Evaluation and standardization of impressions in complete dentures/ orthodontic practice

EVALUATION AND STANDARDIZATION OF
IMPRESSIONS IN COMPLETE DENTURES
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

INTRODUCTION

The subject of complete denture deals with one of the
oldest problems of dentistry .It was discussed argued
over,and written about long before the cast gold
inlay,porcelain jacket crown,and most of the other
branches of dentistry.there have been volumes written on
the subject,yet it remains a very vital issue

The subject of impressions has been a highly controversial one ,and
unusual as it may seem,could still be a subject for a very interesting and
scientific moot.The proper approach for such a study should be from the
stand point of the resilient soft tissues.It should not be from the stand
point of mycology or osteology nor of the merits of a technique to
promote another impression material.One minute ocular and digital
examination of a partially cupped hand will quickly remove or clarify
the mystery ,since the palm and fingers simulate the tissues of the oral
cavity .It is obvious that a proper technique for develoing a mandibular
or maxillary denture into a physiologic appliance should be one that
manipulate a surplus of soft impression material to contact ,flow and set
with a minimum of abnormal relationships or derangement of soft
tissue.Additional retension may be obtained by beading the cast and a
accurate post palatal seal.
To get a proper impression ,the anatomy ,bone foundation is
very important.the impression material and various impression
techniques also play a role in getting a good impression.www.indiandentalacademy.com

Defination;Acomplete denture impression is the negative registration
of the entire denture bearing ,stabilizing and border seal areas of either
the maxilla or the mandible in a plastic material that becomes
relatively hard on set while in contact with the tissues.

There is no fixed numbers of steps.A great deal depends on the
amount of care given in any one step ,one or several corrective
procedure may be used .No given jmpression at a given time is
inviolate .It is the operatives judgement which permits at all times to
modify the impressions or denture base

IMPRESSION OBJECTIVES:
In an impression technique for complete dentures ,the procedure must
strive for 5 primary objectives.
1]PRESERVATION: Preservation of the remaining residual ridges is 1
objective .It is physiologically accepted that with the loss of the
stimulation of the natural teeth the alveolar ridge will atrophy and
resorb.
2]STABILITY: Close adaptation to the undistorted mucosa is most
important .Stability or resistance to horizontal movement ,decreases
with vertical height of the ridges or with the increasein flabby movable
tissues.
3]SUPPORT: Maximum coverage provides the “snow shoe
effect”which distributes applied forces over as wide an area as
possible .This helps in preservation,stability and retention.

4]ESTHETICS:Border thickness should be varied with the needs of
each patient in accordance with the extent of residual ridge
loss.The vestibular fornix should be filled ,but not over filled ,to
restore facial contour.
5]RETENTION:Retention is most often given consideration than is
necessary .It should be readily seen that if the other objectives are
achieved ,retention will be dequate.atmospheric pressure adhesion
cohesion ,mechanical locks,muscle control and patient tolerance
affect retention.

DIFFICULTIES IN IMPRESSION:
1]OVER EXTENSION:If impression is not properly controlled and
if the metal tray is to long in flanges it over extends the impression.
2]UNDER EXTENSION:The movement of facial musculature and
the tongue into positions which the tissues never assume in natural
activity has a tendency to under extend the denture base area .
3]OVER COMPRESSION:A metal tray that is not uniformly adapted
to represent the tissue contour of the mucosa very frequently begins
to compress tissue by contact with the metal .The proper adaptation
of a tray to the tissues to be treated in an impression procedure
cannot be over stressed .And addition of more impression material to
an impression with out adequate preparation of the surface for the
reception of additional material.
4]DISPLACEMENT:Mostly happens when movable tissues are
present and they usually force the denture from its seat.www.indiandentalacademy.com

CLINICAL ANATOMY
It is important to determine the clinical anatomy (the so-called
“functional” anatomy) before the impression procedures are started.
In impression procedures, one deals not with origins and insertions of
muscles but with the resistance or non resistance and with the
movement or lack of movement of tissues. Thus, by examination,
one determines the denture bearing area. It was once thought that a
denture-bearing area should be supported solely by alveolar bone.
Today, we recognize that alveolar bone is only one part of the
denture-bearing structures and that the denture bearing area may be
extended over onto muscle tissue,as in the soft palate, and in the
region of the buccinator attachments along the external oblique ridge.

There are instances in which patients have had considerable
resorption, and, as a result, the buccinator musculature is almost
attached to the lingual mucosa. It has been clearly established that
dentures can rest on muscle tissue, provided that the action of the
muscle tissue does not displace the denture. It is this latter
observation, rather than the fact that the muscle is soft instead of
hard and unyielding like alveolar bone, which determines whether
or not a muscle shall be under the denture-bearing surface. One
must be firmly impressed that muscle can be a denture-bearing
surface.
In addition to employing muscle tissue as part of the denture-
bearing structure, emphasis should be placed upon the polished
surfaces of a denture as they relate to the remaining muscle
structures of the oral cavity. The contours of the outer surfaces of
a denture must be so molded to the softtissues that the action of
these tissues tends to seat the denture and not to unseat it.

The clinical anatomy associated with impression procedures falls into
three areas of consideration: histologic considerations, gross anatomy,
and factors of biophysics.Histologic considerations.-The denture-
bearing area is a keratinized mucosa capable of resisting, without
abrasion and ulceration, the forces and the mild traumas subjected to it
by occlusal force. The firmly attached submucosa provides a firm and
stable base for denture bearing. The submucosa related to the edges of
a denture is sufficiently movable and yielding that when muscles move
and tug upon the flanges the mucosa does not immediately displace the
denture base.


A nonkeratinized mucosa lies on the vestibular fornix and on the
cheek surfaces. Beneath this mucosa lie glandular tissues, mucous
and serous glands and a wide assortment of connective
tissue,ranging from the loose areolar to the firm elastic to the
nonelastic types of tissue. Finally, we find fat, tendon, muscle,
and periosteum lying between the submucosa and the underlying
bone collectively, these hard and soft tissues make up the
supporting structures for the denture. It is the position of these
tissues which we must contend with in our procedures.
One must consider the disposition and distribution of mucous and
serous glands and the character of the vascular system which
provides nourishment to the tissues. When the circulatory system
is poor, tissue ulceration and tissue inflammation are frequent. On
the other hand, diminished pain perception is found associated
with vascular phenomena so that marked ulceration, together with
considerable inflammation and pain, develops.

The statement that the diminished sensory phenomena give
rise to pain appears to be contradictory. Actually , however,
because patients do not feel the mild traumas and do not
complain about them, the ulceration becomes deep and then
becomes infected and
inflamed; only then ,when a serious ulcer has developed, does
pain occur. On the other hand, there are patients in whom no
ulceration appears and yet pain is chronically present
and there appears to be a hypersensitivity. The response to
pain is a complex phenomenon and depends upon many
histologic , anatomic, and psychologic factors.

Gross Anatomy – The gross anatomy of the oral structures
involves several clinical areas
which must be understood: (1) the posterior palatal area in which the
muscles of the soft palate and the character, duration, and vigor of
their movement help to determine the posterior border of a denture:
(2) the hamulus, which should be located accurately in order to relate
the posterior edge of the maxillary denture to the buccal flanges; (3)
the tongue and the floor of the mouth as the tongue position changes
(the sublingual flanges of a mandibular denture and the distolingual
extension of a mandibular denture are both related to the action of
these structures); and (4) the orbicularis oris and the
commissure,which are important to the archform and to the labial
flanges.

Factors of Biophysics – Retention and stability are the two major
phenomena with which the dentist is concerned in the development of
an impression. As indicated previously retention is essentially
associated with the impression. Some or the biophysical considerations
are those of adhesion and cohesion,atmospheric pressure, the chemistry
of saliva,quality,accuracy, and fidelity of the impression materials,
and finally the consistancy of the form and contour of the denture base
material employed in the completed denture.
The physical properties of both the biologic and the nonbiologic
contributors collectively govern the degree of retention. The stability
of denture is a broad phenomenon to which retention is only one
contributing factor .Thus, in attempting to achieve stability, one
should increase the size of the denture-bearing area to obtain greater
retention.The second compressibility of the soft fibrous tissue,the
mucosa,the submucosa, and the glandular substances.The more
immobile the supporting tissues are the more stable a denture will be.

An additional factor is the relation of the musculature to the polished
surface of a denture.If the activity of the musculature is contrary to
maintaining the denture in intimate contact with the tissues,then
retention and stability are diminished.Another factor is the arch form
and the disposition of the occlusal plane.In the impression procedure,
these phenomenon are not fully exploited,since the stage of occlusion
and outer contours has not yet been reached; however, one can
anticipate them and choose border maxillofacial structures which must
be confronted and understood in and impression procedure are as
follows:
1]Muscles of mastication: Temporal,masseter,internal pterygoid,and
external pterygoid muscles.
2]Facialmuscles:Orbicularisoris,mentalis,incisiveinferior,triangularis,ri
sorius,buccinator ,zygomaticus,caninus,incisive superior,and quadratus
superior

3] Muscles of the palate: Asyygosuyalae, palatalgossus,
palatalpharyngeus, tensor palati and leyator palati.
4]Muscles of the pharynx:Superior constrictors, middle constrictors,
inferior constrictors, salpingopharyngeues, stylopharyngeus and
palatopharyngeus.
5]Muscles of the tongue:Intrinsic muscles (which have no bony origin
and alter the contour of the tip and blade of the tongue)-
superiorlongitudinous, inferior longitudinous, transverse,and vertical
fibers;extrinsic muscles of the tongue (move tongue about,having one
insertion in body of tongue and other insertion on bony skeleton)-
genioglossus, hyoglossus, palatoglossus, styloglossus and
chondroglossus.
The activity of this musculature helps determine the flanges of both the
maxillary and the mandibular dentures.the skeletal elements provide
supporting base.The mucosa, submucosa, glandular substances,and fat
tissues provide only contour to the surfaces which can be modified by
the tension of the muscles.

VARIABLE FACTORS ASSOCIATED WITH IMPRESSION
PROCEDURE
These include number of impression materials each having their own
manipulative qualities,patient with individualized anatomical variations
and the dentist with his ability and experience .
RECORDING OF PRILIMINARY MANDIBULAR
IMPRESSION:
There are 3 advantages to making the preliminary mandibular impression
first .
1]a special acrylic or vulcanite tray must be prepared for the final
mandibular impression.
2]If a metal base to be constructed for the mandibular denture ,the time
required for this will furnish an additional healing period for maxillary
tissues.

Marking the Border of the Mandibular Custom Impression Tray
The initial border of the mandibular custom tray should be 1 mm shorter
than the anticipated functional border of the finished prosthesis, all
around the periphery. The oblique ridge usually can be visualized on the
preliminary cast, and the initial tray border should be 1 mm short of this
inferior attachment of the buccinator muscle. The retromolar pad area
must be fully covered. If the mylohoid groove is visible, the tray will
extend approximately 1 mm beyond it.
Mark the border of the mandibular impression tray on the preliminary
cast as described. A single thickness of baseplate wax can be placed over
the crest of the ridge and retromolar pads to ensure that pressure is not
exerted on these areas. Undercut areas should be blocked out to avoid
tray beakage and to ensure patient comfort curing insertion and removal.

3]As a rule the patient experiences less discomfort during the making of
a mandibular impression than during the making of a maxillary
impression.by making the mandibular impression first the dentist may
provide a psychologic benefit for apprehensive patients.
In the preliminary impression made from impression
compound,observations are made of the anatomic landmarks and of the
distance from the crest of the ridge to the reflective border tissues while
the mouth is relaxed and about half open and the tongue is elevated
slightly .This distance is out lined in the preliminary tray .

The labial ,buccal and lingual flanges are knife trimmed about 2mm
short of this out line .The labial flange should be approximately 3mm
thick .The buccal flange should be about 1mm thicker and reflect the
external oblique ridge and masseter grooves .The lingual flange
should be approximately 3mm thick in the anterior region ,slightly
thicker and sloping lingually in the region of mylohyoid ridge .
Distal to the distal end of mylohyoid ridge ,the flange should be about
4mm thick turn laterally towards the ramus and extend to the
retromylohyoid curtain at the back end of the alveolingual sulcus.The
lingual surface of the lingual flange should conform to the shape of
the soft tissues which are affected by the mylohyoid muscle when the
tongue is elevated ,all undercuts below the mylohyoid groove should
be removed .The impression surface of the lingual flange in this
region is knife trimmed to make the inside slope toward the tongue at
about a 45degree angle.

The buccal flange should extend as far as possible with in the
anatomic limitations of the mouth and completely fill the buccal
pouch because this flange will serve as one of the main stabilizers
of the mandibular dentures.the buccal surface of the flange should
face upward and outward .The labial flange separated by labial
notch are developed with 3 objectives in mind .
1] To provide proper thickness for esthetic consideration
2] To establish a guide for seating the tray for the final impression
3] To perfect the labial border seal .
The distal extension of the lingual flange should fill the
retromylohyoid space when the impression is in place and the
tongue is thrust out.

LOWER FINAL IMPRESSION:
The clear acrylic resin tray is inserted into the patients mouth and tested
for retention .the patient is told to move the tongue outward ,to each
cheek and to the palate .The tray should not dislodge by any of these
movements .The ZOE paste is loaded in the tray and seated in the mouth
with light but positive pressure .The following movements have to be
done to achieve the correct record .the patient is told to move the tongue
outward ,side to side ,and to the roof of the mouth ,lower lip upward and
inward as if drawing on a straw and to draw the cheeks inward .These
steps must be done carefully because ,if the impression material is
allowed to harden too much ,it will be impossible to record the border of
the lingual flange accurately .Likewise if the paste is too plastic the
lingual border will not be accurate because the structures on the floor of
the mouth will squeeze the paste lingually .The impression paste must be
just fine enough to offer resistance to the movements of the muscles in
the floor of the mouth to form an accurate border roll .The Final
mandibular impression should be removed once the impression is set to
get the best of the result .

Check List for the Completed Mandibular Impression
The mandibular preliminary impression should be free of voids
and provide detailed reproduction of all of the following:
•Retromolar pad
Sublingual areas
•Vestibular areas
•Labial and buccal frena (if applicable)
No inner portion of the tray should be visible through the
material.

Creating the Sublingual Roll
Adding impression compound in the retromylohyoid area (posterior
sublingual) will compensate for necessary blockout of the custom tray
and will also extend and thicken the border to form a 3-6 mm thick roll.
To ensure the border does not impinge on the tongue space, softened
compound is added to one retromylohyoid area and tempered. When the
tray has been seated with care to avoid distorting the soft compound, the
patient gently extends the tongue to touch the opposite corner of the
mouth. The tray is then removed, material is added to the opposite side,
and the manuever is repeated for the opposite corner of the mouth.

The tray is then removed, material is added to the opposite side, and
the manuever is repeated for the opposite corner of the mouth. To
ensure the anterior lingual and midline extensions do not impinge on
the salivary caruncle and lingual frenum, softened compound is added
to this area and tempered, the tray is inserted, and the patient is
instructed to push the tip of the tongue against the anterior crest of the
maxillary ridge.When border molding is completed, all excess
compound on the interior surface of the tray is carefully removed with
a sharp #11 scalpel. Particular care must be taken in the vicinity of the
retromolar pads, which are readily distorted by excess compound.
Checking Border Function
Observe the patient in normal jaw, tongue, lip, and cheek functions.
The fully border-molded tray should remain stationary during normal
function. Buccal and labial extensions should not be palpable when the
dentist runs his or her fingers superiorly from the inferior mandibular
border. www.indiandentalacademy.com

Filling the Custom Impression Tray
The pooling of saliva in the floor of the mouth mandates some
additional measures for minimizing the impact of the fluid and
places restrictions on choice of material for the mandibular final
impression.
One approach for saliva control is for the dentist to instruct the
patient to swallow all saliva, as the impression material is being
mixed and loaded into the tray. The command is repeated a total of
three times before the tray is inserted. A second approach is to place
a 4x4 gauze sublingually and leave it in place while the tray is
readied for the mouth; the gauze is removed immediately as tray is
seated. Use of a saliva ejector prior to inserting the impression may
also be effective.

Because gravity works against the material being
retained in a mandibular tray, and because of the
difficulty in ensuring a totally dry field, the ideal
impression material for the mandibular final impression
should be a viscous, thixotropic, hydrophilic material.
If a tray adhesive is needed for the selected material, it
should be applied and allowed to dry. The impression
material is then mixed and added to a thickness of 1-2
mm over the internal surface of the tray, covering the
external aspect of all extensions 3-5 mm.

Blockouts
Relief between the custom tray and the preliminary cast is
achieved by selectively placing small amounts of wax on
strategic areas of the cast. Relief is provided for undercut
areas, to minimize likelihood for thin areas in the final
impression, and to allow free flow of the impression material
from areas of excess to areas deficinet in material.
Blocking out undercuts with wax will facilitate separation of
the impression from the master cast and make the patient
more comfortable during insertion and removal of the tray.
For the maxillary tray, a single thickness of baseplate wax
can be placed over the palatal suture and anterior crest of the
ridge to ensure even flow of the material and to prevent
pressure spots.

PRILIMINARY MAXILLARY IMPRESSION :The initial
procedures for making the preliminary impression are similar to these for
the mandibular arch.the compound tray is knife trimmed to resemble the
approximate size of the finished denture .following the contours of the
anatomic structures ,a pencil outline is made along the borders 2mm.
FINAL MAXILLARY IMPRESSION: The tray is held in place with a
light pressure from the index finger of the right hand in the center of the
tray anterior to the posterior palatal seal .When the paste begins to lose
its shiny appearance and assumes a dull ,velvety sheen ,the borders of
the impression are molded.In order to perfect the border near the buccal
notches ,the cheek is grasped below the buccal frenum and pulled
downward backward and forward .This procedure is repeated for the
other side .Labial notch is developed by gently grasping the lips at the
philtrum same 2 fingers and gently elevating the lip straight upward
downward and forward . The distobuccal flange borders are moulded by
stroking the cheek downward ,then patient is asked to move the mandible
left to right

ACRYLIC RESIN TRAY: The construction of an accurate tray is the
key to developing an accurate impression .The choice of the Corrective
impression material is of secondary importance if the tray is functionally
accurate .such a tray must be designed and shaped to resemble the
outline of the completed denture .It must be modified with relief areas to
provide sufficient space for the impression material, so that it may
control and record the shape of all of the anatomic structures during
function and without displacing them.
Marking the Initial Border of the Maxillary Custom Impression
Tray:The border of the custom tray prior to border-molding should be
shorter than the anticipated functional border of the finished prosthesis: 1
mm short of the depth of the vestibule and 2 mm short around frena and
muscle attachments.The posterior extent of the impression tray should
extend 2-3 mm beyond the vibrating line, in order to later provide
adequate visualization and marking of the posterior palatal seal and the
pterygomaxillary seals.The initial border of the maxillary impression
tray is marked on the preliminary cast prior to fabricating the tray.

Loading and Inserting the Tray:The maxillary final impression should be made with a low
viscosity paste, and for that reason zinc oxide-eugenol is an ideal impression material. However,
the use of zinc oxide-eugenol paste is contraindicated in older patients as it can be irritating to
the palatal mucosa and fragments of the set impression material pose a possible aspiration threat.
Polysulfide or polyvinyl siloxane materials are more appropriate materials to use for the older
patient and for the patient with a notably dry mouth or impaired cough reflex.The impression
material base and catalyst are mixed together to form a homogenous paste. The mix is carefully
and quickly applied to a uniform thickness of 1-2 mm all over the internal surface side of the
maxillary custom tray. The functional borders should be covered inside the tray and 3-5 mm
outside the tray.The patient is instructed on his or her role in the impending procedure. A gentle
wiping of the roof of the mouth with gauze will removed adherent, mucinous secretions. A small
amount of the impression material can be swiped into the anterior depth of the palate on a finger
tip. The tray is then inserted and centered in the anterior, then seated posteriorly and finally
rotated anteriorly with gentle pressure. Excess material expressed behind the away with a
posterior extent of the tray is immediately swiped.

Evaluating the Maxillary Impression Tray
The properly selected stock maxillary impression tray approximates the
shape and height of the ridge and adequately covers the tuberosities. To
compensate for an extremely high palatal vault, deep vestibules, or wider
tuberosities, the impression tray can be bent as necessary; or wax or
compound can be added to extend the tray or to fill large voids between
the tray and the anatomy (e.g., a very high palatal arch).By standing
slightly behind the dental chair, the clinician can readily seat the
maxillary impression while retracting cheek tissue. When a patient
presents with an exceptionally high vault, impression material should be
placed gently into the vault area prior to taking the impression to avoid
entrapping air. For the patient with a strong gag reflex, the patient should
be seated upright and be cautioned not to breathe through the mouth.he
impression tray is positioned beneath the ridge by centering in the
anterior region. The posterior is seated first and the tray is rotated
anteriorly. This technique will avoid trapping air and will minimize
excess alginate flowing to the back of the throat.

The Completed Maxillary Final Impression
When set is achieved, the custom tray is removed with abrupt downward
force. Trays not displaced in this manner may be retrieved when the
patient gently closes the mouth and the dentist breaks the seal by
inserting a finger tip posterior and lateral to one of the tuberosities.
Another approach is for water to be sprayed from the syringe along the
lateral periphery, and then the patient is instructed to close the mouth
and forcefully puff out the cheeks. The final impression should reveal a
highly detailed negative likeness of the denture base tissue surface. All
frena should be visible. No portion of the tray should be visible on the
internal surface of the impression. In this example, small voids in the
posterior palatal surface are due to mucous secretions from the palatal
salivary glands.

READING THE IMPRESSION
It is common for tissue contours on ridge surfaces not to represent
the smooth ridge form that one observes in a clssic edentulous
patient. Frequently, ridges have multiple indentations, particularly in
the region of the lower anterior teeth. represents the contour of the
bone in the region of the incisors when there has been progressive
bone loss. After extraction and healing there is usually a prominent
dental ridge. With progressive bone resorption the ridge and the
surfaces become shallower, flatter, and less regular. Frequently a
multiple ridge which represents the highest point in the alveolar bone
gradually changes. The outline of the base of the ridge remains fairly
constant, however, so that as the crest is lost, the ridge, contours
become more and more irregular. The outline is represented in part
by the mylohoid ridge and the genial tubercle lingually and by the
external oblique ridge labially. At times the genial tubercle is higher
than the denture-supporting area which lies more anterior to it.

It must be borne in mind that nature conducts its loss of bone not to fit
a manufacturer’s preconceived idea of ridge form, but rather to meet its
own special requirements for adaptation. One must not have
preconceived notions as to how an alveolar ridge will be contoured.
One should palpate with the fingers and observe visually the contour
and consistency of the basal seat and accept it and adapt a metal tray to
truly fit it.
Manufacturers make trays to fit ridges that have convex surfaces; since
we sometimes must deal with concave ridge surfaces, it becomes
necessary to alter the contours of the tray.
The posterior border of the maxillary metal tray usally comes with an
upward curve. This edge should have a download curve, since the soft
palate always sweeps downward. It is necessary to bend this may cause
crimping along the posterior border. With a pair of shears, one or two
sagittal cuts,1/2
inch long, can be made at the posterior edge. Then, with
pliers, the cut edges should be lapped over each other to give the tray
proper form with a downward slope.www.indiandentalacademy.com

Conclusion :
Impression technique and materials should be selected on the basis of
biologic factors dictated by anatomy and physiology of the mouth and
orofacial tissues.
A good impression can be taken if the procedure is done slow and
carefully with all precaution.

REVIEW OF LITERATURE
1] Carl o boucher 1951) critically analyzing mid century impression
technique for complete dentures , summerises as follows. Impression
techniques in use at the middle of the twentieth century vary not only in
the planof the technique but with each operator as well. evaluation can
be made by an analysis of the resultant impression area by area in
relation to part of the mouthto which that part of the impression is
adopted.
2] Devan M.M(1952)he discusses about the principles of impression
making ,difficulties to over come during impression procedure.
3] Kelin (1957)speaking for the need for the basic impression
procedures.the purpose and the objectives of the complete denture
impression should be
1. retension of complete denture
2. stability
3. comfort
4. maintainance of the health of the supporting tissueswww.indiandentalacademy.com

3] Krajeck(1962)talking on simulation of natural appearance says
denture as they concernfacial appearance are determined best by
recording the functional position of the labial and buccal vestibular
sulcuswhen the final impression is made.
4]Smith,D.E Toolson(1979) tell about one step border moulding of
complete dentureimpresion using a polyeter impression material.
5]klein(1973)in her article on complete dentures prosthetic procedure
mentioned on primary and final impression technique.
6]Mc cartney(1983)advocated the use of wax rim instead of
conv3entional handles on impression trays as an aid in making final
impression for complete denture.
7]Mc Arthur(1985)said the manipulation of the mucobuccal fold should
be done correctly during the border moulding procedure if not the only
resourse may be to reline the denture.

8]CollettH.A:Final impression for complete
denture.J.P.D1970;23:250
9] Ellinger C.W:Minimizing problems in making a complete lower
impression.J.P.D1973;30:558
10] Heartwell:Comparison of impressions made in perforated and non
perforated rimlock trays .J.P.D 1972;27:494
11] Klein.IandGoldstein:Physiologic determinants of primary
impressions for complete dentures.J.P.D1984;51:611
12] Moses C.H: Physical consideration in impression
making.J.P.D1953;3:449

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