Impressions in FDP

CLASSIFICATION OF IMPRESSION
MATERIALS

BASED ON SETTING MECHANISM
1. Reversible ( Temperature changes)
2. Irreversible( Chemical changes)

BASED ON MECHANICAL PROPERTIES
1. Rigid ( Edentulous ridge )
2. Elastic ( tooth form )


ELASTIC
IMPRESSION MATERIALS
WHAT IS AN IMPRESSION MATERIAL ?
ANY SUBSTANCE OR COMBINATION OF
SUBSTANCES USED FOR MAKING AN
IMPRESSION OR NEGATIVE
REPRODUCTION ..
ELASTIC IMPRESSION MATERIALS

1. Aqueous irreversible
a) Alginate

2. Aqueous reversible
a) Agar

3. Non aqueous irreversible
a) Polysulfides
b) Polyethers
c) Condensation silicone
d) Addition silicones

HISTORY
These materials were developed
to mimic natural rubber when
there was shortage during
World War II

They are classified as synthetic
rubbers

ADA Specification no. 19

The first synthetic rubberlike
materials were produced by a
process Vulcanization or
curing
Classification of Elastomers based on Viscosity :

a) light body
b) medium body
c) heavy body
d) putty

Addition silicones available in ( Extra-low and
monophase too )
Elastomers
Term rubber and elastomer are scientifically identical
and interchangeable

Rubber generally referred to natural rubber

Elastomer is synthetic

They are a special group of a wider group called
polymers

Made of long flexible chain or string like molecules
The inside of rubber can be imagined as pile of cooked
spaghetti

Each chain of elastomers will be joined occasionally
along its length to one or more nearby chains with few
chemical bridges

Called cross links

Whole structure forms a coherent network which
prevents the chain from sliding past one another

The process by which cross links added vulcanisation


MIXING SYSTEMS
Three systems available :

1) Hand mixing

2) Static automixing

3) Dynamic mechanical mixing
Hand Mixing

Impression paste dispensed from collapsible tubes

Equal length of base and catalyst taken

Initial mixing in circular motion

Final mixing with broad strokes of spatula

Mixing accomplished in 45 seconds

In case of two putty system kneading with fingers is
performed
Kneading with fingers
STATIC AUTOMIXING

Base and catalyst in separate plastic cartridges

Cartridge placed in mixing gun having 2 plungers

The base and catalyst forced through static mixing tip containing
internal spiral

The two components folded over each other many times as they
are pushed through the spiral

Uniform mix obtained
DYNAMIC MECHANICAL MIXING
Catalyst and base supplied in large plastic bags housed in a
cartridge

Inserted on top of mixing machine

Plastic mixing tip ( motor driven ) in front of the machine

Parallel plungers push collapsible bags

Material forced into the mixing tip

Mixing accomplished by rotation and forward motion

Thus higher viscosity material mixed with ease
Problems in hand mixing :
possibility of contamination
more air incorporation
more material wasted
might not be a uniform mix (homogenous)

Vigorous mixing while hand mixing can lead to
incorporation of air

Mixing tips : available with 11 and 13 spirals
the spirals participate in shear thinning of material thus giving us
more working time ..
material mixed with 13 spirals cant be mixed with 11 spirals as the no.
of spirals might not be enough to provide a homogenous mix

In automix after the first ejection of material the tip should be placed in
the material and further material ejected to avoid air incorporation




Automixing and dynamic mixing in comparison to
hand mixing ::
superior physical properties
uniform mix
reduction of voids
avoidance of contamination

During automixing air can get incorporated while
placement of cartridge in the gun .. Incorporating lot
of air before closing it in the gun
( accdg to an article by JUNGNAM et al )
dynamic mixing was given overall preference to
automixing
on the basis of following criteria
ease of mixing
control of loading
quality of mixing
level of cleanliness
contamination

Duration of mixing for dynamic mixing was said to be
slower than automixing
Ideal Requirements
Dimensionally stable
Radioopaque
Tear resistance
Hydrophillic
No reaction by products
Easy to use
Superior colour
No odour
Biocompatible
accurate surface detail reproduction
Maintain accuracy with multiple pours
Optimal working time

Elastic recovery
addition > condensation > polyether > polysulfide


A set impression must be sufficiently elastic so that it will

return to its original dimensions without significant distortion

upon removal from mouth



Flexibility

polysulfide > condensation > addition > polyether


This property of the material aids in easy

removal of the impression from undercuts in

the mouth
Flexibility of the material is related to the
Glass Transition Temperature
( low temperature behaviour )


GTT of different elastomers is different
Eg . Natural rubber it is 70 C
Therefore it means below this temperature the material behaves like
glass and on hammering can break like glass.

GTT is generally a range 10 degrees

At a temperature above GTT the material will be rubbery .
( flexible )

Strictly speaking we should we should only use the term
elastomer to describe a material only if it is above its GTT

HIGH TEMPERATURE BEHAVIOUR
The upper temperature to which the elastomer can be used depends
on its chemical stability

At high temperature the elastomer gets attacked by oxygen

This attack results in a chemical reaction

2 type of reaction
a) degradative breaks cross links makes rubber soft

b) addition of cross links hardens the rubber


Dimensional shrinkage
polysulfide > condensation > polyether > addition


The amount of shrinkage a material undergoes once the
polymerization process is allowed to proceed

Factors which cause dimensional shrinkage :
1) loss of reaction by products
2) polymerization shrinkage
3) thermal contraction

Polysulfides and condensation silicones have highest dimensional
change during setting ( 0.4 0.6 ) %

shrinkage here is due to evaporation of volatile by products and
rearrangement of bonds with polymerization


Addition silicone have a dimensional change of
maximum of 0.15 %

Polyether dimensional change 0.2%

Less in addition silicone and polyether as there are no reaction
by products

Dimensional stability is important if the impression has to be
sent to the lab and impression poured for that time the
material should be dimensionally stable

Dimensional accuracy :-

1) Greatest dimensional accuracy occuring
immediately after polymerization complete

2) But declining as the impression is stored for extended
periods of time

3) pvs and polyether dimensionally stable for
1-2 weeks after taking impression

4) polysulfide accurate if poured within 1-2 hours of making
an impression

Tear strength
polysulfide > polyether > addition = condensation

Tear strength refers to the property of the material to resist
tearing when removed from undercuts

In deep sulcus the impression can tear thus compromising the
accuracy of the impression

While retrieving the cast from the impression the material must
not tear so that repeated pours can be made
Hydrophillicity
Also referred to as Wettability relates to the ability of a
material to flow in small areas

Impression that wet teeth well , displace moisture well create
less voids

If material has high wetting angle it does not flow in small
crevices ( thus not a good material for FPD )

For FPD material must reproduce detail in area of 20-70 m
For RPD 100-150 m of detail reproduction is ok
Hydrocolloids , Polyether , Polysulfides have relatively low
contact angle

PVS requires surfactants to lower contact angle

They are non ionic surfactants , they have a hydrophillic part
which is towards the surface and the silicone compatible
hydrophobic part which is towards the material

Silicones are intrinsically hydrophobic surfactant ( surface
active additive )

When impression material with surfactant comes in contact with
moisture surfactant has to migrate to surface .

This prevents hydrophillicity to fully develop at very first contact
with moisture
Polyether is intrinsically hydrophillic from the time its
mixed until it sets it is characterised by its tendency to favour
moist surfaces

It captures accurate impressions in presence of saliva and blood

Hydrophillicity is needed when syringing the material and seating
the tray

New surface of material generated as it contacts the saliva

This is the point when hydrophillicity is needed for clinical
success


Hydrophillicity of polyether and polysulfide is due to the
functional group that attract and interacts with water molecules
via hydrogen bond

Hydrophillic group
1) polyether : C=O ( carbonyl )
C-O-C ( ether )
2) polysulfide : S-S ( disulfide )
S-H ( mercapton )

Silicone is hydrophobic because of the hydrophobic
aliphatic hydrocarbon group around siloxane bond
POLYSULFIDE
First elastomeric impression material introduced in
1950

Supplied in 2 pastes ( Base and Accelerator )

Available in 3 consistencies ( low,medium, heavy body )

COMPOSITION
BASE :

Polysulfide polymer
Titanium dioxide ( filler )
Dibutyl Pthalate ( plasticizer )
Sulfur (to enhance the reaction)

CATALYST:

Lead dioxide ( to react with polysufide)
Dibutyl Pthalate ( plasticizer )
Titanium dioxide ( filler )
Oleic / Stearic Acid ( retarders )
Impression should be poured within 30 min following removal
from mouth ( because in 1
st
hour the material undergoes 50%
of the 24 hr shrinkage

Refrigeration prolongs shelf ( but the material must not be
immediately used as the condensed water on it will shorten its
working time

Water is not only the by product but also the catalyst

Storage under warm condition shortens shelf life

Custom tray made must not be used on the same day as it
undergoes 90% polymerization shrinkage during 1
st
8- 10 hours

Problems
During setting polymer contracts during cross linking

Loss of by product ( water ) on evaporation

The impression may imbibe water

Incomplete recovery of deformation

Bad odour

Second pour less accurate
Points to remember !!!!!!!!
Temp working time and vice versa



Altering base : accelerator ratio can help but

a) affect mechanical property

b) not economical (as some paste is not used)



Disinfection using 10% soln. of sodium hypochlorite for 10

min . Prolonged immersion can produce minimal distortion

Minimize the amount of material for making
impression


Use tray adhesive ( eg . For Polysulfides -- butyl
rubber / styrene acrylonitrile ) with suitable solvent
chloroform / ketone


Heavy body material better dimensional stability as it
has lower concentration of reactive groups thus
producing fewer by-products


Condensation Silicone
Introduced in the year 1955

Supplied as:
a) Two paste
b) Paste liquid catalyst system

Available in 2 consistencies
( low and putty )

Putty developed to overcome large polymerisation shrinkage

Also called room temperature vulcanization silicone

Composition
Base paste :
a) hydroxyl terminated polydimethyl siloxane
b) ortho alkyl silicate ( cross linking agent )
c) silica ( inorganic fillers )

Catalyst paste or liquid
a) stannous octate ( catalyst )
b) ortho alkyl silicate ( cross linking agent )
c) thickening agent ( in case its a paste )
Points to Remember
Biologically inert

Not radiopaque

Putty wash technique of impression making applied

Setting shrinkage because of loss of volatile by product

Thus cast to be poured within 30 min of making an impression

Hydrophobic thus requires dry field difficult to pour stone


Addition Silicone
Introduced in the year 1975

Also called vinyl siloxane or
vinyl polysiloxane

Supplied as two paste system and
putty in jars





Available in 5 consistencies
(ultra low , low , medium , high, putty and monophase )

Traditionally hydrophobic

Surfactant added to make it hydrophillic
Composition
BASE:
a) polymethyl hydrogen siloxane
b) filler

CATALYST:
a) divinyl polydimethyl siloxane
b) filler
c) chlorplatinic acid (accelerator)
Points to remember !!!!!!
The polymerisation reaction has no by products

No impurities

If proportions out of balance then hydrogen gas is formed as by
product

It can leave pin point voids on the stone casts if poured
immediately




Palladium or platinum added to scavange the hydrogen gas

Surfactants added allow the material to wet soft
tissues better

Surfactant used is polyether carbosilane

Still they are relatively hydrophobic

Monophase materials are the current trend (one mix of the
material is used for both syringe and tray)



Fast setting and regular setting materials available ( no diff in
properties )

Multiple casts can be poured with same accuracy

Biocompatible

After polysulfide or polyether has been used avoid using pvs
material as the two materials leave a chemical film in the mouth
that inhibits the setting of pvs






The polymerization reaction requires a platinum catalyst

Sulfur or sulfur compounds eg. From latex gloves , rubber dam
can interfere with the platinum catalyst thus affecting the
polymerization reaction

This causes the surface of the impression to remain tacky as the
polymerization is not complete

Preparation and adjacent soft tissues can be cleaned with 2%
chlorhexidine solution to remove contaminants


Putty reline technique used

putty impression serves as the custom tray

Stops used on trays to prevent pushing through wash
material when putty seated

Dimensional stability of monophase better than
polysulfides and condensation

Wash impression
Final Impression

Disinfection done by a) 10% hypochlorite b) 2%
gluteraldehyde ( immersion not greater
than 10 15 min . ) as the surfactant might leach out and make
the material hydrophobic

Hydrophobic materials have water contact angle of 95 degrees
hydrophillic 30-35 degrees

Dilute soln of soap is active surfactant

Can be poured even 1 week after impression

Polyether
Introduced in Germany 1960

This was the first material developed primarily to
function as an impression material

Available in ( low , medium , high ) consistencies

Supplied as 2 pastes

Composition
BASE :
a) low molecular wt. polyether with
ethylene imine terminal group
b) colloidal silica ( filler )
c) glycoether or pthalate(plasticizer)

CATALYST :
a) alkyl aromatic sulfate ( initiator )
b) filler
c) plastcizer
Points to remember !!!!!!
Material is radiolucent

No reaction by product

Can be poured immediately , after several hours , after several
days too

Multiple pours accurate

Material has tendency to absorb water or fluid and leach out
water soluble plasticizer ,thus the stored impression must be
placed in a cool dry place




The only accurate impression material that sets faster than
polyether agar

Both stock and custom trays can be used

Disinfection immersion in 2% gluteraldehyde for 10 min ,
chlorine compounds or iodophors

Bitter taste objectionable to some patients

High stiffness after setting
Rigid , does not tear easily

Enables the dentist to get good subgingival detail without tearing
impression on removal

Material adheres to itself : thus used in correctable impression
techniques ( border moulding )

Improved polyether : ( soft polyether , easy to remove ,
maintains rigidity for wide range of aplications can capture fine
detail in moist conditions )


Snap set behaviour is seen : does not allow material to
start setting before working time ends

When it does set it does so immediately

Since they are hydrophillic care to be taken while
disinfecting to prevent swelling

Spray with disinfectant for 10 min , rinse and dry
immediately before pouring cast

Setting not contaminated by latex gloves

Rigidity of the material makes it the material of
choice for taking impressions for implants


It keeps the tray from distorting in case of
crown and bridges avoid using polyether
because of its rigidity . To avoid pulling out
of restoration

Visible Light-curing Elastomeric Impression
Material
Based on Polyether urethane dimethacrylate

Visible light cure photoinitiators and activators used

Single component system

Syringe contains light body material

Tubes contain tray material

Transparent tray used




Problems
Ability to set completely against wet field

Cross-linked material stiff

Direct the light to all areas of the mouth so that
material cures completely
New Advancement !!!
Colour changing elastomer !!!

Zhermack patented product

Technology used chromatime technology

Colour change indicates impression is entering setting
stage

Colour changes from green to yellow of the wash
impression

Indicates the end of working time in the mouth


Impression Techniques
Copper tube or band technique

Impression making with hydrocolloid

Two impressions are made
a section (quadrant) impression for die
a full-arch impression for working cast
adequate anaesthesia checked. If the impression is
being made at a separate appointment - anaesthetise the
area again.
Tray selection done


Laminate Technique

Combination of Agar and Alginate Impression Materials
The tray hydrocolloid is replaced with a mix of chilled
alginate, that bonds with syringe agar


Gelation
The alginate gels by chemical reaction
Agar - contact with cool alginate

Advantages
Less preparation time
Less complicated when compared to the wet field technique

Disadvantages
Bond between agar and alginate is not strong
High viscosity alginate displaces agar during seating
Dimensional inaccuracy of alginate limits the use to single
units

ELASTOMERIC IMPRESSION MATERIALS

Techniques

Monophase technique
Simultaneous putty/wash technique
Two step putty/ wash technique
Double viscosity double bite technique
Laminar technique
Matrix impression technique


Tray Adhesive


Tray adhesives are specific for each material

Two types
1) paint on
2) spray on

Tray adhesives provide a bond between impression material and the tray

two coats of the tray adhesive has to be applied and wait for 5 10 min.. For it to
dry otherwise the adhesive will interfere with the polymerization reaction

Tray adhesive if not applied can affect dimensional stability as there might be a
debonding of tray with the material thus displacing the impression .



( JPD 2005 ; 94 : 209-213 )

paint on adhesives better than spray on adhesives and adhesives
recommended by manufacturers ..

spray on probably produced a thinner coat ..

the tray adhesive probably was a weaker link as compared to the tear strength
of the material caused the failure at tray impression , adhesive- impression
interface . Causing dimensional instability

The base of the tray adhesive in silicone elastomers may contain a reactive
silicone eg . Poly dimethyl siloxane and ethyl silicate the latter producing a
physical bond with impression tray resin
New development !!!!!!
Unique advancement in impression trays:

The Directed Flow Impression Tray. This new, single-use tray eliminates
the need for a tray adhesive, simplifying both preliminary and final
impressions

The Directed Flow impression tray includes :

1) A self-retentive fleece strip designed to hold the impression material
securely in the tray (eliminating any need for a tray adhesive.)

2) This means fewer handling steps.

3) Saving an estimated five minutes per procedure . No more unpleasant
odor or mess from a tray adhesive.


In addition, the retentive fleece features striations that
act as a barrier to avoid tooth/tray contact and occlusal
flat-spots for better impression results


Impression Techniques

MULTIPLE MIX TECHNIQUE :

1. Two separate mixtures required

2. Light and heavy body mixed simultaneously (by different person )

3. Tray filled with heavy body (uniform thickness)

4. Syringe loaded with light body
5. Light body injected in the mouth within and around tooth preparation

6 Tray is then inserted in the patients mouth and seated over syringe material

7. The two materials should bond together on setting

8. The heavy body will force the light body to adapt to the prepared areas
ensuring accurate detail

PUTTY WASH TECHNIQUE
1. This was developed for condensation silicone to minimize the
effect of polymerization shrinkage

2. Nowadays manufacturers of addition silicone also make putty
material for this technique


A. TWO STAGE PUTTY WASH TECHNIQUE

1. Thick putty is placed in a stock tray and a preliminary
impression is made

2. This is like a custom tray
Putty-wash or reline technique
3. Now some space is created for the wash material

4. This is done by cutting away some of the tray putty

5. Space can also be created by placing polyethylene
sheet as a spacer between the putty and the prepared
teeth

6. A mix of thin wash material is placed in the putty tray
and seated in the mouth for the final impression


B. SINGLE STAGE TECHNIQUE

1. Light body wash material is syringed into place

2. Now unset putty is seated over it

3. The putty may displace light body and push through

4. To avoid this occlusal stops should be used in the tray



Simultaneous Putty/Wash Technique



Apply thin layer of adhesive unless mechanical
retention is assured
Mix equal amounts of putty base and putty catalyst
until streak free.
At the same time the assistant mixes the light body
Choose a spatula large enough to pick up the mixed
impression material
But pliable enough to mix the material against the pad.

First use a circular motion combining the two strands
Then use figure eight motion to blend and flatten on
the mixing pad.
Roll putty into an elongated cylinder.
Insert into the stock impression tray.
By the time assistant finishes mixing the light body
material the unset putty material should already be on
the tray.
Load the syringe with wash material.
Syringe wash material around the preparations & on the
occlusal surface of the teeth in impression.
Make a large dimple in the putty in the area of
preparation so all margins are covered with wash
material.
Fill the dimple with wash impression material.
Slowly seat the filled tray and immobilize until set.



Heavy & Light Body Using Double Mixing
Techniques

A stock tray is usually selected, coated with adhesive.
Gingival retraction is done
Putty base and catalyst are kneaded together until a homogeneous
mix is attained.
Load putty into tray
Cover surface with polyethylene sheet to act as spacer
Place the loaded tray in mouth with a rocking motion to eliminate
undercuts
Wait till initial set.( 2 min)



Then check clinically by a fingernail rebounding.
Remove the impression.
The spacer is removed, excess material & if more space is required
still more material is removed by a knife or acrylic bur & the tray
set aside.
Carefully remove retraction cord.
Mix wash material & inject around preparations & occlusal surface
of teeth using a syringe
Load remaining material in preliminary putty impression
Slowly but firmly seat tray over the teeth to take the final
impression




Closed Bite Double Arch Method
also called Dual quad tray, double arch, triple arch, &
closed mouth impression
Advantages

1.Physical deformation of the impression by the
mandible during opening is minimized.
2. Seating of teeth during maximum intercuspation is
captured.
3. Less material is needed & patient is more
comfortable.
4. Less gagging.

Disadvantages

1.Tray is not rigid- depends on the impression material
rigidity.
2. Not a functionally generated technique so limited to
one casting per quadrant.
3. Distribution of material is not uniform.



Types of Dual Arch Trays
Metal
Plastic
Both with or without side walls.
Depending on the Location
Posterior\anterior sextant
Quadrant
3/4 of an arch
Full arch.

Technique:

Evaluate fit of the tray by checking the distal cross bar
extent
Check for bilateral closure & patient comfort.
Gingival retraction is done.
Load one dispensing gun with lighter body
Light body is injected around the prepared tooth (an intra
oral tip can be attached directly to the mixing tip)

Putty is inserted on both sides of the tray and the patient
is asked to bite in centric occlusion.
After waiting for the set (2 mts), the patient is asked to
open the mouth
The tray adheres to one arch.
After placing fingers on either side of the tray it is
removed with equal pressure bilaterally to minimize the
distortion.
The handle should not be used for removal of the tray
The impression is then washed & checked.



Laminar Technique

Load the dispensing gun with heavy body
A preoperative impression is made.
Impression of the tooth to be prepared is relieved to a
depth of 0.5mm in the cervical area.
Two holes are drilled from the buccal surface, one on the
mesial and one on the distal.
The tray is reinserted
Low viscosity impression material is injected through the
mesial hole and the excess will flow through the distal
hole.


MONOPHASE VISCOSITY
TECHNIQUE




Used with medium viscosity of polyether

Only a single mix is made ( Part placed in tray and
another part used as a syringe material

Success lies in the pseudoplasticity of these two materials



Monophase Technique


Apply thin layer of tray adhesive until mechanical
retention is assured.
Allow it to dry for 5 min.
Load dispensing gun with monophase cartridge
Load the tray with monophase bodied material
Attach intra oral tip to the mixing tip
Syringe wash material around clean dry preparations &
occlusal surface of other teeth
Slowly seat the loaded tray & immobilize until set.


Monophase (polyether)

Tray and Syringe Impression made
material

Matrix Impression System

Mounted fast cut stone is used to relieve internal walls of each
preparation 0.25 to 0.50 mm
Trimming of the matrix is thus complete
The internal incisal / occlusal aspect of the matrix should not be
trimmed
All external aspects of the matrix should be abraded

Features of the refined Matrix
Making The Impression
Placement of refined matrix on the prepared teeth
Selection of stock tray
Matrix filled with low viscosity impression material
Making The Impression
Removal of retraction cords
Syringe material dispensed around the
prepared teeth
The filled matrix is seated on the
prepared teeth with vertically directed
force
Removal of polymerized matrix
impression

Advantages

1.Effective retraction of gingival tissue
2.Effective Hemostasis
3.Effective method of sulcular cleansing
4.Effectively controls the forces that act on gingiva & holds
the sulcus open.
5.Forms optimal flange configuration
6.Overcomes the defect of older systems
7.Delivers impression material into the sulcus with speed &
gentleness but with accuracy.
8.Allows segmentation of complex impression
9.Delivers full arch impression.
10.Renders FPD impression to be a much predictable
sample

1.Incomplete seating of crowns
2.Distortion due to elastic properties of impression materials
3.Delamination due to non bonding of materials
Disadvantages
Types of Failure Causes
Rough or uneven surface on
impression
Incomplete polymerisation
Too rapid polymerisation
Excessively high accelerator / base ratio
Bubbles Too rapid polymerisation
Air incorporated during mixing
Irregularly shaped voids Moisture or debris on surface of teeth

Rough or chalky stone cast
Inadequate cleaning of impression
Excess water left on surface of the impression
Premature removal of cast
Improper manipulation of stone
Distortion Resin tray not aged sufficiently , still undergoing
polymerization shrinkage
Lack of adhesion of rubber to tray
Development of elastic properties before tray is
seated.
Excess bulk of material
Insufficient relief for reline material
Movement of tray during polymerisation
Premature removal from mouth
Rebound of Putty Void due to Improper
Mixing of Material



Distortion due to excessive pressure applied after material
has developed initial elasticity
Thank You