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Errors in impression making

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Page No.

1. Introduction 2-6

2. Review of Literature 7-18

3. Discussion 19-69

4. Conclusion 70

5. Bibliography 71-76
 Ϯ


ERRORS IN IMPRESSION MAKING

INTRODUCTION-
Impression techniques and materials used in dentistry have come a long way since

the early times, where it was just an attempt to record the tissues without the

knowledge and appreciation of the anatomy, physiology and microbiology of tissues

being recorded, to a more scientific, well documented, biologic impression making

that is followed today.1 Several authors and researchers have emphasized the need

to understand the concept behind the number of techniques being used today. 2

It could well be said that Prosthodontics is one of the branches of dentistry where a

good impression holds the key to a successful diagnosis and treatment.

The fundamental requirement of retention, stability and support of any prosthesis

rests in the ProsthodoQWLVW¶V DELOLW\ WR LQFRUSRUDWH these requirements through an

accurate biologic impression of the tissues being involved.3 No matter how good the

prosthesis is constructed, it will not function as intended if it was not made on an

accurate impression.

Impression materials too have gone through a tremendous phase of

development. From olden day clay, to wax to the modern day elastomers, they have

indeed not only improved the quality of the material but also directly influenced the

technique used to manipulate these materials during impression making.4 Many

times both the impression techniques as well as the material have complemented

each other in producing an accurate impression incorporating all principles for an

ideal impression making.5

Impression making is the first and foremost step in diagnosis and treatment planning.

A good impression will produce a cast that will apprise the practitioner of the need of

patient and the prognosis of the proposed treatment. 6 It is to be agreed that time
 ϯ


spent in making a good impression will reduce the time required in adjusting the final

prosthesis in the mouth as well as make it more comfortable for the patient in

accepting the artificial prosthesis.

Ideal outcome of the impression must be borne in the mind of the dentist

before it is in his hand. He must literally make the impression rather than take it. The

impression material is shaped and moulded into a negative likeness of the

supporting area, a cast is made from this impression and the denture base is

constructed on this cast.7 Good impressions are basic to the fabrication of a well-

fitting denture. An impression should mean while also IXOILO00'HYDQ¶VGLFWXP³,WLV

perpetual preservation of what already exists and not the meticulous replacement of

ZKDWLVPLVVLQJ´8

A good impression is not only the first stage in the fabrication process but also the

prerequisite for a high-quality prosthetic restoration. The precision and accuracy of

details of the impression are crucial in determining the accuracy of fit and aesthetic

quality of a fixed restoration. By critically analysing various impressions at different

stages of this study related to impression techniques and material it is hoped to

achieve the following.2

1) A thorough understanding of the biologic principles in impression making.

2) To understand requirements necessary to achieve a biologic impression.

3) The manipulation of different impression materials to achieve the desired

requirements in an impression.

4) The indications, advantage and limitations of each impression technique and

material

5) As a diagnostic tool in understanding the tissues being considered and the need

for further enhancement of such tissues if required.

 ϰ


6) To help determine the treatment plan.

7) To help distinguish from a clinically compromised impression to a clinically

acceptable impression.

8) To make an impression that will maximise support, stability and retention of

prosthesis.

9) To determine a classification system of errors in impressions.

It is obligatory for the dentist to update himself with all the theories and techniques of

impression making as well as impression materials that can be used.9 The

endeavour should always be to choose the best material and apply the specific

technique for a particular patient while making an impression after examining the

condition of soft tissues and the bony ridges, so that best results can be obtained.

Nevertheless the need for evaluation of impression techniques and materials for

errors used in prosthodontics is necessary due to the fast changing scenario in

impression making.

This library dissertation has made an attempt to summarize all the errors in

impression making used in modern day prosthodontics therapy

 ϱ


DEFINITION¶6


1) Impression (GPT-7)10:- 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.
10:
2) Complete denture impression (GPT- 7) - is the negative registration of entire

denture bearing, stabilizing and border seal areas, of either the maxillae/mandible in

a plastic material that becomes relatively hard/ set while in contact with these tissue.

3) Partial denture impression (GPT- 7)10 :-

A negative likeness of part or all of a

partially edentulous arch.

10
4) Altered cast impression (GPT-7) :- A Negative likeness of portion/portions of

the edentulous denture bearing areas made independent of and after the initial

impression of the natural teeth. Thus technique utilizes an impression tray (s)

attached to the RPD framework or its likeness.

5) Preliminary impression (GPT-7) 10:- A negative likeness made for the purpose of

diagnoses, treatment planning/fabrication of a tray.

10
6) Master impression (GPT ± 7) :- A negative likeness made for the purpose of

fabricating prosthesis.
10
7) Impression material (GPT-7) :- Any substance or combination of substance

used/for making an impression/ negative reproduction

11
8) Impression technique (GPT-4) :- Method/manner used in making a negative

likeness.

9) Impression tray (GPT 7) 10:-

a. A receptacle into which suitable impression material is placed to make a negative

likeness.
 ϲ


b. A device that is used to carry, confine and control impression material which

making an impression.

9) Impression Coping (GPT-7) 10:- The component of a dental implant system that is

used to provide a spatial relationship of an endosteal dental implant to the alveolar

ridges and adjacent dentition or other structures. Impression coping can be retained

in the impression or may require a transfer from intra oral usage to the impression

after attach the analog or replicas.

 ϳ


REVIEW OF LITERATURE

COMPLETE DENTURE IMPRESSION

Arthur (1951)5 in his article on the principles of full denture impression making and

their applications mentioned the specification for an adequate full denture

impression.

1. The form of the denture foundation should be recorded without distortion.

2. The entire area to be covered by the denture should be recorded as it is

determined by functional movement of border tissue.

3. 5HOLHIDQGGDPVVKRXOGEHSODFHGDWWKHRSHUDWRU¶VGLVFUHWLRQLQVWUDWHJLFDUHDV

Carl O Boucher (1951)1 critically analysed mid-century impression techniques for

full denture and summarized them as follows. Impression techniques in use at the

middle of the twentieth century vary not only in the plan of the technique but also

with each operator as well. Evolution can be made only by an analysis of the

resultant impression area by area in relation to part of the mouth to which that part of

the impression is adapted. The supporting structures have equal importance with

the limiting structures in this analysis. The value of the procedures used will depend

upon the recognition of possibilities and limitations of anatomic form and structure of

the mouth, and the characteristic of the impression material selected. Arbitrary

impression techniques do not meet the requirements of an impression technique.

 ϴ


Devan3 LQKLVDUWLFOHµ%DVLFSULQFLSOHVLQ LPSUHVVLRQPDNLQJ¶EURXJKW to RQH¶V

attention the basic and fundamentals in making impressions for the purpose of the

construction of mucosa attached artificial dentures.

Leonard S. Fletcher12 (1952) in his article µIXQGDPHQWDO SULQFLSOHV RI IXOO GHQWXUH

FRQVWUXFWLRQ¶GHVFULEHG the impression technique in complete denture construction.

Tiltton13 (1956) described a minimum pressure impression technique. He said that

pressure applied in impression making must be equally balanced throughout the

entire area of the impression.

Klein14 (1957) described the need for basic impression procedures in the

management of normal and abnormal edentulous mouths and the purpose and

objectives of the complete denture impression should be:-

1) Retention of the complete denture.

2) Stability of the complete denture

3) Comfort of the complete denture and

4) Maintenance of the health of the supporting tissues.

Irving R. Hardy and Krishnan K, Kapr15 (1958) described the rationale and

importance of posterior border seal and gave functional and semi functional

technique of developing a posterior palatal seal.

 ϵ


In the functional technique, the final impression was border molded in the

posterior palatal seal area with soft stick modeling compound or wax by sucking and

bubbling movements performed by patients. In semi functional technique the border

molding was done by the dentist.

Roberts4 (1959) in his article on present day concepts in complete denture service,

gave an account on impression making.

Blank16 (1961) described a procedure for making the primary and final impression

for maxillary immediate dentures.

Woelfell9 (1962) described two basic impression techniques.

1. Open mouth technique

2. Closed mouth technique

These techniques are then sub classified according to the desired type of

contact with the oral mucosa as positive pressure or selective pressure. The result of

his study showed that no one specific type of material or technique can be claimed

superior in all aspect for edentulous impressions.

Hickey, Boucher and Woelfel8 (1962) wrote on the impressions for complete

dentures. They said, before impression, the mouth should be studied carefully to

determine all anatomic landmarks and consistency of the soft tissue. The tray that

carries the final impression material should be in harmony with these attachments.

The thickness of the labial flange of the tray is an esthetic factor. The posterior

extension of the impression was also important. The posterior end of the upper

denture passes through the hamular notches.

 ϭϬ


Academy of Denture Prosthetics6 (1963) on principle, concepts and practice in

prosthodontics restated that preliminary impressions were made as the first step in

the construction of a final impression tray.

Barone17 (1963) in his article ³SK\VLRORJLF FRPSOHWHGHQWXUHLPSUHVVLRQV´described

technique for complete denture impression with the utilization of the neuromuscular

concepts. The patient used the function of sucking to border mold the impression.

The contribution of favorable nutrition, muscle and tissue tonus, and tongue position

to the retention and stability of the denture and comfort of the patient had been

explained.

Martone18 (1963) gave the modification of the tray for zinc oxide and eugenol wash

impression. Out line in pencil on the cast the extent and thickness of space needed

for final impression. The relief area were outlined on the cast for the secondary

stress bearing area, one layer of pink base plate wax 1 mm thick was warmed and

moulded to the cast in relief areas. One thickness of green casting wax 0.5 mm was

added to the wax over the retromolar pad area. These regions are easily displaced.

The amount of relief space should be modified to accommodate different anatomical

foundational conditions. For e.g. spiny knife edge ridge may require additional

space, the tray was then constructed.

Scheisser19 (1964) mentioned the impression procedure for complete dentures. A

stock tray was adapted to the residual ridge as closely as possible and a preliminary

modelling compound impression was made. The patient was asked to extend his

tongue as far out as possible close to lip around the tray handle, and draw or suck in

with as hard an action as possible.

 ϭϭ


Collett et al7 (1965) described complete denture impressions, and concluded that

moisture on the tissues and secretion from mucous glands can lead to inaccuracies

in impression.

Lott and levin20 (1966) gave an impression technique for complete dentures, called

the flange technique. The denture flanges were moulded by the patient, through

various functional movements. The authors claimed that the flange techniques were

superior to the results of the discretionary methods of determining the tooth and

tongue positions, and the arbitrary carving of the facial tongue and palatal surfaces.

Rudd21 (1967) said that the defects in complete denture impression resulting from

the effect of palatal mucous secretions can be countered by using antisialogogues in

conjunction with mouth rinses and gauze packs.

Frank22 (1969) in his study on impression pressures stated that impression pressure

can be controlled by tray design and material selection.

Ellinger23 (1973) said that the success of a complete denture was determined by

correct clinical procedures for each given step. The making of an impression, was

one of these steps. The author in this essay tried to gave some tips as to how; we

can minimize problems in making a complete lower impression.

Kiein24 (1973) in her article on complete denture prosthetic procedure mentioned on

primary impression and final impression technique.

Smith25 et al (1979) described a technique which used polyether impression material

for border moulding of complete denture impressions. There was simultaneous

moulding of all borders of either maxillary or mandibular impressions. The border

 ϭϮ


moulding could be accomplished with insertion of the tray. Functional movements

performed by the patient were used in border moulding.

Mc Arthur31 (1980) described a technique of making individualised impression trays

from existing complete dentures. With this method the patient must have existing

dentures, and the border extension must be adequate.

Zinner26 (1981) gave an analysis of the development of complete denture

impression technique. He said that the history of impression making shows that

most of the significant advances occurred before 1930. Basic principles of pressure

maximum extension and equal distribution of pressure were first introduced in 1845-

1899. During 1900-1929 accuracy of impression techniques were emphasised. A

newer method of border moulding was one of the major innovations of the era. The

era from 1930 to 1940 saw great advances in the knowledge of the anatomy of

tissues as they affect impression making. The use of immediate denture technique

and the introduction of several new materials like zinc oxide euginol paste and

hydrocolloids were also noted.

Klean27  LQ KHU DUWLFOH ³SK\VLRORJLF determinants of primary impressions for

FRPSOHWH GHQWXUHV´ JDYH RQ DFFRXQW RI WKH SULPDU\ LPSUHVVLRn procedures in

maxillary and mandibular complete dentures. she modified the periphery of the

compound impression by using Kerr impression wax.

Klein28 (1985) described a secondary impression technique which helps to minimise

distortion of the ridge and border tissue. Clear acrylic resin tray aid in eliminating

excessive displacement at the secondary impression phase. The areas of blanching

can be seen through and such areas were marked and relieved.
 ϭϯ


Shigeto Minagi et al31 (1988) described the concept and technique for making an

accurate final impression for complete dentures using a thixotropic material.

Aquaviva Fernandes et. al29 (2006) described µcorrective Primary Impression

Technique¶ DV a simple, quick and corrective technique for making the preliminary

impression. The defects, which were present in the primary impression with

compound, can be corrected with the use of alginate hence this technique can be

FDOOHGDV³FRUUHFWLYHSULPDU\LPSUHVVLRQWHFKQLTXH´

Anuj Chhabra et al32 (2006) described simple and rapid approach of making the

preliminary impression with sufficient viscosity yet with ample working time.

This may enable the operator to fashion the preliminary impression in a single

operation with practice.

E.G.R.Solomon2 (2011) described complete denture impressions, factors affecting

the properties of impression materials, landmarks of edentulous jaws, biological

considerations in complete dentures.

Kerstin wegner et al33 (2011) described the influence of two functional complete

denture techniques on SDWLHQW¶V satisfaction.

FIXED PARTIAL DENTURE IMPRESSION

Hudson38 (1958) described the clinical use of rubber impression materials and said

a combination mix of light and heavier bodied materials may be used in a disposable

stock tray or a custom made acrylic resin tray for making impressions for fixed partial

dentures. The special syringe was used to inject the light bodied material into the

prepared cavities or about the crown preparation.

 ϭϰ


Davis34 (1958) described the use of rubber base impression materials in the

construction of inlays.

Smith35 (1963) described GHQWLVW¶V responsibility in laboratory procedures and said

that there were many ways to make a good impression, many impression techniques

and materials were there. The merit of each had been evaluated by each dentist.

Duxbery36 (1963) described use of impression trays for rubber base impression

material.

The study cast was covered with one layer of base plate wax which serves as

a spacer. Stops were cut in the wax and a covered cold cure acrylic resin tray was

made.

For smaller LPSUHVVLRQ RI RQH WRIRXUWHHWK  $ µ8¶VKDSHG WUD\ RI perforated

metal of bicuspid or molar size was cut to the required length. A roll of cold curing

acrylic resin material was made. The resin was beaded around the border of the

tray. The tray was placed in the mouth and moulded.

Fusayama37 (1966) described a one piece cast permanent splint for making of the

impression. He used an indirect technique using irreversible hydrocolloid and a

specially designed instrument. The material was spatulated and injected into the

preparation. The tray for the anterior teeth was filled with the impression material

and placed in position or the preparations while the mix was fluid. The impression

was left in the mouth for two minutes after apparent gelation. Then it was removed

and immersed into a 2% znSo4 fixing solution. Then the stone was poured.
 ϭϱ


Going39 (1968) mentioned an accurate rubber base impression procedure. The

gingival retraction was done in the conventional manner. While the dental assistant

was mixing the light bodied material and filling the syringe, the teeth and surrounding

tissues were dried. The retraction cords were removed carefully and light bodied

rubber base impression material was injected into the preparation. The dentist

injects impression material into each gingival trough, and the cavity preparation. A

second injection of the light bodied material was applied to the preparation and

surrounding tissues.

Sheulin40 et al (1970) in their article on the accuracy of correcting a defective rubber

base impression tried these impression techniques, Then the tray filled with heavy

bodied impression material was seated with a slight rocking motion to force the light

bodied material further into place and to express air trapped in placing the tray.

Hubert Darby43 et al (1973) gave a procedure for void free impressions.

Anthony G. Gallegos41 et al (2004 GHVFULEHG WKH XVH RI WKH WRGD\¶ LPSUHVVLRQ

materials, faults in the impression materials, and how to eliminate them.

Len Boksman(2005)43 described requirements of an impression materials and

eliminating variables in impression taking.

Nachum Samet et al (2005)44 described methods to assess the quality of

impressions The study evaluated the quality of impressions sent to commercial

laboratories for the fabrication of fixed partial dentures (FPD) by describing the

frequency of clinically detectable errors and by analysing correlations between the

 ϭϲ


various factors involved A total of 193 FPD impressions were evaluated, immediately

after arrival at 11 dental laboratories, by 3 calibrated examiners. Of the impressions,

89.1% had 1 or more observable errors.

Abdul Rohman Salem45 et al (2009) studied methods to assess the quality of

impressions and was sent to dental laboratories in Jordan. A sample of 136

impressions and stone casts were examined for technical errors in 35 laboratories

that construct fixed partial dentures. They were sorted into these categories:

unusable, unsatisfactory, acceptable or satisfactory. The quality of impressions and

casts made for fixed partial denture assessed were considered unsatisfactory

or unusable in 50% of cases.

Gregori M. Kurtzman47 (2012) described the potential concerns during impression

capture and addressed approaches to improve the overall quality of impressions

taken.

Gary jenkinson46 (2012) described how to spot distortion in an impression and the

methods to avoid that.

REMOVABLE PARTIAL DENTURE IMPRESSION

Mc Cracken50 (1963) on philosophy of partial denture treatment concluded that

elastic impression material which had good accuracy should be used, there were

some advantages to the use of individual impression trays, but since all free end

partial dentures should be made from dual impressions to provide maximum support
 ϭϳ


for the free end bases, a hydrocolloid material was usually used to make an

impression of the anatomic portion.

Rapuano48 (1970) gave a single tray dual impression technique for distal extension

partial dentures. The denture bases were functionally loaded and the functional load

was applied along the entire length of the posterior occlusion of the removable partial

denture and a less bulky final impression was obtained.

Fairchild49 LQKLVDUWLFOH³9HUVDWLOHXVHRI$OJinate impression materiDO´JDYH

the various uses of alginate impression material which facilitates procedures

common to practice of removable prosthodontics.

Appleby51 (1980) described a combined reversible hydrocolloid, irreversible

hydrocolloid system.

Lee52 (1980) gave an elaborate description on the mucostatic impression technique

and principles. He said that the mucostatic is a principle not a technique.

Beanmount56 (1983) gave an impression procedure for maxillary class I removable

partial dentures.

Kastner53 et al (1983) described the fabrication of individualised preliminary

impression trays.

Mc Arthor54 (1984) described an impression procedure for fabricating a full

coverage restoration for existing removable denture.

Bomberg55 (1984) described that the technique of reseating two defective

impression on a preparation by the addition of a controlled amount of impression

 ϭϴ


material for correction purpose. He found out that the results were highly un

predictable.

Wood ward57 (1985) concluded that irreversible hydrocolloid impression made in

perforated trays were more accurate than in rim lock trays, for production of an

accurate cast.

Tjan58 et al (1986) in their study on the accuracy of impression materials found that

the elastic impression materials when properly handled exhibited good clinical

accuracy. Elastomeric impression materials which were made with reversible

hydrocolloids as elastic impression materials were capable of producing clinically

accurate dies.

Zinner63 (1987) described several impression techniques for removable components

of a combination fixed and removable prosthesis.

Nemetz59 HW DO  GHVFULEHG ³5HYHUVLEOH K\GURFROORLG ZDs the oldest elastic

impression material and with appropriate methodology the advantage outweigh the

disadvantage. Skill care and comprehension of the physical properties of the

material ensure success.

Von krammer60 (1988) described a two stage impression procedure for distal

extension removable partial dentures.

A technique was described where an accurate impression of the teeth and

correct border extension of the ridges were obtained with the use of a single custom

tray in conjunction with a single impression material or a combination of materials.

 ϭϵ


Gunne61 et al (1990) conducted a study on the impression techniques for R.P.Ds.

their results indicated that zinc oxide eugenol paste in a border molded tray

produced more extended impression lingually.

Rob Veis62 (2005) described indications, description, treatment procedures, and

contraindications of accurate alginate impressions.

Robert W. Rudd64 (2005) described a review of 243 errors possible during the

fabrication of a removable partial denture. This article was helped eliminating some

of the errors that can be made by those who handle the materials used during the

fabrication of an RPD and perform the procedures required for that process.

DISCUSSION

PRINCIPLES AND OBJECTIVES OF IMPRESSION MAKING:

The basic objective of a maxillary or mandibular impression is to record all the

potential denture-bearing surface available. To a large extent this surface is readily

identified if the biologic considerations of impression making are correctly

understood.1 +RZHYHU WKH GHQWXUH¶V UHWHQWLRQ LV HQKDQFHG FRQVLGHUDEO\ LI WKH

denture extends peripherally to harness the resiliency of most of the surrounding

limiting structures. Therefore clinical techniques and above all, judgement must be

reconciled so that objectives for impression making are to be fulfilled. 1

Although impression techniques, methods and materials of choice are

constantly changing, they nevertheless should be selected on the basis of biologic

factors. Techniques too often follow shortcuts, perhaps to satisfy the SDWLHQW¶V desire
 ϮϬ


for immediate results, without a consideration of the future destruction that such

procedures may induce.2

The objectives of an impression are to provide retention, stability, and support for the

denture.3 An impression also may act as a foundation for improved aesthetics and at

the same time should maintain the health of the oral tissues. 2

Retention for a denture is its resistance to removal in a direction opposite that

of its insertion. It is the quality inherent in a denture that resists the force of gravity,

the adhesiveness of foods, and the forces associated with opening of the jaws.

Retention is the means by which dentures are held in position in the mouth. When

the soft tissues over the bones are displaced under pressure, the denture bases may

lose their retention because of the change in adaptation of the basal surface of the

denture to its basal seat.3

Stability of a denture is its quality of being firm, steady and constant in

position when forces are applied to it. Stability refers especially to resistance against

horizontal movement and forces that tend to alter the relationship between the

denture base and its supporting foundation in a horizontal or rotary direction. The

size and form of the basal seat, the quality of the final impressions, the form of the

polished surfaces and the proper location and arrangement of the artificial teeth play

a major role in the stability of dentures.3

Support is the resistance of a denture to vertical components of mastication

and to occlusal or other forces applied in a direction toward the basal seat. Support

is provided by the maxillary and mandibular bones and their covering of mucosal

tissues.3 It is enhanced by selective placement of pressures that are in harmony with

the resiliency of the tissues that make up the basal seat.

 Ϯϭ


Biologic principles of tissues health must be adhered to before a final impression

procedure will enhance the retention, stability, and support of a denture.5

(Which are all interrelated features):

1. The impression extends to include entire seat within the limits of the health and

functions of the supporting and limiting tissue.

2. The borders are in harmony with the anatomic and physiologic limitations to the

oral structures.

3. A physiologic type of border-molding procedure is performed by the dentist or by

the dentist under the guidance of the dentist.

4. Proper space for the selected final impression material is provided within the

impression tray.

5. Selective pressure is placed on the basal sea during the making of the final

impression.

6. The impression can be removed from the mouth without damage to the mucous

membrane of the residual ridge.

7. A guiding mechanism is provided for correct positioning of the impression tray in

the mouth.

8. The tray and final impression are made of dimensionally stable materials.

9. The external shape of the final impression is similar to the external form of the

completed denture.
 ϮϮ


Anatomic considerations in impression making:

Correlation of anatomical landmarks. A, Intraoral drawing of the maxillary arch; 1, labial

fraenum; 2, labial vestibule; 3, buccal fraenum; 4, buccal vestibule; 5, coronoid bulge; 6,
residual alveolar ridge; 7, maxillary tuberosity; 8, hamular notch; 9, posterior palatal seal
region; 10, foveae palatinae: 11, median palatine raphe; 12, incisive papilla 13, rugae. B,
Maxillary final impression shows the corresponding denture landmarks: 1, labial notch; 2,
labial flange; 3, buccal notch; 4, buccal flange; 5, coronoid contour; 6, alveolar groove; 7,
area of tuberosity, 8, pterygomaxillary seal in area of hamular notch; 9, area of posterior
palatal seal; 10, foveae palatinae; 11, median palatine groove; 12, incisive fossa; 13, rugae.

Correlation of anatomical landmarks A, Intraoral drawing of the mandibular arch; 1, labial

fraenum; 2, labial vestibule; 3. buccal fraenum; 4, buccal vestibule; 5, residual alveolar ridge;
6, retromolar pad; 7, pterygomandibular raphe; 8, retromylohyoid fossa, 9, alveololingual
sulcus; 10, tongue; 11, lingual fraenum; 12, buccal shelf; 13, premylohyoid eminence. B,
Mandibular final impression showing the corresponding denture landmarks 1, labial notch; 2,
labial flange; 3, buccal notch; 4, buccal flange, 5, alveolar groove; 6, retromolar fossa; 7,
pterygomandibular notch, 8, retromylohyoid eminence, 9, lingual flange; 10, inclined plane for
the tongue, 11, lingual notch, 12, buccal flange that fits on the buccal shelf; 13, premylohyoid
eminence.
 Ϯϯ


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Successful complete-denture impressions require an appropriate mold (tray),

method (impression technique) and material (impression material). Individually, their

importance relative to the outcome of the procedure is of minor importance. 6 When

considered in the context of an encompassing technique, however, they are the

cornerstones of obtaining optimal denture stability and retention.6 The mold, method,

and materials often differ between the preliminary (primary) and master (final)

impressions.

Preliminary Impressions:

Selection of an appropriate impression tray begins with the preliminary

impression.7 The ideal features of a preliminary impression tray include
(1) Rigidity

(2) Ease of modification

(3) Compatibility with the impression material

(4) Smoothness or comfort in the oral environment

(5) Ability to be sterilized for reuse (or disposability).

Stock metal or rigid plastic trays that represent a reasonable approximation of

the size and shape of the existing anatomic structures should be selected.
9
Identification of the edentulous ridge areas should be done. Both edentulous and

dentate stock trays are available for preliminary impression procedures. Both types

of stock trays can be modified by bending, shortened by grinding, or extended by

adding compound or wax to cover the entire basal seat area properly, in both types

of trays, the resulting preliminary impression should be overextended in all areas,

 Ϯϰ


recording all supporting tissues. Edentulous trays are favoured for making

impressions of edentulous arches; however, the current trend toward using

disposable impression trays precludes their use because disposable edentulous

trays currently are not available.4 It is at the preliminary impression stage that the

clinician best is able to remake questionable impressions select alternate trays, or

re-evaluate the chosen method.

Material

The impression material of choice for preliminary impressions is irreversible

hydrocolloid. It can be mixed by hand spatulation, or by mechanical spatulation with

or without vacuum. Its advantages include low cost, hydrophilic nature, and the

ability of the clinician to modify its setting time and viscosity by changes in the water

temperature or water to powder ratio without affecting the properties of the material

adversely. Its disadvantages include lack of surface detail (when compared with

other impression materials) and dimensional stability. Owing to the process of

irreversible hydrocolloid impressions should be disinfected immediately, placed in a

humidor or plastic zip-lock bag, and poured within 10 to 15 minutes after removal

from the mouth. Preliminary impressions should be poured in plaster; care should

be taken to remove the set cast prior to the dehydration of the irreversible

hydrocolloid. Failure to do so may result in damage to the surface of the retrieved

cast. Plaster is advantageous when fabricating custom trays for master impressions

because it allows for easy retrieval of the custom tray from the preliminary cast. The

preliminary with the anatomy of the patient to verify the extension of the planned

denture peripheries prior to dismissal of the patient. Direct comparison with the

patient is necessary for proper construction of the custom tray used for the master

impression procedures. The peripheral extent of the proposed dentures is indicated

 Ϯϱ


with indelible pencil on the impression, or with pencil on the resultant preliminary

cast.14

Composition, sometimes called impression compound, is the name given to a

class of thermoplastic materials containing various waxes, resins and fillers which

soften in hot water and harden at or slightly above mouth temperature. Many

proprietary brands are obtainable with optimum working temperatures about 65°C at

which temperature they should flow easily. Whichever composition is selected for

this impression the PDQXIDFWXUHU¶V instructions regarding its working temperature

should be observed.

Composition (impression compound) with its high viscosity, is the only

material suitable for this technique and by varying its degree of softness, and thereby

its rate of flow, the amount of compression obtainable can be controlled within

reasonable limits. A compression impression which has been thoroughly chilled, its

surface heated and the impression reseated can exert far greater compression than

one in which the composition is equally softened throughout its entire mass.17

Method:

a) Preliminary impression with impression compound

Impression Compound

Advantages:

1. It can be used for compressing soft tissues.

2. It can be added to and re-adapted.

3. It can be used for any technique requiring a close peripheral seal.

4. It can be used in combination with other materials.

5. It is a good space-filler and does not slump.

 Ϯϲ


6. Pouring the impression may be delayed, as there are no appreciable dimensional

changes.

7. It is cheap.

Disadvantages:

1. It distorts easily and should not be used where excessive undercuts exist. It may

also be distorted if any pressure is applied to it out of the mouth before it has been

chilled.

2. It does not reproduce fine surface detail.

3. As it can be re-softened and used again it tends to be unhygienic because it

cannot be sterilized without destroying its properties.

4. It can only give an accurate impression with a long and difficult technique.

Indications for use:

1. As a preliminary impression for the construction of individual trays.

2. To modify the fit of stock trays.

3. To obtain peripheral seal

4. For compression impressions.

The upper impression

The composition is softened and prepared in the way already described for

the lower impression. When ready it is formed into a ball and placed in the center of

the palate of the warmed tray. It is then molded outwards to the periphery until the

whole tray is filled, leaving a smooth, uncreased surface identified to form a trough

for the ridge and slightly raised in the middle for the palatal vault. Sufficient
 Ϯϳ


composition must be molded along the periphery to enable the depth of the buccal

and labial sulci to be reached without having to force the tray upwards too far. This

is because excessive pressure together with an abundance of composition in the

palatal region will cause it to flow backwards so far over the soft palate that retching

and vomiting may result.19

It will be seen that the palatal area receives composition from two directions,

while the sulci are filled from only one.

Once the composition has been adapted to the tray the surface is lightly

flamed, tempered in the water bath, inserted in the mouth and centred under the

ridge. Keeping the tray handle in line with the median sagittal plane of the face

ensures correct centring. Firm upward pressure now seats the impression in place

ready for the peripheral moulding. Alternate cheeks are gently pulled upwards and

outwards, and then downwards and inwards and slightly backwards the first

movements release any trapped air or folds of tissue, while the other three

movements simulate the function of the cheek when drawn into aid the placing of

food over the occlusal surfaces of the teeth, and to clear the sulci of debris. The

labial trimming can similarly be carried out by manipulations by the operator or the

patient can be asked to purse up the lips as tightly as possible, then to retract them

forcibly and finally to try to push the impression down with pressure of the upper lip.

During these manoeuvres the tray is firmly held in position and for a further minute

before being removed, chilled and inspected In order to avoid cross-infection

between the clinical area and the laboratory, the impressions may be immersed in a

1 in 20 aqueous solution of chlorhexidine gluconate before delivery to the

laboratory.19
 Ϯϴ


COMMON FAULTS IN UPPER IMPRESSIONS:-

1. A crevice in the mid-line of the palatal posterior third.

Causes:-

a) Insufficient composition in the palatal area when filling the tray.

b) Insufficient pressure.

2. Excess composition extending well beyond the posterior palatal border of the
tray.

Causes:-

a) Excessive pressure or too prolonged pressure when seating a tray.

b) Too much composition in the palatal area when filling the tray.

composition which is unsupported by the tray will fall away from the palate by its
own weight dragging some of the supported composition with it and producing an
accurate impression. Upward pressure on the tray should cease when the
impression material is approximately 1cm beyond the posterior border of the tray.

3. An impression short in one or more regions of the sulci, especially the areas
of the tuberosities or the labial sulcus.

Causes:-

a) Insufficient material in the tray.

b) Failure to mould the peripheral composition in this region when filling the tray so that
it will slip up between the cheek and the tuberosity or the lip and the alveolar ridge.

c) Failure to pull the upper lip outwards and upwards sufficient to allow the composition
to flow into the labial sulcus.

d) Insufficient pressure.
 Ϯϵ


4.) Edge of the tray showing the impression

Causes:-

a) Incorrect centering of the tray before seating.

b) Poorly selected or adapted the tray.

Most deficiencies can be corrected by the addition of small amounts of composition,

as described for the lower impression, but if the tray has been malpositoned or is
small it is better to retake the impression than to attempt adjustments. Palatal excess
should be avoided and therefore, is not considered.21
 ϯϭ


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 ϯϮ


2. The lower impression

The selected composition is placed in a water bath, preferably

thermostatically controlled to maintain the recommended temperature. After a few

minutes the composition is removed from the bath, folded repeatedly from the edges

to the centre thus always presenting a smooth surface on one side and replaced as

quickly as possible to prevent undue loss of heat. Kneading of the composition

incorporates water which acts as a plasticizer and this procedure is repeated until

the material has acquired a uniform softness throughout.

When the composition is ready for use the metal lower tray is warmed in a

Bunsen flame, the composition formed into a suitable-sized roll and placed in the

tray. (If a disposable plastic stock tray is used there is no need to warm it) it is

important to have sufficient bulk extending beyond the flanges so that there is no

restriction in flow when pressed into position over the ridge. a trough may be

indented in the composition with the finger to simulate the ultimate ridge impression,

the surface quickly flamed so that surface detail will be recorded, and tempered by

immersing momentarily in the hot water bath to avoid burning the patient. The tray is

placed in the mouth and when the operator is satisfied that it is a position in relation

to the ridge and correctly centred, the patient is instructed to raise and slightly

protrude the tongue and as this movement begins the tray is pressed vertically

downwards to seat the impression to the desired depth. Pressure in a backward

direction may also be required to counter the forward thrust from the tongue when

protruded.

As soon as the impression is seated in position it must be held there firmly but

without any increase in pressure. In other words, the maximum pressure must be
 ϯϯ


exerted when the composition is nearest to the optimum working temperature as the

farther it drops below that, the less readily will it flow.

The impression obtained so far will reproduce, though not accurately, the

denture-bearing surface, but will be over-extended round the periphery and an

individual tray constructed from it would require considerable time-consuming

adjustment before it could be used for making a master impression. This reduction

of the individual tray can be eliminated, or at least very considerably reduced, if the

muscles around the periphery are brought into play to mould the preliminary

impression and this is done in the following manner.

This is held firmly in position while the patient protrudes the tongue. This

movement of the tongue draws forward the palatoglossal arches, raises the floor of

the mouth and tenses the lingual frenum and thus moulds the composition in the

lingual sulcus to the raised position of these structures. The buccal sulci and frenum

are moulded by manipulating alternate cheeks downwards and outwards, to free any

trapped folds of tissue and then pulling gently upwards, inwards and slightly

backwards to obtain the approximate functional positon. 19

The impression is now completed and all that remains is to hold it lightly but

firmly in place for a further minute, remove, chill thoroughly in cold water and inspect.

COMMON FAULTS IN LOWER IMPRESSIONS:-

1. Insufficient depth in the posterior lingual pouch

Causes:-

a) Flange of the tray short in this region.

b) Lack of composition in the tray.

c) Too little force used in the seating the tray.

 ϯϰ


d) Tongue trapped in the tray flanges because the patient fail to raise the tongue as the

tray was seated.

In some cases it is necessary to push the compound into the lingual pouch area with

the forefinger just before the tray is finally seated.

2. Insufficient depth in the lingual, labial and buccal sulci.

Causes:-

a) Lack of impression material.

b) Not seating the tray with sufficient pressure.

3. The presence of a smooth hollow in the buccal distal periphery.

Causes:-

a) The check was not released from beneath the compositon border during functional

trimming.

4. Edge of the tray showing the impression

Causes:-

a. Incorrect centering of the tray before seating

b. In the anterior lingual region, the forward thrust of the tongue not being countered by

sufficient backward pressure on the tray.

c. Use of too large a tray for the mouth or failure to trim the flanges adequately.
 ϯϱ


Correction to faults 1 and 2 may be made by adding small softened pieces of

composition to the perfect areas and reseating and remount the impression.21

The errors due to cheek folds 3 should be corrected by reheating the impression in

that area and readapting while 4 requires an entirely new impression.

While adding composition to an impression the later should first be thoroughly chilled

and dried and the area requiring correction flamed sufficiently to make it sticky.

A piece of the softened material is then taken, lightly flamed and attached to the

main impression and moulded to the approximate shape required. Its surface is

again flamed and momentarily plunges into the hot water bath before being seated in

the mouth.21

Once the area to be readapted should be heated, the remainder being kept as cool

as possible to avoid distortion on reinsertion.23

 ϯϲ


a. Edge of the tray is visible

b. Insufficient depth in the labial, lingual

and buccal sulci.

c. Insufficient depth in the posterior

lingual pouch.

d. Tongue trapped in the tray flanges

because the patient fail to raise the
tongue as the tray is seated.

a) Edge of the tray is visible

b) Too much force used in the seating

of the tray.

c) Incorrect centering of the tray before

seating

d) Borders are not uniform

a) Not seating the tray with sufficient

pressure.
b) Use of large tray for the mouth or
failure to trim the flanges adequately.
c) Not proper tongue movements.
d) Borders are not uniform.
e) Edge of the tray is visible.

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 ϯϳ


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 ϯϴ


b) Preliminary impression with Irreversible hydrocolloid:

Impression for the Mandibular Arch:

1. Select a slightly oversized perforated impression tray. The mandibular tray

should be refined at its posterior borders with utility wax to carry the impression

material to place.

2. Mix the irreversible hydrocolloid impression material according to the

PDQXIDFWXUHU¶V VSHFLILFDWLRQV  ,Q WKLV VWHS RI WKH SURFHGXUH WLPH WHPSHUDWXUH RI

water and quantity of material are critical. A time clock should be used.

3. Just before inserting impression material instruct the patient to irrigate his mouth

with astringent mouthwash to reduce viscosity of saliva.

4. Load the tray from the side slightly over level full.

5. Using mouth mirror, place a small amount of impression material in the right and

left retromylohyoid spaces.

6. Seat the tray in the mouth. Instruct the patient to raise his tongue and let it fall

slightly forward. Vibrate the tray to place until the material flows out into the labial

and buccal reflection areas.

7. Hold the tray in place for three minutes. Remove from the mouth. Rinse under

gentle stream of tap water, dry and pour immediately with dental plaster or stone.

ERRORS IN LOWER IMPRESSIONS:-

 ϯϵ


a) Removing the impression before

setting time- leading to tearing of thr
impression

b) Edge of the tray is visible

c) Insufficient depth in the posterior

lingual pouch.

d) Tongue trapped in the tray flanges

because the patient fail to raise the
tongue as the tray is seated.

a) Edge of the tray is visible

b) Too much force used in the seating

of the tray.

c) Incorrect centering of the tray before

seating

d) Borders are not uniform

a) Tongue trapped in the tray flanges

because the patient fail to raise the
tongue as the tray is seated.

b) Not proper tongue movements.

c) Borders are not uniform.

d) Edge of the tray is visible.

e) Insufficient depth in the posterior

lingual pouch.

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 ϰϬ


Impression for the Maxillary Arch:

1. Select proper sized tray and using utility wax, extend across the posterior border

and the distal termination of the buccal flange area. If necessary the labial flange

may be altered with utility wax. When the patient has a very high vault utility wax

may be added to this area in the tray these alterations are accomplished to carry the

impression material more accurately to place and insure the same bulk throughout

the palate.

2. Immediately prior to mixing to the impression material, wipe the posterior palatal

seal area of the hard palate and the soft palate with gauze to remove excessive

saliva.

3. Mix impression material as above load the tray from the side.

4. Using the mirror or index finger as a carrier placed the remaining material in the

vault of the palate and the buccal vestibule.

5. Place the tray in the mouth so that the impression material in the tray attaches

itself to the impression material in the mouth.

6. Vibrate the tray and seat until the impression material flows out into the buccal

and labial reflection areas and over the posterior palatal seal area. As the tray is

being seated, instruct the patient to keep his eyes open, relax, take short breaths

through the nose, and flex the head forward.

7. Hold the impression material in place for three minutes remove from the mouth,

rinse with tap water, dry and pour immediately with dental plaster or stone.

ERRORS IN UPPER IMPRESSIONS

 ϰϭ


a) Removing the impression before

setting time- leading to tearing of the
impression

b) Edge of the tray is visible

c) Excess composition extending well

beyond the posterior palatal border
of the tray

d) Impression is short in one or more

regions of the sulci.

a) Insufficient composition in the palatal

region when filling the tray.

b) An impression short in one or more

regions of the sulci, especially the
areas of the distobuccal flange.

c) Non-homogenous mix of the

material..

d) Edge of the tray is visible.

a) An impression short in one or more

regions of the sulci, especially the
areas of the distobuccal flange.

b) Incorrect centering of the tray.

c) Impression borders are not on tray

borders.

d) Excess composition extending well

beyond the posterior palatal border
of the tray
 ϰϮ


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ERRORS IN ALGINATE IMPRESSIONS

Error 1

Using an expired irreversible hydrocolloid.

This will lead to greatly reduced tear resistance and elasticity of the set material.

Solution

Always to code the expiration date or test a little quantity of the material according to
the manufacturer's instructions.64

Error 2

Incorrect storage of the material (Heat or Cool or Freeze), this will alter the setting
time of the material and it will be severely in case of high cooling and irregular in
case of heat.

Solution

Store irreversible hydrocolloid in a controlled temperature between (4.5 - 32.2) 0C

Error 3

Unsealed container or unclosed after used , This will lead to moisture contamination
and alter of the chemical and physical properties of the Alginate material.

Solution

Test the material before using; otherwise you have to be sure of sealing.

Error 4
 ϰϯ


Using irreversible hydrocolloid that has been contaminated by particles of gypsum

that this may contaminate the entire material. 64

Solution

Use a separated dry spatula and rubber bowel for mixing.

Error 5

Using too thin mixture of Alginate:

- This may cause voids in the impression .

- Alginate flow out of the tray and cause gag reflex.

- The tray could not be able to provide enough pressure on the tissue.

Solution

Follow the manufacturer's instructions concerning theproper water/powder ratio.

Error 6

Using too thick mixture of alginate:

- There will be inaccurate flow of the material.

- Set of the material before seating in the mouth and If that will happen there will be
wrong impression and wrong cast.

Solution

Follow the manufacturer's instructions for mixing the material.

Error 7

Attempting to control the setting time of irreversible hydrocolloid by altering the w/p
ratio: This will lead to unreliable result

Solution

It is advisable to modify the temperature of the water to be more than the room
temperature to set the mixture faster.
 ϰϰ


Error 8

Using tap water to mix the powder:

- It is not too bad but, But it may contain different types of chemicals like -

Chlorine , FDUERQIOXRULGHSRWDVVLXPFDOFLXPDQGVRRQ«Wherefore it is not, easy

to know how are

These compounds affect the mixture, but sure it can alter the setting time.

Solution

Scientifically mixing should be always by using distilled water, otherwise tap water
should be used.

Error 9.

Adding water to powder during mixing; this will leave some remnant of powder
unmixed and lead to inaccurate mixture.

Solution

Always powder should be added to water in order to be sure of dissolve of powder

step by step.

Error 10.

Inadequate mixing time of the irreversible hydrocolloid If it is not mixed enough

pockets of dry or partially wetting can be caused and lead to distortion..

Solution

The correct Hand mixing should be 60 sec. and 15 sec.in case of vacuum mixing.

Error 11.

Partially mixed irreversible hydrocolloid and remaining of unmixed powder around

the top of the mixing bowl the dry or partially wetted I.H is in contact with a tooth or
 ϰϱ


soft tissue therefore, the dry material will expand after removal of the impression
from the mouth and washing it.

Solution

Just be sure that there is no dry powder during preparing of the mixture.

Error 12.

Using an impression tray that is too small;

- This may lead to displace the soft tissues.

- The resulting casts may distort also.

- Impression cannot be removed from the mouth without distortion

And tearing, and sometimes the tray may be separated from the impression during
pulling and removing.

Solution

Just be certain to use a suitable size of tray or modify the tray to be suitable.

Error 13

The impression tray is too large;

-The irreversible hydrocolloid material may be away from the soft tissues, e.g; palatal
surfaces.

- It also may be difficult to seat the tray posterior e.g; ramus of mandible.

Solution

The selected tray should be a way from the tissue about few millimeters.

Error 14.

Irreversible hydrocolloid sets under pressure this will cause a distorted impression.

Solution
 ϰϲ


Release the pressure required to seat the impression as soon as it is seated.

Error 15.

applying continuous pressure when seating an impression in a perforated tray;

- It may lead to escape of impression material and lead to a thin layer cover the
teeth.

Solution

Impression Always should be remade.

Error 16.

Failure in support the tray during the initial setting time of the impression about 30
sec it may cause movements of the impression due to tongue movements by the
patient.

Solution

Always highly control the tray and the patient.

Error 17.

Do not allow enough time for the impression material to flow before it sets that may
lead imperfect registration of anatomy of the tissue.

Solution

I H provide a 15 sec. for flow if you need more time you have to use cool water to
increase it to 20 sec.

Error 18.

Making an impression with a coated layer of plaque and debris on the teeth and
interproximal areas This will produce inaccurate cast due to unreliable impression.

Solution

Routinely scaling and polishing should be done before making impression for such
cases by using lubricating prophy paste.
 ϰϳ


Error 19.

Failing to remove prophy pumice and paste may lead to the same problem of the
plaque and debris.

Solution

Use strong air-water spray and scaling if necessary before impression.

Error 20.

Removing the impression before setting time- that may be lead to tearing of the
impression (it is poor tearing resistance).

Solution

- Wait to exact setting time of the material; moreover give additional 2min for
complete curing of the inner material.

- At the same time check the remains of the mixture in the bowel to be sure that the
material is set.

Error 21.

Leaving the impression too long time in the patient mouth;

- It may lead to adhere of the material to the teeth and there will be no enough time
to pour the impression with stone.

Solution

Always check time and follow the accurate method of manipulation.

Error 22.

Removing the impression slowly or with a rocking movements lead to distort the
impression.

Solution
 ϰϴ


Twists the tray otherwise breaks the seal by insert fingers posterior and slightly
snaps movements to the tray.

Error 23.

Failing to inspect the impression and pouring it without checking;

This may lead to undetected defect then to recall the patient for another visit to
repeat the impression.

Solution

Check the impression by light and compare it with the patient mouth and the study
model, if there is any defect it is better to remake the impression immediately better
than the later visit.

Error 24

Failing to clean the impression before pouring with stone may interfere with produce
an accurate cast.

Solution

Always rinse the impression with tap water to remove any debris.

Error 25.

Delay pouring the impression:

This will lead to syneresis and shrinkage of material.

Solution

Impression should be poured immediately after removed from the mouth otherwise
should be covered by a wetted piece of cloth but not more than 10-12 min. in order
to avoid dimensional changes.
 ϰϵ


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 ϱϬ


Alginate;

Advantages:

1. It produces excellent surface detail.

2. It is dimensionally accurate if poured within a short time of removal from the

mouth.

3. It is elastic and will spring over bulbous areas returning to its correct position

when removed from the mouth; this only applies if the undercuts are not too deep.

4. It is hygienic, as fresh material must be used for each impression.

5. It is relatively inexpensive.

6. It is relatively inexpensive.

7. There is a wide range with different viscosities for different clinical situations.

Disadvantages:

1. It does not readily flow into areas in which the tray does not extend.

2. It cannot be used alone for compressing the tissues.

3. It cannot be added to if faulty.

4. Distortion may occur without it being obvious; it must be held stationary in relation

to the tissues throughout its setting period and it must remain adherent to the tray

during removal.

5. It is liable to distortion in the laboratory.

6. It is difficult to box in the laboratory.

Indications for use:

1. For preliminary impressions.

2. For master impressions in rigid individual trays.

 ϱϭ


Suggestions For The Clinical Use Of Alginates

1. The use of perforated metal trays or rimlock metal trays is strongly suggested.

resin trays can be used with success if they are perforated with many holes.

2. Teeth should be cleaned adequately by scaling and polishing before impressions

are made.

3. The mouth should be rinsed well with slightly flavored water at body temperature,

hot or cold water or very astringent mouth rinses should be avoided, as they can

stimulate a body reaction to secrete saliva and mucus, with the resultant undesirable

changes in the impression.

4. Just before placing the alginate impression, the mouth should evacuated clear of

saliva, and an air stream should be blown on the remaining teeth. This air drying is

particularly important in any areas that are to contact with removable partial denture

rests or retainers.

5. As the alginate impression is ready to be placed in the mouth and after air has

been blown on the remaining teeth, a small amount of alginate should be placed on

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locations are the following:

(1) The palate area, especially if it is a high vault or if clefts or indentations

exist:

(2) Occlusal surfaces of all remaining teeth, which often trap numerous

bubbles if not filled with alginate by finger pressure before placing the impression

tray; and
 ϱϮ


(3) Any rests or areas of teeth that are to contact removable portions of the

prosthesis.

6. With any material, placement of the mandibular impression is suggested before

the maxillary impression. Apprehension of patients is higher for the maxillary

impression because of the gag reflex. Therefore, making the mandibular impression

first relieves anxiety when the maxillary impression is placed. Less apprehension

means decreased secretions, less gagging and better impressions.

7. Air bubbles are often formed in the mucobuccal fold area. If the soft tissue is not

pulled toward the facial to free those bubbles and to allow flow of the alginate into

the tissue fold, air bubbles will result in projections on the cast. Custom trays

fabricated on such casts will lack surface detail and intimacy of contact.

8. A common problem with alginate impressions is their premature removal from the

mouth. Alginate impressions should be left in the mouth for 2 to 3 minutes after they

are firm to the touch for adequate maturation of the chemical set.

9. Impressions should be washed with a stream of water to remove debris and

should be dried with an air stream until they have only a slightly moist appearance.

Impressions should be poured within 10 minutes after removal from the mouth for

optimal accuracy.

10. Use of surface tension changing liquids is desirable before pouring alginates.

Placement of very slight quantity of this material is desirable to allow adequate flow

of stone into the impression and to lessen bubbles. Stone should be poured directly

over the slightly moistened impression.

 ϱϯ


Casts should be removed from alginate impressions as soon as the stone has

reached an optimal stage of rigidity. If stone casts are allowed to remain in alginate

impressions until the alginate dehydrates, damaging changes take place in the

surface of the stone

MASTER / FINAL / SECONDARY IMPRESSION:

Mold

Optimal master impressions are achieved best using a custom tray

constructed of auto polymerizing acrylic resin or light-cured composite resin. Custom

tray fabrication and adaptation is one of the most important aspects of complete-

denture impression procedures. The idea features of a custom impression tray

include.

(1) Stability

(2) Rigidity

(3) Proper extension cover the basal seat areas of the edentulous arches (for pro

stability);

(4) A consistently relieved approximation of the vestibular tissues particularly those

involved in the peripheral seal (for proper retention); and ease of modification (either

by grinding or the addition of appropriate material to ensure proper extension.

If the trays overextended, it distorts peripheral tissues during the impression

procedure, leading to an unstable prosthesis that may cause ulceration of the

peripheral tissues. If the tray is under extended, may not maximize the available

denture bearing area, and result in lack retention and stability of the impression tray.

The degree to which relief provided within the custom tray is based on the anatomy
 ϱϰ


and condition of the existing oral structures and on the impression philosophy used

in complete denture construction.

The custom tray should provide the clinician with the best opportunity to

provide stability and retention for the subsequent prosthesis. To be successful, the

custom tray must be maintained in the mouth in a repeatedly stable position

throughout the impression procedures. To achieve this, it should provide intimate

contact with the oral tissues, except in the peripheral areas. These areas should

allow modification of the custom tray during the process of border molding. Border

molding is the shaping of the border areas of an impression tray by functional or

manual manipulation of the tissue adjacent to the borders to duplicate the contour

and size (width and length) of the vestibule of both dental arches.

Impression Material Selection:

Numerous impression materials are available for use in the master impression

procedures. These include the irreversible hydrocolloids, ZOE impression pastes,

polysulfides, polyethers, condensation silicones, and vinyl polysiloxanes.

Impressions Paste (ZOE)18

Advantages

1. It produces excellent surface detail.

2. It is dimensionally accurate as it is only used I a thin layer.

3. It is hygienic, as fresh material must be used for each impression.

4. It does not lose surface detail in wet mouths.

5. It can be added to and re-adapted if faulty.

6. In thin washes it can be used for compressing soft tissues.

 ϱϱ


7. It reduces nausea to a minimum.

8. It adheres well to a dried surface so that when the minimum of material is used

there is little degree of flaking on removal from the mouth.

Disadvantages:

1. It cannot be used when more than a slight undercut exists.

2. May slump in thick layers and therefore can only be used as a wash material.

3. Will not produce a satisfactory impression of the periphery unless supported by a

very accurate or border moulded tray.

4. Some patients find the eugenol content unpleasant.

Indications for use:

1. As a final wash material when using techniques which have produced a closely

adapted periphery.

2. In cases exhibiting pronounced nausea.

 ϱϲ


a) Flecks of impression material on the

borders indicating improper mix.
b) Too many voids and irregularities in
the posterior region indicate
improper flow of material while
recording tissues.
c) Improper impression technique

a) Voids in the posterior region

b) Excess material
c) Improper flow of the material while
making of the impression
d) Overriding of the borders previously
established
e) Entire denture bearing area recorded
under pressure.

a) Improperly positioned tray while

recording

b) Labial flanges too thick

c) Overextensions at posterior region

d) Excess material within the special

tray

&h>dz/DWZ^^/KE^
 ϱϳ


a) Improper molding at buccal vestibule

region
b) Insufficient molding due to the tongue
c) Tray placed slightly anteriorly due to
which the lingual surface in the
anterior region is recorded under
pressure.

a) Overextended impression material

b) Displacement of tray while

recording of the tissues

c) Improper moulding in the vestibular

regions

d) Pressure areas

a) Excessive thickness of impression

material over the borders

b) Improper flow at the time of

impression taking.

c) Insufficient depth in the posterior

lingual pouch.

&h>dz/DWZ^^/KE^
 ϱϴ


&h>dz/DWZ^^/KE^
 ϱϵ


IMPRESSION MATERIAL FOR FIXED PARTIAL DENTURE

Elastomers

Advantages

1. Excellent surface detail.

2. Dimensional accuracy

3. No separator required before pouring casts.

4. Record undercuts but polysulphides may suffer from permanent deformation on

removal.

5. Polysulphides have good tear resistance.

6. Addition silicones have excellent dimensional stability, even in cold sterilizing

solutions.

7. Wide range of different viscosities available to match different clinical situations.

8. Low viscosity silicones suitable for wash techniques

9. Putty silicones are useful as space ±filling materials.

10.
Pleasant appearance and feel in the mouth. 34

Disadvantages

1. They are hydrophobic and so tend to slip on wet, mucus-covered mucosa.

2. Prolonged setting time, especially polysulphides.

3. Tear resistance of silicones is low.

4. Condensation silicones are dimensionally unstable.

5. Silicone putty can easily distort peripheral tissues.

6. Most expensive of all impression materials.

7. After set, borders cannot be adjusted.

8. Polysulphides have strong odour of rubber. 34

 ϲϬ


Indications for use:

1. Where there are severe undercuts.

2. In-patients exhibiting xerostomia.

3. In-patients with lesions of the mucosa, such as pemphigus or lichen planus.

4. For master impressions in rigid individual trays.

Suggestions For Clinical Use Of Polysulfides

1. Lubricate potential skin contact areas of the patient and the clinician.

2. Obtain short setting time polysulfides (5 to 6 minutes)

3. Use the viscosity that suits your needs most adequately

4. Pour impressions within approximately 3 hours after removal from the mouth.

5. Do not spill these materials on clothing. Any inadvertent spill or spot will destroy

the clothing as the elastomer cannot be removed well.38

Suggestions For Clinical Use Of Polyethers

1. /XEULFDWH ERWK WKH SDWLHQW¶V VNLQ DQG FOLQLFLDQ¶V KDQGV YHU\ ZHOO WR DYRLG KDYLQJ

the material stick.

2. Warn the patient about the poor taste of polyethers.

3. Warn the patient that the impression will be difficult to remove from the mouth

because of its rigidity.

4. Mix the material quickly and to a homogeneous consistency. 38

 ϲϭ


Suggestions For Clinical Use Of Condensation Reaction Silicones

1. Casts should be poured very soon after making impressions. Research reports

suggest pouring casts within 1 to 3 hours after removal of the impression from the

mouth. The material shrinks during the first few hours.

2. Because of poor adhesives for these materials, it is advisable to cut holes in the

impression trays if they are not perforated.

3. Purchase of more than a one-year supply of these materials in not suggested

because most of them degenerate rapidly in storage.

4. The liquid catalyst is difficult to proportion with the past exactly each time.

Therefore, squeeze the container to allow counting of number of drops released. 38

Suggestions For Clinical Use Of Addition Reaction Silicones

1. Mix the materials thoroughly to avoid inconsistencies in setting time and other

properties.

2. These materials are relatively fool proof and do not have significantly difficult

clinical use characteristics. 38

ERRORS IN IMPRESSIONS FOR FIXED PARTIAL DENTURE

1. TISSUE CONTACT WITH TRAY

Problem:

‡6L]HDQGVKDSHRIWUD\LVQRWFRUUHFW

‡7UD\LVQRWVHDWHGFRUUHFWO\

‡1RWHQough tray or wash material used

Solution:

‡)LOOWUD\»IXOO8VHPRUHZDVKPDWHULDODURXQG preparation and adjacent teeth.

 ϲϮ


‡8VHFXVWRPWUD\RU-step putty/wash in a stock tray.

‡&KHFNWUD\VL]HDQGUHWDNHLPSUHVVLRQ

‡6HDWWUD\HYHQO\

‡$YRLGWRRWKFRQWDFWZLWKWUD\ZKLOHVHDWLQJ 46

2. NOT ENOUGH WASH MATERIAL & TOOTH CONTACT WITH TRAY & NOT

ENOUGH TRAY MATERIAL

Problem:

‡8QDEOHWRFDSWXUHDOOWKHGHWDLOQHHGHG

‡:LOOQRWEHDEOHWRVXSSRUWWKHZHLJKWRIWKHGLHVWRQHZKHQSRXULQJ

Solution:

‡)LOOWUD\»IXOO

‡8VHPRUHZDVKPDWHULDODUound preparation and adjacent teeth.

‡8VHFXVWRPWUD\RU-step putty/wash in a stock tray. 46

3.) VOIDS & BUBBLES

Problem:

‡,PSURSHUV\ULQJHWHFKQLTXH

‡$LULQFRUSRUDWHGLQWRV\ULQJHZKLOHORDGLQJPDWHULDOLQWRV\ULQJHRUWUD\

‡%ORRGVDOLYDFRQWDPLQation around preparation. 47

 ϲϯ


Solution:

‡7RSUHYHQW³YRLGV´DOZD\V³SXVK´WKHPDWHULDODKHDGRIWKHV\ULQJHWLSDVWKHWLSLV

circled around the prep, and do not pick up the tip around the margin. Keep

expressing syringe material while withdrawing syringe tip.

‡,IXVLQJDV\ULQJHORDGIURPWKHIURQWUDWKHUWKDQWKHEDFN

‡(QVXUHQRH[FHVVSRROLQJRIPRLVWXUH

‡ 5LQVH UHWUDFWLRQ FRUG WKRURXJKO\ SULRU WR UHPRYDO WR HOLPLQDWH VXOIXU EDVHG

contaminates from haemostatic agent or glove.

4.) INADEQUATE MARGINS

Problem:

‡,QVXIILFLHQW7LVVXH0DQDJHPHQW

‡,QVXIILFLHQWZDVKPDWHULDO

‡7LSQRWFRQWLQXDOO\VXEPHUVHGZLWKLQLPSUHVVLRQPDWHULDODQGVXOFXV

‡7HDULQJRIWKHPDUJLQ

‡([FHHGLQJZRUNLQJWLPHRIPDWHULDO

‡0D\UHTXLUHDGGLWLRQDOWRRWKSUHSDUDWLRQIRr adequate sulcus width.

Solution:

‡(QVXUHJRRGWLVVXHPDQDJHPHQW$WOHDVWPPDSLFDODQGPPODWHUDOO\1R

JLQJLYLWLVRU³SXPSLQJ´VXOFXV&OHDQILHOGLVFULWLFDO'RXEOHFRUGPD\DOOHYLDWH
 ϲϰ


‡ .HHS V\ULQJH WLS LPPHUVHG LQ PDWHULDO DQG VXOFXV DQG SXsh the material 360

degrees around sulcus.

‡8VHZDVKPDWHULDOWKDWKDVKLJKHUWHDUVWUHQJWKSURSHUWLHV

‡6HDW5HJXODU6HWPDWHULDOZLWKLQPLQXWHVHFRQGVDQG)DVW6HWPDWHULDOZLWKLQ

35 seconds.

5.) PULLS & DRAGS

Problem:

‡7LPLQJRIZDVKDQGWUD\PDterials not synchronized.

‡7UD\VHDWHGWRRODWH

‡7UD\PRYHPHQWGXULQJLPSUHVVLRQPDWHULDOVHWWLQJUHDFWLRQ

Solution:

‡6HHVHFWLRQRQ0DWHULDO6HOHFWLRQ3DWLHQW(GXFDWLRQDQG6HDWLQJDQG5HPRYDORI

the Tray.

6.) TEARING

Problem:

‡3RRUWHDUVWUHQJWKRf impression material.

‡,QDGHTXDWHVSDFHFUHDWHGGXULQJUHWUDFWLRQ

‡3UHPDWXUHUHPRYDOIURPPRXWK

‡,QDGHTXDWHEORFNLQJRIVHYHUHXQGHUFXWV
 ϲϱ


Solution:

‡ (QVXUH !  PP RI ODWHUDO UHWUDFWLRQ FLUFXPIHUHQWLDOO\ DURXQG ILQLVK OLQH 7KH

greater the bulk of impression material the more resistance to tearing.

‡ 8VH D WLPHU WR HQVXUH WKH VHWWLQJ UHDFWLRQ IURP WLPH RI PL[ LV FRPSOHWH $Q

additional safeguard would be to check the set of the peripheral areas of the

impression prior to removal.

‡%ORFNVHYHUHXQGHUcuts with easily removable material such as soft wax.

7.) INADEQUATE TRAY ADHESION

Problem:

‡7UD\DGKHVLYHQRWXVHGRUDSSOLHGSURSHUO\

‡ 7KH LPSUHVVLRQ PDWHULDO FDQ VKULQN DZD\ IURP WKH WUD\ FDXVLQJ GLVWRUWLRQ WKDW

results in a reproduction smaller than the tooth.

‡ 7KH WUD\ LV QR ORQJHU VXSSRUWLYH RI WKH LPSUHVVLRQ PDWHULDO DQG GLVWRUWLRQ FRXOG

result upon pouring.

Solution:

‡8VHWUD\DGKHVLYHUHFRPPHQGHGE\PDQXIDFWXUHU

‡$SSO\RQHWKLQHYHQFRDWRIDGKHVLYHWRWUD\FRYHULQJDOODUHDVRIFRQWDFWEHWZeen

tray and impression material.

‡$OORZPLQXWHVWRGU\
 ϲϲ


8.) DE-LAMINATION/LACK OF CO-ADAPTATION

Problem:

‡7LPLQJRIZDVKDQGWUD\PDWHULDOVQRWV\QFKURQL]HG

‡0DWHULDOQRWVHWWLQJ

‡/DWH[FRQWDPLQDWLRQ

‡3URYLVLRQDOUHVLGXDOIURPR[\JHQLQKLELWLRQ layer.

‡ %ORRGVDOLYDZDWHU FRQWDPLQDWLRQ HVSHFLDOO\ ZLWK D two-step technique when a

spacer is not used.

‡5HOLQLQJRILPSUHVVLRQZLWKZDVKPDWHULDO

Solution:

‡6HDW5HJXODU6HWPDWHULDOZLWKLQPLQXWHVHFRQGVDQG)DVW6HWPDWHULDOZLWKLQ

35 seconds.

‡8VHDVSDFHUIRU7ZR6WHSWHFKQLTXHV

‡/DWH[JORYHVVKRXOGQRWWRXFKPDWHULDO

‡(QVXUHSURSHULVRODWLRQ

‡'RQRWXse the same impression in a two-step technique for the provisional matrix

and the final impression. 46

 ϲϳ


TISSUE CONTACT WITH TRAY

 ϲϴ

 ϲϵ

 ϳϬ


Conclusion

Making impressions is an important part of every dental practice. Success of

complete dentures largely depends on accuracy of impression.

Some of the more common concerns include tearing, voids, bubbles, and tray

contact, the more that are made, the greater the inaccuracy, and the more that are

eliminated, the better the result.

Complications during the impression process can be perplexing to both the dentist

and laboratory technician .Based on the particular condition, dentist needs to select

material and technique of impression for success of complete denture therapy.

This dissertation addressed solutions for correction of some of the most prevalent

impression defects that are experienced in clinical practice. By taking the necessary

precautions to avoid damaged impressions, clinicians can ensure improved accuracy

in communication of critical parameters as well as an overall improvement in

restorative fit.
 ϳϭ


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 ϳϯ


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 ϳϰ


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