Overview: This guide provides step-by-step instructions to resolve common clinical issues with try-in dentures, including loose fit, tight fit, bite inaccuracies, and aesthetic concerns.
Prerequisites
Before beginning adjustments, ensure you have the following tools available:
- Carbide bur or stone wheel
- Wash impression material
- Pressure-indicating paste (PIP)
- Horseshoe articulating paper
- Black magic marker
Resolve Loose or Rocking Try-in Denture Bases
If a try-in denture is too loose or rocks during the appointment, follow these steps to ensure the final denture fits correctly:
- Relieve the intaglio: Use a carbide bur to relieve the intaglio of the try-in denture base if necessary to avoid unwanted additions to the patient's Vertical Dimension of Occlusion (VDO).
- Apply wash impression: Place a wash impression inside the upper or lower try-in denture.
- Perform extraoral scan: Scan the try-in dentures extraorally 360 degrees.
- Perform intraoral scan: If applicable, scan the opposing arch intraorally.
- Capture the bite: Scan the full arch bite extraorally or capture the left and right bite intraorally.
Resolve Tight Try-in Denture Bases
If a try-in denture is too tight and requires significant adjustment, follow these procedures:
- Apply PIP paste: Apply pressure-indicating paste (PIP) to the intaglio surface of the try-in denture.
- Check muscle movements: Insert the try-in and have the patient perform natural muscle movements.
- Adjust blanching areas: Remove the try-in and use a carbide bur to adjust areas showing blanching or PIP displacement.
- Repeat adjustments: Repeat the process until the optimal fit is achieved.
- Clean the appliance: Remove residual PIP using soap, warm water, and a denture brush.
- Scan the appliance: Scan the try-in dentures extraorally 360 degrees. No wash impression is required for tight-fitting dentures.
Note: If preferred, you may aggressively relieve the entire intaglio surface and take a new wash impression instead of using PIP.
Resolve Bite and Occlusion Issues
Follow these steps if the try-in denture has bite or occlusion issues:
Step 1: Verify Seating and Adjust
Check that the dentures are fully seated before making adjustments.
- Major Adjustments: Aggressively adjust teeth using a carbide bur or stone wheel until the patient can close properly. Place bite registration for accurate indexing.
- Minor Adjustments: Use horseshoe articulating paper to identify high spots and lightly adjust with a carbide bur.
Step 2: Rescan the Try-in
- Perform 360° Scan: Use the 360° scan technique for the try-in dentures.
- Scan Opposing Arch: If applicable, scan the opposing arch intraorally.
- Complete Bite Scan: Capture a new denture bite scan to record the adjusted relationship.
Resolve Aesthetic Issues
If the aesthetics of the try-in denture require correction, use adjustments or photographic documentation.
Mechanical Adjustments
Small aesthetic issues, such as an incisal edge that is too long, can be solved by adjusting the appliance directly to the desired length.
Photographic Documentation
Most aesthetic issues require detailed notes and photographs with the appliance in the patient's mouth.
- Use Markers: Use a black magic marker to indicate the new midline or a high smile line on the try-in before taking photos.
- Scan Requirements: No new scans are required if the bite relationship, VDO, and fit are already correct.