278 Volume 101 Issue 4

25.Rosentritt M, Behr M, Gebhard R, Handel Corresponding author: Acknowledgements

G. Influence of stress simulation param- Dr Sebastian Hahnel The authors thank Ivoclar Vivadent, Schaan,
eters on the fracture strength of all-ce-
ramic fixed-partial dentures. Dent Mater
Department of Prosthetic Dentistry
Regensburg University Medical Center
Liechtenstein, for supplying products for this
investigation. Modified fluid wax impression for a
2006;22:176-82. 93042 Regensburg
severely resorbed edentulous
mandibular ridge
26.Heintze SD, Cavalleri A, Forjanic M, Zell- GERMANY Copyright © 2009 by the Editorial Council for
weger G, Rousson V. A comparison of three Fax: +49-941-944-6171 The Journal of Prosthetic Dentistry.
different methods for the quantification of E-mail: Sebastian.Hahnel@klinik.uni-regens-
the in vitro wear of dental materials. Dent burg.de
Mater 2006;22:1051-62.
Kian M. Tan, BDS,a Michael T. Singer, DDS, MS,b Radi Masri,
BDS, MS, PhD,c and Carl F. Driscoll, DMDd
Baltimore College of Dental Surgery, University of Maryland,
Baltimore, Md
This article describes a technique for making a definitive impression for highly displaceable residual ridges. The tech-
Noteworthy Abstracts of the Current Literature nique is especially applicable for mandibular edentulous ridges. The choice of the impression materials, as well as the
design of the impression tray, focuses on preventing distortion of the displaceable residual ridges during impression
Fractographic analyses of zirconia-based fixed partial dentures making. Using an impression tray with an opening, modeling plastic impression compound and impression wax are
used to accurately capture the shape of the residual ridge and place pressure onto denture load-bearing areas. Low-
Taskonak B, Yan J, Mecholsky JJ Jr, Sertgöz A, Koçak A. viscosity vinyl polysiloxane impression material is then used over the window opening to capture the surface details of
the residual ridge without distorting the displaceable tissues. The use of this technique helps in maintaining the con-
Dent Mater 2008;24:1077-82.
tour and capturing the detail of the tissues, as well as in accurately determining the extent of the muccobuccal denture
extensions. ( J Prosthet Dent 2009;101:279-282)
Objectives: Advances in ceramic processing techniques enable clinicians and ceramists to fabricate all-ceramic fixed
partial dentures (FPDs) for posterior regions using high-strength yttria-stabilized tetragonal zirconia polycrystals (Y-
TZP). However, failures occur in ceramic FPDs due to their design. The objectives of this study were to determine the Making a definitive impression of Most impression techniques for it is difficult to handle and difficult
site of crack initiation and the causes of fracture in clinically failed zirconia-based ceramic FPDs. an edentulous arch can be challeng- the management of displaceable tis- to pour8 and offers little advantage
ing when the residual ridges present sues have been described for the an- over contemporary low-viscosity vinyl
Methods: Five clinically failed four-unit Y-TZP-based FPDs (Cercon ceramics, DeguDent GmbH, Hanau, Germany) with less-than-ideal conditions, es- terior maxilla,5,6 and techniques to polysiloxane materials.
were retrieved and analyzed. The fragments containing the fracture origins in the veneers (Cercon Ceram S Veneer- pecially when there is minimal bone manage displaceable tissues in the Mandibular residual ridges with
ing Ceramic, DeguDent GmbH, Hanau, Germany) of two samples were missing but the rest of veneer structures height, unfavorable residual ridge mandible during impression making adequate bone support can usually
were present. The other three samples had their veneers intact. Fracture surfaces were examined using fractographic morphology, and/or unfavorable are rarely reported. Due to the ana- be precisely recorded with elastomer-
techniques, utilizing both optical and scanning electron microscopes (SEM). Quantitative fractography and fracture muscle attachments.1 Impressions tomical differences between the max- ic impression materials because of
mechanics principles were used to estimate the stresses at failure. are also challenging when the mucosa illa and the mandible, as well as the the inherent accuracy of these materi-
overlying the residual alveolar ridges is differences in primary and secondary als and their propensity to distribute
Results: Primary fractures initiated from the gingival surfaces of connectors at veneer surfaces in four out of the five highly displaceable. Displaceable, hy- load-bearing areas, impressions of pressure equally. As the residual ridg-
samples. However, critical flaw sizes could be measured in three of the five cases since fracture origins were lost in the perplastic, or flabby tissues are com- mandibular ridges with displaceable es resorb, the tissues become unsup-
remaining two due to local fragmentation at the crack initiation site. Delaminations between glass veneer and zirconia monly seen in the anterior region of tissues require special considerations. ported and displaceable; the use of an
core were observed in Y-TZP-based FPDs and a secondary fracture initiated from the zirconia core. Secondary fracture the maxilla in combination syndrome2 A classic impression technique elastomeric impression material in a
controlled the ultimate failure. Failure stresses of the fixed partial dentures that failed due to zirconia fracture ranged or in the mandibular alveolar ridge commonly used for the fabrication confined tray will result in a distorted
from 379 to 501 MPa. Fractures that had origins on the glass veneer surface had failure stresses between 31 and 38 when extensive bone resorption has of immediate complete dentures7 or impression. Therefore, the impression
MPa. occurred.3 Displacing such residual the treatment of patients with com- technique should be modified to pre-
ridge tissues during impression mak- bination syndrome5 uses a custom vent distortion of unsupported and
Significance: Primary fractures in clinically failed Y-TZP-based FPDs initiated from the veneer surfaces. Interfacial de- ing is always a concern. Soft tissues impression tray with a window open- displaceable tissues. A functional im-
lamination in glass veneer/zirconia core bilayer dental ceramic structures controlled the secondary fracture initiation that are displaced during impression ing in the anterior region. When the pression technique, such as fluid wax,
sites and failure stresses in Y-TZP-based fixed partial dentures. making tend to return to their original maxillary edentulous ridge presents captures the primary and secondary
form, and complete dentures fabri- with anterior hyperplastic tissues, load-bearing areas without distortion
Reprinted with permission from the Academy of Dental Materials. cated from the impression will not fit a zinc oxide eugenol impression is of the residual ridge. In the mandible,
accurately on the recovered tissues. As first made, and a creamy mix of im- the alveolar residual ridge serves as a
a result, loss of retention and stability pression plaster is then painted onto secondary load-bearing area, with the
of the dentures, discomfort, and gross the displaceable tissues.5 Impression buccal shelves serving as the primary
occlusal disharmony may occur.4 plaster produces little pressure, but load-bearing area.9,10

a
Postgraduate Prosthodontics Resident.
b
Clinical Assistant Professor; private practice, Bethesda, Md.
c
Assistant Professor.
d
Professor, Program Director.
The Journal of Prosthetic Dentistry Hahnel et al Tan et al
280 Volume 101 Issue 4 April 2009 281
According to Applegate,11 the use
of fluid wax in impression making was
described previously by Everett. It has
the following advantages: (1) it can
be easily controlled to gain maximum
coverage; (2) it can be corrected read-
ily; (3) it can be used to accurately de-
termine the extent of the muccobuc-
cal reflections; and (4) it can be used
to direct pressure to the load-bearing
areas, specifically, the buccal shelves
and the slopes of residual ridges in the
mandible.10,11 The low-viscosity elas-
tomeric impression material is advan- 1 Mandibular edentulous ridge with severe bone resorption. 4 Fluid wax impression. 5 Application of vinyl polysiloxane impression material
tageous because it creates minimal over window opening.
pressure, produces accurate details,
does not distort easily, and is easy to
handle.12,13
An alternative method of making
a definitive impression for mandibular
edentulous arches with displaceable
tissues, using impression wax and vi-
nyl polysiloxane impression material,
is described.

TECHNIQUE

1. Make a preliminary impression

of the edentulous arch (Fig. 1) using
irreversible hydrocolloid impression
material (Jeltrate Alginate; Dentsply
Caulk, Milford, Del) in a metal stock
tray (Rim-Lock Impression Tray;
Dentsply Caulk).
2. Pour the impression in type III
dental stone (Modern Materials Den-
stone; Heraeus Kulzer, Armonk, NY)
(Fig. 2).
3. Fabricate a custom impression
tray on the preliminary cast using
light-polymerized acrylic resin tray
material (Triad TruTray; Dentsply Tru-
byte, York, Pa). Adjust the border ex-
tension of the tray to be at least 2 mm
short of the vestibules on the prelimi-
nary cast.9
4. Evaluate and adjust the exten-
sion of the tray in the mouth, if nec-
essary. Soften modeling plastic im-
pression compound (Gray Stick; Kerr
Corp, Orange, Calif ) in a water bath
at 53°C, and place it on the intaglio
surface of the tray, corresponding to
the region of the mandibular central
incisors and both the mandibular first
The Journal of Prosthetic Dentistry
2 Preliminary cast. Note distortion of left alveolar ridge lingually due
to pressure exerted by irreversible hydrocolloid impression material. 6 Completed modified fluid wax impression.
pression wax (D-R Miner Dental Wax-
es, Medford, Ore) in a container held
in a water bath at 42°C, and apply
the impression wax onto the borders
of the tray with a wax spatula while it
is still fluid. Ensure that the tempera-
ture used to melt the impression wax
is less than the working temperature
of the modeling plastic impression
compound used in the border mold-
ing procedure, to prevent distortion.
9. Place the impression tray imme-
3 Window opening of impression tray. diately over the edentulous ridge, and
leave it in the mouth for approximate-
molars, to serve as spacers for impres- the residual ridge, and create a win- ly 5 minutes. Allow adequate time for
sion wax. dow opening above the displaceable the mouth temperature impression
5. Border mold the tray with mod- alveolar ridge using a No. 8 round wax to flow and escape to the periph-
eling plastic impression compound in bur (Brasseler USA, Savannah, Ga), ery of the impression, as well as to
segments. similar to the tray design described solidify.
6. Remove the spacers with a scal- by Watson.5 Determine the size of the 10. Remove the impression tray
pel blade (Becton, Dickinson and Co, window opening according to the ex- from the mouth and cool it immedi-
Franklin Lakes, NJ) once the border tent of the displaceable tissues (Fig. ately in water at room temperature.
molding is completed. 3). 11. Add impression wax in incre-
7. Trim the tray over the crest of 8. Melt the mouth temperature im- ments on the periphery until a defi-
Tan et al Tan et al
7 Boxing of impression.
nite reproduction of the muccobuccal
fold is obtained.
12. Apply impression wax onto the
intaglio surface of the tray to capture
the remaining surfaces of the residual
ridge. Add impression wax onto the
slopes of the ridge, rather than the
crest, in increments,10 until a glossy
surface is visible.11 Maintain the in-
tegrity of the residual ridge by exerting
pressure onto the slopes (Fig. 4).
13. Trim away any excess impres-
sion wax on the periphery or over
the window opening with a scalpel
blade.
14. Apply adhesive (Caulk Tray
Adhesive; Dentsply Caulk) on the tray
in the area surrounding the window
opening, and allow it to dry.
15. Place the impression tray
onto the residual ridge and inject vi-
nyl polysiloxane impression material
(Aquasil Ultra Monophase Regular
Set Smart Wetting Impression Mate-
rial; Dentsply Caulk) over the window
opening. Prevent distortion of the
soft tissues by placing the impression
material in the most passive manner
possible.
16. Gently blow air onto the im-
pression material to allow the spread
of the impression material over the
mucosal surfaces.
17. Allow the impression material
to polymerize according to the manu-
facturer’s recommendation (Figs. 5
and 6).
18. Remove, disinfect, and box the
impression using a mix of plaster and
pumice as described by Martin et al
(Fig. 7).14 Avoid using a conventional
boxing procedure that requires box-
ing wax, as it may distort the impres-
sion wax.
19. Pour the impression in type
III dental stone (Modern Materials
Denstone; Heraeus Kulzer) as soon as
possible (Fig. 8).
280 Volume 101 Issue 4 April 2009 281
According to Applegate,11 the use
of fluid wax in impression making was
described previously by Everett. It has
the following advantages: (1) it can
be easily controlled to gain maximum
coverage; (2) it can be corrected read-
ily; (3) it can be used to accurately de-
termine the extent of the muccobuc-
cal reflections; and (4) it can be used
to direct pressure to the load-bearing
areas, specifically, the buccal shelves
and the slopes of residual ridges in the
mandible.10,11 The low-viscosity elas-
tomeric impression material is advan- 1 Mandibular edentulous ridge with severe bone resorption. 4 Fluid wax impression. 5 Application of vinyl polysiloxane impression material
tageous because it creates minimal over window opening.
pressure, produces accurate details,
does not distort easily, and is easy to
handle.12,13
An alternative method of making
a definitive impression for mandibular
edentulous arches with displaceable
tissues, using impression wax and vi-
nyl polysiloxane impression material,
is described.

TECHNIQUE

1. Make a preliminary impression

of the edentulous arch (Fig. 1) using
irreversible hydrocolloid impression
material (Jeltrate Alginate; Dentsply
Caulk, Milford, Del) in a metal stock
tray (Rim-Lock Impression Tray;
Dentsply Caulk).
2. Pour the impression in type III
dental stone (Modern Materials Den-
stone; Heraeus Kulzer, Armonk, NY)
(Fig. 2).
3. Fabricate a custom impression
tray on the preliminary cast using
light-polymerized acrylic resin tray
material (Triad TruTray; Dentsply Tru-
byte, York, Pa). Adjust the border ex-
tension of the tray to be at least 2 mm
short of the vestibules on the prelimi-
nary cast.9
4. Evaluate and adjust the exten-
sion of the tray in the mouth, if nec-
essary. Soften modeling plastic im-
pression compound (Gray Stick; Kerr
Corp, Orange, Calif ) in a water bath
at 53°C, and place it on the intaglio
surface of the tray, corresponding to
the region of the mandibular central
incisors and both the mandibular first
The Journal of Prosthetic Dentistry
2 Preliminary cast. Note distortion of left alveolar ridge lingually due
to pressure exerted by irreversible hydrocolloid impression material. 6 Completed modified fluid wax impression.
pression wax (D-R Miner Dental Wax-
es, Medford, Ore) in a container held
in a water bath at 42°C, and apply
the impression wax onto the borders
of the tray with a wax spatula while it
is still fluid. Ensure that the tempera-
ture used to melt the impression wax
is less than the working temperature
of the modeling plastic impression
compound used in the border mold-
ing procedure, to prevent distortion.
9. Place the impression tray imme-
3 Window opening of impression tray. diately over the edentulous ridge, and
leave it in the mouth for approximate-
molars, to serve as spacers for impres- the residual ridge, and create a win- ly 5 minutes. Allow adequate time for
sion wax. dow opening above the displaceable the mouth temperature impression
5. Border mold the tray with mod- alveolar ridge using a No. 8 round wax to flow and escape to the periph-
eling plastic impression compound in bur (Brasseler USA, Savannah, Ga), ery of the impression, as well as to
segments. similar to the tray design described solidify.
6. Remove the spacers with a scal- by Watson.5 Determine the size of the 10. Remove the impression tray
pel blade (Becton, Dickinson and Co, window opening according to the ex- from the mouth and cool it immedi-
Franklin Lakes, NJ) once the border tent of the displaceable tissues (Fig. ately in water at room temperature.
molding is completed. 3). 11. Add impression wax in incre-
7. Trim the tray over the crest of 8. Melt the mouth temperature im- ments on the periphery until a defi-
Tan et al Tan et al
7 Boxing of impression.
nite reproduction of the muccobuccal
fold is obtained.
12. Apply impression wax onto the
intaglio surface of the tray to capture
the remaining surfaces of the residual
ridge. Add impression wax onto the
slopes of the ridge, rather than the
crest, in increments,10 until a glossy
surface is visible.11 Maintain the in-
tegrity of the residual ridge by exerting
pressure onto the slopes (Fig. 4).
13. Trim away any excess impres-
sion wax on the periphery or over
the window opening with a scalpel
blade.
14. Apply adhesive (Caulk Tray
Adhesive; Dentsply Caulk) on the tray
in the area surrounding the window
opening, and allow it to dry.
15. Place the impression tray
onto the residual ridge and inject vi-
nyl polysiloxane impression material
(Aquasil Ultra Monophase Regular
Set Smart Wetting Impression Mate-
rial; Dentsply Caulk) over the window
opening. Prevent distortion of the
soft tissues by placing the impression
material in the most passive manner
possible.
16. Gently blow air onto the im-
pression material to allow the spread
of the impression material over the
mucosal surfaces.
17. Allow the impression material
to polymerize according to the manu-
facturer’s recommendation (Figs. 5
and 6).
18. Remove, disinfect, and box the
impression using a mix of plaster and
pumice as described by Martin et al
(Fig. 7).14 Avoid using a conventional
boxing procedure that requires box-
ing wax, as it may distort the impres-
sion wax.
19. Pour the impression in type
III dental stone (Modern Materials
Denstone; Heraeus Kulzer) as soon as
possible (Fig. 8).
282
8 Resultant definitive cast.
SUMMARY
A definitive impression technique
using both impression wax and vi-
nyl polysiloxane impression material
for displaceable mandibular residual
ridges is described. Consideration has
been given to the choice of impres-
sion materials as well as to the design
of the impression tray to minimize the
amount of pressure exerted onto the
displaceable regions of the residual
ridges during the impression-making
procedure.
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The Journal of Prosthetic Dentistry
REFERENCES
1. McGarry TJ, Nimmo A, Skiba JF, Ahlstrom
RH, Smith CR, Koumjian JH. Classifica-
tion system for complete edentulism. The
American College of Prosthodontics. J
Prosthodont 1999;8:27-39.
2. Kelly E. Changes caused by a mandibular
removable partial denture opposing a
maxillary complete denture. J Prosthet Dent
1972;27:140-50.
3. Xie Q, Närhi TO, Nevalainen JM, Wolf
J, Ainamo A. Oral status and prosthetic
factors related to residual ridge resorption
in elderly subjects. Acta Odontol Scand
1997;55:306-13.
4. Lytle RB. The management of abused oral
tissues in complete denture construction. J
Prosthet Dent 1957;7:27-42.
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5. Watson RM. Impression technique
for maxillary fibrous ridge. Br Dent J
1970;128:552.
6. Lynch CD, Allen PF. Management of the
flabby ridge: using contemporary materi-
als to solve an old problem. Br Dent J
2006;200:258-61.
7. Campagna SJ. An impression technique
for immediate dentures. J Prosthet Dent
1968;20:196-203.
8. Freeman SP. Impressions for complete den-
tures. J Am Dent Assoc 1969;79:1173-8.
9. Zarb GA, Bolender CL, Eckert SE, Fenton
AH, Jacob RF, Mericske-Stein R. Prost-
hodontic treatment for edentulous
patients: complete dentures and implant-
supported prostheses. 12 ed. St. Louis:
Mosby; 2003. p. 232-33, 246.
10.Boucher CO. A critical analysis of mid-
century impression techniques for full
dentures. J Prosthet Dent 1951;1:472-91.
11.Applegate OC. Essentials of removable par-
tial denture prosthesis. 3rd ed. Philadephia:
WB Saunders; 1965. p. 254-5.
12.Al-Ahmad A, Masri R, Driscoll CF, von
Fraunhofer J, Romberg E. Pressure gener-
ated on a simulated mandibular oral
analog by impression materials in custom
trays of different design. J Prosthodont
2006;15:95-101.
13.Masri R, Driscoll CF, Burkhardt J, Von
Fraunhofer A, Romberg E. Pressure gener-
ated on a simulated oral analog by impres-
sion materials in custom trays of different
designs. J Prosthodont 2002;11:155-60.
14.Martin JW, Jacob RF, King GE. Boxing the
altered cast impression for the dentate
obturator by using plaster and pumice. J
Prosthet Dent 1988;59:382-4.
Corresponding author:
Dr Radi Masri
650 West Baltimore St, Room 4228
Baltimore, MD 21201
Fax: 410-706-1565
E-mail: rmasri@umaryland.edu
Copyright © 2009 by the Editorial Council for
The Journal of Prosthetic Dentistry.
Tan et al
Method for fabrication of a cast
mounting device with interchangeable
occlusal templates
Jimmy Londono, DDS,a and Philip S. Baker, DDSb
School of Dentistry, Medical College of Georgia, Augusta, Ga
The cast mounting device is an in- able occlusal templates for orienting from the open end of the cup, reduce
dex for positioning a patient’s maxil- the maxillary cast in articulators using it approximately 10 mm more than
lary cast within the dental articulator. mounting plates. It may permit use of the required final plane height.
This technique is commonly based a single duplicate template on mul- 4. Obtain an indexed dowel pin
upon average measurements made tiple brands and models of articula- and matching sleeve (MR PIN - Dual
from anatomic landmarks. Although tors, when appropriate template bas- Pin and Sleeve; Select Dental Mfg
many studies1-23 have investigated es have been made using the outlined Co, Farmingdale, NY). Using a pencil
arbitrary or kinematic facebows to technique. Alternatively, multiple oc- point, place a hole in the center of the
determine whether they are more ac- clusal templates could be fabricated cup bottom with a diameter slightly
curate methods for cast orientation, to fit a single base made for a specific greater than the widest diameter of
controversy over their use contin- model, system, or brand of articula- the dowel sleeve. Mix mounting stone
ues.24 tor, depending on the manufacturer’s (Mounting Stone; Whip Mix Corp)
Some commercial mounting de- design. and fill the modified cup. Place some
vices currently available are the Artex of the remaining mounting stone into
Set Up Templates for Complete Den- PROCEDURE the retentive features of the mount-
tures (Amann Girrbach AG, Koblach, ing plate on the articulator. Invert the
Austria), the Denar HIP Mounting 1. Using a vacuum forming device stone-filled cup and place it on top of
Platform (Whip Mix Corp, Louisville, (UltraVac Vacuum Former; Ultradent the loaded mounting plate, adjusting
Ky), and the Quick Master Articu- Products, Inc, South Jordan, Utah), for correct alignment as needed. Re-
lator System Mounting Table (FAG duplicate the metal occlusal template move any excess stone expressed from
Dentaire, Cluses, France). The Artex (Trubyte 20 Degree Posterior Tem- the opening in the bottom of the cup,
index is designed for use only in com- plate; Dentsply Intl, York, Pa) with so that it is approximately at the height
plete denture treatment, while the 0.080-inch hard, clear splint material of the original paper bottom. Prior to
Denar Platform and the Quick Mas- (Henry Schein, Inc, Melville, NY). initial stone set, embed the single pin
ter Mounting Tables are intended for 2. Trim the thermoplastic sheet to end of the dowel pin patrix in the cen-
dentulous as well as edentulous pa- the original external template outline tered cup hole, with the pin oriented
tient applications. with a vacuum form trimming bur perpendicular to the table top and
The primary limitation of these (Brasseler H219S.11.023; Brasseler pin shoulder at the level of the stone
commercial devices is their lack of USA, Savannah, Ga). Do not remove surface. Note that the template base
interchangeability with other manu- material from the lingual area. is now completed (Fig. 1, A).
facturers’ articulator systems. Unless 3. Secure a mounting plate to 5. Place a hole in the center of the
the dentist uses the appropriate ar- the lower member of the articulator duplicate 20-degree template using
ticulator with a specific cast mount- of choice. Center an inverted 6-oz a medium acrylic resin trimming bur
ing device, it cannot be ensured that waxed paper cup (Solo Cup Co, High- (Brasseler E-Cutter H79E-050; Bras-
the components will be compatible in land Park, Ill) on top of the mount- seler USA); the hole should allow pas-
either fit or orientation. ing plate. Position the duplicated, sage of the matrix sleeve of the dowel
The purpose of this article is to trimmed template on the cup and pin. Seat the matrix fully on the pa-
describe a simple, quick, and inex- determine the appropriate cup height trix. Place the template on the seated
pensive method for fabricating a to establish the desired occlusal plane sleeve, avoiding dislodgement of the
mounting device with interchange- level within the articulator. Trimming sleeve from the patrix. Position the
Clinical Instructor, Department of Oral Rehabilitation.
a
Associate Professor, Department of Oral Rehabilitation.
b
(J Prosthet Dent 2009;101:283-284)
Londono and Baker