Using Irreversible Hydrocolloid and Gypsum Materials to Fabricate Diagnostic Casts

Irreversible Hydrocolloid (alginate) Making an impression Gypsum Products (dental plaster & stone) Making Diagnostic casts
Impression

Articulator
a mechanical instrument that represents the temporalmandibular joint and jaws to which maxillary and mandibular casts are attached to simulate some or all of the mandibular movements

Patient

Patient replica

Articulator
Articulate- 1. to join together as a joint 2. the relating of contacting surfaces of the teeth or their articial replicas in the maxilla to those in the mandible

What are Diagnostic Casts and Why do We Make Them?

Diagnostic Casts: Artificial stone replicas of the patients oral and dental anatomy used by the dentist to: Plan treatment for patients Help fabricate devices needed in rendering treatment Keep a record of preoperative conditions

Irreversible Hydrocolloid Impression Material

Also called alginate impression material Used to make dental impressions for: preliminary impressions for complete dentures partial dentures with clasps orthodontic models and study models Not used for: crown and bridge impressions (lack of accuracy)

Irreversible Hydrocolloid Impression Material

Alginic acid / salt of alginic acid

Soluble in water

Irreversible Hydrocolloid Impression Material Alginic acid is soluble in water and forms a sol sol: resembles a solution, but is made up of colloidal particles dispersed in a liquid;

Irreversible Hydrocolloid Impression Material

Setting Reaction sol to gel transformation Temperature controlled (reversible) Chemically controlled (irreversible) gel entangled framework of solid colloidal particles in which liquid is trapped in the interstices and held by capillary forces (Jello)

Irreversible Hydrocolloid Impression Material

Reactants: sodium or potassium alginate (12-15%) calcium sulfate dihydrate (8-12%) Retarder: sodium phosphate (2%) (sodium phosphate content adjusted by manufacturer to make either regular or fast-set alginate) (we will use Jeltrate brand regular-set alginate in lab) Reinforcing ller: diatomaceous earth (70%) (for strength and body) (controls the stiffness of the set gel) Potassium sulfate or alkali zinc uorides (~10%) (provides good surfaces on gypsum dies) For esthetics: coloring and avoring agents (traces)

Chemical Reactions
Powder is mixed with water to obtain a paste. 2 main reactions occur when powder reacts with water during setting:
First rxn. provides adequate working time: (Retarder) 2Na3PO4 + 3CaSO4 ----> Ca3 (PO4) 2 + 3Na2SO4 After the sodium phosphate has reacted, remaining calcium sulfate reacts with sodium alginate to form an insoluble calcium alginate, which forms a gel with the water: H2 O Na alginate + CaSO4 --------> Ca alginate + Na2SO4 (powder) (gel)

Manipulation
Generally easy to use Powder (supplied in can) shaken up before use for aeration Water to Powder (W/P) ratio to be carefully followed as specied by the manufacturer Lower W/P ratio increases strength, tear resistance, and consistency; decreases working and setting times and exibility Lower water temperature increases working and setting times Insufcient mixing produces a grainy mixture and poor recording of detail Adequate spatulation produces smooth, creamy mix with minimum of voids

Denitions
Mixing time Time to complete uniform blending of components Working time Time from beginning of the mix until the setting reaction dominates Setting time Time from beginning of the mix until the setting reaction is over Regular set alginate: 1 min, 2.5 min, 3.5 min Fast set alginate: 45 sec, 1.5 min, 2.5 min

Problems with Alginate Impressions

Dimensional stability:
Because it is a gel, it undergoes shrinkage or expansion upon loss or gain of water. Syneresis Loss of water to the surroundings

Imbibition Pick up of water from the surroundings

For least dimensional change/avoid distortion: Store impressions in 100% relative humidity Pour quickly after removal from mouth

Advantages of Alginate
Economical Easy to use Quick setting Fair taste Hydrophilic Stock trays

Disadvantages of Alginate
Limited detail reproduction Low tear resistance Single pour only Quick pouring required Low dimensional stability

Can displace blood and saliva

Use of Alginate Impression Material Armamentarium

Use of Alginate Impression Material

Impression Trays Types: Metal stock trays Disposable plastic trays Must have retentive features: Mechanical - rim lock, perforated Chemical - adhesive spray

Use of Alginate Impression Material

Tray Selection: Select the largest tray that will t comfortably into the patient's mouth * Alginate requires greater bulk of material to produce the most accurate impression.

ADA specications:
<3% deformation with a 10% strain

Use of Alginate Impression Material

Tray modication: Wax or modeling compound used to extend tray borders and/or ll in palate area when high vault present *Distortion can occur if the impression material is unsupported by the tray or if the tray moves during setting

Making the impression Mouth Preparation Rinse and dry the patient's teeth -if teeth are too dry, alginate will stick

Making the impression

Measuring Measure out powder (scoop) and water (plastic cylinder) to appropriate ratio; following specic manufacturers directions. Place water in green exible bowl and add powder to water.

Making the impression

Mixing Mix quickly: < 1 minute for a smooth, creamy consistency

Making the impression

Loading the tray Swipe alginate into tray so as to not incorporate air Wipe impression material onto occlusal surfaces of teeth (and into high palate).

Making the impression

Seat the tray Align the labial frenum with frenum space on front of tray. Seat tray posterior to anterior. Have patient relax facial muscles and extend lips over edges of tray. Do Not Overseat.

Making the impression

Approx. 1 min. after stickiness vanishes, (about 3.5 min. from beginning of mix), remove tray with one quick motion. (Teasing or wiggling set impression from the mouth will cause excessive distortion.) Rinse, disinfect and store impression in humid environment (can wrap in moist paper towel) Pour with stone within 15 minutes

Alginate Impressions
maxillary mandibular

Troubleshooting
Inadequate working or setting time:
temperature of the water, incomplete spatulation W/P too low improper storage of alginate powder

Troubleshooting
Consistency:
preset mix is too thin or thick the W/P ratio is incorrect (avoid by ufng powder before measuring; do not overll powder dispenser) inadequate mixing (avoided by vigorous spatulation and mixing for recommended time) using hot water: grainy and prematurely thick mix

Distortion:
tray movement during gelation or removed from mouth prematurely weight of tray compressing or distorting alginate impression not poured up immediately

Dimensional change:
delay in pouring alginate impression stored in air: results in distorted, undersized cast due to alginate impressions losing water when stored in air

Tearing:
removing impression from mouth before adequately set thin mixes (high W/P ratio) presence of undercuts (blocking out these areas before an impression may help) inadequate amount of impression material in tray (avoided by minimum 3 mm of impression material between tray and oral tissues)

Porosity:
whipping air into the mix during spatulation (proper mixing: after initial wetting of powder by the water, mix alginate so as to squeeze the material between the spatula blade and the side of the rubber bowl)

Loss of detail:
removed from mouth prematurely

Poor stone surface (of cast)

set gypsum remaining in contact with the alginate for too long a period of time

Gypsum Materials
Diagnostic casts

Gypsum Materials
Dental gypsum products are available in 5 forms (ADA types I to V): Impression plaster (Type I) Model plaster (Type II) Dental Stone (Type III) High-strength dental stone(Type IV) High-strength, high-expansion stone (V)

Lab casting procedures

What is gypsum?
Gypsum is the dihydrate form of calcium sulfate, CaSO4 . 2H2O, found in a compact mass in nature. Dental gypsum products are manufactured by driving off part of the water of the calcium sulfate dihydrate to form calcium sulfate hemihydrate. This process is referred to as calcination. The gypsum components of these materials are identical chemically; differences in these materials is attributed to calcination.

Calcination
heat or other means Mineral gypsum ---------------- > Model plaster + Water (CaSO4 . 2H2O) Dental stone High-strength dental stone (CaSO4 . 1/2H2O)

Reverse reaction
When calcium sulfate hemihydrate (dental plaster, stone, etc.) is mixed with water, the reverse reaction takes place, and the hemihydrate is converted back to the dihydrate: CaSO4 . 1/2H2O + 11/2H2O ---> CaSO4 . 2H2O + 3900 cal/g mol Heat is released in this reaction (exothermic reaction).

Gypsum Materials
While setting, growth and subsequent interlocking of gypsum crystals occur. Interlocking contributes to strength and dimensional change of the gypsum. Physical and mechanical properties of the gypsum mass can be inuenced by manipulative procedures that inuence the difference in solubility and growth of the dihydrate crystals.

Types of Gypsum Products

Dental Plaster Type I - impression plaster Type II - model (laboratory) plaster (used for mounting casts) plaster is composed of the form of calcium sulfate hemihydrate crystals
Crystals of model plaster. p.337 Restorative Dental Materials. 9th ed. Ed. RG Craig.

Types of Gypsum Products

Dental Plaster plaster is weaker than dental stone due to: 1.) porosity of the particles, requiring more water for a plaster mix 2.) irregular shapes of particles prevent them from tting together tightly

Crystals of model plaster. p.337 Restorative Dental Materials. 9th ed. Ed. RG Craig.

Types of Gypsum Products

Dental Stone Type III - dental stone (diagnostic casts) Type IV - high strength dental stone (working models) Type V - high-strength, high-expansion dental stone Stone is the

Types of Gypsum Products

Dental Stone - dense, regularly shaped, relatively nonporous cuboidal crystal material - require less water, and are approx. 2.5 times stronger than plaster - stone is widely used in making casts and molds requiring high crushing strength and abrasion resistance

hemihydrate form
Crystal structure typical of dental stone. p.337 Restorative Dental Materials. 9th ed. Ed. RG Craig.

Crystal structure typical of dental stone. p.337 Restorative Dental Materials. 9th ed. Ed. RG Craig.

Types of Gypsum Products

high-strength stone: (Type IV) -harder cast material than dental stone -composed of modied form of calcium hemihydrate crystals -crystals are slightly larger and more dense than those of dental stone -because of increased strength and resistance to abrasion, are used for inlay, and crown and bridge casts -may be referred to as die stones high-strength, high-expansion dental stone: (Type V) - with high expansion, it is especially suited for polyether or polyvinyl impression materials

Composite Technique
Working Model

Mark Margins

Separator

Gypsum materials
Principal difference between plaster, stone, and highstrength stone is in the shape and form of the hemihydrate crystals. Crystals of dental stone and high-strength dental stone are more dense and regular in shape. This makes it possible to obtain the same consistency with less excess water with the stones than with plaster. If gypsum needs to be soaked in water (cast duplication), soaking should be done in water saturated with plaster slurry, only long enough to achieve desired degree of wetting (otherwise gypsum can dissolve). The greatest disadvantage of gypsum products is relatively poor resistance to abrasion. One way to improve abrasion resistance is by adding gypsum hardeners like colloidal silica or synthetic resin.

Differences in gypsum products

Many properties are either inversely or directly related to the W/P ratio: Directly proportional: manipulation and setting times Inversely related: strength and setting expansion

Differences in gypsum products

Because of their lower water requirement, raw hemihydrate used to produce stones and die stones have a higher inherent setting expansion in normal mixes than plaster. This effect is masked by the additives used in their formulation.

Mixing gypsum materials

Hand mixing Vacuum mixing (ideal; results are better) -Reduces porosity -Increases strength

Large

small

Incremental pouring
Reduces bubble incorporation Use dental vibrator to decrease bubble incorporation As material is poured into impression, it is best to start at one distal end (molar area) and allow material to ow into each tooth socket individually around the arch to the other distal end A small instrument may be used to tease bubbles out of material before it sets

Scrape excess into trash then rinse Do Not Clog Sink

2-Pour Technique
The 2-Pour technique involves pouring gypsum material into the impression to cover all surfaces of the impression and allowing the initial pour to set prior to adding more gypsum material to serve as a base for the cast.

2-Pour Technique
1st Pour: Place gypsum material in tooth areas rst, then proceed to cover the palate/tongue space areas Place impression tray-side down onto a at surface, or hang to avoid distortion, and allow to set for 20-40 minutes. (Remember that distortion of the cast can occur if the impression material is unsupported by the tray.) You may want to leave small mounds of material on top of the 1st pour to serve as retentive features for 2nd pour.

2-Pour Technique
2nd Pour: Make sure initial pour is slightly moist Mix material and place on a at surface. Invert the 1st pour on top of the 2nd mix and incorporate around the 1st pour material. Allow to set 30 minutes and separate the impression from the cast.

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Diagnostic Casts (Evaluation Criteria)

All surfaces of the teeth, gingival tissues & articial soft tissues should be accurately reproduced and free of voids and nodules The surfaces of the cast (including the base) should be hard, dense, without voids and free of any grinding sludge left by the trimmer.

Diagnostic Casts (Evaluation Criteria)

The side walls and land areas of the cast should be trimmed appropriately to duplicate the shape of your existing typodont model. The base (bottom) of the cast should be at and not rock when placed on a at surface. Teeth, soft tissues, and land areas are to be poured in Type III dental stone; the base is to be poured in Type II laboratory plaster.

Diagnostic Casts (Evaluation Criteria)

The base of the cast is between 14 and 16 mm thick from the mid-palatal or midtongue space area. The tongue space should be trimmed at and smooth duplicating the typodont. The casts should be trimmed so that the occlusal planes are parallel with the tabletop. When placed on their backs, the casts should articulate properly.

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In 2 weeks

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