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Complete Denture
Impression 101
O
ne of the procedures most dreaded by many den-
tists is the fabrication of the complete denture.
They look at complete dentures as a drain on their
time and patience; however, this need not be the case. Fab-
ricating complete dentures for the patients who need them
can be a gratifying and profitable part of your practice.
Many of the problems related to denture fabrication-
can be traced back to the master impression, the first step
in the procedure. If this procedure is not performed prop-
erly, the outcome will be questionable. Using a strict but
simple protocol will direct the process toward success.
Preliminary Impressions
The capture of important anatomical structures is vital
in the final impressions. This means that the maxillary
impression must clearly show the posterior palatal seal re-
gion, labial and buccal vestibules, tuberosity, hamular
notch, and all frenums (muscle attachments). The mandibu-
lar impression also must capture clear, definable labial
and buccal vestibules, the retromolar pad, the mylohyoid
ridge, and muscle attachments. Every step toward this
goal starts with the preliminary impression and ends with
a flawless final impression. No step is more or less im-
portant than the step that precedes it.
The initial step of the preliminary impression is the
stock tray selection. The choices are numerous. Does one
use metal or plastic, edentulous or conventional? Your
choice should depend on what works best in your hands.
This author finds that conventional metal trays capture lin-
guals of the mandibular arch and buccal vestibules of the
Frank Ortolano, DDS
Private Practice
Holmdel, New Jersey
Phone: 732.671.1052
E-mail: frankortolano@verizon.net
Web site: www.holmdelgentledentist.com
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maxillary arch best, perhaps because they keep the tongue
and cheeks out of the way.
One of the easiest materials to use for these preliminary
impressions is alginate. Mixed to its correct powder/water
ratio, it is an accurate and well-tolerated material. It should
be noted that impressions taken in this manner have accu-
rate detail, but even under optimal conditions (correct mix
and light pressure when placing the tray) they show com-
pression of the mucogingival fold. As long as one under-
stands this situation, it can be dealt with during the
fabrication of the custom tray.
Stone Model
Custom tray fabrication begins with the preliminary im-
pression stone model. A pencil line should be drawn ap-
proximately 3 mm shy of the deepest extension of the
mucobuccal and mucolingual folds. The stone model should
be coated with a thin layer of petroleum jelly. The material
choice for custom tray fabrication falls into 2 categories:
self-cure acrylics and light cured. Examples of self-cured ma-
terials are Fastray (Bosworth), Instant Tray Mix (Lang Den-
tal Manufacturing), and Acratray (Henry Schein). An
example of a light-cured material is Triad TruTray custom
tray materials (DENTSPLY Prosthetics).
When using light-cured materials, it is important to wax
out significant undercuts to avoid locking the tray onto the
model. This author uses a self-cured acrylic and does not
wax out undercuts. However, it is important to remove the
tray from the model once heat is first detected and before the
final set. Wax spacers (one thickness of base plate wax) are
recommended by some dentists to use under the custom tray.
With very few exceptions, this author prefers no wax spacer.
Trimming
As soon as the custom tray has hardened, trimming be-
gins. This is one of the most important steps. The tray must
Dental Learning / November 2010 1
be trimmed to the pencil mark placed previously. Selective
grinding of the tissue-bearing surface is recommended to
allow for a very passive fit of custom tray to model (Figure 1).

Border Molding
Practice Pearl 1: Adaptol
The next most important step in this process is the bor-
der molding of the custom tray. Many dentists were taught
that the only way to border mold was to use green stick
compound. This material is very difficult to control and
Figure 1—Custom tray.
time consuming to use, and is certainly not user-friendly.
A little-known material called Adaptol (Kaye Research
Laboratories) (Figure 2), a thermoplastic molding material
that comes in stick form, is a wonderful but underused
product that has been available for decades. It can be dif-
ficult to find but is a stock item at both Patterson Dental
and Darby Dental. Every colleague to whom this author
has recommended Adaptol has become a believer. Hope-
fully, as more practitioners use Adaptol and realize its ben-
efits, it will become more popular and easier to find.
An Adaptol stick is immersed in a warm water bath. Figure 2—Border molding material.
After softening and while running under hot water, it is Figure 3—Custom
rolled between wet fingers and thinned to a 3-mm diame- tray with border
ter rope. When thinned, it is attached to the borders of the molding in place.
custom tray. It can be placed on one side at a time or, after
some experience with the material, the whole tray at once.
The tray is reimmersed into the warm water bath and
then placed into the patient’s mouth. While setting in the
mouth, muscle mold with the patient. After the tray has set,
rmove it from the patient’s mouth and run under cold water
(Figure 3). Check for any show-through of tray material; if
seen, reduce the tray in this area and reborder mold. Any polyvinylsiloxanes to polyethers. Polyethers— Im-
molding material that flows into the tissue-bearing area can pregum PentaSoft (3M ESPE) or Impregum PentaSoft
easily be cut away with a Bard-Parker knife when chilled. Quick Step (3M ESPE) mixed in a Pentamix Automatic
The entire border molding procedure should take less than mixing unit (3M ESPE)—are the preference of this au-
5 minutes. thor because it is very fast, the mix is perfect every time,
and there is no cleanup.
Final Impression
You are now ready for your final impression. Coat Dispensing Impression Material
the entire interior of the tray with adhesive, extending Practice Pearl 2
at least 2 mm to 3 mm beyond the fold on the outside. As the impression material comes out of the automatic
If the procedures detailed previously have been fol- unit (Figure 4), it is directly filled into a Monoject No.
lowed, the final impression should almost take itself. 412 utility syringe (Covidien) (Figure 5), a 1-piece plastic
Impression materials vary from rubber base to tube/nozzle syringe. The syringe tip should be cut, leaving

2 Dental Learning / November 2010 www.dentallearning.net

 Figure 4—
Impression
syringe in place
over mixing tip
of automatic
dispenser.
Figure 5—Monoject syring, unmodified.
Figure 6—Syringe with cut tip.
about a quarter inch extending out of the tube (Figure 6)
to allow easier flow into the tray.
Placement of the syringe material is important. A ribbon
of impression material is placed on the Adaptol that is on the
borders of the tray. Next, a ribbon is placed at the crest of
the ridge area. In the maxillary arch, a final dollop is placed
at the roof of the palate (Figure 7). Patients with broader
and/or larger arches may require an additional ribbon of im-
pression material. This technique of mixing and placing the
impression tray is much easier and more accurate than using
a dispensing gun or manually mixing. After all, dentists are
extremely comfortable with an anesthetic syringe. The
Monoject utility syringe feels just like that.
One of the keys to a good impression is not overloading
the tray. This will allow uniform thickness of impression
material, less gagging on the part of the patient, and less
mess. The impression tray should be placed starting in the
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Figure 7—
Custom tray
with dispensed
impression
material in
place.
Figure 8—Final
impression.
anterior and slowly seating posteriorly. Any posterior ex-
cess should be removed with a mirror handle. Remember
that too much material and too much pressure is con-
traindicated. When the impression tray is properly seated,
muscle molding begins. On the upper, pull the cheeks out,
down, and then in. On the lower, it is out, up, and in. You
can continue with any of your favorite molding techniques.
As soon as it sets, remove and evaluate the impression for
details (Figure 8).
With practice, impressions should be nearly perfect
every time without causing the usual stress many practi-
tioners dread.
Conclusion
This impression technique should lead to the fabrica-
tion of dentures that are comfortable and retentive for pa-
tients. In addition, it should require the least amount of post
delivery adjustments for the dentist. It truly is the founda-
tion for complete denture success.
Disclosure:
Dr. Ortolano is a consultant for BISCO, Inc.
Dental Learning / November 2010 3