try-in procedure in complete denture presentation

THE TRY-IN APPOINTMENT
(COMPLETE DENTURE)

INTRODUCTION
 The try-in appointment – significant for
successful edentulous patient care.
 It will be the first time that dentist &
patient can see what has been created.
 Decision will be one of acceptance,
modification or change.
 Mutual satisfaction with provisional
waxed-up result – achieved before
dentures are processed.

 Try-in verification or Aesthetic try-in is defined as :-
“ A preliminary insertion of a removable denture
waxup to determine the fit, aesthetics &
maxillomandibular relation” (GPT)

Procedure
 Verification of jaw relation
 Verification of occlusion
 Verification of esthetics
 Verification of phonetics
 Establish the posterior palatal seal.

Before try in appointment
 Find out who decides???
 For many patients, teeth are personal &
private,& they will make their own decisions.
 Others will have a spouse / friend whose
dental opinion they value.
 Insist that your patient bring that “ significant
other” to this appointment.

 Confirm that the wax up will be
ready ????????
 Does it look good ??????
 Will it be comfortable?????

At try in appointment
 At start, explain what to expect in
simple non dental terms !!!!!!!!!

These are not
dentures – teeth
are actual but rest
is wax pattern to
hold teeth.
They are only for
looking , not for
chewing.
Not be as retentive
as the final
dentures – made
on models that are
relieved .
Gingival color is
pink tinted wax.
We want to check
everything, see if
anything needs to
be improved .

Denture comparison
Alma guage – excellent
method of recording the
vertical & lateral distance
between incisor edge &
incisive papilla in a denture.

THE REAL TRY-IN
 In reality, results in the mouth are
what count.
 Will the teeth , as framed by the lips,
look like what the patient wants?????

Checklist of items
Are the bases comfortable & retentive
enough to allow patient to concentrate
on appearance of teeth???
Are the teeth the right color and size???
Are the articulator –mounted models an
accurate record of centric jaw relation ???
Are the teeth in correct position????
Are the base contours supporting the
lips properly ???
Are the wax-ups acceptable s they are???

Anything else??????? Now is the time for
changes !!!!!!!!!
If you & the patient agree on the answers to
these questions , then the dentures are ready
to
process…….

 Depending on answers to above questions &
steps needed to correct things,
A try in appointment may range from lasting
10 mins & reaching a happy mutual
agreement to scheduling another appt to
reach that agreement.

Maxillary anteriors usually the most
visible part of a smile.
 Start here …..expand your investigation
to rest of the smile…..

 How is the color , how is the size of teeth?
 How is the midline ?? Does it look right in centre?
 DO the teeth show enough ?? Or not enough???
 Does the smile appear level , or is it tilted a little ??
 If tilted, should we move it up on one side, or down on the
other , or both?
 Are the lower teeth showing enough??
 Is there adequate space between the teeth & lips apart/mouth
breathing ??

 Smiling lips as the frame around
a picture..
 Teeth should be positioned such
that CENTRAL INCISORS – most
obvious object – centre of
picture.
 Appropriate ratio of dental sizes
& positions of teeth moving
away from that centre, left &
right, up & down & front to back.
All blend in proportion as
outlined by LOMBARDI

Anterior teeth selection
 Satisfaction with a prosthetically created smile is
significant in patient’s decision to accept therapy.
 Shade guides, mold guides, measurement charts, old
photographs, opinion of family members/friends.

 A recommended sequence :-
Find out what patient prefers and
what they don’t want from the
previous records
In case of previous dentures, make
alginate impressions /plaster study
casts of current dentures….guide for
tooth anatomy
Measure exisiting teeth in mm

 Length & width of maxillary central incisor
 Total circumference of six anterior teeth
 Length & height of posterior teeth
These mm dimensions are published by most tooth
manufacturers & facilitate ordering teeth that are similar,
smaller or larger.

 Apply these principles to what you see in the
smile – NOTE & APPROVE , or AGREE to correct –
 Mid line
 Tooth visibility
 Occlusal plane

Evaulate occlusal plane
 Parotid papilla
 Inter-pupillary line
 Camper’s line
 Retromolar pad.

 Level of occlusal plane should by one fourth inch below the
opening of Stensen’s duct.
 Linea alba buccalis – zone of hyperkeratinization that occurs
at level of occlusal interdigitation – guide .
 Interpupillary line – anterior part of maxillay occlusal plane
should be parallel….should be 2mm below upper lip line.
 Camper’s line – posterior part of occlusal plane should be
parallel to ala tragus line when patient sits in upright
position.
 Retomolar pad – Height of mandibular plane – level at
junction of anterior two third & posterior one third. Plane is
kept lower at level of corners of mouth.

Speaking & Phonetic
assessment
 Four goals
Patient gets used to
feeling of new teeth ,
adapts
Develops confidence &
acceptance
Assessment of appearance of teeth &
space between them while speaking
Functional assessment of acceptable
interocclusal dimension between rest and
occlusal positions of mandible.

 Count through the 50’s: “ 51,51,53…etc”……..
 This labial/dental formed sound will assess visibility &
position of upper anterior teeth relative to lower lip.
 Decide if upper teeth appear pleasing in their position or
if they should be moved up/down – forward or
backward.

 Have patient count through the 60’s -
 This lingual/dental formed sound will assess the position
of
1) Upper anteriors to residual alveolus
2) Appropriate height of upper & lower teeth
3) Interocclusal airway space
The SIBILANT sounds like “S” – should be clear & crisp..if
speech is muffled , the upper anteriors must be too short &
or set too high in front of residual ridge.

 The upper & lower teeth should each appear to
be visible with SIBILANT sounds.
 If either the upper or lower are excessively visible
compared with other, consider changing the
occlusal plane for a better balance at same VD.

Vertical dimension of
occlusion
 With the wax-ups in slight occlusion, remeasure
the extra-oral BOLEY GUAGE distance between
your previously identified landmarks.
 If you planned a slight improvement of the VDO,
as a result of your assessment of ridge resorption
& occlusal wear of existing dentures –
Measurement should be slightly greater with the
waxup compared with the old dentures.

 Speech assessment – provide a functional
assessment of mandibular occlusal position.
 Should be a slight ( CLOSEST SPEAKING SPACE )
space between upper & lower teeth during speech.
 If this dark background appears more obvious
than the teeth, perhaps the entire vertical
dimension is inadequate.
 REMEMBER, on an avg for every 1mm of VD
change, the A-P relation also changes at 0.75mm.

Check the dental occlusion
 Assess occlusion & articulation at selected jaw
relationship.
 YOU need to see the teeth as three different positions
as the patient closes :-
1) When the teeth are just apart ( close but not touching)
2) When a first contact is made
3) When all teeth are in occlusion

 The successful dentist has learned what a patient’s
relaxed jaw closing arc feels like, & learned how to
work with patients to let them relax & achieve this
comfortable closure.
 The edentulous patient presents a unique
challenge of making this recording while
simultaneously holding two movable bases in their
correct positions.

Single base stabilization for
try –in assessment
 When upper base is definitely SECURE &
RETENTIVE.
 Double attention to the lower wax-up, the less
secure of the two bases.
 GOAL :- Just hold the base down without shifting
on the tissues.
 Denture base & mandible need to move together
as one unit , while you guide the patient to relax,
open & gently close to assess the occlusion.

Double base stabilization
 If both bases have limited retention /stability,
both must be stabilized by dentist at same time as
mandible is guided in closure.

 Look with your eyes & feel with your fingers.
 What happens between the first light contact &
full occlusal contact ???

 The correct occlusion should not move or shift
denture bases.
 Depending on resiliency of mucosa, the entire
denture bases may move slightly toward
tissue,
 BUT, this mucosal compression should be felt
& seen as only the slightest of equal
movement of denture bases without any
occlusal change.

 Once this is achieved, then the dentist can have
the confidence that the try – in is accurate &
dentures made to this position should be well
fitting after processing adjustment.

WHEN IS A REMOUNT
NEEDED ???????

try-in procedure in complete denture presentation

Verification of Aesthetics
 Visibility
 Lip and check support
 Vermilion border
 Philtrum
 Naso-labial fold
 Mentolabial sulcus.

Establishment of PPS
 If palatal seal area has not been defined at impression
appointment , IT NEEDS TO BE DONE NOW.
 This area is modified by scraping a 2mm wide & deep groove
into final stone model before denture processing.
 Functions:-
1) Compensates for slight shrinkage of processed acrylic across
the arch of palate.
2) Maintains peripheral seal
3) Posterior denture border can maintain adequate thickness for
strength.
4) Blends into mucosal contour – so less noticeable to patient’s
tongue.

 Check & confirm with your patient if any specific
gingival color is better for them.
 Some patients will have differences in skin tones
such that more or less gingival color may appear
better for them.

 When your patient, their significant others, & you
have agreed that waxed model of new smile is
acceptable,
Remind patient what processing dentures really
means.
EXPLAIN:-
1) The actual teeth will be used.
2) The shape will be the same as it is now & wax is
changed to
gingival acrylic.

 Common practice to request a financial deposit &
clarify this by having patient sign an acceptance
agreement.
I, (insert patient’s name), have been given the opportunity to
look at the final arrangement of artificial teeth (while positioned
in wax).
Any necessary changes have been made & I am happy with the
general appearance of the dentures.
SIGNATURE
DATE

Conclusion
 The try-in appointment is the most significant one of
those involved in edentulous patient care.
 For the first time, patient & dentist have the opportunity
to see what the future holds.
 The dentist does his/her best to create an environment &
a result pleasing& satisfactory.
 All of the interests of the patient, dentist & commercial
laboratory come together to be resolved at the try-in
appointment.
 The dentist is responsible for the overall result & if a
change is required , the dentist needs the skills & a
protocol to implement them.
 Sometimes, more than one appointment is needed to
obtain the best result.

try-in procedure in complete denture presentation

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