9-try in stage in complete denture..ppt

try in complete denture

1. Dr Huda Omer

2. Checking on the articulator
(extra-oral):
 Check the
articulator
 Check the casts
 Check trial denture
bases
 Check the teeth
Checking the trial denture in the
mouth(intra-oral):
 The upper trial denture alone
a.Extension of denture base and post
dame area
b.Retention and comfort
c.Stability to occlusal stresses
d.Orientation of occlusal plane
e.Facial support
 The lower trial denture alone
a.Extension of denture base
b.Retention and comfort
c.Stability to occlusal stresses
d.Neutral zone &Tongue space
e.height of the lower occlusal plane
 Both dentures together
a.Vertical dimension
b.Centric occluding relation
c.Evenness of occlusion
d.balanced occlusion
 Appearance.
 Phonetic tests.
Try-in StageTry-in Stage

3. Extra oral evaluation
(Checking the denture on articulator)
1- Checking the articulator
The articulator should move smoothly
from centric to eccentric without
interlocking of teeth
The trial denture base are stable in
their casts.
2-Check the cast
The castes should be good in shape.
(no fracture, no scratches, no air
bubbles) .

4. Extra oral evaluation
3- Check trial denture bases
Should be stable on cast
The periphery of the trial bases are
smooth and round.
4- Check the teeth
The upper anterior teeth overlap the
lower anterior teeth by about 1 – 2 mm,
in both horizontal and vertical planes.
Only exception in case of edge to edge
relation.

5. Intra-oral evaluation

6. The lower trial denture
alone
a.Extension of denture base
b.Retention and comfort
c.Stability to occlusal stresses
d.Neutral zone &Tongue space
e.Height of the lower occlusal plane

7. Intra-oral evaluation
1.Trying in the lower denture
1- Extension of denture base 1- Extension of denture base
[a] the buccal and labial extension:
Move the cheek on one side gently
(outward, upwards , inwards) to
simulating the motion it makes when
chewing.
If rises that means the periphery is
over extended

8. Intra-oral evaluation
extension extension
Another possible cause of denture
movement while moving cheek and lip, is
inadequate clearance for frenai.
Therefore before trimming denture borders,
observe frenai and ensure adequate
clearance; then repeat the procedure.

9. Intra-oral evaluation
lower denture
B] the lingual extension:
ask the patient to protrude his
tongue just to wet his lips.
If the denture lifts at the back, it is
overextended in the posterior
retromylohyoid area, so trim.

10. Intra-oral evaluation
lower denture
•B] the lingual extension
•Next, ask the patient to move
his tongue to touch the palate, if
the denture lifts in the front,
check clearance for the
lingual frenum

11. Intra-oral evaluation
lower denture
•B] the lingual extension
Ask the pt to move his tongue
to right side if denture lifts
that mean there is over
extension on the left side
then do the same on other
side.

12. Intra-oral evaluation
[D] under extension:
If the denture is found to be under extended in any
part of the periphery, replace it on the cast and
check whether the base reaches the full depth or
not; if reaches, this means inaccuracy in the
impression which must be remade before
proceeding further.

13. Intra-oral evaluation
lower denture
2)Retention and comfort
Retention of the lower can be tested by
pulling the denture away from the
ridge if retention is good there will be
sound of suction.

14. Intra-oral evaluation
lower denture
•3) Stability to occlusal stresses3) Stability to occlusal stresses
•Apply finger pressure in the premolar
and molar regions of each side
alternatively
•If pressure on one side causes the
denture to tilt and rise on the other side,
this indicates loss of stability.
•The cause of instability:
setting teeth outside the ridge , denture
base defect, wrong impression tech.

15. Intra-oral evaluation
lower denture
•4) Neutral zone &Tongue space4) Neutral zone &Tongue space
•Teeth should be set in the “neutral zone”,
•If lower teeth are lingual to this neutral zone, this will result
in cramped tongue which causes instability and instant rise
of the denture while moving.

16. 5) height of the lower occlusal plane
•It is necessary to observe the level of the lower occlusal
plane.
•Anteriorly: it should be in the level of the corner of the
mouth, opposite to the tip of the canines.
•In the middle:it should be with or bellow the level of the
lateral border of the tongue.
•Posteriorly: it should be in the level with 2/3 the retromolar
pad.

17. •To test for correct height of occlusal plane ask pt
to place tip of his tongue behind lower anterior
teeth and relax.
•The tongue is lie slightly over posterior teeth.

18. The upper trial denture alone
1.Extension of denture base and post dame area
2.Retention and comfort
3.Stability to occlusal stresses
4.Orientation of occlusal plane
5.Facial support

19. Intra-oral evaluation
upper denture
1. Extension of the denture
•a. the buccal and labial
extension
Is checked as for lower
denture but movement of
the cheek will be
( outwards , downwards ,
inwards)

20. Intra-oral evaluation
upper denture
•b] posterior extension
•For the upper denture; verify carefully that the
posterior edge is correctly situated on the soft
palate (non-movable part), and that the post
dam area on the denture base has been placed
correctly.

21. Intra-oral evaluation
upper denture
•2. Stability to occlusal stresses
•The same as lower denture
•3. Retention and comfort
•To test adaptation of fitting surface
pull the denture vertical and
downward if retention is good,
dislodgement of the trial denture
may be difficult.

22. Test of retention for upper Test of retention for upper
denturedentureFF
FF
Test for the retention of the anterior labial
flanges by bulling the anterior part of the upper
denture downward and inward.
Test for the posterior palatal seal by applying
outward pressure on the upper incisors

23. Test for the seal at the tuberosity area
by applying pressure on canine at
opposite side .
Test of retention for Test of retention for
upper dentureupper denture

24. 4. Orientation of occlusal plane
•For most pt with normal lip : 2mm of incisor
teeth show below the upper lip
•Pt with short lip : 5-6 mm of incisor teeth
show below the upper lip
•F-V-Ph sound aid in proper anterior teeth
position

25. 5. Facial support
Incorrect anteroposterior position
and alignment of anterior teeth
will alter the facial appearance.

26. Both dentures together
1.Vertical dimension
2.Centric occluding
relation(horizontal relation)
3.Evenness of occlusion
4.balanced occlusion

27. 1-vertical relation;
Evaluate the vertical relation by asking the patient to
close his teeth together and swallow. If correct, the
face will be in a natural unstrained appearance,
and swallowing will be easy.
The pt is also asked to pronounce “m” , the lip should
come in contact slightly.

28. vertical relation:
•If it is too close with excessive free way space, this will
result in elderly looking with nose chin approximation
and the lips will be seen to be pressed too firmly
together with some loss of the vermilion border.

29. Intra-oral evaluation
both denture together
2- Horizontal relation;
Evaluate the horizontal relation by
tilting the chair backward.
Hold the lower denture in position
on the ridge and ask the patient to
relax, then to 'close on your back
teeth' gently

30. Horizontal relation(check centric relation)
• If the registration is accurate, the teeth will
interdigitate in the mouth in exactly the same
manner as they do on the articulator
• but if the registration is wrong, the teeth will
not interdigitate correctly and may even
occlude cusp to cusp on one or both sides.

31. Procedure for correcting centric
relation
•Remove posterior teeth from lower
denture base, add soft wax and ask the
patient retrude his tongue and close thus a
new correct relation is taken
•Then remount it according to new relation
•check it again after setting the teeth.

32. 3-evenness of occlusal pressure
•As teeth occlude, they should meet evenly and with
equally distributed pressure all around.
•Evenness of occlusal pressure error may cause
one side to occlude before the other or molar before
premolars

33. •Uneven pressure may be due to:
Centric occlusion dose not exist at centric relation
Uneven contact between occlusal rims
Error in mounting the denture base in articulator

34. Testing the uneven pressure:
a)Let the patient to occlude on a 2 celluloid strips placed
between the posterior teeth, one on each side. Try to remove
the celluloid strips simultaneously, one strip by each hand.
b)Stabilize the upper and lower dentures with the thump and
index fingers of both hands. Request the patient to close gently
and slowly, and to stop closing at the first tooth contact.

35. Correct any uneven pressure
A.If it is very slight; this can be corrected
by grinding the teeth after denture
processed
A.If the unevenness is more than slight;
Remove the lower posterior teeth,
replace by softened wax rim , make the
centric relation record at the previously
accepted VDO. Remount the lower
cast ,resetting and try-in again.

36. Phonetic test
•Speech defects in complete denture may
be due to:
- Poor fit of denture
- improper arrangement of teeth
- high or low vertical dimension
- reduced tongue space
Check sounds of some letters to evaluate
setting of teeth like f, v, s..

37. •The upper and lower
incisors should approach
each other end-to-end, but
they should not touch.
•If there is any problem in
pronunciation it indicate a
possible error in the
amount of horizontal and
vertical overlap of the
anterior teeth.

38. Effects of vertical positioning of anterior
teeth on the pronunciation of th.
A. The tongue is prevented from extending properly
between the teeth.
B. The tongue extending between the teeth when
they are properly positioned

39. 39
If the space formed
between the hard palate
and the tongue is too
narrow and deep
Whistling
if the depth of the space
formed between the hard
palate and the tongue is
decreased or obstructed
Lisping and whistling are opposite phenomena
Lisping (th or etts)

40. Appearance
•Certain basic items should be checked for esthetics;
1) central line.
2) anterior plane.
3) shape of the teeth.
4) Profile and Labial contour
5) amount of tooth visible.
6) regularities of the teeth.
7) patient’s approval of appearance

41. Thank
you