PRS 412 5th Yr Notes Fall 2022

Faculty of Oral and Dental Medicine
‫رؤية ورسالة الكلية‬

‫الرؤية‬
‫تتطلع الكلية أن تكون في مصاف المؤسسات التعليمية المعترف بها إقليميا ً وعالميا ً من خالل برامج تعليمية متطورة وأبحاث‬
.‫تطبيقية مبتكرة وتنمية مجتمعية مستدامة‬
Vision
The Faculty of Oral and Dental Medicine aspires to be a recognized educational institution,
regionally and internationally, by providing advanced educational programs, innovative applied
research, and sustainable community development.
‫الرسالة‬
‫ ذو كفاءة معرفية وتطبيقية من خالل برامج تعليمية متطورة تتوافق‬،‫إعداد طبيب أسنان ملتزم بالقيم االنسانية واألخالق المهنية‬
‫ كما تلتزم الكلية بإعداد بحوث تطبيقية متوافقة مع االستراتيجيات القومية‬.‫مع االحتياجات الفعلية لسوق العمل المحلي والعالمي‬
.‫وكذلك تقديم خدمة مجتمعية مستدامة وفقا ً لمعايير الجودة العالمية‬
Mission
The mission of the Faculty of Oral and Dental Medicine is to prepare knowledgeable and
well-trained dentists committed to human values and professional ethics, by developing
advanced educational programs that correspond to the actual needs of the local and global
labor market. The Faculty is also committed to preparing applied research in line with
national strategies, as well as providing sustainable community service following
international quality standards
2022-2023
Faculty of Oral & Dental Medicine
Course Specifications
A- Basic Information
Course Title: Removable Prosthodontics II
Course Code: PRS 412
Program on which the course is given: Bachelor of Oral and Dental Medicine
Department offering the course: Removable Prosthodontic Department
Department teaching the course: Removable Prosthodontic Department
Academic year/Level: Fifth Year
Date of specification approval: 20/9/2022
Credit hours: 6
Fifth year
Lectures Practical
Total Credit
Semester (contact (contact
Hours
hours/ Week) hours/ Week)
Fall 2022 1 4 3
Spring 2023 1 4 3
Total 2 8 6
Course coordinator: Prof. Dr Eman Eltaftazany
Dr. Rehab Helmy
B- Professional Information
1-1- Overall aims of course
Upon completion of the course, each student should be able to:
● Identify the basic sequela of complete edentulism.
● Design and formulate a treatment plan of a completely edentulous patient.
● Develop knowledge about advanced treatment modalities of Prosthodontics.
● Perform Prosthodontic management for completely and partially edentulous patients.
2- Intended learning outcomes of course (ILOs)
a- Knowledge and understanding:

By the end of this course, the student should demonstrate comprehensive knowledge and clear
understanding of the following:
a10-Recognize the technique of relining and rebasing.
a11-Identify patients’ complaints after complete denture insertion and their management.
a12-Select the suitable management of problematic complete denture cases.
a13-Recognize complete over dentures.
a14-Describe single dentures and different treatment modalities.
a15-Describe immediate denture types and procedures for construction.
Page 1
Quality Assurance Center QA/CSEn/22F-23S
2022-2023
a16-Identify denture duplication.
a17-Recognise the field of maxillofacial Prosthodontics
a18-Classify congenital and acquired defects of the lip and palate
a19-Identify types of radiotherapy prosthesis
a20-Recognise prosthetic rehabilitation of mandibular defects.
a21-Describe different types of stents and their technique of construction.
a22-Recognise etiology and treatment of trismus.
a23- Describe prosthetic management of jaw fractures.
b- Intellectual skills:
By the end of this course, the student should be able to:
b12- Distinguish patient's complaints about complete denture and develop their treatments.
b13- Discriminate different methods for relining and rebasing.
b14- Differentiate between different types of over denture prosthetics
b15- Compare between different types of congenital and acquired defects.
b16- Design removable prostheses for congenital and acquired defects.
c- Professional and practical skills:

c1-Apply clinical examinations, diagnosis and treatment plan for partially and completely
edentulous cases.
c2-Perform the impression procedures for completely edentulous patients.
c3-Practice the procedures of jaw relation registration including centric occluding relation using
static records.
c4-Perform trial insertion of complete denture.
c5-Apply procedures of complete denture insertion and manage occlusal disharmonies and post
insertion follow up.
c6-Apply history taking, clinical examinations, diagnosis and treatment plan for partially
edentulous patients.
c7-Practice the clinical procedures for temporary removable partial denture.
c8-Apply mouth preparation procedures including abutment preparation in removable partial
denture.
c9- Apply procedures of basic impression techniques in removable partial dentures.
c10- Practice the procedures of jaw relation registration for partially edentulous patients.
c11-Apply trial insertion of metal framework and waxed up partial denture.
c12-Perform insertion of finished partial denture and post insertion follow up.
d- General and Transferable Skills:
d1-Deal with patients of different mental attitudes.
d2-Communicate with a lab to achieve required results
d3-Develop skills related to creative thinking, problem solving, oral & written
communication, and teamwork.
3-Contents:
Fall Semester
Page 2
2022-2023
No. of Intended Learning

Practical
Contac Lect Outcomes
Week Topic /
t ure
Tutorial K&U IS P&P G&TS
Hours
One Immediate dentures
& 2 2 0 A15
Two
Three
Single denture 1 1 0 A14
Four Post insertion D2,
& complaints 2 2 0 A11 B12 C5
Five D3
Relining, rebasing A10,
Six 1 1 0 B13
&duplication A16
Revision / Problem
Seven 1 1 0
Solving
Treatment of some
Eight
complete denture
& 2 2 0 A12
Nine problems
Ten Complete over

&Elev dentures 2 2 0 A13 B14
en
Twelv Revision / Problem
e
1 1
Solving Revision
Clinical procedures
C1,
for metallic
c2,
removable partial
1-12 48 0 48 c3,
dentures and
C8,
complete denture
c9
construction
*K&U = Knowledge and understanding.

*IS = Intellectual skills.
*P&P = Professional and practical skills.
*G&TS = General and transferable skills.
Page 3
2022-2023
Contents: Spring Semester
Prac Intended Learning

No. of Lec tical Outcomes
Week Topic Contact tur /
Hours e Tut K&U IS P&P G&TS
orial
Introduction to 1 1 0 A17
the Field of
maxillofacial
One
prosthodontics,
congénital
defects
Management of
B15
Two & congénital
2 2 0 A18 ,
Three defects of the b16
maxilla
Management of B15
Four &
acquired defects of 2 2 0 A18 ,
Five
the maxilla b16
Prosthetic
Six management of 1 1 0 A23
jaw fractures
Intraoral devices 1 1 0 A21
Seven (stents)
Eight Trismus 1 1 0 A22

Mandibular
Nine 1 1 0 A20
defects
Management of
Ten irradiated 1 1 0 a19
patients
Eleven Revision 1 1 0
Clinical c1,c d1,d2
procedures for 2,c3, ,d3
Twelve 40 0 40
temporary c4,c
removable 5,
Page 4
2022-2023
partial dentures c6,
and complete c7
denture
construction
4- Teaching and learning methods
● Lectures ◻
● Interactive teaching
- Group discussion ◻
- Team Based Learning (TBL) ◻
- Problem Solving ◻
- Think Pair Share (TPS) ◻
- Workshops ◻
- Role playing ◻
● Problem Based Learning ◻
● Seminar / Presentations ◻
● Research Project ◻
● Mobile Learning ◻
● Self-learning ◻
● Clinic / Lab demonstrations ◻
● Laboratory training ◻
● Clinical training ◻
● Simulators (dummy heads) ◻
● Four hands technique ◻
● Field training ◻
● Flipped Classroom ◻
● Virtual Classes (online meetings - zoom meetings) ◻
● Online Team Based Learning (TBL) ◻
● Recorded lecture with narrations ◻
● Recorded video lectures ◻
● Forums discussion ◻
● Game based learning ◻
Page 5
2022-2023
● Online breakout rooms ◻
● Clinic /Lab Demonstrations videos ◻
● Audio visual aids (video/YouTube links) ◻
Others……………………………………………………….
5- Student assessment methods
Formative Assessment
● In campus ◻ Theoretical ◻ Practical
● Online ◻ Theoretical ◻ Practical
Summative Assessment
● Written exam ◻ In campus ◻ Online
Practical exam
▪ Data show ◻ In campus ◻ Online
● Practical sheet ◻
● Objective laboratory exam ◻
● Objective clinical exam ◻
● Objective structured clinical examination (OSCE) ◻
● Objective structured practical examination (OSPE) ◻
● Assignments ◻ In campus ◻ Online
● Requirements ◻
● Oral exam ◻
● Others……………………………………………………..
Assessment schedule
Assessment 1 Midterm Exam*
Assessment 2 Practical Exam*
Assessment 3 Final Exam*
* According to MIU calendar.
Weighting of assessments:
semester Midterm Final Attendance Practical Requirements Oral Total

exam exam
Fall 15 25 5 20 15 - 80
(20%)
Spring 15 90 - 55 - - 160
(40%)
Total 30 115 5 75 15 - 60%
Page 6
2022-2023
6- List of references
6.1- Course notes Removable Prosthodontics department notes
6.2- Text books

● Winkler, S. Essentials of Complete Denture Prosthodontics. in: WB
Saunders Co, Philadelphia; 2006.
● Zarb, GA, Bolender, CL, Hickey, JC, Carlsson, GE. Boucher's
prosthodontic treatment for edentulous patients. in: 12th ed. CV Mosby, St.
Louis; 2004.
● Complete dentures and implant supported prostheses. Mosby Co.,12th
edition, 2004
6.3- Beumer J,Curtis TA,Firtell D:Maxillofacial Prosthetics.St.Louis,Mosby,Third
edition 2011
6.4- Periodicals, Web sites, … etc
● Journal of Prosthetic Dentistry
● International Journal of Prosthodontics
7- Facilities required for teaching and learning
● Data show ◻
● Well-equipped lab ◻
● Well-equipped clinic ◻
● Teaching Models ◻
● Digital Library ◻
● On campus Library ◻
● Moodle platform ◻
● virtual classroom software ◻
● Dental photography center ◻
● Studio for video recording ◻
● Internet & intranet ◻
● Well-equipped rooms for online meetings ◻
● Computer labs ◻
● Others …………………………………...
N.B.: Attached :(1) Curriculum map
Course coordinator: Prof. Dr Eman Eltaftazany

Dr/ Rehab Helmy
Head of Department: Prof. Dr Eman Eltaftazany
Date: 20/9/2022
Page 7
CLINICAL COMPLETE DENTURE
CHAPTER I
COMPLAINTS ABOUT COMPLETE

DENTURES
SLOs: At the end of this chapter, the students should be able to:
1. Identify the causes of pain after denture insertion and describe

their management.
2. List the causes of incorrect jaw relation record in complete
dentures and describe their management.
3. Explain the causes that may lead to patient’s dissatisfaction to
denture appearance and describe their management.
4. Identify the causes of patient’s complaints about inefficiency of the
complete denture.
5. List the causes of poor denture retention and stability.
6. List the causes of patient’s complaints about clattering of teeth,
nausea, discomfort and altered speech.
7. Identify the causes of check and tongue biting when using the
complete denture.
8. Explain the causes of Angular Cheilitis after denture insertion.
9. Explain the causes of patient’s complaints about burning sensation
of palate and tongue and describe their management.
10. List the causes of repeated mid line fracture of maxillary denture
and describe its management.
1
I- PAIN
1- Overextension of the Periphery:
This has been described before in the section of denture
adjustments (easing).
 Pressure indicating paste (diagnostic paste or tooth paste) .
 Indelible pencil (vision) .
2- Poor Fit:
This can easily be detected by the poor retention, rocking, tilting
and inability to seat the denture accurately in any position.
Treatment: New dentures, but the old ones can be worn in the
meantime with a lining of tissue conditioning material.
3- Insufficient Relief:
The denture will usually rock on the hard area causing pain. The
painful area is red and possibly ulcerated.
Treatment: Apply a very thin coating of diagnostic paste, or white
tooth paste, to the area which requires relief, insert the denture and on
removal the area will be easily marked; bur away the part of the fitting
surface until adequate relief is obtained.
4-Incorrect Jaw Relationship:
This may be any one of the following faults, or a combination of
them:
a) Wrong anteroposterior of relationship.
Treatment: As discussed before, if only slight it can be cured by
selective grinding, if gross, new dentures will be required.
2
b) Uneven pressure:
Pain may be due to trauma caused by heavy one sided pressure
and is then confined to the crest of the lower alveolar ridge on that
side; sometimes small white areas 4 mm to 6 mm in diameter are to be
seen, as in an opened vertical height. Pain may also be due to tilting of
either denture, more usually the lower, and is then situated near the
buccal periphery on the side of excessive pressure and near the lingual
periphery on the opposite side. Diagnosis can be made as described
previously.
Treatment: If detectable with a spatula, a new lower denture must
be constructed, but if it can be found with celluloid strips, then spot
grinding will usually affect a cure.
c) Over open.
Pain is associated with the lower pressure resisting area, as
distinct from the lateral surfaces of the ridge, and one or small white
patches are to be seen in the painful area. Relief of the denture over
these white patches usually gives immediate relief from pain, but
within a few days the patient returns with the same condition but
differently situated. In nearly all cases of excessive opening the
patient also complaints that the teeth jar, clatter, are' in the way' or '
too high' when eating and sometimes when talking.
Treatment: New lower denture with a slightly decreased vertical
dimension, if the occlusal plane of the upper is judged to be correct,
otherwise, new upper and lower dentures.
3
d) Over closed.
Pain from this cause is rarely associated with new dentures; it is
almost always the result of loss of vertical height through lower
alveolar absorption. The pain is often indefinite in locating and
frequently resembles neuralgia of the cheek on one or both sides.
5-Cuspal Interference:
The dragging action resulted will cause pain with well-fitting
dentures and also instability with those having poorer retention. Hold
the upper denture gently in place between the fingers and thumb that
are placed above the canine teeth, asking the patient to grind the teeth
and the dragging can easily be felt.
Treatment: Selective grinding is the most accurate method of
correcting this error. If the interference is gross, correctly articulated
new dentures will be required.
6- Teeth off the Ridge:
Pain from this cause is confined chiefly to the upper buccal sulci
and maxillary tuberosities. It is usually the result of setting the upper
teeth far buccally in an attempt to overcome marked discrepancies
between the size of the upper arch and that of the lower.
Treatment: New dentures, or sometimes only a new upper denture,
with the teeth correctly placed and, if necessary tilted or mounted to a
cross bite.
7- Retained Roots or Unerupted Tooth:
Treatment: Extraction of the root or tooth followed by relining of
the part of the denture at that area. If for some reason extraction is
4
contra-indicated, then relief may be given 'by easing the denture freely
over that area.
8- V-Shaped Ridge:
Treatment: In the lower, alveoloplasty followed by relining the
denture is the treatment of choice. In the upper, relief over the crest of
the alveolus is often sufficient since the palate can usually resist the
masticatory stresses, the exception being the V-shaped palate.
9- Mental Foramen:
If gross absorption of the alveolar and basal bone has taken place
the foramen may come to lie under the denture causing pain. The pain
may be localized to the immediate vicinity of the mental foramen, or it
may be referred and is then felt as a neuralgic pain in the side of the
face, or more rarely, in the lips or chin. It can usually be diagnosed by
locating the mental foramen and applying firm pressure in that area
which will cause some type of pain.
Treatment: Relieve the denture so that the nerve cannot be
subjected to pressure.
10- Irregular Absorption:
Sometimes during alveolar absorption an area is formed which is
rough, with a number of sharp spicules of bone, and if the mucous
membrane covering it is thin, pain will be caused by pressure on it .
Treatment: Alveoloplasty of the affected area followed by relining
that part of the denture, if necessary with a soft lining.
11- Pathological Conditions:
These conditions should be treated according to the condition and
new dentures are usually constructed.
5
12- Allergy:
Fortunately, it is very rare. Treatment: New-dentures must be
constructed in another material.
13- Rough Fitting Surface:
If a denture has been processed on a poorly poured model, small
pimples will be found on the fitting surface of the denture.
Treatment: Remove the offending roughness from the denture.
14- Difficulty in Swallowing (Tonsillitis) and Sore Throat:
The cause in the upper is extension on the soft palate with firm
pressure and good retention, or excessive pressure in the hamular
notch, whilst in the lower it is overextension distally in the lingual
pouch.
Treatment: The patient will usually know which denture is at fault
and examination of the regions described will show a slight redness.
Reduction of the overextension is all that is required.
15- Severe Undercuts:
Treatment: The fitting surface must be cut away until the denture
can be inserted comfortably but the periphery must not be reduced in
height. Often the flange will be too thin to allow sufficient to be
removed from the fitting surface and if this is the case the flange must
be thickened by the addition of more material. Should this adjustment
ruin the retention, as is likely to be the case if much has to be cut
away, an alveoloplasty will be necessary followed by a new buccal or
labial flange. This may cause warpage with an acrylic denture in
which case a completely new denture will| be the only remedy.
6
II- APPEARANCE
The number of patients who are dissatisfied with their appearance
with the final dentures can be much reduced if the operator insists on a
relation or candid friend being present at the try in stage.
1- Nose and Chin Approximating:
It is due to a closed bite. Treatment: As previously described for
over-closure.
2- Cheeks and Lips Falling In
Treatment: this consists of building out the upper denture, frequently
to a greater extent than the original tissues, to compensate for the loss
of muscular tone. This plumping should be placed in the canine and
premolar region i.e. the region of the modiolus and not on the anterior
region. Care must be taken when making these additions to the
denture to retain a concavity directed outwards and downwards.
3- Angular Cheilitis or Soreness of the Corners of the Mouth:
This frequently results from loss of muscular tone and •vertical
dimension. The corners of the mouth fall in and become bathed in
saliva and develop fissure. Frequently, however a secondary infection
with Monilia Albicans supervenes.
Treatment: The vertical dimension should be restored and the
upper dentures plumped to help restore the muscle tone.
4- Colour, Shape and Position of Anterior Teeth:

a) Color: Comply if possible with the patient's request for lighter
teeth, usually by a compromise between the shade chosen by the
operator and that chosen by the patient.
7
b) Shape. Remove the teeth complained of and replace them with

others mounted in wax, until by a process of trial and error mutually
suitable ones are obtained, which are then permanently attached.
c) Position. The teeth may be too far back in the mouth, or too far
forward, more often the former. New dentures will almost certainly
have to be made.
5- Amount of Tooth Showing:
Usually the dentures should be entirely remade with the occlusal
plane raised or lowered as the case may be, with longer or shorter
anterior teeth if necessary.
6- General Dissatisfaction:
The cause is usually the appearance. The patients are almost all
women and the vast majority are middle-aged spinsters often at; the
menopausal period.
III- INEFFICIENCY
1- Inability to Eat Anything:
This complaint is mainly confined to patients who are wearing
complete upper and lower dentures for the first time and are impatient
at the time which must be spent in acquiring new habits of eating. The
patient must be, persuaded to continue, so that he will either learn
again how to eat, or will define some specific complaint which can be
remedied.
2- Inability to Eat Meat:
It may be due to:
a) Flattening: of the cusps of the posterior teeth.
b) The use of cuspless posterior teeth.
8
c) Overclosure.
d) The use of acrylic posterior teeth due to their resilience and
softness.
e) Unbalanced articulation.
f) Cuspal interference. g) Inexperience.
3- Dentures Dislodged By Eating:
The common causes are:
a) Cuspal interference.
b) Unbalanced occlusion.
c) Upper teeth outside the ridge.
d) Insufficient tongue space.
e) Periphery overextended.
f) Inexperience.
g) Eating causes pain.
VI- POOR RETENTION
1- When Opening the Mouth:
The following are the usual causes:
a) Overextension.
b) Tight lips. Remake with the lower anterior teeth set more
lingually, with a definite labial concavity on the denture and with the
maximum extension in the region of the retromolar pads.
c) Tongue cramped.
d) Underextension.
e) Lack of peripheral seal.
f) Lack of saliva or very thin watery saliva.
9
2- When Coughing or Sneezing:

There is no way of preventing these movements of the dentures but
they are a very minor inconvenience.
V- INSTABILITY
This question has already been discussed in relation to its main
causes:
a- When eating. Under the heading of inefficiency.
b- When talking. Incorrect border extension, especially the posterior
border of the upper denture.
c- The defensive tongue:
Some individuals have what may best be described as a defensive
tongue. It is primarily concerned with preventing any foreign body
other than food reaching the pharynx or remaining in the mouth.
When dentures are fitted it subconsciously but positively ejects them
and the patient finds it difficult or impossible to train a tongue of this
type to control the denture.
Treatment: Persuasion to develop correct tongue habits.
IV- CLATTERING TEETH

1- Too great a vertical height.
2- Grosse cuspal interference.
3- Loose dentures.
4- Porcelain teeth may be the cause. Change into acrylic.
10
IIV- NAUSEA
The causes are:
1- Dentures slightly overextended.
2- Dentures under-extended:
a) Intermittent contact. The denture moves owing to inadequate
seal.
b) A palatal edge.
3- Thick posterior border.
4- Loose dentures.
5- Placing the upper teeth too far in a palatal direction and the
mandibular teeth too far in a lingual direction so that the dorsum of
the tongue is forced into the pharynx during the act of swallowing.
6- Psychogenic factors.
IIIV- DISCOMFORT
1- Cramped tongue space.
2- Altered vertical height.
3- Altered occlusal plane.
IX- ALTERED SPEECH
1-Whistling
It is the failure of contact between tongue & anterior teeth during

pronunciation of sounds . This may occur immediately after denture
insertion and then gradually decreases as the patient gets familiar with
the use of the denture.
If the whistling does not disappear , the cause may be one or all of the
following :
1- Decreased vertical dimension of occlusion with resulting increase
in the free way space .
2- Anterior teeth are placed too labially with increased overjet .
3- Posterior teeth are placed too buccally or inclined buccally .
11
All these factors will increase the intra oral air volume .
Treatment :
Correcting the position of the upper anterior teeth to reduce the overjet
, correcting the vertical dimension if it is the cause or remaking the
denture .
2- Lisping
Lisping results from premature contact between the tongue and
anterior teeth .
The cause may be :
1- Increased vertical dimension with resulting obliteration of the free
way space .
2- Increased denture thickness .
3-Narrow upper arch .
4- Anterior teeth placed too palatally .
All these factors will reduce the intra oral air volume.
Treatment :
Repositioning the anterior teeth , widening the upper arch , reduce the
palatal thickness of the denture or remaking the denture .
.
X- BITING THE CHEEK AND TONGUE
1- Biting the Cheek:
a) Insufficient overjet. Increase the buccal overjet and plump the
denture ; in some cases it may be necessary to remove the last
molar or grind the buccal surfaces of the lower posterior teeth so
that the lingual cusps only will make contact with the upper teeth.
b) Reduced vertical height.
2- Biting the Tongue:
This is almost invariably due to decrease in the tongue space
occurring when fitting new dentures for patients already wearing
dentures.
12
XI- FOOD UNDER THE DENTURES

1- Lack of peripheral seal.
2- Underextension.
XII- COMISSURAL (ANGULAR) CHEILITIS

1- It is frequently attributed to reduced vertical dimension.
2- Placing the maxillary posterior teeth too far in a lateral direction
eliminates the buccal corridor. When the crowns of the teeth are
against the cheeks, the saliva collects at the necks of the teeth and
makes its escape in the area of the cuspids. Commissural cheilitis
often develops when these conditions exist.
XIII- BURNING TONGUE AND PALATE
The burning sensation, which some patients experience in the
anterior third of the palate, may result from pressure on the
nasopalatine area. Relief of the denture over the incisive papilla is
usually effective.
Burning tongue and burning palate are often associated with
menopause in women. The burning sensation may also occur in
middle aged men. It is extremely difficult to determine what produces
the burning sensation.
Corrective procedures are instituted as follows:
1- Instruct patient in good oral hygiene. Recommend cleaning the
tongue with gauze, not a brush.
2- Avoid hot spicy foods and caustic mouthwashes.
3- For vitamins deficiencies prescribe vitamins A and B12 for three
months; discontinue for one month and re-evaluate.
13
4- Prescribe a mild tranquilizer.

5- When this condition is severe and persists, refer the patient to an
oral surgeon for possible surgical intervention.
6- When the condition is persistent and is complicated with other
problems that may be associated with psychic changes, refer the
patient for psychiatric consultation.
XIIII- REPEATED MIDLINE FRACTURE OF UPPER

DENTURE
1- Alveolar bone resorption and consequently, rocking of the denture.
Treatment: repair followed by relining.
2- Presence of torus, palatinus or insufficient relief of the middle
area.
Treatment: Surgical interference, sufficient relief in the midline area
or metal plate.
3- Teeth outside the ridge.
Treatment: reset of the teeth or a new denture.
14
Formative assessment (I)
1-a 50 years old man came to MIU prosthodontic clinic complaining from
midline fracture of his upper complete denture after a short period post
insertion.
Which one of the following is the most appropriate cause of mid line
fracture of the maxillary denture?
a-Overextension of the flanges.
b-High vertical dimension.
c-Insufficient relief of the middle area.
d-Alveolar bone resorption.
2-What is the common cause for the inability of complete denture wearers to
eat meat using their dentures?
a- Cuspless flat posterior teeth.
b- Overextension of the denture periphery.
c- Using porcelain teeth.
d- Insufficient relief in upper denture.
15
CHAPTER II
TREATMENT OF SOME COMPLETE

DENTURE PROBLEMS
1. Identify the challenge in construction of complete denture over severely

resorbed ridge.
2. Distinguish between biological and prosthetic factors which might cause
alveolar bone resorption.
3. Determine prosthetic factors which might cause alveolar bone resorption.
4. Demonstrate different treatment modalities for flat ridge.
5. Determine the causes of flabby ridge.
6. Demonstrate different treatment modalities for flabby ridge.
7. Distinguish between V-shaped palate and flat palate with shallow ridges
in terms of difficulty of construction of complete denture and their
management.
8. Identify the challenge in construction of complete denture with the
presence of gross undercuts, large tuberosities or large torus palatinus
9. Identify the challenge in construction of complete denture over knife edge
ridge.
10.Recognize the difficulties in construction of complete denture in cases
with large torus, tight lip, large tongue and abnormal frenum and their
management.
11.Recognize the difficulties in construction of complete denture for cases
with abnormal jaw relation and their management.
15
Flat Ridge
Construction of complete denture over severely resorbed ridge is
considered as one of the difficult problems for the prosthodontist. This
is because the denture functions will be greatly affected due to the
interference from adjacent musculature and the shape of the ridge
provides no resistance to lateral movement of the denture.
Edentulous ridges are subjected to continuous bone resorption due
to the loss of tensile stimulation provided by the periodontal
ligaments. The extent of ridge atrophy in the mandible was found to
be greater than in maxilla. This was attributed to smaller denture
bearing surface of the mandibular ridge. Therefore the forces applied
to it would be much greater than those applied to the maxillary ridge.
Factors affecting alveolar bone resorption

1-Biologic / Metabolic Factors:
A- Age: Aging is frequently accompanied by osteoporotic changes
in the human skeleton.
B- Sex: An atrophic ridge is frequently encountered in females
during menopause, due to the reduction in estrogen hormone
which in turn causes demineralization and osteoporosis of the
bone.
C- The patient's general health: Poor general health and
debilitating diseases such as uncontrolled diabetes mellitus,
anemia and hypertension, disturb the normal metabolic process
16
and lower the resistance of the tissues to inflammation and bone

resorption.
D- Nutritional deficiencies: Calcium deficiency, decrease vitamin
C content, and/or protein utilization are factors contributing to
bone resorption.
2-Prosthetic factors
A- Faulty impression: Excessive pressure exerted on the mucosa
while making the impression initiates soreness, inflammation of
the denture bearing mucosa, and bone resorption.
B- Excessive vertical dimension of occlusion: Excessive contact of
denture teeth will occur. This transmits excessive pressure on the
ridges and initiates inflammatory changes and bone resorption.
C- Disharmony between centric relation and centric occlusion, and
unbalanced occlusion will contribute to bone loss.
D- Excessive forces transmitted to the underlying basal bone from
the continuous wearing of dentures.
E- Long term wearing of dentures without serviceability and or lack
of follow up treatment.
F- Para functional habits, as in bruxism and clenching may cause
advanced resorption of the ridges depending upon the frequency,
direction and amount of force transmitted to the remaining
ridges.
Treatment
I. Prosthodontic treatment:
All principles and techniques of complete denture construction
in patients with compromised ridges should be directed to minimize
17
the forces transmitted to the supporting bone and decrease the

movement of the prosthesis, and thereby reduce the rate of ridge
resorption. These principles and techniques include:
1- Maximum extension of the denture base within the physiologic
and functional limits is required to increase retention of the
denture and to provide wide distribution of masticatory forces.
2- A special secondary impression procedure, using tissue
conditioning material is used for patients with severe alveolar
atrophy. Tissue conditioning material is allowed to remain in the
mouth for eight to ten minutes, while the operator stabilizes the
tray, directs the tongue to mold the lingual border and digitally
manipulating the check and lip tissue. Such impression will allow
accurate registration of the functional actions of the border tissues
and improves retention.
Definite pressure impression technique (closed mouth technique)
can be used in cases presenting flat ridges with firm mucosa in
order to provide maximum coverage of the denture bearing area.
3- Proper orientation of the occlusal plane in relation to the tongue
and the residual ridge, stabilizes the denture in place.
4- Adequate interocclusal distance is required during the rest
position of the mandible, to decrease the frequency and duration
of tooth contact and reduces the forces transmitted to the alveolar
ridge.
5- The use of acrylic teeth decreases the transmission of the
masticatory forces to the weak ridge.
18
6- Reduction of buccolingual width of the occlusal table, reducing

the number of artificial teeth, and improving the cutting
efficiency helps in reducing the forces transmitted to the
supporting alveolar bone, and provides better centralization of
occlusal forces on the ridge.
7- The use of flat cuspless teeth arranged on the centre of the ridge
will centralize the occlusal forces and improve stability of the
denture.
8- Proper contouring of the denture polished surface improves
stability and retention of the denture. This increases the potential
for the buccinator muscle and tongue to aid in lower denture
stability.
II. Surgical treatment
1- Vestibuloplasty
2- Reduction of prominent mylohyoid ridge
3- Contouring of the genial tubercle
4- Ridge augmentation
5- Implant
Flabby Ridge
Hyperplasia of the soft tissue under a complete denture is the result

of fibro-epithelial response to chronic ridge sorness caused by denture
wearing.
Fibrous hyper mobile crest ridges do not supply stability or support
for denture.
19
Etiology
1. Ill fitting denture bases from constant unbalanced occlusal forces
in a localized area. The hyperplastic tissue may develop from
excessive pressure created by heavy contacts of the opposing
teeth in the same region. i.e. uneven bearing ( uneven occlusal
contact) , or as a result of shifting of the denture base from
deflective occlusal contacts.
2. Anterior hyperocclusion will place excessive forces in the
anterior region of the residual ridge, leading to rapid bone
resorption. In some situations the entire supporting bone may be
resorbed and replaced by hyperplastic flabby tissues. This is
commonly seen in the anterior region of the maxilla.
 Excessive forces in the anterior region may result due to:
a) Maxillary complete denture opposing either a complete set
of natural teeth or bilateral distal extension partial denture
supported by natural anterior teeth. The forces exerted by
mandibular teeth on maxilla causes an excessive resorption
of the anterior aspect of the maxilla.
b) Combination of porcelain anterior teeth with acrylic resin
posterior teeth in the same denture. The low wear resistance
of acrylic resin teeth results in hyperocclusion of the
anterior porcelain teeth that will traumatize both the
anterior upper and lower foundation tissues.
c) Interference between upper and lower anterior teeth due to
lack of anterior clearance during mandibular movement.
This may result due to steep incisal angle caused by deep
20
vertical overlap without sufficient horizontal overlap to

provide anterior clearance during functional and
parafunctional mandibular movement. Anterior interference
also develop due to excessive wear of acrylic resin
posterior teeth, leading to loss of occlusal vertical
dimension and lack of anterior clearance.
3. Long term denture wearing without regular maintenance and
serviceability.
Treatment
Treatment of hyperplastic flabby ridges is based on the severity of
the condition.
I. If the movable tissues is localized and not expected to interfere
with denture stability, then these tissues can be retained and a
conservative prosthetic technique should be employed
A) Tissue conditioning
Before denture construction hypertrophic irritated, hyperemic and
displaced oral mucosa should be conditioned to a healthy state to
regain their normal form.
Two techniques may be used either singly or in combination
depending on the severity of the condition to achieve healthy mucosal
state. This includes:
1. Tissue rest accompanied by proper oral hygiene and tissue
massage. Tissue rest is achieved by instructing the patient not to
wear the existing denture as long as possible.
2. Relining the denture with tissue conditioning material. The
softness and flexibility of these materials permit the tissues to
21
recover and provide an excellent medium to aid in conditioning

traumatized hyperplastic bearing mucosa as they improve
denture stability and equalize pressure.
When the tissues assume their normal non-inflammatory
condition , dentures can be fabricated.
B) Prosthetic treatment
Easily displaceable hyperplastic tissues present unstable denture
base foundation that contribute to excessive horizontal and vertical
movement of the denture. All principles and techniques for denture
construction should be directed to minimize the forces transmitted to
those movable supporting tissues in order to stabilize the denture.
1. Final impression technique
Since easily displaceable tissues are unable to provide efficient
support to the denture base, they need to be recorded in their resting
position using freely flowing impression material. If these tissues are
displaced during making the final impression they will tend to
rebound creating unseating forces and denture instability. Movement
of the denture in any direction on their basal seat causes additional
tissue damage.
A selective pressure impression technique is required to decrease
occlusal forces of the affected area and distributes them over favorable
areas capable to tolerate masticatory forces. Sufficient relief and
escape holes drilled in the special tray opposite to the hyperplastic
tissues will ensure relief of pressure over this area and proper load
distribution.
22
A sectional impression technique (Composite method) is

preferred if the hyperplastic tissue is present on the anterior maxillary
ridge.
2. Centric occluding relation record
Static interocclusal record, using softened wax or thin mix of plaster
will minimize the amount of tissue displaceability and ensure correct
centric occluding relation record.
3. Occlusal form and arrangement of posterior teeth
 To enhance denture stability:
- Flat cuspless teeth are indicated.
- Proper vertical orientation and inclination of the occlusal
plane.
- Placement of teeth in a central position in relation to the
residual ridge and tongue.
 For better centralization of the occluding forces both
antroposteriorly and mediolaterally:
- Reduction of the buccolingual width of the occlusal table.
- Using less number of artificial teeth.
II. An extensive soft tissue lesion that interferes with denture stability
can be treated surgically with one of the following techniques:
1. Surgical reduction: A small, more stable ridge offers better
denture foundation than does a large unstable ridge.
2. Alveolar ridge augmentation: Preservation of the mobile tissue
and augmentation of the underlying ridge with a ridge
augmentation material will improve the ridge condition.
23
V-shaped palate
Reason for the Difficulty:
Retention by adhesion is diminished. Also, acrylic denture bases
tend to warp during curing, and the imperfect fit at the sharp angle of
the palate further reduces the forces of adhesion and cohesion.
Treatment: A cast metal plate may produce a more accurate fit.
Flat Palate with Shallow Ridges

The denture may be displaced during mastication through lack of
ridge support; the shallow sulci adversely influence peripheral seal.
Treatment: Careful peripheral adaptation and balanced articulation
or the use of cuspless teeth.
Gross Undercuts and Large Tuberosities
Retention will be reduced as the denture will have to be trimmed,
during fitting, in order that it passes over the bulbous area of the ridge,
thus causing loss of peripheral seal.
Treatment: Careful blocking out of the undercut areas on the model
or an alveoloplasty to reduce the undercut. Denture flanges may be
carried only slightly into the undercuts of the tuberosities. Soft liners
may also be used to engage the undercuts.
24
Knife-Like Lower Ridge

Pain during mastication.
Treatment:
1- Relief. 2- Resilient lining or 3- Alveoloplasty.
Large Torus Palatinus

The denture may rock across the midline and eventually fracture;
retention may be reduced, as an unrelieved torus prevents bedding into
the soft tissue.
Treatment:
1- A compression impression technique.
2- Adequate relief of the denture in the area of torus.
3- A metal plate will withstand strain fatigue better than an acrylic
denture base, and
4- Surgical interference.
Abnormal Frena
The denture is more easily displaced when frena are attached near to
the crest of the ridge.
Treatment: Division of the frena surgically (frenectomy) before, or
at the time of insertion of the denture.
25
Tight Lip
Instability of the lower denture due to the backward displacement
caused by the lip pressure and vertical lift occurring in the premolar
and canine region from the pressure modioli.
Treatment:
1- Keep the occlusal plane low thus reducing the contact area with the
lip.
2- Adequate extension on the retromolar pads to counteract the lip
pressure.
3- keep the denture narrow across the premolar region.
4- Upper canines and premolars should be prominent to resist the
modioli pressure on the lower denture.
Large Tongue
If the tongue is cramped, or the teeth set up so that they overhang it,
the denture will be moved during function.
Treatment:
1- Keep the occlusal plane low.
2- Provide tongue space by using narrow teeth or grinding away the
lingual cusps.
3- Anterior teeth should be set up slightly forward of the ridge, and
4- Peripherally trimmed impression technique.
26
Abnormal Jaw Relationships

A- Close bite
Lack of interridge space.
Treatment: Acrylic posterior teeth.
B- Superior protrusion
Narrow and retrusive lower arch in relation to a normal size upper
arch.
Treatment:
1- Maintain the natural over jet which will be large.
2- Periphery adapted impression technique.
C. Inferior protrusion
Large and wide lower arch in comparison to the upper arch, leading
to an unstable upper denture.
Treatment:
1- Peripherally adapted impression technique.
2- Metal plate.
3- Balanced articulation.
4- Posterior cross bite.
5- Anterior edge-to-edge bite.
27
Formative assessment (II)
1. A 76 years old man came to MIU Prosthodontic clinic seeking

construction of new dentures. Intra-oral examination revealed maxillary
edentulous ridge with flabby tissue in the anterior area and mandibular
kennedy class I.
What is the most appropriate technique of secondary impression to
be used for construction of the maxillary denture?
a. Selective pressure impression.

b. Mucocompressive impression
c. Anatomic impression.
d. Functional impression
2. A 78 years old patient came to MIU Prosthodontic clinic seeking

complete denture construction; intra-oral examination revealed maxillary
v-shaped palate.
What is the most appropriate treatment modality to mange v-shaped

palate in complete denture construction?
a. Careful peripheral adaptation and balanced articulation or the use of
cuspless teeth to increase retention.
b. Choosing selective pressure impression technique to increase
retention.
c. Maximum extension of the denture base within the physiologic and
functional limits is required to increase retention.
d. Use of cast metal plate to produce a more accurate fit toincrease
retention.
28
CHAPTER III
RELINING AND
REBASING
1. Differentiate between relining and rebasing of complete denture.

2. Mention the importance of relining and rebasing.
2. Enumerate the indications and contraindications for relining or rebasing
procedure.
3. Describe the different relining techniques.
4. Describe the rebasing technique.
5. State the role of Hooper's duplicator in relining and rebasing procedure.
Reline: reline is the procedure used to resurface the tissue side of a

denture with new base material, thus producing an accurate adaptation to
the denture foundation area.
Rebase: rebase is the process of replacing the entire denture base
material on the existing prosthesis.
OBJECTIVES
1- Improvement of retention and stability: loss of fit impairs the
retentive effect of adhesion and cohesion. It may also permit a
rocking or tilting of the denture during function.
2- Improvement of appearance: Resorption of lower jaw has an
influence on the original occlusal plane as it will change its
position. The original position of occlusal plane can be restored by
relining.
29
3- Restoration the vertical dimension: it can be restored by relining.

4- Restoration of evenness of occlusal pressure: with any alteration in
the fit of dentures there will be some alterations in the pressure
transmitted to the tissues when the teeth are brought into occlusion.
Denture relining may correct this condition.
5- To alleviate pain: transmitted due to rocking or movement of the
denture.
INDICATIONS: For relining and rebasing:
1- When the residual alveolar ridges have resorbed.
2- After placement of an immediate denture.
3- For geriatric patient required several appointments for construction
of new dentures.
4- The cost of having new dentures.
5- Rebasing is additionally required in cases of:
a- Porous denture base.
b- Discolored or contaminated denture base.
c- Using the denture for long time.
d- Repeated repair or relining of the denture.
CONTRAINDICATIONS
1- If the dentures have poor esthetics or unsatisfactory jaw
relationships.
2- If the dentures create a major speech problem.
3- When an excessive amount of resorption has taken.
4- When abused soft tissues are present. The relining is delayed until
the tissues recover and return as closely as possible to normal
form.
5- When severe osseous undercut exist, until surgical removal and
healing occurs.
30
PROCEDURES
With any relining and rebasing technique, abused tissues should
be allowed to recover before making impressions.
1- The dentures should be left out the mouth for at least two to
three days before making the final impression.
2- Massage of the soft tissues two to three times a day to stimulate
the blood supply and aid recovery.
If the tissue abuse is extensive and the patient cannot leave the
denture out of mouth for tissue recovery, treatment with a tissue
conditioner is indicated.
1-Indirect technique
1- When the impression is made within an existing denture, care must

be taken to insure that the jaw relationship in the horizontal plane
is not altered.
Zinc-oxide-eugenol impression pastes and polysulphide elestomers
are good examples of materials which can be used.
2- The borders of the denture must be refined with modeling
compound the opposing denture is inserted the denture is then
seated to the contact the oral tissues and the patient is asked to
close.
3- The denture is removed after the impression material has set.
4- The procedure is repeated for the opposing denture.
Also in case where the vertical dimension has to be

reestablished in addition to the fit, a layer of impression material of
greater thickness must be used. In such cases the lower denture
should first be lined with compound impression material and the
31
impression is taken with the teeth in occlusion. The thickness of

the compound impression material used should be such that it
almost restores the desired vertical dimension. The compound
impression, chilled, dried, and the final impression is made with a
film of zinc-oxide paste. If the vertical dimension is being
increased beyond 3-4 mm, and both dentures are being relined.
To minimize the margin of error, the mandibular reline is
carried out to completion before relining the maxillary denture.
II- direct technique
To avoid depriving the patient from his denture till the
laboratory procedures of relining are completed.
Direct relined materials generally supplied as a powder and
liquid which are mixed together.
1- The fitting surface of the denture must be relieved to create a space
for the reline material.
2- Separating medium must be applied to the areas where bonding is
not desired (polished surface and teeth).
3- The mucous membrane having previously been smeared with
Vaseline.
4- The material is mixed and poured into the denture, and the denture
is seated in the mouth after inserting the opposing denture. The
patient is asked to close into centric occlusion and the borders are
molded.
5- The denture is then removed from the mouth after the initial set of
the material and placed in worm water for twenty minutes to allow
the material to cure; the denture is then trimmed and polished.
32
Disadvantages of the chair side reline materials:

a- Some materials may produce a chemical burn on the mucosa.
b- With some materials the resulting reline porous and subsequently
develop bad odor.
c- Color stability is low.
d- If the denture was not positioned correctly, the material could not
be easily removed in order to start again.
Direct reline materials should be considered as only a temporary or
at least semi-permanent solution to the problem of an ill fitting denture.
Articulator of Hooper duplicator
1- The cast and the denture are mounted on the upper member of the
articulator or Hooper duplicator.(Fig.12-1)
2- Plaster is mixed and applied on the lower member of the
duplicator; the upper member with its mounted upper denture is
closed into the soft plaster mix to a depth of 1-2mm.
3- When the plaster occlusal index has completely set, the top and
bottom member of the duplicator are separated. The denture is
removed from the cast, and all impression material is cleaned from
the cast and the denture base.
4- The denture borders are squared to form a butt joint, rather than a
feather edge, for the attachment of the new acrylic resin material.
The palatal portion of the maxillary denture is removed close to the
palatal surface of the teeth.
5- The denture is positioned so that the teeth are placed in the
occlusal index in the lower member of the Hooper duplicator.
6- The post dam is prepared on the maxillary cast.
7- The cast and the denture are removed from the upper member of
the H ooper duplicator to provide easier access for waxing.
33
The denture is processed and finished in the usual manner.
Fig. (12-1) Hooper duplicator and plaster index

Rebasing
The clinical procedures for denture rebasing are the same as those
for relining. The laboratory procedures are also the same till the
hardening of the plaster occlusal index. Then the following steps will be:
1- The top and lower members of duplicator are separated and the
denture is removed from the cast.
2- The denture base material is removed from the teeth.
3- The teeth are cleaned positioned into their positions in the occlusal
index.
4- A base plate is adapted and soft wax rim is prepared to the cast.
5- The top member of duplicator is replaced in its position till the wax
rim attached to the teeth.
6- Posterior palatal seal is prepared on the maxillary cast.
7- Then the cast is removed from the duplicator, the trail denture is
waxed up, processed and finished.
34
Resilient lining
When other causes have been eliminated and pain under lower
denture is considered to be due to the type of ridge form and the
susceptibility of the mucosa to bruising which cannot withstand the
transmitted pressure of mastication, relief of the symptoms may be
obtained by relining the denture with a resilient material.
A resilient material can also utilize gross undercuts achieve
maximum retention of the denture.
The clinical procedure calls for an impression in the existing
denture, the remainder of the technique being carried out in laboratory.
Resilient linings are intended to be permanently attached to the
denture. In fact their general properties are so poor that they must be
considered as semi-permanent.
In practice, the following fallings are commonly seen:
1- Some materials develop a rough surface after wear, with food
being embedded in the surface.
2- Some linings split under stress and/or peel away from the denture
base.
3- There may be a change of color due to staining and deposits of
calculus.
4- The lining may become hard due to loss of plasticizer.
5- The surface may become bubbled if an oxygenating type of
denture cleaner is used.
6- If bleach is used to clean the denture, the lining becomes white
and hard.
35
Formative assessment (III)
1. Which one of the following actions is the most appropriate to instruct the
patient to do during setting of the relining material in direct relining
technique ?
a. Open his mouth as wide as possible.

b. Close his teeth in intercuspal position.
c. Move his jaw in excursive movements.
d. Tap the denture teeth multiple times.
2. Which one of the following best describes the indication for rebasing?
a. Resorption of the alveolar ridge.

b. Following up of immediate denture.
c. Alleviation of pain due to denture movement.
d. Porous denture base.
36
Chapter IV
Duplication of Complete Denture
1. Determine the objective of denture duplication.

2. Identify indications for denture duplication.
3. Differentiate between different methods of denture duplication.
4. Illustrate procedures for different methods of denture duplication.
Duplication of denture
The successful muscular control of dentures is closely associated

with their overall size and shape.
With advancing age, the learning process deteriorates resulting in

subsequent diminution in the ability to develop new muscular behavior
with a new denture.
Therefore the objective of denture duplication is to copy the features

of the existing denture.
37
Indications:
1- Elderly patients usually meet difficulty in adapting with new

denture.
2- Denture spare for the original existing accurate denture in cases of
travelling, business and speakers patients.
3- Changing the deteriorated denture base.
4- Changing worn artificial teeth.
Methods of denture duplication
1-Tray method
This technique can be easily performed in the dental clinic ,using

a duplicating flask or two large upper stock impression trays.
Procedures:
1- Alginate impression material is mixed and loaded into one of
the trays and the denture is seated into the alginate.
2- After setting excess alginate is trimmed to be flushed with
denture borders.
3- Another mix of alginate is placed in the other tray and placed
over the fitting surface of the denture in the first mix.
38
4- After setting the two impressions are separated, the denture is

removed leaving a mold of alginate material supported by the
two stock trays.
5- Two channels are prepared in the alginate at the posterior border
of the mold. This will create escape vents in the mold cavity.
6- A mix of tooth colored cold curing acrylic resin of the proper
shade is prepared and poured slowly into to the tooth
indentations of the first alginate impression.
7- The two halves of the alginate mold are assembled together and
secured tightly with rubber band.
8- A mix of a pour type resin is prepared and poured into one of
the opening until excess flows out to the other opening.
9- The assembled unite is then processed in a pressure pot at 20 Psi
for 30 minutes. Then the denture is finished and polished.
2- Modified denture flask method
In this method a section is removed from the posterior border of

the bottom part of an upper half of the flask ,this opening will provide an
access for the wax spruces , which will be attached to the posterior
border of the upper denture or the lingual surface of the heals of the
lower denture.
39
Procedures:
1- The interior surface of the flask is painted with alginate adhesive.
2- A mix of alginate impression material is prepared and placed in the
fitting surface of the denture and in the flask.
3- The denture is placed in the mix and left to set.
4- The other part of the flask is assembled.
5- A second mix of alginate is prepared and poured into the flask.
6- After the alginate has set, the flask is opened; the denture is
removed with the spruces to leave a mold in which the teeth
material is applied by mixing a tooth colored cold curing acrylic
resin of the proper shade and poured slowly into to the tooth
indentations of the first alginate impression.
7- The two halves of the duplicating flask are assembled together.
8- A mix of a pour type resin is prepared and poured into one of the
opening until excess flows out to the other opening.
9- The assembled unit is then processed in a pressure pot at 20 Psi for
30 minutes. Then the denture is finished and polished.
40
Formative assessment (IV)
1. A 78 -year- old patient came to MIU Prosthodontic clinic seeking

construction of complete denture complaining about worn artificial teeth
of her old dentures. Patient was highly comfortable with the old dentures.
What is the most appropriate treatment for this patient?
a. Duplication of the complete denture.
b. Construction of new complete denture.
c. Construction of new overdenture.
d. Repair of the old dentures.
2. A 64 years old female patient came to MIU Prosthodontic clinic seeking

construction of complete denture.
During duplication of complete denture, using the tray method what
is the most appropriate impression material to be used?
a. Alginate
b. Impression compound
c. Rubber base
d. Zinc oxide eugenol
41
CHAPTER V
SINGLE COMPLETE DENTURES

AGAINST NATURAL TEETH
1. State single denture problems.

2. Mention how to overcome single denture problems.
3. Describe methods used for detecting occlusal modifications.
4. Identify different types of tooth material for single denture.
5. State mandibular single denture problems and the alternative line of
treatment.
6. Define combination syndrome; identify its symptoms, prevention and
treatment.
A single complete denture may be constructed for either the

maxillary ridge or the mandibular ridge to oppose a dentulous arch or
a partially edentulous arch.
I-Mandibular Single Dentures
The denture bearing area for the lower denture is usually limited
and smaller in comparison to those underlying maxillary dentures.
The supporting tissues are also less tolerable to occlusal stresses
transmitted by opposing natural teeth due to the porous cancellous
nature of the residual ridge which enhances the rate of lower ridge
resorption. For this reason, it was previously preferred to extract the
42
opposing natural teeth and avoid the construction of lower single

dentures. However, this is against the recent trends in conservative
dentistry.
Treatment modalities for lower edentulous ridges
-Construction of lower over dentures; if the patient presents with few
remaining teeth that are not candidates as partial denture abutments
and are rather indicated for extraction. It is preferred to retain those
teeth, reduce their contour and height to be used as overdenture
abutments.
-Placement of implants and construction of implant supported
overdentures.
-Lining the lower single denture with a resilient permanent soft liner.
- Extraction of maxillary teeth.
II-Maxillary Single Dentures
Figure(14-1) showing
maxillary single denture
opposing partially
edentulous mandibular
arch.
The construction of maxillary single dentures is commonly

encountered and better preferred compared to lower single dentures
43
due to the larger supporting area and due to the nature and form of the
supporting tissues.
However, some problems are associated with the construction of
maxillary single dentures, these are:
1-The opposing natural teeth usually exert excessive forces that
exceed the physiologic tolerance of the tissues underlying the denture.
This results in rapid resorption of the residual ridge and the formation
of flabby tissues.
For this reason, maximum extension of the denture base within
physiologic and functional limits is recommended in order to widely
distribute the applied forces and to reduce the pressure per unit area
thus reducing the effect of the applied forces. This requires a properly
extended impression.
2-Excessive pressure exerted by the natural teeth also predisposes the

denture to frequent fracture.
For this reason, a strong metal base may be required to withstand the
applied forces.
3-The opposing natural teeth may be malposed, tilted or over erupted

leading to a steeply inclined, irregular or reversed occlusal plane. This
results in horizontal forces which tend to move upper denture
forwards causing soreness of the mucosa and enhancing residual ridge
resorption.
44
For this reason, the treatment plan for adjusting common occlusal
disharmonies depends on the severity of the condition:
a- If natural posterior teeth are not severely tilted, they may be
reshaped by selective grinding.
b- If more reduction is needed, then the ideal treatment is to

restore tilted teeth with cast crowns, onlays or through fixed bridges.
c- Removable partial dentures could be an alternative line of

treatment.
d – Another possible line of treatment involves orthodontic

repositioning of the tilted molars.
e – Extraction is necessary for severely tilted and super erupted

teeth.
4-The opposing lower anterior teeth are usually over erupted resulting
in excessive deep bite and a steeply inclined incisal angle.
For this reason, it may be necessary to either reduce the lower
anterior teeth by grinding or increase the horizontal overlap be
placing the upper anterior teeth forwards without adversely affecting
esthetics and phonetics.
5-The presence of usually over erupted opposing lower anterior teeth
hinders proper adjustment of upper occlusion rim as the labio-lingual
thickness of the wax rim makes difficult for the lower anterior teeth to
close behind the wax rim and the incisal edges of teeth will contact
the wax rim resulting in increased vertical dimension .
For this reason, wax rim should be adjusted by removing wax
palataly to free the contact between the wax rim and anterior teeth.
45
Occlusal Adjustment
Occlusal adjustment is necessary before construction of single
dentures as the occlusal pattern of natural teeth affects the occlusal
plane of the denture to be constructed. This is necessary in order to
control the horizontal component of force which affects denture
stability.
Methods of Occlusal Adjustment
Several techniques were suggested to carry out occlusal
adjustment, these are:
1-The first technique
-Upper and lower casts are mounted on the articulator by the aid of a
tentative inter occlusal centric relation record.
-Setting-up of teeth is carried out, any interference from the opposing
natural teeth encountered during setting -up should be marked and
eliminated from the cast by a sharp wax knife.
-Occlusal adjustment carried out on the cast should be made in the
patient’s mouth guided by the marked cast.
-A new diagnostic lower cast is made and mounted to check the
performed adjustment.
2-The second technique
-A U-shaped curved metal occlusal template with a convex lower
surface is placed on the lower cast to identify the cusps that require
adjustment.
-Over erupted cusps are reduced to achieve even curvature of the
occlusal plane.
46
-The changes made on the cast are then transferred to the patient’s
mouth.
Fig (14-2): The U-shaped occlusal template
3-The third technique

-The occlusal plane of the lower cast is adjusted by reducing the
interfering cusps.
-A clear acrylic resin template is constructed over the modified stone
cast.
-The inner surface of the template is coated with pressure indicating
paste and placed over the natural teeth.
-Occlusal interferences are marked on the natural teeth and eliminated
by grinding.
This process is repeated till the template seats properly.
Selection of Artificial Teeth
Selection of Posterior Teeth for Single Denture
The selection of the occlusal form and cuspal inclination of
artificial posterior teeth is usually dictated by the occlusal form of
natural posterior teeth.
47
Non anatomic teeth are used if cusps of natural teeth exhibited

wear or have been reduced during occlusal adjustment. However, if
natural cusps have been retained, anatomic teeth are used.
Tooth material for Single Denture
1-Acrylic teeth
Acrylic teeth can be easily reduced when occlusal adjustment is
required. They also cause no wear to the opposing natural teeth.
However, they wear easily when opposed by natural dentition
resulting in marked loss of vertical dimension.
2-IPN Resin
This material consists of an unfilled, highly cross-linked,
interpenetrating polymer network. The IPN resin has a higher wear
resistance than the conventional acrylic resin
3-Porcelain teeth
The use of porcelain teeth is not recommended for single dentures.
This is because single dentures usually require occlusal adjustment
which may predispose porcelain teeth weakened by grinding to
fracture or chipping. Porcelain teeth also are not clearly marked by
articulating paper.
4-Acrylic resin teeth with gold occlusal surfaces.
Gold is the best material for or artificial occlusion that opposes
natural teeth. Acrylic teeth are first set-up and the necessary occlusal
adjustment is carried out. The occlusal surfaces are then cut off,
sprued, invested and cast into gold. The gold occlusal surfaces are
then cemented to in place onto the sectioned acrylic teeth.
48
5. Acrylic resin with amalgam stops

The amalgam inserts appear to reduce the occlusal wear, and the
technique is simple and much less time consuming and expensive
than with the gold occlusals. After the acrylic teeth have been
balanced. Occlusal preparations are made in the acrylic teeth,
extending to include as much of the articulating paper tracing as is
possible. Amalgam is considered into the preparations and the
articulator is gently closed, going side to side and back and forth until
the incisal guide pin is again flush with guide pan. Thus the centric
holding areas as well as some of excursions are recorded in amalgam
by the articulator that has programmed to closely simulate the
patient' s jaw movement.
Combination Syndrome “Kelly’s Syndrome”

This is a self- study topic about an oral condition that can occur when
an edentulous maxilla is opposed by natural mandibular anterior teeth.
Refer to the following link as reference for studying the topic.
Note: This will be included in your exams
https://www.aegisdentalnetwork.com/cced/2011/04/combination-syndrome-
symptomatology-and-treatment
49
Formative assessment (V)
1) What is the name of the syndrome which may be encountered

because of long-term use of a mandibular distal extension PD
against a complete maxillary denture?
a) Kelly’s syndrome.
b) Costen syndrome.
c) Crest syndrome.
d) Steven Johnson syndrome.
2) Which one of the following represents the simplest plan for

adjusting the occlusal plane of natural teeth before single denture
construction?
a) Selective grinding of mal posed teeth.
b) Crowning the mal posed teeth.
c) Extraction of mal posed teeth.
d) Orthodontic treatment of mal posed teeth.
50
CHAPTER VI
COMPLETE OVERDENTURE
1- Classify complete overdenture.

2- List the advantages and disadvantages of tooth supported
overdentures.
3- Mention the indications and contra indications of complete
overdentures.
4- Recognize the criteria of patient selection for complete
overdenture.
5- Recognize the design and technique of abutment tooth
preparation.
6- Differentiate between different types of attachments.
(Overlay Denture, Superimposed Prosthesis)

Definition:
It is a complete or partial denture that covers & resets on one or
more remaining natural teeth, roots of natural teeth and or dental
implant.
Classification of complete overdenture:
Overdenture either classified into:
1- Tooth-supported complete overdenture.
2- Implant-supported complete overdenture.
51
Or into:
1. Tooth supported overdenture
2. Tooth tissue supported overdenture
3. Tissue supported overdentu
TOOTH- SUPPORTED COMPLETE OVERDENTUR
Advantages:
1- Preservation of alveolar hone:
Alveolar bone exists as a support for teeth. If the teeth are removed,
then the alveolar process begins a rate of resorption consistent with
the length of time the teeth have been missing.
2- Preservation of proprioceptive response:
With preservation of the teeth for an overdenture, there is also the
preservation of the periodontal membrane that surrounds these teeth.
This preserves the proprioceptive impulses supplied by the periodontal
membrane. The existence of the periodontal membrane under the
overdenture gives the patient a sense that is not possible with
conventional dentures. It also allows the masticatory muscles to exert
the needed effort to masticate different type of food.
3- Support:
This gives the patient a denture that has far more support than any
conventional appliance.
4- Retention:
Improved retention may be obtained by one of the several attachment
devices or by lining the overdenture with one of the resilient denture
liners to utilize available tooth undercuts. Also the shape of prepared
52
abutments could influence the amount of overdenture retention e.g.

long parallel wall abutment aid in denture retention i.e. frictional
retention between abutment wall and denture base.
5- A simple approach to the problem patient:
In the past, patients with congenital defects, such as cleft palate,
partial anodontia, microdontia, amelogenesis imperfecta, subject to a
lengthy, and expensive course of treatment. With the advent of the
overdenture, a reasonably, relatively faster and inexpensive mode of
treatment become possible.
6- Patient acceptance:
Patients are most receptive to and appreciative of this treatment
because they experience a striking improvement in function and
esthetics while still maintaining some of their own teeth.
7- Convertibility:
The overdenture concept is designed so that if for some reason
overlaid teeth must be extracted, the over denture can readily be
converted to accept the alteration.
Disadvantages:
1- Caries susceptibility
The main problem with the overdentures is the carious breakdown of
the overlaid teeth. Accurate home care is stressed as a cure for this
occurrence with frequent recall to detect incipient lesions
2- Bony undercuts:
Because of the limited path of insertion of these appliances, bony
undercuts, especially those found adjacent to the overlaid teeth have
53
posed a problem in regard to the close approximation of the denture

flange to the underlying tissue. To overcome this problem one of
the following is carried out”
a- Blocking out the undercut, but it results in a denture flange that is
spaced away from the tissues, creating food trap and break the
peripheral seal.
b- Shortening the denture flange to end it at the height of contour,
which again will jeopardize peripheral seal
3- Encroachment of the interocclusal distance:
Sometimes, especially when internal attachments are used,
encroachment of the interocclusal distance may occur.
4- Esthetics:
A foreshortened flange that ends at the height of contour of a bony
undercut, a compensated occlusal plane in light of space problem or an
over bulked denture resulting from insufficient space for attachment
and replacement tooth do little for esthetics and, if the problem is
severe enough, may indeed contraindicate an overdenture altogether.
5- Periodontal breakdown of the abutment teeth:

An overdenture not only prevents natural stimulation and cleaning by
the tongue and cheeks, but also it promotes accumulation of plaque
as well as being a potential source of irritation to the gingiva.
54
Indications:
1- Cases having few remaining teeth that are not suitable for fixed or
removable partial denture.
2- Patients having few remaining teeth, which are mobile due to an
unhealthy periodontal condition. The reduction in coronal portion
reduces drastically the mobility of these teeth and makes them
good abutments for overdentures.
3- Patients presenting with abnormal jaw sizes, large maxillary or
mandibular bony defects or with patients with Angle's II or III
jaw relationship.
4- Patients presenting with congenital defects as cleft palate,
microdontia, amelogenesis or dentinogenesis imperfecta or partial
anodontia.
5- It is an alternative line of treatment to single dentures opposing
few natural teeth.
6- In younger patients: overdenture therapy with its maintenance of
tooth and supporting bone should always be considered over
extraction of teeth for young patients.
7- Macroglosia and microglossia as in the case of enlarged tongue it
causes denture dislodgement unlike with small toungue it is
difficult to create lingual peripheral seal.
8- Cases with torus palatines and torus mandibularies which affects
proper denture extention and lateral denture retention.
9- High v shaped or flat palate.
10- Severe bilateral undercut.
55
Contraindications:
1- In cases with poor oral hygiene.
2- Inadequate interarch distance to accept the denture and
abutments.
3- Abutments exhibiting mobility, which exceeds grade II.
4- Decreased motivation.
Patient Selection
1- Possibility of fixed or removable partial dentures:
If the remaining natural teeth are capable of supporting a fixed or
removable appliance, then this form of treatment must be considered
the primary one.
2- Endodontic therapy:
Because of a tooth usually must be treated endodontically to allow
for sufficient reduction of the clinical crown, it must be ascertained
that successful endodontics can be performed.
3- Periodontal condition of the abutment teeth:
Periodontal evaluation is a critical stage in the construction of an
overdenture. We must begin with optimum periodontal health to
ensure the longevity of abutment teeth.
4- Caries:
If abutment teeth are caries prone, then we must seriously question
this mode of treatment.
56
5- Young patients:
Overdenture therapy with its maintenance of tooth and supporting
bone should always be considered over extraction of teeth for young
patients.
6- Location of abutment teeth:
Teeth are most useful in areas of maximum occlusal force and
ridge resorption potential. The anterior aspect of the residual ridge
especially that of the mandible, is very susceptible to change; so
cuspids and premolars are valuable teeth to preserve in this area.
Abutment number and distribution:
 The more the number of the abutment teeth the better will be the
prognosis, but ideally two abutment in each quadrant is enough
followed by tripod distribution i.e. 2 abutment in one side and
another one on the opposite side of the arch, followed by one
abutment in each quadrant. If there is only one abutment tooth left
on one side it’s advisable to add an implant on the other side.
 It’s advisable to keep the teeth on the occlusal destructive force
area (area receiving maximum occlusal force) to act as an
overdenture abutment to receive the greatest amount of force than
the ridge area, also it’s recommended to leave a tooth or more on
the anterior ridge area which has a rapid rate of bone resorption.
57
The Design and Techniques of Abutment Tooth Preparation

A- Vital abutment:
I- Simple tooth modification and reduction:
This technique is often used in patients with severe abrasion of teeth.
Minimum tooth preparation is required because of the presence of a
great deal of interocclusal distance. The abutment teeth are reshaped
to eliminate undercuts
II- Tooth reduction and cast coping (thimble-shaped coping):
This is necessary because of sensitivity or as a caries control (Fig
15-1).
• Adequate interocclusal distance must exist or violation of the
vertical dimension is liable to occur with the result being poor
esthetics and eventual failure because of patient intolerance.
III- The Telescopic overdenture:
• It is constructed to fit over the natural teeth like a sleeve.
• This approach is possible only when the teeth have an adequate
bony support and a good periodontal prognosis, because with this
method there is only a minimum reduction in the crown/root ratio
• Retention is obtained through the frictional resistance produced
between the semi-parallel walls of the copings and the tissue side of
the denture base (Fig 15-1).
58
Fig (15-1): Left; simple tooth reduction and coping. Right;

telescopic crown
B- Endodontically treated teeth:
I- Endodontic therapy and amalgam plug:
• This technique is indicated when there is normal coronal height
and normal interocclusal distance with little or no loss of vertical
dimension.
• In order to create enough space for the overdenture without
increasing the vertical dimension, the teeth must be drastically
reduced, usually to the gingival level, with endodontic therapy (Fig
15-2).
• Even hypermobile teeth may be used because the drastic reduction
in crown/root ratio along with the periodontal therapy promises a very
favorable prognosis.
II- Endodontic therapy and cast dowel coping:
The procedure and indications are almost similar to the
technique of endodontic therapy and amalgam plug with the exception
59
that a casting is placed on the endodontically treated tooth instead of

placing a simple amalgam restoration in the root canal. The casting
that is made is usually a shallow dome shape.
• Retention is gained from a short post that is placed within the root
canal (Fig 15-2).
III- Endodontic therapy with cast coping utilizing some forms of

attachment:
• This approach provides stability & retention. Because of the added

time, cost, and risks, this procedure should be reserved for patients
with a favorable prognosis (Fig 15-2).
Fig. (15-2): Left; endodontic treatment with amalgam plug. Middle;

Dowel coping. Right; stud attachment
60
ATTACHMENTS
An attachment is defined as a mechanical device used for retention
and stabilization of prosthesis.
• They could either be rigid or resilient. Rigid attachment does not
allow for movement of the denture base providing adequate retention.
However, they may induce torque on the abutment. While resilient
attachments allow some controlled vertical movement, and induce
less torque on the abutment teeth. There are three types of attachment:
1- Stud attachments. 2- Bar attachments. 3- Magnetic
attachment.
1- Stud attachments:
Most of the stud attachments are simple in
design, consisting of a male stud type that is
soldered to a base covering the prepared tooth
and accurately fits a female housing that is either
embedded in the acrylic of an overdenture or
soldered to a substructure in the overdenture (Fig
15-3). Fig (15-3)
2- Bar attachment:-
The purposes of the bar attachments are splinting of the abutment
teeth and retention and support of the prosthetic appliance. Bar
attachments are also indicated when the abutment teeth are markedly
61
nonparallel.
The bar follows the curve of the alveolar process and is seated 2-3
mm above the crest of the ridge. Clips or sleeves are embedded in the
denture base and snaps the bar to retain the denture.
Bar attachments are of two types, bar units and bar joints.
Bar units have rigid fixation where there is no movement between

the bar and overlying sleeve and therefore can be classified as tooth
borne as all stresses are transmitted to the abutment teeth (Fig 15-4).
Bar joints permit rotational movement between sleeve and bar,

utilizing more of the residual ridge for support (Fig 15-4).t.
Fig. (15-4); Bar attachment. Left; bar can be used when there is no
parallel abutments. Right; bar and sleeve in position.
3- Magnetic retention
Small, strong mini magnets are successfully used to retain
overdentures. The magnet is fitted in the fitting surface of the denture
62
opposite to a metallic keeper cemented in a prepared cavity of the

endodontically treated abutment (fig 15-5).
Fig. (15-5): Left; magnets in the denture-fitting surface. Right;

Keepers (up view) and keepers in abutments (down).
IMPLANT SUPPORTED COMPLETE OVERDENTURE

Overdentures have been used with a wide variety of implant systems
including blade implants and the root-form Osseointegrated implants.
The overdenture provides additional retention and stability over a
conventional denture. The three attachment systems used with tooth-
supported overdentures are usually used with the implant –supported
overdenture.
The ball attachments are stress- breaking components that retain
and laterally stabilize the tissue-supported overdenture in either arch.
63
Each attachment consists of an implant retained titanium male ball

attachment and a snap-on female cap attachment socket that is
processed into the denture base (fig. 15-6).
Fig. (15-6): Stud attachment (ball and socket),
Bar attachment: The more popular type used with implant retained
overdenture is the bar joint system. The bar joint systems traditionally
used with natural teeth can be used with the various implant systems.
Some implant systems have their own bar joint components
specifically manufactured for use with that particular system.
Magnets provide great resistance to vertical dislodging force.
However, they have little resistance to lateral force and can be easily
moved in horizontal vector, thus providing an inherently stress –
relieved systems as less lateral force is transmitted to the implant. The
majority of the force is directed apically along the long axis of the
abutment.
64
Mini Implants:
When the original root form implants were introduced they
had a diameter of about 3.75 mm. This require at least 5 mm
facio-lingual dimension for placement without grafting
additional bone.
In the last few years root form implant ranging from 1.8 mm
to slightly more than 2 mm in diameter have been promoted
for long term service. These were called mini implants and it
has been used as interim implant. But later it was used as a
permanent implant to support complete and partial over
denture.
Indication of Mini implants:

1. Edentulous arches with minimal remaining bone in
facio-lingual dimension.
2. With removable partial denture Kennedy class I, II and
III.
3. Extra support and retention under fixed partial denture.
Advantages of Mini implant:

1. Reduce bleeding and shortened healing time as it’s a
flapless operation.
65
2. Placement in narrow ridge.

3. Immediate loading.
4. Simple surgical and prosthetic technique.
Dome shaped abutment Abutment with coping
Bar attachement clip
66
Stud attachment Housing for stud attachement
Coping with bar attachment
67
Formative assessment (VI)
1- Which one of the following cases are indicated for tooth supported
overdenture?
a- Few remaining abutment teeth.
b- Abutment mobility exceed grade II.
c- Less motivated patients.
d- Bad oral hygiene.
2- A 55 year old male is presented to the dental clinic to have a removable

denture. After examination it was revealed that the maxilla is completely
edentulous and the remaining lower teeth are 46 43 35 37 , the teeth have
an adequate bony support and a good periodontal prognosis.
If an overdenture was planned, what is the best type of attachment
used for overdenture?
a- Telescopic attachment
b- Bas attachment
c- Ball and socket attachment
d- Magnetic attachment
68
CHAPTER VII
IMMEDIATE DENTURES
1. Define immediate denture.

2. Describe the procedures for immediate complete denture construction.
3. List the contraindications of conventional immediate complete denture
4. List the advantages of conventional immediate denture
5. State the disadvantages of conventional immediate complete denture
6. Clarify the types of complete immediate denture
“An immediate denture is dental prosthesis which is

constructed to replace the lost dentition and the associated oral
structures, to be ready for insertion immediately after the
extraction the last natural tooth or teeth”
An immediate denture could be a removable partial or
complete denture or an immediate over denture.
Immediate dentures provide good solution for patients who
have hopeless badly decayed or loose teeth indicated for
extraction. These patients usually refuse facing the community
without teeth during post extraction healing period until routine
dentures are constructed.
69
Immediate denture may either be a single denture or both

maxillary and mandibular dentures .When both dentures are
proposed, it is advisable to construct them simultaneously to
ensure that irregularities in the dentulous arch will not interfere
with teeth positioning in the immediate replacement in the other
arch.
According to the sequence of teeth extraction,
complete immediate dentures can be classified into:
- Transitional immediate complete dentures.
- Conventional immediate complete dentures.
Transitional Immediate Complete Dentures

A transitional immediate complete denture is also called an
“Intermediate immediate denture” or an “Interim immediate
denture. It is constructed before extraction of any teeth and is
inserted at the time of extraction of both anterior and posterior
teeth.
Transitional immediate denture insertion usually follows a one-

stage surgical approach, where both remaining anterior and posterior
teeth are extracted in one visit. The impressions for the denture are
made with the posterior teeth still in the mouth; hence, it is less
accurate than a conventional immediate denture constructed after the
extraction of posterior teeth.
70
The transitional denture serves the patient for few months until
stability of the denture supporting tissues is achieved and new
dentures are constructed.
Conventional Immediate Complete Denture
A conventional immediate denture CICD is a prosthesis
constructed after six or more weeks after the extraction of all posterior
teeth and inserted at the time of extraction of the anterior teeth.
Conventional immediate denture insertion usually follows a two
stage surgical approach where:
A-Posterior teeth are first extracted leaving only two opposite
posterior teeth bilaterally as centric stops to maintain vertical
dimension of occlusion. A six week waiting period is allowed
for healing of the extraction sites and to allow time for bone
remodeling required to establish height and width for the
posterior border of the denture. During this period the dentures
are constructed.
B-Anterior teeth are then extracted and the finished denture is
immediately inserted.
Procedures for “CICD” Construction:
The steps required for “CICD” construction comprises surgical,
clinical and laboratory prosthetic procedures. These steps are:
- Diagnosis and mouth preparation.
- Extraction of posterior teeth.
- Impressions, Jaw relation and posterior teeth try - in.
- Modification of the casts.
71
- Construction of dentures.
- Extraction of anterior teeth.
- Denture insertion.
- Post - insertion care.
1- Examination and mouth preparation:

- Proper intra-oral and extra-oral examination of the patient should
be carried out.
- Scaling is performed before treatment to render the mouth plaque
free, to obtain accurate impressions and to reduce post – operative
edema.
- Impressions and inter-occlusal records are made to obtain mounted
diagnostic casts. These casts are necessary for diagnosis, treatment
planning and as a reference for subsequent procedures.
2- Extraction of posterior teeth:
The posterior teeth are extracted leaving bilateral centric
stops. A healing period is permitted to allow for healing of the
extraction sites. For this reason the next appointment is
scheduled after six weeks.
3-Preliminary impression:
Preliminary impression is made using suitable stock trays
and alginate impression material to obtain preliminary study
casts. Special trays are then constructed to conform to the
already proposed impression technique.
72
4-Final impression:
Final impression is made using one of following
techniques:
1-Single final impression procedure: Alginate impression

is made in a border molded perforated acrylic special
tray.
2-Two stage final impression procedure: It is also called
sectional impression and is used in cases with deep
anterior undercuts. The impression is first made for the
posterior edentulous segment using zinc oxide and
eugenol in an acrylic resin tray made to conform to the
edentulous posterior segments. The tray is extended
anteriorly to end in positive stops on the lingual surfaces
of anterior teeth. Then an overall alginate impression in a
perforated stock tray is made while the first impression is
located in place. The two sectional impressions are
removed together as one piece (fig.16.1).
73
Figure (16-1)
5-Jaw relation registration and posterior teeth try-in:

The final impressions are boxed and poured to obtain
master casts on which stable, well adapted occlusion blocks
are made (fig.16.2). The lower natural teeth can be a helpful
74
guide in establishing the height of the occlusal plane of the

wax rim. The vertical stoppers are also helpful to preserve the
occlusal vertical dimension. Centric occluding relation is
recorded. Selection of the proper size, shape and shade of
anterior and posterior teeth is carried out at the same visit.
Selection is facilitated by the presence of the remaining
natural teeth. The posterior teeth are set to the proper centric
occluding relation (fig.16.3). Try in is made to verify the
arrangement of posterior teeth in centric occluding relation.
Figure (16-2)
Figure (16-3)
6- Modification of the master cast:
The master cast is modified by removing all the remaining
stone anterior teeth and by contouring the stone residual ridge
75
according to the form previously planned during examination.

The cast is thus made to conform to the post surgical contour
previously planned and that will be carried out in the next
appointment.
7-Surgical procedures and corresponding cast modification:
A. Extraction of anterior teeth with no additional surgery:

In this surgical procedure, the teeth are simply extracted and no more
surgery is performed. The denture could be constructed with or
without a labial flange as follows:
1. Socketted immediate denture:
It is used for cases with insufficient space for a labial flange or if there is
a severe undercut anteriorly. No labial flange is made and the anterior
teeth extend a few millimeters into the labial aspect of the sockets of
their natural predecessors. The artificial teeth are carefully positioned
in the sockets and the denture processed. The socketted type provides
natural appearance as if the teeth are growing from the gums.
2. Flanged immediate denture:
It is used in cases having sufficient available space to accommodate a
labial flange without giving the feeling of excessive lip fullness.
76
B.Extraction of anterior teeth and labial plate alveoloplasty:

This procedure involves extraction of teeth followed by surgical
contouring of the alveolar ridge (alveoloplasty) in patients with
maxillary protrusion and to eliminate deep undercuts. In this case, the
master cast is modified by cutting off the teeth and trimming the
labial alveolar portion required to eliminate the undercut or the
protruded area.
During surgery, the amount of bone to be contoured is determined
and guided by a clear acrylic resin template previously constructed on
a duplicate modified cast.
8-Denture construction:
The trial denture base is extended to the anterior region and the
selected artificial teeth are placed in position and secured with wax to
it. The trial dentures are then flasked, processed and deflasked.
Dentures are finished and polished and are now ready for insertion.
9- Extraction of anterior teeth:

All the remaining teeth are extracted as planned before
modification of the casts. Surgical procedures are carried out guided
by the previously constructed clear acrylic templates. Dentures are
then immediately inserted.
77
10-Denture insertion:
A pressure indicating paste can be used to eliminate
pressure areas from the fitting surface of the denture.
The patient should be assured to keep the denture in place
continuously for 24 hours. The patient should be cautioned not to
remove the dentures, otherwise the tissues may swell and it becomes
impossible to reseat the dentures.
11. Post - insertion care:

Subsequent visits should be scheduled, the following day, 48
and 72 hours later. Immediate denture patients should be recalled
every three months to evaluate the fit, retention and stability of
dentures .The majority of CICD would require rebasing 10-14
Months, after denture insertion.
Duplicating the patients natural teeth
One of the merits of immediate replacements is the ability to

construct anterior artificial teeth that duplicate the natural ones instead
of using stock ready made artificial teeth. This procedure is simple
and rewarding. It permits duplication of the size, color and
arrangement of the patient’s natural teeth. It can be done as follows:
An impression of the anterior teeth is made using rubber base loaded in
the anterior acrylic tray. The impression should be accurate with no
defects or bubbles over the teeth.
78
 The impression is then filled with white carving wax to the level of
the gingival margin and allowed to set.
 The wax pattern is carefully removed from the rubber base material.
Excess wax extending 1 mm below the gingiva should be trimmed
(fig.16.4).
 The wax pattern is invested in a small suitable flask, wax elimination
is carried out. A suitable shade of heat cure acrylic resin is packed
into the mold and processed.
 The teeth are then removed as a block of six teeth. A separating saw
or disc is used to separate the incisal edges and buccal surfaces of the
teeth keeping them in contact only at the cingulum area (fig. 16.5).
 The teeth are then polished and attached to the modified master cast
instead of artificial made teeth.
Figure (16-4)
79
Figure (16-5)
Advantages of CICD:
1. The patient is spared the inconvenience and distress of being

edentulous until conventional complete dentures are constructed.
Immediate dentures are thus helpful in the transition period from
the dentulous to the edentulous state.
2. There is less interruption of the patient’s business and social
activities.
3. Immediate dentures prevent changes in the oral and facial
musculature that may take place due to edentulism. Thus the
appearance is minimally affected. This is because the cheek and lip
support is maintained, the vertical dimension is preserved and
tongue is not allowed to spread making the adaptation to
subsequent dentures more difficult.
80
4. The functions of speech and mastication are sustained when natural

teeth are immediately replaced.
5. The remaining natural teeth are used as a guide for orienting the
position of the artificial teeth. Their presence also facilitates either
the selection or duplication of the size, shade and shape of teeth.
6. Immediate denture serves as a protective bandage to protect the
open sockets and blood clots. Thus promoting faster and less
painful healing.
Disadvantages of CICD:
Patients undergoing rehabilitation with CICD should be previously
informed of the disadvantages of such a service.
These disadvantages are:
1. Immediate replacement doesn’t permit an anterior try-in. i.e. no try
in for the arrangement, color and appearance of anterior teeth.
2. Immediate dentures are more expensive and require extra dental
appointments i.e. require more time and more fees.
3.Immediate replacements necessitates more post insertion
adjustments to maintain the fit, stability and occlusion of the dentures
as these may change due to the expected changes in the contour of the
supporting tissues.
4. Immediate replacements require eventual relining or rebasing.
81
Contraindications to CICD:
Immediate complete dentures are contraindicated in the
following cases:
1. Patients with general systemic conditions that make them poor
surgical risks as uncontrolled diabetics, and patients with
cardiovascular diseases.
2. Patients having acute infections that require drainage.
3. Patients having advanced periodontal diseases except after
proper scaling and curettage.
4. Patients who had or are still having radio therapy to avoid the
danger of osteoradionecrosis.
5. Patients with limited neuromuscular control.
6. Mentally retarded individuals and uncooperative or psychic
patients.
7. Patients with severe gag reflex except after being trained or
treated before extraction of teeth.
82
Formative assessment (VII)
1- Which of the following is a major disadvantage to immediate complete

denture therapy?
a. Trauma to extraction site

b. Impossibility of anterior try in
c. Increased the potential for infection
d. Excessive resorption of residual ridge
2- A patient came to the dental clinic where immediate denture was

constructed. What is the proper timing that should be scheduled for
rebasing?
a. 48 hours
b. 72 hours
c. 3 months
d. 10-14 months
83
References
Allen AA, Heath JR, Mc Cord: Complete Prosthodontics; Problems, Diagnosis and
Management. Mosby-Wolf, London, 1995.
American Dental Association: Guide to Dental Materials and Devices, 7th

ed.,Chicago:A.D.A.; 1975
Barrenas, L. and Odman, P.: Myodynamic and conventional construction of complete

dentures: A comparative study of comfort and function. J. Oral Rehabil.; 1989.
Beresin, V.E. and Schiesser, F. J.: The neutral zone in complete and partial dentures. 2nd
ed. St. Louis, The C.V. Mosby Company: 1978.
Beyli, M.S. and Fraunhofer, J.A.: An analysis of causes of fracture of acrylic dentures. J.
prosthet. Dent. 46: 238-241; 1981.
Calomeni, A.A.; Feldmann, E.E. and KuebKer, VV. A.: Posterior palatal seal locations and
preparation on the maxillary complete denture cast. J. Prothet. Dent. 49: 628-
630; 1983.
Coleman, R. D. and kaiser, W. B.: The Scientific Bases of Dentistry. Philadelphia, W. B.

Sounders; 1966.
Craig, R.G.: Restorative Dental Materials. 8th ed. St. Louis, C. V. Mosby Company. P.
526:1989.
Edwards, L.F. and Boucher, C.D.: Anatomy of the mouth in relation to complete denture. J.
Am. Dent. Assoc.29: 331-345; 1942.
Feldmann,E.E.:Tooth contacts in denture occlusion-centric occlusion only. Dent. Clin. North.

Am. 15: 875-886,1971.
Fenn, H.R.B.; Liddelow, K.P. and Gemson, A.B.: Clinical Dental Prosthetics. 2 ed. London,
Staples; 1974..
Geering AH,Kundert M , Kelesy C: Complete denture and overdenture Prosthetics. Tieme

medical publication Inc. New York, 1993.
84
Grant AR, Heath JR, Mc Cord JF: Complete Prosthodontics; Problems, Diagnosis and
Management. Mosby-Wolf, London, 1996.
Harrison, W.M. and Stansbury, B.E.: The effect of joint surface contours on the transverse
strength of repaired acrylic resin. J. Prothet. Dent. 23: 464-472; 1970.
Heartwell, C.M. and Rhan, A.G.: Syllabu's of Complete Dentures. 3rd ed. Philadelphia, Lea
and Febiger; 1986.
KeIIy, E.: Centric relation, centric occlusion, and posterior tooth form and arrangement. J.
Prothet. Dent. 37: 5-11;1977.
Kern, B.K.: Anthropometric parameter of tooth selection. J. Prothet. Dent. 17: 431-437;
1967.
Kolb, H.R.: Variable denture-limiting structures of the edentulous mouth. Part I .Maxillary
border areas.J.Prosthet.Dent.l6:194-201;1966.
Kotwal, K.R.: The need to use an arbitrary face-bow when remounting complete dentures
with interocclusal records. J. Prosthet. Dent. 42: 224-227; 1979.
Laney, W.R. and Gonzalez, J.B.: The maxillary denture: Its palatal relief and posterior
palatal seal. J. Am. Dent.Associ. 75: 1182-1187; 1967.
Lombard!, R.E.: The principles of visual perception and their clinical application to denture
esthetics. J. Prosthet.Dent. 29: 358-382; 1973.
Lott, F. and Levin, B.: Flange technique: an anatomic and physiologic approach to increased
retention, function, comfort, and appearance of denture. J. Prosthet. Dent. 16:
394-413; 1966.
Lye, T.L.: The significance of the fovea palatina in complete denture prosthodontics. J.
Prosthet. Dent. 33: 504-510; 1975.
Marcroft, K.R.: Fabrication of identical-duplicate dentures. J. Am. Dent. Assoc. 64: 476-481;
1982.
Phillips, R-W.: Science of Dental Materials. 9th ed. W.B. Sounders Company, P 188-191;
1991.
Schneider, R.L.: Diagnosing functional complete denture fractures. J. Prothet. Dent. 54: 809-
814; 1985.
Sharry, J.J.: Complete denture prosthodontics. 3rd ed. NewYork, McGraw-Hill; 1974.
85
Sowter, J.B.: Dental laboratory technology: prosthodontic techniques. Chapel Hill, University
of North Carolina; 1968.
Swenson, K.H.: Complete dentures using the TMJ articulator. J. Prosthet. Dent. 41: 497-506;
1979.
Ten Cate, A.R.: Oral Histology: Development, Structure and Function. 2ed. St. Louis, C. V.
Mosby Company; 1985.
The Academy of prosthodontics: Glossary of prosthodontic terms. J. Prosthet. Dent. 71: 50-
112; 1994.
Thorp, E.R.; Smith, D.E. and Nicholls, J.L: Evaluation of the use of a face-bow in complete
denture occlusion. J. Prosthet. Dent. 39: 5-75,' 1978.
Watt, D.M. and Mac Gregor, A.R.: Designing complete dentures. Philadelphia, W.B.
Sounders; 1976.
Weintraub, G.S.: Establishing the posterior palatal seal during the final impression
procedure: A functional approach. J. Am. Dent. Assoc. 94:505-510; 1977.
Winkler, S.: Essential of complete Denture Prosthodontics. 2nd ed. PSG Publishing Company;
1988.
Winstanley RB: Prosthodontics . Mosby-Wolf, London, 1994.
Zarb, G.A.; Bolender, C.L.; HicKey, J.C. and carlesson, G.E.: Boucher's Prothodontic
Treatment for Edentulous Patients. 7th. Ed. St-Louis, The C.V.Mosby
Company; 1990.
N, B. All pictures in this book are copied from the above references.
86

PRS 412 5th Yr Notes Fall 2022

Uploaded by

Copyright:

Available Formats

You might also like

PRS 412 5th Yr Notes Fall 2022

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

PRS 412 5th Yr Notes Fall 2022

Uploaded by

Copyright:

Available Formats

Faculty of Oral and Dental Medicine

‫رؤية ورسالة الكلية‬

a- Knowledge and understanding:

c- Professional and practical skills:

No. of Intended Learning

Ten Complete over

*K&U = Knowledge and understanding.

Contents: Spring Semester

Prac Intended Learning

Eight Trismus 1 1 0 A22

4- Teaching and learning methods

5- Student assessment methods

* According to MIU calendar.

semester Midterm Final Attendance Practical Requirements Oral Total

6.2- Text books

7- Facilities required for teaching and learning

N.B.: Attached :(1) Curriculum map

Course coordinator: Prof. Dr Eman Eltaftazany

COMPLAINTS ABOUT COMPLETE

1. Identify the causes of pain after denture insertion and describe

4- Colour, Shape and Position of Anterior Teeth:

b) Shape. Remove the teeth complained of and replace them with

2- When Coughing or Sneezing:

IV- CLATTERING TEETH

It is the failure of contact between tongue & anterior teeth during

XI- FOOD UNDER THE DENTURES

XII- COMISSURAL (ANGULAR) CHEILITIS

4- Prescribe a mild tranquilizer.

XIIII- REPEATED MIDLINE FRACTURE OF UPPER

Formative assessment (I)

TREATMENT OF SOME COMPLETE

1. Identify the challenge in construction of complete denture over severely

Factors affecting alveolar bone resorption

and lower the resistance of the tissues to inflammation and bone

the forces transmitted to the supporting bone and decrease the

6- Reduction of buccolingual width of the occlusal table, reducing

Hyperplasia of the soft tissue under a complete denture is the result

vertical overlap without sufficient horizontal overlap to

recover and provide an excellent medium to aid in conditioning

A sectional impression technique (Composite method) is

Flat Palate with Shallow Ridges

Knife-Like Lower Ridge

Large Torus Palatinus

Abnormal Jaw Relationships

Formative assessment (II)

1. A 76 years old man came to MIU Prosthodontic clinic seeking

a. Selective pressure impression.

2. A 78 years old patient came to MIU Prosthodontic clinic seeking

What is the most appropriate treatment modality to mange v-shaped

1. Differentiate between relining and rebasing of complete denture.

Reline: reline is the procedure used to resurface the tissue side of a

3- Restoration the vertical dimension: it can be restored by relining.

1- When the impression is made within an existing denture, care must

Also in case where the vertical dimension has to be

impression is taken with the teeth in occlusion. The thickness of

Disadvantages of the chair side reline materials:

The denture is processed and finished in the usual manner.