Denture Delivery Denture Delivery

EvaluationsEvaluations

1-From the Dentist2-From the Patient3-From Family/Friends

Treatment at the Time of Denture Treatment at the Time of Denture InsertionInsertion

Inspection of dentures & Elimination of basal surface errors.

Dentures to be seated on Healthy Tissues.

Steps of Denture Delivery [6 STEPS]Steps of Denture Delivery [6 STEPS]

STEP 1STEP 1•Check denture base with PIP•Moisten with air/water syringe•No peripheries

Elimination of Fitting Surface ErrorsElimination of Fitting Surface Errors

Pressure Indicator Paste (PIP) to be used for every new denture.

STEP 2STEP 2•Check denture peripheries with PIP•One side at a time&Avoid cheeks

•Median RapheMedian Raphe

•Incisive PapillaIncisive Papilla

•Distal Buccal FlangeDistal Buccal Flange

•Zygomatic ProcessZygomatic Process

•Frenum AreasFrenum Areas

Common areas to Common areas to adjustadjust

Common areas to Common areas to adjustadjust

•Frenum AreasFrenum Areas

•Genial TuberclesGenial Tubercles

•Mylohyoid RidgesMylohyoid Ridges

STEP 3STEP 3•Occlusal adjustment•Remount with help of *Centric record *Stabilized casts

Check occlusionCheck occlusion

Occlusion may seem okay, butOcclusion may seem okay, but……

Pre-Pre-maturitymaturity

AccommodationAccommodation

Resilient TissueResilient Tissue

Abused Abused TissuesTissues

Errors in OcclusionErrors in Occlusion Possible causes of error:Possible causes of error:1-Inaccurate jaw relationship registeration or

transfer to the articulator 2-Failure to use face bow3-Incorrect teeth arrangement4-Denture processing errors5-Changes in denture base material Checking for occlusion errorsChecking for occlusion errors

RE-MOUNT RE-MOUNT : Best done on the articulator

Remounting ProcedureRemounting Procedure

Ask patient to bite on cotton rolls for 10 min.

Guide mandible into CR several times.

Aluwax is placed on the post. Teeth of the mandibular denture.

Place both dentures in the patient’s mandible is guided in a hinge movement.

Obtain interocclusal record of CR.

Mount upper denture using remounting jig.

Mount lower denture

Selective spot grindingSelective spot grinding

The art of reducing premature contacting surfaces, so that an equal pressure exists at all points with interference at no point.

STEP 4STEP 4•Chewing test *Use Cotton roll *Make sure there’s No discomfort *If there’s discomfort now , it will get worse after use

STEP 5STEP 5•Check esthetics & phonetics•If there’s large change , fore-warn the patient

STEP 6STEP 6•Polish•Brasseler denture polishers

Step 7 (Bonus Step)Step 7 (Bonus Step)•Care Instructions with pamphlet

*Stress the limitations of artificial dentures , that’s that the *Stress the limitations of artificial dentures , that’s that the maximum occlusal load which may be developed with upper and maximum occlusal load which may be developed with upper and lower dentures is one-tenth of that possible with a full natural lower dentures is one-tenth of that possible with a full natural dentition.dentition.

*Point out that in the early stages , it’s wise for patients to limit *Point out that in the early stages , it’s wise for patients to limit themselves to items which require little mastication . . They themselves to items which require little mastication . . They should cut up their food into small pieces and should not favor should cut up their food into small pieces and should not favor one side in chewing.one side in chewing.

*Point out that dentures are constructed to fit existing ridges *Point out that dentures are constructed to fit existing ridges and that some resorption will continue to occur . . This may be and that some resorption will continue to occur . . This may be small , but the dentures must be regularly checked and will have small , but the dentures must be regularly checked and will have to be replaced in time if damage to the oral tissues is to be to be replaced in time if damage to the oral tissues is to be avoided and if they are to provide maximum comfort.avoided and if they are to provide maximum comfort.

Eliminating occlusal records in anatomic teethEliminating occlusal records in anatomic teeth

Re-establishment of CO. Correction of working side occlusal

errors. Correction of balancing-side errors. Correction of protrusive relation.

Basic Tooth PositionsBasic Tooth Positions

Balancing ContactsCentric Occlusion Working Contacts

Re-establishment of CORe-establishment of CO[A][A]

Problem: Teeth too longSolution: Deepen the fossae

Problem: Teeth too nearly end to endSolution: Grind Inclines

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]]CC[[

Problem: Too much horizontal overlapSolution: Broaden central fossae

After the CO re-establishmentAfter the CO re-establishment.….…

DO NOT: Reduce maxillary lingual cusps. Reduce mandibular buccal cusps. Deepen the fossae.

Correction of working side occlusal errorsCorrection of working side occlusal errors..

Reduce lingual inclines of buccal cusps of maxillary teeth.

Reduce buccal inclines of lingual cusps of mandibular teeth.

ON WORKING SIDE ONLY!!!

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Problem: Buccal and lingual cusps too long.Solution: Change inclines of balancing cusps.

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Problem: Buccal cusps are too longSolution: Change lingual incline of maxillary buccal cusp

]]CC[[

Problem: Lingual cusp too long.Solution: Change buccal incline of lingual cusp of mandibular tooth.

Correction of balancing-side errorsCorrection of balancing-side errors..

Reduce lingual inclines of mandibular buccal cusps; or

Decide which supporting cusp maintains CO and reduce its opponent.

]]AA[[

Grind the lingual incline of the mandibular buccal cusp.

Correction of protrusive relationCorrection of protrusive relation..

Distal inclines

Mesial inclines

Eliminating occlusal errors in nonanatomic teethEliminating occlusal errors in nonanatomic teeth

Interocclusal CR record is made. Dentures mounted and gross

premature contacts are removed. Final adjustments with articulating

paper.

2424--hour Oral Examination (OE) and hour Oral Examination (OE) and Treatment (Tx)Treatment (Tx)

Examination procedures Adjustments related to:

Occlusion Denture base

Subsequent Oral Examinations and Treatment

Periodic recall for Oral Examination……12 months

•Occlusion•Tissues

What to look for?What to look for?[A][A]

COMMENTCOMMENT : Inaccurate occlusal relationship between the : Inaccurate occlusal relationship between the maxillary and mandibular teeth . . maxillary and mandibular teeth . . ETIOLOGYETIOLOGY , Denture , Denture processing errors or Alteration of the denture base material processing errors or Alteration of the denture base material of the Maxillary Denture Base . . of the Maxillary Denture Base . . MANAGEMENTMANAGEMENT , remake the , remake the maxillary denturemaxillary denture

[[BB]]

COMMENTCOMMENT : Inflammatory hyperplasia of the right labial : Inflammatory hyperplasia of the right labial sulcus . . sulcus . . ETIOLOGYETIOLOGY , long labial flange of an accurately seated , long labial flange of an accurately seated upper denture.. upper denture.. CLINICAL PRESENTATIONCLINICAL PRESENTATION , red inflammed , red inflammed hyperplastic mucosal tissues . . hyperplastic mucosal tissues . . MANAGEMENTMANAGEMENT , Shortening of , Shortening of the offending labial flangethe offending labial flange

[[CC]]

COMMENTCOMMENT : Same as the previous case but with more : Same as the previous case but with more excessive inflammatory hyperplasia which may require excessive inflammatory hyperplasia which may require surgical excision along with irritant removal as an operation surgical excision along with irritant removal as an operation of the management processof the management process

[[DD]]

COMMENTCOMMENT : Early stage frictional keratosis . . : Early stage frictional keratosis . . ETIOLOGYETIOLOGY , ill- , ill-fitting mandibular denture base . . fitting mandibular denture base . . CLINICAL PRESENTATIONCLINICAL PRESENTATION , , pale translucent patch along the lower labial vestibule related pale translucent patch along the lower labial vestibule related to the continuous irritation from the lower labial denture to the continuous irritation from the lower labial denture flange . . flange . . MANAGEMENTMANAGEMENT , remove the irritant i.e. reline the , remove the irritant i.e. reline the anterior denture base, the lesion should resolve or at least be anterior denture base, the lesion should resolve or at least be reduced in intensityreduced in intensity

[[EE]]

COMMENTCOMMENT : Epulis Fissuratum ”Inflammatory Hyperplastic : Epulis Fissuratum ”Inflammatory Hyperplastic Lesion” at the Borders ”Peripheries” . . Lesion” at the Borders ”Peripheries” . . ETIOLOGYETIOLOGY , Ill-fitting , Ill-fitting dentures but in most instances the denture flanges overextend dentures but in most instances the denture flanges overextend secondary to alveolar bone resorption . . secondary to alveolar bone resorption . . CLINICAL CLINICAL PRESENTATIONPRESENTATION , Exophytic elongated lesion at the left labial , Exophytic elongated lesion at the left labial vestibule of the maxilla , Tissue proliferation on both sides of vestibule of the maxilla , Tissue proliferation on both sides of the offending flange & Blood. . the offending flange & Blood. . MANAGEMENTMANAGEMENT , removal of , removal of the irritantthe irritant

[[FF]]

COMMENTCOMMENT : Injury on the mucosa covering the buccal : Injury on the mucosa covering the buccal mandibular basal bone . . mandibular basal bone . . ETIOLOGYETIOLOGY , Irregularity on the , Irregularity on the fitting surface of the denture base . . fitting surface of the denture base . . MANAGEMENTMANAGEMENT , , Elimination of the surface irregularity and polishingElimination of the surface irregularity and polishing

Denture RepairsDenture Repairs

ReferencesReferences D.J. Neill & R.I. Nairn’s D.J. Neill & R.I. Nairn’s Complete Complete

Denture ProstheticsDenture Prosthetics , 3 , 3rdrd Ed. Ed. Bob Loney & Mark Vallee’s Bob Loney & Mark Vallee’s Secrets of Secrets of

Successful DenturesSuccessful Dentures , Lecture , Lecture Dr. Iman Metwaly’s Dr. Iman Metwaly’s White LesionsWhite Lesions , ,

LectureLecture Dr. Mohammed Mahmoud’s Dr. Mohammed Mahmoud’s Oral Oral

Exophytic LesionsExophytic Lesions , Lecture , Lecture Moskona D, Kaplan I.’s , Moskona D, Kaplan I.’s , Oral lesions Oral lesions

in elderly denture wearersin elderly denture wearers