Establishing the posterior palatal seal during the final impression stage

Izharul Haque Ansari, BDS, M D S a

Faculty of Dentistry, Jordan University of Science andTechnology, Irbid, Jordan

A procedure for adding a posterior palatal seal at the final impression stage with green stick
modeling compound is described, The location and degree o f tissue displacement of the posterior
palatal seal area are controlled by the dentist. This procedure is suggested to be more accurate than
the arbitrary scraping o f the master cast. (J Prosthet Dent 1997;78:324-6.)

A n adequate seal of the posterior border of a max-

illary denture is essential for retention. 1 Establishment
of a posterior palatal seal (PPS) is performed routinely
by locating the vibrating line in the patient's mouth,
transferring it to the master cast, and arbitrarily scribing
the cast before processing the dentures. 2-7Although most
dental schools in the United States and Canada (87.5%)
teach arbitrary scribing PPS on the cast, 8 arbitrary scrib-
ing of the master cast is considered by some to be the
least accurate method and leaves the most to chance at
the insertion appointment. 9 The location and incorpo-
ration of the PPS in the maxillary complete denture is Fig. 1. Maxillary ZOE final impression. Redefined transfer pen-
the responsibility of the dentist 8 as the tissue displace- cil marking shows anterior and posterior vibrating lines.
ment can only be determined clinically, not on the cast.
Incorporating the PPS during the final impression stage
has the following advantages over the conventional
method of cast scribing: (1) The procedure places the
entire responsibility of locating and incorporating the PPS
into the hands of the clinician; (2) the practitioncr will
then be able to asscss the retentive qualities of the fin-
ished denture; (3) PPS is incorporated into the trial den-
ture base for added retention, thus increasing the diag-
nostic information and accuracy of record taking proce-
dures; and (4) overcompression of tissue is avoided. The
fluid wax technique 1° is the method ofchoicc for the es-
tablishment of PPS at final impression stage, but it has
the following disadvantages: (1) More timc is required
during the impression appointment, (2) a heating unit is Fig. 2. Criss-cross grooves made with hot instrument for an-
required to condition the wax, (3) difficulty may be ex- chorage of modeling compound.
perienced in handling the materials, and (4) added care
during thc boxing procedure for cast formation is neces- pression by using a zinc oxide-eugenol (ZOE) paste.
sary to prevent distortion of the carefully added PPS wax. 3. Remove the impression from the mouth.
A procedure for establishing the PPS during the final 4. Mark the anterior and posterior vibrating lines in
impression stage is described, which climinates the dis- the mouth with an indelible marling stick? 1
advantages of the fluid wax technique. 5. Reinsert the maxillary impression in the mouth and
transfer the location of vibrating lines to the ZOE
PROCEDURE
impression (Fig. 1). (If a minimal, unilateral tissue
1. Before the border molding procedure, trim and ad- undercut exists, the ZOE impression can generally
just the posterior border of the custom tray 1 to 2 be reinserted. In situations with bilateral or severe
mm distal to the vibrating line. undercuts, surgical correction may be required. If an
2. Complete the border molding and make a final ira- elastic impression material has been used because of
severe undercuts, then this procedure cannot be used.)
aAssistant Professor,Departmentof Prosthodontics. 6. Redefine the transfer marldng on the impression and

324 THE JOURNAL OF PROSTHETIC DENTISTRY VOLUME 78 NUMBER 3

ANSARI THE JOURNAL OF PROSTHETIC DENTISTRY

carefully make criss-cross grooves with a hot instru-

ment within the pencil outline (Fig. 2). This will
provide anchorage to the modeling compound to
be used in the next step.
7. Soften green stick modeling compound (Kerr Mfg.
Co., Romulus, Mich.) over a flame, taper near the
tip, and place within the outline of the PPS area.
Alternatively use modeling compound heated in a
plastic disposable syringe (Surgident Disposal dis-
posable syringes, Columbus Dental, St. Louis, Mo.)
to place the compound precisely as previously de-
scribed (Fig. 3). 12,13
8. Chill the compound after placing precisely within
the pencil outline. Resoften the modeling compound
with pinpoint flame or a Hanau alcohol torch. Fig. 3. Heated impression compound in pJastic disposable
Quickly temper the compound in a water bath and syringe is expressed directly onto outlined PPS.
carry the impression in the patient's mouth and hold
it in place under gentle pressure.
9. For better control of pressure, place the wet im-
pression in the mouth and slowly press in the
midplate region until it is firmly seated; observe the
posterior border of the impression for escaping air
bubbles beneath the distal border. Add the green
stick modeling compound gradually until there is
no leakage. (The patient should not wide open the
mouth during the procedure, which may cause un-
der post damming.)
10. Check the effect of PPS by upward pressure on the
anterior region of the impression tray. An easy break
of the seal indicates that further compression of tis-
sue is required until an effective seal is attained. Ex-
cess modeling compound that flows anterior to the
Fig. 4. Boxed final impression, after completing posterior pala-
anterior vibrating line must bc carefully removed
tal seal, ready for pouring cast.
with a sharp scalpel.
11. Remove the impression from the mouth; bead, box,
and form in stone (Fig. 4). Modeling compound has been successfully used fbr
12. PPS will be incorporated in the master cast, which adding PPS to an existing complete denture 14when it is
allows the record base to be constructed that accu- deficient at the insertion stage. The method presented
rately represents the finished denture base. here uses modeling compound at the final impression
appointment, which is bonded mechanically with criss-
DISCUSSION cross grooves made on ZOE final impression. It does
Arbitrary scraping of the master cast is the most com- not require special care when beading and boxing, as
monly used procedure for the PPS. It is an empirical needed with the fluid wax technique. Because the addi-
technique; therefore the effectiveness of the posterior tion of the PPS is performed in the patient's mouth, it is
seal of the maxillary denture is confirmed only at the unlikely that there would be over- or underextension of
insertion appointment. Placing the PPS after the den- the post dam, which is common with arbitrary scribing
ture has been processed has the following disadvantages: of the master cast. 1°
(1) IfPPS is reestablished with autopolymerizing acrylic
SUMMARY
resin, then the patient may complain of a "patch job"
on his or her new dentures when and if the resin discol- A procedure has been presented to establish the pos-
ors. (2) If the denture is relined or rebased, there is a terior palatal seal at the final impression stage, which is
chance that occlusion and esthetics may be adversely af- easy and simple to perform with materials available in a
fected. Establishing the PPS at final impression stage general dental practice. It is considered to be more ac-
confirms the effectiveness of the posterior palatal seal curate than arbitrarily scribing the cast PPS and allows
and allows the dentist to control its location and the the dentist to control location and degree of tissue dis-
amount of tissue displacement. placement.

SEPTEMBER 1997 325

THE JOURNAL OF PROSTHETIC DENTISTRY ANSARI

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The use o f adhesive metal-ceramic restorations as an

Noteworthy Abstracts alternative to conventional crown and bridge materials
of the Bishop K, Priestly D, Deans R, Joshi R. Br DentJ
Current Literature 1997"182:101-6.

Purpose. This article describes the use of a new adhesive metal-ceramic (AMC) restoration as an
alternative to traditional porcelain fused to metal (PFM) restorations and purely all ceramic dentin
bonded restorations. This article also describes the clinical and laboratory steps in the construction
of this "hybrid crown."
Clinical Reports. The restoration of individuals with anterior and posterior restorations that use
a combination of ceramic and PFM technology were described. The AMC restoration retains the
esthetic and physical properties of the traditional dentin-bonded crown with minimizing the risk
o f damage to the opposing dentition by using a metal occlusal or lingual surface. This fact to-
gether with the need to have a more conservative tooth preparation and also allow the dentist to
control the occlusal or lingual occluding anatomy suggests that this technique may be a viable
alternative to a traditional PFM restoration. The authors describe the fabrication of fixed restora-
tions, which use both the lost wax and refractory die techniques in the fabrication of the AMC
restoration. Preparation for the AMC restoration is an conservative as dentin bonded restoration
and less destructive than its PFM equivalent. The major difference in the preparation o f an AMC
restoration is that a groove is prepared at the potential junction of porcelain and metal. This
groove aids retention and location of the metal to the refractory die during fabrication.
Conclusions. The authors conclude from their clinical studies that the AMC restoration offers a
viable alternative to the traditional PFM and dentin-bonded crown while retaining many of the
advantages of these restorations. However, until further in vitro and in vivo testing is done on
these restorations, they should be used with caution. 6 references. - - R P Renner

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