THEORIES OF IMPRESSION MAKING

AND IMPRESSION PROCEDURE FOR COMPLETE

DENTURE
 INTRODUCTION
 The beginning of a good denture starts with making
of a good impression,so a good impression is a
stepping stone
“Ideal impression must be in the mind of the dentist
before it is in his hand. He must literally make the
impression rather than take it”
- M.M. De Van
 GPT-8

 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.
A complete denture impression
is a negative registration of the
entire denture bearing,
stabilizing and border seal areas
present in the edentulous
mouth.

GPT-7
 Basic Requirements for Impression
Making (LEVIN B.)
 Knowledge of Basic anatomy
 Knowledge of basic reliable technique
 Knowledge and understanding of
impression materials
 Skill
 Patient management
PRINCIPLES OF IMPRESSION MAKING

 Preservation of Alveolar Ridges

 Support
 Retention
 Stability
 Esthetics
Preservation
 PRESERVATION OF REMAINING
STRUCTURES
 De Van (1952) stated that, “the preservation of
that which remains is of utmost importance
and 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.

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Denture support
 SUPPORT

The resistance to vertical forces

of mastication, occlusal forces and
other forces applied in a direction
towards the denture-bearing area.

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 SUPPORT

 The denture base should cover as

much denture-bearing area as
possible to provide good support.
 Confining the occlusal forces to
stress-bearing area and reliving
the non-stress-bearing areas will
aid to improve support

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Retention
 RETENTION
That quality inherent in the prosthesis
which resists the force of gravity,
adhesiveness of foods, and the forces
associated with the opening of the jaws.
(GPT)

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Factors affecting Retention
 Anatomical factors
 Physiological factors
 Physical factors
 Mechanical factors
 Muscular factors

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Stability
 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.

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FACTORS AFECTING 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.

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Esthetics.
 AESTHETICS
 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.

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Classification
 CLASSIFICATION
1) Depending on the theories of impression
making.

2) Depending on the technique

3) Depending on the tray type

4) Depending on the purpose of the

impression

5) Depending on the material used 26

Theories Of Impression Making:
Depending on theories of impression
making

 Mucostatic.
 Mucocompressive.
 Selective pressure.

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Mucostatic or Passive Impression
 First proposed by Richardson and later
popularised by Harry Page.

 Impression material of choice is impression

plaster.
 Retention is mainly due to interfacial surface
tension. The mucostatic technique results in a
denture, which is closely adapted to the mucosa of
the denture-bearing area but has poor peripheral
seal.

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 Demerits

 The lack of border molding reduces effective

peripheral seal.
 The short flanges may reduce support for the
face.
 The shorter flanges prevent the wider
distribution of masticatory stresses.
 Applied aspect:
 The technique holds good in the sense it helps
in preservation of tissue health.
 In practice with short flanges the oral
musculature is non supported and stresses are
not widely distributed.
 This technique is useful in impressions of
flabby and sharp or thin ridges.
 Mucocompressive Impression (Carole
Jones)
 Records the oral tissues in a functional and displaced
form. The materials used for this technique include
impression compound, waxes and soft liners.
 The oral soft tissues are resilient and thus tend to
return to their anatomical position once the forces are
relieved. Dentures made by this technique tend to get
displaced due to the tissue rebound at rest. During
function, the constant pressure exerted onto the soft
tissues limit the blood circulation leading to residual
ridge resorption.
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 Demerits of the theory
1. Excess pressure could lead to increase alveolar
bone resorption.
2. Excess pressure was often applied to the
peripheral tissues and the palate.
3. Dentures which fit well during mastication
tend to rebound when the tissue resume their
normal resting state.
4. Pressure on sharp bony ridges results in pain.
 Applied aspects:
 The technique tells that border tissues are recorded
in their functional positions and denture cannot be
dislodged during functional movements of jaws.
 The pressure applied is more and directed towards
the palate and peripheral tissues. So the retention
will be for short time and will be lost as soon as the
bone undergoes resorption.
 Usually this technique is used for preliminary
impression making as it gives a positive peripheral
seal and tissues are recorded in function. Amount
of pressure applied is for short duration and the
areas can be relieved during the final impression.
 Selective Pressure Impression
(Boucher)
 In this technique, the impression is made to extend
over as much denture-bearing area as possible
without interfering with the limiting structures at
function and rest.
 The selective pressure technique makes it possible
to confine the forces acting on the denture to the
stress-bearing areas. This is achieved through the
design of the special tray in which the non stress-
bearing areas are relieved and the stress-bearing
areas are allowed to come in contact with the tray.
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Selective Pressure Impression (Boucher)
Selective Pressure Impression (Boucher)
 Demerits
 It is impossible to record areas with varying
pressure.
 Some areas still recorded under functional
load, the dentures still faces the potential
danger of rebounding and losing 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.
Depending on the technique

Open-mouth
Closed-mouth

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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 rational behind this technique is

that the supporting tissues are recorded
in a functional relationship.
Requires occlusal rims to be made
Border molding done and final
impressions made
Jaw relations either tentative or final
made
Depending on the tray type

 Stock tray
 Custom tray

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 Selection of tray:

 The beginning of good impression starts with

the selection of the correct stock tray.
 Tray is a device that is used to carry, confine
and control impression material while making
an impression.
 The space available in the mouth for upper
impression is studied carefully by observation
of the width and height of the vestibular spaces
with mouth partly open.
 And in the lower the general form and size of
basal seat is studied.
Depending on the purpose of
the impression
Diagnostic
Primary
Secondary

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 DIAGNOSTIC IMPRESSION
 The negative replica of the oral tissues used to
prepare a diagnostic cast.
 Used for study purposes like measuring the
undercuts, locating the path of insertion.
 Is made as a part of treatment plan and to
estimate the amount of pre-prosthetic surgery.
 Articulate the casts on tentative jaw relation and
evaluate the inter-arch space

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 PRIMARY IMPRESSION
(PRELIMINARY IMPRESSION)

 An impression made for the purpose of

diagnosis or for the construction of a tray.
 There should be at least 5mm clearance between
the stock tray and the ridge.
 The tray should extend over hamular notch and
maxillary tuberosity. Mandibular tray should
cover retromolar pad.
 Tray can be extended using modelling wax.

Impression compound, Alginate, Impression plaster

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 SECONDARY IMPRESSION
(WASH IMPRESSION)

Involve:
Fabriction of custom tray.
Border molding.
Developing the posterior palatal seal.
Making the wash impression.

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Depending on the material used
 Reversible hydrocolloid impression.
 Irreversible hydrocolloid impression.
 Modeling plastic impression.
 Plaster impression.
 Wax impression.
 Silicone impression.
 Thiokol rubber impression. (Polysulphide)

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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
 Position of the operator for
Seating of the patient maxillary impression

Position of the operator for

mandibular impression
 Impression techniques in
compromised/special situations
 Techniques are modified in compromised
situations to achieve as much retention and
stability as possible within limits.

1. Hyper active gag reflex

2. Restricted mouth opening
3. Severely resorbed mandibular ridge
4. Hypermobile / hyperplastic ridges
 Hyperactive gag reflex

 Patients problems should be identified before impression is made.

a) Prosthodontic management
- Avoid thick or over extended trays.
- Avoid excess loading of material
- Use a fast setting material

b) Distraction maneuvers
- Engage the patient in conversation of some special
interest.
- ask the patient to concentrate on one foot or to raise it.
c) Pharmacologic measures
- Local anaesthetics
- Antihistamines, Sedatives, CNS depressants
d) Psychological intervention
- Hypnosis helpful in certain cases
 Restricted mouth opening
 Patient’s may exhibit limited opening of the
mouth following radical surgery or a sequel
facial burns, or due to other pathological
conditions.
 Impressions with the use of sectional trays are
made.
 Severely resorbed mandibular ridge
 Lack of ideal amount of supporting structures decreases support
and encroachment of the surrounding mobile tissues onto the
denture border reduces both stability and retention. The main is
to gain maximum area of coverage.
 Flange technique by Lott & Levin involves making impressions of
the soft structures of the mouth adjacent to the buccal, lingual and
palatal surfaces and incorporating the resulting extension or
flange into the denture.
 Tryde used the dynamic impression method.
 McCord and Tyson in 1997 gave the admixed technique.
Hypermobile or hyperplastic ridges
 These ridges should be recorded without
distortion.
Selective displacive technique.
Window technique
 WINDOW TECHNIQUE

 A primary impression is taken in alginate

loaded in a stock tray. The impression is then
poured and a special tray is constructed on the
model. The special tray is close fitting and has a
hole or "window" over the area corresponding to
the flabby ridge. An impression is taken in
impression paste (mucodisplacive). Once this
has set it is left in place and impression plaster
(mucostatic) is painted over the flabby ridge and
allowed to set and removed as one impression.
The impression is removed as one, cast and the
denture constructed on the resulting model
 Modifications in imp making in some
diseases
 Diabetes Mellitus
 In a diabetic patient there is mucosal drying and
cracking,burning mouth and tongue,decreased salivary flow
and greater predominance of Candida albicans
 So instead of using ZOE for definitive imp some other
material like irreversible hydrocolloids or medium or light
bodied elastomeric materials can be used
 Healing is impaired in diabetics so a closely adapting
denture should be avoided this can be done by giving a full
spacer
 Oral Submucous fibrosis
 In this condition patient has minimal mouth
opening,the mucosa is atrophied,submucosal
layers are fibrosed which makes the oral
mucosa hard and rigid and imparts bone like
consistency
 For imp making in these patients sectional
trays can be used and a mucostatic material is
used for impression making like medium
bodied or light bodied elastomeric compounds
or ireversible hydrocolloids e.g. alginate
 SUMMARY & CONCLUSION
 The main objective of impression making is to
construct dentures, having maximum retention
and stability, without causing any damage to
the supporting structures.
 Dentists should be able to modify his technique
to cope with the conditions of the basal tissues
as presented by each patient.
 Thus, it is the responsibility of the dentist, to
select the best possible procedures, based on
sound knowledge, for achieving the best
possible results for the patient.
 REFERENCES
 Bernard Levin – Impression for complete dentures.
 Boucher’s – Prosthodontic treatment for edentulous patients
– 11th Edition.
 Charles M. Heartwell – Syllabus of complete dentures – 4th
Edition.
 Sheldon Winkler – Essentials of complete denture
prosthodontics – 2nd Edition.
 John Joy Manappallil – Complete denture prosthodontics –
1st Edition.
 Boucher C.O. – A critical analysis of mid-century impression
technique for complete denture. JPD 1951; Vol-1.
 Lee Singer – The marble technique:A method for treating the
hopeless gagger for complete dentures.JPD 1973;VOL-29
 Behruz J Abadi,Gatlazzi –Impression tray for making
complete denture impressions.Quintessance Int 1986;vol-10
 “Good Impressions
Last Forever”

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