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Classification of Impressions
Preliminary impressions Taken either by the dentist or an expanded-function dental assistant. Used to make a reproduction of the teeth and surrounding tissues. Used to make (1) diagnostic models, (2) custom trays, (3) provisional coverage, (4) orthodontic appliances, and (5) pretreatment and post-treatment records.
Final Impression
Delivery
Definition An impression is a negative record of the tissues of the oral cavity which constitutes the basal seat of the denture. An impression is made in a material which has plasticity and which hardens or sets while in contact with the tissue.
Prof Owen Fundamentals of Removable partial dentures 2nd Ed pg. 124 -131 Wits Pros Book Vol 2 Pg. 14 Study pages 14- 31 Vol 2 www.health.wits.ac.za/Prosthodontics Primary impressions in alginate
and sufficient unprepared tooth structure immediately adjacent to margins, to allow the dentist and the technician to be certain of the location and configuration of the finish line.
Other teeth and tissue surrounding the abutment tooth must be
accurately reproduced to permit proper articulation of the cast and contouring of the restoration.
It must be free from air bubbles especially in the finish line area.
High accuracy
(very small contraction <0.5%)
Biocompatibility
Compatibility to stone High tear strength Long shelf life Pleasant color &taste
High dimensional stability High elastic recovery Ease of use Hydrophilic and Hydrophobic Proper setting time
Cost
Elastic recovery
The amount of rebound after a cylinder of material is strained 10% for 30 seconds.
98%
Hydrophilic VS Hydrophobic
removable denture
fixed prostheses What technique do you use?
IMPRESSION MATERIALS
Key Properties
a. Accuracy = ability to replicate the intraoral surface details.
b. Dimensional Stability = ability to retain its absolute dimensional size over time. c. Tear Resistance = ability to resist tearing in thin sections (such as through the feather-edged material within the gingival sulcus.
Impression Tray Impression
PROBLEM ANALYSIS
a. b. c. d. e. f. g. Impressions Casts, Dies Waxing Investing Casting Finishing, Polishing Cementation = = = = = = = +/- 0 +/- 0 +/- 0 + 1.5% - 1.5% +/- 0 +/- 0
CLASSIFICATION SYSTEM
Based on Properties of Set Materials
Properties: Reaction: Irrev Rev Irrev Irrev Rev Irrev Irrev Irrev Irrev Set: (Chem) (Phys) (Chem) (Chem) (Phys) (Chem) (Chem) (Chem) (Chem)
Rigid:
1. 2. 3. Impression Plaster Impression Compound Zinc Oxide/ Eugenol Rigid Rigid Rigid Flexible Flexible Flexible Flexible Flexible Flexible
Impression materials
Plaster Nonelastic
Impression Compound
Polysulfides Polyethers
Condensation silicone Addition silicone
Elastic
Non-aqueous elastomers
Impression Compound
Impression wax
Dental Plaster
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 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 fitting together tightly 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 hemihydrate form Types of Gypsum Products
Calcination
Calcination
H or other means Mineral gypsum ---------------- > Model plaster + Water
(CaSO4 . 2H2O) Dental stone High-strength dental stone (CaSO4 . 1/2H2O)
Reverse Reaction When calcium sulphate 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
A material that is used when an extremely accurate impression is essential. The term elastomeric means having elastic or rubberlike qualities.
Elastic Agar
Hydrocolloids
Alginate
First elastic
Sears AW. Hydrocolloid impression technique for inlays and fixed
bridges. Dent Digest 1937; 43: 230-234. Lin C, Zeiber G J. Accuracy of impression materials for complete arch fixed partial dentures. J Prosthet Dent 1988; 59: 288-291 Philips Science of Dental Materials 11th Ed. Part 2 Pg. 231
Irreversible Hydrocolloid
Material that cannot return to a solution state after
it becomes a gel. Alginate is the irreversible hydrocolloid most widely used for preliminary impressions.
Makeup of Alginate
Potassium alginate (Alginic Acid) (12-15%) Comes from seaweed; is also used in foods such as ice cream as a thickening agent. Calcium sulfate (8-12%) Reacts with the potassium alginate to form the gel. Trisodium phosphate Added to slow down the reaction time for mixing.
phase, the material is in a liquid or semiliquid form. (sol: resembles a solution, but is made up of colloidal particles dispersed in a liquid) The second phase is a gel. In the gel phase, the material is semisolid, similar to a gelatin dessert. gel entangled framework of solid colloidal particles in which liquid is trapped in the interstices and held by capillary forces (Jello)
most commonly used form of packaging. Premeasured packages are more expensive, but save time by eliminating the need for measurement of the powder. Shelf life of alginate is approximately 1 year.
very wet paper towel, the alginate will absorb additional water and expand. This condition is called imbibition. If an alginate impression remains in the open air, moisture will evaporate from the material, causing it to shrink and distort. This condition is called syneresis.
ADA Specifications
<3% deformation with a 10% strain
additional time is needed for the procedure. Warmer water can reduce or shorten the setting time of the procedure.
Water-to-Powder Ratio
An adult mandibular impression generally
requires two scoops of powder and two measures of water. An adult maxillary impression generally requires three scoops of powder and three measures of water.
lateral incisors. There is a complete "peripheral roll," which includes all of the vestibular areas. The tray is not "overseated," which would result in exposure of areas of the impression tray. The impression is free from tears or voids. There is sharp anatomic detail of all teeth and soft tissues. The retromolar area, lingual frenum, tongue space, and mylohyoid ridge are reproduced in the mandibular impression. The hard palate and tuberosities are recorded in the maxillary impression.
Trouble Shooting
Inadequate working or setting time:
temperature of the water, incomplete spatulation W/P too low improper storage of alginate powder
Distortion: Tray movement during gelation or removed from mouth prematurely weight of tray compressing or distorting alginate impression not poured up immediately 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) Loss of detail: removed from mouth prematurely
Consistency: preset mix is too thin or thick The W/P ratio is incorrect (avoid by fluffing powder before measuring; do not overfill powder dispenser) inadequate mixing (avoided by vigorous spatulation and mixing for recommended time) using hot water: grainy and prematurely thick mix
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 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) Poor stone surface (of cast) set gypsum remaining in contact with the alginate for too long a period of time
Reversible Hydrocolloid
An impression material that changes its physical
handling characteristics.
The first bath is for liquefying the semisolid material. A special water bath called a hydrocolloid conditioner at 212 F liquefies the material. After liquefying, the preset thermostat cools the temperature to 150 F automatically. The second bath becomes a storage bath that cools the material, readying it for the impression. At this temperature, the tubes are waiting for use. A third bath is kept at 110 F/44 C for tempering the material after it has been placed in the tray.
A stock water-cooled tray is selected, making sure that the tray does not impinge on any of the teeth or soft tissue. Plastic stops are placed in the tray. Tubing is connected to the tray and to the water outlet for drainage. The material is liquefied and moved to the storage bath. The light-bodied material is placed in the syringe, and heavy-bodied material is placed in the tray. The light-bodied material is expressed around the prepared tooth, and the dentist seats the tray.
Elastic
Polysulfides
Polyethers
Non-aqueous elastomers
Condensation silicone
Addition silicone
GENERAL FORMULATION
For Elastic Impression Materials
1.
Flexible Matrix (Continuous Phase): a. Multifunctional Pre-Polymer or Polymer b. Crosslinking Agent c. Curing Agent (Catalyst or Initiator) d. Modifiers (Accelerators, Retarders, Plasticizers, Flavoring Agents, Colorants)
Filler or Extender (Dispersed Phase):
2.
ELASTOMERIC IMPRESSIONS
Management of Shrinkage
Use 2-step techniques: (a) Light-Heavy Body, OR (b) Wash-Putty
Impression Tray Impression
Impression
ELASTOMERIC MATERIALS
Mixing and Delivery Systems
Polyether, Polyvinylsiloxane
Mixing Options: 2 Pastes on Mixing Pad 2 Pastes in Mixing Gun 2 Pastes in Mixing Machine
IMPRESSION MATERIALS
Management of Distortion During Tray Removal
Strain rate sensitive elastomers !
Slow removal
IMPRESSION MATERIALS
Distortion Time Related to Setting Reaction PS, Silicone
100
VPS Pe
material first. Transfer the material to the fresh surface of the mixing pad. Water, saliva, and blood affect polysulfide material. Impression should be removed quickly after setting-do not rock the tray. Adhesive must be thin and dry before adding the impression material. Wait 20 to 30 minutes before pouring the impression for the stress relaxation to occur in the material. Be careful of glove powder contamination of the impression.
remove without rocking. When removing the impression, break the seal and rock slightly to prevent tearing. Water, saliva, and blood affect polyether material. Added moisture will increase the impressions marginal discrepancy. Increased water absorption occurs if a thinning agent is used.
shrinkage over time. The material is more flexible, so there is more chance for distortion during removal. Wait 20 to 30 minutes before pouring of models for stress relaxation to occur.
material. Pouring of the model can be delayed up to 7 to 10 days. Stiffness of the material makes removal of the tray difficult. Material dispensed using auto-mixing unit and mixing tips.
POLYSULFIDE RUBBER
Chemistry and Setting Reaction
CONTINUOUS PHASE: Polymer Crosslinking Agent Catalysts DISPERSED PHASE: Fillers = Mercaptan Functional Polysulfide = Sulfur and/or Lead Peroxide = PbO2 or Copper Hydroxides (Type I) Zinc Peroxide or Organic Hydroperoxide (Type II) = TiO2 or Zinc Sulfate or Lithopone or Calcium Sulfate Dihydrate
POLYSULFIDE RUBBER
Manipulation and Technique Considerations
a. Two-step techniques recommended: Reduces air entrapment and surface tension effects. Material adversely affected by H2O, saliva, and blood. Set impression should be removed quickly - do not rock tray. No syneresis or imbibition, but distortion due to continued reaction. Ideally need uniform thickness and at least 2 mm thick for accuracy. (1) Adhesive must be thin (2) Adhesive must be dry Paste-Paste Mixing Recommendations: (1) Dispense pastes at the top of the mixing pad (2) Mix pastes with tip of spatula only for 5 seconds (3) Transfer mass to fresh surface at center of mixing pad (4) Wipe spatula off with paper towel; Strop mass for 15s to constant color (5) Load syringe or tray (6) Use pad excess to monitor setting time Pouring of models: (1) Wait 20-30 minutes before pour for stress relaxation to occur (2) RB is non-reactive with model and die materials (3) Be careful of glove powder contamination of impression (4) RB can be electroplated
b. c.* d. e.
f.
g.
SILICONE RUBBER
Chemistry and Setting Reaction
CONTINUOUS PHASE: Polymer Crosslinking Agent Catalysts Modifiers DISPERSED PHASE: Fillers = Polydimethyl Siloxane = Alkyl Orthosilicate or Organo H-Silane = Organo Tin Compounds (e.g., tin octoate) (but not dibutyl tin dilaurate) = Colorants, Flavorants = Silica
SETTING REACTION: Stepwise (relatively slow), Exothermic, Affected by temperature H2O by-products
SILICONE RUBBER
Manipulation and Technique Considerations
a. b. c. d. e. Limited shelf-life: Unstable in tubes. Requires mechanical retention or special tray adhesives No syneresis or imbibition, but continued polymerization shrinkage. Better dimensional stability than RHC but more expensive Pouring of models: (1) More flexible so more chance for distortion during removal (2) Wait 20-30 minutes before pour for stress relaxation to occur
POLYETHER RUBBER
Chemistry and Setting Reactions
CONTINUOUS PHASE: Polymer Crosslinking Agent Catalysts Modifiers DISPERSED PHASE: Fillers = Amine-terminated Polyether = Aromatic Sulfonate = = Colorants, Glycol Plasticizers, Flavorants = Silica
POLYETHER RUBBER
Manipulation and Technique Considerations
a. b. c. d. e. Excellent impression accuracy and dimensional stability. Stiff and therefore difficult to remove without rocking. Break seal and rock slightly to prevent tearing: Low tear resistance. Negatively affected by H2O, saliva, and blood. (1) Since hydrophobic, moisture increases marginal discrepancy (2) Increased water absorption occurs if use thinning agents Can be dispensed from automated extruder and mixer (ESPE PentaMix)
POLYVINYL SILOXANE
Chemistry and Setting Reactions
CONTINUOUS PHASE: Polymer Crosslinking Agent Catalysts Modifiers DISPERSED PHASE: Fillers = Double-bond-functional Silicone Polymer = Chloroplatinic Acid = = Colorants, Flavorants, Plasticizers = Silica
SETTING REACTION: Chain (very fast), Exothermic, Affected by temperature Hydrogen gas released by decomposition of crosslinking agent.
POLVINYLSILOXANE
Manipulation and Technique Considerations
a. b. c. BEST impression material for dimensional stability: Pouring should be delayed at least 4 hours for H2 out-gassing. Pouring can be delayed up to 7-to-10 days (or indefinitely). Stiffness makes removal difficult. Most material dispensed using auto-mixing gun and mixing tips
COMMERCIAL PRODUCTS
1980-1995
COMMERCIAL PRODUCTS
1996-2004
IMPRESSION MATERIALS
Comparison of Key Properties
Poor >---------------------------------> Good
1.
ALG < SIL, PS < PE <= RHC, PVS SIL, PVS < PS < PE <= ALG, RHC ALG <= RHC < PS, SIL < PE, PVS
2.
3.
IMPRESSION IMPRESSIONS
Dimensional Stabilty
PRODUCT EXAMPLES
Stock tray
Perforated tray
Stock tray
Special tray (Custom tray)
Nonelastic Plaster
Impression Compound
Impression wax
Elastic Agar
Hydrocolloids
Alginate
Non-aqueous elastomers
Polysulfides Polyethers
Condensation silicone Addition silicone
Elastic Agar
Hydrocolloids
Alginate Polysulfides
Polyethers
Non-aqueous elastomers
Condensation silicone
Addition silicone
(Ideal Properties)
High accuracy
(very small contraction <0.5%)
Biocompatibility
Compatibility to stone High tear strength Long shelf life Pleasant color &taste
High dimensional stability High elastic recovery Ease of use Hydrophilic and Hydrophobic Proper setting time
Cost
Impression plaster
ADA type I gypsum product
Impression plaster
For
edentulous impression
for undercut
Contraindication
(CaSO4)2.H20
Reduce expansion
Borax Starch
Reduce the rate of setting time Help disintegration of the impression from plaster model
Reaction
Calcium sulfate hemihydrate + water calcium sulfate dihydrate
Mechanical properties
Very low viscosity (mucostatic)
Hydrophilic
Manipulation
Easy to mix, trapping air bubbles W/P ratio must be measured out carefully Use in special tray, thickness of 1.0-1.5 mm. Setting time 2-3 minutes Must apply separating medium before pouring the impression Powder must be stored in air tight
Advantage
Accuracy to soft tissue impression
Good accuracy
Disadvantage
Can not be used in undercut ridge
Able to flow to pharynges
Impression compound
Type I
Impression compound
Type I
Type II
Composition
Natural resin
Waxes
Stearic acid
Filler&inorganic pigment
40% 7% 3% 50%
RESINS
Amorphous organic substance which
WAXES
Straight chain hydrocarbon
Stearic acid
Lubricant and Plasticizer
Fillers
Control
degree of flow Minimize shrinkage Improve rigidity Diatomaceous earth, Soapstone, talc
Mechanical properties
Thermoplastic Reversible Very High High High
37-45 C
physical process
Manipulation
Soften by heating over the flame or water bath Do not heat too much volatile Take impression Room temperature water cooling Pour impression as soon as possible Warm the impression before take the cast
Water bath
Advantage
Disadvantage
Very
High
technique sensitive
Mucocompressive
Must be poured within one hour Low detail reproduction
Troubleshooting
Distortion
Troubleshooting
Compound is too brittle or grainy
Zinc oxide-eugenol
For full arch edentulous impression without or minor
undercut
Wash impression
Bite registration
Composition (base)
Zinc oxide (ZnO)
Oil Hydrogenated rosin Zinc acetate Trace of water
Accelerator Initiator
Composition (reactor)
Eugenol Oil Rosin
12~15%
Filler (kaolin)
Carboxylic acids
Reaction
ZnO + eugenol
(powder)
Zn eugenolate + ZnO(unreacted)
(liquid)
(Solid)
Manipulation
Manipulation
Equal length of the two paste is extruded
Mixed with stainless steel spatula in paper pad or glass slab Mixing time 45-60 s
3-5 min
Temperature&Humidity
Advantage
Accuracy of soft tissue impression (mucostatic)
Disadvantage
Messiness Non elastic Time Unstable setting May irritating to soft tissue
Troubleshooting
Inadequate working or setting time
-unstable tray
Impression wax
KORECTA WAX , IOWA WAX
Manipulation
Functional Impression
Final Impressions: Dip in Gluteraldehyde ,rinse in sterile water, dip again let stand under damp gauze 10 min Spray with Sodium Hypochlorite rinse, spray again & let stand under damp gauze 10 min
Reversible Hydrocolloid
Dip in Gluteraldehyde ,rinse in sterile water, dip again let stand under damp gauze 10 min Spray with Sodium Hypochlorite rinse, spray again & let stand under damp gauze 10 min
In Gluteraldehyde 1 hr., Rinse sterile water Soak in fresh solution Gluteraldehyde 10 min
Silicone Impressions
Polyether Impressions
Dip in Gluteraldehyde ,rinse in sterile water, dip again let stand under damp gauze 10 min
REFERENCES
Skinners Science of Dental Materials
Dental Materials and Their Selection (William J. OBrien) Introduction to dental materials (Richard Van Noort) Dr Sukontip Arwatchanakan
teeth. Extends approximately 2 to 3 mm beyond the third molar, retromolar, or tuberosity area of the arch. Is sufficiently deep to allow 2 to 3 mm of material between the tray and incisal or occlusal edges of the teeth.
Section tray
Covers the anterior portion of the arch.
Perforated tray
Holes in the tray create a mechanical lock to hold the
material in place. Smooth tray Interior of the tray is painted or sprayed with an adhesive to hold the impression material.
Impression Trays
Must be sufficiently rigid to: Carry the impression material into the oral cavity. Hold the material in close proximity to the teeth. Avoid breaking during removal. Prevent warping of the completed impression.
Tray Adhesives
VPS adhesives (blue) For polyvinyl siloxane and polyether impression materials. Rubber Base Adhesive (brown) Used with rubber base impression materials. Silicone Adhesive (orangish-pink) Used with silicone impression materials.
The material selected depends upon the dentists preference and the type of impression required for the procedure. The dentist prepares the tooth or teeth for the impression. The light-bodied material is prepared and loaded into the syringe and transferred to the dentist. The dentist places the light-bodied material over and around the prepared teeth and onto the surrounding tissues. The heavy-bodied material is prepared and loaded into the tray and transferred to the dentist. When the impression material has reached final set, the impression is removed and inspected for accuracy. The impression is disinfected, placed in a biohazard bag, labeled, and readied for the laboratory technician.
without the appearance of elastic properties. The material may be manipulated only during this first stage. Final set The second stage begins with the appearance of elasticity and proceeds through a gradual change to a solid rubberlike mass. The material must be in place in the mouth before the elastic properties of the final set begin to develop. Final cure The last stage occurs from 1 to 24 hours.
Occlusal Registration
An accurate registration of the normal centric
relationship of the maxillary and mandibular arches. Also commonly referred to as the bite registration.