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Townie Casefile: Breathing New Life Into a 20-Year-Old RPD

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Categories: Prosthodontics;
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD 

A creative composite approach

Townie Casefiles spotlight exceptional case studies from our own community. Each article highlights real-world clinical techniques, decision-making strategies, and long-term outcomes from Townies who share their expertise on the Dentaltown message boards.

Case Highlights
Clinician: Dr. Jason Tosto

Patient: 85-year-old male

Chief complaint: Fractured anterior denture tooth on maxillary RPD; patient seeks repair while avoiding transition to complete dentures.

Diagnosis: Severe wear of maxillary and mandibular RPDs; lost vertical dimension (~6 mm); missing multiple teeth; parafunction; erosion; pseudo–Class III occlusion; Stage III, Grade B perio; #24 necrotic with chronic apical periodontitis; fractured #9 denture tooth.

Treatment plan:
  • Composite refurbishment of the lower RPD to regain vertical dimension.
  • Rebase and replacement of #7–10 denture teeth on the upper RPD.
  • Extraction of #24 and addition of denture tooth at the lab.
  • Re-establishment of restorative space for upper RPD repair.
An 85-year-old long-standing patient presented with a fractured #9 denture tooth on an upper RPD that had already been repaired the previous year. Both the maxillary and mandibular RPDs were more than 20 years old. Despite extensive wear, the patient found them comfortable and functional, and was adamant about keeping costs and treatment time to a minimum. He declined implants, full dentures, or new RPDs unless absolutely necessary.

Comprehensive evaluation revealed severe structural and occlusal deterioration: advanced attrition and erosion, a deep curve of Spee with supra-eruption of the lower incisors, pseudo–Class III occlusion, and collapse of vertical dimension. The lower RPD exhibited extensive wear of the denture teeth, eliminating restorative space and making simple repair of #9 predictably unstable (Figs. 1–4).
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD
Fig. 1: Pre-op, upper arch
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD
Fig. 2: Pre-op, lower arch
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD
Fig. 3: Fully occluded pre-op view showing lack of restorative space and collapsed vertical dimension
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD
Fig. 4: Pre-op, smile

Multiple treatment options were reviewed, from new prostheses to implant overdentures. Given the patient’s budget and preferences, a conservative but unconventional approach was selected: rebuilding the occlusal surfaces of the lower RPD with composite to restore vertical dimension, then repairing the maxillary RPD accordingly.

Diagnostic impressions and wax-ups were used to preview the proposed vertical changes and determine whether sufficient restorative space could be recreated (Figs. 5–7). An intraoral mock-up (Fig. 8) confirmed patient acceptance, provided that all fees would be credited toward an alternative treatment if the result failed.
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD
Fig. 5a: Wax-up, lower
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD
Fig. 5b: Wax-up, lower
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD
Fig. 6a: Wax-up, upper
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD
Fig. 6b: Wax-up, upper
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD
Fig. 7: Wax-up, mounted casts
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD
Fig. 8: Intraoral mock-up of proposed vertical changes

Composite refurbishment of the lower RPD
Traditional acrylic denture teeth were not ideal for this case; the patient had repeatedly proven himself a “destroyer of dentistry,” wearing through acrylic rapidly. Composite provided a more durable occlusal surface that resisted his parafunctional load.

The lower RPD was stabilized in a lab putty matrix, and retention features, including potholes, retention grooves, and rabbit joints, were placed. All prepared surfaces were micro-etched and cleaned with 91% isopropyl alcohol before application and curing of Heliobond (Ivoclar). Pala Cre-active clear composite (Kulzer) was applied to the retention forms.

A premade, clear VPS matrix with vent holes was loaded with Voco GrandioSO Heavy Flow A1, followed by heated Z250 A3 sculpted over the flowable layer (Fig. 9). Warming the matrix and composite provided improved flow and adaptation during seating. With the RPD fully seated into the loaded matrix, the assembly was light-cured under pressure and subsequently cured to depth in a Triad unit.
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD
Fig. 9a: : VPS matrix with vent holes loaded with flowable and heated composite
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD
Fig. 9b: : VPS matrix with vent holes loaded with flowable and heated composite

The refurbished lower RPD was finished, polished, and delivered the same day (Figs. 10–11). This step alone re-established sufficient vertical dimension to safely restore the maxillary anterior denture teeth without inducing another premature collapse.
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD
Fig. 10: Refurbished lower RPD, finished and polished
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD
Fig. 11: Refurbished lower RPD, day of delivery
Upper RPD repair and extraction of #24
At follow-up appointments, tooth #24 was extracted and a denture tooth was added to the mandibular RPD at the lab. The upper RPD was rebased and denture teeth #7–10 were replaced (Fig. 12). Two years later, the composite-rebuilt lower RPD continued to show no measurable wear, while the newly placed acrylic teeth #9–10 showed early wear and chipping—further validating the decision to use composite in the lower arch.
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD
Fig. 12: Post-op re-evaluation with #24 addition (Peridex staining visible)br />

Postoperative result
Final delivery revealed restored facial support, improved aesthetics, recovered vertical dimension, and significantly better function than preoperatively (Fig. 13). The patient adapted immediately and reported high satisfaction (Fig. 14).
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD
Fig. 13: Post-op finished case
Townie Casefile: Breathing New Life Into a 20-Year-Old RPD
Fig. 14: Full smile

Two years later, the prostheses continue to function with no degradation of the composite surfaces, and the patient remains comfortable with no interest in pursuing more extensive prosthetic treatment.

Discussion
This case demonstrates an alternative strategy for patients with severe RPD wear who either cannot or will not pursue conventional replacement. Composite resurfacing of RPD teeth is labor-intensive and not universally indicated, but in carefully selected situations, especially when durability is a concern, it can provide significant functional and aesthetic benefit.

While in-lab reprocessing is standard, it would not address the patient’s destructive occlusal patterns. Composite provided a higher-wear, customizable solution that preserved existing prostheses while creating the restorative space needed for upper RPD repairs.

The success of this case depended on:
  • Transparent communication and patient agreement
  • Wax-up verification of achievable vertical dimension
  • Durable composite buildup techniques
  • Realistic expectations for longevity and limitations
This is not textbook dentistry, but it is dentistry tailored to an individual patient’s needs, limitations, and priorities. In this instance, it restored comfort and function while respecting the patient’s constraints.

View the full case study and join the conversation!

Great Dentists, Great Dentistry
Author Dr. Jason Tosto, known to Townies online as dylandoc, has been part of the Dentaltown community since 2007. He graduated from Temple University School of Dentistry and has built a career centered on crown and bridge dentistry, implant restoration, and advanced anesthetic delivery techniques. When he’s not treating patients, he enjoys playing guitar, running, bicycling, home-brewing, collecting vinyl records, and spending time with his wife.


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