TRY-IN STAGE

Prof. Dr. Abdel-Basit Mahmoud 1

CHAPTER V

EVALUATION OF THE TRIAL DENTURES
(Try-in stage)

The try-in is a very important stage in denture construction. All details in the
dentures should be checked at this stage.

Important steps to be followed during the try-in stage.

I- Check the case on the articulator: (Fig. 5: 1)
The mounting rings are firmly secured in their places.
The incisal pin of the articulator is in its proper place contacting the incisal guide
table i.e. the vertical dimension is correct on the articulator.
The articulator's joints are firm and not loose when the articulator is in centric
position,; i.e. no movement is elicited in centric position except simple hinge
movement.
The trial denture bases lie properly on their casts and the teeth meet evenly in
centric.
The horizontal and lateral condylar path inclinations coincide with the readings
obtained from the eccentric jaw relation records and the readings registered on
casts.
The articulator moves smoothly from centric to eccentric positions without
interlocking of the teeth.














Fig. 5; 1: Check the waxed-up dentures on the articulator

TRY-IN STAGE
Prof. Dr. Abdel-Basit Mahmoud 2

II- Check the casts: (Fig. 5: 2)
The casts should be in a good shape free from air bubbles and scratches.
Undercuts should be relieved to avoid scratching the cast upon removing the
trial denture base from the casts. Never use sharp instruments to remove the
impression material from the casts.
The casts should be free from wax spots. Wax spots on the palate or ridges give
false information in the try-in stage.












Fig. 5; 2: Wax spots are left attached to casts. Occlusal vertical dimension is incorrect in the
mouth. S. Space into which a knife blade can pass through.
III- Check the trial denture bases on casts:
Trial denture bases should be stable on their casts.
No sharp edges. The periphery of the trial base should be smooth and rounded.

IV- Check the teeth: (Fig. 5: 4 a & b)
Check the teeth as regards size and shade.
Check that the lower teeth are properly set on the ridge
with no interference to tongue movements.
Check for free articulation and balanced occlusion i.e.
no interlocking from centric to eccentric.
The upper anterior teeth should overlap the lower
anterior teeth without contact between them. The
only exception is when there is edge to edge.
There should be maximum interdigitation buccally and lingually ( you can only
check it lingually on the articulator).


TRY-IN STAGE
Prof. Dr. Abdel-Basit Mahmoud 3

Trying trial denture bases in the patient's mouth.
1. Check the upper denture alone for:
Extension and retention.
Stability to occlusal stresses.
Appearance of the occlusal plane in relation to the ala-tragus and inter-papillary
lines.
Alignment of the teeth and the support of the facial musculature.

2. Check the lower denture alone for:
Extension and retention.
Stability to occlusal stresses.
Neutral zone and tongue space.
Height of the occlusal plane in relation to function.
3. Check both dentures together for:
Vertical dimension of centric occluding relation.
Centric relation.
Equilibration of occlusal pressure.
Appearance of the face and teeth.
Free articulation and balanced occlusion.
Phonetic tests.

4. Patient's approval:




It is advisable to chill the trial denture bases every now and then in ice cold
water, especially if they are made of shellac base plate. Wax softens at mouth
temperature, so, if the trial dentures are left in the mouth too long, the teeth may
become loose or alter their position.





TRY-IN STAGE
Prof. Dr. Abdel-Basit Mahmoud 4
I. Check the upper denture alone for

Extension:
The entire periphery should be checked. An over-extended base exhibits
certain springiness, after being seated; it tends to move away from the tissues when
pressure on it is removed.

Denture extension can be checked by:
Visual examination of the labial and buccal flanges after slight rising of
the lip to see whether the vestibule is properly countered with the denture
flanges.
Palpation of the uneasily seen flanges as at the tuberosities region.
Pressure indicating paste can be used especially if the try-in carried out
on the permanent denture base material. Any easily displaced material
can be used as a testing paste. A thin mix of alginate material can be
used.

Retention:
Test for the retention and peripheral seal of the anterior (labial) part by pulling
the denture from the anterior part vertically downwards.
Test for the posterior palatal (post dam area) by applying upward and out
wards pressure on the cingulum of the upper incisor.
Test for the seal at the tuberosities area by applying up and outward pressure at
opposite canine region.

Stability to occlusal stresses and relief area: (Fig. 5: 5 a & b)
Alternating vertical pressure is applied on the premolar-molar regions,
If, this vertical pressure causes the denture to tilt and rise on the other
side this indicates that the teeth on the side of the applied pressure
are outside the ridge.
If the denture teeters on the middle, it indicates that the denture is
warped in the middle or the relief area is not properly done.
An alginate test may help to show the denture areas that are seated first and the
areas that need relief.



TRY-IN STAGE
Prof. Dr. Abdel-Basit Mahmoud 5
Appearance of the occlusal plane:
1- For a patient with an average length of upper lip, 2 mm of
the incisors should be seen, when the lip is at rest.
For a patient with a short lip, perhaps 5 to 6 mm of
the incisors should be seen.

Long upper lip may necessitate complete coverage
of the anterior teeth, but if possible their incisal
edges should be seen.
2- The plane of occlusion should be parallel with the ala-tragus
line on both sides and with the inter-papillary line in the front.

The F, V, Ph sounds are aids in determining proper tooth placement. In
production of these sounds, the incisor edges of maxillary anterior teeth contact lower
lip at the vermilion border.

Alignment of the anterior teeth and the support of the musculature:

The position of teeth should be in harmony with muscle activity during
swallowing, speaking, laughing, smiling, etc.
Improper anteroposterior placement of anterior teeth and improper base
contour may alter the facial appearance.

Certain aspects that require to be checked as a routine.
Tooth shape, shade and size.
Appearance of the face. While standing in front of the patient note

the vermilion border of upper lip, - angles of the mouth,
philtrum - the nasiolabial sulcus,.
Observe the patient's profile. It should assume a normal contour

Insufficient lip support as a result of setting the anterior teeth too far posteriorly
or improper waxing up .Placing or tilting the anterior teeth more labially and/or
proper waxing up of he flange will improve the appearance.
Excessive lip support due to forward placement of anterior teeth or excessive
waxing up of labial flange is characterized by stretched tight appearance and loss
of contour of philtrum.
TRY-IN STAGE
Prof. Dr. Abdel-Basit Mahmoud 6
II- Check the lower denture alone for

Extension
Denture extension can be examined by:
Visual examination of the parts that can be easily seen as the labial
flanges.
Palpation of the posterior parts that, are difficult to be seen as the buccal
flanges.
The lower buccal flange should not extend beyond the external oblique
ridge, over extended buccal flange interferes with the action of the
powerful masseter muscle. The patient complains of pain in the buccal
vestibule with the contraction of the masseter muscle when the mouth is
closed.

Testing pastes as thin mix of alginate, zinc oxide eugenol pastes (the
white tube only) and disclosing waxes.

Retention
Applying outward pressure on the canine area gives an idea on the retention
of the opposite retromolar area.
Properly contoured denture flanges help stability and retention of dentures. The
tongue and the buccinators muscle act favorably upon concave denture flanges. In
this case the muscle forces are directed to seat the denture.
A better idea about retention of the lower denture is gained if the patient opens his
mouth slightly and let his tongue touch the cingulum of the lower anterior teeth.

Stability to occlusal stresses:
Applying vertical pressure with the ball of the index finger in the premolar and
molar regions of each side alternatively can check stability.
If there is warpage in the denture base, the trial denture bases teeters.
If the vertical occlusal stresses are transmitted outside the ridge the base
will rise on the other side.
Similarly, when the mandible moves to one side, there should be contact
between the tooth on the working side and the balancing side.


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Prof. Dr. Abdel-Basit Mahmoud 7
Neutral zone and tongue space:
The neutral zone is-the potential space between the lips and cheek in one side
and the tongue on the other side. Natural or artificial teeth in this zone are subject to
equal and opposite forces from the surrounding musculature.

Relation between the neutral zone and the crest of the ridge: (Fig; 5: 11)
It should be noticed that the crest of the ridge changes according to the
pattern of ridge resorption ,while, the position of the neutral zone remains
constant, so in case of excessive ridge resorption of the labial ridge, the crest of the
ridge moves lingually, setting teeth on the crest may then interfere with the position of
the neutral zone.


Tongue space:

Encroaching upon the tongue space (whether vertically, laterally or
antro-posteriorly) the tongue will be cramped by the denture. It will grip it as it tries
to expand laterally, and whenever the tongue moves it will move the denture.


Height of the occlusal plane in relation to function:
The occlusal plane should be below the greatest
convexity of the tongue, so that the tongue can
perform the majority of its movements above the
denture. The tongue in this position tends to keep the
lower denture down.


To test for the height of the occlusal plane,
Ask the patient to relax and place the tip of the tongue comfortably and
without strain behind the lower front teeth.
Request the patient to open the mouth without moving the position of the
tongue.
The tongue should lie on top of and slightly over lapping the posterior
teeth.
If the tongue is below the occlusal plane, it tends to raise the lower denture
from its seat during function.
TRY-IN STAGE
Prof. Dr. Abdel-Basit Mahmoud 8
III. Check both dentures together

Now insert both upper and lower dentures in the patient's mouth and check for:

1-Vertical dimension of centric occluding relation:
When the mandible is in physiologic rest position, there should be an inter-
occlusal space of at least 2mm. at the first premolars; some patients require
more than 2mm inter-occlusal distance.
When the teeth are in centric occluding relation, the patient's face should
produce a pleasing appearance.
The patient should be able to speak without clicking of the teeth.

2- Verification of centric relation:
Ask the patient to relax and try to touch the back of the upper denture with the tip
of the tongue and slowly close the teeth together, making sure the bases are
stable without movement.

Note if the teeth interdigitate accurately. They should do so in exactly the same
way as they do on the articulator.

Faulty occlusion may be due to: error either in registration or mounting the
articulator.
If centric relation is found wrong and the teeth do not occlude into centric
occluding relation in the patient's mouth as they occlude on the articulator, a
new record of centric occluding relation is obtained and the mandibular cast
detached and remounted according to the new record.





TRY-IN STAGE
Prof. Dr. Abdel-Basit Mahmoud 9

3- Equilibration of occlusal pressure (Evenness of occlusal pressure):
the teeth should occlude evenly and with equally distributed pressure all round.

The uneven pressure may be due to one of the following errors:
o Unequal pressure on the two sides of the occlusal rims during
registration of the centric occluding relation (improper softening of
the wax used for registering the centric relation).
o Base plates are touching at the rear, stopping the teeth from coming
into occlusion.
o Warpage of the base plates. They do not fit their casts properly.
o Slight error in seating the occlusion blocks (bite blocks) to their casts.
Wax or debris present between the base plate and the cast.
o Error in mounting the lower cast on the articulator.

Testing the equilibration of occlusal pressure:
Inserting the blade of the wax knife between the occlusal surfaces of
the upper and lower dentures denotes gross error in the record of centric
occluding relation.

Place two pieces of thin celluloid strip between the teeth in the molar
region on each side. Request the patient to close in centric occlusion
while the celluloid strips remain in place. Try to remove the celluloid
strips by pulling them out between the closed teeth, holding one strip
with each hand. Any difference in the force required to remove the strips
is interpreted in terms of occlusal pressure. Equal forces means equal
occlusal pressure. Repeat the test in the premolar region.

To correct any unevenness of occluding pressure:
o If it is very slight, this can be corrected by grinding the teeth after the
denture is processed..
o If the unevenness is more than slight, better take a new centric relation
record at this stage.
Remove the lower back teeth, replace by softened wax, and remount the
lower cast .

TRY-IN STAGE
Prof. Dr. Abdel-Basit Mahmoud 10
4- Appearance of the face and the teeth:

Appearance of the Face:
The face should be studied in front view, in right
and left lateral profile views. The effect of the denture
and teeth alignment is noticed while the face is at rest
and while performing various facial expressions.


The following should be checked:
The horizontal overlap and its effect on the contour of the lips and the labio-
mental sulcus.
The amount of upper incisors showing when the upper lip is at rest, and when
the patient smiles.
The prominence of the upper anterior teeth and their effect on philtrum of the
upper lip and the nasiolabial folds.
The prominence of the lower anterior teeth when the lips are supported in
smiling and speech.
The alignment of the posterior teeth and the amount of support they give to
the cheeks (round or sunken cheeks).

Appearance of the teeth:
a. Central line
b. Incisal plane
c. Shape of teeth: The selected tooth form should harmonize with the shape of the
face. People with short, round faces have short, round teeth on the other hand,
People with long, narrow faces should have long, narrow teeth.
d. Size of teeth: The selected tooth size should harmonize with the size of the
face considering your patient's opinion and your artistic judgment.
e. Shade of teeth
f-Regularity of the set up: Too regular a set up in the incisor region looks
artificial to all observed . So a little irregularity is usually called for.





TRY-IN STAGE
Prof. Dr. Abdel-Basit Mahmoud 11
5- Free articulation and balanced occlusion:
Free articulation (mandibular movement): The mandible should move
from centric occluding relation to eccentric occluding relations without teeth
interference.

Balanced occlusion: Balanced occlusion in dentures implies simultaneous
occlusal contacts in the working and balancing sides, which stabilize denture
bases on their respective ridges.

Balanced occlusion results from the co-ordination of the following:
1- Condylar path inclination. 2- Incisal guidance.
3- Cusp height. 4- Compensating curves
5- Plane of orientation.

6- Phonetic tests:
Bad denture produces speech defects due to:
Improper arrangement of the teeth in the dentures.
Faulty extension or fit of the dentures.
High vertical dimension of occlusion.
Lack of tongue space.

IV. Patient's approval

Face Bow Index
At the end of the try-in stage, a face bow index should be prepared to aid in
clinical remounting. The face bow index preserves the face bow record.

Procedure:
Remove lower cast by unscrewing the articulator ring
Secure a new ring to the lower member of the articulator
Place a sheet of wax around the ring to form a matrix.
Place Vaseline on the occlusal surface of upper teeth.
Mix plaster and place in the wax matrix.
Close the articulator so that upper teeth occlude on the plaster.
After the plaster sets open articulator and remove the face bow index by
unscrewing the ring and replace the lower cast again and proceed with
processing.