complete denture instructions to patients/ orthodontic practice

FITTING OF
FINISHED
DENTURE AND
INSTRUCTIONS
FOR PATIENT
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.comwww.indiandentalacademy.com

EXAMINATION OF THE FINISHED
DENTURES
Before fitting the dentures they should be inspected to
ensure that they have been correctly finished by the
technician, following points being most important:
1. The fitting surface must show no irregularities which
are not present in the mouth.
2. The entire periphery should be rounded and highly
polished except the back-edge of the upper denture and
the posterior lingual flange of the lower which should be
thinned down almost to a knife-edge; but perfectly
smooth and not sharp.
3. The edges of the relief area should be rounded and
not left square and sharpwww.indiandentalacademy.comwww.indiandentalacademy.com

Place the dentures, which have previously kept in
water, in the mouth and examine them as for the try-in.
Test the retention of the upper by placing a finger behind
the incisor teeth bringing pressure to bear in an outward
and upward direction. If the back-edge of the denture
has been correctly placed, considerable force should be
needed to break the peripheral seal. The retention will
increase after the patient has worn the dentures for a
few days, due to the adaptation of the soft tissues to the
denture.

CHECKING THE OCCLUSION
If the try-in has been done carefully, the
occlusion should be almost perfect. The
occlusion should be checked with articulating
paper; this is paper impregnated with a blue dye.
Place a piece between the teeth and ask the
patient to chew up and down in centric occlusion.
Remove the dentures from the mouth and
examine them .

The occlusal surfaces will exhibit areas of blue
coloration where the cusps and fossae of the
opposing teeth have been in contact. These blue
areas should be evenly spread over the occlusal
surface, and the coloration of them should be
uniform. Areas of Hard or uneven pressure will show
up as darker, and broader blue spots areas of low
pressure, or no contact at all as very lightly coloured
spots, or not coloured at all. To equalize the
pressure, the high spots should be lightly ground
(according to BULL law) with a carborundum stone.
The denture should then be washed to remove the
dye and a further test with articulating paper made,
and so on until occlusal balance is obtained.www.indiandentalacademy.comwww.indiandentalacademy.com

The Use of Wax Templates
Articulating paper has the disadvantage that it will colour a
tooth even if it only rubs lightly against it, and thus areas which are
not in occlusion are frequently marked. A more satisfactory way of
adjusting the occlusion is by using wax templates. The technique
of this is as follows: Two strips of pink wax 6 mm. wide, of either
single or double thickness, are softened and laid one on either
side of the lower denture on the occlusal surfaces of the posterior
teeth. The denture is then inserted in the mouth and the patient is
instructed to chew up and down on the wax with slow deliberate
movements. The lower denture is removed from the mouth, and
the wax templates chilled in cold water and gently removed from
the denture. If these templates are then viewed by transmitted
light, those areas where the occlusion is hard will be seen as
thinned, completely transparent wax; or even as a hole right
through the wax.

Another advantage of the templates is that, by fitting the
upper and lower dentures into their correct positions in one
template, the actual position of occlusion on the opposite side of
the dentures, as it exists in the mouth, may be observed, and
gross errors readily seen.
It requires to be emphasized that the even adjustment of
the occlusion is most important to the success of the dentures, as
uneven occlusion may cause soreness on the ridge, or in the
sulcus, in its immediate vicinity. This should not be overlooked if
a patient returns complaining of pain, because frequently the
periphery of a denture is blamed for what is in reality a fault of
occlusion.
Uneven occlusion will also increase the patient's difficulties
when attempting to eat with the new dentures because they will
feel uneven and uncomfortable when in occlusion.
To achieve perfection of occlusion a check record should
be taken, the dentures remounted on the articulator and the
occlusion ground in. www.indiandentalacademy.comwww.indiandentalacademy.com

FITTING ANATOMICALLY ARTICULATED
DENTURES
Check as for the try in. Test the articulation in
centric, lateral, and protrusive relations with articulating
paper and carry out a check record.
At the second visit, when the dentures have had
time to settle, the teeth should be ground in. Place a
strip of carborundum wax between the teeth and ask the
patient to chew, until satisfied that the articulation is
even. Although the wax holds the carborundum powder
firmly, it is important to caution your patient not to
swallow when grinding in the dentures as carborundum
powder in the stomach is an irritant. This is especially
important if tooth-paste is used as the vehicle.

FINISHED DENTURES EXHIBITING
AN INCORRECT CENTRIC
OCCLUSION
If the centric occlusion is discovered to be
incorrect at the finished stage, it may be due to a
slight retrusion of the mandible, i.e. the dentures
have been made to a slightly forward position. If
this is not more than a cusp it may be corrected
by means of a check record . When the error is
gross it will require the removal of all the
posterior teeth from the lower denture as follows:www.indiandentalacademy.comwww.indiandentalacademy.com

Gently flame the posterior teeth of the lower
denture playing the flame actually on to the porcelain
and not the acrylic base; conduction of the heat through
the porcelain softens the acrylic without burning it, and
the teeth may be prised off the denture. Wax blocks are
then built to replace the teeth, trimmed to the correct
height by trial, and the centric occlusion re-taken. The
dentures are then re-articulated, and the back teeth
reset.
If the over-jet resulting from the new record is
abnormal, the lower front teeth must also be removed
from the denture and reset. If acrylic posterior teeth were
used they are merely ground down and replaced with
wax blocks for the new registration. In most cases of
gross error the denture needs to be completely re-made.

INSTRUCTIONS
FOR PATIENT

Any prosthesis constructed to replace
missing teeth, restore the ability to speak and
eat, provide a pleasing cosmetic appearance,
and prevent further loss of teeth and residual
bone. A prosthesis however does not accomplish
these objective automatically, the patient and the
dentist must work together to accomplish these
goals.

Prosthetic failures can result from a
misunderstanding between the dentist and patient
in regard to the treatment result. Patients may have
unrealistically high expectations at the beginning of
complete denture treatment. A thorough patient
education program should begin with the initial
patient visit and be interwoven throughout denture
construction. Patient education should help create
a positive attitude for proper oral and denture
hygiene. www.indiandentalacademy.comwww.indiandentalacademy.com

The ultimate acceptance or rejection of a
denture is dependent on the attitude of the patient.
The primary attitudinal determinant may be
whether the actual result of denture service is
consistent with the expected result. For this reason
it is necessary to condition the mind of the patient
to anticipate and accept reasonable goals.

Patient- Physiologic aspects
Psychological aspects
Prosthodontist
(skill)
Materials
Technique Post insertion
instructions
COMPLETE
DENTURE FAMILY

Communication is essential because it
is an act of sharing. It is a participation in a
relationship that involves a deep
understanding of the patient. It includes an
ability to listen, empathize, and ultimately
establish a trusting doctor/patient
relationship.

THE NATURE OF COMPLETE DENTURE
MODELS OR DIAGRAMS
NATURAL TOOTH
Root
Mastication of tough
DENTURE
Rest on a wet,
slippery mucosa
Masticatory force is
taken by interposed
tissue
Proprioceptive
mechanism is not there
Vs
food is possible
Proprioception

These comparisons are made not
to discourage the patient but to
give him or her the understanding
of the physical and mechanical
limitations that are present in
denture prosthesis.

DENTURE HYGIENE
The formation of stain on a denture and
the development of odors are causes for
concern and anxiety for most denture patients.
Plaque formation on the fitting surface of denture
is the cause of denture stomatitis.

1. Rinse under running cold water to remove debris
after eating.Very hot water may cause warpage.
2.Immerse in an effective cleansing solution at least
once each day, preferably overnight.
Brushing in the morning when the denture is
removed from the solution will remove debris
loosened by the action of the cleaning solution.

3.The denture should be brushed over a basin
partially filled with water or covered with a wet
wash cloth to prevent breakage in case they are
dropped.

TISSUE HYGIENE AND MASSAGE
Rinsing the mouth is recommended each time
the dentures are removed for cleaning.
The basal seat mucosa and tongue should be
brushed and massaged to clean the tissues and
stimulate the circulation.

A soft brush applied to the oral tissues, using
long posterior-to-anterior strokes, will remove
surface debris, and the sides of the bristles of the
same brush can be used to deliver vibratory
stimulation to the mucosa. As an alternative to the
brush for tissue massage, the thumb may be used
in the palatal vault areas and an index finger may
be used for the other surfaces.

TISSUE REST
Patient should be advised that the oral tissue
were never indented to be covered or to support a hard
denture base. All occlusal forces are compressive to
the soft tissue and squeeze the tissue between the
denture and bone. Removing the denture at night
allows the oral tissue to offset the daily stress placed
upon them. Failure to allow the tissue to recover
from these forces may result in soreness and
irritation.
If clenching or grinding - remove the mandibular
denture periodically during the daywww.indiandentalacademy.comwww.indiandentalacademy.com

EXCESS SALIVA
New dentures are often interpreted as
foreign objects by the oral system. This leads to
stimulation of salivary glands to produce saliva.
Patient should be assured that this overflow of
saliva is a normal reaction to new dentures and
will decrease over the next few weeks.
Patients should be advised that compulsive
rinsing or spitting should be avoided, as it is
unsettling to the denture.

SPEECH
Speech production depends on valving of
the tongue, lips, teeth and palate. Because the
contour of the valve is often changed in a new
prosthesis, a slight difference in speech is to be
expected initially.
Patient should be encouraged to read aloud
while at home. Speech will attain the natural tone
and fluency within few weeks.

MASTICATION
The dentist should stress to the patient that
mastication with denture is a developed skill. Some
people learn quickly than others.
The food should be cut into small pieces and only
a little placed in the mouth at a time.
Bilateral Chewing with the posterior teeth should
be mastered. This also aids in distributing the forces
of mastication to both sides of the residual ridge.
Soft and non-sticky foods are easier to eat than
the more fibrous types.

TONGUE POSITION
The most common complaint of complete
denture patient is “loose” mandibular denture.Many
of these problems is due to lack of understanding of
the special problem associated with mandibular
complete denture.
The mandibular denture is smaller, covers less
area, and has more border than the maxillary
complete denture, making it difficult to provide
adequate suction.
The mandibular denture is surrounded lingually
and buccally by muscle.www.indiandentalacademy.comwww.indiandentalacademy.com

The mandibular denture depends on proper tongue
position to maintain adequate peripheral seal and
stability
To determine whether the patient has proper tongue
position
Ask the patient to open just wide enough to
accept food. Only the dorsal surface of the tongue and
the occlusal surfaces of teeth should be seen. In this
position, the tongue is in intimate contact with the
lingual surface of denture and the floor of mouth is at
a normal level. At this position mandibular denture will
be stable. www.indiandentalacademy.comwww.indiandentalacademy.com

If the occlusal surface of teeth, lingual
surface of the denture, and the anterior floor of the
mouth is seen, the tongue is in a retracted
position. The denture will be unstable, have no
retention and will be easily dislodged.
Proper tongue position Retracted tongue positionwww.indiandentalacademy.comwww.indiandentalacademy.com

Management
1.Make the patient aware of the proper tongue
position.
2.Demonstrate the proper tongue position and the
subsequent increase in denture retention and
stability while the patient looks in a mirror.

POST INSERTION CARE
At least 3 visits over a period 2 weeks.
First visit within 48 hours.
Second visit is 3 or 4 days later.
The final observation before placing the patient on
a recall basis is at least a week after the second
visit. www.indiandentalacademy.comwww.indiandentalacademy.com

It is difficult for even the most skilled dentist to
completely satisfy the physical and/or emotional
needs of every individual who requires complete
dentures. If the dentist convince the patient that “
Everyone is an individual, every mouth is unique,
every prosthesis is different, and the ability to
learn to use a prosthesis differs” she/he have a
better chance of success with the prosthesis.
CONCLUSION

We should understand that many
problems require “patience with patients”
through effective communication and listening
to their needs.

THANK YOU
For more details please visit
www.indiandentalacademy.com

complete denture instructions to patients/ orthodontic practice

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