Restorative space for dentures

 I have an ongoing full over full denture case at my private practice job. Initially I was quite excited as it seemed like a slam dunk case as the patient has the tallest and widest alveolar ridges that I have ever seen. She has a current full upper denture but is looking for a new set as she has lost her full lower denture and her full upper denture is discoloured, has an occlusal cant and has a missing tooth which was her last remaining natural tooth which was recently extracted. Despite the missing tooth and lack of peripheral continuity, the denture is still quite retentive. 

At the secondary impression appointment the suction of the impressions were very impressive and I had difficulty removing the lower impression which gave me hope of achieving some level of suction in the final lower denture. Everything was looking quite straightforward due to the patient's favourable anatomy. 

At the jaw relation appointment I encountered the difficulty that is inherent in large residual ridges: the lack of restorative space. I asked for an acrylic baseplate on the wax rims and upon carving the rim back to the right incisal edge position I carved it almost all the way back to the baseplate. From inspection of the remaining wax on the baseplate, I knew that quite a bit of the denture tooth would need to be ground back to allow set up on the baseplate. This may be enough to affect the aesthetics of the denture tooth by affecting the occluso-gingival dimension of the tooth. 

A possible contributer may be a baseplate that is too thick so I instructed the lab to grind back the baseplate over the ridge preferentially and if more space is required then grind the base of the tooth rather than the occlusal surface. To some extent if the tooth is set labial to the ridge (which is usual in the maxilla), the space issue becomes less apparent but some effort is still required to grind back the tooth base to make room for the teeth to sit in the correct position.

One concern I did have after dismissing the patient was wondering if I had over carved the rim and if the lab had to over grind the teeth back to fit them which we would then have to move occlusally or labially with excessive damage to the acrylic tooth. In reality, this isn't much of a big deal as the acrylic teeth bond to the pink acrylic so as long as the aesthetics is not affected this should be fine.

I will wait and see how this interesting case turns out. It just goes to show that even apparently easy cases have their own difficulties and things aren't always as simple as they appear.