Title: Removable Prosthodontic Calibration
1Removable Prosthodontic Calibration
Dr. William G. Golden Clinical Associate
Professor and Prosthodontist Director of
Removable Prosthodontics
2Increased Vertical Dimension
I think everyone here would recognize these two
examples as an open bite (increased vertical
dimension).
3Increased Vertical Dimension
But how about these?
4Increased Vertical Dimension
How do you correct the dentures without starting
over?
- Refine the fit of the denture bases to the mouth
with PIP. - Verify the correctness of the vertical position
of the upper anterior teeth. - If the vertical position of these front teeth
are too long, adjust the maxillary anterior teeth
by selective grinding until the fricative sounds
are clear and distinct.
5Increased Vertical Dimension
How do you correct the dentures without starting
over?
- Remount the casts by using a new facebow record
and centric relation record. - Intraorally, reduce the maxillary anterior
teeth until the wet/dry line of the lower lip
contacts their incisal edges. - Replace the maxillary back on the articulator and
raise the guide pin. - Reduce the occlusion of the maxillary posterior
teeth until the maxillary incisors meet with the
mandibular incisors in protrusive. - Evaluate the VDO of the dentures in the mouth
and make another CR record.
6Increased Vertical Dimension
How do you correct the dentures without starting
over?
- Remount the mandibular remount cast.
- Remove all maxillary teeth from the denture
base. - Replace the denture base on the maxillary
remount cast. - Set a new set of teeth on the maxillary denture
base. - Perform a wax try-in of teeth.
- Intraorally, evaluate the VDO of the dentures
and the function of the teeth.
7Increased Vertical Dimension
How do you correct the dentures without starting
over?
- Box and pour the denture as if it were a final
impression. - Trim the cast with the denture in place and
send it to the lab for processing, clearly
stating in the lab prescription the denture base
is to be retained as the denture base of the
final denture. - Have the lab finish and polish the denture and
return it ready to insert in the patients mouth. - Evaluate and treat it as you would the original
denture.
8Vita shades
- Only two of the Bioform shades correspond with
the Vita shades - shades 59 69, therefore,
please do not request them. - We do not provide teeth for complete dentures
made in the predoctoral clinic that are the
brands made for these shades.
910 20 Degree Teeth
- These are not available for use in complete
dentures in the predoctoral clinics. - Students are not trained to use them and it
just adds more confusion to their limited
understanding of complete dentures. - Often, when students complete an occlusal
equilibration, the anatomical teeth resemble 10
20-degree teeth anyway.
10Porcelain Teeth
We do not encourage the use of porcelain teeth
in the predoctoral clinics because they are very
hard to equilibrate to establish bilaterally
balanced occlusion.
11Anatomic teeth for Class II Class III patients?
- These dont allow the freedom of movement
needed for a Class II patient. - There are very difficult to set in a crossbite
situation as is often the case with a Class III
patient. - Unstable dentures cause sore spots.
12Zero-degree teeth set with a compensating curve?
- We set zero-degree teeth in a monoplane
occlusion. If there is no vertical overlap of
the anterior teeth, what is the need for a
compensating curve? - Balancing ramps?
13Anterior guidance with zero-degree teeth?
There should be no anterior guidance/interference
in any complete denture. This causes
instability of the denture, leading to discomfort
and broken/dislodged teeth.
14Patients expecting a reline at six month mark?
- Option of reline presented up front.
- Patient insisting on reline instead of new
denture. - Interim prosthesis.
- Erroneous billing.
- Patient dissatisfaction with the fit.
- Patients not wanting to pay for the tissue
conditioner relines.
If these interim dentures are determined to be
suitable for relining, they are then reclassified
as immediate complete dentures and relined. The
code for the denture must be changed at that time
and the patients account will be changed to
reflect the adjustment and the patient will be
charged the difference in cost between the
interim complete denture and the immediate
complete denture. The patient will also be billed
for a reline. The student will get credit for a
reline.
15Mandibular posterior teeth not set over the ridge.
- Mandibular posterior teeth must be set over the
ridge. - Anatomical mandibular posterior teeth must be
set with the buccal cusps over the middle of the
mandibular ridge. - Zero-degree mandibular posterior teeth are set
with the central fossae over the middle of the
mandibular ridge. - Lines must be drawn on the casts to indicate
the middle of the ridge. - Lines must be drawn on the casts to indicate
the depth of the anterior vestibule.
16Clinical remount is not necessary?
- Clinical remounts are always necessary for
complete dentures. - Increased stability
- Increased retention
- Increased function
- Increased patient satisfaction
17Erroneous Patient Remounts
- Casts not mounted in CR.
- Poor centric relation record not at the
first point of occlusal contact, not one piece. - Poor quality facebow transfer/remount index
- Inaccurate or no protrusive record.
- Horizontal condylar guidance is not set
properly.
18Erroneous Patient Remounts
- Maxillary dentures are not flat-surfaced (if a
monoplane occlusion is used.) - Monoplane teeth - guidance setting not
established parallel to the occlusal plane. - Mandibular occlusal plane not flat and in
intimate contact with the maxillary occlusal
plane. - Poor quality remount casts.
- Instructor did not thoroughly evaluate the
remount.
19Safety Infection Control Regulations
- Faculty not enforcing them.
- Faculty not following them.
- Students not properly attired.
- Patient not wearing safety glasses.
- Student not wearing safety glasses.
- Children in the area.
- Student blowing on dentures with the mouth.
- Student not wearing protective mask properly.
20Safety Infection Control Regulations
- Flames too near to hand disinfectant
dispensers. - Students not keeping area clean, especially the
sink area. - Students not disinfecting the impressions.
- Patient not wearing a patient napkin.
- Student using a non-sterile instrument to mark
the midline on the wax rim. - Students using improper knife or using it
improperly.
21Guide pin is not set at zero.
- Initial mounting - not set on zero.
- Remounting - not set on zero.
- Cannot assume the setting is correct.
- Student used articulator for another case.
- Guide table was not set so the pin was
contacting the axis of rotation mark and the
incisal guide angle was changed.
22The condylar guidance is set wrong for the teeth.
- Student used the articulator for another case
and forgot to change the setting. - Student didnt know what the correct setting
was. - The condylar lock nut is loose.
23Master casts/final impressions have no hamular
notches.
- Cast finished down too close in the distal.
- Hamular notch was not captured in the
impression. - Student did not box the impression properly and
leave adequate room for the land area.
24Master casts/final impressions have no retromolar
pads.
- Cast finished down too close in the distal.
- Retromolar pad was not captured in the
impression. - Student did not box the impression properly and
leave adequate room for the land area. - Retromolar pad area was reduced because it
interfered with protrusive or lateral movements.
(Occlusal plane must be at least 2/3 of the way
up the highest retromolar pad.) - Cast would not fit in the processing flask.
25Master casts/final impressions with excessive
width in the vestibular areas.
- Compound was not scraped/trimmed adequately.
- The tray was not reduced enough initially.
- Excessive blockout of undercuts.
- Mandibular trays without finger rests.
- Inadequate border molding.
- Student chilled the compound before placing the
tray in the mouth.
26Trays with improper handles
Trays must fit the mouth have handles that will
not interfere with the border molding process and
still allow for easy placement and removal.
- Handle did not come off crest of ridge.
- Handle was too short to grasp.
- Handle was made at right angle or drooping down
(prevents lip from being raised or lowered
completely in that area). - Mandibular tray without finger rests.
27Trays that are under-reduced for the impression.
- Overextended impressions in the vestibular
area. - Complete dentures (particularly the lower) with
excessive flange length. - Frenular notches are not present.
28Casts with insufficient or no land area
- Cast finished down too close in the distal.
- Student did not box the impression properly and
leave adequate room for the land area.
29Master casts that are too thick or too thin.
- Impression was not properly boxed poured.
- Thickness of the cast base was over-reduced or
under-reduced. - Student tried to make up for thin cast by
pouring a second pour on the base. - Student did not box and pour the cast but used
the double-pour method.
30Final impressions made of materials other than
polysulfide impression material.
- We use a low viscosity (light-body, injection
type) wash of polysulfide impression material to
make our final impression for a complete denture. - Easier to remove from a cast without breaking
or otherwise marring the cast.
31Improper baseplates/improper blockout destroyed
casts.
- Insufficient blockout.
- Wrong separating medium was used.
- Trays were under-reduced.
- Casts were not soaked in hot water before
removing the tray/impression. - Students focused on a tight fit/lots of suction
with baseplates rather than on protecting the
casts.
32The end