Peninsula Dental Social Enterprise (PDSE)

Transcription

1 Peninsula Dental Social Enterprise (PDSE) Laboratory Procedures for Dentures and Indirect Restorations Version 1.0 Date approved: November 2016 Approved by: The Board Review due: November 2019 Policy will be updated as required in response to a change in national policy or evidence-based guideline. Page 1 of 7

2 Copy Dentures Denture Duplication Secondary Impressions Patient assessment, diagnosis and treatment plan Indications: - Dentures satisfactory/spare set required - Progressive deterioration of both fitting and occlusal surfaces -Dentures have become unsightly Orthodontic tray with laboratory putty to make impression of each denture Separate each half with petroleum jelly When set, carefully remove the dentures and return to patient Send two part moulds to laboratory Laboratory will return copy dentures in acrylic with wax teeth Check and border mould periphery, take medium body silicone or ZnOeugenol impression Record bite registration Page 2 of 7

3 Wax Denture Try-in Do not leave in patients mouth for excessive period, have cold water to cool wax and avoid distortion Try each denture separately to determine physical retention, base extension, neutral zone Try in both together for occlusion, freeway space, appearance, speech (ask pt to say days of week, count 60 70) Check shade, mould, tooth size and position, level and angle of occlusal plane, lip support, centre line Change of occlusion - remove involved teeth (return to the laboratory) and add wax and futard to retake bite registration. Explain and ask lab for retry Proceed to fit stage ONLY when patient AND clinician satisfied Re-try Same procedure as try-in Proceed to fit stage ONLY when patient and clinician satisfied Fitting Dentures Adjust impression surfaces for comfort using pressure paste Modify occlusal surfaces to ensure even occlusal contact using occlusal indicator paper Give patient advice - use leaflet Page 3 of 7

4 Copy Dentures Denture Duplication Secondary Impressions Patient assessment, diagnosis and treatment plan Indications: - Dentures satisfactory/spare set required -Progressive deterioration of both fitting and occlusal surfaces -Dentures have become unsightly Orthodontic tray with laboratory putty to make impression of each denture Separate each half with petroleum jelly When set, carefully remove the dentures and return to patient Send two part moulds to laboratory Laboratory will return copy dentures in acrylic with wax teeth Check and border mould periphery, take medium body silicone or ZnOeugenol impression Record bite registration Page 4 of 7

5 1 st Wax Try-in To check anterior tooth appearance, position and occlusion Check design to establish anterior tooth retention and if backings are necessary CoCr Try-in Check insertion Fit Occlusion Sufficient retention Support Displacement Wax and CoCr Try-in Check Occlusal Vertical Dimension, centre line, periphery, aesthetics Proceed to fit stage only when clinician and patient satisfied, otherwise re-try Remove teeth and reposition or add wax to retake registration if necessary CoCr Fit Check each denture for fit, pressure spots Ensure sulcus extension is correct Check Occlusal Vertical Dimension, centre line, aesthetics Page 5 of 7

6 Patient assessment, diagnosis and treatment plan Periapical radiograph Study models if providing bridgework Crown Preparation Spaced perforated trayalginate/putty for provisional restoration Tooth Preparation Fitting Provisional Using impression Mix Pro-temp and fit into patients mouth Check marginal fit, contact points and occlusion Fit with Temp bond In exceptional circumstances a laboratory made temporary can be used Stress importance of oral hygiene to patient Page 6 of 7

7 Preparation and Working Impression Remove temporary (LA if tooth vital) Clean preparation- check margins Clean temp for re-use Take shade using Vita Linear Guide When necessary use retraction cord +/- haemostatic agent 2 stage impression using rigid tray impregum pentasoft into tray, light bodied Garant L-Duo syringed intra orally around prep Opposing alginate Re-fit temporary Crown Fit Remove temporary Clean preparation Try-in restoration Cement using a luting cement Check occlusion Check marginal fit NEVER ADJUST AN UNCEMENTED CROWN IN THE MOUTH Review Page 7 of 7