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Premedication: An aid in obtaining accurate complete denture impressions
Complete dentures
Premeditation: denture
An aid
in obtaining
accurate
complete
impressions
Kenneth D. Rudd, Colonel, USAF (DC),* and Robert M. Morrow, Major, USAF (DC)** Wilford Hall USAF Hospital, Aerospace Medical Lackland Air Force Base, Texas
Division
(AFSC),
A
ccurate registration of denture-bearing tissues is essential for the success of the denture. Many factors may influence the accuracy of complete denture impressions. One factor, the effect of palatal salivary gland secretions upon the impression medium, will be considered in this article. REACTION
OF IMPRESSION
MATERIALS
TO SALIVARY
SECRETION
Some impression materials seem to be more susceptible to palatal secretions than others. Among those affected the least is plaster of Paris, long recommended as an impression material for complete dentures. The favorable characteristics of plaster of Paris include its ability to absorb secretions during the setting reaction1 This absorption which occurs while the impression is being made effectively reduces voids and consequently improves accuracy. Zinc oxide and eugenol impression pastes, polysulfide, and silicone rubber impression materials are more likely to be affected by glandular secretions. Inasmuch as these materials are widely used, some method of preventing or reducing defects from secretion should be instituted. Or-bar? has divided the glands of the palate into two groups: Those of the hard palate (approximately 250) and those of the soft palate and uvula (approximately 100) (Fig. 1). When the mucus secretion from these glandular aggregates is not controlled adequately, the accuracy of the complete denture impression is affected markedly. METHOD The desirability of keeping the oral tissues relatively dry at the time of making impressions is generally accepted. A method found effective for controlling salivary *Consultant in Prosthodontics to the Surgeon, USAFE. **Staff and Training Officer, Department of Prosthodontics. 86
Vnlume Number
18 2
Premeditation
Fig. 1 A drawing
of the edentulous
palate shows distribution
in obtaining
impressions
87
of glands.
secretion involves the use of an antisialogogue in combination with mouth rinses and gauze packs. In the absence of contraindications, a 15 mg. tablet of Pro-Banthine” is administered orally to the patient 30 minutes before the impression is made. This time interval is used for making preliminary impressions and constructing impression trays or border molding in preparation for making the final impression. At the end of this period, the patient is instructed to use 2 mouth rinses. The first rinse is with cold water, preferably iced or from a refrigerated cooler, and the patient is instructed to swish the cold water vigorously in his mouth before emptying it. Immediately thereafter, he is asked to use Mucosolt in a similar manner. Two sterile 4 by 4 gauze packs are used to absorb excess saliva. They are placed in the mouth gently to prevent secretory stimulation of the salivary glands. Zinc oxide-eugenol paste impression material is mixed and loaded into the border-molded tray. The gauze packs are removed from the mouth and the tray is inserted carefully into position. A minimal amount of impression material is used to prevent the excess from flowing onto the soft palate and eliciting paroxysms of gagging. After the impression is in position, the patient is instructed to lean forward slightly in the chair to facilitate drainage of the saliva. A plastic apron is used to protect the patient’s clothing. Pitting of the impression in the posterior surfaces due to mucus secretion should be minimal (Figs. 2 and 3 ) DISCUSSION For some time the problem of defective and inaccurate impressions due to salivary secretion has been recognized. Boucherl stated that zinc oxide-eugenol impression pastes are displaced by mucus secretions and that plaster of Paris is affected fess by these secretions. B o 11werk3 believed that the mouth should be dried with *G.
D. Searle
jSurgident
Co.,
& Co.,
Chicago,
Los Angeles,
Ill. Calif.
88
Rudd and Morrow
J. Pros. Dent. August, 1967
Fig. 2 An impression made without premeditation indicates the defects caused by salivary secretion. Fig. 3 An impression made 30 minutes after premeditation with 15 mg. of Pro-Banthine and rinses contains minimum defects from palatal secretions. sponges before the impression is made to prevent salivary defects in the impression paste. Austin4 expressed the belief that saliva should be eliminated before the making of impressions and recommended a mouth rinse of caroid powder, glycerine, and water. Similarly, Klein5 recommended prior use of a mouth rinse of water and essence of caroid to impede the undesirable pitting of the impression material by mucus secretion. Lucia6 agreed that the mouth should be dry during the impression-making procedure and suggested premeditating the patient with atropine sulfate or Banthine. He urged the use of 50 mg. of Banthine and 15 mg. of phenobarbital (in tablet form) 1 hour before appointment time and again when the patient is placed in the dental chair. Martone stated that the flow of palatal salivary secretions is increased by the stimulation of the essential oil content of the zinc oxide-eugenol impression material. He believed that this secretion might be controlled by administering 15 mg. of Pro-Banthine with phenobarbital 30 minutes prior to making the impression. He suggested this premeditation also when polysulfide and silicone rubber are used. He agreed with Boucherl that plaster of Paris is affected less by palatal secretions. The use of antisialogogues, mouth rinses, and sponges packed in the mouth (individually or in combination) to control salivation during impression procedures is not new. Antisialogogues are especially helpful, but, as with any drug, the dentist should be cognizant of both contraindications to their use and also possible side effects. Banthine (methantheline) and Pro-Banthine (propyl homologue of methantheline) have been recommended as antisialogogues. These drugs may produce side effects, such as cycloplegia, mydriasis, and difficult urination, but intolerance is rare.s Banthine produces fewer side effects than atropine. Pro-Banthine, which is more potent than Banthine, produces even fewer side effects and is easy to administer. Neither Banthine nor Pro-Banthine should be given to patients with glaucoma, pros-
Premeditation
in obtaining
impressions
89
tatic hypertrophy, or cardiac conditions in which any increase in the heart rate is contraindicated,g because of its minimal side effects, rare intolerance, and ease of oral administration, Pro-Banthine seems to be the drug of choice for temporary salivary suppression during impression procedures. SUMMARY Defects in complete denture impressions resulting from the effect of palatal mucus secretion were discussed. Various methods for minimizing the defects were reviewed. A method requiring the administration of an antisialogogue in conjunction with mouth rinses and gauze packs was presented. The combination procedure minimizes effectively the defects due to mucus secretions by: ( 1) suppressing ordina.ry secretion ( Pro-Banthine and ice water), and (2) removal of excess mucus secretions from the oral cavity with an astringent mouthwash. References 1.
Boucher, C. 0.: A Critical Analysis of Mid-Century Impression Techniques for Full Dentures, J. PROS. DENT. 1: 472-491, 1951. 2. Orban, B.: Oral Histology and Embryology, ed. 2, St. Louis, 1949, The C. V. Mosby Company, p. 138. 3. Bollwerk, E. H.: An Improved. Impression Technique for Partial Dentures With Distal Extension Saddles, J. PROS. DENT. 3: 476-477, 1953. 4. Austin, K. P.: Diagnosis and Treatment Planning, J. PROS. DENT. 6: 173-176, 1956. 5. Klein, I. E.: Complete Denture Impression Technique, J. PROS. DENT. 5: 739-755, 1955. 6. Lucia, V. 0.: Modern Gnathological Concepts, St. Louis, 1961, The C. V. Mosby Company, p. 498. 7. Martone, A. L.: The Phenomenon of Function in Complete Denture Prosthodontics. Clinical Applications of Concepts of Functional Anatomy and Speech Science to Complete Denture Prosthodontics, Part VII. Recording Phases J. PROS. DENT. 13: 4-33, 1963. 8. Sollmann, T.: A Manual of Pharmacology, ed. 8, Philadelphia, 1957, W. B. Saunders Company, p. 399. 9. Drill, V. A.: Pharmacology in Medicine, ed. 2, New York, 1958, McGraw-Hill Book Company, Inc., p. 648. CMR APO
Box NEW
251 YORK
09220
Premeditation: denture
An aid
in obtaining
accurate
complete
impressions
Kenneth D. Rudd, Colonel, USAF (DC),* and Robert M. Morrow, Major, USAF (DC)** Wilford Hall USAF Hospital, Aerospace Medical Lackland Air Force Base, Texas
Division
(AFSC),
A
ccurate registration of denture-bearing tissues is essential for the success of the denture. Many factors may influence the accuracy of complete denture impressions. One factor, the effect of palatal salivary gland secretions upon the impression medium, will be considered in this article. REACTION
OF IMPRESSION
MATERIALS
TO SALIVARY
SECRETION
Some impression materials seem to be more susceptible to palatal secretions than others. Among those affected the least is plaster of Paris, long recommended as an impression material for complete dentures. The favorable characteristics of plaster of Paris include its ability to absorb secretions during the setting reaction1 This absorption which occurs while the impression is being made effectively reduces voids and consequently improves accuracy. Zinc oxide and eugenol impression pastes, polysulfide, and silicone rubber impression materials are more likely to be affected by glandular secretions. Inasmuch as these materials are widely used, some method of preventing or reducing defects from secretion should be instituted. Or-bar? has divided the glands of the palate into two groups: Those of the hard palate (approximately 250) and those of the soft palate and uvula (approximately 100) (Fig. 1). When the mucus secretion from these glandular aggregates is not controlled adequately, the accuracy of the complete denture impression is affected markedly. METHOD The desirability of keeping the oral tissues relatively dry at the time of making impressions is generally accepted. A method found effective for controlling salivary *Consultant in Prosthodontics to the Surgeon, USAFE. **Staff and Training Officer, Department of Prosthodontics. 86
Vnlume Number
18 2
Premeditation
Fig. 1 A drawing
of the edentulous
palate shows distribution
in obtaining
impressions
87
of glands.
secretion involves the use of an antisialogogue in combination with mouth rinses and gauze packs. In the absence of contraindications, a 15 mg. tablet of Pro-Banthine” is administered orally to the patient 30 minutes before the impression is made. This time interval is used for making preliminary impressions and constructing impression trays or border molding in preparation for making the final impression. At the end of this period, the patient is instructed to use 2 mouth rinses. The first rinse is with cold water, preferably iced or from a refrigerated cooler, and the patient is instructed to swish the cold water vigorously in his mouth before emptying it. Immediately thereafter, he is asked to use Mucosolt in a similar manner. Two sterile 4 by 4 gauze packs are used to absorb excess saliva. They are placed in the mouth gently to prevent secretory stimulation of the salivary glands. Zinc oxide-eugenol paste impression material is mixed and loaded into the border-molded tray. The gauze packs are removed from the mouth and the tray is inserted carefully into position. A minimal amount of impression material is used to prevent the excess from flowing onto the soft palate and eliciting paroxysms of gagging. After the impression is in position, the patient is instructed to lean forward slightly in the chair to facilitate drainage of the saliva. A plastic apron is used to protect the patient’s clothing. Pitting of the impression in the posterior surfaces due to mucus secretion should be minimal (Figs. 2 and 3 ) DISCUSSION For some time the problem of defective and inaccurate impressions due to salivary secretion has been recognized. Boucherl stated that zinc oxide-eugenol impression pastes are displaced by mucus secretions and that plaster of Paris is affected fess by these secretions. B o 11werk3 believed that the mouth should be dried with *G.
D. Searle
jSurgident
Co.,
& Co.,
Chicago,
Los Angeles,
Ill. Calif.
88
Rudd and Morrow
J. Pros. Dent. August, 1967
Fig. 2 An impression made without premeditation indicates the defects caused by salivary secretion. Fig. 3 An impression made 30 minutes after premeditation with 15 mg. of Pro-Banthine and rinses contains minimum defects from palatal secretions. sponges before the impression is made to prevent salivary defects in the impression paste. Austin4 expressed the belief that saliva should be eliminated before the making of impressions and recommended a mouth rinse of caroid powder, glycerine, and water. Similarly, Klein5 recommended prior use of a mouth rinse of water and essence of caroid to impede the undesirable pitting of the impression material by mucus secretion. Lucia6 agreed that the mouth should be dry during the impression-making procedure and suggested premeditating the patient with atropine sulfate or Banthine. He urged the use of 50 mg. of Banthine and 15 mg. of phenobarbital (in tablet form) 1 hour before appointment time and again when the patient is placed in the dental chair. Martone stated that the flow of palatal salivary secretions is increased by the stimulation of the essential oil content of the zinc oxide-eugenol impression material. He believed that this secretion might be controlled by administering 15 mg. of Pro-Banthine with phenobarbital 30 minutes prior to making the impression. He suggested this premeditation also when polysulfide and silicone rubber are used. He agreed with Boucherl that plaster of Paris is affected less by palatal secretions. The use of antisialogogues, mouth rinses, and sponges packed in the mouth (individually or in combination) to control salivation during impression procedures is not new. Antisialogogues are especially helpful, but, as with any drug, the dentist should be cognizant of both contraindications to their use and also possible side effects. Banthine (methantheline) and Pro-Banthine (propyl homologue of methantheline) have been recommended as antisialogogues. These drugs may produce side effects, such as cycloplegia, mydriasis, and difficult urination, but intolerance is rare.s Banthine produces fewer side effects than atropine. Pro-Banthine, which is more potent than Banthine, produces even fewer side effects and is easy to administer. Neither Banthine nor Pro-Banthine should be given to patients with glaucoma, pros-
Premeditation
in obtaining
impressions
89
tatic hypertrophy, or cardiac conditions in which any increase in the heart rate is contraindicated,g because of its minimal side effects, rare intolerance, and ease of oral administration, Pro-Banthine seems to be the drug of choice for temporary salivary suppression during impression procedures. SUMMARY Defects in complete denture impressions resulting from the effect of palatal mucus secretion were discussed. Various methods for minimizing the defects were reviewed. A method requiring the administration of an antisialogogue in conjunction with mouth rinses and gauze packs was presented. The combination procedure minimizes effectively the defects due to mucus secretions by: ( 1) suppressing ordina.ry secretion ( Pro-Banthine and ice water), and (2) removal of excess mucus secretions from the oral cavity with an astringent mouthwash. References 1.
Boucher, C. 0.: A Critical Analysis of Mid-Century Impression Techniques for Full Dentures, J. PROS. DENT. 1: 472-491, 1951. 2. Orban, B.: Oral Histology and Embryology, ed. 2, St. Louis, 1949, The C. V. Mosby Company, p. 138. 3. Bollwerk, E. H.: An Improved. Impression Technique for Partial Dentures With Distal Extension Saddles, J. PROS. DENT. 3: 476-477, 1953. 4. Austin, K. P.: Diagnosis and Treatment Planning, J. PROS. DENT. 6: 173-176, 1956. 5. Klein, I. E.: Complete Denture Impression Technique, J. PROS. DENT. 5: 739-755, 1955. 6. Lucia, V. 0.: Modern Gnathological Concepts, St. Louis, 1961, The C. V. Mosby Company, p. 498. 7. Martone, A. L.: The Phenomenon of Function in Complete Denture Prosthodontics. Clinical Applications of Concepts of Functional Anatomy and Speech Science to Complete Denture Prosthodontics, Part VII. Recording Phases J. PROS. DENT. 13: 4-33, 1963. 8. Sollmann, T.: A Manual of Pharmacology, ed. 8, Philadelphia, 1957, W. B. Saunders Company, p. 399. 9. Drill, V. A.: Pharmacology in Medicine, ed. 2, New York, 1958, McGraw-Hill Book Company, Inc., p. 648. CMR APO
Box NEW
251 YORK
09220