IMPRESSION

TECHNIQUES IN
COMPLETE DENTURES

Submitted by :
DHANANJAY VASUDEVA
MDS 1ST YEAR
 CONTENTS
 Introduction
 Basic Requirements of Impression Making
 Principles of impression making
 Objectives of an impression
 Classification of impression materials
 Impression techniques
 Impression techniques in compromised ridges
 Impression techniques for patients with constricted oral opening
 INTRODUCTION

 IMPRESSION
 A negative likeness or copy in reverse of the surface of an object; An imprint of the
teeth and adjacent structures for use in dentistry. (GPT-10)
 The negative form of the teeth and/or other tissues of the oral cavity, made in a plastic
material which becomes relatively hard or set while in contact with these tissues.
(HEARTWELL)

 COMPLETE DENTURE IMPRESSION

 A negative registration of the entire denture bearing, stabilizing, and border seal areas
present in the edentulous mouth. (HEARTWELL)
 PRELIMINARY IMPRESSION
 A negative likeness made for the purpose of
diagnosis, treatment planning, or the fabrication of
a tray. (GPT-8)
 An impression made for the purpose of diagnosis
or for the construction of a tray. (HEARTWELL)

 SECONDARY IMPRESSION
 The impression that represents the completion of
the registration of the surface or object. (GPT-8)
 An impression used for making the master casts.
(HEARTWELL)
 IMPRESSION MATERIAL
 Any substance or combination of substances used for making an impression or
negative reproduction. (GPT- 8)
 BASIC REQUIREMENTS FOR
IMPRESSION MAKING
 Knowledge of Basic anatomy

 Knowledge of basic reliable technique

 Knowledge and understanding of impression materials

 Skill

 Patient management
 PRINCIPLES OF IMPRESSION
MAKING
 Tissues of the mouth must be healthy.
 Impression should extend to include the entire basal seat within the limits of function of the
supporting and limiting tissues.
 If redundant tissue or bony projections of the ridge cannot be surgically removed, space for
them must be created within the denture.
 Proper space for the selected impression material should be provided within a properly fitting
impression tray.
 A guiding mechanism should be provided for correct positioning of the impression tray in the
mouth.
 A physiological type of border molding procedure should be performed by the dentist or by the
patient under the guidance of the patient.
 The external shape of the impression must be similar to the external form of the complete
denture.
OBJECTIVES OF AN IMPRESSION
Retention

Stability

Support

Esthetics

Preservation of residual alveolar ridge and soft tissues

Syllabus of Complete Dentures – Charles M. Heartwell (4 th Edition)

 RETENTION

 Retention begins with the impression

 It is that state of a denture wherein functional forces are unable to destroy the
attachment existing between the denture & the mucoperiosteum
 According to GPT- “that quality inherent in prosthesis, which resist the force of
gravity, adhesiveness of foods & the forces associated with the opening of the
jaws”
 It is the ability of the denture to withstand displacement against its path of
insertion
 Factors affecting Retention

 Anatomical factors
 Physiological factors
 Physical factors
 Mechanical factors
 Muscular factors
 ANATOMICAL FACTORS
 Size of the denture bearing area

 Quality of the denture bearing area.

 PHYSIOLOGICAL FACTORS
 Saliva and its quality

 PHYSICAL FACTORS
 Adhesion
 Cohesion
 Interfacial surface tension
 Capillarity and capillary attraction
 Atmospheric pressure and peripheral seal
 MECHANICAL FACTORS

 Undercuts
 Retentive springs
 Magnetic forces
 Denture adhesive
 Suction chambers and suction discs
 STABILITY

 The quality of a denture to be firm,

steady, or constant, to resist displacement
by functional stresses and not to be
subject to change of position when force
is applied.

 It is the ability of the denture to withstand

horizontal forces.
 Factors affecting Stability

 Vertical height of the residual ridge.

 Quality of soft tissue covering the ridge.
 Occlusal plane
 Quality of the impression.
 Teeth arrangement.
 Contour of the polished surfaces.
 SUPPORT

 It is the resistance to vertical forces of mastication & to occlusal or other forces

applied in a direction toward the basal seat .
 When the natural teeth are missing ,the alveolar ridge & their covering of mucosal
tissue become the supporting elements.
 Unfortunately , they were never meant to endure the forces of mastication & other
constant occlusal pressure that result from swallowing , clenching ,or bruxing.
 To make the best of bad situation , it is necessary to enhance the available support
by utilizing maximum coverage of all usable ridge bearing areas.
 ESTHETICS

 The thickness of the denture flanges is one of the important factors that govern
esthetics.

 Thicker denture flanges are preferred in long-term edentulous patients to give

required labial fullness.

 Impression should perfectly reproduce the width and height of the entire sulcus
for the proper fabrication of the flanges.
PRESERVATION OF REMAINING
STRUCTURES
 Muller De Van (1952) stated that, “The preservation of that which remains is of
utmost importance & not the meticulous replacement of that which has been lost.”

 Impressions should record the details of the basal seat and peripheral structures in
an appropriate form to prevent injury to the oral tissues.
CLASSIFICATION OF IMPRESSION
MATERIALS
Agar (Reversible)
Aqueous
hydrocolloids Alginate
(Irreversible)
Elastic
Polysulfide
ls
Condensation
eria Non- aqueous
Silicone
mat elastomers
ion Addition
ress Plaster Polyether
Imp
Compound
Non - Elastic
Waxes

Zn-O Eugenol
 IDEAL IMPRESSION MATERIAL
 Be non-injurious to the tissues, non-poisonous and non-irritant

 Be capable of compressing the soft tissues to any desired degree without itself being distorted.

 Be sufficiently fluid on insertion to give accurate surface detail.

 Be able to reproduce accurately any undercuts which are present.

 Have a pleasant taste, smell and appearance.

 Have no dimensional changes either in or out of the mouth at all normal degrees of temperature and
humidity.
 Set or harden at, or near, mouth temperature.

 Have a setting time under the control of the operator to allow for individual
variations of skill and speed.

 Be capable of having additions made and of reinsertion in the mouth, without

distortion.

 Be reasonably simple to use.

 Be compatible with all materials in general use for making casts.

 Be reasonably inexpensive with a good-shelf life.

Clinical Dental Prosthetics – A. Roy Macgregor (3rd Edition)

 STEPS IN MAKING AN
IMPRESSION
 Preliminary examination of the patient
 Seating the patient
 Selection of the tray
 Selection of the material
 Making impression-primary
border
molding
secondary
 PRELIMINARY EXAMINATION OF THE
PATIENT

 A complete case history and thorough clinical examination is done.

 Oral tissues must be healthy, with no signs of inflammation.

 LYTLE emphasized the importance of the recovery of abused oral tissues, obtained by
not allowing patients to wear their prosthesis for a minimum of 60 hours prior to
impression.

 Assessment of the available space before the actual impression is made.  

 SEATING OF THE PATIENT

 The patient should be seated upright

in a comfortable relaxed position,
with the occiput resting firmly in the
head rest.

 Chair height and position is adjusted

according to the comfort of the
patient and dentist.

Seating of the patient

Position of the operator for Position of the operator for
maxillary impression mandibular impression
SELECTION OF THE IMPRESSION TRAY:

“A device which is used to carry, confine and control an impression

material while making an impression”.

 The beginning of a good impression starts with the selection of the

correct stock tray. The tray should extend to cover the entire denture
bearing area and provide 5-6 mm space for the impression material.
 Large tray- Will distort the border tissues by pulling them away from the bone.

 Small tray- will collapse border tissues towards the residual ridge thus reducing
support for the denture.

Depending upon the type of the impression material used :

 A perforated or non-perforated tray is used e.g.. Compound or alginate.
 SELECTION OF THE IMPRESSION MATERIAL :

 One should select a material that has the characteristics and physical properties
to achieve the goals of impression.

 Manufacturer’s instructions must be strictly followed to gain maximum

advantage from the material.

 After the material and tray is selected, the primary impression are made.
 IMPRESSION TECHNIQUES

 IMPRESSION TECHNIQUE:
 A method and manner used in making a negative likeness (GPT-10)
MAKING PRELIMINARY
OR
PRIMARY IMPRESSION

 
 
 
Selection of stock tray. Position borders at hamular notches.

Lift the tray anteriorly, space for

impression material.

1/4th inch – Sharry

2-3mm – Winkler
Adequate clearance in frenal Deficient borders corrected by adding utility
areas. wax.
Location of hamular notches. Mark the vibrating line.

Some alginate to be placed in Alginate to be placed in deepest

vestibule. part of palate.
Tray to be rotated into the mouth and Upper lip elevated.
seated first at the back of the mouth.

Tray is held in the mouth.

Completed maxillary Primary Impression
with rounded and molded peripheries.
 Mandibular alginate impression.

Britania metal edentulous tray. Retromolar pad should be

identified

Tray should cover retromolar pad and rest

against external oblique ridge.
Adding utility
was to extend
lingual border.
Patient told to raise the tongue and
Patient told to do tongue movements.
tray is rotated in the mouth.

Gently mold the labial and buccal areas.

 Completed Mandibular Primary Impression.
 SPACER DESIGNS
Roy Mac Gregor
Placement of sheet of metal foil in the
region of incisive papilla and mid
palatine raphe.

Other areas that may require relief –

• maxillary rugae
• areas of mucosal damage
• buccal surface of prominent
tuberosities

Neill
Adaptation of 0.9 mm casting wax all over
except posterior palatal seal area.

The selective pressure maxillary impression: A review of the techniques and presentation of an alternate custom tray
design ( The Journal of Indian Prosthodontics – March 2007)
Boucher
MAXILLARY ARCH - Placement of 1mm
base plate wax on the cast except PPS area.
PPS area – guiding stop to position the tray
properly during the impression procedure.
Placement of escape holes in the palate (no.6
round bur)

MANDIBULAR ARCH – Placement of

1mm base plate wax on the crest and slopes
of the residual ridge, leaving the borders
uncovered.
The buccal shelf on each side also may be
left uncovered.
Morrow, Rudd, Rhoads
Block out the undercut areas with wax and
adapt full wax spacer (2mm short of resin
special tray border)
Placement of 3 tissue stops (4X4mm)
equidistant from each other

Sharry
Adaptation of a layer of base plate wax over
the whole area outlined for tray
Placement of 4 tissue stops, 2 in molar area
and 2 in cuspid region, extending from
palatal aspect of the ridge to the mucobuccal
fold
One escape hole in the incisive papilla region
Bernard Levin
A layer of pink base plate wax (2mm thick)
attached to the areas of the cast with the
softer tissues
Placement of wax spacer all around.
Sheldon
2 techniques –
1st method – Primary impression made with
low fusing modeling compound (Kerr white
cake compound)
2nd method – An alginate primary impression
made and a primary cast is poured
Spacer is placed and border moulding done
Heartwell
Fabrication of a custom tray
Border moulding done
Placement of five relief holes on the palatal region
(3 in rugae area and 2 in glandular region)

Halperin
‘Philosophy of the custom impression tray with
peripheral relief’

The slopes of the ridges - the primary stress

bearing areas - functionally loaded with
compound during making of the final
impression.
Wash secondary impression not required - the tray
surface and the border moulded areas are the
final impression surface.
 TISSUE STOPS

 Provide even thickness of impression

material in custom impression trays.

 Placement of four tissue stops of 2mm width

in cuspid and molar regions – extending
from palatal aspect of ridge to the
mucobuccal fold (edentulous cases)

 Provides stability to the tray.

Custom Impression trays in Prosthodontics – Clinical Guidelines

Indian Journal of Dental Sciences – October 2012
 ESCAPE HOLES
 After removing wax spacer from inside of the tray, a series of holes are prepared, about 12.5mm
apart in the center of alveolar groove and in the retromolar fossa (no.6 round bur).

 Relief holes – provide escape way for the final wash impression material and relieve pressure over
crest of the alveolar ridge and in retromolar pads when the final impression is made.

 Use of tray adhesives and escape holes – chemical-mechanical type of adhesion

Custom Impression trays in Prosthodontics – Clinical Guidelines

Indian Journal of Dental Sciences – October 2012
 TRAY HANDLES

 Useful in loading, orienting and placing

custom impression trays in patient’s
mouth.

 Handle should be 25mm long from edge

of the labial border of tray and 12 mm
wide.

 The handle is positioned in the

approximate position of the upper
anterior teeth so that it doesn’t distort the
upper lip when the tray is in position.
 Two additional handles one on each side – placed in the first molar region.

 Handles are centered over the crest of the residual ridge at its lowest point and approx. 19mm in height.

 Posterior handles
 used as finger rests to complete the placement of the tray on the residual ridges
 To stabilize the tray on the correct position with minimal distortion of soft tissue while the final impression
material sets.

 According to RUDD and MORROW, handles are 4 mm thick, 8 mm long and 8mm high. Horizontal
grooves across facial and lingual surfaces are placed to improve grip.

Custom Impression trays in Prosthodontics – Clinical Guidelines

Indian Journal of Dental Sciences – October 2012
Tray Handles
 Helpful when loading, placing and orientating custom trays in the mouth.

 Source of inaccuracy- when the handle distorts the form of the lip and hence functional sulcus.

 Stepped or angled to avoid interfering with the upper lip .

 Lower tray - three stub handles.

 Positioned as one in the midline-in the anterior region with one each side in the premolar regions.

 Upper anterior flabby ridge- 2 handles should be positioned - one either side in the premolar/molar
regions- to accommodate the open window.

The design and use of special trays in prosthodontics: guidelines to improve clinical effectiveness
P. W. Smith, R. Richmond, and J. F. McCord
Preparation for Secondary Impression

 Denture outline
marked on the
primary
impression.

Completed
preliminary
casts.
 Secondary impression

Denture outline accentuated.

Wax added for relief. Special tray.

.Borders should be rounded Vibrating line marked.

Tray inserted in mouth. Overextensions trimmed.

 Tray should be short of 2 mm
from base of sulcus Borders should be adjusted.

Extra clearence in frenal areas

 Recording the frenum.

Compound added in buccal frenum area.

.

Excess compound on tissue side

trimmed.

Compound placed on posterior

border.
Tray seated in mouth with firm pressure. Junction of tray and compound
smoothened.

Border molded
maxillary custom
tray.
 Impression tray loaded with
•Clearance provided for frenum. Zinc oxide eugenol.

•Tray held gently in place.

  Completed maxillary
final impression.

Primary impression
1. Tray outline marked 2-3 mm short of 2. Custom tray fabricated.
denture outline.

3. Posterior border of tray should

cover anterior half of the pad.
 Tray border should be
resting against the ridge.

Anterior border of the tray adjusted . Lingual border adjusted.

The tray gently seated in place.

The border should be smooth,

round and convex.
Border molded
mandibular tray
 Completed mandibular final
impression.

Primary
impression.
Theories of Impression making and their Rationale in Complete Denture Prosthod
JP Journal
PRESSURE / MUCOCOMPRESSIVE
TECHNIQUE
 GREENE BROTHERS
 First to utilize the entire denture-bearing
area for denture retention.
 Closed mouth all modeling plastic
technique

 Main objective
 To attain better retention of the denture
and is achieved by positive peripheral seal
 TECHNIQUE
• Primary impression made with impression compound

• Special tray made using shellac base plate.

• Second Impression is made in this tray using compound

• Bite rims with uniform occlusal surfaces are then made.

• Areas to be relieved are softened and the impression is inserted in mouth and held
under biting pressure for one or two minutes.

• Borders are molded by asking the patient to perform functional movements.

 DISADVANTAGES
 Displaced tissues, attempts to return to its normal unstrained position and so will
move the denture out of its intended position, resulting in deflective occlusal
contacts.

 Dentures will fit well during mastication only a short period, but will not be as
closely adapted to the tissues, when the patient is at rest. Tissues so distorted tend
to rebound.

 Not always able to obtain desired pressure, but tend to create excessive pressure.
This often resulted in good initial retention but eventual cut off of blood supply,
tissue breakdown & bone resorption. Thus the retention obtained is transient &
harmful.
 This technique does not allow for adequate muscle trimming of the periphery. So
impressions are over extended and must be arbitrarily trimmed .
MINIMAL PRESSURE TECHNIQUE
 Mucostatic¨ was coined by DR. CARROL W.
JONES

 HARRY L PAGE (1938) – Concept of

mucostatics

 ADDISON (1944) – principle of making

impressions of displaceable tissue in its passive
state. ( Interfacial surface tension – main factor
of retention).

 Minimal pressure technique – based on

mucostatic principle.
 PASCAL’s LAW – Any pressure applied to a confined fluid is transmitted undiminished

 HARRY L PAGE (1946) – All soft tissues – chiefly fluid (80% / more of the tissues –
composed of water).
 Since the soft tissues are confined under a denture, any pressure applied will be
transmitted in all the directions
 Interfacial surface tension – only important retentive mechanism in complete dentures
 DYKINS – short lingual flange to resist lateral displacement.

 Principle of mucostatics – Impression material should record without distortion, every detail
of the mucosa so that a complete denture would fit all minute elevations and depressions.

 Elimination of use of separating media results in distortion of the cast.

 Use of chrome, cobalt as denture base results in failure of accurate detail reproduction.

 FISH (1948) – mucostatic denture minimized the role of the musculature.

 TECHNIQUE

 A compound impression is made in a suitable tray and a cast is made , on this wax is
adapted which acts as a spacer.

 According to denture outline, Special tray is made over this spacer.

 Spacer is removed and impression is made with impression plaster with as little
pressure as possible.

 No muscle trimming is advocated.

 Escape holes may be made for relief.

 Zinc-oxide eugenol paste and alginate can also be used.

MERITS
 Minimizes pressure while making impressions & thereby maintaining tissues in
healthy conditions

 It is useful in sharp & flabby ridges.

DEMERITS
 Care taken to obtain minute details of mucosal surface is worthless due to
dimensional changes that occur in impression material and cast .

 Mucosal topography is not static over 24 hrs. period. There is difference between
mucosal contours just after raising in the morning and that exists after 12 hrs. in
upright position [Stephen et. al 1966] so all details achieved in the impression
would be altered by the time denture was completed.
It overlooked the fundamental rules laid by FISH that :
 Denture should extend maximum within the functional limits.

 Periphery should rest in soft tissue at every given point.

 There must neither be under extension nor over extension.

 Short flanges affect stability and retention.

 It is difficult to get an impression with out even a thin film of saliva.

 Since stress from these dentures will not be distributed as broadly over the basal
seal, tissue health and retention may be compromised.
 SELECTIVE PRESSURE

1950).
TECHNIQUE
Based on selective pressure theory (Carl O. Boucher-

 Combines the principles of both the pressure and

minimal pressure technique.

 In this technique idea of tissue preservation is

combined with mechanical factor of achieving
retention, through minimum pressure which is within
physiologic limits of tissue tolerance.

 This theory is based on a thorough understanding of

the anatomy and physiology of basal seat and
surrounding areas.
 Certain areas of maxilla and mandible – withstand loads from the forces of
mastication (stress-bearing areas), while certain areas cannot withstand forces due
to underlying anatomy (relief areas).

 Selective pressure – achieved by

 Scrapping of primary impression in selected areas OR
 Fabrication of a custom/special tray with a proper spacer design and escape holes
(relief).

 In the maxilla – the tissue underlying the region of posterior palatal seal has
glandular and soft tissue between the mucous membrane lining and the
periosteum covering the bone

 The tissue can be more readily displaced for the maintenance of peripheral seal of
the maxillary denture.
 DEMERITS

 Some feel that It is impossible to record areas with varying pressure.

 Some areas still recorded under functional load, the dentures still face the
potential danger of rebounding and loosing retention.
APPLIED ASPECT

 Inspite of some of its apparent drawbacks all the impression techniques based on
the selective pressure technique are still popular.

 Final impressions using this technique are made where relief areas are provided
and pressure is distributed on the stress bearing areas.
 OPEN MOUTH TECHNIQUE

 Made with tray held by dentist and mouth open

 Muscle movements may be emphasized and can be seen by the operator

 CLOSED MOUTH TECHNIQUE

 The supporting tissues are recorded in a

functional relationship.

 Normal functional movements

 Swallowing
 Talking
 Sucking
 Occlusal contacts
 Stanley P Freeman
 Amount of tissue compression is similar to that in function.

 DISADVANTAGE
 Tendency of overextension or underextension
 MUCOSEAL TECHNIQUE

 PRYOR (1948) – variation to the mucostatic technique.

 The anterior lingual border – molded by the floor of the mouth with the tongue in repose.

 Tray is extended horizontally backward, over the sublingual glands toward the tongue to
affect a border seal.

 Utilizes the benefit of minimal pressure

 Provides maximum extension of denture borders and maximum coverage of denture

bearing area.
 SUBATMOSPHERIC PRESSURE
TECHNIQUE
 MILO V KUBALIK and BERT C BUFFINGTON

 Based on concept of mucostatics.

 Objective – to reduce the stress on any given tissue by increasing load bearing area.

 The form of tissue is recorded vertically and laterally, when a controlled partial vacuum
in established in impression tray.

 The difference between the subatmospheric pressure within the tray and the atmospheric
pressure outside the tray – required to center the tray over the ridges in a static position
 A vacuum is developed between the soft tissues and the tray.

 A recording material in a fluid state flows from the border region into the
evacuated space and develops the basal tissues.

 Border seal is determined by the readings remaining constant.

 IMPRESSION TECHNIQUES IN
COMPROMISED RIDGES
 Impression techniques are modified in compromised conditions to achieve as
much retention and stability as possible within limits.

 Main aim of impression procedure –

 to gain maximum area of coverage with minimum pressure by obtaining, a fairly long
retromylohyoid flange for a better border seal and retention.
 To educate and train the patient to maintain tongue position; i.e. forward and resting on
top of lower anterior ridge when the mouth is open.

PROSTHODONTIC MANAGEMENT OF COMPROMISED

RIDGES AND SITUATIONS
NUJHS Vol.4, March 2014
 COMPROMISED
RIDGES

Atrophic Flabby Knife Edge Abused

Ridges Ridges Ridges Ridges
 ATROPHIC RIDGES
 Severe ridge atrophy results in increased inter-arch space, unstable and non-
retentive dentures with inability to withstand the masticatory forces.

 More common in mandible than maxilla

 A good impression holds the key to successful treatment in cases of resorbed

mandibular ridges, where there is minimal tissue to fulfill the fundamental
requirement of retention, stability and support.
 NEUTRAL ZONE IMPRESSION
TECHNIQUE
 The neutral zone technique is an alternative approach for the construction of
lower complete dentures. It is most effective for dentures where there is a highly
atrophic ridge and a history of denture instability.

 This method eliminates the above problem

 The neutral zone is the area where the displacing forces of the lips cheeks and
tongue are in balance

British Dental Journal 198, 269 - 272 (2005) M J Gahan

D Walmsley
 If the buccal flanges of the maxillary denture slope up and out from the occlusal
surface of the teeth and the buccal flanges of the mandibular denture slope down
and out from the occlusal plane ,the contraction of the buccinators will tend to
seat both dentures on their basal seats

 The lingual surfaces of the lingual flanges should slope towards the center of the
mouth so that the tongue can fit against them and perfect the border seal on the
lingual side.

 Natural dentition lies in this zone, and this is where the artificial teeth should be
positioned.

 This area of minimal conflict may be located by using the neutral zone technique.
 TECHNIQUE

 Primary impressions of the upper and lower

jaws are taken in impression compound or
impression plaster

 The model is poured.

 On this model upper wax rims and a lower

special tray are constructed.

 The special tray is a plate of acrylic adapted

to the lower ridge, without a handle, with
spurs or fins projecting upwards towards the
upper arch. These help with retention of the
impression material.
 The upper wax rim is adjusted as in
normal registration for a complete
denture.

 The lower special tray is placed in the

mouth.

 Two occlusal pillars are then built up in

low fusing compound on opposite sides
of the lower arch.

 These pillars are molded and adjusted to

the correct height so as to give the usual
3mm freeway space.
 A thick mix of viscogel is then placed around the rest of the lower special tray,
distally and mesially to the occlusal pillars.
 The patient is then asked to talk, swallow, drink some water etc.
 After 5-10 minutes the set impression is removed from the mouth and
examined.
 The viscogel material will have been moulded by the patient's musculature
into a position of balance.
 Indices are then constructed in the lab, by
surrounding the impression with plaster.

 When the viscogel and the tray is

removed, a gutter corresponding to the
neutral zone is left behind

 The teeth may then be placed into the

neutral zone.

 The resulting denture will be more

comfortable and be more stable and
retentive
 FLABBY RIDGES
 Areas with atrophy of alveolar process – mucosa has no bone support – becomes
loose and flabby

 More than 4mm thick

 Commonly associated with –

 frontal part of the ridges
 floating tubers maxillae
 WINDOW TECHNIQUE
 A preliminary impression of the edentulous arch using irreversible hydrocolloid
impression material

 Mark the flabby ridge on cast and fabricate a special tray providing a window for
marked flabby ridge area.

 Border mold the tray

 Apply the tray adhesive and load the impression tray with light body and immediately
place the tray over edentulous ridge and leave it in mouth for 3-5mintues.
 Remove the impression tray from mouth and trim away the excess impression.

 Place the impression tray back into patient mouth and inject polyvinyl siloxane
impression material over the window opening.

 Allow impression material to polymerize and then remove the impression.

 Remove, disinfect and box the impression with conventional boxing procedure.
WINDOW TECHNIQUE – WATSON
Watson R M. Impression technique for maxillary fibrous ridge. Br Dent J 1970; 128: 552.
 DUAL-TRAY TECHNIQUE
 A preliminary impression was made using
irreversible hydrocolloid impression material

 Extent of flabby ridge was marked on the

maxillary cast.

 Single uniform thickness of dental wax

(1.5mm) is adapted over the entire denture
bearing area to act as spacer for flabby tissue
area.

 A special tray is fabricated over the wax

spacer and locating rod is located in the
centre of palate during fabrication
 Double thickness wax spacer (3mm) is
adapted over flabby region

 Special tray along with double spacer

over flabby ridge. A pick up tray is
fabricated

 Border molding for the special tray and

pick up tray is done

 Wash impression is made. Special tray is

removed and examined and checked for
overhanging material..

 Multiple holes are made in the pick up

tray in the flabby area
 Light body elastomeric impression
material is placed on the area covering
the window portion and then while the
first tray is still in mouth, the pickup tray
is positioned over it and border molding
movements are repeated

 After the setting of the impression

material, the pickup tray along with the
first tray is removed as whole with the
help of the locating rod

 Impression surface is then examined for

any voids or extensions
 KNIFE EDGE RIDGES

 Formed due to rapid resorption of labial and lingual side of the lower anterior
ridge

 Gingiva overlying it becomes rolled and soft tissue proliferates leaving

hypermobile ridge crest tissue.

 They are thin, buccolingually; sharp but smooth and like a feather edge.

 Painful under pressure, seen only in mandible

 MEYER – 3 types of sharp ridges

Saw tooth ridge

SHARP RIDGES Razor like ridge

Ridge with discrete

spiny projections
 IMPRESSION TECHNIQUE
 A preliminary impression of the edentulous arch using irreversible hydrocolloid
impression material is made

 A special tray is fabricated over the primary cast

 A Medium bodied silicone impression material is used to make a fully muscle

trimmed secondary impression

 The impression produces displacement of the mucosa over the sharp bony ridge.
If it is used to construct the final denture prosthesis, there is a potential for the
denture to cause traumatic pain in this region
 The area of the impression over the sharp ridge is cut away using a scalpel blade.

 The tray is perforated over the sharp edge

 Complete impression is made using light bodied impression material

 ALTERNATIVE TREATMENT FOR KNIFE EDGED RIDGES

 Soft liners may be used

DRAWBACK – Hygiene and maintenance problems associated
with these materials.

 A controlled pressure impression technique would decrease occlusal loading over

the affected area and distribute forces more to the primary support areas like
buccal shelf

 Preprosthetic surgery – widely advocated for dealing with sharp bony ridges
DRAWBACK – Surgical trauma to the patient
Loss of potential stabilizing zone
 Differential pressure impression Technique –
enables a conservative preservation of ridge height for stability without
overloading the crest of the ridge
 REFERENCES
 A textbook of Complete dentures – Boucher

 Dental Laboratory procedures for Complete dentures – Rudd, Morrow and

Rhoads

 Syllabus of Complete dentures – Charles M. Heartwell

 Clinical Dental Prosthetics – A. Roy Macgregor (3rd Edition)

 ALOK DWIVEDI, RAJESH VYAS; Theories of Impression Making and their

Rationale in Complete Denture Prosthodontics
 Custom Impression trays in Prosthodontics – Clinical Guidelines Indian Journal
of Dental Sciences – October 2012

 British Dental Journal 198, 269 - 272 (2005) M J Gahan & A D Walmsley

 Prosthodontic management of compromised ridges and situations - NUJHS vol.4,

March 2014

 Sectional Impression tray for patients with constricted oral opening (The Journal
of Prosthetic Dentistry) – ROBERT J. LUEBKE
THANK YOU !!!