1.
MINIMAL VISIT
COMPLETE DENTURE
DIFFERENT TECHNIQUE OF FABRICATING
COMPLETE DENTURE IN SHORTEST
CLINICAL TIME
PRESENTED BY:
Dr. Anshul Sahu
MDS Final Year

2.
CONTENTS:
• INTRODUCTION
• REVIEW OF LITERATURE
• DIFFERENT TECHNIQUES
• THREE-VISIT, COMPLETE-DENTURE TECHNIQUE
UTIIIZING VISIBLE IGHT-CURED RESIN FOR TRAY AND
BASE PIATE CONSTRUCTION
• 3D CD - THREE DAYS COMPLETE DENTURE TECHNIQUE
FOR COMPROMISED GERIATRIC PATIENTS
• CAD/CAM TECHNOLOGY: APPLICATION TO COMPLETE
DENTURE
• SUMMERY & CONCLUSION
• REFERENCES

3.
INTRODUCTION:
• Edentulism has been a serious public health problem in
industrialized countries due to population aging and in
developing countries due to poor oral care.
• Complete dentures are 1 mainstay choice for edentulous
patients. The demand for complete dentures will
continuously increase in the next decades.
• Currently, complete dentures are mainly designed and
fabricated using conventional methods, which involve a
broad series of clinical and laboratory procedures.

4.
• To obtain complete dentures, edentulous patients
typically have to make 5 visits to the dental clinics,
including preliminary impressions, final impressions,
recording jaw relations, trial placement of wax denture,
and placement/insertion of complete dentures.
• Dentists may want to consider using an update of a
unique complete denture technique that saves total chair
time and, therefore, decreases cost.
• Various attempts have been made to reduce complete-
denture procedures to four visits, three visits or less.

5.
REVIEW OF LITERATURE
• In 1953, Swenson reported using four appointments
instead of the usual five to construct complete maxillary
and mandibular dentures.
Swenson MG. Complete Dentures, ed 3. St Louis: Mosby,
1953:384-395,

6.
• In 1992, Harvey and Brada improved on Swenson's
technique by combining the impression and jaw-relation
appointments into one appointment and using triad
visible light-cured resin (VLC, Dentsply International).
Update of a one-appointment master impression and jaw
relation record technique. Quintessence Int 1992;23:547-
550

7.
• In 1994, Maeda et al developed a computer-aided
system including a work station for determining artificial
tooth arrangements, occlusion, the outline of polished
surface, and denture border location using a knowledge
data base.
• A complete denture was fabricated from
photopolymerized resin composite material using a 3D
laser lithography machine via printing, but this complete
denture had poor mechanical properties such as the
strength, thus being unusable in patients.
"A CAD/CAM system for removable denture. Part I:
Fabrication of complete dentures." international Journal of
Prosthodontics 7.1 (1994).

8.
• In 2001, Duncan JP and Taylor TD compared the
conventional method and shortened method for
complete denture fabrication and concluded that stock
tray impressions made in alginate significantly reduced
the visits. The corrective procedures required in
conventional and abbreviated technique showed no
significant difference in a 3 month follow-up period.
Teaching an abbreviated impression technique for
complete dentures in an undergraduate dental curriculum.
The Journal of prosthetic dentistry. 2001 Feb 28;85(2):121-
5.

9.
• In 2005, Kawai Y et al in a randomized control trial
showed there to be no major difference in conventional
and simplified technique in relation to the satisfaction of
the patient or the objective denture quality.
Do traditional techniques produce better conventional
complete dentures than simplified techniques. Journal of
dentistry. 2005 Sep 30;33(8):659-68.

10.
• In 2017, Owen CP and MacEntee MI have described a
technique CD3 to provide dentures in three clinical
appointments. This technique is based on abbreviated
technique involving three clinical sessions.
• There were no significant differences in masticatory
performance or chewing ability after 6 months between
complete dentures made by a conventional or an
abbreviated technique.
"A Randomized Controlled Trial of Mastication with
Complete Dentures Made by a Conventional or an
Abbreviated Technique." International Journal of
Prosthodontics 30.5 (2017).

11.
A three-visit, complete-denture technique
utilizing visible
light-cured resin for tray and base plate
construction
• This article presents a system for making maxillary and
mandibular complete dentures in three appointments
without omitting any procedure used in the traditional
five-visit method of construction.
• It retains the use of modem, highly developed, popular,
proven cross-linked heat-cured polymethylmethacrylate
as the denture base material for the completed dentures.
This technique also eliminates the need for laboratory
procedures associated with the first three visits of the
traditional method for complete-denture construction.
Ling, Booi-Cie. "A three-visit, complete-denture technique
utilizing visible light--cured resin for tray and base plate
construction." Quintessence international 35.4 (2004)

12.
• METHOD & MATERIALS
 First Appointment:
 Primary Impression
 Incorporation of Biometric wax occlusal rim
 Final Impression
 Maxillomandibular relation record
 Second Appointment:
 Try in
 Third Appointment:
 Denture Insertion

13.
MATERIAL REQUIRED:
• Visible light-cured resin (VLC, Dentsply International)
• Anatomic Tray such as Carboxylate Tray, Xantalgin
(Bayer Dental)
• Biometric wax occlusion rim

14.
FIRST APPOINMENT
• This is made possible by using Visible light-cured resin
(VLC, Dentsply International) material as the preliminary
impression material. The resulting light-cured impression
is then used as the tray, as well as the base material, for
the occlusion rim to be used in a combined closed-
mouth final impression and maxillomandibular relation
record.

15.
PRIMARY IMPRESSION:
VLC material spread in
Carboxylate tray
Impression is made, uncured removed from
Mouth
Excess VLC material Deficient VLC material
Cut off with sharp knife New material added
After removal from the mouth, the tray is then put in a light
box to cure the VLC material for 3 to 5 minutes.
The cured VLC-resin impression is then removed from
the tray

16.
Mandibular poly-carboxylate tray with an impression of
the mandibular edentulous ridge made with visible
light-cured base/tray material

17.
Light-poiymerized impression,
separated from the Xantaigin tray

18.
WHAT IF WE DON’T HAVE ANATOMIC TRAY???
• Alternatively, metal stock tray can be used in following
manner:
Primary impression is made with elastomeric putty/impression
compound/ alginate
1.5 to 2 mm of the material is then cut off from the labial, buccal
frenum; the labial and buccal sulcus extension of the impression;
as well as any undercut areas
A sheet of the VLC material is then laid over the initial preliminary
impression, and an impression is made with the VLC material,
uncured
The tray is removed from the mouth, and excess VLC resin is
removed. The tray is then reinserted into the mouth and border
molded
Placed in a light box for 3 to 5 minutes to cure the VLC material
Cured VLC tray is then removed from the stock tray

19.
Mandibular metal stock tray with the initial preliminary
impression made in impression compound.
The VLC base/tray
cured and separated from the initial compound impression.

20.
Maxillary stock tray containing the initial
preliminary impression in irreversible hydrocolloid, and the
final impression tray made with VLC material cured and
separated

21.
Preliminary VLC impressions trimmed, ready for
incorporation of the biometric wax occlusion rim to form the
base plate for making the closed-mouth final impression
and maxillomandibular
relation record.

22.
INCORPORATION OF BIOMETRIC WAX OCCLUSION
RIM:
Biometric wax occlusion rim is soaked in a bowl of warm water
(45'C to 55'C) for approximately 5 minutes
Now is blow dried with compressed air; its fitting surface
heated over the Bunsen flame or blow torch; and is adapted
onto the VLC tray
VD at rest is measured, Desired OVD achieved. Necessary
correction done (i.e lip fullness, Incisal visbility)

23.
FINAL IMPRESSION:
• The impression trays/ base plates are now ready for a
closed-mouth impression technique.
• Border molding done using green stick or putty.
• The patient is instructed to leisurely perform the normal
functional movements viz. swallowing, speaking, smiling,
yawning, whistling, pursing and wetting the lips.
• An impression is then made of the maxillary and
mandibular edentulous ridges with a metallic oxide eugenol
or an elastomeric impression material.
• Both maxillary and mandibular impressions can be done
simultaneously using a closed-mouth impression technique.

24.
• Alternatively, the maxillary impression can be made first,
using an open-mouth impression technique, followed by
the mandibular impression using a closed-mouth
technique, with the mandibular record base and rim
occluding with the maxillary in centric relation.

25.
MAXILLOMANDIBULAR RECORD:
• Patient is guided into the desired centric-relation jaw
position
• Maxillomandibular relationships are recorded using
metallic oxide eugenol-based bite registration paste or
elastomeric bite registration paste.
• The various reference lines such as lip line, canine lines
and middle line are marked on the occlusal rims.

26.
SECOND APPOINMENT
• Trial denture. This visit is the same as the fourth visit for
the conventional five-appointment method of denture
construction.
• During this visit, assessment of the trial denture by the
clinician and patient is made for accuracy of the centric
relation position, the interocclusal clearance, phonetics,
and the esthetic quality of the trial denture
• Any correction should be done at this stage before
processing the denture.

27.
THIRD APPOINMENT
• Denture insertion. During this stage, dentures are
delivered to the patient. Fit, phonetics, occlusion, and
patient satisfaction are verified. The patient is given
instructions on the use and care of the new prostheses.

28.
ADVANTAGES:
 All clinical steps is included
 Easy to applied
DISADVANTAGES:
× Little Bit expensive
× Requires additional curing unit

29.
3D CD - Three Days Complete Denture
Technique for Compromised Geriatric
Patients
• This article presents a case in which a completely
edentulous patient was treated with a rapid method of
treatment 3D CD (Three day complete dentures)
technique, in which the treatment was completed in
three appointments instead of conventional five
appointments. The impression procedures were carried
out in a single appointment along with ANTAG (Anterior
teeth arrangement guide) fabrication followed by jaw
relations recording along with maxillary anterior try-in
and ultimately insertion of complete dentures.
Lodha M, Patil SB, Bhat S, Chaudhari N, Kant A.3D CD - Three
Days Complete Denture Technique for Compromised Geriatric
Patients. Int J Oral Health Med Res 2016;3(1):126-130

30.
• METHOD & MATERIALS
 First Appointment:
 Primary Impression
 Final Impression
 Second Appointment:
 Maxillomandibular relation record
 Maxillary anterior Try in
 Third Appointment:
 Denture Insertion

31.
FIRST APPOINMENT
• On this appointment, maxillary and mandibular
impressions were made, and ANTAG (Anterior Teeth
Arrangement Guide) is fabricated.

32.
• PRIMARY IMPRESSION:
Perforated stock metal trays for edentulous arches is
selected
The wax is adapted on the tissue side of the trays in the
canine and first molar areas and sufficiently softened,
and trays is placed in the patient's mouth such that the
borders of the trays were away from the sulcus areas in
function
The trays were removed and immersed in chilled water
for the wax strips to harden. These wax strips acted as
tissue stops

33.
Impressions is made for the maxillary and mandibular
arches subsequently with putty consistency addition
silicone elastomeric impression material

34.
• SECONDARY IMPRESSION:
The borders of primary impressions is reduced using a
sharp knife 2 mm short of the sulcus in both the maxillary
and mandibular impressions
Notches is made on the borders about 1mm deep and wide
such that they created an undercut for retention of the
border molding material to be added
This impression acted as a custom tray for border molding
and wash impression
Same putty consistency material is mixed added to the
borders of the impressions. The trays were placed in the
mouth, and functional movements are carried out

35.
The impressions are retrieved and checked for any
discrepancies
The borders were then trimmed by another 0.5mm and
wash impressions are made using light bodied
consistency addition silicone material

36.
• ANTAG FABRICATION
Modeling wax and sticky wax are mixed in a ratio of
approximately 4:1 by volume in a hot water bath
When the mixture was sufficiently soft, it is tempered and
adapted to the patient's anterior maxillary ridge with tin
foil on the tissue side. After it is sufficiently hardened it is
removed
The wax is added subsequently on the labial and incisal
aspect of the ANTAG and placed in the mouth so as to
give adequate fullness for the maxillary lip

37.
Its incisal plane was so adjusted to be parallel to the
interpupillary line with adequate visibility. This ANTAG
guided the arrangement of the maxillary anterior teeth.

38.
• FIRST LABORATORY STEP
The impressions are beaded and boxed, and casts are
poured in type III gypsum product or the dental stone
Retrieval of the casts from the impressions
ANTAG is adapted to the maxillary cast
Separating medium is applied to the tissue surface of the
remaining maxillary cast
Temporary record base is made for the posterior
maxillary residual ridge using auto polymerising acrylic
denture base resin

39.
A full arch mandibular temporary denture base is made
using auto polymerising acrylic denture base
The conventional maxillary occlusal rim is made for the
posterior aspect, and a mandibular occlusal rim is made
for the full arch.
Maxillary anterior teeth arranged using the selected
teeth set for the patient.

40.
SECOND APPOINMENT
• In this clinical appointment, jaw relations are recorded
along with maxillary anterior try-in.
• VD at rest is measured, Desired OVD achieved.
Necessary correction done.
• Patient is guided into the desired centric-relation jaw
position
• Maxillomandibular relationships are recorded using zinc
oxide eugenol paste or elastomeric bite registration
paste.

41.
• SECOND LABORATORY STEP
The sealed occlusal rims are placed on their respective
casts
Mounted on a mean value articulator in the recorded
relation.
Teeth Arrangement
Denture Fabrication

42.
THIRD APPOINTMENT
• Denture insertion. During this stage, dentures are
delivered to the patient. Fit, phonetics, occlusion, and
patient satisfaction are verified. The patient is given
instructions on the use and care of the new prostheses.

43.
ADVANTAGES:
 Economic
 Easy to applied
DISADVANTAGES:
× Only maxillary anterior try in is possible

44.
CAD CAM FABRICATED
COMPLETE DENTURE
• Computer-aided design and computer-aided
manufacturing (CAD/CAM) has emerged as a new
approach for the design and fabrication of complete
dentures.
• Several commercial CAD software systems, including
3Shape Dental System and AvaDent digital dentures,
have recently become available for designing
complete dentures.
• With this CAD/CAM technology, only 2 appointments
are needed for patients to get their complete dentures.

45.
• All impressions, jaw relations, occlusal plane
orientation, tooth mold and shade selection, and
maxillary anterior tooth positioning could be finished
in 1 patient visit for the fabrication of complete dentures.

46.
CONVENTIONAL METHOD OF DENTURE
FABRICATION
 ADVANTAGES
 Ability to customize tooth arrangements and to
confirm all preceding steps before the trial placement
stage
 Clinically predictable outcomes

47.
 DISADVANTAGES
× The need for a minimum of 4 to 5 patient visits
× Varying laboratory expenses and time
× Lack of intimate fit of the denture bases with
underlying tissues due to polymerization shrinkage
× Inability to easily create an optimal duplicate denture

48.
• The CAM technology could be classified into 2
types:
 Additive Manufacturing
 Subtractive Manufacturing
• In Prosthodontics subtractive manufacturing CAD/CAM
technology has been extensively used to fabricate
Inlays, Onlays, Crowns, Fixed and Removable Partial
Denture, Implant Abutments, Maxillofacial Prostheses.

49.
• Additive Manufacturing
Any process by which 3D objects are constructed by
successively depositing material in layers such that it
becomes a predesigned shape.
• Subtractive Manufacturing
Any process by which 3D objects are constructed by
successively cutting/milling extra material away from a
solid block of material according to the digital model.

50.
CAD/CAM Technology : Application to
Complete Dentures
• In this article the AvaDent™ softwere system is
discussed. The AvaDent™ digital denture process is
designed to capture the necessary information for the
fabrication of complete dentures in one appointment
without compromising prosthesis quality.
• The entire digital CAD/CAM process consists of the
following appointments:
1. Impressions, jaw relation records, occlusal plane
orientation, tooth mold and shade selection, and
maxillary anterior tooth positioning record
2. Placement of dentures
Kattadiyil, M. T., and C. J. Goodacre. "CAD/CAM technology:
application to complete dentures." Loma Linda University
Dentistry 23 (2012): 16-23.

51.
Flowchart for Designing and Fabricating Complete
Dentures via CAD/CAM Technology

52.
AvaDent™ Kit

53.
APPOINTMENT 1
Customizing Stock Trays
• If old denture is available:
Putty cast created by adaptation to the old
maxillary denture

54.
• Thermoplastic tray selection based on the arch size for
the maxillary and mandibular cast.
Stock tray being tried on maxillary &
mandibular putty cast

55.
• The tray is softened by immersion in a water bath set at
80 C for approximately one minute and adapted to the
putty cast by pressing the material into contact with the
cast
Customized maxillary stock tray

56.
Making Maxillary and Mandibular Final Impressions
• Apply an appropriate adhesive and add tissue stops
(AvaDent™ registration or a fast setting interocclusal
record material is applied as four dabs to distributed
areas on the maxillary tray and three areas of the
mandibular tray).
• The AvaDent™ border molding impression material, or a
medium body poly (vinyl siloxane) impression material,
is then used to border mold the maxillary and mandibular
trays.

57.
• Final impressions of the maxillary and mandibular
arches are made using either the AvaDent™ impression
material or a light-body poly (vinyl siloxane) impression
material.

58.
JAW RELATION RECORD
• The AvaDent denture
technique uses an
Anatomical
Measuring Device (AMD)
that can be adjusted to the
desired occlusal vertical
dimension.
• The AMD consists of a
maxillary tray with a
centrally located
adjustable stylus and an
adjustable lip support
flange and a mandibular
tray with a flat occlusal
tracing plate.

59.
• This AMD maintains this dimension while centric relation
is recorded using the incorporated gothic arch tracing
plate and stylus.
• The AMD is also used to determine the correct amount
of upper lip support, the position of the maxillary six
anterior teeth, and the desired mesio lateral orientation
of the occlusal plane.

60.
• In addition, there is an occlusal plane orientation ruler
that can be inserted into the maxillary AMD and used to
record the alignment of the maxillary AMD with the
interpupillary line to make it possible for the computer
program to align the maxillary teeth with the
interpupillary line.

61.
STEPS FOR RECORDING JAW REALTION
• The maxillary AMD is filled
with AvaDent™ registration
material and seated to
record the ridge
morphology of the
maxillary arch.
• The mandibular tray with
the recording plate is then
filled with the recording
material and used to
stabilize the tray in the
patient’s mouth.

62.
• Maxillary and mandibular
AMDs are positioned to be
fairly parallel to each other.
• Maxillary stylus is located
over the anterior aspect of
the mandibular AMD
tracing plate.

63.
• Confirming occlusal
vertical dimension
• Occlusal vertical
dimension being adjusted
by turning screw
• Gothic arch recording

64.
• A recess is then made in
the tracing plate that
approximates the tip
diameter of the stylus at
the apex of the gothic arch
arrowpoint using round bur
or acrylic resin bur.

65.
Occlusal Plane Orientation, Maxillary Anterior Mold
and Shade Selection, and Maxillary Anterior Tooth
Positioning
• AvaDent™ ruler attached
to the Maxillary AMD
• Determining the appropriate
occlusal plane with AvaDent™
orientation ruler

66.
• The midline on the lip
support flange as well as
the smile line are marked.
• The size of the maxillary
anterior teeth is selected
from the three available
tooth size templates that
matches the patient’s
desired tooth size.
• AvaDent registration
material is injected into the
space between the maxillary
and mandibular arches, with
the jaw stabilized in centric
relation.

67.
• To serve as a guide during
denture fabrication,
flowable composite resin is
applied to the inside of the
selected tooth mold
template.

68.
Jaw relation record with mold tab

69.
• After disinfection, the final
impressions and all the
interocclusal records are
scanned.
• Virtual casts are created
and articulated.
• Teeth are arranged and
bases are virtually formed.

70.
THE DENTURE FABRICATION
• The denture base is milled from a block of pink denture
base resin with recesses that accurately fit each denture
tooth, and the teeth are bonded with special adhesives
with higher adhesive properties.
Determining (virtually) the
borders of the maxillary
Milled CAD/CAM
denture base

71.
MILLING AND GLUING STAGES
• The artificial teeth need high abrasion resistance.
• It is difficult to cut the artificial teeth from a single
property block. Thus, only the denture base is fabricated
by cutting .
• Then commercially available artificial teeth are adhered
to the denture base. Special adhesives with higher
adhesive properties are being developed.

72.
CAD/CAM DENTURES ADVANTAGES:
 Reduced number of patient visits
 Superior strength and fit
 Reduced microbial colonization
 Reproducibility
 Standardization for clinical research
 Better quality control

73.
CAD/CAM DENTURES DISADVANTAGES:
× Absence of a clinical try-in procedure.
× Technique sensitive
× Feasibility
× The denture base is fabricated by cutting. Teeth
fabrication is not possible. Thus commercially
available artificial teeth are adhered to the denture
base.

74.
CONCLUSION
• It is usually seen in edentulous patients that they are
enthusiastic about the replacement of missing teeth with
dentures at the beginning but due to the prolonged time
and an excessive number of appointments, they,
especially the very old, become fatigued and irritated.
This can have an effect on the success of the treatment.
Patients who are institutionalized or bed-ridden and who
are dependent on someone else for locomotion need a
rapid but appropriate treatment regime .
• If the number of appointments can be reduced, it will be
of great help in successful treatment.

75.
• It is possible to fabricate a complete denture with
different techniques in minimal visit. These techniques
has positive benefits saving a lot of time and materials
for both the patient and the clinician.
• However the final result depends on the skill and
knowledge of materials, anatomy, occlusion, function
and ability to determining the proper esthetic
parameters.

76.
REFERENCES
• Swenson MG. Complete Dentures, ed 3. St Louis: Mosby,
1953:384-395
• Update of a one-appointment master impression and jaw
relation record technique. Quintessence Int 1992;23:547-550
• "A CAD/CAM system for removable denture. Part I: Fabrication
of complete dentures." international Journal of Prosthodontics
7.1 (1994).
• Ling, Booi-Cie. "A three-visit, complete-denture technique
utilizing visible light--cured resin for tray and base plate
construction." Quintessence international 35.4 (2004)
• Lodha M, Patil SB, Bhat S, Chaudhari N, Kant A.3D CD - Three
Days Complete Denture Technique for Compromised Geriatric
Patients. Int J Oral Health Med Res 2016;3(1):126-130

77.
• Do traditional techniques produce better conventional complete
dentures than simplified techniques. Journal of dentistry. 2005
Sep 30;33(8):659-68.
• "A Randomized Controlled Trial of Mastication with Complete
Dentures Made by a Conventional or an Abbreviated
Technique." International Journal of Prosthodontics 30.5
(2017).
• Kattadiyil, M. T., and C. J. Goodacre. "CAD/CAM technology:
application to complete dentures." Loma Linda University
Dentistry 23 (2012): 16-23.
• Han, Weili, Yanfeng Li, and Yue Zhang. "Design and fabrication
of complete dentures using CAD/CAM technology." Medicine
96.1 (2017).

78.
THANK YOU