IMPRESSIONS FOR COMPLETE DENTURES
By C arl O . B o u c h e r , D .D .S ., C olum bus, O h io
• A N A T O M Y is the key to the choice
o f an im pressioii techn ic fo r com ­
plete dentures. A study o f the a n at­
om y o f the m o u th reveals th e possible
extent o f the dentures, as w ell as the lo ca ­
tion o f the structures th a t are covered by
them . I t is necessary th a t th e im pression
surfaces o f dentures conform p erfectly to
the tissues w h ic h support them , in order
th at the m axim um retention and stability
m ay be obtained. I t is not enough fo r the
dentures to be in con tact w ith the proper
tissues: the co n tact m ust be such th at
they do not in terfere w ith the h ealth and
the norm al fun ction o f the structures
underlying them .
T h e physical forces th at hold dentures
in p lace w h en no great dislodging force
is applied are adhesion and capillary
attraction. A d hesion is defined b y W eb ­
ster as “ the sticking together o f sub­
stances in co n tact w ith each other.”
C a p illa ry attraction is the force that
holds the m olecules o f a mass together.
T h e saliva, w h ich adheres to the m ucous
m em brane an d to the denture, is held
together by ca p illa ry attraction. In large
quantities o f saliva, cap illary attraction
loses its effectiveness. T h erefore, the im ­
pression surfaces o f the denture must
conform p erfectly to the m ucous m em ­
brane in ord er to lim it the am ount o f the
saliva u n d er th e denture. T h e denture
m ust be protected against lateral or
anteroposterior slipping if a u niform
am ount o f saliva is to be m aintained
From the College of Dentistry, Ohio State
University.
Read before the Section on Full Denture
Prosthesis at the Eighty-Third Annual M eet­
ing of the American Dental Association,
Houston, Texas, October 29 , 19 4 1 .
Jour. A .D .A ., V o l. 30, January 1, 1943
u n der a ll parts o f the denture. M o re­
over, the fo rce o f adhesion and cap illary
a ttraction is d irectly proportional to th e
area covered. T h e larger the area c o v ­
ered b y a denture, the stronger the force
required to dislodge it. T h e area th at
m ay b e covered b y a denture is lim ited
b y the anatom ic form o f the m outh fo r
w h ich it is m ade.
A tm ospheric pressure is the force th at
holds dentures in place w h en a dislodging
fo rce is applied . It has been called a
“ rescue force.” A t sea level, it am ounts
to 14.7 pounds p er square inch. I t re­
quires a p erfect seal o f the periphery
o f the denture to b e effective. T h ere
m ust be no a ir leak around the border
o f a den ture. In order that this condi­
tion m a y be attained, the periphery o f
the denture m ust h ave a definite relation
to the structures th a t lim it it. T h ese
structures m ust b e know n and recognized.
S oft tissues in the m outh m a y v a ry in
thickness over the bone in differen t parts
o f the m outh. M u c h o f this variation can
be observed b y palpation, in connection
w ith an understanding o f the underlying
anatom ic structures. Also, these v a ria ­
tions, in m an y instances, leave definite
indications o r landm arks u pon im pres­
sions fo r dentures. A study o f these
visible landm arks w ill m ake impression
bu ild in g easier and m ore certain.
W e h ave arb itrarily coined nam es fo r
the various visible landm arks on dentures
a n d im pressions in order to relate them
m ore clearly to the structures in the
m ou th th at fo rm them . T h e basis for
the nam e fo r each lan d m ark is the nam e
o f the anatom ic structure th a t causes it,
or its location on the denture. F or
exam ple, the groove on the low er den­
14
 B o u c h e r — I m p r e s s io n s
ture, form ed by the extern al oblique line
on the m andible, is called the external
oblique groove. T h e n otch in the labial
flange, caused b y th e labial frenum , is
called the lab ial n otch. N o doubt this
term inology can be im proved, but it is,
I believe, a start in the righ t direction.
T h e im portant denture landm arks are
as fo llo w s :
1. T h e labial n otch is the notch in the
u p p er lab ial flan ge fo r the u p p er labial
frenum .
2. T h e u p p er b u cca l n otch is the notch
p rod uced b y the u p p er buccal frenum .
3. T h e m axillary tubercular fossa is
the depression m a d e by the m axillary
tuberosity.
Fig. 1 .— Snap impression. Lines marked on
the impression are drawn according to the ob­
servations made of the mouth. 1 , height of
reflection. 2, excess width of flanges. 3 , over­
extension distally.
4. T h e pterygom axillary (portion of)
postdam is th a t portion o f the postdam
w h ich occupies th e h am u lar (pterygo­
m axillary) notch.
5. T h e p a latal (portion of) the post­
dam is th at p o rtio n o f the postdam
w h ich passes a lo n g the vib ratin g line.
6. T h e extern al oblique groove is the
groove p rod uced b y the external oblique
line o f the m andible.
7. T h e m asseter groove is the groove
prod uced b y the anterior border o f the
m asseter m uscle.
for C om plete D entures 15
8. T h e low er bu ccal notch is the n otch
in the b u ccal flange fo r the low er buccal
frenum .
9. T h e lab ia l n otch is the notch in the
low er labial flange fo r the low er labial
frenum .
10. T h e m ylohyoid groove is the groove
in the bu ccal surface o f the lingual flange
prod u ced by the m ylohyoid ridge.
11. T h e lin gu al tu b ercu lar depression
is the depression prod u ced b y the lingual
tuberosity.
12. T h e retrom olar fossa is the d e ­
pression prod u ced by the retrom olar pad
o f tissue.
13. T h e postm ylohyoid em inence is
th at portion o f the lin gu al flange w hich
occupies the postm ylohyoid space.
Fig. 2 .— Snap impression knife trimmed 1.5
mm. short of reflection line. The excess thick­
ness of the flanges has been eliminated. The
labial and buccal notches have been cut.
14. T h e a lveolar groove is that portion
o f eith er denture base overlyin g the a lv e­
o lar ridge.
15. T h e incisive fossa is the depression
at the anterior end o f th e m edian line o f
the u pp er denture th at surrounds the
incisive papilla.
16. T h e m edian groove is the groove in
the m edian line o f the u pp er denture
th a t is caused b y the m ed ian raphe.
17. T h e em inences o f the p alatine
fo v ea are the projections into the fovea
palatina.
T h e techn ic fo r the u p p er impression
i6 T he Journal of th e A m e r ic a n D ental A s s o c ia t io n

is, briefly, a plaster w ash taken in a tray o f each day. I t is a t this tim e th at the
form ed from m od elin g com pound. T h e blood supply should be free and un im ­
tray is form ed in such a w a y as to carry paired to a llo w fo r the m axim um am ount
the plaster into the correct relation to the o f repair. A n im pression taken u nder
tissues o f the m outh . Plaster o f Paris b itin g pressure w ill cause a certain
can cop y tissue surfaces only w h en it is am ount o f rebound w h en the pressure is
prop erly supported in a relatively small released, or it w ill interfere w ith the
mass. T h e plaster is confined in th e tray blood supply to the tissues in the rest
only enough to assure its adap tation to periods.
the tissues, excep t in th e postdam area. T h e im pression fo r the low er denture
In this m anner, the fo rm o f th e soft tis­ is a “ com bination” im pression. T h e p ro ­
sues is recorded in their relaxed, or u n ­ cedure is to form a cast from a plaster
strained, condition. T h e posterior end of wash im pression taken in a m odeling
the tray, how ever, is postdam m ed in such com pound tray, w h ich has been properly
a w a y as to carry the plaster against the extended to cover the m axim u m tissue
p alate u n der enough pressure to assure a surface. T h e n a vu lca n ite tray is m ade
positive seal across the distal end o f the on this cast. T h e vu lcan ite tra y is p re­
denture. pared for a partial com pound im pression

mxsv/s rom

? c m P A U T K Î S S K M I S fE S K S S

Fig. 3 .— Buccal flanges formed to fill buccal Fig. 4 .— Postdam added; masseter groove
vestibules. T he vibrating line is marked on perfected. 1 , pterygomaxillary postdam. 2,
the posterior end of the palatal surface of the palatal postdam. 3 , eminences of palatine
tray. 1 , muscle trimmed black compound. 2, fovea. 4 , alveolar groove.
muscle trimmed red compound. 3 , vibrating
line.
by cu ttin g the periphery 1 mm. short of
the reflected area, an d rem ovin g 0.5 mm.
T h e perip h ery is m uscle trim m ed in from the slopes o f the a lveolar groove.
plaster so as to record th e m ucous m em ­ M o d elin g com pound is ad ded to these
brane reflection in a fu n ctio n al relation­ slopes all the w a y around, in excess, and
ship. T h e ob ject o f the techn ic is to the tray is seated. T h e com pound th at
record the form o f the m ucous m em brane flows across the bottom of the alveolar
surface o f the m outh in the condition in groove is rem oved. T h is process is re­
w h ich it rem ains the greatest part o f the peated until no com pound flows into the
tim e. Pressures from m astication, i.e. a lveolar groove a fte r it has been reheated
b itin g pressures, are exerted upon the and reseated. T h e n the periphery is
tissues on ly a very sm all p a rt o f each m uscle trim m ed.
day. T h e supporting tissues are free from T h is typ e o f im pression has tw o ad van ­
m uscular pressure d u rin g the greater part tages, besides th a t o f extendin g the
 B o u c h e r — I m p r e s s io n s
periphery a c c u r a te ly : 1. T h e soft tissues
on .the crest o f the rid ge are recorded in
a relaxed , unstrained condition. T h is
allows fo r a free b lood supply, w hich
w ill preserve their health . T h e plaster
im pression th a t determ ines the form of
the bottom o f the a lveolar groove does
not stretch the m ucous m em brane over
the crest o f the lon g alveolar ridge and
its sharp spicules, as w o u ld be the case
w ith an all com pound im pression. 2. T h e
b itin g forces w ill tend to seal the denture
m ore firm ly through th e very nature of
the contact. T h e com pound in contact
w ith the slopes o f the rid ge tends to push
the soft tissue u p tow ard the crest o f the
ridge to giv e it extra cushioning.
Fig. 5 .— Completed tray. One half milli­
meter has been scraped from the entire inside
of the tray except the postdam. The flanges
are 1.5 mm. short of the reflection. T he entire
buccal vestibule is filled, except the space on
top of the buccal flanges, to allow for plaster
of Paris. 1 , pterygomaxillary postdam. 2,
palatal postdam. 3 , eminences of palatine
fovea.
T h e techn ic in detail follow s, together
w ith the exp lan ation fo r each step.
T H E U P P E R IMPRESSION
1. S elect a stock m etal tray a t least
5 m m . too large overall fo r the case. T h is
is necessary in order th at sufficient bulk
o f com pound m ay b e carried into the
m outh to form a snap im pression thick
enough to w ork w ith w ith ou t distortion.
2. S often from 2 to 2|- cakes (the
for C o m plete D entures 17
am ount d epending on size o f the case) o f
b lack tray com pound in w a ter a t 140° F .,
and take a snap im pression. T h ere m ust
be at least 5 m m . o f thickness in this snap
im pression in order to avoid distortion.
3. C h ill the snap im pression thoroughly
and rem ove it from the m etal tray.
4. O b serve in the m outh the distance
from the crest o f the ridge to the reflec­
tion area w hen the tissues are a t rest.
M a rk this point on the snap impression.
(p ig- i-)
D eterm in in g this distance is sim ply a
m atter o f m easuring w ith the eye the
distance from the crest o f the ridge to the
reflection area and carryin g that m eas­
urem ent to the tray.
Fig. 6 .— Completed upper plaster wash im­
pression. The postdam showing through the
plaster wash indicates the additional pressure
in this area. 1 , alveolar groove. 2, median
groove. 3 , incisive fossa. 4 , maxillary tuber­
cular fossa. 5 , masseter groove. 6 , eminences
of palatine fovea. 7 , labial notch. 8, buccal
notch. 9 , buccal flange. 10 , labial flange.
1 1 , pterygomaxillary postdam. 12 , palatal
postdam.
5. T r im the h eight o f the periphery of
the b u ccal and labial flange to a h eight
1.5 m m . short o f the line.- (F ig. 2.)
T h is w ill allow for 1.5 m m . of plaster
on the top o f the p erip hery o f the tray.
B e sure to cut b u ccal and lab ial notches
fo r th e b u ccal and labial frenula.
6. T r im from th e lab ial and b u cca l
aspects o f the lab ial and b u cca l flange,
from the second bicuspid region to the
i8 T he J ournal of th e A m e r ic a n D en tal A s s o c ia t io n

second bicuspid, un til the thickness a t the 9. C h ill thoroughly and place green
edge is 2 m m . (F ig . 2.) T h is thickness com pound 2.5 m m . in diam eter on this
allow s fo r m inim um distortion o f the line across the p alate. H eat carefu lly
tissues. w ith a b low pipe and tem per and insert
7. O bserve the space in the m outh b e­ the tray in the m outh under a steady
tw een the rid ge and th e cheek in the pressure. T h e resultant green com pound
b u cca l vestibule, opposite the m olar tooth postdam should be abou t 0.5 to 1 m m . in
position. M a rk this distance on the tray. thickness (d ep en din g u pon the relative
I f there is an excess o f com pound in this thickness o f the soft tissues in th at region)
area, trim it to the approxim ate size and abou t 4 m m . w id e (2 mm. on each
and form , and m uscle trim it. (Fig. 3.) side o f the vib ra tin g lin e ). (Fig. 4.)
I f there is n ot en ou gh m aterial in the N o green com pound should be retained
b u ccal flange to fill th e b u ccal vestibule, in the m axillary tu b ercu lar fossa. I t is
low er fusing red com pou nd m ay b e added a stress-bearing area, covered w ith a
and m uscle trim m ed. (F ig. 3.) T h e b u c­ resistant soft tissue th a t is not readily
c al flange m ust fill th e b u ccal vestibule, displaceable. T h e thickest part o f the
b u t not overfill it, if m axim u m retention postdam w ill b e on each side o f the
is to be obtained. W h e n this is done, the m edian line w here the soft tissues are

Fig. 7 .— Reinforced lower snap impression.
T he distance from the crest of the ridge to the
reflection area and the floor of the mouth is
indicated.
surface area o f the denture is increased,
and thus the am ount o f cap illary attrac­
tion is increased and the peripheral seal
im proved. T h e space a vailab le in the
b u cca l vestibule varies greatly w ith d if­
feren t patients an d varies frequ ently on
the tw o sides o f the sam e patient.
8. O b serve th e ju n ctio n o f the h ard
a n d soft palate, the v ib ra tin g line in the
m outh, and m ark it on the tray. (Fig. 3.)
T h is im aginary line passes th rough the
h am u lar notches on ea ch side, and across
the p alate about 2 m m . in fron t o f the
foveae palatinae.
Fig. 8 .— Snap impression knife trimmed to
proper thickness. The undercut below the
mylohyoid groove has been removed. The cut­
ting on the periphery is at right angles to the
inside surface of the impression. 1 , labial
flange. 2, labial notch. 3 , buccal notch. 4 ,
buccal flange. 5 , lingual notch.
thickest. C a re m ust b e taken to avoid an
excess o f pressure on the side o f the
h am u lar notch w ith the pterygom axillary
postdam .
10. H e at the distobuccal angles o f the
tray. T em p er in w a ter and insert the tray
in the m outh, instructin g the patien t to
protrude the ja w and sw ing it from side
to side. T h is w ill form the u pp er masse-
ter groove. (F ig. 4.) T h is procedure
can be sim plified b y knife trim m in g the
 B o u c h e r — I m p r e s s io n s
distobuccal angle o f the tray in a plane
forw ard , dow n w ard and m edially, before
m uscle trim m ing.
11. S crape 0.5 m m . from the entire
inside o f the tra y excep t the postdam .
R em ove the com pound from the entire
periphery so th at it is 1.5 m m . short of
the reflection area in the m outh. (Fig. 5.)
T h is procedure w ill a llow space fo r the
im pression plaster inside the tray. Scrape
a little extra from the incisive fossa.
12. M ix the impression plaster to a
thin, cream y consistency, or use a hydro-
col base im pression plaster accord in g to
the directions o f the m anufacturer.
13. P our the plaster into the tray and
distribute it evenly over the entire inner
surface and periphery o f the tray, in a
bulk not to exceed 1 mm.
s m a & a CBuasn: oroovs
K.8TH0 « s u a M&S&:
Fig. 9 .— Buccal flanges muscle trimmed.
Red compound has been added on the right
side to supply sufficient bulk to fill the avail­
able space in the buccal vestibule. The lin­
gual flange has been muscle trimmed from
bicuspid to bicuspid. 1 , buccal flange. 2, red
compound added. 3 , lingual notch.
14. C a rry the tray into the m outh and
settle it in place w ith a slight rotation
and hold it in p la ce w ith a m ild, but
steady pressure in the center near the
posterior border o f the tray.
15. M uscle trim the plaster at the crit­
ical instant th at it loses its stickiness and
does not p u ll a w ay w ith the finger. A t
this stage, the plaster is m oldable. M uscle
trim m ing o f the b u cca l portion is accom ­
plished b y raising the cheek up and out,
fo r C om plete D entures 19
then p u llin g it in and dow n gently, a t
the sam e tim e w orkin g it gently forw ard
and b ackw ard to m ake a path fo r the
b u cca l frenum . T h is form s the b u ccal
notch. T o trim the labial portion, raise
the lip, lift it up and ou t and then p u ll it
dow n and from side to side gently. A n
alternate procedure, fo r cooperative p a ­
tients, is to h ave the lip pulled dow n,
form in g the lab ia l n otch fo r the lab ial
frenum . A steady pressure should b e
m aintained in the p alate during all o f
this procedure.
16. B efore the plaster has passed the
m oldable state, the patien t should be
instructed to m ove the ja w from side to
side. T h is w ill perfect the m asseter
groove and determ ine the thickness of
the distobuccal angle o f the denture.
Fig. 1 o.— Lower tray complete except for
preparation for plaster wash. The retromylo-
hyoid eminences have been muscle trimmed
to limit their extent down and back. T he
buccal surfaces of the lingual flange slope
toward the tongue. These surfaces and the
periphery have been muscle trimmed. T he
lingual flanges are perfected. Red compound
was added to obtain the proper extension
down to the floor of the mouth.
17. W h en the plaster is set so th a t it
w ill b reak w ith a clean fractu re, the
im pression m ay b e rem oved from the
m outh. (F ig. 6.)
t h e l o w e r im p r e s s io n
1. S elect a stock m etal tray too large
for the case. ( I t should be large enough
20 T he J ournal of th e A m e r ic a n D ental A s s o c ia t io n

to a llow for sufficient b u lk to avoid dis­
tortion.) T h e tray should h a v e long
lingu al flanges posteriorly, and buccal
flanges that are n early horizontal. T h e
distal ends should cu rve slightly upw ard.
2. Soften from i j to 2 cakes o f b lack
tray com pound in w a ter and take a snap
impression. T h is im pression should be
overexten ded in all directions. I t must
be a t least 5 m m . in thickness from the
alveolar groove to the occlusal side. T his
thickness is necessary fo r strength to
avoid distortion.
3. C h ill and rem ove the snap im pres­
sion from the tray an d reinforce it by
sinking a 10-gage to 14-gage w ire in the
occlusal side to preven t b reakage during
the subsequent steps.
dow n. A little p ractice w ill soon ind icate
h o w this can be accom plished. T h e
relaxed “ fee l” o f the tissues is im portant.
5. K n ife-trim the b u ccal and labial
flanges 1.5 m m . short o f this line. K n ife -
trim the lingual flan ge from bicuspid to
bicuspid in the sam e m anner. T h e n
reduce the thickness o f the bu ccal flanges
u ntil they ju st fill the b u ccal vestibules.
R ed u ce the thickness of the labial flange,
from bicuspid to bicuspid, until it is
a pproxim ately 2 m m . in thickness a t the
periphery. (F ig. 8.) R em ove all u n der­
cuts below the m ylohyoid groove. T h e
b u ccal surface o f the lingu al flange m ust
slope tow ard the tongue. T h e lingu al
flange anteriorly should be abou t 2 mm.
in thickness. Posteriorly, it should be
about 3 m m . thick. (F ig. 8.)

Fig. 12.— C om plete low er plaster wash im ­

F ig. 1 1 .— C om p leted tray. O n e-h alf m illi­
m eter has been scraped from the entire inside
surface of the tray excep t the retrom ylohyoid
em inence. M ore com pound has been rem oved
from th e retrom olar fossa to avoid distortion.
pression. 1, labial notch. 2, b u cca l notch.
3, lin gu al notch. 4, retrom olar fossa. 5, ex­
ternal oblique groove. 6, masseter groove. 7,
retrom ylohyoid em inence.

4. O b serve the distance from the crest 6. M u scle trim the b u ccal flanges to
o f the ridge to the reflection area in the perfect the form over the external
m outh w hen the tissues are a t rest, and oblique groove and the m asseter groove.
m ark it in the tray. M a rk also the T h e tray should b e at least 3 m m . thick
distance from the crest of the ridge to so th at the cheek is in con tact w ith that
the floor o f the m ou th w h en the tongue m uch com pound a t the m u cobu ccal fold.
is raised abou t h a lf w ay. (F ig. 7.) T his I f there is insufficient bulk, red com ­
procedure is again a process o f m easuring pound m ay b e ad d ed and m uscle
w ith the eye. T h e observation m ust be trim m ed. (F ig. 9.)
m ade w hen the tissues are at rest. T h a t 7. M u scle trim the lin gu al flange from
is, the cheeks, lips and tongue should be bicuspid to bicuspid. T h is portion o f the
relaxed, and not p u lled u p or out or lingual flange w ill be m uch shorter than
 B o u c h e r — I m p r e s s io n s
the posterior p a rt o f the lingu al flange.
9
(Fig- -)
8. E xten d the lin gu al flange, distally m m . b elow the level o f the m ylohyoid
to the first bicuspid, from 2 to 4 m m .
below the level o f the m ylohyoid groove.
T h is extension is m ade by ad din g red
com pound to the lingu al flange, shaping
it to the app roxim ate form desired. C h ill
thoroughly and h ea t on the bu ccal side.
Insert the tray in the m outh. I t is
necessary to k eep the lingual side o f the
lingual flange cold an d hard in order to
avoid distortion o f the flange w h en the
tray is inserted in the m outh. M a k e no
attem p t a t m uscle trim m ing a t this time.
(F ig. 10.)
■M3X0HX0ID 3H0CV2
8S5B0 KDUH FOSSA.
LI-'SttM, ît'B V C OUR r * : S3WW
F ig. 13.— L o w e r plaster wash impression
show ing retrom ylohyoid em inence in relation
to other landm arks.
9. R em ove all undercuts below the
m ylohyoid groove. T h e b u cca l surface
o f the lingual flanges should slope tow ard
the tongue. T h is is done by k n ife trim ­
m ing, and then m uscle trim m ing. T o
m uscle trim this surface, heat the surface
1.5 m m . deep an d h a v e the tongue thrust
into the opposite cheek. T h e lingual
surface o f the lingual flange m ust be kept
cold an d hard. (F ig. 10.)
10. M uscle trim the periphery o f the
lingual flange b y h a v in g the tongue thrust
into the opposite cheek after h eatin g the
flange 1.5 m m . deep. R ep ea t this step
for C o m plete D entures 21
until the contour o f the lingu al flange is
perfected. It should extend from 2 to 4
groove and should be abou t th at m u ch
longer than the lingu al flange from
bicuspid to bicuspid. (F ig. 10.)
11. M a k e sure th a t th e distal end of
the lingu al flange extends distally into the
retrom ylohyoid space. T h is space lies
distally from the end o f the m ylohyoid
ridge a t the distal end o f the alveolin-
moæœw
Fig. 14.— C ast o f low er arch m ade from
plaster wash impression.
Fig. 15.— W a x pattern from vulcan ite tray.
gu al sulcus. T h e retrom ylohyoid em i­
nence can be b u ilt up by extendin g the
lingual flange w ith red com pound in the
sam e m ann er th at the lingual flange was
extended dow nw ard. (Step n um ber 8
above.) T o lim it the extent o f this area,
h eat the distal end o f the lin gu al flange,
and h a ve the tongue protruded. T h e n
h eat the low er edge and h ave the tongue
thrust into the opposite cheek. A ll h ea t­
22 T he Journal of th e A m e r ic a n D ental A s s o c ia t io n

in g fo r m uscle trim m ing m ust not be
deeper than i .5 mm. T h e rctrom ylohyoid
em inence lies distally from the end o f the
m ylohyoid groove, below the retrom olar
fossa. T h e retrom olar pad m ust n ot be
distorted by this pressure. (F ig. 10.)
12. S crape 0.5 m m . from the entire
inside of the tray, excep t the retro-
m ylohyoid em inence. M a k e sure there
is no pressure on the retrom olar pad by
scrapin g deeper than 0.5 m m . in the
retrom olar fossa. Also gu ard against
pressure on the m ylohyoid ridge by
scraping deeper than the lin gu al flange
over the m ylohyoid groove. (F ig. 11.)
13. T a k e a plaster wash impression.
M ix the plaster in the same m anner as
labial flanges are m uscle trim m ed by
raising the cheeks out and up w ith a
slight forw ard an d b ack w ard m otion.
T h e labial flange is trim m ed by raising
the lip up and ou t w hile m ovin g it from
side to side. T h is kind o f m uscle trim ­
m ing w ill clear a p ath fo r the frenula
in various fu n ctio n al positions. T h e tray
can be held in position w hile the m uscle
trim m in g is done b y an in d ex finger held
d iagon ally across it. T h e plaster, w hen
it has set until it w ill break w ith a clean
fractu re, m a y be rem oved from the
m outh. T h is im pression records the
tissues on the crest o f the ridge, at rest.
(Figs. 12 and 13.)
14. Pour a cast in the low er impression

Fig. 16.— A , vulcan ite tray w ith excess rem oved. B, tra y p repared fo r com pound. T h e periph­
ery has been shortened 1 mm. all around. A ll the u ndercut has been rem oved from the lin gu al
flange below the m ylohyoid groove. O n e-h alf m illim eter has been rem oved from the slopes of the
alveolar groove. T h e bottom of th e groove is not cut.

for the upp er im pression. T h e plaster
should be distributed in th e tray in the
sam e m anner as fo r the u p p er excep t in
a little greater bulk. T h e tray is carried
to the m outh and seated. T h e distal ends
o f the tray are carried high b ack in the
m outh, and then seated one a t a tim e.
T h en , w ith slight rotation, the tray is
pressed dow n into p la ce and held there
w ith the in d ex fingers on top of the tray
and the thum bs u n der the m andible.
A ll the w hile, the tongue should be held
still, about h a lf w ay up. T h e b u ccal and
(F ig. 14) and form the w a x pattern for
a vu lcan ite tray. T h e w a x should be
extended to cover the fu ll w id th o f the
impression. It should be 2.5 mm. or m ore
in thickness and should h a ve a handle
p laced in the anterior region. (F ig. 15.)
15. Flask, p a ck and vu lcanize the tray.
16. P repare th e vu lca n ite tray fo r the
final im pression. D eflask and trim off the
excess from the tray. (F ig. 16, A .) C u t
1 m m . from the entire periphery. R e ­
m ove all undercuts. M a k e sure that the
b u ccal slope o f the lin gu al flange slopes
 B o u c h e r — I m p r e s s io n s fo r C om plete D entures 23

tow ard the tongue, and that there is no
pressure on the m ylohyoid ridge. T h e
lingual flan ge should extend b elow the
level o f the m ylohyoid ridge, bu t it must
not be un der it. R em ove 0.5 m m . from
the slopes o f the alveolar groove, but
none from the bottom of the groove.
T h is is done w ith a N o. 562 cross-cut
fissure bur. R etain enough o f the alveolar
groo ve to m ake certain o f the proper
seating o f the tray in the m outh. (Figs.
16, B, and 17.)
17. P lace red com pound in excess
AIVCOLAR GROOVE
position in the m outh. R em ove it from
the m outh, ch ill the com pound and re­
m ove all the com pound from the bottom
o f the alveolar groove. R ep ea t this h ea t­
ing and seating and trim m in g u n til the
tray can be seated p erfectly w ith ou t
forcin g com pound into the alveolar
groove. T h e com pound should feather
out at its ju nction w ith the u n cu t v u l­
can ite o f the alv eo la r groove. D o not
perm it m ore th an 2 m m . o f com pound
to extend anteriorly into the retrom olar
fossa from the distal aspect. T o o m uch
com pound here w ill cause distortion of
the retrom olar pad and w ill result in
soreness u nder the com pleted denture.
(F ig. 18.)
19. C h ill and start the m uscle trim -

v u lcan ite tray, in first m olar region ; showing

w here vu lcan ite is rem oved from inside of
tray.

Fig. 19.— F in al low er impression. T h e con ­

tour of the soft tissues o f th e crest of the ridge
is recorded b y plaster of Paris and the p eriph ­
ery is recorded by m odelin g com pound. 1,
a lveolar groove. 2, labial notch. 3, bu ccal
notch. 4, external oblique groove. 5, masseter
Fig. 18.— C om pound added in excess to groove. 6, lin gu al notch. 7, red com pound.
v u lcan ite tray , w h ich has been seated in cor­ 8, vulcan ite. 9, green com pound.
rect position on ridge. Excess com pound that
was pushed across the alveolar groove has been
rem oved. m in g o f the entire periphery. H eat 1 -inch
sections o f the p erip h ery 1.5 m m . deep
arou n d the entire periphery and on the an d m uscle trim . O v erla p each area
slopes o f the alveolar groove of the p re­ h eated and m uscle trim aroun d the entire
pared tray. T h e re should be enough b u cca l and labial periphery. T h is m uscle
com pound so th a t the excess w ill flow trim m in g w ill form the periphery to the
across the a lveolar groove as w ell as out fu ll lim it o f the an atom ic possibilities.
over the periphery. L an d m arks th at w ill b e developed are
18. S often the com pound above a slowthe m asseter groove, the external oblique
flam e or in w ater at i3 5 ° F . and place in grooves, the bu ccal notches and the labial
24 T he Journal of th e
notch. T h e buccal flange w ill extend
across the extern al oblique groove in the
m olar region. T h e suctorial p a d in the
cheek w ill lie on top o f the flange in this
area. T h is w ill m ake the denture-tissue
con tact m ore n early perfect. T h e b u ccal
flange should be abou t 3 m m . in th ick ­
ness (vertica lly) a t the edge. (F ig. 19.)
20. H e at and m uscle trim the lingual
anterior region o f the periphery from
bicuspid to bicuspid by h avin g the tongue
thrust out first, then u p and back. T h e
lingu al groove for the lingual frenum
m ay or m ay not b e developed, the result
dep en din g upon the form o f the in d i­
v id u a l m outh. (F ig. 19.)
21. R em ove all the u n dercu t below the
m ylohyoid groove w ith a knife. H e at the
buccal surface o f the lingu al flange and
MÏLOKÏOID »score
ESTRO MOLAS FOSSA
Fig. 20.— L a te ra l view o f developm ent of low er “ com bination” im pression. A , vulcan ite tray
cleaned up. B, vu lcan ite tra y prepared fo r m odeling com pound. C , com pound added in excess,
bu t all of excess rem oved from alveolar groove so tray can be seated p erfectly. D , com pleted
impression.
have the tongue thrust into the opposite
cheek, to determ ine the cu rve o f the
lingual flange tow ard the tongue. T h e
m ylo h yoid groove is alm ost obliterated
by this step, but it serves as the lim iting
lan d m ark fo r this procedure. (F ig. 19.)
22. A fte r all undercuts h a ve been re­
m oved from this area, heat the low er
border of the lingual flange an d have the
ton gue thrust into the opposite cheek.
T h is w ill lim it the exten t o f th e lingual
flange. (F ig. 19.) ^
23. H e at the distal end o f the lingual
flange and have the tongue thrust out
A m e r ic a n D en tal A s s o c ia t io n
of the m outh. T h is w ill lim it th e length
o f th e lin gu al flan ge as it extends distally
into the retrom ylohyoid space.
24. R e h ea t the low er border o f the
lingual flan ge a t the distal border and
h ave the tongue thrust into the opposite
cheek to lim it the extent dow n w ard in
the retrom ylohyoid space. (F ig. 19.)
25. A d d green com pound 4 m m . in
diam eter to the cen ter o f the retro­
m ylohyoid em inence. H e at this com ­
pound, insert it in the m ou th and have
the tongue p rotru d ed from the m outh,
then into each cheek. T h is w ill add
pressure against the tissues coverin g the
retrom ylohyoid area on the m andible.
T h e am ount o f pressure th at can be
added is lim ited b y the resiliency o f the
tissue to about 0.5 m m . thickness of
MA8SSTKR SBOOYS
com pound. T h is pressure w ill guard
against tip pin g up the b ack end o f the
denture w hen pressure is exerted on the
incisor teeth. I t w ill also p reven t the
tongue from gettin g u n der the b ack end
o f the denture. T h e com pound on the
retrom ylohyoid em inence m ust not distort
or com press the retrom olar pad by flow ­
in g into the retrom olar fossa. (F ig 19.)
T h e com pleted im pression can now be
tested fo r stability and retention. I t must
stand pressure dow n on the ridge on each
side and in the anterior region, and
should not tip w h en pressure is exerted
 K e s e l — D e n t a l C a r ie s
in a dow n w ard direction against the
h an d le o f the tray. T h e im pression w ill
also resist pressure u p w ard against the
h and le o f the tray. H ow ever, this spec­
ta cu lar test depends m ore on the co­
operation o f th e patien t in hand ling
his tongue than on the efficiency o f
the impression. (Fig. 20.)
su m m ar y
T h e upp er plaster w ash im pression is
b u ilt to record the form o f the soft tissues
w ith as little distortion as possible in
order to keep them in good health. T h e
DENTAL CARIES: ETIOLOGY, CONTROL AND
A CTIV ITY TESTS
By R obert G. K e s e l ,*
e t io l o g y
H A T the initial lesion o f dental
T caries begins w ith the destruction
o f the enam el b y a cid is the opinion
o f the m ajo rity o f 237 investigators w h o
reported their ideas and studies in the
second edition o f the vo lu m e entitled
“ D en tal C aries” recently published by
the R esearch C om m ission o f the A m er­
ican D en ta l Association.1 T h is is not a
new idea. I t w as w ell stated as early as
1530. A .D . by an aponym ous w riter in
the G erm an litera tu re : “ C aries is a dis­
ease and evil o f the teeth in w h ich they
becom e fu ll o f holes an d hollow , w h ich
most often affects the b ack teeth, espe­
cially so w h en they are not cleaned of
clin gin g particles o f fo o d w h ich decom ­
pose, p rod u cin g an acid m oisture (liter­
*Professor of dental pathology and thera­
peutics, University of Illinois College of Den­
tistry.
Read before the Section on Operative Den­
tistry at the Seventy-Eighth Annual M id­
winter Meeting o f the Chicago Dental Society,
February 26 , 1942 .
Jour. A .D .A ., V o l. 30, January 1, 1943
25
distal end o f the im pression is protected
from air bla'sts fro m the lungs by a post­
dam located accord in g to the form o f the
m outh. T h e perip h ery is m uscle trim m ed
to accom m odate the tissues th at surround
it in their various actions.
T h e low er “ com bin ation ” impression
is designed to give m axim u m stability to
the denture. A t the same tim e, it relieves
the crest o f the rid g e in order to keep it
healthy, and its perip h ery is developed
and m uscle trim m ed to cover the largest
area possible w ith in the lim its o f the
anatom ic form o f th e m outh.
D .D .S ., M .S ., C h ica g o , 111.
ally, a sharp m oisture) w h ich eats them
aw ay and destroys them so th at finally
w ith m uch p a in th ey rot a w a y little by
little.” 2
W . D . M iller,3 th rou gh his studies a t
the b egin nin g o f this century, did m uch
to establish this b e lie f on a foundation of
fact. H is m ethods o f study h a ve been
im proved upon and his observations
h ave been confirm ed, b u t fe w significant
and generally accep table findings have
been ad ded to his origin al studies o f
fifty years ago. W e h a ve learned m ore
abou t the b acteria th at are associated
w ith caries an d w e h a ve learned some
things abou t the accom p an yin g chem ­
ical activity. Perhaps w e h ave a better
understanding o f the histopathologic
pictu re o f the disease process in the tooth
tissue, b u t w e still are a t a loss fo r a
scientific exp lan ation as to w h y caries
attacks th e teeth o f some individuals and
n ot o f others, or o f w h y teeth in the same
m outh v a ry in vu ln erab ility.
Possible E tiolog ic Factors.— Alm ost