midterm Flashcards
1
Q
why is it important to learn about dental implant terminology ?
A
1- The terminology used in implant dentistry is distinct, in many ways, from the terms and nomenclature used in other discipline
2- Much of the instrumentation used in the placement and
restoration of dental implants has been developed for those
specific purposes and will be new to clinicians entering the field
2
Q
I M P L A N T D E N T I S T R Y ( oral implantology, implant therapy)
The field of dentistry dealing with the __________, _________,
_________, and ________ of dental implants
A
diagnosis
surgical placement
prosthetic reconstruction
maintenance
3
Q
A biocompatible device placed within or on the bone of the maxilla or mandible to provide
support for a prosthetic reconstruction
A
D e n t a l I m p l a n t (fixture)
4
Q
implant types
A
1-subperiosteal
2- transosseous
3- ramus frame
4- mucosal insert
5- endosseous»_space; root form a) threaded screw shaped (parallel sided and tapered)
b) subperiosteal
c) hollow basket
5
Q
An endosseous dental implant circular in cross-section. It may be cylindrical, tapered, threaded, perforated, solid, or hollow in design
A
R o o t - f o r m I m p l a n t
6
Q
S c r e w I m p l a n t
Threaded root-form dental implant, which can be ______or _______
A
parallel-sided
tapered
7
Q
Ta p e r e d I m p l a n t
A
An endosseous, root-form dental implant with a wider diameter coronally than apically. The
sides of the implant converge apical
8
Q
Refers to the coronal aspect of a
dental implant to which abutments, components, and prosthesis may be connected
A
P l a t f o r m
9
Q
I m p l a n t C o n n e c t i o n s
A
E X T E R NA L: A prosthetic connection interface is
external to the dental implant platform
internal : A prosthetic connection interface is internal to the dental implant platform
10
Q
A
external implant connection
11
Q
A
internal implant connection
12
Q
I n t e r i m p l a n t P a p i l l a
A
Soft tissue occupying the
interproximal space confined by
adjacent implant-supported fixed
restorations in contact
13
Q
The horizontal distance
between the platforms of
two adjacent dental implant
A
I n t e r i m p l a n t D i s t a n c e
14
Q
B o n e D e n s i t y
The percentage of all bone tissue that is constituted by _____ bone.
Usually classified from D1 (dense) to D4 (porous)
A
mineralized
15
Q
C r e s t a l B o n e L o s s
A
Physiologic or pathologic bone resorption of the most coronal aspect of the ridge around the neck of the implant
16
Q
Sharp or narrow morphology of a
residual ridge in the mandible or maxilla usually a result of progressive resorption.
Ridge atrophy
A
K n i f e - E d g e R i d g e
17
Q
B o n e G r a f t i n g ( osseous graft )
A surgical procedure performed to establish ____ bone volume, using ________ and/or a___________, prior to or simultaneously with dental implant placemement
A
additional
autogenous bone
bone replacement graft
18
Q
R i d g e A u g m e n t a t i o n ( bone augmentation )
A
Increasing the dimension of an
existing alveolar ridge by
placement of a graft
19
Q
The immediate placement of a grafting material on an extraction socket following tooth extraction
To conserve the bone and soft tissue contour by avoiding bone resorption
A
R i d g e P r e s e r v a t i o n ( extraction socket graft , socket graft , socket preservation )
20
Q
G u i d e d B o n e R e g e n e r a t i o n
A
Bone regenerative technique
that uses physical means
(e.g., barrier membranes) to
seal off an anatomic site
where bone is to be
regenerated
21
Q
S i n u s G r a f t / L i f t (maxillary antroplasty, sinus augmentation, sinus elevation, subantral augmentation)
A
Augmentation of the antral floor with autogenous bone and/or bone substitutes to accommodate dental implant insertion
22
Q
B l a n c h i n g
A
To make or become white or pale, usually in reference to peri-implant or periodontal soft tissue
Deficiency of blood in an area due to constriction
23
Q
P e r i - I m p l a n t i t i s
A
Term for inflammatory reactions in the hard and soft tissues,
with loss of supporting bone, surrounding a dental implant
exposed to the oral environment
24
Q
M a l p o s i t i o n e d I m p l a n t
A
A dental implant placed in a position creating restorative, biomechanical, and/or esthetic challenges for an optimal restorative result
25
O s s e o i n t e g r a t i o n
The direct contact between living bone and a functionally loaded dental implant surface without
interposed soft tissue at the light microscope level.
The clinical manifestation of
osseointegration is the absence of mobility.
26
A surgical protocol consisting of placing an implant in the bone and
leaving it covered with a flap. A second surgery is needed to expose the implant in order to create the prosthesthesis
two stage surgery
27
O n e - s t a g e S u r g e r y
A surgical protocol consisting of placing an implant in bone and leaving it in ______ with the oral environment during the _________, thus
eliminating a ______procedurer
contact
healing process
second surgical
28
I m m e d i a t e I m p l a n t P l a c e m e n t
Placement of a dental implant into
the extraction socket at the time of
tooth extraction
29
The time of applying occlusal forces to a dental implant after its initial placement.
L o a d i n g
30
C O N V E N T I O NA L loading
after 3-6 m
31
immediate loading
placed at the time of implant placement
32
early loading
after 2-3 weeks
33
delayed loading
after 6-12 months
34
late implant failure
The failure of a dental implant after osseointegration
has been established (peri-implantitis)
35
early implant failure
The failure of a dental implant due to the failure to
establish osseointegration
36
T r a n s m u c o s a l L o a d i n g
The pressure exerted through the soft tissue on a submerged
dental implant.
37
A force that produces or tends to produce rotation or torsion.
A measurement of an instrument capacity to continue to rotate
under resistance to rotation.
It is expressed in Newton centimeters (Ncm)
torque
37
To r q u e W r e n c h
An _______, manual or electronic, used to
apply a ________
instrument
torque
38
F i x e d P r o s t h e s i s
A restoration that is not removable by the patient
39
Fixed prosthesis designed to restore and enhance esthetics, stabilization, and/ or function for a limited time
I n t e r i m P r o s t h e s i s / R e s t o r a t i o n
40
O v e r d e n t u r e
Removable partial or complete ______, which may be implant-supported, or implant-tissue supported. The prosthesis is retained by _______
denture
attachment
41
overdenture
42
H y b r i d P r o s t h e s i s
A metal-resin, implant-supported, fixed complete denture. Combination of
a metal framework with a complete denture (PMMA)
43
hybrid prosthesis
44
Technique for total rehabilitation of the edentulous patient placing four
implants in either arch where the distal-most implants are placed in a tilted position to increase support
All on 4
45
A b u t m e n t
The portion of a dental implant or a dental implant component that serves to ______ and/ or _____ a
prosthesis. It may consist of one or more piece
support
retain
46
Te m p o r a r y A b u t m e n t
Abutment used for the fabrication of an interim restoration. It could be cemented or screw-retained
47
temporary abutment
48
A mechanical device for the fixation, retention, and
stabilization of a dental prosthesis. Consists of one or more parts, made of titanium, gold or plastic
A t t a c h m e n t
49
attachement
50
I m p r e s s i o n ( implant level)
The impression of the implant
________ using an implant
___________
platform
impression coping.
51
impression (abutment level )
The impression of an abutment either directly (conventional impression
techniques), or indirectly (abutment
impression coping).
52
A n a l o g
A replica of an implant, abutment or attachment mechanism, usually
incorporated within a cast for a
prosthetic reconstruction
53
A device that registers the position of a dental implant or dental implant abutment in an impression. It may be retained in the impression (direct) or may
require a transfer from intraoral usage to the impression after the attachment of the corresponding analog (indirect)
I m p r e s s i o n C o p i n g
54
C l o s e d - t r a y I m p r e s s i o n
Impression technique that uses an impression coping with _____________. After removal of the impression, the coping is
_________ from the mouth, _______ to a laboratory analog and __________ into the
impression prior to pouring.
positioning features
unthreaded
connected
repositioned
55
O p e n - t r a y I m p r e s s i o n
-Impression technique that uses an impression coping with retentive features around which a rigid
elastic impression material is injected.
-To remove the impression, the impression coping
is first unthreaded through an opening on the
occlusal surface of the tray.
56
The use of dental cement for the retention of a prosthesis to an abutment, or transmucosal
portion of a one-piece dental implant .
C e m e n t - r e t a i n e d
57
S c r e w - r e t a i n e d
The use of a _____ for retention of an abutment or a prosthesis
screw
58
A c c e s s H o l e
The channel in a screw-retained implant prosthesis giving
access to the abutment or prosthetic screw, usually
through the occlusal or lingual surface of the prosthesis
59
A threaded fastener used to connect a
prosthesis to a dental implant, an
abutment, or a mesostructure
P r o s t h e t i c S c r e w
60
C o v e r S c r e w
A cap-type screw used to seal the platform of an implant ________ osseointegration
during
61
H e a l i n g A b u t m e n t
Connects to a dental implant and
protrudes through the soft tissue. It functions in guiding the healing of the mucosal peri-implant tissues and when removed, provides access to the platform.
62
healing abutment
63
P l a t f o r m S w i t c h i n g
The use of an abutment with a
diameter narrower than that of
the dental implant platform.
64
A prosthetic extension supported on one side.
C a n t i l e v e r
65
cantilever
66
R a d i o g r a p h i c Te m p l a t e
A guide derived from a diagnostic wax-up and worn during the radiographic exposure to relate
the tooth position to the anatomical structures.
It serves to assist in the diagnosis and planning phase for dental implant
67
S u r g i c a l G u i d e
A guide used to assist in the preparation for and placement of dental implants.
It can be bone-supported, soft tissue- supported, tooth-supporte
68
Uses milling technologies to produce a variety of different dental restorations, including crowns, veneers, inlays and
onlays, fixed bridges, dental implant restorations and orthodontic appliance
CA D / CA M D e n t i s t r y
69
D i g i t a l Wo r k f l o w
The ______ and _______to acquire intraoral and/or extraoral patient
information in a digital format for the purpose of aiding in the diagnosis and treatment planning phase, from initial _______ scanning to the fabrication of a dental prosthesis in the dental laboratory
clinical
laboratory steps
chairside
70
D i g i t a l I m p r e s s i o n
The use of intraoral scanners to acquire tooth and gingiva morphology and occlusion in a digital format to aid in the diagnosis and treatment planning phase, fabricate a dental prosthesis, orthodontic applications, or fabricate surgical templates for dental implants or
oral surgery procedure
71
A file format native to CAD software. STL files describe only the surface geometry of a
three-dimensional object without any representation of color, texture, or other common CAD model attribut
S T L
72
S c a n n i n g A b u t m e n t
A device that engages a dental implant to allow for an intraoral scan to record it’s
position along with the surrounding anatomical structures creating a digital impressio
73
pre operative roles
1- assessment
2- design
3- planning
74
assessment of dental pathology
75
direct the PLACEMENT of implant fixtures either indirectly via the construction of _______or directly by the use of _______
restrictive surgical guides
image guided navigation.
76
Assessment help us determine the following :
1- detect pathology
2-determine bone volume
3- determine bone quality
4- establish anatomic boundaries
77
What vital structures encroach on the residual alveolar ridge...?
1- maxilla : sinus, nasopalatine canal
2- mandible: mental foramen , inferior alveolar canal
78
what are the prosthetic space requirement
1. Inter-coronal space
2. Oro-facial space
3. Inter-radicular space
4. inter occlusal space
79
how much interocclusal space required for fixed and removable
* FIXED: Allow for soft tissue, abutment, metal, restorative material, ± cement
* Anterior 10-12 mm | Posterior 8-9 mm
* REMOVABLE: Allow for soft tissue,
be adequate abutment and prosthetic Dentum thickness
indusment
* Bar: ≥ 15 mm (15-17mm)
* Attachment: ≥ 7mm (10-12mm)
I
80
surgical guide construction
A guide, derived from the diagnostic wax-up, used to assist in the preparation for and
the placement of implants. It dictates drilling position and angulation.
81
post operative modalities
1- monitor osseointegration
2- immediate or delayed review of implant position
3- establish osseointegration failure
4- prior to implant retrieval
5- graft success
82
Monitoring Osseointegration: Radiographic Success Criteria
* Subjective (patient satisfaction) * Prosthetic criteria
* Peri-implant soft tissue criteria
* Implant
» Absence of pain » Mobility
» Infection
» Radiographic
* <1.5mmcrestalbonelossat1yr * <0.2mmannualcrestalboneloss
after 1st yr
* Absenceofperi-implantradiolucency
83
Monitoring Osseointegration: 2) Marginal Bone Level Stability
1- initial angular defect after loading
2- subsequent bone lose
type:
* branemark 0.05mm/yr
* roughed surface 0.4-0.6 mm/yr
*load (0.05-0.1mm/yr)
* 2stage
0.5 - 1mm (1st yr)
* 1 stage 0.6 mm (mn)/ 1.1 mm (mx)
84
Digital Intraoral Radiography
* Highest resolution of all modalities
* 10% Magnification
* Long cone paralleling
technique mandatory
* Cost and Utility
* Rigid
» Minimizes distortion
* Measurement algorithm
» Reduces intra/inter observer reliability
85
Digital Intraoral Radiography: Advantages and Disadvantages
* Identification of local
anatomy
* Assessment of mesio-distal orientation
» Relative root angulations
* Measurement accuracy
» Good mesial/distal
» Excellent apico-coronal (vertical) accuracy using standardized (calibration) technique*
* No bucco-lingual information
86
Panoramic Radiography: Advantages
* Available
* Simple to perform
* Cheap
* Excellent “screening” of the status of the dentition
87
Panoramic Radiography: Linear Measurement Calibration
* Digital image calibration with radiopaque balls provides clinically acceptable vertical measurement accuracy (95% confidence interval approx. 10%)*
* 2 mm safety zone
* Linear opaque markers assist in determining trajectory for measurement
88
Panoramic Radiography: Measurements and Implant Criteria
1. Interarch
2. Space between
adjacent teeth
3. Space between
roots
4. Residual ridge
89
Panoramic Radiography: Interarch (ridge to occlusal platform) distance
6.5 mm minimum
90
Panoramic Radiography: Restorative space (between crowns)
6.5 mm minimum
91
Panoramic Radiography: Me-Di bone volume (between roots)
1.5 mm from root to implant on either side (= Implant diameter plus 3mm [min = 6.5 mm])
92
Panoramic Radiography: Minimal residual alveolar ridge dimensions
12 mm above IAC for 10 mm Implant
Therefore height = Implant (10mm) + “safe zone” (2mm)
93
Panoramic Radiography: Minimal sinus dimensions
11 mm from Maxillary sinus for 10 mm implant
Height = Min. implant height (10mm) + “safe zone” (1mm) = 11mm
94
CBCT Radiography: Advantages
Advantages
* Assessavailablealveolarbonein3D » quality, height and width
* Boneandproposedimplant inclination.
* Spatialrelationshipofanatomic structures
95
CBCT Radiography: Disadvantages
Disadvantages
* Limitedavailability
* Moderatecost
* Techniquesensitive
* Extendedlearningcurve
96
CBCT Radiography: Application of CBCT in Implantology
Significant _______ _____________ to the patient (c.f. panoramic and selected periapicals) is ______ by increased reliability and accuracy in assessment and predictability in treatment outcome
increase in radiation dose
offset
97
-
98
CBCT Radiography: Avoiding para-sagittal parallax error
Displacement or difference in the apparent position of an object viewed along two different lines of sight.
99
types of implant healing
1- F I B R O O S S E O U S
I N T E G R A T I O N
2- O S S E O I N T E G R A T I O N
100
*Layer of fibrous connective tissue
formed between a dental implant
and surrounding bone.
* TISSUE-TO-IMPLANT CONTACT
F I B R O O S S E O U S I N T E G R A T I O N implant healing
101
F I B R O O S S E O U S I N T E G R A T I O N implant healing
* Initially good success rates but extremely __________ success
* Seen in earlier implant systems
* Considered a “failure” by today’s standards
* _____ bone direct contact with the implant
-poor long-term
-No
102
O S S E O I N T E G R A T I O N implant healing
-The direct contact between living bone and a
functionally loaded dental implant surface
without interposed soft tissue at the light
microscope level.
- BONE-TO-IMPLANT CONTACT
103
A time-dependent healing process whereby clinically asymptomatic rigid fixation of implant is achieved and maintained in bone during functional loading
O S S E O I N T E G R A T I O N
104
4 P H A S E S O F H E A L I N G
1-HEMOSTASIS: Clot formation within minutes
2- INFLAMMATION:Recruitment of immune cells
3-PROLIFERATION:Angiogenesis and fibroblast activity
4-REMODELING:Maturation of bone (Osseointegration)
105
F I R S T F E W H O U R S of implant healing.
Blood clot is in contact with the implant surface: erythrocytes, neutrophils, and macrophages are
trapped in a network of fibrin.
106
3 - 4 D A Y S of implant healing
The clot is replaced by granulation tissuecomposed by mesenchymal cells; disorganized connective tissue matrix and the first vessel
sprouts are evident
107
Most of the inflammatory cells are resorbed and immature woven bone can be evidenced
together with newly formed vessels
1 week of implant healing
108
2 W E E K S of implant healing
Woven bone formation is more pronounced and surrounds the whole implant ____________which is a clear sign of osteogenesis. Osteoclast formation is evidenced and contributes to _________
-mixed with old bone
-bone remodeling
109
4 W E E K S of implant healing
Newly formed mineralized bone extends from the prepared bone surface to the implant coating
110
Bone enters the remodeling phase, more mature bone with the presence of primary and secondary osteons is evident
6 - 1 2 W E E K S of implant healing
111
osseointegration initial stability
The degree of tightness of a dental implant immediately after placement in its prepared osteotomy. An implant is considered to have initial stability if it is clinically immobile at the time of placement.
112
The fixation of a dental implant
to the bone over time and after
osseointegration has occurred
S e c o n d a r y S t a b i l i t y
113
T/F
Bone interface is stronger on the day of implant
true
114
osseo integration
what is needed ?
* A biocompatible material (the implant)
* Atraumatic surgery to minimize tissue damage
* Implant placement in intimate contact with bone
* Immobility of the implant, relative to bone, during the healing phase
115
what are the factors influencing healing
1- systemic
2- local
3- technique
116
how does smoking effect implant healing
* Smokers experienced almost twice as many implant
failures compared with nonsmokers
* Decreased resistance to inflammation and infection
* High failure rates of implants and bone grafts
*Any amount of smoking: Relative contraindication
*Excessive smoking (>1.5 packs/day): Absolute contraindication until smoking cessation
117
how does diabetes effect implant healing
* Direct correlation between implant osseointegration and
glycemic control
* Diabetic patients are prone to developing infections and vascular
complications
*Well-controlled diabetes: No contraindication
I*nsulin-controlled: Contraindication depending on the state of control
118
BISPHOSPHONATES
* Treatment of osteoporosis, metastatic bone cancer, and Paget
disease
* Reduce bone resorption via a direct effect on the osteoclast
* Drug-induced osteonecrosis of the jaw (DIONJ)
-Oral bisphosphonates: Relative contraindication
-IV bisphosphonates: Absolute contraindication
119
SURGICAL TRAUMA
The surgical process of the implant osteotomy preparation and implant insertion results in a regional acceleratory phenomenon of bone repair around the implant interface
120
T/ F
The implant-bone interface is weakest and most at risk for
overload at 3 to 6 weeks after surgical insertion because the
surgical trauma causes bone remodeling at the interface
true
121
IMPLANT SURFACE
Proven to be critical for ______ and differentiation of cells during the ___________ process essential
to osseointegration
adhesion
bone remodeling
122
implant surface , SUBTRACTIVE
1-Etching with Acid (0.5 to 2 μm)
hydrochloric acid, sulfuric acid, hydrofluoric acid, and nitric acid
2-Blasting with an Abrasive Material : alumina, titanium oxide, and hydroxyapatite (HA)
(Different surface roughnesses can be achieved based on the size of
the blasting particles)
3- treatment with lasers : increased hardness, corrosion resistance, and purity with a standard roughness
123
additive implant surface
1- Hydroxyapatite Coating and
Titanium Plasma Spraying : stimulated bone growth during
the healing phase
2- Oxidation or Anodization: electrochemical process thickens and roughens the titanium oxide layer on the surface of implants
124
OPEN SURGERY X FLAPLESS
Less invasive; maintains tissue vasculature; no vertical incisions; less disconfort and Malpositioning
(unless guided)
125
anatomical consideration
maxillary sinus
-Bone quality in the posterior
maxilla is typically the poorest
of any area
-Bone resorption and increased
pneumatization of the sinus
126
anatomical consideration
NASAL CAVIT Y & INCISIVE CANAL
-Vital structures that define
anatomic limitations of implant
placement
-Implants should be placed 1 mm short of the nasal floor and should not be placed in the maxillary midline
127
anatomical consideration
ANTERIOR LOOP OF IAN
The anterior loop measurement should be added to the 2-mm safety zone to ensure adequate space between the implant and the foramen
128
anatomical consideration
INFERIOR ALVEOLAR NERVE
-Minimum 2 mm safe distance
between the implant and nerve
- Pre, intra, post
operative PA’s super important
-CBCT, when not sure
129
R A D I O G R A P H I C T E M P L A T E
-A guide derived from a diagnostic wax-up and worn during the radiographic exposure to relate
the tooth position to the anatomical structures.
-It serves to assist in the diagnosis and planning
phase for dental implants.
130
Device created for a specific case to assist the surgeon in
placing the implants in the intended location
S U R G I C A L G U I D E
131
S U R G I C A L G U I D E purpose
-Ensure accurate _______, ______, and _______ of implants
- benefits
Minimizes surgical _____, improves ______, enhances patient ______
-angulation, depth , positioning
- errors, outcomes , safety
132
why do we use surgical guide
1-Precision in implant placement
2- Reduced chair time and surgical complications
3-Better aesthetic and functional outcomes
133
t/f
placement of surgical guide needs to be planned in all dimensions
1- apical-coronal
2- mesio-distal
3- bucco-lingual
true
134
135
types of surgical guide
1- fabrication method
2- support type
3- restriction
136
fabrication method
137
fabrication method (manual)
1-Impressions and stone model creation
2- Wax-up and clear acrylic fabrication, or
3-Denture duplication (correct occlusion)
4- Drilling template for implant positioning
138
fabrication method (digital)
1-CBCT scanning for 3D anatomical data
2- Digital impressions using intraoral scanners
3- CAD software for guide design
4- 3D printing or milling of the guide
139
compare and contrast manual vs digital surgical guide
- manual: Cost-effective, limited
by manual errors
- digital: Superior accuracy, time-efficient, patient-specific
140
0
141
T O O T H - S U P P O R T E D surgical guide
-The most accurate and easiest guide to use
-INDICATIONS
1. Partially edentulous patients
2. Sufficient number of teeth for guide support
142
T O O T H - S U P P O R T E D surgical guide
REQUIREMENTS (one of the following)
1. Diagnostic cast + CBCT
2. Scanned diagnostic cast + CBCT
3. Digital impression + CBCT
143
M U C O S A - S U P P O R T E D surgical guide
-Flapless surgeries for edentulous patients
-INDICATIONS
1. Only edentulous patients
2. Must have sufficient support (stabilizing pins)
a. Maxilla (palate)
b. Mandible: sufficient vestibular or lingual support
144
M U C O S A - S U P P O R T E D surgical guide
requirement
Dual Scan technique - CDs with markers (CBCT)
145
B O N E - S U P P O R T E D surgical guide
- Requires extensive full-thickness reflection to expose the bony ridges to allow proper seating of
the guide
-INDICATIONS
1. Edentulous patients
2. Partially edentulous (> 3 missing teeth)
146
-
147
N O N - R E S T R I C T E D surgical guide
1-Generalized location of the ideal implant site
2- No actual directional guide is built
3- May result in unacceptable implant placement
(angulation and positioning)
148
P A R T I A L L Y R E S T R I C T E D surgical guide
1- Guided sleeve or a slot for the pilot drill
2- Remaining of the osteotomy and implant placement are free-handed
149
C O M P L E T E L Y
R E S T R I C T E D surgical guide
1- Restricts all of the instruments used for the osteotomy in a
buccolingual and mesiodistal plane
2- Drill stops limit the depth of implant placement
3- The final position of the implant is known before the surgery
150
C O M P U T E R - A S S I S T E D N A V I G A T I O N
F O R I M P L A N T P L A C E M E N T
benefits and limitations
Benefits: Flexibility and real-time visualization
Limitations: 1-Cost and learning curve
2-Cost and accessibility
3- Learning curve for digital workflows
4- Potential inaccuracies in poorly fitted guides
5- Dynamic navigation as an alternative solution
151
I N I T I A L V I S I T AND RECORDS
1. Maxilla and Mandibular alginate impression
2. Bite registration
3. Articulation
4. Diagnostic wax-up on the proposed site - make sure to keep original occlusion
152
L A B WORK
1. Duplicate your Diagnostic wax-up Cast
2. Trim Duplicated cast. Design: U-shape, cast thickness 10-15 mm height
3. Duplicate Cast MUST be fully DRY and CLEANED from flurry stone to continue
4. PA radiograph
153
M A T E R I A L S & INSTRUMENTS
* Duplicated wax-up cast: trim, clean and dry
* Blue/Red Pencil and an indelible marker
* Thermo-forming Material .040
* Blade #15 or 20 with holder
* Cyanoacrylate “Super Glue”
* Torch
* Acrylic burs block
* 7A spatula - Buffalo Knife
* Foiled paper
