Complete Denture Impression 101

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Complete Denture
Impression 101
O
ne of the procedures most dreaded by many den- maxillary arch best, perhaps because they keep the tongue
tists is the fabrication of the complete denture. and cheeks out of the way.
They look at complete dentures as a drain on their One of the easiest materials to use for these preliminary
time and patience; however, this need not be the case. Fab- impressions is alginate. Mixed to its correct powder/water
ricating complete dentures for the patients who need them ratio, it is an accurate and well-tolerated material. It should
can be a gratifying and profitable part of your practice. be noted that impressions taken in this manner have accu-
Many of the problems related to denture fabrication- rate detail, but even under optimal conditions (correct mix
can be traced back to the master impression, the first step and light pressure when placing the tray) they show com-
in the procedure. If this procedure is not performed prop- pression of the mucogingival fold. As long as one under-
erly, the outcome will be questionable. Using a strict but stands this situation, it can be dealt with during the
simple protocol will direct the process toward success. fabrication of the custom tray.
Preliminary Impressions Stone Model

The capture of important anatomical structures is vital Custom tray fabrication begins with the preliminary im-
in the final impressions. This means that the maxillary pression stone model. A pencil line should be drawn ap-
impression must clearly show the posterior palatal seal re- proximately 3 mm shy of the deepest extension of the
gion, labial and buccal vestibules, tuberosity, hamular mucobuccal and mucolingual folds. The stone model should
notch, and all frenums (muscle attachments). The mandibu- be coated with a thin layer of petroleum jelly. The material
lar impression also must capture clear, definable labial choice for custom tray fabrication falls into 2 categories:
and buccal vestibules, the retromolar pad, the mylohyoid self-cure acrylics and light cured. Examples of self-cured ma-
ridge, and muscle attachments. Every step toward this terials are Fastray (Bosworth), Instant Tray Mix (Lang Den-
goal starts with the preliminary impression and ends with tal Manufacturing), and Acratray (Henry Schein). An
a flawless final impression. No step is more or less im- example of a light-cured material is Triad TruTray custom
portant than the step that precedes it. tray materials (DENTSPLY Prosthetics).
The initial step of the preliminary impression is the When using light-cured materials, it is important to wax
stock tray selection. The choices are numerous. Does one out significant undercuts to avoid locking the tray onto the
use metal or plastic, edentulous or conventional? Your model. This author uses a self-cured acrylic and does not
choice should depend on what works best in your hands. wax out undercuts. However, it is important to remove the
This author finds that conventional metal trays capture lin- tray from the model once heat is first detected and before the
guals of the mandibular arch and buccal vestibules of the final set. Wax spacers (one thickness of base plate wax) are
recommended by some dentists to use under the custom tray.
Frank Ortolano, DDS With very few exceptions, this author prefers no wax spacer.
Private Practice
Holmdel, New Jersey
Phone: 732.671.1052 Trimming
E-mail: [email protected] As soon as the custom tray has hardened, trimming be-
Web site: www.holmdelgentledentist.com
gins. This is one of the most important steps. The tray must
www.dentallearning.net Dental Learning / November 2010 1

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 bor-
der 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
Figure 1—Custom tray.
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 dif-
ficult 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. Hope-
fully, as more practitioners use Adaptol and realize its ben-
efits, it will become more popular and easier to find.
An Adaptol stick is immersed in a warm water bath. Figure 2—Border molding material.
After softening and while running under hot water, it is Figure 3—Custom
rolled between wet fingers and thinned to a 3-mm diame- tray with border
ter rope. When thinned, it is attached to the borders of the molding in place.
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 patient’s mouth. While setting in the
mouth, muscle mold with the patient. After the tray has set,
rmove it from the patient’s 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 polyvinylsiloxanes to polyethers. Polyethers— Im-
molding material that flows into the tissue-bearing area can pregum PentaSoft (3M ESPE) or Impregum PentaSoft
easily be cut away with a Bard-Parker knife when chilled. Quick Step (3M ESPE) mixed in a Pentamix Automatic
The entire border molding procedure should take less than mixing unit (3M ESPE)—are the preference of this au-
5 minutes. thor 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 Dispensing Impression Material
the entire interior of the tray with adhesive, extending Practice Pearl 2
at least 2 mm to 3 mm beyond the fold on the outside. As the impression material comes out of the automatic
If the procedures detailed previously have been fol- unit (Figure 4), it is directly filled into a Monoject No.
lowed, the final impression should almost take itself. 412 utility syringe (Covidien) (Figure 5), a 1-piece plastic
Impression materials vary from rubber base to tube/nozzle syringe. The syringe tip should be cut, leaving
2 Dental Learning / November 2010 www.dentallearning.net

Figure 4— Figure 7—
Impression Custom tray
syringe in place with dispensed
over mixing tip impression
of automatic material in
dispenser. place.
Figure 8—Final
impression.
Figure 5—Monoject syring, unmodified.
anterior and slowly seating posteriorly. Any posterior ex-

cess should be removed with a mirror handle. Remember
that too much material and too much pressure is con-
Figure 6—Syringe with cut tip. traindicated. When the impression tray is properly seated,
muscle molding begins. On the upper, pull the cheeks out,
about a quarter inch extending out of the tube (Figure 6) down, and then in. On the lower, it is out, up, and in. You
to allow easier flow into the tray. can continue with any of your favorite molding techniques.
Placement of the syringe material is important. A ribbon As soon as it sets, remove and evaluate the impression for
of impression material is placed on the Adaptol that is on the details (Figure 8).
borders of the tray. Next, a ribbon is placed at the crest of With practice, impressions should be nearly perfect
the ridge area. In the maxillary arch, a final dollop is placed every time without causing the usual stress many practi-
at the roof of the palate (Figure 7). Patients with broader tioners dread.
and/or larger arches may require an additional ribbon of im-
pression material. This technique of mixing and placing the Conclusion
impression tray is much easier and more accurate than using This impression technique should lead to the fabrica-
a dispensing gun or manually mixing. After all, dentists are tion of dentures that are comfortable and retentive for pa-
extremely comfortable with an anesthetic syringe. The tients. In addition, it should require the least amount of post
Monoject utility syringe feels just like that. delivery adjustments for the dentist. It truly is the founda-
One of the keys to a good impression is not overloading tion for complete denture success.
the tray. This will allow uniform thickness of impression
material, less gagging on the part of the patient, and less Disclosure:
mess. The impression tray should be placed starting in the Dr. Ortolano is a consultant for BISCO, Inc.
www.dentallearning.net Dental Learning / November 2010 3

Complete Denture Impression 101

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Preliminary Impressions Stone Model

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2 Dental Learning / November 2010 www.dentallearning.net

Figure 5—Monoject syring, unmodified.

anterior and slowly seating posteriorly. Any posterior ex-

www.dentallearning.net Dental Learning / November 2010 3

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