The chair-side Peter A. Guevara,
transitional D.M.D.,*
denture
and E. Thomas
Elstner, Jr., D.M.D.**
School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pa.
M
any different techniques are available for the fabrication of transitional dentures. .4lthough most are acceptable, some procedures need increased accuracy and some require too many dental materials. The following procedure is a one-visit technique that will greatly simplify the construction of a “personalized” transitional denture while reducing chair time. After the initial impression making, the dentist can begin to extract the teeth while the assistant busies herself with the fabrication of the chair-side transitional denture. TECHNIQUE
Preparation of the cast and tooth arrangement. (1) Examine the patient’s remaining teeth (Fig, 1). (2) Select the proper size of tray. (3) Make the preliminary alginate (irreversible hydrocolloid) impression (Fig. 2). (4) Pour a stone cast from quick-setting plaster. Trim the cast leaving an adequate border (‘/4 inch) to act as a vertical stop during the fabrication of the denture (Fig. 3). (5) Adapt glycerine-based modeling clay (Fig. 4) to the labial surface of the remaining anterior teeth and into the labial vestibular space. The clay indexing core serves as a guide for the proper labiolingual and midline positioning of the artificial teeth (Fig. 5). (6) Knead the clay, and flatten it with a molding block and roller+ on the side marked thick (Fig. 6). (7) Remove the remaining teeth from the cast, and trim the residual ridge on the cast for the estimated surgical result. (8) ‘4pply the clay in a uniform thickness over the prepared cast. (9) Re-place the labial clay indexing core, and arrange the artificial teeth to *Associate **Lieutenant tKerr
226
Professor, (DC)
Manufacturing
Department USNR,
of Prosthodontics;
Quantico,
Company,
Detroit,
Va. Mich.
Director
of Biomaterials
Section
Volume 36 Number 2
Fig. Fig. Fig. Fig. Fig. Fig, Fig. Fig.
Chair-side
1. The patient
is ready to have a transitional
transitional
denture
227
denture constructed.
2. The alginate (irreversible hydrocolloid) impression. 3. The stone cast is poured into the impression. 4. Modeling clay is used to form the base of the denture. 5. The labial clay core index is used to help position the artificial 6. Modeling
clay is rolled
with a molding
block and roller
7. An even layer of clay is molded to the prepared 8. The anterior
teeth are fitted to the cast.
teeth. to the proper
cast, and the labial
thickness. core is positione d.
228
Fig. Fig. Fig. Fig. Fig. Fig.
Gueuara
J. Proatlrrt. DC‘Ix. August, 1976
and Elstner
9. .Artificial teeth are made in a silicone mold using acrylic resin. 10. The waxed-up denture is ready for investing. 11.. Preformed gingival molds may be used to form the clay. 12. A margarine
container
serves as a duplicating
flask. Holes are cut in the base and sildes.
13. The prepared denture with additional clay added to both tuberosities. 14. A thin mix of irreversible hydrocolloid is poured into the reservoir
funnel
flask
Fig. 15. The funnel and corks are removed in readiness to separate the mold and cast. Fig. 16. The denture teeth are positioned in the mold.
to fill the
Chair-side transitional
Fig. 17. Lead ports are cut into the irreversible the middle of the posterior palatal border. Fig. 18. Self-curing
pour acrylic
hydrocolloid.
An optional
denture
escapeway
229
is cut to
resin is used to form the denture.
Fig. 19. The acrylic resin is poured into one hole until that the mold is completely filled.
it flows into the opposite
one indicating
Fig. 20. The cured denture has been removed from the mold.
this index (Figs. 7 and 8). Cold-cured acrylic resin teeth are made from the denture teeth in a prefabricated silicone tooth mold (Fig. 9). (10) Apply additional clay to the labial surface, and carve around the teeth to obtain the necessary esthetic result (Fig. 10). Preformed gingival molds may be used to speed the operation (Fig. 11) . lnuesting and processing. (1) Make a large hole in the base of a margarine container. The container serves as the processing flask. (2) Attach a bottomless alginate (irreversible hydrocolloid) water measure to the hole with cold-cure acrylic resin. It will act as a funnel and reservoir for the irreversible hydrocolloid during duplication. (3) Cut two smaller holes and an optional third vent hole on the side of the tub for pouring acrylic resin. (4) Plug the side holes with corks of proper size (Fig. 12). (5) Make a stone base to hold the tub upright during the pouring of the resin (Fig. 1.2). (6) Seat the cast with setup on the cover of the margarine tub. (7) Add additional clay over both tuberosities to aid in the formation of pouring vents (Fig. 13).
230
Fig. 21. The trimmed
and polished
Fig. 22. Conditioning material surgically prepared mouth.
transitional
is placed
denture.
in the denture,
and then it is seated to the patient’s
(8) Place the flask with the reservoir funnel attached over the prepared transitional denture, being careful to position the tuberosities toward the pouring vents (Fig. 14). (9) Pour a thin mix of irreversible hydrocolloid into the reservoir funnel to fill the flask. Use two parts of water to one part irreversible hydrocolloid. (Six scoops of alginate and 12 measures of water are sufficient for most dentures. ) (10) Cut the reservoir from the flask, and remove the cork plugs after the irreversible hydrocolloid has set (Fig. 15). (11) Separate the denture from the mold, and remove the clay and teeth from the cast. (12) Re-place the teeth into the mold, and paint the cast with a tin-foil substitute (Fig. 16). (13) Cut lead ports into the irreversible hydrocolloid in line with the tuberosities. A third optional vent can be bored to the distal part of the palate (Fig. 17) . (14) Re-place the cast in the irreversible hydrocolloid mold. ( 15) Mix a suitable type of pour acrylic resin* (Fig. 18) . (16) Pour the resin into one of the large holes until it comes out the opposite hole, and then allow it to cure (Fig. 19). (17) Remove the processed denture from the flask, and trim and finish in the conventional manner (Figs. 20 and 21) . Denture insertion. (1) Make a mix of a tissue-conditioning material. (2) Paint the inner surface of the denture with the tissue-conditioning material (Fig. 22)) and immediately place it in the patient’s mouth following the surgical procedures (Fig. 23). CONCLUSIONS
When using irreversible hydrocolloid as an investing medium, the denture surface may appear rough. For this reason, a thick base of clay is used so that these irregularities can be safely removed. *Coe Laboratories,
Inc., Chicago,
Ill.
Chair-side transitional
Fig. 23. The patient
immediately
following
denture
231
surgery.
If no more time is available, conventional wax-up cab be made using pink baseplate wax and a thin covering of silicone tray material over the wax in place of the base of clay. The use of this silicone matrix will provide a smooth surface for the completed denture. The chair-side transitional denture gives patients a personalized service and saves them the embarrassment of leaving the dentist’s office without teeth in their mouths. DR. GUEVARA UNIVERSITY OF PITTSBURGH SCHOOL OF DENTAL MEDICINE PITTSBURGH,
PA. 15213
DR. ELSTNER DENTAL CORPS, USNR QUANTICO, VA. 22172
transitional D.M.D.,*
denture
and E. Thomas
Elstner, Jr., D.M.D.**
School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pa.
M
any different techniques are available for the fabrication of transitional dentures. .4lthough most are acceptable, some procedures need increased accuracy and some require too many dental materials. The following procedure is a one-visit technique that will greatly simplify the construction of a “personalized” transitional denture while reducing chair time. After the initial impression making, the dentist can begin to extract the teeth while the assistant busies herself with the fabrication of the chair-side transitional denture. TECHNIQUE
Preparation of the cast and tooth arrangement. (1) Examine the patient’s remaining teeth (Fig, 1). (2) Select the proper size of tray. (3) Make the preliminary alginate (irreversible hydrocolloid) impression (Fig. 2). (4) Pour a stone cast from quick-setting plaster. Trim the cast leaving an adequate border (‘/4 inch) to act as a vertical stop during the fabrication of the denture (Fig. 3). (5) Adapt glycerine-based modeling clay (Fig. 4) to the labial surface of the remaining anterior teeth and into the labial vestibular space. The clay indexing core serves as a guide for the proper labiolingual and midline positioning of the artificial teeth (Fig. 5). (6) Knead the clay, and flatten it with a molding block and roller+ on the side marked thick (Fig. 6). (7) Remove the remaining teeth from the cast, and trim the residual ridge on the cast for the estimated surgical result. (8) ‘4pply the clay in a uniform thickness over the prepared cast. (9) Re-place the labial clay indexing core, and arrange the artificial teeth to *Associate **Lieutenant tKerr
226
Professor, (DC)
Manufacturing
Department USNR,
of Prosthodontics;
Quantico,
Company,
Detroit,
Va. Mich.
Director
of Biomaterials
Section
Volume 36 Number 2
Fig. Fig. Fig. Fig. Fig. Fig, Fig. Fig.
Chair-side
1. The patient
is ready to have a transitional
transitional
denture
227
denture constructed.
2. The alginate (irreversible hydrocolloid) impression. 3. The stone cast is poured into the impression. 4. Modeling clay is used to form the base of the denture. 5. The labial clay core index is used to help position the artificial 6. Modeling
clay is rolled
with a molding
block and roller
7. An even layer of clay is molded to the prepared 8. The anterior
teeth are fitted to the cast.
teeth. to the proper
cast, and the labial
thickness. core is positione d.
228
Fig. Fig. Fig. Fig. Fig. Fig.
Gueuara
J. Proatlrrt. DC‘Ix. August, 1976
and Elstner
9. .Artificial teeth are made in a silicone mold using acrylic resin. 10. The waxed-up denture is ready for investing. 11.. Preformed gingival molds may be used to form the clay. 12. A margarine
container
serves as a duplicating
flask. Holes are cut in the base and sildes.
13. The prepared denture with additional clay added to both tuberosities. 14. A thin mix of irreversible hydrocolloid is poured into the reservoir
funnel
flask
Fig. 15. The funnel and corks are removed in readiness to separate the mold and cast. Fig. 16. The denture teeth are positioned in the mold.
to fill the
Chair-side transitional
Fig. 17. Lead ports are cut into the irreversible the middle of the posterior palatal border. Fig. 18. Self-curing
pour acrylic
hydrocolloid.
An optional
denture
escapeway
229
is cut to
resin is used to form the denture.
Fig. 19. The acrylic resin is poured into one hole until that the mold is completely filled.
it flows into the opposite
one indicating
Fig. 20. The cured denture has been removed from the mold.
this index (Figs. 7 and 8). Cold-cured acrylic resin teeth are made from the denture teeth in a prefabricated silicone tooth mold (Fig. 9). (10) Apply additional clay to the labial surface, and carve around the teeth to obtain the necessary esthetic result (Fig. 10). Preformed gingival molds may be used to speed the operation (Fig. 11) . lnuesting and processing. (1) Make a large hole in the base of a margarine container. The container serves as the processing flask. (2) Attach a bottomless alginate (irreversible hydrocolloid) water measure to the hole with cold-cure acrylic resin. It will act as a funnel and reservoir for the irreversible hydrocolloid during duplication. (3) Cut two smaller holes and an optional third vent hole on the side of the tub for pouring acrylic resin. (4) Plug the side holes with corks of proper size (Fig. 12). (5) Make a stone base to hold the tub upright during the pouring of the resin (Fig. 1.2). (6) Seat the cast with setup on the cover of the margarine tub. (7) Add additional clay over both tuberosities to aid in the formation of pouring vents (Fig. 13).
230
Fig. 21. The trimmed
and polished
Fig. 22. Conditioning material surgically prepared mouth.
transitional
is placed
denture.
in the denture,
and then it is seated to the patient’s
(8) Place the flask with the reservoir funnel attached over the prepared transitional denture, being careful to position the tuberosities toward the pouring vents (Fig. 14). (9) Pour a thin mix of irreversible hydrocolloid into the reservoir funnel to fill the flask. Use two parts of water to one part irreversible hydrocolloid. (Six scoops of alginate and 12 measures of water are sufficient for most dentures. ) (10) Cut the reservoir from the flask, and remove the cork plugs after the irreversible hydrocolloid has set (Fig. 15). (11) Separate the denture from the mold, and remove the clay and teeth from the cast. (12) Re-place the teeth into the mold, and paint the cast with a tin-foil substitute (Fig. 16). (13) Cut lead ports into the irreversible hydrocolloid in line with the tuberosities. A third optional vent can be bored to the distal part of the palate (Fig. 17) . (14) Re-place the cast in the irreversible hydrocolloid mold. ( 15) Mix a suitable type of pour acrylic resin* (Fig. 18) . (16) Pour the resin into one of the large holes until it comes out the opposite hole, and then allow it to cure (Fig. 19). (17) Remove the processed denture from the flask, and trim and finish in the conventional manner (Figs. 20 and 21) . Denture insertion. (1) Make a mix of a tissue-conditioning material. (2) Paint the inner surface of the denture with the tissue-conditioning material (Fig. 22)) and immediately place it in the patient’s mouth following the surgical procedures (Fig. 23). CONCLUSIONS
When using irreversible hydrocolloid as an investing medium, the denture surface may appear rough. For this reason, a thick base of clay is used so that these irregularities can be safely removed. *Coe Laboratories,
Inc., Chicago,
Ill.
Chair-side transitional
Fig. 23. The patient
immediately
following
denture
231
surgery.
If no more time is available, conventional wax-up cab be made using pink baseplate wax and a thin covering of silicone tray material over the wax in place of the base of clay. The use of this silicone matrix will provide a smooth surface for the completed denture. The chair-side transitional denture gives patients a personalized service and saves them the embarrassment of leaving the dentist’s office without teeth in their mouths. DR. GUEVARA UNIVERSITY OF PITTSBURGH SCHOOL OF DENTAL MEDICINE PITTSBURGH,
PA. 15213
DR. ELSTNER DENTAL CORPS, USNR QUANTICO, VA. 22172
