The mental attitude of patients towards complete dentures plays a significant role in the success of their treatment. Understanding these attitudes can help dental professionals tailor their approach to meet the needs and expectations of their patients. Here are the four primary mental attitudes that patients may exhibit:

1. Philosophical (Ideal Attitude)

• Characteristics:
  • Accepts the dentist's judgment without question.
  • Exhibits a rational, sensible, calm, and composed disposition.
  • Open to discussing treatment options and understands the importance of oral health.
• Implications for Treatment:
  • This type of patient is likely to follow the dentist's recommendations and cooperate throughout the treatment process.
  • They are more likely to have realistic expectations and be satisfied with the outcomes.

2. Indifferent

• Characteristics:
  • Shows little concern for their oral health.
  • Seeks treatment primarily due to pressure from family or friends.
  • Requires additional time and education to understand the importance of dental care.
  • Their attitude can be discouraging to dentists, as they may not fully engage in the treatment process.
• Implications for Treatment:
  • Dentists may need to invest extra effort in educating these patients about the benefits of complete dentures and the importance of oral health.
  • Building rapport and trust is essential to encourage a more proactive attitude towards treatment.

3. Critical/Exacting

• Characteristics:
  • Has previously had multiple sets of complete dentures and tends to find fault with everything.
  • Often has high expectations and may be overly critical of the treatment process.
  • May require medical consultation due to previous experiences or health concerns.
• Implications for Treatment:
  • Dentists should be prepared to address specific concerns and provide detailed explanations about the treatment plan.
  • It is important to manage expectations and ensure that the patient understands the limitations and possibilities of denture treatment.

4. Skeptical/Hysterical

• Characteristics:
  • Has had negative experiences with previous treatments, leading to doubt and skepticism about the current treatment.
  • Often presents with poor oral health, resorbed ridges, and other unfavorable conditions.
  • May exhibit anxiety or hysteria regarding dental procedures.
• Implications for Treatment:
  • Building trust and confidence is crucial for these patients. Dentists should take the time to listen to their concerns and provide reassurance.
  • A gentle and empathetic approach is necessary to help alleviate fears and encourage cooperation.
  • It may be beneficial to involve them in the decision-making process to empower them and reduce anxiety.

Impression making is a critical step in prosthodontics and orthodontics, as it captures the details of the oral cavity for the fabrication of dental prostheses. There are several techniques for making impressions, each with its own principles and applications. Here, we will discuss three primary impression-making techniques: Mucostatic, Mucocompressive, and Selective Pressure Impression Techniques.

1. Mucostatic or Passive Impression Technique

• Proposed by: Richardson and Henry Page
• Materials Used: Plaster of Paris and Alginate
• Key Features:
  • Relaxed Condition: Records the oral mucous membrane and jaws in a normal, relaxed condition.
  • Tray Design: Utilizes an oversized tray to accommodate the relaxed tissues.
  • Tissue Contact: Achieves intimate contact of the tissues with the denture base, which enhances stability.
  • Peripheral Seal: This technique has a poor peripheral seal, which can affect retention.
  • Outcome: The resulting denture will have good stability but poor retention due to the lack of a proper seal.

2. Mucocompressive Impression Technique

• Proposed by: Carole Jones
• Materials Used: Impression compound and Zinc Oxide Eugenol (ZoE)
• Key Features:
  • Functional Recording: Records the oral tissues in a functional and displaced form, capturing the active state of the tissues.
  • Retention: Provides good retention due to the compression of the tissues during the impression process.
  • Displacement Issues: Dentures made using this technique may tend to get displaced due to tissue rebound when the tissues return to their resting state after the impression is taken.

3. Selective Pressure Impression Technique

• Proposed by: Boucher
• Materials Used: Special tray with Zinc Oxide Eugenol (ZoE) wash impression
• Key Features:
  • Stress Distribution: Loads acting on the denture are transmitted to the stress-bearing areas of the oral tissues.
  • Tray Design: A special tray is designed such that the tissues contacted by the tray are recorded under pressure, while the tissues not contacted by the tray are recorded in a state of rest.
  • Balanced Recording: This technique allows for a more balanced impression, capturing both the functional and relaxed states of the oral tissues.

Complete Denture Occlusion

Complete denture occlusion is a critical aspect of prosthodontics, as it affects the function, stability, and comfort of the dentures. There are three primary types of occlusion used in complete dentures: Balanced Occlusion, Monoplane Occlusion, and Lingualized Occlusion. Each type has its own characteristics and applications.

Types of Complete Denture Occlusion

1. Balanced Occlusion

• Definition: Balanced occlusion is characterized by simultaneous contact of all opposing teeth in centric occlusion, providing stability and even distribution of occlusal forces.
• Key Features:
  • Three-Point Contact: While a three-point contact (one anterior and two posterior) is a starting point, it is not sufficient for true balanced occlusion. Instead, there should be simultaneous contact of all teeth.
  • Minimal Occlusal Balance: For minimal occlusal balance, there should be at least three points of contact on the occlusal plane. The more points of contact, the better the balance.
  • Absence in Natural Dentition: Balanced occlusion is not typically found in natural dentition; it is a concept specifically applied to complete dentures to enhance stability during function.
• Importance: This type of occlusion is particularly important for patients with complete dentures, as it helps to minimize tipping and movement of the dentures during chewing and speaking.

2. Monoplane Occlusion

• Definition: Monoplane occlusion involves a flat occlusal plane where the occlusal surfaces of the teeth are arranged in a single plane.
• Key Features:
  • Flat Occlusal Plane: The occlusal surfaces are designed to be flat, which simplifies the occlusion and reduces the complexity of the denture design.
  • Limited Interference: This type of occlusion minimizes interferences during lateral and protrusive movements, making it easier for patients to adapt to their dentures.
• Applications: Monoplane occlusion is often used in cases where the residual ridge is severely resorbed or in patients with limited jaw movements.

3. Lingualized Occlusion

• Definition: Lingualized occlusion is characterized by the positioning of the maxillary posterior teeth in a way that they occlude with the mandibular posterior teeth, with the buccal cusps of the mandibular teeth being positioned more towards the buccal side.
• Key Features:
  • Maxillary Teeth Positioning: The maxillary posterior teeth are positioned more towards the center of the arch, while the mandibular posterior teeth are positioned buccally.
  • Functional Balance: This arrangement allows for better functional balance and stability during chewing, as the maxillary teeth provide support to the mandibular teeth.
• Advantages: Lingualized occlusion can enhance the esthetics and function of complete dentures, particularly in patients with a well-defined ridge.

Kennedy's Classification is a system used in dentistry to categorize the edentulous spaces (areas without teeth) in the mouth of a patient who is fully or partially edentulous. This classification system helps in planning the treatment, designing the dentures, and predicting the outcomes of denture therapy. It was developed by Dr. Edward Kennedy in 1925 and is widely used by dental professionals.

The classification is based on the relationship between the remaining teeth, the residual alveolar ridge, and the movable tissues of the oral cavity. It is particularly useful for patients who are wearing or will be wearing complete or partial dentures.

There are four main classes of Kennedy's Classification:

1. Class I: In this class, the patient has a bilateral edentulous area with no remaining teeth on either side of the arch. This means that the patient has a full denture on the upper and lower jaws with no natural tooth support.

2. Class II: The patient has a unilateral edentulous area with natural teeth remaining only on one side of the arch. This could be either the upper or lower jaw. The edentulous side has a complete denture that is supported by the teeth on the opposite side and the buccal (cheek) and lingual (tongue) tissues.

3. Class III: There is a unilateral edentulous area with natural teeth remaining on both sides of the arch, but the edentulous area does not include the anterior (front) teeth. This means the patient has a partial denture on one side of the arch, with the rest of the teeth acting as support for the denture.

4. Class IV: The patient has a unilateral edentulous area with natural teeth remaining only on the anterior region of the edentulous side. The posterior (back) section of the same side is missing, and there may or may not be teeth on the opposite side. This situation requires careful consideration for the design of the partial denture to ensure stability and retention.

Each class is further divided into subcategories (A, B, and C) to account for variations in the amount of remaining bone support and the presence or absence of undercuts, which are areas where the bone curves inward and can affect the stability of the denture.

- Class I (A, B, C): Variations in the amount of bone support and presence of undercuts in the fully edentulous arches.
- Class II (A, B, C): Variations in the amount of bone support and presence of undercuts in the edentulous area with natural teeth on the opposite side.
- Class III (A, B, C): Variations in the amount of bone support and presence of undercuts in the edentulous area with natural teeth on the same side, but not in the anterior region.
- Class IV (A, B, C): Variations in the amount of bone support and presence of undercuts in the edentulous area with natural teeth remaining only in the anterior region of the edentulous side.

Understanding a patient's Kennedy's Classification helps dentists and dental technicians to create well-fitting and functional dentures, which are crucial for the patient's comfort, speech, chewing ability, and overall oral health.

Arrangement of Teeth in Complete Dentures

The arrangement of teeth in complete dentures is a critical aspect of prosthodontics that affects both the function and aesthetics of the prosthesis. The following five principal factors must be considered when arranging teeth for complete dentures:

1. Position of the Arch

• Definition: The position of the arch refers to the spatial relationship of the maxillary and mandibular dental arches.
• Considerations:
  • The relationship between the arches should be established based on the patient's occlusal plane and the anatomical landmarks of the residual ridges.
  • Proper positioning ensures that the dentures fit well and function effectively during mastication and speech.
  • The arch position also influences the overall balance and stability of the denture.

2. Contour of the Arch

• Definition: The contour of the arch refers to the shape and curvature of the dental arch.
• Considerations:
  • The contour should mimic the natural curvature of the dental arch to provide a comfortable fit and proper occlusion.
  • The arch contour affects the positioning of the teeth, ensuring that they align properly with the opposing arch.
  • A well-contoured arch enhances the esthetics and function of the denture, allowing for effective chewing and speaking.

3. Orientation of the Plane

• Definition: The orientation of the plane refers to the angulation of the occlusal plane in relation to the horizontal and vertical planes.
• Considerations:
  • The occlusal plane should be oriented to facilitate proper occlusion and function, taking into account the patient's facial features and anatomical landmarks.
  • The orientation affects the alignment of the teeth and their relationship to the surrounding soft tissues.
  • Proper orientation helps in achieving balanced occlusion and minimizes the risk of denture displacement during function.

4. Inclination of Occlusion

• Definition: The inclination of occlusion refers to the angulation of the occlusal surfaces of the teeth in relation to the vertical axis.
• Considerations:
  • The inclination should be designed to allow for proper interdigitation of the teeth during occlusion.
  • It influences the distribution of occlusal forces and the overall stability of the denture.
  • The inclination of occlusion should be adjusted based on the patient's functional needs and the type of occlusion being utilized (e.g., balanced, monoplane, or lingualized).

5. Positioning for Esthetics

• Definition: Positioning for esthetics involves arranging the teeth in a way that enhances the patient's facial appearance and smile.
• Considerations:
  • The arrangement should consider the patient's age, gender, and facial features to create a natural and pleasing appearance.
  • The size, shape, and color of the teeth should be selected to match the patient's natural dentition and facial characteristics.
  • Proper positioning for esthetics not only improves the appearance of the dentures but also boosts the patient's confidence and satisfaction with their prosthesis.

→ Following rules should be considered to classify partially edentulous arches, based on Kennedy's classification.

Rule 1:

→ Classification should follow, rather than precede extraction, that might alter the original classification.

Rule 2:

→ If 3^rd molar is missing and not to be replaced, it is not considered in classification.

Rule 3:

→ If the 3^rd molar is present and is to be used as an abutment, it is considered in classification.

Rule 4:

→ If second molar is missing and is not to be replaced, it is not considered in classification.

Rule 5:

→ The most posterior edentulous area or areas always determine the classification.

Rule 6:

→ Edentulous areas other than those, which determine the classification are referred as modification spaces and are designated by their number.

Rule 7:

→ The extent of modification is not considered, only the number of additional edentulous areas are taken into consideration (i.e. no. of teeth missing in modification spaces are not considered, only no. of additional edentulous spaces are considered).

Rule 8:

→ There can be no modification areas in class IV.