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Using a secondary impression with a resin index to correct an

RPD definitive cast
Won-suk Oh, DDS, MSa and Ju-mi Park, DDS, MS, PhDb

The definitive cast for the fabrication of a removable However, this traditional corrected impression proced-
partial denture (RPD) should accurately replicate ure cannot be used when an error is made in the tooth-
the surface detail of the teeth and edentulous ridges of supported area of a partially edentulous arch.1 Although
a partially edentulous arch.1 The cast should also remaking an impression can be a challenge when the
reproduce the functional and physiologic extensions of partially edentulous arch demonstrates an excessive un-
the facial and lingual vestibules, particularly the sublin- dercut associated with tilting of the remaining teeth,
gual vestibule, for the placement of a lingual major when microsomia is present, or when the patient has
connector. difficulty opening the mouth, a new impression should
The single-impression technique may suffice for be made.4
generating an RPD definitive cast with contemporary This article describes an impression procedure to
impression materials.2 This technique requires an correct a tooth-supported area of a partially edentulous
impression made in a border-molded custom tray to re- arch. This method involves a laboratory procedure for
cord both the dentate and edentulous areas of the arch. fabricating a resin index to support an impression ma-
This procedure is convenient and can be supplemented terial and correct inadequate anatomy in the original
with the altered cast technique when an error is found in definitive cast. A secondary impression is made by using
the extensionebase segment of the edentulous ridge.3 the index secured against the teeth and edentulous ridges

Figure 1. Mandibular RPD definitive cast with inadequate replication of Figure 2. Tissue side of relined resin index demonstrating 2 holes
sublingual vestibule (arrow). RPD, removable partial denture. (arrows) for injection of impression material.

a
Clinical Professor, Department of Biologic and Materials Sciences Division of Prosthodontics, University of Michigan, Ann Arbor, Mich.
b
Professor, Department of Prosthodontics, Chonbuk National University School of Dentistry, Jeonju, Republic of Korea.

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Figure 3. Lingual aspect of modified definitive cast demonstrating 2 Figure 4. Facial aspect of modified definitive cast. Metal rods inserted in
channels (arrows) created along sublingual vestibule. cast to demonstrate patency of channels.

to record the area missed in the original impression.5 This 5. Reline the index against the cast by using a silicone
procedure eliminates the need to remake an impression occlusion registration material (Blu-Bite; Henry
of the entire arch, and the use of the index can be Schein Inc) to engage the surface detail of the cast.
extended to verify the accuracy of the original impression Separate the relined index from the cast and cut
and register a maxillomandibular relation record. Thus, out the silicone material over the target area using
the clinical metal framework evaluation can be expedited a sharp blade (carbon steel surgical blade number
as its occlusal relationship can be adjusted on the artic- 25; Miltex Inc).
ulator. However, care should be taken to avoid an error 6. Create 2 holes (1 for inlet and the other for outlet
related to the orientation of the secondary impression to of an impression material) in the index at each end
the definitive cast.3 of the target area using a number 8 tungsten car-
bide round bur (Brasseler USA) (Fig. 2). Set aside
PROCEDURE the index for the clinical procedure of impression
making.
1. Evaluate the impression and definitive cast for the 7. Modify the definitive cast by carving out (approx-
fabrication of a mandibular RPD. Note the inade- imately 1 mm in depth) the target area and
quate anatomy (target area) along the sublingual creating 2 channels (1 for inlet and the other for
vestibule for the design of a lingual major outlet of dental stone) along the sublingual vesti-
connector (Fig. 1). bule by using a number 8 tungsten carbide round
2. Adapt a layer of tin foil (Buffalo Dental) against the bur (Brasseler USA) (Fig. 3). Ensure that the
teeth and edentulous ridges of the definitive cast channels penetrate the facial aspect of the cast and
and block out the undercuts by using baseplate are positioned outside the RPD design area
wax (Coltène). Add a layer of baseplate wax (Col- (Fig. 4).
tène) over the target area to provide space for the 8. Evaluate the intraoral fit of the index to verify the
impression material. accuracy of the original impression and carry out
3. Adapt a layer of light-polymerizing resin (Visible- the border molding procedure7 along the sublin-
Light-Cured Triad; Dentsply Sirona) to cover the gual vestibule of the target area.
target area and edentulous ridges and extend it 9. Seat the index intraorally and secure it firmly
incisally to engage the incisal aspect of the teeth and against the teeth and edentulous ridges. Make an
ensure the stability and accuracy of the orientation. impression by injecting a light viscosity polyvinyl
4. Polymerize the resin as recommended by the siloxane impression material (Aquasil; Dentsply
manufacturer6 and separate the processed index Sirona) through a hole (inlet) of the index until it
from the cast when it has polymerized completely. extrudes though the other (outlet). Separate the
Trim the excess along the borders by using a impression from the mouth when it polymerizes
tungsten carbide bur (E-cutter; Brasseler USA) and completely. Evaluate the impression and trim the
remove the layer of tin foil (Buffalo Dental) to excess using a sharp blade (carbon steel surgical
expose the clean surface of the cast. blade number 25) (Fig. 5).

THE JOURNAL OF PROSTHETIC DENTISTRY Oh and Park

July 2018 149

Figure 5. Secondary impression (arrows) made by means of resin index. Figure 6. Secondary impression trimmed along gingival crest of teeth.

Figure 7. Facial aspect of definitive cast demonstrating dental stone Figure 8. Corrected definitive cast demonstrating adequate anatomy
injected though channels against secondary impression. along sublingual vestibule (arrow) for design of lingual major connector.
Color contrast of dental stones for demonstration purposes.
10. Cut off the incisal extension of the index along the
gingival crest of the teeth by using a disk (Sepa-
REFERENCES
rating Disk; Brasseler USA) (Fig. 6). Seat the
trimmed impression on the cast to verify the fit and 1. Carr AB, Brown AT. McCracken’s removable partial prosthodontics. 13th ed.
ensure the exposure of the lingual aspect of the St. Louis: Mosby; 2016. p. 231-41.
2. Frank RP, Brudvik JS, Noonan CJ. Clinical outcome of the altered cast
teeth. Secure the impression firmly against the cast impression procedure compared with use of a one-piece cast. J Prosthet Dent
and box it along the sublingual vestibule in a 2004;91:468-76.
3. Leupold RJ, Kratochvil FJ. An altered cast procedure to improve tissue support
conventional manner.7 for removable partial dentures. J Prosthet Dent 1965;15:672-8.
11. Mix a Type III dental stone (Microstone; Whip Mix 4. Hegde C, Prasad K, Prasad A, Hegde R. Impression tray designs and tech-
niques for complete dentures in cases of microstomiaea review. J Prosthodont
Corp) as recommended by the manufacturer and Res 2012;56:142-6.
load it in a disposable syringe (Monoject; Covi- 5. Schoenrock GA. The laminar impression technique. J Prosthet Dent 1989;62:
392-5.
dien). Inject the dental stone through a channel 6. Oh W, Morris HF. A simple method to fabricate stabilized record bases: a
(inlet) in the cast until it extrudes though the other modified approach using casting wax for the borders. Eur J Prosthodont Restor
Dent 2013;21:2-4.
(outlet) (Fig. 7). Do not disturb the material until it 7. Zarb GA, Hobkirk JA, Eckert SE, Jacob RF. Prosthodontic treatment for
sets. edentulous patients. 13th ed. St. Louis: Mosby; 2013. p. 161-79.

12. Separate the cast from the impression and evaluate

Corresponding author:
the adequacy of the corrected RPD definitive cast
Dr Ju-mi Park
along the sublingual vestibule of the target area Department of Prosthodontics
(Fig. 8). Chonbuk National University School of Dentistry
664-14 Deokjin-dong 1-ga, Deokjin-gu
13. Proceed to build an occlusion rim on the index to Jeonju, Jeonbuk, 561-756
make an occlusion registration record and mount REPUBLIC OF KOREA
Email: [email protected]
the definitive cast on an articulator for the fabri-
cation of a mandibular RPD framework. Copyright © 2017 by the Editorial Council for The Journal of Prosthetic Dentistry.

Oh and Park THE JOURNAL OF PROSTHETIC DENTISTRY