CE: Delivering Successful Complete Dentures by Dr. Leif Stromberg

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An overview of laboratory procedures, evaluation techniques and the dentist-patient approval process

by Dr. Leif Stromberg

Keys to Success and Predictability With Fabrication of Complete Dentures

PART 1 (April 2024): The consultation/examination appointment
PART 2 (June 2024): Simplified techniques for final impressions
PART 3a (March 2025): Establishing tooth positions
PART 3b (May 2025): Accurately recording vertical dimension of occlusion and centric relation
PART 4 (August 2025): The wax try-in appointment for denture success
PART 5 (this month): Delivery of successful complete dentures

Abstract
The delivery of complete dentures is a pivotal step in the fabrication process and requires understanding and implementing denture fundamentals for predictable success. This course discusses key laboratory procedures that support the delivery appointment, including precision injection processing to control polymerization shrinkage. Clinical steps are presented, including effective refinement of the denture bases using white silicone pressure-detecting paste, followed by accurate occlusal adjustment with Kerr Occlusal Indicator Wax to establish stable, balanced posterior contacts on fully seated denture bases, which results in fewer denture adjustments after delivery.

The course emphasizes the importance of comprehensive patient education and structured follow-up care to support patient adaptation and acceptance of their new restorations and for long-term success.

Educational objectives
After completing this course, readers should be able to:

Describe the importance of controlling polymerization shrinkage of acrylic resin during the processing of tissue-supported complete dentures and identify a method to minimize distortion.
Apply and use a white silicone pressure-detecting paste on the denture base to identify and correct areas of excessive pressure, making adjustments to achieve uniform contact between the denture and its supporting tissues.
Explain principles and techniques for accurately adjusting occlusion intraorally on tissue-supported complete dentures, and describe why the use of articulating paper or articulating foil provides unreliable results for intraoral occlusal adjustment.
Apply fundamental clinical steps and principles in practice to increase predictability and overall success in the fabrication of complete dentures.

Introduction
The delivery of complete dentures is far more than placing a dental restoration—it is a pivotal step in a restorative process that can reshape the quality of life for individuals living with the disability of complete edentulism. Well-fabricated dentures can enable patients to re-enter daily life with renewed comfort, confidence, and satisfaction by improving their ability to chew and speak compared to the limitations of edentulism or the challenges of poorly fitting prostheses, and by restoring natural facial harmony. For the dental team, the delivery appointment provides a meaningful opportunity to confirm that the treatment process has achieved its goal of delivering a successful prosthesis that leaves the patient pleased while helping reduce the likelihood of follow-up challenges.

While the delivery appointment is essential, it is only one of several interrelated steps that must be completed effectively to achieve predictably successful outcomes. Every stage—consultation/examination, impression making, accurate record-taking, and verification at the try-in—contributes equally to producing a prosthesis that is comfortable, functional, and satisfying to the patient. These foundational stages were presented in Parts 1 through 4 of this Dentaltown series on successful complete denture fabrication.

This CE course (Part 5), Delivering Successful Complete Dentures, presents key laboratory procedures that prepare for a successful delivery appointment, and clinical steps that increase predictability and success in the delivery of complete dentures.

Laboratory steps that support a successful denture delivery appointment
After the wax setup has been approved at the try-in acceptance appointment by both the patient and the dentist, predictable success at the delivery appointment depends on the laboratory’s adherence to fundamental procedures that ensure the final dentures accurately replicate the conditions approved. This section outlines three key fundamentals that support a successful delivery appointment: clear communication between the dentist and the laboratory, using the same articulator throughout all stages of fabrication, and controlling polymerization shrinkage of the acrylic resin to produce prostheses that optimally fit and adapt to the supporting tissues.

Effective communication between the dentist and dental laboratory technician remains essential at every stage of denture fabrication, ensuring accuracy, continuity, and consistency from the initial case mounting, through the try-in appointment, to final delivery. Clear laboratory instructions guide the technician in maintaining the desired aesthetics, vertical dimension of occlusion, and centric relation occlusion.

At all stages of fabrication, the case should be mounted on the same articulator that was used for the initial mounting to maintain accuracy. This includes using the same articulator when verifying the occlusion at the try-in appointment and when performing all final occlusal adjustments in the laboratory, both before and after processing. Consistent use of the same articulator preserves the edentulous arch relationship established at the records appointment and the occlusion approved at the try-in. This minimizes the risk of discrepancies that could arise if a different articulator were used.

Controlling the polymerization shrinkage of the acrylic resin during processing contributes to the fit and adaptation of the denture base to the supporting tissues. The use of a precision injection system, such as the IvoBase Injection System, can minimize distortion and warpage of the denture base. Because acrylic resin undergoes a volumetric shrinkage of approximately 7% to 10% during polymerization, conventional denture processing methods can lead to significant dimensional changes in the final prosthesis. A precision injection system maintains continuous pressure on the acrylic resin throughout the curing cycle. As the resin shrinks, the system automatically replaces the lost volume with additional material, preserving the intended contours of the denture base. For this reason, it is recommended that the dentist request the laboratory to process complete dentures using a precision injection system. Fig. 1 shows dentures positioned in injection processing flasks.

Fig. 1: Injection processing

Finishing and polishing should be performed carefully to preserve the structural integrity of the dentures. Excessive contouring or polishing can weaken the prosthesis, shorten its borders, or thin the flanges, resulting in underextension, reduced retention, and diminished facial support.

Successful complete denture delivery appointment
Effective delivery of complete dentures is essential for achieving predictably satisfactory treatment outcomes. This clinical insertion appointment, along with subsequent follow-up visits, requires a systematic and comprehensive approach. This includes adjusting the denture base for close adaptation to the supporting tissues, accurately refining the occlusion, and providing the patient with thorough education on care and expectations for successful use.

Adjusting the denture base for optimal supporting tissue adaptation
The appointment begins with an evaluation of the fit and tissue adaptation of the maxillary denture base. The oral tissues should be healthy, stable, clean, and free of food debris or denture adhesive. Before placing the denture, ask the patient to report any discomfort during insertion or removal (Fig. 2). To identify areas requiring adjustment, apply a thin, even layer of white silicone pressure-detecting paste to the intaglio (inner, tissue-contacting) surface, such as Pressure Disclosing Paste (PDP) by LeeMark Dental, (Fig. 3). After the surface has been dried with gauze and using a coarse-bristle brush, the paste is applied in smooth, single-direction strokes so that the brush pattern is clearly visible (Fig. 4). The denture is seated with moderate to firm, even bilateral pressure in the first molar regions and removed immediately, and the patient reports any discomfort experienced during seating or removal, indicating an area requiring adjustment.

Fig. 2: Patient pointing to area of discomfort

Fig. 3: Pressure Disclosing Paste

Fig. 4: Applied white silicone paste

Carefully evaluate and interpret the brush-mark pattern of the white silicone paste to identify tissue-contact areas and areas where adjustments are needed (Fig. 5). Developing the ability to accurately “read” these contact patterns and brush marks allows the clinician to refine the denture base and achieve close, uniform contact with the supporting tissues.

Three distinct types of markings are created in the paste, each of which guides the adjustment process:

Areas of excessive pressure: Areas of disproportionately heavy tissue pressure appear where the paste has been displaced or rubbed off. These areas indicate excessive pressure and typically require reduction. However, the posterior palatal seal bead (or post dam) should display heavier pressure and without causing discomfort (Figs. 5 and 6).
Areas of most favorable tissue contact: In these areas, the brush marks become blended or obliterated, and the paste appears smooth and uniform. This pattern represents the desired degree of contact across all primary support areas of the denture base (Fig. 7).
Areas lacking contact: Regions of the denture base not in contact with the tissue retain clearly visible brush marks. When this occurs, areas of heavy or favorable contact may need to be selectively reduced to allow the denture to seat fully and achieve uniform contact. In cases where significant non-contact persists, a reline or rebase procedure may be required. Fig. 5 shows a denture that is not fully seated, demonstrating areas of tissue contact and areas with visible brush marks that are not contacting the tissue.

When adjustments are complete, most brush marks should be eliminated, and the posterior palatal seal bead (or post dam) should show firm comfortable pressure. The objective is to achieve uniform, even tissue contact between the denture base and the supporting tissues and firm pressure on the posterior palatal seal bead (or post dam) area (Fig. 7).

Fig. 5: Areas of heavy tissue pressure

Fig. 6: Adjusting heavy contact areas

Fig. 7: Showing areas of favorable tissue contact

The mandibular denture fit is evaluated next using the same technique. A thin, even layer of pressure-detecting paste is applied, and the denture is inserted without rubbing against the tissues (Fig. 8). Instruct the patient to report any discomfort during insertion or removal of the denture. Carefully insert and remove the denture, avoiding tissue contact that would wipe away the paste during seating or removal, since loss of paste may indicate excessive pressure and lead to unnecessary relief of the denture in that area. If the patient reports discomfort, the area of removed paste at the discomfort area likely represents true excessive pressure requiring adjustment. Adjustments continue until seating is comfortable and brush marks are obliterated, and the denture shows uniform contact across the primary support areas: the retromolar pads, the buccal shelves, and the alveolar ridge.

Areas of excessive pressure may include the labial and buccal aspects of the ridge as shown in Fig. 9. These specific areas can be carefully adjusted (reduced) with an acrylic bur.

Fig. 8: Mandibular denture with pressure detection paste applied

Fig. 9: Excessive pressure on labial of ridge

Adjust the lower denture as needed until most of the brush marks in the white silicone pressure-detection paste are obliterated while the paste itself remains intact, confirming uniform contact between the denture base and the supporting tissues.

Border extensions of both maxillary and mandibular dentures should be verified to ensure neither overextension nor underextension is present. All adjustments should be completed before any occlusal refinements because accurate occlusion depends on fully seated, comfortable, and stable denture bases.

Before refining the occlusion, confirm complete seating of both dentures, including complete seating and engagement of the post dam in the posterior palatal seal area. To ensure complete seating, have the patient bite firmly on two cotton rolls positioned between the posterior teeth for five minutes (Fig. 10). While the patient maintains firm closure pressure on the cotton rolls, ask if any discomfort is felt from the denture bases (Fig. 11).

Any discomfort reported during this step indicates areas of excessive pressure that require additional relief. Occlusal adjustments should not be initiated until both dentures are fully seated, stable, and comfortable.

Fig. 10: Biting on cotton rolls to fully seat dentures

Fig. 11: Patient notes area of discomfort

Occlusal adjustment using occlusal indicator wax
The goal of occlusal adjustment of tissue-supported complete dentures is to contour the occluding surfaces of the denture teeth while the denture bases are fully and stably seated, equalizing simultaneous forces to all occluding posterior teeth (without interference of the anterior teeth) when the patient closes in centric relation occlusion, and eliminating eccentric interferences.

Accurate occlusal refinement depends on maintaining denture stability throughout the equilibration procedure. Because tissue-supported dentures rest on movable soft tissues, intraoral use of articulating paper or articulating foil produces unreliable markings; tissue movement allows the dentures to shift during closure, making it difficult to identify true occlusal prematurities because false markings often appear. For this reason, two reliable methods are recommended for accurate occlusal adjustment:

Remounting the dentures on an articulator and refining occlusion on the articulator.
Intraoral occlusal refinement using Kerr Occlusal Indicator Wax (Fig. 12).

Kerr Occlusal Indicator Wax is especially effective for intraoral use because it distributes occlusal pressures evenly across the posterior teeth, on each side and bilaterally, promoting uniform seating of the dentures and minimizing tipping or shifting during closure (Fig. 13).

The wax is supplied with a special wax pencil (Fig. 12) that can be used for marking areas on denture teeth to be adjusted, such as premature contact areas (Fig. 14). Its dense forest-green pigmentation provides excellent visibility of cusp penetrations and allows the clinician to identify which maxillary cusp is closest to contacting its opposing mandibular tooth. If one cusp is closer to contacting its opposing tooth than other cusps, the closest one is an occlusal prematurity. Maxillary teeth should not penetrate fully through the wax to contact an opposing tooth, because tooth-to-tooth contact can cause denture displacement. Adjustments are usually made to the corresponding mandibular tooth surfaces to maintain maxillary cusp form while refining contacts, and adjustments are made until all maxillary functional cusps are equally close to flat opposing occlusal surfaces.

Fig. 12: Kerr Occlusal Indicator Wax

Fig. 13: Patient closing into Kerr Occlusal Indicator Wax during occlusal adjustment of dentures

Fig. 14: Marked premature area before adjustment

Preparing the wax and placing it on mandibular denture teeth
Proper manipulation of the wax is essential for accuracy. Warm the wax to a pliable—but not overly soft—state by dipping a strip in water at approximately 135°F for one-to-two seconds (Fig. 15). Water that is too hot softens the wax excessively and leads to distortion; water that is too cool leaves the wax too firm to record accurate cusp relationships.

Apply a wax strip with the shiny side down onto the mandibular posterior denture teeth (Fig. 16). After applying two strips, briefly (for one to two seconds) dip the mandibular denture with the wax strips into the heated water to ensure the wax reaches uniform, optimal softness across the entire strips and to equalize consistency bilaterally (Fig. 17).

Fig. 15: Warming wax strip

Fig. 16: Placing wax strip on teeth

Fig. 17: Uniformly softening wax

Identifying centric relation occlusal prematurities with occlusal indicator wax
Seat the dentures with wax in place and guide the patient to close gently into centric relation. The patient should close with light pressure only. After closure, remove the mandibular denture and examine the pattern of cusp penetrations (Fig. 18).

Evaluate areas where the maxillary cusps have penetrated into the wax and evaluate the thinness of these wax areas. Areas where the wax is the thinnest or perforated indicate premature contacts or “high spots” when other functioning maxillary cusp tips show less closeness to contact (Fig. 19). With the wax pencil, mark the corresponding premature contact area on the mandibular tooth. In Fig. 19, notice the prematurities at 29 and 30 teeth. These teeth should first be adjusted. (Figs. 20 and 21).

Fig. 18: Dentist evaluating wax

Fig. 19: Premature contacts on right

Fig. 20: Premature contacts being marked with wax pencil

Fig. 21: Prematurities marked

Selective adjustment of premature contacts
After marking a contact area to be adjusted, remove the wax strip and reduce the marked area on the mandibular tooth with an acrylic bur (Fig. 22). The goal is to create a flat, occlusal contact area that the maxillary cusp can contact perpendicularly, helping the dentures remain optimally seated without shifting. As refinement progresses, the remaining posterior maxillary functional cusps will come progressively closer to even contact, which will ultimately establish a stable and well-balanced occlusion.

Fig. 22: Acrylic burs for denture adjustments

A rule when using Kerr Occlusal Indicator Wax: If a maxillary functional cusp is closer to contacting its opposing mandibular tooth than other cusps, the corresponding mandibular tooth surface is contoured.

Repeating the sequence
Reapply fresh wax strips and repeat the process—uniformly warm the wax on the denture (Fig. 17), guide closure into centric relation occlusion (Fig. 13), mark prematurities with the wax pencil (Fig. 20), and selectively refining the occlusion—until all maxillary functional cusps have the same closeness to contacting their opposing mandibular teeth. This ensures a balanced, stable occlusion on fully seated denture bases.

Evaluating excursions
After centric relation contacts are adjusted and even, additional wax strips may be used to evaluate and adjust the dentition in lateral and protrusive movements. The patient may also simulate chewing with the wax in place to identify eccentric interferences, which are selectively adjusted as needed.

Final polishing
Once adjustment is complete, polish only the ground areas surrounding the final occlusal contact points. The contact points themselves should remain unpolished to preserve accuracy.

Recording centric relation for a clinical remount procedure
For details on recording centric relation for a remount procedure for occlusal adjustment of complete dentures, see Part 4 of this 5-Part CE Series, “The Essential Try-In Acceptance Appointment,” in the August 2025 issue of Dentaltown or in the online CE library, where the technique for manually guiding the mandible into centric relation for recording (without a tracer) is discussed.

Educating the patient on denture care, use, and expectations
After completing the necessary adjustments, provide the patient with clear, thorough instructions to support successful adaptation to their new dentures. Demonstrate proper techniques for inserting and removing the prostheses, review oral and denture hygiene procedures, and explain how chewing efficiency and speech will improve gradually during the normal adjustment period. Reinforce the importance of maintaining excellent oral hygiene, cleaning the dentures daily, and adhering to recommended follow-up and recall appointments. These steps help ensure long-term comfort, stability, and overall functional success with the prostheses.

Post-delivery follow-up adjustment appointments
Effective post-delivery follow-up care is essential for long-term success with complete dentures. When the fundamental clinical and laboratory steps have been carried out effectively, sore spots at these appointments are usually minimal. Areas of excessive pressure on the denture bases should be selectively relieved, and pressure-detecting paste can be used as needed to maintain uniform tissue adaptation. Because sore spots may also result from occlusal discrepancies, the occlusion should be evaluated and refined using Kerr Occlusal Indicator Wax. If a significant occlusal discrepancy is observed, a clinical remount procedure may be indicated for evaluation and correction.

Conclusion and clinical takeaways
Predictably delivering successful complete dentures requires a coordinated, systematic approach that integrates sound laboratory procedures, precise clinical techniques, and effective patient education. When each step—from impression-making and accurate records to try-in verification, denture base adjustment, occlusal refinement, and follow-up care—is performed carefully and effectively, clinicians can confidently provide prostheses that offer comfort, stability, function, and long-term patient satisfaction.

Minimizing sore spots at the delivery appointment is especially important. Excessively relieving the denture base in response to pain can reduce retention, compromise stability, and make subsequent occlusal adjustment more difficult for both the dentist and the patient. Establishing uniform tissue adaptation and balanced occlusion at the denture delivery appointment not only enhances patient comfort but also reduces the need for extensive adjustments at follow-up visits.

Patients should be educated that dentures are not permanent restorations. As the oral tissues continue to change and denture teeth wear, periodic relines, rebases, or replacement may be necessary to maintain a healthy mouth, comfort, and function. Regular recall appointments support early identification of issues and maintenance of healthy oral conditions, reinforce home-care instructions, and help preserve the long-term success of the prostheses.

Claim Your CE Credit

Do you prefer to take continuing ed in video format?

Dr. Leif Stromberg has also created a five-part series of video CE courses for Dentaltown about keys to success when creating complete dentures. Click here to check out the lineup.

Author Bio

Leif Stromberg, DDS, MAGD, FADI, FICD, practices general dentistry in Dallas, Texas. Widely recognized for his expertise in restorative dentistry and complete denture fabrication, Stromberg was selected by his peers and named a Texas Super Dentist in Texas Monthly magazine 13 times from 2005 to 2017. In 2022, he was nominated for the Texas Academy of General Dentistry Dentist of the Year Award, and in 2023, he received a fellowship in the International College of Dentists.
Stromberg, a former clinical assistant professor at Texas A&M University College of Dentistry, is a sought-after speaker at dental conferences, where he shares techniques for achieving predictable success in complete denture fabrication. He has also authored a textbook on this topic.
In his free time, he enjoys hiking with friends in U.S. national parks and traveling with his wife, Linda.

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CE: Delivering Successful Complete Dentures by Dr. Leif Stromberg

An overview of laboratory procedures, evaluation techniques and the dentist-patient approval process

January 2026


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An overview of laboratory procedures, evaluation techniques and the dentist-patient approval process

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