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An

Elastomeric
Impression
Material
Breakthrough
Written by Richard L. Brown, Jr, DDS Thursday, 01 October 2009
00:00

INTRODUCTION
Perhaps no procedure done on a routine basis in dentistry
contains more uncertainty and yet of holds more importance
for the outcome of care than that of the dental impression.
Every dentist and dental office team member has at some
point anxiously awaited to see if the fruit of their labor has
been captured correctly in the negative form of an
impression. While in the state of unknown, each goes
through a mental checklist of all the choices made to get to
this point. Is the preparation correct, is the tray correct, is
this the best technique for the situation at hand, did the
tissue get managed properly, and finally was the material
the proper one? While each of these variables is a topic of
discussion, the material choice is the one that influences all
the others in some form or another and perhaps can make
the biggest difference.
There is great confusion out there about the types of
materials, their clinically relevant properties, and their
usage. This is further compounded by the fact that there are
some 40 plus brands of one type of impression material
distributed by some nearly 30 separate companies. The
1

marketing barrage that accompanies these products is


sometimes overwhelming.
The purpose of this article is to highlight the use of a new
elastomeric impression material that takes advantage of the
best properties of both a polyethers and a vinyl polysiloxane
(VPS). This new impression material can be used in
multiple/different situations, and, in the author’s opinion,
should help to clear up the picture of the material of choice
for dental final impressions.

BRIEF HISTORY OF ELASTOMERIC IMPRESSION


MATERIALS
The dental impression has evolved over the past 3 decades
from a cumbersome, labor intensive, ill-tasting event to a
relatively simple experience which can be predictably
accurate if a system for success exists. Polysulfides were
the first elastomeric impression materials. For over 30
2

years, these remained the primary elastomeric material of


choice until polyethers burst on the scene with their
improved hydrophilicity. Polyethers then became the
material of choice for many practitioners. Polyethers still
3

had challenges due to poor taste, relatively low tear-


strength, rigidity upon removal, and difficulty in mixing. This
led to the development of the first condensation-reaction
silicones and then VPS in the 1970s. These materials had
excellent tear strength, great dimensional stable, a good or
neutral taste, and were more flexible and not subject to
plastic deformation upon removal. They had one glaring
deficiency in that they are extremely hydrophobic. Over the
years, surfactants and scavengers have been added to this
class of impression materials to reduce the contact angle,
and to make them less hydrophobic, with a great deal of
success. However, by their nature, they are still hydrophobic
they hate water!
Consequently, and until recently, we have been left with 2
good choices for elastomeric impressions: polyether―with
its excellent hydrophilic qualities and great flow, but with
slow recovery, rigidness, a low tear strength; and VPS―with
its great stability, high tear strength, and excellent recovery,
but with a hydrophobic nature. 4

UNIQUE VPES IMPRESSION MATERIAL INTRODUCED


Figure 1. Multiple viscosities
(EXA’lence [GC America]) of the new
vinyl polyether silicone (VPES)
impression material shown.

Figure 2. Shark Fin Test.

A new elastomeric impression material, (EXA’lence [GC


America] (Figure 1) that takes the best of polyether and VPS
materials and virtually eliminates their weaknesses, has
been recently introduced. It is being referred to as a vinyl
polyether silicone (VPES). This new material has the tear
strength and dimensional stability of VPS, and yet the
wettability and flow of polyether. It is available in multiple
viscosities, and with multiple setting times that will allow it to
be used in nearly every application. It can easily be
disinfected without distortion and is gypsum friendly at the
dental laboratory. According to flow tests, it is better than
virtually all materials on the market as measured by the
traditional “shark fin” test. Testing indicates that in every
viscosity it outperforms other popular products now
available, and the extra light-bodied viscosity reached an
impressive 17.0 mm (Figure 2). Tear strengths of this5

material have also been demonstrated to be higher than the


available VPS materials, and at or better than polyethers,
even in their lowest viscosities .5

The end result is a level of detail that produces an


outstanding restoration which fit’s precisely. In the author’s
opinion, VPES is a new impression material that will simplify
your material selection. I have found that our impressions
are taken more easily, without modifying our basic
techniques. The remainder of this article will address the
clinical use of this new VPES impression material.

CASE REPORT

Figure 3. Comprehensive orthodontic Figure 4. Anterior view: Post-ortho.


treatment.
Figure 5. Lateral view: Post-ortho. Figure 6. Anterior view: Provisionals.

A 44-year-old woman presented for restoration while in


comprehensive orthodontic care with a chief complaint of
discolored, poorly shaped teeth. She desired to have a more
attractive smile (Figure 3). The maxillary teeth exhibited
significant anterior inclination, uneven gingival crest heights,
and recession areas. An additional aesthetic challenge was
present due to the irregular size of the existing provisionals,
the unknown tooth structure present, and shape of the of
the existing preparations.
After multiple finishing visits with the orthodontists, the
orthodontic appliances were removed and the patient
presented with the multiple spaces and unaesthetic
restorations (Figures 4 and 5). Clinical crown lengthening
was performed with osseous recontouring. and new
provisional restorations based upon a diagnostic wax-up of
face-bow mounted stone models on a semi-adjustable
articulator were created (Figure 6).
Figure 7. Anterior view: Preparations. Figure 8. Full-arch VPES impression.

Figure 9. Close-up view of VPES Figure 10. Gypsum cast: Note the
impression. occlusal detail obtained with the use
of the VPES impression material.

Figure 12. Postoperative lateral view.


Figure 11. Postoperative anterior
view.
After 4 months of healing time, the provisionals were
removed and the preparations were refined for final
impressions (Figure 7). At this time, stock (custom-
moldable) plastic impression trays (Strong-Massad Denplant
Impression Tray [Global Dental Impression Trays]) were
selected These trays provide a very accurate dental
impression by allowing an equal thickness of the impression
material in a stock tray, without having to fabricate a custom
tray. The final impression was made with the new VPES
6-8

(EXA’lence) heavy-bodied material, and (EXA’lence) the


extra light-bodied viscosity, in a simultaneous one-step
technique. Note the excellent marginal detail, flow, and
easily readable, intact finish lines (Figures 8 and 9).
Next, an occlusal registration (Occlufast Rock [Zhermack])
and an opposing alginate impression were made, along with
a face-bow for use in mounting the case on a semi-
adjustable articulator. The impression was poured in dental
stone and the dies trimmed for scanning and the fabrication
of zirconium oxide based all-ceramic restorations (Procera
[Nobel Biocare USA]). Note the exceptional detail of the
occlusal surfaces on the stone casts and the finish line.
These details helped to ensure well-fitting restorations
(Figure 10) with accurate intercuspation and guidance. The
outcome was a more attractive final smile for the patient
meeting her chief complaint (Figures 11 and 12).

CONCLUSION
Over the years, very few advances have occurred in the
area of dental impression materials. Manufacturers have
attempted to modify and improve existing impression
materials creating a stream of products, that by their nature,
still presented with some of the same basic weaknesses as
originally introduced. While the future of dentistry and dental
materials may lie in the digital realm, it will take time to
make that complete journey. Since this new VPES
technology takes advantage of all the best properties of
everything currently available, regardless of the technique or
delivery method that is employed for final impressions, this
versatile material makes it both easy and reliable to obtain
consistent accurate impressions.

Acknowledgement
Special thanks to Mr. Tom Sano, CDT, G and H Dental Arts,
Torrance, CA, for the fine dental laboratory work done in this
case, and also for the years of personal friendship.

References

1. Cowie RR.
Understanding
impression
materials and
techniques. Dent
Today.
2007;26:108,
110-111.
2. Coy HD. The
selection and
purpose of
dental restorative
materials in
operative
dentistry. Dent
Clin N Amer.
1957;1:65-80.
3. Schulein TM.
Significant
events in the
history of
operative
dentistry. J Hist
Dent.
2005;53:63-72.
4. Craig RG, Hanks
CT. Restorative
Dental Materials.
7th ed. St. Louis,
Mo: Mosby;
1985:253-302.
5. Testing data on
file at GC
America, Inc,
Alsip, Ill; 800-
323-7063.
6. Eames WB,
Sieweke JC,
Wallace SW.
Elastomeric
impression
materials: effect
of bulk on
accuracy. J
Prosthet Dent.
1979;41:304-
307.
7. Shillingburg HT,
Hobo S, Whitsett
LD.
Fundamentals of
Fixed
Prosthodontics.
2nd ed. Chicago,
Ill: Quintessence
Publishing Co;
1981:228.
8. Massad J,
Strong S. Hidden
cost in
removable
overdentures.
Dental
Economics.
2008;98:46-50.
Suggested Readings
Cagna DR, Massad JJ. Vinyl polysiloxane impression
material in removable prosthodontics. Part 2: Immediate
denture and reline impressions. Compend Contin Educ
Dent. 2007;28:519-526.

Massad JJ, Cagna DR. Vinyl polysiloxane impression


material in removable prosthodontics. Part 1: edentulous
impressions. Compend Contin Educ Dent. 2007;28:452-459.

Dr. Brown is the president and owner of an aesthetic-driven


dental practice in Tulsa, Okla, where he provides his
patients with comprehensive dental care. He is a Fellow of
the Academy of General Dentistry, a member of the
American Academy of Cosmetic Dentistry, the American
Dental Association, the Oklahoma Dental Association, the
Tulsa County Dental Society, and charter member of
Oklahoma Academy of Cosmetic Dentistry. He has lectured
and presented table clinics to the ADA, ODA, Hinman
Dental Meeting, Garmish Dental Meeting, Tulsa Count
Dental Society, dental schools, and local dental societies
and organizations on various dental topics. He has
published several articles in the field of dentistry on the
subjects of dental adhesives, dental implants, dental
impression materials, and tooth-colored restorations and
dental medical ethics. He can be reached at (918) 492-1991
or via e-mail at rlbrowndds@sbcglobal.net This e-mail
address is being protected from spambots. You need
JavaScript enabled to view it .

Disclosure: Dr. Brown receives consulting fees from GC


America.
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