www.dentallearning.

net

Complete Denture Impression 101

ne of the procedures most dreaded by many dentists is the fabrication of the complete denture. They look at complete dentures as a drain on their time and patience; however, this need not be the case. Fabricating complete dentures for the patients who need them can be a gratifying and profitable part of your practice. Many of the problems related to denture fabricationcan be traced back to the master impression, the first step in the procedure. If this procedure is not performed properly, the outcome will be questionable. Using a strict but simple protocol will direct the process toward success.

maxillary arch best, perhaps because they keep the tongue and cheeks out of the way. One of the easiest materials to use for these preliminary impressions is alginate. Mixed to its correct powder/water ratio, it is an accurate and well-tolerated material. It should be noted that impressions taken in this manner have accurate detail, but even under optimal conditions (correct mix and light pressure when placing the tray) they show compression of the mucogingival fold. As long as one understands this situation, it can be dealt with during the fabrication of the custom tray.

Preliminary Impressions
The capture of important anatomical structures is vital in the final impressions. This means that the maxillary impression must clearly show the posterior palatal seal region, labial and buccal vestibules, tuberosity, hamular notch, and all frenums (muscle attachments). The mandibular impression also must capture clear, definable labial and buccal vestibules, the retromolar pad, the mylohyoid ridge, and muscle attachments. Every step toward this goal starts with the preliminary impression and ends with a flawless final impression. No step is more or less important than the step that precedes it. The initial step of the preliminary impression is the stock tray selection. The choices are numerous. Does one use metal or plastic, edentulous or conventional? Your choice should depend on what works best in your hands. This author finds that conventional metal trays capture linguals of the mandibular arch and buccal vestibules of the
Frank Ortolano, DDS Private Practice Holmdel, New Jersey Phone: 732.671.1052 E-mail: frankortolano@verizon.net Web site: www.holmdelgentledentist.com

Stone Model
Custom tray fabrication begins with the preliminary impression stone model. A pencil line should be drawn approximately 3 mm shy of the deepest extension of the mucobuccal and mucolingual folds. The stone model should be coated with a thin layer of petroleum jelly. The material choice for custom tray fabrication falls into 2 categories: self-cure acrylics and light cured. Examples of self-cured materials are Fastray (Bosworth), Instant Tray Mix (Lang Dental Manufacturing), and Acratray (Henry Schein). An example of a light-cured material is Triad TruTray custom tray materials (DENTSPLY Prosthetics). When using light-cured materials, it is important to wax out significant undercuts to avoid locking the tray onto the model. This author uses a self-cured acrylic and does not wax out undercuts. However, it is important to remove the tray from the model once heat is first detected and before the final set. Wax spacers (one thickness of base plate wax) are recommended by some dentists to use under the custom tray. With very few exceptions, this author prefers no wax spacer.

Trimming
As soon as the custom tray has hardened, trimming begins. This is one of the most important steps. The tray must
Dental Learning / November 2010 1

www.dentallearning.net

be trimmed to the pencil mark placed previously. Selective grinding of the tissue-bearing surface is recommended to allow for a very passive fit of custom tray to model (Figure 1).

Border Molding Practice Pearl 1: Adaptol

The next most important step in this process is the border molding of the custom tray. Many dentists were taught that the only way to border mold was to use green stick compound. This material is very difficult to control and time consuming to use, and is certainly not user-friendly. A little-known material called Adaptol (Kaye Research Laboratories) (Figure 2), a thermoplastic molding material that comes in stick form, is a wonderful but underused product that has been available for decades. It can be difficult to find but is a stock item at both Patterson Dental and Darby Dental. Every colleague to whom this author has recommended Adaptol has become a believer. Hopefully, as more practitioners use Adaptol and realize its benefits, it will become more popular and easier to find. An Adaptol stick is immersed in a warm water bath. After softening and while running under hot water, it is rolled between wet fingers and thinned to a 3-mm diameter rope. When thinned, it is attached to the borders of the custom tray. It can be placed on one side at a time or, after some experience with the material, the whole tray at once. The tray is reimmersed into the warm water bath and then placed into the patients mouth. While setting in the mouth, muscle mold with the patient. After the tray has set, rmove it from the patients mouth and run under cold water (Figure 3). Check for any show-through of tray material; if seen, reduce the tray in this area and reborder mold. Any molding material that flows into the tissue-bearing area can easily be cut away with a Bard-Parker knife when chilled. The entire border molding procedure should take less than 5 minutes.

Figure 1Custom tray.

Figure 2Border molding material. Figure 3Custom tray with border molding in place.

polyvinylsiloxanes to polyethers. Polyethers Impregum PentaSoft (3M ESPE) or Impregum PentaSoft Quick Step (3M ESPE) mixed in a Pentamix Automatic mixing unit (3M ESPE)are the preference of this author because it is very fast, the mix is perfect every time, and there is no cleanup.

Final Impression
You are now ready for your final impression. Coat the entire interior of the tray with adhesive, extending at least 2 mm to 3 mm beyond the fold on the outside. If the procedures detailed previously have been followed, the final impression should almost take itself. Impression materials vary from rubber base to

Dispensing Impression Material Practice Pearl 2

As the impression material comes out of the automatic unit (Figure 4), it is directly filled into a Monoject No. 412 utility syringe (Covidien) (Figure 5), a 1-piece plastic tube/nozzle syringe. The syringe tip should be cut, leaving

Dental Learning / November 2010

www.dentallearning.net

Figure 4 Impression syringe in place over mixing tip of automatic dispenser.

Figure 7 Custom tray with dispensed impression material in place.

Figure 8Final impression.

Figure 5Monoject syring, unmodified.

Figure 6Syringe with cut tip.

about a quarter inch extending out of the tube (Figure 6) to allow easier flow into the tray. Placement of the syringe material is important. A ribbon of impression material is placed on the Adaptol that is on the borders of the tray. Next, a ribbon is placed at the crest of the ridge area. In the maxillary arch, a final dollop is placed at the roof of the palate (Figure 7). Patients with broader and/or larger arches may require an additional ribbon of impression material. This technique of mixing and placing the impression tray is much easier and more accurate than using a dispensing gun or manually mixing. After all, dentists are extremely comfortable with an anesthetic syringe. The Monoject utility syringe feels just like that. One of the keys to a good impression is not overloading the tray. This will allow uniform thickness of impression material, less gagging on the part of the patient, and less mess. The impression tray should be placed starting in the

anterior and slowly seating posteriorly. Any posterior excess should be removed with a mirror handle. Remember that too much material and too much pressure is contraindicated. When the impression tray is properly seated, muscle molding begins. On the upper, pull the cheeks out, down, and then in. On the lower, it is out, up, and in. You can continue with any of your favorite molding techniques. As soon as it sets, remove and evaluate the impression for details (Figure 8). With practice, impressions should be nearly perfect every time without causing the usual stress many practitioners dread.

Conclusion
This impression technique should lead to the fabrication of dentures that are comfortable and retentive for patients. In addition, it should require the least amount of post delivery adjustments for the dentist. It truly is the foundation for complete denture success.
Disclosure: Dr. Ortolano is a consultant for BISCO, Inc.

www.dentallearning.net

Dental Learning / November 2010