Impression making

An impression is an imprint or negative likeness of the tooth or teeth and

the surrounding structure. It is made by placing some soft, semi-fluid
material i.e. plastic mass in the mouth and allowing that material to set.
Depending upon the material used, the set impression will be either hard
or elastic. Those impression materials most frequently used for cast
restorations are elastic when removed from the mouth. From this negative
form of the teeth and surrounding structures, a positive reproduction, or
cast is made. The most common impression material which is in use of
construction of the study casts and working casts can be classified as the
following;
I thermoplastic material,
1 Modeling plastic (compounds)
2 Waxes and resins
II. Elastic Materials
1 Hydrocolloids
A. Reversible (Agar Agar)
B. Irreversible (Alginate)
2 Elastomeric Rubber Base .
A. Polysulfide (Mercaptan)
B. Silicone;
i. Conventional (condensation type).
ii. polysiloxane (additional type)
C. Polyether.

The indirect technique for fabricating of fixed restoration either as

individual restoration or retainer for F.P.D. has been an advantage to the
practice of dentistry. It allows most of the laboratory procedures involved in
the fabrication of a restoration to be done away from the chair, substituting
a gypsum cast for the actual tooth. If the restoration is to fit precisely, the
cast on which it is made must be as nearly an exact duplicate of the
prepared tooth in the mouth as possible. This means an accurate,
undistorted impression of the prepared tooth must be made.
The impression must then be handled properly until it is poured up in a
gypsum product. Impression making is an area of restorative dentistry
where much abuse of materials occurs, and many an accurate impression
has been distorted by improper handling or improper delays between re-
moval from the mouth and pouring.
Construction of study cast
 The Alginate impression material is considered to be, one of the most
common impression material, that has ever been used in the dental clinics,
not only because of its economical suitability, but also, for its ease of
manipulation, and accuracy, if it is properly handled, from all aspects.

Alginate impression.
Armamentarium.
1. Full dentulous stock Impression tray
2. Periphery wax
3. Adhesive (spray or paint on).
4. Alginate powder.
5. Water gauge.
6. Scoop.
7. Rubber bawl (flexible and not stiff).
8. Spatula for mixing with good handle, with a firm, and flexible
blade with average measurement of 3cm width and 15 cm
length.
9. Dental napkins.
10. Plaster nipper.

Impression tray
Impression tray, is the instrument into which the impression material
will be loaded, and inserted in the patient mouth, to obtain an
impression of the teeth and the surrounding tissue structure. How ever,
The retention of the impression in the tray during removal from the
patient after complete set of the impression material, is very important
since any dislodgment of the impression from the tray, may will set an
error in the resulting print, thus securing of the impression into the tray
should be carefully achieved, by selecting a tray provided by one

or another means of retention such as (perforations, or, rim-lock or coil

rim) and in some cases an adhesive Trays can be classified to
dentulous and edentulous, and combination it can be stock tray,
disposable, or custom made.
The tray can be perforated, rim-lock, or rim coil, Also trays can be
classified to full arch or segmental.
The selected tray should meet the following requirements.
1. Suitable size that can be inserted in the patient mouth.
2. provides all means of impression retention.
3. Broad Enough to cover all the intended tissues to be included in
the print
4. Available space for the impression material at least 2 mm
between the inner surface of the tray and the tissues.
5. High walls.
6. Good handle that
a. Will not interfere with insertion of the tray.
 b. Provide the operator with proper grip.
The stock trays are average trays, there for there is always a probability
that some of the selected trays dose not fill-full all the requirements
previously mentioned. There for modifications can be done to satisfy the
requirements by using the periphery wax rope, which will render the
selected tray suitable for the intended task;
1. The flanges can be increased in height if the flanges of the tray
you selected were short.
2. The posterior extension of the tray can be increased by addition
of the wax.
3. In the upper jaw, the height of the tray's floor at the area
opposing to the hard palate can be elevated by placing
periphery wax in the form of ball in the tray, and insert the tray in
the patient mouth and press it all the way until the flanges of the
tray are about 3mm short of the depth of the sulcus (modified or
non modified flanges). This modification will achieve
a. The amount of impression material will be reduced in this
area, and thus more control on the flow of the alginate
specially posteriorlly towards the soft palate, and thus, less
chances for gagging stimulation.
b. Since the viscosity of the alginate is low to be able to push
the soft away i.e. the alginate mix has no body to push away
the soft tissues to reach the maximum depth, the wax at that
area will act as supporting material to position the alginate
and preventing it from any slumping before setting.
Gagging reflex control.
Some patients are very sensitive to gag reflex under any little stimuli
which may leads to vomiting and makes making of the impression
some extremely difficult on that session so, avoiding a such reflexes
is very important in order to make decent impression.
1. Set the patient recline position with the head upright position or little
downward in order to
a. Prevent backward flow of the impression material during
insertion and positioning of the tray.
b. Prevent stretching of the mayalo-hayoyed (the floor of the
mouth) muscle and thus the patient can control the
swallowing mechanism ( the saliva which may be
accumulated in the floor of the mouth)
2. The size of the upper tray should be limited posteriorly not to
include the soft palate.
3. Do not overload the tray with the impression material, since any
execs will flow out of the tray and induce gagging.
4. Insert the loaded tray in the patient mouth providing that the
posterior flanges of the tray pressed first and then the front part, by
this approach the execs of the impression material will not flow to
the soft palate but to the front segment of the mouth and can be
removed with your index finger.
 5. In some cases a fast setting impression material can be used, or
accelerate the setting time by mixing of the impression material with
warm water, or delay insertion of the loaded tray which will shorten
the in mouth time
6. Always start the impression with the upper jaw.
7. if any medication inspite of all precaution is still needed such as
local anesthesia use ointment swab on the soft pallet by applicator
not spray since the latter may will inhibits the cough reflex, so if any
foreign body went through the trachea during impression procedure
like piece of impression material, it may dangerous patient life.
1. Set the patient in the proper position recommended previously.
2. Apply the dental napkins on the patient chest.
3. Select the proper size stock trays (upper and lower).
4. Apply the adhesive to the trays if needed prior of starting the max.
5. if the alginate impression material is in cane, shack properly while
the cane is closed, and leave it aside (alginate impression material
is composed of heavy molecules with deferent weight so long
standing cause the most heavy molecules to drop down to the
bottom of the cane) if it is packed in small pouches no need for such
step.
6. A gauged amount of fresh water with the water gauge
recommended by the producer at room temperature prepared, pour
it in the clean and dry rubber bawl.
7. Open the cane ,or (the pouch) and with dray clean scoop
recommended by the producer fill it up to the margins of the scoop
and then pour it in the rubber bawl.
8. By the dray and clean spatula start immersing of the powder with
the water before mixing to avoid splashing of powder dust in the air,
and then start mixing vigorously against the walls of the rubber bawl
in one direction and then collect it all and remix it and so fort, until
you obtain a homogenizes, creamy, and bubble free mix.
9. Load the tray, and the remaining of the impression material should
be used as the following:.
a. In the upper jaw, with your index finger pick up some of
the impression material and, apply it on the occlusal
surface and other area that you are interested in the
most.
b. If the lower jaw, you apply on the occlusal surface, lingual
surfaces of the front teeth and the lingual pouches.
10. While you are standing behind the patient Insert the tray in the
patient mouth, retract by the side of tray while you inserting it, and
by the aid of the mirror retract the check of the other side.
a. If it is the upper jaw, position the tray back word forward
as it has been explained previously.
b. If it is with the lower jaw, do not open or ask your the
patient to open his mouth widely but it should be just
enough to position the tray, also (backward forward),
because when the mouth is opened widely the floor of the
mouth will be elevated and the impression material will fail
 to reach to With a steady pressure stabilize and keep the
tray in position until complete set.
11. Remove with snap shot technique if possible, or minimize rocking
movement during attempting removal of the tray to avoid inducing
of any stresses in the body of the impression.
12. Wash the impression under running tap water to remove any food
debris, blood, and seepage.
13. Chick the impression for any defects such as:-
a. Dislodgment of the impression material from the tray.
b. Metal display.
c. Voids or tearing.
14. Immerse the impression in anti septic solution such as sodium
hypochlorite 2% for 5 Minutes.
15. Rinse again under running tap water and pour
immediately, if not, store it in dampen clothe or in humid-fire.
The custom tray
is an individual disposable well fitted with predetermined impression
material space. tray made either from shellac or light or cold cure acrylic
on study cast.
Custom acrylic tray is an individual tray that must be used once and then
discarded so it is hygienic the custom trays are an important part of rubber
base impression techniques, since Elastomers are more accurate in
uniform, thin layers 2 to 3 mm thick . Stock trays should not be used in
double mix technique because the uneven bulk of impression material may
cause distortion. The custom tray must be;
1. thin and yet still rigid to withstand handling, and will not yield under
the pressure needed for supporting of the tray.
2. the impression material must adhere firmly to the tray. This is
achieved with a rubber adhesive packaged with the tubes of
impression material. These adhesives are not interchangeable, so
use only the type packaged with the brand of material being used.
3. The tray should have stops on the occlusal surfaces of the teeth to
orient the tray properly when it is seated in the mouth and maintain
the space for the impression material from 2 to 3 mm thick .
Advantages

1. The thickness of the impression material is even and minimum

(from 2 to 3mm) which will lead to.
a. Minimum internal stresses.
b. Less sizable changes.
2. Economic.
3. Hygienic.
4. Easier to be inserted and positioned in the patient mouth
especially with a small mouth.
5. It contains the impression material
Polysulfide Rubber Base.
Polysulfide is an Elastomer that is also known as Mercaptan, Thiokol, or
simply as rubber base. This latter term alone is an incomplete one and
should be avoided.
1. chemical composition
This impression material is packaged in two tubes: a base and an
accelerator. The base contains a liquid polysulfide polymer mixed with inert
filler. The accelerator, which is usually lead dioxide, mixed with small
amounts of sulfur and oil, acts as an oxidation initiator on terminal thiol
groups on the polymer. When these two pastes are mixed, the polymer
chains are lengthened and cross-linked through the oxidized thiol groups.
In clinical terms, this can be manifested as an increased in the viscosity of
the mix ,and then the material will be converted to an elastic mass. This
polymerization is exothermic and is affected significantly by moisture and
temperature.
2. Dimensional stability.
Polysulfide rubber base possesses much greater dimensional stability than
does hydrocolloid. However, the polysulfide polymer does contract as
curing occurs. Therefore, if maximum accuracy is to be obtained, a
polysulfide impression should be poured within approximately one hour of
removal from the mouth, or less. Un-poured impressions should never be
sent to a laboratory.
3. Availability.
The product has three consistencies heavy, medium, and light heavy and
medium to make print to the gross details and light body to print more fine
details that why it recommended not to use heavy and medium alone but
should be used in conjunction with light body.
Each consistency presented in two collapsible tubes, one contains base
and it is usually brown in color, and the other one, contains the activator or
the initiator, and it is white in color. When they are mixed together on the
specially made disposable mixing pad extruding of equal lengths achieves
the proper ratio recommended.
4. Notice
1. Large undercut areas in the inter-proximal region should be blocked out
with wax to prevent "locking" the impression into the mouth. This can
lead to distortion of the impression if excessive force must be used to
remove the tray from the mouth.
2. Because of the hydrophobic nature of this material, special care must
be taken to insure that there is no moisture on the preparation when
the impression is taken. Thin layers of moisture on the surface can
make the cast slightly larger, and moisture that becomes incorporated
during the injecting process can cause holes in the impressions and
fins on the cast. Any hemorrhage or fluid seepage in the sulcus will
result in voids and bubbles that will obscure the finish line.
3. Advantages.
1. High tear strength.
2. Enhanced elasticity.
3. Disadvantages.
1. Prolong setting time.
2. If not handled with care it may cause clothes stains.
3. Dimensional unstable.
4. Owing the hydrophobic nature of this impression care should be
 taking during,
a. Impression making (no blood or seepages).
b. Pouring of the impression with stone.
5. Custom tray is mandatory.
Impression armamentarium
1. Polysulfide impression kit (regular base and accelerator).
2. Polysulfide impression kit (light base, and accelerator).
3. Adhesive .
4. Disposable mixing pads.
5. Stiff spatulas
6. Syringe with disposable tips.
7. 2X2 gauze sponges
8. Alcohol.
9. Custom acrylic tray.
Impression making (double mix technique)
1. Be sure that the patient has adequate anesthesia. If the
impression is being made on a separate appointment
subsequent to the preparation of the tooth, it is necessary to
anesthetize the area.
2. Try the custom tray in the mouth to make sure it fits without
impinging on the prepared tooth.
3. Insert the retraction cord, and place a large gauze pack in the
mouth.
The following steps require an assistant.
4. On one disposable mixing pad squeeze out 4 cm each of
light (syringe) base and accelerator. On a second pad place
13 cm strips of regular (tray) base and accelerator.
5. Pull the plunger from the injection syringe and set it aside.
The tip and cap (if removable) should be on the barrel of the
syringe.
6. The assistant should start mixing the tray material on one
pad thirty seconds before the operator begins mixing the
syringe material on the other.
7. Pick up the dark accelerator on the spatula and incorporate
it into the white base.
8. Holding the spatula flat against the pad,
a. mix with a back and forth motion, pressing hard
against the pad.
b. Change directions often to produce a smooth,
homogenous mixture (Fig. 10-14).
c. Be careful not to incorporate bubbles.
d. Do not take more than one minute to mix it.
9. The back end of the syringe is brought in contact with the
pad, and quick, closely spaced sweeps of the syringe will fill
it, with a minimum of material spilled.
10. Remove the 2 x 2 gauze squares from the patient's mouth.
Be sure that the retraction cord is slightly damp before
 removing it from the sulcus. Immediately inject polysulfide
syringe material into the sulcus.
11. Hold the tip just above the mouth of the crevice.
a. Do not drag the tip along the gingiva. Proceed
smoothly around the entire circumference of the
preparation, pushing impression material ahead of the tip.
b. Continue around the preparation until the entire tooth
is covered.
c. A stream of air from an air syringe is directed against
the material. This spreads it evenly over the surface of the
preparation and drives it into small details such as grooves
and boxes. It is also forced more completely into the
gingival crevice. Excessive pressure, prolonged air
application, and use on patients with a thin band of
attached gingiva should be avoided because of the pos-
sibility of producing interstitial emphysema.
12. Seat the tray slowly until the stops hold the tray solidly in
one position. The tray should be held with light pressure for 8
to 10 minutes without movement. The set of the material can
be tested with a blunt instrument. When the material
rebounds completely without leaving any trace, it has set.
13. After it has cured, the impression is removed. The wings on
the sides of the tray can be used for added leverage in this
task. While it is customary to call for removing the tray
suddenly or with a snap, it is more realistic to ask that the
removal be as fast and in as straight a direction as possible.
Only an adult male gorilla could remove a full arch polysulfide
impression with a snap. Rinse the impression to remove
blood and saliva. Blow it dry. An impression of the opposing
arch can be made with alginate.
A good impression for a cast restoration should meet the following
requirements:
a. It should be an exact duplication of the prepared tooth,
including all of the preparation, and enough gingivally uncut
tooth surface beyond the preparation to allow the dentist
and technician to be certain of the location and
configuration of the finish line.
b. Other teeth and tissue adjacent to the prepared tooth must
be accurately reproduced to permit accurate articulation of
the cast and to allow proper contouring of the restoration.
c. The impression of the preparation must be especially in the
area of the finish line;
i. bubble free.
ii. Tear free.
iii. Porosity free.
d. No metal display at the occlusal or axial walls prints.
e. The impression should not be separated from the tray
f.
conventional silicone rubber base.
 The conventional silicone impression materials are also known as
condensation reaction silicones. Composed of base paste and catalyst
either in the form of drops or cream in compressible tubes or base in the
form of putty and the catalyst in drops or cream as well, When the two are
mixed, a chemical reaction will take place converting the materials to a
rubbery consistency. Impressions made in silicone should be poured soon
after removal from the mouth.
The technique for standard silicone rubber base materials is similar in
many ways to that for polysulfide.
1. five centimeters of base are mixed with two drops of accelerator to
provide the material used in the syringe.
2. twenty centimeters of base and eight drops of accelerator are used
to form the quantity required to fill the average full arch impression
tray.
3. Other aspects of the technique for the use of conventional silicone
rubber base impressions are the same as those used for polysulfide
impressions.
Wash technique.
There are other silicone impression materials which utilize a "putty" which
is relined with a thin "wash". These were developed to
1. Reduce the sizable dimensional change which begins to take place
when the conventional silicone impression is not poured
immediately. The putty has a silica filler content of 75 per cent,
which is more than double that in the wash.21 As a result, there is
a much lower dimensional change in this part of the impression.
2. A preliminary impression in the highly-filled heavy bodied material
is made in a stock tray, which will serve as a custom tray for a thin
"wash" of less highly-filled conventional silicone. The accuracy of
this type of material has been found to be quite satisfactory.
3. This material has grown in popularity because this technique can
be applied without the need for a custom tray.
Armamentarium
1. Silicone impression kit (putty, base, and accelerator).
2. Tray adhesive
3. Measuring scoop.
4. Disposable mixing pad.
5. Stiff spatula.
6. Syringe with disposable tips.
7. 2X2 gauze sponges.
8. Stock trays (rim-lock or perforated).
9. Bard-Parker laboratory knife with No. 25 blade.
Tray preparation and impression making
Before the preparation is begun,
1. Select a stock tray that fits the arch.
2. Coat the inside of the tray with a thin, even coat of adhesive and
allow it to dry.
3. Place two scoops of putty (base) for a full arch impression tray on
the pad. Use one scoop for a sectional tray. Add six drops of
 accelerator for each scoop of base. Incorporate on the pad with a
spatula for a few seconds. Then the material is transferred to the
palm of the hand and kneaded for 30 seconds. The material should
be streak free.
4. Roll the base into a cigar shape and place it into a stock impression
tray. Cover the base with a polyethylene spacer, and seat the tray in
the mouth.
5. Remove the tray from the mouth after the initial set has occurred
(about 2 minutes). Peel off the spacer and remove any excess on
the periphery of the tray with a sharp knife. Set the tray aside for
use after the tooth has been prepared.
6. Be sure that the patient has adequate anesthesia. Isolate the
quadrant containing the prepared tooth.
7. Place the retraction cord, and insert a large gauze pad in the
mouth.
8. The following steps require an assistant.
a. Squeeze out 20 cm of the thin wash silicone base onto the
disposable mixing pad (use four inches for a sectional tray).
Add one drop of accelerator per inch of base. Mix
b. With a spatula for 30 seconds; the mix should be free of
streaks.
c. Fill the syringe with the wash material.
d. While you are inserting the plunger and expressing air, the
assistant should carry the remainder of the material in the
mixing pad into the tray.
9. Remove the 2 x 2 gauze squares from the patient's mouth. Be sure
that the retraction cord is slightly damp before removing it from the
sulcus. If necessary, gently blow air on the prepared tooth to dry it
off. Do not blow compressed air on the tooth after the retraction
cord has been removed from the sulcus.
10. Carefully remove the cord from the sulcus by grasping the free end
in the interproximal region with cotton pliers. Tease the cord out
gently so that hemorrhage will not start.
11. Immediately inject syringe material into the sulcus.
a. Hold the tip just above the mouth of the crevice.
b. Do not drag the tip along the gingiva.
12. Proceed smoothly around the entire circumference of the
preparation, pushing impression material ahead of the tip. Do not
skip any areas, but continue around the preparation until the entire
tooth is covered.
13. Give the syringe to the assistant in exchange for the loaded tray.
a. Seat the tray slowly until it is firmly in place.
b. The tray should be held in place with no downward pressure
for six minutes.
c. Pressure exerted on the tray while the wash is polymerizing
will produce stresses in the semi-rigid base lining the
impression tray.
d. When the impression is removed from the mouth, the
stresses will relax, resulting in deformation and distortion of
 the impression.
14. After it has set, the impression should be removed as quickly as
possible and as straight off as possible to prevent plastic
deformation of the material.
15. Rinse the impression to remove blood and saliva. Blow it dry.
16. inspect for any defect as mention before in addition to the following;
a. The wash material should cover the entire putty
impression surface.
b. The surface texture should be smooth and free from any
wrinkles, warping, and tuckeness.
c. The wash surface should be adhered to the putty surface
and can not be pealed off.
NB. An impression of the opposing arch can be made with alginate.

Vinyl polysiloxane silicone rubber base.

In the last several years a new type of silicone impression material has
appeared on the market. Its dimensional stability is so much improved over
that of the conventional silicone, and its reaction so different, that it de-
serves treatment as a separate variety of material.
The vinyl polysiloxane silicones are also called addition reaction silicones,
because of their setting reaction, and chloroplatinic acid silicones, because
of their activation.
The material is packaged as two pastes. One paste contains silicone with
terminal silane hydrogen groups and inert filler. The other paste is made up
of a silicone with terminal vinyl groups, chloroplatinic acid catalyst and a
filler.21 Upon mixing equal quantities of the two materials, there is an
addition of silane hydrogen groups across vinyl double bonds with the
formation of no by-products.20 The result is an exceptionally stable ma-
terial.16, 20, 21 Putty and wash consistencies are made for this type of
silicone also.
Armamentarium
1, Silicone impression kit (base and accelerator)
2. Tray adhesive
3. Disposable mixing pad
4. Stiff spatula
5. Syringe with disposable tip 6. 2 x 2 gauze sponges
7. Custom acrylic tray
Impression making
1. Paint the custom tray with adhesive at least 15 minutes before the
impression is to be made. Squeeze one and one-half inches each
of base and accelerator syringe material onto a working pad. On a
second pad place 12 cm each of the tray consistency base and
accelerator. Remove the plunger from the injection syringe and set
it to one side. The rest of the syringe should be assembled.
2. The assistant and operator can start mixing material at about the
same time. Mix with a spatula for about 45 seconds. When all
streaks are eliminated, load the syringe and tray. Remove the
 gauze pack. Be sure that the retraction cord is slightly damp before
removing it from the sulcus. Carefully remove the cord and inject
the impression material, starting in one interproximal area and
pushing the material ahead of the tip. Exchange the syringe for the
loaded tray and seat it firmly in the mouth. Hold it in place for
seven to eight minutes from the start of mixing.
3. Remove the impression as quickly and straightly as possible to
prevent distortion. Blow it completely dry, and use extreme care in
pouring it. The impression of the opposing arch can be made with
alginate.
Polyether rubber base
Polyether is another type of elastomeric impression material which has
come into use rather recently. Polyether is packaged in two tubes using a
much larger volume of base than accelerator (slightly less than 8:1).
This impression material exhibits accuracy somewhat superior to that of
the other Elastomers. It has excellent dimensional stability, even when
pouring is delayed for prolonged periods of time. The material itself has an
affinity for water and impressions should not be stored in a humidor or
moist environment. Its resistance to tearing upon removal is roughly equal
to that of silicone and less than that of polysulfide.
Armamentarium
1. Polyether impression kit (base and accelerator)
2. Tray adhesive
3. Disposable mixing pad
4. Stiff spatula
5. Syringe with disposable tip 6. 2 x 2 gauze sponges
7. Custom acrylic tray
Impression making
Because of the accelerated setting time of this material, it is imperative that
the operation be well organized and executed very fast.
Double mix technique
a. Coat the custom tray with the adhesive supplied with the
polyether.
b. Approximately eighteen cm each of base and accelerator are
expressed onto a disposable mixing pad.
c. Mix with a spatula for about one minute until all streaks have
been removed. Since contact with unmixed catalyst can
produce sensitization and an allergic reaction, it is important
that no unincorporated catalyst remain.
d. Load the back end of the syringe.
e. The assistant should load the tray while the operator
proceeds. Remove the gauze pack.
f. Be sure that the retraction cord is slightly damp before
removing it from the sulcus. Carefully remove the cord from
the sulcus and inject the impression
g. Material, quickly but carefully, starting in one interproximal
 area. Exchange the syringe for the loaded tray.
h. Seat the tray firmly to place in the mouth. Hold the tray in
place for four minutes.
i. Remove the impression. It should be blown dry immediately
because of polyether's tendency to absorb moisture.
j. Inspect the impression for any defects.
k. The impression of the opposing arch can be made with al-
ginate.