IMPRESSION PROCEDURES FOR REMOVABLE

PARTIAL DENTURES

Presented by: Dr.

Pramodani patel
CONTENTS:
 Introduction

 Tooth supported RPD

 Tooth-tissue supported RPD

 Factors influencing support of distal extension base

 Dual impression techniques:

 Physiologic Impression
 Pick up impressions
 McLean’s technique
 Hindel’s modification

 Functional relining method

 Fluid wax technique
 Selective Pressure Impression
 Altered cast technique

 Summary

 References
 IMPRESSION

 A negative likeness or copy in reverse of the surface of

an object ; imprint of teeth and adjacent structures for
use in dentistry.
GPT – 9
 IMPRESSION FOR RPD DIFFERS FROM
COMPLETE DENTURE IMPRESSION

 Complete denture impression records only soft tissues

 Partial denture impression must accurately register the
relatively soft yielding tissues and at the same time
record the hard unyielding tissues.
Hard structures are irregularly contoured as well as varying
in their vertical position relative to the occlusal plane so
the impression mat. must be capable of contouring into
intimate contact with each crown surface and withstand the
momentary distortion which occurs as the impression is
withdrawn, and instantly spring back to its original form
without distortion or rupture.
 TOOTH SUPPORTED RPD

Occlusal force applied

Directed through the rest and

transmitted to the abutment

Edentulous ridges do not contribute to the support of the partial

denture ….teeth absorb these forces before the forces can be
transmitted to the tissues of the ridges.

A tooth-supported removable partial denture can be constructed

on a master cast made from a single impression that records the
teeth and soft tissues in their anatomic form.
 The impression should also record the moving tissues
that will border the denture in an unstrained position, so
the relationship of the denture base to those tissues may
be as accurate as possible. Although underextension of
the denture base in a tooth-supported prosthesis is the
lesser of two evils, an underextended base may lead to
food entrapment and inadequate facial contours,
particularly on the buccal and labial sides.
 TOOTH-TISSUE SUPPORTED RPD

Occlusal force

Must be equitably distributed

to the abutment and the tissues.

dual impression technique is used in which a "corrected cast" is

generated. The impression of the teeth is made with a material
that captures the teeth in their anatomic positions. In contrast,
the impression of the residual ridge must record the soft tissues
in their functional form .
Impression of residual ridge must

Record and relate the tissues under uniform

loading

Distribute the load over an area as large as

possible

Demarcate the peripheral extent of the

denture base

The distal extension removable partial denture must depend on

the residual ridge for some support, stability, and retention
FACTORS INFLUENCING SUPPORT OF
DISTAL EXTENSION BASE

 Quality of soft tissue covering edentulous ridges

 Type of bone in the denture-bearing area
 Design of the prosthesis
 Amount of tissue coverage of denture base
 Anatomy of the denture bearing areas
 Fit of denture base
 QUALITY OF SOFT TISSUE COVERING EDENTULOUS RIDGES

 Soft tissue displaceablity vary from patient to patient and also

from site to site within the same patient.

 Firm, tightly attached thick mucosa- greatest support

 More displaceable tissue – less is the support
 TYPE OF BONE IN THE DENTURE-BEARING AREA

 Cancellous bone has less ability to resist vertical forces

compared to cortical bone because its irregular surface acts as an
irritant to the overlying soft tissue if vertical stress occurs
chronic inflammation of the soft tissue leads to resorption of the
cancellous bone.
 Forces should be directed to dense cortical regions.
 The crest of the bony mandibular residual ridge is most
often cancellous. Because lining mucosa restricts both
the buccal and lingual mucosae adjacent to teeth in the
mandible, loss of firm mucosa overlying the residual
ridge is common following tooth extraction in the
posterior mandible. Pressures placed on tissues overlying
the crest of the mandibular residual ridge usually result
in irritation of these tissues, accompanied by the
sequelae of chronic inflammation.
 Therefore the crest of the mandibular residual ridge
cannot be a primary stress-bearing region. The buccal
shelf region (bounded by the external oblique line and
the crest of the alveolar ridge) seems to be better suited
for a primary stress-bearing role because it is covered by
relatively firm, dense, fibrous connective tissue
supported by cortical bone.
 The immediate crest of the bone of the maxillary
residual ridge may consist primarily of cancellous bone.
Unlike in the mandible, oral tissues that overlie the
maxillary residual alveolar bone are usually of a firm,
dense nature (similar to the mucosa of the hard palate) or
can be surgically prepared to support a denture base. The
topography of a partially edentulous maxillary arch
imposes a restriction on selection of a primary stress-
bearing area.
In spite of impression procedures, the crestal area of the
residual ridge will become the primary stress-bearing area
for vertically directed forces
DESIGN OF THE PROSTHESIS

 Rotational forces on the ridge in distal extension bases

can be controlled by the design
 The most efficient method to control rotational stress is
by using one or more indirect retainers anterior to the
fulcrum line.
 Steffel and Kratochvil have suggested that as the
rotational axis is moved from a disto-occlusal rest to a
more anterior location, more of the residual ridge
receives vertically directed occlusal forces to support the
denture base. They suggested that occlusal rests may be
moved anteriorly to better use the residual ridge for
support without jeopardizing either vertical or horizontal
support of the denture by occlusal rests and guiding
planes
 AMOUNT OF TISSUE COVERAGE OF
DENTURE BASE

 Broad stress distribution- i.e. the broader the surface area

coverage of the edentulous ridge greater is the distribution of
load.
 All available space must be used without encroaching on
movable tissues
 Kaires has shown that “maximum coverage of denture-
bearing areas with large, wide denture bases is of the
utmost importance in withstanding both vertical and
horizontal stresses.”
 ANATOMY OF THE DENTURE BEARING AREAS

 Occlusal forces must be directed to the portions of the ridge

that are capable of withstanding those forces
 Maxillary edentulous ridge
Crest of the ridge
Hard palate
 Mandibular edentulous ridge
Buccal shelf area
Slopes of the ridge
 FIT OF DENTURE BASE

 To derive optimum support from stress bearing areas,

accurate fit of denture is mandatory.
TYPE AND ACCURACY OF THE IMPRESSION
REGISTRATION
 Anatomic form; A single impression with medium
body/regular body/monophase elastomeric impression
material using a custom tray is the preferred technique.
Putty with light body wash . Irreversible hydrocolloid –
alginates, may also be used.
 Functional form A dual impression technique is used
along with a combination of impression materials – one
that records the teeth in anatomic form and the other that
records the residual ridge in functional form
 McLean and others recognized the need to record the
tissues that support a distal extension removable partial
denture base in their functional form, or supporting state,
and then relate them to the remainder of the arch by
means of a secondary impression
 Steffel has classified advocates of the various methods
for treating the distal extension removable partial denture
as follows:
1. Those who believe that ridge and tooth supports can
best be equalized by the use of stress-breakers or
resilient equalizers.
2. Those who insist on bringing about the equalization of
ridge and tooth support by physiologic basing, which is
accomplished by a pressure impression or by relining of
the denture under functional stresses.
3. Those who uphold the idea of extensive stress
distribution for stress reduction at any one point.
HISTORY
 MCLEAN 1936 - Mclean Technique
 SPRENG 1936 – Chewing impression

Soft gutta percha in valcanite tray molded by chewing

pressure and related to metal framework by plaster
impression
 APPLEGATE 1937 – Fluid wax technique

 HINDLE 1952 – Hindle’s technique

 STEFFEL 1954 – Functional reline technique

 BOUCHER 1963 – TISSUE CONDITIONER as

functional impression material
 LEUOPOLD, KRATOCHVIL,1965 – Aletered cast
procedure;wash out impression by ZOE
 HOLEMS 1970 – similar procedure but impression
material was light body elastomer.
 RAPUNO 1970 – Single tray dual impression technique

 PREISKEL 1971, BLATTERFEIN 1980 – Functional

impression technique for distal extansion cases having
precision attachment
REVIEW OF LITRATURE
 Farhad Vahidi, 1978 -The amount of soft tissue
displacement caused by an impression procedure
depends upon tissue resiliency, proximity to abutment
teeth, and nature of the impression material. The
histologic characteristics of the soft tissue are also
factors which influence the amount of tissue
displacement.
 BAUMAN, 1982- Modification of altered cast
technique in order to overcome the problem of
sectioning of the master cast. Trays attached to
framework in edentulous region. Border molding with
low fusing compound & impression with elastic
material. Wax occlusal rim attached to superior surface
of the tray, reduced short of contact with opposing teeth
& low fusing compound is added & CR recorded. With
tray & rims in mouth an overall alginate impression is
made in stock tray. Reproduces functional form of the
ridge, anatomic form of teeth & jaw relation record as
well
 FITZOLF 1984- Used thermoplastic resinous materials e.g.
Adaptol and Stalite when placed in water bath become
fluid , can be painted on the surface of the tray & functional
molding is carried out.
 LEUPOLD 1966- Compared mucosal displacement &
denture base adaptation with anatomic impression in
alginate & functional impression with altered cast technique.
He concluded that alginate impression distorted loose
mucosal tissue more than altered cast procedure. Distortion
is maximum in retromolar region. Denture bases on altered
cast showed better adaptation.
 FISHER 1983- studied type of impression registration
with respect to material used. Materials were ZnOE paste
, light or regular body rubber base and fluid wax. The
denture base stability was best with rubber base
elastomer than the other two.
 Richard J. Leupold et al 1992 - Compared of vertical
movement occuring during loading of distal extension
removable partial denture bases made by three
impression extension removable partial denture bases
made by three impression technique.
Impression techniques compared were
 Altered cast impression

 An impression made from a border molded custom tray

 Stock tray irreversible hydrocolloid impression

 The 0.19mm difference between altered cast & border molded

custom tray was statistically significant but clinically irrelevant.

JARVIS 1995 - Soft tissue displacement during impression

making may partially be controlled through placement of relief and
escape holes in the tray. Viscosity of the impression material also
determines the displacement of soft tissue.
 Anand U Madihalli in 2011 - compared Hindels
method, selective tissue placement method and
functional reline method and conclude that Tissue
placement was maximum in the posterior region,
followed by the middle region and least in the anterior
region of the mandibular ridge for all three methods.
Selective tissue placement method showed the maximum
overall tissue placement followed by the Hindels method
and minimum placement was by functional reline
method
DUAL IMPRESSION TECHNIQUES

The method of recording the ridge using two

impressions, i.e. one portion in functional form and the other
in the anatomic form, is known as dual impression technique.

Residual
ridge

Anatomic impression

Functional impression
 ANTOMIC
IMPRESSION
• used to record the teeth
• Anatomic form is the
surface contour of the ridge
when it is not supporting
an occlusal load.
FUCTIONAL
IMPRESSION
• used to record the edentulous
ridge.
• Functional form is the form of
the residual ridge recorded
under some loading or
compression. This could be
achieved by occlusal loading,
finger loading, specially
designed individual trays or
consistency of recording
medium.
INDICATIONS FOR DUAL IMP. TECH

 Distal extention cases (class I and II) esp. mandibular .

 Long span anterior edentulous ridge (class IV)

METHODS

DUAL IMPRESSIONS can be broadly classified as :

• Physiologic Impression
 Pick up impressions
• McLean’s technique
• Hindel’s modification
 Functional relining method
 Fluid wax technique

• Selective Pressure Impression

PHYSIOLOGIC IMPRESSION
TECHNIQUES

Physiologic impression techniques record the ridge

portion of the cast in its functional form by placing an
occlusal load on the impression tray during the
impression procedure.
MCLEAN’S TECHNIQUE
PRINCIPLE –
Functional impression of the edentulous ridge is made and a
second impression is made OVER the functional impression & it
records the structures in their anatomic form.

The second impression is known as PICK-UP IMPRESSION.

PROCEDURE
A custom tray is fabricated over the distal extension base area with
wax occlusal rims.

.
 The tray is loaded & inserted into the patient’s mouth
and the functional impression of the distal extension
ridge is made
An alginate over-impression is made using a large stock tray without
removing the custom tray. Finger pressure is applied on the stock
tray over the area of the custom tray.

When removed, the alginate over impression carries the functional

impression along with it.
Now a cast is poured which reproduces the teeth in anatomic form and
tissues in functional form.
DRAWBACKS –

The greatest weakness of the technique was that

practitioners could not produce the same functional
displacement generated by occlusal forces.
HINDEL’S MODIFICATION
Hindels developed stock tray with a large hole on either side
posteriorly so that the finger pressure could be directly applied to
the first imp. through the holes on the tray.

With the set funtional impression in the mouth the second over-
impression is made using special stock tray with large holes using
alginate, maintaining finger pressure till the material sets.
DISADVANTAGES
 Since the tissues are recorded in compressed state, if clasp
retention is good soft tissues are constantly displaced
interruption of blood supply to the ridges hence there will be
excessive bone resorption.
 If the retentive clasp do not hold the denture base properly
the partial denture will be slightly occlusal to the normal
position causing premature contact during occlusion with the
opposing teeth which is uncomfortable to the patient.
FUNCTIONAL RELINING METHOD

This is done after the fabrication of metal framework and

denture base. It consists of adding a new layer to the intaglio or
tissue surface of the denture base.

It is done at the time of insertion of prosthesis or when the

prosthesis no longer fits the ridge adequately due to resorption of
bone.
PROCEDURE –

1. A framework is constructed on the cast made from single

impression(anatomic impression).

2. A soft metal spacer (Ash no. 7) is

adapted on the cast to provide space
for impression material
before making framework.

3.Using greenstick compound the border extensions /Low-fusing

modeling plastic is applied to the intaglio of the denture base,
tempered in a water bath, and seated in the patient's mouth. This
sequence must be repeated until an accurate impression of the
edentulous ridge has been accomplished .
 The border extensions are determined by heating to the borders
and guiding the placement of the cheek and tongue.

 To provide space for the impression material, 1 mm of modeling

plastic is removed from the intaglio surface.

 Final impression is made with free flowing zinc oxide eugenol

paste or light body elstomer.

 If errors in occlusion are slight, the correction may be

accomplished in the mouth. However, in a majority of cases, it will
be necessary to remount the partial denture on an articulator to
correct the occlusion.
ADVANTAGES –

 Superior fit of the denture.

 Tissue surface of the metal framework can be relined after
insertion.
 Amount of soft tissue displacement can be controlled by the
amount of relief given.

DISADVANTAGES –

 Difficult to maintain relationship of the framework with

abutment teeth while making impression.
 Occlusion is affected due to addition of new layer on the
tissue surface.
FLUID WAX FUNCTIONAL IMPRESSION

PRINCIPLE –

The framework fabricated on the cast is converted into a special tray

and a fluid wax impression is made.

USES –

• Reline the tissue surface of an existing RPD.

• Correct the distal extension edentulous ridge of the original master
cast.
OBJECTIVES –

To obtain max. extension of the peripheral borders of the denture

without interfering the movable tissues.

To record the stress bearing areas in functional form.

To record the non-stress bearing areas in anatomic form.

MATERIALS USED –

Fluid waxes are firm at room temp. and have ability to flow at
mouth temp.

Iowa wax (by Dr. Smith)

Korrecta wax No. 4 (by Dr. OC & SG Applegate)
No. 4 has more flow than Iowa wax

 The use of fluid wax requires control of the critical

factors of space and time.
 Space refers to the amount of relief provided between
the impression tray and the edentulous ridge
 The relief should be atleast 1-2 mm.
PROCEDURE –

 water bath maintained at 51 °C to 54°C (125°F to 130°F), into

which a container of the wax is placed . At this temperature the
wax becomes fluid.

 The wax is painted on the tissue side of the impression tray , the
borders must be 2 mm short, tray is seated in patients mouth for
about 5 minutes.

 The tray is removed and the wax is examined for tissue contact
(glossy/dull).
 When the impression evidences complete tissue contact
and when the anatomy of the limiting border structures is
evident , the impression should be replaced in the mouth
for a final time(for 5mins to ensure complete flow and
release of stresses).

 The finished impression must be poured immediately, as

the wax is fragile and subjected to distortion.
ADVANTAGE:

Produces accurate impression if tech. is properly followed.

DISADVANTAGE:

Time consuming and If time periods not followed accurately

excessive tissue displacement occur.
SELECTIVE PRESSURE FUNCTIONAL DUAL
IMPRESSION TECHNIQUE
The selective pressure impression technique attempts to direct
more force to those portions of the ridge to absorb the stress
without adverse response and to protect the areas of the ridge
least able to absorb force, to achieve this the tissue surface of
the tray is selectively relieved.

Based on clinical observation –

a. Histological nature of tissue that cover the residual ridge
bone.
b. The nature of residual ridge bone
c. Its positional relationship to the direction of stress that will
be placed on it.
 For the mandibular posterior region, the crest of
the ridge is not considered to be a pressure bearing area.so
the undersurface of the tray is relieved down to the metal
retention struts. This will usually be atleast 1 mm.
In some patients the soft tissue covering the ridge will be softer and
easily displaced. To obtain more relief and prevent excessive tissue
displacement , holes may be made through the impression tray to
permit the impression material to flow through and dissipate
pressure that might otherwise occur.

Reason;
Over displacement of tissue may result inflammatory reaction, and
sometimes displaced tissue tends to rebound to its former position
putting additional stress on abutment teeth.
 impression materials ; A more viscous impression
material results in greater displacement of the soft
tissues, while a less viscous impression material provides
decreased tissue displacement.

Zinc oxide-eugenol;
Zinc oxide-eugenol paste is generally considered to be the
impression material of choice if the edentulous ridge is free
from gross undercuts. It is particularly effective when soft,
flabby tissue is involved.
 Rubber base; Polysulfide rubber base impression
materials are excellent for use with the selected pressure
impression tech.

Rubber base impression material is particularly a propriate

for those patients displaying moderate to severe undercuts
of the edentulous ridge.
 This procedure is similar to the ridge correction
technique, except for the spacer provided for the special
tray.
 In this technique no spacer is provided and a close
fitting special tray is fabricated on the distal extension
ridge on the denture base minor connector.
 After border moulding with low-fusing green stick
compound, final impression can be made
ALTERED CAST TECHNIQUE

This is done for functional reline, fluid wax, functional selective

pressure dual impression techniques.In all these techniques
anatomic master cast is altered to accommodate new ridge
impression hence called altered cast technique.

Disadvantages:
1.More number of steps involved.
2.Difficult procedure
TECHNIQUE:
 The edentulous area in master cast is cut with the saw.
 Two cuts are made one buccolingual & other
anterioposterior
 Buccolingual cut is made 1mm behind the terminal
abutment & anterioposterior cut is made 1mm lingual to
lingual sulcus
 Vertical grooves are prepared on cut wall

 The framework along with the funtional impression is

placed on the cut master cast
 Framework is sealed & cast is inverted

 Beading & boxing is done & cast is pored

 The resulting cast will have altered ridge contour obtained

from funtional impression.
A favorably extended base will provide stimulation to the
underlying bone and distribute forces uniformly. The
altered cast technique allows the ridge, recorded in
functional form, to be related to the teeth so that when
the prosthesis is seated, it derives support simultaneously
from the teeth and the denture base.
A MODIFICATION OF THE ALTERED CAST TECHNIQUE
RICHARD BAUMAN, D.D.S.,* AND JAMES DEBOER, D. D.S. **

U. S. ARMY DENTAC, FT. CARSON, COLA .

 1. Attach an acrylic resin tray to the framework of the
partial denture in the edentulous area, and add a wax
occlusion rim to the tray .
 2. Functionally border mold the tray using green stick
modeling compound .
 3. Make a corrective wash impression of the edentulous
ridge. Elastic impression materials or fluid wax may be
used according to the preferences of the dentist . Care
must be taken to ensure that all occlusal rests are firmly
seated while the corrective impression is being made.
 Reduce the occlusion rim which is attached to the resin tray
after the impression material has set so that the rim is short of
contact with the opposing teeth.
 Add green stick modeling compound to the rim and make a
centric jaw relation record.
 Thoroughly chill the occlusal record and replace the prosthesis
in the mouth.
 Select a tray and make an irreversible hydrocolloid impression
over the prosthesis and remaining teeth. Placement of the
dentist’s fingers at the border of the edentulous ridge provides
sufficient support to ensure that the two phases of the
impression will not separate when the tray is withdrawn.
 Pour a completely new master cast into the combined
impression. After the stone has set, remove the metal
tray and irreversible hydrocolloid impression material.
Care must be taken to avoid damaging the jaw relation
record which is embedded in the irreversible
hydrocolloid impression.
 Mount the new master cast on the articulator by means
of the interocclusal record. Arrange the teeth and process
the denture base.
SUMMARY:
 Partial denture impression must accurately register the
relatively soft yielding tissues and at the same time
record the hard unyielding tissues.
 Hard structures are irregularly contoured as well as
varying in their vertical position relative to the occlusal
plane so the impression material must be capable of
contouring into intimate contact with each crown surface
and withstand the momentary distortion which occurs as
the impression is withdrawn, and instantly spring back to
its original form without distortion or rupture.
RFERENCES:

 Stewart’s Clinical Removable Partial Prosthodontics 4th Edition

 McCracken’s Removable Partial Prosthodontics 11th Edition
 A combination impression and occlusal registration technique for
extension-base removable partial dentures ;William B. Akerly
 An altered cast procedure to improve tissue support for removable
partial denture;CHANDRASHEKAR SAJJAN
 A COMPARATIVE STUDY OF IMPRESSION PROCEDURES FOR DISTAL
EXTENSION REMOVABLE PARTIAL DENTURES ;ROBERT J. LEUPOLD, C
 Vertical displacement of distal-extension ridges by dual impression
techniques ;Farhad Vahidi, D
 A Comparative Study of Impression Procedures for Distal Extension
Removable Partial Dentures Anand U Madihalli
 A modification of alterd cast techinque ; Richard Bauman jpd
1982(47)2,212-213.
Thank you