This document describes a new impression technique for patients with Atwood's Order VI mandibular ridge deformity. It involves combining elements of different impression techniques, including: 1) Using a custom tray fabricated according to the Dynamic Impression Technique with mandibular rests at an increased vertical height. 2) Applying high-fusing compound to the mandibular rests and having the patient close their mouth to indent the maxillary ridge. 3) Using an impression material recommended by McCord and Tyson's technique for atrophic ridges, which involves mixing compound and tracing stick. 4) Having the patient perform functional movements with the tray in place to capture the functional state, similar to a closed

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2. JOURNAL CLUB
COCKTAIL IMPRESSION TECHNIQUE :
A NEW APPROACH
TO
ATWOOD’S ORDER VI
MANDIBULAR RIDGE DEFORMITY

3. INTRODUCTION
The management of highly resorbed ridge has always posed a challenge to
the prosthodontist for years. The fact that alveolar bone tends to resorb
under complete lower denture is known to both, the clinician as well as the
user of complete denture . It is also accepted that the rate of resorption
varies from person to person . Atwood categorized ridge form into six orders
ranging from pre-extraction state (Order I) to the atrophic depressed
mandibular ridge (Order VI)
.
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Atwood’s Classification
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6. PRELIMINARY AND DEFINITIVE
IMPRESSION TECHNIQUE
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-Preliminary impression is made using patients previous denture with
Irreversible hydrocolloid
-Customized tray is fabricated with autopolymerising acrylic resin
according to Dynamic Impression Technique
-Tray with 1 mm wax spacer and cylindrical mandibular rests in the
posterior region are made at increased vertical height.
- High-fusing impression compound is softened, placed on top of the
mandibular rests and inserted in the patient’s mouth
-Patient is advised to close his mouth so that the mandibular rests fit
against the maxillary alveolar ridge.

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◈ McCord and Tyson’s technique for flat mandibular ridges is followed
for definitive impression .
◈ Impression compound and green tracing stick in the ratio of 3:7 parts
by weight is placed in a bowl of water at 60°C and kneaded to a
homogenous mass that provides a working time of about 90 s .
◈ Wax spacer is removed, this homogenous mass is loaded and patient
is guided to close his mouth on the mandibular rests.

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1.CUSTOM TRAY FABRICATED WITH MANDIBULAR REST
AT INCREASED VERTICAL HEIGHT
2. HIGH FUSING COMPOUND ON MANDIBULAR REST
WITH MAXILLARY RIDGE INDENTATION

10. -For recording the functional state, patient is instructed to run his tongue along his lips, suck in
his cheeks, pull in his lips and swallow by keeping his mouth closed, as in closed mouth
impression technique, till the impression material hardens.
- On removal from the mouth, impression is chilled and reinserted to check the denture
bearing area for pressure sensibility by applying heavy finger pressure on the impression to
simulate functional loads.
-The operator should place the thumbs on the underside of the patients’ mandible and
squeeze. If the mucosa has been properly loaded, the only discomfort that the patient should
report is where the thumbs press on the lower border of the mandible .
-Reheating the impression in whole or part, or adding more material to deficient areas should
not be done as this will result in flow of material which in turn will result in differential loading
of the tissues.
- The retrieved impression is visually inspected for surface irregularities, disinfected and
poured

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3. CUSTOM TRAY AGAINST MAXILLARY ALVEOLAR RIDGE AT
INCREASED VERTICAL HEIGHT
4.PATIENT PERFORMING FUNCTIONAL MOVEMENTS WITH
CUSTOM TRAY IN POSITION

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5.FUNCTIONAL DEFINITIVE IMPRESSION5
6.MASTER CAST OBTAINED AFTER BEADING AND BOXING

13. DISCUSSION
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Every patient has unique treatment requirements. Proper diagnosis
and treatment plan are an important aspect of rehabilitation. The
technique described here utilizes the customized tray fabricated
according to Dynamic impression technique described by Tryde et al. ,
impression material recommended by McCord and Tyson’s technique
for atrophic mandibular ridge followed by functional impression as in
closed mouth impression technique. So the word “Cocktail” refers to
the combination of different impression techniques to obtain a
definitive impression.

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CONCLUSION

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Praveen G. •Saurabh Gupta •Swatantra Agarwal •Samarth Kumar Agarwal
Cocktail_Impression_Technique : A New approach to Atwood's Order VI Mandibular Ridge DeformityJ
Indian Prosthodont Soc (Jan-Mar 2011) 11(1):32–35 33
McCord JF, Tyson KW. A conservative prosthodontic option for the treatment of edentulous patients with
atrophic (flat) mandibular ridges. Br Dent J. 1997;182:469–472.
Atwood DA (1996) The problem of reduction of residual ridges. In: Winkler S (ed) Essentials of complete
denture prosthodontics. 2nd edn, Ishiyaku EuroAmerica, St Louis, pp 22–38
REFERENCES

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Thank You!

17. And tables to compare data
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Blue 30 15 10
Orange 5 24 16
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20. Our process is easy
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21. Let’s review some concepts
Yellow
Is the color of gold, butter and ripe
lemons. In the spectrum of visible
light, yellow is found between green
and orange.
Blue
Is the colour of the clear sky and the
deep sea. It is located between
violet and green on the optical
spectrum.
Red
Is the color of blood, and because
of this it has historically been
associated with sacrifice, danger
and courage.
Yellow
Is the color of gold, butter and ripe
lemons. In the spectrum of visible
light, yellow is found between green
and orange.
Blue
Is the colour of the clear sky and the
deep sea. It is located between
violet and green on the optical
spectrum.
Red
Is the color of blood, and because
of this it has historically been
associated with sacrifice, danger
and courage.
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