Complete denture fabricationPrior to the introduction of osseointegrated implants to dentistry, conventional complete removable dental prostheses were really the only treatment option available for completely edentulous patients.

Modern treatment options utilize dental implants, yet understanding the essential steps required for predictable conventional denture fabrication should aid clinicians seeking to transition patients to implant-retained prostheses. In addition, these steps should assist clinicians seeking to treat edentulous patients who are unwilling or unable to utilize implants.

(Click this link to read more about complete denture strategy.)


9 steps for conventional denture fabrication


  1. Edentulous patient stock trayMake preliminary impression using a stock tray specifically designed for edentulous patients and alginate. Tray periphery may be enhanced with wax.
  2. Fabricate preliminary cast and custom impression tray. This cast should be slightly over-extended in the periphery.
  3. Master impression using border molded custom tray with PVS or polyether. (Click here for a course on impressions for edentulous patients.)
  4. Send impression to laboratory for fabrication of master cast and record base/wax rim.
  5. Contour wax rimsConfirm fit and extension of record base. Contour wax rims for lip support, future incisal edge position, occlusal plane, occlusal vertical dimension and midline. Record facebow transfer and bite registration at correct vertical dimension. Select tooth mold, tooth shade and desired occlusal scheme.
  6. Return all items to laboratory. Lab will index and mount casts and develop trial denture set-up.
  7. Try-in initial denture set-up. Depending on clinician/technician preference this may be either an “esthetic try-in” of just the maxillary anterior teeth (requiring an additional try-in) or the full set-up. Evaluate for accuracy of mounting, occlusal vertical dimension, esthetics and phonetics. Perform modifications as necessary. Patient and clinician should be satisfied before moving to next step.
  8. Return all items to laboratory for prosthesis fabrication. Dentures should be remounted and equilibrated to compensate for errors in denture processing. Dentures should be returned finished and all external surfaces polished. Many clinicians will request clinical remount casts to be fabricated and returned with the case.
  9. Insert and adjust denturesInsert dentures and adjust as necessary. Typical post insertion follow-up includes 24-hour, one-week and one-month appointments. Determine an appropriate recall interval.

Successful patient outcomes with conventional complete dentures are possible. In order to achieve predictable success clinicians require technical skill, competent laboratory support and patient trust. The essential steps outlined here should help clinicians increase the predictability of their conventional removable prosthetic treatments.



Douglas G. Benting, D.D.S., M.S., F.A.C.P. is a member of Spear Resident Faculty.

References:

  1. Zarb GA, Hobkirk JA, Eckert SE, Jacob RF et al. Prosthodontic treatment for edentulous patients: Complete dentures and impant-supported prostheses. 13th ed. St. Louis: Mosby; 2013.
  2. Sadowsky SJ. The role of complete denture principles in implant prosthodontics J Calif Dent Assoc 2003;13:905-909.
  3. Zitzmann NU, Marinello CP. Treatment plan for restoring the edentulous maxilla with implant-supported restorations: Removable overdenture versus fixed partial design. J Prosthet Dent 1999;82:188-96.

Post a Comment

Comments

Commenter's Profile Image Hilary F.
October 22nd, 2015
can you review the tests for phonetics? I haven't made a full denture in years and I forget how to achieve good phonetics!
Commenter's Profile Image Kevin H.
October 22nd, 2015
Hilary, Not to hijack, Dr. Dichter's excellent and accurate article, the phonetic tests I use are quite simple. I have the patient count from 50 to 60, which gives me a good idea of where the maxillary teeth touch the lower lip (goal is the wet/dry line) and a good idea of the palatal design with "S" sounds. A whistle on "s" sounds often indicates that the anterior palate is slightly too thick or the palatal vault of the denture is a bit too narrow; if so, the cameo surface of the denture should be adjusted. Sometimes, you can apply pressure indicating paste (PIP) to the cameo surface of the denture during these tests to see where the tongue touches the cameo surfaces during speech and relieve there if problematic. The second test I use is to have the patient say "57 judges went to the church to pray." The "J" and "ch" sounds give you an idea of vertical dimension; if your VDO is too open, the patient will likely click or bang on the posterior teeth during speech. The "P" sound gives a nice idea of lip competence: if the anterior flange is too bulky or overextended, the "p" sounds will be difficult. Hope this helps, Hilary. Darin, please correct me if you disagree. Great article!
Commenter's Profile Image Darin D.
October 22nd, 2015
Great answer Kevin! Hilary you are not alone- lots of us have gotten a little rusty with our complete denture technique. Keep an eye out for a future digital course at Spear Online Best- d
Commenter's Profile Image Hilary F.
November 8th, 2015
Thank you so much!!!
Commenter's Profile Image Daniel B.
December 29th, 2015
Great advice Kevin! What shoul you expect to see or hear on the ch and j sounds if the VDO is less than it should be. I know it may appear as though they are frowning when overclosed. Any tips to look for? Also, on p sounds what if the flange is underextended or better yet not full enough. I guess the retention will suffer if underextended but what if not full enough? I would greatly appreciate your help. -Dan
Commenter's Profile Image Eric M.
April 5th, 2016
These steps are exactly as I learned in dental school at the University of WA and the same way I still do it 21 years later. It may seem like a lot of steps to some but it works. Nicely written! Thank you