The document discusses the process of final fitting of dentures which involves adjusting the denture base, eliminating occlusal discrepancies, and educating the patient. This includes laboratory adjustments to perfect the occlusion and contour, as well as clinical adjustments like ensuring proper bearing surface, stability, occlusion, and patient comfort by using tools like pressure indicating paste and articulating paper. The patient is instructed on denture care and informed that regular recalls are needed to check the dentures and make any necessary adjustments or replacements over time.

1. Final fitting of the dentures
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Final Fitting of the Dentures
Patient should not be given possession of removable
prosthesis until denture base has been initially adjusted as
required, occlusal discrepancies eliminated and patient
education procedure has been continued.
The term adjustment predicts:
1. The adjustment to the bearing surface of the denture.
2. Occlusal adjustment.
Occlusal adjustments include:
1. Laboratory adjustment.
2. Interocclusal records –using waxes, articulating paper.
3. Clinical remount.
I- Laboratory adjustment:
• After the resin base are processed and before the denture
are separated from the casts the teeth must be adjusted to
perfect the occlusal relationship between opposing
artificial teeth.
• Denture base must be finished to eliminate any excess
acrylic and to perfect the contour of the polished surface
for best function and aesthetics.
Pre-insertion inspection:
Before the patient attends, the dentures should be inspected:
1- The borders should be rounded and smooth.

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2- The impression surface should not have any sharp edges
which are commonly found in the area of the rugae and at
the borders of a relief area.
3- The inner aspect of clasps, bars, plastic and saddles are
inspected for any deficiencies. The acrylic 'pearls should
also be removed.
4- The outer surface should be highly polished.
a
b
Fig. 1 a and b: Denture inspection.
a
b
Fig. 2: a, The impression surface should not have any sharp edges, The acrylic 'pearls
should also be removed. b: If it does not seat, it is likely to be due to acrylic resin
having entered undercuts related to the natural teeth or the alveolar ridges. The area of
acrylic involved may be detected by visual inspection or by the use of disclosing media
(pressure indicating paste) to avoid soreness and traumatizing the soft tissues.

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Fig. 3: Use Pressure indicating paste to
identify pressure area.
Fig. 4: use disclosing wax to check the
flange extension
II-Clinical adjustment:
The denture is now seated in the mouth along the planned
path of insertion and removal. The bearing surface, denture
stability and fitness of the framework should be checked,
occlusion, the patient comfort and esthetics should also be
examined.
• Adjustment of the bearing surface of the denture base to
be in harmony with the supporting soft tissue.
• Adjustment of occlusal interference from the denture
framework.
• Adjustment of occlusion to be in harmony with the
opposing denture.

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1- Adjustment of the bearing surface of the denture
base to be in harmony with the supporting soft
tissue.
Stability:
1. The denture should be retentive and stable. Stability must be
checked by applying pressure anteriorly and posteriorly
alternatively. The denture should exhibit no movement.
2. Once the denture is seated and is comfortable, the fit of all
its components is checked.
3. If the denture cannot be fitted, no attempt should be made to
force it into place. Any interference should be detected and
removed.
4. If free-end saddles rock about their most distal occlusal
rests, this should be corrected by relining the saddles.
Adjustment of the bearing surface of the denture base is
accomplished using pressure indicating paste:
• Pressure indicating paste must be readily displaced by
positive tissue pressure without adhering to the mucosa.
• Pressure indicating paste must be applied in a very thin layer
over the bearing surface of the denture and then digital
pressure is applied to the denture. {The patient is not
expected to apply heavy force on a new denture}.

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• Any area where pressure has been heavy enough to displace
a thin film of the Pressure indicating paste should be
relieved and the procedure is repeated.
N.B: In patients having xerostomia false results may occur as
the Pressure indicating paste may adhere to the mucosa.
If Pressure indicating paste is not used the patient will
return when soreness is developed, in this case over-relieve the
denture at the traumatized area to restore patient’s comfort.
2- Adjustment of occlusal interference from the
denture framework
• Any occlusal interference from occlusal rests or other
parts of the denture framework should have been
eliminated in the try-in of the framework before final jaw
relation is established.
• Much of these adjustments can avoided if proper
treatment plan, proper mouth preparation and proper
design where followed, however occlusal interference
may occur from the casting itself.
3- Adjustment of occlusion to be in harmony with the
natural and artificial opposing dentition
• The occlusion is assessed from the patient's comments,
visual inspection and articulating paper.
• Articulating paper or disclosing wax may help to localize
any premature occlusal contact(s). The paper should be

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applied bilaterally in order to discourage deviation on
closure of the mandible.
• If one of these cusps contacts premature, when the
patient attempts to reach intercuspal position, and is also
premature in lateral excursions, the cusp is reduced in
height.
• If the cusp contacts prematurely on closure as before, but
is not premature in lateral excursions. The fossa is
deepened.
• Once even occlusal contact is achieved at the desired
static jaw relationship, further adjustment of the
supporting cusps should be avoided as possible.
• If a premature contact occurs between a buccal upper
cusp and a buccal lower cusp on the working side in
lateral excursion, only the buccal upper cusp is adjusted.
• Similarly, if in the same excursion, contact occurs
between the upper palatal and lower lingual cusps, the
lingual lower (LL) cusp are reduced.
• This method of adjusting tooth contact on the working side
is called the BULL rule.
• In protrusive excursion, premature contacts are eliminated
by grinding the distal facing inclines of upper teeth and
mesial facing inclines of lower teeth.
• After adjustments of the dentures have been completed,

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areas that have been ground are repolished.
4- Esthetic:
The major decisions on this subject should have been
taken at the previous visit (try-in). The patient's opinion of the
esthetics should be ascertained.
When the practitioner and patient are both satisfied, the
dentist should demonstrate to the patient how to insert and
remove the partial denture in the correct manner.
5- Patient comfort:
The patient's opinion regarding the comfort of the
denture should be sought at this stage. Any inconveniences
should be adjusted.
III- Instructions to the Patient
Instructions to the patient should be given verbally and
also reinforced with a printed sheet.
The patient must be informed about:
1. Any expected difficulties and limitations of the dentures.
2. The possibility of soreness and phonetic problems that may
be observed in some patients.
3. The possibility of gagging or the reaction of the tongue to a
foreign body.

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4. The need for cleaning the denture and the remaining natural
teeth.
5. The Calculus that may precipitate on the denture in some
cases that necessitate taking extra care for its removal.
6. The dentures should be removed at night to give rest to the
oral tissues. They should be placed in a container and
covered with water to prevent its dehydration and
subsequent dimensional changes.
7. The denture and supporting structures should be checked 24
hours after delivery.
For optimum denture service the following advises should be
followed:
• Avoid careless handling of the denture that causes distortion
or breakage.
• Teeth should be protected from caries, by following proper
oral and denture hygiene. Periodic dental examination is
important to do any necessary adjustments.
• Periodontal damage to the abutment teeth can be avoided by
maintaining tissue support of the distal extension bases. This
can be discovered and corrected in the critical time by
relining or rebasing.

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IV- Periodic Recall
• The need for regular review of the mouth and denture
should be emphasized. Not only may the natural teeth
and periodontal tissues require treatment, but it is
necessary to prevent damage from the denture which, in
the initial stages, may be painless.
• Free-end saddles may need to be relined in order to
eliminate the rocking movement that could loosen
abutment teeth and hasten loss of alveolar bone in the
edentulous area.
• It must also be made clear that dentures have a limited
life and therefore replacements will need to be
constructed as appropriate.
• The patient should be given an appointment for review in
approximately seven days' time.