Impressions in fixed

prosthodontics
In brief: ●Physical properties of impression materials

●Comparison between impression materials

●Principles of manipulation

●Impression techniques

●Common errors

We don’t need highly accurate impressions in removable

prosthesis because we take impression of the soft tissue
which is highly resilient, so we need just acceptable, but in
fixed we need very accurate because we take the
impression of the teeth which are hard, non resilient.

Direct restoration: restoration that you do in clinics,

without lab work.

Indirect restoration: restoration that is done in labs

according to the impression that you take.

To have accurate impression we need to be sure about

three things:

1-impression material

2-moisture control

3-impression technique

So we will begin with the impression materials, which are

in general two types elastic and non elastic, but in fixed
prosthodontics we deal only with elastic impression
materials, because like we said before teeth are non
resilient hard materials and full of undercuts.

Physical properties of impression materials:

1-accuracy: a- fine details (ability of the impression
material to record details). Elastomeric materials can
record details down to 20 microns, but the gypsum
products like die stone can record down to 50 micron,
there is 30 micron gab. So from this part of view
impression materials that we have (a silicon, polyether)
are accurate enough. For putty it is 75 micron, so we
should not take our impression with the putty only.

b-dimensional accuracy: the distance

between structures that we are taking its impression, it is
not just we want the fine details of E.g. 1st molar and the
2nd premolar but we also want the distance between
them.

Polyethers and A silicons fit this criteria, but C silicone

didn't fit the criteria because although it can record fine
details up to 20 microns but it doesn’t have dimensional
stability.

2- Elastic recovery: impressions of the mouth will need to

be withdrawn from tooth and tissue undercuts, and
therefore must be sufficiently elastic to deform as they
exit undercuts but then return to their original shape. PVS
(Asilicone) can recover up to 99%.
Note from the handout:

- highly filled materials have less elastic recovery than lower viscosity material.

-C silicone have 98% recovery but it is a stiff material when it sets→ difficult to
disengage →we use a tray that allows adequate bulk of material in the area.

3-Dimensional stability: we should be able to know for how

long the impression will be sufficiently accurate so that it
can be used intelligently (E.g. you want to send your
impression to a lab in Aqaba, so your impression shouldn't
shrink in the road), and how storage conditions may affect
its stability. Again best material for this is PVS (Asilicone),
it can stand for 2-3 days.
Note from the handout:
-polysulphides stands for 48 hours

-polyether can swell in areas of high humidity, it has high dimensional stability
(because they undergo an addition cured polymerization reaction on setting which
has no reaction by-product resulting in a material with high dimensional stability),
can stand up to 48 hours.

-Csilicones can stand up to 6 hours.

-we can do multiple pouring in PVS.

-What is the difference btw dimensional accuracy and

dimensional stability?

Dimensional stability: ability of the material to retain its

size and form. The glossary of prosthodontic term.

Dimensional accuracy: ability of a material to record the

right distances. E.g. if there is 5mm btw molar and
premolar you should measure in the impression 5mm btw
molar and premolar(dimensional accuracy), if this
impression after you take it out of patients mouth as a
whole is 3cm long it should stay 3 cm after an hour or so…
(dimensional stability).

4-Flow: Increasing viscosity→ decrease flow ability (like in

putty)

Decrease viscosity (runny) → increase flow ability

(like in A SILICONE)

thixotropic: ability of impression material to move under

pressure, E.g. you placed impression material on a tray
and it did not cover all of it (because it is not flowable)
when you pressure on it with the air in the 3in1 it will flow
and reach all the places in the tray. Light body ASILICONE
has this ability.

In ideal impression materials we need it flowable enough

to reach all the surfaces we need.

5-Flexibility: all the impression materials have some kind

of elasticity but some are more safe (less rigid) than other,
E.g. polyether is quite rigid material when it sets, so when
there is undercuts or mobile teeth you should not take the
impression with polyether cause it won't come out from
the mouth easily even if it comes out, it will come with the
mobile teeth. So be careful to type of material you use.
The best material from this view is ASILICONE.

Tear resistance: an impression material should be able to

record detail in narrow spaces like in gingival crevice→ it
needs to be strong in thin sections. The best in this is
ASILICONEs and polyethers (although in experiments the
polysulphides recorded the highest tear strength but they
have poor permanent deformation characteristics that
made them unreliable to record areas of thin section), and
hydrocolloids are the worst, that’s why when we need to
take impression with alginate, we should have enough
space of 4-6 mm in the tray to have enough room for the
alginate, even with this it will not record the interproximal
areas of the teeth, it will rapture and leave pieces btw the
teeth, buccal side a piece and palatal (or lingual)another
piece. So if the tear resistance is low the impression will
not come out in one piece.

6-Workability: auto-mixing with little porosity, lots of

working time.

7-hydrophilicity:

Hydrocolloids are the only true hydrophilic materials, their

main component is water; but they will not compensate
for poor moisture control.

Polyethers are hydrophilic; but they need dry field to

capture detail, they need to be stored dry (because they
absorb water→ they will swell), but they are more
forgiving of inadequate moisture control than silicones.

Elastomers are hydrophobic; they don’t have the tendency

to flow across prepared teeth. To eliminate this;
manufacturers added surfactants to lower surface tension.
(But polyether manufacturers said that surfactants lower
tear resistance of elastomers; which is a disadvantage, but
this is not proven by scientific research just by
manufacturers.)

To measure hydrophilicity →placing a drop of water on to

the set surface of the material, and examining the shape
formed after a fixed time period→ if the contact angle is
greater than 90 then it is hydrophobic→ if the contact
angle is less than 90 then it is hydrophilic.

Polysulphide C silicone Polyether A silicone

Polymerizati .4-.45 .4-.6 .2-.25 .145-.17
on shrinkage
Percentage 97-95 98-97 98.5-98 99.9-99.6
recovery
Tear .5 1.6 2 2.4
strength
Numbers are not for memorization just A silicone, although I'm not
responsible from anything, do what you want.

PVS (Asilicone) is the most widely used impression

material in fixed prosthodontics.
PVS

-since 1970s

-Advantages: 1-fine details 2-elastic recovery 3-odorless

tasteless 4-wide viscosities 5-no by-product (in past there
were a by-product which is H2, but they improve it)

-Disadvantages: setting reaction (for cloroplatinic acid

catalyst) inhibited by

1-latex, so you should mix it by bare hands or non-latex

gloves, and do not touch the prepared tooth with your
latex gloves because even if you tried to clean it with
water you cannot remove all the remnants of latex, you
can only remove the remnants with pumice.

2-retraction cord chemicals; not proved yet.

3-acrylic monomer: if you want to use special tray for the
impression it is better to use light cured because it has
less monomer than self cured acrylic. If you insist to use
self cured you should wait 24 hours to let the monomer to
be evaporated from the tray.

Common defects in impressions:

1- Poor manipulation of the impression material: using

latex gloves, poor moisture control…if we take care
of aforementioned two errors we can have good
impression.

2- Poor recorded margins (subgingival)

Principles of manipulation:

1- Proper thickness: in ZnO Eugenol we didn’t remove

the spacer to have homogenous thickness of
material→ even if we have dimensional change
(shrinkage) we have it all the way around, uniformly.

In A silicone usually we don’t use special tray, if we

decided to use →more than 2 mm thickness is good.

2- Adhesion: mechanical (perforations) and chemical

(adhesives). we wait for adhesive 7-15 min till the
filler in the adhesive evaporates leaving the resin, if
you don’t wait for the fillers→ it will act like a
lubricant rather than adhesive.

3- Pouring in proper time

4- Choosing the viscosity: we have different viscosities

generally

Low viscosity→less filler→ high shrinkage→ good

detail

High viscosity→high filler→ low shrinkage→ less

detail
 That’s why we use two phase impression technique;
high body with low body phase.

5- Adequate mixing: auto mixing.

6- Disinfection: PVS is safely disinfected in 1% sodium

hypochlorite for ten minutes. We can't do this with
alginate or polyether because they will absorb water
and swell.

Moisture control and gingival displacement are essential:

1-salivary flow: we use suction, cotton rolls…

2-gingival crevicular fluid: retraction cords, chemicals that

you impregnate the cord with it.

Gingival displacement:

-depicting the cervical margin of your preparation is

usually defective

-this related to humidity and the closeness of gingival

tissue

To pick up that margin, we need to displace the gingiva

and control the moisture in a healthy gum. So if you
don’t have healthy gum you send the patient to
periodontal clinics, till he has healthy gum you don’t take
impression to him, because you cannot control moisture
properly, there will be bleeding...etc.

The displacement must be vertical (below the finish line)

nearly 0.5mm and horizontal (0.2mm) you move it
outward.

Why 0.2mm? Because impression material will go into the

gingival sulcus, if the width of your sulcus is less than
0.2mm when you pick the impression up from patients
mouth it will split. So 0.2mm is the thinnest width that the
impression material will not split.

Note 0.2mm in low body or wash imp.

Why 0.5mm? Because when we send the impression to

the lab, we want the technician to see part of a tooth
underneath the finish line, so he could make his crown in a
way that is growing from the gingiva (emergence profile).

Gingival displacement techniques:

1-mechanical 2-chemical 3-surgical 4-

combination

The most common technique is mechanical-chemical

technique.

When you place the cords in the sulcus you do mechanical

retraction because you displace the gum, and the ferric
sulphate that you impregnate the cord with it is the
chemical retraction, because it will make the gum shrink
→due to vasaconstriction.

Retraction cords are in different sizes 0#, 1#,…etc,

different shapes knitted(loop inside loop), braided(sha3er
el mujaddal), twisted. Knitted and braided will not
unbound easily, but the twisted (previously used) will
unbound easily if subjected to pressure.

Ferric sulphate 15.5% mostly used, it enhances

coagulation (advantage), but you should rub the gum
when using it and you should wait few minutes and it
stains the gum for 48 hours (disadvantage).

Or you could use Al, AlCl3, epinephrine (it is dangerous

for patients have CVS problems)

Chemical-mechanical techniques:

1-single cord: the most common, you place it 6-8 min in

gingival sulcus before removal. You moisten it then
remove to prevent tearing of the crevice lining. It is
preferable to wait 10-15 seconds to see if any bleeding
occurs. You have 30 seconds to take the impression so
you need to be quick.

2-two-cord: narrow cord placed first to ensure a dry field

(it stays during the impression taking), then a second
thicker cord is placed on top to open up the crevice (this
cord is removed during the impression), but be sure not to
forget the cord in patients mouth.

Generally we begin placing the cord from proximal area

mesial or distal then all around the tooth.

In the picture page 5 slide 2, in a he placed the narrow

cord then in b he placed second cord, in c he removed the
second cord, in d impression that he took.

Surgical techniques you should read it from the handouts,

but generally you remove part from the gingiva by burs, it
is very aggressive technique we avoid it usually.

Impression techniques:
1-Monophase technique (regular body): it is dimensional
stability better than low body but lower then putty, it is
less accurate in capturing fine details than low body,
needs special trays because it is highly flowable, high
incidence of voids. We use it rarely in fixed
prosthodontics, we usually use it in Cr-Co partial denture.

2-dual-phase (low+heavy): low body give us more

accuracy and the heavy body give more dimensional
stability because of high filler percentage, usually it is the
most accurate. It is hard to mix, so you need auto-mixing.
No need to special tray.

3-putty wash: -we need stock rigid tray because the putty
is quite rigid material→ you need heavy forces to seat it→
result in outward flexion of the tray wall→ on removing the
tray from the mouth → tray walls will rebound→ resulting
in dies which are undersized buccolingually

-and if you use rigid tray with patient with multiple

undercuts you can't remove the impression from his
mouth, you need to cut the impression.

-putty will give us high dimensional stability and low body

will give good surface detail.

-The main disadvantage is → putty will displace the low

body so part of your impression will be from putty (which
is not accurate remember 75 microns) and part from low
body, this happens especially when we take the
impression in one stage. Like in the picture page 5 slide
(5).

Putty wash techniques:

1-one stage: the nurse mixes the putty at the same time
we squeeze low body to the prepared tooth, then we place
the putty in the tray and squeeze on top of it the low body
and take the impression)

2-two stage: a-unspaced: putty is recorded first and after

setting relined with a thin layer of wash. But logically
thinking we will have slight space because while setting
the putty will shrink toward the tray creating little space.

b-spaced: as for unspaced except a space is

created for the wash.

This space may be made by:

1-polyethene spacer over the teeth prior to making the

putty.

2-recording the putty impression before the tooth

preparation

3-gouging away the putty and providing escape channels

for the wash.
The main disadvantage of this technique: 1-the putty
impression may not be reseated properly causing a
stepped occlusal surface of the cast and a restoration
requiring excessive occlusal adjustment.and it is often
difficult to reseat an impression where the material has
engaged undercuts especially interproximally. 2-we will
have steps in the cast due to the hydrostatic pressure that
can be generated from the seating of the wash which can
cause deformation and subsequent putty recoil on
removal. Like in page 6 slide no.2.

So the best technique is heavy-light body. we don’t use it

here because the putty-wash easier, less time consuming.

When to order special tray?

1-multiple edentulous areas

2-irregular arch form: lingualize teeth…

3-last tooth to be depicted: if you use stock tray the

impression material will flow back to the throat of the
patient and not around the distal side of the last tooth that
we want to pick up its impression.

4-teeth with significant mobility

5-impression technique

What we will do in clinics is:

-PVS

-plastic rigid perforated tray with adhesive 7-15 min, but

we choose bigger size from the arch not to force the tray
to flex.

-single/double-retraction cord impregnated with ferric

sulphate
-one stage putty-wash

Common errors: 1-poor finish line 2-air

bubbles

3-voids 4-unset
impression material

5-invisible errors

1-poor finish line: gingival inflammation and bleeding,

subgingival finish lines, gingival overgrowth, displaced
retraction cord

2-air bubbles: poor mixing, poor loading, tray seating

3-voids:means no impression material in that place, we

need dry field to avoid it, well-confined tray, avoid set light
body because it sets quicker than the putty due to the
difference of the temperature between the patients mouth
(where the light body) and the operating room(where the
putty). So you need to be quick and you need to cooperate
with your nurse→ she loads the putty in the tray and you
squeeze the light body.

4-unset impression material: inhibited setting reaction

(latex), setting time (gag reflex)

5-invisible errors: impression detachment (without using

adhesive or without waiting 7-15 min for the adhesive),
permanent deformation.

SON
DONE BY FARAH ALALI JARADAT