➢ Speaker: prof.dr.

amal

➢ Course: primary maxillary and mandibular impressions

➢ Program: removable prosthodontics

Primary maxillary and mandibular impressions

Introduction and definitions

Complete denture impression

A negative registration of the entire denture bearig , and the border limiting structure .
From which a positive likeness or a cast can be made .

type Primary impression Final impression

A negative likeness made for A negative likeness made for the
the purpose of diagnosis . purpose of fabrication of the
treatment plane and the prothesis
fabrication of special trays
tray Use stock trays Custome made special trays

Stock trays :
Is ready made trays
Use to take the primary impressions
Present in different sizes : 1,2,3
Different material : plastics and metal
Different shapes : perforated and non perforated
Trays for completely edentulous patient have : rounded floor , short flanges . rigid
extended trays for impression materials .

• Objective of impression making

1. Maximux extention without muscle impingement :

maximum coverage within physiological limits
2. Intimate contact with the tissue area covered : no lage trays for small arche
3. Proper form of the border including the posterior border of the maxillary denture
:
Proper physical means of retention as : adhesion , cohesion , surface tension ,
atmospheric pressure depend on posterior and anterior border seal of retention
4. Proper relief of hard and sensitive area
Hard area like : torus mandibularis , median palatine raphe , torus palatinus
5. To equalize forces on denture foundation area : same pressure forces at all parts
 of ridge
To prevent rocking of denture
And produce equal thickness of denture material

• Principles of impression making

1. Oral tissue must be healthy

No inflammation , no ulcers , no pathological tissue , no recent extraction
socker
N.B no anesthesia during impression making .. it is a fetal mistake
As it change the depth of vestibule

2. Adapt intimately with the tissue surface , with sufficient space should be
provided within impression tray for impression material

3. Maximum extension attain maximum area coverage within

anatomico-physiological limit

4. Proper form of the border extend to vestibule to gain better border sael

5. Material should be dimensionally stable : don’t change after setting

The smaller the fitting surface

The greater the mucosal loading

( load per unit )

Increase the resultant pressure on mucosa

increase bone resorption

• objective of impression making

carl o.boucher in 1944 :’ press’

1. Preservation of remaining structure

no more resorption of remaining bone
2. Retention : resistant to tissue away movement
 3. Esthetics
4. Stability and bracing : resistant to rocking and rotational movement
5. Support : resistant to tissue ward movement and distribution of forces
over bearing structures

Retention Stability and bracing Support

Def resistant to tissue resistant to rocking resistant to tissue
away movement and rotational ward movement
movement and distribution of
forces over
bearing structures
Means • Maximum • Equalization of • Wide tissue
coverage pressure coverage
• Perfect • relief • Direction of
peripheral • dimensionally occlusal
seal stable material forces on
• Intimate primary
tissue bearing
contact area as
buccal shelf
of bone in
upper jaw
• Propper
arrangemen
t of artificial
teeth

Esthetics Maintain remaining structure

Def Good appearance of
patient
Means • Sufficient thickness • No more resorption of bone
of flange to provide
lip support
• Propper
arrangement of teeth

It is necessary to enhance the available support , retention , bracing and stability by

utilizing maximum coverage of all usable ridge bearing area
As retromolar bad and post dam area should be covered
 • Anatomical land marks of maxilla

Muscles that influence the border of maxillary Maxillary limiting

denture structure
Example • Labial frenum • Labial frenum
• Orbicularis oris / superior incisive • Labial vestibule
• Buccinator muscles , facial • Buccal frenum
expressions • Buccal vestibule
• Buccinator/coronoid precess • Corono-maxillary
• Pterygomandibular ligament space area
• Palatopharyngus/palatoglossus/velipal • Hamular notch
atini • Posterior palatal
• Pterygoid maxillary raphe / pterygoid seal area
hamulus /hamular notch
• Buccle frenum / caninus /olbicularis
oris
 Labial frenum Labial vestibule Buccal frenum Buccal vestibule
Def • a fold of • Extend from • Dividing line • Extend from
mucous one buccal between labial the buccle
membrane frenum to the and buccle frenum
at the other on the vestibule anteriorly to
median line labial side • It may be a the hamular
• no muscle • The major single or notch
attachment muscle in this double fold posteriorly
area is • Broad or fan • The size of
orbicularis shape vestibules
oris • It has varies
attachment of
following according to
muscles • Contraction of
• Levator anguli buccinator
oris • Position of
• Orbicularis mandible
oris • Amount of
• buccinators bone loss in
maxilla
• The ramus
and coronoid
process of
mandible
• Masseter
How • “v”shaped • Impression • Relief of • Proper
to notch should sufficient buccal frenum extension in
deal be recorded support to lip this area
during • The labial • Over
impression flange should extension
making be at cause
• Excessive sufficient dislodgement
relief height of denture
weakens • No
denture base interference
of labial
flange with
the action of
lip in function
to avoid
movement of
denture
 Retrozygomal Coronoid Hamular notch Posterior
fossa process area palatal seal
( space) area
Def • Vestibular • Molding • Depression • Soft
space this area between tissue at
posterior to by maxillary or along
zygoma movement tuberosity and the
of the hamulus junction
mandible of medial of hard
pterygoid and soft
plate palate on
which
pressure
within
physiolog
ical limits
of the
tissue
can be
applied to
in its
retention
How • Palpate • Place • Distolateral • Mark the
to zygomatic nirror head border of beginning
deal process in lateral to denture flange of motion
buccal tuberosity rest in in the soft
vestibule jest • Move hamular notch palate
buccal to first mandible • The most when an
maxillary to important individual
molar opposite area in say “ah”
• If side maxillary mark the
overextende • Note denture from junction
d binding or one hamular of
..dislodgeme pain notch to movable
nt happened • This give another one and
during some passing the immovabl
opening the indication fovea palatin e portions
mouth of width of which is of the soft
the flange posterior palate
• If over palatal seal in • Extend
extended denture from one
or thick .. • ( post dam ) hamular
pain and • Improve notch to
dislodgme retention the other
 nt one
passing
by th
fovia
palatin
• This
region
contains
glandular
tissue
• Butter fly
in shape

• • Viberating line ah line • Curvature of soft palate

• Posterior viberating line
• Def • It separate the movable • Class 1 = gentle curvature
parte from the immovable • The best one with best seal
part of the soft tissue • Class 11 = medium
• The line is 2mm posterior to curvature
fovea palatin . • Class 111 = abrupt curvature
• This line determine the • The least seal
posterior end of the upper
denture
• Advantage
• Aids in retention by
maintaining contact with
soft palate ( partial vacuum
effect )
• Reduce the tendency of
gag reflex
• Reduce discomfort and
prevent the food
accumulation between the
soft palate and the denture
base
• Compensate for
polymerization shrinkage
• How to • The posterior palatal seal •
deal area
• an area that lies between
the anterior ans posterior
vibrating lines “ ah “ lines :
saying ah will cause soft
 palate to lift , it is found to
be effective in locating the
posterior vibrating line
• blow-line ( Valsalva
maneuuver )
• an accurate method for
locating the anterior
vibrating line which freely
move when the patient
attempts to blow through
the nose when it is
squeezed tightly . the blow
line a close approximation
to the junction of hard and
soft palate
• cohesion , adhesion , and
interfacial surface tension
have limited value unless
an intact peripheral seal is
present
• when cant be recoded at
oral cavity , it can be
scratched at the cast

• Supporting structures of maxilla

Residual ridge Rugae area Maxillary tuberosity Torus palatinus

• shape and • In this area • Bulbus extension • May
size of palate is set at of the residual require
nd
alveolar an angle to the ridge in the 2 removing
rd
ridge residual ridge and 3 molar
• mucous and it ie thinly region
membrane covered by soft terminating in
is firmly tissue hamular notch
attached to • Irregularly • Enlargement can
the shaped rolls of be fibrous or
periosteal the soft tissue bony
• bone • Shouldn’t be • Excess tissue :
undergoes distorted in an prevent proper
resorption impression location of
• 2ry bearing technique occlusal plan and
stress area • Since may interfer with
 • Remove rebounding lower arch
the denture tissue tend to
from 6 to 8 unset the
hours per a denture
day
• • Important to • Important for •
pronunciation of support and
sounds bracing and
• Thick denture at retention and
this area should be
interfere with it covered
• If has sever
undercut ..
should change
the path of
insertion

• Relief areas

Median INCISIVE PAPILLA Fovea palatinae Pterygo-mandi

palatine raphe bular raphae
def • A bony • Land mark for • Bilateral • Connect
midline setting the indentation from the
structure teeth near the hamulus
non • Evaluation of midline of to the
resilient soft tissue the palate mylohyoi
• Extend over the formed by d ridge
from incisive coalescenc • When
incisive foramen e of several prominen
papilla to mucous t can
distalend gland duct cause
of hard • Aids to pain
palate determine
• Thin the
mucosal vibrating
coverage line
with less
sub
mucosa
How • Adequate • Adequate • Need some • Request
to relief relief is relief to relief “
deal should be needed to reduce pain groove” if
 given to avoid burning prominen
avoid sensation , t
trauma pain • Can
frome • As this cause
denture contain dislodge
base and greater ment if
rocking palatine n and • Thick
• N.B .. vessel which border
MAY feed ant part • Over
CAUSE of palate extensio
MIDLINE • N.B n
FRUCTU • Burning • Pressure
RE sensation is area
from
• Ulceration
• Ulergy
• Non relief og
incisive
papilla

• Mandibular anatomical land marks

Limiting structure Muscles that influence the border

• Labial frenum • Pterygo-manbibular raphe
• Labial vestibule • Masseter muscle : any over
• Buccal vestibule extension cause dislodgment
• Aleovlo lingual sulcus • Buccinator
• Buccal frenum • Orbicularis muscle
• Retromolar bad • Palatoglossus muscle
• Pterygomandibular raphe • Superior conistrictor muscle
• Lingual frenum

Success of lower denture depend on the limiting structure and muscle influencing the
border

• Mandibular supporting structure

Support is : resist to tissue ward movement , distribution of forces ,
decrease the forces per unit area

Buccal shelf Retromolar pad ??

Def Horizontal bone By covering the retromolar bad .. I
 1ry stress bearing area should cover buccal shelf of bone
Act as a cushion absorpe the forces
and decrease resorption of bone
Bracing and prevent anrtoposterior
movement
It is soft tissue and I can make a
small post dam at it providing seal and
intimate contact
Anatomical land mark for the occlusal
plane .. fixed anatomical land mark ..
no resorption
Should be covered by denture .

• Relief area

Crest of the ridge Any type of ridge which is not well formed
Mylohyoid ridge Denture should be flared and reliefed
Mental foramen Relief to prevent numbness and pain
As it has innervation of lip
Genial tubercles Attachment os muscle .. need relief
V shaped in the denture to prevent dislodgement
during tongue movement
Labial and lingual inclines
Torus mandibularis Large = surgical removal
Small = relief

Lower denture has less retention than the upper denture :

1. Less surface area

2. More area to relief
3. Tongue movement can break the seal
4. Lower denture pathed in saliva

Area should have special attention :

1. Retromolar bad
2. Retromylohyoid space
3. Buccal shelf of bone
4. Masseter muscle influencing area
• Limiting structure of mandibular denture

Labial Retromolar bad Disto lingual area Mylohyoid

frenum muscle
influencing
area
Def • Band of • Pear shaped • The medial • At floor
fibrous triangle soft pad pterygoid of the
connec of tissue • The superior mouth
tive • Bounded by : constrictor
tissue • Buccinator muscle
• Shorter • Superior • The
and constrictor mylohyoid
wider muscle muscle
than • Pterygomandubul • Palatoglossu
maxilla ar raphe s muscle
ry • Terminal part of
frenum tendon of
• Incisive temporalis
and
orbicul
aris
muscle
influen
ce the
frenum
• Unlike
in
maxilla
the
frenum
is
active .
Ho • • Posterior end of • Over • Over
w retromolar pad extended = extend
to can form sever pain ed=
de postdamming • Under dislodg
al area to aloe extended ement
better seal =less
retention
Buccal frenum Labial Modulus Alveololingual Lingual
vestibule sulcus pouche
• Usually in • Extend • Between • More
st
1 premolar betwee lingual posteri
area n2 frenum to or , the
• The buccal rertomylo lingual
activities in frenum hyoid can flange
this area is • Mentalis be are
horizontal muscle divided to related
as well as is an 3 regions to
vertical .. active : pouch
thus need muscle • Anterior , with its
wider in this meddle , bounda
clearance region posterior ries
• Muscles regions which
acting in • are :
this region : • Post .
• Buccinator the
• Depressor palatogl
anguli oris ossus
• Orbicularis muscle
oris • Ant .
the
mylohy
oid
muscle
• Mediall
y . the
tongue
• Lateral
. the
medial
aspect
of
mandibl
e.
• Need wider • Length • The • Proper
clearance and denture recorging
thicknes base give
s of must be typical s
labial contour shaped
flange ed to of lingual
of the permit flange .
denture the
occupyi modulu
 ng this s to
space function
crucial freely
in • Flange
influenci should
ng lip be short
support and
and narrow
retentio to allow
n action
• Impress that
ion will draw
be the
narrowe vestibul
st in e
anterior superior
labial ly and
flange medially
against
the
denture
.
• Failure
of
contour
of
flange
cause
displace
ment

• First steps in making a denture

Diagnosis and treatment plan

Primary impression
Diagnostic cast
Custom made tray
Final impression
 Master cast

Primary impression

N.B Can use alginate , or compound

Materials Alginate COMPOUND

Perforated tray Non perforated tray
Allow mechanical
retention for the material
N.B Prevent sapation
between material and tray
So More dimentional
stability

• Stock tray should be

a. Well extended tray
b. Fitted
c. Adapted
d. Rigid

• Primary cast is
Study cast produced from 1ry impression
Study ..
1. Ridge shape
2. Palatal value shape
3. Denture bearing area
4. Area of under cut
5. Relief area
6. Posterior palatal seal area
7. Depth of the sulcus
8. Sharp bony edges
9. Inter ridge space
10. Inter ridge relation

Primary impression
Definition
It is a negative registration of entire denture bearing area and the border seal
 area
By using impression material from which a positive likeness can be made ( by
pouring the impression )

N.B
Conventional technique Template technique
Method BY stock trays Old denture can be used
as a tray in sever bone
resorption cases
Can make 1ry impression
by perforating the denture
Or 2ry impression by
using rubber material

Primary impression should provide

1. Contain all of the anatomical region important for the stability of the denture
2. Record the furthest extension into the tissue the denture flange can go
3. Record the tissue surface without distortion
N.B Well extended for good stability , support , bracing and retention
4. Should be accurate

1ry impression tray

1. Should be 5 mm larger than the outside surface if residual ridge
2. Should include all basal seats
3. Any area of under extension should be corrected bu soft wax .

• Steps of maxillary primary impression using alginate impression

material

First step : Selection of the tray

1. Selection of suitable stock tray

N.B rigid adapted fitted well extended

2. Set the patient in the upright position , the head support on the head rest
N.B TO avoid gag sensation
, and the patient mouth in an appropriate level of the elbow and be
sure that patient clothes is protected

3. The hamular notch are marked with an indelible pencil continuously ,

instruct the patient to say “ ah” strongly and mark the vibrating line
N.B it is important limiting structure in maxilla
From one hamular notch to another one passing by fovea palatina , it is the
junction between movable and immovable parts of soft palate

4. Check the fit , extension . adaption of the stock tray to record the entire
alveolar ridge and cover all land mark indicating denture bearing areas .
N.B
Fitted .. suitable size for the patient , not small not large
Well extended .. till limiting structure
If under extended can be modified by soft wax
If over extended can remove the metal
Adapted .. as stable one , no rocking
If rocked or not adapted = not use it
Fitness and extension cam be modified by adding soft wax on the entire
surface

5. Be sure that it cover maxillary tuberosity and the hamular notch , any
deficient inn the posterior area should be corrected with wax

N.B Frenum should be relief

Step 2 :Mixing of the material

1. Mixing the alginate according to the manufacture instruction

2. Load the alginate to the border of the tray
N.B should follow the manufacture to produce creamy mix , non fluidly
mix .. if have more fluid .. more dimensionally stable
Need more effort for mixing the material

Step 3 :
1. The dentist should stand behind the patient
N.B should do 3 :
Centralization : handle in one level with midline of the face
Pressure : from back to the front to prevent gaging by prevent pulling
material backward , and equalization of forces at all area of ridge
Moulding of the muscles
2. Place the tray up toward the palate
3. The tray should be seated from back to the front and pull up upper lip
down as much as possible
4. Centering the tray over the ridge so that the tray handel in the same
alignment with the midline of the face
5. Seat the tray carefully allow material to flow to the labial sulcus
N.B if have deep under cut , put some alginate at it to avoid deficient
material at this area

Step 3 :
1. The seating pressure is stopped and the molding of the border
performed so that the impression not over extended
2. Ask the patient to open his mouth widely and then close and move
mandible from side to side
N.B to allow molding of distobuccal area
3. The tray held in place untile the alginate is completely set

Step 4 :

1. Remove the impression after the complete setting

2. Evaluate the completed impression
3. The sulcus has been recorded
If the border is thick , I should record it on the cast .
4. There is no voids present
5. The tray has been centered
6. The impression material is acceptable
7. All necessary anatomical land mark are visible

Step 4 :

1. All impression should be rinsed to remove sputum , traces or blood

2. Prior or being transported to the dental laboratory .
Disinfect the impression according to the disinfection protocol and
wrap in a damp paper bowl and store and transport upside-down so as
to prevent any pooling of water into the impression , thus potentially
producing distortion , covered witj wet paper towel and put in plastic
bag .

N.B pour iy with the stone immediately to prevent dimensionally

changes

Done by
Dr. Marina Makram