SPECIAL IMPRESSION PROCEDURES
FOR TOOTH-TISSUE–SUPPORTED
REMOVABLE PARTIAL DENTURES AND
SUPPORT FOR DISTAL EXTENSION
CASES.
DR. SPOORTHY
II MDS
CONTENTS:
• Introduction
• History
• Distal extension removable partial denture
• Factors influencing the support of a distal
extension base
• Preparing the Master
• Anatomic form impression
• Methods for obtaining functional support for the
cast
distal extension base
• Impression materials
• Correcting the master
Physiologic or Functional Impression
McLean’s physiologic impression technique
cast
Modification by Hindel
Functional relining technique
• Altering the master cast
The Fluid wax technique
Selective tissue placement Impression procedure.
• Conclusion
• References
2
INTRODUCTION
HISTORY
• Steiger (1959) demonstrated that mucosa is 4-20 times more compressible than the
PDL. The difference in settlement can produce rocking of the denture
• To improve stability, Applegate’s (1955) proposed the theory of physiologic basing.
According to this philosophy, the tissues should be recorded in a compressed state so
that the denture will adapt closer to the contours of the bone.
• Holmes (1965) showed that dentures made from alginate impression will sink more
(0.9mm) than those made from wax impression (0.1mm). Hence wax/rigid impression
materials are preferred for distal extension RPDs.
• Kratochvil (1963) and Henderson (1970) recommended the use of I – bar or RPI
system for distal extension cases to avoid uneven forces on the mucosa. 4
• Kramer & Singer used a double impression technique based on load
distribution by Hindel
• McCracken concluded that a functional technique should be used when
constructing mandibular distal extension based partial denture
5
DISTAL EXTENSION DENTURE BASE
6
• Oliver C. Applegate, An evaluation of the support for the removable
partial denture; The Journal of Prosthetic Dentistry Volume 10, Issue 1,
January–February 1960, Pages 112-123
7
FACTORS INFLUENCING THE SUPPORT OF A DISTAL
EXTENSION DENTURE BASE
• Contour and quality of the residual ridge
• Extent of residual ridge coverage by the denture base
• Type and accuracy of the impression registration
• Accuracy of the fit of the denture base
• Design of the removable partial denture framework
• Total occlusal load applied
8
[Link] AND QUALITY OF RESIDUAL RIDGE
The ideal residual ridge to support a denture base would consists of
cortical bone that covers relatively dense cancellous bone, with a
broad rounded crest with high vertical slopes, and is covered by firm,
dense, fibrous connective tissue.
Such residual ridge would optimally support vertical and horizontal
stresses placed on it by denture bases.
9
The crest of the bony mandibular residual ridge is most often
cancellous
10
The crestal area of the residual ridge will
become the primary stress bearing area to
the vertically directed forces.
The palatal tissues between the medial
palatal raphe and the lingual slopes of the
posterior edentulous ridge are readily
displaced and cannot be considered as
primary stress bearing area.
11
[Link] OF RESIDUAL RIDGE COVERAGE BY DENTURE BASE
• The broader the residual ridge coverage the greater is the distribution of the load...
•
12
• Hindels GW. Stress analysis in distal extension partial dentures. The
Journal of Prosthetic Dentistry. 1957 Mar 1;7(2):197-205.
13
3. TYPE AND ACCURACY OF IMPRESSION REGISTRATION
• The residual ridge may have two forms
1. The Anatomical form
2. The functional from
14
4. ACCURACY OF THE FIT OF THE DENTURE BASE
• Support of the distal extension base is enhanced by the intimacy of
contact of the tissue surface of the base and the tissue that cover the
residual ridge
15
5. DESIGN OF THE PARTIAL DENTURE FRAMEWORK
• Some rotation movement of the distal extension base at the distal
abutment is inevitable under functional loading.
16
6. TOTAL OCCLUSAL LOAD APPLIED
• The support from the residual ridge should be optimized
and shared appropriately with the remaining natural
dentition.
• The number of artificial teeth, the width of their occlusal
surfaces, and their occlusal efficiency influence the total
occlusal load applied to the removable partial denture.
• The reduction of the size of the occlusal table reduces the
vertical and horizontal forces that act on the removable
partial dentures and lessens the stress on the abutment
teeth
17
• HOLMES JB. INFLUENCE OF IMPRESSION PROCEDURES AND OCCLUSAL
LOADING ON PARTIAL DENTURE MOVEMENT. J Prosthet Dent. 1965 May-
Jun; 15:474-83.
18
• [Link], Load distribution in extension saddle partial
dentures;1952. J Prosthet Dent. 2001 Apr;85(4):324-9
19
IMPRESSION MATERIALS
ELASTIC MATERIALS: REVERSIBLE AND
IRREVERSIBLE HYDROCOLLOIDS
RIGID MATERIALS: PLASTER OF PARIS AND
ZOE
THERMOPLASTIC MATERIALS:
MODELLING PLASTIC AND IMPRESSION
WAXES
RUBBER BASE: POLYSULPHIDE,
POLYETHER AND SILICONE
ANATOMIC IMPRESSION FORM
• One stage impression using an elastic
impression material that does not
represents the functional relationship
between the various supporting
structures of the partially edentulous
mouth.
• Only represents hard and soft tissues at
rest
25
FUNCTIONAL IMPRESSION FORM
• The proponents of functional impression put greater emphasis on the tissue
compression to get a registration of “functional ridge form” in order to place
load properly on the ridge and there by minimizing the cantilever action on
the abutment.
26
• OBJECTIVES OF FUNCTIONAL IMPRESSION : (O. C.
Applegate)
• INDICATIONS:
27
METHODS FOR OBTAINING FUNCTIONAL SUPPORT FROM DISTAL
EXTENSION BASE:
• Mc Leans Technique
PHYSIOLOGIC
• Hindel’s method
IMPRESSION
TECHNIQUES • Functional Reline method
• Fluid wax method
SELECTIVE • Equalizes the support
PRESSURE between the abutment
IMPRESSION teeth and the soft tissue
METHOD
28
MC LEAN’S PHYSIOLOGIC METHOD
29
• Disadvantages:
30
MC LEAN’S–HINDEL MODIFICATION
The special tray used
to record supporting
tissues under rest- A special stock tray with
The special tray with Anatomical impression two large holes is used
an occlusal rim is
The special tray with to make the over
fabricated.
impression is left impression.
untouched in the
patient’s mouth
31
• Disadvantages of Hindel’s modification:
32
• Rapuano JA. Single-tray dual-impression technique for distal extension partial
dentures. J Prosthet Dent. 1970 Jul;24(1):41-6
33
34
FUNCTIONAL RELINE METHOD
35
36
• Advantages:
• Disadvantages :
37
CORRECTED CAST PROCEDURE
•• Wu J, Cheng Y, Gao B, Yu H. A novel digital altered cast
impression technique for fabricating a removable partial
denture with a distal extension. The Journal of the American
Dental Association. 2020 Apr 1;151(4):297-302.
BORDER MOLDING THE IMPRESSION TRAY
RELIEVING THE TRAY AND MAKING THE
IMPRESSION
FLUID WAX FUNCTIONAL IMPRESSION
• The most frequently used waxes are –
1. Korrecta wax No. 4 – Dr. O.C & S.G. Applegate at university
of
Michigan
2. IOWA wax – Developed by Dr. Smith at University of IOWA
43
To obtain maximum extension of
peripheral borders while not interfering
with function of movable border
tissues.
OBJECTIVE
To record non-stress bearing To record stress-bearing areas in
areas in their anatomic form. functional form
44
PROCEDURE
FABRICATING THE SPECIAL TRAY IMPRESSION MAKING
45
FABRICATION OF SPECIAL
TRAY
The framework is positioned on the master cast then the
outline of the tray is drawn on the master cast
The cast is then coated with the separating media and
spacer is adapted on the ridge using the baseplate wax
The framework is positioned over the spacer and
Auto-polymerising resin is adapted over the
framework.
Excess material is removed or trimmed
before the resin hardens
46
IMPRESSION
MAKING
Wax is softened in the water bath at 51-54 ℃
The softened wax is painted evenly on the tissue
surface of the impression tray with the brush.
The tray is seated and held in position with three
fingers. The patient should keep his mouth half
open for at least 5 minutes to ensure cooling and
hardening of wax.
The impression is examined and the cast is poured
using altered cast technique
47
• Vahidi F. Vertical displacement of distal-extension ridges by different
impression techniques. J Prosthet Dent. 1978 Oct;40(4):374-7.
48
SELECTIVE TISSSUE PLACEMENT IMPRESSION METHOD
49
50
• Dumbrigue HB, Esquivel JF. Selective-pressure single impression procedure
for tooth-mucosa-supported removable partial dentures. J Prosthet Dent.
1998 Aug;80(2):259-61.
51
52
PREPARING THE MASTER CAST
• Correcting the master cast
• Altering the master cast
53
ALTERING THE MASTER CAST
Edentulous areas are cut from the master
cast
Framework with attached impression seated
on the master cast
The impression is beaded and boxed in
continuity with cast
The resultant master cast will have an
altered ridge contour obtained from the
functional impression
54
• Sajjan C. An altered cast procedure to improve tissue support for
removable partial denture. Contemp Clin Dent. 2010 Apr;1(2):103-6.
55
• LEUPOLD RJ, KRATOCHVIL FJ. AN ALTERED-CAST PROCEDURE TO IMPROVE
TISSUE SUPPORT FOR REMOVABLE PARTIAL DENTURES. J Prosthet Dent.
1965 Jul-Aug;15:672-8.
56
• Lefrançois E, Delanoue V, Morice S, Ravalec X, Desclos-Theveniau M.
A Digital Approach for a Complete Rehabilitation with Fixed and Removable
Prostheses: A Technical Procedure. Dentistry Journal. 2024 Dec 25;13(1):7
57
•• Fueki K, Inamochi Y, Wada J, Arai Y, Takaichi A,
Murakami N, Ueno T, Wakabayashi N. A systematic review of
digital removable partial dentures. Part I: Clinical evidence,
digital impression, and maxillomandibular relationship record.
Journal of prosthodontic research. 2022;66(1):40-52.
•• Ishioka Y, Wada J, Kim EY, Sakamoto K, Arai Y,
Murakami N, Yamazaki T, Takakusaki K, Hayama H, Utsumi M,
Inukai S. Morphological comparison of residual ridge in
impression for removable partial denture between digital and
conventional techniques: a preliminary in-vivo study. Journal
of Clinical Medicine. 2023 Nov 15;12(22):7103.
•• Lefrançois E, Delanoue V, Morice S, Ravalec X, Desclos-
Theveniau M. A Digital Approach for a Complete
Rehabilitation with Fixed and Removable Prostheses: A
Technical Procedure. Dentistry Journal. 2024 Dec 25;13(1):7.
•
•
CONCLUSION
REFERENCES:
• Clinical removable prosthodontics – STEWART’S 3rd edition
• Mc Cracken removable partial denture prosthodontics – 11th edition
• Oliver C. Applegate, An evaluation of the support for the removable partial
denture; The Journal of Prosthetic Dentistry Volume 10, Issue 1, January–February
1960, Pages 112-123
• Hindels GW. Stress analysis in distal extension partial dentures. The Journal of
Prosthetic Dentistry. 1957 Mar 1;7(2):197-205.
62
• [Link], Load distribution in extension saddle partial dentures;1952. J
Prosthet Dent. 2001 Apr;85(4):324-9
• HOLMES JB. INFLUENCE OF IMPRESSION PROCEDURES AND OCCLUSAL LOADING
ON PARTIAL DENTURE MOVEMENT. J Prosthet Dent. 1965 May-Jun; 15:474-83.
• Rapuano JA. Single-tray dual-impression technique for distal extension partial
dentures. J Prosthet Dent. 1970 Jul;24(1):41-6
• Vahidi F. Vertical displacement of distal-extension ridges by different impression
techniques. J Prosthet Dent. 1978 Oct;40(4):374-7.
63
• Sajjan C. An altered cast procedure to improve tissue support for removable partial
denture. Contemp Clin Dent. 2010 Apr;1(2):103-6.
• Dumbrigue HB, Esquivel JF. Selective-pressure single impression procedure for tooth-
mucosa-supported removable partial dentures. J Prosthet Dent. 1998 Aug;80(2):259-61.
• LEUPOLD RJ, KRATOCHVIL FJ. AN ALTERED-CAST PROCEDURE TO IMPROVE TISSUE
SUPPORT FOR REMOVABLE PARTIAL DENTURES. J Prosthet Dent. 1965 Jul-Aug;15:672-8.
• James JS. A simplified alternative to the altered-cast impression technique for removable
partial dentures. J Prosthet Dent. 1985 Apr;53(4):598.
64
T H A N K YO U
