Bruxism Appliance Problems

[TLA]

I need the Gurus here to help me with a problem I'm having, namely my bruxism appliances have not been fitting in the mouth lately! HUGE SETBACK for me!
I've used Eclipse Clear baseplate material, Ivocap processed clear (not the Elastomer) and also Proform Dual Laminate. Everything was going smoothly for awhile, but then BAM! for no good reason nothing is fitting! Even the Ivocap, which I suspect is TOO accurate. I'm processing on the master models, yes I know, I hate to do that too, but first suspect was the dupe models (I use Flexites micowave hydrocolloid). I also use Modern Materials hard set up wax to make the stents, then immediately invest and process. Look and fit great, but then Dr calls and says they won't seat. I take the time to survey cast, block out undercuts, interpoximals, etc. and still they come back.
As for the Eclipse, they're dead on before I light cure. When I re-articulate, they're distorted: on the last one I did, left side was perfect, but the right side was 2mm shy, like the material shrank!. Using Enterra machine, Eclipse/Nightguard 10min cure. Even tried 2 6min cures, as the models seemed hotter than normal. Dentsply tech says machine doesn't get out of calibration, basically no help at all. As for the Proform, they just suck in general because you can't get the soft side hot enough without burning it in the Vacuum Form to adapt closely enough for retention.
I've tried to research this, to no avail, other than running across Glidewell's seemingly perfect machine that spits these things out by the hundreds...maybe I should just cough up the $3K and buy one?
I'd appreciate any advice you have to offer on how to make these appliances!
Thanks all!

 

[thetoothfarie]

First, never work the original model! You lose the proof that it could be the
dr.s impression.
Sounds like the problem is in the model work. If your technic has not changed, how about the stone you are using. Who is duplicating the models? Does the finished guard fit on the original model? Try making 2 duplicates and see if the guard fits the same way on both.
As far as Glidwells machine, had one at the last two labs I worked at and I think the machine is worth its weight in gold. If you decide to get one I would be happy to give you some tips to help straighten out the learning curve.

 

[kcdt]

How old is your hydrocolloid? I use silicone for my dupes, because even colloid can be abused. Something going on there would manifest pretty much as you've described. I'd go over my dupe technique, and probably change out the material for something new.

 

[TLA]

Well, after a weekend of self study and research, I've finally come to the realization that it's not 1985 any more! When I came to work this morning, all the HC went into the trash and I now have adopted Bego Wirosil Silicone as my new preferred medium to duplicate casts and start being a technician again. Now it's just a matter of making sure I work on an acceptable impression/model from the Dr... another challenge! I'll keep the forum posted. Thanks for the help!

 

[TomZ]

Like others here, I rely on a master for fitting and duplicate for processing on.
Problems of the type you describe almost always originate from the impression, so its imperative that you have the master for liabilty issues.

 

[Smilewire]

Hmm, I always use the master cast, they can always take another impression if they need a model, I don't really break teeth so a lot of times they get the model back in fine condition. Many of my Dr.s have said I make the best fitting splints they have ever seen. I'm not familiar with your material, my splints are mostly Talon and hard Acrylic I do however use my Hydrocolloid machine for Talon but I dont use it to duplicate.

What machine are you using for Proform? a crappy Essix type? Try moving the model around keep the colder area away from model also FREEZER SPRAY is your friend for those machines. Suck down then immediately freeze, but honestly buy a real machine with a pressure vacuum and buy Durasoft, Those small vacuum forming machines cant really handle that type of material, and the reason for Durasoft a lot of those other dual laminates seperate when the patients place/remove.

Are you refrigerating your eclipse material?

Are you using a proper powder/water ratio when pouring model duplicates could be your plaster

Maybe not enough blockout? I just slap a bunch of plaster on the model then sponge occlusion and sides down fast and easy, you can see one of my durasofts and blockout here:
.....wire......

let us know if you discovered your issues! or Are you serious you havent changed your HC since 1985.

 

[araucaria]

bruxism appliances have not been fitting in the mouth lately! HUGE SETBACK for me!

Be more critical of the impressions you recieve. Check how the material was used in the surgery and the setting time in the mouth. Is the material properly fixed to the tray? Check that a rigid tray has been used, then check the disinfection procedures. Next step is storage and despatch.
Then it's the model making etc... which should be a straightforward exercise.
Looking deep usually uncovers the truth.

 

[HDL Owner]

I'M Back! I always use the master model for everything it is and will remain the most accurate! A duplicate is that a dupilcate that is "almost" like the orginal! Take a micometer to the master and your dup and you will measure differences regardless.
Second: ProForm Duals--if done according to direction! they come out great and occlusion can be adjusted by adding clear acrylic/or grinding small amounts off.
Next? How can any technician be able to see a slightly distored impression? OK! Gross pulling of material and or shrinkage is visable but! an alginate that bench sits for 20 minutes , rather than being immedately poured can NOT be detected by any tech out there!

 

[AJEL]

Why drive yourself crazy about such a short term appliance material. I drive myself crazy as the CLEARspling appliances are long term, I just relined one I made in 2004, & cleaned & repaired one from 2000. I use the duplicated model for blockout requirements, with the soft suck material that shouldn't be an issue.
Light cure materials tend to be rigid & crack, they also absorb all & any odor/stain. that would explain the term open matrix material, needing a sealant.
Talon is an interesting combination, I don't care for the smell and why does it still have that chemical smell even after a double process? When repairing Talon why does it seem to brown so fast? My uneducated thought is possibly there are uncured elements in Talon. When I used it I had several customers with reactions. I calibrate my equipment with regularity (GMP) so when I follow mfg directions I'm right on, they invented it I follow their directions.
I've used both hydrocoloid for duplication & silicone under magnification the hydrocoloid just seems sharper in detail. The silicone is neat as you can make several models on one mold though. I've read in some threads that to stretch the cost of the silicone folks try to chop up the old molds and put pieces in when making a new mold. Is it just me or does it seem a possibility that a hard piece could cause a deformity in a new mold? Myself I have found it easier to chop up hydrocoloid and keep track of how old & how many times I have broken it down & proper control of temperatures. GMP does take some practice and persistence, possibly I have a little self-discipline to watch details. I'm a boring technician I believe if U do the same thing the same way with the same materials the same result should occur, boring repetition.
We can't spot a slightly off impression, I rarely see them anyway I usually get models. Possibly U could get your DDS to scann & send U the data then you could mill a model to work on!
For comparison I'm just a small lab 2011 I only did 201 Dawson balanced brux & 76 Tanner appliances. I'm mostly a denture lab. I only started brux appliances in 1975 when I heard Henry Tanner DDS talk at a L.D. Pankey Institute sponsored lecture in Chicago.