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Success of complete denture
 

Success of complete denture

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    Success of complete denture Success of complete denture Presentation Transcript

    • 1. Diagnosis and Examination. 5.Jaw relation.2. Taking Impression: 6.Mounting. Primary impression. 7.Setting of teeth. Secondary impression.3. Master cast . 8.Waxing up.4. Record block: 9.Try in. Record base. 10.Denture insertion. Occlusal rim.
    • 1)Arch form• It may be square,ovoid or tapered.• Each shape of this has a role in retention and stability of denture.• Square arch form ►more retention,stability& also support due to increase surface area coverage.• Oval & tapered arch form ►less retention, stability so the dentist should think about other means to increase retention.
    • 2)Vault form• It may be V-shape or U-shape or flat shape vault.• U-shape vault ► good retention & stability.• V-shape vault ►good stability but less retentive and this can improved by making good peripheral seal.• Flat shape vault ►good retention but less stable and this can improved by making good adaptation.
    • 3)Residual ridge contour• It may be rounded,knife edge,flat resorped, flappy fibrous ridge.• Every type needs special impression material & technique.• Rounded firm ridge► taking impression with alginate.• Knife edge ridge► taking impression with rubber base material.• Flat shape ridge ►taking impression with compound.• Flappy fibrous ridge ►need special impression technique as selective pressure technique.
    • 4)maxillary tuberosity• It aids in support&retention of the upper denture as complete coverage give wide area under denture which help in support and also give good seal which help in retention.• It is very important to know the size&form to know how to deal with.
    • 5)Retro molar area• It is called the postdam of lower denture so it should cover to help in retention of lower denture. 6)Maxillary&Mandibular undercuts• It needs a special impression material as alginate orrubber base.
    • 7)Tori• It may found in the palate (torus palatinus) or in the mandible (torus mandibularies)• The tori if present at the patient mouth it may cause interference with denture making as it may cause rocking of the denture and may also lead to ulceration to the tissue and pain to the patient.• So if it is small ► make relief. if it is large ► surgical removal.• Torus palatinus if present in midline of the palate and not relieved it lead to rocking of the denture and may also lead to midline fracture of upper denture.
    • 8) Tongue size & position• It may be one of the interference factors in making denture and may affect the stability of the lower denture.• In edentulous patient for long time tongue take large space and adapt it self to move freely so the dentist should tell the patient to be patient as the tongue will move the lower denture.
    • 9)SalivaThe amount and consistency of saliva play animportant role in making a denture as it help in:• Selection of suitable impression material.• Detection of the amount of base plate retention that help in recording of accurate vertical and horizontal relation.• Great value in complete denture retention.
    • 10)Mucosa• If it is flabby the dentist should follow a special impression technique as selective pressure technique. 11)Depth of the sulcus• Shallow sulcus ► needs special impression technique with adequate peripheral seal to increase retention & stability.
    • is one of the important steps in dentureconstruction as all steps depend on itsexactness, it is a negative registeration of theentire denture bearing and border seal areapresent in the edentulous mouth .
    •  Primary impression: • made in stock tray for making ►a study cast on which a special tray is constructed.
    •  Secondary impression: • made in special tray for making ►a master cast on which the denture is constructed.
    • • Impression must cover all maximum allowable possible denture bearing surface to assure wide distribution of stress and less pressure per unit area .• Impression must form the denture borders.• Impression must record the fine details of the surface of soft tissue to be covered by the denture.• Impression materials should be selected according the patients mouth.
    • Complete denture impression should provide : Retention"• It is the resistance to vertical force away from the softtissue.• It depends on ► peripheral seal. ►post dam in upper arch. And ►close adaptation to undistortedmucosa
    • "Support"• It is the resistance to vertical force towards the basal seat.• Maximum coverage provide distribution of load over wide area ►the force per unit area is reduced ►help in preservation of the supporting structures.
    • "Stability"• It is the resistance to horizontal movement.
    • Denture stability depends on:• The size and form of the basal ridge.(loss of vertical high of the ridge and increase flappy movable tissue decrease stability.)• The quality of the final impression impression.• The form of the polished surface.• The proper location and the arrangement of the artificial teeth.• Denture stability is very important to► preservation denture supporting structures.
    • "Tissue preservation"• Preservation of the remaining residual ridges is the main objectives.• Keep in mind that : pressure in the impression technique results to pressure in the denture and results to soft tissue damage and bone resorption. "Esthetics" Denture should : ► Restore facial contour. ► provide lip suuport.
    • • The custom tray (commonly made by acrylic resins) should be fabricated 24 hours before the impression procedure.• Should be well adapted on the primary cast.• Free of voids and nodules on the surface facing the tissues.
    • • Free of voids or nodules.• The surface of cast should be hard and dense.• The side walls of a cast should be vertical.• The base of cast should not be less than 10mm.• The base of the cast is parallel to the edentulous ridge.
    • • The contour of the anterior border of the base of maxillary cast is pointed at the midline and curved from canine to canine in the mandibular cast.• The peripheral roll should be not deeper than 3-4 mm and the edges of the cat extending out from this 3-4 mm wide.• The land area of 2-3 mm should be maintained around the entire cast.
    • • Well adapted to the final cast.• Stable both on the cast and in the mouth.• Rigid.• Free of voids or projections on the surface that contacts the oral mucosa.• Easily removed fron the cast.• Smooth and rounded.• The border length and thickness is approxamitely the same as the final denture base.• Fabricated from materials that are dimensionally stable.
    • • It should be well attatched to the underlying base.• It must be placed directly over the ridge.• It should follow the form of the arch.• It should have a smooth surface.• It must be constructed from a material that easy to manage.• Its width must permit occlusion of the upper and lower occlusion rims.
    • means the static &functional relation of the mandible to maxilla.  Orientation relationis the references in the cranium ,when the mandible in themost posterior position it can be rotated in sagittal planearound transverse axis plassing through the condyles,thisaxis can be located by :  Kinematic facebow.  Arbitrary facebow.
    •  Vertical relation• The vertical space between upper and lower jaw or the amount of jaw separation allowable for denture• There are 3 types :  VD at Rest  VD of occlusion  VD of other position
    • The effect of excessive occlusal VD • Discomfort the patient has acqired over a period of many years cortical pattern which control automatically &unconsciously certain mandibular movement • Trauma the premature striking of the teeth causes constant truma on the tissue • Clicking of teeth premature contact of teeth during speech or eating will produce clicking • Appearance over-oppeninng may result in an elongation of the face
    • The effect of inadeqate occlusal VD• Cheek biting• TMJ troubles• Inadeqate eating & chewing• Ms fatigue• Angular chelitis
    •  Horizotal relation• The significance of the centric is the irregular loss of teeth has often shunted the mandible into aslight protrusive or lateral position .• The muscles ,the ligaments, the bones, the teeth &all structures grow into what may be named { A muscle center}.
    • How to record centric relation ?• THere are 2 concepts :• Minimal pressure technique ,so;tissue not displaced while recording the opposing teeth touch at their 1st contact ,so will not stimulate pt. to clench.• With heavy pressure technique ,so tissue displaced while recording So produce the same displacement when heavy pressure where applied on the denture .• The choice bet.2 methods depends on the concept of occlusion selected .• Recording horizontal jaw relation ;• Inter occlusal or cheeck bite method .• Graphical or Gothic arch tracing.
    • • A laboratory procedure of attaching the maxillary and the mandibular cast to an articulator or similar instrument.• A mechanical instrument that represents thetempromandibular joint and jaws which maxillary andmandibular casts may be attatched to stimulate some orall mandibular movement.
    • • The articulator must accurately maintain the correct horizontal and vertical relationship of the patient.• The casts must be easily removed and attatched to the articulator without losing their correct relationship.• Should have an incisal guide pin with a positive stop to preserve the patient vertical dimension.• Should be able to open and close in a hing like fashion.• The articulator should accept a facebow transfer.• The condylar guidance should allow right,left lateral protrusive movement.• The incisal guidance should be adjustable.
    •  To achieve balanced occlusion we mustarrange teeth in anatomical articulation... Balanced occlusion • At any occlusal relationship maximum number of teeth are in contact and therefore the masticatory pressure is distributed over the suppoting tissues. Stability • Maximum number of teeth contact no tilting of the denture occur
    •  Reduced truma• as the masticatory pressure will be distributed as evently as possible and thus reduce damage to the supporting tissues. Efficiency• Griding and cutting of food stuff are possiblebecause lateral and protrusive movement can be madeto maintain balanced articulation also chewing timeand masticatory cycle will be reduced pressure on thesupporting tissues and bone resorption will bereduced.
    •  Functional movement• Patients will become accustomed to dentures which anatomically set up as it allow a continuation of normal masticatory movement. Time saving• As balanced articulation have been obtained by thetechnician in the laboratory only minor spot grinding tobe done in the clinic and thus save time.
    •  For anterior teeth • We must take in consideration esthetic&phonetics.
    • For posterior teeth
    • (Law of balanced articulation)• Condylar guidance.• Incisal guidance.• Cusp height.• Compensating curves.• Orientation of the occlusal plane.
    • • Waxing-up: is the process of waxing and carving of the wax to the shape and contour of a trial denture into the desired form.
    • The form of the polished surfaces and the properlocation of the artificial teeth play a major role in:• Stability of the dentures• Influences its retentive quality.• Influences the aesthetic of the denture.• Support the cheeks, lips and tongue
    •  Upper denture• The wax periphery must be – extended to the maximum depth. – Fully rounded – Highly polished.• The labial waxing may be thickened in order to restore lost facial contour.• The buccal surface should face downwards and outwards.• Festooning and cusped eminence should be provided.• Gingival crests should be trimmed exactly to the finished line. No deep grooves should be done.• Stippling of the facial surface.• The palatal surface will face inwards and downwards.• The palate should have an even thickness of 2.5 mm.
    •  Lower denture • The labial surface concave. • The peripheries – Fully rounded – Highly polished. • In the premolar region the buccal surface flat and thin. • In the molar region – The wax thickened and widened – Face outwards and upwards. • The lingual surface must face inwards and upwards (concave). The concavity does not extend under the teeth (in the middle of the flange) so that the tongue does not raise the denture. • The wax should be extended to cover the maximum area possible in the retromolar region. The lingual flange should not be bulky
    • • Preliminary insertion of a complete denture wax-up trial denture to determine the fit, esthetics, maxillomandibular relations• It is the last opportunity to evaluate many of the pervious steps already accomplished• It is also offers an excellent opportunity for patients acceptance of the finished prosthesis
    • • Check maxillomandibulor relationship – Centric occlusion – Centric relation – Acceptance of the vertical dimension of the occlusion• Determine if the position of the teeth and the contours of the denture bases are compatible with the surrounding oral enviroment• To verify tooth selection and arrangement for proper esthetics and phonetics• To make additional interocclsual maxillomandibulor records if needed for future adjustment of the articulator
    • The appointment of denture insertion is the momentawaited by the patient. • physical needs required for performing adequate function without causing truma to the supporting structures. • physiological needs by allowing the proper support needed by the muscles to provide proper esthetic. • psychologic needs by providing proper function and esthetic.
    • • To check retention,stability,accurancy of jaw relation.• To instruct the patient how to use his denture.• To advice the patient on the proper care of his dentures and supporting tissues.• To advice the patient on the limitations to be expected of his denture.
    • • Dental patients with complete dentures need to take care of their oral health, just as if they still had their natural teeth.• The most important thing these dentures are trying to achieve is restoring the patient’s lifestyle.• Dentures ideally remain unchanged; yet, your mouth is constantly changing. If you fail to wear your dentures for a while, for your own reasons, you will find it doesn’t fit any more. As we grow old, the oral cavity tends to shrink and the gum line to withdraw.
    • • Many patients with dentures consider that they no longer need to visit their dentist, since they have no more natural teeth to take care of. Even if you no longer have your natural teeth, your visits to the dentist must not become history. You need to maintain a healthy oral cavity and keep your dentures in good shape. Even at a more advanced age, patients can experience misalignments of their dental arches. It is highly important that you prevent and treat denture irritations and infections. It is better to ask your doctor how often you need to come back for a dental check- up.
    • • Dentures are meant to improve the quality of life in patient who lost their natural teeth, not to cause further inconvenience.• When not in your mouth, your dentures should be kept in a glass of water or other special liquid. Do not place them in hot water and do not let them dry! You need to clean them on a daily basis, using a toothbrush. Never use rough detergents to clean your dentures.• Don’t try to fix your broken dentures at home. As strange as it may seem, many patients try to glue their broken dentures with chemical adhesives they buy from the supermarket and try to adjust them using a nail file or similar to avoid accidents, don’t do this at home! Ask your dentist about any necessary repair.