Learning from one another is one of the top benefits of dental continuing education.

One of the things that I value about continuing dental education is the opportunity to spend time with other dentists.  I always learn something I can bring back to my office. Recently while lecturing at Midwestern Dental School to the faculty, on of the faculty members told me about a new way to stabilize lower models when mounting, and was even kind enough to give me some samples.

Stabilizing a lower model during mounting with centric relation records is critical to the accuracy of the mounting.

Over the years I have tried about every idea possible to optimize mounting the lower model. If the model moves in the bite registration due to pressure during mounting, tipping or shrinkage of the stone it interferes with the accuracy of the mounting. To overcome this I have tried hot glue, compound, rubber bands, hanger wire bent into a V and probably many more.

We realized the Fleximount was incredible the first time we used it. Sold by WhipMix and developed for their articulator systems, I will say I have used it on other systems, and as long as there is a knob on the upper member of the articulator it works fantastic. The Fleximount is trapped inside the stone, so they are disposable. The lower model is held with even pressure directly against the upper( if mounting in MIP) or the bite record, therefore no tipping forces are present as with other stabilizer systems. Because it stays in the stone, you can walk away and let it come to a complete set, instead of having to stand and remove the stabilizer while the mounting stone is still somewhat soft. Both of these features result in a very accurate mounting.

Once the stone is set you simply cut away the rubber band material that is not inside the mounting stone. Now you can finish and groom the lower mounting.

Now that you have fabricated the platform, the next step is to capture the record with the patient. You will need a heat source and a blue Delar wax Pencil.

The first step is to heat the sides of the Master Wax Platform so they are tempered. Take the wax to the patient’s mouth and place it over the maxillary teeth. The anterior edge of the wax should be at the embrasure between the canine and the lateral. Bend the corners over the canines to help with retention. Press the wax against the teeth and ask the patient to close gently into the wax. Cool the wax with your air water syringe, have the patient open, and continue to cool the platform before removing from the mouth.

Using blue delar wax created a small bead where the lower canines have left an impression. Reseat the platform over the maxillary teeth and using bimanual guidance bring the lower canine cusp tips up until they just touch the blue wax. Have your assistant cool the wax with air. After removing the platform from the mouth add Delar wax where the second molars have left a cusp imprint. Then return the platform to the mouth and using bimanual guidance arc the patient into the wax so the lower molar cusp touches, then cool with air.

Your record should now be dropped into cool water. A disposable plastic container from the grocery works great. Write the patients name on it with sharpie marker and add it to their lab pan.

Analyzing a patient’s occlusion is key to providing optimal care. There are multiple ways to take a centric relation bite record, but one of the classics at Pankey has to be utilizing master wax. Easily mounting models in the laboratory is one of the main advantages of this method.

Although a slightly more challenging technique from a chairside perspective, it can still be accomplished with ease. Here is where to start:

Intro to the Master Wax Centric Relation Bite Record

Begin by gathering your necessary tools and materials. Start with a red master wax that looks just like baseplate wax from a standpoint of the size of the wax sheets, although it is different because it’s both softer and tackier. You will also need a blue wax pencil, scissors to cut the wax, a heat source such as an alcohol torch, and a way to light the heat source.

Take a single sheet of wax and temper it in the middle with the intention of being able to bend it in half. Once it is thoroughly tempered, bend it in half without cracking or breaking the wax. Make sure the bend is fairly crisp. After the wax has cooled a little bit, open it back up and cut it in half. Out of every sheet of wax, you should be able to generate two platforms for wax records.

Once again temper the wax halfway in the middle with the heat source. Tempering refers to heating to flexibility but not dripping. Again, fold the wax in half so you have a double thickness sheet. Then, cut the wax into the shape of the platform …

Look for the second part in this series about our master wax technique coming soon. And did you get a chance to read this Pankey Gram blog on enjoying Miami while you visit Pankey? Let us know what you think!

The Dento-Facial Analyzer is a marvelous tool I use in the practice to mount maxillary models. It has made a huge difference in my practice of dentistry and is one of my favorite tools to teach.

Introduction to the Dento-Facial Analyzer

For the critical aspects of diagnostics and sending info to the lab for the completion of a restorative case, mounting models appropriately is so important. They must be mounted in three planes of space referenced to hinge access to capture esthetic information including incisal plane and occlusal plane relative to the horizon.

Traditionally, this has been accomplished by utilizing a Facebow, Earbow, or by actually capturing hinge access position. Now, we have the option of using the Kois Dento-Facial Analyzer to capture both functional information and esthetic information that we would normally get with a Fox’s bite plane or stick bite. All of this functionality is managed with one simple device.

The Kois Dento-Facial Analyzer was designed based on scientific information gathered by Dr. John Kois, which shows that the distance from the incisal edge position of the maxillary central incisors to hinge access on average is 100 mm. Most people fall within a range of 5 mm to the average, therefore this is the assumption made when the device takes a record.

The armamentarium for record capturing with the Panadent instrument includes the analyzer, bite registration silicone in a gun with a tip, VPS adhesive used in an impression tray, and disposable bite plates that snap onto the analyzer (from the device manufacturer Panadent).

You can use bite registration silicone, Panadent bite tabs, wax, or VPS heavy body impression material to capture the record …

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I’ll continue this review of the Dento-Facial Analyzer technique in Part 2, coming soon! And don’t miss one of my recent Pankey Gram favorites from Dr. Bill Gregg on an occlusion-focused hygiene exam. Read it here for his insightful tips.

For an in-person, hands-on lesson in the Dento-Facial Analyzer, check out our Essentials 1 Pankey course. You can also watch this video for a quick refresher.  

Improving the quality of alginate impressions for diagnostic models requires a fine-tuned technique based on specific materials. These materials are used in conjunction with clever steps that lead to a minimization of voids and bubbles.

Dr. Baggett explains his exact procedure for achieving drastically improved alginate impressions. With these recommendations, you’ll find your confidence and efficiency soaring. Impressions are one part of the treatment puzzle that must be as precise as possible to avoid problems down the road.

How to Improve Alginate Impressions for Diagnostic Models

At my practice, we still use alginate impressions as our main impression material for diagnostic models. I generally take them. A very helpful tip to improve the quality of your impressions is to use a 35 ml monoject plastic syringe (from your local dental supplier) and Ivoclar Accudent XD Pre-Sure Tip applicators (Ivoclar Reorder number 67891 Soft Flex Tips).  

By placing the flexible tips on the end of the 35 ml plastic syringes, you are able to squirt excess alginate loaded into the syringe onto the teeth at a 90 degree angle starting at the distals of the second molars. You can do this instead of wiping alginate on the teeth with your fingers before you seat the alginate loaded tray.

This technique results in a lot less bubbles and minimizes the chance for voids distal to the most posterior teeth. The flexible tips are autoclavable, the monoject syringes can be cold sterilized, and petroleum jelly can be applied to the rubber plungers so they can be used again.   

This tip – combined with the use of 1-inch medical tape along the posteriors of our maxillary trays as a post-dam seal – has improved the impressions taken at my practice tremendously.

What aspect of impressions do you find the most challenging and why? We’d love to hear from you in the comments!