1

Impression techniques for

compromised ridges
Contents 2

 Introduction
 Definitions
 Objectives of impression making
 Types of compromised ridges
 Atrophic ridges
 Impression techniques for atrophic ridges
 Flabby ridges
 Impression techniques for flabby ridges
Contents 3

 Knife edge ridges

 Impression technique for knife edge ridges
 Conclusion
 References
INTRODUCTION 4
 Complete dentures are primarily mechanical devices but since they
function in the oral cavity, they must be fashioned so that they are in
harmony with the normal neuromuscular function.

 The wearing of complete dentures may have adverse effects on the

health of both oral and denture supporting tissues.

 It is not always possible to work directly inside the oral cavity

hence a duplicate reproduction is necessary which is done by
impression making.
 5
 Successful complete-denture impressions require an appropriate
‘mold’ (tray), ‘method’ (impression technique), and ‘material’
(impression material).

 For a good impression, knowledge of basic anatomy, basic reliable

technique, understanding of impression materials, skills and patient
management is necessary.
DEFINITIONS 6

 An Impression is defined as a negative likeness or copy in reverse of the

surface of an object; an imprint of the teeth and adjacent structures for use in
dentistry. (GPT – 9)

 A preliminary impression is defined as “a negative likeness made for the

purpose of diagnosis, treatment planning and/or the fabrication of a custom
impression tray”. (GPT – 9)

 A final impression is defined as “the impression that represents the completion

of the registration of the surface or object.” (GPT – 9)
Objectives of Impression making 7

 Preservation of the alveolar ridges

 Support
 Retention
 Stability
 Esthetics
Preservation of the alveolar ridges 8

 M. M. De Van’s dictum, “Perpetual preservation of what remains

rather than meticulous reconstruction of what is lost.”

 In impression making this rule is followed by not using heavy

pressure and by covering as much of the supporting areas as possible
to minimize the possibility of soft tissue abuse and bone resorption.

1. Levin B. Impressions for Complete Dentures. 1st ed. Chicago, Berlin, London, Tokyo:
Quintessence Publishing Co; 1984.
Support 9

 Denture support is the resistance to vertical forces of mastication and to

occlusal or other forces applied in a direction toward the basal seat.

 When the natural teeth are missing, the alveolar ridge and their covering
of mucosal tissues become the supporting tissues.
Support 10

Areas of Support are :

 Primary :
- Maxillary : Posterior ridges and flat areas of the palate
- Mandibular : Buccal shelf area, posterior ridges and pear-shaped pad
 Secondary :
- Maxillary & Mandibular : Anterior ridge and all ridge slopes
 Slight :
Areas of very displaceable tissues i.e. all the vestibular areas that provide
very little support but are needed for the very important peripheral seal

1. Levin B. Impressions for Complete Dentures. 1st ed. Chicago, Berlin, London,
Tokyo: Quintessence Publishing Co; 1984.
Retention 11

 Retention of a denture is it’s resistance to removal in a direction opposite

to that of it’s insertion.
 Factors that affect retention are :
- Adhesion
- Cohesion
- Interfacial surface tension
- Mechanical locking into undercuts
- Peripheral seal and atmospheric pressure
- Oral and facial musculature

1. Levin B. Impressions for Complete Dentures. 1st ed. Chicago, Berlin, London, Tokyo:
Quintessence Publishing Co; 1984.
Stability 12

 The stability of a denture is it’s ability to remain securely in place

when it is subjected to horizontal movements.
 The latter occurs during the functional forces of chewing, talking,
singing, whistling etc.
 To be stable- Good retention, non interfering occlusion, proper tooth
arrangement, proper form and contour, proper orientation of occlusal
plane, good muscular coordination and control.

1. Levin B. Impressions for Complete Dentures. 1st ed. Chicago, Berlin, London, Tokyo:
Quintessence Publishing Co; 1984.
Esthetics 13

 The role of esthetics in impression making refers to the development

of the labial and buccal borders so that they are not only retentive
but also support the lips and cheeks properly.

 Care must also be taken not to over support these structures with
borders that are too thick.

1. Levin B. Impressions for Complete Dentures. 1st ed. Chicago, Berlin, London, Tokyo:
Quintessence Publishing Co; 1984.
IMPRESSION MAKING 14

THEORIES OF IMPRESSION MAKING

• MUCOSTATIC,MUCO-COMPRESSIVE,SELECTIVE PRESSURE

TECHNIQUE

• OPEN MOUTH, CLOSED MOUTH

PURPOSE OF IMPRESSION

• DIAGNOSTIC,PRIMARY,SECONDARY

TRAY TYPE

• STOCK TRAY, CUSTOM TRAY

 15

Atrophic ridges Flabby ridges

Compromised
ridges
Knife edge Abused ridges

Prasad K et al. Prosthodontic management of compromised ridges and situations. Int J Health Allied
Sci20144(1),ISSN:2249-7110
ATROPHIC RIDGES 16

 The atrophy or resorption of alveolar bone is most dramatic during the first year after
the loss of teeth.

 Reconstructive challenges

 Complications

 The introduction of dental implants to the surgeon’s armamentarium has

dramatically reduced the need to consider preprosthetic soft and hard tissue surgical
procedures

2. Whitmyer C, Esposito S, Alperin S. Longitudinal treatment of a severely atrophic

mandible: a clinical report. The Journal of Prosthetic Dentistry. 2003;90(2):116-120.
Atrophic Ridges 17
Atrophic Ridges 18

 A good impression holds the key to a successful treatment in cases

of resorbed mandibular ridges where we have minimum tissue to
fulfil the fundamental requirement of retention, stability and
support.

 No matter how good the prosthesis is constructed, it will not

function as intended if it was not made on an accurate impression.
Atrophic Ridges 19

Impression techniques :
 Flange technique by Lott and Levin (1966)
 A technique by Klein and Broner (1985)
 Modified fluid wax technique (2009)
 “Cocktail impression” by Praveen G et al (2011)
 Two-step technique (using monophase and light body) (2012)
 Wire impression technique by Tanvir H et al (2017)
Flange technique by Lott and Levin 20

 1966

 The technique involves making impressions of the soft structures of the

mouth adjacent to the buccal, labial, lingual, and palatal surfaces of
dentures and incorporating the resulting extensions into the denture
construction. The extensions will be described as flanges or flange
modifications. They will be related to the anatomy and physiology in each
region.
Flange technique by Lott and Levin 21

 Flange wax was rolled from the retro molar pad area to the sublingual
region, large enough to restore the diameter of estimated resorption and
patient is asked to forcefully perform functions of swallowing, speaking
etc. to give border extensions which covers maximum surface area (genial
tubercles and sublingual gland).

 This modification increases the area of intimate contact of the denture

with the oral structures thus improving stability, function, comfort and
appearance of complete dentures over other techniques
22
23
Flange technique by Lott and Levin 24

 It is not truly an impression technique as it is done on the trial dentures

 However it is one of the first techniques described in literature

Lott, Frank, and Bernard Levin. "Flange technique: an anatomic and physiologic approach to increased
retention, function, comfort, and appearance of dentures." The Journal of prosthetic dentistry 16.3 (1966):
394-413.
A technique by Klein and Broner 25

 Given in 1985

Technique :
 Primary impression – modelling compound
 Secondary impression -clear acrylic resin
A technique by Klein and Broner 26

 The adjusted maxillary tray is then prepared by using a No. 6 round bur to
drill four holes approximately 5 mm apart in the anterior palatal
region.

 Six holes are drilled 5 mm apart in the anterior flange from canine to
canine.

 Four holes are made in both the buccal flanges from the first premolar
to the second molar approximately 5 mm apart.
A technique by Klein and Broner 27

 The adjusted mandibular impression tray is prepared for the secondary

impression by using a No. 6 round bur to drill four holes spaced 5 mm
apart on each posterior lingual flange.

 If flabby or loose tissue exists on the buccal, labial, or lingual surfaces,

these regions should be generously relieved before impression
A technique by Klein and Broner 28

 Platforms of modeling compound are placed bilaterally in the premolar

and molar region.

 Their use will aid in reducing the pressure applied to the basal tissues,
because the dentists’ fingers are away from direct contact with the tray
A technique by Klein and Broner 29

Secondary Impressions :
 The impression material of choice is a zinc oxide-eugenol paste.

 The maxillary tray is supported by a single finger in the midpalatal region

after the tray has been fully seated upward and slightly posteriorly.
A technique by Klein and Broner 30

 Movements include opening and closing the mouth, moving the mandible
from side to side, puckering the lips, and smiling to activate the
buccinator muscles

 The impression paste provides sufficient flowing time for border

placement and sufficient resistance to maintain good tissue contact.
A technique by Klein and Broner 31

 The loaded mandibular impression tray is seated posteriorly first and then
in a downward and anterior direction.

 The patient is then asked to activate the lips and cheeks in the same
manner as for the maxillary impression..

Klein, Ira E., and Alan S. Broner. "Complete denture secondary impression technique to minimize distortion of
ridge and border tissues." The Journal of prosthetic dentistry 54.5 (1985): 660-664.
Modified fluid wax technique 32

 Given by Tan et al in 2009

Technique :
 Preliminary impression - irreversible hydrocolloid impression material in
a metal stock tray.
 Fabricate a custom impression tray on the preliminary cast.
Modified fluid wax technique 33

 Border mold the tray with modeling plastic impression compound in

segments.

 Remove the spacers with a scalpel blade once the border molding is
completed.
Modified fluid wax technique 34

 Trim the tray over the crest of the residual ridge, and create a window
opening above the displaceable alveolar ridge using a No. 8 round bur.

 Melt the mouth temperature impression wax in a container held in a water

bath at 42°C, and apply the impression wax onto the borders of the tray
with a wax spatula while it is still fluid.
Modified fluid wax technique 35

 Place the impression tray immediately over the edentulous ridge, and
leave it in the mouth for approximately 5 minutes.

 Remove the impression tray from the mouth and cool it immediately in
water at room temperature.

 Add impression wax in increments on the periphery until a definite

reproduction of the muccobuccal fold is obtained.
Modified fluid wax technique 36
 Apply impression wax onto the intaglio surface of the tray to capture
the remaining surfaces of the residual ridge.

 Apply adhesive on the tray in the area surrounding the window

opening, and allow it to dry

 Place the impression tray onto the residual ridge and inject vinyl
polysiloxane impression material over the window opening. Prevent
distortion of the soft tissues by placing the impression material in the
most passive manner possible.
Modified fluid wax technique 37

 Gently blow air onto the impression material to allow the spread of the
impression material over the mucosal surfaces.

 Allow the impression material to polymerize according to the

manufacturer’s recommendation

 Remove, disinfect, and box the impression using a mix of plaster and
pumice. Avoid using a conventional boxing procedure that requires
boxing wax, as it may distort the impression wax.
Tan KM, Singer MT, Masri R, Driscoll CF. Mod- ified fluid wax impression for a severely resorbed
edentulous mandibular ridge. J Prosthet Dent 2009; 101: 4.
38
 39

Sample Footer Text 6/2/19 39

Two-step technique 40

 Given by Dhananjay et al in 2012

Technique :
 The primary impression - impression compound.

1. A lower custom tray with 3 mm spacing is made with stub handles on
the second premolar region.

2. The custom tray must be 1 mm short of the vestibular reflections in
all the areas.
Two-step technique 41

Final Impression :
 The custom tray is tried in the patient’s mouth Escape holes are made with
a No. 10 round bur, and tray adhesive is applied.

 Two equal lengths of base paste and accelerator paste of monophase

consistency are mixed thoroughly on the glass slab and loaded onto the
tray.

 The impression of the denture-bearing area and the peripheral tissues is

made in a single step.
Two-step technique 42

 Later, equal lengths of base paste and accelerator paste of light viscosity
material are extruded onto the glass slab..

 The tray with the loaded light viscosity material is placed in the patient’s
mouth and stabilized in position holding the stub handles.

 The border molding and tongue movements are repeated. After the
material has set, the tray is removed from the mouth and the impression
inspected for the details recorded. The impression is washed and
disinfected.
 43

Impression made in monophase

consistency Monophase impression
relined with light body
material

Gandage Dhananjay, S., et al. "Two‐step impression for atrophic mandibular ridge." Gerodontology 29.2 (2012):
e1195-e1197.
“Cocktail” impression technique 44

 Given by Praveen G. et al in 2011

Technique :
 Over extended preliminary impression is made with alginate using the
patient’s previous dentures (if available) so as to use the entire basal seat for
support.

 Customized tray is fabricated with autopolymerising acrylic resin with

1mm wax spacer
“Cocktail” impression technique 45

 Cylindrical mandibular rests in the posterior region are made at increased

vertical height.
 High-fusing impression compound is softened, placed on top of the
mandibular rests and inserted in the patient’s mouth.
 Patient is advised to close his mouth so that the mandibular rests fit against
the maxillary alveolar ridge.
 This helps to stabilize the tray in position by preventing anteroposterior and
mediolateral displacement of the tray during definitive impression.
“Cocktail” impression technique 46

 Impression compound and green tracing stick in the ratio of 3:7 parts by
weight is placed in a bowl of water at 60°C and kneaded to a homogenous
mass that provides a working time of about 90 s.

 Wax spacer is removed, this homogenous mass is loaded and patient is

guided to close his mouth on the mandibular rests.

 Functional state recorded

“Cocktail” impression technique 47

 On removal from the mouth, impression is chilled and reinserted to check

the denture bearing area for pressure sensibility by applying heavy finger
pressure on the impression to simulate functional loads.

 The operator should place the thumbs on the underside of the patients’
mandible and squeeze.

 If the mucosa has been properly loaded, the only discomfort that the patient
should report is where the thumbs press on the lower border of the
Praveen, G., et al. "Cocktail impression technique: a new approach to atwood’s order vi mandibular ridge
mandible
deformity." The Journal of Indian Prosthodontic Society 11.1 (2011): 32-35.
48
Wire impression technique. 49

 An impression technique of highly resorbed mandibular ridge using an

orthodontic wire and elastomeric impression materials, to gain maximum
retention and stability.

 A 19 gauge wire (S.S smith) was adapted on the mandibular ridge on the primary
cast in the form of special tray.

 The primary impression was made with putty consistency of Polyvinyl siloxane
 50

 Final impression was made using addition silicone elastomeric

impression material of light body consistency
 Master cast was poured using die stone

Tanvir H, Kumar N, Singh K, Kapoor V. An Innovative Wire Impression Technique of

Highly Resorbed Mandibular Ridge. Periodontics and Prosthodontics. 2017;03(01).
51
Flabby Ridges 52

 The alveolar mucosa over the ridges in completely edentulous patients is

with unusual thickness and mobility.

 In some areas, it is thick from 2 to 4 mm. In other areas where the atrophy
of the alveolar process was rapid and sophisticated, the mucosa has no
bone support and becomes loose and flabby.
Flabby Ridges 53

 The flabby ridge or movable tissues are frequently seen in maxillary

anterior ridge when the edentulous maxilla is opposed by natural teeth in
the mandibular anterior region.

 Kelly in 1972 reported that mandibular anterior teeth cause trauma to

maxillary anterior ridge as all occlusal forces are directed on to this area.

 This results in loss of bone from the anterior maxilla with subsequent
fibrous tissue hyperplasia.
Flabby Ridges 54

 The presence of displaceable denture-bearing tissues often presents a

difficulty in making complete dentures.

 Soft tissues that are displaced during impression making tends to return to
their original form, and complete dentures fabricated using this
impression will not fit accurately on the recovered tissues.

 This results in loss of retention, stability discomfort and gross occlusal

disharmony of the dentures.
Flabby Ridges 55

Impression techniques : ■ Single step monophase

 Dual tray technique (1964) ■ Two part impression
 Open-Window technique (1970) ■ One part impression
 Filler technique (1971)
 Hob Kirk's technique (1997)
 Lynch and Allen’s technique (2006)
 Massad’s technique (2007)
 Modified fluid wax technique
 Controlled lateral pressure technique
Dual Tray technique 56

 Given by Osborne in 1964

Technique :
 A primary impression - irreversible hydrocolloid impression material.

 The extent of flabby tissue is marked on the maxillary cast. Single

uniform thickness of dental wax (1.5 mm) is adapted over the entire
denture bearing area to act as spacer except the flabby tissue area.
Dual Tray technique 57

 A special try is fabricated over the wax spacer and locating rod is located
in the centre of palate during fabrication. This helps to accurately locate
the second part special tray using a stop, thereby allowing for a pre
planned even thickness of impression material.

 Double thickness wax spacer (3 mm) is adapted over flabby region

 Special tray along with double spacer wax over flabby area is picked. A
pick up tray is fabricated after applying petroleum jelly to all the surfaces,
covering the first part of the special tray
58
Dual Tray technique 59

 Border moulding for the special tray and pick up tray is done using green
stick compound to record the depth of the functional sulcus
Dual Tray technique 60

 Wash impression is made using zinc oxide eugenol paste material.

 Multiple holes are made in the pickup tray in the flabby area. Light body
elastomeric impression materials is placed on the area covering the
window portion and then while the first tray is still in the mouth the
pickup tray is positioned over it and border molding movements are
repeated

 After the setting of the impression material the pickup tray along with the
first tray is removed as whole with the help of the locating rod. The
impression surface is then examined for any voids or extensions
Dual Tray technique 61

Osborne J. Two impression methods for mobile fibrous ridges. Br Dent J 1964; 117: 392-394.
Prasad K et al. Prosthodontic management of compromised ridges and situations. Int J Health Allied
Open Window Technique (Osborne) 62

Technique :
 Preliminary impression - irreversible hydrocolloid impression material.
 The cast is poured and the flabby ridge is marked on the cast and a
modified tray with a spacer of 1 mm thickness is made with
autopolymerising resin
 A window is made on the tray over the flabby ridge area and finger stops
are made .
 Border molding is done with softened green stick tracing compound till
functional sulcus is recorded
63
Open Window Technique 64

 Final impression is made with zinc oxide eugenol impression paste.

 The impression is positioned back in the patient’s mouth and impression

plaster is applied on the flabby ridge exposed through the window
 Once it sets the impression is removed and inspected, separating medium
is applied to the plaster area and the cast is poured.
 In this technique the flabby tissue is recorded in minimally displaced
form and the rest of the tissues in functional form.
65
Open Window technique 66

 Described by Watson in 1970

Technique :
 A preliminary impression irreversible hydrocolloid impression material in a
metal stock tray or patient's old denture.

 Mark the flabby ridge area on the cast. Fabricate a special tray in chemically
cured acrylic resin with proper spacer and stoppers on the preliminary cast
simultaneously providing a window for marked flabby ridge area.
67
Open Window technique 68

 Border mold the tray with low fusing modelling plastic impression
compound (green stick).
 Apply the tray adhesive on the border and whole of the tissue surface of
the tray. Load the impression tray with light body and immediately place
the tray over the edentulous ridge and leave it in mouth for 3-5 minutes.
 Remove the impression tray from the mouth, Trim away any excess
impression on the periphery or over the window opening with a scalpel
blade.
69
Open Window technique 70

 Place the impression tray back into patient mouth and inject low viscosity
polyvinyl siloxane impression material over the window opening. Place
the material in most passive manner to prevent the distortion of the soft
tissues.

 Allow the impression material to polymerize according to the

manufacturer's recommendations. Remove the impression and evaluate
carefully.

Osborne J. Two impression methods for mobile fibrous ridges. Br Dent J 1964; 117: 392-394.
71
Filler technique 72

 William H. Filler in 1971 described a technique using two trays

 Preliminary maxillary and mandibular impressions were made in stock

trays with alginate impression method and casts were poured.
 The maxillary and mandibular casts were placed on the surveyor and
all the tissue undercuts were blocked out with utility wax.
 A single thickness of baseplate wax was formed over the casts to form
a spacer. The spacer is terminated short of the posterior palatal seal
area so that the tray material would contact the tissue in this area.
Filler technique 73

 A tinfoilsubstitute was applied to the casts and the first of the two
trays was made in auto polymerizing acrylic resin. Most of the basal
surface of the tray was removed except for the latticework of acrylic
resin, which strengthens the trays.
 The maxillary and mandibular trays are then keyed to orientate the
second tray in at least three places. These keyed positions correspond
with an extension of the second tray and will insure proper seating of
the second tray over the first tray.
 The entire first tray was covered with a single thickness of baseplate
wax, ensuring that the keyed positions here kept free of wax. Both the
first resin tray and the casts were painted with tin foil substitute.
74
Filler technique 75

 The second trays were made in the same manner as the first and extend past
the relieved area of maxillary and mandibular trays and fit into keyed
positions.

 With round bur, numerous holes were made in the second tray

 The deepest portion of the vault of maxillary tray was removed to create a
stop when the final impression was made. The initial tray was sealed with
minimum pressure and autopolymerizing resin on a tongue depressor that
was gently placed in the opening in the vault. When the resin had set a stop
was created on the firm and stable palatal tissue.
76
Filler technique 77

Clinical impression procedure :

The borders of the maxillary tray are formed by adding low fusing
compound and border molding it. A finger placed over the resin
stop will ensure a stable tray. The basal plate was removed and the
flanges reduced 1-2mm with the exception of the part over the
tuberosites and posterior palatal seal area of the maxillary tray.
The mandibular tray was stabilized by the addition of modeling
plastic on the buccal flanges in the region of first and second
molars and in the anterior part of the tray in the incisor area. The
mandibular tray was border molded and baseplate wax was
removed from the mandibular tray every where except at the three
points used for stabilization.
Filler technique 78
 Both the trays were painted with permlastic adhesive. Light body
permlastic was used in initial tray as a corrective wash impression
material. After it set the tray was removed from the mouth and all
excess material was trimmed from the borders and from the area
where the second tray would come into contact with the first tray to
key themselves.
 The second impression was made with plastogum used in corrective
wash impression and plastogum was painted over the entire vault and
all available tissue surface not included in the first impression. The
second tray was filled with plastogum and gently vibrated into place
until keyed parts of the tray were in contact. The two trays were held
lightly together until the impression material set and then the
impression was removed as a unit and the two trays were sealed
together with sticky wax.

Filler, William H. "Modified impression technique for hyperplastic alveolar ridges." The Journal of
prosthetic dentistry 25.6 (1971): 609-612.
 79

PART 2
 80

ANATOMICAL PHYSIOLOGICAL
PHYSICAL FACTORS
FACTORS FACTORS

• SIZE OF THE • SALIVA • ADHESION

DENTURE • COHESION
BEARING AREA • INTERFACIAL
• QUALITY OF SURFACE
DENTURE BASE TENSION
AREA • ATMOSPHERIC
PRESSURE AND
PERIPHERAL SEAL
 81

MECHANICAL FACTORS MUSCULAR FORCES

• UNDERCUTS • SUPPLEMENTARY
• MAGNETS RETENTIVE FORCES
• DENTURE ADHESIVES
• SUCTION CHAMBERS
AND DISKS
Hobkirk’s technique 82

 Given by Hobkirk in 1997

Technique :
 Diagnostic impression - Alginate impression material
 Custom tray- Boucher’s spacer design
 Border molding is performed using green stick compound.
Hobkirk’s technique 83

 Impression is made with medium body vinyl polysiloxane elastomeric

impression material

 The displaceable tissue is then marked in intraoral region and transferred

on the impression and window is created by cutting the marked area to
expose the flabby tissue
Hobkirk’s technique 84

 The tray is painted in this region with light body elastomeric

impression material to record the flabby tissue.
Lynch and Allen’s technique 85

 Given by Lynch C.D. and Allen P.F. in 2006

Technique :
 Preliminary impression - Alginate impression material

 The flabby area is marked on the cast and three layer thickness of
modeling wax is placed as a spacer over the marked area and one layer
thickness of wax over the remaining non-displaceable area.
Lynch and Allen’s technique 86

 Custom tray is fabricated using auto polymerizing resin.

 Border molding

 The custom tray is filled with light body vinyl polysiloxane impression
material and placed in the patient’s mouth.
 Once set, the impression is removed from the patient’s mouth and
inspected
87
Massad’s technique 88

 Joseph Massad in 2007 proposed a modified impression technique which

included building or layering method of impression making, maintaining
the integrity between layers of the impression materials of varying
viscosities depending on the compressibility of the tissues.
Massad’s technique 89

Technique :
 Specially designed trays which can be molded in hot water are selected
for individual patients taking into consideration the size of the arch.
 The tray size selection is done by measuring the distance between the
tuberosities using a caliper and relating it to the chart given with the trays.
 The tray is modified wherever required.
 In this technique depending on the resiliency of the tissues, the
elastomeric impression materials of various viscosities are used
Massad’s technique 90

 High viscosity polyvinyl siloxane material is used for making tissue

stops, ensuring a uniform distance of approximately 2 to 3 mm from the
vestibular sulcus.
 Single step border molding is then performed with high viscosity
polyvinyl siloxane material
 The light viscosity polyvinyl siloxane impression material is loaded
corresponding to the areas to be relieved over the tray and medium
viscosity polyvinyl siloxane is loaded in the other areas.
 The loaded tray is placed in the oral cavity and impression is made
91
 92

Sanaye RS, Shah N, Ram SM. A Comparative Evaluation of the Retention of Denture Bases fabricated
using Selective Pressure, Massad's and Functional Impression Techniques: A Clinical Study. J Contemp
Dent 20144(3)139-144.
Controlled lateral pressure technique 93

 This technique is advocated by many authors for use with a fibrous

(unemployed) posterior mandibular ridge.

 They describe a technique in which tracing compound (green stick) is

used to record the denture bearing area using a correctly extended special
tray.

 A heated instrument is then used to remove the greenstick related to the

fibrous crestal tissues and the tray is perforated in this region.
Controlled lateral pressure technique 94

 Light bodied silicone impression material is then syringed onto the buccal
and lingual aspects of the greenstick and the impression gently inserted.

 The excess material is extruded through the perforations and theoretically

the fibrous ridge will assume a resting central position having been
subjected to even lateral pressures
Single step technique 95

Technique :
 Primary impressions are made with alginate and casts poured using dental
stone
 On the maxillary cast, an “I” shaped spacer was applied along the mid
palatine raphe using modelling wax with additional relief given in the
flabby area from canine-canine region.
 The mandibular cast was first adapted with a layer of wax to provide
extra relief in the flabby region followed by addition of one more layer of
wax covering the ridge except the buccal shelf area
96
Single step technique 97

 A maxillary custom tray was fabricated using clear autopolymerising acrylic resin
covering the tissues except the area that was flabby.

 Over the “open” area of the tray another “supporting tray” of clear acrylic was
made thus covering the flabby ridge.
98
Single step technique 99

Final impression of lower ridge :

 The Buccal shelf area was recorded using impression compound ensuring
a stable and uniform contact on the buccal shelf area.. The remaining
borders of impression were recorded by selective pressure technique
using green stick compound.

 A final impression with monophase (medium body) addition silicone was

made.
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Single step technique 10
1

Final impression of upper ridge :

 The maxillary borders were recorded by selective pressure impression
technique using green stick compound.
 The relief wax was removed and multiple holes were drilled in the
“supporting tray”.
 Tray adhesive was applied.
 Similar to the lower impression a monophase impression of addition
silicone was made.
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Two part impression : Mucostatic and 10
3
mucodisplacive combination
 First described by Osborne in 1964 for use in the mandible

Technique :
 The preliminary impressions are taken and primary casts are poured.
 The displaceable tissue can be marked on the impression and transferred
to the primary cast.
 A close fitting cold-cured or light-cured acrylic base is constructed so that
the flabby ridge area is left uncovered
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4
Two part impression : Mucostatic and 10
5
mucodisplacive combination
 Appropriate border correction is then carried out before an impression of
the firm; supported mucosa is recorded in zinc oxide eugenol or medium-
bodied silicone
 An impression of the displaceable mucosa is then recorded by applying or
syringing a thin mix of impression plaster or light-bodied silicone
 The latter having preferential use in cases involving undercut.
10
6
 10
7

4. Crawford R, Walmsley A. A review of prosthodontic management of fibrous

ridges. British Dental Journal. 2005;199(11):715-719.
One part impression 10
(A selective perforation tray) 8

 Relatively simple technique

 It has been suggested that if the degree of mucosal displacement is
minimal, then this modified conventional technique may be considered.
 Preliminary impressions are taken in stock trays using low-viscosity
alginate after appropriate border correction.
 A spaced special tray is fabricated from the primary cast for use with a
low viscosity impression material, such as impression plaster, low-
viscosity silicone or alginate.
 Pressures on the unsupported, displaceable soft tissue can be minimised
further by the use of perforations in the tray overlying these areas
Knife Edge Ridge 10
9

 A sharp bony ridge is a frequent problem among the edentulous patients

and commonly occurs in the mandible.
 If present it should be identified during the initial assessment by palpation
of residual edentulous ridges.
 When it is conventionally loaded, the overlying mucosa is pinched
between the denture base and the bone which leads to pain over the ridge
Knife Edge Ridge 11
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 According to Meyer the three types of sharp ridges are :

1) Saw tooth ridge
2) Razor like ridge and
3) Those with discrete spiny projections.
Knife Edge Ridge 11
1

Technique :
A Technique which will distribute loading onto alternative areas over the
ridge and relive the mucosa over the sharp bony ridge producing differential
pressure is preferred.
 A preliminary impression of the edentulous arch using Irreversible
hydrocolloid impression material in a metal stock tray is made and a
special tray is fabricated on the primary cast.
 A medium bodied silicone impression is used to make a fully muscle
trimmed secondary impression.
Knife Edge Ridge 11
2

 The impression produces displacement of the mucosa over the sharp bony
ridge. If it is used to construct the final denture prosthesis, there is a
potential for the denture to cause traumatic pain in this region. The area of
the impression over the sharp ridge is cut away using a scalpel blade. The
tray is perforated over the sharp ridge.

 Complete impression is made using light bodied impression material.

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Conclusion 11
4

 Faulty prostheses can alter the character, condition and form of the
underlying oral tissues. The pathological changes must be carefully
examined and resolved, prior to the beginning of the new prosthetic
rehabilitation. A thorough history, a keen eye in clinical
examinations and sound knowledge about the possible treatment
alternatives will help the prosthodontist to provide his patients with
satisfactory complete denture prosthesis.
References 11
5

 Impressions for Complete Dentures. Bernard Levin.

 Klein, Ira E., and Alan S. Broner. "Complete denture secondary impression
technique to minimize distortion of ridge and border tissues." The Journal of
prosthetic dentistry 54.5 (1985): 660-664.
 Chakarvarty K, Tomar SS, Tandan P, Modi R. Managing flabby tissue with
different impression techniques: A case series. IJOCR Apr - Jun 2015;
Volume 3 Issue 8.
 Lamb D J. Problems and solutions in complete denture prosthodontics. pp
57-60. London: Quintessence, 1993.
 Osborne J. Two impression methods for mobile fibrous ridges. Br Dent J
1964; 117: 392-394.
References 11
6

 Dharmendra Kumar Singh et al. Prosthodontics rehabilitation of a maxillary

fibrous ridge – a case report. TMU J. Dent Vol. 1; Issue 4 Oct – Dec 2014.
 Umesh Y. Pai, Vikram Simha Reddy, and Rushad Nariman Hosi, “A Single Step
Impression Technique of Flabby Ridges Using Monophase Polyvinylsiloxane
Material: A Case Report,” Case Reports in Dentistry, vol. 2014, Article ID
104541, 6 pages, 2014.
 Sanaye RS, Shah N, Ram SM. A Comparative Evaluation of the Retention of
Denture Bases fabricated using Selective Pressure, Massad's and Functional
Impression Techniques: A Clinical Study. J Contemp Dent 20144(3)139-144.
 Tan KM, Singer MT, Masri R, Driscoll CF. Mod- ified fluid wax impression for
a severely resorbed edentulous mandibular ridge. J Prosthet Dent 2009; 101: 4.
References 11
7

 Gandage Dhananjay, S., et al. "Two ‐step impression for atrophic mandibular ridge."
Gerodontology 29.2 (2012): e1195-e1197.
 Crawford, R. W. I., and A. D. Walmsley. "A review of prosthodontic management of
fibrous ridges." British dental journal 199.11 (2005): 715-719.
 Prasad K et al. Prosthodontic management of compromised ridges and situations. Int
J Health Allied Sci20144(1),ISSN:2249-7110
 Praveen, G., et al. "Cocktail impression technique: a new approach to atwood’s order
vi mandibular ridge deformity." The Journal of Indian Prosthodontic Society 11.1
(2011): 32-35.
 Lott, Frank, and Bernard Levin. "Flange technique: an anatomic and physiologic
approach to increased retention, function, comfort, and appearance of dentures." The
Journal of prosthetic dentistry 16.3 (1966): 394-413.
References 11
8

 Filler, William H. "Modified impression technique for hyperplastic alveolar ridges."

The Journal of prosthetic dentistry 25.6 (1971): 609-612.
 Kunwarjeet Singh et al. Window impression technique– A treatment modality for
Prosthodontic management of flabby ridge: a Case Report. Journal of
pharmaceutical and biomedical sciences (J Pharm Biomed Sci.) 2012, Novemeber;
24(24); 83-86.
 Sajani R, RanukinariA. Impression techniques for effective management of flabby
ridge-An overview. Joumalof Scientific Dentistry 2012;2(2)29-33.
 Katna V, Chopra V, Chadda A, Gaur A. Management of knife edge ridge- A case
report.Indian Journal of Dental Sciences.2011;5(3):57-58.
 Meyer, Roger A. "Management of denture patients with sharp residual ridges." The
Journal of prosthetic dentistry 16.3 (1966): 431-437.
 11
9

 3. Tanvir H, Kumar N, Singh K, Kapoor V. An Innovative Wire

Impression Technique of Highly Resorbed Mandibular Ridge.
Periodontics and Prosthodontics. 2017;03(01).
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