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Impression techniques for

complete dentures
A negative likeliness or copy
. in reverse of the surface of an
object ;
An imprint of the teeth and
adjacent structures for use in
dentistry.

GPT-7
A COMPLETE DENTURE IMPRESSION
IS A NEGATIVE REGISTRATION OF
THE ENTIRE BEARING, STABILISING,
AND BORDER SEAL AREAS PRESENT
IN THE EDENTULOUS MOUTH.
HEART WELL
OBJECTIVES OF IMPRESSION
MAKING
Preservation of the alveolar ridge
support
stability
esthetics
retention
Preservation of alveolar ridge

M.M.De Vans dictum, it is more


important to preserve what already exists
than to replace what is missing.
Preservation of the alveolar ridge is a very
important objective even though other factors
such as occlusion,interocclusal distance and
centric relation in harmony with centric occlusion
are great importance. Pressure in the impression
technique is reflected as pressure in the denture
base and results in the soft tissue damage and
bone resorption.
SUPPORT
Maximum coverage provides the
snowshoe effect. which distributes
applied forces over as wide an area as
possible. This helps in preservation,
stability and retention.
Areas of support
Primary
areas of the edentulous ridge that are right angles to
occlusal forces and do not resorb easily.
Maxillary
Posterior residual alveolar ridge
Flat areas of the palate
Mandible
Buccal shelf area
Secondary
areas of edentulous ridge greater than at right angle to
the occlusal forces or parallel to them .
slopes of the ridges.
Stability
The stability of a denture is its
ability to remain securely in place
when it is subjected to horizontal
movements.
Close adaptation - undistorted
mucosa.
decreases - loss of vertical height of
the ridges, flabby movable tissue.
Factors governing
stability

Ridge relationship
Arch arrangement
Balanced occlusion
Occlusal plane
Denture surface
retention
RIDGE RELATIONSHIP
A problem of stability - offset ridge relations.

Normal dental relationships - artificial teeth set on the


ridges that are in severe posterior cross bite can
affect stability.

In complete dentures the normal tooth to tooth


position may have to be altered to provide a
relationship that can enhance the stability.
Class 3 patient - Sufficient mandibular
posterior occlusion must be developed -
extend posteriorly more than half the
distance from the incisive papilla to the
hamular notch.
The severe retrognathic or prognathic ridge
relationship can be remedied only to a limited
extent through prosthetic treatment.

surgical intervention is needed.


ARCH ARRANGEMENT

indicate the buccolingual relationship of


the teeth to the crest of the ridge / the
stress bearing area.
is used only in reference to the position
of the mandibular teeth.
The general rule - set the
anterior teeth on the anterior
part of the crest of the ridge
with an incisal tilt of about
twenty degrees
-to set the posterior
teeth over the centre of the
stress bearing part of the
basal seat.
When one looks down on the
occlusal surface of the posterior
teeth, an equal amount of the
denture base should be seen on
both the buccal and lingual sides
of the teeth.
narrow dental arch- the denture encroaches
upon the tongue space-an retracted tongue
position - muscle fatigue - pushes the denture
out of the mouth during relaxation of the
tongue.
BALANCED OCCLUSION
According to G.P.T., it is defined as the
bilateral, simultaneous, anterior and
posterior occlusal contact of the teeth in
centric and eccentric positions.
Placing the teeth so that the resultant
direction of force on the functioning
side is over the ridge or slightly lingual
to it.
Having the denture base cover as wide
an area on the ridge as possible.
Placing the teeth as close to the ridge
as other factors will permit.
Using as narrow a bucco-lingual width
occlusal food table as practical.
OCCLUSAL PLANE
The starting point for establishing the
occlusal plane is the maxillary occlusal
rim.
The incisal plane :
1. Parallel to the inter-pupillary line
2. The maxillary rim is reduced to
approximately one to two millimeters
below the lower edge of the upper lip.
The occlusal plane :
1. Parallel to the campers plane
2. 1/4th inch below the stensens
duct.
The incisal plane in the mandibular
occlusal rim should be

1. Located either at or slightly below the


corners of the mouth.
2. Parallel to the crest of the ridge.
3. The plane must be slightly below the
modiolus level.
The occlusal plane in the mandibular
occlusal rim should be

Located at the junction between


anterior 2/3rd & posterior 1/3rd of
retromolar pads.
Parallel to the crest of the ridge.
An occlusal plane -
too high -forces the
tongue into a higher
position- create
undue pressure on
the border of the
lingual flange.
An occlusal plane -
too low- the tongue
overlaps the
posterior teeth -
cause tongue biting.
DENTURE SURFACES
impression surface
occlusal surface
polished or external surface
Sir Wilfred Fish (1948)
impression surface
Optimal denture
stability requires
that those tissues
that provide
resistance to
horizontal forces be
properly recorded
and related to
denture base.
The occlusal surface:
the dentures must be
free of interferences
within the functional
range of movement.
all the posterior teeth
have simultaneous
contact in centric and
eccentric positions
The polished surface:
the buccal and lingual
flanges of maxillary and
mandibular dentures
should be concave to
permit positive seating by
the cheeks and lips.
development and contour of
the external surface
becomes more critical in
providing denture
stability.
Esthetics
Border thickness should be varied
with the needs of each patient in
accordance with the extent of the residual
ridge loss. The sulcus should be filled but
not over filled with the impression material.
Retention
Retention is too often given more
consideration than is necessary. If all the
other objectives are achieved retention will
be adequate. Atmospheric pressure,
cohesion, adhesion, mechanical locks and
muscle control play a role in retention.
Atmospheric pressure
depends on the peripheral seal
to ensure seal the denture border should
extend into, but not to the extent to damage
movable tissue
Adhesion
attraction of saliva to the denture
Cohesion
Attraction of molecules of saliva to each
other
Classification

method of manipulation
theories of for border molding
impression making position of
the mouth

pressure theory
Hand
manipulation
open mouth
minimal pressure
theory

Functional
selective pressure
closed mouth movements
theory
Muco compressive Muco static Selective pressure

Principles
Based on greens theory Given by PAGE based on Proposed by BOUCHER.
principle is to make an pascals law that the places maximum stress
impression that would pressure on a confined on stress bearing area
press the tissues in liquid will be transmitted and no/minimal stress on
same manner as chewing trough out the liquid in all the non stress bearing
forces. Records tissues direction. area
in function and Tissue recorded in resting
displaced form. or anatomic form.

Advantage
Excellent retention . Preservation of residual Preservation of residual
peripheral seal is good ridge ridge
uniform load
distribution

Disadvanta
Excessive tissue Prevents wider distribution Creates a negative
compression of stress pressure in relief areas

ges Soreness of basal seat


increased resorption of
residual ridges

Materials
Impression compound Impression plaster, ZOE Impression plaster, ZOE
paste paste

used
Concepts to be followed for a
Successful impression

the tissues of the mouth should be healthy.


Proper space for the selected impression
material should be provided within the
impression tray.
A guiding mechanism should be provided for
correct positioning of the impression tray in the
mouth.
The tray and the impression material should be
made of dimensionally stable materials.
A physiological type of border-molding procedure
should be performed by the dentist or by the
patient under the guidance of the dentist.

The border must be in harmony with the


anatomical and physiological limitations of the
oral structures.
The impression must be removed from the
mouth without damage to mucous membrane of
the residual ridges.
The impression should extent to include all the
basal seat within the limits of the functions of
the supporting and limiting tissues.
The external shape of the impression must be
similar to the external form of the complete
denture.
Patient can be receptive to material and
procedures that have
1. An acceptable taste
2. A pleasant color
3. No odor
4. A short setting time
5. A lessened strain factor
6. A reduced chair time
Preliminary impression
It is the impression
which is used for
diagnosis and fabrication
of custom tray. The
material used is alginate
or impression compound
It can be recorded by
using stock tray
Metal or plastic
Perforated or
unperforated
impression should be accurate
if it is inaccurate , will result in
unsatisfactory custom tray.
it will in turn require considerable effort and
time consuming modification before
secondary impression
even a correct tray will not fit the denture
bearing area perfectly
so a relatively high viscosity material to
compensate more easily for the deficiency of
the tray
Silicone putty impression
high viscosity
flow beyond the tray to
compensate tray under
extension
it is elastic and records
undercuts with reasonable
accuracy
it records surface details
poorly
it cannot be added to the
impression if part it is
deficient
irreversible hydro colloid
records details accurately
can cause defects in palate because they
do not absorb the mucous secretions
they loose moisture rapidly and can
consequently change the size
casts must de poured soon after the
impression are made
weight of the stone of the cast may be
sufficient to distort the borders of the
impressions particularly if they are not
supported by the borders of the tray
Impression compound
it is thermoplastic with
high viscosity
it flows beyond the tray
to compensate for under
extension
addition can be made to it
if part of the impression
is deficient
it records surface details
poorly
it does not record
undercuts accurately
Tray selection
The space available in the mouth for the
impression is studied carefully by
observation of the width and height of the
vestibular space
An edentulous stock tray that is 5 mm
larger than the outer surface residual ridge
is selected
Place the tray in the
mouth centering the
labial notch of the tray
over labial frenum
The posterior extent of
the tray relative to the
posterior palatal seal
area is maintained and
then the handle is
dropped downwards to
permit visual inspection
Border of ray should
be short of tissue
reflection
Adequate clearance in
frenal areas
In addition soft utility
wax can be used to
line the border of the
stock tray to create a
rim that helps adapt
the borders of the tray
to the limiting tissue
Locate the hamular
notch

Mark the vibrating


line with a indelible
marker
Impression making
practice placing the tray in position
the upper lip is elevated and the tray is carried
upward anteriorly into position with the frenum used
as a centering guide
when the tray is located properly anteriorly the index
fingers are placed in the 1st molar region on each
side of the tray with alternating pressure seat the tray
upward until the wax across the posterior part of the
tray comes into contact with the tissue in the
posterior palatal seal area
the finger of one hand are shifted into the middle of
the tray and border molding is carried out
the labial and buccal vestibule can be
molded by asking the suck down into the
tray
mandible side to side to record the
influence of coronoid process on the shape
of buccal vestibule
Labial and buccal
borders to be
molded.
The borders of the
custom tray should
now be determined.
The periphery is
outlined with the
disposable indelible
marker on the
impression
Mandibular preliminary
impression
Tray selection
The space available in the mouth for the
impression is studied carefully by observation
of the width and height of the vestibular space
An edentulous stock tray that is 5 mm larger
than the outer surface residual ridge is
selected
Posteriorly retromolar
pads should be
covered
Under extension can
be covered by utility
wax
If impression compound is used for
impression making, the technique is the
same except the borders of the stock tray
are not modified with wax.
It has a high viscosity, and unless care is
taken, it is very easy to displace the
mylohyoid muscle.
Preliminary impression using
impression compound
the compound is placed in
the water that is maintained
at 50-55 degree C and the
compound is kneaded
repeatedly towards the
centre thus presenting a
smooth side on one side
until uniform softness
throughout is maintained
then it formed into a
suitable size roll and
placed ion the tray. it
is important that there
is enough bulk
extending beyond the
flanges so that there is
no restriction in flow
when pressed into
position over the ridge
a trough is
intended in the
compound with the
finger to stimulate
the ultimate ridge
impression. It is
again placed in hot
water and placed in
the pt mouth
when the operator is
satisfied with the position
of the tray in relation to
the ridge, the pt is
instructed to raise and
slightly protrude the
tongue and the operator
applies vertical pressure
on the tray
pressure in backward
direction, may also be
required to counter the
forward thrust from the
tongue when protruded
with the tray held
firmly in position
the tongue is moved
side to side which
brings forwards the
palato glossal
arches, raises the
floor of the mouth
and thus molds the
composition in the
lingual sulcus
The impression is now
complete and the tray
is removed after the
material is set to
prevent distortion and
it is chilled in cold
water.
COMMON FAULTS IN
LOWER IMPRESSION
1 Insufficient depth, in the posterior lingual pouch.
Causes
Flange of the tray short in the region. Lack of
composition in the tray
Little force used while seating
2 Edge of the tray showing
causes:
improper seating of the tray
use of too large a tray
SECONDARY
IMPRESSION
materials available
Impression Plaster
metallic oxide impression paste
poly ether
silicone impression materials
irreversible hydrocolloid
CONSTRUCTION OF
CUSTOM TRAY

Base plate wax approx 1mm thick is placed on the cast within the
actual border to provide space for the final impression material
Posterior palatal seal area on the cast is not covered by wax spacer
1 to achieve posterior border seal
2 guiding stop to held the tray properly
Materials used are
conventional auto polymerizing acrylic resins
thermoplastic resin sheet used in vacuum or pressure
adapting devices
thermoplastic shellac base plate materials.
Diagnostic casts
Wax spacer with tissue
stops
Custom trays made
Additional relief
given in incisive
papilla,ruguae and
mid palatal
raphae region
Requirement of custom tray

the tray should be rigid but not overly thick


it should retain its shape through out the construction and
pouring of the impression
the method of construction should be simple enough so that
an acceptable impression tray can be made in a minimal
amount of time at a reasonable cost.
It should be possible to trim or thin the tray readily with a
bur , mounted stone, scissors, or an arbor band.
The tray should be smooth because sharp edges may injure
oral tissues.
REFINING THE CUSTOM
TRAY
When the custom tray is removed from the
preliminary cast , the wax spacer is left
inside the tray
The spacer allows the tray to be properly
position in the mouth during border
molding procedures
Border molding is the process by which
the shape of the border of the tray is
made to confirm accurately to the
contours of the buccal labial vestibules
For border molding to be carried out
successfully space must be created for the
border molding material.
Flanges of the custom tray should be
reduced by 2mm
Special tray is prepared
with handle

Borders should be
beveled.
Overextensions are trimmed

Tray should be short of 2


mm from base of sulcus

Extra clearance in frenal


areas
Border molding
It can be done either one area at a time or
simultaneously all areas can be recorded

Advantages of recording simultaneously


No of insertion is reduced to one
avoid propagation of errors caused by a
mistake in one section effecting the border
counters in another
The requirements of material to be used for
simultaneous molding
1. have sufficient body to allow it to remain in
position on the borders during loading of the tray
2. allow some pre shaping of the form of the
borders without adhering to the fingers
3. have a setting time of 3-5 minutes
4. retain adequate flow while the tray is seated in
the mouth
5. allow finger placement of the material into
deficient parts after the tray is seated
6. not cause excessive displacement of the tissue of
the vestibule
7. be readily and shaped to excess material can be
removed and the borders shaped before the final
impression is made
Masseteric notch
Tissues that influence
masseter muscle
bucccinator muscle
buccal fat pad
How to activate What activation
accomplishes
instruct patient Masseter muscle
to close down on contracts buccinator
your fingers and muscle
the tray handle
Manually Buccal fat pad is
manipulate the elevated on to outer
buccal fat pad by peripheral border to
drawing the help seal and
cheek up to stabilize denture
bring excess
compound on to
Distal extension area
Tissues that influence
pterygomandibular
raphe
retromolar pad
How to activate What activation
accomplishes

Have patient open his Pterygomandibular


mouth wide raphe stretches ,
capturing the raphe
and defining the most
distal extension of
the impression
Denture base covers
the maximum amount
of bearing area
Buccal
How to activate flange
What activation
accomplishes

Manually manipulate the Moves the fibers of the


cheek with your finger buccinator muscle and
pressure upon the the soft tissues of the
denture border in an cheek in the direction of
anterior-posterior the muscle activity during
direction patient function

Feel and observe the Provides detection of


cheek from the outside overextension of border
Buccal
How to activate frenum
What activation
accomplishes

Elevate the frenum in to Allows for freedom of


the compound and then movement of the
mould the cheek in am connective tissue band
anterior-posterior Permits a seal to form by
direction the manipulation of the
cheek in a back and
fourth motion;
therefore, allows
maximum seal and
Labial flange
Mentalis muscle
Incisive labii inferioris
Orbicularis oris
Labial frenum
How to What
activate activation
accomplishes

Hand massage Activates the


and manipulate orbicularis oris
the lip an a muscle with
associated
side to side
muscles of facial
motion.
expression.

Instruct the Activates the


patient to mentalis
evert the muscle against
lower lip the compound
Activates the
orbicularis oris
Instruct the pt muscle with
to lick the associated
Labial
How to activate frenum
What activation
accomplishes

Elevate the frenum into Allows for freedom of


the compound and then movement of connective
massage the lip with a tissue formed frenum
side to side motion Permits a seal to form by
the molding of the area
using the side to side
movement of the lip;
therefore, maximum seal
Retromolar area and retro
mylohyoid curtain
Superior constrictor muscle
Glossopalatine muscle
How to activate What activation
accomplishes

Instruct the patient Both the muscles


to push his tongue contracts and limits
against the handle the denture border
and then bite down While biting internal
on yours fingers on pterygoid contracts
top of the handle and limits the border
This tongue
Instruct the patient movement moves
to move his tongue impression material
Mylohyoid area
How to activate What activation
accomplishes

Have the patient Causes a forcible


perform repetitive contraction of the
forced swallowing mylohyoid muscle fibers;
moves the compound
inferiorly and medially

Instruct the patient to Raises the floor of the


move his tongue into the mouth through
contraction of mylohyoid
upper and lower
vestibules on each side The amount of movement
of his mouth of the floor of the
How to activate What activation
accomplishes

Contour the The denture border can


border and the extend inferiorly and
outer surface of medially to the mylohyoid
the flange to ridge so as to ;
pass under the help prevent soreness of
tongue the tissues over the ridge
have the tongue rest
upon the outer polished
surface of the denture to
Sublingual fold space
Tissues that influence
genioglossus muscle
tongue
lingual frenum
folds of mucosa covering the genioglossus
muscle and sublingual gland
mylohyoid muscle
How to What activation accomplishes
activate

Causes slight contraction of the


Instruct genioglossus muscle, which
the pushes against the tissue
patient to superior to it. Only mild
gently wet activation of the genioglossus
his upper muscle is accomplished so that
an lower the lingual flange in this area is
lips with gradually reduced until the most
Lingual frenum
How to activate What activation
accomplishes

Instruct the patient Allows freedom of


to protrude his the lingual frenum
tongue slightly and connective tissue
move it from side to band to prevent the
side. Make sure that denture from being
the compound is dislodged during
warmed only in the normal tongue
Lingual frenum
Retrozygomatic
Buccinator area
muscle fibres and overlying mucosa

How to activate What activation


accomplishes

Manually push Enables compound to


softened compound occupy this space
into the which is often
retrozygomatic area blocked by the
with the ball of your coronoid process
index finger ; the
patient mouth should
How to activate What activation
accomplishes
Instruct the Activates the
patient to pull in buccinater muscle
on your finger fiber and moves
with his lips, and the overlying
manipulate the mucosa
cheek in an
anterior posterior
and downward
direction.
Causes the
Instruct the
masseter muscle
Retrozygomatic area and
coronoid process areas
Coronoid process
Coronoidfibres process
of the temporal
muscles attached to coronoid process
How to activate What activation
accomplishes

Instruct the patient Activates the


to open wide then coronoid process and
close and move his the attached fibers
mandible to the of the temporal
opposite side muscle against the
modeling plastic
Molding of coronoid process
Zygomatic and buccal frenal
area
Tissues that mold
Buccinator muscle
Zygomatico maxillary crest
Buccal frenal and associated muscles of
facial expression
How to activate What activation
accomplishes

Manually mold the Stimulates the


cheek in a side to movement of the
side direction. buccinator muscles
Instruct the pt to and associated soft
pull his cheeks in on tissues; the lip
your finger. movement causes the
buccinator muscle to
contract improves
esthetic form of lips
and cheeks
Buccal frenum
How to activate What activation
accomplishes
Pull the buccal Activates the
frenum connective tissue of
frenum while
simultaneously
causing movement of
the associated
muscles of facial
expression (canninus
and orbicularis oris
Labial flange
Tissues that mold
Orbicularis oris
quadratus labii inferosis
risorius

How to activate What activation


accomplishes
mold this area Manually manipulate
externally using your the lips with their
fingers to move the associated
lip back and forth musculature to seal
while simultaneously the denture border in
applying pressure to displaceable tissue;
How to activate What activation
accomplishes
instruct the patient Moves the orbicularis
to lick his upper lip; oris in a common
do this with only the activity
surface of the
compound heated

Observe esthetic Causes compound to


be added or removed
to confirm to
Labial frenum
How to activate What activation
accomplishes
lift the upper lip Manually manipulates
vertically , place the the tissue of the
frenum into the frenum in the
compound ,and then compound to give it
manually mold this freedom to function;
area externally by the pressure ensures
moving the lip while both a seal in the
simultaneously displaceable tissue
applying pressure to and esthetic form
Posterior palatal seal area

Tissues that mold


Pterygomaxillary raphe
Pterygoid hamulus and hamular notch
Palato pharyngeus muscle
Palato glossus muscle
Tensor veli palatini muscle
Levator veli palatini
How to activate What activation
accomplishes
Instruct the patient to Causes the
open wide Pterygomaxillary raphe
to become more taut
Hold the patients Causes the soft palate to
nostrils closed with your depress against the
fingers; instruct the modeling plastic trough
patient to blow through contraction of the tensor
his nose veli palatini, delineating
the junction of the hard
and soft palate

Add an additional layer


Displaces the posterior
Refining of maxillary
impression trays
Add low fusing
compound to the buccal
flange beginning distal
to the buccal frenum
attachment area,
extending distally to
include the hamular
notch and across the
posterior seal area and
ask the patient to make
lateral movements of the
mandible
Molded buccal and labial
borders.

Recording the frenum

Excess compound on
tissue side trimmed.
Compound placed on
posterior border

Tray seated in mouth


with firm pressure

Junction of tray and


compound smoothened
Refining of Mandibular
impression tray
The buccal shelf area
should be developed
bilaterally. This
bilateral procedure
will ensure the proper
seating of the tray as
the rest of the borders
are refined.
Seat the tray in
the patient mouth
and ask the
patient to open
the mouth with
the operator
applying
downward
pressure. This
action forces the
masseter muscle
into action, which
in turn forces the
buccinator to
create the
masseter groove
The labial flange
is developed
unilaterally by
pulling the lips
downwards ,
outwards and
inwards to mould
the labial flange
so as in the
buccal flange
The disto lingual posterior mylohyoid
areas should be developed
bilaterally( placing the compound on the
lingual flange extending up to the retro
molar papilla). Then ask the patient to
protrude the tongue which activates the
mylohyoid muscle and elevates the floor
of the mouth and determines the length
and slope of the lingual flange in the
molar region
Border molding in lingual
areas
Border molded mandibular
tray
PREPARING THE TRAY TO
SECURE THE FINAL
IMPRESSION
Space must now be created
Spacer wax is removed
0.5mm is removed from the inner, outer, and top
surface of the border
the material over posterior area is not adjusted
( three functions)
1. displace the soft tissue at the distal end of the
denture to enhance posterior border seal;
2. it serves as a guide for positioning the tray
properly for the final impression
3. it helps prevents excess impression to the throat
holes can be placed in the palate of the
impression tray with a medium sized round bur
Completed maxillary final
impression
Completed mandibular final
impression
Impression technique for
hyper mobile ridges
The special tray is constructed with relief
wax placed over the mobile ridge.
Border molding is carried out and the final
impression is made after removing the wax
spacer using a free flowing material.