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Presentation on theme: "REVISION (1) B.M.C."— Presentation transcript:



3 Prosthodontics (Prosthetic Dentistry)
Prosthetics The art and science of supplying artificial replacement for missing parts of the human body. Prosthesis An artificial replacement of an absent part of the human body. Prosthodontics (Prosthetic Dentistry) It is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation & maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing/deficient teeth &/or maxillofacial tissues using biocompatible substitute.

4 Components of complete denture
2 1 1- Denture base 2- Artificial teeth

5 Denture surfaces 1- Denture basal surface:

6 2- Denture polished surface:

7 3- Denture occlusal surface

8 Steps of Complete Denture Construction
Clinical Laboratory 1. Examination & Diagnosis 2. Primary impression Study cast Special tray 3. Final impression Boxing and pouring  master cast Occlusion blocks 4a. Jaw relation registration 4b. Selection of artificial teeth Mounting on articulator Setting of artificial teeth and waxing up 5. Try in Processing 6. Insertion 7. Post insertion care

9 Objectives of complete denture
1-Restoration of the function of mastication to restore the normal digestive process 2- Appearance (esthetics) restoring the normal appearance of the face especially the lower third of the face.

10 3- Correction of speech defects
►Loss of teeth (especially anteriors) Speech Defects ►The artificial teeth should be placed in a position previously occupied by the natural teeth. 4- Preservation of the remaining tissues

11 5- Patient Satisfaction


13 Changes That Happen After Teeth Loss :
Face :

14 Anatomical Landmarks In Relation To Complete Denture :
Extra Oral Landmarks Inter pupillary line Ala Tragus Line Naso – Labial sulcus Modulus Labiomental sulcus

15 Anterior Occlusal Plane Determination
Inter pupillary line Anterior Occlusal Plane Determination Ala Tragus line Posterior Occlusal Plane Determination Naso – Labial sulcus Becomes deeper with age and with loss of teeth Modulus Become Flat With The Loss Of Teeth Labiomental sulcus Classes of jaw relations

16 Intra Oral Landmarks Incisive Papilla Denture Bearing areas / Upper
1 . The incisive papilla is a thick part of the mucous membrane covering the incisive foramen. 2 . It is located at the anterior end of the median palatine raphae . 3 . The nasopalatine nerves and vessels pass through the incisive foramen to supply the anterior 2 / 3 of the palate. 4 . In some cases due to the excessive bone resorption, the papilla may lie on the crest of the ridge. 5 . The incisive papilla should be relieved to avoid pressure on the incisive nerves and vessels. CAUSING BURNING SENSATION IN THE ANT. 2/3 OF PALATE

17 Denture Bearing areas / Upper
Palatine Rugae Raugae Area 1 . It is an irregularly shaped elevations of soft tissue extending laterally from the midline in the anterior part of the hard palate. 2 . It serves as one of stress bearing areas in the palate .

18 Denture Bearing areas / Upper
Median Palatine Raphae Median Palatine Raphae 1 . The midline of the hard palate is covered by a thin layer of mucoperiostium , that covers the median palatine suture . 2 . That suture joins the right and the left halves of the hard palate. 3 . It is usually relieved to increase denture stability by preventing its rocking .

19 Denture Bearing areas / Upper
Fovia Palatina Fovia Palatina 1 . It helps in the determination of the posterior border of the upper denture. 2 . The posterior border of the upper denture should be 2 mm posterior to the fovea Palatina .

20 To Continue ( Bearing Areas)
Residual Alveolar Ridge Residual Alveolar Ridge 1 . It should be firm specially in the lower ridge . 2 . It covers the crest of the lower ridge. 3 . Its mobility may cause pressure symptoms under the lower denture. 4 . Also can affect denture stability .

21 To Continue ( Bearing Areas)
Buttress Part Of Bone Buttress Part Of Bone 1 . It is formed of the lower portion of the zygomatic process of the maxilla (the area above the first molar teeth) . 2 . It provides excellent resistance to the vertical forces(Support).

22 To Continue ( Bearing Areas)
Tuberosity Tuberosity 1 . It is important for retention and support of the upper denture against lateral movement. 2 . The denture should cover it , because it is one of stress bearing areas in the upper jaw .

23 To Continue ( Bearing Areas)
Immovable Part of Soft Palate Immovable Part of Soft Palate 1 . The immovable part lies adjacent to the hard palate and the movable part lies more posterior. 2 . The posterior edge of the upper denture should end at the junction of these two parts .

24 Denture Limiting Structures (Upper)
Labial Frenum Labial Frenum It must be relieved in the denture by making a V-shape notch in the labial flange opposite to its position .

25 Denture Limiting Structures (Upper)
Labial Vestibule Labial Vestibule 1 . It Is the reflection of the mucosa of the lip to the mucosa of the alveolar process in the labial vestibule. 2 . The denture in this area is in relation to the orbicularis oris and the superior incisive muscles . 3 . These muscles limit the thickness and the length of the labial flange of the denture.

26 Denture Limiting Structures (Upper)
Buccal Frenum Buccal Frenum 1 . It is a fold of mucous membrane (tendon of the buccinator muscle) varies in size in number and in position . 2 . A notch is made in the denture flange opposite to its position to facilitate its functional movements.

27 Denture Limiting Structures (Upper)
Buccal Vestibule Buccal Vestibule 1 . The denture in this area is related to buccinator muscle. 2 . Buccal flanges must extend in the buccal vestibule . 3 . Due to the horizontal direction of the fibers of this muscle; the contraction of this muscle will not displace the denture.

28 Denture Limiting Structures (Upper)
Hamular Notch Hamular Notch 1 . It is one of the important landmarks for determination of the posterior limit of the upper denture . 2 . A straight line from hamular notch on one side to the other on the other side determines the posterior limit of the upper denture

29 Denture Limiting Structures (Upper)
Vibrating Line ( Ah Line) Vibrating Line ( Ah Line) 1 . It separate the movable part from the immovable part of the soft palate. 2 . This line is 2mm posterior to the fovea palatine . 3 . This line determines the posterior end of the upper denture.

30 Denture Bearing and Limiting Structures (Lower)
Retro Molar Bad Retro Molar pad 1 . It is a pear shaped area of mucous membrane at the posterior end of the mandibular ridge and anterior to the pterygo­mandibular raphae . 2 . It consists of mucous glands , temporal tendon , fibers of the buccinators and superior constrictor muscle . 3 . Lower denture should cover this area for retention and to cover the buccal shelf of bone.

31 Denture Bearing and Limiting Structures (Lower)
Buccal Shelf Of Bone Buccal Shelf Of Bone 1 . The area that lies between the crest of the residual ridge and the external oblique ridge. 2 . It is the primary stress bearing area in the lower arch . 3 . It forms good support for the lower denture .

32 Denture Bearing and Limiting Structures (Lower)
Buccal Vestibule Buccal Vestibule 1 . The denture in this area is related to the buccinator muscle . 2 . Its contraction does not displace the lower denture so flanges of the lower denture must extend in the buccal vestibule.

33 Denture Bearing and Limiting Structures (Lower)
Buccal Frenum Buccal Frenum 1 . It is a fold of mucous membrane in the premolar area, movement of the lip and the cheek move the frenum . 2 . A notch is made in the lower denture to accommodate the frenum.

34 Denture Bearing and Limiting Structures (Lower)
Labial Frenum Labial Vestibule Labial Frenum Labial Vestibule

35 Denture Bearing and Limiting Structures (Lower)
Residual Ridge Residual Ridge

36 Denture Bearing and Limiting Structures (Lower)
Lingual Pouch Lingual Pouch More posteriorly the lingual flanges are related to the lingual pouch with its boundaries which are : Posteriorly : The palatoglosssus muscle . Anteriorly : The Mylohyoid muscle. Medially : The tongue . Laterally : The medial aspect of the mandible.

37 Denture Bearing and Limiting Structures (Lower)
Sublingual salivary gland area Sublingual salivary gland area The lingual flanges of the lower denture should not extend in this area because with excessive resorption of the mandible the gland may bulge superiorly above the body of the mandible.

38 Denture Bearing and Limiting Structures (Lower)
Lingual Frenum Lingual Frenum 1 . More anteriorly a fold of mucous membrane attach the mucosa of the tongue to mucosa of the floor of the mouth 2 . It moves with the movement of the tongue so a notch is made to accommodate the frenum.


40 Types of Trays I- Stock trays II- Custom trays (Special, Individual trays)

41 The body and handle are designed to suit different mouths
1-Dentulous mouth cases . 2-Edentulous mouth cases 3-Partially edentulous mouth cases.

42 Types of special trays 1- Shellac base plate special tray 2- Acrylic resin custom (special) trays: a- cold cured b- heat cured c- light cured Both heat and cold cured are used widely now. It is rigid and light in weight, not wrap in the mouth . 3- Cast or swaged metal tray 4- Vacuum formed plastic sheets It needs a pressure forming machine

43 Comparison between shellac and acrylic resin custom trays
Shellac base plate special tray Low strength. 2. Easily distorted by load and temperature. 3. Improper adaptation to the cast 4. Easily constructed Self-cured acrylic resin special tray Higher strength and rigidity. Not distorted by temperature. Well adapted 4. Easily constructed

44 Tray can be 1- with a spacer 2- without a spacer

45 SHIM OR SPACER “ One thickness of modeling wax or shellac base plate adapted on the study cast under the special tray “

46 Custom Tray With Spacer

47 Impression Impression is a negative likeness or copy. Cast is a positive copy

48 Preliminary (primary) impression
Is defined as: a negative likeness made for the purpose of diagnosis, treatment planning, or fabrication of a special tray. Preliminary (study) cast is defined as: a cast formed from a preliminary impression for use in diagnosis or the fabrication of a special tray.

49 Final (secondary) impression
“The impression represents the completion of the registration of the surface or object. It is an impression which is used for making definitive (master) cast. “


51 Boxing the impression An impression is boxed to preserve the borders of the impression so that it will be accurately reproduced in the cast.

52 Methods for boxing 1- Wax method 2- Plaster and Pumice method

53 Beading wax for boxing 1- Wax Method

54 1-wax method

55 1-wax method Lower impression

56 2-Plaster and Pumice method Plaster and pumice for boxing

57 2-Plaster and Pumice method Upper impression

58 Advantages of boxing 1- The borders of the impression are preserved. 2- The thickness of the base can be controlled 3- It permits vibrating, prevents air bubbles and gives us denser cast. 4- Time for pouring the cast is conserved. 5- Materials are conserved.


They help in 1- Supporting the lips and cheeks to restore the contour of extraoral landmarks. 2-The orientation of the occlusal plane. 3- Determining the vertical dimension. 4-Recording the centric and eccentric jaw relations.

61 Cont. Uses of the Occlusion Blocks
5- Selecting the size and position of the artificial teeth by the aid of the following markings : a- Midline b-High lip line c- Canine line 6-Providing a matrix for arranging teeth.

62 Cont. Trial Denture Bases
Types Temporary 1- Shellac 2- Autopolymerizing and light cured acrylic resin 3- Vacuum formed vinyl or polystyrene 4- Baseplate wax 5- Swaged tin Permanent 1- metallic gold alloys cobalt chromium alloys 2- non-metallic heat cured acrylic resin


64 1-Median palatine raphae 2-Torus palatinus {if present}
Relief areas Hard Prominent areas Maxillary Mandibular Sensitive areas 1-Median palatine raphae 2-Torus palatinus {if present} *Torus mandibularis {if present} *PROMINENT Genial tubercles. *PROMINENT Mylohiod ridge. 1-Incisive papilla 2-Rugae area 3-Flabby ridge 4-Sharp bony spicules 1-Mental foramen in resorbed ridges 2-Flabby ridge 3-Sharp bony spicules

65 Shape of Relief Area It is never well defined. It merges into the surrounding fitting denture surface. Depth of Relief: It depends on the compressibility of the area to be relieved as well as that of the surrounding areas.

66 Methods of Relief I- Direct 1-Scrap the final impression 2-Build tin foil on the master cast II- Automatic

67 I- Direct Relief 1- Scraping the Impression

68 I- Direct Relief 2- Build on the cast

69 II- Automatic Relief (Selective Pressure Impression Technique)
B- Secondary impression in Zn/O eugenol or plaster. A- Scraping the compound selectively.

70 Value of Relief Relief of sensitive areas increases the comfort of the patient. Relief of hard areas improves the denture stability, so it Prolongs the duration of denture service by compensating for denture settling and some ridge resorption . Compensate for polymerization shrinkage.

71 Position of the Post dam area
Posterior vibrating line

72 Functions of posterior palatal seal
Retention of maxillary denture. Prevents food accumulation under the denture. Compensates for polymerization shrinkage. Reduces patient’s discomfort.

73 Width of post dam area

74 Depth of Post Dam Depends on the degree of compressibility of soft tissue in this area and on the extent of functional movement of the soft palate.

75 postdamming Methods of 1-Scraping method 2-Functional method

76 Methods of post damming
1-Scraping method

77 Methods of post damming
2- Functional method

78 Methods of post damming
2- Functional method



81 A close up view of the joint

82 Basic mandibular movements
Rotation in the lower compartment Translation in the upper compartment

83 Possible Mandibular Movements
They are usually classified according to the main direction of movement. The starting position is the habitual intercuspal position, from this point the mandible can move into: Opening and Closing Movement Lateral Movement Forward & Backward Movement

84 B A L N C I G W O R K I N G

85 The inclination of the condylar path
Types : A- Sagittal ( HORIZONTAL) condylar path angle B- Lateral condylar path angle

86 No Translation

87 Translation



90 Border Positions of the Mandible


92 Jaw Relation “ It is any relation between the mandible
and the maxilla.” It is a three dimensional relation ( vertical, anteroposterior and lateral).


94 Vertical dimension Two types are identified: 1- VDR
“ The measurement, when the mandible is in the physiologic rest position.” . 2- VDO “ The measurement , when the teeth or occlusion rims are in contact.”

95 The interocclusal distance
“ It is the difference between the VDR and the VDO. In normal individuals its average value is 2-4 mm. It is also termed interocclusal clearance, gap &/or freeway space.”

96 Short term variables 1- Head position 2- Respiration 3- Stress
Variables of the VDR Short term variables 1- Head position 2- Respiration 3- Stress Long term variables 1- Loss of propiceptors  decrease 2- Age decrease

97 Sequalae of Improper Vertical Dimension of Occlusion

98 Jaw relation record (Maxillomandibular relationship record)
“It is a registration of any positional relationship of the mandible relative to the maxilla.” Records have to be obtained before casts are mounted on the articulator using the ??????.

99 Importance of recording the jaw relation

100 1- Terminal hinge axis method

101 2- Chew in technique

102 3- Graphic tracing method

103 The resulting arrow represents
the centric and eccentric relations

104 4- Check bite technique (Wax wafer method)


106 “A device used to locate the transverse hinge or the condylar axis.”
Types of Face Bows Mandibular “A device used to locate the transverse hinge or the condylar axis.” Maxillary “A device used to record the relation between the maxilla and the TMJ ( terminal hinge axis or condylar axis) and to transfer this relation to the articulator.”

107 Maxillary Face Bow Components: Graduations on the rod Graduated
Condylar Rods Infraorbital Pointer Bite Fork Tightening clamp Universal Joint / Jack Clamp U Shaped Bow

108 Maxillary Face Bow Record
1- Bite fork is heated and inserted into the rim .

109 Cont. Maxillary Face Bow Record
mm 2-The condylar axis is then determined either accurately or arbitrary on the canthus tragus line.

110 Cont. Maxillary Face Bow Record
4- Universal joint once tightened , never opened.

111 Maxillary Face Bow Transfer
1- The slide bar clamp is unscrewd to remove assembly from the face.

112 Cont. Maxillary Face Bow Transfer
2- Assembly is now centralized on the articulator.

113 Mandibular Face Bow Limited opening and closing allows the condylar rods to draw arcs. The rods are moved towards the center of the arcs, until they move in a point . The latter is called the still point and represents the condylar axis. The condyle in this position lies in the most retruded unstrained position in the glenoid fossa, so mandible and maxilla are in centric.

114 ARTICULATORS The articulator is a mechanical device which represents the temporomandibular joint and jaw members to which maxillary and mandibular casts may be attached..

115 Functions of Articulators 1- Helps in maintaining the desired jaw relationship of the cast during setting up of the teeth in the absence of the patient reproduces the mandibular movements.

116 Types Of Articulators Simple Hinge Articulator Mean (Average )Value or Fixed Condylar Path Articulator : Adjustable Articulators : A- Semiadjustable condylar path articulators B- Fully adjustable condylar path articulators

117 1- Simple hinge articulator
Eg. Gariot’s articulator

118 2- Mean (average) value or fixed condylar path articulator
Eg. Gysi and El Mahdy articulator

119 Mounting the upper cast by a face bow record

120 Bonwill triangle Method

121 3- Adjustable articulators a- Semiadjustable condylar path b- Fully adjustable condylar path

122 A- Semiadjustable articulator
Eg. Hanau model H articulator

123 A- Semiadjustable condylar path angulation articulator
Can accept the following records 1-Face bow record to mount the upper cast 2- Centric occluding relation record to mount the lower cast 3- Protrusive record to adjust the articulator’s horizontal condylar path inclination 4- lateral condylar angulation adjusted according to Hanau’s formula L=H/8+12

124 B- Fully adjustable articulator Both horizontal and lateral inclinations are adjusted according to the records taken from patient mouth 1-Face bow record to mount the upper cast 2- centric occluding relation record to mount the lower cast 3-protrusive record to adjust horizontal condylar guidance 4-Right lateral record to adjust the left lateral condylar path angle 5- Left lateral record to adjust the right lateral condylar path angle

125 Adjustable Condylar Path
Articulators Simple Hinge (plain) Fixed Condylar Path Adjustable Condylar Path Semi Adjustable Fully Adjustable Movements Performed Opening and Closing 1) Opening and Closing. 2) Protrusive movement at fixed horizontal condylar path angle.(30°- 40°) 3) Lateral movement at fixed lateralcondylar path angle.(12°- 20°) 1) Opening and Closing. 2) Protrusive according to patients horizontal condylar path. 3) Lateral movement as adjusted from hanau formula. Hanau Formula: L=H/ L= Lateral Condyler Path Angle. H= Horizontal Condylar Path Angle. 1) Opening and Closing. 2) Protrusive according to patient's horizontal condylar path. 3) Lateral movement according to patient's later condyler path. Records Needed to Mount the Upper and Lower Casts. Centric Occluding Relation. 1) Maxilary Faced Bow to mount upper cast. 2) Centric Occluding Relation to mount lower cast. N.B; In some types upper cast can be mounted by Bonwell Triangle. 1) Maxilary Faced Bow to mount upper cast. 2) Centric Occluding Relation to mount lower cast. 3) Protrusive record to adjust horizntal condylar path angle of the articulator. 1) Maxilary Faced Bow to mount upper cast. 2) Centric Occluding Relation to mount lower cast. 3) Protrusive record to adjust horizntal condylar path angle of the articulator. 4) Right lateral record to adjust left lateral condylar path. 5) Left lateral record to adjust right lateral condylar path. Examlpes Gariot's Articulator El Mahdy Articulator Hanau Model H Hanau Kinoscope N.B; -In most designs of this type, the upper member is movable while the lower member is stationary. -Therefore the upper member moves backwards and upwards to simulates patients mandible in protrusion. -This reverse nature of articualtors provides a firm base to facilitate arrangement of teeth.

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