Lab Protocols | Impressions | Custom Incisal Guide Table | Lab Processing Time

Lab Protocols

The Professional Services Laboratory is located on the 3rd floor in room 333. This is where you drop off and pick up lab work.

Monday – Friday               
8:30am – 12:30pm, 1:30pm – 5:00pm
*Closed for lunch every day from 12:30-1:30.

Submitting Lab Work

Each lab item has specific requirements for submission to the lab. Here are some general guidelines:

• Submit all necessary materials for the lab item you are requesting (e.g. a crown requires that you submit mounted diagnostic  casts, a master cast, a custom incisal guide table when indicated, and a wax-up of the desired crown).
  • Impressions must be disinfected and submitted in a plastic bag labeled with your patient’s last name and student #.
  • All casts must be labeled with your patient’s last name and your student #.  
• Submit a lab prescription form signed by a faculty member.  These forms can be found at the clinic reception desk. Please fill out with black or blue ink only.
• Enter the lab item into axiUm before submitting to the lab.
  • If any notes are added to the comment section on your lab form, please add them to your lab axiUm form.

Open the patient’s EHR.

• Click on the Labs tab.
• Click the Add button to add a new entry. If the case is ongoing, it must be continued on the same lab order.
• Find the lab item you want processed from the list of approved items in your patient’s treatment plan. Enter any relevant notes (e.g. “Please process PFM crown for #19 in shade B1 with metal collar and full porcelain occlusal”).
• No faculty swipe is required for the axiUm form – just make sure to move your notes down to the bottom of the form each time you add notes (e.g. a partial denture requires you to submit the same project multiple times, once for processing of the metal framework and again for processing of the acrylic. You should add to the same lab axiUm form each time). The details field is for the PSL staff to enter information. 
• To track your lab item, refer to your entry in the patient’s EHR under the Labs tab.
  • When your  submission  has  been  approved  for  processing  the  status  will  say  OUT.  You  may check the estimated due date in the lab order. This is the expected due date that is assigned to the case to return by 5 PM.
  • When it is ready for pick-up, the status will say IN. You will also receive an axiUm email.
  • Please note: you will NOT receive an axiUm email when or if the due date is changed.  It is in your best interest to check the due dates as your appointment with your patient draws closer.

Work Schedule

Each lab item requires a specific number of working days to be completed. Please keep this timeframe in mind when scheduling patients for subsequent appointments. 

Cases will be delivered from the outsource labs on the due date by 5:00 PM. If you have night clinic on that date, you can safely schedule an appointment for your patient. Otherwise, always schedule your patient for the next day. Relines and repairs sent in by 10:30 AM will return at 4:30 PM the same day.

After you receive an axiUm message indicating that your case is out, the due date will indicate “changed.”  This new date is the date the case is scheduled to come back from the lab.

All immediate denture cases have a 2nd set up and have to be evaluated before processing.  All RPD impressions require custom trays.  

Impressions

Standard Impression Protocols

• Full arch stock trays required for your first four final impressions.
  • Putty wash is acceptable with Splash putty and light body PVS.
  • Putty wash is a two step-technique where putty is set to the arch shape prior to beginning the final impression. 
• Full arch stock trays required for all multi-unit cases.
• Full arch stock tray required for all indirect competency impressions.
• If stock tray does not fit, a perforated custom tray is permitted (1 material / light body PVS only).

Quad and Triple Tray Protocols

• Quad and triple tray impressions are only allowed after the completion of 4 full arch cases. 
• Only allowed on single posterior units with adjacent teeth and proper occlusion. 
• Must capture 4-5 teeth including the canine.
• Cannot be used on terminal teeth in the arch.
• Last tooth in the arch must maintain a vertical stop.
• There must be stable occlusion with multiple stops after the tooth has been prepped. 
• Prep index with opposing tooth is required. 
• Cannot be used on a tooth involved as an abutment for RPD.

Custom Incisal Guide Table

• Required for first 4 cases.
• Required for all cases involving canine prep.
• Required for all cases involving 2 or more teeth. 

Fast Track Single Unit Crowns

• Only after 4 full arch impressions of fixed prosthodontics have been completed.
• Only allowed on single unit posterior teeth (no anterior teeth, including cuspids, allowed).
• Prep index required capturing the opposing tooth and two adjacent teeth.
• Preparations involving terminal teeth are not allowed. 
• Cannot be used on a tooth involved as an abutment for RPD.

Trios Digital Scanning

• After Trios Pre-clinical Hands-On training, delivery of 4 indirect restorations, and passing 1 final impression test case.
• Full arch maxillary and mandibular scans with bilateral digital bite registration will be taken for all restorations. Prep index should be taken for additional verification.
• Should not be taken when: margins are very deep subgingival, limited mouth opening, unable to isolate adequately, unstable occlusion, severely tipped teeth. 
• Must work with appropriate faculty for scanning (attachment below).
• Must complete Axium Lab Rx form, Pacific Fixed Laboratory form (paper) recording the trios unit number (1 – 5), and the Trios Rx form.
• trios_clinic_protocols.pdf File Size: 83 kb

Custom Incisal Guide Table

The Following Sequence of Steps Should Be Followed to Make a Custom Incisal Guide Table

1. Mount the patient’s master cast against the opposing diagnostic cast in maximum intercuspation (MI).
2. Take a stock incisal table and notch the rim in a small area with a bur, so that the lab can tell how to orient the guide table.
3. Mix and use only 1/4 of the Splash putty (the rest of the package should be saved for future use) and place material in the incisal stable so that the putty reaches the rim of the table and reached across the whole surface. Putty should lock in.  
4. Close the articulator with the condyles locked so the incisal guide pin penetrates through the putty and strike the top of the table. This establishes the home position which represents MI.
5. Open the articulator and release the condylar locks. Position the casts so the incisal edges are now touching as in straight protrusive position. Confirm the teeth are touching as you move the maxillary cast to home position. This establishes the straight protrusive incline on the custom incisal guide table.
6. Open the articulator and position the cast in a right lateral edge to edge position. Move the maxillary cast to the home position making certain the teeth are touching. This records the right lateral incline on the guide table.
7. Now repeat on the left side.
8. Now you have recorded the protrusive, right, and left movements.
9. Now record all the lateral protrusive movements by moving the cast between MI, protrusive, right lateral, and left lateral movements. Repeat the movements to establish a smooth incisal custom guide table. Trim off excess.
10. After completion of these steps, all of the functional patterns have been recorded for the patient.