Try-in Stage

CHAPTER
6

TRY-IN STAGE

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 Try-in Stage

TRY-IN STAGE
The trial insertion appointment should begin with
adjustment of the record bases to ensure comfort and proper
fit. If retention is a problem, it is advisable to use an
adhesive to keep the record bases stable during the trial
insertion procedure. The stability and retention is necessary
for proper inspection and will also give the patient
confidence about his or her new dentures.

 Having set-up the teeth according to the records taken

at the jaw relation record stage, it is necessary to try
the waxed-up dentures in the patient’s mouth before
denture processing and delivery.

 All the details in the dentures should be checked at

this stage and all the necessary adjustments and
alterations should be made.

 This step may save the denture from remake, as it is

difficult and sometimes impossible to do alterations
on the finished dentures.

 The same parameters used to determine the vertical

dimension of rest at the maxillomandibular records
appointment should be used once again to check for
the proper interocclusal clearance, phonetics, and
vertical position of the occlusal plane.

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 Try-in Stage

Important steps to be checked before doing

the try-in

I- Check the case on articulator

1- Checking the articulator:

A. Mounting rings are firmly screwed in their places.

B. Incisal pin of the articulator is in its proper place.

i.e. the occlusal vertical dimension on the articulator
is correct.

C. The trial denture bases lie properly on their casts, and

the teeth meet evenly in centric position.

D. When the articulator is in centric position (locked in

centric), the articulator’s joints should be firm and not
loose. No movement is elicited in centric position
except simple hinge movement.

E. The articulator should move smoothly from centric to

eccentric positions without interlocking of teeth.
There should be free articulation of teeth.

2) Check the casts:

A. The casts should be in shape. The casts should not be

destroyed by scratches or air bubbles.

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 Try-in Stage

B. The casts are free from wax spots. Wax spots on the
palate or ridges give false information in the try-in
stage.

C. If there are any undercuts present on the cast, these

undercuts should be relieved to avoid scratching the
cast by the trial denture bases.

3) Check trial denture bases:

A. Trial denture bases are stable on the casts.

B. The periphery of the trial bases are smooth, round and

have no sharp edges.

C. No excess wax or other debris is attached to it.

4) Check the teeth:

 Proper selection of teeth. All instructions recorded on

the patient's treatment chart are fulfilled regarding
shape, size, shade, characterization and type of
anterior and posterior teeth.

 The upper anterior teeth should overlap the lower

anterior teeth, but there should be no contact between
upper and lower anterior teeth (Fig 1). The only
exception is in case of edge to-edge arrangement.

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 The posterior teeth should be in maximum

interdigitation. The setting up of teeth should be
checked from both buccal, and lingual aspects.

 A line drawn on the cast antero-posteriorly bisecting

the mid-sagittal suture, incisive papilla and the labial
frenum should coincide with the midline of the upper
dental arch.

 The labial surface of the central incisor should be

about 8-10 mm in front of the middle of the incisive
papilla.

 The central groove of the lower premolars and molar

teeth should lie over the crest of the ridge, for better
stability of the lower denture.

 The lower posterior teeth should lie vertical on the

ridges. They should not incline lingually, as this
interferes with tongue movements.

Fig. 1: Free incisal contact anteriorly

 No teeth are placed on the upward incline of the

lower ridge.

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 Check for free articulation and balanced occlusion.

- Free articulation of teeth when the articulator is
moved from centric to any eccentric position.
There should not be any interlocking cusps.

II- Trying the Trial Dentures in the Mouth

 After being satisfied with the case on the
articulator, the trial dentures are then tried in the
patient's mouth.
 Since so many points require checking, it is
important to follow a definite plan.

1) Check the upper trial denture by itself for:

a- Peripheral extension and retention.
b- Stability to vertical occlusal stresses.
c- Orientation and inclination of the occlusal plane.
d- Alignment of teeth and facial support.

2) Check the lower trial denture base by itself

for:
a- Peripheral extension and retention
b- Stability to vertical occlusal stresses.
c- Orientation and inclination of the occlusal plane.
d- Tongue space and neutral zone.

3) Check both upper and lower trial dentures for:

i- Centric occluding relation
ii- Vertical relation.
iii- Centric relation.
iv- Eveness of occlusal pressure.

4) Phonetic tests.
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5) Appearance of the teeth:

• Central line.
• Shape, shade and size of the teeth..
NOTICE:

 Before carrying out these checks, the dentures are

removed from the articulator and places in a bowl
containing tap water.

 It is important that waxed-up dentures should be

frequently placed in cold tap water as wax softens at
mouth temperature and, if left in the mouth too long,
the teeth may be displaced.

1) Check the upper trial denture by itself:

A) Stability of Occlusal Stresses

 This test is used to determine if occlusal stresses will

be transmitted over or outside the ridge.

 Alternate vertical pressure is applied with the ball of

the finger in the premolar and molar regions on each
side.

 If pressure on one side causes the denture to tilt, and

rise from the ridge on the opposite side, it indicates
that the denture teeth on the side on which pressure is
applied are outside the ridge.

 Sometimes the trial denture teeters on the middle.

This indicates that the relief area (Median palatine
raphe) is not properly done.
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 Try-in Stage

B) Orientation and inclination of the occlusal plane:

 The plane of occlusion can be checked for proper

orientation by observing the amount of incisor teeth
showing when the lip is at rest (Fig 2).

 For a patient with an average length of upper lip, the

incisor teeth usually show 2mm.

 For a patient with a short lip, perhaps 5-6 mm are

seen. Long upper lips may necessitate complete
coverage of the anterior teeth, but if it is possible
their incisal edge should be seen.

 The F, V and Ph sounds are used as aids in

determining proper tooth placement.

 In the production of F, V, and Ph sounds the incisal

edges of maxillary anterior teeth should contact the
lower lip at the junction of the moist and dry
surfaces of the vermilion border.

 The inclination plane of occlusion should be parallel

with the ala-tragus line on both sides posteriorly,
and with the inter-pupillary line anteriorly (Fig 3).

C) Alignment of anterior teeth and facial expression:

 The normal facial expression and lip support depend

on the position and function of facial muscles.

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 Try-in Stage

 These muscles can function physiologically only

when the denture teeth are positioned in the space as
close as possible to that occupied by their natural
ones.

 Incorrect antero-posterior positioning of the anterior

teeth and/or improper base contour will alter the
normal facial appearance.

 If anterior teeth are in their proper position, the

vermillion borders of the mouth become visible, the
corners of the mouth should assume a normal contour,
many of the small vertical lines above the vermillion
border of the upper lip can be reduced or eliminated,
and the drooping appearance of the nasolabial sulcus
is reduced.

Fig. 2: Too much amount of teeth Fig. 3: Inclined incisal plane

Showing below the upper lip

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 Try-in Stage

2) Checking the Lower Trial Denture by itself:

A) Stability to occlusal stresses

This can be checked by applying vertical pressure with the

ball of the index finger on the premolar and molar regions
of each side alternatively. This test is used to give an idea
about:

A. Whether there is warpage is the trial denture bases.

The trial denture base will then teeter.

B. Whether the vertical occlusal stresses are transmitted

outside the ridge. The trial denture base will then tilt
and rise from the ridge on the other side.

C. Whether the vertical occlusal stresses are transmitted

inside the ridge. The trial base will then remain in its
place and there is unilateral lever balance. This can
be encouraged by:

i.Maximum coverage of the denture bearing area

within the functional limits of the border
tissues.
ii.Placing the occlusal plane close to the ridge as
possible to minimize leverage action.
iii.Placing the teeth op or slightly lingual to the
crest of the mandibular ridge

B) Tongue space and Neutral zone:

The neutral zone is "The potential space between
the lips and cheeks on one side and the tongue on the
other".
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 Try-in Stage

 The natural or artificial teeth, if placed in this zone

are subjected to equal and opposite forces from the
surrounding musculature.

 It is into this zone of neutral pressure that the

artificial teeth must be positioned. Placing denture
teeth lingual to this position will cause cramping of
the tongue.

 Lateral pressure will be exerted, producing

unstabilized forces. The tongue will grip the
denture
as it tries to expand laterally and whenever the
tongue moves, it will move the denture.

 To test for tongue space, the patient is asked to

swallow and to relax his tongue in its normal position.

 While, the lower denture is seated on the ridge, the

patient is asked to raise his tongue. If the tongue does
not have enough space, the denture will begin to rise
immediately as the tongue moves.

 When the tongue has risen a short distance, the

denture will be floating on the side of the extended
tongue.

C) Orientation of occlusal plane in relation to function:

 The occlusal plane should be below the greatest

lateral borders of the tongue (Fig 4).

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 Try-in Stage

 The tongue should perform the majority of its

movements above the lower denture to keep the lower
denture down in its place.
 To test for correct height of the occlusal plane, the
patient is asked to place the tip of his tongue behind
the lower front teeth and to relax his tongue.

 The tongue should lie on top, slightly overlapping the

posterior teeth.

Fig. 4: Posterior teeth are placed in the neutral zone below the
maximum convexity of the tongue.

3) Check Upper and Lower Denture Together:

After examination of the upper and lower dentures
separately, they are examined together. This includes.
1. Centric occluding relation:
i) Vertical relation:
The adequacy of the occlusal vertical dimension and the
available interocclusal distance should be checked.
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 Try-in Stage

A. The trial dentures bases are inserted in the patient's

mouth. The patient is asked to moisten his lips with
the tip of his tongue or to pronounce the letter "M".
The lips should be brought slightly in contact.

B. When the mandible is in the physiologic rest position,

there should be an inter-occlusal clearance between
the upper and lower teeth of at least 2 nun measured
at the first premolar region. To check for the presence
of this interocclusal gap, request the patient to close
his teeth together when his mandible is in the relaxed
position. Meanwhile, watch the chin of the patient.
There should be a small but definite amount of
upward movement of the chin. This upward
movement equals the amount of the free-way space.

C. Check the vertical dimension by more than one

method from among those that are used to record the
vertical dimension of centric occluding relation.
When the teeth are in centric occluding relation, the
patient’s face should produce a pleasing appearance.
The patient should be able to speak without clicking
of the teeth. If the teeth click together, this indicates
that the interocclusal clearance is insufficient, and
that the denture has excessive occluding vertical
dimension.

ii) Check Centric Relation:

1. Checking the accuracy of the centric relation involves

the observation of intercuspation of the teeth when
the mandible is in centric relation. The teeth should
interdigitate exactly as planned on the articulator, i.e.
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 Try-in Stage

there is harmony between centric occlusion and

centric relation.

2. To check for the centric relation, the trial denture

bases are placed in position.

3. The trial dentures are stabilized in place by placing

the middle and the index fingers of both hands on the
trial denture flanges in the region of the bicupsids,
while the thumb of the right hand is placed under the
border of the mandible.

4. The patient is asked to touch the posterior edge of the

upper denture base with the tip of his tongue and
slowly close the teeth together.

5. This procedure puts the jaws in centric relation. In

this position, the teeth should interdigitate accurately,
and each cusp should be situated in its corresponding
fossa (Fig 5a, b).

Fig. 5a: Incorrect interdigitation Fig. 5b: Correct interdigitation

6. Several repeated gentle closures should be made, to

ensure that centric occlusion of teeth is in harmony
with centric relation of the jaws.

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 Try-in Stage

7. During mandibular closure, teeth tip of the cusp

should meet the deepest part of its corresponding
fossa and the trial dentures should remain in their
places while the teeth intercuspate.

8. If errors of jaw relation exists (centric relation of the

jaw is not in harmony with the planned centric
occlusion of teeth), the initial contact between teeth
will be cuspal incline to another cuspal incline.

9. If centric jaw relation was found to be wrong, and the

teeth do not occlude properly. New centric record is
needed and the articulator’s mounting should be
changed.

Procedure for correcting centric occluding relation

(Fig. 6 a :e)

1. Remove all the posterior teeth from the lower trial

denture base, build up in their place a new wax rim,
and secure an imprint of the upper teeth in it while the
jaws are in centric relation at the previously accepted
vertical dimension of occlusion “V.D.O.”.

2. Detach the lower cast from the articulator and

remount it according to the new centric relation
record.

3. The setting-up of teeth is corrected, and the case is

prepared for a new trial in the patient's mouth.

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 Try-in Stage

a- In-correct centric occluding relation is treated by removal of

all posterior teeth from the lower trial denture base.

b- New wax rim is built in place

c- The mandible is guided in centric d- An imprint is made

e-In case of in-correct V.D.O. wax is added between occlusal surfaces

Fig. 6: Procedure for correcting centric occluding relation

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 Try-in Stage

iii) Evenness of occlusal pressure:

To maintain stability of complete dentures, the
opposing teeth must meet evenly on both sides of the
dental arch when the teeth contact anywhere within the
normal functional range of mandibular movement.
An occlusion for complete dentures that provides this
even contact can be developed only when centric
occlusion is in harmony with centric relation.

Different forms of unevenness of contact:

1. It frequently occurs that the teeth on one side of the
mouth occlude slightly before those on the other side.
Such error tends to escape unnoticed at the try-in
stage, especially when the trial denture have little or
no retention.

2. The denture will tend to sink on the side of heavy

pressure and rise on the other side of light pressure,
causing the teeth to appear in good occlusion.

3. Sometimes the posterior teeth may occlude before the

anterior teeth.

4. Uneven occlusal contact may also be manifested by

the premolar occluding before the posterior ones.

This uneven bearing may be due to one of the following:

1. Centric occlusion does not exist at centric relation.

2. Uneven contact between the occlusal rims.

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 Try-in Stage

3. Unequal pressure applied by the patient, on the sides

of the occlusal rims during registration of centric
occluding relation.

4. The trial denture bases are touching at the rear,

stopping the teeth from coming in occlusion.

5. Errors in seating the trial denture bases on their casts.

This may be due to warpage the bases, or presence of
wax and debris on the casts and/or the fitting surface
of the trial bases.

6. Errors in mounting the lower cast on the articulator.

It is rather difficult to test for the exact equilibration

of the occlusal pressure due to the resiliency of the
soft tissues underneath the denture bases. It is much
better to guard against errors in its registration by
obtaining the jaw relationship records on a more
easily displaced material, than the soft tissues as on
plaster or wax wafer softened by heat.

Testing the equilibration of occlusal pressure:

A. To test for the evenness of occlusal pressure, the patient

is asked to occlude on two thin celluloid strips placed
between the posterior teeth, one on each side. The patient
should occlude while the jaws are in centric relation. Try
to remove the celluloid strips simultaneously by pulling
them out between the closed teeth, any difference in
force required to remove the strips is interpreted in terms
of occlusal pressure. Equal pulling forces mean equal
occlusal pressure. The celluloid strips can be placed first

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 Try-in Stage

in the molar region then placed in the premolar region to

get better information about the equilibration of
occluding forces.

B. Stabilize the upper and lower dentures with the thumb

and index fingers of both hands. Request the patient to
close gently and slowly, and to stop closing at the first
tooth contact. Try to see the first contact and feel the
dentures rise from their basal seats.

C. Ask the patient to close in centric, and place the thumb

and index fingers on the flanges of the dentures. The
thumb on the upper flange and the index on the lower.
Try to push the upper denture up and the lower denture
down. Any appreciable movement may be interpreted as
uneven bearing of the dentures. Reverse the position of
the thumb and index fingers. The thumb pushes the
lower denture down and the index the upper denture up
in order to test occluding pressure on the other side.

D. The common practice of inserting the blade of the wax

knife between the occlusal surfaces of the upper and
lower dentures denotes gross error in the record of
centric occluding relation.

Correction unevenness of occluding pressure involves the

following:

If it is very slight, this can be corrected by grinding the teeth

after the denture is processed.

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 Try-in Stage

If the unevenness is more than slight, it is better to take a

new centric relation record at this stage. Remove the
lower back teeth, replace by softened wax rim, and make
the
centric relation record at the previously accepted jaw
separation. Remount the lower cast. Prepare the case for
new trial in the patient's mouth.

4) Phonetics Tests

 The position of artificial teeth and contour of denture

base affect the production of speech, These tests
involve principally the production of "S" and "F"
sounds.

 When pronouncing the letter "S", the tongue's

lateral margins contact the lingual surface of the
posterior teeth, and the tip of the tongue is brought
into contact with the palate in the rugea area, so that it
confines the stream of air between the tongue and the
palate for the escape of air that forms the letter "S".
The size and shape of this space affect the quality of
"S" sound. If the maxillary anterior teeth are placed
too for backward, the patient may Lisp because the
tongue is forced between the teeth on the "S" sound
thus the "S" become a "Th". Another important
observation to be made when the "S" sound is
produced is the relationship of the anterior teeth to
each other. In the production of "S" sound, the
mandible moves to its most forward speaking
position, so that the upper and lower incisors should

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 Try-in Stage

approach each other end to end but they should not

touch. This will provide information about the total

 Length of the upper and lower teeth and their vertical

and horizontal overlap.

 Failure of the incisal edges to approach each other

end to end will indicate a possible error in the amount
of horizontal overlap of the anterior teeth.

5) Appearance of the teeth:

 This includes the study of the position of the central

line, shape, size and shade of the selected teeth,
regularity of the set-up and the central line.
 The central line should coincide with the general
center of the face and the middle of the philtrum.
 To get better idea about the position of the central
line, stand infront of the patient and some distance
away from the patient. The midline of the face should
coincide with contact point between the upper central
incisors.

Shape of teeth:
The general form of the selected tooth should
hormonize with the general outline of the face, when viewed
from the frontal aspect
Also the labial surface of the teeth should hormonize with
the patient's facial profile.

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 Try-in Stage

 People with short round faces should have short

round teeth. People with long narrow faces should
have long narrow teeth.
 If the face presents a flat profile, than a tooth
presenting a flat labial surface should be used.
Size of the teeth:
The selected tooth size should conform to the size of
the face and dental arch.
The mesiolabial aspect of the upper canines should be
visible from the frontal view.
The tip of the lower canine should conform to the
angle of the mouth.

Shade of teeth:
The color of the teeth must be in harmony with the
color of the skin, hair and eyes of the patient

The patient's age should also be considered. Darker

teeth are more suitable for old patients while lighter teeth
are suitable for young patients.

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