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UnitThirtyFourCOMPLETEDENTUREWhensomeonelosesallhisteeth(becomesedentulous),healsolosessomeoftheabilitytoperformcertainaclivities-eating,speaking,facialexpression-andhisappearanceisimpaired.Hisappearanceisimpairednotonlybythelossoftheteeththemselvesbutalsobecauseofthelossofsupportforthefacialtissueslyingoverthem.Whentheteetharelost,someofthesupportingthemboneresorbs.Theartificialsubstitutes-completesdentures-mustnotonlyreplacethelostteethandlostsupportingboneandsofttissue,butalsorestoretheimpairedfunctionsandappearance.ClinicalstageI.HistoryandexaminationClinicalstage2.Primaryimpressions.Objectives:Toobtainanimpressionofthewholeofthedenture-supportingareaofeachjaw;torecordthefullextentofthesulcus;toobtainanimpressioninwhichcertainlandmarksontheedentulousjawsarcrecorded.Byachievingtheseobjectivesamodelcanbeobtaineduponwhichacorrectlydesignedtraymaybeconstructedinordertomakethesecondaryimpression.Furthermore,onlyimpressioncompoundhasthecorrectpropertiesofconsistencyandabilitytobemanipulatewhicharenecessaryinaprimaryimpressionmaterial.LaboratoryproceduresIThepreparationforthevisitatwhichthesecondaryimpressionswillbemadeinvolvestheconstructionofcastsfromtheprimaryimpressionsandtheconstructionofspecialtraysonthesecasts.Clinicalstage2(continued)SecondaryimpressionsObjective:toobtainanimpressionfromwhicharetentivedenturebasecanbeconstructed.Thedenturebaseshouldsatisfythefollowingrequirements:1. Itmustbeextendeduntilitsborderliesondisplaceabletissuewhereasealcanbedeveloped.2. Thetissueadjacenttothebordershouldbedeformedenoughtoachieveasealbutnotsomuchthattheytendtodisplacethedentureorsufferinjury.Musclesrelatedtothebordermustnotbepreventedfromfreeactivity.3. Itshouldhavetheclosestpossiblecontactwiththesurfaceorthemucousmembranelyingbeneathit.4. Extensiontoprovideretentionensuresthemaximumcoverageofthejaw,andthisinturnensuresthatthemininiuniforceperunitareaistransmittedtothesupportingtissuesbythedentureduringfunction.TheadventofVinyl-polysiloxaneoffersanalternativematerialforupperandlowerimpressions.Itisofsuitableconsistencyandgivesanexcellentsurfacelothecastanddentures.Polyethermaterialsarealsoused.Laboratoryprocedures2Atthisstagethepermanentbasesaremadeandwaxocclusionrimsareaddedtotheminpreparationforthenextclinicalstepofrecordingthejawrelation.Clinicalstage3i)Chcckingretentionofthebasespriortoestablishingjawrelationships2) Establishingjawrelationshipswithpermanentbases.Objectives1. Toaccuratelyrecordcentricjawrelationship.2. Totakeafacebowrecordtoenablethebaseplateandocclusionrimstobepositionedinthearticulatorsothattheirrelationshiptotherotationalaxesofthearticulatoristhesameastherelationshiptheywillbeartotherotationalaxesofthemandiblewhentheyarcinthemouth.ProcedureAssessthelipsupportMeasuretherestverticaldimensionEstablishtheocclusalverticaldimensionRecordthecentricjawrelationshipMethods,whichmaybeusedtoassistthepatientinclosingtoaretruded,position.3) ProtrusiverecordWhenapalientprotrudesthelowerjaw(hecondylesbothmoveforwardanddownward,guidedbytheformofthearticularfossae.Thedownwardmovementsofthecondylesresultinasimilardownwardof(helowermolarregion.Theprotrusiverecordmeasures(heamountoflhedrop.Withitthearticulatorisadjustedsothatitwillproduceasimilaramountofdropwhenasimilaramountofprotrusionisused.Theteethonthedenturecanthenbearrangedsothatcontactbetweentheposteriorteethismaintainedinprotrusion(protrusivebalance).4) Thefacebowrecord5) Selectionofteeth.Tochooseartificialteethwhoseformandcolourwillharmonizewiththepatientsfcaturccs.Laboratoryprocedures31) Addingthepost-damtotheupperdenturebase.2) Mounting(hebaseplatesandocclusionrims.3) Selectingposteriorteeth.4) Settingtheteeth.Clinicalstage4ThetrialdenturesTocheckthat(hearrangementofthe(ee(hissuchthatspeechandmasticationwillberestoredandtoensurethatapleasingappearanceisobtained.Laboratoryprocedure4Atthisstagetheprotrusiverecordisusedtosetthecondylartrackanglesandthentheocclusionisadjustedtoprovidebalanceineccentricpositions.Followingthiswaxsurfacesarecontoured,thedenturesareinvestedinaflask,andlhewaxisremovedandreplacedbyacrylicresin.1) Settingthecondylartrackangles2) Developingthelateralandprotrusiveocclusions.3) Contouringandfinishingthewaxsurfaces.4) Processingdentures.Clinicalstage5Insertingthecompleteddentures.Objective.1) Tochecktheretentionandtheaccuracyofthejawrelationsofthecompleteddentures,andtoadjustwherenecessary.2) Toinstructthepatientsin(hecorrectuseoftheirdentures.3) Toadvisethepatientsonthepropercareoftheirdenturesandofthedenture-supportingtissues.4) Toadvisethemonthelimitationstobeexpectedofartificialdentures.Laboratoryprocedures5Alteracheckcentricjawrelationshiprecordhasbeentaken,(helowerdenturemustberemountedinthearticulator,andadjustmentofthecentricandeccentricocclusionsmade.1) Remounting2) Reformingcentriclateralandprotrusiveocclusions.Clinicalstage6Adjustmentofdentures1) Useofdisclosingwax(ontheborder)andpressurereliefcream(onthefittingsurface).2) SubsequentvisitsVOCABUL/XRY1. artificialsubstitutedenture-supportingarea2. sulcuslandmark3. edentulousjawmodel4. trayprimaryimpression5. secondaryimpressioncompound6. bordersealfreeactivity7. trialdenturebalanceineccentivepositions8. investedflaskprocessingdenture9. remountedpost-dam10. reformingdisclosingwax11. pressurereliefcreamfittingsurface12. retentionpermanentbase13. waxocclusionrimestablishingjawrelationship人工替代物义齿承托区（间隙）沟标志无牙颌模型托盘初印模二次印模印模膏边缘封闭自由活动试牙非正中平衡装盒义齿热处理重新上合架后堤纠正指示蜡压力显示糊组织面固位恒基托蜡咬合堤建立咬合关系正中合关系14. centricjawrelationshipfacebowrecord15. articulatorrotationalaxes16. restverticaldimensionocclusalverticaldimension17. articularfossaeprotrusivebalance面弓记录合架旋转轴休息位垂直距离咬合位垂直距离关节窝前伸合平衡人工牙18. artificialteeth
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