1. Occlusal Vertical Dimension and Interocclusal Distance

The occlusal vertical dimension should be verified using the same techniques that were used previously. At this point it is critical that 2-4 mm of interocclusal distance can be measured and felt, and that the posterior denture teeth do not contact during assessment of the closest speaking space. If the vertical dimension is incorrect, it should be changed before altering other aspects of the denture setup, since it can affect the relationship of the maxillary and mandibular teeth and the facial esthetics.

If the vertical dimension is too great, assess whether one or both arches will require reduction in height. Changes can be done in the laboratory, since a change will necessitate the resetting of all the teeth in at least one of the arches. Remember, that the height of both the anterior and posterior teeth must be changed. If only the posterior teeth are changed, there will be an undesired effect on overbite relationships, esthetics, and balancing contacts. Assess how these changes will affect the overall appearance of the patient, before sending the dentures to the laboratory.

2. Centric Position Contacts

Mark the centric contacts with articulating paper while stabilizing the mandibular denture and placing patient into centric relation (you will need an assistant to hold the articulating paper). Place a thin line of polyvinyl siloxane bite registration material over the occlusal table and make a new centric relation record. Using a small amount of registration material will improve the accuracy of the record by providing less resistance during patient closure. The opposing cusps should not penetrate the registration, but you may be able to see the articulator markings through the thin areas of the material. This is a preliminary means of confirming the record was acceptable.

To confirm the accuracy of the articulator mounting, loosen the centric locking mechanism of the articulator, so the condylar elements are free to translate. Seat both record bases and interdigitate the teeth into the centric record. If the mounting is accurate, the condylar elements should be firmly seated in the hinge position (no space between the condylar ball and the wall of the fossae) and the teeth should perfectly interdigitate with the recording medium (no space around the cusps). If either of these criteria are not met, the record should be remade. If a second record shows the mounting to be inaccurate, the mandibular cast should be removed from the mounting ring, half of the mounting plaster ground from inferior aspect and the cast should be remounted, using the new record.

Lateral view of condylar element of Hanau and WhipMix articulators with accurate and inaccurate CR records:

3.Tooth Position

a. Canine Relationship

b. Verify overjet relationships - to help prevent cheek or lip biting. If there is inadequate overjet, the teeth may require bodily movement or tilting to 1-2 mm.

c. Verify patient comfort with the tongue space (denture teeth not set too far lingually) by asking the patient to comment on the comfort of the dentures or their ability to speak with the dentures