Chapter OneIntroduction to Prosthodontic

Prosthesis: “A prosthesis is an appliance which replaces lost or congenitally missing tissue. Some prosthesis restore both the function & the appearance of the tissue they replace, others merely restores one of these factors.

Introduction

Functions of teeth: They divide food finely so that a large surface area is available for

the action of the digestive juices. To assists the tongue & lips to form some of the sounds of speech. The teeth form an important feature of the face, and by supporting

the lips and cheeks enable these structures to perform their functions of manipulating the food & expressing emotion.

Dental Prosthetics: “It is art & science of providing artificial substances for one or more missing teeth and their assistant parts in order to restore lost natural functions, aesthetics, health & comfort.

Objectives of Complete Denture Prosthesis: Biological Objectives: Restore lost part. Restore aesthetics. Restore Physical & Mental Compartments. Restore Function. Restore Health.

Mechanical Objectives: It should be strong enough to withstand various natural stresses. The stresses should be uniformly distributed. It should be well retained. It should be stable in centric & eccentric. It should be so designed so that it can take full advantages of various

sources

Difference between natural teeth & artificial teeth: GENERALLY:

In natural teeth: the teeth are firmly rooted in the bone of the jaws, and in consequence they can incise, tear and finally grind food of any character .

In artificial teeth: They set on the gums & held their by weak forces, In addition they are subjected to powerful displacing forces, so their efficiency as a masticating apparatus is limited.

  AESTHETICALLY: Artificial teeth can be distinguishable from natural teeth, and in

many cases they can enhance the appearance of natural teeth were hypo plastic, grossly carious or unpleasantly irregular.

 

Steps in C.D. Procedure: Charting. Examination of the patient. Evaluation of the patient. Initial impression. Temporary base. Secondary impression. Permanent bases. Maxillary – Mandibular relation Selection of teeth. Arrangement of teeth Trial Insertion Post—insertion complaints

The Mucous MembraneTissue Compression:The varying thickness of mucous membrane

and submucous tissue covering the bones forming the palate and alveolar ridge results in the forces which are applied to the denture during mastication being transmitted unevenly to those supporting structures.

Chapter II: Applied Anatomy

 

The Alveolar Ridges: It must be remembered that edentulous alveolar ridges are not natural

structures. They are what are left of a bone after disease and surgery have been applied to it.

The alveolar ridges vary greatly in size & shape and their ultimate form dependent on the following factors:  

The degree of Calcification. The size of the natural teeth i.e. large teeth are supported by bulky ridges & vice

versa. The amount of bone lost prior to the extraction of the teeth. E.g. In diseases

such as Periodontitis. The amount of alveolar process removal during the extraction of teeth. Rate & degree of absorption. The effect of previous dentures. In this (a) Ill fitting dentures (b) Dentures occluding with isolated groups of natural teeth, may cause rapid

absorption of alveolar process.

Chapter 3 Impression Taking

Upper component.Denture bearing area which is basically

consisted of: Hard bony foundation. Soft tissue covering the bony

foundation. Peripheral seal.  

Anatomical Landmarks

HARD BONY FOUNDATION: The maxillary bony foundation constituted of the following: The palatine processes of the 2 “maxillae” anteriorly and the horizontal

plate of the palatine bone posteriorly. It also rests on the alveolar processes of the 2 “Maxillae” extremely right upto the tuberosity. Up to pterygo-maxillary fissure.  

Inter-maxillary suture: It runs along the sagittal plane anterior-posteriorly. Anteriorly it is

constituted by the palatine processes of the maxillae & posteriorly, by the horizontal plate of the palatine bone.

If this suture is excessively prominent & is usually refers as torus palatinus. Foramina: These are: Incisive foramina : it is located in the median sagittal plane in the maxilla.

(Anteriorly). Posterior palatine foramen: it is located one on each side in the region of the

palatal root of the 2nd molar tooth. Fovea Palatina: There are 2 tiny depression, located approximately 1/8th of an

inch or so from the posterior palatine border. (Vibrating).   

Soft tissue covering the bony foundation: The soft tissue that cover the bony

foundation has got the following feature: In the oral cavity, all the bony structures

are being covered by the mucoperiosteum (periosteum) toward the bony side, and mucous membrane toward the oral side; these 2 structures are separated from one another by C.T layer as to sub-mucous tissue.

Lower Component: It is also studied under the following

headings: Bony foundationSoft tissuePeripheral attatchment.

Bony Foundation: The mandible is composed of the body & the ramus. Body is the

horizontal portion of the mandible. It has the alveolar process which is distinguished from the basal bone by the attachment of muscles & other structures that lies in the vicinity of the mandible. All other structures are mobile in nature, hence the alveolar process or it’s remnants is the only structure available for bony support of the lower denture. The following anatomical Land Marks limits the alveolar process:  

Anterior Labial Section: Starting in the labial section, then is the attachment of mentalis

muscle and portion of orbicularis oris. Lateral to that there is depressor anguli oris (Triangular oris), proceeding laterally, a faint ridge starts taking shape which gets prominence more & more & proceeds posteriorly & ultimately become continous with the anterior border of the ramus. This ridge is called the external oblique ridge which give attachment to the buccinator muscle on the posterior aspects of the molar region, the attachment of the buccinator continous & the lingual half of it blends with the superior constructor of pharynx and the aponeurotic ptyregomandibular raphe limit the bony foundation.

Anterior lingual section: On the lingual aspect in the anterior section; there is a genial tubercle

which gives attachment to genioglossus & geniohyoid muscles. Laterally, In the curvature of the mandible, there is a vertical concavity for the sublingual gland.

Often times lingual to the cuspid, the bone is exostosed forming in an eminence, the torus mandibularis.

Posterior lingual section.

Posterior Limit: Posterior limits for lower denture is formed by the margins of

the external & internal oblique ridge.  Alveolar Process: It takes up varying shape in different individuals. Foramina: There are 2 foraminae, one on either side – The mental

foramen.  Soft tissue overlying the bony foundation:  Like the upper, the lower bony foundation is also covered by the

mucoperiosteum; here it also shows variation in thickness & quality.

The sub-mucous C.T. may be abundant in the anterior region & scanty in the region of the molar.  

The peripheral tissue: The structures laying at the border of the bony foundation have

already been enumerated. Any how they are: Labial fraenum Mentalis Buccal fraenum Depressor anguli oris Pterygo-mandibular ligament. Mylohyoid Palatoglossus

Ideal Impression material would be:- Non-injurios to the tissue. Capable of compressing the soft tissues to any desired degree

without it self being distorted. Sufficiently fluid on insertion to give accurate surface detail. Be able to produce accurately any undercuts which are

present. Have a pleasant taste, smell & appearance. Have No dimensional changes at Normal degree of tepreture

& humidity. Set, or harden at near mouth tempreture. Have a setting time under the control of the operator. Be capable of having additions made and of insertion in the

mouth without distortion. Have a simple technique. Be compatible with all materials in general use for model

making. Be cheap enough to use once only or capable of easy

sterilization if used more than once.

 The Primary Impression: Since this impression will not be used directly in the

construction of the denture but only for making a special tray for one individual mouth, the greatest possible accuracy is not required & it is therefore, possible to select a technique which is simple, quick & gives the P.t. the minimum of discomfort. For these reasons composition has been chosen as the impression material.

 Impression Trays: Impression trays are used as rigid containers for carrying the impression material into the mouth, for maintaining it in position during setting or hardening & supporting it during removal of the mouth & when casting the model.   The most common impression trays used are: Shellac or a similar propriety material Acrylic resin Tin-Lead alloy

Impression technique: Muco-compressive technique or muco-functional technique: In this technique the material are able to compress the tissue e.g. Composition. Waxes Harder type of C.P. Muco-static technique : This is the one in which the soft tissue are in no way compressed or

distorted & there for the impression material must flow readily & impose no pressure in the mucosa this technique is used for the final impression, the material used for this technique are:

Plaster of Paris Alginate (Irreversible hydrocolloid). Zn Oxide Eugenol (CAVEX). Gutta Percha Rubber base material Selective impression technique or Combination of I & II – These areas

which are soft, flabby, bulbous are recorded in mucostatic and bony hard is recorded as muco-functional. Materials: Pastes e.g. Plaster Splint. Soft areas are painted with plaster material. When set the tray is loaded & inserted in the mouth. 1st material act as splint.

Modified Turner-Tuller technique. Splint method

 Objectives Of Impression: The five objectives of an impression are to provide:

Retention Stability Support for the denture Aesthetics for the lips Maintenance the health of the oral tissues.

FINAL IMPRESSION :  Preparation of the temporary base for the secondary or final impression procedure: Before recording the final impression with a finer impression material the temporary bases or (special tray) are to be prepared for their accurate & adequate extension & proper value seals. Wax rim is attached on the temporary bases for the convenience of handling & also for utilizing & controlling the masticatory during the final impression procedure.

Impression Materials

Chapter 4

 ADVANTAGES: It produces excellent surface detail. It is dimensionally accurate if used with anti-expansion solution. It does not distort on removal from the mouth, but fractures if deep undercuts

exist. The rate of set is under the control of operator (4 minutes). It is compatible with all materials commonly used for making models (CASTS). It is cheap. DISADVANTAGES: It can not be used for compressing the tissue. In very wet mouths the surface of the plaster tends to be washed away spoiling

the surface detail. It can not be added if faulty It is disliked by many patients. INDICATIONS FOR USE: In all normal mouths when the factors affecting retention are favourable. Whenever excessive flabby tissue covers the ridges.

PLASTER OF PARIS

ADVANTAGES: It produces excellent surface detail. It is dimensionally accurate “STABLE” if casted within a

short time of removal from the mouth. It is elastic so can record undercuts. In wet mouth it does not lose surface data. DISADVANTAGES: It can not compress the tissue. It can not be added if faulty. Distortion may occur. INDICATIONS FOR USE: Whenever there are undercuts In mouths with excessive flow of saliva.

SODIUM ALGINATE

ADVANTAGES: It produces excellent surface detail. It is dimensionally accurate if used in a thin layer. It is hygienic. It does not lose surface detail in wet mouth. It can be added to & re-adapted if faulty. It can be used for compression soft tissue.  DISADVANTAGES: It can not be used when more than a slight undercut pre-set As it set rapidly (3 ½ - 4 minutes) so, used as wash material. Some patients are allergic to it.  INDICATIONS FOR USE: As a final wash impression material. In cases exhibiting pronounced nausea.

ZINC OXIDE & EUGENOL PASTE (CAVEX)

ADVANTAGES: It can be used for compressive soft tissue. It can be added to & re-adapted. It can be used for any technique. It can be used in combination with other materials.  DISADVANTAGES: It distorts easily & should not be used in undercuts. It does not reproduce fine surface details. As it can be re-softened & used again it tends to be un-hygienic because it can

not be sterilized easily without destroying it’s properties.

INDICATIONS FOR USE:  For compression impression. As a base in wash impression technique. To obtain the maximum peripheral seal. As a first impression for the construction of special trays.

COMPOSITION: (IMPRESSION COMPOUND)

 Chapter 5: Recording the position of

Centric Occlusion OR Maxillo-Mandiular Relations

 The Maxillo-Mandibular relations

There are three relationships of mandible to maxilla: With the teeth in centric occlusion. With the mandible in it’s rest position, when the teeth are always off of

contact (relaxed relation). The dynamic relationship of the jaws during functioning.

 Centric occlusion The maxilla is firmly united to the skull & only moves with this structure.

The mandible is attached to the skull by the 2 temporomandibular joints & is capable of opening, closing, protruding, retruding & laterally movements. The mandible is prevented from overclosing by the occlusion of natural teeth, and it is also necessary to retract the mandible at the conclusion of all functional movements. This relationship is termed as centric occlusion.

OR The harmonious inter-relationship of opposing teeth when the maxillary &

mandibular teeth are in occlusion is referred to as CENTRIC OCCLUSION.

 Relaxed position Or Rest position: When the mandible is not functioning & provided the subject is not

in a state of tension. In this relation the heads of the condyles are fully retruded in the glenoid fossae to the extent that will allow freedom of lateral movements & the occlusal surfaces of the teeth are separated by 2-3 mm. this is rest position. The Term relaxed relation is also commonly used for any relationship of the mandible to the maxilla from this rest physiological rest position upto but not including contact of the teeth.

 The Functional Relation: When the occlusal surfaces of the teeth makes eccentric contact

during function, the cusps & incisal edges of the mandibular teeth slide up the cuspal lines of the maxillary teeth, Thus the mandible flow, definite paths dictated by the guidance it receives from the condylar path posteriorly & the cuspal slopes & incisal edges anteriorly.

THE VERTICAL DIMENSION: There is normally a gap of 2-3 mm between the occlusal surfaces of the teeth

when the mandible is in the rest position & this gap is called the Freeway space, probably the best technique is to record the rest position with the rims in contact & then remove the thickness of the desired freeway space from the occlusal surface of the lwer block.

Many aids are available to help in obtaining the vertical dimension: Freeway measurement: The technique is split up into stages for easy of description: Make a thin horizontal line or pin-head sized mark on the tip of the patient nose

& another on the point of his chin. Seat the patient in the chair & ask him to relax his body as completely as

possible & allow his jaw to rest in a comfortable position with the lips closed. When this position is achieved measure the distance between the marks either with a pair of dividers or a millimetre rule.

Ask the patient to moisten his lips with his tongue & then close them to a comfortable position, check the measurement previously obtained.

Ask the patient to swallow & relax without separating the lips. Again check the measurement.

VERTICAL RELATION

Ask the patient to repeat the letter “M” several times, again check.

Any, or all, of these methods of obtaining a relaxed position must be repeated until at least 3 constant readings are obtained.

Insert the record blocks & trim the occlusal surface of the lower until it occludes evenly with that of the upper, when the distance between the marks is that of the constant reading.

Produce a freeway space by removing a further 2 or 3 mm from the lower record rim.

Check the existence of this freeway space by asking the patient to relax with the records blocks in his mouth & his lips closed. Then ask the patient to close the blocks together, where a slight but definite movement of the chin will take place if there is an adequate freeway space.

Willis’ measurement: It is easy to take these measurements with accuracy on a two dimensional

drawing. The theory of this measurement is that the distance form the lower border

of the septum of the nose to the lower border of the chin is equal to the distance from the outer canthus of the eye to the corner of the relaxed lips in each case with the mandible in it’s position of rest with the teeth out of occlusion.

Ridges’ Relationship: Sears suggests that an indication of the correct vertical height can be

obtained from the parallelism of the upper & lower posterior ridges. Excessive divergence from the parallel, seen when the models have been set on an articulator, indicates that the vertical height is probably wrong & should again be checked.  

Occlusal vertical: When the mouth close, the freeway space is eliminated. This is called occlusal vertical.

Inter-occlusal or Freeway space: Is the distance or gap existing between upper/lower teeth. When the mandible is in physiological rest position.

Denture space: The portion of the oral cavity which is occupied by maxillary & mandibular denture.

INCORRECT VERTICAL DIMENSION EFFECT OF EXCESSIVELY INCREASING THE VERTICAL

DIMENSION:  Discomfort: Due to increase height, the patient feel discomfort when

eating. Trauma: The jarring effect of teeth may also cause pain owing to bruising

of the mucous membrane by these sudden & frequent blows. Loss f freeway space: This may have several effects one of which is nearly

always annoying from the inability to find a comfortable resting position. Other may be trauma cause by constant pressure on the mucous membrane, and muscular fatigue of the muscles of mastication.

  Clicking teeth: Due to greater vertical height, the opposing cusps

frequently meet each other producing embarrassing clicking or clattering sound.

Appearance: It leads to elongation of the face, & at rest the lips are parted.

EFFECTS OF EXCESSIVELY REDUCING THE VERTICAL DIMENSIONS:  Inefficiency: The pressure which is possible to exert with teeth in contact

decreases because the muscles of mastication are acting from attachments which have been brought closer together.

Cheek bite: In some cases where there is a loss of muscular tone, flabby cheeks tends to become trapped between the teeth & bitten during mastication.

 Appearance: The patient looks older, i.e. there is closer approximation of nose to chin, the soft tissue sag & fall in, & the lines of the face are deepened.

Soreness at the corners of the mouth (angular cheilitis).  This results from falling in of the corners of the mouth beyond the

vermilion border & the deep fold thus formed becomes bathed in saliva which may become in fact resulting in soreness.

 Pain in T.M.J Costen’s syndrome: It consists of: Mild catarrhal deafness & dizzy spells Tinnitus Tenderness over the T.M.J Various neurologic symptoms such as burning

sensation of the tongue, throat & side of the nose, head pain. Dryness of the mouth.

Is the relation of the mandible to maxilla in horizontal direction when mandible is in rest position condyles are in there most rtruded unstained position in the glenoind fossa.

It is alos referred to as the anterior-posterior relationship.

THE HORIZONTAL RELATIONSHIP

FUNCTION OF THE RECORD BASES: Registration of correct facial contour & profile. Determination of correct occlusal plane. Determination of correct & proper degree of jaw vertically Registration of correct centric jaw relation. Registration of eccentric movements (lateral &

protrusive). Registration of orientation relation (face bow). Making position of : Cuspids High lip lineLow lip lineCentral line

FACE BOW

FACE BOW:-  Is a device which serves the purpose of measuring the

positional relationship of maxillary ridge or teeth to middle of glenoid fossa or base of skull.

It consists of a metal bow (A), carrying at it’s extremities two gradual rods (B), which slide inwards & outwards for adjustment, & may be fixed by tightening the finger screws (C). The rods bear at their inner ends 2 cups, (D). A flat metal fork (E), is attached to a rod (F), which is united to the centre region of the bow through the agency of a universal joint, (G). This joint (G) can slide along, & rotate around the bow & may be fixed when required by tightening the finger screw (H).

Chapter 5: Selection And arrangement of teeth

Selection of teeth: It is important that the selection of artificial teeth must re-establish, (to the fullest

degree possible), the functions of the loss natural teeth & make a pleasing restoration of facial & oral appearance.

  Objectives: There are two basic objectives of artificial tooth selection i.e.: To chose artificial teeth that will fulfil the aesthetic requirements of the patient. To chose artificial teeth that will meet the functional requirement of the patient.  Aesthetics:- Aesthetic tooth placement & physiological tooth arrangement are biologically

compatible & desirable as end product of proper complete denture construction.  Definition: As the cosmetic effects produced by dental prosthetics which affects the desirable

beauty, attractiveness, character & dignity of individual.

Selection of anterior teeth: The factors that guide the selection of teeth are: Size of he teeth Form of the teeth Colour of the teeth Material of the teeth The occlusal rim should by 1/16 inch or 1—2mm below the lower border of the

upper lip. Size of teeth: The size of the tooth must conform the proportion of the face i.e. square tapering &

ovoid faces may be short, medium or long and also narrow or wide within each classification.

The factors controlling the length of the tooth are: High lip line Low lip line Ridge relationship Inter-ridge space The factors that govern the width of the artificial teeth are: Proper position of cuspid in relation to the angel of the mouth (Cuspid Line) Breadth of the face A balance or harmony with the length of the face.

Selection of teeth can be divided into: Selection of anterior teethSelection of posterior teeth

Selection of Posterior Teeth: The Main or Major functions of Posterior teeth are: Mastication Support of buccal tissue Aesthetics (Posterior facial contours). Health of other oral tissue. Posterior teeth should be selected for: Colour Length (occluso-cervially). Width (mesio-dital)Width (Bucco-lingual). Cuspal inclinationMaterial (Porcelain or acrylic

THE UPPER ANTERIOR TEETH: The labial surface of the upper anterior teeth should be the same as the labial

surface of the upper wax rim as trimmed and adjusted in the P.t’s mouth. As such, the incisal edge of the upper central incisors will be 1/4th -1/2 an inch in front of the incisal papilla.

The mesial surface of the centre incisor should coincide with the medium sagittal plane which in about 90% individual is inclined with the upper labial fraenum.

The upper central incisor should have a labial inclination or it may be vertical. The upper central incisor is set with the long axis of the labial surface vertical

given a slight mesial inclination toward the middle line. The contact point of the central incisor should coincide with the mid-line of the face. The incisor edge of the tooth should touch the occlusal plane.

The lateral incisor should have a labial inclination or it may be vertical. The tooth is given a mesial inclination toward the median line. It is set slightly inward at the neck (i.e. more depressed at the gingival 1/3 than that of upper central incisor). It is incisal edge will not touch the occlusal plane but remain about a millimeter above it.

The upper canine should be vertical (Never labial inclination) with varying mesial inclination but never a distal inclination. The tip of the upper canine should touch the occlusal Plane.

  ARRANGEMENT OF TEETH FOR C.D. PROSTHETICS GENERAL PRINCIPLES OF SETTING THE TEETH

THE UPPER POSTERIOR TEETH:   The upper 1st & 2nd premolar should be vertical or with a slight buccal

inclination. The buccal surfaces of bicuspids should be so arranged that the palatal cusp should be kept as close to the crest of the ridge as possible. Maximum convexity of the buccal surfaces form a straight line with the maximum convexity of the labial surface of the cuspid. There occlusal plane relationship should be such that the buccal cusp of the 1st bicuspid & both the cusps of the 2nd bicuspid should come in contact with the occlusal plane.

The first molar is also arranged in a similar manner as the bicuspid. Slight buccal inclination may be given & the buccal surfaces should be so arranged that palatal cusp is kept as close opposite to the crest of the alveolar ridge as possible. The maximum convexity of the buccal surface of the mesio-buccal cusp should be aligned in the line of the cuspid & bicuspid. Mesio-distally; the tooth has a slight disto-buccal inclination, Occlusal plane parallel to the mesio-palatal cusp, all other cusps are out of contact with the occlusal plane.

The 2nd molar is also arranged in a similar manner.

THE LOWER ANTERIOR TEETH: The lower central incisor are set with the incisal edge touching

the palatal surface of the upper central incisor about 2mm. palatal to the incisal edge. The long axis of it is labial surface should be set vertically but slightly inward at the neck.

The lower lateral incisor is set in such a way so that it is long axis is slightly inclined ditally (i.e. mesial inclination) & inward at the neck. This inclination should not so pronounced as that of the upper lateral incisor.

The lower teeth should have a slight labial inclination, there should be a slight mesial inclination. There should be an overbite as advised & by the pt. It is preferable to have overjet (2mm.) & the lower anterior teeth out of contact with the uppers.

The lower canine is set with it’s long axis very nearly vertical with only a very slight mesial inclination. The tip of the lower canine should articulate in the space between the upper lateral & cuspid. The lower canine should never have a buccal inclination.

The important key point in the arrangement of lower anterior teeth is the lower canine. It’s distal surface should never end beyond the tip of the upper cuspid.

THE LOWER POSTERIOR TEETH: The lower premolars should have a slight lingual

inclination. They may have a slight distal inclination. The lower 1st molar is also lingually inclined. Mesio-

distally it’s vertical. The lower 2nd molar is lingually inclined. Mesio-

distally it has a mesial inclination. The bucco-lingual width of the lower posterior teeth

should be such that there is no overhanging on the tongue. The buccal cusps of lower posterior teeth are functional cusps. Hence they should be located as close to the crest as possible.

Chapter 6: Anatomical Articulation

Advantages of anatomical articulation: Balanced occlusion: In any Position of occlusion, the

maximum No. of teeth are in contact. Stability: Since the maximum No. of teeth are always in

contact, tilting of the denture is less likely to occur, & cuspal interference is eliminated.

Reduced trauma: Since there will be no tilting of the denture, & the masticatory pressure will be disturbed as evenly as possible, the minimum amount of damage will be done to the supporting tissue.

Functional movement: It will allow a continuation of normal masticatory movements.

Efficiency: Grinding & cutting of food stuffs are possible because lateral & protrusive movements can be made whilst still maintaining balanced articulation.

Time Saving: Balanced articulation have been obtained by the technician in the Lab. There remains only minor spot grinding to be done & thus a considerable amount of time is saved.

Definition: Balanced articulation means an arrangement of the teeth so that in any

occlusal relationship as many teeth as possible are in occlusion, & when changing from one relationship to another they move with a smooth, sliding motion, free from cuspal interference & maintaining even contact.

  In order to achieve this, Four thing are needed:   An articulator which can be adjusted copying the movements &

reproducing the relationship of the jaws of the patient. (anatomical articulator).

A means where by these movements & relationships can be measured & transferred to the articulator. “Recording jaw relationship”.

An understanding of the factors which influence the arrangement of teeth to produce balance. “Factors influencing balance”.

Posterior teeth with cusp angles which will permit of their being set-up to give balance articulation. “Teeth for anatomical articulation”.

Balanced Articulation

Chapter 7: Trial Denture or Try-in Stage

Objectives: Trial is done for the following reasons: To verify max-mandibular record. To determine the contour of the teeth. To evaluate arrangement for facial aesthetics. To make any inter-occlusal maxillary-

mandibular adjustment if needed.

The Upper denture by itself: Peripheral outline: Buccal & labial Posterior Border Stability to occlusal stresses

Both Dentures together Check: Position of occlusion: (Maxillary-Mandibular Relationship): Horizontal relationship Vertical height Evenness of occlusal pressure Balanced occlusion

Appearance: Central Line. Anterior Plane Shape of the teeth Size of the teeth Shade (colour) of the teeth Profile Amount of tooth visible Regularity of the teeth Approval of appearance by the patient

Phonetics

Trying-in the lower denture by itself: Place the denture in the mouth & seat it on the ridge. Check the peripheral outline: The entire periphery should be checked to ensure that it is not over or under extended. The buccal & labial periphery: Hold the denture in place with light pressure on the occlusal surface & move the

cheek in a motion similar to that which it makes when chewing (upward & inward). Now relax the pressure on the teeth & observe if the denture rises from the ridge, if it does, trim the periphery where it seems to be extended until little or no movement occur.

The buccal fraena should have adequate clearance. The Lingual periphery: Hold the denture in place with light pressure & ask the patient protrude his tongue

sufficiently to moisten his lips. If the denture lifts at the back; it is over-extended in the region of the lingual pouch.

Next ask the patient to put the tip of his tongue as far on his palate as possible. If the denture lefts in the front it is overextended anteriorly, probably in the region of the lingual fraenum, such overextension must be relieved.

Posterior extension: Ensure that the heels of the lower denture are extended as high up the ascending ramus

of the mandible as possible. Under extension: It is important that the periphery should not be under-extended since dentures must

covers the greatest possible area if maximum retention & stability to be obtain. Check the stability under occlusal stresses: Apply pressures with the ball of the fingers on the premolar & molar region of each

side alternatively. This pressure must be directed at right angles to the occlusal surface. If pressure in one side cause the denture to tilt & rise from the ridge on the other side, It indicates that the teeth on the side on which pressure is applied are out side the ridge.

Tongue space: Natural teeth occupy a position in the mouth where the inward pressure of the cheeks

& lips is equal by the outward pressure of the tongue, & it is into this zone of natural pressure that the artificial teeth must be placed.

Chapter 8: Fitting the finished dentures OR Delivery of Denture

Psychological Aspect: Before the patient is permitted to use the new denture, carefully

check for: Retention Stability Aesthetics Tissue surface for irregularly Relief area (Fraena) Post dam area Occlusion  The patient should be able to: Open wide Smile Swallow Wet his lips Speech properly

Instructions to the Patients: The patient should tell what to expect: Feel strange Excessive salivation Difficulty in speech Biting of Tongue & cheek TendernessWhat patient should do? Less occlusal load: Stress the limitations of artificial denture. It can take 1/10 of natural teeth and

cut small pieces of food & chew in both sides.

 Cleaning: Whenever possible, dentures should be removed after every meal & food

debris washed away. Or at least clean the denture twice a day as: Calculus & debris hurt the patient mechanically. Bacteria in calculus or plaque hurt the patient chemically through their toxins  So, the denture should be thoroughly cleaned with a soft brush and soap or

any recognized brand of denture cleaners e.g. steradent (Talecum or powder in water & put the denture in it for whole night).

Chapter 9: Post-insertion Complaints

Most complaints will fall under one of the following headings, though frequently a patient will have more than one complaints:

Pain Appearance Inefficiency Poor retention Instability Chattering teeth Nausea Discomfort Altered speech Biting the cheek & tongue Food under the denture

The EndDr.Fawaz Al Shorafat