Denture Delivery

Evaluations
1-From the Dentist 2-From the Patient 3-From Family/Friends

Treatment at the Time of Denture Insertion

 Inspection of dentures & Elimination of basal surface errors.  Dentures to be seated on Healthy Tissues.

Steps of Denture Delivery [6 STEPS] [6

STEP 1 Check denture base with PIP Moisten with air/water syringe No peripheries

Elimination of Fitting Surface Errors

 Pressure Indicator Paste (PIP) to be used for every new denture.

STEP 2 Check denture peripheries with PIP One side at a time &Avoid cheeks

Common areas to adjust

Median Raphe Incisive Papilla Distal Buccal Flange Zygomatic Process Frenum Areas

Common areas to adjust

Frenum Areas Genial Tubercles Mylohyoid Ridges

STEP 3 Occlusal adjustment Remount with help of *Centric record *Stabilized casts

Check occlusion

Occlusion may seem okay, but

PrePre-maturity

Resilient Tissue Accommodation

Abused Tissues

Errors in Occlusion
 Possible causes of error:
1-Inaccurate jaw relationship registeration or transfer to the articulator 2-Failure to use face bow 3-Incorrect teeth arrangement 4-Denture processing errors 5-Changes in denture base material

 Checking for occlusion errors

RERE-MOUNT : Best done on the articulator

Remounting Procedure
 Ask patient to bite on cotton rolls for 10 min.  Guide mandible into CR several times.  Aluwax is placed on the post. Teeth of the mandibular denture.

 Place both dentures in the patients mandible is guided in a hinge movement.  Obtain interocclusal record of CR.

 Mount upper denture using remounting jig.  Mount lower denture

Selective spot grinding

The art of reducing premature contacting surfaces, so that an equal pressure exists at all points with interference at no point.

STEP 4 Chewing test *Use Cotton roll *Make sure theres No discomfort *If theres discomfort now , it will get worse after use

STEP 5 Check esthetics & phonetics If theres large change , fore-warn the patient

STEP 6 Polish Brasseler denture polishers

Step 7 (Bonus Step) Care Instructions with pamphlet

*Stress the limitations of artificial dentures , thats that the maximum occlusal load which may be developed with upper and lower dentures is oneone-tenth of that possible with a full natural dentition. *Point out that in the early stages , its wise for patients to limit themselves to items which require little mastication . . They should cut up their food into small pieces and should not favor one side in chewing. *Point out that dentures are constructed to fit existing ridges and that some resorption will continue to occur . . This may be small , but the dentures must be regularly checked and will have to be replaced in time if damage to the oral tissues is to be avoided and if they are to provide maximum comfort.

Eliminating occlusal records in anatomic teeth

    Re-establishment of CO. Correction of working side occlusal errors. Correction of balancing-side errors. Correction of protrusive relation.

Basic Tooth Positions

Balancing Contacts Centric Occlusion

Working Contacts

ReRe-establishment of CO [A]

Problem: Teeth too long Solution: Deepen the fossae

[B]

Problem: Teeth too nearly end to end Solution: Grind Inclines

[C]

Problem: Too much horizontal overlap Solution: Broaden central fossae

After the CO re-establishment. reDO NOT:

 Reduce maxillary lingual cusps.  Reduce mandibular buccal cusps.  Deepen the fossae.

Correction of working side occlusal errors.

 Reduce lingual inclines of buccal cusps of maxillary teeth.  Reduce buccal inclines of lingual cusps of mandibular teeth.
ON WORKING SIDE ONLY!!!

[A]
Problem: Buccal and lingual cusps too long. Solution: Change inclines of balancing cusps.

[B]

Problem: Buccal cusps are too long Solution: Change lingual incline of maxillary buccal cusp

[C]
Problem: Lingual cusp too long. Solution: Change buccal incline of lingual cusp of mandibular tooth.

Correction of balancing-side errors. balancing  Reduce lingual inclines of mandibular buccal cusps; or Decide which supporting cusp maintains CO and reduce its opponent.

[A]

Grind the lingual incline of the mandibular buccal cusp.

Correction of protrusive relation.

Distal inclines

Mesial inclines

Eliminating occlusal errors in nonanatomic teeth

 Interocclusal CR record is made.  Dentures mounted and gross premature contacts are removed.  Final adjustments with articulating paper.

2424-hour Oral Examination (OE) and Treatment (Tx)

 Examination procedures  Adjustments related to:
 Occlusion  Denture base
Occlusion Tissues

 Subsequent Oral Examinations and Treatment  Periodic recall for Oral Examination12 months

What to look for? [A]

COMMENT : Inaccurate occlusal relationship between the maxillary and mandibular teeth . . ETIOLOGY , Denture processing errors or Alteration of the denture base material of the Maxillary Denture Base . . MANAGEMENT , remake the maxillary denture

[B]

COMMENT : Inflammatory hyperplasia of the right labial sulcus . . ETIOLOGY , long labial flange of an accurately seated upper denture.. CLINICAL PRESENTATION , red inflammed hyperplastic mucosal tissues . . MANAGEMENT , Shortening of the offending labial flange

[C]

COMMENT : Same as the previous case but with more excessive inflammatory hyperplasia which may require surgical excision along with irritant removal as an operation of the management process

[D]

COMMENT : Early stage frictional keratosis . . ETIOLOGY , ill-fitting illmandibular denture base . . CLINICAL PRESENTATION , pale translucent patch along the lower labial vestibule related to the continuous irritation from the lower labial denture flange . . MANAGEMENT , remove the irritant i.e. reline the anterior denture base, the lesion should resolve or at least be reduced in intensity

[E]

COMMENT : Epulis Fissuratum Inflammatory Hyperplastic Lesion at the Borders Peripheries . . ETIOLOGY , Ill-fitting Illdentures but in most instances the denture flanges overextend secondary to alveolar bone resorption . . CLINICAL PRESENTATION , Exophytic elongated lesion at the left labial vestibule of the maxilla , Tissue proliferation on both sides of the offending flange & Blood. . MANAGEMENT , removal of the irritant

[F]

COMMENT : Injury on the mucosa covering the buccal mandibular basal bone . . ETIOLOGY , Irregularity on the fitting surface of the denture base . . MANAGEMENT , Elimination of the surface irregularity and polishing

Denture Repairs

References
 D.J. Neill & R.I. Nairns Complete Denture Prosthetics , 3rd Ed.  Bob Loney & Mark Vallees Secrets of Successful Dentures , Lecture  Dr. Iman Metwalys White Lesions , Lecture  Dr. Mohammed Mahmouds Oral Exophytic Lesions , Lecture  Moskona D, Kaplan I.s , Oral lesions in elderly denture wearers