1/2 point CDT documented scientific credit. See Page 36.

Technique for Processing Hollow Obturators

By Khalil Al Arja

Saudi Arabia

Global Dentistry
30 Journal of Dental Technology February 2009

FIGURE 1

FIGURE 2

anufacturing obturators often demands a lot of steps to provide an appliance with sufficient weight. The weight is important because the patients ability to speak, breath and eat depended on the obturator fitting well and, most importantly, the weight of the obturator. Therefore providing an obturator with minimum gravity pull is necessary, but sometimes these appliances come with different shapes and in some cases with two different materials that require as many as three stages to process (Figures 1 and 2).
February 2009 Journal of Dental Technology 31

In the case presented in this article, the patient had an obturator that fitted into the sinus cavity with soft material. The patient requested a new obturator because of leakage and the fact that it didnt fit well. It was duplicated and poured in hard stone to prepare the clear acrylic duplicate and take a final impression (Figures 3 and 4). The clear, hard acrylic duplicate obturator was delivered to the prosthodontist to finalize the impression. Then it is sent back to the laboratory for pouring.

In this specific case, it was not possible to pour the appliance in die stone without the risk of damaging all the fine details inside the sinus cavity. Therefore, I made a silicone negative mold for the impression and poured the positive mold in silicone. This ensures that when the technician removes the obturator from the cast, the inner surface will be safe from chipping or breakage. At the same time a putty mold was made to be used later for mounting with a wax duplicate obturator (Figure 5A - 5C).

The purpose of manufacturing these molds is to try to preserve the impression details for a longer period of time, in case the master cast is damaged. Because the impression is taken with silicone-based material, isolation is an important issue. For this case, I used the Gi-Mask isolator for silicone (ColteneWhaledent). The impression was poured in two halves and the result was a perfect match of the inner and outer part of the patients obturator and sinus cavity (Figure 6).

FIGURE 4

FIGURE 3

FIGURE 6

32 Journal of Dental Technology February 2009

To take the impression the vertical dimension was recorded and the upper obturator was mounted after making the silicone molds. The following five-step process was used to complete this stage. 1. 2. Pour the impression in silicone. This is the negative half. Pour the negative half in silicone after isolating it. Now you have the positive half. Pour the positive half in die stone (Fujirock, GC America) to produce the master model. After eliminating all the retentive areas, again fit the clear acrylic obturator into the master cast. Mount with the opposing dentition, whether it is a denture or cast.
FIGURE 5A

3.

4.

5.

After mounting is complete and the plaster has setup, it is time to create space for the soft material that will fit into the sinus cavity. This was accomplished using the following process. 1. 2. Remove the clear acrylic obturator from the cast. Remove the soft impression material at the inner part. The clear acrylic obturator is ground until necessary space was achieved. Please note that it may take several trials to make sure the space is adequate. Fill the cavity with putty (Express STD, 3M ESPE) and press the modified clear obturator onto it (Figure 7). Remove the clear obturator again, remove the putty and check for adequate thickness.

FIGURE 5B

3.

4.

At this stage, the clear obturator is ready to be replaced with the wax obturator for mounting. After securing the upper and the lower dentures, I used the previous

FIGURE 5C
February 2009 Journal of Dental Technology 33

FIGURE 7

molds made from putty to duplicate the obturator in wax and positioned it again in the master cast. This was accomplished in the following manner. 1. 2. 3. Set the teeth (Ivoclar Vivadent )on the wax. Finish the palate in the shape of the old obturator. Take a puty key to copy concavity of the palate for later use when finalizing the appliance. Carve the palate and empty it before curing. Angle the edge of the opened palate to act as support in order to prevent misplacement of the opening cover when curing it.

4. 5.

The completion of the first stage of flasking and curing was done in the following way. With the obturator still in the cast, it is invested in a usual manner. 1. 2. Invest the lower half of the flask. Before investing the second half, cover the entire obturator starting from the inner hollow part with hard putty and wait for it to set. Invest the second half. Boil out the wax in the usual manner. Open the flask and apply separating medium (Iso 8, Bego USA), but do not remove the putty spacer from the sinus cavity. Mix the acrylic dough and introduce it into the flask. Put under pressure for at least 30 minutes.

3. 4. 5.

6. 7.

FIGURE 8

Because the soft material reline is not fluid, it is necessary to make sure that the hard acrylic is stiff enough so not to deform while pressing it. The second stage of flasking and curing was finished this way.

34 Journal of Dental Technology February 2009

1. 2. 3. 4. 5. 6.

After 30 minutes open the flask again. Remove the sinus spacer. Apply separating medium to the sinus cavity. Fill with soft reline material (Molloplast B, Detax). Put under pressure for five minutes with the use of cellophane sheet. Reopen the flask again and remove cellophane sheet, cut excess and close flask. Cure the entire unit for no less than 112 hours. Let flask cool down and open it.
FIGURE 9A FIGURE 9B

7. 8.

At this stage the obturator is taking shape and the different pre-prepared molds and stages are paying off. The hollow bulb palatal plate was manufactured using this process. 1. 2. Deflask and check for defaults. Remove the putty layer, which fills the hollow bulb and covers the denture. Refine and adjust in the usual manner.

3.

The work was almost done. All that was left was the palatal cover. I filled the hollow part with putty and shaped it with the palatal key already copied from the old obturator. The putty was covered with a sheet of wax (Figure 8). A handle was made to make it easy to remove (Figure 9A and 9B). The edges were checked to ensure they were well engaged. It was removed and processed in the conventional way. After processing the palatal cover it was tried back in its place. Because no adjustments were necessary, it was finished and polished this way. 1. Mix self curing resin (Lucitone 199, DENTSPLY).
FIGURE 10A
February 2009 Journal of Dental Technology 35

2.

Fill the edges of the opening and place the palatal cover edge to edge. Put pressure by hand while fixing it. When the resin is no longer shiny, place it in a pressure pot. Remove it after 20 minutes. Grind excess and polish.

3. 4. 5.

FIGURE 10B

The final obturator was a success (Figures 10A-10D). The patient reported a much improved comfort level with the new appliance. Though it was bigger in shape because of anatomical changes, it actually weighed less. Processing hollow obturators are always a challenge but with the right technique the result can be successful in terms of function and esthetics.

FIGURE 10C

About the Author:

Al Arja graduated in 1989 from Odonto Technology institute- Baabda, Lebanon. He opened his laboratory in 1990, has attended many continuing education courses and holds certificates from Ceramco, Ivoclar Vivadent, Bego, Cercon and Nobel Biocare. Since 2005 he has been deputy dental laboratory supervisor and senior prosthetic technician at a private hospital in Saudi Arabia.

FIGURE 10D

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36 Journal of Dental Technology February 2009