1. REVISION (1) B.M.C

2. **CHAPTER. (1) INTRODUCTION

3. Prosthodontics (Prosthetic Dentistry)
Prosthetics
The art and science of supplying artificial
replacement for missing parts of the human body.
Prosthesis
An artificial replacement of an absent part of the human body.
Prosthodontics (Prosthetic Dentistry)
It is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation & maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing/deficient teeth &/or maxillofacial tissues using biocompatible substitute.

4. Components of complete denture2 1
1- Denture base
2- Artificial teeth

5. Denture surfaces
1- Denture basal surface:

6. 2- Denture polished surface:

7. 3- Denture occlusal surface

8. Steps of Complete Denture Construction
Clinical
Laboratory
1. Examination & Diagnosis
2. Primary impression
Study cast
Special tray
3. Final impression
Boxing and pouring  master cast
Occlusion blocks
4a. Jaw relation registration
4b. Selection of artificial teeth
Mounting on articulator
Setting of artificial teeth and waxing up
5. Try in
Processing
6. Insertion
7. Post insertion care

9. Objectives of complete denture
1-Restoration of the function of mastication to restore the normal digestive process
2- Appearance (esthetics) restoring the normal appearance of the face especially the lower third of the face.

10. 3- Correction of speech defects
►Loss of teeth (especially anteriors) Speech Defects
►The artificial teeth should be placed in a position
previously occupied by the natural teeth.
4- Preservation of the remaining tissues

11. 5- Patient Satisfaction

12. **CHAPTER. (2) LANDMARKS

13. Changes That Happen After Teeth Loss :
Face :

14. Anatomical Landmarks In Relation To Complete Denture :
Extra Oral Landmarks
Inter pupillary line
Ala Tragus Line
Naso – Labial sulcus
Modulus
Labiomental sulcus

15. Anterior Occlusal Plane Determination
Inter pupillary line
Anterior Occlusal Plane Determination
Ala Tragus line
Posterior Occlusal Plane Determination
Naso – Labial sulcus
Becomes deeper with age and with loss of teeth
Modulus
Become Flat With The Loss Of Teeth
Labiomental sulcus
Classes of jaw relations

16. Intra Oral Landmarks Incisive Papilla Denture Bearing areas / Upper
1 . The incisive papilla is a thick part of the mucous membrane covering
the incisive foramen.
2 . It is located at the anterior end of the median palatine raphae .
3 . The nasopalatine nerves and vessels pass through the incisive foramen
to supply the anterior 2 / 3 of the palate.
4 . In some cases due to the excessive bone resorption, the papilla may lie
on the crest of the ridge.
5 . The incisive papilla should be relieved to avoid pressure on the incisive
nerves and vessels.
CAUSING BURNING SENSATION IN THE ANT. 2/3 OF PALATE

17. Denture Bearing areas / Upper
Palatine Rugae
Raugae Area
1 . It is an irregularly shaped elevations of soft tissue extending
laterally from the midline in the anterior part of the hard palate.
2 . It serves as one of stress bearing areas in the palate .

18. Denture Bearing areas / Upper
Median Palatine Raphae
Median Palatine Raphae
1 . The midline of the hard palate is covered by a thin layer of
mucoperiostium , that covers the median palatine suture .
2 . That suture joins the right and the left halves of the hard palate.
3 . It is usually relieved to increase denture stability by preventing its rocking .

19. Denture Bearing areas / Upper
Fovia Palatina
Fovia Palatina
1 . It helps in the determination of the posterior border
of the upper denture.
2 . The posterior border of the upper denture should be 2 mm
posterior to the fovea Palatina .

20. To Continue ( Bearing Areas)
Residual Alveolar Ridge
Residual Alveolar Ridge
1 . It should be firm specially in the lower ridge .
2 . It covers the crest of the lower ridge.
3 . Its mobility may cause pressure symptoms under the lower denture.
4 . Also can affect denture stability .

21. To Continue ( Bearing Areas)
Buttress Part Of Bone
Buttress Part Of Bone
1 . It is formed of the lower portion of the zygomatic process of the maxilla
(the area above the first molar teeth) .
2 . It provides excellent resistance to the vertical forces(Support).

22. To Continue ( Bearing Areas)
Tuberosity
Tuberosity
1 . It is important for retention and support of the upper denture
against lateral movement.
2 . The denture should cover it , because it is one of stress bearing
areas in the upper jaw .

23. To Continue ( Bearing Areas)
Immovable Part of Soft Palate
Immovable Part of Soft Palate
1 . The immovable part lies adjacent to the hard palate and the
movable part lies more posterior.
2 . The posterior edge of the upper denture should end at the junction
of these two parts .

24. Denture Limiting Structures (Upper)
Labial Frenum
Labial Frenum
It must be relieved in the denture by making a V-shape notch
in the labial flange opposite to its position .

25. Denture Limiting Structures (Upper)
Labial Vestibule
Labial Vestibule
1 . It Is the reflection of the mucosa of the lip to the mucosa of the
alveolar process in the labial vestibule.
2 . The denture in this area is in relation to the orbicularis oris and the
superior incisive muscles .
3 . These muscles limit the thickness and the length of the labial flange
of the denture.

26. Denture Limiting Structures (Upper)
Buccal Frenum
Buccal Frenum
1 . It is a fold of mucous membrane (tendon of the buccinator muscle)
varies in size in number and in position .
2 . A notch is made in the denture flange opposite to its position to
facilitate its functional movements.

27. Denture Limiting Structures (Upper)
Buccal Vestibule
Buccal Vestibule
1 . The denture in this area is related to buccinator muscle.
2 . Buccal flanges must extend in the buccal vestibule .
3 . Due to the horizontal direction of the fibers of this muscle;
the contraction of this muscle will not displace the denture.

28. Denture Limiting Structures (Upper)
Hamular Notch
Hamular Notch
1 . It is one of the important landmarks for determination of the posterior
limit of the upper denture .
2 . A straight line from hamular notch on one side to the other on the other
side determines the posterior limit of the upper denture

29. Denture Limiting Structures (Upper)
Vibrating Line
( Ah Line)
Vibrating Line
( Ah Line)
1 . It separate the movable part from the immovable part of the soft palate.
2 . This line is 2mm posterior to the fovea palatine .
3 . This line determines the posterior end of the upper denture.

30. Denture Bearing and Limiting Structures (Lower)
Retro Molar Bad
Retro Molar pad
1 . It is a pear shaped area of mucous membrane at the posterior end of the
mandibular ridge and anterior to the pterygo­mandibular raphae .
2 . It consists of mucous glands , temporal tendon , fibers of the
buccinators and superior constrictor muscle .
3 . Lower denture should cover this area for retention and to cover
the buccal shelf of bone.

31. Denture Bearing and Limiting Structures (Lower)
Buccal Shelf Of Bone
Buccal Shelf
Of Bone
1 . The area that lies between the crest of the residual ridge and
the external oblique ridge.
2 . It is the primary stress bearing area in the lower arch .
3 . It forms good support for the lower denture .

32. Denture Bearing and Limiting Structures (Lower)
Buccal Vestibule
Buccal Vestibule
1 . The denture in this area is related to the buccinator muscle .
2 . Its contraction does not displace the lower denture so flanges of
the lower denture must extend in the buccal vestibule.

33. Denture Bearing and Limiting Structures (Lower)
Buccal Frenum
Buccal Frenum
1 . It is a fold of mucous membrane in the premolar area, movement of
the lip and the cheek move the frenum .
2 . A notch is made in the lower denture to accommodate the frenum.

34. Denture Bearing and Limiting Structures (Lower)
Labial Frenum
Labial Vestibule
Labial Frenum
Labial Vestibule

35. Denture Bearing and Limiting Structures (Lower)
Residual Ridge
Residual Ridge

36. Denture Bearing and Limiting Structures (Lower)
Lingual Pouch
Lingual Pouch
More posteriorly the lingual flanges are related to the lingual pouch with
its boundaries which are :
Posteriorly : The palatoglosssus muscle .
Anteriorly : The Mylohyoid muscle.
Medially : The tongue .
Laterally : The medial aspect of the mandible.

37. Denture Bearing and Limiting Structures (Lower)
Sublingual salivary
gland area
Sublingual salivary
gland area
The lingual flanges of the lower denture should not extend in this area
because with excessive resorption of the mandible the gland may
bulge superiorly above the body of the mandible.

38. Denture Bearing and Limiting Structures (Lower)
Lingual Frenum
Lingual Frenum
1 . More anteriorly a fold of mucous membrane attach the mucosa of the
tongue to mucosa of the floor of the mouth
2 . It moves with the movement of the tongue so a notch is made to
accommodate the frenum.

39. **CHAPTER (3) IMPRESSIONS

40. Types of Trays
I- Stock trays II- Custom trays (Special, Individual trays)

41. The body and handle are designed to suit different mouths
1-Dentulous mouth cases .
2-Edentulous mouth cases
3-Partially edentulous mouth cases.

42. Types of special trays
1- Shellac base plate special tray 2- Acrylic resin custom (special) trays: a- cold cured b- heat cured c- light cured Both heat and cold cured are used widely now. It is rigid and light in weight, not wrap in the mouth . 3- Cast or swaged metal tray 4- Vacuum formed plastic sheets It needs a pressure forming machine

43. Comparison between shellac and acrylic resin custom trays
Shellac base plate special tray
Low strength.
2. Easily distorted by load and temperature.
3. Improper adaptation to the cast
4. Easily constructed
Self-cured acrylic
resin special tray
Higher strength and rigidity.
Not distorted by temperature.
Well adapted
4. Easily constructed

44. Tray can be
1- with a spacer 2- without a spacer

45. SHIM OR SPACER
“ One thickness of modeling wax or shellac base plate adapted on the study cast under the special tray “

46. Custom Tray With Spacer

47. Impression
Impression is a negative likeness or copy. Cast is a positive copy

48. Preliminary (primary) impression
Is defined as: a negative likeness made for the purpose of diagnosis, treatment planning, or fabrication of a special tray. Preliminary (study) cast is defined as: a cast formed from a preliminary impression for use in diagnosis or the fabrication of a special tray.

49. Final (secondary) impression
“The impression represents the completion of the registration of the surface or object. It is an impression which is used for making definitive (master) cast. “

50. 2NDRY IMPRESSION TECHNIQUES
MINIMAL PRESSURE
( MUCOSTATIC)
FUNCTIONAL PRESSURE (MUCOCOMPRESSIVE)
SELECTIVE PRESSURE
(2) PHILOSOPHY
ALL THE TISSUES ARE UNDER THE LEAST PRESSURE.
ALL THE TISSUES ARE UNDER FUNCTIONAL PRESSURE.
TISSUES THAT CAN WITHSTAND PRESSURE ARE LOADED. AND TISSUES THAT CAN'T ARE RELIEVED.
(3) TRAY
PERFORATED + ON SPACER + WITH TISSUE STOPS.
WELL ADAPTED + NO SPACER + WAXRIM.
STOCK TRAY WITH COMPOUND ,THEN IT IS RELIEVED AND WASHED WITH PLASTER IMPRESSION MATERIAL.
(4) PRESSURE
FINGER PRESSURE
PATIENTS BITING FORCE.
FINGER PRESSURE.
(5) IMPRESSION MATERIAL
PLASTER, FLOWY MATERIAL.
ZnO/E , HEAVY MATERIAL
IMPRESSION COMPOUND (HEAVY)+ PLASTER OR ZnO/E(FLOWY)

51. Boxing the impression
An impression is boxed to preserve the borders of the impression so that it will be accurately reproduced in the cast.

52. Methods for boxing
1- Wax method 2- Plaster and Pumice method

53. Beading wax for boxing 1- Wax Method

54. 1-wax method

55. 1-wax method Lower impression

56. 2-Plaster and Pumice method Plaster and pumice for boxing

57. 2-Plaster and Pumice method Upper impression

58. Advantages of boxing
1- The borders of the impression are preserved. 2- The thickness of the base can be controlled 3- It permits vibrating, prevents air bubbles and gives us denser cast. 4- Time for pouring the cast is conserved. 5- Materials are conserved.

59. **CHAPTER (4) OCCLUSION BLOCKS

60. USES Of The OCCLUSION BLOCKS
They help in
1- Supporting the lips and cheeks to restore the contour of extraoral landmarks.
2-The orientation of the occlusal plane.
3- Determining the vertical dimension.
4-Recording the centric and eccentric jaw relations.

61. Cont. Uses of the Occlusion Blocks
5- Selecting the size and position of the artificial teeth by the aid of the following markings :
a- Midline
b-High lip line
c- Canine line
6-Providing a matrix for arranging teeth.

62. Cont. Trial Denture Bases
Types
Temporary
1- Shellac
2- Autopolymerizing and
light cured acrylic resin
3- Vacuum formed vinyl
or polystyrene
4- Baseplate wax
5- Swaged tin
Permanent
1- metallic
gold alloys
cobalt chromium alloys
2- non-metallic
heat cured acrylic resin

63. CHAPTER (5) RELIEF AND POST. PAL SEAL.

64. 1-Median palatine raphae 2-Torus palatinus {if present}
Relief areas
Hard Prominent areas
Maxillary
Mandibular
Sensitive areas
1-Median palatine raphae
2-Torus palatinus {if present}
*Torus mandibularis
{if present}
*PROMINENT Genial tubercles.
*PROMINENT Mylohiod ridge.
1-Incisive papilla
2-Rugae area
3-Flabby ridge
4-Sharp bony spicules
1-Mental foramen in resorbed ridges
2-Flabby ridge
3-Sharp bony spicules

65. Shape of Relief Area
It is never well defined. It merges into the surrounding fitting denture surface.
Depth of Relief:
It depends on the compressibility of the area to be relieved as well
as that of the surrounding areas.

66. Methods of Relief
I- Direct
1-Scrap the final
impression
2-Build tin foil
on the master
cast
II- Automatic

67. I- Direct Relief 1- Scraping the Impression

68. I- Direct Relief 2- Build on the cast

69. II- Automatic Relief (Selective Pressure Impression Technique)
B- Secondary impression in Zn/O eugenol or plaster.
A- Scraping the compound
selectively.

70. Value of Relief
Relief of sensitive areas increases the comfort of the patient.
Relief of hard areas improves the denture stability, so it
Prolongs the duration of denture service by compensating for denture settling and some ridge resorption .
Compensate for polymerization shrinkage.

71. Position of the Post dam area
Posterior vibrating
line

72. Functions of posterior palatal seal
Retention of maxillary denture.
Prevents food accumulation under the denture.
Compensates for polymerization shrinkage.
Reduces patient’s discomfort.

73. Width of post dam area

74. Depth of Post Dam
Depends on the degree of compressibility of soft tissue in this area and on the extent of functional movement of the soft palate.

75. postdamming
Methods of
1-Scraping method
2-Functional method

76. Methods of post damming
1-Scraping method

77. Methods of post damming
2- Functional method

78. Methods of post damming
2- Functional method

80. **CHAPTER(6) MANDIBULAR MOVEMENT.

81. A close up view of the joint

82. Basic mandibular movements
Rotation
in the lower compartment
Translation
in the upper compartment

83. Possible Mandibular Movements
They are usually classified according to the main direction of movement. The starting position is the habitual intercuspal position, from this point the mandible can move into:
Opening and Closing Movement
Lateral Movement
Forward & Backward Movement

84. B A L N C I G W O R K I N G

85. The inclination of the condylar path
Types : A- Sagittal ( HORIZONTAL) condylar path angle B- Lateral condylar path angle

86. No Translation

87. Translation

90. Border Positions of the Mandible

91. **CHAPTER (7) JAW RELATIONS

92. Jaw Relation “ It is any relation between the mandible
and the maxilla.”
It is a three dimensional relation ( vertical, anteroposterior and lateral).

93. (1)VERTICAL RELATION. ( V.DO + V.D.R)
JAW RELATIONS
(1)VERTICAL RELATION ( V.DO + V.D.R)
(2)ANTROPOSTERIOR RELATION ( CENTRIC RELATION + PROTRUSIV RECORD)
(3)LATERAL ( LATERAL RECORDS)

94. Vertical dimension Two types are identified: 1- VDR
“ The measurement, when the mandible is in the physiologic rest position.” .
2- VDO
“ The measurement , when the teeth or occlusion rims are in contact.”

95. The interocclusal distance
“ It is the difference between the VDR and the VDO. In normal individuals its average value is 2-4 mm. It is also termed interocclusal clearance, gap &/or freeway space.”

96. Short term variables 1- Head position 2- Respiration 3- Stress
Variables of the VDR
Short term variables 1- Head position 2- Respiration 3- Stress
Long term variables 1- Loss of propiceptors  decrease 2- Age decrease

97. Sequalae of Improper Vertical Dimension of Occlusion

98. Jaw relation record (Maxillomandibular relationship record)
“It is a registration of any positional relationship of the mandible relative to the maxilla.”
Records have to be obtained before casts are mounted on the articulator using the ??????.

99. Importance of recording the jaw relation

100. 1- Terminal hinge axis method

101. 2- Chew in technique

102. 3- Graphic tracing method

103. The resulting arrow represents
the centric and eccentric relations

104. 4- Check bite technique (Wax wafer method)

105. **CHAPTER (8) FACE BOW AND ARTICULATOR.

106. “A device used to locate the transverse hinge or the condylar axis.”
Types of Face Bows
Mandibular
“A device used to locate the transverse hinge or the condylar axis.”
Maxillary
“A device used to record the relation between the maxilla and the TMJ ( terminal hinge axis or condylar axis) and to transfer this relation to the articulator.”

107. Maxillary Face Bow Components: Graduations on the rod Graduated
Condylar Rods
Infraorbital Pointer
Bite Fork
Tightening clamp
Universal Joint /
Jack Clamp
U Shaped Bow

108. Maxillary Face Bow Record
1- Bite fork is heated and inserted into the rim .

109. Cont. Maxillary Face Bow Recordmm
2-The condylar axis is then determined either accurately or arbitrary on the canthus tragus line.

110. Cont. Maxillary Face Bow Record
4- Universal joint once tightened , never opened.

111. Maxillary Face Bow Transfer
1- The slide bar clamp is unscrewd to remove assembly
from the face.

112. Cont. Maxillary Face Bow Transfer
2- Assembly is now centralized on the articulator.

113. Mandibular Face Bow
Limited opening and closing allows the condylar rods to draw arcs.
The rods are moved towards the center of the arcs, until they move
in a point . The latter is called the still point and represents the
condylar axis. The condyle in this position lies in the most retruded
unstrained position in the glenoid fossa, so mandible and maxilla are
in centric.

114. ARTICULATORS
The articulator is a mechanical device which represents the temporomandibular joint and jaw members to which maxillary and mandibular casts may be attached..

115. Functions of Articulators 1- Helps in maintaining the desired jaw relationship of the cast during setting up of the teeth in the absence of the patient reproduces the mandibular movements.

116. Types Of Articulators Simple Hinge Articulator Mean (Average )Value or Fixed Condylar Path Articulator : Adjustable Articulators : A- Semiadjustable condylar path articulators B- Fully adjustable condylar path articulators

117. 1- Simple hinge articulator
Eg. Gariot’s articulator

118. 2- Mean (average) value or fixed condylar path articulator
Eg. Gysi and El Mahdy articulator

119. Mounting the upper cast by a face bow record

120. Bonwill triangle Method

121. 3- Adjustable articulators a- Semiadjustable condylar path b- Fully adjustable condylar path

122. A- Semiadjustable articulator
Eg. Hanau model H articulator

123. A- Semiadjustable condylar path angulation articulator
Can accept the following records
1-Face bow record to mount the upper cast
2- Centric occluding relation record to mount the lower cast
3- Protrusive record to adjust the articulator’s horizontal condylar path inclination
4- lateral condylar angulation adjusted according to Hanau’s formula L=H/8+12

124. B- Fully adjustable articulator Both horizontal and lateral inclinations are adjusted according to the records taken from patient mouth
1-Face bow record to mount the upper cast
2- centric occluding relation record to mount the lower cast
3-protrusive record to adjust horizontal condylar guidance
4-Right lateral record to adjust the left lateral condylar path angle
5- Left lateral record to adjust the right lateral condylar path angle

125. Adjustable Condylar Path
Articulators
Simple Hinge (plain)
Fixed Condylar Path
Adjustable Condylar Path
Semi Adjustable
Fully Adjustable
Movements Performed
Opening and Closing
1) Opening and Closing. 2) Protrusive movement at fixed horizontal condylar path angle.(30°- 40°) 3) Lateral movement at fixed lateralcondylar path angle.(12°- 20°)
1) Opening and Closing. 2) Protrusive according to patients horizontal condylar path. 3) Lateral movement as adjusted from hanau formula. Hanau Formula: L=H/ L= Lateral Condyler Path Angle. H= Horizontal Condylar Path Angle.
1) Opening and Closing. 2) Protrusive according to patient's horizontal condylar path. 3) Lateral movement according to patient's later condyler path.
Records Needed to Mount the Upper and Lower Casts.
Centric Occluding Relation.
1) Maxilary Faced Bow to mount upper cast. 2) Centric Occluding Relation to mount lower cast. N.B; In some types upper cast can be mounted by Bonwell Triangle.
1) Maxilary Faced Bow to mount upper cast. 2) Centric Occluding Relation to mount lower cast. 3) Protrusive record to adjust horizntal condylar path angle of the articulator.
1) Maxilary Faced Bow to mount upper cast. 2) Centric Occluding Relation to mount lower cast. 3) Protrusive record to adjust horizntal condylar path angle of the articulator. 4) Right lateral record to adjust left lateral condylar path. 5) Left lateral record to adjust right lateral condylar path.
Examlpes
Gariot's Articulator
El Mahdy Articulator
Hanau Model H
Hanau Kinoscope
N.B; -In most designs of this type, the upper member is movable while the lower member is stationary. -Therefore the upper member moves backwards and upwards to simulates patients mandible in protrusion. -This reverse nature of articualtors provides a firm base to facilitate arrangement of teeth.