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LUME ONE
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1 DENTAL LABORATORY
/ PROCEDURES
1 COMPLETE DENTURES
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i^BERT M. MORROW, D.D.S., F.A.C.D., F.I.C.D.
vss< dateDeanfor AdvancedEducation,
>or andHead,PostdoctoralDivision,
nent of Prosthodontics,
hi uliversity of TexasHealth ScienceCenter
at v''-nAntonio,DentalSchool,
3anAntonio,Texas
KENNETH D. RUDD, D.D.S., F.A.C.D., F.I.C.D.
Associate Dean for ContinuingEducation,
°rofessor of Prosthodontics, Department of Prosthodontics,
heUniversity of TexasHealth Science Center
.it SanAntonio, Dental School,
SanAntonio,Texas
JOHN E. RHOADS, D.D.S., F.A.C.D., F.I.C.D.
Formerly Associate Professor, Prosthetic Dentistry,
(cid:127)niversity of the Pacific, School of Dentistry,
.
(cid:127)an Francisco California V
I
ECOND EDITION
vith2067illustrationsincluding12infullcolor
THE C. V. MOSBY COMPANY
.
ST. LOUIS (cid:127) TORONTO (cid:127) PRINCETON 1986
A
4
CONTENTS
1 Effectivedentist-techniciancommunication, 1 Waxboxingmethod.57
.
Basiccommunicationprinciples,1 Plasterof Parisandpumiceboxingmethod 67
Medium(a),1 Caulkingco.mpoundandpaddleboxingmethod,74
Barriers,1 Pouringcasts 80
Feedback, 2 Indexingthecast,80 .
Planning,2 Requirementsforindexing 80
Technician— solicitingnew accounts,2 Grooveindexingmethod.80
I Dentist— searchingforalaboratory,2 Notchindexingmetho.d,84
Agreements.3 Splitremo.untingplates 85
. Summary 89
Legalandethicalobligations 5
Developingtherelationship,5
.
Visitingfacilities 5
5 Baseplates and occlusion rims, 90
Treatmentplanning,5
Prescriptions,5 KENNETHD.RUDDandROBERTM MORROW
Terminology,5
Requirementsforbaseplates,90
Communicatingtoothshades,6
Baseplatematerials,90
Feedback,6
Third-partycommunication,7 Autopolymerizingbaseplates,91
i Evaluation,7 FSipnrginekr-lea-doanpmteedthdoodu,g9h1method.99
* Confineddoughmethods,103 (cid:127)
2 Preliminary impressions: care and pouring, 9 Shellacbaseplates,112
Stabilizedshellacbaseplates,113
.
KENNETHD.RUDDandROBERTM MORROW Baseplatesstabilizedwithzincoxide-eugenolimpression
.
Requirements,9 paste 115
Alginatepreliminaryimpressions,10 Baseplates.stabilizedwithelastomericimpression
Modelingplasticimpressions,22 materials 121
Summary,25 Baseplatesstabilizedwithautopolymerizingresin,121
Thermoplasticresinbaseplatesandvacuum-adaptedresin
baseplates,125
3 Impression trays, 26 Wax baseplates,129
.
. Heat-curedcompression-moldedresinbaseplates 132
KENNETHD.RUDDandROBERTM MORROW
Constructionmountingcasts,136
Requirementsforimpressiontrays,26 Fluidresinbaseplates,136
Impressiontraymaterial,26 Metalbaseplates,143
Autopolymerizingresinimpressiontrays,27 Waxocclusionrims,143.
Impressiontraysforimmedia.tedentures,44 Maxillaryocclusionrims 143
Full-archimpressiontrays 44 Mandibularocclusionrims,144
Customposteriortrays,49 Modelingplasticocclusionrims,145
.
Two-piecetrays 51 Summary,145
Summary,56
6 Articulators and mounting casts, 147
4 Final impressions, boxing and pouring, 57
KENNETHD.RUDDandROBERTM.MORROW
.
KENNETHD.RUDD ROBERTM MORROW,andEARLE.
FELDMAN Requirementsformountingstone,147
* Mountingcasts,147
Boxingimpressions,57 Retrievingmountingplates,184
Summary,186
xi
xii Contents
7 Artificial teeth and gold occlusals, 187 Try-in,275
Grindingporcelainteeth,275
KEKNONEEHTNHED..aRndUDWDIL,LRIAOMBEBR.TAKME.RMLOYRROW,CLARENCEL. Summary,275
Materialsforartificialteeth,187
Porcelainteeth,187 9 Waxing and processing, 276
.
RMeestainl-itneseethrt t1e8e7th,188 KEANMNBERTHOCDIO.RVU.DEDS,PRINOOBZEAR,TanMd.CMHOARRRLOOWT.TEEAGROLREN.EFYELDMAN,
Artificialwithmetalocclusals,188
Componentsof artificialteeth,189 Waxingfortry-in,276
Moldandshadeidentification,191 Waxingthemaxillarytrialdenture,276
Moldnumberingsystems,191 Waxingthemandibulartrialdenture,282
Constructingmetalocclusals,201 Waxingfor flasking,284
Techniqueforsiliconemoldformultiple waxingofsimilar Addingaplasticpalateform,284
toothcontours,222 Flaskingthedenture,287
.
Summary 222 Wax elimination,296
Paintingthetinfoilsubstitute,300
Preparingridgelaps,303
8 Arranging and articulating artificial teeth, 223 Packingthedenture,303
RICanHdAHRUDGAH.SEM.IWTHO.LAF.EANDERSENCAVALCANTI, AltDeernnatutereflaidseknintigficpartoiocne,d3u0re6,307
Curingthedenture,311
Naturalanteroposteriorplacement of maxillaryanterior Deflaskingthedenture,311
teeth,223 Summary,311
Relationshipof archformtotootharrangement,225
Considerationsaffectingplacement andpositioningof
anteriorteeth,226 10 Finishing and polishing, 312
Influenceof asymmetryontootharrangement,229 KENNETHD.RUDD,ROBERTM.MORROW.AMBROCIOV.
Spacingof anteriorteeth,230 ESPINOZA,andJESSES.LEACHMAN
Crowdingandlapping,231
Arrangingmaxillaryanterior teeth,232 Deflasking,312
Positioningof maxillarycanines,233 Remountingdentures,318
Personalizationof setupby selectivegrinding,233 Makingaface-bowindex,321
Considerationsaffectingarrangementofmandibular Removingdenturesfromcast,324
anterior teeth,235 Polishingthecompletedenture,324
Overallevaluationof anteriortootharrangement,236 Preparingragwheel,328
Posterior tootharrangement,237 Pumicingdenture,331
Selectionof posteriormolds,237 Polishingteeth,338
Surveyingthemandibularcast (toaidindetermining Polishingporcelainteeth,338
positionforposterior teeth),237 Summary,338
Arranging33-degreeanatomicmaxillaryposteriorteeth,
238
11 Duplicate dentures, 339
Articulationof 33-degreeanatomicmandibularposterior
teeth,240 KENNETHD.RUDDandROBERTM.MORROW
Checkingcompletedsetupof 33-degreeanatomic
posterior teeth,245 Methods,339
Alternatemethodof articulationof33-degreeanatomic PMooudri-fireeds—in—defnlatsukremfleatshkodm,e3t4h8od,339
maxillaryposteriorstomandibularposteriors,245
Cup-flaskmethod,356
Arranging20-degreemaxillaryposterior teeth,249
Articulationof20-degreeposteriormandibularteeth,251 Summary,363
Alternatemethodof articulationof 20-degreemaxillary
posterior teethtomandibularposterior teeth,255 12 Relining and rebasing,364
Articulationofmaxillary secondmolar,259
Checkingcompletedsetupof 20-degreeposteriorteeth, KENNETHD.RUDD,ROBERTM.MORROW.R.NEALEDWARDS,
260 andAMBROCIOV.ESPINOZA
ArrangingPilkington-Turner30-degreeposteriorteeth,260 Articulatormethod,364
ArrangingRational0-degreeposteriorteeth,262 . Reliningjigmethod,372
ArrangingAnatolineposteriorsinalinearocclusion 263 Rebasing,377
Arranging Anatolineposteriorsinabilateralbalance,266 Jigmethod.377
ArrangingMonolineposteriorsinaflatlineartype Flaskmethod,380
occlusion,268 Summary,382
ArrangingMonolineposteriorsinabilateralbalance,270
ArrangingMonolinemandibularposteriorswith Anatoline
maxillaryposteriorsinalingualized,balancedocclusion,
272
Contents
13 Repairs, 383 Mandibularbases,460
KENNETHD.R%UDD.ROBERTM.MORROW, RBleosciknoruetteanntdiorne,li4e6f,2463
andALEXANDERR.HALPERIN
Materialsforcastmetalbases,463
.
Repairingdenturewithfracturedteeth,383 Conversionof castbasetorecordbase 477
.
Plasticanteriortoothreplacement,383 Summary 478
Porcelainanteriortoothreplacement,389
Plasticposteriortoothreplacement,392
Porcelainposterior toothreplacement,395 18 Maxillofacial procedures, 479
Repairingfractureddenture,398 FREDRICKM.MATVIAS
Nonseparatedfracture,398
I Denturefracturedintotwoormoreparts(components), Immediateobturators,479
401 Requirements,479
Fractureddenturewithsection(s)missing,406 Materials,479
Addingaposteriorpalatalseal,409 Interimobturators,481
Summary,412 Requirements,481
Materials,481
Definitiveobturators,484
14 Immediate dentures, 413 Requirements,484
Materials,484
KENNETHD.RUDDandROBERTM.MORROW
Mandibularresectiondevices,491
Constructingimmediatedentures,413 Requirements,491
Summary,424 Materials,491
Edentulousmandibularresectiondevice,491
.
Dentulousmandibularresectiondevice 494
V
15 Fluid resin complete dentures, 425 Mandibular guideprosthesis,496
WALTERL.SHEPARD Acrylicresinguideflange,497
Speechaids,497
Denturebaseprocessingwithahydrocolloidinvestment, Requirements,497
425 Materials,497
Requirementsfordentalresin,426 Acrylicresinpalatallift,497
Synopsisof method,426 Metalframework withreenforcedacrylicposterior
Materialsandequipmentrequired,426 extension,497
Preparationofcastandwaxpattern,427 Edentulousanddentulousmaxillary speechbulb,498
Preparationofhydrocolloid,427 Facialprostheses,499
Investment,429 Requirements,499
Dewaxing,429 Materials,500
Spruingandventing,431 Laboratory facilityrequirements.500
Replacingteethinmold,431 Radiationappliance,505
Mixingandpouringresin,432 Requirements,506
Curingdentures,433 Materials,506
Deflasking,434 Cranialimplants,508
Finishingandpolishing,434 Requirements,508
Removablepartialdentures,436 Materials,508
Rebasing,438 Silasticimplant,509
Repairing,438 Requirements,509
Summary,440 Materials,509
Summary,511
16 Soft liners, 441
19 Laboratory procedures for immediate
MICHAELJ.MAGINNISandGERALDT.GAUBERT
overdentures, 512
Resilientdenturebaseliners,441
Requirementsof resilientdenturebaseliners,441 ROBERTM.MORROW
Resilientlinermaterials,441
Constructingimpressiontrays,512
(cid:127)Siliconerubbermaterials,442 Constructingbaseplates,516
Summary,459
Shellacbaseplates,516
Resinbaseplates,518
17 Metal bases, 460 Occlusionrims,524
\ / Settingtheteeth,525
/
JAMESS.BRUDVIK Settingtheposterior teeth,526
Settinganteriorteeth,528
Requirementsforcastmetalbases,460
/ % Designprinciples,460 WaPxreinpgarthinegimcamsteadbiautetmoevnetrsd,e5n3tu1re,534
Maxillarybases,460
*
xiv Contents
FlaskingtheImmediateoverdenture,536 21 Custom mouthguards, 551
Makinganimpressionof theoverdenturecast,536
ROBERTM.MORROW.WILLIAMKUEBKER,
Makingasurgicaltemplate,537
andRICHARDSEALS
Preparingridgelaps,537
Applyingtinfoilsubstitute,538 Mouthguardwithfaceguardattachment,555
Packingtheoverdenture,538 Custommouthguardwithoutattachment,561
Correctingprocessingerror,541
Polishingtheoverdenture,541
Summary,544 .
COLOR PLATES followingp 544
1 Pigmented oral tissues
20 Denture base tinting, 545
.
KENNETHD.RUDD ROBERTM.MORROW, 2 Contouring and tinting denture base
andMEADEVANPUTTEN
3 Procedure for tinting denture base
Tintingthedenturebase,545
Useofpracticemold,550
Summary,550
#
4
DENTAL LABORATORY
PROCEDURES
COMPLETE DENTURES
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I (cid:127)
(cid:127)
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t " N*
CHAPTER I
EFFECTIVE DENTIST-TECHNICIAN
COMMUNICATION
Effective communication is svnonvmous with terms parties participate to achieve a desired goal. However,
such as quality and success. M«* any0failures of dental the mere desireof thedentist tocommunicate with the
prosthesiscan usually be traced toa breakdown in com- dental technician is not enough. He or she must also
munication between members of the dental team (usu- have an underlying purpose to convey a message that
ally the dentist and the technician). These communica- will result in a desired behavioral response.
tion failures almost always result in a lower quality
appliance produced at a higher than normal cost. But Medium(a)
I what is most important is the adverse psychologiceffect The communication media the dentist or technician
on the effectiveness of the team members and their re- chooses to use are as vast as they are varied. Commu-
lationships with each other. Both dentist and technician nication is traditionally defined as the successful trans-
spend considerable money and time each year on con- mission of a message from a sender to a receiver by an
tinuing education to improve their skills and tech- appropriate mode. Selection of the proper channel or
niques, but little effort is expended toward formal mode takes on extreme importance. Most dentists and
courses in improving team communication. dental technicians choose those means of communica-
The profound desire of humans to be understood by tion with which they feel comfortable. Basically, the
colleagues and associates often is regarded as a major medium includes verbal communication, written and
-
obstacle or problem. As a result, communication pictorial accounts, and physical and behavioral ges
emerges as a major source of irritation or a stumbling tures. The dentist, when communicating with the den-
block. Although it is generally recognized that ineffec- tal technician, may utilize either one channel or all the
tive communication places undue stress and demands modes of communication within the course ofone day.
on a co-working relationship, it is equally unclear as to Therefore, it is of paramount importance that the
how toovercome these barriers and establish good rap- sender of the message select the appropriate means of
port between working groups hi order to function ef- communication. Face-to-face communication that in-
,
ficiently, the dental technician and the dentist must be volves the technician and dentist mav at one time or
thought of as a working team, using all means of effec- another bean impractical meansofcom0munication, and
tivecommunication to obtain a positive desired result. a less direct means may be employed to yield a greater
measure of success.
BASIC COMMUNICATION PRINCIPLES
Barriers
Theorctically, communication may be viewed from
many different aspects. Common to most theories per- Messages transmitted by the sender to the receiver
* taining to this skill, however, are certain dominating may become distorted, inhibiting accurate transmis-
principles. It is generally agreed that communicating sion.Thesedistortions become stumbling blocksor bar-
1
F
Dental laboratory procedures: complete dentures
riers to both the dentist and the technician. At this concentrating on quantity rather than quality in their
point, it is important to recognize that individual expe- client recruitment program. Quality accounts are those
.
riences are never identical Environment, education, that result in a high degree of personal satisfaction and t 6
personal preferences, social prejudices, and genetic mutual respect between the technician and the dentist.
make-up help determine how we approach communi- The perfect account does not exist; however, bysearch-
cation with other people. Consequently, an individuals ingfor some basicqualities, a laboratory can select sev-
location, state of mind, whom he or she is with at the eral very good accounts:
time of confrontation, and degreeofstress haveadirect 1. When solicitingaccounts, give top priority to those
bearing on message distortion. Pride, intimidation, in- dentists located near the laboratory. Time and distance
securities, fears, and personal ambitions often act as are major factors in maintaining a good working rela-
barriers to effective communication, as well as tone of tionship.
voice, appearance, and undesirable surroundings. Too 2. Search for dentists whose techniques, ethics, and
often, messages between the dentist and technician are philosophies are compatible with your laboratory.
sent and received inaccurately, resulting in one party 3. Search for those dentists whoareconcerned about
assuming that a word has the same meaning for the credentials of the technician, as well as everyone in-
other party. volved in patient treatment. The technician will per-
Poor listening is a major obstacle. The inability to form with more enthusiasm when recognized for train-
listen and ask questions contributes to the confusion ing and experience.
and makes a very simple solution into a complex prob- 4. Avoid any account who has earned the reputation
lem. Often, instead of listening when others are speak- of a “problem payer.” Delinquent accounts can lead to
-
ing, we formulate our own thoughts in anticipation of the demise ofany laboratory. »
responding. To complicate matters further, messages 5. Try to determine if a dentist is searching for a
transmitted become transcribed fragments that are in- quality laboratory or merely searching for unreasonably
.
complete and frequently plagued with colloquial jargon discounted prices
and abbreviations. 6. Always ask dentists why theyarewilling tochange
laboratories. Find out what they liked most and least
Feedback
about their last laboratory. Listen carefully to answers;
Feedback is the reflection of communication. Send- they may provide clues that will lead to an excellent
ers must rely on feedback to ascertain the receivers working relationship.
comprehension of the message. In fact, it should be the 7. Search for those dentists who are responsive to
receiver’sduty to report to the sender theclarity of the commentsand inquiriesfrom the technician concerning
message. A message not acted on becomes wasted ef- clinical techniques that could affect laboratory proce-
fort. Feedback between the dentist and technician dures.
should be encouraged, leaving open the gateway to 8. Search for those dentists who are willing to take
communication. Feedback is a mechanism that can be the time to provide constructivecriticism on laboratory
utilized to correct and adjust meanings, to increase procedures. Often dentists who are unsatisfied with a
(cid:127) clarity of communication, and to determine if the mes- laboratory’sservices will not discuss theirdissatisfaction
sage sent is perceived by the receiver in thesame man- and will switch laboratories, giving no explanation.
ner as it was intended. It is highly unlikely that all of these qualities will be
found in any one client; however, they should serve as
PLANNING useful guidelines for recruiting newaccounts. The tech-
A successful dentist-technician relationship is usually nician must use discretion when using these guidelines
the result of planned communication. These relation- to qualify a client. The sole purpose of qualifying a
ships can becompared to marriages that begin with the client should be to determine compatibility with your
best of intentions but often terminate in bitter conflict. laboratory. Do not engage in unethical gossip that may
(The number of failures in relationships could be dras- result in damage to a dentist or to his/her practice. l
tically reduced with the practice of systematic plan-
ning.) Dentist— searching for a laboratory
The dental health team as viewed by the public has
Technician— soliciting new accounts reached a new position of high esteem for itsexcellence
The best time to eliminate problem accounts is dur- in a health field. In no way is this moreexemplary than
ing the marketing phase of tlu* laboratory operation. theassociation that exists between thedental laboratory
Many laboratories attempt to expand their market by technician and the dentist. The technicians high de- $
4 Dental laboratory procedures: complete dentures
^
Table 1-1. Basic materials checklist
5
Completedentures Fixedpartialdentures Removablepartialdentures Orthodontics
Impressionmaterial Impressionmaterial Impressionmaterial Impressionmaterial
Casts Cast anddies Casts Casts
Baseplate Investments Refractorymaterial Wire
Artificialteeth Castmetals Castmetal Castmetals
Acrylicresin Porcelain Miscellaneoushardware Miscellaneoushardware
Miscellaneous Facing,backing,etc. Baseplatematerial Acrylicresin
Miscellaneoushardware Artificialteeth Miscellaneous
Miscellaneous Acrylicresin
Miscellaneous
situation the dentist should he notified as soon as pos-
sible.
Table 1-2. Sample checklist for procedures
Some dentists may make the mistake of giving the
Completedenture laboratory an early due date to provide a margin of
safety. This practice will jeopardize the dentists credi-
Impression,diagnostic bility with the laboratory. The technician who thinks
Diagnosticcast andtray
Finalimpression that the dentist is providing early due dates is least
Finalcast likely to notify the dentist when a case is going to be
Baseplateandocclusalrims late.
Occlusalrimregistrations Turn-around time is time the laboratory takes to re-
Jawrelations
turn the case to the dentist. Most laboratories have es-
Facebow
Articulatorandarticulation tablished timesfor various procedures. Occasionally the
Toothselection dentist will request a shorter than normal turn-around
Tootharrangement time. This is usually referred to as a rush case." Rush
Occlusion cases will usually alter the normal work flow in a labo-
Trialwax-up
Waxtry-in ratory, often resulting in the ownerhaving to pay over-
Post-palatalseal time or to hire temporary help. Will there be an extra
Finalwax-up charge, or will this be a special courtesy to the client?
Characterization A basic agreement should be outlined; however, it is
Processing wise to allow some flexibility for extenuating circum-
Correctingandperfectingocclusion stances.
Finishing
a. Dentureborders 5. Discuss remake policies. What is an acceptable
b. Polish percentage of remakes? Who will bear the cost of re-
Miscellaneous makes? Howwill dates beadjusted? Remakesareasen-
sitive subject and should be discussed with equal con-
sideration to the position of both the dentist and
laboratory. The important thing to remember is that
trous to the dentists who have already quoted fees to when a case fails, one or both parties are usually frus-
their patients. A moredesirable policy would be togive trated. Therefore the climate is not conducive toestab-
clients reasonable advance notice for price changes on lishing rules for remakes. A good rule on remakes is
routine procedures. one that is acceptable to both parties before the first
*
4. Discuss policies on due dates, turn-around time, case is sent to the laboratory.
and rush cases. Most dentists will have a complete se- 6. Credit and payment policies must be agreed on
ries of appointments for each of their patients; ifan ap- before the first case. Laboratories are like dental prac-
pointment is broken, it has a domino effect. Also, the tices— they cannot continue to operate without suffi-
image of that dentist is jeopardized when the patient cient cash flow. Most laboratories operate on a very
cannot be provided the services scheduled for a given limited cash flow, and delinquent accounts can be
appointment. On some occasions it will be impossible costly or can even bankrupt the business. Since many
for a laboratory to meet a scheduled due date. In this laboratories are competing for accounts, they tend to %
