DYNAMIC IMPRESSION METHODS

GERD TRYDE, L.D.S.,* KAISA OLSSON, L.D.S.,“” S. AA. JENSEN, L.D.S.,*** R. CAN-
TOR.,D.D.S.,**** J. J. TARSETANO, D.D.S.,‘**** AND N. BRILL, DR.oDONT.****‘*
The Royal Dental College, Copenhagen, Denmark

of overcoming treatment difficulties of patients with advanced

T HE POSSIBILITIES
mandibular residual ridge resorption by meansof a dynamic impression method
was stressed in a previous article. l Numerous presentations of dynamic impression
methods include those of Schrott,” Momme, SkogsborgP Greene,j Loos6 Hro-
matka,7 and Matthews8
We have treated a number of patients with extreme resorption of the man-
dibular residual ridge. The shape of the osseousstructures in these patients offers
little possibility of retention and stability of complete dentures. Furthermore,
muscle attachments are located near the crest of the residual ridge and, conse-
quently, the dislocating effect of the muscles on the denture is great. For these
reasons, the range of muscle action, as well as spacesinto which the denture can
be extended without dislocation, must be accurately recorded in the impression.
Such impressions can be made by means of dynamic methods.
The advantages of dynamic impressions are : (1) avoidance of the dislocating
effect of the muscles on improperly formed denture borders, and (2) complete
utilization of the possibilities of active and passive tissue fixation of the denture.r
These advantages are the direct result of the impression material being shaped by
the functional movements of the muscles and muscle attachments that border ,the
denture base.
Dynamic impressions are in contrast to (1) nondynamic impressions. which
are based on recording the tissues of the oral cavity in an immobile condition, and
to (2) semidynamic impressions, in which the denture borders are determined
by partly passive and partly active movements as described by Fournet and Tuller.”
We will refer to these methods henceforth as “conventional” methods.
Since functional activity of musclesand muscle attachments exclusively shapes
the dynamic impression, the arbitrary elementsof conventional methods are reduced.

*Research Fellow, Department of Prosthetic Dentistry.

**Instructor, Department of Prosthetic Dentistry.
***Assistant Professor, Department of Prosthetic Dentistry.
****Guest Instructor, Department of Prosthetic Dentistry.
*****Visiting Oral Surgeon, Department of Prosthetic Dentistry.
******Professor and Chairman, Department of Prosthetic Dentistry.

1023
1024 TRYDE ET AL. J. Pros. Den.
November-December, 1965

An estimation as to the degree the cast should be scored to obtain proper sub-
lingual extension, as indicated by Schreinemakers,lO or an arbitrary determination
of the length of the posterior extension of the lingual flange, as in the mucosal tech-
nique,ll* is not necessary in the dynamic impression technique.

IMPRESSION METHOD I

Impression Material.-Alginate (irreversible hydrocolloid) is an acceptable

impression material for dynamic impressions because this material can be mixed
to the desired viscosity. Other materials can also be used if they possess a similar
resistance to flow which is necessary to record the denture borders adequately,
i.e., to obtain in the finished denture the maximal extension of the denture base
that can be tolerated by the patient. When using irreversible hydrocolloid, the
impression tray, which must be individually fabricated, is not used to carry the
impression material into the correct position. In contrast to conventional pro-
cedures, the tissue to be included within the impression (the basal seat) is covered
with an abundant amount of irreversible hydrocolloid before the impression tray
is positioned in the mouth.
The Inzpression Tray.- The impression tray has three functions. These are:
(1) the tray must not interfere with active muscle movements, (2) the tray must
permit a proper thickness of impression material, and (3) the tray should stabilize
the mandible in a correct position in relation to the maxillae. This third feature re-
quires a special design of the impression tray.
The individual tray is made of acrylic resin on the diagnostic cast and is per-
forated (Fig. 1). The tray is designed to cover the mucous membrane of the
residual ridge that is firmly attached to the underlying bone. However, the tray
may extend over mobile mucosa, both labially and lingually, within the limits of
the muscle activity, i.e., the movements of the tongue, the cheeks, and the lower
lip must not dislocate the tray. The tray must be adjusted, if necessary, to con-
form with the movement of surrounding tissues.
The thickness of the impression material along the margins of the tray is
critical and must be adequate or the irreversible hydrocolloid impression material
may tear or loosen from the tray when it is removed from the mouth. The proper
thickness of the impression is developed along the borders by underextending the
tray so that, labially and lingually, the edge comes no closer than 2 mm. to the
corresponding depth of the vestibular and lingual space. A similar underextension
of the tray should be made to accommodate for the frenums. The part of the tray
that covers the retromolar pad should be trimmed so that the tray edge ends 2 mm.
anterior to the mobile tissues of the pad. If the borders of the tray perforate the
impression material, these surfaces must be removed by grinding and a new
impression made.
The correct thickness of impression material against the denture-bearing
tissue is secured by using “stops” made of a thermoplastic impression material or
green stick modeling compound inside of the impression tray (Fig. 1). These
“stops” should allow a correct orientation of the tray on the residual ridge during
*Note that the European connotation of this technique is in reference to the distal part
of the flange, while in America, the extension is in the anterior region.
 DYNAMIC IMPRESSION METHODS lOi!S

Fig.

Fig. 2

Fig. 3

Fig. l.-The individual dynamic impression tray contains retention holes and the rmo-
plastic s;tops.
Fig. Z.-Thermoplastic mandibular rests are located on the occlusal surface of the indi-
vidual d ynamic impression tray.
Fig. 3.-Mandibular rests have been formed to fit against the occlusal surface of the
maxillae
 J. Pros. Den.
1026 TRYDE ET AL.
November-December, 1965

the making of the impression. One “stop” is placed in the region of the central
incisors and one is located in the region of each first molar. Considering clinical
variations, the stops should extend for 3 to 4 mm. along the residual ridge, be
approximately 2 to 3 mm. wide in a labiolingual direction, and be at least 2 mm.
high. The stops are made by melting the thermoplastic material on the tissue sur-
face of the tray and then pressing it carefully against the preliminary cast until
a space of 2 mm. is achieved between the tray and the surface of the cast. The
tray and the cast are cooled, the tray is removed, and the stops are carved to the
previously mentioned dimensions.
Mandibular rests are placed on the occlusal surface of the tray in the molar
region (Fig. 2). A ridge of self-curing acrylic resin is built up in the premolar
and molar region on each side. These small ridges of resin support the thermo-
plastic material, which is added in a columnar shape. While the thermoplastic
material is still soft, the tray is placed in position on the lower ridge in the mouth,
and the patient is asked to close the jaws slowly. The upper residual ridge will
form an impression in the soft thermoplastic material at a height corresponding
to the rest position of the mandible (Fig. 3). The tray is removed from the mouth
and cooled. Lingually, the mandibular rests should be concave to provide space
for the tongue. If the mandibular rests are too bulky on the lingual side, the patient
will avoid contact with the rests by retracting the tongue and the subsequent
impression will be made with an erroneous tongue position. A tongue rest on the
tray in the central incisor region against which the patient can fix the tip of the
tongue during the making of the impression will help to secure a correct tongue
position (Figs. 4 and 5). Before an impression is made, it is necessary to be sure
that the lower tray is stable on the mandibular ridge when the patient closes his
jaws on the mandibular rests.
Iwzpression Mater&.-An irreversible hydrocolloid (Zelgan) * is used with
50 per cent extra water to obtain the desired viscosity. After spatulation, a suf-
ficient amount of the material to cover all tissues to be included in the impression
is placed directly into the mouth. The sublingual denture space should be com-
pletely filled with the impression material. A small portion is then placed in the
impression tray and the tray is placed in the patient’s mouth. The tray is pressed
through the irreversible hydrocolloid in the mouth by digital force until the stops
are firmly seated on the residual ridge. Then, the patient is asked to close his
mouth slowly until the mandibular rests have obtained firm contact with the max-
illae (Fig. 6). The patient maintains the position of the tray as the impression is
made and simultaneously keeps the tip of his tongue in contact with the tongue
rest on the tray.
The patient should swallow three to four times at 10 second intervals while
the final impression material is still in a moldable condition. The patient should
forcefully protrude the lips (Fig. 7) and vigorously contract the buccinator mus-
cles in between swallows. The action of the muscles that function in deglutition
is accentuated because the mandibular rests prevent the mandible from reaching
the vertical relation of occlusion and force it to remain in its rest position. This

*The Amalgamated Dental Co. Ltd., London Wl., England.

 Volume 15 DYNAMIC IMPRESSION METHODS 1027
Number 6

procedure develops a registration of the denture space, which ordinarily results

in a proper extension of the lingual flange of the finished denture.
Molding of the buccal border of the impression is also achieved during swal-
lowing. The vigorous contraction of the buccinator muscles prevents overextension
of the buccal borders. Therefore this muscle action is particularly required and
should be checked in patients with underdeveloped or atrophic muscles.

Fig. 4.-The concave lingual surface of the mandibular rests provides space for the tongue
at the front of the tray, and the tongue rest is formed.

Fig. 5

Fig. 6

Fig. 5.-The impression tray is fixed by means of mandibular rests to the maxillae and
by means of stops to the mandible. The tongue is located on the tongue rest.
Fig. B.--The impression material is shaped by muscular activity.
 J. Pros. Den.
1028 TRYDE ET AL. November-December. 1965

F ‘lg. 7.-l ‘he labial part of the impression is formed by strong contraction IS c If the orbicu-
laris 1oris i and m entalis muscles.

Fig. 8

Fig. .9

F ‘lg. S.-l ‘he stops in the lower denture base reposition the denture in its rrect vertical
relatic 3n.
F I.Ig. 9.-l ‘he mandibular rests on the lower denture contain the impression the o mpposing
dentit ion
Volume 15 DYNAMIC IMPRESSION METHODS 1029
Number 6

Forceful protrusion of the lips brings the mentalis and orbicularis oris mm-
cles into action and is responsible for forming the labial part of the impression.
After the final impression material has set, the tray is removed from the
mouth and the cast is poured immediately. To take full advantage of a dynamic
impression, the cast should be so constructed that the lingual, labial, and buccal
sulci are reproduced to a depth of at least 4 mm.

IMPRESSION METHOD II

An old lower denture can be used as an individual tray for a dynamic im-
pression when opposing natural or artificial teeth are present. Often, the vertical
dimension of occlusion will have decreased, and then the “stops” are built to a
height that will re-establish the correct vertical relationship (Fig. 8). The man-
dibular rests are built up to include the interocclusal distance (Fig. 9).
The denture must be perforated and completely dry prior to making the
impression. As described previously, the impression material is placed directly
in the oral cavity, the denture base is filled with impression material, and the
impression is made. After removal of the impression from the mouth, the margins
are examined for possible perforation by the border of the denture. Pressure spots
are relieved, the impression material is removed, and a new impression is made.
If necessary, this procedure is repeated (Fig. 10) until the denture borders are
completely covered by impression material.

IMPRESSION METHOD III

The denture is first processed on the basis of a conventional impression

(Fig. 1 l), and mandibular rests are added to the completed denture as described
previously. Then a correcting dynamic impression is made in the denture base to
reshape and complete the final design (Fig. 12) and the denture is relined
(Fig. 13). This procedure was originally indicated by Momme in 1872.
“Stops” are contraindicated in the denture base, as the vertical dimension of

Fig. 10.-A “diagnostic” impression permits the observation of overextensions of the

existing denture borders. Note the overextension of the left lingual flange and the labial border.
 TRYDE ET AL. J. Pros. Den.
November-December. 1965

Fig. Il.-The lower denture is formed on a cast made from a conventional impression.

Fig. lZ.-The finished dynamic impression was made using the denture seen in Fig. 11 as
the tray.

Fig. 13.-The conventional denture as seen in Fig 11 is in its finished dynamic form.

occlusion of the conventional first stage denture is presumed to be correct. There-

fore, the thickness of the final impression material will be critically thin and
irreversible hydrocolloid cannot be used. However, a material such as Ivo-Seal*
is suitable even in thin layers because its adhesive property prevents it from flaking
away from the denture base.

*Ivoclar, A. G., Schaan, Lichtenstein.

Ez ‘6” DYNAMIC IMPRESSION METHODS 10.31

The principles of this third method can also be applied to dentures that are
several months or years old and are lacking in retention and stability, provided
that the vertical dimension of occlusion has remained adequate.

CHARACTERISTICS OF DYNAMIC DENTURES

Dynamic dentures differ characteristically from conventional dentures (Fig.

14). The borders of the denture base from a dynamic impression are longer lingually
and buccally in relation to the amount of extension obtained from a conventional
impression.
Lingual Border En-tension.-The lingual border is determined posteriorly by
the internal pterygoid muscle and inferiorly by the function of the mylohyoid mu+
cle and the tongue. Anteriorly, the lingual border of the impression is shaped by
the genioglossus muscle and its tendinous attachment. During deglutition, the in-
ternal pterygoid, mylohyoid, and genioglossus muscles are activated and the oral
diaphragm is lifted superiorly. The various movements force the impression ma-
terial away from the spheres of action of the muscles, and, consequently, a cor-
responding muscle activity will not dislocate the finished denture.
The mental spine is frequently located close to the crest of the residual ridge
in patients with marked resorption in that region. The swallowing movement dis-
places the impression material over the tendon of the genioglossus and provides
space for its activity in completed dentures.

Fig. 14.-Above, the master cast from a conventional impression differs significantly from
a cast poured in a dynamic impression of the same patient. The denture horders are indicated
by the heavy lines.
 TRYDE ET AL. J. Pros. Den.
November-December. 1965

The muscles that are active during deglutition’ limit the flow of impression
material in a downward direction but do not eliminate impression material that
is located horizontally under the tongue. This material is retained and molded
by the muscles. Thus, this part of the denture space is also fully recorded and ex-
cludes a dislocating effect in the sublingual region on the completed denture. In
certain patients, a marked sublingual extension of the denture that is shaped like
a shelf extends from the right molar region along the ridge to the opposite molar
region (Fig. 15,A).
Labial Border Extension.-The form of the labial border is determined by
the activity of the mental, incisive, and orbicularis oris muscles. Labially, these mus-
cles have an influence similar to that of the mylohyoid muscle lingually since they
limit the downward flow of the impression material and force it away from those
tissues of the alveololabial sulcus that are raised during function.
Buccal Border Extensions.-The buccal border of the denture extends later-
ally as far as possible so that the buccinator muscle can rest on the denture flange
in this region (Fig. 14). The extension of the buccal flange is limited posteriorly
by the activity of the masseter muscle and anteriorly by the buccal frenum. In
some patients, the buccal frenum is absent and the buccal flange merges gradually
with the labial flange.

VARIATIONS BETWEEN DYNAMIC DENTURES

Frequent and large variations of form are to be expected in dentures made

from dynamic impressions (Fig. 1.5) because the individual muscular pattern of
each patient is recorded to a larger extent than with conventional methods. This
characteristic of the dynamic impression is probably a partial explanation of why
patients with difficult oral anatomic conditions can adapt themselves to dynamic
dentures relatively easily.

EXPERIENCES WITH DYNAMIC DENTURES

The dynamic impression method utilizing a special resin tray has been used
by the Prosthetic Department throughout the past five years. At the beginning
of this period, this method was applied tentatively for special patients after varia-
tions of conventional methods had failed. The results were encouraging and,
eventually, the dynamic impression became the impression of choice in the treat-
ment of patients with a questionable prognosis with conventional dentures.
Forty-three patients were treated using dynamic impression methods. These
patients normally would have had some type of extension of the sulcus by sur-
gical means to improve their prosthetic prognosis. However, no operation was
performed. Instead, the patients were treated as mentioned and the treatment was
provided by dental students. A clinical evaluation of the treatment is seen in
Tables I and II.
Thus, by means of the dynamic methods, even in the hands of dental students,
it was possible to reduce the number of patients from 43 to 2 who were in need
of surgical treatment prior to construction of dentures. In addition, 33 dental
students found the dynamic methods easier to use than the conventional pro-
cedures.
E;E ‘6” DYNAMIC IMPRESSION METHODS 1033

Fig. 15.-Four different dentures processed on casts from dynamic impressions. The great
variations in form are partly ascribed to variations in the individual muscular patterns of
the patients.

TABLE I. PATIENT ADAPTATION TO DYNAMIC DENTURES

Easy 3.5 patients

Moderate 3 patients
Difficult 3 patients
Negative 2 patients
Total 43 patients

TABLE II. COMPARISON BY STUDENTS OF DYNAMIC VERSUS CONVENTIONAL METHODS

Dynamic easier 33 students

Both methods equal 6 students
Conventional methods easier 4 students
Total 43 students

SUMMARY

Various dynamic impression methods which are particularly useful for

patients with extreme resorption of the mandibular ridge have been described.
These methods were easily learned and applied by dental students. Satisfactory
results were achieved with few or no corrections and most patients adapted easily
to the dynamic dentures.
1034 TRYDE ET AL.

REFERENCES

1. Brill, N., Tryde, G., and Cantor, R. : Dynamic Nature of the Lower Denture Space,
J. PROS. DEN. 15:401-418, 1965.
2. Schrott: System den genauesten Abdruck and die sicherste Artikulation zu erhalten,
Deutsch. Vjschr. Zahnh. 4:296-304, 1864.
3. Momme, V. : Ganze Gebisse herzustellen, Der. Zahnirzt. 27:3, 1872.
4. Skogsborg, R. : Abdruck des Oberkiefers, Deutsche Monatschr. Zahnh. 26:123-129, 1886.
5. Greene, J. W.: Greene Brothers’ Clinical Course in Dental Prosthesis, ed. 4, Detroit, 1916,
Detroit Dental Manufacturing Co.
6. Loos, S.: Ein Beitrag zur Anatomie der Mundhohle und zur Abdrucktechnik fiir die
totale Prothese, Ztschr. Stomatol. 29:1-25, 1931.
Hromatka, A. : Der Schulckabdruck, Zahnarzt. Reform. 55:7-10, 1954.
ii: Matthews, E.: The Polished Surfaces, Brit. D. J. 111:407-410,1961.
9. Fournet, S. C., and Tuller, C. S.: A Revolutionary Mechanical Principle Utilized to
Produce Full Lower Dentures Surpassing in Stability the Best Modern Upper
Dentures, J.A.D.A. 23:1028-1030, 1936.
10. Schreinemakers, J. : Die Rationalisierung der Abdruckgewinnung zur Herstellung totaler
Prothesen, Deutsche zahn. Ztschr. 15:1632-1641, 1960.
11. Peutsch, W. : Die Muco-Seal-Extensionsprothese, Ztschr. Stomatol. 51:287-290, 1954.
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