Complete Denture Manual Robert W. Loney, DMD, MS 2019 Robert W. Loney, DMD, MS 2019 http://removpros.dentistry.dal.ca Table of Contents History, Examination, DiaGnosis and Treatment Plan ........................................... 1 Medical history ......................................................................................................... 1 Dental History .......................................................................................................... 1 Instructions to Patients ............................................................................................ 5 Limitations of Dentures ............................................................................................ 5 Adaptation to Dentures ............................................................................................ 5 Oral Hygiene ............................................................................................................ 6 a. Dentures: .......................................................................................................... 6 b. Mucosa: ........................................................................................................... 7 Continuing Care ....................................................................................................... 7 Preliminary Edentulous Impressions ...................................................................... 8 Tray Selection .......................................................................................................... 8 Irreversible Hydrocolloid Syringe Technique ........................................................... 8 Possible Problems with Syringe Technique: ...................................................... 11 Diagnostic Casts .................................................................................................... 12 Pouring a Model ................................................................................................. 12 Trimming ............................................................................................................ 12 Tissue ConditioninG ................................................................................................ 13 Tissue Conditioning Techniques: .......................................................................... 13 1. Oral hygiene ............................................................................................... 13 2. Tissue Rest ................................................................................................. 13 3. Occlusal Correction ..................................................................................... 14 4. Temporary Soft Liners ................................................................................ 14 Tissue Conditioning Treatment Protocols .............................................................. 15 Placement of Temporary Resilient Liners (Tissue Conditioners)....................... 16 Custom Trays .......................................................................................................... 19 Border MoldinG ........................................................................................................ 21 Maxilla ................................................................................................................ 22 Mandible ............................................................................................................. 23 Final Impressions for Complete Dentures ............................................................ 25 Polyvinyl Siloxanes (Addition Reaction Silicone) ................................................... 25 Custom Trays: ....................................................................................................... 25 Final Impressions (Seated, two mirror technique) ................................................. 25 Post-palatal Seal ................................................................................................... 26 Boxing and PourinG Final Impression ................................................................... 28 RecordinG Maxillo-mandibular Relationships ...................................................... 30 Record Bases (Baseplates) and Occlusion Rims .................................................. 30 A. Arbitrary Adjustment of Occlusion Rims ........................................................ 31 B. Occlusal Vertical Dimension .......................................................................... 32 C. Technique for Determining Occlusal Vertical Dimension .............................. 32 D. Transverse Horizontal Axis Location ............................................................. 35 Centric Relation (CR) Position ............................................................................... 36 Reasons for NOT using positions other than CR in edentulous patients. .......... 38 Other positions: .................................................................................................. 38 When to use CR as a treatment position: .......................................................... 38 How to obtain CR ............................................................................................... 38 Selection of registration media ........................................................................... 38 Recording centric relation and mounting the mandibular cast: .......................... 39 Setting Protrusive Condylar Inclination .............................................................. 41 SelectinG and SettinG Denture Teeth ..................................................................... 42 Reference Marks on the Occlusion Rims, Record Bases and Master Casts ........ 42 A. Maxilla ............................................................................................................ 42 B. Mandible ........................................................................................................ 44 Selecting Anterior Teeth ........................................................................................ 45 Size .................................................................................................................... 45 Shape ................................................................................................................. 45 Shade/Hue ......................................................................................................... 46 Material .............................................................................................................. 46 SelectinG Posterior Teeth Form (Cusp AnGle) ...................................................... 47 Anatomic (40°, 30°, 20°(semi-anatomic), 10°) ................................................... 47 Non-anatomic (0°) .............................................................................................. 47 Posterior Tooth Size ........................................................................................... 47 Refining Anterior Tooth Position: ....................................................................... 51 Philosophies of Denture Occlusion: ..................................................................... 53 1. Lingualized Occlusal Scheme ........................................................................ 53 2. Monoplane Occlusal Scheme ........................................................................ 54 3. Setting Posterior Teeth .................................................................................. 55 4. Achieving a Balanced Lingualized Articulation ............................................... 58 Principles for DevelopinG & AdjustinG Contacts for LinGualized Occlusion .... 60 The Wax Try-in ......................................................................................................... 63 A. Initial Wax Try-in ............................................................................................... 63 1. Centric Position Contacts ............................................................................... 63 2. Occlusal Vertical Dimension and Interocclusal Rest Distance ....................... 64 3.Tooth Position ................................................................................................. 65 4. Excursive contacts ......................................................................................... 65 5. Esthetics ......................................................................................................... 66 6. Phonetics ....................................................................................................... 66 7. Denture base contours ................................................................................... 67 8. Patient Input ................................................................................................... 67 B. Final Wax Try-in ............................................................................................... 68 C. Completion of the Laboratory Prescription ....................................................... 68 DeliverinG and AdjustinG Complete Dentures ...................................................... 69 8 Step Complete Denture Delivery ........................................................................ 69 Rationale for Clinical Remounts for Occlusal Adjustment ..................................... 72 Fabrication of Remount Casts ............................................................................... 73 Instructions