7 try-in of the wax trial complete denture

Dr. Amal Fathy Kaddah
Professor of Prosthodontic,
Faculty of Oral &Dental Medicine,
Cairo University

When you
lose, don't
lose the
lesson

Try-in Verification / Aesthetic try-in:
 “A preliminary insertion of a removable
denture wax- up to determine the fit,
aesthetics, maxillomandibular relationships ”
 It is the last opportunity to evaluate many of the
previous steps already accomplished. Changes
are made at chairside depending upon the
esthetic needs of the patient and the opinions of
the dentist.
Importance:
GPT
Definitions

 Occlusal relationships
 Esthetics and appearance
 Phonetics
 Posterior palatal seal
 Patient comfort
Verify:
These procedures must be performed in the
sequence listed above.

1. Check the case on
articulator
2. Trying the trial denture in
the mouth:
a- Check the upper denture alone.
b- Check the lower denture alone.
c- Check upper and lower
Aspects of try- in

1. CHECK THE CASE ON THE ARTICULATOR
I. The master cast
As the finished denture is processed on the
master cast. So the master cast should be:
 In good shape and condition.
 Free from air bubbles or scratches.
 Free from wax debris which lead to improper adaptation
of the trial denture bases leading to false relationships.
 If there are any undercuts present in the cast, they
should be relieved to avoid scratching of the cast by the
trial denture bases.

II. The trial denture bases lie properly
on their casts.
 Must be stable.
 The borders should be
smooth, round, and
have no sharp edges.
 The border should be shaped to conform
to the depth and width of the sulci.
 No excess wax or other debris is attached to

Shape of the polished surface
 Duplicate appearance of normal gingiva
 Concave surfaces between marginal
gingiva and denture borders for maximum
retention

2 . The incisal pin of the
articulator.
III-III- The mounting is checked forThe mounting is checked for
 Maintaining of the vertical dimension of occlusion
• Top of the incisal pin is flushed with the upper
member of the articulator.
• The incisal pin is in contact with the incisal table.
1. The mounting rings are
firmly screwed in their
position.

3. Articulators joints.
4. Condylar path inclinations.
5. The trial denture bases lie
properly on their casts and the
teeth meet evenly in centric
relation.
6. The articulator moves
smoothly from centric to
eccentric positions without
cuspal interlocking.
III-III- The mounting is checked forThe mounting is checked for

No touch between the bases and the casts.

Accurate Mounting
Teeth interdigitate perfectly
 No space around the cusps
Condylar ball should contact fossae wall
If either criteria not met, remake record

 The teeth – Properly selected
(for aesthetic) regarding shape,
size, shade.
 Properly positioned and meet
evenly in centric.
IV-IV- The teethThe teeth
o Elimination of the excess wax is done to avoid the
camouflages of the teeth relationships to overlook
the occlusion.
o It is the dentist responsibility to select the proper
shade, and mould of the teeth and to determine that
the teeth are set correctly.

Lower
post.
Teeth
set
vertical
on the
ridge
Buccal
cusps of
lower
prem.
and
molars
positioned
on the
crest of
the ridge
Vertical
overlap
(1-2 mm)
Horizontal
overlap
(1-2 mm )
No contact
Mand.
Incisors
lingually
Inclined
Not
protruded
Labial
surf. of
6 anteriors
set in a
curve
Post.
teeth
in
max.
inter-
cusp-
ation
Post.
teeth
in
max.
inter-
cusp-
ation
0cclusion
Posterior teethAnterior teeth
Buccal
cusps
of upper
prem.
and
molars
overlap
lowers

Cervical necks tilt posteriorly from the central incisor to the canineCervical necks tilt posteriorly from the central incisor to the canine

1. The plane of occlusion should 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 bilaterally.
2. The appropriate Curve of Spee should be incorporated into the
setup.
3. Verify the position of the mandibular denture teeth.
4. Make sure the posterior mandibular teeth are centered over the
ridge

Anterior teeth Vertical overlap (1-2 mm)*
Horizontal overjet (1-2 mm )*
The amount of overlap will vary depending on condylar
inclination, occlusal plane and aesthetics.

Verify working, balancing and protrusive.
Make adjustments as necessary.

articulator
2. TRYING THE TRIAL DENTURE IN
THE MOUTH:
To reduce the risk of cross- contamination, the
trial denture should be sprayed with suitable
antiseptic solution and washed in running
water, before inserted in patient mouth.

articulator
2. TRYING THE TRIAL DENTURE IN
THE MOUTH:
a- Check the upper trial denture alone.
b- Check the lower trial denture alone.
c- Check upper and lower dentures
together.

A .CHECK THE UPPER DENTURE ALONE FOR
1 . Extension of the denture base and post dam area.‑
2. Retention and comfort.
3 . Stability to occlusal stress and relief area .
4 . Appearance of the occlusal plane in relation to the
ala tragus and interpupillary line .‑
5 . Alignment of the teeth and their support of the
facial musculature.
B . CHECK THE LOWER DENTURE ALONE FOR
1 . Retention and comfort.
2 . Extension and peripheral outline.
3 . Stability to occlusal stress.
4 . Neutral zone and tongue space.
5 . Height of the occlusal plane in relation to function

The labial and buccal denture
base extension:
 Marked overextension of the
flanges, leads to elastic recoil
resulting in dislodgment of the
denture, immediate denture
displacement after its seating.
1. Maxillary trial denture base extension
Examination of the extension:
Insertion of the upper trial denture in its place with light
pressure on the occlusal surface, move the cheek in functional
movement. With the release of the pressure, the denture will fall
down.
Need adjustment till little or no movement occurs.
A .CHECK THE UPPER DENTURE ALONE FOR

 Also under extension of the
upper trial denture leads to
poor physical retention.
Correction will usually entail making a new
final impression.
Provision of the frena {labial and buccal} should
be done to ensure that they have adequate
clearance.

 The posterior border of the upper trial denture
base should extended from the one hamular
notch to the other along the vibrating line of the
soft palate, and correctly placed on the master
cast.
 If the p.p.s is not done before, it should be done
at this stage.
 Arbitrary scraping of the cast and readapting the
record base.
Posterior extension

 It is noted that the retention of the trial denture is
less than that of completed denture, due to:
 Absence of a posterior palatal seal.
 Poor adaptation of the trial denture base to the
tissues.
 The trial denture should stay in position when the
mouth is opened.
 Looseness of the upper trial denture makes it
impossible to carry out an accurate assessment
of the occlusion {may use denture fixative}
especially, in patients with unfavorable
anatomical factors
2. Retention

 Seat the upper trial denture with a firm
upward and backward pressure.
 Allow the tissues to settle around the
denture
 Grip the labial and lingual surfaces of the
upper denture teeth between the thumb
and forefinger
 Apply a firm downward vertical pull to
dislodge the denture away from the tissues
How to test the retention of upper denture?
 If the retention is good, dislodgment of the trial denture may
be difficult

Test for retention
Applying a tipping
force to the
anterior incisors to
break the seal
Apply upward & outward pressure
on the canine to test the seal at
tuberosity area at the opposite
side.

Pull upward & outward on canine to
test the seal at post dam /
retrozygomal seal

Applying a pulling force
vertically and downward
to the anterior incisors to
test for the retention and
the peripheral seal of the
anterior labial part
Applying a upward and
outward pressure to
the cigulae of the
opper anterior incisors
to test for the
posterior palatal seal
Test for retention

It is tested by applying pressure in a tissue ward
direction with the ball of the index finger in the
premolar and molar regions on each side alternately.
This pressure must be directed at right angles to
the occlusal surface where displacement does occur.
3. Stability
if, vertical pressure causes denture to tilt and raise on
the other side = teeth on the side of the applied
pressure are outside the ridge.

 Causes of instability
 Warpage of the denture base.
 Hard unrelieved area in the midline
e.g. Median palatine raphe and torus
palatinus.
 Posterior teeth set buccal to the
underlying alveolar ridge

Check for looseness in excursions
with fingers on canines

 Denture base
(fit & contour)
 Poor anatomy
 Occlusion
Denture Looseness

Typical History
Adequate retention initially
Gets worse with time
Clinically:
No discomfort when press firmly on 1st
molars
Denture Looseness due to
Occlusion problems

Denture Looseness due to Occlusion problems
a. Perpetually Loose Maxillary Denture

Incisors placed too far labially
Denture displaces lingually.
Inclined ridge provides no resistance.
Inclined Residual Ridge
b. Lower Incisors placed too far labially

 Contacts not
centered over ridge
 Contacts on inclined
portion of ridge
c. Tilting/ jiggling caused by:

 Even, stable
contacts both
sides
d. Check centric position (articulating
paper)
 Stop patient upon initial contact

Oriented occlusal plane is important to:
 Patient aesthetics.
Patient comfort
Chewing function
Balance of occlusion
4. Orientation of the occlusal plane

 Parallel to the inter-pupillary line anteriorly.
 Parallel to the ala-tragus line posteriorly.
4. Orientation of the occlusal plane

 Height of the occlusal plane:
 For normal patient: 2 mm of the incisors
should be seen, when the lip is at rest.
 For a patient with short lip: 5 to 6 mm of
the incisors should be seen.

 Orientation of the anterior
end of the occlusal plane is
determined by esthetics.
 The movement of the lips
during function varies
considerably among
patient thus, the amount of
the upper teeth that will be
visible varies for each
patient.

Incisors tooIncisors too
longlong
The amount of the upper
anterior teeth that will be
seen during speech and
facial expression depends on
length and movement of the
upper lip Too much amount of teeth.

5. Alignment of the anterior teeth
and the support of the
musculature:
 The vermilion border of upper
lip, angles of the mouth,
philtrum and the nasolabial
sulcus should assume a normal
contour.

 Insufficient lip support:
 Cause:
 Anterior teeth too far posteriorly
 Improper waxing up
 Characterized by:
 Drooping of the angle of the mouth,
 Deepening of nasio-labial sulcus
 Wrinkles above the vermilion border.
 Treatment:
 Placing or tilting the anterior teeth more labially and/or
proper waxing up of the flange will improve the
appearance.

Unsupported lip
Lip Support Assessment.

• Characterized by:
Stretched tight
appearance and loss
of contour of philtrum.
 Excessive lip-support:
 Cause:
 Forward placement of anterior teeth.
 Excessive waxing up of labial flange

 Hold the denture in place
with light pressure and the
patient mouth is slightly
opened to allow the
surrounding Musculature to
be in an acceptable state of
relaxation.
B . CHECK THE LOWER TRIAL DENTURE ALONE FORB . CHECK THE LOWER TRIAL DENTURE ALONE FOR
1. Denture base extension:

 Put the tip of his tongue as far back on
his palate as possible:
If the denture lifts in the front, it is
overextended anteriorly; probably in the
region of the lingual frenum.
 Ask the patient to protrude
the tongue sufficiently to
moisten his lips
If denture lifts at the back =
Overextended of the lingual
pouch.

Place his tongue -successively
in each superior buccal
sulcus:
If the denture lifts, the lingual
extension is deep.
Labial and buccal extensions are
checked as for the upper trial
denture.

Flange bulges into tongue space,
lifts denture during function.
Flange is not
too long.
Denture looseness
Too thick mandibular lingual flange

2. How to evaluate lower denture retention?
 Usually the lower denture
retention is poor when
compared to the upper
denture due to:
1. Small denture bearing area
2. The difficulty in obtaining
an efficient border seal.

a) Hold the denture in place with light pressure and ask
the patient to open his mouth slightly to allow the
surrounding musculature to be in an
acceptable state of relaxation.

b) let his tongue touch the cingula of the
lower anterior teeth, support the chin
of the patient with the left hand and
pull the teeth straight upwards to
check the retention of the anterior

c) Tilt the lower trial denture
outward from the canine
region to test the retention
of the opposite retro molar

3- Lower occlusal plane
 In most patients, the incisal
edges of the natural lower
canines and the cusp tips of the
lower first premolars are
located at the level of the lower
lip at the corner of the mouth
when the mouth is slightly
open.
 The posterior end of the
occlusal plane should be
at the level of the
anterior two thirds of the

The tongue brings the food onto the occlusal
plane then it holds the food between the upper
and lower teeth cooperating with the buccinator
muscle so that the food can be easily crushed.
X
Efficiency of mastication

4. Lack of tongue space
(cramped tongue)
 If the tongue is more mobile
than the cheeks will cause
greater instability of the
lower denture.
 Cramped tongue may be due
to:
1. Posterior teeth set lingually to the
neutral zone.
2. Posterior teeth tilted lingually

Testing of the tongue space
Ask the patient to
raise the tongue. If
the tongue is
cramped, the
denture will begin
to rise immediately.As the tongue moves it tries to expand
laterally and whenever the tongue moves
the denture will move.

To check for the neutral zone
let the patient open his mouth
half-way and touch the lower
anterior teeth with the tip of his
tongue, while his tongue is
relaxed.
Feel the amount of pressure
exerted by the tongue and cheek
on the lower teeth, using a
plastic filling instrument.
Pressure should be roughly
equal on the lingual and buccal
sides of the teeth.

1. Vertical dimension of centric occluding
relation and free way space.
2. Centric relation i.e. antro posterior and‑
lateral dimension at centric occlusal.
3. Free articulation and balanced occlusion.
4. Equilibration of occlusal pressure.
5. Appearance of the face and teeth.
6. Phonetic tests.
7. Pleasing, comfort and approval by the
patient.
C . CHECK BOTH DENTURES
TOGETHER FOR

 Appearance of anterior teeth
 Accuracy of maxillomandibular
records
 Esthetic appearance of face and teeth.
Occlusal Plane
Midlines
Off
Verify:
C . CHECK BOTH DENTURES
TOGETHER FOR

 Phonetics & aesthetics
 Facial dimension &
facial expressions
 Lip length in relation to
teeth
 Inter arch distance & parallelism of the ridges
 Swallowing
1. Verifying the Vertical dimension1. Verifying the Vertical dimension
“VDO”

1. Verifying the Vertical dimension1. Verifying the Vertical dimension
 Evaluation of vertical dimension at
rest & at occlusion
 The amount of inter occlusal distance
to which pt. was accustomed
 When the teeth are in centric occluding
relation, the patient’s face should produce a
pleasing appearance.
 The patient should be able to speak without
clicking of the teeth. If the teeth click
together, this indicates that the interocclusal
clearance is insufficient, and that the denture

 Pt. is guided into CR by a
thumb placed on the
anteroinferior portion of the
chin & index finger bilaterally
on the buccal flanges of the
lower denture.
 Any Error in CR will be
apparent when teeth slide over
each other.
2. Verifying Centric Relation and2. Verifying Centric Relation and EvenEven
occlusal bearingocclusal bearing

If centric jaw relation was
found to be wrong, and the
teeth do not occlude
properly.
New centric record is
needed and the
The articulator
must close in the
hinge position
without condylar
displacement

1. Contact during protrusion. At least three
widely separated points or areas of occlusion
must exist.
3. Verifying Eccentric relation records3. Verifying Eccentric relation records

Mandible must be brought forward 5-6 mm short of
tooth contact while maintaining the mandible in the
midline
Setting the Condylar
Inclination

Contact during lateral movement
Working side Balancing side
3. Verifying Eccentric relation records3. Verifying Eccentric relation records

4.Testing equilibration of occlusal4.Testing equilibration of occlusal
pressurepressure
 The patient is asked to occlude on
two thin celluloid strips placed
between the posterior teeth, one on
each side.
 The patient should occlude while the
jaws are in centric relation.
 Equal pulling forces of the celluloid
strips simultaneously mean equal

1. Appearance of entire lower half of
face should be finally confirmed
after vertical dimension of
occlusion & CR has been verified.
2. Incorrect positioning of anterior
teeth or supporting base material
alters normal appearance of
vermilion border, the philtrum &
mentolabial sulcus.
5. Appearance of face and5. Appearance of face and
teethteeth

 Creating facial and functional
harmony with anterior teeth
 Position of the central line, VD
and CR
a. Evaluation of selection of artificial teeth
 Shape, size and shade and position of the selected
teeth
 Amount of teeth visible, horizontal, vertical
orientation and inclination of anterior teeth
 Regularity of teeth, spaces, smile line

 6 anterior teeth should be
of sufficient overall
width to extend approx.
corner of mouth
Evaluate size, form & color of teeth
 Color should blend with the face
 Any records used in initial selection should
be consulted & changes should be made if it
improves the appearance of patient.

Labial surface of many natural central
incisors are about 8 – 10mm from center
of incisive papilla
b. Horizontal orientation of anterior
teeth

Excessive lip support causes
Stretched lips.
tendency of lips to dislodge
dentures during function.
Elimination of normal
contours of lips, philtrum &
sulci.
teeth

A, Anterior teeth have been set too far out into labial
sulcus.
B, resulting incompetence of the resting lips.

Teeth set directly over ridges causes
insufficient lip support characterized by:
 Drooping of corners of mouth
 Reduction in visible part of vermilion
border
 Deepening of nasolabial sulcus
 Wrinkles over vermilion border
teeth

Facial support affected by:
Position of the incisal edge
Thickness and contour of the labial flange
Gingival contours
Note the contour
of the vermillion
border region.
Without denture With denture

PlumpingPlumping:
Cheeks& lip falling-
in, Unsupported lip
and cheek
(Building – out the
upper denture to
compensate for the
loss of muscular
tone) Smile view of the patient

Sunken lips and cheeksSunken lips and cheeks
Cheeks and lips falling inCheeks and lips falling in because teethbecause teeth
have been set too far lingually or havinghave been set too far lingually or having
insufficient width to the buccal and labialinsufficient width to the buccal and labial

Most elderly patients require
the lip support provided by
the labial flange of the
denture

Intraoral Assessment of
Anterior Teeth
Nasolabial angle
≈ 90°
If insufficient
support, the
vermilion border
will be reduced

• Junction of oral
mucosa (glossy) should
just be visible when
lips are slightly
separated
Intraoral Assessment of
Anterior Teeth
• If not visible - insufficient
support
• Lips meet at junction of
oral & transitional

Sagging face
Notice the lift to the face and
lips

1. Verify length of upper lip.
2. Lower lip is better guide for
vertical orientation of
anterior teeth.
Incisal edges of lower canine &
cusp tip of lower first
premolar are even with
corner of mouth when mouth
c. Vertical orientation of anterior
teeth

1. If lower teeth are above then,
plane of occlusion may be
too high
2. Vertical overlap of anterior
teeth may be too much high
3. Vertical space between the
jaws may be excessive
c. Vertical orientation of anterior
teeth

As the occlusal vertical dimension is too
small, the vermilion border appears thin
and wrinkles occur around the lips. The
chin is apparently protruded.

Intraoral Assessment of Anterior Teeth
Incisal edges of
maxillary incisors
should follow line
of lower lip when
smiling
(‘smile line’)

A typical esthetic display of the maxillary
anterior teeth. The central incisors are
aligned with the midline and the laterals and
cuspids are elevated off the occlusal plane.
Esthetic Determinants of Anterior
Tooth Placement

6. Phonetic Tests6. Phonetic Tests

 “F” and “V” position
 “S” position
Phonetic Tests Clinically
determined by

Note the relationship between the “F”
and “V” position
The Dental- Labial Consonants:

These sounds are made
with the tip of the tongue
against the palate in the
rugae area with small
space or slit like channel
for the escape of air
between the tongue and
hard palate.
The Linguo-Dental Consonants:
The size and shape of this small space or
channel will determine the quality of the

The Linguo-Dental Consonants:
Effects of vertical positioning of anterior teeth on
the pronunciation of th. A. The tongue is prevented
from extending properly between the teeth.
B. The tongue extending between the teeth when
they are properly positioned

01/16/19
• Always check on the total
length of the upper and
lower teeth (including
their vertical overlap)
• The upper and lower
incisors should approach
each other end-to-end,
but they should not touch
that indicate a possible
error in the amount of
horizontal overlap of the
anterior teeth.

 Note the relation of the maxillary to
mandibular
During the production of sibilant sounds The mandible
travels down and forward to create a small space (a space
of about1 mm) is created between the maxillary and
mandibular incisors during the production of sibilant
“S” position

 In most patients the labial
surface of the mandibular
incisors should be roughly
perpendicular to the
occlusal plane.
 The initial vertical
overlap is 1.0 mm
and the amount of
horizontal overlap is
1.5 mm.

The Lateral Incisors and Cuspids
The horizontal overlap should be consistent throughout
the anterior region. It should be about 1.5 mm.

01/16/19 117
If the channel formed
between the hard palate
and the tongue is too
narrow and deep
Whistling
Lisping “Sh” sound
if the depth of the
channel is further
decreased or
obstructed
Lisping and whistling are opposite phenomena
If this channel is too
shallow (broad and
thin)
Lisping (th or etts)

7- Patient's approval7- Patient's approval
Pleasing, comfort and
approval by the patient.

8- Fabrication of Remount Jig8- Fabrication of Remount Jig
(Occlusal index for clinical remounting)(Occlusal index for clinical remounting)
At the end of the try in stage where
the dentist and patient are both
satisfied.
This is a time save procedure for you
because you do not have to make a
new facebow record at the time of
delivery.

Place the Facebow remount jig on
the lower member of the
articulator. Verify that the incisal
guide pin is set at zero. Allow
plaster index to completely set.
Verify that the maxillary teeth can
be repositioned into the

Clinical Remounting ProcedureClinical Remounting Procedure
 Guide mandible into CR
 Obtain the new
interocclusal record of
C.R. using your recording
medium of choice, making
sure that the teeth do not
touch. ???

Do I need New
Face bow
RECORD?????????
Remount upper
denture using
remounting jig
Clinical RemountingClinical Remounting
ProcedureProcedure

Mounting the lower cast with new
CJRR
Make sure the denture bases are
not contacting posteriorly.

7 try-in of the wax trial complete denture

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