First of all the doctor said that we should read some aspects from the dental material course

we have taken , not all thing it just the material that deal with our job in this course of complete denture

So our lecture for today is an introduction for complete denture. In the beginning we will learn some key terms: Complete denture

Q) What's the complete denture? Its a device that used for restore all missing teeth and soft tissue for the patient so that the patient can perform function such as Chewing , Eating and also the patient can have good appearance (esthetic) .

Now we have other key terms such as ( Base plate , Bite rim , Border molding , Centric occlusion , Denture base , Muscle trimming , Overdenture , Vertical dimension) These terms we are going to hear it a lot and we will memorize it so it will be like our daily job for every single prosthetic dentistry work.

Baseplate (Record Base)

Its the base that will record the information from the patient mouth, this is done by taking an impression from the patient mouth and this impression will transfer to a cast "primary cast" , on this cast we are going to perform the record base. It's made up from acrylic the same as the special tray that we have seen in the lab but without handle , we are going to place wax rim (horse U shaped ) on this base and this horse U shaped wax is made up for the upper jaw and also for the lower jaw ,, So called record base. So it's consisted from an acrylic base and a wax rim. Record base is very important because we are going to transfer the movement for the jaws especially the lower jaw protrusion or retrusion and lateral exterusion and also we are going to transfer the height of the mouth ( thats what we called vertical dimension )

Now we have the Bite rim and Border molding

We talk about the border molding in the lab and it means that when you take an impression inside the patient mouth you need your impression to be correct especially the whole details of the impression. Now pay attention that when you make an impression you need to be very accurate because if you record any wrong detail then your denture will be poor retention and it will fall out from the patient mouth and you will repeat all what you have do from the beginning!! So the primary impression which is made up either from impression compound or alginate is the important step for make the complete denture.

Centric occlusion

It means that we are going to take the movement of the lower jaw in horizontal and vertical directions.

Removable Complete Denture It means a denture that the patient can remove it and insert it back to his mouth. Note that we have another type of complete denture but its fixed { Fixed complete denture} and this is what we call implants, this type of denture is screwed to the implant and the patient cannot remove it or clean it, just he use a normal pressure. Now we used it for edentulous patient who dont have any single tooth in their mouth. The Denture is supported by alveolar bone and oral mucosa; we can see areas in the denture ,these areas (arrow in the picture)represents the crest or residual ridge that remained after tooth extraction and resorption of the bone so we end up with such groups on the denture

So we have the crest and residual ridge on the denture, also we have dental flange (we have labial flange and buccal flange) and also we have a V shaped notches (labial frenum notch and buccal frenum notch) ; remember these are very important terms you should keep it in your mind. Now why we make these V shaped grooves in the denture? Because we have a labial frenum (its connect the center of the upper lip and the upper two front teeth) if we dont make this groove or notch so that when we pull the lip of the patient the denture will fall down.. if the patient has got an implant supported over denture whether complete or partial in both cases and even if the patient has single implant tooth he should, every 3-6 month he should return back to the dentist because he cannot clean it by himself so the dentist will perform the process of cleaning action. Indications for a Complete Denture When there is: Extensive bone loss and periodontal disease When the patient has a flat ridge bone or he suffers from gingivitis which will lead to loss of teeth and as a result we replace it by a complete denture.

Lack of motivation or ability to maintain teeth Some of us lack the motivation to visit the dentist or be aware of his teeth; this will lead to caries progression then periodontal ligament disease then loosing of the teeth and as a result we replace the missing teeth by a complete denture. So it's very important to motivate our society about the benefits of teeth.

Gross decay or abscesses Its a caries that progressed to all the teeth so we will make root restoration, if we can't then the choice is to extract the tooth.

Once you see a patient with gross decay comes to your clinic this mean that this patient doesn't care about his oral cavity so you shouldnt make yourself tired and treat this patient making endodontic treatment; directly remove the decay tooth and substitute it with complete denture.

Lack of financial resources for alternative treatments In general the fixed denture is much better than the removable one and it's more comfortable to the patient but its expensive so you will face Some patients come to your clinic and they actually need a fixed denture (implant) but they dont have enough money to do such implants.

Another indication for complete denture In order to make denture we should have: Denture base Saddle: it represents the crest of the residual ridge; in denture the residual ridge will reversed to be like a saddle. Flange: the part of the denture extended inside the vestibule. Anatomical teeth : these teeth have ( cusp, groove etc) Non anatomical teeth: these teeth DON'T have any (cusp, groove..etc) instead of that they have a flat surface; in some situation we are forced to use this type of teeth.

Appointments for a Complete Denture Examination: this is very important part.

We have two type of examination: 1. Extraoral examination: take an idea about the general situation of your patient. 2. Intraoral examination: checking the intraoral soft tissue, bone and the teeth inside the patient mouth, because our construction will be on this tissue that located beneath the denture. If the attachment of the soft tissue (gingival) to the underlying bone is poor then we have to perform the patient to surgery to remove this flat tissue; because the flat tissue acts against denture retention; thats because the retention depend on the negative pressure (the air between the soft tissue and the denture) so if we have a flat tissue the denture will move inside the patient

mouth and later fall down especially in the upper jaw due to the present of the gravity. Consultation: sometimes we go back to the technician to make sure or Consult them in some information. Oral surgery: we have to remove bone that interfere with the placement of the denture; such as "tori" which is a bony extension from the ridge on the palate of the patient or the mid-palatal suture, these extension will interfere with the insertion of our denture so we have to remove it. Final impressions: when we make sure that all things are okay then we can take the final impression. Jaw relationship: its the relationship between the upper and lower jaw; this relationship may be vertical (vertical dimension) or horizontal. Denture delivery: finally you can put the denture inside your patient mouth; you have to tell your patient some instruction about the denture at that time. First follow-up: when you make a complete denture to a patient, you will face him always in your clinic because every single pain that the patient suffers he will return back to you and complain to you from that pain even if you are very busy, and this will be chronic to you; and you are going to hate yourself and hate the patient and hate the money that you take it from the patient!! , this always happens with the patient wear the denture for the first time because they are not used to wear it. Adjustments: adjust the denture to the patient when he returns back to you often after one week.

Anatomical landmarks of the maxilla In the maxilla we have two type of area to bear the denture: a) Primary stress bearing areas : these areas are the palate and the residual ridge And they will bear the pressure caused by the denture before any other part in the mouth. b) Secondary stress bearing areas: these areas are the vestibule.

 Keep in mind that every wide flat area of bone presents in the jaw (both jaws) this will be the primary stress bearing areas.

Here _ in slides 9, 10, 11_ we have some definitions about the anatomical landmarks of the maxilla (the doctor just read the definition and he said if you can't understand any one of them you can return back to him)

In the mandible we have: a) Primary stress bearing areas: these areas are the "buccal shelf area" where the masseter muscle is inserted, and the residual ridge also. b) Secondary stress bearing areas: (the doctor doesn't mention any thing about this point). Here we have some anatomical landmarks as you see in the picture this is an upper final impression, note that we have the saddle area and the incisive papilla area and also the maxillary tuberosity area and the mid palatal suture

Now here we have another landmark for the maxilla such as the Labial frenum, Incisive papilla and the mid palatine suture.etc ,, but note here the blue line it represent the Vibrating line which make the junction between the soft and the hard palate and it's so important to make it accurate in your impression and in your denture, otherwise the denture will lose its retention when this line is not correct.

Now we see here the incisive papilla but what is the benefit of it? It's very important to us for teeth arrangement. The hamular notch represents the last border of the maxillary denture. The frena depression is an important space that represents the buccal frenum; if this does not appear in your impression it means that your impression is wrong.

Anatomical landmarks of the mandible (Again here the doctor just read the definition and he said if you can't understand any one of them you can return back to him),, but note that we have the mylohyoid ridge among these

mandibular landmarks these are muscle attachment areas, if our lower denture is over extended to this part of the mouth it will interfere with the movement of the muscle attachment and then you are going to see the denture move up from its original position during speech, eating and you can then solve this problem by a mild adjustment and everything will be okay !!

Here in this picture we have a maxillary special tray. The brown border material it's made from a material that called the green stick or the brown stick; this is a compound impression material we put it all around the tray to perform the border molding later on, we insert it in the patient mouth without impression and we pull the cheek up and down, the lip anteriorly and down so that these border become rounded and even though we will get good retention without impression , the tray will not fall easily from the patient mouth this means that our retention is perfect then we load the tray with impression material and we take the impression. Once you see such a tray it's called custom tray, special tray or individual tray (it means that the only material that we load in it is a final impression material) Type of the final impression material we usually use in complete denture is "zinc oxide eugenol".

The doctor talked briefly about the midterm exam it will be on 8/11 and it will be from 40 degree ( 25 theory ,, 15 practical) and you have to read the theory well because its so important, and for the practical exam most of it will be on how to construct a special tray and how to construct a record base and the setting of teeth. Final exam will be from 60 degree (30-40 theory,, 20 practical).

Wish you all the best luck.

The happy END please Forgive me for any mistake.

Done by: Mohamad alzou'bi