This is the last stage at which modifications can be made before the wax is replaced by acrylic resin.

Esthetic evaluation

Phonetics
Occlusion

Esthetic evaluation

The shade, mould and arrangement of the artificial teeth should harmonize with the natural teeth

Esthetic evaluation

Phonetics
Although wearing a new prosthesis will likely require some speech adaptation, it is wise to perform a speech evaluation when multiple anterior teeth will be replaced ( f and v ) sounds are made by the patient, the maxillary incisors touch the wet - dry line of the lower lip As the patient makes the s sound, the maxillary and mandibular incisors should just miss contact (less than 1 mm is ideal).

Maxillary incisors contact wet dry line of lower lip when making the f sound.

In making the s sound, the maxillary and mandibular incisors are out of direct incisal contact, with generally less than 1 mm of space between incisal edges.

Occlusion

Occlusion:
Vertical dimension Centric relation ( intercuspation) Evenness of the occlusal contact

-It is the final clinical step before the periodic recall. -During processing of the acrylic bases of the pd. Some changes may occur that may affect the occlusal relationship and the fitting surface of the pd. Bases - these discrepancies should be perfectly corrected at the initial placement phase N.B. Laboratory remounting?

Adjustment of the P. D. can be considered in two points: 1- Adjustment done by the dentist to correct the surfaces of the denture and the occlusion. 2- Adjustment or accommodation by the patient, psychologically, and biologically to the presence of a foreign body in the mouth.
if every step has been carefully planned and executed with skill by the dentist the pt. is better able to accept the adjustment period as a necessary, but transient , step in learning to wear the prosthesis

Occlusal interference from denture framework Adjustment of the fitting surface of the denture base. Adjustment of occlusion to be in harmony with the opposing dentition Instructions to the patients Follow up of the case.

Adjustment of occlusal interference of the metal framework:

It must be done in metal frame work try-in stage as any occlusal interference from occlusal rest or other parts must be eliminated before taking jaw relation record or impression. The prosthesis should be fully seated in place passively

Adjustment of the fitting surface of the denture base:

Through painting the fitting surface by thin layer of pressure

indicating paste (P.I.P) applied by stiff brush.

this paste not adhered to the tissues, it can evenly flow under pressure that applied through

denture occlusion or dentist finger pressure in both vertical

and horizontal directions, if there is evenness of contact to the tissues it will be homogenous in color and thickness if there is pressure area, it will appear as thin film or metal or acrylic display so must be relived to eliminate overpressure.

Pressure areas in lower Jaw are usually : 1-The mylohyoid ridge. 2- Lingual ridge slope opposite to premolar area. 3-Retromylohyoid area (lingual pouch) 4-The distobuccal area (ascending ramus area and external oblique ridge)

2 1 3

1 1 4

Pressure areas in upper Jaw are usually: 1- Over the maxillary tuberosity. 2- Border of the denture at the malar bone prominence. 3- Pterygomaxillary notch (hamular notch). In addition to these anatomical areas there are Bony prominences, spicules, sharp edges are considered pressure areas in need to relief.

2 1 3

Adjustment of occlusion to be in harmony with the opposing dentition:

This step should be done after proper seating of the denture base not before. To ensure occlusal harmony in all jaw positions. When opposing partial dentures are placed at the same time, the adjustment of the occlusion will be similar to complete denture, specially in case of posterior teeth restoration or there are no occlusal stoppers, or the remaining teeth out of occlusion. But when there are natural teeth occlude with each other they will guide the occlusal adjustment as they will affect the mandibular movement.

Adjustment of occlusion to be in harmony with the opposing dentition:

Occlusal adjustment Methods: A-Intraoral detection: This method indicated in case of tooth-borne RPD as it has better stability in the mouth and there are opposing natural teeth acting as occlusal index B-Extraoral detection ( remounting): This method indicated in case of poor stability of the denture base in the mouth as in cases of distal extension cases or when nearly all posterior teeth are restored. It include remounting on the articulator, using the articulating papers through tapping the two jaws together in centric then in eccentric.

Adjustment of occlusion to be in harmony with the opposing dentition:

Articulating paper is used with different colors to differentiate between occlusal contact during centric and eccentric relation the interference appear as (colored ring around white center) the interference removed till harmonious occlusion is obtained in centric and eccentric occlusions.

Adjustment of occlusion to be in harmony with the opposing dentition:

Wax wafer can be used as occlusal indicator as patient tap on the wax, the wax inspected for perforations which result from premature contact or excessive contact

Adjustment of occlusion to be in harmony with the opposing dentition:

occlusal adjustment performed every six months to avoid traumatic occlusion as result of tissues support changes or tooth migration.

Adjustment of occlusion to be in harmony with the opposing dentition:

When the occlusion of the two opposing partial dentures is being adjusted in the mouth, it is best to consider one arch as intact arch and the other one adjusted to it. If one Pd is entirely tooth-supported and the other has tissue support, the tooth support denture should adjusted to the opposing natural teeth first and then the tissuesupported PD. adjusted to occlude with the first one.

Adjustment of occlusion to be in harmony with the opposing dentition:

If both arches are entirely tooth supported, the one occlude with the most natural teeth is adjusted first, and then the second one. The final adjustment of occlusion on the opposing tissues supported PD is usually done on the mandibular P.D since it is the movable member and its occlusion is made to be harmonized with the upper P.D

Instructions to the patients:

R.P.D is considered as foreign body inside the patients mouth, there are some discomfort will face the patient. Include. Soreness, difficult swallowing, speech interference( phonetic problems) so patients need instructions about these

Instructions to the patients:

1-some discomfort and annoyment at first days 2-Possibility of soreness despite the effort of adjustment 3-phonetic problem 4-divide food into small parts and chewing slowly for long period and avoid incising by anterior teeth. 5-Liability of gagging 6-meticulous cleaning of the prostheses and abutments by using Mouthwashes after meals, tooth brushes and dentifrices, soaking the denture inside cleansers for 15 minutes daily

Instructions to the patients:

7-Any deposited calculus should be removed. 8- the tissues should allowed to rest by removing the denture at night( except in bruxism) and keeping it in solution to avoid dryness or dehydration or shrinkage of the denture. 9- giving mirror to the patient and demonstrate how to insert and remove the denture. 10-the denture and supporting structures should be checked 24 hours after delivery 11- avoid careless handling of the denture that cause distortion or breakage.

Follow up of the case (periodic recall):

To ensure health and longevity of the remaining structures Periodic recall every six months should be the rule, or at shorter periods in caries susceptible and periodontally unhealthy pt. increase retention by contouring the clasp arm to engage more undercut rather than forcing the clasp toward the tooth The retention should be held to a minimum for longer serviceability of the pd. The need for relining especially the free end saddle cases.