1/2 point CDT documented scientic credit. See Page 38.

Modified Special Tray Design

By Jonathan Bill, RDT, C&G (England) Article provided by the Englandss Dental Lab Journal

34 Journal of Dental Technology February 2007

Figure 1

he management and treatment of prosthodontic patients is dependent on the accuracy of the dental impression. Today, we can boast of accurate and more patient friendly impression materials that make life easier for all. The preformed stock trays have improved in design over the years and shapes are available for almost all situations.
These designs incorporate many different types of retention aids, such as holes, slots or rim-locking. Normally, with the aid of some impression xative, these are more than adequate to provide the laboratory with accurate impressions for primary models. Of all the retention aids, rim-locking is considered by many to be the most effective, as the impression material is rmly locked into the stock tray. While dental companies have sought better and more effective ways of taking primary impressions, very little consideration has been given to the laboratory custom-made special tray. This article reviews the rationale of a modied special tray design and the nancial advantages it can bring to the laboratory owner. The dental practitioner can use the nest available stock trays, the best impression materials and the most skilled dental technologist to achieve complete accuracy for dental appliances. In a majority of cases this works well, but occasionally the remake appears because of a poor t. It may not happen often, but is still an inconvenience to the patient, surgeon and technologist with no one within the dental team being sure how the discrepancy has occurred. From our experience within the laboratory, this phenomenon is annoying, but the situation is less aggravating if one can pinpoint the problem. Our research, in line with that of others, has concluded that many factors can contribute to impression distortion for example, unsupported heal areas of the impression, poor packaging, length of time before casting, to name but a few. Observations over a period of time show that it takes very little to create distortion within an impression. For example, when a practitioner takes an impression and the material

Figure 2

Figure 3
February 2007 Journal of Dental Technology 35

Figure 4
pulls away from the tray edge (no matter how small), the temptation either of the surgeon or technologist is to push it back into place. Even if the impression material has reseated and fused to the xative, the situation has still been compromised. It has been established that no matter how condent one is that the material has located correctly, distortion is often still present. It is important that no matter how careful a practitioner is in giving an accurate primary impression, as soon as they request a special tray, we potentially compromise the whole process. Whatever retention form is adopted, if there is any difculty in removing the impression, especially an alginate impression, the material can quite easily detach itself from the special tray. When using rim-locked stock trays this is not a problem, so to transfer the rimlock design to special trays is a distinct advantage. It was found that chrome cobolt dentures were the biggest problem with regard to remake for our laboratory. With the help of our dental practitioners, we monitored 20 trial cases, which included a range of different chrome designs with different degrees of complexity. The materials used were constant during the trials, i.e. the same type of alginate (CA37), crown stone (C&J Peach) and light-cured blanks (Davis Schottlander Davis Magilight). All impressions were cast within three hours of being taken. The results were extremely impressive, with all chromes tting well and without need for adjustment. The cases included complex skeletal designs with multiple rests. Since the initial trials took place, the material range has been extended with the same impressive results. The remake count has

Figure 5

Figure 6

Figure 7
36 Journal of Dental Technology February 2007

been reduced dramatically in all types of work and design. Once received, the primary impression is cast (Figure 1) and conventional preparation in shaping the model for special tray construction takes place (i.e. the removal of pimples and the carving of the model in the retention areas). Consideration has to be given to any undercut present and these must be blocked out with wax. Failure to do so will prevent the removal of the tray from the model (Figure 2). The tooth area(s) are blocked out as a separate procedure. It is advisable to proceed in this way to ensure conformity and control of spacer thickness (Figure 3). A single layer of spacer wax is placed over the entire impression surface of the primary model and carefully smoothed and nished (Figure 4). Sprue wax (2mm) is required to create the rim-lock design (Figure 5). The 2mm sprue wax is placed 3mm4mm above the periphery area where the model and spacer wax terminate. The spruing wax is then sealed on the periphery side only. No further sealing is required, as this would compromise the rim-lock effect (Figure 6). The light-cured special tray blank laid over the model, rmly pushed into the sprue wax area and extended slightly onto the model base (Figure 7). The tray handle is shaped and placed into position prior to light curing the tray (Figure 8). Once light cured, the tray is removed from the model. Please note, the sprue wax is retained within the tray (Figure 9). The sprue wax is removed from the tray prior to trimming and nishing. Any trimming should be left at least 1mm short of the recess (lock areas) (Figure 10).

Figure 8

Figure 9

Figure 10

February 2007 Journal of Dental Technology 37

Figure 12
The tray is now nished in the usual manner (Figure 11). Additional impression material retention in the form of countersunk retention holes may be used but, in my opinion, no positive effect is obtained through these additional procedures (Figure 12). The rim-lock special tray has, for me, transformed and greatly improved the accuracy of the master casts produced from the modied custom-tray described in this article. Many wasted working hours created by distorted impressions have been saved with condence in accuracy of t through a full spectrum technical work being achieved.

Figure 11

About the Author:

QUIZ:
Receive .5 point documented scientic credit for passing a quiz about this article. To get the quiz go to JDT Unbound (www.nadl.org/jdtunbound) and click on the CDT link or use the Fax-On-Demand system by calling (877) 355-8029, press 1 for NBC documents and enter document number 46 to have the quiz faxed to you. You can enter your answers to this quiz (course code 13461) at http://quizzes.nadl.org or fax the completed quiz to (850) 222-0053. This quiz is provided to test the technicians comprehension of the articles content and does not necessarily serve as an endorsement of the content by NADL or NBC.

Bill is a dental technologist with Symons, Sibson & Co Ltd. In Leicester, England. You can e-mail him at jonathan.bill@ btconnect.com.

Do you have a fabulous technique or fascinating case study you want to share with your fellow dental technicians? Have you solved one of the problems that crop up during the day-to-day management of a dental laboratory? If so, the Journal of Dental Technology wants to publish your article. Anyone interested in submitting an article or receiving JDTs writers guidelines should contact JDT Editor Cassandra Corcoran at (800) 950-1150 or e-mail cassie@nadl.org.

38 Journal of Dental Technology February 2007