*Quick review: after block out and relief on the master cast, we duplicate it with the block out

and the relief, now we have the refractory cast, which is made out of phosphate bonded investment. We do our wax up on this cast, we invest it, make our mold, sprue it, and cast the metal, then we break the refractory cast (this is why we cant go back to the refractory cast for fitting the framework), we cut away the sprues and we end up with a nice metal framework.

-We take this framework back to the master cast. Our reference is always the master cast, that's why we don't want to damage this cast, Before we fit the framework on the master cast, we'll wash away the block out and relief wax (remember the wax is still on the master cast because we duplicated it to the refractory cast, and the wax wasnt lost or molten away during duplication). If the framework fits and everything is ok, we may proceed to processing the acrylic which is also done on this cast (master cast). *The master cast is used for: 1. Block out and relief. 2. Fitting the metal framework. 3. Processing: waxing up, setting the acrylic teeth, and processing the acrylic. (Question on the exam ) -Where should there be contact? Where do I want interferences? Retentive arms, reciprocating arms, the proximal plates, superior portion of the lingual plate, all maxillary major connectors and the meshwork in one spot which is the tissue stop if present. -Where are the most common interference areas? 1. Under rests 2. Under the rigid portions of direct retainers (the retentive clasps) 3. Inter-proximal portions of lingual plates (where the mandibular major connector enters between teeth in the embrasures).
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4. Inter-proximal minor connectors (where the minor connector enters between two adjacent teeth to reach the rest). 5. Shoulder areas of embrasure clasps.

-As long as the rests are fully seated, even if the guide plate shows a burn through, its ok because in this area the contact is normal. -The reason the DR. mentioned this, is that youre supposed to have contact in these areas. There's a disclosing agent, we paint it inside the denture to see where it touches or interferes. -Its a common mistake by many dentists, they paint the disclosing agent on the partial denture then put it in the patient's mouth, theyll find areas in contact with the tooth (like guide plates, and rests etc...) and theyll start to grind these areas. The point is that u needs to know where and when to stop. -If you keep grinding the areas that are supposed to touch, which give the support, stability and retention, you'll destroy them and end up with poorer support, stability and retention. -You need to make sure that the clasps are shaped correctly; one of the most important concepts is that the end of the clasp is always tapered, it starts broad and then as it goes toward the tip it becomes narrower. This tapering provides the tip of the clasp with flexibility and the base with rigidity -With metal there's an oxide layer produced by the casting process, we need to remove this layer and we can't remove it mechanically because we'll destroy the surface. -We need to remove it in a way so that we only remove one or two molecular layers of the metal alloy, and we do this using an electropolisher; which is a special machine with an electro galvanic current passing through a bath of concentrated acid (sulfuric acid). The galvanic current is used to remove a layer of metal from the prosthesis. So we end up with a nice, smooth, shiny surface, without changing the fit of the prosthesis.
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-But first we have to do the mechanical polish, so we need to make sure that we have the right equipment. *The burs that we use for gross reduction are: 1. Heatless stones (we use a variety of stones, some are aluminum oxide, some are silicon carbide...) 2. Tungsten carbide. 3. Diamond burs (the problem with diamond is that they leave a lot of scratch marks). 4. Coarse stones: shofu coral stones, carborundum disks ( carborundum is silicon carbide, and it's very abrasive, used to cut metal because it's harder than the cobalt chromium, we use them for polishing and trimming)

-Usually we start with something which is coarse and rough to do the gross reduction and then we smooth it off to make the final polish. *A few questions to help us diagnose whose fault the defect is: dentist/technician 1. If I have a metal framework that fits perfectly on the master cast, but it has no relationship to the patient's mouth (it doesn't fit the patient's mouth), the problem here would be due to a bad impression which is done by the dentist.

2. If the framework doesn't fit neither the master cast nor the patient's mouth, the problem here would be either the dentist (bad impression taking) or the technician (bad fabrication). *Note: if the framework fits the master cast, and the master cast isn't scratched or damaged, the problem is most likely the dentist's fault.

*Physiologic relief: -This is specifically for tooth-tissue borne prosthesis (Class 1, 2, long span class 4 and very rare cases of long span class 3).

-We talked about two types of motions: 1. away from the tissue so we need indirect retention 2. Towards the tissue, in this case we need support (To distribute forces between the tooth and the tissue)

-We talked about different ways to relieve the primary abutments, like changing the rests' position (Mesial/Distal), or choosing different types of clasps, in addition to these things we need to relieve under the guide plates either before the framework fabrication using wax, or after the fabrication by trimming. *How do we know where exactly to relieve? -As you remember we already relived under the guide plate with parallel block out, but in most cases it's not enough, we have to double checkwe do this by the following procedures:
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1) We paint a disclosing agent on the fitting surface of the prosthesis where we think it will cause problems, particularly guide plates and sometimes lingual plates. Then place it in the patient's mouth and rotate it, this rotation will result in pressure on the gingival third of the tooth, (we designed our prosthesis so that it has parallel block out, but with rotational forces there still may be
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some contact between the guide plate and the gingiva, or the guide plate and the gingival third of the tooth). -After we seated the prosthesis we take it out of the patient's mouth, the disclosing agent will reveal the areas of contact. -Normal contact areas like the upper part of the guide plate shouldnt be relieved, but abnormal contact areas such as the lower third (gingival third) of the guide plate should be relieved (trimmed). -Remember this unwanted contact (gingival contact) resulted from rotational forces applied on the prosthesis. However when passively seated (meaning that we only inserted and removed it), the prosthesis should show us contact in the upper part of the guide plate (which is normal). -After trimming, we go back to the patient's mouth and check that the relief was enough, and that there are no longer any forces being applied on the abutments

*Special Impression Procedures

-The impressing material that we use is anatomical impressing, that mean if you use alginate or rubber impression material you make a negative copy of the anatomical structure in the mouth. Then you end with anatomical cast

The aim of special impression procedures is to take impression with slight pressure the same as the normal functional pressure in the mouth. We dont face this problem with the short span bonded area bcz the pressure will directly transfer to the teeth, so, you can use conventional impression procedure BUT in the free saddle area we have a problem bcz the soft tissue move and compress so we need to use thus special procedure. And its considering a stress area so, we need to release this stress. *So, our Requirement is: record the tissues under uniform loading distribute load over as large an area delineate the peripheral extent of the denture

*Factors Influencing Support of the Distal Extension Base:

1. Quality of soft tissue covering edentulous ridge A firm, tightly attached mucosa displaying moderate thickness (2 to 3 mm) will offer the greatest support (more thickness, more need for functional force). 2. Type of bone in the denture-bearing area -Cancellous bone, as compared with cortical bone, is less able to resist vertical forces.bcz its sharp so excessive pressure on it end with inflamed tissue)

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-The ideal ridge would consist of: Cortical bone that covers dense cancellous bone with broad rounded crest and high vertical slops. *Cortical bone can resist vertical forces better than cancellous bone.

3. Design of the prosthesis.

-Knowledge of basic principles of designs guides the management of functional forces.The use of indirect retainer will control rotational movement of distal extension RPD. 4. Amount of tissue coverage of denture base

-The broader the coverage of the edentulous ridge, the greater the distribution of the load & the smaller the force per unit area -we try to cover tissue as we can BUT we should avoid over extension.
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5. Anatomy of the denture-bearing area. -Each denture base must be made to fit the areas that can serve as primary stress-bearing regions. We use it to get the primary support. BUT in the maxilla these area are cover by a thin layer of mucosa -In the maxillary arch we dont need to take functional impression bcz the tissue is favorable -In the lower arch, the crest of the ridge are not favorable to be a denture bearing area our aim from using the functional impression is to transform the pressure from the crest of the ridge to the buccal shelf area. *conclusion: To distribute the forces of mastication to the ridge most efficiently, the majority of force must be directed to the primary stress bearing areas that are capable of withstanding that force

6. Fit of denture base: -Support is enhanced by intimate contact between the mucosa and the fitting surface of the partial denture; 7. Type and accuracy of the impression registration: -the majority of the force must be directed to portions of the ridge that are capable of withstanding the force

*Indications for special impression procedure: 1. mandibular distal extension application 2. A long-span anterior edentulous base (normally including at least the six anterior teeth).

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*Impression Methods:
1. McLean physiologic impression 2. Functional reline method 3. Corrected cast procedure (Selected pressure techniques)

**McLean physiologic impression:

-A dual impression technique (We call it a dual impression technique bcz its use 2 impression materials: 1- Functional impression material using functional pressure 2- static impressing material (alginate) which is taken during statics (pic-up impression) Constructed a custom tray on a diagnostic cast, its only covering the edentulous area. A functional impression was made using this tray and a suitable impression material hydrocolloid is also taken "over-impression Could not produce same Functional displacement Generated by occlusal forces.(actually its a problem ) -We used ZOE or polysulfide or polyether or any rubber impression material. -I return it to the patient mouth using a perforated tray then I will get an over impression. -You notice in the picture we have 2 colors the blue is the functional
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impression and the white is the alginate.

*McLean Disadvantage:
clasps is sufficient :may result in compromised blood flow with adverse soft tissue reaction and resorption of the underlying bone clasps is not sufficient: the denture base will be occlusally positioned (premature contact)

*Functional reline method

Done after the partial denture has been completed (done at a later date) but the maclean is taken during the secondary impression. Adding a new surface to the intaglio of the denture base (functional relying) we add the new layer to the fitting surface. The partial denture is constructed on a cast made from a single impression with a soft metal spacer underneath to ensure a uniform space for the impression material (we use the spacer to create a space for the relaying technique).

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 The patient must keep the mouth partially open to permit appropriate tissue control and visual assessment modeling plastic like a green stick is applied to the intaglio(fitting surface) of the denture base

1mm of modeling plastic is removed from the intaglio surface and an impression is made by ZOE or any rubber material.

*Disadvantage:
failure to maintain the correct relationship between the framework and the abutment teeth during the impression Failure to achieve accurate occlusal contact following the reline procedure bcz its must take while the patient opening his mouth so we cant control occlusion force. Occlusal discrepancies must be corrected: slight: accomplished correction directly in the mouth, majority of cases: remount on an articulator.
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*Altered cast technique:

-This subject is very important, and often asked about in exams. -The difference in the mobility and compressibility between the tissue and the tooth is one of the main problems we face when dealing with partial dentures. We can minimize this problem using the altered cast technique.

*Note:
For tooth-tissue borne prostheses, the general term is "physiologic impressions for tooth-tissue borne RPDs" or "special impression procedures for tooth-tissue borne RPDs" rather than "altered cast technique. -There is more than one type of physiologic impression/special impression for tooth-tissue borne RPDs. The Dr. described two in the slides: (1) corrected cast technique. (2) Reline technique.

*Corrected cast procedure (selected pressure techniques)

-We also, called it altered cast technique bcz some alteration is done for the master cast during this technique. -This method is done before acrylic base processing. -We take a muco-static impression of the patient's mouth, and then we pour the cast and fabricate our metal framework. To reduce the

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movement resulting from the difference in compressibility between the teeth and the tissue, we have to compress the tissue. -This compression can't be done on the cast (because stone is not compressible), so we fabricate a tray on the framework only in the edentulous areas (while the framework is on the cast), make sure the trays are 2mm short from the depth of the sulcus, because we're going to border mold. -Place the prosthesis in the patient's mouth, check and see the peripheries (the tray is 2mm short of the sulcus), now border mold. After border molding we need to take an impression.

**Step by step:
1-We adding an impression tray after the framework have been fitted using a chemically activated or light-activated resin. We use its impression only for the free saddle area 2-Undercuts that would interfere with removal of the tray are blocked out -separating medium is then placed -Tray is adapted to the master cast -Boarders trimmed using a laboratory knife and gently rounded -the edge of the tray should be 2 to 3 mm from the depth of the buccal vestibule

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-Border molding for a corrected cast is basically the same as that for a complete denture covers -the buccal flange to the most posterior extent also border molding for the lingual and distolingual flanges

*Impression materials that we can use (they need to be thin and muco-compressive) are:
1) Zinc oxide eugenol with 0.5mm spacer or without spacer (usually it's our material of choice) 2) Functional impression wax (Ex. Kerr Korecta wax or Iowa wax). They are very thin, we paint them on the internal surface of the tray

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(they're designed to soften at the mouth temperature), we apply them in the patient's mouth and we press, they will compress the tissue. 3) Medium/Regular body addition silicon (Ex. polyvinyl siloxane)

-After taking the impression we go back to the cast, this impression will not fit the cast because the cast was made with a muco-static impression while this is a muco-compressive impression, so we have to alter our cast. -We alter the cast by removing or cutting away the stone in the edentulous areas. Now put the framework in its place and use the trays attached to it as an impression to pour the edentulous areas which were removed from the original cast.

-Before pouring we do boxing. Now we pour the stone and we end up with a cast that is mixed with two colors, one color representing the original cast, and another representing the new stone that we poured. -The new stone is lower in relation to the original cast because it's compressed. It's compressed within normal physiological limits so that it won't irritate the patient. The new edentulous areas are taken under function = muco-compressed = muco-displaced.
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*summary:

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