This contains an extensive overview of the intra oral examination that should be done for complete denture patients. any corrections are more than welcome. please do leave a comment and let me know if the presentation is helpful!! The presentation is available on request. Mail me at apurvathampi@gmail.com

1. INTRA-ORAL
EXAMINATION
Presented by
ApurvaThampi
PG 1st year

2. Introduction

3. NEED FOR INTRA ORAL
EXAMINATION
■ Identification of pathologic conditions that may affect use of dentures
■ Identifying the need for tissue conditioning
■ To aid in proper treatment planning and hence deliver a satisfactory
prosthesis

4. Pathologic conditions
■ Conditions involving the oral
mucosa:
(a) Denture stomatitis
(b) Palatal inflammatory papillary
hyperplasia
(c) Angular stomatitis (angular
cheilitis)
(d) Shallow sulci
(e) Denture-induced hyperplasia
(f) Prominent frena.
■ Conditions involving the
bone:
(a) Pathology within the bone
(b) Sharp and irregular bone
(c) Undercut ridges
(d) Prominent maxillary
tuberosities
(e)Tori.
ProstheticTreatment of Edentuous patient - Basker and Davenport, 4th ed

5. Denture stomatitis
 Also called denture sore
mouth
 Patchy diffuse inflammation
of the mucosa covered with
denture
 Common – maxillary
denture base area
ProstheticTreatment of Edentuous patient - Basker and
Davenport, 4th ed

6. Etiology
Candida
albicans
Bacteria
Poor
denture
hygiene
Denture
trauma
Wearing
dentures
at night
Diet
Other
non-
microbial
factors SYSTEMIC CAUSES
 Immunological
deficiencies
 Hormonal imbalance
 Deficinecies ofVitamin
B complex, C and Iron
ProstheticTreatment of Edentuous patient - Basker and
Davenport, 4th ed

7. Palatal inflammatory
papillary hyperplasia
 Also called hyperplastic
denture stomatitis
 Common in palatal
mucosa – multiple
elevations
 “Raspberry”-like
appearance
 Bright red in colour
ProstheticTreatment of Edentuous patient - Basker and
Davenport, 4th ed

8. Elimination of mucosal inflammation
Prosthetic or surgical management of hyperplasia
ProstheticTreatment of Edentuous patient - Basker and Davenport, 4th ed

9. Angular stomatitis
 Also called angular chelitis
 Erythematous, erosive,
non- vesicular skin lesion
radiating from the angles
of the mouth
 Bilateral and painful
 If untreated - scarring
ProstheticTreatment of Edentuous patient - Basker and
Davenport, 4th ed

10. ProstheticTreatment of Edentuous patient - Basker and
Davenport, 4th ed

11. Shallow sulci
• Denture instability
• Unfavourable load distribution – a problem
occurring primarily in the lower jaw.
The problems characteristically created by a shallow sulcus are:
ProstheticTreatment of Edentuous patient - Basker and
Davenport, 4th ed

12. treatment
Alveoloplasty
Frenectomy
Removal of
denture
hyperplasia
Reduction of
undercuts
Removal of
bony
prominences
Transposition
of mental
nerve
Sulcus
deepening
Ridge
augmentation
ProstheticTreatment of Edentuous patient - Basker and
Davenport, 4th ed

13. Denture
induced
hyperplasia
 Single or multiple flaps of
fibrous tissue
ProstheticTreatment of Edentuous patient - Basker and
Davenport, 4th ed

14. PRIMARY CAUSE
Denture over – extension
leading to chronic
irritation of the mucosa
TREATMENT
 Eliminate denture
 Review in two weeks
 Surgical excision if
required
ProstheticTreatment of Edentuous patient - Basker and
Davenport, 4th ed

15. Prominent Frena
■ Bands of fibrous tissue attachment - closest to the alveolar ridge
■ Deep notch – to accommodate denture  fracture of denture base
ProstheticTreatment of Edentuous patient - Basker and
Davenport, 4th ed

16. Pathology with bone
Pathology within the bone should be suspected if one or more of the
following are present:
 a sinus
 a swelling
 irregularity of the shape of the ridge.
ProstheticTreatment of Edentuous patient - Basker and
Davenport, 4th ed

17. Sharp and irregular bone
■ May be present on the crest of the ridge
■ Pain – pressure from denture
■ Insufficient care was taken when the teeth were extracted
TREATMENT:
• Short term lining material
• Surgical removal
ProstheticTreatment of Edentuous patient - Basker and
Davenport, 4th ed

18. ProstheticTreatment of Edentuous patient - Basker and
Davenport, 4th ed

19. Mylohyoid ridges and genial tubercles
The prominences that occasionally cause trouble are:
 the mylohyoid ridges
 the genial tubercles.
ProstheticTreatment of Edentuous patient - Basker and
Davenport, 4th ed

20. Undercut ridges and prominent
tuberosities
■ If ridges are grossly undercut insertion of a denture may be impossible –
excessive reduction of extension
■ Retention and support of the denture is likely to be compromised
ProstheticTreatment of Edentuous patient - Basker and
Davenport, 4th ed

21. Tori
A palatine torus occurs in the midline of the
hard palate and when covered by a thin,
relatively incompressible layer of mucosa
Mandibular tori usually occur bilaterally
on the lingual aspect of the mandible,
frequently in the premolar region
ProstheticTreatment of Edentuous patient - Basker and
Davenport, 4th ed

22. ■ Amount of seat for denture foundation.
■ Greater size – more support.
■ Larger contact surface greater retention .
Arch size
J. Prosth DentThe relationship pf oral examination to dental diagnosis M M House; 1958(8);
208-219

23. Arch form
Arch forms can be classified as:
 Square
 Tapering
 ovoid
J. Prosth DentThe relationship pf oral examination to dental diagnosis M M House; 1958(8);
208-219
Combination type of arches:
• Ovoid-tapering
• Ovoid-square
• Square-tapering
• Reverse tapering.

24. Residual ridge form
Reduction of residual ridges: A maior oral disease entity Atwood D A ; J Prosthet Dent vol
26(3); sept 1971; 266-279

25. Residual ridge form
■ Vary widely
■ Ideal – high ridge with flat crest and parallel sides
■ Knife edge least prognosis
■ Flat-little resistance to horizontal movement
J Prosthet Dent; patient evaluation for complete denture therapy Appleby and Ludwig ; 1970
; 11-17

26. Inter-arch space
■ Best checked on mounted diagnostic casts.
■ Inadequate space  difficulty in locating the occlusal plane
■ Difficulty in setting teeth
British dental journal volume 201 no. 5 sep 9 2006
METHOD
• Facebow record is made with the denture
• Putty is inserted into the intaglio of the denture
• Mounted on the upper member of an articulator  replica of denture bearing area
• An impression is then made of the opposing arch
• Occlusal corrections are made and mandibular cast is mounted
Ideally – 15mm

27. Ridge relationship
Can be classified into :
 Class I : Normal relationship
 Class II : Retrognathic
 Class III : Prognathic
• Patient looks toothy
• Holds mandible forward
• Great range of jaw movements
• Require large inter-occlusal
distance
• Easier to deal with
• Patient functions on a hinge
• Little or no protrusive movements
• Require minimum inter-occlusal
space
Complete Denture Prosthodontics A manual for clinical procedures : Bernard Levin ; 17th Ed

28. LateralThroat form
It is estimated by placing a mouth mirror in the disto-lingual vestibule
(Ewell Neil) :
■ Class I :The mouth mirror is not visible when the tongue is in a slightly
protruded position  most favorable for retention and stability.
■ Class II : One half of the mouth mirror is visible  less favorable.
■ Class Ill :The entire mouth mirror is visibleleast favorable.
Complete Denture Prosthodontics A manual for clinical procedures : Bernard Levin ; 17th Ed

29. Soft palate
Soft palate classified by M M House:
■ Class I : Large and normal soft tissue extends
posteriorly for 5-12 rnm  soft palate becomes
■ Class II: Medium and normal  having movable
tissue approximately 3-5 mm
■ Class Ill: Small and with little or no movable
tissue  soft palate turning down abruptly within
1 mm. of the junction
Complete Denture Prosthodontics A manual for clinical procedures : Bernard Levin ; 17th Ed

30. Palatal sensitivity
Evaluated by lightly running an instrument over the soft palate.
■ Slight/no response most favorable.
■ Moderate controlled by careful denture procedures, counseling and
even medication.
■ Severe poor prognosis

31. Mucosa condition
The color, texture, and consistency has to be recorded
■ Reddened tissues with obvious edema indicate tissue irritation
■ Rough, grainy texture frequently characterizes tissue that usually
requires surgical removal.
■ Mucosa should be in good health before fabrication of the denture
Complete Denture Prosthodontics A manual for clinical procedures : Bernard Levin ; 17th Ed

32. Saliva
CONSISTENCY
■ Class I: Normal amount and
viscosity favorable.
■ Class II :Thin + viscous best
retention.
■ Class III :Thick ropy saliva
complicates impression taking
AMOUNT
■ Excessive  common when
the denture is first inserted
■ Deficient (xerostomia 
geriatric patients (poor
prognosis for denture
retention and comfort)
■ No radiation for oral cancer.
The Journal of Medical InvestigationVol.56 Supplement 2009
JPD Vol. 1985 53(4) 535-539
JPDVol. 1994 72(5) 538-542
Normal : 0.5 to 1 ltrs a day

33. Tongue
■ Normal position  relaxed, completely fills the mandibular arch, and
the apex lightly contacts the lingual of the mandibular teeth - most
favorable
■ Retruded position  poor lingual seal and poor mandibular denture
prognosis
Instruct the patient to open just enough for a small portion of food and observe the
tongue carefully.
• Self-curing resin on the anterior lingual flange
• Asked to keep his/her tongue in contact with the resin, except when eating and
speaking.
• If or when the retruded tongue position improves (usually 2-3 weeks), the raised
resin area is easily removed and polished.
Complete Denture Prosthodontics A manual for clinical procedures : Bernard Levin ; 17th Ed

34. Border tissue attachments
Maxilla
■ Class I : high
■ Class II : medium
■ Class III : low
Mandible
■ Class I : low
■ Class II: medium
■ Class III : high

35. Frenal Attachment
Maxilla
■ Class I : high
■ Class II : medium
■ Class III : low
Mandible
■ Class I : low
■ Class II: medium
■ Class III : high

36. RADIOGRAPHS

38. ■ Presence in the jaw of spiculae, root fragments, impacted teeth, foreign
bodies, and rarefied areas have to be assessed
■ Reveal areas of bone formation
■ The degree of resorption and the bone structure
■ The presence or lack of cortical bone on the crest of the ridge and
spiney or uniformly curved ridges
J. Prosth DentThe relationship pf oral examination to dental diagnosis M M House; 1958(8);
208-219

39. ■ Class I: Dense bony optimum foundation
– The trabeculae are compact the medullary spaces are few
– The cortex is solid and well defined.
– Show little or slow resorption.
■ Class II: Cancellous bone adequate support if occlusal loading is within physiologic
limits.
– The overall picture is much lighter and there is great contrast.
– The trabeculae and medullary space are evenly balanced.
– The cortex is defined but lighter in contrast.
■ Class III: Noncortical bone  poor support
– radioluscent and poor in organic salts.
– no definite cortex; margins are feathery thin and often apiculated.

40. TREATMENT
PLANNING

41. Pre-Treatment records
Includes
■ Diagnostic casts
■ Pre-extraction records

42. Pre-treatment records
Diagnostic casts :
 Inter-ridge distance
 Ridge relationships
 Ridge shape & form
Pre-extraction records
 Old diagnostic casts – tooth size, position & arrangement.
 Old radiographs – tooth size & bony changes
 Photographs – tooth size, position & display during facial expression.
 Old dentures

43. Prognosis
Defined as the forecast as to the probable result
of a disease or a cause of therapy.
must consider the overall picture including patient
expectations, understanding and mental attitude.

44. Treatment planning
■ It is the process of matching possible treatment
options with patient needs and systematically
arranging the treatment in order of priority but in
keeping with a logical or technically necessary
sequence.

45. Treatment plan
1. Addresses patient’s needs
2. Lists specific treatment
3. Specifies logical sequence
Informed consent
1.Treatment
2.Time
3. Fees
Estimate
1. Operating time
2. Lab time
3. Calendar time
4. Fee
Specific care
is delivered
Enables patient to
Dentist delivers
Enables dentist to Patient receives

46. In treatment plan following are decided on:
■ Tissue conditioning /finger massage, type of treatment material,
frequency of soft reline changes etc. for inflamed tissue.
■ Preprosthetic surgery: Procedures proposed and staging
■ Articulator
■ Tooth selection shade, mold and material
■ Denture base material, shade
■ Characterization
■ If old dentures exist – inadequacies, good features are noted down.
■ Impression procedure

47. References
■ Complete Denture Prosthodontics A manual for clinical procedures : Bernard Levin
; 17th Ed
■ Prosthetic Treatment of Edentuous patient - Basker and Davenport, 4th ed
■ Prosthodontic treatment for elderly patients – Boucher
■ DCNA Journal , Complete Denture
■ The Journal of Medical InvestigationVol.56 Supplement 2009
■ JPDVol. 1985 53(4) 535-539
■ JPDVol. 1994 72(5) 538-542

48. ■ JPD 24(1); 11-17; 1970
■ JPD 26; 266-270; 1971
■ BDJ vol 188 No 7 April 2000

49. THANKYOU
AND
HAVE A PLEASANT DAY!!