Complete Denture Diagnosis

By
Dr-M.Ezzat
 Objectives of the lecture
-Identify the clinical pictures ,oral and extra oral patient examination in
relation to completely edentulous patients. (a1)

-Discribe steps for diagnosis and write a diagnostic ,Mouth preparation

and.treatment planning chart for completely and partially edentulous
patients . (a2)

-corelate the clinical finding according to diagnostic chart with mouth

preparation and treatment planning for successful complete and partial
dentures .(b1)

-Perform the clinical procedures required for fabrication of complete and

partial dentures. (C1)

-Communicate effictivelly with other departments for proper tentative

diagnosis and follow up of the cases. (d1)

-Demonstrate appropriate professional attitude and behavior in different

situations toward the patient and supervisors.( d2)

-comunicate with other dental or medical staff for patient referral.(d3)

In short, DIAGNOSIS can be summarized 

as:

Recognizing the problem

Formulating the plan

Carrying out the necessary examination

Finally, interpreting the result.

 OUTLINE OF CLINICAL COMPLETE DENTURE TECHNIQLIE:
1st Visit:
Patient interview, review health history, clinical and
radiographic
examination, diagnosis and prognosis, and patient education
Preliminary impressions with alginate
Select teeth (optional)
Lab:
Pour impressions with yellow stone and trim casts
Outline for custom tray
Fabrication of custom tray
2nd Visit:
Adjust tray borders
Border mold
Final impressions
Select teeth (optional)
Lab:
Pour impressions with vacuum-mixed yellow stone
Trim and key casts
Fabricate record bases with occlusion rims
 3rd Visit:
Adjust maxillary occlusion rim to correct lip level,
parallel ala-tragus line and inter-papillary line
Measure physiologic rest position
Evaluate previous dentures
Face-bow record
Record centric relation at O.V.D.
Select teeth
Lab:
Mount casts
Complete set-up
4th Visit:
Finalize Occlusal Vertical dimension: External
measurements Phonetics Swallowing Facial
appearance and comfort Prove centric relation
Protrusive record -set condylar guidance's
Locate and carve posterior palatal seal
Esthetic
Evaluation -patient approval most important
Lab:
Complete arrangement of teeth in balanced
occlusion
Complete wax-up
Separate master casts from mountings
Laboratory processing and polishing
5th Visit:
•Insert dentures
Have patient bite on cotton rolls for at least 10
minutes
Check adaptation with pressure disclosing paste

•Inter-occlusal centric relation record

Lab:
Equilibrate occlusion
Polish
6th, 7th, etc. Visits:
Adjustments and final evaluation
 1st pt interview

Dentist patient relationship

Diagnosis and treatment planning
I) History taking.
A)Patient data.
B) Chief complaints
C)Dental History.
D)Denture history.
E) Medical History.
F)Mental attitude.
I-Case history:a)Personal data:like:name,age ,gender and
occupation.
Name : for the purpose of communication and cast identification. most
patients liked to be called by their name, this has a psychological
effect as well
Personal age is important as young age patient adapt more quickly to
the dentures. Than older one
Gender: Esthetics and of the influence of Sex hormones on the
supporting structures. Unlike men, women may regard appearance
even above the efficient functioning of the replacement teeth. In the
second consideration, normal physiologic change decrees that women
undergo menopause, a period productive of many problems which
can be against easy denture construction
Patient’s occupation has a relation to the denture design and impression
tech.as most professional men and others who entail intimate contact
to their follows,appearance and retention are more important than
efficiency.Puplic speakers and singers require not only perfect
retention but also proper palatal seal for proper phonation instrument
players require a special modification of the shape and position of the
anterior teeth.
 B) Chief complaints
 The chief complaint is recorded in patients
own words. Pt should be questioned
regarding his/her attitude. The response
allows the practitioner to assess whether
the pt expectations are realistic 2. The
response provides information regarding
the patients psychological classification As
a guide
b)Medical History,
It can affect the complete denture prognosis.
Follow-up significant responses.
Note systemic conditions that impact on therapy
(e.g. angina, hepatitis, Sjogren's syndrome).
Obtain physician consultations if there is a
debilitating disease.
Discuss with instructor to ensure acceptability.
 History
Allergies – Even Anaphylaxis 
Medications – Adverse drug reactions 
Hypertension – LA without adrenalin 
Cardiac problems – prophylaxis 
Epilepsy – short appointments 
Hypoglycemia – syncope or coma 
Xerostomia – poor prognosis 
c)Dental History and mental attitude,
How many dentures?
How long worn?
Satisfaction with dentures?
This all give better evaluation of the mental
atitude of the patient toward wearing dentures.
d)Information regarding loss of natural
teeth.
For example if a patient lost his posterior teeth
and didn’t wear a RPD he/she would eat with
the ant. teeth.
If this habit persists this will produce unstable
complete denture.
 Patient’s Attitude

House classification

1-Philosophical pt
2-Exacting pt.
3-Indifferent pt.
4-Hystirical pt
 Philosophic or reasonable
These are normal ideal.
They understand the limitations of an artificial prosthesis.
They are ready to play their role in the perseverance and
learning phase.
They do not unnecessarily criticize the operator.
They correctly interpret their problems neither overstating nor
under expressing.
Willing to accept the dentist’s judgement without question.
Best mental attitude for denture acceptance.
Motivation is generalized.
Ideal attitude for successful treatment,.
 Critical or exacting

The patient is methodical, precise and

accurate.
At time he is more demanding.
Require extreme care, effort and
patience on the part of the dentist
Can be managed if handled properly.
 Indifferent or passive
Patient shows no concern.
They are not interested and lack motivation.
Pays no attention to the instructions.
They are non cooperative.
They seek prosthesis at the request of family
members or at the advice of the physician.
Require more time for instruction on
value and use of their dentures.
 Skeptical or antagonistic
/hysterical

Emotionally unstable. 
Excitable, hypertensive. 
Grumbling even with little things. 
Patients having family problems or 
psychological disturbances usually
fall into this category.
II) Examination:
A) Extraoral Examination.
B) Intraoral Examination.
C)Examination of existing denture.
D) Radiographic Examination.

III) Preextraction Records:

A) Study casts.
B) Photographs
 General examination

General health and constitution 

Cardiovascular System Disturbances 

Blood pressure, Angina, Infarction, Rheumatic fever

Respiratory System Diseases 

Tuberculosis, Asthma, Dyspnoea, Edema

Gastrointestinal Tract Disturbances 

Ulcers, Jaundice, Nausea, Vomiting, Diarrhea,

Constipation, Cirrhosis
 (i) Systemic Status of the Patient:

DEBILITATING DISEASES 
They must be kept under medical
control
Eg. Diabetes, Blood Dyscrasias
and TB
Require
Extra instruction in oral hygiene, 
eating habits & tissue rest
Physician consultation 
Frequent recall appointments to check 
the status of underlying bone and thus
occlusion
 Local examination

Visual examination
Physical examination
Digital examination
Conditions of occlusion
Clinical examination:

A) Extraoral examination:

1)Neuromuscular skills or coordination.

2) Muscle tone( good , fair and poor)
3) TMJ.
4) Lymph nodes
NEUROLOGICAL DISORDERS: 

Eg. Bells palsy

Parkinson’s disease
Added Problems:
Denture retention 
Maxillo-mandibular relation records 
Supporting musculature 
 Facial Examination
I) Face:
a)Form:
Frontal (Square, tapering, square
tapering, ovoid)
Profile (Class I,II,III)
b)Color.

II) Lips
 Intraoral Exam

Examine one arch at a time

Look, then write
ation.
small , and large).
e, tapering,and ovoid)
tour(Normal , flat, and

rritated, pathologic)
 Intraoral Exam

General tissue health

Mucosa
attached / non-attached
Colour
Character
Displaceability
 1- firmness of the ridges
The ideal mucosa on which to seat full dentures should be :
i) Firmly bond down to sub-adjacent bone .
ii) Slightly compressible .
iii) Of an even thickness .

NORMAL MUCOUS MEMBRANE IS

THCKNED
 Intraoral Exam

Specific Anatomical considerations 

Examine systematically •
Note significance •
of findings to therapy
Visual and tactile exam •
 Intraoral Exam

 Maxilla
• Form of maxillary arch affects
retention
• Advise the patient if retention
will be compromised
 Maxilla

Posterior border of denture:

Hamular notches
Over extension - extreme pain
Under extension - non-retentive
Must be captured in impression
 Maxilla

Posterior border of
denture:
Hamular notches
Posterior denture border
Palpate
Visually deceiving
 Maxilla
 Posterior border of denture
• Vibrating line
 Identified when patient says "ah"
 Junction of movable & non-movable soft palate
 Maxilla
 Posterior border of denture
• Vibrating line
 If termiminate on:
• movable portion - displacement
• hard palate - no retention
Pterygomandibular raphe:
Behind hamular notches - significant when
prominent.
Can displace denture.
Requires relief in extreme cases.
Labial/Buccal vestibule:
2-4 mm width.
Zygomatic process:
can be prominent.
 4. Maxillary tuberosities:
There may be found on visual examination to be bulbous and
to have a definite undercut area above them, but only by palpation
can it be determined whether the bulbous portion is composed of
hard or soft tissues.
If the tuberosity is much undercut ,and covered with only a thin
layer of mucous membrane ,then surgical removal of part of it is
necessary.
Tuberosity:
Displaceability.
Palpate for undercuts - if extreme, denture might not
seat.
If enlarged with fibrous tissue surgical reduction to
make room for dentures.
  Soft Palate:
Classified according to configurations based on the degree of
flexure the soft palate makes with the hard palate and the
width of the seal area.

Class I: Horizontal & demonstrating little muscular movement.

Most favourable condition as it allows for more tissue coverage
for posterior palatal seal.

Class II: Turns downward forming a 45o angle to hard palate.

Potential tissue coverage is less than for class I.

Class III: Turns downward sharply at 70o angle just posterior

to hard palate. Least favourable soft tissue form.

F) Soft palate. (Class I Large more than 5 mm. ,Class II medium

3-5 mm., Class III Abrupt downward soft palate)
Palatal Throat Form

Maxilla

II
III

Flatter the soft palate, the broader the •

area of the vibrating line
E) Palatal vault. (Class I Flat, Class II U shaped,
Class III V shaped)
V- shaped vault: associated with Class III
soft palate
Flat palatal vault: usually associated with
Class I or Class II soft palate.
 Posterior Palatal Seal

Glandular tissue
Posterior palatine salivary
glands
Permits compression of •
tissues
Improves adaptation of •
denture to compensate for
shrinkage of resin

Posterior palatal
seal
H) Saliva
The saliva varies in consistency in varies
individual .
A thick ropy saliva doesn’t promote good
retention of the denture , since it may
collect in undue quantities under the
denture with a resulting decrease in
retention . A serous saliva will offer the
best retention since it provides just
enough of a film between the tissues and
the denture .a low quantity of saliva or
xerostomia willn’t provide intermediary
fluid film and results in poor retention .
 H) Saliva

Deficient saliva: retention of

denture will be affected.
Excess of saliva: complicates
impression making.
Thin serous saliva is the best to
work with.
Thick saliva makes dentures
more difficult to wear.
I) Interarch space

J) Tongue. Position- Tongue Size( Class I Adequate

, Class II Slightly overfill the floor of the mouth,
Class III )
Management of large tongue

K) Tori
 Mandible:
Ridge form more critical:
Less surface area for retention.
Moveable tongue & floor of the
mouth cause displacement if
denture is overextended.
Inform patients.
Retromolar pad:
Terminal border of the denture
base.
Compressible soft tissue.
Cause peripheral seal.
Must be captured in impression.
Labial/Buccal vestibule:
Easy to overextend.
Check with minimal
manipulation of lips.
Masseter:
Affects distobuccal border of
the denture.
If more prominent - concave
border of denture.
Frena:
Labial and buccal frena.
Narrow & wide respectively.
Lingual frenum.
Must allow for movement - or displaces easily.
 Mandibular Support
Areas

Retromolar Pad Buccal Shelf Alveolar Process

 5. Mylohyoid ridges:
Some of these ridges are felt to be
pronounced and sharp and others are felt ill
defined and rounded.
Mylohyoid Ridge:
Palpate.
If prominent, may need
relief.
Mylohyoid muscle.
Raises floor of mouth.
Differences between rest
and activity affects length
of flanges.
 5. Mylohyoid ridges:
Some of these ridges are felt to be
pronounced and sharp and others are felt ill
defined and rounded.
the mylohyoid region of the flange is that area that causes agreat
deal of confusion & misunderstanding concerning the correct
extension of the base.the problem stems from the fact that the
attachment of the muscle to the mylohyoid ridge is quite
high,especially in resorbed ridges. Further the ridge itself is often
sharp and there is an undercut below it,inferiorly.this means that the
denture flange can neither rest on the ridge, nor extend below it.
However ,neither can it stop short of the ridge , as vertical forces
acting on the base in this region will causes soreness, peripheral seal
won’t be maintained as the flange won’t maintain contact with the
mucloingual fold.
6. Lingual pouch:
The extent of the pouch with the tongue at rest and with the tongue
protruded sufficiently to lick the lips and also during the act of swallowing
should be noted. This is done by gently inserting the index finger into the
pouch and asking the patient to perform the above actions.
Tori:
Rarely need surgery unless large
May require relief once dentures are
delivered - advise patient.
Genial tubercles:
Bony insertion for the genioglossus
muscle.
May be projecting above the residual
ridge if there has been severe
resorption.
 IV- X-Ray Examination
X-ray photographs should still be taken to
confirm or assist in diagnosis in the
following cases:
1. Buried roots.
2. Sinuses.
3. Unilateral swellings.
4. Rough alveolar ridges.
5. Areas painful to pressure.
6. Impacted teeth.
7. Cysts.
- Arch relationship:
- For determination the angle classification of the
patient.
Patient could be one of three :
a- upper anteriors in the same level of lower
anteriors ( Angle class I )
b-lower anteriors in retrusion ( Angle class II )
c-lower anteriors in protrusion ( Angle class III )
 Pre-extraction records:
number of perextraction records may be fabricated to
preserve a visual record of the patient’s natural dentition
and facial contours :
1. Radiographs :full mouth x-ray a must when extraction is
considered and are a check for residual infections , impacted teeth
and foreign bodies.
2. Shade: the color or shade of the natural teeth should be recorded
before extraction .
3. Vestibule impression and cast : with the teeth are in centric
occlusion , softened and tempered , modeling compound can be
adapted to the anterior teeth and vestibules and an impression
thus obtained is poured in dental stone which will serve as a
record of the natural anterior teeth.
4. Complete casts : if sufficient posterior teeth are present in
correct centric occlusion , full mouth alginate record. impression
and subsequent casts may be obtained and kept as a record
A
 Pre extraction records: 

Old diagnostic casts: determining both 

size, position & arrangement of teeth.

Old radiographs: determining tooth size 

& bony change.

Photographs: relay information 

regarding tooth size, position & display

during facial expressions. Forms an
effective tool in achieving proper
esthetics & patient satisfaction.
5- Nose –chin contour and distance : This is record is
easily obtained by adapting a soft lead wire to the face in a profile view from
the bridge of the nose to below the chin with the teeth in centric occlusion.
By placing this contoured wire on a piece of cardboard and marking the facial
side of the wire on the cardboard , it can be out and kept as a permanent
record of this contour and distance.

6- Face masks: These may be obtained by applying a hydrocolloid to

the facial structures of and around the mouth , chin and including the nose .
Quick set plaster is then applied over this material and allowed to set.
Rubber tubing should be placed in the nostrils to allow for breathing and the
teeth should be in correct occlusion. This alginate impression is then poured
in dental stone and a permanent record is thus obtained.

7- Casts with the natural teeth: an alginate impression is

obtained immediately before extraction and kept moist on until its later use.
After the extraction completed , the teeth are inserted into the impression
and a cast may be poured in stone and reproduced in auto polymerizing
acrylic.
 References
R1 Neill D.J. & Nairn R.IComplete denture
prosthetics 3rd ed Butterworth-Heinemann©1990 :
(1-3),
R2 Hassaballa MA.Principles of complete denture
prosthetics, King Saud University books press 1st
ed 2004 :(2-12)
R3 Nallaswamy D.Text book of prosthodontics-
Jaypee , Delhy1sted2003: ( 13-32)
R4 Prosthodontic Treatment for Edentulous
Patients .Zarb and Bolender, 12th ed 2010
mosby:(73-94)