Kirkuk dentistry collage

COMPLETE DENTURE

Prepared by:Sanaa Salem Mohammed

Group D
Fourth stage

INTRODICTION
A complete denture is a mechanical object, much of which is
fabricated outside the dental operatory. Its specific fabrication,
however, is dictated by clinical facts, as outlined in instructions
provided by the dentist. This mechanical object must function in
a biologic atmosphere, and every effort must be made to assure a
harmonious relationship between the mechanical and the
biologic. The wax trial denture stage becomes a critical phase of
complete denture care in evaluating this relationship.

Trail denture

Preliminary insertion of complete denture wax up (trial denture)

to determine the fit, esthetics, maxilla mandibular relation.
Importance:
1-it is the last opportunity to evaluate many of the previous steps
already accomplished.
2-It offers an excellent opportunity for patient education and
facilitates the patient's acceptance of the finished prosthesis.
Objectives:
1-To check and verify the established maxilla mandibular
relationship.
 Verify that centric occlusion and centric relation coincide
 Test for the acceptance of the established vertical
dimension of
 2-To determine if the positions of the teeth and the contours of
occlusion the denture bases are compatible with the surrounding
oral environment.
3-To verify the occlusal plane level relative to the ala-tragus and
.interpupillary plane horizontally.
4-To verify tooth selection and arrangement for proper esthetics
and phonetics.
5-To make additional interocclusal maxilla mandibular records
if needed for further adjustment of the articulator e.g: protrusive
interocclusal record.

Three aspects must be considered in the trial visit

 The functional and aesthetic acceptability of the dentures,
according to the dentist (dentist's role).
 The functional and aesthetic acceptability of the dentures,
according to the patient (patient's role).
 The competence of the technical delivery (technician's
role).

Th try-in procedure:
Extra oral examination of the trial denture:
1-On the articulators.Maintaining the Virtical
dimension,firmly screwed.
2-The master cast. As the finished denture is processed on
the master cast. So the master cast should be: In good shape.
Free from air bubbles or scratches,wax debris which lead to
 improper adaptation of the trial denture bases leading to
false relationships.
3-The trial denture bases:round without sharp edges
4-The teeth. Select the proper shade
5denture occlusion.
Intraoral examination of the trial dentures to reduse the
cross contamination,it spread with antiseptic and washed by
water before insertion *Checking the trial dentures
separately a) Trying- in the upper denture b) Trying- in the
lower denture
*Checking occlusion dentures together
*Denture base extension , Retention , Stability, Height of
the occlusal plane.

Insertion of complete denture

A- Evaluation of the denture outside patient's mouth.

B- Evaluation of the denture inside patient's mouth.
C- Evaluation for occlusion.
D- Instruction to patient receiving dentures
We can explain them in simple 8 steps:
8 Step of Complete Denture Delivery step
1/ Adjust Denture base with PIP (spray water on tissue and
PIP prior seating)
 until heavy pressure on 1" molars causes no pain
  If no pain on heavy pressure, then discomfort while
chewing will be probably caused by tilting, twisting from
acclusion Step

2/ Denture peripheries with PIP (one quadrant at a time)

 until border molding doesn't displace denture or show
heavy burnthrough Step
3/ Occlusal Adjustment remount on articulator (AFTER
Denture Base adjusted)
 centric contacts on flat surfaces, middle of occlusal table
 minimize buccal cusp contacts should
 sound like loud knocking when centric contacts are even
 excursive contacts distributed, no bumps, jumps, light
anterior contacts Step
4/ Chewing Test & Rate :until no pain, looseness
 if problem, adjust occlusion until patient rates -95-100%
better
 Locate problem teeth, minimize contacts that are uneven,
heavy, buccal to ridge. Eliminate centric stops on inclines
 If patient not sure it's better, keep adjusting until – 90%
better, "You got it', that's much better! Step
5/ Check OVD, Esthetics & Phonetics Step
6/ Polish
 small areas, use Brasseler polishing points in clinic
 for final polish extensive areas
o disinfect, gloves off, take to lab
o clean pumice with liquid soap (emulsifies) on clean
ragwheel,
tin oxide on clean ragwheel, discard both ragwheels when
complete Step
7 /Care Instructions :verbal and written with pamphlet,
toothbrush, denture cup Step
8 /Recall/Follow-up: As soon as possible (within one day
suggested)
 Within 24 hours mandatory for immediate dentures
 Eliminate problems early happier, comfortable patients
 Dal 6 month recal
 Practice _yearlly recall

Adjustment of complete denture

Note the areas of excessive tissue pressure on the labial and

buccal slopes of the ridge. These are carefully adjusted with an
acrylic burr. When completed with this procedure most of the
brush marks should be obliterated and there should no areas of
our displacement noted. We are often able to adjust dentures
quickly in their offices to relieve discomfort and improve the
product's fit. New dentures commonly require a few adjustments,
and after some time has passed and the wearer's mouth has
changed, more adjustments are often needed.
Symptoms need adjustment are
A- Broken teeth
B- Chips or cracks
C- Difficulty chewing
D- Discomfort
E- Changes in your facial shape
F- Changes in the fit of your dentures
G- Pressure sores
H- Gum irritation
I- Oral sores (exacerbated, not caused, by dentures)

In principle, occlusal distrubances may be adjusted by:

The first most ineffective is to attempt to grind in the occlusion
while the dentures are in the patient's mouth. The mobility of the
denture bases on the supporting tissue does not permit evaluation
and identification of premature contacts in centric occlusion and
in tooth-guided excursions of the man- dible with any degree of
certainty. This is true even for the intraoral central bearing
device described by Marxkors? For direct adjustment of the
occlusion in the patient's mouth.
The second "reocclusion" of the complete dentures. In this
procedure, the polymerized denturesare not removed from the
original models, but are replaced on the articulator and the
occlusion is adjusted there. The results are imprecise, because
dimensional changes in the dentures appear to their full extent
only after removal from the models.' This is particularly true of
the maxillary denture.

The third and most effective alternative is remounting of the

temporarily inserted complete dentures. Transfer models are
prepared for the finished, polished pros- theses for this purpose.
After a new jaw relationship is recorded, the prostheses are
mounted in an adjustable articulator, an occlusal analysis is
performed, and the occlusion is adjusted in the articulator.the
best time for remount- ing. Lauritzen' recommends that the
patient wear the dentures for 8 to 10 days before remounting.
During this period, the prostheses can adjust to the supporting
tissues, and water uptake by the resin is essentially complete.

Occlusal adjustment in the centric occlusion We use fine-

toothed carbide burs for grinding porcelain teeth. We begin by
establishing the initial interfering contact in the retruded contact
position. For this pur- pose, we guide the incisal pin of the
articulator into con- tact with the incisal quide plate; the initial
interfering

Occlusal adjustment of tooth-guided protrusive movements

In the next step, the interfering contacts arising in a tooth-guided
protrusive movement are eliminated. An edge-to-edge position
of the anterior teeth is copied the articulator. This position is held
with the aid of protrusion screws and contact between the incisal
pin and the incisal guidance plate. The protrusion screws are
turned back in the direction of the retruded contact position,
millimeter by millimeter. If the anterior tooth relation permits,
only the central incisors should have contacts; if that is not
possible, the canines. Grinding adjustments may be done only on
the palatal surfaces of the maxillary anteriors or canines after the
edge-to-edge position has been left. If the complete dentures
have been set up with a horizontal overjet because of anatomical
conditions, anterior tooth contacts are not possible in a protrusive
position of 1 or 2 mm from the retruded contact posi- tion. The
contacts in such cases should be established through the
premolars (protrusive group contacts). Grinding of the protrusive
movement
is stopped 0.5 mm before the retruded contact position.

Laterotrusion movement on the working side contacts should

be created both frontally and between the buccal cusps of the
posteriors. For cosmetic reasons, anterior grinding in
laterotrusion should be carried out, if possible, only on the
lowers. Posterior occlusal adjustments are made only to non
occlusion supporting cusps.
Fine grinding and adjustments The incisal edges and occlusal
surfaces of all teeth are covered with abrasive paste.Tooth-
guided pro-trusive, laterotrusive, and lateral movements are
carried out in the articulator until these movements are soft,
smooth, and without interferences. The ground tooth surfaces
are smoothed with rubber polishers.As a final step, fine
adjustments are made in centric, until each pair of posterior teeth
holds slim stock sheets evenly and simultaneously.

Post insertion problems for complete

denture and solving

There is, inevitably,the potential for problems to arise

subsequent to the insertion of complete dentures. These
problems may be transient and may be essentially disregarded by
the patient or they may be serious enough to result in the patient
being unable to tolerate the dentures. Factors causing problems
may be grouped, essentially into four causes.
1_Adverse intra-oral anatomical factors ex: atrophic mucosa. 2_
Clinical factors ex: poor denture stability.
3_ Technical factors ex: failure to preserve the peripheral roll on
a master cast. 4_ Patient adaptation factors.
We can remember some of these problems and solvings:
The end