PROSTHODONTICS III: COMPLETE DENTURE

MIDTERMS LESSONS
National University - College of Dentistry
Transcribed by: Laurence Andrei Fernandez
Professor: Dr. Dyna Jeanne Godoy

LESSON 1 • Radiation Therapy Tumors

INTRODUCTION TO PROSTHODONTICS • Grossly Maligned Teeth
• Iatrogenic Extractions
DEFINITION OF TERMS • Congenitally Missing Teeth
• Prosthetics – is the art and science of supplying • Failure to Erupt
artificial replacements for missing parts of the
human body. POSSIBLE SEQUELAE OF TOOTH LOSS
• Prosthodontics – A branch of Dentistry that • Resorption – Remodeling of empty socket until it
pertaining to the restoration and maintenance of assumes the shape of rounded edentulous ridge.
oral function, comfort, appearance, and health of • Tilting – Leaning of tooth into edentulous space.
the patients. • Drifting – Bodily migration of the adjacent teeth into
• Prosthesis – is an artificial replacement of an the edentulous space resulting to gradual closure of
absent part of the human body. A therapeutic device edentulous space.
to improve or alter functions. A device used to aid • Occlusal Disharmony – Occlusal interferences
accomplishing a desired surgical result. resulting from combination of tilting and drifting.

BRANCHES OF PROSTHODONTICS TREATMENT OPTIONS

• Fixed Partial Denture – these are prosthesis that • Preserving and Prevention
are cemented to the patient, and they cannot be • Post and core/crowns
removed readily. • Implants
• Removable Partial Denture – these are prosthesis • Fixed Partial Prosthesis
that can be removed by the patients. • Casted Removable Partial Denture
- Complete Denture • Overdenture
- Partial Denture • Immediate Denture
• Implant Prosthodontics – Concerns the • Complete Denture
replacements of missing teeth and/or associated • Implant Retained Denture
structures by restoration attached to dental • Maxillofacial Prosthesis
implants. • Splints and Stents
• Maxillofacial Prosthesis- concerns with
restoration and replacement of stomatognathic and “Dentures should not look like dentures.”
associated orofacial structures with prosthesis that
may or may not be removed on a regular basis. LESSON 2
PHYSICAL AND BIOMECHANICAL CONSIDERATIONS IN
COMPLETE DENTURE PROSTHODONTICS
TYPES OF PROSTHESIS
• Denture – a prosthesis which replaces one or more TREATMENT OBJECTIVES
teeth and other related structures of the mouth. • Patient Education
o Depending on the edentulism and • Restorative Aesthetics
depending on whether your patient can or • Improvement of Mastication
cannot remove the denture your denture • Improvement of Speech
can classify into partial denture or • Function without Interferences
complete denture. • Preservation of Remaining Oral Structures
• Maintenance of the teeth and comfort of the mouth
REASONS FOR TOOTH LOSS • Maintenance of the health of the TMJ
• Traumatic Injuries • General Physical and Psychological Well-being of a
• Dental Diseases Patient
• Periodontal Disease
• Infections
• Cysts, Malignancies, Tumors
A dentist must determine patient expectations, and then
educate him in a factual manner on what can and cannot be PATTERN OF RESORPTION
achieved with CD treatment. • Maxilla – Upwards and Inwards
• Mandible – Downward and Outward
ESTHETICS = Pseudo Class III Appearance
• Restoration of the teeth and associated structures
can dramatically improve the esthetics of the face RETENTION, STABILITY, SUPPORT
by: • Retention – quality inherent in the prosthesis acting
✓ Restoring the esthetic natural display of to resist forces of dislodgment resistance to
the teeth and gums removal in a direction opposite that of its insertion.
✓ Restoring the lower facial height • Stability – Quality of a prosthesis to be firm, steady,
✓ Restores lip and cheeks fullness. or constant to resist dislodgment by functional or
✓ Fills out wrinkles and creases which were rotational stresses.
caused by tooth loss. (Aging = Anterior • Support – is the property which results or resist
Teeth) vertical movement or displacement of dentures
towards the basal seat area or tissue.
MASTICATION
• Patient to be able to chew again. The performance DISLODGING FORCES ACTING ON A DENTURE
of an artificial denture does not come anywhere • Act of chewing food.
close to that of the natural teeth. • Adhesive nature of certain foods
• Denture must be well-retained, well-supported, and • Gravity
stable to obtain best function. • Surrounding musculature
• Prematurities in occlusion of denture
DENTURES FROM A PATIENT’S VIEW
• Be comfortable. How are Denture Retained in the Mouth?
• Restore the ability to speak with confidence. *in complete edentulous patients
• Give esthetic smile. • Primary Retention – Obtained from the basal seat
• Allow patient to laugh. area by physical and mechanical means.
• Aid in chewing food. o Physical Means – adhesion, cohesion,
• Function without interference interfacial surface, tension, atmospheric
• Be retentive without adhesives. pressure, capillarity, gravity.
• Look natural and lifelike. o Mechanical Means – moderate, over-
denture attachment, implants, rubber
RESIDUAL ALVEOLAR RIDGE suction disc, suction chambers, magnets.
• Residual Ridge (RR) is a rounded structure that • Secondary Retention
plays a very important role in the construction of o Surrounding musculature
complete denture.
• Used to describe the changes which affect the FACTORS AFFECTING PHYSICAL FORCES
alveolar ridge following tooth extractions, which • Saliva
continues even after healing of the extraction o Quantity – adequate quantity of saliva is
socket (0.4-2.9 mm per year, with a mean of 1.36 needed for good retention: less retention in
mm per year); faulty dentures accelerate this dry mouth. (Xerostomia)
process. o Quality
▪ Serous Saliva: Thin water type
ATWOOD CLASSIFICATION FOR RESORBED RIDGE easily and help wet the denture
base.
▪ Mucous Saliva – Vicious and
adhesive
▪ Mixed Saliva – Has wetability
and adhesive; most ideal
• Surface Area
o The larger the surface area, the greater
the ratio.
 o Maxillary has a largest surface are than FACTORS AFFECTING SUPPORT
mandible. • Surface Area
• Intimacy Content • Nature of Supporting Mucosa
• Peripheral Seal • Impression Procedure
• Accuracy of Fit
SURROUNDING MUSCULATURES AFFECTING • Direct Bone Anchorage
RETENTION
• Cheek Muscles LESSON 3
• Lips DIAGNOSING THE EDENTULOUS MOUTH
• Modiolus
• Recording the general information.
• Tongue
• Recording the chief complaint and assessing
• Floor of the mouth
patient expectations.
• Soft Plate • Recording the relevant medical history.
• Masseter • Recording the current medication
• Neutral Zone • Recording the relevant dental history
NEUTRAL ZONE • Performing a thorough visual and manual
• Potential space between the lips and cheeks on examination of the mouth and head and neck
region.
one side and the tongue on the other.
• Performing radiographic information.
• Area where the forces and cheeks or lips are equal. • Referring for additional tests e.g., blood sugar,
• Potential denture space. urine.
• You should put pontics on the Neutral Zone. • Referring medical consultation.
• Referring to second opinion and opinion from other
FACTORS AFFECTING STABILITY dental specialists when indicated.
• Intimate Contact
• Discussion of diagnosis, treatment planning, and
prognosis of the patient.
• Residual ridge size and contour
• Finding the fees and obtaining a signed consent.
• Residual ridge quality
• Palatal vault THE FIRST MEETING
• Neutral zone and surrounding musculation. • Build mutual trust, understanding, and confidence.
• Flange shape and contour • Communicate in a simple and truthful manner.
• Occlusal factors • Use plain and simple languages which is easy for
the patient to understand.
• Abnormal ridge relationship
RECORDING GENERAL INFORMATION
REQUIREMENTS OF SUPPORT • Name
• Tissue capable of support should have certain • Age
features: • Race
o Should be firm, resilient tissue covered by • Sex
keratinized tissue and which is firmly • Occupation
• Address and Contact Number
attached to the underlying bone.
• Previous Dentist (If any)
o Tissue should be of uniform thickness.
o The underlying bone should be resistant to PSYCHOLOGICAL EVALUATION
resorption. • Determine the level of motivation.
o Is should be in the right angles or as near • House classification of (complete denture) patients
right angles as possible to occlusal on their personality.
surface. o Philosophical
o Exacting
o Indifferent
SUPPORTING AREAS OF THE DENTURE FOUNDATION o Hysterical
• All areas of the denture bearing and should o Skeptical
contribute to support except the relief areas. A. Philosophical
• Primary Stress Bearing Areas • Has the best mental attitude.
o Maxilla: Residual Ridge • Well-motivated and realizes his part in the
success of the denture.
o Mandible: Buccal Shelf
• Rational, sensible,
B. Exacting (Critical)
 • Methodical and precise → Diabetes Mellitus - must be taken into consideration
• Likes each step explained in detail, and especially if pre prosthetic surgery is planned.
occasionally proposes treatment alternatives, or → Cardiovascular Diseases and Disorder - Keep
makes severe demands. appointments short, antibiotic prophylaxis and
• Have some of the good attributes of the adrenaline - free anesthetics may be required for
philosophical patient. surgery, increased blood pressure is not a
Management: Extra care and especially patience. Must contraindication patient id under medication.
listen to their demand but not give in especially if → Diseases of the Joints - limited mouth opening, difficult
unreasonable. to record jaw relations.
→ Diseases of the Skin - mucosa can be extremely
C. Indifferent painful, and constant denture use might be
• May have questionable prognosis. contraindicated.
• Lacks motivation and is not very interested in the → Neurological Disorders - Bell’s palsy, parkinsonism;
treatment. difficulty in denture hygiene, requires assistance.
• Tries to find faults in the treatment and is likely to → Oral Malignancies - surgical removal of affected parts,
blame the dentist for any mishap; tend not to tissue changes, following radiation therapy; delay
cooperate or follow instructions. denture construction until tissues regain health.
Management: Identify such a patient treatment is started; → Transmissible Disease - through blood, saliva, sputum;
educate the patient, improve his interest. May postpone or tuberculosis, AIDS, Hepatitis, Herpes, etc.
refuse treatment, until some improvement is observed.
→ Psychological Disorders - Anxiety, Depression, or
Hysteria
D. Hysterical
• May be easily excited, highly apprehensive,
CURRENT MEDICATION
some being emotionally unstable.
• Insulin
• Rarely cooperates with dentists.
• Anticoagulants - aspirin, dicoumarol, coumadin
• Tend to have unfounded complaints and
• Antihypertensives - can cause dryness of the
unrealistic expectations.
mouth and postural hypotension.
Management: often requires
• Antiparkinsonism - Artane, norflex, akineton, can
cause dryness of the mouth.
E. Skeptical
• Corticosteroids -
• Has had bad results from previous treatment and
are rare doubtful if their problems can be solved.
DENTAL HISTORY
• Often have unfavorable conditions like severely
• History of tooth loss - poor ridges can be expected
resorbed ridges and poor health.
if tooth loss was due to periodontal disease; teeth
Management: Psychological management is as important
lost at different time intervals result to different
as the denture treatment: Genuine kindness, care, and
ridges level.
sympathy should be offered: more time and attention to
• Experience with old dentures
dental should be given to restore confidence in dentist.
• Edentulous period
CHIEF COMPLAINT AND ASSESSMENT PATIENTS
EXTRAORAL EXAMINATION
EXPECTATIONS
• Face
• Chief complaint (CC) should be recorded as far as
• Muscle tone and development
possible in the patient’s own words.
• Lips
o Reason for seeking prosthodontics
• TMJ
treatment - function or esthetic.
• Neuromuscular
o Patient expectations - assess whether
expectations are realistic or not; educate
A. Facial Symmetry, Form, Profile
patient and scale down expectations to
• Symmetric or Asymmetric
more realistic level.
Classification of Frontal Face Form
• Square
MEDICAL HISTORY
• Square tapering
• Determine any condition that might affect the
• Tapering
procedure and outcome of treatment.
• Ovoid
• Practitioner can be ready for any medical
emergency during treatment.
• Suitable precautions can be made to
decontaminate the operatory and prevent
transmission of diseases.
• Occasionally, patient may not be aware of his
condition.
Classification of Lateral Face Form • Uncoordinated jerky movements indicate difficulty in
• Straight jaw relation.
• Concave
• Convex INTRAORAL EXAMINATION
• Tongue
• Mucosa
• Floor of the mouth
• Maxillary tuberosity
• Hard palate
• Soft palate
• Arch relationship
• Arch form
B. Muscle Tonus
• Ridge contour
• House Classification
• Residual ridge size
o Class I: Normal tension, tone, and
• Inter-ridge
placement of the muscles of mastication
• Salava
and facial expression. No degeneration
• Undercuts
o Class II: Normal muscle function but
decreased tone
A. Arch Size and Form
o Class III: Decreased muscle tone and
• Size: Large, Average, Small
function.
• Form: Square, Tapered, Ovoid
▪ (Class 3) Usually accompanied
by ill-fitting denture, decreased
vertical height, decreased biting
force, wrinkles in the cheek.
drooline of commissure • Square arch is the best form to prevent rotational
movement.
C. Lips B. Residual Ridge Contour
• Measure from base of the nose to inferior part of • U-Shaped: Good prognosis. Supported by firm
the lip. keratinized mucosa, favorable for good retention
and support.
• V Shaped or Tapered: favorable prognosis.
Commonly seen in mandibular arch
• Knife Edge: poor prognosis, resorptive process
leaves sharp knife edge ridges. Usually seen in
mandibular
Lip Length
• Flat or Shallow Vault:
Short <18mm
Medium 19-22mm C. Mucosa
Long >23mm • Color
• Thickness
Lip Fullness • Conditions
Thin 6-10 mm
Full 12-20 mm D. Hard Palate
• Thin lips are very sensitive to small changes in the • Class 1: square
anterior teeth position, thick lips. • Class 2: Tapering or V shaped.
• Class 3: Flat
Lip Mobility
• Taut E. Soft Palate
• Incompetent House’s Classification
• Class I: The soft palate is almost horizontal curving
Lip (Smile) Line gently downwards.
• High (Gummy smile) • Class II: The soft palate turns downward at about
• Normal 45 angles from the hard palate.
• Low • Class III: The palate turns downward sharply at
about 70 angles to the hard palate.
D. TMJ Examination
• If pain or difficult to open the mouth
• Palpate the TMJ, check for tenderness, clicking,
crepitus.
 o Reduced - dry mouth or xerostomia;
F. Tongue reduces retention or denture; needs
• Size: Normal or large. salivary substitute or oral moisturizers.
• Position: Normal, Class I, Class II
• Mucosa Lesson 4
ANATOMICAL LANDMARKS
Tongue Size • Anatomy of Edentulous maxillary and Mandibular
• Normal Arches
• Large - after loss of teeth (especially lower • Anatomical Landmarks + Primary and Secondary
posteriors), the tongue may spread and en Stress bearing Areas on Edentulous Models

Tongue Position MAXILLA

• Class I: tongue lies in the floor of the mouth with Supporting Structures
the tip forward and slight below the incisal edges of • Residual Alveolar Ridge
the mandibular anterior teeth. • Maxillary Tuberosity
• Class II: The tip in a normal position but the tongue • Hard Palate (Palatine Vault)
is broadened and flattened. • Rugae Area
• Class III: the tongue is retracted. Limiting Structures
• Labial Vestibule
Management of Large Tongue
• Buccal Vestibule
• The occlusal plane may be lowered.
• Hamular Notch
• Use narrower teeth.
• The intermolar distance may be increases (within Relief Area
limits) • Incisive Papilla
• Grind off lingual cusps. • Median Palatine Raphe
• Avoid setting a second molar. • Labial Frenum
• Buccal Frenum
BULL RULE - Buccal Upper, Lingual Lower (To determine
• Pterygomandibular Raphe
the nonfunctional cusps)

G. Frenal Attachment
House Classification
• Class I: sulcal low attachment
• Class II: Midway between sulcus and crest of ridge
• Class III: Crestal or near crestal; high attachment
(near the crest or residual ridge or is at the crest of
the residual ridge)

H. Tori/Exostoses
• Palatal, Mandibular
MANDIBULAR
House Classification
Supporting Structures
• Absent or minimal
• Moderate • Residual Ridge
• Large • Buccal Shelf
Management: o Boundaries
• Large Torus - might interfere with retention - ▪ Anteriorly - Buccal Frenum
groove. ▪ Posteriorly – Retromolar Pad
• Small Torus - relieve.
▪ Laterally – External Oblique
I. Saliva Ridge
• Consistency ▪ Medially – Crest of the Residual
o Thin Serous: thin watery type that Ridge
spreads easily and help wetting the Limiting Structures
denture base. • Labial Vestibule
o Thick Mucus: more viscous and adhesive • Buccal Vestibule
o Mixed: Has wettability and adhesiveness
• Retromolar Pad
• Amount
o Normal – Ideal for denture retention. • Alveololingual Sulcus
o Excessive • Retromylohyoid Space
Relief Structures • Relief area; if not can lead to irritation.
• Labial Frenum • Can affect the denture seal and retention if close to
• Buccal Frenum the bridge.
• Lingual Frenum
• Mental Foramen Buccal Frenum
• Genial Tubercle • Maybe single or double, broad or fan shape.
• Crest of Ridge • Relief area.
• Mylohyoid Ridge
Labial Vestibule
• Provide valve seal.
• Affect appearance if not properly supported.
• Elastic so easily underextended or overextended.

Buccal vestibule
• Provide peripheral seal.
• Width affected by masseter muscle and
coronoid process.
Maxillary Residual Ridge
• Primary Stress Bearing Area
Coronoid process
• Has compact type of bone.
• Affect the maxillary buccal flange as the mandible
• Covered with fibrous connective tissue that is firmly
moves forward, side to side or opened wide.
attached.
• Can dislodge the upper denture if buccal flange is
too thick.
Rugae Area
• Secondary Stress Bearing Area
Masseter Muscle
• Should be recorded without pressure.
• Reduces mandibular buccal vestibule space
under heavy biting pressure.
Hard Palate
• Anterolateral (Fatty Zone) – Forms part of the
Pterygomaxillary notch
secondary stress bearing area.
• Marks the posterior limit of the denture
• Posterolateral (Glandular Zone) – Forst the part
• Additional pressure can be placed to produce a seal
of the secondary retentive area.
(posterior palatal seal)
Incisive Papilla
Pterygomandibular raphe
• Relief provided to prevent pressure on the
• Extend from the hamulus to the distolingual corner
nasopalatine nerves and vessels.
of the retromolar pad.
• Pressure can cause paresthesia, pain, burning
• Recorded when mouth is opened wide.
sensation and other vague complaints.

Palatine Fovea
Median Palatine Raphe
• 2 small indentations in the posterior palate near the
• Relief area due to very thin and non-resilient
midline
mucosa causing soreness or severe pain.
• Formed by the joining together of several mucous
• Can act as fulcrum point leading to rocking of the
gland ducts.
denture.
• Serves as a guide for the location of the position of
the border of the denture (usually posterior to the
Zygomatic Process (Malar process)
vibrating line is 2mm anterior to the fovea)
• Relieved when prominent to prevent soreness.
• Located on the first molar region.
Posterior Palatal Seal
• Area of between the anterior and posterior vibrating
Maxillary Tuberosity
line.
• Teeth are not set on the tuberosity region.
• Shape like a Cuspid’s bow
• Covered by impression.
• Additional pressure may be placed in this area to
effect a seal.
Labial Frenum
 • Posterior vibrating line marks the posterior limit of o From pre-mylohyoid fossa to distal
the denture.b end of mylohyoid ridge
Lower Residual Ridge o Allows room for the action of the
• Crest (secondary relief area, made up of cancellous mylohyoid muscle.
bone) o Flange height increased in this region.
• Slope (secondary stress bearing area, has thin • Posterior Region:
plate of cortical bone) slopes away from the tongue and towards the ridge
from post mylohyoid to retromylohyoidcurtain
Buccal Shelf Area
• Primary stress bearing area with dense Lingual frenum
smooth cortical bone. • Attaches the tongue anteriorly.
• Failure to relieve can cause soreness and
Mylohyoid Ridge dislodgement.
• Where mylohyoid muscle is attached affect the
height of the lingual flange. Genial tubercle
• Denture flange should extend below the • Prominent only in severe ridge resorption
ridge. • Relieve to avoid pain and soreness.
• If border rest above this ridge it may cause • Denture border should not rest on it.
displacement and soreness can cause irritation if
thin and sharp. Sublingual gland region
• Sublingual gland comes close to the crest of
Mental Foramen the ridge when floor of the mouth is raised.
• Relief area in cases of extremely resorbed ridges. • Affects the height of the flange.
• Pressure can cause numbness of the lip.
Posterior Palatal Seal
External Oblique Ridge • The seal along the posterior border of the maxillary
• Does not govern the extension of the buccal flange. denture.
• Buccal flange may extend up to or over it. • Functions:
o primary purpose: retention
Masseter Groove o serves as a barrier and prevent
Contraction of the masseter muscle pushes inward against food accumulation beneath the denture.
the buccinators muscle and affects the distobuccal o maintains contact with the moving
border of the lower denture. soft palate thus reduces gag reflex.
• Denture border must converge rapidly to o compensate for curing shrinkage.
avoid displacement. o reduces the tongue irritation as
posterior border merge better with palate.
Retromolar Pad • Post Dam:
• Forms the part of the valve seal area. o Anteriorly
▪ Anterior vibrating line
Retromylohyoid Curtain ▪ Shaped like cuspid’s bow.
• Limits the distolingual part of the denture flange. ▪ Located by Valsalva maneuver
• This is pulled forward when tongue is thrust out. or saying “ah” in normal fashion.
• Supported superiorly by the superior o Posteriorly
constrictor muscle and lingually by the anterior ▪ Posterior vibrating line
tonsillar pillar. ▪ Located by saying “ah” in normal
fashion.
Alveololingual Sulcus o Laterally
• Anterior Part: ▪ Pterygomaxillary seal
o Shallowest portion, from frenum to pre- ▪ Located behind the tuberosity.
mylohyoid fossa Ideal Maxillary Ridge
• Middle Region: 1. Sufficient Height
o Slope toward the tongue 2. Square arch
3. Palate U-shaped in cross-section
 4. Moderate palatal vault and reduces stress to areas susceptible to
5. Absence of undercuts resorption or pain.
6. High Frenum Attachment • Retention
7. Well defined hamular notches • Stability
Ideal Mandibular Ridge • Support
1. Well-defined Retromolar Pad • Esthetics
2. Blunt Mylohyoid Ridge
CLASSIFICATION OF IMPRESSION TECHNIQUES
Lesson 5 A. Based on theories of impression.
IMPRESSION MATERIALS USED IN THE MANAGEMENT • Pressure theory
OF EDENTULOUS PATIENT • Minimal pressure theory
Impression Materials
• Selective pressure theory
A. Preliminary Impression Material
B. Based on the position of the mouth while making the
1. Modelling Compound
impression.
2. Alginate
• Open mouth
B. Final Impression Materials
• Closed mouth
1. Plaster
C. Based on the method of manipulation for border
2. Zinc Oxide Eugenol Paste
molding.
3. Irreversible hydrocolloids
• Hand manipulation
4. Tissue conditioner
• Functional movements
5. Elastomeric impression material
Based on Theories Of Impression
Steps In Making Impression
A. Pressure Theory
1. Preliminary Examination of the Patient
• Aka Mucocompressive or Definite Pressure
2. Seating of the Patient
• Was proposed on the assumption that tissues
3. Selection of Tray
recorded under functional pressure (mastication)
4. Selection of Impression Material
provided better support and retention for the
5. Making Primary Impression for Maxillary and
denture.
Mandibular Arch
• Heavy bodied material (Impression compound)
6. Fabrication of custom trays
Advantage
7. Border Molding
• Better retention and support during occlusal
8. Making Secondary Impression for Maxillary and
functions like mastication
Mandibular Arch
Disadvantages
• Excess pressure could lead to increased alveolar
Position of the Operator for Maxillary Impression
bone resorption – loose denture.
• Always behind the patient.
• Excess pressure result in transient ischemia
• Use Vaseline in the corners of the mouth.
• Dentures which fit during mastication tend to
• Posterior to Anterior
rebound when the tissue resume to their normal
resting state.
Position of the Operator for Mandibular Impression
• Pressure on sharp spiny ridges or other bony areas
• In front of the patient
often resulted in pain.
• Anterior to Posterior
B. Minimal Pressure Theory
• Aka Mucostatic or Nonpressure or Passive
Note:
Technique
• 2-3 mm gap (Alginate)
• Interfacial surface tension was the only significant
• 5-6 mm gap (Modelling Compound)
way of retaining complete denture. Retention is
• 3-5 minutes with light finger pressure
achieved through accurate tissue adaptation.
• Covers firmly attached mucosa – shorter flanges.
IMPRESSION THEORIES AND TECHNIQUES
• Equal transmission of pressure to all part
Objectives of Impression Taking
Advantage:
• Preservation of the Alveolar Ridge – use technique
• Tissue health and preservation
that minimize the alveolar resorption; wilder
Disadvantages:
coverage, place greater load on tress bearing area,
 • Shorter flanges prevent the wider distribution of • Jaw Relation – border molding for final
masticatory stresses. impression with mouth closed clenched with
• Reduced coverage, reduced retention patient performing functional movement.
• Lack of border molding reduces effective peripheral • Time saving but overextension can be created.
seal therefore reduced retention.
• Short denture borders provoke irritation to the Based on the Method of Manipulation for Border
tongue. Molding
• Shorter flanges reduce support for the face which A. Hand Manipulation
affects the esthetics. • Border molding is done for impression is
• Shorter flanges, less lateral stability made with hands of the dentist.
• Patients with poor residual ridge were difficult to B. Functional Movements
treat. • Smiling, whistling, and puckering
C. Selective Pressure Theory motion - molds the labial and buccal
• Combines the principles of both pressure and borders.
minimal pressure technique. • Sucking motion – buccal frenum and
Zones of basal seat: buccal borders
a) Primary stress bearing area. • Licking the lips and other tongue
b) Secondary stress bearing area. movements – lingual border
c) Relief areas. • Swallowing motion – lingual border and
Advocates maximum extension within the comfort and floor of the mouth
functional limits of the surrounding muscle and tissue. • Occluding
• Opening and closing and side to side
movements of the jaw
Examination and Conditioning of the Patient and the
Mouth
• Complete Case History
• Thorough Clinical Examination
o Identifying and correcting adverse
conditions of the ridge.
o Identifying factors that can complicate
impression making (gagging, poor
neuromuscular condition, excessive
salivation)
• Thorough knowledge and understanding of the
Advantage:
anatomical landmarks.
• Considers the physiologic functions of the tissues of
the basal seat and therefore appears more sound
Selection of Impression Material
and appealing.
• Factors affecting selection.
Disadvantages:
o The theories of impression
• Some feel that it is impossible to record areas with
o Clinical finding
varying pressure.
o Experience of the dentist
• Since some areas are still recorded under
o Availability of the materials
functional load, the denture still faces the potential
• Patient Related Factors
danger of rebounding and loosing retention.
o Preliminary and final impression to be
completed in one visit.
Based on the Position of the Mouth while Making the
Impression
Classification of Impression Material
a) Open Mouth Technique – Impression are made
Based on Elasticity
with tray that is held by the dentist. Impression
• Rigid – ZOE impression paste, impression
made with mouth open wide.
compound, impression plaster
b) Closed Mouth Technique
• Elastic – alginate, elastomeric impression material
• Wax occlusal rims are made on preliminary
Based on its Prosthodontic Use
cast.
• Preliminary impression material
 o Modelling Compound – Impression Space Requirement for Impression Materials
compound, tray compound, stick
compound.
o Alginate - used both for preliminary
impression material as well as final
impression material.
• Final impression material
o Alginate
o Rubber base Fabricating Custom Tray Material Used:
o ZOE A. Self-Cured Resin
o Impression Plaster B. Visible Light Cured Resin
o Waxes C. Shellac
D. Vacuum Formed Tray
Classification of Impression Trays
Based on Fabrication BORDER MOLDING
A. Stock Tray • The shaping of border areas of an impression tray
B. Custom Tray by functional or manual manipulation of the tissue
Based on Presence of Retentive Holes adjacent to the borders to duplicate the contour and
A. Perforated size of the vestibule.
B. Non-perforated • Determining the extension of a prosthesis by using
Based on Use tissue function or manual manipulation of the
A. Dentulous Trays – square cross section tissues to shape the border areas of an impression
B. Edentulous Trays – rounded cross section material.
C. Combination Trays (RPD) Methods of Border Molding
1. Functional Method - mold the borders in harmony
CUSTOM TRAY with the natural functional movements of daily life.
• Designed to provide more pressure in the primary 2. Manual or Digital Manipulation - which simulates
stress bearing areas and little or minimal pressure the muscle action. Digital(finger) manipulation of the
in the non stress bearing or relief areas by cheeks and lips.
constructing the tray with wax spacer. 3. Combination - combination of digital and functional
Marking the Cast: movements.
• Blue – tray outline
• Red – depth of vestibule (tissue outline) Maxillary Border Molding
Custom Impression Tray Design A. Labial Frenum and Labial Flange
• Well adapted to tissues with only slight wax B. Buccal Frenum and Buccal Flange
blackout of undercut to allow for consistent and C. Coronoid Notch
repeatable seating. - To open mouth wide
• 2-3mm thickness - More of the jaw from side to side
• Border extensions should be 2-3mm short of the D. Posterior Palatal Seal
depth of the vestibule when tissues are at rest.
• Handle design should not impinge on the vestibule
nor distort the lips.
• Finger rests in the 2nd premolar to 1st molar
regions may be placed so that the fingers do not
distort the vestibule when border molding and
making the mandibular definitive impression.
Area “A”
• Instructing the patient to move mandible laterally
Wax Spacer and Relief
and anteriorly, pucker and smile.
Relief – reduction or elimination of undesirable pressure or
• Asking the pt. to open the mouth wide to record the
force from a specific region under denture base.
movement of coronoid process.
• creation of space in an impression tray for the
Area “B”
impression material
• Molded by inserting the patient to pucker and smile.
Area “C” – Anterior Area
• Massage the upper lip with a lateral motion.
• Instruct the patient to pucker and smile.
• Check the flange thickness for proper lip support.
• Do not pull down on the lip. This will foreshorten the
denture flange.
Area “D” – Posterior Palatal Seal
• Place 2-3mm of compound on top of the tray in a
butterfly configuration to displace the tissues in the
posterior palatal seal area. • Area “A” is molded and defined by massaging the
• Seat the tray firmly. After the tray has been in cheek and having the patient pucker and smile.
position for 10 seconds, ask the patient to swallow. • Area “B” is molded by asking the patient to
carefully close their mouth while holding the tray in
Test for Peripheral Seal position, resisting the closure with your forefingers
• Pull on the tray handle to test retention. If retention on the finger rest.
is lacking, check the following: • Area “C” is molded by gently massaging the lower
o Check buccal pouch, hamular notch, and lip. Do not pull up the lip for it will foreshorten the
posterior palatal seal area. labial vestibule.
o Check the length and thickness of the • Area “D” is molded by instructing the patient to
denture extensions. push their tongue against your thumb placed in the
Border Molding Cut Back lower incisor area.
• If retention is adequate, you are ready to cut back • Area “E” is molded by instructing the patient to
the compound. push their tongue against your thumb placed in the
• Scrape away a thin layer of compound from the lower incisor area and to swallow.
border molded periphery. This will create space for • If the retention is adequate, you are ready to CUT
your impression material and avoid excessive BACK the compound.
tissue displacement.
• The areas of the periphery overlying the frenum FINAL IMPRESSION
should be relived more aggressively.
Purpose of Vent Hole/ Scape Holes:
• To permit proper seating of the loaded master
impression tray while making the final impression.
• To relieve the pressure over the incisive papilla and
the rugae/ reduce the build-up of hydrostatic
pressure and facilitate the escape of the material.
• To prevent entrapment of air bubbles in the
impression.
• 2mm diameter at 10mm interval, 2mm short from
the border.
Apply Tray Adhesive
• Apply a thin layer of tray adhesive and permit it to
dry. Note that adhesive is applied 2-3mm onto the
external border of the tray.

Mandibular Border Molding

A. Labial Frenum and Labial Flange
B. Buccal Frenum
C. Buccal Flange (Distal to frenum)
D. Masseteric Notch
E. Lingual Flange