Double-custom tray procedure for immediate dentures

DENTAL DANIEL

TECHNOLOGY

H. GEHL,

LhxMe+cu*m

Section editor

tray

predwre

far

im

Ali Boiouri, D.M.D., D.D.S.* Baylor

College

of Dentistry,

Dallas,

Texas

I

wo common errors are made in the construction of immediate dentures, both resulting in an improper and inaccurate registration of the anterior portion of the denture flange. First, the upper lip may be displaced forward and upward causing distortion. Or, second, deep undercuts of tooth and bone in the labial alveolar ridge may prevent the dentist from sufficiently extending the impression. Consequently, borders not only may be distorted, but may be of insufficient length.lp * To prevent this problem, the dentist should be able to make a precise impression of the reflection. In this procedure, the dentist determines the length and thickness of the labial flange from the patient’s mouth by border molding procedures.l

TECHNIQUE (1) Obtain a diagnostic cast from an irreversible hydrocolloid impression in a stock tray (Fig. 1) .3, 4 (2) Adapt one thickness of baseplate wax over the cast. The wax should be 1 to 2 mm. short of the outline of the tray (Fig. 2). 3* 4 Lubricate the wax on its outer surface with petroleum jelly. (3) Fabricate a custom tray over the baseplate wax with self-curing acrylic resin in a manner similar to that for a complete denture tray.4 The wax should be left uncovered in the region of remaining natural teeth (Figs. 3 to 5). (4) With petroleum jelly, lubricate the outside of the tray around the opening space for the natural teeth (Fig. 5). (5) With a second mix of self-curing acrylic resin, make a tray over the remaining natural teeth by covering the exposed wax and approximately 2 to 3 mm. of the main tray (Fig. 6). For a secure fit of the two trays, a key and keyway are helpful.4-7 (6) Remove the trays from a cast, and separate the two trays. Remove the wax (Fig. 7). Perforate the small tray with a No. 8 bur (Fig. 8). (7) Try the first tray in the mouth and be certain of clearance for border mold*Assistant Professor, Department 344

of Removable Prosthodontics.

“N”kzmr

u

“3i

Fig.

1. The

Fig.

2. The

Procedure

diagnostic

Fig. 3. A self-curing around the natural Fig. 4. The

cast is trimmed

cast is covered

main

with

acrylic teeth.

custom

resin

tray

and

baseplate

tray

is trimmed

second

tray

is fabricated

to be used for

immediate

fabrication

dentures

345

of the tray.

wax.

is formed

over

to the proper

Fig. 5. The main custom tray is lubricated to help position the second tray. Fig. 6. The resin.

ready

for

around by

covering

the baseplate

wax

with

an open

space

Note

the anterior

keyway

self-curing

acrylic

extension.

the open the

open

window. window

with

346

Fig.

J. Yrcahet. March,

Bolouri

7. Both

Fig. 8. The

trays

are separated

second

tray

Fig. 9. The main custom Fig. 10. The main custom

Fig. 11. The

teeth

are

after

removing

is perforated

tray

is placed

has been border

lubricated

the wax.

to facilitate

tray

and

the use of irreversible

in the mouth

covered

to check

of the tissue

part

hydrocolloid.

for overextensions.

molded.

with

tinfoil

to prevent

material.

Fig. 12. An impression

Dent. 1977

in the main

custom

tray.

adherence

of impression

Volume Number

37 3

Procedure

denture. Fig. 13. The final impression for the immediate Fig. 14. The final cast shows the extreme labial inclination

for immediate

of the anterior

dentures

347

teeth.

(Fig. 9). Stops to serve as guides for the correct vertical placement of the tray can be provided in modeling compound. (8) Border mold the final tray as is done for a complete denture (Fig. 10) .4 (9) Check the fit of the second tray over the first tray after border molding is completed. (10) Lubricate the teeth and lips with petroleum jelly, and cover the teeth with tinfoil to prevent the final impression material from adhering to the teeth (Fig. 11) . The first tray is used to carry the final impression material to the mouth. (11) Remove the tray from the mouth after the impression material has set, and remove the excess material from the impression (Fig. 12). ( 12) Re-place the main impression in the mouth, seating it firmly against the tissue. Fill the perforated tray with irreversible hydrocolloid impression material, place it in the proper position, and push it into place until the two trays fit together. After the irreversible hydrocolloid impression has set, remove the whole assembly in one piece (Fig. 13) . (13) Box and pour6 the impression to obtain the final cast (Fig. 14). ing

CONCLUSIONS This double-custom tray technique is applicable for the lower as well as the upper immediate denture. This technique is especially useful for patients with labially inclined and highly mobile anterior teeth. The chance of distortion in removal of the impression from the mouth is greatly reduced. References 1. 2. 3.

Lutes, M. R., Ellinger, C. W., and Terry, J. M.: Immediate Dentures, 18: 202-210, 1967. Passamonti, G.: Immediate Denture Prosthesis, Dent. Clin. North 781-799. Ellinger, C. W., Rayson, J. H., Terry, J. M., and Rahn, A. 0.: Dentures, ed. 1, Philadelphia, 1975, Lea & Febiger, Publishers, pp.

J. PROSTHET. Am.,

Nov.,

Synopsis 277-290.

DENT.

1964,

pp.

of Complete

348 4. 5. 6. 7.

Bolouri Boucher, C. O., Hickey, J. C., and Zarb, G. A.: Prosthodontic Treatment for Edenttiil, :, Patients, ed. 7, St. Louis, 1975, The C. V. Mosby Company. Sowter, J. B., and Todd, L. S.: Dental Laboratory Technology, Chapel Hill. 1968. 1 ii: versity of North Carolina, pp. 16-21. Bolouri, A., Hilger, T. C., and Gowrylok, M. I>.: Boxing Impressions, J. PRO~~.~-IF.T. 13i I : 33: 692-695, 1975. Gehl, D. H., and Dresen, 0. M.: Complete Denture Prosthesis. ed. 1. Philadrlpiiia. :!i.r’ W. B. Saunders Company. BAYLOR COLLEGE OF DENTISTRY 800 HALL ST. DALLAS, TEXAS 75226

-ARTICLES

TO APPEAR

IN FUTURE

ISSUES - __----

Face-bow Yoshinobu

for orienting Tanaka, D.D.S.?

Effects of overdentures H. H. Thayer, D.D.S., A technique Jiro Todo.

for C.D.T.,

A comparison

placing names and E. M. Luke+ of

the

Posterior Lawrence An

unilateral .4. Weinberg.

evaluation

casting

condylar D.D.S.,

nonprecious alloy Thomas A. Wight, D.D.S.. Jr., Ph.D.

ability

of L.

precious

the

C. Bauman.

on

the use of the Denar B.D.S., F.D.S., R.C.S.(Ed.l

pantograph

nonprecious

FcZ.D.Sr..

Its

affecting John

and

Stew+

displacement: MS.

variables M.S.:

structures

bond

and

strength

D.11.S..

M,S..

and

articulator

for -in
treatment

of porcelain

R. W. Phillips, and

alloys

Dip.Ap,p.Ed.~lr~ch

diagnosis

Testing of pit and fissure sealants in the monkey J. S. Wilkins, D.D.S.. M.S.D., M. I.. Swartl, M.S.. and Observations R. B. Winstanley,

_..x..

in dentures D.D.S.

F.R.A.C.D.S.,

of four

.

ear prostheses D.D.Sc.

upon remaining oral and A. A. Caputo, Ph.D

porcelain veneering P. F. X’incent, M.D.Sc.. K. E. Basford, B.Sr.

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Grorw

D.%

to

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