6.3 Complete Denture Diagnosis, Try-In, Insertion, Post-Insertion Problems and Relining
Key Takeaways
At the wax try-in, the maxillary incisal edges should touch the wet-dry line of the lower lip when the patient says "f" or "v", and the closest speaking space with "s" sounds is about 1-2 mm.
Pressure-indicating paste locates tissue-surface pressure spots at delivery, and a clinical remount corrects occlusal errors caused by processing.
Cheek biting usually means insufficient horizontal overlap of the posterior teeth, while gagging often comes from an overextended or poorly sealed posterior palatal border.
A reline replaces the tissue surface of the denture base; a rebase replaces the entire base while keeping the existing teeth.
The McGill consensus (2002) recommends a two-implant overdenture as the minimum standard of care for the edentulous mandible.
Impressions, jaw relations and occlusion schemes were covered earlier. This section completes the sequence: who is a good complete denture candidate, what to check at the wax try-in, how to deliver dentures, and how to diagnose the complaints that bring patients back.
Diagnosis and Case Selection
- Ridge form and resorption: high, broad, U-shaped ridges with firm mucosa give the best support; knife-edge or flat ridges, flabby tissue and prominent mylohyoid ridges complicate treatment.
- Patient attitude (House classification): philosophical (calm, realistic, best prognosis), exacting (demanding but cooperative if expectations are managed), indifferent (poorly motivated), and hysterical or sceptical (unrealistic, poor prognosis).
- Inter-arch space, tongue size and position, salivary flow, neuromuscular control and previous denture history all affect the plan.
- Combination (Kelly) syndrome: an edentulous maxilla opposing natural mandibular anterior teeth leads to anterior maxillary resorption, a flabby anterior ridge, tuberosity enlargement and posterior mandibular resorption.
Wax Try-In
| Check | Acceptable finding |
|---|---|
| Esthetics | Incisal display about 1-2 mm at rest in younger patients, less with age; midline matches face; lip support adequate |
| "F" and "V" sounds | Maxillary incisal edges touch the wet-dry line of the lower lip |
| "S" sounds | Closest speaking space about 1-2 mm; teeth must not click |
| "Th" sounds | Tongue tip just visible between the incisors |
| Vertical dimension | Freeway space about 2-4 mm at rest |
| Centric relation | Teeth meet evenly; record repeated if contacts are uneven |
| Posterior palatal seal | Located on the vibrating line, scribed on the cast |
Errors found here are cheap to correct: re-set teeth, repeat the jaw relation record, or re-mount the casts.
Insertion
- Inspect the processed dentures for sharp edges, nodules and porosity.
- Use pressure-indicating paste on the tissue surface; relieve heavy pressure spots without destroying the peripheral seal.
- Check border extension (no overextension into the coronoid space, frenal areas or hamular notches).
- Check occlusion: processing shrinkage changes the occlusion, so a clinical remount with a new centric relation record and selective grinding on the articulator gives more accurate correction than adjusting with articulating paper alone.
- Give instructions: expect sore spots and speech changes for a few days, eat soft food cut into small pieces, remove dentures at night, clean them with a brush and soap or a denture cleanser, and do not adjust them at home.
Diagnosing Post-Insertion Complaints
| Complaint | Likely cause | Correction |
|---|---|---|
| Localized sore spot | Overextension, pressure point, occlusal prematurity | Relieve with pressure-indicating paste; adjust occlusion |
| Generalized soreness, clicking teeth | Excessive vertical dimension | Reduce vertical dimension (re-set teeth) |
| Cheek biting | Insufficient posterior horizontal overlap (buccal overjet) | Reduce buccal surfaces of mandibular posterior teeth |
| Tongue biting | Mandibular posterior teeth set too far lingually | Re-set or reduce lingual cusps |
| Gagging | Overextended or thick posterior palatal border, poor seal | Adjust border, improve post dam |
| Loose maxillary denture | Inadequate posterior palatal seal, overextended borders, poor occlusion | Correct seal and borders |
| Loose mandibular denture on opening | Overextended lingual flange or retromylohyoid area | Reduce flange |
| Burning palate | Pressure over the incisive papilla, allergy to monomer, candidiasis | Relieve papilla area; investigate |
| Fatigued facial muscles, angular cheilitis | Wrong vertical dimension (too high or too low respectively) | Correct vertical dimension |
Relining, Rebasing and Tissue Conditioning
- Reline: adds new material to the tissue surface to refit a denture to a resorbed ridge (chairside or laboratory).
- Rebase: replaces the whole acrylic base while keeping the existing teeth.
- Tissue conditioners are soft temporary liners that let abused, inflamed mucosa recover before a final impression; they must be replaced every few days to weeks.
- Denture stomatitis (Newton types I-III, associated with Candida and continuous wear) is treated by leaving the denture out at night, cleaning and soaking it, antifungal therapy and correcting the fit. Epulis fissuratum from an overextended flange needs flange reduction and sometimes excision.
Denture Hygiene and Identification
Dentures should be brushed daily with a soft brush and soap or a non-abrasive cleanser, soaked overnight in water or an alkaline peroxide or hypochlorite-based cleanser suitable for acrylic (hypochlorite is avoided on metal frameworks because it corrodes cobalt-chromium), and rinsed before insertion. Leaving dentures out at night lets the mucosa recover and lowers the risk of denture stomatitis. Marking dentures with the patient's name is good practice in hospitals and care homes, where dentures are easily lost or mixed up.
Immediate Dentures and Overdentures
- Immediate dentures are inserted at the extraction visit; they protect the sockets and maintain appearance but need relining after healing (commonly at about 3-6 months).
- Overdentures retain roots (often canines) beneath the denture to slow ridge resorption, preserve proprioception, and optionally provide attachments.
- Implant overdentures: the McGill consensus statement (2002) declared a two-implant mandibular overdenture the minimum standard of care for edentulous mandibles; attachments include balls, locators and bars.
Exam Traps
- Teeth that click during speech mean the vertical dimension is too high, not that the denture is loose.
- A denture that drops when the patient opens wide often has an overextended distobuccal (maxillary) or lingual (mandibular) flange.
At a wax try-in, the patient says "fifty-five" and the maxillary incisal edges fall well short of the lower lip. What does this indicate about the maxillary anterior teeth?
They are too short or set too far palatally and must be repositioned
The vertical dimension is excessive, so the mandibular teeth must be ground
The posterior palatal seal is inadequate and should be deepened before delivery
They are ideally placed, because incisors should never meet the lower lip
A patient with new complete dentures repeatedly bites the buccal mucosa in the molar region. Which correction is most appropriate?
Reduce the posterior palatal seal so the maxillary denture sits more posteriorly
Replace the acrylic teeth with porcelain teeth so that the cheeks slide over them
Increase the posterior horizontal overlap by reducing the mandibular buccal surfaces
Increase the vertical dimension of occlusion by about 5 mm to separate the cheeks
What is the difference between relining and rebasing a complete denture?
Relining is temporary soft lining; rebasing is any permanent hard material
Relining adds new tissue-surface material; rebasing replaces the entire base
Relining replaces all the teeth; rebasing replaces only the palatal surface
They are identical laboratory procedures described with two regional names
Sections you finish are checked off in the contents.