Pei Feng Lim'

Koh Hwee Neo*

Adaptation of
Finger-Smoothed
Irreversible Hydrocolloid to
Impression Surfaces

Kai Loon Yea'

Ahslait Stokes, BDS, MSc"
Faculty o Dentistry
Nalionul University of Singapore
Republic of Singspore

This study investigated a surface moistening technique in which the surface

of an irreversible hydrocolloid impression material was smoothed using a
moistened, gloved finger prior lo impression making. To determine the effect
of the procedure on the surface integrity of machined brass die, impressions
with and without smoothed surfaces were made and examined. Similarly,
multiple impressions were made for a single dentate subject, and stone casts
were poured. These casts were assessed by three experienced clinicians.
Results indicated that he moistened finger technique resulted in fewer
surface bubbles and voids than did impressions made when the material was
only loaded with a spatula and not smoothed. Int I Prosthodont

1995;d:n/-121.

rreversible hydrocolloid (alginate) impressions

are part of everyday dentistry. They provide a
rapid, low-cost method of replicating dental structures where the extreme degree of accuracy inheretit in crown and bridge procedures is not
required.'- Irreversible hydrocolloid impressions
are well suited for diagnostic casts for removable
and fixed prosthodontic procedures.-" The practical limitations of irreversible hydrocolloid impressions include dimensional stability, low tear
strength, and the presence of voids on the impression surface.'
Bubbles and voids on the impression surface are
a major limitation to the satisfactory use of irreversible hydrocolloid impression materials. Air
bubbles are incorporated into the material during
mixing, while voids are associated with moisture
or debris on the oral tissues.'
The surface moistening (SM) technique, in which
impression material is wiped smooth using a moistened gloved finger prior to placing the tray, has
been recommended by some authors as a method
of achieving the most detailed impression sur-

face.'"' However, another author" discourages this

technique on the grounds that it is unnecessary,
time consuming, and may alter the physical properties of the impression surface.
None of the opinions expressed above were supported by objective data. Accordingly, the purpose
of this study was to determine the ability of the SM
technique to reproduce surface detail, compared to
non-surface moistened (NSM) controls, A survey
was also conducted to determine the current status
of the technique within the Asia-Pacific Dental
Schools.
Materials and Methods
To obtain background information on the prevalence of the teaching and use of the surface moistened technique, a mail survey was conducted
involving the Prosthodontic Departments o( 46
Dental Schools in Australia, Hong Kong,
Indonesia, |apan, Malaysia, New Zealand, The
Philippines, Singapore, South Korea, and Thailand.
The survey sought faculty's awareness of the SM
technique and its status in the teaching and/or
practice at the undergraduate level.

Third Year Denla! Sludenl.

"Senior reaching iellaw.

Clinical Study

Reprint requests: Kok Hwee Neo, Deptlmem o Keitorstii/e

A maximum of 6 maxillary irreversible hydrocolDeflifl'y.
Fucutty ol Dentistry. National UnivenHy of
loid impressions were made each day for a single
Singapore, Lower Kent Ridge Road. Singapore 0511, Republic
dentate volunteer. These alternated between the
of Singapore.

3, Number 2,1995

117

The International iournsl of Prosthodomics

' l-lydrocolloid Imprc

Bowl, Yoshida Works, Osaka, |apan) for 30 seconds

with 57 mL of water at 23C, A single operator
placed the mixed impression material into the prepared Iray. For the SM technique, the impression
surface was smoothed using a wet, gloved fmger
(Figs 1 and 2a). For lhe NSM technique, the surface
was loaded using a spatula (Fig 2b).
Placement required up to 10 seconds for NSM
and 20 seconds for SM, The tray was held in the
mouth for yo seconds prior to removal, rinsed in
running tap water for 30 seconds, and disinfected
in 5 percent sodium hypochlorite solution for 60
seconds, followed by a 30 seconds tap water rinse.
Type IV stone (American Dental Association
Specification No, 25) was vacuum mixed (Degussa
Mukivac-4, Wolfgang, Frankfurt, Germany) to a 22
mL water/100 g powder ratio for 20 seconds, and
one studeni carefully vibrated the stone into each
impression. The cast was separated after 1 hour
and trimmed. All the casts were prepared by one
individual. The cast surface initially in contact with
impression material was not modified in any way
during preparation. Casts were dried and assigned
a random label prior to evaluation. Standards were
monitored by both the group and the project
supervisor.
Three experienced prosthodontists independently
evaluated the casts with respect to the quality of the
hard and soft tissue representation. Criteria were:
Excellent. Fiard and soft tissues are smooth,
apparently dense and defect free. There is no evidence of either positive defects (bubbles) or negative defects (holes). Anatomical detail is sharply
represented.
Satisfactory. Hard and soft tissues are generally

SM and NSM technique, the first being decided by

a coin toss. At least 20 minutes elapsed between
each impression, A total of 10 SM and 10 NSM
impressions were made, A pre-study was undertoken before the actual study to train one student
with the mixing process, another with the technique of impression making, and one with the
making of the casts.
A perforated stock tray (Z-Au-., Prima,
Westbyfleet, Surrey, England) was used for all
impressions. Adhesive (Fix, DeTrey/Dentsply,
Weybridge, Surrey, England; Lot/Ch-B:LK80) was
painted on the tray surface and allowed to dry.
Twenty-one grams of a single brand of Type Two
irreversible hydrocolloid material Oeltrate Plus, LD
Caulk/Dentspiy, Milford, DE) were automixed (EZ-

Fig 1 Irreversible tiydrocolloid smoothed using a wet,

gloved finger in the surface moistened (SM) technique.

Fig 2a Irreversible hydrocolloid impression surface after SM

smoothing.

Tl)e International Journal of Prostliodontii

Fig 2b Irreversible hydrocolloid impression surface

loaded using a spatula.

118

Finger-Smoothed Ir reuers i lile H yd meollo fit Impressions

Fig 3

Oblique view of the brass die.

Fig 4

5mooth and detect free. There may be a few positive defects (bubbles], which if removed would not
affect the accuracy of a prosthesis. There are no
negative defects (holes]. Anatomical detail is
sharply represented.
Unsatisfactory, Hard and soft tissues may not be
smooth and defect free. There are a number of positive defects (bubbles), not all of which could be
safely removed. There may be negative defects
(holes). Representation of anatomical detail may
not be 5harp in all regions, (Any one of these criteria should result in an "Unsatisfactory" grading).
The evaiuators were not calibrated prior to their
participation. Clinicians' evaluations for individual
criteria were subsequently decoded and applied to
the SM and NSM groups.

Fig 5 Detail ot irreversible hydrocolloid impression ol brass

die, rjote bubbles on slope and ridge.

Irreversible hydrocolloid impression material

was proportioned and mixed as in the clinical
study. The mixed material was placed in the special trays using the SM and NSM techniques to
provide 10 impressions for each group.
Impressions were removed from the die and the
representations of the die surface were immediately examined by two examiners who were
unaware of the impressions' SM/NSM status (Figs 4
and 5), Bubbles were noted on a plan of the die
surface. Where there was a disagreement between
examiners, the mean number of bubbles was taken
and rounded to the nearest whole number.
The mean bubble count for SM and NSM
impressions was thus determined, and these
formed the basis of an objective measurement of
surface reproduction.

Laboratory Study
A brass die machined with 20-[jm grooves along
a central flat surface and multiple pyramidal projections on both lateral surfaces (Fig 3) was used for
surface reproduction testing. There were a total
number of 289 surfaces on the brass die. Special
trays, providing 3-mm relief, were constructed to fit
the brass die. The die was conditioned to 37'C
prior to impression making. Initial impressions were
made using a tbin layer of water on the brass die,
but there was considerable variability in the impression surfaces, presumably related to the amount of
water trapped in the grooves of the die. To ensure a
uniform procedure, the die was dried using a blast
of air immediately prior to impression making.

; S , Number 2, I'!95

Irreversible hydrocolloid impression ot brass die.

119

I o Proithodoniics

Finger-Sn

- Hydrncolloicl In

Fig 6 Pooled satistaclory/

unsatislactory evaluations oy
three prosthodontists oi
SWHSM casts (n = 30 evaluations for each
group).
Differences between groups
are shown for each criterion
evaluated.

D
Unsatisfactory

D
Satisfactory

SM
NSM
Bubbles

Stul
NStul
Holes

P= 006

SM hJSM
Sharp detail

SM NSM
Overall

P=.U

P= .005

P= .35
Criteria

Table 1 Bubbles Counted on the Surface ol SM and

NSM Impressions ol a Brass Die (n = 10 tor both
groups)

Results
Survey of Dental Schools

Impression number

Replies received from seventeen dt'ntai schools

reported ihat all taught and practiced the use of
irreversible hydrocolioid impression materials.
Respondents from three schools were unaware of
the SM technique, five taught and practiced the SM
technique, one ichooi noted the SM technique was
taught and practiced "sometimes." In four dental
schools, the SM technique was not taught but it
was practiced in the ciinics, while four schools
replied that the SM technique was neither taught
nor practiced. Negative comments included
"affects water/powder ratio," "wastes time," or "is
of no value,"

SM
42
47
56
47
3B

NSM

70
120
62
49

77
87
86
92
100
141
191
149
105
181

Mean

63.3

120.9

Standard deviatioh

25.5

41.$

1
2
3
4
5
6
7
8
g
10

sa

SM significantly difterent tram NSM (P < .001],

square analysis at 99% confidence level, showed

significant differences in that of bubbles (P= .006].

CUnical Study

The evaluations of the independent prosthodontists are listed in Fig 6. Figures for each group were
subjected to ANOVA and means were compared
by Duncan's multiple range procedure (P < .05).
There were no significant differences between the
responses of individual examiners, so results for
each criterion were pooled for final analysis and
presentation. Comparison of SM and NSM groups,
by bubbles, holes, and sharp detail, using chi

The Irrernalional luurriul ol Pro^thodonlK

Lahoratory

Study

The bubble counts for SM and NSM impressions

are shown in Table 1.
Mean counts were b3 bubbles 26 (SD) for the
SM technique and 121 bubbles 42 (SD) for the
NSM technique. Student's t test showed a highly
significant difference {P < .001 .

120

ringer-Smoolhid irreversible Hydrocolloid I

The reduction in the number of bubbles present

on the surface of irreversible hydrocolloid impressions made using the SM technique may be
attributed to one or ail of several factors. First, the
addition of water to the impression surface may
have acted as a spreading factor as a result of the
reduced contact angle. Secondly, the stroking
motion of the wet finger may have compacted the
impression surface, eliminating superficial air bubbles incorporated during mixing. The relative "wetness" of the impression surface associated with the
SM technique has parallels with "wet field technique" of reversible hydrocolioid procedures.' The
outcome of this study implies that there is a basis
for a broader-based investigation in the future.

Discussion
About one third of the dental schools responded
to the survey. The responses were received within
a few weeks of mailing. No follow-up was undertaken. A minority of the respondents felt the technique had merit.
The clinical study was difficult to conduct
objectively. Student operators' lack of experience
and inherent variability contributed to this difficulty. However, the authors attempted to minimize these shortcomings by adhering to a strict
protocol. The conclusions are subject to bias.
Extrapolations beyond the confines of the study are
not merited.
Automatic mixing ensured consistent incorporation of all powder within a 30-second period. The
manufacturer stated the material had 135 seconds
of working time, whether hand- or auto-mixed,
theoretically leaving 105 seconds for tray loading,
surface treatment, and final placement of the
loaded tray. Actual timings were weli within limits
for both SM and NSM procedures.
The SM technique added about 10 seconds to
the pre-placement timing, although comments
from academics of surveyed institutions suggested
that considerably more time might be spent on this
pan: of the impression making procedure, it should
also be remembered that the working time stated
by the manufacturer may not be accurate. In a
study of several dental materials, Hondrum and
Williams' reported that the mean working time of
several batches of Jeltrate Plus was 110 seconds,
shorter than the manufacturer's stated 135 seconds. In less-than-ideal conditions, the SM technique could be closer to the maximum working
time than the NSM technique.
This clinical study showed that the SM technique is associated with less bubbles and voids on
the surface of irreversible hydrocolloid impressions
than the NSM technique.
The laboratory study was conducted in an effort
to quantify the principal factor identified as affecting the surface quality of irreversible hydrocolloid
impressions (bubbles on the impression surface].
The brass die had fine grooves, and as the interest of this study was bubbles, the complex pyramidal surfaces acted as a stern test. The surface of the
brass die was dried (different from the oral condition] which would mitigate against spreading as a
result of greater surface tension. Drying did, however, ensure a standard surface condition, eliminating a variable from the impression making procedure. A significant difference between impressions
produced by the two techniques was evident.

e8. Number 2,1995

Conclusions
This study evaluated the surfaces of casts poured
in irreversible hydrocolloid impressions made
under two conditions, as mixed and loaded into
the tray with a spatula (NSM], and after the surface
was smoothed using a moistened, gloved finger
(SM|, One type of impression material and one
stone were used. Within the limitations of the
study the following conclusions may be made:
1. The SM technique was associated with fewer
bubbles incorporated on impression surfaces
than the NSM technique.
2. The SM technique did not add a substantial
time factor to the procedure of preparing the
irreversibie hydrocolloid impression material
prior to impression making.
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The International loumsl of Prosthodontics