Impression Procedures for Metal Frame Removable

Partial Dentures as Applied by General Dental Practitioners

Wietske A. Fokkinga, DDS, PhDVJudith van Uchelen, DDSVDick J. Witter, DDS, PhD1/
Jan Mulder, BSc2/Nico HJ. Creugers, DDS, PhD3

This pilot study analyzed impression procedures for conventional metal frame removable partial
dentures [RPDs). Heads of RPD departments of three dental laboratories were asked to record
features of all incoming impressions for RPDs during a 2-month period. Records included: (1J
impression procedure, tray type [stock/custom), impression material [elastomer/alginate), use of
border-molding material (yes/no); and [2] RPD type requested (distal-extension/tooth-bounded/
combination). Of the 132 total RPD impressions, 111 [84%) involved custom trays, of which
73 [55%) were combined with an elastomer. Impression border-molding material was used in
4% of the cases. Associations between impression procedure and RPD type or dentists' year/
university of graduation were not found. IntJ Prosthodont 2016;29:166-168. doi: 10.11607/ijp.4540

ppropriate impression procedures for metal frame
A removable partial dentures [RPDs) are crucial for
accurate fit. However, procedures vary with respect to
impression trays and impression materials.1 Often, rel­
atively complex, time-consuming, and expensive pro­
cedures are recommended for distal-extension RPDs,
including use of custom trays, functional border­
molding material, and elastomer impression material,
or the altered cast procedure.2-4 In contrast, for tooth-
bounded RPDs relatively simple, time-efficient, and
low-cost procedures combining stock trays and algi­
nate are recommended.2'3 Generally, dental schools
prescribe specific impression procedures for conven­
tional RPDs in specific dental situations. However, it
is unknown to what extent the recommendations are
actually followed in practice. This pilot study aimed to
'Assistant Professor, Department o f Oral Function and Prosthetic Dentistry,
College o f Dental Sciences, Radboud University Nijmegen Medical Center,
Nijmegen, Netherlands.
2Statistician, Department o f Oral Function and Prosthetic Dentistry, College
o f Dental Sciences, Radboud University Nijmegen Medical Center,
Nijmegen, Netherlands.
3Professor and Chair, Department o f Oral Function and Prosthetic Dentistry,
College o f Dental Sciences, Radboud University Nijmegen Medical
Center, Nijmegen, Netherlands.
investigate associations between impression proce­
dure and RPD type, university from which the dentists
graduated, and year of graduation.
Materials and Methods
Heads of RPD departments of three commercial den­
tal laboratories considered representative for the
Nijmegen region were asked to record features of
all incoming impressions for conventional RPDs dur­
ing a 2-month period. Variables included impression
procedure used, tray type [custom/stock), impression
material (alginate/elastomer), use of specific border­
molding material [yes/no), and RPD type requested
(distal-extension/tooth-bounded/combination). Year
and university of graduation for each participating
dentist were also recorded. Relations between vari­
ables were tested using Fisher exact test [a = .05).
Next, logistic regression models were applied to
further analyze the variables that could influence the
choice of tray type and impression material. In these
models, variables where P <.15 [Fisher exact test)
were included. Data were statistically analyzed using
SAS version 9.2 [SAS Institute).
Results

C orrespondence to: Dr W.A. Fokkinga, Department o f
Oral Function and Prosthetic Dentistry, College o f Dental Sciences,
Radboud University Nijmegen Medical Center, PO Box 9101,
6500 HB Nijmegen, The Netherlands. Fax: +31-24-3541971.
Email: Wietske.Fokkinga@radboudumc.nl
©2016 by Quintessence Publishing Co Inc.
This study included 132 impressions delivered by 69
dentists. The three participating laboratories received
41 [28 custom trays, of which 22 were combined
with elastomer), 60 [53 custom trays, 27 elastomer),
and 31 impressions [30 custom trays, 24 elastomer),
respectively.

166 The International Journal of Prosthodontics

 Fokkinga et al

Table 1 Frequency Distribution of Master Impressions for Metal Frame Removable Partial Dentures (RPDs) According
to RPD Type
Im pression tra y [n = 132)

Custom [n = 111) S tock [n = 21)

RPD type Elastom er A lg in a te Elastom er A lginate Total (n = 132)
D istal-extension 35 15 4 4 58
Tooth-bounded 20 8 0 9 37
C om bination 18 15 0 4 37
Total [n [% ]) 73 [55) 38 [29) 4 [3) 17(13) 132 (100)

Table 2 Frequency Distribution of Master Impressions for Metal Frame Removable Partial Dentures [RPDs) According
to RPD Type and Jaw
M a ndible (n = 84) M axilla (n = 48)
C ustom [n = 67) S tock (n = 17) Custom (n = 44) S tock (n = 4)
RPD type Elast A lgin Elast A lgin Elast A lgin Elast A lgin Total (n = 132)
Distal-extension 28 12 4 4 7 3 0 0 58
Tooth-bounded 8 2 0 6 12 6 0 3 37
Com bination 9 8 0 3 9 7 0 1 37
Total (n [% ]) 45 (34) 22 (17) 4 (3 ) 13 (9 ) 28 (21) 16 (12) 0 (0 ) 4 (3 ) 132 (100)
Elast = elastomer; Algin = alginate.

M o s t im pressions [n = 111, 84%) w e re taken w ith Discussion

custom trays [Table 1). C ustom trays w ere s ig n ific a n t­
ly m ore fre q u e n tly com bined w ith elastom er im pres­
sion m aterial than stock trays [P < .001). A total of
58 [44%) im pressions w e re taken fo r d istal-extension
RPDs, 37 [28% ) fo r to o th -b o u n d e d , and 37 [28% ) fo r
com bined RPDs.
O f 84 m andibular impressions, 48 [57%) w ere fo r
distal-extension RPDs, 16 [19%) w ere fo r to o th -b o u n d ­
ed, and 20 [24%) w ere fo r com bined RPDs [Table 2).
For the maxilla [n = 48), these num bers were: 10 [21%)
fo r distal extension, 21 [44%) fo r too th -b o u n d e d , and 17
[35%) fo r com bined RPDs. The proportion o f m andibu­
lar distal-extension RPDs was significantly higher than
m axillary distal-extension RPDs [P < .001). Im pressions
w ith stock trays [n = 21) included 4 [8%) m axillary and
17 [20%) m andibular im pressions. S pecific border­
m olding material was used in 4 o f the 111 custom
trays; in the 21 stock trays [12 plastic, 9 m etal) border­
m olding m aterial was not applied.
None o f th e variables [la b o ra to ry, jaw, RPD type,
university, or year o f graduation) show ed a s ig n ific a n t
association [Fisher exact test, P > .05) w ith tra y typ e
or im pression m aterial. O nly ja w [P = .14) and univer­
sity [P = .07) w ere associated w ith tra y typ e and w ere
th erefore included in th e lo g istic regression model.
The regression m odel revealed no s ig n ific a n t associa­
tio n w ith th e im pression p ro cedure [P > .05).
In th is p ilo t study, th e m ajority o f im pressions fo r RPDs
used custom trays, o f w h ich 2 o u t o f 3 w e re com bined
w ith elastom er im pression m aterial. S to ck trays w ere
used m ore fre q u e n tly in the m andible [20%) than in
the maxilla [8%). This was not expected, since fu n c ­
tional b o rd e r-m o ld in g in the m andible is considered
m ore relevant fo r d ista l-e xte n sio n RPDs and fo r co r­
re ct location o f m ajor connectors.
It has been rep o rte d th a t metal p e rforated stock
trays com bined w ith alginate result in b e tte r fit o f
RPD fra m e w o rks than those com bined w ith an elas­
tom er.5 However, in the present study, a com bination
o f metal sto c k tray and alginate was applied in only 9
o u t o f 132 cases [Table 2). The altered cast procedure,
recom m ended to provide optim al tissue s u p p o rt fo r
d ista l-e xte n sio n RPDs, is unusual in The N etherlands;
im pressions using th is m ethod w ere not delivered.
Because th e lite ra tu re suggests th a t sp e cific tray
types com bined w ith sp e cific im pression m aterials
determ ine the accuracy o f the fit o f RPDs, it was ex­
pected th a t sp e cific im pression procedures w ere used
fo r sp e cific dental arch co n fig u ra tio n s.1-5 However,
in the present stu d y sp e cific im pression procedures
w ere not related to sp e cific dental arch c o n fig u ra ­
tions. A s de n tists are expected to apply sp e cific p ro ­
cedures aim ing at best practice, it was presum ed th a t

Volume 29, Number 2, 2016 167

Impression Procedures for Metal Frame Removable Dental Prostheses
the procedures used in the present study resulted in
well-fitting RPDs. Further research is needed to ana­
lyze the quality of RPDs and patient satisfaction in re­
lation to impression procedures.
Conclusion
The results of this pilot study indicate a variation in
impression procedures that cannot be explained by
the specific dental arch configurations and RPD type
requested. Associations between impression proce­
dure and dentists’ year or university of graduation also
were not found.
168 The International Journal of Prosthodontics
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