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Impressions for complete

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The Pt. adaptation on his complete dentures are based on the ability of the dentures to restore the missed functions due to the loss of the teeth. Good impression is the first step in the success of the complete dentures. A trial to review all the basics necessary to have a good impression is exposed in this lecture.

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Impressions for complete

  1. 1. IMPRESSIONS FOR CONVENTIONAL COMPLETE DENTURES. Dr. Bahjat Abu Hamdan. Consultant Prosthodontist. DDS, CES, DSO . Damascus – Syria, Paris – France.
  2. 2. 1. Introduction 2. Relevant anatomy and physiology. 3. Patient examination for impressions 4. Impression materials. 5. Classification of impressions -primary impressions -secondary impressions 1.compressive. 2. mucostatic . 3. selective. Conclusion.
  3. 3. 1. Introduction.  The purpose of the CD is to restore function, aesthetic, phonation and maintenance of remaining tissues.  To be able to assume these functions, dentures should enjoy the following mechanical qualities:  Retention  Stability  support
  4. 4. 1. Introduction  The following anatomical factors play a positive or negative mechanical role; 1.Bone size Height and width 2. Maxillo-mandibular relationship. 3. Position and orientation of the occlusal Plane. 4.Muscle attachment and quality of mucous tissue. 5.Presence of opposed natural teeth to edentulous ridge.
  5. 5. 1.Introduction.  Mechanical qualities are also related to all the steps of complete denture construction : 1. good impressions. 2. correct JRR 3. correct setting of the artificial teeth 4. well established static and dynamic occlusion 5. Good processing 6. well formed and polished external surfaces of the dentures.
  6. 6. Mechanical factors
  7. 7. Anatomical factors.
  8. 8. Practical procedures.
  9. 9. 2.Relevant anatomy and physiology.  Good knowledge of the anatomy, physiology and histology of all the elements in relation with the dentures is mandatory;  Bone and mucous tissues.  Kinetics of the muscles of mastication, facial expression, tongue and floor of the mouth.
  10. 10. Intra oral drawing of the maxillary arch.
  11. 11. Neutral zone (free of muscle insertion and muscle action)
  12. 12. Intra oral drawing of the mandibular arch.
  13. 13. The disto-lingual limits to the denture flange
  14. 14. Glands in relation with the lower denture.
  15. 15. palatoglossal arch muscles.
  16. 16. Lateral view of pharynx
  17. 17. Muscles of facial expression.
  18. 18. 3.Patient examination  Its so important to investigate all the elements that may affect the procedure and the quality of the impressions which affect the quality of the dentures.  Medical and dental past.  Extra oral examination.  Intra oral examination.  X ray examination.  Study models.
  19. 19. Extra oral examination.( Nilson triad(
  20. 20. Intra oral Exam.  1. Salivary flow.  2. Alveolar ridge resorption chronology.  3. Combination syndrome.  4. Floor mouth posture and tongue position.  5. Neuromuscular control.  6. Oral diseases and oral lesions.  7. Existing dentures.  8. Muscle tonicity.
  21. 21. Alveolar ridge resorption classification.
  22. 22. Posterior palatal seal Posterior palatine salivary glands Permits compression of • tissues Improves adaptation of • denture to compensate for shrinkage of resin Glandular tissue Posterior palatal seal
  23. 23. Different form of soft palate
  24. 24. Measures to slow resorption.
  25. 25. Preventive measures.
  26. 26. Floor of the mouth and retruded tongue.
  27. 27. shape of retro-mylohyoid area.
  28. 28. Combination syndrome
  29. 29. Combination syndrome
  30. 30. Severe resorbed lower ridge due to combination syndrome.
  31. 31. Oral diseases and oral lesions.  Long term insulin dependent (diabetes)  Oral lichen planus.  Pemphygoid.  Chronic candidiasis.  Inflammatory fibrous hyperplasia.  Premalgnant lesions leukoplakia,erythroplakia.  Malignant lesion.
  32. 32. Surgical preparatory treatment.  Augmentation with bone graft.  -frenectomy -tuberosity reduction -tori removal -surgical removal of redundant tissue (epulus fissuratum) -ridge recontouring e.g. flabby ridges and -bony undercuts -removal of remaining teeth and severe undercut.
  33. 33. 4.Impression materials
  34. 34. Impression Material Usage* Civilian General Dentists  Complete dentures  alginate 58%  vinylpolysiloxane 55%  polyether 27%  Partial dentures  alginate 78%  vinylpolysiloxane 43%  polyether 15% DPR 2002
  35. 35. Handling Properties
  36. 36. Handling Properties
  37. 37. Comparison of Properties  Wettability  best to worst ○ hydrocolloids > polyether > hydrophilic addition silicone > polysulfide > hydrophobic addition silicone = condensation silicone  Castability  best to worst ○ hydrocolloids > hydrophilic addition silicone > polyether > polysulfide > hydrophobic addition silicone = condensation silicone
  38. 38. 5. Classification of impressions in CD
  39. 39. Lower edentulous ridge.
  40. 40. Upper edentulous ridge.
  41. 41. Preliminary impression
  42. 42. Primary impression
  43. 43. Final impression.
  44. 44. Preliminary and primary impression  preliminary impression; 1. Anatomic. 2. Stock tray. 3. Alginate. 4. Surgical preparatory treatment. 5. Occlusal plane adjustment of the remaining teeth.
  45. 45. Preliminary and primary impression  Primary impression 1. Anatomic. 2. Stock tray. 3. Alginate or plaster. 4. Indicate on the cast the flabby tissue, new extraction area, sharp edge, mental foramina and thin mucous tissue area. 5. Special tray; adapted, spaced or partially spaced.
  46. 46. Preliminary and primary impression  In the practice;  Choose a stock tray insuring 3-4 mm of space away from the ridge.  Tray should cover the retro-molar pad area and extend to the palatoglosse arch, hamular notch, palatal fovea use the wax to adjust the extension of the tray.  With floating mouth bottom use thicker consistence dental material.
  47. 47. Preliminary and primary impression  Stock trays.
  48. 48. Primary impression and custom tray.  L to R plaster Imp. Alg. Imp. Anterior flabby tissue tray and Occ. Rim handle.
  49. 49. Final impression (compressive).  Factors controlling the pressure applied by the impression;  Type of the custom tray adapted or spaced.  Consistence of the dental material light, regular or putty.  Holes opposed to a concerned area means less pressure.  Border impression is always compressive in functional impression and partially compressive impression. If it is not, impression is mucostatic (anatomic).
  50. 50. Final impression (compressive).  Custom tray… adapted or spaced.  Borders are 2mm far from the labial and buccal vestibule, 3mm space in the frenum areas (lateral and median).  Tray should cover the vibration line area and hamular notch. Mandibular custom tray; borders are 2mm far from the border in the buccal shelf and anterior sublingual area. Checking up the custom tray is done by pulling the muscles horizontally in the concerned area.
  51. 51. Final impression (compressive).  Border impression includes all the borders of the maxillae.  It includes just the buccal shelf and the anterior sublingual area.  Muscle M. are done functionally by the Pt.( open widely, suction and lateral M. Swallowing, tongue M. Grimace M.). Muscle M. are done by the dentist in case of low muscle tonicity.
  52. 52. Final impression (compressive).  Certain extreme muscle M. coincide with the functional M.  Muscle M. (during border impression can be done by the dentist) but the Pt. should functionally move his muscle in the 2nd phase of final impression.  Border impression is done gradually by the thermoplastic green Kerr. Or one using the regular elastic material. Greene Brothers
  53. 53. Functional movements for border impression.
  54. 54. Border impression. Silicone medium viscosity Impregum Thermoplastic green Kerr
  55. 55. Final impression (compressive).  It is important to use occlusal rim as tray holder ( which represent the missing teeth) so that the functional M. are close to the natural.  The wash material can be ZnO eugenol paste or light elastic material.  Preferable silicone by addition.
  56. 56. Final impression 2nd phase.  Silicone (medium)  Zno eugenol paste  Silicone light
  57. 57. Final impression (mucostatic).  Advocates of this technique believe that impression must be recorded in an anatomic form of the tissues without distortion (resting form). Harry L page 1938, Addison 1944.  Dentures constructed by mucostatic impression technique have shorter flanges.  Short flanges are used to prevent the dentures moving in lateral direction and NOT for border seal.  Metal bases which are dimensionally stable are used.
  58. 58. Final impression (mucostatic).  Dentures do not cover wide area.  No border impression.  Based on the adhesion, cohesion and surface energy but not on the atmospheric pressure (border seal).  It works only when there is good ridge and high alveolar bone.  Denture mobility during function (mucous depression is 4/10 – 10/10 mm) (compressibility of periodontal tissue is 1/10 mm) .Bone compressibility is related to bone quality ( cancellous or cortical ).
  59. 59. Final impression (selective pressure).  Boucher 1950.  Principles of this technique is that certain areas of the maxilla and the mandible are by nature better adapted to withstand extra loads from the forces of mastication.  Tissues adapted for withstanding extra loads are recorded under slight placement of pressure while other tissues are recorded at rest (mucostatic)
  60. 60. Upper edentulous ridge
  61. 61. Lower edentulous ridge
  62. 62. Final impression (selective pressure).  In this way an equilibrium is created between – the resilient and - non resilient tissues. Primary stress bearing areas are recorded under pressure; crest of alveolar ridge, horizontal plate of palatine bone in the maxillae and buccal shelf area in the mandible. Areas requiring minimum pressure; mid-palatine suture, incisive papilla, crest of mandibular ridge, mandibular tori, mental foramina, sharp painful edge, flabby tissue, remaining roots in case of over-denture and new extraction areas.
  63. 63. Final impression (selective pressure).  Posterior palatal seal has glandular and soft tissues are readily to be displaced for maintenance of peripheral seal.  Sublingual area has similar tissue structure and behaviour as the posterior palatal seal.  Border impression includes all the borders of the maxilla, but it includes just the buccal shelf and the sublingual areas in the mandible. (after a good prime impression).
  64. 64. Final impression (selective pressure).  Sublingual area is molded with the tongue in repose.  The tray is extended horizontally backward over the sublingual glands toward the tongue to affect border seal.  Pts with old dentures should remove it 24 hours before the final impression. ( mucous tissues should be at rest and normal situation).
  65. 65. Conclusion.  In certain cases, even if all the steps are well done mechanical qualities of the dentures are spoiled so that patient will not arrive to adapt on, these cases are confronted in case of lack of saliva and paralysis and low tonicity of the muscles in relation with the dentures.  Helping these Pts. Will be through the use of denture adhesive to improve the retention and the Pt. ability to adapt on.
  66. 66. Conclusion.  Indication of denture adhesive;  Xerostomia ( medication, systemic diseases, irradiation and disease of salivary glands)  Neurological disorders;  Oro-facial dyskinesia ( muscles of lips, cheek, tongue and face )  Medication side effects ( neuroleptic, dopamine blocking drugs, pheothiazine and GI medications ) .
  67. 67. Thanks for your attention E mail. ahbahjat@yahoo.fr