Delivering and Adjusting Complete Dentures

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Delivering and Adjusting Complete Dentures
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Prior to the Appointment

• Inspect for spicules with gauze (snags)
• Smooth any sharp areas
• Blend angular changes on periphery with the art
  portion of denture

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Prior to the Appointment

• Inspect posterior border
• (2-3 mm thick)
• Gradually tapers to the soft palate

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Order of Adjustments

• Check and Adjust
• Base Fit with PIP
• Peripheries with PIP (one side at a time)
• Occlusion with Articulating Paper Clinical
  Remount
• Esthetics, phonetics, patient concerns

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Insert Maxillary Denture First

• Ask about comfort
• Identify potential areas for adjustment
• Resistance to seating
• proceed to next step

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Check Adaptation of the Denture Base

• Remove a small amount of pressure indicating
  paste (PIP)
• Place it on a mixing pad
• Reseal the jar to avoid contamination

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Applying Pressure Indicating Paste

• Dry the denture
• Place a thin coat on the tissue surface with a
  stiff brush
• Leave streaks in paste

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Denture should be more the colour of the
indicating medium than the denture
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Prior to Placement

• Ensure damp mucosa
• Spray surface of PIP with air/water syringe

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Seating Denture Firmly

• Dont contact lips/ridge when inserting
• Over first molars (not palate)
• Remove from oral cavity by breaking seal with
  finger pushing up into height of vestibule

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Reading PIP

• Burnthrough (No paste left)
• Excessive pressure that should be relieved
• Streaks remaining
• No tissue contact
• Other areas need to be relieved
• Paste remaining with no streaks
• Acceptable contact

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Read the Paste
No Contact
Normal Contact
Burn through
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Non-retentive DentureWhats Wrong?

• No palatal contact
• Flange in 1st quadrant is short

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Denture Base Adjustment

• Relieve pressure spots - large acrylic burs
• Take care with undercuts
• Looks like burnthrough
• May not require adjustment

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Use Care in Retentive Areas

• Hamular Notch
• Tuberosity Undercuts

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Watch for Bony Impingements

• Relieve

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Check for Retention

• Pull outward upward on lingual of canines

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Repeat Until Denture Fully Seats

• Relatively uniform contact
• Minimal streaks
• No gross burnthrough

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Check for Peripheral Overextensions

• Seat denture border mold
• Flanges should fill vestibule but not be
  dislodged by manipulation
• If denture dislodges, use PIP to adjust

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Peripheries

• Border mold
• Adjust
• Check again
• Adjust high spots or facets

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Special Attention to Frenal Areas
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Special Attention to Frenal Areas
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Use to Check Contours

• Root prominences
• Thick peripheries

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Alter Phonetics

• More Info see Website Resources

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Paste Removal

• Gauze, cotton rolls, brushes
• Alcohol for stubborn areas
• Rinse and replace denture

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Adjust posterior overextensions using an
indelible marker
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Repeat for the Mandibular Denture
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Occlusal Analysis

• Insert both dentures
• Place a cotton roll between posterior teeth
  bilaterally
• Patient bites forcefully for one minute
• Simulates compression of the tissue after the
  patient has worn the denture for a period of time

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Occlusal Analysis

• Place patient in centric relation
• Visually check the occlusion
• Stabilize mandibular denture
• Check with articulating paper

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Anterior Open Bites or Unstable Posterior
Contacts

• Posterior denture base contacts
• Occlusal prematurities
• Use articulating FILM to mark and to eliminate
  gross interferences prior to remount

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Clinical Remount of Processed Dentures

• Remount on an articulator
• Allows extraoral occlusal adjustment
• Eliminates continual removal replacement of
  dentures

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Clinical Remounts Save Time

• Allows identification of interferences not seen
  intraorally
• Reflex avoidance caused by
• Pain
• Instability of the dentures
• Fewer adjustment appointments

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Not all dentures require an occlusal remount. We
will routinely remount dentures in clinics, so
that you have a chance to become competent.
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Remount Cast Fabrication

• Master cast is destroyed during removal of the
  processed denture
• New remount casts without undercuts

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Laboratory Prescription

• Fabricate
• Remount index on your remount jig
• Remount cast

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Remounting Maxillary Dentures

• Place remount jig on articulator
• Seat remount index on jig
• Seat maxillary denture in index
• Place remount cast into denture
• Mount with plaster

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Record Centric Relation

• Small amount of bite registration material
• Just cuspal indentations

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Record Centric Relation

• Lubricate opposing teeth ( petroleum jelly)
• Four small dots of Alluwax on widely separated
  teeth
• Soften evenly with a 7 wax spatula

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Assessing Centric Relation Record

• Ensure no penetration of material
• Allow to fully set
• Ensure the record is precise repeatable

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Assessing Centric Relation Record

• Ensure no penetration of wax
• Remove and chill
• Ensure the record is precise with no distortion

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Mount Mandibular Cast

• Maxillary denture on remounted cast
• Interdigitate dentures
• Stabilize with sticky wax

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Mount Mandibular Cast

• Place cast in mandibular denture
• Invert articulator
• Attach mandibular model

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Ensure No Debris Under Denture
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IMPORTANT Verify Centric Position After Mounting
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Verify the Protrusive Record

• Strip of Alluwax over all posterior teeth
• Patient occludes 4-6 mm in protrusion
• Chill the wax and set the condylar inclination
• Similar to that taken previously

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Adjust the occlusion on the articulator, using
articulating film of separate colour for centric
and excursive contacts
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Ensure

• No anterior contacts in CO
• Uniform simultaneous, bilateral centric contacts
• Smooth excursive movements

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Balanced Occlusion Ensure

• Balancing contacts are present
• Balancing contacts not heavier than working
  contacts
• Light grazing contacts of the anterior teeth in
  excursions

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Intraorally verify that contacts are similar and
the occlusion feels comfortable to the patient
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Check Vertical Dimension

• 2-4 mm of interocclusal distance at physiologic
  rest position

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Phonetics

• F sounds
• maxillary incisors touch lower lip
• S sounds
• incisors close together
• posterior teeth do not contact

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Check Esthetics
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Polish Adjusted Areas

• Initial polish/minor adjustments
• Brasseler Acrylic Polishing Kit

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Different Shapes
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Polish Adjusted Areas

• Final Polish
• Dazzle Paste mixed with water liquid soap
• Dampened felt cloth wheel (disposable)
• On lathe in lab

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Provide Care Instructions
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Insertion/Delivery - Denture Base

• Retentive, does not displace with moderate
  vertical pressure
• Proper flange extension
• Indicating medium reveals no areas of significant
  impingement
• Not underextended
• No spicules and well polished
• Proper flange thickness (generally not gt 4-5 mm,
  rolled not sharp)
• Proper relief of frenula
• Bases terminate at proper anatomical landmarks
• Patient comfortable
• Not rocking on overdenture abutments

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Insertion/Delivery - Occlusion OVD

• Posterior teeth contact bilaterally
  simultaneously, w/o shift
• Degree of balance evident in centric and
  eccentric positions
• Acceptable interocclusal space
• Anterior teeth are not in contact in centric
  occlusion
• Grazing contact in protrusion
• Acceptable esthetics
• Acceptable phonetics
• Instructions re use and home care

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Continuing Care