IMPRESSION

TECHNIQUES IN
COMPROMISED
EDENTULOUS
CONDITIONS

Poor foundation.

POOR FOUNDATIONS, OSMF,GAG REFLEX & FLABBY RIDGE

Oral submucous fibrosis.

Gag reflex.
Flabby ridges.

POOR FOUNDATIONS

Consequences of bone loss in completely

edentulous mandible

FUNCTIONAL PROBLEMS.

CAUSES FOR RIDGE RESORPTION

MECANICAL- Duration of denture wearing,
wearing dentures during sleeping, bruxism,
closure of bite, inadequate extension of denture.
ANATOMIC- Bone quantity and form before
extraction,
BIOLOGIC- Bone quality---osteoporosis, systemic
disease, diet, Vascular supply.
Sex- Female Predominance

Weiman and Sicher have proposed three possible causes

of bone resorption.
Aging with necrosis of the bone.
Increase in the pressure on the adjacent tissue, namely,
the periosteum and the bone marrow.
Direct action of the elements of the blood and tissue
fluids.

J.F. McCord and A.A. Grant.

Impression using Admix of Impression

compound and Tracing compound:
Flat (atrophic) mandibular ridge covered with atrophic mucosa

Impression with Tracing compound:

Fibrous (unemployed) posterior mandibular ridge

Bernard Levin's method.

In case of resorbed mandibular ridges utilizes the
retromylohyoid space and the buccal shelf area to provide an
improvement in the support and peripheral seal.

ORAL
SUBMUCOUS
FIBROSIS
This disease is classified as a precancerous condition as it
affects a large area of the oral cavity without any
demarcation from adjacent tissue.
It gradually involves the mucosa of the pharynx and
spreads further; if felt untreated.
The unchecked disease causes much wasting of the body
due to nutritional deficiency.

Etiology

Spicy food stuff containing chillies.

Betal nut chewing.
Vitamin deficiency / protein deficiency.
Autoimmunity.
Collagen disease.

Clinical features:
The earliest complaint is burning sensation
on oral examination,

Treatment:

Various treatment modalities have been tried out

with some to little success.

 Impression procedure:
Before making an impression the patient is treated
with physical exercise and stretching movements to
improve the mouth opening.

Sectional impression can be made if the patient

has limited mouth opening.

The custom tray is designed so that if fits precisely and

incorporate a locking mechanism that separate easily in the
mouth and reassembles accurately after the impression
procedure is completed.

GAGGING
Gagging can be regarded, at best, as an unpleasant
experience. It is an involuntary control of the
muscles of the soft palate or pharynx which results in
retching.
Description and Identification
Faigenblums classification of patient with a gag
reflex differentiates mild retching from severe
retching
Five regions of maximum sensitivity are identified as
trigger areas. They are faucets, base of the tongue,
palate, uvula and posterior pharyngeal wall.

Causes of gagging
A general classification of the causes of the
gagging:
Systemic disorders.
Psychologic factors.
Physiologic; Extra oral factors
Intraoral factors
Iatrogenic factors

Impression method
Effective management of gagging depends treating the cause and
not merely the symptoms. Thorough examination, taking of an
adequate medical history and conversion with the patient so that the
dentist can determine the patient problem and is related to iatrogenic
factors, organic, anatomic anomalies, biomechanical inadequate to
recognize whether single or multiple factors are causing the
problem.

Numerous approaches
1. Clinical techniques.
2. Prosthodontic management.
3. Pharmacologic measures.
4. Psychologic intervention.

1.Clinical techniques
To avoid substandard impressions because of gagging.
Daniel W. Borkin outlined an impression technique. A
preliminary impression of the edentulous area is made using
an appropriate stock tray and red modelling compound. This
impression can be removed from the mouth at will, warmed
and reseated between paraxisms of gagging until a fairly
accurate impression is obtained. Final impression is made
using low fusing wax.

Psychologic:
Many recommended clinical techniques are directed to
divert the patients attention from the gagging stimuli.

Landa recommended talking to the patient, explaining the

critical nature of accurate impressions.

Kovats reported a technique that has the patient breath

audibly through the nose and at the same time, rhythmically tap
the right foot on the floor.

Krol described a similar technique to divert attention, the

patient is instructed to raise his or her leg and hold it in the air.
As the patients muscles becomes increasingly fatigued, more and
more conscious effort is required to hold the leg up. At the point
where the patient has difficulty carrying on conversation,
intraoral procedures may be attempted.

 When simple concentration on breathing is in

effective, Faigenblum discussed another
approach. Evidence exists that vomiting is
impossible during apnea. To control gagging
the patient should be instructed to prolong the
expiratory effort at the expense of inspiration.
This will produce a state of apnea and
discourage gagging. He also proposed that a
well-rested and relaxed patient with an empty
stomach is less likely to gag.

2.Prosthodontic management
Desensitization technique.

Marble technique.

Feintuch described a
technique
that used a polished
acrylic resin
base tray to help the
denture
patient overcome
gagging problems

3.Pharmacologic measures
Peripherally acting drugs:
Peripherally acting drugs are topical and local anesthetics.
They may be applied in the form of sprays, gels or lozenges
or by injection.
Friedman and Michael I. Weintraus
described a simple method for
temporary elimination of gag reflex
Centrally acting drugs:
Centrally acting drugs, which eliminate or reduce the gag
reflex, may be categorized as antihistamine sedatives and
tranquilizers, parasympatholytics and central nervous system
depressants.

4.Psychologic intervention
Landa claimed that most problematic gagger falls into this
category.
Hypnosis: It has been used as a tool to deal with the psychologic
etiology of gagging.
Advantage:
There is not lingering and or adverse side effects.
Disadvantages:
Many patients cannot be subjected to hypnosis
Few dentists are skilled in the technique.
It needs multiple lengthy intervals.
Behavioral therapy
Here the treatment was designed to reinforce and maximize
patient self management. He was urged to seek his own
solution.

FLABBY
RIDGES
Flabby tissue is an excessive movable tissue.
The cause for flabby ridges are:
If the patient uses his edentulous jaw for
mastication.
Due to abnormal forces generated because of ill
fitting dentures.

WINDOW TECHNIQUE

 J.F. McCord and A.A. Grant

Recommended a selective impression technique

for the displaceable (flabby) anterior maxillary ridge.

 G.H. Spicer
Gave the similar type of impression technique for
the anterior maxillary ridge.

REFERENCES

Factors of bone resorption of residual ridge Harold,

J.P.D. 12: 429, 1962.
Swensons complete denture Boucher 5th edition.
An impression procedure for the severely atrophied
mandible Robert and Attony, J.P.D., 73: 574, 1995.
Impression making J.F. McCord and Grant, B.D.J. 188,
9: 2000.
A text book of oral pathology Shafer Hine Levy.
Impression procedure for patient with severely limited
mouth opening Philip, Robert and Gregory, J.P.D., 84,
2000, 241.
Preliminary impression in patient with microstomia
Bijan, J.P.D., 67, 23, 1992.

 Gagging problem in prosthodontic treatment

Part I Description and causes, J.P.D., 49 : 601,
1983.
Part II Patient management, J.P.D. 49: 757, 1983.
Impressions for Complete dentures Bernald Levin.
Temporary elimination of gag reflex for dental
procedure Mark and Michael, J.P.D., 73, 319, 1995.
Modified edentulous maxillary custom tray to prevent
gagging Gorden, J.P.D., 62, 48, 1989.
Modified impression technique for hyperplastic alveolar
ridges William, J.P.D., 25, 609, 1971.
Impression of ridges with hyperplastic tissue. G.H.
Spicer, J.P.D., 3: 163, 1953.