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 Very important note: you should watch the video on the CD the CR gave us.. It helps a lot.. And sorry for any mistake.. It wasn't easy, the dr. explained a lot on his cast model.. I tried my best. ERRARE EST HUMANUM ! .

There was a video about the procedures of fabrication of cobaltchromium partial denture. So, we are going to do a quick review of the laboratory steps and then you'll go the central lab to see the Casting machine and casting furnace. What are the steps for the fabrication of Co-Cr PD?
Clinic Primary impression Laboratory Primary cast (dental stone III) We do initial surveying and design We fabricate custom tray Tooth \mouth preparation Secondary impression (Alginate) a-Secondary cast (Master ) b-Verification surveying and final design c-Block out and relief d-Duplicate master cast in Agar-Agar or Addition silicon - you get the REFRACTORY CAST made of Phosphate bounded investment material. e-Fabricate wax pattern f-Complete the investment process :sprout and investment g-Casting h-De-investment and cut sprouts i-Finishing and polishing metal framework Jaw Relationship record and Metal framework try in Wax try-in Mounting and teeth setting

Acrylic processing Finishing and polishing Insertion

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1- The initial survey and design are important to formulate the treatment plan. 2- Custom trays are not always necessary, they are necessary for distal extensions and marginal edentulous areas ,short bounded saddle areas don't require custom tray. 3- Mouth preparation in general involving extraction , tooth rest , guide planes (all discussed earlier ). If we are to do border molding we do border molding 4- The secondary impression is done using Alginate ,we need an elastomeric material we can't use a rigid material unless there's an edentulous area ,such as addition silicon ,dimensional silicon or Polysulphides 5- Points from e-f are done on the refractory cast. 6- We put a wax rim on the metal framework and we do Jaw relationship record in the same visit. 7- The acrylic processing is done on the master cast, mounting and teeth setting is on the master cast , the finish and polish is on the master cast; so the master cast after we do duplication we keep it.

Very quickly : Edentulous pt , we take primary impression ,using stock trays using alginate for primary impression ,we can use utility wax to modify alginate trays( different from edentulous ones). We pour it we end up with primary cast made out of stone , we do initial surveying and design , we use it have an idea about the treatment procedure. In the lab, you do custom tray (two layers of spacers near the teeth and one in the edentulous area ) we make final impression and we end up with final cast (master cast) type 3 dental stone or type 4 di-stone ; the final cast will have rest and guide planes on them ; this cast will have the right tissue contour to fit the PD ; the master cast I can't pour the metal ,because won't stand the temp. in Centigrade's it's very high necessary to do the casting ; So I do block out and relief ; shaped block out for the clasps
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 arbitrary block out to simplify the duplication relief to make room for the acrylic which decides where the internal finish line will be . In order to duplicate we need a special material , we usually use a silicon type material , additional silicon ,it's flow able and we use special molds to duplicate ; we end up with a mold which is a copy of the cast ;or we can use Agar Agar (thermoplastic setting ,while silicon chemical set); *Agar Agar is thermoplastic and hydrocolloid; water sensitive and can be re-used in the lab. While silicon can't be reused to do duplication but can be report ; ** Distinction : silicon can be used to make only one copy of one cast but I can pour it many times. Agar Agar I can be use to make copy of many casts I can mount it and use it many times but I can only pour it ones.

Now I have the mold , copy of secondary cast, I'm going to pour it in a material stronger than master cast which can withstand high temperatures. I'll use investments materials ( because the Co-Cr-Mo (CobaltChromium-Molybdenum) alloy has very high melting temp , so I use phosphate bounded investment . I mix it up , I have special liquid with high silica content ; I pour it up then sets and dries ;when I remove it ,sometimes the surface is not very hard,

there's a thin layer of something that shines on the surface; what I do to remove it? I have a hot bath of bees wax, when it's hot I soak cast in it and I take it out again, the surface will absorb some of the bees wax , it will make the surface harder ;technically can't scratch the cast even by mistake during wax patter , so I do hardening of my refractory cast with bees wax.

on the master cast , what am I going to do? I want to make the metal frame work , so what I do is the wax pattern ,there are special wax patterns fabricated by companies so we have : nice even thickness steeled sheet wax ,for the palate mesh work -latex work I-bar ginigivally approaching clasp -circumferential clasps inlay wax to make the rest and meet everything together ;

** In wax pattern we make the external finish line ; the internal finish line formed by the relief. Everything which is wax will turn into metal . The problem is , this is not like acrylic , I can't just make another mold and open it again , so what I do is similar to acrylic fabrication ,I need to make lost wax process but the technique which I use is the sprout technique ; instead of making two-part mold I make one part mold ;what I do is I place a sprout ( a conical sprout) ;the objective of sprout when it's completely enclosed in investment is to allow the wax to escape ,to evaporate and burn out and for the metal to go inside to fill the mold . So how do I do the mold? I put it in a mold former, I seal it ,I mix my investment in a similar technique which I used with stone (in a vacuum mixer )we pour it and we end up with something like a block ,but when I remove the funnel ,there'll be a space , then I put it in the furnace at high temperature approximately 1000 C . for 2 things: setting expansions, from chemical reaction of setting and thermal expansion , because when I increase the temp it will became larger And when my mold is hot the material (metal) will flow much easier ,if my mold is cold and I pour metal inside it , it will cool down before it goes to the details ;so I warm it to allow expansion to compensate for the contraction of metal when it cools * I heat it up to allow metal to flow inside it .

I need to machines to do casting, I need a machine to heat up my mold and another to melt the metal and pour the metal inside the mold . ** one is called the "CASTIING MACHINE " and the other is "CASTING FURNICE" . So I put the mold in the oven ;I leave it for several hours ,there's a special cycle to allow the wax to evaporate without destroying the mold. When it reaches the right temperature ,I take the mold out the oven and I put inside the casting machine ,in the casting machine either using a flame or using an electric coil ;the metal inside this container is heated and becomes liquid metal ; I need to get this liquid metal inside the mold (I don't hold it by hand ,there's a special machine) there are two basics techniques : 1- centrifugal casting force: it start rotating very fast so that the metal inside will flow outside the opening of the machine and it'll go inside the mold, inside the mold because it's rotating so fast, the metal goes in the details of the mold 2- vacuum casting ,(the air force will press on the metal pushing it inside; the air is hot air ); of course the machine is different from centrifugal.

The temperature source can be either flame or induction casting(electric coil) // The casting process is on the CD the Cr gave . After casting we'll move the mold from the casting machine and let it cool down, usually changes in color, it becomes white; inside it will be all metal ,so I'll tap it and inside I'll find something like to indicate where the sprout former were; I'll get the sprout and the metal casting .I use a special machine called "SAND BLASTER" ,is a very simple design, it has a tube with an opening at the top , with air pressure and Aluminum Oxide Abrasive container ..

the air will bring the Aluminum Oxide inside the tube and out of the tip it'll start shooting the aluminum oxide sand and we use it to abrade; the investment will become clean; if I use a bur maybe I'll hit the clasp or destroy the machine ,so the way I'll get rid of this investment I use the sand blaster (it's like sand storm that will remove this investment which become soft after heating ). Also the Aluminum oxide , if you take a look at casting ,because we need the temp around 1000C , look at the surface of the metal isn't shiny ,so the sand blasting of aluminum oxide will remove this strong oxide ,what oxide? What type? Cr oxide, we said we place Cr specifically for a purpose to protect co from other materials, so Cr oxide is more reactive than other materials, this is called passivity .This is why doesnt burn up in high temp ; the Cr oxide is protecting the rest of the alloy.

When we remove the layer of Cr. Oxide so we have a nice clean layer we end with something with less investment ; then I cut the sprouts. . Carbide Lathe bits , carbide is a very strong material ,( it's silicon carbide) ;we have to be very careful when cutting sprouts and working on the metal not to overheat the metal ; if you over heat the metal you will change the molecular structure and grain structure of cast alloy ,it will become softer, like annealing ,usually we cool it in cold water so it doesn't overheat. so we trim this ,we cut all of the sprouts we end up with a bottom,this excess we are allowed to reuse it in about 1/3one metal to 2/3 two metals ;Why? Because there are trace elements less than 1% , which are essential for smooth casting process ;so if I'm going to reuse this metal I need to give new trace elements.

There are bubbles on the surface? Because when I cooled my investment I wasn't too careful , you see where sprouts where attached you can see a very big piece of metal it doesn't look very nice ;it still requires very much work, I we spend very long time waxing it up I won't get a lot of problems. I start up using a carbide lathe bits ..After sand blasting you get rid of flasks and excess, then I'll start suing metal stones...

++ I have a variety of trimming stones use to do polishing of metal framework, they are a bit rough but they are not very expensive we can use them to do initial finishing of the metal; we have green stones and pink stones, they come in a variety of shapes ,sizes. After doing that we can use special tungesten carbide bur with high speed hand piece ,these are reusable ,they last for a long period of time but they are more expensive used for final finishing and polishing .come in different shapes and sizes..

** Do I do any trimming of fitting surface? i can only sand blast but can't do any finishing or polishing, I never touch this surface unless there's a defect. I just work on the polished surface . After that I use a variety of rubbery polishing tips , come in variety of shapes and sizes , show bands and breeds ;Ban material is what we remove ;is the material that does the polishing is not the rubber much as the material impregnated within the rubber; we have a rouge material and a green material ranging from medium green to very light one .Essentially we go through the stages of polishing ,step by step to get a higher and higher shine and the shine increase as the surface layer become more regular and shiner; metal is better to polish than acrylic ,remember when in acrylic we used the cloth wheel , cotton wheel ;with the cobalt chromium we can use something at higher speed ,so the brush of plastic bristles or natural bristles very strong ones, we put a polishing material like Tripoli or rouge ;

usually we don't do polishing on hand piece we do it on the trimming wheel ,it has a larger brush .using to larger brushes at relatively high speed we need to hold them, they'll cover a larger area but for details we can use the smaller brush ;still will not give us the highest shine possible ,we need a higher shine and we need to polish the internal surface ; in order to do this we need to do something called "ELECTRO POLISHING" .

Is a container with concentrated acid solution, we put the metal framework inside and there's an electric current and raw copper plates ;there'll be an electric current which will remove metal ions from the surface of the metal ,it will remove one or two layers of molecules from the internal surface and external one and by removing those layers it will give a high shine to the Co-Cr so it looks like it's nicely polished. The final shine needs an electric current to be achieved.. if we overdo it we destroy the framework ,it dissolves ; usually we leave for 5-15 min depending on the size of metal framework ;

The bead line at the edge is very shallow , it digs into tissues but it won't irritate. At this stage : *the refractory cast is destroyed during processing but I still have the master cast with the block out; I put the master cast in hot water , in a dewaxer, to remove the wax on it and I end up with my master cast without any wax on it.

The metal framework is ready to fit master cast and I put wax rim to do jaw relationship record and fitting in to the clinic ,go back to the lab and do mounting and then set teeth in wax. Notice: The wax is flush with the top surface of the metal ,the external finish line, and in the inside I'll place wax in the inside so it's flush with the internal finish line. The internal finish line goes all the way adjacent to the tooth ;you can see there's metal between the guide plane and acrylic. So in the final denture, the acrylic and the metal will be flush; and between the guide plane and the metal is flush.

How do I get the acrylic on the metal? I need a second lost wax technique, I have two choices for the process: 1- Conventional technique , essentially set the teeth ,place the metal ,put in flask , cover everything metal with plaster and stone ,just
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expose the wax and teeth ,then pour a second layer which will go over wax and teeth ,only the meshwork for acrylic will remain exposed(as acrylic PD I want to cover everything except teeth ) ; so after painting with Cold Mold seal-a variety of Foil substitute , I mix my acrylic and at dough stage and I close my sandwich , I wait for curing and I open the flask and get my acrylic denture , I do finishing and polishing ,then I'll be ready to try in the prosthesis . 2- The second technique doesn't involve processing ,we make a quick mold ,not a flask mold; using the normal technique from adding teeth , I add wax over the meshwork over and below, I do wax rim and I get teeth and set them seal them (done mounted on articulator) ,as we did previously ,we do smoothing and polishing and I have a wax PD .

Quick mold: I make an index , I can use putty or plaster just to know where teeth are; Place separating agent on stone ,like Vaseline;I can make a mold in two ways : 1- I can use putty ( additional silicon putty , there're four consistency of silicon light medium heavy and putty ; putty is most usually mixed by hand ) I place catalyst mix it until becomes homogenous and then I'll make an index on what I have on facial aspect. Essentially this is going to relate the teeth to the index so I can remove the index and teeth and wash out the wax, instead of doing flasking packing dewaxing ; I just do this quick mold , how am I going to get acrylic in ? I just place the acrylic by sprinkling method , soltem poweder technique; i don't like to use putty because it's difficult to control ;

2- the other way to do this , which is probably cheaper and more comfortable , is to make plaster index. ; we make the index out of plaster (I'm going to mix slurry water- Terra Alba , ) .

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So either I use putty or plaster , most of people use plaster because less expensive and easier to use. usually the setting time for this material is about 4-5 min in mouth , it's colder outside the mouth so it'll take a little bit longer. After setting I remove it I'll have an index on it , it's like the second mold in flasking process ,like the top part of the flask .So I take teeth and put them in the index and wash away the wax.. The dr. used plaster rather than putty.. So we put plaster on the facial surface; wait it to set; then I remove the index, remove the wax ,and attach the teeth to the index and wash away the wax then we are going to put Tin foil substitute on the cast . We use slurry water to make the plaster set faster. Two other methods make setting faster: warming and mix for a longer duration of time and faster (the more crystals you create at the begging the faster it'll set). The type of acrylic I'm going to add is not the conventional one; I can add it with a brush I'm almost painting it on.

So I can add acrylic incrementally in 3 ways: 1- Brush it on 2- Sprinkle it on 3- Mixing ,like heat cured acrylic *Since the acrylic used is not heat cured it's cold cured, so one methods allows me to add acrylic to it ; it's called bead brushing ,(acrylic powder and cold cure acrylic called monomer) ; you pick up small beads of the liquid ,touch the brush, touch the powder with the wet brush and fix on the bead of acrylic and then you can paint it on and add it incrementally to the acrylic. This type of acrylic has the same stages of heat cured acrylic , but here we are using it in wet-sandy stage. To keep the brush clean I touch the monomer, and I shape it to the shape I want. This is one technique to make small additions . *the other way is the spinkle technique : it's a bit different, it's like a salten paper ; so the monomer is like the salt , I drop some monomer on the surface ,which I'm going to add to ,and then I sprinkle on some
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powder incrementally , I add some liquid and I add some powder layer by layer until I get the final shape which I want .(this is the most common technique to make orthodontic retainers). *The third technique is to mix it ;I have the monomer : I add powder to the monomer and it'll go through all the stages we talked about :wetsandy , sticky, I take it out when it reaches the dough stage fixed it and do packing . we wait it till it become hard , hard enough to remove it without fracture . So we remove the teeth; remove the wax and we use our index to proceed back where we was. I push each tooth in its specific location; on the cast I need to place a separating agent . I mix acrylic , pour it and squeeze my index to create my PD .I remove the excess

Cold cured acrylic if I leave it exposed to air, not closed flask, the monomer will evaporate, so to accelerate the set and to prevent the monomer we put it inside a pressure bar at temp of 35-40 C and under at least 2-2.5 atmospheric pressure .Like the one we used last semester. 2.5 Bar is enough to prevent the monomer from evaporating; normally we wait about half an hour.

Cold cure even if you place it in pressure bar at temp of 35 C ,you usually end up with some remnant monomer , so when you put it in patient's mouth it can irritate the mucosa ;also because packing Is done with hands the position of teeth is not going to be that accurate so voids accumulate inside the fitting surface; -We use 2.5 bar to make sure there are no voids in it but the problem with cold cure acrylic is even if we do this there maybe some remnant monomer, not like heat cured acrylic in flask... Usually we wait for at least half an hour but the initial set star after 5 mins. ** When there's remaining monomer, this means it will leave some collagen fibers from the denture base which will pick up stains and make the material weaker.
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So we get our PD and the index because teeth on the index, using putty , might slightly move, I can put some wax to fix it. In this procedure there's more polishing to do than packing method .I trim away the excess and do polishing and I end up with an acrylic base . **So I can add acrylic using heat cured acrylic or cold cured acrylic;Either using a brush technique, bead crush or I sprinkle it on or I can mix it and pour it . And you'll get the final Prosthesis.

THEN THE DR. TOOK GROUPS TO THE CENTRAL LAB TO SHOW THE CASTING MACHINE. Done By : Sara Ibdiwi .

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