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Processing and insertion of complete denture
9. lecture
Prof. Dr. Peter KivovicsProf. Dr. Peter Kivovics
Former Head of the Department of Community DentistryFormer Head of the Department of Community Dentistry
DMD, BDS, MSc., C.Sc., Ph.D.DMD, BDS, MSc., C.Sc., Ph.D.
Chief Dental Officer for HungaryChief Dental Officer for Hungary
Semmelweis University Faculty of DentistrySemmelweis University Faculty of DentistryDepartment of ProsthodonticDepartment of Prosthodontic
head of department: Prof. Dr. Hermann Péter
Construction of Complete DentureConstruction of Complete DentureClinical and laboratory stepsClinical and laboratory steps
Clinical Clinical • ComplainComplain→Prognoses→Prognoses
Taking first impressionTaking first impression• Outlining borders of special trayOutlining borders of special tray• Transform special tray to Transform special tray to
functional trayfunctional traySecondary impressionSecondary impression
• Jaw registration with occlusal rimsJaw registration with occlusal rims(ear bow, face bow registration)(ear bow, face bow registration)Tooth selectionTooth selection(size, form, colour)(size, form, colour)
• Try in, trial dentureTry in, trial denture• Fitting Fitting • Short time recallShort time recall• Long time recallLong time recall
LabLab
• First castFirst cast• Special traySpecial tray• Secondary cast (functional cast) Secondary cast (functional cast)
Occlusal rims (baseplate+wax Occlusal rims (baseplate+wax rims)rims)
• Mounting in articulator, Setting up Mounting in articulator, Setting up the teeth, Trial denturethe teeth, Trial denture
• Flasking, Packing,Ready dentureFlasking, Packing,Ready denture
Fitting Complete DentureFitting Complete DentureAssessment on the articulator after that in the mouthAssessment on the articulator after that in the mouth
The dentist should check…The dentist should check…
• Adaptation of impression Adaptation of impression surface to the cast and to surface to the cast and to the edentulous jawsthe edentulous jaws
• Polished surfacePolished surface
• Incisal and occlusal surfaceIncisal and occlusal surfaceOcclusal conceptOcclusal concept
• Centric occlusion, and Centric occlusion, and Vertical dimension of Vertical dimension of occlusal and restocclusal and rest
• AAesthetics, lip support esthetics, lip support appearanceappearance
• Adaptation of baseplate to Adaptation of baseplate to the secondary cast and to the secondary cast and to the edentulous ridge (base the edentulous ridge (base extension)extension)
• AArtificial gumrtificial gum
• Artificial teeth and Artificial teeth and articulation and Occlusionarticulation and Occlusion
• AAesthetics, lip support esthetics, lip support appearanceappearance
AdviceAdvicePatient managementPatient management
• It is not readyIt is not ready!!• It is uncomfortableIt is uncomfortable! (n! (no correctiono correction))• „„It`s moving! It can taken out with my tongueIt`s moving! It can taken out with my tongue!”!”• Wearing dentureWearing denture ((Must not wearing the old dentureMust not wearing the old denture!!
Do not change it!)Do not change it!)
• Cleaning (Cleaning (HHygiene)ygiene)• Problem with tasteProblem with taste• HypersalivationHypersalivation• RRecall! (ecall! (short-term-short-term-, , long-term recall procedureslong-term recall procedures))
Construction of Complete DentureConstruction of Complete DentureClinical and laboratory stepsClinical and laboratory steps
Clinical Clinical • ComplainComplain→Prognoses→Prognoses
Taking first impressionTaking first impression• Outlining borders of special trayOutlining borders of special tray• Transform special tray to Transform special tray to
functional trayfunctional traySecondary impressionSecondary impression
• Jaw registration with occlusal rimsJaw registration with occlusal rims(ear bow, face bow registration)(ear bow, face bow registration)Tooth selectionTooth selection(size, form, colour)(size, form, colour)
• Try in, trial dentureTry in, trial denture• Fitting Fitting • Short time recallShort time recall• Long time recallLong time recall
LabLab
• First castFirst cast• Special traySpecial tray• Secondary cast (functional cast) Secondary cast (functional cast)
Occlusal rims (baseplate+wax Occlusal rims (baseplate+wax rims)rims)
• Mounting in articulator, Setting up Mounting in articulator, Setting up the teeth, Trial denturethe teeth, Trial denture
• Flasking, Packing,Ready dentureFlasking, Packing,Ready denture
SHORT-TERM RECALL SHORT-TERM RECALL PROCEDURESPROCEDURES
• Patient Management (Advice) Patient Management (Advice)
• To solve problems and complaintsTo solve problems and complaints
• Correction of complete dentureCorrection of complete denture
Mucosal ulceration (mucosal Mucosal ulceration (mucosal decubitus, decubital ulceration)decubitus, decubital ulceration)
Denture induced traumatic Denture induced traumatic irritative injuryirritative injury
Causative factors of oral Causative factors of oral ulcerationulceration
• TechnologicalTechnological
• Osteogenic, MucosalOsteogenic, Mucosal
• Denture instability Denture instability
• Incorrect Incorrect OOcclusioncclusion, , AArtikulrtikulationation
• General health stateGeneral health state
TECHNOLTECHNOLGICAL CAUSESGICAL CAUSES
• Superficial irregulariticsSuperficial irregularitics
• PoroPorositysity
• Increased monomer contentIncreased monomer content
• Alteration in the shapeAlteration in the shape
• Polishing and finishing errorsPolishing and finishing errors• Inappropriatic markingInappropriatic marking
OSTEOGENIC AND MUCOSAL OSTEOGENIC AND MUCOSAL CAUSESCAUSES
• ExostosisExostosis (bone irregularities) (bone irregularities)
• Sharp irregular marginal ridgeSharp irregular marginal ridge
• Undercut areaUndercut area• Special anatomic featuresSpecial anatomic features
• Thin and sensitive submucosaThin and sensitive submucosa
DENTURE INSTABILITY DENTURE INSTABILITY CAUSESCAUSES
• Design errors with MDesign errors with Mucosalucosal surface surface
• Design errors with Polished surfaceDesign errors with Polished surface
• Design errors with Occlusal surface Design errors with Occlusal surface and incisal edgeand incisal edge
FAILURE IN THE FAILURE IN THE ORGANIZATION OF ORGANIZATION OF
OCCLUSIONOCCLUSION• Missing of Bilateral Balanced Missing of Bilateral Balanced
Occlusion (imbalance)Occlusion (imbalance)
• False Centric OcclusionFalse Centric Occlusion
• PrematurPrematuree contactcontact
• Parafunctional activityParafunctional activity
GENERAL HEALTH STATUS GENERAL HEALTH STATUS CAUSESCAUSES
• Decreasing of submucosa Decreasing of submucosa
• XXerostomiaerostomia
• Deficiency (Vitamin B, Iron)Deficiency (Vitamin B, Iron)• Decreasing of mucosaDecreasing of mucosa
• Parafunctional activity Parafunctional activity
• DiabetesDiabetes Mellitus Mellitus
DIFFERENT SHAPES OF DIFFERENT SHAPES OF MUCOSAL ULCERATION MUCOSAL ULCERATION
Deep redDeep redGreyishGreyish
DIFFERENT SHAPES AND DIFFERENT SHAPES AND SIZES OF MUCOSAL SIZES OF MUCOSAL
ULCERATIONULCERATION
RoundRound LineLine
TYPICAL LOCATION OF THE TYPICAL LOCATION OF THE DENTURE IRRITATIONDENTURE IRRITATION
Gingival mucosaGingival mucosa(non mobile)(non mobile)
Mobile mucosaMobile mucosaDuring the functionalDuring the functional
movementsmovements
Border of the mobile Border of the mobile and non mobile mucosaand non mobile mucosa
Most frequent regions of Most frequent regions of decubital lesions on decubital lesions on edentulous maxillaedentulous maxilla
Most frequent sites of Most frequent sites of decubital lesions on decubital lesions on edentulous maxillaedentulous maxilla
Most frequently sites of Most frequently sites of decubital lesions on decubital lesions on edentulous mandibleedentulous mandible
Most frequently sites of Most frequently sites of decubital lesions on decubital lesions on edentulous mandibleedentulous mandible
http://www.quintpub.com/userhome/ijp/ijp_20_4_Kivovics_7.pdf
http://www.ncbi.nlm.nih.gov/pubmed/17695871