Completely edentulous patient was assigned and treatment planned for CD/CD. Maxillary and mandibular custom trays were fabricated initially using diagnostic casts. Imaged here is the mandibular final impression using a Polyether impression material after border molding with greenstick compound.
Maxillary master cast was poured after beading and boxing.
Wax rim fabricated for maxilla using anatomic averages for maxillary tooth position.
Mandibular wax rim fabricated using similar averages.
Initial jaw relations visit and mounting casts using facebow and CR record. Anterior positioning of the wax rim was adjusted to provide esthetics (i.e., lip support) and function (i.e., fricative sounds). CR record was taken here using Alluwax.
Here are the master casts without the wax rims. It is of note that the patient previously wore a set of immediate dentures which had an "edge to edge" occlusal scheme. After healing of the edentulous areas, however, it appeared more manageable to use Class I occlusion.
Initial tooth set-up oriented in Class I. At the tooth try-in visit, after CR position was taken, the position of the maxillary and mandibular canines were changed to reach a more harmonious occlusal plane. VDO/VDR was confirmed and posterior teeth were adjusted slightly to provide balanced occlusion.
These were the complete dentures received prior to delivery day from the laboratory. Although a nice image, both the maxillary and mandibular complete dentures needed to be adjusted to fit comfortably in the patient's mouth. Here, for example, the mandibular labial flange appears overextended. This was confirmed on the day of denture delivery using pressure indicating paste, and relief was made to give the vestibule and the labial frenum(s) room. One of my favorite parts of this case has been learning the clinical relevance of edentulous anatomy as it relates to removable dentures.
