Simplified clinical remount for complete dentures

Simplified

clinical

Izharul

Haque

Faculty

of Dentistry,

Ansari, Jordan

remount BDS,

for complete

dentures

MDS”

University

of Science

and Technology,

Irbid,

Jordan

Occlusal errors in new dentures can result from clinical errors and processing changes. Corrections must be made with the dentures in the patient’s mouth or by making new jaw relation records and correcting the occlusion on an articulator. The latter method is far more accurate because the dentures are seated on rigid bases, errors are more easily seen, and soft tissues and saliva do not interfere with selective grinding. This article describes a simple and quick clinical remount procedure using putty material. (J Prosthet Dent 1996;76:321-4.)

T

..

he chmcal remount is an important procedure in the delivery of complete dentures and it is used to establish an optimal occlusion. ‘-lo Changes in occlusion can occur because of processing errors, errors in mounting procedures, warpage of the recording bases, or loose mounting rings. Minor errors can be eliminated by selective adjustment while the dentures are in the patient’s mouth, if a split cast remount procedure was used immediately after the dentures were processed.11-16 However, in a survey of general dental practice, Harrison et a1.17 found that fewer than 5% of dentists use the split cast procedure to remove processing errors. The clinical remount procedure is also used by few practiti0ners.l Many practitioners believe that the dentures should be allowed to “settle in” before occlusal correction or that the occlusion should be adjusted at chairside in the mouth.1s-23 With this philosophy of allowing the dentures to settle in, the dentist surrenders control of occlusion. The denture bases will shift to accommodate occlusal interferences, which cause uneven pressure on the underlying tissues. The dentures will be unstable because of occlusal interferences. Intraoral occlusal adjustment is difficult because of the mobility of denture bases over resilient ridges and uneven tissue contact. Such corrections are less accurate than mounting the finished dentures in an articulator by means of a centric relation record and subsequent elimination of interceptive contacts.5, 24-26 Routine remounting of dentures requires making remount casts or blocking out undercuts and then mounting with quick-setting plaster. 14, 27 The purpose of this article is to provide a simplified mounting procedure that uses putty material and has these advantages: (1) dentures can be remounted without the necessity of making separate remount casts; (2) if the centric relation record is incorrect, the mandibular denture can be remounted quickly with a new centric relation record; (3) blocking out undercuts is not needed; (4) mounting can be performed at chairside aAssistant

SEPTEMBER

Professor,

1996

Department

of Prosthodontics.

ring (left), maxillary (middle), and manplates have been boxed (Aarrows) in divergent cylindrical form according to measurements shown in Figure 2. Resin tray material (B-arrows) has been filled in both boxed forms. Fig.

dibular

1.

Mounting

(right) mounting

with minimal cleanup; and (5) the putty material can be preserved as a record that can be used in a subsequent appointment if necessary. The putty material is expensive; however, the procedure is convenient and little material is required because most of the space in the articulator will be occupied by the maxillary and mandibular custommade mounting jigs (CMMJs).

PROCEDURE This clinical remount procedure requires the use of maxillary and mandibular CMMJs that are constructed over articulator mounting plates. They are made in advance and kept ready for use when required.

Construction

of CMMJs

1. Wrap boxing wax around the periphery of the maxillary and mandibular mounting plates (Fig. 1, arrow A) to form cups for holding the resin self-curing custom tray material (Formatray, Kerr Mfg. Co., Romulus, Mich.). 2. Trim the boxing wax for the maxillary mounting plate

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Fig. 4. Completed

4

/$0 1

maxillary (‘left) and mandibular (right) custom-made remounting jigs. Buccal and lingual undercuts have been made for anchorage of putty material in mounting dentures (arrows).

Fig. 2. Diagrammatic representation of Hanau articulator with attached maxillary and mandibular custom-made mounting jigs (CMMJ) with dimensions. U-shaped edentulous ridge, which is shown by ‘x”, should have vertical height of approximately 4 to 6 mm.

Fig. 5. Maxillary and mandibular CMMJ attached with Hanau articulator. Lower annular groove for alignment of incisal edges of maxillary denture in making face-bow transfer (A, arrow). Interridge space on articulator for mounting dentures (B).

Fig. 3. Roll of acrylic resin tray material of divergent cylinder to make U-shaped

is placed over top edentulous ridge.

so that it makes a l-inch high divergent cylinder with a 2.5 inch diameter at the opening (Fig. 2). 3. Pour a mix of resin self-curing custom tray material to fill the divergent cup (Fig. 1, B). 4. Similarly, trim the wax boxing for the mandibular mounting plate and fill with a mix of resin tray material to form a % inch high divergent cylinder with a 2% inch diameter at the top (Figs. 1 and 2). 5. Allow the tray material to set; remove the wax boxing and form a mix of resin tray material into two rolls and place over the surfaces of both maxillary and mandib-

322

ular divergent cylinders to form U-shaped edentulous ridges (Fig. 3). Trim the edentulous ridges to make buccal and lingual undercuts (Fig. 4, arrows) and adjust the vertical height of the ridges to 4 to 6 mm (Fig. 2, X). (These undercuts will provide anchorage for the putty material during mounting of the dentures.) Finish and polish the maxillary and mandibular custom mounting jigs (Figs. 4 and 5).

Mounting

the dentures

1. In the mouth, check the intaglio surface of each denture with pressure-indicating pastes or waxes24’ 25 and make the appropriate corrections. 2. Make a centric relation interocclusal record with a soft medium such as warm Alminax (Kern-Dent Works, Wiltshire, England) or Aluwax wax (Aluwax Dental Products, Grand Rapids, Mich.) to ensure closure without contact of the denture teeth or bases.

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Fig. rial.

6. Mandibular

denture

mounted

with

putty

mate-

3. Secure the maxillary and mandibular CMMJs in the articulator (Fig. 5). 4. Place high-viscosity elastomer (putty material) (Coe Speedtray, Coe Laboratories, Inc., Chicago, Ill., or Citricon, Kerr Mfg. Co.) over the mandibular CMMJ and position the mandibular denture on it (Fig. 6). 5. Secure the maxillary denture in the centric interocclusal record, place the putty material in the denture, and close the upper member of the articulator into the putty material (Fig. 7). 6. After the material has set, open the articulator and remove the interocclusal record. The putty material serves as remount casts. 7. Close the denture onto articulating paper (Busch and Co., Gmbh Co. KG, Engelskirchen, Germany) and adjust the occlusion (Fig. 8).

DISCUSSION The clinical remount is an important step for correcting laboratory and clinical errors in occlusion and for establishing an occlusion that ensures even pressure in all areas of the arch. The clinical remount also maintains the stability of dentures when the mandible is in centric position. For the purpose of illustration a Hanau semiadjustable articulator was used. The measurements shown in Figure 2 are based on the author’s experience that making a l-inch high maxillary CMMJ and a U inch high mandibular CMMJ leaves sufficient interridge space (Fig. 5, B) on the articulator to accommodate almost any denture without interference.

SUMMARY Intraoral occlusal adjustment may be quicker often less accurate than registering a centric record and remounting the dentures. This article a simplified clinical remount procedure that uses cosity elastomer (putty material). This procedure easily adopted in a routine dental practice.

SEPTEMBER

1996

but it is relation presents high-viscan be

Fig.

7. Mounting

maxillary

OF PROSTHETIC

denture

Fig. 8. Articulating paper interposed and mandibular dentures.

DENTISTRY

with putty material.

between

maxillary

REFERENCES 1. Firtell DN, Finzen FC, Holmes JB. The effect of clinical remount procedures on the comfort and success of complete dentures. J Prosthet Dent 1987;57:53-7. 2. Friedman S. A comparative analysis of conflicting factors in the selection of the occlusal pattern for edentulous patients. J Prosthet Dent 1964;14:30-44. 3. Kotwal KR. The need to use an arbitrary face-bow when remounting complete dentures with interocclusal records. J Prosthet Dent 1979; 42~224-7. 4. Holt JE. Research on remounting procedures. J Prosthet Dent 1977; 38:338-41. 5. Lytle RB. Complete denture construction based on a study of the deformation of the underlying soft tissues. J Prosthet Dent 1959;9:539-51. 6. Woelfel JB. Processing complete dentures. Dent Clin North Am 1977; 21:329-38. 7. Friedman S. An effective pattern of occlusion in complete artificial dentures. J Prosthet Dent 1951;1:402-13. 8. Brudvik JS, Wormley JH. A method of developing monoplane occlusions. J Prosthet Dent 1968;19:573-80. 9. Hall WA Jr. Important factors in adequate denture occlusion. J Prosthet Dent 1958;8:764-75. 10. Ortman HR. Complete denture occlusion. Dent Clin North Am 1977; 21:299-320. 11. Kyes FM. The laboratory’s role in successful full dentures. J Prosthet Dent 1951;1:196-203.

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12. G&l DH, Dresen OM. Complete denture prosthesis. 4th ed. Philadelphia: WB Saunders; 1958:327-g. 13. Heartwell CM, Rohn AO. Syllabus of complete dentures. Philadelphia: Lea & Febiger; 1968:324-34. 14. Hickey JC. Zarb GA. Boucher’s prosthodontic treatment for edentulous patients. 8th ed. St Louis: CV Mosby; 1980:455-79. 15. Sherman H. Denture insertion. Dent Clin North Am 1977;21:339-57. 16. Sidhaye AB, Master JB. Efficacy of remount procedures using masticatory performance tests. J Prosthet Dent 1979;41:129-33. 17. Harrison A, Huggett R, Murphy WM. Complete denture construction in general dental practice: an update of the 1970 survey. Br Dent J 1990;169:159-63, 18. Jones PM. Eleven aids for better complete dentures. J Prosthet Dent 1962:12:220-S. 19. Young HA. Denture insertion. J Am Dent Assoc 1962;64:505-11. 20. Jankelson B. Adjustment of dentures at time of insertion and alterations to compensate for tissue change. J Am Dent Assoc 1962;64:52131. 21. Gronas DG, Stout CJ. Lineal occlusion concepts for complete dentures. J Prosthet Dent 1974;32:122-9. 22. Samant A, McDermott I, Cinotti WR. Delivery of complete dentures: preventing problems after insertion. Gen Dent 1984;32:229-31.

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23. Watt DM, MacGregor AR. Designing complete dentures. 2nd ed. Bristol, England: Wright; 1986:193-5. 24. Heartwell CM, Rabn AO. Syllabus of complete dentures. 4th ed. Philadelphia: Lea & Febiger, 1986:395-400. 25. Boucher CO, Hickey JC, Zarb GA. Prosthodontic treatment for edentulous patients. 7th ed. St Louis: CV Mosby; 1975:464-70. 26. Sharry JJ. Complete denture prosthodontics. 3rd ed. New York: McGraw-Hill; 1974:276-83. 27. Ansari IH. A procedure for making remount casts without blocking out undercuts. J Prosthet Dent 1993;70:482.

Reprint requests to: DR. IZHARUL HAQUE ANSARI FACULJIY OF DENTISTRY JORDAN UNIVERSITY OF SCIENCE AND TECHNOLOGY IRBID JORDAN

Copyright 0 1996 by The Editorial Prosthetic Dentistry. 0022-3913/96/$5.00 + 0. 10/l/74627

Council of The Jo~maZ of

Reverse torque failure of screw-shape implants in baboons: baseline data for abutment torque application. Carr AD, Larsen PE, Papazoglou E, McGlumphy E. Int J Oral Maxillofac Implants 1995;10:167-74. Purpose. Screw-retained implant-supported prostheses have the advantage of retrievability in contrast to conventional fixed prostheses where restoration retrieval is difficult, if not impossible. Insertion and removal of implant prosthesis components may transmit force to the implant bone interface as optimal clamping forces are obtained. This study determined torque resistance of implants placed in baboon jaws for 3- to 4-month healing periods to determine whether the repeated insertion and removal of prosthetic components has the potential to harm the osseointegration process. Material and Methods. Six adult female baboons were used in this study. All posterior teeth were removed 2 months before implant placement. Human implant surgical protocols were used to place six implants in each edentulous quadrant. Alternating placement of commercially pure titanium, Ti-6Al-4V, and hydroxyapatite coded Ti-6Al-4V screw-shaped Sterio-Oss implants ensured biomaterial-jaw location variability. Animals were killed 3 to 4 months after implant placement. A computerized torque driver was used to apply counterclockwise torque to the implant until slip occurred. The torsional force required to induce slippage was recorded and analyzed. Results. Torque to failure values in the mandible were higher than the values in the maxilla, but large SDS were seen for both jaws, preventing the establishment of a statistically significant difference for the results in the mandible or maxilla. The torque values were greatest for hydroxyapatite coded implants (hydroxyapatite 186.29 N/cm, Ti-6Al-4V 79.03 N/cm, commercially pure titanium 74.51 N/cm). Statistical analysis demonstrated significant (p < 0.01) differences for coated and noncoated implants. Conclusions. Connection of prosthetic components to endosseous implants requires the establishment of a preload that will resist screw loosening during function. Abutment fastening torque of 35 N/cm as recommended by implant manufacturers is capable of being resisted by the implant-tissue interface, as demonstrated in this study. Data in this study are described as possibly being more valid than those of previous studies because of the use of a primate model, the use of a torque test rather than a pull-out test, and the use of intraoral implant locations, 26 References.-SE Eckert

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