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Prosthodontics laboratory 3 | Steps of making Provisional dentures

Very important notes to read before starting this script: Although we are studying partial prosthodontics many of the principles apply to both. Youll find that this script is almost identical to the last semester script that talked about complete dentures and not partial dentures. So keep in mind there will be some small differences between the two scripts. All the images in this script are for the last semester script, which was for complete dentures. Keep in mind while reading that you are looking at a partial denture with clasps. (Like the image below). There are some points the doctor talked about them real quick ( like the curing cycles ) other points the doctor didnt talk about them at all ( like Deflasking , Laboratory remount and Finishing and Polishing ) we added them because some of you might be interested to review them , so its up to you wither to study them or not .

As you recall from the first laboratory, we said the design of partial dentures involves making the provisional and the final denture. Todays laboratory will be on how we make the provisional denture.

Brief Introduction
What are the steps to convert the wax transitional RPD into the final acrylic denture?

Lost wax technique is the basic process, but the specific techniques for
dentures are (in order):

1. 2. 3. 4. 5. 6. 7.

Flasking Dewaxing Packing Curing Deflasking Laboratory remount Finishing and Polishing

1) Flasking
Is defined as the process of investing the cast with the waxed denture in a flask to make a mold that is used to make the acrylic 1 denture.(see images 1,2)

Flasks
There are different shapes for flasks (round, ovoid, squared). Each flask has two portions (a cover and a base) and there is an opening between them (see image 2) 2 Closed flasks

Opened flasks 3

The upper flask differs from the lower flask : In the UPPER, the cover and the base are parallel to each other, so when you place the cast inside the base its borders will almost leveled with the land area of the cast, and when you pour plaster you can remove the excess quickly with no worries about the different heights. However; in the LOWER it's oblique so that the retromolarpad is higher than the anterior part of the ridge, and this oblique angle will ease the separation at the dewaxing stage,.(see image 3 , page 5) ** It is written in the top of the cover of the flask (Upper or Lower) to help you distinguish between them.

Notes
1. In order to separate the gypsum from the flask, you should paint Vaseline on the internal surface of the flask so that you can clean it up later on, also put a thin layer of Vaseline on your cast base to keep it safe so that you can re-mount it on the articulator after denture processing to see if teeth occlusion has changed or not. 2. If there is a space underneath the baseplate, when you pour stone it might get below it and stick to the cast! So you have to seal and close the space between the baseplate and the cast all the way around the denture by using hot wax so that nothing can get under the denture .Usually do this step when the cast is still mount on the articulator so it doesnt change the occlusal relationship. 3. This wax that you put around the denture will turn into acrylic, so you have to be careful not to put wax on the teeth or their roots.

The flasking Procedure

Place the cast in the base of your flask; pour plaster around the lower portion in order to prevent RPD 3 movement inside the flask. In complete dentures Plaster goes over everything EXCEPT land area ,wax and teeth . However, in Partial Dentures it differs by that the plaster layer will be higher in order to cover all undercuts. Complete dentures' casts don't have any undercuts ,but in RPD's casts which have teeth on them there This is the lower flask are a lot of undercuts that have to be covered with plaster to ease the opening of the flask.. So wherever there is a natural tooth it has to be blocked out using plaster.

You should cover the natural teeth and the retentive part of the clasp otherwise the clasps will be free in dewaxing process ,so you have to catch them from one side before they become free. But teeth are long so the plaster will be in more vertical shape , more vertical means more friction so you have to trim teeth in an angled way to ease the separation afterwards. So trim 1 mm above clasps ,and 1 mm above the lingual gingival margins. DO NOT damage the wax or artificial teeth during trimming. Trim the back portion of your cast specially the lower cast because it's very high. In summary; you have to cover Natural teeth on the cast in a sloped way and cover the retentive part of the clasp, in the other hand don't cover the wax or the artificial teeth of the denture. In the lower cast it's the same; the plaster goes up to the retromolarpad area but it doesn't cover the lingual area.

** The mixing ratio for plaster: 100 g powder 50 ml of water, You should make the posterior edge of the plaster tapered in order to make it opens and closes more easily. And always remember if any plaster gets to teeth or wax you should remove it.

When the plaster layer sets you will be ready to pour the second part of the mold which is 50/50 plaster and stone, but before that you have to separate between these two layer because gypsum will stick to gypsum, and if you try to open the flask the plaster will break during dewaxing which is a big problem, so use a separating agent between them which is

Vaseline.
To separate gypsum from gypsum use Vaseline To separate gypsum from new acrylic use tin foil substitute (sodium alginate /cold mould seal) If there is an under cut in the plaster ,,when you pour the other layers it will get inside this undercut making the separation of the upper and the lower parts harder which may break the cast . You can add plaster to close these undercuts, but sometimes it will not connect perfectly with the previous layer, so you have to fill it with wax or a lot of Vaseline. During the dewaxing process it will melt away forming a space between the two portions and make the dewaxing easier, but when finishing the denture come out it will turn into acrylic that will need trimming .

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If the surface is rough I can use sandpaper under water to make everything smooth. Always be sure that the teeth are centered correctly, any irregularities may cause difficulties in dewaxing , and this layer is strong enough to keep the acrylic in place and weak enough to be separated in deflasking process.

Next, after the second layer sets pour the third layer that is pure Dental Stone on the top to prevent the movement of teeth .You just need to cover the cusp tip with it. It also helps in deflasking procedure and to keep the shape of the denture.It will go around the teeth to keep them in place, paint a layer of the separating agent between the 2nd and the 3rd layers or not.( your choice ). ** The mixing ratio for Gypsum type 3(dental Stone) is: 100 g powder to 30 ml of water. You should mix it on the vacuum mixer to be more accurate and not to have any bubbles between the flask and the teeth. **In private labs they just make two layers, they may use stone all the way, or 50/ 50 (plaster and stone) all the way, in order to save time but it may cause inaccuracy or difficulties in removing the cast.(( THIS IS WHAT WE DID IN THE LAB )).

With this we have finished our talk about Flasking , and now we will talk about Dewaxing which is the 2nd step of this lab.

2) Dewaxing
After flasking you have to do dewaxing ,,, where you should put the flask in a dewaxer machine (water path with a timer and a thermostat) . Put it for 10 minutes in a 95 C it will soften the wax inside. Once it is soften open the flask through the provided opening (it will be so hot ) .Then put it again in the dewaxer machine while it is opened for another 10 minutes" total 20 minutes " ,then with a hot water jet wash away any remaining wax until you have a clean surface .

After Dewaxing the baseplate is thrown away (it has a temporary job during fabrication ) . At this point I am ready to do packing ,but before packing you should paint Tin Foil substitute over everything in the mold except the teeth and the wires,thus the acrylic will NOT stick to gypsum . either stone or plaster . If you painted on teeth, they will not connect to acrylic. This layer of tin foil substitute (cold mold seal) should be very thin, and you should put more than one thin layer. If it was so thick it will change the depth of the sulcus. Then, you can use a brush to remove the separator agent from teeth. Wait for it to get dry otherwise it will not work as a separating agent.

NOTE: * Tin Foil Substitute is made of Na alginate * Why sodium alginate is used as a separating agent? Because its reaction is similar to the reaction of alginate impression material. Na alginate + Ca sulfate Ca alginate + Na (in solution) + Sulfate (in solution) Ca alginate will make a network and precipitate. The cast is made from Ca sulfate; the same material that react with Na alginate

Dont use Vaseline as separating agent between stone and acrylic; it will not work well as a separating agent in packing.

3) Packing
A short summary of packing would best be like this, Mix the acrylic according to certain ratios, wait till the dough stage, put the acrylic inside the flask, close it so that the excess will get out , use your hand to press it first then use Denture Hydrolic Press So starting off with the first thing which is mixing of acryl: Now what Im going to do is that Im going to mix the acrylic , use porcaline container for mixing acrylic, you need 10 ml of the monomer for a denture then add powder in (1:3) ratio, why?
This is the packing machine , the main concept of this device is Hydrolic pressure

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The answer is when acryl reacts its reaction is exothermic, plus when methylmethacrylate (monomer) react with itself there will be change in size; contraction (reduction in size). Some of the mistakes that might occur during mixing and pouring the acryl are: Not enough monomer during mixing will lead to porosity or Localized Porosity. Adding too much monomer will result in shrinkage. If the mix is not homogenous will also lead to 11 Localized Porosity. There are different stages of the setting reaction of acrylic which are : 1. Powder and liquid stage: you can clearly see in this stage that the powder and liquid are not the same (two different distinguishable materials). Here the shape of Flask clamp the mix is exactly like sand on beach. 2. Wet sandy stage 3. Stringy or the fibrous stage : If you hold the material at this stage and stick it between your fingers itll form fibers , just like holding a gum between your fingers 4. Doughy stage: This is the perfect timing and form for acryl to be placed inside the packing machine. 5. Rubber stage: Using the acryl at this stage is bad , why ?As you know in dental materials we have two different properties, we have Elastic and Plastic , the difference between these two properties is obvious that the later will deform its shape when execrating pressure on it. If you shaped your acryl at this stage, what will happen is that you will have some dimensional changes and this is not good , so no further manipulation can happen at this stage 6. Finally is Harden stage

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So we place the acryl in its doughy stage inside the flasks, but to make sure that both flasks are pressed as much as possible we are going to use the Hydrolic press with the packing machine ( see image 10). A very important note is that the maximum pressure can be made on the cast (which is made of gypsum type lll ) is 3000 Mp , above this pressure will causes fractures or cracks inside the cast . While the denture is inside the packing machine we dont rush things because if we press too fast the excess will come out and no details were recorded, we give the acryl enough time to cover all the possible details After that Ill remove the excess in the flasks and then Ill put the upper and lower denture attached to the Flask clamp , the objective of the clamp is not to excrete pressure and remove excess, its objective is simply to keep the flask close during the processing , there is a special screw and springs in the bottom to keep the flasks close together. (see image 11)

After setting them in the clamp Ill do something called bench curing Ill simply leave them for half an hour to make sure that the monomer in the acrylic mix wet the teeth and make bond with them . So packing is a simple process, mix the acryl place the acryl inside the flasks in its doughy form use packing machine to remove excess use flask clamps bench curing

4) Curing
We will take the flask clamps after leaving them on the bench (bench curing), and put them inside the curing machine (a hot water path that have a timer and a thermostat). The aim of this process is to convert the heat cured acrylic from the dough stage to the final cured hard acrylic stage.(see image 12).

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This is the flask clamp; itll be inserted like this into the curing machine.

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Before we discuss the actual procedure of curing, I want you to know about the curing cycles of acryl. We have long and short curing cycles, each one leads to the same thing which is converting the acryl to its harden form. In this lab the type of acryl we used was Heat Cured acryl, there are some diffrances between long and short, lets talk more about them

Long Acryl Curing Cycle

13 100 95 74 Temp.
2 3

9 hrs

Time
Water Acrylic

Long cycle
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Figure (13) is of great importance to help us understand the long curing cycle; you can see we plotted time vs. temp. Know that the acrylic in this stage is present within the water inside the curing machine. So what happens to the water (rising temp. /lowering temp.) Will also happen to the acrylic. You also have to know that the initiator for the acrylic (chemical reaction ) starts at 74 degree , meaning that acrylic will start harden at 74 or slightly below . With this reaction heat is generated so it is an exothermic reaction (but note that inside the curing machine we have water and acrylic ,water also gives heat ). Looking at the graph , Im heating up the water , rising the temperature until reaching 74 degree the reaction of the acrylic will start (1 in the graph) , but then I stopped Im not going to increase the temperature anymore (source of heat is fixed to 74) . What will happen now , is the acryl reaction will start I have a new source of heat this will lead to a peak as in (2 in the graph) , acryl peak means that the acryl temperature went up until 95 and then went down back to 76 very fast. After the peak is done, Ill fix the temperature for 9hrs (overnight) and this is (3 in the graph). The temperature of water boiling is 100C. The degree of acryl boiling is 100.8C , you can see that the long cycle is a safe cycle , because the temperature of water never reached 100C , it reached only 74C.

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Short Acryl Curing Cycle

14 100 95

2
1

5 4 3 2 hr 1 hr

Temp.
74

Time
Water Acrylic

Short Cycle

What if I cant wait 9hrs for the long curing cycle to complete? What if I want to cure the denture in the shortest time possible? Ill probably use Short Acryl Curing Cycle . Graph 14 is of importance to understand the short curing cycle of acryl,. We start the cycle by increasing the water temperature up to 74C as in (1 in the graph) , the heat now is fixed to 74C .But the acryl has reacted and itll

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cause a peak as in (2 in the graph ) that was one hour of the 2hr for this stage. After that will leave the fixed temperature for another 1 hr as in (3 in the graph ) , after that we will increase the temperature of water to 95C as in (4 in the graph ) , after that the acryl will stay at 95C temperature for 1hr as in (5 in the graph). Why did we increase the temperature up to 95 ( 5 in the graph ) ? Well we did this because we are afraid of the free monomer (the excess) that might cause irritation to the person , but when we increase the temperature we make sure that there is no free monomer . Total duration of the short cycle is 3hrs, comparing with the long cycle this is definitely shorter but the long cycle is safer. The next talk is not about cycles, but rather a mistake that might be done during curing :

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2
>10 10 0 9 5 7 4

Te m p.

Water Acrylic

Time
Gaseous Porosity
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Graph 15 is of importance to help us understand the error Gaseous Prosoity, so lets see what it is. The mistake here is that we increased the temperature of water up to 100C as in (1 in the graph) , as you know by now acryl will have a peak as in (2 in the graph) this peak reached a very dangerous degrees (for e.g. 110C ) , as you know by now the boiling degree of acryl is 100.8 so the acryl in this case had boiled and it had porosities within it , itll continue with water as in (3 in the graph ) . So the danger is because the boiling temperature of water and acrylic are nearly the same 100 and 100.8 respectively This type of porosity happens when we dont use a curing machine , in some labs they just bring a dash and they boil it using a cooking oven the only way they know is when the water boils . And sometimes and might be too late because the acryl has already been deformed. Just know this small note, during the gaseous porosity, the temperature is highest at the middle and not the corners . If we to ask ourselves why Gaseous porosity happens? The answer could be one of these things or combination of them or all of them: A sudden increase in temperature (too fast; didnt give enough time for the temperature to escape) . Rising the temperature beyond 100 degree . Having a thick denture: now some of you might ask where exactly the thickest part of the denture is. Is it on the upper denture? Nope because the palate has even thickness. It is on the lower denture under the teeth, I dont see it on the surface because heat can escape, so usually I see it buried inside the teeth in the lower denture. If we ask ourselves how can we avoid having gaseous porosity mistake? Change the cycle (spending money on expensive curing machine that has a fixed temperature rates and thermostat) Note that we have other types of porosities, as Sub-surface porosity and Homogenous porosity (happens with bad mixing).

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The curing cycles for Acryl Short

1st stage : 74 C in water for (1, 5-2) hours 2nd stage : 95 C for 1 hour It is safer. THEN

Long 74 C for 9 hours (overnight)

After we get the dentures out of the curing machine, we have to give them sometime (about 30min) before moving into the next step , which is deflasking.

Up to this point doctor Esaam finished the lab and we started the practical part. The next talk is for those who are interested in summarizing the rest of the steps .

5) Deflasking

Introduction
After we let the dentures cool down from the curing machine , the first thing
you notice is that tin foil substitute will form a very thin dry layer, you can see slight reddish shade (theyve added this reddish pigment so you can see where tin foil is on). Sometimes tin foil might unfortunately get into the surface of the teeth, what you should do is wipe out the surface of these contaminated teeth using a piece of cotton dipped in acryl monomer , If I dont take out this excess monomer what are the results ? Teeth might fall

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off the denture, why? Read below about how a tooth attaches to the acrylic to know why: 1- One way is Chemical (between the artificial acrylic tooth and the monomer of the denture base) 2- The other way is mechanical, remember when you were making the denture you did the ginval margins some of the facial gingival margins went over the tooth , and some of the lingual gingival margins went also over the tooth .

, , .
selain itu terdapat juga cara mekanikal,sewaktu membuat gingival margin pada denture,sebahagian gingival margin melepasi cervical gigi,dn sebahagian lingual gingiva juga melepasi cervical gigi"

Reasons why we clean the tooth surfaces with acryl monomer are: A) Itll remove the excess tin foil, which might lead to teeth falling off due to insufficient retention B) Itll also help to make the bond between the teeth and the acryl denture stronger We have a layer called The Glazed Layer which is that shinny layer you can spot on teeth , this layer will prevent bonding between the tooth and acryl

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The Procedure
Open the flasks (using the plaster knife to open the flak, sometimes we might use a hammer) but keep in mind, using hammer is not the correct way but most of the labs in the Arab world do it. What are the things that help me to easily separate the flask now? Can you remember? Well: If you put good amount of Vaseline around the borders This layer (look the arrow on image 5) will also help me to open the flask more easily. After getting the flask out of the different layers of 16 gypsum . There is still that gypsum surrounding the cast and the denture (look image arrow on image 16) , now hitting with a hammer around this area is something unacceptable and risky. What we can do is place it in a special device Ultrasonic Water Bath this device will send ultrasonic vibrations that we cant hear, leaving it for half hour one hour the gypsum will dissolve and any excess particles on the denture will fall off. In the Arab world, we use something less expensive way; Lemon acid (citric acid).

6) Laboratory Remount
While removing the plaster off the flasks do we care about having the cast safe? The answer is yes, we need the cast to check the occlusion later. During this entire lab process the teeth will definitely change their position a little bit, so we still need the cast to mount them on the articulator and correct that error later, this step is called Laboratory Remount as you know from the theory part. We also have clinical remount which is different from the laboratory remount, in clinical the correction procedure is done at clinic.

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So , now that we know the aim of the laboratory remount it is very important to know that while doing this step we are going to leave the denture inside the casts and we are going to attach them to the articulator and check occlusion . Why dont we just remove the cast and put the denture on the articulator without the cast? Well, when the denture is attached to the cast it is always stressed, if I remove the cast there might be relaxation and this will lead to errors during laboratory remount. So always remember laboratory remount: Aim is to: correct the slight mispositoned teeth during the entire process. Is done: while the cast and denture are both attached to the articulator.

7) Finishing and Polishing

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Alright, the denture now is clean and ready for the next process which is Finishing and polishing . Before we start off with this process keep in mind that we dont do anything to the fitting surface (look image 17) during this process , we leave it as it is , it is smooth enough and has good details . The only case we try to polish it is if we scratch it by mistake.

Acrylic bur Fissure bur : for clearing out the frenum area Sandpaper mandro : a long bur with a slight in the middle to allow the insertion of the sandpaper Wheel brushes The doctor didnt talk about Acrylic bur , he immediately started with the sandpaper mandro .

The arrow indicates a fitting surface for the upper denture which is the palate area , this is one of the examples about the fitting surfaces

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1. We firstly remove the large excess we use the sandpaper to remove the excess acrylic around the borders but we dont use it in the postdam area. 2. After that we start polishing the surface , well start with sandpaper on slow speed (10k-15k rpm) , If I did good polishing for the wax I dont need to use this very much expect on the borders areas. (The more time you spend waxing the less time you spend finishing). 3. After that well use a special rubber polishing burs that has within the rubber small particles that will give a shine surface. 4. After that Ill use a large trimming wheel ( look image 18 next page ) these wheels are made out of cotton we dont usually use the normal plastic brussures , during using these trimming wheels we dont use them arbitrarily, but we do the following : a. The first stage we use these wheels wet with pumice material, it comes as powder so we add water to it, and it forms like dough. We put it on the wheel and then the wheel goes around the denture and itll give a very shiny nice appearance. (pre-final shine ) b. The final shine comes from : i. Using the wheel dry , at low speeds ii. We use rouge or what is known as ,to give the final shine (look image) . We have two types of rouge in dentistry : 1. The red iron oxide ( picture ) is used to polish metal ( crown , bridges and partial dentures made out of metal ..etc ) , we dont use this polish acrylic. This is called Iron oxide 2. Triplen (not sure about the name) it is the white material we use to polish the acrylic denture. This is called Aluminum oxide

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When we have the final shine we leave it in water, we never let the denture dry out why? Because the denture has very small pores in it, acrylic has these microscopic pores in it. Imagine a sponge filled with water but then the water evaporates what will happen to the sponge? The same thing with acrylic itll shrink. (Think of the final denture as a fish, you always have to put it inside water. If it leaves water itll die). Just to recap with you on the finishing and polishing steps , we start off with the acrylic bur then we used the sandpaper-mandro bur then rubber polishing bur then we used the wet with pumice wheel bur then we used the wheel bur dry.

~The end ~Done by : Enas Salameh and Osama Yousef .

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