Sunday, 7 May 2017

BSDH Spring Conference 2017: Making a Good Impression

This week was the Spring Conference for British Society for Disability and Oral Health (BDSH) and so a trip up to sunny Liverpool was on the cards. After missing my train I did manage to get there on time (phew)! It was great to catch up with some familiar faces as well as hear some fab talks about special care dentistry. 

Arriving into Liverpool for the conference


One of the afternoons we had break out sessions which included a hands on impression taking session. This session I found really useful and was something a little bit different. I thought I would summarise what I learnt as this applies to GDPs as well as those who are in Special Care. 

 Making a Good Impression with Phil Smith

The golden triangle of complete denture success is made up of:
  1. Retention
  2. Support
  3. Stability
Making a good working impression starts with a good primary imp i.e. one that captures all functional anatomy including:
  • Residual ridge, tuberosities, hamular notches
  • Functional sulci and frenae
  • Junction of hard and soft palate
  • Retromolar pads
  • External oblique ridge
  • Lingual sulcus and frenum
  • Mylohyoid ridge, retromylohyoid area
For primary impressions choose rigid disposable stock trays and a viscous mix of alginate if there is a reasonably firm ridge. For more resorbed ridges, use soft putty; for 'flabby' ridges use a thinner mix of alginate and for gagging patients use compound. 

For secondary impressions, tips I learnt that were particularly useful include the use of bite registration paste e.g. JetBite, HydroBite, Blu Mousse, Memosil to border mould instead of putty or green/pink stick. It is much less messy as well as being quick setting. Place the paste as in the photos below. 

My hands on practice impressions (very strange to do on a phantom head!) The white material is the bite registration paste where you would place then border mould

For the special trays ask for tissue stops which should shine through if you fully seat and also finger rests for the lower arch. For good ridges use alginate (if you want to check retention after border moulding do not ask for a perforated tray, as this will not allow). For resorbed ridges use PVS heavy or medium +/- a light PVS wash

What happens if I get an airblow?

To avoid this in the first place consider prepacking or syringing whichever mix you are using into areas of undercuts or in the palate (especially if they have a high arched palate). But if you do get an airblow then...
  • Alginate - you cannot add to, retake the impression. If small blows you can add wax to the deficiencies
  • Silcone - add more silicone (usually light body) to the areas and reseat. If the hole is large, you can create 2 holes in the impression tray in that area and injection mould when the tray is seated in the patient's mouth
Remember that a highly detailed surface impression is good in the upper arch to help increase retention, but in the lower arch it will create blobs of acrylic that will rub the patient when it is in function. 


Many thanks to Phil Smith for delivering such as useful session and BDSH for organising this year's Spring Conference, I will look forward to the next one!



Did you go to BSDH this year? Or have any other tips on making impressions in the edentulous patient? Leave them in the comments section.



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