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An oral rehabilitation technique utilizing copper band impressions
I. LINKOW, B.S., D.D.S. Km: Gardens Hills. N. Y.
LEONARD
TECHNIQUE of Wing copper band impressions as tranSfer copings iS vduable for immediate revelation of parallelism of preparations, for accurate transfer of copings, and for duplication of the prepared teeth. The procedure eliminates the error often encountered in the transfer of dies to distorted wax or plaster records and also eliminates the visit necessary for the try-in of metal transfer copings, A three appointment, step by step procedure for a permanent complete mouth splint will be dIescribed.
T
FIRST
HE
APPOINTMEN’
Complete alginate ( irreversible hydrocolloid) impressions are made of both dental arches for a twofold purpose : i’ 1,) co that a duplicate temporary acrylic resin @int can be fabricated and (2 i to secure diagnostic casts. Lines are drawn on the patient’s face and continued onto the tray with indelible pencil to facilitate the replacement of the impression for splint construction a,fter the teeth are prepared (Fig. 1 ‘I The abutments are prepared except for one or two posterior teeth that are in o~ch~sion with the teeth of the opposite jaw (Fig. 2‘). The unprepared teeth aid in making jaw relation records. Modeling compound impressions are made in copper bands, and after checking each CMP for accurate finishing- lines and scraping off the excess modeling compound. the bands are reseated on the prepared abutments (Fig. 3). The- hands are ligated in a continuous fashion with 24 gauge dead soft brass wire. The brass wire must contact the copper bands and not. the modeling compound. Three inches of wire is extended freely beyond the 1as1Iigated copper band to make contact with the anode of the copper-plating instrunient (Fig. 1). .\ luhricatetl aluminum tray is filled with plaster, and a plaster index is made over all of the copper hands. The impression is cooled sufficiently to prevent distortion of the modeling compound impressions and removed (Fig. 51. A thin war inrvrocclusal centric relation record is made. A temporary acrylic resin splint is then fabricated using the original irreversible hydrocolloid impression. The powder is placed into the impressions of the teeth, and liquid is added until the powder is saturated. The impression is reseated in the mouth using the few unprepared teeth and the indelihle pencil marks (Fig. 1) as guides.
z!r%,‘, ‘4’
COPPER BAND
IMPRESSION
REHABILITATION
TECKNIQUE
717
Fig. 1. Fig. 2. Fig. I.-An irreversible hydrocolloid impression is in place in the mouth. The blue reinsertion of the impression for fabricatim on of a tempo lrary indelible pencil *narks facilitate acrylic rm esin splin It after the teeth have been prepared. abutment teeth are prepared. Two molars are not prepal red, since they are Fig. 2.-The used to %assist in nflaking accurate jaw relation records. Fig. 3.
Fig. 4. Fig. X-The copper band impressions are in position on the prepared teeth. Fig. 4.-A piece of 24 gauge dead soft brass wire is ligated to the copper bands,
LINKOW
J. Pros. Den. July-August, 1961
-4fter the acrylic resin has cured, the impression is removed. The splint is trimmed and cemented in the mouth with zinc oxide-eugenol cement (Figs. 6 and 7). The splint should fit the gingival tissues properly and should duplicate the original teeth so closely that it can be used as a guide in making the interocclusal record after the remaining teeth have been prepared. However, when this procedure is difficult, the unprepared teeth on the second side are used as a guide to perfect the occlusion of the completed crowns on the first side. Then the completed crowns are used as a guide in making the interocclusal record for the prepared teeth on the second side. IXBORATORY
PROCEDURES
The aluminum tray is separated from the plaster index containing the modeling compound band impressions. The terminal 3 inches of the brass wire is attached
Fig. %.--The copper band modeling
compound
impressions
are in place in the plaster
index.
to the anode of the copper-plating instrument, the entire mass is immersed in the sohnion, and the plating process is allowed to continue overnight. Only the copper hand impressions will be plated (Fig. 8). 1)owel pins are the most desirable and adaptable for die attachments with this technique. The copper-plated modeling compound impression bands are filled with acrylic resin, and then the dowel pins are placed in the resin. No trimming of dies i’: necessary (Fig. 9 j r2n artificial stone counter cast is poured into the plaster index which contains the lubricated dowel pins. The stone cast is separated from the plaster index, and ,ilie copper-plated dies should be perfect duplicates and positioned exactly as the prepared teeth in the mouth (Fig. 10). The dies are waxed, and the castings are rnmpleted (Fig. 11). In most instances, the occlusal plane is re-established with the remaining natural teeth as a guide. Castings are not constructed at a level above the highest remaining natural tooth.
i.zl%:rY
COPPER BAND IMPRESSION
REHABILITATION
TECHNIQUE
719
Fig. 6.
Fig. 9.
Fig. 7.
Fig.
Fig.
Fig. 11.
8.
Fig. &-The acrylic resin splint is ready for temporary cementation in the mouth. Fig. ‘I.-The acrylic resin splint is in place ln the mouth. Fig. I.-The copper-plated modeling compound band impressions are in the plaster index. Fig. 9.-Dowel pins are inserted into cold-curing acrylic resin, which is placed in the plated impressions of the prepared teeth. Fig. lO.-The dies have the same relation to each other as the natural teeth. Fig. Il.-The completed castings are on the artillcial stone cast.
J. Pros. Deu. July-August, 1961
LINKOW
Big.
SECOND
lZ.-The
abutment
castings
are in place
in the mouth.
APPOINT,MEXT
The abutment castings are fitted on the prepared teeth (Fig. 12)) and a thin, accurate interocclusal wax record is made and removed. h complete plaster itideA !!~a{ includes the entire dental arch with the castings in place is made. <~OMPLETTNG
THE
RESTORATION
The castings are soldered to one another, and pontics and facings are added wherever necessary (Fig. 13 j. The complete mouth splinted restoration is inserted on the third appointment (Fig. 14).
The advantages of this technique are ( 1 I elimination of complicated maxillomandibular registrations and complex articulators, (2 j obviation of guesswork in seating dies in distorted wax records, (_3) accurate interocclusal records, (4) fewer
Fig.
I?.-The
crowns
are soldered
together,
and facings
and pontics
are added.
~rzr‘d
COPPER
BAND
IMPRESSION
REHABILITATION
TECHNIQUE
721
patient appointments, (5) accurate duplication of the prepared teeth, (6) immediate check on the parallelism of preparations, (7) good tissue retraction from the copper bands, (8) a minimum of patient discomfort, (9) elimination of receding gingivae around ill-fitting temporary fixed resin splints, (10) elimination of drifting of prepared teeth, and (11) ccclusal reduction of high castings. DISADVANTAGES
OF THE
TECHNIQUE
The disadvantages of this technique are (1) the need to cool the plaster index before its removal to prevent distortion of the modeling compound, (2) the possibility that the plaster index :may break during separation if the inside of the aluminum tray is not lubricated, and (3) failure of the impressions to become copper plated if the brass wire does not contact the copper bands.
Fig.
14.-
The com:pleted
restoration
is in place
in the mouth.
Two of the disadvantages are easily corrected. If the metal tray will not separate from the plaster index, the entire surface of the tray is covered with wax and the entire mass is placed in the plating solution. When some of the modeling compound impressions do not accept the copper plating, the plating index is removed from the solution and the plaster is carefully removed to expose the unplated copper bands. The brass wire is wrapped around these bands, the free end of the wire is attached to the anode, and the index is once again immersed in the plating solution. CONCLUSIONS
Simple theories and uncomplicated methods are efficient and produce excellent results in complete mouth rehabilitation. The technique described is simple and permits accurate orientation of dies through the use of modeling compound copper band impressions. 71-17 150TH ST. KEW GARDENS HILLS LANG ISLAND 67, N.
Y.
LEONARD
TECHNIQUE of Wing copper band impressions as tranSfer copings iS vduable for immediate revelation of parallelism of preparations, for accurate transfer of copings, and for duplication of the prepared teeth. The procedure eliminates the error often encountered in the transfer of dies to distorted wax or plaster records and also eliminates the visit necessary for the try-in of metal transfer copings, A three appointment, step by step procedure for a permanent complete mouth splint will be dIescribed.
T
FIRST
HE
APPOINTMEN’
Complete alginate ( irreversible hydrocolloid) impressions are made of both dental arches for a twofold purpose : i’ 1,) co that a duplicate temporary acrylic resin @int can be fabricated and (2 i to secure diagnostic casts. Lines are drawn on the patient’s face and continued onto the tray with indelible pencil to facilitate the replacement of the impression for splint construction a,fter the teeth are prepared (Fig. 1 ‘I The abutments are prepared except for one or two posterior teeth that are in o~ch~sion with the teeth of the opposite jaw (Fig. 2‘). The unprepared teeth aid in making jaw relation records. Modeling compound impressions are made in copper bands, and after checking each CMP for accurate finishing- lines and scraping off the excess modeling compound. the bands are reseated on the prepared abutments (Fig. 3). The- hands are ligated in a continuous fashion with 24 gauge dead soft brass wire. The brass wire must contact the copper bands and not. the modeling compound. Three inches of wire is extended freely beyond the 1as1Iigated copper band to make contact with the anode of the copper-plating instrunient (Fig. 1). .\ luhricatetl aluminum tray is filled with plaster, and a plaster index is made over all of the copper hands. The impression is cooled sufficiently to prevent distortion of the modeling compound impressions and removed (Fig. 51. A thin war inrvrocclusal centric relation record is made. A temporary acrylic resin splint is then fabricated using the original irreversible hydrocolloid impression. The powder is placed into the impressions of the teeth, and liquid is added until the powder is saturated. The impression is reseated in the mouth using the few unprepared teeth and the indelihle pencil marks (Fig. 1) as guides.
z!r%,‘, ‘4’
COPPER BAND
IMPRESSION
REHABILITATION
TECKNIQUE
717
Fig. 1. Fig. 2. Fig. I.-An irreversible hydrocolloid impression is in place in the mouth. The blue reinsertion of the impression for fabricatim on of a tempo lrary indelible pencil *narks facilitate acrylic rm esin splin It after the teeth have been prepared. abutment teeth are prepared. Two molars are not prepal red, since they are Fig. 2.-The used to %assist in nflaking accurate jaw relation records. Fig. 3.
Fig. 4. Fig. X-The copper band impressions are in position on the prepared teeth. Fig. 4.-A piece of 24 gauge dead soft brass wire is ligated to the copper bands,
LINKOW
J. Pros. Den. July-August, 1961
-4fter the acrylic resin has cured, the impression is removed. The splint is trimmed and cemented in the mouth with zinc oxide-eugenol cement (Figs. 6 and 7). The splint should fit the gingival tissues properly and should duplicate the original teeth so closely that it can be used as a guide in making the interocclusal record after the remaining teeth have been prepared. However, when this procedure is difficult, the unprepared teeth on the second side are used as a guide to perfect the occlusion of the completed crowns on the first side. Then the completed crowns are used as a guide in making the interocclusal record for the prepared teeth on the second side. IXBORATORY
PROCEDURES
The aluminum tray is separated from the plaster index containing the modeling compound band impressions. The terminal 3 inches of the brass wire is attached
Fig. %.--The copper band modeling
compound
impressions
are in place in the plaster
index.
to the anode of the copper-plating instrument, the entire mass is immersed in the sohnion, and the plating process is allowed to continue overnight. Only the copper hand impressions will be plated (Fig. 8). 1)owel pins are the most desirable and adaptable for die attachments with this technique. The copper-plated modeling compound impression bands are filled with acrylic resin, and then the dowel pins are placed in the resin. No trimming of dies i’: necessary (Fig. 9 j r2n artificial stone counter cast is poured into the plaster index which contains the lubricated dowel pins. The stone cast is separated from the plaster index, and ,ilie copper-plated dies should be perfect duplicates and positioned exactly as the prepared teeth in the mouth (Fig. 10). The dies are waxed, and the castings are rnmpleted (Fig. 11). In most instances, the occlusal plane is re-established with the remaining natural teeth as a guide. Castings are not constructed at a level above the highest remaining natural tooth.
i.zl%:rY
COPPER BAND IMPRESSION
REHABILITATION
TECHNIQUE
719
Fig. 6.
Fig. 9.
Fig. 7.
Fig.
Fig.
Fig. 11.
8.
Fig. &-The acrylic resin splint is ready for temporary cementation in the mouth. Fig. ‘I.-The acrylic resin splint is in place ln the mouth. Fig. I.-The copper-plated modeling compound band impressions are in the plaster index. Fig. 9.-Dowel pins are inserted into cold-curing acrylic resin, which is placed in the plated impressions of the prepared teeth. Fig. lO.-The dies have the same relation to each other as the natural teeth. Fig. Il.-The completed castings are on the artillcial stone cast.
J. Pros. Deu. July-August, 1961
LINKOW
Big.
SECOND
lZ.-The
abutment
castings
are in place
in the mouth.
APPOINT,MEXT
The abutment castings are fitted on the prepared teeth (Fig. 12)) and a thin, accurate interocclusal wax record is made and removed. h complete plaster itideA !!~a{ includes the entire dental arch with the castings in place is made. <~OMPLETTNG
THE
RESTORATION
The castings are soldered to one another, and pontics and facings are added wherever necessary (Fig. 13 j. The complete mouth splinted restoration is inserted on the third appointment (Fig. 14).
The advantages of this technique are ( 1 I elimination of complicated maxillomandibular registrations and complex articulators, (2 j obviation of guesswork in seating dies in distorted wax records, (_3) accurate interocclusal records, (4) fewer
Fig.
I?.-The
crowns
are soldered
together,
and facings
and pontics
are added.
~rzr‘d
COPPER
BAND
IMPRESSION
REHABILITATION
TECHNIQUE
721
patient appointments, (5) accurate duplication of the prepared teeth, (6) immediate check on the parallelism of preparations, (7) good tissue retraction from the copper bands, (8) a minimum of patient discomfort, (9) elimination of receding gingivae around ill-fitting temporary fixed resin splints, (10) elimination of drifting of prepared teeth, and (11) ccclusal reduction of high castings. DISADVANTAGES
OF THE
TECHNIQUE
The disadvantages of this technique are (1) the need to cool the plaster index before its removal to prevent distortion of the modeling compound, (2) the possibility that the plaster index :may break during separation if the inside of the aluminum tray is not lubricated, and (3) failure of the impressions to become copper plated if the brass wire does not contact the copper bands.
Fig.
14.-
The com:pleted
restoration
is in place
in the mouth.
Two of the disadvantages are easily corrected. If the metal tray will not separate from the plaster index, the entire surface of the tray is covered with wax and the entire mass is placed in the plating solution. When some of the modeling compound impressions do not accept the copper plating, the plating index is removed from the solution and the plaster is carefully removed to expose the unplated copper bands. The brass wire is wrapped around these bands, the free end of the wire is attached to the anode, and the index is once again immersed in the plating solution. CONCLUSIONS
Simple theories and uncomplicated methods are efficient and produce excellent results in complete mouth rehabilitation. The technique described is simple and permits accurate orientation of dies through the use of modeling compound copper band impressions. 71-17 150TH ST. KEW GARDENS HILLS LANG ISLAND 67, N.
Y.