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Modified functional impression technique for complete dentures

Article  in  Brazilian Dental Journal · February 2005

DOI: 10.1590/S0103-64402005000200009 · Source: PubMed

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Braz Dent J (2005) 16(2): 135-139 Acrylic resin handle for final impression 135
ISSN 0103-6440

Modified Functional Impression Technique for

Complete Dentures
Alexandre MALACHIAS
Helena de Freitas Oliveira PARANHOS
Cláudia Helena Lovato da SILVA
Valdir Antônio MUGLIA
Carla MORETO

Department of Dental Materials and Prosthodontics, Faculty of Dentistry of Ribeirão Preto,

University of São Paulo, Ribeirão Preto, SP, Brazil

This report describes the use of a removable acrylic resin tray handle that can be easily attached to custom impression trays to produce
an improved peripheral sealing zone. This device can be indicated to develop functional impressions for complete dentures using the
patient-conducted muscular motion technique. In upper trays, the handle is fixed in the midline with acrylic resin, while in lower trays
the centrally positioned handle is removed before border molding. This removable handle allows patient’s suction and free tongue
movements. Final impression is carried out in two stages: peripheral sealing (low fusion compound) and recording of the main
supporting region of the denture (zinc oxide and eugenol paste). All border records are obtained from the patient’s own movements
(handle suction and tongue motion). The removable handle is simple to use, is reusable, can be adapted to any individual acrylic resin
trays and allows accurate registration of the peripheral sealing zone (border tissues).

Key Words: complete dentures, functional final impressions, removable anterior tray handle.

INTRODUCTION future denture base and the mucous membrane (7).

During the impression procedure, muscular zone
Stability of complete lower dentures has record can be achieved by either the dentist or the patient
challenged dentists and patients alike. In particular, “flat or both. Many dentists pull on the patient’s lips and
lower ridge” is associated with difficulties in providing cheeks to register the border areas (tissues surrounding
successful dentures (1,2). Resorption rates vary from the dentures) (8), which usually provides satisfactory
patient to patient and some authors have postulated border sealing zone (labial and buccal flanges). In the
several etiological factors related to residual (alveolar) technique where muscular zone record is obtained with
ridge resorption, ranging from localized pressure to the patient’s help, the patient is asked to make specific
systemic factors (3). muscular movements of the lips, cheeks, tongue and
Making accurate final impression for complete jaws (open/closure and lateral). The use of an individual
dentures is a multistage process that involves a preliminary tray is necessary for this technique. The borders of this
impression, a customized final impression tray and a tray should be established in such a way that the
final border impression (4,5). It is important to thoroughly patient’s muscular movements are free from them
examine the patient’s mouth and select the most during the impression procedure (9,10).
appropriate impression technique (1,6). A major This article describes the construction and use of
requirement for final impression of complete dentures is a removable functional acrylic resin handle that can be
to develop the peripheral contours to accommodate attached to custom impression trays, allowing an excellent
normal muscular function and to ensure peripheral peripheral sealing zone impression using a patient-
adaptation without allowing air penetration between the conducted muscular and jaw motion technique.

Correspondence: Profa. Dra. Helena de Freitas Oliveira Paranhos, Departamento de Materiais Dentários e Prótese, Faculdade de
Odontologia de Ribeirão Preto, USP, Avenida do Café, S/N, 14040-904 Ribeirão Preto, SP, Brasil. Tel: +55-16-3602-4006. e-mail:
helenpar@forp.usp.br

Braz Dent J 16(2) 2005

136 A. Malachias et al.

MATERIAL AND METHODS resin base (15 mm high with a 10-mm-diameter upper
central hole) should be prepared and fixed to the
Functional tray handles can be used with any individual tray on the residual ridge at its midline. The
individual acrylic resin trays. functional handle is further attached to the upper
These handles are made in a L-shaped metal central hole with a bolt that is 11 mm long and has a
master die (70 mm length and 7 mm in diameter), which diameter of 2 mm (Figs. 1 and 2).
is flasked in brass flasks (Safrany; J Safrany Dental This functional handle can be readily removed
metallurgy, São Paulo, SP, Brazil). After deflasking, the from the tray to facilitate molding of lingual and
heat-polymerized acrylic resin (Clássico Dental Products, sublingual flanges borders with low fusion impression
São Paulo, SP, Brazil) is pressed and molded according compound. The patient can freely move the tongue
to the manufacturer’s instructions to obtain the tray without interference from the tray handle. During this
handle. Thereafter, the handle is finished and polished. procedure, the tray is held in place by digital pressure
Once the individual tray is prepared, the handle can be of the dentist’s right and left index fingers on the
attached to its midline, positioned on the area acrylic resin supports existing in the region of the tray
corresponding to the crest of the ridge. corresponding to the first and second mandibular
For the maxillary arch, the handle can be fixed to premolar (Figs. 3 and 4). During impression of buccal
the tray using acrylic resin. For the mandible, an acrylic and labial flange borders, the functional handle is

Figure 2. Functional removable acrylic handle fixed with the

Figure 1. Functional removable acrylic resin handle, bolt, bolt to the central hole at the midline of the mandibular
individual impression tray with the lateral supports in the area impression tray (lateral view).
corresponding to the premolars/molars (upper view).

Figure 3. Mandibular individual impression tray held in position Figure 4. Patient’s tongue movement to provide impression of
during patient’s tongue movements to form the sublingual flange. the right lingual flange.

Braz Dent J 16(2) 2005

 Acrylic resin handle for final impression 137

such a way that the patient can move his/her tongue

freely during the impression of the sublingual and lingual
flanges. The dentist uses the acrylic resin molar supports
at both sides of the tray, to keep it in position during this
phase of the impression procedure.
For vestibular border impression, the handle is
reattached to help introduce and hold the tray in place
into the mouth and to facilitate suction by the patient.
For lower impressions, during suction, the tray is
balanced by the dentist’s thumb pulling up and the index
finger pressing down, a procedure opposite to that used
for upper impressions.
As the border of the impression has been
Figure 5. Vestibular peripheral sealing zone record (labial and completed (Fig. 6), the next step is to record the main
buccal flanges), with the mandibular individual impression tray supporting surface of the final impression. The tray is
in position. Note the patient sucking on the functional handle loaded with zinc oxide-eugenol paste and gently seated
during the impression procedure. into the patient’s mouth. Once the tray is properly
positioned with the material overflowing, the handle is
reattached to the tray and the patient is asked to removed again for recording the lingual and sublingual
perform a suction movement (Fig. 5). flanges. At this time, the dentist keeps the tray in position
The adjustments on the custom impression tray by pressing the resin molar supports while the patient
are done based on its stability while seated in the performs tongue movements, as previously described,
patient’s mouth. The final impression is carried out in for approximately 20 s. Finally, the handle is quickly
two stages using two types of materials. The first stage reattached to the tray without removing the tray from
consists of border molding with low fusing impression the patient’s mouth and the patient is asked to repeat the
compound. In the second stage, a zinc oxide-eugenol suction movements with the operator firmly holding
paste is applied to the main supporting surface of the onto the tray handle.
impression. Using this final impression technique, border
molding is obtained by the patient’s own movements:
suction in the maxillary arch and tongue movements and
suction in the mandibular arch.
The upper tray is kept properly seated in position
by the operator’s thumb and index fingers. The handle
is rotated (down and up, respectively) during suction on
the handle to balance the tray loaded with impression
material, to effectively force all of the peripheral muscles
into maximum dynamic activity. The procedure does
not cause any discomfort to the patient. Posterior
border impression is enhanced using low fusion
impression compound, with the dentist firmly seating
the impression tray and pressing it against the central
Figure 6. Peripheral impression completed.
area of the palate. The impression is then completed
with zinc oxide-eugenol paste and the loaded tray is
gently seated in the patient’s mouth. The patient is asked DISCUSSION
to suck on the functional handle again, while the dentist
holds the tray in position. Complete denture impression can be defined as a
For lower border molding, the functional handle dynamic process that can be divided into two stages:
is removed from the base by disconnecting the bolt, in preliminary impression and final impression. The aim on

Braz Dent J 16(2) 2005

138 A. Malachias et al.

each patient is to fashion the impression surface and the can freely move the muscles, cheeks, lips and tongue
peripheral rolls of the complete dentures in such a way without interference of the tray handle or the dentist’s
that support, retention and stability of the denture are fingers. For individuals with an accentuated bone
maximized (11). These two stages compliment each resorption, for example, it is difficult to obtain good
other. The initial impression should resemble the basic retention and stability of the complete denture due to the
overall design for the complete denture. It also serves as presence of muscular insertions near the ridge crest or
the template for the final impression, helping to record border, which might cause muscular-induced
the borders (edges) and the base area of the complete displacement of the denture. In these cases, this
denture impression without distortion. During final functional technique is highly recommended. The degree
impression using this technique, the muscular tissues, of muscular activity and the region to which the denture
which may interfere with denture stability, can be can be extended without displacement are important
identified and allowed for their functional movements. aspects of any impression technique.
This warrants better border seal and improves retention The ordinary short tray handle used to guide the
and stability. tray into the mouth may present problems and make it
The peripheral sealing zone (border tissues) is an difficult to keep the tray in position. Suction around this
important region for denture retention and stability and type of custom tray handle is not easy and the tray can
should be precisely contoured during the final impression easily be dislocated. A possible solution would be to
procedure. The dentist should develop an accurate have the patient to suck on his/her own finger, but even
custom tray and use an effective material and border this procedure may unseat the tray. The problem could
molding technique. Several dynamic or functional be solved by asking the patient to suck the dentist’s
impression methods, which we believe are particularly finger, but this is embarrassing for both patient and
useful for patients with intense alveolar resorption, have dentist and may also cause tray displacement and
been reported (5,12,13). undesirable tissue displacement. On upper trays, if the
The characteristics of functional impression dentist pushes the handle up, the tray moves in a
techniques have not been widely investigated (14-16). It posterior direction; if the dentist pulls the handle
is common knowledge that each patient has his/her own backwards, tissue displacement in both the palate and
specific muscular activity. Sometimes the contraction the tuberosity regions can occur. With lower trays, the
of a muscle near its insertion can displace the denture, situation is aggravated because both the pushing down
unless it has a groove to accommodate such contractions. and pulling back movements may cause undesirable
Clinical evidence about the interfering muscle region tissue displacement in the anterior region or the tray may
that might affect denture stability is difficult to detect in move in a posterior direction.
some patients. Therefore, the dentist should attempt to The functional removable acrylic resin handle
record all these individual aspects of the patient’s labial hereby described offers a good support for correct
and buccal anatomy in the final impression in order to positioning of the custom tray in the patient’s mouth
permit normal muscle activity without loosing the denture causing neither displacement on any surface of interest
during function. for impression nor displacement of the tray.
The accuracy of complete denture impression The handle works as a suctioning device for the
techniques has been debated for many years. A wide patient and has the advantage of being removable on
diversity of denture border outlines, resulting from the lower trays, facilitating the full and accurate impression
use of the same impression procedure for all patients, of the sub-lingual flange region. To obtain a proper
has been shown and documented (17). Because each impression of this area, it is important to pay close
patient has his/her own distinct muscular strength and attention to the normal posture of the tongue (2,10,18,19)
anatomy, it is important to individualize peripheral sealing and it is necessary to seat the tray correctly, avoiding
zone impression. The functional handle was designed to any dislocation during tongue movements. This can be
effectively deal with this problem. Unlike other border achieved by removing the handle and holding the tray in
molding techniques, which use manual traction of soft place by pressing both lateral acrylic supports. In
tissues, the functional handle permits muscular addition, the lateral supports can provide an ideal pressure
movements during the final impression, i.e., the patient distribution during the impression procedure and an

Braz Dent J 16(2) 2005

 Acrylic resin handle for final impression 139

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simplicidade de uso.

Braz Dent J 16(2) 2005

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