Try in of complete denture

Instuments used

1. Patient’s file

2. Wax dentures.

3. Articulator.

4. Bowl of cold water.

5. Bunsen burner.

6. Wax knife.

7. Sheet of modeling wax.

8. Lecron carver.

9. Indelible pencil ( each student shoud have its own pencile as it need gaseous sterilization )

Objectives of tr in of the complete denture

Verify all steps of bite regestertion ,

verify the vertical and horizontal relationships

arrangement of teeth concerning easthetic , function and phonetics

in bite registration we measured the vertical relation then the horizontal relation

as the centric relation definition

the maxillomandibular relation in which the condyle articulates with the thinnest portion of the

disk in which the condyles in the most anterior superior position at acertain vertical dimension , means if we change the vertical dimension by default the horizontal will change

verification we put the upper wax denture

1- lip support

2- incisal show 1-2 mm at rest

3- Occlusal plane orientation guidlne ( fox plane )

4- midline ( midline of the upper central incisor with the midline of the face hen the lower midline shuld be coincidence witht he upper )

Then the lower wax denture measures the vertical at rest ant occlusion , once we have verified the vertical relation last step we guide him in CR and having MIC

Teeth appaearence (shade size shape do fit my pateient? ) eg; patient with lage head if you choose asmall sizes teeth which is preferable b our pateints it will not have anatural appearance and this is our dut to educate the patient about the denture to look in a natural appearance .

• Facial measurements

• Phonetics and esthetics

• Patient’s proprioception to inform the patient that this is his last chance to have any modification of your teeth .

• Comparison with the old dentures

Verification of vertical dimension

Eg; in bite regesteraion FWS was 3 mm but in TRY IN it was ( -2 or 9 mm ) Sources of errors are ,

1- Error in the measurement in the bite 2- Mounting while the incisal pin is not adjusted on zero lin e 3- While setting of teeth ,

so what is the mangment ?

you must ask yourself a Q

Did you use an accurate facebow transfer( instrument used with semi adjustable articulator , which is not our case as we use an average value articulator )

YES

Vertical dimension within 4mm

No need to redo the bite just adjust the incisal pin to the new vertical dimention and reset the

lower teeth this the case if we are satisfies with our upper wax denture concerning ( easthetic , phonetic , occlusal plane orientation ) if es we do our modification only on the lower wax denture

No ( in our case since we use avg value articulator )

Upper is ok

Teeth removal from the lower then re mount and resetting teeth

Centric relation

ALWAYS guide the patient into the CR

Stabilize the lower denture bas e with our finger and guide the patient into the CR

By different ways used according to the patient ability ,

1- Put our tounge on the roof of the mouth and close 2- Swallow and close 3- Manual guidance

We must obseve proper MIC

Mandibile is pulled back and ask the patient to close slowly , and obseve the first comtact point where it happens , by this we can observe the presence ofp remature contact on one side

Scenario is premature contact on one side , patient shifts then having MIC , whichy ou will

think of having proper MIC if it was misdetected it will obviouse in the insertion which may require redo of the lower denture

If CR is correct both sides close at the same second , having proper MIC Any error in CR will be apparent when the teeth slide over each other

Error in the CR how to fix it it depends on the amount of the error

Eg :

Patient undergo slight shifting then MIC

Patient occludes onl on both 2nd molar and having an open bite , mangment would differ ,

Premature contact in the post area ,

1- Make sure the the upper wax denture is satisfactory

2- Notice the relation of the upper ANT and the lower ANT over bite as it would be our refrence point

3- Remove posterior teeth and arrange them on apiece of wax keep from 3-3 4- New wax rim at the level of 3 then soften this wax rim to have prper indentition s of the upper

teeth 5- Guide the patient into the CR until he / she achieves the memorized over bite then ask the

patient to stop , and wait until the wax cool 6- Remount of the lower denure 7- Setting of post teeth 8- Secondery try in

If anterior premature contact occur ,

Removal of the lower anterior teeth from 3-3

Softened Wax rim

Ask the patient to close to have proper indentition on the lower wax rim

Remounting of the upper cast then resetting of teeth

CHECK THE APPEARANCE , we ask the paeint to smile and to speak .

With the upper and lower wax dentures in position:

I. Check the lip form to ensure that the upper and lower anterior teeth are in their correct positions.

2. Check the midline.

3. Check the orientation of the occlusal plane to ensure that it is not running down on either side and that the posterior teeth are arranged parallel to the ala-tragus line.

4. Check that the shade and mould of teeth are satisfactory.

5. Check the arrangement of the teeth to ensure that they give a pleasing appearance.

Last thing phonetics ( next lecture )

Midline shift and connoted tilted midline( midline inrelation to nose face loer midline )

Anterior occlusal plane is telted

Patint at rest should not showing lower anterior teeth

Over supported lip, gumm smile due to one of the following :

1- Hight of the wax rim os totll wrong 2- Mistake in Marking the high smile line

3- Setting of teeth

Buccal corridor non of the is correct but the left side is worse the right side is restricted onl showing few teeth ( it must show the teeth in a smooth transition )

Lower teeth is obviose ( complete redo ) since the whole adjustmenr were on the lower rather than the upper

Protrusive recod ( anterior guidance , condylar guidance angle and hanau’s quint

In avg articulator is manufactures on avg value 30 degree

In semiadjustable articulator we must record it by asking the patient to have an edge to edge contact . ,i n order to eliminate the space posteriorly CHRISTENSEN’S PHENOMENA

Which is destructive for the denture

How can you recod it ?

using atype of wax called alumni ( containg aluminium ) , puuting it into hot water will be softened enough to regestir nice good detais , .

wax on the posterior teeth

Edge to edge as lower 3 edge to edge with upper

Trim it

Then we put it on the articulator until having aprecise relation of the upper teeth with indentition

Lock it this the condylar guidance angle

Posterior palatal seal

Aim is retention by compsation of PMMA shrinkage (7%) so the dentire still tuching the sof palate

Indecible pencil to mark Hamular notch ( part of ptergoid plate of sphenoid bone ) and fovea palatnea ( residual M SG) the draw aline( is not straight but arch form ) between the hamula notch ad fovea palatinea )

Vibrating linealso called AH line ( demarcation between movable and the non movable part of the SP ), which is the posterior limit of the pos dam area that is located in SP

Ask your pateint to say ah

How to transfer it ?

1 either you insert the base plate inside the patient mouth

a- Good touch , having a replica on the base plate then you tim it

b- In case of shrinkage , no replica just memorize the anatomy of the vibrating line anterior and fovea palatine posteriorly and drawit on the cast 2- the vibrating line is obvious not covered b the base plate , b aperio probe you measure how much the vibrating line away from the posterior limit of the denture base .

Last step is the pateint acceptance , ou must tell our patient that this is his last chance to have an modification on teeth

As we are student just consume ou time meanwhile in our future clinic it cost ou tima and money without any change .

Alwyas have a consent as postinsertion and listening to comment you just tell the patient that you have signed on it .