THE NEUTRAL ZONE AND POLISHED

SURFACES IN COMPLETE DENTURES

FRANK J. SCHIESSER, JR., B.S., D.D.S.”

Temple University School of Dentistry, Philadelphia, Pa.

REAT STRIDES have been made in many technical procedures in complete den-
G ture prosthodontics. However, some phases still must he explored. Fish1 has
stated, “The fundamental principle in the construction of full dentures is that
every part of every surface of the denture shall be modelled to fit some part of the
patient’s tissues, or some part of the other denture.”
This report describes a technique of developing not only impression and
occlusal surfaces of a finished denture but, in addition, the importance of obtaining
a corrected “polished surface”l and establishing a neutral zone to position the
teeth.;

l)EI\;TURE SURFACES

The impression surface of a complete denture, as its name implies, is derived

from the impression and covers the denture base area. The occlusal surface is that
part of a denture which contacts the teeth of the opposite jaw.
The polished surface of the denture is the surface which is normally brought
to a high polish on a dental lathe and which contacts the tongue, cheeks, and lips.
The shape and position of this surface determines to a great degree whether the
patient will feel “at home right away” with dentures. The contour of the polished
surface is largely dependent upon the buccolingual position of the teeth in relation
to the residual ridge and upon the form of the wax-up of the trial denture bases.
The vertical relation of occlusion and the width of the posterior teeth also affect
the shape of the polished surface.
The force that stabilizes the polished surface is the muscular contraction of
the tongue, and the buccinator, orbicularis oris, and other muscles of the cheeks
and lips. The shape of this complex surface as a whole determines whether muscle
movements will dislodge or stabilize the dentures far more than the outline of
the border of the denture. On the other hand, when the polished surface is properly
formed, the retentive force of the buccinator muscle and tongue on the denture
enables the patient to control his dentures after resorption has occurred and the
tit is no longer accurate. (Fig. 1).

*Instructor, Department of Prosthetic%

TPersonal communication: Tenth, R., and Cavalcanti, A. A., 19fXJ.
x.54
 The l~olisl~erl surfaces of the denture must esliihit a series of inclined planes
in relation to the muscles of the tongue ant1 cheeks. The palatal surface of the
upper denture looks inward ant1 tlowiiwartl, jvliile the lingual surface of the lower
denture looks in\vartl and ulmxrd (Fig. 2) .
The flanges of lower dentures should extend under the fold of the lmccinator
muscle and under the tongue to act as ‘*handles” to hold the denture in Place. The
lower denture mist he narrow in the l~icuspicl region (the region of modiolus func-
tion j to avoid being lifted up 1)~ the corners of the mouth (Fig. 3), and the pos-
terior teeth must not encroach on the tongue posteriorlq- The lower denture will
he unstable if: (1) it is too wide in the bicuspid region, (2 j the incisor teeth are
set so far labially that the liI> causes the denture to rise, and (3) the molars en-

Fig. l.-The pressure of the tongue and cheeks in holding the food in place stabilizes the
dentures by pressing them onto the ridge. The resultant force of these muscles on the denture
tend to seat it on the ridge rather than cause it to become unstable. (From Fish, W. E.: Prin-
ciples of Full Denture Prosthesis, London, 1937, John Bale 8: Sons and Curnow, Ltd.)

Fig. 2.--a, A transverse section through the first molar region of stable dentures shows how
the buccinator muscle and tongue hold the dentures while also holding food. b, A transverse
section through the first bicuspid region of complete dentures shows how the narrow arch of
the lower denture keeps it clear of the modiolus. 2, Zygomaticus muscle. T, Triangularis muscle.
(From Fish, W. E.: Principles of Full Denture Prosthesis, London, 1937, John Bale & Sons and
Curnow, Ltd.)
 SCHEISSER 5. Pros. Den.
Sept.-Oct., 1964

croach on the tongue, and the buccal and lingual flanges in the molar region are
parallel so that the tongue and buccinator muscle will not hold them down (Fig. 4).
The most important basic principle is that the artificial teeth must occupy
a position so that the tongue is pressed inward with just as much force as the
cheek is pressed outward. In this way, the denture will occupy a neutral zone
(dead space)l in the mouth since inward pressure of the lips and cheeks will be
exactly balanced by the outward pressure of the tongue. The proper position for the
teeth is not necessarily on the ridge, inside the ridge, or outside the ridge, but at
a point where the pressures of the tongue and cheek balance each other (Fig. 5).
The size of the tongue and tonus of the muscles forming the modiolus must
be closely examined. One factor that causes most instability of lower dentures
is violation of the neutral zone in the region by either incorrect location of the
teeth or by incorrect form of the labial and lingual angles of the polished surface
(Fig. 6).

Fig. 3.-Muscles forming the modiolus form a V-shaped strap that will press in against the
dentures in the bicuspid region causing the denture to become unstable if it is too wide in this
region. (From Fish, W. E.: Principles of Full Denture Prosthesis, London, 1937, John Bale b;
Sons and Curnow, Ltd.)

Fig. 4.-The pressure of the tongue
ture because the planes of the polished
wrong angle and because of the near
denture. (From Fish, W. E.: Principles
Sons and Curnow, Ltd.)
and the cheeks in holding the food dislodges the den-
surfaces are presented to the tongue and cheek at the
parallelism of the lingual and buccal surfaces of the
of Full Denture Prosthesis, London, 1937, John Bale &
Volume 14 POLISHED SURFACES IN COMPLETE DENTURES 857
Nlnnber 5

Fig. 5. Fig. 6.
Fig. 5.-A diagram of stable upper and lower dentures indicates that all polished surfaces
of the lower denture look upward and all polished surfaces of the upper denture look down-
ward with the exception of the labial surface. The lower denture is narrow in the bicuspid
region to accommodate for the modiolus. The buccal extensions in the molar and the anterior
lingual planes in the premolar region are shaped to help retain the denture. M, Modiolus.
B, Buccal extension in the molar region. F, Space for lingual frenum. .L, Anterial lingual planes
in premolar region. P, Posterior lingual rest. (From Fish, W. E.: Principles of Full Denture
Prosthesis, London, 1937, John Bale & Sons and Curnow, Ltd.)
Fig. 6-A diagram of a stable lower denture for a patient with tight lips and a large
tongue. The entire denture is much less bulky than the denture seen in Fig. 6, but the shape
of the polished surfaces are the same. All surfaces look upward. (From Fish, W. E.: Principles of
Full Denture Prosthesis, London, 1937, John Bale and Sons and Curnow, Ltd.)

Fig. 7. Fig. 8.
Fig. ‘I.-The part of the lower impression that will be used for the lingual “handle” is
outlined.
Fig. 8.-The form of the border of the upper preliminary impression has been molded by
the reflecting tissues.
 J. Pros. Den.
x5x SCHEISSER
Sept..Oct., 1964

I’RELIMIXARY IMPRESSIONS

A stock tray is adapted to the residual ridges as closely as possible and a pre-
liminary modeling compound impression is made. The patient is instructed to
extend the tongue out as far as possible, close the lips around the tray handle and
the forefinger of the dentist, and draw or suck in (as when using a straw J with
as hard an action as possible. These two actions mold the borders of the pre-
liminary impression and form the portion to be used for the lingual “handle” with
great accuracy (Figs. 7 and 8). The lingual “handle” is an extension of the lingual
flanges of the lower denture into one or two of the three spaces described by
Shanahan.” These are : (1) the sublingual crescent-shaped space in the anterior
part of the mouth, (2) the sublingual fossa over the mylohyoid muscle, and (3) the
retromylohyoicl fossa which is below and behind the retromolar pad.
Preliminary casts are poured in plaster and outlines for the extent of the im-
pression tray are drawn on the cast at the location of the mucobuccal and muco-
labial folds. The lingual handle and flanges are marked in the region of the suh-
lingual glands. Undercuts on the preliminary cast are eliminated with wax and
a quick-curing acrylic resin tray is made directly on the cast. The borders of the
tray are reduced as outlined on the cast (Fig. 9).

MODIFYING THE ACRYLTC RESIN TRAY

The trays are placed in the mouth and observed for overextension of the
borders. The lower tray is checked by having the patient say ah, ec, and 012,using
an exaggerated motion of the lips and cheeks to pronounce these sounds. The
dentist presses down on the tray in the bicuspid region during the tests. If the
tray is overextended, it will not remain stationary and will rise and then settle
back down with a “swishing” sound when the dentist presses down on the tray.
Then, the interfering part must be located and relieved until the tray will remain
stable and not rise off the ridges during the production of the ah, cc, and oh
sounds. The upper tray is checked in a similar manner and, in addition, the
labial and buccal notches are slightly overrelieved.

ESTABLISHII‘;G THE NEUTRAL ZONE

A soft material that can be molded by the action of the tongue, cheek, and
lips is used to establish the neutral zone. A red modeling compound* softened at
135” F. is adapted to the top of the lower tray and shaped similar to a wax oc-
clusion rim. The tray and modeling compound are placed in the mouth, and the
patient is instructed to swallow. The actions of the muscles and tongue during
swallowing mold the soft compound into the neutral zone and shape the polished
surfaces of the denture (Fig. 10). The modeling compound is allowed to harden
in the lnoutli sufficiently to prevent distortion and is ~&KXY~in cold water to harden
for trimming.
The modeling conq~ound is trimmed so that the occlusal plane is established
a~q~rosiinately 1 to 2 mm. below the lateral border of the tongue when it is at rest.

*The Kerr Co., Detroit, Mich.

 859

Fig. Q.-The lingual surface of the acrylic resin tray shows the lingual handles upon which the
tongue will rest.

Fig. lO.-The patient has molded the modeling compound into the neutral zone. Note how the
surfaces that will he the polished surfaces all look upward.

Thus, the occlusal plane extends between points approsimately two thirds of the
height of the retromolar pads to the height of the lower lip at rest.
When the occlusal plane has been established, the patient again is asked to
say alz, oh, and ee. The tray supporting the modeling compound is again observed
in order to ascertain its stability. If the tray rises, the modeling compound must be
resoftened and the procedure repeated. Causes for instability at this stage are :
(1) too much modeling compound was used initially, and/or (2) the modeling
compound was not sufficiently softened to be molded by the muscles.
The dentist will see the modeling compound that indicates the neutral zone
as he looks in the mouth. This lower rim will remain stable and in place if cor-
rectly formed, regardless of how little residual ridge is present.

CENTRIC AKD VERTICAL RELATIONS

After the shape of the modeling compound on the lower tray has been per-
fected, the compound is covered with a thin film of petroleum jelly and placed in
the mouth. Soft modeling compound is then attached to the upper tray and molded
to the approximate shape of an upper occlusion rim. Then, the compound is softened
 SCHEISSEK J. Pros. Den.
Sept.-Oct., 196.1

in a 13.5” F. water bath and placed in the mouth, and the patient is instructed to
swallow. The patient has been conditioned by sipping water and swallowing a fe\\
times previously. During the swallowing action, the mandible will be guided into
centric relation, and the correct vertical relation of occlusion will be established
by the action of the muscles3 The modeling compound on the upper acrylic resin
1)aseis chilled and the base is removed from the mouth.
The excess modeling compound that has extended over the buccal, lingual,
and labial sides of the lower occlusion rim is trimmed away. The upper modeling
compound rim is resoftened, placed back in the mouth, and the patient is instructed
to swallow. This procedure is repeated until little or no excess of modeling com-
poured forms at the occlusal surface. By this time, the upper lip will have molded

Fig. Il.-The cast on the right indicates the angle of patient’s teeth before they were
removed. The modeling compound occlusion rim on the left was molded by the lip. Note the
similar angulation.

Fig. lZ.-The upper and lower final impressions. Note the effect of muscle attachment and
border tissues on the upper impression.
Vulume 14 POLISHED SURFACES IN COMPLETE DENTURES 861
Number 5

Fig. 13. Fig. 14.

Fig. 13.-A modeling compound index records the position of the tongue.
Fig. 14.-A modeling compound index records the position of the lower lip.

the compound to indicate the angle and position of the upper anterior teeth
(Fig. 11).
The modeling compound of the upper tray is trimmed to establish the smile
line and the labio-incisal angle of the rim is checked by using phonetic tests. The
modeling compound should contact the inside of the vermillion border of the lower
lip during the f and v sounds.4

FINAL IMPRESSIONS

With the upper rim in place, a zinc oxide and eugenol impression paste* is
mixed and placed on the tissue side of the lower tray. The tray is positioned in the
mouth and the patient is instructed to swallow. The upper and lower rims will
come together in centric relation with a similar pressure as will be exerted while
swallowing,3 and the muscles and their attachments will move as in normal func-
tion (Fig. 12). The dentist does not have his fingers in the mouth, and this avoids
the making of a recording of the borders of the impression with the mouth in an
unnatural, strained (open) position.
After the lower impression has been completed, the upper impression is made
in a similar manner with the lower impression in place in the mouth.

CORRECTING VERTICAL RELATION

After both impressions have been completed, the jaw relation records are
made. The upper modeling compound rim is notched in the second bicuspid and
first molar region with a “v-shaped” cut approximately 4 to 5 mm. deep from the
occlusal surface, the compound is lubricated with petroleum jelly, and the im-

*Impression Paste, S. S. White Co., Philadelphia, Pa.

 SCHEISSER J. Pros. Den.
862 Sel,t.-Oct., 1964

Fig. 1.5. Fig. 16.

Fig. 15.-The tongue and lip index have been replaced after the occlusion rim has been
removed and the neutral zone is formed between them.
Fig. 16.-The modeling compound occlusion rim and lip index is formed on the upper rim.

Fig. 17.-The artificial teeth are set up on an acrylic resin baseplate in just enough wax to
hold them in place.

pression is replaced in the mouth. Then, soft modeling compound is traced onto
the occlusal surface of the lower occlusion rim in the region that will contact the
notch in the upper occlusion rim. The lower rim is placed in the mouth and the
patient is instructed to swallow once more. The soft compound on the lower oc-
clusion rim will engage the notch on the upper occlusion rim. After the compound
has hardened, both rims are removed from the mouth so that they can be related
Volume 14
Number 5
POLISHED SURFACES IN COMPLETE DENTURES 863

to each other for mounting. A face-bow registration is made before the centric
relation record is made so that the upper cast can be oriented properly on the
articulator.

CONSTRUCTING TOiXGUE, LIP, AND CHEEK INDICES

Upper and lower casts are poured and mounted on an adjustable articulator.
The lower cast is notched in the tongue space region and the upper cast is notched
at the junction of the momlting stone. The modeling compound occlusion rims are
lubricated with petroleum jelly and soft compound is molded onto the lingual
surface of the lower rim to make a compound tongue index. Soft modeling com-
pound is molded on the labial and buccal surfaces of the upper rim as far posteriorly
as the first bicuspid region to make compomid indices to simulate the lips and
cheeks of the patient (Figs. 13-16). The occlusion rims are then removed from
the casts, and the tongue, lip, and cheek modeling compound indices are returned
to the cast. The space between these indices represents the neutral zone (Fig. 15).
\\“hen the artificial teeth are set, they must be positioned within this neutral zone
to be physiologically accepted by the actions of the muscles and the tongue.

ARRANGING ARTIFICIAL TEETH

A new baseplate is made on the master cast with borders within the neutral
zone. The upper and lower anterior teeth are set against the inner side of the
modeling compound indices. The tooth length is determined by using the smile line
as a guide. The lower posterior teeth are set in the neutral zone with their occlusal
surfaces at the height of the modeling compound tongue index. These teeth are
set in just enough wax to hold them on the trial denture base (Fig. 17).

ESTABLISHING THE POLISHED SURFACE

The vertical and centric relationships are verified at the try-in, and the an-
terior teeth are rearranged to improve esthetics. Then, the form of the polished
surface is recorded by means of a zinc oxide and eugenol paste. The paste is placed
on the lingual surface of the lower trial denture base with a liberal amount in the
anterior region. Often, a definite shelf will be created in this region which provides
a resting place for the tongue and aids considerably in retention. The trial den-
ture is placed in the mouth, and the patient is instructed to swallow. The paste
is allowed to set, and then more of the paste is placed on the buccal and labial
surfaces to perfect their contour. Iiax may be used instead of the zinc oxide and
eugenol impression material if preferred.j
The impression paste is then distributed evenly over the palatal surface of the
upper denture, and the patient is instructed to place the tongue against the roof
of the mouth, to fi~rslz, and then to swallow. The forming of the external surface
is repeated on the buccal and labial flanges (Fig. 1X).
The excess zinc oxide and eugenol impression material is trimmed away
from the teeth, and the trial dentures are flasked and finished. No denture base
material is removed from the polished surface of the dentures during the finishing
procedures (Fig. 19).
 SCHEISSER J. Pros. Den.
864 Sept.-Oct., 1961

Fig. 18. Fig. 19.

Fig. 18.-The polished surfaces of the upper pal&al and lower lingual flanges are estab-
lished by the zinc oxide and eugenol impression paste. Note the lingual “handles” and the shelf
like area in the lower trial denture where the sublingual glands mold the paste during
swallowing.
Fig. lg.-All polished surfaces of the completed lower denture look upward. The tongue
can press against the lingual surface of the denture to hold it down. The denture is narrow
in the bicuspid region to avoid displacement by the modioli.

DISCUSSION

This technique of developing the shape of all polished surfaces of the dentures
is sufficiently flexible that dentists can adapt it to their routine denture techniques.
Impressions and the vertical and centric relation records can be made by the den-
tist’s method of choice. The most important advantage of this technique is that
it locates the neutral zone of forces to be applied against the dentures so the
polished surfaces can be shaped to overcome many problems encountered I))-
patients wearing lower dentures,

SUM MARY

A technique has been described in which the form of the polished surfaces is
developed in an impression paste at the try-in, and this form is carried through
into the finished dentures. The polished surfaces of dentures are as important as
the occlusal and impression surfaces in the construction of successful dentures.
A method for determining the correct arch form and buccolingual position of
the posterior teeth has been described. This position is called the neutral zone.
A method of forming the contours of occlusion rims with soft modeling com-
pound and establishing the vertical and centric relations by the swallowing method,
and a procedure for developing and recording the smile line and the inclination
of the anterior teeth has been described.
I wish to express my sincere appreciation to Dr. Arvin William Mann, Fort Lauderdale,
Florida, for his help in ariting and organizing this article.
 I’OLlSIIED SURFACES IN COMI’LETE DENTURES 865

REFERENCES

1. Fish, E. W.: Principles of Full Denture Prosthesis, ed. 3, London, 1937, John Bale & Sons
Cut-now, Ltd., p. 2.
2. Shanahan, T. E. J.: Stabilizing Lower Dentures on Unfavorable Ridges, J. PROS. DEN.
12:420-424, 1962.
3. Shanahan, T. E. J.: Physiologic Vertical Dimension and Centric Relation, J. PROS. DEN.
6:741-747, 1956.
4. Pound, E.: Applying Harmony in Selecting and Arranging Teeth, D. Clin. North America,
p. 241-258, 1962.
5. Raybin, r\;. H.: The Polished Surface of Complete Dentures, J. PROS. DEN. 13:236-239,
1963.
716 BETHLEHEM PIKE
PHILADELPHIA 18, PA.

BUR FOR REMOVING IMPRESSION MATERIALS FROM

TRAYS OR DENTURES

A large round three-bladed surgical bur* is efficient for removing zinc oxide
and eugenol impression material and soft resin treatment lining materials from
trays or dentures. This type of bur will not clog as will other types of burs. It is
useful in removing unsatisfactory impressions from trays or dentures and, in the
laboratory, in preparing dentures for relining procedures.

*Busch vanadium steel surgical bur No. 14 (three-bladed), I’fingst & Company, Inc., New
York, 3, N. Y.