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Primary impression

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 Research Title

Primary impression

Prof : Eman abd elsalam mohamed shakal

1- Mohamed esam elden abdalaziz 201700531

2- Shenouda makram Samir zaki 201704668
3- Ahmed Mohamed Ibrahim Soliman 201702482
4- Omar yahya ismail Mahfouz 201704140
5- Abdelrahman Ahmed gonam 201704966

Course Code: DEP4101

Course name: Clinic of removable 1

Fall 2020
List of Contents

Page no.
List of Abbreviations II
List of Figures II
Abstract Keywords 1
Review of Literature 2
Introduction 2
Body of the research: 3
Primary impression 2
Impression materials 4
TECHNIQUES OF USING PRIMARY IMPRESSION 10
Impression procedures
14

Conclusion 18
References 19

List of Figures
Page no.
Fig. 1 Special Tray 3
Fig. 2 Metallic stock tray 4
Fig. 3 Non - metallic stock tray 4
Fig. 4 Impression compound 7
Fig. 5 Zinc oxaide eugenole 7
Fig. 6 Primary impression by impression compound 11
Fig.7 Alveolar process and palatale process 16
Fig. 8 Maxillary tubrosity 17

II
Abstract:
Complete denture is the most important prosthetic appliance that used in dentistry; so many
old people tend to make a complete denture after loss of their teeth. To compensate the
function of teeth as speech, esthetic, mastication and to appear younger by restore their
original appearance. The complete denture is made by a lot of steps alternating between the
clinical steps and laboratory steps. After external and internal examination, and taking
complete history of the patient, the dentists make primary impression, which is a critical step
in fabrication of complete denture. It's a negative imprint of hard tissue "teeth" and soft tissue
in the mouth. Primary impression is taken by specific procedure with specific materials such
as alginate or compound and it must be accurate and record all the details of the tissue as it is
poured for production a study cast, then making special tray to take the final impression. Our
method for making impressions should be based on the basic principles of maximum area
coverage and intimate contact to achieve the objectives of retention, support, stability,
esthetics, preservation of the remaining residual alveolar ridges and supporting structure . Any
denture has 3 surfaces (polished-fitting-occlusal), so success of denture depends on the
accuracy of production of the 3 surfaces. We need to cover maximum area of denture bearing
area and use muscle for fixation not dislodgment and every possible factor for success of
denture and that depend mainly on impression. M.M. Devan" Ideal impression must be in the
mind of the dentist before it is in his hand. He must literally make the impression rather than
take it". A single impression material or technique can't be applied to all patients it depends on
the clinical situation, materials availability, clinician knowledge and experience. Hence it is
obligatory for the dentist to update himself with all the theories and techniques of impression
making as well as types of impression materials. The aim of this work is to discuss and
highlight the definition of dental impression in general then the definition of primary
impressing, also clarify the basic requirement of making impression and the steps of it, the
basic requirement of the tray used and how to select then the types of impression materials
that can be used and how to control nausea and vomiting during impression making

Keywords:

Complete denture, stock tray, special tray,alginate, impression compound

Review of Literature:
In this research, we discuss the the important of primary impression, classifications,
procedures of primary impression, clinical behavior and uses of different types impression
materials
We depend on our research mainly on:
1. Zarb GA, Carlsson GE. Boucher’s prosthodontic treatment for edentulous patients (10th
ed). BI Publication Pvt Ltd. New Delhi 1997;224-42.
1
2. Boucher CO. A critical analysis of mid-century impression technique for full dentures. J
Prosthet Dent 1951;1:472-91.

3. Sarandha DL. Textbook of complete denture prosthodontics. JAYPEE BROTHERS

PUBLISHERS; 2008

Introduction: to Complete Denture Construction

dentures, or fake tooth, are consistent or removable replacements for enamel. tooth
opportunity will become necessary even as the tooth and its roots had been irreparably broken,
and the enamel has been lost or have to be removed. Dentists have long seemed that a missing
eternal enamel need to normally be replaced otherwise the teeth on both side of the space
progressively tilt towards the distance, and the teeth within the contrary jaw start to circulate
toward the distance.

there are numerous general forms of teeth alternative in cutting-edge dentistry. A whole
denture is made to repair both the enamel and the underlying bone while all the enamel are
lacking in an arch. A smaller version is the steady partial denture, additionally called a tough
and rapid bridge, which can be used if commonly healthful tooth are present adjoining to the
space wherein the teeth or tooth were misplaced. The partial is anchored to the surrounding
tooth via attachment to crowns, or caps, which may be affixed to the healthful enamel. A
removable partial denture is used to update more than one missing enamel whilst there are
insufficient herbal teeth to help a hard and rapid bridge. This tool rests at the gentle tissues of
the jaws, and is held in vicinity with metal clasps or allows. Dental implants are the modern-
day tooth-alternative generation. They allow prosthetic tooth to be implanted right now in the
bones of the jaw

Body of the research:

• The purpose of use primary impression is making a preliminary cast which is used for
diagnosis and/or fabrication of a secondary (individualized or custom) impression tray.

• Impression tray: it is a device used to carry, confine and control the impression material from
mouth of the patient while an impression is making. During impression making, the tray make
insertion and removal of impression material from the mouth of patient more easy and
comfortable.

• Parts of the impression tray :-

The Impression tray is consists of two main parts :-

1- Body: the body of tray is consist of : floor and flanges.

2- Handle: The handle is defined as the extension from the union of the
floor and labial flange in the middle region or midline, it's (L) in
shape so that it won't interfere with lip during procedure of
impression.

2
* There are upper tray to make impression for maxillary arch and lower tray to make
impression for mandibular arch.

* The difference between upper and lower tray is that in the lower tray, there is " the lingual
flanges " and in the upper tray, there is palatal portion we called " vault ".

• Types of trays :-
- There are two main types :-

1- Stock trays: These are used for procedure of primary impression

2- Special trays or individual trays: These are used for procedure of final impression

• Stock trays: Impression trays render to carry the impression material to the mouth and while
it hardening, it support it in the correct position. This type of the trays can be used for several
or many patients and used for primary impression [Link] are made of different
materials such as stainless steel, aluminum, tin, plastic or brass, in variety of sizes and shapes
were made to fit different mouths.

• Types of stock trays :-

1- Stock tray which used for dentulous patient.

2- Stock tray which used for edentulous patient.

*We can differentiate between them by : stock trays for dentulous patient have long flanges,
flat and wide floor, while the other have short flanges, narrow and oval floor.

3
*Tray with combination flat and oval floor is suitable for
partial denture work.

• Stock trays can be classified according to impression

material in to two types :-

1- Perforated stock tray.

2- Perforated stock tray without rim lock.
3- Perforated stock tray with rim lock (rim lock stock tray).

✓ These types are used with alginate impression material.

1- Non - perforated stock tray.

2- Non - perforated stock tray without rim lock used with impression compound.
3- Non - perforated stock tray with rim lock ✓ These types are used with alginate impression
material.

• Factors effect in selection of stock tray :-

1- The type of impression material used in the primary impression procedure. As : with impression
compound we used non perforated tray because it will be stick on the tray. And if we use alginate
impression material we should use perforated stock tray.
2- Size of the arch.
3- Form of the arch. (Round, square and taper).
4- Most important point is that the stock tray must cover all the anatomical landmarks needed in
complete denture.
5- Stock tray should give a sufficient space to impression material in all direction (the stock tray
should leave sufficient space or room 4-5 mm for
impression material.

• Types of stock trays also :-

Metallic
it can be aluminum or stainless steel.

Non metallic :-

A- Plastic tray which can be sterilized.

B- Disposable plastic trays.

4
• Square used for dentulous patienwhile oval or rounded used for edentulous patient.

Perforated trays ( which used with alginate) and Non perforated or plain trays (which used
with impression compound).

• Sizes of tray : many sizes as small, medium, large and extra large.

• Adhesives & Perforations : it is essential that impression materials adhere firmly to the
impression trays. This can be achieved by either perforations or by the use of adhesives.
Adhesive solutions are needed forsilicones, alginates and polysulphides. The adhesives for
alginates are solutions of resins in alcohol, they are supplied in a bottle with a brush or an
aerosol spray. Tray adhesive being applied to a metal stock tray for an alginate impression.•
Types of trays :-

- Impression tray: It is device used to carry , confine and control an impression material while
an impression is made.

 Impression materials
Impression materials is a materials that Dimensionally Accurance to record fine details. It
depends on:

• Flow of material

• Dimensional stability during setting and after removal from the mouth

• Easy to be removed from the undercuts

• Adhere to tray

• Compatible with gypsum products(not affect setting of gypsum, not need separating
medium)

- Dimensional Stability to maintain the recorded fine details on storage

Classifications of impression materials

We can classify impression materials into:

- Rigid impressions used for edentulous patients or patients with no undercuts

- Elastic impression materials used for dentulous or partially dentulous with undercuts

5
Rigid (an-elastic) Elastic

impression plaster hydrocolloids rubbers(elastomers

impression compound reversible poly sulfide

(agar-agar)

zinc oxide and eugenol irreversible Silicones (condensation –

(alginate) additional)

1- PLASTER IMPRESSION (Β-CaSO4.1/2 H2O rather than α- CaSO4.1/2 H2O)

- Requires more W/P ratio so:

-increase flow and so more fine details will be recorded

- decrease the effect of exothermic heat evolved

Weaker than α: so it will break during removal from undercut without causing injury to the
patient, it fractured in clear-clean cut that can be easily reassembled

- Potato-starch: to obtain soluble plaster than can

be easily separated and removed from
cast(soaking impression on hot water makes starch
swells and distinguished from cast)

- The only impression needs Separating medium

will obliterate some of fine details obtained

- K2SO4 anti-expansion agent, counteract action

of borax( accelerator for gypsum).

6
2- IMPRESSION COMPOUND

It is a thermoplastic resin, so we must take care of:

-Not to heat over 60 C or by using dry heat: to avoid

evaporation of some important ingredients , this will
affect properties of compound)

-Not to be kneaded in the water bath: water may be

incorporated in the material and acts as a plasticizer
that increases flow increase amount of distortion
during removal from mouth

-Dimensionally inaccurate and instable during

setting : we can re-soften the surface of the set
impression and re-insert it in the patient mouth

-Can be electroplated by copper( not by silver as electrolyte will be silver cyanide which
causes softening and distortion of compound)

3- ZINC OXIDE AND EUGENOL IMPRESSION

- 2pastes

- Moisture is essential in composition:since dehydrated

zinc oxide cannot react with eugenol

ZnO+Eugenol No reaction

ZnO+ H2O Zn(OH)2

Zn(OH)2+Eugenol Zinc eugenolate matrix holding non

reacted ZnO particles

Reaction can be accelerated by Heat (warm glass slab)

b) Addition of one drop of alcohol

c) Presence of moisture or humidity

Reaction can be retarded by: one drop of glycerin

Disadvantages:

a) Eugenol is irritant

7
b) It adheres to tissues, so patients' lips and cheeks should be painted with Vaseline before
making the impression

 HYDROCOLLOIDS
It is dimensionally instable also it has a Synersis and imbibition proparities

Synersis is a loss of water that leads to shrinkage

Imbibitions is the uptake of water that leads to expansion

▪ Relaxation of internal stresses due to pressure on the tray

▪ Thermal changes of impression matrials

Agar: undergoes expansion (circulating water 13 C room temperasture 23 C)

Alginate: undergoes shrinkage (mouth temperature 37 C room temperature 23 C)

Should be poured immediately( 10 min) to avoid synersis and imbibitions, 100% humidity, To
avoid that , they may be protected in 100% relative humidity, this can be obtained by:

- Store it in humidor , 2% K2SO4, wet towel or a napkin for disinfection it shouldn’t be

soaked on disinfectant agent to avoid imbibitions

-Disinfectant is sprayed on the surface or wrap it in a disinfectant soaked paper towel. This has
2 benefits:

▪ disinfection

Incompatible with gypsum;

▪ Gypsum cast obtained from hydrocolloids may be too soft for waxing procedures( difficult to
do wax pattern on it) .this may be due to:

a) presence of water on surface of hydrocolloid that affects setting and surface properties

b) chemical composition of some hydrocolloids(borax in agar) which retard setting of gypsum

▪ Not to leave impression in contact for long time with cast; as set stone will absorb water
from hydrocolloid and results in chalky surface with poor details

▪ This disadvantage can be overcome by:

a) Immersion of impression in solution containing gypsum accelerator

8
b) Incorporation of plaster hardener or accelerator in the composition of hydrocolloids by the
manufacturer

Any movement during taking the impression:

AGAR; as reaction is physical, so layer in contact with tray sets first, and that near to tissues
still soft, so no problem in movement as layers near tissues will flow and compensate for any
inaccuracies

▪ ALGINATE: it is important to avoid any movements; as reaction is chemical so material in

contact with tissues will set first. Any pressure on tray will set up stresses in the gel that leads
to distortion of alginate after its removal from mouth( any movement remake the impression)

For agar-agar; circulating water shouldn’t be less than 13 C: to avoid thermal stresses within
the material which may release later and leads to distortion

ELASTIC IMPRESSION MATERIALS

1- Hydrophilic impression

advantageous:

▪ Easily wet oral soft tissues so record all fine details.

▪ Can be easily wetted by soft model and die materials

▪ But its disadvantage : as it can't be electroplated

Flexibility which is the ability of impression to be removed from the mouth

- Most flexible impression material in all elastics is alginate

- Most flexible rubber impression material is polysulfide

- Most stiff impression material is polyether

(Ability to return to its original dimensions after removal from mouth)

Most elastic impression material is silicone(add-cond.)

Least elastic is alginate

All elastic impression materials should be removed by sharp snap removal: To obtain the
highest tear strength decrease the permanent deformation

9
Polysulfide has the highest tear strength in all rubbers

All rubbers can be electroplated except polyether as its hydrophilic

Polysulfide, condensation silicone: condensation polymerization reaction(associated with by-

product that affect impression accuracy)

Additional silicone, polyether: additional polymerization reaction)

Thickness of rubbers (2-3 mm) less than thickness of hydrocolloids(4-6mm) as the later has
lower tear strength

Hydrocolloids should be poured immediately(10 min) while rubbers within 1 hour(to allow for
anelastic recovery and obtain the best details)

Additional silicone
▪ Least polymerization shrinkage 0.05% , Tear strength is low in comparison to polyether and
polysulfide

▪ Gas absorber should be added: as some types of additional silicone release hydrogen during
setting, this will affect accuracy of impression

▪ Surfactant may be added: as its hydrophobic so surfactant will improve wettability of vinyl
type that:

*allows impression to wet soft tissues

* improve quality of cast and dies obtained from it

▪ Latex gloves shouldn’t be used with it: as this type of gloves will contaminate impression
with sulfur which inhibits the setting of the additional silicon

 TECHNIQUES OF USING PRIMARY IMPRESSION

1- Closed Mouth Technique :-

In this technique the supporting tissues recorded in functional relationship.

The movements of all related tissues

were within functional movements which is normal such as : swallowing , talking , sucking.

Through occlusion rim, pressure similar to that of mastication was developed . This according
to Stanley P freeman-amount of tissue compreassion is like that in function.

10
2- Selective Pressure Technique :-

The tendency of overexertion or underextension

regard as the disadvantage of closed mouth
technique.

Rebound of denture may occur because of

release of pressure of occlusion.

It is contraindicated to be use if considerable

amount of movable tissue is present. Because it
make the operator seeing whether the border
molding is done properly, the open mouth
technique is preferred. Routinely, the functional
manipulation can not be used. Not all patients
can actually move the materials of impression as needed.

3- Posterior Palatal Seal :-

Lieberthal and Greene had developing the concept of posterior palatal seal for the first time.
References were developed for movement of mandible and tissues during impression making.
Wilson and Fish advocate that the border molding was done against the direction of muscle
fibers.

Manipulation in border molding in the direction of its fibers advocated by Swenson et al.
During this time, that the concept of esthetics in impression making was introduced.

4- Mucocompressive Technique :-

Greene brothers was initiate the mucocompressive technique. They introduced a modeling
plastic, a method for manipulating it and a technique that is said to have been the first to
utilize the entire denture bearing area for denture retention. They were the first to teach the
technique of the closed mouth all modeling plastic. Attain better retention of the dentures is
the main objective of this technique. The technique by Greene brothers was as follows:
Making preliminary impression in impression compound and a custom tray was constructed
using base-plate with its periphery 1/8th inch shorter than the

denture outline. With this tray take another impression with compound. Making well fitting
rims with uniform occlusal surface and the height of the bite adjusted against a similar bite rim
on the mandibular ridge. Softening the areas to be relieved like median raphe on the
impression and were again inserted in the mouth and were held under biting pressure for 0.5
minutes. Softening of the peripheral margins of the impression and doing border molding by
asking the patient to give various cheek and

lip movements as in smiling and whistling.

11
5- Mucostatic Technique :

Harry L Page was introduce concept of mucostatics in 1938. Also Addison in 1944
considered interfacial surface tension as one of main retention factors and mentioned the same
principle of making impressions of passive state of displaceable tissue. With new materials
like waxes, elastomers, zinc oxide eugenol, individual tray construction was emphasized.
Minimal pressure technique is based on mucostatic principle. As Harry L Page in 1946 stated
that 80% or more of tissues are composed of water and all soft tissues were chiefly fluid. Any
pressure applied to a confined fluid is transmitted undiminished and equally in all directions (
Pascal's law ). Page contended that since the soft tissues are confined under a denture, any
pressure applied will be transmitted in all directions. The advocates of this principle
considered interfacial surface tension as the only important retentive mechanism in complete
dentures. Therefore, they did not resist vertical displacement, which was the only movement
capable of interrupting surface tension. However, a short lingual flange recommended by
Dykins to resist lateral displacement. The impression material had to record without distortion
according to the principle of mucostatics , every detail of the mucosa so that a completed
denture would fit all minute elevations and depressions. On recording details, so much
emphasis was placed that separating substances could not be used at any point in the
procedure. Mucostatics further
demanded a metal base. One of the most accurate metals which is gold was by passed in favor
of chrome alloy which aren't considered to be quite so accurate as gold. Page’s claim that
retention is a function of surface tension alone is also objectionable because this tensile force
itself is dependent upon adhesion and cohesion. Distortion of cast occur because of the
elimination of use of separating media. Also failure of accurate detail reproduction occur due
to The use of cobalt, chrome as denture bases. The mucostatic principle disregard the value of
dissipating masticatory forces over as largest possible basal seat area. Fish describe the
retentive role of the musculature as described in 1948 is minimized by mucostatic denture. It i
high regard for health and preservation of tissue

due to the merit of this technique.

6- Selective Pressure Theory :-

Boucher advocate it in 1950 it combines the principles of bothminimal pressure and pressure
techniques. Certain areas of the maxilla and mandible are by nature better adapted for
withstanding extraloads from the forces of mastication ( It is the philosophy of the selective
pressure technique ). Under slight placement of pressure these tissues are recorded while other
tissues are recorded at rest or relieved with minimal pressure in a position that will display
maximum coverage with the least possible interference with the health of surrounding tissues.
Here, equilibrium between the resilient and the non resilient tissues occur. Primary stress
bearing areas of maxilla are crest of alveolar ridge and the horizontal plate of palatine bone
and in the mandible it is the buccal shelf area.

Secondary stress bearing areas of the maxillary foundation are rugae area and the slopes of the
ridge in the mandibular foundation. Incisive papilla, midpalatine suture, tori in the maxilla and
12
crest of mandibular residual ridge are areas requiring minimum pressure. In the maxilla, the
tissue underlying the region of posterior palatal seal has glandular and soft tissue between the
mucous membrane lining and the periosteum covering the bone. This tissue can be more
readily displaced for the

maintenance of peripheral seal of the maxillary denture.

7- The Mucoseal Technique :-

Pryor start it in 1948 which was ragarded as a

variation from the mucostatic technique. The floor of the mouth molding anterior lingual
border with the tongue in repose. The tray is extended horizontally backward, over the
sublingual glands toward the tongue to affect a border seal. Thus, this technique utilizes the
benefit of minimal pressure and also provides
maximum extension of denture borders and maximum coverage of denture bearing area. On
the concept
of mucostatics, subatmospheric pressure technique is based on. This
technique is developed by Milo V Kubalik and Bert C Buffington, the objective of which was
to reduce the stress on any given tissue by increasing load bearing area. The form of the tissue
is recorded laterally and vertically, when
a controlled partial vacuum is established in impression tray specially built for the patient. It is
maintained in the mouth
without direct mechanical support of any kind. The
difference between the subatmospheric pressure inside the
tray and the atmospheric pressure outside the tray is all that
is needed to center the tray over the ridges in a static position. Between the soft tissues and the
tray a vacuum is developed. A recording material in a fluid state flows from the border region
into the evacuated space and develops the
basal tissues. By the readings
remaining constant, border seal is [Link] of Impression Technique

epending on the pressure exerted on the tissues during the registration of the impression, the
theories of impression techniques can be classified into:

• Mucocompressive theory.

• Mucostatic theory/minimal pressure theory.

• Mucoselective theory/controlled pressure theory.

13
 Requirements of an Impression
It should be as complete as possible. i.e. it should include the entire denture bearing area.
It should be closely contacting the tissues. In other words, it should reproduce the tissues
without any distortion

The periphery of the impression should closely contact the resilient tissues in the vestibule.

It should not displace the tissues.

There should not be gross surface defects in the impression such as tray exposure, fold and air
voids.

 IMPRESSION PROCEDURE

PRACTICAL GUIDE TO CLINICAL

- The patient should be seated in an upright and relaxed position in the dental chair.

- The jaw should be at the level of the operator’s elbow for the upper impression and at
the level of the operator shoulder for the lower impression

- Hands should be washed in the view of the patient even though it may be washed
previously. The operator should occupy right side back of the patient for maxillary
impression and right front of the patient for mandibular impression

- Selection of tray should be done from the stock trays, which are sterilized.

- Rotatory movement should be used while inserting the tray in the patient’s mouth.

- A tray with clearance of about 6-8mm between the tray and the tissues all round

14
 should be selected.
- The tray should also cover the entire denture-bearing area.
- The distobuccal area in the upper and the distolingual region in the lower should be
observed carefully since they constitute stability potential in treatment consideration.
- IMPRESSION TECHNIQUE FOR PATIENTS WITH COMPROMISED
CONDITION

Impression Technique for Resorbed Ridges

- Impression Technique by Zafarulla Khan
- A window was cut in the custom tray in
relation to the unsupported flabby tissue.
The unsupported area was recorded with
elastic impression material
- Impression Technique by Hobrick
- Border molding was done in the usual
manner and impression was made with
heavy- bodied addition silicone material.
The area of moveable tissue was cut out and
relief holes were made. Impression was
- made with light-bodied impression material
Impression technique for anterior flabby
tissue (A) Flabby tissue in maxillary anterior region (B) Primary impression in alginate
(C) Diagnostic cast (D) Beaded final impression (E) Master cast

- Impression Technique by John D Walter

- The healthy denture-bearing tissue was recorded with zinc oxide eugenol impression
material and the displaceable tissue was recorded with impression plaster.
- Impression Technique by Allan Mack
- A loosely fitting tray was made with heavy relief over the flabby area
- Impression plaster was mixed and applied over the flabby area to a thickness of about
3 mm and was allowed to set
- The tray was loaded with 2nd mix of plaster and the impression was made, with the
initial coating of flabby areas thus acting as a splint during the impression procedure.
 Impression Technique for Restricted Opening to the Mouth
- Walter described a technique with the use of sectional stock trays. Impression of each
side of the jaw was made one at a time and the cast was poured by joining the
impressions in the sectional trays
 Impression Technique for Severely Resorbed Foundation

15
 - Care should be taken to obtain maximum extension in the distolingual sulcus within
physiologic limits in highly resorbed alveolar ridges.
- The impression should involve the entire basal bone including the genial tubercles.

Complete denture for edantulous patient meaning more than the complete denture so should
have its own criteria such as retention, stability, support, esthetic, preservation and remaining
structure.
Which the retention or what it mean the resistant to get away from the underlying structure
which can be affected physically, physiologically, michanically.
Which the physical factor that affected the retention of complete denture varies from adhesion,
cohession, capillary attraction, surface tention, viscosity of the fluid and saliva, atmospheric
pressure, other external forces that applied by oro-facial muscles.
Which the inter facial surface tention determind by the layer of saliva located between denture
base and the underlying supporting structure which has the great response in the retention of
the maxillary denture base making the denture at the
maximum contact to the underlying structure which it
considered as the main proplem for the patient with
xerostomia due to decrease what it called inter facial
surface tention.
Leaking the anatomical land Mark making the
posterior palatal seal has the effective Importanse in
the denture retention and also the hight of the alveolar
bone affected the stability and retention.

Supporting :is considered the resistanse the virtical

movement toward the tissue. Which may be initial
support or long term support which the impression
procedure & loading of the supporting tissue is
considered the types that known as the initial support.
The direction of the occlusal forces against the resistant tissue it known as long term support
the Importanse of the criteria of the support conclude in: - making the denture has cushion
effect.
- keep it in the medium thickness.

The supporting area is different from the maxilla to the mandible :

Which the maxillary arch had hard palate, maxillary tuberosity that what thay know the
primary stress bearing area.
The residual alveolar ridge, rugea that what thay know secondary stress bearing area.

16
The hard palate: is considered as one of the primary
stress bearing area has the greatest Importanse for the
support of the upper denture.

Maxillary tuberosity: one of the primary stress

bearing area for the maxillary arch that REQUIRED
for the supporting where ever the large tuberosity
may provide difficultis in the inter ridge distanse also
may provide the large opposing undercuts.

Also what it know the fiberous tuberousity must be

redused surgically.
The residual alveolar ridge is considered one of the
primary stress bearing area provide the support for the
maxillary denture arch as we mentioned before.
Raugae: raised dense conective tissue area radiated
from midline raphae In the anterior one thired of the
palate which has the greatest response for the
resistanse of the anterior displasement of the denture.

The mandibular arch had the buccal shilf of bone,

retro-molar pad which considered the primary stress
bearing area of the mandibular arch.
The recidual alveolar ridge of the mandible is
considered what we know the secondary stress bearing
area of the mandibular arch.
Buccal shilf of bone: one of the primary stress bearing
area that affect the support of the mandibular arch
which extend between the external oblique ridge (as
the external border), residual ridge (as the internal
border) , buccal frenum (as the anterior border) , retro-
molar pad (as the posterior border) which it formed
from High quality trabiculation.

Retro-molar pad: one of the primary stress bearing area that provide support for the
mandibular dental arch considered as the mass of the soft structure, pear in it's shape,
contaning the mucous glands, ptregomandibular raphae, muscle of the superior constrictor,
buccinator, temporal tendon.
Resedual ridge: which considered the highly keratinized attached gingiva with the squar arch
with abscence of the under cut, well defined hamulous notch is considered the faverable
criteria for the maxillary alveolar ridge.
Well defined retro-molar pad, blunt of the myelohyoid ridge, level of the attachment of frenum
is low is considered the faverable criteria of the mandibular arch.
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Sharp, spongy, irrigular ridge, tourous palatinous &
tourous mandiblaris, severe resorption, mental foramen
in the mast common proplem for the alveolar ridge.

Attwood ordered the mandibulr anterior ridge into: -

preextraction (order 1)
- post extraction (order 2)
-high, well round (order 3)
-knife edge (order 4)
-low,well round (order 5)
-depression (order 6)

 Conclusion:

- Taking impressions may be one of the responsibilities of the dental hygienist in a busy practice
based on the specific condition, dentist needs to select material and technique of
- impression for success of complete denture therapy. There were significant difference toward
specific materials or techniques which revealed different clinical preference in construction of
- conventional complete denture. This study shows the dominance of use of irreversible
hydrocolloid (alginate) in primary impression making, which coincide with normal practices
- all over the world and shows than the compound impression is the best choice as a primary
impression in residual ridge less than 4 mm and for patients with gag reflex. It also shows
- how to minimize gagging [Link] is important that the primary impression must be as accurate
as possible, because the greater the faults in this impression, the more timeconsuming and
difficult will be the modifications of the custom trays required at the final impression stage.

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