clinical procedure in complete denture


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vertical jaw relation
horizontal jaw relation
shade selection
pontic size

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clinical procedure in complete denture

  1. 1. Prosthodontic seminar ll
  2. 2.  vertical jaw relation  Horizontal jaw relation  Shade selection  Pontic size  mounting
  3. 3. Vertical jaw relation
  4. 4. Significance • Provides optimal separation between maxilla and mandible. • Tooth : Acts as a vertical stop. • If not measured accurately, the joint will be strained. • Musculature : Opening and closing muscles tend to be in a state of • If the VD is altered, minimal tonic severe discomfort to contraction. both TMJ and muscles of mastication.
  5. 5. Vertical dimension of rest (VDR). • Vertical separation of the jaws when the opening and closing muscles of mandible are in a state of minimal tonic contraction sufficient only to maintain posture. Vertical dimension of occlusion (VDO). • Vertical separation of the jaws when the teeth or occlusion rims are in contact.
  6. 6. Interocclusal Distance (IOD) It is generally considered that the teeth should not be in contact when the jaws are at the vertical dimension of rest position. The 2 to 4mm distance between the upper and lower teeth when the mandible is at physiologic rest position is called interocclusal distance (IOD) frequently referred to as the “free way space”.
  7. 7. INCREASE IN VDO / DECREASE IN IOD • The chin-nose distance will increase, and then patients will have an appearance of open mouth. • Constant pressure to the basal seat area which will lead to bone resorption. • Soreness of the tissues of the basal seat. • “Clicking”, of dentures during speech. DECREASE IN VDO / INCREASE IN IO • Potentially damaging to the TMJ. • The normal tongue space is limited. Facial distortion appears more noticeable with over closure • The muscles of facial expression lose their tonicity and the face appears flabby instead of firm and full. • Over closure of jaws may lead • Improper phonetics to angular chelitis
  9. 9. DEFINITION  Maxillo-mandibular relationship in which the condyles articulate with the thinnest avascular portion of their respective discs with the complex in the anterior superior position against the shapes of the articular eminences.
  10. 10. TYPES OF HORIZONTAL JAW RELATION CENTRIC  Reference relation with which the desired occlusion can be coordinated and is constant for each patient, provided that the soft tissue structures in the temporomandibular joints are healthy ECCENTRIC  Any relationship of mandible to maxilla other than centric relation which include protrusive and lateral relations.
  11. 11. OCCLUSAL RIM  Simulate teeth and help in establishing vertical dimension and centric relation
  14. 14. Shade selection Selection of shade - Color and shade of tooth The shade consist of: a. Hue i.e specific color b. Saturation i.e. amount of color per unit area. c. Translucency i.e ability of color to permit light to pas through it.
  15. 15. Patients age – With olderage, darker, while lighter teeth are suitable for young patients. Patients complexion: light teeth for fair skin, blue eyes, dark teeth usually for dark skin and black eyes. The color should be matched with the skin of the cheeks
  16. 16. The following facts are true for nearly all natural teeth: a.The neck of the tooth has a more pronounced color than the incisive edge. b.The incisive edge if not worn, is more transluscent that the body of the tooth and is usually of a bluish shade (composed entirely of enamel)
  17. 17. c.The upper central incisors are lightest teeth in the mouth followed by the laterals and canines. Posterior teeth are usually uniform in color. d.Teeth darken slightly with age. - Aid for selecting the shade Shade guides – The shade guide tooth should be moistened and selection made in the normal light. a.Outside the mouth along the side of the nose. b.Under the lip with the incisal edge exposed c.Under the lip with only the cervical end covered and the mouth open.
  18. 18. pontic selection Objectives: 1. Esthetics 2. Masticatory function 3. Correction of speech defects 4. Preservation of the remaining tissue and muscle tone - Primary selection of the teeth must be carried out at the first appointment.
  19. 19. Selection of size Selection of size (width and length) a. Size of the face and head b. Size of the contour of the maxillary arch c. Maxillomandibular relations i. In class I – Normal relationship, the teeth in one arch are compatible with the teeth in the other arch. ii. In class II – The mandible is retruded and the mandibular teeth are frequently smaller iii. In class III – The mandibular teeth are frequently larger than normal
  20. 20. Width of the anterior teeth Bizygomatic width – The average width of the maxillary central incisor is estimated to be 1-16 of the bizygomatic width that is, the distance between the cheek bones measured just in front of the ears. Some simple devices are available from tooth manufacturers for making this determination or caliper may be used to measure this distance. A face bow maybe used as caliper to make this determination. The combined width of the six maxillary anteriors is slightly less than one third the bizygomatic width.
  21. 21. Selection of the form: • Guides for selecting the form of anterior teeth. • Shape of the arch.
  22. 22. Posterior teeth selection Posterior teeth selection – Posterior teeth should have a small bucco-lingual width to keep forces on the supporting structure to a minimum. The mesiodistal measurements of the upper posterior teeth is taken from the distal surface of the canine to the prominence of the tuberosity. The total mesiodistal width of the four posterior teeth is often used as a mould number. The lower posterior teeth should not extend posterior to the mesial border of the retromolar pad.
  23. 23. Mounting  The master cast must be accuretly positioned on an articulator so that proper occlusion will be developed during the tooth arrangment