IMPRESSION MATERIALS & PROCEDURES FOR R.P.

D
Presented by Jean Michael Final Year Part 2

INTRODUCTION
An impression is defined as a negative likeness of the teeth and/or edentulous areas where the teeth have been removed, made in a plastic material which becomes relatively hard while in contact with these tissues

CLASSIFICATION OF IMPRESSION MATERIALS

RIGID MATERIALS

Plaster of Paris Metallic Oxide Paste

THERMOPLASTIC MATERIALS

Modeling plastic Impression Waxes & Natural Resins

ELASTIC MATERIALS Reversible Hydrocolloids Irreversible hydrocolloids Mercaptan Rubber-base materials Polyether Impression Material Silicone Impression Materials
Condensation SIM Addition SIM

IRREVERSIBLE HYDROCOLLOIDS
(ALGINATE)

Indicated for diagnostic casts, orthodontic treatment casts & master casts for R.P.D. Can be used in presence of saliva Hydrophilic Pleasant taste and smell Nontoxic, nonstaining & inexpensive

Can be disinfected with 2% Gluteraldehyde Should be stored in 100% moisture & poured within 1 Hour Low tear strength Surface details - less than elastomeric impression materials Dimensional stability less than elastomeric impression materials

POLYSULFIDE IMPRESSION MATERIALS

High tear strength Long working and setting time (8 to 10 minutes) Can be disinfected Cast poured will have smoother texture & will be harder as they do not retard or etch the surface of the setting stone Should have a uniform thickness that does not exceed 3mm

Medium and heavy body should not be used in case of large/multiple undercuts Long term dimensional stability is poor due to water loss after setting Should be held still during the impression making procedure Allow to rebound for 7 to 15 minutes after removal from mouth and pour immediately Unpleasant odor & Stains clothes

POLYETHER IMPRESSION MATERIALS

Good surface details Hydrophilic good wettability for easy cast forming Shorter working and setting time Flow characteristics and flow - lowest among others Stiffness cast breakage of while removal from tray

Unpleasant taste Absorbs water Cannot be immersed in disinfecting solutions Pour within 2 hours for better results

CONDENSATION SILICONES
Moderate working time (5 to 7 minutes) Pleasant odor Good tear strength Excellent recovery from deformation Can be disinfected with disinfecting solutions without any alternation in accuracy Hydrophobic Ideally pored within 1 hour

ADDITION SILICONES
Most accurate among elastic impression materials Low polymerization shrinkage & distortion Fast recovery from distortion Good tear strength Working time 3 to 5 minutes

Both hydrophilic & hydrophobic forms are available Available in automixing devices Pouring can be delayed up to 1 week Stable in sterilizing solutions Sulfur in latex gloves retards the setting reaction

IMPRESSION OF PARTIALLY EDENTULOUS ARCH

Elastic impression materials are used for making impression of partially edentulous arch This is due to the presence of undercuts in the partially edentulous mouth

MATERIALS AVAILABLE FOR MAKING IMPRESSION

Reversible hydrocolloids (agar-agar) Irreversible hydrocolloids (Alginate) Elastomeric impression materials

STEPS IN IMPRESSION MAKING

Position of patient & dentist Tray selection Mixing the material & loading into the tray Impression making & removal Inspecting, cleaning & disinfecting the impression

POSITION OF PATIENT & DENTIST

Dentist should stand & patient should sit upright Occlusal plane should be parallel to the floor MAXILLARY IMPRESSION- dentist should stand at the right rear of the patient MANDIBULAR IMPRESSION- dentist should stand at the right front of the patient

IMPRESSION TRAY SELECTION

Stock trays for dentulous & partially edentulous arches are of 3 types: Rimlock trays Perforated metal trays Plastic disposable trays

CHECKING MAXILLARY TRAY SIZE

There should be a clearance of 5-7mm between the inner flanges of the tray & facial surface of teeth & edentulous ridge Tray should cover the desired anatomic areas Too large a tray may be difficult to insert & may interfere with the coronoid process of mandible

CHECKING MANDIBULAR TRAY SIZE

There should be a clearance of 5-7mm between the tray and tooth surface and ridge If the tray extends too far in the lingually, there is a tendency to trap the tongue or floor of the mouth. Tray is held in the right hand Left thumb & index fingers are used to manipulate the right corner of the mouth

As the right flange of tray is rotated toward mouth, depress the lower lip & stretch the right corner of mouth with the left thumb & index finger

EXTENDING AN IMPRESSION TRAY

Some times impression tray of adequate width may not cover the desired impression area In such cases, the tray is lengthened using modeling wax

MIXING IMPRESSION MATERIAL

LOADING IMPRESSION TRAY

Place impression material in small amounts. Tray should be filled in level with the flanges Overfilling should be avoided

Mandibular Impression Technique

Inject some material over occlusal surface of teeth, into vestibular areas & alveolo-lingual sulcus Then tray is rotated into mouth & is carefully seated The patient is asked to keep the tip of tongue in contact with the upper surface of tray during gelation Maintain the position of tray by placing the forefinger of each hand on top of tray on premolar area & thumb under patients chin

Maxillary Impression Technique

Inject alginate into occlusal surface & vestibular areas & wipe some amount on the palate Tray must be centered & properly aligned & verify the position by looking at the patients face from above It should protrude straight from the center of the mouth. After this, the tray is seated by using fingers of both hands over the premolar areas & stabilize the tray

Removal of Impression From Mouth

Clinically the initial set of alginate is determined by loss of surface tackiness Release seal by retracting lips & cheek Then impression is removed by a sudden jerk

INSPECT THE IMPRESSION FOR DEFECTS

CLEAN & DISINFECT THE IMPRESSION

Preparation Of Custom Tray

Marking the outline on the cast

Wax spacer adaptation

Self Cure Acrylic

Apply self cure acrylic over wax spacer

Attaching the Handle and polishing

Wax spacer scraped and tray perforated

Secondary Impression
Same as that for diagnostic impression. In this procedure paint or inject impression material in critical areas: Rest preparation Hard palate Peripheral extensions

SPECIAL IMPRESSION PROCEDURES

Anatomic and Functional Form of Ridge

Anatomical form of Ridge

The anatomic form is the surface contour of the ridge when it is not supporting an occlusal load

Functional form of Ridge

The functional form of the residual ridge is the surface contour of the ridge when it is supporting a functional load

SPECIAL IMPRESSION PROCEDURES

1. Physiologic or functional impression technique Functional Relining method Mc Leans and Hindels methods Fluid Wax method 2. Selected Pressure technique

Mc LEANS PHYSIOLOGIC IMPRESSION

Procedure A custom impression tray is constructed over a preliminary cast Functional impression of distal extension ridge is made. Patient applies some biting force with occlusion rims Then an Alginate impression is made with the 1st impression held in its functional position with finger pressure

HINDELS MODIFICATION
Main difference of this with Mc Leans is that impression of edentulous ridge is not made under pressure but is an anatomic impression made at rest with ZOE paste. As the hydrocolloid impression was being made finger pressure was applied through holes in the tray to the anatomic impression.

Disadvantages of these methods Constantly compressed residual ridge is prone to excessive bone resorption. If the clasp do not hold the partial denture, the denture will be pushed slightly occlusally by the tissue causing premature contacts (TISSUE REBOUND)

FUNCTIONAL RELINING METHOD

Here a new surface is added into the inner, or tissue side of the denture base The partial denture is made from a cast made from impression made with alginate A space is provided by adapting a metal spacer over the ridge on the cast before processing the denture base. A functional impression of the edentulous area is made using the cast partial denture framework.

The patient must maintain the mouth in a partially opened position Border moulding is carried out. Then a low fusing modeling plastic/green stick compound is allowed to flow over the tissue side of the denture base. It is tempered in water bath & seated in patients mouth.

To provide space for the impression material, modeling plastic is scraped to a depth of 1mm The modeling plastic serves a s a tray material for the secondary impression material The final impression is made with a Zinc Oxide Eugenol impression paste If undercuts are present, light bodied rubber based impression materials can be used

Advantages
The amount of soft tissue displacement is controlled by the amount of relief given to the modeling plastic before final impression is made Greater the relief, the less will be the tissue displacement. Tissue surface of metal frame work can be relined after insertion Disadvantage Since open mouth technique is used it is difficult to maintain the previous occlusal contact

FLUID WAX FUNCTIONAL IMPRESSION

Make an anatomic impression of the arch using alginate Fabricate a refractory cast using this impression Fabricate the partial denture framework over the refractory cast

Draw the outline of the denture base Cast is coated with separating medium Wax Spacer is adapted over the crest of the edentulous ridge

Framework is placed over the spacer Auto-polymerizing resin is mixed to dough stage and is adapted and contoured over the framework along the length of the ridge Borders of the tray are trimmed

Impression Procedure
Wax is softened at 51 to 54 Softened wax is painted on the tissue surface with a brush Wax is painted in excess near the border to record the sulcus Tray is seated and held in position It takes at least 5 minutes for the wax to set

The tray is removed and the impression is examined The wax surface that has contacted soft tissue appears glossy and the other areas that has not contacted the tissues will appear dull The impression should be placed in the mouth finally for 12 minutes

SELECTIVED PRESSURE IMPRESSION

More force are applied to areas that can absorb stress without adverse response & protect that areas that is least able to absorb force Stress bearing areas are the buccal shelf area & the lingual slopes of residual ridge stress bearing areas The denture base made from this impression will be closely adapted to & in firm contact with the tissues in buccal shelf area

Custom Trays

The tissue surface if the tray is trimmed with burs to provide adequate relief

Impression material is loaded on the prepared special tray and inserted into the patients mouth Impression is made with the patient with his mouth open under finger pressure Only the stress bearing areas will be compressed during impression making

Materials used for Secondary Impression

Zinc Oxide Eugenol impression paste Rubber base material

Altering The Master Cast

This procedure is done to obtain a Hybrid Cast which records the edentulous areas in the functional form and the dentulous areas in the anatomic form

Conclusion
An accurate impression is vital for the success of a cast partial denture. So proper selection of material, impression technique and the skill of the dentist plays a key role in the success of the overall treatment.

REFERENCE
Mc Crackens Removable Partial Prosthodontics Clinical Removable Partial Prosthodontics