An Innovative Approach for Management of Unfavorable Bilateral Mandibular Lingual Undercuts With Collapsible Type Complete Denture: A Case Report.

Abstract

Advanced and uneven residual ridge resorption in mandibular edentulous arches leads to non-retentive and unstable dentures. The hardness of traditional heat-cured acrylic resin makes extending the denture base into bilateral lingual undercuts challenging. This can cause supporting tissue damage, pain, and ulcerations during denture insertion and removal. Although clinical challenges related to limited mouth opening were addressed by modifying the impression technique, incorporating hinges, swing lock attachments, and stainless-steel posts to form collapsible denture bases, there are no documented case reports with proper follow-up regarding the use of such type dentures in cases of mandibular lingual undercuts. A 68-year-old male patient reported, with the chief complaint of missing teeth in the upper and lower jaws for five years and wanting replacement. The intraoral clinical examination yielded findings of a severely compromised mandibular ridge (ACP Class IV) and a moderately compromised maxillary ridge (ACP Class II). In the maxillary arch, the presence of anterior labial undercut, and bilateral undercuts lateral to tuberosity were evident. The patient reported pain on palpation bilaterally in the tuberosity region. Prolonged mandibular edentulism and uneven bone resorption resulted in unfavorable bilateral lingual undercuts, with class III (M.M. House) border tissue attachment in the labial and buccal aspects of the basal tissue area. After enumerating the treatment options, the patient opted for a removable prosthesis for the maxillary and mandibular arch. Pre-prosthetic surgery was done to eliminate tuberosity undercuts. Since the patient was unwilling to take up pre-prosthetic surgical corrections for the mandibular lingual undercuts, a significant challenge emerged: creating a retentive mandibular complete denture without compromising the peripheral seal and retention. A conventional complete denture was fabricated after blocking the unfavorable undercut and reducing the height of the flange. On the recall appointment, the patient complained of reduced retention and food lodgment in the intaglio surface of the denture and pain due to denture movement on mastication. In this case report, stainless steel hinges have been added to the lingual flange of the mandibular complete denture to make it collapsible. The resultant denture facilitated reduced tissue trauma and discomfort during denture removal and insertion and had satisfactory retention and stability compared to the former denture. These collapsible type dentures can be used as an alternative to flexible dentures, wherein patients can't afford surgeries or flexible dentures.