Notion Press

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Chennai - 600 031

First Published by Notion Press 2018

Copyright © Dr. Kasim Mohamed M.D.S 2018
All Rights Reserved.

eISBN 978-1-64429-313-3

This book has been published with all efforts taken to make the material
error-free after the consent of the author. However, the author and the
publisher do not assume and hereby disclaim any liability to any party for any
loss, damage, or disruption caused by errors or omissions, whether such
errors or omissions result from negligence, accident, or any other cause.

No part of this book may be used, reproduced in any manner whatsoever

without written permission from the author, except in the case of brief
quotations embodied in critical articles and reviews.
This book is dedicated to our beloved
Founder Chancellor
Shri NPV. Ramasamy Udayar
PREFACE
 ACKNOWLEDGEMENTS

A few years ago we had conceived this idea to develop a

laboratory manual to assist the dental professionals in the
critical aspects of denture fabrication. We assure that we
have met the goal, while preserving the ability for
prosthodontists to make the training interactively and
explore the real-time difficulties.
We are grateful to our Chancellor Thiru. V.R.
Venkatachalam, and our Pro-Chancellor Thiru. R.V.
Sengutuvan, for providing a state of the art work
environment and supporting all our efforts.
We express our sincere thanks to our Vice-Chancellor,
Dr. P.V. Vijayaraghavan, for always supporting our career
goals and providing endless inspiration. We thank our
beloved professor T. V. Padmanabhan MDS, Former Head
of the Department of Prosthodontics, for mentoring us on
every aspect of our professional initiatives and share credit
on every goal we achieve. He coordinated our team in this
project and made sure we all were on the right track.
We received much support from Dr. D. Kandaswamy
MDS, FDS RCPS (Glasgow), Professor of Eminence and
Adviser (Faculty of Dental Sciences, SRMC & RI, DU)
when it seemed to be cumbersome half way, he motivated
us with encouraging words. We express our heartiest
thanks to him for being with us throughout the journey
guiding us to overcome the hurdles.
Our Dean, Dr. C. Ravindran, Faculty of Dental
Sciences (SRMC &RI DU), for encouraging us with his
generous attitude. We thank him wholeheartedly for
spending his valuable time amidst his administrative
responsibilities in listening to us, reading our work in depth
to impart his valuable suggestions in improving the content.
We like to offer special thanks to our beloved postgraduate
students. Without their insight or contributions, portions of
this book may not have been possible.
Thanks to our friends Dr. P. Rasmi MDS, DDS, and Dr.
Parithimarkaliangnan MDS, for supporting us when
starting this work and following with encouragement.
We thank Notion publishers and their technical staff for
their tremendous job in restructuring our work to a viable
format.
Throughout the process of this book work, many
friends from our campus and our Department colleagues
have taken time out to help us out. We would like to give
special thanks to them for their constructive contribution.
We are grateful to the almighty for giving us the strength
and for sustaining our efforts to accomplish the target.
 CONTENTS

COMPLETE DENTURE – I
Chapter-1: Introduction to Complete Denture
Chapter-2: Anatomical Landmarks
Chapter-3: Primary Impression
Chapter-4: Primary Casts
Chapter-5: Fabrication of Special Tray
Chapter-6: Occlusal Rims
Chapter-7: Articulation
Chapter-8: Teeth Arrangement
Chapter-9: Wax-Up and Carving
Chapter-10: Dearticulation
Chapter-11: Denture Processing
Chapter-12: Laboratory Remounting
Chapter-13: Finishing and Polishing of the Complete
Dentures
Chapter-14: Relining of Maxillary Denture
Chapter-15: Rebasing
Chapter-16: Denture Repair

REMOVABLE PARTIAL DENTURE – II

Chapter-1: Removable Partial Denture
• Introduction and Terminologies
• Classification and Kennedy’s
classification
• Applegate rules
• Components of Removable partial
denture
• Dental surveyor
Chapter-2: Temporary Removable Partial Denture
Steps in Fabrication:
• Drawing extension of the denture base
• Fabrication of Temporary record base
• Fabrication of Occlusal rim
• Articulation
• Teeth Arrangement
• Clasp Placement
• Processing
• Finishing and Polishing
 FIXED PARTIAL DENTURE – III
Fixed Partial Denture
• Introduction
• Types of FPD
• Indications and Contraindications
• Advantages and Disadvantages
• Parts of FPD
• Tooth preparation for Full veneer and Partial veneer
crown
• Tooth preparation for an all ceramic crown
• Tooth preparation for an all metal crown
• Clinical Steps in Fabrication of FPD

MAXILLOFACIAL PROSTHESIS – IV
Maxillofacial Prosthesis
• Introduction
• Materials
• Classification
• Types of Intraoral and Extra oral prosthesis

DENTAL IMPLANT – V
Dental Implant
• Introduction
• Definition and Types of Implant
• Parts of Implant
• Steps in placing an implant for a single missing
mandibular molar

References
COMPLETE DENTURE – I
 Chapter-1
INTRODUCTION TO COMPLETE
DENTURE

Terminologies
1. Complete denture prosthesis:
The replacement of all missing teeth in the maxillary,
mandibular arch and their associated parts by artificial
substitutes or prosthesis.
2. Complete edentulism:
All natural teeth are missing.
3. Partially edentulism:
Few or many natural teeth missing.

Steps in Fabrication of Complete

Denture
– Examination of completely edentulous arch.
– Primary impression.
– Primary cast.
– Special tray.
– Border molding.
– Final impression.
– Master/final cast.
– Record base and Occlusal rim.
– Jaw relation.
– Articulation.
– Teeth arrangement.
– Wax try in.
– Wax up, Carving.
– Processing.
– Trimming and Polishing.
– Complete denture insertion.
– Post insertion review.

Steps in Fabrication of Complete

Denture Prosthesis
Fig. 1.1 Completely edentulous maxillary arch.

Fig. 1.2 Completely edentulous mandibular arch.

Fig. 1.3 & Fig. 1.4 Maxillary and mandibular primary impression made with
impression compound.

Fig. 1.5 Maxillary and mandibular primary casts.

Fig. 1.6 Maxillary and mandibular special trays used for border molding and
to record final impressions.
Fig. 1.7 Sectional Border Molding with low fusing compound.

Fig. 1.8 Maxillary and mandibular final impression with zinc oxide eugenol
impression paste.
Fig. 1.9 & Fig. 1.10 Maxillary and mandibular working casts.

Fig. 1.11 & Fig. 1.12 Maxillary and mandibular record base with occlusal
rims.

Fig. 1.13 Jaw relation.

Fig. 1.14 Articulation in Mean value articulator.

Fig. 1.15 Teeth arrangement.

Fig. 1.16 Wax try in with trial denture base.

Fig. 1.17 Wax up, Carving and Festooning.

Processing

Fig. 1.18 & Fig. 1.19 Flasking procedure.

Fig. 1.20 Dental flask is approximated.

Fig. 1.21 Dental flask placed in clamp, tightened and verified for rim to rim
closure.
Fig. 1.22 Dewaxing.

Fig. 1.23 Packing of acrylic resin.

Fig. 1.24 Bench press after packing.

Fig. 1.25 Curing.

Fig. 1.26 Deflasking.

Fig. 1.27 & Fig. 1.28 Processed maxillary and mandibular dentures.

Fig. 1.29 Trimming.

Fig. 1.30 Polishing.

Fig. 1.31 Finished dentures.

Fig. 1.32 Denture insertion.

Surfaces of Complete Denture

Fig. 1.33 Tissue surface.

Tissue surface is otherwise called intaglio surface, which is in contact with

the denture base foundation.

Fig. 1.34 Polished surface.

It is the labial, lingual, buccal and palatal surface of maxillary and

mandibular denture flanges. Polished surface also includes labial, buccal,
lingual and palatal surfaces of artificial teeth.
Fig. 1.35 Occlusal surface.

It consists of occlusal and incisal surfaces of the artificial teeth.

 Chapter-2
ANATOMICAL LANDMARKS

Introduction
Knowledge about these landmarks enables the clinician to
record a good impression of edentulous maxillary and
mandibular arches. This chapter explains the macro and
microanatomy of all denture bearing tissues and their
clinical significance.

They are broadly classified into Supporting areas,

Limiting areas and Relief areas.
Supporting areas – They are structures which are covered
by the denture base and contribute to support by
withstanding masticatory load with less or no resorption.
They are further classified into:
Primary – Structures which are at right angles to the
direction of occlusal forces, consisting of cortical
bone, firmly adherent mucoperiosteum with
submucosa and sometimes muscle attachment which
resists resorption.
 Secondary – Structures which are at an angle obtuse
to the direction of forces, with less cortical bone when
compared to primary, but with firmly adherent
mucoperiosteum, adipose tissue and muscle
attachments.
Tertiary: It is present in the posterior one third of the
hardpalate either side of the midline, containing
glandular tissue. It provide least support to the
denture.
Limiting areas – These structures limit the extent of
maxillary and mandibular dentures. Including them in
complete denture prosthesis provides adequate border seal
and retention.
Relief areas – Structures containing cancellous bone, thin
mucosa or nerves and vessels are called relief areas. The
denture base fabricated is not in intimate contact with these
areas to avoid resorption, pain and numbness.

Edentulous Maxillary Arch

Supporting Areas:
Primary Support Area:
Fig. 2.1 The horizontal part of hard palate lateral to midline which is at right
angles to occlusal force.

Fig. 2.1 (a) The clinical picture showing the horizontal part of the hardpalate.
The mucosa is covered with keratinised stratified sqamous epithelium and
firmly adherent to the underlying cortical bone which resists resorption.

Secondary Support Area:

a. Palatal Rugae:
Fig. 2.2 Anterior slope of maxillary arch (obtuse angle): a Secondary support
area resisting anterior displacement of denture.

Fig. 2.2 (a) Palatal rugae are raised areas of dense connective tissue radiating
from the midline in the anterior 1/3 of the palate. Underlying cortical bone is
covered with firmly attached mucosa, lined by keratinized stratified
squamous epithelium. Submucosa contains more of adipose tissue.

b. Crest of the Residual Alveolar Ridge:

Fig. 2.3 Crest of the residual alveolar ridge excluding the incisive papilla.

Fig. 2.3 (a) Residual alveolar crest lacks cortical bone covering. The
submucosa is thick, firmly attached to the underlying structure, but resilient
and covered by keratinized stratified squamous epithelium. The crest of the
ridge provides support to the denture but its prone for resorption.

Tertiary Support Area or Glandular Area:

Fig. 2.4 Maxillary glandular area, which is considered as a tertiary support
area, is located on the posterior one third of the hard palate on either side of
the midline. It is perpendicular to the direction of occlusal forces and
increases the surface area of the denture.

Fig. 2.4 (a) Thick submucous layer contain numerous mucous salivary glands
(Approximately 200–300).

Maxillary Tuberosity:
Fig. 2.5 It forms the posterior extent. Denture must be extended to cover
entire maxillary tuberosity for provide support and stability.

Fig. 2.5 (a) Most important area for support. It provides the horizontal
stability for the denture and it is less susceptible to resorption.

Relief Areas in Maxillary Arch:

Incisive papilla and Mid Palatine raphae:
 Green circle – Incisive papilla

Fig. 2.6 Midpalatine raphae and incisive papilla should not be compressed or
stressed during function. Failure to relieve incisive papilla in complete
denture results in pain followed by paresthesia. Inadequate relief in mid
palatine raphe results in soreness and rocking of the denture.

Black line – Midpalatine raphae

Fig. 2.6 (a) The nasopalatine nerves and vessels emerge through the incisive
foramen which lies beneath incisive papilla. Mucosa in midpalatine raphe
region is thin and firmly adherent to the underlying bone and does not contain
submucosa.

Limiting Structures in Maxillary Arch:

Labial and Buccal Frenum:

Blue arrow – Labial frenum

Fig. 2.7 The labial frenum is normally located in the midline of the anterior
vestibule. The buccal frenum is located on either side in the buccal vestibule.
The labial and the buccal frena creates notches on the maxillary complete
denture. Inadequate compensation in the denture for labial and buccal frena
affects the peripheral seal of maxillary complete denture.
 Red arrows – Buccal frenum

Fig. 2.7 (a) The labial frenum is a sickle shaped reflection of mucous
membrane devoid of muscle fibres. The buccal frenum may be a single or
multiple band of tissue usually broad and shorter than the labial frenum. It
over lies levator anguli oris, orbicularis oris and buccinator.

Labial Vestibule and Buccal Vestibule:

Red line – labial vestibule

Fig. 2.8 The Labial vestibule lies between the right and left buccal frenum.
The buccal vestibule extends from the buccal frenum to the hamular notch on
either side.

Blue line – buccal vestibule

Fig. 2.8 (a) The labial and buccal flanges of the complete denture rests on the
labial and buccal vestibules respectively. The labial vestibule is influenced by
orbicularis oris and the buccal vestibular space is influenced by the action of
masseter and coronoid process of the mandible.

Hamular Notch/Pterygomaxillary Notch:

Fig. 2.9 It lies between the Pterygoid hamulus and maxillary tuberosity and
forms the posterior extent of the maxillary denture.
Fig. 2.9 (a) A T-Burnisher is used to locate the hamular notch. The mucosa
over lying the hamular notch is non-keratinised and loosely attached. It
contains elastic fibres.

Posterior Palatal Seal Area (PPS):

Fig. 2.10 PPS is the posterior boundary of maxillary complete denture.

Identifying and recording of this area helps in retention of the maxillary
complete denture. It extends through the pterygomaxillary notch continuing
for 3–4 mm anterolaterally and approximating the mucogingival junction.
This is known as pterygomaxillary seal (PMS). The shape of the posterior
palatal seal is Cupid’s bow due to posterior nasal spine.
 Fig. 2.10 (a)

Boundaries:

• Anteriorly – Anterior vibrating line.

• Posteriorly – Posterior vibrating line.

• Laterally – Hamular notch.

• Medially – It extends from one tuberosity to other Anterior vibrating line

corresponds to the area of attachment between soft and hard palate.

Fovea Palatina:
Fig. 2.11 & Fig. 2.11 (a) Two openings on the posterior portion of the hard
palate usually lying on either side of the midline.

• Ductal openings into which the ducts of minor palatal mucous glands
drain.

• It was considered to be a guideline for the placement of posterior palatal

seal.

Coronomaxillary Space:

Fig. 2.12 & Fig. 2.12 (a)

• It is the space existing between the medial aspect of coronoid process of
the mandible and the buccal aspect of the maxillary tuberosity.

• It must be recorded accurately in the final impression procedure to avoid

dislodgement of the complete denture during lateral and opening
movements.

Edentulous Mandibular Arch

Primary Support Area:

Fig. 2.13 Area between the buccal frenum and the anterior edge of the
masseter on both the sides is known as buccal shelf area.

• Anteriorly bounded by buccal frenum, posteriorly bounded retromolar

pad, medially bounded by crest of the residual alveolar ridge and laterally
bounded by external oblique line.
Fig. 2.13 (a) Bone in this area made of cortical plate, almost perpendicular to
the occlusal forces. Mucous membrane covering the buccal shelf is loosely
attached and less keratinized than crest of the alveolar ridge. The intact
cortical plate does not to resorb due to stimulation of the buccinator muscle
attachment.

Secondary Support Area:

Fig. 2.14 Labial and lingual slopes of mandibular arch on model.

It acts as a secondary support area by preventing anteroposterior movement

of the denture during function.
Fig. 2.14 (a) Clinical picture arrow denotes labial and lingual slopes.

It consists of thin cortical bone, unlike the buccal shelf area it is obtuse to the
direction of occlusal forces. Bone quality is poor in labial and lingual slopes
of the residual alveolar ridge than buccal shelf area. Mucosa is loosely
attached, submucosa is thick, contains loose areolar tissue and keratinization
is lesser than the crest of the alveolar ridge.

Retromolar Pad Area:

Fig. 2.15 It is a pear shaped soft elevation that lies distal to the third molar
area.
• It serves as a guide in fabrication of mandibular occlusal rim.

• The denture base should extend approximately one half to two thirds over
the retromolar pad.

Fig. 2.15 (a) It resorbs rarely due to large and active temporalis muscle
tendons on the distal alveolar bone. It is an important support area and
provides a soft tissue border seal for the mandibular denture.

Boundaries:

Posteriorly – temporalis tendon.

Laterally – buccinator muscle.

Medially – pterygomandibular raphe and superior constrictor muscle.

Contents: Mucosa is composed of nonkeratinized epithelium and sub mucosa

contains glandular tissue, fibers of the temporalis tendon, buccinator, fibers
of the superior constrictor and part of the pterygomandibular raphe.

Relief area:
Fig. 2.16 The red highlighted area indicates the crest of alveolar ridge. It is
relieved with a thin strip of modelling wax prior to the final impression.
(Refer chapter fabrication of special tray).

Fig. 2.16 (a) It consists of cancellous bone without good cortical bone
support over it and tends to resorb under masticatory load. The mucosa is
firmly attached and well keratinized. It acts as a relief area and not
compressed while the final impression is made for complete denture
prosthesis. Inadequate relief causes more resorption.

Limiting Structures in Mandibular

Arch:
Labial and Buccal Frenum:

Fig. 2.17 The labial frenum is normally located in midline of the anterior
vestibule. The buccal frenum is located on either side in the buccal vestibule.
Likewise the lingual frenum is seen in the midline on the lingual side of the
mandibular ridge. The frena create notches on the mandibular complete
denture. Inadequate compensation in the denture for labial, buccal and lingual
frena affects the peripheral seal of mandibular complete denture.

Fig. 2.17 (a) Labial frenum: A band of fibrous connective tissue that helps to
attach the Orbicularis oris muscle. Often shorter and wider than maxillary
labial frenum.

Buccal frenum: Single band often two or more bands of tissue present in first
premolar region. It overlies the depressor anguli oris.

Lingual frenum: A fibrous band of tissue that overlies the genioglossus

muscle.

Labial and Buccal Vestibule:

Fig. 2.18 The labial vestibule lies between the right and left buccal frena. The
buccal vestibule extends from the buccal frenum to the retromolar pad on
either side.
Fig. 2.18 (a) The labial flange and buccal flange of the complete denture rests
on the labial vestibule and buccal vestibule respectively. The labial vestibule
it is influenced by mentalis muscle and the buccal vestibular space is
influenced by the action of buccinator muscle. The distobuccal border of the
buccal vestivible is influenced masseter muscle.

Alveololingual Sulcus:
Anterior, Middle and Posterior Alveololingual Sulcus:
Fig. 2.19 It is the space between the residual ridge and the tongue extending
from the lingual frenum to the Retromylohyoid curtain. The seal of the
mandibular complete denture is maintained when its lingual flange remains in
contact with the alveololingual sulcus.

Fig. 2.19 (a) The alveololingual sulcus is divided in to three regions

namely:

• Anterior sublingual crescent area: It extends from lingual frenum to pre-

mylohyoid fossa.

• Middle mylohyoid area: It extends from pre-mylohyoid fossa to

mylohyoid ridge.

Posterior retromylohyoid fossa: It extends from mylohyoid ridge to

retromylohyoid curtain.

Note: Retromylohyoid curtain is formed by the superior constrictor of

pharynx and palatoglossus.

Anterior Alveololingual Sulcus:

Sub Lingual Cresent Area

Fig. 2.20 Extends from lingual frenum to premylohyoid fossa. Influenced by

genioglossus, lingual frenum and anterior part of the sublingual gland.
Genioglossus muscle are attached to the genial tubercles. Epithelium in this
region is thin, non-keratinized. Submucosa contain loosely arranged
connective tissue fibers mixed with elastic fibers, sub lingual gland and is
attached to the genioglossus muscle.

Middle Alveololingual Sulcus:

Mylohyoid Area

Fig. 2.21 Extends from the premylohyoid fossa to distal end of the
mylohyoid ridge, curving medially from the body of the mandible.
Mylohyoid vestibule is influenced by mylohyoid muscle. The length and
width of the denture flange is determined by the membranous attachment of
the tongue to the mylohyoid ridge and the width of the hyoglossus muscle.
Microscopic anatomy is similar to anterior alveolingual sulcus.

Posterior Alveololingual Sulcus:

Retro Mylohyoid Fossa (Lateral throat form)

Fig. 2.22 The denture flange should include retro mylohyoid fossa to
accomplish the peripheral seal and to aid in retention of the mandibular
denture. Posterior border of the denture is limited by palatoglossus and
superior constrictor muscle. The retromylohyoid curtain is formed
palatoglossus, Superior constrictor and medial pterygoid. Extending the
denture in this area maintains the border seal continuously from retro molar
pad to middle part of alveolingual sulcus.

Microscopic anatomy is similar to anterior alveolingual sulcus; mucosa

covering the retromylohyoid curtain is attached by submucosa to the superior
constrictor.

Boundaries:

• Anteriorly – Mylohyoid muscle.

• Postero medially – Palatoglossus muscle.

• Postero laterally – Superior constrictor muscle.

• Laterally – Retro molar pad.

• Medially – Tongue.
 Chapter-3
PRIMARY IMPRESSION

Introduction
It explains the importance of tray selection, selection of
impression material, manipulation of impression
compound, positioning of the tray in the oral cavity,
recording and refining a primary impression is represented
in an acrylic model, which simulates the oral environment.
The same sequence is adopted for a primary impression
in a completely edentulous patient.

Fig. 3.1 & Fig. 3.2 Completely edentulous acrylic maxillary and mandibular
models.
Fig. 3.3 Impression compound.

It is a type of thermoplastic impression material used to record primary

impressions for completely edentulous arches by mucocompressive
technique.

Fig. 3.4 Maxillary edentulous non-perforated metal stock tray verified for
tray extension on the model. The clearance between the tray and model must
be approximately 3–4 mm to provide space of impression material.
Fig. 3.5 The labial, buccal and lingual flange of the mandibular edentulous
stock tray is adjusted with universal plier to have a clearance of 3–4 mm from
the tissues.

Fig. 3.6 The tray when verified must be 3 mm short of the sulcus to allow
space for the impression material.
Fig. 3.7 & Fig. 3.8 A thin layer of liquid paraffin, separating medium is
applied on the model prior to impression making to aid in easy removal of set
impression.

Fig. 3.9 The compound is broken into smaller pieces and softened in a bowl
of hot water. Softening temperature for the compound ranges between 50–
55°C. Avoid heating the compound directly on flame as direct heating will
cause leaching of volatile compounds.
Fig. 3.10 Kneading of impression compound to make it homogenous and
improve flow of the material.

Fig. 3.11 & Fig. 3.12 The material is contoured with the finger to mimic the
maxillary ridge and mandibular ridge prior to impression making.
Fig. 3.13 & Fig. 3.14 The loaded impression tray is placed on the maxillary
and mandibular edentulous model to record the impression. Apply moderate
pressure on the tray until the excess material flows. The excess material is
then adapted well on the land area and base of the model when the
impression compound is completely harden.

Fig. 3.15 & Fig. 3.16 Primary impression of the maxillary and mandibular
edentulous arches when removed from the model.
Fig. 3.17 & Fig. 3.18 Excess impression compound trimmed and the
impression is refined.

Note: The borders are uniformly 2–3 mm thick.

 Chapter-4
PRIMARY CASTS

Introduction
This chapter enlightens the reader about the making of
primary cast. The importance of beading and boxing an
impression is well explained. Preparation of primary cast is
a vital step which enables the clinician to visualize all the
denture bearing areas as a positive replica of patient’s
mouth. A proper primary cast enables the technician to
fabricate a custom tray with adequate extent and thickness.
Primary cast is preferably made of Type II gypsum product
the dental plaster.
Fig. 4.1 Wash the primary impression with water.

Fig. 4.2 Sterilise the impression with 2% gluteraldehyde.

Beading of Primary Impression

Beading wax

Fig. 4.3 This wax is supplied as strips measuring 3–4 mm in width and
approximately 30 cm in length.

Beading of the impression

Fig. 4.4 Beading wax adapted approximately 2–4 mm below the borders of
the maxillary and mandibular impressions and sealed with warm wax knife.
The wax is adapted at 45 degrees angulation towards the impression surface.

Fig. 4.5 & Fig. 4.6 Beading of maxillary and mandibular primary impression
completed.

Beading is done on the primary impression to create a land area on the

primary cast. The purpose of creating the land area is to preserve the limiting
structures that was recorded in the impression.

Note: The width of beading wax is approximately 3–4 mm.

Boxing of Primary Impression

Fig. 4.7 Boxing wax supplied in strips of approximately 5 cms x 30 cm.

Fig. 4.8 Boxing wax adapted perpendicular along the outer borders of the
beading wax and sealed with warm wax knife.
Fig. 4.9 & Fig. 4.10 The height of the boxing wax must be approximately
10–15 mm from the highest point on the impression, which will provide a
base of the same measurement. Boxing is done to provide adequate height
and strength for working cast.

Fig. 4.11 Maxillary and mandibular primary impression with beading and
boxing.
Fig. 4.12 Application of soap solution which acts as a surfactant to improve
the wettability of impression.

Pouring of Cast

Fig. 4.13 & Fig. 4.14 Dental plaster (Type–II) is proportioned mixed and
poured from one corner of the boxed impressions and gently tapped so that
the plaster flows to the other side.
Fig. 4.15 & Fig. 4.16 More dental plaster is poured evenly throughout the
impressions and the tray is gently vibrated to avoid entrapment of air bubbles
and to obtain a void free cast. The cast is allowed to set.

Fig. 4.17 The boxing wax removed from the set cast.
Fig. 4.18 The beading wax is removed with wax knife.

Fig. 4.19 & Fig. 4.20 The set cast is immersed in a bowl of warm water to
facilitate easy removal of the tray from the cast.

Note: Care should be taken not to over soften the compound to avoid
adherence to the primary cast.
Fig. 4.21 & Fig. 4.22 The softened compound is gently pried using the wax
knife taking care not to break the margins of the cast.

Fig. 4.23 & Fig. 4.24 The maxillary and mandibular primary cast after
removal from the impression trays.
Fig. 4.25 The wax residues are eliminated using hot water.

Fig. 4.26 The rough surfaces on the cast are smoothened with sandpaper, in
sequence from coarse (no 80) to fine (no 320).
Fig. 4.27 Primary cast polished with talcum powder or French chalk.

Fig. 4.28 & Fig. 4.29 Finished maxillary and mandibular primary casts.

Note: The cast is devoid of any compound or wax. The anatomical

structures are reproduced and the margins are intact.
Fig. 4.30 & 4.31 Height of the base of the maxillary and mandibular casts are
approximately 10–15 mm.

Fig. 4.32 Height of the sulcus: This will help in maintaining the correct width
and height of the vestibule, which will influence the fabrication of special
tray. It measures approximately 2–4 mm.
Fig. 4.33 Land area of 2–4 mm on the cast differentiates between anatomical
and non-anatomical areas.

Fig. 4.44 & Fig. 4.45 The land area is at 45 degree to the base. This helps in
contouring of the dental plaster along the borders of the cast during flasking
procedure in master cast.
 Chapter-5
FABRICATION OF SPECIAL TRAY

Introduction
The special tray is fabricated to make the secondary or final
impression of the edentulous arches. The final impression
should record the functional depth and width of the sulcus,
have close approximation with the denture bearing area and
it should also cover maximum area possible. This chapter
details the step by step procedures involved in the
fabrication of a special tray using dough and sprinkle-on
technique. A unique procedure of relief wax strip
adaptation along the border is explained. The reader will be
oriented towards the materials and armamentarium used to
prepare a special tray. The chapter also explains in detail
the requirements of a special tray especially the tray
extension, dimensions and position of tray handle.

Definition
• An individualized impression tray made from a cast
recovered from a preliminary impression. It is used in
 making a final impression.
Ideal requirements of a special tray
• Tray should be rigid and better adaptation on
primary cast.
• Tray material should be non-toxic and non-irritant
to the oral tissue.
• It should be dimensionally stable on cast and mouth.
• Tray border should be 2–3 mm short of sulcus.
• Border of the tray should be 2–4 thick to support the
border molding material.
• Tray material should not interact with secondary
impression material.
• It should have handle.

Fig. 5.1 Maxillary and mandibular primary casts.

Fabrication of Maxillary Special Tray

Advantage of the Technique:
The method of fabrication of a custom or special tray is
sprinkle on technique. The authors have modified this
technique for the ease in fabrication.
Note: The polymer and monomer are added in slopes at a
particular inclination to avoid uneven thickness and
dropping down of polymer while sprinkling. This technique
modification of adapting 2 mm of wax sheet also reduces
the laboratory time of trimming the tray 2 mm short of
sulcus. The adaptation of 2 mm wax also enables the
operator to maintain the 2 mm width along the borders of
the special try. This technique saves time in fabrication and
easy for a beginner to adopt and perform.

Fig. 5.2 Modelling wax cut using scale. Modelling wax is used to prepare
wax strips measuring 2 mm in length and width.
Fig. 5.3 Wax strips will mainain the 2 mm space between the sulcus and the
borders of the special tray.

Fig. 5.4 Adapt the wax strip on the sulcus of the edentulous cast starting from
one hamular notch to another.
Fig. 5.5 Wax strip adaptation completed.

Fig. 5.6 Relief is given with modeling wax on the incisive papilla and mid
palatine raphae.
Fig. 5.7 Apply a layer of sodium alginate (cold mould seal) of separating
medium throughout the cast starting from one side to another side.

Fig. 5.8 The separating medium is applied on land area to facilitate easy
removal of excess acrylic.
Fig. 5.9 After application, wait for few minutes for the sodium alginate (cold
mould seal) to react with calcium sulphate (cast) to form a layer of calcium
alginate.

Sprinkle on Technique

Fig. 5.10 Armamentaruim: Polymer is used with a dropper and monomer in a

syringe.
Fig. 5.11 Cast is tilted approximately at 45 degrees, sift polymer on one side
of the cast and drop monomer over the polymer.

Fig. 5.12 Sift more powder and liquid until there is a uniform layer of auto
polymerising resin approximately 2 mm thick in one half of the palate.
Fig. 5.13 One half of palate and one side of buccal flange is completed by
maintaining the same tilt. This technique easy and reduces the fabrication
time.

Fig. 5.14 Polymerization completed on the buccal side and part of the palate
of the maxillary cast.
Fig. 5.15 The cast is tilted to opposite direction and more polymer and
monomer is added on the other side of the palate.

Fig. 5.16 Sufficient time is given for polimerisation of the acrylic resin.
Fig. 5.17 Adding the polymer and monomer on the labial side of the tilted
maxillary cast.

Fig. 5.18 Polymer and monomer added in small increments on the crest of the
maxillary ridge.
Fig. 5.19 At the end of the procedure, the acrylic should cover all the
anatomical land marks and it should be uniformly 2 mm thick.

Fig. 5.20 Handle Fabrication: Modelling wax strip of 15 mm x 100 mm is

adapted and sealed to forma trough in the anterior region from canine to
canine as shown in the picture.

Note: A labial proclination of 15 degree is given to support the lip while

border moulding.
Fig. 5.21 The trough formed is filled in increments of polymer and monomer
as explained earlier.

Fig. 5.22 After the polymerisation, wax strips are removed from the handle
and the borders of the tray.
Fig. 5.23 Tissue or intaglio surface of the special tray.

1. Borders are approx. 2 mm thick.

2. No surface voids or irregularities.
3. The relief wax covering the incisive papilla and mid palatine raphae
remains in the tray.

Fig. 5.24 Finished special tray with handle.

Fig. 5.25 Finished special tray with handle.

Note: The special tray is 2 mm short of the sulcus.

Handle dimensions:

• Length – 22 mm from labial vestibule. • Width – Extends from Canine to

canine region.

• Thickness – Approximately 3–5 mm. • Labial inclinaton – 15 degree.

Fabrication of Mandibular special tray:

Fig. 5.26 Wax strips measuring 2 mm in width adapted from one retromolar
pad region to another.

Fig. 5.27

• Wax strip adaptation completed along the sulcus.

• A thin strip of wax is adapted on the crest of the residual alveolar ridge for
relief excluding the retro molar pad area.

Fig. 5.28 A single coat of separating medium applied on the cast.

Fig. 5.29 Application of separating medium completed.

Fig. 5.30 Polymer and monomer added on the lingual slopes of one side.
Fig. 5.31 Polymer and monomer added on the buccal side of the arch
maintaining the same tilt.

Fig. 5.32 Addition of acrylic is completed on the buccal and lingual slopes of
the ridge.
Fig. 5.33 The same procedure is done on the crest of residual alveolar ridge.

Fig. 5.34 Sprinkle on method completed on the mandibular cast.

Note: The uniformity of thickness.

Fig. 5.35 Three wax troughs are fabricated as shown in the picture. The
anterior will function as handle and the two posteriors as finger rests. These
are filled with acrylic resin as explained earlier and allowed to polymerise.

Fig. 5.36 Finished special tray.

Note: The extension and position of handle and finger rests.

Fabrication of Maxillary and Mandibular

special Tray (Dough Technique)
Fig. 5.37 & Fig. 5.38 Primary cast prepared. Wax strips adapted and
separating medium applied as explained in previous technique.

Armamentarium:

Fig. 5.39 Cold cure acrylic polymer and monomer, Cold mould seal, dappen
dish, porcelain mixing jar, baseplate and wax carver.
Fig. 5.40 Glass slabs.

Fig. 5.41 Vaseline applied on glass slab.

Fig. 5.42 The auto polymerizing polymer and monomer are mixed in a ratio
of 3:1.

Fig. 5.43 When the acrylic resin reaches the stringy stage, it is spread on the
glass slab.
Fig. 5.44 Glass slab placed and pressed over the cold cure acrylic to make a
sheet of dough with uniform thickness 3–4 mm approximately.

Fig. 5.45 & Fig. 5.46 Maxillary and mandibular baseplate placed on the sheet
of acrylic which would have reached the early dough stage.

Fig. 5.47 & Fig. 5.48 The acrylic is cut according to the shape of the
baseplate with a sharp instrument.
Fig. 5.49 & Fig. 5.50 The acrylic sheet is adapted on maxillary and
mandibular primary cast.

Fig. 5.51 & Fig. 5.52 The excess material is cut with a sharp instrument.

Fig. 5.53 & Fig. 5.54 The maxillary and mandibular special tray after the
excess is trimmed and the borders well adapted.

Fig. 5.55 & Fig. 5.56 Acrylic dough prepared to fabricate a handle for
maxillary and mandibular special tray.

Fig. 5.57 & Fig. 5.58 Handle adapted on maxillary and mandibular tray.

Note: Handle is positioned in such a way that it does not interfere with lip
movements during final impression.
Fig. 5.59 Maxillary and mandibular special tray with handle.

Fig. 5.60 Tissue surface of set trays.

Fig. 5.61 The wax strips are removed.

Fig. 5.62 & Fig. 5.63 The excess acrylic is trimmed with a vulcanite trimmer.

Fig. 5.64 & Fig. 5.65 The borders are smoothened and rounded with fine
acrylic trimmer.

Fig. 5.66 The special tray is finished with sandpaper used in sequence from
coarse (no 80) to fine (no 320).
Fig. 5.67 Finished special tray fabricated with dough technique.
 Chapter-6
OCCLUSAL RIMS

Introduction
It is a wax form that is used to establish accurate maxillo-
mandibular jaw relations and for arranging artificial teeth to
form the trial denture. They also help to determine the
length and width of the natural teeth, midline of the arch to
verify the correct placement of the incisors, the proper lip
support, and the cuspid eminences.
There are four basic factors to be considered in
fabrication of occlusal rims relationship of natural teeth to
alveolar bone, relationship of natural teeth to edentulous
ridge, the fabrication guidelines and the clinical guidelines
for the occlusal rims.

Fabrication of Maxillary and

Mandibular Record bases
• Trial denture base or record base: The recording base is generally a
temporary form that closely resembles the final base of the denture under
 construction. It is used for recording maxillomandibullar jaw
relationships and for arrangement of the artificial teeth.

• Record bases can be fabricated in Autopolymerising acrylic resin, light

cure acrylic resin and shellac base plate.

Fig. 6.1 & Fig. 6.2 Maxillary and mandibular edentulous working casts.

Fig. 6.3 & Fig. 6.4 Separating medium applied on the casts.

Record Base Fabrication – Sprinkle on

Method
Fig. 6.5 & Fig. 6.6 Polymer and monomer added in increments.

Fig. 6.7 & Fig. 6.8 Record bases fabricated.

Fig. 6.9 & Fig. 6.10 Finished record bases.

 The thickness of the record base on the labial and buccal slopes is
Note: approximately 1 mm for ease of teeth arrangement.

Fig. 6.11 Lateral view shows the adequate extension record base.

Fig. 6.12 & Fig. 6.13 Tissue surface of the finished record bases.

Note: The width of the sulcus is maintained on the flange of the record base.
The thickness of the record base is approximately 2 mm in the
borders. The borders of the record base are well rounded.
Fabrication of Maxillary and
Mandibular Occlusal Rims

Fig. 6.14 Pencil marking on crest of the residual ridge and extended to land
area (posterior Region). This is to identify the location of the center ridge
after placing the record base on the cast.

Fig. 6.15 Wax sheet softened over flame and folded to obtain adequate
thickness.
Fig. 6.16 Wax sheet folded in close approximations to avoid entrapment of
air.

Fig. 6.17 White mark indicate centre of the occlusal rim and inner surface of
the occlusal rim is in line with centre of the ridge (lead mark) approximately.
Anterior part of the occlusal rim like arch and it always follow the anterior
part of the ridge. Posterior part of the occlusal rim is always in straight line
from canine region to till the end.

Note: Meticulous fabrication of an occlusal rim on record base is not only

helpful in recording jaw relation but also guides in teeth arrangement.
Fig. 6.18 Width of the maxillary occlusal rim.

Both anterior and posterior width of the occlusal rim is based on labio-lingual
and bucco-palatal width of the natural teeth.

Anteriorly: 4–6 mm approximately.

Posteriorly: 8–10 mm approximately.

The posterior margin of the occlusal rim rounded and is sloped approximately
at 45 degree to the record base.
Fig. 6.19 Height of the maxillary occlusal rim: The anatomic length of the
anterior teeth decides the height of the occlusal rim. Hence the height is
measured from edge of the record base to superior border of the occlusal rim
in canine region.

Labial view: Height approximately 22 mm in canine region.

Fig. 6.20 Anatomic length of the posterior teeth decides the occlusal rim
height in posterior region. Hence it is measured from edge of the record base
to superior border of the occlusal rim in first molar region. Posterior end of
the occlusal rim is angulated at 45 degree, which prevents interference of
record base in retro molar pad region when jaw relation is recorded.

Height approximately is 18 mm in the first molar region.

Fig. 6.21 Mandibular cast

Pencil marking indicates the crest of the residual alveolar ridge extends to the
retro molar pad and land area.

Fig. 6.22 Retromolar pad region.

It is divided into three parts anterior, middle and posterior. The line
corresponding to two thirds height of the retromolar pad is extended to the
land area.
Fig. 6.23 White line indicates center of the occlusal rim and lead mark on
posterior land area indicate center of the crest of the ridge. Unlike maxillary
rim, center of the occlusal rim and crest of the ridge coincides. Anteriorly the
arch form in the mandibular rim also follows the arch curvature. Posterior
part of the occlusal rim is always in straight line from canine region to till
retromolar pad.

Fig. 6.24 Mandibular occlusal rim fabricated. The posterior margin of the
occlusal rim is rounded and merged with the record base.
Fig. 6.25 Dimensions of mandibular occlusal rim
Width: Anteriorly: 4–6 mm approximately.
Posteriorly: 8–10 mm approximately.

Fig. 6.26 Description regarding anterior height and method of measurement

are similar to maxillary occlusal rim.
Fig. 6.27 & Fig. 6.28 Posterior height of the occlusal rim is upto middle third
of the retromolar pad. Marking on the land area indicate position of the
middle third of the retromolar pad. Posteriorly the height must coincide with
two thirds of retromolar pad.
 Chapter-7
ARTICULATION

Introduction
Articulation is a laboratory procedure in which the
maxillary and mandibular casts are attached on the
articulator at an established jaw relation.

Definition of Articulator
It is a mechanical device that represents the
temporomandibular joint and jaw members to which the
maxillary and mandibular casts are attached to simulates
some (or) all the mandibular movements.

Fig. 7.1 & Fig. 7.2 Mandibular cast: A line drawn along the crest of the
mandibular ridge extends to the land area till the base of the cast. This guides
in orientation of the maxillary and mandibular cast.

Fig. 7.3 & Fig. 7.4 Indexing of the maxillary and mandibular casts. Four ‘v’
shaped notches are made on the thickest portion of the base on maxillary cast.
Similarly three V-shaped notches are made on mandibular cast. (Some
authors recommend three notches in the maxillary and mandibular casts).
Carborundum disc is used to create notches and further refined with a sharp
instrument. It plays important role in lab remounting procedure.

Fig. 7.5 Maxillary occlusal rim is positioned 2 mm ahead the mandibular rim
to incorporate overjet and sealed guidelines for anterior teeth arrangement are
marked on the occlusal rims. (Midline and canine line)

Fig. 7.6 Buccal view of the sealed occlusal rims.

Note: Even contact between the occlusal rims and the distal end of
mandibular occlusal rim should not extend beyond the maxillary rim.
The 45 degree angulation of occlusal rim in maxillary tuberosity
region prevents the interference of retromolar pad during articulation.

Fig. 7.7 Posterior view of sealed occlusal rims After sealing of maxillary and
mandibular occlusal rims, the lines on the cast ensures parellelism. The
distance between these lines should be equal.
Fig. 7.8 Application of vaseline on the indexed areas for easy removal of
casts from the articulator during de-articulation procedure. This procedure
maintains the plaster elevations (key) for laboratory remounting procedure.

Fig. 7.9 Application of vaseline on the sides of the maxillary and mandibular
casts to facilitate easy removal of excess dental plaster during articulation.

Parts of the Mean Value Articulator

Fig. 7.10. Mean value Articulator (LateralView).

Fig. 7.11 Mean value Articulator (Posterior View).

Articulation of the Occlusal Rims

Fig. 7.12 Wax roll prepared to aid as support during articulation.

Fig. 7.13 Wax roll cut in three equal sized pieces for articulation.

Fig. 7.14 Seal the segmented wax rolls on the lower member of the
articulator, one in the anterior and two in posterior as shown in the picture.
Fig. 7.15 Thread placed in the articulator to assist proper orientation of
occlusal rims and orientation of the occlusal rims according to the bonwill
theory.

Fig. 7.16 Lateral view of the articulator indicating.

• The tip of the incisal pin oriented to the centre of the mandibular occlusal
rim.

• Placement of the thread bisecting both the occlusal rims.

• Thread placed anteriorly at the centre of the incisal pin with wax.

• Thread placed posteriorly at the centre of the occlusal plane indicator of

 the articulator.

Fig. 7.17 Posterior view of the articulator with occlusal rims in position.

Fig. 7.18 The upper member of the articulator is opened for the articulation
of the maxillary cast.
Fig. 7.19 Add dental plaster on the maxillary cast.

Fig. 7.20 Close the upper member the excess material is removed and shaped
confining to the borders of the maxillary cast.
Fig. 7.21 The excess dental plaster is removed with wax knife.

Fig. 7.22 Maxillary cast articulated and allowed to set.

Fig. 7.23 Once the maxillary cast articulation is complete, the articulator is
turned, the lower member is opened for articulation of mandibular cast.

Fig. 7.24 Add dental plaster on the mandibular cast and articulation done as
explained for maxillary cast.
Fig. 7.25 Articulation completed (Anterior view).

Fig. 7.26 & Fig. 7.27 Lateral and posterior view.

 Chapter-8
TEETH ARRANGEMENT

Introduction
Complete dentures replace the maxillary and mandibular
teeth and also associated structures. Arranging an artificial
teeth is an important element in complete denture
prosthodontics. Teeth arrangement procedure involves the
placement of teeth on the occlusal rims with definitive
objectives. The placement of teeth on the occlusal rims of
trial denture bases. Care should be taken that after teeth
arrangement all the remaining artificial teeth maintain
maximum intercuspation. The Incisal rod of the articulator
remains in contact with the center of the incisal table. The
purpose of the chapter is to describe the art of arranging the
artificial teeth.
Fig. 8.1 Anatomic acrylic teeth.

Arrangement of Anterior Teeth

Fig. 8.2 & Fig. 8.3 Arrangement of maxillary central incisor (Anteior view).
• Its long axis inclines slightly towards the vertical axis when viewed from
the front.

• The incisal edge contacts the occlusal plane.

Fig. 8.4 & Fig. 8.5 Lateral view.

• Central incisor Slopes labially about 15° when viewed from the side.

• The cervical margin should be within the occlusal rim.

Fig. 8.6 & Fig. 8.7 Occlusal view. The position of the central incisor when
viewed palatally is not exactly straight but follows the arch form.

Fig. 8.8 & Fig. 8.9 Arrangement of lateral incisor (Anterior view).

• Its long axis slopes rather more towards the midline when compared to
the central incisor.

• The incisal edge is about 1–2 mm short of the occlusal plane.

Fig. 8.10 Lateral view.

• Lateral incisor is inclined labially about 20° when viewed from the side.

Fig. 8.11 & Fig. 8.12 Arrangement of maxillary canine (Anterior view).

• Its long axis is parallel to the vertical axis when viewed from both front
and side.
• The cervical margin of the canine is more prominent when compared with
central and lateral incisors.
• The tip of the canine contacts the occlusal plane.
• When viewed from front, the mesial slope of canine is more visible.
Fig. 8.13 Lateral view.

• It is parallel to the vertical axis when viewed from the side. The bulbous
cervical half of the tooth provides its prominence.

• When viewed from the buccal side the distal arm of the canine is more
visible.

Fig. 8.14 & Fig. 8.15 Incisal view. The arrangement follows the arch form.
Fig. 8.16 Arrangement of the maxillary anteriors verified on a glass plate.

Fig. 8.17 Anterior teeth arrangement in relation to Horizontal plane.

Fig. 8.18 Occlusal view.

• The symmetry of arch should be maintained.

• Position of the both canines should be symmetrical.

• Distance between midline and tip of the canine should be equal.

Fig. 8.19 & Fig. 8.20 Mandibular central incisor (Anterior View).

• Its long axis also inclines slightly towards the vertical axis when viewed
from the front.

• The incisal edge is about 2 mm above the occlusal plane.

Fig. 8.21 Lateral view.

• It slopes labially when viewed from the side.

Note: The inclination is more pronounced in the incisal half of central

incisor and the cervical region is within the occlusal rim.

Fig. 8.22 Incisal view.

• It follows the arch form.

Incisal edge is almost straight in the arch.

Fig. 8.23 & Fig. 8.24 Mandibular lateral incisor (Anterior view).

• Long axis inclines slightly towards the vertical axis when viewed from
the front.

• The incisal edge is 2 mm above the occlusal plane.

Fig. 8.25 Incisal view: It follows the arch form.

Fig. 8.26 Distal side of the incisal surface is slightly lingually placed than
mesial side.

Fig. 8.27 & Fig. 8.28 Mandibular canine (Anterior view)

• Its long axis leans slightly towards the midline when viewed from the
front.

• The cervical margin is more prominent than incisors.

• The incisal margin is more than 2 mm above the occlusal plane.

Fig. 8.29 Lateral view.

• The incisal half of the canine is lingually tilted and the cervical half is
more prominent when viewed from the side.

Fig. 8.30 Incisal view of mandibular Anteriors.

• The incisors do not form a straight line but curves according to the
curvature in the arch.
Fig. 8.31 Incisal view of the maxillary and mandibular anterior teeth.
Uniformity of space between maxillary and mandibular anteriors overjet
approximately – 2 mm.

Fig. 8.32 Canine relation.

The mesial slope of the maxillary canine overlaps the distal slope of the
mandibular canine.
Fig. 8.33 & Fig. 8.34 Frontal view of the anterior teeth arrangement.

Note: Arch form, uniform overjet and overbite, proclination of anterior teeth
and arch symmetry.

Arrangement of Posterior Teeth

Fig. 8.35 The line is extended onto the maxillary occlusal rim so that it meets
the distal aspect of the maxillary canine. The maxillary posteriors are
arranged such that the central grooves of the posterior teeth correspond to this
line and mandibular teeth are arranged such that the functional (buccal) cusps
correspond to this line.
Fig. 8.36 A line is drawn from the distal aspect of the mandibular canine
corresponding to the centre of the occlusal rim of the mandibular arch. This
line is extends to the land area.

Fig. 8.37 Maxillary first premolar (Buccal view).

• The long axis is parallel to the vertical axis when viewed from the front
and the side.

• Its buccal cusp contacts the occlusal plane.

Fig. 8.38 (Palatal view).

• The palatal cusp is slightly above the occlusal plane.

Fig. 8.39 Occlusal view: The buccal surface of the premolar is line with the
distal slope of the canine.
Fig. 8.40 Maxillary second premolar (Buccal view).

• Its long axis is parallel to the vertical axis, similar to first premolar.

Fig. 8.41 (palatal view).

• Both buccal and palatal cusps contacts the occlusal plane.

Fig. 8.42 Occlusal view: The buccal surface of the first and second premolars
is in line with the distal slope of the canine.

Fig. 8.43 & Fig. 8.44 Maxillary first molar (Buccal view).

• Long axis slopes buccally in front view.

• Long axis slopes distally in side view.

• The only the mesio palatal cusp contacts the occlusal plane.

Fig. 8.45 Occlusal view: Buccal surfaces of second premolar and the first
molar are in line.
Fig. 8.46 & Fig. 8.47 Maxillary second molar (Buccal view).

• Long axis slopes more buccally than first molar in front view.
• Long axis slopes more distally than first molar in side view.
• None of the cusps is in contact with the occlusal plane but mesio-palatal
cusp is close to the occlusal plane.
Note: The mesial surface of the second molar should be in line with the
distal surface of first molar.

Fig. 8.48 Occlusal view: Distal portion of the tooth slightly palatally placed.
Buccal side of the mesiobuccal cusp is close to the line and distobuccal cusp
is palatal to the line.
Fig. 8.49 Relationship of the Maxillary teeth in occlusal plane.

• Central incisors – Incisal edges touching the occlusal plane.

• Lateral incisors – The incisal edge approximately 2 mm above the plane.
• Canines – The incisal tip touching the occlusal plane.
• First premolar – Buccal cusp touching the occlusal plane.
• Second premolar – Buccal and the palatal cusps contacts the occlusal
plane.
• First molar – Mesio palatal cusp contacts the occlusal plane.
• Second molar – Only the mesio palatal cusp close to the occlusal plane.

Fig. 8.50 Relationship of the maxillary posterior teeth and mandibular

residual ridge.

All the palatal cusp of the maxillary posterior teeth falls on centre of the
mandibular residual alveolar ridge. This guides to verify the correct position
of maxillary posteriors.

Fig. 8.51 Mandibular first molar (Labial view).

• Long axis leans lingually in front view.

Fig. 8.52 Mandibular first molar (Buccal view).

• Long axis leans mesially in side view.

Fig. 8.53 The buccal and distal cusps are higher than the mesial and lingual
because of the inclination of the tooth.

Fig. 8.54 Key of occlusion.

• Mesio buccal cusp of the maxillary first molar should lie over the
mesio buccal groove of the mandibular first molar in centric
occlusion.
Fig. 8.55 & Fig. 8.56 Mandibular second premolar (Buccal and labial view)

Long axis is parallel to the vertical axis when viewed from both the front and
the side. Both cusps are about 2 mm above the occlusal plane.

Fig. 8.57 Buccal view.

The buccal cusp contacts the fossa between the two maxillary premolars.
Fig. 8.58 & Fig. 8.59 Mandibular second molar (Buccal and Labial View).

• The long axis leans more lingually and mesially than first molar in front
and side view respectively.

Fig. 8.60 & Fig. 8.61 Mandibular first premolar (Buccal and labial view).

• Long axis is parallel to the vertical axis in front and side view. Its lingual
cusp is 1–2 mm below the occlusal plane.
Fig. 8.62 & Fig. 8.63 The buccal cusps or the central groove of the
mandibular posteriors should coincide with crest of the residual alveolar
ridge.

The pencil mark that appears on the land area of the mandibular cast denotes
the extension crest of the residual alveolar ridge. This mark helps in verifying
the teeth arrangement.

Fig. 8.64 & Fig. 8.65 Completed teeth arrangement (Anterior & Lateral
View).
Fig. 8.66 & Fig. 8.67 Cusp to fossa relationship.

• The palatal cusps of the maxillary molars occludes with the central fossa
of the mandibular molars.
 Chapter-9
WAX-UP AND CARVING

Introduction
Wax up and carving are done once the position and
occlusion of the teeth are verified. Adding and contouring
the wax on the trial denture base reproduces the contours of
the original tissues in dentulous mouth. Cervical carving
and festooning influences the esthetic value of the denture.

Fig. 9.1 & Fig. 9.2 Wax added on the cervical portion, labial and buccal
surface of all the teeth till the periphery of the trial denture base.
Fig. 9.3 Wax-up completed.

Fig. 9.4 & Fig. 9.5 Carver placed at 45 degree angulation to cervical margin
and wax removed upto the interdental area.

Fig. 9.6 & Fig. 9.7

• Carving done without creating a ledge.

• The wax on the interdental area should not exceed beyond the junction of
cervical and middle third and the carver position.
• The cervical margin are not in same height, the central incisor is higher
than the lateral incisor and canine higher than the central and lateral
incisor.
• The cervical carving of the canine and first premolar is almost in the same
height. This provides esthetics.

Fig. 9.8 & Fig. 9.9 Wax up on palatal and lingual surface of trial denture
base respectively.

Fig. 9.10 & Fig. 9.11 Palatal and lingual carving in maxillary and mandibular
anteriors.
Fig. 9.12 & Fig. 9.13 Lines are carved along the labial and buccal surfaces of
the flange to create root carving.

Fig. 9.14 & Fig. 9.15 Festooning or root carving.

In general festooning means decorative chain or strip hanging between two

points. In dentistry it denotes carvings on the trial denture base similar to the
contours of the natural tissues which are further replicated on the denture.

Note: The festooning is more prominent towards the cervical area and
gradually it fades out towards the apical portion and more prominent
in canine to mimic the canine prominence. This provides more
esthetics to a finished prosthesis.

Fig. 9.16 Stippling is incorporated in the waxed up surface with a tooth

brush, especially 2–3 mm above the cervical margin of teeth.
Fig. 9.17 & Fig. 9.18 It resembles the attached gingiva in the natural
dentition.

Fig. 9.19 Palatal rugae, mid palatine raphe and incisive papilla carving.
 Chapter-10
DEARTICULATION

Introduction
The waxed up denture which is anatomically carved is
duplicated in hard acrylic. To facilitate this process the
waxed trial denture along with its model in the correct
orientation is required. The procedure of removing the
waxed denture along with its model from the jaw members
of the articulator is called the dearticulation. This chapter
details step by step procedure and measures to be taken
before the dearticulation to help in processing and post
processing adjustments.

Sealing of the Trial Denture Base with

the Master Cast
Fig. 10.1 Wax strip of 2 mm width is adapted on the maxillary cast from the
hamular notch area on one side to the other side. The wax strip is also
adapted on the posterior palatal seal area.

Fig. 10.2 Wax strips adapted on mandibular cast from the retro molar pad
area on one side to the other side and also along the lingual border.
Fig. 10.3 & Fig. 10.4 It is adapted within the confines of the land area.

Fig. 10.5 & Fig. 10.6 The wax strip is sealed with the cast and record base
with a hot wax spatula.

Fig. 10.7 Wax spatula is heated and used to fuse the wax strip to the cast.
Fig. 10.8 Sealed mandibular denture base.

Fig. 10.9 De-articulation of the mandibular cast with a hammer and wax
knife.
Fig. 10.10 & Fig. 10.11 The indexed surface of the dental plaster on the
articulator, after de-articulation of maxillary and mandibular casts showing
plaster elevations (Key). These elevations guide in reorientation of the master
cast during laboratory remounting procedure.

Fig. 10.12 Articulator after de-articulation.

 Chapter-11
DENTURE PROCESSING

Introduction
Processing in dentistry is to perform any technical
procedure to polymerize dental resins for prostheses.

Steps in Processing
• Flasking of waxed up trial denture,
• Dewaxing,
• Packing of acrylic resin,
• Deflasking of processed denture.

Flasking:
The process of investing a cast and a wax replica of the
desired form in a flask preparatory to molding the
restorative material into the desired product [GPT 8].
Fig. 11.1 Parts of varsity dental flask.

a. Base of the dental flask.

b. Lid for the flask base.
c. Body of the dental flask.
d. Lid for the body of the flask.

Fig. 11.2 Application of thin layer of Vaseline on the lid and base of the
dental flask. This will facilitate easy removal of the investing medium from
the flask.

Note: Excess Vaseline results in mold separation from dental flask during
 dewaxing procedure.

Fig. 11.3 Soak the cast with the trial denture in a bowl of water prior to
flasking to improve the wettability.

Fig. 11.4 & Fig. 11.5 Application of the Vaseline in key ways and base of the
maxillary and mandibular casts to facilitate easy removal during deflasking
and to preserve it for laboratory remounting.
Fig. 11.6 Base and lid approximated.

Fig. 11.7 First Pour: Mix dental plaster and pour it to fill the base of the
dental flask.
Fig. 11.8 Place the dental cast on the base filled with dental plaster.

Fig. 11.9 Excess dental plaster is removed.

Fig. 11.10 & Fig. 11.11 Maxillary and mandibular casts with trial denture
base invested with dental plaster in the base of the dental flask.

The dental plaster should merge along the land area and it slopes towards the
rim of the flask. The outer rim of the flask base must be exposed for proper
orientation of the body of the flask. The tongue space is exposed and dental
plaster is sloped down the base.

Fig. 11.12 & Fig. 11.13 Separating medium (cold mould seal) is applied with
a paint brush on all the plaster surface and exposed land areas of the cast.
Fig. 11.14 A thin layer of vaseline applied on the body of dental flask. It will
facilitate removal of second pour of investing medium from the flask.

Fig. 11.15 & Fig. 11.16 Body of the flask is oriented on the base of the flask
before the second pour. Seating of the body and base must ensured prior to
second pour.
Fig. 11.17 & Fig. 11.18 Mix dental stone (Type III gypsum), apply it on the
labial and buccal surfaces of trial denture base with a brush and slowly
vibrate to avoid entrapment of air bubbles. This accurately reproduces
polished surfaces of complete denture.

Fig. 11.19 & Fig. 11.20 Dental stone painted on the rugae surface to obtain
more accurate duplication of the rugae area. The dental stone is poured along
the buccal and labial sides of the body of the flask, gently vibrated to
eliminate air bubbles and then is filled with dental stone till the occlusal
surface.
Fig. 11.21 & Fig. 11.22 Add more dental stone to cover the entire trial
denture.

Fig. 11.23 The second pour is completed.

Fig. 11.24 The incisal and occlusal surface of the teeth are exposed after the
initial set of the second pour. This is to identify the denture after removal of
third pour during deflasking procedure. There should be a minimum height of
atleast 10 mm between the second pour and the superior surface of the body
of the flask to provide adequate thickness for the third pour.

Fig. 11.25 Apply separating medium prior to third pour.

Fig. 11.26 Mix dental plaster and add it on the set second pour.

Note: The three pour technique facilitates easy identification of processed

denture when the denture is removed from flask. The second pour is
preferably done with dental stone to preserve and reproduce the
polished surface of the trial denture. The first and third pour is
completed with dental plaster to facilitate easy deflasking.
Fig. 11.27 Excess dental plaster escapes through the lid after complete
closure.

Fig. 11.28 The dental flask is tightened on the clamp and left undisturbed for
the plaster to set for half an hour to 45min.

Dewaxing
• The process of removing the wax to make space for the
resin material.
• The failure to eliminate wax completely will result in
incomplete polymerisation between the denture base
material and teeth as a result of which they separate
from the denture base after processing.
Fig. 11.29 Dewaxing bath set at 100 °C temperature.

Fig. 11.30 The clamp is untightened before the flask is placed in the bath for
de-waxing. The flask is kept in the boiling water (100 °C) for five minutes.

Note: If the dental flask is kept in boiling water for a prolonged period the
colouring pigments in the modelling wax gets incorporated in the
mould and on the dental cast.

Fig. 11.31 The dental flask is removed from the clamp. The body and the
base are separated using a wax knife. During this procedure molten wax will
flow from the opening of the flask. Slowly prie the body and the base, this
will allow total elimination of the molten wax.

Fig. 11.32 & Fig. 11.33 When the base and the body are totally separated the
acrylic base will be either fixed to the cast or the counter as shown in the
picture. The wax knife is used to gently remove the acrylic base. At this stage
there will be remnants of molten wax in the interdental areas and on the
surface of the cast also.

Fig. 11.34 & Fig. 11.35 The boiling water is poured from above the flask to
eliminate the wax efficiently. Failure to eliminate the interdental wax will
result in incomplete polymerisation between the denture base and teeth
resulting in separation of teeth from denture after processing.
Fig. 11.36 Warm mild detergent solution and tooth brush is used to remove
the impurities and the set separating medium on the maxillary and
mandibular casts after dewaxing procedure.

Fig. 11.37 Detergent solution is used to remove the impurities and the set
separating medium on the maxillary and mandibular mould surface. Care
should be taken while using the brush to avoid dislodgement of the teeth.
Fig. 11.38 & Fig. 11.39 Maxillary and mandibular moulds and the cast after
dewaxing and cleaning.

Packing
• This involves placement of the denture base material
within the mould space.

Fig. 11.40 & Fig. 11.41 Apply separating medium on the cast and the mould
with a paint brush.
Fig. 11.42 & Fig. 11.43 Application of cold mould seal along the interdental
areas will avoid dental stone incorporation after processing which makes
finishing of the denture easy.

Fig. 11.44 Approximately 20 ml of monomer and 40 grams of powder is

required for maxillary and mandibular dentures.
Fig. 11.45 Polymer is added until it is completely wet with the monomer.
Polymer: monomer ratio is 3:1 to obtain a homogenous mix.

Fig. 11.46 The polymer and monomer is mixed until it is homogenous.

Fig. 11.47 The porcelain jar is then closed to avoid monomer evaporation
Physical Stages of Polimerisation

Fig. 11.48 Wet sandy stage-Little or no interaction occurs at this stage.

Fig. 11.49 Stringy stage-Monomer attacks the surfaces of individual polymer

beads characterized by stringiness and stickiness.

Polymer-monomer Interaction When monomer and polymer are mixed in

proper proportions, a workable mass is formed which passes through five
distinct physical stages: Wet sandy, stringy, Dough-like, rubbery or elastic
and stiff.

Fig. 11.50 & Fig. 11.51 Dough stage.

Increased number of polymer chains enter the solution. Clinically the mass
behaves as a pliable dough. This stage is ideal for packing the material in the
mould space. Kneading with cellophane sheet improves homogeneity of the
acrylic resin.

Fig. 11.52 Rubbery stage.

The viscosity increases and the material rebounds when compressed or

stretched. This stage is inappropriate for packing.
Fig. 11.53 Stiff stage.

This is due to evaporation of free monomer, the mixture appears very dry and
is resistant to mechanical deformation. When the material enters this stage a
sharp instrument cannot pierce the resin.

Fig. 11.54 Kneaded material.

Fig. 11.55 & Fig. 11.56 Kneaded material is spread and placed in the
maxillary and mandibular mould surface in dough stage.

Fig. 11.57 The cellophane sheet placed over the material for trial closure.

Fig. 11.58 The body and the base of the flask are approximated.
Fig. 11.59 The flask is placed on the bench press and closed under pressure.

Fig. 11.60 Note the excess acrylic resin along the rim of the flask when its
tightened on bench press under controlled pressure.
Fig. 11.61 & Fig. 11.62 The flask is then opened and the cellophane sheet is
removed after trial closure.

Fig. 11.63 & Fig. 11.64 The thin layer of resin along the borders of the
denture mould after trial closure is called flash. The flash is carefully cut with
a sharp instrument.

Note: The trial closure is done to remove the excess acrylic and facilitate
accurate trimming of processed dentures. It also ensures flow of
adequate material along the mould space and if any deficiency can be
rectified.
Fig. 11.65 The dental flask is reoriented and tightened. The flask is kept for
bench cure for 30 minutes.

Fig. 11.66 Curing cycle: The dental flasks are kept in the water bath at room
temperature and anyone of the following cycles are followed.

• Long cycle:
– 74 °C for 8 hr or longer with no terminal boiling point.
– 74 °C for 8 hr and then increasing the temperature to 100 °C for 1 hr.
• Short cycle:
– 74 °C approximately 2 hrs and increasing temperature of water bath to
100 °C for 1 hr.
Fig. 11.67 The dental flasks are allowed to bench cool for 30 minutes after
curing.

Fig. 11.68 Then cooled in tap water for 10 minutes prior to deflasking.

Fig. 11.69 The flask is loosened removed from the clamp. The lid of the flask
is removed using a plaster knife.
Fig. 11.70 Hammer is used to tap the spacer and the base.

Fig. 11.71 The base of the flask removed from the mould.

Fig. 11.72 The hammer is used to tap along the body of the flask.
Fig. 11.73 The mould assemby is retrieved from the body and base of the
flask as a single piece.

Fig. 11.74 The third pour of the mould is removed by gently tapping using
hammer and plaster knife.
Fig. 11.75 Removal of the third pour.

Fig. 11.76 The second and third pour are separated. The occlusal surface of
the denture and the second pour is exposed.
Note: The occlusal surface of the denture teeth is seen. This helps in
locating the position of denture for easy retrieval.

Fig. 11.77 Frit saw is used to section the second pour of the mould.
Fig. 11.78 Three saw cuts along the exposed occlusal surface of denture are
made.

Fig. 11.79 The second pour is removed along the sectioned areas.
Fig. 11.80 The denture surface is exposed.

Fig. 11.81 Denture on the cast with the plaster base.

Fig. 11.82 Saw cuts are made on the first pour or the base of the mould.

Fig. 11.83 The plaster base is removed along the sectioned areas.
Fig. 11.84 The processed denture retrieved with the master cast.

Fig. 11.85 The picture shows the retrieved maxillary and mandibular denture.
The same technique is followed to retrieve the mandibular denture.
 Chapter-12
LABORATORY REMOUNTING

Introduction
The Lab remounting procedure is carried out to correct the
post processing occlusal errors. Most of the occlusal
equilibration is achieved during this stage, it reduces the
chair side time.
Errors may occur during acrylization of the denture, for
example, the use of excessive pressure during pressing of
acrylic resin into the flask and/or inadequately closed flasks
during polymerisation. This will lead to occlusal errors.

Armamentarium
 Fig. 12.1

• Sticky wax.

• Articulating paper.

• Micro motor.

• Straight fissure trimmer.

• Sandpaper.
Fig. 12.2 Articulator showing the Plaster indices to facilitate Remounting of
the maxillary and the mandibular cast.

Fig. 12.3 (a) and (b) Cast with the processed denture is cleaned of investing
plaster and checked for the proper orientation to the indices. Interferences
should be eliminated prior to the sealing of the cast.
Fig. 12.4 (a) and (b) Maxillary and mandibular casts are remounted in the
articulator. The casts are sealed to the plaster base with sticky wax/modelling
cement to stabilize them.

Fig. 12.5 When the articulator is brought to centric position, note that the
following.

1. Teeth are disoccluded,

2. The incisal rod is not touching the incisal table.
Fig. 12.6 The articulating paper is placed between the maxillary and
mandibular dentures on both right and left sides and the jaw members are
brought to centric position. The teeth are tapped at centric position repeatedly
with the articulating paper in between, which will indicate the premature
occlusal contacts in centric position.
Fig. 12.7 (a), (b) and (c) The blue marks on the maxillary and mandibular
acrylic teeth indicates the premature contact in centric occlusion.
Fig. 12.8 Only the dark blue marking with white hallow space should be
trimmed because it indicates the pre mature occlusal contacts and the full
dark blue mark indicates equalized occlusal contacts which are not to be
trimmed.

Fig. 12.9 The premature contacts are eliminated in the maxillary denture by
trimming the palatal inclines of the buccal cusps.
Fig. 12.10 (a) and (b) After re-establishing occlusion in centric position the
articulating paper is used to check whether the contacts are equalized on both
sides.

Fig. 12.11 (a) and (b) The maxillary and mandibular teeth are in contact and
in maximum intercuspation after removing the pre-matured contacts. Incisal
pin is in contact with incisal table.
Fig. 12.12 (a) and (b) The sharp margins along the surface of the trimmed
teeth are smoothened with sand paper in the maxillary and the mandibular
dentures.

Fig. 12.13 (a) and (b) Occlusal view of the maxillary and the mandibular
denture after removing the premature contacts.

Removing Dentures from the Cast

Occusal errors are corrected during the lab remounting
procedure and the dentures removed from the cast for
trimming, finishing and polishing. Care should be executed
while removing the dentures from the cast as forceful
removal of the acrylised denture may result in fracture of
the same.

Fig. 12.14 (a) and (b) With the use of the sharp wax knife gently tap the
sides of the cast with hammer to separate the cast from the articulator.

Fig. 12.15 Marker and, metal scale is used to mark the markings. Numbers
are given for sequential sectioning of casts. (maxillary and mandibular casts)
Fig. 12.16 (a) and (b) Hack saw is used to section the cast. The sectioning
are usually done according to the sequential order. Care should be taken not
to touch the intaglio surface of the denture while sectioning the cast from the
denture. First section of the cast is sectioned from the maxillary cast.

Fig. 12.17 (a) and (b) Hack saw is used to section the mandibular cast. First
section of the cast is sectioned from the mandibular cast.
Fig. 12.18 Maxillary and mandibular dentures are removed from the cast.
 Chapter-13
FINISHING AND POLISHING OF
THE COMPLETE DENTURES

Introduction
Finishing of the denture: Removing the excess flash,
stone remaining around the teeth and any nodules of acrylic
resin on the surface of the denture base.
Polishing of the complete denture: Creating a smooth
surface to prevent accumulation of food debris, comfort for
the patient and to allow the patient to maintain denture
hygiene.
Note: Care must be taken not to generate too much heat during polishing to
avoid warpage of the acrylic denture base.
Fig. 13.1 (a) and (b) Excess acrylic trimmed with vulcanite Trimmer.

Fig. 13.2 (a) and (b) Acrylic trimmer is used to trim the surface irregularities
from the flange areas of the dentures.

Fig. 13.3 (a) and (b) Straight fissure is used to remove the nodule and the
stone present in between the inter-dental areas and tissue surface of the
dentures.

Fig. 13.4 (a) and (b) Fine trimming done with the small acrylic trimmers,
especially in festooned areas.

Fig. 13.5 (a) and (b) Denture is finished with the use of sand paper. Using
various grits (No. 80–420).
Fig. 13.6 Wet sandpapering done.

Fig. 13.7 Finished maxillary and mandibular dentures.

Wet Polishing

Fig. 13.8 (a) A slurry of pumice with water is made, the rag wheel is wetted
using the slurry and polished with low speed using dental lathe.

Fig. 13.8 (b) Application of pumice onto the buccal flange of the maxillary
dentures.

Fig. 13.8 (c) Polishing of mandibular denture flange with pumice.

Dry Polishing
Fig. 13.9 Application of universal polishing paste.

Fig. 13.10 (a) and (b) Dry polishing with acrylic rouge.
Fig. 13.11 (a) and (b) Polishing of the maxillary palatal and mandibular
lingual surfaces.

Fig. 13.12 (a) and (b) Final polishing of dentures with dry woolen buff.

Fig. 13.13 (a) and (b) Finished and polished dentures.

 Chapter-14
RELINING OF MAXILLARY
DENTURE

Introduction
The procedure used to resurface the tissue surface of a
denture with new base material to make the denture fit
more accurately-GPT 8.
The main objectives of relining:
Re-establish the correct relation of the denture base to basal
tissue. Restore stability and retention. Restore lost occlusal
and maxillo-mandibular relationship.

Relining – Preclinical Work

Fig. 14.1 Thin layer of vaseline is applied on the intaglio surface of the
denture prior to preparation of the cast.

Fig. 14.2 Cast prepared with type III gypsum product.

Fig. 14.3 Denture retrieved from the cast.

Fig. 14.4 The areas to be trimmed prior to relining and outline of the
dovetails are also marked with the pencil. Vulcanite trimmer is used to reduce
the borders of the maxillary denture flange, and tissue surface of the denture
(approximately 0.5 mm).

Fig. 14.5 The trimmed maxillary denture is seated on the cast to check
whether the flange is under extended approximately 2 mm from the sulcus.

Fig. 14.6 The under extended margins and dovetail area are sealed with
modeling wax.

Fig. 14.7 The denture is invested in dental flask for processing.

Fig. 14.8 The denture surface after dewaxing.

Fig. 14.9 The processed denture.

Note: The under extended margins and tissue surface is filled with heat cure
 denture base resin.

Relining – Clinical Procedures

Fig. 14.10 Patient wearing complete denture complains of loose dentures.

Relining a denture can solve the problem if the occlusion and vertical
dimension are verified to be satisfactory.

Fig. 14.11 Intaglio surface of the denture.

Fig. 14.12 Closed mouth impression recorded with Polyvinyl siloxane
material. [monophase]

Fig. 14.13 Dentures removed after closed-mouth impression.

Fig. 14.14 & Fig. 14.15 The maxillary and mandibular dentures are flasked
with the impression.
Fig. 14.16 Maxillary and mandibular dentures relined.
 Chapter-15
REBASING

Introduction
The laboratory process of replacing the entire denture base
material on an existing prosthesis.

Indications
Processing errors like:
1. Crazing
2. Warpage
3. Porosity

Rebasing – Clinical Procedures

Fig. 15.1 Polished surface of denture.

Fig. 15.2 Intaglio surface of the maxillary denture.

Fig. 15.3 Application of tray adhesive to enhance the bond between denture
and impression material.

Fig. 15.4 Manipulation of medium viscous elastomer for a homogenous mix.

Fig. 15.5 Loading the impression material in the intaglio surface of the
maxillary denture.

Fig. 15.6 Spreading the impression material in the intaglio surface of the
maxillary denture.
Fig. 15.7 Functional impression made.

Laboratory Procedures

Fig. 15.8 Beading and boxing of functional impression.

Fig. 15.9 Pouring cast with dental stone.

Fig. 15.10 The base of the maxillary cast is indexed for articulation.
Fig. 15.11 Modelling wax is adapted to close the space in the lower member
of the mean value articulator.

Fig. 15.12

• Modelling wax is used to create a box.

• The boxing is sealed to the articulator.

Fig. 15.13 Dental plaster poured in the boxed space.

The maxillary denture is placed on the superior surface of the plaster and
mild pressure applied till occlusal third plunged into the plaster to create an
index.

Fig. 15.14

• The denture is removed after the plaster sets.

• The indentations of the maxillary occlusal surface is seen on the plaster

platform.
 The indices will help in orientation of maxillary cast and also prevents
Note: loss in vertical dimension.
Fig. 15.15 (a, b, c) Retreival of cast and the impression material is removed
from the denture.

Fig. 15.16 (a) and (b) The denture is trimmed leaving only the teeth intact as
one unit.

Fig. 15.17 (a) and (b) The entire base of the denture is trimmed and the rim
of denture with the acrylic teeth is oriented on the plaster index.

Fig. 15.18 Modelling wax is added layer by layer and complete wax up is
done.
Fig. 15.19 Dearticulation done.

Fig. 15.20 (a) and (b) Flasking procedure.

Fig. 15.21 Rebasing completed and Processed.

Rebasing – Pre Clinical Procedure

Fig. 15.22 Intaglio surface of maxillary denture.

Fig. 15.23 Polished surface of maxillary denture.

Fig. 15.24 Beading and boxing done.

Fig. 15.25 A thin layer of Vaseline is applied on the tissue surface of the
denture.

Fig. 15.26 Thin layer of stone is poured.

Fig. 15.27 Cast is prepared.

Fig. 15.28 The maxillary cast along with the denture is oriented in the
articulator and it is stabilized before articulation.

Fig. 15.29 The index of occlusal surface of the maxillary teeth is obtained on
the plaster mounting done on the lower member of the articulator. Only the
incisal and occlusal surface of the teeth in denture should be plunged in to the
plaster.

Note: This procedure is done to orient the maxillary denture and to maintain
 the vertical dimension during rebasing procedure.

Fig. 15.30 Note the imprint incisal and occlusal surface of the maxillary teeth
on the plaster index.

Fig. 15.31 The entire base of the denture is trimmed and only the rim of
denture with the acrylic teeth is oriented on the plaster index.
Fig. 15.32 Waxed up denture is sealed to the cast. Cast is disarticulated and
processed by compression moulding technique

Fig. 15.33 Processed denture after rebasing.

 Chapter-16
DENTURE REPAIR

Introduction
PMMA has been the material of choice for fabrication of
dentures. However it does have some unfavourable
mechanical properties, the most important being low
flexural, fatigue and impact strength resulting in fractures.
These fractures are the most common reason for denture
repair. Auto polymerizing acrylic resin is the material of
choice in denture repairs.

Denture Repair with Heat Cure

Acrylic Resin
Fig. 16.1 Broken mandibular complete denture.

Fig. 16.2 The broken fragments are aligned and stabilized with sticks and
sticky wax.
Fig. 16.3 A thin layer of dental stone is poured over the denture initially
which is followed by a thick mix to form a cast.

Fig. 16.4 A thin layer of dental stone is poured over the denture initially
which is followed by a thick mix to form a cast.
Fig. 16.5 Cast prepared with base using base former.

Fig. 16.6 Mandibular denture separated from the cast.

Fig. 16.7 After cast preparation the sticks used for stabilizing the broken
halves are removed and the denture is seated on the prepared cast.
Note:
1. The denture base is trimmed to create a space for about 2 mm on the
fracture site.
2. Care taken to preserve the morphology of the tooth adjacant to the
fracture line.

Fig. 16.8 Lingual view of the broken halves of the denture.

Fig. 16.9 Broken halves are sealed with modeling wax and invested in dental
flask.
Fig. 16.10 Labial view of repaired denture after finishing and polishing.

Fig. 16.11 Lingual view of the repaired denture.

Note: The broken fragment is clearly masked with the acrylic resin.

Denture Repair with Self Cure Acrylic

Resin
Fig. 16.12 Broken fragments of maxillary denture.

Fig. 16.13 Intaglio surface of the fractured segments.

Fig. 16.14 The broken fragments are tentatively aligned.

Fig. 16.15 The aligned fragments are stabilized with sticky wax and sticks.

Fig. 16.16 Cast is prepared. Dove tails prepared with straight fissure trimmer
along the broken fragments of the denture.

Fig. 16.17 The broken fragments are sealed with self cure acrylic resin along
the dovetail.
REMOVABLE PARTIAL
DENTURE – II
 Chapter-1
REMOVABLE PARTIAL
DENTURE

Introduction
The study of removable partial denture is about the
fabrication of restoration along with promotion of oral
health, preservation of remaining oral structures and
restoration of oral function with aesthetically pleasing
results. When one or few teeth are missing in the oral
cavity, they have to be replaced for function, esthetics and
oral comfort of the patient. In some cases the missing teeth
can be replaced by a removable prosthesis which aids in
maintaining the form and function of those teeth. These
prosthesis are fabricated in such a way that the patients can
remove and wear them at their will and with ease.
DEFINITION: Removable Partial Denture (RPD) – It is
defined as any prosthesis that replaces some teeth in a
partially dentate arch. It can be removed from the mouth
and replaced at will – also called partial removable dental
prosthesis (Gpt 8)
Removable partial dentures are fabricated with:
1. PMMA – Acrylic partial dentures-Temporary
prosthesis
2. Cast Metal partial dentures-Definitive prosthesis
Acrylic partial dentures can be one of the following 3
types:
• Interim denture: A fixed or removable dental prosthesis,
or maxillofacial prosthesis, designed to enhance
esthetics, stabilization and/or function for a limited
period of time, after which it is to be replaced by a
definitive dental or maxillofacial prosthesis. Often such
prostheses are used to assist in determination of the
therapeutic effectiveness of a specific treatment plan or
the form and function of the planned definitive
prosthesis.(Gpt 8)
• Transitional denture: Prosthesis serving as an interim
prosthesis to which artificial teeth will be added as
natural teeth are lost and that will be replaced after post
extraction tissue changes have occurred. A transitional
denture may become an interim complete dental
prosthesis when all of the natural teeth have been
removed from the dental arch—called also complete
denture transitional prosthesis. (Gpt 8)
• Treatment denture: 1: A dental prosthesis used for the
purpose of treating or conditioning the tissues that is
 called on to support and retain it. 2: A dental prosthesis
that is placed in preparation for future therapy (Gpt 8).

Terminologies
Removable prosthodontics: The branch of prosthodontics
concerned with the replacement of teeth and contiguous
structures for edentulous or partially edentulous patients by
artificial substitutes that are readily removable from the
mouth. (Gpt 8)
Interim prosthesis: A fixed or removable dental
prosthesis, or maxillofacial prosthesis, designed to enhance
esthetics, stabilization and/or function for a limited period
of time, after which it is to be replaced by a definitive
dental or maxillofacial prosthesis. Often such prostheses
are used to assist in determination of the therapeutic
effectiveness of a specific treatment plan or the form and
function of the planned for definitive prosthesis.
Extension base partial removable dental prosthesis: A
removable dental prosthesis that is supported and retained
by natural teeth only at one end of the denture base
segment and in which a portion of the functional load is
carried by the residual ridge.
Cast: A life-size likeness of some desired form. It is
formed within or is a material poured into a matrix or
impression of the desired form.
Model (1575): A facsimile used for display purposes; a
miniature representation of something; an example for
imitation or emulation;
Surveyor: A paralleling instrument used in construction of
a dental prosthesis to locate and delineate the contours and
relative positions of abutment teeth and associated
structures.
Survey line: A line produced on a cast by a surveyor
marking the greatest prominence of contour in relation to
the planned path of placement of a restoration.
Denture base: The part of a denture that rests on the
foundation tissues and to which teeth are attached.
Abutment (1634) 1: Part of a structure that directly
receives thrust or pressure; an anchorage 2: a tooth; a
portion of a tooth, or that portion of a dental implant that
serves to support and/or retain a prosthesis.
Major connector: The part of a partial removable dental
prosthesis that joins the components on one side of the arch
to those on the opposite side.
Minor connector: The connecting link between the major
connector or base of a partial removable dental prosthesis
and the other units of the prosthesis, such as the clasp
assembly, indirect retainers, occlusal rests, or cingulum
rests.
Direct retainer: Component of a removable partial denture
used to retain and prevent dislodgment, consisting of a
clasp assembly or precision attachment.
Clasp: The component of the clasp assembly that engages
a portion of the tooth surface and either enters an undercut
for retention or remains entirely above the height of
contour to act as a reciprocating element. Generally it is
used to stabilize and retain a removable dental prosthesis.
Clasp assembly: The part of a removable dental prosthesis
that acts as a direct retainer and/or stabilizer for a prosthesis
by partially encompassing or contacting an abutment tooth
— usage: components of the clasp assembly include the
clasp, the reciprocal clasp, the cingulum, incisal or occlusal
rest, and the minor connector.
Indirect retainer: The component of a partial removable
dental prosthesis that assists the direct retainer(s) in
preventing displacement of the distal extension denture
base by functioning through lever action on the opposite
side of the fulcrum line when the denture base moves away
from the tissues in pure rotation around the fulcrum line.
Extracoronal attachment: Prefabricated attachment for
support and retention of a removable dental prosthesis. The
male and female components are positioned outside the
normal contour of the abutment tooth.
Intracoronal attachment: Prefabricated attachment for
support and retention of a removable dental prosthesis. The
male and female components are positioned within the
normal contour of the abutment tooth—see
EXTRACORONAL ATTACHMENT, PRECISION
ATTACHMENT.
Cross arch stabilization: Resistance against dislodging or
rotational forces obtained by using a partial removable
dental prosthesis design that uses natural teeth on the
opposite side of the dental arch from the edentulous space
to assist in stabilization.

Classifications
The following are the classification systems of partially
edentulous arches
1. Kennedy’s classification system.
2. Applegate – Kennedy classification system.
3. Cummer’s classification system.
4. Bailyn’s classification system.
5. Neurohr’s classification system.
6. Mauk’s classification system.
7. Godfrey’s classification system.
8. Beckett’s classification system.
 9. Friedman’s classification system.
10. Austin – Lidge classification system.
11. Skinner’s classification system.
12. Swenson’s classification system.
13. ACP classification system.
Kennedy’s classification is widely used and universally
accepted system, proposed by Edward Kennedy in1923. It
is based on the location of the edentulous spaces. The
sequence of the classification is based on the frequency of
occurrence.
The sequence is also based on the design principles.
Class I, Class II, and long span Class IV are defined as
tooth and tissues supported and Class III is designed as
fully tooth supported prosthesis.

Kennedy’s Classification
• Class I: Characterized by bilateral edentulous areas
located posterior to the remaining natural teeth.
• Class II: Displays a unilateral edentulous area located
posterior to the remaining natural teeth.
• Class III: Presents a unilateral edentulous area with
natural teeth both anterior and posterior to it.
• Class IV: Displays a single, bilateral edentulous area
 located anterior to the remaining natural teeth. It is
important to note that the edentulous space must cross
the dental midline.

Kennedy’s & Applegate Classification

• Class V: Edentulous area bounded anteriorly and
posteriorly by natural teeth but in which the anterior
abutment is not suitable for support.
• Class VI: Edentulous area in which the teeth adjacent to
the space are capable of total support of the required
prosthesis. This denture requires no tissue support.

CLASS I

Fig. 1 Bilateral edentulous area located posterior to the remaining natural

teeth.
CLASS II

Fig. 2 Unilateral edentulous area located posterior to the remaining natural

teeth.

CLASS III

Fig. 3 Unilateral edentulous area with natural teeth both anterior and
posterior to it.
CLASS IV

Fig. 4 Single, bilateral edentulous area located anterior to the remaining

natural teeth.

Applegate’s Rules
Rule 1: Classification should follow rather than precede
extractions that might alter the original
classification.
Fig. 5 All teeth are present and its named as dentulous cast.

Fig. 6 The anterior teeth are extracted and its Kennedys class IV.

Rule 2: If the third molar is missing and not to be

replaced, it is not considered in the classification.
Fig. 7 The classification is Kennedys Class II.

Fig. 8 The third molar is missing in the first quadrant and not to be replaced
on the contralateral side so the classification remains as Kennedys Class II.

Rule 3: If a third molar is present and is to be used as an

abutment, it is considered in the classification.
 Fig. 9

Classification is a kennedys class III, the third molar is to

be used as a abutment, so it is considered in the
classification.
Rule 4: If a second molar is missing and is not to be
replaced, it is not considered in the classification.

Fig. 10
• In figure 10 – The classification is a kennedy’s class II.

Fig. 11

• In figure 11 – The second molar is missing in fourth quadrant, and is not

to be replaced on the contralateral side, so the classification would be a
kennedy’s class II, instead if the second molar is to be replaced, then the
classification would be a kennedy’s class I.

Rule 5: The most posterior edentulous area or areas

always determine the classification.
 Fig. 12

Fig. 13

• For example: Figure 12 – The most posterior edentulous area is the space
between the teeth 25 and 27, therefore the classification is a kennedy’s
class III. In figure 13 – the most posterior edentulous space is the area
extending from the canine distally, so the classification would be a
kennedy’s class II.
Rule 6: Edentulous areas other than those determining the
classification are referred to as modification
spaces and are designated by their number.

Fig. 14

• In figure 14 – The edentulous area marked by arrow denotes the

edentulous space other than the one determing the classification. It
regarded as a modification area irrespective of the extention of the
edentulous span. So the classification is kennedy’s class III modification
1.
 Fig. 15

• In the figure 15 – the areas marked by the arrow refers to the modification
areas, and the classification is a kennedy’s class III modification 2.

Rule 7: The extent of the modification is not considered,

only the number of additional edentulous areas.
 Fig. 16

Fig. 17

• In figure 16 Class II modification 1, similarly in the figure 17 the number

of teeth missing in the marked modification area is more, even then it is
considered as a class II modification 1.

Rule 8: There can be no modification areas in class IV

arches.
Fig. 18 Any modification area posterior to the edentulous area marked by the
arrow mark, so it would determine the classification and hence there is no
modification for Class IV.

Components of Removable Partial Denture

Fig. 19 Removable partial denture framework.

Fig. 20 Removable partial denture.

• A-Major Connectors

• B-Minor Connectors

• C-Direct retainers/clasps

• D-Indirect retainers

• E-Denture base

• F-Denture teeth

Fig. 21 Single palatal bar.

• It’s narrow part is half oval with thickest point at the center. If used, it
 should be limited to short span Kennedys Class III.

Fig. 22 Single palatal strap.

• It consists of a wide band of metal with a thin cross-sectional dimension

with an antero-posterior dimension not less than 8 mm to provide rigidity.
Its indicated for restoration of short span tooth supported bilateral
edentulous area.

Fig. 23 Anterior-posterior palatal bar.

• It displays characteristics of palatal bar and palatal strap major connectors

where the anterior bar is relatively flat and posterior is a half oval. The
two bars, lying in different planes, produce a structurally strong L-beam
 effect improving rigidity.

Fig. 24 Horse-shoe connector.

• It has thin band of metal running along the lingual surface of remaining
teeth and extending onto the palatal tissues for 6–8 mm and is used
primarily when several anterior teeth are being replaced.

Fig. 25 Anterior-posterior palatal strap.

• This major connector is used when numerous teeth are to be replaced or

when a palatine torus is present.
Fig. 26 Complete palate.

• It provides maximum rigidity and support and has greatest amount of

tissue coverage. It is indicated when all posterior teeth are to be replaced
and when remaining teeth are periodontally compromised.

Fig. 27 Lingual bar.

• It is the most frequently used mandibular major connector. It is indicated

for all-tooth supported removable partial dentures. Half pear shaped in
cross-section. 8 mm of vertical space must be present between gingival
margin of teeth and floor of mouth to accommodate this major connector.
Fig. 28 Kennedy bar.

• It displays characteristics of both lingual bar and lingual plate major

connector. The upper bar should be 2 to 3 mm in height and 1 mm thick
and present a scalloped appearance. Indicated in periodontally
compromised mandibular anteriors.

Fig. 29 Lingual plate.

• This major connector is half pear shaped lingual bar with a thin, solid
piece of metal extending from superior border. The superior margins of
the scalloped metal should be knife edged to avoid a “ledging” effect on
the lingual surface of teeth.
Fig. 30 Labial bar.

• It runs across the mucosa on the facial surface of mandibular arch. Used
only when there is presence of gross uncorrectable interference that
makes placement of lingual major connector impossible.

Fig. 31 Minor connector to clasp assembly.

• The minor connector must have sufficient bulk to ensure rigidity and
should not irritate the oral tissues.
Fig. 32 Minor connector to occlusal rest.

• These minor connectors should form right angles with the corresponding
major connectors, but junction should be gently curved to prevent stress
concentration. Should be placed in lingual embrasure to disguise their
bulk.

Fig. 33 Minor connector connecting denture base to major connector – Mesh

type.

• The mesh type of minor connector consists of a thin sheet of metal with
multiple small holes that extends over the crest of the residual ridge to the
same buccal, lingual and posterior limits as lattice-work minor connector.
Used when multiple teeth are to be replaced.

Fig. 34 Minor connector connecting denture base to major connector – Open

construction.
 Consists of longitudinal and transverse struts that form a ladder like
•
network.
• Longitudinal strut should be placed buccal to the crest of the ridge and
other, lingual to the ridge crest.
• Transverse struts must be positioned to facilitate the placement of
artificial teeth.

Fig. 35 Minor connector connecting denture base to major connector – Nail

head or bead type.

• Consists of small spheres on a cast metal base.

• Primary advantage of metal base is related to improved hygiene and
thermal stimulation.
• Disadvantages include difficulty in adjusting and relining cast metal
bases.

Fig. 36 Approach arm for Vertical projection clasp.

• These minor connectors approaches the tooth from an apical direction
rather than from an occlusal direction. The approach arm should display a
smooth, even taper from its origin to its terminus.

Fig. 37 A Precision attachment (Intra coronal)

• An intracoronal direct retainer resides within the abutment and functions

to retain and stabilize a removable partial denture. The retainer consists of
two components (ie) Matrix-metal receptacle contained within normal
clinical contours of a fixed restoration and Patrix-attached to the
corresponding removable partial denture.

Fig. 38
 Semiprecision attachments – A laboratory fabricated rigid metallic
•
extension (patrix) of a fixed or removable dental prosthesis that fits into a
slot-type keyway (matrix) in a cast restoration, allowing some movement
between the components (GPT 8).

Fig. 39 & Fig. 40 Precision attachment (Extra coronal)

• Components that reside entirely outside the normal clinical contours of

abutment teeth.

• Serve to retain and stabilize the RPD when dislodging forces are
encountered.
Fig. 41 Parts of the clasp

• A – Rest

• B – Body

• C – Retentive arm

• D – Reciprocal arm

• E – Retentive terminal

• F – Minor connector

Fig. 42 (a) & (b) Simple circlet clasp.

• It is the most versatile and widely used clasp. It has a reciprocal arm and a
retentive arm. The retentive tip must end near the proximal line angle.
This clasp approaches the undercut on the abutment tooth from the
edentulous area and engage the undercut away from the edentulous space.
Fig. 43 (a) & (b) Reverse circlet clasp.

• This clasp engages the undercut adjacent to edentulous space by

approaching from mesio-occlusal rest. It is indicated for distal extension
partial denture and in cases of mesially inclined. It is easier to construct
and adjust but there will be food entrapment.

Fig. 44 (a) & (b) Multiple circlet clasp.

• Multiple clasp is two opposing simple circlet clasp joined at the terminal
end of the two reciprocal arms. It is indicated when additional retention is
needed and in tooth borne partial denture. Indicated in periodontally
compromised abutment teeth in distal extension situations.
Fig. 45 (a) & (b) Embrasure clasp.

• Embrasure clasp is two simple circlet clasps joined at the body. It is

indicated in Kennedy class II, III, IV cases where no edentulous space is
present. It crosses both marginal ridges and engages undercut on
opposing line angles. Sufficient space must be provided between the
abutment teeth in their occlusal third to make room for the body of
embrasure clasp.

• Arrow heads indicates retentive terminals.

Fig. 46 (a) & (b) Ring clasp.

• It starts on the opposite side of the undercut adjacent to the edentulous

space and engages the undercut by encircling the entire tooth almost from
its origin. The retentive arm is an extension of the reciprocal arm. Due to
greater length of the clasp, it is supported by an auxillary bracing arm
 from the minor connector of denture base to the centre reciprocal arm.
Indicated on lingually tilted molar where undercut is present adjacent to
edentulous space.

• Arrow indicating mesiolingual undercut.

Fig. 47 (a) & (b) Hair-pin clasp.

• This clasp is like the simple circlet clasp with reciprocal and retentive
arm. The retentive arm, after crossing the facial surface of the tooth from
its point of origin, loops back in a hairpin turn to engage a proximal
undercut below its point of origin. The upper part of retentive arm is
considered to be minor connector and is rigid while the lower part of
clasp arm is tapered and the only flexible part of the clasp arm.

Fig. 48 (a) & (b) Combination clasp.

• Consists of wrought round wire retentive clasp arm on buccal side and a
cast reciprocal clasp arm on lingual side. The wrought wire can flex in all
three planes and has greater flexibility than a cast arm. The greater
flexibility of the combination clasp allows it to be placed in a greater or
deeper undercut area.

Fig. 49 Onlay clasp.

• It is an extension of occlusal rest with buccal and lingual clasp arms. It is

indicated when the occlusal surface of the abutment tooth is below the
occlusal plane and the onlay will restore the same.

Fig. 50 (a) & (b) Y-clasp.

 Y clasp is basically a T clasp. The retentive terminal is connected to the
•
denture base minor connector by the “approach arm”; its configuration
occurs when the height of contour on the facial surface of the abutment
tooth is high on the mesial and distal line angles but low on the center of
the facial surface.
• Retentive terminal (Arrows).

Fig. 51 (a) & (b) T-clasp.

• The T clasp is used most often in combination with a cast circumferential

reciprocal arm. The retentive terminal must cross under the height of
contour to engage the retentive undercut, while the other finger of the T
stays on the suprabulge of the tooth. T clasp is used most frequently on a
distal extension ridge where the usual undercut is on the distobuccal
surface of the abutment tooth.
• Retentive terminal (Arrows).
Fig. 52 (a) & (b) Modified-T-clasp.

• The modified T clasp is essentially a T clasp with the non retentive finger
of the crossbar of the T terminal omitted. Most commonly used on canine
and premolar for esthetic reason.
• Retentive terminal (Arrows).

Fig. 53 (a) & (b) I-clasp.

• Arises from denture base minor connector and approaches the undercut
from a gingival direction resulting in “push type” retention. Used on
distobuccal surface of maxillary canines for aesthetics.

I-bar Removable Partial Dentures

• Three components – mesial occlusal rest, I-bar retainer
and long guiding planes (Proximal Plate) designed by
Kratochvil.

Fig. 54 (a) & (b) RPI system Kratochvil design.

• Here the proximal plate is designed to extend along the entire length of
the proximal surface of the abutment with a minimum tissue relief.

Fig. 55 (a) & (b) RPI system-Krol modification-I.

• Here the proximal plate is designed to extend from the marginal ridge to
the junction between the middle and cervical third of the tooth.
Fig. 56 (a) & (b) RPI system-Krol modification-II.

• The proximal plate is designed to contact just about 1 mm of the gingival

third of the guiding plane of the abutment tooth.

Fig. 57 (a) & (b) Indirect retainer.

• The indirect retainer is most often an auxillary rest usually an occlusal

rest but on occasion, where an occlusal rest cannot be used an incisal or
lingual rest on a canine tooth.
Fig. 58 (a) & (b) Occlusal rest seat and rest.

• Outline form of an occlusal rest is rounded triangular, with the base of the
triangle resting on the marginal ridge and rounded apex directed towards
the center of the tooth. The size of the rest varies from one-third to one-
half the mesio-distal diameter and approximately half the buccolingual
width of the tooth measured from cusp tip to cusp tip.

Fig. 59 (a) & (b) Cingulum rest seat and rest.

• The rest seat is V shaped and has two inclines. The labial incline is
parallel to the labial surface of tooth and lingual incline begins at the top
of the cingulum and converges labiogingivally towards the centre of the
tooth. Primarily used in maxillary canines. The cingulum rest is inverted
 crescent shaped.

Fig. 60 (a) & (b) Incisal rest seat and rest.

• They are used when the abutment tooth is sound and cast restoration is
not indicated. The incisal rest is a small V-shaped notch located
approximately 1.5 to 2.0 mm from the proximal incisal angle of the tooth.
The deepest part of the preparation should be toward the center of the
tooth mesiodistally.

Dental Surveyor
Fig. 61 Parts of surveyor

• A-Surveying platform

• B-Cast holder or surveying table

• C-Vertical arm

• D-Horizontal arm

• E-Surveying arm

• F-Mandrel

Fig. 62 Surveyor and Types.

• Surveyor is a paralleling instrument used in construction of a dental

prosthesis to locate and delineate the contours and relative positions of
abutment teeth and associated structures.

TYPES:
1. Jelenko surveyor
2. Ney surveyor

Fig. 63 (a) & (b) Difference between surveyors.

Surveying Tools

Fig. 64 (a) Analyzing rod.

• First tool used in surveying. To locate the height of contour and

determine relative parallelism of one surface to another.
Fig. 64 (b) Undercut gauges.

• Used to determine the amount and location of retentive undercut on the

surface of an abutment tooth. It comes as 0.010, 0.015, 0.020 inch gauge.

Fig. 64 (c) Carbon marker.

• Similar to lead points in a pencil. Used to draw the ‘survey line’ by

contacting teeth similar to analysing rod.

Fig. 64 (d) Wax Knife.

• Used to trim excess wax from blockout areas to make them parallel to
path of insertion used to trim waxed crown restorations to desired path of
insertion.
Uses of Surveyor

Fig. 65 Surveying the diagnostic cast.

• The main objective of surveying the diagnostic cast is to determine the

most desirable path of placement (insertion) that will eliminate or
minimize the interference to placement and removal of prosthesis.

• This involves determining the most favourable tilt of the cast.

Fig. 66 Tripoding the cast.

• Recording the final tilt of the cast for precise repositioning.

Mark – lingual to remaining teeth on tissue surface – three crosses –

• widely separated.

• Use the side of a 45-degree-trimmed carbon marker.

Fig. 67 Contouring wax patterns.

• The surveyor blade is used as a wax carver during this phase of mouth
preperation so that the proposed path of placement may be maintained
throughout the preperation of cast restorations for abutment teeth.

• Guiding planes on all proximal surfaces of wax patterns adjacent to

edentulous areas should be made parallel to the previously determined
path of placement.
Fig. 68 Surveying the crown.

• Ceramic veneer crowns are often used to restore abutment teeth on which
extra coronal direct retainers will be placed.

• The surveyor is used to contour all areas of wax pattern for the veneer
crown except the buccal or labial surface.

Fig. 69 Placing an internal attachments.

• To select a path of placement in relation to the long axes of the abutment

 teeth that will avoid areas of interference elsewhere in the arch.

• To carve excess in wax patterns, to place internal attachment trays in wax

patterns, or to cut excess in castings with the handpiece holder.

Fig. 70 Transfer the marking to master cast.

• After the surveying of the diagnostic cast mouth preparation is done and
the master cast is obtained. The master cast is placed on the surveyor
table. The 3 points selected from the diagnostic cast must be identified
with the analyzing rod held at the fixed vertical position; the cast is tilted
in various ways until the tip of the analyzing rod contacts the points on
the same horizontal plane. The tilt of the diagnostic cast and the master
cast will be same now.
 Chapter-2
TEMPORARY REMOVABLE
PARTIAL DENTURE

Introduction
Fabrication of Temporary Partial Denture involves the
following steps:
1. Fabrication of denture base, which includes marking
of the extent of denture base followed by fabrication
of the denture bases using sprinkle on or dough
method.
2. Fabrication of occlusal rims.
3. Articulation of casts with the occlusal rims.
4. Teeth setting and wax up.
5. De-articulation of casts.
6. Processing of TPD, which includes flasking,
dewaxing, packing, de-flasking, trimming and
polishing of the TPD.
Denture base:
The part of a denture that rests on the foundation tissues
and to which teeth are attached. It is also known as Record
base, Trial base or Stable base. These can be made of a
variety of materials which include:
• Autopolymerising acrylic resin
• Light cure resins
• Thermoplastic resins
• Shellac
• Baseplate wax
In the subsequent chapters we will be discussing
denture bases fabricated with autopolymerising acrylic
resin.
Extension of denture base is an important factor in the
construction of a removable partial denture. It is always
preferable to extend as wide as possible, to facilitate
distribution of the masticatory stresses between the residual
ridges and the natural teeth. This will help in preservation
of natural remaining oral structures.
Fig. 71 (a) & (b) The extension of the denture base on the teeth is drawn with
the help of a lead pencil. When the pencil is held perpendicular to the
remaining natural teeth it contacts the teeth at its most convex region and it is
at this point where a line is marked, which denotes the extent of the denture
base on the teeth. [NOTE: the above pictures depict marking of the line in
Kennedy’s Class I situation.]

Fig. 72 (a) & (b) Extension of denture base in class I situation.

On the teeth: A line is drawn approximately at the height of contour of the

remaining teeth with a pencil. [height of contour is a line encircling a tooth
designating its greatest circumference in a specified plane]. Extending the
denture base above the height of contour helps in increasing the area covered
by the denture base thereby aiding in better retention and also prevents
ingress of food through the prosthesis and sinking of the denture base by
providing horizontal stabilization.

Laterally: The buccal flange should extend upto the sulcus depth to
compensate for the loss of soft and hard tissues, to increase the surface area
covered by the denture to aid in better retention and also to provide horizontal
stabilisation.

Posteriorly: posteriorly as in class I situations there are no posterior teeth to

limit the denture base, so the hamular notch in the maxilla and the retromolar
pad in the mandible is taken as a guide to limit the extension of the denture
base.

Fig. 73 (a) & (b) Extension of denture base in class II situation.

On the teeth: A line is drawn approximately at the height of contour [similar

to procedure done for Class I] of the remaining teeth with a pencil [height of
contour is a line encircling a tooth designating its greatest circumference in a
specified plane]. Extending the denture base till the height of contour helps in
increasing the area covered by the denture base thereby aiding in better
retention and also prevents ingress of food through the prosthesis.

Laterally: The buccal and lingual flanges should extend upto the sulcus
depth to compensate for the loss of soft and hard tissues and also to increase
the surface area covered by the denture to aid in better retention. In class II
situations the denture base should be extended on to the teeth on the
contralateral side to provide cross arch stabilisation when occlusal forces act
on the prosthesis.

Posteriorly: Posteriorly in class II situations there are no posterior teeth on

one side to limit the denture base so the hamular notch in the maxilla and the
retromolar pad in the mandible is taken as a guide to limit the extension of
the denture base and on the contralateral side it extends upto the last tooth in
that quadrant.

Fig. 74 (a) & (b) Extension of denture base in class III situation.

On the teeth: A line is drawn approximately at the height of contour of the

remaining teeth with a pencil [height of contour is a line encircling a tooth
designating its greatest circumference in a specified plane]. Extending the
denture base till the height of contour helps in increasing the area covered by
the denture base thereby aiding in better retention and also prevents ingress
of food through the prosthesis.

Laterally: The buccal and lingual flanges should extend upto the sulcus
depth to compensate for the loss of soft and hard tissues and also to increase
the surface area covered by the denture to aid in better retention. In class III
situations also the denture base should be extended on to the teeth on the
contralateral side to provide cross arch stabilisation when occlusal forces act
on the prosthesis.

Posteriorly: In class III situations the posterior extent of the denture base is
limited to the last tooth present in the arch on both the sides.

Fig. 75 (a) & (b) Extension of denture base in class IV situation.

On the teeth: A line is drawn approximately at the height of contour of the

remaining teeth with a pencil [height of contour is a line encircling a tooth
designating its greatest circumference in a specified plane]. Extending the
denture base till the height of contour helps in increasing the area covered by
the denture base thereby aiding in better retention and also prevents ingress
of food through the prosthesis.

Anteriorly: The buccal and lingual flanges should extend upto the sulcus
depth to compensate for the loss of soft and hard tissues and also to increase
the surface area covered by the denture to aid in better retention.

Posteriorly: In class III situations the posterior extent of the denture base is
limited to the last tooth present in the arch on both the sides.

Blockout and Need for block out:

• Undesirable undercuts on the cast may cause the
denture base to get lodged into them and fracture. To
prevent this, blockout of these areas are done. This
facilitate a single path of insertion.
• The areas to be blocked out include:
1. All gingival crevices that are present below the
height of contour.
2. Gross tissue undercuts that may be present in the
lingual region in the mandibular cast and the
buccal/labial region in the maxillary cast.

Fig. 76 (a) & (b) After the extensions of the denture base are marked, the
interdental areas of the cast are blocked out with dental plaster using a
cement spatula so as to facilitate a single path of insertion, which helps in
easy retrieval and placement of the denture base.

Fabrication of Temporary Record Base

Sprinkle on Method

Fig. 77 (a) & (b) Application of separating media [cold mould seal].

Fig. 78 (a) & (b) Polymer is sprinkled on to the cast with a help of a dropper
and the monomer is dispensed with the help of a syringe. The cast is held at
an angle [as shown in the figure] so as not to allow the polymer to flow.
Fig. 79 (a), (b), (c) & (d) This procedure is continued until the entire extent
of denture of the base [marked earlier] has been covered by the
autopolymerising resin.

Fig. 80 (a) & (b) The set denture base is removed with the help of a wax
carver [Maxilla].

Fabrication of Denture Base by Dough

Technique

Fig. 81 (a) & (b) Removal of excess material is done with sharp instrument
upto the extensions marked.

Fig. 82 (a) & (b) After the material is set it removed from the cast with the
help of a carver.
Fig. 83 Set denture base removed from the cast.

Instructions: General rules for trimming.

• Excess acrylic resin flash is trimmed using acrylic
trimmer, care should be taken not to trim the borders of
the denture or near the collar area excessively,
• The tissue surface of the denture is not trimmed, only
the outer surface of the trial base is trimmed and fitted
accurately to the cast.
The border of the denture base is not to be trimmed as it
• forms a part of the tissue surface of the denture itself.
• The thickness of the denture base is to be maintained at
2 mm.
Fig. 84 (a) & (b) In accordance with the aforementioned instructions the
trimming of the maxillary denture base is carried out on the labial palatal and
edentulous area of the denture base.

Fig. 85 (a) & (b) In accordance with the afore mentioned instructions the
trimming of the mandibular denture base is carried out on the labial lingual
and edentulous area of the denture base.

Trimming of the Collars of the Denture

Base
• The area covering the neck of the adjacent teeth, by
acrylic material, are called the collars of the denture.
• Trimming of the collar is very important, as excessive
trimming in this area will lead to loosely fitting denture
bases.
• When trimming the denture base collars, a hand held
micromotor may be used, fitted with a collar trimming
acrylic trimmer.
• Proper trimming of the collar area is necessary for the
accurate fit of the denture base.

Fig. 86 (a) & (b) The above figures demonstrate trimming of collars of the
maxillary and mandibular denture bases. Note that before trimming the
collars a line is marked on the denture base to demarcate where the collars
should end so as not to trim excessively in this region. As mentioned earlier
the bur in the hand held micromotor is placed straight against the collar
surface and the bur is moved in one direction either towards or away from the
operator.
Fig. 87 (a), (b), (c) & (d) Finished denture bases in self cure acrylic resin.

Fabrication of Occlusal Rim

Fig. 88 (a), (b), (c) & (d) Pencil marking shows area for reduction of denture
base to accommodate the artificial teeth in teeth arrangement. Approximately
1 mm in thickness on the slopes of the ridge.
Fig. 89 (a), (b) & (c) Modelling wax that is used to make the occlusal rim is
softened over the flame while taking care that there is no air entrapment.

Fig. 90 (a) & (b) The desired length of the rolled modelling wax is cut and
positioned over the edentulous area. In the maxillary cast the height of the
rim is kept parallel to the remaining occlusal surfaces, the width is kept at 4–
6 mm and a slight labial inclination is given. In the mandibular cast height of
the rim is again kept parallel to the remaining occlusal surfaces, the posterior
extent is guided by the retromolar pad and the width is kept at 8–10 mm.
[NOTE: The above pictures depict fabrication of occlusal rim on Kennedy’s
Class IV for maxillary cast and Kennedy’s Class II for mandibular cast.
Fig. 91 (a) & (b) After the modelling wax is placed onto the edentulous
surfaces, they are sealed with a heated wax knife on all the surfaces and the
wax knife is also used to smoothen the surfaces of the occlusal rim.

Fig. 92 (a), (b), (c) & (d) Finished occlusal rims.

Fig. 93 (a), (b), (c) & (d) Finished occlusal rims [buccal view].

Articulation Procedure

Fig. 94 (a) & (b)

Articulation of casts is the next step after fabrication of occlusal rims. Before
articulation however three “V” shaped notches are created on the cast. This
procedure is called indexing which helps in accurate repositioning of cast in
the articulator while doing laboratory remounting procedures.

Vaseline is applied to the indexed areas of the cast to facilitate removal of

casts from the articulator without fracture of the indexed areas.

Fig. 95 Hand articulation using wax to stabilise the casts and thread to
establish the occlusal plane before articulating the casts with dental plaster.

Fig. 96 Finished articulation of casts with dental plaster.

Teeth arrangement for Kennedy’s Class IV

Fig. 97 (a) & (b)

Teeth arrangement for Kennedy’s Class I

Fig. 98 (a) & (b)

Teeth arrangement for Kennedy’s Class II

 Fig. 99 (a) & (b)

Teeth arrangement for Kennedy’s Class III

Fig. 100 (a), (b) & (c)

Placement of Clasp

Fig. 101 (a) & (b) Wrought wire clasp: Lines are marked with a pencil on the
labial surface of the tooth. The superior line corresponds to the height of
contour and the inferior line corresponds to the position of the clasp on the
labial surface of the tooth. The second picture depicts the position of the
cross over arm of the clasps on the lingual surface.

Fig. 102 (a) & (b) A 19 gauge wire and universal plier is used to make the
‘C’ clasp. The wire is bent and adapted to the tooth according to the lines
marked on the tooth.
Fig. 103 (a) & (b) Finished ‘C’ clasps stabilized with wax. NOTE: 1–2 mm
distance between the clasp and the distal surface of the teeth (clasp should be
away from undercut if not blocked). This is to accommodate the acrylic resin
that can be trimmed during insertion without disturbing the clasp adaptation
and ease path of insertion.

Fig. 104 (a) & (b) After the fabrication of the clasps the denture base is
seated on the cast to check where it needs to be trimmed to accommodate the
clasps and the corresponding areas are marked with a lead pencil.
Fig. 105 (a) & (b) These areas are then trimmed with the help of a hand held
micro motor and trimmer and the denture base is seated back on the cast.
Care should be taken to ensure that the denture base is seated back
completely without any obstructions due to the clasp.

Fig. 106 (a) & (b) Wax up procedure.

All the borders of the denture base are sealed using modelling wax with a
wax spatula. The wax-up is completed.
Fig. 107 (a), (b) & (c) The carver is to be placed at 45 degrees to the cervical
margin and the wax is removed upto the interdental area.

Fig. 108 (a) & (b) Finished wax up and carving.

Fig. 109 (a), (b) & (c) Dearticulation of maxillary and mandibular casts.

Processing

Fig. 110 Lubrication of flask with petroleum jelly to facilitate easy removal
of cast after processing.
Fig. 111 Cast soaked in water before flasking procedure to improve the
wettability.

Fig. 112 (a) & (b) First pour of plaster is done and maxillary cast seated in
the lower member of the flask with its Occlusal plane parallel to the base of
the flask. The trial denture base is invested in dental plaster on the lower
member of the dental flask. The remaining teeth on the cast is covered with
the dental plaster including the clasp. Only the acrylic teeth and waxed
surface is exposed.

Note: The rim of the flask is exposed. The clasp is covered with dental
plaster to avoid the displacement during dewaxing and packing
procedure.
Fig. 113 Application of separating medium on the all the surfaces except on
teeth and wax.

Fig. 114 The body is approximated on the base after application of separating
medium. The second pour is completed with dental stone and flasking is
completed.

Fig. 115 The upper and lower members of the flask after dewaxing.
Fig. 116 Application of separating medium.

Fig. 117 Packing of acrylic resin.

Fig. 118 After packing the resin the flask is approximated and tightened in
the hydraulic press and maintained in controlled pressure.
Fig. 119 The processed denture retrieved along with the cast after deflasking.

Fig. 120 The processed temporary partial denture removed from the cast. The
cast is preserved to enable proper collar trimming. The denture is placed on
the model following trimming to check the borders.

Fig. 121 Occlusal view of trimmed, finished and polished denture.

Finishing and Polishing

Fig. 122 (a) & (b) Wet and dry polishing of the denture.

Fig. 123 (a) & (b) Finished and polished maxillary and mandibular
temporary partial dentures.
FIXED PARTIAL DENTURE –
III
 FIXED PARTIAL DENTURE

Introduction
Fixed partial denture treatment involves replacement and
restoration of teeth with artificial substitutes that are not
readily removable from the mouth. The focus of fixed
restorations are to restore function, esthetics and provide
comfort to the patient.
Fixed partial denture treatment can range from straight
forward restoration of a single tooth with a crown,
replacement of one or more missing teeth with a fixed
partial denture, to complex restorations of an entire arch or
all the teeth in cases that require full mouth rehabilitation.
Definition: A partial denture that is cemented to natural
teeth or roots which furnish the primary support to the
prosthesis.
Over the years fixed partial denture treatment has
become the mainstay of prosthodontics in the rehabilitation
of missing teeth as it provides excellent form, function and
esthetics at a relatively cheaper cost. That being said, it is
important to have a thorough understanding the
biomechanics of fixed partial dentures along with an
intimate knowledge of the preparation of the teeth to
provide a quality prosthesis which is superior esthetics,
function and marginal adaptation.
This chapter describes the various parts and types of
FPD’S available along with a sequential depiction of the
steps involved in tooth preparation and fabrication of a
fixed partial denture.

Types of FPD
– Conventional Fixed Partial Dentures.
– Cantilever Fixed Partial Dentures.
– Fixed Movable Partial Dentures.
– Fixed Removable Partial Dentures.
– All Metal Fixed Partial Dentures.
– Metal ceramic Fixed Partial Dentures.
– All Ceramic Fixed Partial Dentures.
– Short Span Bridges.
– Long Span Bridges.
– Fixed Partial Dentures Splint.
– Fibre-reinforced Composite Resin Bridges.
– Resin Bonded Fixed Partial Dentures.
Indications of FPD
– Young adult patient.
– Short span edentulous arches.
– Presence of sound tooth can offer sufficient adjacent
teeth to the edentulous area.
– Residual ridge resorption where RPD not applicable.
– Individual patient consent.
– Medically compromised patients.
– Neuromuscular disorders patients.

Contraindication of FPD
– Bone loss due to trauma.
– Adults younger than 18 yrs of age.
– Presence of periodontally compromised abutment teeth.
– Bilateral edentulous area which require cross arch
stabilization.
– Decearsed crown: root ratio
• Very old adult patients.
• Distal extension edentulous area in the maxillary
and mandibular arch.
Advantages of FPD
– Strong.
– High retentive qualities.
– Usually easy to obtain adequate resistance form.
– Option to modify form and occlusion.

Disadvantages of FPD
– Removal of large amount of tooth surface.
– Adverse effect on tissue.
– Vitality testing not readily feasible.

Parts of Fixed Partial Denture

• Retainer [1]
• Pontic [2]
• Connectors [3]
Fig. 1 (a) Anterior 3 unit FPD depicting retainer and pontic.

Fig. 1 (b) Posterior 3 unit FPD depicting the connector.

Retainer
The part of a fixed dental prosthesis that unites the
abutment(s) to the remainder of the restoration.

Pontic
An artificial tooth on a fixed dental prosthesis that replaces
a missing natural tooth, restores its function, and usually
fills the space previously occupied by the clinical crown.

Connector
The portion of a fixed dental prosthesis that unites the
retainer(s) and pontic(s).

Types of Retainers-Based on Materials

All metal FPD

Fig. 2 All metal 3 unit FPD.

• All metal restorations have the best longevity of all fixed restorations.

• They are indicated for teeth that require complete coverage and posterior
teeth in the non esthetic zone.

Metal Ceramic Prosthesis

Fig. 3 (a), Fig. 3 (b) Metal ceramic restorations consists of a complete
coverage cast metal FPD or substructure that is veneered with a layer of fused
porcelain.

Metal Ceramic Facing and Combination

Metal ceramic facing

Fig. 4 (a) Ceramic facing FPD’s are indicated in cases that have lost
moderate amount of tooth structure with intact buccal wall.

Metal ceramic bridge with full metal posterior retainer

Fig. 4 (b) The primary advantage of ceramic facing is conservation of tooth
structure.

Metal Ceramics with Gingival Porcelain

Fig. 5 (a) Laboratory photo of an anterior FPD with gingival porcelain.

Gingival porcelain is generally used in cases with ridge defects in the region
of the prosthesis to attain a better esthetic result.
Fig. 5 (b) Clinical photo of an anterior FPD with gingival porcelain after
cementation.

All Ceramic Splinted Crowns

Fig. 6 (a), Fig. 6 (b) All ceramic restorations do not contain a metal
substructure due to which they have superior esthetics, excellent translucency
and good tissue response.

Types of Full Veneer Crowns

All ceramic crowns
Fig. 7 (a) All ceramic crown – used where there is esthetic demand fracture
resistant is lesser than metal ceramic. Maximum tooth reduction is needed.

Metal Ceramic crown

Fig. 7 (b) Metal ceramic crown – it is used to restore the teeth with multiple
defective axial surfaces. It provide maximum retention, used where need of
esthetics.

All metal crown

Fig. 7 (c) Complete cast crown restore the teeth with multiple defective axial
surfaces. It provide maximum retention, used where there are no esthetic
expectation.

Temporary Acrylic Provisional Restoration

Anterior provisional restoration

Fig. 8 (a) Provisional restorations for the anterior teeth restore the esthetics
until the definitive restoration is cemented.

Posterior provisional restoration

Fig. 8 (b) Provisional restorations for the posterior teeth help maintain the
tooth position, protect the pulp and resist functional loads.

Tooth Preparation for Full Veneer Crown

(Ceramic Facing)
Fig. 9 (a) & Fig. 9 (b) The above figures depict tooth preparation for ceramic
facing case in anterior and posterior teeth respectively. Note the junction of
the ceramic and metal ends in a wing type of preparation. The labial or buccal
portion of the preparation should have a shoulder or deep chamfer finish line.
The palatal and proximal portion should have a chamfer finish line.

Tooth Preparation for Partial Veneer

Crowns

Fig. 10 Depicts the preparation for 3/4th crown. These are indicated when an
intact abutment is to be used as a retainer for a FPD in the esthetic zone.

Fig. 11 Depicts the preparation for 4/5th crown. Note the mesial and distal
guiding grooves and the chamfer finish line on the palatal aspect. The guiding
grooves are prepared wit a no. 171 bur and are extended 0.5 mm short of the
finish line.

Fig. 12 Depicts preparation for a 7/8th crown. Note the mesial and the facial
guiding grooves.
Fig. 13 Depicts preparation for mesial half crown. These are generally
indicated for tilted abutments. Note the guiding grooves on the buccal and
lingual aspect. These are prepared with a no. 171 bur and are placed within 1
mm of the vertical distal extension of the preparation.

Cantilever Bridge
These are FPD’s in which only one side of the pontic is
attached to a retainer. These can be used for replacing the
maxillary lateral incisor, missing first premolar and molar
when there is no distal abutment.
Fig. 14 Depicts a clinical photo of a prepared canine to receive a cantilever
FPD.

Fig. 15 Depicts the clinical photo of the cantilever FPD after cementation.

Laminates
Porcelain laminates are thin facings of ceramic luted
directly to teeth using a composite resin as a bonding
cement. These are generally used to improve esthetics in
cases of diastema, discolouration and malformations.
Fig. 16 Clinical photo depicting discoloured anterior teeth.

Fig. 17 Clinical photo of the anterior teeth prepared to receive a laminate

restoration. The amount of preparation on the labial surface should be 0.5
mm and proximal surface should be 0.8 to 1 mm as the thickness of enamel is
more proximally.

Fig. 18 (a), Fig. 18 (b) Laboratory photo of the fabricated porcelain laminate
veneers tried on the working cast.
Fig. 19 Clinical photo of the laminate veneers. The laminate veneers are
bonded to the teeth with help of resin cement.

Implanted Supported FPD

Fig. 20 Clinical photo of implant supported FPD before second stage surgery.
Note the cover screws seen through the gingiva.

Fig. 21 Clinical photo of implant supported FPD after connection of the

abutments to the implant fixture.

Fig. 22 Clinical photo of the implant supported prosthesis after cementation.

Post and Core Restoration for

Endodontically Treated Teeth

Fig. 23 (a) Endodontically treated tooth. Note the destruction of tooth

surfaces on the distal and palatal aspect.
Fig. 23 (b) Endodontically treated after tooth preparation. Note the deep
chamfer finish line to create a ferrule effect in the cast post and core.

Fig. 24 Post space impression after post space preparation made with low
viscocity A.silicone impression material.
Fig. 25 Cast post and core fabricated in the laboratory to fit the prepared post
space.

Fig. 26 Cast post cemented and preparation modified.

Fig. 27 PFM crown cemented over the cast post and core.

Tooth Preparation for All Ceramic Crowns

Fig. 28 Depth orientation grooves for labial reduction using round end
tapered diamond. The diamond should be inserted into the tooth to its full
diameter to make the depth orientation grooves. Diameter of the diamond
point is equal to the depth of the groove.
Fig. 29 Depth orientation grooves for incisal reduction using round end
tapered diamond. These should be 2 mm in depth.

Fig. 30 (a) Labial and incisal reduction completed with round end tapered
diamond. The labial axial reduction should be 1 mm in depth and the incisal
reduction should be 2 mm in depth.
Fig. 30 (b) Labial and incisal reduction on incisal view.

Fig. 31 Proximal reduction completed with no. 171 bur. Note the heavy
chamfer finish line on the labial surface.
Fig. 32 Lingual reduction completed with small wheel diamond. It is
recommended that lingual reduction be 0.5–1 mm in depth.

Fig. 33 Cingulum reduction completed with round end tapered diamond. The
preparation in this area should be 1 mm in depth and should produce a heavy
chamfer finish line.
Fig. 34 (a) Completed tooth preparation – Labial view.

Fig. 34 (b) Completed tooth preparation – Incisal view.

Fig. 35 Completed tooth preparation – lateral view. Note the two plane
reduction on the labial surface (one plane in cervical half and another in
incisal half).

Fig. 36 Completed tooth preparation in occlusion. Note the 2 mm occlusal

clearance between the lingual fossa and opposing incisors of the mandible.

Tooth Preparation for All Metal Crown

Fig. 37 Depth orientation grooves placed with round end tapered diamond on
the occlusal surface. These should be 1 mm deep on the non functional cusps
and 1.5 mm deep on the functional cusps.

Fig. 38 Occlusal reduction completed with round end tapered diamond.

Fig. 39 Occlusal reduction with functional cusp bevel done with round end
tapered diamond and no. 171 bur. The functional cusp bevel should be
parallel with the inward facing inclines of the cusps of the opposing tooth and
should be made at a depth of 1.5 mm. It provides structural durability for the
restoration. Maxillary-palatal cusp bevel given on functional cusps.

Fig. 40 Buccal reduction completed with torpedo diamond to produce a

chamfer finish line. The depth of the preparation should be approximately 1
mm.
Fig. 41 Lingual reduction completed with torpedo diamond to produce a
chamfer finish line. The depth of the preparation should be 1 mm.

Fig. 42 Buccal and Palatal reduction – occlusal view.

Fig. 43 Palatal view after proximal reduction which is done with short thin
tapered diamond.
Fig. 44 Occlusal view after proximal reduction.

Fig. 45 Functional cusp [maxillary palatal cusps and mandibular buccal

cusps] bevel which provides structural durability.
Fig. 46 Chamfer finish line, width of the chamfer is approximately 0.5 mm.

Fig. 47 Completed tooth preparation – buccal view.

Fig. 48 Completed tooth preparation in occlusion. Note the 1 mm clearance
on the non functional cusps and the 1.5 mm clearance on the functional
cusps.

Clinical Steps in Fabrication of FPD

Fig. 49 Clinical photo depicting gingival retraction after tooth preparation for
metal ceramic crown.
Fig. 50 Final impression of prepared teeth made with elastomeric impression
material.

Steps in fabricating FPD

Fig. 51 Working cast for FPD retrieved from the impression.

Fig. 52 Provisional prosthesis fabricated on another the working cast.

Fig. 53 Die preparation and ditching of the working cast completed. When
ditching the die the original contour of the tooth structure below the margin
must be maintained. Over trimming of die will result in over contoured
restorations.

Fig. 54 Application of die spacer on the abutment teeth. Note the die spacer
should be 0.5 mm – 1 mm short of the finish line. Die spacer is applied to
provide space for cement in the final restoration.

Fig. 55 Wax pattern fabricated over the abutment teeth with inlay wax. The
wax pattern should be 0.5 mm in thickness except for the connector region
which should be 3 mm in thickness.

Fig. 56 Metal substructure casted and tried on the working cast. The metal
casting obtained from the wax pattern should be 0.3 mm in thickness after
trimming and finishing.

Fig. 57 Completed 3 unit FPD after veneering of ceramic over the metal
substructure.

Fig. 58 FPD cementation.

MAXILLOFACIAL
PROSTHESIS – IV
 MAXILLOFACIAL PROSTHESIS

Introduction
Maxillofacial prosthodontics is one of the oldest branch of
prosthodontics. It is a subspecialty that is currently
experiencing more change than at any other time over the
past 50 years of its recognized existence.
Advanced surgical and therapeutic modalities for the
treatment of head and neck malignancy, post tumour
therapy, surgical reconstruction, congenital and
developmental defects have always been a challenge in the
management of such patients. Prostheses are often needed
to replace missing areas of bone or tissue and restore oral
functions such as swallowing, speech, and chewing. In
other instances, a prosthesis for the face or body may be
indicated for cosmetic and psychosocial reasons.
Though the field has undergone many changes in the
past half decade, it has not seen much progress as seen in
other fields like implant dentistry. It is still a challenge to
treat such conditions in patients and to rehabilitate a lost
part in the maxillofacial region and to restore lost function.
The most commonly advocated method is the removable
maxillofacial prosthesis.
Prosthodontists are accustomed to working
cooperatively with ENTs, oral surgeons, general and
specialty dentists, plastic surgeons, neurologists, radiation
oncologists, speech pathologists, anaplastologists and
various ancillary personnel. The ultimate goal is to improve
the quality of life of the patient both functionally and
esthetically.
• Maxillofacial prosthetics: The branch of
prosthodontics concerned with the restoration and/or
replacement of the stommatognathic and craniofacial
structures with the prostheses they may or may not be
removed on a regular or elective basis (GPT 8).

Objectives of Maxillofacial Prosthetics

– Restoration of esthetics or cosmetic appearance of
the patient.
– Restoration of function.
– Protection of tissues.
– Therapeutic or healing effect.
– Psychologic therapy.
• Materials used in maxillofacial prosthetics
 – Acrylic resin.
– Acrylic copolymers.
– Polyvinyl chloride and copolymers.
– Chlorinated polyethylene.
– Polyurethane elastomers.
– Silicones.
• HTV silicone – Required heat for vulcanization.
• RTV silicone – Vulcanized at room temperatures.

Types of Silicones
• Implant grade.
• Medical grade.
– Used for fabricating maxillofacial prosthesis.
• Clean grade.
• Industrial grade.
– Polyphosphazines.
– Adhesives.
– Metal.

Classification
• Congenital defects
• Cleft lip and palate.
• Acquired defect
• Maxillary defects.
I. Hardpalate defects.
II. Soft palate defects.
• Mandibular defects.
I. Discontinuity defects.
II. Continuity defects.
• Ocular defects.
• Orbital defects.
• Nasal defects.
• Ear defects.
• Cranial defects.

Types of Prosthesis
• Extraoral prosthesis
• Ocular prosthesis.
• Orbital prosthesis.
• Nasal prosthesis.
 • Ear prosthesis.
• Cranial prosthesis.
• Intraoral prosthesis
• Obturator.
• Pharyngeal obturator.
• Palatal lift prosthesis.
• Meatal obturator.
• Guiding flange appliance.
• Palatal ramp.
• Miscellaneous prosthesis
• Custom airway tube.
• Tracheostomy obturator.
• Oro-facial plug.
• Mandibular advancement device.
• Tongue prosthesis.
• Esophageal prosthesis.
• Auditory inserts.
• Nasal stent.
• Burn stent.
 • Radiation stent and carrier.
• Trismus appliance.

Maxillectomy Defects – Aramany

Classification

Fig. 1.1 (a) Class I (b) Class II (c) Class III

Class I: The resection is performed in the anterior midline of the maxilla,

with abutment teeth present on one side of the arch.

Class II: The defect in this group is unilateral, retaining the anterior teeth on
the contra-lateral side.

Class III: The palatal defect occurs in the central portion of the hard palate
and may involve part of the soft palate.
Fig. 1.2 (a) Class IV (b) Class V (c) Class VI

Class IV: The defect crosses the midline and involves both sides of he
maxilla, with abutment teeth present on one side.

Class V: The surgical defect is bilateral and lies posterior to the abutment
teeth. Labial stabilization may be needed.

Class VI: Anterior maxillary defect anterior with abutment teeth present
bilaterally in the posterior segment.

Clinical Picture of Class I Defect

Fig. 1.3 Total maxillectomy on the left side.

Total maxillectomy creates a defect which allows the oral cavity, nasal
cavity, maxillary sinus and nasopharynx to become one confluent chamber.

Obturators
Fig. 1.4 Immediate surgical obturator.

Fig. 1.5 Immediate surgical in a patient.

Acrylic resin prosthesis place immediately after the surgery, it restore palatal
integrity and reproduce palatal contour. It helps in separating the nasal cavity
from the oral cavity and prevents entry of fluid into the nasal cavity.

It provides matrix on which the surgical packing can be placed, reduces the
oral contamination, and need of nasogastric tube. It improves the speech and
deglutition.
Fig. 1.6 Delayed surgical obturator.

Fig. 1.7 Delayed surgical obturator in a patient.

Delayed surgical obturator is given 6 to 10 days postsurgically. It is an

acceptable alternative when the defect is extensive and margins in question.
The impression for the delayed surgical obturator is made on the day of
surgical pack removal. Obturating the defect is better than immediate surgical
obturator.

Fig. 1.8 Interim obturator.

Fig. 1.9 Interim obturator in a patient.

The interim obturator prosthesis ‘‘bridges the gap” between the immediate
surgical obturator and the definitive prosthesis. It serves the same objective
of maintaining patient comfort and function until the definitive prosthesis can
be fabricated. Anterior teeth can be included in prosthesis which provide
acceptable esthetics.

Fig. 1.10 Single solid bulb obturator (Occlusal view).

Fig. 1.11 Single solid bulb obturator (Antral view).

This is the permanent prosthesis fabricated 3–4 months after the surgery,
radiotherapy or chemotherapy. It replaces the missing teeth and associated
structure which helps in mastication in minimal level. It extends into the
depth of the defect and provides more retention and more importantly
prevents the entry of fluid into the nasal cavity by causing a separation
between the oral and nasal cavities.

Fig. 1.12 Single closed hollow bulb obturator (Occlusal view).

Fig. 1.13 Single closed hollow bulb obturator (Antral view).

A closed hollow bulb obturator not only reduces the weight of the prosthesis
but also prevents secretions from the defect to get accumulated in the
prosthesis. This is the antral part of the closed hollow bulb obturator that
extends into the defect. This extension depends on the depth of the defect. Its
role is to separate the nasal and oral cavities.
Fig. 1.14 Single open bulb obturator A-Antral part, B-Oral part.

An open bulb obturator also has the same function. it is considered to be

more lighter than the closed bulb obturator. It also provides a better nasal
resonance and airflow.

Fig. 1.15 Two piece hollow bulb obturator A-Oral part, B-Antral part.
Two piece hollow bulb obturator is chosen when the defect in the maxilla is
very deep and the patient’s mouthopening is insufficient to incorporate the
obturator. It is fabricated in two parts namely, the oral and the antral parts.
The antral part is inserted first followed by the insertion of the oral part.

Fig. 1.16 Palatal lift prosthesis A-Oral part, B-Pharyngeal part.

Fig. 1.17 Palatal lift prosthesis in a patient.

A palatal lift prosthesis is a maxillofacial prosthesis which elevates the soft
palate superiorly and aids in restoration of soft palate functions which may be
lost due to an acquired, congenital or developmental defect. It lifts the soft
palate very close to posterior and lateral pharyngeal wall and reduces the
hyper nasal speech.

A definitive palatal lift is usually made for patients whose experience with a
diagnostic palatal lift has been successful.

Helps in restoring the functions of the soft palate.

Fig. 1.18 Speech bulb obturator A-Oral part, B-Pharyngeal part.

Fig. 1.19 Speech bulb obturator in a patient.

Speech bulb obturators are those prostheses used to close defects in the soft
palate region for aiding in speech and reducing nasal regurgitation during
feeding. This obturator replace only missing portion of the soft palate, it does
not displace the soft palate. It creates separation between the oropharynx and
nasopharynx.

It contains a pharyngeal section that goes behind the soft palate. It may be
used to compensate for the hypernasality and to aid in speech therapy.
Fig. 1.20 Prosthesis (Acrylic).

Auricular prosthesis is fabricated in missing of ears due to congenital

malformation or loss of ear due to trauma or neoplasms. Temporary
prosthesis fabricated 4 to 6 weeks after the surgery by heat cure acrylic resin
resin and retained by means of spectacle or Hair bands.
Fig. 1.21 Orbital prosthesis (Silicone).

An Orbital prosthesis is a maxillofacial prosthesis that artificially restores the

eye, eyelids, and adjacent hard and soft tissues. It artificially replaces an eye
missing as a result of trauma, surgery or exenteration of the orbit due to
malignant tumours. Retention is accomplished by means of soft tissue
undercut or adhesives or Osseointegrated implant.

Fig. 1.22 Ear prosthesis (Silicone).

Fig. 1.23 Ready-made ocular shell.

Fig. 1.24 Custom made ocular prosthesis.

Ocular prosthesis is fabricated for those who have lost ocular structures
through orbital evisceration or orbital enucleation.
Fig. 1.25 Nasal conformer.

Nasal conformer fabricated with acrylic or silicone, which is always

fabricated with hollow for airway. It is used to provide a support for cartilage
during post-surgical healing for the correction of nasal deformities in cleft lip
patients. The stent has to be relined periodically to enlarge the nasal aperture.

Fig. 1.26 Auditory insert.

Auditory insert made of acrylic or polyvinyl chloride or silicon, which is used

in surgical reconstruction of an external auditory meatus. It also can be used
as an ear plug after mastoid surgery. It is used as a stent in patients with
external auditory meatus stenosis.

Fig. 1.27 Pressure shield or stent.

Burns stent used in extensive burns, especially on face and extremities. It

prevent scar contraction and hypertrophic scar. Burn stent is fabricated with
autopolymerizing acrylic resin and lined with silicones. Patient need to wear
the stent for 24 hrs.
DENTAL IMPLANT – V
 DENTAL IMPLANT

Introduction
Advancements in the field of a dentistry has lead to newer
technologies and treatment modalities being introduced for
the replacement of missing teeth. One such advancement
that has become very popular over the past decade is the
dental implant. The dental implant is a component that is
placed within the alveolar bone and thus acts as a substitute
for the teeth that are lost.
Historically dental implants used to be manufactured in
various shapes but after extensive research it has been
concluded that root form implants are best suited for
replacement of missing teeth. These implants are also
available in various materials like metal such as titanium,
zirconium; ceramics, polymers and composites.
Replacement of missing teeth with implants has been
universally accepted to provide superior aesthetics,
excellent biocompatibility and better function when
compared to other treatment options such as fixed partial
dentures or removable partial dentures.
The present chapter discusses the various parts of an
implant and its use in detail and also gives a pictorial
description of the steps involved in the placement and
rehabilitation of an implant.

Definition
Dental Implant
A prosthetic device of alloplastic material implanted in to
the oral tissues beneath the mucosal and/or periosteal layer,
and on/or within the bone to provide retention and support
for a fixed or removable prosthesis;

Osseointegration
Direct structural and functional connection between the
ordered, living bone and the surface of a load carrying
implants.

Fibro-osseo integration
The presence of a layer of intervening fibrous connective
tissue between a dental implant and the adjacent bone
indicative of failed Osseo integration.
Different types of dental implants
Subperiosteal Implant
Endoesteal Implant
Transoseteal Implant
Mucosal Implant
Parts of implants and step by step procedure in
placement of implant for an absent tooth.

Fig. 1 Implant fixture which is placed within the alveolar bone.

Fig. 1 (a) Implant fixture and cover screw.

Fig. 1 (b) Implant site after completion of osteotomy.

Fig. 1 (c) Implant fixture placed in the osteotomy site.

Fig. 1 (d) Clinical photograph depicting the cover screw engaged over the
implant fixture.
Fig. 1 (e) Intra oral peri apical radiograph depicting the implant fixture and
cover screw after placement in the osteotomy site.

Fig. 2 Gingival former or Healing abutment placed over the implant fixture
after second stage surgery. This is available in lengths of 2 mm – 10 mm and
prevent overgrowth of tissues around the implant during the healing phase.
Fig. 2 (a) Clinical photo depicting placement of gingival former after second
stage surgery [6–8weeks after implant placement].

Fig. 2 (b) Intra oral periapical radiograph depicting gingival former engaged
over the implant fixture.
Fig. 2 (c) Gingival “cuff” or “collar” formed on 21 days after removal of
gingival former and before making the impression.

Fig. 3 Impression post with screw. This facilitates the transfer of intra oral
location of abutment to a similar position on the cast.
Fig. 3 (a) Impression post engaged over the implant fixture after removal of
gingival former and before making the impression.

Fig. 4 Lab analogue. This component represents the body of the implant
which along the with the impression post helps transfer the orientation of the
implant fixture into the cast.
Fig. 4 (a) Impression post and Lab analogue engaged together before re-
orienting them into the impression.

Fig. 4 (b) Impression post and Lab analogue after re-orienting them into the
impression, the lab analogue helps transfer the orientation of the implant
fixture into the cast.
Fig. 5 Abutment. This component resembles a prepared tooth and provides
retention to the implant prosthesis. They are available in straight and angled
forms.

Fig. 5 (a) Abutment engaged within the cast after laboratory milling.
Fig. 5 (b) Prepared abutment engaged in the cast – Occlusal view.

Fig. 5 (c) Porcelain fused metal restoration fabricated over the abutment.
Fig. 5 (d) Porcelain fused metal restoration checked on the working cast.

Fig. 5 (e) Clinical photo depicting milled straight abutment engaged within
the implant fixture.
Fig. 5 (f) & Fig. 5 (g) Clinical photo depicting seating of the prosthesis,
checking for occlusal contacts and final cementation.

Fig. 5 (h) Intra oral periapical radiograph depicting the implant fixture,
abutment and final prosthesis.
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 ABOUT THE AUTHOR

“Great things are not done by one person, they are done by
a team of people”

The authors expertise in undergraduate and postgraduate

dental teaching for more than a decade in the department of
Prosthodontics, Faculty of Dental Sciences, Sri
Ramachandra Institute of Higher Education and
Research (DU) Porur, Chennai, India. The authors have
played an indispensable role in designing the undergraduate
curriculum and have developed the innovative teaching
methods for the students in Preclinical years. They are
dynamic in research and have published numerous research
papers both in national and international journals. They
have conducted various hands-on courses for students in
national conferences and student conventions. They have a
vast experience in evaluating the clinical and the pre-
clinical procedures in examinations. The team has
collectively contributed to this book to raise the standards
of dental education and to lay a precise foundation for the
aspiring dental students.