Denture Delivery Denture Delivery and Follow Upand Follow Up

Dr. Cecilia E. AragDr. Cecilia E. Aragón ón

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EvaluationsEvaluations

• From the DentistFrom the Dentist

• From the PatientFrom the Patient

• From Family/FriendsFrom Family/Friends

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Treatment at the Time of Treatment at the Time of Denture InsertionDenture Insertion

• Inspection of dentures. Elimination of Inspection of dentures. Elimination of basal surface errors.basal surface errors.

• Dentures to be seated in healthy Dentures to be seated in healthy tissues.tissues.

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Elimination of Intaglio Surface Elimination of Intaglio Surface ErrorsErrors

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

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Check occlusionCheck occlusion

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

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Prematurity

Accommodation

Resilient Tissue

Abused Tissues

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Errors in OcclusionErrors in Occlusion

•Possible causes of error: Possible causes of error: inaccurate inaccurate MMR records or transfer of these, failure to MMR records or transfer of these, failure to use face bow, incorrect teeth use face bow, incorrect teeth arrangement, denture processing errors, arrangement, denture processing errors, changes in denture base material. changes in denture base material.

•Checking for occlusion errorsChecking for occlusion errors– Best done in the articulator: REMOUNTBest done in the articulator: REMOUNT

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Remounting ProcedureRemounting Procedure

• Ask patient to bite Ask patient to bite on cotton rolls for on cotton rolls for 10 min.10 min.

• Guide mandible into Guide mandible into CR several times.CR several times.

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

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

• Obtain Obtain interocclusal interocclusal record of CR.record of CR.

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• Mount upper Mount upper denture using denture using remounting jig.remounting jig.

• Mount lower Mount lower denturedenture

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Selective spot grinding Selective spot grinding

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

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Eliminating occlusal records in Eliminating occlusal records in anatomic teethanatomic teeth

• Re-establishment of CO.Re-establishment of CO.

• Correction of working side occlusal Correction of working side occlusal errors.errors.

• Correction of balancing-side errors.Correction of balancing-side errors.

• Correction of protrusive relation.Correction of protrusive relation.

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Basic Tooth Positions

Balancing Contacts Centric Occlusion Working Contacts

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Re-establishment of CORe-establishment of CO

Problem: Teeth too longSolution: Deepen the fossae

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Re-establishment of CORe-establishment of CO

Problem: Teeth too nearly end to endSolution: Grind Inclines

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Re-establishment of CORe-establishment of CO

Problem: Too much horizontal overlapSolution: Broaden central fossae

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

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

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

• Reduce lingual inclines of buccal Reduce lingual inclines of buccal cusps of maxillary teeth.cusps of maxillary teeth.

• Reduce buccal inclines of lingual Reduce buccal inclines of lingual cusps of mandibular teeth.cusps of mandibular teeth.

ON WORKING SIDE ONLY!!!ON WORKING SIDE ONLY!!!

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

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

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

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

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

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

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

• Reduce lingual inclines of mandibular Reduce lingual inclines of mandibular buccal cusps; orbuccal cusps; or

• Decide which supporting cusp Decide which supporting cusp maintains CO and reduce its maintains CO and reduce its opponent.opponent.

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

Grind the lingual incline of the mandibular buccal cusp.

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Correction of protrusive Correction of protrusive relation.relation.

Distal inclines

Mesial inclines

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Eliminating occlusal errors in Eliminating occlusal errors in nonanatomic teethnonanatomic teeth

• Interocclusal CR record is made.Interocclusal CR record is made.

• Dentures mounted and gross Dentures mounted and gross premature contacts are removed.premature contacts are removed.

• Final adjustments with articulating Final adjustments with articulating paper.paper.

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Instructions to the patientInstructions to the patient

• Individuality of patientsIndividuality of patients

• New dentures and:New dentures and:– AppearanceAppearance– MasticationMastication– SpeechSpeech– Oral HygieneOral Hygiene

• Education materialsEducation materials

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24-hour Oral Examination (OE) 24-hour Oral Examination (OE) and Treatment (Tx)and Treatment (Tx)

• Examination proceduresExamination procedures

• Adjustments related to:Adjustments related to:– OcclusionOcclusion– Denture baseDenture base

• Subsequent OEs and TxsSubsequent OEs and Txs

• Periodic recall for OE……12 months Periodic recall for OE……12 months

•Occlusion•Tissues

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What to look for:What to look for:

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What to look for:What to look for:

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What to look for:What to look for:

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What to look for:What to look for:

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What to look for:What to look for:

Moskona D, Kaplan I. Oral lesions in elderly denture wearers. Clin Prev Dent. 1992;14:11-4 : 500 pts. Total frequency of soft tissue lesions was 16.7% in edentulous non-denture patients and 58.2% in patients with poor quality dentures.

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What to look for:What to look for:

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OverdenturesOverdentures

Bars

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O-ring abutments

Locator attachments

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