Complete Denture Try In

Presented By:-
Dr. Soham Prajapati,
2nd Year PG,
Dept. of Prosthodontics
& Maxillofacial Prosthesis
Including Oral Implantology
Guided By:-
Dr. Dilip Dhamankar
Dr. Ravi Kumar C.M.
Dr. DRV Kumar
Dr. Manish Chadha
Dr. Devendra
Complete Denture TRY-IN
17-7-14
1/80

Contents
• Definition
• Introduction
• The Mandibular Denture By Itself
• The Maxillary Denture By Itself
• Both Dentures Together
• Conclusion
• References
COMPLETE DENTURE TRY-IN 2/80

Definition
• COMPLETE DENTURE PROSTHETICS
– The replacement of the natural teeth in the arch
and their associated parts by artificial substitutes
COMPLETE DENTURE TRY-IN 3
3/80

Definition
• COMPLETE DENTURE PROSTHODONTICS
– That body of knowledge and skills pertaining to
the restoration of the edentulous arch with a
removable prosthesis

Definition
• TRY IN
– A preliminary arrangement of denture teeth that
has been prepared for placement into the
patient’s mouth to evaluate esthetics and
maxillomandibular relationships

Introduction
• Having set-up the teeth according to the
information secured at the record stage, it is
necessary to try the waxed-up dentures in the
patient’s mouth before finishing them, so that
they may be checked.

Introduction
• Once the denture have been processed, it is
laborious and difficult to effect any alterations
whereas in the waxed-up stage changes can
easily be made.

How to Go Forward With The
Complete Denture TRY IN?
• Since so many points require checking, it is
sound practice to get into the habit of working
to a definite plan, and following order is
suggested:
8/20

1. The Mandibular Denture By Itself.
Check -
–Peripheral Outline
»Buccal and labial.
»Lingual.
»Posterior extension.
–Stability to occlusal stresses.
–Tongue space.
–Height of the occlusal plane.
9/80

2. The Maxillary Denture By
Itself.
Check -
–Peripheral Outline
»Buccal and labial.
»Posterior extension.
–Stability to occlusal
stresses.
10/80

3. Both Dentures Together
Check -
–Position of occlusion
»Horizontal relationship
»Vertical Height
–Evenness of occlusal
pressure.
–Balanced Occlusion
(anatomical articulation only)
–Appearance
»Centre line
»Anterior plane.
11/80

3. Both Dentures Together
Check –
–Appearance
»Shape of the teeth.
»Size of the teeth.
»Shade of the teeth.
»Profile.
»Amount of tooth visible.
»Regularity of the teeth.
–Approval of appearance by the
patient.
12/80

TRYING IN THE MANDIBULAR
DENTURE BY ITSELF.
• Place the mandibular denture in the mouth
and seat it on the ridge.
13/80

• The entire periphery should be checked to
ensure that it is not over, or under, extended.
– The Buccal and Labial Periphery
• Hold the denture in place with light pressure on the
occlusal surfaces of the teeth, and move the cheek on
one side gently, upwards and inwards,
• Now relax the pressure on the teeth and observe if the
denture rises from the ridge.
14/80

CHECKING THE PERIPHERAL OUTLINE
– The Buccal and Labial Periphery
• Pay particular attention to the buccal frenum and
ensure they have adequate clearance.
• Repeat for the opposite side and lip.
• Note the bulk and shape of the buccal aspect of the
denture.
15/80

– The Lingual Periphery
• Hold the denture in place with light pressure on the
occlusal surfaces of the teeth and ask the patient to
protrude his tongue sufficiently to moisten his lips, if
the denture lifts at the back, it is over extended in the
region of the lingual pouch.
16/80

• Next, ask the patient to put the tip of his tongue as far
back on his palate as possible, if the denture lifts in the
front, it is over extended anteriorly, probably in the
region of the lingual frenum.
17/80

• Final adjustments are more easily and more accurately
made after the finished denture has been worn for few
days, when areas of slight inflammation will indicate
the precise location of overextension.
18/80

– The Posterior Extensions
• Ensure that the heels of the lower denture as extended
as high up the ascending ramus of the mandible as
practicable.
19/80

– Under Extensions
• Though of less common occurrence, it is equally
important that the periphery should not be under
extended since the dentures must cover the greatest
area possible if maximum retention and stability are to
be obtained.
20/80

CHECKING THE STABILITY UNDER
OCCLUSAL STRESSES.
– This test is used to determine if occlusal stresses
will be transmitted outside the ridge.
– Apply pressure with the ball of the the finger in
the premolar & molar regions of each side
alternatively: this pressure must be directed at
right angles to the occlusal surface.
21/80

CHECKING THE STABILITY UNDER
OCCLUSAL STRESSES.
– If pressure on one side causes the denture to tilt
or rise from the ridge on the other side, it
indicates that the teeth on the side on which
pressure is applied are outside the ridge.
22/80

TONGUE SPACE
– Natural teeth occupy a position in the mouth
where the inward pressure of the cheeks and lips
is equaled by the outward pressure of the tongue,
as it is into this zone of the neutral pressure that
the artificial teeth must be placed.
23/80

TONGUE SPACE
– Tongue, being more mobile than the cheeks, will
cause greater instability of the lower denture if
the teeth are mounted to the lingual side of the
neutral zone than if they are on the buccal side of
it.
24/80

TEST FOR CRAMPED TONGUE
• Ask the patient to relax the tongue.
• Make sure the denture is seated on the ridge.
• Then request him to raise the tongue.
• If the tongue is cramped, the denture will
begin to rise immediately the tongue moves.
25/80

HOW TEST FOR CRAMPED TONGUE IS
DIFFERENT FROM OVEREXTENSION?
• This immediate reaction of the denture tends
to differentiate the movement caused by a
cramped tongue from the movement caused
by lingual overextension.
• Movement due to the latter cause does not
occur until the tongue has risen some
distance.
26/80

CAUSES OF CRAMPED TONGUE
• Posterior teeth set inside the ridge.
• Molar teeth which are too broad
buccolingually.
27/80

CAUSES OF CRAMPED TONGUE
• Molar teeth leaning inwards. (this will not
always cause cramping of the tongue but
should never be allowed to occur as it
interferes with the free vertical movement of
the tongue)
28/80

HEIGHT OF THE OCCLUSAL PLANE
• To obtain maximum stability of a mandibular denture,
the occlusal plane of the mandibular teeth should be
very slightly below the bulk if the tongue, so that the
tongue performs the majority of the movements above
the denture and thus tends to keep the denture down.
29/80

HEIGHT OF THE OCCLUSAL PLANE
• If the height of the occlusal plane is correct,
the tongue will be seen to lie on top of the
lingual cusps.
• It is also important for:
– The greater the height of the mandibular denture,
the longer will be the mandibular front teeth and
the greater therefore the surface exposed to the
pressure of the lower lip.
30/80

• This concludes the examination of the
mandibular denture alone , and it should be
removed from the mouth and placed in a
basin of cold water.
31/80

TRYING IN THE MAXILLARY DENTURE
BY ITSELF.
• Place the Maxillary denture in the mouth and
seat it on the ridge.
32/80

– The Buccal and Labial Periphery is checked as for
the mandiubular denture.
– But the movement will be downward and inward.
33/80

• As for the mandibular denture, but if the teeth
have been set outside the ridge for reasons
dictated by the occlusion or to enhance the
appearance then this test will obviously be
omitted and reliance will be placed on the
positive retention of the finished denture to
produce stability.
34/80

BOTH DENTURES TOGETHER
• CHECK THE ANTEROPOSTERIOR POSITION
– Hold the mandibular denture in position on the
ridge and ask the patient to relax, then to close
the teeth together gently and maintain them in
occlusion whilst the examination is carried out.
– If the registration was wrong, the teeth will not
interdigitate correctly and may even occlude cusp
to cusp on one or both sides.
35/80

– The operator must make quite certain that the
occlusion he sees in the mouth is not due to
movement of the dentures on the ridges, tilting of
either denture or dropping of the upper and lower
denture.
– This is best tested by asking the patient to keep the
teeth together and then trying to separate the
posterior teeth be means of a thin spatula or knife;
this test should be carried out on each side of the
mouth alternatively.

• CHECK THE
ANTEROPOSTERIOR
POSITION
– Observation of the
maxillary and
mandibular centre
lines in relation to
each other.
– If it differ, will
indicate a lateral
swing.

– Major errors in the position of occlusion are easily
detected, but the minor errors may pass unnoticed;
therefore it is extremely important to watch for any
slight movement of the dentures on their respected
ridges from the time the teeth first make contact until
they reach the position of complete interdigitation.
– Care is needed when holding the mandibular denture
in place on the ridge, to avoid pushing it backwards.
38/80

• RE-TAKING THE ANTEROPOSTERIOR POSITION:
39/80

• CHECK THE VERTICAL HEIGHT:
– Ask the patient to relax with the lips closed .
– Watch the point on the chin and then ask the
patient to close the teeth together; the chin
should move upwards a small but definite
amount.
40/80

– If its impossible to obtain this movement, inspite
of repeated attempts, it can be assumed that the
vertical height is too great, and that, if this is
gross, there will be strained apperance when the
lips are brought into contact with each other.
41/80

– Patients who are mouth breathers relax their lips
parted, and frequently have large free way space.
– An over closed vertical height will be associated
with an excessive free way space, and when the
teeth are in occlusion the lips will be seen to be
pressed too firmly together with some loss of
vermilion border.
42/80

• CORRECTING THE VERTICAL HEIGHT:
– The posterior teeth are removed from one of the
dentures and replaced by wax blocks.
– The articulator should be closed or opened
approximately the amount required to establish a
suitable free way space, and then the blocks are
trimmed to occlude with the opposing teeth at
the new vertical height.

• CORRECTING THE VERTICAL HEIGHT:
– Final adjustments for evenness of occlusal
pressure, and for the production of the correct
free way space, are carried out in the mouth.
– Once these are satisfactory, the record blocks
should be chilled in cold water, and a little soft
wax added to their occlusal surfaces to register
the impressions of the opposing teeth when
registering the position of centric occlusion.

– Tactile sense method.
– Phonetics
– Silverman’s closest speaking space

• EVENNESS OF OCCLUSAL PRESSURE
– Provided centric occlusion is correct, the evenness
of the occlusion is checked next.
– It frequently occurs that the teeth on one side of
the mouth occlude slightly before those on the
other, or the molars before the premolars.
46/80

– This may be due to :
• Pressure on the blocks being heavier on one side than
the other when the records are taken.
• A slight error in sealing the models in the blocks when
articulating them.
• Warpage of the base plates.
47/80

– Such errors may escape notice at the try in stage
because the retention of the base-plates is less
than that of the finished dentures, thus allowing
the waxed up teeth to be in occlusion when in fact
they should not be in contact on the side on which
the dentures have tilted.
48/80

– Such irregularity of pressure may be slight or very
considerable, but if it escapes notice at the try in
stage, when the dentures are finished the teeth
will be held apart in the area of heavy pressure
and may require excessive grinding to correct this:
it may be gross as to necessitate complete
remaking one of the dentures.
49/80

– Teeth out of contacting the incisor and premolar
region, due to the molars occluding too early, is
frequently due to this cause.
50/80

• TO TEST EVENNESS OF OCCLUSAL PRESSURE
– Place two pieces of thin celluloid strips between
the teeth in the molar region, one on each side.
– Request the patient to close and then endeavor to
remove the celluloid strips simultaneously, holding
one with each hand, by pulling them out between
the closed teeth.
51/80

– Any difference in the force required to remove the
strips will be readily appreciated, and if this force
is interpreted in terms of occlusal pressure, an
assessment may be made of whether or not it is
error. Repeat the test in the premolar regions.

– To test whether the front of the denture is rising slightly from
the ridge when the back teeth are occluding, insert the point of
a wax knife between the upper and lower incisor teeth and
attempt to push the upper denture upwards and the lower
Denture downwards.
– Any appreciable movement may be intercepted as excessive
pressure in the molar region.
53/80

• CORRECTING EVENNESS OF OCCLUSAL PRESSURE
– If it is slight, gently soften, with pin-point flame;
the wax the teeth of one the denture, on the
offending side. Replace the dentures in mouth
and, holding the lower firmly in place, request
the patient to close. The teeth on the side of
heavy pressure will sink slightly into the
softened wax until the occlusion of the teeth till
the on the opposite side arrests them, thus
evening the occlusal, pressure. if the unevenness
is more than slight, this will not serve, as the
teeth will be forced out of place.
54/80

55/80
• CORRECTING
EVENNESS OF
OCCLUSAL PRESSURE
– Complete re-
taking of the
record of centric
occlusion with
built-up wax
blocks is the only
solution..

• Balanced occlusion and Articulation
–The first check is for centric occlusion,
which, if found to be incorrect,
necessitates the removal of the lower
posterior teeth and the recording of
the correct position on the wax blocks
replacing them.
56/80

• Balanced occlusion and Articulation
–The mandibular model is then
removed from the articulator and re-
set according to the new position, thus
keeping the maxillary model in the
same position as it was set by means
of the face-bow.
57/80

• Appearance
– This aspect of the try-in is a matter more for
individual judgment and the patient's ideas
than for set rules. Certain things require to be
checked, however, as routine. They are:
58/80

(i) Centre Line - Stand in front of the patient,
some distance away; a wrong centre line will
be obvious.
59/80

• Appearance
(i) Anterior Plane
- This may be
observed from
the same
position and
any tendency
for this plane
to slope
markedly up or
down should
be noted and
corrected
60/80

• Appearance
iii) Shape of the Teeth. - Ensure that the
selected teeth conform with the patient's facial
type , and variably consult the patient, to
whom a mirror has been handed.
iv) Size of the Teeth. - Individual judgment
must be relied in here together with the
patient's opinion.
v) Shade of the Teeth
61/80

• Appearance
vi) Profile–
– Observe the patient's profile and note if the lips
are either excessively distended or unduly sunken.
in the first case, remove some wax from the labial
flange and try the dentures in again.
– If this produces insufficient improvement,
examine the denture to see if the teeth can be set
farther in, or if smaller teeth can be used. If this is
not possible, the six front teeth may need to be
set to the gum.
62/80

• Appearance
vi) Profile–
– If the lips are sunken, build up wax on the
labial flange, especially in the canine and
premolar regions, until the profile is correct,
and in some cases set the anterior teeth
further forward.
63/80

• Appearance
vii) Amount of tooth visible –
– Ask the patient to say 'yes', and smile, and note how
much tooth shows.
– Consider whether ,you like it or not. In this connexion
remember that a smiling person usually only shows
the upper teeth; if much of the lower incisors are
visible, or only the lowers show, examine amount of
overbite and, if excessive, reduce it by lowering the
mandibular teeth.
64/80

• Appearance
vii) Amount of tooth visible –
–If this does not effect an improvement,
height of the occlusal plane may require
to be altered.
65/80

• Appearance
– viii) Regularity of the Teeth.
–
• Few natural dentitions
exhibit, perfection, and to
perfect a set-up in the
incisor region, specially in
persons of middle age,
tends to emphasize that
the teeth are artificial,
therefore a little
irregularity is usually
desirable.
66/80

• Appearance
– viii) Regularity of the
Teeth. –
• If the patient already has
dentures and likes the
appearance of them, copy
them, since it is always
inadvisable to alter a
patient's appearance
radically, without his
consent.
67/80

• Approval of apperance by the patient
– It is always wise for the operator to obtain the
patient’s approval of the appearance of the
waxed-up dentures before they are passed for
completion, as this enables the operator to make
necessary adjustments.
68/80

• Approval of apperance by the patient
– It should be remembered that other people will
see more of a patient’s dentures than he will, and
if they are not aesthetically pleasing in the
opinion of his relatives and friend. He will usually
become dissatisfied with them.

CHECKING FACIAL MEASUREMENT
• During the try in, we now make the final
judgment.
• When the patient counts rapidly from 50 to 60
the lower lip should just touch the incisal
edges of the maxillary teeth.
• In repose, the incisal edges of the maxillary
teeth are directed toward the inner margin of
the lower lip as a normal relationship.
70/80COMPLETE DENTURE TRY-IN

CHECKING FACIAL MEASUREMENT
• When the patient counts rapidly from one to
ten, at the “six” and “seven” sounds the
maxillary and mandibular incisors are over
one another and almost touching.

MOST FRUSTATING STATEMENT
• “DOCTOR, I JUST DON’T LOOK LIKE MYSELF”

MOST COMMON STATEMENT OF
DENTIST TO PATIENT
• “THIS IS THE WAY IT LOOKS RIGHT TO ME”

Golden Rule
• We are used to hearing the expression “Set
the teeth on the ridge” but this expression
should be changed to say “SET THE TEETH AS
NEARLY AS POSSIBLE TO WHERE THEY GREW”

Conclusion
• Having set-up the teeth according to the
information secured at the record stage, it is
necessary to try the waxed-up dentures in the
patient’s mouth before finishing them
77/80

References
• Clinical Dental Prosthetics, HRB Fenn, 2nd edition.
• Complete Denture Prosthodontics, John J. Sharry, 3rd
edition
• Prosthetic treatment for edentulous patients, Zarb,
Bolender, 12th edition.
• Syllabus of Complete denture, Charles M. Heartwell,
4th edition.
• Glossary of Prosthodontic terms, 8th edition

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