Single&y dual-impression technique for distal

extension partial dentures

Joseph A. Rapuano, D.D.S.*

New Jersey College of Medicine and Dentistry, Jersey City, N. J,

D istal extension partial dentures are supported

and by the resilient mucosa and underlying
by both the relatively
bone which are covered by the free-end
rigid teeth

denture base of the partial denture. In order to best preserve the teeth, soft tissue,
and bone, the partial denture must be made taking full advantage of these structures
but with abuse to none of them. If the partial denture is made incorrectly, the teeth
will loosen, and the ridges will resorb.
Many investigators feel that a functional impression technique is one of the
major steps the dentist can take to achieve the most favorable prognosis for the
distal extension removable partial denture. Hindelsl feels that the free-end denture
base under masticatory load should be related to the metal framework when it is
finally seated. Applegate uses impression wax to load functionally the residual
ridges. Holmes3 used four different kinds of materials with the altered cast tech-
nique. He found that Korecta-wax IV+ impressions moved the least. Leupold and
Kratochvil* used zinc oxide and eugenol impression paste to record the shape of
the residual ridges and found it to be a satisfactory functional technique. Kramer5
and Singer6 used a double impression technique based on the load distribution
principle described by Hindels. Henderson and Seward? showed that abutment teeth
of a removable partial denture situated farthest from the point of force to the den-
ture base participate the least in resisting that force. McCracken8 concluded that a
functional technique should be used when constructing mandibular distal extension
partial dentures.
This article describes a functional impression technique for making distal ex-
tension removable partial dentures. This technique is based philosophically on
Hindels’ load distribution principle, 1 but it uses a dual impression procedure in a
single tray.

*Associate Professor, Department of Prosthodontics.

tKerr Manufacturing Company, Detroit, Mich.

41
42 Rapuano

Fig

Fig. 1. The anterior teeth on the dia,gnostic c‘asr are blocked nut with three to four layer< f/!
asbestos paper.
Fig. 2. The cold-curing resin is adapted on the diagnostic cast to form the custom tray.
Fig. 3. An opening has been made around the teeth in the resin custom tray. Serial perfora~
tions surrounding the teeth allow the impression material to be attached to the tray.
Fig. 4. The custom tray is seated in the patient’s mouth. Note the accessibility of the teeth.

MAKING THE CUSTOM TRAY

An irreversible hydrocolloid impression is made that includes the mandibular
teeth and residual ridges. A diagnostic cast is obtained which is surveyed for the
design of the removable partial denture. A custom resin tray also is constructed on
this cast.
The teeth and adjacent tissue on the diagnostic cast are relieved with four thick-
nesses of asbestos paper (Fig. 1) . A resin separating medium is applied to the cast,
and a cold-curing resin is adapted over the relieved teeth and. residual ridges (Fig.
2). When the resin has set, the tray is removed from the cast, trimmed, and pol-
ished. The tray is tried in the patient’s mouth to verify the accuracy of its fit. The
borders are sufficiently reduced to allow space for border molding.
The part of the tray covering the teeth is removed completely. The opening is
quite broad due to the thickness of the asbestos-paper space. The tray is serially
perforated around the teeth with a No. 8 round bur. The holes are made about 3
mm. apart (Fig. 3).
When the tray is placed in the patient’s mouth, all the surfaces of the teeth
should be visible. Approximately 2 to 3 mm. of space should exist between the in-
ternal surface of the tray and the teeth (Fig. 4).
 Volume 24 Impression technique for dentures 43
Number 1

Fig. 5 Fig. 6

Fig. 7 Fig. 8

Fig. 5. The border of the tray has been molded to be in harmony with the movements of the
surrounding tissues.
Fig. 6. A zinc oxide and eugenol impression is made of the residual ridges.
Fig. 7. The final impression of the residual ridges is completed.
Fig. 8. An occlusion rim is constructed on the resin tray containing the final impression of the
residual ridges.

IMPRESSION OF THE RESIDUAL RIDGES

The borders of the tray are molded in the edentulous regions (Fig. 5)) and then
an impression of the residual ridges is made using a zinc oxide and eugenol impres-
sion paste (Figs. 6 and 7).

OCCLUSION RIMS FOR DYNAMIC IMPRESSIONS

When the maxillary opposing dental arch is edentulous, a wax occlusion rim is
fabricated on the maxillary master cast. The plane of occlusion is adjusted parallel
with the interpupillary line in the anterior region and to the alatragus line in the
posterior regions. The correct vertical dimension of occlusion is established. Then,
four nonparallel shallow V-shaped notches are cut into the posterior aspect of the
maxillary occlusion rim.
A wax occlusion rim is made on the edentulous part of the lower resin tray con-
taining the final impression (Fig. 8). A wax interocclusal centric relation record is
made at the patient’s predetermined vertical dimension of occlusion. By this pro-
cedure, the surfaces of the maxillary and mandibular occlusion rims will fit together
at the vertical dimension of occlusion and in centric relation. The rims will not
 44 Rapuano

Fig. 9 Fig.

Fig. I1 Fig. 12

Fig. 9. The maxillary and mandibular occlusion rims are in contact at the vertical dimension
of occlusion. The mandible is in centric relation. The anterior part of the maxillary occhuion
rim has been removed so that the irreversible hydrocolloid can be inrced through the opening
in the tray while the residual ridges arc resisting occlusal forces.
Fig. 10. Irreversible hydrocolloid impression material has been forced through the opening in

the tray.
Fig. 11. The single-tray dual-material impression is completed.
Fig. 12. A cIoseup view of the two materials just distal to the abutment tooth shows that the
tissue is under occlusal load.
Fig. 13. The master cast has been recovered from the final impression.

move when in occlusion due to the locking effect of the nonparallel maxillary V-
shaped notches (Fig. 9).
The anterior part of the maxillary occlusion rim is moved down to the resin tray.
The space created permits the insertion of impression material around the lower
teeth through the opening in the mandibular resin tray (Fig. 9).

THE IMPRESSION OF THE MAfdDIBULAR TEETH

The maxillary and mandibular posterior wax planes are placed in the patient’s
mouth, and the mandible is guided into the centric relation record, The occlusion
rims are in intimate contact over the total length of the residual ridges. The pa-
Volume 24 Impression technique for dentures 45
Number 1

Gent is instructed to close forcefully on the occlusion rims. If the closing force is
strong, the rims should be made of a resistant material such as modeling compound.
The impression of the teeth is made with an irreversible hydrocolloid impression
material. Cold water is used to prolong the setting time. The impression material
is loaded into a plaster gun, and the teeth are painted through the large opening in
the tray with the impression material. Then, the impression material in the plaster
gun is injected through the same opening. The impression material is forced to flow
around the teeth and through the multiple perforations in the tray. Once the in-
jection is completed, the border molding is completed (Fig. 10) .
After the impression material has set, the impression is removed (Figs. 11 and
12). If the impression has imperfections, it can easily be made again. An accept-
able single-tray dual-material impression is boxed, and the master cast is poured
(Fig. 13).

INTERNAL ATTACHMENT DISTAL EXTENSION REMOVABLE PARTIAL

DENTURE IMPRESSION
The same technique is excellent for an internal attachment distal extension
removable partial denture. However, quick-setting plaster is used instead of the
irreversible hydrocolloid material. The plaster is injected through the opening in the
tray, and it will flow around the abutment crowns. When natural teeth remain be-
tween the abutment crowns, the undercuts can be relieved before the plaster is in-
jected. This impression positions the functionally loaded residual ridges to the
abutment crowns which will house the internal attachments of the removable partial
denture.

SUMMARY AND CONCLUSIONS

A technique has been presented for the distal extension removable partial den-
ture that records the residual ridges dynamically and the remaining teeth statically.
Some of the advantages of this procedure are as follows: ( 1) The denture bases are
functionally loaded by the patient as he closes his jaws in centric relation at the
proper vertical dimension of occlusion. This fo’rce simulates the functional load that
will be placed on the finished removable partial denture; (2) the functional load
is applied along the entire length of the posterior occlusion of the removable partial
denture; (3) a second tray is not needed; (4) the dual-material single-tray tech-
nique produces a less bulky final impression from which a master cast can be poured;
and (5) internal attachment distal extension removable partial dentures have a
definite, accurate, functional relationship between the residual ridges and the abut-
ment crowns when this procedure is used.

References
1. Hindels, G. W.: Load Distribution in Extension Saddle Partial Dentures, J. PROS. DENT.
2: 92-100, 1952.
2. Applegate, 0. C.: Essentials of Removable Partial Denture Prosthesis, ed. 2, Philadelphia,
1959, W. B. Saunders Company, pp. 230-244.
3. Holmes, J. B.: Influence of Impression Procedures and Occlusal Loading on Partial Denture
Movement, J. PROS. DENT. 15: 474-483, 1965.
4. Leupold, R. J., and Kratochvil, F. J.: An Altered-Cast Procedure to Improve Tissue Sup-
port for Removable Partial Dentures, J. PROS. DENT. 15: 672-678, 1965.
46 Rapuano .I, Pros. Dent.
July, 197ri

5. Kramer, H. M.: Impression Technique for Removable Partial Dentures, J. PROS. Dmx
11: 84-92, 1961.
6. Singer, F.: Functional Impressions and Accurate Interocclusal Records for Removable Par-
tial Dentures, J. PROS. DENT. 12: 536-541, 196:‘.
7. Henderson, D., and Seward, T. E.: Design and Force Distribution With Removable Partial
Dentures: A Progress Report, J. PROS. DENT. 17: 350-364, 1967.
8. McCracken, W. L.: Partial Denture Construction, ed. 2, St. Louis, 1964, The C. V. Moshy
Company, pp. 300-337.

NEW JERSEY COLLEGE OF MEDICINE ASD DENTISTRY

24 BALDWIN AVE.
JERSEY CITY, N. J. 07304