Steps in denture fabrication

Nine visit denture. Seven visit denture. Five visit denture. Four visit denture. Branching technique. Turbyfill technique. Two visit denture. CAD/CAM dentures.

Visits consists of clinic for taking and lab for making that taking clinic for seeing again taking

Nine visit denture

Can be One day sitting

1^st Visit: Clinic 1. Case history 2. Patient evaluation 3. Clinical examination (general and local) 4. Radiological examination 5. Examination of previous records

1. Tray selection
2. Diagnostic impression with irreversible hydrocolloid Laboratory
3. Pouring the diagnostic cast with dental plaster
4. Denture base fabrication with acrylic resin
5. Construction of occlusal rims with modeling wax

2^nd Visit: clinic 11. Customization of occlusal rims 12. Recording the tentative jaw relation to determine the available interarch space Laboratory 13. Articulation of diagnostic cast using tentative relation records

3^rd Visit: clinic 14. Preprosthetic surgery (if required) 15. Primary impressions with impression compound/irreversible hydro-colloid 16. Refining the impression Laboratory 17. Beading and boxing using beading wax and boxing wax (if impression compound was used) 18. Pouring the primary cast with dental plaster 19. Blocking out undercuts with modeling wax 20. Spacer adaptation 21. Fabrication of custom tray with auto-polymerizing acrylic resin(Shellac/Heat cure/Light cure)

4^th Visit: clinic 22. Border molding using green stick compound 23. Recording posterior palatal seal 24. Secondary impression with metallic oxide paste/Polyvinylsiloxane material 25.

Laboratory 25. Beading and boxing using beading wax and boxing wax 26. Pouring the master cast with dental stone 27. Fabrication of temporary denture base using acrylic or shellac 28. Fabrication of occlusal rims using modeling wax

5^th Visit clinic 29. Recording the vertical jaw relation 30. Facebow transfer 31. Tentative centric jaw relation Laboratory 32. Articulation 33. Attaching tracers to occlusal rims

6^th Visit: clinic 34. Performing Gothic arch tracing to determine true centric relation 35. Interocclusal records obtained in centric and protrusive positions Laboratory 36. Remounting mandibular cast according to true centric relation 37. Programming the articulator and determining the condylar guidance 38. Anterior teeth arrangement

7^th Visit: clinic 39. Anterior try in Laboratory 40. Posterior teeth arrangement in balanced occlusion

8^th Visit: clinic 41. Try in verification Laboratory 42. Wax-up 43. Processing the denture 44. Finishing the denture

9^th Visit: clinic 45. Denture insertion 46. Verification of balancing contacts

10^th visit(optional) 47. Review after one month

Here's your denture fabrication process as a story with reasoning, illustrating the journey from the patient's first visit to final insertion and review:

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One-Day Sitting Plan Turned into a Journey: The Making of a Denture

A 65-year-old patient walked into the dental clinic one morning, seeking a solution for missing teeth. Little did they know they were about to begin a structured and scientific journey towards a confident smile.

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1^st Visit – The Foundation: Understanding and Planning

In the clinic, the dentist begins by listening: 1. Case history is taken to understand the patient’s medical and dental background. Why? Because underlying conditions can affect treatment. 2. Patient evaluation follows – general health, habits, and expectations. 3. Clinical examination, both general and local, helps reveal the oral condition. 4. Radiological examination is done to assess bone levels and underlying structures. 5. Previous records are reviewed – sometimes they hold gold.

Once the diagnosis is clear, the next steps are preparation: 6. Tray selection ensures a proper fit for accurate impressions. 7. Diagnostic impression is made with irreversible hydrocolloid – a quick, patient-friendly material.

At the laboratory, this data is transformed: 8. Dental plaster is poured into the impression to create the diagnostic cast – a replica of the patient’s mouth. 9. A denture base is made using acrylic resin, the platform for the next step. 10. Occlusal rims are crafted from wax – these simulate teeth and help assess jaw relations later.

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2^nd Visit – Mapping the Mouth

Back in the clinic: 11. The occlusal rims are customized to the patient’s comfort. 12. Tentative jaw relation is recorded to evaluate the interarch space – vital for aesthetics and function.

At the lab: 13. The diagnostic casts are articulated, aligning the upper and lower arches using the tentative relation records.

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3^rd Visit – Rebuilding the Base

In the clinic, the dentist checks for: 14. Need for preprosthetic surgery, such as removal of tori or flabby ridges – essential for denture success. 15. Primary impressions are taken again using more rigid materials for better detail. 16. The impression is refined, enhancing border extension and surface detail.

At the lab: 17. Beading and boxing techniques preserve impression detail. **18. The primary cast is poured. 19. Undercuts are blocked out to prevent injury during tray insertion. **20. A spacer is placed to allow even material thickness. **21. A custom tray is fabricated – the key to a well-fitting final impression.

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4^th Visit – Precision Begins

In the clinic: 22. Border molding with green stick compound captures muscle dynamics. 23. Posterior palatal seal is recorded to prevent denture dislodgement. 24. A secondary impression is taken with high-precision materials like zinc oxide or PVS.

In the lab: 25. Beading and boxing preserve fine detail. **26. The master cast is poured with strong dental stone. **27. A temporary denture base is made. **28. New occlusal rims are built.

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5^th Visit – Decoding the Bite

In the clinic: 29. Vertical jaw relation is determined – how far apart the jaws should be. 30. Facebow transfer records the spatial relationship of jaws to the skull. 31. Tentative centric relation is recorded for preliminary articulation.

In the lab: 32. Casts are articulated based on new data. 33. Tracers are added to occlusal rims for advanced jaw relation recording.

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6^th Visit – The True Bite

In the clinic: 34. Gothic arch tracing is done – a graphical method to find true centric relation. 35. Interocclusal records are taken in centric and protrusive positions for complete articulator programming.

In the lab: 36. Casts are remounted using accurate centric relation. 37. Articulator is programmed, simulating patient’s jaw movement. 38. Anterior teeth are arranged, focusing on aesthetics and phonetics.

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7^th Visit – Aesthetics Preview

In the clinic: 39. Anterior try-in – the patient sees their new smile for the first time, allowing feedback.

In the lab: 40. Posterior teeth are arranged in balanced occlusion – ensuring chewing efficiency and comfort.

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8^th Visit – Final Checks

In the clinic: 41. Try-in verification – teeth are checked for appearance, speech, and bite.

In the lab: 42. Wax-up – final contouring is done. 43. Denture is processed, replacing wax with acrylic. 44. Finishing and polishing – for comfort and shine.

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9^th Visit – The Big Day

In the clinic: 45. Denture insertion – the patient receives their new teeth. 46. Occlusion is checked, and balancing contacts are verified for even bite forces.

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10^th Visit (Optional) – The Follow-Up

1. A one-month review is recommended – adjustments are made if the patient experiences sore spots, speech issues, or discomfort.

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Why the Process Matters

Each step builds upon the previous to ensure:

Comfort

Function

Aesthetics

Long-term success

Rushing any phase can lead to poor retention, ulcers, chewing difficulty, or patient dissatisfaction. This systematic approach ensures that the denture feels as close to natural teeth as possible.

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Why more impressions

Great question!

We take more than one impression during denture fabrication because each serves a different purpose in the process. Here's the breakdown:

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1. Diagnostic (Preliminary) Impression

When: First visit

Material: Irreversible hydrocolloid (e.g., alginate)

Purpose:

To get a general idea of the patient’s mouth anatomy

Used to create diagnostic casts for treatment planning

Helps in fabricating custom trays for the next accurate impression

This impression is quick and easy but not super detailed.

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1. Primary Impression

When: 3^rd visit

Material: Impression compound or alginate

Purpose:

Captures better detail of edentulous ridges

Used to fabricate a custom tray that fits the patient's mouth precisely

Begins to capture functional borders

This is a more detailed step, but still not the final one.

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1. Secondary (Final) Impression

When: 4^th visit

Material: Zinc oxide eugenol paste, polyvinyl siloxane (PVS), or other fine-detail material

Purpose:

Captures fine surface details of the oral tissues

Ensures a precise fit of the final denture

Border molding is done before this to ensure muscle movements are recorded

This impression is the most accurate, used to make the master cast for final denture construction.

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Why Not Just One?

Because:

The initial materials and trays are not custom-made, so the first impression can't capture details accurately.

A custom tray fitted to the patient’s anatomy gives better detail in the final impression.

Border molding and other refinements can't be done on stock trays.

Final accuracy is essential for retention, comfort, and function.

Think of it like tailoring a suit — you can’t make the final stitch with just one rough measurement.

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Seven visit denture

1. Diagnosis and treatment planning.

Diagnosis: • Patient evaluation (physical, psychological and socioeconomic) • History taking (name, age, sex, address, occupation,religion, past medical history,past dental history, history of present illness, etc.). • General clinical examination (CNS, CVS, RS, GIT) — Extraoral (TMJ, mouth opening, lips, etc.) — Extraoral (TMJ, mouth opening, lips, etc.) — Intraoral (residual alveolar ridge, mucosa, palate, etc). • Radiological examination • Examination of previous dentures, examination of pre-treatment records.

Laboratory 2. Pouring the diagnostic cast using dental plaster • Surveying the diagnostic cast using a surveyor — Identifying the presence of an undercut — Measuring the depth of the undercut — Determining the amount of mouth preparation required — Determining the path of insertion.

Treatment plan: • Choosing the type of prosthesis, (design and material) • Applying design considerations.

1. Clinical procedures Preprosthetic surgery (excision of tori, frenectomy, frenotomy, alveoloplasty, vestibuloplasty, ridge augmentation procedures, removal of undercuts, etc.

2. Making the primary impression using impression compound (material of choice) and refining the impression.

3. Pouring the primary cast using dental plaster. Surveying the primary cast to determine the path of insertion. Tripoding the primary cast. Adapting a spacer and fabricating the special tray over the primary cast. Providing relief to certain area. Materials used: shellac, acrylic, polystyrene, etc.
4. Making the secondary impression.
5. • Border molding using green stick compound. • Recording the posterior palatal seal • Trimming the excess green stick compound. • Scraping out the wax spacer in the special tray • Providing relief holes over areas where additional relief is required • Making the secondary impression using zinc oxide eugenol impression paste.

Mechanisms of fitting

Two glass slabs with water in i.e one is denture and another is palate.saliva is water with sulcus seal border

Retention

Factors affecting retention

Anatomical factors Retention is Directly proportional to Size of the denture-bearing area Tissue displaceability

Physiological factors(saliva and Muscular factors

Physical factors (i) Adhesion (ii) Cohesion (iii) Interfacial surface tension (v) Atmospheric pressure (vi) Gravity

Mechanical factors

(i) Undercuts (ii) Denture adhesives (iii) Suction chambers and discs

Stability

Support

Basic terminology

Impression

A negative likeness or copy in reverse of the surface of an object, an imprint of the teeth and adjacent structures for use in dentistry (GPT8).

Types preliminary impression/primary impression negative likeness made for the purpose of diagnosis, treatment planning or the fabrication of a tray (GPT8)

Final impression/secondary impression/master impression An impression that represents completion of registration of the surface or object, made for the purpose of fabricating a prosthesis

Cast

Preliminary cast/primary cast A cast formed from a preliminary impression for use in diagnosis or the fabrication of an impression tray

Definitive cast/master cast A replica of the tooth surfaces, residual ridge areas and/or other parts of the dental arch and/or facial structures used to fabricate a dental restoration or prosthesis

Tray

Stock tray A metal prefabricated impression tray typically available in various sizes and used principally for preliminary impressions Custom tray/special tray/individualized tray An individualized impression tray made from a cast recovered from a preliminary impression. It is used in making a final impression (GPT8)

Therefore Primary procedure Preliminary impression Preliminary cast Stock tray

Secondary procedure Master impression Master cast Custom tray

Preservation of residual structures

places pressure only on stress-bearing areas is important for this preservation.

Impression Types

Mucostatic/passive/nonpressure/minimal pressure impression technique(static) recording the tissues in a resting state: - open mouth - Thin impression material Mechanism Mucocompressive/pressure impression technique(functional): recording the tissues in a compressed state, they would withstand functional forces - closed mouth - Thick impression material Mechanism (explains why closed mouth and thick impression material)

Selective pressure technique: Recording the tissue in a minimal state by Combination of both resting and compressed state

Impression plaster-for making final impressions. Impression compound-for border moulding ko ZOE impression paste-for making final impressions in a custom tray. Impression waxes-for border moulding

Edentulous arch areas or parts

Maxilla Mandible

Maxilla 1. Supporting structures (Fig. 4.7A and B):

○ Hard palate—rugae

○ Residual alveolar ridge—maxillary tuberosity

1. Limiting structures (Fig. 4.7A and B):

○ Labial frenum

○ Labial vestibule ○ Buccal frenum

○ Buccal vestibule

○ Hamular notch

○ Fovea palatine

○ Posterior palatal seal area

1. Relief areas:

○ Midpalatine suture

○ Incisive papilla

○ Torus palatinus

1. Stress-bearing areas (Fig. 4.7C and D):

○ Primary—horizontal slopes of hard palate lateral to

median sutures

○ Secondary

▪ Crest of the residual alveolar ridge

▪ Rugae

▪ Maxillary tuberosity

Mandible

1. Supporting structures (Fig. 4.10A and B):

○ Buccal shelf area

○ Residual alveolar ridge

1. Limiting structures (Fig. 4.10A and B): ○ Labial frenum

○ Labial vestibule

○ Buccal frenum

○ Buccal vestibule—masseteric notch

○ Retromolar pad

○ Alveololingual sulcus—retromylohyoid space

1. Stress-bearing areas (Fig. 4.10C):

○ Primary—buccal shelf area (Fig. 4.10D)

○ Secondary (Fig. 4.10E)

Labial and lingual slopes of the residual ridge

1. Relief areas:

○ Crest of the residual alveolar ridge

○ Mylohyoid ridge

○ Mental foramen

○ Genial tubercles

○ Torus mandibularis

Final contouring is accomplished in chairside prior to recording the maxillomandibular relations. Some adjustments may also be required while recording jaw relations depending on the patient

Maxillary rim Labial extension or fullness Buccal extension Occlusal plane

Mandibular rim

Guidelines Midline low lip line High lip line Cuspid line

Maxillomandibular relations The relationship of the mandible to the maxilla and their orientation to the cranium

The TMJ is a ‘ginglymoarthrodial joint’. ‘Ginglymus’ meaning a ‘hinge’ joint and ‘arthrodia’ meaning a joint permitting ‘gliding’ motion. Hence, it permits both hinge and gliding movements.

Mandibular movements

Sure, here's a clear explanation of jaw relations, step by step:

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Jaw Relations (Maxillo-Mandibular Relations)

Jaw relations refer to the spatial relationship between the maxilla (upper jaw) and mandible (lower jaw), especially important when no natural teeth are present (like in complete denture cases). Since there are no teeth to guide the bite, these relations must be recorded accurately to make a functional and comfortable denture.

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Types of Jaw Relations

1. Orientation Relation

Establishes the position of the maxilla in relation to the cranial base.

Done using a facebow.

Helps in mounting the maxillary cast on an articulator.

Ensures the prosthesis reflects the patient's natural jaw orientation.

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1. Vertical Jaw Relation

Refers to the vertical distance between the maxilla and mandible.

Two main types:

Vertical Dimension at Rest (VDR): Distance between jaws when muscles are relaxed.

Vertical Dimension at Occlusion (VDO): Distance when jaws are in contact (biting position).

Freeway space = VDR − VDO (usually 2–4 mm)

Must be recorded to avoid:

Too little space → discomfort, clicking dentures

Too much space → sunken appearance, speech problems

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1. Horizontal Jaw Relation

Refers to the anterior-posterior (front-back) and lateral (side-to-side) position of the mandible in relation to the maxilla.

Types:

Centric Relation (CR):

Most important

Repeatable, retruded, muscle-guided position

Used as the reference point for denture occlusion

Eccentric Relations:

Protrusive (mandible moves forward)

Lateral (mandible moves to sides)

Used to program the articulator

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Why Are Jaw Relations Important?

Ensures proper function (chewing, speaking)

Helps in aesthetics (facial profile)

Prevents trauma to soft tissues

Essential for balanced occlusion in dentures

Affects comfort and retention

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