Chairside - Glidewell Dental Labs

Evaluation and Classification of Tissue Quality
After a thorough patient history has been obtained, the
intraoral and extraoral structures should be evaluated
closely. Inspecting intraoral tissue will permit the clinician
to determine the character and mobility of the overlying
soft tissue. Classifying the tissue after examination based
on the differences between tissue character and mobility
will give the clinician a simple method for selecting the
appropriate viscosity to make the impression.
The clinician uses tactile manipulation to assess the character
of the tissue overlying the bony support in the
edentulous arches and classifies the tissue as coarse and
fibrotic, average, or thin and fragile. For example, if a
patient’s tissue quality is determined to be coarse and fibrotic
covering the residual ridges, it is generally thought
that the patient is able to tolerate a removable complete
prosthesis better than if the supporting tissue is classified
as thin and fragile.
The soft tissue overlying the residual ridges should be
assessed using a blunt instrument to determine the relative
amount of displacement or mobility. After tactile assessment,
the tissue can then be classified and recorded
as one of the following: attached, low mobility, low displacement;
average, clinically acceptable displacement;
or high mobility, high displacement. Soft tissue that is
categorized as attached and less mobile quality overlying
the alveolar ridge generally results in better adaptation of
the removable prosthesis. Conversely, soft tissue quality
that is categorized as high mobility and high displacement
typically represents a clinical condition that is more
difficult to manage and prepare for well-fitting complete
dentures 6 (Figure 1).
Materials
It has been demonstrated that the type of impression materials
used for making the final impression can have a
critical effect on the pressures produced during the impression
making procedure; therefore, tray modifications
have less significant influence when the amount of pressure
produced needs to be controlled. 7
48Building
the Edentulous Impression
Figure 1: The tissue character can be assessed using digital/tactile
evaluation.
Figure 2: The patient or a dental assistant can help provide adequate
tissue retraction when building the impression. In this instance, a patient
is shown holding cheek retractors in preparation for the procedure.
Figure 3: Use the high viscosity PVS impression material to create
tissue stops in the stock impression tray.