Preclinical Complete Denture Prosthodontics

Spring 2006

Complete dentures. (Image provided by David M. Hern, D.M.D.)

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.

This is the introductory course to the treatment of the edentulous patient and continues as the student progresses to the Advanced Clinical Complete Denture Lecture Series and the clinical treatment of patients. 

Preclinical Complete Denture Prosthodontics is the basic complete denture course for second year Dental students. 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.

Course Director:
David M. Hern, DMD

Faculty:
Flaviano J. DiFalco, DDS
Joanne M. Falzone, DMD
Steven E. Eisen, DMD
Maria Gonzalez, DDS
Gaurav Puri, BDS, MS
Kevin Loo, DMD  

• Handout: Immediate Dentures
• Setting Maxillary and Mandibular Anterior Teeth
• VLC Record Bases and Wax Occlusal Rims
• Posterior Limit and Posterior Palatal Seal
• Definitions

  Syllabus

  Objectives Students will have a basic understanding of edentulous oral anatomy and CDP techniques, technology and terminology. Students will be competent: a. To properly use and maintain applicable materials and equipment. b. To produce properly contoured casts. c. To fabricate accurate custom final edentulous impression trays. d. To fabricate record bases and occlusion rims neatly. e. To articulate COP casts properly. f. To set up complete denture teeth properly. g. To perform an esthetic wax-up for CDP. Students 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.

  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.

  Session Content

  1:00PM

  • Prelude
  • Reading Assignment for Next Session
  • Announcements
  • Lecture- Basic CDP Technique
  • Questions and Comments
  • Daily Quiz

  1:45PM

  • Lecture, Slides and Demonstration - Laboratory Technique

  2:00PM

  • Laboratory Procedures

  4:30PM

  • Clean up

  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

  Necessary Text

  T.U.S.D.M. Handbook for Complete Denture Prosthodontics - supplied at the beginning of the course and must be present at all sessions. Pertinent sections must be reviewed before each session.

  Suggested Text

  Judson C. Hickey, George A. Zarb. Boucher's Prosthetic Treatment for Edentulous Patients, 10th Edition

  Various Handouts

  Your Notes

  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.

  Didactic Section

  The didactic grade will account for 50% of the final grade for the course. This grade will be based upon the student's performance on:

  • 1 mid-term examination
  • 10 daily quizzes
  • 1 end-term written examination.

  Their value will be equal (1/3, 1/3, and 1/3). The questions in the written examinations will be taken entirely from the CDP Manual or the Laboratory Guidelines Handouts. The daily quiz questions will be from that day's CDP technique lecture.

  Didactic Exams

  • Unexcused absences will result in a zero (0) grade for that particular examination.
  • Should make-up examinations be necessary they will be given on an as-needed basis.
  • Specific instructions for all examinations will be outlined as they are given. These instructions will be governed by the nature of each examination.

  Laboratory Section

  The laboratory grade will account for 50% of the grade for the course. This grade will be based upon the student's performance in three (3) practical competency examinations.

  A. Practical Competency Examinations 1 & 2 will each account for 25% of the complete laboratory grade.

  1. The fabrication of a Triad mandibular edentulous custom final impression tray and handle.
  2. The fabrication of a Triad maxillary edentulous record base and wax occlusal rim.

  B. Practical Competency Examination 3 will account for 50% of the complete laboratory grade.

  1. This is a complete maxillary and mandibular denture set-up and wax clean-up.

  Laboratory Grading System

  The grading of all of the laboratory examinations will be as follows:

  5 = superior (96), 4 = very good (91, 3 = good (85), 2 = passing, but inferior (78) 1 = failure (65)

  Procedures Which Require a Pass/Fail Faculty Evaluation

  Procedures which require a pass/fail faculty evaluation before proceeding to the next step, but which will not be graded, are:

  1. Preliminary cast outlining
  2. Preliminary cast trimming
  3. Maxillary and mandibular custom tray outlining and undercut blackout
  4. Maxillary and mandibular custom trays and handles fabrication
  5. Maxillary and mandibular blockout and fabrication of record bases and occlusion rims
  6. Mounting of the casts, record bases and occlusion rims on the articulator and the correction of the occlusal plane (done by entire class on one day)
  7. Anterior teeth set-up
  8. Posterior teeth set-up
  9. Complete wax clean-up

  Professionalism

  While not a percentage of the actual final grade, proper conduct and good work habits are an extremely influential factor in all aspects of this course. This is also true in every other area of this school as will be the case for the remainder of your dental careers. Start now and continue to conduct yourselves professionally.

  Working, Safety & Dress Code

  Laboratory

  All Risk Management and Dental Laboratory policies apply here and will be strictly enforced.

  1. Safety glasses must be worn at all times
  2. Masks must be worn when drilling or grinding
  3. White, long laboratory coats, buttoned, must be worn with name tag at all times
  4. Medium to long hair must be pinned or tied back
  5. No dangling jewelry
  6. No food or drink
  7. No shorts, sandals or open-toed shoes
  8. Socks or stockings must be worn
  9. No hats
  10. Casual, neat and clean clothing
  11. Place a piece of white bench paper on your area at the start of each work session.
  12. Remove all debris to the trash barrels and completely clean up your area when you have finished each session.

  Anyone in violation of the above will be dismissed from the laboratory until they are in compliance.

  Clinics

  1. A green gown for faculty and blue gown for students worn over appropriate clothing, tied high enough to cover these clothes must be worn at all times. Name tags must be visible. Blue gowns are not to be worn outside of the patient area.
  2. Jeans (of any color) are not allowed.
  3. Sport shoes and open-toed shoes are not allowed.
  4. Socks or stocking are required.
  5. Shorts are not allowed.
  6. Hats are not allowed.
  7. Dangling jewelry is not allowed.
  8. Jewelry on hands or wrists is not allowed.
  9. Long and medium length hair must be tied back.

  Dental Laboratories

  1. A white laboratory coat or a yellow laboratory gown must be worn. Blue treatment gowns are allowed during treatment periods.
  2. Jeans are permitted unless entering treatment areas.
  3. Shorts are not allowed.
  4. Open-toed shoes are not allowed.
  5. Dangling jewelry is not allowed.
  6. Long and medium hair must be tied back.
  7. Hats are not allowed.
  8. Socks or stockings are required.

  Preclinical Laboratory

  1. A clean, white, and buttoned long laboratory coat with the name tag displayed is to be worn at all times.
  2. T-shirts are not allowed.
  3. Open toed shoes are not allowed.
  4. Dangling jewelry is not allowed.
  5. Long and medium length hair must be tied back.
  6. Hats are not permitted.
  7. Clean and neat jeans are permitted.
  8. Shorts are not allowed.

  General Guidelines Which Apply to All Areas of the School

  1. Casual and neat clothing must be worn at all times.
  2. Tailored or collared shirts preferably with a tie must be worn. Turtlenecks are allowed.
  3. T-shirts are not allowed.
  4. Shorts are not allowed.
  5. Jeans are permitted unless entering the patient treatment areas.
  6. Blue treatment gowns are not allowed outside of the clinic areas.
  7. Hair, beards, and mustaches must be well groomed.
  8. Nails must be clean, short, and rounded.
  9. Wounds must be covered with an appropriate bandage.

  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

  Dental Materials Necessary for Each Laboratory Procedure

  Preliminary Edentulous Cast Trimming

  • Maxillary and mandibular untrimmed edentulous casts
  • Maxillary and mandibular trimmed edentulous casts to use as guides
  • Red/blue and black pencils
  • Transparent millimeter ruler
  • Model trimmer
  • Laboratory knife
  • Lathe arbor bands and chuck

  Custom Edentulous Trays (Basic exercise and first practical exam)

  • Maxillary and mandibular preliminary trimmed edentulous casts
  • Red/blue and black pencils
  • Blue Triad VLC material
  • Model release agent
  • Vaseline
  • Laboratory knife
  • Laboratory scissors
  • Slow speed handpiece
  • Assorted acrylic burs
  • Triad curing machine

  Record Bases and Occlusion Rims (Basic exercise and second practical exam)

  • Maxillary and mandibular final casts (yellow stone)
  • Examination casts
  • Pink Triad VLC material
  • Laboratory knife
  • Model release agent
  • Petroleum Jelly
  • Pink occlusion rim wax
  • #7 wax spatula
  • Hyde scraper
  • Triad curing machine
  • Low speed handpiece
  • Assorted acrylic burs
  • Bunsen burner
  • Matches
  • Hanau torch
  • Alcohol

  Complete Denture Set-Up and Wax Up (Basic exercise and fourth and fifth practical exam and last exercise)

  • Pink baseplate wax
  • #7 wax spatula
  • Flat occlusal plate
  • Cleoid-discoid carver
  • Low speed handpiece
  • Assorted acrylic burs
  • Hanau torch
  • Alcohol
  • Bunsen burner
  • Matches
  • Denture teeth - complete set

  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.

  Types of Removable Prosthodontics

  Complete denture: a removable dental prosthesis that replaces the entire dentition and associated structures of the maxillae or mandible.

  Partial denture: a dental prosthesis that restores one or more but not all of the natural teeth and/or associated parts and that is supported in part by natural teeth, dental implant supported crowns, abutments, or other fixed partial dentures; usage: a partial denture should be described as affixed partial denture or removable partial denture based on the patient's capability to remove or not remove the prosthesis.

  Variations:

  • Immediate dentures
  • Overdentures
  • Interim partial or complete dentures
  • Duplicate dentures
  • Implant retained dentures

  Advantages of Complete Dentures:

  • Self image
  • Proper speech
  • The ability to masticate
  • Natural appearance

  Disadvantages of complete dentures:

  • They are not fixed in place.

    Calendar

    Session	Type	Title
    1	Lecture	Orientation
    2	Lecture	1st Appointment - Exam, preliminary impression, cast pouring, marking and preliminary trays
    3	Laboratory	Alginate impression of the edentulous dentiform, pour, trip, and mark for trays, edentulous custom trays
    4	Lecture	Adjust trays intraorally, border moulding, final impression
    5	Laboratory	Complete custom tray fabrication
    6	Lecture	Boxing, pouring and trimming the final casts, record bases and wax rims
    7	Laboratory	Adjust trays, border moulding, final impressions
    8	Lecture	Maxillo-mandibular record-making
    9	Laboratory	Box impression, pour and trim final casts
    10	Examination	First written examination
    11	Lecture	Denture teeth, articulators and facebows
    12	Laboratory	Fabricate record bases and wax rims
    13	Lecture	Articulation, set-up and try-in
    14	Laboratory	Complete record bases and wax rims
    15	Lecture	Lab procedures
    16	Laboratory	Adjust rims on the dentiform, occlusal registration, mount case on the articulator
    17	Lecture	Delivery and aftercare
    18	Laboratory	Demonstrate facebow recording, complete laboratory procedures to date, adjust rims on the articulator
    19	Lecture	Immediate dentures
    20	Laboratory	Anterior denture teeth set-up
    21	Lecture	Tissue conditioning and denture relining
    22	Laboratory	Posterior denture tooth set-up
    23	Lecture	Cranio-facial considerations
    24	Laboratory	Complete set-up