Thursday, October 13, 2022

 Border moulding

Border moulding is defined as ‘the shaping of the border areas of an

impression material by functional or manual manipulation of the soft

tissue adjacent to the borders to duplicate the contour and size of the

vestibule’.

Secondary or final impression can be defined as ‘the impression that

represents the completion of the registration of the surface or object’.

Border moulding can be done by using the following two

techniques:

(i) Multistep or incremental or sectional border moulding

(ii) Single step or simultaneous border moulding

Multistep or incremental or sectional border

moulding

Refining of maxillary impression trays

• Green stick compound is added in sections to the shortened borders

of the custom tray. The compound is then heated with the flame

from an alcohol torch, tempered and moulded in the mouth.

• The tray is carefully removed from the mouth, and the modelling

compound is chilled in ice water.

• The border moulding is accomplished in the anterior region when

the upper lip is elevated and extended outwards, downwards and

inwards.

• In the region of the buccal frenum, the cheek is elevated and then

pulled outwards, downwards and inwards and moved backwards and

forwards to simulate movement of the buccal frenum.

• Posteriorly, the buccal flange is border moulded when the cheek is

extended outwards, downwards and inwards.

• The PPS is formed through both hamular (pterygomandibular)

notches and across the palate over the vibrating line.

• Should the tray be underextended, the length is corrected by the

addition of modelling compound.

• A strip of low-fusing modelling compound is placed over the

vibrating line and through the hamular notches.

• After the border moulding procedure is completed, the spacer wax

is removed from the inside of the final impression tray.

• Holes are placed in the palate of the impression tray with a No. 6

round bur to provide escape ways for the final impression material.

Refining the tissue-bearing areas of the final

upper impression

• The final impression material is mixed according to the

manufacturer’s instructions and uniformly distributed within the

final impression tray.

• All the borders must be covered.

• The tray is positioned in the patient’s mouth.

• The border moulding procedures are performed first in the

posterior regions on both sides and then in the anterior region.

• When the impression material is completely set, the dentist removes

the impression from the mouth by grasping the handle of the tray

downwards and forwards in the direction of the labial inclination of

residual ridge.

• The impression is inspected for acceptability.

Refining of mandibular impression trays

• Green stick compound is added to the borders of the resin tray in

sections, beginning with the labial flange, then the buccal flanges

and finally the lingual flanges.

• Each section of the modelling compound is heated and border

moulded before the next section is added.

• For the border moulding of the labial flange, the lower lip is lifted

outwards, upwards and inwards.

• In the buccal frenum region, the cheek is lifted outwards, inwards,

backwards and forwards to simulate the movement of the lower

buccal frenum.

• Posteriorly, the buccal flange is moulded when the cheek is moved

outwards, upwards, and inwards.

• The distobuccal sulcus is recorded by asking the patient to close the

mouth against resistance. The masseter muscle acting on the

buccinator muscle forms a notch in the impression called the

masseteric notch.

Border moulding of the lingual flanges

• The tray is placed in the patient’s mouth and the patient is

instructed to protrude the tongue.

• This movement creates the functional activity of the anterior part of

the floor of the mouth, including the lingual frenum and determines

the length of the lingual flange of the tray in this region.

• The tray is placed in the mouth and the patient is asked to push the

tongue forcefully against the front part of the palate.

• This action causes the base of the tongue to spread out and develops

the thickness of the anterior part of the lingual flange.

• The compound is then added to the area of the tray between the

premylohyoid and the postmylohyoid eminences on both the sides.

• The heated and tempered compound is placed in the patient’s

mouth and the patient is asked to protrude the tongue.

• This develops the slope of the lingual flange in the molar region to

allow for the action of the mylohyoid muscle.

• The action of the mylohyoid muscle, which raises the floor of the

mouth during this movement, determines the length of the flange in

the molar region.

• The distal end of lingual flange should extend about 1 cm distal to

the end of mylohyoid ridge.

• The flange should be shaped so as it turns laterally towards the

ramus below the level of retromolar pad and mylohyoid ridge.

• Compound on the distal end of flange is heated and the tray is

placed in the mouth.

• The patient is instructed to protrude his/her tongue to activate the

superior constrictor.

• With the lower final impression tray in place in the mouth, the

patient should be able to wipe the tip of his/her tongue across the

vermillion border of the upper lip without noticeable displacement

of the lower tray.

• The compound forming posterior part of the retromolar fossa is

heated, the tray is placed in the mouth and the patient is asked to

open the mouth wide.

• If the tray is too long, a notch will be formed at the posteromedial

border of the retromolar fossa, indicating tray encroachment on the

pterygomandibular raphe.

• The tray is adjusted accordingly.

• The final tray should be so formed that it can support the cheeks

and lips in the same manner as the finished denture would do.

• The wax spacer is removed.

• Holes are cut in the centre of the alveolar groove of the tray.

Refining of the tissue-bearing areas of the final

lower impression

• The final impression material is mixed in proper quantities and

evenly distributed over within the tray, covering all the borders.

• The tray is positioned in the patient’s mouth and the borders are

moulded.

• Once the material is set, the impression is removed from the mouth

and inspected for acceptability.

Single step or simultaneous border moulding

• A material that will allow simultaneous moulding of all borders has

two general advantages:

• The number of insertions of the trays for maxillary

and mandibular border moulding is reduced to

two.

• Development of all borders simultaneously avoids

propagation of errors caused by a mistake in one

section affecting the border contours in another

section.

• The procedure followed is a technique that utilizes polyether

impression materials for border moulding.

• It significantly reduces the time required for making impressions.

Secondary impression or wash

impression

• This is a clinical procedure in complete denture fabrication done to

prepare a master cast.

• This is done after the upper and lower border moulding are

completed.

• Its primary objective is to record the denture-bearing area in great

detail and it also records the muscular peripheral tissues in

function.

• This method makes use of a custom tray or special tray, prepared

from the primary cast.

• The borders of the tray should be 2 mm short from the peripheral

structures.

• The tray can be prepared from autopolymerizing resin or shellac

baseplate.

• Once the tray is ready, the peripheral structures are recorded by a

procedure called border moulding or peripheral tracing.

• Tracing compound or elastomers can be used.

• The impression material chosen for the secondary impression

should be of low viscosity to record the structures accurately.

• The materials of choice for the secondary impression are zinc oxide

eugenol impression paste and medium-bodied elastomeric

impression material.

• The final impression material is mixed according to the

manufacturer’s instructions and uniformly loaded over the tray.

• All borders should be covered before placing the tray in the

patient’s mouth.

• This impression is called wash impression because between the

properly moulded borders and the peripheral tissues, only a thin

film of material will exist.

• Once the material is set, the tray is removed from the mouth of the

patient and inspected for acceptability.

Impression materials

The choice of impression material depends on the following:

• Character and position of the tissues to be reproduced

• Purpose of the impression

• Technique used for making the impression

• Type of submucosa and the relationship of the supporting bone to

the denture base

• Dimensional stability of the material after setting

Various materials commonly used for impression making in complete

dentures are as follows:

• Impression plaster

• Zinc oxide eugenol paste

• Modelling plastic or impression compound

• Reversible hydrocolloid

• Irreversible hydrocolloid

• Rubber base impression material

• Impression waxes

Impression plaster

• Certain modifiers are added to the impression plaster to regulate the

setting time and control the setting expansion.

• Flavouring agents are used.

• These plasters are not commonly used.

Advantages

• Minimal tissue distortion

• Quick flow

• Absorption of palatal secretions during setting

• Accurate record of tissue detail

• Easy manipulation and handling

Disadvantages

• Possibility of warpage

• Subject to breakage due to brittleness

• Messy to use; separation of cast from the impression is tedious

• Pores in impression should be filled before pouring cast

• Undercuts cannot be recorded

Impression compound

• Impression compound is a reversible thermoplastic material, which

is used for making preliminary impressions.

• It is softened in a water bath at 64°C and kneaded until a uniform

mass is obtained.

• The impression is made using a stock tray.

• It has a good dimensional stability but excessive water

incorporation can cause dimensional change.

Advantages

• Surface can be corrected.

• Impression can be reinserted for evaluation of fit.

• Surface does not have to be treated before pouring the stone cast.

• Material can be beaded and boxed for pouring of cast.

Disadvantages

• Due to its viscosity, it can displace the tissue surface and also it does

not record the surface details very accurately.

• Thermal conductivity of modelling compound is low, outer surface

of the impression softens first, whereas the inside sets the last.

• It is subjected to distortion during and after removal from the

mouth.

• Higher is the temperature of compound during impression, more

are the chances of linear thermal expansion.

Zinc oxide eugenol paste

• Its basic composition is zinc oxide and eugenol.

• Plasticizers, fillers and other additives are added to alter certain

properties such as smoothness of the mix, adhesiveness and

hardness.

Advantages

• Tissue details are accurately recorded as a result of fluidity.

• The paste shows minimal distortion, if it is allowed to flow under

minimal pressure.

• It has a good flow and ease of handling.

• It is easy to bead and box for pouring of the cast.

• It is dimensionally stable on setting.

Disadvantages

• Setting time is not easily controlled.

• Temperature and humidity influence the setting time.

• It is difficult to control at the borders.

• It may distort when removed from the undercuts.

Reversible hydrocolloid

• This impression makes use of agar (a reversible hydrocolloid) as the

impression material.

• Hydrocolloid sols change property to gels under certain conditions.

• The agar is taken from the tempering section, which is at 46°C and

loaded on to a water-cooled rim lock tray.

• It requires heat for sol–gel transformation.

Advantages

• It is an elastic material and, therefore, can be used to record

undercuts.

• It shows an excellent surface detail reproduction (up to 25 microns).

• It can be reused.

Disadvantages

• It has a poor dimensional stability due to syneresis and imbibition.

• It is capable of displacing soft tissues.

• It has a tendency to get easily distorted during the gelation period.

• It requires special water-cooled trays and equipment.

• It is not easy to manipulate.

• The tray should be held rapidly during gelation.

• It should be poured immediately.

Irreversible hydrocolloid

• Alginate is the hydrocolloid used for this type of impression.

• Sol–gel transformation occurs by chemical reaction.

• Water/powder ratio is 2:1.

Advantages

• Better peripheral seal than other impressions

• Ease of manipulation

• Less patient discomfort

• Short chairside time

• Accurate reproduction of undercut areas

• Minimal equipment needed

Disadvantages

• It has poor dimensional stability due to syneresis and imbibition.

• It should be poured immediately.

• It deteriorates rapidly at elevated temperatures.

Rubber base impression material

Advantages

• It is dimensionally stable.

• It has an accurate reproduction of detail.

• It does not affect hardness of the stone surface.

• It is easy to manipulate and handle.

• It can record undercuts accurately.

Disadvantages

• Proper mixing is essential.

• If the mass is not homogenous, distortion occurs.

• Ratio of material is critical.

Impression waxes

• Low-fusing impression waxes are not accurate for impression

making.

• These are only used as a corrective material to refine the borders.

Key Facts

• Sublingual crescent is the crescent-shaped area on the anterior floor

of the mouth formed by the lingual wall of the mandible and the

adjacent sublingual fold. It is the area of the anterior alveololingual

sulcus.

• Retromolar pad consists of glandular tissues and the fibres of

temporalis posteriorly, buccinator laterally and pterygomandibular

raphe and superior constrictor medially. It should be covered in the

denture to aid in posterior seal of the lower denture.

• Peripheral seal is the contact of the denture border with the limiting

structures to prevent the passage of air or food.

• Distobuccal border of the maxillary denture is limited by the

coronoid process, ramus of the mandible and the masseter muscle.

• The purpose of boxing the impression is to give definite shape to

the base of the cast and preserve the width of the border after

border moulding.

• Aesthetics of the denture begins during the impression stage itself.

• Mucostatic impression is the negative replica of the oral tissues on

the state of rest.

• Recording jaw relation is difficult in denture construction of patient

with neuromuscular disorders.

• In the upper denture, the accurate adaptation of the labial flange

and the positioning of the teeth influence the aesthetics.

• Neutral zone concept was first proposed by Wilfred Fish.

CHAPTER 5

Articulators and facebows

CHAPTER OUTLINE

Introduction, 77

Mandibular Movements, 77

Influence of Opposing Tooth Contacts, 78

Anatomy and Physiology of TMJ, 78

Axis around which the Mandible Rotates, 78

Actions of Muscles and Ligaments, 78

Neuromuscular Control, 79

Envelope of Motion of the Mandible, 79

Definition, 79

Envelope of Motion in the Sagittal Plane, 79

Envelope of Motion in the Frontal Plane, 81

Envelope of Motion in the Horizontal Plane, 81

Facebow, 82

Definition, 82

Evolution of Facebow, 82

Parts of Facebow, 82

Indications, 83

Contraindications, 83

Types of Facebow, 83

Method of Use, 84

Importance of Anterior and Posterior Reference Point, 85

Definition, 85

Anterior Reference Point, 86

Posterior Reference Point, 86

Hinge Axis, 87

Definition, 87

Concepts of Hinge Axis, 87

Schools of Thought Regarding the Transverse

Axis, 88

Articulators, 88

Definition, 88

Uses, 88

Advantages of Articulators, 88

Limitations, 89

Evolution of Articulators, 89

Classification of Articulators, 90

Fully Adjustable Articulators, 94

Split Cast Method and Its Importance, 94

Definition, 94

Uses, 95

Benefits, 95

Split Cast Methods, 95

Technique Employed, 95

Bennett Movement, 96

Definition, 96

Importance, 96

Introduction

The mouth of the patient is considered as the best articulator, but it is

not possible to arrange prosthetic teeth in the patient’s mouth or to do

any intraoral procedure which is needed for construction of dentures.

Therefore, it is necessary to use a mechanical device which can

simulate jaw movements and transfer the relationship of the jaws to

this device. These devices are called articulator and facebow which are

described in this chapter.

Mandibular movements

Mandibular movements occur primarily around the

temporomandibular joint (TMJ) which is capable of making complex

movements. Condyles articulate with the temporal bone which is

located in the glenoid fossa in which they travel forward, from sideto-side and in some instances slightly backwards. Condyle moves

along the posterior slope of the articular eminence and extends as far

forward as its crest. Movement of the mandible is related to three

planes of the skull, namely, the horizontal, frontal and sagittal planes.

Types of Mandibular Movements

Based on TMJ movement

(i) Rotational movement can occur around three reference planes:

• Rotation around the horizontal axis

• Rotation around the vertical axis

• Rotation around the sagittal axis

(ii) Translational movement

Based on the types of movement

(i) Hinge movement

(ii) Retrusive movement

(iii) Protrusive movement

(iv) Lateral excursive movement

(v) Medial excursive movement

Based on the extent of the movement

(i) Border movement

• Border movements around the horizontal plane

• Border movements around the sagittal plane

• Border movements around the frontal plane

(ii) Intraborder movement

• Functional movements

• Chewing

• Speech

• Swallowing

• Parafunctional movements

• Bruxism

• Clenching

• Any habitual movement

Four movements of prime importance to complete denture service

are as follows:

(i) Hinge-like movement is used in opening and closing the mouth.

(ii) Protrusive movement is used in grasping and incising the food.

(iii) Right or left lateral movements are used in reduction of food.

(iv) Bennett movement is the bodily shift of the mandible which is

recorded in the region of rotating condyle on the working side.

Factors regulating movements of the mandible are as follows:

• Opposing tooth contacts

• Anatomy and physiology of the TMJ

• Axis, around which the mandible rotates

• Actions of muscles and ligaments

• Neuromuscular control

Influence of opposing tooth contacts

• One of the many factors which influence the jaw movements is

occlusion of the opposing teeth.

• Relationship of the occlusal surfaces is not only confined to teeth but

also to the muscles, TMJ and neurophysiological components.

• In complete dentures, the occlusal surfaces on teeth should contact

bilaterally and simultaneously to enhance the stability (balanced

occlusion).

• The inclined planes of the denture teeth should be positioned in

such a way that they are in harmony with the other factors that

regulate jaw movement.

Anatomy and physiology of TMJ

• TMJ is divided into two compartments by the articular disc.

• Movement in the upper compartment is primarily translatory, whereas

movement in the lower compartment is primarily rotational.

• Mandibular movements can be translatory or rotational or

combination of both.

Axes around which the mandible rotate

• Mandible can rotate around three reference axes, namely,

horizontal, sagittal and vertical.

• Horizontal axis of rotation: Mandibular movement around this axis is

a hinge movement, i.e. opening and closing movement (Fig. 5-1).

• This axis is used to properly orient the maxillary cast on the

articulator.

• In lateral movements, the mandible rotates around the vertical axis

passing through the condyle on the working side because the

condyle on the balancing side moves forward and medially (Fig. 5-

2).

• Mandibular movement around the sagittal axis occurs during lateral

movement, as the balancing side condyle moves not only forwards

and medially but also downwards because of the slope of the

articular eminence (Fig. 5-3).

FIGURE 5-1 Mandibular movements around horizontal axis.

FIGURE 5-2 Mandibular movement around vertical axis.

FIGURE 5-3 Mandibular movement around sagittal axis.

Actions of muscles and ligaments

• Muscles responsible for mandibular movements show increased

activity during any jaw movement.

• The activity and interaction of various muscles for series of jaw

movements can be determined using electromyography.

• Temporal and inframandibular muscles retrude the mandible and

maintain it in this most posterior position.

• Lateral pterygoid muscle moves the mandible and the condyle

forward during uncontrolled opening movements.

• It is also responsible for making lateral and protrusive movement of

the mandible which is necessary to make eccentric interocclusal

records or pantographic tracings.

Neuromuscular control

• Muscular control of all the movement of the mandible is governed

by impulses from the central nervous system.

• Loss of teeth eliminates the source of receptors that are located in

the periodontium. These receptors help in controlling the position

of the mandible.

• Such a loss is compensated by construction of dentures with centric

relation (CR) coinciding with the centric position.

Envelope of motion of the mandible

Definition

Envelope of motion is defined as ‘the three-dimensional space

circumscribed by the mandibular border movements within which all

unstrained mandibular movement occurs’. (GPT 8th Ed)

Envelope of motion or maximum border movements can occur

around three planes, namely, the sagittal, horizontal and frontal plane.

Envelope of motion in the sagittal plane (fig. 5-4)

• Tracing is made when a pathway of the bead attached to the lower

central incisor is plotted.

• The tracing starts at point P, which represents the most protruded

position of the mandible with both upper and lower anterior teeth

in contact.

• As the patient moves the mandible posteriorly, it reaches the centric

occlusion (CO) position which is the position of maximum

intercuspation of the posterior teeth.

• When the mandible is further retruded, it attains the most posterior

relation to the maxilla which is represented by the point CR.

• Single restorations are usually constructed at the CO position.

• Multiple restorations and complete dentures are fabricated with

their occlusion in harmony with CR.

• As a patient opens the jaws, there is a separation of the teeth and the

mandible moves in its most retruded position to the position of

maximum hinge opening (MHO).

• Till the position of MHO, the condyles rotate without translation

movement.

• Opening of the jaws beyond MHO will force the condyles to translate,

i.e. to move forward and downward from their most posterior

position.

• Translatory movement of the condyles continue till the maximum

opening (MO) of the jaws.

• At the point MO, the condyles are in their most anterior position in

relation to the mandibular fossa.

• The line joining CR–MHO represents the posterior terminal hinge

movement.

• This movement is clinically used to locate the transverse hinge axis

(THA) for mounting the cast on the articulators.

• The line joining MO–point P represents the pathway of the

mandible, as it moves from its most open position to the most

protruded position.

• The masticatory cycle can be viewed in the sagittal plane and can be

superimposed on the envelope of motion.

• The masticatory cycle begins from CO and then extends downwards

and then upwards to end again at this point.

• In complete dentures, the CR and CO positions should coincide

with each other and, therefore, the masticatory cycle terminates at

this point.

• The mandibular rest position occurs somewhere downwards and

slightly forwards from the point CR as indicated by REST(R).

• This rest position is the habitual postural position of the mandible

when the patient is at ease in the upright position.

• The rest position is one of the most important reference positions to

record the vertical jaw relations.

FIGURE 5-4 Envelope of motion in the sagittal plane.

Envelope of motion in the frontal plane (fig. 5-5)

• The envelope of motion seen in the frontal plane resembles a shield.

• The tracing begins at the CO position.

• As the mandible moves to the right with the opposing 

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