ACADEMICS AND EDUCATION

Current Concepts and Techniques in

Complete Denture Final Impression
Procedures
Vicki C. Petropoulos, DMD, MS,1 and Behnoush Rashedi, DMD, MSEd, MS2

Purpose: In 2001, a survey of U.S. dental schools was conducted to determine which concepts,
techniques and materials are currently prevalent in the teaching of final impression procedures for
complete dentures in the predoctoral clinical curriculum.
Materials and Methods: The questionnaire was mailed to the chairperson of the prosthodontic/
restorative departments of 54 U.S. dental schools. Of these, 44 schools returned the completed survey
resulting in a response rate of 82%.
Results: Results from this survey show that the majority of schools (71%) teach the selective-pressure
technique for final impression making; the majority of the schools (64%) use modeling plastic impression
compound for border molding the final impression tray; 39% of the schools do not place vent holes in the
final impression tray, 30% of schools place more than one hole and 27% place one hole only; the majority
of the schools (98%) are using custom trays for final impressions. Ninety-eight percent of the schools are
border molding the custom tray and 70% of schools are using a visible light-cured (VLC) composite resin
material to make the trays. Thirty-six percent of the schools are teaching the Boucher impression
technique and 34% are teaching the modified Boucher impression technique.
Conclusions: Predoctoral clinical complete denture educational programs agree on many aspects of
final impression making, however, there is variability in their teachings regarding the impression
philosophy and the materials used.
J Prosthodont 2003;12:280-287. Copyright © 2003 by The American College of Prosthodontists.

INDEX WORDS: final impression materials, custom tray, wax relief, dental education, complete
denture impression techniques, border molding, selective-pressure technique

I N 1995, the Institute of Medicine published a

report emphasizing the need for dental educa-
tors to reassess the predoctoral prosthodontic cur-
riculum to make it more relevant to clinical prac-
tice for the general practitioner.1 Such a curriculum
will be important, considering that the number of
persons over age 65 is expected to double by the
year 2030, with the percentage of those needing
treatment with complete dentures remaining al-
most constant.2 As a result, knowledge and clinical
From the Department of Restorative Dentistry, University of Pennsyl-
vania School of Dental Medicine, Philadelphia, PA.
1
Assistant Professor and Course Director of Fixed Prosthodontics.
2
Assistant Professor and Course Director of Removable Prosthodontics.
Accepted April 23, 2003.
Correspondence to: Vicki C. Petropoulos, DMD, MS, University of
Pennsylvania School of Dental Medicine, Department of Restorative Den-
tistry, 4001 Spruce Street, Philadelphia, PA 19104-6003. E-mail:
VPetropoulos@aol.com
Copyright © 2003 by The American College of Prosthodontists
1059-941X/03/1204-0000$30.00/0
doi:10.1016/S1059-941X(03)00108-6
skills in treating patients with edentulism will be
even more important in the decades to come.3
The objectives of the final impression for the
edentulous arch are to provide retention, stability,
support, and esthetics and to maintain health.4
Over the past several decades, the different philos-
ophies and techniques of impression making have
been topics of controversy,5 with debate centering
on (1) the amount of pressure applied to the tissues
while making the impression, (2) the degree of
tissue detail that is captured, (3) the type of im-
pression material selected, (4) the type of impres-
sion tray used, (5) whether the mouth should be
open or closed when the impression is made, and
(6) whether the peripheral borders of the denture
should be functionally border molded or located
arbitrarily.
Three basic concepts for impression making
have been described as they relate to the pressures
selectively applied to the particular anatomic areas:
(1) mucostatic impression technique (minimal-
pressure technique),6 functional impression tech-
nique (pressure technique),7 and semifunctional

280 Journal of Prosthodontics, Vol 12, No 4 (December), 2003: pp 280-287

 December 2003, Volume 12, Number 4
impression technique (selective-pressure tech-
nique).8 Most textbooks recognize the variation in
academic opinion regarding these philosophies and
offer various materials and techniques for different
clinical situations.9 Previous educational surveys
have been conducted to determine the final impres-
sion materials used for the construction of complete
dentures.10-13 The most recent U.S. predoctoral
prosthodontic survey for this topic was conducted in
1993 by Arbree et al14 in an effort to establish what
newer reported techniques and materials predoc-
toral dental schools were using in complete denture
prosthodontics. This 1993 survey asked 2 questions
regarding the materials used for border molding
the impression tray and for the final wash impres-
sion. A review of the literature reveals no more
recent survey of final impression techniques and
materials used in predoctoral prosthodontic pro-
grams in U.S. dental schools. Given the controversy
over final impression making for complete dentures
among academicians,5 the objective of the current
survey was to determine which concepts, tech-
niques, and materials are currently prevalent in the
teaching of final impression procedures for com-
plete dentures in the clinical curriculum of predoc-
toral U.S. dental schools.
Materials and Methods
In November 2001, a questionnaire (Fig 1) was mailed to
the chairperson of the prosthodontic/restorative depart-
ment of 54 U.S. dental schools requesting information on
concepts taught and materials and techniques used for
final impression making in the predoctoral clinical com-
plete denture programs. After a second mailing to schools
that had not returned the questionnaire within a
3-month period, 44 of the 54 schools responded, yielding
a response rate of 82%.
The survey comprised 11 multiple-choice questions
and asked each respondent to circle all responses that
applied to his or her program. The option of providing a
specific answer other than the listed choices was available
for each question. The questions were pilot-tested on-site
by faculty members to evaluate the suitability of the
questions before the questionnaire was mailed to other
schools.
Results
Which impression concept is currently taught
for making a final impression for the fabrica-
tion of a complete denture? (Question 1)
281
Thirty-one (71%) of the schools reported using
the “selective-pressure technique”; 9 schools (20%),
the “mucostatic technique”; and 1 school (2%), a
combination of all 3 techniques. Three schools (7%)
responded “other,” including “standard custom
tray border molded with medium viscosity polysul-
fide,” “simple technique” with no further specifica-
tion, and “alginate.”
What material(s) do you currently teach
for use in border molding the final impres-
sion tray for the edentulous patient? (Ques-
tion 2)
Twenty-eight schools (64%) reported using mod-
eling plastic impression compound for the final
impression tray, 2 schools (5%) reported using poly-
ether, 1 school (2%) reported using polysulfide, 1
school (2%) reported using polyvinylsiloxane, and 1
school (2%) reported using wax materials (Adaptol;
Jelenko International, Heraeus Kulzer, Armonk,
NY). Nine schools (20%) responded “other,” includ-
ing 1 school (2%) that does not perform border
molding, 5 schools (11%) that use both the model-
ing plastic compound and polyvinylsiloxane, 2
schools (5%) that use both the modeling plastic
compound and polyether, and 1 school (2%)that
uses both modeling plastic compound and polysul-
fide. Two (5%) schools did not respond to this
question.
Are you currently teaching students to
place vent holes in final impression tray?
(Question 3)
Seventeen schools (39%) responded “no”; 13
schools (30%) responded “yes, more than 1 hole”;
12 schools (27%) responded “yes, 1 hole”; 1 school
(2%) responded “not applicable”; and 1 school (2%)
responded both “yes, 1 hole” and “yes, more than 1
hole.” Comments from the schools responding “no”
included “will use if high maxillary vault” and “will
use for special circumstances.” The school that
indicated “not applicable” had indicated in the
Question 2 that they do not border mold and also
indicated in Question 1 that they use “alginate” for
the final impression technique.
Are you currently teaching students to use a
custom tray for making final impressions of
edentulous arches? (Question 4)
Forty-three schools (98%) reported using a cus-
tom tray for making final impression of edentulous
arches. Only 1 school (2%) reported not doing so;
this was the same school that reported using “algi-
nate” as the final impression material.
282 Complete Denture Final Impression Procedures: A Survey ● Petropoulos and Rashedi

Figure 1. Questionnaire sent to U.S. dental schools.

What material is used for the fabrication of
custom trays? (Question 5)
Thirty-one schools (70%) reported using a visible
light– cured (VLC) composite resin material for
fabricating custom trays, and 7 schools (16%) re-
ported using self-curing acrylic resin. Six schools
(14%) indicated “other,” including 4 schools (9%)
using both VLC and self-curing acrylic resins. One
school (2%) did not respond to the question, and 1
school (2%) indicated that the question was not
applicable.
Do you teach border molding of the custom
tray for complete denture final impressions?
(Question 6)
 December 2003, Volume 12, Number 4 283

Figure 1. (Cont’d)

Forty-three schools (98%) reported teaching bor-
der molding of the custom tray for complete den-
ture final impression. One school (2%) reported not
teaching this method.
How much relief is used to relieve the custom
tray in complete denture therapy? (Question 7)
The responses to this question are tabulated in
Tables 1 and 2.
What material is used for relief of the cus-
tom tray? (Question 8)
Thirty-two schools (73%) reported using base-
plate wax for relief of the custom tray, 1 school (2%)
reported using beading wax, 1 school (2%) reported
using boxing wax, 2 schools (5%) reported using
both baseplate wax and boxing wax, and 1 school
(2%) reported using baseplate wax, beading wax,
and boxing wax. Three schools (7%) responded
“other,” which included “wax from dip pot, base-
plate wax for the maxillary arch and two squares of
baseplate wax for the mandibular arch, use the
handpiece and bur.” Three schools (7%) indicated
that the question was not applicable, and 1 school
(2%) did not respond to the question.
Which impression method are students be-
ing taught for making final impression for com-
plete dentures? (Question 9)
284 Complete Denture Final Impression Procedures: A Survey ● Petropoulos and Rashedi

Table 1. Amount of Wax Relief for the Custom Table 3. Materials Taught for Use as Final
Tray Impression of Edentulous Arches
Number of Number of Responding
Responding Impression Materials Schools (%)*
Amount of Wax Relief Schools (%)*
Polysulfide 17 (39)
One layer of wax relief 20 (45) Polyvinylsiloxane 4 (9)
Relief only in undercut areas 12 (27) Polyether 3 (7)
“Other” 6 (7) ZOE 0 (0)
No relief 4 (10) Other 20 (45)
Two layers of wax relief 1 (2)
*One school responded “not applicable” to this question.
Discussion
Thirty-eight schools (86%) reported that stu- The results of this predoctoral clinical complete
dents are taught the “open-mouth technique” for denture survey of U.S. dental schools show that
final impression making; 4 schools (9%), the “closed final impression making for the construction of a
mouth method;” 1 school (2%), the “open-mouth complete denture varies from school to school. The
for 1 arch only;” and 1 school (2%), “other,” speci- design of this survey allowed the respondents to
fying “closed mouth for relines.” indicate more than 1 answer where appropriate and
What materials are currently being taught to write in responses when necessary. This was
for use as final impression material for eden- helpful, because the questions did not “lead” any
tulous arches? (Question 10) respondent to choose a response that did not accu-
The responses to this question are summarized rately or fully represent his or her situation. The
in Tables 3 and 4. question that elicited the most multiple responses
What impression philosophy is being taught was Question 10, pertaining to the final impression
for making final impressions of edentulous pa- material used for fabricating complete dentures.
tients? (Question 11) Many schools indicated that they were trying a
Sixteen schools (36%) indicated that they teach variety of final impression materials and were not
students the Boucher impression technique; 15 limited to 1 material.
schools (34%), the modified Boucher technique; 1 The most prevalent impression philosophy being
school (2%), the modified Halperin technique; 1 taught (by 71% of the schools responding) is the
school (2%), both the Boucher technique and the selective-pressure technique. This technique at-
modified Boucher technique; and 7 schools (16%), tempts to place stress on those areas of the maxilla
“other,” including “Smith technique,” “mucostatic and the mandible that can best resist functional
pressure and selective pressure,” and “selective forces of the denture bases.15 Levin and Sauer10 in
loading.” Four schools (9%) did not answer this a 1969 survey asked a similar question, and found
question. that 58% of dental schools surveyed taught the
selective-pressure technique.
The second-most used technique is the muco-
Table 2. “Other” Responses for Amount of Wax static (minimal-pressure) technique, used by 20%
Relief
Number of Table 4. “Other” Responses for Final Impression
“Other” Responses for Amount Responding Materials Used
of Wax Relief Schools (%)
Number of
Relief only where required* 3 (7) “Other” Responses for Final Impression Responding
Relief only in undercut areas and Materials Used Schools (%)
“tori” 1 (2)
One layer of wax* and no relief† 1 (2) Polysulfide and polyvinylsiloxane 10 (22)
Relief only in undercut areas, “rugae Polysulfide and ZOE 4 (9)
and mylohyoid ridge” 1 (2) Polysulfide, polyvinylsiloxane, and ZOE 3 (7)
Irreversible Hydrocolloid 1 (2)
*Included rugae, frenulum, mylohyoid region, median palatine Polysulfide, polyether, polyvinylsiloxane,
raphe, tori, pressure sensitive areas and ZOE 1 (2)
†Indicated that use 1 layer when using polysulfide or polyvinyl- Polyvinylsiloxane and ZOE 1 (2)
siloxane material and no relief when use ZOE impression ma-
terial. *Rounding error, does not equal 100%.
 December 2003, Volume 12, Number 4
of the schools responding to the present survey.
This was similar to the 21% found by Levin and
Sauer.10 The mucostatic technique advocates cov-
ering only the areas of attached mucosa by the
future denture base, and thus the resulting flanges
of the denture are shorter compared to those re-
sulting from the other techniques.15 With this tech-
nique, the mucosa is recorded in a resting state.15
Currently, no responding schools use only the
functional impression technique, which records the
denture-bearing areas while under occlusal func-
tional loading.15 In contrast, the 1969 survey10
found that 21% of the responding schools used this
technique.
The majority of dental schools (64%) are using
only the modeling plastic impression compound for
border molding final impression trays. This ques-
tion did not ask the respondent to indicate specifi-
cally what type of modeling compound was used (ie,
green, gray, or red stick modeling compound).
There is a decline in the number of schools using
solely modeling plastic impression compound for
border molding compared with the 1993 survey by
Arbree et al,14 which reported that 81% of the
schools used this material exclusively.
The present survey indicates an increase in the
percentage of schools (18%) using a combination of
materials. Examples include combinations of poly-
vinylsiloxane impression material and modeling
compound and of polyether impression material
and modeling compound. This change reflects the
introduction of “newer” techniques into the predoc-
toral curriculum. In addition, a recent study16 re-
ported a new technique for border molding eden-
tulous impressions using polyvinylsiloxane material
as an alternative to the conventional method of
border molding using modeling plastic impression
compound. Another study17 reported an abbrevi-
ated technique for complete denture construction
that eliminates the border-molded custom tray.
This technique helps reduce the number of visits
needed to fabricate the complete dentures without
increasing the number of postinsertion appoint-
ments or the need for relines.
The majority of dental schools (59%) reported
that they teach the placement of 1 or more vent
holes in the custom trays. Placing vent holes in the
tray allows for selective relief of pressure during the
making of the final impression and also provides an
escape route for the final impression material.4 The
fact that most schools teach the use of vent holes is
in agreement with the high percentage of schools
285
teaching the selective-pressure technique. In gen-
eral, the choice of impression philosophy dictates
the manner of custom tray construction.18
Most of the responding dental schools (98%) are
teaching students to use a custom tray for complete
denture final impressions. This is in agreement
with a 1985 survey by Jaggers et al,13 which found
that 94% of schools used custom trays for the final
impression procedure. It would be of interest to
determine whether this is in fact the current trend
among private practices in the United States. A
1999 survey of general dentists from the Manches-
ter, U.K. area found that 75% of the dentists rou-
tinely used custom trays for complete denture im-
pressions.9 In the current survey, only 1 school
reported not teaching the use of a custom tray and
not teaching border molding; this school reported
using irreversible hydrocolloid as the final impres-
sion material.
Most of the responding schools (70%) report
using the VLC composite resin material to fabri-
cate custom trays. This represents a switch to a
“newer” material from the 1993 survey,14 which
reported that only 35% of schools were using VLC
composite resin exclusively for custom tray fabrica-
tion.
Most dental schools (98%) are teaching students
to border mold the custom tray for the final com-
plete denture impression. A similar question was
asked in Levin and Sauer’s 1969 survey,10 and most
schools reported teaching students to border mold
the custom tray. The lack of change over the last 32
years reflects the importance of properly recording
peripheral borders during impression making of
complete dentures.
The question on the amount of relief used in the
custom tray elicited varied responses. The purpose
of relief is to provide a space between the tissue and
the custom tray. Most schools (92%) reported using
some type of relief in the impression tray. This
percentage is in agreement with the percentage of
schools (71%) teaching the selective-pressure tech-
nique for final impression making. This correlation
is not surprising, because the manner by which a
custom tray is fabricated is dictated by the institu-
tion’s impression philosophy.18 A shortcoming of
this question was that it did not ask specifically
“where” the layer(s) of wax were placed. However,
Question 11 asked about the impression philosophy
taught, and the responses to this question reflected
the location of the wax relief.
286 Complete Denture Final Impression Procedures: A Survey ●
The schools’ impression philosophy varied
widely, with almost equal percentages using the
“Boucher technique” (36%) and the “modified
Boucher technique” (34%). Both techniques are
based on the selective-pressure philosophy of final
impressions. The Boucher technique advocates a
1-mm wax relief over the entire basal seat area of
the custom tray. The tray is then trimmed 2-3 mm
of the anticipated peripheral extensions, and, after
border molding, the periphery is trimmed 1 mm
and the wax removed to provide space for the wash
impression material.18 The “modified Boucher
technique” includes any modifications of the fore-
going technique. The “Halperin technique” advo-
cates a 1-mm wax relief over the peripheral exten-
sions of the custom tray. The tray is then in
intimate contact with the basal seat areas, and a
butt joint is formed from the peripheral wax for
border molding completion. The master cast is
poured directly into the border-molded custom tray
without a wash impression.18 The “modified Halp-
erin technique” encompasses any modification in
this technique, including variations in the materials
used.
Impressions may be made with the patient’s
mouth open or closed. Most U.S. schools (86%) are
teaching the open-mouth impression technique.
Closed-mouth impression procedures were not in-
troduced until well after 1900. When the mouth is
closed, the tissues of the muccobuccal fold are more
relaxed, permitting greater extension of the bor-
ders. But the closed-mouth techniques confine the
tongue and does not allow it to move as if in
function to form the lingual borders.19
The most popular impression material, used by
39% of the schools, is polysulfide. This represents a
decline in polysulfide’s popularity from the 1993
survey,14 which reported that 48% of schools were
using polysulfide as the material of choice for com-
plete denture final impressions. In the 1969 sur-
vey,10 zinc oxide-engenol (ZOE) was the most pop-
ular (85%) final impression material in the
responding schools. In the current survey, this ques-
tion provided the most “write-in responses” (45% of
schools), and a combination of materials was indi-
cated under “other.” The choice of impression ma-
terial(s) used today in dental schools shows how
schools are moving toward newer materials and
techniques and away from traditional materials,
such as polysulfides and ZOE. Because some
schools are using newer materials in combination
with traditional materials, they may want to expose
Petropoulos and Rashedi
students to the traditional materials and at the
same time introduce them to newer materials and
techniques.
Conclusions
A survey of complete denture final impressions was
conducted to identify the impression philosophies,
techniques, and materials used in U.S. dental
schools; 82% of the schools responded. Information
obtained from the responding schools included ma-
terials and educational techniques used for the
construction of the final complete denture impres-
sion. The responses were tabulated. Some trends
are apparent, as indicated by the large percentage
of schools agreeing on the following:
1. Using the selective-pressure technique for mak-
ing final impressions for edentulous arches
2. Using modeling plastic impression compound
for border molding of the final impression tray
3. Using custom trays for the final impression pro-
cedure
4. Using a VLC composite resin material as the
material of choice for fabricating the custom
tray
5. Teaching border molding of the custom tray as
part of the final impression
6. Using baseplate wax as the material of choice for
relief of the custom impression tray
7. Making vent holes in the custom tray
8. Teaching the “open-mouth” impression technique.
The questions eliciting the most varied re-
sponses were related to the (1) material used for
the final impression, (2) amount of wax relief used
for the custom tray, and (3) impression philosophy
taught.
Acknowledgment
The authors wish to thank all of those who generously
devoted their time and effort to completing the questions
for our survey.
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