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J.F.Maccord and A.A. Grant, Complete dentures: an introduction and clinical

assessment, British dental Jurnal,2000:188(7):373-374.

The purpose of this article is to reflect current changes in philosophy towards the

prescription of complete dentures. To achieve these aims, this article will deal with

trends in edentulousness and changes in perceptions to edentulousness to the

treatment modalities in complete denture provision.

Two factors adding to the relative complexity of this task are:

1. the reduction in teaching of prosthodontic technology and in decreased

minimum requirements of completed cases. This means that new graduates

are potentially less able to provide a satisfactory prosthodontic service.

2. Those patients who are edentulous are becoming more clinically

demanding either because of oral conditions present at the time of total

tooth loss or the deteroration of anatomical, physiological and sometimes

psychological well-being which often are sequelae to edentulousness.

Clinical assessment:

1. Patients assessment: the first of these is practiced by many practioners who take

the opportunity to escort their patients from the waiting area to the surgery. In

addition to the value of the exercise gained, this philosophy affords the clinician

the opportunity to assess the mein, gait and physical appearance of each patient.

2. soft tissue attachment: the tone of the lips and cheeks may be assessed by

asking the fundamental questions which tends to promote unguarded replies and

provide an opportunity for useful observations. This form of questioning will also
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tend to indicate the functional relationship of the lips and toungue to the dentures

in speech.

The oral mucosa should be checked routinely for the presence of ulcers,

stomatitis or frank pathology. The clinician should also note the presence of

adverse soft tissue attachments to the edentulous ridges or any other

abnormalities.

Hard tissue assessment: the edentulous ridges should be assessed for form,

presence of retained roots, tori and degree of inter-ridge space. The classification

of ridge form by Atwood, which has been modified by Cawood and Howell is a

useful means of describing ridge shape, although it does not necessarily

describe the ridge consistency.

In addition to above, the clinician should assess the quality and quantity of

patients saliva. This may affect the decision regarding the selection of the

impression technique and further relate to denture retention potential.

Denture assessment:

 General factors:

Denture wearing history:record the age of the present dentures, the

frequency with which previous dentures have been replaced and the

patients experiences with these dentures. Note the denture base

materials used and the condition of the dentures, including the signs and

sites of wear and usage. It is also useful idea to record the dietary habits
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of the patient to determine the range and consistency of foods eaten by

the patient.

 Specific factors:

Extension of the complete upper denture:

 Check the peripheral extension, including presence, fit and

placement of the postdam. This may be done by using a

ball-ended burnisher to help determine the displacebility of

tissues.

 Appropriate utilization of the functional width and depth of

the sulcus should be present as these relate to function.

 Extension of the complete lower denture

 Check the extension of the denture base in relation to the

optimal available denture-bearing area ,that is half way upto

retromolar pads and functional extension onto buccal

shelves and lingual sulci.

 Appropriate extension relates to stability; instability tends to

result in patients being aware of denture movement in

function.

 Assessment of retention:

 Retention of maxillary denture may be assessed by placing

the thumb on the palatal aspect of the maxillary canine and

the forefinger on the labial aspect and via a rotation of the

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wrist, pulling the thumb labially. This is an assessment of the

adequacy of the peripheral seal.

 A number of factors relate to retention, namely peripheral

seal, tissue fit and secondary factors such as support and

stability. Neuromuscular control, particularly in the case of

dentures worn regularly over many years, is an important

secondary factor.

 Testing the retentive quality of the lower denture is

problematic as it tends to be intimately related with stability.

 Assesment of stability:

 Stability of denture may be generally speaking be assessed

via alternate pressing on the right and left occlusal surfaces

of the premolar teeth to detect the presence of rocking or

rotational movements. This may suggest the presence of

fitting inaccuracies, underutilization of denture bearing areas

or support problems-this applies to both dentures.

 Assessment of upper denture is generally performed with

the operator standing behind the patient

 The presence of inappropriate and adverse occlusal planes

may result in stability problems as may some occlusal

errors. For ex: if upper posterior planes dip posteriorly then

the effect on closure of the dentures will be for the lower

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denture to slide anteriorly , often resulting in an ulcer lingual

to the lower ridge.

 Assesment of dentures as functional units

o Upper tooth position:

 This is usually directly related to the registration visit. A

variety of subtly interconnected factors require to be

established when dentures are assessed.

 Contribution to lip support: has the denture provided

appropriate lip support? Upper anterior teeth placed on the

ridge may affect speech, resulting in problems of instability

with the lower denture and donot restore the vermillion

border of the upper lip.

 Position of the mid-incisal point: this is a function of

appropriate lip support and if correct position is not achieved

or if the maxillary denture teeth are set on the ridge, the

mid-incisal point may be placed inappropriately. The

exception is a patient who has been recently rendered

edentulous or has a large undercut anterior ridge; in these

cases, a full labial flange may not be appropriate.

 Angulation of the incisal plane: a useful guideline is that it

should be parallel to the interpupillary line.

 Angulation of the posterior occlusal plane: this plane should

made parallel to the ipsilateral alar-tragus lines.

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 Lower tooth position

 The central fossae of the lower posterior teeth and the

necks of the lower anterior teeeeth should lie over the

residual mandibular crest.

 Relation to the lingual cusps to the resting tongue height. By

convention, the tongue at rest should lie at the level of the

lingual cusps of the lower denture.

 The presence of lingual undercuts should be avoided as

these may lead to denture instability. This factor may be

extended in case of patients with atrophic mandible. In

these cases, it is considered prudent to position the

mandibular teeth in a position of minimal muscular conflict

 The presence of molar teeth over the ascending portion of

the mandibular ramus tends to encourage displacing

movements of the lower denture and this practise should be

avoided.

 Occlusal relations in retruded contact position(RCP): the minimal

requirements for any complete dentures should be that they exhibit

balanced occlusion in RCP. This means that there should be

simultaneous and even bilateral contacts in RCP. This should be

established with the operators forefinger placed on the buccal periphery

of lower denture to assist stability. The operator should detect any slide,
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be it protrusive or lateral, as these will tend to de-stabilise the lower

denture.

 Assesment of appropriate freeway space: this is measured indirectly by

subtracting the vertical dimension from the resting facial height(RFH-

OVD). Clinicians should determine the biological capacity of the patient to

withstand occlusal loading and prescribe the OVD appropriately.

 Assesment of the appearance: important factors to assess here are:

1. appearance of the anterior teeth:

a. upper lip support

b. restoration of philtrum

c. tooth shade, mould and arrangement

d. buccal corridors

e. harmony of gingival matrices of anterior and posterior teeth

f. lower lip support

2. posterior asthetics

a. occlusal planes

b. anatomical and natural flow from anteriors to posteriors

c. gingival contours

 other aspects of denture assessment: remove both the dentures and assess

the following:

o impression surface of each denture. Ensure no surface irregularities

are present-these may well induce support problems

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o polished surface of each denture. These should be free of undercuts

and should confirm to the structures sorrounding the denture space

o occlusal and incisal surfaces of each denture. Ensure that the

relatioship of teeth to the indentation of the ridge on the impression

surface . in the case of upper antriors, a device such as alma gauge

may help relate these teeth to the incisive papilla. In case of lower

posterior teeth, a wax knife may be used to relate the lower posteriors

to the ridge.

When the assessment of the patient and patients dentures have been made, a realistic

diagnosis of any real or potential problems may be made.