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Emergency dentures
Emergency
denfures
Curtis M. Becker, D.D.S.,* Charles C. Swooper D.D.S., M.S.D.,** Conrad A. Schwalm, D.D.S.*** University of Washington, School of Dentistry, Seattle, Wash.
and
A
technique for rapid construction of an inexpensive temporary denture in emergency situations is needed. For many patients, the loss of their denture or severe denture damage which cannot be repaired means unnecessary social embarrassment. These patients are unable to carry on their social and occupational activities until a new denture is constructed. An inexpensive temporary emergency denture can be fabricated in a few hours. The patient can function with this emergency denture until a new denture can be constructed. After the new denture is in service, the emergency denture can serve as a spare denture for use during future emergencies, repairs, or relines of the more accurately made complete denture. TECHNIQUE Imfwessions. 1. Select the proper size edentulous tray, and modify the extensions with soft periphery wax (Fig. 1) . 2. Palpate the hamular notch and posterior palatal seal area, and record the outline and displacement in the chart. 3. Dry the palate with a gauze sponge, and mark the posterior extension of the denture on the palatal tissue with an indelible pencil, using the hamular notches and vibrating line as guides (Fig. 2). 4. Make an irreversible hydrocolloid impression in a stock tray. 5. Remove the impression, and check it for proper extension, iack of large voids, Read before the American
Prosthodontic
Society in Chicago,
The views expressed herein are those of the authors of the United States Public Health Service. *Graduate
student, Department
reflect
those
of Prosthodontics.
**Professor and Director of Graduate Prosthodontics. ***Graduate student, Department of Prosthodontics, Public Health Service.
514
Ill.
and do not necessarily
and Dental
Surgeon,
United
States
Volume Number
Emergency
32 5
Fig. 1. Extend
the borders of a stock edentulous
tray with
soft periphery
dentures
515
wax.
Fig. 2. Dry the palate with gauze, and mark the posterior extension on the palatal tissue with an indelible pencil. Fig. 3. Darken the indelible pencil line on the impression which represents the posterior extension, so that it will transfer well to the stone cast. Fig. 4. Scribe the anticipated
border extension
into the cast with a sharp knife.
and adequate transfer of the indelible pencil line on the surface of the impression. (Note : Impressions of this type may be overextended at the borders.) Laboratory procedures. 1. Darken the indelible pencil line on the impression so that it will transfer clearly to the stone cast (Fig. 3). 2. Pour dental stone in the impression, using slurry water as an accelerator. 3. Examine the cast, and mark the anticipated border extension with pencil. 4. Scribe this border extension into the cast with a sharp instrument or small round bur (Fig. 4). 5. Carve the posterior palatal seal into the cast, using the information recorded in the chart concerning outline and depth (Fig. 5). The posterior extension is transferred from the indelible line on the impression to the cast. 6. Construct a baseplate from cold-curing tray resin, and trim it to the borderextension scratch line. Registration and clinical try-in. 1. Attach anterior teeth, from the mold guide, to the baseplate with wax, and make adjustments in the mouth to meet esthetic and phonetic requirements (Fig.
516
Becker,
Fig. 5. Carve has transferred Fig. 6. Position Fig. 7. Establish
Swoope,
.1. I’rosthet. Dent. I\‘ovember, 1971
and Srhwalm
the posterior palatal seal into the cast. (The from the impression to the cast.) the anterior vertical
Fig. 8. Record centric
indelible
posterior
extension
linf
teeth in the mouth to meet esthetic demands.
dimension relation
of occlusion
in wax.
in wax.
6). These teeth will be recovered at the boil-out and are not incorporated in the denture. 2. Place a posterior wax occlusion rim on the baseplate, and establish the vertical dimension of occlusion (Fig. 7). 3. Add registration wax, soften the wax surface, and record centric relation (Fig. 8). 4. Select the shade, using the guide appropriate for the cold-curing tooth-colored acrylic resin to be used. 5. Dismiss the patient, asking him to return later in the day. Further laboratory procedures. 1. Carve the posterior wax occlusion rim to simulate posterior tooth shapes on the buccal surface for esthetic purposes, and complete the wax-up around the anterior teeth (Fig. 9). Note: The occlusion was formed by use of the centric relation record. 2. Carry baseplate wax down the full depth of the vestibule to facilitate the investment procedure. Adequate wax thickness is insured at the denture extension (scratch line) by checking with a periodontal probe. Wax is added where necessar) to provide several millimeters of thickness. 3. Polish and stipple the wax.
Vdume 32 Numhr 5
Emergency
dentures
517
Fig. 9. Complete the wax-up around the anterior teeth, and carve the posterior wax occlusion rim to represent posterior tooth shapes on the huccal surfaces for esthetic purposes. Fig. 10. Invest the top half of the flask, using a silicone mold-liner investment technique. Fig. 11. Use autopolymerizing (cold-curing) tooth-colored resin to form the teeth. Fig. 12. After polymerization, remove the resin teeth from the silicone mold, and trim the flash away.
Processing. Processing may be delegated to the commercial laboratory, or the dentist may find it advantageous in certain situations to process the emergency denis not needed since cold-curing resins ture in his own labortory. Sp ecial equipment are used. I. Invest the waxed denture in the bottom half of a flask in the usual manner. 2. Invest the top portion of the flask, using a flexiblr silicone invcstrnent” and dental stone.‘. z Elastic impression materials are not satisfactory for investment use. (a) Use the fingertip or small spatula to work the silicone investment material into the interproximal spaces. Use a thicker layer around the teeth and in the undercut areas (Fig. 10). (b) Immediately fill the flask \vith dental stone accelerated with slurry water. The stone will not adhere to the silicone if the silicone has begun to set. 3. Roil out the wax, retrieve the anterior teeth, and place them back in the mold guide. 4. Paint all stone surfaces with a tinfoil substitute. This separator is not needed on the silicone. 5. Use autopolymerizing (cold-curing) tooth-colored resin to form the teeth. *Dent
Kote, Dentsply
International,
Inc., York,
Pa.
Fig. 13. Pack the mold with pink autopolymerizing denture base resin. to the bead formed by the Fig. 14. Trim and polish the denture scratched
into
the cast. The
Fig. 15. Completed Fig. 16. Completed for an interim
head
emergency emergency
has been darkened
for photographic
previous purposes.
rxtcnsion
Iirlr,
denture. denture.
The
result
provides
acceptable
esthetics
and
function
period.
(a) Use a brush to add small increments of incisal shade resin, and draw it out to taper toward the gingival area. This prevents a sharp transition between incisal and body shades (Fig. 11 ) . (b) Add body-shade resin with a plastic squeeze bottle, keeping all resin saturated with monomer, (c’) Place the top half of the flask in :I pressure pot for 15 minutes \tith 100° F. water at 20 p.s.i. pressure.” (d) After the resin teeth have polymerized, remove them from the silicone mold. Trim the flash. repair defects, and observe the general appearance (Fig. 12). Do 710t polish the teeth at this titne. 6. Pack the base with pink cold-curing resin (Fig. 13), and place it in the pressure pot for 30 minutes with 100’ F. water at 20 p.s.i. pressure. (Note: Heatcuring resin can be used if time permits.) 7. lIeflask, trim, and polish the denture to the bead formed by the extension (scratch) line in the cast (Figs. 14 and 15). Delivery. 1. Remove all sharp areas on the denture surface. 2. Use pressure indicator paste to adjust the basal surfaces. X. Adjust the occlusion. 4. Arrange appointments with the patient to have a new denture constructed at a convenient time in the near future.
Emergency
dentures
519
ADVANTAGES 1. The denture can be fabricated within one day. 2. Minimal chair time and laboratory time are needed. 3. Materials normally found in dental offices are used. 4. It is not necessary to have a stock of denture teeth in the office. 5. An articulator is not required. 6. The technique is simple. 7. The cost of materials and laboratory service is low, and the fee to the patient is reasonable. 8. The entire denture can be constructed in the dental office, or some portion of the work may be delegated to a commercial laboratory. 9. The patient is very grateful to be able to return to his usual activities with minimal inconvenience (Fig. 16). 10. The emergency denture serves as an interim prosthesis while a new denture is being constructed. 11. The emergency denture serves as a spare denture after the new denture is constructed. SUMMARY A technique has been presented for very rapid construction of an inexpensive temporary emergency denture. The prosthesis is easily constructed when a denture is lost or badly damaged. More precise denture construction procedures are used later at a more convenient time. References 1. Marcroft, K. R., Tencate, R. L., and Hurst, W. W.: Use of Layered Silicone Rubber Mold Technique for Denture Processing, J. PROSTHET. DENT. 11: 657-664, 1961. 2. Reisback, M. H.: Silicone as a Denture Mold Liner, J. PROSTHET. DENT. .26: 382-386, 1971. 3. Smith, D. E., Lord, J. L., and Bolender, C. L.: Complete Denture Relines With Autopolymerizing Acrylic Resin Processed in Water Under Air Pressure, J. PROSTHET. DENT. 18: 103-115, 1967. DEPARTMENT OF PROSTHODONTICS SCHOOL OF DENTISTRY UNIVERSITY OF WASHINGTON SEATTLE, WASH. 98195
denfures
Curtis M. Becker, D.D.S.,* Charles C. Swooper D.D.S., M.S.D.,** Conrad A. Schwalm, D.D.S.*** University of Washington, School of Dentistry, Seattle, Wash.
and
A
technique for rapid construction of an inexpensive temporary denture in emergency situations is needed. For many patients, the loss of their denture or severe denture damage which cannot be repaired means unnecessary social embarrassment. These patients are unable to carry on their social and occupational activities until a new denture is constructed. An inexpensive temporary emergency denture can be fabricated in a few hours. The patient can function with this emergency denture until a new denture can be constructed. After the new denture is in service, the emergency denture can serve as a spare denture for use during future emergencies, repairs, or relines of the more accurately made complete denture. TECHNIQUE Imfwessions. 1. Select the proper size edentulous tray, and modify the extensions with soft periphery wax (Fig. 1) . 2. Palpate the hamular notch and posterior palatal seal area, and record the outline and displacement in the chart. 3. Dry the palate with a gauze sponge, and mark the posterior extension of the denture on the palatal tissue with an indelible pencil, using the hamular notches and vibrating line as guides (Fig. 2). 4. Make an irreversible hydrocolloid impression in a stock tray. 5. Remove the impression, and check it for proper extension, iack of large voids, Read before the American
Prosthodontic
Society in Chicago,
The views expressed herein are those of the authors of the United States Public Health Service. *Graduate
student, Department
reflect
those
of Prosthodontics.
**Professor and Director of Graduate Prosthodontics. ***Graduate student, Department of Prosthodontics, Public Health Service.
514
Ill.
and do not necessarily
and Dental
Surgeon,
United
States
Volume Number
Emergency
32 5
Fig. 1. Extend
the borders of a stock edentulous
tray with
soft periphery
dentures
515
wax.
Fig. 2. Dry the palate with gauze, and mark the posterior extension on the palatal tissue with an indelible pencil. Fig. 3. Darken the indelible pencil line on the impression which represents the posterior extension, so that it will transfer well to the stone cast. Fig. 4. Scribe the anticipated
border extension
into the cast with a sharp knife.
and adequate transfer of the indelible pencil line on the surface of the impression. (Note : Impressions of this type may be overextended at the borders.) Laboratory procedures. 1. Darken the indelible pencil line on the impression so that it will transfer clearly to the stone cast (Fig. 3). 2. Pour dental stone in the impression, using slurry water as an accelerator. 3. Examine the cast, and mark the anticipated border extension with pencil. 4. Scribe this border extension into the cast with a sharp instrument or small round bur (Fig. 4). 5. Carve the posterior palatal seal into the cast, using the information recorded in the chart concerning outline and depth (Fig. 5). The posterior extension is transferred from the indelible line on the impression to the cast. 6. Construct a baseplate from cold-curing tray resin, and trim it to the borderextension scratch line. Registration and clinical try-in. 1. Attach anterior teeth, from the mold guide, to the baseplate with wax, and make adjustments in the mouth to meet esthetic and phonetic requirements (Fig.
516
Becker,
Fig. 5. Carve has transferred Fig. 6. Position Fig. 7. Establish
Swoope,
.1. I’rosthet. Dent. I\‘ovember, 1971
and Srhwalm
the posterior palatal seal into the cast. (The from the impression to the cast.) the anterior vertical
Fig. 8. Record centric
indelible
posterior
extension
linf
teeth in the mouth to meet esthetic demands.
dimension relation
of occlusion
in wax.
in wax.
6). These teeth will be recovered at the boil-out and are not incorporated in the denture. 2. Place a posterior wax occlusion rim on the baseplate, and establish the vertical dimension of occlusion (Fig. 7). 3. Add registration wax, soften the wax surface, and record centric relation (Fig. 8). 4. Select the shade, using the guide appropriate for the cold-curing tooth-colored acrylic resin to be used. 5. Dismiss the patient, asking him to return later in the day. Further laboratory procedures. 1. Carve the posterior wax occlusion rim to simulate posterior tooth shapes on the buccal surface for esthetic purposes, and complete the wax-up around the anterior teeth (Fig. 9). Note: The occlusion was formed by use of the centric relation record. 2. Carry baseplate wax down the full depth of the vestibule to facilitate the investment procedure. Adequate wax thickness is insured at the denture extension (scratch line) by checking with a periodontal probe. Wax is added where necessar) to provide several millimeters of thickness. 3. Polish and stipple the wax.
Vdume 32 Numhr 5
Emergency
dentures
517
Fig. 9. Complete the wax-up around the anterior teeth, and carve the posterior wax occlusion rim to represent posterior tooth shapes on the huccal surfaces for esthetic purposes. Fig. 10. Invest the top half of the flask, using a silicone mold-liner investment technique. Fig. 11. Use autopolymerizing (cold-curing) tooth-colored resin to form the teeth. Fig. 12. After polymerization, remove the resin teeth from the silicone mold, and trim the flash away.
Processing. Processing may be delegated to the commercial laboratory, or the dentist may find it advantageous in certain situations to process the emergency denis not needed since cold-curing resins ture in his own labortory. Sp ecial equipment are used. I. Invest the waxed denture in the bottom half of a flask in the usual manner. 2. Invest the top portion of the flask, using a flexiblr silicone invcstrnent” and dental stone.‘. z Elastic impression materials are not satisfactory for investment use. (a) Use the fingertip or small spatula to work the silicone investment material into the interproximal spaces. Use a thicker layer around the teeth and in the undercut areas (Fig. 10). (b) Immediately fill the flask \vith dental stone accelerated with slurry water. The stone will not adhere to the silicone if the silicone has begun to set. 3. Roil out the wax, retrieve the anterior teeth, and place them back in the mold guide. 4. Paint all stone surfaces with a tinfoil substitute. This separator is not needed on the silicone. 5. Use autopolymerizing (cold-curing) tooth-colored resin to form the teeth. *Dent
Kote, Dentsply
International,
Inc., York,
Pa.
Fig. 13. Pack the mold with pink autopolymerizing denture base resin. to the bead formed by the Fig. 14. Trim and polish the denture scratched
into
the cast. The
Fig. 15. Completed Fig. 16. Completed for an interim
head
emergency emergency
has been darkened
for photographic
previous purposes.
rxtcnsion
Iirlr,
denture. denture.
The
result
provides
acceptable
esthetics
and
function
period.
(a) Use a brush to add small increments of incisal shade resin, and draw it out to taper toward the gingival area. This prevents a sharp transition between incisal and body shades (Fig. 11 ) . (b) Add body-shade resin with a plastic squeeze bottle, keeping all resin saturated with monomer, (c’) Place the top half of the flask in :I pressure pot for 15 minutes \tith 100° F. water at 20 p.s.i. pressure.” (d) After the resin teeth have polymerized, remove them from the silicone mold. Trim the flash. repair defects, and observe the general appearance (Fig. 12). Do 710t polish the teeth at this titne. 6. Pack the base with pink cold-curing resin (Fig. 13), and place it in the pressure pot for 30 minutes with 100’ F. water at 20 p.s.i. pressure. (Note: Heatcuring resin can be used if time permits.) 7. lIeflask, trim, and polish the denture to the bead formed by the extension (scratch) line in the cast (Figs. 14 and 15). Delivery. 1. Remove all sharp areas on the denture surface. 2. Use pressure indicator paste to adjust the basal surfaces. X. Adjust the occlusion. 4. Arrange appointments with the patient to have a new denture constructed at a convenient time in the near future.
Emergency
dentures
519
ADVANTAGES 1. The denture can be fabricated within one day. 2. Minimal chair time and laboratory time are needed. 3. Materials normally found in dental offices are used. 4. It is not necessary to have a stock of denture teeth in the office. 5. An articulator is not required. 6. The technique is simple. 7. The cost of materials and laboratory service is low, and the fee to the patient is reasonable. 8. The entire denture can be constructed in the dental office, or some portion of the work may be delegated to a commercial laboratory. 9. The patient is very grateful to be able to return to his usual activities with minimal inconvenience (Fig. 16). 10. The emergency denture serves as an interim prosthesis while a new denture is being constructed. 11. The emergency denture serves as a spare denture after the new denture is constructed. SUMMARY A technique has been presented for very rapid construction of an inexpensive temporary emergency denture. The prosthesis is easily constructed when a denture is lost or badly damaged. More precise denture construction procedures are used later at a more convenient time. References 1. Marcroft, K. R., Tencate, R. L., and Hurst, W. W.: Use of Layered Silicone Rubber Mold Technique for Denture Processing, J. PROSTHET. DENT. 11: 657-664, 1961. 2. Reisback, M. H.: Silicone as a Denture Mold Liner, J. PROSTHET. DENT. .26: 382-386, 1971. 3. Smith, D. E., Lord, J. L., and Bolender, C. L.: Complete Denture Relines With Autopolymerizing Acrylic Resin Processed in Water Under Air Pressure, J. PROSTHET. DENT. 18: 103-115, 1967. DEPARTMENT OF PROSTHODONTICS SCHOOL OF DENTISTRY UNIVERSITY OF WASHINGTON SEATTLE, WASH. 98195