Repairing Complete & Partial Dentures P2
2014
Dab and dish of liquid, dab and dish of powder, dip in the liquid, pick up some powder paint, paint some on. You paint it in a little bit at a time. Again, you want to remember that dental students forget that runs downhill so it shouldn’t be a real surprise that if you’re holding this the way the photograph is, if you’re holding it so that the teeth are vertical and you paint it so that the stuff is here, where is it going to run? It’s going to run all over the labial surface of the teeth, right? I would think that’s self-evident, but it’s amazing, the number of students that don’t bother to pick the thing up and hold it so that labial aspect is facing up so when you go ahead and pour the acrylic on there, it just tends to lay there. If it’s on a curved surface, you’re a little bit frustrated because you can’t do too much of the curve all at once. You’ve got to pick up a little section and lay it on there, and you keep bathing it in liquid until it gets fairly set up, until it gets leathery.
Then, you can do the next part and do the next part and put the thing in the pressure pot. When fill this pressure pot, you check it out at the desk. It’s got a little curly que in it. It’s got a bicycle pump valve on the thing, and next to the model trimmer on the end of the clinics as opposed to the blue clinic is a little quick disconnect that the air hose can plug into. So, you fill this thing about two-thirds full of hot water, put your repair in there, pump it up to 20 PSI or just under 20 PSI, and it will set up that acrylic for you so that it’s quite hard and resist stains and is stronger.
So, many times, you can’t get your entire repair done in one addition because, again, the acrylic wants to slop and run around. So, you may go back a couple or three times to do it, put it in the pressure pot for about 3 to 5 minutes. Then, take it out, paint some more on, put it in for 3 to 5 minutes, take it out, and you can put some repair acrylic. So, there’s your before with the crack, and there’s your repair.
What if you’ve got a fractures or a damaged tooth? One of the easiest things is when a patient comes in, and their tooth just delaminated from the denture. It didn’t break. They’ve got the tooth. They’ve got the tooth, and it just came out of the denture. If that were the situation, what you would do is take your medium skinny acrylic bur and just lightly freshen the plastic in the little divot that the tooth would have left, slightly freshen the plastic on the lingual of the tooth. The tooth will fit right back in the same spot, relieve a little bit from the lingual aspect or the palatal aspect, and you can flow repair acrylic in there. It will seal very nicely.
In this situation, the tooth itself was fractured so one hopes that somewhere in the record, and those of you that make dentures for patients, please in big, bold printing in the form 6 so that Helen Keller could see it, put the mold in the shade of the teeth that you used. So, if the patient shows up in two years with a broken tooth like this, no problem. We’ll just go check out an equivalent tooth from the desk, single central incisor, and we’ll go ahead and grind things out the fix it. So, we whip open the form 6 to look for the shade and mold of the tooth, and it isn’t there. Then, you get out your shade guide and mold guide and do your best to match the tooth.
In a dental office you’re not going to have a big stock of teeth so you would just have a nice relationship with a friendly laboratory dental laboratory that was physically close to you. So, if you were practicing in Ann Harbor, an easy thing might be for you to have a relationship with Sharp Dental Lab because if the patient wants to drop this off in the morning and pick it up later in the afternoon, can you see it doesn’t work to send it to Dental Arts in Lansing for one of those quick turnaround things?
So, wherever you are, unless you’re in Gander Bay, Newfoundland or something like that, there should be a dental lab within reasonable proximity of you so you go ahead and have a relationship with the. Send the denture over to them, and they’ll just do the repair and get it back to you. If it’s one of those situations where if in your office you purchase some self-repair acrylic and one of these pressure pots, you can be an extreme hero to a patient if you can go ahead and set them in the spare room or have them read a magazine in the waiting room while you go ahead and do the repair with some self-repair acrylic in the office. That can be a real practice builder, and they think you’re really a nice person because you got it back to them right away.
So, what we do here is just clean out the divot where the tooth used to be. Now, if the tooth came out intact, you would see a recess like this on the denture. You would just lightly freshen the acrylic with the medium skinny acrylic bur then freshen the acrylic on the inner aspect of the tooth and put the acrylic back in place. Here, again, we shape the tooth so that the tooth fits appropriately in that.
So, stabilize the tooth in there, what happens a lot of time is it’s helpful to put a little, tiny dollop of sticky wax in this incisal corner and on this incisal corner to stabilize this tooth because when this thing’s just sitting here, it’ll fall out. It won’t stay put that well. So, here, again, we take our self-curing acrylic, dab and dish, stick your powder in your paintbrush, and then go ahead. Again, what the circles are here for is you could put a little bit sticky wax on those corners just to stabilize the tooth. Dip in the liquid, pick up some powder, paint it in, cure the thing, finish it and polish it, and you’re good to go.
Here’s a tooth that’s broken on a partial denture next to a clasp area. It’s a similar kind of thing. You can see how this was just ground out. So, we ground out the area where the tooth sat. We got a replacement tooth, same size, shape, and color and went to ahead.
So, again, in practice you’re not going to stock a bunch of these things. So, you can make one of these bonded repairs, but usually you’re going to better off if you have some relationship with a lab in reasonably close proximity where you could send it to the lab, and they’ll return it as quick as is possible.
So, that again just shows grinding things out, finishing it up, trying the tooth in, grind the tooth to fit, we hollow it out, we get things so that they fit, bond them back in. We’re just going to use a little sticky wax to hold it in place. So, here is our repair. Again, back in the pressure pot, we’re going to boil the pot up to about 20 PSI. There’s a little pressure reliever valve right here on the pressure pot so if you try to put a little more air pressure, it’ll just start hissing, and it will let the air out of the pressure pot so it can’t go too high.
So, what if we have a temporary partial or just some sort of a partial? The patient’s going to have teeth extracted. We know the patient’s going to have teeth extracted so they’ve had some sort of a flipper that’s being converted to a denture because they’re having their teeth out. What one can do in that situation is if you go ahead and just take an alginate impression of the patient’s partial in place the day they come in for the surgery, this would presume that you, yourself are not doing the surgery. If you were a private office, you train your auxiliaries how to do it.
So, can you see if you just take a nice alginate impression with the partial in place, typically, the partial will come out with the impression? What we’re going to do is take an appropriately colored repair acrylic and pour it directly right onto the impression. So, if you just take an appropriate shade of repair acrylic and just pour the alginate out with tooth colored acrylic, but you’re only pouring the alginate out to come up to the tissue surface of the tissue side of your temporary partial. So, don’t overfill this grossly. Just the clinical crown aspect up.
What’s going to happen is this polymethylmethacrylate will bond very nicely to the plastic that’s already there with your temporary partial. So, can you see that if you separate this thing out, we’ll have the teeth on it, but we won’t have any labial flange on the labial aspect of that. When we pour acrylic in just to form the teeth, the next thing to do is to go ahead. You can just pour this impression out on either stone, whatever your pleasure is.
What we’ve done now is we poured the teeth in there. Now, we just quickly pour the quick setting plaster model in that so when we separate the impression from the quick setting plaster model, here is our original partial, and here’s the plastic teeth that we just made from the alginate. What we can do here now is just paint pink acrylic ink down here to create a flange on this. This is all done pretty quickly. This doesn’t not take a long time. So, again, dab and dish of liquid, dab and dish of powder, dip, paint the acrylic on the labial aspect on that model, take it off, and trim it.
Depending on which shades of repair acrylic you have, you can get these teeth to match better than we did here. This is a situation where we didn’t have a lot of different shades of repair acrylic, but, again what was this for? To take a plastic transitional partial denture and convert it to a full denture with the extraction of the few remaining teeth.
Reviewing what we did. We took an alginate impression. We first poured the teeth in the alginate and this tooth-colored acrylic then put the plaster model on the inside of it and paint it on labial or buccal flanges to give us flange on the denture. We polish and smooth those, and it can flipper. There were a few teeth that were remaining. They didn’t respond well to perio treatment. They decided they were going to take the teeth out, alginate impression. Just pour acrylic directly onto the impressions of the teeth, pour a model, and go ahead. Here’s your plastic tooth that’s bonded on to this pink plastic. Here’s another one. We can just paint a flange on the outside of this in our model. So, we paint the flange on, and we have potentially converted this flipped to a denture without too much drama for the whole thing.