BASIC PRINCIPLES IN IMPRESSION MAKING

JPD 2005 93:503-8;M.M.Devan Resolution of the problem :
The problem is due to the fact that the mouth is lined by displaceable tissue ; it varies in degree of displaceability according to : Thickness  Rigidity  Point,magnitude,direction of forces applied to it

Definition of impression:
A complete denture impression is a negative registration of the entire denture bearing , bracing, stabilizing and border seal areas present in the edentulous mouths.

THE IMPRESSION AREA ARE:The vault ridge area The flange heel areas

Theories of impression making  Based on amount of pressure used :
Mucostatic Mucocompressive Selective pressure  Depending on the technique used: Open mouth ; Closed mouth

grinning. swallowing. . licking.  Functional movements: Denture borders obtained by asking the patient to perform functional movements such as sucking. Mucostatic or non pressure impression  First introduced by Richardson and later popularised by Harry page  The impression is made with the oral mucous membrane and the jaws in a normal relaxed condition. Depending on the tray type Stock tray Custom tray  Depending on the purpose of the impression Diagnostic Primary final  Hand manipulation: The contour of denture borders obtained by the dentist with the manual manipulations of the lips & cheeks. FACTS :  Law of hydrostatistics tells us that water is incompressable.  Retention is mainly due to surfacetension.  The impression is made with an oversized tray and impression material of choice was impression plaster.  The mucostatic technique results in a denture which is closely adapted to the mucosa of denture bearing area but has poor peripheral seal.  The mucoperioteum is a semi solid with over 80% of water.

the impression is made to extend much denture-bearing area as possible without interfering with the limiting structures at function and rest. Disadvantages :  Displaced tissues attempts to return to its normal unstrained position so will move the denture out of its intended position resulting in deflective occlusal contacts. The materials used for this technique include impression compound.  Useful in sharp & flabby ridge Mucocompressive Impression (Carole Jones)  Records the oral tissues in a functional and displaced form.  The oral soft tissues are resilient and thus tend to return to their anatomical position once the forces are relieved.  This technique does not allow for adequate muscle trimming of periphery. Dentures made by this technique tend to get displaced due to the tissue rebound at rest. waxes and soft liners. . the constant pressure exerted onto the soft tissues limit the blood circulation leading to residual ridge resorption.  Any substance no matter how fluid when enclosed in a rigid container taken same rigidity as that container.  It is unable to obtain desired pressure so tend to create excessive pressure. Merits :  Maintains tissue in healthy conditions. While muceriosteum cannot be compressed it may be displaced in absence of walls.  This technique doesnot allow adequate muscle imming of periphery.  Tissue is elastic and will not remain passive in a displaced position . Selective pressure technique In this technique. During function.

. In maxilla posterior palatal seal is more readily displaced for maintenance of peripheral seal De merits :  Cannot be used for flabby ridge cases  This technique is based on principle of both biologic as well as physical factors of impression procedure it is widely preffered for well formed healthy ridges.  Primary stress bearing areas:  Maxilla : Crest of alveolar ridge & horizontal plate of palatine bone  Mandible :Buccal shelf area  Secondary stress bearing areas :  Maxilla : Rugae area & all ridge slopes  Mandible : Retromolar pad area & all ridge slopes Relief areas :  Maxilla : Incisive papilla . This is achieved through the design of the special tray in which the non stress-bearing areas are relieved and the stress-bearing areas are allowed to come in contact with the tray. Mid palatine suture . The selective pressure technique makes it possible to confine the forces acting on the denture to the stress-bearing areas. spacers Selective pressure can be achieved either by scraping of the primary impression in selected areas or by fabrication of custom tray with a proper spacer design & escape holes. tori  Mandible : Crest of the residual ridge Retromolar pad is an area of support so if denture is not extended over this area a typical boat shaped resorption is seen.

 Boucher :placement of one mm base plate wax on the cast except posterior palatal seal area. Preservation of the alveolar ridge 2. it is more important to preserve what already exists than to replace what is missing.Devans dictum.  Sharry : A layer of base plate wax over the whole area outlined for tray even in pps area. .  Bernard : Attach 2mm thick baseplate wax over areas of cast that usually have softer tissue. rudd. Stability. Support : It is resistance to vertical forces of mastication and to occlusal or other forces applied in a direction toward the basal seat. 5. Esthetics Preservation of the alveolar ridges: M. Placement of 5 relief holes .M. Support 3.  Heartwell mentions 2 techniques 1. wax spacer is placed all around except posterior part of palate. The Basic principles in impression making 1. Scraping in selected areas of impression 2.Different spacer design:  Roy Mac gregor: placement of metal foil in the region of incisive papilla & mid palatine raphae. Retention 4. Rhoads: three tissue stops equidistant from each other.  Morrow. 3 in rugae area & 2 in glandular region.

This is termed as snow shoe effect. Importance of covering pear shaped pad: It rarely resorbs because large active temporalis tendon attached to alveolar bone distal end of this pad. SNOW SHOE EFFECT : All the masticatory forces are distributed across the resilient tissue. Importance of covering buccal shelf area It is a intact cortical plate and not to resorb due to stimulation and attachment of buccinator muscle. pear shaped pad Secondary: Areas of edentulous ridge greater than at right angle or parallel to occlusal forces. Areas of support : Primary : Secondary slight Primary: Areas of edentulous ridge at right angles to occlusal forces & donot resorb easily.The support is enhanced by utilizing maximum coverage of ridge areas.posterior ridges .  Maxillary: posterior ridges & flat areas of palate  Mandibular: Buccal shelf area . The areas of edentulous ridge that are at right angles to occlusal forces but tend to resorb under load  Maxillary: Anterior ridge & all ridge slopes  Mandibular: Anterior ridge & all ridge slopes Slight: areas of displaceable tissues like vestibular areas. PALATAL SUPPORT .

adhesiveness of foods &forces associated with the opening of the jaws-GPT The factors that affect retention are: 1. muscular Anatomical factors . Physiological factors 3. u-shape: Excellent support  high or v-shape: secondary support ROOFLESS DENTURES o Better taste perception & good phonation. Mechanical 5. Improving support :  Surgical removal of pendulous tissue  Use of tissue conditioning materials  Surgical reduction of sharp ridge  Surgical enlargement of ridge  implants Retention It is defined as that quality inherent in the prosthesis which resists forces of gravity . Anatomical factors 2. Physical factors 4. o Used when maxillary ridge is good & opposing a complete mandibular denture.

The size of maxillary denture bearing area is about 24 cm & that of mandible is about 14 cm  Quality of the denture bearing area : Tissues displaced during impression making will lead to tissue rebound during denture use. Physical factors      Adhesion Cohesion Interfacial surfacetension Capillarity Atmospheric pressure Adhesion : It is the physical attraction of unlike molecules. Physiological factors Saliva :  The viscosity of saliva determines retention. leading to loss of retention. The size of denture bearing area 3 The type of saliva .  Cases with Ptyalism can lead to gagging & in patients with xerostomia dentures produce soreness & irritation of mucosa. It acts when saliva sticks to denture base & mucous membrane of basal seat. o The quality of adhesion depends on: 1. size of the denture bearing area : Retention increases with increase in size of denture bearing area. Close adaptation of denture 2.

 Surface tension is inversely proportional to the thickness of the moisture layer between the two surfaces  This indicates that the better the complementary fit. originally tight. why a denture. Interfacial surfacetension :  It is resistance to separation by the film of liquid between the denture base and supporting tissues.  It is most effective when the salivary film is thin and even.  For retention this factor is more importanrt.  It combines action of adhesion and cohesion and it is similar to capillary action.  The application of this principle can also be used to explain.o The most adhesive saliva is thin but it is not as effective due to its inability to draw up column of saliva. cohesion : • It is the physical attraction between like molecules. the more attraction the surfaces will have for each other.  As the tissues resorb. • In order to be effective the salivary layer should be thin. becomes a floater  Stress impressions often reduce the fluid layer over the tissues either by forcibly squeezing out the film or by their setting actions. the space between the denture base and oral tissues increases causing the liquid film to increase in depth. To obtain maximum interfacial surface tension: . in part.  It is totally dependent on the presence of air between liquid and solid contact. thus losing surface tension and affording a better opportunity for the oral fluids to destroy the meniscus. A thin and consequently very powerful film remains. • Retentive effect is in direct proportion to the amount of area covered.

 A liquid tends to rise in a capillary tube by maximizing its contact along the walls of the tube at the interface between the liquid & glass. Hence low pressure is maintained.  Atmospheric pressure can be utilized when the denture base is partially unseated without breaking the seal Mechanical factors :  Undercuts .  There should be good adhesive and cohesive forces which aid to enhance interfacial surface tension.  Peripheral seal prevents air entry between denture surface & soft tissue . Saliva should be thin and even  Perfect adaptation should be present between the tissues and denturebase  The denture base should cover large area. Capillarity : It is defined as that quality or state because of surface tension causes elevation or depression of the surface of a liquid that is in contact with a solid.  Atmospheric pressure plays a roll in retention when relief is present & not filled with saliva.  Peripheral seal & atmospheric pressure are most important & effective factors for retention. Peripheral seal & atmospheric pressure :  peripheral seal is a positive contact of the denture base to the resilient tissues that outline the basalseat.  When there is close adaptation between the denture and mucosa the film of saliva tends to flow & increase its contact there by increasing the retention.

Suction chambers: creates negative pressure & enhances retention Oral & Facial Musculature  Oral & facial muscle action Can significantly contribute to retention but if the polished surfaces of denture are correctly positioned.  It depends primarily on forces that produce attachment of the denture to the mucosa. the maximum buccal extension of the mandibular denture in the buccinator attachment zone.  These forces are adhesion. cohesion. utilization of retromylohyoid space & the sub lingual crescent areas with in physiologic limits will augment retention & stability Forces of retention:  Retention begins with impression. So forces of cohesion in between water molecules not there then there is no adhesion. .  Attachment of denture to mucosa is possible only when these molecules adhere to water. surfacetension  Mucostatics dissmisses adhesion cohesion as factors in retention entire phenomenon being attributed to surfacetension.  To get maximum retention for mandibular denture. Retentive springs  Magnetic forces  Denture adhesives  Suction chambers & suction discs  Denture adhesives: These are available as creams or gels or powders. They should be created on the tissue surface before wearing the denture  .

Occlusal plane  It is mainly related to esthetics & occlusion. • proper tooth arrangement: The best denture stability will be obtained if teeth are placed on or lingual to crest of the ridge. • Vertical height of residual ridge: The residual ridge should have sufficient height to obtain good stability.Stability : It is the ability of a denture to remain securely in place when it is subjected to horizontal movements.e the dentures should have bilateral balanced occlusion. . To be stable a denture requires:  Good retention  Non interfering occlusion  Proper tooth arrangement  Proper form & contour of polished surfaces  Proper orientation of occlusal plane  Good control & coordination of patient musculature  Vertical height & residual ridge occlusion Ideally the denture should be fabricated so that all the posterior teeth have simultaneous contact in eccentric positions as well as in centric relation i.

Esthetics The role of esthetics in improving impression making refers to the development of labial & buccal borders so that they are not only retentive but also support lips & cheek. Strategy of using soft tissue A denture may be supported . possessing tensile strength. A base from which to suspend an object must be tough . Ideally best stability is obtained when occlusal plane is parallel to & anatomically oriented to ridges. ReLation of denture to mucosa o When the force is directed toward the base . the base is used to suspend the object. Patient muscle control & coordination A well coordinated patient will usually manage if the dentures are inadequate. the base is used to support the object A base to support an object must b e hard & unyielding possesing compressive strength. suspended or sustained by the mucosal base in one of 3 ways . When the force is directed away from base . The dead weight of the lower denture is supported by lower base where as upper is held in suspension by the upper base.

Attachment through atmospheric pressure is usually transient for air chambers & reliefs tend to fill in with tissue or saliva. A denture is supported when the force is base wise& perpendicular resulting in compressive loads. . Interfacial surfacetension will resist only forces perpendicular to axes of surfacetension forces.  A denture is suspended when the force is counterwise resulting in tensile loads. atmospheric pressure or both. Mucosa contacted but not contained The mouth tissues including the mucosa may be contacted but it can hardly be said that they can be contained The pascals law would apply namely  Any substance no matter how fluid when enclosed in a rigid container takes on the same rigidity as that container  Pressure applied to a confined liquid is transmitted undiminished to all parts & acts in all directions.  A denture is sustained when the force is base wise in one area & simultaneously counterwise in another area. In function atmospheric pressure is superior to interfacial surface tension as a retentive force for forces horizontal as well as parallel to the mean mucosal plane are resisted. Means of attachement The means of attaching a denture to the mucoperiosteum is by interfacial surface tension .

 These are in a constant state of flux depending on fluid content & stresses applied to it . If adhesion fails that is if denture is detached & dislodged it is probably due to extreme torque & failure of border tissues to maintain contact. In presence of mucosal torque a relief in the palatal area helpful in retention.Mucostatic school The pages announcement in this:  Soft tissues should be registered in an impression in unstrained rest position & any other position lead to dislodgement of denture. Rotation puts more strain on retention than traslation When denture shifts bodily that is horizontally the cheek on working side comes to rescue & help to stop movement A Mathematical approach Rest registration of ridge areas is important in attaining stability The horizontal stability is impossible in the presence of horizontal forces .  Free movement of tissue are limited by 2 factors namely thickness & rigidity.  A denture may move with mucosa without being detached from it.  When the denture moves under masticatory loads the function of border tissue & roll is to enable the border tissues to follow the movement & thus keep out saliva as well as air. Palatal relief prevents vault from acting as a fulcrum & permits the denture to shift bodily the movement being more translatory than rotatory.

there is but little space for the buccinator muscle to pass between the denture base and the tuberosity.  The middle fibers arise posteriorly on the pterygomandibular raphae with those of the opposing constrictor pharynges superior  They are joined in the molar regions by the upper fibers from above maxillary molars & lower fibers from below mandibular molars & all 3 sets of fibers converse as they proceed to angle of the mouth. A closing movement will squeeze an impression material against the tuberosity and often mold the posterior border of the buccal flange to a more or less sharp edge. Movement of angle of mouth Backward : middle fibers Upward : upper fibers Downward : lower fibers When the maxillary tuberosity is prominent.According to Synge. . This is interesting and important because many dentures have been shaped with too thick a disto buccal margin and a swing of the mandible to the opposite side has caused pain or dislodgment of the denture or both Conclusion: . the increasing in displaceability of an incompressible membrane placed between two rigid bodies is directly proportional to the cube of increase in thickness or cube of decrease in rigidity Maxillary & Mandibular buccal regions  The buccinator is the principle muscle of cheek.  It originates in 3 sets of fibers.

stability and support of a complete denture proper impression making is must. & appearance of dentures. Tilton DDS o Physical considerations in impression making . JPD 7:14. Charles H.1957 LOTT.logan DMD . JPD 4:232. For making proper impression the clinician should have an idea about basic principles in impression making. B. S.S.: physical factors affecting the retention of complete dentures o Bernard Levin o Principles involved in impression making Theodare E. comfort..Collett DDS jacksonville. function. Friedman. o Complete denture impression Henry A. h.For achieving adequate retention. Moser DDS MSC . Fla o A Minimum pressure Complete denture impression technique Glen E.: Flange technique: An anatomic & Physiologic approach to increased retention.: A critical analysis of the mucostatic principle. References Bhanna. : Edentulous impression procedures for the maximum retention & stability. JPD 16:394 . & LEVIN. 1954.m.F..1966 o STAMOULIS.

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