Dental Clinical Practice 3

Primary Impression in complete dentures Dr. Ammar A.Razek Prosthodontist

BDS,MSc,GradCertClinDent

Impression
An impression is defined as an imprint or negative likeness or registration of the denture bearing , denture stabilizing , denture bracing & peripheral limiting structures obtained in one of the plastic or semiplastic impression materials registered at their crystallization.

Examination
Intraoral condition
Important to assess anatomy and morphology of soft and hard tissues due to the variety of impression material and types of impression trays. Morphology of hard tissues influences thixotropic flow of impression materials, thus it may create undesirable voids and bubbles. Anatomical features such as undesirable undercuts will limit the type of impression material we can use.

 On flabby tissue areas, compression of tissue is higher under loads, leading to permanent deformation of impression material and therefore compromising accuracy of final impression. Rigidity of hard tissue areas allows reproduction of a more stable impression surface.

Anterior flabby tissue area

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Objectives of an impression
1. Accurate impressions depends on technique and material 2. correctly extended impressions depends on knowledge of regional anatomy. 3. It should provide the best possible distribution of physical forces to reproduce the surface of the denture bearing tissues for accurate fabrication of a denture base. 3. minimally distorted tissue depends on technique & material

Principles of an impression
1. Retention intimate contact between the impression surface of the denture base & the underlying tissue - correct design & extensions of the periphery to ensure border seal. 2. Support appreciation of the denture supporting tissue. - maximum coverage.

3. Stability
Extensions which avoid interference with adjacent structures in function. Close adaptation to the undistorted mucosa (satisfactory retention & support)

4. Aesthetics correct design of extensions

to ensure lip & cheek support.

5. Tissue preservation- avoid excessive load .

- avoid impressions of distorted tissue.

Types of impressions in complete denture construction

Two types. 1. Preliminary impression ( primary impression) 2. Final impression (secondary impression)

Preliminary impression
Primary impression is a negative likeness made for the purpose of diagnosis , treatment planning or the fabrication of a custom impression tray used for making the final or secondary impression. The preliminary impression should include as much as possible of that portion of the residual ridge that is to support the denture.

Uses of preliminary impression

1. To provide the study cast. 2. To provide a cast for the fabrication of a final impression tray. 3.In some techniques the impression itself is modified for use as a impression tray..

The preliminary impression should :

1. Record all denture support area. 2. Record the oral anatomy adjacent to the denture support area, & 3. Record the natural form & physiologic extension of oral tissues.

Impression materials
Primary impression: 1. Irreversible Hydrocolloids (eg. Alginate) 2. Impression compound

Secondary Impression : 1. Elastomers : (rubber base) 2. ZnOE

Eg. - Polyether - Silicones (PVS) -Polysulphide

Consistencies: - Heavy body(putty) - Medium body - Light body

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 A protruded maxillae with a soft tissue undercut at the fornix area will require a more flexible material such as polyvinyl siloxane (PVS) rather than a less flexible one such as polyether

Impression material generally used for the preliminary impression

1.Irreversible hydrocolloid (alginate) 2. Impression compound

Impression materials Irreversible hydrocolloids

Irreversible hydrocolloids (alginates) have been widely used as a primary impression material. Because these materials uptake water to start their chemical reaction, the consistency and setting times vary greatly depending on both the amount and the temperature.

After removal from the mouth and disinfection, the impression should be covered with damp gauze or napkin to prevent syneresis.
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Irreversible hydrocolloids (cont.)

Accuracy of primary impression most likely depends on the material consistency achieved and post-impression handling. As these materials are relatively inexpensive and their setting time relatively faster compared to elastomeric materials, several attempts can be performed in order to secure a good impression cast.

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Materials used for final impression

Zinc oxide eugenol Polyvinyl Siloxane Polyether

This will be covered in final impression lecture

Impression trays
Is defined as a device , which is used to carry , confine & control impression material for making an impression. Impression trays are used to make impressions to replace missing structures of either soft or hard dental tissues or both (i.e. in edentulous patients or dentate patients).

Pressure of impression materials

Accuracy of impression is influenced by setting and mechanical properties of impression materials and pressure exerted by confined space of impression tray.

Impression tray not only holds impression material but also provides a box-like feature, limiting the flow direction of the impression material and allowing a less saliva contamination and deformation of the materials.

Musculature of cheeks and tongue acts as walls that, depending on the amount of recording material, exert less pressure towards the gingival tissues.

Important to choose an appropriate consistency of recording material with an appropriate impression tray.

Functions of impression tray

1. To support the impression material in planned contact with oral tissues. 2. To support the impression material when removed from the mouth so that a cast can be poured

Types of impression trays

1. Stock trays A. Edentulous tray a. non- perforated b. Perforated B. Dentulous box tray a. Non- perforated b. Perforated c. Rim lock

Closed tray This type of configuration exerts an increased pressure over soft and hard tissues

Open /perforated trays This type of configuration exerts a slightly decreased pressure over soft and hard tissues

Closed trays
Important to indicate to laboratory technician the amount of spacing needed according to the impression material likely to be used. More space will allow more impression material filling, thus decreasing the pressure on vital structures. Less space decreases thickness of impression material used, with risk of tearing off from supporting surface of special tray.

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Open trays
Adequate amount of impression material is needed to reach the tissues. Less pressure Metallic trays /stock trays provide retention by the rim lock and the perforations

2. Custom trays

A. Compound tray B. Shellac tray C. Acrylic resin tray a. Close fitting b. With spacer & stops The preliminary impression is usually made with alginate impression material placed into a stock metal impression trays designed for edentulous jaws.

Custom trays
It is an impression tray made on the diagnostic cast & is designed to make a more accurate & detailed impression. It is fabricated for a specific impression procedure for the patient & is discarded after use. Requirements; It should be dimensionally accurate It should be rigid

 It should nearly have the shape of the completed impression. It should be evenly thick.( 2mm) Tray borders should be short of the final impression by 2mm. Fabrication- Custom tray fabrication should be done only after ensuring completeness of diagnostic cast, with a good land area of the cast.

 Estimated border should be marked with indelible pencil on the diagnostic cast before designing the custom tray. Tray should be sufficiently thick as to be rigid. The design of the tray should be done according on the basis of impression technique.(The amount of pressure exerted on the tissue) Mucocompressive,Mucostatic, Mucoselective

Modifications according to different Impression Materials - Adhesives

Surface adhesive is needed in most cases to provide retention of impression material to custom tray, as there is no chemical bonding between impression material and the acrylic or resin surface.
This does not apply when using ZOE paste.

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Adhesives (cont.)

Adhesives

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Adhesives (cont.)

Adhesive application

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Tray modifications (cont.)

Stock plastic trays

Perforations on custom tray

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Tray modifications (cont.)

If further extensions are required, modifications to trays can be performed by using: periphery blue wax on primary impressions or a more rigid material such as green compound on secondary impressions.

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Tray modifications (cont.)

Periphery wax and green compound

Increased peripheral extensions

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Laboratory Procedures
Choose between cold-cured acrylic and light-cured resin. Cold-cured acrylic might be easier to adjust as it is slightly softer compared to light-cured resin.

Compliance with occupational health and safety should be ensured before mixing the polymers.
Working area should be under adequate ventilation to control fumes from polymerisation reaction.

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Cold-cured acrylic
1. Prepare cast models by removing excess of stone on buccal and lingual areas. Use indelible marker to delimit extensions.

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Cold-cured acrylic (cont.)

2. Stone should be blocked for undesirable undercuts and spaced. 3. Space is provided by softening and adapting a thin baseplate recording wax onto teeth and residual alveolar ridge. 4. Cast impression should be covered with tinfoil or separator medium such as a lubricant (Vaseline).
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Cold-cured acrylic (cont.)

5. Cold-cured acrylic is then mixed until a homogeneous consistency comes out from the rubber beaker.

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Cold-cured acrylic (cont.)

Upper tray
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6. If making an upper tray, shape into a thin and round sheet of acrylic.

Lower tray

If making a lower tray, shape into a sausage with a T shape.

Cold-cured acrylic (cont.)

7. Adapt cold-cured acrylic to the surface using light finger pressure.

Upper tray

Lower tray

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Cold-cured acrylic (cont.)

8. Allow 2-3 mm from the border when pressing to obtain a rolled shape.

Upper tray

Lower tray

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Cold-cured acrylic (cont.)

9. Shape a small handle.

Upper tray

Lower tray

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Cold-cured acrylic (cont.)

10.Before the exothermic setting reaction is finished, remove from the cast model and round the borders with your finger tips.

Upper tray

Lower tray

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Cold-cured acrylic (cont.)

11. Allow to 3-5 minutes to set cure.

Upper tray

Lower tray

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Cold-cured acrylic (cont.)

12. Remove from the cast and clean the excess of lubricant with a clean tissue. Use detergent to wash the surface, dry and pack in an opened bag.

Upper tray

Lower tray
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Light Cured Resin

1. Prepare the cast models by removing excess stone and delimit the extensions with an indelible marker.

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Light-cured resin (cont.)

2. Stone should be blocked for undercuts and spaced.

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Light-cured resin (cont.)

3. Space is provided by softening and adapting a thin baseplate recording wax onto the teeth and the residual alveolar ridge. 4. The cast impression should be covered with tinfoil or separator medium such as a lubricant (Vaseline).

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Light-cured resin (cont.)

5. If making an upper tray, photo polymerised resin sheet is shaped into an arch form. If making a lower tray, section the bottom portion of the resin sheet with a wax knife.

Upper tray

Lower tray
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Light-cured resin (cont.)

6. Adapt resin sheet with light fingertip pressure.

Upper tray

Lower tray

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Light-cured resin (cont.)

7. Trim excess with a wax knife.

Upper tray

Lower tray

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Light-cured resin (cont.)

8. The trimmed excess should be rolled and used to create a small handle.

Upper tray

Lower tray
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Light-cured resin (cont.)

9. Blend the handle resin to tray surface with a wax knife.

Upper tray

Lower tray

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Light-cured resin (cont.)

10. A light curing unit is used to polymerise both sides of the light-cured resin for 3 minutes each side.

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Light-cured resin (cont.)

11. Trim sharp borders of special tray with a tungsten carbide acrylic bur.

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Light-cured resin (cont.)

12. Remove from the cast, wash with detergent, dry and pack in an opened bag.

Upper tray

Lower tray

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Terminology
Thixotropic:
the property of certain gels to become less viscous when shaken or subjected to shearing forces and returning to the original viscosity upon standing (e.g. synovial fluid) a characteristic of a system exhibiting a decrease in viscosity with an increase in the rate of shear, usually a function of time.
(CancerWEB's On-line Medical Dictionary)

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Terminology
Syneresis:
the contraction of a gel by which part of the dispersion medium is squeezed out.
(CancerWEB's On-line Medical Dictionary)

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Thank you