Presentation on theme: "Complete Dentures The Wax Try-In. Introduction Goals: Evaluate and finalizeEvaluate and finalize the anterior esthetics. Verify the vertical dimension.Verify."— Presentation transcript:
Introduction Goals: Evaluate and finalizeEvaluate and finalize the anterior esthetics. Verify the vertical dimension.Verify the vertical dimension. Evaluate and finalizeEvaluate and finalize the occlusion.
The student/practitioner should: Complete the wax-up/set-up.Complete the wax-up/set-up. Evaluate all aspects of the set-up.Evaluate all aspects of the set-up. Obtain patient approval.Obtain patient approval.
Armamentarium Mounted Casts/Wax Dentures. Dental floss. Fox plane. Denture Adhesive. Hand Mirror. Cup of water. Mold Chart. Denture tooth shade guide. Denture base shade guide.
Armamentarium Tongue blade. Baseplate Wax. Flexible Ruler. Waxing Instruments. Bunsen burner. Alcohol torch. Indelible transfer stick. Red-handled knife and a sharp blade. Green handled knife.
Prior to this appointment, the wax dentures are completed. All teeth are set properly and the wax-ups are festooned properly. Zero-degree, monoplane occlusions must have perfectly flat occlusal planes on both maxillary and mandibular dentures.
Flat planes should exist from the mid-buccal of the canines to the mesio-buccal of the first molars and from the mesio-buccal of the first molars to disto-buccal of the second molar on a plane turned approximately 20 o toward the palate from the first plane so that the buccal surfaces of all molars are in a straight line. This rule applies to both anatomical teeth and zero-degree teeth.
Mandibular posterior teeth must be set so that they are over the crest of the ridge, with zero-degree teeth set so that the central fossas lie directly over the crest and anatomic teeth set so that their buccal cusps are over this line. With severely resorbed ridges, lines are drawn from both sides of the retromolar pad and intersect at the canine. The teeth would be set so they fall between these two lines. Mandibular posterior teeth must be set so that they are over the crest of the ridge, with zero-degree teeth set so that the central fossas lie directly over the crest and anatomic teeth set so that their buccal cusps are over this line. With severely resorbed ridges, lines are drawn from both sides of the retromolar pad and intersect at the canine. The teeth would be set so they fall between these two lines.
The anterior teeth should not be placed further forward than a line drawn perpendicular to the occlusal plane from the middle of the labial vestibule.
1.The buccal surfaces of the maxillary posterior teeth must not be placed any more buccally than a line perpendicular to the occlusal plane drawn from the depth of the buccal vestibule. 2. If ideal positioning of the mandibular posterior teeth dictates that maxillary posterior teeth must be set more buccal than this rule allows, the maxillary teeth must be set in crossbite.
1.Zero-degree teeth set in a monoplane occlusal scheme is desired for all crossbite situations in the pre-doctoral clinic. 2.Denture teeth should not be set on maxillary tuberosities. 3.Denture teeth should not be set on the retromolar pad as this would create forces that would dislodge the denture anteriorly.
A Trubyte R Millimeter Rule will aid in enhancing the curvature of the arch and impart a more balanced look to a denture.
Things to Check Fit and Extension of Denture Bases. Labial Flange thicknesses in Frenum Areas. Posterior Palatal Seal Area. Posterior Tooth Positions: 1. Relation of Plane to Retromolar Pad. 2. Relation of plane to Ala-Tragus Line. 3. Tongue Space. 4. Ridge Relationship.
Things to Check VDO & VDRVDO & VDR Centric relation (CR)Centric relation (CR) ProtrusiveProtrusive Esthetics and phoneticsEsthetics and phonetics Posterior palatal sealPosterior palatal seal Physiologic rest positionPhysiologic rest position Phonetics and estheticsPhonetics and esthetics Ability to swallowAbility to swallow Compare to old denture.Compare to old denture.
Things to Check Positions of Anterior Teeth 1. Lip Support 2. Length 3. Relation to upper lip 4. Interpupillary line 5. Midline 6. Phonetic exercise: F sounds (length of max. anteriors). Wax-up. 1. Lip support. 2. External form.
Things to Check Vertical Dimension of Face. 1. Phonetic exercise: S sounds 2. Palatal contour 3. Swallowing Esthetics 1. Picket fence or chicklets appearance 2. Too much or too little of teeth show. 3. Color (Shade) 4. Size (mold, length & width) 5. Too much base material is visible.
Things to Check Positions of.Posterior Teeth 1. Is the occlusal plane parallel with ala-tragus line? 2. Does the occlusal plane allow the patient to move in protrusive relation w/o the maxillary posterior teeth contacting the heels of the mandibular denture? 3. Are posterior teeth set in an end to end relationship in occlusion? 4. Do premature occlusal contacts exist?
Things to Check Patient Instructions. 1. Dentures fit better than baseplates because the undercuts are blocked out. 2. The color of the denture base is selected to match the natural color of the patients gums. 3. There are only a few tooth shades available for denture teeth.
Esthetic Set-Up Factors: Tooth Alignment Golden Mean Anatomic Contours
Tooth Alignment Midline is centered with the patients face. Occlusal plane is parallel with the eyes. This is a computer-generated picture and is not a picture of an actual patient.
Smile Line Should follow the contour of the lower lip. Varies with each patient.
Smile Line Relaxed Positive Negative Esthetics Closest speaking space (CSS) is used for the final test to determine if the vertical dimension is correct. Different amounts of teeth are visible when the patient speaks than when they smile. Use s sounds Use s sounds Count from 60-70 Count from 60-70 CSS
Plane of Occlusion Anterior-Posterior Horizontal Orientation. Parallel With Patients Eyes Anteriorly.
In many people, the width of the six anterior teeth and the width of the nose are approximately the same. In many people, the width of the six anterior teeth and the width of the nose are approximately the same. This is a computer-generated picture and is not a picture of an actual patient.
Length of Maxillary Centrals Should lie just above the resting lip. Should contact the wet-dry line during speech (F,V sounds).
F and V sounds Fricative sounds: Patients should be able to make clear f and v sounds when the incisal edges of the maxillary central incisors contact the lower lip.
Maxillary anteriors are in harmony with lower lip. Maxillary anteriors are over-long and collide with the lower lip.
During the production of the Sibilants (s or z) sounds: a) The anterior and posterior teeth should not collide (no clicking). b)There should be no hissing or air loss (not sound like th). c)The closest speaking space should be 1.5 to 3 mm at the second molar region. d)The patient will move the jaw 2-3 mm forward during speaking. Sibilant Sounds
The plane of occlusion of a complete denture with the second molar left off to match the mandibular posterior teeth where there was insufficient room to set the mandibular molar without setting it on the rise to the mandible. The plane of occlusion of a complete denture with the second molar left off to match the mandibular posterior teeth where there was insufficient room to set the mandibular molar without setting it on the rise to the mandible.
Verify Centric Relation Insert dentures and hold lower in position with your index fingers. Insert dentures and hold lower in position with your index fingers. Retrude the mandible and close into centric relation. Retrude the mandible and close into centric relation. Observe any shift in the upper denture. Observe any shift in the upper denture. Look for even contact of the posterior teeth bilaterally. Look for even contact of the posterior teeth bilaterally. Note the separation of the posterior teeth in CR. This patients centric relation is incorrect.
Note the separation of the posterior teeth in protrusive in this patient. This situation would not work because denture would impact constantly on the anterior ridge, creating instability, and greatly increasing the rate of resorption. The diastemas between the teeth are permitted at the patients request or with their approval. Note the separation of the posterior teeth in protrusive in this patient. This situation would not work because denture would impact constantly on the anterior ridge, creating instability, and greatly increasing the rate of resorption. The diastemas between the teeth are permitted at the patients request or with their approval.
Soften a stick of compound over a Bunsen burner. Place the compound onto the occlusal surfaces of the mandibular posterior teeth. Temper the compound in a water bath set at the proper temperature (110 o ) and smooth it with your wet gloved finger. (140 o if green stick compound is used.) Verify Centric Relation
Make a centric relation record Recline the chair back, this will help retrude the mandible. Recline the chair back, this will help retrude the mandible. Stabilize mandibular base with your index fingers on the buccal flange and the thumbs under the mandible (bimanual technique). Stabilize mandibular base with your index fingers on the buccal flange and the thumbs under the mandible (bimanual technique). Rehearse closing with the patient. Rehearse closing with the patient. Have patient gently close into the compound just short of tooth contact Have patient gently close into the compound just short of tooth contact.
Remove and trim the record so that only the indentations from the cusp tips are present. Place the new record onto the master casts on the articulator. Make sure the articulator condyles are locked in centric position. Close the articulator. If the maxillary teeth contact the indentations exactly as they did in the mouth, you have proven that your original centric record was correct.
If the teeth do not contact the index exactly, remount the mandibular cast. Loosen the condylar locks. Set the teeth in the index. Drop the pin so that it contacts the table. Tighten the set screw. Remove the mandibular cast. Lock the articulator in centric. Remount the mandibular cast to the new record. Raise the pin so the teeth contact. Tighten the set screw at that point.
Function Evaluate: Vertical dimension Space available for tongue, lip-support, etc.
Esthetic Try-In Use of a small amount of denture adhesive is helpful in building patients confidence at the try-in stage.
Observe Maximum Intercuspation Centric occlusion should correspond with articulator.
Denture provides lip support in B as compared to A, leading to recovery of patients natural appearance. Lip Support Should Come From Labial Surfaces of Anterior Teeth. A B These pictures are computer-enhanced.
Proper contouring of dentures can significantly improve the physical appearance of the patient. These are computer-enhanced pictures and not pictures of an actual patient.
Evaluate The Relation Of Mandibular Teeth In Relation To Lower Lip. Mandibular anterior teeth should be positioned to contact lower lip.
Evaluate Cheek Contact. Teeth Should Be in Muscular Balance Between Cheeks and Tongue (Neutral Zone).
Evaluate Position of the Teeth Relative to the Tongue. Difficult to evaluate
Golden Proportion Mona Lisa Nature is asymmetric, but proportionate Parthenon Great Pyramids
Golden Proportion When viewed from the front each tooth differs from its neighbor by a ratio of 1.618 to 1.
Selective grinding or rearranging of the teeth can provide a much more lively and more natural appearance. Teeth may need recontoured to permit a proper overlap or contact. Esthetics Patient Approval/Acceptance Recontoring Get patient approval before you characterize anterior teeth. Standard setting & contouring
Standard arrangement Diastema A patient may desire to have a diastema placed in the same location that his natural teeth had a diastema.
Overlapping Mesiolingual rotation Crowding of the teeth may be desirable for the same reason.
Anterior setup follows the lip line Pointed canines Large incisal embrasures All these characterizations provide the patient with a youthful appearance.
Texture Look closely at the texture of the gingiva. What do you see? The denture wax-up is contoured to resemble natural tissue by festooning and stippling the wax. Attached gingivae – orange peel texture Attached mucosa - smooth Orange Peel Smooth
Check working (A) and balancing. (B) A B Should be finished and neat before seating the patient. Wax-Up Wax to ideal contour. Do not over-polish. (minimal polish of areas around teeth)
Facial support affected by: Position of the incisal edge Thickness and contour of the labial flange Gingival contours Without teeth With teeth Note the contour of the vermillion border region. These pictures are computer-enhanced.
Rotated right cuspid Pointed right lateral incisor Distal incisal edge of the right central has been recontoured Left cuspid is pointed Mesiofacial rotation of the left lateral Incisal edge of the left central has been flattened What do you see in this setup?
Posterior Nasal Spine Velum Glandular tissue Posterior Palatal Seal
Make points in the fovea palatina area and the hamular notch areas. Connect these points with a solid line. Place points in the glandular area 5-8 mm forward of this first line and about two mm anterior to the line at the mid palate. Draw a second line anterior to first in a butterfly pattern connecting these dots (looks like two mountains with a valley in between).
a)Carve the seal with a cleoid/disoid &/or #7 spatula or the back of a green-handled knife (best). b)It should be.5 mm deep in the middle of the posterior palate, 1 mm deep in the hamular notch area, and 1.5 mm deep in the glandular area between the hamular notch and the middle of the posterior palate. c)It should feather out to zero at the anterior line. d)It should not extend onto the tuberosities or onto a torus.
Check off list Check vertical dimension of occlusion and vertical dimension of rest. Prove centric relation record. Make protrusive record. Evaluate esthetics and phonetics. Mark the posterior palatal seal. *These procedures must be performed in the sequence listed above.