Review of Basic Concepts In Complete Denture Prosthodontics

Mohammad Zakaria Nassani DDS, PhD Al-Farabi College for Dentistry and Nursing Prosthetic Dental Sciences Department

Introduction
It is fundamental to the success of treatment

with removable complete dentures to understand the factors that are involved in the function of complete dentures

Introduction
The aim of this lecture is to review the

following concepts which are crucial to the effective function of complete dentures:

Retention

Stability

Support

What is Retention?
The resistance against vertical displacement
Complete denture retention: is the resistance

to displacement of the denture base away from the ridge

Retention
In the absence of adequate retention, dentures

are unlikely to be functionally effective or physiologically acceptable A retentive denture contributes significantly to patient acceptance and satisfaction with removable denture treatment

Factors affecting denture retention

Physical Anatomical Physiological Mechanical Psychological

1- Physical Factors

Adhesion

Cohesion

Surface tension Atmospheric pressure Gravity

1- Physical factors
1- Adhesion
The force of attraction existing between dissimilar bodies in close contact
Example: the molecular attraction of saliva to the denture base and saliva to the mucosa

1- Physical factors
Adhesion
This force acts most powerfully at right angles to the surface, and is proportional to the area Adhesion of the surfaces in contact
MUCOSA

Saliva Molecules Adhesion

DENTURE

1- Physical factors
Adhesion

Adhesion acts when saliva sticks to the denture base and to the mucosa membrane of the basal seat It depends on: 1. Close adaptation of the denture base a thin film of fluid resists flow more than a thicker film

1- Physical factors
Adhesion: It depends on:
2. Size of denture bearing area Patients with small jaws cannot expect retention by

adhesion to be as effective as patients with large jaws can The denture must be extended as much as functionally possible in order to obtain the maximum adhesion and retention 3. Viscosity of saliva ( fluids having a high viscosity resist flow more effectively than those of lower viscosity)

1- Physical factors
2- Cohesion The physical attraction existing between similar bodies in close contact Example: the molecules of saliva attract each other The cohesive forces in a fluid (such as saliva) will keep the film of saliva under the resin base of the denture

1- Physical factors

Cohesion
Adhesion Cohesion

MUCOSA

Saliva Molecules

Adhesion
DENTURE

1- Physical factors
3- Surface tension It is the resistance to separation developed between two well-adapted surfaces by a thin film of fluid

A thin film of fluid

1- Physical factors
4- Atmospheric pressure:
When there is a close fitting denture and the denture

completely seated over the foundation tissues, the air will be expelled from in between the denture and the mucosa which will give a positive force to maintain the denture in its place. Peripheral and posterior palatal seal

1- Physical factors
5- Gravity
Gravity is working with lower denture and

against the upper denture In the upper jaw, light weight is helpful In the lower jaw, additional weight may help to keep the denture in place ( but this should be kept within the physiological limits of tolerance for the patient)

1- Physical factors
In order to obtain the maximum possible benefit for denture retention from the physical forces: 1. The denture base should cover the maximum area of the mucosa but not interfering with other oral structures 2. A close adaptation between the denture base and the supporting mucosa (The saliva film should be thin as possible as a thin film of fluid resists flow more than a thicker film) 3. An accurate peripheral and posterior palatal seal

2- Anatomical Factors
1. Shape of the edentulous ridge 2. Undercuts 3. Anatomy of the border tissues

Shape of the edentulous ridge

Denture retention can be enhanced by the existing of regular and firm ridge

A ridge with almost vertical, parallel sides produces the best resistance to unstabalising forces The shallower the ridge, the less effective it is in resisting any displacing forces

Undercuts
When bony undercuts exist, retention may be enhanced by designing the denture to utilize these undercuts areas (tuberosity region)

Anatomy of the border tissues

The anatomy of the border tissues should be such that it is possible to develop a good denture flange, the periphery of which can lie in contact with displaceable and elastic tissues The elderly patient is often a problem since ageing tissue losses its elasticity In addition, in the elderly patient, the alveolar ridges are often reduced in height reducing the denture area available

3- Physiological Factors
Neuromuscular control Viscosity and volume of saliva

Neuromuscular control
Neuromuscular control refers to the functional forces exerted by the musculature of the patient that can affect denture retention It is a learned biological phenomenon The ability of the patient to control the action of the lips, cheeks and tongue can be a major factor in the retention of a denture A patient who lacks the ability to control the movement of these tissues may not be able to retain a prosthesis

Neuromuscular control
The muscles of the lips, cheeks and tongue can aid denture retention provided that: The teeth are positioned within the neutral zone
The occlusal plane at the correct level Denture must extend to cover the maximum area

without interfering with the health and function of the structure that surrounds the denture

Viscosity and volume of saliva

If the saliva is viscous , the retentive force is increased Whenever the denture tries to move, the viscosity of the interposed saliva film resists this movement

(a thin film of saliva resists flow much more than a thicker film)

Viscosity and volume of saliva

Adequate saliva volume is necessary to obtain a good denture retention Therefore, retention is poor in the mouths of the patients whose saliva volume is low (patients

with xerostomia, elderly patients, patients who receive radiation therapy to head and neck region)

4-Mechanical Factors
1. Balanced occlusion 2. Contour of the polished surfaces 3. Position of the occlusal plane 4. Position of the teeth in respect to the alveolar ridge 5. Inclination of the teeth labiolingually at the incisal edge

1- Balanced occlusion
The bilateral simultaneous, anterior and posterior occlusal

contact of teeth in both centric and eccentric occlusion. (Usually not exist in the natural teeth) The occlusion must be free of interferences within the functional range of movement of the patient, to avoid dislodging forces A balanced functional occlusion is critical in promoting denture retention (Schlosser, 1946)

2- Contour of the polished surfaces

The polished surfaces including the teeth should be shaped or positioned in such a way that the surrounding musculature does not displace the

denture, but rather contributes to its retention The surface of a denture is usually made slightly concave so as to improve the retentive force towards the border

3- Position of the occlusal plane

The higher the occlusal plane, the greater the tilting forces exerted on the base of the denture By keeping reduced intermaxillary space in patients with flat ridges, we reduce the amount of tilting force transferred to the denture base and thereby increase its stability

3- Position of the occlusal plane

4- Position of the teeth in respect to the alveolar ridge

The tipping forces on the lower denture can be reduced by setting the posterior teeth over the crest of the residual alveolar ridge

5- Inclination of the teeth labiolingually

at the incisal edge

The occlusal plane should be inclined upward

slightly toward the posterior This is in order to direct the forces of occlusion upward and forward on the upper jaw and downward and backward in the lower jaw

5- Inclination of the teeth labiolingually at the incisal edge

This is in harmony with the supporting structures of the upper and lower jaws
The rugae prevent anterior movement on the

upper The retromolar pad resists posterior movement of the lower denture

5- Psychological factors
Mental attitude: patient has to make a positive effort towards acquiring the skill to use

removable dentures Expectations: patients with high expectations need motivation and education

What is Stability?
The ability of the denture base to remain in contact with the ridge without being lifted or rotated out of position when forces are applied to it In other words: It is the resistance to horizontal and rotational forces that prevents lateral or anterioposterior movement of the denture base

What is Stability?
A stable denture is one which moves little in relation to the underlying bone during function

Factors affecting denture stability

1. Retention 2. Proper relief of hard areas 3. Balanced occlusion 4. Height of the occlusal plane 5. Position of the posterior teeth 6. Palate and ridge form

7. Shape of the polished surface of the denture

8. Shape and size of the tongue

Factors affecting denture stability

1. Retention For a denture to be stable, it should be retentive

Factors affecting denture stability

2. Proper relief of hard areas
Insufficient relief of hard areas under the denture may cause rocking and instability of the denture
Median palatine raphe, torus palatinus and torus

mandibularis are examples of hard areas that should be considered.

Factors affecting denture stability

3. Balanced occlusion This means harmonious contact between upper and lower teeth in different positions of the mandible If there is cusp interference, stability will be impaired

Factors affecting denture stability

4. Height of the occlusal plane
The higher the occlusal plane in relation to the residual

ridge, the greater will be the leverage action, and the lesser will be the stability of the denture. Therefore, the occlusal plane should be as near as possible to the ridge to enhance the denture stability.

Factors affecting denture stability

5. Position of the posterior teeth
The posterior teeth should be set up over the crest of the ridge. If the teeth are set up too far outside the ridge, stability will be decreased.

Factors affecting denture stability

6. Palate and ridge form
Residual ridges with high vertical walls resist well lateral forces and accordingly enhance denture stability. On the contrary, flat ridges offer minimal

resistance to lateral stresses and so decrease the chance of the denture stability.

Factors affecting denture stability

6. Palate and ridge form
Considering the palate form; a high arched vault offers good resistance to lateral stresses, while a flat vault permits skidding of the denture.

Factors affecting denture stability

7. Shape of the polished surface of the denture

The polished surface should be concave. The muscles of the tongue, cheeks and lips

when acting on a concave polished surface will tend to seat rather than unseat the denture. The reverse happens when the polished surface is convex

Factors affecting denture stability

8. Shape and size of the tongue Broad and thick tongue enhances denture stability On the other hand, small narrow tongue or extremely large tongue reduces denture stability

What is Support?
The foundation area on which a dental prosthesis rests

Complete denture support It is the resistance to vertical movement of the denture base toward the ridge It counteracts those forces directed toward the ridge at right angles to the occlusal surfaces

Support
The supporting tissues in complete dentures are: The attached mucosa covering the alveolar bone The underlying bone of the residual ridge The palate

Support
Sufficient support is essential to the function of complete dentures in order to resist tissueward movement under loading

Support
Effective support is realized when: The denture is extended to cover a maximal surface area without impinging on movable or flabby tissues Snow Shoe principle: a broader denture-bearing area decreases the stress/unit area leading to decreased tissue displacement and reduced denture base movement

Support
Effective support is realized when:
Those tissues most capable of resisting

resorption are selectively function

loaded during

Support

Support
Effective support is realized when:
Those tissues most capable of resisting vertical

displacement are allowed to make firm contact with the denture base during function Compensation is made for the varying tissue resiliency to provide for uniform denture base movement under function and maintain a harmonious occlusal relationship

Support
Initial denture support is achieved by using impression procedures that provide optimal extension and functional loading of the supporting tissues (which vary in their resiliency)

Long-term support is obtained by directing the forces of occlusal loading toward those tissues most resistant to remodeling and resorptive changes

Concluion
Retention, stability and support are interrelated Taking these concepts into consideration in making complete dentures is essential to achieve a successful outcome with this kind of prosthetic treatment

Retention

Stability

Support

Thank you for your attention