Lecture 2

Clinical and laboratory steps

Preliminary impression
Preliminary cast
 Complete dentures
• Components (parts)
– Denture base – acrylic resins
– Artificial teeth
• Acrylic resins
• Composite resins
• Ceramic
• Surfaces
– External – smooth, polished
– Internal – intimate contact with the
underlying tissues, except the areas
that need to be relieved
 Clinical and laboratory steps
1. Clinical examination
– Diagnostic
– Treatment plan
2. Pre-prosthetic or pro-
prosthetic treatments
– If needed
Pre-prosthetic treatments =
treatments that are required
to be performed before the
construction of a complete
denture: removal of fixed
partial dentures, extractions,
surgical removal of tumors
 Clinical and laboratory steps
1. Clinical examination
– Diagnostic
– Treatment plan
2. Pre-prosthetic or pro-
prosthetic treatments
– If needed
Pro-prosthetic treatments =
treatments that are meant
to enhance the stability and
the retention of the
complete dentures
 Clinical and laboratory steps
3. Preliminary impressions

4. Preliminary casts
 Clinical and laboratory steps
5. Custom tray fabrication

6. Final impressions
 Clinical and laboratory steps
7. Master cast fabrication

8. Occlusion rim fabrication

 Clinical and laboratory steps
9. Recording of maxillo-mandibular relations

10. Transferring maxillo-mandibular relations to

the articulator
 Clinical and laboratory steps
11. Arrangement of artificial teeth

12. Try-in and adjustments

 Clinical and laboratory steps
13.Transforming the waxed-up denture in the
final acrylic denture

14.Finishing, polishing
 Clinical and laboratory steps
15. Denture application and adjustments

16. Indications for the denture wearer,

monitoring the patient
 Optimal qualities for impression
materials
• They should have low enough viscosity to adapt to the oral
tissues, yet to be viscous enough to be placed in the tray
• The material should have adequate wettability of the oral
tissues
• The material should have pleasant taste and odor
• Short setting time
• Adequate strength
• Upon removal from the mouth, should show adequate
elastic recovery with no permanent deformation
• Dimensional stability
• Compatible with the cast material
• Biocompatible
• Cost-effective
 The preliminary impression
= an impression made for the purpose of
diagnosis or construction of a tray
 The preliminary impression
• It is not appropriate to extend the borders of
the denture randomly  poor stability and
retention
• Careful clinical examination and impression
making should be carried out in order to
achieve maximum denture retention and
stability
• Often called primary impression, anatomical
impression
 Objectives
• The objective of preliminary impression is to
record all the anatomical landmarks that will
support the future denture
– In this step, it is mandatory to record at least the
supporting structures: residual ridges,
tuberosities, hard palate, retromolar pad
– However, maximum extension of the impression
in the buccal, paralingual folds should be tempted
 Preliminary impression materials
• Large selection of available materials
• The choice is influenced by
– the proper selection of trays (stock or custom
made),
– the condition of residual ridges,
– the presence of displaceable tissues in the
denture bearing area,
– salivary flow,
– the dentist’s ability to handle the material
 Armamentarium – alginate
impressions
• Stock trays
• Impression material
• Dispenser, mixing bowl, spatula, measuring
spoon
 Stock trays
• To support the impression material
during impression taking
• Metal/plastic; perforated/ not perforated
• Dentate/ edentulous patient
• Adults/ children
• Different sizes: S, M, L, XL, XXL; NS, NM;
1-5
• Upper arch/ lower arch
• Full arch/ hemi-arch
 Stock tray selection
• Dentate/ edentulous patient
• Upper/ lower arch
• Size  according to the size of the arch
– Should include the entire bearing area
– Should not distort the vestibule
– Should extend 1-2mm beyond vibrating line, and 1-2mm over
the mylohyoid ridges
– A space of ~3mm should exist between the tissues and the tray

Clinical case – Prof.Dr. Diana Dudea

Alginate = irreversible hydrocolloid
– Powder + water  gel phase
– 1:1 ratio
– Cold water!!
– Chromatic alginates  color changes during
setting time
 Technical considerations in the
manipulation of alginates
– Use the correct powder/liquid ratios provided by the
manufacturer (1:1)
– Modifications of these can result in changes in the
properties of the material
– Fast setting (1-3 min), regular setting (3-4.5 min)
– Altering the water temperature can influence the
setting of the material  cold water - delay of the
setting time
– When mixing the material in the bowl, it must be
squeezed between the spatula and the side of the
rubber bowl  homogenous consistency, avoid the
incorporation of bubbles
 Technical considerations in the
manipulation of alginates
– Powder should be added to the water in the mixing
bowl to ensure complete wetting of the powder
– The mixing bowl should be clean, without traces of
gypsum  can alter setting time and properties of
alginate impressions
– Mixing time – as recommended by the manufacturer
(45-60 sec)
– Can be used in perforated or non-perforated trays
– A minimum of 3mm of impression material should be
present between the tray and oral tissues to avoid
tears in the impression
 Technical considerations in the
manipulation of alginates
– Alginates are dimensionally unstable  once
removed from the mouth, they should be cleaned,
disinfected and poured in gypsum (10 min)
– Once poured, stone cast should remain in contact
with alginate between 30-60 min before
separation from the impression to ensure
complete setting of the stone; if it is left more
than 60 min  alteration of the mechanical
properties of the cast, poor quality of its surface
 Impression taking
• Filling the tray
• The surface of the alginate is smoothened with cold water
• Inserted in the mouth from one side
• Seated in the mouth from posterior towards anterior  to eliminate
excess material and to avoid the incorporation of bubbles
• Cheeks are pulled to allow air to be eliminated and to shape the buccal
folds
• The tray is maintained in the mouth until the material has set, holding a
light constant pressure
• Removing the tray from the mouth

Clinical case – Prof.Dr. Diana Dudea

 Verifying the impression
• No voids, bubbles allowed
• The handle should be centered on the midline
• Uniform material thickness, no portion of the tray should be visible
• Accurate record of the bearing area, buccal/lingual folds, vibrating line
• The material should not be detached from the tray

7
4
4

5 5 6
6
3
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2
8 1 2
8
 Verifying the impression
• No voids, bubbles allowed
• The handle should be centered on the midline
• Uniform material thickness, no portion of the tray should be visible
• Accurate record of the bearing area, buccal/lingual folds, vibrating line
• The material should not be detached from the tray

1 6
6
1

4
2 2
5 4
3
3

5
• Cleaning, disinfecting the impression
• Check compatibility of the disinfectant with
the impression material
• If not poured immediately  wrapped in a
wet tissue and put in a nylon bag
 Common errors encountered when
making alginate impressions
• Inadequate working or setting time – high water temperature,
incomplete mixing, incorrect water:powder ratio, alteration of the
powder
• Distortions – movement of the tray during setting of the alginate,
premature removal of the tray, delay in pouring the cast
• Tearing – premature removal of the tray, low consistency of the
alginate, deep undercuts, inadequate material in the tray
• Loss of detail – premature tray removal from the mouth
• Consistency – incorrect water:powder ratio, incorrect mixing, use of
hot water
• Dimensional changes – delay in pouring the impression
• Porosity – bubbles incorporated in the mix
• Poor stone surface – delay in the separation of the cast from the
impression
• Advantages
– Easy manipulation
– Normal/fast setting time
– Elastic material
– Can record reasonable undercut
– Good accuracy
– Patients tolerate well alginate impressions (wide
variety of flavors)
– Biocompatible
– Hydrophilic nature
• Disadvantages
– Dry out fast (desiccation)  the preliminary cast
should be poured within 10 minutes
– Poor dimensional stability
– Less accurate than elastomers (silicones)
 Other materials for preliminary
impressions
• Impression compound
(thermoplastic material)
• Impression plaster
 Preliminary cast
= a positive reproduction of the upper or lower jaw
tissues that is made in an impression and over
which impression custom trays may be fabricated
Requirements of a preliminary cast
• All surfaces to be contacted by the tray and denture
should be accurate and free of voids or nodules
• The surface of the cast should be hard and dense
• A cast should extend sufficiently to include all of the
area available for denture support
• Buccal and lingual folds should be free of voids and
nodules
• The base of the cast should not less than 10 mm at the
thinnest point
• The tongue space in the mandibular cast should be flat
and smooth
 Making the preliminary cast
• Prior to pouring, examine the impression carefully
• remove excess moisture from the impression; however, the
surface of the alginate impression should not be thoroughly
dry; it should shine
• trim excess alginate that extends beyond the back of the tray
 to prevent touch the laboratory bench when the impression
rests on it
•The preliminary alginate impression is poured using dental
plaster
• weigh the dental stone and mix it with recommended
amount of water (Approx. 50ml water to 100g powder)
• Mixing in a rubber bowls using circular movements; mixing
using a mechanical spatulator is recommended
• Creamy, homogenous consistency
• The impression is positioned on a vibrating table and
filled with plaster from the highest point  to allow
the paste to flow in the lowest details without
incorporating air bubbles
• Avoid prolonged vibration  separation and distortion
• The base of the cast is fabricated by using another
quantity of plaster, placed on a plastic slab
• The impression filled with plaster is inverted and
positioned parallel with the floor
• The margins are trimmed using a trimming machine,
after the setting of the plaster (approx. 30 min)
• Base formers are also used
– Fast, clean, easy
• Verifying the preliminary cast
– All details recorded with the
impression should be reproduced
on the cast
– No voids, fractures are allowed
– The denture bearing area has to be
easily identifiable: hard palate,
residual ridges, tuberosities,
retromolar pad
– Buccal and lingual folds are also
important to be accurately
recorded
Clinical case – Prof.Dr. Diana Dudea
• Verifying the preliminary cast
– The base should have a
minimum thickness of 10mm in
the thinnest point (hard palate
and lingual folds)

Clinical case – Prof.Dr. Diana Dudea

 Common errors encountered when
making preliminary cast
• Cast surface chalky and soft – impression not
separated from the cast within 1 hour after
pouring, incorrect powder:water ratio, mix too
thin
• Voids on surface of the cast – air bubbles
entrapped in the mix, stone poured into the
impression to quickly, mix too thick
• Cast too thin or too thick, critical areas of the cast
trimmed away – cast trimmed improperly
• Cast broken easily – improper powder:water
ratio; cast trimmed to thin