Complete (F/F) Dentures

[jbowman]

Hi all, I was hoping to get some advice about my complete denture case.

My patient has a skeletal Class I jaw relationship. I mounted the casts in Centric Relation on the articulator.

However, the patient naturally postures her jaw forward when she bites down, so when she bites down, she appears to be in a Class III jaw relationship.

Now, I have just set and did a trial insertion of the anterior teeth. I was advised by my tutor to procline the upper anteriors, since the patient postures the jaw forward, so once she bites down naturally, the teeth will be in a Class I relationship with normal overbite and overjet.

However, because my casts on the articulator were mounted in CR, there is now a significant overjet (almost 10mm) when I place the denture base back onto the casts.

The next step is to set the posterior teeth, but I'm not sure what to do.
Because there is such an excessive overjet when the bases are on the articulator, I am not sure how I set the posterior teeth while ensuring that I get the correct occlusion.

Very confused, I really hope someone here can give some advice!

Thanks

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[browncrack]

This sounds like you don't fully understand complete dentures-you might want to go back and flip through the dental decks. short answer- use monoplane teeth and you'll save yourself some frustration but reduce some functionality for the patient. Fully edentulous persons end up with what looks like skeletal class III when not using their dentures due to reduced vertical dimension.

 

[omaralt]

Also forget CR; Take the bite in MICP

 

[jbowman]

Thanks for the replies.

Unfortunately, my prosths unit coordinator has 'banned' use of monoplane teeth. I'm not sure on his reasoning though.

Also forget CR; Take the bite in MICP

Does this mean I need to go back and take MMR? And instead of recording CR, I record MI. Then remount the casts on the articulator?

 

[omaralt]

Does this mean I need to go back and take MMR? And instead of recording CR, I record MI. Then remount the casts on the articulator?

many patients have a slide from CR to MICP... many dental school professors want you to force the patient into CR, why? they've adapted to MICP and have no issues, leave it there. when taking the bite (with the occlusal rims), have the patient bite into where they're jaws are comfortable. record that position and do a try in and see how the patient feels. trying to put somebody into CR who has a pronounced shift will bring you many, many headaches

 

[browncrack]

No monoplane teeth? Use 10 degree, set the teeth, and grind as needed. Alternatively, get a good bite/jaw relationship with your wax rim, and send it to the lab. Let the lab tech set 33 degree teeth. Getting CR with a patient without any teeth shouldn't be too difficult. Reset the teeth with a new record on your try-in if you miss the bite the first time.

 

[mike3kgt]

With denture patients, I don't know if MICP is an appropriate term due to the fact that it's dependent upon tooth to tooth contacts.

With dentures, you are probably having the patient close into a habitual position or a 'rest jaw position' (GPT). If the patient was edentulous for an extended period of time with poor dentures or without any dentures, chances are they will be posturing forward.

Trying to force 100% of patients into a "denture centric position" (which is not 'centric relation') and you will get a pissed off patient now and then. Not everybody wants to be forced back, but you do need a reliable, repeatable, and physiologic position to set your dentures to. Habitual positions generally are physiologic, but more difficult to be reliable and repeatable in denture patients (where they are much more reliable in dentate patients).

Proclining the teeth is an OK idea, but may result in poor esthetics. Trying to put a patient like this into full cusp bilateral balance (33/33deg) will be extremely difficult and the patient will most likely not wear the lower denture (or both).

Monoplane is an OK idea as well but they look like heck. Why don't you consider Lingualized occlusion? Take 33 deg maxillary teeth opposing 0 or 10 degree teeth and give the patient freedom in the centric position.

Do some research on lingualized and I think you'll like what you see. If you have the information and can defend it, your professors may allow it.

 

[efficient]

Balanced lingualized occlusion or Nonbalanced lingualized occlusion.
And if you're banned from using monoplane teeth, just grind them down if you choose to do a nonbalanced occlusion.

 

[DrJeff]

Personally I've found through many a case where I tried to force the patient into a jaw relationship position for their denture teeth that I was told they should be restored too, verses restoring them to a jaw relationship position that THEY'RE comfortable with, that the further you attempt to take the full/full denture patient awy from a jaw relationship that they're used to and comfortable with, the more time you'll spend grinding the plastic of that new full/full set of teeth you just delivered to the patient in the days/weeks after the delivery date

For *most* folks, the difference between that hallowed CR and the patients own MCP is quite small, so if you try and restore them in CR, that difference to get them to THEIR desired MCP is quite small and often achieved with minor adjustment to the dentures upon delivery. For that small portion of patients where they have a dramatic difference between their CR and MCP, go with the MCP, as you'll save yourself a large amount of headaches and a number of conversations between you and that patient where you're telling them why CR is great and they're telling you "but Doc, these don't FEEL like my teeth"

 

[omaralt]

Personally I've found through many a case where I tried to force the patient into a jaw relationship position for their denture teeth that I was told they should be restored too, verses restoring them to a jaw relationship position that THEY'RE comfortable with, that the further you attempt to take the full/full denture patient awy from a jaw relationship that they're used to and comfortable with, the more time you'll spend grinding the plastic of that new full/full set of teeth you just delivered to the patient in the days/weeks after the delivery date

For *most* folks, the difference between that hallowed CR and the patients own MCP is quite small, so if you try and restore them in CR, that difference to get them to THEIR desired MCP is quite small and often achieved with minor adjustment to the dentures upon delivery. For that small portion of patients where they have a dramatic difference between their CR and MCP, go with the MCP, as you'll save yourself a large amount of headaches and a number of conversations between you and that patient where you're telling them why CR is great and they're telling you "but Doc, these don't FEEL like my teeth"

+1; what i said above, but more eloquent

 

[The Hammer]

1. You have not mounted your patient in CR. You have mounted them in the rear most position that you could force their condyles which is not CR. You rarely if ever will get a patient into CR by forcing back on the mandible.

2. Because your patient has lost their teeth and thus Vertical dimension. They are in an "adapted centric"

3. Use cusped teeth on the upper with a lingualized occlusion. Use mandibular teeth with very very shallow fossa and as mentioned before grind them down to make them closer to a monoplane tooth.

4. To make your life and the patient's denture experience better, take the wax trying you have now, put it in the patient's mouth and have the patient close down. If the teeth are meeting in an acceptable position have them open and then use a VPS bite material and record that bite. Carefully remove the mounting plaster from the lower cast and do a remount using the dentures with the bite registration that you just took. Rub your tummy, smile and go home and sleep well.