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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(partial and complete dentures). 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
about 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, Finishing and Polishing ) we added
them because some of you might be interested to review them , so its up
to you whether 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 about how we make the
provisional denture.






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Brief Introduction
1) Flasking

Flasks

What are the steps to convert the wax transitional RPD into the final acrylic
denture?
Lost wax techniqueis the basic process, but the specific techniques for
dentures are (in order):
1. Flasking
2. Dewaxing
3. Packing
4. Curing
5. Deflasking
6. Laboratory remount
7. Finishing and Polishing



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
denture.(see images 1,2)


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)



Closed flasks
1
2
Opened flasks
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Notes
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 retro-molar pad 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 at the top of the cover of the flask (Upper or Lower) to help
you distinguishing between them.


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 this step is done when the cast is still mount on the articulator
so the occlusal relationship will not be changed.
3. This wax that you put around the denture will turn into acryl, so you
have to be careful not to put wax on the teeth or on their roots.





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The flasking Procedure

Place the cast in the base of your flask; pour plaster
around the lower portion in order to prevent RPD
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
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, on 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 retro-molar pad
area but it doesn't cover the lingual area.




This is the lower flask
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** 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 layers 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.



If there is an undercut 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 acryl that needs
trimming.


To separate gypsum from gypsum use Vaseline
To separate gypsum from new acrylic use tin foil substitute (sodium
alginate /cold mould seal)
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If the surface is rough you 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 acryl 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 tips of the cusps 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 2
nd
and the 3
rd
layers or
not.(it's your choice ).
** The mixing ratio for Gypsum type 3(dental Stone) is: 100 g powder to
30 ml of water.

You should mix it in 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 might
cause inaccuracy or difficulties in removing the cast.(( THIS IS WHAT
WE DO IN THE LAB )).





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2) Dewaxing

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




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 softened open the flask through the
provided opening (it will be too 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 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
wires, thus the acryl will NOT stick to gypsum neither stone nor plaster. If
you paint it over the teeth, they will not connect to acryl.

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 too thick it will change
the depth of the sulcus. You can use a brush to remove the separator agent
that gets over the 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 is sodium alginate used as a separating agent?
Because its reaction is similar to the reaction of alginate impression
material.
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3) Packing

This is the packing machine ,
the main concept of this device
is Hydrolic pressure
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Dont use Vaseline as separating agent between stone and acryl; it will not
work well as a separating agent in packing.





A short summary of packing would best be like this,
Mix the acryl according to certain ratios, wait till the dough stage, put
the acryl inside the flask, close it so that the excess will get out, and 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
acryl , use porcaline container for mixing acryl, you
need 10 ml of the monomer for a denture then add
powder in (1:3) ratio, why?
The answer is when acryl reacts its reaction is
exothermic, plus when methylmethacrylate (monomer)
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Flask clamp
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
Localized Porosity.
There are different stages of the setting reaction of
acryl 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 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 performing pressure on it. If you shape
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

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
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4) Curing

This is the flask clamp;
itll be inserted like this
into the curing
machine.
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note is that the maximum pressure can be made on the cast (which is made
of gypsum type lll ) is 3000 Mp , pressure above this point 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 will be
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 dentures attached to the Flask clamps , the objective of the
clamp is not to exert pressure and remove the excess, its objective is simply
to keep the flask closed during the processing, there is a special screw and
springs in the bottom to keep the flasks close together. (See image 11)

After putting them in the clamp Ill do something called bench curing,
simply leave them for half an hour to make sure that the monomer in the
acrylic mix wet the teeth and make bond to 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 the excess
use flask clamps bench 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 acryl from the dough stage to the final
cured hard stage.(see image 12).
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 the harden form. In this lab the
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Long Acryl Curing Cycle


9 hrs

Water
Acrylic
Long cycle
74
95
100


1
2
3
13
type of acryl we have used was Heat Cured acryl, there are some diffrances
between long and short cycles, lets talk more about them




Figure (13) is of great importance to help us understand the long curing
cycle; you can see we plotted time vs. temp. The acryl in this stage is present
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within the water inside the curing machine. So what happens to the water
(rising temp. /lowering temp.) will also happen to the acryl.
The reaction (chemical reaction) of the acryl starts at 74 degrees, meaning
that the acryl will start hardens 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 acryl, water also gives
heat).
Looking at the graph , Im heating up the water, rising the temperature until
it reaches 74 degrees the reaction of the acryl will start (1 in the graph) , then
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 reaches 100C , it has reached only 74C.







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Short Acryl Curing Cycle



2 hr
1 hr

Water
Acrylic
Short Cycle
74
95
100


1
2
3
4
5
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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 at 74, but the acryl has reacted and itll
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Water
Acrylic
Gaseous Porosity
7
4
9
5
10
0

>10
1
2
3
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cause a peak as in (2 in the graph ) that was one hour of the 2hr of this stage.
After that will leave the fixed temperature for another 1 hr as in (3 in the
graph ) , then we will increase the temperature of water to 95C as in (4 in the
graph ) , and 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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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 acryl 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 the temperature is when the water boils. And sometimes that
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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5) Deflasking

Introduction






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.





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 on). Sometimes tin foil might unfortunately get into the
surface of the teeth, what you should do is to 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
The curing cycles for Acryl

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

Long 74 C for 9 hours (overnight) It is safer.


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off the denture, why? Read below about how a tooth attaches to acryl 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 gingival 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 acrylic 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 acrylic 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
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6) Laboratory Remount


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?:
If you put good amount of Vaseline around the borders
This layer (look at 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
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 Arab
world, we use something less expensive way; Lemon acid (citric acid).



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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7) Finishing and Polishing

17
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
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 mis-positioned teeth during the entire
process.
Is done: while the cast and denture are both attached to the articulator.




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 mandriel : 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 mandrel.

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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 post
dam 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 border 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 large trimming wheel ( look image 18 next page )
these wheels are made out of cotton we dont usually use the normal
plastic brushes , while 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 acryl 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-mandrel 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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