immediate complete denture impressions

Continuing Education

Immediate CompleteDenture Impressions

Case Report and Modern Clinical Technique

Authored by Joseph J. Massad, DDS and David R. Cagna, DMD, MS

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ABOUT THE AUTHOR

Dr. Massad is director of removableprosthodontics at the The ScottsdaleCenter for Dentistry in Scottsdale, Ariz.He is an associate faculty member ofTufts University School of DentalMedicine in Boston, and is an adjunct

associate faculty member of the Department ofProsthodontics at the University of Texas Health ScienceCenter Dental School in San Antonio, Tex. He can bereached at (918) 749-5600 or [email protected]. Disclosure: Dr. Massad is the developer and holds thepatent for the Strong-Massad Dentate & Implant Trays.

Dr. Cagna is a professor and director of the Department of RestorativeDentistry, Advanced ProsthodonticProgram, at the University ofTennessee Health Science CenterCollege of Dentistry in Memphis, Tenn.

He may be contacted via e-mail at the address dcagna@ utmem.edu.Disclosure: Dr. Cagna is a stockholder in Global DentalImpression Trays, which is the company that manufacturesthe impression trays used in this article.

INTRODUCTION

For patients confronted with the extraction of theirremaining natural teeth and the need for complete pros-thodontic rehabilitation, the transition is generallypsychologically challenging for the pa-tient and demandingof the clinician. This dramatic treatment is oftennecessitated by generalized caries, extensive periodontaldisease, or a malocclusion that is not amenable totreatment. Of considerable significance to many patientsfacing this course of treatment is their desire to specificallyimprove the appearance of their anterior teeth, contributingto an attractive smile. In order to optimize immediatedenture therapy, thoughtful consideration must be given tothe treatment planning, definitive impression making, anddenture tooth set-up phases of therapy.

The primary advantage of an immediate denture is theabsence of an edentulous period where prosthetic toothreplacement is not available. Specifically, advantages ofimmediate complete dentures include the maintenance orimprovement of: 1. dental aesthetics, 2. perioral and facialtissue support, 3. masticatory function, and 4. phonetic ability.If the patient’s natural anterior teeth remain but are scheduledfor extraction, the selection and arrangement of anteriordenture teeth, from an aesthetic perspective, may be easier.

From the patient’s viewpoint, immediate completedentures provide the psycho-social advantage of continuoustooth display to allow personal and public interactions.Though abrupt, the transition from the dentulous state toedentulism may be made less difficult by incorporatingimmediate complete dentures in the treatment plan.

Major disadvantages of immediate denture therapyrelate to the technical difficulties associated with denturefabrication. Because immediate complete dentures areconstructed prior to extraction of the remaining teeth, 4significant challenges arise: 1. the making of anatomicallyand physiologically accurate definitive impressions in thepresence of remaining teeth and associated soft and hardtissue undercuts is often difficult and occasionallyimpossible, 2. if the residual teeth are mobile, recordingaccurate interocclusal jaw registrations may be difficult, 3.creating edentulous contours on dentate master castsutilizing clinically valid and reliable estimation techniques isoften associated with unavoidable errors, and 4. the


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Recommendations for Fluoride Varnish Use in Caries Management

LEARNING OBJECTIVES:

After reading this article, the individual will learn:

• historic techniques for taking impressions forimmediate complete dentures, and

• a new technique for taking accurate impressions forimmediate complete dentures.

Immediate CompleteDenture Impressions Case Report and ModernClinical Technique

inability to accomplish a full wax try-in of the proposeddenture tooth arrangement makes the aesthetic outcomeunpredictable. It is due to these technical difficulties thatimmediate complete dentures are often considered“interim” prostheses requiring replacement upon healing ofthe edentulous ridges.

Optimal retention, support, and stability for removableprosthodontic restorations are important factors intreatment success and patient comfort. When consideringim-mediate complete dentures, certain clinical conditionsoften prohibit achieving ideal retention, support, andstability in the planned prostheses. As mentioned, thepresence of residual natural teeth and associatedunfavorable osseous and soft tissue contours require thatthe clinician: 1. modify existing techniques to generatephysiologically and anatomically accurate impressions andmaster casts, 2. evaluate existing den-tate or partiallyedentulous clinical conditions and predict expected eden-tulous ridge contours following tooth extractions, 3. developthese edentulous contours on the master casts, and finally4. construct the immediate complete dentures.

Although techniques have been developed to fabricateimmediate complete dentures, significant obstacles arefrequently encountered. The development of diastematasecondary to advanced periodontal disease maycomplicate impression procedures. Varying degrees ofperiodontal involvement of the residual dentition will resultin an irregular contour of the edentulous alveolar ridges.Irregular osseous contours that protrude into the vestibularsulcus interfere with an accurate impression in this area,ultimately affecting the development of a peripheral seal inthe final prostheses.

The accurate, physiologic replication of vestibularanatomy (including frenum attachments, the postpalatalzone, and the retromylohyoid space) is important to thedevelopment of peripheral denture seal and dentureretention. When physiologic vestibular anatomy isrepresented accurately in the immediate denture flangecontours, the denture may function effectively as suction isachieved. Under such conditions and in the presence ofappropriate volume of saliva, optimal consistency of thesaliva, accurate fit, and a favorable occlusal scheme,satisfactory denture retention is possible.

It is not uncommon to encounter problems with dentureretention on the day of immediate denture insertion. Asmentioned, this problem can often be traced back toinaccurate adaptation of the denture flanges to thephysiologic limits of the vestibular sulci. Horizontal and/orvertical overextension of vestibular anatomy duringimpression making, as is common when usinginappropriately contoured stock impression trays andirreversible hydrocolloid im-pression materials, does notallow physiologically accurate impressions. The result willbe overextension of the immediate denture flange.Ultimately, extensive adjustments are necessary on the dayof denture placement and during the post-operativeadjustment period.

Although challenging in many ways, anatomic andfunctionally accurate impressions are critical to successfulimmediate denture therapy. A predictable immediate dentureimpression technique adaptable to a wide variety of dentateand partially edentulous conditions is available. The followingcase report discusses historical immediate denture im-pression techniques, and concerns in regard to the utility of theresultant casts. Also presented are step-by-step proceduresfor making immediate denture impressions using a newimpression tray design and modern impression materials.

CASE REPORT

A 44-year-old white female presented on referral from hergeneral dentist for evaluation and treatment of a severelycompromised dentition. The patient was a professionalmakeup artist and expressed concern regarding theaesthetics of her smile and the appearance of her teeth duringclose, personal, daily interactions with her clients. Thepatient also reported that she smokes cigarettes (one halfpack per day). This habit began 15 years ago.

Intraoral examination revealed multiple missing teeth,substantial accumulation of dental plaque and calculus,many teeth with 6 to 9 mm probing depths, generalizedbleeding on probing, generalized moderate to severemobility, and severe fremitus involving most teeth (Figures 1and 2). Following scaling and root planing, many of theteeth previously demonstrating moderate mobility nowdisplayed severe mobility.


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Immediate Complete Denture Impressions: Case Report and Modern Clinical Technique

The patient’s remaining teeth were not salvageable.Treatment options, duration, and prognosis, as well as cost,were reviewed with the patient. The patient elected fullmouth extractions and placement of immediate maxillaryand mandibular complete dentures.

IMMEDIATE DENTURE IMPRESSION TECHNIQUES

A number of different impression techniques have beendescribed for use in the fabrication of immediate completedentures. These techniques include:1. An irreversible hydrocolloid im-pression made in a

stock impression tray.1-5

2. An elastomeric impression made in a border moldedcustom impression tray.6-20

3. A combination or double impression21-25 involving (a) aprimary impression made in a border molded customtray using an elastomeric impression material tocapture only edentulous regions and associatedvestibular areas, and (b) a secondary impression madein a stock impression tray using irreversiblehydrocolloid to capture the remaining teeth andassociated vestibular areas. The secondary impressionis made with the primary impression in place in thepatient’s mouth.

4. A sectional impression20,26-35 involving (a) a posteriorsection im-pression made in a border molded custom trayusing an elastomeric impression material to captureedentulous posterior regions, associated vestibular areas,and the lingual aspects of the residual dentition, and (b) an anterior section impression, or facial matrix, madeby placing a bulk of impression material in the labialvestibular space associated with the residual dentitionand allowing it to set. Alternatively, the impressionmaterial may be carried to the mouth in a secondsectional tray that is indexed to the primary tray. Ineither case, the anterior section impression will capturethe facial anatomy of the teeth, the vestibular anatomy,and indices on the primary impression/tray. Uponremoval of the anterior and posterior sectionsseparately, the 2 sections are reassembled outside themouth (using the indices) and prepared for casting.

5. The “Campagna” combination impression36-39 involving(a) a primary impression made in a border moldedcustom tray using an elastomeric impression material tocapture the posterior edentulous regions and ALLvestibular areas, and (b) a secondary impression, orover-impression, made in a stock impression tray usingirreversible hydrocolloid to capture only the residualdentition and pick-up the primary dentition.

Because of the residual teeth, associated osseousundercuts, and the use of hydrocolloid impression materials,these impression techniques fail to register anatomically andphysiologically accurate vestibular anatomy. With thedevelopment of a new impression tray system (Strong-Massad Dentate & Implant Trays, Global Dental ImpressionTrays) and the use of vinyl polysiloxane many of theshortcomings associated with classic immediate dentureimpressions may be successfully avoided. The impressiontechnique illustrated here employs vinyl polysiloxane (VPS)impression material to accomplish single ap-pointmentdefinitive immediate denture impressions.

THE MAXILARY IMPRESSION

Tray SelectionThe first step is to determine the dimensions of the

dental arch and select a stock impression tray of appropriate


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Figure 1. The patient’sclinical appearanceprior to immediatedenture therapy.

Figure 2. The patient’sradiographic conditionprior to immediatedenture therapy.

size (Figure 3). The im-pression trays illustrated here areconstructed from a clear polystyrene-based polymer andpermit see-through visibility to assist when selecting andfitting the tray (Figure 4). Retention slots perforate the traysto maximize mechanical retention of the material. PVSadhesive should NOT be used in the trays. Rather, it ispreferred that the im-pression material is wiped clean fromthe tray in areas where the tray impinges on border andperipheral tissues. The elimination of im-pression materialfrom tray borders indicates the need to selectively adjust thetray prior to making the definitive impression.

Tray AdaptationCustomized tray adaptations can be made to

accommodate existing anatomic contours. The traysillustrated here are thermoplastic. To effect subtle alterationof flange trajectory, pass the tray quickly through alaboratory flame until the resin begins to soften. Oncesoftened, carefully manipulate the tray flange into thedesired shape. Cool the tray in water. Border extensions ofthe tray may also be reduced by grinding with aconventional acrylic resin bur.

Tray StopsThe impression procedure described here requires

repetitive placement of the impression tray in the patient’smouth. In order to achieve consistently accurate trayplacements, tray stops are used. Using high viscosity VPS,dispense quarter-size mounds in the molar, incisor, andmid-palate areas of the tray (Figure 5). Seat the tray in thepa-tient’s mouth and center the tray over the residual teethand ridge. Upon polymerization, remove the tray andinspect the stops to assure even thickness and that theteeth and ridge crest are centered within the tray. Trim theVPS with a sharp knife to eliminate all but the occlusalsurface and incisal edge impressions and minimize anyareas of soft tissue contact (Figure 5). Tray stops permit: 1.adequate and even space between the tray and residualtissues for impression material, 2. adequate and evenspace between the tray and vestibular reflections forimpression material, and 3. consistently repeatablepositioning during tray placement.

Border MoldingFor maxillary impressions, it is recommended that a

high or medium viscosity VPS material be used for bordermolding. Dispense a rope of VPS material along theperipheral tray borders, including the postpalatal seal area(Figure 6). Place the tray in the patient’s mouth and seat thetray onto the maxilla using the tray stops as guides. Use thefollowing tissue manipulations to define peripheral borders:


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Figure 3. Animpression tray(Strong-MassadDentate & ImplantTrays, Global DentalImpression Trays) isselected to fit themaxillary arch.

Figure 4. The clearpolystyrene impressiontray permits see-through visibility forselecting and fitting thetray to the dental arch.

Figure 5. Impressiontray stops are formedin the tray using highviscosity VPSimpression material.

Figure 6. Highviscosity VPSimpression material is applied to theimpression tray bordersprior to border molding.

• To define the labial notch, grasp the filtrum close to thevermilion border and pull downward (Figure 7).

• To form the labial vestibular borders, ask the patient topurse the lips using a sucking action (Figure 7).

• To define the buccal notches and buccal vestibularborders, grasp the cheek with the forefinger and thumb atthe corner of the mouth and pull downward and forward(Figure 7). Repeat this process on the opposite side.

• To define the coronomaxillary vestibular border andhamular frenum area, ask the patient to open the mouthwide (Figure 8). This will cause the coronoid processesto translate through the coronomaxillary spaces,bringing associated muscles to their terminal positions.If the mandibular opening is restricted, instruct thepatient to move the mandible from side to side.

• To functionally form the posterior border of the tray,instruct the patient in Valsalva’s maneuver.40-42

Manually occlude the patient’s nostrils and ask thepatient to attempt to forcibly exhale through the noseonly (Figure 8). This causes the soft palate to movedownward, forming the VPS along the postpalatal sealaspect of the impression tray.

Following polymerization of the VPS, remove theimpression tray and inspect all peripheral borders to assurethat appropriate anatomic and functional detail is present. If the resin tray is apparent through the border molding material, adjust the tray by grinding. Finally, in preparation forthe definitive impression, relieve one to 2 mm from all bordersusing a scalpel blade and/or rotary instrument (Figure 9).

Definitive ImpressionDispense low-viscosity VPS impression materials into

the maxillary impression tray (Figure 9). Inject extra-low-viscosity VPS material around all residual teeth usingmanual syringes (Figure 10). Extra-low-viscosity VPSmaterial possesses relatively low tear strength43, permittingeasier recovery of the polymerized impression from thepatient’s mouth without damaging periodontally involvedteeth. The relatively low stiffness of low viscosity VPS alsofacilitates recovery of the definitive master cast from theimpression without damage.

Following injection of low viscosity VPS around allteeth, place and center the impression tray on the maxilla(Figure 10) using the tray stops as guides. Repeat allborder molding manipulations. Upon polymerization of theVPS, remove and inspect the impression for appropriateanatomic, functional, and surface details (Figure 11). Oncesatisfied with the quality of the definitive impression, bead,


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Figure 7. Themaxillary impressiontray is placed in thepatient’s mouth andborder moldingprocedures areaccomplished.

Figure 8. Additionalborder molding isaccomplished forthe maxillaryimpression tray.

Figure 9. Borderadaptation of themaxillary impressiontray is carefullyinspected. All areas ofVPS tissues contactare reduced by one to2 mm using a bur or

scalpel blade. The tray is then loaded with low viscosity VPSimpression material in preparation for the final impression.

Figure 10. Extra-lowviscosity VPSimpression material isinjected aroundresidual teeth and theimpression tray isseated on the maxilla.

box, and cast the impression44 using a suitable vacuummixed dental stone (Figure 11).

THE MANDIBULAR IMPRESSION

Examine the dimensions of the mandibular dental arch andselect a stock impression tray of appropriate size (Figure 12).

Tray AdaptationCustomized tray adaptations may be made to

accommodate existing anatomic contours. As with themaxillary impression procedure previously described,subtle thermoplastic tray reshaping and selective removalof tray material using an acrylic bur may be accomplisheduntil an acceptable fit is achieved.

Tray StopsBecause the impression tray will be reseated in the

patient’s mouth a number of times during the impressionmaking, and accurate tray placement is essential, a systemof tray stops must be developed early in the impressionprocedure. Using high-viscosity VPS, dispense a ribbon ofmaterial along the occlusal wall of the impression tray(Figure 13). Seat the tray in the patient’s mouth and centerthe tray over the residual teeth and ridge (Figure 13). Uponpolymerization, remove the tray and inspect the stops toassure even thickness and that the teeth and ridge crestare centered within the tray. Trim the VPS with a sharp knifeto eliminate all but the occlusal surface and incisal edgeimpressions (Figure 14).

Border MoldingFor mandibular immediate denture impressions, it is

recommended that a medium viscosity VPS material be usedfor border molding. Dispense a rope of medium viscosityVPS material along the peripheral tray borders (Figure 14).Place the tray in the patient’s mouth and seat the tray ontothe mandible using the tray stops as guides. Use thefollowing tissue manipulations to define peripheral borders:

• To functionally form the lingual and retromylohyoidflange borders, have the patient place the tip of thetongue forward out of the mouth and then move thetongue side to side (Figure 15). Next, have the patientretract the tip of the tongue to touch the posterior palate.

• To form the labial notch, grasp the lower lip at thevermilion border and pull outward and upward.

• To functionally form the labial and buccal borders,stabilize the tray with the index and middle fingers onthe finger rest and the thumb beneath the chin. Ask thepatient to purse the lips using a sucking action and thensmile widely (Figure 15).


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Figure 11. Thedefinitive maxillaryimpression is carefullyinspected. A mastercast is then pouredusing an appropriatedental stone.

Figure 12. Animpression tray(Strong-MassadDentate & ImplantTrays, Global DentalImpression Trays) isselected to fit themandibular dental arch.The clear polystyrene

impression tray permits see-through visibility for selecting andfitting the tray to the dental arch.

Figure 13. Acontinuous impressiontray stop is formed inthe tray using highviscosity VPSimpression material.

Figure 14. Theimpression tray stop istrimmed with a scalpelblade or bur. Mediumviscosity VPSimpression material isapplied to the trayborders in preparationfor border molding.

• To form the buccal notches, grasp the cheek with theforefinger and thumb at the corner of the mouth andpull upward and forward. Repeat this process on theopposite side.

Following polymerization of the VPS, remove theimpression tray and inspect all peripheral borders to assure that appropriate anatomic and functional detail isrepresented. If the resin tray is apparent through the bordermolding material, adjust the tray by grinding. Finally, relieveall borders approximately one to 2 mm using a scalpelblade and/or rotary instrument in preparation for thedefinitive impression (Figure 16).

Definitive ImpressionDispense low-viscosity VPS im-pression materials into

the mandibular impression tray (Figure 16). Inject extra-low-viscosity VPS material around all residual teeth usingmanual syringes (Figure 17). As noted previously, extra-low-viscosity VPS material possesses relatively low tearstrength43 permitting easier recovery of the polymerizedimpression from the patient’s mouth without damagingperiodontally involved teeth. The relatively low stiffness oflow-viscosity VPS also facilitates recovery of the definitivemaster cast from the impression without damage.

Following injection of low-viscosity VPS around allteeth, place and center the impression tray on the mandible(Figure 18) using the tray stops as guides. Repeat allborder molding manipulations (Figure 18). Uponpolymerization of the VPS, remove and inspect theimpression for appropriate anatomic, functional, andsurface details (Figure 19). Once satisfied with the qualityof the definitive impression, bead, box and cast theimpression44 using a suitable vacuum mixed dental stone(Figure 19).

CONCLUSION

The provision of prosthodontic restorations immediatelyfollowing extraction of all remaining nonrestorable teeth isan important treatment option. Many patients in need of thistherapy are eager to receive aesthetic replacement of theirmissing teeth, but express concern about edentulism. Asnew denture wearers, these patients will require time to

accommodate to their situation. It is also expected that the post-extraction denture adjustment and maintenancephase of therapy will be challenging. Therefore, it is imperative that techniques be continuously developed tooptimize the accuracy of immediate dentures in an effort tofacilitate the difficult transition to edentulism.

As we improve conventional approaches to common


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Figure 15. Themandibularimpression tray isplaced in the patient’smouth and bordermolding isaccomplished.

Figure 16. Borderadaptation of themandibular impressiontray is carefullyinspected. All areas ofVPS tissues contactare reduced by one to2 mm using a bur orscalpel blade. The tray

is then loaded with low viscosity VPS impression material inpreparation for the final impression.

Figure 17. Extra-lowviscosity VPSimpression material is injected aroundresidual mandibularteeth.

Figure 18. Theimpression tray isseated on the mandibleand the patient isinstructed toaccomplish all bordermolding movements.

prosthodontic problems, the incorporation of new materialsand techniques must also be considered. The immediatedenture impression procedures presented here combinestandard concepts of im-pression tray relief and physiologicborder molding with modern concepts of improvedimpression tray design and vinyl polysiloxane materials tofacilitate better clinical outcomes for patients. It is importantto carefully evaluate impression border details, thereplication of critical anatomy in the master cast, and thedevelopment of anatomic and physiologic accuracy in thedefinitive denture borders (Figure 20). Attention to detailwhen capturing the physiologic and anatomiccharacteristics of the denture foundation and peripheralsulci during impression making will facilitate retention,support, and stability of the definitive prostheses.

Following impression making and cast construction,care must also be given to: 1. accurate mounting ofcasts in a semiadjustable articulator, 2. extraction of theresidual dentition from the casts, 3. recontouring ofextraction sites to simulate expected soft and hard tissuechanges, and 4. setting of denture teeth for acceptabledenture function and aesthetics.


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Figure 19. Thedefinitive mandibularimpression is carefullyinspected. A mastercast is then pouredusing an appropriatedental stone.

Figure 20. A carefullydeveloped maxillaryimpression displaysvestibular details thatare carried through themaster cast, to thecontours of thedefinitive immediatemaxillary completedenture.

REFERENCES1. Terrell WH. Immediate restorations by complete dentures.

J Prosthet Dent. 1951;1:495-507.2. Standard SG. Preparation of casts for immediate dentures.

J Prosthet Dent. 1958;8:26-30.3. Nagle RJ, Sears VH, Silverman SI. Denture Prosthetics -

Complete Dentures. 2nd ed. St Louis, MO: Mosby; 1962.4. Boucher CO. Swenson’s Complete Dentures. 5th ed. St Louis,

MO: Mosby; 1964. 5. Rayson JH, Wesley RC. An intermediate denture technique.

J Prosthet Dent. 1970;23:456-463.6. Swenson MG. Improving immediate dentures in general

practice. J Am Dent Assoc. 1953;47:550-556.7. Appleby RC, Kirchoff WF. Immediate maxillary denture

impression. J Prosthet Dent. 1955;5:443-451.8. Freese AS. Simplified impressions for immediate complete

dentures. J Am Dent Assoc. 1957;54:240-242.9. Gehl DH, Dresen OM. Complete Denture Prosthesis. 4th ed.

Philadelphia, PA: WB Saunders; 1958.10. Leathers LL. Overcoming obstacles and objections to

immediate dentures. J Prosthet Dent. 1960;10:5-13.11. Klein IE. Immediate denture prosthesis. J Prosthet Dent.

1960;10:14-24.12. Blank HH. Impression materials for maxillary immediate

dentures. J Prosthet Dent. 1961;11:414-419.13. Passamonti G. Immediate denture prosthesis. Dent Clin

North Am. 1964;8:781-800. 14. Rapuano JA, Vinton PW. A single tray, dual material technique

for immediate dentures. N Y State Dent J. 1970;36:73-76.15. Bates JF, Stafford GD. Immediate complete dentures. 4.

Techniques in construction. Brit Dent J. 1971;131:449-454.16. Sharry JJ. Complete Denture Prosthodontics. 3rd ed.

New York: McGraw-Hill; 1974.17. Passamonti G. Atlas of Complete Dentures. Chicago, IL:

Quintessence Publishing; 1979.18. Anderson JN, Storer R. Immediate and Replacement Dentures.

3rd ed. Oxford, England: Blackwell Scientific Publications; 1981.19. Nimmo A, Winkler S. Conventional immediate complete

dentures. In: Winkler S, ed. Essentials of Complete DentureProsthodontics. 2nd ed. Littleton, MA: PSG Publishing;1988:361-374.

20. Arbree NS. Immediate dentures. In: Zarb GA, Bolender CL,Carlsson GE, eds. Boucher’s Prosthodontic Treatment forEdentulous Patients. 11th ed. St Louis, MO: Mosby-Year Book;1997:415-422.

21. Pound E. An all-inclusive immediate denture technic. J Am Dent Assoc. July 1963:16-22.

22. Cupero HM. Impression technique for complete maxillaryimmediate denture. J Prosthet Dent. 1978;39:108-109.

23. Morrow RM, Feldmann EE. Clinical appointment V - impressionprocedures. In: Morrow RM, ed. Handbook of ImmediateOverdentures. St Louis, MO: Mosby; 1978:73-106.

24. Heartwell CM. Conventional immediate complete dentures. In:Winkler S, ed. Essentials of Complete Denture Prosthodontics.Philadelphia, PA: WB Saunders; 1979:517-537.

25. Rahn AO, Heartwell CM. Textbook of Complete Dentures. 5thed. Philadelphia, PA: Lea & Febiger; 1993.

26. Schlosser RO. Complete Denture Prosthesis. Philadelphia, PA:WB Saunders; 1939.

27. Geller JW. Prosthetic dentistry. J Prosthet Dent. 1960;10:33-36.28. Kelly EK. The immediate denture. In: Prosthodontic Syllabus -

United States Army Institute of Dental Research. Washington,DC: Walter Reed Medical Center; 1965:200-208.

29. Lutes MR, Ellinger CW, Terry JM. An impression procedure forconstruction of maxillary immediate dentures. J Prosthet Dent.1967;18:202-210.

30. Lambrecht JR. Immediate denture construction: the impressionphase. J Prosthet Dent. 1968;19:237-245.

31. Javid N, Tanaka H, Porter M. Split-tray impression techniquefor immediate upper dentures. J Prosthet Dent. 1974;32:348-351.

32. Ettinger CW, Rayson JH, Terry JM, Rahn AO. Synopsis ofComplete Dentures. Philadelphia, PA: Lea & Febiger; 1975.

33. Firtell DN, Elahi JM, Harman LL. Impression technique for animmediate or transitional denture. Quintessence Int Dent Dig.1980;11:33-36.

34. Lucia VO, Swanson KH. Treatment of the Edentulous Patient.Chicago, IL: Quintessence Publishing; 1986.

35. Gardner LK, Parr GR, Rahn AO. Modification of immediatedenture sectional impression technique using vinylpolysiloxane. J Prosthet Dent. 1990;64:182-184.

36. Mitchel KF. Muscle-trim and tissue control in immediatedentures. Dental Digest. 1942;48: 318-320.

37. Campagna SJ. An impression technique for immediatedentures. J Prosthet Dent. 1968;20: 196-203.

38. Bolouri A. Double-custom tray procedure for immediatedentures. J Prosthet Dent. 1977;37: 344-348.

39. Wyatt CCL. Immediate dentures. In: MacEntee MI, ed. TheComplete Denture: A Clinical Pathway. Chicago, IL:Quintessence Publishing; 1999:99-107.

40. Laney WR, Gonzalez JB. The maxillary denture: its palatalrelief and posterior palatal seal. J Am Dent Assoc.1967;75:1182-1187.

41. Naylor WP, Rempala JD. The posterior palatal seal: its formsand functions. (I) Diagnosis. Quintessence Dent Technol.1986;10:417-422.

42. Lavelle WL, Zach GA. The posterior limit of extension for acomplete maxillary denture. J Acad Gen Dent. 1973;21:31.

43. Johnson GH. Impression materials. In: Craig RG, Powers JM,eds. Restorative Dental Materials. 11th ed. St Louis, MO:Mosby; 2002:330-389.

44. Rudd KD, Morrow RM, Feldmann EE. Final impression, boxingand pouring. In: Morrow RM, Rudd KD, Rhoads JE, eds.Dental Laboratory Procedures. Volume One: CompleteDentures. 2nd ed. St Louis, MO: Mosby; 1986:57-79.


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POST EXAMINATION INFORMATION

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POST EXAMINATION QUESTIONS

1. Advantages of immediate complete denturesinclude all of the following EXCEPT:a. maintenance or improvement of aesthetics.b. maintenance or improvement of masticatory function.c. maintenance or improvement of phonetics.d. eliminates post-delivery adjustments.

2. Disadvantages of immediate complete denturesinclude all of the following EXCEPT:a. With residual teeth and soft/hard tissue undercuts,

anatomically/ physiologically accurate definitive impressions are difficult.

b. Arranging denture teeth in the lab is substantially more difficult compared to conventional complete dentures.

c. If residual teeth are mobile, accurate interocclusal jaw registrations may be difficult.

d. Creating edentulous contours on dentate master casts using valid estimation techniques may involve unavoidable errors.

3. Which of the following is/are necessary forcomplete denture retention?a. Peripheral denture seal.b. Appropriate volume and consistency of saliva.c. Accurate denture fit. d. ALL of the above.

4. Which is a concern when using irreversiblehydrocolloid (alginate) impression material fordefinitive immediate denture impressions?a. Poor soft tissue detail.b. Hyper-allergenic patient response.c. Over extension of peripheral impression borders.d. Patient acceptance of the material’s taste.

5. Which is an alternative immediate dentureimpression technique described in the literature?a. Irreversible hydrocolloid impression material in a

custom impression tray.b. Irreversible hydrocolloid impression material in a stock

impression tray.c. Elastomeric impression material in a non-border-

molded stock impression tray.d. Zinc oxide impression material in a stock impression tray.

6. In the impression technique described, which VPSmaterial is preferred for border molding theimpression tray?a. Extra-low viscosity material.b. Low viscosity material.c. Medium viscosity material.d. High viscosity material.

7. In the impression technique described, whatadvantage(s) is/are suggested for using extra lowviscosity VPS material?a. Low tear strength permits easier recovery of the

polymerized impression without damaging periodontally weakened teeth.

b. The bright orange color is easily discernible when inspecting the final impression.

c. Low stiffness facilitates recovery of the definitive mastercast from the impression without damage.

d. Both a and c are correct.

8. The purpose of Valsalva’s maneuver during bordermolding is:a. Functionally forms lingual flange extensions into the

retromylohyoid space.b. Causes exaggerated physiologic movement of the

mandibular buccal frena.c. Permits reduced thickness of the maxillary labial flange

during impression making for aesthetics.d. Helps form a physiologically accurate posterior border

in the maxillary final impression.


10


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