Impression Making in

Removable
Prosthodontics
Introduction

• Dentists must understand the maxillary and mandibular tissues as they relate to maintaining support,
stability, and retention of the dentures.

• Dentures contact mucosa with a continuum of compressibility and movement that varies between each
arch, among areas within the arch, and among patients.

• Contact and extension of the static intaglio and cameo surfaces of the dentures is a composite of the
adjacent tissues at rest and in function.

• Short-term and long-term health of the contacting tissues is influenced by the methods used to capture
these tissues and the final adaptation of the denture bases in function.
 Terminologies (GPT-9)

• 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.

• Impression Material:
any substance or combination of substances used for making an impression or negative
reproduction

• Impression Tray:
a receptacle into which suitable impression material is placed to make a negative likeness
OR
a device that is used to carry, confine, and control impression material while making an
impression
 Terminologies (GPT-9)

• Preliminary impression:
a negative likeness made for the purpose of diagnosis, treatment planning, and/or the fabrication
of a custom impression tray

• Final impression:
the impression that represents the completion of the registration of the surface or object

• Anatomic Landmark:
a recognizable anatomic structure used as a point of reference

• Cast:
a life-size likeness of some desired form; it is formed from a material poured into a matrix or
impression or from a CAM printed replica
• Before the 18th century- Blocks of ivory & bone were

used.

• During 18th century – Bees Wax

• 1848 - Colburn & Blake – Gutta percha

• 1844 - Wescott, Dwinelle & Dunning – Plaster of Paris HISTORY

• 1925 - Alphous Poller – 1st suggested use of agar

• 1930’s - Ward and Kelly - first used ZOE for impressions.

• 1938 - Muco statistics

• 1944 – Boucher - Selective pressure

• 1950 - Elastomeric impression materials.

CLASSIFICATION:
BASED ON THE TRAY USED:

1. Stock tray
- perforated tray
- non perforated tray

2. Custom tray

This Photo by Unknown Author is licensed under CC BY

• BASED ON THE TYPE OF MATERIAL:

1. Reversible and irreversible hydrocolloid impression

material
2. Thermoplastic impression material
3. Impression plaster – type 1 gypsym product
4. Zinc oxide eugenol
5. Silicone impression materials
6. Impression waxes or fluid waxes
7. Activated resins
• Based On The Pressure Applied:

1. Positive Pressure
2. Negative Pressure
3. Selective Pressure
4. Non-Pressure

• Based on the theories of impression making:

1. Mucostatic impression technique
2. Minimal Pressure impression technique
3. Mucocompressive impression technique
4. Selective pressure impression technique
• Based on the method used:
- open mouth technique
- closed mouth technique

• Based on the method of manipulation:

- Hand manipulation technique
- Functional /dynamic impression technique
 Muco-compressive

• Advocates of this technique often employed closed mouth procedures.

• A pressure impression is one in which the impression material and tray that supports it are less displaceable than
the tissue.

• The operator applies force in seating the impression tray and/or asks the patient to close his mouth with force
while the impression material sets.
• Pressure technique produce final casts in which the tissue has been displaced significantly more than with a non
pressure technique.
• It claims to record tissue in their functional form to achieve stability in occlusal function.
 Disadvantages of Muco-compresive technique

• The displaced soft tissues tend to rebound upon the denture base when the patient is at
rest, providing a constant dislodging force.

• The increased pressure causes tissue compression beyond its biologic tolerance, resulting
tissue irritation and potentially increased bone resorption.
 Muco-Static Impression

• It was introduced by Page.

• Primary objective: Make the impression without displacing the tissues, therefore capturing them in their
most undisturbed state.

• An impression material with low viscosity and high flow capabilities is selected and a minimal amount of
pressure is used in seating and holding the impression tray.

• These technique is advocated for two reasons:

1. Dentures are under pressure from occlusal load only a relatively small amount of time

2. It has been suggested that retention and stability of the dentures will be increased.
Disregarding all other retention factors the Mucostatic principle credits
interfacial surface tension as being the only retentive means of
importance.

It sacrifices the concepts of maximum ridge coverage and border seal.

 Minimal pressure theory is a
compromise between the Muco-
compressive and Mucostatic
theory.
Minimal
Pressure It advocates application of minimal
possible pressure which is
supposed to be little more than
the weight of free flowing material
Selective pressure (advocated by Boucher)

In this technique the dentist can decide which denture bearing tissues to make impression of
with more or less tissue displacement.

It combines the principle of both pressure and non pressure procedures.

The non stress bearing areas are recorded with the least amount of pressure and selective
pressure is applied to the areas that are capable of withstanding the forces of occlusion.

The purpose is to best utilize the patient’s particular anatomy and tissue tone to achieve
maximum stability and retention.
Selective Pressure can be
achieved by:

1. Scraping the primary

impression in
selected areas

2. By fabrication of a
custom tray with a
proper spacer design
and escape relief.
IMPRESSION
MATERIALS
 Characteristics of Impression Materials
• Dimensional accuracy: how closely the impression material reproduces the details of
the patient’s mouth.

• Dimensional stability: how long the material maintain accuracy after an impression is
made.

• Hydrophilic properties: the ability to tolerate moisture and produce an accurate

impression.

• Wettability: how well the material flows into small areas. More wettability means that the
material displaces moisture well and results in fewer voids in the impression.
• Elastic recovery: ability to resist distortion once set and removed from the patient’s mouth. In other
words, the material should return to the original dimensions.

• Flexibility: ease of removal from the mouth after setting. If the material is stiff, it is considered less
flexible and cannot be used in areas with undercuts

• Ease of handling: Features that affect ease of handling include viscosity and the working time/set
time ratio.

• Tear strength: likelihood of tearing when removed from the patient’s mouth.

• Contact angle: It affects how easily the material reproduces detail. The lower the contact angle,
the less technique sensitive the impression material is.
 Plaster

Compound
Non-elastic
Waxes

ZnO - Eugenol

Impression
Materials Agar (reversible)
Aqueous
Hydrocolloids
Alginate (irreversible)

Elastic
Polysulfide
Condensation
Non-aqueous
Silicones
Elastomers
Addition
Polyether
Impression Materials
Selection of
Impression
Materials
Based on Soft Tissue Condition
1) Where the soft tissues are hard:
• Primary:
• a resistant material (modelling compound)
• Final:
• acrylic custom tray,
• medium fusing compound

2) Where the tissue is of average resiliency and tissue placement is desirable:

• Primary:
• modelling compound
• Final:
• Custom tray
• zinc oxide eugenol paste or a similar material of average resistance.
3) Where the tissues are readily movable:
• Primary:
• a freely flowing irreversible hydrocolloid or some similar non resistant material.
• Final:
• Perforated acrylic tray using
• zinc oxide and eugenol paste

4. Where the tissues are extremely hypertrophied

• Primary:
• soft free-flowing alginate

• Final:
• perforated tray
• freely flowing alginate or a thin mix of plaster of Paris.
Based on Ridge Shape
• V-shaped Ridge: • Sharp Knife Edge:
• Primary: Modelling Compound • Non Pressure Impression
• Secondary: Zinc Oxide Eugenol with Perforated
tray
BASED ON PALATE
SHAPE

NOTE:

All Except U-Shaped palate require

additional retention by increasing the ridge
and borders seal
 Types of Seals
1. A soft tissue seal exists when the denture base has
an equalized intimate contact with the palatal area and
the crest, labial, and buccal sides of the ridge. It is a
basal seat seal.

2. A ridge seal exists when the denture base is sealed

to the labial and buccal sides of the ridge at the borders
and along the posterior border of the denture.

3. A border seal exists when the denture border

completely fills the muco-buccal space and buccal
pouch, and seats itself against the cheeks
Based on Muco-
buccal Fold
• If Mucobuccal fold is close to the ridge:
• The flange will not be sufficiently
extended
• Therefore we must obtain as much
extension as possible
• Seal must be adequate for lateral
retention
• Zinc Oxide Eugenol is the material of
choice
Based on Size of Denture Bearing Area

Only Type I Throat forms are ideal.

The remaining type II and III require

additional ridge and border seal
OBJECTIVES OF IMPRESSION MAKING
• The objectives of an impression are to provide retention, support, stability, esthetics and preservation of the
ridge for the denture.

• An impression also will act as a foundation for improved appearance of the lips and, at the same time, should
maintain the health of the oral tissues.

• The impression should record all the potential denture- bearing surfaces available.

• An impression should record the depth and the width, otherwise the denture will lack retention.

• Impression techniques, methods, and materials vary and should be selected on the basis of biological factors
PRINCIPALS OF IMPRESSION MAKING
1. The tissues of the mouth must be healthy.

2. The impression should extend to include all of the basal seat within the limits of the functions of the
supporting and limiting tissues.

3. The border must be in harmony with the anatomical and physiological limitations of the oral structures.

5. Proper space for the selected impression material should be provided within the impression tray.
PRINCIPALS OF IMPRESSION MAKING cntd

5. The impression must be removed from the mouth without damage to the mucous membrane of the residual ridges.

6. A guiding mechanism should be provided for correct positioning of the impression tray in the mouth.

7. The tray and the impression material should be made of dimensionally stable materials.

8. The external shape of the impression must be similar to the external form of the complete denture.
IMPRESSION MAKING
MAXILLARY
IMPRESSIONS
 ANATOMY OF MAXILLA

1° firm tuberosities and hard palate on either side of palatal raphe

2° alveolar ridge and rugae

 RESIDUAL ALVEOLAR RIDGE

• The crest of the edentulous ridge is an important area of support.

• However, the bone is subject to resorption, which limits its potential for support, unlike the palate, which is resistant to
resorption.

• Because of this, the ridge crest should be looked on as a secondary supporting area, rather than a primary supporting
area.

• The inclined facial surface of the maxillary ridge provides little support, although the peripheral tissues should be
contacted to provide a border seal.

• The submucosal layer is sufficiently thick to provide adequate resiliency to support the denture.
Incisive Foramen
• It is located beneath the incisive papilla, which is situated on a line immediately
behind and between the central incisors.

• It lies nearer to the crest of the ridge as resorption progresses.

• The location of the incisive papilla gives an indication as to the amount of

resorption that has taken place.

• The nasopalatine nerves and blood vessels pass through the foramen, and relief
should be provided so that the denture base does not impinge on them.
MAXILLARY TUBEROSITY

• Primary Stress Bearing area

• The tuberosity region can hang down abnormally low when the maxillary posterior
teeth are retained after the mandibular molars have been extracted and not replaced.
 TORUS PALITINUS

• The torus palatinus is a hard-bony enlargement that occurs in the

midline of the palate in about 20% of the population.

• It is covered by a thin layer of mucous membrane that is easily

traumatized by the denture base unless a relief is provided.

• This relief should conform accurately to the shape of the torus

because an extensive arbitrary relief robs the denture of part of its
support area.
ANATOMY OF PERIPHERAL
OR LIMITING STRUCTURES
OF MAXILLA
 LABIAL FRENUM

• It is a fold of mucous membrane at the median line.

• It divides the labial vestibule into a left and right labial vestibule

• It contains no muscle and has no action of its own.

• It starts superiorly in a fan shape and converges as it descends to its terminal

attachment on the labial side of the ridge.

• The labial notch in the labial flange of the denture must be just wide enough and just
deep enough to allow the frenum to pass through it without manipulation of the lip.
LABIAL VESTIBULE

• The tone of the orbicularis oris muscle

depends on the support it receives from the
labial flange and the position of the teeth.

• The orbicularis oris has only an indirect

effect on the extent of an impression and
hence on the denture base because the fibres
run in a horizontal direction.
BUCCAL FRENUM

• It forms the dividing line between the labial and buccal vestibules.

• It is sometimes a single fold of mucous membrane, sometimes double, and, in

some mouths, broad and fan shaped.

• The Levator anguli oris muscle attaches beneath the frenum and consequently
affects the position of the frenum.

• The orbicularis oris pulls it forward, and the buccinator pulls it backward.

• Thus it requires more clearance for its action than the labial frenum does
BUCCAL VESTIBULE

• The size of the buccal vestibule varies with the:

1. Contraction of the buccinator muscle
2. Position of the mandible
3. Amount of bone lost from the maxilla.

• The size and shape of the distal end of the buccal flange of the
denture is affected by:
1. Ramus
2. Coronoid process
3. Masseter muscle.
BUCCAL VESTIBULE

• The buccal vestibule is reduced when:

1. mandible opens or moves to the opposite side (coronoid process )

2. masseter muscle contracts under heavy closing pressures

• The root of the zygoma lies distal to the buccal frenum, opposite the first molar region. It may require
relief due to resorption of the ridge.

• The distal limit of the buccal vestibule is formed by the hamular notch (between the tuberosity and the
hamulus of the medial pterygoid)

• It can be safely displaced by the posterior palatal border of the denture to help achieve a posterior palatal
seal.
• The vibrating line is an imaginary line drawn across the palate that marks the
beginning of motion in the soft palate when an individual says “ah.”

• It extends from one hamular notch to the other.

VIBRATING LINE
• At the midline, it usually passes about 2 mm in front of the fovea palatinae. (can
vary)

• Fovea palatinae are indentations near the midline of the palate formed by a
coalescence of several mucous gland ducts.

• The vibrating line is not the junction of the hard and soft palate and is always on
the soft palate.

• The distal end of the denture should extend at least to the vibrating line. Ideally
ending 1 to 2 mm posterior to it

• It is not a well-defined line and should be described as an area rather than a line.
Preliminary Impression
• Stock trays used may be either :
1. Metal or plastic
2. Perforated or unperforated.

• Even a correctly selected stock tray will not fit the

denture-bearing area perfectly.

• Due to this we should select an impression material

that has a relatively high viscosity eg:
1. alginate (irreversible hydrocolloid),
2. silicone putty
3. impression compound
 SILICONE PUTTY
• Silicone putty impression material has a high viscosity.

• It will flow beyond the tray to compensate for underextension of the stock tray, and
once set, it will support itself in this position.

• It exhibits some degree of elasticity and can record undercuts

• High viscosity means that it records surface detail poorly

• It cannot be added to if part of the impression is deficient.

• Requires tray adhesive

ALGINATE
• It records details accurately if they are properly controlled

• They lose moisture rapidly and can consequently change

their size

• The weight of stone of the cast may distort the borders of

the impression,

• Requires a perforated stock tray

 IMPRESSION COMPOUND
• It is a thermoplastic material with a high viscosity.

• The material will flow beyond the tray to compensate for underextension
and will support itself in this position once it is chilled.

• Additions can be made to it if part of the impression is deficient.

• Surface detail reproduction is poor.

TRAY SELECTION
• The space available in the mouth for the upper impression is studied carefully with the mouth partway open and
the upper lip held slightly outward and downward.

• An edentulous stock tray that is approximately 5 mm larger than the outside surface of the residual ridge is
selected.

• Atleast 2 to 3 mm of space should be there between the side wall of the tray and the surface of the oral tissues to be
imprinted.

• Posteriorly, the tray must include both the hamular notches and vibrating line.

• Alginate impression material will not support itself away from the confines of the tray, so any areas of under-
extension need to be corrected with soft boxing wax before the impression is made.
 OPERATOR POSITION

Maxillary Mandibular
 IMPRESSIONS TECHNIQUE (Alginate)
• The trays are painted with an adhesive material or perforated stock trays are used.

• The impression material is mixed according to the manufacturer’s instruction and is placed in the tray and
evenly distributed to fill the tray to the level of its borders.

• A small amount of impression material is placed in the anterior part of the palate and in the sulci opposite the
tuberosities to help prevent air from being trapped in these parts.

• The loaded tray is then positioned in the mouth

• The upper lip is elevated, and the tray is carried upward anteriorly into position, with the labial frenum used
as a centring guide.
• The index fingers are placed in the first molar region on each side of the tray, and with alternating pressure
they seat the tray upward until the wax across the posterior part of the tray comes into contact with the tissue
in the posterior palatal seal area.

• The fingers of one hand are shifted into the middle of the tray, and border molding is carried out.

• The labial and buccal vestibules can be molded by asking the patient to “suck down” onto the tray.

• The patient should be asked to move the mandible from side to side and then open wide. This will record the
influence of the coronoid processes on the shape of the buccal vestibules.

• Once the material has set, the cheeks and upper lip are lifted away from the borders of the impression to
introduce air between the soft tissue at the reflection and the border of the impression.

• While the lip is elevated, the tray is removed from the mouth in one motion and inspected to ensure that all
the basal seat has been recorded.
• The borders of the custom tray should now be determined. Two choices are
available:
1. Either the periphery is outlined with a disposable indelible marker on the impression at the chairside
(the preferred option)
2. The outline is somewhat arbitrarily marked on the poured cast in the laboratory.

• The completed impression should be inspected next to the patient’s mouth

• The impression is poured in Gypsum to obtain the cast

• Custom Trays are fabricated on this cast

Considerations with Impression Compound

• The cake compound is heated and tempered in a water bath at 140℉ (60℃)

• Sufficient amount is placed in the tray to ensure adequate coverage beyond the confines of the tray.

• The material is rough-shaped with finger pressure to the contours of the maxillary residual ridge.

• The surface is flamed and tempered in the water bath before insertion

• Impression Procedure is carried out as mentioned earlier

CUSTOM TRAYS
• TYPES:
1. Sprinkle on Method
2. Finger Adapted Dough Method
3. Vacuum Adapted Method
4. Double Folded Shellac
5. For Immediate Dentures:
a) Full arch Impression Trays
b) Custom Posterior Edentulous Tray
c) Two Piece Trays
FABRICATION OF CUSTOM TRAYS
Block out of undercuts Adaptation of wax spacer
Separating Media Application
Tissue stops made as slits in wax
And
Fabrication of custom tray with acrylic (2mm thick)
Handles on custom tray approximate anterior teeth Custom tray with three handles

• 3-4mm thick
• 8mm long
• 8mm high
SPACER DESIGNS

Roy Mac Gregor’s design Neill’s design Boucher’s design

sheet of metal foil in the 0.9 mm casting wax all over 1 mm base plate wax on the
region of incisive papilla and except posterior palatal seal cast except posterior palatal
mid palatine raphae. area. seal area.
Morrow, Rudd, Rhoads design J.J Sharry’s design Bernard Levin’s design

• Spacer of base plate wax over placement of wax spacer all

• Spacer 2mm short of tray.
the whole area around, except the posterior part
• 4 tissue stops 2 mm in width in of the palate
• 3 tissue stops (4x4 mm)
molar and cuspid region
equidistant from each other
 BORDER MOULDING

• It is a process by which the shape of the border of the tray is made to conform accurately to the contours of the
buccal and labial vestibules.
• This ensures an optimal peripheral seal.

MODIFICATION OF THE CUSTOM TRAY FOR BORDERMOULDING

• The flanges of the custom tray should be reduced until they are 2 mm short of the reflections.
• The tray must contain both hamular notches and extend approximately 2 mm posterior to the vibrating line
• The vibrating line is recorded and the posterior border of the tray is adjusted accordingly
• If it is underextended, the length is corrected by the addition of modeling compound.
• The tray is now ready for border molding
• Border Moulding can be done in two ways:
1. One Step Technique (Polyether)
2. Incremental Technique (Stick Tracing Compound/ Low fusiong impression compound)

• Advantages of recording all of the border simultaneously :

1. Number of insertions of the tray is reduced to one
2. We can avoid propagation of errors caused by a mistake in one section affecting the border contours in
another.

Note:
• Stick impression compound is ideally suited for carrying out border moulding in sections.

• However, it is unsuitable for recording all parts of the border simultaneously because it is impossible to
soften over the full length of the border.

• Polyether impression materials are well suited for border molding as they meet all of the requirements
 Border Mouldings: Procedure
1. The wax spacer is left inside the tray but should be removed from the border to allow space for the impression material.

2. The Stick compound is added to the borders, softened and quickly preshaped to proper contours

3. The tray is placed in the mouth making certain that the lips are retracted sufficiently to avoid scraping the material from the
border

4. Border molding is then carried out:

• Anteriorly: - the lip is elevated and extended out, downward, and inward.
- the patient can be asked to make aggressive lip movements (pucker, sneer, open wide, grimace, smile)

• Buccal Frenum: the cheek is elevated and then pulled outward, downward, and inward and moved backward and
forward to simulate movement of the frenum

• Posteriorly: - The buccal flange is border molded by extending the cheek outward, downward, and inward.
- The patient is asked to open wide and move the mandible from side to side.
5. Hamular Notch: -Push compound into notch, ask patient to
close against resistance.
-Vertical notch of pterygo-mandibular raphe
will be recorded as well

6. The tray is carefully removed from the mouth, and the

impression compound is chilled in cold water.

7. The border molding is examined to determine that it is

adequate:
1. The contour of the border should be rounded.
2. Any deficient sites can be corrected
POSTERIOR
PALATAL
SEAL AREA
Purposes of the tissue-displacing nature of the posterior palatal
seal:

Posterior Border Posterior Seal Shrinkage

Recess the denture Create a border seal to Counters the effect of

border in the posterior to decrease the risk of polymerization shrinkage
minimize the end of the dislodgment on speaking
denture to the patient’s and mastication.
tongue during swallowing
and speaking.
 Anterior and Posterior Vibrating Lines

Anterior Vibrating Line: Posterior Vibrating Line:

It is the junction between the attached It is the junction of the aponeurosis of

tissues overlying the hard palate and the movable the tensor veli palatini muscle and the
tissues of the immediately adjacent soft-palate: muscular portion of the soft palate.
(it is always on the soft palate)
Recording the Posterior Palatal Seal Area

Techniques:

Arbitrary
Conventional Fluid Wax
Scraping of
Technique technique
Master Cast
 Conventional Technique
• An acrylic or shellac tray is fabricated on the master cast

• The patient is seated upright and an astringent mouthwash may be given

• Posterior palatal area is dried with gauze

• a “T ” burnisher or a mouth mirror is used to palpate for the hamular processes

• Once located, they should be marked with an indelible pencil or noted visually

• The instrument (“T ” burnisher or mouth mirror) is then placed along the posterior angle of the
tuberosity until it drops into the pterygomaxillary notch

• A line is drawn through the notch and extended 3 to 4 mm anterolateral to the tuberosity on both the
sides .

• This will complete the outlining of the pterygomaxillary seal.

• The patient is asked to say “ ah ” in short bursts in an unexaggerated fashion.

• While observing the movement of the soft palate, the posterior vibrating line is marked with an indelible
pencil.

• We then connect the line through the pterygomaxillary seal with the line just drawn demarcating the post-
palatal seal (posterior vibrating line).

• This gives us the posterior extent of the denture.

• The resin/shellac tray is then places in the mouth and the markings are transferred and re-defined

• The tray is then trimmed to this line

• Returning again to the mouth, the palatal tissues anterior to the posterior border are palpated with the “T ”
burnisher or mouth mirror to determine their compressibility in width and depth.

• The termination of the glandular tissue usually coincides with the anterior vibrating line.
• This line (cupids bow shape) is marked with a pencil and transferred to the cast.

• It should be noted that in the region of the pterygomaxillary seal, the anterior and posterior
vibrating lines are confluent.

• A Kingsley scraper is then used to score the cast

• The deepest areas of the seal are located:

• On either side of the midline
• One third the distance anteriorly from the posterior vibrating
• It is scraped 1- 1.5 mm

• The shallowest area is the medial palatine raphe which is scraped only 0.5- 1 mm

• Within the outline of Cupid's bow, the cast is scraped to a depth of about one half the amount
to which the palatal tissues in that area can be compressed

• It progressively becomes shallower anteriorly until it feathers out in the area of the anterior
vibrating line.
Fluid Wax Technique
• The marking of the PPSA are conventionally recorded and transferred to the secondary
impression.

• The melted wax is painted onto the impression surface within the outline of the seal area (slightly
in excess)

• It is allowed to cool to increase its viscosity

• The impression is carried to the mouth and held in place under gentle pressure for 4 to 6 mins to
allow time for the material to flow.

• The maximum depression (downward and forward position) of the soft palate will be recorded
when the Frankfort plane (porion-orbitale) is 30° below the horizontal plane.

• The patient is asked to periodically rotate the head so that all functional positions of the soft
palate are recorded.
• The impression tray is removed from the mouth and the wax examined for
uniform contact throughout the posterior palatal seal area:

• The secondary impression is reinserted:

• 3-5 mins of gentle pressure
• 2-3 mins of firm pressure

• Upon removal the wax should terminate in a feather edge near the anterior
vibrating line.

• Advantages:
1. It is a physiologic technique displacing tissues within their physiologically acceptable limits.
2. Over-compression of tissues is avoided.
3. Posterior palatal seal is incorporated into the trial denture base for added retention.
4. Mechanical scraping of the cast is avoided
Preparing the Tray to Secure the Final Impression
• The spacer wax is removed from inside the tray along with any border molding material that has flowed over
it.

• Any excess material on the outside of the tray also is removed.

• If necessary, the thickness of the labial flange should be adjusted to approximately 2.5 to 3 mm in thickness
from one buccal frenum to the other.

• Material that extends into an undercuts is reduced because this allows the tray to be seated more easily.

• Approximately 0.5 mm is removed from the inner, outer, and top surface of the border.

• Stick impression compound is adjusted with a scalpel; the polyether is adjusted with either a scalpel or a bur.
• The material over the posterior area is not adjusted. This is because:
1. It slightly displaces the soft tissues at the distal end of the denture to enhance posterior border seal.
2. It serves as a guide for positioning the tray properly for the final impression.
3. It helps prevent excess impression material from running down the patient’s throat.

• Relief holes can be placed in the palate of the impression tray with a medium-sized round bur to provide
escape ways for the final impression material,

• Adhesive material may be applied.

• The holes furnish relief during the making of the final impression

• Holes can be placed over:

• Medial palatal raphe
• Anterolateral and posterolateral regions of the hard palate
• Residual ridge sites where the soft tissues are mobile and displaceable
Secondary Impression
• The final impression material of choice is mixed according to the manufacturer’s instructions and
uniformly distributed within the tray.

• All borders must be covered.

• The tray is then positioned in the mouth and border molding is performed.

• When the final impression material has set, the tray is removed from the mouth and inspected for
acceptability.

• If it needs to be remade, the impression material is removed with care to preserve the border
molding.
MANDIBULAR
IMPRESSIONS
ANATOMY OF
MANDIBLE
ANATOMY OF SUPPORTING STRUCTURES

• The total area of support from the mandible (14 cm2) is significantly less
than from the maxilla(24 cm2).

• Therefore, extra care must be taken if the available support is to be used to

advantage
CREST OF RESIDUAL RIDGE

• The crest of the residual alveolar ridge is covered by fibrous connective tissue.

• Underlying bone is cancellous and without a good cortical bony plate covering it.

• Therefore, the crest of the residual ridge may not be favorable as the primary
stress-bearing area for a lower denture.
THE BUCCAL SHELF AREA

• It is bound:
• medially by the crest of the residual ridge
• laterally by the external oblique ridge
• distally by the retromolar pad.

• The total width increases with alveolar resorption.

• The inferior part of the buccinator muscle is attached below the buccal shelf

• The bone of the buccal shelf is covered by a layer of cortical bone. This, plus the fact that
the shelf lies at right angles to the vertical occlusal forces, makes it the most suitable
primary stressbearing area for a lower denture.
MYLOHYOID RIDGE

• Soft tissue usually hides the sharpness of the mylohyoid ridge.

• Anteriorly, its attached mylohyoid muscle, lies close to the inferior border of the
mandible.

• Posteriorly, it lies flush with the superior surface of the residual ridge.

• The mucous membrane over a sharp or irregular mylohyoid ridge will be easily
traumatized by the denture base, unless relief is provided in the denture base.

• The area under the mylohyoid ridge is an undercut.

MENTAL FORAMEN

• As resorption takes place, the mental

foramina will come to lie closer to the
crest of the residual ridge.

• Therefore, relief is provided.

GENIAL TUBERCLES

• The genial tubercles usually lie well away

from the crest of the ridge.

• With resorption, they become

increasingly prominent.
TORUS MANDIBULARIS

• The torus mandibularis is a bony prominence

• Usually found bilaterally and lingually near the first and

second premolars midway between the floor of the mouth
and the crest of the ridge.

• It often needs to be removed surgically because it can be

difficult to provide relief without breaking the border seal.
ANATOMY OF PERIPHERAL OR
LIMITING STRUCTURES

• The influence of the limiting structures in the mandible is more difficult to

record than in the maxillae because structures on the lingual side must be
considered as well
LABIAL VESTIBULE

• The muscles are inserted close to the crest of the ridge, thus limiting its
extension.
• When the patient’s mouth opens wide, the orbicularis oris muscle
becomes stretched, narrowing the sulcus.
• This would displace the mandibular denture if the flange was unnecessarily
thick.
• Mandibular dentures and, hence, impressions will always be narrowest in
the anterior labial region.
LABIAL FRENUM

• It contains a band of fibrous connective tissue that

helps attach the orbicularis oris muscle.

• Therefore, the frenum is quite sensitive and active,

and the denture must be fitted carefully around it to
maintain a seal without causing soreness.
BUCCAL VESTIBULE

• The buccal vestibule extends from the buccal frenum to the

outside back corner of the retromolar pad.
• The impression (denture) is always widest in this region.
• The extent of the buccal vestibule is influenced by the
buccinator muscle, which extends from the modiolus
anteriorly to the pterygomandibular raphe posteriorly and
has its lower fibers attached to the buccal shelf and the
external oblique ridge.
BUCCAL VESTIBULE CONTD

• The distobuccal border must converge rapidly to avoid displacement by

the contracting masseter muscle, whose anterior fibers run outside and
behind the buccinator muscle in this region. This denotes the Masseteric
Notch

• The extent of its effect will be recorded only when the masseter muscle
contracts.
DISTAL EXTENSION

• The distal extension of the mandibular denture is limited by:

1.Ramus of the mandible
2.Buccinator muscle fibers that cross from the buccal to the lingual side
as they attach to the pterygomandibular raphe
3.Superior constrictor muscle
4.Sharpness of the lateral bony boundaries of the retromolar fossa,
which is formed by a continuation of the internal and external oblique
ridges ascending the ramus.
RETROMOLAR PAD

• The retromolar pad is a triangular soft pad of tissue at the distal end of the lower ridge.

• Its submucosa contains:

1. Glandular tissue
2. Fibers of the buccinator
3. Fibres of superior constrictor muscles,
4. Pterygomandibular raphe
5. Terminal part of the tendon of the temporalis muscle.

• Because of this, the denture base should extend approximately one half to two thirds over the retromolar
pad.
LINGUAL BORDER

• The lingual tissues under the tongue exhibit less direct resistance than the
labial and buccal borders do and are distorted easily when the impression
is being made.

• This can cause tissue soreness and dislodgement of the denture by tongue
movements.

• For success to be achieved with a lower impression, it is important to

understand the action of the mylohyoid muscle.
MYLOHYOID MUSCLE

• Posteriorly the mylohyoid

muscle in the molar region
affects the lingual impression
border in swallowing and in
moving the tongue.

• During swallowing, the

mylohyoid muscles contract,
raising the floor of the mouth.
SUBLINGUAL GLAND REGION

• In the premolar region, the sublingual

gland rests above the mylohyoid muscle.

• When the floor of the mouth is raised, this

gland comes quite close to the crest of the
ridge
ALVEOLINGUAL SULCUS

• The border can be considered in the following Three regions:

1) Anterior region
2) Middle region
3) Posterior region
ANTERIOR REGION

• Here a depression, the premylohyoid fossa, can be palpated.

• The lingual border of the impression should extend to make contact with
the floor of the mouth when the tip of the tongue touches the upper crest
of the ridge.

• The lingual flange will be shorter anteriorly than posteriorly.

MIDDLE REGION

• It extends from the premylohyoid fossa to the distal end of the mylohyoid
ridge, curving medially from the body of the mandible.

• This curvature is caused by the prominence of the mylohyoid ridge and the
action of the mylohyoid muscle.

• The middle of the lingual flange is made to slope toward the tongue, the
tongue can rest on top of the flange and aid in stabilizing the lower
denture on the residual ridge.
POSTERIOR REGION

• Here the flange passes into the retromylohyoid fossa.

RETROMYLOHYOID FOSSA

• It is the area posterior to the mylohyoid muscle.

• As the lingual flange moves into this fossa, it ceases to be influenced

by the action of the mylohyoid muscle and moves back toward the
body of the mandible producing the typical S curve of the lingual
flange.

• The denture border should extend posteriorly to contact the

retromylohyoid curtain when the tip of the tongue is protruded as this
causes the retromylohyoid curtain to move forward
 PRELIMINARY IMPRESSION
• Posteriorly, the retromolar pads should be covered by the tray.

• If the stock tray is made from metal, the lingual flanges can be reshaped, by bending to allow for the action of the
mylohyoid muscle

• Any areas of underextension need to be corrected with soft boxing wax before the impression is made. (Most Common:
Retromolar Pad, Retro-mylohyoid Fossa.) (Not Done For Impression Compound)

• Once the tray is seated, the borders of the impression are molded.

• Technique is similar to that for Maxillary Impressions

Note: if Impression Compound is used then care is taken to ensure that it does not displace the mylohyoid muscle
while making the impression.
FABRICATION OF CUSTOM TRAY

• Procedure is the same as for Maxillary Custom Tray

• A wax spacer, approximately 1 mm thick, is placed over the crest and slopes of the
residual ridge leaving the borders uncovered

• The buccal shelf on each side may be left uncovered by the spacer.

• Extra wax can be placed over the lingual slopes of the cast below the level of the
mylohyoid ridge to provide additional space for the action of the mylohyoid muscle.
BORDER MOLDING: PROCEDURE
• When an incremental technique is used, The following order is Followed:
1. Border of the labial flange
2. Each buccal flange.
3. Anterior lingual border
4. Left and right posterior lingual extension, including the Retromolar pads.

• The one-step technique for border molding the lower custom tray is similar to that used for the
upper tray.
1. Labial flange: is molded by lifting the lower lip outward, upward, and inward.

2. Buccal frenum: the cheek is lifted outward, upward, inward, backward, and forward to simulate
movement of the frenum.

3. Posteriorly: the cheek is pulled buccally to ensure that it is not trapped under the tray, and then the
cheek is moved upward and inward.
• The effect of the masseter muscle on the border of the impression is recorded by asking the patient
to exert a closing force while the dentist exerts a downward pressure on the tray.

4. Anterior lingual flange: is molded by asking the patient to protrude the tongue and then to push
the tongue against the front part of the palate.
• Protruding the tongue determines the length of the lingual flange
• Pushing the tongue causes the base of the tongue to spread out and develop the thickness
5. Mylohyoid muscle: Protruding the tongue raises the floor of the mouth.
• This helps the dentist determine the length and slope of the lingual flange in the molar region.
• The lingual flange must slope toward the tongue parallel to the direction of the fibers of the mylohyoid muscles.

6. Distal end of the lingual flange:

• Protruding the tongue This action activates the superior constrictor muscle, which supports the retromylohyoid
curtain.
• Close the mouth as the dentist applies downward force: this records the effect of the medial pterygoid muscle on the
retromolar curtain.

7. Pterygomandibular raphe: Finally, the patient is asked to open wide.

• If the tray is too long, a notch will be formed at the posteromedial border of the retromolar pad

Note:
• Patient can be asked to perform lip movements like puckering, sneer, grimace and smile
• To record the lingual borders the patient may be asked to lick upper and lower lip, right and left cheek.
 • The wax spacer is removed from inside the tray along with
any border molding material that has flowed over it.

Preparing the • Any excess material on the outside of the tray is removed,
Tray to Secure and approximately 0.5 mm of border molding material is
removed from around the border.
the Final
• Finally, small holes can be drilled through the tray,
Impression approximately 10 mm apart, in the center of the alveolar
groove and over the retromolar pads.
 FINAL IMPRESSION

• The final impression material of choice is mixed according to the manufacturer’s instructions and evenly distributed
within the tray. All borders must be covered

• The tray is rotated into the mouth in the horizontal plane with the anterior handle until it is over the residual ridge.

• At this time, the patient is asked to raise the tongue slightly, and the tray is moved downward toward its final
position.

• The dentist’s index fingers of each hand are placed on top of the posterior handles, and, with alternating gentle
pressure, the tray is seated until the buccal flanges come into contact with the mucosa covering the buccal shelf.

• With the tray held steadily and not moving on the residual ridge, the borders of the impression are formed in the
manner already described.

• The tongue must be kept forward, touching the upper lip, while the impression material sets.
 RESONS FOR REMAKING OF IMPRESSION
1. A thick buccal border on one side and thin on the opposite side
• tray was out of position in the direction of the thick border.

2. A thin labial border with the tray showing.

• tray was placed too far posteriorly

3. A thick lingual border on one side and thin on the opposite side.
• tray was out of position in the direction of the thin border.

4. A thin anterior lingual border with the tray showing.

• tray was too far forward in relation to the residual ridge.
5. Excess thickness of impression material over the fitting surface
• tray was not seated down sufficiently

6. The tray showing through the impression material over the fitting surface
• tray has been seated on the residual ridge with too much pressure

7. Voids or discrepancies too large to be corrected accurately

8. Incorrect consistency of the final impression material

9. Movement of the tray while the final impression material was setting

10. Incorrect border molding procedures

11. The use of either too much or too little impression material
SPECIAL
TECHNIQUES
 IMPRESSIONS FOR
RELINING

• METHODS:

1. Static impression technique:

a) Open Mouth
b) Closed Mouth

2. Functional impression technique

3. Chair-side technique.
Static Impression Technique
• The static impression technique involves the use of either:
1. closed mouth
2. open-mouth

CLOSED MOUTH TECHNIQUE

• The dentures are used as impression trays and either:
• Existing CRO is used to seat the dentures
• CR is recorded (in the registration medium of choice) before the impressions are made.

OPEN MOUTH TECHNIQUE

• Existing Dentures are essentially used as custom trays
• New CRO record is obtained after the impressions are made
• Requires additional Laboratory work.

➢ Therefore, the closed-mouth reline/rebase technique is preferred when the static impression method
 Integral Steps for a Closed-Mouth Reline
Technique
• Large undercuts relieved along with resin surfaces (1.5 to 2 mm)

• “Escape holes” drilled, particularly in maxillary base; this will also assist easy removal of palatal portion during
laboratory rebase

• Denture periphery is shortened to create flat border

• Maxillary Denture may be retained with a denture adhesive

• Border molding and Posterior palatal seal recording is done with preferred material (i.e., low-fusing compound)

• Three compound stops may be required on the impression surface of the denture to reestablish a proper occlusal
relationship or to improve the occlusal plane orientation.
 Active functional movements
UPPER JAW :
1. Mouth narrowing and widening (labial and anterior buccal valve)
2. Lower jaw movements toward left and right (posterior buccal valve – width of paratuberal space)
3. Mouth opening (dorsal border)
4. Pronunciation of the letter A (pharyngeal valve).

LOWER JAW:
1. Mouth narrowing and widening (labial and anterior buccal valve)
2. Mouth opening (posterior buccal valve and dorsal border)
3. Saliva swallowing (posterior sublingual valve)
4. Licking the upper lip (medial and anterior sublingual valve).

Performance of passive movements are done to record frenulum and plica insertion and for
patients who are not able to perform active movements
MATERIALS USED
1. Zinc oxide eugenol pastes (Luralite, Kerr, Germany)

2. Condensation silicones (Coltex Extra Fine, Coltene, Switzerland),

3. Poly vinyl siloxane (Dimension or Express, 3M ESPE, Germany)

4. Polyethers (Impregum Soft, 3M ESPE, Germany)

5. Kerr’s impression wax (Iowa wax)

Impression for
Atrophic Mandibular Ridge
NEUTRAL ZONE
REVERSED SEQUENCE IN DENTURE CONSTRUCTION

USUAL SEQUENCE REVERSED SEQUENCE

✓ Primary impression.
✓ Primary impression
✓ Stable denture base
✓ Construction of custom tray&
✓ Instead of wax , modeling compound
final impression. is used for occlusion rim.

✓ Fabricate denture base ✓ Rim molded to locate the neutral

zone.
✓ Occlusion rim to establish VD& ✓ Tentative VD, CR are made
CR
✓ Final impression is made. (Functional
impression is Preferred)

✓ VD &CR are refined & finalized.

FLANGE TECHNIQUE FOR NEUTRAL ZONE:

• Flange technique by Lott and Levin introduced in 1966

• It involves making impressions of soft tissues of mouth adjacent to

the buccal, lingual, labial, palatal surface

• These are then incorporated into the flanges of the denture.

The keels in place in the occlusion rims which
• Coat the occlusal surfaces with a little petroleum jelly and
insert the occlusion rims in the mouth.

• Direct the patient to read aloud and rapidly on some

interesting subject.

• A good alternative is to engage the patient in an animated

conversation on a subject of mutual interest.

• Direct the patient to forcefully grin, purse the lips and swallow
as a final requirement.

• These actions will cause the natural function of most, if not all,
of the muscles involved.

• This record the neutral zone

• Functional Impressions are then recorded using this

MICROGNATHIA
AND
LIMITED MOUTH
OPENING
SECTIONAL IMPRESSION
TECHNIQUE:
• Buy Supoj and Kiattisorn

• Horse shoe shaped flexible plastic tray used for

fluoride application in children

• Perforate the tray with #8 round bur

• Silicone putty impression is made

• Make a wash impression with light body

• Make a dental stone diagnostic cast

• Make 2 conventional custom made trays

• Cut the 1st tray antero posteriorly following a line to the left side of the midline and on the other tray
following the right

• Trays must be trimmed enough to pass through the limited oral opening

• Make impression on each tray with elastomeric impression material

CAST POURED FROM THE IST IMPRESSION IS PLACED ON THE 2ND IMPRESSION:
SECTIONAL DENTURE :
ONUR GECKILI AND ALTUG
• Fabricate custom impression tray
• Section tray mesiodistally along the middle of
the palate
• Tungsten carbide bur was divided into three
pieces of equal length. One of the bur sections
was placed on top
• Second tray fabricated to slide through the bur
sections
• First tray – labial vestibule and labial frenum
• Second tray – buccal vestibule and freni
• Zinc oxide eugenol impression
DISPLACABLE
TISSUES
Kian M.Tan, Michael T.singer,
Radi masri and Carl F.driscoll

• Make a preliminary impression of the edentulous

arch using an irreversible hydrocolloid impression
material in a metal stock tray
• Pour impression in type III dental stone
• After Border moulding, spacer is removed and a
window is made.
• Tray adhesive is applied
• Tray is repositioned into the patients mouth and
polyvinyl siloxane impression material is injected
over the window opening
• Gently blow air
RALPH CARLSON APPLEBY:
• After border moulding, compound on the residual
ridge is removed and escape holes made

• Zinc Oxide Eugenol Impression is made

WILLIAM H. FILLER’S TWO TRAY TECHNIQUE:
• Border molding is done

• Light Body Material is used in the initial tray as the corrective wash
material.

• The second tray is filled with Plastogum and gently vibrated into place until
the “keyed” parts of the trays are in contact.

• The two trays are held lightly together until the impression material sets,
and then the impression is removed as a unit.

• The two trays are then sealed together with sticky wax at their junction.
 OTHER TECHNIQUES FOR FLABBY TISSUES:
1. Hobrick :
• the area of movable tissue was cut out and relief holes were made and wash
impression was made with light bodied impression material.

2. John D. Watter:
• recorded the healthy denture bearing tissue with ZnoE and the displaced tissue
with impression plaster.

3. Allan Mack:
• A loosely fitting tray made with heavy relief over the flabby
• Plaster was mixed and applied over the flabby and was allowed to set. tray was
filled with 2nd mix of plaster and the impression was made over the first impression
MANAGEMENT
OF GAGGING
1. Tip of tongue is salted for 5 seconds with table salt.
2. Relaxation techniques: breathing control
3. Distraction techniques: talking to the patient
4. Desensitization techniques
5. Hypnotherapy
6. ‘Ego enhancement’ and ‘confidence reinforcement
7. Local anaesthesia techniques
8. Sedation techniques
9. General anaesthesia
10. Strong anti-emetic (metoclopramide)
11. Correct head position during impression making
12. Using trays of appropriate size
13. Using adequate amounts of material
14. Use of flavoured alginates
 Non pressure technique
Low viscocity material
(alginate)
MANAGEMENT OF
XEROSTOMIA Using artificial salivary
substitutes could be an
adjuvant while making
impressions
DISINFECTION
• Reversible (Agar) and irreversible hydrocolloid (Alginate)
materials should be handled carefully to prevent distortion.

• The impression should be thoroughly soaked by spraying with a

hospital-level disinfectant.

• Impressions should be loosely wrapped in a plastic bag to prevent

evaporation of the disinfectant

• They should then be rinsed and handled in an aseptic manner

IMPRESSION MATERIALS DISINFECTION

1. Compound - 1:213 Iodophors;

1:10 Sodium hypochlorite

2. ZOE impression paste - 2% Glutaraldehydes;

1:213 Iodophors

3. Reversible hydrocolloid - 1:213 Iodophors;

1:10 Sodium hypochlorite

4. Alginate - 1:213 Iodophors;

1:10 Sodium hypochlorite
solution
5. Polysulfide - Glutaraldehydes
1:213 Iodophors
1:10 Sodium hypochlorite
Complex phenolics
6. Polyether - 1:213 Iodophors
1:10 Sodium hypochlorite
Complex phenolics
7. Silicone - Glutaraldehydes
1:213 Iodophors
1:10 Sodium hypochlorite
Complex phenolics
 Aluminum - - Heat sterilize via autoclave
- Chemical vapor or dry heat
- Ethylene oxide sterilization.

Chrome-plated - Heat sterilize via autoclave

Impression - chemical vapor or dry heat

- Ethylene oxide sterilization.
trays
Custom acrylic resin - Discard after intra oral use
-Disinfect with tuberculocidal hospital
(for reuse during the next visit)

Plastic - Discard.
 CONCLUSION:

• If a denture must be closely adapted to the structures on which it rests, and if its
occlusion must be accurate, then it is equally important that it be intimately
adapted to the muscles, cheeks, tongue, and lips with which it is constantly in close
contact and with which it must function in harmony.

• No impression material or method serves as a gold standard. It is the duty of the

dentist to have a knowledge about the oral anatomy and select the material and
technique with which best possible results can be obtained
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
• Boucher C.O. – A critical analysis of mid-century impression technique for complete
denture. JPD 1951; Vol-1
• George A. Buckley – Diagnostic factors in the choice of impression material and
methods. JPD, 1955 Vol-5.
• Henry A. Collett – Complete denture impressions. JPD 1965; Vol-15.
• Marvin R. Lutes – an impression procedure for construction of maxillary immediate
dentures. JPD september 1967:18
• Supoj – Impression procedure for progressive sclerosis patient : a clinical report.JPD
march 2000:83
• Onur Geckili – Impression procedure and construction of a sectional denture for a
patient with microstomia: a clinical report. JPD december 2006:14
• Ralph Carson – A mandibular impression technique for displaceble tissue –JPD may
1954 :4

• Kian M.Tan – Modified fluid wax impression for a severely resorbed edentulous mandibular ridge
JPD March 2009:20

• Lott and Levin – Flange technique – an anatomic and physiologic approach for increased
retention,stability and support of dentures
JPD may-june 1966:16