Osama Awesome notes for Prosthodontics Clinical steps . Part 1 : Taking the Primary Impression . 1) The first visit .
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Osama Awesome notes for Prosthodontics Clinical steps Part 1 : Taking the Primary Impression
1) The first visit • First of all you’re going to make an extensive examination of your patient ( medical , social , dental and family history ) . And then you’re going to study his eduntoules mouth ( type of ridges , amount of reseorbtion ..etc ) . HERE are some notes :-I just want to point out something that you might have forgotten , ask the patient to loudly say Ahh to differentiate between the hard palate and soft palate ( determining the vibrating line ) . - Determine the midline . Sometimes the incisors might be abnormal so use the nose to determine the midline.
What’s the purpose of primary impression ? • To make a cast ( the primary ) cast to help us fabricate a custom tray which will be used on the more accurate impression which is the secondary impression .
What material are we going to use ? • we’re going to use the impression compound ( picture : Thermoplastic ) . It’ll be presented with circular blocks . • According to Dr demo he said : -Maxilla 1 block and a half-Mandible 1 block only But this might vary according to your patient .
Positions Patient : Upright You right handed ( image 1 ) You left handed ( image 2 ) 1 2
Position according to jaws • Maxilla : Patient position – maxillary arch: - When making a mandibular impression, the operator should be standing between the 9 o’clock and 12 o’clock position - The patient’s upper jaw should be approximately between the level of the operator’s elbow and shoulder
Cont. • Mandible : Patient position – mandibular arch: - When making a mandibular impression, the operator should be standing between the 6 o’clock and 9 o’clock position. - The operator’s elbow should be approximately level with the patient’s lower jaw
Tray • You’re going to use Non-profratted tray • Select a tray that’s good for your patient ( S , M or L ) • Put the tray in his/her mouth before starting to see if it’s good.
Preparing • Get yo bowel . Put a piece of cotton at the base of the bowl so the material won’t stick , add REALLLLLY hot water ( it has to be hot you can’t even touch it not warm ) . • Break the impression compound ( it’s really tough so use force ) . • Add the approprtie amount to the bowl • Leave it for until you can easily shape it
Insertion of the tray • Insert the tray , make sure it’s on the midline . ( an easy way is to aim the handle of the tray with the midline . In that way you’re certain it’s on the midline ) . • Softly apply it over the whole arch . Then gradually press , make sure to put one of your fingers at the back so you prevent the tray from falling • Leave it there for 1 min appx. • While you’re waiting you either ask the patinet to do some movements with his cheeks or you do it for him . Simple movmentsمو تروحو تعملو بخدوده شوراع • For the mandible it’s the same , only tell them to lift their tounge UPWARD as much as they can . ( very important ) .
Management of gag reflux • Be HONEST tell him it’s OK to be uncomfortable and that’s totally normal . But tell him/her we have to get this thing done today and he/she must be tolerant • -Be decisive and firm don't allow them to complain too much . Make it clear that this thing need to be done . • - Tell them to breathe from their noses when taking the impression . • - Don't tell them to hold their breath , most of them are very old and can't do this.