Impression techniques (CD)

Definition
Impression: A negative likeness or copy in reverse of the surface of an object, an
imprint of the teeth and adjacent structures for use in dentistry (GPT8).
Preliminary impression: A negative likeness made for the purpose of diagnosis,
treatment planning or the fabrication of a tray (GPT8); also referred to as 'primary
impression'.
Final impression: An impression that represents completion of registration of the
surface or object, made for the purpose of fabricating a prosthesis; also referred
to as 'secondary impression' or master impression

Objectives
1. Retention
2. Stability
3. Support
4. Preservation of residual structures

5. Aesthetics

Retention
Definition: That quality inherent in the dental prosthesis acting to resist the forces
of dislodgment along the path of placement (GPT8)
• It iS related to forces that resist the forces of gravity, adhesiveness of food and
opening of the jaws

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 • The process of obtaining denture retention begins with impression making.
Factors that attach the denture to the mucosa affect retention.
Factors affecting retention
1. Anatomical factors
(i) Size of the denture-bearing area Retention increases with increase in the size
of the denture-bearing area.The average size of the maxillary denture-bearing
area is around 24 cm² and that of the mandibular denture-bearing area is around
14 cm²
(ii) Tissue displaceability
The displaceability of the tissues affects the retention of the denture Tissues
displaced during impression making will rebound during function and lead to loss
of retention.
2. Physiological factors
• The amount and consistency of saliva affects retention.
• Thin, watery saliva- best retention,
•Thick and ropy saliva- loss of retention.

• The absence of saliva (xerostomia)- affects retention, cause irritation and

soreness of the denture-bearing tissues
3. Physical factors

(i) Adhesion
• Adhesion is defined as the physical attraction of unlike molecules to one
another.
• It depends on: Close adaptation of denture; Size of denture-bearing area; Type
of saliva.

(ii) Cohesion
• Cohesion is defined as the physical attraction of like molecules to one another.

• This occurs within: film of saliva and aids in retention

• Normal saliva is not very cohesive; hence, retention from mucosa interface is
more dependent on adhesion and surface tension.

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 (iii) Interfacial surface tension∙ Interfacial surface tension is defined as the tension
or resistance to separation possessed by a film of liquid between two well
adapted parallel surfaces. • It is dependent on the ability of the liquid to 'wet the
surfaces. The wettability' of the fluid is inversely proportional to the surface
tension of the surfaces.

(iv) Capillarity That quality or state, which because of surface tension causes
elevation or depression of the surface of a liquid that is in contact with a solid. •
Capillarity causes the thin film of saliva to rise and increase its contact with the
denture base and the mucosa.

(v) Atmospheric pressure

• This can help resist dislodging forces if the dentures have an effective border
seal. Peripheral seal or border seal is defined as the contact of the denture border
with the underlying or adjacent tissues to prevent the passage of air or other
substances (GPT8)
• When a force is exerted perpendicular to and away from the basal seat of a
denture which is properly extended and fully seated, pressure between the
prosthesis and mucosa drops below the ambient pressure, resisting displacement.
This has been previously referred to as 'suction'
(vi) Gravity This natural force can aid in the retention of the mandibular denture
especially when there is more weight and other retentive forces and factors are
marginal

4. Mechanical factors
(i) Undercuts• Moderate undercuts enhance retention because of the resiliency of
mucosa. Examples are unilateral tuberosity undercuts, undercuts in maxillary
premolar area, distolingual areas and lingual to the midline of mandible.
(i) Denture adhesives These commercially available products enhance retention
by increasing adhesive and cohesive properties and by eliminating voids between
denture base and basal seat tissues

(ii) Suction chambers and discs These have been used to create a negative
pressure in the palatal surface of the maxillary denture, thereby enhancing
retention.

5. Muscular factors

Impression techniques (CD) 3

 The oral and facial musculature and tongue supply supplementary retentive
forces. For this to be effective: • Teeth must be positioned in the 'neutral zone'
between the tongue and cheeks. • Polished surfaces of the dentures should be
properly contoured• Denture bases must be extended to cover maximum area.•
Occlusal plane must be at correct level.

Stability
Definition: The quality of a removable dental prosthesis to be firm, steady, or
constant, to resist displacement by functional horizontal or rotational stresses
(GPT8).

Factors affecting stability

1. Vertical height of the residual ridge• Stability deceases with loss of vertical
height of the ridges
2. Quality of soft tissue covering the ridge • Flabby ridges provide poor stability.

3. Adaptation of denture to the tissues ◦ Close adaptation of the denture to the

basal seat tissues is very important to ensure proper stability. An accurate
impression is essential to achieve this,

4. Occlusal plane

5. Teeth arrangement• Setting teeth in 'balanced occlusion' and in the 'neutral

zone' promotes stability

6. Contour of polished surface• The polished denture surface should be in

harmony and with the functioning of oral muscles to promote stability.

Support
Definition: The resistance to the vertical forces of mastication, occlusal forces and
other forces applied in a direction towards the basal seat tissues. To provide
adequate support, the denture base should cover as much denture-bearing area
as possible. This distributes the forces over a large area and is known as
snowshoe effect

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 Preservation of residual structures
• Preservation of remaining oral structures is vitally important to long-term
success of the denture ◦ Accurate impressions using a selective pressure
impression technique that places pressure only on stress-bearing areas is
important for this preservation.

Aesthetics
• Denture border and flange thickness are dependent on the amount of residual
ridge loss and varies with each patient. • Reducing or increasing the thickness of
this area leads to poor aesthetics.

Classification of impressions
Depending on purpose of impression making

Diagnostic impression

• This is an impression made for the purpose of diagnosis, treatment planning

and fabricating diagnostic casts

• Materials used - irreversible hydrocolloids.

Primary/Preliminary impression

• This is made for the purpose of making a preliminary cast on which a special
tray is constructed.

• Materials used -irreversible hydrocolloids, impression compound, putty and

heavy body elastomeric impression materials.
Final/Secondary/Master impression

• This is made for the purpose of fabricating a master cast, on which the
prosthesis is fabricated.
• Materials used - zinc oxide eugenol (ZOE) impression paste, impression plaster,
medium and light body elastomeric impression materials

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 Depending on theories of impression making
Minimal Selective
Pressure Theory Pressure Pressure
Theory Theory

Mucostatic or
Mucocompressive
nonpressure or
Synonyms or definite
passive
pressure.
technique

Principle It was proposed The minimal Advocated by

on the pressure Boucher, this
assumption that technique was technique
tissues recorded based on the combines the
under functional principle of principles of
pressure (as mucostatics both pressure
during (age, 1946). • and minimal
mastication) According to pressure
provided better this principle. techniques.
support and interfacial This theory is
retention for the surface tension based on a
denture was th only thorough
significant way understanding
of retaining of the anatomy
complete and physiology
dentures, • of basal seat
Retention is and
achieved surrounding
through areas.
accurate tissue Pressure is
adaptation. applied
Accordingly, selectively on
the impression areas capable
should cover of resisting
only those stress (stress-
areas of the bearing areas),
denture and reduced
foundation, from areas

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 Minimal Selective
Pressure Theory Pressure Pressure
Theory Theory
where the incapable of
mucosa is tolerating
firmly attached. stress (relief
• Thus, areas).
dentures made
with this
technique have
shorter flanges

Technique Technique • A compound

introduced by impression is
Greene is as made.
follows: • A baseplate
• A custom tray is wax space is
fabricated with its adapted on the
periphery short resulting cast
by 1/8 inch. according to
• A second the outline of
impression is the denture.
made in this tray • A special tray
using compound. is adapted over
• Bite rims with the wax spacer.
uniform occlusal • The spacer is
surfaces are then removed and
made. an impression
• Areas to be made with a
relieved (e.g. free-flowing
median palatal material with as
raphe) are little pressure
softened and the as possible
impression is • Escape holes
again inserted in may be made
the mouth and is for relief. Many
held under biting of Page's
pressure for 1 or 2 contentions
min. have now been
• The borders are questioned and
moulded by his techniques

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 Minimal Selective
Pressure Theory Pressure Pressure
Theory Theory
asking the patient based on this
to perform theory have
functional fallen out of
movements like favour
whistling and
smiling

The technique
considers the
physiologic
• Better retention
• High regard functions of the
and support
for tissue tissues of the
Advantages during occlusal
health and basal seat, and
functions like
preservation. therefore
mastication.
appears more
sound and
appealing

Disadvantages • Excess pressure A. Most of the A. Some feel

could lead to disadvantages that it is
increased alveolar stem from the impossible to
bone resorption use of shorter record areas
eventually flanges with varying
resulting in loose B. The shorter pressure
dentures. flanges prevent B. Since some
• Excess pressure the wider areas are still
was applied to the distribution of recorded under
peripheral tissues masticatory functional load,
and the palate stresse the denture still
which was not C. With faces the
well suited to reduced potential
receive pressure coverage, the danger of
resulting in possibility of rebounding and
transient getting greater loosing
ischaemia. retention, retention
• Dentures fit well including the Impression
during retaining techniques
mastication, but potential of based on the

Impression techniques (CD) 8

 Minimal Selective
Pressure Theory Pressure Pressure
Theory Theory
tend to rebound surrounding selective
when the tissue musculature is pressure
resume their lost. technique are
normal resting D. The lack of most popular
state. border even today.
• The resorption moulding
eventually results reduces
in loose dentures. effective
• Pressure on peripheral seal,
sharp spiny thereby further
ridges or other reducing
bony areas often retention
results in pain. E. The lack of
border seal
also permits
food to slip
beneath the
denture
F. The short
denture
borders are
readily
accessible to
thrringue which
might provoke
some tion.
G. The shorter
flanges may
reduce support
for the face
which can
affect
aesthetics
H. The shorter
flange would
mean less
lateral stability.

Impression techniques (CD) 9

 Minimal Selective
Pressure Theory Pressure Pressure
Theory Theory
I. Patients with
poor residual
ridges and
reduced areas
of attached
gingiva were
difficult to treat.

Depending on impression technique

Open mouth

• This records the oral tissues in a static state with displacement

• The amount of displacement depends on the ability of the different oral tissues
to withstand pressure, the amount of space provided for the impression material
and the consistency of the impression material.

• With the patient's mouth in open position, the dentist applies controlled pressure
on the inserted tray to record the tissues in a static form

• Disadvantages:The tissues are not recorded in a functional state.

Closed mouth

• In this technique oral mucosa is recorded in a functional, compressed form. It is

assumed that the occlusal loading during impression making is comparable to
occlusal loading during function.

• Occlusal rims or teeth are attached to the impression trays

• Impression is recorded, while patient applies pressure and performs functional
actions like swallowing, grinning or pursing the lips. Thus, the peripheries of the
dentures are established during function.
• Impression materials used for this technique are waxes and soft liners.
• Indicated for atrophic ridges

•Disadvantages:

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 ○ Difficult to control the amount of pressure leading to pressure spots.
○ Even occlusion is essential for recording, which may be difficult to establish.

○ Can produce distorted impressions

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