Sas 2 10

DM 444: PROSTHODONTICS SEMINAR 2
Module #2
Name: Class number:

____________________________________________________________ _______
_____ Richard Cheng Date:
Section: ____________ Schedule: ________________
A1
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Lesson title: Biomechanics of the Edentulous State Materials:

Lesson Objectives: Ballpens, erasers, pencils and
1. Review the biomechanism involved in the process of module 2
edentulism.
2. To be able to compare and differentiate edentulism with References:
normal healthy dentition.  Prosthodontic Treatment for
Edentulous Patient, 13th Ed
3. – Zarb, Hobkirk, Eckert,
Jacob
 Essentials of Complete
Denture Prosthodontics, 3rd
Ed – Sheldon Winkler
 Textbook of Complete
Dentures 6th Ed – Rahn,
Ivanhoe
 Prosthetic Treatment of the
Edentulous Patient 5th Ed –
Basker, Davenport,
Thomason
Productivity Tip:
Warm up is a preparation for physical exertion or a performance by exercising or practicing gently
beforehand, usually undertaken before a performance or practice. Athletes and singers do warm ups.
Playing chess or other games (even pc games) that requires concentration can help your brain before
studying. That’s what I did in my licensure exam review and I’m not joking!
A. LESSON PREVIEW/REVIEW
Introduction (2 mins)
Welcome to module 2; Biomechanics of the edentulous state.
Biomechanics is the study of the structure, function and motion of the mechanical aspects of edentulism
and will also try to compare to the dentulous state for differentiation.
This document is the property of PHINMA EDUCATION

Module #2
Name: Class number:

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_____ Date:
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This will be the first lesson in this series of modules. This module tackles important key points in
denture prosthodontics.
The learning target/s is/are:
1. To learn the important aspects of complete denture prosthodontics;

2. To help students understand the biomechanical aspects of both dentulous and
edentulous states;
3. To ready the students to handle actual patients;
MAIN LESSON
Content Notes (13 mins)
***READ and understand the content notes provided
1. This text seeks to provide an understanding of the edentulous state and its clinical
management. It recognizes that tooth loss causes adverse anatomic, esthetic, and
biomechanical sequelae (aftereffects or results from the forces applied), a predicament
compounded by the resultant demise of the periodontal ligament with its support and sensory
functions for which the residual ridges are a poor substitute.
*** What is this module all about? (This is an example question that is created from #1 only
to be created for activity 1 and answered in activity 2)
2. Edentulism is due to (or caused by) various combinations of dental disease together with
cultural (ex. sharpening/grinding of the teeth makes one look beautiful in some culture but is
destructive to the teeth), financial (lack of financial capability to undergo RCT so it is better to
extract the teeth because it is cheaper than other performed procedures), and attitudinal (a
mentality like “ it is better to extract to remove the problem) determinants, as well as previous
dental treatment. Therefore, Edentulism is caused by both disease (like caries, periodontal)
and non-disease (cultural, financial, attitudinal) factors.
*** What causes edentulism?
3. The edentulous ridge bares all the forces when a completely edentulous patient eats. The
edentulous ridge is made up of the bone (that is significantly less hard than teeth) and soft
tissue that covers it. In patients with natural teeth, it is the periodontal ligament that bares all the
force. (so, comparing periodontal ligament vs. soft tissue, which do you think can better handle
the force?). In the edentulous patients, the bone of the residual will eventually suffer since bone
heals lesser than soft tissues.
*** Do dentures contribute to bone loss? Why?

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*** Is there bone loss even if the patient doesn’t have dentures? Why?
4. The primary function of the teeth is to prepare the food for digestion. Digestion starts in the
mouth by mixing food with the digestive enzyme, a salivary amylase called PTYALIN, and
breaks down (thru hydrolysis) starch, a complex carbohydrate to maltose (disaccharide, glucose
+ glucose) and dextrin (D-Glucose chain). If teeth are not present, initial digestion in the mouth
will be very minimal which not only waste food and its nutrients but also can cause systemic
disturbance in the form of indigestion which eventually lead to malnutrition.
Create possible questions from #4 below:
*** What is the primary function of the teeth? Prep the food for digestion
*** What digestive enzyme is being released while masticating food in the mouth? PTYALIN
*** If teeth is not present, how does digestion occur in the mouth? Very minimal, leading to malnutrition
*** PTYALIN breaks down starch into? Maltose and dextrin
5. In a normal healthy dentition, the teeth are not in occlusion except during the functional
movement of mastication (chewing) and deglutition (swallowing). They are in contact only ~17.5
mins in 1 day. Actual chewing per meal is ~450 strokes @ 1sec per stroke. So, an entire meal
would be ~450 sec and each tooth contact during mastication last 0.3sec. In swallowing, tooth
contacts last longer (~1sec per contact).
*** What is the duration (normally) the teeth are in contact in a day?
*** What is the duration the teeth are in contact during mastication?
*** Which has longer tooth contacts, chewing or swallowing?
6. Masticatory load (biting force) is ~ 44 Lbf (pound force) or ~ 20 Kgf (kilogram force) in conscious
effort and lesser if unconsciously done (chewing is an unconscious/unmindful process).
Complete denture chewing only produces ~13-16 Lbf (or ~6-8 Kgf), which is significantly lower
than naturally dentulous patients or there will be injury on the soft tissue and the bone.

*** How much is the masticatory load in conscious effort? 20kg force
*** How much is the masticatory load in complete dentures? 6-8kg force
*** Why is the masticatory load in complete dentures lower than naturally dentulous patients? Soft
tissue and bone injury
7. The mean denture-bearing area (area of support/soft tissue area covered by the denture) of a
complete denture is ~22.96 cm2 (or 22.96cm x 22.96cm) for the Maxilla and ~12.25 cm2 for the
mandibular. In comparison, the periodontal membrane has a total/combined area of 45 cm2. (On
a single arch alone). The denture-bearing area of the edentulous ridge gets smaller as it resorbs
so the biting force that the edentulous ridge can handle diminishes and the denture retention
becomes more of a problem.
*** How wide are the denture bearing areas (force bearing area) of the edentulous ridge?
*** How wide is the total force bearing area of the periodontal ligament area (total)?

Module #2
Name: Class number:

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*** Compare the force bearing area of dentulous and edentulous teeth
*** Why is the mandibular edentulous ridge have faster resorption rate than the maxillary
edentulous ridge?
8. Chewing occurs in the posterior teeth (premolar and molar) regions. The tougher consistency
food is chewed preferably in the premolar. Biting occurs in the anterior (Incisors and canine)
teeth.
*** The tougher consistency food is chewed preferably where? Premolar
*** Biting occurs? Incisors and canines
9. Retention is always the problem with complete dentures since normally, saliva is the only thing
holding the dentures, however, the dentist can minimize dislodgement or increase retention by:
1. Extending the outline of the denture bases properly in relation to the mucous membrane
(wider coverage = better support and retention); 2. Maximum area of contact between basal
seat (ridge) and basal surface (denture surface that is in full contact with the soft tissue/ridge);
3. Intimate contact of the basal seat and the basal surface (2 and 3 are dependent on the
accuracy of the impression).
*** How does the dentist minimize dislodgement of complete dentures? Extending the outline of
the denture bases properly in relation to the mucous membrane
*** What is the usual problem of complete dentures? Retention
10. The three muscles: the Buccinator; the Orbicularis oris; and the Intrinsic (longitudinal,
transverse and vertical fibers = widening and narrowing movement) muscles and Extrinsic (In
and out movement, the muscles originate in the tongue and attached to something else other
than the tongue) muscles also helps in denture retention by pushing/shaping action. But also
remember that these muscles are also to blame for dislodgement (because of its mobility) if the
denture is not properly made like overextended denture bases and muscle movement specially
the tongue.
*** What are the three muscles that can contribute to denture dislodgement? Buccinators,
Orbicularis oris, Intrinsic and Extrinsic muscles
*** How does muscles help in denture retention? By pushing/shaping action
*** What are other factors that can lead to denture dislodgement? Overextended denture base and
tongue movement
11. Mastication (Chewing) on dentulous patient happens on 1 side only (unilateral and happens
either side) whereas with dentures are bilateral. If the denture is used in a unilateral chewing, it
will dislodge.
12. Having new dentures requires learning and acquisition of skill. Even removing dentures (to let

Module #2
Name: Class number:

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_____ Date:
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the soft tissues rest and heal) at night and placing them in the morning is usually awkward for
the patient. Once it becomes a habit, the patient becomes well adapted and the patient forgets
he is wearing dentures.
Source: Prosthodontic Treatment for Edentulous Patient, 13th Ed – Zarb, Hobkirk, Eckert, Jacob
Textbook of Complete Dentures, 6th Ed (2009) – Rahn, Ivanhoe, Plummer
Activity 1. Create questions on the particular topic/s or paragraph (Look for tables in the content
notes).
Activity 2: Answer (In your own words) the questions that you have created
#4
Prep the food for digestion
PTYALIN
Very minimal, leading to malnutrition
Maltose and dextrin
#6
20kg force
6-8kg force
Soft tissue and bone injury
#8
Premolar
Incisors and canines
#9
Extending the outline of the denture bases properly in relation to the mucous membrane
Retention
#10
Buccinators, Orbicularis oris, Intrinsic and Extrinsic muscles
By pushing/shaping action
Overextended denture base and tongue movement

Module #2
Name: Class number:

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_____ Date:
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LESSON WRAP-UP
Activity 3: Thinking about Learning (5 mins)
A. Work Tracker
You are done with this session! Let’s track your progress. Shade the session number you just
completed.
B. Think about your Learning
1. Rate from 0-5 were 0 means “Hard as rock” and 5 means “Easy – like a hot knife slicing through
butter “, How difficult was this module?
5
2. Was our learning target/objective met? Refer to objective/s and answer yes or no
yes
Contact Details
 Dr. Allan Rotello Sia Ebua

 Mobile: +63-968-317-1218, +63-929-886-1569
 Facebook/Messenger: https://www.facebook.com/dr.allan.ebua, DM444 A1
 Email: For submission of modules, use email below based on your section:
[email protected]

Course Code: Course Title
Module #3
Name: Class number:

____________________________________________________________ _______
A1
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Lesson title: Tissue Response to Complete Dentures Materials:

Ballpens, erasers, pencils and
Lesson Objectives: module 3
1. Learn the tissue response to complete dentures
2. Learn the different soft tissue changes and treatment References:
3. Learn the changes the bone will undergo in edentulous  Prosthodontic Treatment for
patients Edentulous Patient, 13th Ed
– Zarb, Hobkirk, Eckert,
4. Jacob
Ivanhoe
Basker, Davenport,
Thomason
Productivity Tip:
SLEEP EARLY AND WAKE UP EARLY. The early bird catches the worm, right? College students are
notorious for staying up late. It just seems like a given. Especially if you have later classes. I’m not telling you
to wake up at 5 AM every day (I certainly don’t). For example, if you have an 11 AM class, wake up at 8:30.
You can go to bed at around 12 midnight, get enough sleep, and still have enough time to do something
productive in the morning before class.
Welcome to module # 3: Tissue response to complete dentures. In the previous module, we learn the
biomechanics of the edentulous state – what happens when the patient becomes edentulous. This is a
continuation of the previous module. Learn the tissue changes commonly encountered with patients
wearing complete dentures in both normal and normal.

Module #3
Name: Class number:

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_____ Date:
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B. MAIN LESSON
Activity 1: Content Notes (13 mins) Read and understand the notes
 SOFT TISSUE CHANGES TO COMPLETE DENTURES

1. In the edentulous state the mucosa demonstrates low tolerance to injury or irritation. Women
wearing dentures tend to have thinner mucosa that predisposes to mucosal injury than men.
*** Why are women susceptible to mucosal injury when wearing dentures than men? Women
have thinner mucosa
2. When tolerance of the denture is exceeded, injury and inflammation will result and the
denture can’t be worn. When injury, inflammation and/or trauma is tolerable, a fibrous response
of the tissue is elicited in a form of flabby hyperplastic tissue.
*** What happens when the denture exceeded its tolerance level? Injury will result and
denture cannot be worn
3. Frequently encountered soft-tissue response to tolerable injury in long-term denture wearing

are: Soft-tissue Hyperplasia and Denture Stomatitis.
*** What are the frequently encountered soft-tissue response to tolerable injury in long-term
denture wearing? Soft-tissue Hyperplasia and Denture Stomatitis
4. Soft tissue injury eventually heals. If left untreated or the denture uncorrected, it is the bone
that is going resorb in the process because the healing process of soft tissue is much
faster/better. Bone healing/rebuilding is lost as soon as teeth are extracted because there are
more osteoclastic activity (resorption) than osteoblastic (rebuilding) activity.
*** What happens to the bone after tooth extraction? More bone resorption less rebuilding
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Soft-tissue Hyperplasia
What are the different soft tissue injuries?
A. It is called a Flabby Ridge if it is located on the edentulous ridge. It looks like the ridge but it
is actually just the soft tissue without bone supporting it.
*** Describe flabby?
*** Where is flabby ridge located?
B. If the fibrous epithelial response is located around the periphery of the denture (denture

Module #3
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border), it is called EPULIS FISSURATUM. It is due to chronic irritation from ill-fitting dentures
or over-extended denture borders.
Create possible questions from #B below:
*** What do you call a fibrous epithelial response located around the periphery of the denture?
EPULIS FISSURATUM
*** What causes EPULIS FISSURATUM? Due to chronic irritation from ill-fitting dentures or
over extended denture borders
Treatment: Excision of the flabby tissue and E. Fissuratum is the done and adjustment of the
dentures should be done after the excision. Flabby tissue is usually caused by unstable denture
or unbalanced occlusion. In case the border of the denture is over-extended (cause of E. Fiss),
shortening of the border of the denture is made. Otherwise, the problem recurs. Alternative Tx
for flabby ridge is ridge augmentation (grafting) after excision:
***What is the treatment for soft tissue hyperplasia?
*** After removal of hyperplastic tissue, what do you do with the denture?
Ridge may look unresorbed but is

actually soft and unsupported by
Flabby Ridge bone when palpated. Flabby =
lacking resilience or firmness

Module #3
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Epulis Fissuratum
here
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Denture Stomatitis (same as Denture Sore Mouth)
A chronic inflammation of the denture-bearing mucosa (basal seat). It can be localized

inflammation (Type I), generalized (Type II) or nodular/papillary (Type III). Trauma from ill-fitting
dentures or parafunctional habit (bruxism) are the predominant cause. Most patients are not
aware they have this since they are mostly asymptomatic. Some suggested it is a
hypersensitivity (allergic response) of denture component (monomer leeching out due to
incomplete curing of the resin) or Candida albicans infection and poor oral hygiene.
*** What are the 3 different types of DSM?
*** What are the predominant causes of DSM?
*** Why are patients not aware they have DSM?
*** What are the other suggested causes of DSM?
DSM may also be accompanied by Angular cheilitis (Perleche).
Prevention: Good hygiene and letting the tissue rest (not wearing for a time to let the rest and
heal)
Treatment: Construction of new dentures, use of tissue conditioners, relining of dentures,
antifungal drugs, use of 2% Chlorhexidine gluconate and gingival massage with toothbrush or
fingers.

Module #3
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Risk factors: Wearing an upper complete denture, older dentures, xerostomia (dry mouth),
diabetes or high carbohydrate diet.
*** What are the preventive measures to decrease risk of developing DSM?
*** What are the treatment options when the patient has DSM?
*** What are the factors that increases the risk of developing DSM?
Denture Sore Mouth (DSM)

Type I – Localized DSM (rubor)
Type II – Generalized DSM (rubor)
Type III – Nodular/Papillary DSM
Type I DSM
Type II DSM
Ulcerations (arrow) may be present
Type III DSM
 Tissue changes due to aging

*** What are the different soft tissue changes caused by aging?

Module #3
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1. Changes in the mucosa

Atrophy is the thinning of the tissue, usually encountered during menopause. Also seen in
kidney diseases and nutritional deficiency.
Clinical Significance: Decrease healing ability on atrophied mucosa, easily injured.
*** What is usually encountered during menopause? Atrophy
*** Atrophy is also seen in? kidney disease and nutritional deficiency
*** What happens to an atrophied mucosa? Decrease healing ability and easily injured
2. Changes in the Residual bone and Maxillo-mandibular relationship

Osteoporosis – decrease of mineral content of the bone
Disuse Atrophy – Flat residual ridge distal to natural teeth are frequently seen, dentures also
contribute to the resorption.
*** What is osteoporosis?
*** Describe disuse atrophy of the residual ridge.
Note: There will be changes in the size (becomes smaller/resorb) of the basal seat due to
Osteoporosis and atrophy
*** What happens to the mucosa when there’s osteoporosis or atrophy?
3. Changes in Tongue and taste

Due to diminishing taste buds, nerve tension (like stretching the tongue to prevent denture
from dislodgement). The tongue also becomes bigger because of the loss of the teeth, and
the patient feels awkward when new sets of dentures are worn.
***what are the changes in the tongue and taste in edentulous and denture-wearing
patients?
Note: Patient’s frequently blame the dentures for altered taste sensation.
4. Changes in the salivary flow

Old patients most likely to have Xerostomia (dry mouth), may be due to medications. like
Diuretics, Antihypertensives, Antidepressants, Antihistamines, Antineoplastic, Antipsychotic
and Bronchodilators. Atrophy of the salivary glands causes decrease in salivary flow. It can
also be psychological, and certain diseases like Sjogren Syndrome, Celiac disease and
Sicca syndrome. Radiation therapy also causes dry mouth. Denture retention is a problem
with patients who have this/these condition.
What could cause xerostomia on old patients? Due to medications
What could diminish salivary flow on old patients? Atrophy of salivary glands
What diseases that could contribute in the change of salivary flow? Sjogren Syndrome, Celiac
disease and Sicca syndrome.
Why is denture retention a problem in older patient? Less saliva less retention of denture

Module #3
Name: Class number:

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Textbook: Prosthodontic Treatment for Edentulous Patient, 13th Ed – Zarb, Hobkirk, Eckert, Jacob
 Ralph JP, Stenhouse D: Denture-induced hyperplasia of the oral soft tissues: vestibular lesions, their characteristics
and treatment, Br Dent J 132(2):68-70, 1972.
 Coelho CM, Zucoloto S, Lopes RA: Denture-induced fibrous inflammatory hyperplasia: a retrospective study in a
school of dentistry, Int J Prosthodont 13(2):148-151, 2000.
 Jainkittivong A, Aneksuk V, Langlais RP: Oral mucosal lesions in denture wearers, Gerodontology 27(1):26-32, 2009.
 Newton AV: Denture sore mouth: a possible aetiology, Br Dent J 112:357-360, 1962.
 Petersen PE, Yamamoto T: Improving the oral health of older people: the approach of the WHO Global Oral Health
Programme, Community Dent Oral Epidemiol 33:81-92, 2005.
 Ramage G, Tomsett K, Wickes BL, et al: Denture stomatitis: a role for Candida biofilms, Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 98(1):53-59, 2004.
 Budtz-Jorgensen E: Ecology of Candida-associated denture stomatitis, Microb Ecol Health Dis 12:17-185, 2000.
 Shulman JD, Rivera-Hildago F, Beach MM: Risk factors associated with denture stomatitis in the United States, J
Oral Pathol Med 34:340-346, 2005.
Activity 2. Create question/s
Activity 3. Answer the question that you have created (in your own words)
Soft tissue changes
#1
Women have thinner mucosa
#2
Injury will result and denture cannot be worn
#3
Soft-tissue Hyperplasia and Denture Stomatitis
#4
More bone resorption less rebuilding
#B
EPULIS FISSURATUM
Due to chronic irritation from ill-fitting dentures or over extended denture borders
Tissue changes due to aging:

#1
Atrophy
Kidney disease and nutritional deficiency

Module #3
Name: Class number:

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Decrease healing ability and easily injured
#4
Due to medications
Atrophy of salivary glands
Sjogren Syndrome, Celiac disease and Sicca syndrome.
Less saliva less retention of denture
C. LESSON WRAP-UP
A. Work Tracker
You are done with this session! Good Job! Now let’s track your progress. Please shade the session
number you have just completed.
1. Rate from 0-5 were 0 means “Hard as rock” and 5 means “Easy – like a hot knife slicing
through butter “, How difficult was this module?
5
1. Was our learning target/objective met? Refer to objective/s and answer yes or no
yes
2. In case this module gave you some difficulty, which part of this module did you encounter such
difficulty? Place NA if not applicable.
I really enjoyed learning this new type of module, I got to make my own questions that I can easily
remember and absorb.

Module #3
Name: Class number:

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_____ Date:
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FAQs
1. If a completely edentulous patient wants to have a new set of dentures but the ridge is flat or almost flat are
we allowed to fabricate a denture?
ANSWER: It is the discretion of the dentist. If you have given all the necessary information to the patient that
the patient needs to know but the patient still wants to have the complete denture then you may fabricate.
2. What are the dentist approach to the problem when the patient has a flat edentulous ridge?
ANSWER: Getting the correct treatment plan is the key to success in the practice. Options can be: Vestibular
extension, Ridge augmentation (ex. bone grafting, guided growth with artificial bone substitute), complex
implant, etc.
This module will be collected at a designated time and place for checking and grading.
Phone calls/virtual calls/chat/ to students will be scheduled for work monitoring, providing guidance,
answering questions and checking understanding.
Contact Details

 Mobile: +63-968-317-1218, +63-929-886-1569
[email protected]

Module #4
Name: Class number:

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A1
Lesson title: Charting - Part 1 (History Taking, Clinical Exam, Materials:

Diagnosis and Treatment Planning) Ballpen, erasers, pencils, long
bond papers and module 4
Lesson Objectives:
1. Learn how to diagnose References:
2. Learn and understand treatment planning  Prosthodontic Treatment for
3. To help the students provide instructions for the patient. Edentulous Patient, 13th Ed
4. Learn how to create a complete denture pamphlet – Zarb, Hobkirk, Eckert,
Jacob
5. Denture Prosthodontics, 3rd
Basker, Davenport,
Thomason
Productivity Tip:
If you are tired, TAKE A BREAK OR A NAP. There is no learning if your brain is tired. Just don’t make it too
long or you will start all over again.
Hello students! Welcome module 4 – Diagnosis and treatment planning Part 1. After module 3, we
proceed to this module the “patient evaluation”. The relevance of patient evaluation cannot be denied
since we will not be able treat the patient if we do not know what the patient’s problem is/are. Thus,
asking the right questions and understanding the needs of the patient is an important the step in the
whole treatment process.
B.MAIN LESSON
Activity 1: Content Notes (13 mins) Read and understand

Module #4
Name: Class number:

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 EVALUATION OF PATIENT
Failure of countless dentures can often be traced to the first five minutes between the dentist
and the prospective patient. The patient meets the dentist in the office and often starts the interview
with inquiry about the cost of a set of teeth". The dentist quotes a figure. The patient agrees, and the
dentist begins heating the impression compound.
In these first few minutes, a pattern of failure has likely begun for both the dentist and the patient. The
all-important step of patient evaluation was ignored.
FIRST APPOINTMENT
The purpose of the first appointment is to acquaint the dentist with the patient in as many
respects as possible. TRUST and UNDERSTANDING should be the main objective of the first
appointment. Knowing the patient’s attitude is the key to a successful complete denture treatment.
RAPPORT has to be established on the first appointment. These are all important to the success of the
complete denture treatment and dental practice as a whole.
*** What is the purpose of the first appointment?
*** What is the main objective of the first appointment?
Some of the points to watch for are:

1. care of the mouth; - how do you clean your mouth?
2. attitude of the patient toward any past restorations; -how was your past dental appointment? did you
have any problems with dental procedures?
3. attitude of the patient toward other dentists; - Did you have problems with your previous dentist/s?
4. attitude of the patient with regard to new dentures – did you had problems when those old dentures
were new?
In the course of this first appointment, the dentist will be tempted to develop a further line of
questioning but this should be left for the second appointment. The suggestion that they should avoid
extensive questioning during the first appointment is made with the idea that it can be done during the
second appointment to a much greater advantage.
In the first appointment, the patient may be advised to remove the dentures from the mouth to
allow the tissues to rest and to resolve any inflammation or swelling. The 1st appointment can be also
be ended with some advice in nutritional modifications, seek medical clearance from physician for the
dental treatment or additional medications for the patient.
SECOND APPOINTMENT
In the course of the second appointment, the dentist will endeavor to learn as much as possible

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about the patient by the use of specific interrogation. The line of questioning can allow three principal
divisions of continuity: health, tolerance (mental and tissue) and adaptability.
A. QUESTION ABOUT HEALTH.

An effective leading question as the dentist seeks information as to the general health of the
patient is Have you been to a physician lately? If so, would you mind telling me for what reason/s?
"Often this information will reveal general difficulties that might otherwise be concealed. Any general
systemic debility will make denture success uncertain. Likewise, questions can rephrase to have an
indirect approach in case you are suspecting the patient is trying to hide anything like “what
medications have you taken for the last 6 months?”. Tell the patient that the conversation will be
confidential (google Doctor-Patient Confidentiality or Doctor-Patient Privilege) and that the information
taken will be detrimental to the whole treatment process. Some question can be in an indirect form of
questioning like: “Can you recall what medications were you taking before?” can often reveal previous
conditions/disease that the patient had.
Here are some of the health conditions and its clinical significance important to complete
denture construction and complete denture treatment process:
1) Infectious/contagious disease – significance: contagion, drug interactions, altered oral microflora
Viral (symptoms are systemic)- Herpes, HIV, Hepatitis, SARSCOV etc.
Bacterial (symptoms are usually localized)-Syphilis, Chlamydia, Gonorrhea, Tb, Strep. etc.
Fungal- Candidiasis
2) Drug and Alcohol abuse– causes xerostomia, altered taste, altered mucosa, nutritional imbalance,
dentures less retentive, fast bone resorption
3) Head and neck injury- deferred treatment
4) Hypertension- short treatment procedures, xerostomia, loose dentures, some antihypertensives
causes drug-induced hyperplasia (ex. Calcium channel blockers), possible drug interactions
5) Immunodefiency- caused by HIV, malnutrition, or immunosuppressive drugs- Px has poor healing
6) Heart disease- xerostomia, possible drug interactions, malnutrition, altered oral microflora
7) Epilepsy- attacks, avoid stressing the patient, possible drug interactions, anticonvulsant (causes
hyperplasia)
8) Allergies- denture base allergies, watch for stress-induced allergies and attacks, antiallergic drugs
also induces dry mouth like antihistamines
9) Migraine- unknown etiology, some may be from incorrect vertical dimension of the dentures or
occlusal disharmony affect the TMJ.
10) Cancer- xerostomia caused by chemotherapeutic agents and radiotherapy, poor healing

Module #4
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11) Anemia- malnutrition, poor healing, risk of infection.

12) Uncontrolled Diabetes- poor healing, gangrene, mucosal ulcerations, xerostomia
B. QUESTION ABOUT TOLERANCE

A patient's tolerance factor is somewhat more difficult to determine. A line of questioning about
success with past surgical restorations, dental appliances, etc., is the direct approach and often
suffices. A few qualifying remarks will usually remove the surprise from such questions as, “Do you
have trouble with your feet.” The answer to such a query quite naturally will lead the questioning in the
reasons for trouble with the feet.
C. QUESTION ABOUT ADAPTABILITY

The adaptability factor is an essential one but difficult to do anything about. "Did you have
difficulty adjusting your bifocal glasses"? How long was it before you could handle your partial denture?
Such questions can give the dentist useful indications as to how easy can a patient adapt to something.
INSTRUCTIONS AND INFORMATION FOR DENTURE PATIENTS

The use of a compact instruction sheet or booklet will do an excellent job of conditioning a
patient's attitude. Verbal instructions and information are not sufficient because the patient will not
remember all of the facts unless they are printed and in his possession. These information and
instructions should be read and discussed with the patient after a thorough examination of all the
conditions has been made. A copy is given to the patient and then he has no excuses for complaining
of not having been informed fully concerning inherent difficulties of complete dentures. If this is not
given and if difficulties arise later the dentist is then put in the light of making excuses for faulty
construction, even though the difficulty is beyond his control.
CONTENTS OF THE PAMPHLET FOR THE PATIENT:

1. RESULTS TO BE EXPECTED WITH THE NEW DENTURES
Satisfaction with complete dentures depends upon so many factors that no two patients ever have
the same results. Much depends upon the personal attitude. One cannot expect too much, too fast, in
spite of the advance in this science and art. Results depend upon temperament, age, health, shape and
size of mouth, length of time teeth has been missing, condition of the bone and soft tissues, relative
size of the dental arches, and how much you expect, as well as upon skill, knowledge and material
used in construction. No two patients are alike therefore, no two results are alike.
The lower denture is seldom equal to the upper denture in either ability to remain in place or to
withstand biting pressure. The lower denture has only a rim to grip and rest on, with the tongue to
disturb it, whereas the upper denture has the entire roof of the mouth which is free from interference.

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2. SHRINKAGE AND RELINING NEEDED FOR THE NEW DENTURES

The idea that dentures can remain permanently satisfactory is a mistaken one. Under the influence
of saliva other fluids, the materials deteriorate. The supporting bone and tissue undergo constant
change. The greatest change takes place in the first 6 months after the natural teeth are lost. To
maintain full use and appearance, the dentures must be altered to meet these changes or new
dentures must be constructed.
3. LEARNING TIME FOR THE NEW DENTURES
You will usually talk quite well immediately and will improve with practice. Learning to eat well may
require many months of practice, you should understand, that, during a two-day period, mastication of
food, such as crackers, soft toast, chopped meat, etc., is the recommended diet, but no attempt should
be made to handle food at the table. During the learning period of mastication, you are advised to be
away from the critical observation of friends or members of the family for it is expected that you will be
awkward in the beginning and susceptible to embarrassment and resulting discouragement.
Appearance will not be the best at the start. The lips have not yet adapted to the fullness of the
denture borders and arches and may present a distorted appearance that will smooth out with time. If
you are not careful in following these instructions you will become unfairly critical of the dentures and
develop an attitude which will be difficult for the dentist to overcome. During the edentulous or partially
edentulous period of time, a gradual shortening' of the face and collapsing of the lips will have
occurred. The collapse of the face has usually become so gradual that family and friends have not been
aware of it. Therefore, the complete change of repositioning of the lips by a restoration of former facial
dimension and contour may seem too great a change in appearance. This sudden change may come to
you and your family as a shock because they have forgotten your former appearance.
People 20 to 30 years can learn to handle dentures in about ten days, whereas those 30 to 40
years need nearly 3 weeks. Persons 40 to 50 years often take two or 3 months and those in poor health
may be a year before becoming unconscious of the presence of dentures.
4. CARE OF DENTURES
New dentures may be left out of the mouth for short rest periods. Once you have mastered the use
of your dentures, they should be left out at night or at some time to give blood circulation an opportunity
to rebuild the tissues of the bearing area.
Constant wearing of dentures without proper brushing causes soreness and additional shrinkage.
The dentures should be brushed daily with a soft bristle brush and dishwashing (nonabrasive)
detergent. This should be done above water, so that they will not break if dropped.
SPECIFIC DIAGNOSTIC FACTORS
Age is an important factor because the younger the person, the more rapidly will he adapt
himself to this abnormal condition:
A person's social position has much to do with his esthetic requirements. The higher the
position, the more exacting will be the patient's attitude. Some people expect dentures to cure all their

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ills in respect to comfort and appearance.

Generally speaking, the expectancy of patient is growing; they expect for more in this day of
great inventions and conveniences and not to mention their growing sense of entitlement.
Edentulous ridge resorbed in proportion to the amount of time the teeth have been missing.
Extreme resorption is a handicap to the denture. Patients seldom become completely edentulous in a
short period of time. The teeth are usually lost gradually over a long period of time and the ridges and
adjacent structures are affected accordingly. The older the ridge, the more resorbed it is.
Activity 2: Skill-building Activities (18 mins + 2 mins checking)

Design a compact booklet, pamphlet, instruction sheet or a brochure that contains instruction and
information for your complete denture patients using the “CONTENTS OF THE PAMPHLET FOR THE
PATIENT” as guide. Use a separate bond paper or use PC or tablet or phone. Be creative and
informative. When using a pc, tablet or phone you can print or send office readable file to your teacher
info at the last page. Grading criteria: Creativity = 1 (less creative) 2 (creative) and 3 (very creative),
Informative = 1 (less informative), 2 (informative and 3 (very informative)
Activity 3: Check for Understanding (5 mins)

SHORT QUIZ (2 pts per number)
1.) Conditions that increase the possibility of dislodgement of complete dentures
I.) cancer undergoing radiotherapy
II.) drug and alcohol abuse
III.) taking antihypertensive drugs
IV.) people experiencing migraine
V.) patient with uncontrolled diabetes
A. I, II, III, IV
B. II, III, IV, V
/ C. I, II, III, V
D. I, III, IV, V
E. I, II, IV, V
2.) Formulate a question to let the dentist become aware of the attitude of the patient regarding any
past dental restoration
Do you have any complains about your past dental restoration?

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3.) Formulate a question that would reveal the attitude of the patient towards his previous dentist.
What can you tell me about your previous dentist?
4.) Formulate a question that would reveal the attitude of the patient regarding new dentures.
What was it like when the when your old dentures were new?
5.) Age is an important factor in the ability of the patient to adapt. The younger the patient, the less
amount of time the patient needs to adapt to the new dentures which is good. However, it can also
be bad. In what way? (Answer in 1 or 2 sentences).
When the adaptation is with the incorrect denture or an abnormal condition.
C. LESSON WRAP-UP
A. Work Tracker
completed.
1.) Rate from 0-5 were 0 means “Hard as rock” and 5 means “Easy – like a hot knife slicing through butter
“, How difficult was this module?
5
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2.) Was our learning target/objective met? Refer to objective/s and answer yes or no
yes
3.) In case this module gave you some difficulty, which part of this module did you encounter such
NA
FAQs
1.) What if the patient keeps on complaining that is old dentures are better than the new ones the
dentists made, how does the dentist address this?
ANSWER – If the dentist is quite confident that the new dentures were done correctly, get the old
dentures to prevent the patient from comparing with it and just tell the patient that the old dentures will
be returned on the next appointment. Give ample time to the patient to use the new denture and adapt.
The patient will always feel that the older dentures are better because he is used to it. When creating
new dentures as replacement of the old ones, Dentist usually will not deviate too much from the old
dentures to make adaptation easy for the patient.
2.) If the new dentures were done correctly and still the patient complains of difficulty, what will the
dentist do?
ANSWER – the most likely solution is reducing the vertical dimension a little bit or increasing the
freeway space a little as most complete denture patients have a hard time adapting to correct vertical
dimensions. “DO NOT DEVIATE TOO MUCH FROM THE OLD DENTURES”.
ANSWERS TO ACTIVITY 5.
1.) C – except migraine
2.) What can you tell me about your past dental restoration?
Do you have any complains about your past dental restoration?
3.) What can you tell me about your previous dentist?
Do you have any problems with your previous dentist?
4.) What was it like when the when your old dentures were new?
5.) When the adaptation is with the incorrect denture or an abnormal condition.

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Contact Details

 Mobile: +63-968-317-1218, +63-929-886-1569
[email protected]

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ACTIVITY 2

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Lesson title: Charting – Part 2 (History Taking, Clinical Exam, Materials:

Diagnosis and Treatment Planning) Ballpens, erasers, pencils and
1. Learn patient evaluation procedures (history taking, clinical
exam, diagnosis and treatment for patients). References:
2. Understand patient behavior  Prosthodontic Treatment for
3. Learn how to manage different complete denture patient’s Edentulous Patient, 13th Ed
behavior. – Zarb, Hobkirk, Eckert,
Jacob
4.  Essentials of Complete
Ivanhoe
Productivity Tip:
START THE DAY BY WRITING IN YOUR PLANNER and plan the things you do for the day or for the entire
week. I knew a dentistry student who plans everything… even going to the toilet. He graduated with high
honors (magna com laude). No, I’m not asking you to do the same (but you can actually do better if you want
to). Plan the things that you want to do and when to do it and write it down.
Hello student! Welcome to Charting Part 2. This module “DIAGNOSIS AND TREATMENT PLANNING
FOR PATIENTS WITH NO TEETH REMAINING” is a continuation of the previous module. In this
module, we will learn the different attitudes and learning behaviors of edentulous patients. We need to
understand the patient in order to address the patient’s needs successfully.
B. MAIN LESSON
Activity 1: Content Notes (13 mins) Read and understand

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DIAGNOSIS AND TREATMENT PLANNING FOR PATIENTS WITH NO TEETH REMAINING
PATIENTS MENTALITY WHEN RECENTLY MADE EDENTULOUS

Patients who have had their teeth removed less than 6 months previously have problems different
from those who have had some denture-wearing experience. Likewise, the problems faced by dentists in
treating recently edentulous patients are different from the problems of treating patients who have been
edentulous for a long time.
The first difference is in the patient's awareness of the difficulties involved and in their expectations
regarding dentures, and the second is in the biologic aspects of the treatment.
Patients who are edentulous and have never attempted to wear dentures face problems that do not
know exist. At best, they are not aware of any difficulties and assume that the dentures will be placed in
their mouth and that they will continue to use the same eating habits as with their natural teeth.
PATIENTS' CONCEPTS OF THE PERMANENCE OF DENTURES

Many recently edentulous patients expect their new teeth to last them the rest of their lives. Some
even believe that by obtaining complete dentures they will no longer require the services of the dentists. Of
course, this is not true or possible. Changes occur in the basal seats for the dentures and these will allow
the positions of the dentures to change in relation to their foundation and to each other. When the teeth are
removed, there remain the cavities in the bone (alveoli) which contained in the roots of teeth and sharp
ridges around each alveolus. It would be nice if the new bone would entirely fill the alveolus but this does
not happen often. At the same time that bone is forming in the tooth socket, the bony edge of the socket is
resorbing in its attempt to become rounded. Unfortunately, in many people the tooth sockets do not
completely fill with new bone, and the edges of the sockets do not always round off as desired. These
conditions can cause problems for both dentist and the patient.
The residual ridges may have undercuts after tooth extractions, which make the removal of
impressions and dentures painful and sometimes difficult. This can be determined by palpation of the
tissues and a survey of the diagnostic casts. It is important that the patient be informed about inevitable
changes before any impressions are made.
*** What happens when bony undercuts in the ridge are present?
*** How do you determine the presence of bony undercuts in the edentulous ridge?
To postpone giving the patient this information until later will almost certainly lead to
misunderstanding between the dentist and the patient, who will look on this information as excuses. The
patient must be warned in advance that the dentures will become progressively looser as the residual
ridges change their form.
Changes in the bone supporting the basal seat continue as long as the patient lives. They vary
greatly in amount from patient to patient, but they are unavoidable. Recent extraction patients should be
warned of these changes, which are more rapid in the first year after teeth are removed than they will be

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later on.
*** Why should you warn/inform the patient about changes (resorption) of the ridge in newly
extracted teeth.
Dr MM House Classification (1950) of Patients Attitude

In 1950, Dr MM House, whose contributions advanced the science and art of prosthodontics, devised a
classification system on the basis of patients’ psychological responses to becoming edentulous and
adapting to dentures. Relying strictly on his clinical impressions, House classified patients into 4 types:
philosophical mind, exacting mind, hysterical mind, and indifferent mind.
1) The Philosophical patient:
The best mental attitude for denture acceptance is the philosophical type. This patient is
rationale, sensible, calm and composed in different situations. His motivation is generalized, as he
considers dentures for the maintenance of health and appearance and feels that having teeth
replaced is a normal acceptable procedure. These patients are willing to rely on the dentist’s advice
for diagnosis and treatment. Philosophical patients will follow the dentist’s advice when advised to
replace their dentures.
*** What is the best mental attitude for denture acceptance? Philosophical type
*** What is a philosophical type of patient? These patients are willing to rely on the dentist’s advice for
diagnosis and treatment.
Treatment may proceed with no additional attitude or behavioral management for these
patients. Although this patient may be easy to handle, under no circumstances that the dentist will
assume that this behavior will remain after the dentures are given to the patient. Information has to
be supplemented to have the patient fully understand the whole denture treatment.
2) The Exacting Patient

The exacting patient may have all of good attributes of the philosophical patients; however,
he may require extreme care, effort and patience on the part of dentist. This patient is methodical,
precise, and accurate and at times makes severe demands. They are above average in intelligence
often dissatisfied with past treatment, doubt the dentist’s ability to make dentures that would satisfy
their esthetic and functional needs and often want written guarantees or remakes at no additional
charge. Once satisfied an exacting patient may become the practioner’s greatest supporter.
*** What is/are the negative trait/s of an “Exacting” patient?
A pre-treatment consultation should include the establishment of esthetic goals. This can be
accomplished by clarifying the patient’s expectation of the treatment outcome and attainment of a
comprehensive understanding of the positive and negative factors that may influence that outcome.
Only by taking all factors described previously into consideration and after the patient fully
understands the treatment procedure as well as the advantages and disadvantages of the proposed
treatment can a realistic treatment plan be made. Furthermore, those issues, such as the shape,
color of the dentures, and arrangements for artificial teeth, etc., which have close relation with the
esthetics, shall be decided only after thorough and careful consideration.

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As long as there are no flaws in the denture fabrication process, clinicians can provide
patients with more positive information about their prosthesis and guide them toward acceptance
and satisfaction with the outcome.
3) The Hysterical Patient

The hysterical type is emotionally unstable, excitable and excessively apprehensive. These
patients submit to treatment as a last resort, have negative attitude, are often in poor health, are
poorly adjusted, often appear exacting but with unfounded complaints, have failed at past attempts
to wear dentures, and have unrealistic expectations. They expect the prosthesis to look and function
like natural teeth. Prognosis is poor for these patients.
Clinical management of this type of patient may be beyond the dentist control. The patient or
family may be directed to seek behavioral or medical expert before any successful dental treatment
can be administered. Under no circumstance should the dentist attempt to manage this type of
patient as it will most likely end in denture treatment failure.
*** What is a hysterical type of patient? Emotionally unstable, excitable and excessively apprehensive.
*** Prognosis for hysterical patients? Poor
4) Indifferent:
The indifferent type of patients presents a questionable or unfavorable prognosis. This
patient evidences little if any concern; he is apathetic and uninterested and lacks motivation. He has
managed to survive without wearing dentures. He pays no attention to instructions, will not co-
operate, and is prone to blame the dentist for poor dental health. One important reason for
reevaluation of House classification is that it pertains to the patient in isolation. House provided little
attention to how the patient’s reactions and behaviors are codetermined by the treatment and
behavior of the dentist. The proposed new classification includes both the patient and the dentist as
codeterminers of treatment outcomes, regardless of whether the patient is edentulous or dentate.
WINKLERS CLASSIFICATION
Categories of patients.
1. The Hardy elderly:
These are individuals who are well-preserved physically and psychologically, are active in their
professional and social lives and quickly adapt to their age changes.
2. The Senile aged syndrome:
These are individuals who are disadvantaged emotionally and physically and may be described as
handicapped, chronically ill, disabled, infirm and truly aged. They cannot handle daily stresses and
are susceptible to disease.
3. The Satisfied old denture wearer:
These patients are satisfied with their old dentures in spite of severe problems. They have learned
to live with them and are happy with them.
4. The Geriatric patient who does not want dentures:
An elderly person who has been without teeth for many years and has no desire for complete

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dentures and lacks motivation. The last two categories of patients lack motivation and have a poor
prognosis if forced into undergoing treatment.
*** What are the 4 different categories of patients according to Winkler?
THE “IDEAL” GERIATRIC DENTURE PATIENT

O’Shea characterized the ideal dental patient as compliant, sophisticated and responsive.
Winkler described four traits that characterize the ideal patient’s response: realizes the need for the
prosthetic treatment, wants the dentures, accepts the dentures and attempts to learn to use the
dentures. It is evident from the various classifications that a so-called ideal psychological profile, though
rare, is often desired by most dentists as it provides the greatest chance of success. Strictly speaking,
the definition of the term ‘ideal’ may be relative, but it does provide a standard to refer to.
Patient may also be classified as:
1. Cooperative
They may or may not recognize the need for dentures but they are open-minded and are
amenable to suggestion. Procedures can be explained with very little effort and they become fully
cooperative.
2. Apprehensive
Even though these patients realize the need for dentures they have some irritational problem
which cannot be overcome by ordinary explanation. They are of different types.
a. Anxious - The patients are anxious and upset about the uncertainties of wearing dentures. They
often put themselves into a neurotic state.
b. Frightened - They will have unwanted fear about the dentures
c. Obsessive or exacting - They are naturally of an exacting nature. They state their wants and are
inclined to tell the dentist how to proceed. They must be handled firmly and tactfully.
d. Chronic complainers - They are a group of people who are habitually fault finding and
dissatisfied. Appreciating the corporation and incorporating of as many of their ideas as possible
with good denture construction is the best way to handle them.
e. Self-conscious - The apprehension here centers chiefly on appearance. It is wise to give overt
reassurance to the self-conscious patient and permit participation as far as feasible in order to
establish some responsibility in the result.
3. Uncooperative
They do not feel a need for dentures though the need exists. Their general attitude is
negative. They constitute an extremely different group of potential denture members.
IMPORTANT NOTE: In the actual practice, dentist will refer patients that are difficult to manage due
to behavioral problems because it is beyond their capacity or may be due to ulterior motives. When referrals
like this are done, the dentist should inform the colleague if he has the capacity to treat such patient or

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misunderstanding will ensue between dentists.
DESIRES AND EXPECTATIONS

To establish rapport and confidence, the dentist must find out just what the patient's desires and
expectations are. Questions such as, “What difficulties are you having with your present dentures?” may
stimulate the patient to tell of looseness, soreness, or difficulty in eating and talking.
The question by the dentist, “Are you happy with the way you look with your present dentures?” can prompt
a flood of comments that will be helpful later on in the arrangement of teeth for esthetics. This question
should be asked during the examination appointment rather than after treatment has been started.
DIAGNOSIS OF THE PATIENT WITH NO TEETH REMAINING

The examination of edentulous mouths should be visual, palpatory, and radiographic, and it should
be made after some preliminary questioning by the dentist.
GENERAL OBSERVATIONS AFFECTING DIAGNOSIS:

1. AGE
The age of the patient has a definite bearing on diagnosis for complete dentures. A young person
will be more adaptable to new situations such as new dentures than an older person.
With advancing age, people have more difficulty in adapting to new situations and learning new
skills. This increases their problems in learning how to use their new teeth. If the patient has a hearing loss
along with advancing age, the communication of instructions becomes more difficult.
*** How does age affect complete denture diagnosis?
2. GENERAL HEALTH.
The general health of the patient may or may not be correlated with the patient's age. Poor health
may cause the physiologic age of the patient to be far beyond the chronologic age. The general health of
patients can be estimated by observation of their posture and gait when they enter the dental operatory.
Responses to the questions, “Are you taking any medicines? or what medicines are you taking? will
tell the dentist much more about his health. For example, if patients say they are taking chlordiazepoxide
(Librium), diazepam (valium), or some other tranquilizer, the dentist will know there is some nervous tension
involved that may be a real problem during denture construction or in adaptation to the new prostheses.
*** How does general health affect complete denture diagnosis?
3. SOCIAL TRAINING

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The life-style or social training of patients must be considered when the diagnosis is made. Some
people wish to have their face lifted and all the lines and wrinkles removed by their new teeth, even though
to do this would give a grotesque appearance. They want the bloodless face-lifting and the wrinkle removed
although it is clearly impossible to turn the physiologic clock back 20 years or 50, just because the patient
desires. Instead, the new dentures should be planned to restore the dignity and harmony of the mouth
region with the conditions found in the rest of the face.
*** How does social training affect diagnosis?
4. PATIENT'S COMPLAINTS
Patients much given the opportunity to tell what problems they had with the old dentures. The
reason for this is the guidance the dentist may receive from the complaints about the area of greatest to the
patient. Is it comfort, ability to eat, difficulty with speech, looseness, gagging? Is it the attitude of friends and
relatives or the appearance of their teeth? When this is known, the dentist will know which parts of the
procedures will be most critical, how to overcome the difficulty if possible and thus how to adjust the time
schedule and fee.
*** How does patient complaint affect diagnosis?
5. LIP SUPPORT
If the tissue around the mouth has wrinkles and the rest of the face does not, significant
improvement can be expected. If the existing anterior are set too far lingually or palatally, the lips will lack
the necessary support, and plans can be made to bring the new teeth further forward and thus provide the
necessary support to help eliminate the wrinkles.
*** How do dentures provide lip support?
6. LIP THICKNESS
Patients with thin lips present special problems. Any slight change in the labiolingual - tooth position
makes an immediate change in lip contour.
*** How do dentures affect lip thickness?
7. LIP FULLNESS
The fullness of the lip is directly related to the support it gets from the mucosa or denture base and
the teeth in back of it, an existing denture with an excessive thick labial flange could make the lip appear to
be too full rather than displaced.
*** How do dentures affect lip fullness?
8. PROFILE (shape of the face viewed on the side) AND CONTOUR OF FEATURES
Observation of the facial profile gives an indication of the relative size of the upper and lower jaws
and of the vertical jaw relations. A receding chin and convex profile mean the upper jaw is larger than the
lower, and the occlusion will have a characteristic Class II disharmony in centric relation.
If the chin is prominent, the profile will be concave, and the occlusion will have a characteristic Class
II disharmony.

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ORAL HEALTH
The health of the oral tissues should be thoroughly studied as soon as the existing dentures are
removed from the mouth. The reason for doing this at once is that the dentist may be able to distinguish
between damage being caused by the old dentures and damage from underlying conditions that may be
observed.
1. COLOR OF THE MUCOSA

The color of the mucosa will reveal much observation about its health. The difference in appearance
between a healthy pink mucosa and red inflamed tissue are apparent. The problem is how to get all the oral
mucosa into a state of health.
Regardless of the problem and its treatment, however, the oral tissues must be healthy before
impressions for new dentures are made, to fail to see that the issues are healthy is to invite trouble from a
continuing inflammation or new dentures that become loose because the inflammation disappears after the
new dentures are in service.
*** What color is a healthy mucosa?
*** What color of the mucosa suggest that it is inflamed?
*** What happens when you take impression on an inflamed (note: swelling is also present during
inflammation) mucosa?
2. ABRASIONS
Abrasions, cuts, or other sore spots may be found in any location ender the basal seats of the existing
dentures or at the borders. They may be the result of overextended dentures or underextended borders or
malocclusion may cause them. At the time of the examination the causes should be removed to allow the
tissues an opportunity to heal before impressions are made.
*** What are the possible causes of mucosal abrasion?
3. PATHOSIS
Pathologic lesions should be diagnosed and treated before impressions are made. Among the more
common lesions found in the mouths of edentulous patients are pseudoepitheliomatus hyperplasia, papillary
hyperplasia, aphthous ulcers, lichen planus, hyperkeratosis, leukoplakia and Epulis Fissuratum. Dentist's
obligations in the area of health do not end when the last teeth are gone. Instead, they become more
important.
4. HARD AND SOFT AREAS IN THE MAXILLARY BASĄL SEAT

Each basal seat has some areas that are harder than others and these should be located so that the

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dentures can be planned to distribute occlusal and limiting forces where they should be.
An ideal basal seat for a maxillary denture is one that has a more or less uniform layer of tissue over the
bone. The ideal layer of tissue is one that is quite firm, but still slightly resilient.
*** What are the qualities of an ideal mucosa?
An even more hazardous condition affecting stability and support for maxillary dentures is the
hyperplastic or flabby maxillary ridge. The best treatment for this condition is to remove it by surgery.
5. TORUS PALATINUS
It is a bony enlargement found at the midline of the hard palate. The palatine tori are covered with a thin
layer of soft tissue, and consequently they are hard. Therefore, the torus palatinus must be relieved, or it
may be removed by surgery. Palatine tori are easily relieved of pressure by placement of an appropriately
thick sheet of lead foil over it (aka Relief) on the cast when the denture is processed. If torus is large,
ostectomy must be performed.
*** Can you see torus palatinus in the mandible? Why?
*** How is a palatine torus removed?
6. THE MANDIBULAR BASAL SEAT

The hard areas in the mandibular basal seat are either favorable (as a broad residual ridge crest) or
unfavorable (as a torus mandibularis, a series of hard sharp points, or a sharp bony ridge).
The torus mandibularis is a bony bulge or knob found on the lingual side of some mandibular alveolar
ridges in the region of the premolar teeth. The range in size from a small pea to half a hazelnut or larger.
They are usually removed (by ostectomy) long before impressions for complete dentures are made.
MECHANICOBIOLOGICAL CONSIDERATIONS:
1. ARCH SIZE
The size of the mandible and the maxillae determines the ultimate support available for complete
dentures. Large jaws provide more support than small jaws, and the difference is directly proportional to their
sizes. Therefore, a patient with small jawbones should not expect to put as much closing force on the
dentures as a person with large jawbones.
*** How does arch size affect denture support?
2. DISHARMONY IN JAW SIZES
Some patients have large maxillary jaws and small mandibular jaws and some have the opposite
disharmony with the mandibular jaw being larger than the maxillary one. These conditions arise from genetic
factors and from improper growth and development.

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Date:
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*** What is the cause of jaw disharmony?
3. RIDGE FORM
The ideal ridge has a broad top and more parallel sides. When severe undercuts exist after the teeth has
been removed, some surgical alteration may be necessary.
***What is the shape of an ideal ridge?
4. RIDGE RELATIONS
The bones of the upper jaw resorb primarily from the occlusal surface and facial surfaces. This means
that, upper residual ridge becomes shorter and that the maxillary arch becomes narrower from side to side
and shorter anteroposteriorly.
*** What is the resorption pattern of the mx edentulous ridge?
The lower jaw resorbs primarily from the occlusal surface to and becomes shorter. It appears as though
the mandibular arch becomes broader while the maxillary arch becomes narrower. The mandible changes
in this way because the inferior border of the mandible is broader from one side of the jaw to the other than
the occlusal part of the mandible.
*** What is the resorption pattern of the mn edentulous ridge?
5. SHAPE OF THE PALATAL VAULT

Palatal vaults vary considerably from patient to patient. The most favorable vault form is one that has a
medium depth, with a well-defined incline of the rugae area in the anterior part of the palate,
Dentures in a mouth with a flat palatal vault can resist removal by a direct downward pull, but they can
easily be dislodged by a laterally or anteriorly directed force or by a rotating force.
A high, narrow, V-shaped vault is also unfavorable for the retention of dentures. The tighter the denture
presses against the sides of the palatal vault, the faster the denture will loosen and slip out of place.
*** What are the 3 different shapes of the palatal vault?
6. MUSCULATURE DEVELOPMENT
The muscular development of the tongue, cheeks and lips is a significant factor of influencing impression
making and the ability of patients to use their dentures after they have been completed.
Tongues seem to become larger and more powerful if patients have been wearing loose or otherwise
inadequate dentures. Apparently, the tongue is used by these patients to hold their upper dentures up and
others even masticate their food by pushing it against the roof of the mouth with the tongue. Patients who
have worn a complete upper denture against eight or ten lower anterior teeth are especially prone to develop
these habits.

Module #5
Name: Class number:

Date:
________________
7. SALIVA
The amount and consistency of saliva will affect the stability and retention of dentures and the comfort
with which patients can wear them.
An excess of saliva will complicate impression making and can be annoyance to patients. The new
dentures may feel like foreign objects, which they are, and this does stimulate the flow of saliva.
A saliva that is thick and ropy can cause problems. Thick, ropy saliva is also a factor in causing patients
to gag while impressions are made and after the placement of new dentures. Ideally, there should be a
moderate flow of serous - type saliva, which seems to be the situation most frequently found.
The palatal surface should be wiped free of saliva before the final impression is made, and the mucous
glands should be massaged with a small piece of gauze just before the final impression made to eliminate as
much of the mucous as possible.
*** How does saliva affect denture retention?
8. CHEEKS AND LIPS

The muscles in the cheeks and lips have a critical function in successful use of dentures. The denture
flanges must be properly shaped so that they can aid in maintaining the dentures in place without conscious
effort on the part of the patient. This involves the development of the proper arch form and tooth positions as
well as the shape of the polished surface and the thickness of the denture borders. and a little practice.
Note the shape of the polished surface conforming

to the shape of the cheek (tissue compliance).
When the denture flange is shaped like this, the
cheek aids in retaining the denture.

Module #5
Name: Class number:

Date:
________________
9. GAGGING
A patient's protective gag reflex can compromise a dental treatment plan if the reflex is an active one.
The exaggerated gag reflex can frustrate both patient and dentist. Effective management of the gagging
problem tends to be based on experience and anecdote with combinations of clinical techniques,
prosthodontic management, medication and psychologist referral being regarded as the most successful
approaches. * Use the right amount of impression materials and correct contour of denture base.

1.) List the traits, behavior or attitudes (according to House, Winkler etc.) of patients that the
dentist/clinician will have no difficulty in dealing with when treating patients for complete denture
restoration. Use commas as separator.
Philosophical, The hardy elderly, Cooperative
2.) List the traits, behavior or attitudes of patients that the dentist will encounter with slight difficulty
when treating this type of patient. Use commas as separator.
Exacting, The senile aged syndrome, Apprehensive
3.) List the traits, behavior or attitudes of patients that the dentist will encounter with extreme difficulty
and most likely will end with treatment failure. Use commas as separator.
Hysterical, Indifferent, the satisfied old denture wearer the geriatric patient who does not want
dentures, Uncooperative

1.) The age of the patient affects diagnosis and treatment because:
I.) the younger the patient the more they can readily adapt;

Module #5
Name: Class number:

Date:
________________
II.) the older the patient the more experience they have;
III.) skills are acquired readily by younger patients than older patients;
IV.) learning new skills of old patients are lesser compared to younger patients;
V.) older patients are usually stubborn than younger patients.
A.) I, II, III, IV

B.) I, II, III, V
/ C.) I, III, IV, V
D.) II, III, IV, V
E.) I, II, IV, V
2.) Is it possible to mostly eliminate the wrinkling around the mouth if wrinkling is only found in the
mouth of the patient when a new set of dentures are made? (If yes, Why? If no, Why not?)
Yes, since it is found around the mouth only, the cause of the wrinkling is edentulism
3.) How can you distinguish healthy mucosa from inflamed mucosa?
Healthy mucosa is pink in color while inflamed mucosa is red
4.) Regarding question #3 above, what happens when a denture is fabricated on an inflamed mucosa?
a.) After taking an impression of an inflamed mucosa, denture becomes lose when the mucosa
heals
b.) If the mucosa did not heal and the denture is inserted, the inflammation may get worst.
5.) If a torus palatinus is encountered, what should be done?

Cover it with the denture base if it is small. If it is big, it has to be surgically removed.

Module #5
Name: Class number:

Date:
________________
C. LESSON WRAP-UP
A. Work Tracker
completed.
5
yes
NA
KEY TO CORRECTIONS
Answers to Activity#3
1.)
Philosophical, The hardy elderly, Cooperative
2.)

Module #5
Name: Class number:

Date:
________________
Exacting, The senile aged syndrome, Apprehensive
3.)
Hysterical, Indifferent, the satisfied old denture wearer the geriatric patient who does not want
dentures, Uncooperative
Answers to Activity#5
1.) C
2.) Yes, since it is found around the mouth only, the cause of the wrinkling is edentulism
3.)
Healthy mucosa is pink in color while inflamed mucosa is red
4.) There will be two possible scenarios that will happen:

a.) After taking an impression of an inflamed mucosa, denture becomes lose when the mucosa
heals
b.) If the mucosa did not heal and the denture is inserted, the inflammation may get worst.
5.) Cover it with the denture base if it is small. If it is big, it has to be surgically removed.
Contact Details

 Mobile: +63-968-317-1218, +63-929-886-1569
 Facebook/Messenger: https://www.facebook.com/dr.allan.ebua; DM444 A1
[email protected]

DM 037: PROSTHODONTICS 3
Module #6

Section:A1 Schedule: Click or tap here to enter text.
Date:
Lesson title: IMPROVING THE PATIENT'S DENTURE Materials:

FOUNDATION AND RIDGE RELATIONS Ballpens, erasers, pencils and
1. How to improve the denture foundation and ridge relation.
2. Learn what are the different methods of improving denture References:
foundation.  Prosthodontic Treatment for
Edentulous Patient, 13th Ed
Jacob
Ed – Sheldon Winkler
Ivanhoe
Basker, Davenport,
Thomason
Productivity Tip:
START YOUR DAY BY LOOKING AT THE MIRROR SMILING. If you start the day happy, the rest of the
day will be pleasant. A smile will not cost you anything but it is the best thing you can wear. You will always
look better when you smile and it is very contagious... more contagious than COVID19.
Hello students! Welcome to module # 6 “IMPROVING THE PATIENT’S DENTURE FOUNDATION”. In

this module we will be learning the different approach on how to improve the tissue foundation before
any attempt to fabricate a new set of dentures. If the dentures are made on the supporting tissue that
has some abnormalities, problems will arise and will lead to failure of the whole complete denture
treatment.
B. MAIN LESSON
Activity 2: Content Notes (13 mins)

Read and understand the content notes. Answer the questions in your own word/s (the shorter the better).

Module #6

Date:
IMPROVING THE PATIENT'S DENTURE FOUNDATION AND RIDGE RELATIONS
Dentures can be no better than their supporting tissue foundations and several conditions in the
edentulous mouth should be corrected or treated before the construction of complete dentures. The methods
of treatment to improve patient's denture foundation and ridge relations are usually either nonsurgical or
surgical in nature, or a combination of both methods. (Nonsurgical or surgical, or combination of both)
*** What are the methods of treatment to improve patient's denture foundation and ridge relations?
NONSURGICAL METHOD OF IMPROVING THE DENTURE FOUNDATION
*** What are the nonsurgical methods of improving the denture foundation?
A. REST FOR DENTURE SUPPORTING TISSUES (Rest for denture supporting tissues, & many more below)
Rest for denture- supporting tissues can be achieved by removal of the dentures from the mouth (for
24 hours or more) for an extended period of time or the use of temporary soft resilient liners. Both
procedures allow deformed tissue of the residual ridges to recover (heal to) normal form. When impression
is taken and denture fabricated on an inflamed tissue, the result will be a loose (non-retentive) or a
painful/uncomfortable new denture. (Removal of the dentures from mouth)
*** How is rest for denture-supporting tissues achieved? (Loose or painful denture)
*** What will happen if impression is taken and dentures fabricated on an inflamed tissue?
Soft liners act as a cushion to

distribute the force during
mastication. It also enhances
fit decreasing looseness.
It also has been demonstrated that tissue abuse caused by improper occlusion can be corrected by
(1) withholding the faulty dentures from the patient, (2) adjusting/correcting the occlusion and refitting the
denture by means of a tissue conditioner, and (3) substituting properly made dentures once the denture-
bearing tissues have recovered. This usually can be readily achieved by removing the dentures for 48 to 72
hours before the impressions are made for the construction of new dentures.
*** How is tissue abuse caused by improper occlusion corrected? (Withholding faulty dentures)
Letting the tissue rest for at least 24 hours plus the additional use of tissue conditioners are

Module #6

Date:
regarded as essential preliminaries to each prosthetic appointment. Tissues recover rapidly when the
dentures are not worn or when treatment liners are used. The method of achieving optimal health of the
denture-bearing tissues is not as important as the result (the tissues being made healthy). Many dentures
fail because the impressions or registrations of the relations are made when the tissues are distorted by the
old dentures.
*** How long should you let the tissues of the edentulous ridge rest? (24 hrs.)
B. OCCLUSAL CORRECTION OF THE OLD PROSTHESES

An attempt should be made to restore an optimal vertical dimension of occlusion (VDO is the length
of the patient’s face when the teeth are occluded) to the dentures presently worn by the patient by using an
interim resilient lining material.
Altered cuspal inclines may be the cause of denture looseness which makes the denture to slide, tilt,
tip or twist upon contact. It can result to localized pressure, pain or loosening. Premature contact in the
buccal cusps are most notable for this. It must be noted that dentures must simultaneously contact (both left
and right) upon use as opposed to natural teeth which is unilateral in contact during mastication.
*** What happens when the cuspal inclines are altered? (Denture looseness)
*** Which part of the denture is it notable? (Buccal cusp)
(Natural teeth unilateral contact)
*** How does denture teeth and natural teeth differ during use (mastication)?
It must however be emphasized that although the lining material will alter the occlusion, this is not its
prime purpose other than to change the VDO. Its use must therefore be accompanied by an assessment of
the occlusion and any necessary alterations to the occlusal surfaces of the teeth. This may involve grinding
or the addition of material to the (occlusal surface of the) teeth.
*** Is altering the occlusion the prime purpose of the liners? (Assessment of the occlusion)
*** How is occlusion altered in dentures? (Grinding or addition of material to surface
of teeth)
C. GOOD NUTRITION
A good nutrition program must be emphasized for each edentulous patient. This is especially
important for the geriatric patient whose metabolic and masticatory efficiency have decreased.
*** Why is it necessary to have a good nutritional program for geriatric patients?
(They have poor metabolic and masticatory
D. CONDITIONING OF THE PATIENT'S MUSCULATURE activity)
The use of jaw exercises can permit relaxation of the muscles of mastication and strengthen their
coordination as well as help prepare the patient psychologically for prosthetic service. Certain muscles of
facial expression like the buccinator and the orbicularis oris may also be included as this muscle help to
retain the denture.
*** How is musculature conditioning done? (Jaw exercises)
*** What muscles help in denture retention? (Orbicularis oris and buccinator)
Oral and facial musculature provides supplementary
properly shaped. Therefore, the shape of the buccal and

Module #6
retentive forces, provided that the prosthetic teeth are

This document is the property of PHINMA EDsUitiC
po onAeTdIO
inNthe “neutral zone” between the cheeks and
tongue and the polished surfaces of the dentures are
properly shaped. Therefore, the shape of the buccal and

Module #6

Date:
SURGICAL METHODS OF IMPROVING THE DENTURE FOUNDATION

Infrequently, certain conditions of the denture-bearing tissues require surgical interventions. These
conditions may be the result of unfavorable morphological variations of the denture-bearing area, or more
commonly, they result from long-term wear of ill-fitting dentures.
*** What conditions require surgical intervention? (High frenular attachments)
A. HIGH FRENULAR ATTACHMENTS AND PENDULOUS MAXILLARY TUBEROSITIES PROBLEMS
Frena or fibrous bands of tissue attached to the bone of the mandible and maxillae are frequently
superficial to muscle attachments. If the frenum is close to the crest of the bony ridge it may be difficult to
obtain the ideal extension and border of the flange of the denture. This tissue can be removed surgically.
The frenectomy can be carried out before prosthetic treatment is began or it can be done at the time of
denture insertion when the new denture can act as a surgical template. The former is preferred because the
patient will not have to contend with postoperative discomfort along with adjustment to the dentures.
***What is the term for surgical removal of the frenum? (frenectomy)
Pendulous, fibrous maxillary tuberosities are frequently encountered in edentulous ridge. They occur
unilaterally or bilaterally and may interfere with denture construction by excessive encroachment on or
obliteration of the interarch space (no more space for pontics). Surgical excision is the treatment of choice.

Module #6

Date:
***What is the treatment of choice for pendulous, fibrous maxillary tuberosities? (surgical excission)
Flabby, mobile tuberosity should be excised as shown in part D (a, incisions made in fibrous tuberosity; b,
wedge of fibrous tissue removed; c, incisions made under the mucosa for removal of all unwanted fibrous
connective tissue; d and e, thin mucosal flaps fitted, trimmed, and sutured).
B. BONY PROMINENCES, UNDERCUTS, SPINY/SHARP RIDGES AND NONPARALLEL BONY RIDGES

PROBLEMS

Module #6

Date:
Different sized and located maxillary and mandibular tori (A to E) may be managed by relief design in the acrylic resin denture bases
(shown in part B), or else by surgical excision. The latter is indicated if the tori are particularly large, extend distally in the maxilla so
as to compromise the efficacy of the posterior palatal seal, or else preclude the desired basal seat coverage for a mandibular
prosthesis.
Mandibular tori are usually removed to avoid undercuts and to make possible a border seal beyond
them against the floor of the mouth. On the other hand, maxillary tori are infrequently removed. Satisfactory
dentures can be made over most palatine tori unless the additional thickness of the denture causes

Module #6

Date:
discomfort, difficulty in speech or breaks posterior seal.

***When is it necessary to remove a palatal torus? (To avoid undercuts)
Sharp spiny ridges (F) may need rounding off for optimal denture seating. It may be approached in 2
ways: Alveoloplasty (rounding off/removal/altering the shape) or Ridge augmentation (adding of bone or
bone substitute to make the ridge taller) or both.
***How do you deal with sharp spiny ridge? (Alveoplasty or ridge augmentation)
C. NEEDING ENLARGEMENT OF DENTURE-BEARING AREA (ridge area covered by denture) BY:

VESTIBULOPLASTY (sulcus deepening by reattachment of tissue)
The reduction of alveolar ridge size frequently accompanied by an apparent encroachment of muscle
attachments onto the crest of the ridge. These so called high (mandibular) or low (maxillary) attachments
serve to reduce the denture-bearing' area available and to undermine denture stability. The anterior part of
the body of the mandible (Mn anterior edentulous ridge resorbs the fastest because it is the narrowest part)
is the site frequently involved.
***Which part of the edentulous mouth frequently needs vestibuloplasty?
(Mn anterior edentulous ridge)
E
F

Module #6

Date:
A to C, A sulcus-deepening procedure requires surgical detachment of labial and buccal muscle attachments followed
by placement of a mucosal or skin graft. While this approach yields a larger available area for acrylic resin coverage
(D), it also risks a so-called “witch’s chin” appearance as a result of localized altered morphology and muscle function
(E). This outcome is equally evident when a more extensive sulcus deepening is carried out (F to H). The procedure is
less frequently prescribed for the edentulous maxilla (I, J, and K). All of these preprosthetic surgical procedures have
now been virtually eclipsed by routine implant placement and advances in bone grafting combined with implant
prescriptions.
*** What is the appearance of the patient as a result of altered morphology from sulcus deepening?
(witch’s chin)
MYOPLASTY (detachment of muscle whether partially or fully)
***What is Myoplasty? (Detachment of muscle)
Myoplasty accompanied by sulcus deepening has been carried out in an attempt to improve denture
retention. With this operation the oral surgeon detaches the origin of muscles on either the labial or lingual
side, or both ridges. This enables the prosthodontist to increase the vertical extensions of the denture
flanges.
D. VERY RESORBED RIDGE PROBLEMS

RIDGE AUGMENTATION/GUIDED BONE REGENERATION

Module #6

Date:
For many years, surgeons have attempted to restore by placing onlay bone grafts from the iliac or rib
source above (Autograft) or at the side of the ridge specially the mandible which resorbs faster than the
maxillary edentulous ridge.
Guided bone regeneration (GBR) is dental surgical procedures that use barrier membranes (barrier
membranes may be resorbable or non-resorbable) to direct the growth of new bone at sites with insufficient
volumes or dimensions of bone for proper function, esthetics or prosthetic restoration.
***What is GBR? (Guided bone regeneration)
E. DISCREPANCIES IN JAW SIZES PROBLEM

The recent advances in surgical techniques of mandibular and maxillary osteotomy (osteotomy=
shortening or lengthening) have enabled the oral surgeon to create optimal jaw relations for prosthetic
patients who have discrepancies in jaw size. The prognathic patient frequently places considerable stress
and unfavorable leverages on the maxillary basal seat. This may cause excessive reduction of the maxillary
residual ridge. A mandibular osteotomy in such situations can create a more favorable arch alignment and
improve cosmetic appearance as well.

Module #6

Date:
Orthognathic surgery also known

as corrective jaw surgery or
simply jaw surgery, is surgery
designed to correct conditions of
the jaw and lower face
Correction of jaw size discrepancy for maxillary prognathism (left pic) and mandibular prognathism (right pic)
***How is jaw size discrepancy dealt to create optimal jaw relations? (Osteotomy)
F. PRESSURE ON THE MENTAL FORAMEN PROBLEM
When the resorption of the bone of the mandible has been extreme, the mental foramen may open
near or directly at the crest of the residual bony process. When such condition exists, pressure from the
denture against the mental nerve exiting from the foramen and over this sharp bony edge will cause pain or
numbness of the lower lip. The most suitable way of managing this is to alter the denture so pressure does
not exist by creating relief areas (relief areas are areas of the denture not touching or minimally touching the
tissue to avoid impingement) in the denture. (Alter the denture)
*** What should be done on the denture to avoid pressure on the mental nerve in a resorbed ridge?
Location of mental
foramen on a jaw with
natural teeth (left). A very
resorbed edentulous ridge
(right) and the location of
mental foramen directly
above it.

Module #6

Date:
G. REPLACING TOOTH ROOTS BY OSSEOINTEGRATED DENTAL IMPLANTS

Recent research has provided irrefutable evidence of the desirability and the feasibility of osseo
integrating tooth root replicas or analogues in edentulous jaws. In this technique, a number of cylindrical
shaped screws, made of specific materials and confirming to specific designs, are buried inside the selected
host bone sites.
LESSON WRAP-UP
A. Work Tracker
completed.

Module #6

Date:
5
yes
NA
FAQs
1.) Is implant still the best option for patients with ideal or slightly less than ideal height of the edentulous
ridge?
ANSWER: Yes, dental implants are the most appropriate option. In edentulous patients, when
osteointegrating implants are use, the bone resorption is very minimal and denture retention is
maximized. The only drawback is that it is expensive. The rejection of implant by the tissue is very low.
2.) Is it possible to construct a denture over a sharp/spiny on the crest of the edentulous ridge?
ANSWER: Yes, as long as relief areas are created on the basal surface over the sharp areas of the
ridge to avoid impingement of the mucosa. Options like ridge augmentation (best option) or
Alveoloplasty (rounding off) should also be considered to improve denture foundation first.

Module #6

Date:
Contact Details

 Mobile: +63-968-317-1218, +63-929-886-1569
[email protected]

Module #7
Name:_Richard Cheng Class number:

Section: _A1
Schedule: Date:
Lesson title: BIOLOGIC CONSIDERATIONS OF MAXILLARY Materials:

IMPRESSIONS Ballpens, erasers, pencils and
module 7
Lesson Objectives:
1. Learn the biologic considerations of maxillary impressions. References:
2. Learn the different anatomical landmarks of the maxilla  Prosthodontic Treatment for
relevant to complete dentures construction. Edentulous Patient, 13th Ed
Jacob
Ivanhoe
Thomason
Productivity Tip:
Go with the “REAL STUDY GROUP” not the “GOSSIP STUDY GROUP”. A study group is good for
exchanging ideas. The alpha (the most intelligent of the group) can help the weakest member.
Hello students! Welcome to module # 7 “BIOLOGIC CONSIDERATIONS FOR MAXILLARY

IMPRESSIONS. After improving the denture foundation from module#6, this module, we will learn the
anatomical landmarks that needs to be considered when taking maxillary impressions. Incomplete
capture of the denture foundation will lead to uneven distribution of forces which leads to faster
resorption and denture dislodgement. Likewise, overextension of borders also leads to dislodgement
and/or pathosis.
Activity 1: What I Know Chart, part 1 (3 mins)
Read the questions on the second column and try to answer the first column with what knowledge you
have. Your answer in the first column can be based on stock knowledge. Any information, processes,

Module #7

Section: _A1
Schedule: Date:
hypotheses, opinions, feelings, procedures, reasoning, solutions, and others can be used. The third
column is left blank at this time.
What I Know Questions: What I Learned (Activity 4)

Basal seat 1 What is/are the Basal seat
supporting
structure/s of the
maxilla? (These
are your primary
and secondary
stress bearing
areas)
Labial frenum 2 What are the labial frenum

limiting structures labial vestibule
in the maxilla? buccal frenum
buccal vestibule
coronoid bulge
residual alveolar ridge
maxillary tuberosity
hamular notch
The oral mucosa must be checked 3 What is the The quality of the mucosa is
for differences of thickness as this significance of the important and has to be taken into
could lessen the retention of the microscopic consideration specially the
denture. anatomy (quality) difference in thickness and
of the mucosa? resiliency. The tissues of the basal
seat will be subjected to forces
when the denture is used and
therefore the effect of compression
of the tissues on different areas are
not the same.
B. MAIN LESSON

Module #7

Section: _A1
Schedule: Date:
BIOLOGIC CONSIDERATIONS OF MAXILLARY IMPRESSIONS

Complete dentures are artificial substitutes for living tissues that have been lost. The dentures must
replace the form of the living tissues as closely as possible. Most importantly, the dentures must function in
harmony with the remaining tissues that both support and surround them. For this harmony of living tissues
and nonliving material (dentures) to coexist for reasonable periods of time, the dentist must fully understand
both the macroscopic and microscopic anatomy of the supporting and limiting structures of the dentures.
MACROSCOPIC ANATOMY OF SUPPORTING STRUCTURES OF THE MAXILLA:

The foundation for dentures is called the basal seat and it is made up of bone that is covered by the
MUCOUS MEMBRANE (the 2 layers are: Mucosa and submucosa). The part of the denture that covers the
basal seat (tissue) is called the basal surface of the denture.
SUPPORT FOR THE MAXILLARY DENTURE
A. MAXILLA: 1, labial frenum (not visible); 2, labial vestibule; 3, buccal frenum; 4, buccal vestibule; 5, coronoid
bulge; 6, residual alveolar ridge; 7, maxillary tuberosity; 8, hamular notch; 9, posterior palatal seal region (vibrating
line); 10, foveae palatinae; 11, median palatine raphe; 12, incisive papilla; 13, rugae; 14, displaceable soft and hard
palate (glandular region).
B. MAXILLARY DENTURE SHOWS THE CORRESPONDING LANDMARKS: 1, labial notch; 2, labial flange; 3,
buccal notch; 4, buccal flange; 5, coronoid contour; 6, alveolar groove; 7, area of tuberosity; 8, pterygomaxillary seal
in area of hamular notch; 9, area of posterior palatal seal; 10, foveae palatinae; 11, median palatine groove; 12,
incisive fossa; 13, rugae; 14, “butterfly” outline of posterior palatal seal.
The ultimate support for a maxillary denture is the bone. The residual ridge, made up of the two
palatine processes of the maxillae and the maxillary processes of the palatine bone form the foundation for
the hard palate and provide considerable support for the denture.

Module #7

Section: _A1
Schedule: Date:
1. MAXILLARY RESIDUAL RIDGE (A-6)

The shape and size of the alveolar ridges changed when the natural teeth are removed. The
resorption of the alveolar process will cause the foundation for the maxillary denture to become smaller and
otherwise change its shape.
2. MAXILLARY STRESS - BEARING AREAS (A-6)

The residual ridge is considered to be the primary stress-bearing area in the upper jaw. The crest of
the residual ridge is covered with a layer of fibrous connective tissue, which is most favorable for supporting
the denture because of its firmness and position. The primary stress-bearing areas are those areas covered
by the denture and where the forces are directed when the denture is in use/function. The hard palate area
is a supporting structure except the median palatine raphe (A-11) which is a very sensitive area and the
glandular region.
The rugae area (A-13) is considered to be the secondary stress-bearing area in the upper jaw, since
it can resist the forward movement of the denture. The rugae are irregularly shaped rolls of soft tissue in the
anterior part of the palate. They served no function, but for the sake of the patient's comfort they should not
be distorted in an impression technique, since rebounding distorted tissue tends to unseat the denture.
The third area of special concern is the glandular region on either side of the midline in the posterior
part of the palate. This region should be covered by the denture so that it can aid in retention, but it should
not be expected to provide support for the denture.
3. INCISIVE PAPILLA (A-12)

The incisive papilla covers the incisive foramen and is located on the median line immediately behind
and between the maxillary central incisors. Relief (B-12) for the incisive papilla should be provided in every
denture to avoid any possible interference with the nasopalatine vessels and nerve supply.
4. ZYGOMATIC PROCESS (felt as a bulge between A-3 and A-4)

The zygomatic, or malar process, which is located opposite the first molar region, is one of the hard
areas found in mouths that have been edentulous for a long time, some dentures require relief over this area
to aid retention and prevent soreness of the underlying tissues specially in resorbed ridges.
5. MAXILLARY TUBEROSITY (A-7)

The tuberosity region of the maxilla often hangs abnormally low because when the maxillary
posterior teeth are retained after the mandibular. molars have been lost and not replaced, the maxillary tooth
extrude, bringing the process with them.

Module #7

Section: _A1
Schedule: Date:
6. TORUS PALATINUS (may be present in the A-11 area extending to A-10))

A hard, bony enlargement that occurs in the midline of the roof of the mouth is called a torus
palatinus. This condition occurs in about 20% of the population. The extent of the torus, can be determined
by palpation.
MACROSCOPIC ANATOMY OF LIMITING STRUCTURES OF THE MAXILLA:

The functional anatomy of the mouth determines the extent of the basal surface of dentures. The
denture base should include the maximum surface possible within the limits of the health and function of the
tissues it covers and contacts. This means that dentures should be made in such a way that they cover all
the available basal seat tissues without causing soreness at the denture borders and without interfering with
the action of any of the structures they contact or that surround the denture. The anatomy to be considered
is the anatomy in function, rather than descriptive anatomy.
The limiting structures of the maxillary basal seat can be analyzed in different regions: The anterior region
extends from one buccal frenum to the other on the labia! side of the maxillary ridge and is called the labial
vestibular space.
1. LABIAL FRENUM (A-1 not shown)

The maxillary labial frenum is a fold of mucous membrane at the median line. The labial notch in the
labial flange of the denture must be just wide enough and just deep enough to allow the frenum to pass
through it without manipulation of the lip. A shallow bead can be formed in the denture base around the
notch to help perfect the seal.
2. ORBICULARIS ORIS MUSCLE

Module #7

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G, Muscles that maintain facial support. When artificial teeth and the denture base material restore the lips to their
correct contour, the facial muscles will be at their physiological length, and contraction will create the normal facial
expression of the patient. H, Functional unit of the buccinator. This muscle (1) and the orbicularis oris muscle (2)
depend on the position of the upper denture for their proper action.
It is the main muscle of the lips, and it lies in front of rests upon the labial flange and teeth of a
denture. Its tone depends on the support it receives from the thickness of the labial flange and the position of
the arch of teeth. It is a sphincter-like muscle that is attached to the maxillae and mandible on the median
line.
3. BUCCAL FRENUM (A-3)

The denture border between the labial frenum and the buccal frenum is known as the labial flange.
The buccal frenum is sometimes a single fold of mucous membrane, sometimes double, and in some
mouths, broad and fan shaped. The buccal frenum requires more clearance for its action than the labial
frenum. The caninus (levator anguli oris) muscle attaches beneath the buccal frenum and affects the
position of the frenum. The orbicularis oris muscle pulls the buccal frenum. forward, the buccinator muscle
pulls it backward. The buccal notch in the denture must be broad enough to allow this movement of the
buccal frenum, Inadequate provision for the buccal frenum can cause dislodgment of the denture when the
cheeks are moved posteriorly as in broad smile.
4. BUCCAL VESTIBULE (A-4)

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The buccal vestibule is opposite the tuberosity and extends from the buccal frenum to the hamular,
or pterygomaxillary, notch. This space between the ridge and the cheek in the buccal vestibule is available
for the buccal Flange of the maxillary denture, which should fill but not overfill it.
5. PTERYGOMAXILLARY (HAMULAR) NOTCH (A-8)

The hamular notch is situated between the tuberosity of the maxilla and the hamulus of the medial
pterygoid plate. This notch is used as a boundary of the posterior border of the maxillary denture back of the
tuberosity.
6. PALATINE FOVEA REGION (A-10)

The foveae palatinae are indentations near the midline of the palate that are formed by a
coalescence of several Mucous gland ducts. The foveae are close to the vibrating line and are always in soft
tissue, which makes them an ideal guide for the location of the posterior border of the denture.
7. VIBRATING LINE OF THE PALATE (A-9)
The vibrating line is located on the soft palate, and it elevates slightly
when the patient says “ah.” Anterior to this line there is no movement on
phonation.
The vibrating lines is an imaginary line drawn across the palate that marks the beginning of motion in
the soft pan late when the patient says "ah." It is a line extending from one pterygomaxillary notch to the
other. At the midline it usually passes about 2 mm? in front of the foveae palatina. The vibrating line is not to
be confused with the junction of the hard and soft palates, since the vibrating is always on the soft palate.

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The distal end of the upper denture must extend at least to the vibrating line. In most instances, the
denture should end 1 or 2mm posterior to the vibrating line.
8. RETROZYGOMAL FOSSAE/SPACE (A-5)
The Retrozygomal space is located posterior to the zygomatic/malar process. It is part of the
buccal vestibule and is lateral to the maxillary tuberosity. The posterior buccal flange occupies the
area when the maxillary denture is placed. This area is often incompletely captured during
impression. When a denture flange is short and not properly extended and adapted in this area, the
peripheral seal is not complete and the denture will easily dislodge.
MICROSCOPIC ANATOMY: THE HISTOLOGIC NATURE OF SOFT TISSUE AND BONE

The bones of the upper and lower edentulous jaws are covered with soft tissue, and the oral cavity is
lined with soft tissue known as mucous membrane. The denture bases rest on the mucous membrane,
which serves as a cushion between the bases of the supporting bone. The mucous membrane is composed
of two layers, the mucosa and the submucosa.
CLASSIFICATION OF ORAL MUCOSA

Most classifications divide the oral mucosa into three categories, depending on its location in the
mouth: the masticatory mucosa, the lining mucosa, and the specialized mucosa.

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/
1. MASTICATORY MUCOSA
In the edentulous patient the masticatory mucosa (1) covers the crest of the residual ridge, including
the residual attached gingiva that is firmly attached to the supporting bone, and (2) covers the hard palate.
They are keratinized stratified squamous epithelium, found on the dorsum of the tongue, hard palate,
and attached gingiva
2. LINING MUCOSA
The lining mucosa forms the covering of the lips and cheeks, the vestibular spaces, the alveololingual
sulcus, the soft palate, the ventral surface of the tongue, and the unattached gingiva found on the slopes of
the residual ridges. nonkeratinized stratified squamous epithelium, found almost everywhere else in the
oral cavity, including the:
 Alveolar mucosa, the lining between the buccal and labial mucosae. It is a brighter red, smooth, and
shiny with many blood vessels, and is not connected to underlying tissue by rete pegs

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 Buccal mucosa, the inside lining of the cheeks and floor of the mouth; part of the lining mucosa.
 Labial mucosa, the inside lining of the lips; part of the lining mucosa
3. SPECIALIZED MUCOSA
The specialized mucosa covers the dorsal surface of the tongue. The mucosal covering is
keratinized and includes the specialized papillae on the upper surface of the tongue. Found specifically in
the regions of the taste buds on lingual papillae on the dorsal surface of the tongue; contains nerve endings
for general sensory reception and taste perception
The quality of the mucosa is important and has to be taken into consideration specially the difference
in thickness and resiliency. The tissues of the basal seat will be subjected to forces when the denture is used
and therefore the effect of compression of the tissues on different areas are not the same. So, the ability of
the mucosa to tolerate or get injured has to be taken into consideration. The difference in tissue resiliency
will also lead air getting inside the “denture-tissue” interface making denture retention a problem if careful
evaluation is not considered.

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Identify the numbered parts of the maxilla in the picture above (pic A 1-14) and write in the table below
where it belongs.
Primary stress-bearing Secondary stress-bearing Limiting Structure Relief Areas
Area Area
(6) Maxillary edentulous 13) Rugae area and most (1) labial frenum (11) median palatine raphe
ridge of the hard palate (2) labial vestibule (12) incisive papilla
(7) Maxillary tuberosity (3) buccal frenum (14) displaceable soft and
(4) buccal vestibule hard palate (glandular
(5) coronoid bulge region)
(6) residual alveolar ridge
(7) maxillary tuberosity
(8) hamular notch
Near (9) and near(10)
vibrating line
Identify the numbered parts as to what type of mucosa (see picture A 1-14 above)
Masticatory (use numbers) Lining (use numbers) Specialized (use numbers)
6, 7, 10 11, 12, 13, 14 1, 2, 3, 4, 5, 8, 9 None

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Review the questions in the “What I Know” Chart, part 1 from Activity 1 and write your answers to the
questions based on what you know now in the third column of the chart “What I learned”.
Short Quiz
1.) Support is provided by these areas

I. Maxillary tuberosity
II. Maxillary ridge
III. mid-palatine raphe
IV. hard palate
V. Rugae area
A.) I, II, III, IV

B.) I, II, III, V
/ C.) I, III, IV, V
D.) I, II, IV, V
E.) II, III, IV, V
2.) Limits the extension of the denture base

I. frena
II. mucobuccal fold
III. incisive papilla
IV. mucolabial fold
V. vibrating line
A.) I, II, III, IV

B.) I, II, III, V
C.) I, III, IV, V
/ D.) I, II, IV, V
E.) II, III, IV, V
3.) Relief areas
I. mid-palatine raphe
II. glandular region
III. incisive papilla
IV. zygomatic bulge
V. rugae area

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/ A.) I, II, III, IV

B.) I, II, III, V
C.) I, III, IV, V
D.) I, II, IV, V
E.) II, III, IV, V
4.) Why should relief be provided in the incisive foramen and the median palatine raphe area on the
denture base?
To avoid pain and/or discomfort or numbness. (bulging median palatine raphe has a thin mucous
membrane with rich nerves and also the incisive foramen the mucous membrane covering the bone is
also rich with nerves and blood vessels).
5.) What are the potential implications if the borders of the denture overextend to the limiting
structures?
It may result to any or combination of these: pain, discomfort, pathosis, dislodgement of dentures
C. LESSON WRAP-UP
A. Work Tracker
completed.
“, How difficult was this module? 5

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Schedule: Date:
2.) Was our learning target/objective met? Refer to objective/s and answer yes or no Yes
NA
FAQs
1.) Why is the Retrozygomal space/fossa always a problem when taking impression?
ANSWER: This area is usually presented as an undercut so using an impression material that readily
flows in this area is important. (The impression tray specially a stock tray is “rounded off” in this area
since impingement of the tissue in this area (if the fossa is shallow) would give discomfort to the patient
during impression because of the bulging coronoid process when the patient opens the mouth.)
2.) What can be done to minimize problems when taking the impression on the retrozygomal
space?
ANSWER: Correct extension of the impression tray, adequate impression material in this area of the
tray and deflection of the mucous membrane before tray is seated. Syringe technique can also be used
to introduced impression material in this area before seating the impression tray.
KEY TO CORRECTIONS
Answers for Activity 3
Identify the numbered parts of the maxilla in the picture above (pic A 1-14) and write in the table below
where it belongs.
Primary stress-bearing Secondary stress-bearing Limiting Structure Relief Area
Area Area

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Schedule: Date:
(6) Maxillary edentulous (13) Rugae area and (1) labial frenum (11) median palatine raphe
ridge most of the hard palate (2) labial vestibule (12) incisive papilla
(7) Maxillary tuberosity (3) buccal frenum (14) displaceable soft and
(4) buccal vestibule hard palate (glandular
(5) coronoid bulge region)
(6) residual alveolar ridge
(7) maxillary tuberosity
(8) hamular notch
Near (9) and near(10)
vibrating line
Masticatory Lining Specialized
6, 7, 10 11, 12, 13, 14 1, 2, 3, 4, 5, 8, 9 None
Answers for Activity # 5

1.) C
2.) D
3.) A
4.) To avoid pain and/or discomfort or numbness. (bulging median palatine raphe has a thin
mucous membrane with rich nerves and also the incisive foramen the mucous membrane
covering the bone is also rich with nerves and blood vessels).
5.) It may result to any or combination of these: pain, discomfort, pathosis, dislodgement of
dentures
Contact Details

 Mobile: +63-968-317-1218, +63-929-886-1569
[email protected]

Module #8

Section: A1 Schedule: Click or tap here to enter text.
Date:
Lesson title: MAXILLARY IMPRESSION Materials:

1. Learn the maxillary impression procedure for edentulous module 8
patients.
2. Learn the principles, objectives and fundamentals of References:
maxillary impression  Prosthodontic Treatment for
Jacob
Ivanhoe
Thomason
Productivity Tip:
Don’t be afraid to “ASK QUESTIONS”. The only stupid question is the one you don’t ask. Engage,
participate or interact. It makes learning fun and enjoyable.
Hello students! Welcome to module # 8 “MAXILLARY IMPRESSION PROCEDURES. After familiarizing

the anatomical landmarks that needs to be considered when taking maxillary impressions. We will be
learning the principles, objectives and fundamentals in making impressions for the maxilla. This module
will also cover maxillary impression techniques, methods and impression materials of choice.
B. MAIN LESSON

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MAXILLARY IMPRESSION PROCEDURES:

THE PRINCIPLES AND OBJECTIVES OF IMPRESSION MAKING
Impression techniques, methods, and materials of choice are constantly changing, but underlying
principles and fundamentals remain constant.
An impression is a record of the negative form of the tissues of the oral cavity that make up the
basal seat for the denture. An impression is made to make a “cast” that is a replica (cast = positive
impression, impression material in a tray duplicating the ridge = negative impression) of the shape and size
of the same oral tissues. The five objectives of an impression are to provide retention, stability, and support
for the denture, provide esthetics for the lips, at the same time maintain the health of the oral tissues.
*** What is an impression? Is a record of the negative form of the tissues of the oral cavity
***What is negative imp? Impression material in a tray duplicating the ridge
***What is a positive impression? Cast
***What are the five (5) objectives of an impression? Retention, stability, support, esthetics and health
Retention (resistance to removal) for a denture is its resistance to vertical direction opposite that of
its insertion. It is the quality inherent in a denture that resists the force of gravity (gravity is a dislodging
force to Mx denture while retentive to Mn denture), the adhesiveness of foods (ex: caramel/tira-tira), and the
forces associated with the opening of the jaws.
***What is retention? Resistance to removal
*** What is the effect of gravity in the maxillary denture? Dislodging
*** What is the effect of gravity in the mandibular denture? Retentive
The stability of a denture is the quality of a denture to be firm, steady, and constant in position when
forces are applied to it laterally. Stability refers especially to resistance against horizontal movement and
forces that tend to alter the relationship between the denture base and its supporting foundation in a

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horizontal or rotatory direction. When the denture lacks stability (ex: resorbed ridge), retention therefore is
also compromised.
***What is stability? Quality of denture to be firm, steady and constant
***Site an instance where stability in denture is compromised? Resorbed ridge
Denture support is the resistance to vertical components of mastication and to occlusal or other
forces applied in a direction toward the basal seat (resistance to tissueward movement). Support is
provided by the maxillary and the mandibular bones and their covering of mucosal tissues. But the ultimate
support is provided by the bone.
***What is denture support? Resistance to vertical components
***What provides support for dentures? Provided by bone
CONTRIBUTING FACTORS TO THE RETENTION OF DENTURES
1. ADHESION (occurs when saliva sticks to the denture or to the mucous membrane)
Adhesion is the physical attraction of unlike molecules for each other. Adhesion acts when saliva
wets and sticks to the basal surface of dentures and, at the same time, to the mucous membrane of the
basal seat. The effectiveness of adhesion depends on the close adaptation of the denture base (the thinner
the denture basal seat-saliva-mucosal basal surface interface the better is the retention) to the supporting
tissues and the fluidity of the saliva. In short, the adhesiveness of saliva to retain the denture depends on
the accuracy of the impression.
*** What is adhesion? Physical attraction of unlike molecules to each other
Thick, ropy saliva adheres well to both the denture base and to mucosa, but since much of this type
of saliva is produced by the palatal glands under the maxillary basal seat, it builds up and literally pushes
the denture out of position. In patients with xerostomia (dry mouth), the denture base is adhering to the dry
mucous membrane in a significantly less effective manner. Nonalcoholic oral rinses should be used by
these patients. Additionally, saliva stimulants and artificial saliva can also be used.
Produced by palatal
***Why do patients with thick ropy saliva have denture retention problems? glands
***What will the dentist give if patient has dry mouth? Saliva stimulants and artificial saliva
The amount of retention supplied by adhesion is directly proportional to the area covered by the
denture. Patients with small jaws (basal seats) cannot expect retention by adhesion to be as effective as
patients with large jaws can. Likewise, patients with bigger jaws have better support than patients with
smaller jaws.
2. COHESION (occurs between molecules of saliva)

Cohesion is the physical attraction of like molecules for each other. It is a retentive force because it
occurs in the layer of saliva between the denture base of the mucosa.

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***What is cohesion? Physical attraction of like molecules

While thick, high mucin–content saliva is more cohesive than thin watery saliva, it will result in
reduced retention because of the increased thickness of the film that results in reduced interfacial retention
forces.
***What is the relationship of saliva film thickness to retention? Thick saliva more
3. INTERFACIAL FORCE (surface tension) cohesive
Interfacial force is the resistance to separation of two parallel

surfaces that is imparted by a film of liquid between them. It results
from a thin layer of fluid that is present between two parallel planes of
rigid material. It is dependent on the ability of the fluid to wet the oral
mucosa and denture base. The salivary film between the denture base
and the mucosa of the basal seat results in a retentive force by virtue of
the tendency of the fluid to maximize its contact with both surfaces. It
depends on the existence of a saliva/air interface (atmospheric
pressure/suction) at the terminus of the liquid/solid contact. Therefore,
it does not play as important a role in the retention of the mandibular
denture as much as for the maxillary one because of the presence of
saliva on both sides of the peripheral seal in the mandibular prosthesis.
The force is proportional to the surface area of the prosthesis and the
viscosity of the saliva. It is inversely proportional to the distance
between the denture base and the basal seat. Therefore, it is highly
dependent on good adaptation of the denture base to the oral tissues.
*** What is interfacial force?

Is the resistance to separation of two parallel surfaces
4. UNDERCUTS, ROTATIONAL INSERTION PATHS, AND PARALLEL WALLS.
Modest undercuts combined with the relative resiliency of the mucosa and submucosa can enhance
retention of the prosthesis.

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Deep undercuts are less beneficial than modest ones

because of the limited resiliency of the supported tissues,
which results in limited contact area with the denture
base. Undercuts are defined as such if they exist in
relation to a linear path of insertion. In some cases, the
denture can be seated first in the undercut (relative to the
linear path of insertion) and then rotated and brought into
close proximity with the basal seat. The so-called
“undercut” provides resistance to vertical displacement of
the prosthesis. Prominent alveolar ridges with parallel
buccal and lingual walls increase retention by increasing
the surface area between denture and mucosa and
thereby maximizing interfacial and atmospheric forces.
***Why are deep undercuts less beneficial to denture retention? Limited resiliency
5. ATMOSPHERIC PRESSURE (Suction/vacuum)
Atmospheric operates as a retentive force when dislodging forces are applied to dentures. Some
have called it “suction" because it is a resistance to the removal of dentures from their basal seat. For
atmospheric pressure to be effective, the denture must have a perfect seal around the entire denture
border. Atmospheric pressure is an emergency retentive or rescue force.
*** How does atmospheric pressure play a role in denture retention?Operates as a retentive force
*** What must be done for atmospheric pressure to be effective in retaining the denture? Perfect seal
NOTE: For adhesion – cohesion - surface tension and atmospheric pressure to contribute significantly in
denture retention, the edentulous ridge must be accurately registered in the impression. These forces, although weak
naturally, will have good retentive qualities when done correctly. Example: 2 glass slabs with water between it. Even if
water is a poor adhesive, there is a good amount of resistance if you try to pull the two glass slabs apart
perpendicularly.
6. USE OF ORAL AND FACIAL MUSCULATURE

For the oral and facial musculature to be most effective in providing retention for complete dentures,
the following conditions must be met: (1) denture bases must be properly extended to cover the maximum
area possible without interfering with the health and function of the structures that surround the denture, (2)
the occlusal plane must be at the correct level, and (3) the arch form of the teeth must be in the neutral
zone between the tongue and cheeks. (see pic below)
***What are the conditions to be met for the oral and facial musculature to be effective in providing
retention for complete dentures? Denture base must extend to cover the area

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Therefore, the shape of the buccal and lingual flanges must conform to the musculature to fit against
the denture and thereby reinforce the border seal. The base of the tongue also may serve as an additional
retentive force for some patients.
The complete denture has 3 surfaces: 1.

the occlusal surface (contacts the
opposing dentition), 2. the basal surface
(contacts the basal seat tissues and 3. the
polished surface (contacts tongue and
cheek. The cheek and tongue acting on a
concave polished surface with deflecting
borders of the denture enhances/helps in
denture retention.
7. GRAVITY (act as dislodging force for Mx dentures but retentive for Mn dentures)
In an upright position of the patient, gravity may act as a retentive force for the mandibular denture
but as displacing force for the maxillary one. In most cases, the gravitational force is very minimal in
comparison with other forces applied on the dentures. Cast metal base may theoretically increase the
retention of the mandibular prosthesis because of its increased mass, but its benefits should be highly
weighted against its limitations. Mx dislodging, Mn retentive
***What is the effect of gravity on the Mx denture? how about the Mn denture?
HEALTH OF BASAL SEAT TISSUES OF THE MAXILLA

It is essential that the oral tissues be healthy before impressions are made. Some conditions require
immediate attention before impressions are made, such as the following:
***What are some conditions requiring immediate attention before impressions are made?
(1) Inflammation of the mucosa. Inflammation of the mucosa
All inflammation must be eliminated before the new impressions

are made or the new dentures will not fit the tissues after they are
no longer distorted by swelling. Treatment is accomplished by
surgery or proper medication or by keeping the old dentures out of
the mouth until the tissues are healthy. The old dentures must be
kept out of the mouth at least 24 hours. before impressions are
made.

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***How do you deal when there is inflammation of the mucosa? Inflammation must be eliminated
(2) Distortion of denture-foundation tissues. (distortion of the basal seat)
The denture that the patient is wearing may appear to have good retention and stability, but
at the same time it may not fit the true form of the oral structures. In such a situation, the denture
had molded the soft tissues to its own shape. The distortion of the oral tissues can be corrected
when the old dentures are left out of the mouth for 1,2 or more days before the impressions are
made.
***How do you deal with distortion of denture-foundation tissues? Can be corrected when old
dentures are left out of the
mouth for 1, 2 or more days
(3) Excessive amounts of hyperplastic tissue.
Since the maxillae and the mandible (the bones) are the real Foundations for dentures, their
soft tissue covering must be firm. Excessive amounts of movable soft tissue will permit the dentures
to move in relation to the bone, of there will result many types of difficulties, such as looseness,
tipping, malocclusion of the dentures, a difficulty in recording jaw relations accurately. The treatment
is by finger massage on a daily prescribed basis or by surgical removal of the hyperplastic tissue,
followed by sufficient time for complete healing.
***What are the problems encountered when dentures are made when there are hyperplastic
tissue/s? Looseness, tipping, malocclusion of dentures, difficulty recording jaw relations
***How do you treat this problem? Finger massage or surgical removal
(4) Insufficient space between the upper and lower ridges.

Usually, the insufficient space is found in the tuberosity region. It may be caused by an
excessive amount of fibrous connective tissue covering the tuberosity.

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Excess fibrous tissue should be removed surgically, and time should be allowed for complete
healing before impressions are made.
***What problem will you encounter with large mx tuberosity? Insufficient space
***What is the treatment of choice? Removed surgically
IMPRESSIONS FOR EDENTULOUS PATIENTS FOR THE MAXILLA

Impressions are made with many types of materials and techniques. The choice is made by the
dentist on the basis of the oral conditions, concept of the function of the tissues surrounding the denture,
and ability to handle the available impression materials.
IMPRESSION TRAYS

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Stock tray for

preliminary
impression and
fabrication of
diagnostic cast to
which a custom
tray is made later.
Custom tray for final impression and master cast fabrication
Regardless of the type of impression being made, the tray in which it is made (tray selection) is the
most important part of the impression. If the tray is too large, it will distort the tissues around the borders of
the impression and will pull the soft tissues under the impression away from the bone. If the tray is too
small, the border tissues will collapse inward onto the residual ridge.
The design of trays must be related to the impression material to be used. If the impression material
is a modeling compound, there must be sufficient space between the tray and the soft tissue to allow for
adequate bulk of material and to allow the sluggish-flowing material to move into the desired relationship
with the basal seat and border tissues.
If the impression material is a zinc oxide eugenol paste, which flows readily, the tray must fit more
accurately than for Plaster of Paris, which is free flowing but more viscid. Consequently, these free-flowing
materials must be used in trays made especially for each patient. These individual or "custom" trays are
made of different materials with borders that can be adjusted so that they control the movable soft tissues
around the impression but do not distort then.
The second most important part of the impression is the proper positioning of the final impression
tray on the basal seat in the mouth. One can best accomplish this by using guiding factors incorporated into
the tray and by practicing proper placement of the tray in the mouth before actually making the final
impression.
***What is the most important part in the impression? Tray selection
***What is the second most important part in the impression? Proper positioning of final impression tray
THE TWO QUESTIONS ABOVE WILL MOST LIKELY COME OUT IN THE LICENSURE EXAM
***What is the third most important part in the impression? Ans: Choice of impression material
*** What is the fourth most important part in the impression? Ans: Imp technique employed
FINAL IMPRESSION MATERIALS
Many types of materials have been used successfully for making final impressions. Zinc oxide eugenol
paste, irreversible hydrocolloid (alginate), silicone, polysulfide, polyether, and tissue conditioning Soft liner)
material have been used for this purpose.

IMPRESSION TECHNIQUES FOR THE MAXILLA
Module #8

Date:
C. LESSON WRAP-UP
A. Work Tracker
completed.
5
Yes
NA
FAQs
1. In the review for the practical exam in the licensure, you will most likely encounter this statement: “It is OK to
have borders of the trial dentures sloping downward” rather than sideways for simplicity.
ANSWER: NO. For the oral musculature to be effective in helping to retain the dentures and to have an
accurate seal of the periphery, the borders must slope to the side. This can be accomplished by correct
placement of the pontics (it should be in the “neutral zone”), using pontics with narrower occlusal table, correct
shaping of the polished surface and/or incorporating extensions lateral to the border.

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KEY TO CORRECTIONS
ANSWERS for Activity 5
1. The most important part in impression taking here:

A.) proper seating of the imp. tray in the mouth
B.) the type of impression material used
C.) the use of border-molding technique
D.) the use of readily flowing impression material
2. What happens when a denture is created on an enlarged maxillary tuberosity? Explain briefly in 2-3
sentences.
In enlarge but still has sufficient space for denture base and pontic then there will be no problem. If the
tuberosity is too large, it will present problems when setting the artificial teeth or the denture base
material may be too thin in this area and will be prone to breakage.
3. Briefly explain in 2-3 sentences why a thick ropy saliva is not good for denture retention
Thick ropy saliva is springy and pushes the denture out thus preventing the denture in having good
denture-tissue interface. Adhesion, cohesion, interfacial surface tension, and atmospheric pressure
depends on material interface (the thinner the interface the better is the retention)
4. Name some conditions that require immediate attention before impressions are made
* Inflammation of the mucosa
* Distortion of the denture-foundation tissues
* Excessive amounts of hyperplastic tissue
* Insufficient space between the upper and lower ridge

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5. List the types of materials that have been used successfully for making final impressions.
Zinc oxide eugenol paste, irreversible hydrocolloid (alginate), silicone, polysulfide, polyether, and tissue
conditioning material
Contact Details

 Mobile: +63-968-317-1218, +63-929-886-1569
[email protected]

Module #9

Date:
Lesson title: BIOLOGIC CONSIDERATIONS OF MANDIBULAR Materials:

IMPRESSIONS Ballpens, erasers, pencils and
1. Learn the biologic considerations of mandibular impressions.
2. Learn the different anatomical landmarks of the mandible References:
relevant to complete dentures construction.  Prosthodontic Treatment for
Jacob
Ivanhoe
Thomason
Productivity Tip:
PRACTICE MEMORY TRICKS. There are memory competitions every year, and despite what you think, the
champions aren’t savants with rare memory gifts. They’re average people like you and me. Here’s a simple
trick you probably already know. Make up a song around things you’re trying to memorize. The same way
you learned the alphabet as a kid will be the same way you can memorize and study for an upcoming quiz or
test. Read and say things repeatedly. Singers cannot master a song by reading the lyrics once unless they
have a photographic memory.
Hello students! Welcome to module # 9 “BIOLOGIC CONSIDERATIONS OF MANDIBULAR

IMPRESSIONS”. We will learn the anatomical landmarks that needs to be considered when taking
mandibular impressions. Incomplete capture of the denture foundation will lead to uneven distribution of
forces which leads to faster resorption and denture dislodgement. Likewise, overextension of borders
also leads to dislodgement and/or pathosis.

Module #9

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Read the questions on the second column and try to answer the first column with what knowledge you
have. Your answer in the first column can be based on stock knowledge. Any information, processes,
hypotheses, opinions, feelings, procedures, reasoning, solutions, and others can be used. The third
column is left blank at this time.
What I Know Questions: What I Learned (Activity 4)

Basal seat 1 What is/are the Tongue
supporting Basal seat
structure/s of the
mandible?
Labial frenum 2 What is/are the labial frenum

Labial vestibule limiting labial vestibule
structure/s of the buccal frenum
maxilla? buccal vestibule
alveololingual sulcus
lingual frenum
( premylohyoid eminence region
The oral mucosa must be checked 3 What is the The quality of the mucosa is
for differences of thickness as this significance of important and has to be taken into
could lessen the retention of the the microscopic consideration specially the
denture. anatomy (quality) difference in thickness and
of the mucosa in resiliency. The tissues of the basal
taking seat will be subjected to forces
impressions? when the denture is used and
therefore the effect of compression
of the tissues on different areas are
not the same.
B. MAIN LESSON

Module #9

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BIOLOGIC CONSIDERATIONS OF MANDIBULAR IMPRESSIONS
The basal seat of the mandible is different in form and size from the basal seat of the maxillae. The
submucosa in some parts of the mandibular basal seat contains anatomic structures that are different from
those found in the upper jaw. The presence of the tongue and its individual size, form, and activity complicates
the impression procedures for lower dentures and the patient's ability to learn to manage them.
The denture bases must be extended to cover the maximum area possible without interfering with the
health or function of the tissues, whose support is derived from bone. The support for the mandibular denture
is supplied by the body of the mandible. The total area of usable support from the mandible is less than it is
from the maxillae.
SEQUELAE TO THE LOSS OF TEETH
When the teeth are removed from the mandible, the alveolar tooth sockets will tend to fill with new
bone, but the bone of the alveolar process will start resorbing. It means that the bony foundation for the
mandibular dentures becomes shorter vertically and narrower buccolingually. The bony crest of the residual
ridge becomes narrower and sharper.
The total width of the bony foundation of mandibular basal seat becomes greater in the molar region
as resorption continues. The reason is that the width of the inferior border of the mandible from side to side is
greater than the width of the mandible at the alveolar process from side to side.
MACROSCOPIC ANATOMY OF SUPPORTING STRUCTURES OF THE MANDIBLE
A, The anatomy and related denture form is noted here. 2, labial vestibule; 3, buccal frenum; 4, buccal vestibule; 5,
residual alveolar ridge; 6, buccal shelf; 7, retromolar pad; 8, pterygomandibular raphe; 9, retromylohyoid fossa; 10,
alveololingual sulcus; 11, sublingual caruncles; 12, lingual frenum; 13, region of premylohyoid eminence. B, Mandibular
denture revealing 1, labial notch; 2, labial flange; 3, buccal notch; 4, buccal flange; 5, alveolar groove; 6, buccal flange,

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which covers the buccal shelf; 7, retromolar pad; 8, pterygomandibular notch; 9, lingual flange with extension into
retromylohyoid fossa, 10, lingual flange; 12, lingual notch; 13, area of premylohyoid eminence.
BUCCAL FLANGE (B4) AREA AND BUCCAL SHELF (A6)

The area between the mandibular buccal frenum and the anterior edge of the masseter muscle is
known as the buccal shelf.
The buccal shelf may be very wide and is at right angles to the direction of vertical occlusal forces. For
that reason, it offers excellent resistance to those forces. The buccal shelf is the principal bearing surface of
the mandibular denture and takes the occlusal load off the sharp narrow crest of the residual alveolar ridge
that so many edentulous mandibles present.
FLAT MANDIBULAR RIDGES (A5)

Many edentulous mandibles are extremely flat because of the loss of the cortical layer of bone. The
surface is weakened and changed in form by the more rapid resorption of the cancellous portion of the
mandible. The bearing surface often becomes concave, allowing the attaching structures, especially on the
lingual side of the ridge, to fall over onto the ridge surface,
DIRECTION OF RESORPTION OF RIDGES

The maxillae resorb upward and inward to become progressively smaller because of the direction and
inclination of the roots of the teeth and the alveolar process. Consequently, the longer the maxillae have been
edentulous, the smaller is their bearing area. The opposite of the mandible w/o inclines outward of becomes
progressively wider according to its edentulous age. This progressive change of the mandible and maxillae in
the edentulous state makes many patients appear to be prognathic.
(1) MYLOHYOID RIDGE

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The soft tissues often hide the sharpness of the mylohyoid ridge, which can be found by
palpation. The shape and inclination of the mylohyoid ridge varies greatly among edentulous
patients.
(2) MENTAL FORAMEN AREA RESORPTION

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The mental foramina on or near the crest of the residual ridge of greatly resorbed mandibles result in
an impingement on the mental nerves and blood vessels if relief is not provided in the denture base. Pressure
on the mental nerve can cause numbness in the lower lip.
(3) INSUFFICIENT SPACE BETWEEN THE MANDIBLE AND THE TUBEROSITY

The maxillary sinus enlarges throughout life if it is not restricted by natural teeth or dentures, thus
moving the tuberosity downward. The lack of space causes many denture failures.
(4) TORUS MANDIBULARIS

The torus mandibularis is a bony prominence usually found in the region between the first and second
premolars, midway between the soft tissue of the floor of the mouth and the crest of the alveolar process.

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The torus mandibularis is covered by an extremely thin layer of mucous membrane and for that reason
may be irritated by slight movements of the denture base.
MACROSCOPIC ANATOMY OF LIMITING STRUCTURES

Mandibular dentures should be extended as far as possible within the limits of health and function of
the tissues and structures that support and surround them.
BUCCAL AND LABIAL BORDER ANATOMY

Mandibular dentures should be wide back of the buccal frenum and narrow in the anterior labial region.
The part of the denture that extends between the labial frenum (labial notch) of the buccal frenum (buccal
notch) is called the mandibular labial flange.
BUCCAL VESTIBULE
The vestibule extends from the buccal frenum posteriorly to the outside back corner of the retromolar
pad and from the crest of the residual ridge to the cheek.
EXTERNAL OBLIQUE RIDGE AND BUCCAL FLANGE

The buccal Flange area, which starts immediately posterior to the buccal frenum and extends to the
anterior portion If the masseter muscle, swings wide into the cheek of is nearly at right angles to the biting
force, thus providing the lower denture with its greatest surface for resistance to vertical occlusal forces. The
external oblique ridge does not govern the extension of the buccal flange because the resistance or lack of
resistance encountered in this region varies widely.

Module #9

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MASSETER MUSCLE REGION

The distobuccal corner of the mandibular denture must converge rapidly to avoid displacement
because of contracting pressure of the masseter muscle, whose anterior fibers pass outside the buccinator
muscle in this region.

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DISTAL EXTENSION OF MANDIBULAR IMPRESSION

The distal extent of mandibular impression is limited by the ramus of the mandible, by the buccinator
muscle and the superior constrictor muscle, and by the sharpness of the lateral bony boundaries of the
retromolar fossa, which is formed by a continuation of the internal and external oblique ridges as they ascend
the ramus. If the impression extends onto the ramus, the buccinator and adjacent tissues will be compressed
between the hard border of the denture and the sharp external oblique ridge. This will not only cause soreness
but also limit the function of the buccinator, which is part of the kinetic chain of swallowing.
RETROMOLAR REGION AND PAD

The distal end of the mandibular denture region is bounded by the anterior border of the ramus; thus,
the denture includes the retromolar pad posteriorly, which defines its posterior limit. The retromolar pad is a
triangular soft pad of tissue at the distal end of the lower ridge and must be covered by the denture to perfect
the border seal in this region.

Module #9

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LINGUAL BORDER
The lingual extension on mandibular impressions has been the most abused a misunderstood border
region in complete denture construction. This misunderstanding is caused by the peculiarities of the tissue
under the tongue which has less direct resistance to the lingual flange of the denture, Because of their lack of
immediate resistance, these tissues are easily distorted when the impression is being made. Such extension
over a long time will cause tissue soreness or dislodgment of the denture by tongue movement.
SUBLINGUAL GLAND REGION
In the premolar region on the lingual side of ridge, the sublingual gland rests above the mylohyoid
muscle. When the floor of the mouth is raised, this gland comes quite close to the crest of the ridge o reduces
the vertical space available for flange extension in the anterior part of the mouth.
DIRECTION OF THE LINGUAL FLANGE

The lower border of the lingual flange runs parallel to the lower edge of the mandible from the lingual
frenum to the posterior end of the denture. This makes the flange short in the anterior region and long in the
posterior region because the crest of the ridge of the mandible turns up rather sharply as it approaches the
ramus.

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SUBLINGUAL GLAND REGION
ALVEOLOLINGUAL SULCUS

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The alveololingual sulcus (the space between

the residual ridge and the tongue) extends posteriorly
from the lingual frenum to the retromylohyoid curtain.
Part of it is available for the lingual of the denture.
The alveololingual sulcus three regions:

A. ANTERIOR REGION
This extends from the lingual frenum to where the mylohyoid ridge curves down below the level of the sulcus.
B. MIDDLE REGION. This part of the alveololingual sulcus extends from the pre-mylohyoid fossa to the distal end of the
mylohyoid ridge curving medially from the body of the mandible.
C. POSTERIOR REGION
This part of the alveololingual sulcus is the retromylohyoid space or fossa. It extends from the end of the mylohyoid ridge to
the retromylohyoid curtain being bounded on the lingual by the anterior tonsillar pillar rat the distal end by the retromylohyoid
curtain and superior constrictor) on the buccal by the mylohyoid muscle, mandibular ramus, and retromolar pad.
LINGUAL FRENUM AND LINGUAL NOTCH

The lingual frenum (that is, the anterior attachment of the tongue) is extremely resistant and active and
often wide. It Forms the lingual notch in the lower impression. The denture border needs complete functional
trimming so movements of the lingual frenum will not displace the denture or create soreness of this sensitive
band of tissue.

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MICROSCOPIC ANATOMY
Activity 3: Skill-building Activities (with answer key) (18 mins + 2 mins checking)

Module #9

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Identify the numbered parts of the mandible in the picture above (pic A 1-13) and write in the table
below where it belongs.
Primary stress-bearing Secondary stress- Limiting Structure Relief Area

Area bearing Area
Buccal shelf (6) (1) labial frenum (5) Residual ridge
Retromolar pad (7) (2) labial vestibule
(3) buccal frenum
(4) buccal vestibule
(10) alveololingual sulcus
(12) lingual frenum
(13) premylohyoid
eminence region
Masticatory (use numbers) Lining (use numbers) Specialized (Use numbers)

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5 ,6, 7, 8 1,2,3,4,9,10,11,12,13 none

Review the questions in the “What I Know” Chart, part 1 from Activity 1 and write your answers to the
questions based on what you know now in the third column of the chart “What I learned”.
Short Quiz

I. Buccal shelf
II. rounded mandibular ridges
III. triangular retromolar area/pad
IV. flat mandibular ridges
V. crest of spiny mandibular ridges
/ A.) I, II, III, IV

B.) I, II, III, V
C.) I, III, IV, V
D.) I, II, IV, V
E.) II, III, IV, V

I. buccal frena
II. external oblique
III. retromylohyoid space
IV. mylohyoid muscle attachment
V. ascending ramus
A.) I, II, III, IV

B.) I, II, III, V
C.) I, III, IV, V

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/ D.) I, II, IV, V

E.) II, III, IV, V
3.) Why should relief be provided on the denture in the mental foramen area on a resorbed ridge?
Impingement of the mental foramen by the denture causes pain and discomfort
structures?
It will push the denture out or dislodge when the tissues in the border is active. It also predisposes to
denture hyperplasia.
C. LESSON WRAP-UP
A. Work Tracker
completed.
5

yes
Module #9
Name: Class number:
Date:
Section: Schedule:
NA
FAQs
1.) What happens when the borders on the mandibular dentures are under-extended?
ANSWER: The area of support will diminish and forces will be concentrated in a smaller area that will
translate to faster resorption of the supporting bone
2.) What happens when the borders of the mandibular dentures are over-extended?
ANSWER: It will cause the denture to unseat therefore making the dentures less stable. When the
dentures are less stable, the lower denture creates uneven pressure (rocking denture) in certain parts of
the ridge when the denture is in function which in return injury of the tissues and/or resorption.
KEY TO CORRECTIONS
ANSWERS for Activity 3
Identify the numbered parts of the mandible in the picture above (pic A 1-13) and write in the table
below where it belongs.

Module #9
Name: Class number:
Date:
Section: Schedule:
Primary stress-bearing Secondary stress- Limiting Structure Relief Area

Area bearing Area
Buccal shelf (6) Retromolar pad (7) (1) labial frenum (6) Residual ridge
(2) labial vestibule
(3) buccal frenum
(4) buccal vestibule
(10) alveololingual sulcus
(12) lingual frenum
(13) premylohyoid
eminence region
Masticatory (use numbers) Lining (use numbers) Specialized (use numbers)
1,2,3,4,9,10,11,12,13 none
5 ,6, 7, 8
Short Quiz

I. Buccal shelf
II. rounded mandibular ridges
III. triangular retromolar area/pad
IV. flat mandibular ridges
V. crest of spiny mandibular ridges
A.) I, II, III, IV D.) I, II, IV, V
B.) I, II, III, V E.) II, III, IV, V
C.) I, III, IV, V
I. buccal frena
II. external oblique
III. retromylohyoid space
IV. mylohyoid muscle attachment
V. ascending ramus
A.) I, II, III, IV B.) I, II, III, V

Module #9
Name: Class number:
Date:
Section: Schedule:
C.) I, III, IV, V E.) II, III, IV, V

D.) I, II, IV, V
3.) Why should relief be provided on the denture in the mental foramen area on a resorbed ridge?
Impingement of the mental foramen by the denture causes pain and discomfort
structures?
It will push the denture out or dislodge when the tissues in the border is active. It also predisposes to
denture hyperplasia.
Contact Details

 Mobile: +63-968-317-1218, +63-929-886-1569
[email protected]

Module #10

Date:
Lesson title: MANDIBULAR IMPRESSIONS Materials:

1. Learn the mandibular impression procedures and techniques. module 10
2. Learn the principles, objectives and fundamentals of
mandibular impression References:
 Prosthodontic Treatment for
Jacob
Ivanhoe
Thomason
Productivity Tip:
DON’T OVERTHINK. You will just have a headache. You have all the time in the world. Don’t overload your
brain by thinking too many things at once. Stop thinking about your boyfriend. Let them think about you.
Hello students! Welcome to module # 10 “MANDIBULAR IMPRESSION PROCEDURES. After

familiarizing the anatomical landmarks that needs to be considered when taking mandibular
impressions, we will be reviewing the principles, objectives and fundamentals in making impressions for
the mandible. This module will also cover mandibular impression techniques, methods and impression
materials of choice.
B. MAIN LESSON
MANDIBULAR IMPRESSION

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CLASSIFICATION OF MANDIBULAR IMPRESSIONS
1) SELECTIVE PRESSURE IMPRESSIONS (also known as modified functional impression technique)

These are made in trays that have more space in them for the final impression material in some places
than in others. The places that have less space/relief will transmit more pressure from the denture when in
function to favorable part of the bone (such as the buccal shelf and the retromolar pad - the primary &
secondary stress-bearing areas of the mandible) & less pressure to unfavorable parts (such as sharp ridge or
bony spicule and anterior part of the mandibular ridge – the nonstress-bearing or relief areas). In the stress-
bearing areas, the impression material is thinner and thicker in the nonstress-bearing/relief areas. This will
require a heavier body or less fluid type of impression material.
*** Where is pressure applied in selective pressure technique? Buccal shelf and retromolar pad
*** Where is relief or less pressure applied in selective pressure technique? Sharp ridge or bony spicule
***What type of imp material is used in this technique? and ant part of Mn ridge
Heavier body or less fluid type imp mat.
The disadvantage of this technique:
When the dentures are brought into initial contact/occlusion, the midlines of both upper and lower are not in
alignment and becomes aligned when pressure is exerted from full contact. With this, the lower denture
creates frictional movement between the mucous membrane and the denture and risk in injuring the tissue.
Initial denture contact creates a misaligned midline
Midline aligns later when more pressure is exerted
2) PRESSURELESS IMPRESSIONS (also known as MUCOSTATIC or ANATOMIC impression)

These are made with the least possible displacement of soft tissues covering the residual alveolar bone. They
incorporate a large amount of space between the tray of the soft tissues of the basal seat and consequently
require a very fluid type of impression material.
*** Where is pressure applied in mucostatic technique? Soft tissue covering the residual alveolar bone

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***What type of imp material is used in this technique?

Very fluid type of imp material
The disadvantage of this technique:

When the dentures are brought into initial contact, the midlines of both upper and lower are in alignment and
may or may not misalign when pressure is exerted from full contact. Since pressure is exerted on all surfaces
simultaneously, presence of sharp areas like sharp ridges may cause discomfort or pain during function.
Initial denture contact creates an aligned midline.

During full contact or more pressure is exerted on the
denture, the midline may or may not misalign.
SELECTIVE PRESSURE TECHNIQUES:

1. FIRST TECHNIQUE - BORDER-MOLDED SPECIAL TRAY (refer to module #8)
2. SECOND TECHNIQUE-ONE-STEP BORDER-MOLDED TRAY (refer to module #8)
3. THIRD TECHNIQUE - CUSTOM TRAY DESIGN BASED ON THE PREVIOUSLY WORN DENTURE.
In this technique, the patient's original denture is refitted with a treatment liner. The optimized fitting
surface of the denture or the denture bearing (tissue contacting) area is reproduced in stone. A wax
spacer is placed to cover the entire cast, 3 to 4 mm short of the borders. A custom tray is fabricated
over the spacer, and a final impression is made in the tray.
Clinical experience suggests that any of these three techniques will produce an impression that fulfills
biomechanical objectives. However, when advanced residual ridge resorption in the anterior mandible is
present, and particularly if it is accompanied by high unfavorable soft tissue attachments (which minimize the
amount of gingiva available for direct stress bearing), the first and third techniques are easier to apply.
General Requirements for Biomaterials Used to Make Complete Dentures

1. The material must be biocompatible (i.e., with minimal harmful effects on the oral tissues):
• Nontoxic, nonirritating

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• Nonallergenic, noncarcinogenic
• Chemically minimally degradable or its degradation processes are biocompatible
2. The material must fulfill clinical objectives by possessing appropriate optimal physical properties:
• Adequate mechanical properties such as hardness, elasticity, and strength
• Adequate wear resistance
• Adequate thermal coefficient of expansion and conductivity properties
• Acceptable esthetic properties
• Ease of cleansing
• Relative ease of fabrication and manipulation
• Readily available and economical to use
• Allows for easy and inexpensive maintenance such as repairs and additions
Optimal Qualities for Prosthodontic Impression Materials

• They should have low enough viscosity to adapt to the oral tissues, yet be viscous enough to be contained
in the impression tray.
• The material should have adequate wettability of the oral tissues to allow for accurate adaptation and
capturing of the oral structures and tissues.
• The material must have a pleasant taste and odor.
• In the mouth, the material should set into a rubbery or rigid solid in a reasonable amount of time.
• Upon removal from the mouth, the set impression should show adequate elastic recovery with no
permanent deformation.
• The material must have adequate strength to avoid tears or breakage upon removal from the mouth.
• The impression should be dimensionally stable after setting and until pouring of the cast.
• The impression can remain dimensionally stable to be repoured after removal from the cast.
• The material must be compatible with the cast material.
• The material must be biocompatible, nontoxic, and without irritant constituents.
• The material must be of a color and opacity that allows for proper evaluation of the impression by the
dentist.
• The material could be readily disinfected without significant loss of accuracy or loss of mechanical
properties.
• The material must have an adequate shelf life for storage.
• The materials, associated processing time, and equipment should be cost-effective.
Types of impression materials used:

1.) Non-Elastic Impression Material
A.) Impression or modelling compound (type I and II)
B.) ZOE Impression material
C.) Plaster (not used anymore)
2.) Elastic Impression Material
A.) Hydrocolloids (Reversible=Agar and Irreversible=Alginate)
B.) Elastomeric – Polysulfide, Condensation silicone, Addition silicone, Polyether)
***Examples of non-elastic imp materials? Impression or modelling compound
***Examples on elastic imp materials? Hydrocolloids

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Zinc Oxide Eugenol (ZOE) Impression Paste Applications

• Mainly used for final impressions of edentulous ridges with minor or no undercuts
• As a wash impression with other impression materials, such as impression compound
• As an occlusal registration material
• As a temporary liner material for dentures
• As a surgical dressing
****What are the uses of ZOE? Used for final impressions
Zinc oxide, in the presence of moisture, reacts with eugenol (oil of cloves) to form zinc eugenolate, a
chelate (the process is called chelation). The setting reaction is accelerated by the presence of water, high
humidity, or heat. Some of these factors can be controlled by the dentist to decrease or increase the setting
time. The materials are classified as hard or soft pastes according to their consistencies, hardness, and
setting times (10 and 15 minutes, respectively). Initial setting time for both types is 3 to 5 minutes.
Noneugenol pastes, containing carboxylic acids in place of eugenol, also are available. This avoids the
stinging and burning sensation of eugenol experienced by some patients.
*** Zinc eugenolate = Zinc oxide + Eugenol + ??? Oil of cloves
***What is the product called when Zinc oxide is mixed with Eugenol? Zinc eugonolate
***What accelerates the setting reaction/time of ZOE? Water, high humidity or heat
***Site (2) disadvantages of using ZOE imp?
Stinging and burning sensation of eugenol
Dental Impression Compound (Types I and II)

Impression compound, also called modeling plastic, is a thermoplastic material that is supplied in the form of
cakes (red) or sticks (green, grey, or red), with the colors representing different fusing temperatures.
Compound Types:
Type I (Lower Fusing Material)

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Cakes: As an impression material for completely edentulous patients, the material is softened by
heat, inserted into the tray, and placed against the tissues before it cools to a rigid mass. Sticks: As a border
molding material for the custom tray, the material is used before making the final impression.
Type II (Higher Fusing Material) (tray material)
Type II compound is used as a tray adaptation material, which requires more viscous properties. It is
used for making a primary impression of the soft tissues and then used as a tray to support a thin layer of a
second impression material, such as ZOE paste, hydrocolloids, or nonaqueous elastomers.
Composition and Manipulation

Dental compound is a mixture of waxes and thermoplastic resins (principal ingredients that form a matrix)
plus fillers that increase viscosity above mouth temperatures and provide rigidity at room temperature. It also
includes shellac, stearic acid, and gutta percha, which contribute to plasticity and workability.

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Agar (Reversible Hydrocolloid)

Composition of Agar: Agar is supplied as a gel and contains the following ingredients:
• Agar (Red algae): gelling agent
• Borax: improves strength
• Potassium sulphate: gypsum hardener, provides a good surface for the gypsum casts
• Alkyl benzoates: preservatives
• Water: reaction medium, the principal ingredient in the set material (>80%)
• Coloring agents
• Flavoring agents
***What are the ingredients of agar? “Site each and their function”
***What is the main ingredient of agar? Note: this is a board question? Red algae
Alginate (Irreversible Hydrocolloid)
Alginate is provided as a powder, which contains the following ingredients:

• Potassium or sodium alginate: dissolves in water and reacts with calcium ions
• Calcium sulphate dihydrate: a reactor, reacts with potassium alginate to form a dihydrate insoluble alginate
gel
• Zinc oxide: filler particles, affects properties and setting time
• Potassium titanium fluoride: accelerator, counteracts the inhibiting effect of the hydrocolloid on the setting
of stone; ensures good quality surface of the cast
• Diatomaceous earth: filler particles, controls the consistency of the mix and the flexibility of the set alginate
• Trisodium phosphate: retarder, controls the setting time to produce either regular or fast-set alginates
• Coloring agents
• Flavoring agents
*** What are the ingredients of Alginate? “Site each and their function”
*** What is the main ingredient of alginate? Sodium alginate
ELASTOMERS
Polysulfide Rubber
The Base:
 Polysulfide polymer is the principal ingredient.
 Fillers such as titanium dioxide and zinc are added. (Note: fillers are not involved in the chemical
reaction they are added to the polymer liquid to make a paste-like consistency or make the
material more viscous)
 Sulphate, copper carbonate, or silica is added for strength.
 The filler content varies according to the consistency of the paste.
 Dibutyl phthalate, a plasticizer, confers viscosity to the base.
The Accelerator/Reactor:
 Lead dioxide, hydrated copper oxide, or organic peroxide is used as a reactor.
 Sulfur, a promoter, accelerates the reaction.

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Date:
 Oleic or stearic acid, a retarder, controls setting reaction.

 Working time: 5-7 minutes, considered the longest among elastomers
 Setting time: 8-12 minutes
 Pouring the cast: The impression must be poured within 30 minutes to 1 hour.
***What are the ingredients of polysulfide rubber? “Site each and their function”
***Working time of polysulfide? 5-7 minutes
***Setting time of polysulfide? 8-12 minutes
Condensation Silicones
The Base Paste
 High molecular weight polymer, such as polydimethylsiloxane
 Fillers, such as silica or calcium carbonate
The Liquid Accelerator

 A metal organic ester, such as tin octoate Orthoalkyl silicate Oil-based diluents
 As a paste, the accelerator would have thickening agents added to increase viscosity
 Working time: 3 minutes
 Pouring the cast: The impression must be poured as soon as possible within the first 30 minutes
***What are the ingredients of condensation silicones? “Site each and their function”
***Working time of cond silicones? 3 mins
***Setting time of cond silicones? 6-8 mins
Addition Silicones
The Base
 Polymethylhydrosiloxane (low molecular weight polymer), fillers
The Accelerator
 Divinyl polymethyl siloxane Other siloxane prepolymers, fillers
 Platinum salt, as a catalyst
 Retarder, controls the working and setting times
 Working time: 2-4.5 minutes
 Pouring the cast: The cast can be poured up to 1 week after making the impression.
***What are the ingredients of addition silicones? “Site each and their function”
***Working time of addn silicones? 2-4.5 mins
***Setting time of addn silicones? 3-7 mins
Polyether Elastomer
The Base
 Polyether polymer Colloidal filler, such as silica Plasticizer, such as glycol ether or phthalate

Module #10

Date:
The Accelerator
 Alkyl aromatic sulfonate, an initiator
 Filler
 Plasticizer
 Working time: 2.5 minutes
 Setting time: 4.5 minutes
 Pouring the cast: The impression can be poured up to 1 week of storage.
***What are the ingredients of polyether? “Site each and their function”
***Working time of polyether imp? 2.5 mins
***Setting time of polyether imp? 4.5 mins
C. LESSON WRAP-UP
A. Work Tracker
completed.
5
yes
3.) In case this module gave you some diffic ulty, which part of this module did you encounter such

Module #10

Date:
NA
FAQs
1. Why is the retromylohyoid the most likely area to incompletely capture during mandibular
impression?
ANSWER: A. Because of the shape: The retromylohyoid area is an undercut so a material that has a low
viscosity is needed or some modification of the technique like the “syringe technique” should be employed and
also the shape of the lingual flange of the tray which mostly deflect the impression material away from the
area; B. Because of its location: the retromylohyoid is located distal to the floor of the mouth and posterior to
the mylohyoid muscle attachment, and C. Inadequate impression material in the lingual flange of the tray.
2. Why is it that even if we have the same patient as my classmate, I have fewer buccal frena registered
than she has?
ANSWER: Your classmate performed the border-molding technique better than you.
Contact Details

 Mobile: +63-968-317-1218, +63-929-886-1569
[email protected]

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DM 444: PROSTHODONTICS SEMINAR 2

Name: Class number:

Lesson title: Biomechanics of the Edentulous State Materials:

Welcome to module 2; Biomechanics of the edentulous state.

This document is the property of PHINMA EDUCATION

Name: Class number:

The learning target/s is/are:

1. To learn the important aspects of complete denture prosthodontics;

Content Notes (13 mins)

***READ and understand the content notes provided

This document is the property of PHINMA EDUCATION

Name: Class number:

Create possible questions from #6 below:

This document is the property of PHINMA EDUCATION

Name: Class number:

This document is the property of PHINMA EDUCATION

Name: Class number:

This document is the property of PHINMA EDUCATION

Name: Class number:

Activity 3: Thinking about Learning (5 mins)

B. Think about your Learning

 Dr. Allan Rotello Sia Ebua

This document is the property of PHINMA EDUCATION

Name: Class number:

Lesson title: Tissue Response to Complete Dentures Materials:

This document is the property of PHINMA EDUCATION

Name: Class number:

 SOFT TISSUE CHANGES TO COMPLETE DENTURES

3. Frequently encountered soft-tissue response to tolerable injury in long-term denture wearing

This document is the property of PHINMA EDUCATION

Name: Class number:

Ridge may look unresorbed but is

This document is the property of PHINMA EDUCATION

Name: Class number:

A chronic inflammation of the denture-bearing mucosa (basal seat). It can be localized

DSM may also be accompanied by Angular cheilitis (Perleche).

This document is the property of PHINMA EDUCATION

Name: Class number:

Denture Sore Mouth (DSM)

Ulcerations (arrow) may be present

Type III DSM

 Tissue changes due to aging

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Name: Class number:

1. Changes in the mucosa

2. Changes in the Residual bone and Maxillo-mandibular relationship

3. Changes in Tongue and taste

4. Changes in the salivary flow

This document is the property of PHINMA EDUCATION

Name: Class number:

Activity 2. Create question/s

Tissue changes due to aging:

This document is the property of PHINMA EDUCATION

Name: Class number:

Decrease healing ability and easily injured

Activity 6: Thinking about Learning (5 mins)

B. Think about your Learning

This document is the property of PHINMA EDUCATION

Name: Class number: