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1. TRY IN APPOINTMENT & POST INSERTION INSTRUCTIONS Int. Academy of Prosthodontics www.prosth.net

2. THE TRY – IN APPOINMENT : DEFINITION : A trial denture defined as preliminary arrangement of denture teeth that has been prepared for placement into the patient’s mouth to evaluate aesthetics and maxillo – mandibular relationship.

3. Section 1 : Perfection and verification of jaw relation records. Section 2 : Eccentric jaw relation records ; articulator and cast adjustments ; establishment of posterior palatal seal. Section 3 : Creating facial and functional harmony with anterior teeth. Section 4 : Phonetics.

4. Section 1 : Perfection and verification of jaw relation records. Verifying vertical dimension Verifying the centric relation Intraoral observation of intercuspation Extra oral articulator method

5. Verifying vertical dimension Pre extraction records. The amount of inter occlusal distance. Phonetics and aesthetics. The amount of inter occlusal distance between the teeth when the mandible is in its rest position. Study of facial dimension and facial expressions. Lip length in relation to the teeth. The inter arch distance and parallelism of the ridges. The condition and amount of shrinkage of the ridges.

6. Verifying the centric relation Intraoral observation of intercuspation

7. Extra oral articulator method

8. Section 2 : Eccentric jaw relation records Methods of registering the condyle path Extra oral Gysi & McCollum techniques Intra oral Plaster & carborundum grid – in Chew – in by opposing wax Chew – in modified by a central bearing point Needles’s styluses cutting a compound rim Needles’s technique modified by Messer man tracer Protrusive registration in softened compound Protrusive registration in plaster Protrusive registration in softened wax

9. establishment of posterior palatal seal. Soft tissue along the junction of hard and soft palates on which pressure within the physiological limits of the tissues can be applied by a denture to aid in retention of the denture. T burnisher is used for marking the hamular notch on each side and PPS is marked. PPS extends from ………. Anteriorly … anterior vibrating line Posteriorly… posterior vibrating line Laterally … pterygomaxillary notch

10. Techniques : Conventional technique Boucher’s technique Fluid wax technique Stick compound technique Extended palatal technique

11. Section 3 : Creating facial and functional harmony with anterior teeth. Maintaining facial support and neuromuscular balance When the muscles are correctly supported by a complete dentures impulses coming to them from the CNS cause a shortening of the fibers that allows the face to move in a normal manner. Three factors affect the face in repositioning the orbicularis oris with complete denture. The thickness of the labial flanges. The anterioposterio position of the anterior teeth. The amount of the separation between the mandible and the maxilla.

12. When properly shaped dental arches and favorable vertical dimension Normal function of the facial muscle Normal facial expressions and proper tone of the skin

13. Basic guides to developing facial & functional harmony : The preliminary selection of the artificial teeth. The horizontal orientation of the anterior teeth. The vertical orientation of the anterior teeth. The inclination of the anterior teeth. Harmony in the general composition of the anterior teeth. Refinement of the individual tooth positions. The concept of harmony with sex, personality, and age of the patient. The correlation of the aesthetics and incisal guidance.

14. The preliminary selection of the artificial teeth. Size , form , color of the teeth. Rotation , overlapping and spacing between the teeth. The horizontal orientation of the anterior teeth. If the anterior teeth are in proper position vermilion border is visible ,corner of the mouth assume normal contour & skin is toned & nasolabial groove is prevented from drooping. A common error is to attempt to establish a standard vertical & horizontal overlap without regard to the ridge relation this should not be done because anterior posterior position must correspond to the position of the ridges.

15. The vertical orientation of the anterior teeth. Test : length of the upper lip can be estimated by placing the index finger on the incisive papilla with relaxed upper lip extending down over the finger. the finger length covered by the upper lip indicates the length of the upper lip.

16. The inclination of the anterior teeth. The inclination of the anterior teeth should be parallels to the profile line of the face.

17. Harmony in the general composition of the anterior teeth. Central incisors in square arch assume a position on a line with a canine. In tapering arch rotating and overlapping of the teeth is common. In ovoid arches canine position forwardly with seldom rotation.

18. Refinement of the individual tooth positions . Maxillary central incisors – parallel to the profile line Maxillary lateral incisors – cervically inwards Maxillary canine – cervically outward Mandibular central incisors – cervically inward Mandibular lateral incisors – cervically outward then mandibular central incisors Mandibular canine – cervically outward

19. The concept of harmony with sex, personality, and age of the patient. Femininity is characterized by curved surface, roundness and softness. Masculinity is characterized by boldness , vigor and square ness. Personality divided into delicate , medium, and vigorous. It affects the selection of molds , colors , position of the teeth and forms.

20. Section 4 : Phonetics Bilabial sounds …. B, P, M are the sounds where the two lips contacts. Labiodental sounds …. F, V are the sounds shows the relationship of the incisal edges of the maxillary incisors to the lower lip. Linguodental sounds …. eg Th are the made with the tip of the tongue extending slightly between the upper and lower anterior teeth. Linguoalveolar sounds …. T , D, S, Z, V, L are the sounds which makes the contact of the tip of the tongue with the most anterior part of the palate.

21. POST INSTRUCTIONAL INSTRUCTIONS : INDIVIDUALITY OF THE PATIENT Don’t compare their progress with new denture to the other person’s experiences. Adaptability to new denture is modified by age. APPEARANCE WITH NEW DENTURE Feel strange , bulky,. Fullness of the lips and cheeks Advice to change glasses and hair styles.

22. MASTICATION WITH NEW DENTURES 6 – 8 weeks Excess flow of saliva Soft food Both sides Eat from posterior teeth SPEAKING WITH NEW DENTURES 2 – 3 weeks Read aloud and repeat words that are difficult to pronounce

23. ORAL HYGIENE Instructed to rinse the dentures after meal Cleanser Never use tooth paste because most contains abrasive materials Denture should be brushed over a basin partially filled with water Brush ridge and tongue PRESERVING THE RESIDUAL RIDGES Denture must be left out from the mouth in the night Not to use abrasive and home liners for ill – fitting denture Put the denture in the water

24. Thank you