Introduction to Complete Dentures

Advances in oral disease prevention and increased concern for dental care over the past several decades have resulted in recent generations of people with healthy mouths and teeth. However, there still remain many people who lose some or all of their natural teeth. This is usually due to a lack of interest on their behalf, time restraints or for various financial reasons. For these people partial dentures or complete dentures will restore their lost teeth, allowing them to eat and speak properly and have a natural appearance.

For patients who have lost some of their natural teeth, but still have some healthy and strategically placed natural teeth, a partial denture is indicated. This type of denture replaces the lost teeth and associated structures and is held in place by the remaining natural teeth. For patients who have lost all of their natural teeth complete dentures are their last resort. These dentures replace all of their lost natural teeth and supporting structures.

The following is a brief explanation of the steps that are necessary in the fabrication of a complete denture. At the first clinical appointment, a thorough medical and dental history would first be taken. Complete head, neck and oral examinations are recorded. All indicated x-rays be taken and evaluated. If everything appears to be within nonnallimits the first or preliminary set of impressions is made.

Upper and lower dental casts are made from these impressions. These casts provide a reasonable physical duplication of the patient's denture bearing areas and also give the dentist additional diagnostic input. Using these casts custom impression trays are made which will fit the patients mouth accurately. At the next appointment the second or final set of impressions will be made which exactly duplicate the patient's denture bearing areas. These casts or duplicates of the patient's upper and lower jaws are the basis for the way that the final dentures will fit.

Occlusal or bite registration bases and rims are made on the casts. At the third clinical appointment, these are used to record how far apart the patient's jaws are when their jaws are at rest and when they properly close together. A record is also made of how the upper and lower jaws relate when the patient is in their correct occlusal or biting relationship. The denture teeth best suited for each patient are then chosen.

The casts, record bases, and wax rims are mounted on an instrument, the articulator, which will hold them in the determined position. The articulator also allows the denture teeth to be set-up in wax, in their most esthetic and functional position. The patient then returns for the fourth or try-in visit. Both the patient and the dentist approve the esthetics, or the selection and position of the chosen denture teeth. The jaw relationships established at the previous appointments are also confirmed. All of the necessary changes are made to the case.

Following this quality control appointment, the dentures are processed in the dental laboratory so that the wax foundations holding the denture teeth are converted to a sturdy plastic material. The patient is given appropriate instructions for the care and use of their new dentures. The patient returns for adjustments as often as is necessary until both they and the dentist are satisfied with the case. The patient is recalled yearly for a complete oral examination and denture evaluation. A number of variations of this basic complete denture system are available and are indicated by the complexity of the patient's condition, economic factors, time restraints, or the desire to incorporate more sophisticated techniques into the treatment of the edentulous patient.

Sessions

This is the basic complete denture course for second year Dental students. There are 10 regular sessions and each 3.5 hour session is divided as follows:

1. General announcements
2. A lecture and slide presentation covering the step-by-step technique for the fabrication of a complete denture. This lasts approximately thirty minutes and covers the technique for the taking of the patient's records through the patient's re-care appointment.
3. A four question written quiz, based on that day's lecture material, will be given.
4. A lecture and slide presentation of each session's laboratory procedures with occasional practical demonstrations will be presented. This usually takes about 10 minutes.
5. The laboratory phase fills the remainder of the afternoon and includes marking and trimming preliminary casts, marking and the fabrication of maxillary and mandibular custom edentulous trays, the fabrication of maxillary and mandibular record bases and occlusion rims, and a complete denture teeth set-up.
6. There are 3 practical examinations, 10 written quizzes and 2 written examinations upon which the grades are based.

The course is structured around a handbook, which was written and edited by the Complete Denture Prosthodontics faculty.

Strict risk management and laboratory safety policies are maintained throughout the course.

Upon completion of this course, students are deemed competent to:

1. Use essential materials and equipment.
2. Fabricate custom trays and occlusion rims.
3. Articulate and set-up denture teeth for complete dentures.

Goals

The goal of the course is to familiarize the dental student with all of the clinical steps and laboratory procedures which are required during the treatment of patients who will receive complete dentures, overdentures, immediate dentures and full maxillary opposing Mandibular removable partial dentures. This goal is accomplished through lectures like presentations, videos, demonstrations, and visual aids.

As the introductory course to the treatment of edentulous patients, students completing this course:

1. Will have a basic understanding of edentulous oral anatomy and CDP techniques, technology and terminology.
2. Will be competent:
   1. To properly use and maintain applicable materials and equipment.
   2. To produce properly contoured casts.
   3. To fabricate accurate custom final edentulous impression trays.
   4. To fabricate record bases and occlusion rims neatly.
   5. To articulate COP casts properly.
   6. To set up complete denture teeth properly.
   7. To perform an esthetic wax-up for CDP.
3. Will have a basic understanding of accessory CDP techniques, such as relines, overdentures, immediate dentures, dentures with anatomic and semi-anatomic teeth, tissue conditioning, Triad techniques, dental laboratory communications and how to perform laboratory procedures professionally, cleanly, and safely.

Readings

Requirements

Students enrolled in this course will be required to:

• Read and understand the CDP handbook.
• Attend all scheduled lectures and demonstrations.
• Complete all laboratory exercises in an acceptable and timely manner.
• Achieve passing grades in the didactic and laboratory sections of the course.

Grading Policy

The minimal requirement for passing this course is a final overall grade of 70% and not having a failing grade in any of the practical/competency examinations. Such a failing grade will require the re-taking of the examination until a passing grade is achieved.

All of the practical/competency examinations will be graded numerically with seventy (70) as the minimal passing grade. This course will use the same competency policy that the students will have during their clinical experience. This policy is that a failed examination must be retaken until a passing grade is achieved. A grade of 70% will then be submitted for this examination.

Working, Safety & Dress Code

Instrument and Supply List

• Safety Glasses
• Masks
• Lab Coats
• Hanau Torch
• Alcohol
• Bunsen Burner
• Tubing Matches
• Articulator Casts
• Triad Curing Machine
• Model Trimmer
• Hyde Scraper
• Flat Plane Plate
• Pink Triad LVC Material
• Blue Triad LVC Material
• Pink Wax
• Denture Teeth
• Lead Pencils -Black and Red/Blue
• Transparent Millimeter Ruler
• Articulating Paper
• Slow Speed Handpiece
• Assorted Acrylic Burs
• #7 Wax Spatula
• Bard-Parker Knife
• Utility Lab Knives
• Cleoid-Discoid Carver
• Scissors
• Arbor Bank Chuck
• Arbor Bands

Removable Prosthodontics

The branch of prosthodontics concerned with the replacement of teeth and contiguous structures for edentulous or partially edentulous patients by artificial substitutes that are removable from the mouth.