Sri Guru Ram Das Institute Of Dental Sciences And Research, Sri Amritsar Deptt.

Of Prosthodontics Seminar Impressions Techniques In Fixed Partial Denture Presented to

Dr. Sarabjit Kaur Dr. Kavipal Singh Dr. Kamleshwar Kaur Dr. Nimish Sethi Dr. Simrat Kaur Dr. Imandeep Singh Dr. Aman Arora Dr. Neelam Suman Dr. Akash Duggal Presented by Ramninder kaur Batch- 2009

Introduction
To obtain an impression is the first step necessary for the indirect fabrication of a prosthesis. An acceptable impression must be an exact negative replica of the prepared tooth . The impression should reproduce the critical area where tooth and restoration meet so that the restoration can be correctly contoured. All teeth or tissues immediately surrounding the prepartion must be reproduced in the impression.

An impression made for Fixed partial denture should meet the following requirements
1. It should be a an exact duplication of the prepared tooth, including all of the preparation and enough uncut tooth surface beyond the preparation to allow the dentist and the technician to be certain of the location and configuration of the finish line. 2. Other teeth and tissue adjacent to the prepared tooth must be accurately reproduced to permit proper articulation of the casts and contouring of the restoration. 3. It must be free of bubbles especially in the area of the finish line and occlusal surfaces of other teeth in the arch.

Impression techniques
1.Stock tray technique double mix single mix 2.Custom tray technique single mix 3.Closed bite double arch technique 4.Copper band technique 5.Reversible hydrocolloid technique

Putty wash Method

Double mix and single mix.
Stock trays can also be used with medium and heavy bodied elastomers normally used with custom trays.

Advantages:
1)Eliminates time and expense of fabricating custom trays. 2) Metal stock trays are rigid and are not susceptible to distortion.

Disadvantages:
1) More impression material is required 2) Metal tray must be sterilized

Technique:
A trays is selected based on shape and size of the patients

arch.
Coat the tray evenly with adhesive on the inside.  Mix the high viscosity putty impression material according

to manufactures instruction.
Roll putty into elongated cylinder. Insert into the stock

impression tray.
Cover putty with the spacer (a sheet of polyethylene) .

Insert and seat the tray with a rocking type of motion. Hold and wait until initial set (approximately 2min). Remove from the mouth with minimal side ward movement Wait and test for final set. When the impression rebound completely. Peel of the spaces. Remove excess impression material with a sharp knife.

Putty placed on the tray

Placing the spacer

Removal of the spacer from the tray

Making the final impression

Mix the low viscosity impression material according to the manufactures instructions . Load the low viscosity impression material on to a syringe . Syringe the inaccessible area first eg disto lingual line angle For the stock tray double mix insert the low viscosity impression material into the tray without overfilling it.

For stock tray single mix technique the unset high viscosity material should already be in the tray and the preparation syringed with low viscosity impression material. Seat the tray . Wait for the final set. Remove the tray parallel to the preparation path of withdrawal. The impression is evaluated for the finish lines and for any distortion and tear.

Putty impression with polyethene spacer sheet and then wash

Scalpel to create space

Final impression

ne stage or one step putty wash impression

(Simultaneous technique / squash technique / twin mix technique) Disadvantage : Difficult to control thickness of wash material Higher viscosity material displaces the wash material Setting distortion of the putty add to over all distortion of impression

Custom Tray Fabrication For Elastomeric Impression

Custom tray is made from autopolymerizing acrylic resin or vacuum formed thermoplastic resin. Tray rigidity is important for even slight flexing of the tray will lead to distorted impressions. Resin thickness of 2 or 3mm is needed to give adequate rigidity. Clearance between the tray and the teeth should be 2 to 3mm however greater clearance is needed for the more rigid polyether material.

Procedure:
1)Mark the border of the tray on the diagnostic cast with a pencil approximately 5mm apically to crest of the free gingiva. 2)Adapt a wax space to the diagnostic cast two layers for 2.5mm thickness approximately. 3)Apply a layer of tinfoil over the wax. 4)Mix autopolymerizing acrylic manufacturers recommendation resin according to

5)Adapt the resin to the cast when in dough stage. 6)After the material has polymerized ,remove it from the cast and trim with an acrylic trimming bur.

Custom tray method

Mixing method-single mix Advantages .
Less impression material is required than stock tray. The tray is used only once so sterilization is not a problem. Less distortion of the impression .

Disadvantages
Construction of the custom tray is time consuming . The tray should age for 24 hours to minimize distortion

Making the final impression.

Medium or high viscosity is used in the tray and low viscosity in

the syringe.
The low viscosity material is mixed first then the high viscosity

material.
The syringe is loaded with the low viscosity material and

syringed in the prepared site.

The high viscosity material is placed in the custom tray and

seated in the mouth.

The impression is removed and evaluated.

Removal of the tray using the wings

Close bite double arch method .

synonyms :dual quad tray, double arch, triple arch, accu bite, closed mouth impression. Requirements
The articulator should provide for a positive stop or there should

be sufficient teeth to maintain the vertical dimension.

There should be sufficient space distal to the terminal tooth in

the arch to allow tray approximation.

Advantages
The physical deformation of the mandible is minimal The shifting of teeth occurring during maximum intercuspation

is captured.
Less impression material is needed. Less gagging may occur.

Disadvantages
The tray is not rigid . Limited to one casting per quadrant . The distribution of impression material is not uniform

Technique
Evaluate the fit of the tray in the patients mouth. Observe the complete bilateral closure and the patients comfort. Practice till the patient is familiar with the task.

Making the final impression

Mix the low viscosity material and load the syringe The high viscosity material is used in the tray.

After the low viscosity material is syringed the tray is

positioned on the arch.

Instruct the patient to close the mouth and observe for the

interdigitation on the opposite arch.

Wait for the material to set . Instruct the patient to open the mouth remove the tray by

applying equal pressure bilaterally.

Evaluate the impression.

Closed mouth impression

Copper band or tube method

The copper band is used to salvage an impression of multiple preparation where there is only vague margins on one or two preparation that are not adequately replicated in the impression.

Fitting of the copper band to preparation

A copper band is selected and annealed by heating on a flame and quenching in alcohol. Mark the finish line with the explorer and round off the edges. Also evaluate the fit and cut orientation hole in top one fifth of the facial surface .

Copper band with orientation holes

Copper band contoured

Evaluating the fit of the copper band

Making the compound plug

The red stick compound is heated over the Bunsen flame . Insert the warm compound mass to fill approximately the top third of the copper band. Seat and orient on to preparation and compress excess in to the band. The compound should just touch the occlusal surface . Remove and evaluate the impression, only the occlusal surface should be impressed. Remove 0.2mm of the compound to create space for the heavy body poly vinyl silicone. Drill a hole through the centre of the compound plug.

Making the impression.

Make 4 to 5 holes evenly distributed above the bottom of the copper tube for the retention of the impression material. Coat the internal surface sparingly with adhesive . Clean and isolate the preparation. Mix heavy viscosity material and inject in to the band and position it on the tooth. Wait the material to set remove the band and inspect the impression

Copper band with the final impression

Reversible hydrocolloid technique

This impression technique requires a special conditioning unit which consists of 3 thermostatically controlled water baths. 1. A liquefaction bath . 2.A storage bath . 3.A tempering bath.

Hydrocolloid conditioner

Rimlock trays with stops

Procedure
Select the correct size of water cooled impression trays. Place small modeling compound or prefabricated stops in the tray to prevent over seating . Fill the impression tray with heavy bodied material from the storage bath and place it in the tempering bath Load the syringe material in the syringe and replace it in the storage bath. Carefully remove the retraction cord and flood the tooth with water.

Inject the syringe material on the tooth cover the entire tooth. Remove the impression tray from the bath wipe with the gauze and place it in the mouth. After seating cold water is circulated through the tray until the impression material is set. Remove the impression with a rapid motion, wash with cold water ,evaluate for accuracy.

Removal of the retraction cord

Injecting hydrocolloid into the sulcus

Final impression in reversible hydrocolloid

HYDROCOLLOID LAMINATE TECHNIQUE ALGINATE AGAR METHOD Suggested by Schwartz in (1951)

Prepared tooth surfaces

Injection of reversible Stock tray with hydrocolloid chilled alginate

Combined alginate agar impression

Master cast

Critical to success bond between agar and alginate Advantages : Satisfactory surface reproduction Good wettability (smooth, dense model) Simple conditioning (no tempering bath / water cooled trays) More economical Disadvantages : The bond between agar and alginate is not sound Higher viscosity alginate displaces agar hydrocolloid

Summary
A good impression is an exact replica of each prepared tooth and should include adequate surfaces adjacent to the margin. Impression technique should be selected on the basis of biologic factor dictated by the anatomy and the physiology of the mouth dictated by the orofacial tissues. Even though there are innumerable techniques and procedure for impression making ,it is the responsibility of the dentist to select the best possible procedure for achieving the best possible result for the patient. amount of the unprepared

REFERENCES

Phillips science of dental materials. 11th edition Rosensteil. Contemporary fixed prosthodontics. 3rd
ed.

Shillinburg H.T. Fundamental of fixed prosthodontics

3rd edition. 7th edition.

Tylmans theory and practice of fixed prosthodontics A clinical evaluation of fixed partial denture
impressions. JPD 2005; 94: 112-7.

An impression technique for cast restorations JPD

1975; 33(4): 417-421.