24.refine denture setup
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This document provides instructions for refining denture setups after the trial denture try-in. It discusses refining setups for different types of occlusal schemes, including lingualized occlusion, monoplane occlusion, lingualized opposing monoplane, semi-anatomic, and anatomic. The key steps involve verifying occlusal contacts and relationships in centric, working, balancing, and protrusive positions and making adjustments as needed to achieve the desired occlusion.
24.refine denture setup
- 1. 24. Refine Denture Setup John Beumer III, DDS, MS Division of Advanced Prosthodontics, Biomaterials and Hospital Dentistry UCLA School of Dentistry This program of instruction is protected by copyright ©. No portion of this program of instruction may be reproduced, recorded or transferred by any means electronic, digital, photographic, mechanical etc., or by any information storage or retrieval system, without prior permission.
- 2. Refining your Denture Setups After try in of the trial denture, the denture setup must be refined so that minor discrepancies in occlusal plane, centric and bilateral balance etc., are corrected. The purpose of this section is to review the appropriate methods of refining your denture setups prior to processing.
- 3. Refining your Denture Setups Posterior tooth forms Lingualized Monoplane – neutrocentric Monoplane with balancing ramps Lingualized opposing monoplane Semi anatomic (20 degree) Anatomic (30 degree)
- 4. Check to see that the marks made previously on the casts indicating midline, crest of the ridge, and the retromolar pad are still present . These landmarks will be used to refine your denture setup. Maxilla Midline Anterior land Mandible Ridge Retromolar pad Refining your Denture Setup
- 6. Refining your Denture Setup Position the appropriate protrusive insert, and check to ensure that the incisal guide pin is set at zero and in contact with the incisal guide table. Lingualized occlusion
- 7. Lingualized Occlusion Anterior teeth The position of the maxillary anterior teeth were established at try in. Note that the maxillary anterior teeth follow the curvature of the arch.
- 8. Anterior teeth Vertical overlap (1-2 mm)* Horizontal overlap (1-2 mm )* * The amount of overlap will vary depending on condylar inclination, occlusal plane and esthetics. Lingualized Occlusion
- 9. Lingualized Occlusion Ensure that the denture teeth are on plane. The plane of occlusion should be parallel to the body of the mandible and extends from the incisal edges of the central incisors and the middle portion of the retromolar pads bilaterally. The appropriate Curve of Spee should be incorporated into the setup.
- 10. Lingualized Occlusion Verify the position of the mandibular denture teeth. Make sure the posterior mandibular teeth are centered over the ridge
- 11. Verify centric and make adjustments as necessary. The lingual cusps of the maxillary posterior teeth must rest in the central fossa of the opposing mandibular teeth. There should be no buccal cusp contacts of posterior teeth in centric or in lateral excursion. Lingualized Occlusion
- 12. Lingualized Occlusion Check centric from the lingual.
- 13. Lingualized Occlusion Verify working, balancing and protrusive. Make adjustments as necessary. This is the working position.
- 14. Lingualized Occlusion In the anterior region there should be only light contact during lateral excursions.
- 15. Lingualized Occlusion Verify working, balancing and protrusive. Make adjustments as necessary. This is the balancing position.
- 17. Refining your Denture Setup Position the appropriate protrusive insert, and check to ensure that the incisal guide pin is set at zero and in contact with the incisal guide table. Monoplane occlusion
- 18. Monoplane Occlusion Anterior teeth The position of the maxillary anterior teeth were established at try in. Note that the maxillary anterior teeth follow the curvature of the arch.
- 19. Anterior teeth Vertical overlap (1-2 mm)* Horizontal overlap (1-2 mm )* * The amount of overlap will vary depending on condylar inclination, occlusal plane and esthetics. If a neutrocentric concept of occlusion is used no vertical overlap should be incorporated into the set up. Monoplane Occlusion
- 20. Refining your Nonanatomic Setup Verify that all cusp tips except the lateral incisors and sometimes the cuspids, contact the plane of occlusion and check to see that the plane conforms with these landmarks. Make changes as necessary. Midpoint of the retromolar pads and the edges of the central incisors Plane should be parallel to the plane of the body of the mandible
- 21. Refining your Nonanatomic Setup Verify that the posterior mandibular teeth are centered over the crest of the ridge. Make corrections as needed.
- 22. Refining your Nonanatomic Setup Check the horizontal overlap of the posterior teeth. Make corrections by moving the maxillary posterior teeth.
- 23. Refining your Nonanatomic Setup Verify again that all the maxillary teeth, with the exception of the lateral incisors and perhaps the cuspids, are on the plane of occlusion. Make corrections by manipulating the maxillary teeth. When you have completed this step, thoroughly cool the wax before proceeding to the next step.
- 24. Refining your Nonanatomic Setup Reestablish centric contacts by manipulating the mandibular posterior teeth. Make sure that the incisal guide pin contacts the incisal guide table when you have completed this step. While performing this step make sure you do not alter the horizontal overlap. If the neutrocentric concept has been used you are finished. If bilateral balance with balancing ramps is your objective, go on to the next step. Neutrocentric
- 25. Refining your Nonanatomic Setup Add the balancing ramp as shown. In all lateral excursions you should observe at least three points of contact bilaterally if bilateral balance is to be achieved. Monoplane with balancing ramps
- 27. Refining your Denture Setup Position the appropriate condylar insert, and check to ensure that the incisal guide pin is set at zero and in contact with the incisal guide table. Lingualized opposing monoplane
- 28. Lingualized Opposing Monoplane Anterior teeth The position of the maxillary anterior teeth were established at try in. Note that the maxillary anterior teeth follow the curvature of the arch.
- 29. Anterior teeth Vertical overlap (1-2 mm)* Horizontal overlap (1-2 mm )* * The amount of overlap will vary depending on condylar inclination, occlusal plane and esthetics. If a neutrocentric concept of occlusion is used no vertical overlap should be incorporated into the set up . Lingualized Opposing Monoplane
- 30. Lingualized Opposing Monoplane Verify again that all the maxillary teeth, with the exception of the lateral incisors and sometimes the cuspids, are on the plane of occlusion. Make corrections by manipulating the maxillary teeth. When you have completed this step, thoroughly cool the wax before proceeding to the next step.
- 31. Lingualized Opposing Monoplane Verify that the posterior mandibular teeth are centered over the crest of the ridge. Make corrections as needed.
- 32. Lingualized Opposing Monoplane Check the horizontal overlap of the posterior teeth. Make corrections by moving the maxillary posterior teeth.
- 33. Lingualized Opposing Monoplane Verify again that all the maxillary teeth, with the exception of the lateral incisors and sometimes the cuspids, are on the plane of occlusion. Make corrections by manipulating the maxillary teeth. When you have completed this step, thoroughly cool the wax before proceeding to the next step.
- 34. Lingualized Opposing Monoplane Reestablish centric contacts by manipulating the mandibular posterior teeth. Make sure that the incisal guide pin contacts the incisal guide table when you have completed this step. While performing this step make sure you do not alter the horizontal overlap. If the neutrocentric concept has been used you are finished. If bilateral balance with balancing ramps is your objective, go on to the next step.
- 35. Lingualized Opposing Monoplane In all lateral excursions all posteriors and the incisors maintain contact. Working Balancing Protrusive Neutrocentric
- 36. Lingualized Opposing Monoplane Note that the maxillary 2 nd molar extends slightly posterior to the mandibular 2 nd molar in order that it may engage the balancing ramp during lateral excursion. Bilateral balance with balancing ramps
- 37. Lingualized Opposing Monoplane The balancing ramps are added as shown. In all lateral excursions you should observe at least three points of contact bilaterally to maintain bilateral balance. Bilateral balance with balancing ramps
- 38. Refining your Denture Setup Position the appropriate protrusive insert, and check to ensure that the incisal guide pin is set at zero and in contact with the incisal guide table. Semi-anatomic
- 39. Refining your Semi-anatomic Setup Anterior teeth The position of the maxillary anterior teeth were established at try in. Note that the maxillary anterior teeth follow the curvature of the arch.
- 40. Anterior teeth Vertical overlap (1-2 mm)* Horizontal overlap (1-2 mm )* * The amount of overlap will vary depending on condylar inclination, occlusal plane and esthetics. Refining your Semi-anatomic Setup
- 41. Refining your Semi-anatomic Setup Verify that the posterior teeth are on plane and the posterior mandibular teeth are centered over the mandibular ridge. For bilateral balance in excursions, the appropriate amount of the Curve of Wilson and the Curve Spee should be incorporated into the setup
- 42. Refining your Semi-anatomic Setup Check buccal and lingual centric.
- 43. Refining your Semi-anatomic Setup Check to ensure you have retained appropriate contacts in working, balancing and protrusive. Balancing Working Protrusive
- 44. Refining your Anatomic Setup
- 45. Refining your Denture Setup Position the appropriate protrusive insert, and check to ensure that the incisal guide pin is set at zero and in contact with the incisal guide table. Anatomic occlusion
- 46. Refining your Anatomic Setup Anterior teeth The position of the maxillary anterior teeth were established at try in. At this stage only the central incisors need be on the occlusal plane. Note that the maxillary anterior teeth follow the curvature of the arch.
- 47. Anterior teeth Vertical overlap (1-2 mm)* Horizontal overlap (1-2 mm )* * The amount of overlap will vary depending on condylar inclination, occlusal plane and esthetics. Refining your Anatomic Setup
- 48. Refining your Anatomic Setup Verify that the posterior teeth are on plane and the posterior teeth centered over the mandibular ridge.
- 49. Refining your Anatomic Setup Check buccal and lingual centric.
- 50. Refining your Anatomic Setup Check to ensure you have retained appropriate contacts in working, balancing and protrusive. Balancing Protrusive Working