22

Tala Atieh , Areej Al-Shweiki

Name

Name

Rasha Alamoush |Page1

 Impression Techniques in Removable
Prosthodontics (including RPD&CD)

Outline and Objectives

1-Understand the differences in resilience and support between
soft and hard tissues.
2- Discuss different impression techniques.
-Conventional techniques.
-Functional techniques.
-Selective pressure techniques.
3-To know which impression technique to use and why.

Impressions for RPD

*Types of RPD
1-Tooth supported
2- Tooth-tissue supported
What is the difference between them??? The main difference is in
the resilience and compressibility of tissues, for ex: When the tooth
is compressed under occlusal load maximum it will be intruded by
20 micrometres but when the mucosa is compressed under the
same occlusal load it will be displaced up to 500 micrometres
(much more than the tooth).
(**So by understanding this we will have an idea about why we do
either functional impression or mucostatic impression or selective
pressure impression.)

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Mucostatic versus mucocompressive
(these two concepts can be applied for RPD&CD)
1- Impressions that record the tissues with minimal displacement
are described as “mucostatic{anatomic}” we don’t apply any
amount of pressure.
2- Whereas those that displace the tissues are classified
as “mucocompressive” we apply some pressure, so we compress
the tissues here while taking the impression.

Conventional Technique
-Anatomic and also known as Mucostatic ; The surface contour of
the ridge is recorded at its resting form (no occlusal load)

-Material of choice (soft or less viscous impression material – not

very compressible material-) alginate!
** choose the material according to the compressibility -some
materials are more compressible than others-
- Disadvantages: In free-end saddle dentures, distal end will
show tissue-ward movement under occlusal load
→ridge resorption.

- Recommended for tooth supported partial dentures

*Kennedy’ ’s class III and IV.
*These are bounded saddles (tooth supported).

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Functional Impression Technique
-Impressions are recorded under functional load
(pressure) i.e. Record functional load (pressure) i.e. Record tissue
in a compressed form.
- We record it in a compressed form to maximize the support from
the mucosal tissues.
- Also known as: Mucocompressive impression.

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-As we can see in the anatomic form: The mucosal thickness will
stay the same.
-But in the functional form: The mucosa will be compressed.

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Support in free end saddle
-In tooth tissue supported cases the main support will be from the
mucosa (free end saddle) not from the teeth like in tooth supported
cases.
- so maximum coverage of the mucosa is needed to gain the
maximum support from it.
- the mucosa here should be compressed to a certain level to create
.minimum movement of the denture base during function
(slide):
-Support from tooth (rest seat) and soft tissue (mucosa)
-Tooth is rigid, mucosa is soft and displaceable, the free end
saddle will be pushed.
-During function, the free end saddle will be pushed towards
the tissue and then bounces back. This movement may cause
loosening of abutment tooth and resorption of alveolar bone.
-The aim is to create minimum movement of the denture base
during function. Therefore, selective pressure technique may be
used to achieve this.

Selective Pressure Technique

-So here we select to apply pressure in one area without other
areas.
- Mucostatioc impression for teeth AND Mucocompressive
impression for mucosa.

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A: mucostatic: more irregular and the border molding is less
defined, less stable, less tissue coverage.
B: mucocompressive: less irregular. Nicer, smoother and well
defined borders so better border molding here because the
impression is done in two steps, more stable , greater tissue
coverage.

selective pressure Technique

There is 2 Techniques to achieve selective pressure

impression;
1- Functional dual impression technique.
2- Altered cast technique or Applegate technique
We said that selective pressure technique companies 2 techniques
mucostatic and mucocompressive, so Altered cast technique is an
example of the selective pressure technique, we can have another
technique which is the Functional dual impression technique.

Functional dual impression

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 • We record the ridge using two impression (2 steps), i.e., one
portion in the functional form and other in the anatomical
form. we don’t do the same as in altered cast technique.
• Dual impressions are indicated for all tooth tissue supported
partial denture(Kennedy's class I and class II)
• the functional and anatomical impression are fused together
(pick-up impression).
For dual impression it’s like combination of both materials, we
start with one impression for the tissues functional impression then
we will have a pick up impression for the teeth. There are many
techniques for this impression described by many clinicians but in
general what we need to know is which tissue we have to do it
functional and which tissue we have to do it anatomical.
• A functional impression of the edentulous ridge is made. The
2nd impression made over functional impression and record
structures in their anatomic form.

As we can see here we we do our secondary then we have

started with border impression just for the another pick up
molding tissue supported fit impression with
alginate for the
teeth

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 Altered cast technique
• Anatomical master impression of
oral structure is made
• Construct master cast and
refractory cast.
• Construct metal framework with
temporary self-cured acrylic resin
cured acrylic resin saddle.

- It has the same principle but here we send our metal try in, once
done you take your secondary impression, send it to the lab, then
they will give you the metal framework, you try it in and check
everything like fit, retention, occlusion… everything it’s just like a
normal metal framework check in and then we send it back to the
lab, they will adapt some self cured acrylic which will act as a tray
which is like partial tray for that part of the tissue.

-Then you will have your final impression using

either compound or ZOE and then you send it
back to the lab.

• A cast is poured from the anatomical impression and later

altered according to the functional impression (altered cast
technique).
• A viscous impression e.g. Impression Compound, ZOE is
painted onto surface of saddles, then placed inside mouth, to
get an impression of the ridge.
• In the lab, the saddle area is cut away from stone cast.

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• The metal frame is located onto the abutment teeth
abutment.
• The saddle area is beaded and boxed.
• The saddle area is cast with stone.

As you can see here, they will section the previous secondary
impression you send it to them and construct your metal framework
on it.
Now you are going to adapt the metal framework to the impression
and then we do beading and boxing.
we pour it and then we have to have some indentation here to get
more retention for that fit.
then the final impression was poured with die (colored) stone to just
make it clear.

finally they will construct the denture base using this final cast with a
compressible area in the last pic in pink which is recorded into a
functional form so we get the maximum support and satability.

**Altered cast technique is very important for the exam

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 Disadvantages of selective pressure
techniques

Tissues are constantly compressed because you have recoreded

your impression while the tissue is compressed and this can cause
bone resorption due to 2 reasons:
1- Constant pressure stimulate formation of osteoclasts.
2- Constant pressure reduces blood supply, which simulates
formation of osteoclasts too.

If you have taken the impression while the clasps and the metal
framework not very well seated & If retentive clasps do not hold
denture in place, the denture will be slightly occlusal to normal
position→ you will have some premature contacts on you final
RPD .

Now we are done with RPD techniques, there are some special
impression techniques for CD as well.

Displaceable (flabby) anterior maxillary

ridge
What’s wrong with the ridge here?

- Here we apply selective pressure technique in CD to flappy

maxillary ridge, we actually need somewhat of relief and we
need to deal with it gently and not as other areas which is bone
supported or not flappy and mobile.

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 - So here we follow the same steps for secondary impression, we
do the border molding, we check that our retention is good.
- Once we are happy with the final impression with our border
molding we go and take the final impression.
- However we need after that to mark the area where the flappy
tissue exist, we mark it and then we cut it out from our tray as
you can see in pic A, we cut out the whole area opening a
window. So this technique is also called window impression
technique.
- Now we can fit this tray back to the tissue and we inject a light
body or any flowable material, we inject it around the tissue to
have the impression without compressing the tissue.
- Pic b is the final shape after we have the light body injected.

Off course we need something to support it from outside, we can use

either plaster or compound or any material to support the impression.

Fibrous (unemployed) posterior mandibular

ridge

Other tissue that might need special attention in impression for CD is

Fibrous (unemployed) posterior mandibular ridge it has the same
principle.
so here we have abnormal tissue it’s either flappy as in the previous
example or fibrous as in here, so we follow the same steps we have
the final impression , retention, border molding… everything is done
as the conventional technique as we go through it.
Then finally we just make a window that fit around the fibrous part
of the ridge and then we cut that fit around the fibrous part of the

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ridge and then we have an overall impression either with alginate or
silicone.

Flat (atrophic) mandibular ridge covered

with atrophic mucosa
➢ Atwood's ridge class v and vi
➢ admix of 3 parts by weight of impression compound to 7
parts by weight of greenstick

Also in some cases we have very resorbed flat ridge, in this case we
want to maximize our support and stability of the material there was a
technique suggested by McCord and Tyson.
They suggest to use a mix that called admix of impression compound
with greenstick, it has to be 3 to 7 by weight, 3 of impression
compound and 7 of greenstick, and you just mix them as usual using
hot water and to add some Vaseline to improve the mixing.
Then we have the final impression using these 2 materials.

Functional impressions (neutral zone technique)

Another technique that we use it mostly for the lower arch where you
will have some patients will come back and have a problem with
stability and support from lower arch especially if they have very low

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muscular tone or very resorbed ridge, you should know the cases
where we can use these impression techniques and when it’s
advisable to use it.

In this case we want to use a functional impression and we call it

neutral zone technique.

The very basic aim of this impression is that we want to set the lower
teeth in their neutral zone where the forces from the tongue is
equalized by the forces from cheek and lips.

So basically we follow the steps, we have the tray from the lab but
here the lab will add a kind of wire or something to put the impression
material on it. We add the impression material just above the tray and
then we ask the patient to do the functional movements like speaking
or whatever normal functions , so that the teeth appear on their neutral
zone and then we will send them back to the lab where they will do
some plaster index and set the waxed teeth initially to do a try in and
to check bite registration then send it back to the lab to do the primary
try in.

**The material that the doctor sent you is required for the exam

Good luck

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