Textbook of Complete Dentures, 6th Edition

465 Pages·2009·19.97 MB·English

by  Arthur O. Rahn

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Textbook of
Complete Dentures
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SIXTH EDITION
Textbook of
Complete Dentures
Arthur O. Rahn
Professor Emeritus
Department of Oral Rehabilitation
Medical College of Georgia
School of Dentistry
Augusta, Georgia
John R. Ivanhoe
Professor Emeritus
Department of Oral Rehabilitation
Medical College of Georgia
School of Dentistry
Augusta, Georgia
Kevin D. Plummer
Associate Professor
Section Director of Removable Prosthodontics
Department of Oral Rehabilitation
Medical College of Georgia
School of Dentistry
Augusta, Georgia
2009
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Notice: The authors and publisher have made every effort to ensure that the patient care recommended herein, includ-
ing choice of drugs and drug dosages, is in accord with the accepted standard and practice at the time of publication.
However, since research and regulation constantly change clinical standards, the reader is urged to check the product
information sheet included in the package of each drug, which includes recommended doses, warnings, and
contraindications. This is particularly important with new or infrequently used drugs. Any treatment regimen, particu-
larly one involving medication, involves inherent risk that must be weighed on a case-by-case basis against the benefits
anticipated. The reader is cautioned that the purpose of this book is to inform and enlighten; the information
contained herein is not intended as, and should not be employed as, a substitute for individual diagnosis and treatment.
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This book is dedicated with love
This textbook is dedicated to all students of the clinical practice of complete denture
prosthodontics. The rehabilitation of completely edentulous patients requires skill,
compassion and perseverance in order to arrive at a point that improves a patient’s life
both in social situations and in healthy dietary function. The “basics” are so truly impor-
tant when other options might fail and the editors and authors have strived to put those
“basics” at your finger tips in this book. We hope that this textbook will improve your
ability to provide solid care for the complete denture patients in your practice.
This book was the work of many individuals and the original concept was built on
Dr. Arthur Rahn’s work over many years. His dedication to the dental profession and
the education of dental students is renowned and was the inspiration to the new editors
to undertake this project. His advice and friendship is greatly appreciated.
Sadly my co-editor, Dr. John Ivanhoe passed away shortly after the manuscript was
finished and he will not get to see the textbook in production. During this project,
John’s enthusiastic spirit kept all of those involved excited and hopeful that this textbook
would be a reference helpful to both dental students and practitioners providing those
skills so important in complete denture prosthodontics. He is missed as a colleague and
most importantly as a close friend. His sweet wife Alice supported John in all of his work
and I’m sure John would give her credit for her inspiration to him during all their time
together.
I would like to acknowledge my friends who are authors of the various chapters for their
time and effort to support this project. We all know this type of work is a labor of love
for dental education. Of course, as always, my wife Connie keeps me on track and
provides the support and loving family life that sustains me in all I do.
And thanks to you—students of the dental profession
Kevin D. Plummer
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Contents
C h a p t e r 1
Introduction and Definitions 1
Introduction 2
Definitions 3
C h a p t e r 2
Dental Materials for Complete Dentures 7
Denture Base Materials 8
Resin-Based Dentures (Heat- and Auto-Polymerized Materials) 8
Metal-Based Dentures 10
Denture Teeth 10
Tooth Retention 10
Porcelain Teeth 10
Polymer (Plastic) Teeth 11
Denture Liners 11
Chairside Reline Materials 12
Laboratory Reline Materials 13
Denture Tissue Conditioners 13
Denture Repair 14
Impression Materials 14
Alginate Hydrocolloid 14
Polyvinyl Siloxane (PVS) and Polyether (PE) 15
Dental Stones 16
Types of Stones 17
Interocclusal Registration Materials 17
Registration Materials 17
Dental Waxes 18
vii
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viii Contents
Denture Cleansers 18
Abrasive Cleansers 19
Solution Cleaners: Hypochlorites, Ozygenating Agents, Mild Acids 19
Denture Adhesives 20
Powder-Based Products 20
Paste-Based Products 21
C h a p t e r 3
Anatomy of the Edentulous Ridges 25
Extraoral Features 26
Structures of the Facial Vestibules 27
Alveolar (Residual) Ridges 29
Maxillary Arch 30
Mandibular Arch 34
C h a p t e r 4
Diagnosis and Treatment Planning 45
Diagnosis 46
Medical History 46
Present Medical Condition 47
Dental History 48
Clinical Extraoral Examination 48
Intraoral Examination 51
Mental Attitude of Patient 57
Additional Diagnostic Information 58
Treatment Planning 60
Prognosis 61
C h a p t e r 5
Pre-prosthetic Surgical Considerations 65
Patient Evaluation and Expectations 66
Treatment Planning 67
Review of Flaps 67
Commonly Used Preprosthetic Procedures 68
Ridge Alveoloplasty with Extraction 68
Intraseptal Alveoloplasty 69
Edentulous Ridge Alveoloplasty 70
Buccal Exostosis 71
Maxillary Tuberosity Reductions 72
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Contents ix
Mandibular Tori 72
Maxillary Tori 75
Mylohyoid Ridge Reduction 76
Genial Tubercle Reduction 77
Soft Tissue Procedures 77
Maxillary Soft Tissue Tuberosity Reduction 78
Maxillary Labial Frenectomy 78
Excision of Redundant/Hypermobile Tissue Overlying the Tuberosities 80
Excision of Inflammatory Fibrous Hyperplasia (Epulis Fissuratum) 80
Inflammatory Papillary Hyperplasia of the Palate 81
Surgical Guides (Templates) 82
C h a p t e r 6
Preliminary Impressions, Diagnostic Casts,
and Custom (Final) Impression Trays 85
Making the Preliminary Impressions 87
Pouring the Diagnostic Casts 94
Shaping the Diagnostic Casts 95
Custom (Final) Impression Trays 97
Custom Impression Tray Extensions 97
Impression Philosophies as Related to Tray Fabrication 98
The Selective Pressure Impression Tray and Stress-Bearing Areas 99
Block Out and Relief Wax 99
Fabrication of the Impression Tray 101
C h a p t e r 7
Final Impressions and Creating the Master Casts 105
Proper Custom Impression Tray Extension 107
Border Molding 113
Border Molding with Modeling Compound 116
Border Molding the Maxillary Arch 117
Border Molding the Mandibular Arch 118
Preparing the Tray for the Impression 119
Making the Final Impression 120
Posterior Palatal Seal Area 122
Creating the Master Cast 122
C h a p t e r 8
Record Bases and Occlusion Rims 131
Record Base Fabrication 132
Occlusion Rim Fabrication 136