7-Try-in of the wax trial complete denture

Dr. Amal Fathy Kaddah
Professor of Prosthodontic,
Faculty of Dentistry
Cairo University

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 dentures together.
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 it

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- The mounting is checked for
1. The mounting rings are firmly
screwed in their position.
 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.

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

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.

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
maximum
inter-
cusp-
ation
0cclusion
Posterior teeth
Anterior teeth
Buccal
cusps of
upper
prem. and
molars
overlap
lowers

Cervical 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

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.

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

Butterfly in shape
Posterior Nasal Spine
Velum

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

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
upper anterior incisors to test
for the posterior palatal seal
Test for retention

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 post dam/
retrozygomal and tuberosity area at the
opposite side.

 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 / Denture Looseness
 Poor Retention
 Warpage of the denture base.
 Unrelieved area in the midline e.g. Median palatine
raphe and torus palatinus.
 Posterior teeth set buccal to the underlying alveolar
ridge
 Poor anatomy

 Denture base (fit & contour)
 Occlusion
 Poor anatomy
 Causes of instability / 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

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

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

 Even, stable
contacts both sides
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.

 The amount of the upper teeth that
will be visible varies for each
patient. Orientation of the anterior
end of the occlusal plane is
determined by esthetics.

Incisors too long
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 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) Pull the teeth straight upwards to check the
retention of the anterior labial and lingual flanges.
let his tongue touch the cingula of the lower
anterior teeth, support the chin of the patient with
the left hand and

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

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 retro molar
pad.

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
3. Posterior teeth too broad bucco-lingual.

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 dimension
“VDO”

 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
has excessive occluding vertical dimension.
1. Verifying the Vertical dimension

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

 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 and Even occlusal bearing

If centric jaw relation was found to be wrong, and the
teeth do not occlude properly. New centric record is
needed and the articulator’s mounting should be changed.
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 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
3. Verifying Eccentric relation records
Working side Balancing side

4.Testing equilibration of occlusal pressure
 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 occlusal pressure

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 and teeth

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
 Creating facial and functional harmony
with anterior teeth
 Position of the central line, VD and CR

 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 – 10 mm 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.
b. Horizontal orientation of anterior teeth

A, Anterior teeth have been set too far out into labial sulcus.
B, resulting incompetence of the resting lips.
and C, excessively full lip appearance.

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

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

Plumping: 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

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

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

 Verify length of upper lip and Lower lip
which is a 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 is slightly
open.
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

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

 “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 sound

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
The Linguo-Dental Consonants:

11/22/2021
•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 sounds.
“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.

11/22/2021 106
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 approval
Pleasing, comfort and approval
by the patient.

8- Fabrication of Remount Jig
(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 indentations.

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

References:
1. Boucher, C. O., Hieckey, J. C. and Zarb, G. A.: Prosthodontic treatment for edentulous patients. 2nd ed., C. V. Mosby Co. St.Louis, 2000.
2. Eissman, M.R.: Dental laboratory procedures, complete denture, C.V. Mosby company, St. Louis, Toronto, London, 2000.
3. El Mahdy, A. S.: Complete Denture Prosthesis. Anglo-Egyptian book shop, Cairo, Egypt. 1968.
4. Hassaballa, M. A.: Clinical complete denture prosthodontics. 1st edition. Academic Publishing and Press, Riyadh, Saudi Arabia, 2004.
5. Iwao Hayakawa: Principles and Practices of Complete Dentures creating the mental image of a denture, Tokyo Medical and Dental University, Tokyo,
Japan. Quintessence Publishing Co., Ltd. 1999.
6. Iwao Hayakawa: research profile on BiomedExperts,The Journal of prosthetic dentistry 2007;98(2):141-9. 2007.
7. Iwao Hayakawa: Principles and practices of complete dentures: creating the mental image of a denture, rapidshare.com, 27 Dec 2009.
8. Kaddah, A. F.: OCCLUSION IN PROSTHODONTICS, Varieties, Aberrations & Management. Dar El-Etehad. First Co. First ed. Cairo Egypt. 98/7071, 1998.
9. Tamer El-Gendy: Introduction to complete denture, Didactic and Laboratory Manual, Course Director: Tamer El-Gendy BDS, MS. Assistant Professor.
COLLEGE OF DENTISTRY, THE OHIO STATE UNIVERSITY.2000.
10. Winkler, S.: Essentials of complete denture prosthodontics. 2nd ed., PSG Publishing. Co. Inc., 2005.
11. Zarb, G. A., Bolender, C. L., Hickey, J.C. and Carlsson G. E.: Boucher’s Prosthodontic Treatment for Edentulous Patients, ed. 12th . St. Louis Mosby, 2000.
Internet Sites:
- Full denture relining using Tokuso Rebase, By Dr. David J. Sultanov, DMD, Pittsburgh, PA. Information provided by J. Morita USA. The British Dental Journal
is published by Nature Publishing Group for the British Dental Association.© 2002 British Dental Association
- http://www.dentistry.bham.ac.uk/ecourse/pros/casetreat_w3.asp
- http://www.tpub.com/content/medical/14274/css/14274.
- The School of Dentistry, Birmingham UK
- Treatment options for edentulous spaces. Dr David C. Attrill d.c.attrill@bham.ac.uk
Lectures and PowerPoint® presentation slides:
- Full denture relining using Tokuso Rebase By Dr. David J. Sultanov, DMD, Pittsburgh, PA. Information provided by J. Morita USA
- Lectures Posted by dental products .net. Originally published in the April 2001 Dental Products Report. Copyright 1999-2005 Advanstar Dental
Communications.
- Lectures Produced in the United States of America. ISBN 0-7216-9770-4
- Related Links: About Tokuso® Rebase; Rationale for relining; Tips for success.

7-Try-in of the wax trial complete denture

7-Try-in of the wax trial complete denture

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7-Try-in of the wax trial complete denture