Module 2 – Complete Dentures Course

Transcript

1. © M. Leif Stromberg, DDS, MAGD 3 Clarifying the Fundamentals of Complete Denture Fabrication Presenter: M. Leif Stromberg, DDS, MAGD Elevate your success with complete dentures NOW!
2. © M. Leif Stromberg, DDS, MAGD Clarifying the Fundamentals of Complete Denture Fabrication 4 Presenter: M. Leif Stromberg, DDS, MAGD Module 2 — Simpli fi ed Final Impression Techniques for Complete Denture Success and Lab Preparation for the Records Appointment
3. © M. Leif Stromberg, DDS, MAGD 📜 DISCLOSURE 5 The presenter declares that neither he nor his immediate family have a financial interest that would create a conflict of interest that would influence or restrict his independent judgment with regard to the content of this course.
4. © M. Leif Stromberg, DDS, MAGD 6 LEARNING OBJECTIVES FOR MODULE 2 — PARTICIPANTS WILL BE ABLE TO: 1. Identify intra-oral anatomic landmarks to record when making fi nal impressions for tissue-supported edentulous restoration. 2. Make very good edentulous fi nal impressions using simpli ed techniques. 3. Describe the anatomy of the posterior palatal seal area and the 360° peripheral seal for retention of a maxillary complete denture. 4. Discuss making the important preliminary centric relation/ vertical dimension of occlusion record for the laboratory to use when fabricating the setup for the records appointment. 5. Create guidance information for the laboratory regarding the dimensions and contours of the upper esthetic wax rim.
5. © M. Leif Stromberg, DDS, MAGD What is adequate? The purpose of this course is to help dental teams fabricate adequate complete denture restorations. Adequate- it is within acceptable limits. An adequate denture 1. has good esthetics (relative to the patient’s anatomic features), 2. has a good vertical dimension of occlusion (not pathologic and works well for the patient), 3. has good retention (relative to the patient’s anatomic features), and 4. has good stability (relative to the patient’s anatomic features). 5. All posterior teeth contact evenly in maximum intercuspation in centric relation. • An adequate edentulous impression has all the details for fabricating an adequate complete denture. 7
6. © M. Leif Stromberg, DDS, MAGD The Appointment for Final Impressions for Edentulous Patients 8
7. © M. Leif Stromberg, DDS, MAGD Simpli fi ed techniques for edentulous nal impressions UCLA, IvoclarVivadentInc, ACP AccuDent XD Syringe Colloid and Tray Colloid by Ivoclar, Inc. For accurate impressions with detail of the tissues. 9
8. © M. Leif Stromberg, DDS, MAGD 10 The tray material is heavy body and the syringe material is light body. UCLA, IvoclarVivadentInc, ACP XD is Extra De fi nition The Accu-Dent XD Impression System Uses two alginate impression materials of different viscosities (tray and syringe) and a syringe delivery system. Viscosity- refers to the state of being thick light body-low viscosity heavy body-high viscosity
9. © M. Leif Stromberg, DDS, MAGD Ivoclar.com AccuDent XD Syringe and Tray Materials Advantages of AccuDent XD Impression System 11 • Pre-measured sealed packaging of the alginate powder • Water measuring vial • Syringe delivery into the buccal, labial, and lingual vestibules • Non-slumping of syringe material • Tray material does not run down the patient’s throat
10. © M. Leif Stromberg, DDS, MAGD Setup for AccuDent XD Impressions • AccuDent XD Syringe Material • AccuDent XD Tray Material • Water measuring vial • Edentulous impression trays • Tray adhesive • Two mixing bowls and two spatulas • Syringe • Indelible ink markers • Boley Gauge or calipers 12
11. © M. Leif Stromberg, DDS, MAGD AccuDent XD Edentulous Dispos ble Impression Tr ys — The upper a nd lower tr a ys a re he t mold ble. Ivoclar.com 13
12. © M. Leif Stromberg, DDS, MAGD Making a fi nal impression of an edentulous maxilla for a tissue-supported complete denture. 14
13. © M. Leif Stromberg, DDS, MAGD Tray Selection (maxillary) Select a tray that is slightly wider than the residual ridge on each side… and try it in the mouth to evaluate size and coverage. 15 UCLA, IvoclarVivadentInc, ACP
14. © M. Leif Stromberg, DDS, MAGD The Accu-Dent XD Impression trays are heat moldable. Trays • Thermoplastic heat moldable • Heat in 158°F water bath for 20 seconds Lower tray altered 16 UCLA, IvoclarVivadentInc, ACP
15. © M. Leif Stromberg, DDS, MAGD Hold®Spray-On Tray Adhesive Always use the appropriate adhesive on the impression tray when making an alginate impression to ensure the retention of the impression material to the tray. Let the adhesive set on the tray for the appropriate time before making the impression. Be sure the adhesive is sticky before adding the impression material to the tray. 17 AccuDent XD Tray Adhesive
16. © M. Leif Stromberg, DDS, MAGD 18 The vibrating line and hamular notches can be marked with an indelible ink marker, indicating the posterior extension of the maxillary denture base.
17. © M. Leif Stromberg, DDS, MAGD The indelible ink marking of the vibrating line and the hamular notches on the tissues transfers to the alginate impression and also transfers to the stone cast. 19
18. © M. Leif Stromberg, DDS, MAGD 20 The vibrating line and hamular notches can be marked using an indelible ink marker e.g., Dr. Thompson’s Color Transfer Applicators which are disposable.
19. © M. Leif Stromberg, DDS, MAGD The vibrating line de fi nes the posterior border of the maxillary denture base. Dr. M. M. House’s classi fi cation of palatal throat forms. The vibrating line is the junction of the immovable and movable soft palate tissues. 21
20. © M. Leif Stromberg, DDS, MAGD UCLA, IvoclarVivadentInc, ACP 22 Anatomy of the hard palate, soft palate, and posterior palatal seal area The vibrating line is the junction of the immovable soft palate and the movable soft palate. Movable soft palate Immovable soft palate - posterior palatal seal area
21. © M. Leif Stromberg, DDS, MAGD 23 Posterior palatine salivary glands The presence of these glands permits compression of the tissues in the posterior palatal seal area, enhancing peripheral seal and retention of the upper denture. Glandular tissue Posterior palatal seal area UCLA, IvoclarVivadentInc, ACP
22. © M. Leif Stromberg, DDS, MAGD courtesy Centric Dental Lab Post Dam on maxillary denture is a ridge (or elevated area) on the tissue side along the posterior border of the maxillary denture — is 6 mm wide antero- posteriorly in some areas. Elevated area 24
23. © M. Leif Stromberg, DDS, MAGD Post dam on the maxillary denture compresses the immovable soft palate and hamular notches to create an air-tight seal for increased denture retention. courtesy Centric Dental Lab 25 The immovable soft palate (posterior palatal seal area), vibrating line, and hamular notches
24. © M. Leif Stromberg, DDS, MAGD Are always present in the soft palate (posterior to the hard palate) and are usually anterior to the vibrating line. Fovea Palatinae 26 A guide for the location of the vibrating line
25. © M. Leif Stromberg, DDS, MAGD Hamular notch • Hamular Notch - is a narrow groove distal to the tuberosity and contains loose connective tissue covered by mucosa. The hamular notch is the ideal location for the posterior extension of the denture. • The post dam should compress the tissues of the hamular notch and the posterior palatal seal area. UCLA, IvoclarVivadentInc, ACP Tuberosity 27
26. © M. Leif Stromberg, DDS, MAGD Cheek and labial muscle function Gravity Want the post dam of the denture to compress the posterior palatal seal area and hamular notches for retention. UCLA, IvoclarVivadentInc, ACP For Suction and Retention • Want extension of the denture base into vestibules to cheek and labial muscle function. 28
27. © M. Leif Stromberg, DDS, MAGD 1. With 2 x 2 gauze, dry the labial and buccal vestibules, the hamular notches, and the palate. 2. Locate and mark the hamular notches with a moistened, indelible ink marker. 3. Locate the vibrating line (the junction of the immovable and movable soft palates) and mark it with an indelible ink marker. Have the patient say: AH, AH, AH. Then, wearing magni fi cation, see the movable soft palate move. 4. Then ask the patient to hold their mouth open to keep maxillary tissues relatively dry while mixing AccuDent XD impression material for the maxillary impression. Preparing the mouth for the maxillary impression Steps for locating and marking the vibrating line and hamular notches — 29
28. © M. Leif Stromberg, DDS, MAGD 30 • The fovea palatinae can be a guide for locating the vibrating line. • The nose-blowing technique can be a guide when it is challenging to locate the vibrating line. Suggestions for locating the vibrating line: • Wear eye magnification. • The hamular notches can be helpful for locating the vibrating line. Dr. M. M. House
29. © M. Leif Stromberg, DDS, MAGD Making a maxillary fi nal impression for an edentulous patient Treatment sequence 1. place adhesive on the tray, 2. mark the vibrating line and hamular notches, 3. make impression. 31
30. © M. Leif Stromberg, DDS, MAGD AccuDent XD Syringe Alginate Impression Material Light body, low viscosity alginate impression material. Pre-measured sealed packaging of the alginate powder. water measuring vial 32 UCLA, IvoclarVivadentInc, ACP
31. © M. Leif Stromberg, DDS, MAGD 33 Accu-Dent XD Impression System Alginate material – Syringe Material with water measuring vial and syringe Syringe alginate - light-bodied syringe alginate ows (low viscosity) yet stays in place (resists slumping). It is placed in the peripheral border areas and vault of the hard palate using the AccuDent XD Syringe delivery system. UCLA, IvoclarVivadentInc, ACP
32. © M. Leif Stromberg, DDS, MAGD 34 Begin placing light-bodied material in the hamular notch on one side. Syringe delivery permits precise placement.
33. © M. Leif Stromberg, DDS, MAGD UCLA, IvoclarVivadentInc, ACP 35 Continue injecting into the buccal vestibule, keeping the syringe tip embedded in the material up to the labial frenum, and stop.
34. © M. Leif Stromberg, DDS, MAGD The light-body syringe impression material attaches to the tissue, stays in place, and does not slump. 36
35. © M. Leif Stromberg, DDS, MAGD AccuDent XD Impression System Alginate Tray Material with water measuring vial Loading the tray (maxillary) The shape of the tray alginate material in the maxillary tray is important. Most of the material should be placed anteriorly and slope to the posterior. UCLA, IvoclarVivadentInc, ACP 37
36. © M. Leif Stromberg, DDS, MAGD Shape of the tray alginate material in the maxillary tray. 38
37. © M. Leif Stromberg, DDS, MAGD 39 The heavy body tray alginate does not fl ow down the patient’s throat, signi fi cantly reducing the gag re fl ex. • Seat the tray anterior to posterior until the Tray and Syringe alginates appear beyond the posterior of the tray. • Then, stop seating the tray.
38. © M. Leif Stromberg, DDS, MAGD 2022 Border mold the maxillary impression — Simulate muscle function by manipulating the lips and cheeks adjacent to the final denture borders to replicate the shape and size of the vestibule. Be careful not to move the impression tray. Massage the cheeks very lightly with your fingers. UCLA, IvoclarVivadentInc, ACP Pull straight down once on the philtrum at the vermilion border. 40
39. © M. Leif Stromberg, DDS, MAGD 41 UCLA, IvoclarVivadentInc, ACP
40. 42 What questions and comments do you have?
41. © M. Leif Stromberg, DDS, MAGD Making a fi nal impression of an edentulous mandible for a tissue-supported complete denture. 43
42. © M. Leif Stromberg, DDS, MAGD 1. Use calipers to measure the right-to-left width of the residual arch in the first molar regions. This can be done on the existing denture, as shown, or in the patient’s mouth. 2. Use this measurement to select the appropriate size lower tray. When in doubt, use a smaller tray. 3. Evaluate retromolar pads in relation to the impression tray and plan to capture the retromolar pads in the impression. Tray selection (mandibular) 44
43. © M. Leif Stromberg, DDS, MAGD Try the selected mandibular impression tray in the mouth to assess the following: 1. there is su ffi cient lingual clearance (1/4 inch thickness of alginate is ideal), and 2. the tray covers the retromolar pads to ensure capturing the pads in the impression. 45 Key to Success
44. © M. Leif Stromberg, DDS, MAGD Have the patient raise their tongue • to center the tray, and • to practice placing the tongue on the top of the tray so the tongue does not get caught under the tray when making the impression. When trying the mandibular impression tray in the mouth 46 UCLA, IvoclarVivadentInc, ACP
45. © M. Leif Stromberg, DDS, MAGD AccuDent XD Edentulous Dispos ble Impression Tr a ys a re he a t mold ble. 47 Select the mandibular impression tray
46. © M. Leif Stromberg, DDS, MAGD The Accu-Dent XD Trays • Thermoplastic heat moldable • Heat in 158°F water bath for 20 seconds UCLA, IvoclarVivadentInc, ACP Lower tray altered Impression Tr a ys a re he a t mold ble. 48
47. © M. Leif Stromberg, DDS, MAGD Massad Edentulous Tray Massad Edentulous Trays can be purchased from leemarkdental.net 49 The retromol a r p a ds c a n be e a sily recorded with most edentulous impression tr a ys. This mandibular impression tray has a moderate distal rise.
48. © M. Leif Stromberg, DDS, MAGD 50 UCLA, IvoclarVivadentInc, ACP Remember the importance of recording the retromolar pads in the lower impression. They are primary support areas for the mandibular denture and a guide for the occlusal plane level.
49. © M. Leif Stromberg, DDS, MAGD • Mark the retromolar pads with indelible ink. • If the impression tray does not extend high enough in the posterior to cover the retromolar pad, consider adding periphery wax or green stick compound to extend the tray, or use a moldable tray that can be extended to cover the pads. 51 UCLA, IvoclarVivadentInc, ACP Retromolar Pad
50. © M. Leif Stromberg, DDS, MAGD 52 Massad Edentulous Trays can be purchased from leemarkdental.net Massad Edentulous Trays The posterior of the mandibular trays can be stretched to extend over the retromolar pads.
51. © M. Leif Stromberg, DDS, MAGD Accu-Dent System Trays Are no longer manufactured. Tray selection (mandibular) — •Choose the tray type that best suits the patient. • Trays have a moderate distal rise to accommodate the moderately resorbed ridge. •Trays have a high distal rise to help accommodate the severely resorbed ridge. High distal rise UCLA, IvoclarVivadentInc, ACP 53 Low distal rise
52. © M. Leif Stromberg, DDS, MAGD Dental Trays for Edentulous Jaw Impressions I found these impression trays online Heels of mandibular impression trays high above ridge to cover retromolar pads 54 For sale on eBay.com Dental Trays for Edentulous Jaw Impressions - Trays 18pcs Autoclavable • $25 - $50
53. © M. Leif Stromberg, DDS, MAGD Retromolar Pad 55 Trays to capture retromolar pads in impressions. High distal rise of the mandibular impression trays to cover the retromolar pads UCLA, IvoclarVivadentInc, ACP
54. © M. Leif Stromberg, DDS, MAGD UCLA, IvoclarVivadentInc, ACP 56 AccuDent XD Impression System Alginate Syringe Material with water measuring vial and syringe Syringe alginate - light-bodied syringe alginate ows (low viscosity) yet stays in place (resists slumping). Place into the peripheral border areas using the AccuDent XD Syringe delivery system.
55. © M. Leif Stromberg, DDS, MAGD AccuDent XD Alginate Tray Impression Material Thoroughly mix tray material - powder and water. Load mandibular impression tray. UCLA, IvoclarVivadentInc, ACP 57
56. © M. Leif Stromberg, DDS, MAGD AccuDent XD Alginate Tray Impression Material 58 Shape the impression material into a ridge.
57. © M. Leif Stromberg, DDS, MAGD Before making the lower impression, aspirate and wipe the lower ridge area with 2 x 2 gauze. Then mark the retromolar pads with indelible ink. 59
58. © M. Leif Stromberg, DDS, MAGD Have the patient hold their tongue up when injecting the syringe material. Then continue to hold the tongue up when placing the lower tray with impression material, and then lay their tongue on top of the tray. 60 UCLA, IvoclarVivadentInc, ACP
59. © M. Leif Stromberg, DDS, MAGD • In the buccal vestibule from the retromolar pad anteriorly to the midline, and repeat on the other side of the arch. • In the lingual vestibule from the retromylohyoid fossa to the midline, and repeat on the other side of the arch. Making the Mandibular Impression — Express Syringe material in buccal and lingual vestibules. UCLA, IvoclarVivadentInc, ACP 61
60. © M. Leif Stromberg, DDS, MAGD 62 Syringe delivery permits precise placement !! Making the Mandibular Impression — Express Syringe Alginate in the buccal and lingual vestibules.
61. © M. Leif Stromberg, DDS, MAGD AccuDent XD Alginate Tray Impression Material 63 Shape the impression material into a ridge.
62. © M. Leif Stromberg, DDS, MAGD 1. Have the patient hold their tongue upward as you place and rotate the tray into position. 2. Seat the tray anterior to posterior until the Tray alginate appears above the posterior of the tray, which is above the retromolar pad. Then, stop seating the tray. 3. Have the patient rest their tongue on the top of the tray - and remain motionless. 64 UCLA, IvoclarVivadentInc, ACP
63. © M. Leif Stromberg, DDS, MAGD 65
64. © M. Leif Stromberg, DDS, MAGD 66 If the anatomy is accurately identified and marked, this impression can serve as the final impression. Fully extended mandibular impression UCLA, IvoclarVivadentInc, ACP
65. © M. Leif Stromberg, DDS, MAGD 67 After the fi nal impressions and master casts have been made, the dental lab should construct the setup for the records appointment • upper and lower stable baseplates with gothic arch tracers and • a well- fi tting upper baseplate with an esthetic wax rim.
66. © M. Leif Stromberg, DDS, MAGD 2022 Additional records to make at the nal impressions appointment so the records appointment will be a breeze … easy, e ff i cient, quick, and accurate ! 68 Papillameter reading Alameter reading Preliminary bite record
67. © M. Leif Stromberg, DDS, MAGD 69 1. For increased predictability and success of tissue-supported complete dentures, record a preliminary vertical dimension of occlusion/centric relation record (called a preliminary verticentric record) for the laboratory to use when fabricating the setup for the records appointment. 2. Record the papillameter and alameter readings and other guidance information so the laboratory contour the upper esthetic wax rim close to the positions of the denture teeth. 3. These additional records will enable the lab to custom design the setup for the records appointment for this patient so the records appointment can be easy, e ff i cient, quick, and accurate. Additional records spend a few extra minutes at the impressions appointment to reduce time and stress at the records appointment
68. © M. Leif Stromberg, DDS, MAGD Avoid this clinical nightmare … these will not be easy to use. Sometimes, the laboratory uses preformed wax rims for the fi nal wax rim contours, and this can lead to clinical situations with signi fi cant adjustments being necessary. 70 UCLA, IvoclarVivadentInc, ACP 61
69. © M. Leif Stromberg, DDS, MAGD Want the laboratory to return the maxillary esthetic wax rim contoured close to the teeth positions of the final denture. 71 UCLA, IvoclarVivadentInc, ACP 61
70. © M. Leif Stromberg, DDS, MAGD 72 60 Centric Tray Preliminary verticentric record (with fast-setting putty) • Master casts mounted and • wax rims or gothic arch tracer set up ready to adjust e ff i ciently for your fi nal verticentric record. UCLA, IvoclarVivadentInc, ACP
71. © M. Leif Stromberg, DDS, MAGD A preliminary jaw relationship record of the patient’s vertical dimension of occlusion and centric relation can be recorded quickly with a Centric Tray (or similar). UCLA, IvoclarVivadentInc, ACP 73 Centric Tray by Ivoclar, Inc. using a fast-setting putty
72. © M. Leif Stromberg, DDS, MAGD Amazon.com A Full Arch Disposable Bite Registration Tray can also be used for a preliminary verticentric record using a fast-setting putty. 74
73. © M. Leif Stromberg, DDS, MAGD 75 The gothic arch tracer or wax rims can arrive from the laboratory very close to the patient’s vertical dimension of occlusion and centric relation, and only minimal chairside adjusting will be needed. 61 UCLA, IvoclarVivadentInc, ACP
74. © M. Leif Stromberg, DDS, MAGD How to make a preliminary verticentric record using the Centric Tray 1. Determine the patient’s vertical dimension of rest (VDR) and vertical dimension of occlusion (VDO) (details in Module 3). 2 and 3. Load the Centric Tray with impression putty (or heavy body VPS impression material) and place it in the patient’s mouth. 4. Chin guide the patient into centric relation and have the patient close to the preliminary VDO. 1 2 3 4 UCLA, IvoclarVivadentInc, ACP 76
75. © M. Leif Stromberg, DDS, MAGD 77 Centric tray with a preliminary verticentric record Centric Tray Centric Tray UCLA, IvoclarVivadentInc, ACP Master casts in a preliminary verticentric record
76. © M. Leif Stromberg, DDS, MAGD Mount the master casts on an articulator using the preliminary verticentric record. 78 60 Centric Tray UCLA, IvoclarVivadentInc, ACP
77. 79 What questions and comments do you have?
78. © M. Leif Stromberg, DDS, MAGD 80 Guides for the dental laboratory regarding the contours of the esthetic wax rim. The maxillary esthetic wax rim should be contoured by the laboratory close to the estimated positions of the denture teeth, so only minor adjustments will be required clinically. Guides include: • alma gauge readings, • papillameter readings, • alameter reading, and • instructions regarding the desired contours. 61 UCLA, IvoclarVivadentInc, ACP
79. © M. Leif Stromberg, DDS, MAGD Want the laboratory to return the maxillary esthetic wax rim contoured close to the teeth positions of the final denture. 81 UCLA, IvoclarVivadentInc, ACP 61
80. © M. Leif Stromberg, DDS, MAGD 82 A useful device to determine the horizontal and vertical relationships of the incisal edges of the maxillary central incisors to the incisive papilla and communicating this to the dental laboratory. Alma Gauge UCLA, IvoclarVivadentInc, ACP
81. © M. Leif Stromberg, DDS, MAGD 83 Alma Gauge Plunger with tip in incisive papilla Horizontal measurement grid Vertical measurement grid UCLA, IvoclarVivadentInc, ACP
82. © M. Leif Stromberg, DDS, MAGD 84 The measurements can then be used to help guide the initial contours of the wax rim. On average, the horizontal distance from the center of the incisive papilla to the incisal edges of the central incisors is 9 mm. UCLA, IvoclarVivadentInc, ACP
83. © M. Leif Stromberg, DDS, MAGD Notice the incisive papilla on the edentulous ridge after extensive alveolar bone loss UCLA, IvoclarVivadent, ACP The central incisor natural teeth are located labial to the incisive papilla. 85 On average, the distance from the center of the incisive papilla to the labial surfaces of the central incisors is 9 mm.
84. © M. Leif Stromberg, DDS, MAGD www.researchgate.net free image on Safari 86 courtesy Blue Dolphin Dental Products Using the Alma Gauge
85. © M. Leif Stromberg, DDS, MAGD Papillameter and Alameter readings are made and recorded • papillameter - measurement of upper lip length. • alameter - is a guide for the estimated width of the maxillary dental arch at the canines and a guide for the anterior denture teeth molds. 87
86. © M. Leif Stromberg, DDS, MAGD Papillameter • It is a device that measures the length of the patient’s upper lip in relation to the incisive papilla. • Measurement of the lip length below the incisive papilla. UCLA, IvoclarVivadentInc, ACP 88 measurement grid for lip length
87. © M. Leif Stromberg, DDS, MAGD Incisive Papilla Rest Place the flat platform inside the mouth and up against the incisive papilla. P a pill a meter is used for determining the length of the upper lip a t rest a nd when smiling. The me a surements en a ble the dent a l l a b technici a n to est a blish the a nterior length of the w a x rim, which will help determine the position of the a nterior teeth. 89 UCLA, IvoclarVivadentInc, ACP
88. © M. Leif Stromberg, DDS, MAGD P a pill a meter Place the incisive papilla rest inside the mouth and up against the incisive papilla. 90 Record the length of the upper lip at rest. UCLA, IvoclarVivadentInc, ACP
89. © M. Leif Stromberg, DDS, MAGD Alameter • Guide for the width of the anterior portion of the maxillary dental arch at the canines. • A convenient method to aid in the mold selection of anterior teeth. 91 UCLA, IvoclarVivadentInc, ACP
90. © M. Leif Stromberg, DDS, MAGD Alameter Reading The alameter measurement is a guide to 1. the width of the maxillary wax rim at the canine locations and 2. the width of the six maxillary anterior teeth from the center of one canine to the center of the contralateral canine. 92
91. © M. Leif Stromberg, DDS, MAGD MAXILLARY ESTHETIC WAX RIM A smooth wax rim made of hard pink baseplate wax on an upper baseplate; the baseplate should be well-adapted to the cast for intra-oral stability and retention! The laboratory should contour the wax rim to approximately where you think the teeth will be - occlusal plane and buccolingual tooth position. 93
92. © M. Leif Stromberg, DDS, MAGD Maxillary Esthetic Wax Rim The thickness of the wax rim •Molar region - 8 mm •Premolar region - 6 mm •Anterior region - 3 mm The lingual contours should not impinge on the tongue space. Make the wax rim thinner anteriorly 
 and tooth-width posteriorly. 94
93. © M. Leif Stromberg, DDS, MAGD Wax Rims The wax rim on the right is bulky. The bucco-lingual thickness of the wax rim may feel uncomfortable to the patient and may result in decreased accuracy of the wax rim records. 95
94. © M. Leif Stromberg, DDS, MAGD The average length for a maxillary esthetic wax rim at the lateral incisors is approximately 20 to 22 mm below the highest point of the labial vestibule above the lateral incisor to the incisal edge. This can be used when adjusting the length of the wax rim. 96
95. © M. Leif Stromberg, DDS, MAGD • The wax rim is marked 20-22 mm down from the labial border of the record base (the highest point of the labial vestibule) over the lateral incisor. • Dr. Stromberg recommends hard pink baseplate wax for the wax rim. UCLA, IvoclarVivadentInc, ACP 97 20-22 mm
96. © M. Leif Stromberg, DDS, MAGD Swissedent Wax Rim Former to create the occlusal plane The heated wax rim former is rotated upward against the wax rim. The rim is melted down to the desired dimensions. The rim of the rim former is placed in hamular notches and creates an occlusal plane parallel to the horizon. Wax fl ows through channel 98
97. © M. Leif Stromberg, DDS, MAGD The Swissedent wax rim former is an important tool for creating the Esthetic Wax Rim. 99 Swissedent Wax Rim Former
98. © M. Leif Stromberg, DDS, MAGD Use the Swissedent Wax Rim Former to create a maxillary wax rim • with the occlusal plane parallel to the horizon and parallel to Camper’s Plane (the Ala-Tragus Line) and • the desired length. image courtesy Blue Dolphin Dental Products- bdpdental.com 100
99. © M. Leif Stromberg, DDS, MAGD 101 The dental lab should return for the records appointment: • upper and lower baseplates with gothic arch tracers, and • a well- fi tting upper baseplate with an esthetic wax rim.
100. © M. Leif Stromberg, DDS, MAGD SYNOPSIS OF MODULE 2: 1. Important intra-oral landmarks to record in adequate nal impressions include all peripheral rolls, the retromolar pads, tuberosities, the vibrating line, and hamular notches. 2. Adequate maxillary and mandibular edentulous nal impressions can usually be obtained with the Accudent XD alginate impression system (Ivoclar, Inc.) 3. The use of the alma gauge and Swissedent wax rim former are helpful for contouring the maxillary esthetic wax rim. 4. In preparation for the records appointment, the lab should construct a well- fi tting maxillary baseplate with an esthetic wax rim contoured to be where you estimate the teeth will be located, and upper and lower baseplates with gothic arch tracers. 5. Record a preliminary verticentric record for the laboratory to use to set up the gothic arch tracer or wax rims. 102
101. THANK YOU M. Leif Stromberg, DDS, MAGD Dallas, TX CONTACT ME strombergdds@gmail.com StrombergDentistry.com 103
102. © M. Leif Stromberg, DDS, MAGD 104 My website: StrombergDentistry.com My email address strombergdds@gmail.com M. Leif Stromberg, DDS QR Code