JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL SCIENCES Kunwarjeet Singh et al. Window impression technique A treatment modality for Prosthodontic management of flabby ridge: a Case Report. Journal of pharmaceutic al and biomedical sciences (J Pharm Biomed Sci.) 2012, Novemeber; 24(24); 83-86.(Articl e 18) The online version of this article, along with updated information and services, is located on the World Wide Web at: www.jpbms.info Journal of pharmaceutical and biomedical sciences (J Pharm Biomed Sci.), Member journal. Committee of Publication ethics (COPE) and Journal donation project (JDP).

ISSN NO-2230 7885 CODEN JPBSCT NLM Title: J Pharm Biomed Sci. Kunwarjeet Singh et al. J Pharm Biomed Sci. 2012, Novemeber; 24 (24); 83-86. Available at jpbms.info Case report Window impression technique A treatment modality for Prosthodontic management of flabby ridge: a Case Report Kunwarjeet Singh1*, Himanshu Aeran2, Narendra Kumar3 and Nidhi gupta4 1 Reader, Department of Prosthodontics and implantology, 3 Professor, Department of Prosthodontics and implantology,4 Reader, Department of Pedodontics and Preventi ve Dentistry,Institute of Dental Studies and Technologies, Modinagar, Ghaziabad, Ut tar Pradesh, India. 2 Professor,Department of Prosthodontics and implantology,Seema dental college,R ishi Kesh, uttar Pradesh, India. Abstract: Aims and objectives: Making of definitive/secondary impression of displaceable f labby tissues with minimum or no displacement of tissue by using window impression technique. Background: Displaceable, flabby or hyperplastic tissues or commonly seen in the anterior region of edentulous maxilla opposing mandibular anterior natural teeth or in the mandibul ar alveolar ridge when extensive bone resorption has occurred. Prevalence of flabby ridges can vary, oc curring in up to 24% of edentulous maxilla and in 5% of edentulous mandible. Displacement of flabby tiss ues during impression making is always a concern. Soft tissues that are displaced during impression ma king tend to return to their original form, and complete dentures fabricated from such impression will not accurately fit on the recovered tissues resulting in loss of retention, stability and occlusal disharm ony the dentures. Materials and Methods: This technique uses a custom tray with a window over mobi le tissues and a mucostatic impression material to minimize distortion of tissues while making im pression. First an accurate record of the denture supporting and limiting structure is made except for the mobile tissues which are recorded in second step using light body polyvinyl siloxane impression material in the window area of special tray. Conclusion: The use of this technique helps in maintaining the contour and recor ding the detail of the tissues without displacing the flabby tissues. Hence it improves the prognosis f or complete denture without surgical removal of hyperplastic tissues.

Key Words: Window impression technique, flabby ridge, polyvinyl siloxane, hyperm obile tissues, Mucostatic, light body. Introduction: complete dentures fabricated using this The flabby ridge or movable tissues are frequently seen in maxillary anterior ri dge when the edentulous maxilla is opposed by natural teeth inthe mandibular ant erior region (Figure 1). Kelly[1] in 1972 reported that mandibular anterior teet hcause trauma to maxillary anterior ridge as allocclusal forces are directed on to this area. This result in loss of bone from the anterior maxilla with subsequ ent fibrous tissue hyperplesia.Themucosa is highly movable and loosely attached tounderlying periostium of the bone. The presenceof displaceable denture-bearing tissues often presents a difficulty in making complete dentures.Displacement of such mobile tissues during impression making is always a concern. Soft tissues that are displaced during impressionmaking tends to return to their original for m, and impression will not fit accurately on the recoveredtissues. This results in loss of retention, stabilitydiscomfort and gross occlusal disharmony of thedentures[ 2]. Many impression techniques have been proposedto help overcome this difficulty. W hile these may vary in approach, they are similar in their complexity, are often quite time-consuming toperform, and rely on materials not commonly inuse in con temporary general dental practice. Oneof the impression technique commonly used forthe fabrication of immediate complete dentures[3] or the treatment of patient s with combination syndrome[1,4] uses a custom impression tray with awindow open ing in the anterior region. Zinc oxideeugenol impression paste is first used for making

Kunwarjeet Singh et al. J Pharm Biomed Sci. 2012, Novemeber; 24 (24); 83-86. Available at jpbms.info Kunwarjeet Singh et al. J Pharm Biomed Sci. 2012, Novemeber; 24 (24); 83-86. Available at jpbms.info ISSN NO-2230 7885 CODEN JPBSCT NLM Title: J Pharm Biomed Sci. impression and then impression plaster is paintedonto the displaceable tissues[5 ]. Impression plasteris a Mucostatic impression material and produceslittle pres sure, but it is difficult to handle anddifficult to pour[6] and offers little ad vantage overlow viscosity polyvinyl siloxane materials. Light body polyvinyl sil oxane is also a Mucostatic material. It is dimensionally most stable and elastic material. The purpose of this article is to describe an impression technique for flabby ri dges that makesuse of low viscosity polyvinyl siloxane impressionmaterial routin ely available in general dental practice. Technique 1. Make a preliminary impression of the edentulous arch (Figure 1) using Irrever siblehydrocolloid impression material in a metal stocktray or patient s old dentur e. 2. Pour the impression in type II/III gypsumproduct (Figure 2) to obtain primary cast. 3. Mark the flabby ridge area on the cast. Fabricate a special tray in chemicall y cured acrylicresin with proper spacer and stoppers on the preliminary cast sim ultaneously providing a window for marked flabby ridge area (Figure 2).The borde r of the special tray should be kept 2mmshort of the sulcus. Figure 1: Maxillary anterior flabby ridge 4. Evaluate and adjust the extension of the tray inthe mouth, if necessary. 5. Border mold the tray with low fusing modelingplastic impression compound (gre en stick) inSegments or in single step by using medium bodypolyether or polyviny l siloxane elastomeric impression material.. 6. Remove the spacers with a scalpel blade oncethe border molding is completed. 7. Window in the custom tray can be createdbefore border molding or it can be cr eated afterborder molding above the displaceable alveolarridge using round and f issure bur. Determine thesize of the window opening according to the extentof th e displaceable tissues (Figure 2). 8. Apply the tray adhesive on the border andwhole of the tissue surface of the t ray. Let the adhesive dry for 10 minutes before loading thetray with light body silicone to create a strongbond between the impression material and traythereby preventing displacement of material fromtray. Figure 2: Special tray with window over mobile tissue. 9. Load the impression tray with light body andimmediately place the tray over t he edentulousridge and leave it in mouth for 3-5 minutes (followmanufacturer s ins tructions). 10. Remove the impression tray from the mouthand evaluate the impression careful ly (Figure 3).Trim away any excess impression on the periphery or over the windo w opening with ascalpel blade. 11. Place the impression tray back into patientmouth and inject polyvinyl siloxa ne impressionmaterial over the window opening. Place the material in most passiv e manner to prevent thedistortion of the soft tissues. Figure 3: Wash impression of denture supporting and limitingstructures except mo bile tissue made with light body.

Kunwarjeet Singh et al. J Pharm Biomed Sci. 2012, Novemeber; 24 (24); 83-86. Kun warjeet Singh et al. J Pharm Biomed Sci. 2012, Novemeber; 24 (24); 83-86. ISSN NO-2230 7885 CODEN JPBSCT NLM Title: J Pharm Biomed Sci. Available at jpbms.info 12. Allow the impression material to polymerizeaccording to the manufacturer s rec ommendations. Remove the impression and evaluate carefully (Figure 4). Figure 4: Wash impression of mobile tissue made with light body. 13. Remove, disinfect and box the impression byconventional boxing procedure usi ng boxing waxor using a mix of plaster and pumice. 14. Pour the impression in type III dental stone toobtain master cast. Impressio n of polyvinylsiloxane can be poured immediately, after 1 day oreven after seven days because it is dimensionallymost stable material. If base and catalyst of p olyvinyl siloxane are present in equal proportion,impression can be poured immed iately but if baseand catalyst are not present in equal proportion,hydrogen gas formation takes place which formvoids in cast if poured immediately so impressio nshould be poured after 1 hour. While manipulatingpolyvinyl siloxane, vinyl glov es should be usedinstead of latex gloves because dithiocarbamates,sulfur and sul fur chloride[7] used in manufacturingof latex gloves inhibit setting of this mat erial. Theeffect is so strong that even touching of tissueswith latex gloves bef ore making impression inhibits setting of material adjacent to tissues thereby a ffecting the dimensional stability of theimpression. Discussion With increase in dental awareness among generalpopulation and advancement in den tal technologyand dental treatment many patients retain some,or all, of their na tural teeth until later part of life[8]. Sometimes, unusual arrangements of rema iningnatural teeth can lead to unfavorable distribution of occlusal forces on re sidual alveolar ridges,resulting in bone resorption and development of flabby tissues. Due to poor health, medical condition/systematic diseases such e lderlypatients may be unsuited for surgical proceduressuch as removal of flabby ridges, bone grafting, orplacement of dental implants. So the techniquequoted ca n be successfully used for Prosthodonticmanagement of these patients along with basicprinciples of complete denture fabrication withoutany invasive surgical pro cedures. When the flabby tissues are displaced duringfabrication of complete dentures, on e of the chiefcomplaint of the patient is loosening of completedentures. Many de ntists advise chair side reline 8 to minimize looseness of denture but this appr oach is inappropriate and will not solve theproblem. In chair side reline techni que, completedenture will act as a tray and viscous reline material will further displace the flabby tissue.The tissues will once again tend to recoil and thede nture will still be loose . The technique described in this article does notinvolve extra clinical steps in the construction of acomplete denture, thereby keeping clinical time to a minimu m. The impression technique can be accomplished relatively quickly, and uses mat erials with which the general dental practitioner is already familiar. Polyvinyl siloxane is dimensionally stable and does not need to bepoured immediately. The y are also less brittle than plaster of Paris . Other treatment modalities used for managingthese patients are surgical excision of the flabbytissues and the use of dental implants. Surgicalremoval of flabby tissues is mainly a historicalconcept nowadays. The rationale behind its use was

that removal of flabby tissues would result in a normal compressible denture bear ing area. Some of the difficulties caused by this approachinclude the fact that many complete denture patients are elderly or have complex medical histories, fo r which any form of surgery is contraindicated. Bone loss, the excision of flabb ytissues and resultant shallow ridge may providelittle retention or resistance to lateral forces on the resultant denture. The use of dental implantsin such cases is very difficult because of excessivebone resorption and replacement by flabby tissues, and then there will be little bone remaining into which dental implant s can be placed. While it would be technically possible toaugment the remaining ridge with bone grafts, the

ISSN NO-2230 7885 CODEN JPBSCT NLM Title: J Pharm Biomed Sci. Kunwarjeet Singh et al. J Pharm Biomed Sci. 2012, Novemeber; 24 (24); 83-86. Available at jpbms.info prognosis of such treatment would be questionable. Furthermore, there are a grou p ofpatients who due to some clinical or medical reasons are unsuited for dental implant treatmentand also some patients who do not wish to havesurgically invas ive procedures such as placementof dental implants. So these types of patients c anbe successfully managed prosthodontically byusing this technique. Conclusion This article describes a simple technique for making wash impression of maxillar y anterior highly displaceable ridge with low viscositypolyvinyl siloxane. Consi deration has been givento the choice of impression materials as well as tothe de sign of the impression tray to minimize theamount of pressure exerted on the dis placeabletissues during the impression-making procedure.The materials used are r eadily available and usedin general dental practice. The technique does notrequi re additional clinical visits compared to fabrication of a conventional complete denture.The time required for the specialized impressiontechnique is not excess ive. This technique can be Competent interest: The authors declare that they have no competing interests. Source of funding: None *Corresponding author Dr Kunwarjeet Singh., House No 609, First Floor, Sector-5, Vaishali Ghaziabad (201010), Uttar Pradesh, INDIA. Contact no:-+094777215910. readily completed by the general dental practitioner in his/her dental clinic an d can successfully manage such type of patients. References: 1. Kelly E. Changes caused by a mandibular removable partialdenture opposing a m axillary complete denture. J Prosthet. Dent 1972;27:140-50. 2. Lytle RB. The management of abused oral tissues in completedenture constructi on. J Prosthet Dent 1957;7:27-42. 3. Campagna SJ. An impression technique for immediate dentures. J Prosthet Dent 1968;20:196-203. 4. Palmqvist S, Carlsson GE, Owall B. The combination syndrome: a literature rev iew. J Prosthet Dent 2003; 90: 270275. 5. Watson RM. Impression technique for maxillary fibrous ridge. Br Dent J1970;12 8:552. 6. Freeman SP. Impressions for complete dentures. J Am DentAssoc 1969;79:1173-86

. 7. Stephen F Rosensteel, Contemporary Fixed prosthodontics, 4th edition, page no 444. 8. Basker R M, Davenport J C. Prosthetic treatment of the edentulous patient. 4th edn. Oxford: Blackwell, 2002. Quick Response code (QR Code) for mobile user to access JPBMS website electronically. Website link:-www.jpbms.info Submit your next manuscript to Journal of Pharmaceutical and Biomedical Sciences (JPBMS) (International member journal of COPE and JDP) and take benefit of: Convenient on line submission with persistent Authors support. Thorough peer review. High visibi lity and citation of article with readers /authors across the boundaries. Immedia te publication on acceptance. Inclusion in COPE, JDP, CAS, DOAJ, NLM catalog, Goog le Scholar and many more. Submit your manuscript at: www.jpbms.info. Member jour nal of committee of Publication ethics (COPE) and Journal donation project (JDP) .