I always tell my students that learning how to do a complete denture is fundamental to everything in prosthetic dentistry. Specifically, the step in jaw relation is very critical in determining how to set the teeth in space. This step will ultimately influence the patient’s aesthetic and functional outcome. In this video, I am doing a jaw relation appointment in preparation for a full upper implant bridge. This case was referred to me midway and I have to figure out where the teeth need to be before I can finalize the design and the material of the implant bridge.
The steps here are exactly how I would do for a complete denture except I am doing this for an implant fixed prosthesis.
1/Evaluate soft tissue and lip support. Adjust the anterior rim and the flange as required. Here I am intentionally removing the flange as it is not required for an implant bridge
2/Start to establish occlusal plane. I use the interpupillary line and the alar tragus line as my reference.
3/Refining the occlusal rim using phonetics and smile guidelines. I like to use fricative and sibilant sounds here.
4/Checking the patient’s pre-existing VDO to what I have developed to ensure I haven’t introduced anything too drastic that cannot be tolerated by the patient.
5/I start training the patient into various jaw movement as a way to deprogram the muscle and to help me find centric relation.
6/Once I am happy with what I have developed, I marked the midline, canine lines and the smile line of the upper lip.
7/I also check the back of the master models to ensure the heels are not interfering with proper articulation. If they are hitting, I will trim them myself.
8/Taking pictures of the patient’s smile with and without the retractors will give my technician soft tissue information that will help with the teeth set up.
9/Checking to ensure I am happy with everything and then I trimmed the wax to create troughs and notches in preparation for the jaw relation record.
10/Then finally taking the CR Record and trimming it to ensure the models come together the same way I saw in the mouth
Some steps that are not shown here are the shade selection and the other healing abutments/temporary crowns removal and re-insertion.
Note: In preparation for this step, I often get asked if I want to incorporate some temporary abutments to help secure the occlusal rim. Over the years, I stop doing that as the incorporation of abutments on the record base can slow me down significantly during the initial wax rim try in. However, once I have contoured it the way I like it, I may ask for the teeth set up with the incorporation of the temporary abutments to facilitate teeth try in appointment.
I hope you find this short video helpful in reinforcing some concepts in complete dentures. Thanks for watching and reading.