Preliminary Edentulous Impressions

Preliminary Edentulous Impressions

Preliminary impressions needed for diagnostic casts for making custom trays

Custom Tray
Required to accurately register moveable mucosa Create seal for retention

Stock Trays
Stock trays can result in distortion and shortening of the final denture flange

Alginate Syringe Technique

Irreversible hydrocolloid Ensures capture of critical anatomy - sometimes missed with just a tray

Border Molding
Minimizes distortion of the movable vestibular tissues Displacement could lead to dislodgment during function

Irreversible Hydrocolloid Storage

Pre-weighed pouches
Easier dispensing Minimizes contamination

Bulk material
Store in cool dry airtight containers

Irreversible Hydrocolloid Storage

Deteriorates if:
Stored above 54C Repeated openings

Deterioration results in:

Thin mixtures Reduced strength Permanent deformation

Tray Selection
5 mm of clearance with soft tissues Hydrocolloid requires bulk for accuracy, strength and stability

Tray Selection
Maxillary trays should extend slightly beyond vibrating line Mandibular trays should cover the retromolar pads

Tray Selection
Sto-K edentulous trays Short flanges, so dont distort vestibule

Tray Modification
Trays can be modified with compound to extend the tray if desired

Irreversible Hydrocolloid Syringe Technique Critical anatomy registration

Retromylohyoid area Hamular notches Retrozygomal area

Patient Preparation
Practice placing tray Rotate into place

Patient Preparation
Dry the mucosa
Dry the maxilla with folded gauze Pack 3 gauze in mandible Dont let patient close

Mark Vibrating Line

Prior to making preliminary & final impressions Fovea should not be used

Vibrating Line
If denture terminates anteriorly, poor seal If terminates posteriorly, soft palate movement may cause it to dislodge Denture may be unretentive and/or uncomfortable

Locate & Mark the Hamular Notch

Posterior border of a complete denture Between the bony tuberosity & hamulus

Locate & Mark Hamular Notch

Denture border must terminate on soft displaceable tissue Provides comfort and retention Notch may be posterior to depression in soft tissue

Locate & Mark the Hamular Notch

Hamular Notch

Use the head of a mirror, to palpate the notch Mark with an indelible marker

Tuberosity mucosa soft palate

actual position of hamular notch visual determination of hamular notch mouth mirror

Locate Posterior Border of Hard Palate

Ensure the denture terminates posteriorly by palpating

Indelible Marks Prior to Impression

Transfer to the impression and cast when it is poured Eliminates error Tissue should be relatively dry to be most effective

Syringe Preparation
12 cc disposable syringe Cut off the tip where it begins to curve 5 mm orifice

Plunger Preparation
Vaseline plunger Ease of extruding material Use:
Uncontaminated bowl, spatula Regular set alginate

Measuring Powder
Fluff (shake) the powder, measure, tap and flatten the scoop with powder Use three scoops for syringe impressions

Mixing
Assistant mixes for at least 45 seconds Smooth creamy homologous mixture that glistens Not granular or lumpy

Syringe Loading
The assistant loads the syringe nearly full from the back and inserts plunger

Syringe Technique
Syringe a broad rope into the vestibule Begin at the posterior Move quickly toward anterior Fill the vestibule to labial frenum

Cheek Retraction
Use a mirror, instead of a finger Provides better visibility, more maneuverability

Maxillary Impressions
Begin opposite the tuberosity Inject until alginate is seen in the hamular notch before moving forward

Mandibular Impressions
Start with the buccal vestibule adjacent retromolar pad Move forward to the labial frenum Repeat on the opposite side

Lingual Vestibule
Roll syringe tip under tongue Inject into retromylohyoid space until alginate appears between tongue & ridge Move anteriorly, filling to lingual frenum
Repeat on the opposite side

Deep Palatal Vaults

Material can be syringed into the palate Smooth with a finger, or voids may occur

Partially Edentulous
Syringe a small amount of hydrocolloid on the occlusal surfaces Force into the occlusal surfaces with finger

Cleaning the Syringe

Preliminary Impressions
The assistant loads the tray while the clinician is syringing Place the anterior portion of the tray first, then seat the posterior of the tray

Preliminary Impressions
Less gagging if the patient is lying down Tongue position avoids gagging Mold the vestibular area Pull on the cheeks and lips to activate muscles and frena

Finger Sweep at Posterior

If excess material at border Use finger or cotton swab

Preliminary Impressions
Support the tray during setting - do not leave the patient Movement causes distortion

Preliminary Impressions
Break peripheral seal
Drops of water Pull up cheek and let air in Wiggle tray until hear seal break

Preliminary Impressions
Once seal broken, remove quickly (to avoid permanent deformation) Evaluate impression Pour within 12 minutes

Preliminary Impressions
Rinse thoroughly with water Gently shake to remove excess water

Preliminary Impressions
Spray with disinfectant to coat all surfaces, and seal in a bag for ten minutes

Sample Impressions

Sample Impressions

Syringe Technique Problems

Vestibular material may not join the tray material
Saliva contamination Insufficient material

Syringe Technique Problems

Omitting plunger lubrication may make it difficult to express the alginate Trapping tongue under the tray will result in underextension of the lingual vestibule

Problems with Syringe Technique

Severe gaggers poor tolerance for intraoral motion Use traditional technique

Diagnostic Casts

Pouring a Model
Weighing powder, measure water Vacuum mix (less time, stronger cast) Use a two pour technique

Two Pour Technique

In Removable Prosthodontics: Preliminary Impressions Only

Pouring a Model
Modulate speed of pouring by tilting back and forth or pressing the tray more firmly onto vibrator

Pouring a Model
Model moist during trimming Soak in slurry water, or soak with base of cast in water

Pouring a Model
Casts should be a minimum of 12 mm (.5 inch) in thinnest part Separate the alginate impression from the stone cast after 45 minutes

Trimming Casts
Trim the base on the model trimmer parallel to the residual ridges Leave the vestibular reflection intact for making a custom tray

Trimming Casts
All anatomical surfaces should be included with minimum voids