Finishing dentures on overextended casts.

[Denturepropgh]

So I just started working as an in-house technician again because I got kind of drained in the production setting. In the clinic, they take alginate impressions with stock trays lined with ropes of utility wax. I've been making dentures for 20 years, but have not experienced all these adjustments of border length from the clinic. They just use wax for their baseplates, don't want to do custom trays, and mount everything on a metal hinge-type articulator. I know that I just made some heads explode. But the metal articulator thing; I'm going to try to persuade the doctors to use semi-adjustable. Sometimes I might need to open/close the bite some during setting of teeth and I think it translates differently since we use the crappy hinge-type, and in the mouth the bite seems slightly off. It would be nice if we were given perfectly contoured wax rims with all the markings, but that's not reality right now. Everything that would make a prosthodontist scoff is happening right now, and it bites!

Would having the assistants practice muscle trimming their alginate impressions solve the overextension issue? This is driving me nuts, and definitely knocked me down a few rungs and humbled me a bit. I just feel weird coming in here and changing the way they do things. I always feel like people take me as being condescending but I really just want us all to do less work.

And to anyone who has finished dentures to an overextended cast, please explain your thought process in how long/thick to leave your flanges. Because if you take them to the border, they'll need cut back what seems to be at least 3-4mm. Thank you for your insight!

 

[JKraver]

I am in house as well. Sounds like they aren't listening to you, and providing that you need to do your job. Talk to your boss, have him buy the proper stuff. Then follow the protocol that you think is best. Your boss will decide if they use you effectively and make more work for themselves and you.
Buy a stratos 100, and some custom tray wafers.

 

[FASTFNGR]

So I just started working as an in-house technician again because I got kind of drained in the production setting. In the clinic, they take alginate impressions with stock trays lined with ropes of utility wax. I've been making dentures for 20 years, but have not experienced all these adjustments of border length from the clinic. They just use wax for their baseplates, don't want to do custom trays, and mount everything on a metal hinge-type articulator. I know that I just made some heads explode. But the metal articulator thing; I'm going to try to persuade the doctors to use semi-adjustable. Sometimes I might need to open/close the bite some during setting of teeth and I think it translates differently since we use the crappy hinge-type, and in the mouth the bite seems slightly off. It would be nice if we were given perfectly contoured wax rims with all the markings, but that's not reality right now. Everything that would make a prosthodontist scoff is happening right now, and it bites!

Would having the assistants practice muscle trimming their alginate impressions solve the overextension issue? This is driving me nuts, and definitely knocked me down a few rungs and humbled me a bit. I just feel weird coming in here and changing the way they do things. I always feel like people take me as being condescending but I really just want us all to do less work.

And to anyone who has finished dentures to an overextended cast, please explain your thought process in how long/thick to leave your flanges. Because if you take them to the border, they'll need cut back what seems to be at least 3-4mm. Thank you for your insight!

I do not see the problem in all you are saying. It has to be something in the steps that is missing. 29 years using those hinges metal articulators and ZERO adjustments in the mouth. Someone has to track step by step all procedures to evaluate what is happening.

 

[Denturepropgh]

I am in house as well. Sounds like they aren't listening to you, and providing that you need to do your job. Talk to your boss, have him buy the proper stuff. Then follow the protocol that you think is best. Your boss will decide if they use you effectively and make more work for themselves and you.
Buy a stratos 100, and some custom tray wafers.

Thanks for the advice.

 

[Denturepropgh]

I do not see the problem in all you are saying. It has to be something in the steps that is missing. 29 years using those hinges metal articulators and ZERO adjustments in the mouth. Someone has to track step by step all procedures to evaluate what is happening.

So you can open/close the bite on a hinge articulator if needed and it works just fine in the mouth? I think my problem is that they are taking too much wax off of the biteblocks, and pt's vdo is overclosed. Every one that comes into the lab hardly ever has a vdo of 38-40mm vestibule to vestibule. It's always like 30mm sometimes even less. After they get done melting down the wax rims, it literally gives me 4mm of room in the max anterior, and I have to open the bite to give me at least 9mm to set a tooth. I'm like, you guys know that teeth aren't 2 mm tall, right? I like to see at least 16-20 mm interarch space for setting teeth. There are the oddballs, but not every single one.

 

[TheLabGuy]

I am in house as well. Sounds like they aren't listening to you, and providing that you need to do your job. Talk to your boss, have him buy the proper stuff. Then follow the protocol that you think is best. Your boss will decide if they use you effectively and make more work for themselves and you.
Buy a stratos 100, and some custom tray wafers.

I agree, have your Doc throw them pieces of metal/covered in plaster metal hinges out the door, or better yet, wrap in Christmas paper and give to the assistants since they love them so much. Like JKraver stated, get the stratos 100 with Adesso magnetic plates, so much cleaner and user friendly.

 

[JKraver]

I agree, have your Doc throw them pieces of metal/covered in plaster metal hinges out the door, or better yet, wrap in Christmas paper and give to the assistants since they love them so much. Like JKraver stated, get the stratos 100 with Adesso magnetic plates, so much cleaner and user friendly.

Better yet get two and calibrate them. One for Dr side and one lab side.

 

[JKraver]

I do not see the problem in all you are saying. It has to be something in the steps that is missing. 29 years using those hinges metal articulators and ZERO adjustments in the mouth. Someone has to track step by step all procedures to evaluate what is happening.

I am impressed no adjustment chairside in almost 30 years. Using hinge articulators. I thought I was good.

 

[FASTFNGR]

I am impressed no adjustment chairside in almost 30 years. Using hinge articulators. I thought I was good.

I have a patient in the US on how to do denture in 2 visits too. Understanding denture from a to z gets you to avoid mistakes and it did not come overnight.

 

[Datguypeter]

I have a patient in the US on how to do denture in 2 visits too. Understanding denture from a to z gets you to avoid mistakes and it did not come overnight.

Hes being sarcastic he knows its impossible to never have any adjustments made. You almost always have them especially if youre cutting corner like you are. 2 visits arent enough to make a good denture

 

[bigj1972]

Defining the extensions of the denture is in the technicians hand. If they are overextended, it's because your leaving them that way. Based on your 20, you should be able to look at a cast and know where that defining line is. You certainly aren't gonna teach a dental assistant how to do it.
Don't worry about the articulators right now. I've used them all and is unrelated to your problems. Gotta pick your battles.

They are screwing up the wax rims not controlling patient mush biting the rims.
Someone needs to teach them the purpose of a wax rim. To establish jaw position, VDO, midline, lipline.

Find a vid on YouTube and show them how to correctly use record bases.... Better yet get the Dentist to show them, because the dentist is the only one lawfully permitted to use them.
Unless they have an expanded function, assistants have no training in record bases. And the dentist should teach them since it's his license to practice.. Even though you know how to do it cuz it's not rocket science, it is about establishing boundaries. A hygienist could probably extract a tooth, but that don't fly either.
Most of my clients would NEVER let assistants trim and melt wax rims. Your job is to put those teeth where they register the defining areas. This you should discuss with your dentist, or start sending those 3mm teeth.

Sounds like your in one of those practices where the dentist only wants to do the big money work, and "all these picky, I don't like" tasks are delegated to the staff so he can play on his iPhone and feel important. The goal of maximum production, minimum effort.

 

[Denture Dude]

I am in house as well. Sounds like they aren't listening to you, and providing that you need to do your job. Talk to your boss, have him buy the proper stuff. Then follow the protocol that you think is best. Your boss will decide if they use you effectively and make more work for themselves and you.
Buy a stratos 100, and some custom tray wafers.

Don’t you work for your brother?

 

[bigj1972]

I do not see the problem in all you are saying. It has to be something in the steps that is missing. 29 years using those hinges metal articulators and ZERO adjustments in the mouth. Someone has to track step by step all procedures to evaluate what is happening.

That's someone is supposed to be a licensed dentist.

 

[Flipperlady]

There are different styles, price ranges and ways of making dentures, you are going to need to decide which kind of dentist you want to work for. The style you describe I've mostly seen with older dentists (ex military dentists) , those with limited denture skill, those who do medicaid dentures, or just don't care. It's a basic denture, sometimes good, sometimes bad. If you wanted to go through all the stress to try and change this office, let the doc know you are going to start studying to get your cdt and offer to invite supply reps into the office for training and classes, most dentists like shiny new things. Or you could put in your resume somewhere new without all the headache

 

[FASTFNGR]

Hes being sarcastic he knows it’s impossible to never have any adjustments made. You almost always have them especially if youre cutting corner like you are. 2 visits arent enough to make a good denture

If you understand why you have so many visits to make a denture you wouldn’t be saying that. Visit 1 is impression, visit 2 is bite rim, visit 3 wax try in, if all is done properly visit 4 is delivery ( if tou are lucky). Now if you combine impression , rim and wax try in in the first visit and you deliver in the second, why is that impossible? Aren’t digital denture in some way or form advertising that you can do denture in 2 visits? I am doing this in an analog way because even with digital you have to print a model and send out for try in unless the Dr scan the original denture and order a similar one.
From my background between mechanical and civil engineering plus a denturist studies ( never took the test) 30 years doing this with dentist in their office, yes you can do dentures in 2 visits.
Now minor adjustment for tooth or 2nd cause of tissue displacement in the mouth, i do not call that a big deal.
I am, and I can teach that if you want. It is all in the name of education and serve edentulous people who I see suffering at the hand of some Dr who never experienced removable during their studies.

 

[Datguypeter]

If you understand why you have so many visits to make a denture you wouldn’t be saying that. Visit 1 is impression, visit 2 is bite rim, visit 3 wax try in, if all is done properly visit 4 is delivery ( if tou are lucky). Now if you combine impression , rim and wax try in in the first visit and you deliver in the second, why is that impossible? Aren’t digital denture in some way or form advertising that you can do denture in 2 visits? I am doing this in an analog way because even with digital you have to print a model and send out for try in unless the Dr scan the original denture and order a similar one.
From my background between mechanical and civil engineering plus a denturist studies ( never took the test) 30 years doing this with dentist in their office, yes you can do dentures in 2 visits.
Now minor adjustment for tooth or 2nd cause of tissue displacement in the mouth, i do not call that a big deal.
I am, and I can teach that if you want. It is all in the name of education and serve edentulous people who I see suffering at the hand of some Dr who never experienced removable during their studies.

You have to take the impressions make a bite rim and you also do a wax tryin ?? How long do patients have to stay during the first visit? Usually its 4-5 really short visits and some patients still find a way to complain. No patients want to be there for hours.
Also no adjustments despite not taking final impressions with a custom tray for a c/c? Doubt

 

[FASTFNGR]

You have to take the impressions make a bite rim and you also do a wax tryin ?? How long do patients have to stay during the first visit? Usually its 4-5 really short visits and some patients still find a way to complain. No patients want to be there for hours.
Also no adjustments despite not taking final impressions with a custom tray for a c/c? Doubt

That is because rim and teeth are already in one piece all the dentist have to do is take a wash ( I had to teach them how to do it ). Custom tray is not my problem if a dentist does not know how to heat adjust a plastic tray with molding to take an impression that is if the dentist is doing that in the first place. A lot of the problems we have as techs is that the assistants are doing the Dr’s job. And the biggest mistake regardless whether the dentist or the assistance do it is the bite registration. We speak about “the lost wax technique”, bite rim should be forbidden to be used. That is why I have a patent on this stuff. Instead of fighting an idea look into it. Nothing is impossible if you put your mind into it.

 

[JonnyLathe]

I work at an in house lab as well. In general I overwax and always plan on cutting my flanges down a couple mm's. I'm just more comfortable having more material than I need than not having enough.

If you're looking to convince your docs to get a semi-adjustable articulator look into AD2. It's a really affordable panadent knockoff that have their own facebows and everything. It's even interchangeable with panadent I believe.

Unfortunately your docs just sound like they're wanting to cut costs and invest in the lab as little as possible. You're going to have to convince them that investing in good lab equipment/supplies/techniques will save them a lot of chairtime (i.e. $$$) in the form of adjustments, relines, repairs, and even remakes.

 

[bigj1972]

That is why I have a patent on this stuff. Instead of fighting an idea look into it. Nothing is impossible if you put your mind into it.

It's nothing new... Several iterations of preforms and moldable arches have been around decades ago. Even triad had a prefab arch that fell off the edge of existence.

Then there was those dracula teeth the dentist stuck on the front of a wax rim to register lipline and midline probably 20yrs ago. Big flop.

However kudos to you for putting together a system yourself.

For that leg of the flowchart, 3d printing will overtake.

 

[Doris A]

I work at an in house lab as well. In general I overwax and always plan on cutting my flanges down a couple mm's. I'm just more comfortable having more material than I need than not having enough.

If you're looking to convince your docs to get a semi-adjustable articulator look into AD2. It's a really affordable panadent knockoff that have their own facebows and everything. It's even interchangeable with panadent I believe.

Unfortunately your docs just sound like they're wanting to cut costs and invest in the lab as little as possible. You're going to have to convince them that investing in good lab equipment/supplies/techniques will save them a lot of chairtime (i.e. $$$) in the form of adjustments, relines, repairs, and even remakes.

The AD2 is interchangeable with the panadent. I have both. AD2 also has mounting plates for ALL other articulators on their website.