Complete/Partial Removable Denture Procedure

Acrylic CD/RPD simple flow:

1st visit in Clinic:

• History taking amd examination.
• CD: Primary impression using compund cake on metal tray
• RPD: Primary impression using Alginate impression material on stock tray

1st lab work:

• Casting diagnostic cast/ primary cast
• Fabricate custom/special tray with spacer; on non-stress bearing tissues

2nd visit in Clinic:

• Border moulding on special tray lower > upper
• CD: Secondary impression using ZOE/ Monophase silicone (if theres gingival undercut)
• RPD: Silicone Putty on sadle area & Secondary impresion using Highly Precision Alginate

2nd lab work:

• Casting master cast/ secondary cast
• Fabricate acrylic base with occlusal rim wax

3rd visit in Clinic:

• CD: Check wax rim; VDO,VDR,FWS, Centric Relation
• Intraoral check: esthetic, phonetic, occlusal plane, occlusion 
• Post dam (spoon shaped, butterfy shaped)
• Bite registration
• Tooth shade seletion

3rd lab work:

• Articulator check: fit, VDO
• CD: Balance Occlusion
• Tooth setting with wax

4th visit in Clinic:

• Try in base plate with setup teeth; check all features as 3rd visit

4th lab work:

• Fabricate denture
• Finishing & polishing

5th visit in Clinic:

• Delivery and do at least 2 recall

Side notes:

EXTRA ORAL EXAMINATON:

• TMJ examination (12 points):

1. tenderness
2. clicking
3. popping/crepitus
4. deviation
5. displacement
6. 
   

• Muscle (classified into 2):

1. opening:
• lateral pterygoid
• mylohyoid
• geniohyoid
• digestric
2. closing

• temporalis
• messeter
• medial pterygoid
• Lymph nodes
• CHECK SYSTEMATICALLY - so not miss an area!

INTRA ORAL EXAMINATION:

• Ridge Class (Atwood's Classification):

I : Pre extraction
II : Post extraction
III : high well rounded ridge
IV : knife edge shaped ridge
V : low weel rounded ridge
VI : depressed bone level

• Hard palate class (horizontal):

I : U shaped ; the most favourable for retention & stability
II : V shaped ; not favourable, slight movement will break the seal/ loss of retention, assosiated with tappered arch
III :  Flat/ Shallow vault

• Soft palate class (anterior-posterior):

I : almost horizontal curving
II : 45° angle from hard palate
III : 70° angle from hard palate

• Frenal Attachment:

I : sulcus/low attachment

II : midway between sulcus & crest of the ridge

III : crestal/ near crestal (high) attachment

• Tongue size:

(Mallampati Classification: rough estimate tongue size to the oral cavity)

DEFINATION:

• Centric Relation: 
• most retruded position of mandible to maxilla
• when the condyle in the most anterior & superior position in glenoid fossa
• Centric Occlusion:
• the occlusion of teeth when jaw in centric relation
• may/ may not coincide the maximum intercuspal position
• Balanced Occlusion:
• bilateral, simulteneous, anterior and posterior occlusal contact of teeth in centric & eccentric position
• Curve of spee:
• anterio-posterior curve
• Curve of Wilson:
• medio-lateral curve
• Maximum Intercuspal Position:
• complete intercuspatation of opposing teeth independent of condylar position
• best fit of teeth regardless of condylar position