The 3 Most Important Steps in CD construction 1.

Classification According to purpose

1. Accurate Impression Primary Impression

2. Correct Jaw relation
o The first impression of the jaw is usually
3. Proper Occlusion
made with alginate or modeling plastic.
Objectives of Complete Denture Impression
Objectives:
1. To provide retention for the denture. 1. To obtain an overextended negative copy of
2. To provide stability for the denture. the denture bearing areas.
3. To provide support for the denture. 2. To obtain from it a diagnostic cast.
4. To provide aesthetics for the lips and 3. For the fabrication of the individual tray.
cheeks.
Final Impression
• A well-developed border of an
impression restores lip and cheek o Secondary impression
contour when the denture is in place. o A more accurate impression for making
• Provides the required support to the the master cast.
muscles involved.
Advantages of making an Edentulous impression
5. To maintain the health of the oral tissues.
in 2 steps
• Related to the preservation of the
supporting tissue. 1. More accurate determination of the
• The factors involved are: peripheral border extensions.
o Maximum area coverage 2. More control of applied pressure in
o Close adaptation to the tissues. making the secondary impression.

Classification of Impression Techniques

2. Classification according to pressure
1. Accdg to Purpose/Use/Objective exerted
a. Preliminary impression o Mucostatic Impression technique
b. Final impression o Pressure less technique
2. Accdg to pressure exerted upon the o Impression obtained with
tissue (theories of impression) minimal tissue compression
a. Mucostatic impression technique o Used on portions of the
b. Functional impression technique basal seat where the
c. Selective impression technique mucosa is soft and flabby.
3. Based on the position of the Mouth o Deliberate Pressure Technique
during impression making. o Functional or dynamic
a. Open mouth impression technique
b. Closed mouth o There is a desirable degree
4. Based on the manipulation method for of compression of the
border molding tissues.
a. Hand manipulation
b. Functional movements
 o Selective Pressure Impression ▪ Tissue Conditioner
Technique - Use for functional impression, old
o Requires extra pressure on denture used as a tray
some areas of the basal ▪ Impression Plaster
seat, whereas it should be - Rigid, flows easily, records fine
pressureless in some areas. detail, absorbs saliva, and a
separating medium is needed before
Requirement of a Good Impression
the cast is poured.
1. Broad Area coverage ▪ Waxes
2. Accurate Tissue detail - Correct deficiencies in final
3. Effective Peripheral Seal impressions

Selection of Impression Material Impression Trays

▪ Based on Elasticity A. Stock Trays

- Rigid (ZOE paste, impression 1. Perforated tray (partial/ full)
compound, impression plaster) 2. Rim lock trays
▪ Based on prosthodontic use 3. Plastic trays
- Preliminary impression materials 4. Water-cooled trays
- Final impression materials B. Individual Trays

Preliminary Impression Materials Stock trays

▪ Impression compound ▪ For a preliminary impression

- Impression compound - Metal or plastic
- Tray compound (used to make a - Perforated or non-perforated
custom tray directly in the mouth) - Rim lock or non-rim lock
- Stick compound (for border ▪ Tray Selection
moulding) - 5mm larger than the outside surface
▪ Alginate of the residual ridge
- Must include both hamular notches
Final Impression Material
and vibrating line.
▪ Alginate
Individual trays
- elastic, give fine details, tray adhesive
needed ▪ Custom tray, special tray, custom-made
▪ Rubber base materials tray.
- Elastic, gives fine detail and is very ▪ Tray made specifically for the patient.
stable, water phobic, tray adhesive ▪ Used for making a final impression.
needed.
▪ Zinc Oxide Eugenol paste
- Most popular for CD, rigid, flows well,
and records fine detail; tray adhesive
not needed.
Requirements of a Good Individual Tray CAST

▪ Rigid and stable Is a positive reproduction of the tissues of the

▪ Borders should be rounded and smooth upper and lower arch.
▪ Made of a material that will allow
Study Cast
adjustment and trimming
▪ 2-3mm thick and uniform thickness ▪ Made up of plaster of paris
▪ With a handle that will not interfere with ▪ Helps in diagnosing a case
the lips (same inclination of the incisors ▪ Obtained from a preliminary impression
when present) ▪ Used for the fabrication of individual
▪ Should be 2mm underextended trays
▪ Also called preliminary casts,
Types of Individual Trays
Diagnostics casts, study model.
(according to the material used)
Master Cast
1. Shellac
2. Acrylic Resin ▪ Made up of dental stone (cast stone),
3. Tray compound which can withstand processing
4. Vacuum-formed baseplate pressure.
5. Old denture ▪ Cast where the denture is fabricated.
▪ Made from the final impression
Types of Individual Trays
▪ Cast where the setting of artificial teeth is
(with or without spacers)
done.
1. Close-fitting tray
Refractory Cast
- Special tray without spacers
- Used to exert pressure upon the ▪ Made up of investment compound
mucosa ▪ A duplicate of master cast
- Used in zinc oxide pastes and ▪ Where casting of framework is done
impression wax
Master Cast
2. Spaced special tray
- Special tray with spacer 1. Secondary cast
- Maybe made up of wax or paper 2. Final Cast
- Used in impression plaster (2mm) 3. Working Cast
o Alginate with tray perforation
Requirements of Master Cast
(3mm)
o Elastomeric impression 1. Should include all anatomic surfaces of
(1.5mm) the final impression.
2. Should include a 2-3mm land area
around the entire periphery of the cast
3. Should show a full peripheral border
4. Should have a base 10-15mm thick, and
parallel to the residual ridge.
 5. Contains no bubbles and flaws in the 5. 1mm thick on the crest and facial slope
stone. of the ridge so as not to interfere with
placement of teeth
Treatment of Final Cast
6. 2mm thick in the palatal and lingual
1. Nodules must be removed flange for rigidity
2. Voids should be filled up 7. Borders should be smooth and rounded,
3. Undercuts are relieved with suitable and should reproduce the reflection of
plastic material the cast
a. Wax
Types of TRB (According to materials)
b. Modelling clay
c. Wet asbestos 1. Temporary bases
d. Plaster of paris a. Shellac
- To permit removal and replacement b. Cold-curing resin
of the bases. c. Vacuum-formed vinyl or polystyrene
- To prevent scoring, marring, d. Baseplate wax
abrading, or breaking the surface of e. Light-cured resin
the cast. 2. Permanent bases
a. Processed acrylic resin
Record Base
b. Gold
▪ Recording base c. Chromium cobalt alloy
▪ Trial Record Base d. Chromium nickel alloy
▪ TRB
Shellac Baseplate
▪ Trial denture base
▪ Trial base ▪ Inexpensive
▪ Baseplate ▪ Easily and quickly adapted
▪ Tends to warp when subjected to
A temporary form representing the base of the
repeated changes in temperature
denture
▪ Brittle- prone to leakage
Uses: ▪ To increase strength, rigidity, reinforced
with wire gauge #12-14
1. For making a maxillomandibular jaw
relation record. Cold-cure resin
2. For arranging the artificial teeth
▪ Rigid, stable, easily contoured and
3. For trial placement in the mouth.
polished
Criteria of Record Base ▪ Fit accurately
▪ Not easily distorted
1. Well adapted to the final cast
▪ Take up needed space for setting
2. Rigid and dimensionally stable
▪ May become loose because of necessary
3. Stable and retentive in the mouth
block out of undercuts
4. Smooth and not irritate the oral tissues
Vacuum-Formed Vinyl Uses of OCR

▪ Fast and efficient means of forming rigid, ▪ Determination of arch form (relative to
accurately fitting bases. the activity of the lips, cheeks and
tongue)
Baseplate Wax
▪ Determination of the plane of occlusion
▪ Inexpensive ▪ Establishes the preliminary
▪ Easily formed maxillomandibular relation records
▪ Esthetic (includes the vertical and horizontal jaw
▪ Lacks rigidity and stability relation)
▪ Easily distorted ▪ Placement of guidelines
▪ Easiest for arranging the teeth ▪ To see the patient's response to a
▪ Reinforced with denture-like form
▪ Arrangement of artificial teeth
Processed Resin
Occlusion Rim Dimension
▪ Rigid, accurate, stable
▪ Retention and stability can be tested ▪ Length
▪ Undercuts not block out (destruction of Upper Rim
final cast) Anterior 20-22mm
Posterior 16-18mm
Cast Alloys
Lower Rim
▪ Rigid, accurate, stable Anterior 16-18mm
▪ Add more weight to mandibular denture Posterior 2/3 of the retromolar pad
▪ More thermal conductivity to maxillary ▪ Width
denture Anterior 3-5mm
▪ Costly Premolar 7mm
▪ Refractory cast are prepared from the Molar 8-10mm
final cast
Placement of OCR
Occlusion Rims
▪ Upper arch
Wax rim, record rim, bite rim, occlusion contour - Anterior region
rim, OCR, bite block, bite plate, occlusion model. Labial to the ridge
- Posterior region
- An occluding model built on
Buccal to the ridge
temporary or permanent denture
▪ Lower arch
bases for the purpose of making
- Anterior region
maxillomandibular jaw relation
Labial to the ridge
record and for arranging the artificial
- Premolar region
teeth.
Over the ridge
- Molar region
Slightly lingual to the ridge
Posterior termination of OCR Establishing the Level of the Occlusal Plane

▪ Upper Two techniques:

- Anterior to the maxillary tuberosity
1. Occlusal plane established on the
region
maxillary arch and lower rim adjusted to
▪ Lower
meet evenly the upper rim (not regarded
- Terminates at the anterior part of the
as applicable to all patients)
retromolar pad
2. Occlusal plane established on the
Establishing the OCR mandible arch and lower rim adjusted to
meet the lower rim (tends to enhance
1. Designing the arch form (lip and cheek
mandibular denture stability)
support)
2. Establishing the level of the occlusal Modiolus
plane
▪ A point near the corner of the mouth
3. Establishing vertical dimension at
where several muscles of facial
occlusion
expression converge.
4. Placement of guidelines
▪ Use as a guide for establishing the
5. Registering centric jaw relation
occlusal plane
Guidelines in Determining the Arch Form ▪ Can cause unseating of the denture
▪ Muscles meeting the modiolus:
▪ Consider the pattern of bone resorption
- Zygomaticus major
▪ Use of anatomical landmarks that are
- Risorius
relatively stable in position
- Buccinator
▪ Use of facial landmarks
- Triangularis
Facial Landmarks - Orbicularis Oris
- Quadrator Labi superioris
▪ Philtrum
- Quadrator labi inferioris
- Flattened if unsupported; obliterated
- Canninus (levator anguli oris).
if over-supported.
▪ Nasolabial folds
- Deeper if unsupported; shallow if
over-supported.
▪ Mentolabial folds
- Deeper if unsupported; shallow if
over supported.
▪ Corners of the mouth
- Droops if unsupported; moves
laterally if over-supported
 JAW RELATION o When interocclusal check records are
used
- Refers to any relation or position of o When occlusal vertical dimension is to
the mandible to the maxilla. be changed during teeth setting
- According to the “Glossary of o For diagnostic mounting and treatment
prosthodontic terms’ the term jaw planning
relation is objectionable, o For making occlusal corrections after
Maxillomandibular relationship is denture processing.
recommended.
Classifications of Face Bow

Arbitrary

▪ Gives approximate values

▪ Condylar rods placed approx. over the
condyle
▪ Fork attached to maxillary occlusal rim
▪ Approx determines the terminal hinge
axis
▪ Used for CD procedures

Kinematic
1. Orientation Relation
o Establish references in the cranium ▪ Fixed values
o Relationship of the jaw to the TMJ or ▪ Condylar rods placed accurately over the
opening axis of the jaw condyles
▪ Fork attached to mandibular rim
Opening axis can be located using a Face Bow.
▪ Accurately determines the terminal hinge
Face Bow axis
▪ Used commonly for fixed or RPD
o U-shape frame caliper-like device that is
used to:
▪ Record the relationship of
2. Vertical Relation/ Vertical Dimension
the jaws to the opening axis
o It is the vertical measurement of the face
of the TMJ
between any two arbitrarily selected
▪ To orient the casts in this
points conveniently located one above
same relationship to the
and one below the mouth usually in the
opening axis of the
midline.
articulator.
Types of Vertical Relation/ Dimension
Indications for Face Bow Use
1. Vertical dimension at Rest (VDR)
o When balanced occlusion is desired
2. Vertical Dimension at Occlusion
o When cusp form teeth are used
(VDO)
3. Vertical Dimension at other position
 A. Vertical Dimension at Rest (VDR) ▪ Face appears long
▪ Vertical dimension when the mandible is ▪ Patient could hardly close the mouth
in the physiologic rest position. ▪ Rapid destruction of residual ridges
▪ Established by muscle and gravity. ▪ Facial muscles appear strained.
▪ Used as a guide to the lost vertical
Consequences of Decrease Vertical Dimension
dimension at occlusion (VDO)
▪ Measured when the head is upright in ▪ Reduces function of the muscles with
position and not supported by the resultant loss of muscle tone.
headrest. ▪ Cause creases at the corners of the
mouth
Interocclusal Distance/ Freeway ▪ Cause loss of space in the oral cavity
Space/ FWS with an adverse effect on the eustachian
▪ Space or gap between the upper and tube – may affect hearing
lower teeth when the mandible is in ▪ May produce trauma in the TMJ
physiologic position ▪ Chin appears too far forward
▪ Usually 2-4mm when observed at the ▪ Shrunk appearance of the face
position of the first premolars. ▪ Vermillion borders of the lips reduced
▪ Essential because it maintains health of approximately to a line
periodontal tissue when teeth are ▪ Lips lose their fullness
present. ▪ Face is flabby instead of being firm
▪ Corners of the mouth turn down or droop.
B. Vertical Dimension at Occlusion (VDO)
Methods of Determining Vertical Dimension
▪ Established by the natural teeth
when present and in occlusion. Physiologic Methods
▪ Established by the vertical height of 2
1. Physiologic Rest Position
dentures/OCR in contact.
o Swallow and Relax
▪ Computed by the formula
▪ Presence of interocclusal
VDO = VDR – FWS
distance of 2-4mm at the
C. Vertical dimension at other position
premolar area.
▪ No significance in CD construction
o Niswonger’s Method
▪ Vertical dimension when mouth is half
▪ Two marking are made, one on
open or wide.
the upper lip below the nasal
Consequences of Increase Vertical Dimension septum, the other one the chin.
Patient is told to swallow and
▪ Trauma on the tissue – due premature
relax.
striking of teeth.
▪ The distance between the two
▪ Possibility of pain in TMJ
marks are measured in a
▪ More awkward to manipulate – due to
difference of 2-4mm when VDO
longer leverage
is subtracted from VDR.
▪ Clicking of dentures
o If less than 2mm, VD is probably too
▪ More easily displaced
great.
o If greater than 4mm, VD is considered too 4. Swallowing
small. o Presence of a very light contact at the
beginning of the swallowing cycle.
2. Phonetics o If denture occlusion is missing – VD
o Consists of listening to speech sounds. maybe too small.
o Using “m” sound, presence of 2-4mm o If there is difficulty – VD is probably too
space. great.
o Observing the relationship of teeth during
the production of ch, s and j sounds 5. Tactile Sense
(brings anterior teeth together but no o Patient tactile sense
contact) ▪ Patient is aksed if the rims
▪ Presence of speaking space of appear to touch too soon, or if
not more than 1mm at the the jaw closes too much or if it
anterior. feels just right.
o Using thirty three, enough space for tip of o Boos Bimeter
the tongue to protrude between the ▪ A device that measures the biting
anterior. force.
o Using f, v sounds, maxillary incisal edge, ▪ Maximum biting force occurs at
lightly contact the lower lip. VDO
o Silverman’s closest speaking space o Lytle’s method
(1mm), presence of space during the ▪ Using a central bearing plate
function of speech. and pin
▪ If speaking space is too large – o Electromyography
VD is considered too small. ▪ Rest position determined by
▪ If speaking space is too small – recording minimal activity of
VD is probably too great. muscles of mastication.

6, Patient perceived Comfort

3. Esthetics Mechanical Methods

o Facial Esthetics
o Ridge relation
▪ Tone of skin throughout the face
▪ Incisive papilla to
should be the same.
mandibular incisors.
o Willis Method
Approximately 4mm in
▪ Distance between the outer
natural dentition.
canthus of the eye and corner of
▪ Parallelism of ridges
the mouth should be equal to the
o Measurement of former denture.
distance between the lower
o Pre extraction records
border of the septum of the nose
▪ Profile radiographs
and lower border of the chin.
- Have been used but cannot be
considered adequate.
 ▪ Cast of teeth in occlusion Significance of Centric Relation
- Give an indication of the amount of
o If centric relation and centric occlusion
space required between the ridges
do not coincide, it will result to denture
for the teeth of this size.
instability and pain or discomfort.
▪ Facial measurement
- Use of Willis gauge Methods of Retruding the Mnadible

Horizontal Jaw Relation 1. Passive method

▪ Dentist guide mandible in
o Refers to the front to back, side to side
terminal hinge axis movement.
relation of the mandible to the maxilla.
2. Active method
o Classification of Horizontal Jaw Relation
▪ Patient responds to instruction
1. Centric Relation
by actively retruding the
- The basic horizontal jaw relation
mandible.
2. Eccentric Relation
a. Protrusion Techniques to retrude the mandible
b. Right and left lateral excursion
o Finger guidance
c. All intermediate position
o Central bearing point
Centric Relation o Stretch-relax exercises
o Tongue curling backward
o A maxilla-mandibular relationship in
o Swallowing
which the condyles articulate with the
o Reclining the patient
thinnest avascular portion of their
o Palpation of temporal muscle
respective disks with the complex in the
anterior- superior position against the
slopes of the articular eminence.
1. Static method
o The most retruded position of the
- Placing the mandible in centric
mandible against the maxilla at the
relation, then making a record of the
established vertical dimension.
2 rims to each other.
Centric Relation vc Centric Occlusion - Advantage : minimal displacement of
recording bases in relation to the
o Centric Relation
supporting bone.
▪ This position is independent of tooth
2. Functional Method
contact and is repeatable position.
- Involve functional activity or
o Centric Occlusion
movement of the mandible at the
▪ The occlusion of opposing teeth when
time the record is made:
the mandible is in centric relation.
▪ Includes:
▪ In natural dentition this may or may not
A. Chew-in technique by
coincide with maximum inter-cuspal
needles, house, essig,
position.
Paterson.
▪ In complete denture, CR=C0-MIP
B. Swallowing
 - Disadvantage: causes lateral and 1. Hinge movement
anteroposterior displacement of the 2. Translatory movement
record base. - Forward or protrusive
3. Graphic Method - Direct lateral side shift (Bennett
- Involve intraoral or extraoral tracing movement)
devices, with a central bearing point - Translatory movement that occurs
secured to the record base. when the mouth is opened wide.

Recording Medium/ Materials Used in Envelope of motion

Recording CR
▪ Border movements of the
▪ Plaster mandible
▪ Wax ▪ Types:
▪ ZOE paste 1. Envelope of motion in
▪ Cold cure acrylic resin sagittal plane
▪ Warm staple wires 2. Envelope of motion in the
▪ Pins frontal plane
3. Envelope of motion in the
Complications in Recording CR
occlusal plane.
Biologic:
Articulators
- Realeff
Mechanical device that represents the TMJ and
- Neuromuscular problems’TMJ
jaw members to which maxillary and mandibular
abnormalities
casts can be attached.
Mechanical:
Parts of an Articulator
- Ill fitting bases
o Upper and lower arm/member
- Excessive pressure
▪ Represents the maxilla and
Psychological mandible where casts are
attached.
- Patient factors
o Mounting plates
- Operator abilities.
▪ Connects the casts to the
Mandibular Movements articulator arm
o Condylar Analogues
o Mandibular movements occur during:
▪ Represents the condyle
-Mastication
o Condylar guidance
Speech
▪ Represents the slope of the
Swallowing
articular eminence which guides
Respiration
the movement of the condyle.
Facial expression
▪ Can be fixed or adjustable or
Parafunctional habits like clenching and
customized
bruxism.
o Incisal guide pin
▪ Represents the vertical
dimension at occlusion
o Incisal guide table
▪ Represents the lingual slopes of
the maxillary anterior teeth along
which the lower incisors move.
▪ Can be fixed or adjustable or
customized.
1. Simple Hinge
▪ Accept only centric relation
record
▪ Can be opened and closed only
▪ Also called one-dimensional
instrument because only one
interocclusal record is necessary
for its adjustment and use.
2. Mean value
▪ Allows lateral and protrusive
movements based on average
determinations.
▪ Condylar guidance angle and
incisive guidance are fixed, 30
and 10 degrees respectively.
3. Semi- adjustable
▪ With individually adjustable con