INTRO USE OF THE CD MANUAL REMOVABLE PROS DEPT POLICIES NEW COMPLETE DENTURE PATIENTS SCHEDULING SEQUENCING

1st Homework Assignment

Appt. One Interview & Exam

Appt. Two
Master Impressions

Appt. 3
Inter-occlusal records

Appt. 4 Wax Tryin

Appt. 5
Placement

Appointment One
Interview and Examination TO Treat Or Not to Treat??? Preliminary Impressions

 Interview
Personal Information History (Medical and Dental) Prosthodontic History

Personal Information
Age Sex

Occupation
General Health Edentulous History

History (Medical and Dental)

Neuromuscular Control Medications Health Risks

Prosthodontic Assessment
Interview patient Assess existing prosthesis Assess physical condition Assess Prosthodontic Outcomes

INTRA ORAL ASSESSMENT

INTRA ORAL ASSESSMENT

LIP MOBILITY & LENGTH
Gingival Exposure

Denture Base Contour

INTRA ORAL ASSESSMENT

FACIAL MUSCLE TONE
ESTHETICS

SUPPORT

INTRA ORAL ASSESSMENT

SIZE OF JAW
RESIDUAL RIDGE FORM

INTRA ORAL ASSESSMENT

Class I Class II

RESIDUAL RIDGE RELATIONSHIP INTER ARCH SPACE

Class III

INTRA ORAL ASSESSMENT

PSEUDO CLASS III

ALVEOLAR RIDGE CONTOUR

The rate of resorption in the mandible is much higher (4X) than in the maxilla Maxillary arch

Mandibular arch *Talgren, 1964

Annual Bone Loss: 0.1 mm Maxilla 0.4 mm Mandible

PRIMARY SUPPORT

ALVEOLAR RIDGE CONTOUR

RETROMOLAR PAD One constant, relatively unchanging structure on the mandibular denture bearing surface is the retromolar pad (dotted line).

The pad contains glandular tissue, loose areolar connective tissue,the lower margin of the pterygomandibular raphe, fibers of the buccinator, and superior constrictor and fibers of the temporal tendon. The bone beneath does not resorb secondary to the pressure associated with denture use. It is one of the primary support areas.

ALVEOLAR RIDGE CONTOUR

BUCCAL SHELF

The external oblique line and the crest of the alveolar ridge form the boundaries of the buccal shelf (area within the dotted lines).
Masseter groove area

Buccinator limits the extension in this area

The buccal shelf is a primary support area because it is parallel to the occlusal plane and is relatively resistant to resorption due to the dense cortical nature of the bone.

INTRA ORAL ASSESSMENT

PALATAL FORM

INTRA ORAL ASSESSMENT

POST PALATAL SEAL AREA

Glandular tissue

INTRA ORAL ASSESSMENT

POST PALATAL SEAL AREA

THROAT FORM

INTRA ORAL ASSESSMENT

TORI
MAXILLARY MANDIBLE

INTRA ORAL ASSESSMENT

GAG REFLEX
PHYSIOLOGIC PSYCHOLOGIC

INTRA ORAL ASSESSMENT

BORDER TISSUE ATTACHMENTS

INTRA ORAL ASSESSMENT

SOFT TISSUES
KERATINIZED PAPILLARY HYPERPLASIA

INTRA ORAL ASSESSMENT

TONGUE SIZE AND POSITION

INTRA ORAL ASSESSMENT

FLOOR OF THE MOUTH

NEILS LATERAL THROAT FORM

INTRA ORAL ASSESSMENT

SALIVA
Consequences of low salivary flow rates Difficult to achieve and maintain peripheral seal of the maxillary denture Compromised adhesion and cohesion SALIVA AS A LUBRICANT - low flow rates Primarily affects the mandibular denture bearing surfaces. Results in more friction at the mucosa-denture interface as the mandibular denture slips and slides over the denture bearing surface during function.

PATIENT ASSESSMENT

HOUSE PSYCHOLOGICAL CLASSIFICATION

EXACTING

HYSTERICAL

INDIFFERENT

PHILOSOPHICAL

DENTURE ASSESSMENT

Assessment of existing dentures

Retention Stability Vertical dimension of occlusion Centric relation Esthetics

DENTURE ASSESSMENT

Posterior teeth
Tooth forms Materials Wear

DENTURE ASSESSMENT

Testing maxillary denture retention

DENTURE ASSESSMENT

Testing maxillary denture stability

PROGNOSIS

PROGNOSIS BASED UPON: INTRA ORAL ASSESSMENT NEUROMUSCULAR CONTROL HISTORY PSYCHOLOGICAL CLASSIFICATION

Impression Tray Selection

Preliminary Mandibular Impressio

Retromolar pads Buccal shelf areas External oblique lines Residual ridge Frenal attachments Retromylohyoid space Sublingual spaces Labial and buccal vestibu

Preliminary Maxillary Impression

Frenal attachments Entire buccal vestibule Residual ridge Palate Fovea palatini and vibrating line Tuberosities Hamular notches

Preliminary Casts

A single pour is acceptable Pour the preliminary impressions in plaster Support the impression by the handle while forming the base

Custom Trays For Edentulous Impressions

Custom tray extensions

Trays tend to be overextended(too long) when made on casts from preliminary impressions The first step is to determine, as closely as possible, th exact dimensions for custom trays. Trays that are too short or too long cause timeconsuming correction and inaccurate impressions The goal is to make a tray that is 2-3mm short of the patients buccal and lingual soft tissue reflections and that is close to the exact extensions desired

Outline Tray on Preliminary Casts

Extensions: Buccally extend to mucogingival junction, leaving room over frenum attachments Extend to hamular notch Extend posterior to Fovea Palatini

Outline Tray on Preliminary Casts

Extensions:
Buccally extend to mucogingival junction, leaving room over frenum attachments Extend to cover entire retromolar pad Extend lingual to depth of vestibule

Block out undercuts on preliminary casts

Use Triad Custom Tray Material

The soft VLC tray material is adapted to the cast with light finger pressure. Excessive pressure will cause thin areas in the tray

 A knife may be used to trim the VLC material around the borders of the cast. Hold the knife at right angles to the cast so as not to thin the peripheries of the tray. Cut the tray material to the blue tray outline. Be sure the material is adapted to the cast around the borders after trimming.

TRAY HANDLE

Angled at same degree of slope as the maxillary centrals

The excess material is formed into a handle of the desired shape. The handle must be placed so that it will not interfere with any movements of the patients lips during the impression procedure. The handle should be shaped so that it is easy to hold.

The mandibular custom trays are formed in a similar manner

The tray is trimmed to the outline using a lathe or acrylic bur

The surface and borders of the tray must be smooth . Be careful to hold the bur at right angles in order to maintain the edge thickness of the VLC tray material

Grading Criteria
The tray outlines follow the anatomic extensions of the patients denture-bearing area. The tray outlines are clear and neat and the two lines are properly related to each other. The complete impression trays are clean, neat, and smooth, but not polished The trays are extended to the proper length and follow the red line closely. The frena attachments are properly relieved.

Grading Criteria Continued

The edges of the trays are blunt and smooth, not thin, sharp, or burred. The trays are uniform in thickness: 2mm for the maxillary tray and for the flanges of the mandibular tray The handles should be shaped so as to avoid interference with the lips. The handles should be firmly attached to the trays, smooth, but easy to grip.