Is functional impression essential for the success of removable partial dentures?

A moldagem funcional é essencial para o sucesso de próteses parciais removíveis?

ABSTRACT

Removable partial dentures are a viable option for the rehabilitation of partially edentulous arches in dentistry. Their success depends on biological, mechanical, psychological, and technical factors, with the impression process being fundamental to achieving proper fit and patient comfort. Functional impressions, which mimic dynamic oral activities such as mastication and swallowing, are particularly beneficial in distal extension cases, as they provide better tissue support and reduce excessive loading on abutment teeth and surrounding soft tissues. However, the limited number of comparative studies between functional impressions and conventional static techniques has hindered a comprehensive understanding of their clinical advantages, leading to a lack of consensus in the literature. This review analyzes current scientific and technical data on the role of functional impressions in the success of removable partial dentures. The searches were conducted in the PubMed, SciELO, and Lilacs databases, without date restriction, resulting in the selection of 13 articles for final analysis. Although recent studies using contemporary materials are scarce, historical evidence suggests that functional impressions, particularly with the modified impression technique, offer better adaptation and stability than single static impressions. Furthermore, advancements in digital impression technologies are transforming the functional impression process, improving accuracy and reducing chairside time. Despite these innovations, the unique biomechanical demands of removable partial dentures make functional impressions essential for balanced force distribution, preventing prosthetic failures, and ensuring long-term treatment success.

Indexing terms
Dental impression technique; Dental prosthesis; Denture, partial, removable

RESUMO

As próteses parciais removíveis são uma opção viável na reabilitação de arcos parcialmente desdentados na prática clínica. O êxito dessas próteses depende de aspectos biológicos, mecânicos, psicológicos e técnicos, com a moldagem desempenhando um papel essencial para garantir um ajuste adequado e conforto. A moldagem funcional, que simula movimentos como mastigação e deglutição, é especialmente benéfica em áreas de extensão distal, proporcionando suporte adequado e diminuindo a sobrecarga nos tecidos de sustentação. No entanto, a escassez de estudos comparativos com a técnica de moldagem única estática limita a compreensão clara de suas vantagens, resultando em falta de consenso na literatura. O objetivo desta revisão foi explorar as evidências científicas e técnicas disponíveis sobre a relevância da moldagem funcional no sucesso das próteses parciais removíveis. As buscas foram realizadas nas bases PubMed, SciELO e Lilacs, sem restrição de data, resultando na seleção de 13 artigos para análise final. Apesar da ausência de estudos recentes com os materiais atualmente disponíveis no mercado, estudos anteriores indicam que a moldagem funcional com a técnica do modelo alterado oferece melhor adaptação e estabilidade das próteses em comparação à técnica de moldagem única. Com os avanços em tecnologia digital, como CAD-CAM e scanners intraorais, a moldagem funcional está sendo revolucionada, aumentando a precisão das próteses e reduzindo o tempo de tratamento. Ainda assim, devido aos fatores biomecânicos das próteses parciais removíveis, a moldagem funcional permanece nos procedimentos de confecção de uma prótese parcial removível para garantir suporte equilibrado e prevenir falhas, contribuindo para o sucesso e durabilidade do tratamento.

Termos de indexação
Técnica de moldagem odontológica; Prótese dentária; Prótese parcial removível

INTRODUCTION

Epidemiological studies indicate a decreasing prevalence of complete edentulism, suggesting a prospective decline due to improved access to oral healthcare services [¹,²]. Simultaneously, there is a growing population of partially edentulous individuals who may be rehabilitated with implants, Fixed Partial Dentures (FPD), or Removable Partial Dentures (RPD), depending on the number of missing teeth and the condition of the residual ridge, with the state of the remaining bone being essential to determine the viability of these rehabilitations [³]. RPD are the treatment of choice for patients who need to replace missing teeth but cannot receive implants due to general health issues, financial limitations, or fear of surgery [⁴].

Biological, mechanical, esthetic, and psychological factors are associated with the success of this type of treatment [⁵]. Furthermore, patient comfort, stability, and especially acceptance of the prosthesis depends on a series of essential technical procedures [⁶]. Therefore, to provide effective and comfortable treatment, proper diagnosis, planning, and careful maintenance are necessary [⁷]. Among the various important steps that must be followed for the fabrication of RPD, the impression procedure is critical for both short- and long-term success [⁸].

From a biomechanical perspective, the transmission of masticatory forces from these prostheses to the alveolar bone may occur solely through the abutment teeth (tooth-supported) or also involve the mucosa of the residual ridge (tooth-and-mucosa-supported) [⁹]. Thus, the impression for an RPD must accurately record both a relatively soft and flexible tissue (oral mucosa) and a hard, inflexible tissue (remaining teeth) [⁶]. In this context, the impression techniques, especially in distal extension cases, should provide maximum support for the RPD to ensure the maintenance of occlusal contact between the natural dentition and artificial teeth, while minimizing movement of the denture base over the mucosa of the residual ridge [¹⁰,¹¹].

Functional impression is generally performed only on the posterior free-end of the dental arch in Kennedy Class I and II cases, or on the complete arch when few teeth remain, following a preliminary anatomic impression [¹²-¹⁴]. However, the literature does not present a clear consensus regarding the advantages of this approach compared to performing a single static impression. Therefore, the objective of this literature review was to analyze the available evidence on the importance of functional impression techniques for the success of RPD treatment.

METHODS

Type of Review

Narrative review.

Search Strategy

Searches were conducted in the USA National Library of Medicine (PubMed), Scientific Electronic Library Online (SciELO), and Latin American and Caribbean Health Sciences Literature (LILACS) databases, using the following keywords: “functional impression technique” OR “impression technique” OR “functional impression” AND “removable partial denture,” in August 2024 by two independent reviewers. Studies were included if they were published in English, in peer-reviewed journals, with no restriction on publication date, and addressed the topic of interest. Exclusion criteria included non-indexed articles, unpublished texts, books, dissertations, theses, and publications lacking a research protocol, such as opinion pieces, correspondence, editorials, and letters to the editor.

RESULTS

Different combinations of keywords were applied to each selected database without time restrictions. A total of 492 articles were identified, and only 13 relevant articles were selected and retrieved for final analysis, including 3 clinical studies, 2 case reports, 4 technique articles, 2 literature reviews, 1 epidemiological study, and 1 systematic review.

Biomechanics of RPDs

Treatment with RPDs is considered a prosthetic challenge, particularly in cases involving long edentulous spans and distal extensions [¹⁵]. In distal extension situations, the support needed to resist vertical masticatory forces is provided by the relatively rigid artificial teeth, the resilient mucosa, and the underlying bone [¹⁰]. The resiliency of the tissue-bearing surface of the denture base ranges from 0.4 to 2.0 mm, compared to 0.1 mm of the healthy periodontal tissue [¹¹]. To achieve satisfactory function, it is necessary to balance this difference between the relatively non-resilient periodontal ligament of the abutment tooth and the more resilient mucosa covering the residual ridge [¹⁰].

The prosthesis components are subjected to stress, and may also generate stress on the supporting structures [¹⁶]. The abutment teeth, as elements of support and retention, are subjected to stress during function, insertion, and removal of the prosthesis. If this stress exceeds their natural resistance, it may result in alveolar bone resorption, abutment loss, and ultimately prosthesis failure [¹⁷,¹⁸]. Similarly, distal extension saddles are subjected to stress during function, resulting in bone resorption, loss of support, and decreased prosthesis stability [¹⁹,²⁰]. Therefore, for RPD rehabilitation to reach the desired level of success without damaging the supporting structures, all treatment steps, including diagnosis, planning, pre-treatment preparation, impression, framework adaptation, and follow-up, must be carefully developed [⁷].

Some strategies have been proposed to improve the biomechanics of RPDs in anterior or posterior free-end edentulous areas, such as the use of T retainer and occlusal rests positioned away from the edentulous space [⁹,²¹]. Additionally, a functional impression of the free-end extension is commonly recommended to ensure optimal support for the RPD bases [⁶,²²].

Advantages of functional impression in RPD biomechanics

Anatomic impressions record hard and soft tissues at rest. When only this type of impression is used in a distal extension condition, ideal occlusal contact is achieved at rest, however, during clenching or mastication, the denture base yields along with the displacement of the mucosal lining [¹¹]. Furthermore, when occlusal forces are applied to the artificial teeth of the distal extension, the denture base behaves like a harmful lever, rotating with the abutment teeth as the fulcrum and concentrating occlusal forces in a small area at the distal end of the edentulous ridge, where the denture base ends [¹⁰].

In contrast, the functional impression records the residual ridge tissues under function by simulating different movements such as swallowing, suction, and mouth opening [¹¹]. The goal of any functional impression technique is to provide maximum support for the RPD bases and prevent the future saddle from excessively compressing the distal extension mucosa during mandibular rest or mastication [¹¹,²²]. Proper contact between the saddle and the distal extension mucosa avoids overloading the abutment tooth, thus preventing periodontal issues and consequent bone resorption [²²].

Functional Impression Techniques

Functional impression can be performed using the custom tray technique, the altered cast or Applegate technique, or the open or closed mouth techniques [²²]. The first technique is conducted after the preliminary preparation of the abutment teeth. The second technique is commonly performed after the metal framework try-in. Open and closed mouth techniques are executed during the esthetic and functional try-in of acrylic resin teeth [¹³]. Regardless of the technique, during the impression procedure, the patient should perform active functional movements such as mouth opening, swallowing, pronouncing the letter “A”, and mandibular movements [²³].

The custom tray technique is often recommended in cases where few teeth remain in the dental arch, however, it can be applied to all Kennedy classifications (Class I, II, III, and IV). The procedures are like those used in functional impressions for complete dentures [²²]. Initially, an anatomic impression is made, from which a custom tray is fabricated. The functional impression is performed in two steps, first, border molding using a thermoplastic material, followed by the final impression using a low-viscosity material [²³].

In the altered cast or Applegate technique, the sequence begins with the fabrication of the metal framework on the master cast. After the try-in, a partial custom tray is prepared and attached to the framework via meshwork in the saddle area. The functional impression is made in a single step using zinc oxide-eugenol paste or a light-body elastomer. The edentulous area of the master cast is trimmed, and mechanical retentions are created to passively adapt the functional impression. The final functional cast is obtained by pouring a special dental stone over this refined impression [¹¹,²⁴,²⁵].

The open and closed mouth techniques are performed after the esthetic and functional try-in of acrylic resin teeth set in wax, using the provisional resin base as the custom tray. As in the altered cast technique, the functional impression is made in a single step using zinc oxide-eugenol paste or a light-body elastomer. In the open mouth technique, the patient maintains the mouth open, allowing the clinician to control the mandibular position. In the closed mouth technique, the patient occludes throughout the impression procedure, preventing an increase in the vertical dimension of occlusion. Both techniques require prior occlusal adjustment, and the patient must be instructed to occlude at the end of the procedure [²²].

Evidence in the literature

The clinical studies by Diwan and Fahmi [²⁶] and Sykora [²⁷] compared the functional impression using the altered cast technique with the conventional single-step impression. The findings revealed that the altered cast technique provides better adaptation to the supporting tissues and greater prosthesis stability compared to the conventional technique, improving fit and overall functionality of the prosthesis [²⁶,²⁷]. These results were corroborated by a systematic review, which found that although both techniques can be effective, the altered cast technique generally results in better marginal adaptation and prosthesis stability, and is preferable in distal extension cases [²⁸].

In contrast, the clinical study by Frank et al. [²⁴] indicated that when considering factors such as support of the acrylic resin base, abutment health, and long-term patient comfort, the altered cast technique offers no significant advantages over the single-step impression, provided all technical procedures are properly followed.

Regarding the prevalence and preferences of professionals concerning different functional impression techniques for RPD, an epidemiological study was conducted to identify factors influencing these choices, such as clinical experience and the type of prosthesis to be fabricated. The results showed a wide variety of practices, with a significant trend toward simpler and faster techniques, 66% of participants reported using custom trays for anatomic-functional impressions, while 17% preferred the altered cast technique. However, the study found no correlation between impression technique, tray type, or materials used, and the complaints reported by patients [⁶].

Digital workflow, current and future perspectives

Advancements in computer-aided design and manufacturing (CAD-CAM) have led to the production of more precisely fitted milled restorations, and the widespread use of the digital workflow in fabricating dental prostheses [²⁹]. In the field of RPDs, digital dental applications are increasingly being used [³⁰]. Intraoral scanners can replace conventional impressions and be used to acquire data for RPD fabrication [³¹,³²]. Furthermore, the metal framework can be designed from the resulting digital file, either by creating a pattern additively manufactured with photopolymer and using the lost-wax casting technique, or directly through selective laser sintering [³³].

To reduce chairside time and the number of appointments, digital approaches have been developed to optimize functional impression procedures based on the principles of the altered cast technique [³⁴,³⁵]. The technique described by Wu et al. [³⁴] begins with a conventional anatomic impression to create a partial tray from the digitized model, then, a functional impression is made to generate the altered gypsum model, which is subsequently scanned for the digital design of the framework. In contrast, Cameron et al. [³⁵] combined an intraoral scanner with polyvinyl siloxane impression material to create a digitally altered cast model, providing high precision and efficiency for RPD treatment.

DISCUSSION

RPDs are a treatment option that stands out for being minimally invasive, cost-effective, reversible, and versatile, and are often preferred over fixed partial dentures (FPD) or implant therapy in various clinical scenarios [³⁶,³⁷]. The main challenge of this treatment is to restore function, esthetics, and patient comfort while minimizing potentially harmful forces on the abutment teeth and supporting tissues [³⁷]. Therefore, for treatment success, accurate diagnosis, careful planning, and long-term maintenance are essential.

In Kennedy Class I or II cases, where distal extension saddles are present, the denture bases supporting the artificial teeth of the RPDs tend to move toward the mucosa during function, which can compromise the stability and support of the prosthesis [³⁸]. The presence of extended distal edentulous areas presents additional challenges in RPD fabrication due to differences in resilience between teeth and mucosa [²⁸]. To improve the biomechanical behavior of the prosthesis, it is crucial that the dental morphology is accurately recorded, as well as the mucosa in its functional form [²⁸,³⁵]. Adequate contact between the saddle and the distal extension mucosa is fundamental to ensure optimal support of the RPD bases, preventing overload on abutment teeth and bone resorption [⁶,²²].

Although the literature supports the use of functional impression based on the biomechanics of RPD, there are few clinical studies comparing it to single-step impression. All comparative studies analyzed employed the altered cast technique [²⁴,²⁶,²⁷]. Despite the challenges, costs, and additional time required, this approach offers better support and extension for the prosthesis [³⁸]. On the other hand, an epidemiological study showed that most participants prefer using custom trays for an anatomic-functional impression [⁶].

The studies by Diwan and Fahmi [²⁶] and Sykora [²⁷] reported advantages in using functional impression over single-step impression, while the study by Frank et al. [²⁴] observed that the technique offers no significant benefits compared to conventional single-step impression. A systematic review concluded that, although both techniques can be effective, the altered cast impression generally provides better marginal adaptation and prosthesis stability, and is preferable in distal extension cases [²⁸].

Finally, to improve efficiency and reduce the number of appointments, digital methods have been developed to enhance functional impression based on the principles of the altered cast technique [³⁴,³⁵]. Although both methods aim to improve prosthesis adaptation and patient comfort, they differ in the integration of digital technologies with traditional materials, reflecting the evolution of impression techniques and the growing adoption of digital solutions in dentistry.

Considering the biomechanical challenges of RPD, especially in distal extension areas, the use of functional impression, particularly with the altered cast technique, is highly recommended. This approach provides improved support and prosthesis stability, which are essential to prevent overload on abutment teeth and bone resorption. Despite limitations related to increased time and cost, functional impression offers significant advantages in terms of adaptation and prosthesis longevity. However, further randomized controlled clinical trials are needed, using currently available materials and digital techniques, to validate the clinical effectiveness of this approach.

CONCLUSION

• Treatment with RPD is challenging, especially in distal extension areas, where it is crucial to balance support among rigid teeth, resilient mucosa, and underlying bone.

• The literature shows a scarcity of clinical studies comparing the single static impression technique to functional impression techniques, and most of these studies are over 20 years old. Considering significant advances in dental materials since then, these results may not reflect current clinical practices.

• Despite limitations, functional impression techniques stand out for providing balanced support, preventing overload, bone resorption, and prosthetic failure, thus significantly contributing to treatment success and longevity.

• The altered cast technique is the most widely used and recommended, according to the literature.

• With recent advances in digital technology, such as CAD-CAM and intraoral scanners, new approaches are revolutionizing the field of RPD by optimizing functional impression procedures, improving accuracy, and reducing chairside time.

• How to cite this article
  Rangel BT, Sugio CYC, Garcia AAMN, Gomes ACG, Neppelenbroek KH, Porto VC. Is functional impression essential for the success of removable partial dentures? RGO, Rev Gaúch Odontol. 2025;73:e20250040. http://dx.doi.org/10.1590/1981-86372025004020250018

Data availability

The research data are available in the body of the document.

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Edited by

• Assistant editor:
  Luciana Butini Oliveira

Publication Dates

• Publication in this collection
  07 Nov 2025
• Date of issue
  2025

History

• Received
  18 Feb 2025
• Accepted
  07 July 2025