delivery of complete dentures ,prostho lec 11

8/3/2019 Delivery of Complete Dentures ,Prostho Lec 11

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DELIVERY OF THE COMPLETED DENTUREIn the lab we are doing setting of teeth now after this "after finishing the setting of teeth"which is laboratory step then the technician will send the teeth in wax trial denture to the

dentist.

The dentist will do the try-in. After the try-in, the dentist will send back the trial denture

to the technician .

The technician will process them in to cure acrylic and send them back to the dentist.

The dentist will insert them (or will deliver them) to the patient, so the delivery of thecomplete denture is the end result of the lab work and clinical work.

Now we want to insert them in patient mouth

Delivery stage is not important; it is just taking the dentures and insert them in the

mouth.

And that is WRONG.

The delivery stage is very important stage clinically and very important also for the

assessment of complete denture.

SLIDE (2)

The first thing we do is what we called it Dentist Evaluations so you need to evaluate thecomplete denture ok? .

So you have delivery visitandfollow up visits.

" the dentist evaluate is the success of the complete denture and the delivery visit and

follow up visit"

,compulsory because most of the timeoptional is somethingNOTvisit isfollow upNow,

most the complete denture they have complains at follow up visit.


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So at the delivery visit you evaluated and you think these are successful dentures but

some time or most of the time the patient comes back to you with complains like over

extension, causing ulcer, inability to eat properly, problems with occlusion and a lot of

things.

So you have to do proper evaluation at delivery visit and at the follow up visit.

We have Patient Evaluations

You evaluate the denture in the term of scientific information about success of the

denture like retention , stability, support, esthetic,for tic occlusion.

Now the patient dose not know about these things, the patient evaluate the denture in

term ofaesthetic appearance "is the most important thing to the patient" andfor tics .

but you can't assessbitehe tries to chew or to bite and he will evaluate theSometimes

function shear side although some patients bring some types of food to eat onshear side

but it dose not evaluate.

To evaluate the ability of chewing ,you need to send the pt home then he comes back

after ONE week assessing the ability of chewing because he will not chew only one type

of food, he will chew different types of food.

Now we have Friend Evaluation

Is very common for who wearing complete denture to have escort (moraf8) with them .

The friends evaluations usually based on one thing which isesthetic appearance they tell

them if the denture are esthetically acceptable or not, so the friends evaluation might be

misleading to the patient , sometimes you find the patient satisfies to appearance but the

escort or friends is not satisfy and they affect negatively to the satisfaction of the patient

.

At the end if the patient is not satisfied the treatment will be failure whatever you did "if

you did the best denture in the world ,if the patient is not satisfied the end result isfailure"

So we need to have dentist evaluations ,patient evaluations and friends evaluations , and

all of these at the end they satisfy the demands of the patient ,esthetically and

functionally

The patient should be able to eat , to speak properly, and the appearance is acceptable to

the patient and to the people around.

SLIDE(3)

Now we will talk about Denture Insertion .


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The first thing ,before inserting the dentures in the patient mouth the dentist u have to

technical errorcheck for

Don't expect the technician or the technical work will be perfect

((in this year you do technical work and you can see how many mistakes you do in the

technical work, the same thing for technician they are human being like you but they arewith more training and experience but still they do mistakes or sometimes they don't

know where the mistake is, for that we teach you how to do lab work to know the

mistakes of technician so you have to check the technical errors))

The dentures come from the lab in bag filled of water the first thing you do, you open the

bag and you remove the denture, you reins them (wash them )and with your finger, you

check all the margins, all the border and the fitting surface and all-around of the denture

>if there is sharp marginsharp marginsanyis? to check if thereWHYwith your fingerorreliefyou have toth the first thingmou'sDON'T insert the denture inside the patient

is the most important step .. thiseliminate this sharp margin

Number 2 with upper and the lower denture you check them together to see if the

occlusion is good

If the teeth don't interdigitated outside the patient mouth they will not interdigitated

inside patient mouth.

SO what you check outside the patient mouth, you should check theFinishing , Polishing ,

if there are any sharp margins and you check the occlusion of the dentures .

It Is very common for the technician to leave stone (Jeps) between the teeth after the

flasking procedure , so you have to check if there is any remaining between the teeth.

If your patient is already denture wearer you have to tell him at[ try-in] stage to keep the

the denture?WHYbefore insertion2 days2th for at leastold denture out of his mou

foundation area is covered by soft tissues and the soft tissues are compressible ,so if thepatient wears the old denture, the denture foundation (soft tissue) takes the shape of

fitting surface of the old denture , so the new denture might not fit properly and you ask

before insertion fordays22th at leastmouhispatient to take the old denture out ofthe

recall of the soft tissues so that the new denture fit the soft tissues and it settle on the

soft tissues and it change the shape of the soft tissues according to the new fitting surface

.

SLIDE(4)


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Now if you have basal surface errors

=How many surface we have in the denture ?

We have 3 surfaces 1-polished surface 2- occlusal surface 3- fitting or integrally surface

So the Elimination of The Basal Surface Errors ,

Thepolished surface should be highly smooth, the polished surface consists of smooth

part of the denture which is not in contact with denture bearing area plus the buccal and

the lingual surface of teeth.

NOTE: the buccal and lingual surface of the teeth are NOT part of the occlusal surface,

.Polished Surfacethey are

Now , the fitting surface

ause, bec?Whytouch the fitting surfaceDON"Tideally weImperfections,nohashouldIt s

the fitting surface "the flex" is the anatomy of the denture bearing area, so the fitting

andacrylic voidsareor theresharp areaexcept if we havearea should not be touched

you need to eliminate any imperfections exist on the fitting surface.

You have checked the polished surface and fitting surface, now you have to insert the

denture in the patient's mouth , you can't insert both of them(upper & lower) at the same

time. The ideal way is to insert denture by denture , you can insert the upper or thelower first, but the ideal way is to insert the UPPER first, because the upper determines

the esthetic outcome.

(retention means resistantcheck the retentionyouthenSo you insert the upper denture

to the dislodgment "moving")

We have different type of retention to check;

>>The 1st

thing the vertical dislodgment.

In upper denture after you insert it you'll hold the denture with index and the thumb

finger and you try to pulled it down.

Now if you can do this easily , the retention is questionable , if you have resistant, this is

good.

>>The 2nd thing you put the thumb finger on the right side and you push if the left side

dislodges this means the retention is questionable


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>>The 3rd

thing the thumb finger on the left side and you check the retention on the right

side

>>The 4th

thing "is very important " to check the post dam area , the retention posteriorly

by your thumb finger or index finger on the anterior teeth if it dislodges posteriorly easily

this means the posterior palatal or the post dam is questionable .

Keep in your mind this is insertion, still the dentures are not complete settle and the

dentures bearing area are not designed exactly to the fitting surface, so what you see at

the insertion will be better at follow up , because the denture will settle at follow up

stage and the soft tissue are compressible ,so the retention at the follow up stage is

BETTER than retention the insertion stage.

If you think that your retention is not 100%. that's fine, [but not poor retention , when

you put denture and it falls down by itself that's not good]. If you find that small forcewill dislodge your denture don't rush and say this is poor retention and we need to adjust

the denture by relining or other procedures. no, you have to give it time for the follow up,

in most cases they improve retention.

resistance to lateral and rotationalthe(which isstabilitythecheckhave toyouNow

functional forces . )

We check with 2 thumbs one on right and other on the left if you press on the right you'll

feel axial to the left this means poor stability and if you insert your index finger and

thumb finger and rotate the denture and it rotates significantly this means poor stability

.stability is the most important factor for the success of complete denture because

stability is the resistant to the lateral and rotational forces during function and this is

what the patient needs which is stable denture during function .if you have poor stability

you might have to reline or remake the denture .

Most of the time the cause of the poor stability is technician error.

After we checked the retention and the stability of the upper denture we remove it and

insert the lower denture .

Again we check the retention, as the upper

Upward forces , force on the right side , force on the left side and force anteriorly to

check the retromolar pad area retention ,and we check the stability by moving the

denture from side to side and you put pressure on the both side of the denture to see if

there is any rock.


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Note ; DONT misleading with a little movement of denture cuz the denture is fitting on

soft tissues and soft tissues move a little bit and this is normal.

We have minor degree of movement but not poor stability when you put your finger on

one side the other side is rocks this is mean distortion in the acrylic .

properhave theshould be rounded andof the dentures. itthe flangesNow you check.impression in border molding

ndand that was important in the 2extensionthickness and

the aim was to register the functional depth and width of the sulcus,which is the

thickness and the extension of the flanges .why we need to register that? to have good

peripheral seal and so we'll have good retention and during function the muscledont

dislodge the denture because the edges of the flanges of the dentures are in the

functional depth and in the width of the sulcus .

How do we check if the flange is over extended or under extended ?

When you insert the denture you'll flag the lips and cheeks and you'll see the functional

sulcus if the flange is like this that means it is short and it need to be adjusted if it is

pushing the sulcus, this means over extended and it needs to be adjusted also .

Sometime the patient complains about sore areas or painful areas . Even if the patient

dose not complain cuz the denture dose not completely settle at insertion.

pressure indicating pasteWe have material called

It Is a useful paste that used to check pressure area or high spot of fitting surface when

you insert the denture you can't see the fitting surface you don't know where are the

pressure areas on the soft tissues by this material you paint the fitting surface with a thin

layer and then you insert it in the pt mouth.

If there is any pressure areas the paste will be washed away and the acrylic will appear,

and the other areas paste will stay on them.

Where the paste has washed away, it should be relief .

SLIDE (5)

Look at this upper and lower denture, look at the surface how it is polished, these are

relieved areas of the frenum. look how the flanges is, and the margins how it's rounded,

carving, finishing , polishing every things is fine .

SLIDE(6)


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Now we need to check occlusion

We need to check the upper and the lower when they occlude cuz this is important thing ,

when the pt functions it is related to occlusion

It's common to have errors in occlusion

Let's say every day(bel 3yadat) we have 5 to 10 insertions, at least 2 to 3 have major

errors of the occlusion to a degree that you have to remake the denture.

most of them have minor errors of the occlusion

What are the causes of the errors in the occlusion?

When we try the denture at the stage of [Try-in] and the occlusion was good.

The final denture is almost copy of the [try-in] denture ,,, so what happened here is

.change of TMGs

Changes of the TMGs don't happened in one week. over time, suppose the try-in has one

period of time you might have errors in the occlusion or the pt has Diseases at TMG so

that at try-in we have certain bite and at insertion we'll have different bite

Inaccurate maxillomandibular relations

When you do the registrations of the maxillomandibular relations ,and that registrations

were not accurate, that lead to errors of the occlusion

inaccurate mounting

now we did what we call it ((jaw relation registration)) and you send the record block to

the technician. When he do the mounting, he moves the relation.

This kind of errors(inaccurate mounting) you can discover it at the try-in stage, but

sometimes at try-in stage the teeth are fixed with wax and you can't check minor errors

but at insertion because the teeth are fixed by heat cure acrylic. the minor errors can

.cause frank errors in occlusion

articulator:vertical dimensional occlusal on thetheChange of

At setting of the teeth, the pen of the articulator might be elevating form incisial table. in

this case the vertical dimension has been changed (increased)

Sometime the pen stays in touch, but we have spaces bt the teeth. The pt mouth will

have decreased VDO


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Movement of teeth at dewaxing

When we do processing for the denture, we have step called dewaxing, when you

eliminate the wax around the teeth but sometimes the teeth move. At the try in the teeth

were perfect but during processing, the teeth moved. we would have errors at the

insertion stage.

of theclosuretheif you don't completeflaskwe have something calledprocessingAt the

flask or you use too much pressure to close the flask this may lead to errors in occlusion.

nsist of 2,, flask coin the occlusionto avoid mistakesflasking should be done properlySo

parts if they don't close properly and we have space bt the 2 parts this will affect the

occlusion Or when you use excessive pressure on the flask to close it ,this may lead to

move the teeth and this lead to errors in the occlusion.

, most of dentureshrinkage of acrylicis theitInherent property of acrylic whichWe have

at try-in if you look at them carefully the occlusion is a little bit different WHY cuz the

acrylic shrinks (polymerization shrinkage ) and when it shrinks the teeth would have

minor movement

We can't avoid the shrinkage but we can minimize it by the follow of the manufacturer's

instructions in mixing and in processing to keep the shrinkage as small as possible and it

doesn't affect the occlusion of the teeth.

to expansion.sand leadwater absorptionwhat we call itacrylic doOver time the

even the property of acrylic when it's wet different from when it's dry ,,, over time may

lead to occlusion errors cuz of water absorption

Sometimes the technician finalizes the dentures and put it in the bag of water and he

sends it to the doctor, the pt doesn't come for 2 or 3 months and the dentures still in

water there might be water absorption and this causes expansion of the denture and

leads to occlusion errors.

All of these they can cause errors of occlusion.

SLIDE(7)

How do we check the occlusion clinically ?

articulating paperWe have paper called

This articulating paper for complete denture is like horse shoe shaped , for dentate it is

straight.


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from one side blue , and thethat marks when the pt biteperpaaisArticulating Paper

other side red so that you can check the occlusion at centric, and you can check the

occlusion at eccentric with different colors so that you can differentiated between

contacts at centric occlusion and contacts at ex-curve movement or at eccentric occlusion.

Selective GrindingNow you do what we call it

You check with the articulating paper

[Ideally the anterior teeth are out of the occlusion "out of contact"]

upper,en contacts distributed in all posterior teethsee evtoideallyisSelective Grinding

and lower

Now with selective grinding when you insert the articulating paper you see for ex the

lower 2

nd

premolar buccal cusp has a dark dot "bold dot" and the others have light dots,this means buccal cusp of the lower 5 needs to be grind. So here the selective grinding is

needed.

Now if you have minor mistakes, selective grinding in pt mouth might fix the problem but

the selective grinding in the pt mouth is Not accurate for many reasons:

denture.thehifting ofS;onest

The 1>>

At insertion time, is the first time for pt to bite on this new denture so he isn't use to thishe might shift the denture or the dentureor to this occlusion yet, somt3awed""Mobite

.bases

And when you start registering you think this is the true high spot so you keep grinding

while it's not, cuz the denture had been shifted

Tissue Distortion;neond

>>the 2

The complete denture bites on the soft tissues, if we have an area with high spot "or

premature contact" when the pt bites on the soft tissues, this area will have compression

itstime. At thatto think the occlusion is goodyousmight misleadTissue Distortionso.

high in this area but because of the distortion of the soft tissues happened. you think it's

acceptable occlusion.

eccentric closure.one;rd

>>the 3

You ask the pt to bite at centric and you think the pt was biting at centric but he deviated

the mandible at this registration so you end up with multiple marks but they are not truemarks they are false marks.

saliva;oneth

>>the 4


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The articulating paper it's a paper, with saliva it becomes wet and can be easily torn, and

it doesn't mark with saliva so it's not easy for you to check these marks with articulating

paper.

All of this factors they make the selective grinding in pt mouth is not accurate procedure.

SLIDE(8)

.LABis to do the selective grinding in thesthese factorofThe solution

Pre Centric CheckorCheck RecordsorClinical RemountingHOW? We do what we call it

Record

What's the main objective of clinical remounting??

To do the selective grinding on the articulator.

Why?" For the reasons that I said for few minutes"

Cuz the selective grinding in the pt mouth is not accurate enough for many reasons and

Distortion of The Soft Tissuesthe main reason is the

For ex: the pt have very minor high spot on the right side and he bites on the tissue. The

tissue distorts and you can't check if this is high or not.

While on the articulator the denture occludes on the cast and the articulator metal, so

even microns you can check them by the articulating paper and you do remounting for

the denture.

""Now quickly I will talk about it cuz the doctor sarah should give u something about

occlusion and I don't know what she will talk about ""

AluwaxWe have special type of wax called>>

This aluwax you enter between the upper denture and lower denture and you bring the

posterior teethon the mandibularyou place the aluwaxandaluwax

(the two.or retruded contact positionguide the pt to bites at centric relationyouhen>>T

names are the same meaning )

Now when the pt bites you don't want the teeth to contact cuz when the teeth contact

we will go back to the same idea of high spot that will cause the denture to move.

We want the teeth to be very close to each other but without contact.


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How can we check this ? when you remove the lower ,if you see any perforation in the

wax, this means there was contact between the teeth and you have to repeat it.

So ideally you see the indentation of the upper teeth in the lower wax without

.pre centric check recordtheitcallpenetration "perforation" of the wax, for that we

precentric relation but becauce the teeth don't contact we call itis on theThis relationdcentric check recor

""Imount the upper and lower denture on the articulator using face bowAfter that we>>

don't want to talk about the face bow cuz it is different topic""

Now we have the upper and the lower denture on the articulator with wax between

them.

>>We'll remove the wax and the incisal pin, so the teeth contact, if there is a high spot.using the articulating paper and you have to grind itbyyou can see it right away

>>We have 4 types of adjustments:

e , thislos& Cpenwhich it is On contactadjustment on the centric relatioWe have

not in contactisand we do it when the incisal pinfossaandcuspsrelation is between

with the incisal table.

andleft,right(you can notice that the articulator can movelateral movement>>We have)posteriorly

So we have movements anterioposteriorly , right and left. we will do this movements

with the incisal pin in contact with the incisal table. so that it guides you to these

movement.

working side or balancing side]-[nonand[working side]In lateral movement we have

The working side: is the side toward the mandible moves y3ny when you ask the pt to

move to the right

The right side will be >> the working side

And the other side will be >> the non-working side or the balancing side

""Now I will talk about very important subject which you will asked about it in the next

years ""


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SLIDE (9) "plz refer to slides to see the pic "

Let's take the 1st

position which is (A) position when the articulator opens and close

What is the possibility of interferences ?

Which cusps are the function cusps?

buccallower&upper palatal

Now the possibility of the interferences is high in

orfossa of the lowerwithupperPalatal cusp of the

fossa of the upperwithBuccal cusp the lower

fossaein this area we eliminate from thehigh,it isIn this case if

the vertical dimension will be,functional cusps if we grind them? Cuz these are theWHY

reduced cuz they are the one that determine the vertical dimension.

>>>now in the case of centric if it was high and it was cusp to fossa relationship you have

to eliminate the acrylic from the fossa

to the rightwhen the pt movesworking sideNow we will go to the

>>The possibility of interferences will be on

orbuccal slop of the lower buccal cuspand thepalatal slop of the upper buccal cuspthe

[buccal slop of the lower lingual cuspand thethe palatal slop of the upper palatal cusp

(B) position ]

lowerandcuspupper buccaligh spot in this area we will eliminate fromif we have h

functional cusps-noncuz they arelingual cusp

BUCCAL UPPER CUSP & LINGUAL LOWER CUSP to keep theruleBullthis is what we call it

vertical dimension of occlusion.

So the rule of working side is the BULL rule we remove from buccal upper and lingual

lower.


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Now the non-working side, when the pt move to the right, the mandible will move to the

left.

>>In this case the interferences will be in

[ (C)lingual slop of the lower buccal cuspwithslop of the upper palatal cuspuccalB

position ]

Functional cusptheonwe workworking side-In the case of non

In this case I have to grind from the functional cusps but I don't take from the height of

cusps, I have to take it from the slop of the cusps so the vertical dimension occlusion

retained as it is to the high degree.

So in the non-working side we will grind from the slops of the functional cusps to avoid

significant reduction of the vertical dimension of ccclusion

These three (A,B,C) are very important and we call it selective grinding [to know how to

remove from fossa or cusps , to remove from buccal or palatal cusps or buccal or lingual

cusps, or to remove from the slops of the cusps. This's very important topic]

Those are the movement that I was talked about slide 10,11.

Notice how it moves, the interferences you have to remove it all.

SLIDE (12)

Now the mesiodistal when it moves anterioposteriorly

The possibility of the interferences is in

mesial slops for lower posterior cuspsof thedistal slops for mesial upper cuspsthe

In this case we grind the slops of cusps.

SLIDE(13)

Notice here how it's look when you do selective grinding on the articulator and the marks

distributed on the teeth. for ex: on this case you have to remove all of these marks cuz

we're talking ideally we don't want marks on the anterior teeth on the complete denture.

SLIDE (14)

Look here how is the occlusion in the pt mouth


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The 1st

pic is on the centric ,and the 2nd

is on the eccentric .when the pt moves notice here

how we get balanced occlusion. all cusps guide to the lower posteriorly

SLIDE (15)

What do we aim in complete denture occlusion? ""as what doctor 3sam told us""

We aim for what we call it balanced occlusion or articulation

What dose balanced occlusion means?

Balanced occlusion by definition: bilateral simultaneous contacts at static and dynamic

positions of the lower jaw

That means in every position, the upper moves against lower and it should be at least 3contacts right, left, anterior..WHY?

Cuz complete denture is not natural teeth. when you have a contact on one side,

dislodgment of the other side might happened.

Now in the natural teeth we have (Christensen's Phenomenon.).

.posteriorlyteethseparation ofwill haveyouprotrusion anteriorlysomeone of you doIf

separation of teeth are dis occlusiontheChristensen's Phenomenon.what we call itposteriorly upon protrusion.

In complete denture, we prefer Contact we DON'T want Christensen's phenomenon in

complete denture, WHY?

To avoid dislodgment during function and this what's we call it balanced occlusion

in literature, do we really need balanced occlusion in complete denture ? the answer is

yes and no,

Don't think that the complete dentures that we did have balanced occlusion. most of

them have not.

How it will be successful? cuz the balanced occlusion is the movement like this!!!. Now

during function are the teeth in contact?? NO

cuz we will have bolus of food, so already we have separation of the teeth and usually

the teeth don't contact during function only at the end of chewing cycle.

.practicalmore thantheoreticalsion is somethingBalanced occlu

But still in the complete denture occlusion, we aim for balanced occlusion.(we try to do it)


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thction, this will be on empty mou? Because it has advantage in stability during funWHY

but when the pt function with bolus of food it's not that important clinically.

""To this point we finished the insertion completely""

SILDE(16)

""Hala2 r7 nraw7 el pt""

We have very important instructions we must give it the pt

These instructions are:

every pt will behave or will accept the denture in his way:Individuallity of pt-1

""Sometime I see pt, and the students do for him denture with mistakes and I wonder

how he wears like this denture and the pt is happy with it. and some pt, the student do

for him excellent denture and he is unhappy""

So there are big individualities for pts

""and in the 4th

year I will tell you about complete denture, pt psychology and all of this

issues""

You give instructions according to the pt.

Some pts even if you tell him about instructions he don't understand those instruction,

cuz he is not highly educated so when you give him instructions is wasting of time

So you have to give instruction to his son or daughter

Some pts are highly educated and they can speak English

Those kind of pts , the instructions will be easy for them.

you tell the pt this is the final appearance and usually it can't be change but:Apperance-2

it may has minor change according to the muscle.

If the pt isn't happy from the appearance, that means failure of treatment.

and don'tnatural teethnotthese are denture teeth,: you say to the pt lookmastication-3

accept that you can chew everything.


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of natural teeth(1/10)one tenthisccording to the study the deficiency of masticationA

specially if he was first time denture wearer, and you'll tell him this is the first time

mastication for you and the chewing ability will become better over time, and at the

avoid anteriorposterior teeth,theon,not sticky food,small pieces of foodbeginning try

ability of masticationthe,oS.masticationtheuntil you get you used toteeth mastication

will get better.

Appearance is almost the same

Soft food, small pieces on posterior teeth

Avoid sticky and hard food

So many pts try the denture on the nuts (moksarat) this is unfair and doesn't make sense

cuz he can't chew nuts until he used to the denture

the lower denture if the denture designed inofwill help stabilizeit>>TongueNow, the

proper way.

Some of students will do setting of teeth in the lower, teeth will be lingualy tilted and the

tongue will be destabilizing factor in this case.

ction ofaccording to construfactordestabilizingfactor orstabilizingwill betongueSo the

the complete denture , the technics of clinical or technics of laboratory.

denture. The posteriorupperdenture and thelowerTongue with time will stabilize the

third of the tongue will stabilize the upper denture.

over time the pt accommodatesandinsertionthe: if the pt has good speech atspeech-4

to the new dentures and he can speak better. if at the insertion the speech is not perfect

that doesn't mean remake . No

With time the pt will get used to it

:Oral Hygiene-5

denture stomatitiscuz the poor oral hygiene will causesThe pt should clean the denture

,chronic candidosis,inflammatory papillary hyperplasiaoral patho ),elly a5dtoh bel(

(bad smell)feltid order,fungal infection

So the pt should have good oral hygiene

By using soft brush after every meal under tap water to clean the denture


18/19

SLIDE(17)

This pt with poor oral hygiene and has fungal infections

Notice the white and red color

And these are implants supported over the denture ( the denture will be over these

implants )

SLIDE(18)

1- Rinse after meals

2- soft brush for both dentures and mucosa

It's good to rub the mucosa with soft brush to avoid any black accumulation on the soft

tissue if you clean the denture but there was black on the soft tissueit's the same idea (it's useless"ma astafadna shi")

andit is tablet.cleansing agentdentures something calledselltheythe pharmacyIn-3

the pt puts it with water.

Usually you ask the pt in the first week to wear the denture at day and night to get used

to the denture.

After the first week we ask him to remove the denture at night for the soft tissues torelax and recoil back and keep the dentures in the [denture cleansing agent]

3- ask the pt to avoid abrasive pastes and it will cause abrasion for the denture

avoid strong bleaching agent some pt puts colorix and the denture will turned to white in

color

4- it's very common when you give the pt new dentures he may get trauma from it ,sometime he even can't wear the denture.

In this case You tell him to Remove the dentures, Put them in the denture cleansing agent

with water

And 1 to 2 days before coming back to me, Wear the denture.

In this way I can see the place of trauma or ulcers in the recall visit

SLIDE(19)


19/19

Recall visit usually is after one week of the insertion and this is not optional it is

compulsory

You have to do review even if the denture excellent at the insertion.

Most of dentures which are excellent at insertion have problems at review

This means the recall visit is not optional it is compulsory very rare not having adjustment

at recall 95% of dentures have adjustment at recall visit

Again the same thing at recall

you examine denture bearing area

oral hygiene

occlusion

ulcers and hyperplasia

and you ask the pt if there is any complains regarding the denture.

adjustment

The end. sorry for any mistakes I try my best >>>>>Done by

Seba M.Basheer HawassHadeel abud el-razaq

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Special thanks to Lilo and to ablah nazerah(Ranoon) and RawanOoo

delivery of complete dentures ,prostho lec 11

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