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Try-In RPD

The document discusses the process of an esthetic try-in for a removable partial denture. It involves evaluating the fit, occlusion, tooth positioning and appearance. The dentist assesses lip support, tooth length, spacing between teeth, overlap, vertical alignment and shade. Feedback is obtained from the patient while viewing themselves in the mirror. Phonetics are also evaluated by having the patient make specific sounds. Modifications are made to the denture based on the evaluation.

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46 views8 pages

Try-In RPD

The document discusses the process of an esthetic try-in for a removable partial denture. It involves evaluating the fit, occlusion, tooth positioning and appearance. The dentist assesses lip support, tooth length, spacing between teeth, overlap, vertical alignment and shade. Feedback is obtained from the patient while viewing themselves in the mirror. Phonetics are also evaluated by having the patient make specific sounds. Modifications are made to the denture based on the evaluation.

Uploaded by

SRO oO
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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4th year Lect Prosthodontics Dr.

Ihab Nabeel Al-mgotar

Try-in of removable partial denture


(This may be at the fourth visit or according to clinical requirements).
This is the last stage at which modifications can be made before the wax
is replaced by acrylic. A careful routine must be followed to prevent any
mistakes continuing through to the finished dentures. The replacement of
anterior teeth often represents an important event in the life of an
individual.
Although many patients identify improved function as the primary reason
for seeking treatment, a sense of esthetics always remains. A patient may
be dissatisfied with a prosthesis even if it meets all functional and
biologic requirements. Therefore, if anterior teeth are to be replaced, an
esthetic try-in is essential. A try-in appointment allows the patient to view
the prosthesis and provide feedback. This appointment also allows the
practitioner to evaluate the esthetic and phonetic characteristics of the
prosthesis and to make appropriate changes in the arrangement of teeth.
An additional indication for the appointment is to verify the accuracy of
jaw relation records made during the previous appointment. If there is any
doubt regarding the accuracy of the articulator mounting, a try-in
appointment should be scheduled.
The trial dentures should firstly be examined on the mounted casts in
respect of:-
1. Adaptation of partial dentures on the casts.
2. Occlusion.
3. Position of artificial teeth with regard to adjacent natural ones.
4. The arrangement of anterior teeth.
5. Extension and contouring of wax flanges.
In the mouth the trial dentures should be examined in respect of:-
1. Adaptation of the dentures. Comfort, and function of the appliance.
2. Vertical dimension including the vertical dimension of occlusion
and rest.
3. Occlusion, check centric jaw relation and centric occlusion. Prove
the centric record and take new occlusal registration.
4. Evaluate the shade, mold, and arrangement of the teeth. (Esthetic
and phonetic).
5. Appearance. Modify positions of teeth and incisal edges of anterior
teeth to achieve a pleasing result.

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6. Ask for patient's comments on appearance. Show the patient the
dentures in the mirror and ensure that they are satisfied.
7. Note any changes on the laboratory prescription.
Esthetic try-in
The patient should be seated in a treatment room that provides a quiet,
relaxed atmosphere. This helps to alleviate the tension that may develop
as the patient views the tooth arrangement for the first time.
The dentist should evaluate the positions of anterior teeth and assess lip
support. There is a tendency to position the artificial teeth lingual to the
positions occupied by the natural teeth. If anterior teeth have been
missing for 6 months or more, the patient may report a sensation of
abnormal fullness at the upper lip. A short period of accommodation
usually will eliminate this problem.
A. Teeth length:
Tooth length should be carefully evaluated. If all anterior teeth are being
replaced and the upper lip is of normal length, the edges of the central
incisors should be visible when the lip is relaxed. When the lip is drawn
upward (e.g., in an exaggerated smile), the gingival contours of the
denture base should be minimally evident.
B. Short space:
If an anterior edentulous space has been decreased by drifting of the
teeth, a decreased number of teeth should not be placed. This technique
usually results in an abnormal appearance. Instead, attempts should be
made to rotate or overlap the denture teeth in order to achieve an
acceptable esthetic result.
C. Large space:
If the anterior edentulous space is relatively large, diastemata may be
incorporated into the tooth arrangement. If this is to be accomplished, the
patient should be informed of potential difficulties associated with
interdental spacing. Spacing complicates oral hygiene procedures,
increases the likelihood of food impaction, and may create difficulties
with phonetics.
D. Overlap of the anterior teeth:
Attention should be paid to the horizontal and vertical overlap of the
anterior teeth. If some natural anterior teeth remain, the overlap should be
duplicated. If no natural teeth remain, care should be taken to avoid
excessive vertical overlap without accompanying horizontal overlap. This

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could result in the application of undesirable forces to the artificial teeth
and associated soft tissues.
E. Vertical alignment of the teeth:
Vertical alignment of the teeth also should be evaluated. A slight
deviation from the vertical can produce an acceptable esthetic result, but a
significant deviation can create esthetic difficulties. The practitioner
should pay particular attention to the maxillary midline. This midline
must be examined for its vertical alignment and for its midface position.
Any error in the position of the maxillary midline can be extremely
distracting.
F. Tooth shade:
Verification of tooth shade should be accomplished during the evaluation
process. The presence of natural teeth makes shade selection and patient
acceptance a critical component of removable partial denture therapy. To
ensure selection of an appropriate shade, the prosthesis should be viewed
using a variety of light sources (e.g., natural, fluorescent, and
incandescent).
Tooth position: The positioning of any posterior is compare with the
position of the remaining natural teeth.

The arrangement of the anterior should be harmonize with the abutment.


The appearance may need to be modified, if incisal wear is present on
the natural teeth it should be simulated
on the
denture.

The shade, mould and arrangement of the artificial teeth should


harmonize with the natural teeth. The incisal edges of the natural anterior
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teeth tend to follow the curve formed by the lower lip when smiling.
Reproduction of this relationship when positioning artificial anterior teeth
can contribute significantly to a pleasing appearance.
(The incisal edges of the natural anterior teeth
tend to follow the curve formed by the lower lip
when smiling).

Denture base consideration


A. Wax flanges should be of a thickness and extension corresponding to
the amount of bone resorption in the area so that they only replace the
tissue that has been lost, restoring the former contour of the alveolar
ridge. Mesial and distal borders should be thin so that the flange blends
with the adjacent mucosa, thus avoiding food trapping and promoting
patient comfort.

B. If the path of insertion and withdrawal permits, the lateral borders of


any anterior flange should be thinned and should terminate over the
convexities produced by the roots of the abutment teeth. This
arrangement should also permit the labial flange to restore the papilla of
the abutment tooth next to the edentulous space. The positioning and
contour of papillae and gingival margins around the artificial teeth should
harmonise with those of the adjacent natural
teeth.

4
C. A common error, which creates a poor appearance, is to place the gum
margin of the artificial maxillary premolars at a lower level than that of
the adjacent natural teeth . This may be overcome by careful waxing up
and by the selection of an artificial tooth of appropriate crown length .

D. The borders of mucosa, or partially mucosa-supported saddles, should


extend to the full depth of the sulci recorded on the cast. This is so that
the occlusal forces may be distributed as widely as possible and so that
the adjacent musculature may be utilized to reinforce the retention and
stability of the prosthesis.

E. If the chosen path of insertion and withdrawal for the denture does not
eliminate undercuts on the labial or buccal sides of the ridge, the flanges
should be thinned as they pass over the survey line and end
approximately 1mm beyond it.

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The patient evaluation
The patient should stand several feet from a wall mirror to examine the
teeth critically. The use of a hand mirror should be discouraged because
the patient’s attention will be focused on individual teeth and not on the
overall effect of the prosthesis. The patient’s remarks should be noted,
and required changes should be made. Arrival at mutual acceptance by
the patient and dentist frequently demands a high level of communicative
skill combined with psychological insight.
Phonetics evaluation
As fricative ( “ f ” and “ v ” ) sounds are made by the patient, the
maxillary incisors touch the wet - dry line of the lower lip. As the patient
makes the “ s ” sound, the maxillary and mandibular incisors should just
miss contact (less than 1 mm is ideal). However, in some instances,
patients are able to provide the proper air escape at slightly greater
distances. These patients are generally skeletal Class II patients.

(Maxillary incisors contact wet - dry line


of lower lip when making the “ f ”
sound).

(In making the “ s ” sound, the


maxillary and mandibular incisors are
out of direct incisal contact, with
generally less than 1 mm of space
between incisal edges).

6
Verification of Jaw Relation
The jaw relation only needs to be verified in limited instances:
1. If problems were encountered during jaw relation procedures and
there is any doubt regarding the accuracy of the articulator
mounting.
2. If the partial denture is opposed by a complete denture.
3. If all posterior teeth in both arches are being replaced.
4. If there are no opposing natural teeth in contact and verification of
the occlusal vertical dimension is necessary.

A dentist should never complete a prosthesis without confidence in the


accuracy of the jaw relation records and the articulator mounting. A
considerable amount of unnecessary work can be avoided if the
`practitioner pays close attention to detail throughout these procedures.
To ensure accuracy, it is essential that the practitioner evaluate the
mounting using additional jaw relation records . As a result, the
importance of a face-bow transfer becomes particularly evident at this
stage of treatment. For a mounting to accept additional jaw relation
records, the arc of rotation for the articulator must be the same as the arc
of rotation for the patient’s mandible.

Making a polyvinylsiloxane verification record


The patient is instructed to open the mouth moderately. The fingers of
one hand are positioned to permit visualization of the dental arches . The
polyvinylsiloxane registration material is mixed and introduced into the
patient’s mouth . The operator’s remaining hand is then positioned on the
facial surfaces of the mandibular anterior teeth, and the patient is guided
into the prescribed closure . This position is maintained until the
polyvinylsiloxane material has reached a suitable consistency.
When the recording medium has set, the patient is instructed to open the
mouth. The record and removable partial denture (or dentures) are
removed from the oral cavity. The record is carefully examined to
determine its acceptability. There should be no signs of penetration
through the record. If the record is acceptable, it is properly trimmed
using a surgical scalpel.

7
The operator’s dominant hand is properly
positioned and used to guide mandibular closure.

Choice of tooth materials


Acrylic resin pontics are the teeth of choice for most patients. Current
cross - linked polymers resist abrasion and are compatible with opposing
occlusal surfaces of enamel or metal. However, if the RPD pontics
oppose porcelain restorations, consideration should be given to more
wear - resistant materials such as metal occlusal surfaces or porcelain
denture teeth. Since porcelain teeth are attached to the denture base by
mechanical retention, they require additional interocclusal space when
compared to acrylic resin denture teeth, which have the ability to bond to
the denture base. Some patients also report unnatural sounds — for
example, “clacking” — when porcelain denture teeth oppose each other.
Other, recommend that custom glass ceramic occlusal surfaces be
fabricated and cemented to prepared acrylic resin denture teeth in order to
reduce the wear caused by opposing ceramic occlusal surfaces.

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