PATIENT VISIT 3

Clinical Procedures

1. Objectives
a. To develop the posterior palatal seal.
b. To contour the occlusion rims and establish the plane of occlusion.
c. To establish the face-bow transfer record.
d. To determine the vertical relation of rest position and occlusion.
e. To record centric relation.
f. To select the artificial teeth.

2. Instruments and materials
a. Patient's chart
b. Gloves, mask, and eye protection for patient and student/dentist
c. Radiographs
d. Water bath heated to 140 degree F (60 degree C)
g. Hanau torch and matches
h. Master casts with stable record bases and wax occlusion rims
i. Straight handpiece
j. Assortment of acrylic burs and stones
k. Baseplate wax, pink, 1 sheet
l. Face-bow
m. Fox occlusal plane
n. Mouth mirror and periodontal probe
o. 2 Tongue depressor
p. Gauze sponges - 2x2
q. "T" burnisher
r. Knife, B.P. No. 6 with sharp No. 25 blade
t. Stick compound - 1 green
u. Spatula, No. 7, 31 and Cottrell
v. Spatula (rubber base spatula)
x. Carver, Roach and discoid/cleoid
y. Indelible marker, disposable, available in clinic
z. Bite registration paste
aa. Mixing pad
bb. Spatula, cement
cc. Pencil
dd. Vaseline
ee. Dental floss

3. Preparation
a. Properly disinfect the assigned operatory and obtain starting check.
b. Have all instruments and materials ready before the patient's arrival.
c. Seat the patient in an upright position and protect the patient's clothing with a napkin.

4. Procedures for this appointment:
a. Locate the proper distal length of the maxillary denture and create the posterior palatal seal.
b. Create the tentative plane of occlusion by first determining the proper length of the maxillary anterior teeth.
c. Mount the maxillary anterior teeth with a face-bow
d. Determine the vertical relation of occlusion
e. Record the centric relation of occlusion
f. Mount the mandibular cast
g. Select the artificial teeth.
    Note: Steps a, b, c are completed using the maxillary record base is necessary.

5. Definitions:

Posterior palatal seal area - The soft tissues along the junction of the hard and soft palates which can be displaced by pressure by a denture to aid in the retention of the denture.

Posterior palatal seal - The seal at the posterior border of the maxillary denture produced by displacing the palatal tissue by scraping a groove in the master cast.

Plane of occlusion - An imaginary surface which is related anatomically to the incisors and tips of the occluding surfaces of the posterior teeth.  In complete denture prosthodontics, this plane is parallel to Camper's line, a line running from the inferior border of the ala of the nose to the superior border of the tragus of the ear.

Physiologic rest position -  The habitual postural position of the mandible when the patient is resting in an upright position and the condyles are in a neutral, unstrained position in the glenoid fossae.

Vertical relation at rest position -  The length of the face when the mandible is in the physiologic rest position.  The wax rims should not touch.

Vertical dimension of occlusion - The distance measured between two points when the occluding members (upper and lower Occlusion rims) are in contact. It is about 2-3mm less than Vertical Relation at Rest Position.

Centric relation record - A registration of the relationship of the maxilla and the mandible in centric relation made at the established vertical relation of occlusion.

Camper's plane - A plane established by the inferior border of the right or left ala of the nose and the superior border of the tragus of both ears.