Full Denture Technique
The main indication for The Larell One Step Denture is for complete dentures for the edentulous patient. The processes for immediate dentures and implant overdentures are in other instruction pages. This section will address the complete dentures.
The first part of the process is to establish vertical dimension. This is accomplished in a standard fashion by having the patient stand or be seated straight up and swallow once or twice and then hold the jaw in a relaxed position. Reference marks are placed on the tip of the nose and chin. This distance is measured for later use. Alginate impressions of the jaw(s) are made and poured in quick set stone. There are five sizes of templates. The closest fitting template to the ridge form is chosen. The teeth should ideally be over the ridge as seen below. The template is placed into the boiling pot for about a minute. It will become malleable and can be fitted to the model. The palate will be done first, then the flanges including buccal and lingual
The flanges are then adjusted. Excess flange height is removed at this time. The template is ready to be tried in the mouth. The occlusal plane plate is put in place to determine the plane of occlusion (ala/tragal line) and pupillary line (Frankfort Horizontal). Vertical positioning of the teeth and anterior posterior positioning of the template are done visually. There should be 2-3 mm of space between the height of the flange and the height of the buccal fold. This allows sufficient room for the border molding process to ensure an adequate periphery of reline material. The posterior palatal edge is reduced top the level of the vibrating line.
Customization of template: movement of the posterior teeth for occlusion, characterization of the anterior teeth should be done at this time, prior to the custom chairside reline. The template is now ready for reline. This is accomplished in a standard method for a chairside reline. The thickness of the reline material should remain ideally at no more than 2 mm to allow for the best results.
Adhesive is applied to the intaglio surface of the template (provided with the reline material). It should extend about 2 mm over the edge of the flange onto the buccal surface for best adherence.
For the average reline, about 8 ml of monomer is used. If desired for a darker gingiva to match skin tone, tinting concentrate is added. Approximately 3 drops is added to the monomer prior to mixing. Add powder to the monomer until a smooth consistency is achieved, just to the point of not being runny. Mixing time is approximately 1 minute. The reline material is then placed into the template to fill the template. The template is placed into the mouth, positioned first for midline, second for occlusal plane (confirm with occlusal plane plate) and then check for esthetic look. Be sure to check the midline of the teeth to the lip to assure proper esthetics. You can move or manipulate the template as needed. Border molding is completed at this time. Setting time is 3-4 minutes. Once the exothermic reaction starts (patient will tell you the template is getting warm) it can safely be removed from the mouth. Excess material can be removed from the outside of the template at this time, either with scalpel, acrylic bur or grinding wheel on lathe.
Once the rough trim is completed the template is checked in the mouth for retention. The post dam is added at this time. A small amount of reline material is mixed. Using a cement spatula a small amount is placed on the spatula and placed across the posterior palatal border. Do not place this material in the hamular notches as it will affect retention. Allow the post dam to harden (hardening can be hastened by putting in cold water). The template is then checked again in the mouth.
Pressure indicating paste is used on the intaglio surface to assure no high spots. A thin layer is placed, the template is placed into the mouth, removed and checked for areas needing adjustment. Reduce those area and apply more paste only in those areas of reduction. This should be repeated as necessary until no high spots remain, typically 2 or 3 times. Articulating paper is used to check and balance the occlusion. The denture is now ready for final finishing and polishing. The video webinar demonstrates these techniques.
The process is repeated for the lower denture. The completed upper denture is in place. The lower template is tried in the mouth to establish occlusion with modification of widening or narrowing to obtain best occlusion achievable. The steps to prepare the template are the same as for the upper denture.