The World’s 1 CAD/CAM Denture Company st
The World’s 1st CAD/CAM Denture Company Contents Requirements for Impressions [Included in Starter Kit / Supplies Required by Doctor] Ve Ve al Dimens i rtic P. 21 al Dimens rtic elations R cR elations R cR ord ec ord ec Cen tri P. 14 Cen tri P. 4 Registrati ite Registrati ite P. 25 er Ston ow er Ston pp on e e L + U ord ec P. 18 + Registrati ite P. 9 B elations R cR Cen tri P. 22 on P. 15 on P. 5 B Ma n al Dimens i rtic ion Ve ular Impre dib on P. 20 on P. 13 ion ss P. 3 P. 6 B Ma n ular Impre dib Ma x ry Impres illa Ma x ry Impres illa ion ss Single Arch Mandibular Denture n sio Single Arch Maxillary Denture n sio Complete Denture Requirements for Impressions Included in Starter Kit Jaw Gauge x 1 Single Arch Plates x 8 (2 of each size/orientation) S, M x2 L, XL x2 XL x2 L x2 Lip Ruler x 1 M x2 DENTCA Trays x 8 (2 of each size) - Upper and Lower EZ-Tracer x 8 S x2 Supplies Required by Doctor Impression Gun Fast Setting Light Body PVS Fast Setting Heavy Body PVS Bite Registration Material Permanent Marker or Pen Stone Mixing Tips (For Single Arch Denture Only) Bur Surgical Blade Drill P. 2 | Complete Denture: Components Complete Denture: Maxillary Impression | Components . Maxillary Impression A 2 P. 3 Apply thick layer of fast-setting heavy body PVS (to create custom impression tray). C Layer 2 (Wash): Apply thin layer of fast-setting light body PVS on top of entire heavy body impression. Top 1 Seat firmly for 5 seconds using finger spots on bottom of tray. Bottom 5 4 4 3 1 Anterior Part of Maxillary Tray 2 Posterior Part of Maxillary Tray 3 Anterior Part of Mandibular Tray 4 Posterior Parts of Mandibular Tray 5 Center Pin & Plate BORDER MOLDING Pull, stretch and tug the patient's cheeks and mouth muscles forcefully to ensure proper border molding. Do not skip or neglect this procedure. 1. Have the patient open mouth wide then close. 2. Have the patient move jaw side by side. Tray Selection Small Medium Large 3. Pull the patient's right cheek out and down. Then pull the patient’s left cheek out and down. X-Large Repeat entire sequence 4 times (#1-4) B Select the correct DENTCA tray size (Small, Medium, Large, Extra-Large) that best fits the patient’s mouth. Compare tray sizes against the patient’s existing dentures or directly in the patient’s mouth. 4. Pull the upper lip down. Adjust any exposed tray areas with a bur. D If there are any tray parts still exposed, adjust with a bur and go back to Step C. P. 4 | Complete Denture: Mandibular Impression Complete Denture: Vertical Dimension (VD) | . Mandibular Impression A Apply thick layer of fast-setting heavy body PVS (to create custom impression tray). C Layer 2 (Wash): Apply thin layer of fast-setting light body PVS on top of entire heavy body impression. Seat firmly for 5 seconds using finger spots on bottom of tray. P. 5 . Vertical Dimension (VD) You must find the correct VD before recording CR. A Separate the tray posteriors to avoid interference when measuring VD. Cut and remove /RRNDWWKHVLGHRUERWWRPRIWKHWUD\WRVHHZKHUHWKHVHSDUDWLRQOLQHLV Cut through the impression with a surgical blade at the separation line. BORDER MOLDING B Remove impression overflow on cameo side. Pull, stretch and tug the patient's cheeks and mouth muscles forcefully to ensure proper border molding. Do not skip or neglect this procedure. Cut away 1 1. H Have the h patient i stick i k his/her hi /h tongue out. 2. Squeeze S in i both b thh cheeks h k while h l the h mouth is completely relaxed. C Cut away Attach center pin to mandibular tray. Click Cut 3. Pull the patient’s right cheek out. Then pull the patient’s left cheek out. 4. Pull the lower lip up. Cut ut the bottom portion of the center pin if it comes close to touching tongue or soft tissue. Repeat entire sequence 4 times (#1-4) B Adjust any exposed tray areas with a bur. D If there are any tray parts still exposed, adjust with a bur and go back to Step C. (rotate clockwise) center pin with fingers or tweezer to reach VD. D VD Adjust Remove and adjust extraorally if needed. If VD is minimal and the trays touch each other, adjust those tray areas with a bur before finalizing VD measurement. VD = lips barely touching at rest P. 6 | Complete Denture: Centric Relations Record (CR) : Simplified Tracing Complete Denture: Centric Relations Record (CR) : Gothic Tracing | . Centric Relations (CR) Accurate CR recording is essential to accurate denture setup. Choose one of three CR recording methods: 1. Simplified Tracing 2. Gothic Arch Tracing 3. Direct Check Bite Option 2. Gothic Arch Tracing A Have patient move their mandible from the most anterior to the most posterior position. Anterior Prepare for CR recording: Attach EZ-Tracer™ to maxillary tray. EZ-Tracer ,IWKH(=7UDFHULVQRWDYDLODEOHDSSO\WUDFLQJPDWHULDORUPDJLF marker on the maxillary tray bottom for CR tracing. Maxillary tray bottom Posterior Seat trays back in patient’s mouth with center pin p attached to the mandibular tray. + Maxillary Tray 3RVLWLRQ\RXUILQJHUWRZKHUHWKHSDWLHQWVKRXOGPRYHWKHLUMDZ,QVWUXFWWKHSDWLHQWWR PRYHWKHLUMDZWRWKDWSRVLWLRQ ,IWKLVLVFKDOOHQJLQJJXLGHWKHMDZZLWK\RXUKDQGWRIROORZWKH&5FDSWXUHPRYHPHQWV B Mandibular Tray Move the mandible from the most posterior center position laterally to the right. Move the mandible back to the posterior center position. Option Anterior Anterior A Ant t Anterior rio io Posterior Posterior 1. Simplified Tracing A Have patient move their mandible from the most anterior to the most posterior position. Anterior Anterior Posterior Posterior C Move the mandible from the most posterior center position laterally to the left. Move the mandible back to the posterior center position. 3RVLWLRQ\RXUILQJHUWRZKHUHWKHSDWLHQWVKRXOGPRYHWKHLUMDZ,QVWUXFWWKHSDWLHQWWR PRYHWKHLUMDZWRWKDWSRVLWLRQ Anterior Anterior Posterior Posterior ,IWKLVLVFKDOOHQJLQJJXLGHWKHMDZZLWK\RXUKDQGWRIROORZWKH&5FDSWXUHPRYHPHQWV Repeat Steps A-C several times Repeat Step A multiple times to trace a precise arrow that points to the posterior center position on the upper tray. to trace a line segment between the most anterior and posterior point on the maxillary tray. B D The most posterior point of the line segment is the CR position. The apex of the arrow is the CR using Gothic Arch Tracing. 5HFRUGWKH&5SRVLWLRQE\GULOOLQJDVPDOOGLPSOHDWWKLVSRLQW (for the center pin knob to snap into during bite registration.) 5HFRUGWKH&5SRVLWLRQE\GULOOLQJDVPDOOGLPSOHDWWKLVSRLQW (for the center pin knob to snap into during bite registration.) Bur Bur Good Bad (re-do) Good Bad (re-do) P. 7 P. 8 | Complete Denture: Centric Relations Record (CR) : Direct Check Bite Complete Denture: Bite Registration | . Bite Registration Option 3. Direct Check Bite A P. 9 Hold the patient’s mandible in the most posterior position and have them bite down numerous times. Take the trays out of the mouth to examine the direct check bite points. Anterior Anterior Posterior Posterior VERY IMPORTANT: Hold the lower tray firmly in place while recording bite registration to prevent slipping or tilting. 1. Seat trays back in the mouth. Make sure the center pin locks into the CR point dimple. 2. Inject bite registration material between the trays to record. Once the bite registration material hardens, remove the trays from the patient’s mouth. Stand behind the patient to hold their jaw in the most posterior position while they bite down multiple times. 7KHFHQWHUSLQVKRXOGPDUNDVHULHVRISRLQWVDWWKHSRVWHULRURIWKH(=7UDFHUDVWKH patient bites down. Very Important t Repeat Step A multiple times to find the CR point. B Using the lip ruler, measure the upper lip length from the incisive papilla to upper lip line. The most posterior point where the highest concentration of points are gathered is the CR using direct check bite. 5HFRUGWKH&5SRVLWLRQE\GULOOLQJDVPDOOGLPSOHDWWKLVSRLQW (for the center pin knob to snap into during bite registration.) Bur Good Bad (re-do) 9LHZWKHOLSUXOHUVWUDLJKWRQIRUFRUUHFWPHDVXUHPHQW9LHZLQJWKHUXOHUIURPDQXSZDUG or downward angle will show an inaccurate measurement. Finished! You’re all done with the impression visit. CR Summary - Choose any of these three methods: 1. Simplified Tracing 2. Gothic Arch Tracing 3. Direct Check Bite Ordering / Shipping 1 2 3 1. Place your denture order online at www.dentca.com om 2. Package, label and ship the impression parts (including detached posteriors) and the printed denture order form to DENTCA. P. 11 Single Arch Denture: Components | Components 8SSHU$WWDFKPHQW3ODWH 1R+ROH Top 1 Bottom 2 Top 3 Bottom /RZHU$WWDFKPHQW3ODWH +ROH 1 Upper Attachment Plate 2 Center Pin 3 Lower Attachment Plate Tray Selection DENTCA trays must be used for all impressions. Large & X-Large Small & Medium 8VH60VL]HGDWWDFKPHQWSODWHZLWKWUD\VL]HV 6RU0 or or 8VH/;/VL]HGDWWDFKPHQWSODWHZLWKWUD\VL]HV /RU;/ or or Select the correct DENTCA tray size (Small, Medium, Large, Extra-Large) that best fits the patient’s mouth. Compare tray sizes against the patient’s existing dentures or directly in the patient’s mouth. Single Arch Maxillary Denture: Impression | P. 13 . Maxillary Impression A Apply thick layer of fast-setting heavy body PVS (to create custom impression tray). C Layer 2 (Wash): Apply thin layer of fast-setting light body PVS on top of entire heavy body impression. Seat firmly for 5 seconds using finger spots on bottom of tray. BORDER MOLDING Pull, stretch and tug the patient's cheeks and mouth muscles forcefully to ensure proper border molding. Do not skip or neglect this procedure. 1. Have the patient open mouth wide then close. 2. Have the patient move jaw side by side. 3. Pull the patient's right cheek out and down. Then pull the patient’s left cheek out and down. 4. Pull the upper lip down. Repeat entire sequence 4 times (#1-4) B Adjust any exposed tray areas with a bur. D If there are any tray parts still exposed, adjust with a bur and go back to Step C. P. 14 | Single Arch Maxillary Denture: Vertical Dimension (VD) Single Arch Maxillary Denture: Centric Relations Record (CR) : Simplified Tracing | . Vertical Dimension (VD) . Centric Relations (CR) You must find the correct VD before recording CR. A P. 15 Accurate CR recording is essential to accurate denture setup. Choose one of three CR recording methods: 1. Simplified Tracing 2. Gothic Arch Tracing 3. Direct Check Bite Cut through and detach the posterior part of the maxillary tray and impression to avoid interference when measuring VD. Prepare for CR recording: Attach EZ-Tracer™ to maxillary tray. marker on the maxillary tray bottom for CR tracing. Cut through the impression with a surgical blade at the separation line. Cut and remove B EZ-Tracer Maxillary tray bottom Seat Maxillary Tray back in the patient’s mouth. Insert center pin to Lower Attachment Plate pinhole. Then attach Lower Attachment Plate to existing lower dentition with bite registration material. Remove impression overflow on cameo side. + Maxillary Tray Lower Attachment Plate Option 1. Simplified Tracing Cut away C Attach center pin to Lower Attachment Plate. Attach Lower Attachment Plate to existing lower dentition with bite registration material. A Have patient move their mandible from the most anterior to the most posterior position. during VD adjustment. Cut Anterior Anterior Posterior Posterior Repeat Step A multiple times if it comes close to touching tongue or soft tissue. to trace a line segment between the most anterior and posterior point on the maxillary tray. B The most posterior point of the line segment is the CR position. (rotate clockwise) center pin with fingers or tweezer to reach VD. Remove and adjust extraorally if needed. D VD Adjust If VD is minimal and the t trays touch each o other, adjust those tray areas with a bur t b before finalizing VD measurement. m VD = lips barely touching at rest Bur Good Bad (re-do) P. 16 | Single Arch Maxillary Denture: Centric Relations Record (CR) : Gothic Arch Tracing Single Arch Maxillary Denture: Centric Relations Record (CR) : Direct Check Bite | Option Option 2. Gothic Arch Tracing 3. Direct Check Bite A Have patient move their mandible from the most anterior to the most posterior position. A Anterior P. 17 Hold the patient’s mandible in the most posterior position and have them bite down numerous times. Take the trays out of the mouth to examine the direct check bite points. Anterior Anterior Posterior Posterior Posterior 3RVLWLRQ\RXUILQJHUWRZKHUHWKHSDWLHQWVKRXOGPRYHWKHLUMDZ,QVWUXFWWKHSDWLHQWWR PRYHWKHLUMDZWRWKDWSRVLWLRQ ,IWKLVLVFKDOOHQJLQJJXLGHWKHMDZZLWK\RXUKDQGWRIROORZWKH&5FDSWXUHPRYHPHQWV B Move the mandible from the most posterior center position laterally to the right. Move the mandible back to the posterior center position. Stand behind the patient to hold their jaw in the most posterior position while they bite down multiple times. 7KHFHQWHUSLQVKRXOGPDUNDVHULHVRISRLQWVDWWKHSRVWHULRURIWKH(=7UDFHUDVWKHSDWLHQW bites down. Ante A Anterior Ant tteerior eAnterior riio ri o Anterior Repeat Step A multiple times to find the CR point. Posterior Posterior C Move the mandible from the most posterior center position laterally to the left. Move the mandible back to the posterior center position. Anterior Anterior Posterior Posterior B The most posterior point where the highest concentration of points are gathered is the CR using direct check bite. 5HFRUGWKH&5SRVLWLRQE\GULOOLQJDVPDOOGLPSOHDWWKLVSRLQW (for the center pin knob to snap into during bite registration.) Bur Good Bad (re-do) Repeat Steps A-C several times to trace a precise arrow that points to the posterior center position on the upper tray. D The apex of the arrow is the CR using Gothic Arch Tracing. CR Summary - Choose any of these three methods: 5HFRUGWKH&5SRVLWLRQE\GULOOLQJDVPDOOGLPSOHDWWKLVSRLQW (for the center pin knob to snap into during bite registration.) 1. Simplified Tracing 2. Gothic Arch Tracing 3. Direct Check Bite Bur Good Bad (re-do) 1 2 3 P. 18 | Single Arch Maxillary Denture: Bite Registration . Bite Registration VERY IMPORTANT: Hold the lower attachment plate firmly in place while recording bite registration to prevent slipping or tilting. 1. Seat trays back in the mouth. Make sure the center pin locks into the CR point dimple. 2. Inject bite registration material between the maxillary tray and lower attachment plate to record. Once the bite registration material hardens, remove the trays from the patient’s mouth. Very Important t Using the lip ruler, measure the upper lip length from the incisive papilla to upper lip line. 9LHZWKHOLSUXOHUVWUDLJKWRQIRUFRUUHFWPHDVXUHPHQW9LHZLQJWKHUXOHUIURPDQXSZDUG or downward angle will show an inaccurate measurement. Finished! You’re all done with the impression visit. Ordering / Shipping 1. Place your denture order online at www.dentca.com a.com 2. Package, label and ship the impression parts (including detached posteriors, lower attachment plate, bite registration), the mandibular stone cast and the printed denture order form to DENTCA. P. 20 | Single Arch Mandibular Denture: Impression Single Arch Mandibular Denture: Vertical Dimension (VD) | . Mandibular Impression A Apply thick layer of fast-setting heavy body PVS (to create custom impression tray). C Layer 2 (Wash): Apply thin layer of fast-setting light body PVS on top of entire heavy body impression. Seat firmly for 5 seconds using finger spots on bottom of tray. P. 21 . Vertical Dimension (VD) You must find the correct VD before recording CR. A Separate the tray posteriors to avoid interference when measuring VD. Cut and remove B BORDER MOLDING /RRNDWWKHVLGHRUERWWRPRIWKHWUD\WRVHHZKHUHWKHVHSDUDWLRQOLQHLV Cut through the impression with a surgical blade at the separation line. Remove impression overflow on cameo side. Cut away Pull, stretch and tug the patient's cheeks and mouth muscles forcefully to ensure proper border molding. Do not skip or neglect this procedure. C Attach Upper Attachment Plate to existing upper dentition with bite registration. Attach center pin to Mandibular Tray. Click 1 h patient i i k his/her hi /h tongue out. 1. H Have the stick S i both b thh cheeks h k while h l the h 2. Squeeze in mouth is completely relaxed. 3. Pull the patient’s right cheek out. Then pull the patient’s left cheek out. Repeat entire sequence 4 times (#1-4) B Adjust any exposed tray areas with a bur. Cut 4. Pull the lower lip up. D If there are any tray parts still exposed, adjust with a bur and go back to Step C. Cut ut the bottom portion of the center pin if it comes close to touching tongue or soft tissue. (rotate clockwise) center pin with fingers or tweezer to reach VD. Remove and adjust extraorally if needed. D VD Adjust If VD is minimal and the trays touch each other, adjust those tray areas with a bur before finalizing VD measurement. VD = lips barely touching at rest P. 22 | Single Arch Mandibular Denture: Centric Relations Record (CR) : Simplified Tracing . Centric Relations (CR) Accurate CR recording is essential to accurate denture setup. Choose one of three CR recording methods: 1. Simplified Tracing 2. Gothic Arch Tracing 3. Direct Check Bite Single Arch Mandibular Denture: Centric Relations Record (CR) : Gothic Arch Tracing | Option 2. Gothic Arch Tracing A Have patient move their mandible from the most anterior to the most posterior position. Prepare for CR recording: Attach EZ-Tracer™ to upper attachment plate. ,IWKH(=7UDFHULVQRWDYDLODEOHDSSO\WUDFLQJPDWHULDORUPDJLF marker on the upper attachment plate bottom for CR tracing. Anterior EZ-Tracer Posterior Upper attachment plate bottom Attach Upper Attachment Plate to existing upper dentition with bite registration material. Seat mandibular tray back in patient’s mouth with center pin attached. B + Upper Attachment Plate 3RVLWLRQ\RXUILQJHUWRZKHUHWKHSDWLHQWVKRXOGPRYHWKHLUMDZ,QVWUXFWWKHSDWLHQWWR PRYHWKHLUMDZWRWKDWSRVLWLRQ ,IWKLVLVFKDOOHQJLQJJXLGHWKHMDZZLWK\RXUKDQGWRIROORZWKH&5FDSWXUHPRYHPHQWV Mandibular Tray Guide mandible from the most posterior center position laterally to the right. Guide mandible back to the posterior center position. Anterior Anterior Posterior Posterior Option 1. Simplified Tracing A Have patient move their mandible from the most anterior to the most posterior position. Anterior Anterior Posterior C Guide mandible from the most posterior center position laterally to the left. Guide mandible back to the posterior center position. ,IWKLVLVFKDOOHQJLQJJXLGHWKHMDZZLWK\RXUKDQGWRIROORZWKH&5FDSWXUHPRYHPHQWV Posterior Posterior Repeat Steps A-C several times Repeat Step A multiple times to trace a precise arrow that points to the posterior center position on the upper tray. to trace a line segment between the most anterior and posterior point on the maxillary tray. D The most posterior point of the line segment is the CR position. 5HFRUGWKH&5SRVLWLRQE\GULOOLQJDVPDOOGLPSOHDWWKLVSRLQW 7KHGLPSOHVKRXOGEHODUJHHQRXJKIRUWKHFHQWHUSLQNQREWRVQDS into during bite registration.) Good Anterior Posterior 3RVLWLRQ\RXUILQJHUWRZKHUHWKHSDWLHQWVKRXOGPRYHWKHLUMDZ,QVWUXFWWKHSDWLHQWWR PRYHWKHLUMDZWRWKDWSRVLWLRQ B Anterior Bad (re-do) The apex of the arrow traced is the CR using Gothic Arch Tracing. g. 5HFRUGWKH&5SRVLWLRQE\GULOOLQJDVPDOOGLPSOHDWWKLVSRLQW 7KHGLPSOHVKRXOGEHODUJHHQRXJKIRUWKHFHQWHUSLQNQREWRVQDS into during bite registration.) Bur Bur Good Bad (re-do) P. 23 P. 24 | Single Arch Mandibular Denture: Centric Relations Record (CR) : Direct Check Bite P. 25 . Bite Registration Option 3. Direct Check Bite A Single Arch Mandibular Denture: Bite Registration | Hold the patient’s mandible in the most posterior position and have them bite down numerous times. Take the trays out of the mouth to examine the direct check bite points. Anterior Anterior Posterior Posterior VERY IMPORTANT: Hold the lower tray firmly in place while recording bite registration to prevent slipping or tilting. 1. Seat trays back in the mouth. Make sure the center pin locks into the CR point dimple. 2. Once Inject thebite biteregistration registrationmaterial materialbetween hardens, the remove mandibular the traystray from and theupper patient’s attachment mouth. plate to record. Once the bite registration material hardens, remove the trays from the patient’s mouth. 6WDQGEHKLQGWKHSDWLHQWWRKROGWKHLUMDZLQWKHPRVWSRVWHULRUSRVLWLRQ 7KHFHQWHUSLQVKRXOGPDUNDVHULHVRISRLQWVQHDUWKHSRVWHULRURIWKHPRXWKDVWKHSDWLHQW bites down. Very Important t Repeat Step A multiple times to find the CR point. B The most posterior point where the highest concentration of points are gathered is the CR using direct check bite. Using the lip ruler, measure the upper lip length from the incisive papilla to upper lip line. 5HFRUGWKH&5SRVLWLRQE\GULOOLQJDVPDOOGLPSOHDWWKLVSRLQW 7KHGLPSOHVKRXOGEHODUJHHQRXJKIRUWKHFHQWHUSLQNQREWRVQDS into during bite registration.) Bur Good Bad (re-do) 9LHZWKHOLSUXOHUVWUDLJKWRQIRUFRUUHFWPHDVXUHPHQW9LHZLQJWKHUXOHUIURPDQXSZDUG or downward angle will show an inaccurate measurement. Finished! You’re all done with the impression visit. CR Summary - Choose any of these three methods: 1. Simplified Tracing 2. Gothic Arch Tracing 3. Direct Check Bite Ordering / Shipping 1 2 3 1. Place your denture order online at www.dentca.com t 2. Package, label and ship the impression parts (including detached posteriors, upper attachment plate, bite registration), the maxillary stone cast and the printed denture order form to DENTCA. Impression Manual Summary Impression Separation VD & CR Bite Registration Copyright © 2014 DENTCA, Inc. All rights reserved.
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