The trial denture appointment is used to evaluate and change, if necessary, the vertical dimension of occlusion, centric relation, mold, shade and the esthetic arrangement of anterior teeth, and other characteristics of the denture before final processing. The centric relation record is proven and a protrusive record is made. These procedures are illustrated in detail in this program.
Complete Dentures» Next Lecture› [next_page]
Complete Dentures – Trial Denture Appointment — Course Transcript
- 1. 23. Trial Denture Appointment John Beumer III, DDS, MS and Robert Duell DDS Division of Advanced Prosthodontics, Biomaterials and Hospital Dentistry UCLA School of Dentistry This program of instruction is protected by copyright ©. No portion of this program of instruction may be reproduced, recorded or transferred by any means electronic, digital, photographic, mechanical etc., or by any information storage or retrieval system, without prior permission.
- 2. Now you are ready for the wax try in! This setup is tentative. Changes are made at chairside depending upon the the esthetic needs of the patient and the opinions of the dentist. Trial Denture Appointment
- 3. Trial Denture Appointment* Check vertical dimension of occlusion and rest Prove centric relation record Make protrusive record Evaluate esthetics and phonetics Posterior palatal seal * These procedures must be performed in the sequence listed above .
- 4. Methods of Assessing the VDO Physiologic rest position Phonetics and esthetics Swallowing Comparison with the old denture
- 5. Closest Speaking Space Closest speaking space is used for the final test to determine if the vertical dimension that we have chosen is correct “ s” sounds Count from 60-70
- 6. Prove the CR Record Method used to verify your mounting -Observe any shift in the upper denture -Look for even contact of the posterior teeth bilaterally This patients centric relation is incorrect
- 7. Soften the compound over the bunsen burner Place the compound onto the occlusal surfaces of the mandibular posterior teeth Temper the compound in a water bath set at the proper temperature (110 °) and smooth it with your wet gloved finger. Proof of Mounting-CR Record
- 8. Tips for making records a) Recline the chair back, this will help retrude the mandible b) Stabilize mandibular base with your index fingers with the thumbs under the mandible (bimanual technique) c) Rehearse closing with the patient d) Have patient gently close into the compound just short of tooth contact . Verifying the CR Record
- 9. Remove and trim the record so that only the indentations from the cusp tips are present Centric Relation Record
- 10. Proving the Record Place the new record onto the master casts Loosen the centric locking screw If the maxillary teeth contact the indentations exactly as they did in the mouth, you have proven that your original centric record was correct. The articulator must close in the hinge position without condylar displacement
- 11. Protrusive Record Clinical steps Practice the protrusive movement with patient before making the record Mandible must be brought forward 5-6 mm short of tooth contact while maintaining the mandible in the midline
- 12. Setting the Condylar Inclination Loosen the centric locking pins Observe the space that develops between the condylar elements when the casts are completely seated in the protrusive record
- 13. Setting the Condylar Inclination Select a condylar inclination that best fits the space Place the condylar inclination insert into position Orange insert 20 ° condylar inclination Note space remaining
- 14. Setting the Condylar Inclination Black Insert 30 ° condylar inclination Fits perfectly into position & completely fills the space
- 15. Esthetics and Phonetics
- 16. Facial support affected by: Position of the incisal edge Thickness and contour of the labial flange Gingival contours
- 17. Facial support affected by: Note the contour of the vermillion border region. Without teeth With teeth
- 18. Phonetic Evaluation “ F” and “V” sounds Fricative sounds Patient should be able to make a clear “f” and “v” sound with the maxillary incisal edges against the lower lip.
- 19. Phonetics – Sibilants During the production of the “s” or “z” sound: a) The anterior and posterior teeth should not touch b) There should be no hissing or air loss
- 20. Anterior Tooth Arrangement Normal arrangement Mesiolingual rotation Diastema
- 21. Hollow the lingual surface of the lateral incisor in order to obtain a proper overlap. Anterior Characterization
- 22. What do you see in this setup? Rotated cuspid Pointed lateral incisor Distal incisal edge of the right central has been recontoured Left cuspid is pointed Mesiolingual rotation of the left lateral Incisal edge of the left central has been flattened
- 23. Anterior setup follows the lip line Pointed canines Large incisal embrasures All these characterizations provide the patient with a youthful appearance. Denture Esthetics
- 24. Arrangement of mandibular anterior teeth Get patient approval when you characterize anterior teeth.
- 25. Posterior Palatal Seal Posterior Nasal Spine Velum Glandular tissue
- 26. Posterior Palatal Seal Draw a line 1mm anterior to the posterior extension of the denture Draw a second line anterior to first in a butterfly pattern Carve the bead seal with a discoid cleoid It should be 1 mm in depth It should feather out into the hamular notch It should not extend onto the tuberosities or onto a torus