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IVAN JOJO OBED OBEHI EROMOSELE JULIANA UNICORN IBIJOKE SMITH DAVID AMEYAW Clinical year III, UGDS

Introduction to Complete Dentures Definition Complete denture prosthodontics or full denture prosthetics is defined as The replacement of the natural teeth in the arch and their associated parts by artificial substitutes. It can also be defined as The art and science of the restoration of an edentulous mouth. Complete denture is also defined as A dental prosthesis which replaces the entire dentition and associated structures of the maxilla and mandible

Generally complete dentures are fabricated for geriatric patients. Some young patients who are borne with congenitally malformed teeth or edentulous arches require complete dentures. It is essential for the dentist to evaluate the patient before treatment.

Functions of a Complete Denture A complete denture functions to restore aesthetics, mastication and speech. 1. Aesthetically: the complete denture should restore the lost facial contours, vertical dimension. Artefacts like stains can be incorporated in order to improve the aesthetics. 2. Functionally (Mastication): A complete denture should have proper balanced occlusion in order to enhance the stability of the denture. 3. Phonetics: One of the most important functions of a complete denture is to restore the speech of the patient.

The

successful outcome of complete denture treatment depends on the dentist, the technician and the patient who has to adapt to the dentures and accept their limitations. The patients ability to adapt is vital To adapt, the patient must 1-Become accustomed to the sensation of the dentures(Habituation) 2-Learn to control the dentures 3-Come to terms with the new appearance

HABITUATION

This is the gradual diminution of responses to repeated/ continued stimuli. When new dentures are placed in the mouth they stimulate mechanoreceptors in the oral mucosa. Touch and pressure impulses from these receptors are transmitted to the sensory cortex for the patient to feel the dentures.

Dentures are foreign bodies in the mouth and when fitted for the first time most muscular actions tend to expel them.

With

time the receptors adapt to the new environment and the patient loses conscious awareness of the denture
If replacement dentures are constructed whose shape is dissimilar to the existing one, a new set of stimuli will be evoked and the process of habituation starts all over again

The

successful manipulation of dentures depends on purposeful muscular activity which in turn is related to adequate sensory feedback.. The patients ability to control dentures involves a learning process which initially is conscious However as a result of repetitive stimulation new reflex arcs are set up and the conscious effort is replaced by subconscious behaviour.

Thus,

gradually ,the denture wearer learns to differentiate between the food and the dentures and, at first consciously but later subconsciously , to control and to stabilize them with the tongue and cheek. The tongue by resting on the lower denture and pressing it downwards and forwards, can control its tendency to rise, and also counterbalance to a large degree destabilizing masticatory forces.

The

tongue can also be unconsciously trained to prevent the back edge of the upper denture dropping while the front teeth are incising. The muscular cheeks can be trained, again unconsciously to press downwards on the buccal flanges of the denture, while still carrying out their function of placing food between the teeth.

The

ability to adapt is difficult when a previous denture wearer gets a new denture. Controlling dentures that are different in shape from what they had, particularly the contours of the polished surfaces is difficult. Therefore the basis for copy dentures is the maintenance of conditioned neuromuscular control.

Through

a copy denture technique therefore it is possible to reproduce the polished surfaces of dentures together with the introduction of selective changes.

Definition
A copy denture is a second denture intended to be a replica of the first denture.
Synonyms

Duplicate dentures, Template dentures, Replica dentures.

The transfer of contours from old to new dentures for maintenance of neuromuscular control. Any modifications done to the basic shape of the old denture should therefore be only those necessary to correct the loss of fit i.e., (patients complaint) and those considered essential by the operator, e.g., slight increase in the OVD and worn denture teeth.

1. When it is desirable, especially for the older patients, to provide replacement dentures (with improved fit) similar in most aspects to those to which patients are already accustomed. It is not easy for a geriatric patient to get used to a new denture with altered polished surface contours readily. 2. Renewal of old deteriorated and stained denture base material.

3. If it is desired by a patient to have a spare denture in case of accidental fracture or loss of the original denture. The patients often are concerned about being without dentures during required repair or relining process. 4. If the need to experiment interchanging occlusal relationship of the dentures for clinical or research reasons. This could be carried out on the spare denture, without changing the original one.

denture is not duplicated unless its examination reveals satisfactory findings as regards to esthetic, physiologic, and psychologic needs of a patient. denture(s) should be evaluated for any previous fractures, craze lines, missing or replaced teeth, esthetics, phonetics, accuracy of fit, and vertical & centric relations. the basis of this examination, the patient is then advised whether the existing denture should be duplicated or remade.

The

On

If

the polished surfaces of the dentures are incorrect i.e. not in the neutral zone. If the previous dentures are not available.

A number of methods or techniques have been reported for producing a template for a duplicate or copy denture. All these techniques are similar except in the use of mould container and materials. Some of these methods are, Modified denture flask method Duplicating flask method Pour resin flask method Cup flask method Soap container method Agar container method

Basically,

a mould of the old denture is produced in an elastic material, such as alginate or silicon putty supported in a rigid container. The wax or auto-polymerizing resin template is fabricated from this mould. Any necessary modifications to the old denture are performed on this template denture and tried in the patients mouth before finishing the prosthesis. In some of the techniques, auto-polymerizing resin teeth are also fabricated instead of using available ready-made moulds.

This visit includes duplication of the old denture in auto-polymerizing acrylic resin, recording the centric jaw relation, and selection of the shade, size, and form of the denture teeth, if the previous selection (old denture) is not accepted by the dentist and the patient.

This visit includes try in of the dentures verification of the jaw relations and tooth positions for esthetics and phonetics. A relining / rebase impression is then obtained as in the conventional reline technique. Laboratory Procedure

The dentures are now processed, finished and polished with routine laboratory procedures.

This visit includes all the necessary clinical procedures performed at the insertion appointment of a complete denture including this includes occlusal adjustments.
A clinical remount procedures should also be carried out to perfect the occlusion of the duplicated dentures.

1. Rigidity of the Box The container used for fabricating the alginate mold must be rigid to avoid distortion of the alginate and subsequently the self-cured acrylic resin template. Precautions must be taken so as the rubber bands used to hold two halves of the mold must not distort the soap container.

2. Distortion of the Alginate ridge Immediately after pouring the wax to from template teeth, the mold should be reassembled to check that the alginate impression of the ridge does not indent the soft wax. Wax is removed if necessary to avoid any possible distortion of the alginate ridge and production of a base plate without an intact all-acrylic resin impression surface.

3. Impression & Jaw relation records These steps should be performed with utmost care. Silicone impression material is recommended for obtaining the reline impressions as the template dentures have to be re-inserted in the mouth for recording the OVD and Centric Relation.

4. Tooth position and Tissue contours


Since the spatial positioning of the teeth and the resin contours of the polished surfaces are important for neuromuscular control, the selection and placement of the stock (ready made) teeth on the templates must be undertaken with great care.

R.M.Basker,

J.C.Davenport, H.R.Tomlin, Prosthetic Management of the edentulous patient, second edition,1990,Macmillan , pg 9-10,81-89. A.A. Grant, W. Johnson, Removable Denture Prosthodontics, second edition,1992,Churchill Livingstone, pg 299302 www.wikipedia.com