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THEORIES OF IMPRESSION MAKING
AND IMPRESSION PROCEDURE FOR COMPLETE
DENTURE
Dr. Dipal Mawani
1
CONTENTS
 History
 Definitions
 Biologic Considerations For
Maxillary Impressions
 Biologic Considerations of
Mandibular Impressions
 Principles of Impression
Making
 Classification of Impressions
 Impression Procedures
 Impression Techniques in
Compromised Situations
 Review of literature
 Conclusion
 References
2
3
“Ideal impression must be in the mind of the dentist before it
is in his hand. He must literally make the impression rather
than take it”
- M.M. De Van
History
1728: Pierre Fauchard made dentures by measuring the mouth with
compasses and cutting bone into an approximate shape.
1845-1899: Concepts of atmospheric pressure, maximum extension of
denture bearing area, equal distribution of pressure and close adaptation of
the denture bearing tissues were stressed.
1886 – Richardson mentioned about making plaster impressions of tissues
at rest & achieving adhesion by contact
1896: Greene brothers introduced Muco-compressive theory.
1900-1929: Concepts like Rebase impressions, border molding, posterior
palatal seal and techniques for flabby tissues were introduced.
4
1930-1940: This era recognized the anatomy of the
denture bearing areas and muscle physiology was related
to impression procedures. This is evident by descriptions
of border molding & concept of special trays.
1946: Page gave the concept of mucostatics
1951: Boucher introduced selective pressure theory.
1965-1980: Techniques to manage compromised situations
were introduced
5
6
COMPLETE DENTURE IMPRESSION :-
a complete denture impression is a negative
registration of the entire denture bearing,
stabilizing and border seal areas present in the
edentulous mouth. (GPT-9)
PRELIMINARY IMPRESSION :-
a negative likeness made for the purpose of diagnosis, treatment planning, and/or the
fabrication of a custom impression tray preload . (GPT-9)
BORDER MOLDING :-
the shaping of impression material along the border areas of an
impression tray by functional or manual manipulation of the soft tissue
adjacent to the borders to duplicate the contour and size of the
vestibule (GPT-9)
IMPRESSION MATERIAL :-
any substance or combination of substances used for making an
impression or negative reproduction (GPT 9)
7
Limiting and supporting structures of maxillary
denture bearing area
8
Maxillary stress bearing and relief areas
Primary
Hard palate on
either side of
raphae
Firm tuberosity
9
Secondary
Rugae area
Crest of Residual
Alveolar Ridge
Relief
Incisive Foramen
Mid Palatine Raphae
Palatal Tori
Sharp Spiny Processes
Limiting and Supporting areas of mandibular denture
bearing area
10
Mandibular Stress bearing and Relief areas
11
Primary
Buccal Shelf Area
Retromolar Pad
Secondary
slopes of
Residual Alveolar
Ridge
Relief
Mandibular Tori
Mental Foramen
Genial Tubercles
Prominent Retromylohyoid Ridge
To achieve a successful impression, the following
concepts should be adhered to, irrespective of the
selected technique:
1. The impression should extend to include the entire basal seat.
2. The border must be in harmony with the anatomical and
physiological limitations of the structures.
3. Physiological type of border moulding procedure performed (dentist
/patient under the guidance of the dentist).
4. Space for the final impression material within the impression tray.
12
5. Selective pressure on the basal seat during impression making.
6. The impression must be removed without damage to mucous membrane
7. A guiding mechanism is provided for correct positioning of the tray.
8. Tray and impression material should be dimensionally stable.
9. External shape is similar to external form of the complete denture.
13
Principles
of
Impression
Making
Support
Retention
Stability
Esthetics
Preservation
of alveolar
ridges
14
Retention
• that quality inherent in the dental prosthesis acting to resist the forces of
dislodgment along the path of placement (GPT-9)
• It is the quality inherent in the prosthesis which resists forces of gravity,
adhesiveness of food and forces associated with opening of mouth
15
Physical
Factors
affecting
Retention
Adhesion
Cohesion
Gravity
Interfacial
Surface
Tension
Capillary
Attraction
Atmospheric
Pressure &
Peripheral
Seal
16
Adhesion :-
• Physical attraction of unlike molecules
• It acts when saliva sticks to the denture base & to the
mucous membrane of basal seat .
17
Cohesion:-
the act or state of sticking together tightly (GPT-9)
• Physical attraction of like molecules for each other
• Occurs within the layer of fluid (usually saliva ) present between
the denture base & the mucosa.
• Effective – layer should be thin
18
Interfacial surface tension:-
• Resistance to separation by the film of liquid between the denture
base & the supporting tissues .
• Dependent on the ability of the fluid to wet the rigid
surrounding material .
19
Mucostatics dismiss adhesion and cohesion as factors in retention,
the entire phenomenon being attributed to interfacial surface
tension.
But it has been proved that if it was not for the forces of adhesion
and cohesion, the forces of interfacial surface tension wont exist.
Attachment of a denture is possible because both tissue and denture
base material can become wet which means its molecule will adhere
to water molecules.
Basic principles in impression making
J Prosthet Dent 2005;93:503-8.
20
Atmospheric pressure:-
• Acts to resist dislodging forces applied to the denture, if dentures have an effective seal
around their borders i.e. Peripheral Seal. (14.7lb/in2)
• Retention due to atmospheric pressure is directly proportional to the area covered by
the denture base.
21
Anatomical Factors involved in Retention
•Maxilla – PPS, Retro zygomatic space
•Mandible – Pear shaped pad, Retro Mylohyoid
Space
22
Mechanical Factors involved in Retention
•Undercuts
•Rubber Suction Discs
•Magnets
•Suction Chambers
23
Stability
the quality of a complete or removable partial denture to be firm,
steady, or constant, to resist displacement by functional horizontal
or rotational stresses (GPT-9)
24
Support
the foundation area on which a dental prosthesis rests;
“the resistance to forces directed toward the basal tissue or underlying
structures” (GPT-9)
Esthetics
Role of esthetics in impression making refers to the development of the
labial and buccal borders, so that they are not only retentive but also
support the lips properly.
25
Preservation of the alveolar ridges
DeVan (1952) stated that “the preservation of that which
remains is of utmost importance and not the meticulous
replacement of that which has been lost”
• Stress-bearing areas and non-stress bearing areas should be recorded
under stress and relief respectively.
• Peripheral tissues to be recorded without over extensions.
• Wide tissue coverage
26
Classification
Depending on
the theories of
impression
making
Muco-
compressive
Muco-static
Selective
pressure
Depending on
the technique
Open
Mouth
Closed
Mouth
Depending on
the purpose
of the
impression
Diagnostic
Primary
Secondary
27
Definite pressure technique/ Muco-compressive
• Introduced by Greene brothers
• The tissues recorded under functional pressure provide better support and
retention for the denture.
• Many advocate the use of closed-mouth impression techniques.
• Advocates of this theory believe that occlusal loading during impression
making is comparable to the occlusal loading during function.
28
• Primary impression made with impression compound
• Special tray made using shellac base plate. And its periphery are 1/8th inch shorter
than denture outline.
• Second Impression is made in the special tray using compound
• Bite rims with uniform occlusal surfaces are then made.
• Areas to be relieved are softened and the impression is inserted in mouth and held
under biting pressure for one or two minutes
• Borders are molded by asking the patient to perform functional movements
• The PPS was obtained by making the patient swallow, under biting pressure.
29
Advantages
• Better retention and support
during functional movements
• Provide more tissue coverage
Disadvantages
• The pressure applied can
overstress the tissues.
• This often resulted in good
initial retention but eventual
bone resorption and loose
dentures.
• Loss of retention during rest
due to tissue rebound.
30
Minimal pressure theory/ Mucostatic:-
• Described by Addison, 1944 who attributed it to Henry L. Page.
• He applied Pascal’s Law to soft tissues “Any pressure applied to a
confined fluid is transmitted undiminished in all directions”.
• Mucosa being more than 80% water, will react like a liquid in a closed
vessel & cannot be compressed.
• The impression material should record, without distortion, every detail of
the mucosa denture would fit all minute elevations & depressions.
31
• Demanded that a metal base be used instead of acrylics
• This theory has regarded interfacial surface tension as the only important
retentive mechanism.
• Did not use conventional flanges (did not resist vertical displacement).
• Dykins (1947) recommended a short lingual flange to resist lateral
displacement.
32
• High regards for the
tissue health and
preservation
• Good stability due to
close adaptation of
denture bases
• Less tissue coverage
• Reduced retention
• Lack of border-moulding reduces
effective border seal
• Lack of border seal permits food
lodgment
• Compromised aesthetics due to
short denture flanges
• Tissue variations at the time of
impression making and insertion
may affect the results.
33
Advantages Disadvantages
Selective Pressure Technique (Boucher):-
• Principle – mucosa over the ridge is best able to withstand pressure
mucosa covering midline is thin and has little submucosal
tissue.
• Forces acting on the denture confined to the stress-bearing areas.
• Non stress-bearing areas are relieved and the stress-bearing areas are
allowed to come in contact with the tray.
34
Disadvantages of selective pressure technique
•Demands firm, healthy mucosal covering over the ridge.
Hence, it cannot be used in flabby ridges
35
MUCOSEAL TECHNIQUE :-
• Stated by Pryor, 1948
• Introduced as a variation to mucostatic technique
• Anterior lingual border molded by the floor of the mouth with the
tongue in repose
• Tray extended horizontally backward, over sublingual glands towards
the tongue to achieve a border seal
• Benefit of minimal pressure, provides maximum extension of denture
borders & maximum denture bearing area coverage.
36
Impression by the use of subatmospheric pressure
– Milo V. Kubalek, Bert C. Buffington (1966)
• The objective of this technique is to reduce the stress on
any given tissue by increasing the load bearing area.
• To realize the idea, the form of tissues must be recorded
both vertically and laterally so that all surfaces can bear an
equal load and vacustatic technique is an attempt to
achieve this.
• When a controlled partial vacuum is established, an
impression tray specially built for the patient is maintained
in the mouth without direct mechanical support of any
kind.
• The difference between subatmospheric pressure within
the tray and atmospheric pressure outside is all that
retained the impression in a static position.
• It denotes the equilibrium of forces which results when a
controlled vacuum is established.
37
38
Open mouth impressions:-
• Made with a tray that is held by the dentist.
39
Advantages
Visualization of the muscle trimming
Various movements can be accomplished easily.
Denture retention can be predicted in open as well as in
closed mouth movements.
Pressure or pressure-less technique can be employed by
using this technique.
Closed mouth impressions:-
• Supporting tissues are recorded in functional relationship.
• Requires wax occlusal rims.
40
• Interferences of tray handles
and operator’s finger is
eliminated.
• Time saving -- Border molding,
final impression, jaw relation
(tentative/final) can be
completed in 1 time.
• Rebound of the tissues during rest leads
to denture displacement.
• Tendency for over-extension or under-
extension
• Fatiguing to the dentist and patient.
• A constant pressure is exerted over
tissues, hence blood supply is
compromised leading to ridge
resorption.
41
Advantages Disadvantages
• Hand manipulation
The contour of the denture borders may be obtained by the
dentist with the use of manual manipulation of the lips and
cheeks within functional limits. Patient’s tongue movements
record the lingual borders.
• Functional movements
The denture border may also be formed by having the
patient make “functional” or “physiological” movements such
as sucking, grinning, licking, swallowing etc.
42
Depending on Manipulation :-
(1) Diagnostic Impression :-
• The negative replica of the oral tissues used to prepare a diagnostic cast.
• Used for study purposes like measuring the undercuts, locating the path
of insertion.
• Is made as a part of treatment plan and to estimate the amount of pre-
prosthetic surgery required.
• Can be used for tentative jaw relation and to evaluate the inter-arch
space. 43
Depending on the purpose of the impression
(2) Primary Impression :-
• An impression made for the purpose of construction of a special tray.
• There should be at least 6mm clearance between the stock tray and the
ridge for materials used in making primary impression.
(3) Secondary Impression:-
• Making the wash impression.
• Developing the posterior palatal seal.
44
(A) Selection of Impression material :-
• The material is selected according to the clinical findings,
availability, which in turn influences the technique as well
45
• The beginning of good impression starts with the selection of
the correct stock tray.
(B) Selection of Impression tray :-
Selection of maxillary stock
Tray :-
• Width and height of the
vestibular spaces
• Posteriorly - cover the
Hamular notches & vibrating
line
• Anteriorly - labial notch
should coincide with labial
frenum providing sufficient
clearance for the impression
material
• Tray under extended –
• Tuberosities
• Distobuccal areas.
46
Selection of mandibular
stock tray :-
• Posteriorly the tray should cover
the retromolar pad
• Anteriorly should be centralized
with labial frenum with adequate
clearance
• Tray under extended –
• Retromolar pad or in
• Retromylohyoid fossae.
47
(C) Selection of impression technique :-
• Clinical findings
• Availability of the materials
• Experience of the dentist
• Patient related factors
48
Operator position for maxillary impression
Correct
49
Incorrect
Operator position for Mandibular Impression
50
Correct Incorrec
t
Making the preliminary impression
Tray should be
adjusted by bending
51
Selection of stock tray Position borders at
hammular notches
Lift the tray anteriorly,
3-5 mm space for
impression material
Border of the tray
should be cut if
required
Borders should be
smoothened
Material
Manipulation
(hot water bath
at 140F)
52
Placing the tray in the patients mouth.
Performing Movements to mold the material.
53
• Impression compound is softened in a hot water bath at 140°F.
• After kneading it is loaded on to the tray and shaped roughly to
the shape of the ridge with the fingers.
• The distolingual flange areas can be molded with fingers to
simulate the final impression.
54
Mandibular Impression
• The left posterior corner of the tray is inserted while retracting the
right cheek with operator’s left hand and tray is rotated and
centralized over the ridge.
55
• Patient is instructed to lift the tongue, and tray is seated while applying
pressure
• Light border molding movements are performed including tongue
movements.
• Compound is allowed to harden and chilled after removal impression is
inspected.
56
57
Different
Techniques
Modified
stock tray -
Type II
impression
compound Double
thickness or
reinforced
shellac base
plate
Sprinkle-on
method for
acrylic resin
traysFinger
adaptation
Dough
method for
acrylic resin
trays
Vacuum-
formed
thermoplasti
c resin trays
Visible light
cure resin
trays
58
Special Tray :-
An individualized impression tray made from a cast recovered from a preliminary
impression. It is used in making a final impression (GPT 8 )
Depth of the sulcus is marked on the cast Borders are kept 2mm short
Lip and cheek are reflected and the
borders are observed
Over-extensions are
trimmed 59
Checking for tray extensions
60
Tray Inserted In the patient’s
mouth
Lip and cheek are reflected and the borders
are observed
Over-extensions are trimmed
61
Tongue is Protruded Lateral movements performed Over-extensions are trimmed ;
Borders are smoothened.
If tray displaces =
indicates contra-lateral
side over extension
If tray raises posteriorly
distolingual flange need
adjustment.
Border molding (Peripheral tracing , Muscle
trimming)
• Border molding materials include:
• Modelling compound sticks (Green Stick)
• Polyether impression paste
• Tissue conditioners
• Auto polymerizing acrylic resin
• Impression waxes
62
Methods of border molding
Labial and
Buccal
borders
Smiling
whistling
grinning
63
(1) Functional method :-
 Normal functional movements mold the borders in harmony with
muscle action
Buccal frenum
and Buccal
borders
Sucking
Lingual
borders
Licking the lips
and tongue
movements
Lingual border
and Floor of
mouth
Swallowing
Distobuccal
borders
Opening, closing
and side to side
movements
(2) Digital manipulation :-
• Dentist manipulates the lips and cheeks of the patient to
simulate the influence of these on the denture borders.
• Easy ; does not require much of patient cooperation.
• Influenced by the direction of movement and the force
applied.
(3) Combined :-
• Border molding is usually done by a combination of digital
manipulation by the dentist and functional movements by
the patients.
64
Steps in Sectional border molding
65
Softened compound added along dry
borders of required segment
Cheek outward, downward and
inward
Softened again with alcohol torch.
Tempered in warm water bath.
66
Labial Border Molding
outward, downward and inwards
Molding the Frenum
Compound placed on posterior border. Tray seated in mouth with firm pressure.
Compound placed on posterior border
71Compound added on buccal border
The tray gently seated in place.
The borders should be smooth,round
and symmetrical
Compound placed on labial border
72
Labial Border Molding
outward, upward and inward
Lingual Border Molding Movements
77
Secondary impression
The final impression material is mixed according to manufacturer’s
directions and uniformly distributed within the tray.
78
79
Techniques of Impression making
80
One step border molding procedure (polyether)
( Boucher, JPD:1979:41:347 )
Dale E. Smith
81
Adhesive is
applied on
the tray
Polyether
loaded into a
plastic
syringe with
slightly less
catalyst
Material is
syringed
around the
borders &
PPS area
Quickly pre-
shaped to
proper contours
with finger
moistened in
cold water
Tray is inserted
in the mouth
without
material
distortion
Borders
checked for
proper
extensions
All
movements
carried out
quickly.
Remove tray
when
material is set
Examine for
accuracy
Deficient site
corrected with
a small mix of
polyether
material added
to the area
Advantages :
• Numbers of insertion of the tray are reduced.
• Developing all borders simultaneously avoids propagation of errors
caused by a mistake in one section affecting the border contours in
another. 82
Impression using new silicone impression
materials
I.Hayakawa, I Watanabe(2003)
• Convenient technique for making
impression using newer silicone
materials .
• Heavy bodied silicone material is
used for simultaneous molding of
all borders . (Exahiflex GC)
• Final wash impression is made
with light bodied silicone material
(Exadenture GC)
83
Tray 2mm short of tissue
Apply adhesive
Add silicone across border and PPS area
Examine borders ; trim excess material ; Deficient areas remolded
84
Advantages :
• Easy to perform
• Recommended for beginners
• Reduction in chair side time
• Silicone material – non irritating, minimal patient discomfort.
85
Impression techniques in compromised situations
86
Unsupported
hyperplastic
flabby ridges
Severely resorbed
mandibular ridge.
Restricted access
to oral cavity.
Unemployed
Mandibular
Ridge.
Impression technique for patient with
unsupported flabby ridges
87
Hobkirk
Technique
Zafrulla Khan
Technique
Jone.D. Walter
Technique
Splint method
by Allan
William.H.Filler
Technique
• The hypermobile tissues should be recorded without distortion with
minimum displacement.
• Rest of the tissues are recorded with selective pressure technique.
88
Hobkirk technique:
• Single custom tray used.
• Border molding is done in the
usual manner.
• Impression - heavy bodied
addition silicone
89
Material overlying the hypermobile tissue is cut away and escape
holes made.
Wash impression - light bodied material.
90
Walter Technique: (BDJ 1964:117:392)
• Healthy tissues - zinc oxide eugenol paste
• Undisplaced fibrous tissue - impression plaster.
91
Zafurulla Khan Technique: -
92
Splint Technique by Allan Mack
• Exceptionally flabby tissues.
• Special tray made with heavy relief over the flabby area, plaster is mixed
and applied (3mm), allowed to set.
• Tray is filled with 2nd mix of plaster and the impression is made.
• The initial coating of the flabby areas thus acting as a ‘splint’ whilst the
impression is made and it gets removed along with the second
impression
93
Impression Technique For Severely Resorbed
Mandibular Ridge
• Cases which lack of ideal amount of supporting structure.
• Encroachment of the surrounding mobile tissues on to the denture
border reduce both stability and retention.
• Thus the main aim of the impression procedure is to gain maximum
area of coverage with minimum pressure by obtaining a fairly long
retromylohyoid flange for a better border seal and retention.
94
Flange Technique
Dynamic Impression
Technique
Winkler’s
Technique(Functional
Reline)
Miller’s Technique
Mccold and Tyson
Admixed Technique
95
Flange technique by Frank Lott and Bernard Levin
(JPD 1966:16:394-413)
• Making impressions of the soft structures adjacent to the buccal, lingual labial
surfaces and incorporating the resulting extensions or flanges in denture.
• Fluid wax is rolled from the retromolar pad region to sublingual region, large
enough to restore the areas of estimated resorption.
• Patient is asked to forcefully perform functional movements to give a border
extensions which covers maximum surface area.
96
Dynamic impression method
(G. Tryde, K.Olsson, Jenson)
Dislocating effect of the muscles on improperly formed denture
borders is avoided
Impression material : Irreversible hydrocolloid
• For this mandibular rests are made
on the occlusal aspect of lower record
base with thermoplastic material.
97
• Alginate is mixed and DIRECTLY
APPLIED on tissues & then tray is
placed
• When material is soft the patient is
asked to close the jaw slowly.
• Impression material is shaped by
muscular activity.
• Patient should swallow 3 to 4 times
in the 10 seconds interval till the
material in still moldable state .
98
•Winkler’s technique : -
He described closed mouth
impression technique which uses
tissue conditioners and the final
impression is made with a light body
elastomeric impression material
Miller’s Modification: -
Uses mouth temperature waxes
instead of tissue conditioners
99
• Complicated by folds of atrophic and/or non-
keratinised tissue lying on the ridge
• Impression medium -- admix –
3 parts (red) impression compound
7 parts of greenstick (by weight)
• The working time of this admix is 1–2 minutes
and this enables the clinician to mould the
tissues to give good peripheral moulding
100
Flat mandibular ridge covered with atrophic
mucosa : McCord and Tyson admixed
technique
Fabrication of a sectional impression tray and sectional complete
denture for a patient with microstomia and trismus: A clinical
report (J Prosthet Dent 2003;89:540)
• Maxillary impression inserted into the patient’s mouth in 2 separate
pieces: left and right.
• After placement, these pieces were stabilized by means of the acrylic
resin block.
• Zinc-oxide eugenol impression.
101
•After the impression paste set, acrylic resin block detached from the
pins, right and the left pieces removed separately by fracturing the
impression material.
•The acrylic resin block was carefully fitted on the pins, and after it
was determined that the fracture line joined smoothly, and cast were
poured
102
Unemployed mandibular ridge
• Due to continuous ridge resorption in old denture wearers support
of the denture becomes progressively transferred to peripheral
parts of the denture bearing areas while the ridge takes less load.
Thus the ridge is referred as unemployed.
• Technique:
103
Old
denture
New denture
• Primary impression - alginate and cast poured.
• Impression compound impression is taken of the cast.
• Periphery is trimmed.
• Green stick is applied to the periphery and placed in patients mouth to
record borders with border molding.
• The compound over the ridge is then cut with a sharp knife.
• Record the working surface with impression paste under heavy digital
pressure -- transfer as much of the load as possible to the peripheral
parts of the denture bearing area.
104
105
Cocktail Impression Technique: A New Approach to Atwood’s Order VI
Mandibular Ridge Deformity
Praveen G
J Indian Prosthodont Soc (Jan-Mar 2011) 11(1):32–35
Custom tray with mandibular
rests
Custom tray fits against maxillary
alveolar ridge at an increased ht.
106
Patient performing functional
movements
The final impression
Review of Literature
107
Diurnal variation in palatal tissue thickness –
Stephens, Cox, Sharry (1966)
• In this study the variation in palatal thickness at
different time of the day is measured.
• A small micrometer was attached to an acrylic resin
hood which straddled the upper arch and fitted the
occlusal surface of the molar and premolar teeth, this
was used to measure the diurnal changes in palatal
tissue.
• The results indicated that the palatal tissues were
thickest when the subjects were lying in bed after a full
night sleep and it starts to shrink in the morning and
continues in the afternoon. Slight increase in tissue
thickness is seen again in the evening.
108
CONCLUSION
The main objective of impression making is to fabricate
dentures having maximum retention and stability
without causing any damage to the supporting
structures. Thus the choice of impression technique and
material is made by the dentist on the basis of the oral
conditions, concepts of function of the tissues
surrounding the denture and ability to handle the
available impression material.
109
References :
• Zarb GA,Bolender CL,Prosthodontic treatment for edentulous patients- 12th
ed, 13th ed
• Rudd KD, Morrow RM, Dental laboratory procedures complete dentures Vol.
l ,2nd ed
• Impression for complete dentures, Bernard Levin
• Complete denture prosthodontics, John J Sharry, 3rd ed
• Essentials of Complete Denture Prosthodontics, Winkler
• A colour atlas of overdentures and complete dentures
• Basic principles in impression making MM Devan J Prosthet Dent
2005;93:503-508
• Complete denture impressions J Prosthet Dent;1965:15(4):603-614
• Jacobson TE, Krol AJ. A contemporary review of the factors involved in
complete denture retention, stability, and support. Part I: retention. The
Journal of prosthetic dentistry. 1983 Jan 1;49(1):5-15.
110
• Jacobson TE, Krol AJ. A contemporary review of the factors involved in complete
dentures. Part II: stability. The Journal of prosthetic dentistry. 1983 Feb 1;49(2):165-
72.
• Jacobson TE, Krol AJ. A contemporary review of the factors involved in complete
dentures. Part III: support. The Journal of prosthetic dentistry. 1983 Mar 1;49(3):306-
13.
• Management of the flabby ridge: using contemporary materials to solve an old
problem,BDJ:2006:258:261
• Modified impression technique for hyperplastic alveolar ridges JPD:1971:25:609.
• Physiological determinants of primary impressions for complete
dentures,JPD:1984:53:611
• A systematic review of impression technique for conventional complete denture J
Indian Prosthodont Soc :10(2):105-111
• A critical analysis of mid century impression techniques for full dentures J Prosthet
Dent 1951; 472-491
• A critical analysis of complete denture impression procedures: contribution of early
prosthodontists in India J Indian Prosthodont Soc ;11(3):172-182
• Impressions for complete dentures using new silicone impression materials
Hayakawa, Watanabe; Quintessence International:34:3:177-180
• Fabrication of a sectional impression tray and sectional complete denture for a patient
with microstomia and trismus: A clinical report; J Prosthet Dent 2003;89:540 111
THANK YOU
112

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theories of impression making in complete denture

  • 1. THEORIES OF IMPRESSION MAKING AND IMPRESSION PROCEDURE FOR COMPLETE DENTURE Dr. Dipal Mawani 1
  • 2. CONTENTS  History  Definitions  Biologic Considerations For Maxillary Impressions  Biologic Considerations of Mandibular Impressions  Principles of Impression Making  Classification of Impressions  Impression Procedures  Impression Techniques in Compromised Situations  Review of literature  Conclusion  References 2
  • 3. 3 “Ideal impression must be in the mind of the dentist before it is in his hand. He must literally make the impression rather than take it” - M.M. De Van
  • 4. History 1728: Pierre Fauchard made dentures by measuring the mouth with compasses and cutting bone into an approximate shape. 1845-1899: Concepts of atmospheric pressure, maximum extension of denture bearing area, equal distribution of pressure and close adaptation of the denture bearing tissues were stressed. 1886 – Richardson mentioned about making plaster impressions of tissues at rest & achieving adhesion by contact 1896: Greene brothers introduced Muco-compressive theory. 1900-1929: Concepts like Rebase impressions, border molding, posterior palatal seal and techniques for flabby tissues were introduced. 4
  • 5. 1930-1940: This era recognized the anatomy of the denture bearing areas and muscle physiology was related to impression procedures. This is evident by descriptions of border molding & concept of special trays. 1946: Page gave the concept of mucostatics 1951: Boucher introduced selective pressure theory. 1965-1980: Techniques to manage compromised situations were introduced 5
  • 6. 6 COMPLETE DENTURE IMPRESSION :- a complete denture impression is a negative registration of the entire denture bearing, stabilizing and border seal areas present in the edentulous mouth. (GPT-9) PRELIMINARY IMPRESSION :- a negative likeness made for the purpose of diagnosis, treatment planning, and/or the fabrication of a custom impression tray preload . (GPT-9)
  • 7. BORDER MOLDING :- the shaping of impression material along the border areas of an impression tray by functional or manual manipulation of the soft tissue adjacent to the borders to duplicate the contour and size of the vestibule (GPT-9) IMPRESSION MATERIAL :- any substance or combination of substances used for making an impression or negative reproduction (GPT 9) 7
  • 8. Limiting and supporting structures of maxillary denture bearing area 8
  • 9. Maxillary stress bearing and relief areas Primary Hard palate on either side of raphae Firm tuberosity 9 Secondary Rugae area Crest of Residual Alveolar Ridge Relief Incisive Foramen Mid Palatine Raphae Palatal Tori Sharp Spiny Processes
  • 10. Limiting and Supporting areas of mandibular denture bearing area 10
  • 11. Mandibular Stress bearing and Relief areas 11 Primary Buccal Shelf Area Retromolar Pad Secondary slopes of Residual Alveolar Ridge Relief Mandibular Tori Mental Foramen Genial Tubercles Prominent Retromylohyoid Ridge
  • 12. To achieve a successful impression, the following concepts should be adhered to, irrespective of the selected technique: 1. The impression should extend to include the entire basal seat. 2. The border must be in harmony with the anatomical and physiological limitations of the structures. 3. Physiological type of border moulding procedure performed (dentist /patient under the guidance of the dentist). 4. Space for the final impression material within the impression tray. 12
  • 13. 5. Selective pressure on the basal seat during impression making. 6. The impression must be removed without damage to mucous membrane 7. A guiding mechanism is provided for correct positioning of the tray. 8. Tray and impression material should be dimensionally stable. 9. External shape is similar to external form of the complete denture. 13
  • 15. Retention • that quality inherent in the dental prosthesis acting to resist the forces of dislodgment along the path of placement (GPT-9) • It is the quality inherent in the prosthesis which resists forces of gravity, adhesiveness of food and forces associated with opening of mouth 15
  • 17. Adhesion :- • Physical attraction of unlike molecules • It acts when saliva sticks to the denture base & to the mucous membrane of basal seat . 17
  • 18. Cohesion:- the act or state of sticking together tightly (GPT-9) • Physical attraction of like molecules for each other • Occurs within the layer of fluid (usually saliva ) present between the denture base & the mucosa. • Effective – layer should be thin 18
  • 19. Interfacial surface tension:- • Resistance to separation by the film of liquid between the denture base & the supporting tissues . • Dependent on the ability of the fluid to wet the rigid surrounding material . 19
  • 20. Mucostatics dismiss adhesion and cohesion as factors in retention, the entire phenomenon being attributed to interfacial surface tension. But it has been proved that if it was not for the forces of adhesion and cohesion, the forces of interfacial surface tension wont exist. Attachment of a denture is possible because both tissue and denture base material can become wet which means its molecule will adhere to water molecules. Basic principles in impression making J Prosthet Dent 2005;93:503-8. 20
  • 21. Atmospheric pressure:- • Acts to resist dislodging forces applied to the denture, if dentures have an effective seal around their borders i.e. Peripheral Seal. (14.7lb/in2) • Retention due to atmospheric pressure is directly proportional to the area covered by the denture base. 21
  • 22. Anatomical Factors involved in Retention •Maxilla – PPS, Retro zygomatic space •Mandible – Pear shaped pad, Retro Mylohyoid Space 22
  • 23. Mechanical Factors involved in Retention •Undercuts •Rubber Suction Discs •Magnets •Suction Chambers 23
  • 24. Stability the quality of a complete or removable partial denture to be firm, steady, or constant, to resist displacement by functional horizontal or rotational stresses (GPT-9) 24
  • 25. Support the foundation area on which a dental prosthesis rests; “the resistance to forces directed toward the basal tissue or underlying structures” (GPT-9) Esthetics Role of esthetics in impression making refers to the development of the labial and buccal borders, so that they are not only retentive but also support the lips properly. 25
  • 26. Preservation of the alveolar ridges DeVan (1952) stated that “the preservation of that which remains is of utmost importance and not the meticulous replacement of that which has been lost” • Stress-bearing areas and non-stress bearing areas should be recorded under stress and relief respectively. • Peripheral tissues to be recorded without over extensions. • Wide tissue coverage 26
  • 27. Classification Depending on the theories of impression making Muco- compressive Muco-static Selective pressure Depending on the technique Open Mouth Closed Mouth Depending on the purpose of the impression Diagnostic Primary Secondary 27
  • 28. Definite pressure technique/ Muco-compressive • Introduced by Greene brothers • The tissues recorded under functional pressure provide better support and retention for the denture. • Many advocate the use of closed-mouth impression techniques. • Advocates of this theory believe that occlusal loading during impression making is comparable to the occlusal loading during function. 28
  • 29. • Primary impression made with impression compound • Special tray made using shellac base plate. And its periphery are 1/8th inch shorter than denture outline. • Second Impression is made in the special tray using compound • Bite rims with uniform occlusal surfaces are then made. • Areas to be relieved are softened and the impression is inserted in mouth and held under biting pressure for one or two minutes • Borders are molded by asking the patient to perform functional movements • The PPS was obtained by making the patient swallow, under biting pressure. 29
  • 30. Advantages • Better retention and support during functional movements • Provide more tissue coverage Disadvantages • The pressure applied can overstress the tissues. • This often resulted in good initial retention but eventual bone resorption and loose dentures. • Loss of retention during rest due to tissue rebound. 30
  • 31. Minimal pressure theory/ Mucostatic:- • Described by Addison, 1944 who attributed it to Henry L. Page. • He applied Pascal’s Law to soft tissues “Any pressure applied to a confined fluid is transmitted undiminished in all directions”. • Mucosa being more than 80% water, will react like a liquid in a closed vessel & cannot be compressed. • The impression material should record, without distortion, every detail of the mucosa denture would fit all minute elevations & depressions. 31
  • 32. • Demanded that a metal base be used instead of acrylics • This theory has regarded interfacial surface tension as the only important retentive mechanism. • Did not use conventional flanges (did not resist vertical displacement). • Dykins (1947) recommended a short lingual flange to resist lateral displacement. 32
  • 33. • High regards for the tissue health and preservation • Good stability due to close adaptation of denture bases • Less tissue coverage • Reduced retention • Lack of border-moulding reduces effective border seal • Lack of border seal permits food lodgment • Compromised aesthetics due to short denture flanges • Tissue variations at the time of impression making and insertion may affect the results. 33 Advantages Disadvantages
  • 34. Selective Pressure Technique (Boucher):- • Principle – mucosa over the ridge is best able to withstand pressure mucosa covering midline is thin and has little submucosal tissue. • Forces acting on the denture confined to the stress-bearing areas. • Non stress-bearing areas are relieved and the stress-bearing areas are allowed to come in contact with the tray. 34
  • 35. Disadvantages of selective pressure technique •Demands firm, healthy mucosal covering over the ridge. Hence, it cannot be used in flabby ridges 35
  • 36. MUCOSEAL TECHNIQUE :- • Stated by Pryor, 1948 • Introduced as a variation to mucostatic technique • Anterior lingual border molded by the floor of the mouth with the tongue in repose • Tray extended horizontally backward, over sublingual glands towards the tongue to achieve a border seal • Benefit of minimal pressure, provides maximum extension of denture borders & maximum denture bearing area coverage. 36
  • 37. Impression by the use of subatmospheric pressure – Milo V. Kubalek, Bert C. Buffington (1966) • The objective of this technique is to reduce the stress on any given tissue by increasing the load bearing area. • To realize the idea, the form of tissues must be recorded both vertically and laterally so that all surfaces can bear an equal load and vacustatic technique is an attempt to achieve this. • When a controlled partial vacuum is established, an impression tray specially built for the patient is maintained in the mouth without direct mechanical support of any kind. • The difference between subatmospheric pressure within the tray and atmospheric pressure outside is all that retained the impression in a static position. • It denotes the equilibrium of forces which results when a controlled vacuum is established. 37
  • 38. 38
  • 39. Open mouth impressions:- • Made with a tray that is held by the dentist. 39 Advantages Visualization of the muscle trimming Various movements can be accomplished easily. Denture retention can be predicted in open as well as in closed mouth movements. Pressure or pressure-less technique can be employed by using this technique.
  • 40. Closed mouth impressions:- • Supporting tissues are recorded in functional relationship. • Requires wax occlusal rims. 40
  • 41. • Interferences of tray handles and operator’s finger is eliminated. • Time saving -- Border molding, final impression, jaw relation (tentative/final) can be completed in 1 time. • Rebound of the tissues during rest leads to denture displacement. • Tendency for over-extension or under- extension • Fatiguing to the dentist and patient. • A constant pressure is exerted over tissues, hence blood supply is compromised leading to ridge resorption. 41 Advantages Disadvantages
  • 42. • Hand manipulation The contour of the denture borders may be obtained by the dentist with the use of manual manipulation of the lips and cheeks within functional limits. Patient’s tongue movements record the lingual borders. • Functional movements The denture border may also be formed by having the patient make “functional” or “physiological” movements such as sucking, grinning, licking, swallowing etc. 42 Depending on Manipulation :-
  • 43. (1) Diagnostic Impression :- • The negative replica of the oral tissues used to prepare a diagnostic cast. • Used for study purposes like measuring the undercuts, locating the path of insertion. • Is made as a part of treatment plan and to estimate the amount of pre- prosthetic surgery required. • Can be used for tentative jaw relation and to evaluate the inter-arch space. 43 Depending on the purpose of the impression
  • 44. (2) Primary Impression :- • An impression made for the purpose of construction of a special tray. • There should be at least 6mm clearance between the stock tray and the ridge for materials used in making primary impression. (3) Secondary Impression:- • Making the wash impression. • Developing the posterior palatal seal. 44
  • 45. (A) Selection of Impression material :- • The material is selected according to the clinical findings, availability, which in turn influences the technique as well 45 • The beginning of good impression starts with the selection of the correct stock tray. (B) Selection of Impression tray :-
  • 46. Selection of maxillary stock Tray :- • Width and height of the vestibular spaces • Posteriorly - cover the Hamular notches & vibrating line • Anteriorly - labial notch should coincide with labial frenum providing sufficient clearance for the impression material • Tray under extended – • Tuberosities • Distobuccal areas. 46
  • 47. Selection of mandibular stock tray :- • Posteriorly the tray should cover the retromolar pad • Anteriorly should be centralized with labial frenum with adequate clearance • Tray under extended – • Retromolar pad or in • Retromylohyoid fossae. 47
  • 48. (C) Selection of impression technique :- • Clinical findings • Availability of the materials • Experience of the dentist • Patient related factors 48
  • 49. Operator position for maxillary impression Correct 49 Incorrect
  • 50. Operator position for Mandibular Impression 50 Correct Incorrec t
  • 51. Making the preliminary impression Tray should be adjusted by bending 51 Selection of stock tray Position borders at hammular notches Lift the tray anteriorly, 3-5 mm space for impression material
  • 52. Border of the tray should be cut if required Borders should be smoothened Material Manipulation (hot water bath at 140F) 52
  • 53. Placing the tray in the patients mouth. Performing Movements to mold the material. 53
  • 54. • Impression compound is softened in a hot water bath at 140°F. • After kneading it is loaded on to the tray and shaped roughly to the shape of the ridge with the fingers. • The distolingual flange areas can be molded with fingers to simulate the final impression. 54 Mandibular Impression
  • 55. • The left posterior corner of the tray is inserted while retracting the right cheek with operator’s left hand and tray is rotated and centralized over the ridge. 55
  • 56. • Patient is instructed to lift the tongue, and tray is seated while applying pressure • Light border molding movements are performed including tongue movements. • Compound is allowed to harden and chilled after removal impression is inspected. 56
  • 57. 57
  • 58. Different Techniques Modified stock tray - Type II impression compound Double thickness or reinforced shellac base plate Sprinkle-on method for acrylic resin traysFinger adaptation Dough method for acrylic resin trays Vacuum- formed thermoplasti c resin trays Visible light cure resin trays 58 Special Tray :- An individualized impression tray made from a cast recovered from a preliminary impression. It is used in making a final impression (GPT 8 )
  • 59. Depth of the sulcus is marked on the cast Borders are kept 2mm short Lip and cheek are reflected and the borders are observed Over-extensions are trimmed 59
  • 60. Checking for tray extensions 60 Tray Inserted In the patient’s mouth Lip and cheek are reflected and the borders are observed Over-extensions are trimmed
  • 61. 61 Tongue is Protruded Lateral movements performed Over-extensions are trimmed ; Borders are smoothened. If tray displaces = indicates contra-lateral side over extension If tray raises posteriorly distolingual flange need adjustment.
  • 62. Border molding (Peripheral tracing , Muscle trimming) • Border molding materials include: • Modelling compound sticks (Green Stick) • Polyether impression paste • Tissue conditioners • Auto polymerizing acrylic resin • Impression waxes 62
  • 63. Methods of border molding Labial and Buccal borders Smiling whistling grinning 63 (1) Functional method :-  Normal functional movements mold the borders in harmony with muscle action Buccal frenum and Buccal borders Sucking Lingual borders Licking the lips and tongue movements Lingual border and Floor of mouth Swallowing Distobuccal borders Opening, closing and side to side movements
  • 64. (2) Digital manipulation :- • Dentist manipulates the lips and cheeks of the patient to simulate the influence of these on the denture borders. • Easy ; does not require much of patient cooperation. • Influenced by the direction of movement and the force applied. (3) Combined :- • Border molding is usually done by a combination of digital manipulation by the dentist and functional movements by the patients. 64
  • 65. Steps in Sectional border molding 65 Softened compound added along dry borders of required segment Cheek outward, downward and inward Softened again with alcohol torch. Tempered in warm water bath.
  • 66. 66 Labial Border Molding outward, downward and inwards Molding the Frenum Compound placed on posterior border. Tray seated in mouth with firm pressure.
  • 67. Compound placed on posterior border 71Compound added on buccal border The tray gently seated in place. The borders should be smooth,round and symmetrical
  • 68. Compound placed on labial border 72 Labial Border Molding outward, upward and inward Lingual Border Molding Movements
  • 69. 77
  • 70. Secondary impression The final impression material is mixed according to manufacturer’s directions and uniformly distributed within the tray. 78
  • 71. 79
  • 73. One step border molding procedure (polyether) ( Boucher, JPD:1979:41:347 ) Dale E. Smith 81 Adhesive is applied on the tray Polyether loaded into a plastic syringe with slightly less catalyst Material is syringed around the borders & PPS area Quickly pre- shaped to proper contours with finger moistened in cold water Tray is inserted in the mouth without material distortion
  • 74. Borders checked for proper extensions All movements carried out quickly. Remove tray when material is set Examine for accuracy Deficient site corrected with a small mix of polyether material added to the area Advantages : • Numbers of insertion of the tray are reduced. • Developing all borders simultaneously avoids propagation of errors caused by a mistake in one section affecting the border contours in another. 82
  • 75. Impression using new silicone impression materials I.Hayakawa, I Watanabe(2003) • Convenient technique for making impression using newer silicone materials . • Heavy bodied silicone material is used for simultaneous molding of all borders . (Exahiflex GC) • Final wash impression is made with light bodied silicone material (Exadenture GC) 83 Tray 2mm short of tissue Apply adhesive
  • 76. Add silicone across border and PPS area Examine borders ; trim excess material ; Deficient areas remolded 84
  • 77. Advantages : • Easy to perform • Recommended for beginners • Reduction in chair side time • Silicone material – non irritating, minimal patient discomfort. 85
  • 78. Impression techniques in compromised situations 86 Unsupported hyperplastic flabby ridges Severely resorbed mandibular ridge. Restricted access to oral cavity. Unemployed Mandibular Ridge.
  • 79. Impression technique for patient with unsupported flabby ridges 87 Hobkirk Technique Zafrulla Khan Technique Jone.D. Walter Technique Splint method by Allan William.H.Filler Technique
  • 80. • The hypermobile tissues should be recorded without distortion with minimum displacement. • Rest of the tissues are recorded with selective pressure technique. 88
  • 81. Hobkirk technique: • Single custom tray used. • Border molding is done in the usual manner. • Impression - heavy bodied addition silicone 89
  • 82. Material overlying the hypermobile tissue is cut away and escape holes made. Wash impression - light bodied material. 90
  • 83. Walter Technique: (BDJ 1964:117:392) • Healthy tissues - zinc oxide eugenol paste • Undisplaced fibrous tissue - impression plaster. 91
  • 85. Splint Technique by Allan Mack • Exceptionally flabby tissues. • Special tray made with heavy relief over the flabby area, plaster is mixed and applied (3mm), allowed to set. • Tray is filled with 2nd mix of plaster and the impression is made. • The initial coating of the flabby areas thus acting as a ‘splint’ whilst the impression is made and it gets removed along with the second impression 93
  • 86. Impression Technique For Severely Resorbed Mandibular Ridge • Cases which lack of ideal amount of supporting structure. • Encroachment of the surrounding mobile tissues on to the denture border reduce both stability and retention. • Thus the main aim of the impression procedure is to gain maximum area of coverage with minimum pressure by obtaining a fairly long retromylohyoid flange for a better border seal and retention. 94
  • 88. Flange technique by Frank Lott and Bernard Levin (JPD 1966:16:394-413) • Making impressions of the soft structures adjacent to the buccal, lingual labial surfaces and incorporating the resulting extensions or flanges in denture. • Fluid wax is rolled from the retromolar pad region to sublingual region, large enough to restore the areas of estimated resorption. • Patient is asked to forcefully perform functional movements to give a border extensions which covers maximum surface area. 96
  • 89. Dynamic impression method (G. Tryde, K.Olsson, Jenson) Dislocating effect of the muscles on improperly formed denture borders is avoided Impression material : Irreversible hydrocolloid • For this mandibular rests are made on the occlusal aspect of lower record base with thermoplastic material. 97
  • 90. • Alginate is mixed and DIRECTLY APPLIED on tissues & then tray is placed • When material is soft the patient is asked to close the jaw slowly. • Impression material is shaped by muscular activity. • Patient should swallow 3 to 4 times in the 10 seconds interval till the material in still moldable state . 98
  • 91. •Winkler’s technique : - He described closed mouth impression technique which uses tissue conditioners and the final impression is made with a light body elastomeric impression material Miller’s Modification: - Uses mouth temperature waxes instead of tissue conditioners 99
  • 92. • Complicated by folds of atrophic and/or non- keratinised tissue lying on the ridge • Impression medium -- admix – 3 parts (red) impression compound 7 parts of greenstick (by weight) • The working time of this admix is 1–2 minutes and this enables the clinician to mould the tissues to give good peripheral moulding 100 Flat mandibular ridge covered with atrophic mucosa : McCord and Tyson admixed technique
  • 93. Fabrication of a sectional impression tray and sectional complete denture for a patient with microstomia and trismus: A clinical report (J Prosthet Dent 2003;89:540) • Maxillary impression inserted into the patient’s mouth in 2 separate pieces: left and right. • After placement, these pieces were stabilized by means of the acrylic resin block. • Zinc-oxide eugenol impression. 101
  • 94. •After the impression paste set, acrylic resin block detached from the pins, right and the left pieces removed separately by fracturing the impression material. •The acrylic resin block was carefully fitted on the pins, and after it was determined that the fracture line joined smoothly, and cast were poured 102
  • 95. Unemployed mandibular ridge • Due to continuous ridge resorption in old denture wearers support of the denture becomes progressively transferred to peripheral parts of the denture bearing areas while the ridge takes less load. Thus the ridge is referred as unemployed. • Technique: 103 Old denture New denture
  • 96. • Primary impression - alginate and cast poured. • Impression compound impression is taken of the cast. • Periphery is trimmed. • Green stick is applied to the periphery and placed in patients mouth to record borders with border molding. • The compound over the ridge is then cut with a sharp knife. • Record the working surface with impression paste under heavy digital pressure -- transfer as much of the load as possible to the peripheral parts of the denture bearing area. 104
  • 97. 105 Cocktail Impression Technique: A New Approach to Atwood’s Order VI Mandibular Ridge Deformity Praveen G J Indian Prosthodont Soc (Jan-Mar 2011) 11(1):32–35 Custom tray with mandibular rests Custom tray fits against maxillary alveolar ridge at an increased ht.
  • 100. Diurnal variation in palatal tissue thickness – Stephens, Cox, Sharry (1966) • In this study the variation in palatal thickness at different time of the day is measured. • A small micrometer was attached to an acrylic resin hood which straddled the upper arch and fitted the occlusal surface of the molar and premolar teeth, this was used to measure the diurnal changes in palatal tissue. • The results indicated that the palatal tissues were thickest when the subjects were lying in bed after a full night sleep and it starts to shrink in the morning and continues in the afternoon. Slight increase in tissue thickness is seen again in the evening. 108
  • 101. CONCLUSION The main objective of impression making is to fabricate dentures having maximum retention and stability without causing any damage to the supporting structures. Thus the choice of impression technique and material is made by the dentist on the basis of the oral conditions, concepts of function of the tissues surrounding the denture and ability to handle the available impression material. 109
  • 102. References : • Zarb GA,Bolender CL,Prosthodontic treatment for edentulous patients- 12th ed, 13th ed • Rudd KD, Morrow RM, Dental laboratory procedures complete dentures Vol. l ,2nd ed • Impression for complete dentures, Bernard Levin • Complete denture prosthodontics, John J Sharry, 3rd ed • Essentials of Complete Denture Prosthodontics, Winkler • A colour atlas of overdentures and complete dentures • Basic principles in impression making MM Devan J Prosthet Dent 2005;93:503-508 • Complete denture impressions J Prosthet Dent;1965:15(4):603-614 • Jacobson TE, Krol AJ. A contemporary review of the factors involved in complete denture retention, stability, and support. Part I: retention. The Journal of prosthetic dentistry. 1983 Jan 1;49(1):5-15. 110
  • 103. • Jacobson TE, Krol AJ. A contemporary review of the factors involved in complete dentures. Part II: stability. The Journal of prosthetic dentistry. 1983 Feb 1;49(2):165- 72. • Jacobson TE, Krol AJ. A contemporary review of the factors involved in complete dentures. Part III: support. The Journal of prosthetic dentistry. 1983 Mar 1;49(3):306- 13. • Management of the flabby ridge: using contemporary materials to solve an old problem,BDJ:2006:258:261 • Modified impression technique for hyperplastic alveolar ridges JPD:1971:25:609. • Physiological determinants of primary impressions for complete dentures,JPD:1984:53:611 • A systematic review of impression technique for conventional complete denture J Indian Prosthodont Soc :10(2):105-111 • A critical analysis of mid century impression techniques for full dentures J Prosthet Dent 1951; 472-491 • A critical analysis of complete denture impression procedures: contribution of early prosthodontists in India J Indian Prosthodont Soc ;11(3):172-182 • Impressions for complete dentures using new silicone impression materials Hayakawa, Watanabe; Quintessence International:34:3:177-180 • Fabrication of a sectional impression tray and sectional complete denture for a patient with microstomia and trismus: A clinical report; J Prosthet Dent 2003;89:540 111

Editor's Notes

  1. The beginning of a good denture starts with making of a good impression,so a good impression is a stepping stone
  2. 1.Labial frenum - notch 2.Labial vestibule - labial flange,orbicularis oris 3.Buccal frenum – buccal notch,levator anguli oris 4. Buccal vestibule- buccal flanges,buccinators,masseter 5- CORONOID CONTOUR 6 – RESIDUAL ALVEOLAR RIDGE- ALVEOLAR GROOVE 7- MAXILLARY TUBEROSITY 8 HAMULAR NOTCH- PTERYGOMAXILLARY SEAL AREA,distal of tuberosity 9- PPS REGION 10 – FOVEA PALATINAE 11- MID PALATINE RAPHAE – MID PALATINE GROOVE 12- INCISIVE PAPILLAE – INCISIVE FOSSA 13- RUGAE 14 – DISPLACABLE HARD AND SOFT PALATE REGION
  3. 1.Labial frenum – labial notch ,orbicularis 2.Labial vestibule – labial flange 3.Buccal frenum- buccal notch, depressor anguli oris 4.Buccal vestibule – buccal flange 5. Residual alveolar ridge – alveolar groove 6.Buccal shelf area 7. Retro molar pad- pterygomandibular raphae, sup. Constrictor, temporal tendon 9. Retro mylo hyoid fossa 10. Alveololingual sulcus(ant-genioglossus, mid-mylohyoid, sublingual gland, post.-sup const.,palatoglo ,tongue, retromolar pad 11. Sublingual caruncles 12 .Lingual frenum – lingual notch 13. Area of premylohyoid eminence
  4. with stand displacement against its path of insertion. Factors affecting retention Adhesion Cohesion Interfacial surface tension Capillarity Atmospheric pressure
  5. Quality of adhesion depends on :- Close adaptation of denture Size of denture bearing area Type of saliva – thin with mucous components Adhesion is achievied by ionic forces between charged salivary glycoproteins & surface epithelium or acrylic resin.
  6. Role of surface tension is through capillary attraction or capillarity. Capillary attraction – force that causes the surface of a liquid to elevate and depress when in contact with a solid.
  7. To be stable, a denture requires :
  8. Stress bearing areas have thicker mucosa The bone is less susceptible to resorption as its made of dense cortical bone Secondary stress bearing area is made up of cancellous area – it is subjective to resorption when compared to cortical bone
  9. Soft tissues are mainly fluid, 80% of the tissue are composed of water. So Page contended that since the soft tissues contain water and are confined under a pressure exerted by denture, any pressure applied will be transmitted undiminished in all directions
  10. Impression compound, Alginate, Impression plaster
  11. Behind and to the right with the patients occlusal plane at elbow level
  12. Front and to the right with patient, occlusal plane at shoulder level
  13. Sequence of border moulding in mandibular Labial flange- buccal flange- distobuccal area including massertic notches-anterior lingual flange-
  14. Once the material starts to thicken, lips and cheeks are molded to prevent overextension
  15. A window is cut in special tray where unsupported area is present. Unsupported area is recorded with impression plaster. The remaining tissues are recorded with final final impression material