PROSTHODONTICS
Table of Contents
Topic
Page Number
Basic Information
2
Fixed Pros Scheduling
3
Single Crowns
5
Fixed Partial Dentures
9
RPD Scheduling
14
RPDs
16
Denture Scheduling
24
Dentures
26
Post Delivery Trouble Shooting Guide
35
Articulator Basics
46
1
PROSTHODONTICS
The following guide is an outline for fixed and removable clinic & lab procedures, but each patient will have
individual and unique needs that may require using different methods, materials, or sequence of appointments.
Be sure to check with your faculty before each appointment to discuss the needs of the patient.
 Indicates a step that requires a faculty check.
Screening Appointment, Information & Tips for the D3 Clerkship
•  Check with your faculty before (a minimum of 24 hours in advance) every appointment!
o Before competencies, check with both your primary and secondary faculty.
• Call patients personally to confirm each appointment.
• Each patient that comes to the pros department will have a screening appointment first:
o Patient may require additional consultations
o General observations, psychological evaluation
o Check if the patient has been through OD (comprehensive care patient vs. limited care, evaluate
radiographs needed)
• Escort the patient to the business office after the screening appointment, initial exam appointment, and
for any treatments that require payment (D code procedures). Down payments are required to be made
prior to preps, any final impression or prior to repairs of the prosthesis.
• It is best to schedule all of your patient’s appointments at their initial appointment if possible. Be
cognizant of your faculty’s schedule as well, making sure either your primary or secondary faculty are
present.
• If you need to switch instructors, make sure the two instructors have discussed the case.
• Different appointments require different dispensary trays. Make sure to get the proper tray at the
beginning of the morning/afternoon.
• All occlusal analyses should be evaluated by an instructor within 48 hours.
• Pour cast of impressions immediately and evaluate with faculty. Make sure to be clear with the faculty
why the cast is either acceptable or unacceptable.
• Save all original casts, making any alterations on duplicate casts.
• Lab time indicated is in business days (M-F).
• Every appointment in Axium (done prior to the patient leaving the clinic):
o Note
o Post codes (s= step, d= patient needs to stop at business office)
o Evaluation
o Walk out statement
• Lab authorization examples are available on ICON in the D3 Pros Seminar/Pros Clinic classes.
2
Fixed Pros (Crowns and Fixed partials)
Appointment
1. Initial Exam
Materials Needed
-Plastic tray
-Bosworth tac
-Alginate
-Mixing Bowl
-Mixing Spatula
-Facebow
-Bite Fork (make sure its
sterilized)
-Regisil
-Wax wafers
-Water bath (hot and cold)
-Exam tray from dispensary
Procedures/Steps
Medical and Dental history
Initial clinical exam
(general observations,
psychological evaluation).
Patient may need
consultation (foundation?)
Make necessary radiographs
Clinical photographs if
indicated
Diagnosis and treatment
plan. Change if needed.
Informed consent
 Diagnostic impression
Pour Diagnostic casts
 Facebow
 Make CR & protrusive
records
Lab Work
Duplicate diagnostic
casts x2 (for wax up and
custom tray fabrication),
save original
Trim diagnostic and
duplicate casts
Mount diagnostic casts
Diagnostic wax up
Duplicate wax up
Make vacuum formed
matrix from duplicate of
wax up
Fabricate custom tray
Complete occlusal
analysis
Notes
Inform patient of number
of appointments:
FPD: ~6-7
Single unit ~4-5
1 CPC will add ~2
appointments
Treatment plans that
include surveyed crowns or
combo cases may require
additional appointments
Discuss patient’s schedule
& schedule out further
appointments if possible
If the patient is unable to
come on the same day as
your assigned faculty is
available, consider
switching faculty
(All of these need to be
checked by the professor)
Fill out screening form
Schedule appointments
2. Crown Preparation
(Appointment 2 needs to
be planned for new
foundation – if it is found
that the foundation is not
needed then the prep can
be started)
-PVS putty
-Vacuum formed matrix
-PMMA
-Retraction cord
-Tempgrip cement
Make putty matrix – may
consider making on waxed
up cast
Crown Preparation
Interim Fabrication
- Fabricate trial base for
mounting for patients that
are partially edentulous
(discuss with facultynecessary for 2nd diagnosis
appointment requiring
mounting)
Inform patient to call if
interim falls off or breaks
If adequate time, you can
proceed to impressions and
shade selection
 Cement interim
3. Master Impression,
Occlusal records,
Porcelain shade selection
-Custom tray
-Kerr tray adhesive
-Extrude medium body
-Extrude light body
(some faculty prefer heavy
body)
-Trial base if indicated
-Tempgrip cement
 Remove excess cement
Remove interim
Re-evaluate prep and make
necessary modifications
Make master impression
Occlusal records (CR/MI
depending on patient,
discuss with faculty prior to
appt. Usually MI for fixed
patients)
Select porcelain shade
Recement interim
Box impression
Pour definitive casts
Pindex definitive cast
Base definitive cast
Section die(s)
If the patient is partially
edentulous, may need to
fabricate a trial base for
mounting. This may require
an additional appointment.
Your instructor will help
you choose which lab to
send to.
Trim die(s)
Mount definitive casts
Mark margin, place die
spacer, and resin rock
hardener
 Fill out laboratory
authorization (practice
authorization sheets
available to have checked
by faculty)
Lab time: 7 days for most
3
4. Metal framework try-in
(don’t usually do for single
unit crowns)
-GC resin
-Lab Plaster
-Mixing bowl
-Mixing spatula
-Shimstock
-Acufilm
-Disc to section framework
-Fit checker
 Inspect metal framework
(proximal contacts, internal
fit, marginal integrity,
stability, occlusion, external
contours, surface finish)
Section metal framework
and re-position it to make it
more stable, if necessarytech/faculty help.
things (10-15 days to
make all ceramic crown)
Request lab to re-solder
framework in new position
Lab time: 7 days
May have second
framework try-in
appointment
The lab time is usually less
than 7 days. Can call to find
out.
GC resin to hold Framework
sections in positiontech/faculty help.
Impression of framework
with lab plaster
5. Delivery
Appointment
-Shim stock
-Acufilm
-Porcelain polishing kit
-Fit checker
-RelyX Luting
-Metal polishing
instruments for all
metal crn
Evaluate fit of
prosthesis: Margins,
internal fit,
interproximal contacts,
occlusion (have faculty
check before you
adjust occlusion)
Inform patient of
potential for
sensitivity
Have patient look
before you cement
 Cement
 Excess cement
removal
4
Preparations
All Ceramic Crowns
Indications for ACC:
• Anterior crowns
• High esthetic requirement
• Optimal tooth preparation possible
• Favorable distribution of occlusal load
Contraindications for ACC:
• Unfavorable occlusion – occlusion in cervical
third
• Inadequate tooth preparation for support –
ceramic thickness greater than 2 mm.
Ideally ceramic is 1.2-1.5 mm thick.
• Never for molars
Prep considerations
• Subgingival margins can be no greater than
½ the depth of the gingival sulcus.
• Round all angles
• 1.2-1.5mm clearance
*Incisal Reduction is only 2 mm in clinic.
Anterior Porcelain Fused to Metal Preparation
Indications for PFM:
• Increased occlusal forces
Parafunctional habits
*Incisal Reduction is only 2 mm in clinic.
• Posterior teeth
• Fixed partial dentures
• Metal substructure design can optimize porcelain thickness
• Surveyed Crown (RPD Abutment- design required prior to
preparation)
Prep considerations
• Lingual clearance – 1.0mm if centric contact in metal.
1.5mm if centric contact on ceramic. Want centric contacts
1.5 to 2 mm from porcelain/metal junction. Base decision
on opposing occlusion, opposing material, and vertical
overlap.
• Metal thickness must be a minimum of 0.3 mm to 0.5 mm
thickness in areas to be veneered with porcelain.
• Porcelain thickness must be a uniform 1 to 2 mm. Provide
support for porcelain in stress bearing areas (cusp tips,
incisal edges, etc)
Margin Framework Design:
• Metal collar – width >/= 0.5 mm.
o Margin geometry- light chamfer or modified shoulder.
• Disappearing Margin – 1 mm
o Margin geometry – heavy chamfer or modified shoulder.
• All porcelain shoulder
o Margin geometry- modified shoulder.
o Extend margin completely through the proximal contact area.
Full Cast Crown
Indications for FCC
5
•
•
First choice when restoring a posterior tooth with a full veneer crown.
Best longevity of all fixed prosthodontics
restorations.
• Least abrasive to opposing teeth.
Prep considerations
• Morphological Occlusal Reduction
o Functional cusp – 1.5mm clearance
o Central fossa – 1.5mm clearance
o Non-functional cusp- 1.0mm reduction
Margins
• Chamfer: FCC, PFM & ACC
• Modified shoulder: PFM & ACC
Additional Information
• TOC is greater than 20 degrees the preparation requires
modification.
• Adequate R and R form
o Height/base ratio should be greater than 0.4 for
all teeth.
o Incisors and premolars – 3 mm minimum height. Molars – 4 mm minimum height.
6
Interim Crown Fabrication
PMMA
• 10 drops liquid
• Add powder to slight excess, remove excess
• Add 1-2 drops monomer
• Mix and fill matrix
• Seat matrix when PMMA in doughy stage
• Lift matrix over height of contour in 30 seconds intervals throughout polymerization reaction (=2 min)
• Trim excess and then bead brush deficiencies
Protemp (Discuss use of this product with faculty prior to using this material)
• Fill & seat matrix over prep
• Close patient into MI
• Allow set for 30 sec, until rubbery
• Lift matrix over height of contour
• Reseat & repeat every 30 seconds throughout polymerization (2 min)
• Correct deficiencies with flow-it. Light cure for 30 seconds.
Polycarbonate Interim Crown
• Size chosen based on the mesial-distal width of the tooth being restored
• Trim off the excess gingival length with a carbide bur and reline with PMMA
Custom Impression Tray
• Draw extension on cast – 3-5 mm apical to gingival margins
• Provide 2-3 mm of space for impression material (2 thicknesses of base plate wax). Adapt wax to
diagnostic cast. OR can soak cast in supernate solution and dip wet cast in a wax pot 2-3X. Measure
thickness with probe, because wax consistence varies, to be sure it is acceptable).
• Create stops on non-prepared teeth (tripod) Avoid cusp tips.
• Adapt tin foil to wax surface and burnish into tissue stops.
• Adapt Stern-tec over tin foil and trim excess.
• Light cure for 2 min. Remove wax spacer and light cure intaglio for 1 minute.
• Trim and smooth borders.
• Two trays are needed for each preparation
Impressions
• “Simultaneous dual viscosity technique”
• Check fit of custom tray intraorally, before the adhesive.
• Apply thin even coat of Kerr adhesive and let it air dry.
• Pack cord
• Prepare the patient by checking that the field is dry, there is hemostasis and cover the patient with a
plastic cover sheet (gown).
• Remove retraction cord.
• If working alone: load custom tray with medium body PVS first and set it aside. Load syringe with Light
body PVS and immediately start impressing. Single use syringes may be preloaded and ready to use.
• Keeping the tip of the syringe at the margin, begin at line angle of interproximal surfaces. Express
impression material until it flows through the interproximal surface.
• Continue around the facial, keeping the syringe in impression material at all times.
• Circle around from gingival to occlusal until entire preparation is covered.
• Capture occlusal surfaces of unprepared teeth.
• Seat tray in patient’s mouth till tissue stops contact.
• Hold in place throughout the setting reaction (about 5 min).
• Remove by releasing at corner.
7
•
Evaluate (see evaluation criteria) – no voids on margins. Minimal voids on axial and occlusal surfaces.
Definitive Cast Fabrication
• Trim lateral over-extension of impression flush with custom tray.
• Leave 5-8 mm of vertical height from cervical margins of teeth.
• Create a flat surface parallel to tray base- occlusal plane.
• Clip out interproximal areas on unprepared teeth only.
• Debubblizer can be applied, then dry prior to pouring.
• Box & pour with Type IV gypsum (Resin Rock).
• Complete a second pour for the solid cast.
• Trim so that base thickness is 10-12 mm from margin. Trim the lingual surface of the cast with a slight
bevel toward the base. Base should have a uniform width of 15mm.
Pindex
• Mark cast where pins will be placed (2 pins per section). Pin hole locations must be within the cast base,
centered F-L.
• Cement pin with Type 202 cyanoacrylate & immediately clean off any excess cement. Cement short pins
first.
o Long pins have white sleeves, short pins have gray sleeves. Sleeves should be flush with cast
base. Long pins are placed in single pin situations and on Facial when used with a short pin in a
segment.
Pour base
• Check the fit of the cast in the base former.
• Spray super-sep on cast base.
• Pour base with Type III stone. Rotate cast into stone until long pins hit the bottom.
• Remove excess stone and allow setting for 45 min.
• Trim cast periphery flush with junction of 1st and 2nd pours. Do not trim cast bottom – will hit pins.
• Carefully separate 1st pour from cast base.
Die trimming
• Identify dowel pin locations and desired saw cut locations. Lines must be parallel to pins and between
the pins.
• Reseat 1st pour into cast base.
• Section with saw entirely through the 1st pour and slightly through the cast base. Use short strokes with
sawing.
• Trim the cast die to create independently removable dies with ideal root form emergence profile (3mm
below margin). Helpful to draw emergence profile first
• Trim with carbide bur or bard parker. If you have any concerns with trimming, please ask faculty for help
and some may request that they work with you on this step.
• Mark margin with red wax pencil.
Mounting & Die spacer
• Create a window for access to long dowel pins in the bottom of the base.
• Index base.
• Cover access window with boxing wax.
• Create (needed to be completed a the final impression appointment) and CO (MI) interocclusal record
and trim.
• Articulate casts and secure with zapit/super glue.
• Mount on articulator with plaster.
8
•
•
•
•
Correct small voids on occlusal or axial surfaces of die with T03 TX cyanoacrylate, slightly overfill the
defect.
Remark margin with red wax pencil.
Apply die hardener to margin and dry with air syringe.
Apply 3 layers of die spacer. Stay 1 mm above margin. Apply smooth even coats, allow to dry 2 min
between each coat.
Fixed Partial Dentures
Preparation
o Evaluate occlusal contacts and clearance.
o Consider the path of draw.
• All metal retainer considerations
o 1.5mm occlusal clearance on functional cusps
o 1.0mm occlusal reduction on non-functional cusps
• PFM retainer considerations
o 2.0 m reduction on facial non-functional cusps for esthetics.
o The material you choose for your contact will dictate how far through the proximal you extend
your heavy chamfer margin.
Supplementary R/R forms
• If retention and resistance is compromised place a supplementary groove on M or D for a single tooth
prep and on F or L for a FPD. Groove should be 1mm above facial margin and 1mm depth at the bottom.
Indirect-direct interim technique
• Pour extra cast and an extra vacuform matrix that is fitted over the occlusal surface of most of the
unprepared teeth
• Conservatively prepare abutment teeth for planned prosthesis (0.5-1.0 mm)
• Evaluate for draw
• Apply Alcote to cast (2 coats)
• Mix acrylic resin
• Fill interim matrix with resin
• Seat filled resin over tooth preparations
• Place rubber band to hold matrix over unprepared teeth
• Place (interim side down) in bowl of warm water
• Remove indirect interim from cast and contour
9
•
•
Pumice but do not high shine
At next patient appointment verify shell seats fully and reline by filling with acrylic resin.
Pontic designs:
• Hygienic/sanitary – no contact with ridge. 2-3 mm space between ridge and pontic. Adequate space
from hygiene without being a food trap. Convex in all directions.
• Conical – passive contact with ridge crest. Rounded and cleansable. Suited for thin/resorbed mandibular
ridges. Non-esthetic regions.
• Saddle/ridge-lap – NEVER used.
• Modified ridge-lap – passive contact with tissue facial to ridge crest. Convex tissue surface. Used
routinely in the esthetic zone.
o Convex in all directions
o Minimal contact
o Smooth, highly polished
o No pressure on tissue
o Contact on keratinized mucosa
o Minimum connector height: 3-4 mm (Remember maintaining height of connector is more
important due to the law of beams)
o Minimum connector width: 3-4 mm
• Ovate
Custom Incisal Guide Table
• Used to record the true path of anterior guidance. Records the physiologic lingual contours and length
of maxillary anterior teeth.
• Indicated when mechanical guide table cannot be set to simulate anterior guidance and when restoring
maxillary anterior teeth or mandibular anterior teeth.
• Steps:
o Place mounted diagnostic casts on articulator
o Remove mechanical table
o Replace it with a plastic custom incisal guide table
o Reverse incisal guide pin so that rounded end is pointed toward table and is also typically 1 mm
off the table to create the stop in resin.
o Verify pin is at zero.
o Lubricate rounded end of incisal pin with Vaseline
o Place 1-2 drops of monomer to wet plastic incisal guide table platform
o Mix monomer and polymer in dappen dish
o Remove acrylic resin from dappen dish when it reaches the stringy stage and place on plastic
guide table.
o Unlock centric relation pins on condyle and close the articulator. Verify tip of pin has positive
contact with table surface.
o Guide the maxillary cast into a right lateral movement until the canines reach end to end. Going
just past the end to end positions will guarantee the full height is captured.
o Repeat this procedure with a left lateral movement and protrusive.
o Complete guide table by moving incisal pin through all possible intermediate latero-protrusive
movements.
o If guide pin does not touch the acrylic resin during all movements, reline the custom incisal
guide table.
10
Framework Try-in (For FPD)
Pre-clinical evaluation:
• Marginal adaptation
• Internal surface
• Inter-abutment stability
o Prosthesis is completely stable. NO rock, no open margins.
o Evaluate inter-abutment stability on master cast and on solid cast.
• Proximal contacts
o Evaluate on definitive and solid casts
• Occlusal contacts
o Should be greater than or equal to 1.5 mm from porcelain-metal finish lines
• Occlusal anatomy and finish
• Axial contours
• FPD design
o Metal-ceramic finish lines
 Internal finish lines- 90 degrees and rounded
 External finish lines – metal ≥ 90 degrees, porcelain ≤ 90 degrees, sharp
o Framework design to support porcelain
o Pontic contours
o Connector location; dimension; contour
o Adequate cut-back for porcelain
 Occlusal porcelain should be greater than 1 mm and less than 2 mm
o Adequate metal thickness in areas to be veneered
 Metal must be ≥ 0.3 mm thick.
Clinical evaluation and adjustment procedures:
• Evaluate interim to verify that is has remained intact during interim period.
• Gently remove interim FPD with a hemostat by VERY gently rocking F-L.
• Disinfect interim, place in a zip lock bag, clean in an ultrasonic bath with temporary cement
remover.
• Gently re-polish, disinfect, and re-cement at the end of framework try-in appointment.
• Remove all temporary cement from abutments.
• Pumice with flour pumice and rubber cup.
• Proximal contacts
o Evaluate with shimstock, articulating film and floss
o Selectively adjust region of binding from peripheral to central portion of mark
• Internal fit
o Use fit checker
o Selectively grind with #1 round carbide bur
o Sandblast and steam clean
• Stability
o If unsatisfactory FPD inter-abutment relationship section and re-relate FPD- have a lab
tech or instructor help you
o Where section?
 History of solder – resection here
 Location – next to worst fitting retainer
 Size – connector dimension
 Access – clinically
o Soldering gap size should be 0.25-0.75 mm, and space should be parallel. Section
with a ultra-thin carborundum separating disc (0.2 mm thick)
o Section without starting and stopping
11
After sectioning evaluate fit of individual retainers and smooth (clean) sectioned
surfaces with a Craytex rubber wheel
o Re-relating the FPD segments:
 GC Pattern resin – applied with a bead brush technique. Stability retainers
(may need to use fit checker) [Better to work with someone helping to hold
it in place], wet solder joint with monomer, apply GC pattern resin in small
increments, and continue till gap is slightly overfilled. Allow GC resin to fully
polymerized. When set remove and inspect for stability.
 Occlusal Plaster Soldering Index – Use quick set plaster in metal denture
tooth frame tray. Can seat plaster on occlusal surfaces in the mouth or can
make GC resin in mouth and set this in plaster index and send both to lab.
Only cover occlusal 1/3 of the axial walls. Once in the plaster, do not
remove.
Marginal integrity
o Check interproximals with floss, watch for tears
Occlusion
External contours
Surface finish
Send to the lab for porcelain application
o
•
•
•
•
•
Crown evaluation
Evaluate prosthesis quality at least 24 hours prior to patient appointment.
Preclinical evaluation:
• Marginal adaptation
• Internal surface: Use occlude, Steam clean after die evaluation
• Proximal contacts: Check one at a time with removable dies and on solid cast
• Occlusal contacts: Minimum of 2 centric contacts
• Axial contours
• Finish: Highly polished
Crown Delivery Appointment
Clinical adjustments:
• 1. Proximal contacts
o Check with shimstock, acufilm, and floss
o Leave slightly tight to allow final polish. As adjustments are made, the stone or wheel
used should be less course and start the polishing during the final adjustment.
• 2. Internal fit
o Remove positive contacts (with the exception of the margins, which should have
positive contact).
o Use fit-checker
o Do selective grinding with #1 round carbide bur
o Sandblast and steam clean (do just before cementation)
o Clean tooth with flour pumice (do just before cementation)
• 3. Stability
o Check Facial-lingual rock and rotation
• 4. Marginal integrity
o If negative defect (short or open margin) need to remake
o If positive defect (overextension) use stone or rubber wheel on slow speed handpiece to
grind
12
Seat crown and hold, pull floss through contact and rub on margin, if tears know margin
isn’t fully closed
5. Occlusion
o Use shimstock and articulating film
o Before grind check thickness with Iwanson gauge
o Check reference contacts without prosthesis
6. External contours
7. Surface finish: Final polish with rouge and robinson brush wheel
Extrinsic characterization
 Use metal oxide stains, fire, apply glaze, fire
o
•
•
•
•
Cementation
• Very gently remove interim crown with hemostat
• Remove temporary cement
• Flour pumice tooth
• Isolate and dry tooth
• Polish should be completed.
• Crown intaglio should be air-abraded, ultrasonically or steam cleaned and dried.
• Dispense powder or Rely-X first, then liquid (3 scoops powder to 3 drops liquid)—or mixing gun
• Mixing time 30 sec
• Coat inside of crown
• Seat on tooth with pressure
• Verify complete seating by feeling margins
• Setting time 5 min – have patient bite on cotton roll
• Remove excess cement. To remove off of interproximal tie a knot in a piece of floss and run through
embrasures.
• Verify occlusion, adjust if necessary and re-polish
13
Removable Partial Dentures
Appointment
1. Initial Exam
Materials Needed
-Alginate
-Mixing bowl
-Mixing spatula
-Wax wafers
-Gold Color Form (Use as
a guide)
2.Diagnostic Jaw
Relations
-facebow
-bitefork
-regisil
-trialbases/occlusal rims
3.Tooth
Modification &
Master
Impression
(Should have
Surveyed Crowns
completed and
delivered by this
step)
-Custom trays
-Kerr adhesive
-light and medium body
PVS
-Compound
-Waterbath
Steps/Procedure
Medical and Dental History
Chief Complaint
Radiographs – periapicals
of all remaining teeth

Evaluate the need for a
panorex
 Clinical Exam (include
abutment evaluation, surveyed
crown necessary or replacement
of restorations, vitality,
periodontal status), border
tissues, and denture bearing
surface)
 Diagnosis and treatment
planning
 Diagnostic Impression

Pour diagnostic cast

(Jaw Relations if adequate
distribution of teeth)
*Discuss and determine
between CR and MI with
instructor
 Facebow Record
 Bite fork
 CR (or possibly MI) and
protrusive interocclusal records



 Prep tooth modification
 Check tooth modifications
with alginate or aluwax to
confirm adequate
dimensions
*Discuss with instructor if there
is enough time and it would be
beneficial to take alginate
impression, pour up with snap
stone, and survey to make sure
Lab Work
 Trim diagnostic
casts
 Mount diagnostic
casts if Jaw relations
were obtained and
complete goldenrod
RPD form
 Fabricate occlusal
rims
Notes
Inform patient
that
7-10
appointments
will be needed
 Mount diagnostic
casts
 Survey diagnostic
(duplicated casts)
casts
 Formulate RPD
design (Signed off on
RPD procedural
(requirement) form
AND gold sheet)
 Fabricate custom
tray
 If doing survey
crown, need
diagnostic wax-up
of RPD teeth
Instructor will
require prepared
rest preparations
on duplicate case
before third
appointment
 Box up master
impression
Pour definitive cast,
this should be only
tripoded and
surveyed. The
duplicate or diagnostic
case should also be
tripoded, surveyed
and final design
All other
preparation of
teeth done here:
caries, fixing
previous
restorations, etc.
Restorations on
non-abutment
teeth may be
referred to
Operative.
If doing survey
crown, insert that
sequence of
appointments
here
-Can do a wax-up
of tube teeth and
send to the lab so
you can have
them on the frame
for the try-in
- Best to tripod
master cast on
surveyor and leave
alone.
14
everything is adequate for the
design.
 Border molding (ask a fellow
student who is in the lab to
assist if needed) *Good idea
to have border molding
checked and to get a
demonstration for the first
time.
 Make master impression –
might be maken in alginate to
help reduce the risk of breaking
off lone-standing teeth.
 Inspect RPD framework
 Evaluate fit
 Check tissue stop(s)
 Disclose and adjust intaglio
surface
*If framework fits, can proceed
to next step.
4.Framework Try
In
-Disclosing wax
-wax spatula
-Ask Faculty if they
would like you to do an
altered cast impression
(be prepared for,
determined chairside,
usually done on
mandibular only)
5.Definitive Jaw
Relations (can be
combined with
framework try in)
Use Jaw Relations
Tray
-Aluwax/Regisil
-barb parker
-buffalo knife
-wax spatula
-vaseline
-facebow
-bite fork
aluwax/regisil
-bard parker
-buffalo knife
-wax spatula
-vaseline
-facebow
-bite fork
 Facebow transfer
 CR or MI interocclusal
records
 Protrusive interocclusal
records
 Select denture teeth shade,
size, shape
 Try in tooth set up
 Make adjustments if needed
 Make CR record and Verify
articulation
-aluwax/regisil
-barb parker
-buffalo knife
-wax spatula
-Shimstock
-Articulation Ribbon
-Pressure indicating
paste
 Adjust intaglio before
records are completed
 Make CR record, remount
definitive cast, and Verify
articulation
 Correct occlusion
 Provide post-op instructions
 Place on recall
6.Try in and Tooth
Setup (discuss
with patient and
faculty to
determine the
need for a try-in
appointment.
7.Insertion and
Delivery
drawn on cast (Type IV
stone)
*Best to have a backup cast in Type IV
stone
 Complete lab
authorization
 RPD framework
fabrication (7 days
lab time)
 Fabricate occlusal
rims on top of
framework (done
only AFTER
framework has
been tried in) (can
be completed
chairside, but
usually done in the
lab)
 Mount definitive
cast
 Denture tooth set
up (lab time: 5 days)



Complete Lab
Authorization
Process and finish
RPD (5 days)
Request remount
cast (typically not
requested in RPD
cases.
-If have lots of
posterior teeth,
may need to try-in
appointment as
well.
-Preferably not on
Friday
-Inform patient of
need for 24 hour
and 1 week postinsertion checks
(which should
already be
scheduled)
15
Surveying
• Attach cast to table & adjust to 0 degree tilt (occlusal plane horizontal & analyzing rod parallel to long
axes of teeth), look for undercuts & guide planes, examine all surfaces & soft tissue
• Readjust tilt to find most favorable path of insertion (path of insertion parallel to analyzing rod, within
10-15 degrees of 0 tilt)
o Retentive undercuts
 Best is optimum F-L retentive undercuts on primary abutment teeth (adjacent to
edentulous spans)
• Facial and/or lingual .01-.02 in gingival 1/3
• False undercuts result from excessive tilt, ‘created’ at cost of other undercuts
• Fewest soft tissue undercuts (more important for infrabuldge clasps)
o Additional Clasp Considerations:
 Located as gingival as practical, dictated by tooth contour
 Cast (half-round): 0.01-.015” undercut
 WW (round): .015-.02” undercut
 Undercuts usually on facial surfaces of max teeth & mand anterior & premolars, lingual
of mand molars, deepest at line angles
o Guide planes
 Parallel surfaces in non-retentive locations- proximal surfaces & bracing surfaces
opposing retentive undercuts or convex surfaces that could be modified into planar
surfaces
o Esthetics
 Minimize & equalize spaces bw framework & teeth in edentulous areas (‘black holes’)
 Creating extensive guide planes alters look of tooth (therefore natural axial surfaces in
esthetic zone are strong influences on path of insertion)
o Avoid interferences (tipped teeth, ridge undercuts, frenums, exostoses)
 Avoid, alter path of insertion, pre-prosthetic correction
• Mark survey lines- all areas potentially contacted by RPD, locate undercuts (mark in blue), Tripod cast
(highlight in red & circle in blue)
RPD Mouth prep
 Disease control (caries around abutment teeth #1 reason for failure of RPD)
 Pre-prosthetic surgery
o Remove unavoidable tori, tuberosity reduction, impacted teeth
o Cannot do anything about hard/soft tissue undercuts assoc w presence of teeth
 Enameloplasty to create guide planes, ideal survey lines, retentive undercuts, rest seats (only if
adequate enamel thickness & no extensive restorations present, only after survey cast & determine final
design- ‘grind list’)
o Guide planes
 Planar in O-G direction, follow tooth curvature, do not cross line angles in distal
extension, should be ovoid/football shape (doesn’t change occlusal shape)
 Tooth supported RPDs: 1/3 to 2/3 tooth height
 Distal extension RPDs: less than 2mm to decrease movement from RPD to abutmentrelieve stress
 Esthetic zone: minimal/no modification to proximal contact, true guide planes located
lingual to proximal contact
o Optimize survey lines
 Ideally at junction of middle & gingival thirds
 Lower line on side where retentive arm originates
16
Retentive depressions when undercut isn’t adequate on relatively vertical surfaces, in
gingival third where clasp will terminate, near line angle (well rounded borders, approx
4x3mmx.01”, parallel to gingival margin)
o Prep rest seats (polished, smooth, cleansable!)
 Occlusal: M/D fossa, adjacent to areas accessible by minor connector, rounded triangle,
positive seat
• ¼ - 1/3 the M-D width of tooth (apex at pit), B-L 1/3 – ½ intercuspal width, > or
= 1mm clearance
 Embrasure: adjacent MO/DO, rounded channel joins F-L embrasures, must maintain
proximal contact, channel >/= 1.5mm clearance and 2-3mm wide, positive seats
• Use when widely spaced rests not possible
• Better w teeth w space bw
 Cingulum: must not interfere w occlusion (contraindicated w deep overbite), positive
seat, external angles rounded slightly, mark opposing occlusal contact to ensure that
seat is well away
 Anterior ball (Krol): round depression on lateral aspect of cingulum or marginal ridge,
minimal dimension to achieve positive seat, just inside marginal ridge
• Anterior areas where opposing contacts contraindication traditional cingulum
rest
• Most effective on relatively horizontal cingulums
 Incisal: near proximal angle but far enough away not to undermine enamel, most often
in mandibular when used (rare), shallow ‘u’, saddle shaped
• Would use if insufficient enamel for cingulum and surveyed restoration was
contraindicated (severe lingual inclination)
• Poor esthetics, in incisal occlusing area, unfavorable
o Enamel perforation: informed consent prior important, fluoride therapy & regular recall
Rest seats best on unaltered enamel, then metal, then porcelain, then occlusal amalgam/composite,
worst on DO/MO amalgam/composite.




Fixed pros restoration (crowns, FPDs, inlay/onlay, resin-retained rests, porcelain/composite veneers)
o Indications: inadequate contours, malposed/broken down abutments, poor occlusal
relationships, splinting periodontally involved abutments, elminate undesireable mod spaces
o Can create ideal abutment contours regardless of tooth anatomy/enamel thickness
o Caries protection beneath RPD components
o Modification spaces
o FPD may be more esthetic, more functional
o FPD will simplify RPD design & prevent lone-standing ‘pier’ abutments
Surveyed Abutment Design
o Tooth prep requires extra reduction in rest seat area (0.5mm for metal)
o Place components ideally on metal portions of PFM surveyed restorations (small components on
porcelain, or esthetic- facial arms)- ceramic crowns contraindicated
o Ideal guide planes- long enough O-G for true reciprocation, can replace natural tooth contours
lost during guide place prep w framework components (more comfortable for pt)
o Mx lingual ledge an option
o Rest seats always in metal
o Resin retained components: require features to orient the component on tooth- sectioned off
after bonding (resin bonds to Ni-Cr, etchable metal)
Master Impressions & Definitive Casts
o Tooth supported: Irreversible hydrocolloid in stock tray
17
o
o
o
o
o
Tooth-tissue supported: One-step border molded impression w custom tray/two-step technique
(CoD uses one-step)
 One step: use for all tooth-tissue supported RPDs, tooth supported RPDs w long
edentulous span when border molding is desired
One-step fabrication: PVS impression adhesive, light body (Kerr extrude) in syringe to critical
concave areas- rest seats & occluding surfaces, lingual plated surfaces/contact w connectors,
abutment tooth retentive undercuts, abutment surfaces. Medium body extrude w large automixing cartridge into tray
 In clinic: after approx 30 sec., gently border mold excess material on facial back to
compound & ask pt to gently protrude tongue to border mold mandibular lingual
 Trim excess & interproximal extensions, level and support impression, box (verify full
thickness of rope wax visible & wax is sealed), dububblizer, pour w resin rock
Two-step technique “altered/corrected cast impression”: make impression for framework
fabrication, try-in, attach individualized trays to D extension areas of framework, border mold &
alter/correct the tissue supported areas on original cast
 Corrects for errors due to inaccurate relationship bw teeth, framework & soft tissues
 Difficult & easy to incorporate error, requires 2 appts, even more dif in Mx arch
 Use for Mandibular to correct inaccurate relationship
Border molding: records depth & width of edentulous vestibule (ensures denture border will
form a seal w patient vestibular tissues for rentention) & records border tissues in active
postitions (ensures functional movements will not unseat denture)
No opposing cast needed to go to lab usually, only if need to communicate contact locations so
occlusal rests will not be hyper-occluded/lingual plates placed in contact areas
Framework try-in
o RPD must be completely passive when seated
o Should be ASAP after master impression is made (so teeth don’t move)
o Pre-clinical eval: Major Connector type & outline, clasp assemblies, retentive arms tapered,
finish lines, appropriate blockout & relief, rigidity of connectors, finish, intaglio surface, examine
definitive cast for abrasion (expect from retentive clasps), should fit cast, rests seat fully,
margins flush, no food traps, tissue stops contact tissues
o Clinical try-in: disclosing wax, spray w silicone emulsion to prevent wax from sticking to teeth,
seat intraorally, evaluate, adjust & repeat until disclosed layer is thin, translucent gray in all
areas, rests seat fully, margins flush, no food traps, tissue stops contact tissues, no rocking
Definitive Records
o Jaw relation records (after try-in & occlusal adjustment of framework)
o Remaining natural tooth contacts determine VDO
o Without interarch contacts, denture methods: rest distance (3mm), phonetics, esthetics
o Interocclusal records
 Need record bases for Class I, II, and long spans
• Made with RPD framework in place, base attached to retentive lattice
• Use hard baseplate wax, sterntek base, & PMMA
• Area under lattice must be blocked out & base material must attach over the
lattice
• 2-4mm clearance w rim indexed
 Recording materials: aluwax/regisil
 Protrusive records for balanced occlusion (protrusive records are for setting condylar
inclinations which can influence lateral movements whether natural dentition or
denture occlusion.
18
Tooth selection & arrangement
• Denture Teeth
o Shade (select denture teeth shade first if also doing crowns), mold, size: completely fill M-D
width first (must cover proximal plate of RPD framework)
o Grind-in technique: for denture teeth opposing natural teeth (enhanced stability & patient
function)
 Lower pin 1-3mm, set teeth in MI, raise pin back & equilibrate occlusion until pin
contacts again
o Contacts
 Occlusion can rarely be improved w a RPD (preprosthetic correction is important to level
occlusal plane/elminate interferences)
 CR when no posterior natural tooth contacts remain
 MI when natural posterior contacts are present
 Equilibration of natural dentition to CR should be considered for pts w few natural
posterior contacts
o Excursive movements
 Many prosthetic teeth: emulate full denture occlusion—fully balanced (ex: RPD
opposing complete denture/long span extensions w limited retention/Class IV)
 Few prosthetic teeth: mutually protected occlusion (posterior protect anterior in CR/MI,
anterior protect posterior in excursive movements)- canine guidance whenever possible
w natural teeth, group function w/o natural teeth anterior guidance
• Tube tooth: Framework waxed to fit intimately around tooth (tube cut into tooth), tooth pressed on, can
be very esthetic, more complicated/costly, good for short posterior tooth spans w normal spacing and
alignment
• Custom formed resin teeth: formed on base directly, for small/irregularly spaced tooth spans, easier to
form than modify a denture tooth
• Metal pontic: tooth waxed and cast as part of framework, for extremely small spans, occlusal precision is
poor, difficult to adjust, poor esthetics
RPD Insertion
o Pre-clinical: polish, framework flush at finish lines, no scratches, no distortion on clasp arms
o Objectives for insertion appointment
 Correct fit: cast base rarely need adjustment (evaluated at frame-work try in), acrylic
always req adjustment (PIP paste, relieve pressure areas & repeat), border extensions
(PIP paste)
 Correct occlusion: better to adjust intraorally (and more stable than denture because of
clasps), clinical remount for RPD opposing complete denture or if not stable on oral
tissues (make sure to block out undercuts in RPD so doesn’t get stuck in stone- get
MI/CO and make facebow transfer if necessary)
 Adjust clasps arms: cannot fix clasps severely distorted from processing, can make minor
changes (avoid work hardening clasps), increase retention by moving further into angle
of convergence
 Give post op instructions: clasp retention should be minimum necessary, removing RPD
by clasp arms will cause loosening, caustic chemicals will corrode framework, recall
imperative
Classification System
o Interim: all acrylic resin construction with wire retentive clasps (no rests, entirely tissure
supported)
o Kennedy System
 Class I: Bilateral edentulous extension
19
•
•
•
•
Class II: Unilateral edentulous extension
Class III: Unilateral toothbound edentulous span
Class IV: Single edent span anterior that crosses the midline (no mod)
Applegate’s rules:
o Most posterior edentulous area determines classification
o Modification spaces designated by # of spans- NOT teeth
o Missing 3rd/2nd molars that will not be restored should not be considered
o Include teeth planned for extraction
Design
• General principles
o KISS
o Maintain symmetry as much as possible
o Incorporate essential elements w each retainer
o Minimal tissue coverage (open designs preferred, plated only when additional RPD or tooth
stabilization is required or framework is closely spaced)
o Distribute rests, retention, guiding/stabilization widely
o Incorporate perpendicularly facing surfaces for guidance & stabilization
o Avoid placing framework components in occlusal contact areas (occlusal instability when RPD is
out of mouth)
o Consider likely future tooth loss that may change the design
• Design Sequence (black= survey lines, red= cast framework, blue= undercuts & WW, red/blue= tripod
mark)
o 1. Major connector type
o 2. Class I & II: axis of rotation & undesireable locations for cast retention
 No cast retentive elements Mesial to axis of rotation
o 3. Determine direct retainers
 Adjacent to edentulous spaces
 Tripod/quadrilateral configuration
o 4. Determine indirect retainers/rests (Class I & II)
o 5. Determine auxillary rests
o 6. Verify 2-4 DRs & tripod/quad configuration
o 7. Determine retainer types (see chart below)
o 8. Determine location of specific clasp components
o 9. Locate acrylic resin finish lines & retentive lattices/grids
o 10. Determine specifics of major connector design
o 11. Connect all elements w minor connectors
• Tooth-tissue supported RPDs (tooth= <0.2mm movement, tissue= >1mm movement plus continuous
resorption, plus border movements)
o Iowa Philosophy
 Careful technique to minimize movement potential of RPD***
 Stress releasing framework design**
 Regular recall/maintenance to maintain denture base***
Design Principles by Classification
o Class I & II
 RPD rotates around axis when occlusal force placed on distal extension
• Requires direct retainers with stress releasing design, indirect retention (at least
1) & consideration of support from edentulous base
• Retentive arms
o Best: M rest with RPI retentive arm D to rest= disengaging forces, clasp
deeper into undercut
20
Gingivally directed forces from above the survey line (resisted by PDL)
(2nd best)
o D rest w modified T- retentive tip also D= mesial directed forces
(resisted by dental arch)
o Worst: D rest w CC/Akers retentive arm M to rest= extracting forces,
clasp engages undercut
• Farther the retainer is from the fulcrum the less harmful
• Stress-releasing designs
o Relationship to fulcrum (M rests on primary abutments)
o Flexible clasps (longer- I Bar, or wrought wire)
• NEVER place a cast arm Mesial to fulcrum on primary abutment
• If a distal rest must be used, use Wought Wire
• Indirect retainers as far from fulcrum as possible
• Use short guide planes next to edentulous base
• Avoid plating (may result in non-stress releasing design)
 Incorporate provision for relining denture base (acrylic resin base & tripod/quad
configuration always first choice)
 Metal base only when necessary (limited width/height, tube teeth)
Additional Class II Considerations
 Do not restore posterior modification space with FPD
 Major Connector configuration more often tripod
Class III
 No axis of rotation, no need for indirect retention, ideal for precision attachments
 Use CC/Akers clasps, Infrabulge if in esthetic zone
 Use Ring Clasps for lone standing, mesially-tipped distal abutment
 Type of denture base not critical, reline unnecessary
• Acrylic resin normally first choice when reline anticipated
• Metal for short spans/limited O-G height
Class IV (or long anterior edentulous spans)
 Esthetics & practical considerations influence design more than biomechanical
principles, consider group function occlusion
 Restore with FPD when possible
 Rests as close to anterior span as possible (esthetic considerations may contraindicate a
clasp in anterior)
 Rotational path (dual path) concept
• First path: rigid anterior retainers w/o facial clasps inserted into mesial proximal
undercuts adjacent to edentulous space
• Second path: remaining segments rotated into place
• Anterior rigid proximal plate (no blockout), cingulum/occlusal rest, lingual
bracing arms
• CC clasp in posterior
• Superior esthetics
• Technically demanding, precision fit, cannot adjust retention, limited application
 Denture base: poor esthetics if not trimmed right, contour anterior flange carefully &
blend
• Metal can be more esthetic bc no acrylic-soft tissue junction, teeth emerge from
tissue, can incorporate diastemas (most complicated & costly)
o
o
o
o
21
Major Connectors
Must be away from marginal gingiva or extend over gingiva to plate (4-6mm in max, 3mm in mand)
Should cross marginal gingiva at a right angle
Block out: use of wax in undercuts to allow insertion of components over the undercut (0 degree= blockout trimmed
parallel to the path of insertion using surveyor wax carver)
 Relief: space between any part of the RPD framework and tissues, created by thin wax placed on master cast during
fabrication. No relief on maxillary except for palatal tori/boney midlines
 Scribe beading on Maxillary: ensures firm contact of major connector with tissue, aids lab in fabrication (no beading wn
6mm of free gingival margin)
Major Connectors
Design Requirements
Indications
Contraindications
Palatal Strap
<1mm Thick
Class III
At Least 8mm Wide
Palatal Bar
2-3mm Thick
Very short edentulous
Mesial to 2nd Premolars
spans/interims
Class III
Anterior-Posterior
<1mm Thick
Long Span Class III
Strap
At Least 8mm Wide
Most Class II
Anterior terminates at anterior
Class I (with adequate
abutments, in valley of rugae.
direct and indirect
Posterior ends at vibrating line.
retention)
Class IV
Large, inoperable palatal
tori.
Anterior strap with Anterior Strap: 1x8mm
Maxillary torus within 8
Posterior Bar
Posterior bar:
mm of vibrating line
2-3mmx<8mm
Palatal Plate
<1mm thick
Class I (with non-ideal
Not Necessary for Class IV
Terminate at vibrating line/hamular support)
Few Remaining Teeth
notch.
Inadequate Retainers
Variable anterior termination.
Compromised Anteriors
Acrylic Resin Palate
When reline will be
Used infrequently
necessary
Maxillofacial Obturator
U-Shaped
Terminates medially at junction of
Inoperable Maxillary Torus Avoid if possible
vertical ridge and horizontal palate. to vibrating line
>1mm think
Gaggling Patient



Lingual Bar
Lingual Plate
Stepback Design
Double Lingual
(Kennedy) Bar
Labial Bar
5mm tall x 2.5mm thick
At least 3 mm from gingival margin
Lingual plate only to the distal of
posterior abutment
Apron covers cingulums, up to
proximal contact.
Supported by rests on both sides
Lingual plate only to the distal of
posterior abutment
Lingual Plate with interproximal
plating omitted for esthetics
Lingual Plate with middle portion of
apron missing
Lingual Bar on Facial
If 8mm from gingival
margin to floor of mouth is
available
1st choice for mandibular
In sufficient space for bar
Compromised/missing
anterior teeth
Future anterior tooth loss
expected
“Non-ideal”
support/design
Most frequently used
Diastemas
severe axial misalignment
multiple diastemas
If can’t use lingual bar due
to severe lingual
inclination/lingual tissue
undercuts, inoperable tori
Maxillary RPD’s
22
RPD Denture Base
• Resin (PMMA, composite): Adequate strength w bulk, discolor, wear, good esthetics, reline possible*
o Open lattice or meshwork (may weaken acrylic)
o Extension
 Just facial to crest of ridge
 Max: Distal over max tuberosity, mesial to hamular notch & posterior termination of
palatal major connector
 Mand: Distal to ascending portion of ridge, lingual above lower border of major
connector
 Acrylic continuous w major connector border, completely surrounds lattice
o Relief: space beneath lattice for acrylic resin (lab: 1 layer 24 gauge wax, 1mm from proximal
blockout to create internal finish line)
o Tissue stops: placed on D end of mand extension base lattice- only part of lattice that contacts
cast or soft tissue (absence of contact indicates inaccurate relationship bw teeth, framework,
tissues & supports frame during processing)
• Relining: replacing tissue surface of base
o Border mold deficient borders w impression modeling compound, relieve tissue surface of base
to depth of lattice/mesh, make the wash impression
• Rebase: replacing all/most of acrylic resin
• Reconstruction: replace all portions of the RPD except cast framework
• Metal (CrCo, NiCr, Ti/alloy, Au alloy): most accurate, CrCo excellent, cannot reline
o Indicated for short edentulous spans, no relief
o Teeth held within acrylic resin onto metal base w nailheads/beads on base for retention
Interim RPD
Can be done in 2 to 5 appointments.
Complete a jaw relation appointment if there are quite a few posterior teeth left.
Complete a wax try-in if in the esthetic zone.
If you can get a good diagnostic impression, you may be able use it as the final impression.
23
Complete Denture Fabrication
Appointment
Initial exam
Border molding
& master
impressions
(Typically this
requires two
appointments,
one for maxillary
arch and one for
mandibular arch)
Materials Needed
• Alginate
• Mixing bowl
• Plastic tray
• Bosworth tac
• Compound
•
•
Custom trays
(at least 2)
Kerr tray
adhesive
Compound
Hot water
bath
Alcohol torch
Bunsen
burner
Bard parker
Wax spatula
Medium body
extrude
(usually
Aquasil)
Impression
gun
Iowa wax
•
•
•
•
•
•
•
•
•
Acrylic burs
Bard parker
Buffalo knife
Alcohol torch
Bunsen burner
Hot plate
Fox plane
Facebow
Bite fork
•
•
•
•
•
•
•
•
•
Jaw relations &
tooth selection
Steps/Procedure
 Exam/Diagnosis/
• Treatment Planning
• Radiographs
• Assess if patient is ready to
begin treatment
 Diagnostic impressions
• Tentative shade selection
• Patient education
• Consent & Screening forms
• Goldenrod form
• Escort patient to business
office
Lab Work
• Pour and trim
diagnostic casts
 Fabrication of
custom
impression trays
Inform extraction
patients that most
likely they will
require a reline in
a year (which will
be additional
costs)
•
•

•
Jaw relation records
Facebow
Interocclusal in CR
(aluwax technique
differs with each
instructor)
Determine lip and facial
support, VDO-VDR
•
•
•
Patient may
require preprosthetic surgery
before denture tx
Typical COD
patient:
Extractions, 6
week healing
check, begin
denture treatment
after 3 months
 Border molding (demo 1st
time)
 Master impressions
• Create functional posterior
palatal seal
Notes
Ask patient to
remove dentures
for 48 hours prior
to appointment
Box impressions
Pour and trim
master casts
 Fabrication of trial
bases and occlusion rims
Mount definitive
casts
 Arrange denture
teeth/occlusion
• OR: Complete lab
authorization for
tooth set up & send
articulator to lab
Tooth set up at the
lab takes approx 5
days
24
•
•
•
Wax try-in
•
•
•
•
•
•
•
Have patient bring
someone with
 Try-in wax dentures
• Verify JRR, esthetics,
phonetics, VDO-VDR
• Remount casts if necessary
according to verified JRR
• Check occlusion
• Get patient ok on esthetics
to process dentures
• Typically protrusive record
is made to set articulator
condyles
 Deliver dentures
 Fit dentures with PIP and
•
•
PIP paste
Acrylic burs
Wax spatula
Aluwax
Alcohol torch
Cold/Hot
water bath
Acufilm
Shimstock
•
•
•
Acrylic burs
PIP paste
Gauze
•
•
Adjustment
 Prosthetic tooth selection
Acrylic burs
Bard parker
Buffalo knife
Alcohol torch
Bunsen
burner
Hot plate
Facebow
Bite fork
Aluwax
Vaseline
Wax spatula
Hot water
bath
Acufilm
Shimstock
•
•
•
•
•
•
•
Denture Delivery
Regisil
Aluwax
Vaseline
Wax spatula
•
•
•
•
•
•
 Finalize denture
setup & festoon
 Work Authorization
• Process dentures
• Laboratory remount
procedure
• Fabricate remount
casts and remount
index
• Mount maxillary
denture with
remount cast in
articulator
• Finish and polish
dentures
•
adjust tissue surface
 Make new CR record &
verify
 Clinical remount
• Post-insertion patient
education
•
 Adjust sore
•
spots/occlusion
•
Clinical remount
procedures
Verify mounting and
finalize occlusal
adjustment
Final polishing
Remount casts if
necessary
Ask lab to
fabricate a
maxillary remount
cast and remount
index
Denture finish
takes the lab
approx 5 days
If VDO, VDR, or CR
is significantly off,
nd
may require a 2
wax try-in
appointment
Make sure patient
understands that
additional
modifications after
today will cost
more
Adjustment
appointment best
if within 24 hours
of delivery
appointment
*Never deliver
denture on a
Friday unless
arranged prior!
COD policy is free
adjustments for 6
months after
delivery
25
Anatomy
1: Labial frenum; 2: labial vestibule; 3. buccal frenum; 4: buccal vestibule; 5: coronoid bulge; 6: residual alveolar ridge; 7:
maxillary tuberosity;8: hamular notch; 9: posterior rugae; 10: foveae palatinae; 11: median palatine raphe; 12: incisive
papilla; 13: rugae
1: Labial notch; 2: labial flange; 3: buccal notch; 4: buccal flange; 5: coronoid contour; 6: alveolar groove; 7: area of
tuberosity; 8: pterygomaxillary seal in area of hamular notch; 9: area of the posterior seal; 10: fovea palatinae; 11: median
palatine groove; 12: incisive fossa; 13: rugae
1: Labial frenum; 2: labial vestibule; 3: buccal frenum; 4: buccal vestibule; 5: residual alveolar ridge; 6: buccal shelf; 7:
retromolar pad; 8: Pterygomandibular raphe; 9: pterygomandibular fossa; 10: tongue; 11: alveololingual sulcus; 12: lingual
frenum; 13: region and premylohyoid eminence
1: Labial notch; 2: Labial flange; 3: Buccal notch; 4: Buccal flange; 5: Alveolar groove; 6: Buccal Flange; 7: Retromolar pad; 8:
pterygomandibular notch; 9: Lingual flange; 10: Inclined plane for the tongue; 11: lingual flange; 12: Lingual notch; 13:
premylohyoid
Initial Exam
• Note: Patient may need preprosthetic surgery based on hard tissue findings (undercuts, roughness, root
tips)
• Exam/Diagnosis/Treatment Planning
o Ideally, the patient will leave their dentures out for 48 hours prior to final impressions
o Discuss patient’s previous denture experience
o Radiographic exam: Trabeculation, ridge resorption, note tori, etc.
o Identify patient occlusion & anatomy: frenum attachments, retromolar area, mylohyoid space,
other soft tissue undercuts, tongue position
o Examine TMJ
o Note patient’s attitude & expectations
• Preliminary impressions
o Bosworth Tac adhesive on tray
o Alginate (4 scoops for maxillary, 3 for mandibular)
o Impression criteria
 Capture all landmarks
 Capture vestibule to full depth (CA if <2mm not captured)
 No negatives/voids on denture-bearing area
 Impression material adhered to tray
26
• Tentative shade selection
Diagnostic Casts & Custom Trays
•
Pour and trim diagnostic casts
o Lab plaster with double pour technique
o Trimming criteria
 13-20mm at thinnest part (10-13 or 20-24 CA)
 Land area 3-5mm
 Vestibule and all surrounding tissues present
 Small and infrequent voids/positives only
o Fabrication of custom impression trays- Sterntek/PMMA tray depending on instructor, **
Fabricate a duplicate custom tray (or 3)
o Draw lines on cast
 Red: full extension of denture (bottom of vestibule, between hamular notches on
maxillary, around retromolar pads on mandibular)
 Blue: 2mm inside red line for entire mandibular; 2mm inside red line in vestibule and
same as red line between hamular notches for maxillary
o Wax spacer (trimmed to blue line)
 Method 1: softened baseplate wax adapted to cast
 Method 2: dip in wax pot (4 dips with 10-15 sec. between each)
o Adapt Stern-Tek and trim to blue lines
o Make a handle for each tray (square piece in anterior area)
o Light cure 1 minute on each side of tray
o Smooth borders
Border Molding & Master Impression
•
•
•
•
Make sure custom tray fits – not overextended, and trim if necessary
o Trays should be stable and not rock and be 2mm inside vestibules
Border molding
o Heat impression compound with torch & Bunsen burner
o Temper in water bath – move quickly, only a couple seconds to work
 Water baths should be set at 140 degrees for the green compound we use.
 Red: 130-132°F
 Green: 122-124°F
o Apply to small section of denture
o Insert in patient’s mouth and border mold that area
o Repeat until border of entire denture is captured
o Can reheat and re-do any areas that don’t turn out well
Master impressions
o Caulk Tray Adhesive
o Aquasil (even layer with no bubbles/voids)
o Impression criteria
 No voids in denture area
 No distortion
 All land area captured
 Impression adhered to tray
 Trim excess
Create functional posterior palatal seal with Iowa wax
27
o
o
Apply softened wax and place in patient’s mouth with pressure mid-palate. Should flow along
the anterior to vibrating line into hamular notch but not on the tuberosity
Seal along the borders
Box & Pour, Trial Bases, Occlusion Rims
•
•
•
•
Box impressions
o Trim impressions
o Create rope wax legs under tray so ridges are parallel to bench top
o Apply adhesive 3-4mm below borders of impression
o Apply rope wax to adhesive area and seal with hot wax spatula
o Use baseplate wax to block tongue area on mandibular
o Adapt boxing wax around rope wax
 Height needs to be 13-15mm above highest area of impression
 Seal with wax spatula and ensure it is water-tight
Pour and trim master casts
o Type III Microstone
o Trimming criteria
 Land area 3-5mm wide, 3 mm deep, and flat or slightly slanted outward
 15-20mm thick at thinnest part
o Indices
Fabrication of trial bases
o Use baseplate wax to block out undercuts
 Maxillary: frenums, rugae, DB of tuberosity areas, facial of ridges by #6-11
 Mandibular: frenums, antero-lingual areas of retromolar pads
o Paint 2 layers Alcote on casts, drying between layers
o Form trial bases with ortho resin powder and liquid
 Apply several drops of liquid followed by powder sprinkle
 Tilt cast to flow mix where it’s needed
 Repeat until 2-3mm even thickness in all areas (not too thick in middle!)
 Soak in pressure cooker in warm water (110°F) at 15-20 PSI for 10-15 min
 Remove base plates from casts and trim excess with lathe or carbide bur
 Polish with silicone points and wet pumice on lathe and high shine (NOT on tissue side)
o Trial Base Criteria:
 Tissue surface free of voids and clean
 Tray stable
 Extends to full border length and duplicates contour of peripheral roll
 Uniform 2mm thickness
 Borders rounded and outer surface smooth and polished
Occlusion rims
o Mark on casts
 Mandibular: Use red or blue pencil lines on crest of residual ridges
 Maxillary: pencil mark 7mm anterior to center of incisive papilla
o Adapt Bite Block wax to trial bases and shape
 Maxillary:
• anterior edge of wax lined up with line on cast
• center wax in posterior ridge areas
 Mandibular:
• anterior edge of wax on facial edge of labial vestibule
• lines on cast should bisect wax B-L in posterior
28
o
o
o
o
o
o
• so mandibular teeth will end up directly over ridge
Use baseplate wax as needed to fill in deficient areas
Seal junctions with wax spatula
Rims end at second molar area
Use hot plate to create flat occlusal area of rims
Trim with buffalo knife and smooth with hot plate as necessary
Dimensions: (**Approximates – adjust based on observations of patient)
 Maxillary: usually is slightly buccal of ridge
• 8mm thick anterior
• 12mm thick posterior
• 20mm height from labial frenum sulcus to edge of wax
• 18mm height from buccal frenum sulcus to edge of wax
• 80-85° angulation in incisal area
• Labial edge of rim on line drawn 7mm anterior to incisive papilla
 Mandibular: to top of retromolar pad, directly over ridge
• 8mm thick anterior
• 12mm thick posterior
• 15mm height from labial frenum sulcus to edge of wax and to top of bilateral
retromolar pads
• 80-85° angulation in incisal area
Jaw Relations & Tooth selection
•
Determine lip and facial support, VDO-VDR
o Measure VDR
 Have landmarks on upper and lower and measure VDR when patient is at rest (have
patient open wide until fatigued and then close until lips just touch)
 Swallow and then rest
 “M” test
 Observe relaxed patient to check if esthetics are correct
o VDR-VDO (Interocclusal Distance) is usually 2-4mm
 Use to approximate VDO
o Try occlusion rims in patient
o Using hot plate and Bunsen burner, adjust rims
 Adjust upper rim first
• Lip support
• Tooth display (how much depends on patient age
• oriented to occlusal plane
o use Foxplane instrument
o parallel to interpupillary line
o parallel to Camper’s plane
• Anterior at or 1mm below level of upper lip
• Posterior parallel with alae-tragus line and ½-2/3 height of retromolar pads
• Establish arch form
o Corners of the mouth should be canine/1st premolar area
o Incisal edges of maxillary centrals will be 8-10mm anterior to center of
incisive papilla
 Adjust lower rims to upper so rims contact and are flush at tentative VDO
• Verify with phonetics
o “S” test (rims should not be in contact when patient says “S”)
29
“F” sound – upper rim should hit at wet/dry line and rims shouldn’t
contact
 Be sure rims don’t interfere with VDR
 Create a 2mm horizontal overlap of maxillary rim over mandibular rim at the canine
area
Jaw relation records
o Facebow
 Carve 2-3 V-shaped indices on maxillary rim, 3-4mm deep and non-parallel
 Vaseline maxillary rim and indices
 Remove 2-3mm thickness of wax on mandibular rim posterior to premolar area
 Mark maxillary and mandibular midlines on rims
 Use a marker to mark an anterior reference point on patient’s right cheek 43mm above
labio-incisal edge of upper rim
 Take a record of upper rim using Regisil on bitefork (make sure stem is on right side of
patient and midline lines up!)
• Trim any excess after it is set
• There should be no perforations into Regisil and indices should be captured
 Use bite registration to take facebow
• Make sure earpieces are in patient’s ears and tighten center wheel
• Assemble facebow with all numbers facing you
• Raise or lower bow so pointer aligns with anterior reference point and tighten
clamp 1
• Make sure horizontal part of bow is parallel to interpupillary line and tighten
clamp 2
• Loosen center wheel, slide bow open, and remove from patient
• Detach transfer jig and position on articulator
o Centric Relation Record
 Vaseline maxillary rim
 Soften Aluwax and secure onto mandibular rim where you removed wax; top should be
1.5-2mm higher than anterior of rim
 Soften Aluwax with torch or spatula to dead soft
 Seat mandibular rim in patient’s mouth
 Manipulate patient’s mandible into CR and close jaw until 0.5-1mm separation between
wax rims
 Chill Aluwax with air spray
 Remove trial bases from patient’s mouth
o
•
Prosthetic tooth selection
•
•
•
This will be discussed & determined with your instructor. Each case is different and each instructor has
different preferences.
The tooth mold will also correspond with the occlusal concept used for set-up.
Considerations
o Easiest to begin looking at this at earlier appointments
o Use previous dentures, extraction records, radiographs, or photographs. Ask patient what they
did and did not like about their previous teeth.
o Shade: Narrow down to your top 2-3 choices, then involve patient in decision
o Anterior tooth form
 Corner of mouth should be distal of canine and ala of nose should be middle of canine
• Less than 48mm = relatively small teeth
30
o
• More than 52mm = relatively large teeth
 Bizygomatic width: 16x width of maxillary central incisor = 3.3 times maxillary 5 anterior
teeth arranged on the curve
 Length: Distance between hair line to lower edge of chin at rest = 16x length of maxillary
central incisor
 Shape: teeth should mirror upside down head shape (square, tapering, ovoid, combo)
 Masculine vs. Feminine
Posterior tooth form (consider with occlusal concept, discuss with instructor)
 Tooth mold considerations:
• Flat plane/Monoplane: indicated with severely resorbed ridges, cross-bites,
some class II/III, or when recording CR has been difficult due to poor
neuromuscular coordination
o Simplest set-up, wide range of posterior tooth positions available,
minimize lateral stresses
o May appear less esthetic, may be less efficient
o Anterior need more overjet and no overbite
• Cusped teeth: indicated in patient with well-formed ridges, class I relationship,
with adequate neuromuscular control
o Slightly more efficient, more natural
o Requires more time and accurate records
• Flat teeth with compensating curve
• Combinations/”Lingualized set up”: monoplane lower posterior with anatomical
upper posterior, lingual intercuspation (no buccal cusps touching)
o Uppers appear more natural, slightly better chewing than flat plane
o Some grinding required to obtain contacts
Mounting & Teeth set up
•
•
•
Mount definitive casts with Aluwax CR record
Arrange denture teeth/occlusion
o Before you begin:
 Idealize occlusion rims with baseplate wax to determined VDO, 2mm horizontal overlap
from canine to canine, maintain 80-85 degrees of labial inclination with both rims, and
have definite and sharp labio-incisal line angles.
 Mark midline by connecting upper and lower labial frenums on occluson rims.
 Mark on casts (to land area): two lines representing the crest of the mandibular residual
ridges, top of the retromolar pad, bottom of the retromolar pad, and 2/3 up from
bottom to top of retromolar pad.
 Check articulator settings.
o Sequence of set up: Max anteriors (centrals, laterals, canines) -> Mand anteriors  Max 1st
premolars -> Mand 1st premolars -> Mand posteriors -> Max posteriors (one side at a time
working posterior) -> Balance, wax up & festoon
Denture teeth set up
o Occlusal concepts
 Always avoid anterior guidance
 Bilateral balanced
• Usually used with anatomical/cusped molds (optimal esthetics), but can also be
used with nonanatomical teeth as well, with a compensating curve
• Bilateral posterior contact in MI and lateral and protrusive excursive
movements. Said to create more stabilized base during function.
31


• Usually easiest to set mandibular teeth first to establish occlusal plane
Non-balanced/nonanatomical
• Generally used with nonanatomical teeth molds, although can be used with
cusped teeth
• Condylar inclinations set to 0 degrees, only a hinge articulator required
• Usually maxillary set for posteriors first to establish occlusal plane
• Bilateral posterior tooth contacts in MI, usually with unilateral posterior tooth
contact in lateral excursive (working side) movements, and no posterior
contacts in protrusive movements
• Easiest to arrange
• Minimal lateral stresses (may preserve the ridge more)
• Optimal for patients with decreased neuromuscular function
• Can be used for some class II or class III malocclusion patients
• Horizontal, but not vertical, overlap
Lingualized
• Generally used with a combination of upper anatomical and lower nonanatomical molds (more esthetic than flat plane)
• Maxillary lingual cusps contact mandibular central fossa, mortar & pestle
contacts, buccal cusps of maxillary posteriors usually shortened so there is no
excursive contacts on them
• May be either balanced or non-balanced
• Usually mandibular posteriors set first to establish occlusal plane
• Typically requires more time to set up
Wax Try In
•
•
•
Try-in wax dentures. Evaluate arrangement by utilizing criteria from tooth set-up.
Verify
o JRR: check CR with new Aluwax/PVS record on posterior teeth between the patient and
articulator. Drop incisal guide pin 1mm to compensate for thickness of record. Keep record thin
(1mm), but no perforations. Repeat if necessary. Remount mandibular cast if record is not
accepted.
o Esthetics: midline, smile line, buccal corridors, facial contours/support, occlusal plane,
interocclusal distance
o Phonetics: speaking space, “S” sound (horizontal overlap), “F” position
o VDO-VDR
Get patient ok to process dentures: Show patient after you have done your evaluation and made
necessary changes.
Remount casts, remount index & finish
• Remount casts if necessary according to newly verified JRR
• Finalize denture setup, festoon
• Process dentures
• Ask for the lab to return the finished dentures with remount casts using facebow preservation record
Once returned from lab:
•
•
Mount maxillary remount cast on articulator using remount index from lab
Finish and polish dentures
32
o
o
o
o
o
Should be smooth with no voids (minimize plaque traps), check polish dry
No sharp borders; round margins
Preserve thickness & extension (can check with the master cast if it hasn’t been destroyed
during processing)
Tissue surface smooth
Gingival/tooth anatomy
Denture Delivery
•
•
•
•
•
•
•
•
•
•
•
Deliver dentures
Fit dentures with PIP and adjust tissue surface: Have PIP paste out and ready before appointment. Check
maxillary and mandibular tissue surfaces (one at a time) and border extensions (labial frenums) with a
thin layer of PIP. Adjust pressure areas with slow speed handpiece with an acrylic bur. Do any occlusion
adjustments prior to checking tissue contacts by having the patient bite dentures together. Can use
cotton rolls to bite down on instead of opposing denture. Clean off PIP with gauze square or may require
solvent and toothbrush from lab or placing in plastic bag in ultrasonic cleaner. (This step is done before
any CR records are made).
Verify CR record with softened Aluwax over posterior teeth (cusp tips only and no perforations)
Check occlusion & adjust if needed
o Clinical remount (better field of vision, stable foundation, eliminates patient confusion, easier to
get the work done): Use new, verified CR record to mount the mandibular denture & cast.
o Refine the occlusion with selective grinding
o Use same criteria to evaluate as with tooth set up & wax try in. (CR, protrusive, right/left lateral,
heel interference, coronoid process interference, horizontal overlap adequate in posterior)
Can use Kerr Disclosing wax to check border overextensions. 1-2mm thickness along borders. Place in
patient’s mouth and perform border molding movements. Overextensions will show through and can be
relieved. Clean wax off with a gauze square
Repolish any adjustments
Check maxillary palatal seal, vertical dimension, and phonetics (horizontal overlap “S” sounds, vertical
overlap, “F” position)
Esthetics: occlusal plane, smile line, buccal corridors, midline, retention of maxillary denture, mandibular
denture stability, facial corridors, interocclusal distance
Post-insertion patient education: Written and oral
Verify mounting and finalize occlusal adjustment
Final polishing
Post-Delivery
•
Don’t throw away your remount casts yet because it might require another clinical remount
o Check fit with PIP paste
o Remount if necessary
Reline Procedure
• Indications: loss of retention or stability, but satisfactory VDO, esthetics are still ok, prosthetic teeth are
not severely worn, borders acceptable, and occlusion is satisfactory.
• Reline one arch at a time, treat less stable first
• Standard Reline Procedure:
o Remove undercuts, reduce borders and slightly relieve tissue surface (approx 1-2mm), place
relief holes if necessary.
o Border mold
33
o
o
o
o
o
o
Make impression with PVS in denture with patient in CR at appropriate VDO
Trim excess
Place posterior palatal seal with Iowa Wax (or give lab instructions to place)
Replace the denture and do same steps for opposing arch if needed at this time.
Recollect dentures, dismiss patient & send dentures to lab for processing
Deliver dentures at next appointment (inspect, adapt with PIP, perform clinical remount, and
review patient education)
Immediate Dentures
• Conventional immediate denture: after healing, the denture is relined to fit better
• Interim immediate denture: after healing, the plan is to fabricate a second, new complete denture that
fits properly
• Advantages: The primary advantage is esthetics during the healing process (no edentulous period);other
advantages are related to creating the denture: easier to measure and maintain the VDO, jaw
relationships, duplicate the tooth shape and position, and the patient usually adapts quicker and has
less post-extraction healing pain because the extraction sites are protected.
• Disadvantages: more difficult to fit because teeth in the way of taking impressions, the anterior ridge
undercut is more severe with teeth in place, can’t do a try in, it costs more because of the increase in
appointments and will need to be relined/replaced fairly soon
• Indications
o Patient is concerned about esthetics and cannot fathom being edentulous
o Patient has at least their maxillary anteriors remaining
o Maxillary only
• Basic procedure: Extract posteriors and fabricate denture base and tooth set up for edentulous
posterior extensions. Anterior tooth set up is estimated based on filling in the anticipated gap, and
placed immediately after extractions. Patient CANNOT remove denture during first 24 hours. 24-hour
check in appointment, and patient comes in for remount procedure after 1-2 weeks.
Combination Cases (RPD vs. Complete Denture)
*Dr. Aquilino will be lecturing on this early in the block. Students will get adequate information from his
lecture(s). FYI: most of the complete denture appointments will need to be completed first because in order to
design the RPD, you need to know what will be opposing it.
34
Post-Delivery Trouble-Shooting Guide (courtesy of Drs. Clancy, Schneider, Scandrett, and Luebke)
I.
Retention Problems
A. Problem: Maxillary Denture Lacks Retention at Time of Insertion.
Possible Cause
Diagnostic Procedure
Treatment
1. Tissue contours or fluid balance
changed since time of impression.
Patient closes firmly on cotton
rolls for 5 min. to determine if
retention improves.
Patient reassurance if retention
improves.
2. Incorrect posterior palatal seal.
Place pressure on lingual of
incisors and canines while
supporting denture. Denture
dropping indicates incorrect seal.
Treatment depends upon type of
error. (See Below)
a. Seal placed on non-displaceable
tissue. (Denture too short
posteriorly)
Check posterior extension by
placing transfer ink on posterior
border. Dry tissues and insert
denture to transfer ink line to
palatal tissues. Relate line to
vibrating line.
Relieve original palatal seal.
Extend denture with wax or
compound. Add seal with
impression wax or beading wax
until retention is improved.
Replace wax/compound with
autopolymerizing resin as a lab
procedure.
b. Seal on movable tissue
(Denture too long posteriorly)
Use transfer ink to relate
posterior border to vibrating line.
Shorten denture to vibrating line.
Add seal with autopolymerizing
resin/or/ create seal with wax
until retention improves. Replace
wax with resin (Lab Procedure)
c. Inadequate depth and seal does
not extend into hamular notch.
Add wax seal along posterior
border and check for
improvement in retention.
Replace wax with
autopolymerizing resin (lab
Procedure)
d. Posterior border and seal does
not extend into hamular notch.
Transfer ink line to palate with
denture. Slide blunt instrument
along distal slope of tuberosity
until instrument ‘falls’ into notch.
Relate to ink line.
Extend posterior border into
hamular notch with wax or
compound. If retention improves
replace wax with resin as a lab
procedure.
3. Inadequate clearance for labial
or buccal frenum.
Pull lip or cheek down firmly in
area of frenum while supporting
denture to check for
dislodgement.
Use P.I.P. or disclosing wax to
determine area for adjustment.
4. Posterior palatal seal causing
tissue rebound and denture
displacement.
Use P.I.P. to check. Complete
displacement of P.I.P. Indicates
excessive depth. Patient will
usually complain of pain or
pressure.
Relieve seal, checking with P.I.P.
until retention improved and
discomfort corrected.
35
Possible Cause
Diagnostic Procedure
Treatment
5. Thin tissue covering over
prominent mid-palatal suture or
tours.
Displacement of P.I.P. when
alternating pressure placed on
posterior teeth.
Relieve area of P.I.P.
displacement.
6. Dry mouth because of
alcoholism, radiation medication
or disease.
Place saliva substitute to check if
retention is improved.
Prescribe saliva substitute as rinse
and for placement in denture.
7. Inaccurate denture base
because if inaccurate impression
or war of finished denture.
Place thin mix of alginate
impression material in denture
and seat firmly in mouth. Thick
areas of alginate indicate poor
tissue adaptation.
Retract check and visually check.
Reline or remake the denture.
8. Posterior border too short or
too thin to fill buccal vestibule.
9. Short labial flange or excessive
notch for labial frenum.
Retract lip horizontally and
visually check. Denture drops
when patient smiles widely.
Extend border with compound or
impression wax and border mold.
Replace impression material with
resin as a lab procedure.
Extend border with compound or
impression wax. Replace
impression material with resin as
a lab procedure.
B. Problem: Maxillary denture loosens when patient opens widely.
Possible Cause
1. Posterior borders too thick or
too long.
Diagnostic Procedure
Pull cheek out and down over
border to check for dislodgement
of denture.
2. Interference with coronoid
process if mandible by distobuccal
flange.
Place finger in anterior teeth and
have patient protrude mandible
and move it from side to side.
Feel for movement of denture.
C.
Treatment
P.I.P. or disclosing wax on border.
Overextension or excessive
thickness may be indicated by only
a thin line of displacement of
indicating material. Adjust area of
show through.
Use P.I.P. or disclosing wax to
indicate area for adjustment.
Adjust show-through.
Problem: Maxillary denture loosens while patient is speaking.
Possible Cause
1. Inadequate posterior palatal
seal.
2. Interference with coronoid
process of mandible.
3. Posterior border too long or too
thick.
4. Short labial flange or excessive
notch for labial frenum.
Diagnostic Procedure
Place pressure on lingual of
incisors and canines while
supporting denture. Denture
dropping indicates incorrect seal.
Place finger on anterior teeth and
have patient protrude mandible
and move from side to side. Feel
for movement or dislodgement of
denture.
Pull check out and down over
border to check for dislodgement
of denture.
Retract lip horizontally and visually
check. Denture drops when
patient smiles widely.
Treatment
Treatment depends upon type of
error. (See section I A-3)
Same as I B-2
Same as I B-1
Extend border with compound or
impression wax. Replace
impression material with resin as a
36
Possible Cause
5. Notch for buccal frenum too
thick or of insufficient size.
Diagnostic Procedure
Grasp cheek and pull down and
out in buccal frenum area. Move
cheek anteriorly and posteriorly
and check for dislodgement.
Treatment
lab procedure.
Use P.I.P. or disclosing wax and
repeat movements. Adjust show
through areas.
D. Problem: Mandibular denture lacks retention at time of insertion.
Possible Cause
1. Change in tissue contours or
fluid balance since impression.
Diagnostic Procedure
Cotton rolls placed between
posterior teeth and patient closes
firmly for 5min. Check for
improvement.
Patient places tip of tongue on the
mandibular incisors and opens.
Lips and cheeks are lifted up and
around borders to check for lifting
of denture.
Pull cheek outward and upward at
a 45degree angle and move cheek
forward and back. Space between
border and cheek indicates
unerextension.
Treatment
Reassurance if retention improves.
4. Labial flange under extended.
Pull lip out in horizontal direction
and move it from side to side.
Space between border and
mucobuccal fold indicates under
extension.
Same as I D-3
5. Inadequate notch for lingual
frenum.
Patient forcibly places tongue to
touch posterior palate. Check for
lifting of denture.
Patient lightly places tip of tongue
into right and left buccal
vestibules. Note forceful lifting of
denture.
P.I.P. to indicate area for
adjustment.
2. Borders too wide to too long in
labial or buccal flange areas.
3. Buccal flanges under extended.
6. Overextension or excessive
thickness of lingual border in
molar area.
7. Overextension or excessive
thickness in distolingual area.
Patient protrudes tongue from
mouth. Forceful lifting indicates
need for adjustment of denture.
8. Under extension of lingual
border in molar/and/or/
distolingual area.
Apply impression wax on border.
Patient lightly protrudes tongue
from mouth, into each cheek and
opens widely. Wax remaining
with dull surface appearance
indicates lack of contact and under
extension.
Lengthen and widen lingual
border from premolar to premolar
with impression wax. Patient licks
9. Inadequate lingual seal.
Place P.I.P. or disclosing wax and
repeat lifting of lip and cheek
while holding denture in position.
Adjust show-through areas.
Extend and border mold with
compound or impression wax.
Replace with resin as a lab
procedure.
Place disclosing wax on border on
side of forceful lifting. Repeat
tongue movement while holding
denture firmly in place. Adjust
show-through areas.
Disclosing wax is placed around
border on distolingual one third of
denture. While holding denture in
place, patient forcefully protrudes
tongue to indicate area for
adjustment. Thin distolingual
border to 2mm.
Add additional wax or use
compound to extend border and
border mold. When retention is
improved, replace with resin as a
lab procedure.
Replace wax with resin as a lab
procedure.
37
Possible Cause
10. Retracted tongue position
(tongue doesn’t lie comfortably
with lip touching lingual incisors
and lateral borders not contacting
teeth.)
11. Lack of adequate
neuromuscular control. (elderly
stroke, disease.)
12. Posterior teeth set too lingual
crowding tongue.
13. Poorly contoured polished
surfaces. (Should be contoured so
that lower fibers of buccinator and
tongue will add in retention.)
14. Dry mouth because of
alcoholism, medication or disease.
Diagnostic Procedure
lips, clears buccal vestibules and
retrudes tongue to touch posterior
palate. Improved retention
indicates inadequate seal.
Place dentures firmly in mouth.
Ask patient to open slightly.
Observe relationship of tongue to
denture.
Treatment
Tongue exercises twice daily. Place
resin nodule on lingual of
mandibular incisors to serve as
reference point for tip of tongue.
Patient observation. Evaluate
patients’ ability to manipulate lips
and tongue on command. Observe
facial musculature for
hypotonicity.
Lingual cusps should lie within
triangle formed by lines
connection the lingual and buccal
aspects of the retromolar pad with
the mesial contact point of the
properly positioned canine.
Polished surfaces too convex with
denture base wider than borders.
Use of denture adhesives for a few
weeks until control of denture
improves. Improve contours of
polished surfaces if they are not
ideal.
Reposition teeth on denture base
and process with resin. Minor
errors may be corrected by
grinding lingual surfaces.
Place saliva substitute in denture
to check if retention improves.
Prescribe saliva substitute as rinse
and for placement in denture.
Reshape denture base to
acceptable contours.
D. Problem: Maxillary denture loosens at different times of day.
Possible Cause
1. Heavy secretion of mucinous
saliva from palatal salivary glands.
2. Periods of excessive dry mouth
because of alcoholism, radiation
medication or disease.
E.
Diagnostic Procedure
Tissue surface of maxillary denture
covered with ropy saliva. Usually
affects a first time denture wearer.
Heavy carbohydrate diet may
contribute to problem.
Place saliva substitute to check if
retention is improved.
Treatment
Remove and clean denture several
times daily; use of astringent
mouth rinses; reassurance that
palatal glands tend to atrophy
when covered.
Prescribe saliva substitute as rinse
and for placement in denture.
Problem: One or both dentures loosen while eating.
Possible Cause
1. Teeth set too far buccal to crest
of ridge.
2. Occlusal plane higher than
retromolar pad.
3. Interceptive contact in
occlusion.
Diagnostic Procedure
Lingual cusps should fall within
triangle formed by buccal and
lingual aspects of retromolar pad
and the mesial contact of the
canine.
Check relation of occlusal plane to
anatomic landmarks.
Carefully check relationship of
teeth throughout the chewing
process.
Treatment
Reposition teeth on denture base.
Reposition teeth of both dentures.
Remount and correct posterior
occlusion. Hollow grind lingual of
maxillary anterior teeth if
necessary to eliminate anterior
interferences in function range of
38
Possible Cause
4. Inadequate neuromuscular
control with new dentures.
II.
Diagnostic Procedure
Rule out all possible errors of
dentures.
Treatment
movement.
Reassurance that it will take time
for oral structures to
accommodate to new contours of
new dentures. Adhesives may be
used for 1-2 weeks until control of
denture improves.
PATIENT DISCOMFORT PROBLEMS
A. Problem: Excessive salivation.
Possible Cause
1. Strangeness of new denture.
Diagnostic Procedure
Usually occurs first 72 hours of
wearing new dentures.
Treatment
Reassurance. Patient should be
counseled about problem prior to
denture insertion. Probably
caused by reflex parasympathetic
simulation of the salivary glands.
B. Problem: Sore mouth at 24 hours or subsequent post insertion appointment. (during first 2 weeks)
Possible Cause
1. Pressure areas from impression
or war of denture. Lack of relief in
non-yielding areas such as tori,
lingual tuberosities, exostoses or
sharp bony areas.
2. Borders too long, too wide, or
border left sharp.
Diagnostic Procedure
Examine bearing area for
reddened areas or red areas with
central ulceration. Swelling of
inflamed area helps to identify
pressure area with P.I.P.
Examine border areas for red line,
long slit or cut in tissue; or a wellcircumscribed reddened area or, a
grayish white area that appears to
be sloughing.
Treatment
P.I.P. to indicate area for
adjustment. May encircle area
requiring adjustment with transfer
ink.
3. Errors in occlusion causing
movement of denture.
4. Overextension in masseter area
of mandibular denture.
Carefully check occlusion. Irritated
areas are on ridge slopes.
Disto-buccal contour of
mandibular denture does not
assume 45degree angle from top
of pad, and soreness is on lingual
of mandible. Place disclosing wax
on disto-buccal borders and have
patient close very firmly on cotton
rolls to activate masseter muscle.
Remount and correct occlusion.
5. Insufficient relief over
undercuts.
Use combination of P.I.P. and
transfer ink to locate exact area on
denture. Area may be reddened
and/or ulcerated.
Adjust denture until patient feels
improvement. Do not over relieve
denture.
Use P.I.P. or disclosing wax and
manipulate borders to determine
area of overextension. Area may
be encircled with transfer ink to
help identify overextension.
Borders must be rounded.
Adjust areas where wax is
displaced.
C. Problem: Non-specific pain with a new denture.
Possible Cause
1. Pressure over zygomatic
process.
Diagnostic Procedure
Palpate and apply pressure over
zygomatic area to check for pain.
Treatment
Locate pressure area with P.I.P.
and adjust.
39
Possible Cause
2. Disto-buccal border of maxillary
denture base too wide.
Diagnostic Procedure
Place finger on maxillary anterior
teeth and have patient protrude
mandible and move from side to
side. Feel for movement or
dislodgement of denture.
Treatment
Use P.I.P. or disclosing wax to
indicate area for adjustment.
D. Problem: Generalized soreness after repeated adjustments.
Possible Cause
1. Clenching and bruxing.
Diagnostic Procedure
Shiny wear facets on teeth,
observation and questioning of
patient.
2. Inadequate Interocclusal
distance. (freeway space)
Utilize rest position and phonetics
to determine if rest position has
been encroached by vertical
dimension of occlusion.
Carefully remount and analyze
occlusion. Check for interferences
at position of habitual closure if it
differs from centric relation.
(retrognathic patients)
Careful history – relationship of
soreness to initiation of drug
therapy or a change of
medication.
Thorough dietary analysis.
3. Errors in occlusion. (Soreness on
crest or slopes of residual ridge)
4. Post menopausal endocrine
changes or endocrine therapy.
5. Low tissue tolerance due to
nutritional deficiencies.
6. Low tissue tolerance due to
disease such as uncontrolled
diabetes, pemphigus vulgaris.
Thorough history. Rule out all
possible local causes.
Treatment
Patient awareness, stretch and
relaxation procedures. Keep
denture out at night or wear a soft
mouth guard over denture.
Remount and reposition or
equilibrate teeth restoring
adequate Interocclusal distance
(freeway space.)
Correct occlusion. May have to
remount to help in eliminating
interferences.
Consult with physician for possible
interruption of drug therapy or
change in medication.
Dietary counseling; with
knowledgeable physician if
problem persists.
Referral to physician for diagnosis
and treatment.
E. Problem: Cheek biting.
Possible Cause
1. Insufficient horizontal overlap of
posterior teeth.
Diagnostic Procedure
Observe relationship of posterior
teeth. Should be approx. 2mm. Of
horizontal overlap.
2. Insufficient clearance between
denture bases and distal to last
tooth.
3. Sharp buccal cusps.
Check for clearance of 3-4mm.
4. Replacement teeth extend too
far posteriorly.
Run finger over buccal surface of
posterior teeth.
Teeth set over retromolar pad or
tuberosity.
Treatment
Normal relationship: round in
buccal cusps of mandibular
molars; crossbite: round in buccal
cusps of maxillary molars.
Thin denture bases to allow space
for tissues of check.
Round over sharp edges and
polish.
Remove most posterior tooth and
grind it off denture base.
F. Problem: Tingling and/or pain of lower lip.
Possible Cause
1. Pressure over mental foramen.
Diagnostic Procedure
Only ridges with extensive
Resorption. Palpate firmly in area
of mental foramen to reproduce
Treatment
Use transfer ink to encircle area.
Relieve area liberally.
40
Possible Cause
Diagnostic Procedure
symptoms.
Treatment
G. Problem: Burning sensation of upper lip and side of nose.
Possible Cause
1. Impingement of nasopalatine
nerves exiting incisive foramen.
Diagnostic Procedure
P.I.P. to verify pressure over
incisive foramen. Area may be
reddened.
Treatment
P.I.P. or place transfer ink on
papilla to locate area of denture
for liberal relief.
H. Problem: Patient complains of sore throat.
Possible Cause
1. Overextension and ulceration
on soft palate.
2. Overextension beyond hamular
notch, disto- buccal of maxillary
denture, disto-lingual of
mandibular denture or onto
pterygo-mandibular raphe above
retromolar pad.
Diagnostic Procedure
Use transfer ink to determine
overextension onto movable
tissue.
Inspection for inflamed or
ulcerated tissues in these areas,
Treatment
Shorten and reestablish a
posterior palatal seal.
P.I.P. or disclosing wax and
transfer ink to locate area of
denture for adjustment. Adjust
and polish denture.
III. GAGGING WITH DENTURES
A. Problem: Gagging at time of insertion.
Possible Cause
1. Nervousness at receiving first
denture.
Diagnostic Procedure
Rule out other possible causes.
2. Posterior border too long.
Apply transfer ink to posterior
border of denture and insert after
drying tissues. Relate ink line to
vibrating line.
3. Posterior border thick.
Inspect posterior border for
thickness over mm.
4. Disto-lingual flange of
mandibular denture too long or
too thick.
Check to determine that distolingual borders are not over 2mm.
thick. Use disclosing wax or P.I.P.
to check for overextension.
Simulate contact on tongue with
mouth mirror to check for gagging
response.
5. Maxillary occlusal plane too low
triggering tongue gagging.
Treatment
A Piece of hard sweet-sour candy
to occupy tongue when symptoms
appear – first day or two only.
Adjust denture if it extends
beyond vibrating line. Reestablish
a posterior palatal seal.
Reduce thickness from
overextended and thin distolingual
border to 2mm.
Shorten borders if overextended
and thin distolingual border to
2mm.
Reposition teeth on denture base
or remake denture.
B. Problem: Delayed gagging – begins subsequent to day of insertion.
Possible Cause
Diagnostic Procedure
Treatment
41
Possible Cause
1. Heavy mucinous saliva form
palatal salivary glands escaping
from posterior border.
Diagnostic Procedure
Remove denture and observe
thick ropy saliva.
Treatment
Remove and clean denture
frequently. Use of astringent
mouthwash. Reassurance that
secretion will eventually decrease
2. Mandibular teeth set too far
lingual triggering tongue gagging.
Verify correct buccal-lingual
position and lingual aspects of
retromolar pad and the incisal
contact of the cuspid.
Use rest position and phonetics to
verify adequate Interocclusal
distance. (freeway space)
Grind lingual surfaces of
mandibular posterior teeth or
reposition teeth on denture.
3. Vertical dimension of occlusion
increased beyond physiologic
limits.
Reposition or equilibrate teeth to
increase the Interocclusal
distance.
IV. SPEECH PROBLEMS
A. Problem: Patient has difficulty speaking with first or new denture.
Possible Cause
1. Unfamiliarity with new denture
contours
Diagnostic Procedure
Generalized awkwardness in
speaking – no specific consonants.
2. Vertical dimension of occlusion
increased beyond physiologic
limits.
3. Anterior teeth set with too
much vertical overlap and/or
tooth little horizontal overlap.
(Common problem when teeth set
in normal relationship for patients
with retrognathic jaw relationship
Posterior teeth as well as anterior
strike while speaking, particularly
in the “s”, “ch” and “j” sounds.
Watch relationship of anterior
teeth when patient says words
with “s”, “ch” and “j”. Rule out
increased vertical dimension of
occlusion and loose dentures.
Treatment
Reassurance. Suggest reading
aloud for practice. Suggest use of
tape recorder to help build
confidence.
Reposition teeth or equilibrate
after remount to establish
adequate “speaking space”.
Recontour anterior teeth by
creating incisal wear and/or by
hollow grinding lingual surfaces of
maxillary teeth. Reposition teeth
if necessary.
B. Problem: Prolonged difficulty in speaking clearly.
Possible Cause
1. History of corrected speech
problems as a child.
Diagnostic Procedure
All denture causes of problem
ruled out. Take a detailed history.
Patients often forget early lisps or
other problems that were
corrected by time or therapy.
Treatment
Enlist the aid of speech therapist.
C. Problem: Whistle on ‘s’ sounds.
NOTE: Normal ‘s’ sound is created by hiss of air as it escapes from median groove of tongue when tip of tongue is just
behind maxillary incisor teeth. Lateral borders of tongue in contact with posterior teeth and tissue.
Possible Cause
1. Median groove of tongue too
deep. Maxillary anterior teeth set
too far labial or insufficient
denture base material on lingual
of maxillary anterior teeth.
Diagnostic Procedure
Add wax to anterior palate to
create normal “s” curve of palate
and have patient speak words
with “s” sound.
Treatment
Replace wax with resin if whistle is
corrected.
42
Possible Cause
2. Posterior teeth set too far
lingual or denture base material
too prominent causing median
groove to deepen.
Diagnostic Procedure
Combination of relieving posterior
denture base and add wax to
anterior palate.
Treatment
Replace wax with resin if whistle is
corrected.
D. Problem: “S” sound sounds as “SH” or “TH”.
Possible Cause
1. Median tongue groove too
shallow and air escaping at lateral
borders of tongue: Excessive base
material lingual to anterior teeth
or anterior teeth set too far
lingual.
2. Air escaping at lateral borders of
tongue because of lack of denture
base material restoring tissue.
Diagnostic Procedure
Problem with “S” sound not
pronounced.
Treatment
Relieve anterior palatal denture
base.
“S” sounds as slushy “sh” or a
lisping “th”. Build up lingual tissue
roll with wax until problem is
corrected.
Replace wax with resin.
Articulator Basics
• Condylar Guidance: simulates the anatomy and function of the glenoid fossa
o Condylar Track: rotated on horizontal transverse axis from +60 to -20
o Bennett Angle: medial-lateral adjustment of condylar guidance rotated from 0 to 30
o Centric Lock: when locked, allows only hinge movement; when opened, allows lateral and
protrusive movements
• Incisal Guide Table: allows independent adjustment of anterior guidance
o Table secured or moved by using larger diameter locknut
o Protrusive: rotates anterior-posteriorly from 0 to 60 (smaller diameter locknut on underside)
o Lateral: may be elevated from 0 to 45 (fixed by thumbnuts on sides)
43