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.
_____
Grorw
D.%
to
U. !‘*;ilc~:,