The most common technique is the putty wash technique

There are essentially three ways of recording a putty-wash impression:

One stage impression putty and wash are recorded simultaneously (also called twin mix or laminate technique) Two stage unspaced putty is recorded first and after setting relined with a thin layer of wash Two stage spaced as for two stage unspaced except a space is created for the wash. This space may be made by: Polythene spacer over the teeth prior to making the putty impression Recording the putty impression before tooth preparation Gouging away the putty and providing escape channels for the wash.

RETRACTION CORD As the margins of crowns are often placed in a juxta-gingival position or slightly apical to the free gingival margin, it is often necessary to obtain a degree of gingival dilation in order to accurately record the finish line of the preparation. It is also helpful to record a small amount of tooth structure apical to the finish line in order to allow the technician to create the correct emergence profile for the restoration. Methods to achieve this include the use of retraction cord, electrosurgery amongst others. Retraction cord physically pushes the gingivae away from the tooth surface for a short time to allow impression material to flow into this area. The retraction cord used at the Hospital is braided to prevent the cord unravelling. An aqueous solution of ferric

sulphate ions may be used to coagulate proteins. The cord is left for 5 minutes before removing. Ensure that the cord is not dry when it is removed as it can tear the delicate tissues.

A single-stage impression will be taken, in which both 'high' and 'low-viscosity' (wash) materials are mixed and allowed to set in the mouth simultaneously. Use the Pentamix machine. Set out all the armamentarium you need before taking the impression. Select the appropriate size of tray (President tray or Poly-tray) and apply the correct adhesive. The adhesive requires several minutes to mature. Pack retraction cord around the preparation once it has been soaked in Astringident Prepare the impression site; make sure the area is dry. The assistant will hand over the wash impression material in the gun with a mixing tip and intra-oral tip attached. When you are prepared and your assistant has started to load the tray with the high viscosity material, inject the low viscosity/wash material into the gingival sulcus of the preparation first. Do not lift the tip of the syringe out of the material whilst injecting or this may trap air bubbles. Then place the low viscosity material over the remainder of the preparation and also on the occlusal surfaces of the other teeth in the arch. The assistant will hand over the high viscosity material in the stock tray, which was being dispensed whilst the wash material was being injected around the impression. The high viscosity material should not be in the palatal aspect of the impression but confined like a sausage to the area of the teeth. Locate the tray onto the model as quickly as possible - the wash material should still be fluid as the tray is seated to ensure good flow of the wash material. Maintain a very light pressure on the tray whilst it is setting. Remove the impression in one clean easy movement. Apply pressure to the material not the tray on removal (removing the tray using the tray handle may cause the impression to be distorted). Inspect the impression for air voids and folds. The impression will need to be dry and viewed under good illumination. Considerable skill is needed to interpret the negative impression of the preparation and a cursory glance may miss a fundamental flaw in the impression resulting in an unsatisfactory die cast from that impression.

Checking your impression:

The following provides you with some general guidelines on checking whether your impression is good enough to send us for fabrication.

1. 2. 3. 4. 5. 6. 7. 8. 9. Dodgy margins?

Uniform homogeneous mix of the impression material Tray adhesive applied thoroughly Rigid and sturdy impression tray No voids or pulls on the margin detail Detailed margins with no tears or rough surfaces No burn-through of heavy bodied material Strong bond between heavy bodied and light bodied materials Strong bond between impression material and tray No tooth contact with tray

Lack of Impression Detail Cause

Blood and/or saliva contamination around the preparation margins.

Solution
Rinse and dry the preparation margins just prior to taking the impression.

Lack of Impression Detail Cause

Inadequate retraction of sulcus around the preparation. Exceeding the working time of the impression material.

Solution
Good retraction technique with proper moisture control and proper tissue retraction. Follow the manufacturers working time specifications.

exposing part of the tray through the impression?

Improper Tray Seating Cause Solution

Prepared teeth contacting the sides or bottom of Avoid contact of teeth with any surface of the impression tray. tray. Test various tray sizes to ensure proper size. Order a fabrication of a custom impression tray from our lab if necessary. Contact of the prepared tooth with the pre-set Relieve the heavy body impression material to tray impression material when using the two-step ensure a 23mm space. impression taking technique. Tray seated too quickly or forcefully. Slowly position tray into patients mouth.

Tray movement or rocking during the impression. Use passive pressure to immobilize the tray for the recommended set time. Weaker plastic trays can allow deflection of the tray which may rebound upon removal. Use a stiffer, more rigid stock tray.

Retraction:
The aim of gingival retraction is to allow access for the impression material beyond the abutment margins and to create space for the impression material to be sufficiently thick.#

Impression with less sulcular width have higher incidences of voids, tearing of impression materials, and reduction in marginal accuracy The advantage of using a cord is that it is inexpensive and can achieve varying degrees of retraction. But, cords can be painful and uncomfortable for the patient. Also the sulcus collapses soon after the removal of the cord. Hemostasis achieved is limited and the placement of the cord in the sulcus takes time.

Visible flaws related to impression technique which occur commonly include:

Finish line not visible Air bubbles in critical places Voids or drags Unset impression material on surface of impression and cast

Invisible impression flaws, resulting in an apparently good fit of the restoration on the die but a poor fit on the tooth, may also occur because of:

Tray and impression recoil (as described for the putty-wash technique) Detachment of impression from tray Permanent deformation

Visible flaws Finish line not visible Because: Gingival inflammation and bleeding: pt needs perio problems resolved first. well contoured provisional restoration placed beforehand. it may be helpful to prescribe an antimicrobial rinse (eg Chlorhexidine gluconate 0.12%) for 2 weeks. Subgingival finish line: use retraction cord. Means of retraction

Retraction cord (plain or impregnated) with or without accompanying solution Two-cord technique (

1.

BDA. Advice sheet A12: Infection Control in Dentistry. pp12 British Dental Association Advisory Service 1996.