Support

Resistance to vertical
movement of the
denture base towards the
tissues.
Factors affecting support:
1. Bone support
2. Surface area
3. Impression technique
4. Accuracy of fit
5. Nature of the
supporting mucosa
(tissues).

Sources of support: All

denture bearing areas:
In maxilla Hard palate,
maxillary tuberosity and residual
alveolar ridge.
In mandible buccal shelf and
residual alveolar ridge.
** Impression must cover as
much area as possible, with
relief of the limiting structures.

Retention
Resistance to vertical
movement of the denture
base away from the tissues.
Factors affecting retention:
1. Anatomical factors :
- Size and quality of the
denture bearing area.
2. Physiological factors:
- Quality and viscosity of
the saliva.
3. Physical factors:
- Adhesion, cohesion,
interfacial surface tension,
capillary attraction,
atmospheric pressure.
4. Biologic factors:
- Intimate tissue contact,
neuromuscular control.
5. Mechanical factors:
- undercuts, rotational
insertion path, parallel
walls.
6. Oral and facial
musculature
7. Psychological effects
and patients
tolerance.
-Good peripheral seal

improves retention

Stability

Resistance to ho
movement or ro
movement of th
base.

Factors affecting
1. Residual ridge
contour and q
2. Proper locatio
arrangement
artificial teeth
3. Abnormal ridg
relationships
4. Neutral zone
surrounding
musculature
5. Occlusal facto
6. Palatal vault
7. Direct bone a
8. Flange shape
contour
9. Quality of fina
impression
10.Denture base
11.Occlusal plan

-1+3 are the most impo

factors affecting the sta

 Prosthodontics: The branch of dental arts and science pertaining to

the restoration and maintenance of oral function by the replacement

of missing teeth and structures by artificial devices.
Prosthesis: Replacement of any absent part of the human body by an

artificial part.
Denture: An artificial substitute for missing natural teeth and adjacent

structures.
Complete denture: A dental prosthesis that replaces all of the

natural dentition and associated structures of the maxilla or

mandible.
Partial denture: Prosthesis that replaces one or more, but less
than all, of the natural teeth and associated structures.
Restoration of partial tooth loss either: 1. Fixed partial denture
(bridge) 2. Removable partial denture 3. Implants
Removable partial denture: a partial denture that can be readily
placed in the mouth and removed by the wearer.
Dentures compensate for bone and supporting structures in addition to
teeth.
Causes of teeth loss: 1. Caries 2. Trauma 3. Iatrogenic dentistry
4.congenital 5. Periodontal disease.
Facial muscles: https://www.youtube.com/watch?v=Xmz3oLrnzBw
If the border of the denture is on the insertion of a muscle, each time
this muscle function the denture will be dislodged.

Objectives of prosthodontic treatment:

Restore masticating function / Improve appearance/Improve speech (as
phonation depends on the relationship between upper and lower anterior
teeth)/ Improve psychology.

Anatomical changes associated with loss of teeth:

1. Bone loss: because the function of bone is to carry teeth and when
teeth are gone bone resorption will happen.
2. Diminished masticatory efficiency: biting forces are not enough for
masticatory functions.
3. Morphological face height changes:
- Protrusion of the lower chin because of losing the contacting unit of
teeth which were preserving the vertical dimension (height).
- Wrinkles on the upper lip because the labial plate is resorbed losing
the supporting anterior teeth.
** Dentures resolve these problems.

Change in facial appearance is due to:

Loss of teeth.
Resorption of the alveolar bone.
Lack of support for the facial muscles.
Ability of the patient to move the mandible closer to the nose.
How to insert the tray inside the patients mouth? Insert it posteriorly
then anteriorly.

- The impression material weve used in the lab is the impression

compound,Its properties:
1. Highly viscous and can support itself. so even if the tray is not in the
proper size we dont have to modify it using wax.
2. Thermoplastic so it is softened by thermal effect
In hot water 55-60c for 1-3 minutes.
3. Another name Red Cakes, Kerr
4. Kneed in Vaseline in order not to be very sticky.

Complete denture treatment procedures

1. Preparatory phase. Most of

the patients need some sort of
treatment before wearing the
denture.

2. Construction phase.(five
appointments between each one and
the next theres a laboratory step):
1-Primary Impressions.
2-Secondary Impressions.

A. Diagnosis and treatment

plan:
1.History.(Medical and dental
history) ask the patient for how long
he has missing teeth (longer time
more severe where more bone
resorption had happened) & did he
have a previous denture.
2. Examination (visual, existing
denture, palpation, measurement
measure the facial height, saliva,
soft tissue, tongue)
3. Diagnosis. 4. Treatment plan.
(Matching treatment options with
patient needs)
B. Surgical procedures. - Complete
clearance for teeth and if 1 or 2 teeth are
left but they are in unfavorable situation.
- Very prominent frenum that extends to
the ridge and come in touch with the
borders of the denture so we make
frenectomy.
C. Oral tissues returned to optimum
health. Treating oral diseases and
inflammation like gingival inflammation

3-Registration of jaws relation.

4-Denture try-in.
5-Denture Insertion.

The structures under the fitting surface

1. Stress-bearing area
(supporting area); this
area gives support for
denture. (Compressible)
-Areas of mouth that has
thick submucosa,
glandular tissue, fatty
tissue.(areas firmly
attached to bone, not
movable)
-in order to consider any structure
as a supporting structure, it
mustnt be resorbed by time
(minimal resorption is
acceptable)

2. Peripheral area (limiting

area), (Areas loosely
attached to bone,
compressible &movable)
- Its not good for support
because if you stretch it, the
depth of sulcus will change,
because any movement will
result in dislodgement and
will break the seal

3. Structures to be
relieved; ( non-resilient
area)
-Areas of mouth that has
thin submucosa or if it has
a nerve; cant tolerate
stress (will be
traumatized, cannot
provide support to
denture)!
Areas to be relieved:

-so simply its the borders of

the denture.

-median palatine raphe

- Incisive papilla

In maxilla:

The horizontal/ lateral area

of hard palate (around median
raphe).
Rugae. Residual ridges.
-1 is a primary supporting area
(cant be resorbed at all)
-2+3 are secondary (could be
exposed to minimal resorption)

In Mandible:
Primary supporting area:
buccal shelf. (the bone here is
cortical)
Secondary supporting area:
residual ridges.(cancellous bone)

The denture must end here in

order to ensure that it will
stay stable in its position even
when opening of mouth,
eating, speaking.

In Maxilla:
*Labial + buccal frenum
* Labial+buccal vestibule
* Hamular notch * Vibrating
line

In mandible:
*labial+buccal+lingual
frenum
*labial+buccal vestibule

- Torus palatinus
(pathologic case)

 Denture surfaces:
1. Fitting surface; which also called impression surface, where we put
the impression material, toward tissues.
2. Occlusal surface; the surface where upper and lower jaws contact
each other.
3. Polished surface; which is in contact with oral structures, muscles,
cheeks and tongue.

The thickness and consistency of SUBMUCOSA will determine the

degree of stress the tissue can tolerate
One cause of resorption is dental history, like periodontal problems.
Factors affecting form&size of the supporting bone:
-

its original size & consistency/general health/surrounding musculature

periodontal disease/wearing a dental prostheses/surgery at the time of

extraction

the relative length of time different parts of the jaws have been
edentulous

Mucosa of mouth is divided into:

1. Masticatory mucosa: stratified squamous epithelium, keratinized
(mucosa that covers the stress-bearing area)
2. Lining mucosa: covers Oral surface of cheeks
3. Specialized mucosa: covers Vermilion zone of the lip
Casts provide a positive image of the denture while impressions
provide a negative image.

 If we have a flange/bulge in impression there will be a

sulcus/vestibule in cast
If we have a fossa in impression there will be a papilla in cast
If we have a notch in impression there will be a frenum in cast
If we have a groove in impression there will be a ridge/raphe in
cast
Residual ridge is divided by buccal frenum into: anterior and
posterior residual ridges.
the anterior is from buccal frenum in one side to the one in the other
side and the posterior residual ridge is posterior to the buccal frenum
Maxillary tuberosity; it is the end of residual ridge.
Coronoid bulge is a bulge resulting from coronoid process; a thin,
triangular eminence protruding from mandible to maxilla; an
attachment for masseter and temporalis muscles from the lateral
aspect of it, thats why we ask the patient to open wide when we want
to make a denture, in order to record the effect of coronoid.

Vibrating line:
- The very end line of our denture, (denture shouldnt extend more than
this line)
- it is the posterior border of the posterior palatal seal area
- It is called vibrating line because it keeps moving during speaking (you
can see it if the patient says aaah as the soft palate moves upward.)
- It is located within soft palate and it is the separating border between
movable & non-moveable parts of it.

Border that separates hard palate from soft is called: Anterior

border of posterior palatal seal area

Fovea palatinae:
- Two dots; located on the vibrating line or just 2 mm posterior to it

- They are orifices for salivary gland

- Their Importance: theyre always clear, so if the patients dont have a
clear vibration. Theyll be helpful for identification of the vibrating line
within soft palate;
If we know where the vibrating line is, then we can know where the
posterior border of denture must be located.

Three structures have to be recorded when constructing a denture,

achieved by asking the patient to open his mouth widely: 1.Coronoid
process 2.Masseter muscle 3. Pterygomandibular raphe
if the denture extends on these structures, one of two results will
happen;
1. The denture will cause a trauma or cut to these structures
2. The denture will be dislodged from the patient mouth when he
opens widely.

it is important to ask the patient to open widely even if you want to

construct a mandibular denture. in order to record the effect of
pterygomandibular raphe, and therefore not to extend beyond the
retromolar pad area.(when the patient open his mouth wide, this area
will become interiorly positioned (stretched) so we can construct a a
good denture with good details)

Retromolar pad area of mandible is matching the hamular notch in

maxilla.
Both of them are the ending structure of the denture.

Buccal shelf:
- a horizontal shelf between crest of the posterior residual ridge and the end
of the buccal sulcus.

-Surrounded from inside by posterior residual ridge & attached to buccinator

from
outside.
-the importance of it? It is a primary supporting area of mandible.

Polysulphides

Primary impression

Synthetic
ela stom ers

Importance of landmarks
identification?

S ilicones

Polyethers
Elastic m aterials

Revesib le(agar)

-to know the extent of your

Denture/ the limit of the denture
bearing area /where to end your
denture.

H ydrocolloids
Irreversible(Algin
ate)

Im pressiom
materials

Im pression
plaster

Im pression
com pound
N on-elastic
m a terials
Zin c/ox idee ugeno l pastes

Im pression
waxes

Precautions before taking the impression (in the preparatory phase)

The patients tissue should be healthy , especially if he have an old denture.

Primary impression
Types of the trays:
- perforated, non-perforated. - plastic trays, metal trays.

Criteria of the tray Selection:

1- it must be rigid. 2- Biocompatible.3- able to accommodate the impression
material.
4-extend to cover all anatomical landmarks.
(In the maxilla it must extend to the Hamular Notch and covering the
Maxillary Tuberosity at first and then we seat the tray anteriorly.
(because in this way we ensure the visibility for the posterior structures to be sure that we reached the
Hamular notches and that the tray is extended there and then we seat it anteriorly) .

*plastic trays can be modified more than metal trays, for example you can
shorten and grind a plastic tray

Primary Impression

Secondary (definitive) impression

The
impression
material is
hold in:

Stock Tray (Plastic or metal)

Special Tray (we made it from heat

The Aim

- to record the entire Denture

Bearing Area (outline the
available support).

cured resin)

- gives us a general idea of

what we have in the patient
mouth.

The next
step

materials
that we use

minor reason; helping us to

make the special tray for
secondary impression.
make the special tray for
secondary impression.
1 Alginate

- produce the form and extent of

the fitting surface of the denture.
- so the secondary impression is
exactly the fitting surface of the
denture.
- the fitting surface of the denture
will be a copy of the secondary
impression, thus maximizing
support, retention and stability.
pour it we get the Master Cast in
order to construct the denture
on it
(Alginate; can also be used for secondary
impression but it should be poured
immediately because of the poor dimensional
stability so we dont even wait for 10 minutes
especially if we are recording a secondary
impression so we dont use alginate that
much).

2. Compound

3. Silicones (according to the

silicones viscosity we can use the high
viscosity (putty) in primary impressions)

but we use the medium and low viscosity in

secondary impressions.

4. Impression waxes (but its not

used anymore because of the poor
dimensional stability).
1. Impression plaster

(some people
use it for primary impression also).

2. Zinc oxide eugenol

(very high
dimensional stability we used it in clinics
unless we have an undercut we cant use it
because its non-elastic material).

3. Polyether.

4. Polysulfide

composition of impression *
:compound

1. Thermoplastic material: becomes moldable and workable with heat, so by

common sense it has to have wax and resins in it, they give the material its
thermoplastic property and thats why they constitute almost 47% of the
material.
2. Filler: it gives the material its high viscosity and a bulky appearance
(constitute 50%).
3. Stearic acid as a lubricant (constitute 3%).

*properties:
1- high coefficient of thermal expansion (disadvantage) :
means a little change in the room temperature reflects a big change in
dimensions, so this builds up internal stresses so we need to pour it as soon
as possible (maximum 1 hour).
2- poor thermal conductivity:
it can build up internal stresses.
but how? It will build up internal stresses if we took it out, while the inside of
this material is still soft, so because of the change in temperature between
the patients mouth and the room, this soften material will cause a change in
dimensions.
We cant consider this property as a disadvantage its just a property for us
to know how to handle the material unless in the previous example where
the inside was still soft we can somehow say that its a disadvantage in
this particular situation.
3- High viscosity:
it is an advantage when its extends the borders and a disadvantage
because it cant give us accurate landmarks so its varying according to the
situation.
4- Doesnt give fine surface details:
this doesnt mean that it gives no details because it does give me acceptable
details like the Rugae but they are not fine details , this is why we dont use
it for secondary impression , so it is suitable for the aim of the primary
impression.
Note: Silicone putty = heavy (high) viscosity silicone

**Why didnt we use type 4 gypsum when we made our casts?

Because we dont need that much strength and details and that much
expensive material .
the gypsum stone is more flowy and it wouldnt stand by its own so it will
need boxing.
So the gypsum plaster (plaster of Paris) that we all used to make our
primary casts is reasonable to use because I will just use the primary cast to

make a special tray so I dont need that much details and its easier to
handle.

**Requirements of model
material :
1. Dimensional accuracy.
2. Adequate mechanical properties:
- strong to resist accidental fracture.
- hard to resist abrasion.
3. Fluid at the time it is poured.
4. Compatible with all impression materials.

What does model material mean?

It means Gypsum product.

**Gypsum is a naturally occurring white

powdery mineral, chemical name :
calcium sulphate dihydrate
CaSO4 . 2H20.

*Impression techniques:
Mucostatic: alginate, plaster
Mucocompressive: compound
Selective Mucocompressive: combination
1. Mucostatic technique: from its name it doesnt do any compression on
the tissues it just records the landmarks, like the materials alginate and
plaster, these materials need to be of low viscosity so that it doesnt exert
any compression on the tissues.
2. Mucocompressive: like the compound because it is viscous therefore it
gives me compression (it compresses the tissue).
3. Selective Mucocompressive: we have combination between the both
techniques, so I have areas that I want to relieve and other areas that I want
to compress.

*amount of pressure depends on:

1- Viscosity of the impression material.

Which means when you compare perforated tray with non-perforated tray, which
one exerts less pressure on the tissues?
the perforated because the pressure of the material on the tissues will be relieved
trough the perforations of the tray, this is important because we can select which
area we want to relive and which one we want to compress; for example I can make
a perforation around the median palatine raphe in my special tray, this way I have
relieved only the raphe but exerted pressure that I need on all other structures

2- Distance to the escape way.

3- Closeness of the tray to the mucous membrane.
the closer the higher the pressure on the tissues.

*Reaction of the mucous membrane to pressure depends on:

1- Firmness + thickness of the mucous membrane.
there are tissues that will tolerate the pressure according to its firm
attachment to the bone, the more the thickness of the tissue the more
compressible the tissue is.
2- Availability of bone support.
when we have more bone support we can compress the tissue more and
more.

** pressure exerted on the denture bearing area during impression

procedures will lead to compression, displacement and extension of the
soft tissues. Which means that the form recorded is different from what we
see intra-orally when we examine the edentulous mouth.

*The degree of difference depends on two basic

factors:

1- The amount of pressure exerted locally on the soft tissues during

impression recording.
=This factor is determined by the type of material used, its manipulation
and the spacing and venting of the tray
2- The tissues susceptibility to compression displacement or extension
due to outer pressure.

*To achieve a successful impression, the following

concepts should be adhered to:
1- The tissues of the mouth should be healthy.
> for example if I have an undercut I have to use an elastic material to
register it.
2- The impression should extend to include the entire basal seat within the
limits of the of the health and functions of the supporting and limiting
tissues.
3- The border must be in harmony with the anatomical and histological
limitations of the oral structures.
> also for the tray not to be over extended and try as much as possible to
reduce the deformities that happens to the tissues because of the pressure.

4- A physiological type of border-molding procedure should be

performed by the dentist or by the patient under the guidance of the dentist.
5- Proper space for the selective impression material should be provided
within the impression tray.
> remember when we did selection of the tray we must have 2 to 3 mm
space in width with the maxillary tuberosity, because we are using
compound which is viscous compressible material so we have to provide
space for the material to move out to have a nice impression with a good
thickness

6- Selective pressure should be placed on the basal seat during the

making of the impression.
> selective pressure according to the state of the tissues.
7- The impression must be removed from the mouth without damage
to the mucus membrane of the residual ridges.
8- A guiding mechanism should be provided for correct positioning of the
impression tray in the mouth.
> where to center the tray to get all landmarks.
9- The tray and the impression material should be made of dimensionally
stable materials.
> we need the materials that we have to be dimensionally stable, from the
special tray to the impression material to gypsum product, everything must
be stable because any dimensional changes will stay with us till the end.

10- The external shape of the impression must be similar to the

external form of the completed denture.