57ODONTOLOGÍA VITAL ENERO-JUNIO 2021

Fernández, E., Rivero, M.G., Díaz-Yokens, M., Padilla, P. (2021) Traditional versus simpliﬁed impression methods for

complete dentures: critical appraisal of evidence. Odontología Vital 34: 57-64.

Traditional versus simpliﬁed

impression methods for complete dentures:

critical appraisal of evidence

Traditional versus simpliﬁed

impression methods for complete dentures:

critical appraisal of evidence

Método tradicional versus simpliﬁcado en

impresiones para prótesis total removible:

evaluación crítica de la evidencia

Método tradicional versus simpliﬁcado en

impresiones para prótesis total removible:

evaluación crítica de la evidencia

Enrique Fernández, Universidad San Sebastián and Universidad Nacional Andrés Bello, Santiago, Chile,

enrique.fernandez@uss.cl

Marta G. Rivero, Clínica privada, Santiago, Chile, martagrivero.uss@gmail.com

Marco Díaz-Yokens, Universidad San Sebastián, Santiago, Chile, marco.diazyokens@ gmail.com

Paula Padilla, Universidad San Sebastián, Santiago, Chile, paula.andrea.padilla.a@gmail.com

RE SU MEN

Introducción: Pese a los avances de la odontología, el fenómeno del envejecimiento de la población ha generado

que la cantidad de personas desdentadas totales aún represente una cifra signiﬁcativa. Los artiﬁcios protésicos

implanto-asistidos constituyen, en la mayoría de los casos, la mejor alternativa rehabilitadora. Sin embargo,

la variable económica surge como el principal impedimento para que los pacientes accedan a este recurso, y

por este motivo, mantienen la prótesis total removible como una opción terapéutica. Para su confección, el

método tradicional indica la necesidad de tomar dos impresiones: una preliminar y una deﬁnitiva o funcional.

El método simpliﬁcado, confecciona la prótesis a partir de la primera impresión, obtenida con cubeta de stock.

Objetivo: Revisar evidencia cientíﬁca que compara ambos métodos en cuanto a las variables de: satisfacción del

paciente, calidad clínica, rendimiento y capacidad masticatoria. Resultados: No se veriﬁcan ventajas a favor del

método tradicional en relación a las variables estudiadas. Conclusiones: En concordancia con la información

recabada, los resultados clínicos obtenidos mediante el método tradicional de toma de impresiones para

prótesis totales no son signiﬁcativamente superiores a los del método simpliﬁcado en relación a calidad clínica,

satisfacción del paciente, rendimiento y capacidad masticatoria.

PALABRAS CLAVE

Prótesis removible; Prótesis total; Técnica de impresión dental; Satisfacción del paciente;

Práctica basada en la evidencia.

ABSTRACT

Introduction: Inspite of the great advances in dentistry, aging populations imply that there are still signiﬁcant

numbers of edentulous people worldwide. In most cases, implant-assisted prosthetic rehabilitation is the best

solution. However, economic issues constrain access to this therapeutic approach, meaning that conventional

removable prosthetics continue to be the most frequent treatment. In the removable denture making process, the

so-called traditional method has been widely taught and used. It involves taking two impressions: a preliminary

one followed by a deﬁnitive one (or functional). The simpliﬁed method constructs the prosthesis directly from

the ﬁrst impression obtained with a stock tray, without the need of a second impression. Purpose: To review the

scientiﬁc evidence comparing both methods in terms of patient satisfaction, clinical quality, and masticatory

performance and capacity. Results: No advantages have been found in favor of the traditional method regarding

the four variables selected. Conclusions: According to the available information, the traditional method of

taking impressions for complete removable dental prostheses does not provide signiﬁcantly superior clinical

results when compared to those obtained using the simpliﬁed method in terms of clinical quality, patient

satisfaction, performance and masticatory capacity.

58 ODONTOLOGÍA VITAL ENERO-JUNIO 2021

Revista Odontología Vital Enero - Junio 2021. Año 19. Volumen 1, No. 34

INTRODUCTION

Over the recent decades, there has

been an ongoing worldwide trend

towards increased life expectancy

both at birth and as a percentage

increase in the older adult popu

lation (Balachandran et al., 2020).

Internationally, there are reports

that in some Balkan countries

complete edentulism can be as

high as 78% of the adult population

(Petersen et al., 2005). In Chile, the

average tooth loss in 65-74 year-

old population currently stands at

15.8 teeth per person; with 69.8%

of them being partially edentulous

and 29.1% being completely eden-

tulous (Chilean Ministry of Health

(MINSAL), 2017).

Because ﬁnancial constraints and

systemic conditions faced by some

patients contraindicate the use of

dental implants (Hwang & Wang,

2006), complete removable dental

prostheses continue to be a suit

able therapeutic alternative (Carls-

son, 2010). A critical step in the

construction of these devices is

the impression of the edentulous

ridges. Several techniques (Rao et

al., 2010) have been proposed for

this purpose; though there are still

a number of controversies in this

regard (Petropoulos & Rashedi,

2003). Most dental schools and

pertinent texts (Petropoulos &

Rashedi, 2003) teach and describe

the so-called “traditional method”

(Rao et al., 2010), which advises

taking a deﬁnitive open-mouth im-

pression, using a custom tray made

from an initial impression. Addi-

tionally, relief in the stress bear-

ing areas should be fashioned, as

well as peripheral extensions and

border molding (dual impression

technique - Boucher technique or

its modiﬁcations - associated with

the selective pressure philosophy)

(Petropoulos & Rashedi, 2003; Rao

et al., 2010). The above-mentioned

method claims that this technique

provides better clinical results and

greater patient satisfaction as com

pared to a “simpliﬁed method” in

which a prosthesis is created from

the preliminary impression taken

with a stock tray (Heydecke et al.,

2008). Its proponents maintain

that there is evidence indicating

that this technique saves time and

cost without affecting clinical re-

sults or patient satisfaction (Dun-

can & Taylor, 2001; Jagger, 2006).

The “patient satisfaction” variable

is related to the his/her perception

of the treatment, and is measured

along a rating scale. The most wide-

ly used scales are the subjective

Oral Health-related Quality of Life

(OHRQol) (Kawai et al., 2010; Ye

Ye & Sun, 2017; Albuquerque et al.,

2020) and the Oral Health Impact

Proﬁle (OHIP) (Ye Ye & Sun, 2017;

Albuquerque et al., 2020; Nuñez et

al., 2013) which is based on func-

tional limitations, physical pain,

psychological discomfort, physical

disability, psychological disability,

social disability, and handicap. An-

other relevant variable is the “clini-

cal quality”, understood as the den-

tist’s clinical criteria regarding the

prosthesis (Ye Ye & Sun, 2017) and

its fulﬁllment of retention, support

and stability requirements. Other

variables assessed using question-

naires with binary responses and

numerical rating scales (Schott et

al., 2010; Cunha et al., 2013) are

“masticatory performance,” de

ﬁned as the objective measure-

ment of the degree of grinding to

which food can be subjected in an

established number of masticatory

cycles (Schott et al., 2010; Cunha et

al., 2013); and “masticatory capac-

ity,” a subjective parameter which

measures the individual’s assess-

ment of their mastication (Schott

et al., 2010).

The purpose of this review is to

explore the scientiﬁc evidence re-

ported in specialized publications

comparing the results of the “tra-

ditional” (functional impression)

and “simpliﬁed” methods used in

making complete removable den-

tal prostheses, considering patient

satisfaction, clinical quality, per-

formance, and masticatory capac-

ity, among others.

MATERIALS AND METHODS

MEDLINE databases (MESH cri-

teria) were used to conduct two

searches. The ﬁrst search was con-

ducted using the following combi-

nation of keywords and search op-

erators: “impression techniques”

OR “dental impression” AND “tra-

ditional method” AND “simpliﬁed

method” and their corresponding

terms in Spanish, i.e., “técnica de

impresión” OR “impresión dental”

AND “método tradicional” AND

“método simpliﬁcado”. The second

search employed the combined

terms “impression techniques” OR

“dental impression” AND “selec-

KEY WORDS

Removable denture; complete denture; dental impression technique;

patient satisfaction; evidence-based practice.

Recibido: 11 noviembre 2020

Revisado: 8 enero 2021

Aceptado para publicar: 26 enero 2021

59ODONTOLOGÍA VITAL ENERO-JUNIO 2021

tive pressure” AND “mucostatic,”

and the corresponding terms in

Spanish.

Four criteria were deﬁned for in-

clusion in this study: (a) that the

studies had been published be-

tween 2000 and the ﬁrst quarter

of 2020 (date on which the search

was conducted); (b) that they were

randomized clinical trials, criti

cal reviews, or systematic reviews

comparing both methods regard

ing the impression-taking process

for making a complete removable

dental prosthesis; (c) that both the

abstract and the article were avail

able online; and (d) that they were

written in English and/or Spanish.

The lead author, who conducted

the searches, selected the articles

based on a review of their abstracts

using a checklist of inclusion and

exclusion criteria. A summary

table of the selected articles was

generated in chronological order

(see Table 1). As neither a statisti-

cal analysis of the results of the

selected articles nor an exhaustive

search of those studies not avail-

able online was performed, this

paper is classiﬁed as a critical ap

praisal of evidence.

RESULTS

A total of 23 publications, including

critical or systematic reviews and

randomized clinical trials, met all

of the inclusion criteria (see Table

1). In 16 randomized clinical trials

(Duncan & Taylor, 2001; Kawai et

al., 2005; Jagger, 2006; Heydecke et

al., 2008; Kawai et al., 2010; Galaz

et al., 2012; Núñez, 2013; Cunha

et al., 2013; Omar et al., 2013; Jo et

al., 2015; Mengatto et al., 2017; Ce-

ruti et al., 2017; Kawai et al., 2018;

Lira-Oetiker et al., 2018; Tripathi et

al., 2019; Albuquerque et al., 2020),

involving more than 800 patients,

no signiﬁcant differences were re-

ported in terms of masticatory per-

formance controlled at 3 months

Fernández, E., Rivero, M.G., Díaz-Yokens, M., Padilla, P. (2021) Traditional versus simpliﬁed impression methods for

complete dentures: critical appraisal of evidence. Odontología Vital 34: 57-64.

(Cunha et al., 2013; Albuquerque

et al., 2020), 6 months (Mengatto

et al., 2017; Albuquerque et al.,

2020), and 10 years post-treatment

(Kawai et al., 2018); masticatory ca-

pacity at 3 months (Heydecke et al.,

2008 ; Albuquerque et al., 2020) and

6 months (Mengatto et al., 2017;

Albuquerque et al., 2020); the same

was true for patient satisfaction as

sessed at 1 month (Núñez, 2013;

Omar et al., 2013; Jo et al., 2015), 3

months (Jagger, 2006; Kawai et al.,

2005; Omar et al., 2013; Albuquer

que et al., 2020), 6 months (Kawai

et al., 2005; Jagger, 2006; Kawai et

al., 2010; Núñez, 2013; Lira-Oe-

tiker et al., 2018; Albuquerque et

al., 2020) and 10 years (Kawai et

al., 2018); and also with respect

to clinical quality assessed at 3

months (Kawai et al., 2005; Omar

et al., 2013) and 6 months (Kawai

et al., 2005; Kawai et al., 2010; Lira-

Oetiker et al., 2018) respectively. By

comparison, the favorable results

for the “simpliﬁed method” in-

clude the following: fewer clinical

sessions required for manufactur-

ing the prosthetic device (Duncan

& Taylor, 2001; Ceruti at al., 2017),

without undermining retention

(Galaz et al., 2012); nor increasing

the number of subsequent check-

ups (Duncan & Taylor, 2001; Al-

buquerque et al., 2020); overall

satisfaction, stability and aesthetic

appearance at 3 months post-in-

stallation (Heydecke et al., 2008),

and less resorption of the man-

dibular residual ridge in individu-

als with decreased bone density,

as assessed by CT scan, one year

after installation of the prostheses

(Tripathi et al., 2019).

One article reported that for the 24

subjects evaluated the patient sat

isfaction rating was higher for the

traditional method (Jo et al, 2015).

The selected critical reviews (Carls

son, 2009; Carlsson, 2010; Carls-

son et al., 2013; Uram-Tuculescu

& Constantinescu, 2017; Jayara-

man et al., 2018) and systematic

reviews (Regis et al., 2016; Ye Ye &

Sun, 2017), reported that there is

no evidence to support that one

impression technique provides

better results than the other in the

long-term follow-ups (Carlsson,

2009; Jayaraman et al., 2018), nor

signiﬁcant differences between

both methods in terms of: perfor-

mance and masticatory capac-

ity (Regis et al., 2016; Ye Ye & Sun,

2017); patient satisfaction (Carls-

son, 2009; Carlsson, 2010; Carlsson

et al., 2013; Regis et al., 2016; Ye Ye

& Sun, 2017; Uram-Tuculescu &

Constantinescu, 2017) and clinical

quality (Carlsson, 2009; Carlsson,

2010; Carlsson et al., 2013; Regis et

al., 2016; Ye Ye & Sun, 2017; Uram-

Tuculescu & Constantinescu,

2017).

DISCUSSION

The traditional impression method

for a complete removable dental

prosthesis involves taking two im

pressions: a preliminary one, gen-

erally with irreversible hydrocol-

loid and a stock impression tray,

and following casting creating a

model in which an individual tray

is made. This tray is then used to

record the three-dimensional con-

tours of the denture with a ther-

moplastic molding compound,

followed by a second impression,

usually with silicone elastomers

or zinquenolic paste (Petropoulos

& Rashedi, 2003; Rao et al., 2010;

Carlsson et al., 2013; Jo et al., 2015).

However, a so-called simpliﬁed

method has also been proposed

and used, advocating restoring pa-

tient functionality and aesthetics,

and also optimizing dental care.

It postulates the use of the pre-

liminary impression, without need

for a second one or assembly in a

semi-adjustable articulator (Dun

can & Taylor, 2001; Heydecke et

al., 2008; Carlsson, 2010; Carlsson

et al, 2013; Jo et al., 2015; Ye Ye &

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Revista Odontología Vital Enero - Junio 2021. Año 19. Volumen 1, No. 34

Table 1: Articles Included

Author Year Type of Study Methodology Results

Duncan JP,

Taylor TD.

2001 Randomized

clinical trial.

Comparison in a randomly

divided group of 80 patients,

assessing the efﬁcacy of both

impression methods.

Simpliﬁed method decreased

the number of clinical sessions,

without increasing the number

of subsequent adjustments.

Kawai Y,

Murakami

H, Shariati B,

Klemetti E,

Blomﬁeld JV,

Billete L.

2005 Randomized

clinical trial.

Comparison in a randomly

divided group of 122 patients,

assessing prosthesis quality,

patient satisfaction, comfort,

and function between the two

methods.

No signiﬁcant differences were

obtained in terms of satisfac

tion and clinical quality.

Jagger R. 2006 Randomized

clinical trial.

Comparison in a randomly

divided group of 119 patients,

assessing patient satisfaction

between the two methods.

No signiﬁcant differences

obtained.

Heydecke G,

Vogeler M,

Wolkewitz M,

Turp JC, Strub

JR.

2008 Randomized

clinical trial.

Comparison in a group of 20

patients. Each patient received

2 sets of complete removable

dental prostheses, each one

constructed with a different

method, to assess chewing

capacity.

Simpliﬁed method yields better

overall satisfaction, stability,

and aesthetic appearance.

Carlsson GE. 2009 Critical Review Databases used: PubMed, Med

Line.

Review of 9 randomized clinical

trials.

There is no evidence that one

technique or material produces

better long-term results than

another.

No signiﬁcant differences were

obtained in terms of satisfac

tion and clinical quality.

Carlsson GE. 2010 Critical Review Databases used: PubMed, Med

Line. 95 articles were included.

The text is based on an update

of the lecture given at the mee

ting of the International Asso-

ciation for Dental Research in

Barcelona on July 16, 2010.

No signiﬁcant differences

were found between the two

methods in terms of prosthesis

quality, tissue response and

patient satisfaction.

Kawai Y,

Murakami H,

Takanashi Y,

Lund JP, Feine

JS.

2010 Randomized

clinical trial.

Comparison in a randomly

divided group of 122 patients,

assessing the efﬁciency (deﬁ

ned as associated costs, patient

satisfaction and clinical quali

ty) of both methods in private

practice.

No signiﬁcant differences were

obtained in terms of satisfac

tion and clinical quality.

Galaz S, Mi

randa F, Gar-

cía O, Acosta

H, Carrasco L.

2012 Randomized

clinical trial

Comparison in a group of 16

patients, assessing the retention

obtained in upper complete

removable dental prostheses

constructed with alginate and

zinquenolic paste impressions.

The impressions taken with

alginate had a statistically sig

niﬁcant higher retention rate.

Omar R, Al-

Tarakemah

Y, Akbar J,

Al-Awadhi S,

Behbehani Y,

Lamontagne

2013 Randomized

clinical trial.

Comparison in a group of 43 pa-

tients randomly divided into 4

groups (1: omission of functio

nal impression, 2: omission of

functional impression+semi-

ajustable articulator use, 3:

omission of semi-adjustable ar

ticulator use, 4: control group).

No signiﬁcant differences were

obtained in terms of satisfac

tion and clinical quality.

61ODONTOLOGÍA VITAL ENERO-JUNIO 2021

Fernández, E., Rivero, M.G., Díaz-Yokens, M., Padilla, P. (2021) Traditional versus simpliﬁed impression methods for

complete dentures: critical appraisal of evidence. Odontología Vital 34: 57-64.

Cunha TR,

Vecchia MP,

R. Regis RR,

Ribeiro AB,

Muglia VA,

Mestriner W.

2013 Randomized

clinical trial.

Comparison in a group of 39

randomly divided patients,

assessing masticatory perfor

mance and capacity.

Both groups have similar mas

ticatory behavior.

Carlsson GE,

Ortorp A,

Omar R.

2013 Critical Review Databases used: PubMed, Med

line, The Cochrane Library. Five

relevant randomized clinical

trials were included, compa

ring both methods by assessing

clinical quality and patient

satisfaction.

No signiﬁcant differences ob

tained between both methods.

Nuñez M, Sil

va D, Barcelos

B, Reles C.

2013 Randomized

clinical trial.

Comparison in a randomly

divided group of 52 patients,

assessing quality of life and

patient satisfaction.

No signiﬁcant differences ob

tained between both methods.

Jo A, Kana

zawa M, Sato

Y, Iwaki M,

Akiba N, Mi

nakuchi S.

2015 Randomized

clinical trial.

Comparison in a group of 24

patients randomly divided into

2 groups, assessing patient

satisfaction and oral-health-

related quality of life.

No signiﬁcant quality of life

difference was obtained. The

traditional method was supe

rior in terms of patient satisfac-

tion.

Regis RR, Al

ves CC, Rocha

SS, Negreiros

WA, Freitas-

Pontes KM.

2016 Sistematic

Review.

Databases used: PubMed, Med

Line.

16 articles were included.

No signiﬁcant differences were

found in terms of clinical qua-

lity, patient satisfaction, and

quality of life improvements.

Mengatto

CM, Gameiro

GH, Brondani

M, Owen P,

MacEntee MI.

2017 Randomized

clinical trial.

Comparison in a group of 20

randomly divided patients, as

sessing and masticatory perfor-

mance and capacity.

No signiﬁcant differences

obtained.

Ceruti P, Mo

bilio N, Bellia

E, Borracchini

A, Catapano

S, Gassino G.

2017 Randomized

clinical trial.

Comparison in a randomly

divided group of 64 patients,

assessing clinical quality and

patient satisfaction.

No signiﬁcant differences ob

tained between both methods.

Ye Ye, Sun J . 2017 Sistematic

Review.

Databases used: MedLine, Pub

Med, EMBASE. Eleven articles

were included, 7 of which were

randomized clinical trials.

No signiﬁcant differences were

obtained between the two

methods in terms of patient

satisfaction, clinical quality and

chewing capacity.

Uram-Tucule

cu S, Cons-

tantinescu M.

2017 Critical Review Databases used: PubMed, Ame

rican College of Prosthodontists

database and non-indexed sou

rces. Does not specify quantity

of items included.

No signiﬁcant differences were

obtained in terms of clinical

quality and patient satisfaction.

Kawai Y,

Murakami H,

Feine JS.

2018 Randomized

clinical trial.

Comparison in a randomly

divided group of 103 patients,

assessing patient satisfaction

and masticatory performance at

10 years post-inhalation.

No signiﬁcant differences ob

tained between both methods.

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Revista Odontología Vital Enero - Junio 2021. Año 19. Volumen 1, No. 34

Lira-Oetiker

M, Seguel-

Galdames F,

Quero-Valle

jos I, Uribe

SB.

2018 Randomized

clinical trial

Comparison in a randomly

divided group of 38 patients,

assessing patient satisfaction

and clinical quality.

No signiﬁcant differences ob

tained between both methods.

Jayaraman

S, Singh BP,

Ramanathan

B, Pazha

niappan P,

MacDonald L,

Kirubakaran

2018 Critical Review Databases used: Cochrane Li

brary, MedLine, EMBASE.

Nine articles were included, 8

of which studied a total of 485

patients.

No signiﬁcant differences ob

tained between both methods.

Tripathi A,

Singh SV,

Aggarwal H,

Gupta A.

2019. Randomized

clinical trial.

Comparison of a group of 96

randomly divided patients

evaluating bone resorption of

the mandibular residual ridge

in patients with different bone

densities, objectively assessed

by means of a CT scan at one

year post-installation.

Simpliﬁed method generates

less bone resorption of the

mandibular residual ridge in

patients with decreased bone

density.

Albuquerque

IS, Freitas-

Pontes KM,

Souza RF,

Negreiros WA,

Ramos M,

Peixoto RF,

Regis RR.

2020 Randomized

clinical trial.

Comparison in a group of 52

randomly divided patients, as

sessing mandibular resorption

in terms of masticatory perfor

mance and capacity, patient

satisfaction, and subsequent

adjustments.

No signiﬁcant differences ob

tained between both methods.

Sun, 2017; Kawai et al., 2018). This

procedure offers comparative ad

vantages such as reducing costs,

materials, number of clinical ses-

sions and laboratory time, thereby

providing access to the treatment

for the most disadvantaged popu-

lation, without sacriﬁcing biofunc-

tional and prosthodontic princi-

ples (Duncan & Taylor, 2001; Owen,

2004; Kawai et al., 2005; Cunha et

al., 2013; Carlsson et al., 2013). A

considerable number of studies

report that there are no signiﬁcant

differences between the two meth-

ods in terms of patient satisfaction,

clinical quality, performance and

masticatory capacity, when these

variables were controlled for over

the short and long term (Duncan

& Taylor, 2001; Kawai et al., 2005;

Carlsson, 2010; Omar et al., 2013;

Cunha et al., 2013; Ye Ye & Sun,

2017; Mengatto et al., 2107; Ceruti

et al., 2017; Kawai et al., 2018; Lira-

Oetiker et al., 2018).

Based on the consistency of the

evidence presented, the simpliﬁed

method appears as an acceptable

protocol for the manufacturing

and quality control of prosthetic

devices (Carlsson, 2010; Carlsson

& Omar, 2010; Omar et al., 2013;

Carlsson et al., 2013).

It seems that the prevailing ap

proach in the literature, under-

graduate teaching, and specialized

practice as to the need for and the

“superiority” of using the tradi-

tional method, in detriment of the

simpliﬁed method, should be re-

considered. While some particu-

lar clinical situations may beneﬁt

from the application of the tradi

tional method, the simple and in-

expensive one-step procedure - the

simpliﬁed method - has shown that

it fulﬁlls the needs of the vast ma-

jority of totally edentulous patients

(Petropoulos & Rashedi, 2003;

Kawai et al., 2010; Carlsson et al.,

2013; Kawai et al., 2018). Regard-

ing the advisability of exclusively

teaching the traditional method at

the undergraduate level, we sug-

gest to revise the dental curriculum

- including the simpliﬁed method

(Duncan & Taylor, 2001; Kawai

et al., 2018; Carlsson et al., 2013),

while highlighting the beneﬁts that

this change will have providing

wider dental coverage, especially

for patients from disadvantaged

communities.

63ODONTOLOGÍA VITAL ENERO-JUNIO 2021

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CONCLUSIONS

According to the available infor

mation, the traditional method of

taking impressions for complete

removable dental prostheses does

not provide signiﬁcantly superior

clinical results when compared to

those obtained using the simpliﬁed

method in terms of clinical quality,

patient satisfaction, performance

and masticatory capacity.

Considering the limitations of this

study, which arise mainly from

the methodology employed, and

despite the fact that some special

clinical situations may beneﬁt

from other combinations of mate-

rials and techniques, the reported

scientiﬁc evidence supports the

appropriateness of the simpliﬁed

approach in fulﬁlling the prosthet-

ic needs for the majority of com-

pletely edentulous patients.

CHILE

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