Patient Videos

1. Maxillary Heavy Body Impression

Taking the maxillary impression is easy. First fill the maxillary tray completely with fast-setting, heavy body PVS material. Setting time varies depending on the manufacturer, please rever to manufacturer DFU's on appropriate setting time for the impression material.* Make sure you cover the entire surface of the tray with enough material. Then seat the tray all the way in the patient's mouth and hold it FIRMLY UPWARDS. Seat the tray FIRMLY by pressing up on the center and the two finger spots on the left and right side of tray. One of the biggest areas of error can occur with the maxillary tray seating since it is counter to gravity, among other reasons. Please seat the tray firmly before, during, and after you begin BORDER MOLDING.

*We recommend using Flexitime Fast & Scan

BORDER MOLDING:

  1. Have the patient relax their mouth and open it wide, then close it.
  2. Then have them move their jaw side to side
  3. Pull and stretch the patient's cheeks out and down, one at a time. (You must keep the tray FIRMLY in place with your other hand.)
  4. Pull the patient's lips down to mold the front borderline.

REPEAT THIS PROCESS 3–4 times while the PVS material is setting. Border molding captures the smooth contours of where the denture's borders will meet the soft tissue. PVS material may overflow, but that is fine. Always keep the tray firmly in place from seating to completing the border molding and setting.

2. Maxillary Tray Adjustment

Sometimes the maxillary tray needs to be adjusted if tray areas, borders, or edges are showing after the impression is taken. Using a common dentist's drill, adjust the tray areas that are showing, since those areas will be touching soft tissue otherwise.

3. Maxillary Wash (light body wash material)

Use light body wash material to cover the entire tray and impression area. You only need about 1–2 mm thickness with the light body wash material, but the light body wash must cover the entire surface of the impression you just took. The wash captures all the muscle details of the patient's mouth, so it is important the wash material covers the entire impression. Spread it around like butter to cover the entire surface area. Gently place the tray back in the patient's mouth and seat it FIRMLY in place using the center area and side positions on the bottom of the maxillary tray. Be sure to get the best wash impression by having the patient relax their muscles while you hold the tray in place and go through the BORDER MOLDING movements. Always keep the tray firmly seated using one hand to ensure an accurate impression.

4. Mandibular Heavy Body Impression

Load the fast-setting, heavy-body PVS material onto the mandibular tray starting from one edge and filling the tray entirely to the other edge. (Do not start from the center out.) It is important that you place plenty of PVS material towards the left and right posterior ends. Overflow is fine. Seat the tray FIRMLY in the patient's mouth and hold it for several seconds. Always hold the tray firmly in place and begin border molding. Have the patient relax their mouth and then stick their tongue out. Always keep the tray in place with one hand so there is no slippage in the impression.

BORDER MODLING for MANDIBULAR: Always keep the tray firmly seated with one hand.

  1. Have the patient stick their tongue out.
  2. Squeeze both cheeks to get the distro-buccal corners while the patient is in a relaxed mouth state.
  3. Pull and stretch the patient's right cheek, then left cheek.
  4. Pull down their lower lip.

REPEAT THIS PROCESS 3-4 times to get the best MANDIBULAR IMPRESSION. After several minutes, depe nding on the setting time of your PVS material, take out the tray and look for places that need adjustments. If the tray is showing anywhere, adjust the tray.

5. Mandibular Tray Adjustment

Look for protruding edges and trim or grind the excess areas with the common dentist's drill. Adjust and grind.

6. Mandibular Wash

Add wash material to the mandibular tray over the impression area. Don't use too much wash material, but cover the entire surface area. Place the tray in the mouth and hold it firmly down and make sure the seating is correct. This should take about 5–10 seconds. Then hold the tray down in the seated position with one hand (using the two finger locations on the tray) and have the patient relax their mouth and stick their tongue out a couple times to begin border molding. Always keep the tray firmly in place and have the patient relax, pucker up, and relax while you stretch the lip and cheek areas.

7. Separation (Posterior Attachments)

After you complete the impression process, detach the posterior attachments. Using a surgical blade, cut the impression area all the way through between the posterior and anterior sections of the tray. Be sure to cut all the way through the impression material with ONE CLEAN CUT all the way around so the tray can easily separate from the connection area. (If you have multiple cut lines, impression areas may get lost or damaged.) It may be helpful to look at another unused tray to see where the cut line should be. Once you make the proper incision along the tray, the posterior and anterior parts should snap apart easily. With the parts detached, clean off any impression material on the non-impression side of the main trays so when you take the bite registration, those areas of the trays are clean. Once you cut through the impression, pull apart the posterior wings and set them aside for shipping.

8. Vertical Dimension of Rest, Occlusion and Centric Relation

To capture the Vertical Dimension of Occlusion (VDO) using bite registration, you must actually find the vertical dimension of rest (VDR). The software will convert the VDR you capture into the proper VDO.

To find the vertical dimension of rest (VDR) using the center pin:
  1. Attach the center pin to the mandibular tray and set it to the highest position.
  2. Place the maxillary tray in the patient's mouth and make sure it is firmly seated.
    (If the impression was well-taken, the maxillary tray should have good retention at this point.) Gently place the mandibular tray (with the pin attached) into the patient's mouth.
  3. Instruct the patient to gently close his/her mouth, and not bite too hard. This position will most likely be too high, so the lips will not be close to their natural relaxed position. Make sure the mandibular tray is also firmly seated and start rotating the center pin clockwise to arrive at the correct VDR.
  4. If the pin needs to be further lowered, and your fingers cannot reach the pin in the mouth, remove the tray and adjust the center pin a few times outside the mouth and place back in to get the right VDR. (If the patient has a very low VDR to the point the tray posteriors are touching, adjust them with a burr so you can get the right VDR.)*
  5. After arriving at the correct VDR, prepare to capture the centric relation (CR) by using the center pin as an intraoral gothic arch tracer. Apply a small amount of tracing material on the lower side of the maxillary tray before starting the tracing movements. Whiteboard markers work fine as tracing material. After having the patient move their jaw in and out and laterally to trace the gothic arch, remove the trays and you should see an arrow etched into the tracing material. Drill a very tiny hole at the tip of the arrow, a small dimple where the center pin will lock into place with. This marks the optimal CR point. The arrow created by the gothic arch tracing should point towards the posterior when the maxillary tray is back in the patient's mouth. The adjustable pin should now lock into this small hole you just drilled when the trays are placed back in the patient's mouth so you can take the bite registration without any slippage of the trays. (Slippage or tilting of the trays is the biggest chance of error, so make sure the tray is firmly seated and locked into place when taking the bite registration.) Once the trays are locked into position back in the mouth, inject bite registration material all around in between the space between the trays to capture the VDR (ultimately VDO) and CR all at once. The CR and VD are captured when the patient's lower jaw is in the most posterior position. If you need to lower the pin very far down, snap or cut the pin in half so it does not interfere with the patient's soft tissue or tongue. If the posteriors of the trays are touching, the VD will be inaccurate, so adjust the posteriors if needed. (This is very infrequent.)

*See additional video

That's it. Everything you need to do for final denture delivery is done! Pack up all the detached posteriors along with the impression/bite registration. Ship everything to your Pala Digital Denture lab along with your order sheet and we'll start the CAD/CAM process.

9. Intraoral Gothic Arch Tracing

Intraoral Gothic Arch Tracing: This video shows the conventional gothic arch tracing used to capture the optimal CR. Use the Pala Digital Denture trays for gothic arch tracing by attaching the center pin into the lower tray and spraying Occlude or other tracing material onto the bottom of the maxillary tray. Move the patient's jaw forward and backwards and laterally to trace the precise arrow with the pin. The tip of the arrow is the ideal CR point. Drill a small hole into this tip on the maxillary tray to mark the CR point, and to create a dimple for the center pin to lock into when the trays are seated for bite registration capture.

* Please note pricing may be subject to change due to laboratory pricing. If you have questions on pricing, please consult with your laboratory partner.
Kulzer