DELIVERY OF THE FINISHED DENTURES

Objectives
1. To check the retention and the accuracy of the jaw relations of the
completed dentures, and to adjust where necessary.
2. To instruct the patients in the correct use of their dentures.
3. To advise the patients on the proper care of their dentures and of the
denture-supporting tissues.
4. To advise them on the limitations to be expected of artificial dentures.

Procedure
1. Inspection of the finished dentures
2. Test for retention of dentures
3. Check the centric jaw relationship
4. Instructions to patients regarding the use of the dentures.

1. Inspection of the Finished Dentures

Prior to the placing of dentures in the patient's mouth, the dentures
should be inspected to be sure that
 There are no imperfections on the tissue surface,
 The polished surface is smooth,
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 The denture flanges have no sharp angles and are not too thick, and
 The denture borders are rounded and smooth with no obvious
overextension.
 The occlusion of all complete dentures should be perfected before
the patient is allowed to wear the dentures.
2. Test for retention of dentures
Test for the retention and prepheral seal of the anterior labial part
1. Seat the upper denture with a firm upward and backward pressure.
2. Allow the tissues of the lips and cheeks to settle around the dentures.
3. Pulling the anterior labial part of the upper denture vertically
downward and assess resistance to it (fig.1).

Fig. (1): Test for the retention and prepheral seal of the anterior labial part
Test for the posterior palatal seal
By appling upward and outward pressure on the cingulae of the upper
incisors (fig.2).

Fig. (1): Test for the posterior palatal seal

Test for the seal at tuberosity area
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By applying upward and outward pressure at the opposite canine region
(fig.3).

Fig.(3): Test for the seal at tuberosity area

Test the retention of the lower denture,
Applying an upward force, bearing in mind that the extent to which
retention can be developed in the lower denture is commonly less than that
of an upper.
If the retention is poor then the base must be corrected.

3. Check the centric jaw relationship

Check the centric jaw relationship by following the procedures
already detailed under record taking. Have the patient close in centric jaw
relationship and note the manner in which the opposing teeth occlude.

Treatment at the time of denture insertion

The patient should have been instructed to keep any previous dentures
out of the mouth for 12 to 24 hours immediately before the insertion
appointment to get the tissues healthy.
1. Elimination of Basal Surface Errors
The use of pressure indicator paste is essential to evaluate the accuracy
of tissue contact. It is especially helpful when bilateral undercuts on the
residual ridge interfere with the initial placement of dentures or when
pressure spots are present or suspected in the final impression.
The paste is brushed on the tissue surface of the denture base in a thin 3Page
layer. The denture is carefully placed in the mouth and pressure is applied by
the dentist on the teeth to reveal any pressure spots in the denture base that
would displace soft tissue. A repeat recording should be made for verification
of pressure spots, and the denture base carefully relieved. Pressure indicator
paste should be used for every new denture, and any necessary adjustments
should be made before proceeding with the occlusal adjustment (fig.4)
 Fig.(4): pressure indicator past with

2- Elimination of maxilla mandibular relation errors:-

Finished dentures exhibiting incorrect centric relation
If the difference is not more than a 1/4 cusp it may be corrected by
means of selective grinding.
When the error is gross it will require the removal of all the posterior
teeth from the lower denture as follows:
A. If Acrylic posterior teeth were used:-
1- The teeth are ground down and replaced with wax blocks for new centric
relation registration.
2- The blocks are trimmed to the correct height by trial and the centric
relation is retaken.
3- The dentures are then re-articulated, and the block teeth are reset.
4- If the overjet resulting from the new record is abnormal, the lower front
teeth must also be removed from the denture and new teeth are reset. 4Page
B. If porcelain teeth were used:-
1.The teeth are gently flamed playing the flame actually on the porcelain
and not the acrylic base; conduction of the heat through the porcelain
softens the acrylic without burning it.
2.The teeth are removed from the denture.
 3.The teeth are then replaced with wax blocks as described before.
4.In most cases of gross error, the denture need to be completely remade.

Finished dentures exhibiting an incorrect vertical dimension

If the occlusal plane of the upper is judged to be correct, a new lower
denture with the correct vertical height should be constructed. If the occlusal
plane is incorrect, new upper and lower dentures should be constructed.

Occlusal disharmony (Error)

Errors in occlusion can result from:-
1. Clinical errors.
2. Errors in mounting models on the articulator.
3. Errors arising during processing of the dentures.

1. Clinical Errors:-
The clinical errors may result from one or more of the following factors:
1- Record bases that do not fit accurately as a result of faulty adaptation
or warpage of the bases or the presence of intervening wax on the
models.
2- A shifting of the record bases over displaceable tissues.
3- Excessive pressure exerted by the patient during the registering of 5Page
maxillomandibular relations.
4- Unequal distribution of stress (uneven bearing) during registering of
maxillomandibular relations. This may be due to premature contact of
the record rims on one side of the mouth in the second molar region of
both sides or in the incisor region.
 5- Interference of the record bases in the posterior region during
registeration
6- Tooth movement may occur when trying in the waxed dentures.
7- Patients not registering centric relation because of systemic factors
such as muscle spasm, abnormalities of muscle tonus, or because of
inability of mental, aged, or senile patients to understand instructions-
factors beyond the control of the dentist.
8- Errors in the transfer of rnaxillomandibular relation to the articulator.

2. Errors in Mounting Casts:-

Errors in mounting casts on articulators may be caused by:
1. Record bases that are not properly seated and secured to casts
during mounting procedures.
2. Occlusion rims not being definitely locked or keyed for correct
orientation during the mounting on the articulator.
3. Distortion of the wax used in sealing the record rims together. For
this reason, softened wax is preferred than soft type waxes because it
hardens immediately after sealing.
4. Interference of casts in the posterior region during mounting.
5. Articulator not maintaining horizontal and vertical relationship of
casts e.g. interfering wax or plaster or loose mounting ring. 6Page
6. Articulator wears. All articulators are subject to wear and the older and
more worn the articulator the greater will be the errors in occlusion and
articulation.

3. Errors Arising During Processing of the Denture:-

a) Irregularities in setting the teeth. The technician when setting teeth is
 unlikely to produce a perfectly even contact in centric and lateral
occlusions, some teeth will be in good occlusion whilst other will be
slightly out of occlusion, thus producing areas of heavy pressure.
b) In waxing up. It is possible for the teeth to move slightly due to the
contraction of the wax on cooling, causing irregularities in the
articulation and occlusion of completed dentures.
c) Tooth movement when flasking and packing.
d) Incomplete flask closure. Such an occurrence not only causes increase of
vertical dimension but also results in an upset balanced occlusion.
e) Warpage of the dentures by overheating them during polishing.

Treatment of occlusal disharmony

These errors in occlusion must be eliminated before the dentures are
worn, so the soft tissues interposed between the bone and the denture bases
will not be distorted by discrepancies in the occlusion.

One of the following methods may be used for correcting occlusal

disharmony by selective grinding:

I- Intraoral methods. 7Page

II- Direct remount.
III- Clinical remount (Remount via new jaw relationship records).
I- Intra-Oral Methods
A- Articulating paper (fig 5):
Articulating paper alone will not give as accurate indication of
premature contacts as some other methods, because:-
1- The resiliency of the supporting tissues allows the dentures to shift;
therefore, the paper markings are frequently false and misleading.
2- The denture bases can move from the basal seat causing the teeth in the
opposite side of the arch or the opposite end of the arch to contact
prematurely and produce an incorrect marking.
3- To place articulating paper on one side of the arch may induce the patient
to close to or away from that side. Articulating paper should be placed on
both arches, procedure sometimes difficult to do accurately

Fig (5): Articulating paper marks on premature contact

B- Occlusal Wax (fig 6):
Adhesive wax is placed on the occlusal surface of the mandibular
denture and the patient is instructed to close his mouth in centric relation.
Points of penetration may be marked with a lead pencil and relieved where 8Page
indicated. With this method one may also locate points of interference
during functional movements.

Fig: (6): checking occlusion with wax

Disadvantage of the intra-oral method:-
Shifting of the dentures over resilient supporting tissues in eccentric
jaw positions will give false markings. This is an excellent method for
correcting occlusion in the centric position.
C- Abrasive Paste:
The use of abrasive paste in the mouth has many disadvantages:-
1. The shifting of the base a result of a premature contact may result in
altering the occlusion so that centric occlusion does not correspond to
centric relation.
2. Cusps that maintain the occlusal vertical dimension may be destroyed.
3. Abrasive paste is not selective.

II- Direct Remount

(The Split Cast Method or Laboratory Remount)
Steps of direct remounting (fig 7):-
1. During denture construction the bases of the working models are
tapered and indices are cut in them (Fig.7).
2. A separating medium is also applied to them before mounting.
3. The working model can, then, be removed from the articulator
mounting with the waxed dentures. 9Page
4. Protect the indices by tinfoil during processing.
5. The working models can be returned to the original plaster mounting
of the articulator for selective grinding after the dentures have been
processed in acrylic resin and before the models are removed for
finishing.
 This method will only correct errors arising during processing of the
denture. However, it will not eliminate errors produced by the impressions or
jaw relation records nor it will eliminate errors that develop when the
dentures are removed from the casts or are polished.

Fig (7): The base of the cast is indexed for direct remounting Right; direct remounting
of dentures after processing

III- Clinical Remount

(Remount via new centric relation record)
A- Registeration of centric relationship without tooth contact:
1- Mounting of the upper denture:
a) The undercuts of the finished dentures are blocked out, separating media is
applied and the dentures are poured into dental stone.
b) Mount the maxillary cast on the adjustable articulator according to a new
face-bow record or remounting platform with the occlusal index.
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2- Centric relation record:
a) The upper and lower dentures are removed from the casts, and the upper
denture is seated in position in the mouth.
b) A strip of softened wax of double thickness is placed on occlusal surface of
the lower denture.
c) The lower denture is seated in the mouth and the patient requested to close
 in the retruded position until the teeth are almost in occlusion. It is
extremely important that the teeth are not allowed to make contact, for if
tooth contact does occur the lower cusps by moving along the cuspal
inclines of the upper teeth may guide the mandible into the position of
occlusion to which the dentures were constructed and thus, if an error
exists, prevent the desired correction of maxillomandibular relationship.
d) The lower cast was luted to the mounting ring of the lower member of the
articulator by using the interocclusal record.
3- Lateral or protrusive records:
a) A strip of softened wax of double thickness is placed on occlusal surface of
the lower denture.
b) The denture is placed in the mouth and the mandible is moved to the right
lateral position and closed almost to tooth contact.
c) A second template records the left lateral position.
d) If the patient experiences difficulty in making lateral movements, then a
single protrusive record should be taken with the mandible protruded
approximately 1/4 inch.
e) These records are used to set the condylar guide paths of the adjustable
articulator.
Selective grinding
The principles of selective grinding should be followed whether intra- 11Page
oral or direct or clinical remounting techniques are employed. There are only
slight differences in the procedures between the different techniques as
follows:-
a) In the intra-oral technique, the occlusal disharmony is detected inside the
mouth of the patient. While the occlusal disharmony in direct and clinical
remounting is detected in the articulator.
b) The incisal pin should be kept in place in direct remounting to be a guide
for the predetermined occlusal vertical dimension. The incisal pin should
be removed in clinical remounting as new records are undertaken in the
present of occlusal discrepancy and while the opposing teeth are not
making contact. Thus, the presence of incisal pin will not allow any
selective grinding to be done to correct occlusal disharmony and reducing
the vertical dimension to the original predetermined vertical dimension.
I-Grinding In Centric Occlusion:
Articulating paper is used with an open and close movement of the
articulator or the mandible in intraoral method, to discover any traumatic
points on the occlusal surfaces of the teeth. These are removed until even
contact throughout the arch is obtained.
In case of direct remounting, contact of the incisal guidance pin on the
incisal table indicates that the correct vertical dimension has been re-
established.
In the posterior segment the surfaces to be reduced are selected according
to two basic rules (fig 8).
a- If the cusp is high in both centric and eccentric occlusion, reduce the cusp.
b- If the cusp is high in centric but not in eccentric occlusion, deepen the
fossa.

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Fig (8): Correction of error in centric occlusion. Left; the cusp high in centric and
eccentric. Right; the cusp high in centric only
II-Grinding to obtain occlusal balance in lateral movements:
A- Anterior teeth:
In case of clinical remounting, remove the incisal guidance pin from
the articulator. Place articulating paper between the dentures on the
articulator or intraorally and make lateral movements of the articulator arm or
mandible.
Selective grinding of the anterior segments should simulate the wear
patterns of the natural teeth and preserve the aesthetics of the dentures. If the
anterior dentition is found to be in traumatic contact reduce the traumatic
areas of contact using the following rules (fig 9):
a) Reduce the lingual surfaces of the maxillary incisal edges.
b) Reduce the labial surfaces of the mandibular incisal edges.
c) Reduce the disto-lingual slopes of the maxillary cuspids (canines).
d) Reduce the mesio-labial slopes of the mandibular cuspids.

Fig (9): Correction of error in lateral movements of anterior teeth.

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B- Posterior teeth:
Where the posterior dentition is found to be in traumatic contact reduce
the traumatic area of contact using the following rules (fig 10):
Working side
Grind on 'bull' rule, to avoid the supporting cusps (the upper palatal
and the lower buccal cusps). Which preserve the vertical dimension of
occlusion
1- Reduce the inner inclines of maxillary buccal cusps.
2- Reduce inner inclines of mandibular lingual cusps.

A B c
Fig (10):- Correction of errors on the working side: A; The supporting cusps. B, buccal
cusps too long; reduce buccal upper cusp. C, lingual cusps too long; reduce lingual lower.

Balancing side:
Reduce the inner inclines of the mandibular buccal cusps in preference
to the opposing maxillary slope. This is important because grinding usually
involves removal in part or whole of the cusp, which is an established centric
occlusal contact. Therefore the maxillary cusp is left to provide a more
stabilizing effect for the lower denture (fig 11).

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Fig (11): Equilibrating the occlusion in balancing side

III-Grinding to obtain occlusal balance in protrusive movements:
1. If the anterior dentition is found to be in traumatic contact reduce the
traumatic areas of contact as described for lateral movements.
2. If the posterior dentition is found to be in traumatic contact reduce the
traumatic areas of contact, grinding in accordance with the BULL Rule
(fig. 12):
3. Grind only cuspal slopes, which are not providing centric contact. Grind
distal inclines of maxillary buccal cusps and mesial inclines of mandibular
lingual cusps.

Fig (12): Interference of anterior & posterior teeth during protrusion

IV- Milling-In
On completion of selective grinding the dentures should be "milled-in".
Place abrasive paste between the dentitions and make lateral and protrusive
movements of the articulator arm. This serves to reduce any slight high spots
that may be present in dynamic movements and thus aids the development of
balanced articulation.
Finally rubber-stone any ground areas of teeth, carefully remove the
dentures from the articulator and repolish the teeth and any areas of the
polished surface of the denture as necessary.
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INSTRUCTIONS TO PATIENTS RECEIVING COMPLETE
DENTURES
1- Eating:
Eating may be difficult at first. The food should be cut into small
pieces and the patient should take his time chewing. Chewing is better
restricted, at first, to the premolar region. Tough and sticky foods should be
avoided over the learning period.
2- Cleaning:
The dentures should be removed and cleaned after each meal. A soft
brush with soap and cold water are sufficient for cleaning. Alternatively, a
proprietary denture cleaner may be used, following the manufacturers'
instructions. The patient should be warned against using harsh abrasive
materials and hard bristle brushes, since both will wear away the surface
detail of the teeth and denture base.
3- Wearing dentures at night:
Generally, patients should be instructed to remove their dentures at
night in order to rest the tissues which support them. The dentures should be
stored in water or mild antiseptic to prevent them drying out and warping.
Solutions containing phenol must be avoided as they are liable to craze the
surface of the denture.
4- Talking: 16Page
People who have been edentulous for a considerable period will have
adapted themselves to the prevailing conditions, and probably will have
corrected any speech defects arising from the loss of teeth. With the insertion
of the dentures, the conditions are suddenly changed and the tongue is
conscious of the reduction of the space, and may be cramped temporarily by
the bulk of the lingual flange of the lower denture, this may lead to difficulty
on forming the speech sounds until the tongue has had sufficient time to adapt
itself. Patients who are likely to experience speech difficulties should be
advised to read loud, and practice any word which causes trouble. A few
hours spent in this manner will enable most patients to speak naturally and
with complete ease.
5-Pain and soreness:
Pain and soreness occur with new dentures. Adjustment may be
required. If the pain is severe, the patient should leave the dentures out and
arrange an appointment with his dentist as soon as possible. The patient
should wear the dentures the day he returns to the dentist so that the sore area
may be seen. The patient should never attempt to adjust the denture himself.

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