Ch52, denture

Chapter 52
Removable Prosthodontics

Copyright 2003, Elsevier Science (USA).
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Produced in the United States of America
ISBN 0-7216-9770-4

Copyright 2003, Elsevier Science (USA). All rights reserved.

Introduction
 Removable prosthodontics is the
specialty of dentistry that replaces missing
teeth with a removable prosthesis.
 Removable partial denture , also
referred to as a partial, replaces one or more
teeth in the same arch.
 Removable full denture , also referred to
as a denture, replaces all of the teeth in one
arch.


Fig. 52-1 Removable partial denture.


Fig. 52-2 Full denture.


Extraoral Factors that Influence the Choice
of a Removable Prosthesis
 Physical health
 Mental health
 Motivation
 Age
 Dietary habits
 Socioeconomic factors
 Occupation


Intraoral Factors that Influence the Choice
of a Removable Prosthesis
 Musculature
 Salivary flow
 Residual alveolar ridge
 Oral mucosa
 Oral habits
 Tori


Indications for a Removable Partial
Denture
 To replace several teeth in the same quadrant or
in both quadrants of the same arch.
 As a temporary replacement for missing teeth in
a child.
 To replace missing teeth for patients who do not
want a fixed bridge or implants.
 For the patient who finds it easier to maintain
good oral hygiene.
 To serve as a splint to support periodontally
involved teeth.


Contraindications for a Removable
Partial Denture
 A lack of suitable teeth in the arch to support,
stabilize, and retain the removable prosthesis.
 Rampant caries or severe periodontal
conditions that threaten the remaining teeth in
the arch.
 A lack of patient acceptance for esthetic
reasons.
 Chronic poor oral hygiene.


Components of a Partial Denture
 Framework
• The cast metal skeleton that provides
support for the remaining components of the
prosthesis.
 Connectors
• Join various parts of the partial together
• Major connector
• Minor connector


Components of a Partial Denture-
cont’d
 Retainer
• Known as a clasp, it supports and provides
stability to the partial denture by partially
circling an abutment tooth.
 Rest
• A metal projection designed to control the
seating of the prosthesis.
 Artificial teeth
• Constructed from either acrylic or porcelain.


Appointment Sequencing for a Partial
Denture
 Appointment 1: Records
• Updated health and dental history.
• Prophylaxis.
• Preliminary impressions.
• Radiographs.
• Photographs.


Denture-cont’d
 Appointment 2: Preparation
• Prepare the teeth.
• Take the final impression.
• Take the occlusal registration.
• Select the shade and mold of the teeth.
• Prepare the laboratory prescription.


Denture-cont’d
 Appointment 3: Try-in
• Evaluate the fit, comfort, and function of the
appliance.
• Evaluate the shade, mold, and
arrangement of the teeth.
• Take new occlusal registration.
• Note any changes on the laboratory
prescription.


Denture-cont’d
Appointment 4: Delivery
 Have patient place partial.
 Check occlusion.
 Detect any pressure points.
 Check retainers for tension on the natural
abutment teeth.
 Polish partial.
 Give patient home instructions.


Home Care Instructions for a
Partial Denture
 Store prosthesis in water or a moist airtight
container when not wearing it.
 After eating, remove from mouth and brush or
rinse the retainers, rests, and complete partial.
 Brush and floss abutment teeth and natural
teeth to keep them free of food debris and
plaque.
 Advise patient not to adjust the partial denture.


Denture-cont’d
 Appointment 5: Postdelivery check
• Evaluate the fit.
• Check the mucosa for pressure areas and
sore spots.
• Evaluate the function of the prosthesis.


Indications for a Full Denture
 The patient is edentulous.
 The remaining teeth cannot be saved.
 The remaining teeth cannot support a
removable partial denture, and no acceptable
alternatives are available.
 The patient refuses alternative treatment
recommendations.


Contraindications for a Full Denture
 Another acceptable alternative is available.
 Physical or mental illness affects the patient's
ability to cooperate during the fabrication of
the denture and to accept or wear the
denture.
 The patient is hypersensitive to denture
materials.
 The patient is not interested in replacing
missing teeth.


Components of a Full Denture
 Base
• Designed to fit over the residual alveolar
ridge and surrounding gingival area.
 Flange
• Part of the base that extends over the
attached mucosa from the cervical margin
of the teeth to the border of the denture.


Components of a Full Denture-cont’d
 Post dam
• Retention of a maxillary denture depends
on the suction seal.
 Artificial teeth
• Fabricated from acrylic or porcelain.


Appointment Sequencing for a Full
Denture
 Appointment 1: Records
• Updated health and dental history.
• Preliminary impressions.
• Radiographs.
• Photographs.


Denture-cont’d
 Appointment 2: Final impression
• Essentials of a final impression for dentures
• Landmarks of the dental arches are accurately
reproduced.
• Maxillary should include the hamular notches, post
dam, tuberosities, and frenum attachments.
• Mandibular should include the retromolar pads,
oblique ridge, outline of the mylohyoid ridge and
the genial tubercles, plus the lingual, labial, and
buccal frena.
• Laboratory prescription


Denture-cont’d
 Appointment 3: Try‑in of
baseplate‑occlusal rim
• Occlusal rim records
• Vertical dimensions evaluated.
• Occlusal relationship.
• Smile line.
• Canine eminence.

• Select artificial teeth


Denture-cont’d
 Appointment 3: Try‑in of
baseplate‑occlusal rim-cont’d
• Occlusal registration measurements
• Centric relation.
• Protrusion.
• Retrusion.
• Lateral excursion.


Denture-cont’d
 Appointment 4: Try-in
• Denture is evaluated for fit, comfort, and stability.
• Appearance of the denture, including the shade,
mold, and alignment of the teeth, is verified.
• Retention of the denture setup is checked as the
patient verbalizes the f, v, s, and th sounds;
swallows; and yawns.
• Occlusion of the denture is checked.
• Laboratory prescription for the completion of the
denture is prepared.


Denture-cont’d
 Appointment 5: Delivery
• New denture is inserted into the patient's
mouth.
• Shade and mold of the artificial teeth are
checked for natural appearance.
• Patient is requested to perform facial
expressions and the actions of swallowing,
chewing, and speaking, using s and th sounds.
• Occlusion is checked.
• Home instructions are given.


Home Care Instructions for a Full
Denture
 Thoroughly rinse the oral tissues at least once
daily.
 All surfaces of the denture should be
thoroughly cleaned with a denture brush and
mild abrasive.
 When dentures are not in the mouth, they must
be stored in a moist, airtight container to
prevent drying and warpage.


Denture-cont’d
 Appointment 6: Postdelivery of a full
denture
• Check the mucosa for pressure areas and
sore spots.
• Schedule recall appointment.


Immediate Dentures
 Type of denture that is placed immediately
after the extraction of a patient's remaining
anterior teeth. This type of denture serves as
a compress and bandage to protect the
surgical site.


Construction of an Immediate Denture
 Occlusal wax rims are completed with posterior
teeth and tried in before extraction of anterior
teeth. The denture, complete with the anterior
teeth, is constructed, sterilized, and ready for
placement at the time of surgery.
 Surgical template
• Clear plastic impression tray of the anterior
area that the surgeon uses as a guide in
properly contouring the remaining alveolar
ridge.


Denture Relining
 Relining is accomplished by placing a new
layer of denture resin over the tissue surface
of the prosthesis.
• Impression is taken with the present
denture used as the impression tray.
• Patient is instructed to close-in normal
occlusion.
• Denture and written prescription are sent to
the laboratory technician for relining.


Denture Repairs
 Simple repairs can be handled in the dental
office laboratory by using cold‑cured acrylics.
 Complicated repairs, particularly those
involving the replacement of teeth or the
complex fracture of the denture, are usually
sent to the dental laboratory technician.


Fig 52-19 Broken denture.


Denture Duplication
 Because dentures can break or require time
for relining, the patient should have a
duplicate denture made.


Ch52, denture

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