COMPLETE DENTURE CONSTRUCTION 1- Diagnosis and Treatment Planning for Removable Prosthodontics 2- Preliminary Maxillary and mandibular impression procedures 3- Final Maxillary and mandibular impression procedures 4- Jaw Relation Registration a. Introduction and the stomatognathic system What 'occlusion' is and why it is important b. Definitions. c. Check denture foundation and Establishment of facial contour. d. Establishment of the occlusal plane. e. Importance of mounting the maxillary cast using Maxillary face-bow record and transfer. f. Determination of vertical dimension of centric occluding relation. g. Determination of centric and eccentric relations at the accepted vertical dimension. 5- Selection of Artificial Teeth 6- Prosthetic Problems and possible solutions in Setting –up of teeth for skeletal Class I, II and Class III arch relationship of completely edentulous patients. 7- Try-in of the wax trial complete denture. 8- Complete denture insertion (Delivery) 9- Occlusal corrections. 10- Managements of Post Insertion Problems and Complaints. 11- Single denture and Kelly's Syndrome 12- Denture Processing and Laboratory Errors.

3. Prof. Amal Fathy Kaddah
Dr. Mohamaed Kandel
Department of Prosthodontics,
Faculty of Dentistry, Cairo University.
Dr. Marwa Anas El-Wegoud
Dr. Mohamed Adel
Dr. Mohamed Esawi
Dr. Ramy kalaifa
Dr. Mariam Roshdy
Dr. Heba Salama
Dr. Samah Ahmed
Dr. Abobakir abasho

4. When you realize you've made a mistake, take immediate
steps to correct it.

5. Contents:
I-Introduction
II-Factors affecting teeth arrangement
1. Pattern of bone resorption
2. Esthetics and phonetics requirements.
3. Stability
4. Occlusal plane
5. Arch form ( Arrangement of teeth in harmony with ridge contour)
6. Interdigitation of the teeth
7. The inclination for proper occlusion
8. Arch relationship
III- Guidelines governing the position of artificial teeth
IV- Arrangement of teeth in normal cases.
V- Atypical arrangement of teeth (Class II, Class II)
VI- Common errors in teeth setting.

6. Guidelines for arrangement of teeth
A- Key of occlusion
a.Canine key of occlusion
b.Molar key of occlusion
B- Anatomical landmarks
C- The normal Overjet & overbite

7. Identifying the problem
Through:
1) Clinical examination Extra-
oral & intra-oral
2) Diagnostic bite record and
mounting on articulators
3) Radiographic analysis

8. Introduction
 According to the relation between the bones of the
face and the jaws, facial skeletal pattern is classified
into:
Angle’s classification of the facial skeletal pattern

9. Introduction
 The selection of teeth for edentulous patients requires a
knowledge and understanding of some physical, biological
and mechanical factors.
 Any choice of artificial teeth must be considered as a
preliminary selection until the teeth are arranged on trial
denture bases and viewed in the patient’s mouth.
 The teeth are not only an important component of facial
appeal, they give each face a unique identity and make it
easily recognized ( Important factor for denture success ).

11. NORMAL OCCLUSION
The mesial incline of the maxillary canine occludes with the distal incline of the
mandibular canine. The distal incline of the maxillary canine occludes with the mesial
incline of the mandibular first premolar.
Normal Line of Occlusion, normal smooth curves. normal overbite and overjet and
coincident maxillary and mandibular midlines.
Molar Relationship:
• According to Angle, the mesiobuccal cusp of the
maxillary first molar aligns with the buccal groove of
the mandibular first molar.
Canine Relationship: The maxillary canine occludes
with the distal half of the mandibular canine and the
mesial half of the mandibular first premolar.

12. Class I Malocclusion
Molar Relationship and Canine Relationship as normal occlusion, but
Line of Occlusion: ALTERED in the maxillary and mandibular arches
Individual tooth irregularities (crowding/spacing/other localized tooth
problems).
Inter-arch problems (open bite/ deep bite/cross bite).
Mesognathic: normal, straight face profile with flat facial appearance.

13. • Molar relationship: The molar relationship
shows the mesiobuccal groove of the
mandibular first molar is DISTALLY (posteriorly)
positioned when in occlusion with the
mesiobuccal cusp of the maxillary first molar.
• Usually the mesiobuccal cusp of maxillary first
molar rests in between the first mandibular
molar and second premolar.
Class II malocclusion
• Canine Relationship: The mesial incline of the maxillary canine occludes
ANTERIORLY with the distal incline of the mandibular canine. The distal
surface of the mandibular canine is POSTERIOR to the mesial surface of the
maxillary canine by at least the width of a premolar.

14. CLASS II DIVISION 2
Condition when class II molar
relationship is present with
retroclined upper central
incisors, upper lateral incisors
may be proclined or normally
inclined.
Overjet is usually minimal.
CLASS II DIVISION 1
Condition when class II
molar relationship is
present with proclined
upper central incisors.
There is an increase in
overjet.
CLASS II SUB-DIVISION
Condition when the
class II molar
relationship exists on
only one side with
normal molar
relationship on the
other side.

15. 1. TRUE class III malocclusion (SKELETAL) which is
genetic in origin due to excessively large mandible or smaller
than normal maxilla. The mesiobuccal cusp of the lower fist
molar occludes mesial to the class I position
Class III malocclusion
has 3 subdivisions:

16. (FALSE or postural) which occurs when mandible shifts anteriorly
during final stages of closure due to premature contact of incisors or
the canines. It’s also known as postural class III.
Forward movement of the mandible during jaw closure can also result
from premature loss of deciduous posterior teeth.
2- PSEUDO Class III malocclusion

17. 3- Class III Sub-division:
• Class III molar relationship exists on one side and
the other side as a normal Class I molar relationship.

18. Certain rules and principles
that should be followed
during managing complete
denture cases

19. 1. In the cases with abnormal arch relationships, The
relationship cannot be changed by setting up the teeth,
and any attempt to make the occlusion normal in
abnormal arch relationships would compromise
esthetics, phonetics and function.
2. In the cases with abnormal arch relationships,
treatment should be restored in the Centric relation.
 Positions other than centric relation are not repeatable
 However, some modifications during setting-up are
necessary.

20. 3. Mandibular posterior denture teeth must be placed over the
lower residual ridge, and adjustments made with the
maxillary occlusal table.
The horizontal
relations to the
residual ridges
The vertical positions of
the occlusal surfaces
and incisal edges
between the residual
ridges

21. 4. Freedom of movement is a must during eccentric
movements.
5. Multiple occlusal contacts must be established in
centric and eccentric positions whatever the occlusal
scheme used. (with the use of Anatomic Teeth, a
Steep Occlusal Plane, a More Pronounced Curve Of
Spee, and with monoplane teeth use of a Balancing
Ramp which is necessary for protrusive balance).

22. 6. Whether the relation is class I,II or III,
when setting up dentures, the upper
and lower first molars must have the
same relationship to each other as in
an Angle class I.
i.e.: Upper mesio-buccal cusp of first molar has contact between the
lower mesial buccal and buccal cusp of first molar.
Note: in class III, reverse cusp fossa relationship could be done

23. class I
class II
class III

24.  In the maxilla: After extraction of the teeth resorption
of bone occurs vertically, labially and buccally, so it
becomes small in size.
 In the mandible: bone resorption occurs vertically and
lingually, so it becomes wide.
 By understanding this pattern setting of the anterior
teeth should be inclined labial to the crest of the ridge
to restore the natural position of the anterior teeth.
Factors affecting setting of teeth
1- Pattern of bone resorption

25. 2- Esthetics and phonetics:
 Labial surface of teeth should support the lips.
 It's important to produce pleasant appearance and to simulate the
natural teeth to a great extent.

26. 3- Role of The occlusal plane on Esthetics,
phonetics and stability:
a. Anterior teeth should be 2mm below the upper lip.
b. In flat lower ridges, occlusal plane should be as close as
possible to the ridge.

27. c. The horizontal relations to
the residual ridges
d. The vertical positions of
the occlusal surfaces and
incisal edges between the
residual ridges

28. Factors must be considered:
1- Aesthetic base
2- Functional base
(chewing and speech)
3- Physical and mechanical
(leverage action and parallelism)

29.  It is the ability of a denture to be firm, steady
or constant, by functional stresses and not to
be subjected to change of position when forces
are applied .
 It is the ability of a denture to resist
displacement by functional stresses.
4- Stability:

30.  If the teeth are placed too far forward, they will
displace the denture due to active lip muscles.
 If they are placed too lingualy, they can cause
tongue crowding which also results in denture
displacement during tongue movement.
 If placed too far buccally, the action of the
buccinator muscles can dislodge the denture too.

31.  The level of the occlusal plan should be below the level
of the maximum convexity of the tongue to provide
denture stability

32. VD CO # CR
Uneven
pressure
Cuspal
interference
Teeth off ridge
Tuberosity of
opposite side
In upper buccal
sulcus of working
side
White sore
area on the
site of
pressure
VD
(Neurological
pain)
VD (white
patch)

33. 5- Interdigitation of teeth
 Maximum interdigitation should be
achieved.
 The upper and lower teeth should
be set to have a definite cuspal
relation to each other, in order to
maintain both positional and
functional relationship.

34.  The maxillary arch:
U-shaped form.
While
 The mandibular arch:
V-shaped form.
6- Arch form:

35. The arch form can be:
 Square Arch:
Central incisors are in line with
canines.
 Tapering Arch:
Central incisors are at a greater
distance forward than canines.
 Ovoid Arch:
In between

36.  According to the relation between the bones of the
face and the jaws, facial skeletal pattern is classified
into class I, II and II arch relationship:
7- Jaw relationship
Animation

37. Factors governing the position
of artificial teeth
I- Key of occlusion
1. Canine key of occlusion
2. Molar key of occlusion
II- Anatomical landmarks
III- The normal Overjet & overbite

38. I-Key of occlusion:
It denotes the relationship of
upper and lower teeth during
function.
1- Canine relationship:
The mesial incline of the upper canine aligns
with the distal incline of lower canine

39. 2- Molar relationship:
 The mesiobuccal cusp of maxillary
first molar should aligns with the
mesiobuccal groove of mandibular
first molar.
 The mesiolingual cusp tip of
mandibular first molar should fit into
the central fossa of the upper first
molar.

40. II. Anatomical Landmarks
1) Incisive papilla as a guide
2) The canine lines
3) Midline
4) High Lip Line
5) Interpupillary line
6) Ala- Tragus line
7) Retromolar pad
8)The maxillary tuberosity.

41. Try-in ???

42. The anteroposterior positioning of anterior teeth
is important for esthetics and phonetics, because
of the support that is provided to the lips, cheeks
and other tissues of the oral cavity from the
teeth.
Anterior teeth
Therefore, anterior artificial teeth should be placed in the same position
or as close as possible to that occupied by the natural teeth to maintain
natural patient appearance.
II. Anatomical Landmarks
1) Incisive papilla as a guide

43. • Mark corners of mouth on wax occlusal rims.
• A line perpendicular to midline of palate through distal
border of incisive papilla.
1) Incisive papilla as a guide

44.  The incisive papilla is a
valuable guide for anterior
teeth placement because it has
a constant relationship to the
natural central incisors.
The labial surfaces of upper central incisors are 8-10 mm
anterior (in front) of the middle of to the incisive papilla.

45. Incisive papilla as a guide
The incisive papilla is situated on a transverse line passing
through the tips of the canines in the dentate person.

46. 2) The canine lines:
The six maxillary anterior teeth occupy the
space between the distal of the right canine
eminence and the distal of the left canine
eminence.
3) Midline:
A line drawn anteroposteriorly bisecting the
midsagittal suture, incisive papilla and
labial frenum coincide with the midline of
upper dental arch.

47. • Nose – Distance between tips of canine is same as width
of base of nose
• A vertical line extending along the lateral surface of the
ala often will pass through the middle of the natural upper
canine.
• Philtrum – Width of upper centrals, approximates the width
of philtrum.

48. 4- High Lip Line
• Highest point of upper lip
when smiling
• Cervical necks lie at or
above this line
• If shorter teeth are selected,
esthetics compromised

49. High lip line
Low lip line
Amount of teeth showing

50. Amount of teeth showing

51. 5) Interpupillary line:
The occlusal plane of maxillary
anterior teeth should be parallel to
the interpupillary line.
The posterior occlusal plane should
be parallel to the ala-tragus line
(from the ala of the nose to the
tragus of the ear).
6) Ala- Tragus line

52. 7) Retromolar Pad:
• It is a fixed anatomic landmark used most frequently as a
reference for teeth arrangement as it applies in three
dimensions: vertically, laterally and anteroposteriorly.
• Laterally, it guides the buccolingual position of posterior teeth.

53. • Anteroposteriorly, no artificial teeth
are placed posterior to the anterior
boundary of the pad, to avoid having a
tooth over an incline which results in
denture sliding.
• The posterior occlusal plane should
be at the level of 2/3 the height of
retromolar pad.
Fixed Position
Measurable
Identifiable
Relationship to natural dentition
Mesiodistal Width available.
7) Retromolar Pad:

55. Aligned Occlusal Groove
The occlusal groove of the
posterior teeth should lie on
the straight line joining the
distal arm or the tip of the
canine anteriorly and the midpoint of the occlusal rim
posteriorly.

56.  The posterior teeth are generally
placed to enhance the stability of the
mandibular denture.
 The mandibular teeth should be
arranged so that they are positioned
over the crest of mandibular residual
ridge.
 The Retro molar pad is used as a
guideline to determine the buccolingual
position.

57. • Not to encroach on tongue space and buccal
corridor.

58. 8)The maxillary tuberosity
•It lies immediately posterior to
the maxillary second molar.
•Teeth should not be set on the
tuberosity as it can lead to lever
imbalance and cheek biting in
posterior region.

59. Buccolingual Width
• Sufficient to act as a table to
hold food.
• Less than width of natural
teeth.
• Limits forces directed to ridge

60. Determined by available inter ridge space, occlusal plane and
height of anterior teeth.
Occluso-gingival Height

61. III- Overjet and overbite:
The overjet is measured in horizontal plane while the
overbite represents the vertical plane.
 Normal overjet should be: 1.5 mm
 Normal overbite should be: 0.5 mm

62.  The horizontal overlap between
upper and lower anterior teeth is
automatically decided by the
relation between the upper and
lower residual ridges.
 The upper and lower anterior
teeth shouldn't be in contact in
centric occlusion.

64. Arrangement of anterior teeth

65. • The middle of the crest of the mandibular ridge should be recorded.
• Mark the midline of the patient’s face by placing a dot on the
incisive papilla and marking this midline on the maxillary anterior
land area, extending down the front of the cast. The incisive papilla
is a much more reliable landmark for the midline than the labial
frenum.

66. 1. Arranging the maxillary anterior teeth
a. Maxillary central incisors
•The long axis of the tooth should incline slightly distally.
•The contact point should coincide with the midline of the
face.

67. • The incisal edge should touch the mandibular occlusion rim.
• The facial surface of the central incisors should be 8-10 anterior to the
center of the incisive papilla.
• The neck is slightly depressed.
a. Maxillary central incisors
1. Arranging the maxillary anterior teeth

68. b. Maxillary lateral incisors
1. The long axis should
inclined slightly distally.
2. The neck is more depressed.
3. Incisal edges of central incisors & canines at level
of the occlusal plane. Laterals placed approximately
0.5 to 1 mm above the occlusal plane.

69. Bucco-Lingual Tilt
• Facial surface of central is
perpendicular occlusal plane
or slightly inclined labially
• Neck of lateral is depressed
• Neck of canine is prominent.
Central Canine
Relations and inclinations of maxillary anterior teeth.

70. 1. The canine tooth is an important
tooth in any tooth arrangement because
it forms the corner of dental arch . The
incisal edge of the canine should touch
the mandibular occlusion rim.
2. The long axis (buccolingually)should be
perpendicular to the occlusal plane and
mesiodistally should be tilted more posteriorly
(distally) than other teeth, with a more prominent
cervical neck
3. Distal aspect of the canine should coincide with
the crest of the ridge.
c. Maxillary Canines

71. Incisal views of anterior teeth showing their angle of rotation.
Central & lateral incisors must begin to turn along
the curvature of the arch

72. The greatest height of
the free gingival
margin is slightly distal
to the mesiodistal
center of the tooth

73. Amount of teeth showing
Width of max. Centrals = width of philtrum
Low L L
High L L

74. Amount of teeth showing

75. • Make a cut with a heated, sharp knife, at the midline in
the anterior wax rim. Cut all the way to the baseplate.
Make a similar cut just distal to the canine point.
Remove this section of wax in its entirety.
Procedures for arranging the maxillary anterior teeth

76. • Use a flat plate to position the central incisor so that it
contacts the occlusal plane.
• Set the rest of the anterior teeth on the right side
according to the curve defined by (occlusal rim).

77. N.B. Anterior teeth are set to follow the arch form
of the patient's residual ridges. The incisal edges
of the anterior teeth should be set to correspond to
the shape of the arch.

78. • Use a flexible plastic ruler to verify that the incisal
portion of the tooth’s labial surface is properly
located and in contact with the anterior curvature of
the occlusion rim.

79. • An anterior view of the maxillary anterior teeth shows that
only the lateral incisors do not touch the occlusal plane as
recorded by mandibular wax rim.

80. Lower central incisor
• Long axis should be set perpendicular to the occlusal plane.
• The neck of tooth should be slightly depressed.
• The incisal edge should form (1-2mm) horizontal and
vertical overlap in respect with upper central incisor
Lower lateral incisor:
• Long axis slightly inclined.
• The occlusal height should be the same as the central
incisors.
Lower canine:
• Long axis is nearly perpendicular to the occlusal plane
• The neck of tooth should be set prominent and the cusp tip
2mm above the occlusal plane .
2. Arranging the mandibular anterior teeth
Vertical
overlap
Horizontal
overlap

81. • Mark the midline of the mandibular ridge on the mandibular
wax rim and cut out a section representing the right
mandibular anterior teeth from the rim.
• Arrange the lower anterior teeth following the arch shape
• Position the teeth over the crest of the ridge.
Procedures for arranging the mandibular anterior teeth

82. Set the mandibular central incisors so that the
maxillary incisors cover them, 1mm vertically and
1mm horizontally (1mm horizontal and vertical
overlap) if you are using anatomic posterior teeth

83. 3- Arranging the maxillary posterior teeth

84. Upper first premolar
• The facial surface of 1st premolar must harmonies with
canine.
• Long axis of tooth perpendicular to the occlusal plane.
• Buccal and palatal cusps touch the occlusal plane
• Palatal cusp over crest of mandibular ridge
Upper second premolar
• Long axis of tooth perpendicular to the occlusal plane.
• Palatal cusp is about 1 mm over the occlusal plane.
• Palatal cusp over crest of mandibular ridge
Relation of buccal surfaces
of premolars and molars
with the buccal surface of
the canine
Palatal
Buccal

85. Upper first molar
• Mesio-palatal cusp touch the occlusal plane.
• The facial surface 1st molar must harmonies with 1st and 2nd premolar.
• The disto-buccal cusp is raised about 1/2 mm and the disto-Palatal
cusp is raised about 1/2 to 3/4 mm above the occlusal plane.
Upper second molar
All four cusps are above
the occlusal plane
The facial surface of 2nd
molar must harmonies
with 1st molar
Cusps of the second molar are raised from the occlusal plane following
the position of the first molar.

86. • Remove the wax on one side of the maxillary baseplate.
• The rim is left intact on the opposite side because this will help
you to maintain the location of the occlusal plane as explained
before.
Relation of maxillary posterior teeth to occlusal plane.
Procedures for arranging the maxillary posterior teeth

87. • Set the teeth so that the buccal surfaces of the premolar(s) and mesial cusp
of the first molar line up with the mid-buccal surface of the canine. Fig. 1
• The distobuccal cusp of the first molar should deviate approximately 20o
from this plane and the second molar will fall along this plane. Fig. 2, 3
• Set the teeth on the maxillary right side so that the mesiolingual cusp of the
maxillary first molar rests in the central fossa of the mandibular first molar.
Relation of buccal surfaces with the canine.
1
2
3

88. Lower second premolar
• Long axis of tooth perpendicular
to the occlusal plane.
• Buccal and palatal cusps above
the occlusal plane.
3- Arranging the mandibular posterior teeth
Lower first premolar
• Long axis of tooth perpendicular to the occlusal plane.
• Buccal cusp above the occlusal plane.
• Lingual cusp is below the occlusal plane.

89. • Buccal cusp of the lower 1st premolar
contacts the mesial marginal ridge of the
upper 1st premolar.
• Buccal cusp of the lower 2nd premolar
contacts the fossa between two upper
premolars.
• Mesiobuccal cusp of the lower 1st molar
occludes in the fossa between upper 2nd
premolar and 1st molar.
• Mesiobuccal cusp of the lower 2nd molar
occludes in the fossa between upper 1st
and 2nd molars.

90. In centric occlusion, the disto-buccal cusps of the
mandibular teeth fit into the central fossae of the
maxillary teeth while the lingual cusps of the maxillary
teeth fit into the central fossae of the mandibular teeth.
This position establishes the proper buccal overjet.
Section through the molar region of full maxillary and mandibular dentures.

91. Procedures for arranging the mandibular posterior teeth
 With a pencil, use a ruler to mark the
crest of the mandibular ridge from the
base of the retromolar pad to the canine
area. This will identify the crest of the
mandibular ridge (B)
 Extend the previous markings onto the
wax rim to serve as a guide when
arranging the teeth.
 Line extend from canine tip and center of
retromolar pad.

92.  Enough wax is removed opposite the
maxillary second premolar and first
molar to allow setting of the posterior
teeth.
 Mandibular first molar intercuspating
with the maxillary second premolar and
first molar.
 Mandibular second molar intercuspating
with the maxillary first and second
molar.

93.  Check the position of the teeth
over the crest of the ridge.
 Mandibular first premolar
intercuspating with maxillary
first premolar and canine.
Central grooves in line with canine
tip and center of retromolar pad.

94. N. B.
• Incisal pin should touch the
incisal table throughout the
whole work.
• If there is no space for the
mandibular first premolar, it is
advisable to grind the
mandibular first premolar.

96. Problems and possible
solutions

97. Problem >> Convex face
profile resulting from a
mandible that is too
small or maxilla that is
too large.
Class II

98. • Distobuccal cusp of maxillary first
molar falls on the mesio-buccal
groove of mandibular first
permanent molar.
It is divided into:
Class II Div 1: Upper incisors are proclined
Class II Div 2: Upper laterals overlap centrals and the
centrals are retroclined
Class II

99. Prosthodontics' problems in angle class II
Problem in static relationship and functional
Relationship.
• Functional
-Anterior Posteriorly

100. 1. Lower ridge is narrower than the upper
and associated with a receding chin.
2. Setting the upper teeth inside the ridge
and lower teeth outside the ridge does
not produce marked stability
3. Large overjet is preserved. Angulations of the upper teeth
give the patient a rabbit appearance .
Angulations of the lower tend to unstabilize the denture
Prosthodontics' problems in angle class II

101. In a normal bite (class I) the upper
cuspid is positioned posterior to
the lower cuspid.
In a (class II) deep bite a reverse
cuspid relationship due to a strong
overjet.
Class II Cuspid relationship.

102. 1.Modifications Done in Setting Up of Teeth for Angle
Class II
2.Modifications Done in Posterior Teeth Morphology:
SR Orthotyp Teeth

103. Modifications Done In Setting Up of Teeth for Angle Class II
Anterior teeth arrangement
1- Vertical overlap should be kept as
minimal as the esthetics and phonetics
permit.
2-Maxillary anteriors are set-up with their incisal edges inclined
more palatal than their necks.
3- Labial inclination of lower anteriors.
4- Leave out a lower central or lateral incisor, or overlap lower
teeth.

104. 5. When retrusion is not extreme,
 Narrower lower anteriors.
 Slight spaces between the upper anterior teeth or
 Slight crowding of lower anterior teeth
Modifications Done In Setting Up of Teeth for Angle Class II

105. 6. When it is too great and can not be by modification
of anterior teeth >> Remove lower first bicuspid
In case, the lower first bicuspid was dropped in order to
achieve a correct posterior relationship.

106. Angle’s Class II division 2 :
If the overbite and minimal overjet
of these cases is reproduced in an
artificial tooth set-up, the patient
could be locked into an impossible
situation. So there needs to be some
re-positioning of the teeth to reduce
the overbite as much as possible
without overly compromising
aesthetics.

107. Slight labial inclination of lower anteriors + Slight lingual
inclination of upper anteriors
Slight spacing of upper anteriors or Slight crowding of lower
anteriors

108.  The incisal edge of the upper anteriors should point toward the lower mucolabial fold
Set up the upper posteriors starting with the first molar to ensure correct occlusion in
order to achieve popper occlusal contacts and balancing movements the molars have to
be in a normal occlusal relationship to one another
 Starting the upper posterior set- up with the first molar

109. Posterior teeth arrangement
1. Non-anatomic teeth or teeth with
shallow inclines are selected to
reduce the stress on the weaker lower
ridge.
2. Eliminate lower 4
3. Upper posterior teeth can be placed
slightly palatal to provide a working
occlusal contact with the lower teeth.

110. 4. The lower posterior teeth are placed over crest of the ridge.
The upper teeth are then set so that they occlude with the
lower teeth
5. Upper palatal cusp ...........
‫؟؟؟‬
............ (lingualized occlusion)
6. A combination of lever balance and occlusal balance is
possible by incorporating both a buccal tilt and a lingual tilt
in the posterior arrangement.

111. If the upper arch is much wider than lower arch :
- Set the lower first on the ridge
- Set the upper and lower separately

112. A further complication arises in those cases
where the upper arch is much wider than the
lower.
In these cases, the lower teeth are first set in
their most appropriate positions relative to the
lower arch. The uppers are then set in their most
appropriate positions for aesthetics. If then it is
found that the uppers and lowers don’t meet, a
further line of teeth can be placed palatal to the
uppers, or the base can be waxed to the lowers
and replaced with tooth-colored resin.

113. - Lingualized occlusion
Occlusal scheme
The problem is that the patient functions in a variety
of positions anterior to centric relation position, and
providing for protrusive balance is very difficult with
cusped teeth.
With a lingualised concept, however, the occlusal
tables of each tooth can be successively recruited to
maintain contact during protrusion, and a long
anteroposterior area of contact can be obtained. This
is done by placing the lower teeth on an appropriate
compensating curve and then adjusting the occlusal
tables for all protrusive movements.
- Monoplane occlusion

114. Problems and possible
solutions

115. Problem >>
Concave face profile with
prominent mandible is
associated with Class III
malocclusion.
Angle class III

116. Problems associated with class III cases
1. The relation between the ridges may vary
from edge to edge relationship to extreme
prognathism of the lower arch.
2. Wider lower arch leads to problems in
selecting the size of the teeth as selecting
the same mold size for both arches leads to
spacing between lower anterior teeth which
reduce aesthetics
3. The Crest of the lower arch is located further buccally than that of the upper one,
leading to problems in obtaining an adequate occlusal relation between upper and
lower teeth.

117. Class III – Cross Bite
There are different types of cross bites:
1. Unilateral cross bite.
2. Bilateral cross bite( due to maxillary atrophy, the lower arch is larger the upper
arch. Cross bite begins usually at the 2nd premolar.)
3. Bilateral cross bite including an anterior cross bite (rare: overdevelopment of the
lower arch in comparison with the upper).

118. Anterior teeth arrangement:
1. Edge to edge relationship
2. Inclining the mandibular anteriors lingually
as possible without encroaching the tongue
space.
Modifications done in setting up of teeth for angle Class III
3. Inclining the maxillary anteriors more anterior to the crest of the ridge
than usual, with their incisal edges being inclined more labial than their
necks

119. Slight crowding of upper anteriors
4. Addition of lower lateral or central incisor
5. Wider lower anteriors.
6. Slight crowding in upper anteriors.

120. Posterior teeth arrangement:
1. Monoplane posterior teeth or cuspless teeth (preferred)
2. Upper posterior teeth can be placed slightly buccal to the
crest of the upper ridge.
3. Cross-bite is accomplished to avoid unfavorable leverage that
compromises denture stability
4. Larger sized upper posteriors + Medium sized lower posteriors
5. In case of wider lower arch, an interchange can be done by
using upper teeth on the lower denture and lower teeth on the
upper denture.

122. Lingualized articulation
• “An occlusion for all reasons” There is hardly a clinical situation where it is not applicable
and the adjustments, especially at the chairside,
• This scheme use cusped upper teeth 30_ or 33_ cuspal angles, modified to ensure that the
buccal cusps take no part in the articulation.
• The lower teeth use 20_ or 0_ teeth,
• Occlusal surfaces are in harmony with the angles of the upper palatal cusps, as well as the
• Refers to the inner maxillary cusps as palatal cusps,
for obvious reasons. The main problem with posterior
tooth placement in these cases, is that of a medio-
lateral arch discrepancy and the need for a cross-bite
arrangement.
• In this case, the lingualized concept
becomes a “buccalized” one

124. 2. Modifications done in posterior teeth morphology:
SR Orthotyp Teeth
 It was Designed by Dr. R Strack in the 1950’s and
manufactured by Ivoclar Vivadent.
His morphology recognizes the three bite classifications:
Class I (normal bite –N mould)
Class II (deep bite- T mould) and
Class III (cross bite – K mould).
 They differ in the cusp angulations and the guiding surfaces.

126. • Failure to make the canine the turning point of the arch
• Setting mandibular 1st premolar to the buccal side of the
canines.
• Setting the mandibular posterior teeth too far to the lingual
side in the 2nd molar region which cause tongue interference
and mandibular denture displacement.
• Failure to establish the occlusal plane at the proper level and
inclination.
• Establishing the occlusal plane by an arbitrary line on the face.
Common errors in arrangement of teeth

127. Buccal Corridor
• Space between buccal Surface of
posterior teeth and inner surface of
cheeks.
• Excessive Buccal Corridor results when
posterior teeth are set too far lingually.
• Resulting dark space appears excessive
and unaesthetic.
• Inadequate Buccal Corridor occurs
when posterior teeth are set too far
buccally, causing obliteration of the
buccal corridor.

128. Surgical correction of severe discrepancy
In case of severe jaw size discrepancy,
surgical correction may be a successful
alternative for routine prosthetic work.
In many cases this choice may be refused
due to systemic disease or patient
aware.
Ridge osteotomy is considered a major
surgery usually done under general
anesthesia so benefits must be weighted
against harms.
Bimaxillary Osteotomy in a Young Edentulous Patient

129. Conclusion:
 Generally monoplane teeth are more adaptable for unusual jaw
relationships and permits the use of a simplified and less time
consuming technique
 Lingualised articulation is also recommended for the majority of cases
where it can easily solve most difficulties provided the principles of
balanced articulation .
 Multiple approaches deal with class II and class III edentulous
patients, any evidence based technique when followed precisely to the
right indicated patient will give successful result, but time must be
taken in diagnosing patient’s condition and deciding the correct
treatment plan.

131. References
1. Kaddah A, and Libshtien IA. (1988)) Occlusion in Prosthodontics: Varieties, aberrations and
managements.
2. Applebaum M. (1984): Plans of occlusion. In: Dental Clinics of North America:
3. Becker C.M., Swoope C.C. and Guckes A.d. (1977): Lingualized occlusion for removable prosthodontics.
Journal of Prosthetic Dentistry 38:601-608.
4. Krishna Prasad D. et al. “Enhancing Stability : A Review of Various Occlusal Schemes in Complete
Denture Prosthesis” NUJHS Vol. 3, No.2, June 2013, ISSN 2249-7110
5. Symposium on removable prosthodontics. Pp 273-285. W.B.Saunders, Philadelphia.
6. Ivoclar vivadent company
7. Occlusal considerations for partially or completely edentulous skeletal class II patients. Part I:
Background information, Thomas A. Curtis, D.D.S.
8. Occlusal considerations for partially or completely edentulous skeletal class II patients. Part II:
Treatment concepts Thomas A. Curtis, D.D.S.
9. A contemporary review of the factors involved in complete dentures. Part II: Stability.T. E. Jacobson,
D.D.S.
10. Principles And Practices Of Complete Dentures Creating The Mental Image Of A Denture -
Quintessence Pub; 1 edition (April 1999).
11. Prosthetic Treatment of the Edentulous Patient - Wiley-Blackwell; 5th edition (25 Mar 2011).
12. Techniques in Complete Denture Technology - Wiley-Blackwell; 1 edition (April 23, 2012).
13. Textbook of Complete Denture Prosthodontics - Jaypee Brothers Medical Pub; 1 edition (December 30,
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14. Textbook of Prosthodontics - Jaypee Brothers; 1 edition (December 1, 2006).
15. Simple Method For Cross-bite Setup For Complete Dentures: A Case Report. Leonardo Marchini.
16. Arrangement of artificial teeth in abnormal jaw relations: Maxillary protrusion and wider upper arch -B.K. Goyal, B.D.S.