Complete Denture (CD) Diagnosis and Treatment Plan

October 4, 2011 | By | Reply More

Complete Denture (CD) Diagnosis and Treatment Plan

Medical history

– Make efficient use of time – don’t need history of relatives 4x removed

– Follow-up significant positive responses

– Note systemic conditions that impact on therapy (e.g. angina, hepatitis, Sjogren’s syndrome)

– Obtain physician consultations where appropriate

– If some debilitating disease – discuss with instructor – to ensure acceptability

Dental History

– How many dentures, how long patient has worn dentures

– Satisfaction with dentures

– Things patient likes – what they want changed

– Be brief

Clinical Exam – routine clinical exam

Intraoral Exam – Examine one arch at a time – look, then write

1. General tissue health

– Attached mucosa / non attached

– Colour

– Character

– Displaceability

2. Specific Anatomical considerations

– Examine systematically, e.g. posterior 1st quadrant to post. 2nd quadrant, then palate

– Note the significance that a finding has to the therapy you are providing

– Visual and tactile exam.


The form of the maxillary arch affects retention – advise the patient if retention will be compromised.

A. Posterior border of denture:

1. Hamular notches – posterior denture border – palpate position, visually deceiving

– Over extension – extreme pain

– Under extension – non-retentive

– Must be captured

2. Vibrating line – identified when the patient says “ah”

– At junction of the movable and non-movable portions of the soft palate

– Don’t want denture on movable soft palate – it may be displaced

– Fovea – rough guide to the position of the vibrating line

– Throat form can affect breadth of vibrating line

3. Pterygomandibular raphe

– Behind hamular notches – significant rarely

– Have patient open wide as possible

– Can displace denture – requires relief in extreme cases

B. Tuberosity

– Displaceability

– If undercut – use elastomeric impression material – palpate for undercuts

C. Ridge form

– Advise patient if poor, since it will affect retention and stability

D. Labial/Buccal vestibule – 2-4 mm thick

– Buccal vestibule – zygomatic process – can be prominent

– When flat ridge – use care in accurately registering the vestibule to maximize retention

E. Frena – check prominence:

– Buccal frenum – usually broader

– Thin labial frenum

F. Bony areas, tori – mid palatal suture

– Don’t want binding or fulcruming on the midline

– Fulcruming will cause discomfort, loss of retention and possible fracture of the denture.


Form of the mandibular arch is even more critical than in the maxilla, since there is less surface area for retention and the moveable structures of the tongue and floor of the mouth can cause denture displacement if the denture is overextended- inform patients of any potential retentive problems.

A. Retromolar pad

Terminal border of the denture base

– Compressible soft tissue – affects comfort and denture peripheral seal

– Must be captured in impression

B. Buccal shelf

– Check width – alginate will almost always overextend – painful

– Custom tray, border molded – not felt extraorally

– External oblique ridge sometimes prominent – do not cover – painful

C. Labial/Buccal vestibule

Easy to overextend

– Check with minimal manipulation of lips

– Masseter – affects distobuccal border

– If more prominent – concave border of denture

D. Frena

– Labial and buccal frena – narrow and wide respectively

– Lingual frenum – must allow for movement – or displaces easily

E. Retromylohyoid fossa

– Need to capture – especially when there is a severely resorbed ridge

– Mylohyoid muscle – raises floor of mouth during activity – in some cases there may be large differences between level at rest and level when active

– Affects length of flange.

– Mylohyoid ridge – palpate – if prominent, it will probably require relief

F. Tori

– Rarely need surgery unless large

– May require relief once dentures are delivered – advise patient

G. Genial tubercles

– Bony insertion for the genioglossus muscle

– May be projecting above the residual ridge if there has been severe resorption.

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Category: Dental, Prosthodontics

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