Complete Dentures Overview

Preliminary Differences Between Natural Teeth and Complete Dentures

• Natural teeth are held by the periodontal ligament (PDL), allowing slight movement and acting as a shock absorber.
• Complete dentures rest on soft, movable tissues, resulting in potential displacement and trauma to supporting structures from premature deflective contacts.

Healing Processes After Extractions

• Maxillary arch heals by moving "up and in."
• Mandibular arch heals by moving "down and out."

Space Considerations for Dentures

• Space of Donders: area between the tongue's dorsum and the palate.
• Limited space for accommodating dentures is described as very restrictive.

Goals of Complete Denture Occlusion

• Minimize trauma to supporting structures.
• Preserve remaining structures and enhance stability of dentures.
• Restore aesthetics, speech, and mastication in that order of priority.

Key Components of Denture Functionality

• Three staples of dentures: support, stability, and retention.
• Balanced occlusion involves simultaneous contact between maxillary and mandibular teeth during various jaw movements.

Maxillary and Mandibular Occlusal Rim Goals

• Maxillary rim should contour for phonetics and aesthetics, resting slightly below the lip line.
• Mandibular rim should maintain contact with the maxillary rim, incorporating a horizontal overjet of 1-2mm.

Understanding Vertical Dimension (VD)

• Vertical dimension is the distance between two selected points, maintained through occlusion (OVD) or muscle contraction (VDR).
• Establishing the correct OVD requires careful measurement and patient feedback.

Interocclusal Distance

• Defined as the difference between VDR and VDO, typically ranging from 2-4mm.
• Inadequate or excessive interocclusal distance can lead to improper occlusion and functional issues.

Recording Centric Relation (CR)

• CR represents the jaw position when condyles articulate with the thinnest part of their discs, requiring correct OVD for proper records.
• Alu-wax is an interocclusal recording medium used to capture accurate relationships during CR.

Tooth Selection Factors

• Anterior teeth selection involves considerations of width, shape, size, and character consistent with the patient's facial features and age.
• Available materials for dentures include porcelain, plastic, and Interpenetrating Polymer Networks (IPN), each with distinct characteristics.

Anterior and Posterior Teeth Characterization

• Anterior teeth should align with the smile line; characterizations should reflect the patient’s personality and age.
• For posterior teeth, factors influencing selection include material, size, and occlusal height aligned with interarch distances.

Importance of Occlusal Rims

• Occlusal rims function as occluding surfaces that assist in achieving maximum intercuspation records and guide tooth arrangement.
• Placement of guidelines on occlusal rims is crucial for the final aesthetics and function of the complete denture.

Guidelines for Tooth Arrangement

• The arrangement must follow the arch's contour; maxillary and mandibular teeth should interdigitate properly.
• Canine positioning is key for ensuring proper bite registration and aesthetics.

Role of Aesthetics in Denture Design

• Aesthetic considerations include gingival heights variation based on tooth type, with meticulous attention to natural appearance and age appropriateness.
• Staining methods can also be used to enhance natural looks, especially on common staining areas like incisal edges.

Laboratory Communication

• Essential information for the lab includes patient demographics and existing structures to facilitate quality denture fabrication tailored to individual needs.

Final Considerations

• The balance of functional, aesthetic, and physical attributes in denture design is essential for patient satisfaction and effective oral function.
• Continuous evaluation of denture placement and function throughout the fitting process ensures optimal results.