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Complete DentureComplete DentureDiagnosis & Treatment Planning Diagnosis & Treatment Planning Complete DentureComplete DentureDiagnosis & Treatment Planning Diagnosis & Treatment Planning
This presentation includes images and text from the UCLA/APC/Ivoclar Educational Curriculum
Medical HistoryMedical History Medical HistoryMedical History
Be efficient - don't need extensive history of Be efficient - don't need extensive history of relativesrelatives
Follow-up significant responsesFollow-up significant responses Note systemic conditions that impact on therapy Note systemic conditions that impact on therapy
(e.g. angina, hepatitis, Sjogren's syndrome)(e.g. angina, hepatitis, Sjogren's syndrome)
Be efficient - don't need extensive history of Be efficient - don't need extensive history of relativesrelatives
Follow-up significant responsesFollow-up significant responses Note systemic conditions that impact on therapy Note systemic conditions that impact on therapy
(e.g. angina, hepatitis, Sjogren's syndrome)(e.g. angina, hepatitis, Sjogren's syndrome)
Medical HistoryMedical History Medical HistoryMedical History
Obtain physician consultationsObtain physician consultations If some debilitating disease If some debilitating disease
– discuss with instructor discuss with instructor – to ensure acceptabilityto ensure acceptability
Obtain physician consultationsObtain physician consultations If some debilitating disease If some debilitating disease
– discuss with instructor discuss with instructor – to ensure acceptabilityto ensure acceptability
Dental HistoryDental HistoryDental HistoryDental History
How many dentures?How many dentures? How long worn?How long worn? Age of present set?Age of present set? Satisfaction with dentures?Satisfaction with dentures? Things patient likes - what they want Things patient likes - what they want
changedchanged
How many dentures?How many dentures? How long worn?How long worn? Age of present set?Age of present set? Satisfaction with dentures?Satisfaction with dentures? Things patient likes - what they want Things patient likes - what they want
changedchanged
Clinical Exam Clinical Exam Clinical Exam Clinical Exam
Routine clinical examRoutine clinical exam Routine clinical examRoutine clinical exam
Intraoral Exam Intraoral Exam Intraoral Exam Intraoral Exam
Examine one arch at a time Examine one arch at a time – Look, then writeLook, then write
Examine one arch at a time Examine one arch at a time – Look, then writeLook, then write
Intraoral ExamIntraoral ExamIntraoral ExamIntraoral Exam
General tissue healthGeneral tissue health– Mucosa Mucosa
• attached / non-attachedattached / non-attached– ColourColour– CharacterCharacter– DisplaceabilityDisplaceability
General tissue healthGeneral tissue health– Mucosa Mucosa
• attached / non-attachedattached / non-attached– ColourColour– CharacterCharacter– DisplaceabilityDisplaceability
Intraoral ExamIntraoral ExamIntraoral ExamIntraoral Exam
Specific Anatomical considerations Specific Anatomical considerations – Examine systematicallyExamine systematically– Note significance Note significance
of findings to therapyof findings to therapy– Visual and tactile examVisual and tactile exam
Specific Anatomical considerations Specific Anatomical considerations – Examine systematicallyExamine systematically– Note significance Note significance
of findings to therapyof findings to therapy– Visual and tactile examVisual and tactile exam
Intraoral ExamIntraoral ExamIntraoral ExamIntraoral Exam
MaxillaMaxilla– Form of maxillary arch affects Form of maxillary arch affects
retention retention – Advise the patient if retention will Advise the patient if retention will
be compromisedbe compromised
MaxillaMaxilla– Form of maxillary arch affects Form of maxillary arch affects
retention retention – Advise the patient if retention will Advise the patient if retention will
be compromisedbe compromised
MaxillaMaxillaMaxillaMaxilla
Posterior border of denture:Posterior border of denture:– Hamular notches Hamular notches
• Posterior denture border Posterior denture border • PalpatePalpate• Visually deceiving Visually deceiving
Posterior border of denture:Posterior border of denture:– Hamular notches Hamular notches
• Posterior denture border Posterior denture border • PalpatePalpate• Visually deceiving Visually deceiving
MaxillaMaxillaMaxillaMaxilla
Posterior border of denture:Posterior border of denture:– Hamular notches Hamular notches
• Over extension - extreme painOver extension - extreme pain• Under extension - non-retentiveUnder extension - non-retentive• Must be captured in impressionMust be captured in impression
Posterior border of denture:Posterior border of denture:– Hamular notches Hamular notches
• Over extension - extreme painOver extension - extreme pain• Under extension - non-retentiveUnder extension - non-retentive• Must be captured in impressionMust be captured in impression
MaxillaMaxillaMaxillaMaxilla
Posterior border of denturePosterior border of denture– Vibrating line Vibrating line
• Identified when patient says "ah"Identified when patient says "ah"• Junction of movable & non-Junction of movable & non-
movable movable soft palatesoft palate
Posterior border of denturePosterior border of denture– Vibrating line Vibrating line
• Identified when patient says "ah"Identified when patient says "ah"• Junction of movable & non-Junction of movable & non-
movable movable soft palatesoft palate
MaxillaMaxillaMaxillaMaxilla
Posterior border of denturePosterior border of denture– Vibrating line Vibrating line
• If terminate on: If terminate on: – movable portion - displacementmovable portion - displacement– hard palate - no retentionhard palate - no retention
Posterior border of denturePosterior border of denture– Vibrating line Vibrating line
• If terminate on: If terminate on: – movable portion - displacementmovable portion - displacement– hard palate - no retentionhard palate - no retention
MaxillaMaxillaMaxillaMaxilla
Vibrating lineVibrating line• Fovea - close to Fovea - close to
vibrating linevibrating line• Throat form can affect Throat form can affect
widthwidth
Vibrating lineVibrating line• Fovea - close to Fovea - close to
vibrating linevibrating line• Throat form can affect Throat form can affect
widthwidth
Palatal Throat FormPalatal Throat FormPalatal Throat FormPalatal Throat Form
IIII
IIIIIIIIIIIIIIIIIIII
MaxillaMaxillaMaxillaMaxilla
• Flatter the soft palate, the broader the area of the vibrating line
• Flatter the soft palate, the broader the area of the vibrating line
MaxillaMaxillaMaxillaMaxilla
Posterior border of denture:Posterior border of denture:– Pterygomandibular raphe Pterygomandibular raphe
• Behind hamular notches - Behind hamular notches - significant when prominentsignificant when prominent
• Have patient open wide as Have patient open wide as possiblepossible
• Can displace denture – Can displace denture – requires relief in extreme casesrequires relief in extreme cases
Posterior border of denture:Posterior border of denture:– Pterygomandibular raphe Pterygomandibular raphe
• Behind hamular notches - Behind hamular notches - significant when prominentsignificant when prominent
• Have patient open wide as Have patient open wide as possiblepossible
• Can displace denture – Can displace denture – requires relief in extreme casesrequires relief in extreme cases
GlandularGlandular tissuetissueGlandularGlandular tissuetissue
Posterior palatal sealPosterior palatal sealPosterior palatal sealPosterior palatal seal
Posterior palatine salivary glandsPosterior palatine salivary glands• Permits compression of tissues Permits compression of tissues • Improves adaptation of denture to Improves adaptation of denture to
compensate for shrinkage of resincompensate for shrinkage of resin
Posterior palatine salivary glandsPosterior palatine salivary glands• Permits compression of tissues Permits compression of tissues • Improves adaptation of denture to Improves adaptation of denture to
compensate for shrinkage of resincompensate for shrinkage of resin
Posterior Palatal SealPosterior Palatal Seal
MaxillaMaxillaMaxillaMaxilla
Tuberosity Tuberosity – DisplaceabilityDisplaceability– Palpate for Palpate for
undercuts - if undercuts - if extreme, denture extreme, denture might not seatmight not seat
Tuberosity Tuberosity – DisplaceabilityDisplaceability– Palpate for Palpate for
undercuts - if undercuts - if extreme, denture extreme, denture might not seatmight not seat
MaxillaMaxillaMaxillaMaxilla
TuberosityTuberosity – If enlarged with fibrous If enlarged with fibrous
tissue tissue • surgical reduction to surgical reduction to
make room for denturesmake room for dentures
TuberosityTuberosity – If enlarged with fibrous If enlarged with fibrous
tissue tissue • surgical reduction to surgical reduction to
make room for denturesmake room for dentures
MaxillaMaxillaMaxillaMaxilla
Ridge formRidge form– U-shape bestU-shape best– Non-moveable bestNon-moveable best– Advise patient if poorAdvise patient if poor– Affects:Affects:
• retentionretention• stabilitystability
Ridge formRidge form– U-shape bestU-shape best– Non-moveable bestNon-moveable best– Advise patient if poorAdvise patient if poor– Affects:Affects:
• retentionretention• stabilitystability
MaxillaMaxillaMaxillaMaxilla
Labial/Buccal vestibule Labial/Buccal vestibule – 2-4 mm width2-4 mm width– Zygomatic processZygomatic process
• can be prominentcan be prominent
Labial/Buccal vestibule Labial/Buccal vestibule – 2-4 mm width2-4 mm width– Zygomatic processZygomatic process
• can be prominentcan be prominent
MaxillaMaxillaMaxillaMaxilla
Labial/Buccal vestibuleLabial/Buccal vestibule – Flat ridges Flat ridges
• maximize retention by maximize retention by accurately registering accurately registering the vestibulethe vestibule
Labial/Buccal vestibuleLabial/Buccal vestibule – Flat ridges Flat ridges
• maximize retention by maximize retention by accurately registering accurately registering the vestibulethe vestibule
MaxillaMaxillaMaxillaMaxilla
Frena - check prominence:Frena - check prominence:– Buccal frenum Buccal frenum
• Usually broaderUsually broader– Thin labial frenumThin labial frenum
Frena - check prominence:Frena - check prominence:– Buccal frenum Buccal frenum
• Usually broaderUsually broader– Thin labial frenumThin labial frenum
Maxilla: Maxilla: MidlineMidlineMaxilla: Maxilla: MidlineMidline
Tori Tori Mid palatal sutureMid palatal suture
– Eliminate binding or Eliminate binding or fulcrumingfulcruming
– Discomfort, loss of Discomfort, loss of retention and possible retention and possible fracture of the denturefracture of the denture
Tori Tori Mid palatal sutureMid palatal suture
– Eliminate binding or Eliminate binding or fulcrumingfulcruming
– Discomfort, loss of Discomfort, loss of retention and possible retention and possible fracture of the denturefracture of the denture
Mandibular Support AreasMandibular Support AreasMandibular Support AreasMandibular Support Areas
Retromolar PadRetromolar PadRetromolar PadRetromolar Pad Alveolar ProcessAlveolar ProcessAlveolar ProcessAlveolar Process Buccal ShelfBuccal Shelf Buccal ShelfBuccal Shelf
Mandible Mandible Mandible Mandible
Ridge form more criticalRidge form more critical– Less surface area for Less surface area for
retentionretention– Moveable tongue & floor Moveable tongue & floor – Displacement if denture is Displacement if denture is
overextendedoverextended• Inform patientsInform patients
Ridge form more criticalRidge form more critical– Less surface area for Less surface area for
retentionretention– Moveable tongue & floor Moveable tongue & floor – Displacement if denture is Displacement if denture is
overextendedoverextended• Inform patientsInform patients
MandibleMandibleMandibleMandible
Retromolar pad Retromolar pad – Terminal border of the Terminal border of the
denture basedenture base– Compressible soft tissue Compressible soft tissue
• Comfort Comfort • Peripheral sealPeripheral seal
– Must be captured in Must be captured in impressionimpression
Retromolar pad Retromolar pad – Terminal border of the Terminal border of the
denture basedenture base– Compressible soft tissue Compressible soft tissue
• Comfort Comfort • Peripheral sealPeripheral seal
– Must be captured in Must be captured in impressionimpression
MandibleMandibleMandibleMandible
Buccal shelfBuccal shelf– Custom tray, border Custom tray, border
molded - should not molded - should not feel edge extraorallyfeel edge extraorally
– External oblique ridge External oblique ridge • do not cover do not cover • Alginate will almost Alginate will almost
always overextend always overextend • PPainfulainful
Buccal shelfBuccal shelf– Custom tray, border Custom tray, border
molded - should not molded - should not feel edge extraorallyfeel edge extraorally
– External oblique ridge External oblique ridge • do not cover do not cover • Alginate will almost Alginate will almost
always overextend always overextend • PPainfulainful
MandibleMandibleMandibleMandible
Labial/Buccal Labial/Buccal vestibule vestibule – Easy to overextendEasy to overextend– Check with minimal Check with minimal
manipulation of lipsmanipulation of lips
Labial/Buccal Labial/Buccal vestibule vestibule – Easy to overextendEasy to overextend– Check with minimal Check with minimal
manipulation of lipsmanipulation of lips
MandibleMandibleMandibleMandible
Masseter Masseter – affects distobuccal borderaffects distobuccal border– if more prominent - if more prominent -
concave border of dentureconcave border of denture
Masseter Masseter – affects distobuccal borderaffects distobuccal border– if more prominent - if more prominent -
concave border of dentureconcave border of denture
MandibleMandibleMandibleMandible
FrenaFrena– Labial and buccal frena Labial and buccal frena
• Narrow & wide respectivelyNarrow & wide respectively– Lingual frenum Lingual frenum
• Must allow for movement - or Must allow for movement - or displaces easilydisplaces easily
FrenaFrena– Labial and buccal frena Labial and buccal frena
• Narrow & wide respectivelyNarrow & wide respectively– Lingual frenum Lingual frenum
• Must allow for movement - or Must allow for movement - or displaces easilydisplaces easily
Buccal frenumBuccal frenum
LingualLingual frenumfrenum
MandibleMandibleMandibleMandible
Retromylohyoid fossa Retromylohyoid fossa – Need to captureNeed to capture– Especially with severely resorbed ridgeEspecially with severely resorbed ridge
Retromylohyoid fossa Retromylohyoid fossa – Need to captureNeed to capture– Especially with severely resorbed ridgeEspecially with severely resorbed ridge
Lateral Throat FormLateral Throat FormLateral Throat FormLateral Throat Form
Class Class IIIIII
Class IClass IClass IIClass II
MandibleMandibleMandibleMandible Mylohyoid RidgeMylohyoid Ridge
– PalpatePalpate • If prominent, may need reliefIf prominent, may need relief
Mylohyoid muscleMylohyoid muscle • Raises floor of mouth Raises floor of mouth • Differences between rest and Differences between rest and
activityactivity• Affects length of flangesAffects length of flanges
Mylohyoid RidgeMylohyoid Ridge – PalpatePalpate
• If prominent, may need reliefIf prominent, may need relief
Mylohyoid muscleMylohyoid muscle • Raises floor of mouth Raises floor of mouth • Differences between rest and Differences between rest and
activityactivity• Affects length of flangesAffects length of flanges
Mucosa in this region is poorly Mucosa in this region is poorly keratinized and prone to traumakeratinized and prone to traumaMucosa in this region is poorly Mucosa in this region is poorly keratinized and prone to traumakeratinized and prone to trauma
Mylohyoid ridgeMylohyoid ridgeMylohyoid ridgeMylohyoid ridge
Mylohyoid ridge can cause ulcers if it is a Mylohyoid ridge can cause ulcers if it is a sharpsharp
Mylohyoid ridge can cause ulcers if it is a Mylohyoid ridge can cause ulcers if it is a sharpsharp
Residual Ridge Resorption (RRR)Residual Ridge Resorption (RRR)
MandibleMandibleMandibleMandible
ToriTori– Rarely need surgery unless largeRarely need surgery unless large– May require relief once dentures May require relief once dentures
are delivered - advise patientare delivered - advise patient
ToriTori– Rarely need surgery unless largeRarely need surgery unless large– May require relief once dentures May require relief once dentures
are delivered - advise patientare delivered - advise patient
MandibleMandibleMandibleMandible
Genial tuberclesGenial tubercles– Bony insertion for the Bony insertion for the
genioglossus musclegenioglossus muscle– May be projecting May be projecting
above the residual above the residual ridge if there has been ridge if there has been severe resorptionsevere resorption
Genial tuberclesGenial tubercles– Bony insertion for the Bony insertion for the
genioglossus musclegenioglossus muscle– May be projecting May be projecting
above the residual above the residual ridge if there has been ridge if there has been severe resorptionsevere resorption
SummarySummarySummarySummary
Anatomy:Anatomy:– Affects complete denture Affects complete denture
retention & stabilityretention & stability– Should be captured in Should be captured in
preliminary & final impressions preliminary & final impressions – If poor, advise patientIf poor, advise patient– Exercise todayExercise today
Anatomy:Anatomy:– Affects complete denture Affects complete denture
retention & stabilityretention & stability– Should be captured in Should be captured in
preliminary & final impressions preliminary & final impressions – If poor, advise patientIf poor, advise patient– Exercise todayExercise today