Border Molding Procedures For Maxillary arch

SUBMITTED BY:Chandni setia

 The secondary impression is an important procedure in the fabrication of the complete denture done to prepare a master cast. It involves three steps mainly :1. Border molding or peripheral tracing 2. Making the master or wash impression 3. Post damming

Border Molding For Maxilla

Border molding is the process by which the shape of the border of the tray is made to conform accurately to the contours of the buccal & labial vestibules. According to GPT , it is defined as the shaping of an impression material by the manipulation or the action of the tissues adjacent to the borders of the impression.

Also called as: MUSCLE TRIMMING PERIPHERAL TRACING

IMPORTANCE
Oral environment is surrounded by many muscles which are active when we speak,chew,smile,swallow. These muscles can have destabilizing effect on the denture. Border molding shapes the impression border and allow the muscles to function in harmony with the denture . It also improves the border seal of the denture.

 It begins with manipulation of border tissue against moldable impression material that is properly supported and controlled by the tray

For Border Molding to carried out space must be created for the material. Therefore , the flanges of the custom tray should be reduced 2mm short of the vestibule.

Procedure:2 techniques

Ideal characteristic of material for simultaneous border molding

It should : Have sufficient body to allow it to remain in position during loading. Allow some preshaping of the form of the border without adhering Have setting time of 3-5 min Retain adequate flow while tray seated in mouth Be readily trimmed.

Tray Wax Spacer

Remains in place during border molding procedures.

Spacer should be 2mm thick. It is cut in 2-4 places so that the special tray touches the ridge in these areas.

 4 stoppers are placed = two on canine eminences on either side & two on posterior part of the ridge. Stopper is = 2mm square,a 2 by 4 mm rectangle or 2mm mesiodistally palatally on crest of the ridge & buccaly half way into the sulcus.

Single step / Simultaneous

Procedure by which the entire periphery of the tray is refined in a single step. Material of choice 1)poly ether 2)self cure acrylic resin ( limited because of long setting time & difficulty in trimming)

Steps:1) Adhesive for impression is placed on border of tray(wax spacer is left inside the tray) 2) Material mixed & syringed around the border and posterior palatal seal and is quickly shaped with fingers moistened with cold water. 3) Position of patient upright. 4)Tray placed in mouth by retracting the lip.

Movements: Lip is elevated & extended Outward , Downward , Inward. In region of buccal frenum cheek is elevated pulled Outward , Downward , Inward and moved backward and forward. Buccal flange extend cheek outward , downward , inward open mouth wide and move mandible side to side.

 Posterior part of palate is recorded by asking the patient to say ah while refining the posterior border. When the material sets , the tray is removed.

Incremental / sectional border molding

 It is the procedure in which portions of the periphery of the tray are refined individually. Material of choice green stick compound. In this spacer is removed just before impression making.

1) Green stick compound is softened over the flame and added along the borders of the tray Warm until it starts to droop Do not overheat if catches fire or boils, it will not mold properly.

Compound Application
Apply over periphery of tray, in a thickness just slightly narrower than the compound stick

Re-soften After Application

Flame with a hand torch until all seams or sharp contours have disappeared Do not melt wax spacer inside tray

Preventing Slumping
Hold the tray upside down so that compound droops toward the depth of the vestibule

Prepare Patient
Patient seated, head against headrest, mouth open & relaxed If patient opens wide, commisures constrict, limiting access.

Maxilla - Seating the Tray

Seat tray firmly in midpalatal area during border molding procedures

 Mold by pulling on the cheeks, lips Have patient make functional movements

2) Labial vestibule is molded initially follows by buccal vestibule and then posterior palatal seal 3) Material should be tempered with warm water before placing intraorally.

Maxilla - Labial Frenum

Pull lip outward & downward and inward
Do not pull to one side

 Labial frenum should be narrow Buccal freni usually broader, V-shaped

In region of buccal frenum cheek is elevated, pulled Outward, Downward , Inward and moved backward and forward.

For Buccal flange extend cheek outward , downward ,inward.

For distobuccal angle of buccal flange:Patient moves mandible side to side & opens wide
Molds the retrozygomal area Allows for movement of coronoid process Prevents impingement of pterygomandibular raphe

Posterior Border
Terminates at vibrating line and hamular notches. Mark with an indelible stick Insert tray & check visually

 Vibrating lines can be marked: By asking the patient to say a series of Ahh Ahh By Valsalva maneuver- patient should hold his nose and attempt to blow through it.

 A strip of green stick is traced on the tray over the vibrating lines and through hamular notches. The tray is then seated in mouth under pressure. When properly formed PPS will be about 1mm thick and 4mm wide.

After Removal
Chill in cold water Trim excess over wax spacer or external material that is thicker than 4-5 mm.
Clean debris from tray

After Trimming
If border is sharp or has seams, reflame, temper and readapt intraorally Repeat until periphery is completed

Evaluating Maxillary Border Molding

Retentive

Tray Preparation After Border Molding

Wax spacer is removed to provide space for the impression material. 0.5 1mm of the tracing material is removed from the inner, outer & the top surface of the border. The thickness of the labial flange should be 2.5-3 mm from one buccal frenum to other.

Stick impression compound is adjusted with the scalpel & polyether with scalpel or bur. The material over posterior palatal seal is not adjusted as, i) It slightly displaces the soft tissue at the distal end of the denture to enhance the post. Palatal seal ii) Serves as a guide for positioning the tray iii) Helps prevent aspiration of excess material.

 Holes can be placed in the palate of the impression tray with the medium sized round bur i) to provide escape ways for the final impression material.

i) To provide relief over the medial palatal raphae & anterolateral and postero lateral regions of the hard palate to prevent mucus membrane displacement. ii) Also over residual ridge where soft tissue are mobile & displaceable.

After the holes are drilled , the tray is ready for making the final impression. The material of choice for a secondary impression are ZnOE IMPRESSION PASTE or medium bodied elastomeric impression materials.