear. He presented with a decreased vertical dimension of occlusion, which was attributed to significant tooth wear and loss of occlusal support, and poorly fitting dentures. The decreased vertical dimension was treated with provisional restorations and interim dentures. After confirming esthetic and functional satisfaction, telescopic overdentures were delivered as the final dental prostheses.

Discussion: The high rigidity of the framework and the rigid support provided by multiple abutment teeth in dentition with a loss of occlusal support may have led to an improvement in impaired masticatory function and a high level of patient satisfaction.

Conclusion: Treatment with telescopic overdentures is an effective prosthetic strategy for partially edentulous patients; however, careful follow-up is required for patients with dentition that has lost occlusal support.

Patient: The patient was a 71-year-old man. He came to our hospital with the chief complaint of difficulty in mastication due to pain when wearing a denture. The mandibular bilateral molars had significant crest resorption, and the denture was not maintained or stabilized. Since there were many problems with the old denture, we first fabricated a treatment denture and then placed an implant overdenture in the mandible to further improve the function of the denture.

Discussion: Two implants were placed in this patient with significant mandibular crest resorption and an overdenture was placed to control the movement of the denture. This resulted in a more stable denture and improved patient satisfaction.

Conclusion: A case of severe mandibular crest resorption was successfully treated with an implant overdenture.

Patient: A 66-year-old female patient presented at our hospital with a chief complaint of difficulty with mastication and compromised esthetics as a consequence of not using her mandibular removable partial denture. The patient’s masticatory function was improved by modifying the design of the major connector of the removable partial denture. A fixed partial denture was also fabricated to treat the compromised maxillary esthetics.

Discussion: The findings of this case report showed that the modified design of the major connector minimized interference of the removable partial denture with the tongue and improved the support and bracing provided by the denture, thus reducing discomfort during use.

Conclusion: It was concluded that the modified design of the major connector in a removable partial denture was associated with decreased discomfort.

Patient: A 62-year-old man with chief complaints of pain and gingival swelling of the upper right central incisor, had been using a removable denture in the maxilla for several years. The patient wished to restore masticatory and esthetic function with a fixed prosthesis, therefore, a fixed implant-supported prosthesis with pink gingival porcelain, crown, and bridge was planned to restore function.

Discussion: The acquisition of occlusal support and esthetic improvement by the fixed prosthesis contributed to the improvement of oral health-related quality of life.

Conclusion: This case with a highly atrophic maxilla treated with a fixed implant-supported prosthesis including pink gingival porcelain showed an excellent result.

Patient: The patient was a 70-year-old woman. Her chief complaint was difficulty in chewing with removable partial dentures and poor esthetics of maxillary fixed partial dentures. In addition to reduced occlusal vertical dimension and mandibular deviation due to the missing molars left untreated, occlusal canting of the maxillary fixed partial dentures was found. Provisional restoration and treatment dentures were delivered immediately allowing occlusal support to recover mandibular deviation. Screw-retained implant-supported crowns were inserted as definitive prostheses.

Discussion: The alteration of occlusal vertical dimension after recovering occlusal support with implant-supported crowns could be identified and corrected by observation of the mandibular position for 10 months.

Conclusion: Improvement of difficulty in chewing and poor esthetics of maxillary fixed partial dentures could be identified using interim partial removable dentures and implant-supported crowns for occlusal reconstruction including mandibular deviation.

Patient: A 72-year-old male had difficulty chewing due to missing lower left molars and an ill-fitting fixed partial denture on the lower right molars. After informed consent, the patient underwent dental implant treatment on the defect with a surgical guide made by an intraoral scanner and CAD/CAM system.

Discussion: Implants were placed in a prosthetic-driven manner using CBCT and an intraoral scanner. The superstructure was fabricated using a CAD/CAM system. This combination improved the patient’s masticatory function and achieved an excellent long-term prognosis.

Conclusion: Lower free-ended and intermediate edentulous spaces were treated with implant-supported fixed dentures using digital technology. Improved masticatory function and patient satisfaction were successfully established.

Patient: A 77-year-old woman came to our hospital with a complaint of pain in the mucosa under the denture base during mastication. Occlusal support was assessed as Eichner classification C1, and the patient was treated with basic periodontal therapy and fitted with a treatment denture that met the design requirements. The occlusal plane of the remaining teeth was malocclusion and severe periodontitis was also present, but the patient did not want intervention. Therefore, a denture with high connecting rigidity with occlusal rests was placed.

Discussion: Prosthetic treatment with a denture having high connecting rigidity and capable of correcting the occlusal plane was performed. As a result, it was possible to minimize the denture mobility and a good prognosis was obtained.

Conclusion: In this case of Eichner C1 with a disturbance of the occlusal plane, masticatory ability was improved by installing the definitive prosthesis with increased connecting rigidity.

Patient: The patient was a 58-year-old male patient with masticatory problems. Severe periodontitis, insufficient occlusal support and temporomandibular joint disorders (TMD) were observed. After provisional treatment, followed by prosthetic treatment with a removable partial denture (RPD) using the milling technique, the patient was satisfied with the resulting function and esthetics.

Discussion: By using a denture prosthesis with the milling technique, minimization of unfavorable sway of the denture during function and stabilization of the condylar position at centric occlusion seemed to be achieved in this case. Supporting the esthetics of the anterior teeth, even when the RPD was not worn, would have enhanced the satisfaction of the patient and might have contributed to the stable course that was observed.

Conclusion: RPD using the milling technique was advantageous for establishing a stable denture and thus providing favorable occlusion. In this case, improvement of TMD and esthetics resulted in better oral health related quality of life.

Patient: The patient was a 60-year-old woman who complained of occlusal discomfort and difficulty in chewing due to a mismatched maxillary single complete denture. The shape of the denture was unsuitable, there was disharmony of the occlusal plane, the mandibular position was unstable, and her oral hygiene was poor. Periodontal treatment and oral rehabilitation using interim prostheses were performed. After confirming the appropriate maxillomandibular relationship and occlusal balance, definitive prostheses with metal plate dentures and crowns were placed.

Discussion: The gothic arch tracing method helped to identify an appropriate maxillomandibular relationship, and definitive prostheses designs considering stability during denture function contributed to a favorable outcome.

Conclusion: Placement of definitive prostheses after improving the mandibular position and occlusal plane and establishing occlusal balance can result in beneficial treatment results.

Patient: The patient was a 39-year-old woman who complained of esthetic disorder and dull pain in the right maxillary central incisor. According to a comprehensive diagnosis based on cephalometric analysis, orthodontic treatment was performed after extraction of the central incisor to improve the profile and midline. In addition, porcelain laminate veneer was delivered on the adjacent supernumerary tooth to restore the morphology of the central incisors and enhance the esthetics.

Discussion: After the treatment, there was no periodontal tissue inflammation, and the gingival morphology was maintained. Also, the patient’s psychological discomfort was greatly improved. We believe that the long-term stable result was achieved by the harmony between the prosthesis and gingiva, the tooth axis according to the skeletal structure, and the appropriate occlusion.

Conclusion: Top-down treatment based on a comprehensive diagnosis can achieve prosthetic treatment that harmonizes esthetics and function even in the case of a single-tooth prosthesis.

Patient: The patient was a 66-year-old woman with maxillary anterior teeth missing and a remarkable difference of maxillary and mandibular size. She complained of poor appearance of the maxillary anterior prosthesis.

Discussion: A maxillary telescopic denture and mandibular crown prostheses were inserted. Alteration of the occlusal plane using provisional restorations, including a treatment denture, and adequate confirmation of fit and esthetics before placing the final dentures, improved patient satisfaction.

Conclusion: The prosthodontic treatment with the removable partial denture based on the concept of rigid support resulted in improved esthetic appreciation and adequate satisfaction, which may have contributed to success for a certain period.

Patient: The patient was a 66-year-old female. She came to the hospital with the chief complaint of not being able to eat without using denture adhesives for her maxillary and mandibular removable complete dentures. She was distrustful of her past dental treatment, and obtaining informed consent was a particular issue. Therefore, when implementing prosthodontic treatment, subjective and objective evaluations were shared with the patient, and both evaluations were used as a guide in treating her prosthodontic problem.

Discussion: Sharing subjective and objective evaluation records with the patient is considered to have reduced the distrust of past dental treatment, leading to cooperation in prosthodontic treatment as a result.

Conclusion: Subjective and objective evaluations are effective tools for building rapport with patients and also help determine the criteria for branching off of treatment.

Patient: The patient was a 60-year-old female with masticatory disturbance caused by pain in the mucosa of the residual ridge resulting from multiple bone torus and decreased occlusal vertical dimension due to flaring of the maxillary teeth. After correction of her mandibular position with an occlusal splint, a maxillary metal-framed removable partial denture was placed.

Discussion: It was necessary to determine the mandibular position with an occlusal splint because denture adjustment was (extremely) difficult due to the lack of denture space. Subsequently, appropriate treatment allowed the patient to maintain adequate masticatory function and inhibited the progression of periodontitis.

Conclusion: The patient had a good outcome with wearing a rigid removable partial denture after correction of the mandibular position with an occlusal splint for improvement of masticatory disturbance caused by the multiple bone torus and decreased occlusal vertical dimension.