IMPRESSION MATERIALS

Alginate Synthetic Elastomers Impression Compound

DR. HIRA RAZA B.D.S

IDEAL PROPERTIES OF AN IMPRESSION MATERIAL

Accuracy and detail reproduction Dimensional stability Manipulation: ease of handling , short setting time, long working time Cost effective Pleasant taste and non-toxic Compatible with plaster Tear resistant Resistant to disinfectants

CLASSIFICATION
ACCORDING TO 1 - VISCOSITY HIGH
Impression compound Putty Elastomers

MEDIUM
Regular Elastomers

LOW
Impression Plaster
Impression Paste [ Zinc Oxide Eugenol] Hydrocolloids [ Agar and Alginate] Light Body Elastomers

2- ELASTIC PROPERTIES
SYNTHETIC ELASTOMERS POLYSULPHIDES , SILICONES , POLYETHERS HYDROCOLLOIDS REVERSIBLE: AGAR IRREVERSIBLE: ALGINATE

ELASTIC

RIGID

IMPRESSION PLASTER IMPRESSION PASTE [ZINC OXIDE EUGENOL]

THERMOPLASTIC

IMPRESSION COMPOUND IMPRESSION WAXES

MODELLING/IMPRESSION COMPOUND
Classified as a highly viscous, mucocompressive, thermoplastic impression material Types: Type 1: low fusing (impression materials: sheet and stick) Type 2: high fusing (impression trays) FUNCTION COMPONENT Composition EXAMPLE
THERMOPLASTIC MATERIAL 47% NATURAL OR SYNTHETIC RESIN OR WAXES TALC CHARACTERIZES SOFTENING TEMPERATURE

FILLER

INCREASES VISCOSITY AND DECREASES THERMAL CONTRACTION

LUBRICANT

STEARIC ACID

IMPROVES FLOW PROPERTIES

TYPE 1: SHEET /CAKE AND STICK

 Sheet /Cake form 1. colors: grey, green, red 2. softened using a water bath at a temperature of 55-60C if the conditioning time is too long or if its re-used, stearic acid can leach out 3. Uses 1- primary impression of edentulous arch 2- primary impression of kennedys class 1 and 2 [2 piece impression technique] 3- modification of stock tray [borders, palatal vault,postdam] 4- impression of maxillofacial defect for fabrication of obturator [2 piece impression technique]

Under extended tray thin edge of unsupported impression of the posterior lingual sulcus

 Stick form [ tracing compound] 1. colors: grey ,green ,red: indicates fusing temp 2. softened with bunsen burner and tampered with warm water before placing in patients mouth. 3. Uses 1- border moulding of custom tray for final impression of edentulous arch: creates peripheral and postdam seal 2- border moulding of custom tray for kennedys class 1 and 2 3- modification of stock tray 4- recording impressions of single crowns [copper ring technique , now superseded by use of silicone]

Modification of impression tray for high palatal vault

 Properties 1. Thermoplastic 2. Viscous/ muco-compressive 3. Poor conductor of heat 4. Flows above mouth temperature, sets at mouth temperature. ( cool water can be sprayed on tray while its in mouth) 5. High co-efficient of thermal expansion, hence shrinkage on cooling and after removal Advantages 1. Can be re-used in same patient theres a risk of leaching out of stearic acid and change in flow and properties 2. Possible to make additions 3. Non-irritant

4. Mucocompressive 5. Good adhesion with tray 6. Supports itself if tray is short 7. Pouring maybe done within an hour Disadvantages 1. Risk of burning mucosa 2. Difficult to handle, requires skill and experience 3. Surface details can not be recorded 4. Distorted on removal from undercuts 5. Takes time for center to be softened or set 6. Poor dimensional stability Disinfection with immersion in 0.5 percent hypochlorite , iodophor or gluteraldehyde Rinse and pour within an hour. Question: - can cake form be used in custom tray?

ALGINATE
Classified as Elastic ,Irreversible Hydrocolloid impression material Composition
MATERIAL SODIUM/POTASSIUM ALGINATE GYPSUM [CALCIUM SULPHATE DIHYDRATE] TRISODIUM PHOSPHATE FILLER[DIAMOTACEOUS EARTH] REACTION INDICATOR POTASSIUM SULPHATE OR POTASSIUM ZINC /TI FLUORIDE FLAVORING AGENT FUNCTION REACTANT; DISSOLVES IN WATER CONVERTS FROM SOL TO GEL ON CROSSLINKING PROVIDES CA IONS FOR CROSSLINKING OF ALGINATE CHAINS INCREASES WORKING TIME[RETARDER] CONTROLS VISCOSITY , STRENGTH AND ELASTICITY COLOR CHANGE ON SETTING COUNTERS INHIBITING EFFECT OF ALGINATE ON SETTING OF GYPSUM ,INCREASING SURFACE HARDNESS

 Setting reaction
Na alginate + CaSO4 [sol] ---> Ca alginate + Na2SO4 [gel]
1. 2. 3. 4. Alginate + water sol form Calcium from gypsum is released which cross-links K/Na Alginate [flexible gel] As reaction proceeds, elastic properties develop , viscosity increases, and color changes Role of Sodium Phosphate: it increases the working time by reacting with calcium ions[ to form CaPO4] , thereby denying supply of calcium to react with alginate. setting starts after all the trisodium phosphate has reacted with calcium ions

There is a well-defined working time during which there is change in viscosity.

1. Fast set alginate: Working time: 1- 2 minutes Setting time: 1.5-3 minutes 2. Normal set alginate Working time: 3-5 minutes Setting time: 3-5 minutes Controlling the setting 1. Altering W/P ratio[not advised] 2. Temperature of water 3. Amount of retarder [by manufacturer]
Qs 1. Which substance will be less in a fast set alginate? 2. Which substance will be less in a less viscous alginate?

 Available as 1. Powder in container 2. Pre-weighed powder in sachets 3. Paste type in 2 viscosities: tray and syringe 4. Dustless or Dustfree Alginate
Silica present in the dust which rises from the can after fluffing alginate powder is a health hazard. Dustless alginate powder coated with glycol which bind particles together

 Caution! Store below 54C ,in a cool dry place, airtight Humidity and high temperatures can deteriorate the powder , therefore containers should be kept close Keep separate bowls for alginate and gypsum. Gypsum accelerates the setting of alginate, while contamination of gypsum with alginate affects strength

Alginate Syringe Technique

USES
Impressions of partially dentate arch Removable prosthesis Fixed prosthesis Diagnostic casts Orthodontic appliances Indirect Restorations Bleaching tray Night guard/splint/mouth protectors for atheletes

1.

2. Primary and Secondary impressions of edentulous arch 3. Duplicating material 4. Impression of maxillofacial defect
Qs What is the ideal impression material for fixed prosthesis? What other material is used as duplicating material?

 Advantages
1. Hydrophilic : compatible with stone and saliva/blood 2. Elastic enough to be drawn over the undercuts, but tears over the deep undercuts 3. Low viscosity[mucostatic]: records surface details 4. Ease of mixing & manipulation 5. Setting can be controlled with temperature of water 6. Cheap 7. Pleasant taste and color 8. Non-toxic and non-irritant 9. No risk of burning mucosa 10. Can be used in stock tray 11. Good shelf life
They are good for only one pour per impression They can reproduce subgingival contours and anatomy but tear upon removal

 Disadvantages:
1. Low tear strength especially in thin section (deep undercuts interproximal and subgingival and sulcular areas) 1. Viscoelastic 2. Inability to produce fine details 3. Poor dimensional stability (dehydration and imbibition] 4. Distortion may occur if tray not held immobile during setting. 5. Can not be refined/ reused 6. Messy to work with 7. Can not support itself (modification of tray often required ) 8. Single pour 9. Incompatibility with some gypsum materials[SYNERESIS] 10. Pour asap Gelation takes place next to tissues due to their warmth and any movement of the tray will result in movement of unset portion of alginate in relation to the set portion. This will induce internal stresses that are released on removal of the impression ,leading to distortion.

Under extended tray thin edge of unsupported impression of the posterior lingual sulcus and RM pad

Add wax or modeling compound in the tuberosity & palatal area for maxillary, or in the lingual flanges for a mandibular impression.

TWO PIECE IMPRESSION TECHNIQUE

A maxillary impression taken with combination of impression compound in the distal extension areas and overall alginate impression. Alginate
has been cut off on one side to show its thickness.

in the presence of deep undercuts (bilateral lingually tilted premolars) alginate may be stressed beyond its elastic limit on removal.

open inter-dental spaces should be occluded with soft wax prior to inserting the loaded tray,

otherwise the impression material will flow beneath the contact points and lock the impression in place and distortion will occur upon removal.

 Mixing and Manipulation of Alginate

 Mechanical mixing with Alginator

ensures that the alginate mix is the same each time they are mixed. Mixing time is 60 seconds for manual spatulation and 15 seconds for mechanical.

 Mixing and Manipulation

1) Read the directions on the side of the alginate container to identify manufacturer's dispensing and manipulation suggestions. 2) Determine if your alginate mix is normal or fast set. 3) Shake the container two or three times to ensure an even distribution of contents 4) Place 2-3 scoops of powder in rubber bowl followed by corresponding 2-3 measures of water at room temp ( powder in water ensures wetting of powder) 5) Overfill the scoop with powder, and tap the scoop with the side of the spatula. Scrape the excess from the scoop with the spatula. Dump scoop into bowl

 6) Use three scoops for the maxillary arch and three measures of water and two scoops for the mandibular arch 7) Mixing should be rapid with wide bladed spatula for 45sec -1min 8) Swipe against walls, reducing air bubbles and encouraging a smooth creamy consistency. (Figure of 8) it should not drip off the spatula when lifted from the bowl 9)The tray must be filled with the impression material up to the tray borders and any excess unsupported material (over-filled tray) at the periphery must be removed with the mixing spatula to avoid gag 10)The surface of the alginate is smoothed with a wet gloved finger. This reduces entrapment of air against teeth

POWDER IN WATER

 Smooth and Creamy mix Not granular or lumpy!

 CARE OF IMPRESSION!! 1- Dimensional changes

Alginate impressions must be poured as soon as possible ,or a maximum 10-15 minutes delay Dehydration occurs on exposure to air leading to shrinkage. Imbibition occurs if immersed in water and disinfectants This is avoided by 1- pouring immediately 2-placing it in 100 percent humid atmosphere [humidor]or 3- wrapping in wet/disinfectant soaked paper towel and sealed plastic bag for 10 minutes at max.

2-Syneresis:
mucinous exudate given off by alginate retards setting of gypsum which leads to chalky /soft cast surface and inaccuracy this is avoided by 1-immersing impression in a solution of accelerator or using alginate which already has accelerator [KSO4 or KTiFl] 2- pouring immediately

MAKING IMPRESSION

1. Explain the procedure to the patient 2. Tray Selection: Perforated or Rim-lock stock tray that covers the postdam and peripheries and has 3-5mm space between mucosa and tray Tray Modification: Extend with wax or compound as required ,eg postdam, palatal surface,distal extension,borders Adhesive on plastic tray and nonperforated tray recommended

3. Place the patient upright on headrest with arch parallel to floor [ better to take mandible first] 4. As material is mixed , ask patient to rinse with cool water to eliminate saliva and mucin, reducing surface tension and air bubbles 5. Place some material on occlusal surfaces of teeth, abutments, palate vault and rugae and sulci to avoid air entrapment/voids 6. Retract the cheek away from you and rotate tray into mouth from side near you and insert the tray

Stand behind (for maxillary) and in front of the patient (for mandibular) impression. Retract the cheek with the tray and with your free hand and rotate the tray in the mouth.

7. Centralize the tray ,then seat the tray first on side away from you, then anteriorly while retracting the lip, then side near you 8. Tray shouldnt be pressed too deep, leaving room for thickness of material over occlusal surfaces 9. Functional movements done before start of setting time 10. Hold tray immobile till it sets, with fingers on right and left premolar areas. (Only light finger pressure to avoid internal stresses)

11. Break seal by retracting lips and cheeks /or using air syringe in buccal sulcus and remove with one quick snap along long axis of teeth one quick snap allows elastic recovery, and prevents tear or detachment. Impressions are less distorted with relatively high but brief forces than with lower, repeated forces for longer times. 12. Wash with cold water or dust with plaster to remove thick saliva, dry and inspect for anatomical landmarks ,abutments, residual ridge etc

RETRACT SOFT TISSUES

HOLD THE TRAY GENTLY

BREAK SEAL BEFORE REMOVAL

13. disinfection with 1% sodium hypochlorite(household bleach 1:10 dilution) or 2% glutaraldehyde solutions for 10 min [spray form recommended] Others: iodophor, chlorhexidine,phenol
14. Impression should be hung up, rather than laying on bench so that the heels are not put under weight of impression, neither should they come in contact with hard surface. 15. Rinse ,slightly blow air and pour asap or wrap in disinfectant soaked paper towel in a sealed LABELLED plastic bag or place in 100 percent humid environment[humidor] for not more than 10-12 minutes. Before pouring, rinse with water to remove disinfectant. Avoid placing in heat or sunlight

FAULTS IN ALGINATE IMPRESSION

SHORT WORKING OR 1. SETTING TIME 2. 3. 4. 5. DISTORTION 1. 2. 3. 4. 5. 6. 1. 2. 3. 4. 5. 6. 7. HIGH WATER TEMPERATURE INCOMPLETE SPATULATION LOW W/P RATIO IMPROPER STORAGE OF ALGINATE POWDER USING TAP WATER MOVEMENT OF THE TRAY DURING SETTING CAUSING STRAINS PREMATURE REMOVAL OF TRAY NO QUICK REMOVAL OF TRAY UNDUE FINGER PRESSURE DURING SETTING DELAY IN POURING IMPRESSION PLACED ON BENCH WITH HEELS TOUCHING INCREASED W/P RATIO:THIN MIX PREMATURE REMOVAL OF TRAY SLOW RATE OF REMOVAL OF IMPRESSION FROM MOUTH PRESENCE OF DEEP UNDERCUTS INADEQUATE MATERIAL IN TRAY INADEQUATE SPACE IN TRAY EXPIRED MATERIAL

TEARING

DETACHMENT

1.

USE OF NONPERFORATED TRAY WITHOUT ADHESIVE

LOSS OF DETAIL

1. INADEQUATE MIXING:GRAINY MIX 2. PREMATURE REMOVAL OF TRAY 3. MUCINOUS SALIVA FILLS IN MINUTE TISSUE FOLDS AND WRINKLES 1. INCORRECT W/P RATIO 2. INADEQUATE MIXING OR WATER ADDED TO POWDER 3. HOT WATER FOR MIXING REDUCES MIXING TIME 1. INADEQUATE MATERIAL IN TRAY 2. UNDEREXTENDED TRAY

CONSISTENCY/GRAINY MIX

UNDEREXTENDED

DIMENSIONAL CHANGES 1. DELAY IN POURING[IMBIBITION AND SYNERESIS] POROSITY/VOIDS/PITS 1. AIR ENTRAPMENT DURING MIXING 2. AIR ENTRAPMENT ON RUGAE,SULCI,PITS AND FISSURES OF TEETH LEADING TO BLOW HOLES 3. INCORRECT W/P RATIO 4. EXCESSIVE SALIVA
1. FAILURE TO SEPARATE THE CAST AFTER AN HOUR 2. EXCESS WATER LEFT ON IMPRESSION SURFACE 3. SURFACE BLOW HOLES ON IMPRESSION [BLEBS ON CAST]

POOR STONE SURFACE:ROUGH OR CHALKY

Other errors in impression maybe due to incorrect technique ,for-eg failure to centralize tray, over-seating Incorrect size of tray leading to underextended or overextended impression, entrapment of tongue

DETACHMENT FROM TRAY

LOSS OF TISSUE DETAILS DUE TO MUCINOUS SALIVA

SYNTHETHIC ELASTOMERS
1. 2. 3. 4. POLYSULPHIDES/ MERCAPTAN RUBBER BASE/THIOKOL CONDENSATION SILICONES ADDITION SILICONES/ POLYVINYL SILOXANES POLYETHER

They were developed mainly for industrial uses Now most widely used impression materials due to better accuracy,tear resistance and dimensional stability as compared to hydrocolloids

 Elastomers are supplied as 2 component paste system or a paste and liquid system

Set by polymerization reaction to form crosslinked chains Four viscosity classes 0 Putty [only in silicones] 1 Heavy-bodied 2 Medium/Regular-bodied 3 Light-bodied

POLYSULFIDE/MERCAPTAN RUBBER BASE

Also known as thiokol impression materials Composition Base Paste: polysulphide prepolymer plasticizer for viscosity filler (Ti02 and Zinc) for viscosity sulphur and silica for strength Catalyst Paste: Lead dioxide as reactor sulphur as catalyst oil stearic acid as retarder

 Setting reaction: Condensation polymerisation By-product : Water Continued reaction after apparent setting Color change: grey-brown Reaction accelerated by an increase temperature and moisture Working time: 5-7 min Setting time: 8-12 minutes Viscosity heavy-bodied regular -bodied light-bodied Heavy-bodied is more dimensionally stable It also has less reactive groups, hence produce fewer byproducts

 Viscoelastic optimize elastic recovery with one swift pull should not be used where large and multiple undercuts are present [96.5% recovery] Most flexible Highest tear strength Hydrophobic: less hydrophobic than condensation silicone and but more hydrophobic than alginate. it can bear some moisture Accuracy: excellent detail reproduction with custom tray space in custom tray: 1.5-3mm Adhesive required Relatively cheap

 Dimensional stability is better than hydrocolloids, but inferior to polyether and addition silicones Factors affecting dimensional stability 1. Viscoelastic 2. Continued setting reaction causing shrinkage 3. Evaporation of water(by-product) causing shrinkage

Pouring of cast is delayed for 7-15minutes to allow for elastic recoil should be done within 30min- 1hour to minimize dimensional changes Unlike alginate, cast surface is smoother as elastomers do not retard setting of gypsum

CLINICAL USES

 Clinical Uses 1. Crown and bridge with light-bodied injected on abutment and heavy-bodied loaded in special tray 2. Final impression of edentulous arch with lightbodied in spaced custom tray 3. Corrected final impression of partial denture: Altered Cast Technique Use diminished with availability of other elastomers

 Disadvantages: 1. Stain clothes 2. Messy to work with 3. Bad smell and bad taste 4. Long setting time 5. Hydrophobic 6. Prone to dimensional changes compromising accuracy 7. Needs custom tray and adhesive to avoid distortion 8. Allergic reaction in patients allergic to latex gloves 9. Health hazard: Lead toxicity [controversial] lead free polysulphides available now

 Advantages 1. Accuracy and fine details in custom tray 2. Highest tear resistance 2. Long working time 3. Most flexible [easy to remove from undercuts] 4. Moderately hydrophilic 5. Cheaper than other elastomers 6. Only radio-opaque material (lead oxide)

POLYETHER
Supplied as two-paste system Composition Base paste[large tube] prepolymer, silica as filler and plasticizer Catalyst[ small tube] sulphonate as initiator, silica and oil Viscosities: Heavy, regular and light-bodied

 Sets by addition polymerisation with no by-products Working time: 2.5 minutes Setting time: 4.5 minutes Advantages: 1. Moderate elastic recovery [better than polysulphides] 2. Accuracy : detail reproduction [inferior to some addition silicones] 3. Low tear resistance 4. Maybe used with stock tray

5 Good dimensional stability in low humid conditions 6 Hydrophilic to give void-free impressions : high wettability of oral tissues and compatible with stone 7 Impression should be poured in 2 hours. If kept dry, it maybe poured up to 1 week

 Disadvantages 1. Sets as rigid or stiff , hence poses difficulty in removal from severe undercuts This can produce deformation,extrude mobile teeth or break teeth on cast while separating from impression.This is resolved by -blocking undercuts in mouth prior to impression - using newer formulations with reduced silica content 2. Short working time[ improved in newer formulation] 3. Allergy to sulphonic acid catalyst system

Blocking undercuts prior to impression

4. Absorption of water in humid conditions Prolonged immersion in disinfectant should be avoided. Spray form is preferred.
5. Bitter taste objectionable to patients

6. Expensive
7. Adhesive required 8. Can not be re-poured due to relative stiffness

 Clinical applications: 1. Crown and bridge[ light-bodied and heavy bodied, or regular-bodied as monophase] 2. Final impression of edentulous arch in spaced custom tray [ border moulding with regularbodied and wash with light-bodied] 3. Final impression of partially dentate arch with regular-bodied 5. Bite registration 6. Inlays and onlays 7. Stiffness and good wettability facilitate the use of polyether for impression of implant abutments to pick up copings

BORDER MOULDING WITH POLYETHER

FINAL IMPRESSION OF EDENTULOUS ARCH

PICK IMPRESSION OF COPINGS

IMPRESSION FOR FIXED PROSTHESIS

 Contraindications 1. Mobile teeth 2. When taking impression with addition silicones, polyether shouldnt be used for border moulding of custom tray

SILICONE IMPRESSION MATERIALS

SILICONE IMPRESSION MATERIALS

CONDENSATION SILICONES
DISPENSATION CONSISTENCIES DEPENDING ON FILLER COMPOSITION
2-PASTE SYSTEM OR PASTE AND LIQUID[CATALYST] LIGHT-BODIED AND PUTTY

ADDITION SILICONES (POLYVINYLSILOXANE)

2 PASTES- MANUAL MIXING OR AUTOMIXING GUN LIGHT-BODIED, MEDIUM-BODIED, HEAVY-BODIED, PUTTY BASE: SILICONE PREPOLYMER WITH SILANE TERMINAL GROUP FILLER CATALYST: SILICONE PREPOLYMER WITH VINYL TERMINAL GROUPS FILLER PLATINUM COMPOUND RETARDER ADDITION POLYMERISATION NO BYPRODUCT EVOLUTION OF HYDROGEN GAS

BASE PASTE: POLYDIMETHYLSILOXANE PREPOLYMER AND FILLER SILICA CATALYST PASTE OR LIQUID: ALKYL SILICATE AS CROSSLINKING AGENT, TIN COMPOUND AS CATALYST, OIL-BASED DILUENTS

SETTING REACTION

CONDENSATION POLYMERISATION BY-PRODUCT: ETHYL ALCOHOL

WORKING TIME SETTING TIME

3 MINUTES 6-8 MINUTES

2-4.5 MINUTES 3-7 MINUTES CHILLING THE PASTES BEFORE USE EXTENDS WORKING TIME EXCELLENT[99-100%] LESS FLEXIBIBLE THAN CSILICONE AND POLYSULPHIDE,SO REMOVAL MAY BE DIFFICULT LOW-MODERATE LESS THAN POLYSULFIDES HYDROPHOBIC

ELASTIC RECOVERY

HIGH BETTER THAN POLYSULPHIDES AND POLYETHER

TEAR RESISTANCE

LOW-MODERATE LESS THAN POLYSULFIDES VERY HYDROPHOBIC: DRY FIELD REQUIRED PROBLEM OF BLOW HOLES IN IMPRESSION AND LOW WETTING BY STONE LEADING TO BUBBLES USE SURFACE ACTIVE SPRAY/WETTING AGENT ON TISSUES TO INCREASE AFFINITY WITH TISSUES AND GYPSUM

AFFINITY WITH WATER

HYDROPHILIC :ADDITION OF WETTING AGENT IN FORMULATION

ACCURACY

AFFECTED BY PRESENCE OF MOISTURE ACCEPTABLE WITH STOCK TRAY

EXCELLENT WITH HYDROPHILLIC TYPE ALLOWING BUBBLE FREE STONES GOOD WITH STOCK TRAY

POURING THE CAST

AS SOON AS POSSIBLE, UPTO 1 WEEK; WITHIN FIRST 30 MINUTES PREVIOUSLY, DELAY OF 1HOUR WAS ADVISED TO ALLOW ESCAPE OF GAS WHICH RESULT IN PITTING OR VOIDS IN CAST SURFACE. NONE SULPHUR COMPOUND [DITHIOCARBAMATE ]IN LATEX GLOVES REACTS WITH CATALYST AND RETARDS SETTING. USE DITHIOCARBAMATE FREE GLOVES OR VINYL

INHIBITION BY LATEX /RUBBER GLOVES

DIMENSIONAL CHANGES

EVAPORATION OF ALCOHOL BY LESS POLYMERISATION PRODUCT AND CONTINUED SLOW SHRINKAGE SETTING [SHRINKAGE] LESS THAN ALGINATE BUT MORE THAN POLYSULPHIDES POUR AS SOON AS POSSIBLE AND USE TWO STEP PUTTY-WASH TECHNIQUE NON-TOXIC ACCIDENTAL SPLASHES CAN CAUSE IRRITTAION AND BLISTERING OF EYES CONTACT DERMITITS IF MIXING DONE WITHOUT GLOVES

HEALTH HAZARD

USES

FIXED PROSTHESIS PARTIAL DENTURE COMPLETE DENTURE Wetting agent required

FIXED PROSTHESIS PARTIAL DENTURE COMPLETE DENTURE BITE REGISTRATION

CUSTOM TRAY

SPACE OF 1.5-3MM ADHESIVE PUTTY-WASH TECHNIQUE ELIMINATES USE OF CUSTOM TRAY

SPACE OF 1.5-3MM ADHESIVE CAN BE USED WITH BOTH STOCK AND CUSTOM TRAY

SMELL /TASTE

PLEASANT

PLEASANT

COST

MOST EXPENSIVE

MULTIPLE POURS

POSSIBLE

 Clinical applications:
1. Crown and bridge: Light body on abutment to record details and heavy-bodied/putty to support it in tray or with regular bodied used in both cases[ monophase] 2. Initial impression of edentatulous arch with putty Final impression with Light body in border-moulded spaced custom tray 3. Final impression for partial denture [kennedys class 1-2] in custom tray including altered cast technique. 4. Impression for Inlays and onlays 5. Bite registration paste [addition silicone only] 6. Impression for Implant 7. Impression of maxillofacial defect

FINAL IMPRESSION OF EDENTULOUS ARCH

IMPRESSION FOR FIXED PROSTHESIS

IMPROVING FIT OF DISTAL EXTENSION BASE BY ALTERED CAST TECHNIQUE

BITE REGISTRATION PASTE ( PVS light bodied)

IMPRESSION OF PALATAL DEFECT

IMPRESSION OF MIDDLE EAR

COMPARISON OF ELASTOMERIC PROPERTIES

ELASTIC RECOVERY ACCURACY FLEXIBILITY [EASE IN REMOVAL FROM MOUTH] TEAR STRENGTH

POLYSULFIDE

MODERATE

GOOD

HIGHEST

HIGHEST

POLYETHER

MODERATE

GOOD
BETTER THAN POLYSULPHIDE AND C-SILICONES

LOWEST
MOST STIFF

LOW

CONDENSATION SILICONES ADDITION SILICONES

HIGH

GOOD

MODERATE

LOW TO MODERATE LOW TO MODERATE

EXCELLENT
[HIGHLY

EXCELLENT
[HIGHLY

MODERATE

PUTTY-WASH IN STOCK TRAY

MULTIPLE POURS

DIMENSIONAL STABILITY

HYDROPHILIC/ HYDROPHOBIC

POLYSULFIDE

CUSTOM TRAY TO AVOID DISTORTION

LOW
WATER BYPRODUCT 30-60 MIN

MODERATE

POLYETHER

YES

HIGH IN LOW HUMID CONDITIONS

UPTO 1 WEEK

HYDROPHILIC

CONDENSATION SILICONE

YES

LOW
ALCOHOL POUR WITHIN 30 MIN

HYDROPHOBIC

ADDITION SILICONE

YES

POSSIBLE, DUE
TO BEING DIMENSIONALLY STABLE AND RELATIVELY FLEXIBLE

HIGH
UPTO 1 WEEK

HYDROPHOBIC HYDROPHILIC

 Disinfection Impression with elastomers are rinsed and then disinfected with immersion in 2% gluteraldehyde or sodium hypochlorite [1:10] for 10 minutes without loss of accuracy. Polyether, being hydrophilic, may undergo changes if immersion is longer than 10minutes. Alternately, polyether can be sprayed by 2% gluteraldehyde, wrapped in disinfectant soaked paper towel and placed in sealed plastic bag for 10 minutes. The impression is rinsed, dried and poured.

Special Precautions! 1: For patients who have thick and ropy salivation: a) with LA in guaze anesthesize the palatal salivary glands to avoid mucous secretions

b)ice cold water rinse

c)bicarb soda rinse

2. For patients who have excessive saliva a) cold water rinse b)cotton roll in floor of mouth and opposite to maxillary 1st molar ;remove just before impression
c)tandem technique

2. Hypergag reflex/ Retching Exaggerated gag reflex can frustrate both the patient and the dentist. It can also compromise the treatment plan, procedures and even wearing dentures It may be so severe that even examination becomes difficult Retching may also induce salivation. Management 1. Reassurance and kind handling. 2. Upright position of the patient and stand at the back 3. Record lower impression first 4. Avoid overloading the tray 5. Distract patients mind talking, raising one foot etc.

6. Posterior palate sprayed or infiltrated with LA ( Posterior 3rd of tongue may also need to be sprayed) 7. Drugs: Sedatives Antihistamines Parasympathetic depressants 8. Impression material with minimum flow. 9. Desensitization: patient touches the back of palate with toothbrush and over weeks,the brush is placed further back until it touches soft palate without causing retching.