Clinical Update

Vol. 31, No. 2

Naval Postgraduate Dental School National Naval Medical Center Bethesda, Maryland

2009

Impression techniques for fixed prosthetics Lieutenant Erin K. Zizak, DC, USN and Captain Crai !. Neitzke, DC, USN
Introduction "ro#t$odonti%# &o%u#e# on t$e re#toration o& &or' and &un%tion o& t$e #to'ato nat$i% #(#te'. Due to t$e %on&ined #pa%e )it$in t$e oral %a*it( and t$e 'aterial# u#ed, it i# ne%e##ar( to &a+ri%ate re#toration# t$rou $ indire%t te%$ni,ue#. -$en u#in an indire%t te%$ni,ue, 'akin a ood i'pre##ion i# a ke( #tep in t$e produ%tion o& a ,ualit( &i.ed re#toration. /t i# i'portant to #ele%t t$e appropriate i'pre##ion 'aterial and te%$ni,ue &or ea%$ %lini%al #ituation. 0$i# %lini%al update )ill di#%u## i'pre##ion te%$ni,ue# utilizin pol(*in(l #ilo.ane 1"VS2 i'pre##ion 'aterial#. /'pre##ion te%$ni,ue# de#%ri+ed in t$e literature in%lude *ariation on +ot$ t$e dual and #in le ar%$ te%$ni,ue#. Dual arch impression techniques 0$e dual ar%$ i'pre##ion te%$ni,ue )a# &ir#t de#%ri+ed +( -il#on and -errin in 1933. 1 4d*anta e# o& t$e te%$ni,ue in%lude5 le## ti'e and 'aterial re,uired, +uilt6in intero%%lu#al re%ord, and patient %o'&ort. Dual ar%$ i'pre##ion# are indi%ated )$en t$e patient $a# an inta%t dentition, %la## / o%%lu#ion, %anine uidan%e and a #ta+le !/ po#ition. 0$e( %an +e 'ade &or #in le %ro)n#, onla(# or intra%oronal inla(#, a##u'in t$at t$e re#toration i# not on t$e 'o#t di#tal toot$ in t$e ar%$. 2 !an( tra(# are a*aila+le &or u#e )it$ t$i# te%$ni,ue. 0$e( in%lude5 pla#ti%, 'etal, )it$ )all#, )it$out )all# and %u#to' #$ape# &or #pe%i&i% lo%ation# in t$e ar%$. !aterial# utilized in 'akin t$e i'pre##ion in%lude lo), 'ediu', $ea*( +od(, putt( and +ite re i#tration "VS. 0$ere are %on&li%tin opinion# %on%ernin t$e a%%ura%( o& t$e di&&erent %o'+ination#7 $o)e*er, t$ere i# eneral %on#en#u# t$at a 'ore ri id tra( )ill produ%e a 'ore a%%urate i'pre##ion &or #in le re#toration#. Error# en%ountered in a )ell6'ade i'pre##ion )it$ proper te%$ni,ue %an 'o#t likel( +e %o'pen#ated &or )$en t)o %oat# o& die #pa%er are u#ed +e&ore &a+ri%ation o& t$e re#toration. 3 8ne6#tep te%$ni,ue5 0$e one6#tep te%$ni,ue u#in a dual ar%$ i'pre##ion tra( re,uire# t$at a lo) *i#%o#it( i'pre##ion 'aterial +e in9e%ted around t$e teet$ )$ile t$e tra( i# loaded )it$ a +ite re i#tration or $ea*(6+od( "VS 'aterial. 4 depre##ion i# 'ade in t$e tra( 'aterial and &illed )it$ lo)6*i#%o#it( i'pre##ion 'aterial to redu%e +urn6t$rou $ o& tra( 'aterial. 0$e patient t$en %lo#e# do)n into !/. 0)o6#tep te%$ni,ue#5 0$e t)o6#tep te%$ni,ue %an +e +roken do)n into t)o #u+%ate orie#5 Hydraulic pressure technique 5 /n t$i# te%$ni,ue, an i'pre##ion o& t$e ,uadrant prior to toot$ preparation or )it$ t$e pro*i#ional in pla%e a%t# a# a $i $l( a%%urate %u#to' tra(. Con&ir' t$at t$ere are no inter&eren%e# in re#eatin t$e tra(. /'pre##ion 'aterial i# in9e%ted around t$e toot$ and into t$e preoperati*e i'pre##ion. 0$e patient i# t$en in#tru%ted to %lo#e do)n into !/. : Laminar impression technique: /n t$i# *er#ion o& t$e t)o6#tep te%$ni,ue, $ole# are drilled into t$e &a%ial, 'e#ial and di#tal a#pe%t# o& t$e pre6operati*e i'pre##ion o& t$e toot$ to +e re#tored. .; '' #$ould +e re'o*ed around t$e anti%ipated 'ar in area to allo) &or +ulk o& ne) i'pre##ion 'aterial. 0$e i'pre##ion i# t$en re6in#erted into t$e 'out$. /'pre##ion 'aterial i# in9e%ted into t$e &a%ial $ole, )it$ t$e t)o re'ainin $ole# allo)in &or t$e e#%ape o& e.%e## 'aterial. 0$i# te%$ni,ue i# a ood %$oi%e &or lo%ation# t$at are di&&i%ult to i#olate. ; 0$e dual ar%$ te%$ni,ue# $a*e t$eir ad*anta e#, +ut t$e( are al#o *er( te%$ni,ue #en#iti*e. Spe%ial %are 'u#t +e taken to en#ure t$at t$e &inal produ%t i# a%%urate. <,= Make sure the tray fits . Sele%t a tra( t$at )ill )i le )$en t$e patient i# %lo#ed in !/. /& t$ere i# re#i#tan%e, 'odi&( t$e tra( +( rindin a)a( t$e inter&eren%e. 0$e 'e#$ %an al#o +e %ut in t$e area o& i'pin e'ent to allo) t$e tra( )all# to &le. a)a( &ro' t$e inter&eren%e. Check for distortion 5 0$e i'pre##ion #ur&a%e #$ould +e %o'pletel( %o*ered )it$ "VS. /& t$e tra( +urn# t$rou $, t$e tra( i# di#torted durin t$e i'pre##ion pro%e## +( &le.in a ain#t a re#i#tant o+9e%t. 0$e i'pre##ion o& t$e preparation #$ould +e %aptured in a #in le *i#%o#it( o& i'pre##ion 'aterial. /& t$e lo)6*i#%o#it( 'aterial i# di#pla%ed, di#tortion )ill o%%ur at t$e inter&a%e o& t$e t)o 'aterial# on t$e preparation. How far forward should the impression extend: 0$e uidan%e o& t$e patient #$ould +e %aptured in t$e e.tent o& t$e i'pre##ion. >or e.a'ple, an i'pre##ion o& a patient )it$ 'utuall( prote%ted o%%lu#ion 'u#t e.tend to in%lude t$e %anine. Confirm that the patient is closed in MI: /n #o'e %a#e#, t$e pre#en%e o& t$e i'pre##ion 'aterial )ill %au#e t$e patient to %lo#e in an altered po#ition. 0$ere are t)o te%$ni,ue# t$at are de#%ri+ed in t$e literature to %on&ir' !/. >ir#t, lo%ate a %onta%t on t$e %ontralateral #ide t$at $old# #$i' #to%k. 0$e #a'e %onta%t #$ould #till $old t$e #$i' #to%k )$en t$e i'pre##ion i# in pla%e. 0$e #e%ond te%$ni,ue in*ol*e# t$e &a+ri%ation o& a uidan%e 9i &or t$e %ontralateral #ide 'ade out o& a%r(li%. /& patient %annot %lo#e relia+l( into !/ )it$ t$e tra( in t$e 'out$, a #in le ar%$ te%$ni,ue #$ould +e u#ed. = Complete arch impression techniques

Se*eral te%$ni,ue# are a*aila+le &or 'akin a &ull ar%$ &inal i'pre##ion. 8ne #tep te%$ni,ue#5 8ne6#tep te%$ni,ue# in*ol*e t$e appli%ation o& 'ultiple *i#%o#itie# o& "VS at t$e #a'e ti'e. 0$i# i# nor'all( done )it$ a $ea*( +od( or putt( 'aterial pla%ed in t$e tra( and a li $t or 'ediu' +od( "VS in9e%ted around t$e toot$ preparation. /t i# i'portant t$at t$e 'ar in o& t$e preparation +e &ull( %aptured )it$ t$e li $t or 'ediu'6+od( i'pre##ion 'aterial. 0)o6#tep te%$ni,ue#5 0$e t)o6#tep te%$ni,ue i# de#%ri+ed in t)o %ate orie#5 t)o6 #tep putt(6)a#$ te%$ni,ue and t)o6#tep putt(6)a#$ te%$ni,ue )it$ a pol(et$(lene #pa%er. 4 preli'inar( i'pre##ion i# 'ade )it$ "VS putt( prior to toot$ preparation or )it$ pro*i#ional re#toration# in pla%e. Eit$er a #to%k tra( or %u#to' tra( %an +e u#ed. 4 pol(et$(lene #$eet %an +e pla%ed +et)een t$e putt( and t$e dentition to pre*ent %lo#e adaptation. /n t$e #e%ond #tep o& t$e pro%edure, li $t +od( i'pre##ion 'aterial i# in9e%ted around t$e toot$ and pla%ed in t$e pre6'ade i'pre##ion +e&ore #eatin . 0$ere i# %on%ern a+out t$e e&&e%t# o& t$e#e te%$ni,ue# on t$e a%%ura%( o& t$e )orkin die. 0$e %riti%al &a%tor t$at in&luen%e# t$e a%%ura%( o& t$e t)o6#tep putt( te%$ni,ue i# t$e %ontrol o& t$e )a#$ +ulk. 0$i# %ontrol i# not pre#ent in t$e one6#tep or t$e t)o6#tep )it$ pol(et$(lene #$eet. /t i# ideal to $a*e a #tandardized t$i%kne## o& 'aterial around t$e preparation i'pre##ion. 3 0$e t)o6#tep putt( )a#$ te%$ni,ue )it$out t$e pol(et$(lene #$eet )a# &ound to +e 'ore a%%urate t$an t$e one6#tep te%$ni,ue and t$e pol(et$(lene putt( )a#$ te%$ni,ue )$en e*aluatin &ull ar%$ i'pre##ion#.3 Sin le toot$ i'pre##ion# )it$ &ull ar%$ pi%k6up i'pre##ion5 Di'a#$kie$ de#%ri+ed a 'et$od t$at u#e# a pre&or'ed pol(%ar+onate pro*i#ional #$ell or alu'inu' %ro)n to 'ake t$e #in le toot$ i'pre##ion t$at i# t$en pi%ked up in a &ull ar%$ i'pre##ion. ?in i*al di#pla%e'ent i# a%%o'pli#$ed +( $a*in t$e #$ell &it loo#el( pa#t t$e &ini#$ line, a*oidin t$e need &or di#pla%e'ent %ord, $e'o#tati% a ent# or ele%tro#ur e. /t i# #u e#ted t$at t$e $(dro#tati% pre##ure o& t$e 'aterial )ill di#pla%e and air or &luid )ill %onta%t t$e toot$. 4d$e#i*e 'u#t +e pla%ed on t$e internal and e.ternal #ur&a%e# o& t$e pol(%ar+o.(late %ro)n. 0$i# te%$ni,ue i# #u e#ted &or i'pre##ion# t$at )ill in*ol*e 'ultiple a+ut'ent#. 9 !atri. te%$ni,ue5 4 'atri. o& o%%lu#al re i#tration 'aterial i# 'ade o*er t$e toot$ preparation#. 0$e 'atri. i# tri''ed, retra%tion %ord i# pla%ed, and an i'pre##ion o& t$e preparation# i# 'ade in t$e 'atri. )it$ a $i $6*i#%o#it( i'pre##ion 'aterial. 4 #to%k tra( i# t$en &illed )it$ 'ediu'6*i#%o#it( i'pre##ion 'aterial and #eated o*er t$e 'atri. and re'ainin teet$ to produ%e t$e &ull ar%$ i'pre##ion. 10 Summary -it$ all o& t$e te%$ni,ue# a*aila+le, )$i%$ te%$ni,ue i# t$e +e#t@ 0$e an#)er i#5 /t depend#. 0$ere i# %on&li%tin re#ear%$ %on%ernin t$e %o'parati*e a%%ura%( o& t$e i'pre##ion te%$ni,ue# de#%ri+ed. /n eneral, t$e dual6ar%$ te%$ni,ue# $a*e +een &ound to +e a# a%%urate i& not 'ore a%%urate t$an t$e #in le ar%$ te%$ni,ue# )$en u#ed in li'ited %lini%al #ituation#.11,12 Sin le6ar%$ i'pre##ion# are *er( *er#atile, and %an +e applied in an( #ituation. /& a #in le6ar%$ i'pre##ion

te%$ni,ue i# %$o#en, #pe%ial %are #$ould +e taken )$en &a+ri%atin and arti%ulatin t$e oppo#in %a#t. A0$e 'o#t %o''on pro+le' )it$ $i $ o%%lu#ion u#in a &ull6ar%$ i'pre##ion )a# t$e ina%%urate oppo#in %a#t#...B 13 /t i# i'portant t$at t$e denti#t &ind a te%$ni,ue t$at )ork# %on#i#tentl( in t$eir $and#, and +e a+le to adapt )$en a %lini%al #ituation )arrant# a di&&erent approa%$. References 1. -il#on E?, -errin SC Dou+le ar%$ i'pre##ion &or #i'pli&ied re#torati*e denti#tr(. D "ro#t$et Dent. 1933 >e+7:912251936202. 2. 0u%ker CV, !i(a D!. Con#er*ati*e %a#t old re#toration#5 0$e 0u%ker te%$. /n5 Su''itt5 D.E, Co++in# D-, S%$)artz CS, Do# Santo# D, ed# >unda'ental# o& 8perati*e Denti#tr( 2 nd ed. Carol Strea', ///.5 Fuinte##en%e7 20015;2<6:;. 3. Ce($an D4, Do$n#on ?G, Lepe H, 0$e e&&e%t o& tra( #ele%tion, *i#%o#it( o& i'pre##ion 'aterial, and #e,uen%e o& pour on t$e a%%ura%( o& die# 'ade &ro' dual6ar%$ i'pre##ion#. D "ro#t$et Dent. 2003 4u 79012251:369. :. "en#ler 4V. Sen#e and non#en#e a+out i'pre##ion 'aterial# 1//2. 0$e i'pre##ion te%$ni,ue# 1%o'+ined +ite and patient +ite2. Fuinte##en%e /nt Dent Di . 19=3 De%79112251=62:. ;. S%$oenro%k ?4. 0$e la'inar i'pre##ion te%$ni,ue. D "ro#t$et Dent. 1939 8%t7<21:253926;. <. /'+er( 0. Si'pli&(in dual ar%$ i'pre##ion#. D 4' Dent 4##o%. 1993 No*7129111251;996<00. =. Kaplo)itz ?D. 0rou+le6#$ootin dual ar%$ i'pre##ion //. D 4' Dent 4##o%. 199= Sep7123192512==631. 3. Ni##an D, Lau&er EZ, Ero#$ 0, 4##i& D. 4%%ura%( o& t$ree pol(*in(l #ilo.ane putt(6)a#$ i'pre##ion te%$ni,ue#. D "ro#t$et Dent. 2000 >e+73312251<16;. 9. Di'a#$kie$ !C, !or ano S!. 4 pro%edure &or 'akin &i.ed pro#t$odonti% i'pre##ion# )it$ t$e u#e o& pre&or'ed %ro)n #$ell#. D "ro#t$et Dent . 199; Dan7=311259;6<. 10. Li*aditi# ?D. Co'pari#on o& t$e ne) 'atri. #(#te' )it$ traditional &i.ed pro#t$odonti% i'pre##ion pro%edure#. D "ro#t$et Dent. 1993 >e+7=912252006=. 11. Da*i# CD, S%$)artz CS. Dual6ar%$ and %u#to' i'pre##ion a%%ura%(. 4' D Dent. 1991 4pr7:122539692. 12. Ce($an D4, Do$n#on ?G, Lepe H, "$illip# K!. 4 %lini%al #tud( %o'parin t$e t$ree6di'en#ional a%%ura%( o& a )orkin die enerated &ro' t)o dual6ar%$ tra(# and a %o'plete6ar%$ %u#to' tra(. D "ro#t$et Dent . 2003 Sep790132522363:. 13. C$ri#ten#en ?D. !akin &i.ed pro#t$e#e# t$at are not too $i $. D 4' Dent 4##o%. 200< Dan713=11259<63. Lieutenant Zizak i# a 2003 pro#t$odonti% raduate at t$e Na*al "o#t raduate Dental S%$ool. Captain Neitzke i# t$e C$air o& t$e "ro#t$odonti% Depart'ent at t$e Na*al "o#t raduate Dental S%$ool. 0$e *ie)# e.pre##ed in t$i# arti%le are t$o#e o& t$e aut$or# and do not ne%e##aril( re&le%t t$e o&&i%ial poli%( or po#ition o& t$e Depart'ent o& t$e Na*(, Depart'ent o& De&en#e, nor t$e U.S. ?o*ern'ent.