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Cu-Sil denture: A novel approach for the preservation of teeth and bone
*Corresponding author: Madhumitha Subramanian, CRI, Department of Prosthodontics, Sri Ramakrishna Dental College and Hospital, Coimbatore, Tamilnadu, India. madhumithasubramanian05@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Subramanian M, Kannan S. Cu-Sil denture: A novel approach for the preservation of teeth and bone. J Academy Dent Educ. doi: 10.25259/JADE_79_2024
Abstract
Muller De Van’s dictum states that “the perpetual preservation of what remains is more important than the meticulous replacement of what is lost.” In today’s context, this principle emphasizes the importance of preserving natural teeth rather than extracting them and replacing them with artificial alternatives. One notable modification of conventional removable partial dentures is the Cu-Sil denture, a type of transitional denture that covers the remaining natural teeth while allowing them to be preserved. Maintaining natural teeth is crucial for sustaining the integrity of the alveolar bone and the proprioceptive function of the periodontium. Cu-sil denture can be the best option for patients who are not willing for extraction or endodontic treatment, this boosts the confidence of the patient by the presence of natural teeth along with proprioception, esthetics, masticatory efficiency, and self-confidence. This case report details that the fabrication of a Cu-Sil denture is a tooth and tissue-bearing acrylic denture with holes for the natural tooth to emerge through it and a gasket surrounding their neck by long-term soft silicon liner.
Keywords
Cu-sil denture
Proprioception
Soft silicone liner material
Transitional denture
INTRODUCTION
The current approach to dentistry emphasizes the preservation of remaining natural teeth and the periodontium. Maintaining these natural teeth is crucial for preserving the integrity of the alveolar bone and the proprioceptive function of the periodontium. In the past, it was believed that total extraction of remaining natural teeth, followed by the use of complete dentures, was a cost-effective and permanent solution. However, this approach often leads to a significant issue known as residual ridge resorption, which results in poor retention, stability, and support for the prosthesis.[1,2]
Today, there are various treatment options available for individuals with a few remaining teeth, including overdentures, immediate dentures, transitional dentures, and implant-supported prostheses. One such treatment is the Cu-Sil denture, a type of transitional denture designed to preserve remaining natural teeth while being both easy and affordable.[3] A Cu-Sil denture is a removable partial denture that features holes allowing the natural teeth to emerge through it. These holes are surrounded by a silicone rubber gasket, which encircles the natural teeth and creates a natural suction effect beneath the denture. This rubber gasket not only cushions the natural teeth but also enhances the retention of the denture. The silicone gasket acts like a splint for periodontally compromised teeth. The fabrication of Cu-Sil dentures does not require any preparation of the existing teeth or additional laboratory steps. Cu-sil denture was planned in the patient till the last teeth get exfoliated on their own, the existing denture can be modified to accommodate the gap to obtain a complete denture.[4,5]
Indications
Patients who do not want to lose their remaining teeth.[6]
Patients with few teeth mucosa, and supporting bone have a poor prognosis for complete dentures.
Psychological benefit of the patient.
Contraindications
Patients with poor oral hygiene.
Periodontally compromised patients.
Patients with many remaining natural teeth.
Unfavorable undercuts interfere with denture fabrication.[7]
Limitations
It cannot be used in patients with a large number of evenly placed teeth and with severe undercuts.
Often requires relining of the soft liner.
Potential for plaque accumulation due to the silicone coverage at the gingival margin and the short functional duration of the soft liner.[4]
CASE REPORT
A 68-year-old female patient reported to the Department of Prosthodontics Crown and Bridge, Sri Ramakrishna Dental College and Hospital, Coimbatore, with the chief complaint of replacement of missing teeth in the upper and lower front and back tooth region. There is no relevant medical history. Dental history revealed that the patient had a previous conventional interim removable partial denture with the clasp 10 years ago. On intraoral examination, the patient presented with only one posterior tooth remaining (37) all other teeth which were missing [Figures 1 and 2]. Treatment options were explained to the patient:-
- Intraoral maxillary arch.
- Intraoral mandibular arch.
Implant-supported prosthesis
Overdenture
Interim conventional removable partial denture (RPD)
Cu-sil denture
However, the patient insisted on a removable complete denture in the maxillary arch and a Cu- Sil denture for the mandibular arch.
Clinical steps
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The primary impression of the maxillary and mandibular arch was made with irreversible hydrocolloid impression material (Alginate) in a metal stock tray [Figure 3].
Figure 3:- Primary impression, (a) Maxillary arch, (b) Mandibular arch.
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The primary casts were poured using dental plaster for the maxillary arch and dental stone for the mandibular arch [Figure 4].
Figure 4:- Primary casts, (a) Maxilla, (b) Mandible.
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Spacer Design: Sharry’s spacer design was given for the maxillary arch, and a complete spacer design was given to the mandibular arch with two tissue stops in the canine and molar region [Figure 5].
Figure 5:- Spacer design, (a) Maxilla, (b) Mandible.
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The custom tray was fabricated using cold-cure acrylic resin for the maxillary arch, and the mandibular arch tooth was also covered with cold-cure acrylic resin [Figure 6].
Figure 6:- Custom tray, (a) Maxilla, (b) Mandible.
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Border molding of the maxillary and mandibular arches was made using a green stick impression compound, and a secondary impression was made with polyether impression material [Figure 7].
Figure 7:- Mandibular secondary impression, (a) Maxillary, (b) Mandibular.
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Beading was done using dental plaster, and boxing was done using modeling wax [Figure 8].
Figure 8:- Beading and Boxing, (a) Maxilla, (b) Mandible.
The master casts were poured using dental stone.
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The undercuts were blocked using a dental surveyor [Figure 9]. Temporary denture bases were made with self-cure acrylic resin.
Figure 9:- Surveying.
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Tentative jaw relation recording was done, and the casts were mounted on the mean value articulator [Figure 10].
Figure 10:- Articulation.
Semi-anatomic teeth were selected, and teeth arrangement was done.
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A complete try-in procedure was performed and checked for occlusion, retention, stability, esthetic, and phonetics [Figure 11].
Figure 11:- Try-in, (a) Complete wax try-in, (b) Left Lateral view.
Processing was done for the upper and lower dentures.
A silicone gasket was given in the region of 37 to provide a cushioning effect. Temporary long-term soft liner adhesive was applied to the surrounding acrylic neck area of the denture and allowed it to dry for about 10 s and inserted into the patient’s mouth.
Silicone liner material was mixed with the base and catalyst and applied in the region of 37 and held in position till the final setting of the material took place to about 3 min. Long-term soft reliner typically need to be replaced every 2 years. Then, the denture was removed, the excess was trimmed, and finishing and polishing were done.
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Insertion of the upper removable complete denture and the lower Cu-Sil denture was made, and the denture was examined for retention, stability, phonetics, and esthetic [Figure 12].
Figure 12:- Insertion.
Post-insertion instructions were given, and the patients were asked to come for review after 24 h, 48 h, 1 week, and periodic review.
DISCUSSION
Preserving the remaining natural teeth is essential for maintaining the health of the periodontium, which helps prevent the resorption of the residual ridge. This regulation of the natural jaw reflex provides psychological benefits for the patient as well. Soft liners are used around the remaining natural teeth to provide a cushion-like effect, which helps distribute forces evenly across the denture.[8] However, temporary soft liners require frequent changes, which can be a disadvantage. In addition, there is a high rate of plaque accumulation, and fungal growth may occur on the dentures.[9] Therefore, patients are advised to maintain good oral hygiene and use denture cleansers, such as Sodium Perborate Monohydrate.
CONCLUSION
Cu-sil dentures are an excellent option for those who have a few remaining teeth and are not willing to undergo extraction or endodontic treatment. These dentures help preserve the integrity of the alveolar bone, thereby enhancing masticatory efficiency, stability, support, and retention compared to conventional removable complete dentures.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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