the complete

denture
insertion
appointment

Denture Delivery Appointment

In order to successfully
complete this appointment,
you will need the polished
dentures, the articulator with
the maxillary remount cast
mounted and the mandibular
remount cast.
 Denture Placement Sequence
1. Adjust denture base
2. Adjust denture borders
3. Remount in centric relation
4. Verify
5. Occlusal adjustment
6. Patient education
7. 24 hour follow-up

The completed dentures will be returned in sealed containers in a

liquid (usually an antiseptic mouthwash).
!
Before placing them in the patients mouth, examine the tissue side of the
dentures. Remove any bubbles, blebs or pointed details with a scraper, sharp
instrument or handpiece.

Clinic gloves and gauze are good detectors for these features.

Denture Placement Sequence

1.Adjust denture base

2. Adjust denture borders
3. Remount in centric relation
4. Verify
5. Occlusal adjustment
6. Patient education
7. 24 hour follow-up
 Pressure Indicator Paste sequence (PIP)
!

Dry denture surface

Brush a thin, even layer of PIP onto the surface of the denture- you want
brush marks (Si spray optional)

Seat the denture with pressure in the first molar region bilaterally with solid
finger pressure

Remove immediately- dont smear

Inspect and adjust bearing surface as necessary

 Pressure indicating paste (PIP) to detect improper adaptation.
!
The Mizzy silicone spray may be used to prevent the PIP from sticking to the mucosa, and giving false
positives.
 Pressure Indicator Paste sequence (PIP)
!

Remember- the tissue fit must dictate the occlusal contacts, not the
other way around.

Dont let the patient contact the unadjusted teeth and expect accurate
pressure patterns in the paste!
The PIP pattern here indicates severe pressure on the portion of the denture that overlies the
torus.
This area is adjusted with an acrylic bur.

When this step is completed, the brush marks are mostly absent
and the posterior palatal seal bead is showing.

PIP the mandibular denture

!
!

Use smooth even brush strokes

Carefully insert denture so as to avoid wiping off PIP in
undercut areas
Adjust as necessary

Pay particular attention to the retromylohyoid and mylohyoid

ridge regions.
 Note the areas of excessive tissue pressure on the labial and buccal slopes of the ridge.
These are carefully adjusted with an acrylic bur.

When completed with this procedure most of the brush marks will be obliterated
and there should be no areas of tissue displacement noted.
 Denture Placement Sequence
1. Adjust denture base
2. Adjust denture borders
3. Remount in centric relation
4. Verify
5. Occlusal adjustment
6. Patient education
7. 24 hour follow-up

Disclosing wax is used to check the length

of the denture borders.

Apply disclosing wax to the dried denture border. Small

sections work best.
Carefully insert the denture and mold the borders of the
selected area.
 Carefully adjust the denture flange as necessary.
Re-apply, border mold and adjust until areas of overextension are eliminated.

The retromylohyoid area shown here may require adjustment before the denture can be seated.
Check with your Instructor first!
These flanges are too thick

These flanges are too long

 Denture Placement Sequence
1. Adjust denture base
2. Adjust denture borders
3. Remount in centric relation
4. Verify
5. Occlusal adjustment
6. Patient education
7. 24 hour follow-up
 Purpose of the Clinical Remount is to
correct for following:

Adjusted denture bases seat more accurately than record bases

Accommodate for errors made during the making of centric
relation records
Tooth shift and resin distortion from processing must be
accounted for

Make centric relation record and verify the record

Carry to mouth and have the patient close in centric relation just short of tooth contact. While making
the record, use the method that worked before.
Centric Relation record made
with Aluwax at a slightly
increased Occluding Vertical
Dimension
 Hanau

Infraorbital!
Notch

Hanau
 Remove the record.
Chill in cold water and trim so that only the cusp tip indentations remain.
Trim the buccal side so that the seating of the dentures can be visually checked from a
lateral viewpoint.

The denture remount casts are used to return the dentures to

the articulator for final equilibration. The position of the
maxillary denture in regard to the original facebow was
preserved by using a remount index
Using the remount casts the dentures are remounted on the articulator. Make sure to lock the
condyles in centric while remounting the dentures.
 Denture Placement Sequence
1. Adjust denture base
2. Adjust denture borders
3. Remount in centric relation
4. Verify
5. Occlusal adjustment
6. Patient education
7. 24 hour follow-up
 Verification of CR Record
1. Pin up
Insures the teeth can close into the record without interference between the pin and incisal table
2. Centric Latch unlocked
Insures the teeth can seat into record without distortion from the locked arc of closures
3. Teeth fit record
Teeth must fit record regardless of any other factors
4. Condylar elements positioned correctly
Evaluate proper position to the rear wall of the condylar housing
Return the record to the mouth and re-check the record.
Contact should be equal and simultaneous bilaterally.
If not, repeat the record.
Observe the maxillary denture as the patient closes.
If the denture moves during closure, repeat the record.
 Denture Placement Sequence
1. Adjust denture base
2. Adjust denture borders
3. Remount in centric relation
4. Verify
5. Occlusal adjustment
6. Patient education
7. 24 hour follow-up
Indicating paper is used to mark
the occlusal surfaces

Indicating paper is used to mark

the occlusal surfaces
For balanced occlusal schemes, burs are used to reduce prematurities until
the maximum centric relation contacts exist and then the excursive contacts
are refined. All adjustments are made on the mandibular arch for balanced
occlusal schemes.

For Lingualized Non Balanced Occlusions, re-establish a

flat plane on the mandibular teeth
 For Non-balanced monoplane occlusal schemes sandpaper strips are used to
reduce prematurities until the maximum centric relation contacts exist
without reducing the OVD and creating vertical overlap of the anterior teeth

Strip faces the maxillary teeth

because we have re-established a
flat plane on the mandibular denture

For Non-balanced monoplane occlusal schemes sandpaper strips are used to

reduce prematurities until the maximum centric relation contacts exist without
reducing the OVD and creating vertical overlap of the anterior teeth
 Denture Placement Sequence
1. Adjust denture base
2. Adjust denture borders
3. Remount in centric relation
4. Verify
5. Occlusal adjustment
6. Patient education
7. 24 hour follow-up
 1. The dentures are polished and
inserted in the patient and rechecked
intraorally.
2. Home care instructions and
expectations for the initial use of the
dentures are given orally and in
writing to the patient.
3. Post insertion checks are scheduled
for the next day and one week later.

Explain the following to the patient

Limitations of dentures
Expected tissue response
Care of the prostheses and tissues
Desirable followup treatment
Removal of dentures from mouth at night
Give your patient the printed instructions and denture care
kit- remember to remove the denture adhesive paste from
the kit!
 Denture Placement Sequence
1. Adjust denture base
2. Adjust denture borders
3. Remount in centric relation
4. Verify
5. Occlusal adjustment
6. Patient education
7. 24 hour follow-up

24 hour follow-up
Inquire about the patients problems and conduct a thorough oral
examination
Check the denture for pressure areas with PIP and adjust the denture as
needed
Check borders for overextension with disclosing wax and adjust as needed
Evaluate articulation, refine as necessary, and recheck finish and polish.
Analogy: Dentures are like a pair of shoes (Leather boots) that never break-
in. WE need and expect to adjust them for all our patients.
Questions?