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1、UnitThirtyFour COMPLETEDENTURE Whensomeonelosesallhisteeth(becomesedentulous),healsolosessomeoftheabilitytoperformcertainaclivities-eating,speaking,facialexpression-andhisappearanceisimpaired.Hisappearanceisimpairednotonlybythelossoftheteeththemselvesbutalsobecauseofthelossofsupportforthefacialtis

2、sueslyingoverthem.Whentheteetharelost,someofthesupportingthemboneresorbs.Theartificialsubstitutes-completesdentures-mustnotonlyreplacethelostteethandlostsupportingboneandsofttissue,butalsorestoretheimpairedfunctionsandappearance. ClinicalstageI. Historyandexamination Clinicalstage2. Primaryimpre

3、ssions. Objectives:Toobtainanimpressionofthewholeofthedenture-supportingareaofeachjaw;torecordthefullextentofthesulcus;toobtainanimpressioninwhichcertainlandmarksontheedentulousjawsarcrecorded. Byachievingtheseobjectivesamodelcanbeobtaineduponwhichacorrectlydesignedtraymaybeconstructedinordertomak

4、ethesecondaryimpression.Furthermore,onlyimpressioncompoundhasthecorrectpropertiesofconsistencyandabilitytobemanipulatewhicharenecessaryinaprimaryimpressionmaterial. LaboratoryproceduresI Thepreparationforthevisitatwhichthesecondaryimpressionswillbemadeinvolvestheconstructionofcastsfromtheprimaryim

5、pressionsandtheconstructionofspecialtraysonthesecasts. Clinicalstage2(continued) Secondaryimpressions Objective:toobtainanimpressionfromwhicharetentivedenturebasecanbeconstructed. Thedenturebaseshouldsatisfythefollowingrequirements: 1. Itmustbeextendeduntilitsborderliesondisplaceabletissuewhere

6、asealcanbedeveloped. 2. Thetissueadjacenttothebordershouldbedeformedenoughtoachieveasealbutnotsomuchthattheytendtodisplacethedentureorsufferinjury.Musclesrelatedtothebordermustnotbepreventedfromfreeactivity. 3. Itshouldhavetheclosestpossiblecontactwiththesurfaceorthemucousmembranelyingbeneathit.

7、4. Extensiontoprovideretentionensuresthemaximumcoverageofthejaw,andthisinturnensuresthatthemininiuniforceperunitareaistransmittedtothesupportingtissuesbythedentureduringfunction. TheadventofVinyl-polysiloxaneoffersanalternativematerialforupperandlowerimpressions.Itisofsuitableconsistencyandgivesane

8、xcellentsurfacelothecastanddentures.Polyethermaterialsarealsoused. Laboratoryprocedures2 Atthisstagethepermanentbasesaremadeandwaxocclusionrimsareaddedtotheminpreparationforthenextclinicalstepofrecordingthejawrelation. Clinicalstage3 i)Chcckingretentionofthebasespriorto establishingjawrelations

9、hips 2) Establishingjawrelationshipswithpermanentbases. Objectives 1. Toaccuratelyrecordcentricjawrelationship. 2. Totakeafacebowrecordtoenablethebaseplateandocclusionrimstobepositionedinthearticulatorsothattheirrelationshiptotherotationalaxesofthearticulatoristhesameastherelationshiptheywillbea

10、rtotherotationalaxesofthemandiblewhentheyarcinthemouth. Procedure Assessthelipsupport Measuretherestverticaldimension Establishtheocclusalverticaldimension Recordthecentricjawrelationship Methods,whichmaybeusedtoassistthepatientinclosingtoaretruded,position. 3) Protrusiverecord Whenapalientp

11、rotrudesthelowerjaw(hecondylesbothmoveforwardanddownward,guidedbytheformofthearticularfossae.Thedownwardmovementsofthecondylesresultinasimilardownwardof(helowermolarregion.Theprotrusiverecordmeasures(heamountoflhedrop.Withitthearticulatorisadjustedsothatitwillproduceasimilaramountofdropwhenasimilara

12、mountofprotrusionisused.Theteethonthedenturecanthenbearrangedsothatcontactbetweentheposteriorteethismaintainedinprotrusion(protrusivebalance). 4) Thefacebowrecord 5) Selectionofteeth. Tochooseartificialteethwhoseformandcolourwillharmonizewiththepatient'sfcaturccs. Laboratoryprocedures3 1) Addin

13、gthepost-damtotheupperdenturebase. 2) Mounting(hebaseplatesandocclusionrims. 3) Selectingposteriorteeth. 4) Settingtheteeth. Clinicalstage4 Thetrialdentures Tocheckthat(hearrangementofthe(ee(hissuchthatspeechandmasticationwillberestoredandtoensurethatapleasingappearanceisobtained. Laboratoryp

14、rocedure4 Atthisstagetheprotrusiverecordisusedtosetthecondylartrackanglesandthentheocclusionisadjustedtoprovidebalanceineccentricpositions.Followingthiswaxsurfacesarecontoured,thedenturesareinvestedinaflask,andlhewaxisremovedandreplacedbyacrylicresin. 1) Settingthecondylartrackangles 2) Developin

15、gthelateralandprotrusiveocclusions. 3) Contouringandfinishingthewaxsurfaces. 4) Processingdentures. Clinicalstage5 Insertingthecompleteddentures. Objective. 1) Tochecktheretentionandtheaccuracyofthejawrelationsofthecompleteddentures,andtoadjustwherenecessary. 2) Toinstructthepatientsin(hecor

16、rectuseoftheirdentures. 3) Toadvisethepatientsonthepropercareoftheirdenturesandofthedenture-supportingtissues. 4) Toadvisethemonthelimitationstobeexpectedofartificialdentures. Laboratoryprocedures5 Alteracheckcentricjawrelationshiprecordhasbeentaken,(helowerdenturemustberemountedinthearticulator

17、,andadjustmentofthecentricandeccentricocclusionsmade. 1) Remounting 2) Reformingcentriclateralandprotrusiveocclusions. Clinicalstage6 Adjustmentofdentures 1) Useofdisclosingwax(ontheborder)andpressurereliefcream(onthefittingsurface). 2) SubsequentvisitsVOCABUL/XRY 1. artificialsubstitutedentu

18、re-supportingarea 2. sulcuslandmark 3. edentulousjawmodel 4. trayprimaryimpression 5. secondaryimpressioncompound 6. bordersealfreeactivity 7. trialdenturebalanceineccentivepositions 8. investedflaskprocessingdenture 9. remountedpost-dam 10. reformingdisclosingwax 11. pressurereliefcreamfi

19、ttingsurface 12. retentionpermanentbase 13. waxocclusionrimestablishingjawrelationship 人工替代物義齒承托區(qū)（間隙）溝標(biāo)志無(wú)牙頜模型托盤(pán)初印模二次印模印模膏邊緣封閉自由活動(dòng)試牙非正中平衡裝盒義齒熱處理重新上合架后堤糾正指示蠟壓力顯示糊組織面固位恒基托蠟咬合堤建立咬合關(guān)系正中合關(guān)系 14. centricjawrelationshipfacebowrecord 15. articulatorrotationalaxes 16. restverticaldimensionocclusalverticaldimension 17. articularfossaeprotrusivebalance 面弓記錄 合架 旋轉(zhuǎn)軸 休息位垂直距離咬合位垂直距離關(guān)節(jié)窩 前伸合平衡 人工牙 18. artificialteeth