10/25/13 INDIAN DENTAL ACADEMY: THEORIES OF IMPRESSION MAKING IN COMPLETE DENTURE TREATMENT

indiandentalacademy.blogspot.com/2013/08/theories-of-impression-making-in.html 1/15

Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and

offering a wide range of dental certified courses in different formats and courses we offer Dental Implantology, fixed

orthodontics, rotary endodontics,General dentistry. and various online dental courses having best faculty of world wide

repute

INDIAN DENTAL ACADEMY

Fixed orthodontics training online orthodontic training advanced Implant dentistry courses

Fixed orthodontics training certified orthodontic online courses Rotary Endodontic courses

Tuesday, August 20, 2013

THEORIES OF IMPRESSION MAKING IN COMPLETE DENTURETREATMENT

Theory means observation based on principles and concept is the

application of these theories. Impression forms a important virtue for the

success of compete denture treatment and hence the concepts of impression

should be properly understood. From time immemorable there have been

different theories that had been advocated. Green Brothers were the first to

introduce the principle of muco compression during impression technique.

The shortcomings of this principle gave rise to the mucostatic technique by

Hary L. Page with high regard for tissue health. But again due to the

disadvantage of this technique, there was an impetus for the introduction of

the selective pressure technique which combined the concepts of both the

previous techniques. There are various techniques adopted by different

practitioners and there may be as many techniques as the number of dentists

regarding impression which in general means negative likeness but in

prosthodontics it is the negative registration of the denture bearing denture

stabilizing, denture bracing and peripheral limiting structures obtained in one

of the plastic / semiplastic materials which is registered at the moment of

crystallization of the impression material.

At the moment of crystallization means that the tissues are registered at

a particular moment. Since the denture bearing tissues are always in a state

of flux with new cells being generated and cells being shed of at different

moment of time, the tissues at the time of impression making will differ from

that at the time of denture insertion.

It is not feasible to group all the techniques into rigid compartments but

DIFFERENT THEORIES OF IMPRESSION MAKING AND

RATIONALE FOR THE DIFFERENT TECHNIQUES IN

COMPLETE DENTURE TREATMENT

Introduction

Indiandentalacademy

ida

Follow 555

View my complete

profile

Indiandentalacadem

y

▼ 2013 (91)

▼ August (51)

INDIANDENTALACADEMY:STRUCTURE OFMATTERAND PRI...

STRUCTUREOFMATTERANDPRINCIPLES OFADHESION

INDIANDENTALACADEMY:gypsumproducts

gypsumproducts

INDIANDENTALACADEMY:solidification andmicrostr...

solidificationandmicrostructure ofmetals

INDIANDENTALACADEMY:osseointegration

osseointegration

INDIANDENTALACADEMY:gypsumproducts

gypsumproducts

INDIANDENTALACADEMY:RETRIEVE

Blog Archive

Share 1 More Next Blog» Create Blog Sign In

10/25/13 INDIAN DENTAL ACADEMY: THEORIES OF IMPRESSION MAKING IN COMPLETE DENTURE TREATMENT

indiandentalacademy.blogspot.com/2013/08/theories-of-impression-making-in.html 2/15

a broad classification is possible. They may be classified as scientific /

empheric depending on whether they are based on knowledge of anatomy.

b. They may be classified as open / closed mouth impressions depending on

the condition of the mouth at the time of impression making.

c. They may be classified as either pressure, nonpressure / minimal

pressure, and selective pressure depending on the amount of pressure

applied at the time of making impressions.

Prior to 1600 complete denture replacement were not made due to lack

of understanding of retention.

Ø In 1711, Mathian Gottfried Purman recorded the use of wax.

Ø In 1728 Pieree Fauchard made dentures measuring the mouth with

compases and cutting bone into an approximate shape for the space to be

filled.

Ø In 1736, Phillip Pfaff of Germany made impressions in wax sections of half

of the mouth at a time.

1845-1899

Ø In 1886 Richardson mentioned about making plaster impressions of tissues

at rest and achieving adhesion by contact.

· Concepts of atmospheric pressure, maximum extension of the denture

bearing area, equal distribution of pressure and close adaptation of the

denture bearing tissues were stressed.

· Many changes in impression making became evident during this era. A

single impression formely deemed sufficient, advanced to a method using

priliminary impression of guttapercha, beeswax or modelling compound

followed by secondary wash impression made of plastic within preliminary

impression.

1900 – 1929

Ø A concentrated effort was directed towards accuracy.

Most impression were of compressive type and by the closed mouth

technique. To prevent buildup of excessive pressures vents were made.

Ø In this technique the supporting tissues recorded in a functional

relationship.

Ø The movement of all related tissues were in normal functional movements

such as swallowing, talking, sucking and occlusal contacts.

Ø A pressure similar to that of mastication was developed through the occlusal

rins.

This according to Stanley P Freeman-amount of tissue compression is like that in

function.

Ø Selective pressure technique.

Ø The disadvantage of closed mouth technique is the tendency of

overextention or underextention.

Ø Release of pressure of occlusion may permit a rebound of denture.

Closed mouth technique

RETRIEVEL OFDENTURE,CORRE...

RETRIEVELOFDENTURE,CORRECTION OFOCCLUSAL DISCR...

INDIANDENTALACADEMY:castinglaws

casting laws

INDIANDENTALACADEMY:HYDROCOLLOIDS

HYDROCOLLOIDS

INDIANDENTALACADEMY:STRUCTURE OF

MATTER

INDIANDENTALACADEMY:THEORIESOFIMPRESSION MAKI...

STRUCTUREOFMATTER

INDIANDENTALACADEMY:THEORIESOFIMPRESSION MAKI...

THEORIESOFIMPRESSIONMAKING INCOMPLETEDENTURE...

CASTINGPROCEDURES

INDIANDENTALACADEMY:DIEMATERIALS ANDTECHNIQUE...

DIEMATERIALS ANDTECHNIQUE OFFABRICATION

STRUCTUREOFMATTERANDPRINCIPLES OFADHESION

Dental waxes

INDIANDENTALACADEMY:SELECTIVEGRINDINGIN

10/25/13 INDIAN DENTAL ACADEMY: THEORIES OF IMPRESSION MAKING IN COMPLETE DENTURE TREATMENT

indiandentalacademy.blogspot.com/2013/08/theories-of-impression-making-in.html 3/15

Ø It is contraindicated in the presence of considerable amount of movable

tissue.

The open mouth technique is preferred because the operator can see whether the border

molding is done properly.

The functional manipulation cannot be used routinely not all patients can truly move the

impression materials as needed, some may use extreme movements and others use.

Ø Two techniques were developed for the management of flabby ridge.

1st technique – it was of muco compressive type compound impression which

displaced the flabby tissue paratally.

2nd technique – it was advocated by Greene Brothers, which captured the

tissue in its passive form.

Ø Concepts of posterior palatal seal were developed by Liberthal and Greene.

Ø For the first time there were references to movement of tissues and the

mandible during impression making.

Ø Border molding was done against the direction of muscle fibres as

advocated by Wilson.

Ø There were others like Nichais, Neil Fish, Swenson et al who advocated

manipulation in border molding in the direction of its fibres.

Ø It was during this era that the concept of esthetics in impression making

was introduced.

Ø The muco compressive technique was initiated by Greene Brothers. They

introduced a modeling plastic, a method for manipulating it and a

technique that is said to have been the first to utilize all the denture bearing

area for denture retention.

Ø They were the first to teach the closed mouth all modeling plastic technique

called the Greene Brothers all compound impression.

Ø The main objective of this technique was to attain better retention of the

dentures.

The typical technique by Greene brothers was as follows.

· A preliminary impression was made in impression compound and a custom

tray was constructed using baseplate with its periphery 1/8th inch shorter

than the denture outline.

· With this tray another impression with compound was taken.

· Well fitting rinse with uniform occlusal surface were made and the height of

the bite adjusted against a similar bite rim on the mandibular ridge.

· Areas to be relieved like median raphe was softened on the impression and

was again inserted in the mouth and was held under biting pressure for

one / two minutes.

· The peripheral margins of the impression was then softened and border

molding was done by asking the patient to give various cheek and lip

movement as in whistling and smiling.

MUCOCOMPRESSIVE TECHNIQUE

INCOMPL...

INDIANDENTALACADEMY:Stress andforcefactors in...

Stress andforcefactors inImplants

DESIGNCONSIDERATIONS &PARTS OFIMPLANTS.

Recentadvancesin Dentalmaterials

SELECTIVEGRINDINGINCOMPLETEDENTURE

PosteriorToothPreparation-

IMPRESSIONS IN FIXEDPARTIALDENTURES

INDIANDENTALACADEMY:IMPRESSIONMATERIALS FORCO...

IMPRESSIONMATERIALS FORCOMPLETEDENTURES

BIOMECHANICS OFDENTALIMPLANTS- SEMINAR

INDIANDENTAL

ACADEMY:ALLOYSUSED INDENTISTRY

ALLOYSUSED INDENTISTRY

INDIANDENTALACADEMY:STRUCTURE OFMATTERAND PRI...

STRUCTUREOFMATTERANDPRINCIPLES OFADHESION

INDIANDENTALACADEMY:CLASSIFICATION OFRPD -SEM...

10/25/13 INDIAN DENTAL ACADEMY: THEORIES OF IMPRESSION MAKING IN COMPLETE DENTURE TREATMENT

indiandentalacademy.blogspot.com/2013/08/theories-of-impression-making-in.html 4/15

· The posterior palatal seal was obtained by swallowing movements by the

patient under biting pressure.

· The claims made by the advocates of this technique was that since border

molding was done in their functional positions, the final dentures would

retain well and cannot be dislodged during functional movements of the jaw.

· Some used the preliminary impression itself as the tray and impression to

be improved by border molding.

· Some preferred to make custom trays in a more stable and stronger

material than compound for better results.

· Relief in hard areas was obtained in number of ways. Some custom trays

were made with escape holes in areas overlying the hard tissues and close

adaptation provided in those areas covering the soft tissues.

· Some use low fusing compound by softening and adapting it to the soft

tissues.

· Some advocate unnatural movement of the mouth along with massaging of

the cheeks and lips from outside during border molding.

· Post dam is obtained in number of ways.

· The addition of soft wax like carding wax or low fusing compound for this

purpose is common.

· Scraping of cast is also used.

The amount of pressure applied to the tissues in the muco compressive

technique was not only great but was applied to the centre of the palate and

the peripheral tissues which were not well suited to receive the maximum biting

load this interferes with normal blood supply of the tissues resulting in their

breakdown.

As soon as this change took place both the peripheral seal and

excellent retention were lost. Hence the retention achieved by these means

was transient and harmful to the health of tissues.

Dentures made by this technique would fit well during mastication i.e.

only a short period each day, but would not be closely adapted to the tissue

when the patient was at rest. This is because of the rebounding of tissues.

These disadvantages indicated a need for spacer in the custom tray

fabrication.

1930-1948

· Concept of mucostatics was introduced by Harry L. Page in 1938.

· Addison in 1944 also mentioned the same principle of making impressions

of displaceable tissue in its passive state and considered interfacial

surface tension as one of the main factors of retention.

· With new materials like zincoxide eugenol, waxes, elastomers, individual

tray construction was emphasized.

Variations in this technique

Minimal pressure technique based on

CLASSIFICATION OFRPD -SEMINAR

INDIANDENTALACADEMY:DENTALWAXES -SEMINAR

DENTALWAXES -SEMINAR

certifiedorthodonticcourses

Metals inprosthodontics

INDIANDENTALACADEMY:oral microflora -seminar

oral microflora -seminar

INDIANDENTALACADEMY:Radiographs inprostheticd...

Radiographsinprostheticdentistry -seminar

► July (36)

► June (3)

► May (1)

► 2011 (1)

► 2010 (8)

Join this sitew ith Google Friend Connect

Members (3)

Already a member? Sign in

Followers

10/25/13 INDIAN DENTAL ACADEMY: THEORIES OF IMPRESSION MAKING IN COMPLETE DENTURE TREATMENT

indiandentalacademy.blogspot.com/2013/08/theories-of-impression-making-in.html 5/15

· In a Brochure published by Hary L. Page in 1946 he stated that all soft

tissues were cheifly fluid and 80% or more of the tissues are composed of

water. According to pascal’s law which states that any pressure applied to

a confined fluid is transmitted undiminished and equally in all directions.

Page contended that since the soft tissues are confined under a denture,

any pressure applied will be transmitted in all directions.

· The advocates of this principle considered interfacial surface tension as

the only important retentive mechanism in complete dentures. Therefore

they did not resist vertical displacement, which was the only movement

capable of interrupting surface tension. However, Dykins recommended a

short lingual flange to resist lateral displacement.

· According to the principle of mucostatics the impression material had to

record without distortion, every detail of the mucosa so that a completed

denture would fit all minute elevations and depressions. So much emphasis

was placed on recording details that separating substances could not be

used at any point in the procedure.

· Mucostatics further demanded a metal base. Gold, one of the most

accurate metals was bypassed in favour of chrome alloy which are not

considered to be quite so accurate as gold.

A typical impression method representing this technique was as

follows.

· A compound impression was made in a suitable tray and a cast was made.

· On this base plate wax was adapted which acted as a spacer according to

denture outline.

· Custom tray was fabricated over this spacer.

· A soft ribbon of carding wax was applied at the posterior margin of the

maxillary tray and it was placed in the mouth under light pressure and

patient was asked to do swallowing movements inorder to obtain a posterior

palatal seal.

· A small amount of impression plaster mixed into a smooth consistently was

placed in the tray, introduced in the mouth and was slowly raised to

position and held with as little pressure as possible.

· No border molding was advocated but the soft plaster was expected to mold

itself to the relaxed vestibular tissues.

· The impression was held till the impression hardened and was then

removed.

· Some techniques use compound instead of wax for obtaining post dam.

· Some techniques advocate post dam over the final impression.

· Zinc oxide eugenol and alginate had also been used for similar results.

· Page’s application of Pascal’s law to the field of denture impressions is

only partly correct because the tissues involved are not wholly

incompressible and fluids may escape through the borders of the denture.

mucostatic principle

Variations in the technique

10/25/13 INDIAN DENTAL ACADEMY: THEORIES OF IMPRESSION MAKING IN COMPLETE DENTURE TREATMENT

indiandentalacademy.blogspot.com/2013/08/theories-of-impression-making-in.html 6/15

· Page’s claim that retention is a function of surface tension alone is also

objectionable because this tensile force itself is dependent upon adhesion

and cohesion.

· The elimination of use of separating media results in distortion of the cast.

· The use of chrome cobalt as denture bases results in failure of accurate

detail reproduction.

· The mucostatic principle ignores the value of dissipating masticatory forces

over as largest possible basal seat area. Further the mucostatic denture

minimized the retentive role of the musculature as described by Fish in

1948.

The merit of this technique was its high regard for health and

preservation of tissue.

1948 – 1964

· There was an increased emphasis on biologic factors of complete denture

impression making.

· Selective pressure concept by Boucher became popular.

· Craddock, Landa et al advocated use of escape vents.

· More attention was given to esthetics in the impression techniques used

greater emphasis was on flanges, border molding, posterior palatal seal

and denture extension.

· In 1948, the mucoseal technique – a variation of the mucostatic technique

was introduced.

· Vacustatics concept was developed by Milo V. Kubalib and C. Buffington to

eliminate the functional limitations of impressions.

Selective pressure technique based on selective pressure theory

· Advocated by Boucher in 1950 it combines the principles of both pressure

and minimal pressure techniques.

· The philosophy of the selective pressure technique is that certain areas of

the maxilla and mandible are by nature better adapted for withstanding

extra loads from the forces of mastication. These tissues are recorded

under slight placement of pressure while other tissues are recorded at rest

or relieved with minimal pressure in a position that will offer maximum

coverage with the least possible interference with the health of surrounding

tissues.

· Here an equillibrium between the resilient and the non resilient tissues is

created.

Primary stress bearing areas of maxilla are crest of alveolar ridge and

the horizontal plate of palatine bone and in the mandible it is the buccal shelf

area.

Secondary stress bearing areas of the maxillary foundation are rughae area and the slopes

of the ridge in the mandibular foundation.

Areas requiring minimum pressure are incisive papilla, midpalatine

suture, tori in the maxilla and crest of mandibular residual ridge.

10/25/13 INDIAN DENTAL ACADEMY: THEORIES OF IMPRESSION MAKING IN COMPLETE DENTURE TREATMENT

indiandentalacademy.blogspot.com/2013/08/theories-of-impression-making-in.html 7/15

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. This tissue can be more readily displaced for

the maintenance of peripheral seal of the maxillary denture.

Ø A well fitting tray with a uniform clearance of about 5mm was selected and a

compound impression was obtained with little border molding done on the

peripheries.

Ø This compound impression was separated from the metal tray and its

peripheral borders were trimmed 1 – 2 mm short.

Ø The base portion of the impression was then scrapped evenly to a depth of

about 2mm except in the posterior seal area where no scraping was done.

Ø A sufficient amount of creamy mix of plaster was spread over this

impression and was placed in the mouth with little pressure.

The cheeks and lips were lightly patted from outside while the plaster

was still soft. This procedure gave sufficient value like seal without exaggerated

pressure on soft tissues.

Ø Most of the techniques prefer taking a preliminary impression and using a

custom tray rather than use the initial compound impression for further

improvement.

Ø The preliminary impressions are usually taken in compound but materials

like alginate, elastomeric impression materials are also used.

Ø Certain methods advocate the use of three small compound stops in the

base area of special tray before doing border molding. This prevents the

periphery of the tray from impinging on the tissues and it standardizes the

relation of the tray to limiting tissues for every insertion of tray.

Ø The amount of material, consistency of material, use of space or escape

vents and the manual pressure with which the impression is made are all

possible variable which have been used to advantage by different

techniques.

The mucoseal technique was stated by Pryor in 1948 which was introduced as a variation to the

mucostatic technique.

· The anterior lingual border is molded by the floor of the mouth with the

tongue in repose.

· The tray is extended horizontally backward, over the sublingual glands

towards the tongue to effect a border seal.

· Thus this technique utilizes the benefit of minimal pressure and also

provides maximum extension of denture borders and maximum coverage of

denture bearing area.

Ø Milo V. Kubalik and Bert C. Buffington developed this technique the

An earlier technique representing this groupconsisted of the following steps:

Variations in the technique

Sub-atmospheric pressure technique basedon the concept of mucostatics

10/25/13 INDIAN DENTAL ACADEMY: THEORIES OF IMPRESSION MAKING IN COMPLETE DENTURE TREATMENT

indiandentalacademy.blogspot.com/2013/08/theories-of-impression-making-in.html 8/15

objective of which was to reduce the stress on any given tissue by

increasing load bearing area. the form of the tissue is recorded vertically

and laterally, when a controlled partial vacuum is established in impression

tray specially built for the patient. It is maintained in the mouth without

direct mechanical support of any kind. The difference between the

subatmospheric pressure within the tray and the atmospheric pressure

outside the tray is all that is needed to centre 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.

1. Alginate, modeling plastic or a reversible hydrocolloid for preliminary

impression.

2. Clear acrylic resin for making the final impression.

3. An adequate sealing agent for use around special fittings in the tray.

4. Thermoplastic border recording impression material.

5. A fluid (low viscosity) impression material that seats firmly enough to

avoid distortion.

6. A periphery wax to be used as a flexible material between impression

and the boxing wax.

1. To suck on the tube (this pulls the cheeks in a starts border molding).

2. To say “00000” and EEEE alternately (This refines the border molding

of the buccal and labial flanges and provides space for the frenum.

3. To blow against closed nostril (This flexes the soft palate and molds the

posterior palatal seal area. Wipes of any excess adapted extending

beyond the border of the tray.

4. To move the mandible from side to side (This molds the flanges lateral

to the tuberosities.

5. To swallow warm water (This allows for swallowing movements in the

shape of the posterior palatal seal.

6. To open and close the mouth (This records the shape and action of the

paramusculature used in extreme opening and closing movements.

1. To suck on the tube (This flexes the labial, buccal and lingual vestibular

structures and mold the flanges in these regions).

2. To force the tip of the tongue against the palate (This forcibly molds the

flange in the sublingual space with the paralingual musculature.

3. To say “0000” and “EEEE” alternatively (This further molds the buccal

and labial flanges)

4. To lick the upper and lower lip (This molds the flanges in the lingual

Materials used

Molding ExercisesFor the maxillary impression the patient is told

For mandibular impression the patient isinstructed

10/25/13 INDIAN DENTAL ACADEMY: THEORIES OF IMPRESSION MAKING IN COMPLETE DENTURE TREATMENT

indiandentalacademy.blogspot.com/2013/08/theories-of-impression-making-in.html 9/15

space in the region of Wharton’s ducts and genioglossus muscle.

5. To place the tongue in the right cheek and left cheek (This further

molds the flange in the sublingual fold space).

6. To swallow warm water (This molds the posterolingual flange in relation

to the palatoglossus and mylohyoid musculature).

7. To tense and flex the lower jaw as if clenching one’s teeth (This molds

the buccal flange from the external oblique ridge to the retromolar pad.

1965 – 1982

Ø New techniques had been developed to manage compromised conditions.

For poor mandibular ridges – Sublingual flange technique by Tyrde and Robert Flange technique

by Lott and Levin.

For hyperplastic alveolar ridges by Zafarulla Khan, William H. Filler.

Flange technique by Lott and Levin introduced in 1966 involves making

impressions of soft tissues of mouth adjacent to the buccal, lingual, labial,

palatal surface and incorporating the resulting extensions or flange in the

denture. Flange wax was rolled from the retromolar pad area to the sublingual

region, large enough to restore the diameter of estimated resorption and

patient is asked to forcefully perform functions of swallowing etc to give border

extensions which covers maximum surface area (genial tubercles and

sublingual gland).

Tyrde in 1965 used the dynamic impression method on the same

principle to obtain sublingual flange.

Roberto Von Krameck et al in 1982 used modeling compound to record

the extensions. This sublingual flange extension increases the tissue surface

without interfering the functions of mastication, deglutition and phonation. The

active incorporation of tongue activity also stabilizes the denture.

Impression technique for patients with unsupported movable tissue (Hyperplastic or flabby tissue):William H. Filler described a technique using two trays.

a. Preliminary maxillary and mandibular impressions were made in stock

trays with alginate impression method and casts were poured.

b. The maxillary and mandibular casts were placed on the surveyor and all

the tissue undercuts were blocked out with utility wax.

c. A single thickness of baseplate wax was formed over the casts to form a

spacer. The spacer is terminated short of the posterior palatal seal area so

that the tray material would contact the tissue in this area.

d. A tinfoil sustitute was applied to the casts and the first of the two trays was

made in autopolymerizing acrylic resin. Most of the basal surface of the

tray was removed except for the lattice work of acrylic resin which

strengthens the trays.

e. The maxillary and mandibular trays are then keyed to orientate the second

tray in atleast three places. These keyed positions correspond with an

extension of the second tray and will insure proper seating of the second

tray over the first tray.

Impression techniques for severely resorbedfoundation

10/25/13 INDIAN DENTAL ACADEMY: THEORIES OF IMPRESSION MAKING IN COMPLETE DENTURE TREATMENT

indiandentalacademy.blogspot.com/2013/08/theories-of-impression-making-in.html 10/15

f. The entire first tray was covered with a single thickness of baseplate wax,

ensuring that the keyed positions here kept free of wax. Both the first resin

tray and the casts were painted with tin foil substitute.

g. The second trays were made in the same manner as the first and extend

past the relieved area of maxillary and mandibular trays and fit into keyed

positions.

h. With round bur, numerous holes were made in the second tray.

i. The deepest portion of the vault of maxillary tray was removed to create a

stop when the final impression was made. The initial tray was sealed with

minimum pressure and autopolymerizing resin on a tongue depressor was

gently placed in the opening in the vault. When the resin had set a stop

was created on the firm and stable palatal tissue.

Clinical impression procedure

Ø The borders of the maxillary tray are formed by adding low fusing

compound and border molding it. A finger placed over the resin stop will

ensure a stable tray. The basal plate was removed and the flanges reduced

1-2mm with the exception of the part over the tuberosites and posterior

palatal seal area of the maxillary tray.

Ø The mandibular tray was stabilized by the addition of modeling plastic on the

buccal flanges in the region of first and second molars and in the anterior

part of the tray in the incisor area. The mandibular tray was border molded

and baseplate wax was removed from the mandibular tray every where

except at the three points used for stabilization.

Ø Both the trays were painted with permlastic adhesive. Light body permlastic

was used in initial tray as a corrective wash impression material. After it set

the tray was removed from the mouth and all excess material was trimmed

from the borders and from the area where the second tray would come into

contact with the first tray to key themselves.

Ø The second impression was made with plastogum used in corrective wash

impression and plastogum was painted over the entire vault and all available

tissue surface not included in the first impression. The second tray was

filled with plastogum and gently vibrated into place until keyed parts of the

tray were in contact. The two trays were held lightly together until the

impression material set and then the impression was removed as a unit and

the two trays were sealed together with sticky wax.

Zafarulla Khan described a technique where a window was cut in the

custom tray where the unsupported area was present. The unsupported area

was recorded with impression plaster and the remaining area was recorded

with perrmlastic impression material.

a. Hobrick described a technique where only a single custom tray was used.

Border molding was done in the usual manner and impression was made

with heavy bodied addition silicone. The area of movable tissue was cut out

and relief holes were made and wash impression was made with light

bodied impression material.

b. Joh D. Watter recorded the healthy denture bearing tissue with ZnoE and

the displaced tissue with impression plaster.

Other techniques used in case of flabbytissues

10/25/13 INDIAN DENTAL ACADEMY: THEORIES OF IMPRESSION MAKING IN COMPLETE DENTURE TREATMENT

indiandentalacademy.blogspot.com/2013/08/theories-of-impression-making-in.html 11/15

c. Split method by Allan Mack is useful if tissues are exceptionally flabby. A

loosely fitting tray made with heavy relief over the flabby areas was taken.

Plaster was mixed and applied over the flabby area to a thickness of about

3mm and was allowed to set tray was filled with 2nd mix of plaster and the

impression was made with the initial coating of flabby areas thus acting as

a splint while the impression was made and being removed.

a. Modified Fournet Tuller technique by Allan Mack also utilizes the principle

of achieving maximum peripheral seal together with minimal pressure on

the crest of the ridge to obtain retention and stability.

b. Winkler described a technique which used tissue conditions and over

extended primary impression of alginate was made. Occlusal wax rims

were constructed and the borders were adjusted so that the lingual flange

and sublingual crescent area were in harmony with the resting and active

phases of the floor of the mouth by as open and closed mouth technique 3

applications of conditioning material were used – each application for

approximately 8-10 minutes. The third and final wash was made with light

bodied material. The technique resulted in an impression that had tissue

placing effect with relatively thick buccal lingual and sublingual crescent

area.

Miller used mouth temperature waxes instead of tissue conditioners.

Klein proposed the development of impression without a tray, as a stock tray

may cause some distortion of the tissue and may result in a over extended

impression. He used a moldable material (putty silicone) reinforced by an

internal metallic core which was placed over the residual ridge and the borders

molded by speech exercises. A low viscosity material was placed on the

impression surface of this tray and functional impression was made.

Walter described a technique with the use of sectional stock trays.

Impressions of each side of the jaw was made on at a time and two holes were

joined and cast was poured.

The recording of denture borders may be done by either hand

manipulation and functional movement.

The contour of the denture borders may be obtained by the dentist with

the use of manipulation of lips and cheeks within functional limits. Patients

tongue movements record the lingual borders.

The denture borders are also formed by having the patient make functional or physiological

movement such as swallowing sucking, grinning, licking etc.

Tench’s neuromuscular concept values the functions of sucking and

swallowing while making the impression to bring the denture base into

harmony with the physiological behaviour of the muscles. Forming an

impression by neuromuscular concept develops a completely passive contact

of all impression borders to the basal seat tissues, passively fills all marginal

spaces and develops basal seat area coverage that is compatible with

Other techniques used for poor foundation

Impression technique for restricted access tothe mouth

Hand manipulation

Functional movements

10/25/13 INDIAN DENTAL ACADEMY: THEORIES OF IMPRESSION MAKING IN COMPLETE DENTURE TREATMENT

indiandentalacademy.blogspot.com/2013/08/theories-of-impression-making-in.html 12/15

function.

Barone states that normal or natural movements will provide better borders than by manipulation.

The only truly functional or physiological method of making impressions is the so called dynamic

impression. In this technique the basal seat and borders are obtained with the use of impression

materials that continue to flow over an extended period of time such as tissue conditioning

materials or wax. This material is placed in the patients transitional denture and the patients

normal activities mold the borders over a period of time.

Functional reline rebase technique is based on the same principle.

Clinical procedure in selective pressure technique:

1. Preliminary examination and conditioning of the patient.

2. Seating the patient:

i. Patient should be in a upright position and relaxed.

ii. The jaw should be at the level of the operator’s elbow for maxillary

and at the level of operator’s shoulder for mandibular impression.

3. The hands should be washed in the view field of the patient even though

they may have been previously washed.

4. The tray should be selected from the stock trays which should be kept

ready sterilized while inserting the tray in the patient’s mouth using a

rotatory movement. There should be an equal clearance of 6-8 mms.

Between the tray and the tissues all round.

5. Operator’s position:

i. Right back side of the patient for upper impression.

ii. Right side front of the patient for lower impression.

The selected tray should cover the entire denture bearing area. Check

the tuberosity area in the maxillary and lingual pouch in the mandibular

foundation.

6. Compound is softened in chotwater.

i. A large bowl should be used.

The compound is kneaded thoroughly to soften it uniformly. In case

maxillary impression the compound is molded to a rounded form, placed in the

centre of the tray and thoroughly spread over the surface of the tray.

In case of mandibular impression the compound is formed into a rope

form and spread over the surface of the tray.

In case of maxillary impression, the tray is centered slightly anterior to the final position assumed

by the tray when it is correctly seated. It is then moved upward and backward direction. The

compound is manipulated by index finger into the deep buccal sulcus area. In case of mandibular

impression the tray is centered exactly over the ridge and seated straight down. With the index

finger the compound should be manipulated into the deep lingual pouch.

Ø Simulation of the tissue should then be done.

Ø The compound is allowed to harden and withdrawn from the mouth.

Ø The impression is chilled in cold water and examined thoroughly. It is

examined for completeness border tissue functions, distortion and gross

physical defects.

Materials used:

a. Low fusing impression compound sticks – Advocated by Boucher.

Discussion

In the mucostatic principle

10/25/13 INDIAN DENTAL ACADEMY: THEORIES OF IMPRESSION MAKING IN COMPLETE DENTURE TREATMENT

indiandentalacademy.blogspot.com/2013/08/theories-of-impression-making-in.html 13/15

b. Autopolymerizing acrylic resins

Advocated by Jones – not used due to the heat of polymerization and monomer irritant.

c. Tissue conditioning materials (modified resins)

Chare has described the use of one such tissue conditioning material.

They are effective when used correctly. They set slowly and continue to flow

under pressure at a rate inversely proportional to time becoming stiffer but

never losing resiliency.

d. Metallic pastes and elastomeric materials.

Ideally body elastomeric impression material is used. Smith Dale E has

advocated one technique where the border molding is done in one step with

polyether impression material.

e. Impression waxes

Use of impression wax adapted for border molding was reported by

Knapl. But these waxes distort easily.

f. Perio pack : Kerk and Idolt has described one step border molding with the

use of periopack.

The diagnostic cast is made of dental plaster. The form of the custom

tray helps us to make impression based on specified theory. The areas to be

retrieved on the casts and undercut areas are marked and blocked with wax.

Care must be taken while providing relief, as excessive relief causes flabby

tissue formation. The custom tray must be 2mm less than the denture outline

except in the posterior palatal seal and retromolar pad area. The peripheries of

the tray should not be sharp / rough.

The custom trays are checked in the mouth. The tray should cover the

entire denture bearing area. If the tray is underextended, compound should be

added wherever necessary. If the tray is overextended the tray should be

trimmed where required. The tray is also checked for retention and stability.

Border molding is done quadrant by quadrant (By hand manipulation)

within the functional limits of tolerance.

Border molding:

The shaping of the border areas of an impression tray by functional or manual manipulation of the

tissue adjacent to the borders to duplicate the contour and size of the vestibule.

Glossary of prosthodontic lesions 7th edition.

Ø The anterior limit of posterior palatine seal area is marked using T –

burnisher. The line of minimal function is marked by asking the patient to

tell Ah.

Ø The low fusing impression compound is softened and placed in this area the

tray is seated in the mouth to obtain posterior palatine seal.

Ø The tray is then checked for completed border molding. It should have same

appearance as the finished denture. The tray is reinserted and border seal

and retention and stability are checked.

a. Impression plaster (Rarely used).

b. Zinc oxide eugenol paste – 2mm.

c. Irreversible and reversible hydrocolloids – 6mm

The different material used for final impression are

10/25/13 INDIAN DENTAL ACADEMY: THEORIES OF IMPRESSION MAKING IN COMPLETE DENTURE TREATMENT

indiandentalacademy.blogspot.com/2013/08/theories-of-impression-making-in.html 14/15

Posted by Indiandentalacademy ida at 2:33 PM

Labels: academy, B.DS, courses, DENTAL EDUCATION, dental implants, f ixed orthodontics, orthodontics, training

d. Elastomeric impression materials – 4mm, 2mm.

e. Mouth temperature waxes –

f. Soft acrylic resins (functional impression) – 1-2mm

The relief wax spacer is removed. If zinc oxide eugenol paste is used, it should be mixed fairly stiff

and a ribbon of even thickness of paste should be applied to the tray. The tray is quickly inserted

and sealed in the correct position and border molding is carried out by gently simulating tissue

function in those areas.

ConclusionAlthough there are many techniques with varied logic, the success of the prosthodontics treatment

depends on the clinical diagnostic alumen, understanding of the theories of impression making and

its application by the operator.

References1. Boucher : Prosthodontic treatment for edentulous patients.

2. Boucher C.O. : A critical analysis of mid century impression technique for full dentures. J.

Prosthet. Dent., 1 : 472-491.

3. Ellinger Charles W. “Synopsis of complete denture.

4. Edgar N. Starke : Historical review of complete denture impression materials. JADA, 91 : 1037-

1041.

5. Filler W. H. : Modified impression technique for hyperplastic alveolar ridges. J. Prosthet. Dent.,

25 : 609-612, 1971.

6. Glossary of Prosthodontics. J. Prosthet. Dent., Edition 7th, 81 : 48-110, 1999.

7. Heartwell Charles M. : Syllabus of complete dentures.

8. Luin Bernard : Impressions for complete dentures.

9. Lott F. and Luin B. : Flange technique : An anatomic and physiologic approach to increase

retention, function, comfort and appearance of dentures”. J. Prosthet. Dent., 13 : 394-413,

1966.

10. Milo V. Kubalek and Bert C. Bufington : Impressions by the use of substathmospheric

pressure. J. Prosthet. Dent., 16 : 213-223, 1966.

11. Page H.H. : Mucostatics, A principle not a technique by Harry L. Page, Chicago, 1946.

12. Portar C.G. : Mucostatics – A panaua or propagan. J. Prosthet. Dent., 3 : 464-466.

13. Sharry J.J. :Complete denture prosthodontics.

14. Tyrde G.K. : Dynamic impression method. J. Prosthet. Dent., 15 : 1023-1034, 1965.

15. Udani T.M. : Critical analysis of complete denture impression procedures (unpublished article).

16. Victor O. Lucia : Mucostatics, text book of treatment of edentulous patients. 17-21.

+1 Recommend this on Google

10/25/13 INDIAN DENTAL ACADEMY: THEORIES OF IMPRESSION MAKING IN COMPLETE DENTURE TREATMENT

indiandentalacademy.blogspot.com/2013/08/theories-of-impression-making-in.html 15/15

Newer Post Older Post

No comments yet

Add a comment

Home

Subscribe to: Post Comments (Atom)

Simple template. Powered by Blogger.