Fixed Prosthodontics Burleson CH.

17 - IMPRESSIONS An impression is a negative form of the teeth which will be used to make a positive reproduction, or cast. If the restoration is to fit precisely, the cast on which it is made must be as nearly an exact duplicate of the prepared tooth in the mouth as possible. An impression for a cast restoration should meet the following requirements: 1. exact duplication of the prepared tooth - including all of the preparation and enough uncut tooth to adapt margins 2. other teeth must be accurately reproduced - to permit proper articulation of the cast 3. free of bubbles - especially near the finish line and occlusal surfaces of other teeth in the arch I. COMPARISON OF IMPRESSION MATERIALS - reversible hydrocolloid, polysulfide, condensation silicone, polyvinyl siloxane, and polyether - see table 17.1 for a list of the attributes of each material A. Wettability - ease of pouring with gypsum products varies among the different impression materials - hydrophilic - readily wettable by gypsum - hydrophobic - resistant to wetting - the greater the contact angle, the greater the probability of air entrapment during pouring - materials exhibiting large contact angles are more readily repelled by hemorrhage or other gingival sulculs moisture Hydrophilic - easy to poud, low contact angle a) irreversible hydrocollid (alginate) b) reversible hydrocolloid c) polyether Hydrophobic - hard to pour; high contact angle a) polysulfide b) polyvinyl siloxane c) condensation-reaction silicones B. Viscosity - least viscous - light-bodied polysulfide and condensation silicone - most viscous - heavy-bodied polysulfide - viscosity increases as the time elapses after the start of mixing - these materials have lower viscosity when the shear rate increases = allows expression thru a syringe - shear rate - the speed at which a liquid flows under external forces - monophasic - single-viscosity material; exhibits false body and allows material to stay in the tray - thixotropic - materials that become more fluid when the shear rate is increased by deforming/disturbing it Table 17-1 - Comparative Properties of Impression Materials 1. reversible hydrocolloid - 5 minute setting time, easy removal, excellent moisture tolerance, easy to pour - disadvantages: poor finish line readability, weak tear strength 2. polysulfide rubber base - 12 minute setting time, good finish line readability, 60 min. pouring time, radiopaque - disadvantages: difficult to mix, poor odor / taste 3. condensation silicone rubber base - 10 minute set time, easy removal, good finish line readability, easy mixing - disadvantages: poor moisture tolerance, poor pouring ease 4. polyether rubber base - 5-6 minute set time, good finish line readability, 7 day pouring time, good pouring ease - disadvantages: difficult to remove; poor odor / taste 5. polyvinyl siloxane rubber base - 6-8 minute set time, good finish line readability, 7 day pour time, easy mixing - disadvantages: poor moisture tolerance and poor pouring ease for standard hydrophobic brands

Fixed Prosthodontics Burleson REVERSIBLE HYDROCOLLOID - reversible (agar) hydrocolloid has been used as impression material in fabrication of gold rests. for 60 yr. - packaged as a semi-solid gel in polyethylene tubes - it is liquified in a hydrocolloid conditioner by placing it in boiling water : liquid sol in this stage - the sol is tempered and placed in the mouth; cool tap water is circulated thru the special tray to complete - hydrocolloid is approximately 85% water; it can lose its water by syneresis or by evaporation - it can also absorb water by imbibition - the impression begins distorting as soon as it is removed from the mouth : pour as soon as possible - borax is added to the gel since gypsum will not set when in contact with any gel Conditioner for Preparing Hydrocolloid 1) liquefying bath - 212F 2) storage bath - 150F 3) tempering bath - 110F CUSTOM RESIN TRAYS - custom trays are utilized in elastomeric impression techniques because these materials are more accurate in uniform thin layers of 2-3mm - however, the mean difference of material between custom and stock trays is only 1.0mm - tray space seems to have no effect on dimensional accuracy of monophasic polyvinyl siloxane impressions except for the distance between fixed partial denture abutment preparations - stock trays probably provide sufficient accuracy for single-tooth restorations, esp. if PVS or polyether is used - however, if a one-piece FPD of three or more units is to be fabricated on the cast, the custom tray should be used - do not make a custom tray by lining a stock tray with modeling compound - it will be attacked and softened by the plasticizers in the elastomers and thus distort the impression Custom Tray: 1) must be rigid, accurate, and not impinging on soft tissues 2) must have stops on the occlusal surfaces 3) lined with rubber adhesive - custom trays are made of VLC urethan dimethacrylate resin (Triad) - the impression materials will adhere to the trays differently, depending on type and manufacturer - PVS bonding strength to tray can be increased by roughening the inner surface and driling perforations in the tray - elastomeric impressions should not be stored in a moist environment : acrylic resin tray may imbibe water - paint the inside surface of the tray with a thin layer of adhesive; allow to dry 15 minutes before material is inserted Tray Preparation: - adapt baseplate wax of 2-3mm thickness over the cast; extending 2-3mm beyond the teeth necks - horeshoe-shaped form is used for both arches, with no palatal coverage on the maxillary arch - a stop should be distal to the prepared tooth - tin foil is used to cover the wax and prevent it from touching the VLC resin - the tray should be prepared at least 6 hours in advance, to offset any shrinkage which may occur POLYSULFIDE (Rubber Base) - polysulfide is an elastomer tha it also known as mercaptan, thiokol, or simply rubber base - it is packaged in two tubes: a base and an accelerator - base: liquid polysulfide polymer, inert filler - accelerator: lead dioxide, sulfur, oil - the accelerator acts as an oxidation initiator on terminal thiol groups on the polymer - polymerization : polymer chains are lengthened and crosslinked through the oxidized thiol groups - this results in increased viscosity and finally in an elastic material - exothermic - polysulfide has much greater dimensional stability than hydrocolloid but the polyer does contract as it cures - therefore, polysulfide impressions should be poured within 60 minutes of removal from the mouth - hydrophobic nature of this material = ensure there is no moisture on the preparation when the impression is made - polysulfide is unique because it is radiopaque (presence of lead dioxide in the accelerator) - this lead dioxide can irritate the soft tissues and is toxic - do not mix for more than 1 minute; use syringe to express around margins; seat and hold for 8-10 minutes

gelation

Fixed Prosthodontics Burleson CONDENSATION SILICONE - also called organo-tin silicones, which is a reference to their catalyst - base paste: liquid silicone polymer with terminal hydroxyl groups, inert fillers - reactor: viscous liquid consists of crosslinking agent, ethyl silicate, organo-tin activator (tin octoate) - the condensation reaction occurs by elimination of ethyl or methyl alcohol - evaporation of which causes shrinkage - this material therefore has poor dimensional stability - silicone impressions should be poured soon after removal - technique for silicone rubber base materials is similar to that for polysulfide - preliminary impressions can be made with heavy-body putty in stock tray - serves as custom tray - the thin wash of low-viscosity silicone is used in the custom tray and used for the final impression - this putty/reline technique allows delayed pouring up to 6 hours POLYVINYL SILOXANE - polyvinyl siloxane silicone is also called addition silicone because of its setting reaction - also called vinyl polysiloxane, or even vinyl silicone - excellent dimensaional stability - packaged as two pastes: - one paste: contains silicone with terminal silane hydrogen groups and inert filler - other paste: contains silicone with terminal vinyl groups, chloroplantinic acid catalyst, and filler - mix equal quantities: addition of silane hydrogen groups across vinyl double bonds with no by-products formed - PVS is still accurate even when poured 7 days after removal from the mouth - in its unaltered form, PVS is hydrophobic - surfactants can be incorporated into the material to make it less hydrophobic and easier to pour - casts poured in hydrophilic polyvinyl siloxanes with intrinsic surfactants produce slightly less accurate casts - twin-barreled cartridge system eliminates air entrapment, ensures consistency in ratios, prevents contamination - if putty is used, it should not be used or dispensed wearing latex gloves: setting will be impeded POLYETHER - polyether is a type of elastomeric impression material that has become popular in the last 25 years - it is a copolymer of 1,2 epoxyethane and tetrahydrofuran that is reacted with an alpha, beta unsaturated acid such as crotonic acid, to produce esterification of the terminal hydroxyl groups - polyether is packaged in two tubes; using much larger volume of base than accelerator (about 8:1) - polyether has excellent dimensional stability - giving accurate pours up to 7 days after removal from the mouth - this material is hydrophilic and allows easy pouring and should not be stored in a moist environment - this material is somewhat brittle however POLYETHER URETHANE - this material appeared on the market briefly in 1980 - it is a polyether urethane dimethacrylate resin with a diketone initiator, an amine accelerator, and 40-60% silica filler - the material is used in a clear tray and is photoinitated by 400 to 500nm wavelength blue light - this provides nearly unlimited working time and short setting time Impressions of Pin Holes - nylone bristles are used to duplicate pin holes since impression materials will not fill the small-diameter holes - place a bristle in each pin hole and proceed with the impression in the usual manner - the nylone bristle used to duplicate the pin hole will remain in the cast; simply remove it with plyers = now have a hole