Dr.

Amal Fathy Kaddah

Professor of Prosthodontic,
Faculty of Dentistry,
Cairo University
 Introduction

Causes of Denture Errors

 Clinical errors

 Technical errors

 Inherent deficiencies in the

material itself
Clinical Errors
 Errors in impressions

 Ill-fitting trial denture bases

 Inaccurate jaw relation records

 Errors during transfer of the records

to articulator

 Incorrect arrangement of posterior

teeth
Processing and Technical faults

Distortion due to improper flasking

 Failure to close flask completely

 Too much pressure while closing the flask

from the flask press.

 Tooth movement during flasking or packing

 Failure to cool flask before deflasking

Warpage due to overheating during polishing

Technical discrepancies could be
due to:
1- Dimensional Changes in the wax due to
variation in temperature.

2- Expansion of the investing material during the

processing (plaster and dental stone ).

3- Errors which may occur during packing of

acrylic resin.

4- Changes in the acrylic resin material during

processing procedures (polymerization
shrinkage).
Types of Occlusal Errors
 C.O. not coincide with C.R.

 Premature contact (high point) in

one or both sides

 Uneven distribution of occlusal

contacts

 Eccentric movement prematurities

(protrusive & lateral)
Why is it difficult to detect
occlusal errors in the mouth?

*Shifting of denture bases,

incorrect closure by patient

* Resiliency of the Soft tissue

* Negative attitude (assume an

error exists and try to find it)
How can you Detect Occlusal
Errors?

 Denture dislodges (instability) or

shifts when patient occludes

 Patient complains of pain beneath

denture bases >> worst by time

 Sliding of denture bases or uneven

pressure caused by faulty occlusion
can lead to ulceration of mucosa.
 Steps of
Occlusal
Correction
TRIAL INSERTION STAGE
Cervical necks tilt posteriorly from the central incisor to the canine
• The appropriate Curve of Spee should
be incorporated into the setup.

• Make sure the posterior mandibular

teeth are centered over the ridge
• The plane of occlusion should be parallel to the
body of the mandible and extends from the
incisal edges of the central incisors and the
middle portion of the retromolar pads
bilaterally.
TRIAL INSERTION STAGE
TRIAL INSERTION STAGE
• Finalize Wax up
 Fabrication of Occlusal index for
clinical remounting

• At the end of the try in stage where

the dentist and patient are both
satisfied.

• This is a time save procedure for you

because you do not have to make a
new facebow record at the time of
delivery.
Place the Facebow remount jig on the lower member of the
articulator. Verify that the incisal guide pin is set at zero.
Allow plaster index to completely set. Verify that the
maxillary teeth can be repositioned into the indentations.

Occlusal index for

clinical remounting
 To save the position of
the maxillary cast

No need for face bow

record in the clinical
remounting step
Flasking for Processing
- During deflasking: be careful to preserve the
cast, also do not left or remove the denture
from the casts
 Clean the denture and cast from plaster.

 Remove any stone or bubbles from the

exposed acrylic resin and from the occlusal
surfaces of the teeth.

 Remove any particles of stone from the base

of the cast and index grooves.

 Using a stiff brush, soap and water clean the

denture and cast before starting the
laboratory remount
 Dentures being re-mounted on the original
articulator and adjustments carried out to provide
correct articulation (Laboratory Remounting).
* Laboratory Remounting

Carried out, after defalsking and before

polishing of the denture, (before the
dentures are delivered to the patient),
for perfection of occlusion.

Occlusal discrepancies may result

from technical discrepancies.
Purpose
• To correct errors in occlusion that
have occurred during processing

• To return dentures to the correct

vertical dimension

• To obtain a smooth even contact

of the teeth in centric and
eccentric positions.
Disadvantages
 Cannot correct errors made while
recording jaw relations

 Cannot correct errors made while

mounting the casts on the articulator

 Does not compensate changes caused

by settling of the denture bases
 The processed denture on the master cast is
repositioned to its old position on the articulator
by means of remounting indices made in the
master cast before mounting.
Remount and Adjust for Processing Errors
 The condylar elements of the articulator are
locked in the centric relation and the
articulator is closed.

 The incisal guide pin not contact the incisal

guide table, The occlusal vertical dimension
has been changed and must be re-established.
• Place red articulating paper between
the teeth and gently tap the teeth
together in centric occlusion.
The adjustment in centric occlusal position
should be stopped when widespread
Contacts are produced
The incisal guide pin usually stays in
contact with the incisal guide table.
The adjustment in eccentric occlusal
positions
The adjustment in eccentric occlusal positions should be stopped
when widespread Contacts are produced and the incisal guide pin
usually stays in contact with the incisal guide table.
The Aim of Laboratory
Remounting

The prematurities are ground until

multiple, uniformly distributed and
even contacts are obtained bilaterally

The incisal guide pin stays in contact

the incisal guide table
Finishing and Polishing
1. PRE-INSERTION PREPARATION
a . Adjustment of Processing Error .

b . Finishing and Polishing of Denture.

2. INSERTION VISIT
1 . Re-examine dentures and foundation tissues.
2 . Insert each denture independently.

3 . Occlusal equilibration to be accomplished

at this time.
a . Clinical Remount of the upper cast.
b . Interocclusal records - waxes.
c . Remount the lower denture.
Correcting occlusal
errors in patient's mouth

Articulating paper in the mouth

. Not give accurate indication due to the
resiliency of the supporting tissues

Adhesive Wax
or
Clinical remount
Dentures should be remounted
with new records obtained from
the patients
Mount the upper cast according to a
face-bow record or occlusal index *
and Mount the lower cast according
to a new centric relation record.
Advantages of Clinical Remounting
with New Interocclusal Records *

 Less chair side time

 Corrections away from the patient’s

view

 No saliva which makes detection by

articulating paper difficult

 No shifting of dentures or incorrect

closure by patient
The Aim of Clinical
Remounting

The prematurities are ground

until multiple, uniformly
distributed and even contacts
are obtained bilaterally
Clinical remounting is
currently the most
commonly preferred
method of occlusal
correction
 Fabrication of Remount casts
at the time of delivery

Block out undercut areas

in the tissue surfaces
before pouring the plaster
Clinical Remounting Procedure

 Ask patient to bite on

cotton rolls for 10 min.

 Guide mandible into CR

several times.

 Bite registration
material is placed on
the posterior teeth of
the mandibular denture
Clinical Remounting
Procedure
 Guide mandible into CR

 Obtain the new

interocclusal record of
C.R. using your recording
medium of choice,
making sure that the
teeth do not touch. ???
Try in??????
Clinical Remounting Procedure

Remount upper
denture using
remounting jig

Do I need New Face

bow
RECORD?????????
Mounting the lower cast with new CJRR
Make sure that the denture bases are not contacting
posteriorly.
 The procedures of
Perfection of occlusion

I. Selective grinding

II. Milling
Selective Spot Grinding
* Reducing premature contacting
surfaces, so that an equal pressure
exists at all points with no interference
Supporting cusp or Functional Cusp
The buccal cusps of the mandibular
posterior teeth and lingual cusps of
maxillary teeth are called supporting cusps.
These cusps occlude in central fossa and
maintain the occlusal vertical height.
They also called centric cusps and holding
cusps.

Non Functional Cusps

The lingual cusps of mandibular posterior teeth and buccal
cusps of the maxillary posterior teeth called guiding cusps.
They guide the mandible in lateral movements.
Note that the stamp
cusps (those fitting
into the central
portion of the
opposing teeth)
compromise 60% of
the total faciolingual
tooth dimension.
Basic Tooth Positions
Ideally all holding cusps * of the maxillary and mandibular
posterior teeth will make simultaneous contacts.

Balancing Contacts Centric Occlusion Working Contacts

 How to Recognize Premature
Contacts?

A dark ring
with a light
center usually
denotes a
premature
contact
 How to Recognize Premature
Contacts?

 You should distinguish between marks

made by normal occlusal contacts and
those of premature contacts

 Articulating paper
should not be reused
many times and
should be changed
often.
Selective Spot Grinding

Make grinding until even (same

intensity), stable, and multiple
marks spread over wide area in both
sides
Procedures of

*Eliminating Occlusal Errors

(selective grinding)
The sequence of steps should
be as follows

 Restore the vertical dimension

 Re-establishment of C.O.

 Correction of working side occlusal

errors.

 Correction of balancing side errors.

 Correction of protrusive relation.

1. Adjust the articulator to the proper setting

• The condylar elements of the articulator

are locked in the centric relation and the
articulator is closed.

• Grind the teeth with small diamond stones.

• Use red articulating paper to mark the area

of premature contacts for making centric
occlusion and blue articulating paper for
the eccentric movements
• Lock the upper arm of the articulator in
centric relation. Check the occlusion by
opening and closing the articulator.

• Place red articulating

paper between the
teeth and gently tap
the teeth together in
centric occlusion.
 2. Establish the occlusal vertical
dimension in centric:

Occlusal VD is maintained
by occlusion of palatal
upper cusp and buccal
lower cusp
(in normal occlusion)

( Supporting cusps)
a. If the cusp is high in centric and
eccentric relation, reduce cusp.

b. If the cusp is high in centric but not

eccentric, deepen fossa.
Correction of occlusion
done by reducing
buccal incline of upper
B
Lingual cusp and
Lingual incline of lower p

buccal cusp or
deepening their
corresponding fossae
3- Re-establishment of C.O.

•Do not grind the cusp

tips unless it is high
in every excursion,
but rather reduce the
fossa or inclined
plane of the cusp.
Re-establishment of CO

Problem: Teeth too nearly tip to

tip (If insufficient
overjet)
Solution: Grind Inclines

- Grind the inner inclines of upper buccal & lower lingual

Cusps.
- Grind lingual incline of upper lingual cusps.
- Grind buccal incline of lower buccal cusps.
So that the cusp tips contact the central fossae.
The cusp tips should not be shortened.
Re-establishment of CO
Problem: Too much horizontal overlap(upper
teeth too far buccaly to lower ones)
Solution: . Broaden central fossae
• Grind the inner inclines of upper
lingual cusps & lower Buccal cusps.
The cusp tips should not be shortened.
The adjustment in centric occlusal position
should be stopped when widespread
Contacts are produced
 Reduce the teeth until the incisal pin
touches the incisal guide table and uniform
contact exists on all posterior teeth.
Anterior teeth should not touch in
centric occlusion.
After the CO re-establishment

 DO NOT Reduce maxillary lingual

cusps.

 DO NOT Reduce mandibular buccal

cusps.
These cusps are essential to maintain
the recorded vertical dimension

 DO NOT Deepen the fossae.

4. Refine occlusion in eccentric
Loosen the locks on the condylar elements
and move the denture in eccentric
movements. Using blue articulating paper
between the teeth.
The adjustment in eccentric
occlusal positions
 The adjustment in eccentric occlusal
positions should be stopped when widespread
Contacts are produced and the incisal guide
pin usually stays in contact with the incisal
guide table.
• If the cusp contacts
prematurely on closure
as before, but is not
premature in lateral
excursions, the fossa is
deepened

• Prematurely contacts in
centric and in lateral
excursions, the cusp is
reduced in height.
a- Lateral movement:
i. On the working side:
Follow "Bull rule" of reducing buccal

upper and lingual lower cusp inclines.

ii. On the balancing side:
Bull rule does not work. Reduce
interceptive cusp as shown by the carbon
paper.
b. Protrusive movement:
Reduce distal inclines of maxillary cusp
and mesial inclines of mandibular cusps
 i- "Bull rule on the working side "

• Reduce lingual inclines of

buccal cusps of upper teeth.
• Reduce buccal inclines of
lingual cusps of lower teeth.
ON WORKING SIDE ONLY!!!
"Bull rule on the working side "

Problem:
Buccal and
lingual cusps
too long.
ii. Correction of Balancing Side interferences

Occurs between the lingual upper

and buccal lower supporting cusps
Which are the functional cusps

Adjustment Rule:
Buccl inclines of the lingual upper cusps .
lingual inclines of the buccal lower cusps .

LUBL
ii. Correction of Balancing Side Errors

Decide which supporting cusp

maintains CO and reduce its opponent.
Correction of Balancing Side interferences

If interference exists on the balancing side Grind

the lingual incline of the mandibular buccal cusp.

It is a centric holding cusp so grind carefully

and do not reduce the cusp tip.
b- Correction of Protrusive Relation

a. If the anterior teeth have heavy contact

with no contact on the posterior teeth
grind the labial surface of the lower
anterior and the palatal surface of the
upper anteriors.

b. If heavy posterior contact exists with no

anterior contact reduce the distal
inclines of the maxillary cusps and the
mesial inclines of the mandibular cusps.
Adjustment Rule: DUML
In protrusive excursion, premature contacts are
eliminated by grinding the distal facing inclines of upper
teeth and mesial facing inclines of lower teeth
Proceed with selective
grinding until you get
balance at centric
contact and occlusal
harmony in eccentric
movements
Briefly

BULL rule in:

-Working side interferences.

LUBL rule in:

-Non-working side interferences.

DUML rule in:

-Protrusive interferences.
Direct Intraoral Correction
Disadvantages
 Requires a lot of patient cooperation
 Patient should have good
neuromuscular control
 Saliva
 Inaccurate closure by patient
 Misleading due to resiliency of
tissues and shifting of denture bases
Direct Intraoral Correction

• Check for the coincides of maximum

intercuspation with centric relation
position, and whether the vertical
dimension of occlusion is unchanged or not.

• Only small discrepancies in maximum

intercuspation, can be adjusted following
the same rules as for correcting occlusal
errors on the articulator.
Rules for selective grinding:
1. Never grind a centric cusp tip unless it contacts prematurely
in all excursions of the mandible. Always grind the opposing
fossa or marginal ridges where the centric holding cusps occlude

2. Utilize the BULL rule when perfecting working occlusion, For

interference in the posterior teeth reduce the upper buccal
cusp slopes and the lower lingual cusp slopes.

3. When grinding to perfect balancing occlusion never grind the

interfering cusp tips but grind the cusp inclines.

4. In correcting protrusive interference in the anterior teeth

grind on the labial portion of the incisal edges of the lower
teeth and the lingual portion (palatal surfaces) of the upper
teeth.

5. In protrusive balance, the anterior teeth should make incisal

edge contact at the same time that the tips of the buccal and
lingual cusps of the posterior teeth contact.
 Balance occlusion in
Working side, Balancing
side, Protrusive position
II- Digital methods
Digital technology helps
clinicians to identify premature
contacts, high forces, Timing
and interrelationship of
occlusal surfaces.
 T-Scan is an objective assessment
tool used to evaluate the occlusion of
a patient. Unlike articulating paper,
which can only determine location,
T-Scan can identify
both force and timing, two of the most
fundamental parameters for measuring
occlusion.
II. Milling XXX
A small amount of carborubdum
abrasive paste is placed over the
lower teeth and the articulator is
closed in centric position. Several
movements are made from centric
into each eccentric position to
eliminate any slight interference
Remounting has the
following advantages

1- Reduce patient's participation.

2- Allow for better visualization.

3- Provides a stable working foundation.

4- More accurate markings with the

articulating paper in absence of
saliva.
3. POSTINSERTION CARE
1 . First appointment within 48 hours of delivery .

2 . Second appointment within 3 days .

3 . Third appointment within 1 week of 2nd visit .

4. CASE COMPLETION
1 . Patient able to masticate food .
2 . Patient should present a normal individual appearance .
3 . Patient should be able to speak distinctly .
4 . Patient should experience oral comfort .
5 . Patient should be educated as to the need for periodic
examination .
5. RECALL
References
1. Boucher's prosthodontics treatment for edentulous
patients. Twelfth Edition. Chapter 20.
2. Complete Denture Prosthodontics, 1st Edition, 2006 by
John Joy Manappallil, chapter 19
3. Dalhousie continual education
4. Denture placement & patient education - dr.Rola shadid
https://drrolashadid.Weebly.Com/uploads/1/4/9/4/14946992
/lecture_10_1.Ppt
5. Https://wsdav6.Squarespace.Com/s/i-hate_love-complete-
dentures-ronnie-schnell.Pdf
6. John Beumer III, DDS, MS: 24. Refine Denture Setup
Division of Advanced Prosthodontics, Biomaterials and
Hospital Dentistry UCLA School of Dentistry
7. Washington state dental association's 2015 pacific ... -
WSDA