Primary impression of

complete denture

• AHMED MUSAD RAKHA

BY: • AHMED MOAWAD SARHAN
• MOHAMED ELSAYED WASEF
• DONIA AHMED MOHEY
• RANIA LOTFY ELSAYED
Head lines:
1. terminologies

2. Objectives of complete denture impression

3. Anatomical landmarks

4. Requirements of good impression

5. Classification of impressions

6. Impression making

7. Management of gag reflex

Definition of impression
It is the negative registration of the entire
denture bearing, stabilizing and border seal
areas present in the edentulous mouth , made
in an elastic or a plastic material which
becomes relatively hard and set while in
contact with these tissues.
The impression is one of the most important
steps in denture construction, as all steps
depend on its exactness, but impressions
alone do not make good dentures;
 Primary impression

An impression of the edentulous mouth which

is made for the purpose of producing a
diagnostic cast upon which custom
impression trays will be fabricated.
 Final (secondary) impression:

A finally detailed impression which is used for

construction of the master cast upon which the
denture is fabricated.
The dental cast:

It is a positive reproduction of the form of the tissues of the upper

or lower arch over which denture bases or other dental restorations
may be fabricated.
Objectives of complete denture impression :

1- Retention
Retention for a denture is defined as 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 the opening of the jaws.
 Factors affecting retention

• Anatomical ----size & quality of denture bearing area

• Physiological - viscosity of saliva (thick/ thin)

• Physical ------- adhesion, cohesion & atmospheric pressure

 Retention can be achieved by:

① Maximum coverage of the denture bearing area within the

physiologic movement of the border limiting structures

② Perfect peripheral seal by intimate contact of the denture

borders with the surrounding tissues extending the borders
to the resilient tissues of the vestibule and filling it both in
width and depth.

③ Close adaptation of the denture base to the underlying

tissues.
 Factors affecting retention

• Mechanical ---- undercuts, retentive springs,

magnets,adhesives, suction chambers/ discs
 2- Stability

stability of a denture is the quality of a denture to be

firm, steady, and constant 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 rotatory
direction.
2- Stability

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 the dentures. The lack of
stability of the denture seems to cause most of the gross
soft tissue and bone changes that occur under dentures.
  Factors affecting stability

Vertical height of ridge - resorbed ridge - poor

stability

Quality of soft tissue -firm / flabby tissues

Quality of impression--- accurate, smooth, stable

 Factors affecting stability
Occlusal plane --__---- should be parallel to ridge

Arrangement of teeth --- balanced occlusion

Contour of the polished surfaces

3- Support

Denture support is the resistance to vertical

components of mastication and to occlusal or
other forces applied in a direction toward the basal
seat.Maximum coverage provides

the"snowshoe" effect, which distributes applied

forces over as wide an area as possible.
How can we achieve support?
1- wide tissue coverage(snowshoe effect)
2- An impression technique that direct most of the
occlusal forces to the primary stress bearing areas and
relief to non stress bearing areas.
How can we achieve support?
3- Area of the impression surface of the denture :-
the smaller the fitting surface, the greater the mucosal
loading ( load per unit area)
Increase the resultant pressure on the mucosa >> bone
resorption
 4- Esthetics:

Esthetics or the appearance of the patient begins with

the impression. border thickness of the impression
should be varied with the needs of each patient in
accordance with the extent of residual ridge loss. The
vestibular fornix should be filled, but not overfilled, to
restore facial contour. i.e. the patient should look
aesthetically pleasing before accepting the final
impression.
4- Esthetics:
By controlling border thickness and restoring facial contour as
the shape of the final denture should be similar to the shape of
the impression.
- In patients with severely resorbed maxillary ridge flanges and
borders should have sufficient thickness to provide proper lip
support
 5- Preservation of the residual ridges:
Preservation of the remaining residual ridge is
of prime importance to the success of
complete denture treatment.

As the teeth extracted , the stimulation of

natural teeth to alveolar ridge will be lost so the
alveolar ridge will atrophy or resorb.
 5- Preservation of the residual ridges:
The prosthodontist should keep constantly in mind the
effect the impression technique and the impression
material may have on the denture base, and the effect the
denture base may have on the continued health of both the
soft and hard tissues of the jaws. Pressure in the
impression technique is reflected as pressure in the denture
base and results in soft tissue damage and bone resorption.
 ANATOMICAL LANDMARKS
This knowledge aids in determining :–

• The selective placement of forces by the denture bases upon

the supporting tissues.

• The form of the denture borders that will beharmonious with

the normal function of the limiting structures that surround
them.
Terminologies

 Stress bearing area

the surfaces of oral structures that resist forces, strains,Or
pressures brought on them during function.
 Relief area
that portion of the dental prosthesis that is reduced to eliminate
excessive pressure .
 Limiting area
that limiting boundary of a dental prosthesis .
Maxilla Anatomical Landmarks
 Supporting structure
Primary stress-bearing areas :-
(areas which able to resist the vertical forces of occlusion.)
• Hard palate
• The residual alveolar ridge
Secondary stress-bearing areas :-
(areas that resist the lateral forces of occlusion)
• Maxillary tuberosity
• Rugae area
 Hard palate
The hard palate is made up of the anterior two-thirds of the palatal
vault supported by bone (palatine processes of the maxillae and
the horizontal plates of the palatine bones).° The palatine process
are joined together at the medial suture

 Residual alveolar ridge

Crest of the ridge = the highest continuous surface of the ridge
Can be U, V, round or flat
 Maxillary tuberosity
Medial and lateral walls of the max tuberosity resist horizontal
and torqueing forces
Maxillary denture should cover the max tuberosity
and fill the hamular notches

 Rugae area
• These are raised areas of dense connective tissue in the anterior
One-third of the
• palate. It aid in the formation of vocal sound also regarded as a
secondary stress
• bearing area.
MAX . RELIEF AREAS

 Incisive papilla
• Fibrous CT over the incisive foramen
• immediately behind the central incisors
• Used for correct placement of artificial central incisors
• Should be relieved to avoid compression on the nerve bundle
which can lead to burning sensation
 Median palatal raphe
• The area where the 2 palatine processes join together
• Improper relief leads to denture instability .

 Zygomatic process
It is located opposite to the 1st molar region, hard area found in
the mouth that
has been edentulous for long time. Relief over this area may be
required to
prevent soreness of the underlying
Tissues .
 Torus palatinus
Bony enlargement – large →remove surgically
small→relief the denture .

 Canine eminence
It is a round elevation in the corner of the mouth, it represent the
location of the
root of the canine which is helpful to be use as a guide for the
arrangement of
maxillary anterior teeth.
MAX. LIMITING STRUCTURES

They determine and confine the extent of the denture .
 Labial frenum
• Just mucous membrane – no muscle
• V shaped notch should be recorded during impression
• Notch should be wide + deep to accommodate labial frenum
 Labial vestibule
• It extends on both sides of the labial frenum to the buccal
frenum, bounded by the upper lip and residual alveolar ridge.
The reflection of the mucous membrane superiorly determines
the height of the vestibule. It contains no muscle fibers. In the
denture the area that fills this space is known as labial flange
 Buccal frenum
• It produces the maxillary buccal notch in the maxillary
impression or denture which must be broad enough because of
the movement of the Frenum which is affected by some of the
facial muscles as the orbicularis muscle pull it forward while
buccinator muscle pull it backward.

 Buccal vestibule
• Is the space distal to the buccal frenum. It is bounded laterally
by the cheek and medially by the residual alveolar ridge. The
stability and retention of a denture are greater enhanced if the
vestibule space properly filled with the flange distally
 Hamular notch
It is a narrow cleft of loose connective tissue situated between
the maxillary tuberosity and the pterygoid hamulus
(approximately 2mm antero-posteriorly). It is used as boundary of
the posterior border of maxillary denture.

 Vibrating

line An Imaginary line drawn across the palate extended from

one hamular notch to the other.it is not well defined as a line;
therefore it is better to describe it as an area rather than a line.
The direction of the line varies according to the shape of the
palate in the denture. The posterior border of the denture known
as posterior palatal seal area.
ANATOMICAL LANDMARKS IN THE
MANDIBLE
 Supporting Structures:
The mandibular denture poses a great technical challenge.
The support for a mandibular denture comes from the body of the
mandible.
The available denture-bearing area for an
edentulous mandible is 14 cm2 but for
maxilla it is 24 cm2.
 Buccal Shelf Area:
• It is the area between the buccal frenum and anterior border of
the
masseter.
Its boundaries are:
• Medially the crest of the ridge
• Distally the retro-molar pad
• Laterally the external oblique ridge

 Residual alveolar ridge

Cancellous bone - Primary stress bearing area
 MAND. RELIEF AREAS

 Mental foramen
When resorption happens the mental formane becomes closer to
the alveolar ride Should be relieved to avoid compression on the
nerve bundle which can cause numbness of the lower lip

 Genial tubercle:
These are a pair of bony tubercles found anteriorly on
the lingual side of the body of the mandible. Due to resorption, it
may become increasingly prominent making denture usage
difficult
 Mylohyoid ridge
On the lingual side of the mandible might become closer to the
crest of the ridge as a result of resorption
** sharpness of the ridge can be masked by the overlaying mucosa
Should be relieved

 Mandibular tori
• Bony enlargement on the lingual aspect on the mandible in the
premolar region
• Small→relief …….. large →surgically remove
MAND. LIMITIG STRUCTURES
 Labial Frenum
Unlike the maxillary labial frenum, it is active. The mandibular
labial frenum receives attachment from the orbicularis oris muscle.
Hence, it is quite sensitive and active. On opening wide, the sulcus
gets narrowed

 Labial Vestibule
This is the space between the residual alveolar ridge and the lips.
The length and thickness of the labial flange of the denture
occupying this space is Important in influencing lip support and
retention.
 Buccal Frenum
The fibers of the buccinator are attached to the frenum. It should
be relieved to prevent displacement of the denture during
function.

 Buccal Vestibule
It extends posteriorly from the buccal frenum till the retromolar
region. It is bound by the residual alveolar ridge on one side and
buccinator on the other side.
 Lingual Frenum

It is a fold of mucous membrane can be observed when the tongue

is elevated, From the superior genial tubercles to the base of the
tongue
It will produce the lingual notch in the denture. This frenum is
activated when the tongue is moved therefore it must be molded
well in the impression to prevent displacement of the denture or
ulceration of the tissue. The height and width of the frenum varies
considerably.

High lingual frenum is called –

ankyloglossia ( tongue tie)
 Alveolingual sulcus
Space between the residual ridge and tongue - from the lingual
frenum to retro mylohyoid curtain
• Anterior= called sublingual crest
• Middle = called mylohyoid vestibule ( largest portion of the
lingual vestibule)
• Posterior=called lateral throat form or retromylohyoid fossa (
should give S shape in proper impression)
 Retromolar Pad (Pear-Shaped Pad):
The retromolar pad, is soft elevation of mucosa that lies distal to
the
third molar. It contains loose connective tissue with an aggregation
of
mucous glands and is bounded
• Posteriorly= temporalis tendons
• Laterally = buccinator
• Medially= pterygomandibular raphe +superior constrictor of
• the pharynx
The retromolar pad is quite important for the support
and the peripheral seal.
Requirements of good
impression:
 To obtain an impression of the whole of the denture-bearing
area of each jaw.

 To record the full extent of the sulcus. Extension into the

vestibule to create a border seal without impingement on the
action of the muscles.

 To obtain an impression in which certain anatomic landmarks

on the edentulous jaws are recorded .
 Maximum area of coverage to the denture bearing area  wide
distribution of forces.

 Must record fine details of the soft tissues  intimate adaptation of

the denture

 Determine the selective placement of forces by the denture base on

the supporting structures
 Requirements of impression’s material:
 An ideal impression material should also demonstrate

 excellent detail reproduction

 good tear strength

 no distortion when removed from the mouth.

 It must be biocompatible

 non-toxic

 have an acceptable odor and taste.

Retention & stability test
 long working time,

 short setting time

 long shelf life.

 does not set by chemical action

 good flow ability at mouth temperature

 dimensionally stable until poured.

Classification of impressions due to type of tray:

1. Stock trays:

Used for primary impression and made of metal Perforated

or non perforated
2. Custom trays: (Special trays):

 Used for final impression and may be made of

 Thermoplastic (shellac-compound)

 Resins (self-heat-light cure acrylic resin- plastic sheets)

 Metals (casted-swaged)

 Old dentures
 Classification due to the material used:
• Non -elastic
Plaster ,Compound ,Waxes .Zinc oxide
• Elastic
 Aqueous hydrocolloids
Agar ,Alginate
 Non-Aqueous hydrocolloids

Polysulfide ,Silicones (condensation / addition ),Poly ether

 Classification due to purpose of the imp:
a) Diagnostic imp :
To make study cast to detect size, position and
arrangement of the teeth before extraction, detect ridge
relations ad interridge distance
a) Primary imp :
To make primary cast and fabricate custom tray (
special tray )
a) Secondary imp :
To make final cast and fabricate record block and
occlusion rim
 Position of the Dental Chair

 Seat the patient in an upright

position with the head in line with
the body. The back and the head-
rest should be adjusted to give
support.
 Adjust the height of the chair according to the impression being made
as follows:

1- Lower impressions
When making the lower impression the patient's mouth should be on
a level with the operator's shoulder.
2- Upper impressions
When making the upper impression, the patient's mouth should be on
a level with the operator's elbow and the chair may be titled back a little
 Position of the Operator
1. Lower impressions
When making the lower impression, the operator should be in
front of the patient and on the right side .
2. Upper Impressions
When making the upper impression, the operator should be to the
right and a little behind the patient .
 Selection of stock trays

Stock trays should be oversize to the extent of providing some 3 mm of

space between the inner surface of the tray and the tissues to be
recorded in the impression, and the flanges should not impinge on the
frenal attachments.
 Ideal features of stock impression trays include:

1. Rigidity
2. ease of modification
3. compatibility with impression material
4. smoothness or comfort in the oral envi-ronment, and
5. ability to be sterilized
 Modification of Stock Trays
The fit of any stock tray is invariably less than perfect. In some
cases increased accuracy is possible through modification of the
tray either by reduction of its extensions or by addition of soft
utility wax or modeling compound in order to correct border under
extensions.
 Modification of Stock Trays

For upper trays, utility wax may be added across the posterior
border and distal termination of the buccal flange area. If the
palatal vault is deep, the central portion of the tray is built- up with
utility wax in order to ensure a relative uniform thickness of
impression material and to guard against slumping of the
impression material away from the palate
The sequence of making the impression
It is generally advisable that the lower impression should be made first for
two reasons:

 The upper impression causes greater discomfort and anxiety, either

through stimulation of the retching reflex or from fear of being shocked by
the impression material, but those symptoms are usually absent with the
lower impression.
 A foreign body placed in the mouth produces
an increase in the rate of salivation.

Therefore, it is preferable to have the lower

impression seated in position before this takes
place.
 Preparation of the patient
 The patient must be comfortable in the chair with the head upright
and at such a height relative to the dentist

 The patient's clothing should be protected with a towel or napkin.

Smearing the lips with vaseline is a good preparatory measure as this
facilitates removal of any excess alginate,
 Preparation of the patient
• The mouth itself is prepared by using a warm
mouthwash of sodium bicarbonate. This, being
a solvent of mucus, effectively removes any
surface film from the hard palate,
 Alginate preliminary impressions
1. Mandibular Impression
 Start with lower ridge impression f ir st, to let the patient
accommodated to the material to decrease gagging reflex.
 Perforated tray is used or solid trays with impression adhesive
 Modif ic ation of the stock tray may be made with cutting and
bending
 Modify the tray peripheries with utility wax, if indicated to
increase the length of the f lange. Seat the tray in the patient's
mouth to adapt the wax

 Instruct the patient to rinse his mouth vigorously with

mouthwash to remove a ropy, sticky saliva or debris.
• Mix the alginate according to manufacture instruction: 2 scoops
powder, 2 water measurement, using rubber bowl and plaster
spatula. The mix must be smooth and creamy. Avoid trapping
air bubbles
Load the tray quickly with the
alginate, put a sufficient amount of
alginate in the lingual pouch using
tongue depressor (to compensate
insufficient material in this area),
dry the ridge with gauze quickly.
 Seat the tray on the ridge, have the tray handle in the middle of
the ridge, as the impression is being seated, ask the patient to
raise the tongue, retract the lip back and make certain that the
alginate material is f lo wing into the vestibule and over the
edges of the tray. Instruct the patient to put the tongue forward
touching the lingual aspect of the tray. Hold the tray with the
index f in ger on bicuspid area and the thumb below the
mandible.
 P e r f o rm m o l d i ng a c t i o ns f o r
mandibular impression. Wait for
the material to set.
1. Maxillary Impression

• Modify the tray with utility wax, it is necessary to bead the posterior
border of the maxillary tray. It must be contact the tissue of the palate
to prevent the flow of the alginate towards the throat with the
resultant possibility of gagging and discomfort. For deep vault, build
the tray up with wax for support. This will prevent an air pocket in the
palatal area.
• Seat the tray firmly in the patient's mouth to adapt the wax.

• Instruct the patient to rinse vigorously with mouthwash to remove

thick saliva or debris.

• Mix the alginate according to manufacture instruction: 2 scoops

powder, 2 water measurement, (water temperature-70°) using rubber
bowl and plaster spatula. The mix must be smooth and creamy.
Avoid trapping air bubbles.
• Dry the ridge with gauze, place the alginate in the center of the
palate with spatula (especially in high vault cases).
• Retract the left corner of the mouth with a mouth mirror using
the left hand, insert the tray with right hand against the ridge
corner of the mouth, seat the tray first against the hamular
space area and rotate the tray into position. Retract the lip more
and make certain that the alginate material is flowing into the
vestibule and spilling over the edges of the tray, release the lip
and hold the tray with your finger on each side without
movement until set.
• Remove the impression from the mouth gently.
 Common faults:
 Impression made on inflamed tissues
 Improper tray: short, long, small (incomplete coverage of the tray),
large
 Improper tray position: too forward, backward
 Inadequate or excessive pressure: If metal shown in the ridge area, it
means too much pressure used. If it is showing through the border
area, it means either too large or too small tray.
 Voids, air bubbles on the impression: Due to tongue trapped
under the lingual flange. Multiple small bubbles in the alginate
are due to failure to mix the alginate thoroughly or presence of
thick saliva on the alginate surface

 Dislodgment of the imp from tray

 Insufficient alginate material used.

 Early removal: causing dimensional

changes as the first layer contacting
the mucosa set first. The alginate
should be removed by sudden down
word movement
 Handling the Impression after Removal from the Mouth
 If there is thick saliva, adhere to the impression, wash it with a
solution of plaster and water.
 Cover the impression with wet gauze (while doing the other).
Stored in 100% humidity
 Pour the impression immediately, not more than 12 minutes.
Longer than that will cause dehydration (syneresis and imbibition)
and inaccurate cast.
COMPOUND PRIMARY IMPRESSION

Steps:
POSITION OF THE DOCTOR:
• Position of the doctor: upper impression is behind the
patient, lower impression is in the front of the patient
• Impression compound is heated in a water path, softened,
heated on the flame and tempered. The proper amount of
compound is manipulated between the fingers till the material
acquires uniform softness.
MAXILLARY IMPRESSION:
• The material is formed into a ball, dried and loaded in the
centre of the palate of the tray after warming it over a flame.
Then spread the compound over the tray and shaping it
roughly like arch.
• PERFORM MOLDING
ACTIONS:
1. for labial and buccal flanges pull the lips and cheeks upward,
outward, downward, and back word in a rotatory movement (to
release entrapped tissue at the sulcus and provide proper
thickness of the impression borders.
2. for the tuberosity, make the patient open his mouth wide
and move the mandible to right and left positions the ramus
and coronoid process of the mandible will push the compound
to the buccal surface of tuberosity at the distobuccal border of
the impression.
3. for proper molding at posterior palatal seal, ask the
patient to swallow, move the head down to the chest,
close his mouth and try to suck the tray, the soft palate
will go downward
4. The impression is removed and washed with water
to remove saliva.
MANDIBULAR IMPRESSION:
• The material is formed into a roll, dried and loaded in
the tray after warming it over a flame. Then spread the
compound over the tray and shaping it roughly like
arch.
 • PERFORM MOLDING ACTIONS:
1. for labial and buccal flanges pull the lips and cheeks
downward, outward, upward, and back word in a rotatory
movement (to release entrapped tissue at the sulcus and
provide proper thickness of the impression borders.
2. for retromolar pad, make the patient open his mouth
wide and move the mandible to right and left positions.


3. for lingual flange, ask the patient to swallow, protrude his
tongue (or raise of the tongue tip to the anterior border of the
palate) and move it to right and left position to activate lingual
frenum, elevate floor of the mouth (mylohyoid muscle) and
activate palatoglossus arch
4. The impression is removed and washed with water to
remove saliva
2018--2019
COMMON FAULTS
1. Poor selection, modification, loading of stock tray
2. Inadequate border thickness (thin or thick border)
3. Insufficient materials loaded in the tray
4. Excessive material loaded in the tray (sagging)
5. Insufficient seating pressure.
6. Excessive prolonged seating pressure.
7. Incorrect centralization of the tray
8. Patient open his mouth too wide
9. Pressure areas and exposed tray
10.Poor border molding
11.Detachment of the compound from the tray


MANAGEMENT OF GAGGING REFLEX DURING IMPRESSION
MAKING COMPLETE DENTURE

Gag reflex : tendency for vomiting during impression 

making either a primary or master impression and
during examination . It’s a Protective reflex form in all
individual and vary from one to another ( some of
them very severe Or severe ,mild ,moderate, v.v.little)
MANAGEMENT OF THIS PHENOMENA DURING
MAKING AN IMPRESSION

it is your responsibility to communicate

with patient

1. The dentist have to be confidence to overcome such problem .

2. Assure the patient that this is a normal phenomena in all people
but vary from one to another
 MANAGEMENT OF THIS PHENOMENA DURING
MAKING AN IMPRESSION
3. Seat the patient in upright position with his/her head slightly forwards
and instruct them to breathe through their nose not mouth because the
dentist put the impression in the patient mouth so if the patient breath
from his mouth so the patient will choking.
4. some technician tend to spray the local anesthesia or ethyl chloride at
the sensitive areas but it is not sense to anesthesia every patient need to
do complete denture but in some cases when it is very severe ; only if he
open his mouth he start gagging so you can give him an general
anesthesia
5. Other try to mix the impression material with local anesthesia ,some
research try to mix special alginate with local anesthesia .
6. Try to take the lower impression before the lower impression
MANAGEMENT OF THIS PHENOMENA DURING
MAKING AN IMPRESSION

7. Try to use slow flow impression material as impression

• compound, heavy body silicone. but don`t use alginate a lot of
patient fear from it so don`t use it in such patient (it`s very flowy).
• You can use silicon in very severe cases
8. Behavioral therapy: (Hypnosis)
9. Try to occupy the patient mind through the impression processors
like told him to count from 1_10 or put the left leg in the right one and
so on until you finish the impression processor so you concern his
brain from processor


MANAGEMENT OF THIS PHENOMENA DURING
MAKING AN IMPRESSION

10. Drug therapy: ( But it is not a common processor )

• Barbiturates antidepressant :to depress the
central nervous system .
• Anti-histamine to reduce the feeling of
sickness.
• Atropine: to reduce the saliva flow.


❖ DISINFECTION OF IMPRESSIONS

The primary goal of infection control is to prevent cross-

contamination between patients and dental care providers.
a. Personal Protective Equipment
Wear protective eyewear, an outer cover gown with long sleeves, a
mask, and gloves when handling a contaminated impression until
it has been disinfected.
 b. Rinse the Impression
Immediately after an impression is taken in the dental
operatory , rinse it under running water to remove any saliva or
blood). This step is essential for optimum disinfection of the
impression
.
 C. DISINFECTION TECHNIQUES
Once the impression has been rinsed and shaken to remove
excess water, it must be disinfected. This may be
accomplished by :-
1. immersing the impression
2. spraying the impression
with an acceptable disinfectant. Always refer to the
manufacturer’s recommended disinfection technique for a
particular material.
OUR MAIN
SOURCES:
1- Clinical complete denture prosthodontics.
2- Complete denture of Mansoura university
Thank you