SALMEO, Harlynn Joy E.

STEP BY STEP PROCEDURE IN CD

1. Tray Selection
This step is important before taking the preliminary impression in order to support the
impression material while in contact with oral tissues. This is also used when pouring of the
cast so that there will be a support of the impression material. In this step, stock trays are
used. First, fit it in the patient’s mouth. Take it out then trim using prostho scissors. It
should have space (not exactly fitting) because preliminary impression is overextended.
Then smoothen it with sandpaper so that it won’t hurt the patient.

2. Preliminary Impression
This step is done in order to have the study cast. This should capture all intraoral landmarks,
retromolar pads, retromylohyoid space, hamular notches, etc. This should be slightly
overextended and must capture the 3-D contours of the vestibular borders of the limiting
structures. This is done by soaking a modelling compound in hot water until soft and easily
manipulated. Place it on the stock tray. Make sure that there is a petroleum jelly in the
patient. Place the tray with the modelling compound inside the mouth and take the
impression.

3. Study Cast/ Diagnostic Cast

This is a positive copy of the parts of the oral cavity that is used for study, treatment,
planning, and fabrication of final impression trays. With the preliminary impression on the
stock tray, pour a mixture of plaster of paris and wait until it sets. Trim it and then put it in a
base former and let it set. Trim it after and mark with a red and blue pencil. The red mark
should be outside and 2 mm away from the blue mark.

4. Custom Tray
This is also called individual tray. It is made from the study cast that was poured from the
preliminary impression. This is used in taking the final impression. It is a custom tray made
specifically for a particular patient which is used to carry, confine, and control a final
impression material while making an impression. With a baseplate wax, heat it until soft and
place it within the blue mark on the study cast and trim with carvers. Then, mix self-cure
powder and liquid and make a ball like-shape. Place it on a glass slab and then press it with
another glass slab until flat. Place it on the study cast within the red mark. Make handles. 1
for the maxillary, and 3 for the mandibular. Once it sets, trim it using a micromotor.

5. Border Molding
Using a green stick, heat it until soft and place it on the border of the custom tray by
segment. For maxillary, it is done in 4 segments (A-D). For mandibular, it is done in 5
segments (A-E). Place it inside the patient’s mouth. The border of the impression tray is
 shaped through functional movements or manual manipulation of tissues to duplicate the
contour and size of the vestibule.

6. Final Impression
This is the negative copy of the edentulous mouth in which the complete denture will be
worn. This is used to make the master cast. The patient must have removed the current
dentures worn within 24-48 hours prior to visit. With the custom tray with the border
molded already, place the impression material (usually cavex outline impression paste) and
place it inside the patient’s mouth then take the impression.

7. Boxing and Pouring

This is used to fabricate a cast that preserves the peripheral role, providing a protective rim
around the cast (land- 3-4 mm wide). It should be 10-15 mm thick to permit flasking. With a
utility/sticky wax, heat it and place around the final impression (around 2-3 mm below).
Then place a boxing wax around it after. For the mandibular, place a baseplate wax on the
lingual area. Seal the waxes around the final impression. Pour water and check if there are
no water leakage. If there is none, mix a cast stone mixture and pour. Wait until it sets.

8. Master Cast
Once poured and set, the cast is trimmed and marked with necessary marks and lines. This
is a positive replica of the prepared tooth surface, residual ridge area, and other parts of the
arch as reproduced from impression. This must be 10-15 mm thick with a land (2-3 mm).

9. Trial Denture Base

This is a material or device representing the base of the denture. This serves as a base to
fabricate and support the wax occlusion rims and trial denture. With a mixture of self cure
powder and liquid, the salt and pepper method is used. Make sure it is 2-3 mm thick only.
Trim it and smoothen. Check the measurement with calipers.

10. Occlusion Rims

Used as provisional substitute for the planned complete dentures, and are used to record
both the neutral zone and the maxillomandibular relation. Proper thickness/measurements
should be followed. With a baseplate wax, heat it and fold it into a cigarette shape. Place it
on the TDB and adjust the measurements with a heated spatula.

11. Maxillo-mandibular Relations

This is a record of the relationship between the maxilla and mandible. This is done on the
patient using the prepared OCR. This are done with fox plane, calipers, rulers, bite wax, etc.
The measurements are adjusted using heated spatulas.

12. Mounting
 The joint maxillary and mandibular occlusal rims by the bite wax are mounted on the
articulator using a mixture of plaster of paris. Take note of the midline when mounting.

13. Anterior Setting

Having the necessary size of the pontics, set the anterior pontics by making a “dig” on the
OCRs using carvers or knives. Adjust the pontics using micromotor if needed or adjust the
OCRs using baseplate wax.

14. Posterior Setting

Having the necessary size of the pontics, set the posterior pontics by making a “dig” on the
OCRs using carvers or knives. Adjust the pontics using micromotor if needed or adjust the
OCRs using baseplate wax. Compensating curves must be taken into importance as well as
the centric relation.

15. Festooning
This is done so that there will be appropriate contours. Appropriate contours enhance
stability and control of the lower denture, provide support for the lips and cheeks, enhance
esthetics particularly in patients with a high smile line and prevent cheek biting. A properly
contoured denture also improves tolerance and comfort. This is done using carvers. The
gingiva is carved naturally. Place melted baseplate wax in areas lacking because of the
carving for a more natural look.

16. Unmounting From the Articulator and Sealing of TDB to MC

The TDC is sealed to the MC using baseplate wax, torch, lamps, and carvers.

17. Investing/Flasking
This is the process of investing the cast and the wax denture in a flask preparatory to
molding the denture-base material into the form of the denture. These are done using
metal flasks and presser and plaster of paris as well as a separating medium.

18. Wax Elimination

The flask is placed in boiling water for 4 to 6 minutes. Then it is removed from the water
and opened. Then the wax is washed away with boiling water. After that the mold is washed
with boiling water containing detergent, and then finally washing it with clean boiling water.

19. Mixing and Packing of Heat Cure Acrylic

Acrylic resin dough is made by mixing the powder (polymer) and liquid (monomer) to
form 'dough' which is packed into a gypsum mold for curing. It should be done when the
mixture reaches dough stage, as the dough is rolled into a rod- like form and placed in the
upper half of the flask then a polyethelen (nylon sheet) is placed over the dough in the
 upper half and then the two halves of the flask are closed until they are almost in
approximation, this is done to spread the dough evenly throughout the mold.

20. Denture Processing/Curing

It is polymerization of the hot cure acrylic to produce the final denture. The material is
cured by heating in a water bath; pressure is applied during curing. Flask is kept in water at
room temperature. Temperature is raised to 74 deg. C or 165 degF and maintained for 2
hrs. It is then brought to boil for 1 hour.

21. Deflasking
Deflasking is the process of removal of the processed denture from the flask and investment
mold. Before deflasking of the processed denture begins the flask is left to cool to room
temperature. If not, increased distortion of the acrylic may occur.

22. Trimming and Polishing

In this step any excess acrylic is removed from the processed denture by the use of stone
wheel burs, stone burs, and steel burs. Care must be taken not to heat the denture during
grinding, because this may cause distortion of the denture base. Finally, the denture should
be smooth and clean, as no plaster and no deep scratches should remain after the
preparation for polishing. In polishing a rag wheel with pumice is used for smoothing the
denture. Then a final high polish is given to the denture with a rag wheel and polishing
material (Rouge).

23. Install
The denture is installed in the patient. It is further trimmed when necessary using
micromotor, acrylic trimmers and polishers, and articulating paper (for the occlusion/bite).

24. Recall
The patient goes back and interviewed on how the denture is for them. The denture is
checked and modified if there are problems.

References:
Prosthodontics III Laboratory Guide by Dr. A.C. Pasumbal <3
Videos watched, lectures, own experience 