Bete Ctl § Gags § pote Re FO ANC (4 ALA TdHINOD BO eeeAlginate impressions 2 - 32 Alginate can be used to record impressions where there are undercuts. It may be used in a stock tray which should be coated with 2 suitable adhesive. Upper impression tray loaded with alginate. 34 The loaded tray should be seatad first at the back of the ‘mouth, and then lifted gently at the front. Note the position of the upper lip. Once the tray has been seated the patient should be asked to make functional movements of the cheeks and lips, and move the jaw from side to side. 33 The escape of alginate from the back of an upper impression tray may be minimised by placing strip of carding wax on the fitting surface. Reey 35 The completed alginate impression.36 Tt can sometimes be helpful to prepack (preload) areas of 37 Prepacking adjacent to the maxillary tuberosities can also the mouth where the impression may be underextended be advantageous. Tbecause of deficiencies of the tray, or where air may be trapped. Such an area is the anterior part of the palatc. 39 Once the material is in place, the first spatula may be Temoved and the second retracted, keeping it pressed against the ridge so that the impression material is ‘wiped off into the [38 Prepacking the lingual pouches is best carried out using eas two spatulae — onc to retract the tongue. the second to insert the impression material 4Recording secondary impressions Secoadury impressions are made to improve on the primary impressions. A superior result is possible because special trays are used. The design of these varies with the impression technique, but they should be rigid, evenly spaced from the mouth, and capable of being adjusted to the optimum extension. Sccondary impressions arc commonly recorded in close-fitting special trays using a two-stage technique. This involves first making 2 record of the width and depth of the functional sulcus, using greenstick compound traced on the tray periphery. An overall impression is then made in the modified tray with zinc oxide-cugenel paste. If the patient has a very dry mouth an elastomeric impression material (‘elastomer’) should be substituted fer the zine oxide- sugenol paste, because this material is less likely to adhere to the tissues. Elastomeric materials may also be used with bencfit where there arc lange undercuts. AU the cnd of this visit the impressions should be retuned to the technician with a prescription for the record rims and bases, Table 1 Recommended spacer to be used when constructing spacial ‘trays for some commonly used impression materials. Impression material Spacer Zinc oxide-eugenol paste 0.5mm Alginate 3.0mm Plaster 1.5mm Elastomeric 0.5-1.5mm (Depending on viscosity)40 Instruments and materials used when recording secondary ‘impressions, 41 Acrylic resin impression trays constructed on the primary casts with a 0.5 mm thick wax spacer, for use with zine oxide-eugenol paste. Note the location of the handles and finger rests. The handles should be small and vertical so as not to interfere with the action of the lips. 16 Fig. 40 spatula Paper mixing pad on glass block Zinc oxide-eugenol paste Proprietary paste remover Alcohol torch Bunsen burner and matches Denture bowl, bib and chain Mouthwash Nepkin and mirror | Laboratory prescription card and plastic impression bag indelible pencil Straight handpiece and burs Special trays Tracing compound Trimming knife Wax knife Large pair of scissors Le Cron carver Scalpel 42 The finger rests are used to seat the lower impression tray, and hold the fingers clear of its periphery so as to avoid distortion of the sulci.43 The impression tray should be checked in the patient’s 44 The tray should be some 2 mm short of the functional ensure that if has the correct extension. sulcus (arrowed). This tray is 61 ded. 45 The tray should be reduced until it has the correct 46 Correctly extended impression traya7 47 ‘The posterior border of the upper tray should extend as jon between the fixed and moveable parts of This is usually in the region of the fovea palatina and should he de d with an indelible pencil 49 A slot is then cut, with a fissure bur, into the posterio: border of the tray us far forwards as the mark. 448 The pencil mack is transferred to the fitting surface of the impression tray when it is seated in the mouth 50 The tray should then be reinserted in the patient’s mouth, and the patient asked to say ‘ah’. Te will be possible to see whether the anterior part of the slot is cvin vibrating line. If not, it may be extended furth however, the slot is extended too far forwards, then the line will be scen clearly Id be marked oa the tray with an indelible peril of the tray is then trimmed to coi vibrating line.Wy $1 The buceal extensios tray is then checked ina similar fashion, Posterioriy, it should extend across the retromolar pad until it lies just short of the mobile tissucs anterior to the ascending ramus of the mandible asking the patient to procrude the to to side. and put the tip of the tc litts then it should be redu s $4 It may then be tray ‘d readily ak soft the periphery of the 19adapted with the fingers to correct 55 The material may any minor irregularit this process the compound tends to become st should therefore be softened with an alcohol torch, © care not to burn it 57 Betore being be tempered in the water bath, and checked with the operator's fingers. ed in the mouth the compound should 58 I the impression material is rigid when it is inserted, or me inte contact with the tissues, thea it will have a59 Compound which has been mouled by the tissues will from side to Side $0 as to n impression of the sulei as they are have a matt surface narrowed by the coronoid processes. should then be inserted in the patient's mouth and the 60 Excessive compound on the fitting sur S. pull down the lip, and move tte jw gadily removed wth a scalpel. A simisr impression is then mad ‘opposite side, and compound finally placcd alon; posterior border of the tray on the fitting surface, s0 as to produce displacement of tissues in she post-dam region ice of the impression tray is The impression patient wsked to suck in the ch 12 Saft 61 The completed upper tracing. The greenstick compound at the Posterior border should be trimmed to the back cdge of the impression tr ly indicate the palatal extension af the denture. ‘This clatively little alveolar resorption and the ore comparatively narrow al aspect of tuberosity fac coronoid ss of the mandible during lateral ex: functional sulcus was the ursions of the jawv 68 Gi the mouth The impression of th asking th: snstick compound is then traced along a section of the lower impression tray, tempered. and the tray ins reed int functional buccal sulcus is made by patient ta suck in the checks. i i 65... move it to the left and right 64 The lingual sulci are recorded by asking the pati the tip of the tongue to 1 6 nt to put back of the mouth and press the lips together and swallow. Note the position of the operator's fingers on the finger rests. The thumb to support the mandible during thesePAYLUT] SUOHOIIIGNY |ODIPSYy S4OA\A uopuoy ‘joydsoH jojuag UOUWYSOz “tuoynsuod Aso1OUOH] Puc Ug_UOT {oO Aysusaiup) ‘AvaBing joyuag Jo ANYSUP ‘Aussyusg Waysscig #0 JuawLDdsg a4) J POSLy PUD sOssajOIg (upg puo -8u3) sousay ‘sag ‘aud GOH “YT Seinjuagq ajajduo7 jo SDI AINOJOD v senbiuyse) joyueq67 The impression of the lingual and buccal sulci 69 Having completed the tracing of impression trays, a thin wash of zine 9 then plas the compound so that any miaur errors be corrected. Equal lengths of the zine oxide and cugenol based pastes are extruded on to a mix 68 The completed lower traci 70... and thoroughly mixed an homogenous mass.71 A thin layer of paste is then smeared on the greenstic ound. Note that this should not be placed in th jam region. ‘The impression tray is then placed in the mouth and the “functional” movements uscd to mould the 73. Areas of heavy contact are indiezted by penetration of the paste. 72 The c 34 The underlying these areas hetore the mmpleted peripheral ‘washes’ pound should be cut b inal impression is recor.76 Excessive paste which border of the upper tray, should be avoided. The impre with slightly warm lent encouraged to ms ent paste wed beyond the posterior buck to the compound pel, so as to avoid [recluring the before 77 Note the thin layer of impression region. Excessive paste indicates failure impression tray fully, and thus produce the displacement, (sce 83) 78 Completed upper and lower impressionsProblems 79 and 80 Small defects m: local addition of pink wax. 82 Local penctratic tray indicates @ faulty primar which has been made without ted This def of the paste by the impression t must be corrected by grinding rial and removing all epeating th the 893 Failure (0 scat the impression tray fully in the pest-dam region produces a thick laver of paste in this area. An adequate post-dam seal should then be produced by trimming the master cast at a Tater Mage (sce 209) BL Large ai by placing bubbles such as this. may be con @ small amount of zinc oxide only enough paste to fill the dete, p will be produced inAlternative impression techniques a4 cedure may be used to deal splaceable tissuc. The plaster ue employs a conventional impression tray constructed for use with inc oxide-eagenol paste. A window is cur in the tray over the displaceable tissue ¢ impression robiem of locall the soft tissues ia the 17 Impression plaster is next run88... until the displaceable tissue is cover 90 The localised addi mucostatie impression 0 d jon of plaster has produced 2 the displaceable tiscue. 89 The completed composite impression 91. A similar proce elastom eat in ic umpression material. In this case jure may be carried out using 3a awindow is aot impression tay, which is border-moulded with greeastich compound in the usual fashion93 Excessive impression matterial will escape through the relative mueo. holes in the impression tray. resultiny impression of the “flabby” tissue, aad displacement elsewhere 92 The impression is then completed with a relativ elastomeric impression material. Whea set, this is removed he arca where it is desired to produce 4 mucostat Impression. Holes are then drilled through the impression ¥ in this region (arrowed). The entire impression i nex filled with a light-bodied elastomeric impression material, of ¢ same chemical type as the original, and the impression 95 A completed plaster impression. This material is rigid tissue displacement (sce 84-90) techniue with this when set bul causes minima Itis sometimes helpful to use a preloadin material (sec 36-39)Recording jaw relationships At this stage the rclationship i recorded of the mandible to the manilla at the desired occlusal vertical dimension (OWD), with the jaw on the retruded condylar axis (RCA). This is done with record rims, which are also trimmed to prescribe the positions of the denture teeth, which should be selected at this stage. The rims are normally made from modelling wax which should pre! on either temporary or ‘permanent’ acrylic bases At the end of this stage the record rims, face bow and prescription for the trial deatures are sent to the technician! 97 Wax record rims on temporary acrylic bascs uscd for recording jaw relationships. These shouk! be Checked in the mouth in lum and any peripheral discrepancies idenufied and corrected. 30 96 Instruments and materials » the jaw relationships. 98 and 99°The occlusal. buccal an the record rims may be readily adjusted with an clectrically heated trimmer, or a hot paint sc labial surfaces of d when recording Fig. 96 Electrically heated record rim trimmer Mould and shade guides for artificial teeth Alcohol torch Proprietary paste remover Bunsen burner and matches Denture bowl, mouthwash, bib and chain Paint scraper Laboratory prescription card and plastic denture bag Recard rims on acrylic bases Master casts Straight handpiece and burs Face-bow Flexible mm ruler and indelible pencil Staples and Adams" pattern pliers Dividers Trimming knife, wax knife and Le Cron carver Willis gauge Figure-of eight callipers Occlusion registration paste, mixing pad and spatula Mirror and napkin Occlusal plane guideAdjusting the rims 100 100 and 101 The upper record rim is placed in the patient's mouth, and trimmed so as to provide an appropriste degree of labial support. Where this is inadequate, a3 here, the Patient's face will tend to appcer flat and the nasolati obtuse 102 and 103 An adequate degree of labial support will result in a more pleasis 101104 The incisive papilla Ties over the incisive 105 Following alveolar resorption. the incisive ¢ 4), and forms @ useful guide to the te lic on the ridge crest, xs does the cl of the upper anterior should be some 10 mm in front of the sons of their natural predecessors will Tie buccal and labiel to the residual alveolar ridge. The record rim shox to indicate the position of both anterior and posterior teeth. 107 106.10 109. pair of figure-of- useful methed of com, ‘occlusal plane on the rec: patient's exist 2 dentures.Contents Preface Recording primary impressions Recording secondary impressions Recording jaw relationships Trial dentures Denture insertion The review appointment Additional techniques Alternative denture bases Rebasing a complete denture Temporary modifications to dentures Tissue conditioning materials Ocelusal stops Denture copying Further reading Index 30 47 66 67 7 1% 78The level of the upper occlusal plane is a matier of judgement, although normally it should lic appronicnately mm below the lower margin of the upper lip when the patieat A little lower in patients with short lips, a littl i the elderly and those with long lips 110 Having decided upon the level of the upper anterior teeth, the mim should be trimmed so that the occlusal plane is Parallel wath the ala-trayal line (marked). and with the teeth appearing level in the mouth from side to side. This will uuswally mean placing them parallel with the inter pupillary line 111 and 112 An occlusal plane guide provides « uscful method of assessing the position of the occlusal plane in relation to the face 313 14 's head is reclined in relation har at will meet the upp: thea 2 faulty reading will be ebtaincd. ‘OVD. The Willis gauge provides 2 uscful guide to th assessment of the correct vertical jaw relationship. It should be used with the paticnt upright amd with the head i the trunk. Note th m has heen beat neck the body the sliding 2 LIS Errors. will also occur if the excessively is tilted ards 116 An_ alternative ationship of the ya pair of dividers to dots marked on the nose and chin. method of determining he vertical to emplus 120 119 and 120 Failure to provide an adequate OVD « in the anterior mandibular ridge assuming 2 more labial relationship to the upper ridge. a results121 Patients with inadequate freeway space also have a characteristic appearance. The face appears lengthened, and the lips can he seen struggling to produce a labial seal. 122 w 124 Where paticnts have become accustomed to a large freeway space over many years, increasing the OVD should be carried out with caution. even though it may be theorctically ideal to do so.used to retract the lower lip, with supporting the chin the labial aspect of the upper record r 126 The thumb and firs eft hand are used (0 stabilize the lower record rim, which then slides gently past them, enabling the operator to assess visually. and by touch, whether the rims are mecting evenly. Al the same time. the paticnt is ‘asked (0 put the tip of the tongue st the back of the fh, which helps to keep the mandible maximally retruded. In this case there is a posterior premamare contact. andearried — between the Tims on ci and the mandi The pat 127 The rims should meet evenly all the way round the arch. As this can be difficult to achieve, an .e-point contact, anteriorly 1er side of the arch. is acceptabl is then trimmed labially. indicate the positions of and posteriorly on le. The lower rien uecally and fingually to markedom 129 Marks are also made across the junction icf sidke, while they are in le is maximally retraded ‘should then be asked to close the rims together several times, to check that retruded has been obtained.Relating the rims 131 132 the occlusal surface olar region using 2 130 The rims may then be joined logether usin: 1BI_ Vertical slots are then cut office staples. which should be oasto of the lower record rim in the n avoid the possiblity of a staple unknowingly being bot wax knife. swallowed or inhaled by the patient ghly chilled to avoid displacement of the es. Both rims arc then placed in the patient's mouth, and brought together with the mandible maximally retruded. x A page 134 135 and 134 The rclationship of the rims is next ‘checked, allowing for parallax errors, and they are ‘then joined together by pressing two staples across their junction on either side.135 ‘of the first fingers of ci \@ are next placed below the periphery of the lower rim while the patieat opens the mouth. This prevents the rims being pulled apart. 1397 137 A check must be made that there is ao interference 138 The record rims are then sealed together lingually with a posteriorly. If there is, them the base must be trimmed and the hot wax knife Procedure repeated.An altemative method ding medium be! t the blocks may be or record a aun of rel ber of d 140 | 140 When using paste, this should be smeared on the lower rim, the rims placed in thc mouth and the paticnt asked to bring and bold them together in the retruded position. Care pes not slide the rims over must be taken that the patient ef at this stage. cr ix sme: 139 Grooves are cut in the rims, and the upy with a separating medium, such as vz iam 141 MI The techaique is essentially similar when using softened wax, except that the lower rim should be trimmed vertically allow for the thickness of the wz143 The rims are then removed, and the wafer trimmed, Note the shallow indentations in the wax. and that the wafer has been reduced buccally 14 _ Id water spray 145 144... te facilitate checking 145 When a patient protrudes the mandible with resoed rims in the mouth, a gap is created posteriorly which is related to the condyiar angle. This effect is known as the Christensen Phenomenon, and a wax wafer placed in the gap to record its dimensions may be subsequently used to set the condslar angles on an articulator (see 188) 41The face-bow 1146 ‘The facc-bow is an adjustable calliper, uscd to record the lationship of the m F sbital pointer on the lower 148 ‘The condylar pointers are placed over the RCA, and adjusted so that the bow is symmetrical about the condyles. Some designs of face-bow use intra-auricular pointers for location, teens be wae 6 im, and the entire wssembly then plu prevent excessive deformation of the wax. 149 A completed face-bow record 49Fig. 1 ‘Thermostatically controlled water bath containing compound — 4 Alcohol torch Bunsen burner and matches Denture bow! Mouthwash Napkin and mirror Laboratory prescription card and plastic impression bag Stock impres Trimming knife Wax knife Large pair of scissors Patient's bib and chain 1 Instruments and materials used for recording primary impressions, 2 ‘The upper denture-bearing area is hounded laterally and 3 The lower denture-bearing arca is bounded by the anteriorly by the functional sule. Posteriorly itis limited by functional sulci, und posteriorly on each side by the activities he hamulur notches and the junction heween the fixed and of the buecinator muscle us it erosses the ascending ramus of moveable purls of the palate (vibrating tine) the mandible, It usuully ends at leust halfway aeross the retromolar pads, which should be fully recorded by the impression150 ether. the cen joined to, ISI When the record rims have net fork is covered with softened wax, accurately the record rims, an hare then set u thus the casts, on the articulate. The produce trial dentures. 152 shed dentures it nd and pressed ith trial or fi 153 If the fork is being used should be covered with softened compoi 152 It is then pressed against the occlusal surface of the upper with a separating medium, K 10 be located against t record rim, which has heen cuate: cord rim enable the 3 V-grooves in the155 te a ‘Using this procedure. the fork should be held in place by tic’ The projection of the RCA onto the faze may be located by palpation, or the use of & hinge-axis locator. More nmonly, a point 12 mm in front of the most posterior part to te ouier canthus of ked with water-based ink 156 and 157 The condylar pointers are then placed on the ks and the fuce-bow adjusted until its symmetrical about the head, as indicated by the scales oa each pointer.158 160 fi 158 While an assist t RCA, the bow is fixed to universal joints, ids the condylar pointers on the oni of the ¥ 159 ‘The lower border of the eft bony and the orbital pointer positioned ov it is then palpated 161 ‘The completed feec-bow record. The tightness of the universal joints should be checked before the162 Teeth of an appropriate matcrial, mould and shape are then selected, 164 a AA A ds 164 Artificial teeth tend to be much smaller than thei natural predecessors, and a less false appearance is often obtained by using the larger tecth i ‘particular shadecan mouth, Darker tecth PT ek: Arvin ee rr re is. ee 165 Large angular teeth tend to look more “masculine” than small, rounded ones.Trial dentures Trial dentures provide dentist and patient with an opportunity of assessing the probable result of complete denture treatment. The paticnt will usually be concerned principally with appearance, however, the dentist should use the aecasion to chack all the features which he plans to incorporate in the dentures. ach trial denture should be inserted in turn, and a note made of the base extension, the relationship of thc tecth to the soft tissues, the position of the occlusal planc. and the mould, shade and arrangement of the teeth. Both trial dentures should then be inserted and the jaw registration and the patient's appearance checked. ‘At the end of this stage the trial dencures should be returned to the technician with a prescription for their modification, or construction of the completed dentures. 167 Upper and lower trial dentures on acrylic bases. 166 Fig. 166 < Prescription form and plastic denture bag Trial dentures, master casts and articulator ‘Bunsen burner and matches Bontre. bowl, mouthwash, wD - Bo and chai Hand mirror Pink wax Dividers, wax knife and ‘Le Cron carver —=_ NSS eae es ae ere — Willis gauge 168 The trial dentures should be mounted on an : . articulator so that the dynamic relationships of the ie ain tezth can be checked, and to facilitate any ture stage. adjustments which may be necessary a7169 The lower denture should be inserted and its fit stabil and retention checked. Note should be made of the relationship of the tecth to the surrounding soft tissues: they should interfcre with neither tongzc nor cheeks. and their ‘occlusal surfaces should be just below the lateral margin of the tongue, im 474 It is unusual for the lower anterior tecth to be much evidence when the patient is at rest. The lower oeclusal plane is too high in this patie 170 teeth should similarly provide adequate lip of the tongue 0 The anteri support, and space for the ac 172 172 ‘The upper trial denture is then inserted and checked. Wry. four the Here. the level of the occlusal plane is satisfacte t00 far palatally, the centre line is towards teeth have been s the patieat’s right and there is inadequate labial support173 174 173 A common error is to set the tecth so thal their “apice 174 A more natural-looking result is achieved with the are apparently close to each other. This gives an artific correct angulation of the tecth. appearance. 175 176 17S and 176 If its felt that the wpper an set too low, then their ends may he masked with a black wax pencil. This makes it possible to assess the effect of moving them, without the effort of doing so 49