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Impression techniques in rpd
“ Good technique pays off ” is not merely a motto to hang on a wall but these are words of wisdom… IMPRESSION TECHNIQUES IN RPD PRESENTED BY: APURVA THAMPI 1ST YR PG CONTENTS • INTRODUCTION • TERMINOLOGIES • COMPLETE DENTURE IMPRESSION V/S RPD IMPRESSION • IMPRESSION MATERIALS • ANATOMIC...CONTENTS • MCLEAN’S PHYSIOLOGIC IMPRESSION TECHNIQUE • HINDEL’S MODIFICATIONS • FUNCTIONAL RELINING METHOD • FLUID WAX TEC...INTRODUCTION • Preservation of remaining tissues. • Contribute to trauma to the surrounding tissues. • Stress tolerance of...IMPRESSION A NEGATIVE LIKENESS OR COPY IN REVERSE OF THE SURFACE OF AN OBJECT ; IMPRINT OF TEETH AND ADJACENT STRUCTURES F...A RECEPTACLE IN TO WHICH SUITABLE IMPRESSION MATERIAL IS PLACED TO MAKE NEGATIVE LIKENESS OR A DEVICE THAT IS USED TO CARR...RPD IMPRESSION VS COMPLETE DENTURE COMPLETE DENTURE IMPRESSION THE EDENTULOUS MUCOSA WITH UNDERLYING BONE ONLY PARTIAL DE...IMPRESSION MATERIALS • NON-ELASTIC • ELASTIC • AQUEOUS HYDROCOLLOIDS • AGAR • ALGINATE • NON-AQUEOUS ELASTOMERS • POLYSULF...Impression Materials Non-elastic Elastic Aqueous Hydrocolloids Non-aqueous Elastomers Polysulfide Silicones Polyether Cond...FACTORS THAT INFLUENCE THE SELECTION OF IMPRESSION MATERIALS ARE Convenience of use Time of manipulation and setting time ...BASED ON THE METHOD OF IMPRESSION MAKING 13 RESIDUAL RIDGE Anatomic form Functional form ANATOMIC FORM • THE SURFACE OF THE RESIDUAL RIDGE AT REST. • IT IS THE SHAPE OF THE RIDGE BEFORE FUNCTIONAL LOAD IS APPLIE...FUNCTIONAL FORM • IT MEANS THE SHAPE OF THE RESIDUAL RIDGE TISSUE WHEN IT IS FUNCTIONING TO SUPPORT THE DENTURE BASE. • IT...16 Anatomic or Resting form Supporting or Functional form McCracken’s Removable Partial Prosthodontics 3rd edition IMPRESSION MATERIALS ANATOMIC IMPRESSIONS • IRREVERSIBLE HYDROCOLLOID • ELASTOMERIC IMPRESSION MATERIALS • REVERSIBLE HYDR...CONCEPT OF FUNCTIONAL IMPRESSION THE TERM FUNCTIONAL IMPRESSION MEANS RECORDING THE FUNCTIONAL FORM OF THE RESIDUAL RIDGE ...• Record and relate the tissues under uniform loading • Distribute the load over as large an area as possible • Accurately...INITIALLY….. • APPLEGATE IMPRESSION WAX TO LOAD FUNCTIONALLY THE RESIDUAL RIDGE • HINDEL FREE END DENTURE BASE UNDER MAS...• KRAMER & SINGER USED A DOUBLE IMPRESSION TECHNIQUE BASED ON LOAD DISTRIBUTION BY HINDEL • MCCRACKEN FUNCTIONAL TECHNIQ...NEED OF FUNCTIONAL IMPRESSION • THE DISPLACEABILITY OF THE MUCOSA OF RESIDUAL RIDGE IS NOT UNIFORM. • IN CASES OF DISTAL E...INDICATIONS FOR FUNCTIONAL IMPRESSION Mandibular distal extension partial dentures • Mainly kennedy’s class I & II edentul...OBJECTIVES OF FUNCTIONAL IMPRESSION (O.C. APPLEGATE) To obtain the maximum area of coverage Traumatic impact on any area m...SUPPORT OF DISTAL EXTENSION BASED PARTIAL DENTURE minor support abutment teeth major support elastic fibrous connective ...FACTORS INFLUENCING THE SUPPORT OF DISTAL EXTENSION BASE • CONTOUR & QUALITY OF RESIDUAL RIDGE 26 Stewart’s clinical Remov...EXTENT OF RESIDUAL RIDGE COVERAGE BY THE DENTURE BASE 27 Stewart’s clinical Removable partial denture prosthodontics – 4th...TYPE & ACCURACY OF IMPRESSION REGISTRATION 28 Stewart’s clinical Removable partial denture prosthodontics – 4th ed McCrack...ACCURACY OF FIT OF DENTURE BASE 29 Stewart’s clinical Removable partial denture prosthodontics – 4th ed •Design of partial denture framework 30 McCracken’s Removable Partial Prosthodontics TOTAL OCCLUSAL LOAD APPLIED 31 McCracken’s Removable Partial Prosthodontics METHODS OF FUNCTIONAL IMPRESSION PHYSIOLOGIC OR FUNCTIONAL IMPRESSION SELECTED PRESSURE IMPRESSION TECHNIQUE McLean's meth...MCLEAN’S PHYSIOLOGIC METHOD 33 Clinical Removable Partial Prosthodontics – Stewart. 3rd edition McLean “The basic problem of partial denture stabilization is to equalize the resilient and non resilient support” Custom tray over a preliminary cast 35 36 Functional impression of extension area under occlusal load Hydrocolloid impression over the first impression made under finger pressure. 37 • FINGER PRESSURE NOT EQUAL TO BITING PRESSURE • CLOSELY AFFECT THE DIRECT RETENTION 38 Disadvantages- • IMPRESSION IS MADE WITH A MODIFIED TRAY APPLYING FINGER PRESSURE. 39 Clinical Removable Partial Prosthodontics – Stewart...40 HINDLE’S FINGER LOADING 41 HINDLE’S FINGER LOADING • TISSUES ARE IN CONSTANT STAGE OF COMPRESSION • ISCHEMIA AND BONE RESORPTION • PREMATURE CONTACTS...THE MAIN PURPOSE OF THESE TECHNIQUES WAS TO RELATE AN IMPRESSION OF THE EDENTULOUS RIDGE TO THE TEETH UNDER A FORM OF FUNC...FUNCTIONAL RELINE METHOD 44 Clinical Removable Partial Prosthodontics – Stewart. 3rd edition LAYER OF RELIEF GIVEN 45 Clinical Removable Partial Prosthodontics – Stewart. 3rd edition THE DENTURE IS PROCESSED & FITTED IN THE MOUTH IN CUSTOMARY MANNER, EXCEPT THAT THE RELIEF METAL IS LEFT IN PLACE. 46 It s...THE RELIEF METAL IS STRIPPED OFF FROM THE ACRYLIC. 47 Clinical Removable Partial Prosthodontics – Stewart. 3rd edition LOW FUSING MODELING COMPOUND IS ADDED IN INCREMENTS 48 BORDER MOLDING DONE. 49 1 MM MODELING PLASTIC IS REMOVED FROM THE INTAGLIO SURFACE. 50 IMPRESSION MADE USING ONE OF THE CORRECTIVE MATERIALS : FLUID WAX, ZINC-OXIDE EUGENOL PASTES OR ANY ELASTOMERIC IMPRESSION...FUNCTIONAL RELINE METHOD DISADVANTAGE • OCCLUSION MAY BE ALTERED SLIGHTLY • FINE LINE OF DEMARCATION BETWEEN THE NEWLY ADD...FLUID WAX TECHNIQUE 53 Clinical Removable Partial Prosthodontics – Stewart. 3rd edition THE MOST FREQUENTLY USED WAXES ARE Korrecta wax no. 4 - Dr. O.C.& S.G. Applegate at University of Michigan IOWA wax -Devel...THE ARMANTARIUM FOR FLUID WAX TECHNIQUE. (51- 54 DEGREE CELSIUS) 55 UNDERCUTS ELIMINATED USING BASEPLATE WAX 56 SEPARATING MEDIUM APPLIED TO THE CAST. 57 FRAMEWORK SEATED ON THE CAST. 58 TRAY MATERIAL ADAPTED 1-2 MM RELIEF BETWEEN RESIDUAL RIDGE AND INTAGLIO SURFACE OF TRAY. 59 EXCESS MATERIAL REMOVED. Tray ...FLUID WAX PAINTED ONTO THE INTAGLIO SURFACE OF TRAY (1 -2 MM) 60 Assembly seated in patients mouth.(5 -7 mins) COMPLETED IMPRESSION. CHECK FOR PROPER TISSUE CONTACT 61 SELECTIVE TISSUE PLACEMENT IMPRESSION METHOD 62 Direct more force to those portions of ridge able to absorb stress without adverse response & to protect the areas of ridg...Framework tried on the cast Tray outline marked for extension 64McCracken’s Removable Partial Prosthodontics FRAMEWORK WITH TRAY FABRICATED ON IT WITH HOLES ON ITS RIDGE. 65 McCracken’s Removable Partial Prosthodontics AREAS IN WHICH RELIEF IS TO BE PROVIDED IS MARKED 66 TRAY IS BEING RELIEVED BEFORE THE FINAL IMPRESSION IS MADE Clinical R...Acrylic resin impression trays with holes Framework with tray tried in patient’s mouth Functional impression made 67 WELCOME BACK! ALTERED CAST TECHNIQUE ALTERED CAST : A FINAL CAST THAT IS REVISED IN PART BEFORE PROCESSING A DENTURE BASE—CALLED ALSO CORRECTED CAST, MODIFIED ...• ALSO KNOWN AS CORRECTED CAST OR SPLIT CAST TECHNIQUE. • IT IS MAINLY A MODIFICATION OF FUNCTIONAL IMPRESSION THROUGH LAB...Functional impression made Final impression 72 McCracken’s Removable Partial Prosthodontics 12thedition Edentulous area cut from the master cast 73 Framework with attached impression seated on the master cast It is imperative that all the rests occupy their proper posit...Assembly from underside of the cast Peripheral borders of the impression are protected with utility wax 75 THE NEWLY OBTAINED ALTERED CAST WITH NEWLY ADDED STONE 76 ALTERNATE TECHNIQUES 77 78 Boxed elastomeric final impression in which edentulous ridges have been separated with contoured baseplate wax (A arrow...79 Mix of properly proportioned dental stone vibrated into three compartments of impression. Impression must be overfilled...80 Master east ready for duplication. Three to 5 mm thick base (line shown by arrow) below level of separating wax to prev...81 Base of the cast has been trimmed to line shown by arrows immersion in boiling slurry water. Izharul Haque Ansari: A n...82 View from bottom of master cast after base has been trimmed to expose separating wax and wax dovetails. Izharul Haque A...83 Edentulous portions separated from rest of master cast when removed from boiling clear slurry water. Appearance of dove...ALTERNATE BOXING TECHNIQUE 84 Leila Jahangiri, Patrick Mascarenhas and Donald Kitzis: A simple technique for boxing impres...85 Replacement of impression and framework on master cast after removal of edentulous distal extension areas of cast. Fram...86 Protection of teeth in master cast with irreversible hydrocolloid. Leila Jahangiri, Patrick Mascarenhas and Donald Kitz...87 Immersion of master cast and frame assembly within supporting base. Framework with corrected impression is seated into ...• MAKE A SUPPORT BASE MIX WITH • 2 PARTS (26 ML) CORNSTARCH • 1 PART (13 ML) FINE PUMICE, AND • 1 PART (13 ML) PLASTER. • ...• MIX 50% CORNSTARCH AND 50% WHITE MODELING PLASTER BY VOLUME WITH WATER TO A CREAMY CONSISTENCY. POUR THIS INTO THE BOXIN...• SOAK THE MASTER CAST IN SLURRY WATER FOR 5 MINUTES. POUR THE CAST USING THE SAME STONE AS THE ORIGINAL MASTER CAST. NO S...91 Boxing wax placed around plaster base and cast leaving at least 20 mm from top of wax to highest point on impression. L...92 Completed altered cast. Leila Jahangiri, Patrick Mascarenhas and Donald Kitzis: A simple technique for boxing impressio...ALTERNATE BOXING TECHNIQUE 93 Ming-Sheh Chen, W.A. Eichhold, Chao-Chin Chien and D.A. Curtis : An altered-cast impression ...94Ming-Sheh Chen, W.A. Eichhold, Chao-Chin Chien and D.A. Curtis : An altered-cast impression technique that eliminates co...95 Tissue surface of distal-extension with irreversible hydrocolloid pickup impression. Irreversible hydrocolloid is overe...96 Irreversible hydrocolloid pickup impression after trimming is completed. It shows relationship between final impression...97 Tissue surface of final impression is surrounded by a uniform land of irreversible hydrocolloid. Ming-Sheh Chen, W.A. E...98 Tissue surface of pickup impression. Note wax blockout (arrows) of all undesirable mechanical undercuts. Ming-Sheh Chen...99 Master cast obtained by this method. Ming-Sheh Chen, W.A. Eichhold, Chao-Chin Chien and D.A. Curtis : An altered-cast i...ALTERNATIVE TO ALTERED CAST TECHNIQUE 100 Herman B. Dumbrigue and Josephine F. Esquivel: Selective-pressure single impress...101Herman B. Dumbrigue and Josephine F. Esquivel: Selective-pressure single impression procedure for tooth-mucosa–supporte...102Herman B. Dumbrigue and Josephine F. Esquivel: Selective-pressure single impression procedure for tooth-mucosa–supporte...103Herman B. Dumbrigue and Josephine F. Esquivel: Selective-pressure single impression procedure for tooth-mucosa–supporte...104Herman B. Dumbrigue and Josephine F. Esquivel: Selective-pressure single impression procedure for tooth-mucosa–supporte...Richard P. Frank et al :clinical outcome of altered cast impression procedure compared with use of A one piece cast J pros...IMPRESSION TECHNIQUE FOR MAXILLARY REMOVABLE PARTIAL DENTURES - C D. LEACH & T E. DONOVAN JPD 1983 (50)2,283-285 A MODIFICATION OF THE ALTERED CAST TECHNIQUE -RICHARD BAUMAN & JAMES .D B – JPD 1982(47) 2, 212-213 FOR THE PRODUCTION OF ACCURATE MASTER CAST THE IMPRESSION TECHNIQUE FAR OUT WEIGHTS THE SELECTION OF THE IMPRESSION MATERI...1. GLOSSARY OF PROSTHODONTIC TERMS -8 TH EDN, 2005. 2. STEWART, RUDD, KUEBKER : CLINICAL REMOVABLE PARTIAL PROSTHODONTICS....AN ALTERED CAST PROCEDURE TO IMPROVE TISSUE SUPPORT FOR REMOVABLE PARTIAL DENTURES - R J. LEUPOLD, F J. KRATOCHVIL : JPD 1...THANK YOU AND HAVE A PLEASANT DAY! Impression techniques in rpdImpression techniques in rpdImpression techniques in rpd

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  • Based on tissue borne/ tissue tooth borne  the stress over the underlying tissues
  • Occlusal forces must be equally distributed to the abutment and the tissues of the ridge  cannot be accomplished by a single impression
  • Compressibility of tissue  recognised  vary from patient to patient and site to site
    Thick and displacable  less support
    Firm and tightly attached  2-3mm moderate thickness  greatest support
    Redundant tissues over tuberosities  surgically removed
  • Made to fit the areas that serve as the primary stress bearing areas
  • P record the ridge in its functional form  place an occlusal load on the tray
    S equalize the support between the abutments and soft tissue  relieve the tray in some areas
  • As a result they developed a dual impression technique
  • Clasps sufficient to maintain the positiontissues of ridge in functional form compromised blood flow
    Clasps not sufficient  DB occlusally positioned  premature contact
  • AN ALTERED-CAST PROCEDURE TO IMPROVE TISSUE SUPPORT
    FOR REMOVABLE PARTIAL DENTURES
  1. 1. “ Good technique pays off ” is not merely a motto to hang on a wall but these are words of wisdom…
  2. 2. IMPRESSION TECHNIQUES IN RPD PRESENTED BY: APURVA THAMPI 1ST YR PG
  3. 3. CONTENTS • INTRODUCTION • TERMINOLOGIES • COMPLETE DENTURE IMPRESSION V/S RPD IMPRESSION • IMPRESSION MATERIALS • ANATOMIC FORM AND FUNCTIONAL FORM • CONCEPT OF FUNCTIONAL IMPRESSION • NEED OF FUNCTIONAL IMPRESSION • INDICATION FOR FUNCTIONAL IMPRESSION • OBJECTIVES OF FUNCTIONAL IMPRESSION • DISTAL EXTENSION BASED PARTIAL DENTURE 3
  4. 4. CONTENTS • MCLEAN’S PHYSIOLOGIC IMPRESSION TECHNIQUE • HINDEL’S MODIFICATIONS • FUNCTIONAL RELINING METHOD • FLUID WAX TECHNIQUE • SELECTIVE PRESSURE IMPRESSION • ALTERED CAST TECHNIQUE • MODIFICATIONS OF ALTERED CAST TECHNIQUE • REVIEW OF LITERATURE • SUMMARY • CONCLUSION • BIBLIOGRAPHY 4
  5. 5. INTRODUCTION • Preservation of remaining tissues. • Contribute to trauma to the surrounding tissues. • Stress tolerance of supporting anatomic structures, • Denture base always moves towards the supporting muscle. • Support for the partial denture  to be considered Rationale behind using RPD….
  6. 6. IMPRESSION A NEGATIVE LIKENESS OR COPY IN REVERSE OF THE SURFACE OF AN OBJECT ; IMPRINT OF TEETH AND ADJACENT STRUCTURES FOR USE IN DENTISTRY. GPT – 8 PARTIAL DENTURE IMPRESSION A NEGATIVE LIKENESS OF A PART OR ALL OF A PARTIALLY EDENTULOUS ARCH – GPT – 8 Terminology
  7. 7. A RECEPTACLE IN TO WHICH SUITABLE IMPRESSION MATERIAL IS PLACED TO MAKE NEGATIVE LIKENESS OR A DEVICE THAT IS USED TO CARRY, CONFINE AND CONTROL IMPRESSION MATERIAL WHILE MAKING AN IMPRESSION. IMPRESSION TRAYS
  8. 8. RPD IMPRESSION VS COMPLETE DENTURE COMPLETE DENTURE IMPRESSION THE EDENTULOUS MUCOSA WITH UNDERLYING BONE ONLY PARTIAL DENTURE IMPRESSION  RELATIVE SOFT YIELDING TISSUES (THE ORAL MUCOSA) + HARD UNYIELDING SUBSTANCE (THE REMAINING TEETH).
  9. 9. IMPRESSION MATERIALS • NON-ELASTIC • ELASTIC • AQUEOUS HYDROCOLLOIDS • AGAR • ALGINATE • NON-AQUEOUS ELASTOMERS • POLYSULFIDE • SILICONES • CONDENSATION • ADDITION • POLYETHER
  10. 10. Impression Materials Non-elastic Elastic Aqueous Hydrocolloids Non-aqueous Elastomers Polysulfide Silicones Polyether Condensation Addition Agar (reversible) Alginate (irreversible) Plaster Compound ZnO - Eugenol Waxes O’Brien Dental Materials & their Selection 1997
  11. 11. FACTORS THAT INFLUENCE THE SELECTION OF IMPRESSION MATERIALS ARE Convenience of use Time of manipulation and setting time Cost Operator training and preference Need for special trays
  12. 12. BASED ON THE METHOD OF IMPRESSION MAKING 13 RESIDUAL RIDGE Anatomic form Functional form
  13. 13. ANATOMIC FORM • THE SURFACE OF THE RESIDUAL RIDGE AT REST. • IT IS THE SHAPE OF THE RIDGE BEFORE FUNCTIONAL LOAD IS APPLIED. 14
  14. 14. FUNCTIONAL FORM • IT MEANS THE SHAPE OF THE RESIDUAL RIDGE TISSUE WHEN IT IS FUNCTIONING TO SUPPORT THE DENTURE BASE. • IT IS THE SHAPE OF THE RIDGE AFTER FUNCTIONAL LOAD IS APPLIED. 15
  15. 15. 16 Anatomic or Resting form Supporting or Functional form McCracken’s Removable Partial Prosthodontics 3rd edition
  16. 16. IMPRESSION MATERIALS ANATOMIC IMPRESSIONS • IRREVERSIBLE HYDROCOLLOID • ELASTOMERIC IMPRESSION MATERIALS • REVERSIBLE HYDROCOLLOID FUNCTIONAL IMPRESSIONS • FLUID WAXES • METALLIC PASTES • ELASTOMERIC IMPRESSION MATERIALS • SOFT RELINERS 17
  17. 17. CONCEPT OF FUNCTIONAL IMPRESSION THE TERM FUNCTIONAL IMPRESSION MEANS RECORDING THE FUNCTIONAL FORM OF THE RESIDUAL RIDGE TISSUE & TO OBTAIN UNIFORMITY OF SUPPORT WHEN THE FUNCTIONAL LOAD IS APPLIED. 18
  18. 18. • Record and relate the tissues under uniform loading • Distribute the load over as large an area as possible • Accurately delineate the peripheral extent of the denture base Therefore, the impression must…
  19. 19. INITIALLY….. • APPLEGATE IMPRESSION WAX TO LOAD FUNCTIONALLY THE RESIDUAL RIDGE • HINDEL FREE END DENTURE BASE UNDER MASTICATORY LOAD SHOULD BE RELATED TO METAL FRAMEWORK WHEN IT IS SEATED • HOLMES USED FOUR DIFFERENT MATERIALS WITH ALTERED CAST TECHNIQUE • LEUPOLD & KRATOCHVIL USED ZINC-OXIDE EUGENOL PASTE TO RECORD THE SHAPE OF RESIDUAL RIDGES Leupold RJ, A comparative study of impression procedures for distal extension removable partial dentures. J Prosthet Dent 1966; 16:708. 20
  20. 20. • KRAMER & SINGER USED A DOUBLE IMPRESSION TECHNIQUE BASED ON LOAD DISTRIBUTION BY HINDEL • MCCRACKEN FUNCTIONAL TECHNIQUE SHOULD BE USED WHEN CONSTRUCTING MANDIBULAR DISTAL EXTENSION BASED PARTIAL DENTURE Leupold RJ, A comparative study of impression procedures for distal extension removable partial dentures. J Prosthet Dent 1966; 16:708. 21
  21. 21. NEED OF FUNCTIONAL IMPRESSION • THE DISPLACEABILITY OF THE MUCOSA OF RESIDUAL RIDGE IS NOT UNIFORM. • IN CASES OF DISTAL EXTENSION BASED PARTIAL DENTURE. • SHORT SPAN DISTAL EXTENSION BASES. 22
  22. 22. INDICATIONS FOR FUNCTIONAL IMPRESSION Mandibular distal extension partial dentures • Mainly kennedy’s class I & II edentulous arches. 23
  23. 23. OBJECTIVES OF FUNCTIONAL IMPRESSION (O.C. APPLEGATE) To obtain the maximum area of coverage Traumatic impact on any area must be avoided At rest there must be no islands of ischemia Under work loads all areas must receive massage 24
  24. 24. SUPPORT OF DISTAL EXTENSION BASED PARTIAL DENTURE minor support abutment teeth major support elastic fibrous connective tissue pad 25
  25. 25. FACTORS INFLUENCING THE SUPPORT OF DISTAL EXTENSION BASE • CONTOUR & QUALITY OF RESIDUAL RIDGE 26 Stewart’s clinical Removable partial denture prosthodontics – 4th ed
  26. 26. EXTENT OF RESIDUAL RIDGE COVERAGE BY THE DENTURE BASE 27 Stewart’s clinical Removable partial denture prosthodontics – 4th ed
  27. 27. TYPE & ACCURACY OF IMPRESSION REGISTRATION 28 Stewart’s clinical Removable partial denture prosthodontics – 4th ed McCracken’s Removable Partial Prosthodontics
  28. 28. ACCURACY OF FIT OF DENTURE BASE 29 Stewart’s clinical Removable partial denture prosthodontics – 4th ed
  29. 29. •Design of partial denture framework 30 McCracken’s Removable Partial Prosthodontics
  30. 30. TOTAL OCCLUSAL LOAD APPLIED 31 McCracken’s Removable Partial Prosthodontics
  31. 31. METHODS OF FUNCTIONAL IMPRESSION PHYSIOLOGIC OR FUNCTIONAL IMPRESSION SELECTED PRESSURE IMPRESSION TECHNIQUE McLean's method Functional relining method Hindel’s modification for McLean's method The Fluid wax technique 32
  32. 32. MCLEAN’S PHYSIOLOGIC METHOD 33 Clinical Removable Partial Prosthodontics – Stewart. 3rd edition
  33. 33. McLean “The basic problem of partial denture stabilization is to equalize the resilient and non resilient support”
  34. 34. Custom tray over a preliminary cast 35
  35. 35. 36 Functional impression of extension area under occlusal load
  36. 36. Hydrocolloid impression over the first impression made under finger pressure. 37
  37. 37. • FINGER PRESSURE NOT EQUAL TO BITING PRESSURE • CLOSELY AFFECT THE DIRECT RETENTION 38 Disadvantages-
  38. 38. • IMPRESSION IS MADE WITH A MODIFIED TRAY APPLYING FINGER PRESSURE. 39 Clinical Removable Partial Prosthodontics – Stewart. 3rd edition HINDEL’S MODIFICATION
  39. 39. 40
  40. 40. HINDLE’S FINGER LOADING 41
  41. 41. HINDLE’S FINGER LOADING • TISSUES ARE IN CONSTANT STAGE OF COMPRESSION • ISCHEMIA AND BONE RESORPTION • PREMATURE CONTACTS AT REST. 42 Disadvantage
  42. 42. THE MAIN PURPOSE OF THESE TECHNIQUES WAS TO RELATE AN IMPRESSION OF THE EDENTULOUS RIDGE TO THE TEETH UNDER A FORM OF FUNCTIONAL LOADING.
  43. 43. FUNCTIONAL RELINE METHOD 44 Clinical Removable Partial Prosthodontics – Stewart. 3rd edition
  44. 44. LAYER OF RELIEF GIVEN 45 Clinical Removable Partial Prosthodontics – Stewart. 3rd edition
  45. 45. THE DENTURE IS PROCESSED & FITTED IN THE MOUTH IN CUSTOMARY MANNER, EXCEPT THAT THE RELIEF METAL IS LEFT IN PLACE. 46 It should be worn for a trial period of a week & all needed adjustments are done Clinical Removable Partial Prosthodontics – Stewart. 3rd edition
  46. 46. THE RELIEF METAL IS STRIPPED OFF FROM THE ACRYLIC. 47 Clinical Removable Partial Prosthodontics – Stewart. 3rd edition
  47. 47. LOW FUSING MODELING COMPOUND IS ADDED IN INCREMENTS 48
  48. 48. BORDER MOLDING DONE. 49
  49. 49. 1 MM MODELING PLASTIC IS REMOVED FROM THE INTAGLIO SURFACE. 50
  50. 50. IMPRESSION MADE USING ONE OF THE CORRECTIVE MATERIALS : FLUID WAX, ZINC-OXIDE EUGENOL PASTES OR ANY ELASTOMERIC IMPRESSION MATERIAL. 51
  51. 51. FUNCTIONAL RELINE METHOD DISADVANTAGE • OCCLUSION MAY BE ALTERED SLIGHTLY • FINE LINE OF DEMARCATION BETWEEN THE NEWLY ADDED & OLD RESIN OF THE DENTURE 52
  52. 52. FLUID WAX TECHNIQUE 53 Clinical Removable Partial Prosthodontics – Stewart. 3rd edition
  53. 53. THE MOST FREQUENTLY USED WAXES ARE Korrecta wax no. 4 - Dr. O.C.& S.G. Applegate at University of Michigan IOWA wax -Developed by Dr.Smith at University of IOWA 54 Korrecta wax no. 4 is slightly more fluid than IOWA wax
  54. 54. THE ARMANTARIUM FOR FLUID WAX TECHNIQUE. (51- 54 DEGREE CELSIUS) 55
  55. 55. UNDERCUTS ELIMINATED USING BASEPLATE WAX 56
  56. 56. SEPARATING MEDIUM APPLIED TO THE CAST. 57
  57. 57. FRAMEWORK SEATED ON THE CAST. 58
  58. 58. TRAY MATERIAL ADAPTED 1-2 MM RELIEF BETWEEN RESIDUAL RIDGE AND INTAGLIO SURFACE OF TRAY. 59 EXCESS MATERIAL REMOVED. Tray border smoothed using laboratory bur. Should be 2 mm short of border extension required.
  59. 59. FLUID WAX PAINTED ONTO THE INTAGLIO SURFACE OF TRAY (1 -2 MM) 60 Assembly seated in patients mouth.(5 -7 mins)
  60. 60. COMPLETED IMPRESSION. CHECK FOR PROPER TISSUE CONTACT 61
  61. 61. SELECTIVE TISSUE PLACEMENT IMPRESSION METHOD 62
  62. 62. Direct more force to those portions of ridge able to absorb stress without adverse response & to protect the areas of ridge which are least able to absorb forces. 63
  63. 63. Framework tried on the cast Tray outline marked for extension 64McCracken’s Removable Partial Prosthodontics
  64. 64. FRAMEWORK WITH TRAY FABRICATED ON IT WITH HOLES ON ITS RIDGE. 65 McCracken’s Removable Partial Prosthodontics
  65. 65. AREAS IN WHICH RELIEF IS TO BE PROVIDED IS MARKED 66 TRAY IS BEING RELIEVED BEFORE THE FINAL IMPRESSION IS MADE Clinical Removable Partial Prosthodontics – Stewart. 3rd edition
  66. 66. Acrylic resin impression trays with holes Framework with tray tried in patient’s mouth Functional impression made 67
  67. 67. WELCOME BACK!
  68. 68. ALTERED CAST TECHNIQUE
  69. 69. ALTERED CAST : A FINAL CAST THAT IS REVISED IN PART BEFORE PROCESSING A DENTURE BASE—CALLED ALSO CORRECTED CAST, MODIFIED CAST ALTERED CAST PARTIAL DENTURE IMPRESSION : A NEGATIVE LIKENESS OF A PORTION OR PORTIONS OF THE DENTURE BEARING AREA(S) MADE INDEPENDENT OF AND AFTER THE INITIAL IMPRESSION OF THE NATURAL TEETH. 70
  70. 70. • ALSO KNOWN AS CORRECTED CAST OR SPLIT CAST TECHNIQUE. • IT IS MAINLY A MODIFICATION OF FUNCTIONAL IMPRESSION THROUGH LABORATORY PROCEDURE. • FUNCTIONAL IMPRESSION FOR THIS TECHNIQUE CAN BE MADE USING ANY MENTIONED MATERIALS AND TECHNIQUES. 71 Robert J. Leupold And Frank J. Kratochvil:An Altered-cast Procedure To Improve Tissue Support For Removable Partial Dentures .J Prosthet Dent 1965:672-679
  71. 71. Functional impression made Final impression 72 McCracken’s Removable Partial Prosthodontics 12thedition
  72. 72. Edentulous area cut from the master cast 73
  73. 73. Framework with attached impression seated on the master cast It is imperative that all the rests occupy their proper position on the cast 74
  74. 74. Assembly from underside of the cast Peripheral borders of the impression are protected with utility wax 75
  75. 75. THE NEWLY OBTAINED ALTERED CAST WITH NEWLY ADDED STONE 76
  76. 76. ALTERNATE TECHNIQUES 77
  77. 77. 78 Boxed elastomeric final impression in which edentulous ridges have been separated with contoured baseplate wax (A arrows) and sealed to anatomic contour of impression at base. Triangular wax bars (B arrows) are attached to make dovetails (three separate compartments of impression). Izharul Haque Ansari: A new procedure for separating the edentulous distal extension portion from the master cast when an altered cast is made. J Prosthet Dent 1994;72:666-9.
  78. 78. 79 Mix of properly proportioned dental stone vibrated into three compartments of impression. Impression must be overfilled to make solid base to prevent premature separation Izharul Haque Ansari: A new procedure for separating the edentulous distal extension portion from the master cast when an altered cast is made. J Prosthet Dent 1994;72:666-9.
  79. 79. 80 Master east ready for duplication. Three to 5 mm thick base (line shown by arrow) below level of separating wax to prevent premature separation while cast is handled to make the framework. Izharul Haque Ansari: A new procedure for separating the edentulous distal extension portion from the master cast when an altered cast is made. J Prosthet Dent 1994;72:666-9.
  80. 80. 81 Base of the cast has been trimmed to line shown by arrows immersion in boiling slurry water. Izharul Haque Ansari: A new procedure for separating the edentulous distal extension portion from the master cast when an altered cast is made. J Prosthet Dent 1994;72:666-9.
  81. 81. 82 View from bottom of master cast after base has been trimmed to expose separating wax and wax dovetails. Izharul Haque Ansari: A new procedure for separating the edentulous distal extension portion from the master cast when an altered cast is made. J Prosthet Dent 1994;72:666-9.
  82. 82. 83 Edentulous portions separated from rest of master cast when removed from boiling clear slurry water. Appearance of dovetails for additional retention for dental stone. Izharul Haque Ansari: A new procedure for separating the edentulous distal extension portion from the master cast when an altered cast is made. J Prosthet Dent 1994;72:666-9.
  83. 83. ALTERNATE BOXING TECHNIQUE 84 Leila Jahangiri, Patrick Mascarenhas and Donald Kitzis: A simple technique for boxing impressions for fabrication of altered casts. J Prosthet Dent 2001;85:519-20 Kevin D. Plummer:Technique for boxing an altered cast impression. J Prosthet Dent 1982;47:573-575
  84. 84. 85 Replacement of impression and framework on master cast after removal of edentulous distal extension areas of cast. Framework is luted to master cast with sticky wax. Leila Jahangiri, Patrick Mascarenhas and Donald Kitzis: A simple technique for boxing impressions for fabrication of altered casts. J Prosthet Dent 2001;85:519-20 Kevin D. Plummer:Technique for boxing an altered cast impression. J Prosthet Dent 1982;47:573-575
  85. 85. 86 Protection of teeth in master cast with irreversible hydrocolloid. Leila Jahangiri, Patrick Mascarenhas and Donald Kitzis: A simple technique for boxing impressions for fabrication of altered casts. J Prosthet Dent 2001;85:519-20 Kevin D. Plummer:Technique for boxing an altered cast impression. J Prosthet Dent 1982;47:573-575
  86. 86. 87 Immersion of master cast and frame assembly within supporting base. Framework with corrected impression is seated into a plaster mix contained bv wax boxing sheet. Leila Jahangiri, Patrick Mascarenhas and Donald Kitzis: A simple technique for boxing impressions for fabrication of altered casts. J Prosthet Dent 2001;85:519-20 Kevin D. Plummer:Technique for boxing an altered cast impression. J Prosthet Dent 1982;47:573-575
  87. 87. • MAKE A SUPPORT BASE MIX WITH • 2 PARTS (26 ML) CORNSTARCH • 1 PART (13 ML) FINE PUMICE, AND • 1 PART (13 ML) PLASTER. • ADD TO 115 ML WATER. POUR THE MATERIAL INTO A DENTURE FLASK. • LET SET FOR 15 MINUTES. • SEPARATE MASTER CAST FROM THE SUPPORTING BASE AND IRREVERSIBLE HYDROCOLLOID 88 Leila Jahangiri, Patrick Mascarenhas and Donald Kitzis: A simple technique for boxing impressions for fabrication of altered casts. J Prosthet Dent 2001;85:519-20
  88. 88. • MIX 50% CORNSTARCH AND 50% WHITE MODELING PLASTER BY VOLUME WITH WATER TO A CREAMY CONSISTENCY. POUR THIS INTO THE BOXING WAX FORM. PLACE THE IMPRESSION IN THE MIXTURE. • ALLOW THE MIXTURE TO SET FOR 10 MINUTES. • SEAL THE PREVIOUSLY USED BOXING WAX TO THE TRIMMED BASE LEAVING AT LEAST 20 MM FROM THE TOP OF THE BOXING WAX TO THE HIGHEST POINT ON THE IMPRESSION. 89 Kevin D. Plummer:Technique for boxing an altered cast impression. J Prosthet Dent 1982;47:573-575
  89. 89. • SOAK THE MASTER CAST IN SLURRY WATER FOR 5 MINUTES. POUR THE CAST USING THE SAME STONE AS THE ORIGINAL MASTER CAST. NO SEPARATING MEDIUM IS NEEDED • WHEN THE STONE IS SET, REMOVE THE BOXING WAX AND PLACE THE CAST IN A WATER BATH OF 110” F • SEPARATE THE PLASTER/CORNSTARCH MIXTURE WITH PLASTER PLIERS AND YOUR FINGERS.
  90. 90. 91 Boxing wax placed around plaster base and cast leaving at least 20 mm from top of wax to highest point on impression. Leila Jahangiri, Patrick Mascarenhas and Donald Kitzis: A simple technique for boxing impressions for fabrication of altered casts. J Prosthet Dent 2001;85:519-20 Kevin D. Plummer:Technique for boxing an altered cast impression. J Prosthet Dent 1982;47:573-575
  91. 91. 92 Completed altered cast. Leila Jahangiri, Patrick Mascarenhas and Donald Kitzis: A simple technique for boxing impressions for fabrication of altered casts. J Prosthet Dent 2001;85:519-20 Kevin D. Plummer:Technique for boxing an altered cast impression. J Prosthet Dent 1982;47:573-575
  92. 92. ALTERNATE BOXING TECHNIQUE 93 Ming-Sheh Chen, W.A. Eichhold, Chao-Chin Chien and D.A. Curtis : An altered-cast impression technique that eliminates conventional cast dissecting and impression boxing. J Prosthet Dent 1987;57:471-474
  93. 93. 94Ming-Sheh Chen, W.A. Eichhold, Chao-Chin Chien and D.A. Curtis : An altered-cast impression technique that eliminates conventional cast dissecting and impression boxing. J Prosthet Dent 1987;57:471-474 Tissue surface of final impression. Lingual surface of custom tray. Only 3 mm of impression material is left over and above border flange.
  94. 94. 95 Tissue surface of distal-extension with irreversible hydrocolloid pickup impression. Irreversible hydrocolloid is overextended 3 to 5 mm around distal-extension region. Ming-Sheh Chen, W.A. Eichhold, Chao-Chin Chien and D.A. Curtis : An altered-cast impression technique that eliminates conventional cast dissecting and impression boxing. J Prosthet Dent 1987;57:471-474
  95. 95. 96 Irreversible hydrocolloid pickup impression after trimming is completed. It shows relationship between final impression, irreversible hydrocolloid land, and stock metal tray. Ming-Sheh Chen, W.A. Eichhold, Chao-Chin Chien and D.A. Curtis : An altered-cast impression technique that eliminates conventional cast dissecting and impression boxing. J Prosthet Dent 1987;57:471-474
  96. 96. 97 Tissue surface of final impression is surrounded by a uniform land of irreversible hydrocolloid. Ming-Sheh Chen, W.A. Eichhold, Chao-Chin Chien and D.A. Curtis : An altered-cast impression technique that eliminates conventional cast dissecting and impression boxing. J Prosthet Dent 1987;57:471-474
  97. 97. 98 Tissue surface of pickup impression. Note wax blockout (arrows) of all undesirable mechanical undercuts. Ming-Sheh Chen, W.A. Eichhold, Chao-Chin Chien and D.A. Curtis : An altered-cast impression technique that eliminates conventional cast dissecting and impression boxing. J Prosthet Dent 1987;57:471-474
  98. 98. 99 Master cast obtained by this method. Ming-Sheh Chen, W.A. Eichhold, Chao-Chin Chien and D.A. Curtis : An altered-cast impression technique that eliminates conventional cast dissecting and impression boxing. J Prosthet Dent 1987;57:471-474
  99. 99. ALTERNATIVE TO ALTERED CAST TECHNIQUE 100 Herman B. Dumbrigue and Josephine F. Esquivel: Selective-pressure single impression procedure for tooth-mucosa–supported removable partial dentures. J Prosthet Dent 1998;80:259-61
  100. 100. 101Herman B. Dumbrigue and Josephine F. Esquivel: Selective-pressure single impression procedure for tooth-mucosa–supported removable partial dentures. J Prosthet Dent 1998;80:259-61 Aluminum foil and two sheets of baseplate wax over diagnostic cast before tray fabrication.
  101. 101. 102Herman B. Dumbrigue and Josephine F. Esquivel: Selective-pressure single impression procedure for tooth-mucosa–supported removable partial dentures. J Prosthet Dent 1998;80:259-61 Custom tray fabricated with extensions reduced 2 mm short of vestibule.
  102. 102. 103Herman B. Dumbrigue and Josephine F. Esquivel: Selective-pressure single impression procedure for tooth-mucosa–supported removable partial dentures. J Prosthet Dent 1998;80:259-61 Custom tray with softened modeling compound reseated on diagnostic cast. Modeling compound over residual ridges shaped appropriately before intraoral placement.
  103. 103. 104Herman B. Dumbrigue and Josephine F. Esquivel: Selective-pressure single impression procedure for tooth-mucosa–supported removable partial dentures. J Prosthet Dent 1998;80:259-61 Border molding procedure completed.
  104. 104. Richard P. Frank et al :clinical outcome of altered cast impression procedure compared with use of A one piece cast J prosthet dent 2004;91:468-76 ALTERED CAST PROCEDURE DOES NOT OFFER SIGNIFICANT ADVANTAGES OVER ONE PIECE CAST IF THE FOLLOWING STANDARDS ARE MET : • COMPLETE EXTENSION OF IMPRESSION • USE OF MAGNIFICATION TO ADJUST AND ENSURE COMPLETE SEATING OF THE FRAMEWORK. • COVERAGE OF RETROMOLAR PAD AND BUCCAL SHELF AREA BY THE BASE 105 92
  105. 105. IMPRESSION TECHNIQUE FOR MAXILLARY REMOVABLE PARTIAL DENTURES - C D. LEACH & T E. DONOVAN JPD 1983 (50)2,283-285
  106. 106. A MODIFICATION OF THE ALTERED CAST TECHNIQUE -RICHARD BAUMAN & JAMES .D B – JPD 1982(47) 2, 212-213
  107. 107. FOR THE PRODUCTION OF ACCURATE MASTER CAST THE IMPRESSION TECHNIQUE FAR OUT WEIGHTS THE SELECTION OF THE IMPRESSION MATERIAL. CONCLUSION
  108. 108. 1. GLOSSARY OF PROSTHODONTIC TERMS -8 TH EDN, 2005. 2. STEWART, RUDD, KUEBKER : CLINICAL REMOVABLE PARTIAL PROSTHODONTICS. 3. MCGIVNEY GP, ALAN B CARR DAVID T BROWN : MCCRACKEN’S REMOVABLE PARTIAL DENTURES-11 TH EDN. 4. KENNETH D RUDD, MORROW: DENTAL LAB, PROCEDURE FOR REMOVABLE PARTIAL DENTURES. BIBLIOGRAPHY
  109. 109. AN ALTERED CAST PROCEDURE TO IMPROVE TISSUE SUPPORT FOR REMOVABLE PARTIAL DENTURES - R J. LEUPOLD, F J. KRATOCHVIL : JPD 1965(15), 4, 672- 678 SINGLE- TRAY DUAL- IMPRESSION TECHNIQUE FOR DISTAL EXTENSION PARTIAL DENTURES JOSEPH A. R- JPD 1970(24,1,41-46) IMPRESSION TECHNIQUE FOR MAXILLARY REMOVABLE PARTIAL DENTURES- C D. LEACH & T E. DONOVAN JPD 1983 (50)2,283-285 AN ALTERED CAST IMPRESSION TECHNIQUE THAT ELIMINATES CONVENTIONAL CAST DISSECTING & IMPRESSSION BOXING - M S. CHEN AND et al - JPD 1987 (57) 4, 471-474 A MODIFICATION OF THE ALTERED CAST TECHNIQUE -RICHARD BAUMAN & JAMES .D B – JPD 1982(47) 2, 212-213 AN IMPRESSION TECHNIQUE TO MAKE NEW MASTER CAST FOR AN EXISTING REMOVABLE PARTIAL DENTURE -PHILIP J. R - JPD 1992 (67) 4, 488-490
  110. 110. THANK YOU AND HAVE A PLEASANT DAY!
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