8/3/2019 Prosthodontics Lab 2,Making of special trays
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Prosthodontics Lab Thursday Section 6/10/2011
Today we will learn how to make the 2nd step of making a denture which
is “The Special Tray “
So at first we had an “edentulous” Patient. We did first Impression, the
patient went home and the specialist made a cast using plaster of pairs
(Gypsum type ll ) , We called this a primary cast or diagnostic cast . The
aim of the primary cast is simply to make the special tray.
Why do we need to make another tray?
The stock tray we used on the first visit is made for average patients andthey do not give a proper extension for the different structures in the oral
cavity for each patient.
What are the materials we use to make the special tray?
We will talk in this section about the materials we can use to make the
special tray, keep in mind that each material has advantages anddisadvantages. Some are widely used some are very rare to use.
The most widely used are Acrylic materials and specifically: Light cured
and cold Cured materials.
Light Cured :
They look like sheets, and come in a box that has a black paper that actsas a shield. Remember that it is very important not to expose it to light
and not allow the setting rxn. to take place
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every Acrylic material has two components Monomer and Polymer
(Monoetheal Crinite and Polymethal Crinite respectively ~ names are
not of importance ).
You have to know that the setting reaction in Acrylic materials is CrossLinking, this means the Monomers particles cross link with the Polymer
particles.
Advantages of the Light cured :
1. It is already made sheets; this means it has an equal thickness.
This is very useful for you when you want to fabricate and adapt.
2. Easy to manipulate
Cold cured / Self cured / Chemical Cured :
It comes as a Liquid and powder mixed together in an endothermic rxn.
by you. The initiator of this rxn is called Venzyol Paraxide .
**IMP** The Acrylic has 5 different stages in which they reach upon
setting and become ready:
1. Powder-Liquid stage (when mixed become 2nd stage)
2. Fibrous stage / Strength stage
3. Doughy stage ةنيجع / Operative stage: In this stage we make the
custom tray and we shape it the way we want.
4. Rubber stage: in this stage the temp increases and the setting
starts to occur. No further manipulation can be made when
reaching this stage
5. Hard / Setting stage : our work is done
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Advantages of Self cured:
1. Less brittle than the Light cured but both of them show
considerable brittleness within them
2. Smooth surface: because you are the one who is mixing in self
cured. The light cured demands polishing and adding of Vaseline
to it to make it smooth.
3. Easy to manipulate
Main Advantages of Acrylic (both light and self cured):
1. Cheap
2. Easy to use3. Strong enough to act as a special tray
Main Disadvantages of Acrylic(both light and self cured):
1. Brittle (especially if thin, this is why the minimum thickness is
2mm). If the material is think it could break in three different
situations : 1- on the patients mouth 2-upon removing 3-on tray
2. Polymerization shrinkage, as a rule every polymerization reactionwill induce shrinkage. So it is very important to make good
adaptations before putting the work inside the curing machine, if
there are errors in your work you will end up with shrinkage and
you will have spaces, we don’t want spaces in our work.
Which one is less shrinkage the light or self? It is actually the
light because in light you don’t actually mix anything thus reducing
the chances of micro-spaces. You have to understand that
Shrinkage is absolutely a defect in the structure of the material, butwill it affect the making of tray? If we had spaces in our tray is this
very bad? It is always better to avoid them but if we did have
spaces this will not affect the function of the tray much.
3. Allergy of Acrylic: Acrylic is known for triggering Allergy reactions,
but in the case of special trays none of the patinas reported having
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that. This simply due to the small amount of time the special tray is
being exposed to the oral cavity
4. Flexibility and undercuts: Some patinas have undercuts, you will
definitely see them if you designed your tray without taking into
account the undercuts what will happen? The tray won’t come out
and harden (not flexible). You either break the Acrylic or the
patinas head: D . The solution here is to make “Blocking for
undercuts” in this way the tray won’t go into the undercuts, the
same thing we do if we have irregular ridges.
What other materials can we use other than the Light /Self
cured?
The heat cured can be used occasionally ( has better accuracy and
strength )
Shellac is also used which is a thermostatic material meaning that
upon heating it becomes less hard and when it is cold it is hard, the
main disadvantage is that it is very brittle.
Metals can also be used but they are expensive
Final conclusion, Light cured and self cured are the most commonly
used special trays making materials.
Requirements for Special Trays:
What is Spacer?
From the name Spacer it implies that it is used to give space, sometimes
we need space when we have mobile organs. Is it only used in upper as
we see in the lab? NO the spacer can be used both on the upper and
lower, in the lab you see the spacer on the upper for educational
purposes only.
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A very important thing you should know is that the type of wax we use in
spacer is called “Modeling wax” from the family “Utility wax “
What is the most important thing in making the Special
tray ?
It is the peripheral borders; the depth of the tray must cover the sulcus
(why?) We do this to have a peripheral seal good retention
What are the Retention forces we make in the denture?
We have physical, mechanical and chemical forces .Our talk will be on
the Physical.
1. Adhesion and cohesion: imagine having two slides of glass, in
situation A I want you to stick them together and then try to
separate them , very easy right ? In situation B I want you to put a
drop of water or oil and stick them, try to separate them, very hard
right? What happened is that the Oil ( Saliva in mouth ) stuck with
the Glass ( soft tissue in mouth ) and the other drop of oil (Saliva )
stuck with the other glass ( Denture in mouth ) , this is simply the
concept of Adhesion “ the sticking force between Dissimilar
objects ). Cohesion is the same but within the object like Saliva.
2. Atmospheric Pressure: We make a (-) pressure inside the denture
to have good retention, We do this by creating something called
peripheral seal which includes 1- The end of the Denture 2-Width
3-Depth of slucus, These three things we do something called
Border Molding which in turn will make peripheral seal this
seal will make the pressure inside the denture less than the oral
cavity (-) pressure good retention. If the image not yet
understood imagine the balloons you see in shopping centers and
how they stick to the root once they are free.
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3. Denture extension: this is very important in keeping the (-)
pressure, look at the figure below.
What is the Vibrating line?
Most of students think that the Vibrating line is actually the line between
the hard and sot palatals, this is completely wrong. It is actually an
imaginary line between the moving and non-moving part of the soft
palate, this line has other names like AHH line (we ask the patient to
make this sound to see the where the vibrating ends and starts, we can’t
see a line though), it is also named the peripheral seal.
How to locate the Vibrating line?
The landmarks for this line are Fovea Palatine.
After disusing the retention forces we use, let’s see what are the
requirements we need to have a good special tray:
1. Spacer , we talked about this above
2. Retention factors , also explained
3. Handle ( in both the upper and lower trays )
4. Finger rests (exclusive only for lower): In the lower tray when you
want to make an adjustment there is nothing to rest your fingers
on, not like the upper where your fingers are rested on the palate
area , This is why we make them.
• ant : Labial Slculs
• post : Hammular notch
• must extends to the vibrating lineupper
• ant : Labial Slcus
• post : Retromolar area ( atleast 1/3
- 2/3 included )lower
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• Canine
•6 or 7
upper
• Canine or Anteroir
• 6 or 7lower
5. Stoppers: We use them only if we have spacers. Their function
simply is two things A) to stop the tray from sinking even more
upon pressure and B) They give
even thickness to the material.
Now the locations of the
stoppers is in the figure below ,
Notice also in the upper we will
do a butterfly shape posteriorly
we have to insert a stopper there , the difference here is this
stopper function is different from the other stoppers , its function is
to make the vibrating line (peripheral seal ) more pronounced.
6. This might be known by now , but the material should be 2 mm
shorter than slculs
7. The final tray must be polished
This was the ending of the theory part, Now will go into the practical part.
Keep in mind this is only small points to refresh your memory and not
everything is written.
The doctor started the demo with the upper:
Holding a pencil insert it into the deepestpart of the sulcus , start drawing a line at
any desired point you like move slowly
and gently around the borderline of the
entire cast.
You will face frenulum pass above it and
create a V when you do so , do this with
all the frenum and hummalr notches
You just created the sulcus line Now do another line that is exactly like the first line but it is above it
by 2 mm and attach it with the first line posteriorly and release it
from it anteriorly, this is called tray line
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Now do another one exactly like the two lines but it is above the
tray line by 2 mm , here you do the butterfly appearance , this is
called the spacer line.
Now get your wax piece and expose it to heat until you feel it is
ready to be used
Put it on the cast , start pressing with your thumbs not nails on the
palatal area and then into the rest of the cast , try to record the
depth of sulcus correctly
After the entire cast is covered by the wax , now remove the
excess by pressing the wax to the edge of the cast and by using a
carver
Now cut the wax according to the sulclus line using the carver (pen
grip here )
Now it is time to make stoppers , put them in the locations we
stated earlier , they should be something around 5*5 mm squares
Put it in water for 5 min
Fill the stoppers and the butterfly area with Acrylic , do the same
thing for Acrylic excess as we did earlier
It is time to make a handle , the trick here is to make a small
concavity with your carver and open it as if you are opening a bookthis will be the attachment of your handle to the object , you can
either make the handle all vertical or vertical and at the tip oblique
both are right.
Put the object in the machine for 3 min , remove it from the gypsum
cast and put it again for 1 min , by doing so you will be certain that
no soft material is at the core and all of it is harden.
The cast for the lower part is also similar only for the following things :
You only draw two lines the Sucls line and the Tray line , both of
them do not meet posteriorly
You put Vaseline to your work before inserting it into the machine
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We come now into the other phase of making the special tray which is
“Finishing and polishing”, Dr.Essam Did the demo.
We do the polishing with an instrument called “Laboratory Hand piece “
the one you use in cons is called “ Contra angle hand piece “. We have
different labs here one is new and the other is old . The only difference
between the hand pieces in both labs is the motor, in the old it is hanging
on the desk and you can see it.
What is the correct way to hold the hand piece?
Here unlike cons lab , we avoid the pen grip instead we do the
Palm grip , The doctor showed many other grips but he didn’texplain what he was doing in the record at was ( I put my hand
here and I grip here , I put my hand there and do this .. so it wasn’t
clear )
How to attach the bur?
For the new lab simply rotate it put the bur rotate back , before
opreatiing make sure the bur is in its place by pulling it.
For the old lab you will see a lever, 12 clock means it is close 6
clock means it is open.
The doctor reviwed the types of bur , the one we didn’t have am
going to write about it : it is called Mandro حمال we use it to attach a
sandpaper or paper around it and run the bur to bolish
Rotation of the bur in this lab
Note that although cons lab had the slow bur run for something 15k
and the fast could reach up to 100k and in this lab you can reach
only up to 35k. But they are different in the diameter so in short
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they both show strong powers and could damage if not used
properly
How far should I cut ?
If you did the lines correctly you should do the polishing up to the
third line for upper and up to the 2nd line for lower.
Done by :
Osama Emad Hsan Ahmaed Mohamed Salem Sayed Yousef