successful dentures part 2

8/13/2019 Successful Dentures Part 2

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Dalhousie Continuing Education

Dr. Mark Vallee BSc MS DDS DP FRCDC

Secrets to Successful DenturesPart II

Topics! Conventional Denture Treatment:

! Trends in removable prosthodontics.!Anatomy

! Maxillo-Mandibular Relationship

! Vertical Dimension

! Tooth Selection, Arrangement, and Occlusion

! Implant Supported Overdentures:

! Overdenture abutments

! Implant Placement

! Locator Abutments

! Converting a denture into an overdenture.

! Direct Pickup

Conventional Denture Treatment

Trends in RemovableProsthodontics

! Patient Demographics

! Esthetic Awareness

! Implant treatment

Patient Demographics

!Average lifespan of patients:

10

11

12

13

14

1960 1970 1980 1990

Perc

ent

30

40

50

60

1960 1970 1980 1990

Percent Edentulous

18+ yrs old

Percent Edentulous

65+ yrs old

Trends in tooth lossTrends in tooth loss



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!! Will there be a need for complete dentures inWill there be a need for complete dentures in

2020?2020?

!! Complete dentures patients will increase fromComplete dentures patients will increase from

33.6 million adults in 1991 to 37.9 million adults in33.6 million adults in 1991 to 37.9 million adults in

2020.2020.

!! The 10% decline in edentulism experienced eachThe 10% decline in edentulism experienced each

decade for the past 30 years will be more thandecade for the past 30 years will be more than

offset by the 71% increase in the adult populationoffset by the 71% increase in the adult population

older than 55 years.older than 55 years.

Esthetic Awareness

Esthetic Awareness

!An increase in esthetic awareness has promptedan increase in patient demand for qualityremovable prosthodontic restorative treatment.

Implant Treatment

! Out of 33 million edentulous patients only 2-4% have received

implant treatment

! Estimated 60% of patients are NOT given implants as a

treatment option

! Implant supported overdentures are now the standard of care for

the edentulous mandible

Anatomy

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a. Labial frenum

b. Buccal frenumc. Labial vestibuled. Anterior buccal vestibulee. Posterior buccal vestibule

Retrozygomatic spaceCoronoid bulge

f. Hamular notchPterygomaxillary notch

g. Fovea palatinih. Vibrating line

i. Residual alveolar ridgej. Palatal rugae

k. Incisive papillal. Median palatine raphe

m. Maxillary tuberosity

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a. Labial frenumFold of mucous membraneDoes not contain muscleLabial notch in denture isnarrow

b. Buccal frenumOverlies levator anguli oris

May be moved in an A-Pdirection by the actions of the

orbicularis oris and buccinator

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c. Labial vestibuleReflection contains no muscle

d. Anterior buccal vestibuleOverlies buccinator musclewhose fibers are downward andforward and limit the height and

thickness of the buccal flangee. Posterior buccal vestibule

Thickness determined by themasseter muscle

Coronoid process of themandible encroaches on thespace during lateral excursions

Labial and buccal flanges of thedenture must contact movable tissues

in order to make a seal

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f. Hamular notchPterygomaxillary notchDoes not contain anymuscles or ligaments tointerfere with the addition

of pressure with apostdam

g. Fovea palatini2 small pits representing

mucous gland openingsUsually located just

posterior to the vibratingline

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Posterior Palatal SealArea not a lineFunctions: border seal, prevent food

impaction beneath, improve retention,compensate for shrinkage of denture

resinPressure on displaceable mucosa thatcovers palatal glandsAnterior border junction betweenhard and soft palate; blow linePosterior border (vibrating line)

junction between movable andimmovable soft palate; ah line

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h. Vibrating lineImaginary line across palate

Connects thepterygomaxillary notches

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Denture bearing areas

i. Residual alveolar ridge

Crest is primary stressbearing area

Fibrous CT leastdisplaceable and bestable to carry the stress ofmastication

j. Palatal rugaeSecondary stressbearing area

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k. Incisive papillaGuards the incisivecanalPressure will interfere

with the blood and nerve

supply causing a burningsensationProvide relief

l. Median palatine raphe

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a. Labial frenumb. Buccal frenumc. Lingual frenumd. Labial vestibulee. Buccal vestibulef. Residual alveolar ridgeg. Buccal shelfh. Retromolar padi. Pterygomandibular raphe

j. Mylohyoid ridgek. Alveololingual sulcus

l. Retromylohyoid space

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a. Labial frenum

Fold of mucousmembraneDoes not contain muscle

b. Buccal frenumOverlies depressor

anguli oris (VII)Movable by the

buccinator and orbicularisoris (VII) resulting in a

wide notch in the denturec. Lingual frenum

Overlies genioglossusmuscle (XII)

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d. Labial vestibule

e. Buccal vestibule

Entire periphery of denturemust end in soft tissuesStability of denture mustcome from the maximum useof all bony foundations wheretissues are firmly and closelyattached to bone

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Denture bearing areas

f. Residual alveolar ridgeg. Buccal shelf

Bounded laterally by the

external oblique ridge andmedially by the crest of the

ridgeAttachment of buccinator

muscle (VII)Buccal flange rests uponbuccinator and should extendas far as the tissues permitMasseter muscle (V3) maycrowd buccinator forwardagainst the denture causing an

indentation at the DB angle

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h. Retromolar pad

Contains:Retromolar glandPterygomandibularrapheBuccinator muscleTemporal tendon

Underlying basal bone isresistant to resorptionCoverage will provide someborder seal

i. Pterygomandibular rapheExtends from the pterygoid

hamulus superiorly to thealveolar ridge inferiorly under

the retromolar gland

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j. Mylohyoid ridgeAttachment of mylohyoidmuscle (V3) which forms themuscular floor of the mouthFibers are almost horizontal infront of the hyoid where they jointhose of the opposite side to

form a rapheAt the level of the hyoid they

pass almost vertically downwardto insert into the hyoid

k. Alveololingual sulcusSlopes toward the tongue to

permit action of the mylohyoidLength of flange distallycompared to anteriorly is greaterowing to the changed length anddirection of the mylohyoid fibers


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l. Retromylohyoid spaceDL extension determined

by styloglossus (XII)Posterolateral extension

determined by superiorpharyngeal constrictor (X)and palatoglossus (X)Overextension maycause pain on swallowing

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Maxillary Tuberosity

Coronoid Process of mandibleMandibular Condyle

Articular Eminence

Glenoid Fossa

Shadow of tongueStyloid Process

Mandibular Canal

External Oblique Ridge

Pterygomaxillary FissureNasal Septum

Hard Palate

Mental ForamenEarlobeLip Lines

Hyoid Bone

Facial Artery Notch

Cervical Vertebrae

OrbitAnterior Nasal Spine

Mandibular Foramen

Symphysis

EAMZygomatic Arch

Pharynx

Maxillo-Mandibular Relationship

Maxillary Relations! Incisal Display! Dental Midline

! Occlusal Plane Orientation! Facebow

Maxillary Relations

! Incisal edge of centralincisor in relation to

the lip line at rest

! Young woman 3 mm

below lip line at rest

! Young man 2 mm


! Middle age 1.5 mm


! Elderly (>80) 0 mm

below to 2 mm above

lip line at rest

Rest After Wax Adjustment

Maximum Smile After WaxAdjustment

Incisal Display at Rest

Natural Dentition


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Maxillary Relations

Rest After

Smile After

Dental Midline

Maxillary RelationsDental Midline

Maxillary RelationsDental Midline

Maxillary Relations

! Frontal Plane

! Parallel to

interpupillary line! Fox Plane

Occlusal Plane Orientation

Maxillary RelationsOcclusal Plane Orientation

Maxillary Relations

! Sagittal Plane! Parallel to Campers Line

! Inferior border of the ala ofthe nose to the superiorborder of the tragus of theear

! Frankfort horizontal plane! Orientation to the external

auditory meatus andorbitale

! Cephalometric landmark

Occlusal Plane Orientation

FHP

CLOP


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Mandibular Relations

!

Vertical Dimension! Centric Relation

Vertical Dimension

! Adjust occlusal plane! Parallel to maxillary rim

!

Clinical assessment of verticaldimension! Anatomic landmarks

! Physiologic rest position

! Pre-extraction records

! Existing prosthesis

! Esthetics

! Phonetics

! Swallowing

! Average occlusal rimdimensions

Vertical Dimension

! Anatomic Landmarks

! 2/3 up the height of the retromolar pad

Vertical Dimension! Anatomic Landmarks

! Level with the lower lipat rest

Vertical Dimension! Esthetics

Vertical Dimension! Phonetics

S F

Ch M


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Vertical Dimension! Swallowing

During swallowing After swallowing

Vertical Dimension!Average Occlusal Rim Dimensions

Maxillary 22 mm Mandibular 18 mm

Tooth Selection

Anterior Tooth Selection


!Anterior teeth areprimarily selected to

satisfy estheticrequirements

! Posterior teeth areprimarily selected to

satisfy masticatoryrequirements/

occlusion


Guides! Pre-extraction records

! Photos, diagnostic

casts, old radiographs

! Existing dentures

! Patients facialcharacteristics

! Patients gender,personality, age

!Arch size and shape

! Patients preferences


! Shape

! Square, tapering,

ovoid

! Size

! Length, width,

circumference

! Shade


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Dentogenics concept

! Gender

! Male rugged with square teethand bold central incisors

! Female pronouncedcurvatures, rounded point angles

! Personality

! Vigorous or delicate maxillarylateral varies more in size, form,

and position

! Age! Young tapered, ovoid, rounded

teeth

! Middle somewhere betweenyoung/old

! Old square, sharp corners

Shape Anterior Tooth Selection

! Ovoid! Pronounced gingivo-incisal

curvature which tends to

disperse light and create asoftened appearance

! Tapering! Rounded contours which

taper towards the cervical

ridge

! Moderate gingivo-incisal

curvature

! Square

! Central incisor is dominant and gingivo-incisal curvature is

moderate

! Offers maximum light deflection and creates a bold effect

50

Shape


! Width of 6 anteriorson a curve

!Average 46-56 mm

Size Anterior Tooth Selection

Wax rim & ruler

Commissure of lips represents distal surface of canine

Size


Major rugae of palate points to canine position

Size Anterior Tooth Selection

Exaggerated Smile Length

! High smile 11%

! Reveals total length of

maxillary anterior teeth and acontinuous band of gingiva

! Average smile 69%! Reveals 75-100% of

maxillary anterior teeth and

interproximal gingiva only

! Low smile 20%

! Displays less than 75% ofmaxillary anterior teeth

Size


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Anterior Tooth Selection Size & Shape

Commercial Products


! Determine the facialoutline

! Compare form of faceto vertical lines

! Square tapering

! Determine the size of

the maxillary central! Indicator is

proportioned in a ratioof 16:1

! Width 9.25 mm

! Length 11 mm

56

Size & Shape

Width

Length


Take a picture Insert it into a program

57

Size & Shape Anterior Tooth Selection

! Portrait shade guide

Shade

Anterior Tooth Selection! Aim to harmonize

between color of the

skin, hair, & eyes

! Guides

! Complexion

!

Hair color! Eye color

! Age

! Personality & activity

! Patient desires

! Need to educate patients

Shade Anterior Tooth Arrangement

! Position has been tentatively established during the

clinical refinement of the maxillary occlusal rim

! Adequate lip support

! Proper phonetics


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Anterior Tooth Arrangement

! Anterior teeth are set primarilyfor esthetics not function

! Considering creatingasymmetry after discussionwith patient

! Each tooth should appear asan individual tooth

! Gingival 1/3 of maxillaryincisors provide lip support

! Incisal 1/3 of maxillary incisorsprovides esthetics

! Maxillary anterior teeth are seton the smile line

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General Arrangement

Considerations

62

Maxillary Anterior ToothArrangement

! Central

! Labial surfaces flush with wax rimcontour

! Long axis slightly distal to

perpendicular

! Incisal edge is at occlusal plane

! Lateral

! Long axis at an angle more distalthan central

! Incisal edge is slightly aboveocclusal plane

! Canine

! Long axis at a more distal anglethan lateral

! Cervical is prominent, incisaledge looks tucked-in

! Incisal edge is at occlusal plane



Labial surface of the centrals usually 5-7mm anterior to incisal papilla

65


! Ratio of 1.618:1

! Proportion between a

larger part and a smaller

part! Width of the central

incisor is in the golden

proportion to the width of

the lateral incisor

Golden Proportion

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Maxillary Anterior Tooth

ArrangementEsthetics of naturalteeth Avoid lampshade

convergence of roots!


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Mandibular Anterior ToothArrangement

Mandibular Anterior ToothArrangement

Teeth are set over bone

Anterior Tooth Arrangement Anterior Tooth Arrangement

0 mm Overbite

2-3 mm Overjet

Tooth Selection

Posterior Tooth Selection

Goals of Complete DentureOcclusion! Minimize trauma to the

supporting structures

! Preserve remaining

structures

! Enhance stability of the

dentures

! Facilitate esthetics andspeech

! Restore masticationefficiency to a reasonablelevel

! Decrease lateral forces tothe residual ridges

Right Working

Left Working


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General Concepts of Denture

Occlusion

Common Features! Functional anatomy is the main

determinant of denture tooth

position

! Simultaneous, bilateral posteriorcontact in centric relation

! Centralization of centric occlusalforces over the mandibularresidual ridges

! Buccal-lingually

! Anterior-posteriorly

Centric Relation

Occlusal Spectrum

! Anatomic! Balanced occlusion

! Lingualized

! Balanced occlusion

! Non-balanced occlusion

! Non-anatomic (Monoplane)

! Balanced occlusion

! Non-balanced occlusion

! Neutrocentric

Occlusal Spectrum

anatomic

semi-

anatomic

Lingualized

(lingual contact)

non-

anatomic(balancing

ramp)

non-

anatomic

Posterior Tooth Selection

Criteria

! Resorbed or flabby ridges

! Physical condition of the patient

! Patients who clench or brux

! Previous denture occlusion

! Ridge relationship

! Immediate dentures

! Opposing arch

Posterior Tooth SelectionIndications

Anatomic

! Good residual ridges

! Well coordinated patient

! Previously successful withanatomic dentures

! Class I ridge relationship

! Denture opposes naturaldentition

! When Lingualizedocclusion is desired

Non-anatomic

! Poor residual ridges

! Poor neuromuscular control

(Bruxers, CP, etc.)

! Previously successful with

monoplane dentures or

severely worn occlusion onprevious denture

! Arch discrepancies

! Class II or III or cross-bite


! Except when opposing naturaldentition

! Potential poor follow-up


Anatomic

! Good residual ridges

Non-anatomic

! Poor residual ridges


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Anatomic

! Well coordinated patient

Non-anatomic

! Poor neuromuscular control(Bruxers, CP, etc.)


Anatomic

! Previously successful withanatomic dentures

Non-anatomic

! Previously successful with

monoplane dentures or

severely worn occlusion onprevious denture


Anatomic

! Class I ridge relationship

Non-anatomic

! Arch discrepancies

Class II or III or cross-bite


Anatomic

! Denture opposes naturaldentition

Non-anatomic


Except when opposing naturaldentition

Anatomic Occlusion

Advantages

! Definite point of positiveintercuspation may be

developed

! Esthetically similar to natural

dentition

! Tooth-to-tooth and cusp-to-cusp balanced occlusion canbe achieved

! Maintains some shearingability after moderate wear

Disadvantages

! Difficult to set

! Less adaptable to archrelation discrepancies

! Horizontal force

development due to cuspinclinations

! Harmonious balancedocclusion is lost with denturebase settling

! Requires frequent follow-upand may require morefrequent relines to maintainproper occlusion

Lingualized Occlusion

Indications

! High esthetic demands

! Severe mandibular ridge

atrophy

! Displaceable supporting

tissues

! Malocclusion

! Previous successful denture

with lingualized occlusion

Advantages

! Good esthetics

! Freedom of non-anatomicteeth

! Potential for bilateral balance

! Centralizes vertical forces! Minimizes tipping forces

! Facilitates bolus penetration(mortar and pestle effect)


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Non-Anatomic Occlusion

Advantages

! Reduction of horizontal

forces

! CR can be developed as anarea instead of a point

! Freedom of movement

! Can develop solid occlusiondespite arch alignmentdiscrepancies

! Easily adapted to situationsprone to denture baseshifting

! Easy to set and adjust teeth

Disadvantages

! No vertical component to aid

in shearing during

mastication

! Occlusal adjustment impairs

efficiency unless spillways

and cutting edges restored

! Patients may complain of

lack of positive

intercuspation position

! Somewhat esthetically

limited (dont look like natural

teeth)

Is Balance Necessary?

Bolus inBolus in

Balance outBalance out

Complete Denture Occlusion

! Investigators have not shown one

type of denture occlusion to be:

! Superior in function

! Safer to oral structures

! More acceptable to patients

! Neuromuscular control may be

the single most significant factorin the successful manipulation ofcomplete dentures under function

! Tongue function and denturewearing experience

Posterior LandmarksLandmarks for the Arrangement of Posterior Denture

Teeth

! Crest of the ridge! Mandibular posterior teeth

are centered over the ridge

! Medial/lateral

! Retromolar pad! Medial/lateral

! Superior/inferior

! 2/3 height retromolar pad

88

Posterior Landmarks

Three landmarks used to determine the plane of occlusion

! Retromolar pad! 2/3 height retromolar pad

! Incisal edge of the

mandibular central incisor

Mandibular Posterior ToothArrangement

90


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! Horizontal Plane

! Pounds triangle

! Lingual aspect of mandibular teeth should be positioned withina triangle created by drawing 2 lines from the mesial aspect

of the canine to each side of the retromolar pad

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! Horizontal Plane

! Central grooveof denture teeth centered over the crest of the

ridge

92


! Sagittal Plane

! Boucher

! Occlusal plane of mandibular arch should be established at !height of the retromolar pad

! Teeth are not set on the ascending area of the mandibular ridgeor the retromolar pad

! Otherwise the mandibular denture tends to shift forward

93


! Sagittal Plane

! Long axes of the teeth are perpendicular to the occlusal plane

! Marginal ridges of adjacent teeth should be at the same level

94


! Frontal Plane

! Facial view

! Buccal and lingual cusps should contact the occlusal plane

analyzer

95


! Frontal Plane

! Lingual view

! Buccal and lingual cusps should contact the occlusal planeanalyzer

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Maxillary Posterior ToothArrangement

97

Maxillary Posterior ToothArrangement

98

! Lingual cusps should be

set over central fossa of

mandibular teeth

! Teeth should be set up

to, but not on top of, the

tuberosity

! Teeth should not extend

beyond the denture base

periphery on the facial

Implant Supported Overdentures

Conventional Dentures! Tooth loss increases with age

! the number of edentulous people will continue to increase for

several decades because of the increase in mean age.

! Complete dentures have been the traditional standard ofcare for edentulous patients for more than a century.

! Complete denture wearers are usually able to wear anupper denture without problems, but many struggle with

the complete lower denture because they are loose.

! Conventional dentures have a bite force of 25% and 20%chewing efficiency of natural teeth.

66.7 %25.6 %

7.7 %

Fully SatisfiedModeratelySatisfied

Dissatisfied

Patient satisfaction also depends uponPatient satisfaction also depends upon

expectations and some patients may have veryexpectations and some patients may have very

unrealistic expectations. For this reason it isunrealistic expectations. For this reason it is

important to guide and educate the patient.important to guide and educate the patient.

Patient Demographics Implant Supported Overdentures! Patients are significantly more satisfied with 2-implant

overdentures than with new conventional dentures

regardless of the type of attachment system used

! bar, ball, magnet, locator.

! Implant overdentures increase the bite force to 60%

of natural teeth.! Patients find implant overdentures significantly more

stable,

! their ability to chew various foods are significantly

easier,

! they are more comfortable

! and speak more easily.


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Implant Supported Overdentures! Studies of several populations have shown that ratings of

quality of life are significantly higher for patients whoreceive 2-implant mandibular overdentures opposingcomplete maxillary conventional dentures than for thosewith conventional dentures.

! People who receive mandibular 2-implant overdenturesmodify their diets which improves their nutritional state.

! Such improvements may have a strong positive impact ongeneral health, particularly for senior adults who arevulnerable to malnutrition.

! 2-implant overdenture are becoming the first choice oftreatment for the edentulous mandible.

Overdenture Attachments

! Ball attachments

! Ball and rubber o-rings and/or metal housings

! Used to be the attachment of choice

! Wear quickly, not as retentive


! Bar Attachments

! 1-3 bars with 1-3 clips

! Retentive at first, get loose or break over time.

! Hard to adjust and fix

! Not as popular anymore


! Locator

! Lowest vertical height of 3.17mm.

! Self aligning

! Durable

! Up to 40 angle correction

! Retention flexibility


! Can also have a bar with locators cast or tapped into the framework.

! Usually have 3 - 4 locators incorporated.

! Framework can be gold (cast) or titanium (milled).

! Framework must be passively attached to the implants.

! Returns the bite-force of the edentulous to approximately 80% of naturalteeth.

! Implant supported and retained.

Fixed Full-arch Restorations

! Returns the bite-force of the edentulous pt close to natural teeth

! Must have enough space for restoration, minimum of 10mm.

! Framework can be gold (cast), titanium or zirconia (milled).

! Prosthesis can be metal-ceramic, or metal-acrylic.

! Framework must be passive.

! Patient must be able to clean underneath framework

! Implant supported and retained.


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External-hex and Internal-hex! External-hex Implants

! More common in the past

! Good for multiple unit restorations

! Rely more on the screw for retention of

single unit restorations.

! Internal-hex Implants

! More common now

! Good for single tooth restorations

! Can use for multiple unit restorations -cement retained or need specific

abutments.

! Rely more on the connection for

retention of single unit restorations.


! Md Implants usually placed in position of:

! 2 implants - 33, 43

! 4 implants - 32, 34, 42, 44

! Mx Implants usually placed in position of:

! 4 implants - 13, 23, 16, 26

! 6 implants - 13, 23, 15, 25, 17, 27

! Tissue supported, implant retained.

0#, 4)2$#"9+ ?1%& $;+&)4,)"+

! -+"$+1 %? $;+ 1)4:+ @0AB)

! C%% ?#1 #.#1$D

!


20/24

Panoramic Radiograph Panoramic Radiograph

Panoramic Radiograph Panoramic Radiograph

Panoramic Radiograph Locator Abutments

! Diameter of Locatorretention top 3.85mm.

!Available in a variety

of cuff heights and for

most implant typesand sizes.

! 1.5 mm of the topshould be

supragingival to beable to retain theoverdenture.

! Recommended torque

mm

height mm

Height mm 1 2 3 4 5


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Locator Selection

! Select the correct Locator Abutment based on thelevel of tissue indicated when using the Abutment

Depth Gauge.

! Appropriate abutment height keeps the top 1.5

mm extended above the soft tissue.

Locator Abutment Delivery

! Seat the Locator Abutment using the LocatorAbutment Driver, part of the Core Tool.

! For final tightening, use the Torque Wrench Bittogether with a Torque Wrench, or insert a driver

into the Abutment Driver.

! The recommended seating torque is 20-25 Ncm.

Next steps

! Make a new denture start to finish

! Initial impression

! Final impression with your choice of implant

impression

! Wax Rim adjustment

! Wax try-in

! Delivery

! Convert an existing denture into an overdenture

! With a reline impression (indirect approach)

! Direct pickup of Locator housings with a chairside

reline.

Implant ImpressionsOpen Tray Impression

Coping

Closed Tray Impression

Coping

Locator Pickup

Impression Coping

I)6$01+ B+J+,


22/24

Converting a denture into anoverdenture.

! Identify the positionsof the Locator

Abutments in thedenture base.

! Relieve the denturebase to obtain

adequate space forthe impressionmaterial and the

Locator AbutmentPick-up.


! Make an impressionusing an elasticimpression material

! Make a reline if

needed.


! Firmly place theLocator AbutmentReplica in theimpression copings,

which, if indicated, are

then repositioned inthe impression


! Fabricate a workingmodel with the Locator

Abutment Replica andhigh-quality stone

material.

! Complete the reliningand convert theexisting denture into a

Locator attachmentretained overdenture


! Replace the processing insert with the required

retentive insert.

! Remove the Locator Insert by using the InsertRemoval Tool portion of the Locator Core Tool.

! Press a new Locator Insert over the Insert Seating

Tool, and press the Locator Insert into the housing


! Five types of LocatorInserts are available toobtain the requiredretention for the

prosthesis.

! The inserts come withdifferent retentiveholding force levels:

! Clear 5 Pounds

! Pink 3 Pounds

! Blue 1.5 Pounds

! Green 3-4 Pounds*

! Red 1.5 Pounds*

(*for angled implants)


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Direct Pickup

! Choose, insert, and tighten correct Locator

abutments

! Place processing ring and locator housingwith black processing insert on the abutments.

Direct Pickup

! Identify position and relieve denture base, create vent

for excess acrylic.

! Apply acrylic and seat denture, allow for adequate

curing.

! Trim and polish, remove processing ring, and replace

insert with appropriate retentive insert.

Locator Core Tool

Insert Removal Tool Insert Seating Tool Abutment Driver

Locator Core Tool UseGap

Loosen the Insert Removal Toola full 3 turns counter clockwise.You will see a visible gap.

To remove an insert from the titanium metal housing;simply insert the tip into the insert assembly and pushstraight in to the bottom of the nylon insert.Then tilt the tool so that the sharp edge of the tip willgrab hold of the insert and pull it out of the cap.

To discard the insert from the new tip on the Locator Core Tool;point the tool down and away from you and tighten theInsert Removal Tool clockwise back onto the Locator Core Tool.This will activate the removal pin and dislodge the insert from

the tip end of the Insert Removal Tool.

Separate the Insert Removal Tool section fromthe Locator Core Tool and use the Insert Seating Toolend of the remaining two sections to place anew insert into the empty titanium metal housing.

Gap

1. Loosen Insert Removal Tool 2. Remove the Insert


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3. Discard the Insert4. Remove the Insert Removal

Tool

5. Place a New Insert

Insert Seating Tool end

Questions?

successful dentures part 2

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