A triple tray for impressions

by Michael DiTolla, DDS, FAGD

Since my son plays ice hockey, he pretty much needs a new PlaySafe® mouthguard (Glidewell Laboratories; Newport Beach, Calif.) every season.

He needs a new mouthguard particularly from the incessant chewing while he is on the bench, not unlike a dog with rawhide. You would think he would take better care of the mouthguard, considering how much he dislikes have the impressions taken every year.

When it comes time to take the impressions, it does not seem to matter if we use alginate or an alginate substitute material; there seems to be a fair amount of gagging. I think the gagging is dependent more on the tray shape than the tray material itself.

Somehow the Alfa™ Triple Tray® (Premier Products Co.; Plymouth Meeting, Pa.) has flown under my radar for a long time. But my son and I are quite pleased that I stumbled upon it recently.

The Alfa tray is a specially designed triple tray for taking simultaneous full-arch upper and lower alginate, or alginate substitute, impressions. From the patient's point of view, the number of impressions taken goes from two to one (Fig. 1), which is important for anyone who gags or is nervous about gagging.

Fig. 2 (left) and Fig. 3

Also, because these trays are manufactured without a palate, the patient's tongue is allowed to sit in a position where it can block impression material from traveling down the throat (Fig. 2). As a result, patients do not get that panicked look on their faces when their protective reflexes are being challenged, as with typical full-arch metal or plastic trays.

Since the Alfa trays are available in small, medium, and large, we are able to accommodate nearly every patient with one impression rather than two (Fig. 3).

So here is my current protocol for my son and other concerned gaggers:

1. Have the patient do a 45-second swish with DYC rinse (Steven's Pharmacy; www.stevensrx.com, Costa Mesa, Calif.). This topical rinse provides 20 minutes of anesthesia to all the soft tissues in which it comes in contact.
2. Try in the Alfa tray to determine the proper size. The medium fits nearly 90% of my patients. Try it in, and have the patient bite down all the way as he or she will for the actual impression.
3. Mix the alginate substitute and fill both sides of the tray, slightly overfilling the maxillary anterior region (especially for mouthguard impressions). Seat the Alfa tray as though it were just a maxillary impression, and then have the patient bite all the way down.
4. When the material has set, press down on the buccal ledges of the tray (Fig. 2) as the patient pops his or her teeth apart. Remove and inspect for accuracy.

We now use the Alfa trays to take impressions for athletic mouthguards, snoring appliances, nightguards, bleaching trays, and custom trays. Considering how long I have been using double-arch impressions for simple crown-and-bridge cases, I am a little embarrassed that it took me this long to embrace the same patient-friendly technique for alginate impressions as well. Better late than never!

Michael DiTolla, DDS, FAGD, is the director of clinical research and education at Glidewell Laboratories in Newport Beach, Calif. He lectures nationwide on both restorative and cosmetic dentistry. Dr. DiTolla has several free clinical programs available on DVD through Glidewell Laboratories or online at www.glidewelldental.com.