N22​ WORKING IMPRESSIONS -

RECORDING THE FUNCTIONAL SURFACE
Overview
Working impressions serve to record the
denture-bearing surface and functional sulcus.
By ensuring that the working model is a
precise duplicate of the mouth, when the Zinc oxide/eugenol impression pastes
denture is prepared the thinnest possible
saliva film separates it from the supporting Figure 2
tissues. Optimum retention then follows.

Choice of impression materials

On the basis of their pre-set properties, two

types of impression material are defined for
working impressions viz. mucostatic and
mucodisplacing. A mucostatic impression
material has a low viscosity and records the
Undercut mandibular ridge
soft tissues at rest. A mucodisplacing
impression material has a high viscosity and is
said to record the tissues in a more functional Figure 3a
state. On the clinic three impression materials
are popular for working impressions, zinc
oxide (Fig. 1), silicone, and alginate. All three
can be dispensed in a range of viscosities
depending on the way they are dispensed and
their time and rate of mixing. Although
clinicians have favourite techniques and
materials, no clinical trial has yet established
the superiority of any one material over any
Close-fitting tray – terminating just short of the
other in terms of patient satisfaction with the
sulcus
final product.

Once set, impression materials can be either Figure 3b

elastic or rigid. Of the three commonly
available materials, only zinc oxide is rigid. It
therefore cannot be used to record undercut
ridges (Fig. 2) and this factor is the primary
criterion used in selection.

Adjustment of special trays

While the ideal special tray must cover the Sulcus formed by impression material rather
entire denture-bearing area, it should end than margin of tray
1-2mm short of the sulcus, so ensuring that
the functional sulcus depth is not distorted by Adjustment of special trays takes place in two
the tray margin and is formed by impression stages. First check the periphery of the tray
material only (Fig. 3a and b).
on the primary model using the transferred
outline mark as a guide. Underextensions - or
overextensions - are easily identified (Fig. 4)
Figure 1
and can be corrected by addition of light-cure
composite (Fig. 5). They are then cured in a
light-box in the laboratory (Fig. 6).
Overextensions, if small, are corrected by
adjustment with a handpiece at the chairside.
More substantial overextensions are corrected Figure 5
on a lathe in the laboratory.

After placing the tray in the patient’s mouth

check for overextension by observing
movement when traction is exerted on the
modiolus and the lips, and when the tongue is
protruded. Reduce the tray appropriately.
Then, again with the tray in the patient's
mouth, use a mouth mirror to check for
underextension. These are common (and
most difficult to identify) in the maxillary
tuberosity region. To correct underextension, Additions made in light-cure resin
additions are made, again with light cure
composite, muscle-trimmed in the mouth (Fig. Figure 6
7a) and cured (Fig. 7b).

It is important to correct underextension

because if an impression is taken in an
underextended tray the impression material
will be unsupported at the periphery and will
distort when a model is cast.

Typical light-box
Figure 7
Figure 8

Buccal addition in light cure resin

Addition cured in place

Figure 4
Impression technique

Close fitting tray

Mandibular impression

After dispensing equal lengths of zinc oxide

Tray deficient labially
and eugenol impression pastes, mix on a
paper pad to a smooth, streak-free
consistency (Fig. 8). Load the tray with the
material (Fig. 9). Standing in front of the
patient rotate the tray into the mouth and place
accurately over the residual ridge observing
extrusion of material from around the entire
periphery (Fig. 10). Maintain in position until
set, with the forefingers in the premolar region
of the tray. Do not exert so much pressure
that the tray penetrates the layer of impression
material.

Encourage the patient to protrude their tongue Tray loaded

to ensure that the lingual periphery is not
overextended (Fig. 11). Do not encourage
repeated tongue movements unless the Figure 10
impression material has a very slow set,
otherwise it will tend to slump back as the
muscles relax and then be fragmented by
repeated displacement. Gentle inwards and
backwards traction on the modiolus will ensure
that the impression material is not
overextended buccally.

Finally, remove the impression carefully from

the patient’s mouth. Inspect it to confirm the
periphery is rounded and intact and extends Extrusion of paste in buccal region
distally to show the entire retromolar pads
(Fig. 12).
Figure 12

Figure 11

Example of completed mandibular impression

Maxillary impression​.
Protrude the tongue to ensure lingual extension
correct Load the tray (Fig. 13) with zinc oxide. Ensure
that the entire fitting surface and periphery are
Figure 8 coated. A little excess may be left in the
anterior region. Standing behind the patient,
rotate the tray into the mouth. Raise the lip
and seat the tray first anteriorly (Fig. 14),
observing that the zinc oxide paste enters the
labial sulcus, then posteriorly. Once fully
seated check that the paste has entered the
sulcus posteriorly (Fig. 15). This technique
ensures that the flow of the impression paste
is from before backwards, so preventing a
bubble of air being trapped in the deepest part
of the palate.
Mixed zinc oxide paste
When the tray is correctly seated, functionally
Figure 9 trim the periphery by traction downwards and
backwards on the modiolus. Pressure on the
outside of the lip reduces the thickness of the
labial extension and improves the final
appearance of the patient by preventing
excess lip support.

Finally remove the impression and inspect for

defects. (Fig. 16)

Spaced tray.

Except for using a greater volume of

impression material, the general technique for
a spaced tray is as for a close-fitting tray. On
insertion, take care that the spacing of the tray
from the ridge is the same as on the model
(Fig. 17). Too little and on removal of the
impression the thickness of impression
material may be insufficient to ensure that the
elastic limit is not exceeded and distortion will
follow.

Figure 16

Completed maxillary impression

 Figure 13
Tray loaded with zinc oxide paste
Figure 14
Check that paste enters the labial sulcus
Figure 15
Check that paste enters the buccal sulcus
Figure 17
Spacing maintained throughout
Correction of impressions
Ideally the surface of the set impression
should be intact without visible faults where
the tray has perforated the impression
material. The presence of such a fault means
that the soft tissues may have been
compressed by the tray rather than being
recorded in an unstressed state by the fluid
impression material.
When detected, reduce the surface of the tray
locally at the perforation (Fig. 18). Place a
small amount of fluid impression paste on the
site of adjustment and replace in the mouth,
seating firmly. On examining the set surface
there should be no evidence of the addition
(Fig. 19).
When the tray does not show, small
imperfections of the periphery can be
augmented in the same way but adjustment of
the underlying tray is unnecessary.
Technical Details
Cross-infection procedures are as for primary
impressions. To ensure the periphery is
recorded accurately, impressions can be
beaded with a strip of soft wax 2-3mm above
the deepest part of the sulcus (Fig. 20). When
casting the model, the plaster is extended to
the beading so ensuring that the functional
sulcus is recorded (Fig. 21). Instructions to
the technician must include the materials to be
used for the registration blocks.
Figure 21
Model showing record of sulcus
Figure 18

Site of perforation identified and reduced
Figure 19
Completed addition
Figure 20
‘Beaded’ impression
Special technique
When fibrous tissue has replaced the anterior
maxilla, special difficulties are encountered
and any impression material enclosed in a
special tray will cause soft tissue
displacement. A tray is indicated which has a
‘window’ removed over the site of the soft
fibrous tissue. At the working impression
stage, the normal tissues are first recorded by
the close-fitting part (Fig. 22). The soft fibrous
tissue, which protrudes through the window, is
later recorded by freehand application of a
fluid impression material (Fig. 23).
(Contents)
Figure 22
‘​Windowed’ tray – first stage
Figure 23
‘Windowed’ tray – impression complete