STEP BY STEP PROCEDURE ON

COMPLETE DENTURE FABRICATION

Presented to the Faculty of the Dentistry Department

College of Dentistry

Adventist University of the Philippines

Silang, Cavite

In Partial Fulfilment of the Requirements for DENT 224L

Prosthodontics III (Complete Denture) Laboratory

Maligayo, John Allan Paul D.

Dentistry 2nd year proper

March 19, 2020

OBJECTIVES

 To identify the procedures involved in fabricating Complete Dentures

 To recognize the importance of each procedures involved in fabricating Complete

Dentures

PROCEDURES

1. Tray Selection

- In selecting a proper tray, it is important to choose the correct shape and size

conforming to the patient’s oral cavity. Doing so would provide the best support

while in contact with oral tissue and would also provide support to the impression

material in which the cast is poured during preliminary impression. Minor

modifications of the tray may be done using Prosthodontic scissors, Orthodontic

pliers and Sandpapers.

2. Preliminary Impression

- This Procedure Requires the negative impression of the patient’s mouth using the

modelling compound as an impression material. It is placed in a hot water bath

(enough to soften the impression), once it softens, it is placed on the modified stock

tray and while it is still soft, the operator must place it on either the maxilla or the

mandible (depending on the tray). During this stage the operator may apply pressure

on the tray, against the maxilla or mandible and/or massage the patient’s cheeks to

capture the intraoral landmarks, retro mylohyoid space, hamular notches etc. It is

important that the impression overextend to capture the 3-D contours of the vestibular

boarders of the limiting structures.

3. Study Cast/ Diagnostic cast

- After registering the patient’s impression, A dental cast mixture (Plaster of Paris +

water) is poured into the negative impression producing the positive likeness of the

patient’s oral cavity for the purpose of treatment planning, and/or fabrication of final

impression trays. The extent of the denture base is outlined using a red pencil with the

following landmarks as basis for the Design.

Maxillary Mandibular

Mucobuccal fold Mucobuccal fold

Coronomaxillary space External Oblique Ridge

Hamular notch Masseteric Notch

Vibrating line Retromolar pad

Frenum Mylohyoid Ridge

Frenum

Lastly, using a blue pencil, the tray design is outlined having it 2 mm shorter than the

planned denture base for the mandibular design and 2mm shorter than the

mucobuccal fold, except along the posterior palatal seal area, making an apron-like

outline 3-4mm wider than the planned posterior palatal seal area instead for the

maxillary design.

4. Custom tray

- A baseplate wax is heated long enough for it to soften placing it to the cast and

applying pressure enough for the wax to adapt to the shape of the cast. Using a wax
 carver, the excess wax is trimmed using the blue outline placed on the cast as a

reference. ¼ cup of acrylic resin is used for both maxillary and mandibular tray

having a 2:1 Polymer (powder) monomer (liquid) weight ratio. It is mixed on a glass

container or on a acrylic bowl until is has a doughy consistency. It is then pressed

with a glass slab to obtain the proper thickness (1-2 mm) and the resin material is then

adapted to the cast, using a carver to trim any excess. In a maxillary tray, A handle is

placed that extend straight down from the alveolar ridge, 10mm high and 15 mm

wide. In a mandibular tray, Finger rests are placed to aid in holding the tray in

position while making the wash impression. Without finger rests, it is likely that the

impression material will be forced back to the vestibule distorting this portion of the

impression. Note that the finger rest should not impinge upon the tongue space and

not extend above the occlusal plane. The tray handle must extend vertically from the

crest of the ridge and be approximately 10mm high and 15 mm wide.

5. Boarder molding

- Boarder molding is done to shape the boarder of the tray to conform accurately to the

contours of the limiting structures. The primary material is a green stick impression

compound heated until it is drooping using sectional/ incremental boarder molding.

As the name suggest, sectional/ incremental boarder molding follows a sequence of

application of the green stick sections of the individual tray and placing it intraorally.
 For live patients, it is important to temper the material in hot water before inserting it in

the patient oral cavity to regulate the temperature of the material that may cause

discomfort during boarder molding. During boarder molding, is asked to pucker the lips,

smile, move the mandible side to side while the operator can manipulate the cheeks to in

order to register the boarders accurately. The boarder molded tray is then immersed in

cold water and evaluated for its retention and stability.

6. Final impression

- For the final impression material, an impression paste may be used. A specific brand,

namely Cavex Outline ™ uses a two-paste system that is eugenol-free. The white

paste is the base component while the blue paste is the catalyst. It is mixed using

equal lengths of the base and the catalyst. The tray must be coated with a thin layer of

the impression paste and should not overextend. The impression must have smooth

defined peripheries, maximum even pressure distribution and intimate tissue contact.

7. Boxing and pouring

- Boxing is done to fabricate a cast that preserves the peripheral role, provides a

protective rim around the cast (must be 4-6 mm wide), and to produce of vacuum

mixed stone of the proper dimension (10-15 mm thick) to permit flasking. Beading

wax is attached around the impression 3mm below the periphery using a heated metal

spatula to flatten the top boarder of the beading wax forming the land. In the

mandibular impression, the lingual tongue area is sealed using a baseplate wax. The

boxing wax is applied around the beading wax forming the container that would
 provide the thickness we need for the master cast. Pouring is done with a dense cast

stone mix and should avoid entrapment of air bubbles. This can be done either by

vigorously tapping the mix into a flat surface or using a vacuum mixer. It is advised

to start pouring on the buccal of one side and progress to the other side.

8. Master Cast

- After waiting for the cast to set, the cast-impression is immersed in hot water to

soften the surrounding wax for easier cast retrieval. Trimming can be done for the

cast to fit within the confines of the denture flask. Necessary landmarks are drawn in

the cast.

9. Trial denture base

- This gives support to the occlusal rims and the artificial teeth for clinical procedures

like jaw relations and try-in, giving us a clear idea about the contour, extent and

aesthetics of the denture. Acrylic self-cure resin can be used as a material for trial

denture base using salt and pepper technique. Powder and liquid are loaded in two

different dispensers. A small quantity of the powder is sprinkled over a part of the

cast and is polymerized by sprinkling drops of liquid over it. This process is

continued until entire ridges and associated landmarks are covered. Using this method

will achieve better tissue adaptation, however, even thickness cannot be obtained

which is why trimming must be done after setting.

10. Occlusion rims

- Consist of wax rims attached to well-fitting trial denture bases for the purpose of

making maxillomandibular relation records and arranging teeth. Occlusion rims can

be made using a baseplate wax. The wax is flamed slowly by passing it through the

flame quickly until the entire sheet of wax is used. The wax is formed in a horseshoe

and is attached to the trial denture base over the ridge crest area.

- For the maxillary occlusion rim, the dimension is as follows:

1. The anterior wax rim height is 20-22 mm

2. The posterior wax rim height is 16-18 mm

3. The width of the anterior rim is approximately 3-5mm

4. The width of the occlusal rim in the posterior region is approximately 8-10 mm

- For the mandibular occlusion rim, the dimension is as follows,

1. The anterior wax rim height is 15-18 mm

2. The posterior wax covers 2/3 of the retromolar pad

3. The width of the anterior rim is approximately 3-5 mm

- Dimensions of the occlusal rim can be adjusted using a heated metal spatula.

11. Maxillomandibular relations

- As the name suggest, maxillomandibular relations is the spatial relationship of the

maxilla to the mandible. For live patients, a facebow is used to record the

maxillomandibular relation the relation of the maxilla to the temporomandibular joint

which would determine the jaw relations that is to be transferred to the articulator

when mounting.
12. Mounting

- Mounting involves attaching the master cast into the semi adjustable articulator.

Index notches are added to the cast applied with a separating medium. This is to

easily remove the plaster in the master cast when it is time to flask it. Plaster of Paris

is used to mount the cast into the magnetic mounting plate of the articulator. The cast

must be seated all the way into the bite cork until it touches the guide plate.

13. Anterior teeth setting

- For the setting of the anterior teeth, guidelines should be followed:

Anterior teeth Front view Sideview Occlusal Plane

Maxillary central Long axis parallel Slopes labially at Incisal edge is in

incisors to the vertical axis about 14 degrees contact with
occlusal plane

Maxillary lateral Long axis slopes Slopes labially at Incisal edge is 1mm
incisors midline at incisal about 20 degrees short of occlusal
edge plane

Maxillary canine Long axis parallel Long axis parallel Cuspid tip is in
to the vertical axis to the vertical axis contact with the
occlusal plane

Mandibular central Long axis slightly Slopes labially Incisal edge is 0.5-
incisors inclines towards the 1mm above the
vertical axis occlusal plane

Mandibular lateral Long axis inclines Slopes labially less Incisal edge is 0.5-
incisors towards the vertical than central incisor 1mm above the
axis occlusal plane
 Mandibular canine Long axis inclines Slopes lingually Cuspid tip is 0.5-
towards the midline 1mm above
occlusal plane

14. Posterior tooth setting

For the setting of the posterior teeth, guidelines should be followed.

Posterior teeth Front view Sideview Occlusal Plane

Maxillary 1st Long axis parallel Long axis parallel Buccal cusp is in
premolar towards the towards the contact with
vertical axis vertical axis occlusal plane and
palatal cusp is
1mm short of
occlusal plane
Maxillary 2nd Long axis parallel Long axis parallel Both buccal and
premolar towards the towards the palatal cusp are in
vertical axis vertical axis contact with
occlusal plane
Maxillary 1st molar Long axis slopes Long axis slopes Only mesiopalatal
buccally distally cusp in contact
with occlusal plane

Maxillary 2nd Long axis slopes Long axis slopes Only mesiopalatal
molar buccally distally slightly cusp in contact
more than the 1st with occlusal plane
molar
Mandibular 1st Long axis parallel Long axis parallel Buccal cusp is in
premolar towards the towards the contact with
vertical axis vertical axis occlusal plane and
palatal cusp is
1mm above the
occlusal plane
Mandibular 2nd Long axis parallel Long axis parallel Buccal cusp is in
premolar towards the towards the contact with
vertical axis vertical axis occlusal plane and
palatal cusp is
1mm above the
occlusal plane
 Mandibular 1st Long axis leans Long axis leans All cusps are at
molar lingually mesially higher level than 2nd
premolar, buccal
and distal cusps are
higher than the two
Mandibular 2nd Long axis leans Long axis leans The mesiobuccal
molar more lingually more mesially cusp occludes on
the fossa between
the two maxillary
molars

15. Festooning

- Festooning involves creating appropriate contours that enhance stability and control

of the lower denture, provide support for the lips and cheeks, enhance esthetics

particularly in patients with a high smile line and prevent cheek biting. A properly

contoured denture also improves tolerance and comfort. The softened roll of baseplate

wax is adapted on the facial surface and extend. It is then sealed around the neck of

each tooth with a wax spatula. The gingival margins of anterior teeth is carved with a

carver held approximately at 60 degrees. The gingival margins of posterior teeth by a

carver held approximately at 45 degrees. Flaming the wax surface should be done to

show the gingival contour and the root forms. The baseplate wax is then adapted on

the lingual surface of the trial denture and carve.

16. Unmounting from the articulator and sealing the Trial denture base to the Master

cast

- The cast can be unmounted from the articulator by soaking the master cast and

mountings in water for a few minutes and gently removing the cast from the

mountings. Sealing is done by sealing the periphery of the denture flange to the inner

edge of the land of the cast.

17. Flasking/Investing

- It is the process where the festooned wax is converted to resin to make a final

denture. The inner surface is covered with Petroleum jelly while the base of the of the

cast is covered with a separating medium to prevent the investment material (i.e.

plaster of Paris) from attaching to the cast. The first layer of gypsum investment is

poured in the lower half and the cast is placed on top of the investment. A separating

medium is painted on it again to prevent the sticking of the second layer of the

gypsum investment to the first layer. A mix of plaster is placed over the surface of the

teeth in the invested trial denture. The body of the flask is put in place, then the

second mix of gypsum investment is placed on the first layer and covers the wax,

denture base and teeth. After the setting of the second pour, a layer of separating

medium is applied. A third pour of plaster is poured to fill the body, a lid is then

placed in the body. A clamp is placed and tightened the flask, holding its position. It

is left 30-60 minutes to reach final setting time.

18. Wax elimination

- The flask is placed in boiling water for 4 to 6 minutes. Then it is removed from the

water and opened. Then the wax is washed away with boiling water. After that the

mold is washed with boiling water containing detergent, and then finally washing it

with clean boiling water.

19. Mixing and packing of the heat cure

- Acrylic resin dough is made by mixing the powder and liquid (monomer) to form a

dough which is packed into a gypsum mold for curing. It should be done when the

mixture reaches dough stage, as the dough is rolled into a rodlike form and placed in

the upper half of the flask then a polyethylene (nylon sheet) is placed over the dough

in the upper half and then the two halves of the flask are closed until they are almost

in approximation, this is done to spread the dough evenly throughout the mold.

20. Denture processing curing

- It is polymerization of the hot cure acrylic to produce the final denture. The material

is cured by heating in a water bath; pressure is applied during curing to decrease the

effect of thermal, to decrease the polymerization shrinkage and to increase the

evaporation of monomer thus decreases porosity. Flask is kept in water at room

temperature. Temperature is raised to 74 degree Celsius and maintained for 2 hrs. It is

then brought to boil for 1 hour.

21. Deflasking

- It is the process of removal of the processed denture from the flask and investment

mold. Before deflasking of the processed denture begins the flask is left to cool to

roomtemperature. If not, increased distortion of the acrylic may occur.

22. Trimming and Polishing

- In this step any excess acrylic is removed from the processed denture using stone

wheel burs, stone burs, and steel burs. Care must be taken not to heat the denture

during grinding, because this may cause distortion of the denture base. The denture

should be smooth and clean, as no plaster and no deep scratches should remain after

the preparation for polishing. In polishing a rag wheel with pumice is used for

smoothing the denture. Then a final high polish is given to the denture with a rag

wheel and polishing material.

23. Install

- It is the act of attaching the Complete denture to the patient’s oral cavity. This is to

check if there are any adjustments needed to be done before giving it to the patient. If

there are no adjustments needed to be done, then the denture may be given to and

used by the patient.

24. Recall

- A recall is done to check on the patient’s adaptation on his/her new denture. It is often

done every six to 12 months, if there any minor regarding of the dentures,

adjustments must be done immediately to prevent further complications.