REMOVABLE PROSTHODONTICS

SECTION EDITORS
LOUIS BLATTERFElN S. HOWARD PAYNE (;EORGE A, ZARB

A loading impression technique for semiprecision and

precision removable partial dentures
Louis Blatterfein, D.D.S.,* Ira E. Klein, D.D.S.,** and Joseph C. Miglino, D.D.S.***
New York University, College of Dentistry, New York, N. Y.

R e&ration of ridge contour

generally accepted as desirable
under a load is
for ridge support of
loaded form. This will minimize prosthesis rotation
during function and result in less torque to abutment
the base of a distal-extension removable partial teeth. Also, the wear of rests and rest-seat compo-
denture.le6 The importance of this concept is accen- nents will be reduced.
tuated when semiprecision or precision retainers are The registration of ridge contour in a loaded form
used.7 They transmit functional forces to abutment has been described by many authors.‘3-‘7 Their
teeth which can result in cantilever action. techniques are generally effective; however, they use
primarily shallow rest and clasp removable partial
RATIONALE OF DESIGN dentures. When semiprecision and precision retain-
Semiprecision retainers for distal-extension remov- ers are used, these techniques are not applicable
able partial dentures can be designed to minimize because they do not provide firm seating for the
the dangers of cantilever action.8~‘z However, when abutment castings that are to be placed in the
prefabricated semiprecision or precision retainers impression. The loading impression techniques that
which do not allow. prosthesis rotation are used, use rebasing concepts”’ I8 also have limitations when
supplementary procedures are necessary to prevent used for a semiprecision or precision removable
torque on the abutment tooth. Stress breakers and partial denture. The repeated seatings required with
the registration of ridge contour in a loaded form are the framework are difficult and unwieldy when the
effective in minimizing torque. abutment castings are uncemented. If the technique
Stress breakers (stress equalizers) have been used is done after cementation, repeated seatings are
with varying degrees of success. Controversy exists as difficult because of the frictional resistance that is
to the validity of their rationale and their ideal usually present in newly placed deep rest retainer
designs if the validity is accepted. Stress breakers are removable partial dentures.
complicated, costly, and prone to disorientation and
breakage. A strict regimen of patient recall and EXISTING DEEP REST IMPRESSION
maintenance is mandatory to provide patients with TECHNIQUES
proper service. These factors limit the use of stress Impression techniques that are used to “pick up”
breakers as a broad-based treatment plan for or provide firm seats for deep rest abutment castings
patients of limited financial means. are effective in providing these seats. However they
An alternative treatment would be to use semipre- may fail to accomplish proper extension of the
cision or precision rests designed to allow for varying borders of the base and loading of the ridge muco-
amounts of prosthesis rotation. These can be coupled sa.
with a denture base fitted to ridges registered in a The all-plaster technique”‘. ” provides a highly
accurate method of relating abutment castings to
Presented to the Greater New York Academy of Prosthodontics, one another and to the ridges. However, the tech-
New York, N. Y. nique fails to provide accurate border extension for
*Professor Emeritus, Department of Removable Prosthodontics.
the denture base, while loading of the ridge mucosa
**Professor, Department of Graduate Removable Prosthodon-
tics. is minimal or nonexistent.
***Clinical Associate Professor, Department of Removable Pros- Techniques that combine mercaptan rubber,8 sili-
thodontics. cone, or polyether impression materials in a spaced

0022-3913/80/010009 + 06$00.60/O 0 1980 The C. V. Moshy Co. THE JOURNAL OF PROSTHETIC DENTISTRY 9
 BLATTERFEIN, KLEIN, AND MIGLINO

Fig. 1. The preliminary irreversible hydrocolloid im- Fig. 3. A layer of baseplate wax has been placed over the
pression (alginate) has been made with the abutment teeth on the cast.
castings in position on the teeth.

Fig. 4. A second layer of baseplate wax has been placed

Fig. 2. Cast poured from the preliminary impression. over the spaced and unspaced parts of the cast.

custom tray in conjunction with plaster seats for the and tray pressure on occlusion rims are often incor-
abutment castings overcome the problem of uncon- porated into these techniques to provide ridge load-
trolled border extension of the denture base. Correct ing.” When these adjuncts are used, the result
border extension can be attained by using a stiff- becomes unpredictable and prone to error because of
bodied elastomer impression material’ in a slightly uneven pressure and malrelation of the parts of the
underextended custom impression tray or by border impression.
molding an underextended impression tray with
modeling composition before applying a lighter IMPRESSION TECHNIQUE
bodied elastomer impression material. Both ap- The limitations of existing techniques for deep rest
proaches register the ridges in a passive, anatomic distal-extension removable partial dentures can be
form and fail to provide the ridge loading that is overcome by using a specially prepared custom tray
desired. Some impression techniques register only in conjunction with modeling composition, activated
the ridges in an unspaced custom tray and then acrylic resin, and a polyether gel impression materi-
relate this base impression to the abutment castings al. This technique will provide a final impression
and remaining natural teeth with an overall impres- that has firm seats for the abutment castings, correct
sion of plaster or similar material. The resulting final border extension of the denture base, and ridge
impression does not provide much ridge loading. loading.
Special steps such as biting pressure, finger pressure, After the abutment castings have been properly

10 JANUARY 1980 VOLUME 43 NUMBER 1

LOADING IMPRESSION TECHNIQUE

Fig. 5. Windows have been cut in the spacing wax to

provide stops for a custom impression tray. Two stops are Fig. 7. A view of the inner surface of th13 impression tray
on the ridges, two are on the abutment castings, and one is that shows the five elevated stops.
on part of the incisal edges of the central incisors.

Fig. 8. Modeling composition has been placed in the

ridge parts of the tray. A firm seat has been established for
Fig. 6. An activated acrylic resin impression tray has the tray against the ridges. Borders have been molded for
been fabricated over the prepared cast. proper height and width.

fitted to the prepared teeth, an irreversible hydrocol- over the spaced and unspaced parts of the cast (Fig.
loid (alginate) impression is made of the jaw with the 4). This creates space for the impression materials
abutment castings in position (Fig. 1). A cast is that will be used to establish the border limits of the
poured in artificial stone for the purpose of fabricat- denture base and provide ridge loading.
ing an activated acrylic resin impression tray (Fig. 2). For the purposes of positioning and orienting this
The planned impression tray is to be spaced from the spaced tray, reference contacts (stops) for the oral
remaining teeth, abutment castings, and ridges. A structures and abutment castings are needed. These
layer of baseplate wax is first adapted only around contacts (stops) are provided by cutting out small
the remaining natural teeth and abutment teeth windows in selected parts of the spacing wax (Fig. 5).
(Fig. 3). The purpose of the initial spacing is to allow Three windows are cut for stops that will provide a
for a greater thickness of the final polyether impres- stable seat for the impression tray and two more
sion material in this part of the tray. The set windows are cut in the spacing wax over the abut-
polyether has little yield when confined to a slightly ment castings for seating stops. Windows for the
spaced tray, and the teeth of the poured cast may be tray-stabilizing stops on the ridges are usually cut
fractured during separation. over the horizontal parts or buccal. shelves of the
A second layer of baseplate wax is then adapted ridges midway between their anterior-posterior

THE JOURNAL OF PROSTHETIC DENTISTRY 11

 BLATTERFEIN, KLEIN, AND MIGLINO

Fig. 9. Duralay is applied to the stops on the abutment
castings and incisors to reestablish firm contact on
them.
Fig. 11. Impression has been completed with a polyether
gel. Abutment castings have been “picked up” in the
impression and have a firm unyielding seat in the impres-
sion. There is a thin lining of the gel over the modeling
composition registration of the ridges.

Fig. 10. View of the inner surface of the tray showing the
three stops corrected in relation to the modeling compo-
sition basing that has been established on the ridges. ’ Fig. 12. Duralay with dowel inserts have been placed in
the abutment castings. Borders of the impression have
been protected by rimming ‘before final boxing and
limits. The windows for natural tooth contacts are pouring.
cut over the mesial halves of the incisal edges of the
central incisors.
An activated acrylic resin tray is fabricated over the resulting impression are then heated, tempered,
the prepared cast (Fig. 6). The inner surface of the returned to the mouth, and molded to register the
tray will show five well-defined teeth, abutment correct height and width that is available for support
casting, and ridge stops (Fig. 7). The tray is then of the denture base (Fig. 8).
trimmed so that its borders are about 2 mm short of The modeling composition places the mucosa of
the reflection of the tissues of the mucobuccal and the ridge. It registers a form that the mucosa will
mucolingual folds. Sufficient reduction of the edges assume when functional forces are applied to the
is necessary to allow for the bulk of the basing completed prosthesis. A firmer seat will be available
material necessary for proper border molding. for the removable partial denture and less stress will
Modeling composition is placed on the ridge parts be transmitted to the abutments. The potential for
of the impression tray, thoroughly heated and overloading and trauma is reduced.
tempered, and the tray is then positioned in the After completing the basing of the ridge sections of
mouth. This step is repeated until a uniform and the impression tray, the relationship of the tray stops
detailed seating has been obtained. The borders of to the abutment castings and natural teeth must be

12 JANUARY 1980 VOLUME 43 NUMBER 1

LOADING IMPRESSION TECHNIQUE

Fig. 13. Anterior section of the impression tray has been Fig. 14. Completed final cast with abutment castings
cut away after pouring to avoid breaking the teeth of the related to the remaining natural teeth and ridges in a
cast during separation. The extra layer of spacing wax that loaded form.
was used facilitates this step.

accurately reestablished. Varying thicknesses of the the poured cast is hazardous. The stiffness of the set
basing material will change the original relation of polyether gel will usually cause the teeth of the
the stops to remaining teeth and abutment castings. poured cast to break away.
A correction is effected by applying Duralay* to the The acrylic resin impression tray should be cut
three anterior stops (Fig. 9) and then firmly reseating away in the region of the teeth (Fig. 13). This
the tray. A hard unyielding seat is now provided for procedure is facilitated by the extra thickness of
the abutment castings when the impression tray with polyether gel that was produced by the double-wax
the final impression material is placed in position spacing of the preliminary cast prior to the fabrica-
(Fig. 10). tion of the impression tray.
A polyether impression material is used for the The casts that result from this impression tech-
final impression. This material has good flow when nique will have an accurate relation of the abutment
mixed, and it has adequate firmness when set. The castings to one another and to the ridges (Fig. 14).
good flow allows it to correct any unevenness of The ridges will be registered in a form that they
the modeling composition basing and still retain assume when functional forces are applied to the
its loading effect. Its adherence to the modeling artificial teeth of the completed removable partial
composition and tray in a thin film is assured by denture. This provides a favorable environment and
using the adhesive supplied with the material foundation for a bilateral distal-extension removable
(Fig. 11). partial denture and minimizes the potential for
The firmness of the material stabilizes the abut- trauma and overloading of the abutrnent teeth.
ment castings against horizontal displacement. The
Duralay occlusal stops stabilize the abutment cast- SUMMARY
ings against vertical displacement in the combina- The rationale of designing a semiprecision or
tion final impression. precision distal-extension removable partial denture
Seats for the abutment castings on the final cast and the justification of ridge loading in distal-
can be provided by placing Duralay or pouring extension ridge impression techniques have been
low-fusing metal in the properly prepared internal presented. The effectiveness of existing impression
surfaces of the abutment castings. Dowels are placed techniques in securing firm seats for abutment cast-
in the poured material to provide for their anchorage ings, accurate border extension of the denture base,
to the final artificial stone cast. and loading of the ridge mucosa has been evalu-
The impression can be easily rimmed and boxed ated.
to preserve the borders that have been established A technique has been described that overcomes
(Fig. 12). Direct separation of the impression from the limitations of existing impression techniques for
semiprecision and precision distal-exl:ension remov-
*Reliance Dental Mfg. Co., Worth, I11 able partial dentures.

THE JOURNAL OF PROSTHETIC DENTISTRY 13

 BLATTERFEIN, KLEIN, AND MIGLINO

REFERENCES 13. Applegate, 0. C.: The partial denture base. J PROSTHET

DENT 5:636, 1955.
1. Cummer, W. E.: Impressions in partial denture service. Dent 14. Kramer, H. M.: Impression technique for removable partial
Cosmos 70:272, 1928. dentures. J PROSTHET DENT 11:84, 1961.
2. McLean, D. W.: The partial denture as a vehicle for
15. Holmes, J. B.: Influences of impression procedures and
function. J Am Dent Assoc 23:1272, 1936. occlusal loading on partial denture movement. J PROSTHET
3. Singer, F.: Functional impression and interocclusal records DENT 15:474, 1965.
for removable partial dentures. J PROSTHET DENT 12:536, 16. Leupold, P. J., and Kratochvil, F. J.: An altered-cast
1962. procedure to improve support for removable partial den-
4. Hindels, G. W.: Load distribution in extension saddle partial tures. J PROSTHET DENT 15:672, 1965.
dentures. J PROSTHET DENT 2:92, 1952. 17. Rapuano, J. A.: Single-tray dual-impression technique for
5. Applegate, 0. C.: Essentials of Removable Partial Denture distal-extension partial dentures. J PROSTHET DENT 24:41,
Prosthesis, ed 3. Philadelphia, 1965, W. B. Saunders Co., pp 1970.
253-270. 18. Wilson, J. H. L.: Partial dentures-relining the saddle
6. Henderson, D., and Steffel, V. 0.: McCracken’s Removable supported by the mucosa and alveolar’bone. J PROSTHET
Partial Prosthodontics, ed 4. St. Louis, 1973, The C. V. DENT 3:807, 1953.
Mosby Co., pp 261-268. 19. Steffel, V. L.: Relining removable partial dentures for fit and
7. Preiskel, H. W.: Impression techniques for attachment- function. J PROSTHET DENT 4:496, 1954.
detained distal-extension removable partial dentures. J PROS- 20. Prothero, J. H.: Prosthetic Dentistry, ed 2. Chicago, 1916,
THET DENT 25:620, 197 1. Medico-Dental Publishing Co., pp 506-516.
8. Blatterfein, L.: The use of the semiprecision rest in remov- 21. Nichols, I. G.: Prosthetic Dentistry. St. Louis, 1930, The C.
able partial dentures. J PROSTHET DENT 22:307, 1969. V. Mosby Co., pp 567-575.
9. Thompson, M. J.: Reversible hydrocolloid impression mate- 22. Leff, A.: Precision attachment Dentures. J PROSTHE? DENT
rial: Its treatment and use in operative and prosthetic 2:84, 1952.
dentistry. J Am Dent Assoc 39:708, 1949.
10. Harris, F. N.: The precision dowel rest attachment. J Re+zt requests to:
PROSTHET DENT 5:43, 1955. DR. LOUIS BLATTERFEIN
11. Morrison, M. L.: Internal precision attachment retainers for 1 HANSON PLACE
partial dentures. J Am Dent Assoc 64:209, 1962. BROOKLYN, N. Y. 11243
12. Koper, A.: An intracoronal semiprecision retainer for remov-
able partial denture-the Thompson dowel. J PROSTHET
DENT 30:759, 1973.

ARTICLES TO APPEAR IN FUTURE ISSUES

Cementation, of cast complete crown retainers

Jacob Abelson, D.D.S.

The combined reversible-hydrocolloid/irreversible-hydrocolloid impression

system
David C. Appleby, D.M.D., M.Sc.D., Cornelis H. Pameijer, D.M.D., M.Sc.D., DSc., and Joseph
Boffa, D.D.S., M.P.H.

Glass-mounted composite-slide fabrication

Isaac E. Appleton, D.D.S., M.S.

A review of the submerged-root concept

David M. Casey, D.D.S., and Frank R. Lauciello, D.D.S.

Reliability of the fovea palatini for determining the posterior border of the
maxillary denture
Ming-Sheh Chen, B.D.M., M.Sc.

JANUARY 1980 VOLUME 43 NUMBER 1