reading

Cover
Title Page
Foreword
1. The Need to Understand Edentulous Patients
2. Reference
Preface
About the Companion Website
1 Assessment of Edentulous Patients
1. Introduction
2. The Patient Interview
3. The Facial Analysis
4. Prosthetic Factors
5. Oral Characteristics
6. Summary
7. References
2 Orthopedic Resolution of Mandibular Posture
1. Introduction
2. Conditioning Abused Tissues and Stabilizing the Existing Prosthesis
3. Re‐establishing Orthopedic Mandibular Position
4. Summary
5. References
3 Definitive Impressions
1. Preimpression Considerations
2. Background
3. Impression Fundamentals
4. Impression Materials
5. Edentulous Impression Trays
6. Technique for Making Single Appointment Definitive Impressions for Conventional Complete Dentures
7. Techniques for Making Single Appointment Definitive Impressions for Implant‐Assisted Complete Dentures and Immediate Dentures
8. Implant‐Retained Overdentures
9. Implant‐Retained and Supported Overdentures
10. Immediate Dentures
11. Master Cast Production
12. Summary
13. References
4 Fabricating Record Bases, Occlusal Rims, and Mounting a Central Bearing Device
1. Introduction
2. Fabrication of Record Base and Occlusal Rims
3. Fabrication of Maxillary Wax Occlusal Rim
4. Fabrication of Neutral Zone Mandibular Occlusal Rim
5. Jaw Recorder Device (Central Bearing Device)
6. Mounting the Jaw Recorder Device on Record Bases
7. Summary
8. References
5 Developing an Esthetic Blueprint
1. Introduction
2. Contouring and Shaping the Maxillary Occlusal Rim
3. Summary
4. References
6 Registering the Maxillo‐Mandibular Jaw Relationship
1. Introduction
2. Facebow Recording
3. Centric Relation Recording for the Edentulous Patient
4. Centric Relation Recording for the Partially Dentate Patient
5. Summary
6. References
7 Neutral‐Zone Registration
1. Introduction
2. Recording the Physiologic Neutral Zone for Edentulous Patients
3. Recording the Physiologic Neutral Zone for a Dentate Patient
4. Summary
5. References
8 Second Laboratory Procedure
1. Introduction
2. Indexing the Esthetic Blueprint Record
3. Indexing the Neutral Zone Record
4. Selection of Anterior Teeth
5. Maxillary Anterior Teeth Arrangement
6. Mandibular Anterior Teeth Arrangement
7. Selection of Posterior Teeth
8. Mandibular Posterior Teeth Arrangement
9. Maxillary Posterior Tooth Arrangement
10. Tooth Selection and Arrangement for the Partially Edentulous Patient
11. Summary
12. References
9 Trial Placement Appointment
1. Trial Placement
2. Evaluation of Esthetics
3. Evaluation of Phonetics
4. Evaluation of Occlusal Vertical Dimension (OVD)
5. Evaluation of Centric Contact Position
6. External Impressions
7. Summary
8. References
10 Denture Placement
1. Introduction
2. Placement of Immediate Dentures
3. Evaluation and Adjustment of Intaglio Surface
4. Evaluation and Adjustment of Denture Borders
5. Evaluating the Cameo Surface
6. Occlusal Evaluation and Correction
7. Patient Education and Instructions
8. Home Care Instructions for Denture Patients
9. Postplacement Problems with New Dentures
10. Summary
11. References
11 Use of CAD/CAM Technology for Recording and Fabricating Neutral‐Zone Dentures
1. Introduction
2. Registering the Neutral Zone during Impression Making
3. Registering the Neutral Zone during Maxillo‐Mandibular Records
4. Registering the Neutral Zone during the Trial Placement
5. Summary
6. References
Index
End User License Agreement

List of Illustrations

Chapter 01
1. Figure 1.1 (a) A female patient with convex appearance; (b) a female patient with concave appearance.
2. Figure 1.2 Patient demonstrating presence of deep wrinkles, nasolabial folds, poor muscle mass and tone.
3. Figure 1.3 (a) Evaluation of muscle tone by digital palpation; (b) evaluation of muscle tone by placing the index finger and middle finger on the cheek; (c) evaluation of muscle tone by asking patient to pucker their lips; (d) evaluation of muscle tone by asking patient to smile.
4. Figure 1.4 (a) Inadequate maxillary incisal display in smile; (b) excess maxillary incisal display during full smile in an old male patient.
5. Figure 1.5 (a) Asymmetric movement of the upper lip; (b) asymmetric movement of the lower lip.
6. Figure 1.6 Inadequate display of the vermillion border of upper and the lower lip in a male patient.
7. Figure 1.7 (a) Measurement of RVD using calipers to gauge distance between nose and chin in rest position; (b) measurement of OVD using calipers to gauge the distance between nose and chin when teeth are in contact; (c) patient presenting with pseudo class III appearance due to inadequate OVD.
8. Figure 1.8 (a) Broad palatal throat form, Class I; (b) class II palatal throat form; (c) class III palatal throat form.
9. Figure 1.9 Maxillary anterior ridge height measured from depth of labial vestibule to crest of edentulous ridge.
10. Figure 1.10 Use of a transparent ruler to measure depth of palatal vault.
11. Figure 1.11 (a) U shaped maxillary residual ridge; (b) knife edged maxillary residual ridge.
12. Figure 1.12 Measurement of height of mandibular anterior ridge using transparent ruler.
13. Figure 1.13 (a) Inverted U shaped mandibular residual ridge; (b) knife edged mandibular residual ridge; (c) flat mandibular residual ridge.
14. Figure 1.14 (a) The compressibility of denture‐bearing soft tissues based on thickness. (b) Characterization of soft tissue displaceability.
15. Figure 1.15 (a) Lip ruler; (b) Measurement of maxillary esthetic space made with a lip ruler at rest.
16. Figure 1.16 (a) Triangular shaped measuring gauge used to measure interarch (ridge to ridge) distance during maximum oral opening; (b) triangular shaped measuring gauge used to measure interarch (ridge to tooth) distance during maximum oral opening; (c) triangular shaped measuring gauge used to measure interarch (tooth to tooth) distance during maximum oral opening.
17. Figure 1.17 Head of the mirror placed in retromylohyoid space for assessing lateral throat form.
18. Figure 1.18 (a) Normal tongue position; (b) retracted tongue position.
19. Figure 1.19 (a) Restricted neutral zone; (b) reduced neutral zone; (c) optimal neutral zone.
Chapter 02
1. Figure 2.1 Tissues abused from current denture.
2. Figure 2.2 (a) Dye solution evenly painted on intaglio surface of maxillary denture; (b) intaglio surface relieved using laboratory rotary instruments.
3. Figure 2.3 Tissue conditioning material applied and functionally adapted on maxillary denture.
4. Figure 2.4 (a) Recording of rest vertical dimension; (b) existing occlusal vertical dimension.
5. Figure 2.5 Striking plate mounted on maxillary denture and pin receiver mounted on mandibular denture.
6. Figure 2.6 Dentures in CR with central bearing pin at the desired OVD.
7. Figure 2.7 Freshly mixed resin placed over the occlusal surfaces of mandibular posterior teeth.
8. Figure 2.8 Path of mandibular movement visualized on striking plate.
9. Figure 2.9 (a) Evaluation of occlusal contacts; (b) occlusal surfaces of the mandibular denture re‐established; (c) occlusal device finished, polished and delivered to the patient.
10. Figure 2.10 (a) Frontal view of the patient before orthopedic device (top); patient after orthopedic device (bottom); (b) profile view of the patient before orthopedic device (left); patient after orthopedic device (right). Note: there is a significant difference in OVD and esthetics before and after placement of orthopedic device.
Chapter 03
1. Figure 3.1 Maxillary thermoplastic tray immersed in water bath.
2. Figure 3.2 Patient performing various movements to physiologically mold thermoplastic tray.
3. Figure 3.3 Tray stops formed in maxillary and mandibular trays.
4. Figure 3.4 VPS material dispensed along peripheral extent of maxillary tray.
5. Figure 3.5 Patient purses lips outward with a sucking action to register the labial vestibular extension.
6. Figure 3.6 Patient moves the mandible from side to side, drops it down to opening position, to record distobuccal vestibular sulci and hamular frena.
7. Figure 3.7 Patient’s nostrils occluded and patient instructed to exhale only through nose to aid in forming postpalatal border.
8. Figure 3.8 Impression tray is secured and patient is asked to purse lips out and suck to record the buccal and labial vestibules.
9. Figure 3.9 The patient asked to open wide and then close the lower jaw while the practitioner exerts a downward force on tray to define posterior extent and retromolar pad areas.
10. Figure 3.10 Border molded and relieved maxillary and mandibular impression tray.
11. Figure 3.11 Maxillary impression tray loaded with two different viscosities of VPS material.
12. Figure 3.12 Maxillary and mandibular definitive edentulous impressions.
13. Figure 3.13 Implant attachment transfer copings connected to each overdenture abutment.
14. Figure 3.14 Clear thermoplastic stock impression tray for implant / dentate impressions.
15. Figure 3.15 Tray stops formed with rigid VPS impression material.
16. Figure 3.16 Tray borders molded and trimmed prior to making final impression.
17. Figure 3.17 Mandibular closed tray definitive impression for implant retained overdenture fabrication.
18. Figure 3.18 Direct transfer copings connected to all implants.
19. Figure 3.19 Tray stops formed and tray is relieved in areas adjacent to transfer copings.
20. Figure 3.20 Open tray definitive impression for fabrication of implant supported and retained overdenture.
21. Figure 3.21 (a) Implant analogs attached to transfer copings and soft tissue material placed appropriately prior to cast fabrication; (b) definitive implant level soft tissue cast.
22. Figure 3.22 Tray stops formed for immediate denture definitive impression.
23. Figure 3.23 Border molded impression. Note: borders are trimmed by 1–2 mm prior to making definitive impressions.
24. Figure 3.24 Extra low viscosity impression material injected around all teeth.
25. Figure 3.25 Definitive impression for fabrication of maxillary immediate denture.
26. Figure 3.26 Fluid dental stone poured in boxed and beaded impression for definitive cast fabrication.
27. Figure 3.27 Automatic dispensing unit and automatic vacuum mixing unit for dental stone.
28. Figure 3.28 Definitive mandibular cast (top) and definitive mandibular impression (bottom).
Chapter 04
1. Figure 4.1 Digitally printed record base. Maxillary record base (left). Mandibular record base (right). Note: retention ledge incorporated in the design for aiding with the retention of the wax / prosthetic teeth to the record base.
2. Figure 4.2 (a) Esthetic space measured and recorded during diagnostic appointment (left) The tab on the lip ruler placed on the crest of the ridge while measuring esthetic space (right); (b) lip ruler (left) and compass (right); (c) the lip ruler is appropriately positioned on the maxillary cast and the esthetic space measurement transferred using the compass; (d) the planned incisal length of maxillary occlusal rim; (e) the compass is rotated laterally on the cast to scribe a line recording the esthetic space measurement on cast.
3. Figure 4.3 The ridge areas roughened with laboratory rotary instruments (left). Retention ledge incorporated in the design (right).
4. Figure 4.4 The compass is repositioned on cast and the predetermined length marked on rim.
5. Figure 4.5 (a) Elevated ridge of the rim former is positioned in hamular notches of the cast and it is rotated towards cast while decreasing height of wax occlusal rim; (b) the heated rim former used to produce the desired height of wax occlusal rim.
6. Figure 4.6 The completed maxillary wax occlusal rim frontal (left) and lateral view (right).
7. Figure 4.7 The ridge areas roughened with laboratory rotary instruments (left). Retention ledge incorporated in the design (right).
8. Figure 4.8 (a) The esthetic space is measured and recorded during the diagnostic appointment (left). The tab on the lip ruler is placed on the crest of the ridge while measuring esthetic space (right). (b) The lip ruler is appropriately positioned on mandibulary cast and the esthetic space measurement transferred using the compass.
9. Figure 4.9 (a) The planned incisal length of mandibular occlusal rim. (b) The compass rotated laterally on the cast to scribe a line to record esthetic space measurement on cast.
10. Figure 4.10 (a) The compass is repositioned on the cast and the predetermined length marked on rim. (b) The Occlusal rim is trimmed with a sharp blade to the predetermined length.
11. Figure 4.11 The Neutral zone mandibular occlusal rim occlusal view (left). The neutral zone mandibular occlusal rim lateral view (right).
12. Figure 4.12 Jaw recorder device assembly: A – striking plate; B1 – small pin receiver; B2 – medium pin receiver; B3 – large pin receiver; C – threaded pin; D – clear plastic positioner disc.
13. Figure 4.13 (a) Striking plate attached to maxillary record base; (b) pin receiver attached to mandibular record base.
14. Figure 4.14 Recesses created in record base to fit over implant abutments.
15. Figure 4.15 (a) Record base fabricated with tissue stops in edentulous area for improved stability; (b) retentive claps incorporated in record base for improved stability.
16. Figure 4.16 (a) Striking plate is attached to maxillary record base below occlusal plane for a partially edentulous arch; (b) striking plate adjusted and then attached to maxillary record base to avoid tooth impingement.
17. Figure 4.17 (a) Pin receiver attached to mandibular record base below occlusal plane, occlusal view (left), lateral view (right); (b) Small pin receiver adjusted and attached to mandibular record base to avoid tooth impingement.
18. Figure 4.18 (a) Matrix and the teeth trimmed to the optimal height with laboratory rotary instruments; (b) adjusted matrix functions as a reduction coping.
Chapter 05
1. Figure 5.1 Animated depiction of the maxillary ridge following extraction of teeth (left) and the change in maxillary ridge form following ridge resorption (right).
2. Figure 5.2 Evaluation of lip support in repose: frontal view (left); profile (right).
3. Figure 5.3 Wax rim is 1–2 mm longer than the relaxed upper lip when the lips are separated.
4. Figure 5.4 Rim touching the wet dry line of the lower lip when executing fricative (“F” and “V”) sounds.
5. Figure 5.5 A horizontal line is scribed on the wax rim to record maximum elevation of the upper lip (high smile line).
6. Figure 5.6 Facial midline determination.
7. Figure 5.7 (a) Sliding caliper adjusted to approximate the interalar width, and (b) the distance transferred to the wax rim.
8. Figure 5.8 Location of the Occlusal plane based on the interpupillary line (left). Location of the Occlusal plane based on ala‐tragus line (right).
9. Figure 5.9 Preview shell teeth (labial aspect).
10. Figure 5.10 Midline extended to the incisal/occlusal surface of the wax rim and adaptation of shell teeth.
11. Figure 5.11 Pre‐determined incisal length of the wax rim guides the incisal edge positioning of shell teeth.
12. Figure 5.12 Evaluation of preview shell teeth intraorally. Repose (left). During smile (right).
Chapter 06
1. Figure 6.1 Class III semi adjustable articulator.
2. Figure 6.2 The facebow fork loaded with interocclusal registration material and inserted in the mouth (left). Center of fork aligned with the midline (right).
3. Figure 6.3 Properly aligned facebow assembly secured and made rigid by tightening remaining adjustment screws. Frontal view (top); Profile (bottom).
4. Figure 6.4 Quick mount facebow record assembly.
5. Figure 6.5 Facebow assembly mounted on the articulator and the maxillary cast carefully joined to the record.
6. Figure 6.6 Maxillary and mandibular record bases with mounted jaw recorder device.
7. Figure 6.7 Treatment OVD established with orthopedic occlusal device being registered.
8. Figure 6.8 OVD greater than the treatment OVD (left). Threaded pin adjusted to restore the OVD to treatment OVD (right).
9. Figure 6.9 Striking plate painted using permanent indelible ink marker.
10. Figure 6.10 (a) Patient asked to maintain contact between the threaded pin and striking plate throughout the tracing procedure; (b) patient instructed to move the mandible forward; (c) patient instructed to make left and right lateral mandibular movements.
11. Figure 6.11 Gothic arch tracing (arrow point) on the striking plate. Note: the apex of the arrow is taken to represent CR position of the mandible.
12. Figure 6.12 Clear plastic receiver disc attached to striking plate. Note: the hole of the receiver disc is positioned to correspond with the tip of the arrow point tracing.
13. Figure 6.13 (a) Occlusal registration material injected between the maxillary and mandibular record denture bases to register CR position of mandible at established OVD. (b) The CR record being registered at the predetermined OVD. (c) Registration material, the maxillary and mandibular record bases are removed from the mouth (top). Maxillary and mandibular record bases are carefully separated from each other (bottom). (d) Inaccuracies present including posterior interfering contact of the record bases and separation of the wax rim from the maxillary record base. (e) The centric relation record reassembled and carefully placed on the maxillary cast with the articulator inverted. The mandibular cast is carefully placed into the record (left). Mandibular cast mounted in the articulator (right).
14. Figure 6.14 (a) Record bases with mounted jaw recorder for a partially edentulous patient. (b) Threaded pin adjusted to desired OVD (left) as recorded by points on nose and chin (right). (c) Occlusal contacts identified with articulating paper (top) and transferred to cast (bottom). (d) Matxix placed on the cast and the marked contacts eliminated (top). Matrix placed in the mouth to guide tooth reduction (bottom). (e) Contacts/interferences adjusted (top) until eliminated (bottom). (f) Gothic arch tracing (left). Pin receiver attached over apex of the tracing (right). (g) CR registered at established OVD. Patient postured in CR position (top, left). Occlusal registration material is injected between the maxillary and mandibular record bases to register CR (top, right). Casts are mounted in articulator (bottom).
Chapter 07
1. Figure 7.1 (a) Modeling plastic impression compound occlusal rim immersed in a warm water bath set at 140 °F; (b) compound rim uniformly softened upon removal from the water bath.
2. Figure 7.2 Uniformly softened modeling plastic impression compound occlusal rim inserted in the patient’s mouth.
3. Figure 7.3 (a) Patient given a cup of warm water to sip (left) and then asked to swallow (right) (b) sipping warm water and swallowing (top left) results in muscles of the cheeks and lips functioning inward and muscles of the tongue expanding outward (top right) thereby forming the neutral zone registration (center).
4. Figure 7.4 (a) Illustration of the neutral zone between tongue medially, lip labially, and cheeks buccally. (b) Clinical image demonstrating the formed registration. (c) Neutral zone registration from occlusal (left above) and lingual (right below) views.
5. Figure 7.5 Neutral zone registration trimmed with a sharp blade.
6. Figure 7.6 (a) Grooves created on the lingual land area serve as indices – facial and lingual vestibular spaces filled with vinyl polysiloxane impression material to facilitate complete seating of the completed indexes during tooth setup; (b) indexed lingual matrix developed around the neutral zone record using laboratory putty; (c) indexed facial matrix developed around the neutral zone record using laboratory putty; (d) neutral space visible between the facial and the lingual indexes.
7. Figure 7.7 Vinyl polysiloxane (VPS) impression material injected on labial and buccal surfaces of the maxillary arch (left) and mandibular arch (right).
8. Figure 7.8 Maxillary (buccal) cameo impression (left); mandibular (buccal) cameo impression (right).
9. Figure 7.9 (a) VPS impression material injected on the lingual surface of the mandibular arch; (b) mandibular (lingual) cameo impression.
10. Figure 7.10 Indexed facial matrix developed around the cameo impression of the maxillary arch using laboratory putty (left). Indexed facial and lingual matrices developed around the cameo impression of the mandibular arch using laboratory putty (right).
Chapter 08
1. Figure 8.1 Definitive casts mounts on semiadjustable articulator using maxillo‐mandibular jaw relationship records (left). Lateral view of the mounted casts (right).
2. Figure 8.2 (a) Indentations made on the labial surface of the cast; (b) indexed facial matrix fits accurately on the land area of the cast.
3. Figure 8.3 Indentations made on the base of the mandibular cast (top) and VPS material used to block out vestibular extensions (bottom).
4. Figure 8.4 (a) Curved occlusal template; (b) flat occlusal plane.
5. Figure 8.5 Indexed facial and lingual matrices trimmed and replaced on the cast.
6. Figure 8.6 (a) The midline of the teeth should coincide with the midline marked on the EBP index and also should correlate with the position of the incisive papilla; (b) the labial aspect of the maxillary anteriors is aligned with the inner surface of the EBP index.
7. Figure 8.7 Canines are slightly distally inclined with prominent cervical thirds and their tips are at the same level occlusally as the central incisor. The distal portions of the labial surfaces are not visible from the frontal perspective when the patient displays the teeth. Frontal view (top). Profile view (bottom).
8. Figure 8.8 (a) Characteristics seen in male dentitions. Note sharp line angles, point angles and square shaped teeth. Frontal view (top). Occlusal view (bottom). (b) Characteristics seen in female dentitions. Note rounded line angles and point angles and oval shaped teeth. Also the lateral incisor is rotated to create a soft appearance. Frontal view (top). Occlusal view (bottom). (c) Characteristics seen in aging dentitions. Note the presence of wear facets, staining and cervical recession associated with the teeth. Frontal view (top). Occlusal view (bottom).
9. Figure 8.9 Vertical overlap created to achieve a balanced occlusion. Frontal view (left). Lateral view (right).
10. Figure 8.10 The mandibular anterior teeth placed within the neutral zone space. Note the anterior teeth are placed within the neutral space but slightly lingual to the labial index to achieve the desired horizontal overlap between the maxillary and the mandibular anterior teeth.
11. Figure 8.11 (a) Nonanatomic prosthetic teeth set in monoplane occlusion – normal (left) and reverse (right) articulation; (b) semianatomic prosthetic teeth set in monoplane occlusion – normal (left) and reverse (right) articulation; (c) Semianatomic or anatomic prosthetic teeth set to balance stamp cusps – normal (left) and reverse (right) articulation; (d) anatomic or semi anatomic prosthetic teeth set to balance stamp and supporting cusps – normal (right) and reverse (left) articulation.
12. Figure 8.12 (a) The mandibular posterior teeth set within the neutral zone. Line indicates crest of the mandibular ridge; (b) The occlusal plane posteriorly placed at the middle or at the level of 2/3rd the height of the retromolar pad. Note: prosthetic teeth should not be placed on the slope of the retromolar pad.
13. Figure 8.13 Central groves and the centers of the marginal ridges of all the posterior teeth lie on a straight line.
14. Figure 8.14 (a) posterior teeth set on curve for balanced occlusion; (b) posterior teeth set on flat plane for nonbalanced (monoplane) occlusion.
15. Figure 8.15 Posterior teeth set in normal articulation with appropriate horizontal overlap.
16. Figure 8.16 Maxillary posterior teeth set in cross bite (reverse articulation).
17. Figure 8.17 (a) VPS putty matrix fabricated to surround the neutral zone record; (b) VPS putty matrix will serve as a reference during teeth arrangement; (c) the labial perimeter established by the combined anterior teeth is consistent with the VPS matrix; (d) maxillary posterior teeth arrangement determined by the VPS matrix and the arrangement of the mandibular posterior teeth; (e) maxillary teeth arranged to articulate with the opposing mandibular teeth. Frontal view (left). Left lateral view (top, right). Right lateral view (bottom, right).
Chapter 09
1. Figure 9.1 Evaluation of the teeth arrangement on the articulator.
2. Figure 9.2 Position, shade and mold of prosthetic teeth evaluated during the trial placement appointment.
3. Figure 9.3 (a) Evaluation of midline of wax trial dentures; (b) evaluation of anterior occlusal plane of wax trial dentures; (c) evaluation of posterior occlusal plane of wax trial dentures; (d) evaluation of patient’s smile with wax trial dentures; (e) Patient evaluating their smile with wax trial dentures.
4. Figure 9.4 (a) Incisal edges of the maxillary anterior teeth touch the wet‐dry line of the lower lip while making the “F” and “V” sounds; (b) the upper and lower anterior prosthetic teeth approach end to end but not touch while making the “S” sounds.
5. Figure 9.5 (a) Verification of OVD with wax trial dentures in the mouth; (b) the three‐thirds of the face (upper third, middle third, and lower third) are nearly equal.
6. Figure 9.6 Verification of CR with wax trial dentures.
7. Figure 9.7 The musculature of lips, cheek, and tongue exerts an elastic pressure on the polished surfaces of the denture.
8. Figure 9.8 (a) The baseplate wax apical to the denture teeth removed carefully from buccal, labial and palatal flanges of the maxillary wax trial dentures – frontal view (left), occlusal view (center), right lateral view (right); (b) the baseplate wax apical to the denture teeth removed carefully from buccal, labial and lingual flanges of the mandibular wax trial dentures – frontal view (left), lingual view (center), right lateral view (right).
9. Figure 9.9 Adhesive applied to the polished surface of the wax trial dentures – maxillary denture (top), mandibular dentures (bottom).
10. Figure 9.10 Vinyl polysiloxane impression material applied to the labial and buccal surfaces of the trial dentures in the regions of wax removal – maxillary denture (top), mandibular denture (bottom).
11. Figure 9.11 Lips and cheeks are retracted to prevent displacement of material during insertion.
12. Figure 9.12 Trial denture with the VPS material inserted in the mouth – maxillary denture (left), mandibular denture (right).
13. Figure 9.13 Pt movements for physiologically molding the labial and the buccal polished surfaces of the maxillary wax trial denture. (a) Pucker lips forward. (b) Full smile. (c) Open mouth wide.
14. Figure 9.14 Patient movements for physiologically molding the labial / buccal surface of the mandibular wax trial denture – puckering of lips (left), smiling (right).
15. Figure 9.15 External impression of the labial and buccal surfaces of maxillary wax trial denture.
16. Figure 9.16 External impression of the labial and buccal surfaces of the mandibular wax trial denture.
17. Figure 9.17 Pt movements for physiologically molding the palatal polished surface of the maxillary wax trial denture. Patient instructed to drink a sip of water and then swallow (left). Patient makes fricative sounds (right).
18. Figure 9.18 Patient movements for physiologically molding the lingual polished surface of the mandibular wax trial denture. Patient instructed to drink a sip of water and then swallow (left). Patient extends the tongue and moves it from left to right (right).
19. Figure 9.19 External impression of the palatal surface of the maxillary wax trial denture.
20. Figure 9.20 External impression of the mandibular wax trial denture.
21. Figure 9.21 Maxillary (top left) and mandibular (bottom left) external impressions trimmed appropriately with a sharp blade. Maxillary (top right) and mandibular (bottom right) wax trial dentures with adapted cameo surfaces ready to be processed.
Chapter 10
1. Figure 10.1 Definitive maxillary denture. Intaglio surface (top left), occlusal surface (top right), Polished surface (frontal view, bottom left), Polished surface (lateral view, bottom right).
2. Figure 10.2 Definitive mandibular denture. Intaglio surface (top left), Occlusal surface (top right), Polished surface (frontal view, bottom left), Polished surface (lateral view, bottom right).
3. Figure 10.3 (a) PIP applied on intaglio surface of denture base (in a thin layer) using unidirectional brush strokes; (b) denture base with PIP applied, is immersed in a bowl of room temperature water; (c) Denture carefully inserted in the patient’s mouth with an optimal path of insertion.
4. Figure 10.4 Displacement of paste with denture base visible, suggests areas of substantial or excessive tissue contact.
5. Figure 10.5 Reticulated foam polishing wheel used to relieve and refine excessive contact areas.
6. Figure 10.6 (a) VPS material dispensed on the lingual borders of the mandibular denture; (b) patient performs tongue movements to mold the VPS material physiologically; (c) denture with the VPS material removed from the patient’s mouth and analyzed for excessive pressure; (d) indelible marker painted over the disclosing material and visible portion of denture border (left). VPS material removed from the denture border (right); (e) The marked area represents the overextended area; (f) Areas of overextension (marked areas) adjusted using reticulated foam polishing wheel. Note: the reticulated foam wheel removes the marked areas while leaving a smooth surface.
7. Figure 10.7 (a) VPS interocclusal registration material applied to buccal cameo surface of maxillary denture; (b) Cheeks retracted and the denture is carefully placed in the patient’s mouth; (c) patient is asked to perform various movements to physiologically mold the VPS material; patient is instructed to suck on the finger (left); patient is instructed to smile broadly (right); (d) denture is removed from the patient’s mouth and areas of show through are evaluated; (e) indelible marker painted over disclosing material and visible portion of denture surface; (f) the marked area represents the overextended area; (g) areas of excessive contact (marked areas) adjusted using reticulated foam polishing wheel.
8. Figure 10.8 Central bearing point device mounted on complete dentures to diagnose occlusal discrepancies.
9. Figure 10.9 Thin articulating film placed between prosthetic teeth to mark first premature contacts.
10. Figure 10.10 Premature contacts adjusted using appropriate rotary instruments.
11. Figure 10.11 (a) Large class I cavity preparations made in all mandibular posterior prosthetic teeth; (b) Light polymerized composite resin filled (left) and carefully condensed in to the preparation to avoid overfilling (right).
12. Figure 10.12 Occlusal contacts verified with articulating paper. Note: this procedure is performed for both the additive and the subtractive technique.
13. Figure 10.13 Occlusal surfaces finished and polished in the laboratory.
14. Figure 10.14 (a) Application of appropriate amount of denture adhesive: 3–4 small beads of adhesive placed on the intaglio surface of the maxillary denture (top left) and spread to the entire ridge area (top right); Adhesive evenly spread (bottom left) and the denture is quickly dipped in a bowl of water (bottom right); (b) adhesive appropriately applied to maxillary denture.
15. Figure 10.15 Dentures placed in the patient’s mouth.
16. Figure 10.16 Occlusal interferences may cause sore spots or ulcerations on the ridges.
17. Figure 10.17 Thick left distobuccal border of the maxillary denture may cause sore throat.
18. Figure 10.18 Thick posterior border of the maxillary denture may lead to gagging.
Chapter 11
1. Figure 11.1 Recording the neutral zone at the time of making definitive edentulous ridge impression using medium viscosity VPS impression material. The occlusal extent of the lingual depression marked with a black line, generally denoting the height of the occlusal plane.
2. Figure 11.2 Neutral zone impression formed, trimmed occlusally up to the marked black line.
3. Figure 11.3 Milled trial denture tried in the patient’s mouth.
4. Figure 11.4 Neutral zone impression made using modeling plastic impression compound.
5. Figure 11.5 (a) Scanning the neutral zone record and mandibular cast (left). Scanned image of the neutral zone record (right); (b) Scanning the EBP wax rim along with the maxillary cast (left). Scanned image of the EBP wax rim (right); (c) scanning the opposing casts with the interocclusal record; (d) a three‐dimensional electronic image depicting the interarch relationship and neutral zone space of the mandibular arch; (e) Top, neutral zone used to identify prosthetic teeth positions; Bottom, maxillary and mandibular teeth digitally arranged.
6. Figure 11.6 Impression boxed to expose the borders.
7. Figure 11.7 Maxillary printed record base with attached tracing plate and completed gothic arch tracing (upper left); mandibular printed record base with central bearing pin assembly attached (upper right); interocclusal record made with gothic arch device (bottom).
8. Figure 11.8 Cameo surface neutral zone impressions made on printed trial dentures.
9. Figure 11.9 Definitive milled dentures.