Chapter 4

4. Final Impression for Partially Edentulous Cases

inal impression of RPD is made after carrying-out the different steps

of mouth preparation. The primary purpose of definitive impressions; is to
accurately record the tissues of the denture-bearing areas, in addition to
recording the functional width & depth of the sulci. Making the secondary
or final impression is important for the preparation of a master cast.

Two types of impression techniques can be used in partial denture

construction:

I- The anatomic form impression.

II- The physiologic or the functional form.

I- The anatomic form impression:

 The anatomic form impression is a one-stage impression method using
an elastic impression material.
 It will produce a cast that represents the hard & soft tissues at rest. The
cast will not represent the functional relationship between the various
supporting structures of the partially edentulous mouth.
Indication:
- In cases of totally tooth supported PD cases
 Tooth supported RPD can be constructed on a cast obtained from a single
stage that records the teeth and the supporting structures at rest in their
anatomic form (anatomic form impression).

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  As the occlusal forces are transmitted along the long axis of the
abutment teeth through occlusal, lingual or incisal rests, the edentulous
ridge do not contribute to the support of the PD i.e. all forces are
absorbed by the teeth.
- Technique of making anatomical final impression:
a. Position of patient and dentist
b. Verifying and adjusting special impression tray
c. Mixing impression material
d. Loading impression tray
e. Making the impression
f. Removal of impression from the mouth
g. Inspecting the impression
h. Cleaning the impression
i. Pouring of the cast
j. Trimming the cast

- Procedures for making the anatomic form impression:

 After all the steps of mouth preparation are completed, the impression
procedure is made in the similar manner as described previously for the
preliminary impression using an adequately spaced (2 mm rubber base, 4-6
mm alginate) special tray (Figure ‎4-1).
 N.B.:

a. No bubbles should be around or in rest preparations.

b. No bubbles should be in the palate where major connectors are to be
constructed.
c. There should be no tearing of the impression material where the teeth are
involved in the design.

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 Figure ‎4-1: Special tray constructed for anatomic impression technique

d. The tray should not be showing through the cusp tips.

e. After checking the impression and its approval, the impression is poured
with dental stone and the master cast is obtained. On the master cast the
different steps for metal framework construction and the completion of the
RPD are carried out.

II- Physiologic or functional impression:

 When occlusal forces are applied to a tooth-tissue-supported RPD, these
forces must be equally distributed to the abutments & the tissues of the
ridge. So a dual impression technique is used in which a (corrected cast)
is generated.
 The impression of the teeth should be made in its anatomic form, because
normally the teeth do not change position under function to any
measurable degree. On the other hand, the impression of the residual ridge
must record the soft tissues in their functional form
- The main objective in an impression for distal extension is

1. To provide maximum support for the RPD and distribute the

masticatory load on as large an area as possible. Hence, occlusal

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 contact is maintained to help in distributing the occlusal forces over
the natural and artificial teeth.
2. To minimize movement of the base that may create leverage on the
abutment teeth.
3. Equalize support derived from edentulous ridges and abutment teeth.
4. Direct forces to the primary stress bearing areas.

- These objectives are achieved by a dual impression technique which

does the following:
1. Record and relate the tissues under uniform loading.
2. Distribute the load over the largest possible area.
3. Accurate determination of the peripheral extent of the denture base.
4. A dual impression technique is used to equalize as much as possible
the support derived from the edentulous ridge& that received from
the abutment teeth.
A thorough understanding of the impression techniques and materials is essential
in RPD construction to provide maximum support.

- Indications of dual impression technique:

1. In mandibular distal extension ridge, because
a. There is a limited ridge area can be used as a primary stress bearing
area.
b. Difficulty to obtain the proper peripheral extension for denture base
because of the movable tissues in the flower of the mouth.
In the maxillary arch the dual impression does not often improve
the stress distribution. Because, the maxillary distal extension
ridge is usually covered by a firm, dense will attached mucosal the
stress bearing area must be the crest & buccal slope of the ridge.

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 2- Long span anterior edentulous ridge where the residual ridge
must supply some support for the RPD.
To determine to what extent the soft tissue supporting the denture base should be
displaced during impression making, a number of factors that influence the
amount of tissue displacement should be considered. These factors influence
each other.

- Factors influencing support of the distal extension base:

1. Contour and quality of the residual ridge (nature of the

mucoperiosteun )

2. The Extent of area coverage by the denture base

3. Accuracy and fitness of the denture base

4. The accuracy and type of impression registration (anatomical or

functional)

5. The Design characteristics of the components parts of the RPD

6. Total occlusal load applied.

1. Contour and quality of the residual ridge

The ideal residual ridge to support a denture base would consist of:

a. A broad round ridge crest with high vertical slopes.

b. Formed from cancellous bone and covered by cortical bone and
dense fibrous connective tissue.
 Such a residual ridge would optimally support vertical and horizontal
stresses placed on it by denture bases.
 The contour and quality of the residual ridge may be improved by
recovery program, tissue conditioning or even surgical intervention.

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2. The extent of residual ridge coverage by the denture base:

 To counteract the tissue-ward component of a rotational force, each

distal extension base must cover a relatively large surface area. The
broader the coverage of the edentulous ridge, the greater the distribution
of the load and the smaller the force per unit area.
 The denture base should be maximally extended and all available space
must be used, within the physiologic tolerance of the limiting border
structures, without encroaching on the movable tissues. Overextension of
the denture base causes soft tissue irritation, ulceration and torque forces
applied to the clasped teeth and periodontal breakdown (Figure ‎4-2).

Figure ‎4-2: Maximum extension of the denture base without encroaching on movable
tissues produces better denture support

3. Design of RPD:

 In distal extension bases, rotation around the most posterior retainer is

inevitable under functional loading.
 The greatest movement takes place at the most posterior extent of the
denture base.
 As the rotational axis (fulcrum line) of the denture is moved anteriorly,
more of the residual ridge is used to support the denture base, thereby
distributing stresses over a proportionally greater area. This is done by
placing the occlusal rest anteriorly (Figure ‎4-3).

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 Figure ‎4-3:
Mesial placement of the occlusal rest would tend to tip the abutment tooth
mesially, while placement of a distal rest would encourages distal tipping of that tooth

4. The total occlusal load applied:

 The amount of the occlusal force applied to a denture base on a distal

extension ridge influences the amount of support required to stabilize the
denture. A partial denture opposed by natural teeth in young individuals
requires more support than that opposed by a complete denture in elderly
patients.

Therefore support may be improved through:

a. Maximum area coverage of the residual ridge.

b. Narrowing the occlusal table of the artificial teeth will reduce the load
transmitted to the denture base eg. using premolars instead of molars.
c. Increasing the efficiency of artificial teeth by supplemental grooves and
sluiceways. These aid the cutting action and improve the cutting
performance of the teeth.
d. Decreasing cuspal interferences by creating free articulation reduces the
lateral forces applied to the ridge.
5. Accuracy of fit of the denture base:

 Support is enhanced by the intimacy of contact of the tissues that cover the
residual ridge. The tissue surface of the denture base must represent a true
imprint of the basal seat regions.

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6. Accuracy of impression registration:

 Accurate impression making may ensure construction of a RPD that

accurately fits the underlying structures and improve support. The better
the base fits the denture foundation, the less the degree of displacement.
 Materials and techniques that will ensure the greatest dimensional stability
should be selected. Metal bases have better fit than acrylic resin bases.

- Different impression techniques for distal extension cases:

1. The functional or physiologic impression techniques (prior to

framework construction).
2. The selective pressure impression technique (after framework
construction).
3. The functional reline method (after RPD construction).

1. The functional or physiologic impression technique:

The residual ridges are recorded under some degree of loading. The
philosophy of this technique is to record the edentulous ridges under
functional pressure (to have functional form) and the other supporting
structures during rest (to have anatomic form).
a. McLean's physiologic impression technique:

In this technique the residual ridge that supports the distal extension
base is recorded in its functional form. The remainder of the arch is then
related it to by an overall hydrocolloid impression, while the first
impression is held in position in the mouth. After removal the composite
impression from the mouth, a master cast was poured with the
edentulous areas recorded under functional loading.

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 Technique:

 An acrylic special tray is constructed on the study cast covering only the
distal edentulous ridges and connected together by a bar (metal or acrylic
resin); 1-2mm away from the underlying mucosa, gingival margins and the
movable tissues in the floor of the mouth.
 The idea of this is to have a tray as one unit extending from one side to the
other.
 An occlusal rim is constructed & applied onto the acrylic tray.
 The wax rims are adjusted in both the vertical and anteroposterior relations
(Figure ‎4-4).

Figure ‎4-4: Wax rims constructed on the saddle areas of the acrylic tray
to let the patient bite on them during the impression procedures
 Border molding is carried out using green stick compound.
 The impression is made using free flowing zinc oxide and eugenol
impression material under biting force to make an impression in the tray
over the distal extension base only (Figure ‎4-5).

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Figure ‎4-5: Impression for the free end saddles using Zn/O and eugenol and green stick
compound for border molding. The special tray is constructed to cover the saddle areas
which are connected together via lingual bar,

 Using a stock tray with modeling plastic stops in the fitting surface of the
tray, an overall alginate impression is made with the first impression held
in place with finger pressure (Figure ‎4-6).
 From this impression a master cast is obtained on which the framework is
constructed.

Figure ‎4-6: Overall alginate impression recording the teeth and

picking up the Zn/O and eugenol impression in the fitting surface of the stock tray

Disadvantages:

 The tray used for overall impression was in contact with the occlusion
rims of the original impression & held in this position with finger
pressure. This pressure does not simulate the occlusal loading, which
leads to losing the advantage due to differential force of biting and finger
pressure.
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 b. Hindel's physiologic impression technique:
The impression of the edentulous ridge was recorded anatomically with
no biting force, while the second alginate impression records the details of
the rest of the tissues with finger pressure applied through holes in the
stock tray.
The main purpose of this technique was to relate an impression of the
edentulous ridge to the teeth under a form of function loading (supported
form).
Technique:

 An acrylic resin special tray is constructed on the study cast covering only
the distal extension and connected on both sides by a connector (the same
as in the previous technique).
 Border molding of the peripheries is carried out, and then an anatomic
impression of the edentulous ridges is made using Zinc Oxide and Eugenol
impression material, under light finger pressure (Figure ‎4-7).

Figure ‎4-7: The free end saddle areas recorded in Zn/O

and eugenol under light finger pressure
 Using a stock tray with ¾ inch holes in the regions of the first molar area
of the distal extension base, an overall alginate impression is made, while
pressing the special tray with fingers passing through the holes of the
stock tray (Figure ‎4-8).

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 Figure ‎4-8: Holes created in the stock tray in the first molar region
to allow for the dentist’s fingers to pass through
 The pressure had to be maintained until the alginate is completely set.
 The finished impression was a reproduction of the anatomic surface ridge
recorded under pressure and the surface of the teeth (Figure ‎4-9).

Figure ‎4-9: Finished impression shows the stock tray containing

a record of teeth in alginate and a record of tissues in Zn/O and eugenol
Disadvantage:

 The main drawback of this technique is although the use of the tray with
holes in this technique eliminates the possibility of error arising from
incorrectly placed modeling plastic stops (in the previous technique).
 However, it did not eliminate the variable of the dentist's individual
interpretation of what constitutes functional loading.

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 2. Selective pressure impression technique:
 Selective pressure impression technique helps to equalize the support
between the abutment teeth and the residual ridge, and directs the force to
the portions of the ridge that are most capable of withstanding these forces
i.e. the primary stress bearing areas.
a. The Altered Cast Technique:
An impression of the distally extended edentulous ridge is made by
using an impression tray attached to the metallic framework, and the
master cast is then altered to accommodate the new ridge impression.

Technique:

 This impression technique is made after construction of the framework on a

cast obtained from an anatomic impression. It is mainly used in mandibular
class I and II cases.
 The framework is tried in the patient's mouth, and adjusted to fit accurately
on the supporting structures with the rests seated properly on their seats and
the indirect retainers in their position. The occlusion with the opposing
dentition is also adjusted.
 Areas that need relief e.g. internal oblique ridge if prominent and the crest
of the ridge (lower ridge) are relieved on the master cast using wax.
 The stress bearing areas (buccal shelf of bone) is left without relief (Figure
‎4-10).

Figure ‎4-10: a. Master cast with the framework fitting on it and relief wax applied to
the distal extension areas except at the buccal shelf bone (primary stress bearing area)
b. acrylic resin special tray comstructed on the relief wax

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 An acrylic resin special tray is constructed in the ridge area, attached
mechanically to the mesh of the framework (by seating the framework
property over the cast while the acrylic resin is still soft (Figure ‎4-10).
 The framework with the tray attached to it is tried in the patient's mouth,
making sure that the framework fits accurately.
 The borders are then shortened, and border molding using green stick
compound (Figure ‎4-11).

Figure ‎4-11: Border molded acrylic custom made tray

 The trays are then loaded with the impression material and the framework
seated in the patient's mouth (Figure ‎4-12).

Figure ‎4-12: a. The framework is seated in the patient's mouth (3 finger pressure)

b. Impression of the distal extended saddle taken functionally

Different materials may be used for making the impression as:

 Zinc oxide and eugenol

 Rubber base materials.
 Or fluid wax. Fluid waxes are waxes that are firm at room temperature and
have the ability to flow in mouth temperatures (Iowa wax no. 1 and
Korrecta wax no. 4). Their main drawback is that it is time consuming as

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Chapter 4 Final impression

it is applied layer by layer and needs some experience.

 After the impression has been made and is accepted, the distal
extension areas on the master cast are sawed off or cut off by means of
a disc. Two cut lines are made on each side, one horizontal distal to the
last abutment and the other nearly perpendicular to it in the lingual
sulcus. Retentive grooves are then cut on the sides of the cast along the
cut off areas.

 The framework with the impression is reseated on the cast, making sure
that the framework is perfect seated in position with no interference
anywhere (Figure ‎4-13).
 Modeling plastic placed on the rests and indirect retainers may aid in
ensuring that no movement of the framework occurs during pouring the
new impression of the edentulous ridges.

Figure ‎4-13: Framework with the impression is reseated on the cast

The impression is beaded, boxed (

 Figure ‎4-14) and the edentulous ridge is poured with stone preferably
with a different color than that of the original cast (Figure ‎4-15).

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Chapter 4 Final impression

Figure ‎4-14: The impression is boxed after sawing

Figure ‎4-15: Poured in stone of different color

NB: Be sure that the occlusal rests and indirect retainers are properly seated and
maintained in position by the three fingers of the operator (two on the main
occlusal rests and one on the indirect retainer) until complete setting of the
impression material.

b. One stage selected pressure impression technique: (Fig.22)

 Dumbrigue and Esquivel in 1998 described a technique for the selected

pressure impression technique from a single impression made prior to
framework construction and after mouth preparation.

Technique:

 On the study cast a tray is constructed as follows (Figure ‎4-16):

Two layers of base plate wax relief are adapted on the teeth and
residual ridges.
Aluminum foil is burnished over the wax.
Occlusal stops are placed over the remaining teeth by cutting boxes

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Chapter 4 Final impression

through the aluminum foil and wax to ensure proper seating of the
tray.
Construct an acrylic resin special tray 2mm short of the borders.
Remove wax from the cast and wet the surface of the cast.
 On the tissue surface of the tray, corresponding to the residual ridges,
apply softened modeling compound and seat the tray on the cast (to shape
the compound appropriately before intraoral placement).
 Reheat compound and place intra-orally with finger pressure on the area of
the residual ridge.
 Remove, check and then apply modeling compound to the borders to
perfect border molding.
 Relief the tissue surface of the compound 1mm except for the primary
stress bearing area (buccal shelf of bone).
 Make a complete impression using rubber base material applying finger
pressure on the residual ridge while the impression material is setting.
 Pour the impression. This precedes the steps for constructing the
framework.

Figure ‎4-16: a. Wax applied on the cast

b. One stage selective pressure impression technique

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Chapter 4 Final impression

III-The functional relining impression technique:

 After denture use for many years, a combination of occlusal wear and
sinking of the denture following alveolar resorption occurs. So functional
impression is required to correct this situation

 A distal extension RPD constructed from a single anatomic impression

will show movement on application of masticatory load on the edentulous
area creating torque on the abutment teeth. Movement will also occur if
ridge resorption occurs after sometime of denture wearing.
 To improve the RPD fit to the underlying tissues & also to record the
tissues in their functional form, a functional relining impression
technique can be made
 Functional impression may be made at the step of denture insertion or
many years after denture use. It is an open mouth procedure.
Technique of functional relining impression:

 The borders are shortened and the denture base is relieved to allow room
for the impression material. Vents are made to allow escape of impression
material (Figure ‎4-17).

Figure ‎4-17: a.The fitting surface is relieved, undercuts are removed and borders are
shortened b.Vents are made to allow escape of material

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Chapter 4 Final impression

 Modeling plastic is applied over the tissue surface and tempered in water
bath, seated in the patient's mouth and held in position with 3 fingers, two
on the main occlusal rests and one on the indirect retainer. This is done
several times until an accurate impression of the ridges is obtained (Figure
‎4-18).

Figure ‎4-18: a. Modeling plastic is applied over the tissue surface and seated in the
patient's mouth and held in position with 3 fingers. b. denture with the compound

 The tissue surface is then scraped to about 1mm thickness. A mix of zinc
oxide and eugenol material is then applied. The denture is seated in the
patient's mouth and held in position by the three fingers the same as before
until complete setting of the material. Different impression materials may
be used successfully for functional relining impression; zinc oxide and
eugenol, rubber base, silicones, mouth temperature waxes as well as tissue
conditioning material (soft liners) provided that there is proper space and
border molding is carried out.
 An overall alginate impression is made and the whole impression is
poured.
 The denture on the obtained cast is flasked and relining procedure is
completed.
 It is essential that occlusal errors are adjusted, so the relined denture
should be remounted and occlusion is adjusted.

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