|Year : 2015 | Volume
| Issue : 1 | Page : 66-68
Sublingual crescent extension: A solution for loose lower denture
Nishna Pradeep, Jinsa P Devassy, AV Sreekumar
Department of Prosthodontics, Kannur Dental College, Kannur, Kerala, India
|Date of Web Publication||30-Jul-2015|
Dr. Jinsa P Devassy
Department of Prosthodontics, Kannur Dental College, Kannur, Kerala
Source of Support: None, Conflict of Interest: None
Mandibular complete dentures frequently lack retention and stability and offer less denture-supporting area than maxillary dentures. In case of severely resorbed ridges retention is highly compromised. Extending the anterior lingual flange of the lower denture sublingually makes it possible to achieve satisfactory retention in severely resorbed ridges. This clinical report describes a simpler method to achieve retention during impression making and thus help to maintain the retention and stability of lower dentures during the function.
Keywords: Resorbed ridges, retention, sublingual crescent
|How to cite this article:|
Pradeep N, Devassy JP, Sreekumar A V. Sublingual crescent extension: A solution for loose lower denture. Saint Int Dent J 2015;1:66-8
|How to cite this URL:|
Pradeep N, Devassy JP, Sreekumar A V. Sublingual crescent extension: A solution for loose lower denture. Saint Int Dent J [serial online] 2015 [cited 2019 Nov 12];1:66-8. Available from: http://www.sidj.org/text.asp?2015/1/1/66/161822
Achieving retention and stability in lower complete denture with a severely resorbed ridge is still a challenging one for the general dentist.  This article presents a simple solution for loose lower denture, which gives excellent retention and stability to normal or medium height ridges and satisfactory retention in severely resorbed ridges, where otherwise achieving retention is a dream.
Though many terms have been given to the regions covered by the sublingual flange, the appropriate term is sublingual crescent because it describes the region from both anatomic and topical aspects.
According to the Glossary of Prosthodontic terms, sublingual crescent area [Figure 1] is the crescent shaped area on the anterior floor of the mouth formed by the lingual wall of the mandible and the adjacent sublingual fold. Sublingual crescent extension is defined as the portion of the sublingual flange of the mandibular denture that covers the anterior region of the floor of the mouth. 
| Case Report|| |
A 63-year-old female patient reported to the Department of Prosthodontics, Kannur Dental College with a chief complaint of the looseness of lower denture since 6 years. Her history revealed that she was edentulous for 20 years and a denture wearer for 19 years. Medical history revealed she was a known diabetic for past 25 years. The intra-oral examination revealed completely edentulous maxillary and mandibular arch with considerable resorption in the lower anterior region. Keeping the various challenges associated with the case, clinical steps and treatment plan was modified to give a mandibular complete denture with sublingual crescent extension opposing a conventional maxillary denture.
| Technique|| |
The primary impression was made by irreversible hydrocolloid in the perforated stock tray. The special tray was fabricated on the primary cast without using a spacer.  After special tray extensions were corrected border molding with low fusing compound was done in the conventional manner starting from the distolingual sulcus [Figure 2]. The labial and buccal areas were then border molded [Figure 3]. Sublingual recording was initiated with impression compound. Soften the impression compound in hot water (60°C) and add it into borders of custom acrylic resin tray from premylohyoid, from one side to the other [Figure 4]. The added compound was then tempered in hot water, the special tray was placed in the patients mouth. The patient was instructed to gently place the tongue against the lingual side of tray handle. The tray was removed from the mouth and cooled in cold water. This procedure was repeated until the sublingual crescent area was recorded satisfactorily. The impression compound was relieved in frenal notch area to expose the openings of sublingual ducts. The low fusing compound was carefully added along the borders of the recorded sublingual crescent in impression compound and patient was asked to repeat the same movement. The added sublingual crescent extension now maintains contact with the sublingual fold when the tongue touches the lower lip [Figure 5]. It also maintains contact with the floor of mouth even when the tongue is in retracted position, thereby developing a good peripheral seal. Relief holes were made in the special tray, and the secondary impression made zinc oxide eugenol impression paste [Figure 6]. Remaining steps were done in the conventional manner, and the denture was fabricated in heat cure acrylic resin using long curing cycle [Figure 7].
| Discussion|| |
In case of severely resorbed ridges, the factors affecting retention are highly compromised. Lewis  was first to report about the anterior sublingual area anatomy and utilization of sublingual crescent space for the retention of the mandibular denture. Many of the problems that arise during the course of denture construction can be solved easily through a knowledge of anatomy and anatomic landmarks. Lewis, in his article, states that the most important area for retention of the lower denture is the anterior lingual region, from cuspid to cuspid. We must examine this area thoroughly and according to its character, learn to evaluate the mandible and the floor of the mouth for the construction of a good denture. Mandibular complete dentures frequently lack retention and stability and offer less denture-supporting area than maxillary dentures. A sublingual flange extension improves the retention and stability of complete lower dentures. It increases the tissue surface of the denture, augmenting simple adhesion and, therefore, retention. von Krammer  described the principles and techniques of sublingual crescent extension and suggested its utilization in distal-extension lower partial dentures also. Azzam et al.  describes the importance and clinical procedure for sublingual crescent extension. In his article, he reports that upon completion of the sublingual crescent border, evidence of enhanced resistance to dislodgment is usually achieved and the denture is more stable during normal tongue movements such as swallowing, speaking, and eating. The size and position of sublingual folds vary considerably in different patients. Some are large and well developed, whereas others are much smaller, particularly in elderly patients in whom degenerative changes have occurred. The smaller the fold, the poorer are the chances of complete success and the greater becomes the care required to achieve the necessary contact with the mucosa of the floor of the mouth.  Over extended sublingual crescent extension will diminish the denture retention.  In this modern era implants can help to increase the retention and stability, but in cases where it cannot be done, sublingual crescent extension offers a simpler alternative. In this case, we did not use patient's past denture because it was ill fitting and can't use an impression tray. The material of choice of sublingual crescent extension is modeling compound.  One requirement of the sublingual extension of the impression is to have minimal pressure exerted on the floor of the mouth with the tongue at rest. Minimal pressure may be described as the weight of the softened modeling compound. Excess pressure will occlude the opening of the sublingual gland ducts with swelling of the tissues.  In our case we reviewed the patient after 1-, 2- and 4-week, patient was very satisfied with the denture and on examination no swelling or ulcer seen in any area.
| Conclusion|| |
This is a very simple technique which can be easily incorporated in our day-to-day clinical practice to enhance retention of mandibular dentures, especially in resorbed ridges.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gafoor MA, Kumar VV, Sheejith M, Swapna C. Recording ′sublingual crescents′ in lower complete dentures: A technique so effective but still esoteric and arcane. J Contemp Dent Pract 2012;13:222-6.
Azzam MK, Yurkstas AA, Kronman J. The sublingual crescent extension and its relation to the stability and retention of mandibular complete dentures. J Prosthet Dent 1992;67:205-10.
Lewis ET. Repositioning of the sublingual fold for complete dentures J Prosthet Dent 1958;8:22.
von Krammer R. Principles and technique in sublingual flange extension and complete mandibular dentures. J Prosthet Dent 1982;47:479-82.
Lawson A. Influence of the sublingual fold on retention of complete lower dentures. J Prosthet Dent 1961;11:1038-44.
Chang JJ, Chen JH, Lee HE, Chang HP, Chen HS, Yang YH, et al.
Maximizing mandibular denture retention in the sublingual space. Int J Prosthodont 2011;24:460-4.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]