SECTION EDITORS
LOUIS BLATTERFElN S. HOWARD PAYNE (;EORGE A, ZARB
0022-3913/80/010009 + 06$00.60/O 0 1980 The C. V. Moshy Co. THE JOURNAL OF PROSTHETIC DENTISTRY 9
BLATTERFEIN, KLEIN, AND MIGLINO
Fig. 1. The preliminary irreversible hydrocolloid im- Fig. 3. A layer of baseplate wax has been placed over the
pression (alginate) has been made with the abutment teeth on the cast.
castings in position on the teeth.
custom tray in conjunction with plaster seats for the and tray pressure on occlusion rims are often incor-
abutment castings overcome the problem of uncon- porated into these techniques to provide ridge load-
trolled border extension of the denture base. Correct ing.” When these adjuncts are used, the result
border extension can be attained by using a stiff- becomes unpredictable and prone to error because of
bodied elastomer impression material’ in a slightly uneven pressure and malrelation of the parts of the
underextended custom impression tray or by border impression.
molding an underextended impression tray with
modeling composition before applying a lighter IMPRESSION TECHNIQUE
bodied elastomer impression material. Both ap- The limitations of existing techniques for deep rest
proaches register the ridges in a passive, anatomic distal-extension removable partial dentures can be
form and fail to provide the ridge loading that is overcome by using a specially prepared custom tray
desired. Some impression techniques register only in conjunction with modeling composition, activated
the ridges in an unspaced custom tray and then acrylic resin, and a polyether gel impression materi-
relate this base impression to the abutment castings al. This technique will provide a final impression
and remaining natural teeth with an overall impres- that has firm seats for the abutment castings, correct
sion of plaster or similar material. The resulting final border extension of the denture base, and ridge
impression does not provide much ridge loading. loading.
Special steps such as biting pressure, finger pressure, After the abutment castings have been properly
fitted to the prepared teeth, an irreversible hydrocol- over the spaced and unspaced parts of the cast (Fig.
loid (alginate) impression is made of the jaw with the 4). This creates space for the impression materials
abutment castings in position (Fig. 1). A cast is that will be used to establish the border limits of the
poured in artificial stone for the purpose of fabricat- denture base and provide ridge loading.
ing an activated acrylic resin impression tray (Fig. 2). For the purposes of positioning and orienting this
The planned impression tray is to be spaced from the spaced tray, reference contacts (stops) for the oral
remaining teeth, abutment castings, and ridges. A structures and abutment castings are needed. These
layer of baseplate wax is first adapted only around contacts (stops) are provided by cutting out small
the remaining natural teeth and abutment teeth windows in selected parts of the spacing wax (Fig. 5).
(Fig. 3). The purpose of the initial spacing is to allow Three windows are cut for stops that will provide a
for a greater thickness of the final polyether impres- stable seat for the impression tray and two more
sion material in this part of the tray. The set windows are cut in the spacing wax over the abut-
polyether has little yield when confined to a slightly ment castings for seating stops. Windows for the
spaced tray, and the teeth of the poured cast may be tray-stabilizing stops on the ridges are usually cut
fractured during separation. over the horizontal parts or buccal. shelves of the
A second layer of baseplate wax is then adapted ridges midway between their anterior-posterior
Fig. 9. Duralay is applied to the stops on the abutment Fig. 11. Impression has been completed with a polyether
castings and incisors to reestablish firm contact on gel. Abutment castings have been “picked up” in the
them. impression and have a firm unyielding seat in the impres-
sion. There is a thin lining of the gel over the modeling
composition registration of the ridges.
Fig. 10. View of the inner surface of the tray showing the
three stops corrected in relation to the modeling compo-
sition basing that has been established on the ridges. ’ Fig. 12. Duralay with dowel inserts have been placed in
the abutment castings. Borders of the impression have
been protected by rimming ‘before final boxing and
limits. The windows for natural tooth contacts are pouring.
cut over the mesial halves of the incisal edges of the
central incisors.
An activated acrylic resin tray is fabricated over the resulting impression are then heated, tempered,
the prepared cast (Fig. 6). The inner surface of the returned to the mouth, and molded to register the
tray will show five well-defined teeth, abutment correct height and width that is available for support
casting, and ridge stops (Fig. 7). The tray is then of the denture base (Fig. 8).
trimmed so that its borders are about 2 mm short of The modeling composition places the mucosa of
the reflection of the tissues of the mucobuccal and the ridge. It registers a form that the mucosa will
mucolingual folds. Sufficient reduction of the edges assume when functional forces are applied to the
is necessary to allow for the bulk of the basing completed prosthesis. A firmer seat will be available
material necessary for proper border molding. for the removable partial denture and less stress will
Modeling composition is placed on the ridge parts be transmitted to the abutments. The potential for
of the impression tray, thoroughly heated and overloading and trauma is reduced.
tempered, and the tray is then positioned in the After completing the basing of the ridge sections of
mouth. This step is repeated until a uniform and the impression tray, the relationship of the tray stops
detailed seating has been obtained. The borders of to the abutment castings and natural teeth must be
Fig. 13. Anterior section of the impression tray has been Fig. 14. Completed final cast with abutment castings
cut away after pouring to avoid breaking the teeth of the related to the remaining natural teeth and ridges in a
cast during separation. The extra layer of spacing wax that loaded form.
was used facilitates this step.
accurately reestablished. Varying thicknesses of the the poured cast is hazardous. The stiffness of the set
basing material will change the original relation of polyether gel will usually cause the teeth of the
the stops to remaining teeth and abutment castings. poured cast to break away.
A correction is effected by applying Duralay* to the The acrylic resin impression tray should be cut
three anterior stops (Fig. 9) and then firmly reseating away in the region of the teeth (Fig. 13). This
the tray. A hard unyielding seat is now provided for procedure is facilitated by the extra thickness of
the abutment castings when the impression tray with polyether gel that was produced by the double-wax
the final impression material is placed in position spacing of the preliminary cast prior to the fabrica-
(Fig. 10). tion of the impression tray.
A polyether impression material is used for the The casts that result from this impression tech-
final impression. This material has good flow when nique will have an accurate relation of the abutment
mixed, and it has adequate firmness when set. The castings to one another and to the ridges (Fig. 14).
good flow allows it to correct any unevenness of The ridges will be registered in a form that they
the modeling composition basing and still retain assume when functional forces are applied to the
its loading effect. Its adherence to the modeling artificial teeth of the completed removable partial
composition and tray in a thin film is assured by denture. This provides a favorable environment and
using the adhesive supplied with the material foundation for a bilateral distal-extension removable
(Fig. 11). partial denture and minimizes the potential for
The firmness of the material stabilizes the abut- trauma and overloading of the abutrnent teeth.
ment castings against horizontal displacement. The
Duralay occlusal stops stabilize the abutment cast- SUMMARY
ings against vertical displacement in the combina- The rationale of designing a semiprecision or
tion final impression. precision distal-extension removable partial denture
Seats for the abutment castings on the final cast and the justification of ridge loading in distal-
can be provided by placing Duralay or pouring extension ridge impression techniques have been
low-fusing metal in the properly prepared internal presented. The effectiveness of existing impression
surfaces of the abutment castings. Dowels are placed techniques in securing firm seats for abutment cast-
in the poured material to provide for their anchorage ings, accurate border extension of the denture base,
to the final artificial stone cast. and loading of the ridge mucosa has been evalu-
The impression can be easily rimmed and boxed ated.
to preserve the borders that have been established A technique has been described that overcomes
(Fig. 12). Direct separation of the impression from the limitations of existing impression techniques for
semiprecision and precision distal-exl:ension remov-
*Reliance Dental Mfg. Co., Worth, I11 able partial dentures.
Reliability of the fovea palatini for determining the posterior border of the
maxillary denture
Ming-Sheh Chen, B.D.M., M.Sc.