Prosthesis I

Technical complete denture
DR. OSAMA A. BARAKA

Professor of Removable Prosthodontics
Faculty of Dental Medicine
AL-Azhar University
DR. HUSSEIN ELDAWASH

Assistant Professor of Removable Prosthodontics
Faculty of Oral and Dental surgery and Medicine
Al- Zagazig University
2021
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CONTENTS
Chapter Subject Page
I Introduction and anatomy 3
II Impression trays, impressions and boxing 32
III Retention, stability and support 50
IV Posterior palatal seal and relief 56
V Mandibular movements and jaw relations 66
VI Record blocks 73
VII Face bows and dental articulators 86
VIII Selection of artificial teeth 96
XI Arrangement of teeth and waxing-up 107
X Processing dentures. 127
XI Repair, relining and rebasing. 137
Bibliography. 145
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CHAPTER I
INTRODUCTION AND ANATOMY
Definitions
A Prosthesis: An artificial appliance, which replaces a lost or
congenitally missing part of the human body.
Prosthetics: The art and science of designing and fitting artificial
replacement for lost or missing part of the body.
Prosthodontics (Dental Prosthetics): is the branch of dental art and
science, which, deals with replacement of missing teeth and oral tissues.
Prosthodontist is a specialist in prosthodontics.
Removable Prosthodontics is the art and science of replacement of
missing teeth and oral tissues with a prosthesis designed to be removed by
the wearer. It includes removable complete and removable partial
prosthodontics.
Fixed Prosthodontics: The branch of prosthodontics pertaining to the
replacement of missing teeth by artificial substitute that cannot be removed
by the patient.
Maxillofacial Prosthodontics: The branch of prosthodontics that deals
with replacement of the stomatognathic and craniofacial structures.
Implant Prosthodontics: The branch of prosthodontics that deals with
replacement of missing teeth and associated structures by restorations that
are retained by the dental implants.
Natural dentition is the natural teeth in the dental arch.
Dentulous is a condition on which natural teeth are present in moth.
Edentulous is a condition in which the mouth is without teeth.
Partially edentulous condition which some of the natural teeth are lost.
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Denture is an artificial substitute for missing natural teeth and adjacent

tissues.
Complete denture is an artificial prosthesis that replaces the entire
natural dentition and associated structures of the maxilla and mandible for
patients who have lost all their remaining natural teeth (Fig. 1-1).
Partial denture is a dental prosthesis that replaces one or more. but
not all, of the natural teeth and associated structures. It may be fixed or
removable.
Removable partial denture is a partial denture that can be removed
from the mouth and replaced (Fig. 1-1).
Fig. (1-1): Left; complete denture. Right; removable partial denture.

Fixed partial denture is a partial denture that is cemented to the
natural teeth or to dental implant (Fig. 1-2).
Fig. (1-2): Fixed partial denture. Left; supported by natural teeth. Right; supported by
implant.
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Retention is a quality inherent in a prosthesis acting to resist dislodging

forces along the path of placement.
Stability is the quality of prosthesis to be firm, steady, or constant, to
resist displacement by functional horizontal or rotational forces.
Support is the quality of prosthesis to resist vertical tissue ward force.
Supporting area is the foundation area on which a dental prosthesis
rests.
Functions of complete dentures
I- Restoration of the function of mastication:
Food is prepared in the mouth to be digested in the stomach. Loss of
teeth may cause impaired digestion, and general ill health. The mastication
of food with complete dentures restores normal digestive process and
assists the edentulous patient in obtaining adequate nutrition.
2- Correction of speech defect:
During speech the tongue contacting the teeth and palate forming many
sounds. The proper placement complete denture teeth are necessary to
restore a good speech. Proper contouring of the denture base aids in the
correction of speech defect.
3- Restoration of facial contour and appearance (Esthetics):
Loss of teeth results in prematurely aged appearance due to loss of lip
support and overclosure (Nose-chin approximation). Premature wrinkles are
formed around the mouth and cheeks. Restoration of lost facial contour,
vertical dimension of the face and absent teeth will improve the patient
appearance.
4- Health of the alveolar bone and temporomandibular joints:
The alveolar process which supports the natural teeth resorb after loss
of teeth. Restoration of the chewing function through denture minimizes
alveolar bone resorption resulting from lack of function. Also, TMJ troubles
resulting from prolonged overclosure are avoided by the wear of complete
dentures.
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The differences between natural teeth and artificial teeth

1- The natural teeth arc firmly rooted in the bone of the jaws and in
consequence they can incise, tear, and finely grind food of any character.
Artificial dentures on the other hand rest on the soft tissues and are held by
weak forces, which result in a reduced masticatory efficiency.
2- Complete dentures move during function. This movement is related
to the resiliency of the supporting mucosa with the inherent instability of the
dentures.
3- Aesthetically, artificial teeth can be indistinguishable from natural
Teeth, and in many cases, it is of better appearance than the carious or
irregular natural teeth.
4- The speech of complete denture wearers should be normal once the
tongue and lips have adapted themselves to the denture.
Component parts of complete dentures
Fig. (1-3): Component parts of complete denture. 1, denture base. 2, denture flange. 3,
denture border. 4, denture teeth.
1- Denture base
The part of a denture that rests on the foundation tissues and to which
teeth are attached. Forces applied to the denture are distributed and
transmitted to the basal seat through the denture base. Denture bases are
made of acrylic resin or metal (Fig. 1-4).
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Fig. (1-4): Left; acrylic denture base. Right; metallic (Cobalt-chromium) denture base.
2- Denture Flange
The part of the denture base that extends from the cervical ends of the
teeth to the denture border. It provides peripheral seal and horizontal
stability. They are classified according to the vestibule where it extends as
labial, buccal and lingual.
a- Labial flange
The portion of the flange of a denture that occupies the labial vestibule
of the mouth and provides lip support (Fig. 1-5).
b- Buccal flange
The portion of the flange of a denture that occupies the buccal vestibule
of the mouth and provides the cheek support (Fig. 1-5).
Fig. (1-5): Left: Labial flange of the denture Right: Buccal flange of denture.
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c- Lingual flange
The portion of the flange of a mandibular denture that occupies the
alveololingual sulcus (Fig. 1-6). It should maintain contact with the tissues of
the floor of the mouth.
Fig. (1-6): Lingual flange

3- Denture border
The margin of the denture base at the junction of the polished surface
and the impression surface (Fig. 1-3).
4- Denture Teeth
Functions of denture teeth are to improve aesthetics, phonetics and
mastication. They are made of acrylic or porcelain.
Complete denture surfaces
Fig. (1-7): Complete denture surfaces. 1, impression, 2, polished and. 3, occlusal surface.
1- Impression surface (Fitting or intaglio surface):
The portion of the denture surface that has its contour determined by
the impression. It is that part of the denture in contact with the tissues on
which the denture rests.
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2- Occlusal surface:
The surface that is intended to make contact with an opposing occlusal
surface. Aids in mastication and directs forces of mastication to the
supporting tissues.
3- Polished or external surface (Cameo Surface):
The portion of the surface of a denture that extends in an occlusal
direction from the border of the denture and includes the palatal surfaces. It
is the external surface of the denture without the teeth that is usually
polished
Steps in Fabrication of Complete Dentures
Clinical procedures Laboratory procedures
1- Diagnosis and treatment planning

2- Mouth preparation
3- Primary impressions 4- Primary cast
5- Fabrication of custom trays
6- Secondary impressions 7- Master cast
8- Fabrication of occlusal rims
9- Recording jaw relations 10- Articulation
11- Arrangement of artificial teeth
12- Try-in 13- Processing of denture
14- Denture insertion
15- Postinsertion review and
maintenance
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ANATOMY IN RELATION TO COMPLETE DENTURES
A- Extraoral landmarks
1- The nasolabial sulcus:
It is a depression extends downward and laterally from the ala of the
nose to the corner of the mouth (Fig 1-8). It becomes deeper by aging and
loss of natural teeth. The construction of complete denture with the proper
vertical dimension, tooth position and thickness of the denture flanges will
reduce the depth of this sulcus.
Fig (1-8): A, The Nasolabial sulcus. B, Mentolabial sulcus.

2- Mentolabial sulcus:
It extends horizontally between the lower lip and the chin (Fig 1-8). Its
curvature demonstrates three classes of jaw relationship (Fig 1-9):
a- Angle class I (normal anteroposterior jaw relation); the mentolabial
sulcus shows a gentile curvature (obtuse angle).
b- Angle class II (retruded mandible); the mentolabial sulcus presents
an acute angle with the lower lip is folded towards the chin.
c- Angle class III (protruded mandible); the mentolabial sulcus may form
an angle of 1800.
3- Philtrum:
This is a diamond shaped area at the center of the upper lip and base
of the nose (Fig 1-10). With the loss of the teeth it becomes flattened. Proper
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tooth placement will restore a good curvature of the philtrum.
Fig (1-9): The mentolabial sulcus demonstrates three classes of jaw relationship. a: Angle
class I. b: Angle class II. c: Angle class III.
4- Vermillion border:
It is the transitional epithelium between the mucous membrane of the lip
and skin (Fig 1-10). With the loss of teeth and resorption of alveolar bone
the lip is folded inward with the decrease in the amount Vermillion border
shown. Proper denture flange thickness and anterior teeth position can
improve this characteristic appearance of edentulous face.
Fig. (1-10): PH, The philtrum. VB, The vermillion border.

5- Angle of the mouth (Commissures):
Lack of support to the angle of the mouth by the denture as in reduced
vertical dimension may cause angular cheilitis (Fig. 1-11). It is inflammation
and fissuring of the angle of the mouth due to continuous wetting from
saliva.
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6- Modiolus:
It is located at the meeting point of buccinator and other facial muscles
(Fig. 1-11). It is supported by the maxillary premolars. With the loss of teeth,
it drops giving the characteristic sunken cheeks.
Fig. (1-11): Left: Angular cheilitis. Right: The modiolus.

7- Interpupillary line:
It is an imaginary line running between the two pupils of the eye when
the patient is locking straight forward. It is used for anterior occlusal plane
orientation in completely edentulous patients (Fig. 1-12).
8- Ala-tragus line (Camper’s plane):
An imaginary line running from the inferior border of the ala of the nose
to the superior border of the tragus of the ear. The posterior occlusal plane
is oriented parallel to this line (Fig. 1-12).
Fig. (1-12): The interpupillary line and ala-tragus line.

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B- Intraoral landmarks
The anatomic landmarks of significance in relation to maxillary and

mandibular complete denture impressions can be discussed as:
1- Supporting areas.
A- Primary stress-bearing areas.
B- Secondary stress-bearing areas.
2- Relief areas.
3- Limiting areas.
Maxillary anatomic landmarks
1- Supporting Structures
A- Primary stress-bearing area
a- Firm tuberosities.
b- Hard palate on either side of palatal raphe.
c- Alveolar ridge.
B- Secondary stress-bearing area: Rugae area.
2- Relief Area:
a- Incisive papilla.
b- Midpalatine raphe.
c - Secondary stress-bearing areas.
Fig. (1-13): Maxillary supporting structures.
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1- The alveolar ridge:

The crest of the alveolar ridge is made up of cancellous bone covered
by mucous membrane. This mucous membrane is composed of two layers,
the mucosa (keratinized stratified squamous epithelium) and fibrous
submucosa. The mucosa is usually firm and dense that capable of resisting
occlusal (primary stress bearing area). The buccal slopes of the ridge,
normally covered by cortical bone, can withstand lateral stresses.
Clinical significance: Residual alveolar ridge forms the main
supporting area for the maxillary denture.
2- The hard palate:
The main support for the maxillary denture is the bone of two maxilla
and palatine bone. It is covered by keratinized epithelium. Soft tissue
covering the median palatal suture is non-resilient and may be relieved to
avoid trauma.
In the area of rugae, the palate is set at an angle to the residual alveolar
ridge and is thinly covered by soft tissue which contributes to the secondary
stress-bearing area.
Clinical significance:
Horizontal portion of the hard palate lateral to midline provides the
primary support area for the maxillary denture.
The palatal vault is formed anteriorly by the hard palatal and
posteriorly by the soft palate. The palatal surface of the alveolar arch forms
the lateral and anterior boundaries of the palatal vault
Types of alveolar ridges and palatal form:
a- Well-developed upper ridge but not abnormally thick ridges and a
palate with a moderate vault (Fig. 1-14).
b- High V-shaped palate usually associated with thick bulky ridge (Fig.
1-14).
c- Flat palate with small ridge and shallow sulcus (Fig. (1-14),
d- Ridge exhibiting gross undercut areas (Fig. (1-15).
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Fig. (1-13): Shape of hard palate. A, U-Shaped. B, V-Shaped. C, Flat.
Fig. (1-15): Ridge undercuts. A, anterior undercut. B, bilateral posterior undercuts.
3- The Palatal gingival vestige:

It is the remains of the palatal gingivae (Fig. 1-16). After tooth extraction
the position of the vestige remains relatively constant, the same as the
incisive papilla. This can be a very helpful pointer for posterior tooth
positioning during complete denture construction.
Fig. (1-16): The Palatal gingival vestige (Arrows).

4- The maxillary tuberosities:
It is a rounded bulge behind and slightly above the distal end of the
residual maxillary ridge (Fig. 1-17). Large tuberosities offer very satisfactory
retention, support and resistance to the lateral movement of the denture.
Hence it should be included in the denture bearing area, as it permits
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coverage of a wide area and good bearing surfaces. However, tuberosities

exhibiting gross undercuts may require surgical correction before complete
denture construction.
Fig. (1-17): The maxillary tuberosities (Arrows). Left, in cast. Right, intraoral.
5- Incisive Papilla;
It is a pear-shaped elevation of tissue located in the midline just
posterior to the ridge crest (Fig. 1-18). Incisive foramen is located beneath
the incisive papilla on a line immediately behind the central incisors. As
resorption progresses, it comes to lie nearer to the crest of the ridge.
Nasopalatine nerves and vessels pass through the foramen.
a- While making final impression of the maxillary arch, pressure should
not be applied on the incisive papilla region.
b- Compression of the incisive papilla region will cause compression of
the blood vessels and nerves causing necrosis and paraesthesia of anterior
palate (Relief area).
c- Used as a guide for anteroposterior placement of anterior teeth. The
labial surfaces of the central incisors are usually 8-10 mm in front of the
incisive papilla.
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Fig, (1-18): Incisive papilla. Left; in dentulous. Right; in completely edentulous.
6- The palatine rugae:

These are mucosal folds located in the anterior region of the palatal
mucosa (Fig. 1-19). Folds of mucosa play an important role in speech.
These are considered to be secondary stress-bearing areas.
While making final impression for the maxillary arch, one should make
sure pressure is not applied on the rugae area which can cause distortion of
the tissue.
7- Median palatine raphe:

The midpalatal suture is formed by the union of the palatine processes
of the maxilla and horizontal plates of the palatine bones. It is covered by
mucous membrane with little or no submucosa. Its position in the palate is
marked with a raised area of mucous membrane called the median palatine
raphe (Fig. 1-19).
a- As the submucosa is very thin, pressure cannot be applied over the
midpalantine raphe region during making of final impression.
b- This area is hard or sensitive and requires relief within the denture
base. This relief prevents rocking of the maxillary denture that could result in
soreness and or denture splitting.
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Fig. (1-19): Rugae area (R) and median palatine raphe (MPR). Left; in dentulous. Right,
diagram shows median palatine raphe (MPR). Primary stress bearing areas; alveolar
ridge (A), tuberosity (B) and palate (C). Secondary stress bearing area; rugae (R).
8- Torus palatinus:
It is a raised bony ridge in the midline of the hard palate or on each side
lateral to the median palatine suture, at any part of the distance from the
anterior palatine foramen to the posterior border (Fig. 1-20). It varies in size
and form. It may be round smooth or pedunculated. It should be removed
surgically if it is too large or extends to the area of posterior palatal seal. If it
is small the denture base is relieved in this area.
Fig. (1-20): Torus palatinus. Left, in dentulous. Right, in completely edentulous.
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Maxillary denture limiting areas:
Fig. (1-21): Border structures that limit the periphery of maxillary denture.
1- The maxillary labial frenum:

It is a fibrous band covered by mucous membrane that extends from the
labial aspect of the residual alveolar ridge to the lip. It may be single or
multiple and may be narrow or broad. It has no muscle fibers and has no
action.
Clinical significance: A labial notch must be provided in the midline of
the denture border opposite to the frenum. This notch prevents ulceration of
the frenum or displacement of the denture (Fig. 1-22).
Fig. (1-22): Left, labial frenum. Right, notch in labial flange for labial frenum.
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2- Labial vestibule:
Potential space bounded by the labial aspect of the residual alveolar
ridge, mucolabial alveolar fold and orbicularis muscle. It houses the labial
flange in both sides between the labial frenum and the buccal frenum. The
mucosa lining is thin with nonkeratinized epithelium. Submucosal layer is
thick and contains large amount of loose areolar tissue and elastic fibers.
a- The labial flange of the denture provides the support for the upper lip.
b- The labial flange of the denture will be in complete contact with labial
vestibule to provide a peripheral seal in the denture.
3- Buccal frenum:
Band of tissue that overlies the levator anguli oris muscle. Orbicularis
oris muscle pulls the frenum forward and buccinator muscle pulls the frenum
backward. Its reflection is in anteroposterior direction (Fig. 1-23).
As there are muscle attachments in the buccal frenum, sufficient relief
should be provided so that the denture will not dislodge during functions, like
chewing, and smiling.
4- Buccal vestibule:
It extends from the buccal frenum to the hamular notch. It houses the
buccal flange of the denture between the ridge and the cheek. In this area
the denture flange is related to the buccinator muscle. Due to the horizontal
direction of these muscle fibers, it does not displace the denture.
a- The width and the height of the buccal flange of the upper denture is
determined by the coronoid process of the mandible. The patient’s mouth
should be kept half open during the final impression procedure. When the
mouth is kept wide open, the coronoid process of the mandible comes
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forward narrowing the buccal vestibule. (Fig. 1-23).

b- The root of the zygomatic bone (malar bone) flares upward and
outward from the area above the first molar. The denture border in this area
may require some relief to avoid impingement of soft tissues.
Fig. (1-23): Left, two buccal frenum. Right, the space for the maxillary buccal flange is
checked while the coronoid process moves forward during wide mouth opening.
5- Pterygomaxillary (hamular) notch:

It forms distal limit of buccal vestibule as a depression situated between
hamulus of the medial pterygoid and tuberosity. The pterygomandibular
ligament is attached to the hamular notch. (Fig. 1-24).
The denture border should extend till the hamular notch. If the denture
border is short of the hamular notch, the denture will not have a posterior
seal resulting in loss of retention of the denture. If the denture border is
extended beyond the hamular notch, the pterygomandibular raphe is pulled
forward when the patient opens the mouth wide open causing dislodgement
of the denture.
6- The posterior vibrating line of the palate:

The soft palate has two parts. The anterior part that is adjacent to the
hard palate is immovable while the posterior part is movable. The posterior
vibrating line is an imaginary line drawn across the posterior part of the
palate that marks the beginning of motion in the soft palate when the patient
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says "ah." It extends from one pterygomaxillary notch to the other (Fig. 1-
24). This line lies about 2 mm posterior to the fovea palatinae.
The distal edge of the maxillary denture base terminates at this line.
Posterior palatal seal is made at the distal end of the maxillary denture.
Fig. (1-24): Left, hamular notches marked on cast. Right, posterior vibrating line between
hamular notches marked in the patient’s mouth.
7- Fovea palatinae:
They are two pits one on each side of the midline of the palate formed
by the opening of mucous gland ducts (Fig. 1-25). They are just posterior to
the junction of the soft and hard palate. The posterior border of the maxillary
denture extends about 2 mm posterior to the fovea palatinae.
Fig. (1-25): Fovea palatinae. Left, in model. Right, intraoral.
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Mandibular anatomic landmarks
1- Supporting Structures
a- Primary stress-bearing area: Buccal shelf area.
b- Secondary stress-bearing area:
Buccal and lingual slopes of the residual alveolar ridge.
2- Relief Areas:
a- Mental foramen.
b- Genial tubercles.
c- Mandibular tori.
d- Mylohyoid ridge.
e- Undercuts or sharp boney prominence on ridges.
Fig. (1-26): Mandibular supporting areas. Buccal shelf (Primary stress bearing area) and
slopes of alveolar ridge (Secondary stress bearing areas).
1- Mandibular alveolar ridge:
The crest of the mandibular ridge cannot be used as a primary stress-
bearing area because it is composed of cancellous bone covered by a thin
and less firm tissue than that in the maxilla. The slopes of the residual ridge
both buccal and lingual have cortical bone coverage and can be considered
as a secondary stress bearing area.
a- Sharp (knife edge) ridge crest require relief of the denture.
b- In severely resorbed alveolar ridge with thick movable fibrous tissue
coverage, it should be treated before impression.
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Types of mandibular ridge:

The mandibular alveolar ridges are classified according to the stage of
bone resorption into high well rounded, low well-rounded, knife edge, and
flat ridge (Fig. 1-27).
Fig. (1-27): Residual ridge form: (A) High well rounded (B) Low well-rounded, (C)
Knife edge, (D) Flat
2- Mental foramen:
It is located on the buccal surface of the mandible between the roots of
the first and second premolars (Fig. 1-28). The mental nerves and vessels
pass through it. In case of severe bone resorption it becomes at the ridge
crest. In this case, relief of the denture in this area is necessary to avoid pain
and numbness of the lower lip.
3- External oblique ridge;

It is a dense bony ridge, which descends obliquely downward and
forward from the ramus of the mandible across the outer surface of the body
and fades out near the mental foramen (Fig. 1-28). This ridge is recorded in
the impression and is used as a point reference for denture extension. The
lower denture should cover but not extend beyond the external oblique ridge
to avoid denture displacement by the powerful musculature in this area.
4- Buccal shelf area:

This area is bounded medially by the crest of the residual ridge, laterally
by the external oblique ridge, anteriorly by the buccal frenum, and posteriorly
by the retromolar pad (Fig. 1-28).
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The buccal shelf is considered a primary stress-bearing area of the

mandibular denture, because:
a- It is covered with cortical bone.
b- It is usually at right angles to the occlusal forces.
c- The buccinator fibers under this area runs horizontally and does not
displace the denture during function.
Fig. (1-28): Left, Diagram for external surface of dentulous mandible. Middle, Buccal shelf
area in edentulous cast. Right, cross section through denture and alveolar ridge.
5- Retromolar pad area:

It is a triangular soft pear-shaped pad of tissue at the distal end of the
lower ridge (Fig. 1-29). Mucosa composed of thin, nonkeratinized epithelium
and loose alveolar tissue. Submucosa contains glandular tissue, fibers of
buccinators and superior constrictor muscle, pterygomandibular raphe and
terminal part of the tendon of temporalis.
a- It should be covered by the denture as determined by the muscle
attachments.
b- The retromolar pad provides the peripheral posterior seal for the
lower denture.
7- Mylohyoid ridge (Internal oblique ridge):
It is an irregular bony ridge begins in the region of the third molar and
descends downwards and forwards across the inner surface of the body of
the mandible to the lower border at the incisor region (Fig, 1-30).
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Fig. (1-29): Left, retromolar pad marked in cast. Right, diagram show muscle attachments
to the retromolar pad.
It gives attachment to the mylohyoid muscle and should be covered by

the denture. This ridge becomes prominent and progressively higher on the
mandible as resorption occurs. The denture may require relief over it or it
may require surgical removal if it is highly prominent.
Fig. (1-30): Mylohyoid ridge. Left, dried mandible. Right, cross-section through the
alveolar ridge and denture. Sharp ridge should be relived.
8- Torus Mandibularis:
It is bony projection sometimes found on the inner surface of the
mandible in the premolar region (Fig. 1-31). It may be unilateral or bilateral.
It is covered by a thin mucous membrane and relief of the denture in this
area is necessary. If it is too large surgical removal is indicated.
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9- Genial tubercles:
They are two small bony prominences on the inner surface of the
mandible, one on each side of the midline (Fig. 1-31). The genioglossus
muscles are attached to their upper surfaces and the geniohyoid to their
lower surfaces. The denture may require relief over it if it becomes at the
ridge crest in case of severe bone resorption.
Fig. (1-31): Left, torus mandibularis. Right, genial tubercles.
Mandibular limiting structures:
Fig. (1-32): Anatomic landmarks that limit the mandibular denture.
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1- The mandibular labial frenum:

It is a fibrous band covered by mucous membrane that helps to attach
the orbicularis oris muscle to the labial aspect of the alveolar ridge. It moves
with the movement of the lower lip.
During final impression making, sufficient relief must be given for the
labial frenum without compromising the peripheral seal.
2- Labial vestibule:
It runs from the labial frenum to buccal frenum. Fibers of orbicularis
muscle, incisivus, and mentalis are inserted near the crest of the ridge.
Mentalis muscle is particularly the active muscle (Fig. 1-33).
Extent of the denture flange in this region is often limited because of
muscles that are inserted close to the crest of the ridge. Thick denture
flanges may cause dislodgement of dentures when patient opens the mouth
wide open.
3- Buccal frenum:
It is a fold of mucous membrane extending from buccal mucous
membrane reflection toward the slope or crest of the residual ridge in the
region just distal to the cuspid eminence. It may be single or double, broad
U/V shape. It overlies depressor anguli oris muscle (Fig 1-33).
Relief for the buccal frenum is given in denture to avoid displacement of
the denture.
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Fig. (1-33): Left, section through alveolar ridge, labial vestibule and lower lip. Mentalis
muscle is attached higher than the vestibule and limit the denture flange extension. Right,
buccal frenum and relief in denture.
4- Buccal vestibule
It extends from buccal frenum to the outside back corner of the
retromolar pad. It is nearly at right angles to biting force. Extent of the
vestibule is influenced by buccinators muscle, which extends from modiolus
anteriorly to pterygomandibular raphe posteriorly and has its own fibers
attached to buccal shelf and external oblique ridge (Fig. 1-34).
The masseter muscle contracts under heavy closing force and pushes
inward against the buccinators muscle to produce a masseteric notch in the
distobuccal border of the lower denture (Fig. 1-34).
Fig. (1-34): Right, Diagram shows the masseter muscle. Right: Masseteric notch at the
distobuccal border of lower denture.
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5- The retromolar pad area:

The mandibular denture should cover the retromolar pad area and
extends posteriorly till the anterior border of the ramus of the mandible.
6- Lingual frenum:
It is a fold of mucous membrane from undersurface of the tongue to the
floor of the mouth existing in midline when the tip of the tongue is elevated. It
overlies the genioglossus muscle which takes origin from the superior genial
tubercle.
a- The relief for the lingual frenum should be registered during function.
b- Relief for the lingual frenum should be provided in the denture.
7- Alveololingual sulcus:
It is the space between residual ridge and tongue. It extends from
lingual frenum to retromylohyoid space posteriorly. It is divided into:
a- The sublingual salivary gland area:
In the premolar region, the lingual flange of the lower denture is related
to the sublingual salivary gland (Fig. 1-34). The lingual flange in this area
should be shallow to accommodate the gland and to avoid irritation of the
mucous membrane, which is the least keratinized and the most sensitive
Fig. (1-34): Diagram show lingual flange extension and limiting structures.
30
b- The mylohyoid muscle influencing area:

More posteriorly the lingual flange of the lower denture is related to
mylohyoid muscle (Fig. 1-34), which attaches to the mylohyoid ridge. The
flange extends downward covering the mylohyoid ridge to fill the alveolingual
sulcus. The alveolingual sulcus is determined by the extent of functional
movement of the mylohyoid muscle.
c- The retromylohyoid space (lingual pouch):

The distal extension of the lingual flange lies in the lingual pouch (Fig.
1-34). Its boundaries are:
Medially; the tongue.
Laterally; the mandible;
Posteriorly; the palatoglossus arch, which is formed in part by the
palatoglossus muscle, and in part by the lingual extension of the superior
constrictor muscle.
Anteriorly; the posterior 3 mm of the mylohyoid muscle.
Over extension of the distolingual border of the lower denture will cause
sore throat due to the pressure on the palatoglossus arch muscles.
31
CHAPTER II
IMPRESSION TRAYS, IMPRESSIONS AND BOXING
Impression trays:
They are instruments used for carrying the impression material into the
mouth for maintaining it in position during setting and supporting it during
removal from the mouth and when casting the model.
Component parts of a tray:
The impression tray is composed of a body and a handle. The body
consists of a floor and flanges. The difference between the upper and lower
trays is that the upper has a palatal portion while the lower has lingual
flanges (Fig. 2-1).
Fig. (2-1): Left: Parts of a maxillary tray. Right: The difference between maxillary and
mandibular trays
Requirements of impression trays:
1- They should be strong and rigid.
2- They can be cleaned and sterilized.
3- They should allow for equal thickness of impression material over the
entire fitting surface.
4- The tray must cover the whole impression areas and its flanges must
reach the functional depth of the vestibules.
5-The trays should hold the impression material in correct position to
prevent distortion of the material during setting and removal from the mouth.
32
Types of trays:
1- Stock trays: Used for making primary impression.
2- Special trays (Custom or individual): Used for making final
impressions.
I- Stock Trays (Prefabricated trays):
a- Stock trays are ready made, rigid and dimensionally stable.
b- The trays can be used several times.
c- They are available in different sizes and specifically for upper and
lower arches.
d- The perforations in the trays help in retention of the set impression
material while removing the impression from the patient’s mouth.
e- The space for the impression material is not uniform.
f- They are usually made from nickel Silver, tin, stainless steel,
aluminum or plastics (Fig.2-2).
Fig. (2-2): Left; stainless-steel perforated trays. Right; plastic perforated trays.
Classification of stock trays:

1- According to the impression material:
a- Perforated for hydrocolloid and rubber base impression materials (fig.
2-3).
b- Non-perforated trays are used for sticky materials as compound
impression materials.
33
Fig. (2-3): Left; non-perforated tray. Right; perforated tray.

2- According to the patient:
a- For completely edentulous patients
Stock trays having round floors and short flanges are designed for
edentulous cases (Fig. 2--4). The handles of the trays for edentulous cases
should bent in the form of L and join the floor of the tray at right angle to
clear the lip and allow for molding of the impression borders.
b- For dentulous patients:
Those having flat floors and vertical high flanges (long) are usually used
for dentulous cases. The handles of the trays for dentulous cases can be
made straight by extending it straight across the floor of the trays.
Fig. (2-4): Left; tray for edentulous patient. Right, tray for dentulous patients.
c- For partially edentulous patients:
Trays with combined round floor and short flange for edentulous area
and flat floors and long flanges for dentulous area, are also manufactured for
partially edentulous cases (Fig. 2-5).
34
d- Sectional trays:
Sectional trays are used for making impressions of dentulous arches in
sections, like anterior and posterior sections. They are usually used for
making provisional or temporary restorations in fixed prosthodontic
procedures. Sectional trays are perforated trays made of plastic material.
Fig. (2-5): tray for partially edentulous patient. Right, sectional trays.
Factors affecting stock tray selection:
1- Type of impression material: Perforated or non-perforated tray is
selected according to the impression material used. Tray adhesives have to
be applied for un-sticky materials with non-perforate tray as elastomeric
impression material.
2- Shape of the arch (Square, ovoid or V-shaped).
3- Size of the arch: It should cover all the anatomic landmarks needed
and to provide enough space for impression material all over the basal seat
area.
Impressions for complete dentures:
An impression is an imprint or negative reproduction of an object from
which a positive likeness or cast can be made.
In dental prosthesis, an impression is a negative reproduction of the
entire denture bearing area, stabilizing area and border seal area.
Primary impression: It is an impression made in a stock tray for the
purpose of making a study or primary cast on which special tray is
constructed (Fig. 2-6).
35
Fig. (2-6): Primary alginate impressions.
Final impression: It is an impression made in special tray and is used

for the purpose of making the master cast on which the denture is
constructed (Fig. 2-7).
Fig. (2-7): Final Zink oxide impressions.
Cast (Model):
It is a positive reproduction of the form of the tissues of the upper or
lower jaw, which is made from an impression and over which denture bases
and other dental restorations may be fabricated. A study or dianostic cast is
produced by pouring the primary impression in plaster.
36
Pouring study cast:

1- Measure powder liquid ratios appropriate to the models to be
poured (approximately one-part water to two parts plaster). Add powder to
water rather than water to powder in rubber bowl. Mix, for best results,
vacuum mixing is recommended.
2- For alginate impressions rinse the impression and gently vibrate the
plaster into the impression and allow it to set. Do not invert the impression,
as this will cause the plaster to flow away from the impression surface and
lose detail.
3- When the plaster has set, prepare a thick mix of plaster to form a
base and invert the impression onto the plaster patty. Allow to set for at
least half an hour.
4- Remove the impression tray and alginate and recover the
diagnostic cast. In case of compound impression, the impression with the
set plaster is immersed in warm water for few minutes to soften compound
and facilitates removal of cast.
5- Adjust the peripheries of the diagnostic cast using the model
trimmer in preparation for the construction of the custom tray (Fig. 2-8).
Fig. (2-8): Left, rubber bowl and spatula. Right, primary casts.
37
II- Custom (Special or individual) Trays
Individual or custom trays are made on preliminary cast (produced from

a primary impression) designed to enable the dentist to make a more
accurate and detailed impression than the primary one.
Advantages:
1- It is accurately fits to the arch and has correct border extensions.
2- An even space is provided inside the trays so the shape of the
tissues may be recorded with minimal displacement.
3- The thickness of the impression material is reduced with less
dimensional changes on hardening.
4- Less impression material is used (more economic).
5- More comfortable to the patient.
Types
Custom trays are fabricated depending on the condition of the ridge:
1- Custom tray with spacer
Indicated for ideal ridges where a uniform pressure can be given to the
entire denture-bearing tissues and impression is made of the tissues in an
undistorted state (Fig. 2-12).
Advantages of spacer:
It provides a space of even thickness in the tray for the impression
material. Thus;
1- Any dimensional change in the material will be equal throughout the
impression.
2- The shape of the tissues may be recorded with minimal
displacement.
2- Custom tray with relief (Close fitting tray):
Areas such as the incisive papilla, mid-palatine suture and rugae area
in maxilla and the crest of the residual ridge in the mandible, sometimes
need to be relieved. One thickness of baseplate wax is applied over the
38
areas when relief is indicated, on maxillary and mandibular cast (Fig. 2-9). A
close-fitting tray is made over the areas without spacer. This produces a
selective pressure impression distributing more load to the stress-bearing
areas.
Fig. (2-9): Relief areas. Left, the incisive papillae and mid-palatal suture. Middle, the
incisive papillae, mid-palatal suture and rugae area. Right, the crest of mandibular ridge.
3- Custom tray with window:
This is indicated with flabby and displaceable tissues. Usually the
anterior ridges are affected. A minimal or controlled pressure impression is
indicated for the displaceable tissue while a normal impression can be made
for the remainder of the arch. This is another example of a selective
pressure impression. The affected area is marked and blocked out in the
preliminary cast and a custom tray is constructed without involving this area
(Fig. 2-10).
Fig. (2-10): Left, Maxillary anterior flabby ridge marked on preliminary cast. Right,
Custom tray with a window in the flabby ridge area.
39
Construction of wax spacer or shim

1- On the primary cast the periphery is outlined with an indelible marker.
The tray should extend 2mm short of the reflection of the mucosa. The
peripheral extension of spacer should be 2mm short of the custom tray (Fig.
2-11).
Fig. (2-11): A, Spacer outline. B, tray outline. C, Full depth of vestibule.

2- The cast is dusted by talcum powder or immersed in warm water for
10 minutes, to prevent sticking of hot wax or base plate to the cast.
3- Modeling wax sheet is adapted to the cast and cut down at the
outlined border.
The posterior palatal seal area on the maxillary cast is not covered with
the wax spacer. Thus, the tray will contact the posterior palatal seal to
prevent the final impression material from sliding down into the pharynx. In
mandible, spacer should not cover the retromolar pad.
4- Tissue stops are square or rectangular areas where the spacer is
removed. The custom tray is in direct contact with the ridge in these areas.
They function to correctly orient and stabilize the tray during impression
making and ensure uniform thickness of impression material. Generally, 4
square stops are given, 2mm in dimension, two in the canine region and two
in the molar region, on the crest of the ridge (Fig. 2-12).
40
Fig. (2-12): Spacer with stops. In maxilla, not cover the posterior seal area. In mandible,
not cover the retromolar pad.
Types of special trays
1- Shellac special tray:

Shellac base plates are supplied in the form of sheets shaped to
correspond to the general shapes of the maxillary and mandibular arch. It is
made of a thermoplastic material that softens by heating and hardens when
cooled.
These materials are normally used when the impression is to be taken
in plaster of Paris or alginate impression materials.
Construction of shellac special tray:
1- When a shim is used it should be dusted over with French chalk to
prevent the tray material sticking to it.
2- The shellac base plate material is softened uniformly by passing it to
and fro over a flame and is then adapted to the shim. If necessary, it is
softened again to complete the process (Fig. 2-13).
3-The edges are trimmed with a sharp knife or scissors and smoothen
with a file and sandpaper, leaving a rounded periphery to the tray (Fig. 2-
14).
41
Fig. (2-13): Left; shellac base plate is softened. Right; base plate adapted to cast.
Fig. (2-14): Left; excess base plate cut. Right; finished special tray.
4- If alginate impression is made, the tray is perforated over its entire

surface by drilling holes of approximately one sixteenth of an inch diameter
spaced about one quarter to three eighths of an inch apart.
5- A handle can be made of shellac base plate or thick German silver or
iron wires and attached to the tray in such a way to clear the lip and avoid its
distortion.
Disadvantages of shellac special trays:
1- Low strength.
2- Easily distorted by load and temperature.
3- Improper adaptation to the cast.
42
2- Acrylic resin special trays
Acrylic resin trays can be made from heat-cured, light-cured or auto-

cured resins, but it is usually made in auto-curing acrylic resin.
Advantages of acrylic resin special trays:
1- Easy to construct.
2- High strength and rigidity.
3- Not distorted by temperature.
4- Good adaptation.
5- Light in weight
6- Can be easily cut down, if over-sized, and its borders can be traced.
Disadvantages:
1- Undergo dimensional changes for 24 hours following fabrication. It is
recommended for use only after this period.
2- Potential sensitizer, can produce allergic manifestations
Construction Auto-polymerizing acrylic resin tray

a- Dough method:
1- On the primary cast the periphery is outlined with an indelible marker.
2- Undercuts on the cast are blocked out with plaster or wax and the
model is painted with a separating medium or immersed in a warm water for
10 minutes.
3- The powder and liquid of the acrylic resin are measured and mixed
according to the manufacturer's instruction.
4- When the material is dough in consistency it is rolled flat to an even
thickness and spread rapidly over the cast, using the fingers to adapt it (Fig.
2-15). Two glass plates with two small pieces of shellac base plates in
between are used to shape the dough into a sheet of the desired thickness.
5- A knife is used to trim the soft material from around the borders.
43
Fig. (2-15): Left, Acrylic dough placed in between two glass slabs. Right, The flattened
dough is adapted on the cast with mild finger pressure until the material sets
6- A handle is shaped from the excess resin and attached to the tray.
The handle is placed in the upper anterior teeth so it will not distort the upper
lip when the tray is in the mouth.
7- The tray is left till polymerization occurs. Polymerization will take
place in a few minutes at room temperature, and it can be accelerated by
placing the cast in warm water.
8- The tray is lifted from the cast using a knife. The periphery is trimmed
with a stone or bur. The final tray should be 2 mm short to allow for border
tracing by green stick compound in the patient’s mouth (Fig. 2-16).
Fig. (2-16): Finished custom trays with handles.
44
b- Sprinkle-on method
1- The powder is taken in a container with a perforated top like a salt
and pepper dispenser, while the liquid is loaded in a syringe or taken in a
dropper from a dappen dish.
2- Powder is shifted onto a particular area and is then saturated with
monomer. This is continued until the area is built-up to a thickness of
2.5mm. The procedure is extended to cover the entire denture-bearing area
with the resin (Fig. 2-17).
Advantage: Wastage of material is minimal.
Disadvantages:
1- Difficult to obtain uniform thickness throughout.
2- Greater chances of porosity due to inadequate saturation of polymer.
Fig. (2-17): Left, cast is tilted approximately at 45-degree, polymer is sifted on one side of
the cast and monomer is syringed on it. Right, completed tray.
3- Vacuum formed special trays:
Vacuum or pressure forming machine is used. The material used is
supplied in the form of uniform thermoplastic sheet (Fig. 2-18).
Fig. (2-18): Vacuum formed special tray.

45
Boxing-in final impressions and making master casts
Boxing-in an impression is the process of building-up of vertical walls

around the final impressions to pour the stone cast.
Advantages of boxing:
1- The correct width of the periphery of the impression is preserved.
2- The mixed stone can be vibrated; the cast will not contain air bubbles
and a stronger cast will be produced.
3- The thickness of the cast may be more accurately judged.
4- Boxing-in is time saving, because trimming may not be required.
5- Material is economized.
Methods of boxing
I- Wax boxing method:
1- A strip of beading wax (4 mm wide) is attached all the way around
the outside of the impression approximately 3 mm below the border and
sealed to it with a spatula.
2- The tongue space in the lower impression is filled with a sheet of wax
that is fitted and attached on the superior surface of the beading wax.
3- A thin sheet of wax is used for making the vertical walls of the
boxing. It is attached around the outside of the beading strip so as not to
alter the borders of the impression. It should extend at least 13 mm above
the highest point of the impression (Fig. 2-19 and 2-20).
Fig. (2-19): Diagram for wax boxing-in maxillary denture. Left; top view, Right; cross
section. A; cast. B; impression material. C; special tray. D; beading wax. E; boxing wax.
46
Fig. (2-20): Boxing in maxillary and mandibular impressions.

4- A stone is mixed carefully and vibrated, and then sufficient stone is
poured into the boxed impression.
5- The stone is allowed to harden for at least 30 minutes before
separation.
6- After the final impression is separated from the cast; the borders of
the cast are trimmed to leave a ledge of about 3mm posteriorly and little
anteriorly.
II- Plaster of Paris and pumice boxing
The beading wax does not adhere to alginate and rubber base
impression materials, so the following method is used:
1- A mix of half plaster and half pumice is made.
2- The mix is poured on glass slab and smoothed by spatula.
3- The tray is placed with the under surface over the mix. The material
is raised up by spatula to a height of 3-4 mm below the border of the
impression and of 4 mm thick
4- The mix around the impression is allowed to set and then it is
removed from the slab and trimmed to the desired height and width.
5- Boxing wax is adapted to the impression to be at least 13 mm above
the highest point of the impression and sealed to the outer surface of the mix
(Fig. 2-21).
6- The exposed surface of the plaster and pumice is painted with
separating medium. Then a mix of stone is vibrated into the impression.
47
Fig. (2-21): Plaster and pumice boxing. Left; plaster and pumice boxing base. Right; wax
wall attached to plaster and pumice.
Master cast criteria:
1- Base of minimum thickness of 11-15 mm as measured from the
deepest part of the palate or the floor of the mouth (Fig. 2-22).
Fig. (2-22): Minimum thickness for the base of cast 11-15 mm.
2- After trimming, the base of the model must be parallel to the residual
ridge (Fig. 2-23 and 2-24).
3- The depth of the buccal sulcus is approximately 2-mm below the land
area. The width of the land area measured on the cast is 2–3mm and make
45 degrees. (Fig. 2-23- 2-25).
4- The base must be indexed for mounting and remounting. (Fig. 2-26).
5- Positive defects (bubbles), if any, must be in non-vital areas and
small enough to be easily removed (1-mm diameter or less as a guide).
6- Negative defects (voids), if any, should be small and in non-critical
areas. These should be filled with stone to blend with the surrounding
anatomy.
48
Fig. (2-23): Cross section of a maxillary cast. (a) Ridge is parallel to base (b) sides are
perpendicular to base (c) land area 2–3mm at 45º (d) sulcus 2mm depth below land area
and (e) base of 11–15mm.
Fig. (2-24): Cross section of a mandibular cast. (a) Ridge is parallel to base (b) sides are
perpendicular to base (c) land area 2–3mm at 45º (d)sulcus 2mm depth below land area
and (e) base of 11–15mm.
Fig. (2-25): Left, Height of the land area measured from the sulcus is 2mm. Right, The
width of the land area measured on the cast is 2–3mm and make 45 degree.
Fig. (2-26): Base of cast indexed.

49
CHAPTER III
RETENTION, STABILITY AND SUPPORT
RETENTION
It is the quality inherent in a denture that resists the dislodging force

(gravity, adhesiveness of food and muscle force).
Displacing Forces on the Denture
1- Force acting on the occlusal surfaces and incisal edges, e.g. Sticky
food.
2- Muscular forces acting on the periphery or polished surface.
3- Sudden entry of air between denture and oral supporting tissues.
Factors of Complete Denture Retention
A- Physical Factors:
The physical factors of retention depend on surface area, denture fitness
and direction of the displacing force. The upper dentures are mainly retained
by these factors due to its considerable surface area. Lower denture on the
other hand due to its smaller surface area is poorly retained by the physical
factors and retained mainly by mechanical factors. The physical means are:
1- Inter facial surface tension:
Interfacial surface tension is the resistance to separation possessed by
the film of liquid between two well-adapted surfaces. It is found in the thin film
of saliva between the denture-base and the mucosa of the basal seat. It
depends on adhesion and cohesion.
a- Adhesion This is attraction between dis-similar molecules
(substances). In the case of dentures- dis-similar molecules are denture
fitting surface and mucous membrane. These two different surfaces when in
contact there will be adhesion.
50
b- Cohesion is the physical attraction of like molecules to each other. It

is a retentive force because it occurs in the layer of saliva between the
denture base and the mucosa. It is effectiveness is in direct proportion to the
area covered by the denture (Fig. 3-1).
Fig. (3-1): Adhesion and cohesion.

2- Atmospheric pressure:
Atmospheric pressure can act to resist dislodging forces applied to the
denture. For atmospheric pressure to be effective, the denture must have a
perfect seal around its entire border. When the upper denture is inserted, air
is expelled out from the area between the fitting surface of the denture and
the mucous membrane. The resulting pressure on the polished surface of
the denture is more than that on the fitting surface. The difference between
the two gives a positive force, which holds the denture in place (Fig. 3-2).
Fig. (3-2): Retention of maxillary complete denture. A. Atmospheric pressure (high). B.

Fitting surface with low pressure, C. Peripheral seal.
3- Gravity:
When a person is in an upright posture, gravity acts as a retentive force
for the mandibular denture and a displacing force for the maxillary denture.
B- Anatomic Factors:
51
1- Ridge form: A high well-developed ridge with round crest gives good
support, retention and stability more than flat ridges, ridges exhibiting slight
undercut areas or knife-edge ridges.
2- Palatal vault form:
U shaped palatal vault is the most favorable for retention and stability of
complete denture as it resists vertical and horizontal forces. V shaped vault
resists the lateral shift well but vertical displacing forces break the seal. Flat
vault resists vertical displacement but not the lateral.
3- Arch form:
The arch may be square, tapering or ovoid. A square arch form is more
favorable for denture retention than the tapered and ovoid.
4. Arch relationship:
A problem with retention and stability usually appear with smaller arch
with class II and III angle classification.
C- Physiologic Factors:
1- Acquired muscle control:
After denture insertion an adaptation period is required so that the
muscles of the cheek and tongue will seat rather unseat the dentures.
2- Saliva:
It is the medium that allows the physical factors of retention to act such as
adhesion, cohesion, surface tension, and capillary attraction. Watery,
diminished and abnormally viscous saliva can lead to poor denture retention.
D- Mechanical Factors:
1- Denture foundation area:
Covering wide area by the fitting surface of the denture increases the
forces of adhesion and cohesion and accordingly increases denture
retention.
2- Presence of undercuts:
52
The engagement of undercut area in the edentulous region is possible to

allow mechanical resistance to a direct dislodging force. Gross undercuts
may cause problem on insertion and removal of complete denture.
3- Denture extensions: Properly extended borders help peripheral seal
and accordingly increase denture retention.
E- Aids to Retention:
1- Denture adhesives:
It is used in powder or cream form. The powder is sprinkled on and the
cream is applied to the fitting surface of the denture. Gradually the adhesive
jelly is pressed from under the denture or washed away by the saliva, for this
reason it will not be so effective with the lower denture.
Indications:
a- In all well-fitting dentures, adhesive use can enhance denture retention
stability and bite force. Also adhesives enhance the patient’s sense of
security.
b- In patient requiring excellent retention, e.g. musician, and public
speakers.
c- In patients with xerostomia, severe compromised residual ridge, and
maxillofacial jaw resection.
Contraindications:
a- Patients with open cuts or sores in the mouth.
b- In ill-fitting denture.
c- With inadequate oral and prosthetic hygiene.
d- With known hypersensitivity to any product ingredient.
2- Dental implants:
An over denture retained by dental implants is the most recent and
effective way in solving the problem of complete denture retention (see the
section of overdenture).
53
STABILITY
Definition:
Stability of a denture is its quality of being firm steady and constant in
position when forces are applied to it. It refers especially to resistance of
lateral and rotational forces.
Factors Affecting Stability of Complete Denture:
1- Retention:
For a denture to be stable, it should be retentive.
2- Balanced Occlusion:
Harmonious contact between the upper and lower teeth in different
positions of the mandible helps to keep the denture in position without
movements. Cuspal interference on the other hand reduces stability.
3- Occlusal Plane:
The higher the occlusal plane in relation to the lower ridge the lesser will
be the stability of the denture.
4- Position of The Posterior Teeth:
If the teeth are set outside the ridge the stability of the denture will be
reduced. So, the posterior teeth must be placed over the ridge crest.
5- Proper Relief of Hard Areas:
Insufficient relief of hard areas as medium raphe and torus palatinus may
cause rocking and instability of the denture.
6- Ridge and Palate Form:
High well-developed ridges with vertical walls resists lateral forces and
accordingly enhance denture stability.
A high arched vault offers good resistance to lateral stresses and
increases denture stability. Shallow vault reduces lateral stabilization of the
denture.
7- Width of The Occlusal Table.
Reducing the occlusal table by using narrow posterior teeth, will make
the denture more stable.
54
8-The Polished Surface:

It should be concave so that the tongue and check help to retain the
denture.
9- Tongue:
Moderately large tongue provides an excellent seat for the lower denture.
Placing the occlusal plane of the lower denture below the level of the tongue
allow the tongue to rest on the occlusal surfaces of the teeth and stabilize
the denture.
SUPPORT
Definition: The resistance to the vertical forces of mastication, occlusal

forces and other forces applied in a direction towards the basal seat tissues.
To provide adequate support, the denture base should cover as much
denture-bearing area as possible. This distributes the forces over a large
area and is known as snowshoe effect.
55
CHAPTER IV
POSTERIOR PALATAL SEAL AND RELIEF
Posterior Palatal Seal
Definitions:
Posterior palatal seal (postpalatal seal or post-dam): the seal area
at the posterior border of a maxillary removable dental prosthesis.
Posterior palatal seal area: the soft tissue area at or beyond the
junction of the hard and soft palates on which pressure, within physiologic
limits, can be applied by a maxillary complete denture to aid in its retention
Posterior palatal seal area is bounded anteriorly by the anterior
vibrating line, posteriorly by posterior vibrating line and laterally by the
hamular notch. (Fig. 4-1).
Fig. (4-1): Posterior palatal seal area (PPS) Left: Model. Right: Intraoral
1- Anterior vibrating line is an imaginary line at the junction between

immovable tissues over the hard palate and slightly movable tissues of the
soft palate. It takes the shape of a cupid’s bow due to the projection of the
posterior nasal spine. It is located by asking the patient to hold both nostrils
56
and gently blow through the nose (Valsalva manoeuvre). This will place the
soft palate inferiorly at the junction of the hard palate and the junction can
then be marked. It can also be located by instructing the patient to say ‘ah’ in
short vigorous bursts.
2- Posterior vibrating line is an imaginary line at the junction between
aponeurosis of tensor veli palatine muscle and muscular portion of the soft
palate that is markedly displaced during function. It is a slightly curved line. It
can be located by instructing the patient to say ‘ah’ in short bursts but in a
normal, unexaggerated manner.
The soft palate:

Soft palate determines the extent of additional area available for
retention as well as the width of the posterior palatal seal area.
Classification: Based on the angulations between the hard and the
soft palate (Fig. 4-2):
Class I: Soft palate is almost horizontal, curving gently downwards. This is
most favorable, as it provides maximum tissue coverage for palatal seal
because muscular activity is minimal.
Class II: Soft palate turns downwards at about 45° from the hard palate.
Palatal coverage is less than that of class I.
Class III: Palate turns downwards sharply at about 70° to the hard palate.
Usually seen along with a deep V-shaped palate. This is least favorable, as
the available space for the palatal seal is minimum.
Fig (4-2): Classification of soft palate: (A) Class I. (B) Class II. (C) Class III.
57
Functions of posterior palatal seal: It can be incorporated in the

impression tray by tracing compound and in complete denture.
Functions in impression tray:
1- Establishes positive contact posteriorly and prevents impression
wash material from sliding down the pharynx.
2- Guides the positioning of impression tray.
3- Creates slight displacement of soft tissues.
4- Helps verify retention and seal of potential denture border.
Functions in complete denture

1- Primary function is retention of maxillary denture.
2- Reduces gag reflex by reducing patient awareness of this area.
3- Prevents food accumulation beneath the posterior aspects of the
denture.
4- Reduces patient’s discomfort when contact occurs between dorsum
of tongue and posterior part of denture.
5- Compensates for volumetric shrinkage that occurs during
polymerization of methyl methacrylate resin.
Recording the posterior palatal seal

1- Conventional (Functional scraping of cast) method:
This procedure is done on the trial denture base that is fabricated on
the master cast:
a- The hamular notches are located by T-burnisher and marked with an
indelible pencil. The posterior vibrating line is established and marked
between the hamular notches (Fig. 4-1).
b- The trial denture base is inserted into the patient’s mouth and the
vibrating line is transferred to the record base.
c- The trial base is trimmed till the posterior vibrating line and seated on
the master cast to transfer this line to the cast.
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d- With a burnisher or mouth mirror palpate the junction of the soft and
hard palate and mark it with indelible pencil which in turn transferred to the
cast.
Scraping the master cast:
It is Cupid’s bow in shape narrow in the mid line due to the presence of
posterior nasal spine, then becomes broader in the lateral sides then
narrows again in the hamular notch area till end in the muccobuccal fold.
The depth of scraping for the post dam should vary according to
compressibility of the tissue. The mucosa at the midline of the palate is less
compressible than that at the sides.
The deepest area of seal is located on either side of midline, one-third
the distance anterior to posterior vibrating line. This is scrapped to a depth of
1–1.5mm. In the region of the midpalatine raphe and hamular notches, it
should be only 0.5–1mm in depth. From the deepest portion, it should taper
towards the anterior and posterior vibrating lines (Fig. 4-3).
Fig. (4-3): (a) Functional scraping of cast, butterfly in shape. (b) Sagittal section showing
depth of scraping in deepest portion (1–1.5mm) and midpalatine suture and hamular
notch areas (0.5mm). (c) Enlarged view of section of deepest part. PVL, posterior
vibrating line and AVL, anterior vibrating line
The advantages of placing the seal in the trial base:

1- It becomes more retentive in recording jaw relation.
59
2- The patient will be sure that his denture will be retentive (psychological
value)
3- The dentist can determine amount of retention.
The disadvantage of this technique:

1- Not physiologic method
2- The potential for over compressing is great.
2- Arbitrary scraping of the master cast:

This technique is the least accurate and un-physiologic as the
technician attempts to place the posterior palatal seal. A line is drawn across
the posterior border of the cast between the two hamular notches passing
behind the fovea palatinae. Arbitrary scraping of cast is carried out as a
notch (beading) formed in the cast along the posterior vibrating line, or as a
butterfly anterior to this line. (Fig. 4-4).
Fig. (4-4): Arbitrary scraping of master cast. Left, in beading form (Arrow). Right, in
butterfly form.
3- Fluid wax technique:

The seal is established after making zinc oxide eugenol final
impressions but before pouring the master cast.
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a- The anterior and posterior vibrating lines are marked in the patient’s
mouth and transferred to the final impression (Fig. 4-5).
b- The final impression is painted with fluid wax within the marked seal
area.
c- The impression tray is inserted in the mouth, with patient’s head tilted
forward and tongue down, the patient is asked to rotate the head to record
the functional movements of the soft palate.
d- The impression is removed after 4–6 minutes and examined. Glossy
wax should be obtained. Wax is added to dull areas and the procedure is
repeated (Fig. 4-5).
Fig. (4-5): Left: Final ZO-E impression with vibrating lines transferred to it. Right: A
butterfly posterior palatal seal is created with impression wax.
Advantages:
a- It is a physiological technique.
b- Overcompression of tissues is avoided.
c- Increased retention of the record base and convenience in jaw
relation.
d- There is no need for scraping the master cast mechanical.
Disadvantages:
a- Increase chairside time during patient appointment.
b- Handling of material is difficult.
c- Care needed while pouring master cast.
61
RELIEF
Definitions:
Relief is the reduction or elimination of undesirable pressure from a
specific region under a denture base.
Relief area is the area in the fitting surface of the denture that is
reduced to eliminate excessive pressure.
Structures require relief:

I- Hard structures:
In certain area such as the midline of the palate and over bony
prominence, the mucous membrane is united directly to the periosteum
forming unyielding mucoperiosteum. In other parts there is a definite
submucous layer, which contributes to displaceability of these tissues.
A rigid denture base constructed on a cast obtained from mucostatic
impression (impression with law viscosity material and minimal tissue
displacement), will transfer the load to the unyielding areas of the jaws. This
will result in inflammation of underlying tissues. In addition, if such areas are
centrally placed the denture will tend to rock when vertical force is applied to
the teeth (Fig. 4-6). So that it is frequently necessary to relieve the denture
over areas of thin mucosa in order to avoid pain and /or rocking of the
denture.
Fig. (4-6): Mucosa over ridge crest and sides of the vault is moor thick than that at the
median palatine raphe which require relief (Arrow).
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Hard structures require relief:

1- In the maxillary arch:
a- Median palatine raphe.
b- Torus palatinus.
c- Thin bony edges.
2- In the mandibular arch:
a- Thin knife edge lower ridge.
b- Torus mandibularis.
c- Prominent genial tubercles.
d- Sharp bony protuberance on the ridge.
II- Sensitive structures:
1- In the maxillary arch:
a- Incisive papilla (Refer to maxillary anatomic landmarks).
b- The rugae are usually rough, resistant to friction and insensitive, yet
they sometime become flattened and deformed by pressure of an unrelieved
denture base, and they should be relieved.
2- In the mandibular arch:
Mental foramen, if it is located on the crest of the ridge as a result of
excessive bone resorption. If not relieved, pain, burning sensation or
numbness of the lower lip may occur (Fig. 4-7).
Fig. (4-7): Left, relief areas for maxillary arch. Right, diagram for structures require relief
in mandibular arch. a, mylohyoid ridge. b, crest of mandibular ridge. c, torus
mandibularis. d, genial tubercles. e, mental foramina.
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Methods of relief
1- Automatic relief during impression:
a- Mucocompressive impression technique: Impression is made by
the use of viscous impression material in a closely fitting tray under biting
force. This will compress the displaceable tissues as during function.
b- Selective pressure impression technique: Areas to be relieved
receive less pressure during impression making by creating more space in
the special tray or providing holes in the tray over these areas. Areas not to
be relieved receive more pressure using a well-adapted tray in these areas
(Refer to special tray with relief).
2- Direct relief:
This method is convenient and accurate. An outline of the area to be
covered should be penciled on the cast (Fig. 4-8). Tin foil of 0.003-inch
thickness is then cut into the desired shape, burnished by blunt instrument
into close contact and cemented to the cast before the trial denture is made.
Fig. (4-8): Left; area of relief is outlined on cast. Right; tin foil applied to the outlined area.
Depth of the relief:

The depth of the relief is dependent on the compressibility of the areas
of thick mucous membrane and should be sufficient to prevent the denture
64
from pressing on the areas of thin mucosal coverage when full masticatory
loads are imposed.
If the alveolar ridge is comparatively compressible, more than average
relief is required over the median palatine raphe. If the alveolar ridge is firm
and the palate center is yielding, little or no relief is required.
Value of relief:
1- Comfort for the patient.
Relief of sensitive areas gives comfort to the patient. Also, it prevents
pressure over thin mucous membrane.
2- Stability:
Relief areas improve the stability of the denture and prevent them from
rocking.
3- Compensate for bone resorption:
Bone resorption occurs mainly in the alveolar process and no change
occurs in the shape of the palatal area. This lead to instability of the
maxillary denture. Palatal relief contributes to the stability of the denture for
a prolonged period.
4- Compensate for technical discrepancies:
Relief in the maxillary denture compensates for the shrinkage of acrylic
resin during processing. Shrinkage makes the upper denture slightly
narrower across the tuberosities and higher in the palatal vault areas.
Relief is also required to compensate for stresses and strains produced
in the impression material. Pressure is high in more confined areas, as in the
center of the vault. Most impressions, if not relieved, will produce
undesirable heavy pressure in the center of the palate.
65
CHAPTER V
MANDIBULAR MOVEMENTS AND JAW RELATIONS
Mandibular movements
Mandibular movements occur primarily around the temporomandibular
joint (TMJ) which can make complex movements.
Factors affecting mandibular movement
1- Temporomandibular joint (TMJ) anatomy:
Each condyle head of the mandible articulates with the temporal bone
in a concave depression called the Glenoid fossa. The anterior border of the
Glenoid fossa is convex forming the articular eminence. Between the
Glenoid fossa and the condyle, the inter-articular fibrocartilage disc (The
meniscus). The disc is biconcave and attached anteriorly to the superior
head of the lateral pterygoid muscle and posteriorly to the retrodiskal tissue
(elastic) and posterior ligamentous attachment of disk to the condyle
(Inelastic (Fig. 5-1).
Fig. (5-1): The TMJ anatomy. I, Posterior slope of the eminentia. 2, condyle. 3, disk . 4,
superior lateral pterygoid muscle. 5, inferior lateral pterygoid muscle. 6, synovial tissue. 7,
retrodiskal tissue (elastic). 8, posterior ligamentous attachment of disk to the condyle
(Inelastic).
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The articular capsule is a loose fibrous envelop, attached above to the

zygomatic arch and articular eminence and below to the neck of the condyle.
A lateral thickening of the condyle forms the temporomandibular ligament.
Each compartment of the joint is lined by synovial membrane which acts as
lubricant and nutrient to the non-vascular surface of bone and disc.
The temporomandibular joint movements:
1- Rotation: The condylar head of the mandible rotates on the
undersurface of the disc (Fig. 5-2).
2- Translation: The condylar head and the disc translate downwards
and forwards as a one unit against the articular eminence (Fig. 5-2).
Fig. (5-2): Left; rotation of the condyle. Right; translation of the condyle.
All mandibular movements are combination of rotation and translation
except posterior (when the condyles in most retruded position) opening and
closing for about 20 mm. In this position the condyle do pure rotation and it
is used in determination of the transverse hinge axis (Fig. 5-3).
Fig. (5-3): Pure rotation of condyles around transverse axis occurs when the condyles are
in most retruded position during opening and closing for about 20 mm between the incisal
edge of anterior teeth.
67
2- Contact of opposing teeth:

From practical point of view, it is essential to distinguish between
movements taking place with contact between the upper and lower teeth
(contact movement, gliding movements or articulation) and movements
without contact of the opposing teeth. An example for the effect of the tooth
contact on mandibular movement is the incisal path.
The incisal path is the path taken by the incisal edges of the lower
incisors on the palatal surface of the upper incisors until the teeth touch
edge to edge (Fig. 5-4).
The incisal path angle is the angle between the incisal path and the
horizontal plane.
Fig. (5-4): The incisal path (Arrow).

3- The muscle action:
Fig. (5-5): The muscles of mastication.

The muscles of mastication include the temporalis, masseter, medial
pterygoids and lateral pterygoids (Fig. 5-5). The first three muscles are
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elevators. The lateral pterygoid muscles move the condyle downward and
forward during uncontrolled opening. It is also responsible for mandibular
protrusion (If the muscles in the both sides act) and lateral movement (If one
muscle is contracted).
4- The TMJ ligaments:
They provide limits or borders of the mandibular movements.

Movements on the boundaries of the movement space are called border
movements. Border movements are of value when transferring mandibular
movements and position to articulators. Movements within the boundaries of
movement space can be designated as intra-border movements. They are
functional and parafunctional.
a- Functional movements e.g. chewing, speech and swallowing
b- Parafunctional movements e.g. bruxism and clenching
5- The neuromuscular regulation: Muscular control of all mandibular
movements is governed by impulses from the central nervous system.
Basic mandibular movements

1- Opening and closing:
Habitual opening starts from the intercuspal position to the maximum
opening position. The closing movement is in reverse; from maximum
opening to intercuspal position. Translation (forward and downward) and
rotation of the condyle occur during this movement.
2- Forward (protrusive) movement:
Translation of the condyle forward and downward occurs during
protrusion. The path of the condyle during this movement is termed the
horizontal (sagittal) condylar path. It forms an angle with the horizontal
plane termed the horizontal condylar path angle (Fig. 5-6). This angle
varies in individuals and even in the same individual between the right and
left sides.
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A separation of the posterior teeth occurs during protrusion due to the

downward and forward translation of the condyles. This is called
Christensen’s phenomenon (Fig. 5-6) and used to record the horizontal
condylar path angle.
Fig. (5-6): Left: 1; the horizontal condylar path. 2; the horizontal plane. 3; the horizontal
condylar path angle Right; Christensen’s phenomenon.
3- Backward (retrusive) movement:

The retrusive movement of the mandible is similar to the protrusive one
but in a reverse (upward and backward along the same inclination). Starting
from maximum protrusion to intercuspal position then slightly backwards to
maximum retrusion (centric relation).
4- Lateral movement:
The mandible moves to the right and left from intercuspal position.
When the mandible moves to the right side the condyles in this side (working
side) rotates mainly with a slight bodily shift (Bennett movement). The
condyle in the left side (non-working or balancing side) moves forward,
downward and medially (Fig. 5-7).
The lateral condylar path is the path along which the balancing
condyle head moves medially during lateral movement.
The lateral condylar path angle (Bennett angle) it is the angle
between the lateral condylar path and the sagittal plane (Fig. 5-7).
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Fig. (5-7): Lateral movement of the mandible. 1, the lateral condylar path. 2, The sagittal
plane. 3, the lateral condylar path angle (Bennett angle). 4, is the Bennett movement
(lateral bodily shift).
Jaw relationships
It is any relation of the mandible to the maxilla. It is classified into

vertical, horizontal and orientation relations.
I- Orientation relations (cranio-maxillary orientation):

The relationship between the maxilla and the condyles or the cranium is
recorded by the face bow and transferred unchanged to the articulator.
II- Vertical relations:

It represents the amount of jaw separation and classified into (Fig. 5-8):
1- Vertical dimension of occlusion; the vertical measurement of the
face when the teeth are in occlusion.
2- Vertical dimension of rest; the vertical measurement of the face

when mandible at rest position.
The rest position is obtained when the patient’s head is upright and
the elevator and depressor muscles are in equilibrium. At rest the teeth are
71
not in contact, the gap in between the teeth is called the interocclusal
distance or the freeway space (Fig. 5-8).
Fig. (5-8): RVD =Rest vertical dimension. OVD= Occlusal vertical dimension. FWS- Free
way space.
III- Horizontal relations:
They are anteroposterior and side-to-side relations of the mandible to
maxilla. They include:
Centric occlusion (Maximum intercuspation):
It is the relation of opposing occlusal surfaces, which provides the
maximum planned contact and /or intercuspation.
Centric relation.
It is the relation of the mandible to the maxilla when the condyles are in
the uppermost and rearmost position in the glenoid fossa at a given degree
of vertical dimension (jaw separation).
The importance of centric relation in complete denture construction is
that it is the only that the patient can repeat. So, it should be recorded and
transferred to the articulator for setting up of teeth.
Eccentric relations:
They are any relations of the mandible to the maxilla other than centric.
They are the protrusive, right and left lateral relations.
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CHAPTER VI
RECORD BLOCKS
Record blocks are generally made of occlusion rims attached to well

fitted trial denture base.
The recording bases
An interim denture base used to support the occlusal/record rim

material for recording maxillomandibular records.
It is also known as baseplate, trial base or temporary base. It supports
the occlusal rims and the artificial teeth for clinical procedures like recording
jaw relations and try-in.
Requirements of recording bases: It should be:
1- Well adapted and accurately formed to the final cast.
2- Stable, both on the cast and in the mouth.
3- Rigid and strong.
4- Smooth and rounded to be comfortable to the patient.
5- Easily contoured and polished.
6- Fabricated from material that are dimensionally stable.
7- The material used should be easy to manipulate.
8- Baseplate material should be non-irritant to the mouth tissues
9- They should be of proper thickness (about 2 mm in the hard palate
area and 1 mm over the crest and facial slope of the ridge to not interfere
with artificial teeth placement).
Material for recording bases
The materials commonly used for making record bases are classified as
temporary and permanent.
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A- Temporary recording bases

These materials are used during the various technical procedures, but
discarded at the time the denture is processed into its permanent form. They
include:
1- Shellac baseplate.
2- Cold-curing acrylic resin.
3- Light-cure resin.
4- Thermoplastic resins (Vacuum formed vinyl or polystyrene).
I- Shellac recording base material:

Shellac is a commonly used material for recording bases. It is
constructed as the shellac special tray but without spacer and handle.
Advantages:
1- Record bases can be easily fabricated and it is not time consuming.
2- They are inexpensive and easily available.
3- Record bases with shellac baseplate can be easily corrected.
4- Uniform thickness can be maintained
Disadvantages:
1- Shellac baseplates have less strength and easily break.
2- During setting of teeth or fabrication of rims, they tend to distort/wrap
due to repeated changes in temperature.
3- Do not fit accurately.
Reinforcement of shellac bases:
Wires should be used to increase strength and rigidity, and thus reduce
distortion of shellac bases. For the maxillary cast, the wire is placed across
the posterior palatal border. For the mandibular arch it is placed in the
lingual flange (Fig. 6-1).
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Fig. (6-1): Wire reinforcement of shellac trial denture base.
II- Autopolymerizing resin record bases:

Advantages
1- They have better strength.
2- They are dimensionally stable.
3- They have better stability and do not wrap due to repeated changes
in temperature.
4- They are closely adapted to the tissue surface of the cast.
5- They can be easily trimmed with the acrylic burs.
Disadvantages
1- Fabrication process is time consuming.
2- During fabrication, it is difficult to control the thickness.
2- Residual monomer present in record bases can cause irritation to
oral tissues.
Technique:
Three basic techniques are used to fabricate recording bases utilizing
chemically activated resins:
1- Dough technique.
2- Sprinkle-on technique.
3- Flasking method.
75
1- Dough technique. (Finger adapted):

a- All undercuts in the final cast are blocked out with wax or another
suitable plastic material. A layer of tin foil (0.001 inch) or a thin layer of
petrolatum is applied to the cast.
b- The autopolymerizing resin is mixed, when it reaches the dough
stage, it is rolled to the desired thickness 2 to 3 mm. Keeping the fingers wet
with water during handling will prevent sticking of the material to operator’s
hand.
c- The resin sheet is adapted to the hard palate area first or to the
lingual surface of the mandibular cast and then onto the crest of the ridge
and into the reflection area.
d- A sharp instrument is used to trim the excess resin while it is in the
soft, moldable state.
e- After polymerization has been completed, the resin base is removed.
Soaking the cast in water will help removal of the base if difficulty is
encountered.
f- The borders are further adjusted with burs, and the external surface
can be polished with wet pumice.
The main disadvantage of the finger-adapted method is that it is
impossible to adapt and apply pressure throughout the tray during
polymerization. This results in lift-off or rebound of the resin causing
distortion.
2- Sprinkle-on method:
Well adapted base can be formed using this method; since any
shrinkage that occurs in first application is partially compensated for by each
subsequent application and polymerization shrinkage is kept minimal.
The sprinkle-on technique has been described for making custom trays
and the technique is similar.
76
3- Flasking method:
This method requires considerable time for fabrication and more costly.
a- Since breakage of the master cast is possible with this technique it is
advisable to duplicate the cast and to construct the recording base on the
duplicated model.
b- A wax is adapted to the cast and flasked. After setting of the
investment material wax elimination is carried out.
c- An autopolymerizing resin is mixed in a glass jar and packed into the
mold when it reaches the doughy stage, then the flask is closed. Resin is
allowed to polymerize under pressure for 20 to 30 minutes.
d- The base is removed from the flask, trimmed, and polished. If
undercut is present that will interfere with seating the base on the cast, it
must be relieved before seating is attempted.
III- Light-polymerized resins

Urethane dimethacrylate is used. They are available in sheet and gel
forms. Sheet forms are used for base fabrication.
a- The sheet is adapted to the master cast following block out undercuts
and after application of separating medium.
b- The cast with the adapted sheet is then placed in a light curing
chamber for 2 minutes, following which the base is removed, inverted and
cured again for 6 minutes.
c- It is then trimmed and finished.
Advantages:
a- Easy to fabricate.
b- Dimensionally stable, can be used immediately.
Disadvantages:
a- Brittle
b- Produce fine particles during grinding
d- Need special curing chamber.
77
Fig. (6-2): Temporary denture bases. Left, shellac. Middle, self-cured resin. Right, light-
cured resin.
IV- Thermoplastic resins:
They are made of vinyl or polystyrene materials. Available in the form of
sheets. As heat is used to adapt the materials, high fusing wax or tin foil can
be used as spacer. They can be fabricated manually or using vacuum
former.
a- Manually: The material is softened in a water bath at 77°C and
manually adapted to the cast.
b- Vacuum formed: These are adapted using a vacuum forming
machine. The sheet is held in place over the cast, heated until it sags and
adapted on the cast under vacuum.
Advantages: Adaptation is excellent.
Disadvantages:
a- Strength is less than the acrylic resins.
b- Expensive specialized equipment is needed.
Stabilization of temporary recoding bases:
Tin foil is adapted to the cast. A thin mix of zinc-oxide paste is
distributed on the fitting surface of the base plate. Then the base is placed
and pressed on the foiled cast. The paste will adhere to the foil. The excess
material is removed and the base is left till the material set.
In case where the residual ridge exhibits moderate to severe undercut,
light-bodied rubber base impression material or soft denture liner is used to
adapt the record base. The fitting surface of the base is painted by adhesive
before applying the lining material.
78
B- Permanent denture bases

It is one that eventually becomes the base of the finished denture. They
include:
I- Heat-cure acrylic resin:
a- Undercuts are not, blocked out. A wax form of the desired shape and
dimensions is adapted onto the cast.
b- The wax pattern is invested, wax is eliminated and resin is mixed and
packed into the model.
c- The resin is processed according to the manufacturer's instructions.
The processed base is recovered and finished.
d- Undercuts on the tissue side of processed bases are blocked out
with a plastic material, and dental stone is poured into the base to provide
mounting casts for the transfer of jaw records to the articulator.
d- The artificial teeth are set in wax and cold-cured resin or heat-cured
resin may be used to attach the teeth to the processed base.
Advantages:
1- Accurate, strong and rigid bases.
2- It enables a check for the retention and stability of the finished
denture at an early stage.
3- Minimizes dimensional changes that occur during processing which
may cause occlusal error.
Disadvantages:
1- Time consuming.
2- The master cast is destroyed and another cast should be poured.
2- Warpage may occur when acrylic resin is subjected to reprocessing.
The teeth are attached by self-curing resin to avoid this problem.
79
II- Metal denture bases:

Advantages:
1- Cast recording bases are rigid can withstand forces during jaw
relation recording.
2- Accurate fitness with minimal tissue displacement.
3- Dimensionally stable and no warpage during jaw relation recording.
4- They adds more weight to mandibular dentures, which increase
retention.
5- Thermal conductivity, which contribute to the health of the tissues.
6- Surface smoothness and cleanliness.
Disadvantages:
1- Expensive and require more time for fabrication.
2- The finished denture base is difficult to reline.
Construction:
Refractory casts are prepared from the final cast. A wax pattern is
formed on the refractory model. The pattern is designed to cover the palate
and terminates at the crest of the alveolar ridge. In the lower jaw it is usually
covering the lingual slope of the ridge and terminates at its crest (Fig. 6-3).
The wax pattern is sprued, burned out, and the molten alloy is cast into
the mold cavity. On cooling, the casting is removed from the investment,
finished and polished.
Buccal and labial flanges are extended to the full depth of the sulcus
with shellac base plate or wax before jaw relation recording.
The teeth are attached to the metal base in the finished denture by heat
or self-cured resin.
Materials used:
1- Type IV gold alloys.
2- Chromium based alloys.
3- Titanium and titanium alloys
80
Fig. (6-3): Metallic denture bases.
OCCLUSION RIMS
Definition:
Occluding surfaces fabricated on the interim or final denture bases for
the purpose of making maxillomandibular relationship records and arranging
teeth.
Uses of the occlusion rim:
1- The proper lip and cheek support (fullness of the lips and cheeks)
and arch form can be indicated in the wax rim.
2- The height and inclination of the occlusal plane determination. The
occlusal plane is oriented parallel to the interpupillary line anteriorly and to
the ala-tragus line posteriorly.
3- Accurate maxillomandibular jaw relation records i.e. help to
determine:
a- Vertical dimension of occlusion and interocclusal distance.
b- Horizontal jaw relations (centric, protrusive and lateral relations).
4- Determination of the length and width of the artificial teeth.
5- The midline, canine line, high lip line and low lip line, and intercanine
distance are recorded on the wax occlusion rims.
6- Arrangement of the artificial teeth (setting-up of teeth).
81
Characteristics of occlusion rims:

1- Should be parallel to the long axis of the tooth to be replaced and
follow the contour of the arch.
2- Wax rims are smooth and have a flat occlusal surface. They are
about as wide buccolingually as denture teeth; wider in the posterior,
narrower in the anterior.
3-The occlusal rim is properly sealed to the baseplate without any
voids.
4- The upper rim terminates at the anterior aspect of the maxillary
tuberosity. The lower rim terminates anterior to the retromolar pad. The
maxillary and mandibular rims are beveled posteriorly towards the base to
not interfere during recording of jaw relationships (Fig. 6-4).
Dimensions the Occlusal Rim:
Fig (6-4): Left: The height of the wax rim. Note the labial inclination of the anterior rims
and beveling of distal ends. Right: Diagram shows the height of anterior teeth.
Maxillary Occlusal Rim
Anterior:
Height: 22mm from highest portion of the labial flange to incsal edge.
Width: 4–6mm.
Inclination: the anterior border of the rim should be about 8mm from
the incisive papilla or a labial inclination of 5° (Fig. 4-4).
Relation to ridge: slightly labially.
82
Posterior:
Height: should be 16mm from highest portion of buccal flange to
occlusal edge.
Width: 8–10mm.
Inclination: buccal aspect inclined 5° palatal. Palatal aspect has buccal
inclination (Fig. 4-5).
Relation to ridge: slightly buccal.
Mandibular Occlusal Rim
Anterior:
Height: should be 18mm from the deepest portion of the labial flange to
occlusal edge.
Width: 4–6mm.
Inclination: labial inclination of 5°.
Relation to ridge: slightly labial.
Posterior:
Height: At a level of the junction of the anterior 2/3rd and posterior
1/3rd of the retromolar pad.
Width: 8–10mm.
Inclination: buccal aspect slightly inclined 5° lingual and lingual aspect
has buccal inclination (Fig. 6-5).
Relation to ridge: Lingual to the ridge.
Fig. (6-5): Left, Width of occlusion rims. Right, the buccal aspect of maxillary and
mandibular rims is inclined 5° lingual. Upper posterior palatal aspect and lower posterior
lingual aspect has buccal inclination.
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Types of occlusion rims:

1-Base plate wax rim:
Procedures of construction:
1- Dry the record base thoroughly as wax will not adhere to a wet
surface. Roughen the area of the record base where the wax will be
adapted.
2- Uniformly soften a sheet of hard pink baseplate wax. Flame the wax
on a Bunsen burner flame slowly by passing the wax quickly through the
flame many times. When the wax is thoroughly softened, fold the wax in half.
Continue to flame the wax to soften it. Repeat the folding and warming until
the required roll is formed (Fig. 6-6).
Fig. (6-6): Left, wax roll placed on base follow arch curvature. Right, pre-formed wax
rims.
3- Form the wax into a horseshoe shape and adapt the wax to the
record base over the ridge crest area. Begin at one posterior end and
continue to the anterior and to the opposite end.
4- Seal it to the record base with molten wax using a hot spatula. Add
wax as needed to contour the rim. Sticky wax can also be used to attach the
occlusion rims.
5- The rim should approximate the position of the natural teeth.
Remember the facial surfaces of the maxillary central incisors are 8-10 mm
anterior to the center of the incisive papilla. The wax rim must be anterior to
the crest of the maxillary ridge.
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6- Use a heated wax spatula to develop a flat occlusal plane.

7- Adjust the height and width of the wax rims to the previously
mentioned dimensions.
2- The composition (compound) rim:
Compound rim is indicated when it is desired to obtain more than one
jaw relation record or when Gothic arch tracing is to be taken (Fig. 6-7).
Fig. (6-7): Composite rim.

3- Plaster and pumice rim:
When a functional recording of mandibular movements is to be made, a
mixture of plaster and pumice rims is used. In this technique the patient
grinds the maxillary and mandibular rims together and produces the occlusal
plane conforming to the mandibular movements. This plaster-pumice
combination is mixed (equal parts) with water into a thick consistency and a
roll of it is placed on to the base. These plaster-pumice rims should be used
through 24 hours before they became hard (Fig. 6-8).
Fig. (6-8): Plaster and pumice rims.

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CHAPTER VII
FACE-BOWS AND DENTAL ARTICULATORS
FACE-BOWs
The face-bow is a caliper-like device that is used to record the
relationship of the maxilla to the temporomandibular joints or the opening
axis of the jaws and to orient the casts in this same relationship to the
opening axis of the articulator.
Types of face-bow:
There are two basic types of face-bow; the kinematic, and the maxillary.
1- The kinematic (Mandibular) face-bow:
It is used to locate the kinematic (true or terminal or transverse) hinge
axis. The transverse hinge axis is an imaginary line, which the mandible
rotates during posterior (maximum retrusion) opening and closing for about
20 mm between the incisal edge of anterior teeth.
2- The maxillary (Arbitrary) face-bow:
It is used to record the position of the upper jaw in relation to the hinge
axis and transferring this relation to an articulator (Figs. 7-1- 7-3).
Fig. (7-1): Parts of maxillary face bow.

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The maxillary face-bow is oriented to the kinematic or arbitrary hinge axis.

The arbitrary hinge axis is positioned on a line extending from the outer
canthus of the eye to the middle of the tragus of the ear and approximately
13 mm. in front of the external auditory meatus. The ear face-bows utilize an
arbitrary axis by fitting into the external auditory meatus.
Fig. (7-2): left; arbitrary hinge axis. Right, face bow on patient.
Fig. (7-3): The maxillary face-bow on the articulator.
Importance of the face-bow:

1- An arbitrary mounting of the maxillary cast without a face-bow
transfer can introduce errors in the occlusion of the finished denture.
2- A face-bow transfer allows minor changes in the occlusal vertical
dimension on the articulator without having to make new maxillomandibular
records.
3- It is helpful in supporting maxillary cast while it is being mounted on
the articulator.
87
Dental Articulators
Definitions:
Articulator: It is a mechanical instrument that represents the
temporomandibular joints and jaw members, to which maxillary and
mandibular casts may be attached to simulate some or all-mandibular
movements.
Articulation: The static and dynamic contact relationship between the
occlusal surfaces of the teeth during function.
Occlusion: The static relationship between the incising or masticating
surfaces of the maxillary or mandibular teeth or tooth analogues.
Uses of dental articulators:

1- To simulate the patient’s temporomandibular joint movements and
mandibular movements.
2- Mounting the dental casts in a fixed relationship.
3- Mounting the dental casts for proper diagnosis, treatment planning
and presentation to patient.
4- To help in the fabrication of fixed and removable restorations.
5- To arrange artificial teeth.
6- To correct and modify the existing restorations.
Advantages of articulators:
1- It is helpful in visualizing the patient’s occlusion with much more
ease, especially the lingual occlusion.
2- Patient cooperation is not needed while using the articulators
because the articulator itself provides the necessary movements.
3- It is more comfortable and there is refinement in the work, as there is
no disturbance, like shifting of denture base or resiliency of the soft tissues.
4- Reduced chair time with the patient.
5- Role of patient’s saliva, tongue, cheeks and posture is avoided.
88
Limitations of Articulators
1- The articulator is subject to errors in tooling and errors resulting from
metal fatigue and wear.
2- No articulator can exactly duplicate the condylar movements of an
individual.
3- It cannot compensate for any errors in jaw relation records.
Requirements:
1- It should hold casts in the correct horizontal and vertical
relationships.
2- It should provide a positive anterior vertical stop (incisal pin).
3- It should open and close in a hinge movement.
4- It should allow protrusive and lateral jaw motion.
5- The moving parts should move freely.
6- The non-moving parts should be rigid.
7- It should accept a facebow transfer record.
Classification of articulators:
I- Based on adjustability:
1- Simple hinge articulators.
2- Fixed or mean value condylar path articulators.
3- Adjustable condylar path articulators.
a- Semi-adjustable condylar path articulators.
b- Fully-adjustable condylar path articulators.
II- Based on position of condylar elements:
1- Arcon: The condylar element is attached to the lower member
whereas the condylar guidance is attached to the upper member of the
articulator (Fig. 7-4). This articulator resembles the TMJ, e.g. Whip Mix
articulator.
2- Non-arcon: The condylar elements are attached to the upper
member and the condylar guidance is attached to the lower member (Fig. 7-
4), e.g. Hanau H series.
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Fig. (7-4): Left, arcon articulator. Right, non-arcon articulator.
1- Simple Hinge Articulators (plain line)

Design:
It consists of upper and lower members held apart at a certain
distance by a screw which acts at the back. The screw can increase or
decrease the distance between the two members and permits only a hinge
like movement (Fig. 7-5).
Possible movements:
This type of articulators gives only opening and closing movements.
Records required:
1- Vertical dimension of occlusion.
2- Centric relation record.
Disadvantages:
These articulators do not represent the temporomandibular joint and the
dynamic mandibular movements.
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Fig. (7-5): Left, hinge articulator. (a) Hinge (b) set screw (c) upper member (d) lower
member. Right, the arc of closure of the articulator is smaller than that of patient. This will
produce occlusal error of the prosthesis.
II- Mean Value Or Fixed Condylar Path Articulators
Design:
The two members of these articulators are joined together by two joints
that represent the TMJ. The horizontal condylar path is fixed at certain angle
that ranges from 30 – 40 which is the average of most patients. The incisal
guide table is also fixed at a certain angle from horizontal (Fig. 7-6).
On the fixed and most condylar path articulators the upper members
are movable and the lower members are stationary. Therefore, the upper
member moves backward and upward in protrusion. This reverse
arrangement provides a firm base and facilitates setting up of teeth.
Possible movements:
1- Opening and closing.
2- Protrusive movement at a fixed condylar path angle.
Records required:
1- Vertical dimension of occlusion.
2- Centric relation record.
3- Face-bow record: In some designs of these articulators, the upper
cast can be mounted by a face bow transfer.
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Disadvantages:
1- Most of these articulators does not accept face-bow record.
2- The condylar path moves to a fixed angle and it is successful in-
patients whose condylar angle approximates that of the articulator.
3- No lateral movements.
Fig. (7-6): Mean value articulator. a. Upper member. b. Condylar shaft and slot with
spring. c. Lower member. d. The two vertical arms on either side, hold the upper and
lower members together. e. rubber band to guide the occlusal plane orientation during
articulation. f. Incisal adjustment screw. g. Incisal pin. h. Midincisal pin. i. Incisal pin table.
Procedures for mounting casts on a fixed condylar path articulator:

1- The upper and lower casts are prepared for laboratory remounting by
cutting indices on the undersurface of their base.
2- The upper and lower trial denture bases are sealed together and to
the casts.
3- The incisal pin of the articulator is adjusted so that it's top flush with
the top of the upper member (This makes the articulators members parallel).
4- The arms of the articulator to be used are lubricated with Vaseline or
oil to facilitate cleaning of the articulator later on.
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5- A piece of clay is placed on the lower member of the articulator and

the casts with attached record blocks are placed on the clay.
6- The occlusal plane of the wax rim is adjusted parallel to the
orientation plane of the articulator. To facilitate the orientation of occlusal
plane, a rubber band is warped around the articulator at level of incisal pin
mark anteriorly and the two marks on the condylar posts posteriorly.
7- The upper member of the articulator is opened and a mix of plaster is
placed on the top of the upper cast. The articulator is closed slowly until the
incisal pin touches the incisal table. This will attach the upper cast to the
articulator.
8- After setting of plaster, clay is removed and the lower cast is
attached to the articulator by plaster. The excess plaster is removed while it
is still soft and the mounting plaster is smoothed with a sand paper.
III- Adjustable Condylar Path Articulators
This type of articulators differs from the fixed condylar path articulators
in that it has adjustable condylar and incisal guidances. They can be
adjusted so that the movements of its jaw members closely resemble all
movements of the mandible for each individual patient.
A- Semi Adjustable Condylar Path Articulators

Design:
In these articulators (e.g. Hanau articulator, fig. 7-7) the horizontal
condylar path is adjusted by a protrusive record obtained from the patient.
The lateral condylar path inclination is adjusted according to the
Hanau’s formula: L=H/8+12.
Where, L = The lateral condylar path
H = The horizontal condylar path.
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Fig. (7-7): Hanau semi-adjustable articulator.

Possible movements:
1- Opening and closing.
2- Protrusive movement according to the horizontal condylar path angle
determined from the patient.
3- Lateral movement to the angle estimated from the Hanau formula.
4- Some types have Bennett movement (immediate side shift).
Records required:
1- A maxillary face bow record to mount the upper cast.
2- Vertical dimension and centric relation to mount the lower cast.
3- Protrusive record to adjust the horizontal condylar path inclination of
the articulator.
Disadvantages:
1- The lateral condylar path angle is determined from the formula.
2- Most of these articulators have no Bennett movement.
B- Fully adjustable articulators

They differ from the semi-adjustable articulators in that the lateral
condylar path inclinations are adjusted according to records taken from the
patient (Fig. 7-8).
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Possible movements:
The same movements of the semi-adjustable articulators. In addition,
they have Bennett movement.
Records required:
1- A maxillary face bow record to mount the upper cast.
2- Vertical dimension and centric relation to mount the lower cast.
3- Protrusive record to adjust the horizontal condylar path inclination.
4- Right and left lateral records to adjust the lateral condylar path angle.
Disadvantages:
Multiple records are required with the possibility of errors. The
semi-adjustable articulators are usually enough for complete denture
construction.
Fig. (7-8): Denar D5A fully adjustable articulator
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CHAPTER VIII
SELECTION OF ARTIFICIAL TEETH
The anterior teeth are primarily selected to satisfy esthetic

requirements. Whereas the posterior teeth are primarily selected to satisfy
masticatory functional requirements. Though there is no single rule to decide
the selection, it certainly requires artistic skill in addition to scientific
knowledge.
Objectives:
The following are the main objectives in selecting artificial teeth:
1- To establish harmony with surrounding tissue.
2- Maintenance of vertical dimension.
3- Aesthetic acceptability.
4- Masticatory efficiency.
Selection of anterior teeth
I- Shape (form or mold):

The form or shape of the anterior teeth is selected according to:
1- Form and contour of face:
The shape of artificial anterior teeth from the labial surface should
harmonize with the shape of the frontal surface of patient's face.
The outlines of faces can be grouped into square, tapering and ovoid
(Fig. 8-1). Two lines are imagined, one on either side of the face, running
about 2.5 cm. in front of the tragus of the ear and through the angle of the
jaw. If these lines are almost parallel the patient’s face is square, if they
converge towards the chin the face is tapering and if they diverge at the
chin, the face is ovoid.
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Fig. (8-1): The shape of the face and teeth form. A, square. B, tapering, C, ovoid.
Also, the labial surface of anterior teeth viewed from the mesial or distal
aspect should conform to the contour of the facial profile. If the face
presents a flat profile, a flat labial surface is the one of choice. If the face
presents a curved profile, a tooth should be selected to harmonize with that
profile (Fig. 8-2).
Fig. (8-2): The shape of facial profile. Left; straight. Middle; convex. Right; concave.
2- The shape of maxillary arch:

If the upper model when viewed from the occlusal surface, presents a
tapering arch form, then a tapering tooth may be indicated, square arch
indicates, square teeth and so on (Fig.8-3).
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Fig. (8-3): The shape of the maxillary arch and teeth. A, square. B, tapering, C, ovoid.
3- Dentogenic concept:
It is based on sex, personality and age of the patient
a- Sex: Curved facial features are associated with femininity and
square with masculinity. To create harmony between the tooth form and
face, teeth of females may be more ovoid or tapering than square as
compared to males. The incisal edges may also be rounded for females.
Square feature is associated with masculinity (Figs. 8-4).
b- Personality: A vigorous personality requires square teeth with flat
incisal edges, while a delicate personality will require ovoid teeth.
c- Age: With age, the teeth wear at the incisal edges and interproximal
surfaces. Labial surfaces seem flatter and form appear squarer. The same
should be considered while selecting the teeth.
4- Pre-extraction Records
Provide general information about the outline form of anterior teeth.
They include facial photographs and diagnostic casts of patients natural or
restored dentition.
Fig. (8-4): Mould selected for male with sharp edges (Left). Mould selected for female
with round edges (Right).
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II- Size of the anterior teeth:

The size of the teeth represents their width and length. Thickness of the
teeth is of no esthetic importance but has a considerable effect on
phonetics.
A- Anterior Teeth Width:
1- Size of Face and Head
a- The average combined width of the maxillary anterior teeth is
determined by dividing the bizygomatic width by 3.3. (measured 1–1.5
inches behind the lateral corner of the eyes).
b- The average width of the maxillary central incisor is determined by
dividing the bizygomatic width by 16 (Fig. 8-5).
c- The average length of the maxillary central incisor is determined by
dividing the length of the face by 16. Length of the face is a measure of
distance from the hairline to the lower edge of the bone of the chin, with the
face at rest.
Fig. (8-5): Left, Bizygomatic width. Right, Corners of the mouth are marked on occlusal
rims, this determines the width of maxillary anterior arch.
2- Anatomical Landmarks
a- Mark or pin is placed at the corners of the mouth on the wax occlusal
rims. The width of the maxillary anterior arch is determined by measuring the
distance from the two marks with a flexible ruler (Fig. 7-5).
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b- Lines from the lateral surface of ala of nose gives the position of
apex of canine teeth. Also, the width of the central incisor approximates the
width of the philtrum (Fig. 8-6).
c- The middle of incisive papilla in a transverse line with the tips of the
canine teeth (Fig. 8-6). This distance can be measured with a flexible ruler.
Fig. (8-6): Left, apex of the canine teeth with the parallel lines from ala of the nose and
width of the central incisor approximates the width of the philtrum. Right, Tip of maxillary
canine is positioned on a line drawn through middle of incisive papilla.
3- Maxillomandibular Relations:
a- In class III arches, the mandibular anterior teeth are selected larger
than normal.
b- In class II arches, the mandibular anterior are selected smaller than
normal.
4- Pre-extraction Records
a- Facial photographs:
By comparing, clearly visible factors like interpupillary distance of
patient in photo and in person with the tooth width in photo, the actual width
of the anterior tooth can be calculated.
b- Diagnostic casts help in selecting the width of the anterior teeth.
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B- Length:
1- Vertical Distance Between the Ridges
This determines the length of the teeth. When space is available, it is
more aesthetically acceptable to use teeth that are long enough to eliminate
the display of denture base (Fig. 8-7).
Fig. (8-7): Left: Small interridge distance. Right: Large interridge distance.
2- The lips:
a- The high lip line: The distance from the high lip line and the lower
edge of the upper occlusion rim represents the length of the upper anterior
teeth. The high lip line is a line drawn on the upper wax rim marking the
edge of the upper lip while patient is smiling.
Amount of tooth visible below the upper lip depends on the age and sex
of the individual. It should be more in a young patient than an elderly patient.
The lower edge of the upper occlusion rim should be about 2mm below the
upper lip at rest in young males and 3mm in young females
b- In speech, the incisal edges of the maxillary anterior teeth should
contact the lower lip at the junction of the moist and dry surfaces of the
vermilion border, when the patient pronounces the letter ‘f’.
3- Shade (Color);
a- The complexion: The color of artificial teeth is selected according to
color of the face and eyes. Light teeth are used for white peoples and blue
or green eyes. Dark teeth are indicated for dark skin and eyes. The color of
101
the hair is a very unreliable guide for tooth color selection, as the patient
could be dyeing the same.
b- The age and sex: The older the patient the darker will be the shade
required. Also, men will usually require a darker shade than women.
c- Pre-extraction records
A record of the patient’s tooth color before extraction can be a useful
guide in selecting the color, but extracted teeth are unreliable as they
dehydrate and become lighter.
A shade guide is used in tooth color selection. It consists of a number
of shades graduated from a very light to a dark yellow or grey. The color is
observed with the skin and under the lip with incisal edge exposed (Fig. 8-8).
Fig. (8-8): Left; shade guides along the side of the nose. Left; Under the lips with only
incisal edge exposed. Right, Under the lip with only the cervical end covered and mouth
open.
The characteristics of natural teeth color:

a- The neck of the teeth is darker than the incisal edge.
b- The incisal edge is more translucent than other two thirds because it
is made entirely from enamel.
c- The upper central incisors are the lightest followed by the upper
laterals, the lower centrals and laterals, and the upper and lower canines are
the darker.
d- Posterior teeth are usually uniform in color.
e- Natural teeth darken with age as a result of deposition of secondary
dentine.
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Selection of posterior teeth
I- Form (Mould or shape):

A- The Anatomic Teeth is made to reproduce the anatomical features
of natural teeth. This usually results in a well-defined cusp formation (e.g.
33-degree teeth) and necessitates the use adjustable articulator if balanced
articulation is to be produced (Fig. 8-9).
Indications: Used in high and well-rounded residual alveolar ridges
and normal jaw relations.
Advantages:
1- Good masticatory efficiency.
2- Good esthetics.
3- Balance: They can be arranged in balanced occlusion in eccentric
relations.
Disadvantages:
1- The presence of cusps generates more horizontal force during
function.
2- Harmonious balanced occlusion is lost when settling of denture base
occurs.
3- The bases need frequent refitting to keep the occlusion stable and
balanced.
B- The semi-anatomic teeth have low cusp (20 degree) and have the
same anatomic carvings of anatomic teeth.
Indications: Used in well-formed and low rounded residual alveolar
ridges.
Advantages
1- Easy to obtain balanced occlusion in complete dentures
2- Shallow cuspal inclination will generate less horizontal forces
compared to anatomic teeth.
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Disadvantages:
1- Aesthetics is less compared to anatomic teeth.
2- Chewing efficiency is less compared to anatomic teeth.
C- Flat plane (non-anatomic) teeth:

The occlusal surfaces of such teeth are not perfectly flat but are
serrated by grooves or channels (inverted cusp) to help in mastication.
Fig. (8-9): The cusp angle of posterior teeth. Left, anatomic (33 degrees). Middle, semi-
anatomic (20 degrees). Right, flat.
Indications:
1- In class II and III jaw relations.
2- Patients with temporomandibular joint disorders.
3- In case of atrophic alveolar ridge.
4- In the presence of hyper mobile gingival tissues (flabby ridge).
Advantages of flat plane teeth:
1- No possibility of cusp locking and hence more stable dentures and
fewer traumas to the alveolar ridge.
2- After the dentures have been worn for years, the vertical dimension
is reduced by bone resorption or tooth attrition or both, and then the
accompanying forwards movement of the mandible does not result in a
deranged occlusion.
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3- Setting is easier, teeth may be interchanged, and cross bites are

solved more satisfactory.
4- These teeth are particularly indicated in cases where the lower ridge
is markedly reduced and, retention and stability are likely to be poor.
Disadvantages of flat plane teeth:
1- Reduced masticatory efficiency.
2- Their appearance in no way resembles natural teeth.
3- There may be a tendency for food to become packed into the
depression of inverted cusp teeth.
4- With cuspless tooth it is very difficult to obtain a balance and the
most satisfactory way of doing so is to use functional recording of occlusal
plane using plaster of Paris record blocks.
II- Size of posterior denture teeth:

A- Length:
This is determined by the amount of denture space available between
the upper and lower ridges. The length of maxillary premolars should be
comparable to that of maxillary canine to have the proper esthetic effect.
B- The mesiodistal width: The distance between the distal aspect of
the canine and the tuberosity in the maxillary denture, and the retromolar
periphery of the lower denture determines the mesiodistal width.
C- The buccolingual width: The teeth with a narrow buccolingual width
are selected to reduce the occlusal table and consequently the load falling
on the ridge. However, this reduction in width should not be accomplished at
the expense of losing support for the cheek.
3- Shade (color):
The shade of the posterior teeth should harmonize with that of the
anterior teeth.
105
Selection of tooth material
A- Acrylic Teeth
Indications:
1- Used in situations where opposing teeth are natural teeth
2- Used in situations where interarch space is less
3- Used in resorbed residual ridges
B- Porcelain Teeth
Indications:
1- Used in situations where the interarch space is more
2- Used in situations with well-formed ridges
Comparison between acrylic and porcelain teeth:

Resin Porcelain
1 Wears easily with loss of VD No clinically significant wear

2 Easy to grind and adjust Difficult to grind and adjust
3 Chemical bonding to denture Mechanical bonding using
pins (for anterior teeth) and
diatoric holes (for posterior
teeth)
4 Does not abrade opposing natural Abrades opposing natural
teeth and restorations
5 Colour instability—can stain easily Does not stain easily
6 Soft impact sound; no clicking Sharp impact sound;
sounds when opposing teeth meet
clicking present
7 Rebasing is a problem as it is difficult Easy to separate the teeth
to separate the teeth from denture
and rebase
base
8 No leakage Marginal staining is possible
due to capillary leakage
9 Good impact resistance—chipping Poor impact resistance;
chipping of denture tooth is
a problem
106
CHAPTER IX
ARRANGEMENT OF TEETH AND WAXING-UP
The carved occlusal rims provide a reliable guide for placement of the
anterior teeth in the arch. These guides are:
1- guide lines (midline, high lip line and canine lines (Fig. 9-1)).
2- The proper placement of the occlusal plane.
3- Proper lip support (Fig. 9-1).
4- Correct jaw relationships (vertical dimension of occlusion and centric
relation).
Fig. (9-1): Left; guidelines (central, canine and high lip lines). Right, the proper lip
support.
Factors affecting teeth arrangement:

1- Anatomical landmarks
2- Dentogenic concept
3- Esthetics and phonetics.
4- Neutral zone.
5- Balanced occlusion.
6- Ridge relation.
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1- Anatomical Landmarks
a- Residual Ridge:
Maxillary teeth are positioned labial to the ridge and mandibular teeth
on the crest of ridge due to the resorptive pattern of the ridge. The lingual
cusp of the maxillary posterior teeth should be centered over the mandibular
ridge and mandibular anterior teeth should not be set too far from the center
of the ridge to ensure denture stability (Fig. 9-2).
Fig. (9-2): Left, position of anterior teeth in relation to ridge. Middle, mandibular teeth are
set on the residual ridge crest. Right, the lingual position of the mandibular posteriors
should not go beyond the line from lingual of retromolar pad to distal of canine.
b- Arch form:
In tapered arches, the central incisors are arranged further forward than
the canines. In square-shaped arches, central incisors are arranged nearly
horizontal than the canines. In ovoid arches, the anterior teeth are arranged
in a gentle curve.
c- The incisive papilla:
The distance from the center of papilla to gingival margin of central
incisor is 8 mm and from papilla to incisal edge is 10 mm. Also, a line
connecting tips of canines transverses the incisive papilla (Fig. 8-3).
d- The rugae: The distance from labial surface of canine to lateral
margin of rugae is 10.5 mm (Fig. 9-3).
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Fig. (9-3): The relation between the incisive papilla and the central incisors and between
the canine and rugae area.
e- Retromolar pad
The line extending from the tip of lower canine to the upper 2/3 of
retromolar pad will determine the height of the lower posterior teeth (occlusal
plane) (Fig. 9-4).
Fig. (9-4): Relation of retromolar pad in determination of height of posterior teeth.
2- Dentogenic Concept:
a- Sex: In men, the incisal edges are more angular and are arranged in
straight line. Lateral incisors are almost at the same level as central incisors
and canine tooth is prominent which impart quality of hardness. In women,
the incisal edges of the anterior teeth are more rounded and follow the curve
of lower lip. Lateral incisors are narrower and shorter than central incisors
and impart quality of softness (Fig. 9-5).
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Fig. (9-5): Left: Feminine smile characterized by curvature of incisal line coinciding with
the lower lip. Right: Masculine smile characterized by straighter incisal line.
b- Personality Factor grouped into three categories. Vigorous, medium

and delicate types. Vigorous look is given as in men. Delicate look is created
as in women.
c- Age: As age advances, central and lateral incisors abrade in straight
line and cuspids abrade in a curve. This results in flattening of the arch. In
youth, interdental papillae are stippled and pointed. Shortening of the
papillae and raising gingival line occurs by age. In dentures, the wax is
contoured to suggest recession (Fig. 9-6).
Fig. (9-6): Left: Age factor on the incisal edge. Dotted line; young age. Darker line; as age
advances. Right: Age changes on denture base A, Young adults. B, Advanced age.
3- Esthetics and phonetics:

Aesthetics and phonetics are used as a guide in arranging the maxillary
anterior teeth. When the patient says ‘fifty-five’ the incisal edges of the
maxillary central incisor should contact the vermilion border of the lower lip
at the junction of the moist and dry mucosa.
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The amount of visibility of the upper anterior teeth during speech and
facial expression depends on the length and the movement of the upper lip.
The anterior teeth should be placed to support the lip and muscles of
expression. Irregularities in natural teeth may be reproduced in complete
denture to improve esthetic.
4- The neutral zone:

The natural teeth buccolingual position is determined by forces exerted
against them by the muscles of the face and tongue. The facial muscles
push the teeth lingually and the tongue pushes them buccally.
Consequently, they finish in the position where the opposing forces balance
each other. This position has been called the neutral zone. In this position,
there will be the least tendency for the musculature to displace the denture
and it is logical to place the posterior teeth in the neutral zone (Fig. 9-7).
Fig. (9-7): Diagram shows the position of the teeth in the neutral zone.
5- Balanced occlusion:
To achieve balanced articulation, the posterior teeth are arranged so
that their cusps present anteroposterior and lateral curves. These curves
correspond to the curve of Spee and curve of Monson (compensating
curves). These curves allow for teeth contact during lateral and protrusive
movements because the mandible moves in a curved path.
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In the working side the upper buccal cusps meet the lower buccal
cusps. In the balancing side the palatal cusps of maxillary posterior teeth
contact the buccal cusps of the mandibular teeth (Fig. 9-8).
Fig. (9-8): Tooth contact during lateral movement.
6- Ridge relations:
Principles of individual teeth arrangement according to ridge relations in
centric occlusion can be classified into class I, class II and class III ridge
relations.
A- Teeth arrangement for class I ridge relation
Maxillary anterior teeth
Fig (9-9) Inclination of the maxillary anterior teeth and their relation to the occlusal plane.
A; labial view. B; proximal view.
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a- Maxillary central incisors

1- The long axis of the tooth should be perpendicular to the occlusal
plane when seen from the front.
2- Its long axis should be inclined downwards and slightly labially when
seen from the side.
3- The contact point should coincide with the midline of the face.
4- The incisal edge should touch the mandibular occlusion rim.
5- The facial surface of the central incisors should be 8-10 mm anterior
to the center of the Incisive papilla.
b- Maxillary lateral incisors
1- The long axis should incline slightly distally when seen from the front.
2- The cervical portion of the tooth should incline slightly lingually.
3- The incisal edge of the lateral should be raised approximately 1 mm
from the mandibular occlusion rim.
c- Maxillary canines
1- The incisal edge of the canine should touch the mandibular occlusion
rim.
2- The long axis should be vertical or inclined slightly distally (frontal
view).
3- The long axis when viewed from proximal is vertical or cervical third
is inclined buccally to achieve some prominence.
4- The mesio- labial aspect of the canine should be visible when viewed
from the anterior. This will be accomplished by tilting the neck of the canine
slightly to the distal (in addition to being tilted to the buccal).
Procedures for arranging the maxillary anterior teeth:
1- Check the articulator settings.
2- Seal the baseplate borders using base plate wax, No wax on land
area.
3- Extend the midline and canine lines on the maxillary occlusion onto
the land area of the maxillary cast with a pencil (Fig. 9-10).
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4- Mark the center of the incisive papilla and extend it to the land area
(Fig. 9-10).
Fig. (9-10): Left: The central and canine lines extended to the cast base. Right: The
center of the incisive papilla is marked.
5- Using a warmed knife cut enough wax from the right side of the
maxillary occlusion rim to allow the positioning of the right central incisor.
6- Set the upper central incisor with its incisal edges touching the
mandibular wax rim, its mesial edge at the midline previously marked using
the occlusion rim remaining on the left as a guide. It may be necessary to
grind on the record base with a rotating instrument. It may also be necessary
to adjust the ridge lap portion of the denture tooth.
7- Seal the tooth in position on the lingual surface with wax.
8- Arrange the right lateral and canine in the same manner.
9- Cut away the left side of the anterior portion of the maxillary
occlusion rim and arrange the left central, lateral, and canine teeth. Evaluate
the position of the incisal edges of these teeth relative to the plane of
occlusion using a glass slap.
Fig. (9-11): Setting the maxillary anterior teeth.
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The mandibular anterior teeth

a- Mandibular central incisors
1- The long axis of the mandibular central incisor should be set
perpendicular to the occlusal plane when viewed from the front.
2- Its long axis slopes labially when viewed from the side.
3- If anatomic posterior teeth are used, 1-1.5 mm horizontal and vertical
overlaps are made (Fig. 9-12).
4- The contact point of mandibular incisors should coincide with the
midline of the maxillary teeth.
Fig. (9-12): About 1-1.5 mm horizontal and vertical overlap of anterior teeth.
b- Mandibular lateral incisors:
1- The long axis of the mandibular incisor should be slightly inclined
distally at the cervical portion of the tooth.
2- From the side it is inclined labially, but its labial inclination is less
than that of the central incisor.
3- The occlusal height should be the same at the central incisors.
c- Mandibular canines
1- The long axis of the mandibular canine is nearly perpendicular to the
occlusal plane with a slight distal inclination.
2- The canine inclines upwards and lingually when seen from the side.
3- The tip of the canine should be at the same occlusal height as the
mandibular central and lateral incisors (Fig. 9-13).
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A B
Fig. (9-13): Setting of lower anterior teeth A, buccal view. B, side view.
Procedures for arranging the mandibular anterior teeth:

1- Using a warmed knife cut enough wax from the right side of the
mandibular occlusion rim to allow the positioning of the right central incisor.
2- Arrange the lower central incisor with its mesial edge at the midline
previously marked using the occlusion rim remaining on the left as a guide.
3- Seal the tooth in position on the lingual surface with wax.
4- Arrange the right lateral in the same manner.
5- Arrange the canine so that the cusp tip of the mandibular canine is
placed between the maxillary canine and lateral
6- Now, cut away the left side of the anterior portion of the mandibular
occlusion rim and arrange the left central, lateral, and canine teeth.
7- Evaluate the position of the incisal edges of these teeth relative to
the plane of occlusion using a glass slap (Fig. 9-13).
Fig. (9-13): Setting of lower anterior teeth.
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The maxillary posterior teeth:

The upper first and second premolars:
1- Long axis is parallel to the vertical axis when viewed from the front or
the side.
2- Palatal cusp touches the occlusal plane and buccal cusp touches the
occlusal plane or raised about ½ mm.
3- The central sulcus lies directly over the lower ridge crest.
4- The buccal surface is aligned with the canine.
The upper first molar:

1- Its long axis inclined slightly upward mesially when viewed from the
front.
2- Its long axis inclined slightly downward and buccally when viewed
from the side.
3- Only its mesiopalatal cusp is in contact with the horizontal plane.
4- The central sulcus lies directly over the lower ridge crest.
5- The buccal cusps of molars are angled slightly inward from line
extending along facial surfaces of canine and premolars (Fig. 9-14).
The upper second molar:

1- Its long axis slopes as the first molar but steeper.
2- All four cusps are short of the horizontal planer but the mesiopalatal
cusp is always nearest to it.
Fig. (9-14): The position of upper posterior teeth. Left; buccal view. Right; side view.
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The mandibular posterior teeth:

The lower first premolars
If the maxillary posterior teeth were set first, space available to lower
first premolar may be small and its mesiodistal width may require reduction
from the mesial contact point. In the other hand, if the mandibular posteriors
were set first, a spacing (1/4 to ½ mm) of the maxillary posteriors will be
necessary to achieve the proper intercuspation.
The buccal cusp of the lower first premolar touches the mesial marginal
ridge of upper first premolar.
The lower second premolar.
1- The buccal cusp should be over the crest of mandibular ridge.
2- The buccal cusp touches distal marginal ridge of first premolar and
mesial marginal ridge of second premolar.
3- Lingual cusp rest lingually between the maxillary first and second
premolars.
The lower first molar:
1- The buccal cusp should be over the crest of mandibular ridge or
slightly lingual to it.
2- Its long axis leans upward mesially when viewed from the front
3- Its long axis leans upward lingually when viewed from the side.
4- All the cusps are at a higher level above the horizontal plane, the
buccal and distal cusps being higher than the lingual and mesial.
5-The central fossae are in contact with the lingual cusps of the
maxillary molar. The mesiobuccal cusp of maxillary first molar lies in the
mesiobuccal groove of the lower first molar.
The lower second molar:
The same inclinations and relation to the maxillary teeth as in the first
molar. However, the long axis inclination is more prominent.
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Fig. (9-15): Setting up the lower posterior teeth. Left; buccal view. Right; lingual view.
First premolar Second premolar First molar

Fig. (9-16): Setting up the lower posterior teeth (side view).
Procedures for setting-up the posterior teeth:

1- Mark the land areas of the mandibular cast with a pencil to serve as
a guide in tooth arrangement. With the mandibular record base removed,
place a mark on the land where the mandibular ridge turns superiorly. This
will represent the posterior limit for tooth arrangement (Fig 9-17).
Fig. (8-17): Left: A; the point where the ridge is raised-up. B; the crest of the ridge. Right;
the ridge crest marked on wax rim.
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2- With a pencil, use a ruler to mark the crest of the mandibular ridge
from the base of the retromolar pad to the canine area. This will identify the
crest of the mandibular ridge.
3- Replace the mandibular record base and occlusion rim, and using a
straight edge, extend the previous markings onto the wax rim to serve as a
guide when arranging the maxillary teeth (Fig 9-17). Repeat this procedure
for the other side.
The maxillary posterior teeth:
a- Place the right maxillary first premolar with its long axis at right
angles to the occlusal plane. The buccal and lingual cusps are placed on the
plane.
b- Place the right maxillary second premolar in like manner. Align the
buccal surfaces of the premolars and the canine with the edge of metal or
plastic occlusal plane template.
c.- The mesio-buccal and mesio-lingual cusps of the right maxillary first
molar touch the occlusal plane. The disto-buccal and the disto-lingual cusps
are raised about 0.5 mm above the occlusal plane.
d- All of the cusps of the second molar are raised from the occlusal
plane following the position of the first molar. The mesio-buccal cusp should
be about 1 mm from the occlusal plane (Fig. 9-18).
e- Follow the same procedure in placing the posteriors on the opposite
side.
Fig. (9-18): Left; Buccal view; the maxillary posterior teeth arrangement. Right; occlusal
view; buccal ridges of molars are angled slightly inward from line extending along facial
surfaces of canine and premolars.
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The mandibular posterior teeth:

The mandibular 1st molar is a key tooth in articulation. If careful
attention is paid to setting this tooth, it will facilitate considerably articulation
of the remaining posterior teeth.
a- Remove enough wax from the mandibular occlusion rim on the right
side to have space for the posterior teeth.
b- Set the right mandibular first molar in its correct position but slightly
high in occlusion. Close the articulator carefully to bring the mandibular
molar into its proper position. Guide it to the correct occlusal relation with the
maxillary first molar and maxillary second premolar, making certain that the
incisal guide pin remains in contact with the incisal table during all
excursions (Fig. 9-19).
c- Follow the same procedure in placing the right mandibular second
molar and second premolar.
d- In some instances, there is not sufficient space for the mandibular
first premolar. For esthetic reasons, it is usually advisable to grind the
mandibular first premolar to fit the available space rather than altering the
anteriors (Fig. 9-19).
e- Follow the same procedure in placing mandibular teeth on the left
side.
f- Remove all wax from the teeth. Flame the wax to smooth it.
Fig. (9-19): Setting-up the mandibular posterior teeth.

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WAXING-UP OF COMPLETE DENTURES
Waxing: The contouring of a wax pattern or the wax base of a trial

denture into the desired form.
Importance:
The form of the polished surfaces and the proper location and
arrangement of the artificial teeth play a major role in:
1- The aesthetic values of the denture.
2- The stability and retention of the dentures. Properly contoured facial
and lingual surfaces of complete denture allow the tongue, lips and cheeks
to closely adapt themselves to the denture surfaces and help in seating the
denture.
3- An adequately waxed denture also reduces the time required to finish
and polish the processed denture.
Requirements of wax-up
1- Wax-up should duplicate the soft tissues as closely as possible.
2- Contours of the denture flanges should be compatible with the shape
of the cheeks and lips.
3- Contours of the lingual flange should be compatible with the tongue.
It should have least possible amount of bulk.
4- Palatal section of the maxillary denture should accurately reproduce
the patient’s palate.
5- Notches should be provided to accommodate the frenum in both size
and direction.
6- Borders, both labial and lingual, should fill the vestibule.
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Waxing procedure for maxillary trial denture

1- The thickness of the denture flanges and the borders are reduced or
built-up to desired dimension dictated by the final impression.
2- Wax is contoured just above the cervical end of the tooth to produce
the gingival bulge or fullness simulating the attached gingiva. Gingival bulge
area is almost nonexistent in the first premolar region and is more prominent
posteriorly.
3- Wax is contoured around the cervical margin of the tooth at 45°
angulation with the long axis of the crown for anterior teeth and 35°
angulation for the posterior teeth (Fig. 9-20).
4- Wax is contoured above the canine to simulate the canine eminence
(Fig. 9-20).
Fig. (9-20): Left, the angulation (45 degree) for gingival carving anteriorly. The anterior
trial denture is slightly convex labially. Right, canine prominence added.
5- The wax is craved at the cervical line of the artificial teeth to simulate
the natural appearance of the gingival margin and gingival papillae
(Festooning). The gingival papilla should be convex both occlusogingivally
and mesiodistally and should fill the interproximal space below the contact
point. Long and pointed interdental papillae are carved for the young patient,
whereas short and blunt papillae are carved for old (Fig. 9-21).
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Fig. (9-21): Left: Interdental papilla in young adult. Right: Interdental papilla in elderly.
6- Root portion of the anterior teeth is carved in a triangular manner

with the canine root being the longest followed by the central incisor and the
lateral incisor (Fig. 9-22). The root extension carvings are a little less
prominent for premolars and least for molars.
7- Stippling can be accomplished using a brush in the region of
attached gingiva (Fig. 9-22). Stippling contributes to the natural appearance
by reducing even light refraction.
Fig. (9-22): Left: Triangular markings on wax for carving root portion. Right: Stippling is
accomplished using brush.
8- The contour of the anterior trial denture should have slight convex
effect overall (Fig. 9-20). The buccal surface (from the first premolar
backwards) should be concave (Fig. 9-23). This contour allows the
buccinator muscle to lie against the denture and aids in its retention and
stability.
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9- Palatal surface is waxed to restore contours present before the loss

of teeth and supporting structures. The palate should have an even
thickness of 2.5 mm.
10- Wax is adapted on the palatal surface of the tooth so as to create a
smooth curve and a least prominent margin. Palatal rugae may be
reproduced to aid in the proper formation of speech sounds (Fig. 9-23).
Fig. (9-23): Left: The proper thickness of palate and buccal flanges. The buccal surface
should be concave. Right: The wax should blend smoothly with the teeth on the palatal
surface with less prominent margins. Palatal rugae is reproduced to aid in phonetics.
Wax-up procedure for mandibular trial denture

1- The free gingival margin, gingival bulge and the interproximal papilla
are contoured similarly to the maxillary trial denture.
2- The labial surface should be slightly concave and un-protrusive as
possible to minimize the pressure of the lower lip on the denture, possibly
causing its displacement. The peripheries should be fully rounded and thin
edges should be avoided (Fig. 8-24).
3- The buccal surface must be kept flat and wax thin in the premolar
region. In the molar region the wax may be thickened and widened and the
surface must be concave (Fig. 9-24).
4- The contour of the lingual surface must be slightly concave without
extending the concavity under the lingual surface of the teeth (concavity in
the middle of the flange). A concavity under the teeth acts as an undercut
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into which the patient's tongue will slip, thereby causing the denture to be
unseated (Fig. 9-24).
5- The lingual flange should have least amount of bulk, except at the
border which is made thicker. This thickness is below the narrower portion of
the tongue and it greatly enhances the seal of the denture. However, the
borders at the lingual pouch area should be thin so that it does not interfere
with normal tongue movement.
Fig. (9-24): Left; the anterior labial and lingual flanges are slightly concave, have rounded
borders and minimal bulk. Middle; concavity in the middle of lingual flange. Right; the
buccal and lingual flanges are slightly concave. Correct contouring of buccal and lingual
flanges in molar region in left side, while right side is incorrect.
6- The wax should be extended to cover the maximum area possible in
the retromolar region.
7- Carving of the wax is smoothened by gently flaming using alcohol
torch, followed by cooling in chilled water.
Fig. (9-25): Finished waxing-up of both trial dentures.
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CHAPTER X
PROCESSING DENTURES
Denture processing:
The conversion of the wax pattern of a denture or a portion of a denture
into resin or other material.
Flasking
Flask is a metal to make sectional mould for processing acrylic resin during
fabrication of denture base and other prosthetic appliances (Fig. 10-1).
Fig. (10-1): Dental flask (A) Lower compartment (B) Upper compartment (C) Lid.
Purpose of flasking:
To produce a mould of the waxed-up denture for packing and
processing of the acrylic material.
Technique:
1- The dentures are sealed to the casts by molten wax around the
periphery with a wax knife to prevent any plaster flowing underneath the wax
during flasking.
2- The maxillary and mandibular casts are removed from their
articulator mountings (de-articulated) by placing a wax knife at the junction
of the cast and mounting and gently tapping with a hammer (Fig. 10-2). The
casts are trimmed to fit the flasks selected. In all cases the cast should be
tapered to facilitate deflasking.
127
Fig. (10-2): Casts removed from articulator.

3- Select a flask that is big enough for the model, allowing at least half
an inch between the teeth and the flask edge. The trial denture is tested in
the flask to establish its height in relation to the height of the flask.
4- The inner walls of the flasks should be smeared with Vaseline to
facilitate removal of the denture after processing.
5- The model should be soaked in cold water for 5 minutes so that the
flasking plaster will not come into contact with a dry surface and set
prematurely. Also, the sides and base of the cast are covered with a
separating medium.
6- The shallow section of the flask is filled with plaster, and the model is
placed in it. The plaster must reach the edges of the flask and brought up to
the periphery of the wax (Fig. 10-3). Excess plaster is wiped away and
smoothed so that no rough surfaces or undercuts will cause breakage on
separation of the other section.
7- A separating medium is painted over the plaster and the top part is
placed in position.
8- Another fresh plaster mix is placed over the teeth and wax surfaces
and vibrated to remove any air bubbles, which produce a rough surface of
the denture.
9- The top section is filled with plaster and excess plaster is wiped away
so that the flask edges are visible, and the two sections are closed together.
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10- Place the lid on the flask firmly and tap it gently to ensure the flask
has been completely filled, and then allow plaster to set (Fig. 10-1).
Fig (10-3): Left; flasking at the lower half. Right; complete flasking. Excess plaster
escaping through lid
Wax elimination
1- The flask in the holder is placed in boiling water for 5 minutes to

soften the wax. Prolonged heating will case molten wax to penetrate the
flasking plaster.
2- With a blunt end of plaster knife separate the flask. It is placed in the
slot in the posterior border of the flask, which is gently opened.
3- The molten wax and plastic denture base are discarded. Then Check
that no denture teeth have been dislodged on opening the flask.
4- Wax is removed from the plaster mould with boiling water. A little
detergent is added to the water. The flask is placed over gauze so that any
teeth that may be loosened will not be lost.
5- With a brush wax should be removed in Spaces between the necks
of the teeth, which may prevent union between acrylic resin teeth and the
base material.
6- The flask is placed aside to cool (10-4).
129
Fig. (10-4): The flask opened and wax eliminated (Lower denture).
Separating medium application:

The tin foil substitute (sodium alginate solution) is applied to the flasking
plaster and cast while the flasks are warm and wet (at about 45 degrees).
Care should be used to avoid painting any trace of separator on the teeth.
Only one coat of substitute is necessary on the tissue surface of the
edentulous cast. It prevents absorption of monomer into the plaster.
Packing the denture:

Packing: The act of filling a mold.
Denture packing: The act of pressing a denture base material into a
mold within a refractory flask.
1- Proportion polymer to monomer (3.5 to 1 by volume). By means of a
measuring cylinder 6-8 c.c. of monomer is placed in the mixing container.
The polymer is added slowly, the jar is tapped on the bench and stir to keep
the color uniform. The lid is placed on the mixing vessel till resin reaches the
dough stage. During packing a clean hands and instruments are essential.
2- A slight excess of material is placed into the tooth section of the
flask, using glass or stainless-steel spatula. Two pieces of cellophane paper,
moistened in cold water, are placed over it, and the two sections of the flask
are closed together.
130
3- The flask is placed in the bench press and closed gradually. No

more pressure should be applied after the first resistance is felt.
4- The flask is opened and the cellophane is stripped off the resin and
the excess removed with a sharp knife. Whenever deficiencies of the
material exist, more material is added.
5- The trial packing is repeated until the mould is completely filled and
the two halves of the flask are in contact at the last trial (Fig. 10-5).
6- The cast is painted with a separating medium and the two sections of
the flask are brought together and final closure is carried out. No cellophane
paper is placed at this time.
7- The flask is placed in a compensating flask press, which is firmly
closed to be ready for curing.
Fig. (10-5): Left: Kneaded material placed in the mandibular mould space and covered
with cellophane. Right: Trial closure procedure for mandibular denture and removal of
extruded acrylic.
Curing of acrylic resin:

The packed flask is heated in an oven or water bath; both the
temperature and time of heating must be controlled (Fig. 10-6). The
polymerization reaction is exothermic and the boiling point of monomer is
100.8°C. Uncontrolled temperature rise will lead to boiling of monomer and
subsequently denture porosity. One of these curing cycles is used:
131
A- Long curing cycle: Curing is made in constant temperature water

bath at 74 C for 9 hours with no terminal boil. Longer curing times will not
result in any degradation of properties.
B- Short curing cycle: Curing is carried out at 740 c for 1.5 hours and
then to increase the temperature of the water bath to boiling for an additional
one hour.
C- Rapid curing method: To save time, laboratories are frequently
using rapid heating in boiling water for 20 minutes.
Fig. (10-6): Acrylizing unit
Cooling
The flask should be cooled slowly on the bench to room temperature
before deflasking begins. Slow cooling permits relief of stresses by plastic
deformation. If rapid cooling is carried out increased distortion (warp) of the
acrylic will occur.
Deflasking
1- The first stage is to remove the investing plaster in one block from
the flask and this may be brought about by ejector or by gently tapping the
plates in the bottom of each section.
2- The investing plaster surrounding the model is separated by inserting
the knife blade between the two parts or by cutting down to the base of the
model.
132
3- The model is removed from the denture. It will be easier to remove it

while the denture is still held in the reverse investing plaster than after this
plaster has been removed. The model should be sectioned with a saw and
then the pieces removed with the knife.
4- The remaining plaster is then carefully sectioned with a saw-blade
and the separate sections surrounding the labial and buccal areas are
removed.
5- The plaster in the palatal portions of uppers may then be separated
by gentle leverage with knife. In the lowers plaster may have to be cut from
the posterior area forwards to the incisor region before separation.
Finishing and polishing:

Finishing: The refinement of form prior to polishing.
Polishing: The act or process of making a denture or casting smooth
and glossy.
1- The excess flush at the periphery of the denture is removed with a

large stone or bur
2- The surfaces are shaped until it is smooth and cleans. Particular care
must be taken to make the periphery rounded.
3- The fitting surface is checked for any small pimples of material which,
should be removed with a small stone or bur.
4- Polishing in the first instance may be done with brush wheel and
pumice, the final polish being obtained with rag wheel and felt cone with
pumice or Tripoli (ground porous rock mixed with wax).
133
Processing errors of acrylic resins
I- Porosity:
Porosity presents many problems:
1- It makes the appearance of denture base unsightly.
2- Proper cleaning of the denture is not possible.
3- It weakens the denture base.
a- Internal (Gaseous) porosity:
Internal porosity appears as voids or bubbles within the mass of the
polymerized acrylic. It is usually not present on the surface of the denture. It
is confined to the thick portions of the denture. Internal porosity is due to the
vaporization of monomer when the temperature of the resin increases above
the boiling point of monomer (100.8 °C). So, dentures with excessive
thickness should be cured using a long, low temperature curing cycle.
b- External (Contraction) porosity:
It occurs because the monomer shrinks by 2o% of its volume during
polymerization (Fig. 10-7). It can occur due to two reasons:
i- Lack of homogeneity, the portions containing more monomer will
shrink more. It is avoided by using proper powder/liquid ratio and mixing it
well and packing in the dough stage.
ii- Lack of pressure during polymerization or inadequate amount of
dough in the mold during final closure causes bubbles.
Fig. (10-7): External porosity.

134
II- Tooth movements:

Teeth may change its position during processing.
Causes:
1- The use of plaster instead of stone in investing the trial denture.
2- Incomplete closure of the flask.
3- Excessive and rapid pressure during trial closure.
4- Over packing of the mold with resin material before final closure.
III- Denture base and teeth breakage during deflasking.
Causes:
1- Knife blade hit teeth when removing stone cap.
2- Hammer used to tap denture out of the flask.
IV- Fractured or cracked teeth:
Causes:
1- Packing the dough in the rubbery stage making the material too stiff.
2- Excessive and rapid application of pressure during trial packing.
3- Setting the teeth directly on the stone cast.

V- Crazing of acrylic resin base or acrylic teeth:
Crazing of resin consists of the formation of small cracks, which may
vary, in size from microscopic dimension to the visible size, it indicates
beginning of fracture. Cross-linking of resin reduces this fault considerably.
Causes:
1- Stresses induced by the contraction of the resin around the tooth by
rapid cooling.
2- The use of solvents to remove wax from the mold before packing.
VI- Bleaching of acrylic resin:
Causes:
1- Contamination of the acrylic resin with some acrylic solvents.
135
2- Under cured acrylic resin due to incorrect time and temperature of

curing.
3- Incorporation of the tinfoil substitutes with the acrylic resin.

4- Incorporation of the jelly like material of wet cellophane into the resin.
VII- Color streaks in the resin material:
Causes:
1- Improper mixing of the monomer and polymer.
2- Contamination of the resin mix with dirty hands or instrument.
3- Adding resin material in layers during trial packing.

VIII- Sandy appearance of the acrylic resin:
Causes:
1- Too much delay in curing after packing (more than 1/2 hour).
2- Evaporation of the monomer.

3- Insufficient monomer in the mix.
IX- Stone adhere to the surface of the denture.
Causes:
1- Insufficient separating medium on the mold before packing.
2- The application of separating medium contaminated with stone.
3- Incomplete elimination of wax during washing out thus rendering

separating medium ineffective.
X- Space between the teeth and resin base:
Causes:
1- Delayed curing, leaving the flask without curing for a long time.
2- The application of separating medium on the teeth.
136
CHAPTER XI
REPAIR, RELINING AND REBASING
Repair
Causes of denture fracture:
A- Construction faults:
1- When posterior teeth, particularly upper, are set outside the ridge.
2- Unbalanced articulation will result in abnormal stress being applied to
the denture or the teeth.
3- Excessive relief sometimes accounts for a broken denture by
reducing the midline denture thickness.
4- The use of incorrect dough consistency when packing, inadequate
polymerization times and temperatures, and too rapid cooling after
processing, will result in a denture base of reduced strength and
dimensional inaccuracy.
Causes of teeth off, but not broken
1- Insufficient packing of acrylic resin.
2- A film of grease, separating medium or wax on resin teeth.
3- Packing acrylic resin when the dough is at too advanced stage; there
will be insufficient free monomer to unite with the acrylic resin teeth.
B-Causes in the mouth:
1- Excessive force applied during mastication or by the patient
clenching or grinding the teeth.
2- Alveolar absorption will cause the denture to be unevenly supported
and is a common cause of fracture.
3- A labial frenum attached high on the ridge may necessitate a deep
frenal notch in the denture. Such a notch may be the site of the
commencement of a denture crack (fracture).
137
4- Inadequate relief of an upper denture in midline of the palate, Fatigue

fracture may follow.
C- Causes out of the mouth:
Excessive pressure during cleaning or dropping the denture on the floor

or onto a wash bowl.
Repair of complete fracture:

1- The broken edges of the denture are cleaned of food and material
debris, so the two parts will fit together well.
2- The parts of the broken denture must be reassembled accurately and
fixed together by means of an old bur or matchsticks which are luted to teeth
and the adjacent resin surfaces by means of sticky wax (Fig. 1-11). No wax
is placed over the fracture, so that the tissue and palatal sides of the fracture
can be examined to see that they are in correct apposition.
Fig. (11-1): Left; fractured denture. Right; reassembling the fractured denture.
3- Plaster is vibrated onto the palatal surface of the denture to form the
cast.
4- When the model has set the sticky wax is removed and the broken
parts of the denture are removed from the model.
5- The resin on both sides of the break is cut away (2-3 mm) and
beveled (Fig. 11-2). Then the cast is replaced,
138
In the case of complete upper dentures, it is advisable to remove the

entire palatal resin to minimize the warpage of the old acrylic resin during
the polymerization of new material.
A- Repairs using cold-curing resin

The use of cold-cure acrylic resin is advised for all repairs in order to
minimize the warpage of the old material. The possible weakness with cold
cure material is the area of union of the old and new resin.
Acrylic resin monomer is painted on the cut surfaces, and a cold-curing
repair resin is placed in the break. Finishing and polishing of the denture are
performed after curing of the repair resin.
B- Repairs using heat-curing acrylic resin:

The palatal or lingual area in the case of a lower denture is waxed up,
together with the labial flange.
The waxed-up denture is flasked. The denture on its model should be
embedded completely in deeper section of the flask so that only the wax is
exposed.
Wax elimination, packing and curing of acrylic resin, Deflasking,

finishing and polishing are carried out as for a new denture.
Fig. (11-2): Left; the fracture line widened. Right; complete repair.
139
Replacement of teeth
1- If an anterior tooth is loosened it should be stabilized with sticky wax
at the incise edge and a plaster (index or matrix) overcast is poured to
register the position (Fig. 11-3).
Fig. (11-3): Left; tooth attached in position by sticky wax. Middle; Plaster index on
denture. Right; Acrylic applied from palatal aspect.
2- When the plaster of the overcast has set, the tooth is removed. The
wax is washed out. The resin on the lingual or palatal side is cut and a
dovetail is prepared for the new resin. This gives adequate access and
provides mechanical as well as chemical retention.
3-The index is coated with separating medium and placed in position.
4-The tooth is set in place by the help of the index.
5-The repair acrylic is made to fill the space around the teeth. It is then
cured finished and polished
If a tooth or teeth have been broken or are missing from a complete
denture, a similar method is used for their replacement. New teeth must be
waxed to the denture and it may be necessary to check the shade and
position by reference to the mouth.
In replacing posterior teeth, care must be taken to maintain correct
occlusion by reference to the opposing denture.
Repair of a fractured denture with missing part:
Plaster or compound impression material is applied to the missing part,

after setting of the impression material the denture is removed and a cast is
140
poured. Self-curing resin is applied to restore the missing part (Fig. 11-4).
Fig. (11-4): Left, compound impression for missing part. Right, repaired denture.
Relining and rebasing

Definitions:
A Reline: is the resurfacing of the tissue side of a denture with new
base material to provide more accurate fit.
A Rebase is a process of refitting a denture by replacing the denture
base material without changing the occlusal relation of the teeth.
Objectives:
1- Improvement of complete denture retention and stability.
2- Restoring position of occlusal plane and improvement of appearance.
3- Restoration the vertical dimension of occlusion.
4- Restoration of evenness of occlusal pressure.
5- To alleviate pain due to rocking of the denture.
Indications for relining and rebasing:
1- Adaptation of the denture bases to the ridges is poor due to resorption of
the residual alveolar ridges.
2- For geriatric or chronically ill patients when the construction of new
dentures can cause physical or mental stress.
3- Rebasing is additionally required in cases of:
a- Porous denture base.
b- Discolored or contaminated denture base.
c- Repeated repair or relining of the denture.
141
Contraindications:
1- Excessive ridge resorption- make new dentures.
2- When hyperplastic soft (Flabby) tissues are present
3- If the dentures have poor esthetics or unsatisfactory jaw relationships.
Denture preparation for relining or rebasing:
1- Border extension is checked and corrected.
2- Undercuts are relieved.
3- Occlusal disharmony is corrected by selective grinding.
4- Pressure spots are adjusted.
5- Accurate posterior palatal seal is established.
Clinical procedures:
For either a rebase or a reline, an impression with the denture is made
without incorporating errors in the occlusion, by having the patient bite in
centric occlusion until the impression material sets.
Laboratory procedures:
The relining or rebasing impression is beaded, boxed and poured with
dental stone. The cast is not separated from the impression.
The difference between relining and rebasing is in the amount of old
denture base removed and replaced. For rebasing (Fig. 11-5), the entire
denture base is eliminated excepting the teeth and may be 2 mm of
adjoining denture base. To facilitate removal of palatal section of maxillary
dentures, holes are drilled in the palate before impression making.
Fig. (11-5): Left: Perforation of denture. Holes drilled in palatal portion. Right: Trimming of
the entire denture-bearing surface except for teeth for rebasing.
142
One of the following methods can be used for conversion of the impression
material to denture base material:
I- Flask method
II- Articulator or Jig or Hooper duplicator method.
I- Flask method:
1- The cast with the denture is imbedded in a processing flask.
2- The flask is warmed to soften the impression compound before
opening it to remove the impression material.
3- The border of the denture is roughened for relining or the base is
trimmed for rebasing (Fig. 11-5).
4- Separating medium is applied on the plaster and stone molds, and
heat-polymerized denture base resin is packed into the mold. The flask is
closed and clamped to ensure maintenance of occlusal vertical dimension.
4- The acrylic is then processed.
5- After processing, the flask is cooled slowly and the denture is
retrieved from the stone mold, finished and polished.
II- Articulator or Jig or Hooper duplicator methods:

1- The cast and the denture are mounted on the upper member of the
articulator (Fig. 11-6) or jig or Hooper duplicator (Fig. 11-7).
2- Plaster is mixed and applied on the l ower member of the
instrument; 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 instrument are separated. The denture is removed
from the cast, and all impression material is cleaned from the cast and the
denture base.
4- For relining, the denture borders are squared to form a butt joint for
the attachment of the new acrylic resin material. The palatal portion of the
143
maxillary denture is removed close to the palatal surface of the teeth. For
rebasing, the entire denture base and the palatal portion are removed.
Fig. (11-6): Left: Completed mounting of relined impression with cast on the articulator with
formation of index for the denture teeth. Right: Key or index of denture teeth.
5- The denture is positioned so that the teeth are placed in the
occlusal index in the lower member of the instrument.
6- The post dam is prepared on the maxillary cast.
7- The denture is waxed-up.
8- The waxed-up denture is removed from the mounting, flasked,
processed with heat-cure acrylic resin, finished and polished.
Fig. (11-7): Left, diagram of a jig. A, upper member. B, denture with relining impression.
C, plaster index. Middle, denture mounted to upper member of Hooper duplicator. Right,
lower member of Hooper duplicator with plaster index.
144
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N, B. All pictures in this book are copied from the above references and from internet.
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Technical complete denture

DR. OSAMA A. BARAKA

DR. HUSSEIN ELDAWASH

Chapter Subject Page

I Introduction and anatomy 3

II Impression trays, impressions and boxing 32

III Retention, stability and support 50

IV Posterior palatal seal and relief 56

V Mandibular movements and jaw relations 66

VII Face bows and dental articulators 86

VIII Selection of artificial teeth 96

XI Arrangement of teeth and waxing-up 107

X Processing dentures. 127

XI Repair, relining and rebasing. 137

INTRODUCTION AND ANATOMY

Denture is an artificial substitute for missing natural teeth and adjacent

Fig. (1-1): Left; complete denture. Right; removable partial denture.

Retention is a quality inherent in a prosthesis acting to resist dislodging

The differences between natural teeth and artificial teeth

Component parts of complete dentures

Fig. (1-6): Lingual flange

Steps in Fabrication of Complete Dentures

Clinical procedures Laboratory procedures

1- Diagnosis and treatment planning

ANATOMY IN RELATION TO COMPLETE DENTURES

Fig (1-8): A, The Nasolabial sulcus. B, Mentolabial sulcus.

tooth placement will restore a good curvature of the philtrum.

Fig. (1-10): PH, The philtrum. VB, The vermillion border.

Fig. (1-11): Left: Angular cheilitis. Right: The modiolus.

Fig. (1-12): The interpupillary line and ala-tragus line.

The anatomic landmarks of significance in relation to maxillary and

Maxillary anatomic landmarks

Fig. (1-13): Maxillary supporting structures.

1- The alveolar ridge:

Fig. (1-13): Shape of hard palate. A, U-Shaped. B, V-Shaped. C, Flat.

Fig. (1-15): Ridge undercuts. A, anterior undercut. B, bilateral posterior undercuts.

3- The Palatal gingival vestige:

Fig. (1-16): The Palatal gingival vestige (Arrows).

coverage of a wide area and good bearing surfaces. However, tuberosities

Fig, (1-18): Incisive papilla. Left; in dentulous. Right; in completely edentulous.

6- The palatine rugae:

7- Median palatine raphe:

Fig. (1-20): Torus palatinus. Left, in dentulous. Right, in completely edentulous.

Maxillary denture limiting areas:

1- The maxillary labial frenum:

forward narrowing the buccal vestibule. (Fig. 1-23).

5- Pterygomaxillary (hamular) notch:

6- The posterior vibrating line of the palate:

Fig. (1-25): Fovea palatinae. Left, in model. Right, intraoral.

Mandibular anatomic landmarks

Types of mandibular ridge:

3- External oblique ridge;

4- Buccal shelf area:

The buccal shelf is considered a primary stress-bearing area of the

5- Retromolar pad area:

It gives attachment to the mylohyoid muscle and should be covered by

Fig. (1-31): Left, torus mandibularis. Right, genial tubercles.

Mandibular limiting structures:

Fig. (1-32): Anatomic landmarks that limit the mandibular denture.

1- The mandibular labial frenum:

5- The retromolar pad area:

b- The mylohyoid muscle influencing area:

c- The retromylohyoid space (lingual pouch):