Physiologic determinants of primary impressions for
complete dentures
Ira E. Klein, D.D.S.,* and Barry M. Goldstein, D.D.S.,**
New York University, College of Dentistry, New York, N.Y.
lhe building block for a complete denture is the
primary impression. It is imperative to understand
thoroughly the tissues contacted. This article will
discuss key considerations for primary impressions and
describe a technique that addresses them.
OBJECTIVE
The specifications as formulated by Roberts’ are
correct: “The form of the denture founda-
tion . . . should be recorded without distortion,” and
“The outline of the basal seat . . . should be recorded as
it is determined by functional movements of border
tissues.”
Although the basal seat for a complete denture can
be contacted in a passive or loaded manner, the
peripheral tissues must be contacted passively. The
zone of unattached mucosa should be registered differ-
ently and with a different impression material than the
attached mucosa. The unattached mucosa is usually
nonkeratinized and the submucosa contains loose con-
nective tissue and elastic fibers (Figs. 1 and 2). The
attached mucosa that covers the residual ridge is thickly
keratinized and has a relatively thin submucosa (Figs.
3 to 5). It is the difference in types of oral mucosa that
should be considered when complete denture impres-
sions are made.
IMPRESSION MATERIAL REQUIREMENTS
Accurate registration of the different oral tissues
requires material that (1) causes minimum peripheral
tissue displacement, (2) is accurate, (3) is easily han-
dled, (4) does not set by chemical action but flows until
chilled, (5) has good flowability at mouth temperature,
and (6) is dimensionally stable until poured.
Presented at the meeting of the American Prosthodontic Society,
Chicago, Ill.
*Professor and Clinical Director of the Advanced Education Pro-
gram in Prosthodontics.
**Clinical Assistant Professor, Department of Fixed Prosthodon-
tics.
THE JOURNAL OF PROSTHETIC DENTISTRY
Kerr impression wax sticks, (Kerr Mfg. Co., Romu-
lus, Mich.) is a material that fulfills the require-
ments.2-4With this material the peripheral tissues can
generate physiologic molding and are not immobilized
as they would be if conventional modeling compound
were used.
MAXILLARY PRIMARY IMPRESSION
Tray selection
An aluminum tray that is well short of the mucobuc-
cal fold is selected to concentrate modeling compound
over the bearing areas (Fig. 6).
Impression procedures
Two cakes of softened medium fusing modeling
compound are loaded on the tray, finger-molded to the
approximate shape of the arch, and seated to the tray.
The objective of the initial insertion is to center the
loaded tray and distribute the bulk of modeling com-
pound as evenly as possible.
The tissue surface of the compound is dried, heated
with an alcohol torch, tempered in a water bath at 140”
F, and seated with light pressure. The impression is
removed and chilled.
All obvious overextensions in width and height are
reduced. A groove is cut into the tissue surface of the
modeling compound to a depth of approximately 1 mm.
The surface of the compound is heated with an alcohol
torch, tempered in the 140” F water bath; and the
impression is then seated with firm pressure, removed,
and chilled. This step allows the warm compound to
flow toward the groove or out over the borders, thus
reducing the flowing time and distance of the flow.
Greater surface detail of the basal seat and a deeper
seating of the impression with minimized tissue dis-
placement are accomplished.
Preparation of compound for the low jking-peri’h-
era1 impression wax. The flanges of the compound
impression are trimmed to the junction of the movable
and nonmovable tissue (Fig. 7). A stick of Kerr
impression wax is luted carefully to the dry cut flanges
611
 KLEIN AND GOLDSTEIN

Fig. 6. Stock aluminum tray trimmed short of muco-

buccal fold.

Fig. 9. Stock mandibular aluminum tray trimmed.

and sealed with a hot spatula. The wax is molded to the

general shape of the denture borders, gently heated
with an alcohol torch, and tempered in the water bath
at 145” F.

Maxillary primary impression completion

It is imperative that the patient close after the
impression is introduced to widen the buccal space
opposite the tuberosity and thereby allow proper
registration of border height in this important area.
The patient is told to open wide to allow the coronoid
process of the mandible to mold this area for proper
width. The patient performs the usual border-molding
Fig. 7. Compound trimmed to receive peripheral movements for the labial and remaining buccal periph-
wax. ery for approximately 3 minutes. The heat of the oral

Fig. 1. Edentulous maxilla showing junction between attached and unattached

mucosa.
Fig. 2. Edentulous mandible showing junction between attached and unattached
mucosa.
Fig. 3. Region of maxillary first molar. A = Attached mucosa; B = unattached mucosa;
C = junction of attached and unattached mucosa; D = mucobuccal fold.
Fig. 4. Region of mandibular premolar. A = Attached mucosa; B = unattached mucosa;
C = junction of attached and unattached mucosa; D = mucobuccal fold; E = lingual
unattached movable tissue.
Fig. 5. Region of mandibular molar. A = Attached mucosa; B = unattached mucosa;
C = junction of attached and unattached mucosa; D = mucobuccal fold; E = lingual
unattached movable tissue.
Fig. 8. Completed maxillary primary impression.
Fig. 10. Mandibular compound impression trimmed to receive peripheral wax.
Fig. 11. Distolingual, distobuccal, and retromolar pad with completed peripheral
wax.

612 MAY 1984 VOLUME 53 NUMBER 5

PRIMARY IMPRESSIONS FOR COMPLETE DENTURES

Figs. 1 to 5, 8, 10, and 11. For legends, see opposite page.

THE JOURNAL OF PROSTHEnC DENTISTRY 613

 KLEIN AND GOLDSTEIN

Figs. 12, 13, and 14. Completed mandibular primary impression with buccal, labial,
and lingual peripheral wax.
Fig. 15. Completed mandibular primary impression with lingual peripheral wax and
compound buccal and labial.
Fig. X6. Boxed maxillary primary impression.
Fig. 17. Boxed mandibular primary impression.

614 MAY 1954 VOLUME 51 NUMBER 5

PRIMARY IMPRESSIONS FOR COMPLETE DENTURES
cavity allows the wax to continue to flow until the
anatomic and physiologic registrations are completed.
The impression is syringe-chilled with cold water and
carefully removed. Any inadequacy is corrected by
adding or reducing the wax (Fig. 8).
MANDIBULAR PRIMARY IMPRESSION
Tray selection
A properly fitting tray is used as a convenient carrier
to localize the mass of modeling compound over the
bearing areas. The tray must cover the retromolar pad
and is trimmed well short of the displaceable labial,
buccal, and lingual tissues. The posterior sections are
bent upward to allow for the rise of the mandible and
thus permit a uniform amount of modeling compound
anteriorly and posteriorly (Fig. 9).
Impression procedures
Two cakes of softened medium fusing modeling
compound are placed on the tray, finger-molded to the
approximate shape of the ridge, and seared to the tray.
The tray is seated with light pressure and removed
after chilling. The objective of the initial seating is to
evenly distribute the bulk of compound from anterior to
posterior and side to side, as well as to center the
tray.
A groove is cut 1 mm along the crest of the ridge.
The compound surface is heated with the alcohol torch,
tempered in the water bath, and reinserted into the
mouth. This provides a deeper seating and greater
surface detail of the basal seat with minimum tissue
displacement.
Preparation of the compound to receive the wax. All
obvious overextensions are removed. The region lin-
gual to the retromolar pad, the sublingual space, is
knife-trimmed until it is level with the mylohyoid
ridge. The anterior lingual border from premolar to
premolar is generously trimmed to allow for the
thickness of the impression wax.
The tissue surfaces of the posterior lingual and
anterior lingual flanges are shaved almost to the crest of
the ridge to allow for a thickness of wax. The
compound of the retromolar pad area is shaved to
prevent displacement of soft tissue that forms the pad
(Fig. 10).
Application of the peripheral wax. A softened stick of
Kerr’s low-fusing impression wax is applied to the
trimmed lingual flange and luted with a hot spatula.
The thickness of the wax stick in the posterior lingual
flange areas is approximately 3 mm. The thickness of
the wax stick from premolar to premolar lingually is
approximately 2 mm.
THE JOURNAL OF PROSTHETIC DENTISTRY
Mandibular primary impression completion
The entire impression is immersed in the water bath
for a few seconds and then inserted into the patient’s
mouth. It is positioned higher and more posteriorly and
then seated down and forward for the final setting.
This prevents distortion of the wax lingually because
the oral cavity is wider posteriorly.
The patient is told to perform the usual tongue
movements, that is, moving the tongue forward outside
the mouth to mold the distal lingual surface and the
lingual frenum, moving the tongue into the cheek of the
opposite side to mold the middle lingual surface, and
moving the tongue outside the mouth toward the
commissure of the lips of the opposite side to mold the
anterior lingual flange.
The movements are continued for approximately 3
minutes to allow the heat of the mouth to soften the
wax sufficiently to form an accurate lingual periphery.
The impression is thoroughly syringe-chilled with cold
water. It is removed by carefully lifting upward and
posteriorly and then forward out of the mouth. This
will prevent distortion of the wax flanges (Figs. 5,
11-15).
Use of buccal and labial wax border. It is desirable to
use the peripheral wax on the labial and buccal
surfaces of the mandibular primary impression wher-
ever possible. The compound from the distobuccal
surface of one side to the distobuccal surface of the
opposite side is cut approximately 2 mm short of the
mucobuccal fold. The same amount of wax is added to
the cut compound. It is luted and gently heated; and
after it is seated in the mouth, the patient goes through
the usual movements to obtain the buccal and labial
periphery. It is then syringe-chilled with cold water
and carefully removed. When wax labial and buccal
borders are developed, they must be completed before
the lingual wax is used.
Contraindications to labial-buccal wax borders.
When the patient has been traumatized surgically
around the lips or cheeks or has scleroderma or similar
diseases that effect the oral opening, the use of wax on
the labial and buccal borders is contraindicated.
Instead, low-fusing compound is used on the buccal
and labial borders, but the wax is always used on the
lingual border.
BOXING PROCEDURES
A special boxing procedure is recommended for this
type of impression. Equal portions of laboratory pum-
ice and plaster are mixed into a relatively thick mass.
The pumice is used to eliminate the heat of crystalliza-
tion of plaster, which would distort the wax borders.
615
 KLEIN AND GOLDSTEIN

The impression is sunk into the plaster pumice mix
so that this material is 3 mm below the labial and
buccal borders, and the entire tongue space is filled to
within 3 mm of the lingual border. The boxing is
smoothed and the excess is trimmed. The procedure is
completed by the use of a boxing wax (Figs. 16 and 17).
The plaster-pumice rim is lubricated with a soapy
solution as a separating medium, and the impression is
poured with an accepted dental stone.
DISCUSSION
Dentistry has learned that techniques and impres-
sion materials are passing, but fundamentals and
procedural guides are constant.
A variety of materials have been used for border-
molding usually as extensions of custom trays immedi-
ately prior to making the final impression. The
materials include modeling plastic,5 acrylic resin6
heavy-body or putty-type silicone or rubber,’ and
polyether.
The major disadvantages of these materials are:
short flow time, displacement of the movable tissues,
difficult to trim or add to if deficient, and difficult to
handle. The periphery is a major component of a
complete denture. The advantages of obtaining a
physiologic periphery by the use of wax are great. Wax
permits the unattached peripheral mucosa to move
when registered and not be imprisoned by the use of
materials that have a short flow time. The border seal
that is produced in this manner will enhance retention.
The physical factors of adhesion, cohesion, interfacial
surface tension, gravity, and atmospheric pressure will
certainly add to the retentive quality of the completed
denture.
SUMMARY
A technique has been described whereby a physio-
logic registration of the attached and unattached tissues
of the denture-bearing areas can be attained. A low-
fusing impression wax in conjunction with modeling
compound is used for this purpose.
REFERENCES
1. Roberts, A. C.: Full denture impression making. J PR-THET
DENT 1:213, 1951.
2. Dirksen, L.: Composition and properties of a wax for lower
impressions. .J Am Dent Assoc Z&270, 1939
3. Swenson, M. G.: Complete Dentures, ed I. St. Louis, 1940,
The C. V. Mosby Co., pp l-32.
4. Klein, I. E.: Complete denture impression technique. J PROS-
THET DENT “.‘i.739 I 1955.
5. Green, J. MT.: Green Brothers Clinical Course in Dental
Prosthesis, ed 5. Detroit, 1910, Detroit Dental Mfg. Co.,
P 1.
6. Smith, R. A.: Impression border molding with a cold-curing
resin. J PROSTHETDENT 3Ot914, 1973.
7. Sullivan, D. Y.: A border molding technique for complete
denture impression. Gen Dent 2534, 1977.
8. Smith, D. E., Toolson, L. B., Bolender, C. L., and Lord, S. L.:
One-step border molding of complete denture impressions
using a polyether impression material. ,J PROSTHET DENT
41:347, 1979
f?eprm1reyur.tt.sto:
DR. IRA E. KLEIN
19 w. 44TH ST.
NEW YORK, NY 113036

616 MAY 1984 VOLUME 51 NUMRER 5