BERNARD A. SUSSMAN, D.D.S. New York, N. Y.

IN GENERAL PRACTICE depend upon techniques for complete denture construction which have been found suitable to their skills, and supplement their techniques with new concepts offered by specialists. However, areas of disagreement may undermine the dentist’s ability to make successful dentures. This article is a resume of material pertaining to complete denture service. Too often, the efficient, painstaking efforts used in making complete dentures are negated by the use of an incomplete technique for the delivery of dentures. Downs1 commented “. . . no one has a trouble-free prosthodontic practice.” Martone said “It is possible for successful dentures to be ‘denture failures’ simply because the necessary adjustments are not made.” A technique for the delivery of dentures will be described.

I)

ENTISTS

IMPRESSION

PROCEDURES

Impressions should be made of tissues that are free of irritation and free of thick mucous saliva.3 The impressions should have contact pressure4 and should cover as much tissue as possible without encroaching on the surrounding tissues. T’he contact of the borders of the impression with the surrounding tissue is most important. Before impressions are made, dentures should be left out of the mouth for as long a time as is necessary to permit the mouth to return to good health and uritil the tissues have recovered from damage and irritation resulting from previous dentures.5-7 Patients can leave dentures out of the mouth from Friday evening until Monday morning (about 60 hours). This is a suggested recovery period.
TISSUE CONDITIONING

Chase* outlined his technique to condition tissues with a soft reline resin which does not require the dentures to be left out of the mouth. This technique necessitates many appointments with the patient and a great amount of work. However, in spite of all the time that goes into the making of a conditioning impression, there can be no guarantee that the complete denture will not need adjustments. Boucherg wrote, “Why ‘condition’ oral tissues and immediately place new dentures on them which uncondition the tissues as soon as they are inserted?”
IMPRESSION TECHNIQUES

Great interest can be aroused by any announcement that a new material assures the success of a complete denture because it produces an accurate impression
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the high degree of *Cable Denture Research Company.” I use acrylic resin trial baseplates. Den.” JAW RELATION PROCEDURES Many articles describe the accuracy of techniques used to determine the physiologic rest position. . 1966 surface of the tissues to be covered or because it conditions tissues.17 and Jones I8 describe the efficiency of this instrument. TerreW5 wrote “The accuracy of the registrations will be lost if the bases do not fit accurately. and centric relation.” Hughesll summarized the impression problem when he noted “There are many opinions. . Moyer-l9 said I‘. . “ .12~rs CENTRIC RELATION No ingenuous adjustment technique can make dentures acceptable if the centric relation is incorrect. TuckfieldlO said “I think the impression surface has the least effect on the stability of the denture.. therefore. the vertical relation of occlusion.la Porter.4 the free-way space (interocclusal distance). HINGE AXIS Is there a true hinge axis ? TrapozzanozO concluded that because of the inability of dentists to stabilize the denture bases with a sufficient degree of accuracy. Raleigh. cannot be disregarded. . The medial occlusal position becomes a convenience position which is functional to the patient because of habit and use. Sometimes the setscrew of the instrument which is attached to the upper trial baseplate will register a sharp pointed tracing on the graph plate which is attached to the lower baseplate. N. We. An intraoral needle point tracer* can be used to locate the centric relation.” Trapozzano and Lazzariz3 concluded “These findings indicate that. A correct centric relation record is the most important factor in complete denture construction. the accuracy attributed to the use of the hinge axis is more fancied than real. since multiple condylar hinge axis points were located. the more likely centric relation is to be found somewhere other than in the most retruded position. . .” But McCollumzl said “The hinge axis is a component of every masticatory movement of the mandible and. . but no facts. Pleasure.452 STJSSMAN J. Pros. . May-June.” I accept as centric relation the horizontal relation of the mandible to the maxillae when the mandible is in its most retruded position that is convenient for jaw movement and comfort. This indicates that one or both of the condyles is anterior or medial to the most retruded position. . the greater the occlusal disharmony.” Where is the hinge axis ? Grangerz2 reported that “Anatomists seem to be in agreement that the center of rotation lies in the condyle and is not some imaginary point beyond it. who accept the fact that the physiologic rest position has great significance.i4 Good fitting trial baseplates are essential to obtaining an accurate centric relation record. Inc. . . Sometimes the tracing is a blunt and rounded registration. must realize that there is no scientific instrument that can accurately find this measurement. C. This apex indicates that the condyles are in their most retruded position.

Universal Dental Dental Co.” Koskiz4 is of the opinion that in many instances the axis could be found on the mastoid process of the temporal bone.” Koskiz4 observed that “The great variability of mandibular movements and the location of the axis can hardly be reproduced by a man-made mechanical device. Philadelphia.e. The tlorders should be thickened to help maintain the denture against the dislodging forces produced by masticatory and nonmasticatory movements. DELIVERY OF THE COMPLETED DENTURES A proper techniqu’e for the delivery of dentures is essential and can eliminate some of the errors that are not within the control of the dentist. and what controls its movements . buccolingually. the occlusal height of the lower bicuspid teeth should be placed at the incisal height of the cuspid teeth. Pa. The final adjustments of the teeth can be made in the mouth on the completed dentures. They can produce successful dentures without intricate articulators. ARTICULATORS Any sturdy articulator which retains the relationship of the mandible to the maxillae at the established vertical relation of occlusion and centric relation should suffice for the placement of teeth..+ The teeth retain sluiceways and grooves and are narrow. and not to do what it can do poorly. Philadelphia. Jones7 commented *French’s Posteriors. If possible. We must wait for further research to prove whether or not there is a true hinge axis.” These authors have strengthened my belief about the choice of an articulator. ARTIFICIAL TEETH I use posterior teeth that are nonanatomic* and teeth whose cusp height is reduced. A wide arch form should be maintained so that the tongue is given maximum space for movement and will not displace the denture. FINISHING AND PROCESSING THE DENTURES Acrylic resins are used for denture bases and the laboratory is instructed to follow the manufacturer’s directions in processing them.. i. Universal tNic Posteriors. Co.e. retain centric relation and vertical dimension .53 infallibility attributed to hinge axis points may be seriously questioned. Dentists who use the simple but sturdy inexpensive articulators should not feel embarrassed because their offices are not geared to use highly adjustable instruments. . we also await a less intricate technique for finding it. The discrepancies resulting from processing procedures are kept at a minimum. Pa. where it is located. imitate functional movements. The external form of the denture is very important to its retention.Volume Number 16 3 COMPLETE DENTURE TREATMENT 4.. SDthey can be placed in the proper position in relation to the residual ridge. i.” Kaires*5 concluded “The findings indicate that the occlusal contacts established on the articulator did not coincide with the occlusal c’ontacts made during the functional movements in the mouth. Fleasurele said “We rely on the articulator to do only what it can do well..

. they can practice the manipulation of food without embarrassment. INSERTION OF DENTURES The patient is asked to leave his old dentures out of the mouth from Friday evening until Monday morning before the new dentures are inserted. it would indicate that there is a lack of contact between the external surface of the denture and the surrounding tissues. Patients are informed that they will feel comfortable when the treatments are completed.26The paste is placed on both sides of the border of the upper denture in the tuberosity region. They are advised to eat slowly. If the disclosing paste is thick or unmoved on the external surface of the denture when it is removed from the mouth.” Our patients are people whose physiologic responses to the emotions of fear. and to indicate pressure areas on the basal surfaces of dentures. ADAPTATION OF THE DENTURE BASES I use a disclosing paste to adjust the external surfaces and borders of the denture bases to proper contact with the surrounding tissues. This permits the new dentures to be inserted on tissues which have been given the opportunity to return to a near normal state of health. The new dentures are placed in the mouth and the patient is told to open and close his mouth about ten times. May-June. 1966 “Our goal is to detect irritation soon after its inception and to make the necessary corrections then. . The denture is carefully placed in the mouth and the patient is instructed to use the same cheek and lip movements that were used when the impressions were made. Pros. . pride. This treatment is continued until no denture base material shows through a thin film of the paste. an opinion of the accuracy of the centric relation can be determined.” Anthony and Peyton26 observed “. Patients are often unable to give us the cooperation that we must have. Such patients should be placed under light sedation so they will be more amendable to our requests. The surfaces of the base material from which paste has been displaced should be reduced. illness. They are told that it usually takes one to two months to learn how to manipulate foods of different textures with new dentures. Within the confines of their homes. These emotional antagonisms may be fortified by the fact that some relatives and friends have had fewer dental disturbances. the esthetics can be observed. hate. 4. rather than waiting until the patient is suffering great discomfort and has a lowered morale. The movements of the muscles against the external surface and border of the denture and the use of pressure against the tissue surface will disclose errors which may have been incorporated into the completed denture. love. They may have an obvious or subconscious antagonism to dental care. . . By noting the position of the lips. The dentist must impress the patient with the fact that the use of modern techniques eliminates pain-such as the pain that may have disturbed other people. to break the food into small pieces. and anxiety are influenced by all other people with whom they come into contact. By noting the contact of the upper and lower teeth. . Den.454 SUSSMAN J. a small amount of time spent adjusting both the accuracy of fit and the occlusal relationship when the dentures are inserted may be an important factor in the ultimate satisfaction. and to eat at home.

the occlusion must be corrected for function. the facial muscles will not help retain the denture in position when it is accidentally dislodged.Vclume Number 16 3 COMPLETE DENTURE TREATMENT 455 Therefore. He is given an appointment to return in two days. Some people eat slowly in a gentle manner. He will not need extensive adjustment. People eat differently. He now knows that he is able to use the dentures with comfort for the nonmasticatory functions. talking.to balanced occlusion.” The occlusion should not confine mastication to a narrow limited “tear drop” design of mandibular movement. At the third adjustment appointment. BALANCED OCCLUSION After the patient has used the dentures for about a week to ten days. If the paste is thick and unmoved on the tissue surface of the denture. Many dentures fail because of an incorrect contact of the denture base with the labial frenum. It is corrected at a subsequent visit should noticeable signs of irritation develop. and swallowing. The occlusion is observed again for deflective occlusal contacts. Other . The disclosing paste is used to adjust the lower denture in the same manner as was done on the upper denture. even though there should not be any complaints of pain. I use a definite technique to grind the teeth in. The patient almost always volunteers the observation that the teeth “feel much better. INSTRUCTIONS TO THE PATIENT The patient is instructed to wear the dentures at all times except for eating. The procedure is begun at one posterior border and continued around to the opposite side.e patient. Then the lingual surfaces of the denture are corrected.4 The posterior palatal seal is not adjusted at this time. the patient most likely will be pain free. the dentures receive the same treatment that they received at the other visits.ve been completed.) These three adjustment visits produce a good psychologic effect and promote a feeling in the patient that all the ensuing treatments will be successful. the disclosing paste procedure is used to locate incipient sites of discomfort which may have been induced by the nonmasticatory functions of yawning. All corrections can be made with a cold curing resin reline material after the denture has been adjusted to tissue contact from tuberosity to tuberosity. The first visit for adjustment procedures is completed after the teeth have been Spot ground to remove any obvious deflective occlusal contacts. the impression was incorrectly made. The three adjustment visits instill a sense of confidence and encouragement in tE. Full freedom of movement for the buccal frenum must be provided in the same manner. (All patients “cheat” and learn that they can use the dentures for eating soft foods without pain. The patient is instructed that he should not use the dentures for eating and that he is to return in three days. At the next adjustment appointment. The buccal flange is adjusted after the adjustments on the tuberosity region ha. with little protrusive or lateral mandibular movement. However.

A mass of cold curing acrylic resin at a puttylike consistency is added to both sides of the lower denture. May-June. and use the Coble Intra Oral Balancer* as a guide in grinding the teeth. The lower denture is set aside to permit the acrylic resin to complete its curing. The petroleum jelly and any resin that may have become attached to the upper denture are cleaned away. Pros. Then the acrylic resin ramps are adjusted to provide protrusive and lateral balancing contacts. The patient’s teeth are guided into centric occlusion. A technique for the insertion of dentures has been described. However..27 If the upper residual ridge is small with a flat palate and with short lateral walls. Den. The upper molar teeth. This technique stresses the importance of the series of postinsertion visits. the denture base material in the region of the tuberosities. Caution must be exercised when the teeth are ground into the reverse curve of occlusion. GRINDING THE TEETH man- Teeth in dentures have been formed into the Monson (compensating) curve by grinding from the buccal cusps of the upper teeth and the lingual cusps of the lower teeth. and the lower molar teeth are coated with petroleum jelly.30 or (2) by the use of ramps. Raleigh. the dentures are replaced in the mouth and adjusted into centric occlusion.29. l C!oble Denture Research Company. 1966 people eat with gusto in a violent manner.29 I grind the teeth into the reverse occlusal pattern. with large lateral and protrusive dibular movements. Inc.4J4Js-1s. N.4p31s32 I use ramps to form balancing contacts . . The ramps provide lateral and protrusive balancing contacts and prevent the tipping of the maxillary denture in protrusive and lateral positions. stability can be added to the lower denture if the teeth are formed into the reverse occlusal curve by grinding from the lingual cusps of the upper teeth and the buccal cusps of the lower teeth. BALANCING CONTACTS AND RAMPS Schuyler2s wrote that “A balancing contact of the posterior teeth in both the protrusive position and on the balancing side are essential to the success of a full prosthesis.4 The ramps are added after the teeth have been ground into functional occlusion.4.56 SUSSMAN J. distal to the lubricated area. When the resin has started to cure. C. except when the maxillae have a poor form. the Monson (compensating) curve should be developed in the occlusion. When the acrylic resin on the lower denture has completely cured. Upper complete dentures that rest on maxillae which are of unfavorable form will lose stability if the teeth are ground into the reverse occlusal curve. SUMMARY A resume of a number of techniques for constructing complete dentures has been presented. the dentures are removed from the mouth.” Balancing contacts can be produced by: (1) a tooth-to-tooth contact 7 16~17.

. D. DENT. Y. 1953. PROS. R. Coulouriotes.1953. : Free-way Space. DENT. 8:740-752. A. A:: A Discussion of “Present-Day Concepts in Complete Denture Service. K. PROS. B. C. Lammte. A.1958.: Eleven Aids for Better Complete Dentures.: PROS. 1954. 10.: 1. C. 10:428-435. G. 3:8-28. Jones.196O. : Occlusal Records.: Dimensional Accuracy of Various Denture-Base Materials.” J.: A Biomechanical Approach to the Problem of Prosthetic Occlusion. B. 1962. 13:204-228. DENT. J. and Beresin. 9:952-961. PROS. DENT. J. H. M.6t. G. and Lazzari. J. W. J. Kairesi929. 8:220-229. DENT. : Saliva and Denture Retention. DENT. PROS. 1%3. 1955. 6:472-487. B. PROS. 26. J. : ‘Some Pl tysiologic Considerations of Centric and Other Jaw Relations. 22. Trapozzano. McCollum. M. 25.. PROS.: A Study of Hinge Axis DEXT. E. . J. 10023 . J. (6:183-194. PROS. A:. : Occlusal Surface Contacts During Mastication..: The Management of Abused Oral Tissues in Complete Denture Construction. Grangc2q2Ei9Fi: The Temporomandibular 19. A. H. 10:37-38.: A Realistic Approach to Complete Denture Construction. P. Schuyler. 4:782-804. 18. C.: Discussion of “Soft Tissue Displacement Beneath Removable Partial and Complete Dentures. J. hf. Sussm.3. : The Problem of the Mandibul ar Denture. 1955. 3:772-782. J.” J. PROS. < ‘1. Tissue Conditioninr Utilizina Y Dvnamic Adantive Stress. and Peyton. DENT. DENT. N. Martone. W. 12:~ 44-46. DENT.1:804-815. PROS. 10:658-663. R. PROS. DENT. F. J. Kurth. 4. G.: Trends in Clinical Methods of Establishing an Ideal Interarch Relationship. i. 1. il. DENT.: Clinical Applications of Concepts of Functional Anatomy and Speech Science to Complete Denture Prosthodontics. 20. Part VIII. 32. Yurkstas. V: R. 1954. PROS. V. Anthony. C. 1962. DENT. A. 24. and Storer.1961. PROS. J. 5:313-318.< T.: The Cuspless Centralized Occlusal Pattern. H. PROS. 10:39-41. 17. J. Tuckfield. DENT.: Factors of Occlusion Applicable to Restorative Dentistry. : Procedures in Complete Denture Prosthesis. 203 WEST 74~~ ST. PROS. H. M. G. 12:67-81.196O. H. DENT. 13:70-71. 1955. 11. :. PROS. H. 6. ii: Chase.: Biomechanics and Artificial Posterior Teeth. The Final Phases of Denture Construction. W. Koski. DENT. J..: The Mandibular Hinge Axis and a Method of Locating.. R. 28. W. J. DENT. A. W. 21. Ostlund. PROS. J. 1. PROS. J. DENT. Hughes. 8:411-424. 30. DENT. J. J. Joint in Prosthodontics. 1962. Bouchelr. 1962. PROS. 5:305-312. Moses. S. PROS. PROS. DENT. Sears. J. Pleasure. 5:194-199.: Fundamentals Important to Good Complete Denture Construction. A. 1961.: More Successful Complete Upper Dentures. J. 27. PROS. T. : Centric and Eccentric Occlusions. Beresin. Trapozzano.. B.: Balanced Occlusion.” J. and Emerson. E. 1956. 1957. 1960. A. DENT. PROS. DENT. J. ‘9. 11:858-863. L. Moyers. 8:243-251. NEW YORK. DENT. Lytle. J. PROS.. 10:1029-1036. Determination. Downs. J. Sussm!$6fl.K. 1958. 16. 1963. DENT. 0. PROS. lO:lOll-1021. B. 1. 1958. DENT. PROS. DENT. A. :!I Terrell. H.ll. PROS. J. DENT. 1954.: Occlusion of Cuspless Teeth for Balance and Comfort.: A Study of Tooth Contact Durtng Mastication With Artificial Dentures. P. 1960. 4:168-174. Porter. PROS.: Axis of the Opening Movement of the Mandible.It. 7:27-42. PROS. 10:239J. L. 12:888-894. J. DENT. J. 1958. G. DENT. R.: A Preliminary Report on Resilient Denture Plastics. 29. 23. V. T. 12:220-228. ‘R. PROS. 12.Volume 16 Nnmber 3 REFERENCES COMPLETE DENTURE TREATMENT 457 A Discussion of “Prosthodontic Research in Progress at the School of Aerospace Medicine. PROS. V. DENT. E. 1955. DENT. 5:325-332. Willie. Jones.. DENT. 4:150-167. 1956. PROS.

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