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Anterior Bite Plane Appliance

Part 2 - Fabrication of the anterior bite plane appliance part I

Lee Ann Brady, DMD
Dr. Brady begins the step by step process to fabricate an anterior bite plane appliance.

So the first step in fabricating an anterior bite plane appliance is going to be that we need a model to work from. So what we've simply done off camera is we've taken an alginate impression on Katie just of her upper arch. So I don't need the lower and I don't need bite records. I simply need the upper. Now why take an alginate impression? For me, I make all of my anterior bite plane using silicon model. Now you could pour this model in stone and whether you're using snap set stone or some other amount time that it takes for the stone to set and we'll talk about when we make the Biocryl sort of what pros and cons are on stone. I actually make a silicon model. And I do it for two reasons. One it's a very very quick technique so I can have a model as you're going to see here probably in about 90 seconds or so. The other reason I do it is because the silicon model is very easy to work with. With the Biocryl I don't need a spacer to prevent it from getting too tight. So it just makes the entire process quick and easy. And a lot of times for me I'm actually making anterior bite plane while the patient is in the office so they're waiting. So I don't want to take the time to wait for stone to set. So what do we need to make an anterior bite plane silicon model? What we're going to need is the alginate. And for a silicon model you cannot use a silicon impression material so it will stick to VPS to polyether so that's why I use alginate. Reversible hydrocolloid would work as well. They do make a separating liquid that you can paint on a VPS or polyether impression but I've never personally tried it. We're going to actually use Mach-2 Die Silicone and Mack-2 is a product from Parkell and it's a fabulous product for making these models. And we're going to then base the model using bite registration paste. So the reason we use the bite registration paste to base the model is it's much easier to dispense. It creates a great model and I don't need the accuracy of the Mach-2 like I need in the actual teeth of the occlusal tables. So how am I going to this first is I've got my Mach-2. I've got my tip on here. You can notice I do have the little yellow intraoral tip. And the first thing I'm going to do is I'm actually going to cut tip back just using some scissors so that I'm going actually be able to express more material out more readily. And I've got my bite registration paste and you can see that I'm working on a vibrator. One of the hardest things about this technique is being able to do it without getting bubbles in the model and the Mach-2 tends to set very rapidly. Now they do make a product called Mach-SLO that in the beginning you may want to try cause it will give you some more working time. So I'm going to actually try to talk over the vibrator. So I'm going turn that on. I got my impression here. And I'm going to actually start injecting the Mach-2 and I'm actually up on the gingiva over the second molar and I'm letting it run in. And once it fills then I'm going to actually get down into the teeth and I'm just letting the Mach-2 run ahead in the impression of where I'm at and then vibrating it in to try to avoid getting any air bubbles. I'm trying to fill completely right up pass the cervical margins of all of the teeth with the Mach-2 that's where I need this to be very accurate in how it fits. And now I'm around all the way to the opposite second molar and I can look all the way around if I need to flow some more material in to pass the CEJs. I can do that. And once I've got just the occlusal all full I can now turn the vibrator off. And now we're going to complete the model using bite registration paste. And so this is just my Flexitime bite registration paste from Heraeus. And now I'm going to fill all the way up pass where the alginate went down in the vestibule. I'm not going to fill the palate on this upper. I'm just going to create a horseshoe. And I'm going all the way up pass so that I can now flip it over on a flat surface. I'm just using the top of the vibrator. Normally I would use a counter top so that we have a nice flat surface so that I have a base to the model. So now classically when we would do a stone model we would advise you never to flip it over because it decreases the accuracy of the model because the stone tends to then slump out of the cusp tips. One of the beauties of this is that Mach-2 was fully set prior to having the base in there. So I don't have to worry about that. And now it's just simply a matter of waiting for my bite registration paste to set completely. While I'm doing that one of the things, I use this technique for these models all the time. I do it for all my anterior bite plane appliances. It's also a great way to fabricate bleaching trays, athletic mouth guards. Anything that's going to go into my Ministar or vacuum form machine this is the perfect model. It also is an unbelievably quick, easy way to fabricate indirect provisional. So if you want to be able to get a quick alginate impression of the prep teeth move to the lab, have a model that you can then make indirect provisional on. I love using this especially from my veneer provisional. So there are a lot of uses on this. We keep a lot of Mach-2 in the office cause the ladies in my office know that I make a lot of these models because they're just so easy to work with. We're probably now just about 15-20 seconds away from being able to now pull this alginate off. The other that we use is we use this alginate specifically it's called Kromopan and one of the things we love about that it actually is rated to double pour. So most of the time after we complete our silicon model we'll also pour a stone model that now we don't need immediately but we have it to keep as part of the patient's permanent record. So now that everything is completely set it's very simple to separate the alginate. And we have a model and it will just peel right off the countertop or right off in this case the vibrator. And now you can see we have an accurate representation of all of the teeth pass the cervical margins and we have this nice silicon base. So now we'll be able to go and fabricate our anterior bite plane appliance. All right now that we have our silicon model we've actually moved it in here to the lab. So first thing I want to do is just to let you know that you are going to see where it's kind of a tight space in the lab in my office. And we want you to get the best possible camera shot of the things that I'm doing so far technical shots. We actually have another camera set up here beside so we can do our close ups. I don't know if you can probably see that because of the lack of space. But our commitment really is that you have things you need so that you can do this in your practice. The next step now that we have our silicon model is actually to now create the Biocryl form that we're going to use to fabricate our appliance. And so for me I'm going to actually do that. I'm going to use my Ministar machine which I got from Great Lake Orthodontics. And so as we fabricate this you can see now that I actually have the silicon model set down into the silicon beads. I actually have my Biocryl set in my Ministar. And what I'm going to use for today is I'm going to use 1-mm Biocryl. You can actually use 1.5 when you're doing an anterior only. If you need a little more retention I would use the 1.5. These materials all come with the heating instruction on the back of the box. And I actually usually add just about 5 seconds over what they say is the heating time and I can always stop it. I watch how the material is slumping in this part. And if I need to I can get it over as soon as I need to. These machines are set automatically to set the amount of time that the pump will run after you heat the material. So for today I'm going to use 1-mm. Now I'm not using anything as a separator because I'm using a silicon model. If I was actually using a stone model which is a common technique before I actually did my Biocryl form I would use the material called Isofolan which also comes from Great Lakes Orthodontics and it actually is a spacer. So I would actually put that in the machine, heat it up, and adhere that to the model first then without removing it heat up my Biocryl and put that on. The challenge of the stone model is it creates a rigidity that appliances become so tight can be hard to get them comfortable in the mouth. We don't have that problem with the silicon model. So I'm not going to use the spacer. So really to get this machine started once the time is set it's very simple. I just pull the heating element into place and you'll see that it automatically begins that process and it begins to count down. So at this point really it's not about me having to control it. I just have to follow what the machine is telling me to do. If I was making this appliance as I said for long term use I would actually have wanted to get also lower impression and have a lower model and I would be using this same 1-mm Biocryl material to actually create my lower Essix retainer. And so we're at the limit of our time according to the box so I'm going to step back and look. And we got 4 more seconds to go. As soon as I push this out of the way it turns the heat off. I simply flip this over, lock it down and now my Ministar has automatically started to create the air pressure. And for this material what it's saying is it needs about 51 more seconds. And then we'll be able to release it. After this we'll actually just be moving over so that we can then cut the Biocryl to get to the right shape and size.