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The new edition of this well established and highly regarded textbook has been completely

the Edentulous Patient


Prosthetic Treatment of
revised and updated to reflect the latest developments in the field of tooth loss and denture
provision. Primarily aimed at students in the undergraduate and immediate postgraduate years,
it will also be of value to all those, including clinical dental technicians, who are faced with the
increasingly challenging problems of complete denture treatment in dental practice.
Starting with a thorough grounding in the background and theory of denture treatment, the
book goes on to describe clinical procedures for all stages of treatment as well as devoting
a chapter to the diagnosis and management of clinical problems. The clinical chapters also
include sections on quality control, where topics are suggested for consideration in audit cycles.

Prosthetic
Now in full colour throughout, this fifth edition of Prosthetic Treatment of the Edentulous Patient
contains nearly 200 illustrations and also includes a brand new section on implant overdentures.
KEY FEATURES
• Stresses the importance of evidence-based treatment
• Emphasises care of the elderly and the value of holistic treatment
• Uses a flexible approach to accommodate patient variation
Treatment of
the Edentulous
• Highlights the importance of good communication between clinician and dental technician
• Includes many high-quality full colour illustrations

REVIEWS OF THE PREVIOUS EDITION


“This textbook is highly recommended to undergraduate students as it is well written, clearly
laid out and helpfully illustrated... The text should also be of interest to practitioners and those
preparing for postgraduate exams.”
Patient
Dental Update

fifth edition
“In summation, the authors have achieved their aims and I would recommend this textbook for
undergraduates.”
British Dental Journal
fifth edition
THE AUTHORS
R.M. Basker, OBE, DDS Birm, BDS Lond, FDSRCS Edin, MGDSRCS Eng, LDSRCS Eng
Emeritus Professor, University of Leeds, UK
J.C. Davenport, PhD Birm, BDS Brist, FDSRCS Eng, RBSA
Emeritus Professor, University of Birmingham, UK
J.M. Thomason, PhD Ncl, BDS Ncl, FDSRCS Ed
Professor of Prosthodontics and Oral Rehabilitation, Newcastle University, UK

ALSO OF INTEREST
Basics of Dental Technology: A Step by Step Approach R M BASKER

THOMASON
DAVENPORT
BASKER
Tony Johnson, David G. Patrick, Christopher W. Stokes, David G. Wildgoose and Duncan Wood
978-1-4051-7875-4
J C DAVENPORT
Applied Dental Materials
Ninth Edition
John F. McCabe and Angus W.G. Walls J M THOMASON
978-1-4051-3961-8
Removable Partial Dentures: A Clinician’s Guide
John D. Jones and Lily T. Garcia Cover design: Meaden Creative
978-0-8138-1706-4 Cover illustration by J.C. Davenport

ISBN 978-1-4051-9261-3

9 781405 192613

basker_9781405192613_pb.indd 1 11/1/11 12:11:17


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Prosthetic Treatment of the


Edentulous Patient
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Prosthetic Treatment of the


Edentulous Patient
Fifth Edition

R.M. Basker
OBE, DDS Birm, BDS Lond, FDSRCS Edin, MGDSRCS Eng, LDSRCS Eng
Emeritus Professor, University of Leeds, UK
Formerly Consultant in Restorative Dentistry, Leeds Teaching Hospitals NHS Trust
Formerly External Examiner in the Universities of Birmingham, Bristol, Dundee, London, Malaya
Manchester, Newcastle upon Tyne, Sheffield and Wales, University College Cork,
Universiti Kebangsaan (Malaysia)
Examiner, MGDS of the Royal College of Surgeons of England

J.C. Davenport
PhD Birm, BDS Brist, FDSRCS Eng, RBSA
Emeritus Professor, University of Birmingham, UK
Formerly Consultant Dental Surgeon, Southern Birmingham Community Health NHS Trust
Formally External Examiner in the Universities of Amman (Jordan), Dublin, Glasgow, Leeds, London
Manchester, Newcastle upon Tyne, University College Cork and Wales

J.M. Thomason
PhD Ncl, BDS Ncl, FDSRCS Ed
Professor of Prosthodontics and Oral Rehabilitation, Newcastle University, UK
Visiting Professor and Adjunct Professor, McGill University, Montreal, Canada
Consultant in Restorative Dentistry, Newcastle upon Tyne Hospitals NHS Foundation Trust
Formally External Examiner in the Universities of Dublin, Glasgow, Manchester, King’s College
London, Hong Kong
Examiner in MRD and MFDS examinations of the Royal College of Surgeons of Edinburgh

A John Wiley & Sons, Ltd., Publication


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This edition first published 2011



C 1976, 1983, 1992 by R.M. Basker, J.C. Davenport and H.R. Tomlin

C 2002 by Blackwell Munksgaard

C 2011 by R.M. Basker, J.C. Davenport and J.M. Thomason

Blackwell Publishing was acquired by John Wiley & Sons in February 2007. Blackwell’s publishing program has been merged
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Library of Congress Cataloging-in-Publication Data


Basker, R.M.
Prosthetic treatment of the edentulous patient / R.M. Basker, J.C. Davenport, J.M. Thomason. – 5th ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4051-9261-3 (pbk. : alk. paper) 1. Complete dentures. 2. Edentulous mouth.
I. Davenport, J. C. (John Chester) II. Thomason, J. M. III. Title.
[DNLM: 1. Denture, Complete. 2. Mouth, Edentulous. WU 530]
RK656.B338 2011
617.6 92–dc22
2010040959

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF [978-1-4443-9324-8]; ePub [978-1-4443-9325-5]

Set in 9.5/12 pt Palatino by Aptara


R
Inc., New Delhi, India

1 2011
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To our families
And to the memory of Bob Tomlin
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Contents

Foreword to the First Edition by John Osborne ix


Foreword to the Fifth Edition by Gunnar E. Carlsson x
Preface xi
Acknowledgements xiii

1 An Appraisal of the Complete Denture Situation 1

2 Factors Influencing the Outcome of Prosthetic Treatment 20

3 Transition from the Natural to the Artificial Dentition 31

4 Stability of Dentures 55

5 Jaw Relations – Theoretical Considerations 68

6 Introductory Remarks to the Clinical Chapters 76

7 Assessment of the Patient 80

8 The Relevance of Existing Dentures 91

9 Preparation of the Mouth 111

10 Impressions 130

11 Recording Jaw Relations – Clinical Procedures 150

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viii Contents

12 Dentures and Muscles 174

13 Try-in Procedures 189

14 Fitting Complete Dentures 203

15 Recall Procedures 220

16 Some Clinical Problems and Solutions 228

Index 265
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Foreword to the First Edition

This addition to prosthetic literature must be cal or technical operative detail. Given a sound
widely and warmly welcomed. For a number of basic understanding of the principles to be ob-
years there has been a shortage of British texts served in the treatment of the edentulous, chair-
for students concerning the edentulous patient. side experience rapidly perfects each individ-
The authors have, correctly, stressed the seri- ual’s manipulative skills.
ous problems that more and more frequently Being not unfamiliar with the labours in-
present themselves now that life expectancy is volved in producing textbooks, one is conscious
on the increase and the average age of the eden- of the time and effort that have gone into the
tulous is advancing. The dental profession is preparation of this book. It should achieve all
becoming aware of the particular geriatric situ- the success that these efforts of one’s former col-
ations it now has to face and this book will un- leagues deserve.
doubtedly help in solving many prosthetic geri-
atric problems. John Osborne
Emphasis has been placed more upon gen- Shalfleet, Isle of Wight, 1975
eral principles than upon the minutiae of clini-

ix
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Foreword to the Fifth Edition

The breakthrough of implant-supported increase in the number of the elderly will coun-
and/or -retained prostheses has revolutionised teract the diminishing rate of edentulism. It
dental treatment. A great part of the pro- is therefore likely that the need to rehabili-
grammes at current prosthodontic conferences tate edentulous patients will remain consider-
includes presentations based on high-tech able for many more decades. Complete den-
implant treatment for partially and totally tures will continue to play a central role in
edentulous patients. So successful have the the rehabilitation of edentulism; thus, teaching
clinical outcomes with implant treatment been and training in complete denture prosthodon-
that many clinicians have come to believe that tics must continue.
implants can solve all problems related to tooth This successful textbook has reached its fifth
loss. This is of course not true, confounded as edition. It combines a straightforward descrip-
it is not only by unfavourable oral situations tion of well-proven principles and methods for
but also by a number of non-dental factors. the treatment of an edentulous patient with
Of these, the greatest obstacle is undoubtedly modern evidence-based examples of solutions
economic. Viewed in a global perspective, for problems and complicated situations. The
poverty is still extremely widespread, and it text is easy to read and the illustrations give
exists even in many industrialised countries. excellent explanations of principles and tech-
Sadly, a majority of edentulous people will niques described. The book will therefore be of
never be candidates for any type of implant great value in both undergraduate and post-
therapy and complete dentures will remain graduate education, and it deserves a place in
their sole option. the office of any dentist who treats adult and
The declining prevalence of edentulism older patients.
would seem to indicate a reduction in the num-
ber of people in need of complete dentures.
However, when epidemiological and demo- Gunnar E. Carlsson
graphic data are combined, the ongoing large Gothenburg, Sweden, November 2010

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Preface

Two of us have had the particular pleasure that the clinical approaches adopted in this
of welcoming Mark Thomason to the authors’ book will play a part in clarifying that choice.
team. His presence has ensured not only that During the last 8 years, there has been an
the text has been brought up to date in a num- explosion in the number of published papers
ber of important areas, but also that writing a dealing with implant-supported complete den-
new edition has continued to be a pleasurable tures. This development is highly relevant to
and stimulating experience. the all-important stage when decisions have to
Thirty-four years ago, we commented in the be made on how to manage the transition from
preface to the first edition that it was important what remains of the natural dentition to the to-
to adopt a flexible approach to the formulation tally artificial one. We have expanded the chap-
of treatment plans and to the application of clin- ters dealing with this critical period.
ical techniques. This opinion was based on the Another major change in the UK since the
fact that as there is a great deal of variation in publication of the fourth edition has been the
the condition of our patients and their mouths formal registration of two further members of
a ‘one size fits all’ approach is not appropriate. the dental team – the clinical dental technician
We see no reason to change this view. Indeed, and the dental technician. The clinical dental
the recently published work of Professor Gun- technician is a qualified dental technician who
nar Carlsson (Carlsson 2009) strengthens our is able to provide complete dentures directly
opinion. He has drawn the profession’s atten- to patients. Patients with natural teeth or im-
tion to the lack of randomised controlled trials plants must see a dentist before the clinical den-
in many aspects of complete denture provision tal technician can begin treatment. The den-
and has highlighted the fact that there is often tal technician makes dentures to a prescription
a poor correlation between a clinician’s assess- from a dentist or clinical dental technician. The
ment of denture quality and the level of patient educational programmes for both newly regis-
satisfaction with a prosthesis. There is surely tered members of the dental team are formally
considerable scope for further research to help recognised.
to improve the reliability of clinical decision We are strongly of the view that there must
making in this area. In the meantime, we hope be good communication between dentist,

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xii Preface

clinical dental technician and dental techni- tulous population is living longer. Thus, the de-
cian – the right hand must know what the left is mand for prosthetic care will remain at a sig-
doing or is planning to do. Published work sug- nificant level for the foreseeable future, and
gests that the level of communication between the challenges this presents to the clinician will
surgery and laboratory still leaves something increase in difficulty as the patients become
to be desired (Juszczyk et al. 2009). At the end older.
of chapters dealing with the clinical stages of
denture construction, we have again included Leeds, Birmingham and
short sections on ‘communication with the Newcastle upon Tyne, 2010
dental technician’ and ‘quality control and en- RMB, JCD and JMT
hancement’. We hope that they will encourage
the development of clearer communication.
Throughout the book, the description ‘clin-
References
ician’ refers to dentist and clinical dental
technician. Carlsson, G.E. (2009) Critical review of some dogmas
We have taken the opportunity of thor- in prosthodontics. Journal of Prosthodontic Research,
53, 3–10.
oughly revising the text and, with the en-
Juszczyk, A.S., Clark, R.K. & Radford, D.R.
couragement of our publishers, of introducing (2009) UK dental laboratory technicians’
colour into the book. views on the efficacy and teaching of clinical-
Although there has been a major reduction laboratory communication. British Dental Journal,
in total tooth loss in many countries, the eden- 206, E21.
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Acknowledgements

We are most grateful to the many friends and ciation’s Information Centre in helping with the
colleagues whose support over the years has literature searches.
encouraged and influenced our thinking on the We are most grateful to the members of
care of the edentulous patient. We are also in- the Medical and Dental Illustration Unit of
debted to our students and young colleagues the University of Leeds and the Photographic
in training who have challenged our ideas, Department of the Dental School at the Uni-
shaped our thinking and shared our learning. versity of Birmingham for their skill over the
Our grateful thanks are extended to Pro- years.
fessor John McCabe, Professor Jim Ralph, Dr We are most grateful to Lucy Nash and Nick
Chris Watson, Mr Francis Nohl and Mr Stewart Morgan at Wiley-Blackwell and Amit Malik at
Barclay for the generous loan of photographs, Aptara for their support, understanding and
to Dr Rachel David and Mr Simon Littlewood encouragement throughout the production of
for their most helpful comments on those this book.
sections of the book dealing with speech and We acknowledge with thanks the permis-
orthodontics respectively, and to Professor sion of the Editor of the British Dental Journal to
Damien Walmsley for helpful discussion. reproduce figures which have appeared in that
We would like to acknowledge the friendly journal.
expertise of the staff of the British Dental Asso-

xiii