Writing a book on Prosthodontics was always one of our dreams and
with blessings of God, parents, teachers and wishes of colleagues and
students it seems to be fulfilled.
First we would like to extend our sincere and heartfelt gratitude to
our teachers who have been instrumental in shaping our thoughts at
various points of our career. Our sincere gratitude to all our teachers
during graduation and postgraduation, especially to our guides Dr
Mariette D’souza (Manipal) and Dr Sanjay Tewari (Rohtak). We are
grateful to our friends and colleagues whose support over the years
have encouraged and influenced our thinking.
We wish to express our love, gratitude and respect to our parents
who have always been pillars of strength and have motivated us
throughout our lives. A special hug to our children who have made
A special measure of appreciation to our students over the years
who have inspired us to excel and make teaching fun filled and
Finally, our sincere thanks to excellent editorial team of ELSEVIER
India, especially to Ms Nimisha Goswami, Mr Anand K Jha, Dr
Nabajyoti Kar for the expertise and enthusiasm shown towards this
project. We wish to also acknowledge the efforts of artist Mr R K
1. Introduction to edentulous state
2. Diagnosis and treatment planning for edentulous
3. Mouth preparation of complete denture patients
4. Impressions in complete dentures
6. Maxillomandibular relationship
7. Selection and arrangement of teeth
9. Wax try-in and laboratory procedures
10. Insertion and troubleshooting in complete
12. Single complete dentures and immediate
Introduction to edentulous state
Component Parts of Complete Denture, 3
Importance of Temporomandibular Joint in Complete Dentures, 7
Role of TMJ in Biomechanical Phase of the Prosthetic
Importance of Patient Motivation and Patient Education, 9
Patient Motivation and Education, 9
Physiological Rest Position and its
Morphological Changes Associated with
Soft Tissue Changes in Denture Patients, 11
Loss of teeth in a patient results in psychological, aesthetic and
functional impairment. There is a need to restore and replace the
missing teeth and adjacent structures with artificial substitutes to
allow the patient to lead a normal life. Replacement of teeth and
adjacent structures is covered under specialized branch of complete
Complete denture prosthodontics is defined as ‘that body of
knowledge and skills pertaining to the restoration of the edentulous arch with
a removable dental prosthesis’. (GPT 8th Ed)
Complete denture prosthetics is defined as ‘the replacement of the
natural teeth in the arch and their associated parts by artificial substitutes’.
Complete denture is defined as ‘a removable dental prosthesis that
replaces the entire dentition and associated structures of the maxillae or
Objectives of complete denture prosthetic care are as follows:
• To enable the patients to masticate food so as to get adequate
• To restore the aesthetics by preserving the normal appearance.
• To restore speech as distinctly as the breathing factors permit.
• To provide oral comfort and improve the patients’ sense of wellbeing.
• To educate the patients about the changes to be expected in the
• To convince them about the need for regular check-ups and
A complete denture has three surfaces and four component parts.
This surface is in direct contact with the basal seat tissues and limiting
structures. It is a negative replica of the tissue surface of the jaw.
FIGURE 1-1 Denture surfaces: Impression surface (1),
polished surface (2), occlusal surface (3).
It is defined as ‘the portion of the denture surface that has its contour
determined by the impression’. (GPT 4th Ed)
This surface includes the external surface of the denture, i.e. the labial,
buccal, lingual and the palatal surfaces of the denture. This surface is
desired to be highly polished to facilitate plaque control.
It is defined as ‘that portion of the surface of the denture that extends in
an occlusal direction from the border of the denture and includes the palatal
surfaces. It is that part of the denture base that is usually polished, and it
includes the buccal and lingual surfaces of the teeth’. (GPT 4th Ed)
This surface consists of denture teeth which simulate the natural teeth
and cusps and act as sluiceways to aid in eating.
It is defined as ‘a surface of a posterior tooth or occlusal rim that is
intended to make contact with an opposing occlusal surface’. (GPT 1st Ed)
Component parts of complete denture (fig. 1-2)
It is that part of the denture which rests directly over the oral tissues
and to which teeth are attached and which helps in mastication and
FIGURE 1-2 Parts of denture: Denture base (1), denture
flange (2), denture border (3), denture teeth (4).
It is defined as ‘that part of a denture that rests on the foundation tissues
and to which teeth are attached’. (GPT 8th Ed)
• To transmit the forces acting on the denture to the basal seat tissues.
Wider the denture base, more is the retention and lesser are the
forces on the underlying tissues.
• Forms the foundation of the denture.
• Can be characterized to enhance aesthetics.
Denture base is commonly made of acrylic resin. However, metals
can also be used for constructing denture bases. Some of the
commonly used metals are gold and gold alloys (type IV), cobalt–
• It is the commonly used material to construct denture bases.
• It is supplied as monomer and polymer.
• It is easy to fabricate and is economical.
• It is easily relined or rebased.
• It can be characterized to enhance aesthetics.
• It has adequate rigidity to resist functional forces.
• It cannot be used in thin sections.
• Wear is faster as compared with metal base.
• Thermal conductivity is less.
• There are chances of acrylic warpage.
Metallic denture base is defined as ‘the metallic portion of a denture base
forming a part or the entire basal surface of the denture. It serves as a base for
the attachment of the resin portion of the denture base and the teeth’. (GPT
Commonly used metals for denture base are type IV gold alloys,
cast chrome-based alloys and aluminium-based alloys (Fig. 1-3).
FIGURE 1-3 Metal base dentures.
• Less chances of tissue change under the metal base
• Lesser porosity and, therefore, easy to clean
• Less chances of deformation under function
• Difficult to reline or rebase
• Fabrication is time consuming and technique sensitive
It is defined as ‘that part of the denture base that extends from the cervical
ends of the teeth to the denture border’. (GPT 8th Ed)
In the upper denture, the denture flange includes the labial and the
buccal flanges, whereas in the lower denture, the denture flange
includes the labial, buccal and the lingual flanges, which is the vertical
extension along the lingual side of the alveololingual sulcus.
The labial flange provides the lip support, fullness and aesthetics. If
the labial flange is thick, it gives an artificial denture look to the
The buccal flange provides support to the cheeks and occupies the
buccal vestibule of the mouth. In the lower denture, it also transfers
the occlusal forces to the buccal shelf region, which is the primary
stress-bearing area in the mandible.
Lingual flange occupies the space adjacent to the tongue. It contacts
the floor of the mouth and provides the peripheral seal to aid in
retention of the denture. Overextended lingual flange may result in
loss of retention of the denture.
It is defined as ‘the margin of the denture base at the junction of the
polished surface and the impression surface’. (GPT 8th Ed)
It is the peripheral border of the denture base at the facial, lingual
and the posterior portion. This part of the denture provides the
peripheral seal which aids in the retention and stability for the
denture. Overextended and underextended dentures result in the loss
of retention. Denture border should be smooth and well polished; any
sharp margins may irritate and injure the underlying soft tissues.
Denture teeth form the occlusal surface of the denture; these provide
aesthetics, enable the patient to chew and aid in speech. These are
usually made of acrylic resin or porcelain.
On the basis of tooth morphology, denture teeth can be classified as
On the basis of type of the material used, these can be classified as
• Acrylic resin with amalgam stops
• Acrylic teeth with metal inserts
• Interpenetrating polymer network (IPN) resin teeth
FIGURE 1-4 (A) Anatomic tooth. (B) Semi-anatomic tooth.
Residual ridge resorption (RRR) is defined as ‘a term used for
diminishing quantity and quality of the residual ridge after the teeth are
RRR is considered as the chronic, progressive, irreversible and
cumulative oral disease. It is described under the following headings.
Basically, the ridge resorbs and decreases in size under the
• Although there is primary localized loss of bone, sometimes this loss
may be accompanied by redundant tissues.
• Maxilla resorbs vertically and palatally in the anterior region and
vertically and medially in the posterior region.The maxillary ridge
becomes progressively smaller and the incisive foramen comes
nearer to the crest of the ridge as the resorption progresses.
• Mandible resorbs vertically and lingually in the anterior region and
vertically and laterally in the posterior region. Mandibular ridge
appears progressively wider on resorption. Progressive resorption
of the maxillary and mandibular ridges makes the maxilla narrower
Atwood’s classification of the form of residual ridge (1963) (Fig. 1-5):
• Order III: High, well rounded
FIGURE 1-5 Atwood’s classification of residual ridge: Order
(I): pre-extraction; order (II): postextraction; order (III): high,
well rounded; order (IV): knife edge; order (V): low, well
rounded; order (VI): depressed.
• After the extraction of the teeth, the empty sockets are filled with
blood to form blood clot. During healing, a new bone is laid down.
The residual ridge changes in shape and size at varying rates in
different individuals and in same individual at different times. RRR
progresses slowly over a longer period of time resulting in reduced
• A. Tallgren (1972), D.A. Atwood and W.A. Coy (1971) found that the
mean ratio of the anterior maxillary RRR to the anterior mandibular
RRR is a multifactorial biomechanical disease resulting from the
RRR varies with the quantity and quality of the bone
• RRR a-anatomic factors: More the bone, more are
the chances for resorption, but the rate at which it
• RRR is a localized loss of bone on the crest of
residual ridge and certain local and systemic factors
may influence the rate of resorption.
• Local factors are endotoxin, osteoclast activating
factor, prostaglandins, heparin, trauma, etc.
• Systemic factors may influence the balance between
the bone formation and bone resorption.
• Remodelling of the bone is influenced by the force
• The amount, frequency, duration, direction, area
and the damping effect of the underlying tissue
• RRR may increase in a patient with parafunctional
habits such as clenching and grinding of teeth.
• The amount of force applied may be affected
inversely by the damping effect or energy
• Damping effect takes place in the mucoperiosteum
which is viscoelastic in nature.
• Energy absorbing quality may influence the rate of
• Maxillary residual ridge is broader, flatter and has
increased cancellous bone than mandible and,
therefore, has greater damping effect.
The goal is to reduce the amount of force on the ridge and, therefore,
to reduce the RRR. It can be accomplished by the following:
• Reduced buccolingual width of the teeth
• Centralization of occlusal contact
• Avoidance of inclined planes
• Provision of adequate tongue space
• Adequate interocclusal space
Importance of temporomandibular joint
Temporomandibular joint (TMJ) is a complex synovial joint in which
mandible articulates bilaterally to the cranium. It is a
ginglymoarthrodial joint which is capable of making hinge and
FIGURE 1-6 Anatomic components of temporomandibular
joint (TMJ): Head of condyle (1), articular disc (2), articular
eminence (3), superior joint cavity (4), inferior joint cavity (5),
retrodiscal (6), superior lateral pterygoid muscle (7), inferior
TMJ is formed by the mandibular condyle fitting into the
mandibular fossa of the temporal bone. Separating these two bones
from direct articulation is the articular disc. This disc serves as the
nonossified bone that permits the complex movement of the joints. In
the sagittal plane, the disc is divided into three regions (intermediate,
anterior and posterior zones) according to the thickness. The hinge
movement occurs between the condyle and the articular disc and the
gliding movement occurs between the disc and the articular eminence
Each of the joints can simultaneously act separately but not
completely without the influence of the other joint. Unlike the other
joints, TMJ is not composed of the hyaline cartilage. The articular
surfaces and the middle or intermediate portion of the articular disc
are made of nonvascular, nerve-free, dense fibrous connective tissues.
The intermediate portion of the articular disc is the load-bearing area.
The articular disc is thicker both anterior and posterior to the
Role of TMJ in biomechanical phase of
Studies show that the condyles are stress-bearing structures, and the
continuous positioning of the disc on the articular surface throughout
the normal movements suggests that the intermediate zone of the disc
must assume pressure during function. In the normal position, the
articular surface of the condyle is located on the intermediate zone of
the disc, bordered by the thicker anterior and posterior regions. As
sensory feedback and provides a biomechanically stable relationship.
As the articular eminence is an inclined plane, the condyle disc
assembly should be stabilized on this slope by the muscular activity
unless it is in the position of biomechanical equilibrium. The lateral
pterygoid muscle plays an important role in determining the position
of the condyle disc assembly on the eminence at any given movement.
The fibres of the TM ligaments are oriented in appropriate directions
to limit posterior movement of the mandible. A posterior force tends
to pivot the condyle superoanteriorly because of the restriction by this
In a dentulous patient, the physiological relation between the
condyles, disc and their glenoid fossa is maintained during maximal
occlusal contacts and movements guided by the occlusal elements.
This occurs in the centric relation position.
• Centric relation is the most superior position of the mandibular
condyles with the intermediate zone of the disc in contact with the
articular surface of the condyle and the articular eminence. This
position is consistent with the functional bearing capacity of the
posterior slope of the eminence, the adaptation of the intermediate
zone of the disc and the biomechanical stability of the joint resulting
from the shape of its components.
• In an edentulous patient, the pathological or adaptive changes of
TMJ occur over a period of time. Centric relation position coincides
with the reproducible posterior hinge position of the mandible and
should be recorded with accuracy in the edentulous patient.
• Centric relation is considered as an essential relationship in any
• The occlusion of the complete denture patient should harmonize
with the primitive unconditioned reflex of the patient swallowing.
• It is observed that unconscious swallowing occurs when the
mandible is at or near the centric relation position.
• If the occlusion in a complete denture patient does not coincide with
the centric relation, morphological changes can occur in TMJ.
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