COMPLETE DENTURE CONSTRUCTION 1- Diagnosis and Treatment Planning for Removable Prosthodontics 2- Preliminary Maxillary and mandibular impression procedures 3- Final Maxillary and mandibular impression procedures 4- Jaw Relation Registration a. Introduction and the stomatognathic system What 'occlusion' is and why it is important b. Definitions. c. Check denture foundation and Establishment of facial contour. d. Establishment of the occlusal plane. e. Importance of mounting the maxillary cast using Maxillary face-bow record and transfer. f. Determination of vertical dimension of centric occluding relation. g. Determination of centric and eccentric relations at the accepted vertical dimension. 5- Selection of Artificial Teeth 6- Prosthetic Problems and possible solutions in Setting –up of teeth for skeletal Class I, II and Class III arch relationship of completely edentulous patients. 7- Try-in of the wax trial complete denture. 8- Complete denture insertion (Delivery) 9- Occlusal corrections. 10- Managements of Post Insertion Problems and Complaints. 11- Single denture and Kelly's Syndrome 12- Denture Processing and Laboratory Errors. 13- Relining, rebasing and repair of removable dentures

3. When you realize you've made a mistake,
take immediate steps to correct it.

4. . Inspection of the finished denture
. Clinical evaluation of the denture
• Refinement of the occlusion.
• Post-Insertion Instruction.
• Post-Insertion care.
Aspects of try- in
1.Check the case on articulator ( When ????)
2.Trying the trial denture in the mouth
3. Fabrication of Remount Jig ( Occlusal index for clinical remounting)
After the dentures have been processed and before its separation from the cast,
adjustment of processing error is done through:
1. Laboratory remounting.
2. Selective grinding.
Pre-insertion preparation

5. 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.

6. 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.

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

9. Pre-Insertion Preparation
After the dentures have been processed and before its
separation from the cast, adjustment of processing error
is done through:
1. Laboratory remounting.
2. Selective grinding.

11. Laboratory Remounting
Using the split-cast method
The cast with the processed denture should be remounted
on the articulator using the V-shaped notches.

12. Dentures being re-mounted on the original
articulator and adjustment is carried out to
provide correct articulation

14. The incisal guide pin not contact the incisal
guide table

15. Place red articulating paper between the teeth and
gently tap the teeth together in centric occlusion.

18. The adjustment in eccentric occlusal positions

19. The adjustment in eccentric occlusal positions should be stopped when
widespread Contacts are produced and the incisal guide pin usually stays
in contact with the incisal guide table.

22. Finishing and Polishing

23. Finishing and Polishing

24. . Inspection of the finished denture
. Clinical evaluation of the denture
 Checking the border extension.
 Checking the support.
 Checking the stability.
 Checking the retention.
 Checking the occlusion.
•Refinement of the occlusion.
•Post-Insertion Instruction.
•Post-Insertion care.

25. I. Inspection of the finished denture
A- The polished surface must be concave

26. o The fitting surface must show no irregularities
o The entire periphery should be rounded and highly
polished
o The edges of the relief area should be rounded
B- The finished surface must be concave

27. II. Clinical evaluation of the denture
 Checking the border extension.
 Checking the support.
 Checking the stability.
 Checking the retention.
 Checking the occlusion.

28.  Checking the border extension and position of teeth.

30.  Checking the support, Pressure areas

31.  Checking the retention ??
 Checking the stability ??

32. 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 an upward and
outward pressure to the
cingulae of the upper anterior
incisors to test for the
posterior palatal seal
Test for retention

33. 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.
Test for retention

34.  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.
Test for stability

35. Test for stability

36.  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

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

38. III. Refinement of the occlusion

39. III. Refinement of the occlusion
 Intra-orally

40. Clinical remount
Dentures should be remounted with new records
obtained from the patients
Mount the upper cast according to a face-bow
record or occlusal index and mount the lower
cast according to a new centric relation record.
III. Refinement of the occlusion

41. Fabrication of Remount casts at the
time of delivery
Block out undercut areas in the tissue
surfaces before pouring the plaster

42. Try in??????

43. CLINICAL REMOUNT AND
OCCLUSAL REFINEMENTS
with new centric relation
Remounting the Maxillary Denture
Do I need New Face
bow RECORD?????????

44. Mounting the lower
cast with new CJRR

45. IV. Post-Insertion Instruction
1) Wearing dentures (Adhesives ???)
2) Mastication
3) Speaking
4) Oral and denture hygiene

46. Wearing dentures
Wear their dentures day and night only for the
first two days
Place them in a container filled with water to
prevent drying and dimensional changes in
the denture base material.
Cautioned about using denture adhesives as
these may modify the position of the denture
on the ridge resulting in change in the
vertical and centric relations. By time
patients may feel insecure without adhesives.

47. Mastication
Patients should be advised to:
 Start eating experience with soft food.
 Food should be cut into small pieces and only a little should be placed in
the mouth at a time.
 Cut food with fork and knife rather than incise with anterior denture teeth.
 Incision should be rather done near the corners of the mouth.
 Bilateral rather than unilateral chewing is advised to prevent tipping of the
denture.
 Sticky and fibrous food should be avoided in the early period.

48. Speaking
Patients should be informed that speaking normally
with dentures requires a short practice period.
The tongue becomes conscious of the reduction of
space resulting from the presence of dentures
causing difficulty in speech.
This condition usually resolves after adaptation of
the tongue to the new condition.

49. Oral and denture hygiene
Patient should be instructed to
rinse his denture and mouth
after meals.
Recommended method for
holding a lower denture during
cleaning.

50. Whenever dentures are removed they should be
thoroughly cleaned and then placed in water
Leaving the denture in a cleansing agent once
a day for 30 minutes.
Dentures should be brushed with a soft tooth
brush
Tooth paste and solutions containing phenol
should be avoided to prevent abrasion and
crazing of the denture.
Oral and denture hygiene

51. V- Post Insertion care
1 . First appointment within 48 hours of delivery.
2 . Second appointment within 3 days
3 . Third appointment within 1 week of 2nd visit.

53. CASE COMPLETION
1 . Patient able to masticate food.
2 . Patient should present a normal individual
appearance.
3 . Patient should be able to speak distinctly.
4 . Patient should experience oral comfort.
5 . Patient should be educated as to the need for periodic
examination.
RECALL

54. Pre-Insertion Preparation
After the dentures have been processed and before its separation
from the cast, adjustment of processing error is done through:
1. Laboratory remounting.
2. Selective grinding.
Complete denture insertion
. Inspection of the finished denture
. Clinical evaluation of the denture
• Refinement of the occlusion.
• Post-Insertion Instruction.
• Post-Insertion care.
In Summary

55. Welcome to my page on Facebook
Prof. Amal Kaddah Scientific Forum

56. 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.

57. Next lectures
Occlusal Correction

58. Post- insertion care and patient complaints
I . PROBLEMS RELATED TO SOFT TISSUE
II . PROBLEMS RELATED TO FUNCTION
III. PROBLEMS RELATED TO ESTHETICS
1. PROBLEMS RELATED TO PHONETICS
2. PROBLEMS RELATED TO MASTICATION
Next lectures