Complete denture

Anatomical landmarks
1. Extraoral landmarks & facial appearance of 3. Limiting ( border) structures ( maxilla &
edentulous pt. mandible)
2. Intraoral landmarks ( maxilla & mandible) 4. Stress bearing areas ( maxilla & mandible)
5. Relief areas ( maxilla & mandible)

 Intraoral landmarks ( Maxilla )

1- Rugae(hor. part of palate) responsible for lingual palatal sound “S”
2- Residual ridge Covered by dense fibrous C.T that is favorable as supporting structure.
3- Palatine vault Formed anteriorly by hard palate & posteriorly by soft palate.
It may be high ( V shaped) , shallow (flat), U shaped
4- Max. tuberosity Denture should cover it to improve support &retention
5- Hamular or pterygo A depression distal to max. tuberosity.
maxillary notch Posterior palatal seal should extend through hamular notch.
6- Median palatine raphae Covers median palatine suture.
Raised area of mucous membrane
It should be relieved to avoid rocking & midline fracture.
7- Incisive papillae Pear shaped Covering incisive f. where nasopalatine n pass.
After extraction ,it migrates on crest of the ridge .
It should be relieved to avoid burning sensation.
8- Torus palatinus If small , should be relieved
If large , should be surgically removed
9- Fovea palatina Posterior border of the denture should be extended 2 mm posterior to it.

(Mandible )
1- Buccal shelf of bone Primary stress bearing area Formed of compact bone
2- Mental foramen Should be relieved to avoid numbness
3- Retromolar pad Shock absorbent , bearing area. It must be covered by denture base.
- Occlusal plane of mand. teeth should not be >1/2 of its level.
4- Torus mandibu. small  relieved large,  surgically removed.
5- Genial tubercles - Attachments of geniohyoid & genioglossus ms.
(mental spines)
6- Tongue - Teeth have to be set on the crest of the ridge with occlusal plane lower
than its highest convexity to reflect loads on occlusal surface.
7- External oblique - A ridge of dense bone extends just above the mental f superiorly &
ridge distally the continues with anterior border of ramus of mandible.
- Lower denture should cover but not extend beyond it .
8- Internal oblique - Gives attachment to mylohyoid ms (floor of the mouth)
ridge - After extraction of teeth, mylohyoid ridge lie close to crest of ridge.
(mylohyoid ridge) - It should be included in denture bearing area.
- If sharp , should be relieved or surgically removed.

Extraoral landmarks
1- Interpupillary line Orientation of occlusal plane of upper denture ( // to upper. Anterior teeth
2- Ala-tragus line Orientation of posterior occlusal plane //posterior teeth are paralleled to
(Camper plane)
3- Canthus tragus Arbitrary location of condyle

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 4- Nasolabial sulcus Became deeper by aging, can be restored by proper VDO , proper labial
contouring, proper positioning of teeth.
5- Mentolabial Determine maxillo-mandibular relationship (Angle`s I ,II,III)
sulcus
6- Philtrum Distorted by loss of teeth & alveolar bone resorption, restored by proper
arrangement of teeth & proper flange contouring.
7- Angle of mouth Angular cheilitis , due to prolonged edentulism & pt with lower VDO.,
(commissures) resolved by proper vertical dimension of occlusion.
8- Modiolus After loss of teeth & alveolar bone resorption , modiolus drops inwards
which gives the characteristic appearance of edentulous pt.

Limiting structures of maxillary & mandibular dentures

Maxillary denture Mandibular denture
1- Labial frenum 1- Labial frenum
2- Labial vestibule 2- Labial vestibule ( orbicularis oris ms )
( orbicularis oris ms) 3- Buccal frenum
3- Buccal frenum 4- Buccal vestibule (buccinator ms)
4- Buccal vestibule ( buccinator 5- masseter influencing area (distobuccal corner of mandible )
ms) 6- palatoglossal arch (palatoglossus ms) distolingual of mand.
5- Hamular notch Over extension of the denture cause sorethroat.
6- Posterior vibrating line( AHH 7- mylohyoid influencing area : lingual flange of lower denture
line) should be extended to mucolingual sulcus & determined by
Imaginary line separating immovable & functional movement of mylohyoid ms.
movable part of soft palate , denture 8- Lingual frenum (genioglossus ms)
should extend just anterior to it.
Stress bearing areas Maxilla Mandible
1ry stress bearing 1- Flat areas of hard palate. 1- Buccal shelf area
areas 2- Max. tuberosity 2- Crest of ridge
(resist vertical 3- Crest of ridge
forces)
2ry stress bearing 1- Rugae area. 1- All ridge slopes
areas 2- Buccal & labial surfaces of
(resist horizontal ridge.
forces) 3- Lateral slopes of palate

Relief areas
Maxilla Mandible
1- Incisive papilla 4- Fovea palatina 1- Mylohyoid ridge 4- Torus mandibularis
2- Median palat. raphe 5- Sharp bony prominences 2- Mental foramen 5- Flabby ridge
3- Torus palatinus (canine eminence) 3- Genial tubercles 6- Sharp bony spicules

Steps of CD constrcuitn
Clinical  Laboratory
1. Examination and diagnosis
2. 1ry impression Study cast Special cast
3. Final impression Boxing and pouring  mas6ter cast and occlusal blocks
4. Jaw relation registration Mounting on articulator  setting of artificial teeth and waxing up
Selection of artificial teeth
5. Try in processing
6. Insertion
7. Post insertion care

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 Impression taking
 Primary impression in stock tray is taken using :
1. Alginate 2. Elastomers 3.Impression compound in case of flat ridge
 Spacer of different impression materials used for 2ry impression in special tray :
1. ZnOE → 0.5mm 2. Elastomers → 0.5 -1.5 mm 3.Alginate → 3 mm
Special (custom tray) should 2 mm short at borders to provide space for the material to mold.
2ry impression techniques:
Mucostatic Mucocompressive Selective pressure impression
Record imp. at rest Record imp. At function Applying manual pressure at areas
Impression Compound needed to Gloss
Matt or be recorded at function
Appearance
Perforated tray with spacer after border
Nonperforated tray without spacer moulding?Which
selectively relieved “window”itTray
appearance should
Materials used: be ?
Viscous impression Intermediate impression materials
1. Flowy mix of alginate materials are used:
2. Light rubber base 1. ZnOE
3. Plaster of paris (historical/not used) 2. elastomers
Stable at rest Stable at function BOTH
Normal ridge Flat ridge Different ridge types or bony spicules
Eg: flabby ridge in anterior area of upper maxilla
 Special techniques:
1. Neutral zone impression technique :
- used for recording 2ry impression & occlusion for pt with limited natural retention .
- records 2ry impression & occlusion after jaw relation.
- Pt do functional border molding by saying (oooh , eee) & swallow.

2. Functional impression technique :

- Used for old dentures with inflamed tissues
- Done by using tissue conditioning material where material is left in pt mouth for 1 hr then casting.
Common impression errors
1. During impression 1) Impression taking for inflamed tissue
taking 2) Improper tray selection or construction:
 Overextended tray →
 tray borders show through impression→ underextended imp. → repeat imp
 Underextended tray → feather edge → corrected by adding green stick to
the tray → imp. Should be repeated
2. Air bubbles  If small:  filled with soft wax .If large: remake
3. Tray not cantered
4. Handle position Dislodged handle
5. Retching / gagging  over flowy mix of material  improper position of the pt.
6. Dry mouth Avoid use of ZoE
7. Improper relief result in pressure areas & soreness

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  Materials used in border molding :
1- Green stick compound
2- Wax (awa wax , correcta )
3- Elastomers

Check:

Consistency of material-Air bubbles-Extension of tray-Area of tray not covered

 Why do we use spacer ?

1- For minimum hydraulic pressure
2- To provide room for impression material
Matt…complete setting-completely touches the tissues

Auxillary handles (posterior stub handles):

Used for stabilization of lower tray only . they are always found on 2 nd PM & 1st M areas.

Alginate syringe technique :

1- Used for areas that can’t be recorded properly

 Retromylohyoid area(between premolar and molar area at lingual sulcus)
 Hamular notch
 Retrozygomal area( near upper 6)
2- Selective impression technique

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 Jaw relation records

Curve of Spee  arch-shaped progression in sagittal direction (sagittal occlusion or compensation

(sagittal curve).
compensatio  The imagined centre of the circle is situated in the orbit. The radius is approx. 7 cm,
n curve) and under ideal conditions touches the anterior surface of the condyle.

 This system is used in complete denture prosthetics under the assumption that:
1. The condyle is situated on the same circular path as the posteriors,
2. The posteriors remain in constant contact during protrusive movement.
Curve of Wilson  a line connecting the cusps of the lower posteriors in the transversal direct.
(transversal  Its progression is determined by the fact that the lingual cusps are situated at
compensation curve) a lower height than the buccal cusps.
Curve of  based on the curve of Spee in the sagittal direction and the curve of Wilson in the
Monson transversal direction.
 This gives rise to a 3-dimensional spherical curvature (sphere of Monson), a
spherical surface on which the posterior teeth are arranged.

Vertical relationship
Vertical at rest(VDR) Vertical relation of the lower 1/3 of face ,between two points (chin &
diesmiuo nose) ,when ms are in state of rest & equilibrium between elevators &
n depressors.
occlusion VDO = VDR – 2mm (freeway space)
(VDO)
Freeway space Space between wax rims in physiological rest position
hortizontal
Centric It is repeatable relation between mandible & maxilla when mand. is in the most retruded
relation unstrained position in relation to maxilla.(bone to bone relation)
Centric It is non repeatable teeth to teeth relation (cusp to fossa), that is not always coinciding with
occlusion centric relation . recorded during complete denture construction.
Centric occlusion relation When both relations are coinciding.
Eccentric protrusive it is the relation resulting from protrusion of mand. & can be recorded
relation
Eccentric lateral relation The relation between maxilla & mandible in a position to the left or right of
the midsagittal plane & can be recorded.

1.Checking trial denture base for proper extension , retention & stability.
2.Adjustment of upper occlusal block , done by fox bite plane.
•Lip support
•Occlusal plane , should be :
 // to inter pupillary line anteriorly
 // to ala tragus line posteriorly
 1-2 mm should be visible from pt lip at rest.
3.Adjustment of lower occlusal block

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 •Below level of retromolar pad
•At rest ,tongue should rise just above lower occlusal plane posteriorly
• There must be 1-2 mm horizontal overjet between upper & lower blocks.
4.Establishing vertical dimension of occlusion
•By getting VDR when pt is ion upright position.
•VDR -FWS = VDO
 Vertical dimension can be assessed by :
1. Willis bite gauge
2. Spring dividers / calipers → contraindicated in beared men.
3. Closing speaking space method (phonetics)..swallowing/M( less accurate method)
5.Face bow transfere
A caliper-like instrument used to record the spatial relationship of the maxillary arch to the rotational
hinge axis and then transfer this relationship to an articulator.
 What are the two types of facebows?

Kinematic Arbitrary
• Terminal hinge axis • A hinge axis by using anatomical landmarks
• Used with a fully adjustable articulator • Used with semi-adjustable articulators
• Facial-bow
• Ear-bow

 Articulators:
A mechanical device to which mandibular and maxillary casts are attached
 Uses :
1. Diagnostic mounting (in CR or CO)
2. Treatment planning
3. Discussion of case with patient
4. Fabricating prosthesis
5. simulates some jaw positions and movements

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 Types
Simple/hinge/non-adjustable Semi-adjustable Fully adjustable

• Most basic articulator • Replicates some but not • Most sophisticated

• Single crowns all of the patient’s instrument for replicating
fabrication movements mandibular movement
• No adjustments possible • Accepts a facebow • Very closely resembles
• Does not accept a • Can be programmed patient’s movements
facebow • Usually an arbitrary • Most accurate articulator
• Inexpensive facebow transfer. available
• Simple to use (no • Opening and closing • Beginning, end, and in-
programming) pathways closely between pathways of all
• No ability to reproduce resemble those of the movements
mandibular movements patient.
accurately

Common jaw relation faults & problems :

A. Inaccuracy caused by poorly fitting bases
B. Rims are contacting prematurely posteriorly & flipping up anteriorly or vice
versa.
C. Failure to provide adequate freeway space FWS.
D. Attempting to correct too much when replacing old worn dentures & exceeding
the adaptive capacity of the pt .

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 Try -in
Check base extension This is done visually where possible, checking the relationship between the
denture border, sulcus depth and soft tissue mobility at rest and under
tension.
posterior border Identify the vibrating area by observing the soft tissue moving when the
extend back to the patient says ‘Ahhh’ and/or apply pressure
vibrating area with a blunt instrument such as a ball-ended burnisher to define the extent of
displaceable tissue.
denture retentive Check by pulling down on the upper denture in the premolar region.
Check retention of the by trying to displace the denture with forward pressure behind the anterior
post dam teeth.
there close adaptation Is Look at the fit surface and check for voids between tissue and denture with a
of the denture base to disclosing material such as a low viscosity silicone.
the mucosa?
Make an assessment of Measure the facial height at rest and with the denture in occlusion. Subtract to
the occlusal vertical identify the freeway space.
dimension and
patient’s
rest vertical dimension
Check the occlusion Check whether the denture meets the natural teeth correctly in retruded
correctly in the position. Are there any premature contacts?
retruded position
Assess in particular
whether the denture is
stable on lateral
excursive movements.
Appearance Check Carefully question the patient as to whether they are satisfied with the
tooth shade denture

 Common try in faults & problems :

A. Overextension of flanges , reduce
B. Underextension pof flanges , try a temporary wax addition to flange first to check effect of extending
it . if satisfactory a new impression is required.
C. Teeth are out side neutral zone . Remove offending teeth & replace with wax.
D. Incorrect OVD . if decreased → add wax to the occlusal surface of teeth .
If increased → replace lower teeth with wax & re-record OVD.

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 • Howdiscrepancy
E. Occlusal large shouldwith
theanterior
freewayopen
spacebite
be?or posterior open bite, replace all lower posterior teeth &
re-record OVD.
 This depends on the patient. The average freeway space is 2–4 mm measured in the premolar region, and
F. Too little of upper anterior teeth are visible , reset anterior teeth.
dentures may be constructed to this dimension for most patients.
G. Too much of upper anterior teeth are visible , reduce length of incisors or reset anterior teeth.
 Inadequate
H. lip support
However,there are some, add wax to labial
circumstances aspectthis
in which of upper try in.
clearance needs to be increased. Some patients
become habituated to an increased freeway space, either because of worn artificial teeth or because of
faulty denture construction.
 In some cases the freeway space may exceed a centimetre and it would be unreasonable to expect such
patients to accommodate rapidly to the normal freeway space. Provided the increased freeway space is
not associated with any problems a compromise increased freeway space is appropriate.

Denture delivery
1- Adjustment of fitting surfaces & smoothening of any roughness
2- Check occlusion
3- patient instructions (verbal and written)

 Denture instructions
 When you start wearing dentures, during initial days you may feel that the
dentures are bit loose. Slowly you will learn to keep them in place with the
help of your cheek and tongue muscles. You may find that the dentures are
loose when you laugh, or cough or even smile. To reposition them, close your
teeth gently and swallow.
 During the initial few days you may also feel that dentures are bulky, your
tongue feels cramped or experience slight gagging sensation and your mouth
may feel sore. After few weeks, oral tissues get adjusted to wearing dentures,
these problems should decrease. Contact me if you continue to experience
irritation and soreness in any area.
 Wearing denture can make pronunciation of some words difficult. To help
overcome this, practice reading aloud. If denture teeth click together when
you talk, speak slowly. Bring any problems of speech to my notice.
 During initial days it is best to eat soft food. Cut your food into small pieces
and chew on both sides with your back teeth to keep your dentures from
tipping. After a few days when you feel comfortable you should be able to eat
normal diet.
 When you first wear dentures, your facial expression may seem different. A
normal expression will return when the muscles of cheek and lips adapt to the
denture.
 Every day before insertion of your denture brush your tongue, gums and
palate with a soft bristled brush.
 Clean the plaque and food deposits from your dentures daily. Dentures can
be cleaned using a mild soap or commercially available denture cleanser
using a soft brush.
 Take out your denture before bed at night and place them in a container of
denture cleanser or water. Never put dentures in hot water they can warp.
i. If your dentures break, crack or if denture tooth becomes loose, call the dental
office. Try to preserve broken pieces and bring it back to the dental office for
repair.

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 Review : the pt should be seen 1-2 weeks
 If pain is experienced the patient should try to
after fitting to ease the denture , adjust
continue wearing their dentures and return for
occlusion & localize any cause of irritation .
adjustment as soon as possible so that affected - Pressure relief cream painted onto
areas can easily be seen. If this is not possible they fitting surface of denture.
should stop wearing - Inedible pencil or denture fixative
the dentures until 24h prior to the next visit. powder mixed with ZnO . applied to
 Although patients should be encouraged not to wear pressure area & the denture is inserted.
their dentures at On removal the mark will have been
night, adaptation may be speeded up if they are worn transferred to the adjacent mucosa.
full-time for the first 1–2 weeks. - If there is no obvious cause of
 When the dentures are not being worn they should be irritation ,excessive OVD is expected as
stored in water to prevent them drying out and it cause generalized soreness under
lower denture
warping. plastic denture boxes are cheap, and safer
than a glass of water at the bedside.
 Cleaning , hypochlorite solution without hot water
for acrylic dentures , alkaline peroxide for metallic
denture Denture maintenance
Problems caused by lack of aftercare of
complete denture
1. Resorption
2. Predisposition to candida
infection
3. Denture irritation hyperplasia
4. Inflammatory papillary
hyperplasia of palate.
All of these are exacerbated by wear of
occlusal surfaces
 Rebasing : replacement of most or all of
denture base.
 Relining : replacement of the fitting surface.

 Indication for rebasing :  Indication for soft relining :

1. Discolored denture base. 1. Older pt with atrophic mucosa
2. Resistant fungal infection 2. After preprosthetic surgery
3. Porosity in denture base 3. Get use of soft tissue undercuts to
4. Improper gingival shade increase retention following
hemimaxillectomy or clefts.

No material is ideal & soft

 Materials used for relining :
 Soft relining by resin & silicone lining is best avoided
 Hard relining by resin only
Denture repair
 Causes of fracture :
1. Unrelieved torus
2. Overrelieved torus .
3. Deranged occlusion
4. Accidentally drop
5. Parafunctional habits.
 Management :
1- As a prophylaxis to avoid fracture , a combined denture base can be used
( metallic + acrylic ) .It is more hygienic & better tolerated but heavier & less retentive.

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 2- If already fractured , impression for the pt without denture → pour casts → reassembly the broken
fragments → dovetails & bevels for better adhesion → sticky wax & matches → go to lab → packing
with new resin for short acrylic cycle (30 min. only to avoid damage to old acrylic)

Tissue conditioners
 Definition :
They are resilient materials which gives a more even distribution of loading & thus promote tissue recovery
 Indications :
 Atrophic ridges
 To utilize soft tissue undercuts to↑ retention
 Used when ill fitting dentures cause trauma .
 Allow tissue to recover before impressions for replacement dentures or a rebase are taken.
 Used for preprosthetic surgeries
 Clinical tips :
- Relieve any pressure areas & reduce overextensions.
- Minimum thickness of soft liner 2 mm is required .
- Soft liner material should not be left more than 1 week.
- Repeated application may be necessary.
- Materials used : GC reline , permasoft
- No material is ideal & soft linings are best avoided.

Retention & stability of complete denture

Factors affecting retention of complete denture :

A. Physical
B. Mechanical
C. Anatomical

A. Physical
1. Adhesion (saliva + mm & fitting surface))
2. Cohesion (saliva it self)
3. Interfacial surface tension ( thin film of saliva)
4. Capillary attraction ( well adapted denture )
5. Atmospheric pressure ( to be effective the denture must have well fitting base , wide area ,
peripheral seal buccally & labially , posterior palatal seal , very thin film of saliva)
B. Mechanical
1. Shape of polished surface.
2. Wide coverage
3. Teeth in neutral zone
4. Engagement of undercuts

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 5. Denture borders.
C. Anatomical
1. Ridge form (high , no undercuts , flat crest →↑ retention )
2. Vault form (u shaped →↑ retention)
3. Arch form ( square arch →↑ retention)
4. Arch relationship ( CII is the worst )
5. Interarch distance ( decreased distance → ↑ retention & stability)
6. Tongue ( large tongue → ↑ retention)
7. Mucosa ( firm , compressible , even thickness →↑ retention)
8. Saliva ( thin →↑ retention)
Retentive aids
Denture adhesives Suction chamber Rubber suction disc Springs Magnets
(sucker)

- Unpleasant feel The mucous membrane - Unhygienic

- Temporary in this area will - May cause
disadvantages

- Less effective proliferate & fill the pathological

for lower chamber. conditions like
denture perforation of
- Prolonged use the palate or
cause malignancy.
constipation

 Factors affecting stability of complete denture:

1- Retention ( retentive denture →↑stability)
2- Balanced occlusion
3- Occlusal plane ( higher occ. Plane → ↑ stability )
4- Position of posterior teeth ( directly over crest of ridge)
5- Proper relief of hard areas
6- Ridge form ( high well developed →↑ stability)
7- Shape of the vault ( high vault →↑ stability)
8- Width of occlusal table ( wide base + narrow teeth →↑ stability)
9- Parallism of the ridge ( ↑ stability)
10- Form of the polished surfaces ( concavity of polished surface adapt convexity of buccinator ms →↑
stability)
11- Denture base material ( metal base →↑ stability)
12- Occlusal plate ( short occ plate →↑ stability)
13- Residual ridge relationship ( class II is the worst)
14- Neuromuscular control “ physiological factor “ control of action of tongue , lips , cheek by the pt
Denture complaints

1-Pain 2-Looseness

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On a single Denture faults: Patient factors :
tooth - No peripheral seal - ↓ volume of saliva
- Excessive Other causes - Teeth out of neutral - Poor ridge form
load / - Roughness of fitting zone - ↓ adaptive capacity
traumatic surface - Unbalanced with old age
occlusion - Errors of occlusion articulation
- ↓ stability - Lack of freeway space
- Tight clasp - Bruxism - Unsatisfactory
- ↓ lining - Remaining roots polished surface
below - Other pathology
amalgam → - Premature contact
Galvanic - Exposed mental f. →
shoch with localized pain
metal
denture.

3-Burning mouth 4-Speech defects

 Local causes :  Systemic causes :  Difficulty with (F_V) → incisors are too far
- ↑ OVD - menopause palatally
- Sensetivity to - cancerphobia  Difficulty with ( D,S,T) → alteration of palatal
acrylic monomer - deficiency status contour or incorrect overjet & overbite.
- Irritant mouth wash xerostomia  S becomes Th → incisors too far palatally or too
- Candidiasis thick palate
 Whistling → palatal vault is too high behind
incisors
Clicking teeth → OVD or lack of retention.

5-Cheek biting 8-Recurrent fracture

6-Retching/gagging reflex
1. Teeth out of neutral zone - It is mainly due to ↑↑ palatal
2. ↓ OVD extension
3. ↓ buccal surface of lower - It can be treated by :
molars (abnormal buco-lingual 1. Dentures without palatal coverage.
relationship) 2. Training dentures.
3. Hypnosis.
4. Implants.
7-Grossly resorbed ridges
Mainly lower ridge > upper ridge, can be  Causes:
treated by : 1.Careless pt.
1. ↓ forces over lower ridge ( get 2.Fatigue of acrylic
maximum extension , ↓ number & 3.Flexing of the denture due to bone resorption ,or
width of teeth , ↑ freeway space , flabby ridge ,or palatal tori ,or no relief over stress
lowering occlusal plane ) bearing areas.
2. Neutral zone impression technique

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 3. Surgery
4. Implants

10- Candida infection

 Two types of candida are associated with denture wearers :
 Denture stomatitis
 Angular chelitis
Denture stomatitis = chronic atrophic candidosis
 Definition ; it is symptomless condition seen as redness of the palate under upper complete
denture , with petechial & whitish areas.
 Incidence :
F>M ( 90% due to candida albicans)
30-60% of upper & lower complete denture wearers ,,
Usually affects upper denture bearing area only.
 Aetiology :
1. Infection with candida
2. Poor denture hygiene
3. Night –time wear of dentures
4. Trauma
5. High sugar intake
6. Systemic causes of candidiosis ( iron & vitamin deficiency anaemia ,steroids ,drugs causing
xerostomia ,endocrine abnormalities)
 Management :
- Dentures should be removed during night.
- Cleansing dentures ( sink–brush-sink ‘SBS’).
- New dentures may be required if old dentures are a reservoir for candida.
- Reduce sugar intake.
- Miconazole gel can be added to the fitting surface of the denture before insertion.
- Refer to general medical practitioner for underlying systemic diseases.
- Coexisting papillary hyperplasia of the palate may require surgical excision.
- Systemic fluconazole may be required.

 Metallic denture should be soaked in chlorohexidine solution

 Acrylic denture should be soaked in sodium hypochlorite sol.
 House hold bleach should be avoided for any denture.

Specific complete denture designs

1.Immediate complete denture

 Indications :
1. Transition from RPD to complete denture when poorly prognosed teeth expected to be extracted.
2. To ↓↓ bone resorption.
3. To ↑↑ healing
4. To maintain OVD
5. To allow pt adaptation to complete denture.
 Types :
Flanged ( nonsocketed type) Flangless (socketed type)(open face)
- ↓ aesthetics - ↑ aesthetic
- Used for lower ridge only - Used for upper only
- Either full or part extended 1 mm beyond - Artificial teeth are sit over socket of
maximum bulbosity of ridge. natural teeth.

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- Preferable , as it provides better retention. - Indicated for deep labial undercut.

 Another classification :

Interim Transitional Conventional

 immediately repeated addition of  extract all posterior teeth &
after teeth teeth to existing RPD preserve anterior teeth only as
extraction. occlusal stops →take an
impression →jaw relation →
extract anteriors & make
complete denture ( in a period
from 6 w to 12w)

 Recall intervals :
-
After extraction of teeth & insertion of immediate denture , you should
ask the pt not to remove it before 24 hrs.
- After 1 day → check healing
- After 1 week → remove sutures
- After 1 mon. → check occlusion
- After 3 mon. → relining & rebasing
- After 1 year → discard immediate denture & complete denture is
2.Copy denture
constructed.
 Copy denture techniques allow favourable features to be replicated while allowing minor
improvements.
 Indications :
1. To duplicate preferred polished surface of complete denture.
2. To copy partial denture for immediate denture construction for subsequent extractions.
3. Spare denture
4. Surgical guide during implant
 Copy denture techniques typically involve fewer stages and less clinical time than conventional
processes.
 Procedures:
clinic Lab
moulds of the original dentures are temporary rigid bases are produced in light cured
obtained in silicone putty.(duplication) or self-cured acrylic with wax teeth
 Secondary impression the impressions are cast, articulated and a trial set
 The retruded jaw record is obtained and up is constructed
a facebow record is made if appropriate

 Try-in  Any final adjustments.

 The position of the new post dam is  The dentures are removed from the flask,
scribed on the master model checked on the articulator for processing
errors and polished.

 Delivery

3.Over denture
 Definition:

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It is partial or complete denture with derived support from ( mucosa / implant ) , (mucosa/tooth) , teeth
only , remaining roots only , implants only.
 Types:
1. Transitional (modified RPD)
2. Training denture
3. Immediate replacement (post extraction and serve as a denture later on)
4. Definitive overdenture
 Advantages :
1. Pcsychological benefits for the patient
2. Effects upon edentulous ridge (dec. resorption)
3. Effective mastication
4. Improved stability and retention of the denture
 Disadvantages :
1. RCT is probably required.
2. Cost
3. Root caries
4. Need ↑ maintenance by pt & dentist.
5. ↑ risk of fracture especially over thin portions of acrylic over retained teeth.
6. Periodontal breakdown
 Indications :
1. Motivated pt. with good oral hygiene
2. Useful for free end saddle to ↓↓ bone resorption
3. Cleft lip & palate
4. Hypodontia
5. Severe tooth wear
 Choosing abutments :
1. Bilateral , symmetrical with at least one tooth space between them
2. Canine is the most preferred abutment for over denture , then Molars > Premolars > Incisors.
3. Healthy attached gingiva with no mobility.(>1/2 root length in bone)
4. Feasible RCT.
 Preparation to abutment teeth :
1. Just above mucosal level..bare root face(GI/amalgam plug)”Nayyer technique”-dome shaped
copings(gold)
2. Attachments(bar,stud/anchor,magnet)
Thimble shaped copings(two layered telescopic copings)
 Problems :
1. Caries of abutment teeth.
2. Periodontal breakdown.
Hybrid dentures = a partial denture that utilize intra or extracoronal precision attachment
.  Impla
nt
supported over dentures:
 Rigid attachment: milled bars
 Resilient attachment: Round bars-ball abutments-locators-magnets

Maxilla :4–6 implants splinted with a bar,

although freestanding abutments are
increasing in popularity.
Mandible: two freestanding abutments appear to be
the treatment of choice

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 4.Single denture
 Classification:
1. Maxillary complete denture opposing mandibular natural dentition.
2. Maxillary complete denture opposing mandibular partial denture
3. Mandibular complete denture opposing a maxillary natural dentition.
4. Mandibular complete denture opposing a maxillary partial denture
 Indications :
1. In patients with discrepancies in jaw size who require a complete denture, it is advisable to retain
teeth in mandible.
2. In patients with inoperable cleft or perforated palates, it is advisable to retain teeth in maxillary
arch. This is because the convectional maxillary complete denture would be a failure due to
absence of peripheral seal.
 Disadvantages :
1. Malposed, tipped or supra-erupted teeth in lower arch with interfere with balanced occlusion. The
imbalance may produce soreness mucosal changes and ridge resorption in maxilla and the
maxillary denture will tend to get displaced.
2. As the lower anteriors are present in a fixed position it is difficult to obtain aesthetic teeth
arrangement.
3. Use of acrylic teeth opposing natural teeth will produce abrasion of the acrylic teeth where as use
of porcelain teeth opposing natural teeth will produce abrasion of natural teeth.

Combination syndrome(Kelly’s sundrome)

This syndrome progresses in a sequalae / sequential manner. Progress of disease can occur in any one of
following sequence:
• Single denture..denture opposing partial
denture/natural teeth

• Upper complete denture+kennedy class 1 lower

• How to avoid this problem?

1. Upper and lower complete denture
2. Implant supported overdenture
3. If syndrome already happened
• complete denture can be repeated using selective pressure impression technique
• Lower…RPI can be done (solve problems of both dentures!)
Denture casting defects

• What causes monomer to

vaporize during processing?
The boiling point of
methylmethacrylate is 100.3°C at
standard temperature and

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pressure. If the boiling point is exceeded then the methylmethacrylate vaporizes and bubbles produce
porous defects. The polymerization of methylmethacrylate is exothermic and will contribute to
vaporization if precautions are not taken to reduce the temperature. Because the process is heat-
dependent, it is most likely to develop in thick sections of the denture and in the last portions to be
polymerized.
• How is gaseous porosity normally prevented?
Methylmethacrylate should be polymerized at a low temperature and under pressure. Packing the dough
under pressure raises the boiling point of the methylmethacrylate, and polymerization at 72°C for 16 hours
(or 72°C for 2 hours and 100°C for a further 2 hours) followed by slow cooling gives time for the heat of the
exothermic reaction to dissipate.

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