International Journal of Health & Allied Sciences

ORIGINAL ARTICLE
Year
: 2012  |  Volume : 1  |  Issue : 4  |  Page : 255--257

Uncomplicated impression techniques for hypermobile alveolar mucosa: A hope for the hopeless


Prince Kumar1, Kishan Singh1, Ashish Kumar2, Ashish Khattar3, Roshni Goel4, Harkanwal Preet Singh5,  
1 Department of Prosthodontics and Oral Implantology, Shree Bankey Bihari Dental College, Ghaziabad, Uttar Pradesh, India
2 Department of Prosthodontics and Oral Implantology, ITS Dental College, Ghaziabad, Uttar Pradesh, India
3 Private Practitioner, Pitampura, New Delhi, India
4 Department of Conservative Dentistry and Endodontics, IDST Dental College, Modinagar, Ghaziabad, India
5 Department of Oral Pathology and Microbiology, Swami Devi Dyal Hospital and Dental College, Panchkula, Haryana, India

Correspondence Address:
Prince Kumar
Department of Prosthodontics and Oral Implantology, Shree Bankey Bihari Dental College and Research Centre, Masuri, N.H. 24, Ghaziabad
India

Abstract

Context: Alveolar mucosa over the jaw bones in edentulous patients has varying thickness and mobility at different areas and is often imprecise at the time of impression making. Such impressions in the finished dentures cause inflammation and instability of the complete dentures. Aim: To present three methods for selective pressure impressions for complete denture treatment in patients who had different kinds of localization and abnormalities of the thickness of alveolar ridges mucosa. Materials and Methods: Three different impression techniques were used for selective pressure impressions in 15 completely edentulous patients based on the location of flabby tissue and special tray modifications. The patients expressed comfort and satisfaction during the usage of the new dentures, compared with the previous one fabricated with the new impression technique. Conclusion: The suggested methods eliminate the excessive displacement of the soft tissues at the secondary impression; thus, a physiologic and anatomic registration of the attached and the unattached tissue of the denture-bearing areas is attained.



How to cite this article:
Kumar P, Singh K, Kumar A, Khattar A, Goel R, Singh HP. Uncomplicated impression techniques for hypermobile alveolar mucosa: A hope for the hopeless.Int J Health Allied Sci 2012;1:255-257


How to cite this URL:
Kumar P, Singh K, Kumar A, Khattar A, Goel R, Singh HP. Uncomplicated impression techniques for hypermobile alveolar mucosa: A hope for the hopeless. Int J Health Allied Sci [serial online] 2012 [cited 2021 Oct 19 ];1:255-257
Available from: https://www.ijhas.in/text.asp?2012/1/4/255/107889


Full Text

 Introduction



The alveolar mucosa over the ridges in completely edentulous patients is with unusual thickness and mobility. In some areas, it is thick from 2 to 4 mm and the vertical pressure causes distortion of the mucosa, which rebounds after the pressure is eliminated. In other areas where the atrophy of the alveolar process was rapid and sophisticated, the mucosa has no bone support and becomes loose and flabby. [1] Such mucosa is more than 4 mm thick and forms folds usually at the frontal part of the ridges and floating tubers maxillae. [2] Impression making in complete denture treatment is of great importance, not only for denture retention and stability but also for the mucosa status which should be kept and reflected without any distortions. The aim of the authors is to present three methods for selective pressure impressions for complete denture treatment in patients who had different kind of localization and abnormalities of the thickness of alveolar ridges mucosa. [3],[4]

 Materials and Methods



A total of 15 edentulous patients, 9 women and 6 men, with a mean age of 61 years and with dissimilar kind of mucosal abnormalities were divided into three groups and treated with complete dentures. Among them, eight patients (four women and four men) had flabby mucosa at different places of the alveolar ridges of both the jaws (group I); three women had mucosal folds in the frontal area of both the jaws and one man had the same on the upper jaw only (group II); and three patients, two women and one man, had floating maxillary tuberosity [Figure 1] and [Figure 2] (group III). For the first group of patients, the following methods were used. In the first group models, the places with flabby mucosa were delineated, as well as the places on the "median raphe" and "torus palatinus." Those spots were then enclosed with a wax layer 1 mm in width. After that, an individual special tray was formed with autopolymerizing resin and holes were drilled at the places corresponding to the critical spots mentioned, approximately 5 mm apart.{Figure 1}{Figure 2}

For the patients with hypermobile mucosa at the front part of the alveolar ridges, we used the following method. Individual tray made up of autopolymerizing acrylic resin was used (DPI, India) in which the anterior part was removed like a "Window" corresponding to the place of the mucosal folds [Figure 3]. The handle then was prepared at the distal parts of the tray. For the patients with floating maxillary tuberosity, light-curing polymer base plate was used after the following preparations. In the first model, the maxillary tuberosity and torus palatinus were delineated and relieved with a layer of wax 1 mm in thickness. Another base plate wax covered the whole basal seat, i.e., the surface outlined for the tray. Wax was cut away in locations where stops were desired. The tray was completed with the wax spacer as relief. The handle was not reaching the maxillary tuberosity. Holes were drilled at the places corresponding to the maxillary tuberosity and torus palatinus 3-4 mm apart. All the impressions were made after an accurate adjustment of the individual tray for stability, retention, and muscle interferences. The impression itself included two phases. In the first step, a peripheral seal/physiologic border was established with green stick compound (Pinnacle, DPI, Mumbai, India). After that, a low-viscosity silicone impression was made (Aquasil, Dentsply) as a wash impression with moderate pressure. In the second group, the silicone material was put by syringe at the place of the "Window." The prostheses were processed, and at the first appointment, the pressure under the tissue was assessed using pressure indicating paste (Mizzy, Pearson Dental, Sylmar, CA). Control appointments were given at the 2 nd , 7 th , 14 th days, and after a month.{Figure 3}

 Results



The pressure indicating paste at the delivery appointment showed even layer of the material over the base plate of the dentures, except for two patients from the first group where there were places of excessive pressure spot and the acrylic was seen under the paste layer. [5],[6] The regions were marked on the dentures and the corresponding parts were corrected with an appropriate stone bur. In the successive appointments, the mucosal state of the denture-bearing areas was carefully observed and palpated for inflammatory signs, but there were not any. The patients expressed comfort and satisfaction during the usage of the new dentures, compared with the previous one. The results obtained were tabulated [Table 1].{Table 1}

 Discussion



In the modern era, even if the implant-retained prosthesis is able to overcome many of the shortcomings associated with conventional complete dentures, it is not a valuable technique for managing the patients with flabby tissues in the maxilla. The most common etiology may be attributed to the insufficient bone volume for implant placement without bone grafting. In the conventional prosthodontic approaches, managing a patient having a flabby maxillary ridge with standard muco-compressive impression techniques is likely to be terminated in an unretentive and unstable complete denture, whereas in muco-compressive impression technique, the movement of the denture base relative to the underlying support tissues due to the compression may result in distortion of denture's stability. The use of selective pressure or minimally displacing impression technique should facilitate overcoming some of these limitations. In the present article, the final impression caused some displacement, no matter how cautiously it was made. Such tissue alteration can result in annoyance and dislodgement if duplicated in the finished complete denture. The effects of tissue displacement and distortion during impression making should be eliminated. The use of holes, windows, and wax relief reduces the hydraulic pressure mainly at the central region of the tray, to allow escape of the excess impression materials and to minimize the displacement of the bearing tissues. [7],[8],[9],[10],[11],[12]

 Conclusion



The completely edentulous alveolar ridges frequently have different resorption patterns, and rarely, the reduction of the residual ridges is identical and even, so that the ridges remain aligned and parallel. The recommended three methods eliminate the excessive displacement of the soft tissues at the final impression; thus, a physiologic and anatomic registration of the attached and the unattached tissue of the denture-bearing areas is attained with overall enhanced denture prognosis.

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