This Lecture is included in the exam , you should also to refer to the handout also its included in the

Mid term exam

Definition of the impression: An imprint / negative likeness of the teeth &/or edentulous areas where the teeth have been removed, made in a plastic material which becomes relatively hard or set while in contact with the tissues .

A complete denture impression is a negative registration of the entire denture bearing( the area that will bear the denture ) , stabilizing & border seal areas ( the depth of the sulcuses or vestibules ) present in the edentulous mouth.

This is a complete denture impression for the uppr and lower ,made up of impression compound material .

See the anatomical landmarks that we have talked about during dental anatomy , it is present in these impression , you should get these landmarks here .

We have impression techniques , we have 3 types : 1- close mouth or impressiong pressure technique : we took an impression or register or record an impression by applying a load to the underlying tissue , because the foundation of the complete denture is the residual ridge and the remaining tissue of the oral cavity .

2- Non pressure or mucostatic technique : we record the tissue without applying pressure to the tissue .( without under loading)

3- Selective compression impression technique : Record impression with more compression with some tissue and the other tissues are left without loading , its very difficult to use .

We are going to discuss these techniques .. Depending on theories of impression making Mucostatic / passive impression (Richardson & Henry L. Page) Mucocompression / functional impression (Carole Jones & Greene brothers) Selective Pressure impression (Boucher )

Depending on the technique Open mouth / Closed mouth technique : OPEN mouth : we take the impression when the mouth is open , and we will wait until the impression material become hard and remove it from the patients mouth ) CLOSE mouth : we place the impression inside the patients mouth and we ask the patient to close his mouth , we wait until the material to become hard and then we remove it . Hand manipulation for functional movements (Dynamic impression) Depending on type of tray . Stock tray / Custom tray impression . we have stock trays are made up from metal , and most of them for the dentulous patiens come perforated , for the Edentuloues it comes flat without any perforation .
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Custom made : special tray

Depending on purpose of the impression Diagnostic / Primary / Secondary Primary : A patient come to your clinic complaining of something , we took the impression and study it not intraorally , on a cast which is called study cast or primary cast that made from Gypsum material which is plaster ( white in color ) Depending on the material used A variety of types : Agar, Alginate, Impression Compound, Plaster, Wax, Silicone, Thiokol rubber impression .

Principles of impression making

( The most important ) : Oral tissues must be healthy Impression should include basal seat within limits. (Basal Seat: it the area where the denture rest) Borders must be in harmony with anatomical & physiological limitations of oral structures Selective pressure techniques. Enough space should be provided within impression tray for impression Material because when you press the impression on the tissue it comes from the sides of the tray , theres no space , so our impression will become faulty ! Guiding mechanism (tissue stops & handles) should be provided for correct positioning of tray
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 Impression Should be removed from mouth without damaging the mucosa Materials used must be dimensionally stable, when we took an impression and take it from the patients mouth, some impression must be poured immediately with a gypsum material , other impression you can let it aside for a period of time . External shape of impression should be similar to external form of complete denture .

Objectives of impression making Preseve we have to preserve of remaining natural structures , impression should record details in appropriate form to prevent injury of the soft tissue , this depend upon your selection of tray and upon your performing your special tray ( should not be sharp ) . * Relief for the non-stress bearing areas, thus preventing damage ( you shouldnt apply pressure to the area that are going to be subjected to load during function ). *Avoid overextensions ( the most important thing when you construct any device that Hs got acrylic flanges , it should never overextend the soft tissue ,,, ( The overextension means loss of the tissue !! )

R retention : The quality inherent in the prosthesis( complete or partial denture that you will make ) which resists the force of gravity, adhesiveness of foods, and the forces associated with the opening of the jaws . we should extend the blocks to the border areas of the cast , so that the muscle will rest on these border areas , and later on its going to create a seal all around , so that the upper record block will never fall when you check it inside the patients mouth . It is the ability of denture to withstand displacement against the path of insertion ( when you insert the denture it will not fall down . )

Factors affecting retention

Anatomical : size & quality of denture bearing area When the size and the quality increases, it means that we will get more retention . Physiological: viscosity of saliva (thick/thin) . Thin saliva passes easier than thick saliva so the retention become batter theres a problem when the saliva is thick , theres no retention in thick saliva . because when you insert upper denture and press it on the tissue , the air that is surrounded with the saliva is going out from this area will cause stickiness to the tissue .if the saliva was stick its very difficult that this saliva itll come out and from underneath the complete denture . this process is called microtubular process . Physical : adhesion , cohesion, surface tension, capillarity ( microtubular ) & atmospheric pressure . Mechanical : undercuts, retentive springs, magnets( aids in adhesion) , adhesives, suction chambers/discs ( these are created at a special kind of dentures ) Muscular : Neutral zone or Natural Zone ( important , because not all of the edentulous patients that comes to the clinic have proper height, width, length of the residual ridge . Some of our patients come with extremely resorbed residual ridge . we are going to depend on a technique that include the folds of the cheek that are going to produce retention by sitting on the flat flanges of the denture . The flange of the denture will not pass down, it will become like a wing !

Stability
Defenition : The quality of a denture to be firm, steady, or constant, to resist displacement by functional stresses & not to be subject to change of position when forces are applied - when there is loading or mastication or speech , the denture should remain in the patients mouth and when the patient coughs or sneeze ,the denture will not fall out from patients mouth . It is the ability of the denture to withstand horizontal forces. Factors affecting stability Vertical height of ridge -- resorbed ridge means poor stability. Quality of soft tissue : firm / flabby tissues Firm soft tissue : attach to the underlined bone firmly, when a denture sits in position it will not move this tissue . Flabby soft tissue ) ( : it will not return on denture position Quality of impression: the impression should be accurate, smooth and stable. if your impression is irregular and not smooth it will be annoying to the patient when you create the other steps . Occlusal plane : should be parallel to ridge , unfortunately ,once we finish we are going to see the creation of your settings , the most terrible things ! the incisal edge must touch the incisal table

Arrangement of teeth --- balanced occlusion . For a natural dentition ,when there is teeth you can chew on right or left side . but , for a denture if you chew on one side it means that you will break the seal on the other side and the denture will fall down , so you have to advice the patient for this note . Contour of the polished surfaces : denture must be shiny polished so that the muscle can perform movement better .
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Support
The resistance to vertical forces of mastication, occlusal forces & other forces applied in a direction towards the denture bearing area. TThe denture bearing area & The residual ridge and the hard palate is going to support our denture . Support must be achieved by covering as much area as possible . This helps to distribute forces like snowshoe .it means the forces will be distributed equally on both sides .

Esthetics
Thickness of flanges should never exceeds 2 mm in . Otherwise it will become functionally unacceptable , its going to affect the space that are occupied by the origin and insertion of the muscles Impression must reproduce width & height of sulcus

Recording the Preliminary Impression

TRAY : A receptacle into which a suitable material is placed to make an impression A device which is used to carry, confine & control an impression material while making an impression . Stock tray metal / plastic, 2-3mm clearance, should cover tuberosity & hamular notch. It has many different sizes , we have to find a size that matches our patients residual ridge . It means that theres enough space for the impression material , and we have to check it properly when its inside the patients mouth .
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 Special tray A custom made device prepared for a particular patient which is used to carry, confine & control an impression material while making an impression. Material used should be well adapted, stable, 2mm thick, contrast in color & 2mm short in sulcus . Fabrication of tray : shellac, self cure resin, thermoplastic resins, vacuum formed Vinyl or Polystyrene. Storing the trays

1st of all , you ask the patient to open his mouth and then youre going to reflect the cheek by this round movement to the side form the tray flange ,and then for the upper: * you stand in front of the patient * you insert the tray starting from the tuberosity area like the picture shows And then we make the tray up, and then we move the cheek to see if there is any spaces for the buccal frenum , because when you take an impression you have to make border molding. And then you pull it(impression) gently . when I say border molding it doesnt need that force to pull it down , but gently and smoothly to check for the space of the labial frenum , once we make sure that our tray is perfect fitting the same size and shape of our maxillary denture area , then we are going to take the impression. Dr. is asking : what is the materials that used in constructing the primary impression ??Ans : Alginate , impression compound , Agar refer to the hand out for more information about them ! , its included in the exam , and important
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The impression material which is impression compound is a hard material , when sets it is very hard , not like alginate ( when sets it still flexible ) . impression compound theres no need to pour it immediately with primary gypsum material like plaster . but, the alginate you should pour it immediately with plaster or gypsum material because it is going to loose its humidity and there will be shrinkage in the impression . Impression compound , this material is fit on elastic material . It means it become flexible when it is placed in a hot water ,it should not stick to our fingers ! , we take the impression from the posterior part , and then we left it come to anterior part making these border move , once we finish and the impression tray Is loaded and set in position , we have to stand behind the patient ( whether to the left or the right) and support the tray . After that we move it from the patient mouth . For the lower tray : the same .. we have to check the frame , the size whether its fit or not . and then we have to check it also inside the patients mouth . you have to pull the cheek with your finger or let it away by this movement with your tray , otherwise it will not inter the mouth ! .. let the cheek to the side GENTLY Insert the impression , to see the whole residual ridge & to see the retro molar area is it come with our impression ? .. Is there any space enough on any side? .. after we check this we also we pull the cheek out and up to check for the space of the flanges , its going to create the rounded border area around the impression tray . HERE WE FINISH !!

Done By : Majd M. Hidmi .. Forgive me for any mistakes, Good luck In Exam
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