Assessment of Existing Complete DenturesAssessment of Existing Complete Dentures

Note Denture-wearing history: Age of the present dentures, the frequency with which previous dentures have been replaced and the patient's experiences with these dentures.

Note the denture base materials and the condition of the dentures, including signs and sites of obvious of wear and denture usage.

Record dietary habits of the patient: the range and consistency of foods eaten by the patient.

Assess denture: retention, stability, tooth positions, esthetics and occlusal relations.

Note Denture-wearing history: Age of the present dentures, the frequency with which previous dentures have been replaced and the patient's experiences with these dentures.

Note the denture base materials and the condition of the dentures, including signs and sites of obvious of wear and denture usage.

Record dietary habits of the patient: the range and consistency of foods eaten by the patient.

Assess denture: retention, stability, tooth positions, esthetics and occlusal relations.

Assessment of Existing Complete DenturesAssessment of CDs outside the mouth:Assess impression surface of each denture. No surface

irregularities present (induce support problems).Polished surfaces of each denture: Free of undercuts and

conform to structures surrounding the denture space.Occlusal and incisal surfaces of each denture: The relationship of teeth to the indentation of the ridge on

the impression surface is as desired. In the case of upper anteriors, a device such as the Alma

Gauge will help assess teeth relations to the incisal papilla. In the case of the lower posterior teeth, a wax knife may be used to relate the lower posteriors to the ridge.

Assessment of Existing DenturesAssessment of Existing DenturesAssessment of CDS inside the mouth:Assess upper complete denture for:Denture base & peripheral extension.Presence, fit and placement of the post dam. Use a ball-ended burnisher to help determine the

displaceability of soft tissues across the palate.Peripheral borders of CDs filling the functional

width & depth of the sulcus.

Assessment of CDS inside the mouth:Assess upper complete denture for:Denture base & peripheral extension.Presence, fit and placement of the post dam. Use a ball-ended burnisher to help determine the

displaceability of soft tissues across the palate.Peripheral borders of CDs filling the functional

width & depth of the sulcus.

Varying Thickness & Displaceebility of Soft tissues Across the Palate

Assessment of Existing DenturesAssessment of Existing DenturesLower complete denture: Check the extension of the

denture base in relation to the optimal available DBA, i.e half-way up the retromolar pads and functional extension onto buccal shelves and lingual sulci.

Assessment of Denture Retention: CDs in mouth.Retention of the maxillary denture:

Place thumb on the palatal aspect of the maxillary canine and the fore-finger on the labial aspect.Rotate the wrist & pull the thumb labially. Denture show no, some or good resistance to dislodgment depending on quality of retention.

Lower complete denture: Check the extension of the denture base in relation to the optimal available DBA, i.e half-way up the retromolar pads and functional extension onto buccal shelves and lingual sulci.

Assessment of Denture Retention: CDs in mouth.Retention of the maxillary denture:

Place thumb on the palatal aspect of the maxillary canine and the fore-finger on the labial aspect.Rotate the wrist & pull the thumb labially. Denture show no, some or good resistance to dislodgment depending on quality of retention.

Assessment of Existing DenturesAssessment of Existing DenturesAssess the retention of Lower CD (-/CD): Ask the patient to relax with his/her tongue at rest. Place a probe between the lower incisor teeth and assess

the resistance to upward movement of the probe and -/CD.

The presence of a peripheral seal help resist upward movement of the denture.

Assess Denture Stability : Alternate pressing on the right and left occlusal surfaces of

the premolar teeth will detect the presence of rocking or rotational movements

Lack or poor CD stability is caused by poor fit , under-extended base, occlusal errors or poor support e.g. flabby & uneven ridges).

Assess the retention of Lower CD (-/CD): Ask the patient to relax with his/her tongue at rest. Place a probe between the lower incisor teeth and assess

the resistance to upward movement of the probe and -/CD.

The presence of a peripheral seal help resist upward movement of the denture.

Assess Denture Stability : Alternate pressing on the right and left occlusal surfaces of

the premolar teeth will detect the presence of rocking or rotational movements

Lack or poor CD stability is caused by poor fit , under-extended base, occlusal errors or poor support e.g. flabby & uneven ridges).

Assessment of Existing Complete DenturesAssessment of CD stability:Presence of rocking or rotational movements suggest the

presence of fitting inaccuracies, underutilization of DBAs or support problems (i.e flabby ridges).

Assessment of the upper denture is generally performed with the operator standing behind the patient.

The presence of inappropriate and adverse occlusal planes & Occlusal errors affect CD stability.

If the upper posterior planes dip posteriorly then on bringing dentures into occlusion, the lower CD will slide anteriorly, resulting in an ulcer lingual to the lower ridge.

Assessment of Existing Complete DenturesAssessment of Existing Complete Dentures

Assess tooth position of CD/-:Contribution to lip support: is it appropriate ?

Upper anterior teeth placed on the ridge affect speech, renders -/CD unstable & do not restore the vermilion border of the upper lip.

Position of the mid-incisal point:This is a function of appropriate lip support and if the correct position is not achieved or if the maxillary denture teeth are set on the ridge, the mid-incisal point may be placed inappropriately. The exception is a patient who has been recently rendered edentulous or has a large, undercut anterior ridge; in these cases, a full labial flange may not be appropriate.

Assess tooth position of CD/-:Contribution to lip support: is it appropriate ?

Upper anterior teeth placed on the ridge affect speech, renders -/CD unstable & do not restore the vermilion border of the upper lip.

Position of the mid-incisal point:This is a function of appropriate lip support and if the correct position is not achieved or if the maxillary denture teeth are set on the ridge, the mid-incisal point may be placed inappropriately. The exception is a patient who has been recently rendered edentulous or has a large, undercut anterior ridge; in these cases, a full labial flange may not be appropriate.

Assessment of Existing Complete DenturesAssessment of Existing Complete Dentures

Assess tooth positions on CD/-:Appropriate tooth show: Normally anterior tooth-

show is 2mm (Incisal edges just seen).Plane of Occlusion:Incisal plane: Parallel to the inter-pupillary line.

Affects Esthetics, phonetics & Stability of CDs. Posterior Occlusal Planes:

Parallel to the ipsilateral alar-tragus lines. Inappropriate occlusal planes affect the stability of lower dentures.

Assess tooth positions on CD/-:Appropriate tooth show: Normally anterior tooth-

show is 2mm (Incisal edges just seen).Plane of Occlusion:Incisal plane: Parallel to the inter-pupillary line.

Affects Esthetics, phonetics & Stability of CDs. Posterior Occlusal Planes:

Parallel to the ipsilateral alar-tragus lines. Inappropriate occlusal planes affect the stability of lower dentures.

The Occlusal Plane of Posterior Denture Teeth of the Upper CD is Dropping Down

Assessment of Existing DenturesTooth Positions on Lower CD:In the interests of (lower) denture stability, the central

fossae of the lower posterior teeth and the necks of the lower anterior teeth should lie over the residual mandibular crest.

The tongue, at rest, should lie at the level of the lingual cusps of the lower denture.

An undercut lingual flange lead to denture instabilityMandibular teeth in a position of minimal muscular

conflict (neutral zone).Molar teeth not over the ascending portion of the

mandibular ramus (elicits displacing movements of the lower denture .

Teeth with excessive bucco-lingual width presents lingual undercuts to the tongue, thereby inducing denture instability.The second molars are positioned on the ascending portion of the mandible, encouraging an incline-plane effect on the lower denture.

Teeth with excessive bucco-lingual width presents lingual undercuts to the tongue, thereby inducing denture instability.The second molars are positioned on the ascending portion of the mandible, encouraging an incline-plane effect on the lower denture.

Assessment of Existing DenturesCentric Occlusal Relations (RCP):CDs should exhibit balanced occlusion (BO) in RCP. This

means simultaneous & even bilateral contacts in RCP. It is assessed with the operator's forefinger placed on the buccal periphery of -/CD to assist stability. Upon mandibular closure, opposing teeth should be in maximum inter-cuspation. If not, the first tooth contacts are detected and from this the operator will detect a slide (protrusive or lateral) as they tend to de-stabilize the -/CD. For protrusive and lateral movements to take place, appropriate anterior and buccal overjets must be present . The presence of incisal and /or cuspal locking indicate occlusal imbalance & occlusal errors.

Assessment of Existing Complete Dentures

Assessment of Freeway Space (FWS):One CD placed in the patients’ mouth.Patient keeping mandible at physiologic rest position.Distance between reference points measured.This gives Resting Face height (RFH) or RVD.Now both CDs in mouth are brought into occlusal position.Measurement made between same reference points.This gives occluding face height (OFH) with teeth in

occlusal position or occluso-vertical dimension (OVD).FWS is measured indirectly by:

Subtracting the OFH or OVD from the RFH or OVD as FWS = RFH – OFH orFWS = RVD – OVD = FWS or Inter-Occlusal Space (IOS).

Assessment of Free Way Space or Inter-Occlusal Space

Assessment of Existing DenturesFunctional Assessment of CDs:Does the patient experience pain when dentures occlude?

Cause: systemically-related, occlusally-related or related to a support problem.

Do speech problems occur when dentures are worn?Check if present when no dentures are worn or with other, unassociated dentures.

Does retching / gagging / vomiting occur and if so, when?This is not uncommon and functional condition is best recognized and treated prior to definitive treatment and usually involves a period of desensitizing and/or provision of a training plate.