REMOVABLE

PROSTHODONTICS
Alternative impression techniques for severely resorbed ridges

DONE BY:
Seba Saqer
20180482

SUPMITTED FOR:

Dr. Nour Kullab

18 OCT 2022
Introduction:

Restoration of masticatory function, comfort and esthetics are the

functional goals of complete denture treatment. Often
accomplishment of these goals is challenging to the clinician in
severely resorbed atrophic ridges. The principal functional problem
arises from the inability of the residual ridge and its overlying tissues
to withstand masticatory forces. The mucosa is sandwiched between
the denture base and the underlying bone so that all the forces exerted
during function are transmitted through this atrophic tissue. Extreme
resorption of the maxillary and mandibular denture bearing areas
results in unstable and non-retentive dentures with associated pain
and discomfort. These problems are more pronounced in mandible
due to lesser denture bearing area and other anatomical limitations.

A complete denture impression is a negative registration of the

entire denture bearing, stabilizing, and border seal areas present in
edentulous mouth. Impression techniques can be broadly divided into
pressure, non-pressure and selective pressure techniques. Dynamic
impression techniques were also proposed with the intent of
maximizing support from underlying tissues. The changes in
impression techniques can be attributed to evolution of newer
impression materials and better understanding of underlying tissues.

Long term edentulism and use of ill-fitting dentures result in severe

resorption of edentulous ridges, making a definitive impression
challenging. This paper presents a novel, cost effective technique for
impressing a class IV edentulous ridge with the intent of maximizing
retention, stability, tissue support, without over compressing the
tissues with the help of readily available dental materials.

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 A Physiologic Impression Technique for Resorbed
Mandibular Ridges:

The presented procedure describes a simple, quick and reliable

technique to impress the class IV mandibular ridge using a custom
tray, green stick compound and elastomeric impression material. Area
to be relieved, namely the crest of the ridge, is impressed in anatomic
form and the primary stress-bearing area is recorded in its functional
form ensuring healthy state of the tissues for extended periods.

This technique combines both traditional and contemporary

methods and the amalgamation leads to prosthesis with better
retention and stability. Use of a viscous material in a close-fitting tray
allows physiological compression of tissues in the primary stress
bearing areas. Elastomeric impression material helps in recording
finer details of the ridge. Thus, this technique helps in maximizing the
functional support from the edentulous ridge. Due consideration is
given to histological characteristics of the tissues and ensures the
preservation of the residual alveolar ridge, thereby fulfilling all the
objectives of impression making. Furthermore, readily available
dental materials were used making this technique easy to adapt and
master. As it is a new technique, its usefulness and relevance need to
be evaluated further. Patient education is mandatory prior to and
following the treatment as he must understand the limitations of
denture performance prior to the treatment.

➢ Technique:

1. Make a preliminary impression of the edentulous arch 6 using

McCord's technique. [3 parts impression compound (DPI
Pinnacle impression compound) +7 parts greenstick compound
(DPI Pinnacle tracing sticks)] in a metal stock tray.

2. Refine the impression using irreversible hydrocolloid

(Neocolloid alginate impression material Zhermack) over the
existing primary impression.

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3. Remove, disinfect and pour the impression with dental plaster
within 12 minutes. Retrieve the casts and adapt spacer wax
extending from left canine to right canine region. Do not use a
spacer in the buccal shelf area.

4. Fabricate a custom impression tray on the preliminary cast

using self-cure acrylic resin (DPI-RR Cold cure acrylic repair
material). Adjust the border extension of the tray to be at least 2
mm short of the vestibules. Evaluate and adjust the extension of
the tray in mouth, if necessary. Remove the wax spacer.

5. Soften modeling plastic impression compound (green stick) by

heating over the flame and load it over the anterior third of the
intaglio surface of the special tray. Temper and seat the tray over
the denture bearing area, mold the labial and buccal borders and
ask the patient to perform various tongue movements to mold
the lingual flange.

6. Repeat this procedure for middle third, followed by posterior

third of the impression tray on either side simultaneously. Trim
away any excess green stick material on the periphery with a
Bard-Parker blade No. 20.

7. Trim away the material from the crest of the ridge providing the
required relief. Roughen the impression surface by making
grooves. This will enable mechanical retention of light body
polyvinyl siloxane (ExpressTM VPS impression material light
body regular set).

8. Apply adhesive on the impression and tray borders and allow it

to dry (Universal tray adhesive Zhermack).

9. Mix base and catalyst pastes of light body Poly Vinyl Siloxane
impression material, spread it over the intaglio surface of the
impression and obtain the final wash impression by performing
lip, cheek movements and tongue movements. Allow the
impression material to polymerize according to the
manufacturer's recommendations.

10. Remove, disinfect the impression and pour with dental

stone.

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 Lost salt technique for severely resorbed alveolar ridges:

This method has advantages over the previously described

techniques. The salt crystals being heat labile melt during the
curing procedure and thorough flushing after curing results in
no crystals remaining in the denture thereby maintaining the
integrity of the denture, avoiding the tedious effort to remove
the spacer material from the denture. This technique of lost salt
technique is simple to execute and utilizes a very cheap and
easily available spacer material.

Extreme resorption of the ridge whether maxilla or mandible

will lead to a reduced denture bearing area which in turn will
affect retention, stability and support for the complete denture.
Problems that are likely to be faced may be due to narrower and
more constricted residual ridge as the resorption progresses,
causing reduced supporting tissue with larger restorative space
between maxillary and mandibular residual ridges.

In general, a heavy denture, whether maxillary or mandibular, is

likely to cause poor denture bearing ability. Even though it is
suggested that gravity and the additional weight to the
mandibular complete denture may aid in prosthetic retention, it
is not a universally accepted one.

Extensive volume of the denture base material in prosthesis

provided to patients with large maxillofacial defects or severe
residual ridge resorption is always a challenge to prosthodontist.
To increase the retention and stability of heavy prosthesis, many
methods have been tried like utilizing the undercuts, modifying
the impression technique, use of magnets, use of implants, etc.

Apart from this, when we look into the history of bulkier

prosthesis reduction in prosthesis weight also have been tried
by making the denture hollow. Such weight reduction
approaches have been achieved using a solid 3-dimensional
spacer including dental stone, cellophane wrapped asbestos,

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silicone putty or modeling clay during the laboratory procedures
which are removed later to provide a hollow denture base.

➢ Technique:

1. Maxillary and mandibular impression was made followed by

border molding with green-stick (DPI Pinnacle tracing sticks, The
Bombay Burmah Trading Corporation Ltd.,) and final impression
with zinc oxide eugenol impression paste (DPI Impression paste,
The Bombay Burmah Trading Corporation Ltd.,).

2. Compound occlusal rims were fabricated by using modeling

compound (DPI Pinnacle Impression Compound, The Bombay
Burmah Trading Corporation Ltd.) mixed with greenstick (DPI
Pinnacle Tracing sticks, The Bombay Burmah Trading Corporation
Ltd.) in ratio of 3:7 i.e. 3 parts impression compound +7 parts
greenstick compound) as per McCord's technique for making a
neutral zone record by having the patient perform various
Orofacial movements.

3. Then index of this record was then made with plaster of Paris and
rims were duplicated in wax.

4. The maxilla-mandibular relationship was recorded using wax

occlusal rims and transferred to the articulator and the artificial
teeth were arranged.

5. Try in procedure was done and then, all the wax excluding the wax
surrounding the teeth was removed and replaced with light body
elastomeric impression material (Aquasil Ultra LV Dentsply Caulk,
Milford, USA).

6. Trial denture bases were reinserted into the patient's mouth and
she was instructed to perform various Orofacial movements so as
to record the polished surface of the denture in harmony with the
Orofacial musculature.

7. After the try in procedure, wax up was done and dentures were
made ready for processing.

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8. The mandibular denture was processed using the conventional
procedures.

The Special Steps Taken for the Fabrication of Hollow Maxillary

Complete Denture were as Follows:

9. The maxillary trial denture was flasked and dewaxed in the

conventional manner.

10. Half of the heat cure PMMA (Trevalon, Dentsply India Pvt.
Ltd., Gurgaon, India) in dough stage was positioned accurately
over the dewaxed mould and then salt crystals were placed
over it.

11. Above that, the remaining heat cure resin was packed and
cured at 74 degree C for 7-8 hours.

12. Cured denture was retrieved and 2 holes were made in the
thickest palatal area.

13. All the residual salt crystals were removed by flushing

water with the high-pressure syringe through the holes.

14. After making sure that all the salt crystals have been
removed, the escape holes were closed with auto polymerizing
resin (Trevalon, Dentsply India Pvt. Ltd., Gurgaon, India).

15. The hollow cavity seal was verified by immersing the

denture in water, if no air bubbles are evident, an adequate seal
is confirmed.

16. The dentures were inserted in the patient's mouth and

instructions regarding care, hygiene and maintenance were
given. On 3-month follow up, the patient reported that she was
quite comfortable with the dentures and she had encountered
no problems.

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Conclusion:
Rehabilitation of severely resorbed ridges is a challenge to the
prosthodontist. Even though, the choice of rehabilitation can be
overdentures, implant retained over-dentures, ridge augmentation,
etc., many a times the patients who comes with such a problem are
geriatric patients with many systemic illnesses. Hence, the best way is
to rehabilitate them with conventional complete dentures. Apart, from
modifying the impression technique to get maximum denture bearing
area, modifying the type of denture also may be better accepted by
patients. Hence, less denture weight provides for healthy and
comfortable living.

References:
• Herekar M, Sethi M, Fernandes A, Kulkarni H A physiologic
impression technique for resorbed mandibular ridges. 2012;
2(2):80-82.

• Aggarwal H, Jurel SK, Singh RD, Chand P, Kumar P. Lost salt

technique for severely resorbed alveolar ridges: An innovative
approach. Contemp Clin Dent. 2012 Jul;3(3):352-5. doi:
10.4103/0976-237X.103636. PMID: 23293499; PMCID:
PMC3532806.

Thank You

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