Primary Impressions and Border Molding Techniques

Obtaining denture border extensions
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Obtaining denture border extensions
1. Diagnostic tray selection and modification

2. Accurate diagnostic impressions

3. Diagnostic cast fabrication

4. Accurate custom impression tray

5. Knowledge of anatomy and physiology
Armamentarium for CD diagnostic casts
Wax, torch, stock tray, adhesive

Caliper

Cheek retractor

Alginate syringe
Edentulous diagnostic impressions - Selection of right size tray
Size the tray to the edentulous arch by using the "Edentulous tray caliper"
Edentulous tray selection techniques
If the patient has an existing prosthesis, fit the prosthesis to one of the edentulous trays

OR

Use edentulous Tray Caliper to size the prosthesis and select the appropriate size.
The edentulous tray may need to be altered using 3 techniques
1. Adjusting the tray with an acrylic bur

2. Heating and altering the tray

3. Strategically adding rope wax
Modifying the tray using acrylic bur
The tray will need to be altered so it has the proper height for an edentulous arch

If it is not trimmed correctly, it will force the tissues out of the way and alginate cannot reach and capture the anatomy
Modifying the tray using heat
Identify where tray does not reach to capture all the borders. Using a flame to alter the tray Use flame torch

Heat the edge of the tray and carefully mold the border with your fingers
Image: Modifying the tray using heat
Modifying the tray using wax - Placing rope wax in the edentulous areas:
To reduce the alginate thickness

Extend the tray reach
Modifying the tray using wax - Locations
Retro mylohyoid

Retro molar pads

Labial
Retract lips and cheeks
Use cheek retractors

Tongue blades

This helps seating of the tray
Retract lips and cheeks - Alginate syringePlace vaseline on rubber stopper Checking the rubber guide The plunger needs to slide in the barrelInject alginate into intraoral ____________ using alginate syringeUndercutsComplete denture custom tray laboratory techniques - Armamentarium• Surveyor • Hanau Torch • RPD tray • Baseplate wax • #11 Scalpel blade • Triad custom tray material • Vaseline • Low Speed and Acrylic BursBorder molding the maxillary and mandibular custom trays - Correlate oral anatomy to the ___________Tray extensionsTray proximity to the alveolusMake notch in tray to relieve frenum Leave room for border molding material around hamular notchCustom tray - Tray should have _________ bordersSmooth and roundedCustom tray - May need some adjustments based on ____________ prior to impression makingIntraoral examinationBorder molding rationaleMaximum denture bearing area Extension of the denture bearing area Denture needs to be stabilizedPrinciple factor in stabilizing the full lower denture is the modeling of that part of its surface which comes in contact with the...Muscles of the cheeks, tongue and lipsFabrication of complete dentures is dependent upon accurate final impressions that capture the movable tissues in their...Functional stateFlipLabial frenum between #8 & 9 Buccal frenumIdentify the muscles in and around the maxillary that affect the complete dentureA - labial notch B - labial flange C - buccal flange D - buccal notch E - zygomatic-alveolar border F - distal buccal flange or coronoid contour G - hamular notch or pterygomaxillary notch H - distal border of impression I - fovea palatine J - incisive fossa K - ruggae grooves L - median palatine groove M - residual ridge groove N - maxillary tubercular fossaLabel the anatomical structures recorded in the maxillary edentulous impressionLF - Labial frenum LV - Labial vestibule AR - Alveolar ridge BF - Buccal flange LTF - Lingual tubercular fossa RP - Retro molar pad MG - Masseter groove PMN - Pterygomandibular notch RE - Retromandibular notch LT - Lingual tubercle MYG - Mylohyoid groove AS - Alveolar sulcus LGF - Lingual frenum MF - Mylohyoid flangeLabel anatomical structures recorded in the mandibular edentulous impressionFlip backArmamentarium for final impression• Custom Tray • RPD Cassette • Alcohol Torch • Green Border Molding Compound • Hot Water Bath • Tempering Bowl • 25 bladeModification of custom trays Most times following tray fabrication, the custom tray will need some modification before...intraoral try-in and border moldingModification of custom trays Creating freedom for ___________Buccal frenumModification of custom trays The tray should not interfere with any of the...Muscle attachmentsModification of custom trays The tray should be relieved _______ from all structures while they are going through movements2 mmBorder molding procedure with green border molding compound Place in the _______ water bath for 10 seconds150 FBorder molding procedure with green border molding compound Heat the compound in hot water bath until...It become malleableBorder molding procedure with green border molding compound Border mold in __________SegmentsBorder molding procedure with green border molding compound Add ______ of compound to the custom tray1-2 inchesBorder molding procedure with green border molding compound Take the tray to the patient's mouth and _____________Activate the musculatureBorder molding procedure with green border molding compound Hold the tray up with a ____________ from which the compound was placedFinger on the opposite handBorder molding procedure with green border molding compound Have the patient go through the various muscle movements to reproduce the _________AnatomyBorder molding procedure with green border molding compound Continue adding border molding compound until the entire border of the tray has been completed The compound should have a _______ appearance with no __________Smooth, matte Folds or voidsBorder molding procedure with green border molding compound Final maxillary border moldingTray may be retentive in patients mouthBorder molding procedure with green border molding compound Final mandibular border moldingCheck muscle movements and external oblique ridge Create an opening for buccal frenumBorder molding the mylohyoid areaYou must direct the compound distal and downward with your finger because of the muscular forces The tongue and floor of the mouth may displace the materialBorder molding the retromolar padShould be completely covered during border molding and subsequent impression makingBorder molding - Removing excess materialUsing a 25 blade, scrape away all excess compound, about 1mm, from the inside of the tray Be careful not to lock into the compound and fracture it off of the tray Scrape the excess compound from the outer aspect of the tray Rinse out the tray and try it in the patient's mouthBorder molding procedure with PVS - MaterialsPVS putty or Heavy-body PVS Use retractors since PVS is not as viscous as compoundUsing heavy-body or putty for ___________ and using light-body PVS _____________Border molding To washChecking buccal frenum and vestibuleWhen pulled down, the cheek should not dislodge the tray and should have about 2mm of clearance from the vestibular depth.Border molding procedure with PVS - Apply _______ of heavy-body PVS to the custom tray borders2 inchesBorder molding procedure with PVS - Take the tray to the patient's mouth and activate the __________MusculatureBorder molding procedure with PVS - Continue border molding using _______ in segmentsHeavy-body PVSBorder molding procedure with PVS Border molding with putty or heavy-body completed Tray is painted with...PVS adhesiveBorder molding procedure with PVS The custom tray is filled with __________, note the ______ is also coatedLight-body PVS BorderBorder molding procedure with PVS Seat the tray and continue _________Border moldingBorder molding procedure with PVS Final impression is made