EARN This course was

3CREDITS
CE written for
dentists,
dental hygienists,
and assistants.

Identifying and Managing

Dental Impression Problems
A Peer-Reviewed Publication
Written by Gregori M. Kurtzman, DDS, MAGD, FPFA, FACD, FADI, DICOI, DADIA

PUBLICATION DATE: APRIL 2018

EXPIRATION DATE: MARCH 2021

SUPPLEMENT TO
PENNWELL PUBLICATIONS
EARN

3CREDITS
CE This educational activity was made possible through
an unrestricted educational grant by Ultradent.

This course was written for dentists, dental

hygienists and assistants, from novice to skilled.

Educational Methods: This course is a self-

instructional journal and web activity.

Provider Disclosure: PennWell does not have

a leadership position or a commercial interest in
any products or services discussed or shared in
this educational activity nor with the commercial
supporter. No manufacturer or third party has had any
input into the development of course content.

Requirements for Successful Completion: To

obtain 3 CE credits for this educational activity you
must pay the required fee, review the material,
complete the course evaluation and obtain a score of

Identifying and Managing at least 70%.

CE Planner Disclosure: Heather Hodges, CE

Dental Impression Problems

EDUCATIONAL OBJECTIVES
At the conclusion of this educational activity, participants will be able to:
1. Learn how to identify common impression problems
2. Learn how to correct impression problems
3. Learn how to avoid impression problems and improve impression quality
4. Learn what types of impression materials are best suited for particular
restorative needs
Coordinator does not have a leadership or commercial
interest with products or services discussed in this
educational activity. Heather can be reached at
hhodges@pennwell.com
Educational Disclaimer: Completing a single
continuing education course does not provide enough
information to result in the participant being an
expert in the field related to the course topic. It is a
combination of many educational courses and clinical
experience that allows the participant to develop skills
and expertise.
Image Authenticity Statement: The images in this
educational activity have not been altered.

Scientific Integrity Statement: Information shared

in this CE course is developed from clinical research
and represents the most current information available
ABSTRACT from evidence based dentistry.

Fixed restorative dentistry requires an impression of the teeth and area to be restored
for the laboratory to fabricate the desired restorations. Traditional impressions are
still utilized the majority of the time to capture the needed information. Selection
of the correct viscosity will vary depending on what prosthesis is to be fabricated,
which tray is being used and whether the preparations are on natural teeth or
implants. Problems can arise during impression taking that can compromise the
Known Benefits and Limitations of the Data:
The information presented in this educational activity
is derived from the data and information contained
in reference section. The research data is extensive
and provides direct benefit to the patient and
improvements in oral health.
Registration: The cost of this CE course is $59.00 for
3 CE credits.

ability of the lab to fabricate the restoration or affect the accuracy and fit of the
finished prosthesis. Identifying impression problems is part of the process, but how
to manage these to improve the quality and accuracy of our impressions is critical
to fixed prosthetics.
Cancellation/Refund Policy: Any participant who is
not 100% satisfied with this course can request a full
refund by contacting PennWell in writing.

PennWell designates this activity for 3 continuing educational credits.

Dental Board of California: Provider 4527, course registration number CA#03-4527-15259

“This course meets the Dental Board of California’s requirements for 3 units of continuing education.”
Go Green, Go Online to take your course
www.DentalAcademyofCE.com The PennWell Corporation is designated as an Approved PACE Program Provider by the
Academy of General Dentistry. The formal continuing dental education programs of this
QU I CK AC C E S S C O D E 15259 program provider are accepted by the AGD for Fellowship, Mastership and membership
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dentistry or AGD endorsement. The current term of approval extends from (11/1/2015) to
(10/31/2019) Provider ID# 320452.
 DENTAL ACADEMY OF CONTINUING EDUCATION

INTRODUCTION
Impression fabrication is a critical and technique-sensitive step in the Figure 2
fabrication of fixed prosthetics. It can also be a frustrating stage during
treatment, both to the clinician and laboratory technician. Potential
complications need to be identified and corrected prior to sending the
impression to the lab for fabrication of the prosthetics. This article will
address some common difficulties, what factors may cause impression
errors, and present methods to correct and avoid complications related
to impression capture.

INADEQUATE MARGINAL DETAIL INTERNAL BUBBLES

The primary complaint laboratory technicians voice with the impressions
they receive daily is inadequate marginal detail and the majority of im-
pressions they receive have issues. Marginal detail is the most critical
aspect of the impression as it indicates where the restoration will termi-
nate on the tooth. Failure to capture the true details of the margin of the
preparation will result in open or overhanging margins and inadequate
fit of the crown, onlay/inlay or bridge. Voids at the margins are the result
of either insufficient retraction or fluid accumulation that prevented the
impression material from flowing around the margin. (Figure 1) This can
be avoided by using improved retraction methods such as syringeable
hemostatics (e.g. Viscostat and Astringedent, Ultradent, UT; Retrac,
Centrix, Shelton, CT; Expa-syl1-3, Kerr Sybron, Orange, CA). The traditional
approach to achieve sufficient retraction utilizes retraction cords with
these syringeable hemostatics such as Ultrapak (Ultradent), Gingi-Plain
(Gingi-Pak, Camarillo, CA), Knit-Pak (Premier Dental, Plymouth Meeting,
PA), UniBRAID (Dux Dental, Oxnard, CA). Another approach are retrac-
tion pastes are placed into the gingival sulcus following preparation and
held under pressure with a GingiCap (Centrix Dental, Shelton, CT) or
Comprecaps (Coltène/Whaledent, Cuyahoga Falls, OH) creating hemo-
stasis and dilation of the sulcus. When adequate retraction is achieved
to allow the impression material to capture the prepared restorative
margin the lab is able to visualize where the practitioner wants the
restoration to terminate on the tooth. (Figure 2).
Alternatively, a diode laser (Gemini laser, Ultradent; Picasso, AMD
LASERS, Indianapolis, IN; Epic, Biolase, Irvine, CA; Precise LTM, CAO
Group, West Jordon, UT) can be used to trough the sulcus both widen-
ing it to better visualize the prepared margin and hemostasis is also
achieved. The laser is kinder to the tissue without the potential for
recession that was reported with electrosurgery.4
Figure 1
Vinyl polysiloxane (VPS) is the most widely used of impression materi-
als available. These materials were introduced over 30 years ago and
initially were hydrophobic (repealed by water)2 in nature. Manufacturers
have improved the chemistry of these impression material to make
them more hydrophillic (adaptable to wet surfaces). But, moisture
(water, saliva, blood) trapped at internal angles may lead to bubbles in
the impression.
Internal bubbles occur as a result of either fluid accumulation (when
larger and less sharp in definition) or air entrapment (when small and
well defined) (Figure 3). Fluid in the sulcus, be it blood or saliva will
interfere with accurate capture of the restorations margins in the im-
Figure 3
pression. Achieving proper hemostasis solves these issues. Bubbles on
the margins of the preparations can negatively affect the fit of the
prosthetics. If the bubbles occur on the internal line angles of inlay and
onlay preparations due to fluid accumulation, a substandard fit will be
developed. If they occur due to air entrapment, the fit of the restoration
will not be compromised. Bubbles occurring due to fluid accumulation
may be large enough to affect the long-term success of the luting agent,
which must now fill a wider space. The thicker the luting material the
weaker the interface between the restoration and underlying tooth.
The prosthetic material may also be thinner than recommended,
weakening the restoration and material failure of the crown may result
under function. This is more critical when using all-ceramic materials,
as they require minimum thicknesses to perform as expected. Use of
a wash impression is difficult in a completed impression (2-step impres-
sion), as complete seating can be hampered. Should a 2 step approach
be considered, removal of impression material interproximally in the

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 DENTAL ACADEMY OF CONTINUING EDUCATION
set impression with scissors will prevent the interproximal
material from preventing full reinsertion of the impres-
sion intraorally. Additionally, new wash material should
be placed in all the tooth areas on the side of the impres-
sion before reseating the previously set impression. Place-
ment of wash material only at the prepared teeth may
result in a "stepped" impression and lead to a restoration
that is not accurate related to the occlusion.
While the cause of large, internal, ill-defined areas in
these preparations is usually fluid accumulation, air en-
trapment may also be a factor in narrow, deep inlay prepa-
rations. These errors may be avoided by thorough flushing
and drying of the preparation prior to impression taking.
Placing an intraoral impression tip into the deepest part
of the preparation floor and extruding a light body VPS
material to backfill the preparation, making sure to keep
the tip in the material as its expressed, will force air out
of the preparation decreasing entrapment potential.
If an air bubble remains on the cast after the impression
is poured, a corresponding void will be created in the
prosthetic material. This should not interfere with seating
of the restoration and will be filled with the luting agent.
These spots can often prevent complete seating when
removed from the cast prior to restoration fabrication as
alteration of the casts surface may not match what is
present intraorally on the preparation. Identification of
premature internal contacts can be performed with paint
on occlusion indicator liquids (e.g., Accufilm IV, Parkell
Inc, Farmingdale, NY; Arti-Spot Bausch, Nashua, NH). The
laboratory can block out around these tiny internal bubbles
prior to fabrication to decrease chairside time.
MARGINAL TEARS
Marginal tears usually occur when a wash (syringable)
material with insufficient tear strength is used (Figure 4).
Tear strength will vary from manufacturer to manufacturer
Figure 4
4 www.DentalAcademyOfCE.com
and between viscosities. The lower the viscosity the more likely it may tear in the
sulcus due to the thinness expressed subgingivally. The deeper the sulcus, the
thinner the wash material and the higher the potential for it to tear when removed
intraorally. Additionally, removal of the impression prior to complete setting of the
wash material may also cause marginal tearing.3 Elastic recovery of the wash mate-
rial is also critical to impression accuracy. The material may not tear upon removal
intraorally, but if it does not return to its pre-removal shape, the resulting impres-
sion will not be accurate and the prosthesis will not fit the teeth.
Should an impression need to be retaken due to sulcular material tearing, any
remnants of the original impression material must be removed from the sulcus.
Additional tissue retraction may be indicated to widen the sulcus to facilitate
thicker sulcular impression material. Switching to a more viscous wash material
may further prevent development of another tear. Syringable hemostatic materi-
als (ViscoStat® Clear, Ultradent, South Jordan, UT; Quick-Stat Free, Vista Dental
Products, Racine, WI) can be used to limit the amount of fluid evident in the
treatment area, and the patient can be instructed to occlude into a cotton cap
for several minutes, thereby physically pushing the tissue away from the tooth
and forcing the hemostatic deeper into the tissues.5, 6
DRAGS AND PULLS
A common complication encountered when using high viscousity impression ma-
terials (i.e., putty or heavy body materials) are drags and pulls. A drag results when
long, rounded depressions that resemble the cuspal edges of the teeth are left in the
impression material upon insertion of the tray (Figure 5). Whereas, a pull (also referred
to as a fold) results when the material creates a fold in the material, usually at the
gingival aspect (Figure 6). These deformities can both result from:
• Teeth rebounding off the tray and sliding into position.
• Impression material beyond its working time (no longer in its most fluid state)
• Failure of the impression material to adapt to the teeth.
• Exceeding working time of the material prior to intraoral insertion.
• Insertion of the tray in one motion.
Drags and pulls can be avoided by using a less viscous material either syringed
around the teeth or placed over the more viscous material in the tray prior to insertion.
Correction of a pull in the impression can be accomplished by removal of the inter-
proximal impression material so the impression can be reinserted without interference.
A wash impression material (light or extra-light) should be placed over the entire
Figure 5 Figure 6
 DENTAL ACADEMY OF CONTINUING EDUCATION
impression, and the depressions should be filled where the teeth are. The impression
can then be reinserting intraorally. Drags, on the other hand often are not correctable
by adding additional material, as they may have caused distortion of the tray. Avoiding
contact between the tray and the teeth will help avoid these deformations.
TRAY SELECTION
Tray selection is important to capture the needed area without distortion and
provide the needed details.7, 8 The tray, either a dual arch tray (also known as a triple
tray) or stock single arch tray, should be large enough encompass all the teeth
without contacting the soft tissue (Figure 7). The completed impression should
not demonstrate any show through of the tray. Full arch trays are available in small,
medium and large and arch shape varies by manufacturer with some trays round
in shape and others more square. When using stock full arch trays it is important
to select a tray that is long enough to capture the entire arch from the hamular
notches or retromolar pads to the most anterior aspect of the buccal vestibule. A
tray that is too narrow may prevent adequate seating of the tray leading to missing
of needed arch detail (Figure 8). Metal trays may be bent to widen them in the
posterior, but modifications to the anterior of the tray can be difficult. Plastic stock
trays are easier to modify. An alcohol torch may be used to heat the plastic tray and
the flanges readapted to fit the specific patient.
Dual-arch trays also are available in different widths that can accommodate
different width arch sections. It is best to have a variety of these trays to accom-
modate each patients arch size and shape. Show-through of the tray in the impression
indicates that the tray used was either positioned improperly or the tray was too
small. (Figure 9) With dual-arch trays contact with the tray by soft tissue may cause
distortion of the resulting impression and a restoration that does not fit the prepared
tooth. When using quadrant or dual arch trays, it is important to capture at least
one full tooth (or the equivalent space) both mesial and distal to the tooth to be
restored. Failure to provide this in the impression may make it difficult for the labo-
ratory to properly mount the casts and achieve an accurate occlusion (Figure 10).
Figure 7 Figure 8
Figure 9 Figure 10
www.DentalAcademyOfCE.com 5
Figure 11
SEPARATION FROM THE TRAY
Separation of the impression material from the tray may
not be obvious until the restoration is returned and tried
in (Figure 11). This deformation may be overlooked when
using trays with slots and holes to lock the impression
material and can occur with VPS, polyethers and even
alginate. The heavier the viscosity of the impression mate-
rial the higher the potential for the material not to lock
into the retention areas of the tray. Tray adhesive should
be used with all impressions to help eliminate impression
separation from the tray creating a chemical bond between
the tray and impression material.9 Additional holes for
mechanical retention may be placed with a lab bur in stock
trays if needed. Each impression material’s chemistry is
different so it is advised that the clinician use the tray
adhesive from the same manufacturer as their impression
material to ensure chemical compatibility between the
adhesive and impression material. Following application
of the adhesive to the tray, allow the adhesive to dry prior
to applying the impression material. The adhesive can be
applied at the beginning of the appointment and will then
be dry and ready when it is time to take the impression.
TRAY DISTORTION
Trays may distort when they come in contact with the
teeth or tissue and this is more problematic with dual-arch
trays then full arch trays due to their design. Distortion of
the tray with dual arch trays is due to their more flexible
nature as the patient occludes especially if soft tissue
contacts the rigid part of the tray or posterior loop. This
distortion may cause either a widened cast tooth when
the impression material is stiff enough to resist spring back
 DENTAL ACADEMY OF CONTINUING EDUCATION
(Figures 12a). Use of a medium body (monophase) VPS as
the main tray material will allow the tray to distort when it
contacts soft tissue or tooth and an elongated cast tooth
results as the tray springs back. (Figure 12b) Proper selection
of a tray that does not contact the teeth and is rigid enough
to resist distortion is critical. When using dual-arch trays, it
is advisable to use a rigid setting VPS material (e.g., a heavy
body or tray material) as the bulk of the impression to provide
a stable impression.10 Two-phase impressions can be used
to create a custom format using the dual-arch tray. The
preliminary impression creates a rigid base that will provide
hydraulic pressure to force the wash material in and around
the preparations. Trimming the interproximal material from
the preliminary impression will aid in seating the wash
impression fully when the wash phase is performed.
Figure 12a Figure 12b
INADEQUATE SYRINGE MATERIAL
A “stepped” impression may result when using a two-phase
impression technique and insufficient wash material has been
placed (Figure 13). The result will be restorations that require
excessive occlusal adjustments. This can be avoided by filling
the entire set tray material where the teeth depressions are
with wash material, to provide a uniform impression.
Figure 13
6 www.DentalAcademyOfCE.com
DUAL ARCH TRAYS
Dual arch trays work well for fixed prosthetic applications as long as the patient
has holding occlusal contacts in the section of the arch to be restored. As previously
indicated, it’s important that at least one tooth mesial and distal to the prepared
tooth be captured in the impression. Dual arch trays are available as posterior
quadrant, anterior arch, ¾ arch, and full arch versions.
When the tray is inserted and the patient occludes, it is important that maximum
intercuspation be observed on the adjacent side (Figure 14). When using anterior dual
arch trays it is often difficult to determine if the patient has occluded fully, so a separate
bite should be provided to the laboratory in a very rigid VPS material designed for
occlusal records. It is recommended that the lab be instructed to use the separate bite
record provided to mount the case and avoid hand articulating the casts or using the
dual-arch impression to determine occlusion. Wax bites should not be used as they
are unstable in transport to the lab due to changes in temperature during shipping.
Posterior and ¾ quadrant trays have a plastic distal loop on the tray to stabilize the
tray at insertion. It is critical that the patient not occlude on this loop as this will lead
to distortion of the tray and resulting spring back when the tray is removed (Figure 15).
Figure 14
Upon dual arch tray impression removal, the clinician should be able to see
contacts through the material to the trays mesh where the teeth are intercuspated
(Figure 16). Holding the tray up to the light should reveal illumination at these
contact points. An impression that was improperly occluded will show lack of oc-
clusal shine through and thicker material between the arches. If there is any chance
that the laboratory cannot verify the occlusion, a separate bite should be taken
with an appropriate VPS material and included with the case.
Figure 15 Figure 16
 DENTAL ACADEMY OF CONTINUING EDUCATION

Figure 17

Figure 18

SURFACE CONTAMINATION
A less common problem, unset im-
pression material on the surface of
the set tray material may present. This
typically presents as an unset tacky
layer (Figure 17). Exposure to air in- INADEQUATE IMPRESSION MATERIAL MIXING
hibited methacrylates (e.g., compos- Once the impression material is combined, it should be
ites, adhesives, core build-up materi- uniform in color with no streaking. Streaking is more com-
als, bis-acryl temporary crown and mon with hand mixed putty materials than with cartridge
bridge materials) may leave a greasy coat on the prepared tooth that inhibits the materials (Figure 18). When hand mixing putty, the material
material’s ability to set correctly. When using two-step impressions, failure of the should be kneaded quickly to keep within the working time
wash material to adhere to the tray material may occur when the preliminary and yield a uniform color when completed. But, may also
impression is utilized to fabricate the temporary prosthesis. Wiping down both the occur if the automix cartridge is not bled prior to attaching
tooth and preliminary impression with alcohol to remove the greasy air-inhibited the mixing syringe, allowing one component to extrude
layer can prevent these issues. out of the cartridge first. Standard operating procedure
Hemostatic agents may transfer sulfur to critical areas of the impression and cause should be to bleed the cartridge right before a new automix
inhibition of the setting reaction of the marginal VPS material. These include retrac- tip is placed to ensure both base and catalyst are equally
tion cords and solutions containing ferric sulfate or aluminum chloride; glove contact flowing to avoid mixing issues. It is also recommended
of the prepared teeth or surrounding tissues; rolling retraction cord in gloved fingers; that the practitioner use the wash and tray material from
or the use of a rubber dam. Rinsing the area with mouthwash or water after rubber the same manufacturer to ensure that chemically the two
dam removal and thoroughly drying can avoid this problem. Latex contamination of materials are designed to work together. Mixing materials
the putty can occur when mixing by hand. This may be avoided by washing gloved from different companies may lead to separation of the
hands to remove any residual powder and surface sulfides. Powder-free, nitrile or vinyl wash material from the tray VPS decreasing the impressions
gloves are alternatives to prevent putty contamination. It is advised that following accuracy when the lab pours the model.
use of a hemostatic agent to control gingival hemorrhage, the preparation be vigor-
ously washed with the air/water syringe to clean any residual hemostatic and debris CAST DISCREPANCIES
from the tooth. Should any gingival oozing begin, additional hemostatic is burnished Large bubbles on the cast will correspond to a defect in
into the gingiva to arrest the hemorrhaging. If no bleeding is noted the prep is air dried the impression material and should be identified before
and impressioning can begin. This will avoid sulcular bleeding that will lead to having dismissing the patient so that a new impression or a wash
to retake the impression and the impression is only begun when your assured all in the defective impression can be taken to correct the
hemorrhage in the sulcus has been controlled. problem (Figure 19). These bubbles invariably are caused
When a small area of unset material is noted in the final impression, but the re-
mainder of the material has set properly. This may be the result of a failure to bleed
the cartridge prior to expressing material from the auto mix tip. All new cartridges
should be “bled” prior to use. It is a wise practice to express a small amount of base
and catalyst prior to placement of an automix tip each time to ensure that both
materials are flowing from the cartridge and have not set at the end of the
cartridge. Figure 19
Disinfection of the completed impression can be performed either prior to sending
the impression to the laboratory or at the laboratory. Immersion of the impression in
common disinfecting solutions (i.e. phenols and gluteraldehydes) used for periods of
time up to 60 minutes have not shown clinically significant distortion or surface al-
teration of the impression material.11, 12 Although, overnight immersion is not recom-
mended as this may result in a decrease in accuracy of the final cast.13

www.DentalAcademyOfCE.com 7
 DENTAL ACADEMY OF CONTINUING EDUCATION
by insufficient impression material in the tray or air trapped
between the impression material and the arch at tray inser-
tion. These defects can be avoided by syringing material
around the teeth and into the vestibule prior to tray inser-
tion. Patients with deep palates, it is also advisable to place
some impression material into the depth of the palatal
vault. Additionally, as these large bubbles are more frequent
in maxillary impressions, how the filled tray is inserted
also plays a factor. Inserting the tray posteriorly first will
not only limit impression material extruding out the back
which may cause gagging in some patients, but also pushes
impression material anteriorly as the tray is rotated into
position and with it the air that might become trapped.
Should a void in the impression be present upon tray
removal due to air entrapment, a wash impression can be
used to fill the void. It is advisable that the interproximal
material be removed from the impression to allow full
seating and the entire tray be covered in the wash material
to ensure a continuous impression with no “step” appear-
ance. Large bubbles in the impression in non critical areas
of the opposing arch may not require a wash in the impres-
sion to fill the void, but that is up to the practitioner to
decide what the laboratory ideally needs to create the
prosthetics being requested.
A cast that is covered with multiple tiny voids (bubbles)
when the impression does not have corresponding defects
may be the result of hydrogen gas release from the impres-
sion (Figure 20). Hydrogen is a by-product of VPS polymer-
ization. Should the cast present with this defect, if the im-
pression is still intact it can be re-poured. This type of defect
can be avoided by following the manufacturer’s recommen-
dation with regard to the duration that should be observed
prior to pouring the cast. Typically, waiting 30 minutes or
longer before pouring the impression is sufficient to allow
the impression to "de-gas". This is not a concern if the impres-
sions will be sent to the lab where they will pour them.
Figure 20
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IMPLANT IMPRESSIONS
Impressions for implants involving impression materials are divided into two catago-
ries; open tray and closed tray impressions and the impression copings for these differ
in geometry. (Figure 21) Open tray impressions require that the impression coping is
retained in the impression and they are removed together and have a long pin that
will protrude through the impression and tray. (Figure 22)
Whereas when a closed tray impression is taken the impres- Figure 21
sion is removed intraorally leaving the impression coping
attached to the implant. The impression coping is then re-
moved intraorally, an analog attached and it is reinserted
back into the impression extraorally. (Figure 23) What im-
pression material is selected is dependent on which type of
impression will be taken. A stiffer tray material (heavy body
or tray VPS) is required when taking an open tray impression
to lock the impression copings into position so that they are Open
Closed
oriented both to each other and the connector rotation is tray tray
captured so the resulting master soft tissue model is accurate
to fabricate the prosthetics. Closed tray impressions, as the
coping must be reseated into the impression extraorally need a more resilient viscosity
of impression material. If a stiff VPS such as a heavy body were used, it may tear
around the copings when it is removed intraorally and would hamper full seating of
the coping back into the impression. Thus, a medium body (monophase) VPS is ide-
ally suited for this application allowing the impression to spring off the coping as it
is removed intraorally and allow the coping to be reinserted back into the impression
to fabricate the master soft tissue model. It is advised with both approaches that a
wash material be syringed around the gingival aspect only, to capture the gingival
position better then may be achieved with the material in the tray alone. Implant
impressions differ from impressions of natural teeth, as implants do not have a PDL
rigidity of the impression material is more important for the precision of the prosthet-
ics that will be fabricated when adjacent implants are to be restored.
WHAT TO LOOK FOR IN AN IMPRESSION MATERIAL?
Not all impression materials are equal and what to look for when selecting an
impression material is important to achieve accurate predictable impressions.
Setting time is important for patient comfort and the shorter the impression is
in the mouth the happier the patient is typically. Faster setting VPS are available
Figure 22
 DENTAL ACADEMY OF CONTINUING EDUCATION
Figure 23
but it is important to know the working time for that material. The impression
needs to be dispensed into the tray and inserted within that working time. If this
is exceeded the impression material has started the setting process and may not
fully seat, plus will not accurately capture the needed details intraorally. As
discussed high tear strength for the wash material with good elastic recovery
will allow accurate capture of the marginal details. Hydrophilicity, is also an
important feature in quality VPS impression materials. Materials that have high
hydrophilicity will adapt to the prepared tooth better especially subgingivally
where fluid may be present. Those that have low hydrophilicity or are hydrophobic
will not adapt to wet surfaces and lead to lower impression quality as a result.
Some of the materials that fulfill those qualities include; Thermo Clone VPS
(Ultradent), Imprint (3M/ESPE) and Take One (Kerr Dental).
CONCLUSION
Complications during the impression process can be perplexing to both the dentist
and laboratory technician. Some of the more common concerns include tearing, voids,
bubbles, and tray contact. Identifying the problem is only half the solution and under-
standing why it occurred helps guide the practitioner to correct the issue and prevent
future occurrences. This article addressed solutions for correction of some of the most
prevalent impression issues that are experienced in clinical practice. By taking the
necessary precautions, clinicians can ensure improved accuracy in communication
of critical parameters as well as an overall improvement in restorative fit related to
their impressions. Key to these goals are achieving sufficient hemostasis (retraction
cord, retraction pastes or laser) and using a quality impression material so that treat-
ment success is maximized for the doctor, lab and most importantly the patient.
REFERENCES:
1. Shannon A.: Expanded clinical uses of a novel tissue-retraction material. Compend Contin Educ
Dent. 2002 Jan;23(1 Suppl):3-6
2. Poss S.: An innovative tissue-retraction material. Compend Contin Educ Dent. 2002 Jan;23(1
Suppl):13-7
3. Pescatore C.: A predictable gingival retraction system. Compend Contin Educ Dent. 2002 Jan;23(1
Suppl):7-12
4. Kurtzman GM, Agarwal T.: Laser Troughing to Improve Scanning and Impressions. Dent Today. 2017
Jan;36(1):122-5.
5. Hondrum SO.: Tear and energy properties of three impression materials. Int J Prosthodont. 1994
Nov-Dec;7(6):517-21.
6. Chai J, Takahashi Y, Lautenschlager EP.: Clinically relevant mechanical properties of elastomeric
impression materials. Int J Prosthodont. 1998 May-Jun;11(3):219-23.
7. Brosky ME, Pesun IJ, Lowder PD, Delong R, Hodges JS.: Laser digitization of casts to determine the
effect of tray selection and cast formation technique on accuracy. J Prosthet Dent. 2002
Feb;87(2):204-9.
www.DentalAcademyOfCE.com 9
8. Thongthammachat S, Moore BK, Barco MT 2nd, Hovijitra S, Brown DT,
Andres CJ.: Dimensional accuracy of dental casts: influence of tray
material, impression material, and time. J Prosthodont. 2002
Jun;11(2):98-108.
9. Giordano R 2nd.: Issues in handling impression materials. Gen Dent.
2000 Nov-Dec;48(6):646-8.
10. Ceyhan JA, Johnson GH, Lepe X.: The effect of tray selection,
viscosity of impression material, and sequence of pour on the
accuracy of dies made from dual-arch impressions. J Prosthet Dent.
2003 Aug;90(2):143-9.
11. Rios MP, Morgano SM, Stein RS, Rose L.: Effects of chemical
disinfectant solutions on the stability and accuracy of the dental
impression complex. J Prosthet Dent. 1996 Oct;76(4):356-62.
12. Oda Y, Matsumoto T, Sumii T.: Evaluation of dimensional stability of
elastomeric impression materials during disinfection. Bull Tokyo
Dent Coll. 1995 Feb;36(1):1-7.
13. Lepe X, Johnson GH.: Accuracy of polyether and addition silicone
after long-term immersion disinfection. J Prosthet Dent. 1997
Sep;78(3):245-9.
AUTHOR PROFILE
Gregori M. Kurtzman, DDS, MAGD,
FPFA, FACD, FADI, DICOI, DADIA, Dr.
Kurtzman has completed over 4,500 hours
of continuing education in the areas of
IMPLANT DENTISTRY, COSMETIC DENTISTRY
AND OTHER DENTAL TOPICS. A graduate of
The AAID / Howard University College of
Dentistry IMPLANT MAXI COURSE, he has been trained in all aspects
of Implant Dentistry. He has achieved FELLOWSHIP in the Academy
of General Dentistry (AGD), Pierre Fauchard Academy (PFA),
International Congress of oral Implantologists (ICOI), the American
College of Dentists (ACD) and the Academy of Dentistry
International (ADI). Holds MASTERSHIP in the AGD and the Implant
Prosthetic Section of the ICOI. He also has achieved DIPLOMATE
status in the ICOI and the American Dental Implant Association
(ADIA). He is a former Assistant Program Director for a university
based IMPLANT MAXI-COURSE and a former Assistant Clinical
Professor at University of Maryland, Baltimore School of Dental
Surgery in the department of Endodontics, Prosthetics and
Operative Dentistry. An International lecturer, he has been
recognized annually since 2006 as one of the “TOP DENTAL
LECTURERS” by Dentistry Today. Dr. Kurtzman has published over
180 dental articles in national and international dental journals and
is a consultant to multiple dental manufacturers.
AUTHOR DISCLOSURE
The author has no affiliations with any company who would have
a gained interest in the material published in this course. The
author is not employed by a company that would stand to profit
off the publication of this course. All research is presented in an
unbiased manner.
 DENTAL ACADEMY OF CONTINUING EDUCATION
ONLINE COMPLETION
Use this page to review the questions and answers. Return to www.DentalAcademyOfCE.com and sign in. If you have not previously purchased the program select it from the “Online
Courses” listing and complete the online purchase. Once purchased the exam will be added to your Archives page where a Take Exam link will be provided. Click on the “Take Exam” link, complete
all the program questions and submit your answers. An immediate grade report will be provided and upon receiving a passing grade your “Verification Form” will be provided immediately for
viewing and/or printing. Verification Forms can be viewed and/or printed anytime in the future by returning to the site, sign in and return to your Archives Page.
1. Primary complaint from labs is?
a. Inadequate marginal detail
b. Torn sulcular material
c. Voids on the marginal material
d. All of the above
2. Failure to capture the marginal details
will result in?
a. Overhanging restoration margins
b. Overextended restorative margins
c. Open restorative margins
d. A and C
3. Methods to better visualize the
restorative margin to capture with an
impression?
a. Retraction cord
b. Retraction pastes
c. Laser
d. All of the above
4. Internal bubbles on the impression may
be due to?
a. Trapped moisture
b. Trapped food
c. Unset impression material
d. Poor tooth preparation
5. Which is problematic in the impression?
a. Bubbles on teeth not being restored that do
are not adjacent to the prep
b. Bubbles on the opposing arch
c. Bubbles at internal line angles
d. Bubbles at the margins
6. If a bleb is noted related to a bubble on
the internal line angle of the prep on the
cast it is recommended to?
a. Ignore the bleb as it won’t affect fabrication
of the restoration
b. Scrap off the bleb on the cast
c. Block out the area on the cast around the
bleb if it is small
d. Block out the area on the cast around any
size bleb
7. Large bubbles in the impression at
internal line angles may?
a. Compromise the strength of metal
restorations fabricated on the cast
b. Compromise the strength of ceramic
restorations fabricated on the cast
c. Not effect the integrity of the restoration
fabricated
d. May be altered on the cast to remove
before restoration fabrication
10 www.DentalAcademyOfCE.com
QUICK ACCES S CO DE 15259
QUESTIONS
8. When using a 2-step impression 14. Exceeding the working time of the
technique? impression material can result in?
a. Trim interproximal material with scissor in a. Drags and folds
set tray material before step 2 b. Failure of the wash material and tray
b. Avoid drying the set material in the tray material to adhere to each other
c. Place wash material over all tooth c. No effect on the final impression
areas in the set tray material before d. Make removal of the impression intraorally
reinserting more difficult
d. A and C 15. To avoid drags and pulls when using
9. When capturing an occlusal or proximal heavier body tray materials you can?
preparation it is advised to? a. Use a 1-step technique
a. A. Use a wash material placed into the tray b. Use a 2-step technique
over the unset tray material c. Syringe wash material around all of the
b. Place an intraoral tip to the bottom of the teeth before inserting the previously set
preparation and backfill it to prevent air tray material
entrapment d. Syringe wash material around all of the
c. Utilize a 2-step technique teeth before inserting the unset tray
d. Avoid use of a heavy body VPS material
10. Identification of internal premature 16. When using a dual-arch tray?
contacts on an inlay/onlay restoration a. Use a heavy body VPS in the tray
can be aided by? b. Use a medium body VPS in the tray
a. Liquid occlusal indicator c. Viscosity of the tray material is not
b. Use of articulating film instead of important
articulating paper d. All trays are the same
c. Relief of the entire internal area of the 17. Tray selection is important because?
restoration with a bur/diamond a. Patient arches vary and one manufacturers
d. Relief of the entire preparation with a bur/ tray will not fit all arches of that same
diamond size
11. Marginal tears of the impression b. Prevent show through of the tray in the
material are related to? completed impression
a. Low wash material tear strength c. Not contact soft tissue when inserted that
b. Deep margin with narrow sulcus may lead to distoration
c. Premature removal of the impression d. All of the above
intraorally 18. When using full arch trays it is
d. All of the above important to select a tray that is?
12. Regarding marginal tearing, a. Long enough to capture the entire arch
which viscosity will be stronger in a b. Long enough to capture the teeth being
deeper sulcus to capture needed treated
detail? c. Tray contact with soft tissue is not
a. Very light body VPS important
b. Light body VPS d. Not wider then the arch
c. Medium body VPS 19. When using a dual-arch posterior tray it
d. Universal body VPS is important that?
13. When using a heavier body VPS in the a. Contact with the posterior loop helps
tray you may notice? stabilize the occlusion of the impression
a. Longer setting time b. Upon biting not have contact with the
b. Drags may be noted due to air entrapment posterior loop
c. Drags may be noted due to the cusps when c. Show through on the occlusal surface not
inserted be present
d. Lack of adhesion to the wash material d. Contact with the tray be evident to ensure
when doing a 1-step technique an accurate impression

20. Separation of the impression material
from the tray can be avoided by?
a. Application of a compatible adhesive to the
tray
b. Selection of a tray with adequate retentive
elements
c. Addition of holes or slots to the stock tray
before taking the impression
d. All of the above
21. A “stepped” impression may result
when?
a. Inadequate wash material is used in a
1-step technique
b. Inadequate wash material is used in a
2-step technique
c. Working time of the materials has been
exceeded
d. Different brands of VPS used together
22. Unset VPS on the impression surface
may be a result of?
a. Contact with oxygen inhibited
methacrylates
b. Contact with blood
c. Contact with powder-free latex gloves
d. All of the above
23. Bleeding the automix cartridge is
important to
a. Ensure flow of base and catalyst from the
cartridge
b. Ensure the material has not expired
c. Ensure complete mixing from the
automix tip
d. A and C
www.DentalAcademyOfCE.com 11
QUESTIONS (CONTINUED)
24. When disinfecting an impression you can?
a. Spray with disinfectant and immediately
rinse off
b. Immerse in approved disinfecting solution
for up to 30 minutes
c. Immerse in approved disinfecting solution
for up to 60 minutes
d. Immerse in approved disinfecting solution
overnight
25. When taking a VPS impression one
should?
a. Pour the impression immediately
b. Wait at least 30 minutes before pouring
c. Wait at least 60 minutes before pouring
d. Pour the impression before sending to the
lab for maximum accuracy of the cast
26. Multiple tiny bubbles on the cast that
are not in the impression is an indication
of?
a. Impression did not have adequate time to
de-gas
b. Moisture was present on the impression
before it was poured
c. Impression was dry before it was poured
d. The impression material is not compatible
with the stone used to fabricate the cast
27. When taking an open tray implant
impression?
a. A medium body VPS is recommended
b. A heavy body VPS is recommended
c. Any viscosity VPS may be used
d. VPS should not be used as the impression
material
NOTES
28. When taking an closed tray implant
impression?
a. A medium body VPS is recommended
b. A heavy body VPS is recommended
c. Any viscosity VPS may be used
d. VPS should not be used as the impression
material
29. If a tray material VPS is used to capture
a closed tray impression what potential
problems can occur?
a. Impression may tear upon removal of the
impression intraorally
b. No problems will result using a tray
material
c. Reinsertion of the coping back into the
impression extraorally may not be accurate
d. A and C
30. Use of a heavy body VPS as the tray
material when taking an open tray
impression
a. Locks the impression copings accurately in
relation to other adjacent implants
b. Accurately captures the implants rotational
orientation
c. Is more accurate then taking a closed tray
impression
d. All of the above
 PUBLICATION DATE: APRIL 2018 ANSWER SHEET

Identifying and Managing Dental Impression Problems

EXPIRATION DATE: MARCH 2021

Name: Title: Specialty:

Address: E-mail:

City: State: ZIP: Country:

Telephone: Home ( ) Office ( )

Lic. Renewal Date: AGD Member ID:

Requirements for successful completion of the course and to obtain dental continuing education credits: 1) Read the entire course. 2) Complete all information above.
3) Complete answer sheets in either pen or pencil. 4) Mark only one answer for each question. 5) A score of 70% on this test will earn you 3 CE credits. 6) Complete the
Course Evaluation below. 7) Make check payable to PennWell Corp. For Questions Call 800-633-1681
If not taking online, mail completed answer sheet to

EDUCATIONAL OBJECTIVES PennWell Corp.

Attn: Dental Division,
1. Learn how to identify common impression problems
1421 S. Sheridan Rd., Tulsa, OK, 74112
2. Learn how to correct impression problems or fax to: 918-212-9037
3. Learn how to avoid impression problems and improve impression quality
For IMMEDIATE results,
4. Learn what types of impression materials are best suited for particular restorative needs go to www.DentalAcademyOfCE.com to take tests online.
QUICK ACCES S CO DE 15259
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______________________________________________________________________________ 10. 25.
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