Chapter 2 Preliminary impression

CHAPTER 2
2. Preliminary Impressions, Diagnostic
Casts and Custom (Final) Trays

dental impression is a negative imprint of an oral structure used

to produce a positive replica of that structure which acts as a permanent record
or is used in the production of a dental restoration or prosthesis. It is done in
two stages:

1. Preliminary impression: It is a negative likeness made for the

purpose of Diagnosis, treatment planning and fabrication of a custom tray.

2. Secondary impression: It is a negative likeness made for the purpose

of recording the areas of mouth preparation and constructing the patient’s
prosthesis or restoration.

1. Preliminary impression
The objective of the 1ry impression is to obtain an impression overextended
along the borders.

 Uses of the preliminary impression

1. To provide the study cast for case diagnosis.
2. To provide a cast for the fabrication of a final impression tray.
3. In some techniques the impression itself is modified for use as a final
impression tray.

 The preliminary impression should:

1. Record the entire denture support area.
2. Record the oral anatomy adjacent to the denture support area.

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3. Record the natural form & physiologic extension of oral tissues

 Stock trays:
1) Selection of stock trays for 1ry impression:
The tray used for 1ry impression should:
a. Be large enough to provide adequate thickness for the alginate
impression material (5-7 mm).
b. Have mechanical means of retention for impression material.
c. In high vault palate, build up the tray with impression compound to
prevent the hydrocolloid from sagging away from the palatal surface.
d. The stock tray might require some modifications using impression
compound or it may need to be trimmed (Figure ‎12-1).

Figure ‎12-1: Stock tray modified by wax to improve adaptation and stability inside the
patient’s mouth

2) Impression material used for preliminary impression:

Irreversible hydrocolloid (Alginate) impression material is the most commonly
used material because of the following advantages:
i. It is easily manipulated.
ii. Has fast setting time.
iii. Has soft consistency & pleasant for the patient.
iv. Used in presence of saliva.
v. Hydrophilic can be poured in stone
vi. Has pleasant taste & odor and non expensive.
vii. Can be disinfected with 2% glutaraldehyde
viii. Stored in 100% humidity and then poured within one hour.
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 Common problems in making alginate impressions:

i. Surface inaccuracy due to: Air bubbles, or mucous film on
the soft tissue.
ii. Dimensional inaccuracy due to:
 Synerisis & imbibition.
 Strain caused by movement or removal during
gelation.
 Dislodgment of impression from the tray
 Displacement during pouring.
iii. Cast has rough surface or chalky appearance due to:
 Poor alginate mix.
 Saliva retained on impression surface.
 Impression left long period in contact with the cast.
 Trapping of air.
iv. Low tear strength of alginate can be improved by lifting the
impression in the patient mouth one or two minutes more
after setting.

Figure 2-2: A pressure area in the impression in left canine region

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Chapter 2 Preliminary impression

 A successful impression should have:

i. Maximum area of coverage within the physiological limits
of the tissues surrounding the denture.

ii. Intimate adaptation to with the tissue surface to reproduce

the foundation and border tissues accurately.

iii. Extension into the vestibule to create a border seal.

 Possible Causes of an Inaccurate and/or a Weak Cast of a Dental

Arch
i. Distortion of the hydrocolloid impression By:
 The use of elastic impression tray
 Partial dislodgment of impression from the tray
 Shrinkage caused by dehydration
 Expansion caused by imbibitions
 Attempt to pour the cast with stone that has already
begun to set.
ii. High water - powder : it will result in a weak cast.
iii. Improper mixing. This results in a weak cast or one with a
chalky surface.
iv. Air Trapping either in the mix or in pouring or insufficient
vibration.
v. Soft or chalky cast surface that results from the retarding
action of alginate.
vi. Premature separation of the cast from the impression.
vii. Failure to separate the cast from the impression for an
extended period.

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Chapter 2 Preliminary impression

 Impression technique:
i. A stock tray of a suitable size should be selected for each patient.
ii. The material is mixed in a rubber bowl using a curved spatula. This helps
to breakdown the fibrous network leading to an increase the mixing time.
iii. The material is loaded onto the tray and a small amount of material is
applied on to the palate.
iv. The tray is carried into the patient’s mouth and seated firmly in position
until gelation is complete.
v. The tray is removed in a single stroke with a single path of removal.
Rotating the tray during removal will cause distortion of the impression.
vi. The path of removal of the impression should be parallel to the long axis
of the remaining teeth.
 Inspecting the impression:
i. The impression made is inspected for air inclusions and voids.
ii. The surface is inspected to verify if all the landmarks have been
recorded accurately.
 Disinfecting the impression:
i. The impression is disinfected using iodophor.
ii. It should be left undisturbed for ten minutes.
iii. 2 % Glutaraldehydeis also the disinfectant of choice.

3) Pouring the diagnostic cast

i. The cast should be poured within 12 minutes after making the
impression.
ii. Minimal expansion dendrite dental stone is used.
iii. The cast is poured with two-pour technique.
iv. Stone mix is made under vacuum and the first pour is made.
v. The thickness of the first pour should be at least 6 mm.
vi. After 10 to 12 minutes, slurry water is sprayed over the first pour.

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vii. Next the impression is inverted over a mix of stone (second pour)
and the base of the cast is shaped using a plaster knife
viii. The cast is separated 45 - 60 minutes after the initial set of the
gypsum.
4) Trimming of the cast:
i. Minimum thickness of base (at the thinnest portion) 10 mm at the
center of hard palate in the maxilla.
ii. 10 mm at the depth of lingual sulcus in the mandible.
iii. Posterior surface of the cast must be perpendicular to the base.
iv. The sides of the cast are trimmed so that they are parallel to the
buccal surfaces of the teeth.
v. Periphery should be 3 mm wide all around the cast.

 The base of the upper cast should have seven sides.

They are:
— Two anterior surfaces meeting at the midline.
— Two surfaces on the sides.
— One surface at the posterior end.
— Two surfaces in-between the sides and the posterior end.

 The base of the lower cast will have only six sides
— It should have a single anterior curve instead of two anterior surfaces.

5) Evaluating the Diagnostic Cast

 After making the diagnostic casts, they should be evaluated to determine
the problems that the clinician might face during the fabrication of the
RPD.

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 The diagnostic casts can be evaluated using two procedures both of

which are essential:
• Surveying the diagnostic cast using a surveyor.
• Mounting the diagnostic cast in an articulator.

 Factors that complicate impression making:

1. Amount and consistency of saliva:
i) Excessive salivation & thick ropy saliva complicates impression
making.
ii) This occurs by forming voids in the impression.
iii) May cause the patient to gag while impressions making.
iv) The palatal surface should be wiped free of saliva with a piece of
gauze before impression making.
2. Thick cheeks:
i) Patients with thick cheeks may present problems during impression
making.
ii) They do not allow easy border molding of impression material.
3. Tone of the facial muscles:
i) Too tense or too weak muscle tone is unfavorable.
ii) Tense muscle interferes with proper extension of the denture borders.
iii) Extra time is required to make functional molding of the impression
borders.
iv) In patients with strong muscle tension, the vestibule will be too
shallow & the impression border becomes thin and short.
4. Muscular control:
i) Tongue movements are used for border molding the lingual flange of
the mandibular impression.
ii) Exaggerated tongue movements will cause under extended lingual
borders.
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Chapter 2 Preliminary impression

iii) In such conditions proper training can help the patient in learning the
proper location of the tongue.
5. Gagging:
Active gag reflex complicates impression making.
 Gagging can be triggered by:
i. Encroaching upon the palatoglossal muscle by long tray.

ii. Distal portion of the lingual tray make excessive contact with the
posterior third of the tongue.

iii. Upper tray that is too short or too long. Short tray causes sagging
of the impression on the dorsal surface of the tongue, that trigger
gagging.

 Management :
i. Careful manipulation of impression trays.
ii. Keeping the patient’s head forward.
iii. Using minimal amount of impression material
iv. Instructing the patient to breathe deeply through the nose &
diverting the patient from the actual work are helpful.
v. Mandibular impression should be made before the maxillary
impression
vi. Local anesthesia can be used in severe cases.
6. The presence of undercuts:
i. Presence of severe undercut areas interferes with the insertion and
removal of the tray.
ii. This requires suitable path of insertion & using elastic impression
material.

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