A Technique to Correct Anterior-Posterior Tooth Discrepancy

for a Maxillary Immediate Complete Denture

Edmond A. Bedrossian, DDS, Armand Putra, BDS, MSD, & Kwok-Hung Chung, DDS, MS, PhD
Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, WA

Keywords Abstract
Denture base; denture correction; denture
occlusion; denture rebasing; malocclusion.
This article describes a chairside technique to correct inappropriate occlusal vertical
dimension as well as the inaccurate anterior-posterior tooth set-up of a maxillary
immediate complete denture. When fabricating an immediate denture, the inability of
Correspondence
a wax-denture trial and the potential for unpredictable complications during surgery,
Edmond Armand Bedrossian, University of
compromised esthetics and function of an immediate complete denture may pose a
Washington School of Dentistry, Department
of Restorative Dentistry, Graduate
clinical problem, which needs instant correction. The technique described can provide
Prosthodontics, 1959 NE Pacific St., B-469,
an alternative method to correct and deliver a definitive immediate complete denture
Box 357456, Seattle, WA 98195-7456. on the day of surgery.
E-mail: Edmon1@uw.edu

Presented at the ACP Annual Session, 2016,

San Diego, CA and awarded third place at the
poster session.

The authors deny any conflicts of interest

related this paper.

Accepted July 25, 2017

doi: 10.1111/jopr.12713

An immediate complete denture (ICD) can be either a defini-
tive or a transitional prosthesis inserted immediately following
the removal of all unsalvageable remaining dentition. Several
procedures have been described for fabricating an ICD.1-3 As
an ICD provides many advantages, the fabrication methods for
a predictable treatment outcome is not always easily achieved,
as the prosthesis cannot be completely assessed before inser-
tion. The inability of a preoperative evaluation of a wax-denture
trial, as well as potential complications during surgical proce-
dures, may readily effect the occlusal vertical dimension (OVD)
and anterior-posterior (A-P) position of the anterior maxillary
teeth, making an ICD challenging with potential functional and
esthetic compromises.4 The dentist and patient may desire cer-
tain modifications of tooth arrangement and in these cases, the
appraisal must be deferred until the ICD can be placed.5 To
prevent or correct any of the aforementioned undesirable es-
thetic errors of the transitional prosthesis, alternative methods
for ICD fabrication have been recommended.6-8 Bouma et al8
described a process by “staging” the delivery of the ICD re-
moving the anterior and selected posterior teeth, fabricating an
interim removable partial prosthesis, and thereby allowing both
the dentist and patient to evaluate and establish OVD, esthet-
ics, and phonetics prior to delivery of the ICD. Although this
nontraditional technique provides the coveted step of a wax
try-in, the additional chairside time, fabrication of an interim
prosthesis, and increased cost of overall treatment may not be
an ideal treatment consideration for most patients. Proper A-P
position of the central incisors relative to the mandibular in-
cisors has been shown to have importance for esthetics and
phonetics.9
The potential need for alveoloplasty of the premaxilla may
make the proper prediction of the A-P tooth position challeng-
ing, as the laboratory alveolar reduction on the stone model may
be arbitrary.10 Sadowsky et al reported a technique for correc-
tion of improper A-P position of the anterior teeth by detaching
the anterior segment from an ICD and a rebase procedure to
correct an incisal edge discrepancy.11 Inversely, if the anterior
plane is acceptable but the posterior is not, detaching the poste-
rior segment from the ICD and rebasing could possibly correct
such a predicament; however, when the entire complete arch
tooth setup is in an inappropriate A-P tooth position, an alter-
native approach may be necessary. The purpose of this paper is
to present a chairside and laboratory technique to resolve inap-
propriate A-P and horizontal tooth position of a maxillary ICD
delivering the definitive prosthesis on the same day of surgery
fulfilling the patient’s expectations.

Journal of Prosthodontics 00 (2017) 1–5 

C 2017 by the American College of Prosthodontists 1
Immediate Complete Denture Correction
Figure 1 Primary closure of extraction wounds.
Figure 2 Immediate postsurgical delivery of ICD at rest position.
Figure 3 Postsurgical ICD with inappropriate A-P tooth position and
OVD.
Technique
Scenario: Ill-fitting ICD
Following the surgical procedure, the maxillary arch was eden-
tulated with severe anatomical irregularity following socket
preservation procedure and an unexpected complication of an
2 Journal of Prosthodontics 00 (2017) 1–5 
Bedrossian et al
Figure 4 Horseshoe denture base and teeth.
Figure 5 Border molding with Wagner Tray.
Figure 6 Horseshoe tooth setup attached to acrylic base with utility
wax.
oral-antral communication, closed with the buccal fat pad at
the upper right tuberosity region (Fig 1). The prefabricated
ICD could not be seated completely owing to the lack of ade-
quate sulcus depth and severe tissue undercut, resulting in an
inappropriate overjet of anterior teeth and A-P tooth position
(Figs 2 and 3).
C 2017 by the American College of Prosthodontists
Bedrossian et al
Figure 7 Intraoral verification of correct A-P tooth position and OVD.
Figure 8 Articulated master cast with correct A-P tooth position and
OVD.
Figure 9 New maxillary complete denture with correct A-P tooth posi-
tion.
1. Initial correction: After conducting a chairside clinical
remount, remove the overextended flange and palate,
leaving only a horseshoe-shaped denture base and origi-
nal tooth setup (Fig 4).
2. Border molding and final impression: Place a thermo-
plastic tray (Wagner Thermoplastic Tray, Bigjawbone
Journal of Prosthodontics 00 (2017) 1–5 
C 2017 by the American College of Prosthodontists
Immediate Complete Denture Correction
Figure 10 Intaglio surface of new maxillary prosthesis.
Figure 11 Rest position of new maxillary complete denture.
Figure 12 Smile of new maxillary prosthesis with correct A-P tooth
position and OVD.
LLC, Albuquerque, NM) in water (70°C) and let sit
for 1 minute. Once the material feels like a “well-
tempered compound,” perform border molding and form
a custom tray (Fig 5).12 Make a final impression us-
ing regular body poly(vinyl siloxane) material (Aquasil
Ultra Monophase; Dentsply Intl, Milford, DE), pour a
3
Immediate Complete Denture Correction
master cast (Dentstone Golden; Heraeus, Cologne, Ger-
many), and fabricate an acrylic denture base (Ortho
Resin; Lang Dental, Wheeling, IL) using the sprinkle-on
technique.13
3. Correcting procedures: Place the maxillary tooth setup
intraorally in the appropriate overjet and A-P tooth po-
sition, opposing the existing mandibular fixed implant-
supported complete dental prosthesis, and attach the teeth
to the acrylic base using utility wax (White wax ropes
square; Coltene/Whaledent Inc. Cuyahoga Falls, OH)
(Fig 6). Verify OVD, esthetics, phonetics, and function
of the newly positioned tooth setup (Fig 7). If the patient
maintains an increased OVD, either reduce the registra-
tion base thickness or reduce the intaglio of the horseshoe
tooth setup until the desired OVD is achieved.
4. Verification of correcting results: Transfer corrected
tooth setup to the articulator and secure the final ver-
tical and A-P tooth position onto the acrylic base us-
ing sticky wax (Sticky wax; Kerr Dental, Orange, CA)
(Fig 8). Complete full-contour wax-up for processing.
5. Processing the corrected denture: Use the compres-
sion molding technique to process the acrylic denture
base material (Lucitone 199; Dentsply Intl) at 74°C for
2 hours and increase the temperature of the water bath
to 100°C to continuously process for 1 hour (Figs 9
and 10).14
6. Deliver and evaluate the adjusted prosthesis: Evaluate
esthetics and phonetic function intraorally (Figs 11 and
12).
Discussion
Being edentulous can be a debilitating experience for patients.
Having an interim prosthesis enables them to restore self-
confidence and avoid social settings in the edentulous state.
When the inability to deliver an immediate prosthesis on the
day of surgery is not an option, there is need for a technique
to provide a more esthetic and functioning transitional pros-
thesis. Careful tooth extraction is imperative to maintain the
integrity of the labial and palatal bony plates, unless a decision
is made for pre-prosthetic surgical intervention. Retention of
an ICD is often dependent on the accuracy of the impression
and the surgical management that mimics cast surgery. When
the surgical intervention does not match the “cast surgery,”
this may result in changes in the OVD and A-P tooth position.
Hard relines or rebases are traditional treatment rationales to
“service” complete dentures to keep pace with their changing
environment: loss of OVD and/or wear of the prosthetic teeth.15
However, in the patient treated here, due to lack of premaxillary
alveoloplasty resulting in an excessive OVD and inappropriate
A-P position of the entire complete tooth arch, such prosthetic
post-insertion management would not adequately resolve the
complications.
The current technique provides easy, sequential steps to re-
solve excessive OVD and A-P tooth discrepancy of an ICD.
The use of the Wagner thermoplastic tray allows quick fab-
rication of a custom tray, in order to adequately capture the
proper extensions and ridge anatomy of the newly edentulated
ridge morphology. The removal of the flange and palate leaving
4 Journal of Prosthodontics 00 (2017) 1–5 
Bedrossian et al
the horseshoe tooth setup preserves the denture tooth position,
while allowing for the ease of manipulation and re-orientation
to the appropriate A-P and vertical position. If an increased
OVD remains, the intaglio of the horseshoe can be further re-
lieved, or a window in the registration base can be made to
facilitate tooth placement in the ideal relation to the ridge. This
step is the most coveted step in this technique, as it allows
for the desired wax denture try-in, providing the information
necessary for both the patient and clinician to evaluate and fi-
nalize the proper esthetics, phonetics, and function of the newly
arranged tooth setup. Finally, sending the newly oriented reg-
istration base and tooth setup to a nearby laboratory allows for
a short processing protocol for same day delivery of the tran-
sitional prosthesis. One drawback for this service would be the
necessity for accessibility to a nearby laboratory. The authors’
best assessment of an alternative approach would be the use of
repair resin or dual-cure denture resin using a remount/reline jig
to fabricate a new prosthesis chairside; however, the outcome of
this material modification is uncertain. Another disadvantage
would be the prolonged chairside time during the delivery ap-
pointment; however, allowing the patient to leave the operatory
with a well-fitting and esthetic prosthesis on the same day may
outweigh the extended delivery time.
Conclusions
This article proposes a new chairside technique with intensive
procedures to correct an ill-fitting interim denture immediately.
This technique allows for ease of correcting the A-P tooth
discrepancy into a more ideal position, thereby allowing for
delivery of a prosthesis on the same day of surgery to fulfill the
patient’s expectation.
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