Preclinical Fixed Prosthodontics

Class of 2011

Tissue Management and

Impression Techniques and
Material

Parag R. Kachalia DDS

Jessie V. Vallee, DDS
 Impression Musts!

• 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 as possible
 Impressions

• High potential for improper use of material

• Much variation from material to material
• Accurate impressions have been destroyed due to
incorrect handling
• Have also been destroyed due to delays between
removal from the mouth and pouring
 Impression Must Meet
Following Requirements

• Exact duplicate of the prepared tooth and enough

tooth structure below the margin for accurate
definition of the finish line
• Other teeth must accurately be reproduced in order
to articulate the casts correctly
• It must be free of bubbles and voids (especially in
the area of the finish line)
Comparison of Impression
Materials
Your choice is based on:
1) personal preference
2) ease of manipulation
3) strength and shelf life
4) predictability
5) economics
6) accuracy
 Choice of Materials
Final Impressions:
1) Polysulfides
2) Reversible Hydrocolloids
3) Condensation Silicone
4) Polyvinyl Siloxane*
5) Polyether*
* - used at UOP
 Wettability

• Can be described as ease of pouring with gypsum

products
• Classified as readily wettable (hydrophilic), resistant
to wetting (hydrophobic)
 Love it or leave it
•Hydrophilic Materials: •Hydrophobic Materials:
• Irreversible •Polysulfide
Hydrocolloid •Polyvinyl Siloxane
(alginate) •Condensation-Reaction
Silicones
• Reversible
Hydrocolloid
• Polyether
 Viscosity
• Shear Thinning - a materials viscosity decreases as
it is expressed through a syringe, yet maintains its
body when left alone. This allows for a
“monophasic” material to respond differently
under different conditions
• This type of material may also be termed
thixotropic
 Viscosity

• Materials on today’s market range

from 2.6 pounds of pressure
required to express through a
syringe to 112 pounds of pressure
(polysulfide through a small
diameter syringe)
 Cost
• Should not be considered as a primary factor in
impression material selection
• Least expensive impression found is a polysulfide
in custom trays (average of $5.50 in 1998)
• Most expensive impression found is a polyvinyl
siloxane in stock metal trays (average of $13.50 in
1998)
• Today’s average cost of a final impression is
approximately $15.00
 Reversible
Hydrocolloids
• In use for over 60 years
• Sold in a semi-solid state
• Liquefied by placing in boiling water, then cooled
in two stages
• Cool tap water is circulated through the tray
• Material is 85% water
• Inexpensive and can be removed in 3 minutes!
 Reversible
Hydrocolloids
• What then are the drawbacks of this material?
• Can only be poured once
• Quite temperature dependent
• Potential injury to the patient
• If left exposed, can begin to distort readly
 Polyether
• 1) Excellent dimensional stability
• 2) Hydrophilic in nature
• 3) Will lock into undercuts if not blocked out
• 4) 0.5% of individuals have shown some reaction to
this material
• 5) 8:1 ratio of base-accelerator
• 6) Can be somewhat brittle
 Polysulfide

• Commonly called rubber base

• Comes as two tubes of base and catalyst
• Will begin to shrink after one hour from removal
• Should be poured immediately
• Only radiopaque impression material
• Can become locked into undercuts
 Condensation
Silicones
• Can have pronounced shrinkage due to evaporation of
alcohol during reaction [poor dimensional stability]
• Used in a similar fashion to polysulfides
• Must be poured within six hours
• Dies produced from this material are undersized
 The above occurs due to the evaporation of the
biproduct of the condensation reaction.( H2O for
polysulfides and ethanol for Condensation silicones)
Our Material - Polyvinyl
Siloxanes
• Also know as addition silicones
• Dimensional stability is quite high in this group
• Least affected by pouring delay of any material (due to no
volatile biproduct formation, carbon double bonds, in the
form of vinyl groups open up during polymerization and
link the monomer groups together via an addition reaction)
• Comes in many varieties (putty-wash, wash-wash)
• Surfactants have been added to the material to decrease it
hydrophobia, but dies are 14-33% softer
Our Material - Polyvinyl
Siloxanes
• Mixing guns are the most popular form of this
material
• We utilize a monophase-wash system (one
step)
• Latex gloves retard the setting of this type of
material
• Must not come into contact with any surface
touched by a glove
 Polyvinyl Siloxane
Impression Technique
• Type of Impression:
• Heavy body wash (Monophasic material) in a stock
tray with medium or light wash around
• Light body wash in a custom tray
 Polyvinyl Siloxane
Impression Technique
• One step monophasic-wash technique:
• Stock tray preparation
• Tissue management
• Final wash
• Evaluation
Stock Tray Preparation
Washing Hands Is A Must!

Powder from latex gloves can

react with impression material.

It must be removed to prevent

incomplete setting of the
impression material.
Phase One: Stock Tray
Preparation
 Phase One: Stock Tray
Preparation

• Tray adhesive is applied to help retain material within

tray [the adhesive for aquasil and impragum are
different]
 Phase Two: Tissue
Management
• Techniques:
• No cord - margins supragingival

• Single cord technique

• Dual cord technique

• Either single or dual cord technique with hemostatic

agent

• Either single or dual cord technique with epinephrine

• Electrosurgery/laser
 Phase Two: Tissue
Management

• Astringedent contains 20% Ferric Sulfate

which stimulates blood clotting
• ViscoStat contains 20% Ferric Sulfate
Phase Two: Tissue
Management
 Phase Two: Tissue
Management

• Reaction begins immediately upon application to

bleeding area
 Phase Two: Tissue
Management

• The Ferric Sulfate [ViscoStat] is applied to the

bleeding tissue using this tip attached to a syringe
 Phase Two: Tissue
Management

• The Ferric Sulfate can be injected onto a cord that has

been previously packed into the gingival sulcus
Cord Placement
Armamenterium
 Phase Two: Tissue
Management

• Clinical presentation after completion of

preparation
 Phase Two: Tissue
Management

• Ferric sulfate being scrubbed into sulcus via

tufted syringe tip
 Phase Two: Tissue
Management

Knitted

Braided

• Two types of cord are available for purchase:

• 1) Braided and 2) Knitted
 Phase Two: Tissue
Management

• Cord can be purchased in a variety of sizes to be used

in varying sulcus widths and depths
Phase Two: Tissue
Management
 Phase Two: Tissue
Management

• Cord is positioned above the sulcus and using a length

cut to surround the tooth without overlap
 Phase Two: Tissue
Management

• Cord is packed into the sulcus to retract tissue and aid

in moisture control
 Phase Two: Tissue
Management

• Tissue is rinsed after scrubbing with ferric sulfate,

hemostasis is confirmed, more ferric sulfate is placed
into sulcus prior to introducing the first dry cord.
 Phase Two: Tissue
Management

•Tooth with first cord in place. Ferric sulfate is scrubbed

into sulcus again and rinsed
 Phase Two: Tissue
Management

• Second cord (larger) Placed into sulcus for

lateral retraction of soft tissue
 Phase Two: Tissue
Management

• Second cord is in place circumferentially

Phase III: Introduction of
wash

• Coronal cord is removed to expose margin and

apical cord
Phase III: Introduction of
wash

Note retraction
could be better at
ML line angle

• View margin and check for any heme. If heme

is present rescrub with ferric sulfate
Phase III: Introduction of
wash

• Wash is introduced into the sulcus making sure tip

stays in contact with material at all times
 Phase III: Introduction
of wash and tray material
• Once the prepared tooth has had wash placed
around it insert stock tray with monophase
material into the patients mouth.
• Seat the tray completely and do not allow the
tray to move once setting has begun.
Lingual View
Of Our
Impression
Flash

The impression material cervical to the margin is termed

“flash”.
The more flash cervical to the impression, the easier it is to
trim the dies during the laboratory phase of any project.
 Lingual View
Of Our
Impression
• All of the margin has been captured on the facial
surface
• Far less flash is present on the facial making that
portion of the die far more difficult to trim
 Ideal
Impression

• Note marginal clarity around each of the four anterior

teeth . This was accomplished with Aquasil and good
tissue management.
Apply Tray Adhesive Load cartridges
Bleed Cartridge Attach
Mixing tip
Load Tray - Monophase Inject Around Prep
• Working time 2 min. 30 sec. (seat tray)
• Setting time 5 min.
• Remove and inspect for accuracy.
 Phase Two: Tissue
Management

• Need to measure sulcus with periodontal probe

• And assess need for hemostatic agent
 Cord Placement

• Cord is placed into the sulcus. This will allow for

the tissues to be position laterally from the margin.
 Preparing the Syringe Tip

• Make sure tip is not made too large. This will prevent
adequate force on the impression material
 Phase Three: Final Wash

Wash Materials used an

Pacific

• Aquasil light body

• Impragum light body
Loading The Tray and
Syringe

Tip must be kept in contact with the impression tray

and impression material to prevent bubble
formation
 Final Wash of Preparation

• Final wash is applied with force so that impression

material is expressed into the sulcus.
Alternative Soft Tissue
Management Techniques
Electrosurgery
• State of the art high
frequency electrical
device used for easy
and effective soft
tissue contouring and
coagulation
 Electrosurgery
• Gingivectomy –
removing excess tissue
• must not violate biologic
width
• adequate attached
gingiva
• caution in cosmetic areas
(adequare sulcus depth,
and attatched gingiva),
although it can be used
for aesthetic contouring
of gingival tissue
 Electrosurgery

• Advantages over
blade surgery
• Less bleeding

• Less need for sutures

• Less scarring

• Better access
 Electrosurgery

• Gingivectomy –
removing excess
tissue
Straight tip (scalpel)
 Electrosurgery

•Uses of the electrosurge

•Inflamed tissue
•Hyperplastic tissue
•Frenum removal
•Sulcus expansion
 Dental Lasers

• Pacific’s laser:
• diode laser
Laser unit
Fiber optic
Foot pedal
Protective eyewear

Handpiece
DioDent Laser
 Gallium Alluminum
Arsenide Solid State
laser diode provides the
optical energy
 Fiber optic handpiece
delivers up to 10 watts
of laser energy
 Pulse and power output
can be adjusted
DioDent Laser
 Cosmetic Dentistry
 Endodontics
 Periodontal proceedures
 Oral soft tissue surgery
including gingivectomy,
gingivoplasty,
biopsy,etc.
 Tissue retraction for
impressions
 I and D’s
 Implant recovery
 Today’s project

• Refine patient preparation as needed

• Place retraction cord
• Take final impressions utilizing Aquasil