Part II Secondary Impression for an Edentulous Patient I Maxilla

Summary

In this instructional video, the process for making a secondary impression for an edentulous maxilla is demonstrated. The video highlights crucial steps such as marking the tray border, trimming excess material, and applying impression compounds. The border molding process is explained in detail, emphasizing techniques to ensure a proper fit and accurate capture of the oral structures. Key techniques include using lip and cheek movements to contour the tray to the patient's mouth and ensuring all critical areas, including the vibrating line, are accurately recorded. The final impression is made using zinc oxide eugenol, with emphasis on even application and setting time before retrieval of the tray. The completed impression is then sent for lab processing.

Highlights

• Mark tray borders with a 2-3mm allowance for optimal fit. ✒️
• Generous relief around frina is essential for comfort. 🚪
• Use a straight handpiece to trim over-extended borders. ✂️
• Apply low fusing compound for border molding success. 🔥
• Incorporate movements of lips and cheeks for accurate molding. 😄
• Address all borders and vibrate line meticulously for a solid impression. 📏
• Ensure proper set of zinc oxide eugenol to avoid impression adherence. ⌛️

Key Takeaways

• Always mark tray borders accurately for effective impression making. 🖌️
• Relief is crucial around frina and tray borders for a proper fit. 🚪
• Use indelible pencil for marking and trimming excess material. ✏️
• Heat and application techniques are key to border molding success. 🧤
• Ensure materials are properly set before removing from the patient. 🕒

Overview

The video outlines the meticulous process of achieving a well-fitting impression for edentulous maxillae. It starts with carefully marking and trimming tray borders to ensure they are neither too short nor overextended, taking into account necessary relief for comfortable fitting. This precision is the cornerstone of a successful impression-making process.

Using a combination of heat-molded compounds and patient-assisted movements such as opening the jaw and sealing the lips, the border molding is carefully crafted. Each area of the mouth, including the buccal frenum and coronoid bulge, is systematically addressed to secure a precise and comfortable fit for the denture.

Finally, the video demonstrates the application of zinc oxide eugenol for the final impression. By ensuring the material is evenly distributed and adequately set, one can achieve a detailed capturing of all oral structures which is critical for the subsequent stages of denture fabrication. Proper handling and removal of the tray, alongside thorough inspection, ensure no detail is missed before the impression is sent for laboratory processing.

Chapters

• 00:00 - 00:30: Introduction and Tray Preparation This chapter covers the steps for preparing an impression tray for an edentulous maxilla. The tray's border should be marked short of the final intended border. Ample relief should be given to the freina, with the border extending to the vibrating line and hamular notch. Additional relief is necessary for the buccal frenum and tray borders.
• 00:30 - 01:00: Frenum Marking and Tray Trimming The chapter 'Frenum Marking and Tray Trimming' involves the technique of adjusting dental trays that are slightly over-extended labially. The process requires shortening the trays by one to two millimeters. An indelible pencil is used to mark the buccal and labial frenum as well as the over-extended borders. Following this, over-extensions are trimmed away using a chairside straight handpiece and an acrylic bur.
• 01:00 - 03:00: Border Molding with Impression Compound The chapter discusses the process of border molding using low fusing impression compound, also known as green stick. The material is chosen for its favorable heating properties, becoming glossy and pliable when heated over a direct flame. Once it reaches the right consistency, it is applied incrementally to the three borders of the tray used in dental procedures.
• 03:00 - 05:00: Vestibule Recording and Trim Excess The chapter focuses on the process of recording the vestibule and trimming excess material. It begins with the technique of border molding, specifically dealing with the labial frenum. The chapter outlines the initial steps which include applying the compound to the tray, ensuring it's about two millimeters short of the full sulcus depth or denture borders. Once the compound is placed, it should be positioned beyond the expected vestibule height, heated, and then tempered in hot water before being placed in the mouth. The process starts by molding the labial vestibule first.
• 05:00 - 06:30: Left Side Border Molding The chapter 'Left Side Border Molding' covers the technique of border molding using a movement of the lip in an upward and downward direction to shape the Arabian vestibule and the labial frenum. It involves asking the patient to seal their lips around the tray handle as a means of activating the orbicularis oris, which helps record the depth and width of the labial vestibule. Emphasis is placed on inspecting the tray borders under good lighting to ensure the material has lost its gloss, indicating proper molding.
• 06:30 - 08:00: Hamular Notch and Vibrating Line The chapter discusses the process of ensuring proper contact and molding of dental trays for fitting. It highlights the importance of trimming excess material from the inner borders of the tray, heating the periphery, and molding the dystopical vestibule on the right hand side. The chapter emphasizes the need for applying adequate thickness of the compound during this procedure.
• 08:00 - 10:00: Final Impression with Zinc Oxide Eugenol The chapter discusses the process of creating a final impression using Zinc Oxide Eugenol. It explains the importance of applying impression material on the borders of the tray to capture the full width and depth of the vestibule. The use of Vaseline on fingertips is recommended to manipulate the impression compound effectively, ensuring it extends two to three millimeters beyond the tray borders.

Part II Secondary Impression for an Edentulous Patient I Maxilla Transcription

• 00:00 - 00:30 this video we'll demonstrate the impression making procedures for the edentulous maxilla the border of the tray is marked two to three millimeters short of the intended border generous relief should be made to the frina and the border should extend posteriorly to the vibrating line and the hamular notch area notice how more relief is required for the buccal freedom and the tray borders
• 00:30 - 01:00 are slightly over extended labially so i need to make them shorter by one to two millimeters use an indelible pencil to mark the buccal and labial frenum and the over extended borders trim away over extensions using a chairside straight hand piece and an acrylic bear
• 01:00 - 01:30 and trim the borders just until the line that you've marked previously low fusing impression compound or green stick is the material of choice for border molding the material is heated over direct flame once you see that the material has become glossy and has dropped slightly then it's ready to be loaded on the tray the material is applied incrementally to the three borders
• 01:30 - 02:00 start with border molding the labial frenum place the compound on the tray which is approximately two millimeters short of the full depth of the sulcus or the denture borders after placement of compound position it beyond the expected height of the vestibule heat it and temper it in hot water and then place in the mouth the labial vestibule is molded first
• 02:00 - 02:30 move the lip in an upward and downward direction to border mold the arabian vestibule and the labial freedom and then ask the patient to seal their lips around the handle of the tray by saying this will activate the orbicularis oris and will record the full depth and the width of the labial vestibule inspect the tray borders under good lighting conditions notice how the material had lost its gloss meaning that
• 02:30 - 03:00 it had turned dull indicating that it had made contact with the tissues properly trim the excess material on the inner borders of the tray and then heat the periphery to order mold the dystopical vestibule on the right hand side it is important to apply adequate thickness of the compound
• 03:00 - 03:30 material on the borders of the tray so that you record the full width and the full depth of the vestibule use a small amount of vaseline on your fingertips to manipulate the impression compound push it beyond the borders of the tray making sure that they extend about two or three millimeters beyond the borders of the tray
• 03:30 - 04:00 and then heat it on the one side burner and then temper it before introducing it again to the patient's mouth seat the tray into position to border mold the buckle freedom move the lips and cheeks gently in an upward outward and then downward direction this movement will bolter mold the effect of the muscles of the modulus which is a collection of muscles of
• 04:00 - 04:30 facial expression located just at the corners of the mouth next ask the patient to move their mandible to the right and left this will record the vestibule of the maxillary denture in addition to recording the coronoid bulge in which the coronoid process of the mandible affects the width and the height of the dystopical vestibule
• 04:30 - 05:00 once the material has cooled down remove it from the patient's mouth gently and then inspect it under the lighting conditions trim the excess material from the inner borders of the tray and notice how the buccal freedom is order molded and that you have created the coronoid bulge
• 05:00 - 05:30 now is the time to border mold the left hand side heat the periphery of the previous border molding apply the material on the borders of the tray heat it on the wanted burner and then temper it with warm water before introducing it again to the patient's mouth observe how the tray is seated into the patient's mouth
• 05:30 - 06:00 rotate the tray into position and pull the cheeks and lips away as you're seated observe closely as we border walled the buccal freedom in addition to border molding the dystopical vestibule in which the patient is instructed to move third jaw to the right and the left side
• 06:00 - 06:30 inspect the borders of the tray under good lighting conditions and remove any excess material the final area to border mold is the hamura notch and the vibrating line area apply the material as instructed previously and then introduce it to the patient's
• 06:30 - 07:00 mouth ask the patient to move their jaw to the right and left sides in addition to saying ah out loud this will move the soft palate and will help record the posterior vibrating line
• 07:00 - 07:30 inspect the three borders the notch of the three command bill rafi can be noted the final impression material of choice is zinc oxide eugenol apply equal length of the eugenol paste and the zinc oxide paste on a mixing pad
• 07:30 - 08:00 the material is then gathered in the center of the mixing pad and mixed in a figure eight motion with a metal spatula until a homogenous pink mixture is achieved
• 08:00 - 08:30 the final impression material is then loaded into the tray tray borders should be covered and the material is uniformly distributed within the tray apply vaseline on the patient's lips and cheeks to avoid adherence of the zinc oxide to the skin
• 08:30 - 09:00 seed the tray into the patient's mouth use the labial femurum and the tray handle as a reference repeat the border molding movements to record all the details of the denture borders
• 09:00 - 09:30 prepare for impression removal by inspecting that the material has fully set if you stab it with your fingernail it will not leave an indent so this is how you know that it's fully set notice here how it's difficult to break the seal so ask the patient to seal their lips tightly around the handle and
• 09:30 - 10:00 blow forcefully this will break the seal and then you'll be able to retrieve the tray from the patient's mouth once more inspect the tray under good lighting conditions and make sure that you have recorded all the borders of the tissue once done disinfect the impression and send it to the lab for the fabrication of record blocks
• 10:00 - 10:30 you