Dr.

Michael Brandon Lewis Registered Specialist Prosthodontist BDS (Hons) DClinDent (Pros) MRACDS (Pros)

APPOINTMENT 2: SECONDARY IMPRESSIONS.

GOALS OF THIS APPOINTMENT: Take secondary impressions EQUITPMENT REQUIRED: Pros wrap Special trays SS White Orange Solvent Gauze Light-body PVS Greenstick (as required) Vasaline (as required) Alginate Scalpel PROTOCOL: MAXILLA PRIMARY IMPRESSION 1. Inspect special trays on primary casts with your tutor and trim any obvious overextension 2. Try in special trays intraorally and check for stability 3. Disclose special tray: a. Load the periphery of the maxillary special tray with light-medium alginate (1 powder: 1.2 water ratio) and take a border moulded impression b. Section through the alginate vertically to inspect the height of alginate above the denture periphery. We are aiming for 3mm clearance c. Mark any areas of overextension with your tutor, and adjust tray as required d. Retake disclosing impression until satisfied with sulcular clearance 4. Capture peripheries in Zinc-oxide eugenol: a. Mix equal quantities of SS White impression paste and catalyst until homogenous b. Bead along periphery of impression tray (including post dam region) c. Take the impression from behind the patient do not stand in front of them. d. Retract the cheek using a mirror and maneuver the impression tray such that it slinks into the patients mouth with a minimum of discomfort e. Free the upper lip so that it rests over the tray, and is not trapped by the labial border of the stock tray f. Seat the impression tray using a puddling motion E: Michael@michaellewis.com.au W: www.michaellewis.com.au

Dr. Michael Brandon Lewis Registered Specialist Prosthodontist BDS (Hons) DClinDent (Pros) MRACDS (Pros) 5. Mould periphery whilst Zinc oxide sets sets using functional movements. These may include the patient: a. Making ooh sounds/ pucker lips registers buccal sulcus, buccal frenum and lingual frenum b. Making eee sounds/ broad smiling registers labial sulcus and buccal frenum c. Get patient to shift jaw side to side Moulds hamular notch region 6. Offer your patient a rinse and inspect the final impression 7. Inspect peripheries and retake specific areas if deficient you can add zinc-oxide to zinc-oxide! 8. Wipe down periphery of zinc oxide using orange solvent on a square of gauze this removes the surface 0.5mm and makes space for the PVS wash impression 9. Apply PVS adhesive to the special tray 10. Offer your patient a rinse and inspect the final impression PROTOCOL: MANDIBULAR PRIMARY IMPRESSION Unlike the maxilla, the mandibular edentulous primary impression is taken in two steps first in a thick, putty like alginate, which is used to customize a stock tray, then overextension is trimmed and relined using a wash technique using a light- medium alginate. 1. Select an appropriate size edentulous stock tray and check for appropriate intraoral clearance. 2. Place 4 stops in blue beading wax. 3. Try intraorally again and indent blue wax against the ridge. Ensure stable seating against all stops. Ensure that the ridge is centered in the tray with even space for impression material to flow. 4. Spray impression tray lightly with adhesive and air dry. 5. Mix a thick, putty-like consistency of alginate (1 powder:0.5 water ratio) and take impression: a. Take the impression in front of patient b. Retract the cheek using a mirror and maneuver the impression tray such that it slinks into the patients mouth with a minimum of discomfort c. Free the upper lip so that it rests over the tray, and is not trapped by the labial border of the stock tray d. Get the patient to raise tongue to allow material to flow into the lingual sulcus e. Press the impression tray vertically down until seated on the stops 6. Mould periphery whilst alginate sets using functional movements. These may include the patient: a. Making ooh sounds/ pucker lips registers buccal sulcus, buccal frenum and lingual frenum

E: Michael@michaellewis.com.au W: www.michaellewis.com.au

Dr. Michael Brandon Lewis Registered Specialist Prosthodontist BDS (Hons) DClinDent (Pros) MRACDS (Pros) b. Making eee sounds/ broad smiling registers labial sulcus and buccal frenum c. Get patient to shift jaw side to side Moulds the masseteric notch region d. Get the patient to open and close Moulds the masseteric notch region 7. Offer your patient a rinse. 8. Using a scalpel, remove overextended alginate. Basically we use the first, thick mix as a filler. Some areas of the edentulous ridge are difficult to compress (i.e. the alveolar ridge), whilst others will distend freely (the sulcus). We want to remove any area which has been overextended and then to reline in the next step using a light-medium alginate a. Trim 5mm of sulcus periphery everywhere it is likely that these regions will be overextended. b. Remove excessive alginate width that will balloon out impression c. Remove alginate in the retromolar region d. Round all reductions as to avoid transition lines between putty and alginate washes 9. Spray customised stock tray using fix. Gently air dry. 10. Take a wash impression over customised stock tray using a light- medium alginate (1 alginate: 1.2 water ratio). Perform functional movements as before. 11. Offer your patient a rinse. 12. Inspect impressions. HOW TO ASSESS IMPRESSIONS: We have adequately captured all denture bearing surfaces The sulcus has been captured in a mucostatic state Absence of bubbles/ voids SECONDARY TRAY PRESCRIPTION: 1mm spaced tray (1 sheet of pink wax) 4 embracing stops in the canine and first molar region Tray periphery 3mm short of sulcus Post dam build into special tray No holes or perforations Handle protruding at 45 degrees, so that it is not pushing the lip out

E: Michael@michaellewis.com.au W: www.michaellewis.com.au