Complete Denture Diagnosis & Treatment Planning This presentation includes images and text from the UCLA/APC/Ivoclar Educational Curriculum

Medical History  Be efficient - don't need extensive history of relatives  Follow-up significant responses  Note systemic conditions that impact on therapy (e.g. angina, hepatitis, Sjogren's syndrome)  Be efficient - don't need extensive history of relatives  Follow-up significant responses  Note systemic conditions that impact on therapy (e.g. angina, hepatitis, Sjogren's syndrome)

Medical History  Obtain physician consultations  If some debilitating disease –discuss with instructor –to ensure acceptability  Obtain physician consultations  If some debilitating disease –discuss with instructor –to ensure acceptability

Dental History  How many dentures?  How long worn?  Age of present set?  Satisfaction with dentures?  Things patient likes - what they want changed  How many dentures?  How long worn?  Age of present set?  Satisfaction with dentures?  Things patient likes - what they want changed

Clinical Exam  Routine clinical exam

Intraoral Exam  Examine one arch at a time –Look, then write  Examine one arch at a time –Look, then write

Intraoral Exam  General tissue health –Mucosa attached / non-attachedattached / non-attached –Colour –Character –Displaceability  General tissue health –Mucosa attached / non-attachedattached / non-attached –Colour –Character –Displaceability

Intraoral Exam  Specific Anatomical considerations –Examine systematically –Note significance of findings to therapy –Visual and tactile exam  Specific Anatomical considerations –Examine systematically –Note significance of findings to therapy –Visual and tactile exam

Intraoral Exam Maxilla –Form of maxillary arch affects retention –Advise the patient if retention will be compromised Maxilla –Form of maxillary arch affects retention –Advise the patient if retention will be compromised

MaxillaMaxilla  Posterior border of denture: –Hamular notches Posterior denture borderPosterior denture border PalpatePalpate Visually deceivingVisually deceiving  Posterior border of denture: –Hamular notches Posterior denture borderPosterior denture border PalpatePalpate Visually deceivingVisually deceiving

MaxillaMaxilla  Posterior border of denture: –Hamular notches Over extension - extreme painOver extension - extreme pain Under extension - non-retentiveUnder extension - non-retentive Must be captured in impressionMust be captured in impression  Posterior border of denture: –Hamular notches Over extension - extreme painOver extension - extreme pain Under extension - non-retentiveUnder extension - non-retentive Must be captured in impressionMust be captured in impression

MaxillaMaxilla  Posterior border of denture –Vibrating line Identified when patient says "ah"Identified when patient says "ah" Junction of movable & non- movable soft palateJunction of movable & non- movable soft palate  Posterior border of denture –Vibrating line Identified when patient says "ah"Identified when patient says "ah" Junction of movable & non- movable soft palateJunction of movable & non- movable soft palate

MaxillaMaxilla  Posterior border of denture –Vibrating line If terminate on:If terminate on: –movable portion - displacement –hard palate - no retention  Posterior border of denture –Vibrating line If terminate on:If terminate on: –movable portion - displacement –hard palate - no retention

MaxillaMaxilla  Vibrating line Fovea - close to vibrating lineFovea - close to vibrating line Throat form can affect widthThroat form can affect width  Vibrating line Fovea - close to vibrating lineFovea - close to vibrating line Throat form can affect widthThroat form can affect width

Palatal Throat Form II IIII IIIIII MaxillaMaxilla Flatter the soft palate, the broader the area of the vibrating line

MaxillaMaxilla  Posterior border of denture: –Pterygomandibular raphe Behind hamular notches - significant when prominentBehind hamular notches - significant when prominent Have patient open wide as possibleHave patient open wide as possible Can displace denture – requires relief in extreme casesCan displace denture – requires relief in extreme cases  Posterior border of denture: –Pterygomandibular raphe Behind hamular notches - significant when prominentBehind hamular notches - significant when prominent Have patient open wide as possibleHave patient open wide as possible Can displace denture – requires relief in extreme casesCan displace denture – requires relief in extreme cases

Glandular tissue Posterior palatal seal Posterior palatine salivary glands Permits compression of tissuesPermits compression of tissues Improves adaptation of denture to compensate for shrinkage of resinImproves adaptation of denture to compensate for shrinkage of resin Posterior palatine salivary glands Permits compression of tissuesPermits compression of tissues Improves adaptation of denture to compensate for shrinkage of resinImproves adaptation of denture to compensate for shrinkage of resin Posterior Palatal Seal

MaxillaMaxilla  Tuberosity –Displaceability –Palpate for undercuts - if extreme, denture might not seat  Tuberosity –Displaceability –Palpate for undercuts - if extreme, denture might not seat

MaxillaMaxilla  Tuberosity –If enlarged with fibrous tissue surgical reduction to make room for denturessurgical reduction to make room for dentures  Tuberosity –If enlarged with fibrous tissue surgical reduction to make room for denturessurgical reduction to make room for dentures

MaxillaMaxilla  Ridge form –U-shape best –Non-moveable best –Advise patient if poor –Affects: retentionretention stabilitystability  Ridge form –U-shape best –Non-moveable best –Advise patient if poor –Affects: retentionretention stabilitystability

MaxillaMaxilla  Labial/Buccal vestibule –2-4 mm width –Zygomatic process can be prominentcan be prominent  Labial/Buccal vestibule –2-4 mm width –Zygomatic process can be prominentcan be prominent

MaxillaMaxilla  Labial/Buccal vestibule –Flat ridges maximize retention by accurately registering the vestibulemaximize retention by accurately registering the vestibule  Labial/Buccal vestibule –Flat ridges maximize retention by accurately registering the vestibulemaximize retention by accurately registering the vestibule

MaxillaMaxilla  Frena - check prominence: –Buccal frenum Usually broaderUsually broader –Thin labial frenum  Frena - check prominence: –Buccal frenum Usually broaderUsually broader –Thin labial frenum

Maxilla: Midline  Tori  Mid palatal suture –Eliminate binding or fulcruming –Discomfort, loss of retention and possible fracture of the denture  Tori  Mid palatal suture –Eliminate binding or fulcruming –Discomfort, loss of retention and possible fracture of the denture

Mandibular Support Areas Retromolar Pad Alveolar Process Buccal Shelf Buccal Shelf

MandibleMandible  Ridge form more critical –Less surface area for retention –Moveable tongue & floor –Displacement if denture is overextended Inform patientsInform patients  Ridge form more critical –Less surface area for retention –Moveable tongue & floor –Displacement if denture is overextended Inform patientsInform patients

MandibleMandible  Retromolar pad –Terminal border of the denture base –Compressible soft tissue ComfortComfort Peripheral sealPeripheral seal –Must be captured in impression  Retromolar pad –Terminal border of the denture base –Compressible soft tissue ComfortComfort Peripheral sealPeripheral seal –Must be captured in impression

MandibleMandible  Buccal shelf –Custom tray, border molded - should not feel edge extraorally –External oblique ridge do not coverdo not cover Alginate will almost always overextendAlginate will almost always overextend P ainfulP ainful  Buccal shelf –Custom tray, border molded - should not feel edge extraorally –External oblique ridge do not coverdo not cover Alginate will almost always overextendAlginate will almost always overextend P ainfulP ainful

MandibleMandible  Labial/Buccal vestibule –Easy to overextend –Check with minimal manipulation of lips  Labial/Buccal vestibule –Easy to overextend –Check with minimal manipulation of lips

MandibleMandible  Masseter –affects distobuccal border –if more prominent - concave border of denture  Masseter –affects distobuccal border –if more prominent - concave border of denture

MandibleMandible  Frena –Labial and buccal frena Narrow & wide respectivelyNarrow & wide respectively –Lingual frenum Must allow for movement - or displaces easilyMust allow for movement - or displaces easily  Frena –Labial and buccal frena Narrow & wide respectivelyNarrow & wide respectively –Lingual frenum Must allow for movement - or displaces easilyMust allow for movement - or displaces easily

Buccal frenum Lingual frenum

MandibleMandible  Retromylohyoid fossa –Need to capture –Especially with severely resorbed ridge  Retromylohyoid fossa –Need to capture –Especially with severely resorbed ridge

Lateral Throat Form Class III Class I Class II

MandibleMandible  Mylohyoid Ridge –Palpate If prominent, may need reliefIf prominent, may need relief  Mylohyoid muscle Raises floor of mouthRaises floor of mouth Differences between rest and activityDifferences between rest and activity Affects length of flangesAffects length of flanges  Mylohyoid Ridge –Palpate If prominent, may need reliefIf prominent, may need relief  Mylohyoid muscle Raises floor of mouthRaises floor of mouth Differences between rest and activityDifferences between rest and activity Affects length of flangesAffects length of flanges

Mucosa in this region is poorly keratinized and prone to trauma Mylohyoid ridge Mylohyoid ridge can cause ulcers if it is a sharp Residual Ridge Resorption (RRR)

MandibleMandible  Tori –Rarely need surgery unless large –May require relief once dentures are delivered - advise patient  Tori –Rarely need surgery unless large –May require relief once dentures are delivered - advise patient

MandibleMandible  Genial tubercles –Bony insertion for the genioglossus muscle –May be projecting above the residual ridge if there has been severe resorption  Genial tubercles –Bony insertion for the genioglossus muscle –May be projecting above the residual ridge if there has been severe resorption

SummarySummary  Anatomy: –Affects complete denture retention & stability –Should be captured in preliminary & final impressions –If poor, advise patient –Exercise today  Anatomy: –Affects complete denture retention & stability –Should be captured in preliminary & final impressions –If poor, advise patient –Exercise today

Materials for Border Moulding Signout:   RPD tray   Bunsen burner   Low temperature water bath   Slow speed lab handpiece   Acrylic adjustment burs Your own:   Hanau torch ( filled with alcohol )   Ice water in a mixing bowl   Partner’s custom tray Supplied:   Compound, gloves, masks, scalpel blades and will be supplied. Signout:   RPD tray   Bunsen burner   Low temperature water bath   Slow speed lab handpiece   Acrylic adjustment burs Your own:   Hanau torch ( filled with alcohol )   Ice water in a mixing bowl   Partner’s custom tray Supplied:   Compound, gloves, masks, scalpel blades and will be supplied.