Which type of soft wax is used in cold climates to record occlusal rims and set denture teeth

  1. 1. Posterior palatal seal (post damming( Dr. Waseem Bahjat Mushtaha Specialized in prosthodontics 1
  2. 2. Posterior palatal seal (post damming( 1-The posterior palatal seal (post dam) of the upper denture should be placed on non-movable tissue of the soft palate just behind the hard palate. 2-The vibrating line of the soft palate , normally used as a guide to the ideal posterior border of the denture, is usually located slightly posterior to the foveae palatine. 3-The posterior palatal seal is formed through both humular (pterygomaxillary) notch and across the palate over the vibrating line. 4-The vibrating line is observed in patient's mouth as the patient says a series of short "ah" and the hamular notches are palpated. 2
  3. 3. Techniques of post-damming There are several established for the placement of the posterior palatal seal: 1-Conventional method 2-Scraping of master cast 3-Post damming during try-in stage 3
  4. 4. 1-Conventional method A strip of low fusing compound is traced on the impression over the vibrating line and through the hamular notches. The compound is heated with alcohol torch, tempered and seated in the mouth under pressure. The added material will spread out on both sides of the vibrating line and form a raised strip across the distal end of the impression. The final impression with the posterior border seal is carefully boxed and poured in stone. 4
  5. 5. 2-Scraping of master cast A –this technique is the least accurate and leaves the most to chance of tissue compressibility of the insertion of the denture. B – This technique is almost as unphysiologically correct as the technician's attempt to place the posterior palatal seal. So post damming must be done at the impression stage rather than by attempting the scrap the cast. 5
  6. 6. 3-Post damming during try-in stage The trial denture base is inserted so the indelible pencil line marked on vibrating line of the soft palate will be transferred from the soft palate to the trial denture base. And the excess base plate is reduced to this line. The trial denture base is placed on the cast and a knife or pencil is used to mark a line following the posterior limits of the base plate. 6
  7. 7. 7
  8. 8. Dimensions of the post dam 1-The post dam extends from the humular notch on one side to the other humular notch of the other side. It should be wide enough to avoid cutting or irritating the soft tissues, but not so wide to compress too large an area and thus prevent the denture from sealing properly. 8
  9. 9. 2-The post dam is usually narrow in it's central part, wider as it extends laterally on each side, and narrow again as it approaches the hamular notch to fade out behind the tuberosity. It is sometimes called butterfly (Cupid's bow) post dam 3-The post dam should be about 3-4mm wide in its widest part. The depth or thickness of the post dam should vary in different individuals, according to compressibility and softness of the tissue. Its depth should also vary in different parts of the same mouth in exactly the same manner as its width. The average thickness is 1mm. 9
  10. 10. 10
  11. 11. Function of post damming 1-during impression making: The rational for the placement of a post dam in the impression tray is: A – To establish contact posteriorly to prevent the final impression material from sliding down in to the pharynx. B – To serve a guide for positioning the impression tray, especially if a shim has been used within the tray to establish the borders. 11
  12. 12. 2-during jaw relationship: 1-Posterior palatal seal is incorporated into the trial denture base for added retention. 2-To determine if adequate retention and seal of the potential denture border is present. 12
  13. 13. 3-Post dam with finished denture: 1-it slightly displaced the soft tissue of the distal end of the denture to inhance the posterior border seal: A- Increase retention of the denture by atmospheric pressure. B –it prevents air and food from getting under the denture. 2-it makes the thickness of the base less conspicuous to the tongue and diminishes reflex irritation. 13
  14. 14. Boxing-in the impressions and making the casts 14
  15. 15. Boxing-in the impressions and making the casts Def: Boxing in an impression is the process of building up of vertical walls, usually in wax developing around the final impression for complete dentures to produce the desired size and form of the base of the cast, and to preserve certain landmarks of the impressions. 15
  16. 16. Technique 1-A strip of boxing wax is attached all the way around the outside of the impression approximately 1 to 2mm below the border and seated to it with a spatula. 2-The strip must be at its full width, particularly at the distal ends of the impression, to hold the vertical wall of the boxing away from the impressions and provide space for adequate thickness of the cast in these regions. 16
  17. 17. 3-the vertical walls of the boxing are made of sheets of beeswax. 4-The tongue space in the lower impression is with a sheet of beeswax or plasticine that is fitted and attached on the superior surface of the boxing wax. The beeswax tongue space filler is seated to the boxing wax. And located just below the lingual border. 17
  18. 18. 5-A thin sheet of wax is used for making the vertical walls of the boxing. This may be special boxing wax. Or half sheet of beeswax may be cut lengthwise and used as a boxing wax. It is attached around the outside of the boxing strip so as not to alter the borders of the impression. It should extend 9 to 15mm above the impression so the base of the cast at its narrowest point will be of this thickness. 6-The sheet of boxing wax should extend completely around the impression and be seated to the boxing wax strip to prevent the escape of stone when this is poured in to the impression. Sufficient space must be available posteriorly between the impression and boxing to provide for adequate thickness of casts distal to the impression. 18
  19. 19. 7-A stone is mixed carefully and vibrated, and then sufficient stone is poured in to the boxed impression that the base of the cast will be 9 to 15mm thick. The stone is allowed to harden for at least 30 minutes before impression. After the final impression is separated from the cast, the borders of the cast are trimmed to leave a ledge of about 3mm posteriorly and little anteriorly. The cast must be shaped to maintain the form of the borders of the impression and yet be easily accessible for adaptation of the materials used in making the record blockes. 19
  20. 20. 20
  21. 21. 21
  22. 22. 22
  23. 23. 23
  24. 24. Advantages of boxing –in 1-The correct width of the periphery of the impression is preserved. 2-the mixed stone can be vibrated, the cast will not contain air bubbles and a stronger cast will be produced. 3-The thickness of the cast may be more accurately judged. 4-boxing-in is time saving, because trimming may be not be required. 5-Material is economized. 24
  25. 25. Recording bases and occlusion rim 25
  26. 26. Recording bases and occlusion rim Def: the recording base (trial denture base) is a temporary form that closely resembles the final base of the denture under construction. It is used for recording maxillo-mandibular jaw relationships and for setting the artificial teeth. 26
  27. 27. Function of recording base 1-Establishment of the rest and occlusal vertical dimensions. 2-Determination and recording of centric relation 3-The transfer of the accurate jaw relationships to an articulator 4-Enabling the setting of artificial teeth for the trial denture. 27
  28. 28. Requirements for recording base 1-Well adapted and accurately formed to the final cast. 2-Stable, both on the cast and in the mouth. 3-Rigid and strong. 4-Smooth and rounded to be comfortable to the patient. 5-Easily contoured and polished. 6-Fabricated from materials that are dimensionally stable. 7-the materials used should be easy to manipulate. 8-Base plate materials should be non-irritant to the mouth tissues. 28
  29. 29. Materials for recording bases I-Temporary recording bases: the materials that are most frequently used are: 1-Shellac base plate wax. 2-cold-curing acrylic resin. 3-vacuum formed vinyl or polystyrene. 4-base plate wax. 5-swaged tin base plate. N.b these materials are used during the various technical procedures, but discarded at the time the denture is processed in to its permanent form. II-permanent denture bases: Is one, which eventually becomes the base of the finished denture: 1-Processed (heat-cured) acrylic resin. 2-cold 3-chromium – cobalt alloys. 4-chromium – nickel alloys. 29
  30. 30. I-Temporary recording bases 1-Shellac recording base material: 1-Shellac is commonly used material for recording base. 2-it is supplied in forms shaped to correspond to the general shapes of the maxillary and mandibular arches. 30
  31. 31. 3-if adapted accurately strengthened and handled carefully, it can be effectively utilized both for maxillary and mandibular recording base. If not adequately strengthened, shellac tends to warp when subjected to repeated changes in temperature. Wires should be used to increase strength rigidity and thus reduce distortion of shellac base. For the maxillary cast, the wire is placed across the posterior palatal seal area, while for the mandibular cast it is adapted within the lingual flange. 31
  32. 32. Fabrication of shellac recording base 1-The proper shellac form, corresponding to either the maxillary or the mandibular arch, is selected for the final cast. 2-all undercut must be blocked out prior to adapting the base. 32
  33. 33. 3-to prevent the base material from sticking to the cast, A- It is first dusted with talcum powder B-soaked in water for a short period of time until the surface of the cast is moist: immersion of the cast in water for a prolonged period of time many damage the surface of the cast. C-tin foil (0.001 inch) can be adapted to the cast. 4-soften the shellac until it appears shiny and applied with wet fingers to accurately adapted the shellac to the palatal portion of the maxillary cast or to the lingual surface of mandibular cast. 33
  34. 34. 5-the material is then reheated and adapted over the crest of the ridge and into the reflections. Care must be taken to avoid trapping air between the shellac form and cast surface. 6-while the material is still warm and soft; it is removed from the cast and trimmed with scissors, leaving approximately 5mm beyond the edge of the cast. 7-the shellac is repositioned and reheated, and then carefully readapted. The trimmed edges are heated, elevated from the cast, and folded onto themselves and burnished with wax spatula to form a smooth rounded border. 8-care must be taken not to overheat, the shellac overheating will cause the molten shellac to adhere to the surface of the cast on cooling attempt to remove the shellac base can result in a fracture of the cast surface. 34
  35. 35. Advantages of shellac recording base: 1-It can be easily and quickly adapted 2-inexpensive Disadvantages: Shellac being a brittle material, it is subjected to breakage. 35
  36. 36. 2-autopolymerizing resin recording base materials Fabrication of autopolymerizing resin recording base: three basic techniques are used to fabricate recording base utilizing chemically activated resins: A-no-flasking method: 1-a layer of tin foil (0.001 inch) or a thin layer of petrolatum is applied to the prepared final cast. 2-all undercuts are blocked out with wax or and the suitable plastic material. 36
  37. 37. 3-The autopolymerizing resin is mixed, when it reaches the doughy stage, it is rolled to the desired thickness 2 to 3mm. 4-a thin film of petrolatum must be applied to prevent the resin from adhering. A thin application of petrolatum to the fingers will prevent the resin from sticking to the hands. Keeping the fingers wet with water during handling will also prevent this difficulty. 5-the resin sheet is transferred to the cast, adapted to the hard plate area first or to the lingual surface of the mandibular cast and then onto the crest of the ridge and into the reflection area. 37
  38. 38. 6-a sharp instrument is used to trim the excess resin while it is in the soft, moldable state. 7-after polymerization has been completed; the resin base is removed and trimmed. Soaking the cast in water will help removable of the base if difficulty is encounted. 8-the borders are further adjusted with burs, and the external surface can be polished with wet pumic. The thickness on the facial slope of the ridge and extending over the crest of the ridge is reduced to approximately 1mm. 38
  39. 39. B- Alternating application of cold- curing powder (sprinkle-on technique(. 1-well-adapted bases can be formed using this technique. 2-undercuts are blocked out and tin foil or petrolatum is applied to the cast. 39
  40. 40. 3-polymerization shrinkage is kept to a minimum. A thin layer of powder (polymer) is dusted over a small surface area of the cast and sufficiently wetted with liquid (monomer) to produce a slight flow. 4-alternative applications of powder and liquid are made until a thickness of 2 to 3mm has been developed 5-the complete base is then removed, trimmed and polished. The polymerization reaction takes approximately 20 to 30 minutes; the bases should not be removed during this period in order to prevent distortion. 40
  41. 41. C-flasking method 1-recording bases produced from this method are accurate and stable. Thy do, however, require considerable time for fabrication and therefore are most costly them bases formed using shellac or autopolymerizing resin. 41
  42. 42. 2-since breakage of the master cast is possible with this technique, it is advisable to duplicate the cast and to construct the recording base on the duplicated model. 3-An autopolymerizing resin is mixed in glass jar and then covered .when the resin reaches the doughy stage ,its placed into the model , the flask is closed, and the resin is allowed to polymerize for 20 to 30 minutes . The base is removed from the flask, trimmed, and polished. If there are a number of undercuts present that will, interfere with seating the base on the master cast, they must be relieved before seating is attempted 42
  43. 43. Advantage of resin recording base: 1-acrylic resin base plates are excellent for making maxillo-mandibular relation records. 2-They fit accurately and are not easily distorted 3-any type of occlusal rims can be mounted on it Disadvantages: 1-They may take up space needed for setting the teeth, necessitating some grinding of the resin base in required areas. 2-they may be loose because of the necessary block out of undercuts in the cast 43
  44. 44. 3-vacuum-formed bases 1-the vacuum method provides a fast and efficient means of forming rigid, accurate fitting recording base. Depending on the material used, temporary or permanent bases can be formed. Permanent bases formed using this method have not gained wide acceptaptance. 2-the cast is prepared by blocking out the existing undercuts with a suitable material (wax or any other material that melts during heating should no be used 44
  45. 45. 3-a sheet of base plate resin is inserted in the frame located below the electric heater coil, and the heater is activated. Heating is contained until the resin sheet begins to sag approximately 12 inch. At this time, the sagging sheet of softened resin is lowerd onto the cast by means of the supporting farm and vacuum is turned on. 4-the sheet of soften resin is drawn in to close adaptation to the cast. The heater is then turned off and the base allowed to cool for one minute. After removal from the cast the base is trimmed and finished. 45
  46. 46. Vacuum-formed base 46
  47. 47. Other recording base materials 1-base plate wax: This type of base plate is used in conjunction with wax rim so forming the all wax-recording blocks. Talcum powder is applied to the cast .an alternative the cast may be immersed in water for a short period of the time until moist. The wax is then softened and adapted. Excess wax is removed with a sharp instrument and the borders rounded and smooth. 47
  48. 48. Advantages: Base plate wax recording bases are inexpensive, easily formed and esthetic. Disadvantages: 1-base plate wax recording base softens readily at body temperature that leads to distortion during the maxillo-mandibular jaw relations recording 2-it does not withstand the pressure to witch it is subjected during jaw relationship recording. 48
  49. 49. 2-swaged tin base plate Three pieces of 5-gauge tin are swaged down on top of other, on to a model die made from the master cast and trimmed similar in out line to a cast or swaged metal base. The layers of tin may be cemented together with a thin film of hard wax and the complete until re-swaged for final adaptation to the cast. 49
  50. 50. Advantage: 1-it does not soften at mouth temperature 2-it has a reasonable accurate fit 3-it gives a uniform thickness for the palate of the finished denture. 4-it reproduces the rugae to some extend. Disadvantage: 1-time consuming 2-expensive 50
  51. 51. II-Permanent denture base A-processed resin (heat-curing acrylic resin(: 1-fabrication of heat-processed resin recording bases result in the destruction of the final casts. The recording bases that are formed are permanent and become part of the final denture. 51
  52. 52. 2-undercuts are not blocked out. A wax form of the desired shape and dimensions is adapted onto the cast. The wax pattern is invested in applied, and a denture resin is mixed and packed into the model.The resin is processed according to the manufacture's instruction.The processed base is recovered and finished. Undercuts on the tissue side of processed base are blocked out with a plastic material, and dental plaster or stone is poured in to the base to provide mounting casts for the transfer of jaw records to the articulator. 3-the artificial teeth are set in wax, which is attached to the processed base, to provide the trial denture. When satisfactory, the trial denture is flasked, processed and finished. Either cold-cured resin or heat-cured resin may be used to attach the teeth to the processed base. 52
  53. 53. Advantages of processed resin-recording base: 1-Accurate base plates are produced 2-no warpage during recording jaw relationship. 3-the bond between the wax rim and base is strong. 4-it also enables a check on the accuracy of the final impression to be made at an early stage in denture construction, since their retention and stability should be equal to that of the finished denture. Disadvantage: 1-Time consuming 2-owing to the warpage that always occurs when acrylic resin is subjected to reprocessing; it is not advisable to finish the denture on these bases. 53
  54. 54. B-cast alloys Cast recording bases are more costly than other types of bases, since they require more time to fabrication. They become part of the final prosthesis and are therefore called permanent bases. Cast recording base rigid, accurate, and dimensionally stable. They have several advantages over the other materials they add more weight to mandibular dentures and more thermal conductivity to maxillary dentures. 54
  55. 55. .Refractory casts are prepared from the final cast. A wax pattern is formed on the refractory model (a cast made of material that withstand high temperatures without disintegrating called investment cast), which is sprued, invested in a suitable investment, the wax is burned out, and the molten alloy is cast into the model cavity. on cooling, the casting is removed from the investment ,finished and polished, and then retained to then final cast. The artificial teeth are set in wax on the metal base. Once satisfactory, the teeth are attached to the metal base in the same manner as for the processed base. 55
  56. 56. 56
  57. 57. Occlusion rims An occlusion rim is a wax form used to establish: 1-the proper lip and cheek support (fullness of the lips and cheeks( 2-the arch form, which is related to the activity of the lips, cheeks and tongue. 3-the level of the occlusal plane. 57
  58. 58. 4-accurate maxillo-mandibular jaw relations i.e. Help to determine: A-vertical dimension and an estimate of the interocclusal distance. B-horizontal jaw relations (centric occluding relation and condylar path( 5-occlusion rims help to determine the length and width of the artificial teeth: A-high and low lip lines are used for determining the length of the artificial teeth. B-canine line i.e. corners of the mouth; the distance between the canine lines determines the width of the six anterior teeth. C-the distance between the canine line and the posterior end of the occlusion rim determines the mesiodistal width of the posterior teeth. 6-position of midline of the arch for the correct placement of the central incisors. 7-arrangement of the artificial teeth to the trial denture (setting up of the teeth(. 58
  59. 59. Base plate wax is the most commonly used occlusal rim material. Compound and a mixture of the plaster and pumice are sometimes used for constructing occlusal rims. There are basic factors that should be considered in the proper fabrication of occlusion rims, to assist the dentist and the dental laboratory technician throughout the many phases of denture construction. 59
  60. 60. These factors are: 1-relationship of natural teeth to alveolar bone: Since the final goal in the treatment of the edentulous patient is to provide a functional and esthetic prosthesis, the relationship of the natural teeth to the alveolar bone must be understood. The fabrication of successful replacements can be accomplished in most cases only if the artificial teeth are placed in the same position that was occupied by the natural teeth they are replacing. The natural maxillary anterior teeth are inclined slightly forward of the alveolar bone. They contribute to the support of the upper lip With the canines providing support for the corners of the mouth. The mandibular incisors are also inclined forward and tend to support the lower lip. The maxillary posterior teeth are positioned slightly buccal to the alveolar ridge, when occluding with the mandibular molars; the maxillary buccal cusps usually project 2 to 3 mm. beyond the buccal cusps of the mandibular teeth. The crowns of the lower posterior teeth are inclined inward 60
  61. 61. 2-relationship of occlusion rims to edentulous ridges: The location and dimensions of the occlusion rims in relation to the edentulous ridge are basically the same as those for the crowns of the natural teeth that are to be replaced in their relation to the alveolar ridge. The occlusion rims simply replace the natural teeth both in dimension and in their relationship to anatomic structures. These relationships should be re-established by the occlusion rims even if resorption of the residual ridge has occurred following the removal of the natural teeth. 61
  62. 62. 3-fabrication technique and dimensions of occlusion rim: 1-base plate wax (modeling wax(: A sheet of base plat wax is heated over approximately one half its length until the wax is soft and pliable. The soft wax is rolled to point to a point just short of unheated area. The wax is again heated and rolled until a soft roll has been formed. The soft wax roll is adapted to a bead of sticky wax that was previously applied to the recording base. The roll is further seated to the base. The roll is further seated to the base with spatula, with additional molten wax. 62
  63. 63. The edges of the roll are extended along the lateral surfaces to the border of the recording base. Additional wax is added to fill any voids in the contour of the rims. A heated broad bladed knife or plaster spatula is, used to quickly shape the labial surface of occlusion rim. The anterior surface should be inclined outward while the posterior surface is sloped slightly inward. A hot wax spatula is used to smooth the lingual surface and form a rim approximately 5mm wide in the anterior area and approximately 8- 10mm in the posterior area. These basic dimensions are subjected to final chair side changes, since the dentist uses the rims to determine the proper vertical dimension, occlusal plane, facial support, as well as the midline of the arch, the length and width of the anterior teeth, the buccal eminence, the smiling (high) lip line, and the speaking(low) lip line. The occlusal surface of the occlusal rim must be smooth and flat. All surfaces of the rim should be smooth. 63
  64. 64. 64
  65. 65. 65
  66. 66. 66
  67. 67. 67
  68. 68. 68
  69. 69. 69
  70. 70. 2-the composition (compound impression( 1-May be used and softend in warm water, molded into a back of the necessary size and placed into position. 2-a hot wax knife is used to adapt the edge, the surface is best smoothed with a sand paper. 3-the use of compound is indicated when it is desired to obtain more than one record of the occlusion, as with any type of fully adjustable articulator, or when gothic arch tracing is to be taken. 70
  71. 71. 3-plaster and pumice When a functional recording of mandibular movements is to be made by the patient chewing on bite rims, these should be made of a mixture of plaster and pumic. In this technique the patient goes through the movement of mastication with the bite blocks in occlusion and so produces the occlusal plane conforming to those movements. An acrylic base is the most satisfactory for this technique. The plaster is mixed with pumic equal parts of each, to facilate the grinding down in the mouth. 71
  72. 72. This plaster-pumic combination is mixed with water into a thick consistency and a roll of it is placed on to the base while the initial set is taking place. It can be smoothed with moistened fingers before setting is completed. A preliminary recording of vertical dimension is desirable which should be taken 3mm greater than finally required to allow for the reduction in grinding down in the mouth. These plaster rim should be made less than 24 hours before they are required , otherwise the patient will have difficulty in grinding them down owing to the increased hardness of the plaster. 72
  73. 73. Wire attached to shellac denture base 73
  74. 74. Plaster & pumice occlusal rim 74