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Steps of the complete denture fabrication:
Dental office Dental laboratory
1. Anamnesis, oral examination, upper 2. Stone cast fabrication, fabrication of
and lower alginate impression, drawing of light curing acrylic custom tray
custom tray border
3. Check the fit of the custom tray, shape 4. Beading and boxing, fabrication of
if needed, border moulding, functional functional cast, fabrication of record base
impression - ADD MOVEMENTS on shellac base plate, fabrication of upper
and lower occlusal rims
5. Control of occlusal rims (ridge line, 6. Articulation and tooth set up
UPPER RIDGE FIRST ACCORDING
TO CAMPER AND BIPUPILLARY
LINE), defining OVD and CR, spatula
probe, AND FACEBOW TRANSFER
shade selection
7. Trial of denture, spatula probe 8. Flasking, re-occlusion (processing the
denture)
9. Delivery of denture, spatula probe
10. Remontage AND FACEBOW
REMONTAGE (if necessary)
1. Dental office: Anamnesis, oral examination, upper and lower
alginate impression, and drawing of custom tray border
Anamnesis:
History
o Medical and dental
o Current medications
Insulin
Anti-coagulants
Anti-hypertensive: dryness and postural
hypertension
Diuretics
Anti-histamines
Atropine
Anti-cholinergic
Corticosteroids: dryness, confusion and behavioural
changes
Anti-Parkinson agents: dryness, confusion and
behavioural changes
, o Socioeconomic status
Extra-oral examination
o General appearance (healthy, signs of proper nourishment?)
o Facial symmetry
o Skin: color, deep wrinkles
o Palpation of head and neck (lymph nodes and muscles) –
lips and cheeks
o TMJ
Clicking, popping or crepitus, pain
Intra-oral examination
o Lateral border of the tongue
o Base of the tongue
Favourable tongue is averaged sized, moves freely,
covered by healthy mucosa
It should normally rest in a relaxed position on
lingual flanges, this will retain denture and
contributes to denture stability by controlling it
during speech, mastication and swallowing
o Floor of the mouth and ventral surface of the tongue
o Tonsillar region and soft palate
Fish- pocket examination:
o We do a bilateral manual examination
o Using index fingers
o Bring tongue out
o When the tongue is pushed out, if you feel the following:
The entire floor of the mouth rising up and pushed
the fingers out of place
If this occurs, the fish-pocket area is not an
ideal area for retention
The tongue pushes the fingers to the mandible (at
the border of the angle and the body of the mandible
– innerside)
If this occurs, it is again not an ideal area for
retention.
In these cases, the border of the tray should be the
same as the level of the movable and attached
mucosa.
So, if the fish-pocket is usable (in 99% of cases):
use border moulding even with the deeply negative
ridges.
If the fish-pocket is not usable: a bit of green Kerr
can be placed.
X-ray
, 3
o OP to rule out any bony conditions that could affect the
treatment
o Supplemental radiographs: peri-apical, occlusal, and lateral
cephalograms if needed
o Fractured roots or roots lying close to the surface should be
removed if patient is fir for surgery; deep seated retained
teeth or root fragments may be left if they are
asymptomatic
Prosthodontics assessment
o Clinical factors influencing stability, retention, and support
of complete dentures
o Denture assessment
o Prognosis
Fees and signed consent
o When patient agreed on treatment including the fees, he
must sign a written consent to prevent later
misunderstandings.
- Select a stock tray without any border or holes and check it in the patient’s
mouth: to make sure we chose the correct size
o It must cover all the areas
o Shouldn’t be uncomfortable
o Disinfect and use tape all around the selected tray
- Alginate impression:
o Upper jaw: press on the posterior region initially
o Lower jaw: tongue must be elevated
o Why is alginate used?
Cheap
Easy handling
Good for undercut areas
Pleasant for the patient
Poor shrinkage
- Disinfect the impression and evaluate it
- Note, if we are only making a complete denture of one of the jaws, we must also
take an antagonist impression; so either way, we always take an upper and lower
alginate impression
- This impression is used for planning, diagnosis and to order the custom tray
- This is an over-dimensional impression = we see parts of the cavity that are not
really necessary for the fabrication of the prosthesis
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- Making of custom tray borders:
o The borders of the fixed and movable mucosa cannot be seen on the
impression so we draw them
o Draw 2mm above (occlusally) the junction between the movable and
attached mucosa
