Try in step in complete

denture
By Dr Reem Eltayeb
 Definition
Preliminary insertion of complete denture wax
up (trial denture) to determine the fit, esthetics,
maxilla mandibular relation.
 Importance
1- It is the last opportunity to evaluate many of
the previous steps already accomplished.
2- It offers an excellent opportunity for patient
education and facilitates the patient's
acceptance of the finished prosthesis.
 Objectives
1-To check and verify the established maxilla
mandibular relationship:
A- Verify that centric occlusion and centric
relation coincide.
B-Test for the acceptance of the established
VDO.
2- To determine if the positions of the teeth and
the contours of the denture bases are
compatible with surrounding environment:

A- To verify the occlusal plane level relative to

the ala-tragus and inter- pupillary plane
horizontally.

B- to assess the post. Arch width as it relates to

the mand. Residual ridge ,modiolus area, and
buccal corridor.
3- To verify tooth selection and arrangement for
proper esthetics and phonetics.
4- To make additional inter-occlusal maxilla
mandibular records if needed for further
adjustment of the articulator e.g. protrusive
inter-occlusal record.
The steps of the try-in procedure
 1- Extra oral examination of the trial
dentures
A- On the articulators :
the mounted cast is checked for:

1) Maintaining of the vertical dimension of

occlusion.
- Top of the incisal pin is flush with the upper
member of the articulator.
- The incisal pin is in contact with the incisal
table.
2) The mounting rings are firmly screwed in their
position.
3) Moving of the articulator smoothly from
centric to eccentric positions without cuspal
interlocking.
4) When the articulator is locked in centric, no
other movements are permitted other than
simple hinge movement.
B - The master cast:
As the finished denture is processed on the
master cast. So the master cast should be:
1- Has good shape.
2- Free from air bubbles or scratches.
3- Free from wax debris which lead to improper
adaptation of the trial denture bases leading to
false relationships.
4- If there are any undercuts present in the cast,
these undercuts should be relieved to avoid
scratching the cast by the trial denture bases.
C - The trial denture bases:
Checking the following:
1-The trial denture bases must be stable.
2- The borders of the trial denture base should
be smooth, round, and have no sharp edges.
3- Also the border should be shaped to conform
to the depth and width of the sulci.
D- The teeth:
1- The dentist responsibility to select the proper
shade, and mold of the teeth to determine that
the teeth is settled correctly.
2- The relation of both upper and lower teeth to
the opposing ridges must be checked.
3- if there is excessive anterior tooth contact on
the articulator, should be corrected to avoid the
excessive forces on the maxillary anterior ridge.
E- denture occlusion :
The occlusion of the teeth on the articulator
should meet the following in the class I jaw
relationship:
1- The upper anterior teeth overlap the lower
anterior teeth by about 1 – 2 mm, in both
horizontal and vertical planes.
2- The mandibular incisors do not protrude
beyond the labial vestibule.
3- The lower posterior teeth should be set
vertically on the ridge (not lingual to not
interfere with the tongue).
4- the central grooves of mandibular (posterior
teeth should be on the crest of the ridge (better
stability).
5- The posterior end of the occlusal plane should
be located at the junction between the middle
and the distal thirds of the retro molar pad.
6- the height of the occlusal plane coincides with
the line joining the incisal tip of the mandibular
canine to the retro molar pad.
7- Uniformly balanced occlusal contacts
between the maxillary and mandibular posterior
teeth.
8- maximum intercuspation between upper
and lower posterior teeth when checked from
both buccal and lingual aspects.
 After being satisfied with
the case on the articulator
 2- Intraoral examination of the trial
dentures
• To reduce the risk of cross- contamination, the
trial denture should in a suitable antiseptic
solution, washing in running water , before
inserted in patient mouth.
1- Checking the trial dentures separately:
A- Trying- in the upper denture.
B- Trying- in the lower denture.
2- Checking the upper and lower dentures
together.
1- Checking the trial
dentures separately
 A - Trying- in the upper denture
1- denture base extension :
A- the labial & buccal extension:
i. Insert the upper trial denture if the denture falls
down if:
- overextended ----- reduce it.
- under extended -------- making a new final impression
ii. Relive buccal frenum .
B- Posterior extension:
extended from the hamular notch to the other along the
vibrating line of the soft palate.
2- Retention:
It is noted that the retention of the trial denture
is less than that of CD , due to:
A- Absence of a posterior palatal seal.
B- Poor adaptation of the trial denture base to
the tissues.
Test:
• Grip the labial and lingual surfaces of the
upper denture teeth between the thumb and
forefinger
• Apply a firm downward vertical pull to
dislodge the denture away from the tissues
( if there is resistance it means retentive).
3- Stability:
Defined as ability of the denture base to remain in
contact with the ridge without lifting.
Test :
• by applying pressure in a tissue ward direction
with the ball of the index finger in the premolar
and molar regions on each side alternately.
• This pressure must be directed at right angles to
the occlusal surface where displacement does
occur.
 Causes of denture instability
1- warpage of denture base.
2- posterior teeth set buccal to the underlining
alveolar ridges .
3- hard unrelieved area in the midline e.g. torus
palatinus.
4- Orientation of the occlusal plane:
• orientation of the anterior occlusal plane is
determined by aesthetics.
• Pt with long lip at rest no visible teeth is
shown.
• The post. Occlusal plane should be at level of
anterior 2/3rd of retromolar pad .
 B- Trying- in the lower denture
1- Denture base extension:
a) The labial and buccal extension.
b) Lingual extension:
• The Distolingual area:
Ask the pt to protrude the tongue to moisten the
lips -------- if its lifting -----over extended.
• Lingual flanges area :
Ask the pt to move his tongue right and left to
touch the cheeks ----- if its lifting -----over extended
• The lingual frenum area :
Ask the pt to curl the tongue backward so that
the tip lies on the post. Palatal tissues. if its
lifting -----over extended
C- posterior extension:
Should cove the retromolar pad
( to buttress the denture against the backward
of the lower lip).
2- Retention :
Retention of the lower trial denture is poor
compared to the upper?!
A- relatively small denture bearing area.
B- difficulty in obtaining an efficient border seal.
Test :
Same as the upper.
3- Stability :
The lateral margins of the tongue should be
seen to be lying over at least part of the occlusal
surfaces of the post. Teeth.
Test :
Same as the upper.
4- tongue space :
• Teeth should not be set too far lingually or
buccally
Lack of tongue space ( cramped tongue):
Result of :
1- post. Teeth set lingual to the neutral zone.
2- post. Teeth tilted lingually.
3- post. Teeth too broad bucco – lingually.
Causes of lower denture movement
1- Cramped tongue .
2- Lingual over extension.
How to differentiate btw them:
Ask the pt to rise the tongue :
- Immediate lifting of the denture … tongue
cramp.
- Denture moves after the tongue has risen
some distance …… Lingual over extension.
5- height of occlusal plane:
• Assess the position of the lower teeth relative
to the lower lip & retromolar pad.
• The height of the occlusal plane in relation to
the tongue :
- Ask the pt to relax the tongue and place the
tip to the tongue behind the lower ant. Teeth
without pressure ,then open the mouth .
- ( relaxed tongue is seen lie on top of lingual
cusps of post .teeth).
The height of occlusal plane in relation to
the tongue

High occlusal Correct occlusal

plane plane
2- Checking the upper
and lower dentures
together
 2- Checking the upper and lower dentures
together
• Insert the lower trial denture first and then,
the upper trial denture:
- Less chance of having the upper denture to
drop down.
- More confident pt.
• Then ,evaluate the following :
1- DVO :
a- facial measurement .
b- phonetics.
c- esthetics .
d- pt proprioception.
2- the centric occlusion.
3- evenness of occlusal pressure.
4- evaluating of esthetics .
5- approval of appearance by the pt .
6- registration of the protrusive record.
 1 – Evaluation of the vertical dimension of
occlusion
• The patient should be seated in an upright
position with head not supported by the
headrest.
a- Facial measurement:
Instruct the patient to wet his lips, swallow, and
then allow his mandible to part his lips to see
whether his ,rest. While the patient is in resting
position :
- If the teeth are touching ……new record of VDO.
 b- phonetics
1- evaluate the ( closest speaking space):
- Ask the pt to say s,s,s rapidly .
- Ask the pt to count from 50 – 60.
2- instruct the pt to pronounce ( j) and ( CH):
- Used as guide to the adequacy of horizontal &
vertical overlap of the anterior teeth.
3- instruct the pt to say ( TH) :
- The tongue should protrude slightly ( 2-4 mm )
to occupy the IOS .
4- instruct the pt to say ( M) in rapid succession.
5- instruct the pt to say ( F) &(V) :
- Observe him from the side .
- Evaluate both ant. Post. Sup.inf. Position of
man. Ant. Teeth.
- The incisal edges of the upper teeth should
just touch the wet /dry line of the lower lip.
6- instruct the pt to say ( T) & ( D):
- These sound are formed by contacting the tip
of the tongue with the ant. Palate and lingual
surface of the upper ant. Teeth.
 c- esthetics
• Facial form is an important guide to whether
the pt is at the correct VDO .
• The apperance of the pt should be noted in
front and lateral view.
• With pt mouth closed and half open.
 d- pt proprioception
Ask the pt :
• If he feels that the teeth touch at about the
right moment.
Part 2
 2- centric relation ( occlusion)
• Ask the pt to relax and try to touch the back of the upper
denture with the tip of the tongue.
• The teeth should interdigitate in the same way as on the
articulator.
• If not …… new centric relation is obtained. How?
1- Remove the man. Post. Teeth from the lower trail denture
base .
2- place small amount of softened wax to replace post. Teeth.
3- a new record of centric relation is obtained at accepted
VDO.
2- errors in seating of the trail denture bases on
their cast ( warpage , wax debris on the cast,
denture bases are touching heals ).
3- errors in mounting the lower cast on
articulator.
 Tests for evenness of occlusion
1- insert the blade of the wax knife btw occlusal
surfaces of upper & lower denture…….. Gross
error in recording centric occluding relation.
2- the pt closing in centric occlusion on two
pieces of thin celluloid strip btw the teeth in the
molar region on each side :
- Try to remove the celluloid strip simultaneously
by pulling them out btw the closed teeth, holding
one strip with each hand.
 Correction of unevenness of occlusal
pressure
A- if the error is slight :
- Soften the wax beneath the teeth with heavy
occlusion .
- Inserted in pt mouth and ask him to close, the
teeth on the side of heavy occlusion will sink
until the occlusion on the opposite side arrest
them
B- if the error is gross:
1- a layer of soften alu wax is added btw the
occlusal surfaces of the teeth on the side of light
or no occlusal contact , ask the pt to close until
the teeth on the opposite side stops them.
2- the post. Teeth are removed from of the
dentures and are replaced by a wax occlusion
rim without altering the VDO…… new centric
relation is done.
 4- evaluation of esthetics
• One of the main objectives of CD .
• Evaluated in frontal and lateral view.
• Evaluated when the pt smile , rest, speak.
• Evaluated when mouth is closed and half
opened.
• Check for the following:
A- the midline :
- In relation to the midline of the face.
- If not correct reset teeth entirely .
B- smile line:
- The max. teeth should just touch the lower lip.
- The max . Teeth should follow the curvature of
the lower lip.
- The lower teeth should be slightly or not visible
at all.
C- corners of the max . Arch :
- Canine should be located at the corner of the
mouth.
- Buccal corridor should be evident btw the teeth
& cheeks.
D- verify tooth selection :
- Assess shade , mould , size of the teeth.
- The orientation and level of the occlusal plane .
- The amount of tooth visible and the degree of
lip support.
- Check for the face form / tooth form.
 5- approval of appearance by the pt

• The pt should view the denture in front of a

wall mirror .
• The pt should be encouraged to bring a
member of his family for opinion.
• If he is wearing an old denture it should be
removed for 48 – 72 hr before placement of
new denture.
6- registration of protrusive record
• May be made on the occlusal rim during the jaw
relation .
• May be made following the try in
• The pt is asked to close in protrusive relation until
the ant. Teeth touch ( 5- 6 mm protrusion) .
• As the man. Moves forward the teeth separate
post. Creating space called Christensen
phenomenon
• Needed in obtaining lateral condylar guidance for
articulator.