The diagnostic cast:

• The primary cast should be poured immediately after making the

1ry impression. (Why?)
(The impression compound tends to distort according to the
environmental changes)  The impression is poured in dental plaster.
• The cast should be separated from the impression about an hour
after the initial set.

FABRICATION OF A SPECIAL TRAY:

• A special tray should fulfill the following requirements:
• It should be well adapted to the primary cast.

• It should be dimensionally stable on the cast and in the mouth.

• The tissue surface should be free of voids or projections.
• It should be at least 2 mm thick in the palatal area& lingual flange
for adequate rigidity.
• It should be rigid even in thin sections.
• It should be easy to remove.
• It should not react with the impression material.
• It should be easy to manipulate.
• It should not flow or warp.
• It should have a contrasting color to make its margins appear
prominent when placed in the patient‟s mouth.
• It should have 2 mm shorter than the sulcus so that border molding
material can be applied in sufficient sections.
• Final impressions are made using custom-made special trays.
• The primary purpose of definitive impressions; is to accurately
record the tissues of the denture-bearing areas, in addition to
recording the functional width & depth of the sulci.
• Making the secondary impression is important for preparation of
a master cast.
 Secondary impression involve the following steps
1. Border molding or peripheral tracing
2. Making the master or wash impression, and
3. Post damming.
• Master impression should record the denture-bearing area at
rest to reproduce finer details.
• It should also record the peripheral tissues in function.
IMPRESSION MATERIALS
Impression materials are used to copy the teeth and surrounding oral
structures by creating a dental impression poured with dental plaster
to fabricate a dental cast. This procedure provides a tridimensional
and accurate mouth replica, allowing dental work even in the
absence of the patient.
Classification
Impression materials can be classified as follow:
 Based on Use
For primary impressions, e.g., alginate, impression compound,
elastomeric putty.
For secondary impressions, e.g., light body elastomers and zinc oxide
eugenol.
 Based on Setting Reaction
Reversible (physical): impression compound, impression waxes, agar.
Irreversible (chemical): alginate, impression plaster, elastomeric
impression materials.
 Based on the State of the Impression Material After Setting in the
Oral Cavity
Rigid: impression compound, zinc oxide eugenol, impression plaster,
impression waxes.
Elastic: alginate, agar, polysulfides, addition and condensation silicones,
polyether.
 Based on Compression of Underlying Tissues
Mucostatic: impression plaster, light body elastomers.
Mucocompressive: impression compound, putty elastomers.

TYPES OF MATERIAL :-
1-Impression Compound :
It is a thermoplastic, rigid and reversible impression material (meaning it can be
reused in the same patient if an impression needs to be repeated)
Advantages
 It can be reused in the same patient until a good impression is made.
 It can compensate for a short impression tray because it does not sag under its weight.
 It can be electroplated to form dies.
 It can be added or removed until a good impression is made.
Disadvantages
 Due to high viscosity, it does not record fine details.[8]
 Its dimensional stability is poor due to the release of internal stresses incorporated
into the material during kneading.
Indications
 Edentulous arch impressions for complete denture fabrication.
 Border molding procedure.
 A single prepared tooth impression (copper tube impression).
Contraindications
 It should not be used in undercuts areas.
2- Zinc Oxide Eugenol Impression Material (impression paste):
It is an irreversible nonelastic material used as a final impression (wash impression) in
complete denture fabrication. It records the tissues in the undistorted state .
Indications:
 Wash impressions (secondary impression) in complete denture fabrication and dual
impression in distal extensions partial dentures.
 Bite registration and interocclusal records.[12]
Contraindications:
 It is a brittle material; it cannot impress dentulous mouths or severe undercuts areas.
 It should not be used in patients who are allergic to eugenol.
Advantages:
 Economical and easy to use
 Good flow helps in recording fine details
  Dimensionally stable
Disadvantages:
 It cannot be used in stock trays; custom trays are mandatory
 Fragile
 Can produce burning sensation of the mucosa
 Setting time varies with temperature and humidity

3-Agar:
Agar is another hydrophilic colloid impression material like alginate but reversible. It
is the first elastic impression material to be used in dentistry.
Indications:
The agar has been used in dentistry for cast duplication and impression making. Its
use is now limited as it requires a complicated setup.
Advantages:
 Reversible
 Affordable
 Nontoxic, odorless, and nonstaining
Disadvantages
 Requires purchasing a water bath
 Low tear strength
 Dimensional instability
 Infection control unfriendly

4-Polyether:
it has become popular because it only requires a stock tray and a single mix.
Advantages:
 Hydrophilic
 Accurate and high dimensional stability - makes it possible to delay casting
and allow multiple pouring.
 Good elastic recovery
 Good compatibility with gypsum
 Good shelf life
 It can be used as a single-phase material or with a syringe tray technique
Disadvantage:
  Most rigid of all the elastomers makes it hard to remove (newer polyethers are
slightly more flexible)
 May cause allergy due to sulfonate acid esters

5-Digital Impressions :
 The advantages of intraoral scanning are too many: the material and
armamentarium used in analog impressions are avoided (e.g., impression
trays, impression material, gypsum); the communication between the clinician
and laboratory technician is improved since the image can be modified,
recaptured, a soft copy can be stored; and the cross infections can be
minimized due to absence of physically stored casts.
 However, digital impressions require an expensive setup, images of
completely edentulous arches are less accurate, the presence of blood and
saliva obscures subgingival finish lines, and they do not record complete
occlusal information for comprehensive prosthodontic treatments.[26]
[27] But, for single units and segmental dentistry, the intraoral scanners are
highly accurate.[28]

TECHNIQUES FOR MAKING THE MASTER

IMPRESSION:
1. Mucostaticand mucocompressive impression technique
2. Selective pressure impression technique
3. Functional impression technique.
4. Conventional impression technique
5. Reline and rebase impressions (including secondary template
impressions).

I- Muco-static Impression Technique (Minimal Pressure

Impression or Open mouth impression Technique):

Definition: Mucostatic impression technique records the denture

bearing tissues in its static position.

• It is an impression made with the least possible

displacement of the soft tissues covering the residual
alveolar bone.

Tray used:
 The tray is constructed over a spacer with stoppers and 1-2
holes to allow escape of excess impression material.
Impression material:
Plaster of Paris is the only true mucostatic impression material
though alginate often gives equally good clinical results.

Indications
1- in flabby ridges
2- pt liable to severe bone resorption like diabetes
3- easily irritated mucosa like in radiotherpy
4- pt with anatomic undercut providing good retention
5- cooperative pt with less nausia and vomiting

Advantages:
1- Open mouth The operator can see and insure
proper border molding and muscle movements are more
easily accomplished.(overextended or thick borders are
avoided)
2-There is less distortion to the mucosa  tissues will
not exert a displacing force on the denture increase
stability
3- Tissues are not subjected to continuous pressure
which can cause interference with blood supply and
bone resorption
Denture base:
• Metallic denture base is preferred to than
dimensionally unstable acrylic denture base in order to
attain accuracy and proper fit of the denture base.

Disadvantages:
1. The mucosal topography (contour) is not static over the
day. It changes throughout the day. the denture may not fit the
mucosa all the time. Denture is retentive at rest but when the
mucosa is displaced during mastication the denture become
loose and retained by anatomic structures
2. This technique causes un-even loading of the denture bearing
area.
(Hard bony areas will bear most of the occlusal load causing tissue
irritation & denture instability).
3. The role of peripheral seal in retaining the denture is neglected.
 4. There is no intimate contact between the finished denture &
basal seat (due to dimensional changes of the impression material, the
cast material or during denture processing).

2. Mucofunctional or Mucocompression
impressions:

A- Closed mouth impression technique

• This theory was proposed by Greene in 1896 gave this

concept on the assumption that tissues recorded under
functional pressure provided better support and retention for
the denture
• Records tissues in their functional/supporting form

• All tissues are recorded under equal pressure irrespective of

their anatomy

• Mechanical rather than biological

• When tissues are held in a displaced position, the pressure

limits the normal blood flow When normal tissues are
deprived of their blood supply, the result is resorption.
• The impression material most commonly used for this
technique is zinc oxide and eugenol paste.
• Trays require occlusion blocks set at the required vertical
dimension.

Technique
*Primary impression is made with impression compound
*Special tray with bite rims with uniform occlusal surfaces are then
prepared.
*Secondary Impression is made using zinc Oxide and Eugenol
impression material
*The impression is inserted in mouth and held under biting pressure
for one or two minutes.
*Borders are molded by asking the patient to perform functional
movements.

Advantages:
1. Better retention and support
2. The patient can exert his own masticatory force on the impression
material Stable during function

Disadvantages of the theory

1. Excess pressure could lead to increase alveolar bone resorption.
2. Excess pressure on peripheral tissues and the palate interferes with
blood supply leads to transient ischemia, and this may accelerate ridge
resorption.
3. Pressure applied during making the impression is not identical to
functional load
4. Dentures constructed from such an impression do not fit well at
rest, as the compressed tissues rebound when the tissues resume their
normal resting state.
5. Pressure on sharp bony ridges results in pain.
6. An overextended denture may result due to improper border
molding.
B- open mouth impression technique
Similar to conventional impression technique

II- Selective Pressure Impression Technique:

Definition:
This technique combines considerable pressure on certain areas
& minimal pressure on others.
Custom Tray:
• The tray is constructed with relief over areas of no
pressure and closely adapted over other areas (stress
bearing areas).
• Sometimes there is need to modify the impression
procedures as:
i- Displaceable upper anterior (flabby) ridge.
 ii- Fibrous (unemployed) posterior mandibular ridge.

Sectional impression technique ( Window technique)may be

used in:
i. Flabby Anterior Maxillary Ridge:
• Border molding is carried-out to ensure peripheral seal
• A wash impression of the whole maxilla is taken using either
zinc-oxide-eugenol (ZO/ E) or a medium-body polyvinyl
siloxane (PVS) impression material (Preferred)
• The impression is removed from the mouth after setting,
checked & disinfected.
• The extent of the displaceable tissue is drawn on the
impression surface & it is then removed using an acrylic bur.
• The modified impression is then inserted into the patient
mouth to ensure complete clearance of flabby area.

•
• the impression is retained in the patient mouth; then a low
viscosity material will be painted or syringed these onto the
displaceable tissue (to record them in a minimally-displaced
position)
(Plaster of Paris if ZO/E was used, light-bodied PVS if a medium-bodied
one was used)

• On setting, it should be apparent that a peripheral seal has

been re-established.

ii. Fibrous posterior Mandibular ridge:

• This condition may be diagnosed by the presence of a thin, mobile
wiry ridge covered by fibrous tissue.
• The green stick compound is used to make impression of the
denture-bearing area.

• The greenstick related to the fibrous area is scraped &the tray

is perforated the tray in this region.

• The tray is checked intra- orally to ensure complete clearance

of the fibrous area & patient comfort

• Light-body PVS is injected onto the buccal & lingual shelves

of the greenstick and gently insert the impression.

• The fibrous ridge will be recorded under minimal pressure.

• Whenever the material sets; the impression is checked for

details, disinfected and etc.

Steps of sectional impression for fibrous mandibular

ridge.

Another technique
 Make a primary impression with modelling
compound in stock tray
 Remove or scrap the compound over the areas which
need relief and make perforations in the compound to
allow escapement of the impression material without
displacing the flabby tissue
 Make the final impression (wash) with ZOE or
medium rubber base impression material.

III- Functional impressions:

 • Functional impression technique may be used in the
presence denture instability problem.

• When the patient suffers from denture looseness due to the

presence of localized areas of poor functional adaptation.
• In these cases, the application of a thin mix of a chairside
resilient lining material may be beneficial (e.g Visco-Gel)

Procedures:
• The chair side relining material is mixed according to the
manufacturer instructions.
• The material is added to the fitting surface of the denture &
the patient is instructed to wear the denture for one hour.

• After one hour of functional molding; the denture is

removed from the patient mouth & the conventional relining
process completed.

Functional impression using a chair-side resilient lining material

 Advantages:
1- Allow equal distribution of pressure to allow mucosal
recovery.
2- Record mucosa during function.
3- Allow maximum extension of the denture.

IV- Conventional impression technique:

Checking the final impression tray:
1. Labially, buccally, and lingually the borders of the tray
should be 2-3mm short of the reflection area &
contacts it when the tray is inserted in the mouth and
the lips and cheeks are slightly lifted.

2. The posterior border of the both trays should contact the

posterior palatal seal area & the retro-molar pad area to
apply additional stresses on these areas during
impression making to ensure effective peripheral seal.
 3. The posterior border of the upper tray should extend
2mm beyond the vibrating line.

The tray should be checked on the cast & intra-orally.

• The tray should be 2mm short labially & buccally.

• The tray should accommodate the labial & buccal frena.
• The tray should extend 2mm posterior to the viberating line.

The mandibular tray is checked on the cast& intra-orally

• Tray should be 2mm shorter than vestibular depth to accommodate the border
molding material
• Tray should cover the retromolar pad

Border molding
Border molding is "The shaping of an impression material by
•
the manipulation or action of the tissues adjacent to the
borders of the impression"
• Border molding begins with manipulation of the border tissues
against the border molding material applied on the tray
borders.
Border molding may be:

a. Sectional border molding

b. One step border molding

a. Sectional border molding:

• Green stick compound is the molding material of
choice.
• The material is added in 3-4mm sections, to the
shortened borders of the acrylic resin tray.
 • The material is heated & molded intra-orally to a form
in harmony with the physiologic action of the
surrounding structures.
b- On step border molding:

• Molding of all the borders is made in one step.

• Polyether impression material & medium bodied
rubber base may be used for one step border
molding.
The simultaneous border molding material should:

1- Have sufficient body.

2- Retain adequate flow in the mouth.
3- Does not cause excessive displacement of the
border limiting tissues.
4- Allow some finger reshaping of the borders &
Have sufficient setting time of 3-5 minutes.

Advantages of one step border molding:

1- Reduced numbers of tray insertion intra-orally.
2- Errors occur in one section affecting the border contour in
another section is eliminated.

Clinical procedure for maxillary arch:

a. An adhesive is applied on the outer surfaces & the
inner borders of the tray.
b. Polyether impression material is mixed using less
amount of catalyst to increase the working time.
c. The mix is then loaded in the syringe.
d. The material is applied along the borders of the tray
and contoured using wet fingers.
e. The patient should be seated in an upright position.
f. The lips and cheeks are retracted and the tray is
placed on the mouth.
The following movements are carried-out:

The lips are first elevated & then moved outwards, downwards and
inwards.

• The cheek is elevated & pulled outward, downward and

inward.
• The buccal frenum is recorded by pulling the cheek
backwards and forwards.
• The distobuccal area may be recorded by pulling the cheek
outwards, downwards and inwards followed by opening the
mouth wide & moving the mandible from side to side.
• The posterior part of the palate is recorded. The patient is
asked to say “ah” while refining the posterior border.

• After the border molding poly ether impression material

sets, the tray is removed.
• The borders are examined for deficiencies & over-
extensions and a master impression is made.

Making the Final Impression:

• Adhesive is painted in the tissue surface of the tray.

• The final impression material is mixed & placed on the tray
to cover the basal surface of the tray and the borders.
• The tray is seated into position by applying alternating
pressures on the right and left molar regions using the index
fingers.
• Tray placement is complete only when the posterior border
of the tray rests in the hamular notch and is in contact with
the palate.

• The tray is maintained in this position by placing a finger in

the palatal region of the tray, immediately anterior to the
posterior palatal seal.
 • Passive border molding movements should be repeated
during wash impression making.
• After the material sets, the tray is removed in a single jerky
movement.
• The impression is inspected for deficiencies or voids.
• The completed impression is then removed from the mouth
& inspected for accuracy.

• If pressure spots are detected (the tray shows through the

impression), this area should be reduced with a carbide bur,
and an overall impression is made.

• Small amount of the final impression is mixed and spread

over the entire tissue surface of the impression and the
loaded tray is than positioned in the mouth.

Steps of making final maxillary wash impression Green stick compound & ZnO/E

Border Molding The Final Mandibular Impression Tray:

• The prepared mandibular tray is painted with adhesive over

the borders.

• The mixed polyether material is applied on the borders of

the tray & the tray is inserted in the patient mouth by a
rotating motion, while the lip is retracted sufficiently to
avoid scraping the polyether material from the borders.

• The patient is instructed to elevate his tongue as the tray is

seated.

• Labial & buccal border molding are performed by

manipulating the lower lip and cheeks outward, downward
and upward.
 • The patient is instructed to protrude the tongue to adjust the
length of the anterior lingual flange.

• Patient is instructed push his tounge against the anterior part

of the, to regulate the thickness of the anterior lingual
flange;

• & to move the tongue from side to side to determine the

length of the borders in the molar region.

Making mandibular Final or Wash Impression:

• Tray placement should be practiced before making the final
impression.

• Dry gauze should be placed in the floor of the mouth to remove

the saliva.

• The gauze should be removed before making the impression.

• The impression material is manipulated and loaded onto the tray.

• The tray is rotated in a horizontal plane and inserted into the

mouth using the anterior handle.

• The tray is seated completely by applying alternating pressure

over the posterior handles.
• The patient should be asked to touch his upper lip with his
tongue while making the impression.
• Passive movements similar to those performed during border
molding should be repeated.
• After the material is set the impression is removed and examined
for any defects.
• Wash impression or final mandiualar should be inspected to
make sure, that all the landmarks are recorded accurately.
• Small voids can be rectified by filling them with wax.
INSPECTING THE IMPRESSION:

• The surface is inspected to make sure that the landmarks are

recorded accurately.
• The impression made is inspected for air inclusions & voids.
• Small voids can be rectified by filling them with wax.

DISINFECTING THE IMPRESSION:

• The impression is disinfected using Iodophor or

2%Gluteraldehyde.
• It should be left undisturbed for ten minutes.
REMAKING THE IMPRESSION:

May be carried- out in the following conditions:.

a. Improper positioning of the impression tray.
• Improper tray placement leads to excessively thick on the shifted
side & the thin impression flange on opposite side.

b. Large voids
c. Improper consistency of impression material
d. Movement of the tray during the setting of the impression material.
Inadequate scrapping of the border molding material

e. Using too much or too little impression material.

 MAXILLARY IMPRESSION

a.
incisive papilla
K A
b. palatal rugae

J B
c. median palatine raphe

d. maxillary tuberosity
I
e. pterygomaxillary notch
C
f. fovea palatini and
vibrating line area

i. residual alveolar ridge

D D
j. buccal frenum

k. labial frenum E E

MANDIBULAR IMPRESSION

a. retromolar pad A A
b. mylohyoid (internal
oblique line)
c. masseteric notch B
d. residual alveolar
ridge C
D E
e. lingual frenum
f. external oblique
F
line
g. buccal frenum
G G
h. labial frenum

Inspecting Maxillary &Mandibular landmarks in final

impressions
 # BOXING OF IMPRESSION
Beading and boxing is done to preserve width and height of sulcus in a
cast and boxing is done to obtain a uniform smooth well shaped base of
the cast. Boxing can be defined as the enclosure (box) of an impression to
produce the desired size and form of the base of the cast and to preserve
desired details. Beading and boxing final impressions before pouring
preserves the extension, as well as the thickness, of the border; controls
the form and thickness of the base of the cast; and boxing also facilitates
placing remounting plates in the cast; and conserves artificial stone. It
ensures the capture of the mucobuccal and mucolingual borders of
impression. Beading and boxing the impression can facilitate to pour a
base on the secondary impression without inverting. Inverting can
sometimes cause the stone in the impression to move. The use of vibrator
at the time of pouring the stone into the boxed impression causes the
heavier particles fall to the bottom. This means that the tissue surface of
model will be stronger. The more watery mix will now be on the base of
the cast which is now on top.

Procedure :
1. After taking and disinfecting the impression, remove the excess water
from the impression.
2. Use permanent marker to place a line around the entire impression
approximately 3 mm from the peripheral border roll to designate the
desired extension for the border .
3. Adapt two or three pieces of beading wax to the tray’s polished surface to
adjust the impression above the countertop to keep the ridge level.
4. Invert the tube of the commercially available instant adhesive downwards
and then squeeze gently to apply it along the marked line, taking care that
it does not contact the skin .
5. Take the pre-prepared bead of the wax or bead made up of base plate wax
and stick it at the mark line with instant adhesive
6. Further strengthening of the junction of bead and elastic impression is
done by melting the wax around.
7. Place the boxing wax over the wax beading in usual manner by instant
adhesive or by melting the wax .
8. Make a mix of dental stone and pour the boxed impression in the
customary manner to control the thickness of the stone for the base .
9. After the stone is set, remove the boxing and beading from the impression
and trim the cast if required to preserve the land of the cast .

2-Plaster and pumice boxing technique:

Method:

Place the final impression into plaster. Try to seal around the impression
using wet finger. About 2-3 mm of the impression borders should be
visible superior to the plaster and all the tissue surface should plaster free.
Again use wet finger to smoothen and seal the surface of the plaster. Rap
a strip of boxing wax around the plaster. Seal it with hot wax spatula.

The advantages of this technique are its speed and ease of use. Then
pouring and trimming the master casts is performed.

#Digital versus Conventional Impression in Complete Denture :

Digital impression for CD A relatively new approach employs Computer-

Aided Design/ ComputerAided Manufacturing (CAD/CAM) technology
to take a digital impression intra orally, fabricate the master model, and
design as well as produce the final restoration.
This method aims to overcome certain physical limitations of
conventional means, such as the dimensional changes of impression
materials, the expansion of dental stone, and human errors .
The evolution of the CAD/ CAM technology decreases the duration of
prosthesis manipulation and provide superior functional and esthetic
outcomes.
Also changes of the prosthesis volume and/ or shape is reduced or
eliminated in this approach compared to the conventional procedures.
Thus, the produced prosthesis adheres tightly to the tissue and uniformly
transferring loads on it. Furthermore, it permits easy duplication of the
denture and manufacture of new one using stored digital data.
CAD/CAM systems parts
(1) A data acquisition unit, which gathers the information or data from
the mouth and then converted into visual or optical impressions which are
created directly or indirectly at the same time.
(2) Different software’s: are used for the designing of the final
restorations which are secured in optical impressions and prepared for the
milling parameters.
(3) A computerized milling system for the final manufacturing of the
restoration with solid blocks of the appropriate restorative material. The
first two parts of the system are associated in the CAD phase, while the
third one is the CAM phase.
Digital scanner A digital scanner is a non-contact measuring device that
records and reconstructs three-dimensional (3D) surfaces or volumes. It
consists of an optical acquisition system in association with 3D
reconstruction software .
• IOS is a medical device composed of a handheld camera (hardware), a
computer, and software. The goal of IOS is to record with precision the
threedimensional geometry of an object. The most widely used digital
format is the open STL or locked STL‐like.
• The IOS devices use an advance optical surface scanning technology
that are similarly to a camera using the sensors measure light reflection
times from various texture through processes to capture the object three
dimensionally instead of simply capturing lights and colors in the camera.
The information is then captured by the 3D software that uses specific
alignment algorithms to allow for registration of the object. Mobile and
record directly in the mouth
• Extra-oral scanners (EOS) are used to digitize impressions/models in
laboratories.
• Facial scanners can be used for recording aesthetic lines or extra-oral
defects in maxillofacial prosthetics.