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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 9  |  Issue : 3  |  Page : 257-260

Campagna technique: A boon for debilitated dentition patients


Department of Prosthodontics, Crown and Bridge and Implantology, Dr. D. Y. Patil Dental College and Hospital, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India

Date of Submission07-Mar-2022
Date of Decision21-Jun-2022
Date of Acceptance11-Jul-2022
Date of Web Publication14-Nov-2022

Correspondence Address:
Akanksha Shinde
Department of Prosthodontics, Crown and Bridge and Implantology, Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_41_22

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  Abstract 


Immediate complete denture insertion followed by removal of teeth provides a positive emotional response to the patient by saving the embarrassment of being edentulous and minimal alteration in general appearance, muscle tone, and speech. The patient gets adjusted to the change more quickly; the healing period is faster and less painful. However, the fabrication of immediate denture requires different impression techniques to follow than routine conventional complete denture procedure. This case report presents the fabrication of conventional immediate denture using Campagna impression technique which appears to be more precise among all the techniques as it ensures a similar degree of accuracy of the borders in the dentulous as well as edentulous region of the maxillary dental arch. To provide optimum benefit from the constructed denture, a lingualized balanced occlusal scheme was given.

Keywords: Complete denture, dental impression technique, dental occlusion, immediate denture


How to cite this article:
Shinde A, Bulbule N, Bhatt V, Bhandari A, Balachandran G, Jagtap A. Campagna technique: A boon for debilitated dentition patients. J Dent Res Rev 2022;9:257-60

How to cite this URL:
Shinde A, Bulbule N, Bhatt V, Bhandari A, Balachandran G, Jagtap A. Campagna technique: A boon for debilitated dentition patients. J Dent Res Rev [serial online] 2022 [cited 2023 Jan 30];9:257-60. Available from: https://www.jdrr.org/text.asp?2022/9/3/257/361136




  Introduction Top


Denture esthetics plays a crucial role as it is one of the objectives of impression making and is considered from the very first step.[1] The key to esthetic replacement to all losses is to support and harmonize the collapsed dentition and eventually the appearance of the face with various treatment modalities available at the hand of a prosthodontist.[1] The construction of immediate denture thus provides ultimate benefit to the patient in terms of esthetics, phonetics as well as functional efficiency and preserves the psychological and social well-being of the individual.[2],[3],[4]

According to GPT-9, an immediate denture is any fixed or removable dental prosthesis fabricated for placement immediately following the removal of a natural tooth/teeth.[5] This case report presents the fabrication of conventional immediate denture fabricated using Campagna impression technique which appears to be more precise among all the techniques.[6] For better stability of immediate denture considering the ridge form, a lingualized balanced occlusal scheme was given.


  Case Report Top


A 60-year-old male patient reported to the Department of Prosthodontics, Crown and Bridge, Dr. D. Y. Patil Dental College, Pune, with the chief complaint of inability to chew food due to missing front and back teeth of his lower jaw and wanted to get them replaced. The patient presented with good general health, no medical history, or adverse habit history. His dental history revealed uneventful extraction with multiple mobile and carious mandibular teeth few months back.

Intraoral and extraoral examination of a case was assessed, it was found that tooth 24 was having Grade 2 mobility. Other findings were as furcation involvement with 16, 26 and generalised recession, generalised bone loss. There was associated abrasion defect with 14, 15, 16, 22, 24, 25, 26 and Root caries with 14, 11, 12, 21, 22, 23, 24, 25.

The mandibular arch was completely edentulous with Atwood's order 5 resorption pattern. Considering patient's clinical and radiographic findings, different fixed and removable treatments options were proposed to the patient. Amongst the treatment options given, the patient opted for maxillary conventional immediate denture and mandibular conventional complete denture due to aesthetic and functional reasons. Patient's written informed consent was taken prior to the procedure.

As per the planned conventional immediate denture fabrication procedure, the patient underwent extraction of all maxillary posterior teeth including first premolars and reported back after 7 weeks of the healing period.

Primary impression was made for maxillary arch using irreversible hydrocolloid impression material and primary mandibular impression with impression compound (Y-Dents, MDM, India) and poured with dental stone (Dental Stone, India). A primary cast was obtained.

On the maxillary diagnostic model, respective undercuts were blocked. The custom impression tray was fabricated which was 2 mm short of the depth of labial and buccal vestibules on the primary cast passing till the pterygomaxillary notches, and extending till the posterior vibrating line, and the window was made in the remaining anterior teeth region. This opening was 2–3 mm from the gingival margins of the remaining teeth so that tray allows ease of placement and removal and does not bind with the remaining anterior teeth. Hence, for the final impression of the maxillary arch with remaining anterior teeth, the fit of the custom tray with a labial flange was checked intraorally; necessary adjustments in the custom tray were carried out [Figure 1]a.
Figure 1: Intraoral fit of the custom tray with labial flange was checked for extension and ease of removal and placement without binding with teeth and final impression was made using light body impression material

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Then border molding of the maxillary arch was carried out using green stick in a conventional way and the final impression was made with polyvinyl siloxane elastomeric impression material (3M ESPE, Germany) [Figure 1]b. It allows the impression to be removed from severe tooth and tissue undercuts which are usually found in the anterior region of the maxillary arch. Tray adhesive was applied to the tray and impression material was loaded. The final impression was then taken and, when it was set, was removed, inspected for any absence of voids, and reseated back in the patient's mouth. A stock tray of appropriate size was selected, and with irreversible hydrocolloid impression material, pickup impression was taken [Figure 2]. The main purpose of this impression was to record the shape, position of the anterior teeth, and their relationship to the final impression of the palatal and edentulous regions. When the impression was set, it was removed and inspected again. Pickup impression material should not cover final border molded borders.
Figure 2: Maxillary Final impression picked up in a stock tray (a); Mandibular final impression using Zinc-oxide Eugenol impression paste (b)

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For the mandibular arch, conventional custom tray fabrication, border molding, and final impression using zinc oxide eugenol impression paste (DPI, India) were made [Figure 2]. Both impressions were poured using dental stone and casts were obtained. Maxillary and mandibular record bases were fabricated in autopolymerizing acrylic resin using dough method (DPI-RR Cold Cure Resin, India), followed by occlusal rims using modeling wax (MAARC, India).

A facebow record was made to orient the maxillary cast on the articulator, followed by recording an accurate centric relation at an acceptable vertical dimension of occlusion [Figure 3]. Maxillary and mandibular casts were then mounted on Hanau Wide-Vue Articulator. Considering the Class 2 ridge relationship, a lingualised balanced occlusal scheme was planned. According to lingualised balanced occlusal scheme, maxillary palatal cusps were maintained contacting the shallow inclines of modified mandibular teeth. After posterior teeth arrangement, denture try-in was done.
Figure 3: Facebow record

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Then, the remaining anterior teeth present on the master cast were trimmed according to the rule of thirds given by Kelly [Figure 4].[7] As there was no evident gingival inflammation with 2 mm of overall sulcus depth present, the rule of third option was chosen for cast trimming so as to reduce maxillary anteriors' proclination by changing their position and achieve a stable Class 1 relation.
Figure 4: Maxillary Cast trimming done according to Rule of third and master cast

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After complete trimming of the cast, tooth setting was completed in the lingualized occlusal scheme and finishing polishing of trial denture was done [Figure 5].
Figure 5: Teeth arrangement in balanced lingualised occlusal scheme

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The maxillary master cast was duplicated before proceeding for the processing of immediate denture for fabrication of a surgical template. The objective of the surgical template is to check for pressure points after alveoloplasty to ensure adequate trimming. The objective of surgical template is to check the pressure points, as it acts as a guide to duplicate the cast trimming clinically during alveoloplasty. Then, conventional denture processing, i.e., flasking, dewaxing, packing in heat cure acrylic resin (Triplex, Ivoclar Vivadent), and bench curing for 45 min, followed by curing using a short curing cycle was carried out for maxillary and mandibular dentures. The final finished and polished dentures were kept aside.

The remaining teeth were removed as atraumatically as possible which was followed by alveoloplasty. After alveoloplasty, a surgical template fabricated in clear autopolymerizing acrylic resin was used for checking the blanching of mucosa indicative of pressure points and was relieved [Figure 6]. Once sutures were placed, the disinfected complete dentures soaked in Betadine solution before the placement were inserted. Denture occlusion was evaluated in a centric and eccentric position and necessary instructions were given to the patient [Figure 7] and [Figure 8].
Figure 6: Post-alveoloplasty surgical template in situ to check for pressure spots

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Figure 7: Denture inserted immediately after sutures placement (frontal view and lateral view)

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Figure 8: Pre-operative and Post-operative Extraoral View

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The patient was recalled after 24 h and the denture was removed carefully. Dentures and oral cavity were thoroughly cleansed and evaluated for any ulceration, sore spots. Denture was relieved in that area using tissue conditioner. Occlusion was evaluated and corrections were carried out.

The patient was given instructions after immediate denture insertion which were:

  1. Not to remove dentures during the first 24 h and call the next day
  2. Application of cold packs suggested for the first several hours after surgery, to have a soft and nutritious diet with proper hygiene maintenance, rinsing the mouth with warm salt water
  3. Dentures are supposed to be worn at night only for the first 3–4 days, then to be removed at night, or else tissue inflammation and edema may prevent reinsertion of denture for further few days
  4. A temporary liner can be given as per the need in the first few months due to healing and gingival shrinkage, and also denture adhesives can be used. Denture adhesives along with improved retention and stability aid in soft-tissue healing, reducing compression or irritation of the oral mucosa.[8] The patient is also informed that after 6–8 months, as healing is completed, he may complain of loose denture, but if he is satisfied with esthetics and function, a more permanent relining is necessary. For major occlusal errors or extension or retention problems, remaking of a new denture will be required.[2]



  Discussion Top


Final impressions for immediate dentures are fabricated using combinations of different materials and methods. One of these methods includes the use of irreversible hydrocolloids, but it does not record the proper height, width, and length of the labial and buccal vestibules because this material has tendency to displace unattached mucosa and impression is overextended, so it is considered the poorest material for final immediate denture impression.[6],[9] Second, a sectional custom impression tray with rubber base impression material or zinc oxide eugenol paste in correlation with irreversible hydrocolloids leads to overextended labial flange as custom tray does not include the anterior region and causes an inaccurate impression of the labial vestibule.[6],[9] Hence, to overcome these problems, Campagna impression technique was employed due to its greater potential for a more accurate impression of the labial vestibules which was given by Campagna Sebastian in 1968.[6],[9]

A significant role in the stability of mandibular complete denture is played by the size, position of prosthetic teeth as well as the contours of the polished surface as they are likely to be affected to impaired forces from the tongue, lips, and cheeks if placed in objection with the functioning of these structures.[10] Considering low well-rounded ridge form and existing relative relation of maxillary anterior teeth to the mandibular ridge of mild Class 2 type, a balanced lingualized occlusal scheme was given. Lingualized occlusal scheme eliminates the lateral component of forces and thus detrimental forces to the denture-bearing areas are avoided and a mortar-pestle type cusp fossa relation improves masticatory efficiency.[3]

Trimming of casts plays an important role in immediate denture construction, and it is based on anatomic factors and the positional changes that take place in gingival tissues when teeth are extracted.[7] Trimming of the cast, in this case, was done according to the “rule of thirds” to get positional change in anterior teeth.

Immediate dentures are one option for the patient facing an edentulous state. The patient must be educated accordingly. Periodic recall, examination, rebasing, and adjustments are imperative for optimal health care.[4]


  Conclusion Top


This case report describes a Campagna impression technique that can be used for debilitated dentition for the purpose of fabricating immediate dentures. This technique has shown ascertaining an equal degree of accuracy of the borders in the dentulous as well as the edentulous region of the maxillary dental arch that helps establish complete physiologic adaptation of the denture base. Furthermore, the lingualized occlusal scheme employed is beneficial for the biomechanical preservation of denture-bearing tissues with better stability of dentures.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bulbule NS, Shah J, Kulkarni S, Kakade D. Rehabilitation of a completely edentulous patient using TENS to record functional borders and cheek plumpers for esthetics. Int J Prosthodont Restor Dent 2013;3:78-82.  Back to cited text no. 1
    
2.
Winkler S, editor. Essentials of Complete Denture Prosthodontics. 2nd ed. Littleton, MA: PSG Publishing; 1988. p. 361-74.  Back to cited text no. 2
    
3.
Zarb GA, Bolender CL. Prosthodontic Treatment for Edentulous Patients. 12th ed. St. Louis: Mosby; 2009.  Back to cited text no. 3
    
4.
Smith RA. Immediate complete dentures-A starting point. J Am Dent Assoc 1973;87:641-5.  Back to cited text no. 4
    
5.
The glossary of prosthodontic terms: Ninth edition. J Prosthet Dent 2017;117:e1-105.  Back to cited text no. 5
    
6.
Campagna SJ. An impression technique for immediate dentures. J Prosthet Dent 1968;20:196-203.  Back to cited text no. 6
    
7.
Jerbi FC. Trimming the cast in the construction of immediate dentures. J Prosthet Dent 1966;16:1047-53.  Back to cited text no. 7
    
8.
Nagaraj E, Kondody RT, Kalambettu A, Vinnakota DN, Hari J. Changing trends and clinical recommendations of denture adhesive in complete denture: A review. J Dent Res Rev 2021;8:228-32.  Back to cited text no. 8
  [Full text]  
9.
Jain S, Kapila R. Immediate complete denture with campagna impression technique. Ann Dent Res 2013;2 Suppl 1:114-8.  Back to cited text no. 9
    
10.
Bhandari AN, Bulbule NS, Jagtap AK, Bhatlekar T, Nandi A, Mondal S. A zone of minimal conflict: “The neutral zone”– Case series with 6 month follow up. Int J Curr Res Rev Vol 2020;12:152.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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