Removable prosthetics workflow 1/7 – First clinical appointment - YouTube

This video shows you how to fabricate a complete denture according to the BPS concept.

Clinicians and dental technicians work hand in hand

to achieve functional and highly esthetic removable dentures.

The results are satisfied, loyal patients.

Subsequent adjustment appointments are very rarely necessary.

First appointment:

Examination, primary impressions and preliminary bite registration using the Centric Tray.

During the intraoral examination, examine and palpate the mucous membranes and the alveolar ridges.

Watch out for pathological changes and evaluate the general condition of the alveolar ridges,

including the degree of resorption.

Select a suitably sized tray.

Use callipers for this purpose.

Measure the largest vestibular extension of the alveolar ridge in the upper jaw.

In the lower jaw, measure the distance to the centre of the retromolar pad.

Now check the fit of the selected tray intraorally.

There should be approximately five millimetres space for the impression material

between the tray margin and the alveolar ridge.

The patient should be able to easily move her tongue in the lower jaw without pain.

Mix the impression materials according to the manufacturer’s instructions.

Fill the application syringe with low‐viscosity material.

Then load the tray with high‐viscosity material.

Make sure that you press the material through the retention holes of the tray well.

Use cold water to give the impression material a wedge‐shaped design,

so that you have more material in the anterior region and less in the posterior region.

Inject the low‐viscosity material into the mucolabial fold of the upper jaw.

Start behind the maxillary tuberosity.

Make sure that the lips and cheeks are sufficiently retracted during this working step.

Apply the last portion to the anterior palatal area.

Then rotate the tray into place.

First press it into place in the anterior region to keep the lip away.

Then rotate it slowly upwards towards the posterior region

until impression material escapes at the dorsal margin of the tray.

Stop applying pressure to the tray, but keep it in place until the material has set.

Once the impression material has set, carefully remove the impression.

Do not pull by the tray handle, but break the vacuum with your index finger in the area of the tuberosity.

This way you can detach the impression from the oral tissues.

The finished impression should be free from air bubbles and all the important anatomical details should be visible.

Remove any excess material in the posterior region.

Use a special pen to mark the distal limitation or A‐line.

This should enable you to transfer the line to the inserted impression.

You can additionally carve in the line with a scalpel.

These impressions are overextended.

For example: The extension of the individual trays should be 3 millimetres shorter

than the lowest part of the vestibulum.

Additionally, the extension should roughly correspond with the indicated red marking.

The impression of the lower jaw is taken in the same way as that of the upper jaw.

Apply the orange material, starting in the area of the retromolar pads.

Once the tray is in position, ask the patient to push her tongue forward as far as possible

and then to move it to the left and to the right.

After that, allow the material to set with her mouth slightly closed.

The finished impression should be free from air bubbles and all the important anatomical details should be visible.

Next, make a mark on the nose and on the chin of the patient to determine the maxillo‐mandibular relationship.

Ask the patient to wet her lips with her tongue,

then close them in a relaxed position and breathe out softly a few times.

Measure the distance between the markings and adjust the callipers accordingly.

You have now determined the physiological resting position.

Reduce the measured value by 3 millimetres “freeway space” to obtain the vertical dimension.

Try the Centric Tray in the patient’s mouth to check the available space.

If alginate is your preferred impression material for this step, its consistency should be quite thick.

This is achieved by mixing the powder with less water than specified by the manufacturer.

Alternatively, silicone putty can be used.

Apply the impression material to the Centric Tray:

Give it a slightly convex shape in the upper jaw.

In the lower jaw, create a shallow rim and shape it with the help of some cold water.

Rotate the Centric Tray into the mouth moving from top to bottom.

Position the rim on the lower alveolar ridge.

Ask the patient to close her mouth slowly until the distance measured with the callipers is attained.

Now ask the patient to swallow.

This will prevent strong protrusion of the lower jaw.

When using Centric Tray, there is no need to take complete impressions of the jaws.

Just make sure there is sufficient three‐point support,

so that the models can be articulated.