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8 Metho PDF
8 Metho PDF
8 Metho PDF
Table of Contents
A. Patient Examination ................................................................................................................ 52
i. Medical History ........................................................................................................................ 52
ii. Dental History .......................................................................................................................... 52
iii. Intra Oral Examination ....................................................................................................... 52
B. Complete Denture Construction .............................................................................................. 53
C. Patients Grouping .................................................................................................................... 56
Group I (Control Group) ................................................................................................................ 57
Group II (Test Group) ..................................................................................................................... 60
System components and technique .................................................................................................. 60
D. Patient’s Instructions ............................................................................................................... 66
E. Determination of the geographic center of the lower denture: ............................................... 67
F. Clinical evaluation of mandibular complete denture retention .............................................. 68
G. Digital evaluation of mandibular complete denture................................................................ 69
H. Patient satisfaction evaluation of mandibular complete denture............................................ 71
50
Materials & Methods
Inclusion criteria
Exclusion criteria
51
Materials & Methods
A. Patient Examination
Full medical and dental histories were taken from each patient followed by
intra-oral examinations to fulfill the selection criteria.
i. Medical History
Patients were asked about both the date of last extraction and the cause of
extraction whether it was due to dental caries or periodontal disease. Moreover,
they were asked about having any previous experience with oral prosthetic
restorations.
Visual and digital examinations were thoroughly carried out to assess the intra-
oral condition to fulfill the pre-mentioned criteria:
52
Materials & Methods
i
Cavex Dental- Holland.
ii
Elite Rock Stone- Zhermack Clinical- Italy.
iii
Acrostone- Acrylic resin cold cure- Egypt
53
Materials & Methods
The tray was painted with adhesive for silicone material. Border tracing was
performed using heavy bodied condensation silicone i . The material was mixed
following the manufacture`s instruction., applied to the borders of the tray and
seated properly in the patient`s mouth. The impression was held in place and
border molding was done by asking the patient to perform physiological functional
movements as pursing the lips and cheeks, swallowing and sucking. The tray was
held without pressure in position till the material has set for three minutes.
i
Heavy body Condensation Silicine- Zhermack Clinical- Italy.
ii
Regular body Condensation Silicine- Zhermack Clinical- Italy.
iii
Elite Rock Stone- Zhermack Clinical- Italy.
54
Materials & Methods
Occlusion blocks were constructed on the master casts. The upper occlusion
block was adjusted to developed proper lip support and properly orient its occlusal
plane. A face bow record was made to mount the maxillary cast on a semi-
adjustable articulatori then transferred to the articulator. Centric occluding relation
was recorded at the predetermined vertical dimension of occlusion following inter-
occlusal wax technique to mount the lower cast with protrusive record, figure (3).
i
Bioart Dental- Brazil.
55
Materials & Methods
The waxed up denture was tried in the patient's mouth to ensure proper
facial contour, esthetic, even contact between all the posterior teeth and harmony
between centric occlusion and centric relation at the predetermined vertical
dimension of occlusion, figure (4).
C. Patients Grouping
i
Acrostone Dental Plus- Egypt.
56
Materials & Methods
The waxed trial denture bases were flasked in a metallic dental flask with
dental stone using two pour technique.
The base of the flask was painted with vaseline and filled with dental stone.
The cast with the waxed up denture base was immersed into the plaster filled base
at the center of the flask.
Once the base was invested, a separating medium was applied and the
second pour was done. The flask was left for 30-60 minutes undisturbed till the
investing stone reach its final setting time.
Wax elimination was done by placing the flask in boiling water for 15
minutes. After 15 minutes, the flask was taken out of the water bath. The base and
the body were carefully separated and the softened wax was flushed out using hot
water stream, figure (5).
57
Materials & Methods
The powder and the liquid of the heat cured acrylic resin were mixed
following the manufacturer's instructions and packed into the mold when the mix
reached the dough stage. Pressure was applied on the flask after the first packing
within 100- 150 Bar using calibrated compressor, figure (6).
58
Materials & Methods
After the final closure of the flask, it was kept at room temperature for 30-60
minutes for bench curing, and then the flask was heated in water bath following the
short curing cycle (72 °C for 0.5 h and 92 °C for 1.5 h). The flask was cooled
slowly and deflasking was done carefully to avoid cast fracture.
The finished dentures were delivered to the patient after performing the
needed occlusal adjustment, figure (7).
59
Materials & Methods
i
Impexbo - Impexbo SARL, Route de Lausanne 3, CH - 1041 Bottens.
60
Materials & Methods
3. Processing caps were fitted onto the valves bodies before installation process
to protect the valves. They removed only after the polishing phase.
4. Two diaphragm and two spares came with the system kit. These tiny plastic
discs seal the inlet under negative atmospheric pressure and release the
pressure under resting conditions.
5. Service key had two extremities. The upper part was used to grip, close and
open both the valve covers and the processing caps. The lowest part was
slightly larger replica of the valve and might be used as a gauge for depth
and diameter, figure (8).
Extra hard stone was used to pour the casts from the impression and after
setting, the cast models were trimmed. On the ridge, the location of the spacer was
marked, making sure that the bar stopped at least1 cm short of the end of the
denture, figure (9).
61
Materials & Methods
Acrylic base plates were prepared on the top of the spacer bars followed by
bite blocks. After jaw relation record, the casts were mounted on an articulator and
teeth set up for try in was carried.
Each cast was packed in three part flask, the spacer bar remained on the
model and any undercuts were blocked out.
After polymerization and deflasking, the bars were removed from the
dentures by digging prudently to prevent damage to walls of the retention chamber.
The dentures were trimmed and polished.
At the chosen lingual side, the location of the valves was drawn with a felt
marker between first and second premolar, with the center of the valve preferably
1-1.5 mm above the highest point of retention chamber, figure (10).
62
Materials & Methods
The cavities for the valves were prepared with a round bur intermittently
using the gauge side of the service key for guidance i.e. depth and diameter.
Processing caps were then placed in the valves to protect the core from being filled
with self cure acrylic resin and then tried in, figure (11).
63
Materials & Methods
The valves were installed with cold cure acrylic. Soft rubber cylinder points
were used to remove excess material and to polish around the valves. The dentures
were given a final sheen, figure (12).
64
Materials & Methods
The processing caps removed and the valve body inspected. Using 1mm
fissure, a communication channel was created between the valve and the high point
of the retention chamber. For the dentures with significant thickness of acrylic
between valves and the retention chamber, drilling was done on an obtuse angle,
figure (13).
Each valve was rinsed and dried thoroughly to ensure a smooth placement of
the diaphragm into its housing. The perforated cover was fitted and tied up using
the service key, figure (14).
65
Materials & Methods
D. Patient’s Instructions
Patients were instructed to perform oral and denture hygiene as follow:
• Cleaning the dentures after every meal under running water only.
• Not to use any type of denture cleansers, tooth paste and solutions
containing phenol. Also, denture adhesives should be avoided.
• Removing the prosthesis at night for tissue rest and immersing it in a cup of
tap water.
66
Materials & Methods
By the using of digital digimizer software i , figure (15), three lines were
drawn on the cast and extended to the cast base to aid in determining the
geographic center of the mandibular denture. Line (1) connecting two points at the
apices of the retro molar pads of both sides of the arch, line (2) passing through the
crest of the anterior ridge and parallel to line (1), line (3) passing through the mid
line of the crest and perpendicular to both lines (1) and (2), point (A) the midpoint
between line (1) and (2) drawn on line (3), line (4) passing though point (A) and
running parallel to lines (1) and (2). The denture was then placed on the cast and
prepared for the retention test.
i
MedCalc Software- USA
67
Materials & Methods
i
Eagle Scale- India
68
Materials & Methods
When complete dentures were finished, the dentures were prepared for
retention tests. The measurement of mandibular complete denture was measured by
pulling the denture from its geographic center.
The retention was measured by digital force-meter which can apply forces in
upward and downward directions. The pull off procedure was repeated 10 times to
obtain 10 records for each, the mean of which was calculated, figure (17).
The method considered for the occlusal analysis was a computerized system i.
The system was composed of a computer with a specific board and software
i
Tekscan Corp, Boston, Massachuttes, USA.
69
Materials & Methods
The Tekscan USB handle, figure (18), does not require an additional interface
card or parallel box in order to be connected to computer. When inserted into
computer, the computer`s operating system will automatically detect and configure
the hardware for use. The T-Scan sensor was an ultra-thin (.004”, 0.1 mm), flexible
printed circuit that detected the patient`s occlusal parameters.
The recordings were taken by placing the sensor in the patient`s mouth, with
the sensor support pointer between the two central incisors and keeping the
scanning handle as parallel to the occlusal plane as possible. Having the patient
70
Materials & Methods
bite down normally on the sensor, the first tooth contact would cause the system to
begin recording, figure (19). While recording was in progress, the Real-time Status
Bar showed the frame count progress.
71
Materials & Methods
72