24.refine denture setup

24. Refine Denture Setup24. Refine Denture Setup

John Beumer III, DDS, MSJohn Beumer III, DDS, MSDivision of Advanced Prosthodontics, Division of Advanced Prosthodontics, Biomaterials and Hospital DentistryBiomaterials and Hospital Dentistry

UCLA School of DentistryUCLA School of Dentistry

This program of instruction is protected by copyright ©. No portion of This program of instruction is protected by copyright ©. No portion of this program of instruction may be reproduced, recorded or transferred this program of instruction may be reproduced, recorded or transferred by any means electronic, digital, photographic, mechanical etc., or by by any means electronic, digital, photographic, mechanical etc., or by any information storage or retrieval system, without prior permission.any information storage or retrieval system, without prior permission.

Refining your Denture SetupsRefining your Denture Setups

After try in of the trial denture, the denture setup must be refined so that minor discrepancies in occlusal plane, centric and bilateral balance etc., are corrected. The purpose of this section is to review the appropriate methods of refining your denture setups prior to processing.

Refining your Denture SetupsRefining your Denture Setups

Posterior tooth forms Lingualized Monoplane – neutrocentric Monoplane with balancing ramps Lingualized opposing monoplane Semi anatomic (20 degree) Anatomic (30 degree)

Check to see that the marks made previously on the casts indicating midline, crest of the ridge, and the retromolar pad are still present. These landmarks will be used to refine your denture setup.

MaxillaMidlineAnterior land

MandibleRidgeRetromolar pad

Refining your Denture SetupRefining your Denture Setup

Lingualized OcclusionLingualized Occlusion


Position the appropriate protrusive insert, and check to ensure that the Position the appropriate protrusive insert, and check to ensure that the incisal guide pin is set at zero and in contact with the incisal guide incisal guide pin is set at zero and in contact with the incisal guide table.table.

Lingualized occlusion


Anterior teethThe position of the maxillary anterior teeth were established at try in. Note that the maxillary anterior teeth follow the curvature of the arch.

Anterior teeth• Vertical overlap (1-2 mm)*• Horizontal overlap (1-2 mm)*

* The amount of overlap will vary depending on condylar inclination, occlusal plane and esthetics.



Ensure that the denture teeth are on plane. The plane of occlusion should Ensure that the denture teeth are on plane. The plane of occlusion should be parallel to the body of the mandible and extends from the incisal edges be parallel to the body of the mandible and extends from the incisal edges of the central incisors and the middle portion of the retromolar pads of the central incisors and the middle portion of the retromolar pads bilaterally. The appropriate Curve of Spee should be incorporated into the bilaterally. The appropriate Curve of Spee should be incorporated into the setup.setup.


Verify the position of the mandibular denture teeth.Verify the position of the mandibular denture teeth.• Make sure the posterior mandibular teeth are centered over the ridgeMake sure the posterior mandibular teeth are centered over the ridge

Verify centric and make adjustments as necessary. The lingual cusps of the Verify centric and make adjustments as necessary. The lingual cusps of the maxillary posterior teeth must rest in the central fossa of the opposing mandibular maxillary posterior teeth must rest in the central fossa of the opposing mandibular teeth. There should be no buccal cusp contacts of posterior teeth in centric or in teeth. There should be no buccal cusp contacts of posterior teeth in centric or in lateral excursion. lateral excursion.



Check centric from the lingual.


Verify working, Verify working, balancing and balancing and protrusive. Make protrusive. Make adjustments as adjustments as necessary. This is necessary. This is the working the working position.position.


In the anterior region there should be only In the anterior region there should be only light contact during lateral excursions.light contact during lateral excursions.


Verify working, balancing and protrusive. Make adjustments Verify working, balancing and protrusive. Make adjustments as necessary. This is the balancing position.as necessary. This is the balancing position.

Monoplane OcclusionMonoplane Occlusion



Monoplane occlusion


* The amount of overlap will vary depending on condylar inclination, occlusal plane and esthetics. If a neutrocentric concept of occlusion is used no vertical overlap should be incorporated into the set up.


Refining your Nonanatomic SetupRefining your Nonanatomic Setup

• Verify that all cusp tips except the lateral incisors and sometimes the cuspids, contact the plane of occlusion and check to see that the plane conforms with these landmarks. Make changes as necessary.• Midpoint of the retromolar pads and the edges of the central incisors• Plane should be parallel to the plane of the body of the mandible


Verify that the posterior mandibular teeth are centered over the crest of the ridge. Make corrections as needed.


Check the horizontal overlap of the posterior teeth. Make corrections by moving the maxillary posterior teeth.

Refining your Nonanatomic SetupRefining your Nonanatomic Setup Verify again that all the maxillary teeth, with the exception

of the lateral incisors and perhaps the cuspids, are on the plane of occlusion. Make corrections by manipulating the maxillary teeth. When you have completed this step, thoroughly cool the wax before proceeding to the next step.


Reestablish centric contactsReestablish centric contacts by by manipulating the mandibular manipulating the mandibular posterior teeth. Make sure that the posterior teeth. Make sure that the incisal guide pin contacts the incisal incisal guide pin contacts the incisal guide table when you have guide table when you have completed this step.completed this step. While While performing this step make sure you performing this step make sure you do not alter the horizontal overlap.do not alter the horizontal overlap.

If the neutrocentric concept has If the neutrocentric concept has been used you are finished. If been used you are finished. If bilateral balance with balancing bilateral balance with balancing ramps is your objective, go on to ramps is your objective, go on to the next step.the next step.

Neutrocentric


Add the balancing ramp as shown. In all lateral excursions you Add the balancing ramp as shown. In all lateral excursions you should observe at least three points of contact bilaterally if should observe at least three points of contact bilaterally if bilateral balance is to be achieved. bilateral balance is to be achieved.

Monoplane with balancing ramps

Lingualized Opposing MonoplaneLingualized Opposing Monoplane


•Position the appropriate condylar insert, and check to ensure that the Position the appropriate condylar insert, and check to ensure that the incisal guide pin is set at zero and in contact with the incisal guide incisal guide pin is set at zero and in contact with the incisal guide

table.table.

Lingualized opposing monoplane

Anterior teeth

• Vertical overlap (1-2 mm)*• Horizontal overlap (1-2 mm)*

* The amount of overlap will vary depending on condylar inclination, occlusal plane and esthetics. If a neutrocentric concept of occlusion is used no vertical overlap should be incorporated into the set up.



Verify again that all the maxillary teeth, with the exception of the lateral incisors and sometimes the cuspids, are on the plane of occlusion. Make corrections by manipulating the maxillary teeth. When you have completed this step, thoroughly cool the wax before proceeding to the next step.


Verify that the posterior mandibular teeth are centered over the crest of the ridge. Make corrections as needed.


Check the horizontal overlap of the posterior teeth. Make corrections by moving the maxillary posterior teeth.


Verify again that all the maxillary teeth, with the exception of the lateral incisors and sometimes the cuspids, are on the plane of occlusion. Make corrections by manipulating the maxillary teeth. When you have completed this step, thoroughly cool the wax before proceeding to the next step.


Reestablish centric contactsReestablish centric contacts by manipulating the mandibular posterior teeth. Make sure that the by manipulating the mandibular posterior teeth. Make sure that the incisal guide pin contacts the incisal guide table when you have completed this step.incisal guide pin contacts the incisal guide table when you have completed this step. While While performing this step make sure you do not alter the horizontal overlap.performing this step make sure you do not alter the horizontal overlap.

If the neutrocentric concept has been used you are finished. If bilateral balance with balancing ramps is your objective, go on to the next step.If the neutrocentric concept has been used you are finished. If bilateral balance with balancing ramps is your objective, go on to the next step.


In all lateral excursions all posteriors and the incisors maintain contact.In all lateral excursions all posteriors and the incisors maintain contact.

Working Balancing

Protrusive

Neutrocentric


Note that the maxillary 2Note that the maxillary 2ndnd molar extends slightly posterior to the mandibular 2 molar extends slightly posterior to the mandibular 2ndnd molar in molar in order that it may engage the balancing ramp during lateral excursion.order that it may engage the balancing ramp during lateral excursion.

Bilateral balance with balancing ramps


The balancing ramps are added as shown. In all lateral excursions you should observe at The balancing ramps are added as shown. In all lateral excursions you should observe at least three points of contact bilaterally to maintain bilateral balance. least three points of contact bilaterally to maintain bilateral balance.

Bilateral balance with balancing ramps



Semi-anatomic

Refining your Semi-anatomic SetupRefining your Semi-anatomic Setup



Verify that the posterior teeth are on plane and the posterior mandibular teeth are centered over the mandibular ridge. For bilateral Verify that the posterior teeth are on plane and the posterior mandibular teeth are centered over the mandibular ridge. For bilateral balance in excursions, the appropriate amount of the Curve of Wilson and the Curve Spee should be incorporated into the setup balance in excursions, the appropriate amount of the Curve of Wilson and the Curve Spee should be incorporated into the setup


Check buccal and lingual centric.Check buccal and lingual centric.


Check to ensure you have retained appropriate Check to ensure you have retained appropriate contacts in working, balancing andcontacts in working, balancing and protrusive.protrusive.

BalancingBalancingWorkingWorking

ProtrusiveProtrusive

Refining your Anatomic SetupRefining your Anatomic Setup



Anatomic occlusion


Anterior teethThe position of the maxillary anterior teeth were established at try in. At this stage only the central incisors need be on the occlusal plane. Note that the maxillary anterior teeth follow the curvature of the arch.

Anterior teeth

• Vertical overlap (1-2 mm)*• Horizontal overlap (1-2 mm)*




Verify that the posterior teeth are on plane and the Verify that the posterior teeth are on plane and the posterior teeth centered over the mandibular ridge.posterior teeth centered over the mandibular ridge.


Check buccal and lingual centric.Check buccal and lingual centric.


Check to ensure you have retained appropriate Check to ensure you have retained appropriate contacts in working, balancing andcontacts in working, balancing and protrusive.protrusive.

Balancing Protrusive

Working

24.refine denture setup

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