Complete denture DPT 223 1

UE Dentistry
PL Lecture 1 – (11/13/18) § Non-keratinized stratified squamous epithelium
§ Soft palate, cheek, lips, linguo-alveolar sulcus,
PROSTHODONTICS frenum
• Also called Dental Prosthetics or Prosthetic Dentistry C. Specialized Mucosa
• Area of dentistry that focuses on dental prosthesis § Tongue (dorsum), taste buds, lingual papilla, sulcus
• Prosthodontist is the one who specializes in Prosthodontics terminalis
II. DIFFERENT CONSISTENCIES OF MUCOSA
BRANCHES OF PROSTHODONTICS A. Resilient
• Fixed Partial Prosthodontics § Can resist forces when applied
• Removable Prosthetic Dentistry § Ideal mucosa for denture bearing mucosa
B. Flabby
o Removable Partial Denture
§ Movable and not easily ___ stable
o Removable Complete Denture
§ Thick submucosal tissue
• Maxillofacial Prosthetic Dentistry
§ Bone is totally resorbed or areas not supported by
• Implant Prosthetic Dentistry bone
C. Unyielding
PROSTHODONTICS IS CONCERNED WITH THE REPLACEMENT OF TEETH
§ No movement and stable
OF PATIENTS WHO:
§ Thin submucosal tissue
• Have lost all their teeth – Conventional Complete Denture
• Are about to lose all their teeth – Immediate Denture PL Lecture 2 – (11/15/18)
• Are not completely edentulous – Overdenture
HARD AND SOFT TISSUE LANDMARKS OF MAXILLA AND MANDIBLE
OBJECTIVES OF PROSTHODONTICS I. MAXILLARY ARCH
• To restore function
• To Restore phonetics
• To provide aesthetics
• To provide comfort

YMATO FACTOR ® Dentist-Patient-Technician Relationship

• Dentist interacts with both technician and patient.
• Technician only applies mechanical principles but cannot
analyze biological considerations

DIAGNOSIS
Psychological Classification of Patients (Dr. Milus House’s)
• Philosophical
o Accept the dentist’s judgement without question
• Exacting
o Patient who ask a lot of questions A. Residual Alveolar Ridge
§ Once there is no tooth present on alveolar bone
• Hysterical
o Patients with past bad experience (unstable) § Primary stress bearing area, where we get our
retention especially for upper denture
• Indifferent B. Incisive Papilla
o Does not care about oral hygiene § Most stable landmark because no matter how
recessive the bone, the incisive papilla remains
PATIENT’S EXAMINATION AND EVALUATION
§ Basis of midline
• Overall appraisal of the patient C. Maxillary Tuberosity
• Patient’s needs and expectation § Most posterior point of the upper arch
• Medical, psychological and behavioral considerations D. Pterygomaxillary Notch
• Anatomic and physiologic factors § Just posterior and superior maxillary tuberosity
o Buccal Shelf E. Vestibular Fold
o Interarch Distance F. Frenae
§ There is relief in this area
ANATOMY OF EDENTULOUS MAXILLA AND MANDIBLE 1. Labial
I. CLASSIFICATION OF MUCOSA - Middle of central incisors
A. Masticatory Mucosa 2. Buccal
§ Found in hard palate, attached gingiva, and residual G. Vestibule
alveolar ridge 1. Labial
§ Keratinized stratified squamous epithelium 2. Buccal
§ Most hard parts of oral cavity are covered by this H. Palatine Fovea
B. Lining Mucosa § 2 pits or depression on the most posterior area in
between the median palatine raphe
DR. RHODORA LUCIANO, DMD DDC BUHAT, JOHN PATRICK Q.
Complete denture DPT 223 2
UE Dentistry
I. Vibrating Line § So, we have to make sure it doesn’t over extend
§ Found 1-2 mm above palatine fovea (anatomically) 1. Premylohyoid
§ Ask the patient to say “ahh” (physiologically) - Canine to Canine area
J. Rugae 2. Mylohyoid
K. Coronoid Bulge - Floor of the mouth is covered with this muscle
§ Seen on anterior and lateral of maxillary tuberosity - Connected from one mylohyoid ridge to
is a bulge another mylohyoid ridge
§ Prominent when mouth is opened - Premolar to Molar Area
L. Median Suture 3. Retromylohyoid Sulcus
M. Torus Palatinus*
- S-shaped
§ Most females are affected
II. MANDIBULAR ARCH - Area of retention
- Medial to retromolar pad
H. Masseteric Notch
§ Powerful muscle attachment
- Do not overlap the outline
- Must do a reverse S when outlining
§ Lateral to retromolar pad
I. Vestibules
1. Buccal vestibule
2. Labial vestibule
J. Retromylohyoid Curtain
§ Just above the retromylohyoid area
K. Pterygomandibular Raphe
§ Just above the retromolar pad
L. Lingual Tubercle
§ Medial and superior to retromolar pad
M. Sublingual Caruncle
A. Retromolar Pad N. Torus Mandibularis*
§ Pear shaped § Elevation is more than 1mm then it is not allowed
in the clinic
§ Diamond shape on the most posterior part of lower
arch
CLASSIFICATIONS OF GYPSUM:
§ Most stable landmark
Type 1 (Impression Plaster)
§ Basis of getting the height occlusal plane Type 2 (Plaster of Paris) – what we used for our study cast
B. Buccal Shelf Type 3 (Dental Stone) – for our master cast
§ Hard structure Type 4 (Improved Dental Stone or Die Stone High Strength Stone)
§ Plateau Type 5 (Dental Stone, High Strength, High Expansion / Investment
§ Primary stress bearing area Compound?)
C. Residual Ridge
D. Frenae Water first then powder
§ If you don’t relieve the frenum area, our denture Too much powder ratio ® weakens your cast
base will move, it will attach to the tongue but not Initial setting time of type 2 gypsum ® more or less 20 minutes
the lingual frenum
Full strength ® after 5 minutes
§ If the lingual frenum’s attachment goes over at the
lingual of the anterior residual ridge then you need
to have surgery PRIMARY AND SECONDARY STRESS BEARING AREAS
1. Labial • Stress bearing areas – it is the denture base area, covered
2. Buccal by the denture base
3. Lingual • Denture base is covered by the mucosa, mucosa covers the
E. Mucobuccal Fold and Mucolabial Fold bone. So, when the force is placed on the denture base it
§ Ends or periphery of the denture goes to the mucosa, it goes to the bone
F. Sublingual Crescent • If there is a force or stress that falls directly, perpendicularly
§ Seen when tongue is raised, posterior to lingual to the surface of your denture base or perpendicular to the
frenum surface of the denture of the denture bearing areas it is
G. Alveolingual Sulcus called a ® Primary Stress Bearing Area
§ On the ligual side, a specific lingual vestibule • Lateral receiving load, not perpendicular ® Secondary Stress
§ This is important because it sets the boundary of Bearing Area
the denture which is the lingual boundary of the • Basal Seat – also known as denture bearing area
denture
o 3 important areas:
§ If you over extend the lingual periphery of your
denture it touches the floor of the mouth so § Stress Bearing Area
gagalaw galaw yung denture mo kasi andun yung § Non-Stress Bearing Area / Relief Area
tongue § Posterior Palatal Seal Area
DR. RHODORA LUCIANO, DMD DDC BUHAT, JOHN PATRICK Q.
Complete denture
UE Dentistry
• Note:
o Impression surface of denture:
§ Must cover all the denture bearing areas or
supporting areas
§ Peripheral or the limiting area
• Rule of Thumb:
o The foundation of the denture lies on bone and residual
ridge which is covered by mucous membrane
• Mucous Membrane
o Submucosa
§ A connective tissue which varies in from dense to
loose areolar tissue
§ Acts as cushion
§ Submucosa of Flabby tissue is thick
§ Submucosa of Unyielding is thin
o Mucosa
§ A stratified squamous epithelium
§ Keratinized
§ Lamina dura - Connective Tissue
§ Masticatory Mucosa - hard palate, crew or ridge,
residual mucosa
§ Favorable Type of Mucosa:
- Submucosa is firmly attached to the
periosteum of the bone withstand the
pressure of denture (Resilient)
- Thin non-resilient which traumatized the
mucous membrane easily (Unyielding)
- Loose – easily displaced which affect the
stability (Flabby)
MAXILLARY ARCH
I. STRESS BEARING AREAS
A. Primary Stress Bearing Areas
1. Crest of Maxillary Residual Ridge
2. Hard Palate
B. Secondary Stress Bearing Areas
1. Rugae
2. Lateral Sides of the Residual Alveolar Ridge
II. RELIEF AREAS
o These are the non-stress bearing areas which means
you’re not supposed to cover these areas because if
you put load in these areas it will cause mark to the
tissue
A. Frenae
B. Incisive Papilla
C. Torus Palatinus - with unyielding lining
D. Median Palatine Raphe – it is where hard palate fuse
III. POSTERIOR PALATAL SEAL AREA
o If this area is not sealed, air will pass when talking
o Lower is sealed because of pull of gravity
A. Hamular Notch
B. Vibrating Line
MANDIBULAR ARCH
I. STRESS BEARING AREAS
A. Primary Stress Bearing Areas
1. Buccal Shelf
2. Slopes of the Residual Alveolar Ridge
- On the slopes of the residual ridge because
the ridge is pointed, unlike upper which is
rounded
- Bone recedes faster from labial to lingual
unlike in upper which recedes only on facial
DR. RHODORA LUCIANO, DMD
DPT 223 3
- Crest is pointed and flabby
B. Secondary Stress Bearing Area
1. Retromolar Pad
II. RELIEF AREAS
A. Frenae (Labial, Buccal and Lingual)
B. Masseteric Notch
C. Crest of Mandibular Residual Ridge
D. Torus Mandibularis
Study cast ® individual tray
Final impression is to produce ® master cast / working cast
MOUTH PREPARATION/PREPROSTHETIC PROCEDURES
I. NON-SURGICAL METHODS
II. SURGICAL METHODS
o Management of Hard and Soft Tissues
• Aim: Improving the patient’s denture foundation and ridge
relations
o Give the retention and stability
I. NON-SURGICAL METHODS
A. Rest for Denture Supporting Tissues
1. Removal of dentures from mouth for 48 – 72 hours
- To get the true form of the ridge
- Stress is comparable to pressure
- The mucous membrane or gingiva will not be
subjected to any pressure therefore you will
get the mucostatic stage or the true form of
your ridge
2. Use of temporary soft liners inside the old dentures
- Silicone based material applied on the tissue
side of the denture and placed inside the
mouth to relieve the gingiva of any pressure
3. Finger or toothbrush massage
- To improve circulation
4. Mouthwash
- To remove areas with undercuts because it
may harbour bacteria which affects the
integrity of the gingiva wherein there are
times that infection is present that will not
give you the actual form of the gingiva
[Soft liner pictures]
B. Occlusal and Vertical Relation Correction of Old
Prosthesis
§ Why do we check the old prosthesis? Bone recedes
therefore the vertical relation decreases
§ How long should the patients wear their dentures?
5 - 7 years
C. Good Nutrition
§ Elderly, who wears dentures, always malnourished
- They think that they cannot properly
masticate the food because they don’t have
their natural teeth anymore
- Aim: providing them with good natural denture
to provide good function
§ Grinding of food leads to absorption of food (initial
digestion inside their oral cavity)
- The elderly does not grind their food much
D. Conditioning of the Patient’s Muscles
§ Muscles of Mastication must be checked because
patients with edentulous ridges mostly have TMD
DDC BUHAT, JOHN PATRICK Q.
Complete denture
UE Dentistry
§ If you lost any tooth or teeth there will be changes
because the normal harmony of the vertical
distance will be changed unless the tooth is
replaced immediately
§ When would the symptoms appear? Depends on
the conditioning of the patient
§ Ex: TMD Dysfunctions
II. SURGICAL METHODS
Management of Hard and Soft Tissues
A. Correcting conditions that preclude optimal prosthetic
functions
1. Hyperplasia of the Palate
- During early prosthodontic practice, it is
believed that in order to enhance the
retention of the upper denture you would have
to create a vacuum
- So, on the tissue side of the denture you
would have to create a space
- Harbours bacteria
- Today, how is the retention of upper denture
improved?
- Denture will create the peripheral borders
of the posterior palatal seal which will
comprise of the vacuum
- Treatment: removal of denture for 72 hours
- If it doesn’t go back to the original form,
then the dentist would have to do an
excision
2. Hyperplastic Ridge
- Excessive formation of ridge due to trauma,
pressure or ill-fitting denture
- Treatment: reduce and do incision to reduce
the height
3. Epulis Fissuratum
- Due to overextended denture bases or
denture plunges
- Once there is irritation, you make the cells so
active and will proliferate and grow further
- Treatment: surgical removal
4. Papillomatosis
- Found in the inner part of lips or cheeks
caused when the patient constantly biting on
the area
- Treatment: excision
5. Unfavorably located frenular attachments
- Diastema is usually caused by high attachment
of the frenum
- In edentulous case, you would have to cut the
frenum if it interferes with the retention
capability
6. Pendulous fibrous maxillary tuberosities
- Movable part of maxillary tuberosity which is
not an adequate bone support without bony
structures underneath
- Treatment: removal
7. Bony prominences, undercuts, spiny ridges and non-
parallel bony ridges
- Non-parallel bony ridges caused by different
times of extraction
DR. RHODORA LUCIANO, DMD
DPT 223 4
- Higher alveolar bone for tooth that is recently
extracted
- Alveolectomy is done for it to be parallel to
other remaining parts
8. Discrepancies in jaw size
9. Torus
- Treatment: surgical removal
- Indications of maxillary torus:
- Too large torus that affects extend and
stability of the maxillary denture
- An undercut torus that traps food
causing a chronic inflammatory condition
- A torus that extends up to the junction
of the hard and soft palate thus
preventing adequate peripheral seal
- One that causes the patient concern
10. Pressure on the mental foramen
- Mental foramen is found found in your
mandibular premolars
- If the ridge of the patient is so flat, if you will
pressure the mental foramen then there will
be burning sensation
- Treatment: relieve the area or vestibuloplasty
to improve the position of the mental foramen
- Improvement of the Class II relationship by
removing some portions of the alveolar bone
on the labial part so there is no maxillary
protrusion
- Class III is not treated, only rearrangement of
the setting of the maxillary
PL Lecture 3 – (11/22/18) & PL Lecture 4 – (11/27/18)
B. Enlargement of Denture Bearing Areas
§ Treatment: Vestibuloplasty (deepen the vestibular
fold) to increase the height of the residual ridge or
Bone Graft
§ Ridge augmentation
C. Replacing tooth roots by osseointegrated dental
implants
§ If you want to improve the retention, patients
agree to have dental implants
§ Teeth Implant Requirements
- Maxillary: 4 - 6 implants (on Canine and Molar
region)
- Mandibular: 2 - 4 (on the Central or Canine)
IMPRESSION
I. DEFINITION
o A negative copy of the mouth being taken
o Positive copy is the cast
II. CLASSIFICATION
A. According to the type of impression
1. Preliminary Impression
2. Final Impression
B. According to the pressure applied
1. Minimal Pressure Technique (Mucostatic Impression)
- Impression of natural state condition of the
gingiva
- Alginate or Rubber Impression (Final
Impression)
2. Selective Tissue Placement Technique (Selective
Pressure Impression)
DDC BUHAT, JOHN PATRICK Q.
Complete denture
UE Dentistry
- You will relieve some part of the tissues like
flabby tissue
3. Pressure Technique (Functional Impression)
- You will have to retract
- Preliminary Impression
C. According to the mouth position
1. Open Mouth Impression
- Taking 1 impression at a time
2. Closed Mouth Impression
- Use of old denture to take impression
- Load the impression material on the tissue
side of the denture
- To record all denture bearing surfaces that are
available and cover the widest area possible
within the limits of function and tolerance
III. OBJECTIVES/ REQUIREMENTS/ PRINCIPLES
A. Objectives of accurate impression making
1. To record all the potential denture bearing surface
available (all anatomic structures)
2. To cover the widest area possible within the limits
of function and tolerance
- Ex. Pxs who have active gag reflex
3. To provide esthetics, support, retention, and
stability for the denture
- For accuracy:
- 3mm width of muccoLa/Bu fold
4. Will act as foundation for improved appearance of
the lips and at the same time maintain health of
oral tissues
B. Requirements
1. Knowledge of the oral anatomy
2. Knowledge of materials to use and how to use
them
3. Knowledge of reliable technique
4. The proper skills to make an impression
5. Knowledge on how to manage a patient
6. Should maintain the health of the oral tissues
- You need to try-in the tray first to prevent
any injuries to mouth
7. Must restore aesthetics by providing lips with
proper support
8. Must provide retention
- By copying denture bearing areas
9. Must provide stability
10. Must provide support
- Do not shorten borders of impression tray
C. Principles
1. Support
- Resistance to vertical forces of mastication
and other occlusal forces
- Areas of support:
ü Alveolar ridges
ü Hard palate
ü Buccal shelf
ü Retromolar pads
2. Retention
- Resistance to dislodgement, resist adhesion of
food, forces of gravity
3. Stability
- Resistance to horizontal forces
- Cover all denture-bearing areas
- Assure good retention
DR. RHODORA LUCIANO, DMD
DPT 223 5
- Using correct impression material and
technique
FACTORS OF RETENTION OF COMPLETE DENTURES
i. Adhesion
o Physical attraction of unlike molecules
o Adhesion of saliva to the mucous membrane
o Cover fovea palatinate – secretes saliva
o Physical property of retaining two particles together
o Involves chemical properties
o Less retention if there is salivary gland problem
ii. Cohesion
o Physical attraction of like molecules
o Occurs within layers of fluid (saliva)
o In between denture base and mucous membrane is saliva
o Is the reaction of same molecular property?
iii. Interfacial Surface Tension
o Results from a thin layer of fluid that is present between
two parallel planes of rigid material
o It is dependent on the ability of fluid to “wet” the rigid
surrounding material
o Reaction between cohesion and adhesion
iv. Capillary Attraction
o Or Capillarity is what causes liquid to rise in a capillary
tube
o Liquid will maximize its contact with the walls of the
tube
o Clean to prevent space
o Denture base to mucosa, space filled with thin film of
saliva acts as capillary tube, liquid seeks to a contact
o Attraction between or on the/near surface area or
peripheral borders of the same molecule
v. Atmospheric Pressure
o Can resist dislodging forces by providing a resistance
force called “suction” force
§ Peripheral Seal
- (+) contact of the entire periphery of the
denture base to the tissue covering the basal
seat
- Make an accurate impression of mucolabial and
mucobuccal fold
§ Border Molding
- Procedure involving impression of the
vestibules: La, Bu, and Li palatal
vi. Oral and Facial Musculature
o Supplementary retentive forces, provided that:
§ Teeth are positioned in the “neutral zone” between
the cheeks and tongue
- Set the teeth at the crest of the ridge
- Central fossa
- Zone of Equilibrium
- Both sides are exerting the same force
§ Polished surfaces of denture base properly shaped
IV. IMPRESSION MATERIALS
A. Preliminary impression materials
1. Modelling Compound - best material
2. Alginate - alternative material
B. Final impression materials
1. Plaster of Paris (impression plaster – type 2 dental
gypsum) : rigid
2. Zinc Oxide Eugenol Paste : rigid, not used
3. Irreversible Hydrocolloids (Alginate) : non-rigid
DDC BUHAT, JOHN PATRICK Q.
Complete denture
UE Dentistry
4. Tissue conditioner – intermediate px
5. Elastomeric impression material (rubber impression
materials) – best material
V. IMPRESSION TRAYS
Classifications
A. Ready-made trays
1. Aluminum Edentulous Stock Trays
- For preliminary impression
2. Edentulous Stock Trays
3. Patient’s Old Denture
B. Custom-made trays/ individual trays
1. Modelling Compound Preliminary Impression
2. Shellac Base Plate
3. Self-Cured Acrylic Resin Tray
4. Light-Cured Resin Tray
CONSTRUCTION OF INDIVIDUAL TRAYS
i. Outlining of casts
o Record Base/Denture Base Outline
§ Continuous red line
§ Done on deepest part of the vestibular fold
§ For the lower, you move 1mm away from
masseteric notch
o Tray Outline
§ Interrupted blue line (with apron for the upper)
§ 1mm inside the denture base outline
- Purpose: to have enough space for your
impression material to flow
§ When you reach the hamular notch area, about 3
mm from the middle of the hamular notch area you
make a diagonal line of about 2 – 3mm as much
as possible overlapping the fovea palatini
- Purpose of Apron: for displaceable area or
tissue to be displaced - area where you want
to cover everything
- Bone underneath the soft palate is
palatine process of maxillary bone but
only in the superior part
- Bone underneath hard palate is palatine
process of maxillary bone
§ Shellac Base Plate
- 1 mm short of the denture base outline
except on the posterior palatal seal area
because you will extend the tray outside to
make an apron
- Apron
- For overextending the tray so that you
are assure to get an accurate impression
and extension of the posterior palatal
seal area
- Use an alginate
§ VLC
- 2 mm short of the denture base outline
- You will do border molding for more accurate
periphery of the denture
- Use rubber impression
ii. Blocking out of undercuts
o Placement of wax
o Block out the anterior (labial) area, tuberosity sulcus,
superior to incisive papilla, prominent palatal rugae
o For easily removing and prevent breakage
iii. Blocking out of relief areas
iv. Placement of wax spacer and tissue stops
DR. RHODORA LUCIANO, DMD
DPT 223 6
o Shellac
§ 5x5 pink wax on premolar and molar areas (areas
where you put on pressure)
o VLC
§ No need for tissue stop, you need a closed fitting
tray
§ Rubber impression – flow (not as flowable as
alginate)
§ Put a hole at the center to release a pressure
v. Adaptation of the tray material
vi. Placement of the handle
o For the lower, height of vertical component is about 2/3
an inch
§ Guide is the upper border of upper lip
o Horizontal component is about an inch long
o Width is about 2/3 an inch
o Handle for lower is 90 degrees
o Upper handle is 45 degrees on top of incisive papilla and
crest of alveolar ridge
vii. Trimming and placement of perforations
o Perforations
§ Alginate: retention
§ Rubber impression: release of pressure
o On VLC, place 1 hole on palatal area for upper and 1
on each side for the lower
o Folding is done for shellac
o Attachment for alginate is by mechanical
o Attachment for RIM is by chemical via an adhesive
VLC is done on the blue line because bolder moulding
still has to be done
Bolder molding is placing a stick modelling compound
and reinserted in patient’s mouth then trim peripheral
folders to get exact vestibular fold
VI. TECHNICAL PROCEDURE
A. Maxillary PRELIMINARY Impression Technique (11 o’ clock
position)
1. Fit the tray
2. Adjust and smoothen the tray
3. Load the tray with Impression Material
- Alginate
- Figure of 8
- Should be flat and end at the rim or edge
of the tray
- Correct consistency of alginate: when
you turn it upside down it will not fall
down
4. Insert and seat the tray postero-anteriorly
5. Lift the upper lip
6. Do muscle trimming
7. Hold steadily until impression material sets
B. Mandibular PRELIMINARY Impression Technique (7 o’
clock position; same technique as maxillary but ask the
patient to raise and move the tongue)
1. Fit the tray
2. Adjust and smoothen the tray
3. Load the tray with impression material
4. Insert and seat the tray evenly
5. Ask the patient to raise tongue
6. Do muscle trimming
7. Hold steadily until impression material sets
C. Maxillary and Mandibular FINAL Impression Technique
1. Fit the tray
DDC BUHAT, JOHN PATRICK Q.
Complete denture
UE Dentistry
2. Do the adjustments when necessary
3. Do border molding
- For VLC
- Modelling compound stick (green)
- Heavy body elastomeric impression material
4. Determine and mark posterior palatal seal
5. Load the tray with preliminary material
6. Insert and seat the tray postero-anteriorly
7. Lift the upper lip
8. Do muscle trimming
9. Hold steadily until impression material sets
10. Break peripheral seal
Remove the final impression in one motion
3-5 mins setting time of impression materials
D. Mandibular FINAL Impression (Almost same with
Maxillary)
1. Fit the tray
- Do adjustments when necessary
2. Do bolder molding since trays are short by 1 mm
- Areas should be rounded
- Best technique:
- For the upper: anterior area first, then
posterior area and then PPS
- For the lower: premolar area first
- No excess on the tissue side
3. ____________________
4. Insert and seat the tray evenly
5. Do muscle trimming (to get vestibular fold)
- Dictates thickness of flanges
6. Hold steadily until impression material sets
- Hold the nose to check if you have complete
PPS
- Before a indelible pencil is used to mark the
vibrating line
- Use of methylene blue ink by using a micro
brush to apply in PPS area which will leave a
mark on the final impression
- Insert postero-anteriorly
7. Remove mandibular final impression in one motion
- Remove from PPS area by asking the patient
to blow
CASTS AND OCCLUSION RIMS
I. DEFINITION
o Cast
§ Positive copy of the denture bearing areas and
other structures of the oral cavity in the desired
form
II. CLASSIFICATION
A. Diagnostic/Study Cast
§ A likeness of the parts of the oral cavity for the
purpose of:
- Study and treatment planning
- Evaluation of the pxs oral anatomy and jaw
relationship on the absence of the px
- Reveals new information or confirms condition
- Construction of individual tray
§ Use Plaster of Paris
- β hemihydrate
- Coarser particle
DR. RHODORA LUCIANO, DMD
DPT 223 7
- Crystals: spongier, bigger
- A lot of water needed
- Coarser bigger weaker
B. Master/Working Cast
§ A replication of the denture bearing areas and other
structures of the oral cavity needed to fabricate a
dental prosthesis
§ Use Dental Stone
- α hemihydrate
- Finer particle
- Crystals: prism-like, rod-like
- More water needed
- Denser, smaller, finer, stronger
- Initial setting time of gypsum: 20-30 mins.
- Final setting time of gypsum: 45 mins. – 1 hr.
PL Lecture 5 – (12/11/18) & PL Lecture 6 – (12/13/18)
A LAND on the cast should be 3mm wide
INCISIVE PAPILLA – a stable landmark, it does not change its position
APRON – for you to get a more accurate impression for the posterior
palatal seal
MASTER CASTS WITH GUIDELINES
I. GUIDELINES FOR THE UPPER MASTER CAST:
A. Denture base outline
§ For the denture base
B. Encircle the incisive papilla and divide it into two and
extend the line anteriorly and also posteriorly along the
mid palatine raphe and extend it until the back of the
cast
§ The line at the middle will now be our basis for
placing the midline of the denture which means
when you set your two central incisors the mesial
side should be touching/centered at the center of
the line. When you cover it already with your
denture base, you will no longer know where the
midline is, you have to remember you need to have
a symmetry.
§ The line at the back of the cast is for mounting
C. Outline of the post dam
§ Shape of a butterfly
§ Start from the hamular notch, you pass along the
vibrating line and end along into another hamular
notch
§ When scraping, the widest portion is in the middle
which is about 3-6mm wide
§ The depth of the posterior dam is about 1.5-2mm
deep and the end line of the post dam is 0 meaning
there is no more depth on that side. So, the slope
of your post dam is gradual
§ The deeper end is on the posterior side and shallow
portion is on the anterior going to the incisive
papilla area
II. GUIDELINES FOR THE LOWER MASTER CAST:
A. Denture base outline
B. Encircle the retromolar pad and divide it into three equal
parts and only the 2/3 part is extended at the side of
the cast
§ That 2/3 line corresponds to the height or basis
for the occlusal plane of the occlusion rim
DDC BUHAT, JOHN PATRICK Q.
Complete denture
UE Dentistry
C. Line along the crest of the ridge
§ Starting from the apex of the retromolar pad and
extend it anteriorly and posteriorly
§ This line represents the neutral zone where we are
supposed to set the posterior teeth and where all
central fossa of the teeth falls along this line
§ For stability
Master Cast/Working Cast – a replica of the denture beating areas and
other structures of the oral cavity needed to fabricate a dental
prosthesis
TREATMENT OR CAST CONSTRUCTION
I. BOXING
o The procedure of preserving the functional width and
depth of the sulci when making an impression
o Red stick wax:
§ To produce a land
o Functions:
§ It allows vibration of the stone resulting in a
stronger and denser cast
- Bubbles = weak cast
§ It preserves border contours recorded in the
impression procedure
II. BASING
o The procedure of placing a material under the cast
o Functions:
§ It provides strength to the cast
§ It allows easy mounting of the cast
o Requirements:
§ ½ inch thick – from the deepest portion of your
vestibule (man: lingual sulcus)
§ Equal thickness – flat base
§ No U-shaped casts for the mandibular
§ Open for accessibility where you can outline and
produce base plate easily
§ Do not use rubber base formers (only for ortho)
III. TRIMMING
o The procedure of reducing the size and altering shape
of the cast and retaining the important structures behind
o Requirements:
§ Smooth and flat base
§ Absence of nodules
- Problem: bubbles on the impression
- Internal porosities are caused by insufficient
pouring
§ Absence of undercuts
POST DAMMING OF THE MAXILLARY CAST
I. DEFINITION:
o Beading (scour or scrape) the cast along the posterior
palatal seal (PPS) area
§ Beading – do impressions or grooving on the cast
along posterior palatal seal area which collects your
hamular notch and passing through the vibrating
line
o Landmarks: hamular notches and vibrating line
o Why scrape?
§ To create a depression because the post dam is an
elevation on the tissue side of the denture
II. FUNCTIONS:
o To provide tissue displacement for peripheral seal
DR. RHODORA LUCIANO, DMD
DPT 223 8
§ Post dam is an elevation
§ Which means when the soft palate goes up there
is tissue displacement but because of the elevation
air will not go in
§ So, we need post dam for retention for the denture
§ That area of displaceable tissue need to be sealed
o To compensate for any acrylic resin dimensional change
that takes place after processing
§ Polymerization shrinkage is the dimensional change
o To maintain constant intimacy of contact between the
posterior border of the maxillary denture and the
movable tissues of the soft palate during function
Purpose – so that when the soft palate goes up there is no space, air
cannot go in. Denture will not dislodge. But if there is no post dam and
when the soft palate goes up and there will be space, air goes in and
denture goes down
There is dimensional change in resin – expansion or contraction
III. PROCEDURES:
A. Determine the type of soft palate form of the patient
§ Form A (wide movement)
- For narrow soft palate or hard palate form
- You will have a wider and deeper post
damming
§ Form B (normal movement)
- For average soft palate or hard palate form
- You will have a narrower butterfly shaped or
even a straight line
§ Form C (minimal movement)
- Broad and deep soft palate form
B. The posterior border of the PPS is drawn on the cast
§ Best guide: 1-2mm anterior to fovea palatini
C. The anterior border of the PPS is drawn on the cast to
coincide with the displaceable (glandular) soft tissues
of the palate. It is approximately 3-6 mm anteriorly to
the vibrating line and follows the contours of the
displaceable tissue
§ Must follow displaceable tissue shape
D. Deepest extent of PPS should be on the posterior
border. A cut of 1.5mm in depth is made and must be
perpendicular to the cast
§ It could be 1mm but not less than 1
§ A discoid end of a vehe carver is used
§ It must extend laterally 3mm from the crest of the
hamular notches
E. The anterior border of the cast is scraped from 0
depth anteriorly to 1.5mm depth posteriorly
DDC BUHAT, JOHN PATRICK Q.
Complete denture DPT 223 9
UE Dentistry
§ Meaning going anteriorly, the depth decreases from the Occlusion Rim cannot stand by itself, it has to place on the top of
1.5 to 0mm the Denture Base.
§ We want this area to be smooth because that
space will be filled in by the denture base so that What is the role of the Record Rim?
the mucous membrane will not be irritated To record the maxillomandibular relationship and this is where we
§ We need that retention establish Occlusal Plane so that we will know where to set the teeth
§ There should be a gradual slope from anterior to Why is Occusal Plane important?
posterior Because we need to know where to set the teeth. Occlusal Plane is
§ Smoothen the scraped area recorded on the Occlusion Rim
RECORD BASES AND OCCLUSION RIMS II. REQUIREMENTS OF RECORD BASES
I. DEFINITION
o It should be readily adapted to the required shape and
o Baseplate/Record Base contour with a minimum of fine, expense and technical
§ An interim (temporary) material or device used for skill
making maxillomadibular relations records and for o It must be rigid and strong in relatively thin sections
arrangement of teeth
o It must not exhibit flow at mouth temperature
§ Used for placing OCR for placing of the teeth o It does not warp or distort during the procedures of
§ What would become of your record base? It will denture fabrication
become the final denture base o It must exhibit a color close to that of the natural
o Denture Base gingiva so as not to cause distraction during denture
§ The part of a denture that rests on the denture try-in
bearing areas and to which teeth are attached III. MATERIALS FOR RECORD BASES
o Maxillomandibular Relation o Shellac Baseplate
§ Vertical Relation o Autopolymerizing Resin/ Self-cured Resin
- Vertical Relation of Occlusion o Light Cured Resin
- Relationship of maxilla and mandible o Wax
- Swallow, close, occlude the teeth o Vacuum Formed Base
- Loses in an edentulous patient o Microwave Activated Resin
o Processed Acrylic Resin/ Heat-cure Resin
- Vertical Relation of Rest Position
o Cast Alloys
- Mandible is in physiologic rest position
- Constant – seen in a patient with or Most reliable/accurate for denture base?
without teeth Processed Acrylic Resin/ Heat-cure Resin
- Ask the patient to say “emma”
Least reliable?
Vertical Relation of Rest Position is GREATER because of the space, and Wax
that space occupies a distance
Upper: using shellac (single processing)
Patients who are candidates of complete denture. They loss the Vertical Lower: (double processing) 1st process the denture base and after
Relation of Occlusion because there are no teeth making the wax denture you’re going to process it again and that’s the
2nd process
Vertical Relation of Rest Position is constant throughout life with or
without teeth IV. ADAPTATION OF RECORD BASES
A. Shellac Baseplate
Occlusal Plane – an imaginary plane. Passes through the occlusal tips § Available as a preformed shaped for maxillary and
of the posterior teeth and incisal edges of the anterior teeth; Anterior mandibular arches
and Posterior Occlusal Plane § Advantages:
When establishing the occlusal plane. Always start from the lower - Inexpensive
because it is very easy, 2/3 of the retromolar pad for the posterior - Easily and quickly adapted
plane and for the anterior plane it follows the corner of the mouth § Disadvantages:
- Tends to warp
o Occlusion Rim/Record Rim - Can be strengthened with a 12-14 gauge wire
§ Occlusal surfaces fabricated on record or denture - Warp when exposed to direct sunlight
bases for the purpose of making maxillomandibular - Do not expose to direct sunlight
relationship records and or arranging teeth
- Brittle (thermoplastic)
§ Made of wax
- When overheated, it adheres to the surface of
the cast, producing bubbles on the surface or
Record Rim is actually the Occlusion Rim. Record Rim is the combination turns black which is esthetically unacceptable
of the Record Base and Occlusion Rim. Record Rim can also mean the B. Autopolymerizing Resin/Self-Cured Resin
whole thing. Occlusion Rim is more specific because it is the wax that
is place on the top of the Record Base. So, if you say Record Rim it § Polymer and monomer pink resin with fibers
could mean the whole thing, the Record Base + the Occlusion Rim. But § Advantage:
when you say Occlusion Rim the Denture Base is already there because - Easy to manipulate
DR. RHODORA LUCIANO, DMD DDC BUHAT, JOHN PATRICK Q.
Complete denture DPT 223 10
UE Dentistry
§ Disadvantage: § It can be made up of gold, chrome cobalt, nickel
§ High polymerization shrinkage chrome, etc.
§ Techniques/Types: § Heat conductor
- Non-flasking § For RPD
- Sprinkle (Salt and pepper technique) § Advantages:
- Pressured (with flask) – for heat cured resin - Rigid
C. Light Cured Resin (VLC) - Accurate and dimensionally stable
§ There are co-polymers of urethane dimethacrylate - Thinner with thermal conductivity
and copolymer with silica fibers § Disadvantages:
§ Exposed to high intensity light 400-500nm for 10 - More expensive
minutes - Time consuming
§ Advantages: - Adds more weight
- Do not contain monomer V. USES OF OCCLUSION RIMS
- Not under time pressure § Wax forms are used to establish:
- Can be molded to desired shape - Level of occlusal plane
- Flexible dentures do not contain - Arch form
monomer - Different jaw relation records
ü Only used for partial dentures since
we need a more rigid in complete - Orientation Relations – establish the
denture reference in the cranium
§ Disadvantage: - Vertical Relations – establish the amount
of jaw separation allowable for use of
- Slightly lower strength compared with dentures
autopolymerizing resin
§ Not used as a record base anymore but used as a - Horizontal Relations – establish front-to-
back and side-to-side relations of one jaw
tray
D. Baseplate Wax to the other
§ Extra hard baseplate wax reinforced with or without
wire NEUTRAL ZONE – Fish – argued that the natural teeth occupy a zone
of equilibrium, with each tooth assuming a position that is the resultant
§ Use of high heat wax of all the various forces acting on it. This is always stable in position
§ Advantage: unless changes in the dentition occurred
- Easier to work during setting of teeth with
restricted inter-arch distance V. USES OF OCCLUSION RIMS
- If you have defect in inter residual ridge o Wax forms are used to establish:
distance, you wouldn’t need to cut the 1. The Level of Occlusal Plane
artificial teeth that much - An imaginary plane that runs along the incisal
§ Disadvantages: edges of the anteriors and occlusal edges of
- Brittle the posterior teeth
- Lacks rigidity and stability - Fox plane guide
- Easily distorted - Gadget used in establishing the occlusal
E. Vacuum Formed Bases plane
§ It makes use of an omnivac machine and - Put the edge on the incisal and occlusal
polystyrene record base material of the teeth
§ Colorless - Parts/Divisions:
F. Microwave Activated Resin ü Anterior plane of occlusion
§ It uses electromagnetic waves to activate the ü Posterior plane of occlusion
polymerization process of acrylic resin base - Frontal View
§ It makes use of glass fiber-reinforced plastic flask - Incisal plane parallel to the interpupillary
G. Processed Acrylic Resin/Unibase line (fox plane)
§ It makes use of heat cured resin
§ Advantages:
- Permanent denture base
- Stable
§ Disadvantage:
- Might get distorted during double processing
when not properly handled
H. Single Process - Sagittal/Proximal View
§ Curing the denture once after try-in - Occlusal plane parallel to the ala-tragus
I. Double Process line (camper’s line), inclined upwards
§ Cure or process the denture twice
J. Cast Alloys (Metals)

DR. RHODORA LUCIANO, DMD DDC BUHAT, JOHN PATRICK Q.

Complete denture DPT 223 11
UE Dentistry
VI. CONSTRUCTION
A. Soften 2 sheets of pink waxes over a flame and roll
lengthwise tightly
B. Contour the wax rims over the ridge and flange areas of
the record bases. Position them as follows:

- Retromolar pad – determines the height of

occlusal plane
- Will be divided into 3 equal parts
- 2/3 – will be the level of the occlusal
plane (make sure it is not below ½)
2. The Arch Form
- For setting of the teeth
- Related to the activity of the lips, cheeks and
tongue and harmonious with the various
forces acting on it
- Arch form should mimic the facial profile
- In placing the neutral zone – it must
stimulate dental arch, as if teeth are
there
- Placed in a neutral zone or zone of equilibrium
to stimulate the dental arch form of the
artificial teeth
- Buccal corridor – dark space seen when
smiling
- Anterior: 3-5mm
- Posterior: 8-10mm
- Premolar: 6-8mm
- In the upper, the arch form terminates on the
second molars
- In the lower, the arch form terminates on 2/3
retromolar pad
- Set the artificial teeth in a position as close
as possible to the one previously occupied
Pattern of Bone Resorption
Maxillary Mandibular
Anterior: Labial Anterior: Labial
Posterior: Buccal Premolar: Buccal and Lingual
Molar: Lingual
- Incisal edges of maxillary central incisors are
8-10 mm anterior to the center of incisive
papilla
- Canine must be 1mm in front of papilla
- Draw an inter canine imaginary line
- Tips of canines are 1 mm in front of the
papilla
- Upper OCR will have an overlap over the lower
- When you look frontally, you will see
2mm of overlap
3. The Different Jaw Relations
- Orientation Relation
- Face bow
- Vertical Relation
- Distance of maxillary and mandibular
- Horizontal Relation
- Movements of jaw (lateral, forward, etc.)
C. The posterior limit of the wax rims should be:
- Max: 2nd molar region
D. Occlusal rim should be perpendicular or (maxillary 10
degrees) outward in the anterior region canine to canine
area should be perpendicular to the base or inclined
inward (maxillary 10 degrees) in all other areas
E. Additional was is placed on the labial and buccal surfaces
if the rim and smoothly contoured
F. Maxillary and mandibular occlusal rims must occlude and
are in even contact with each other
Labial surface should extend and give it a labial inclination for about 15
degrees from the straight profile to provide lips support. So, when you
set your central incisors it should be beveled.
For the back part, there is a bevel/ cut part. Because when you occlude
it with your lower cast there will be a problem (imagine mo nalang
haha)
PLANES OF OCCLUSION
• Maxillary Occlusion Rim – 1-2mm from the resting upper lip
o Frontal view – incisal plane to interpupillary line (fox
plane)
§ By using a gadget, Fox Plane Guide
o Proximal view – occlusal plane parallel to ala-tragus line
(camper’s line)
• Mandibular Occlusion Rim – in level with the corners of the
mouth (area of modiolus) when the mouth is halfway open
o Posterior plane of occlusion at the 2/3 of the retromolar
pad
o Anterior plane of occlusion, basis is the corners of the
mouth
What are the 2 specific division of the Planes of Occlusion:
Anterior and Posterior Plane of Occlusion
For establishing the plane of occlusion for the lower, ask the px to say
“emma” the incisal or the area near the premolar at the corners of the
mouth is the level of the anterior plane of occlusion. When higher to
the corners of the mouth, you reduce the anterior plane of occlusion
not the posterior plane of occlusion.
For establishing the plane of occlusion for the upper, the anterior plane
of occlusion must be parallel to the interpupillary line (20-22mm). Ask
again the px to say “emma” the incisal edge should be 1-2mm but it
depends on the level of the lip of the px, if short lip length the incisal
edge is longer. So, the basis for the anterior plane of occlusion with
regards to the length of the teeth is the lip length of the px.

DR. RHODORA LUCIANO, DMD DDC BUHAT, JOHN PATRICK Q.

Complete denture DPT 223 1
UE Dentistry
MT Lecture 1 – (01/07/19) & MT Lecture 2 – (01/10/19) • Record the relationship between the upper jaw and arbitrary
points near the condyles and transfer to the articulator
JAW RELATIONSHIPS
• TRIANGULATION = to know the exact location of the maxilla
• Relations of one jaw with the other jaw or another reference and mandible (landmarks: condyle and nasion)
• Aims: • Always related to facebow
o To produce a replacement that can restore all the
functions that has been lost (fulfill mastication) • Movement of the jaw
o To provide replacement that can restore the primary • Keywords: Orientation relation. Cranium and facebow
functions of the masticatory system • Orients the dental casts in the same relationship as the
§ Mastication opening axis of the articulator
§ Phonetics
§ Confidence/ Esthetics FACEBOW
o Require knowledge of the functional unit of anatomy and • A caliper-like device used to record the relationship of the
interrelationship of the components of the masticatory jaws to the TMJ
system • Orient the casts in the same relationship to the opening axis
of the articulator
CONDYLAR GUIDANCE • Orients the maxillary arch to condyle
• Indicates the inclination of the condyles from the glenoid • Locate the maxilla of the px in relation to the condyle
fossa
I. HORIZONTAL CONDYLAR GUIDANCE – gives rise to Horizontal • It determines the opening axis of the jaws of the px and
Condylar Inclination allows the cast to be oriented in the same relationship to the
II. LATERAL CONDYLAR GUIDANCE – gives rise to Lateral opening axis of the articulator
Condylar Inclination • Bitefork is attached to the maxillary
• When you’re using a facebow, you’re using a semi adjustable
HORIZONTAL CONDYLAR INCLINATION articulator
• 30 degrees inclination along the condyle and articulator
eminence I. PARTS
• Influenced by the incisal guidance and condylar inclines on A. U-shaped frame
the working and balancing side B. Condyle rods
C. Bite fork
• Determine the inclines of the articulator eminence as the § Attaches to the occlusion rims
condyle moves along II. TYPES
• Mimics the inclines of the articulator eminence and glenoid A. Arbitrary
fossa § Semi Adjustable Articulators (SAA)
LATERAL CONDYLAR INCLINATION
§ Most common and accurate
§ Not as precise as the kinematic
• 15 degrees inclination as the condyle moves medially (Right
§ Guess/ proximate
or Left) ® Bennett Shift § Use of: Fascia & Earbow
• When the condyle moves along the glenoid fossa, it moves
sideways in addition to the rotational movements in lateral § Condylar Rods
excursions
- Fascia style
COMPONENTS OF THE MASTICATORY SYSTEM - 13 mm in front of the external auditory
I. JAWS AND TEETH meatus
II. TMJs - Generally, locates the rods within 5 mm
III. MASTICATORY MUSCULATURE of the true center of the opening axis of
IV. TONGUE, CHEEKS, LIPS AND OTHER ORAL SOFT TISSUE the jaws
V. INNERVATION AND VASCULATION (blood supply) SUPPLYING - Earbow style
THE SYSTEM - Similar to a stethoscope earpiece
I. ORIENTATION RELATION – establish the point of reference in B. Kinematic/ Hinge Bow
the cranium § More precise/exact in location of the maxilla
II. VERTICAL RELATION – establish the amount of separation
allowable for dentures § Fully Adjustable Articulator (FAA)
III. HORIZONTAL RELATION – establish the front-to-back and III. VALUE OF FACEBOW
side-to-side relationship of one jaw to the other o Essential for avoiding errors in the occlusion of finished
dentures
ORIENTATION RELATION or FACEBOW RECORD o Theoretical advantages of using a facebow to orient the
• It establishes the references in the cranium (nasion and maxillary cast on the articulator
temporal bone near the TMJ) o In different types of facebow, you will still have facebow,
nasion and bitefork
• For the articulator to provide accurate inter-occlusal
relationship, the cast on the articulator must relate to the o Record the relationship of the TMJ
hinge axis of the instrument in as nearly as possible to same
way the jaws relate to the patient’s arc of closure PANTOGRAPHS – certain reading device where you can record protrusive
and lateral movements with the use of gothic arch tracers
DR. RHODORA LUCIANO, DMD DDC BUHAT, JOHN PATRICK Q.
Complete denture
UE Dentistry
INTERPUPILLARY LINE – line is based on maxillary anterior occlusal plane
ALA TRAGUS LINE – checked based on maxillary posterior occlusal plane;
occlusal plane parallel on sagittal aspect
To check OCR, ask px to say “ah” and there must be 1-2mm show of
OCR
PLANES OF OCCLUSION
I. MAXILLARY OCCLUSION RIM
o 1-2 mm from the resting upper lip (resting lip line)
§ “emma”, physiologic rest position
o Frontal view/anterior plane of occlusion
§ Incisal plane parallel to interpupillary line (fox plane)
o Proximal view/posterior plane of occlusion
§ Occlusal plane parallel to ala-tragus line (camper’s
line)
o When px smile: half of the crown is exposed
o When talking: 1-2 mm is exposed
o When smile broadly: cervical line
II. MANDIBULAR OCCLUSION RIM
o Always start with the lower because it is easier
o In level with the corners of the mouth (area of modiolus)
when the mouth is half way open
o Posterior plane of occlusion at the 2/3 of the retromolar
pad
FIT THE OCR
• Should have no spaces in between
• If there’s a space, decrease on the posterior of the maxillary
OCR
• When the px smile: half of the crown should be seen
• When the px smile broadly: cervical of the teeth
REVIEW!
BASIS OF ANTERIOR PLANE OF OCCLUSION (LOWER) – corners of the
mouth
BASIS OF POSTERIOR PLANE OF OCCLUSION (LOWER) – 2/3 of the
retromolar pad
BASIS OF ANTERIOR PLANE OF OCCLUSION (UPPER) – 1-2mm below the
resting lip-line when the px says “emma”; anteriorly, checking the
inclination, it should be parallel to the interpupillary line
BASIS OF POSTERIOR PLANE OF OCCLUSION (UPPER) – ala-tragus line
Why is it important that we should know the planes of occlusion?
Because it is our basis for setting the teeth. Because if you know the
planes of occlusion you would know how high or low to set the teeth;
Because you want to know the area where the teeth incisally and
occlusally will be touching.
PLACING OCR FOR THE LOWER
Anteriorly – place it labial to the ridge
Posteriorly – just place it right on top of the ridge
When reducing for the lower OCR, reduce on the anterior! Do not touch
the posterior part!
FOR DEAN LUCIANO!
Whenever we work on the OCR, we start with the planes of occlusion
then we continue on the vertical jaw relation of occlusion and after is
the orientation relation (putting the facebow; we’re only doing the
orientation relation in the upper OCR) and after orientation relation we
DR. RHODORA LUCIANO, DMD
DPT 223 2
mount the upper cast and after mounting we already know the exact
position of the maxilla. After mounting the upper cast, you can get the
OCR from the upper cast and let it set and then place the OCR into
the px’s mouth and then let the upper and lower OCR occlude and then
get your arbitrary centric jaw relation. After getting the arbitrary centric
jaw relation, get both OCR and replace the upper OCR on the upper
cast and after it has set already (of course the upper and lower OCR
are locked already) so turn the articulator upside down and then mount
the lower cast and then YOU’RE DONE!
FOR SOME PROFESSORS!
After finishing the upper OCR ® do your orientation relation (without
doing vertical jaw relation. Just planes of occlusion for the upper and
get the orientation relation and then mount the upper cast and while
it’s still setting continue with the planes of occlusion of the lower)
SAA – mimics the movement of the upper and lower jaws of the px. It
can reproduce the actual movement of the jaws because of the hinges,
you can adjust the hinges so that you can actually simulate the
movement of the lower jaw. Maxillary is fixed so it is important that
you should know the exact position of the maxilla because it is the
basis of the centric occlusion. Maxilla doesn’t move but only the
mandible. But in the articulator the movable part is the maxilla because
we have to know the exact position of the maxilla so we need to adjust
it and the mandible will just follow the position of the maxilla. So, in
order to know the exact position of the maxilla is by orientation relation
by using a facebow.
VERTICAL RELATION
• Distance of jaw separation along the vertical plane of
reference
• Vertical measurement of the face between any 2 points
located, one above and one below the mouth in the midline
o Glabella to the base of nose
o Base of nose to the base of chin
• Up and down relation of jaw
• Correct vertical distance
I. 3 TYPES
A. Vertical Relation of Occlusion (VRO)
§ Teeth are in maximum intercuspation
§ Lost when all teeth are extracted
§ This is not postural. Once you occlude it whether
you are sitting up straight or not the measurement
is still the same unlike VRRP
B. Vertical Relation of Rest Position (VRRP)
§ Teeth do not come in contact
§ With or without teeth it is constant throughout life
§ When measuring, tell the patient to sit up straight
and tell her to say “emma” and then measure it
with the two dots from the tip of the nose and
from the chin
§ Depends on the posture of the px’s head
§ Also called the Postural Position of the Mandible
C. Inter-occlusal distance/Freeway space (IOD)
§ Closest speaking space
- Closest distance when upper and lower teeth
come in contact without touching when the
patient says “s” or “ch”
- Mississippi
§ 2-4mm, gap of upper and lower
§ Difference between VRRP & VRO
DDC BUHAT, JOHN PATRICK Q.
Complete denture DPT 223 3
UE Dentistry
§ When you say “emma” and the jaw is at rest Dr. Fish
position and that space is called the IOD (2-4mm) Studied anterior plane of occlusion (corners of the mouth; modiolus)

VERTICAL RELATION OF REST POSITION Dr. Thompson

When the mandible is in a physiologic rest position. The teeth of Coined the term “freeway space”
occlusion rims do not come in contact. It remains constant throughout
life Dr. Silverman
Studied closest speaking space
VERTICAL DIMENSION OF REST (or PHYSIOLOGIC OR POSTURAL POSITION
OF THE MANDIBLE Foxplane
Is established by muscles and gravity; influenced by position of head Interpupillary line

VERTICAL RELATION OF OCCLUSION Camper’s Line

When the teeth are in maximum intercuspation or the occlusion Ala-tragus line
occlusion rims are in contact. It is lost if without teeth
Frankfurt Plane
VERTICAL DIMENSION OF OCCLUSION Line drawn from the tragus of the ear to corner of the eye;
Established by natural teeth when they are present and in occlusion Also known as the “ear-eye line” established arbitrary location of angles

INTER-OCCLUSAL DISTANCE (FREEWAY SPACE) Patterson’s Chew-in Method

It is the gap or space in between the upper and lower teeth or occlusiom Mandibular movement will generate compensating curve in the OCR
rims when the mandible is in the physiological rest position;
It has an average measurement of 2-4mm Bennett Shift
Movement of the mandible in lateral directions
CLOSEST SPEAKING SPACE
Closest distance when the upper and lower teeth/ OCR come in contact Compensating Curve
without touching, when the px says “S” “CH” Curve of spee in a denture

Curve of Spee
II. FORMULAS Physiologic curve;
o VRRP = VRP + IOD Created following the path of the condyle
o IOD = VRRP – VRO
o VRO = VRRP – IOD INCREASED VDO DECREASED VDO
III. BASIS OF THE MIDLINE
Generalized soreness No show of teeth
o Middle of the face Difficulty in swallowing Many folds on the face
IV. METHODS IN DETERMINING THE VERTICAL DIMENSION
A. Mechanical Methods Fast bone resorption Complains of TMJ pain:
“Costen’s syndrome”
§ Ridge relation
• Tinnitus (ringing of the
- Distance from incisive papilla to mandibular ear)
incisors
• Crepitus (cracking when
- Checks parallelism of the ridge opening)
§ Measurement of former dentures
• Neuralgia (pain)
§ Pre-extraction records Muscle fatigue Excessive freeway space
B. Physiologic Methods
Facial elongation
§ Physiologic rest position Difficulty in closing the mouth
§ Phonetics and esthetics Greater freeway space
§ Swallowing threshold
§ Tactile sense MAXILLARY OCR
§ Patient perceived comfort 1-2 mm from the resting upper lip

• Vertical Relation of Occlusion MANDIBULAR OCR

o Increased = IOD is inversely proportional
o Ex. VRRP: 58 mm; VRO: 57 mm; IOD: 1 mm
• Cuspid line
o Mesio-distal width of the 6 anterior teeth
• High lip line
o Smile broadly
o Cervico-incisal length of the CI
• Labial Inclination of the OCR
o For labial support
Dr. Wright
Studied posterior plane of occlusion (2/3 of retromolar pad)
In level with the corners of the mouth when the px is halfway open.
Check philtrum of the lip, vermillion border and buccal corridors
To get correct centric, one must get the correct vertical relation
MT Lecture 3 – (01/15/19)
ARTICULATORS
• Are instruments that attempt to reproduce the range of
movement of the jaws
• Maxillary and mandibular casts can be attached to the
articulator so that the functional and parafunctional contact
relations between teeth can be studied
TYPES OF ARTICULATORS

DR. RHODORA LUCIANO, DMD DDC BUHAT, JOHN PATRICK Q.

Complete denture DPT 223 4
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I. NON-ADJUSTABLE ARTICULATORS ½ anterior to the tragus of the ear approx. the size of a finger along
A. Simple Hinge/ Plane line or Straight line articulator the ear-eye line (Frankfurt plane)
B. Arbitrary/ Articulator with fixed condylar controls
II. SEMI-ADJUSTABLE ARITCULATORS AXES OF MANDIBULAR MOVEMENTS
o Has individually adjustable condylar guidances both I. HORIZONTAL AXIS
horizontally and laterally o Opening & Closing, the condyle rotates on its axis
o Most articulators today are arcon instruments (Horizontal Axis of Rotation)
A. Arcon – condylar guidance is located in the upper o Forward, backward
(cranial member) and ball (condylar analogue) is located II. VERTICAL AXIS
in the lower member o When you protrude the jaw. The condyle goes downward
B. Non-arcon – condylar guidance is located in the lower and forward (Vertical Axis of Rotation)
and ball (condylar analogue) is attached to the upper o Downward, upward
member III. SAGITTAL PLANE – medial physiology of the TMJ
III. FULLY ADJUSTABLE ARTICULATORS o When you move the jaw right/left (Sagittal Axis of
Rotation)
MT Lecture 4 – (01/22/19) o Laterally
What can be adjusted in the SAA? FACTORS THAT REGULATE JAW MOTION
Horizontal & Lateral Condylar Guidance I. CONTACTS OF OPPOSING TEETH
II. ANATOMY AND PHYSIOLOGY OF THE TMJ
What is the degree of Horizontal Condylar Inclination? III. ROTATIONAL AXES OF THE MANDIBLE
30 degrees. Because it follows the curvature of the anterior articular IV. ACTION OF THE CONTROLLING AND MOVING MUSCLES
eminence (NEUROMUSCULAR REGULATION)
• During centric and eccentric positions of the mandible, the
What is the degree of Lateral Condylar Inclination? occlusal surfaces of the teeth should meet evenly on both
15 degrees. Which means the mandible can move medially (right/left) sides
• Inclined planes of teeth should pass over one another
Lateral Condylar Angle is also known as the smoothly
Bennett Angle or Medial Shifting of the Condyle
TMJ is divided into two compartments:
JAW MOVEMENTS Upper & Lower Compartment
• Occur during mastication, speech, swallowing, respiration, and
facial expressions
• Knowledge in the mandibular movements is essential to
understand occlusion, arranging artificial teeth and selection
and adjustment of recording devices and articulators
• Articulators should stimulate jaw movements
I. OPENING
II. CLOSING
o Opening & Closing, the condyle rotates on its axis
(Horizontal Axis of Rotation) When the mandible moves forward and the condyle goes down the
III. LATERAL meniscus or the articular disk goes within and this is the reason why
o When you move the jaw right/left (Sagittal Axis of when there is clicking of the jaw it is because as the condyle moves
Rotation) downward and there is a disruption or disorder of the meniscus the
IV. PROTRUSIVE meniscus snaps back and goes to its place and the snapping back of
o When you protrude the jaw. The condyle goes downward the meniscus is the one causes the clicking sound because if the patient
and forward (Vertical Axis of Rotation) has no clicking noise when the patient moves the mandible forward it
V. RETRUSIVE goes downward and forward the meniscus goes within and it goes back
• III, IV, V are in eccentric jaw relations (any movement outside
centric relation) INFLUENCE OF THE TMJ
• Centric Relation – the horizontal reference position of the • All mandibular motion is either rotational or translation (or
mandible that can be routinely assumed by edentulous combination of these)
patients under the direction of the dentist • ROTATIONAL MOVEMENT – one which all points within body
describe a concentric circle around common axis
You can’t move the jaw further more backward (retrude) that means o Opening or closing jaw
you already reach the Terminal Hinge Axis o Take place in the Lower Compartment of the TMJ
between the superior surface of the condyle and the
The Terminal Hinge Axis is the axis of rotation of the mandible when inferior surface of the articular disk
the mandibular condyles are in their most superior position in the glenoid o Initial movement of the jaw when it opens
fossa • TRANSLATION MOVEMENT – the whole body moves at the
same time and at the same plane
Hinge Axis – point of rotation of the condyle o Happens in the upper compartment. Because the condyle
together with the meniscus glides down along the
Location of the Terminal Hinge Axis anterior articular eminence

DR. RHODORA LUCIANO, DMD DDC BUHAT, JOHN PATRICK Q.

Complete denture DPT 223 5
UE Dentistry
o Take place in the Upper Compartment of the TMJ • Complete interdigitation of teeth
between the superior surface of the articular disk as it
moves with the condyle and the inferior surface of the CONCEPTS IN CONSTRUCTION OF CD
glenoid fossa • To have the maximum intercuspation position coinciding with
o Maximum opening of the jaw centric relation
• These 2 refer to the movements of the condyle • In many patients, a broader area of stable contacts near
centric relation is necessary, the so-called “freedom in
HORIZONTAL JAW RELATION or CENTRIC JAW RELATION centric” or “long centric”
• 2 types: • Most people occlude in a position that is slightly anterior
A. CENTRIC JAW RELATION (0.5-1mm) to the centric relation
B. ECCENTRIC JAW RELATION
1. Protrusive Relation
2. Lateral Relation “muscular position” – on grounds that it is the most frequently used
3. Retrusive Relation in function; a position reached after a relaxed mandibular closure from
the rest position; usually coincides with the maximum intercuspation in
• Relationship of teeth and jaws along the horizontal plane a healthy natural dentition.
Research have shown that muscular position is more variable than a
CENTRIC JAW RELATION retruded position and is not recordable with the same predictability as
• Maxillomandibular relationship in which the condyles articulate centric relation is.
with the thinnest avascular portion of their respective discs, It is true, however, that most people occlude in a position that is
with the complex in the antero-superior portion against the slightly anterior - .5 to 1mm to centric relation. (this fact speaks in
slopes of the articular eminences favor of a freedom of tooth contacts in the occlusion anterior and
• It is the most physiologic position of the condyle lateral to centric relation)
• It is a repeatable position
DIFFERENT TECHNIQUES OF RECORDING CENTRIC RELATIONS
• The most retruded physiological relation of the mandible to I. DEGLUTITION GUIDANCE
the maxilla to and from which the individual can make lateral II. PHONETICS GUIDANCE
movements III. TONGUE GUIDANCE
• It is a condition that can exist at various degrees of jaw o A ball of red stick wax is placed at the posterior palate,
separation tongue reaches the wax
• It occurs around the terminal hinge axis (THA) IV. MUSCLE FATIGUE
o Protrude the jaw
• The most retruded relation of the mandible to the maxillae V. BIMANUAL MANIPULATION
when the condyles are in the most posterior unstrained o Guide the px as he bites and closes at centric
position in the glenoid fossa from which lateral movements VI. TEMPORAL MUSCLE CHECK
can be made at any given degree of jaw separation o Temporal muscles bulge when at centric
• The relationship of the mandible to the maxilla where the
condyles are at their most retruded, unstrained position, at MT Lecture 5 – (01/24/19)
an established vertical dimension
• The most posterior relation of the lower to the upper jaw DIFFERENT METHODS OF RECORDING CENTRIC RELATION
from which lateral movements can be made at a given vertical • STATIC – the jaws are placed at centric relation and a record
dimension (VRO or VRRP) is made with the use of occlusion rims
All definitions agree that centric occlusion is determined by • GRAPHIC – recordings are done with intraoral or extraoral
the TMJ structures and not by the dentition tracing devices.
• FUNCTIONAL – the record is made at the time when the jaw
Centric Position is in functional movement or activity. With pantographic
Swallow and let the teeth occlude that position is the centric jaw tracing device.
position and your teeth is in centric occlusion. Slightly open your mouth
and say “emma” that position is centric jaw position but your teeth I. STATIC METHOD OF RECORDING CENTRIC RELATION
are not in centric occlusion. So, the physiologic rest position is also the A. Interocclusal Record
centric jaw position 1. Wax – aluwax, beeswax
2. Impression plaster
Importance of the Centric Jaw Position 3. Rubber impression material
Because at first you need to make the denture functional. All movement 4. *Staple wires XXX
of the mandible starts and ends in centric position that’s why you need II. GRAPHIC METHOD OF RECORDING CENTRIC RELATION
to get the centric jaw position. Making the denture/articulator functional B. Gothic Arch Tracers
you need to mount the lower cast properly by getting the correct § A device used to trace mandibular movements
centric position along a horizontal plane
§ Arrow point/Seagull/Gothic arch tracing
CENTRIC RELATION OF OCCLUSION III. FUNCTIONAL METHOD OF RECORDING CENTRIC RELATION
• The occlusion of opposing teeth when the mandible is in C. Pantographic Tracing Device
centric relation
• This may or may not coincide with the maximum intercuspal PROCEDURE IN USING GOTHIC ARCH TRACERS
position I. Attach firmly the upper and lower tracers without raising the
incisal pin of the articulator
MAXIMUM INTERCUSPATION o Stylus – upper; Plate - lower
DR. RHODORA LUCIANO, DMD DDC BUHAT, JOHN PATRICK Q.
Complete denture DPT 223 6
UE Dentistry
o Use the square metal to level the tracers o Maxillary Li cusp as the main supporting cusp in the
o Level the tracers to the plane of occlusion rims occlusal contact pattern falls on the central fossae of
II. Try in the rims with the tracers. Check for good fit and the lower teeth
stability. o Bu cusps of lower teeth come in contact with the Li
III. Adjust the stylus in the upper rim until it touches the plate inclines of the maxillary Bu cusps
on the lower rim. o Class 1 molar relationship
IV. Insert the rims with stylus inside the patient’s mouth. II. WORKING INTERFERENCE
V. Ask the patient to move the jaw to the right and left sides o Occlusal interference will result from the contact
repeatedly. between the Li inclines of the maxillary Bu cusps and
VI. Remove the tracing plates and rims. the facial inclines of the Bu cusps of the mandibular
VII. Position the hole of the plastic control piece teeth
VIII. to the apex of the tracing mark. o 1st molar relationship
IX. Attach the plastic to the plate using hard wax.
X. Reinsert the rim with trracing plates into the mouth and seat o Contact between the Li inclines of the max Bu cusp and
the facial incline of the man Bu cusp
properly. III. NON-WORKING
XI. Ask the patient to close the jaw making sure that the stylus
hits the plastic hole. o Occlusal interference will occur between the Li cusps of
XII. Place plaster index and allow to set. the maxillary teeth as they move across the Li inclines
XIII. Remove the whole thing carefully of the Bu cusps of the mandibular teeth
XIV. Mount to the articulator o Contact between the Li cusp of max as they move
across the Li inclines of the Bu cusp of man
ECCENTRIC JAW RELATION IV. PROTRUSIVE INTERFERENCE
I. PROTRUSIVE RELATION o Result from the maxillary lingual cusps gliding over the
o Edge to edge relationship distal Li cusps of the mandibular tooth in a straight
o Christensen’s Phenomenon protrusive movement
§ It is caused by the downward/forward movement o Li cusp relationship
of the condyles o Maxillary lingual cusp gliding over the mesial inclines of
distolingual cusp of the mandibular teeth in straight
§ It is the development of distal spaces between the protrusive movement
upper and lower occlusal surfaces of the occlusion
rims or dentures in protrusion; caused by FULLY BILATERAL BALANCED OCCLUSION
downward/ forward movement of the condyles
o If the occlusion of the dentures is to be balanced, there • To maintain stability of CD, the opposing teeth must meet
should be a uniform contact between upper and lower evenly on both sides of the dental arch when the teeth
teeth throughout the functional range of jaw movement, contact anywhere within the normal functional range of
the amount of this space must be determined mandibular movement. It is used to adjust the Bennett Angle.
o Average setting of the condylar inclination can be done. Average 15 degrees
Horizontal condylar guidance is adjusted, average of 33
degrees THREE TYPES OF BALANCE
I. UNILATERAL BALANCE
o Represents the horizontal condylar inclinations II. BILATERAL BALANCE
o Lateral condylar guidance set an average of 15 degrees III. PROTRUSIVE BALANCE
(Bennett angle)
o Lateral condylar inclination (Hanau Formula) • In all types of balance, a 3-point contact must always be
achieved
§ L= H/8 + 12
MT Lecture 7 – (01/31/19)
MT Lecture 6 – (01/29/19)
TOOTH SELECTION
II. LATERAL JAW RELATION
o Movement of mandible to the left or right; working and • Selecting denture teeth
non-working sides • Place reference marks on the OCRs to aid in tooth selection
o Working Side and placement
§ Side where you move the mandible
o Non-Working Side ANTERIOR TEETH SELECTION
§ Also known as the balancing side I. MOULD
II. SIZE
o Lateral Jaw Movement III. SHADE
§ The rotational centers of the mandible also may IV. TYPE
shift laterally
§ This movement or shift is the result of the POSTERIOR TEETH SELECTION
movement of the condyles along the glenoid fossa I. SIZE
§ It is known as the “Bennett Shift” II. CUSP HEIGHT
§ 15° (Bennett Angle)
ANTERIOR TEETH SELECTION
I. MOULD (Shape)
TYPES OF OCCLUSAL INTERFERENCES A. Outline form of face
I. CENTRIC INTERFERENCE 1. Square
o Maximum intercuspation at CJR position 2. Square tapering
DR. RHODORA LUCIANO, DMD DDC BUHAT, JOHN PATRICK Q.
Complete denture DPT 223 7
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3. Tapering • Technician sets the teeth without seeing the px
4. Ovoid
B. Tooth Curvature • Wax rim contours aid selection and setting:
1. Flat o Occlusal vertical dimension
2. Curved o Angulation of facial rims affects lip support
II. SIZE (Dimension) o Overjet
o MD Width • Maxillary Reference Marks
§ House and Loop’s Rule o Midline Position
- BZW/ 3.3 = Width of 6 Maxillary Anterior § Critical reference
Teeth § #7 wax spatula
- BZW/ 16 = Width of Maxillary Central Incisor § Score a line parallel the facial midline
III. SHADE (Color) § Mark both rims
A. Shade of the remaining natural teeth
B. Age of the patient GUIDELINES FOR SETTING ANTERIOR TEETH
C. Color of the patient’s skin • High lip line
D. Maxillomandibular Relationship o Highest point of upper lip when smiling
IV. TYPE (Tooth Material)
o Cervical necks lie at or above this line
A. Conventional Acrylic Resin
o If shorter teeth are selected, esthetics compromised
§ Cross linked
§ More dense • Corners of mouth
o Measure circumference between marks
§ Wear resistant
o Size of 6 anterior teeth read off ruler (mm or by letter
§ Easily bonds to resin code A, B, etc.)
§ Easily reshaped and polished
• Angulation is as important as midline
§ Does not make much noise
B. Interpenetrating Polymer Network “IPN” • Palatal midline
§ Highly cross linked o Through middle of incisive papilla and mid-palatal raphe
o Extend onto land area
§ Harder, more abrasion resistant
o Check for symmetry
§ More stain resistant
C. Composite Resin Teeth § If not symmetrical, adjust rim
§ More esthetically acceptable TOOTH SIZE SELECTION
§ Greater wear resistance
D. Porcelain Teeth • Use existing teeth as a guide
o Too big or small?
§ Highest wear resistant
o If so, use your own judgment
§ More stain resistant o Does px like them? Do you?
ACRYLIC RESIN TEETH PORCELAIN TEETH
o If acceptable, measure width and length
Bonds well to acrylic denture Pins are used for mechanical o Compare to mould guide chart
base retention to acrylic denture § CIs dimensions listed
base § Tooth photos are life size
Doesn’t make much noise when Makes clicking noise • Measuring existing teeth
teeth come in contact • High lip line
Stains and wears with time Subject to chipping and fracture o Inclination of inciso-gingival line
Subject to abrasion with Stain resistant
inappropriate scrubbing/ • Corners of the mouth
cleaning SHAPE SELECTION
Wear resistant
• Tooth shape does not correspond to facial shape
POSTERIOR TEETH SELECTION • Use existing teeth as a guide
I. SIZE • Do they look good?
A. Buccolingual Width • Use common sense and observation
§ Narrower than the natural teeth
B. MD Length DENTURE TOOTH MATERIAL
§ Distal of canine to RP • Porcelain teeth less common now
§ Posterior limit when ridge begins to ascend
C. Vertical Height • Acrylic easier to set and adjust
§ Available interarch space • Last life of denture (5-7 yrs)
II. CUSP HEIGHT • Porcelain
A. Non-Anatomic – 0 degrees o Less wear
B. Semi-Anatomic – 12 degrees o More translucent
C. Anatomic – 20 degrees o Brittle
D. Fully Functional – 33 degrees § Fracture easily
o Bond to base
REFERENCE MARKS FOR SELECTING ANTERIOR TEETH
§ Mechanical bond with screw inside
DR. RHODORA LUCIANO, DMD DDC BUHAT, JOHN PATRICK Q.
Complete denture DPT 223 8
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o Difficult to set and adjust
o Heavy
• Acrylic
o New acrylics wear better
o Improved translucency with layers
o More resilient – less breakage
o Chemically bonds to base
o Quieter
o Easier to set or adjust

DR. RHODORA LUCIANO, DMD DDC BUHAT, JOHN PATRICK Q.