Case Presentation: Maxillary Immediate and Mandibular Complete Denture for Vulnerable Patient

Kim Wiley

Wiley, Kim, Mark, Stephanie
University of Pennsylvania School of Dental Medicine, Department of Preventive and Restorative Sciences


The overarching goal of the Survivors of Torture (SOT) clinic honors program is to provide comprehensive, compassionate, and patient-oriented dental care to an extremely vulnerable population. Providing dental care to our case study subject, SJ, involved unravelling her complex medical and dental history and creating a treatment plan that would relieve her pain and address her dental needs.


A comprehensive treatment plan was created for SJ which included sectioning of the patient’s existing maxillary 14-unit fixed dental prosthesis (FDP) and extraction of the five abutment teeth. All teeth were extremely periodontally involved and #11 had significant bone loss due to the presence of a lateral periodontal cyst on the distal aspect. The fixed dental prosthesis was sectioned to allow for extraction of #4, #11, and #13 and removal of the distal extensions of the FDP. At the next appointment, final impressions of the maxilla and mandible were taken. These impressions were poured up and used to fabricate occlusal rims and accurately mount the models. The maxillary model was then trimmed to approximate the anterior ridge after the remaining teeth were extracted. A final occlusal rim which covered the entire ridge was fabricated and the denture teeth were set into these rims. After confirming esthetics and function, the dentures were processed and returned for delivery. On the day of delivery, #6 and #8 were extracted and the prostheses were immediately inserted. The dentures were evaluated for areas of overextension, high spots, and appropriate occlusion.


We are currently waiting to complete SJ’s case. Unfortunately, a previous ailment has presented itself again more aggressively and we will wait until SJ has gone through treatment to continue the work. We planned to fabricate a definitive complete maxillary denture and implant-retained mandibular overdenture for the patient. While every effort was made to accurately approximate the anterior portion of her maxillary ridge, the incisors of the maxillary immediate denture were placed slightly too anterior. When fabricating her final maxillary prosthesis, it will be possible to more accurately set the anterior teeth and create a more esthetic outcome.


Working with patients in a vulnerable population often changes the way treatment can be executed. The patient's chief complaint was that she wanted to fix her teeth so that she could eat. Thus, this complex treatment plan was created to work around the constraints of the patient’s concerns as well as what would be functionally and aesthetically best.