First Impressions Count

By Anish Mehay and Oliver

Milton

Definitions
Retention resistance of a denture to vertical movement
away from the tissues
Support resistance of a denture to occlusally directed loads
Stability resistance of a denture to functional forces

Important anatomical landmarks

maxillary edentate arch
Incisive papilla anterior tooth position
guide
Hard palate support for denture
Fovea palatinae guide for the
posterior border of special tray/denture
Hamular notches guide for the
posterior border of special tray/denture
PERIPHERAL SEAL AND THEREFORE
RETENTION!

Important anatomical landmarks

mandibular edentulous arch
Retromolar pad retention
Retromylohoid fossa stability
Buccal shelf support
Residual alveolar ridge crest - stability

Patient complains of
A loose fitting denture
Establish wether cause is from
inadequate retention, support or
stability, or more commonly..a
combination of all three
FAULTS IN IMPRESSION TAKING

Primary Impressions
Why?

Enables
study model
manufacture

Production
of custom
tray

Primary Impressions
Edentulous patients:
- Outlines areas involved with denture
support
- Outlines correct extensions for
special tray
-Helps facilitate
If criteria
not met peripheral seal
- Impossible to record satisfactory second
impression

Primary Impressions
Partial denture cases
Casts can be surveyed and provisional
designs can be drawn
- Due to assessment of:
Tooth/hard tissue undercuts
Depths of sulci
Position of fraenal attachment
Presence of naturally occurring guide
planes

Primary impressions
Metal or plastic stock trays can be
used
-Disposable plastic most common
-Easy to trim if overextended
-Silicon/wax used to extend
underextended

Primary Impressions
Silicon putty/impression compound
used to adjust tray
Alginate commonly used
Silicones/impression comp can be
used
-If inadequate detail- Thin wash of alginate may be
used

Primary Impressions
Upper Impression
- Stand behind pt.
- Seat anterior first

Lower Impression
Stand in front of pt.
Avoid trapping tongue
Pt. to protrude tongue to lower lip

Remove with snap movement

Infection control
Upon taking the primary impression
must disinfect for adequate time
according for manufacturers
instructions
PERFORM 10% for 1 minute

Secondary impressions
Record of denture bearing area
Relevant abutment teeth
Tissues in contact with denture base during function and the sulci,
with the lips and cheeks supported, must be recorded
Peripheral border seal - if its not good we can add green-stick
compound
If there is under-extension green-stick compound
There is over-extension trim special tray with an acrylic bur

Anterior fibrous change

If the lower teeth occlude with
an edentulous maxillary ridge
we can get fibrous change to
the maxillary anterior ridge can
occur over time.
Use of a normal impression
technique may lead to
displacement of the ridge
unretentive denture
produce a special tray with a
window over the fibrous area so
excess material can flow out

Replica/copy denture
Replication of current denture
Taking impression of fit surface and
polished surface

http://www.mecourse.com/ecourse/pages/page.asp?
pid=1393

Replica/copy denture
Under-extensions corrected prior to
impression of original denture
Method:
Large stock tray used with alginate or silicon
Embed denture (polished surface down)
Lubricate fit surface
Fill another tray
Seat over fit surface + sandwich
Send to lab

Replica/copy denture
On second visit
Impression of patient denture
bearing tissues taken
Use ZOE or Light body silicon
Using wash technique on constructed
replica
Take jaw reg (after impression)

Neutral zone technique

Definition:
A zone in which the forces of the
cheeks and lips are said to be in
equilibrium with those of the tongue

Neutral zone technique

Improves stability of the lower
denture if set within it
Impression techniques to determine
its location
Aim to locate the teeth on the
denture within this zone
Helpful if pt. has powerful oral
muscular control

Neutral zone technique

Method
Undertake conventional impression and jaw
reg technique
Construct mandibular baseplate with vertical
stops to upper surface (contact max. try-in
denture)
Wire running between retains imp. Material
Take impression with upper in
Tongue movements
Leave upper and lower together

Reline/Rebase:
Remove undercuts on the fit surface
Apply thin wash of flowable
impression material
Two techniques

Open technique: using denture as a special tray, seating it in the

mouth with wash material
Closed technique: patient lightly closes mouth to reach position of
maximum intercuspation.
Any excess material will flow out from edges

Summary
The Golden Triangle of impression
taking
An appreciation of the anatomical
features
Material used to take the impression
Clinical handling/operative technique
applied

Thank you for listening

Any Questions??

References

Turner JW, Moazzez R, Banerjee A. Restorative Dentistry:

First Impressions Count. Dental Update 2012; 39: 455-471