Prosthodontics: the art of replacing missing teeth Complete denture: introduction and fabrication

1. Introduction to
Prosthodontics
Dr. Aamir Godil
Department of Prosthodontics
M.A.R.D.C.

2. Dental Specialties

3. Scope of dentistry
Oral Medicine &
Radiology
Periodontology Oral & Maxillofacial
Surgery

4. Scope of dentistry
Conservative Dentistry
& Endodontics
Pedodontics Orthodontics &
Dentofacial Orthopedics

5. Scope of dentistry
Oral Pathology &
Microbiology
Public Health Dentistry

6. Prosthodontics
Prosthodontics
Complete
Dentures
Fixed Parital
Dentures
Maxillofacial
Prosthetics
Removable
Partial
Dentures
Implantology

7. Prosthodontics
Prostho-
Related to prosthesis/ artificial
-dontics
Study of a dental subject

8. Prosthodontics
The branch of dentistry concerned with the design,
manufacture, and fitting of artificial replacements
for teeth and other parts of the mouth.
-Oxford Dictionary

9. Prosthodontics
Prosthodontics is the dental specialty pertaining to the
diagnosis, treatment planning, rehabilitation, and
maintenance of the oral function, comfort, appearance,
and health of patients with clinical conditions
associated with missing or deficient teeth and/or
maxillofacial tissues by using biocompatible substitutes.
-Glossary of Prosthodontic Terms – 9 (GPT-9)

10. Tooth Loss…
Edentulism

11. Edentulism
e-dĕn΄cha-lĭz-um (1998)
the state of being edentulous; without
natural teeth
-Glossary of Prosthodontic Terms – 9 (GPT-9)

12. Edentulism

13. Complete V/S Partial
Edentulism
Completely
edentulous
mandibular arch
Partially
edentulous
maxillary arch

14. Consequences of Edentulism
1. Chewing efficiency
• Poor digestion
• Impaired sensations
2. Appearance (esthetics)
• While smiling and talking
• Loss of muscle tone and lip support
3. Psychological effects
• Social awkwardness
• Lack of confidence
4. Affect on adjacent teeth and tissues
• Supra-eruption of antagonist teeth
• Tipping of adjacent teeth
5. Bone resorption
• Loss of alveolar bone and bone height
• Deterioration of quality of ridge

15. Treatment
Modalities for
Edentulism

16. Removable Prosthodontics
Complete Denture
for completely edentulous arches
Cast Partial Denture
for partially edentulous arches

17. Fixed Prosthodontics
Tooth supported FPD
e.g. crowns, bridges, veneers, etc.
Implant supported FPD
for partial and complete
edentulous cases

18. Maxillofacial
Defects &
Prosthesis

19. Maxillofacial Defects &
Prosthesis
Congenital (by birth)
e.g. Cleft palate
Acquired (surgically resected)
e.g. cancer, infection

20. Maxillofacial Defects &
Prosthesis
Missing parts of face and body
e.g. eyes, nose, ears, etc.

21. Brief History
of Prosthodontics

22. History of Prosthodontics
Animal
teeth
Teeth from
slaves
Wood Metals Ivory

23. Some important
terminologies
in Prosthodontics

24. Terminologies in
Prosthodontics
Impression Dental cast Impression trays Wax rims
Teeth set Articulator
Micromotor
handpiece
Occlusion

25. What all do you
deal with?
in Prosthodontics

26. Patients
Missing teeth
Malformed teeth
Unpleasant teeth
Faulty restorations
Maxillofacial
defects
TMJ disorders
Parafunctional
habits
Derma fillers

27. Labs
Denture
fabrication
Crowns
and
bridges
Implant
prosthesis
Computer
aided
designs
3D
printing
Planning
and
evaluation
Precision
milling

28. Art & Engineering
Prosthodontics
Mechanical
properties of
materials
Feather light
hand
Technological
advancements
Artistic
approach
Chemistry of
materials
Esthetic sense

29. Dental Materials
Impression materials Cast and die materials
Denture base materials Metals and alloys
Ceramics and esthetic materials Implant biomaterials
Maxillofacial materials Auxilliary materials

30. Variety of Armamentarium
Burs Handpiece Chairside instruments Sculpting instruments Articulator & Facebow
Shade guides Implant drills Surveyor Lab machinery Digital & Softwares

31. Occlusion
:the static relationship between the incising or masticating surfaces
of the maxillary or mandibular teeth or tooth analogues

32. Temporomandibular Joint

33. And of course,
TECHNICIANS!

34. Introduction to
Complete Dentures
Dr. Aamir Godil
Department of Prosthodontics
M.A.R.D.C.

35. Complete
Dentures…
from nothing to everything

36. Complete denture
:a fixed or removable dental
prosthesis that replaces the entire
dentition and associated structures
of the maxillae or mandible
-Glossary of Prosthodontic Terms – 9 (GPT-9)

37. Functions of complete
denture
Mastication
EstheticsSpeech

38. Complete denture surfaces
Polished /cameo
surface
Impression
/intaglio surface
Occlusal surface

39. Complete denture parts
Complete denture
Base
Acrylic
Metal
Flange
Labial
Buccal
Lingual
Border Teeth
Acrylic
Porcelain
Labial flange
Denture border
Buccal flange
Artificial
teeth

40. Steps in fabrication of
complete denture
Diagnosis and
treatment plan
Primary impressions
and primary casts
Final impressions and
final casts
Jaw relation, mounting
and teeth arrangement
Try in and evaluation
Denture processing and
denture insertion
Maintenance and
follow-up

41. Steps in fabrication of
complete denture
Laboratory step
Clinical step

42. 1. Diagnosis and treatment
planning
Steps:
• Detailed case history record
• Clinical evaluation
• Radiographic evaluation
• Pre-prosthetic considerations
• Diagnosis
• Formulation of treatment plan
Clinical evaluation
Radiographic evaluation

43. 2. Primary impression
Steps:
• Selection of tray based on choice of
impression material
• Impression materials: impression compound,
hydrocolloids, elastomer
• Marking significant landmarks e.g.: posterior
palatal seal, flabby tissues, etc.

44. 3. Primary casts
Steps:
• Beading and boxing primary impression
• Pouring the impression in dental plaster
• Trimming, conditioning and marking the cast

45. 4. Fabrication of custom tray
Steps:
• Marking tray extensions, relief areas,
tissue stops
• Adaptation of spacer wax
• Material manipulation and adaptation
• Tray handle
•Trimming and finishing

46. 5. Final impression
Steps:
• Border moulding using low
fusing compound (Green stick)
• Removal of spacer wax
• Relief holes (if necessary)
• Final/ wash impression

47. 6. Final casts
Steps:
• Beading and boxing final impression
• Pouring the impression in dental stone
• Trimming, conditioning and marking the cast

48. 7. Fabrication of record
base and occlusal rims
Steps:
• Block undercuts, relief areas on
final cast with wax
• Fabrication of record base using
cold cure PMMA
• Fabrication of occlusal rims
using modelling wax

49. 8. Jaw relation record
Steps:
• Orientation of maxilla and mandible
• Three records:
• Orientation jaw relation | Vertical jaw relation | Centric jaw relation

50. 9. Mounting on articulator
Steps:
• Orientation of sealed rims on the articulator with clay
• Mounting upper and lower cast to respective members of
articulator with dental plaster

51. 10. Teeth arrangement
Steps:
• Following teeth selection, maxillary
and mandibular anterior teeth
arrangement
• Posterior teeth arrangement
• Waxing, carving and characterization

52. 11. Try in and evaluation
Steps:
• Intra-oral evaluation of teeth
arrangement
• Assessment of:
• Comfort
• Phonetics
• Esthetics
• Occlusion

53. 12. Denture processing
Steps:
• Sealing the arrangement to cast
• Flasking: mould preparation
• Dewaxing: wax elimination
• Packing: Heat cure acrylic
• Curing: Processing in 740C water
under pressure

54. 13. Finishing and polishing
Steps:
• After retrieval, excess trimmed with carbide bur
• Plaster removal using small head bur, cones, etc
• Finishing with increasing grits of sand paper
• Polishing: wet buffing with pumice slurry + dry buffing

55. 14. Denture insertion
Steps:
• Assessment of
• Fit, extension and
retention
• Esthetics, phonetics,
occlusion

56. 15. Maintenance and follow up
Steps:
• Instructions for wear and
daily use
• Periodic follow-up and recall

57. Thank you…