A technique for making denture surgical stent
an esthetic
maxillary
complete
John E. Ward, DDS, MSD,a John P. McCasland, DDS,a Donald G. Crabtree, DDS,b and John J. Cziglan” Virginia Commonwealth University, School of Dentistry, Richmond, Va. A technique for making an esthetic complete denture as a surgical stent to be used in conjunction with hydroxyapatite augmentation surgery of the maxillary arch is presented. The technique involves the use of an articulator, a remount jig, and duplication of a surgically prepared cast. (J PROSTHET DENT 1992;67:345-7.)
A
technique for making a maxillary complete denture as a surgical stent to be used in conjunction with hydroxyapatite augmentation surgery of the maxillary arch is described.The stent provides an esthetic replacement immediately following surgery. It alsohelps confine and stabilize the moldable implanted material during the healing phase.Function may alsobe provided by the stent if occlusion with the opposingarch is developed. The first step involves mounting maxillary and mandibular castsin an articulator in centric jaw relation at the determined occlusal vertical dimension. This procedure allowsobjective planning of the surgery. Next, the maxillary castis modified according to the proposedsurgery. The cast is then duplicated and the surgical stent is made on the duplicate cast. BAssociate Professor, Department of Removable Prosthodontics. bAssistant Professor, Department of Removable Prosthodontics. CCertified Dental Technician, Department of Removable Prosthodontics. 10/l/29416
Fig. 2. Incisal/occlusalindex of arrangementof maxillary teeth is made using remount jig.
Fig.
3. Maxillary cast is waxed-up to proposedcontours.
PROCEDURE 1. Obtain dental stone castsof the maxillary and manFig.
1. Maxillary denture teeth are arranged on record
base to satisfy esthetic, phonetic, and occlusal requirements.
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
dibular dental arches. 2. Mount the maxillary and mandibular castsin a semiadjustablearticulator at a tentative vertical dimension of occlusion and centric jaw relation.
345
WARD
4. Waxed-up maxillary cast is indexed to upper member of articulator.
Fig.
ET AL
Fig. 6. Duplicate castof waxed-up mastercastismounted to upper member of articulator using index.
Fig. 7. IncisaUocclusalindex of trial denture set-up related to mounted duplicate cast of waxed-up master cast. Fig. 5. Two duplicate casts of waxed-up maxillary cast are made.
3. Arrange the maxillary prosthetic teeth on a record base to satisfy esthetic, phonetic, and occlusal requirements. 4. Have a wax try-in of the arranged teeth to verify the articulator mounting, program the articulator with appropriate jaw relation records, and obtain the patient’s approval of the esthetics of the trial denture (Fig. 1). 5. Remove the mandibular cast and its mounting from the articulator. 6. Make an incisal/occlusal index of the arrangement of the maxillary teeth using a remount jig (Remounting Record Jig, Teledyne Dental, Hanau Division, Buffalo, N.Y.) (Fig. 2). 7. Removethe maxillary cast from the articulator and, in
346
consultation with the oral surgeon,wax the proposed contours of the maxillary dental arch (Fig. 3). 8. Place the waxed-up maxillary cast in the articulator and index it to the remount jig (Fig. 4). 9. Make two duplicate stone castsof the waxed-up maxillary cast. One duplicate cast will be usedto construct the surgical stent, the other will be usedfor a surgical template (Fig. 5). 10. Place a duplicate of the waxed-up maxillary cast in the index of the wax-up maxillary cast on the remount jig in the articulator and mount it to the upper memberof the articulator (Fig. 6). 11. Removethe index of the waxed-up maxillary castfrom the remount jig and replace it with the incisal/occlusal index of the trial denture set-up (Fig. 7). 12. Remove the denture teeth from the trial denture and secure them in the proper position in the incisal/ occlusalindex (Fig. 8).
MARCH
1992
VOLUME
67
NUMBER
3
ESTHETIC
COMPLETE
DENTURE
SURGICAL
STENT
Fig. 8. Denture teeth are positioned in incisal/occlusal index, which is properly related to duplicate cast of waxed-up master cast.
10. Completedmaxillary denture-type surgicals#tent and template. Fig.
17. It may benecessaryto reline the completedenture type surgical stent with a temporary basematerial at the surgical appointment. SUMMARY
Fig.
9. Completed wax-up of surgical stent.
13. Secure the teeth with wax to the duplicate of the waxed-up maxillary cast and complete the wax-up of the maxillary complete denture surgical stent (Fig. 9). 14. Complete the surgicalstent usingthe customary techniques and materials (Fig. 10). 15. Make a clear plastic surgicaltemplate on the other duplicate cast (Fig. 10). 16. Disinfect the surgical template and stent for the surgery-delivery appointment.
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
The surgical stent provides an esthetic replacement immediately following surgery and helpsconfine and stabilize the implanted material during the healing phase.Function may be provided by developing occlusionwith the opposing arch. This technique may be used for augmentation surgery for the maxillary dental arch using any appropriate material. The technique may also be used for surgical procedures involving the repositioning of the maxillary arch by modifying the way the surgical cast is prepared. Reprint requests to: DR. JOHN E. WARD Box 566 MCV STATION RICHMOND, VA 23298
347
an esthetic
maxillary
complete
John E. Ward, DDS, MSD,a John P. McCasland, DDS,a Donald G. Crabtree, DDS,b and John J. Cziglan” Virginia Commonwealth University, School of Dentistry, Richmond, Va. A technique for making an esthetic complete denture as a surgical stent to be used in conjunction with hydroxyapatite augmentation surgery of the maxillary arch is presented. The technique involves the use of an articulator, a remount jig, and duplication of a surgically prepared cast. (J PROSTHET DENT 1992;67:345-7.)
A
technique for making a maxillary complete denture as a surgical stent to be used in conjunction with hydroxyapatite augmentation surgery of the maxillary arch is described.The stent provides an esthetic replacement immediately following surgery. It alsohelps confine and stabilize the moldable implanted material during the healing phase.Function may alsobe provided by the stent if occlusion with the opposingarch is developed. The first step involves mounting maxillary and mandibular castsin an articulator in centric jaw relation at the determined occlusal vertical dimension. This procedure allowsobjective planning of the surgery. Next, the maxillary castis modified according to the proposedsurgery. The cast is then duplicated and the surgical stent is made on the duplicate cast. BAssociate Professor, Department of Removable Prosthodontics. bAssistant Professor, Department of Removable Prosthodontics. CCertified Dental Technician, Department of Removable Prosthodontics. 10/l/29416
Fig. 2. Incisal/occlusalindex of arrangementof maxillary teeth is made using remount jig.
Fig.
3. Maxillary cast is waxed-up to proposedcontours.
PROCEDURE 1. Obtain dental stone castsof the maxillary and manFig.
1. Maxillary denture teeth are arranged on record
base to satisfy esthetic, phonetic, and occlusal requirements.
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
dibular dental arches. 2. Mount the maxillary and mandibular castsin a semiadjustablearticulator at a tentative vertical dimension of occlusion and centric jaw relation.
345
WARD
4. Waxed-up maxillary cast is indexed to upper member of articulator.
Fig.
ET AL
Fig. 6. Duplicate castof waxed-up mastercastismounted to upper member of articulator using index.
Fig. 7. IncisaUocclusalindex of trial denture set-up related to mounted duplicate cast of waxed-up master cast. Fig. 5. Two duplicate casts of waxed-up maxillary cast are made.
3. Arrange the maxillary prosthetic teeth on a record base to satisfy esthetic, phonetic, and occlusal requirements. 4. Have a wax try-in of the arranged teeth to verify the articulator mounting, program the articulator with appropriate jaw relation records, and obtain the patient’s approval of the esthetics of the trial denture (Fig. 1). 5. Remove the mandibular cast and its mounting from the articulator. 6. Make an incisal/occlusal index of the arrangement of the maxillary teeth using a remount jig (Remounting Record Jig, Teledyne Dental, Hanau Division, Buffalo, N.Y.) (Fig. 2). 7. Removethe maxillary cast from the articulator and, in
346
consultation with the oral surgeon,wax the proposed contours of the maxillary dental arch (Fig. 3). 8. Place the waxed-up maxillary cast in the articulator and index it to the remount jig (Fig. 4). 9. Make two duplicate stone castsof the waxed-up maxillary cast. One duplicate cast will be usedto construct the surgical stent, the other will be usedfor a surgical template (Fig. 5). 10. Place a duplicate of the waxed-up maxillary cast in the index of the wax-up maxillary cast on the remount jig in the articulator and mount it to the upper memberof the articulator (Fig. 6). 11. Removethe index of the waxed-up maxillary castfrom the remount jig and replace it with the incisal/occlusal index of the trial denture set-up (Fig. 7). 12. Remove the denture teeth from the trial denture and secure them in the proper position in the incisal/ occlusalindex (Fig. 8).
MARCH
1992
VOLUME
67
NUMBER
3
ESTHETIC
COMPLETE
DENTURE
SURGICAL
STENT
Fig. 8. Denture teeth are positioned in incisal/occlusal index, which is properly related to duplicate cast of waxed-up master cast.
10. Completedmaxillary denture-type surgicals#tent and template. Fig.
17. It may benecessaryto reline the completedenture type surgical stent with a temporary basematerial at the surgical appointment. SUMMARY
Fig.
9. Completed wax-up of surgical stent.
13. Secure the teeth with wax to the duplicate of the waxed-up maxillary cast and complete the wax-up of the maxillary complete denture surgical stent (Fig. 9). 14. Complete the surgicalstent usingthe customary techniques and materials (Fig. 10). 15. Make a clear plastic surgicaltemplate on the other duplicate cast (Fig. 10). 16. Disinfect the surgical template and stent for the surgery-delivery appointment.
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
The surgical stent provides an esthetic replacement immediately following surgery and helpsconfine and stabilize the implanted material during the healing phase.Function may be provided by developing occlusionwith the opposing arch. This technique may be used for augmentation surgery for the maxillary dental arch using any appropriate material. The technique may also be used for surgical procedures involving the repositioning of the maxillary arch by modifying the way the surgical cast is prepared. Reprint requests to: DR. JOHN E. WARD Box 566 MCV STATION RICHMOND, VA 23298
347
