Combining Conventional Impressions and Intraoral Scans: A

Technique for the Treatment of Complete Denture Patients

with Flabby Tissue
Seoung-Jin Hong, DMD, PhD ,1 Hyeonjong Lee, DMD, PhD ,2 Janghyun Paek, DMD, PhD ,3
Ahran Pae, DMD, PhD ,3 Hyeong-Seob Kim, DMD, PhD ,3 Kung-Rock Kwon, DMD, PhD ,3 &
Kwantae Noh, DMD, PhD 3
1
Department of Prosthodontics, Kyung Hee University Dental Hospital, Seoul, Republic of Korea
2
Department of Prosthodontics, School of Dentistry, Pusan National University, Yangsan, Republic of Korea
3
Department of Prosthodontics, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea

Keywords
Complete denture; flabby tissue; impression
technique; intraoral scanning; mucostatic
impression.
Correspondence
Kwantae Noh, Department of Prosthodontics,
School of Dentistry, Kyung Hee University,
26, Kyungheedae-ro, Dongdaemun-gu, Seoul
02447, Republic of Korea.
E-mail: nhokt@naver.com
Abstract
The conventional method for impressions of flabby tissue uses modified trays and
highly flowable materials, but mucostatic impressions are difficult to achieve due to
the viscous and the elastic natures of impression materials. In this report, a technique
is presented in which conventional impression and intraoral scanning for a fully
edentulous patient with flabby tissue are combined. The definitive impression was
obtained by applying appropriate pressure to each tissue area, and the denture can be
maintained passively and stable at rest and during function.

This work was supported by the National

Research Foundation of Korea (NRF) grant
funded by the Korean government (MSIT)
(No. NRF-2017R1C1B5076904).

The authors deny any conflicts of interest

regarding this study.

Accepted March 23, 2019

doi: 10.1111/jopr.13060

The Glossary of Prosthodontic Terms defines flabby tissue as
excessively movable tissue.1 The loose and unstable tissue is
easily displaced, leading to movement of the denture during
function, with resultant loss of retention in the denture. This
excess movement also reduces the overall stability and support
of the denture.2
Making an accurate impression that prevents the displace-
ment of flabby tissue and enables a passive fit of the denture
is a challenge.3 Since the 1930s, the concept of mucostatic
impression of flabby tissue has been supported by a number
of clinicians, and various static methods including the use of
spacers or perforations in impression trays, window technique,
and detachable trays have been reported.4-8 However, it has
also been reported that the amount of pressure on the tissue
area is more influenced by the impression material than the
tray design.9,10 Impression plaster has been classically used to
record flabby tissue, but it is not easily applicable due to the
difficulty in handling, long setting time, and possibility of acci-
dental breakage of impression during the pouring procedure.11
Due to the viscoelastic behavior of impression materials, pres-
sure is exerted and consequently displaces the movable soft
tissues.12 Intraoral scanning can capture the tissues in a passive
state, thereby producing a completely mucostatic impression;
however, it is difficult to record denture borders and the pos-
terior palatal seal for marginal sealing of the complete denture
through intraoral scanning alone.
The purpose of this report is to describe a technique to digi-
tally combine conventional impressions and scanned flabby tis-
sue in the treatment of a complete denture patient with flabby
tissue.

592 Journal of Prosthodontics 28 (2019) 592–595 

C 2019 by the American College of Prosthodontists
Hong et al Management of Flabby Tissue by Intraoral Scanning

Figure 4 Two impressions were merged, and definitive impression was

made using 3D software.
Figure 1 Flabby tissue in patient is checked.

3. Pour the impression using Type III dental stone (Neo

Technique
1. Check and identify the flabby tissue area in the patient’s
mouth (Fig 1).
2. Make a preliminary impression according to the conven-
tional method using irreversible hydrocolloid impression
material (Aroma Fine Plus; GC Corp., Tokyo, Japan).
Plum Stone; Mutsumi Chemical Industries Co., Mut-
sumi, Japan).
4. Fabricate a custom tray on the preliminary cast us-
ing autopolymerizing acrylic resin (Ostron 100; GC
Corp.). Mark the area overlying the flabby tissue on the
tray.
5. Perform border molding with impression modeling com-
pound (Peri Compound; GC Corp.).

Figure 2 Sequential process of superimposition. (A) Scan of flabby tissue through window, and outside of impression tray using intraoral scanner,
(B) scan both impression area and outside of impression tray using model scanner, and (C) superimposed datasets of 2 scanned impressions (A and
B) on the basis of outside of impression tray.

Figure 3 Check precise superimposition of 2 impression datasets using 3D image analysis software. (A) Overview and 3 planes are sectioned, (B)
most posterior cross-section, and (C) most anterior cross-section.

Journal of Prosthodontics 28 (2019) 592–595 

C 2019 by the American College of Prosthodontists 593
Management of Flabby Tissue by Intraoral Scanning
6. Apply tray adhesive (3M VPS Tray Adhesive; 3M ESPE,
St. Paul, MN) and allow it to dry.
7. Load the tray with regular-body vinyl polysiloxane
(VPS) impression material (Imprint II Garant; 3M
ESPE) and place the loaded tray into the patient’s
mouth.
8. Make a window in the area corresponding to the flabby
tissue and carefully remove the impression material in
the window area corresponding to the flabby tissue and
any impression material residue that may move during
intraoral scanning.
9. Reseat the impression in the patient’s mouth and use
an intraoral scanner (Medit i500; Medit, Seoul, Ko-
rea) to scan the flabby tissue through the window and
the outside of the impression tray for superimposition
(Fig 2A).
10. Remove the impression from the patient’s mouth and
scan both the impression area and the outside of the im-
pression tray, using a desktop scanner (rainbow Scanner
Prime; Dentium, Seoul, Korea) (Fig 2B).
11. Superimpose the standard tessellation language (STL)
file of the impression (step 10) and the STL file of the
intraoral scan of the flabby tissue (step 9), based on the
outside of the impression tray, using the best-fit algorithm
in the software (Geomagic Control X; 3D Systems, Rock
Hill, SC) (Fig 2C).
12. Confirm precise superimposition of the 2 impression
datasets in the cross-sections of the superimposed data,
using 3D image analysis software (Geomagic Control X)
(Fig 3).
13. Merge and make a definitive impression in one STL
file using 3D software (Meshmixer; Autodesk Inc., San
Rafael, CA) (Fig 4). This impression can then be used to
fabricate the complete denture.
Discussion
Conventional modified methods for impression of flabby tissue
used several materials and methods to reduce displacement of
the flabby tissue area, but the pressure could not be completely
eliminated, and it was difficult to handle the impression mate-
rials such as impression plaster. Two-step impression with an
open window technique, commonly used in the treatment of
maxillary complete denture patients with flabby tissue mini-
mizes the displacement of the flabby tissue.13 However, it is
difficult to control the impression material in the flabby tis-
sue area due to high flow of material and gravitational forces,
even when using VPS, which is preferred by most clinicians.14
However, in this technique, the flabby tissue was easily scanned
using an intraoral scanner, and pressure was not applied to the
flabby tissue.
The trueness of this technique is good (Fig 3), and the line
on the sectioned plane shows precise superimposition of the 2
impressions. In the anterior sectioned plane, the lower green
line shows precise superimposition, but the lateral blue and
yellow lines show differences in the 2 impressions (Fig 3C).
This distortion is due to limitations in accessibility of the intra-
oral scanner,15 and is not an error of superimposition. Extrao-
ral scanning of the impression is performed on multiple sides
594 Journal of Prosthodontics 28 (2019) 592–595 
Hong et al
of the impression; however, access of the intraoral scanner in
the vertical direction to the lateral border of the impression is
limited in the oral cavity. Furthermore, advancement of the in-
traoral scanner deeply into the lateral border of the impression
may result in movement of the impression in the oral cavity.
Thus, lateral borders may have slight distortions compared to
the palate or the alveolar ridge. In this technique, intraoral scan-
ning was performed at right angles to the flabby tissue, and the
outside of the impression tray was also scanned. Therefore, the
flabby tissue and the reference area for superimposition were
precisely captured. Because the superimposition is performed
as described above, the difference in the junction levels of the
2 impressions in the superimposed datasets is due to the dif-
ference in the pressure exerted by each impression method and
the displaceability of the mucosa (Fig 2C). In the impression
procedure, the extent of mucosal displacement is determined
by the amount and site of applied pressure,16,17 and the apply-
ing pressure is influenced by the tray design and impression
material,18-20 with the latter exerting more influence.9,10
The merged definitive impression prevents displacement and
rebound of the flabby tissue, and shows the proper shape of
the denture border and posterior palatal seal, thereby providing
good retention and stability of the complete denture. Although
the accuracy of the superimposition was confirmed, further
clinical long-term validation is necessary.
Summary
This report describes a combination technique of the conven-
tional impression and intraoral scanning in the fully edentulous
patient with flabby tissue, and a definitive impression obtained
through appropriately applied pressure at each tissue area. The
impression technique is performed in 4 steps: (1) conventional
impression is made with a custom tray, and a window is formed
at the flabby tissue area; (2) intraoral scanning of the flabby
tissue through the window and outside of the impression tray
in the patient’s mouth; (3) scanning both the impression area
and the outside of the impression tray using a desktop scanner;
and (4) superimposition performed on the basis of the outside
of the impression tray.
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