Complete Dentures

1
Insertion of
Complete Dentures
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Prior to Appt. 5

• Wax-Up is completed.
• Record is signed by 2 instructors
• Lab request is signed.
• CD is fully processed.
• CD is remounted on the articulator.
• Processing error is corrected.
• A remount index is made (preserves facebow
  record).
• CD removed from the cast
• They are thoroughly polished.
• Remount casts are made (max. is mounted on
  articulator using the remount index.)

3
ARMAMANTARIUM

• Articulator Polished Dentures
• Remount Index Jig
• Buffalo Knife or Green-Handled Knife
• Acrylic Burs
• Straight Handpiece
• Articulating Paper
• Shim Stock
• Pressure Indicator Paste Brush
• Exam Pack
• 2 Tongue blades
• Mixing Bowl Spatula
• Disclosing wax
• Mounting plaster
• Room Temperature Water

4
Processed CD

• Processing error correction
• Lab remount
• Occlusal Equilibration
• Patient (clinical) remount

• Centric Occlusion
• Lateral excursions
• Protrusive

5
When the dentures are sent to the lab for
processing, they are separated from their
mountings, which are retained so that the casts
can be remounted to them when they are returned
from the lab.
OPEN GUIDE PIN
The casts are attached to the mountings and are
secured by sticky wax which surrounds the entire
periphery of the mounting and cast.
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It is anticipated that there will be an
increase of vertical dimension that occurs during
processing and is aptly named processing error.
This will have to be corrected during a
laboratory remount procedure. It shows up as an
gap between the guide pin and the incisal guide
table. No cusps are reduced in the process.
This is the only correction done during the lab
remount. Since there are no cusps on zero-degree
teeth, the only reduction made on a zero-degree
denture is that the occlusal surfaces of the
maxillary denture teeth are made flat using a
flat piece of sand paper resting on a flat
surface. A sanding sponge is not used for this
procedure as it will not produce an absolutely
flat surface.
7
CENTRIC OCCLUSION
A thin piece of articulating paper is used to
mark the occlusal contacts on anatomic teeth in
centric occlusion and the gap is corrected by
deepening the fossae until the pin touches the
guide table.
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Occlusal (Remount) Index
An occlusal remount index is made immediately
after the laboratory remount to preserve the
original facebow transfer, thus preventing having
to make another facebow transfer to mount the
casts during the clinical remount. During the
clinical remount, teeth contacts will be adjusted
so that the dentures have simultaneous and even
contacts on both sides in lateral and protrusive
excursions. This state is called bilateral
balance and is necessary for maximum denture
stability and retention.
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The Occlusal (Remount) Index
With the condylar balls locked in centric and
the incisal guide pin set at zero, the remount
table is placed on the lower member of the
articulator. Masking tape is placed around the
remount table, and an index is poured of mounting
plaster recording only the cusp tips (no more
that 1 mm deep). The index is marked with the
patients name to identify it for future use.
10
The Clinical Remount
The dentures are placed in the patients mouth
and any adjustments are made to the tissue
surface to make them fit the patients mouth.
After both dentures are adjusted, including the
flange length (particularly of the mandibular
anterior flange), a centric relation record is
made (and a protrusive record for dentures with
anatomic teeth) and the dentures are mounted on
the articulator with mounting plaster.
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The denture and the remount cast are placed in
the plaster index and mounted on the articulator.
The incisal guide pin must be set at zero and the
condyles must be locked in centric. The denture
must be checked to ensure it is completely seated
in the index. The original mounting can be
utilized to minimize the amount of plaster that
is necessary to mount the cast. To ensure maximal
retention and stability of the dentures, no
blocking out of undercuts is done on the tissue
side of the denture.
12
The mandibular cast is mounted at this time
using the centric relation record that was made
after the new dentures were adjusted. It is
necessary that all occlusal records be made
before starting the remount procedure because the
dentures will not be removed from the remount
casts until after they are adjusted. This
insures that the dentures are absolutely stable
during any adjusting that is done on the
articulator.
13
No eccentric adjustments are made to the
occlusion prior to the clinic remount, as it is
impossible to obtain totally accurate records of
jaw relationships with baseplates and wax rims or
teeth set in wax. This is why only the occlusion
is adjusted in centric relation in a laboratory
remount to correct the changes in VDO due to
processing error.
14
The cast is separated from the denture, all flash
is removed with a bur and/or arbor band, and the
it is finished to a high shine by various
polishing agents and methods.
15
Place the finished dentures in water in a sealed
plastic bag.
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Before seating

• Examine the denture

• Tissue surface
• Rough areas may be detected by rubbing the
  tissue surface with a 2X2 gauze.
• Carefully adjust any area that pulls a thread.
• Undercuts of flanges

• May prevent seating of the denture.
• Hard tissue may bruise the tissues when the
  denture is placed. Adjust these areas.
• Soft tissue may not need adjustment.
• Adjust rugae area if labial undercuts cause
  denture to not seat.

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Insertion Sequence

1. Trial placement of the denture.
2. Adjust the bases.
3. Adjust the borders.
4. Test dentures for comfort retention.
5. Make interocclusal relationship record in CR.
6. Make protrusive record.
7. Remount in centric relation.
8. Adjust centric contacts.
9. Equilibrate in lateral excursions.
10. Adjust in protrusive.
11. Polish and insert dentures.
12. Instruct patient.
13. Do a 24-hour follow-up correct as needed.
14. Do a 72-hour follow-up correct as needed.

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Denture Insertion - Evaluate Dentures in
Patient's Mouth
The interrelationship between base adaptation
and occlusion cannot be precisely duplicated
outside of the mouth, both because of minor
distortions in the fabrication process and
because the oral tissues are dynamic. Casts of
the edentulous arches only represent the oral
contours at the time the impressions were made
and the accuracy of the tray. Articulators can
only represent mandibular movements, they cannot
duplicate them.
Wet the dentures. Seat the dentures firmly in the
mouth. Have the patient close together.
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Clinical Evaluation of the New Prosthesis
(Maxillary Denture Retention is checked by
pulling downward with two fingers.)

• Should resist displacement.

• A drop indicates trapped air under the denture
  base.

• Likely caused by overextension.

• Could cause ulceration within a matter of hours
  or days.

• Denture may drop when smiling or opening the
  mouth widely.

After you evaluate the retention, have the
patient try to remove them. Then instruct the
patient to slip the finger along the buccal
corridor and break the air seal.
20
Retention of the Mandibular Denture
(Push gently against denture with tongue at rest position.)
The retention of the lower denture is assessed
by gently pushing it posterior against the facial
surfaces of the mandibular incisors. The denture
should not become dislodged. Pressure
indicator paste should be used to recheck the
adaptation to the bearing tissues of both upper
and lower prostheses, even if retention seems
acceptable. Small areas of excess pressure can
disrupt occlusal harmony or lead to ulceration
that erodes patient acceptance of the prosthesis.
21
Adjustment of Tissue Surfaces
Pressure indicating paste (PIP)

• A handy brush is used to wipe on the paste.
• A disposable syringe will make application
  easier.
• PIP spray or mouthwash is used in xerostomia
  patients to prevent the PIP from sticking to the
  mucosa.

22
Adjusting a Denture
A
B
A. Paint a thin, even coat of PIP on a dry
denture surface with a bristle brush. B. Brush
marks will show areas that are not in contact,
smudged areas indicate contact with the
underlying tissues. Smudged areas over undercuts
in displaceable soft tissue are not reduced as
they would likely break the seal.
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Adjusting a Denture
D
C
C. Adjust pressure areas, wipe off, add more,
adjust, etc. Adjust sparingly, as the impression
is expected to have been very accurate. Do this
until the pressure is evenly distributed over the
entire tissue surface of the denture. D. Expect
to see contact spots in palatal seal area. These
are desired and should not be adjusted unless
they are excessively heavy.
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• This area is adjusted with an acrylic bur.

When completed, the brush marks are mostly
absent and the posterior palatal seal bead is
showing. Pay particular attention to the
mylohyoid ridge area of the lower denture and the
tori of a maxillary denture.
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Adjustment (Max.)
Areas routinely relieved

• Retrozygomatic prominence
• Midpalatal suture groove
• Buccal notch
• Incisive fossa
• Labial notch

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Adjustment (Mand.)
Areas routinely relieved

• Retromylohyoid flange
• Buccal Flange
• Lingual notch
• Labial notch
• Labial Flange

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Adjustment

• Denture flange

• Disclosing wax
• After denture can be inserted.

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Disclosing wax is used to check the length of
the denture borders. In this example it has been
placed in a disposable syringe. It is not the
same as PIP.

• Temper the wax in the syringe in a warm water
  bath.
• Apply disclosing wax to the dried denture border.
• Carefully insert the denture and mold the borders
  of the selected area.

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Disclosing Wax
A
B
A. Place the disclosing wax on the flange with
an instrument. B. Make sure there is adequate
thickness.
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Disclosing Wax
C
D
C. Start with maxillary anterior. D. Adjust the
area that is highlighted.
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Disclosing Wax
E
F
E. Continue with other areas and reapply until
all overextensions are eliminated. F. Dont
forget the buccal surfaces of flanges.
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G
H
G, H I. Continue with lower denture.
Especially check the lingual frenum area. This
area is the most common problem area on a
lower denture. Also the retromyloid flange area
and the labial notch frequently require
adjustment.
I
33

• Other examples of commonly overextended areas

These flanges are too thick.
These flanges are too long.
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Finish the posterior border of the denture down
to blend in with the tissue of the soft palate.
Allow about 1-2 mm over-extension until the
patient has worn the denture for 24 hours.
2 mm
The palate is of even thickness and the posterior
palatal seal is beveled on the polished side
toward the tissue so that there is s 1-2 mm
overlap and it meets the tissue smoothly.
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Clinical Remount
(Best method)

• Make a new centric relation record and a
  protrusive record.
• Mount the dentures on the articulator using
  mounting plaster.
• The maxillary denture is mounted using a
  remount index.
• Make sure the incisal guide pin is set on 0.
• Make sure the condyles are locked back in centric
  position.
• Set the lateral condylar guidance at 15 degrees.
• Mount the mandibular denture using the new
  centric relation record.
• Set the horizontal condylar guidance using the
  protrusive record.
• Judiciously grind, removing any interferences.
• Centric
• Lateral
• Protrusive

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The patient remount is done by making two bite
registrations, one in CR and one in protrusive.
A rigid bite registration material such as
compound is the preferred and the registration
should cover the entire arch. The patient is
instructed to bite down until they feel the first
contact, then stop. After the impression
material has set, it is removed from the mouth
and the dentures are mounted in centric relation.

37
When the mounting plaster has set, the lateral
condylar guidance is set by loosening the large
black nut on top of the articulator, moving the
condylar element to 15, and tightening the lock
nut. The horizontal condylar guidance is set by
loosening the condylar lock screw, freeing the
balls in their guides, and raising or lowering
the setting until all teeth are in exact contact
with the registration.
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The dentures are first adjusted in centric
occlusion.
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Adjusting in Lateral Excursions

• Working side prematurities
• Rule of BULL
• Reduce maxillary buccal cusps.
• Reduce mandibular lingual cusps.

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Adjusting in Lateral Excursions

• B. Balancing side prematurities
• Rule of BULL
• Reduce buccal inclines on upper lingual cusps.
• Reduce lingual inclines on mandibular buccal
  cusps.

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B
Then they adjusted in working and balancing.
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Finally, they are adjusted in protrusive.
43
Use thin articulating film to record the
contacts and the end of a large lab acrylic bur
to make adjustments. A smaller bur will make
potholes in the occlusal surfaces. A thicker
articulating paper will make multiple contacts
and it would be hard to determine just which
contacts needed adjusting. A piece of the onion
skin paper from between the pieces of
articulating film can be used to evaluate the
contacts.
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The dentures are adjusted in all excursions and
checked with thin onion skin paper to see if the
desired contacts are there bilaterally. After
the protrusive contacts are finalized, the
denture is again checked to see if the contacts
are still there in all other excursions.
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Patient Instructions
The patient is instructed to

• Wear dentures overnight the first night only.
• Wear dentures 4-6 hours for the first few days.
• Not wear old dentures if problems arise.
• Learn to keep tongue forward for retention.

• Remove the dentures at night and place them
  
• in water.
• Not attempt to eat big meal for first few days.
• Return for 24-hour appt.
• Return for 72-hour appt.

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Explain the use of a denture brush and denture
tooth paste.
Caution the patient against biting off foods
with the anterior teeth.
Explain the use of denture adhesives (creams,
powders) and their
qualities, advantages and/or disadvantages.
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The End