9 new denture insertion

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬

2. Complete Denture Insertion
& Patient Instruction

3. Objectives of Complete denture insertion appointment:
The main objectives :
1- evaluation of the impression surface , to identify and
correct potential areas that will cause soreness or
discomfort to the patient
2- evaluation of the denture borders that may affect the
retention and stability of the denture
3- evaluation of the polished surface that may affect
esthetics or denture retention

4. Objectives of Complete denture insertion appointment:
The main objectives :
4- refinement of the occlusion
5- instruct the patient in correct use and care of the
denture, for rapid adaptation and efficient usage
6- advise the patient on the limitations of the denture
to be expected

5. If the patient using an old denture , he must prepare
for the denture placement appointment by leaving the
old denture out of the mouth for at least 48 hours. This
permit the soft tissues to return to a relatively healthy,
undistorted form.

6. Evaluation of the tissue surface and
denture borders

7. Evaluation of the tissue ( impression ) surface and denture borders:
1- extra oral examination:
Visually, digitally , or by using piece of cotton for voids, porosities or
sharp edges, and prominences of acrylic resin
Corrected by grinding stone to avoid mucosal irritation, pain and
patient discomfort

8. Evaluation of the tissue ( impression ) surface and denture borders:
2- intra oral examination :
By application of thin coat of pressure indicating paste using brush
with coarse bristles in a dry denture surfaces
then gently seat the denture in the patient mouth
To detect ( interpretation) pressure areas, or areas of no contact,
relief areas or normal areas
Over or under extended borders , frenal areas

11. Refinement of occlusion

12. Causes of occlusal discrepancies:
1- errors during jaw relation registration
2- errors in mounting the casts on the articulator
3- processing errors
4- dimensional changes of the acrylic denture base
materials

13. Refinement of occlusion ( correction of occlusal discrepancies):
1- Intra oral technique:
- Articulating paper
- Occlusal indicator waxes
-Abrasive paste
2- Extra oral technique:
-Laboratory remounting
- Clinical remounting

14. 1- Intra oral technique:
-Articulating paper:
-Not give accurate indication of premature contact
Due to the resiliency of the tissues , shifting the
denture producing false and misleading marking
- Saliva may affect marking

15. Occlusal indicator wax:
Two strips of adhesive green occlusal indicator wax placed on the occlusal
surface of posterior teeth
Any perforation is marked and corrected
Abrasive paste:
not preferred as it cause loss of vertical dimension, loss of tooth sharpness of
anatomic teeth & accentuate the errors of the occlusion by denture base
shifting.

16. 2- Extra oral adjustment technique:
By remounting and selective grinding on the articulator
Advantages:
1- Reduce patient participation
2- Permit the operator to see better what he is doing
3- Provide stable working foundation ( no shifting on resilient tissues)
4- Absence of saliva give more accurate markings
5- Adjustment can be made away from the patient , preventing the objections
when the patient see the denture being ground
Types:
1- Laboratory remounting
2- Clinical remounting

17. LABORATORY REMOUNTING
After processing , dentures should be returned on their master casts before
separation to their original positions on the articulator mounting
Can be easily accomplished by using split cast mounting plates
Or by notching the base of the master cast to create a key in the mounting
plaster

18. LABORATORY REMOUNTING

20. CLINICAL REMOUNTING
Remounting the finished dentures on an articulator by using a
new face bow record or face bow remounting index and
new interocclusal record made in the patient mouth

21. CLINICAL REMOUNTING
New Face Bow record

23. Face bow remounting index

24. CEA
• Place both dentures in
the patient’s mouth
• mandible is guided in a
hinge movement.
• Obtain interocclusal
record of CR.

26. CEA
Selective grinding
The art of reducing premature
contacting surfaces, so that an
equal pressure exists at all points
without interference.

29. Perfection of occlusion

30. Perfection of occlusion
Centric occlusion:
If there is Premature contact deepen
the fossa
if the cusp making premature contact
in centric and eccentric position , so
reduce the cusp

31. BULL Rule

32. Balancing side contact

33. Protrusive contact

34. Patient Education and
instructions

35. Patient Education and instructions:
To till the patient what can be expected during the
post-placement period, over an extended period of
time, and the expected longevity of the prosthesis
The limitation of the prosthesis, the adjustment period
Verbal and written instructions
To achieve the objectives of complete denture
treatment

36. 1- initial sensation : temporary feeling of fullness, tongue may be
crowded, upper lip may feel distended ……. Normal feeling
disappear shortly by habitution
2- excessive saliva: which may affect retention , normal , slowly
decreased
3- mastication with new denture:
masticatory efficiency slowly developed and refined by time
- soft food, small pieces, extended time , on both sides , avoid
using anterior teeth for incising, avoid sticky, tough food

37. 4- difficulty with the mandibular denture:
-Small surface area,
- surrounded by the tongue, cheek and lip muscles
- flow and pooling of saliva
-Depend on proper tongue position for peripheral seal and stability
5- Tongue training : to help the stability of the denture especially
the lower
6- Speaking with new denture: the speech may be distorted at the
beginning , due to the feeling of bulk, altered in the intra oral
anatomy, teeth position and excessive salivation
So, reading a loud, and avoidance of rapid speech will correct the
minor difficulties

38. 7- coughing and sneezing: the patient should cover the mouth to
avoid dislodgement by the explosive muscle movement
8- wearing denture at night:
Only at the 1st 10 days for adaptation
Then must be left out of the mouth at night to: provide rest from
the stresses on the residual ridge , avoid clinching and broxism, to
avoid tissue inflammation, infection, and ridge resorption

39. 9- Denture irritation: may be expected
10- care of oral tissues : massaging and brushing with soft brush
11- Denture hygiene:
12- recall procedure : 1st recall after 24 hours