A Technique for Digital Impression and Bite Registration

for a Single Edentulous Arch

Yiqin Fang, DDS, Jing-Huan Fang, DDS, Seung-Mi Jeong, DDS, PhD, & Byung-Ho Choi, DDS, PhD
Department of Dentistry, Yonsei University Wonju College of Medicine, Wonju, South Korea

Keywords
Bite registration; digital impression;
edentulous jaw; intraoral scan.
Correspondence
Byung-Ho Choi, Department of Oral and
Maxillofacial Surgery, Yonsei University
Wonju College of Medicine, 162 Ilsandong,
Wonju, South Korea.
E-Mail: choibh@yonsei.ac.kr
This work was supported by the Ministry of
Trade, Industry & Energy (MOTIE, Korea)
under Industrial Technology Innovation
Program (grant # 10073062).
Abstract
Few studies have reported the application of digital technology for the process of
impression and interocclusal recordings in edentulous patients. This article describes
a digitizing system for generating digital edentulous models with a jaw relationship
by taking direct digital impressions and a virtual bite registration using intraoral
digital scanning. A specialized scan retractor was used to make digital impressions of
edentulous jaws in patients’ mouths using an intraoral scanner. Virtual bite registration
was obtained with optical scanning of the buccal surfaces of both jaws at the occlusal
vertical dimension. The registration was then used as a reference for aligning both
jaws. Digital edentulous models that include the jaw relationship would be clinically
beneficial for the fabrication of complete dentures in edentulous patients.

The authors deny any conflicts of interest.

Accepted November 30, 2017

doi: 10.1111/jopr.12786

Conventional prosthodontic treatments and laboratory tech-
niques have been conducted by indirect methods using various
impression materials for more than 400 years.1 Conventional
prosthodontic procedures involve many steps with the possibil-
ity for errors at any stage. Errors can occur while taking impres-
sions, obtaining interocclusal records, or transferring models
to an articulator.2 Although the errors can be minimized using
careful techniques and control of the materials, errors cannot
be completely eliminated because of the inherent properties
of the impression materials that are used in the procedure or
human error.2 Conventional prosthodontic procedures also re-
quire many visits, even if attempts have been made to reduce
their number.
Recently, with the introduction of new intraoral scanner sys-
tems, intraoral digital impressions allow clinicians to directly
acquire data from the mouth without the need to take a conven-
tional impression and pour a cast.3,4 Intraoral digital scanners
have the ability to obtain image information for a full dental
arch scan with the same accuracy as conventional impressions.5
Therefore, the steps needed for fabrication are reduced, and
potential errors, such as expansion, shrinkage, and distortion
of impression materials and/or the gypsum master model, are
eliminated or minimized; however, few studies have been pub-
lished regarding the application of digital technology for taking
impressions and interocclusal records in edentulous patients.
Edentulous jaws represent a mucosa-based clinical situation
involving several mobile zones (areas of the oral vestibule) and
smooth-surface textures covered entirely by saliva. These fac-
tors are challenging with regard to direct digital impressions.6
Our previous works suggested that direct digital impressions
of edentulous jaws could be obtained using a specialized scan
retractor.7,8 The purpose of this article was to introduce a dig-
itizing system for generating digital edentulous models with
jaw relationships by taking direct digital impressions and vir-
tual bite registrations in patients’ mouths using an intraoral
scanner.
Technique
The patient described in this article has a maxillary edentulous
arch and a mandibular implant-supported overdenture (Fig 1).
1. To make digital intraoral impressions of the maxillary
edentulous jaw, a specialized scan retractor was fabri-
cated (DIO Implant Co., Busan, Republic of Korea) with
a universal size (Fig 2). It has a frame constructed of
aluminum wire with a connected handle flexible enough
to permit the shape change necessary for the frame to fit

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Virtual Bite Registration Fang et al

Figure 1 Preoperative clinical view.

Figure 4 Scan of the edentulous maxilla taken with an intraoral scanner
(TRIOS) and scan retractor.

Figure 2 Specialized scan retractor for digital impressions of maxillary Figure 5 Scan of the mandible taken using an intraoral scanner (TRIOS).
edentulous jaws.

Figure 6 Interocclusal record made by injecting interocclusal record ma-

terial into the area between the record base and the occlusal surfaces
of the mandibular overdenture teeth.
Figure 3 Scan retractor positioned on the maxillary edentulous jaw.
vertically from the frame in the canine region and turns
into the vestibular area. The frame thickness should be anteriorly to pass over the lip with minimal interference
sufficient to provide retractor rigidity, but should not be with the oral musculature. The handle, which is located in
excessive. The shape of the frame on both posterior sides the canine region, allows the scan head to move from the
is flat, allowing for the application of the frame beyond anterior to the posterior alveolar ridge segments without
the distal end of the alveolar process. The handle extends interference.

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Fang et al
Figure 7 Half of the interocclusal record placed in the mouth.
Figure 8 Bite scan images.
Figure 9 Virtual models aligned using the bite registration as a
reference.
2. Prior to intraoral scanning, adapt the scan retractor in-
traorally to fit the contour of the maxillary edentulous
arch by bending the frame. Extend the frame as far as
possible buccally to scan the labial or buccal surface of
the edentulous ridge.
3. After the scan retractor has been contoured, acquire in-
traoral digital impressions using an intraoral scanner
(TRIOS; 3Shape A/S, Copenhagen, Denmark). First,
clean the edentulous ridge and completely eliminate the
presence of saliva. Position the scan retractor on the max-
illary edentulous jaw so that the frame will push the
Journal of Prosthodontics 00 (2018) 1–5 
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Virtual Bite Registration
Figure 10 The completed prosthesis.
vestibule down further, exposing the edentulous ridge
to capture the greatest amount of surface area of the
vestibule (Fig 3). Perform scanning by retracting the lip
and cheek with the scanner head itself while stretching
and fixing the vestibular area with the metal frame of
the retractor. First, scan one-third of the upper jaw on
the left side, starting at the distobuccal area, moving the
scanner head in a slow zigzag toward the anterior area,
and returning to the soft palatal areas. Second, scan an-
other third of the upper jaw in the middle, starting at
the soft palatal areas, moving the scanner head in a slow
zigzag toward the anterior areas, and returning to the soft
palatal areas. Finally, scan the remaining one-third of the
upper jaw, starting at the soft palatal areas, moving the
scanner head in a slow zigzag toward the anterior areas
following the palatal side of the ridge and returning to
the distobuccal areas on the right side (Fig 4).
4. Scan the denture teeth of the existing overdenture in the
mandibular arch while moving the scanner head in a
zigzag manner, starting at the distal area of one side and
following the jaw crest to the opposite side (Fig 5).
5. To record the jaw relationship, establish the occlusal ver-
tical dimension (OVD) using bimanual manipulation of
the mandible and place marks on the tip of the patient’s
nose and on the anterior prominence of the chin. Cre-
ate interocclusal records at the OVD using putty (Fresh;
Dreve Dentamid GmbH, Unna, Germany). First, use
heavy-body putty to fabricate a record base for the pa-
tient’s maxillary edentulous arch. The material should be
seated and adapted intraorally to fit the contours of the
arch. After placing light-body putty over the heavy-body
putty base, reseat the record base on the maxillary edentu-
lous arch. Inject a vinylpolysiloxane interocclusal record
material (EXABITE II NDS Bite Registration Creme;
GC America, Inc., Alsip, IL) into the area between the
record base and the occlusal surfaces of the mandibu-
lar teeth, then guide the patient’s mandible to the OVD
where it should be stabilized until the interocclusal record
material is completely polymerized (Fig 6).
6. Remove the interocclusal record from the mouth and
cut out its anterior part between the first premolar sites.
3
Virtual Bite Registration
Return the remaining part to the mouth (Fig 7). The
record is used to create an occlusal stop to hold the de-
sired OVD.
7. On the anterior side where the interocclusal record is
absent, record the virtual bite registration with optical
scanning of the labial surfaces of the maxillary edentu-
lous ridge and the opposing teeth in the patient’s mouth
using an intraoral scanner, while maintaining both jaws
at the OVD (Fig 8).
8. Virtually align the scanned maxillary edentulous jaw and
mandibular teeth images using the bite registration as a
reference. The digital recording of the maxillary eden-
tulous jaw relationship with the opposing teeth is now
complete (Fig 9).
Discussion
Very few reports have been published regarding the application
of digital technology for the process of impression and inte-
rocclusal recording in edentulous patients. When using digital
technology for the process of interocclusal recording, a com-
mon technique included additionally scanning an interocclusal
record whose negative could then be used to correctly align both
arches.9-12 Interocclusal records, due to their dimension and
elasticity, were bound to introduce errors when used to align the
maxilla and mandible.10,13,14 In addition, the technique required
a second appointment for obtaining interocclusal records, as
edentulous patients who had no occlusal contact points of nat-
ural teeth required the fabrication of resin or wax record bases
for stable interocclusal records.15,16 Any attempt to reduce the
number of visits and chair time reduces overhead expenses and
is appreciated by patients. This consideration prompted us to
refrain from using resin or wax record bases for interocclusal
registrations. This article described virtual bite registration that
was performed with the optical scanning of labial surfaces of
the maxillary edentulous ridge and the opposing teeth in the
patient’s mouth using an intraoral scanner, while maintaining
both jaws at the OVD with putty impression material. In the
procedure, the putty impression material was used to create an
occlusal stop to hold the desired OVD. The bite scan images
obtained were then used as a reference in aligning both jaws to
generate a 3D virtual bimaxillary model.
This article described a specialized scan retractor to make
direct digital impressions of edentulous jaws using an intraoral
scanner. The key factors involved in the failure to acquire direct
digital impressions of edentulous jaws using intraoral scanners
are mucosa properties. The mucosa, especially in the vestibular
area, exhibits high displacement, which makes the border diffi-
cult to determine. Another factor may be that the mobile tissue
of the lips, cheeks, and tongue moves constantly while taking a
digital impression. Unlike conventional impression techniques,
intraoral scanning cannot be performed while the mobile tissue
is moving.17 The main advantage of the scan retractor described
in this article is that it can be bent to fit the contour of the maxil-
lary edentulous arch, an ability necessary for it to adapt well to
the vestibule. Moreover, it facilitates stretching and fixation of
the vestibular area, which is important to set the border of the
impression. A further advantage of the retractor is that it helps
retract the lips and cheeks. The quality of digital impression im-
4 Journal of Prosthodontics 00 (2018) 1–5 
Fang et al
ages obtained in this instance was good enough to determine the
denture outline and anatomical landmarks such as the hamular
notch, incisive papilla, and mucogingival junction. Thus, the
digitalization process for edentulous jaws has been simplified,
as the scan retractor allows clinicians to directly acquire data
from the mouth. The digital edentulous models with a jaw re-
lationship would be clinically beneficial for the fabrication of
complete dentures in edentulous patients (Fig 10).
The digital impression technique using the scan retractor
also has disadvantages, however. The vestibule can be overex-
tended/stretched with the scan retractor. Recording the vestibule
in an overextended/stretched position will lead to denture pe-
riphery overextension and a lack of retention for the denture.
Therefore, chairside adjustments and a reline procedure may be
necessary. A further advantage of the digital impression tech-
nique is that when the border seal of the denture is deficient,
the denture can be used as a custom tray for border molding
and the definitive impression. The digital images of the denture
base obtained by scanning the definitive impression can be used
to fabricate a new denture. Therefore, the fabrication of new
dentures is simplified, as the digital workflow allows dentists
to acquire the necessary data easily.
We are also interested in the use of this technique for the
mandible, but that was not included in this article. Further
studies involving another specialized scan retractor for making
direct digital impressions of edentulous mandibular jaws are
planned. For the mandibular arch, it should have a lingual frame
that can be extended deep into the lingual vestibule to enable
fixation of the lingual vestibule and retract the tongue as well.
Summary
This article described a method for direct digital impression tak-
ing and virtual bite registration using intraoral digital scanning
to create a digital edentulous model having a jaw relationship
without the need to take a conventional impression and pour
a cast. The method suggests the use of intraoral optical scan-
ning to capture the detailed morphology of edentulous jaws
and align both jaws into the appropriate maxillomandibular re-
lationship. The method and the edentulous models created may
serve as the foundation for the fabrication of complete dentures
in edentulous patients.
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