Dr.

Amal Fathy Kaddah

Professor of Prosthodontic,
Faculty of Dentistry
Cairo University
Definitions
Try-in Verification / Aesthetic try-in:
 “A preliminary insertion of a removable denture wax-

up to determine the fit, aesthetics, maxillomandibular

relationships ”
GPT

Importance:
 It is the last opportunity to evaluate many of the
previous steps already accomplished. Changes are
made at chairside depending upon the esthetic needs
of the patient and the opinions of the dentist.
Aspects of try-
in
1. Check the case on articulator

2. Trying the trial denture in the mouth:

a- Check the upper denture alone.

b- Check the lower denture

alone.
c- Check upper and lower
dentures together.
1. CHECK THE CASE ON THE ARTICULATOR

I. The master cast

As the finished denture is processed on the

master cast. So the master cast should be:

In good shape and condition.

Free from air bubbles or scratches.

Free from wax debris which lead to improper

adaptation of the trial denture bases leading

to false relationships.

If there are any undercuts present in the cast, they should be

relieved to avoid scratching of the cast by the trial denture bases.
II. The trial denture bases lie properly on their casts.

 Must be stable.

 The borders should be smooth,

round, and have no sharp edges.

 The border should be shaped to

conform to the depth and width of
the sulci.

 No excess wax or other debris is

attached to it
Shape of the polished
surface
Duplicate appearance of normal gingiva

Concave surfaces between marginal gingiva and

denture borders for maximum retention
III- The mounting is checked for

1. The mounting rings are firmly

screwed in their position.

2 . The incisal pin of the articulator.

 Maintaining of the vertical dimension of occlusion

• Top of the incisal pin is flushed with the upper member

of the articulator.
• The incisal pin is in contact with the incisal table.
III- The mounting is checked for

3. The trial denture bases lie properly

on their casts and the teeth meet
evenly in centric relation.

4. Articulators joints.

5. Condylar path inclinations.

6. The articulator moves smoothly

from centric to eccentric positions
without cuspal interlocking.
No touch between the bases and the casts.
Accurate Mounting

Teeth interdigitate perfectly

 No space around the cusps
Condylar ball should contact fossae wall
If either criteria not met, remake record
IV- The teeth
 The teeth – Properly selected (for

aesthetic) regarding shape, size, shade.

 Properly positioned and meet evenly in

centric.

o It is the dentist responsibility to select the proper shade, and

mould of the teeth and to determine that the teeth are set
correctly.
o Elimination of the excess wax is done to avoid the
camouflages
of the teeth relationships to overlook the occlusion.
 Anterior teeth Vertical overlap (1-2 mm)*
Horizontal overjet (1-2 mm )*
The amount of overlap will vary depending on
condylar
inclination, occlusal plane and aesthetics.
Verify working, balancing and protrusive.
Make adjustments as necessary.
1. The plane of occlusion should be parallel to the body of the mandible
and extends from the incisal edges of the central incisors and the
middle portion of the retromolar pads bilaterally.
2. The appropriate Curve of Spee should be incorporated into the
setup.
3. Verify the position of the mandibular denture teeth.
4. Make sure the posterior mandibular teeth are centered over the ridge
1. Check the case on
articulator
2. TRYING THE TRIAL DENTURE IN THE MOUTH:

To reduce the risk of cross- contamination, the

trial denture should be sprayed with suitable

antiseptic solution and washed in running water,

before inserted in patient mouth.

1. Check the case on
articulator
2. TRYING THE TRIAL DENTURE IN THE MOUTH:

a- Check the upper trial denture alone.

b- Check the lower trial denture

alone.

c- Check upper and lower dentures

A .CHECK THE UPPER DENTURE ALONE FOR
1 . Extension of the denture base and post-dam area.
2. Retention and comfort.
3 . Stability to occlusal stress and relief area.
4 . Appearance of the occlusal plane in relation to the ala-tragus
and interpupillary line.
5 . Alignment of the teeth and their support of the facial
musculature.

B . CHECK THE LOWER DENTURE ALONE FOR

6 . Retention and comfort.
7 . Extension and peripheral outline.
3 . Stability to occlusal stress.
4 . Neutral zone and tongue space.
5 . Height of the occlusal plane in
A .CHECK THE UPPER DENTURE ALONE FOR

1. Maxillary trial denture base extension

The labial and buccal denture base extension:

 Marked overextension of the flanges,

leads to elastic recoil resulting in
dislodgment of the denture, immediate
denture displacement after its seating.
Examination of the extension:
 Insertion of the upper trial denture in its place with light
pressure on the occlusal surface, move the cheek in functional
movement. With the release of the pressure, the denture will fall
down.
 Also under extension of the upper
trial denture leads to poor physical
retention.

 Correction will usually entail

making a new final impression.

 Provision of the frena {labial and

buccal} should be done to ensure that
they have adequate clearance.
Posterior extension
 The posterior border of the upper trial denture base
should extended from the one hamular notch to the
other along the vibrating line of the soft palate,
and correctly placed on the master cast.

 If the p.p.s is not done before, it should be done at

this
stage.

 Arbitrary scraping of the cast and readapting the

record base.
Posterior Nasal Spine

Velum

Butterfly in shape
2. Retention
 It is noted that the retention of the trial denture is less
than that of completed denture, due to:
 Absence of a posterior palatal seal.
 Poor adaptation of the trial denture base to the
tissues.
 The trial denture should stay in position when the
mouth
is opened.
 Looseness of the upper trial denture makes it impossible
to carry out an accurate assessment of the occlusion
{may use denture fixative} especially, in patients with
Test for retention
Applying a pulling force
vertically and downward to the
anterior incisors to test for
the retention and the
peripheral seal of the
anterior labial part
Applying a upward and
outward pressure to the
cigulae of the upper anterior
incisors to test for the
posterior palatal seal
Test for retention

Applying a tipping force Apply upward & outward pressure on the

to the anterior incisors to canine to test the seal at post dam/
break the seal retrozygomal and tuberosity area at the
opposite side.
Test for retention
3. Stability
 It is tested by applying pressure in a tissue ward
direction with the ball of the index finger in the
premolar and molar regions on each side alternately.

 This pressure must be directed at right angles to the

occlusal surface where displacement does occur.

if, vertical pressure causes denture to tilt and raise on

the other side = teeth on the side of the applied
pressure are outside the ridge.
Test for stability
 Causes of instability / Denture Looseness

 Poor Retention

 Warpage of the denture base.

 Unrelieved area in the midline e.g. Median palatine

raphe and torus palatinus.

 Posterior teeth set buccal to the underlying alveolar

ridge

 Poor anatomy
4. Orientation of the occlusal plane
 Parallel to the inter-pupillary line anteriorly.

 Parallel to the ala-tragus line posteriorly.

 Height of the occlusal plane:
 For normal patient: 2 mm of the incisors should be seen,
when the lip is at rest.

 For a patient with short lip: 5 to 6 mm of the

incisors should be seen.
Incisors too long
The amount of the upper anterior teeth
that will be seen during speech and facial
expression depends on length and
movement of the upper lip

Too much amount of teeth

5. Alignment of the anterior teeth and the support of
the musculature:
 The vermilion border of upper lip,

angles of the mouth, philtrum and

the nasolabial sulcus should assume
a normal contour.
B . CHECK THE LOWER TRIAL DENTURE ALONE FOR

1. Denture base extension:

 Hold the denture in place with
light pressure and the
patient mouth is slightly
opened to allow the
surrounding Musculature to
be in an acceptable state of
relaxation.
 Ask the patient to protrude the
tongue sufficiently to moisten his
lips

 If denture lifts at the back =

Overextended of the lingual
pouch.

 Put the tip of his tongue as far

back on his palate as possible:

If the denture lifts in the front, it is overextended anteriorly;

probably in the region of the lingual frenum.
Place his tongue -successively in each
superior buccal sulcus:
If the denture lifts, the lingual extension
is deep.
Labial and buccal extensions are checked
as for the upper trial denture.
2. How to evaluate lower denture retention?

 Usually the lower denture

retention is poor when compared

to the upper denture due to:

1. Small denture bearing area

2. The difficulty in obtaining an

efficient border seal.

a) Hold the denture in place with light pressure

and ask the patient to open his mouth slightly

to allow the surrounding musculature to be
in an acceptable state of relaxation.

b)Pull the teeth straight upwards to check the

retention of the anterior labial and lingual flanges.
let his tongue touch the cingula of the lower
anterior teeth, support the chin of the patient with
the left hand and
c) Tilt the lower trial denture outward from the
canine region to test the retention of the
opposite retro molar pad
3- Lower occlusal plane
 In most patients, the incisal edges of the
natural lower canines and the cusp tips of the
lower first premolars are located at the level of
the lower lip at the corner of the mouth when
the mouth is slightly open.

 The posterior end of the occlusal plane should

be at the level of the anterior

two thirds of the retro

molar pad.
Efficiency of mastication
The tongue brings the food onto the occlusal plane then it
holds the food between the upper and lower teeth
cooperating with the buccinator muscle so that the food
can be easily crushed.

X
4. Lack of tongue space (cramped
tongue)
 If the tongue is more mobile than

the cheeks will cause greater

instability of the lower denture.

 Cramped tongue may be due to:

1. Posterior teeth set lingually to

the neutral zone.

2. Posterior teeth tilted lingually

3. Posterior teeth too broad

Testing of the tongue space

Ask the patient to raise the

tongue. If the tongue is cramped,
the denture will begin to rise
immediately.

As the tongue moves it tries to expand laterally

and whenever the tongue moves the denture will
move.
To check for the neutral zone
Let the patient open his mouth half-way
and touch the lower anterior teeth with
the tip of his tongue, while his tongue
is relaxed.

Feel the amount of pressure exerted by

the tongue and cheek on the lower teeth,
using a plastic filling instrument.
Pressure should be roughly equal on the
lingual and buccal sides of the teeth.
C . CHECK BOTH DENTURES TOGETHER FOR

1. Vertical dimension of centric occluding relation and free way space.

2. Centric relation i.e. antro-posterior and lateral dimension at centric

occlusal.

3. Free articulation and balanced occlusion.

4. Equilibration of occlusal pressure.

5. Appearance of the face and teeth.

6. Phonetic tests.

7. Pleasing, comfort and approval by the patient.

1. Verifying the Vertical dimension
 Phonetics & aesthetics

 Facial dimension & facial

expressions
“VDO”
 Lip length in relation to
teeth

 Inter arch distance & parallelism of the ridges

 Swallowing
1. Verifying the Vertical
dimension
 Evaluation of vertical dimension at rest & at occlusion
 The amount of inter occlusal distance to which pt.
was accustomed

 When the teeth are in centric occluding relation,

the
patient’s face should produce a pleasing
appearance.

 The patient should be able to speak without clicking of the

teeth. If the teeth click together, this indicates that the
interocclusal clearance is insufficient, and that the denture
2. Verifying Centric Relation and Even occlusal bearing

 Pt. is guided into CR by a thumb

placed on the anteroinferior
portion of the chin & index
finger bilaterally on the buccal
flanges of the lower denture.

 Any Error in CR will be

apparent when teeth slide over
each other.
 If centric jaw relation was found to be wrong, and the
teeth do not occlude properly. New centric record is
needed and the articulator’s mounting should be changed.

The articulator must close in the hinge position without condylar displacement
3. Verifying Eccentric relation records

1. Contact during protrusion. At least three widely

separated points or areas of occlusion must exist.
Mandible must be brought forward 5-6 mm short
of tooth contact while maintaining the
mandible in the midline

Setting the Condylar Inclination

3. Verifying Eccentric relation records

Working side Balancing side

Contact during lateral movement

4.Testing equilibration of occlusal pressure

 The patient is asked to occlude on two thin celluloid

strips placed between the posterior teeth, one on
each side.

 The patient should occlude while the jaws are in

centric relation.

 Equal pulling forces of the celluloid strips

simultaneously mean equal occlusal pressure
5. Appearance of face and
teeth
1. Appearance of entire lower half of face
should be finally confirmed after
vertical dimension of occlusion & CR
has been verified.

2. Incorrect positioning of anterior teeth or

supporting base material alters normal
appearance of vermilion border, the
philtrum & mentolabial sulcus.
a. Evaluation of selection of artificial teeth

 Creating facial and functional harmony

with anterior teeth

 Position of the central line, VD and CR

 Shape, size and shade and position of the selected

teeth

 Amount of teeth visible, horizontal, vertical

orientation and inclination of anterior
teeth
b. Horizontal orientation of anterior teeth

Labial surface of many natural central incisors

are about 8 – 10 mm from center of incisive
papilla
b. Horizontal orientation of anterior teeth

Excessive lip support causes

 Stretched lips.
 tendency of lips to dislodge
dentures during function.
 Elimination of normal contours
of lips, philtrum & sulci.
Teeth set directly over ridges causes insufficient
lip support characterized by:

Drooping of corners of mouth

Reduction in visible part of vermilion border

Deepening of nasolabial sulcus

Wrinkles over vermilion border
Plumping: Cheeks& lip falling-in,
Unsupported lip and cheek
(Building – out the upper denture to
compensate for the loss of muscular
tone)

Smile view of the patient

Most elderly patients require the
lip support provided by the
labial flange of the denture
c. Vertical orientation of anterior teeth

 Verify length of upper lip and Lower

lip which is a better guide for vertical
orientation of anterior teeth.

 Incisal edges of lower canine & cusp

tip of lower first premolar are even with
corner of mouth when mouth is
slightly open.
Esthetic Determinants of Anterior Tooth Placement

A typical esthetic display of the maxillary anterior

teeth. The central incisors are aligned with the midline
and the laterals and cuspids are elevated off the
occlusal plane.
6. Phonetic Tests
Phonetic Tests Clinically determined by

 “F” and “V” position

 “S” position
The Dental- Labial Consonants:

Note the relationship between the “F” and “V”

position
The Linguo-Dental Consonants:

These sounds are made with the tip

of the tongue against the palate in
the rugae area with small space or
slit like channel for the escape of air
between the tongue and hard
palate.

The size and shape of this small space or

channel will determine the quality of the
sound
The Linguo-Dental Consonants:

Effects of vertical positioning of anterior teeth on the pronunciation of

th.
A. The tongue is prevented from extending properly between the teeth.
B. The tongue extending between the teeth when they are properly
positioned
• The upper and lower incisors
should approach each other end-
to-end, but they should not
touch that indicate a possible
error in the amount of
horizontal overlap of the
anterior teeth.

• Always check on the total length

of the upper and lower teethap)
(including their vertical overl
 Note the relation of the maxillary to mandibular

During the production of sibilant sounds The mandible travels

down and forward to create a small space (a space of about1
mm) is created between the maxillary and mandibular incisors
during the production of sibilant sounds.

“S” position
 If this channel is too
shallow (broad and Lisping “Sh” sound
thin)

if the depth of the

channel is Lisping (th or
further
decreased or
etts)
obstructed
If the channel formed
between the hard palate
and the tongue is too
Whistling
narrow and deep

11/22/2021
Lisping and whistling are opposite phenomena 106
 7- Patient's approval

Pleasing, comfort and approval

by the patient.
 8- Fabrication of Remount Jig
(Occlusal index for clinical remounting)

At the end of the try in stage where the

dentist and patient are both satisfied.

This is a time save procedure for you because

you do not have to make a new facebow record
at the time of delivery.
Place the Facebow remount jig on the lower member of the
articulator. Verify that the incisal guide pin is set at zero.
Allow plaster index to completely set. Verify that the
maxillary teeth can be repositioned into the indentations.
 Clinical Remounting Procedure

Remount upper denture

using remounting jig

Do I need New Face bow

RECORD?????????
References
:
1. Boucher, C. O., Hieckey, J. C. and Zarb, G. A.: Prosthodontic treatment for edentulous patients. 2nd ed., C. V. Mosby Co. St.Louis, 2000.
2. Eissman, M.R.: Dental laboratory procedures, complete denture, C.V. Mosby company, St. Louis, Toronto, London, 2000.
3. El Mahdy, A. S.: Complete Denture Prosthesis. Anglo-Egyptian book shop, Cairo, Egypt. 1968.
4. Hassaballa, M. A.: Clinical complete denture prosthodontics. 1st edition. Academic Publishing and Press, Riyadh, Saudi Arabia, 2004.
5. Iwao Hayakawa: Principles and Practices of Complete Dentures creating the mental image of a denture, Tokyo Medical and Dental University, Tokyo, Japan.
Quintessence Publishing Co., Ltd. 1999.
6. Iwao Hayakawa: research profile on BiomedExperts,The Journal of prosthetic dentistry 2007;98(2):141-9. 2007.
7. Iwao Hayakawa: Principles and practices of complete dentures: creating the mental image of a denture, rapidshare.com, 27 Dec 2009.
8. Kaddah, A. F.: OCCLUSION IN PROSTHODONTICS, Varieties, Aberrations & Management. Dar El-Etehad. First Co. First ed. Cairo Egypt. 98/7071, 1998.
9. Tamer El-Gendy: Introduction to complete denture, Didactic and Laboratory Manual, Course Director: Tamer El-Gendy BDS, MS. Assistant Professor.
COLLEGE OF DENTISTRY, THE OHIO STATE UNIVERSITY.2000.
10. Winkler, S.: Essentials of complete denture prosthodontics. 2nd ed., PSG Publishing. Co. Inc., 2005.
11. Zarb, G. A., Bolender, C. L., Hickey, J.C. and Carlsson G. E.: Boucher’s Prosthodontic Treatment for Edentulous Patients, ed. 12th . St. Louis Mosby, 2000.

Internet Sites:
- Full denture relining using Tokuso Rebase, By Dr. David J. Sultanov, DMD, Pittsburgh, PA. Information provided by J. Morita USA. The British Dental Journal
is published by Nature Publishing Group for the British Dental Association.© 2002 British Dental Association
- http://www.dentistry.bham.ac.uk/ecourse/pros/casetreat_w3.asp
- http://www.tpub.com/content/medical/14274/css/14274.
- The School of Dentistry, Birmingham UK
- Treatment options for edentulous spaces. Dr David C. Attrill d.c.attrill@bham.ac.uk

Lectures and PowerPoint® presentation slides:

- Full denture relining using Tokuso Rebase By Dr. David J. Sultanov, DMD, Pittsburgh, PA. Information provided by J. Morita USA
- Lectures Posted by dental products .net. Originally published in the April 2001 Dental Products Report. Copyright 1999-2005 Advanstar Dental
Communications.
- Lectures Produced in the United States of America. ISBN 0-7216-9770-4
- Related Links: About Tokuso® Rebase; Rationale for relining; Tips for success.