OUTLINE

1- Treatment and management of the edentulous patient

2- Anatomy of the edentulous patient

3- Preliminary impressions for complete dentures

4- Final impressions for complete dentures

5- Jaw relation record

6- Complete denture occlusion

7- Trial denture try-in and posterior palatal seal

8- Denture processing and delivering

Reference Book

Done By:
Dana Albassri
Definitions:
1- Dentulous:
A condition in which natural teeth are present in the mouth “dentate”
2- Partial edentulism:
Loss of one or more natural teeth
3- Edentulous:
Without teeth
Causes of Tooth loss: Periodontal disease, Caries, Trauma, Other factors.

Edentulous patients

Young patients Elderly patients

Relatively rare More often
Good health condition Multiple medical condition
Low experience with removable prosthesis Some or high-level experience with removable prosthesis
High esthetic and functional demands Understanding of limitations

Effects of edentulism:
1- Appearance
2- Function
3- Emotional effects
4- Physical effects
Treatment options for the edentulous patient:
1- Conventional compete denture
2- Implant supported overdenture
3- Implant supported fixed prosthesis

Conventional compete denture:

A removable dental prosthesis that replaces the entire dentition and associated structures of the maxilla and mandible.
- Most common form
- Supported by bone and soft tissue (muco-periosteum)
Variations of compete denture:
1- Overdenture:
- Compete denture supported by teeth and implants in addition to muco-periosteum.
- Provide support
- Preserves bone
2- Immediate complete denture:
- For delivery same day as extraction of remaining teeth
- Multiple variation depending on patient condition
3- Obturator:
- Extension of compete denture close off a defect: congenital (cleft palate)- acquired secondary to cancer
surgery
Denture Terminology:
1- Cameo surface
The viewable, external surface of the denture extending from the border to the teeth (the outside of the denture which is
highly polished).
2- Intaglio surface
The internal surface of the denture or that portion whose contour is determined by the impression.
3- Denture base
The portion of the denture which rests on the tissue support and which the teeth are attached
4- Denture periphery (border)
The margin of the denture base at the junction of the cameo and intaglio surfaces representing the full extent of the denture
base
5- Denture flange
The part of the denture which extends from cervical ends of the teeth to the denture border

5 Clinical appointments denture delivery sequence:

Appointment no1:
 • Patient interview
• Clinical examination
• Preliminary impressions (alginate)
• Diagnostic casts

Appointment no2:

• Adjustment of Custom Trays

• Border Molding
• Final Impressions
• Beading & Boxing
• Master Cast

Appointment no3:

• Record Base & Rim

• Jaw Relations
• Tooth Selection

Appointment no4:

• Wax try-in

Appointment no5:

• Adjust tissue surface

• Peripheral extension
• Occlusion
• Esthetics

Denture Maintenance

Adjustments, after delivery

• At least 2 appointments for adjustments are needed
• The first appointment – 24 to 48 hours postoperatively
• The second appointment, approximately one week after the delivery
Recall
• Annually
Denture prosthesis lifespan
• 6-8 years with the needed reline

Anatomy of edentulous patient

Anatomic Landmarks
Maxillary Mandibular
Frena Residual ridge
Vestibular spaces Frena
Incisive papilla Vestibular spaces
Residual ridge Buccal shelf
Rugae Retromolar pad
Median suture Mylohyoid ridge
Torus palantinus Retro-mylohyoid space
Maxillary tuberosity Mandibular tori
Hamular notch
 Pterygomandibular raphe

Compete denture support

- Resistance shown against forces directed towards the basal seat
- Vertical forces of mastication during oral function

Denture bearing area (Basal support)

Consisting of tissues (bone and mucosa) of varying thickness, attachment and resistance to pressure
Based on this characterization, the tissues can be characterized as:
§ Primary stress bearing area
- Most capable area for support
- Thicker mucosa/ or bone
- Resist vertical forces of occlusion
Maxilla Mandible
Most of the hard palate Buccal shelves
Firm tuberosities Retromolar pads

§ Secondary stress bearing area

- Resistant to lateral forces of occlusion
- Minimizes movement of compete denture
Maxilla Mandible
Rugae Residual alveolar ridge
Residual alveolar ridge

§ Relief areas
Maxilla Mandible
Incisive papilla Sharp mylohyoid ridge
Median suture Torus mandibularis
Torus palatinus Mental foramen
Prominent genial tubercles

Factors affecting the foundation of a compete denture:

1- Age
2- Medical condition
3- Time period of being edentulous
4- Wearing denture
5- Opposing dentures
 Support

Stability Retention

Complete denture biomechanics

1- Stability
- Resistance to forces causing lateral displacement
- Close contact to the underlying tissues
2- Support
- resistance to forces of dislodgment along the path of placement
3- Retention
- Resistance to removal in a direction opposite to that of the insertion (away from the basal seat)
- Resist the:
1- Adhesiveness of foods
2- Force of gravity
3- Forces associated with opening of the jaws

§ Compete denture retention:

1- Adhesion
2- Cohesion
3- Interfacial surface tension
4- Peripheral seal
5- Oral and facial musculature
6- Mechanical lock

Impressions for compete denture

- Impression: a negative likeness or copy in reverse of the surface of an object; an imprint of the teeth and
adjacent structures for use in dentistry

- In compete dentures all the tissues of edentulous mouth required for the support, stabilization and
retention of a compete denture

Objectives of preliminary impression

1- Preservation: we want to avoid excessive pressure on the tissue (basal seat) because this can result in soft injury or
bone resorption
2- Retention: resistance to removal in a direction opposite to that of the insertion, away from the basal seat
3- Esthetics: influence of proper border thickness on lip support and facial appearance
4- Support: resistance shown against forces directed toward basal seat. Maximized by distrusting forces over a wide
area (vertical forces of mastication during oral function)
5- Stability: resistance to forces causing lateral movement. Close contact to underlying undistorted tissues is needed, to
maximize effect.
 Philosophies of impression making:
1- Mucostatic:
- Pressure free
- Minimal extension, no border seal
2- Functional
- Applied pressure
3- Selective pressure
- Directs pressure to areas most capable of support
- The steps followed in the selective pressure technique in order to obtain master cast:
1- preliminary impressions
2- diagnostic casts
3- custom stray fabrication
4- border molding and final impression
5- master casts

preliminary impression: impression of the entire denture bearing area used for the purpose of diagnosis and fabrication of
custom trays
- ideal impression material:
1- free flowing
2- dimensionally stable
3- accurate
4- neat, clean and easy to manipulate
5- elastic with high tear strength
6- ample working time, shorting setting time
7- hydrophilic
8- economical

material used in preliminary impression is Alginate (irreversible hydrocolloid), but not suitable for final impression.
- Advantage of Alginate:
1- Simple
2- Ease to manipulation
3- Minimum required equipment

- Disadvantage of Alginate:
1- Displaces soft tissues
2- Unable to capture fine tissue details

- Types of alginate:
1- Regular set
2- Fast set
- Proportioning
1- Fluff container for consistency
2- Dispense by volume
3- Room temperature water
4- Mixing
o Add powder to water -> less air
o Add water to powder -> control of consistency
• Try selection:
- ¼ (o.5cm) uniform space of impression material
- need modification (with wax), in order provide additional length of flange or posterior border to achieve
the desired material thickness
• loading and seating try:
- retract with mirror
- finger-load into difficult areas
- angle tray into center of mouth- align tray handle with patient’s nose
- seat posterior-anterior to avoid dripping the material to the throat
• removal of impression:
- release soft tissue
 - snap removal in order to avoid distortion
- rinse thoroughly
- disinfect
- eliminate excess moisture
- store in 100% humidity
v reasons for rejecting impressions:
1- incomplete/improper seating
2- Voids
3- Obvious distortion
4- Separation of material from tray
5- Failure to capture landmarks
• Pouring the impression
- Single pour: compete denture diagnostic casts only

- Double pour: all other casts

• Trimming the cast

- Pre-soak the cast
- Turn the water “om” before using the model trimmer
- Turn the sink water “on” also
- Keep casts moist
- Trim extra stone away to gain access to the vestibule for fabrication custom tray

Diagnostic cast:
Desired characteristics:
- ½ (1cm) base thickness
- Access to vestibule
- Base parallel to ridge
- No sharp angles
Uses:
§ Diagnosis:
- Undercuts
- Space vestibule
§ Fabrication of custom trays
Purpose of use:
- Accuracy of fit
- Control of border extension
- Control final impression material
- Assure uniform thickness of impression material

Custom Tray:
- Individualized trays, made from diagnostic cast
- Used for final impression
- Control final impression material
- Assure uniform thickness of impression material
Requirements:
- Rigid, strong and adjustable
- Uniform thickness
- No interference with muscle or frenal attachment
- Border extension, should be 2mm short of the vestibular depth
- Smooth and rounded borders
- Anterior handles should not interfere with lips manipulation, during border molding
- Comfortable to the patient
- Simple to fabricate and easy to adjust
- Reasonable to low cost
Fabrication:
- The maxillary posterior border is determined by a line extending between the two hamular notches
passing just posterior from the fovea palatine
 - The entire retromolar pad should fall within the outline of mandibular tray

Tray over-extension Tray under extension

Tissue injury Loss of retention and stability
Loss of retention and stability Possible problems, during border molding
Uncomfortable for the patient

- Block-out undercut areas (for easier placement and removal of the tray from the mouth during the
procedure of border molding- free flow of the impression material and minimizing the thin areas in the
final impression)
Maxillary undercut areas Mandibular undercut areas
Frenum (labial and buccal) Mylohyoid ridge
Buccal surface of tuberosity Mylohyoid space
Rugae Frenum (labial and buccal
Flabby portion, if any, of the alveolar ridge

- Wax spacer and tissue stoppers

§ Custom trays are fabricated by using a relief or spacer
§ The reason for this relief to have uniform/even thickness of the impression material
§ Placing one sheet of baseplate wax (1-2mm)
§ Tissue stoppers are created
§ Tissue stoppers will be filled with acrylic resin it helps the practitioner to have a repeatable
position during border molding
Materials:
- Auto polymerizing acrylic resin
- Visible light-activated composite (VLC) resin
Evaluation:
- 2mm of space is needed between the border of the tray and the depth of the vestibule
- If less than 2mm, the custom tray is over-extended:
§ Result in tissue injury
- If more than 2mm, the custom tray is under-extended:
§ Result in no tissue injury but less retention and stability

Border molding
The shaping of the border areas of an impression tray by functional or manual manipulation of the tissue adjacent to the
borders to duplicate the contour and size of the vestibule

Material:
- Impression compound
- Elastic impression
Objectives:
- Determination of the contour, height and width of the borders of the compete denture

Final impression
The negative registration of entire denture support areas along with border seal areas present in the edentulous mouth, used
to fabricate mater cast
- The soft tissues supporting a removable prosthesis should be in a state of a health prior to making the
impression
§ Recovery from denture inflammation
§ 8-weeks of post-surgical tissue healing
- Obtaining oral tissue health
§ Tissue rest
§ Use of tissue conditioners
- Clinical significance
§ Patient should limit
§ Denture use 24 hours prior to the impression appointment
- The patient should be seated in upright position
§ Mandibular impression: the patient should be on a level with the operator shoulder
 § Maxillary impression: the patient’s mouth should be on a level with the operator’s elbow and the
chair may be tilted back
- Impression material should be uniformly distributed within the tray and all the borders should be covered
- Positioning of tray intraorally using the labial frenum and the tray handle as references
Tissue manipulation
- Maxilla
§ Manipulation of cheeks and lips
§ Patient moves mandible from side to side
- Maxilla
§ Puckered lips
§ Patient moves tongue forward and side to side
Removal of the impression
Rinse with water, dry and disinfect the impression
Inspection of impression
- Anatomical landmarks are reordered
- Absence of voids or tears
- Tray was correctly seated

Beading and boxing

the enclosure of an impression to produce the desired size and form of the base of the cast and to preserve desired details

purpose:
- Preserve desired details and critical areas
- Provides a land area
- Control of base thickness
- Conserve material
- Allows for denser cast, which is crucial for the denture processing
Master cast
A replica of the tooth surface, residual ridge area, and/or other parts of the dental arch and/or facial structures used to
fabricate a dental restoration or prosthesis
- The accuracy of the cast will determine the support, stability and retention of the compete denture
- All of the anatomical landmarks and border areas must be included
- Loss of any landmarks or border areas, will result in a defective prosthesis
- Crest ridge should be parallel to base of cast
- Base thickness around 10-25mm
Land Area:
- Artificial area created during beading/boxing which delineates the useful limits of the impression
- The land area is around 2-3mm wide and slopes downward at a slight angle

Jaw Relation:
- A study of the relationships between the jaws and the cranium and one another.
- Jaws relation used to evaluate and record information from the patient and transfer the information to the
articulator

Types of Jaw relation:

- Orientation:
§ Occlusal plane establishment
- Vertical:
§ Rest Vertical Dimension (RVD)
§ Vertical Dimension of Occlusion (OVD)
- Horizontal:
§ Centric Relation
§ Centric occlusion
§ Eccentric occlusion
Record Blocks:
- Consist of two parts:
§ Record base or baseplate
§ Record rim or occlusion rim
It is temporary form representing base of denture
- Uses:
1- Jaw relation records
2- Arranging teeth
3- Trial insertion
- Material:
1- Auto polymerizing acrylic resin
2- Visible light activated acrylic resin (Triad)
- Requirements of record base
§ Stability
§ Accuracy
§ Rigidity
§ Comfortable for the patient
§ Ease of manipulation
- Occlusion rims:
§ Baseplate wax built on record bases to simulate position of teeth
§ Used in conjunction with record bases to record jaw relation and for arranging teeth
§ Measurements of occlusion rims
Orientation Relations:
Relations of the jaws to references in the cranium
- Maxillary wax rim:
1- Lip support
§ Look from the side and evaluate the angle between the lip and the nose
(nasolabial angle)- around 90 degrees
§ Esthetic evaluation of the patient’s profile

2- Lip length
§ With the lips at rest the wax rim should project 1-2mm below the lip line which
decreases with age
§ Phonetic evaluation: “f” and “v” sounds- incisal edge of max rim lightly touches
wet-dry line if lower lip

3- Establishment of the occlusal plane

§ Interpupillary line: maxillary occlusion rim is set parallel to the interpupillary line,
measured with a fox plane (Template used to evaluate contours of wax rims
relative to facial planes)
§ Camper’s line (ala-tragus line): an imaginary line connecting the superior border of
the tragus of ear with the inferior border od the ala of the nose. in lateral view,
the maxillary occlusal rim is set parallel to camper’s line
§ Incisal plane if the anterior teeth and occlusal plane of posterior teeth should be
parallel with the interpupillary line and camper’s line as determined by the fox
plane guide

Þ Establishment of guiding lines for teeth set-up

1- Central line
2- Canine line
3- High lip line

Vertical jaw relation:

Is a maxilla to mandible relation in vertical direction
- Evaluation of vertical jaw relation:
• Rest Vertical Dimension (RVD): vertical height of the face with the mandible in the physiologic rest position
• Occluding Vertical Dimension (OVD): vertical height of the face when the teeth or occlusion rims are in
contact- about 3mm less than (RVD)
• Interocclusal Distance (IOD): IOD= VDR-VDO = 3mm
• Phonetics: evaluate closest speaking space with S sound
• Facial appearance
 - Problems with vertical dimension:

• Insufficient:
1- Esthetic
2- Reduced functional efficiency

• Excessive:
1- Jaw pain, TMJ symptoms
2- Clicking dentures
3- Loss of retention and stability
4- Ridge soreness
Horizontal jaw relation:
Recording the side to side and front to back relations of the maxilla and mandible.
- Centric relation: the maxillomandibular relationship in which the condyles articulate with the thinnest
avascular portion of their respective disks with the complex in the anterior-superior position against the
shapes of the articular eminencies
• Clinical significance:
1- Bone to bone relation
2- Independent of tooth contact
3- Reproducible, recordable
4- Reference position for compete denture occlusion
• Centric relation record: a registration on the relationship of the maxilla to the mandible
when the mandible is in the centric relation
• Registration of centric relation
1- Swallow
2- Tip of the tongue on the upper record base and closure of mouth
3- Gothic arch
4- Anterior deprogrammer/ Lucia jig
5- Chin point guidance technique
6- Bilateral lower jaw guidance technique (Dawson technique)
- Eccentric relation: any relation of the mandible to the maxilla other than centric relation
1- Protrusive relation: the relation of mandible to the maxilla when the mandible is in the
thrust position
2- Lateral relation: the relations of the mandible to the maxilla when the mandible is moved to
the right or left side
Þ Facebow: a caliper- like device used to record the relationship of the maxillary arch to the hinge axis and then transfer
the relationship to the articulator.

Compete Denture occlusion

• Occlusion: the relationship between occlusal surfaces of the maxillary and mandibular teeth when they are in contact
• With dentures, the quantity and the intensity of these contacts determine the amount and the direction of the forces
that are transmitted through the bases of the denture to the residual ridges
• The patient perspective: esthetics, function, comfort
• When designing an occlusion for denture it is natural to make comparison with natural dentition and try to stimulate
the occlusion
Natural teeth Artificial teeth
Occlusal forces directed toward one tooth normally do occlusal forces directed toward one tooth affect the
not influence surrounding teeth entire denture (the denture function as a unit)

Supported in alveolar process by periodontal ligament
Capable of adaptive response to increased functional
demand
Incising does not affect posterior teeth
Second molar is the most favorable area for
mastication
Rest on mucosa of varying thickness and resistance
No adaptive capacity, instead degenerative response
Incising will dislodge the denture posteriorly in addition
to anterior resorption
Second premolar and first molar are the favorable areas
for mastication
 • Designing denture occlusion:
- Limitations:
1- movable supporting base
2- supporting tissues susceptible to injury
3- reduced efficiency and comfort

- Design principles:
1- Denture stability, minimize tipping
2- Center teeth over support
3- Minimize incisal guidance
4- No interference in lateral movement

• Concepts of Denture occlusion:

Bilaterally balanced occlusion Neutrocentric (monoplane) occlusion Lingualized occlusion

•imultaneous, bilateral contact of
maxillary and mandibular posterior
teeth in centric relation
•There is no contact on the anterior
teeth
•bilateral balanced occlusion in natural
teeth considered as a premature
(pathologic) contact on the non
working side (balanced side)
•easier to obtain with artificial teeth
which have significant cuspal anatomy
(anatomic teeth 30+ cuspal inclination)
•tight intercuspation of the centric
supporting cusps in centric relation, this
relationships facilitate obtaining
contacts in lateral excursion
•Advatages:
•1- distribute occlusal forces over a wide
area of the oral tissues
•2- resist tipping forces
•3- improved stability and esthetics
•4- reduced trauma to oral tissues
•5- masticatory efficiency is improved
and can retain shearing ability after
moderate wear
•Factors influencing balanced occlusion:
Hanau Quit(1925)
•1- condyle inclination
•2- incisal guidance
•3- cusp height
•4- occlusal plane
•5- compensating curves
•the concept of balance in eccentric • the maxillary lingual cusps articulate
posotion is unnecessary, the inclines with the mandibular occlusal surface.
would result in reduced stability to the • a compromise betweeen balanced
denture base occlusion and neutrocentric concept
• they promote a vertical pattern of • anatomic maxillary posterior teeth
function which minmize lateral forces (30 or 33 dgree)
on the ridge •semi anatomic or non-anatomic
• plane of occlusion should be parallel to mandibular teeth are used
the underlying ridge to direct forces of •only one contact point
occlusion perpendicular to the ridge
•less lateral forces
•non anatomic (00) teeth are set on a
•forces centered over ridge crest
single, flat plane (monoplane)
•buccalization of the buccal cusps allows
•no vertical overlap of the anterior teeth
more of an escape way for the bolus of
•incisal guidance is set at zero food
•bucco-linugual width of the teeth is
•Idications:
reduced to direct force toward the
•1- High esthetic demand
center of the support area
•severe alveolar resorption
•articulator fuction as a simple hinge
with 00 horizontal and lateral guidance •Displaceable supporting tissue
angle •class II and III jaw relation
•lower molar incline should be avoided •parafunctional habits
by keeping the teeth a head of it
•indications:
•1- senile patient with poor jaw
coordination
•2- atrophic residual rdiges
•3- excessive inter-ridge distance
•4- class II and class III jaw relationships
•5- crossbite
•advantages:
•1- simple technique
•2- less lateral forces
•3- easy to adjust
•Disadvantges:
•1- Esthetic
• 2- flat teeth impairs mastication
 Þ Investigators have not shown one type of occlusion or tooth form to be:
- Superior in function
- Safe to oral tissues
- More acceptable to patients

Selection of Tooth Form and Occlusal scheme

- Selection of tooth form and arrangement is according to the philosophy and experience of the practitioner
based on his/her interpretation of the anatomic and physiologic needs of the patient
- Classification of tooth forms
1- Anatomic
§ 33o
§ 30o
2- Semi-anatomic
§ 20o
§ 10o
3- Non-anatomic
§ 0o cusp incline
Þ Anatomic and semi anatomic:
- Cuspal inclination 10-33 degree
- Ideally for balanced occlusal schemes
- More esthetic than non-anatomic
- Well suited for partial dentures as they occlude against natural teeth
Þ Non-anatomic tooth form:
- No cuspal inclination (0o)
- Indicated for monoplane occlusal scheme where balanced is not considered
- Indicated for in class II and III jaw relationships or any situation where precise intercuspation is difficult to
obtain (crossbite)
- Atrophic ridge- minimal lateral forces is desired
- Poor esthetic value

Materials:
1- Porcelain
2- Acrylic
3- Composite resin
4- Metal
Trial Denture Try-in
- The process of placing trial denture in the patient’s mouth for evaluation.
- The trial denture try in appointment is the last opportunity to make changes in the dentures before they are
processed.
- Sequence of evaluation of the trial dentures:
1- Extra-orally (on the articulator)
Ø The teeth meet evenly in centric position
Ø Trial base should be:
I. Stable on their casts
II. No sharp edges
III. No touch between the upper and lower bases and the opposing casts
Ø Check the teeth set-up

2- Intra-orally:
First, make sure that dentures are stable and retentive in the patient’s mouth. If not, use denture
adhesive on the tissue surface of the dentures
§ Vertical dimension:
¨ The vertical dimension of occlusion should be evaluated first because centric relation
needs to be registered at a vertical dimension which is close to the appropriate vertical
dimension occlusion
¨ The basic principles and procedures of evaluating the vertical dimension at this
appointment is similar to those used to establish the vertical dimension at the
registration appointment
1- Observe the patient’s facial appearance (lower facial third should be equal to
the middle and upper facial third)
2- Evaluating the interocclusal space (2-3mm between upper and lower teeth at
rest position)
3- Patient input (ask the patient if he/she feels comfortable with existing vertical
dimension
¨ If any change was made to correct the vertical dimension, then a new centric relation
records need to be taken

§ Centric relation:
¨ Direct the patient to bite on his teeth gently in centric occlusion
¨ Look for any tilting or sliding movement of either dentures due to premature contact
¨ If the interference is great, such as in correct centric, new centric relation of occlusion
record should be made

§ Eccentric occlusion
¨ Direct the patient to move the lower jaw in protrusive and lateral positions and
observe for proper articulation in these positions

3- Checking the esthetic:

¨ Contours of the lips and checks
¨ Lip support: nasolabial angle: 90 degree
¨ Tooth display: Ask the patient to slightly open his mouth and check the relation of the
maxillary incisors to the upper lip
¨ Ask the patient to smile to check the high lip line, and use the dental floss to check the
midline

4- Checking the speech

¨ Use phonetic test to check the position of the upper and lower incisors
¨ The incisal relationship is checked with sibilant sounds such as “S” and “CH”
¨ Tooth to lip relation can be checked with dento-labial sounds like “F” and “V”
I. Upper anterior teeth are too short (set too high up), V sound will be more
like an F
 II. If they are too long (set too far down) F will sound more like a V
¨ Contour of the record base in the rugae area and the palatal gingiva of maxillary teeth
might affect the phonetics

5- Registering the protrusive record

¨ Protrusive records are registered mainly to adjust the condylar guidance on the
articulators
¨ The reliability of protrusive records is questionable
6- Patient approval

¨ Patient should sign esthetic approval form before processing of the dentures

Posterior Palatal Seal:

The soft tissue area at or beyond the junction of the hard and soft palates on which pressure, within physiologic limits, can be
applied by a complete denture to aid in its retention

- Purpose:
1- Prevent food and liquids from getting under denture’s border
2- Firm contact with the tissue of the soft palate reduce the tendency to gag
3- Compensate for acrylic processing error
4- Promote denture retention

- Anterior Vibrating line (AVL): “Ah line”

An imaginary line located at junction between the hard palate and soft palate

- Posterior vibrating line (PVL): “Ah line”

Within the soft palate, An imaginary line between the portion that has limited movement and the portion
that is movable (it is the limit of the posterior extension of the maxillary denture

- House’s classification:

¨ Higher class (II, III) Greater deflection less extension and depth of seal
¨ Class I most favorable

- Recording PPS methods:

1- Conventional method (marking the anterior and posterior vibrating lines intraorally using indelible pencil)
2- Fluid wax methods (lowa wax)
3- Arbitrary (cast scraping/carving) method) “least accurate”
Denture Processing and Delivery

v Denture processing:
A laboratory procedure that involves a series of coordinated steps in which the trial denture (wax pattern) is converted to
the final denture
- Processing methods:
1- Compression
2- Injection Molding
3- Microwave
4- Light cured
- Boil out: the process in which the wax is removed, and the casts cleaned and prepared for packing phase
- Due to the dimensional changes that happened to the dentures during the processing phase, multiple
adjustments need to be done to correct these changes
- These adjustments can be done extra-orally by:
1- Laboratory remount
2- Clinical remount

- Laboratory Remount Procedure:

§ This process is to correct the processing errors that cause expansion of the acrylic and
increases the vertical dimension
§ The master cast must fit tightly against the plaster mount
§ You may observe a change to the vertical dimension and occlusal contact
§ Place articulating paper on the occlusal surfaces and close the articulator and grind the high
contacts
§ Move the articulator in protrusive and lateral direction and grind the high contacts
§ Continue, repeatedly using articulating paper to check the contacts, until the vertical
dimension is reduced

v Denture Delivery:
- Inspection of the finished denture
§ Evaluation of the tissue side of the denture base for under-cut areas
§ Fitting surfaces must show no irregularities
§ Entire periphery should be rounded and polished
§ Edges of the relief area should be rounded
§ Each denture should be evaluated individually

- Before inserting the denture, apply on the tissue side of the denture base with a thin
coat of pressure disclosing paste, insert and then remove denture, when tissue
undercuts are present, the paste will be voided from the denture base in the area
tissue contact

- Clinical evaluation of the denture:

1- Evaluation of the borders
§ Checking for adaption
§ Checking for border extension
§ Checking for frenal relief
2- Evaluation of the denture retention and stability
§ Retention: Dislodging forces, like we want to remove the denture
§ Stability: apply pressure with the finger on the premolar area, one side at a time and check
for tilting (rocking) movement of the denture
3- Evaluation of jaw relation
§ Centric Relation (CR)
¨ Occlusal adjustments are always needed when inserting new dentures
¨ Occlusal contact is checked using a thin articulating paper
¨ Heavy contact should be corrected by removing the heavy points using acrylic bur
4- Evaluation of denture esthetics
5- Evaluation of speech
 - Clinical remount procedure:
§ If the dentures occlusion requires significant amount of adjustments, then a new centric
relation records should be taken for a clinical remount procedure
§ Then upper and lower dentures are then mounted on the articulator based on the new bite
registration records
§ Then the occlusal adjustments are completed extra-orally on the mounted casts
§ Advantages:
1- Stable working foundation. The dentures are positioned on the remounted casts, not on
the resilient denture supporting tissue
2- Clean and clear working field (no saliva)
3- Less patient involvement
Post insertion instructions:

v Appointment schedule:
- First appointment within 24-48 hours after the delivery
- Second appointment after 1 week
- In case, of emergency (injury), we call our patient the soonest
- Recall every year, for edentulous ridges screening and denture check

v Different experiences and discomfort:

- Feelings of oral fullness
- Retention comparison between natural and artificial teeth
- Saliva (increase in amount)
- Speech
- Eating (specific type and manner)
- Tongue position and problems with the lower denture compared to the upper denture

v Wearing Dentures and habituation:

- Within 24 hours, little discomfort will lead to soreness
- In case of pain, burn or ulceration, consult your dentist

v Speech:
- Read out loud, as a training method
- Acts of coughing and sneezing often dislodge the dentures

v Denture Hygiene:
- Rinse mouth properly before wearing the denture
- Dentures must be cleaned before and after meals
- Inside surface, should be cleaned gently using a clean, wet cotton
- Commercially available denture cleansers can be recommended
- Once cleaned, dentures should remain immersed in water to prevent over drying of the base, with resultant
warping of the prosthesis
- No repairs or adjustments should be made by the patient

v Poor Denture Hygiene:

- Mucosal irritation
- Inflammatory papillary hyperplasia
- Denture stomatitis
- Chronic candidiasis
- Stain retention
- Halitosis

v Eating:
- For 2-3 weeks, soft foods in small bites simultaneously in both sides
- Avoid sticky food and always chew on back teeth
- Chew with posterior teeth. Anterior only for esthetic and phonetic