Table Of Content

https://t.me/BibliotecaMedicoOdontoTecnica ar . \ Tlgrm @BibliotecaMedicoOdontoTecnica LUME ONE f t 1 DENTAL LABORATORY / PROCEDURES 1 COMPLETE DENTURES r ' i^BERT M. MORROW, D.D.S., F.A.C.D., F.I.C.D. vss< dateDeanfor AdvancedEducation, >or andHead,PostdoctoralDivision, nent of Prosthodontics, hi uliversity of TexasHealth ScienceCenter at v''-nAntonio,DentalSchool, 3anAntonio,Texas KENNETH D. RUDD, D.D.S., F.A.C.D., F.I.C.D. Associate Dean for ContinuingEducation, °rofessor of Prosthodontics, Department of Prosthodontics, heUniversity of TexasHealth Science Center .it SanAntonio, Dental School, SanAntonio,Texas JOHN E. RHOADS, D.D.S., F.A.C.D., F.I.C.D. Formerly Associate Professor, Prosthetic Dentistry, (cid:127)niversity of the Pacific, School of Dentistry, . (cid:127)an Francisco California V I ECOND EDITION vith2067illustrationsincluding12infullcolor THE C. V. MOSBY COMPANY . ST. LOUIS (cid:127) TORONTO (cid:127) PRINCETON 1986 A 4 CONTENTS 1 Effectivedentist-techniciancommunication, 1 Waxboxingmethod.57 . Basiccommunicationprinciples,1 Plasterof Parisandpumiceboxingmethod 67 Medium(a),1 Caulkingco.mpoundandpaddleboxingmethod,74 Barriers,1 Pouringcasts 80 Feedback, 2 Indexingthecast,80 . Planning,2 Requirementsforindexing 80 Technician— solicitingnew accounts,2 Grooveindexingmethod.80 I Dentist— searchingforalaboratory,2 Notchindexingmetho.d,84 Agreements.3 Splitremo.untingplates 85 . Summary 89 Legalandethicalobligations 5 Developingtherelationship,5 . Visitingfacilities 5 5 Baseplates and occlusion rims, 90 Treatmentplanning,5 Prescriptions,5 KENNETHD.RUDDandROBERTM MORROW Terminology,5 Requirementsforbaseplates,90 Communicatingtoothshades,6 Baseplatematerials,90 Feedback,6 Third-partycommunication,7 Autopolymerizingbaseplates,91 i Evaluation,7 FSipnrginekr-lea-doanpmteedthdoodu,g9h1method.99 * Confineddoughmethods,103 (cid:127) 2 Preliminary impressions: care and pouring, 9 Shellacbaseplates,112 Stabilizedshellacbaseplates,113 . KENNETHD.RUDDandROBERTM MORROW Baseplatesstabilizedwithzincoxide-eugenolimpression . Requirements,9 paste 115 Alginatepreliminaryimpressions,10 Baseplates.stabilizedwithelastomericimpression Modelingplasticimpressions,22 materials 121 Summary,25 Baseplatesstabilizedwithautopolymerizingresin,121 Thermoplasticresinbaseplatesandvacuum-adaptedresin baseplates,125 3 Impression trays, 26 Wax baseplates,129 . . Heat-curedcompression-moldedresinbaseplates 132 KENNETHD.RUDDandROBERTM MORROW Constructionmountingcasts,136 Requirementsforimpressiontrays,26 Fluidresinbaseplates,136 Impressiontraymaterial,26 Metalbaseplates,143 Autopolymerizingresinimpressiontrays,27 Waxocclusionrims,143. Impressiontraysforimmedia.tedentures,44 Maxillaryocclusionrims 143 Full-archimpressiontrays 44 Mandibularocclusionrims,144 Customposteriortrays,49 Modelingplasticocclusionrims,145 . Two-piecetrays 51 Summary,145 Summary,56 6 Articulators and mounting casts, 147 4 Final impressions, boxing and pouring, 57 KENNETHD.RUDDandROBERTM.MORROW . KENNETHD.RUDD ROBERTM MORROW,andEARLE. FELDMAN Requirementsformountingstone,147 * Mountingcasts,147 Boxingimpressions,57 Retrievingmountingplates,184 Summary,186 xi xii Contents 7 Artificial teeth and gold occlusals, 187 Try-in,275 Grindingporcelainteeth,275 KEKNONEEHTNHED..aRndUDWDIL,LRIAOMBEBR.TAKME.RMLOYRROW,CLARENCEL. Summary,275 Materialsforartificialteeth,187 Porcelainteeth,187 9 Waxing and processing, 276 . RMeestainl-itneseethrt t1e8e7th,188 KEANMNBERTHOCDIO.RVU.DEDS,PRINOOBZEAR,TanMd.CMHOARRRLOOWT.TEEAGROLREN.EFYELDMAN, Artificialwithmetalocclusals,188 Componentsof artificialteeth,189 Waxingfortry-in,276 Moldandshadeidentification,191 Waxingthemaxillarytrialdenture,276 Moldnumberingsystems,191 Waxingthemandibulartrialdenture,282 Constructingmetalocclusals,201 Waxingfor flasking,284 Techniqueforsiliconemoldformultiple waxingofsimilar Addingaplasticpalateform,284 toothcontours,222 Flaskingthedenture,287 . Summary 222 Wax elimination,296 Paintingthetinfoilsubstitute,300 Preparingridgelaps,303 8 Arranging and articulating artificial teeth, 223 Packingthedenture,303 RICanHdAHRUDGAH.SEM.IWTHO.LAF.EANDERSENCAVALCANTI, AltDeernnatutereflaidseknintigficpartoiocne,d3u0re6,307 Curingthedenture,311 Naturalanteroposteriorplacement of maxillaryanterior Deflaskingthedenture,311 teeth,223 Summary,311 Relationshipof archformtotootharrangement,225 Considerationsaffectingplacement andpositioningof anteriorteeth,226 10 Finishing and polishing, 312 Influenceof asymmetryontootharrangement,229 KENNETHD.RUDD,ROBERTM.MORROW.AMBROCIOV. Spacingof anteriorteeth,230 ESPINOZA,andJESSES.LEACHMAN Crowdingandlapping,231 Arrangingmaxillaryanterior teeth,232 Deflasking,312 Positioningof maxillarycanines,233 Remountingdentures,318 Personalizationof setupby selectivegrinding,233 Makingaface-bowindex,321 Considerationsaffectingarrangementofmandibular Removingdenturesfromcast,324 anterior teeth,235 Polishingthecompletedenture,324 Overallevaluationof anteriortootharrangement,236 Preparingragwheel,328 Posterior tootharrangement,237 Pumicingdenture,331 Selectionof posteriormolds,237 Polishingteeth,338 Surveyingthemandibularcast (toaidindetermining Polishingporcelainteeth,338 positionforposterior teeth),237 Summary,338 Arranging33-degreeanatomicmaxillaryposteriorteeth, 238 11 Duplicate dentures, 339 Articulationof 33-degreeanatomicmandibularposterior teeth,240 KENNETHD.RUDDandROBERTM.MORROW Checkingcompletedsetupof 33-degreeanatomic posterior teeth,245 Methods,339 Alternatemethodof articulationof33-degreeanatomic PMooudri-fireeds—in—defnlatsukremfleatshkodm,e3t4h8od,339 maxillaryposteriorstomandibularposteriors,245 Cup-flaskmethod,356 Arranging20-degreemaxillaryposterior teeth,249 Articulationof20-degreeposteriormandibularteeth,251 Summary,363 Alternatemethodof articulationof 20-degreemaxillary posterior teethtomandibularposterior teeth,255 12 Relining and rebasing,364 Articulationofmaxillary secondmolar,259 Checkingcompletedsetupof 20-degreeposteriorteeth, KENNETHD.RUDD,ROBERTM.MORROW.R.NEALEDWARDS, 260 andAMBROCIOV.ESPINOZA ArrangingPilkington-Turner30-degreeposteriorteeth,260 Articulatormethod,364 ArrangingRational0-degreeposteriorteeth,262 . Reliningjigmethod,372 ArrangingAnatolineposteriorsinalinearocclusion 263 Rebasing,377 Arranging Anatolineposteriorsinabilateralbalance,266 Jigmethod.377 ArrangingMonolineposteriorsinaflatlineartype Flaskmethod,380 occlusion,268 Summary,382 ArrangingMonolineposteriorsinabilateralbalance,270 ArrangingMonolinemandibularposteriorswith Anatoline maxillaryposteriorsinalingualized,balancedocclusion, 272 Contents 13 Repairs, 383 Mandibularbases,460 KENNETHD.R%UDD.ROBERTM.MORROW, RBleosciknoruetteanntdiorne,li4e6f,2463 andALEXANDERR.HALPERIN Materialsforcastmetalbases,463 . Repairingdenturewithfracturedteeth,383 Conversionof castbasetorecordbase 477 . Plasticanteriortoothreplacement,383 Summary 478 Porcelainanteriortoothreplacement,389 Plasticposteriortoothreplacement,392 Porcelainposterior toothreplacement,395 18 Maxillofacial procedures, 479 Repairingfractureddenture,398 FREDRICKM.MATVIAS Nonseparatedfracture,398 I Denturefracturedintotwoormoreparts(components), Immediateobturators,479 401 Requirements,479 Fractureddenturewithsection(s)missing,406 Materials,479 Addingaposteriorpalatalseal,409 Interimobturators,481 Summary,412 Requirements,481 Materials,481 Definitiveobturators,484 14 Immediate dentures, 413 Requirements,484 Materials,484 KENNETHD.RUDDandROBERTM.MORROW Mandibularresectiondevices,491 Constructingimmediatedentures,413 Requirements,491 Summary,424 Materials,491 Edentulousmandibularresectiondevice,491 . Dentulousmandibularresectiondevice 494 V 15 Fluid resin complete dentures, 425 Mandibular guideprosthesis,496 WALTERL.SHEPARD Acrylicresinguideflange,497 Speechaids,497 Denturebaseprocessingwithahydrocolloidinvestment, Requirements,497 425 Materials,497 Requirementsfordentalresin,426 Acrylicresinpalatallift,497 Synopsisof method,426 Metalframework withreenforcedacrylicposterior Materialsandequipmentrequired,426 extension,497 Preparationofcastandwaxpattern,427 Edentulousanddentulousmaxillary speechbulb,498 Preparationofhydrocolloid,427 Facialprostheses,499 Investment,429 Requirements,499 Dewaxing,429 Materials,500 Spruingandventing,431 Laboratory facilityrequirements.500 Replacingteethinmold,431 Radiationappliance,505 Mixingandpouringresin,432 Requirements,506 Curingdentures,433 Materials,506 Deflasking,434 Cranialimplants,508 Finishingandpolishing,434 Requirements,508 Removablepartialdentures,436 Materials,508 Rebasing,438 Silasticimplant,509 Repairing,438 Requirements,509 Summary,440 Materials,509 Summary,511 16 Soft liners, 441 19 Laboratory procedures for immediate MICHAELJ.MAGINNISandGERALDT.GAUBERT overdentures, 512 Resilientdenturebaseliners,441 Requirementsof resilientdenturebaseliners,441 ROBERTM.MORROW Resilientlinermaterials,441 Constructingimpressiontrays,512 (cid:127)Siliconerubbermaterials,442 Constructingbaseplates,516 Summary,459 Shellacbaseplates,516 Resinbaseplates,518 17 Metal bases, 460 Occlusionrims,524 \ / Settingtheteeth,525 / JAMESS.BRUDVIK Settingtheposterior teeth,526 Settinganteriorteeth,528 Requirementsforcastmetalbases,460 / % Designprinciples,460 WaPxreinpgarthinegimcamsteadbiautetmoevnetrsd,e5n3tu1re,534 Maxillarybases,460 * xiv Contents FlaskingtheImmediateoverdenture,536 21 Custom mouthguards, 551 Makinganimpressionof theoverdenturecast,536 ROBERTM.MORROW.WILLIAMKUEBKER, Makingasurgicaltemplate,537 andRICHARDSEALS Preparingridgelaps,537 Applyingtinfoilsubstitute,538 Mouthguardwithfaceguardattachment,555 Packingtheoverdenture,538 Custommouthguardwithoutattachment,561 Correctingprocessingerror,541 Polishingtheoverdenture,541 Summary,544 . COLOR PLATES followingp 544 1 Pigmented oral tissues 20 Denture base tinting, 545 . KENNETHD.RUDD ROBERTM.MORROW, 2 Contouring and tinting denture base andMEADEVANPUTTEN 3 Procedure for tinting denture base Tintingthedenturebase,545 Useofpracticemold,550 Summary,550 # 4 DENTAL LABORATORY PROCEDURES COMPLETE DENTURES * T* % I (cid:127) (cid:127) * - t " N* CHAPTER I EFFECTIVE DENTIST-TECHNICIAN COMMUNICATION Effective communication is svnonvmous with terms parties participate to achieve a desired goal. However, such as quality and success. M«* any0failures of dental the mere desireof thedentist tocommunicate with the prosthesiscan usually be traced toa breakdown in com- dental technician is not enough. He or she must also munication between members of the dental team (usu- have an underlying purpose to convey a message that ally the dentist and the technician). These communica- will result in a desired behavioral response. tion failures almost always result in a lower quality appliance produced at a higher than normal cost. But Medium(a) I what is most important is the adverse psychologiceffect The communication media the dentist or technician on the effectiveness of the team members and their re- chooses to use are as vast as they are varied. Commu- lationships with each other. Both dentist and technician nication is traditionally defined as the successful trans- spend considerable money and time each year on con- mission of a message from a sender to a receiver by an tinuing education to improve their skills and tech- appropriate mode. Selection of the proper channel or niques, but little effort is expended toward formal mode takes on extreme importance. Most dentists and courses in improving team communication. dental technicians choose those means of communica- The profound desire of humans to be understood by tion with which they feel comfortable. Basically, the colleagues and associates often is regarded as a major medium includes verbal communication, written and - obstacle or problem. As a result, communication pictorial accounts, and physical and behavioral ges emerges as a major source of irritation or a stumbling tures. The dentist, when communicating with the den- block. Although it is generally recognized that ineffec- tal technician, may utilize either one channel or all the tive communication places undue stress and demands modes of communication within the course ofone day. on a co-working relationship, it is equally unclear as to Therefore, it is of paramount importance that the how toovercome these barriers and establish good rap- sender of the message select the appropriate means of port between working groups hi order to function ef- communication. Face-to-face communication that in- , ficiently, the dental technician and the dentist must be volves the technician and dentist mav at one time or thought of as a working team, using all means of effec- another bean impractical meansofcom0munication, and tivecommunication to obtain a positive desired result. a less direct means may be employed to yield a greater measure of success. BASIC COMMUNICATION PRINCIPLES Barriers Theorctically, communication may be viewed from many different aspects. Common to most theories per- Messages transmitted by the sender to the receiver * taining to this skill, however, are certain dominating may become distorted, inhibiting accurate transmis- principles. It is generally agreed that communicating sion.Thesedistortions become stumbling blocksor bar- 1 F Dental laboratory procedures: complete dentures riers to both the dentist and the technician. At this concentrating on quantity rather than quality in their point, it is important to recognize that individual expe- client recruitment program. Quality accounts are those . riences are never identical Environment, education, that result in a high degree of personal satisfaction and t 6 personal preferences, social prejudices, and genetic mutual respect between the technician and the dentist. make-up help determine how we approach communi- The perfect account does not exist; however, bysearch- cation with other people. Consequently, an individuals ingfor some basicqualities, a laboratory can select sev- location, state of mind, whom he or she is with at the eral very good accounts: time of confrontation, and degreeofstress haveadirect 1. When solicitingaccounts, give top priority to those bearing on message distortion. Pride, intimidation, in- dentists located near the laboratory. Time and distance securities, fears, and personal ambitions often act as are major factors in maintaining a good working rela- barriers to effective communication, as well as tone of tionship. voice, appearance, and undesirable surroundings. Too 2. Search for dentists whose techniques, ethics, and often, messages between the dentist and technician are philosophies are compatible with your laboratory. sent and received inaccurately, resulting in one party 3. Search for those dentists whoareconcerned about assuming that a word has the same meaning for the credentials of the technician, as well as everyone in- other party. volved in patient treatment. The technician will per- Poor listening is a major obstacle. The inability to form with more enthusiasm when recognized for train- listen and ask questions contributes to the confusion ing and experience. and makes a very simple solution into a complex prob- 4. Avoid any account who has earned the reputation lem. Often, instead of listening when others are speak- of a “problem payer.” Delinquent accounts can lead to - ing, we formulate our own thoughts in anticipation of the demise ofany laboratory. » responding. To complicate matters further, messages 5. Try to determine if a dentist is searching for a transmitted become transcribed fragments that are in- quality laboratory or merely searching for unreasonably . complete and frequently plagued with colloquial jargon discounted prices and abbreviations. 6. Always ask dentists why theyarewilling tochange laboratories. Find out what they liked most and least Feedback about their last laboratory. Listen carefully to answers; Feedback is the reflection of communication. Send- they may provide clues that will lead to an excellent ers must rely on feedback to ascertain the receivers working relationship. comprehension of the message. In fact, it should be the 7. Search for those dentists who are responsive to receiver’sduty to report to the sender theclarity of the commentsand inquiriesfrom the technician concerning message. A message not acted on becomes wasted ef- clinical techniques that could affect laboratory proce- fort. Feedback between the dentist and technician dures. should be encouraged, leaving open the gateway to 8. Search for those dentists who are willing to take communication. Feedback is a mechanism that can be the time to provide constructivecriticism on laboratory utilized to correct and adjust meanings, to increase procedures. Often dentists who are unsatisfied with a (cid:127) clarity of communication, and to determine if the mes- laboratory’sservices will not discuss theirdissatisfaction sage sent is perceived by the receiver in thesame man- and will switch laboratories, giving no explanation. ner as it was intended. It is highly unlikely that all of these qualities will be found in any one client; however, they should serve as PLANNING useful guidelines for recruiting newaccounts. The tech- A successful dentist-technician relationship is usually nician must use discretion when using these guidelines the result of planned communication. These relation- to qualify a client. The sole purpose of qualifying a ships can becompared to marriages that begin with the client should be to determine compatibility with your best of intentions but often terminate in bitter conflict. laboratory. Do not engage in unethical gossip that may (The number of failures in relationships could be dras- result in damage to a dentist or to his/her practice. l tically reduced with the practice of systematic planning.) Dentist— searching for a laboratory The dental health team as viewed by the public has Technician— soliciting new accounts reached a new position of high esteem for itsexcellence The best time to eliminate problem accounts is dur- in a health field. In no way is this moreexemplary than ing the marketing phase of tlu* laboratory operation. theassociation that exists between thedental laboratory Many laboratories attempt to expand their market by technician and the dentist. The technicians high de- $ 4 Dental laboratory procedures: complete dentures ^ Table 1-1. Basic materials checklist 5 Completedentures Fixedpartialdentures Removablepartialdentures Orthodontics Impressionmaterial Impressionmaterial Impressionmaterial Impressionmaterial Casts Cast anddies Casts Casts Baseplate Investments Refractorymaterial Wire Artificialteeth Castmetals Castmetal Castmetals Acrylicresin Porcelain Miscellaneoushardware Miscellaneoushardware Miscellaneous Facing,backing,etc. Baseplatematerial Acrylicresin Miscellaneoushardware Artificialteeth Miscellaneous Miscellaneous Acrylicresin Miscellaneous situation the dentist should he notified as soon as pos- sible. Table 1-2. Sample checklist for procedures Some dentists may make the mistake of giving the Completedenture laboratory an early due date to provide a margin of safety. This practice will jeopardize the dentists credi- Impression,diagnostic bility with the laboratory. The technician who thinks Diagnosticcast andtray Finalimpression that the dentist is providing early due dates is least Finalcast likely to notify the dentist when a case is going to be Baseplateandocclusalrims late. Occlusalrimregistrations Turn-around time is time the laboratory takes to re- Jawrelations turn the case to the dentist. Most laboratories have es- Facebow Articulatorandarticulation tablished timesfor various procedures. Occasionally the Toothselection dentist will request a shorter than normal turn-around Tootharrangement time. This is usually referred to as a rush case." Rush Occlusion cases will usually alter the normal work flow in a labo- Trialwax-up Waxtry-in ratory, often resulting in the ownerhaving to pay over- Post-palatalseal time or to hire temporary help. Will there be an extra Finalwax-up charge, or will this be a special courtesy to the client? Characterization A basic agreement should be outlined; however, it is Processing wise to allow some flexibility for extenuating circum- Correctingandperfectingocclusion stances. Finishing a. Dentureborders 5. Discuss remake policies. What is an acceptable b. Polish percentage of remakes? Who will bear the cost of re- Miscellaneous makes? Howwill dates beadjusted? Remakesareasen- sitive subject and should be discussed with equal con- sideration to the position of both the dentist and laboratory. The important thing to remember is that trous to the dentists who have already quoted fees to when a case fails, one or both parties are usually frus- their patients. A moredesirable policy would be togive trated. Therefore the climate is not conducive toestab- clients reasonable advance notice for price changes on lishing rules for remakes. A good rule on remakes is routine procedures. one that is acceptable to both parties before the first * 4. Discuss policies on due dates, turn-around time, case is sent to the laboratory. and rush cases. Most dentists will have a complete se- 6. Credit and payment policies must be agreed on ries of appointments for each of their patients; ifan ap- before the first case. Laboratories are like dental prac- pointment is broken, it has a domino effect. Also, the tices— they cannot continue to operate without suffi- image of that dentist is jeopardized when the patient cient cash flow. Most laboratories operate on a very cannot be provided the services scheduled for a given limited cash flow, and delinquent accounts can be appointment. On some occasions it will be impossible costly or can even bankrupt the business. Since many for a laboratory to meet a scheduled due date. In this laboratories are competing for accounts, they tend to %