Impression materials, gypsum products, and waxes

Classification of all dental impression materials in dentistry: 1According to chemical reaction of the material. Some

materials have a thermoset reaction, which means a chemical reaction occurs and then the material sets and it is irreversible. (alginate, ZO/E, rubber impression material) 2According to physical changes which are called thermoplastic

materials. Thermoplastic means that at certain temperatures the materials begin to soften, and if you leave them to cool, they start to set or harden. It is a reversible reaction. (impression compound, agar agar)

We can classify the impression materials according to their use.

1Elastic/inelastic (after they set): alginate and rubber are

examples of materials that are elastic after they set. Some impression materials are inelastic after they set like impression compound. ZO/E is inelastic even though some books classify it as semi-rigid/ semi-elastic because when it sets, it has some elasticity, but this elasticity is not technically useful. It would not work in deep undercuts, which is why it is considered inelastic. 2Accuracy: alginate is an impression material, which is elastic,

but it is not accurate enough for secondary or final impression purposes. On the other hand, additional silicon and rubber are accurate.

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Flow (viscosity): this classification is before setting. The

material could have high flowability (low viscosity) or low flowability (high viscosity). An example on a flowable (low viscosity) material is alginate, mainly mucostatic. Impression compound is the least flowable impression material and it has the highest viscosity. It is important to have different viscosities because it affects the impression technique the dentist wants to use. A mucostatic impression requires low viscosity and a

mucocompressive impression requires high viscosity.

If there is a deep undercut, a material with high

viscosity would not flow, but alginate, which has a low viscosity, could be used for deep undercuts.

*The most clinically useful classification is when the impression materials are divided into 2 types which are elastic and inelastic, and the elastic can be aqueous or non aqueous.

A)

Inelastic impression materials: Plaster of paris Wax and impression compound ZO/E

B)

Elastic impression materials:

1- (Aqueous elastomers):
Alginate (irreversible hydrocolloid) Agar (reversible hydrocolloid)

*Elastomers are elastic when they set. When you apply pressure to an alginate impression, it will compress and it will also have some recoil effect (not 100%). Some materials recoil almost 100% like rubber impression material and additional silicon. Elastomers have a certain degree of flexibility and recoil.

C)

Nonaqueous elastic impression materials (nonaqueous

elastomers): Polysulfides Silicones (addition, condensation) Polyethers

*Rubber impression materials have the best recoil effect.

It is preferred to use custom trays rather than stock trays, because if there is a deep undercut, the impression material flexes and the tray also flexes. But if you have a custom tray made of strong acrylic material, it will not flex and the material itself will flex and deflex. This is why for secondary impressions it is preferred to used a special tray or a custom tray. Custom trays are more rigid. Uniform thickness can be achieved. Stock trays do not

have uniform space on top of the occlusal surface but special trays do, and stoppers can also be added to special trays.

PLASTER OF PARIS
- It is a gypsum material and it is contraindicated for dentate patients. 3

- Flavors and setting accelerators are added. - Only used for edentulous patients. (No longer used) - It was considered one of the best impression materials for mucostatic impressions alongside ZO/E. The problem is that if you take a secondary impression with plaster of paris and you pour it using another type of gypsum, they will bond together, therefore a separator is used on the impression. - Main disadvantage: it is rigid when it sets which means it is not suitable for shallow, moderate, deep or bilateral undercuts. - Advantage: cheap.

WAX
- Can be a type of impression material. - Cheap and easy to use. - Different forms. (Sticks, stripes, tubes) - Thermoplastic. (Reversible) - Main disadvantage of wax: poor dimensional stability and is not recommended to be used as a secondary impression material. - Only used for edentulous patients. - Can be used to correct impressions like ZO/E. Rubber cannot be corrected.

IMPRESSION COMPOUND
- Very common impression material, especially in Jordan. - Thermoplastic. (Reversible) 4

- Does not have good thermal conductivity. - Wax with fillers. - Stronger than wax, but more brittle when set. - 2 forms: cake which is mainly used as a primary impression material for edentulous patients. The other form comes in sticks, also known as green stick (tracing impression compound), which is used for border molding. Green stick gives more accurate details and is low fusing. - This material is only used for edentulous patients! - Ideal tray to be used is non perforated metal tray. You can heat the metal tray before using it so that the impression compound can stick to it and you can also you use the tray again unlike disposable plastic trays. Plastic trays are not recommended because they are disposable and they flex. The trays should not be perforated because you will not be able to clean them. - One of the main advantages of impression compound is that it is reversible because it is thermoplastic and it is also correctable. - The softening temperature of impression compound is 55 C. (Possible question) - Impression compound is sticky when it is soft, so a gauze pad is placed inside the rubber bowl to prevent the material from sticking to the walls. - Green stick softens at 45 C. - Disadvantages of impression compound: 1- It is rigid and not suitable for undercuts. 2- It becomes brittle after setting. 3- Highly viscous and has to be pushed properly into the areas that need to be registered. - Main advantages: 1- Reversible. 5

2- Can be corrected. 3- Ideal for mucocompression. 4- Supports itself by itself, no need for long tray flanges. 5- Suitable for gaggers. 6- Cheap.

ZINC OXIDE-EUGENOL
- Inelastic, rigid material used for edentulous patients. - Could be used for free end saddle area in partially edentulous patients on the tissues only not the teeth. - Commonly used in Jordan - It comes in two tubes, paste and catalyst. - When it sets, it is considered hard and brittle. - Low tear resistance. - Inexpensive compared to rubber. - Cannot be used for deep undercuts or bilateral undercuts. - One of the main advantages is that it can be corrected. - It comes in different colors (red + white), mixed until we get a homogeneous color. - It can be mucostatic or mucocompressive based on the pressure applied. - Viscosity almost like alginate and gives very nice surface details. - Hydrophilic, it does not need meticulous moisture control. - Suitable for gaggers as its viscosity is lesser than rubber. - When it sets, it is hot so the patient complains of a burning sensation. - Some patients are allergic. - Setting time depends on the weather and the accelerators added. 6

- It is messy. When soft, it is very sticky therefore you should wipe your hands and the patient's face with Vaseline. - Working and setting time are acceptable. - Dimensionally stable for only 24 hours.

AGAR AGAR
- Used in the lab and clinically. - Reversible hydrocolloid. - Carbohydrate polymer. - Hysteresis is the process when melting and gelling occur at different temperatures. - Used in duplication of models in the lab. - It sets at room temperature. (25C) - It needs a special cooling system and a disinfection system. - Low tear resistance. - It is not recommended for clinical impressions. - It is elastic and suitable for undercuts.

-NON AQUEOUS RUBBER MATRIALS-

POLYSULFIDES
- Base and catalyst. - Polymerization reaction. - Thermoset. (Irreversible) - Chain lengthening of polymers and cross linking between chains. 7

- When you mix the base with the catalyst, the catalyst starts the reaction and the chains become longer and this leads to copolymerization. So it is a chain linking and cross linking reaction. Two types of polymerization in rubber: 1- Addition Two parts are mixed with no byproducts. 2- Condensation You condense the material and end up with a byproduct. Byproducts make the material dimensionally unstable. (Distort) - Condensation polymerization reactions usually have water as a byproduct and syneresis occurs. (Loss of water) - Bad smell and bad taste. - Long setting time. - Working time 4-6 minutes. (Advantage) - Not used clinically these days because of its disadvantages. (Bad smell, bad taste and long setting time) - Dimensional changes due to water evaporation. - Humidity accelerates setting. - Inexpensive. - Used for edentulous, dentate and partially dentate patients because it is a rubber material. - All rubber materials are hydrophobic except for polyether which is hydrophilic. - One of the main disadvantages of rubber materials is that they are hydrophobic. - Polysulfides come in light, medium and heavy viscosities. For complete dentures medium is used or light with medium. For crown and bridge light with heavy viscosities are used. 8

SILICONES- MOST COMMON USED RUBBER MATERIAL 12Condensation Addition

CONDENSATION SILICON
- Hydrophobic. - Condensation polymerization alcohol byproduct. - Cannot be used for secondary impression for crown and bridge work because it is not accurate. (unless impressions are poured immediately) - These days condensation silicones are mostly used in the labs. - Used for temporary crowns because it is cheap.

**Potential exam question: The most common used rubber impression material and the most common used impression material for crown and bridge work is: Addition silicone.

ADDITION SILICON
- Most popular. - Most accurate and dimensionally stable. - Can be poured after 7 days and still be very accurate. - Main disadvantage: expensive - Common name for addition silicon is polyvinyl siloxane. (PVS) - No byproduct addition polymerization reaction (very important advantage) - Can be used for any impression except for mucocompressive because it is not viscous enough even if it was in putty form. 9

- Light (wash), medium (regular), heavy and putty viscosities. - Monophase viscosity: new product and it is used alone. - In complete dentures monophase is used alone. Medium viscosity, light + heavy and light + putty can also be used. - In crown and bridge work combinations are used for better accuracy. - The lower the viscosity, the more accurate the impression is. - Light or wash is the most accurate and putty is the least accurate. - Having 5 different viscosities mean more clinical advantages of this material. -Main disadvantage: hydrophobic bubbles form on the cast. A surfactant can be used to reduce the bubbles. - Some addition silicones may produce hydrogen as a byproduct. - It is preferred to pour all impression materials soon after the impression is taken except for addition silicon. If hydrogen vapor byproduct is present, it would be during the first 30-60 minutes after the impression is taken. This byproduct does not affect the accuracy, but if the impression is poured immediately, bubbles will be present on the model. (Nowadays most addition silicones do not have hydrogen byproducts) - To achieve the most accurate results, delay pouring of the impression from anywhere between 2-24 hours. This will give time for the parts of the impression that were in undercuts to recoil and return to their original positions. -Wearing latex gloves should be avoided when working with addition silicon because it affects the polymerization reaction. (Sulfur in the latex gloves inhibits the polymerization reaction) - Can be used for both edentulous and dentate patients.

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POLYETHER
- Hydrophilic, cationic polymerization it is addition but contains cations. - No byproducts. - It is the stiffest rubber impression material. Usually used in maxillofacial cases and it is hard to tear. - Very good impression material. - Setting time is 5 minutes. - It comes in two tubes. - Unpleasant taste, but not as bas as polysulfide. Patient can tolerate it. - Used in dentate and edentulous patients. - As it has a good viscosity, it could be used for border molding. - It needs to be poured immediately.

GYPSUM PRODUCTS
- Made from gypsum rock. (CaSO4.2H2O) - Gypsum rock is grinded to give a fine powder and then process it by heat (calcination) and by this process we get the different types of gypsum. Plaster: - Heating is done in an open containerH2O loss from the crystals. - Calcination is not regular so we get porous and irregular particles. - Plaster of paris is called type 2 or beta-hemihydrate. - Least strength because it is highly porous, usually used for primary models ONLY in complete dentures. - Mixing ratio: 45ml H2O/100g powder. - Usually white.

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Stone: - Controlled calcination under steam pressure in a closed container, so water loss is controlled. - More regular, more surface details and less porous therefore stronger and more expensive than plaster. - Alpha hemihydrate or type 3. - Mixing ratio: 28-30ml H2O/100g powder, less water because it does not lose water as much as the plaster. - Used for primary and secondary impressions for complete dentures and RPDs. - It comes in different colors, usually yellow. High- strength (improved stone): - Controlled calcination in calcium chloride solution which leads to much denser particles. - Stronger than plaster and dental stone, most expensive. - Very good surface details because it is not porous as plaster and dental stone. - Used in crown and bridge work for making dies and that is why it is called "die stone". - Type 4, density, modified alpha hemihydrate. - Mixing ratio: 19-24ml H2O/100g powder. - Type 5: higher strength, higher than type 4 but higher setting expansion. - Usually used for RPDs (cobalt chromium).

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*Other types: - Fast set gypsum: - It sets in 2-3 minutes. - Mounting: Little expansion so it does not affect the accuracy of mounting. - Impression material: it has flavors and accelerators.

- The reaction of all gypsum products is exothermic. - One of the main disadvantages is setting expansion (crystal thrust). - Plaster of paris has the highest expansion rate (0.2-0.3%) Stone (0.08-0.10%) Die stone (0.05-0.07%) - Thicker mix and more spatulation causes expansion so you should follow the manufacturer's instructions. - Hygroscopic expansion if the model is left in the water, it gets expanded. - Increase the setting time decrease mixing, higher water/powder ratio, borax retarder. - Decrease the setting time increased mixing, lower water/powder ratio, potassium sulphate, and use accelerators. - Airtight storage is to avoid evaporation of water. - Vacuum mixing gives less porous model compared to hand mixing. - Setting time there is a test to check if the material is set or not, as the material has an initial setting time and a final setting time. - Gillmore needle is used to check the setting time.

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WAXES
- Natural waxes: bee wax/ synthetic waxes. - Dental waxes are combined. - Inexpensive compared to other dental materials but more expensive. than paraffin wax. - Soft wax dimensionally unstable. Types of waxes: - Inlay wax no residues when heated, hard relatively and have higher melting temp than other types, not sticky. Sticky wax hard, melts at higher temperatures, used usually after the jaw relation registration to stick the models together. Baseplate wax used for making wax rims and record blocks. Medium hard and is not sticky. Utility waxes baseplate, boxing, beading. Soft, flexible slightly sticky at room temperature.

Written by: Fares "fa'nay'nay" Hanafieh and Fahad "fido" Salehi

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