1. Done by: Ali Sami Mohammed Nuri
Noor al-Huda Ahmed Jasim
Supervised by:
Dr. Aseel Salih
Dr. Sura Abd Al-Jabbar
Complete Denture
2. Contents:
Definition
Treatment objectives of CD
Mucous membrane
Biologic consideration for maxillary impression
Biologic consideration for mandibular impression
Principles of impression making
Occlusion of complete denture
Insertion of complete denture
Classification of post-insertion denture problems
3. Definition:
Complete Denture:
A removable dental prosthesis that replaces the entire dentition and associated
structures of the maxilla and mandible
Complete Denture impression:
A complete denture impression is a negative registration of the entire denture bearing,
stabilizing and border seal areas present in the edentulous mouth.
What is a primary impression?
A primary impression (preliminary impression) is an impression made for the purpose of
diagnosis or for the construction of a tray.
What is a final impression?
A final impression is an impression for making the master cast.
4. IMPRESSION MATERIAL:
Any substance or combination of substances used for
making an impression or negative reproduction.
-gpt 8
Types of impression material:
• Alginate
• Agar
• Elastomeric impression materials, which are:
• 1-Addition silicone
• 2-condensation silicone
• 3-polysulfide
• 4-polyether.
5. Treatment objectives of CD
Patient Education
Restoration of esthetics
Improvement of mastication
Improvement of speech
Preservation of remaining oral structure
Maintenance of the health and comfort of the mouth
Maintenance of the health of the TMJ
General physical and psychological well-being of the patient
6. Mucous membrane
The bones of the upper and lower edentulous jaws are covered with soft tissue, and the oral cavity is lined with soft
tissue known as mucous membrane.
The denture bases rest on the mucous membrane, which serves as a cushion between the bases and the supporting
bone.
The mucous membrane is composed of two layers
Mucosa: is formed by the stratified squamous epithelium.
Submucosa: is formed by connective tissue.
largely responsible for the support that the soft tissue affords the denture since in most instances
the submucosa makes up the bulk of the mucous membrane.
In a healthy mouth, the submucosa is firmly attached to the
periosteum of the underlying bone of the residual ridge and
will usually successfully withstand the pressure of the denture.
7. CLASSIFICATION OF ORAL MUCOSA
The oral mucosa is divided into three categories depending on its location in the mouth:
1-Masticatory mucosa: It is characterized by a well defined keratinized layer on
its outermost surface subject to changes in thickness.
A-the crest of the ridge
B-the residual attached gingiva firmly adherent to the supporting bone
C-hard palate
2-Lining mucosa: lining mucosa is generally devoid of the keratinized layer. It is found to cover the :
mucous membrane of lips, cheek, vestibular spaces, alveolingual sulcus, soft palate ventral surface of the tongue and,
the unattached gingiva found on slopes of residual ridge.
3-Specialized mucosa: The specialized mucosa covers the dorsal surface of the
tongue. This mucosal covering is keratinized.
8. RESIDUAL RIDGE: The shape and size of the alveolar ridges change
when the natural teeth are removed. The alveoli become mere holes in the jawbone and begin to fill up with new bone, b
The residual alveolar ridges
Following loss or extraction of teeth:
The empty socket fills with clot and gradually replaced with new bone
The bone around the socket reorganizes
The mucoperiosteum gradually heals & covers the healing socket
The remodelling process results in a rounded ridge like structure known
as the residual alveolar ridge (RAR)
9. Rate of resorption
Most rapid in the first 1 year after extraction and can be as high as 4.5 mm/year.
After healing of the residual ridge, the annual rate of reduction in height is about 0.1-0.2 mm in the mandible
The annual rate of reduction in height is about 4X greater in the mandible
than in the maxilla.
Pattern of resorption
Maxilla: The resorption is upwards and inwards (smaller)
Mandible: The resorption is downward and outward (wider)
Masticatory loads
Significantly lower than that produced by natural teeth
Natural teeth can produce forces up to 175 pounds but usually 40 to 50 pounds
Denture wearers: the average force was in the region of 22-24 pounds in the molar-bicuspid region
CD wearers are able to generate forces that are only 10-15% of
those with natural teeth
10. Biologic consideration for maxillary impression
If dentures and their supporting tissues are to coexist for a reasonable length of time, the anatomy of the supporting an
the selective placement of forces by denture bases on supporting tissues
the form of the denture borders that will be harmonious with the normal function of limiting structures around them.
11. The anatomical landmarks in the maxilla are:
• Limiting structures:
Labial frenum, Labial vestibule, Buccal frenum, Buccal vestibule, Hamular notch and Posterior palatal seal area
•Supporting Structures:
Primary stress bearing areas:-
Hard palate and Postero-lateral slopes of residual alveolar ridge.
Secondary stress bearing areas:-
Rugae, Maxillary tuberosity and Alveolar tubercle.
Relief areas:
Incisive papilla, Cuspid eminence, Mid-palatine raphe and Fovea palatina.
12. Vibrating Line Of The Palate:
This is an area at or distal to the junction of the hard and soft palate where movement occurs when the patient says “ah”
Posterior vibrating line:
That is 4-12mm or on an average is 8.2 mm dorsally to the hard and soft palate junction. In most instances the denture s
13. Biologic consideration for mandibular impression
The considerations for mandibular impressions are generally similar to that for those of maxillary impressions and yet m
The basal seat of the mandible is different in size and form from the maxillary counterpart.
The submucosa in some parts of the mandibular basal seat contains anatomic structures different from those in the uppe
The nature of the supporting bone on the crest of the residual ridge usually differs between the two jaws.
The presence of the tongue complicates the impression procedures for the lower denture.
14. The available area of support from an edentulous mandible is 14 cm2
while the same for the edentulous maxilla is 24cm2
The supporting and the peripheral sealing areas will be in contact with the dentures fitting or
impression areas. The support for the mandibular denture is derived from the body of the mandible.
The landmarks can be broadly grouped into:
Limiting structures:
Labial frenum, Labial vestibule, Buccal frenum, Buccal vestibule, Lingual frenum
Alveololingual sulcus, Retromolar pads and Pterygomandibular raphe.
Supporting structures:
Buccal shelf area, Residual alveolar ridge
The buccal shelf area can range from 4-6 mm wide on an average mandible to 2-3 mm or less in a narrow mandible
Relief areas:
Crest of the residual alveolar ridge, Mental foramen, Genial tubercles
and Torus mandibularis.
15. BASIC REQUIREMENTS FOR IMPRESSION MAKING
• Knowledge of Basic anatomy
• Knowledge of basic reliable technique
• Knowledge and understanding of impression materials
• Skill
• Patient management
OBJECTIVES OF IMPRESSION MAKING
1-RETENTION
2-STABILITY
3- SUPPORT
4- ESTHETICS
5-PRESERVATION OF REMAINING STRUCTURES
RETENTION: Retention is defined as that state of a denture wherein functional forces are unable to destroy the attachm
mucoperiosteum. Retention resists the adhesiveness of food, the force of gravity, & the forces associated with the open
of jaws. Retention begins with the impression. It depends upon factors that produce attachment of the denture
to the mucosa.
16. Factors affecting Retention:
Anatomical factors
Physiological factors
Physical factors
Mechanical factors
Muscular factors
Anatomical factors
Size of the denture-bearing area
Quality of the denture bearing area.
Physiological factors
• Saliva and its quality
Physical factors
• Adhesion
• Cohesion
• Interfacial surface tension
• Capallarity and capillary attraction
• Atmospheric pressure and peripheral seal
Mechanical factors
• Undercuts
• Retentive springs
• Magnetic forces
• Denture adhesive
• Suction chambers and suction discs
Muscular factors
The muscles apply supplementary retentive forces on the denture.
It is most effective in the neutral zone.
17. STABILITY: The quality of a denture to be firm, steady, or constant, to resist displacement by functional stresses and
to withstand horizontal forces.
Factors Affecting Stability:
• Vertical height of the residual ridge.
• Quality of soft tissue covering the ridge.
• Occlusal plane
• Quality of the impression.
• Teeth arrangement.
• Contour of the polished surfaces.
SUPPORT: It is the resistance to vertical forces of mastication & to occlusal or other forces applied in direction toward
When the natural teeth are missing, the alveolar ridge & their covering of mucosal tissue become the
supporting elements.
Unfortunately, they were never meant to endure the forces of mastication & other constant occlusal pressure that result f
To make the best of a bad situation, it is necessary to enhance the available support by utilizing maximum coverage of a
18. ESTHETICS
The thickness of the denture flanges is one of the important factors that govern esthetics.
Thicker denture flanges are preferred in long-term edentulous patients to give required labial fullness.
Impression should perfectly reproduce the width
PRESERVATION OF REMAINING STRUCTURES
Impressions should record the details of the basal seat and peripheral structures in an appropriate form to prevent injury
19. Occlusion of complete denture
Occlusion: Occlude means ‘to close’. This word is used to describe the static contact relationship between the incising o
Occlusion in complete denture must be developed to function efficiently and with the least amount of trauma to the supp
Centric occlusion: the occlusion of opposing teeth when the mandible is in centric relation. This may or may not coincid
Centric relation: The most posterior relation of the lower to the upper jaw from which lateral movements can be made a
Types of Occlusion
1-Balanced occlusion: A stable simultaneous contact of the opposing upper and lower teeth in a centric relation position
20. 2-Monoplane occlusion: It is also called neutrocentric occlusion.In this type of occlusion
non-anatomical cuspless teeth (zero degrees) are used.
3-Lingualized occlusion: The lingualized occlusion concept is a variation of the bilaterally balanced occlusion concept.
Monoplane Occlusion
Lingualized occlusion
21. Factors affecting the selection of the occlusion concept
l- Age of the patient
2- Condition of oral health (soft tissue and residual ridge).
3- Social status and demand of the patient esthetic and function.
4- Skill and philosophy of the dentist in occlusion concept, the dentist must really on clinical skill and experience wh
5- The availability of the material and dental laboratory efficiency.
22. Insertion of complete denture
The overall objective when fitting complete dentures is to ensure that the patient is given the best possible start with the
Checking the finished denture
A.Checking the polished surface and peripheries.
B.Assessment of the impression surface.
C.Checking of retention.
D.Checking the stability.
E.Checking the esthetic and facial contour.
.F
Assessment of the occlusal surface.
23. Instructions to Denture Patients
A. What To Expect From Your New Dentures
1. You must learn to manipulate your new dentures. Most patients require at least three weeks to learn to use n
2. Dentures are not as efficient as natural teeth so you should not expect to chew as well with dentures as with
3. Speaking will feel awkward for a while.
B. Adjustments
1.You must return to your dentist for follow-up treatment after the dentures have been inserted.
2. If you develop soreness, Call your dentist for an appointment. Do not expect soreness to go away by itself.
3. If you are unable to reach your dentist during weekends or holidays, remove your dentures to prevent excess
C. Cleaning
1. Your dentures and supporting ridges must be cleaned carefully after each meal. "Denture breath" is a result
2. Clean your gum with a soft brush and toothpaste.
3. Clean your dentures with liquid detergent, and gently brush with a soft denture brush. Many types of toothpa
4. Soak your dentures at night in a denture cleaner or a water mouthwash solution.
5. Always keep your dentures wet when not wearing them to prevent warping.
24. Classification of post-insertion denture problems
Complains on the comfort of the denture
Complains on functions of the denture
Complains on aesthetics of the denture
Complains on phonetics
Most of the complaints associated with complete dentures are actual
and not psychological.
Complaints about the comfort of the denture:
• Sore spots
• Burning sensation
• Redness
• Pain in TMJ
• Tongue & cheek biting
• Swallowing & sore throat
• Nausea & gagging
• Deafness
• Fatigue of the muscles of mastication.
25. Complaints about the function of the denture:
• Instability or poor fit
• Interference
• When swallowing
• Clicking
• Complaints about esthetics:
• Fullness under the nose
• Depressed philtrum or naso-labial sulcus
• Upper lip sunken in
• Too much of teeth exposed
• Artificial look (unattractive appearance)
Complaints about phonetics
• Whistle on "S" sounds
• Lisp on "S" sounds
• Indistinct "TH" & "T"' sounds
• "T sounds like "TH"
• "F" & "V" sound indistinctive
