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

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 toothbounded 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.

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).

3Professor and Chair, Department o f Oral Function and Prosthetic Dentistry,

College o f Dental Sciences, Radboud University Nijmegen Medical

Results

Center, Nijmegen, Netherlands.

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.

166

The International Journal of Prosthodontics

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.

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)

RPD type

Elastom er

S tock [n = 21)

A lg in a te

Elastom er

A lginate

Total (n = 132)

D istal-extension

35

15

58

Tooth-bounded

20

37

C om bination

18

15

Total [n [% ])

73 [55)

Table 2

38 [29)

37

4 [3)

17(13)

132 (100)

Frequency Distribution of Master Impressions for Metal Frame Removable Partial Dentures [RPDs) According
to RPD Type and Jaw
M a ndible (n = 84)
C ustom [n = 67)

RPD type

M axilla (n = 48)

S tock (n = 17)

Custom (n = 44)

S tock (n = 4)

Elast

A lgin

Elast

28

12

58

Tooth-bounded

12

37

Com bination

Total (n [% ])

45 (34)

22 (17)

13 (9 )

28 (21)

16 (12)

Distal-extension

4 (3 )

A lgin

Elast

A lgin

Elast

A lgin

0
0 (0 )

Total (n = 132)

1
4 (3 )

37
132 (100)

Elast = elastomer; Algin = alginate.

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

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%)

Discussion
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

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

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

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.

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.

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).

o u t o f 132 cases [Table 2). The altered cast procedure,

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.

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The International Journal of Prosthodontics

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3. Davenport JC, Basker RM, Heath JR, Ralph JP, Glantz PO. A
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5. Hochman N, Yaniv O. Comparative clinical evaluation of re
movable partial dentures made from impressions with different
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