1. 30. Insertion and Followup
John Beumer III, DDS, MS
and
Robert Duell DDS
Division of Advanced Prosthodontics,
Biomaterials and Hospital Dentistry
UCLA School of Dentistry
This program of instruction is protected by copyright ©. No portion of
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2. Insertion Appointment
In order to successfully complete
this appointment, you will need the
polished dentures, the articulator
with the maxillary remount cast
mounted and the mandibular
remount cast.

3. Insertion Appointment
 Reexamine the tissue side of
the dentures and carefully
remove any bubbles present
with a Kingsley scraper or
other sharp instrument.
•Prior to delivery the dentures must be
soaked in water for 72 hours.

4. Insertion Appointment Sequence*
 Adjust denture base
 Adjust denture borders
 Remount in centric relation
 Equilibrate in lateral excursion
 Patient education
*Prior to the insertion appointment the old dentures
must be left out of the mouth for 24 hours.

5. Purpose – Insertion Appointment
“ The insertion appointment
is the process of
eliminating errors.”
F. J. Kratochvil, 1966
Faithfully executing the steps of the insertion
appointment will save time and money.

6. Adjusting the Denture Base
 Zinc oxide paste is used as
a pressure indicating paste
(PIP) to detect improper
adaptation. Here, it has
been placed into a
disposable syringe for easy
use.
 The PIP spray is used in
patients with xerostomia in
order to prevent the PIP
from sticking to the mucosa.

7. Adjusting the Denture Base
PIP Sequence
 Dry denture surface
 Brush a thin even layer of PIP onto the
surface of the denture
 Seat the denture with pressure in the
first molar region
 Remove immediately
 Inspect and adjust bearing surface as
necessary

8. Adjusting the Denture Base
 The PIP pattern indicates severe pressure on the
portion of the denture that overlies the torus.

9. Adjusting the Denture Base
 This area is adjusted with an acrylic burr.
When completed the brush marks are mostly absent
and the posterior palatal seal bead is showing.

10. Adjusting the Denture Base
PIP the mandibular denture
Use smooth even brush
strokes
Carefully insert denture so as
Pay particular attention to the mylohyoid ridge region.

11. Adjusting the Denture Base
Note the areas of excessive tissue pressure on the labial
and buccal slopes of the ridge.
These are carefully adjusted with an acrylic burr.
When completed with this procedure most of the brush marks should be
obliterated and there should no areas of tissue displacement noted.

12. Adjusting the Denture Borders
Disclosing wax is used to check the length
of the denture borders. In this example it
has been placed in a disposable syringe.
 Temper the wax in the
syringe in a water bath.
 Apply disclosing wax to
the dried denture border.
 Carefully insert the
denture and mold the
borders of the selected
area.

13. Adjusting the Denture Borders
 Carefully adjust the denture flange
as necessary.
 Reapply, border mold and adjust
until areas of overextension are
eliminated.

14. Adjusting the Denture Borders
 Other examples of commonly overextended areas
These flanges are too thick
These flanges are too long

15. Clinical Remount
Purpose
To Correct for the fact that:
 Adjusted denture bases seat more
accurately than record bases
 Accommodate for errors made during the
making of centric relation records
“Measure twice, cut once”

16. Clinical Remount
 Seat the posterior palatal seal
• Place two cotton rolls between the posterior teeth and have the
patient bite down for 5 minutes.

17. Clinical Remount –Lingualized Occlusion
 The maxillary
denture has already
been mounted on
the articulator with
the plaster remount
cast and maxillary
facebow transfer jig.

18. Clinical Remount – Lingualized Occlusion
 Place compound sticks in the water bath at 105 degrees.
Make sure you use enough compound to cover the
posterior teeth.
 Apply the melted compound to the occlusal surfaces of the
posterior teeth.

19. Clinical Remount – Lingualized Occlusion
Make centric relation record and prove the record
 Carry to mouth and have the patient close in centric relation
just short of tooth contact. While making the record, instruct
the patient to retrude and elevate the tongue. This will ensure
that the condyles are properly seated while making the record.

20. Clinical Remount – Lingualized Occlusion
 Remove the record. Chill in cold water and trim so that only
the cusp tip indentations remain. Trim the buccal side so
that the seating of the dentures can be visually checked.

21. Clinical Remount – Lingualized Occlusion
Return the record to the mouth and recheck the record.
Contact should be equal and simultaneous bilaterally. If not
repeat the record. Observe the maxillary denture as the patient
closes. If the denture moves during closure repeat the record.

22. Clinical Remount – Lingualized Occlusion
Using the remount casts the dentures are remounted on the
articulator. Make sure to lock the condyles in centric while
remounting the dentures.

23. Clinical Remount – Lingualized Occlusion
 Begin by equilibrating in centric relation. If your
original Centric Relation record was correct, little or
no adjustment will be necessary.

24. Clinical Remount – Lingualized Occlusion
 Make a protrusive record. Instruct the
patient to bring their mandible forward
8-10 mm when making the record.

25. Clinical Remount – Lingualized Occlusion
Protrusive record
• Transfer the record to the articulator and insert one of
the protrusive inserts. Hold the upper member of the
articulator down into the record and adjust the condylar
inclination.

26. Clinical Remount – Lingualized Occlusion
Protrusive record
A steeper insert (30 degrees) was eventually chosen.
The dentures are seated in the protrusive record and the
condylar shaft is in contact with the protrusive insert.
We are now
ready, if
necessary, to
equilibrate in
excursions.

27. Clinical Remount – Lingualized Occlusion
 Check excursions. This is protrusive. If necessary,
adjust the occlusion to restore bilateral balance.

28. Clinical Remount – Lingualized Occlusion
Bilateral balance in lateral
Balancing
Centric Working

29. Lingualized Occlusion
Indications for use Advantages
 High esthetic demands  Good esthetics
 Severe mandibular ridge  Freedom of non-
atrophy anatomic teeth
 Displaceable supporting  Potential for bilateral
tissues balance
 Malocclusion  Centralizes vertical
 Previous successful forces
denture with Lingualized  Minimizes tipping forces
Occlusion  Facilitates bolus
penetration (mortar and
pestle effect)

30. Clinical Remount – Monoplane Occlusion
 Use a centric relation record and the remount cast
to mount lower.

31. Clinical Remount – Monoplane Occlusion
Neutrocentric
 Equilibrate in centric first.

32. Clinical Remount – Monoplane Occlusion
 Neutrocentric
When complete all of the maxillary and mandibular posterior
teeth plus the central incisors will be on the occlusal plane.

33. Clinical Remount – Monoplane Occlusion
Monoplane with balancing ramps
Balancing
ramp is
incorporated
into the
denture base.
Equilibrate in centric as before.

34. Clinical Remount – Monoplane Occlusion
Monoplane with balancing ramps
Equilibrate in
working,
balancing and
protrusive.
Protrusive Balancing
Upon completion the articulator should slide
easily from working to balancing to protrusive
and back. There should be no bumps along
the road. If the contacts on the balancing
ramps are insufficient they may be
supplemented with autopolymerizing acrylic
resin. Working

35. Patient Management
Explain the following to the patient
 Limitation of the dentures
 Expected tissue response
 Care of the prostheses and tissues
 Desirable followup treatment
*Remember the kind of patient with whom you are dealing.

36. House Classification of Patients
 Philosophical – Rational, sensible, organized and
overcomes conflicts (Expectations are real)
 Exacting – Methodical, precise and accurate; places
severe demands (Must reach an understanding before
starting treatment)
 Indifferent – Apathetic, uninterested, uncooperative and
lacks motivation; blames dentist for poor health; pays no
attention to instructions (Unfavorable prognosis)
 Hysterical – Emotionally unstable, excitable,
apprehensive (Psychiatric help may be required)

37. 24 hour check
 Inquire about the patient’s problems and
conduct a thorough oral examination
 Check the denture for pressure areas and
adjust the denture as needed with PIP
 Check borders for overextension with
disclosing wax and adjust as needed
 Evaluate occlusion, refine equilibration as
necessary, and recheck finish and polish.

38. 24 hour check
Ask the patient

39. 24 hour check
 Note the ulcer
associated with the
denture border
overlying the canine
eminence.

40. 24 hour check
Note the posterior palatal seal area:
The bead is too deep and too sharp.
Note the ulcer at the midline.

41. 24 hour check
 Note the lesions associated with
the anterior mandibular denture
border. They correspond to the
PIP pattern.

42. 24 hour check
This area represents a
bony spicule just beneath
the mucosa. Unless the
denture is properly
adjusted in this area, the
irritation will progress to
ulceration.

43. 24 hour check
Inspect the frenum areas. This is the anterior maxillary
frenum. It is the most common frenum to become irritated
from denture overextension.

44. 24 hour check
 With the aid of disclosing
wax, the frenum area is
adjusted with the small
diameter acrylic burr
using a slow speed
handpiece.

45. 24 hour check
Beware of the inferior alveolar nerve
In patients with severe resorption of the alveolar ridge,
a portion of the inferior alveolar nerve may be exposed.
Pressure in these areas may cause significant pain.

46. Evaluate the Occlusion
Open contact
If you observe change repeat the clinical remount procedure

47. Complete Denture Manipulation
 Neuromuscular control may be the single
most significant factor in the successful
manipulation of complete dentures under
function
 Tongue function and
denture wearing
experience are important
prognostic indicators.

48. Common Problems
Mandibular denture
Discomfort
Poor retention and stability
Lack of support
Maxillary denture
Poor retention and stability
Esthetics and phonetics

49. Discomfort May be Secondary to:
 Open vertical dimension of occlusion
 Inaccurate centric relation record
 Lack of occlusal balance
 Poor denture base adaptation
 Inappropriate denture base
extensions

50. Retention and Stability Compromised by:
 Occlusal discrepancies
 Poor denture base adaptation
 Inadequate denture extensions
These factors are controlled by the dentist

51. Retention and Stability also Affected by:
Moderate to severe resorption
Unfavorable floor of mouth posture
Retruded tongue position
Reduced salivary flow
Poor neuromuscular control
These factors are beyond the control of the dentist

52. Possible Solutions
Osseointegrated implants
Denture Adhesives
Permanent soft liners

53. Possible Solutions
1. Dentures retained with osseointegrated implants
Result:
a. Improved retention. Note denture snaps onto retention bar.
b. Improved stability (from the implants and the retention bar).
c. Improved support (anteriorly).
d. Better control of the bolus (tongue no longer must position denture and
control bolus simultaneously and can concentrate on control of the bolus).

54. Possible Solutions
Denture adhesives We generally discourage the use of denture
adhesive. In very few cases for short periods of
 Powder time adhesive may help keep new dentures in
 Cream place. Denture retention, particularly in the
mandible, is a matter of neuromuscular control
 Pads which is gained by practice and time.

55. Possible Solutions
Permanent soft liners – Silicone elastomers
Indications
 Limited to mandibular dentures
 Chronic soreness
 Bruxers
 No attached gingiva
Contraindications
 Poor oral hygiene
 Patients with xerostomia
 Must be replaced more frequently

56. Possible Solutions
Special burs
Moloplast-B required for
adjustment
• Poor ridge height
• Lack of attached mucosa

57. Problems with Phonetics
 Check the thickness of the maxillary
palatal portion. A common problem is
excessive thickness.
 Reevaluate the position of the maxillary
anterior teeth.
 If everything appears normal it may be a
matter of time for the patient to adapt.
 Open vertical dimension of occlusion

58. Complaints with Esthetics
 Allow the patient to wear the denture
for a period of time.
 If the patient is unhappy with their
appearance occasionally the anterior
teeth must be changed.

59. Gagging
 Palate excessively thick
 Palatal extension too long
 Lack of tongue space (teeth set too far
to the lingual
The End

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