Saturday, February 18, 2012

Edentulous Custom Tray for PVS Impression Fabrication

Note: Trays should be fabricated at lease 24 hours in advance to ensure triad shrinkage is minimal during the impression.
Maxillary PVS Custom Tray Fabrication Sequence

Identify location in which over-extended alginate impression tissue appears to begin to fold and mark with a blue pencil.  Then mark about 1 mm superior to the blue line a red line.

Adapt one layer of base plate wax to intimately cover the tissue surface of the maxillary arch.  Cut the pink wax back to the previously scribed red line.  Cut three tissue stops into the pink base plate wax; one in the anterior and one in each posterior segment.

Apply separating medium over the wax and then adapt triad tray material over the entire wax relieved area.  Cut the excess triad about 2 mm from the pink base plate wax extension.  Using a wax spatula curl the excess triad material back against the pink base plate wax until the blue line is at the same level as the triad extension.  Then add a handle that won't interfere with the patients lips.  Cure for 2 minutes and remove the wax.  Then cure for 6 minutes intaglio surface up.

 Mandibular PVS Custom Tray Fabrication Sequence
Fallow the same steps as described above with the mandibular custom tray.


Maxillary Teeth and Mandibular Semi-precision Removable Partial Dentures with Distal Extension Implant

Patient presented with a partial edentulous mandibular arch with the very strong request "I do not want anything removable."  We investigated the possibility of implants with a diagnostic wax up and subsequent cone beam CT scan.  It was very evident that there was insufficient bone for implant restorations for fixed prostheses.  The patient was presented with the option of survey crowns with semi-precision attachments and an small implant supporting the unilateral distal extension, as well as restoring her maxillary teeth to a more ideal esthetic and occlusal relationship.  After reviewing the option in detail and considering the patient's finances, the patient elected to restore the mandibular arch with two survey crowns with semi-precision attachments and on implant supporting the distal extension on the left side.  The patient was somewhat apprehensive about the idea of having something removable right up to the day of insertion.  Once it was in the patient's mouth and taken home and used for a while I received this note in an e-mail...

"I love my partial!!  Thank you for doing such a great job; believe it or not, I don't want to remove it.  It is just that comfortable."