Denture Placement Techniques Quiz

Prosthodontics - Sheet #14

• Denture Insertion Procedure:
  • Final denture is delivered in a sealed plastic bag with tap water after lab procedures.
  • Denture evaluation should occur: outside the patient's mouth, inside the patient's mouth, for occlusion, and instruction to the patient.
  • Prior to insertion, the patient should remove their old denture for 12-24 hours.
  • Common error sources in complete dentures include: dentist errors, laboratory errors, material deficiencies, and biological factors.

Prior to Appointment

• Extraoral Examination:
  • Inspect for sharp areas on the denture using gauze.
  • Smooth out any sharp edges or angles using appropriate techniques.
  • Blend angular changes on the denture's periphery.
  • Inspect the posterior border. Ensure a gradual tapering of the posterior border to the soft palate (2-3 mm thick).

Order of Adjustments

• Check and Adjust:
  • Evaluate base fit using pressure-indicating paste (PIP).
  • Check peripheries with PIP (one side at a time).
  • Check occlusion using articulating paper.
  • Clinically remount if necessary.
  • Account for esthetics and phonetics, patient concerns.

Insert Maxillary Denture First

• Adaptation Check:
  • Evaluate the denture's comfort and resistance to seating. Identifying potential adjustment areas.
  • Use pressure-indicating paste (PIP) to check for proper adaptation of the denture base.

Clinical Remount (if necessary)

• Indications: Not always required. Usually with gross errors and non-cooperative patients, but otherwise done chair-side.
• Procedure: Dentures are remounted on an articulator to allow adjustments, avoid complications associated with removal/replacement in the patient's mouth.

Remounting Maxillary Dentures

• Procedure: Carefully place a remount jig, seat the remount index on the jig, seat the maxillary denture in the index, and mount the cast into the denture using plaster.

Record Centric Relation

• Procedure: Record the relationship between upper and lower dentures using a small amount of bite registration material. Ensure precise and repeatable recording, with no penetration of material. Soften modelling compound in a water bath (110°F).
• Placement into water bath Mandibular denture placed in water bath for 10 seconds, then place the lower denture intraorally, and guide the patient into centric relation just short of tooth contact. Once complete, remove the CR record.

Maintaining Accuracy and Appearance

• Trimming: Trim excess material, carefully and precisely, only removing cusp tip indentations
• Visually Checking: Visually verify the accuracy of the seating of the dentures.

Mounting Mandibular Cast

• Procedure: Mount the mandibular cast based on the interocclusal relation recorded. Interdigitate the dentures and stabilize them with sticky wax.

Selective Grinding

• Procedure: Use articulating paper, progressively thinner, to ensure smooth, simultaneous, bilateral centric contacts, on posterior and anterior teeth.

Balanced Occlusion

• Ensure balanced contacts are present during all movement.
• Intensity: Ensure that contacts are not heavier than the working contacts.
• Grazing: The contacts of anterior teeth are light grazing (minimal).
• Vertical Dimension: Verify vertical dimension (2-4 mm interocclusal distance).

Phonetics

• Checking Sounds: Check 'F' and 'S' sounds for proper phonetics.

Polish Adjusted Areas

• Use Brasseler Acrylic Polishing compound and Dazzle Paste to ensure the denture is clean, smooth and non-discolored.

Provide Care Instructions (Post Insertion Instructions)

• Instructions: Include instructions on mastication and speaking, as well as oral and denture hygiene.

Summary - Denture Base

• Retentive: The base should be retentive, non-displaceable under moderate vertical pressure.
• Extension: Flange extension should be appropriate (medium extension, no areas of significant impingement).
• No spicules/sharpness: No spicules, smooth and well-polished.
• Thickness: Proper flange thickness (generally not > 4-5 mm, rolled, not sharp).
• Frenula: Proper relief for frenula.
• Landmarks: Base should terminate at anatomical landmarks.
• Patient Comfort: Ensure that the patient is comfortable.

Summary - Occlusion

• Contacting Posterior Teeth: Posterior teeth contacting bilaterally/simultaneously, no shifting.
• Contact in Eccentric Positions: Acceptable degree of balance evident in centric, eccentric positions.
• Interocclusal Space: Acceptable interocclusal space.
• Anterior Tooth Contact: Anterior teeth should not be in contact in centric occlusion.
• Grazing Contact in Protrusion: Grazing contact in protrusion.
• Esthetics & Phonetics: Acceptable phonetics and esthetics.

Post-Insertion Problems

• Denture Base: Common issues include impingements, spicules, sharp edges, soreness, and inflammation.
• Occlusion: Problems include pain, difficulty in determining the cause, avoidance of certain movements, discomfort when biting.
• Retention: Problems with retention include short flanges, altered lip-seal, difficulties in maintaining tissue contact or inadequate tissue contact.
• Vertical Dimension: Vertical dimension problems may result in excessive pressure, fatigue, and muscle soreness, or insufficiency (difficulty in biting).
• Occlusal Vertical Dimension: Excessive or insufficient occlusal vertical dimension leading to pain and difficulty biting.
• Allergies and Infections: These can manifest as generalized inflammation.
• Tooth Position: Instability or improper tooth position can lead to complications during chewing.

Most Common Areas Requiring Adjustments

• Maxillary: Hamular notches, labial frenum, mid-line fulcrums, zygomatic impingement.
• Mandibular: Lingual frenum, retromylohyoid overextension (sore throat, changes in posture), buccal shelf overextension, phonetic problems.