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Immediate Complete Denture Impressions Case Report and Modern Clinical Technique Authored by Joseph J. Massad, DDS and David R. Cagna, DMD, MS

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Recommendations for Fluoride Varnish Use in Caries Management INTRODUCTION

Immediate Complete Denture Impressions

For patients confronted with the extraction of their remaining natural teeth and the need for complete prosthodontic rehabilitation, the transition is generally psychologically challenging for the pa-tient and demanding of the clinician. This dramatic treatment is often necessitated by generalized caries, extensive periodontal disease, or a malocclusion that is not amenable to treatment. Of considerable significance to many patients facing this course of treatment is their desire to specifically improve the appearance of their anterior teeth, contributing to an attractive smile. In order to optimize immediate denture therapy, thoughtful consideration must be given to the treatment planning, definitive impression making, and denture tooth set-up phases of therapy. The primary advantage of an immediate denture is the absence of an edentulous period where prosthetic tooth replacement is not available. Specifically, advantages of immediate complete dentures include the maintenance or improvement of: 1. dental aesthetics, 2. perioral and facial tissue support, 3. masticatory function, and 4. phonetic ability. If the patient’s natural anterior teeth remain but are scheduled for extraction, the selection and arrangement of anterior denture teeth, from an aesthetic perspective, may be easier. From the patient’s viewpoint, immediate complete dentures provide the psycho-social advantage of continuous tooth display to allow personal and public interactions. Though abrupt, the transition from the dentulous state to edentulism may be made less difficult by incorporating immediate complete dentures in the treatment plan. Major disadvantages of immediate denture therapy relate to the technical difficulties associated with denture fabrication. Because immediate complete dentures are constructed prior to extraction of the remaining teeth, 4 significant challenges arise: 1. the making of anatomically and physiologically accurate definitive impressions in the presence of remaining teeth and associated soft and hard tissue undercuts is often difficult and occasionally impossible, 2. if the residual teeth are mobile, recording accurate interocclusal jaw registrations may be difficult, 3. creating edentulous contours on dentate master casts utilizing clinically valid and reliable estimation techniques is often associated with unavoidable errors, and 4. the

Case Report and Modern Clinical Technique LEARNING OBJECTIVES: After reading this article, the individual will learn: • •

historic techniques for taking impressions for immediate complete dentures, and a new technique for taking accurate impressions for immediate complete dentures.

ABOUT THE AUTHOR Dr. Massad is director of removable prosthodontics at the The Scottsdale Center for Dentistry in Scottsdale, Ariz. He is an associate faculty member of Tufts University School of Dental Medicine in Boston, and is an adjunct associate faculty member of the Department of Prosthodontics at the University of Texas Health Science Center Dental School in San Antonio, Tex. He can be reached at (918) 749-5600 or [email protected]. Disclosure: Dr. Massad is the developer and holds the patent for the Strong-Massad Dentate & Implant Trays. Dr. Cagna is a professor and director of the Department of Restorative Dentistry, Advanced Prosthodontic Program, at the University of Tennessee Health Science Center College of Dentistry in Memphis, Tenn. He may be contacted via e-mail at the address dcagna@ utmem.edu. Disclosure: Dr. Cagna is a stockholder in Global Dental Impression Trays, which is the company that manufactures the impression trays used in this article. 1

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Immediate Complete Denture Impressions: Case Report and Modern Clinical Technique inability to accomplish a full wax try-in of the proposed denture tooth arrangement makes the aesthetic outcome unpredictable. It is due to these technical difficulties that immediate complete dentures are often considered “interim” prostheses requiring replacement upon healing of the edentulous ridges. Optimal retention, support, and stability for removable prosthodontic restorations are important factors in treatment success and patient comfort. When considering im-mediate complete dentures, certain clinical conditions often prohibit achieving ideal retention, support, and stability in the planned prostheses. As mentioned, the presence of residual natural teeth and associated unfavorable osseous and soft tissue contours require that the clinician: 1. modify existing techniques to generate physiologically and anatomically accurate impressions and master casts, 2. evaluate existing den-tate or partially edentulous clinical conditions and predict expected edentulous ridge contours following tooth extractions, 3. develop these edentulous contours on the master casts, and finally 4. construct the immediate complete dentures. Although techniques have been developed to fabricate immediate complete dentures, significant obstacles are frequently encountered. The development of diastemata secondary to advanced periodontal disease may complicate impression procedures. Varying degrees of periodontal involvement of the residual dentition will result in an irregular contour of the edentulous alveolar ridges. Irregular osseous contours that protrude into the vestibular sulcus interfere with an accurate impression in this area, ultimately affecting the development of a peripheral seal in the final prostheses. The accurate, physiologic replication of vestibular anatomy (including frenum attachments, the postpalatal zone, and the retromylohyoid space) is important to the development of peripheral denture seal and denture retention. When physiologic vestibular anatomy is represented accurately in the immediate denture flange contours, the denture may function effectively as suction is achieved. Under such conditions and in the presence of appropriate volume of saliva, optimal consistency of the saliva, accurate fit, and a favorable occlusal scheme, satisfactory denture retention is possible.

It is not uncommon to encounter problems with denture retention on the day of immediate denture insertion. As mentioned, this problem can often be traced back to inaccurate adaptation of the denture flanges to the physiologic limits of the vestibular sulci. Horizontal and/or vertical overextension of vestibular anatomy during impression making, as is common when using inappropriately contoured stock impression trays and irreversible hydrocolloid im-pression materials, does not allow physiologically accurate impressions. The result will be overextension of the immediate denture flange. Ultimately, extensive adjustments are necessary on the day of denture placement and during the post-operative adjustment period. Although challenging in many ways, anatomic and functionally accurate impressions are critical to successful immediate denture therapy. A predictable immediate denture impression technique adaptable to a wide variety of dentate and partially edentulous conditions is available. The following case report discusses historical immediate denture impression techniques, and concerns in regard to the utility of the resultant casts. Also presented are step-by-step procedures for making immediate denture impressions using a new impression tray design and modern impression materials.

CASE REPORT A 44-year-old white female presented on referral from her general dentist for evaluation and treatment of a severely compromised dentition. The patient was a professional makeup artist and expressed concern regarding the aesthetics of her smile and the appearance of her teeth during close, personal, daily interactions with her clients. The patient also reported that she smokes cigarettes (one half pack per day). This habit began 15 years ago. Intraoral examination revealed multiple missing teeth, substantial accumulation of dental plaque and calculus, many teeth with 6 to 9 mm probing depths, generalized bleeding on probing, generalized moderate to severe mobility, and severe fremitus involving most teeth (Figures 1 and 2). Following scaling and root planing, many of the teeth previously demonstrating moderate mobility now displayed severe mobility. 2

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Immediate Complete Denture Impressions: Case Report and Modern Clinical Technique 4. A sectional impression20,26-35 involving (a) a posterior section im-pression made in a border molded custom tray using an elastomeric impression material to capture edentulous posterior regions, associated vestibular areas, and the lingual aspects of the residual dentition, and (b) an anterior section impression, or facial matrix, made by placing a bulk of impression material in the labial vestibular space associated with the residual dentition and allowing it to set. Alternatively, the impression material may be carried to the mouth in a second sectional tray that is indexed to the primary tray. In either case, the anterior section impression will capture the facial anatomy of the teeth, the vestibular anatomy, and indices on the primary impression/tray. Upon removal of the anterior and posterior sections separately, the 2 sections are reassembled outside the mouth (using the indices) and prepared for casting. 5. The “Campagna” combination impression36-39 involving (a) a primary impression made in a border molded custom tray using an elastomeric impression material to capture the posterior edentulous regions and ALL vestibular areas, and (b) a secondary impression, or over-impression, made in a stock impression tray using irreversible hydrocolloid to capture only the residual dentition and pick-up the primary dentition.

Figure 1. The patient’s clinical appearance prior to immediate denture therapy.

Figure 2. The patient’s radiographic condition prior to immediate denture therapy.

The patient’s remaining teeth were not salvageable. Treatment options, duration, and prognosis, as well as cost, were reviewed with the patient. The patient elected full mouth extractions and placement of immediate maxillary and mandibular complete dentures.

IMMEDIATE DENTURE IMPRESSION TECHNIQUES

Because of the residual teeth, associated osseous undercuts, and the use of hydrocolloid impression materials, these impression techniques fail to register anatomically and physiologically accurate vestibular anatomy. With the development of a new impression tray system (StrongMassad Dentate & Implant Trays, Global Dental Impression Trays) and the use of vinyl polysiloxane many of the shortcomings associated with classic immediate denture impressions may be successfully avoided. The impression technique illustrated here employs vinyl polysiloxane (VPS) impression material to accomplish single ap-pointment definitive immediate denture impressions.

A number of different impression techniques have been described for use in the fabrication of immediate complete dentures. These techniques include: 1. An irreversible hydrocolloid im-pression made in a stock impression tray.1-5 2. An elastomeric impression made in a border molded custom impression tray.6-20 3. A combination or double impression21-25 involving (a) a primary impression made in a border molded custom tray using an elastomeric impression material to capture only edentulous regions and associated vestibular areas, and (b) a secondary impression made in a stock impression tray using irreversible hydrocolloid to capture the remaining teeth and associated vestibular areas. The secondary impression is made with the primary impression in place in the patient’s mouth.

THE MAXILARY IMPRESSION Tray Selection The first step is to determine the dimensions of the dental arch and select a stock impression tray of appropriate 3

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Immediate Complete Denture Impressions: Case Report and Modern Clinical Technique size (Figure 3). The im-pression trays illustrated here are constructed from a clear polystyrene-based polymer and permit see-through visibility to assist when selecting and fitting the tray (Figure 4). Retention slots perforate the trays to maximize mechanical retention of the material. PVS adhesive should NOT be used in the trays. Rather, it is preferred that the im-pression material is wiped clean from the tray in areas where the tray impinges on border and peripheral tissues. The elimination of im-pression material from tray borders indicates the need to selectively adjust the tray prior to making the definitive impression.

Figure 3. An impression tray (Strong-Massad Dentate & Implant Trays, Global Dental Impression Trays) is selected to fit the maxillary arch.

Figure 4. The clear polystyrene impression tray permits seethrough visibility for selecting and fitting the tray to the dental arch.

Tray Adaptation Customized tray adaptations can be made to accommodate existing anatomic contours. The trays illustrated here are thermoplastic. To effect subtle alteration of flange trajectory, pass the tray quickly through a laboratory flame until the resin begins to soften. Once softened, carefully manipulate the tray flange into the desired shape. Cool the tray in water. Border extensions of the tray may also be reduced by grinding with a conventional acrylic resin bur.

Figure 5. Impression tray stops are formed in the tray using high viscosity VPS impression material.

Tray Stops The impression procedure described here requires repetitive placement of the impression tray in the patient’s mouth. In order to achieve consistently accurate tray placements, tray stops are used. Using high viscosity VPS, dispense quarter-size mounds in the molar, incisor, and mid-palate areas of the tray (Figure 5). Seat the tray in the pa-tient’s mouth and center the tray over the residual teeth and ridge. Upon polymerization, remove the tray and inspect the stops to assure even thickness and that the teeth and ridge crest are centered within the tray. Trim the VPS with a sharp knife to eliminate all but the occlusal surface and incisal edge impressions and minimize any areas of soft tissue contact (Figure 5). Tray stops permit: 1. adequate and even space between the tray and residual tissues for impression material, 2. adequate and even space between the tray and vestibular reflections for impression material, and 3. consistently repeatable positioning during tray placement.

Figure 6. High viscosity VPS impression material is applied to the impression tray borders prior to border molding.

Border Molding For maxillary impressions, it is recommended that a high or medium viscosity VPS material be used for border molding. Dispense a rope of VPS material along the peripheral tray borders, including the postpalatal seal area (Figure 6). Place the tray in the patient’s mouth and seat the tray onto the maxilla using the tray stops as guides. Use the following tissue manipulations to define peripheral borders:

4

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Immediate Complete Denture Impressions: Case Report and Modern Clinical Technique •

To define the labial notch, grasp the filtrum close to the vermilion border and pull downward (Figure 7).

•

To form the labial vestibular borders, ask the patient to purse the lips using a sucking action (Figure 7).

•

To define the buccal notches and buccal vestibular borders, grasp the cheek with the forefinger and thumb at the corner of the mouth and pull downward and forward (Figure 7). Repeat this process on the opposite side.

•

To define the coronomaxillary vestibular border and hamular frenum area, ask the patient to open the mouth wide (Figure 8). This will cause the coronoid processes to translate through the coronomaxillary spaces, bringing associated muscles to their terminal positions. If the mandibular opening is restricted, instruct the patient to move the mandible from side to side.

•

Figure 7. The maxillary impression tray is placed in the patient’s mouth and border molding procedures are accomplished.

Figure 8. Additional border molding is accomplished for the maxillary impression tray.

To functionally form the posterior border of the tray, instruct the patient in Valsalva’s maneuver.40-42 Manually occlude the patient’s nostrils and ask the patient to attempt to forcibly exhale through the nose only (Figure 8). This causes the soft palate to move downward, forming the VPS along the postpalatal seal aspect of the impression tray.

Figure 9. Border adaptation of the maxillary impression tray is carefully inspected. All areas of VPS tissues contact are reduced by one to 2 mm using a bur or scalpel blade. The tray is then loaded with low viscosity VPS impression material in preparation for the final impression.

Following polymerization of the VPS, remove the impression tray and inspect all peripheral borders to assure that appropriate anatomic and functional detail is present. If the resin tray is apparent through the border molding material, adjust the tray by grinding. Finally, in preparation for the definitive impression, relieve one to 2 mm from all borders using a scalpel blade and/or rotary instrument (Figure 9).

Figure 10. Extra-low viscosity VPS impression material is injected around residual teeth and the impression tray is seated on the maxilla.

Definitive Impression Dispense low-viscosity VPS impression materials into the maxillary impression tray (Figure 9). Inject extra-lowviscosity VPS material around all residual teeth using manual syringes (Figure 10). Extra-low-viscosity VPS material possesses relatively low tear strength43, permitting easier recovery of the polymerized impression from the patient’s mouth without damaging periodontally involved teeth. The relatively low stiffness of low viscosity VPS also facilitates recovery of the definitive master cast from the impression without damage.

Following injection of low viscosity VPS around all teeth, place and center the impression tray on the maxilla (Figure 10) using the tray stops as guides. Repeat all border molding manipulations. Upon polymerization of the VPS, remove and inspect the impression for appropriate anatomic, functional, and surface details (Figure 11). Once satisfied with the quality of the definitive impression, bead, 5

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Immediate Complete Denture Impressions: Case Report and Modern Clinical Technique box, and cast the impression44 using a suitable vacuum mixed dental stone (Figure 11).

Figure 11. The definitive maxillary impression is carefully inspected. A master cast is then poured using an appropriate dental stone.

THE MANDIBULAR IMPRESSION Examine the dimensions of the mandibular dental arch and select a stock impression tray of appropriate size (Figure 12). Tray Adaptation Customized tray adaptations may be made to accommodate existing anatomic contours. As with the maxillary impression procedure previously described, subtle thermoplastic tray reshaping and selective removal of tray material using an acrylic bur may be accomplished until an acceptable fit is achieved.

Figure 12. An impression tray (Strong-Massad Dentate & Implant Trays, Global Dental Impression Trays) is selected to fit the mandibular dental arch. The clear polystyrene impression tray permits see-through visibility for selecting and fitting the tray to the dental arch.

Tray Stops Because the impression tray will be reseated in the patient’s mouth a number of times during the impression making, and accurate tray placement is essential, a system of tray stops must be developed early in the impression procedure. Using high-viscosity VPS, dispense a ribbon of material along the occlusal wall of the impression tray (Figure 13). Seat the tray in the patient’s mouth and center the tray over the residual teeth and ridge (Figure 13). Upon polymerization, remove the tray and inspect the stops to assure even thickness and that the teeth and ridge crest are centered within the tray. Trim the VPS with a sharp knife to eliminate all but the occlusal surface and incisal edge impressions (Figure 14).

Figure 13. A continuous impression tray stop is formed in the tray using high viscosity VPS impression material. Figure 14. The impression tray stop is trimmed with a scalpel blade or bur. Medium viscosity VPS impression material is applied to the tray borders in preparation for border molding.

Border Molding For mandibular immediate denture impressions, it is recommended that a medium viscosity VPS material be used for border molding. Dispense a rope of medium viscosity VPS material along the peripheral tray borders (Figure 14). Place the tray in the patient’s mouth and seat the tray onto the mandible using the tray stops as guides. Use the following tissue manipulations to define peripheral borders: •

To functionally form the lingual and retromylohyoid flange borders, have the patient place the tip of the tongue forward out of the mouth and then move the tongue side to side (Figure 15). Next, have the patient retract the tip of the tongue to touch the posterior palate. 6

•

To form the labial notch, grasp the lower lip at the vermilion border and pull outward and upward.

•

To functionally form the labial and buccal borders, stabilize the tray with the index and middle fingers on the finger rest and the thumb beneath the chin. Ask the patient to purse the lips using a sucking action and then smile widely (Figure 15).

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Immediate Complete Denture Impressions: Case Report and Modern Clinical Technique •

To form the buccal notches, grasp the cheek with the forefinger and thumb at the corner of the mouth and pull upward and forward. Repeat this process on the opposite side.

Figure 15. The mandibular impression tray is placed in the patient’s mouth and border molding is accomplished.

Following polymerization of the VPS, remove the impression tray and inspect all peripheral borders to assure that appropriate anatomic and functional detail is represented. If the resin tray is apparent through the border molding material, adjust the tray by grinding. Finally, relieve all borders approximately one to 2 mm using a scalpel blade and/or rotary instrument in preparation for the definitive impression (Figure 16).

Figure 16. Border adaptation of the mandibular impression tray is carefully inspected. All areas of VPS tissues contact are reduced by one to 2 mm using a bur or scalpel blade. The tray is then loaded with low viscosity VPS impression material in preparation for the final impression.

Definitive Impression Dispense low-viscosity VPS im-pression materials into the mandibular impression tray (Figure 16). Inject extralow-viscosity VPS material around all residual teeth using manual syringes (Figure 17). As noted previously, extralow-viscosity VPS material possesses relatively low tear strength43 permitting easier recovery of the polymerized impression from the patient’s mouth without damaging periodontally involved teeth. The relatively low stiffness of low-viscosity VPS also facilitates recovery of the definitive master cast from the impression without damage. Following injection of low-viscosity VPS around all teeth, place and center the impression tray on the mandible (Figure 18) using the tray stops as guides. Repeat all border molding manipulations (Figure 18). Upon polymerization of the VPS, remove and inspect the impression for appropriate anatomic, functional, and surface details (Figure 19). Once satisfied with the quality of the definitive impression, bead, box and cast the impression44 using a suitable vacuum mixed dental stone (Figure 19).

Figure 17. Extra-low viscosity VPS impression material is injected around residual mandibular teeth.

Figure 18. The impression tray is seated on the mandible and the patient is instructed to accomplish all border molding movements.

CONCLUSION

accommodate to their situation. It is also expected that the post-extraction denture adjustment and maintenance phase of therapy will be challenging. Therefore, it is imperative that techniques be continuously developed to optimize the accuracy of immediate dentures in an effort to facilitate the difficult transition to edentulism. As we improve conventional approaches to common

The provision of prosthodontic restorations immediately following extraction of all remaining nonrestorable teeth is an important treatment option. Many patients in need of this therapy are eager to receive aesthetic replacement of their missing teeth, but express concern about edentulism. As new denture wearers, these patients will require time to 7

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Immediate Complete Denture Impressions: Case Report and Modern Clinical Technique prosthodontic problems, the incorporation of new materials and techniques must also be considered. The immediate denture impression procedures presented here combine standard concepts of im-pression tray relief and physiologic border molding with modern concepts of improved impression tray design and vinyl polysiloxane materials to facilitate better clinical outcomes for patients. It is important to carefully evaluate impression border details, the replication of critical anatomy in the master cast, and the development of anatomic and physiologic accuracy in the definitive denture borders (Figure 20). Attention to detail when capturing the physiologic and anatomic characteristics of the denture foundation and peripheral sulci during impression making will facilitate retention, support, and stability of the definitive prostheses. Following impression making and cast construction, care must also be given to: 1. accurate mounting of casts in a semiadjustable articulator, 2. extraction of the residual dentition from the casts, 3. recontouring of extraction sites to simulate expected soft and hard tissue changes, and 4. setting of denture teeth for acceptable denture function and aesthetics.

Figure 19. The definitive mandibular impression is carefully inspected. A master cast is then poured using an appropriate dental stone. Figure 20. A carefully developed maxillary impression displays vestibular details that are carried through the master cast, to the contours of the definitive immediate maxillary complete denture.

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Immediate Complete Denture Impressions: Case Report and Modern Clinical Technique REFERENCES

24. Heartwell CM. Conventional immediate complete dentures. In: Winkler S, ed. Essentials of Complete Denture Prosthodontics. Philadelphia, PA: WB Saunders; 1979:517-537. 25. Rahn AO, Heartwell CM. Textbook of Complete Dentures. 5th ed. Philadelphia, PA: Lea & Febiger; 1993. 26. Schlosser RO. Complete Denture Prosthesis. Philadelphia, PA: WB Saunders; 1939. 27. Geller JW. Prosthetic dentistry. J Prosthet Dent. 1960;10:33-36. 28. Kelly EK. The immediate denture. In: Prosthodontic Syllabus United States Army Institute of Dental Research. Washington, DC: Walter Reed Medical Center; 1965:200-208. 29. Lutes MR, Ellinger CW, Terry JM. An impression procedure for construction of maxillary immediate dentures. J Prosthet Dent. 1967;18:202-210. 30. Lambrecht JR. Immediate denture construction: the impression phase. J Prosthet Dent. 1968;19:237-245. 31. Javid N, Tanaka H, Porter M. Split-tray impression technique for immediate upper dentures. J Prosthet Dent. 1974;32:348351. 32. Ettinger CW, Rayson JH, Terry JM, Rahn AO. Synopsis of Complete Dentures. Philadelphia, PA: Lea & Febiger; 1975. 33. Firtell DN, Elahi JM, Harman LL. Impression technique for an immediate or transitional denture. Quintessence Int Dent Dig. 1980;11:33-36. 34. Lucia VO, Swanson KH. Treatment of the Edentulous Patient. Chicago, IL: Quintessence Publishing; 1986. 35. Gardner LK, Parr GR, Rahn AO. Modification of immediate denture sectional impression technique using vinyl polysiloxane. J Prosthet Dent. 1990;64:182-184. 36. Mitchel KF. Muscle-trim and tissue control in immediate dentures. Dental Digest. 1942;48: 318-320. 37. Campagna SJ. An impression technique for immediate dentures. J Prosthet Dent. 1968;20: 196-203. 38. Bolouri A. Double-custom tray procedure for immediate dentures. J Prosthet Dent. 1977;37: 344-348. 39. Wyatt CCL. Immediate dentures. In: MacEntee MI, ed. The Complete Denture: A Clinical Pathway. Chicago, IL: Quintessence Publishing; 1999:99-107. 40. Laney WR, Gonzalez JB. The maxillary denture: its palatal relief and posterior palatal seal. J Am Dent Assoc. 1967;75:1182-1187. 41. Naylor WP, Rempala JD. The posterior palatal seal: its forms and functions. (I) Diagnosis. Quintessence Dent Technol. 1986;10:417-422. 42. Lavelle WL, Zach GA. The posterior limit of extension for a complete maxillary denture. J Acad Gen Dent. 1973;21:31. 43. Johnson GH. Impression materials. In: Craig RG, Powers JM, eds. Restorative Dental Materials. 11th ed. St Louis, MO: Mosby; 2002:330-389. 44. Rudd KD, Morrow RM, Feldmann EE. Final impression, boxing and pouring. In: Morrow RM, Rudd KD, Rhoads JE, eds. Dental Laboratory Procedures. Volume One: Complete Dentures. 2nd ed. St Louis, MO: Mosby; 1986:57-79.

1. Terrell WH. Immediate restorations by complete dentures. J Prosthet Dent. 1951;1:495-507. 2. Standard SG. Preparation of casts for immediate dentures. J Prosthet Dent. 1958;8:26-30. 3. Nagle RJ, Sears VH, Silverman SI. Denture Prosthetics Complete Dentures. 2nd ed. St Louis, MO: Mosby; 1962. 4. Boucher CO. Swenson’s Complete Dentures. 5th ed. St Louis, MO: Mosby; 1964. 5. Rayson JH, Wesley RC. An intermediate denture technique. J Prosthet Dent. 1970;23:456-463. 6. Swenson MG. Improving immediate dentures in general practice. J Am Dent Assoc. 1953;47:550-556. 7. Appleby RC, Kirchoff WF. Immediate maxillary denture impression. J Prosthet Dent. 1955;5:443-451. 8. Freese AS. Simplified impressions for immediate complete dentures. J Am Dent Assoc. 1957;54:240-242. 9. Gehl DH, Dresen OM. Complete Denture Prosthesis. 4th ed. Philadelphia, PA: WB Saunders; 1958. 10. Leathers LL. Overcoming obstacles and objections to immediate dentures. J Prosthet Dent. 1960;10:5-13. 11. Klein IE. Immediate denture prosthesis. J Prosthet Dent. 1960;10:14-24. 12. Blank HH. Impression materials for maxillary immediate dentures. J Prosthet Dent. 1961;11:414-419. 13. Passamonti G. Immediate denture prosthesis. Dent Clin North Am. 1964;8:781-800. 14. Rapuano JA, Vinton PW. A single tray, dual material technique for immediate dentures. N Y State Dent J. 1970;36:73-76. 15. Bates JF, Stafford GD. Immediate complete dentures. 4. Techniques in construction. Brit Dent J. 1971;131:449-454. 16. Sharry JJ. Complete Denture Prosthodontics. 3rd ed. New York: McGraw-Hill; 1974. 17. Passamonti G. Atlas of Complete Dentures. Chicago, IL: Quintessence Publishing; 1979. 18. Anderson JN, Storer R. Immediate and Replacement Dentures. 3rd ed. Oxford, England: Blackwell Scientific Publications; 1981. 19. Nimmo A, Winkler S. Conventional immediate complete dentures. In: Winkler S, ed. Essentials of Complete Denture Prosthodontics. 2nd ed. Littleton, MA: PSG Publishing; 1988:361-374. 20. Arbree NS. Immediate dentures. In: Zarb GA, Bolender CL, Carlsson GE, eds. Boucher’s Prosthodontic Treatment for Edentulous Patients. 11th ed. St Louis, MO: Mosby-Year Book; 1997:415-422. 21. Pound E. An all-inclusive immediate denture technic. J Am Dent Assoc. July 1963:16-22. 22. Cupero HM. Impression technique for complete maxillary immediate denture. J Prosthet Dent. 1978;39:108-109. 23. Morrow RM, Feldmann EE. Clinical appointment V - impression procedures. In: Morrow RM, ed. Handbook of Immediate Overdentures. St Louis, MO: Mosby; 1978:73-106.

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Immediate Complete Denture Impressions: Case Report and Modern Clinical Technique 3. Which of the following is/are necessary for complete denture retention?

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a. b. c. d.

Traditional Completion Option: You may fax or mail your answers with payment to Dentistry Today (see Traditional Completion Information on following page). All information requested must be provided in order to process the program for credit. Be sure to complete your “Payment”, “Personal Certification Information”, “Answers” and “Evaluation” forms, Your exam will be graded within 72 hours of receipt.. Upon successful completion of the post-exam (70% or higher), a “letter of completion” will be mailed to the address provided.

4. Which is a concern when using irreversible hydrocolloid (alginate) impression material for definitive immediate denture impressions? a. b. c. d.

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a. b. c. d.

a. b. c. d.

a.

maintenance or improvement of aesthetics. maintenance or improvement of masticatory function. maintenance or improvement of phonetics. eliminates post-delivery adjustments.

b. c.

2. Disadvantages of immediate complete dentures include all of the following EXCEPT:

c. d.

Extra-low viscosity material. Low viscosity material. Medium viscosity material. High viscosity material.

7. In the impression technique described, what advantage(s) is/are suggested for using extra low viscosity VPS material?

1. Advantages of immediate complete dentures include all of the following EXCEPT:

b.

Irreversible hydrocolloid impression material in a custom impression tray. Irreversible hydrocolloid impression material in a stock impression tray. Elastomeric impression material in a non-bordermolded stock impression tray. Zinc oxide impression material in a stock impression tray.

6. In the impression technique described, which VPS material is preferred for border molding the impression tray?

POST EXAMINATION QUESTIONS

a.

Poor soft tissue detail. Hyper-allergenic patient response. Over extension of peripheral impression borders. Patient acceptance of the material’s taste.

5. Which is an alternative immediate denture impression technique described in the literature?

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a. b. c. d.

Peripheral denture seal. Appropriate volume and consistency of saliva. Accurate denture fit. ALL of the above.

d.

With residual teeth and soft/hard tissue undercuts, anatomically/ physiologically accurate definitive impressions are difficult. Arranging denture teeth in the lab is substantially more difficult compared to conventional complete dentures. If residual teeth are mobile, accurate interocclusal jaw registrations may be difficult. Creating edentulous contours on dentate master casts using valid estimation techniques may involve unavoidable errors.

Low tear strength permits easier recovery of the polymerized impression without damaging periodontally weakened teeth. The bright orange color is easily discernible when inspecting the final impression. Low stiffness facilitates recovery of the definitive master cast from the impression without damage. Both a and c are correct.

8. The purpose of Valsalva’s maneuver during border molding is: a. b. c. d. 10

Functionally forms lingual flange extensions into the retromylohyoid space. Causes exaggerated physiologic movement of the mandibular buccal frena. Permits reduced thickness of the maxillary labial flange during impression making for aesthetics. Helps form a physiologically accurate posterior border in the maxillary final impression.

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Immediate Complete Denture Impressions: Case Report and Modern Clinical Technique PROGRAM COMPLETION INFORMATION

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Dentistry Today Daytime Telephone Number With Area Code

Department of Continuing Education 100 Passaic Avenue Fairfield, NJ 07004

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Fax: 973-882-3662

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Approved PACE Program Provider FAGD/MAGD Credit Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. June 1, 2006 to May 31, 2009 AGD Pace approval number: 309062

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