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J Bagh College Dentistry

Vol. 21(3), 2009

The influence of impression..

The influence of impression techniques of distal extension


removable partial dentures on the periodontium of the
abutment teeth
Hikmat J.AL.Judy B.D.S., M.Sc.,Ph.D. (1)

ABSTRACT
Background: the purpose of this study was to compare the periodontal status in patients receiving partial dentures
constructed from conventional and altered cast impression techniques.
Materials and Methods: twenty patients receiving mandibular bilateral distal extension removable partial dentures
were assigned for treatment, the patients divided into ten patients receiving partial dentures constructed from
conventional impression technique and other ten patients receiving partial dentures constructed from an altered
cast impression technique. The periodontium of the last abutments had been evaluated using gingival bleeding
index and probing pocket depth, the first score have been made at time of insertion, the second score made after
3days of insertion, the third score after 10days of insertion, the fourth score after 30 days of insertion, the fifth score
after 45 days of insertion and the last score was made after 60 days of insertion. Student t-test had been made to
evaluate the periodontal conditions at different time intervals.
Results: the results revealed that there would be a decrease in both periodontal indexes scores with time.
Conclusion: the use of altered cast impression technique for distally extended removable partial dentures will result in
a less stress concentration on the abutment teeth resulting in a proper periodontal health and reducing damage of
periodontal tissues this will be in addition to proper oral hygiene being established.
Key words: Impression technique, distal extension, periodontium, last abutment. (J Bagh Coll Dentistry 2009; 21(4):3740)

INTRODUCTION
Mandibular distal extension removable
partial dentures usually require the altered cast
impression procedure during fabrication or a
relining at time of insertion to improve the
stability and support of the prosthesis.(1)
In the field of construction of distally
extended partial denture had linked the optimum
mucosal support to the method of making
impressions and materials used, in an attempt to
relate between teeth, hard tissues and soft tissues
covering edentulous ridges.(2)
Several studies have demonstrated the
advantages of the altered cast impression
technique that compared with use of a one piece
cast (4).
The removable partial denture fabricated
using altered cast impression technique is
believed to promote patient comfort and preserve
oral health. (1, 18)
For restoration of missing posterior teeth in
distal
extension
edentulous
ridge
the
displacements are quite different between the
residual ridge mucosa and the periodontal
support tissues of abutment (3)

A correct design for a removable partial


denture should prevent rotary movement in order
to protect the supporting tissues, therefore, the
altered cast impression technique for distal
extension removable partial denture attempts to
accommodate the difference in resiliency of soft
tissue overlying the edentulous ridges and the
periodontium of abutment teeth (5-7).
When restorative procedures are not carried
out properly, further damage can result (7),with
this in mind, the present study was designed to
compare the periodontal status in patients
receiving RPD constructed from conventional
and altered cast impression techniques.

MATERIALS AND METHODS


The study population consisted of 20 elderly
patients (mean age: 55 years) for whom bilateral
distally extended lower arches had been
prescribed,10 patients receiving partial dentures
constructed from a conventional impression
technique and the other 10 patients receiving
partial dentures constructed from an altered cast
impression technique. Inclusion criteria included
patients
with
CL.I.
ApplegateKennedy
classification for partially edentulous arches with
the mandibular second premolars is the last
abutments. None of the patients displayed any
medical condition which contraindicated their
inclusion in the study. All patients agreed to use
their dentures both day and night and to follow

(1) Lecturer, department of prosthodontics, college of dentistry,


university of Baghdad.

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J Bagh College Dentistry

Vol. 21(3), 2009

oral hygiene instructions based on twice daily


mechanical tooth cleaning using a tooth brush
supplemented with inter dental cleaning using
dental floss and an inter space tooth brush.
All patients received the following
periodontal treatment.
i. Motivation and instruction for their oral
hygiene.
ii. Scaling and polishing with pumice and
rubber cup.
iii. Root planning if necessary.
Following periodontal treatment, patients
undergo prosthodontic therapy by making a
preliminary
impression
using
alginate
(Hydrogum Zermack) and production of study
model for designing of the partial denture,
followed by mouth preparation of occlusal rests
and guiding planes.
Depending on the space available between
the free gingival margin and alveolingual sulcus,
the lingual bar major connector will be used if
sufficient space is available if not the lingual
plate will be used. After completion of rest seat
preparation, final impression have been made
using alginate irreversible hydrocolloid using rim
lock stock tray, and pouring of impression with
dental stone (Elite-Model, Zermack) to produce
the master cast.
After the conventional fabrication of RPDs,
the finished denture consisted from major
connector, I- bar type cast clasp in distobuccal
under cuts and distal proximal plates on second
premolar abutment.
Clinical try of the finished RPD framework
inside patients' mouth for fitness would be done,
for conventional impression technique group.
The construction steps of the dentures will be
completed, while for the other group, an altered
cast impression procedure was done. The next
laboratory steps of RPDs were completed and
inserted inside the patients mouths for both group
at the same time. After an initial post
prosthodontic treatment examination (day zero
examination), five additional recall appointments
were conducted at 2 month intervals (at 3 days,
10 days, 30 days, 45 days, and at 60 days) for
both groups. At each of the follow up
appointments selected periodontal parameters
were carefully recorded.
Periodontal
parameters
included
the
following:1. Gingival index (GI) according to Loe and
Silness(12).
2. Probing pocket depth (PD) as measured from
the gingival margin to the bottom of the clinical
pocket on mid buccal mid palatal, mesiobuccal
and distopalatal abutments tooth surface using a

Restorative Dentistry

The influence of impression..

thinned Willima's periodontal probe with a 0.5


mm tip diameter and gentle pressure.
All patients met the following periodontal
criteria prior to receiving RPDs.
1. The gingival index (GI) equal and less than 2.
2. The probing pocket depth (PD) equal and less
than 4.
Statistical analysis were done using Students
t-test to compare the periodontal condition at
different time intervals for patients using RPDs
constructed from conventional and an altered cast
impression technique.

RESULTS
Tables 1-5 show the descriptive statistics
(mean, standard deviations and standard error)
for both gingival bleeding index and periodontal
pocket depth for patients wearing distal extension
removable partial dentures constructed from a
conventional and an altered cast impression
technique. The results revealed that, there would
be a decrease in both periodontal indexes scores
with time
For gingival bleeding index, the results
indicated that there were non significant
differences between the conventional and altered
cast impression technique partial dentures at first
,second and third score, while the difference
became significant at the other scores (table3).
For periodontal pocket depth index, the results
indicated non significant differences at the first
scores for both impression techniques, but the
differences were significant at the other scores
till became highly significant at the sixth score
recorded (table 6). For both indices there were no
statistically significant difference at day zero (at
time of insertion of the partial dentures in
mouths) (tables 3,6), but there were a statistically
significant difference after 30 days of insertion in
gingival bleeding index.
For the scores of periodontal pocket depth,
there would be a significant difference at 10, 30
and 45 days then the difference became highly
significant at 60 days following insertion of the
partial denture in mouth (table 6).

DISCUSSION
Support for bilateral and unilateral distal
extension removable partial dentures is shared
between the abutment teeth and the edentulous
ridges, difference in resiliency between these
supporting elements have prompted examination
of numerous laboratory and clinical models and
their effects on the forces exerted on abutment
teeth (8-10).

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J Bagh College Dentistry

Vol. 21(3), 2009

4.

Leupold RJ, Flinton RJ, Pfeifer DL. Comparsion of


vertical movement occurring during loading of distalextension removable partial denture bases made by
three impression techniques. J Prosthet Dent 1992; 68:
290-3.
5. Maxfield JB, Nicholls JI, Smith DE. The
measurement of forces transmitted to abutment teeth of
removable partial dentures. J Prosthet Dent 1979; 41:
134- 42.
6. Frank RP, Brudivk JS, Leroux B, Milgrom P,
Hawkins N. Relationship between the standards of
removable partial denture construction, clinical
acceptability and patient satisfaction. J Prosthet Dent
2000; 83: 521-7.
7. Jorge JH, Giampaolo ET, Vergani CE, Machado
AL, Pavarina AC. Clinical evalation of abutment teeth
of removable partial denture by means of the periotest
methods. J Oral Rehabil 2007; 34: 222-7.
8. Zlataric DK, Celebic A, Peruzovicv. The effect of
removable partial dentures on periodontal health of
abutment and non abutment teeth. J Periodontal 2002
37: 137-44.
9. Lyons KM, Beumer J, Caputo AA. Abutment load
transfer by removable partial denture actuator
frameworks in different acquired maxillary defects. J
Prosthet Dent 2005; 94: 281-8.
10. Akaltan F, Kaynak D. An evaluation of the effect of
two distal extension removable partial denture designs
on tooth stabilization and periodontal health. J Oral
Rehabil 2005; 32: 823-9.
11. Yeung ALP, LeoCM, ChowTW, Clark RKF. Oral
health status of patients 5-6 years after placement of
cobalt- chromium removable partial dentures. J Oral
Rehabil 2000; 73: 137-42.
12. Le H, Silness J. Periodontal disease in pregnancy.
Acta Odontal Scand 1963; 21: 533.
13. Igarashi Y, Ogata A, Kuroiwa A, Wang CH. Stress
distribution and abutment tooth mobility of distal
extension removable partial dentures with different
retainers: An in vivo study. J Oral Rehabil 1999;
26:111.
14. Vanzeveren C, Hoore WD, Bercy P, Leloup G.
Treatment with removable partial dentures: a
Longitudinal Study Part I. J Oral Rehabil 2003; 30:
447-58.
15. Vanzereren C, Hoore WD, Bercy P, Leloup G.
Treatment with removable partial dentures: a
Longitudinal study part II. J Oral Rehabil 2003; 30:
459-69.
16. Shifman A, Ben U. The mandibular first premolar
as an abutment for distal extension removable partial
dentures. British Dent J 2000; 188: 246.
17. Lay LS, Lai WH, Wu CT. Making the framework
trying, altered cast impression and occlusal registration
in one appointment. J Prosthet Dent 1996; 130: 1476.
18. Feit BD. The altered cast impression technique
revisited. J Am Dent Assoc 1999; 130: 1476.
19. Vanzereren C, D'hoore W, Bercy P. Influence of
removable partial denture on periodontal indices and
microbiological status. J Oral Rehabil 2002; 29: 232-9.
20. Jorge JH, Pavarina AC, Varjao FM, Garcia PPSN,
Machado AL. Oral health care of partial edentulous
patients in prosthetic rehabilitation. J Dent Res 2002;
81: 186.
21. Kern M, Wagner B. Periodontal finding in patients
10 years after insertion of removable partial dentures. J
Oral Rehabil 2001; 28: 991-997.

An important factor that may have


contributed to the favorable results from the
present investigation was the fit of the distal
extension denture bases over the residual ridge
promoted by the altered cast impression
technique. This impression technique provides
the least movement of extension bases under an
occlusal load when compared with bases
processed from a conventional cast (4,13-15). These
facts were related in our study in that there was a
decrease in both periodontal indexes scores from
time of insertion till the last visit of follow up,
(tables 1-4). This decrease in periodontal scores
may be attributed to the advantages of the altered
cast impression technique in providing stability
to the extension base and increase support for the
base that resulted in a decrease forces on the
abutment tooth in addition to mesial rests that
had been used in cases examined in this
investigation. This mesial rest transferring the
chewing force more perpendicular to ridges than
the distal occlusal rests (16), hence the gingival
mucosa of the abutment tooth was better
protected, this explain the results in the present
investigation in that the gingival index scores
become statistically significant difference from
the fourth score till the last score, this mean that
the gingival tissues is better response to the
applied load, this will lead to decrease in amount
of inflammation in gingival tissues with time, at
the same time the periodontal pocket depth
scores showed only highly significant difference
in last scores, this was attributed to time that
would be required for the pocket tissue to be
healed and proper tissue attachment will be
developed around the abutment teeth, these
finding being in agreement with Jorge et al (7)
and Vanzeveren et al (14,15), therefore; properly
designed removable partial denture with using of
an altered cast impression technique this may
provide a homogenous distribution of occlusal
forces, this will create a regular adaptation of
periodontal tissues and an obvious decrease in
periodontal pocket depth score with time
especially when supported by strict oral hygiene
routine and frequent recall visits (20,23,24).

REFERENCES
1.

Frank RP, Brudvik JS, Noonan CJ. Clinical outcome


of the altered cast impression procedure compared with
use of a one- piece cast. J Prosthet Dent 2004; 91: 46876.
2. AL EL-Sheikh H, Abdel Hakim AM. Sectional
impression for mandibular distal extension removable
partial dentures. J Prosthet Dent 1998; 80: 216-20.
3. Holmes JB. Influence of impression procedure and
occlusal loading on partial denture movement. J
Prosthet Dent 1965; 15: 474- 83.

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J Bagh College Dentistry

Vol. 21(3), 2009

22. Frechette AR. The influences of partial denture


design on distribution of force to abutment teeth. J
Prosthet Dent 2001; 85: 527-539.
23. Yusof Z, Isa Z. Periodontal status of teeth in contact
with denture in removable partial denture wearers. J
Oral Rehabil 1994; 21: 77-86.
24. Petridis H, Hempton TJ. Periodontal considerations
in removable partial denture treatment: A review of
literature. In J Prosthodont 2001; 14(2): 164.

Table 4: Mean and standard deviation of


Periodontal Pocket depth for patients
wearing partial dentures constructed from
conventional impression Technique
Score Score Score Score Score Score
1
2
3
4
5
6
Mea
3.648 3.619 3.595 3.566
n
SD 0.1338 0.135 0.1353 0.1364
SE 0.0423 0.0427 0.0428 0.0432
Min 3.37 3.35 3.32 3.31
Max 3.84 3.81 3.79 3.76

Table 1: Mean and standard deviation of


Gingival bleeding Index for patients
wearing partial dentures constructed from
conventional impression Technique
Score Score Score Score Score Score
1
2
3
4
5
6
Mea
1.856 1.83 1.796 1.774
n
SD 0.0558 0.0589 0.0599 0.0635
SE 0.0177 0.0186 0.0189 0.0201
1.7
1.68
Min 1.75 1.71
Max 1.93 1.89 1.86 1.87

0.0539
0.0171
1.61
1.76

Mea
3.613 3.58 3.542 3.529
n
0.113 0.1079 0.1169 0.1157
SD
SE 0.0358 0.0341 0.037 0.0366
Min 3.41 3.39 3.31 3.29
3.7
Max 3.79 3.76 3.72

Score Score Score Score Score Score


1
2
3
4
5
6
1.702

3.491 3.464
0.1104
0.0349
3.27
3.68

0.1084
0.0343
3.23
3.64

Table 6: t-test between conventional and


altered cast impression technique partial
dentures with all scores of periodontal
pocket depth

1.63

0.0618 0.0699
0.0196 0.0221
1.64
1.6
1.81 1.81

Scores t-test P-value Significance


NS
Score1 1.026 0. 47
S
Score2 2.208 0.049
S
Score3 4.342 0.002
S
Score4 2.828 0.020
S
Score5 3.842 0.004
HS
Score6 4.556 0.001

Table 3: t-test between conventional and


altered cast impression technique partial
dentures with all scores of Gingival bleeding
Index

*P<0.05 Significant
**P>0.05 Non
significant
**P<0.01 High significant

Scores t-test P-value Significance


NS
Score1 0.502 0.627
NS
Score2 1.036 0.327
NS
Score3 1.328 0.217
S
Score4 2.257 0.049
S
Score5 2.557 0.031
S
Score6 2.797 0.046
*P<0.05 Significant
**P>0.05 Non significant

Restorative Dentistry

0.1223 0.1189
0.0387 0.0376
3.3
3.3
3.72
3.7

Score Score Score Score Score Score


1
2
3
4
5
6

Table 2: Mean and standard deviation of


Gingival bleeding Index for patients
wearing partial dentures constructed from
altered cast impression Technique

Mea
1.853 1.816 1.775 1.739
n
SD 0.0506 0.0554 0.0528 0.0549
0.016 0.0175 0.0167 0.0174
SE
1.7
1.67
Min 1.77 1.72
1.9
1.84 1.82
Max 1.94

3.552 3.527

Table 5: Mean and standard deviation of


Periodontal Pocket depth for patients
wearing partial dentures constructed from
altered cast impression Technique

1.744 1.688
0.0521
0.0165
1.66
1.81

The influence of impression..

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