Processing and insertion of complete denture

9. lecture

Prof. Dr. Peter KivovicsProf. Dr. Peter Kivovics

Former Head of the Department of Community DentistryFormer Head of the Department of Community Dentistry

DMD, BDS, MSc., C.Sc., Ph.D.DMD, BDS, MSc., C.Sc., Ph.D.

Chief Dental Officer for HungaryChief Dental Officer for Hungary

Semmelweis University Faculty of DentistrySemmelweis University Faculty of DentistryDepartment of ProsthodonticDepartment of Prosthodontic

head of department: Prof. Dr. Hermann Péter

Construction of Complete DentureConstruction of Complete DentureClinical and laboratory stepsClinical and laboratory steps

Clinical Clinical • ComplainComplain→Prognoses→Prognoses

Taking first impressionTaking first impression• Outlining borders of special trayOutlining borders of special tray• Transform special tray to Transform special tray to

functional trayfunctional traySecondary impressionSecondary impression

• Jaw registration with occlusal rimsJaw registration with occlusal rims(ear bow, face bow registration)(ear bow, face bow registration)Tooth selectionTooth selection(size, form, colour)(size, form, colour)

• Try in, trial dentureTry in, trial denture• Fitting Fitting • Short time recallShort time recall• Long time recallLong time recall

LabLab

• First castFirst cast• Special traySpecial tray• Secondary cast (functional cast) Secondary cast (functional cast)

Occlusal rims (baseplate+wax Occlusal rims (baseplate+wax rims)rims)

• Mounting in articulator, Setting up Mounting in articulator, Setting up the teeth, Trial denturethe teeth, Trial denture

• Flasking, Packing,Ready dentureFlasking, Packing,Ready denture

FittingFitting

InsertionInsertion

Fitting Complete DentureFitting Complete DentureAssessment on the articulator after that in the mouthAssessment on the articulator after that in the mouth

The dentist should check…The dentist should check…

• Adaptation of impression Adaptation of impression surface to the cast and to surface to the cast and to the edentulous jawsthe edentulous jaws

• Polished surfacePolished surface

• Incisal and occlusal surfaceIncisal and occlusal surfaceOcclusal conceptOcclusal concept

• Centric occlusion, and Centric occlusion, and Vertical dimension of Vertical dimension of occlusal and restocclusal and rest

• AAesthetics, lip support esthetics, lip support appearanceappearance

• Adaptation of baseplate to Adaptation of baseplate to the secondary cast and to the secondary cast and to the edentulous ridge (base the edentulous ridge (base extension)extension)

• AArtificial gumrtificial gum

• Artificial teeth and Artificial teeth and articulation and Occlusionarticulation and Occlusion

• AAesthetics, lip support esthetics, lip support appearanceappearance

AestheticsAesthetics

AdviceAdvicePatient managementPatient management

• It is not readyIt is not ready!!• It is uncomfortableIt is uncomfortable! (n! (no correctiono correction))• „„It`s moving! It can taken out with my tongueIt`s moving! It can taken out with my tongue!”!”• Wearing dentureWearing denture ((Must not wearing the old dentureMust not wearing the old denture!!

Do not change it!)Do not change it!)

• Cleaning (Cleaning (HHygiene)ygiene)• Problem with tasteProblem with taste• HypersalivationHypersalivation• RRecall! (ecall! (short-term-short-term-, , long-term recall procedureslong-term recall procedures))

Construction of Complete DentureConstruction of Complete DentureClinical and laboratory stepsClinical and laboratory steps

Clinical Clinical • ComplainComplain→Prognoses→Prognoses

Taking first impressionTaking first impression• Outlining borders of special trayOutlining borders of special tray• Transform special tray to Transform special tray to

functional trayfunctional traySecondary impressionSecondary impression

• Jaw registration with occlusal rimsJaw registration with occlusal rims(ear bow, face bow registration)(ear bow, face bow registration)Tooth selectionTooth selection(size, form, colour)(size, form, colour)

• Try in, trial dentureTry in, trial denture• Fitting Fitting • Short time recallShort time recall• Long time recallLong time recall

LabLab

• First castFirst cast• Special traySpecial tray• Secondary cast (functional cast) Secondary cast (functional cast)

Occlusal rims (baseplate+wax Occlusal rims (baseplate+wax rims)rims)

• Mounting in articulator, Setting up Mounting in articulator, Setting up the teeth, Trial denturethe teeth, Trial denture

• Flasking, Packing,Ready dentureFlasking, Packing,Ready denture

SHORT-TERM RECALL SHORT-TERM RECALL PROCEDURESPROCEDURES

• Patient Management (Advice) Patient Management (Advice)

• To solve problems and complaintsTo solve problems and complaints

• Correction of complete dentureCorrection of complete denture

Are you Are you happy with happy with the the denture?denture?

Mucosal ulceration (mucosal Mucosal ulceration (mucosal decubitus, decubital ulceration)decubitus, decubital ulceration)

Denture induced traumatic Denture induced traumatic irritative injuryirritative injury

Causative factors of oral Causative factors of oral ulcerationulceration

• TechnologicalTechnological

• Osteogenic, MucosalOsteogenic, Mucosal

• Denture instability Denture instability

• Incorrect Incorrect OOcclusioncclusion, , AArtikulrtikulationation

• General health stateGeneral health state

TECHNOLTECHNOLGICAL CAUSESGICAL CAUSES

• Superficial irregulariticsSuperficial irregularitics

• PoroPorositysity

• Increased monomer contentIncreased monomer content

• Alteration in the shapeAlteration in the shape

• Polishing and finishing errorsPolishing and finishing errors• Inappropriatic markingInappropriatic marking

OSTEOGENIC AND MUCOSAL OSTEOGENIC AND MUCOSAL CAUSESCAUSES

• ExostosisExostosis (bone irregularities) (bone irregularities)

• Sharp irregular marginal ridgeSharp irregular marginal ridge

• Undercut areaUndercut area• Special anatomic featuresSpecial anatomic features

• Thin and sensitive submucosaThin and sensitive submucosa

DENTURE INSTABILITY DENTURE INSTABILITY CAUSESCAUSES

• Design errors with MDesign errors with Mucosalucosal surface surface

• Design errors with Polished surfaceDesign errors with Polished surface

• Design errors with Occlusal surface Design errors with Occlusal surface and incisal edgeand incisal edge

FAILURE IN THE FAILURE IN THE ORGANIZATION OF ORGANIZATION OF

OCCLUSIONOCCLUSION• Missing of Bilateral Balanced Missing of Bilateral Balanced

Occlusion (imbalance)Occlusion (imbalance)

• False Centric OcclusionFalse Centric Occlusion

• PrematurPrematuree contactcontact

• Parafunctional activityParafunctional activity

GENERAL HEALTH STATUS GENERAL HEALTH STATUS CAUSESCAUSES

• Decreasing of submucosa Decreasing of submucosa

• XXerostomiaerostomia

• Deficiency (Vitamin B, Iron)Deficiency (Vitamin B, Iron)• Decreasing of mucosaDecreasing of mucosa

• Parafunctional activity Parafunctional activity

• DiabetesDiabetes Mellitus Mellitus

DIFFERENT SHAPES OF DIFFERENT SHAPES OF MUCOSAL ULCERATION MUCOSAL ULCERATION

Deep redDeep redGreyishGreyish

DIFFERENT SHAPES AND DIFFERENT SHAPES AND SIZES OF MUCOSAL SIZES OF MUCOSAL

ULCERATIONULCERATION

RoundRound LineLine

TYPICAL LOCATION OF THE TYPICAL LOCATION OF THE DENTURE IRRITATIONDENTURE IRRITATION

Gingival mucosaGingival mucosa(non mobile)(non mobile)

Mobile mucosaMobile mucosaDuring the functionalDuring the functional

movementsmovements

Border of the mobile Border of the mobile and non mobile mucosaand non mobile mucosa

Most frequent regions of Most frequent regions of decubital lesions on decubital lesions on edentulous maxillaedentulous maxilla

Most frequent sites of Most frequent sites of decubital lesions on decubital lesions on edentulous maxillaedentulous maxilla

Most frequently sites of Most frequently sites of decubital lesions on decubital lesions on edentulous mandibleedentulous mandible

Most frequently sites of Most frequently sites of decubital lesions on decubital lesions on edentulous mandibleedentulous mandible

http://www.quintpub.com/userhome/ijp/ijp_20_4_Kivovics_7.pdf

http://www.ncbi.nlm.nih.gov/pubmed/17695871

Denture correcion

• Carefull polishingCarefull polishing

• Diagnosztic impressionDiagnosztic impression

• Pressure indicator paste, disclosing mediumPressure indicator paste, disclosing medium

• Not in one sittingNot in one sitting