1. Alginate impression
For the production of study cast
Requirements of a good alginate impression:
o Maxillary:
All erupted & unerupted teeth
Impression on the palatal side should extend beyond the vibrating line (imaginary line drawn between the
hamular notches at the junction of aponeurosis of the Tensor veli palatini & muscular portion of soft palate)
Labial & buccal frenum & sulcus reflection
o Mandibular:
All erupted & unerupted teeth
Extent of the lingual sulcus, including retromylohyoid fossa, with the mylohyoid muscle in its elevated &
contracted position
Labial & buccal frenum & sulcus reflection
o Ensure that:
No voids in critical areas
All areas are to be covered by prosthesis are included in the impression
The alginate is not torn in critical areas
The alginate has not detached from the tray
No ‘shown through’ of tray/compound, particularly in the area of teeth
No thin alginate less than 3mm
1.1. Selection & preparation of tray
Stock trays are widely used & supplied in different sizes:
o Types:
Autoclavable stainless steel stock tray: Used in clinic
Disposable (single use only) plastic tray: Not as rigid
o Perforated: Holes for retentive tags; 2-3mm holes separation
o Sizes (smaller the number, larger the tray):
Upper: 1, 3, 4, 5, 7
Lower: 20, 21, 22
o Proper tray selection should ensure:
Extend facially to include all teeth as well as the musculature & vestibule
Extend distally approximately 2-3mm beyond the last tooth in the arch
Maxilla: Include maxillary tuberosity
Mandible: Include the retromolar pad
Provide 3 mm depth of alginate beyond the occlusal surface & incisal edge
Comfortable to patient
Tray modification with impression compound
o Can be used to:
For patient with high palatal vault: To reduce bulk of alginate used (obtain 3mm optimal alginate thickness)
Extend the tray distally to cover all teeth & relevant structures
For patient with edentulous ridge
o Procedures:
1) Soften it with heat from blow torch or immersing in warm water bath (~60°C)
2) Modify the tray with the compound
3) Place the tray in patient’s mouth with the occlusal/incisal edges of teeth touching the base of tray
4) Hold it in place for ~1 minute until the compound hardens
5) Remove the tray & trim the compound with Stanley knife at the areas contacting the teeth/mucosa
Line the tray & the compound with adhesives
1.2. Preparing the patient
Explain the procedure to the patient:
o All removable prosthesis should be removed beforehand
o Don’t speak when taking impression; raise hand if in discomfort or in need
o To minimise gagging or vomiting
Breath through nose
Lower your chin
o Practice seating the tray in patient’s mouth to familiarize the patient with the procedures
Give patient a paper towel
Ensure the oral condition of patient is suitable for impression taking (low plaque level; no spontaneous bleeding;
no debris)
o Give patient a cup of water/mouthwash for mouth rinsing to reduce the amount of bacteria, debris & saliva
Use wax to block out pontic & crown undercuts that may cause tearing & distortion of the impression material
Remove any large debris & dry patient’s mouth (esp. teeth) with gauze to avoid salivary bubbles
o Teeth should not be completely dry as alginate sticks to dried teeth very easily & will tear upon removal
1.3. Impression taking: Take mandibular impression first
1) Mixing alginate
o Fluff the powder so that the lighter & heavier particles are remixed
o Use a calibrated water measure (21-25°C), place the right amount of water into a bowl to be mixed with
alginate within the period given in the manufacturer’s instructions (60s)
The cooler the water, the more working time there will be, but the consistency will be thinner
Excess water may also prevent bonding of the material in the tray to the material on the occlusal surface of
the teeth
2) Load the tray with mixed alginate
o Mandibular: Begin to load from the facial aspect of the tray
o Maxillary: Begin to load from the posterior aspect to push the alginate anteriorly
3) Smear alginate over the occlusal and interproximal surfaces & deep undercuts of teeth to help reduce air
bubbles
4) Rotate the tray into the mouth & seat the impression whilst retracting patient’s lips
o The tray should align with midline of the face
o Ask the patient to relax the cheeks & lips muscles
o Maxillary: Seat the posterior first before anterior
o Mandibular: Ensure that the alginate fills the lingual sulcus before asking the patient to hold the tongue up &
outwards
o Hold the impression in place with light pressure with 3-5mm alginate between tray & teeth
o Important to capture the sulci & if possible the labial flange
o Setting time: ~2-3 mins or until you can feel the alginate has hardened
5) Remove the impression with a firm quick snap
o Alginate has a high shear strength when it is being ‘deformed’ quickly so that it will not undergo permanent
deformation easily
6) Rinse the impression under running water to remove saliva residue
7) Assess the impression in good light & cover with a damp gauze if it is satisfactory
8) Excess unsupported alginate may be trimmed off the edges
1.4. Disinfection & storage
1) Dip the impression in 0.8% sodium hypochlorite for 2 seconds
2) Rinse the impression under running water & shake of surface water
3) Repeat (1) & (2) once more
4) Dip again in sodium hypochlorite solution
5) Cover it with a gauze dampened with sodium hypochlorite & leave it on an impression stand for 10 minutes
6) Rinse under running water once more & shake off surface water
7) Cover the impression with gauze dampened with water & leave it in a zip lock polyethene bag labelled
‘disinfected’ & patient’s name
2. Facebow registration
To take record of jaw relationship for the mounting of the upper cast
o An instrument that transfer the relationship of maxilla & some anatomical reference points (Arbitrary hinge axis)
AHA:
Represents a reasonable approximation of the axis about which the mandible rotates when the patient opens
the teeth slightly
Located by:
Joining the two points, each of one side, marked 13mm from the posterior edge of the tragus along the line
drawn between the canthus of eye and the center of tragus of ear, to form an imaginary line
Identification of this line is far simpler than methods required to locate the true axis of rotation (terminal
hinge axis)
2.1. Types of articulators
Semi-adjustable
o Allows for adjustment of the condylar inclination & the Bennett angle with the use of interocclusal protrusive &
lateral records
o The lateral & protrusive pathways are represented as flat surfaces
o The casts can be related to the hinge axis
o Intercondylar distance is not usually adjustable, being fixed to an anatomical average
o Anterior guidance may be set by the use of an adjustable incisal table
o 2 types:
Non-arcon articulator: Dentatus
The intercondylar axis is located on the upper member
∴ A backward movement of the intercondylar axis of the articulator instead of a forward movement as
occurs in the patient (which is reproduced by an arcon articulator)
🙂 Dentatus simulates CR-CO movements better & is more convenient for checking of excursions →
Helpful in making dentures
☹ Upper unit NOT removable → more difficult for technicians to fabricate the crowns & bridges
Arcon articulator: Denar
The condylar path is part of the upper member of the articulator
Stimulates the actual relationship that occurs in the patient, i.e. condyle attached to the mandible &
glenoid fossae to the skull
🙂 Reproduces patient condylar inclination more accurately
🙂 Upper & lower members are more easily dissembled → Helpful in making crowns & bridges
☹ Does NOT allow CR-CO movement unless the cast was mounted with a thin metal plate behind the
condyle beforehand → Inconvenient for denture production which requires checking for excursions
Hinge articulators
o Simulates only opening & closing movements: NO lateral, retrusive or protrusive movements of the casts
o Only accepts a single static relationship → NO place in removable prosthodontics
o Their dimensions do not allow for the mounting of casts in relation to the terminal hinge axis and the articular
hinge axis located posteriorly and inferiorly to that of the patient → not possible to close the articulator
beyond the vertical dimension of the interocclusal record without the introduction of large errors
Fixed condyle
o Allows lateral and protrusive movements with fixed condylar inclinations and intercondylar distances
o Some types allow for the orientation of the maxilla to the terminal hinge axis with a facebow record
o Resulting eccentric movements and tooth-to-tooth positions may not match the patient’s
o Can be used for individual posterior restorations and short span posterior bridges and removable partial
dentures where there is no tooth contact is planned in lateral and protrusive movement Not suitable for
complete dentures or more extensive bridgework
Fully-adjustable
o Designed to fully reproduce the direction and curvature of the condylar movements as recorded with a
pantograph
o Casts are normally related to a kinematically located hinge-axis and intercondylar distance is completely
adjustable
o Usually restricted to complex occlusal problems requiring extensive reconstructions with fixed prosthesis Fossa
Fossa-moulded
o Attempt to reproduce functional movements of the mandible by moulding condylar pathways using
movements traced by a mounted functionally generated path record
o This record may be intra or extra-oral
2.2. Procedures
1) Align a ruler between the canthus (outer corner) of the eye & the center of tragus of the ear
2) Mark a point 13mm posterior from the posterior edge of the tragus along this tragus-canthus line with a
moistened indelible pencil
3) Repeat the marking on the opposite side
4) Palpate to locate the inferior border of the left infraorbital notch
5) Apply a sheet of pink modelling wax that has been softened in a Bunsen flame (or in a water bath) to the bite
fork such that a two layer thickness lies on the upper surface & a single layer on its lower surface
o The rod of the bite fork should be on patient’s right side!
6) Whilst the wax remains soft, apply it to the upper teeth to create sharp (but not deep) indentations with cusp
tips
o Ensure that the bite fork is correctly centered on the teeth
o The rod of the fork should remain reasonably parallel to the patient’s sagittal plane
7) After allowing a period for the wax to harden, remove the bite fork from the mouth & check that the cusp tips
have been sharply recorded in the wax & the cusps of the upper teeth of the cast can be accurately seated into
the record
8) Set one condylar rod of the facebow to a fixed reading (e.g. 70 mm) & position the face bow on a patient’s face
so that the two condylar rods both touch the marks made on the arbitrary hinge axis
9) Take a reading from the second condylar rod & calculate the average of the two readings
10) Set both condylar rods to this same value
o Such calibrations are present to allow the facebow to be accurately centered on the patient’s face
11) Relocate the bite fork in the mouth & hold it in a steady position on the teeth with the first two fingers of the
left hand
12) Attach the facebow to the bite fork & position the condylar rods so that they both touch the marks on the face
13) Tighten the locking clamp for the bite fork
o The condylar rods should be in contact with the marks even when the operator/DSA’s hold on them is
released
14) Place the orbital pin in its locking clamp & position its tip over the left infraorbital notch & tighten the locking
clamp
15) Assess the followings:
o Tooth & wax are in contact
o Occlusal plane parallel to inter-pupil line
o Bite fork & orbital pointer/pin parallel to the sagittal plane
o Mid-point of the bit fork matches the midline of patient
o Sharp but NOT deep indentations on the wax
o All screws are tightly locked
16) Release the set screws for the condylar rods & remove the facebow from the patient
17) Check the tightness of the two locking clamps & label the facebow with the patient’s name before transporting
it to the laboratory
2.3. Evaluation of the facebow record (without referring to the patient)
All the screws are tightly locked
Bite fork at the center of the facebow & mid-point of the bite
Occlusal plane is parallel to the horizontal rod of the facebow
RELEVANT ANTAOMI CAL FEATURES
MAXILLA
Maxillary tuberosity
o Round eminence at the lower part of the infratemporal surface of maxilla, esp. prominent after growth of third
molars
o Rough on the lateral side for the articulation with the pyramidal process of the palatine bone, & in some case,
lateral pterygoid plate of sphenoid bone
o Gives origin to a few fibers of medial pterygoid muscle
o Adjacent to its lingual border is greater palatine foramen (greater palatine VAN passes through)
Hamular notch
o A depression about 2mm wide between the maxillary tuberosity & the hamular process of medial pterygoid
plate
o Significance:
A straight line drawn from the hamular notch on one side to the other determines the posterior limit of
the upper denture: Overextension causes soreness
Hamular frenum
o A tendon-like structure originating from the posterior aspect of the maxillary tuberosity, & extending across
the crest of the hamular notch area
o Primarily activated indirectly by pull of the pterygomandibular raphe (a line of union between the buccinators
& the superior pharyngeal constrictor muscle)
o Significance:
Will cause denture displacement if impinged upon
Vibrating line
o An imaginary line across the posterior part of the palate, marking the junction of the attached tissue overlying
the hard palate & the movable tissues of the immediately adjacent soft palate
o Clinically:
The line will vibrate when the patient says ‘ahh’, marking the beginning of motion in the soft palate
Usually but not always, lies within 3mm in front of the palatine fovea (two small depressions, one on each
side of the midline)
Palatine aponeurosis
o A firm, fibrous lamella attached to the posterior border of hard palate, which supports the muscles & gives
strength to the soft palate
o Serves as insertion for tensor veli palatine (origin: medial pterygoid plate of the sphenoid bone; action: tension
of soft palate) & levator veli palatini
SUPPORTING STRUCTURES
o Hard Palate
Flat areas as secondary retentive areas
o Residual ridge
Ridge left after the extraction of teeth
Mucosa is firmly attached to the periosteum of the bone
Consist of dense collagenous fibers
Considered as a secondary stress-bearing areas, because it is subjected to resorption contrary to horizontal
portion of hard palate
o Palatal rugae
Resist horizontal forces against the denture
Should not be overcompressed
MANDIBLE
Retromolar pad
o Non-keratinized area of tissue forming a posterior
continuation/extension of the pear-shaped pad
o A small inclination going up & posteriorly, bordered by
muscles in the back of the jaw
o Significance:
Two third of pad must be covered by the denture to
perfect the border seal of the denture
Used as a guide for locating the level of occlusal
plane, which must not be higher than half its vertical
height
Mylohyoid ridge
o A ridge on the lingual surface of the mandible that
extends at an angle from the level of the roots of the last molar to the floor of the mouth
o Serves as origin of the mylohyoid muscle
o Significance:
Important in determining the contour of the lingual flange
The lingual flange should extend a bit below the level of the mylohyoid ridge, & the tongue should rest
on top of the flange & aids in stabilizing the lower denture
Retromylohyoid fossa
o Extends from the distal end of the mylohyoid ridge to the retromylohyoid curtain
o Significance: Lingual flange of the denture should extend laterally & fill the retromylohyoid fossa
Premylohyoid fossa
o Fossa between the lingual frenum & the first premolar area
Retromylohyoid curtain
o Situated between the anterior pillar of fauces & pterygomandibular fold
o Formed by: superior constrictor muscle, palatoglossus muscle & lateral surface of tongue, & mylohyoid
muscle & submandibular gland
o Significance:
Acts as a limiting structure in forming the lingual flange of mandibular denture
Pulled forward when tongue is protruded out
Posterior border of denture should touch the retromylohyoid curtain when the tip of the tongue is placed
against the central part of the residual alveolar ridge
Mylohyoid muscle
o Origin: Mylohyoid line of the mandible
o Insertion: Hyoid bone, median raphe
o Innervation: Mylohyoid nerve from inferior alveolar nerve (V3)
o Action: Elevates tongue, depresses muscle
o Significance: Mould the lingual sulcus by raising floor of mouth (as patient protrudes his tongue) when it
contracts
Geniohyoid muscle
o Origin: Inferior mental spine of mandible
o Insertion: Hyoid bone
o Innervation: Hypoglossal nerve
o Action: Assist in depressing mandible, brings hyoid bone upward & forward
Styloglossus muscle
o Origin: Styloid process of temporal bone
o Insertion: Tip & sides of the tongue
o Innervation: Hypoglossal nerve
o Action: Retraction & elevation of tongue
Buccinator muscle
o Origin: Alveolar processes of maxilla & mandible, &
TMJ
o Insertion: In the fibers of the orbicularis oris
o Innervation: Buccal branch of the CN7
o Significance: Mould the buccal sulcus in premolar area
when it contracts
Masseter muscle
o Origin: Zygomatic arch & maxilla
o Coronoid process & ramus of the mandible
o Significance: Mould the buccal sulcus in retrormolar
area when it contracts
Pterygomandibular raphe
o Ligamentous band of the buccopharyngeal fascia
o Attached superiorly to the pterygoid hamulus of the
medial pterygoid plate, inferiorly to the posterior end
of the mylohyoid line of the mandible, posteriorly to
superiorly pharyngeal constrictor muscle, & anteriorly to the posterior edge of the buccinator
DENTAL MATERIAL SCIENCE
DESIRABLE PROPERTIES OF IMPRESSION MATERIALS