Impression Materials Used in Removable and Fixed Prosthodontics by Guy Deyton DDS Tallgrass Dental Seminars The Missouri

Dental Association has expressed permission to publish this for the benefit of its members.

Learning Objectives 1. Understand the definitions of the terms used to describe characteristics of impression materials. 2. Review the types and characteristics of common impression materials suitable for taking impressions for complete dentures, removable partial dentures, crowns and bridges. 3. Understand the appropriate uses for each material. 4. Understand how to identify applications that dont fit material characteristics and would make it difficult to capture an excellent impression regardless of technique.

Introduction Successful complete dentures, removable partials, crowns and bridges depend to a large extent on accurate impressions. Below are the most common types of impression materials suitable for taking impressions for complete dentures, removable partial dentures, crowns and bridges. Each has its advantages and disadvantages. Each, used correctly can be a valuable material. In order to be used properly, one has to know the materials characteristics, advantages, and disadvantages. Each of these materials used in the wrong situation or without an adequate knowledge of their characteristics will yield poor results regardless of how hard you try. For more information on the subject of fixed and removable prosthetic impressions, please refer to available courses on Successful Impression Techniques for Fixed Prosthetics and Successful Impression Techniques for Removable Prosthetics. Philosophy Skilled professionals understand that the first step toward a successful outcome is the selection of the proper material for the appropriate application. When the right material is used with the proper impression technique, an excellent impression can be obtained. Any laboratory technician will tell you that excellent impressions are the hallmark of a master dentist.

Methods 1. Understand the definitions of the terms used to describe characteristics of impression materials. A. Hydrophilic: (water loving) The relative ability of an impression material to tolerate moisture in an impression site and still provide an accurate impression. A material that will tolerate a modest amount of moisture is considered hydrophilic. Hydrocolloids are the most hydrophilic of the materials listed below. B. Hydrophobic: (water fearing). An impression material with a very low ability to tolerate moisture in an impression site and still provides an accurate impression. Despite manufacturer claims, all polyvinyl siloxane materials are inherently hydrophobic. C. Wetting Angle: the relative ability of an impression material to flow into small crevices. This is really defined by the materials desire to stick to itself. 1. High Wetting Angle: Materials like Permadyne tray material have a greater desire to stick to themselves, than flow onto another surface. Therefore, Permadyne tray material would have a very high wetting angle, a poor characteristic if it were to be used by itself as a crown and bridge impression material. 2. Low Wetting Angle: Water is the best example of a material with a low wetting angle. It has very little desire to stick to itself and would rather run into every nook and cranny. This is a very good characteristic for a syringable material, but would be a problem for a tray material. D. Detail Reproduction: the ability of an impression material to accurately reproduce small detail. Crown and bridge impression materials require high detail reproduction. These materials are able to reproduce details as fine as 20-30 microns. Impression materials with moderate detail reproduction are able to reproduce details as fine as 100-150 microns. Impression materials with moderate detail reproduction are quite acceptable for removable prosthodontics. With the exception of alginates and methacrylates, all impression materials listed below have an excellent ability to reproduce details. Alginates and methacrylates have a moderate ability to reproduce fine detail. E. Dimensional Stability: The ability of an impression material to maintain the accuracy of the impression over time. Practically, an impression from a material with high dimensional stability can be poured several weeks later and still produce an accurate model. Polyvinyl siloxanes are the most dimensionally stable of the commonly used materials. Alginates and hydrocolloids have low dimensional stability. F. Rigidity: the relative stiffness of the material after setting. A material with high rigidity needs less support from a tray to prevent distortion on pouring; makes a good jaw relation material. Rigid impression materials are excellent for implant impressions where removable impression posts must accurately transfer the spacial position of the implant. Rigid impression materials will also be more difficult to remove in a full arch impression of periodontally involved teeth. An example of a rigid impression material is Permadyne tray material, a polyether. G. Tear Strength: the relative ability of a material to resist tearing after setting, even in thin sections. This is important in capturing an accurate impression of subgingival margins

where the material flows into thin sulcular spaces. Polyether has the highest tear strength of the commonly used materials. Hydrocolloid has low tear strength. H. Taste: a category that becomes very important to your patients. Recently Discus Dental has introduced Berry and chocolate flavored polyvinyl siloxane. Rubber base and polyether still take worst of show in the taste category. I. Cost: Simply put, you want the least expensive impression material that will give you consistently good results. There are two costs you must consider: initial cost and the cost of retakes. If you consider how much chair time is worth in your office, you will understand that the impression material with the least initial cost would be the most expensive if you had to retake a significant number of impressions. The relative cost data provided is initial cost. J. Disinfection: the relative ease that an impression material can be disinfected after setting without risk of distortion. Polyvinyls are virtually impervious to all disinfection protocols. Hydrocolloids, Alginates, Polyethers, and Methacrylates all have specific disinfection protocols, which if not adhered to will cause distortion of the impression. K. Contact Angle: the relative ability of the set impression material to have another material (dental stone) flow over its surface. A low contact angle would mean that stone flows easily and bubble free models were relatively easy to produce. A material with a high contact angle would need more attention to produce an excellent model. All the materials listed below have relatively low contact angles except polyvinyl siloxane. Surfactants are available in spray form to lower the contact angle of any impression material. 2. Review the types and characteristics of common impression materials suitable for taking impressions for complete dentures, removable partial dentures, crowns and bridges. ( + indicates positive characteristic. - indicates negative characteristic.) A. Hydrocolloid (Rubberloid) + Hydrophilic: high. Will still capture accurate impression in the presence of a little blood or saliva. + Wetting angle: low. Easier to capture a perfect full arch impression with than with polyvinyls. + Detail reproduction: excellent. - Dimensional stability: poor. Must be poured immediately unless stored in K2SO4. Absolutely only one accurate pour per impression. +/- Rigidity: low. Impressions more easy to remove than polyvinyls or polyethers Hydrocolloids must have rigid trays. Not suitable for triple trays. - Tear strength: low. Will capture a subgingival impression well but has tendency to tear on removal. Not as strong as polyethers or polyvinyls.

+ Taste: neutral. Much better than polyether or polysulfide. + Cost: low - Disinfection: difficult. High risk of distortion from disinfection if not performed correctly. Due to hydrophilic nature, tend to swell when immersed in water or disinfectant. Protocol: spray with 2% gluteraldehyde, place in plastic bag, and time for 10 minutes. Rinse immediately. Soak in K2SO4 + Comment: Setting reaction not contaminated by latex proteins from rubber gloves. - Comment: will not adhere to itself. Can not be used to border mold and for correctable impression technique. - Comment: requires special equipment and trays. B. Alginate (Jeltrate, Kromoscop) + Hydrophilic: high. Will still capture accurate impression in the presence of a little blood or saliva. + Wetting angle: low. Easier to capture a perfect full arch impression with than with polyvinyls. - Detail reproduction: moderate. Not accurate enough for crown and bridge. Suitable for primary impressions and framework impressions for partial dentures when altered cast technique is employed. - Dimensional stability: poor. Must be poured immediately. (Maximum 10-minute delay or distortion will occur.) Absolutely only one accurate pour per impression. - Rigidity: low. Impressions more easy to remove than polyvinyls or polyethers. Alginates must have rigid trays or they will distort. Not suitable for triple trays. - Tear strength: low. Will capture an impression well but has tendency to tear on removal. Not as strong as polyethers or polyvinyls. + Taste: neutral, which makes it much better than polyether or polysulfide. + Cost: low range - Disinfection: difficult. High risk of distortion from disinfection if not performed correctly. Due to hydrophilic nature, tend to swell when immersed in water or disinfectant. Protocol: spray with Lysol and time for 3 minutes or spray with 2% gluteraldehyde and time for 10 minutes and place in plastic bag. Rinse immediately and pour. + Comment: Setting reaction not contaminated by latex proteins from rubber gloves. - Comment: will not adhere to itself. Can not be used to border mold and for correctable

impression technique. - Comment: although the most frequently used impression material for complete and partial dentures, it is virtually impossible to accurately border mold alginate impressions. This difficulty is due to the viscosity of the material, the tendency of stock trays to distort tissues or fail to adequately support impression material, and relatively short working time. Alginate is an excellent primary impression material or a final impression material for partial denture framework. C. Polysulfide (rubber base) (Permalastic) + Hydrophilic: low to moderate. Will still capture accurate impression in the presence of a little blood or saliva. + Wetting angle: low. Easier to capture a perfect full arch impression with than with polyvinyls. + Detail reproduction: excellent. 0 Dimensional stability: fair. May allow two pours of accurate casts if no thin subgingival margins present. +/- Rigidity: low to moderate depending on viscosity of material selected.. Impressions easier to remove than polyethers. Polysulfides are not suitable for triple trays. + Tear strength: medium. Will capture a subgingival impression, usually without tearing on removal. Much better than hydrocolloids; better than polyvinyls. - Taste: bitter. Polysufides fall in to the category of You know it has to be good because it tastes so bad. + Cost: low range - Disinfection: difficult. High risk of distortion from disinfection if not performed correctly. Due to hydrophilic nature, tend to swell when immersed in water or disinfectant. Protocol: spray with 2% gluteraldehyde and time for 10 minutes. Rinse and bone dry immediately. + Comment: Setting reaction not contaminated by latex proteins from rubber gloves. + Comment: Polysulfides are an encellent choice for subperiosteal implant impressions because of excellent detail reproduction, low wetting angle, and favorable rigidity characteristics when using heavy and light body dual viscosity technique. - Comment: will not adhere to itself. Can not be used to border mold and for correctable impression technique. D. Polyether (Impergum, Permadyne) + Hydrophilic: moderate. Will still capture accurate impression in the presence of a little

blood or saliva. + Wetting angle: low. Easier to capture a perfect full arch impression with than with polyvinyls. + Detail reproduction: excellent. + Dimensional stability: excellent. Allows multiple pours of accurate casts for several weeks after impression. +/- Rigidity: high. Impressions more difficult to remove than polyvinyls. Excellent for implant impressions. Polyethers are very suitable for triple trays. + Tear strength: high. Will capture a subgingival impression without tearing on removal. Much better than hydrocolloids; better than polyvinyls. - Taste: bitter. Polyethers fall in to the category of You know it has to be good because it tastes so bad. - Cost: high range $.38 -.84 / ml - Disinfection: difficult. High risk of distortion from disinfection if not performed correctly. Due to hydrophilic nature, tend to swell when immersed in water or disinfectant. Protocol: spray with 2% gluteraldehyde and time for 10 minutes. Rinse and bone dry immediately. + Comment: Setting reaction not contaminated by latex proteins from rubber gloves. + Comment: will adhere to itself. Can be used to border mold and for correctable impression technique. E. Polyvinyl Addition Silicones (Express, Cinch, Aquasil, Splash) + Hydrophobic generally. (Aquasil slightly hydrophilic.) Any moisture from blood or saliva can prevent an accurate impression - Wetting angle: moderately high. Makes polyvinyls more difficult to capture a perfect full arch impression than hydrocolloid, polysulfide, or polyether. + Detail reproduction: excellent. + Dimensional stability: excellent. Allows multiple pours of accurate casts for several weeks after impression. + Rigidity: generally moderate. Impressions remove more easily than polyethers. Some polyvinyls have insufficient rigidity to be suitable for triple trays. + Tear strength: much better than hydrocolloids; not as good as polyether.

+ Taste is generally neutral which makes it much better than polyether or polysulfide. + Cost: moderate range $.15-.41 / ml - Disinfection: Excellent. Polyvinyls are virtually impervious to all disinfection protocols. Polyvinyls are the only impression materials that may actually be cold sterilized without danger of distortion. Disinfection protocol: 30 minute soak in 2% gluteraldehyde. Cold sterilization protocol: 8 hour soak in 2% gluteraldehyde. - Pouring: moderate difficulty. Addition silicones release hydrogen on setting. Many require 1 to 3 hour de-gassing period before pouring impression or master cast will have surface porosity. Greater tendency to trap air bubbles due to moderately high contact angle. This means greater care necessary when flowing stone. - Comment: Contamination by latex proteins from rubber gloves may interfere with setting reaction. - Comment: Most will not adhere to itself after set. Therefore, most cannot be used to border mold or for correctable impression technique. Aquasil is an exception. F. Polyethyl and Polymethyl Methacrylate (Coe Comfort, Coe Soft, Lynol, Hydrocast, and Visco-Gel) Polyethyl and polymethyl methacrylates are commonly used as as tissue conditioners, temporary soft-liners, and functional impression materials for removable prosthodontics. Tissue Conditioners differ from soft liners because they have a flow period in which they continue to adapt to tissues after they have reached their set. Functional impression materials have an extended flow period. Hydrocast and Visco-Gel can be used as excellent functional impression materials. All are polyethyl or polymethyl methacrylate materials combined with an alcohol-based plastisizer. It is the plasitcizer that makes each unique. + Hydrophilic: moderate. Will still capture accurate impression in the presence of a little blood or saliva. + Wetting angle: low. Very easy to capture a perfect full arch impression. + Detail reproduction: moderate. Suitable for tissue impressions for complete and partial dentures + Dimensional stability: fair. Must be poured within one hour to insure stability4. Absolutely only one accurate pour per impression. +/- Rigidity: low. Methacrylates must have rigid trays that support to within 3 millimeters of peripheral borders of denture or partial denture or they will distort. Impressions relatively easy to remove. + Tear strength: low. Will capture an impression well but thin areas have a tendency to tear on removal. Not as strong as polyethers or polyvinyls.

+ Taste: neutral, which makes it much better than polyether or polysulfide. - Cost: moderate range $.38 -.84 / ml - Disinfection: moderate. Protocol: soak in 8% hydrogen peroxide for 8 minutes. Rinse and dry prior to pouring. Will not distort due to water absorption. However, due to its alcohol base, methacrylates will distort easily when exposed to alcohol based disinfectants such as Lysol. + Comment: This is an excellent impression material for reline or rebase of removable prosthetics. Once relined and trimmed, the patient wears the prosthesis for one day to two weeks (depending on the product) producing a perfectly molded functional impression. Each version is unique due to its plastisizers. Methacrylates are sticky in their working phase and there is definitely a learning curve in order to use effectively. + Comment: will adhere to itself. Can be used to border mold and for correctable impression technique. Acrylic additives are available to stabilize extended borders of impression if necessary. Coe Comfort: a true tissue conditioner. It has longer adaptive flow (1 to 2 days) than Coe Soft, but will need to be replaced every 3 to 4 days. Coe Soft: also a true tissue conditioner. It will flow for 2 to 4 hours and will need to be replaced in one week. It is more resistant to stain and odor than Coe Comfort. Caulk Lynol: is not a tissue conditioner; it is a temporary soft-liner. It trades moldability for longevity. It only flows for about 30 minutes. However it has a flexible life span of about 2 3 weeks. Use Lynol for patients who need a cushion for longer than one week, like patients with immediate or transitional dentures. Hydrocast (Kaysee Dental): is a unique product that has extended flow characteristics for two to four weeks and will retain its resiliency for 2 - 3 months. It may be used as a tissue conditioner, a soft-liner, and a final impression for the tissue surface of a complete or partial denture. Its primary disadvantage is that it handles differently than the other 3 temporary soft-liners and there is a learning curve in order to use it successfully. Visco-Gel: is a product similar to Hydrocast, but with modified plastisizers that shorten its flow characteristics to 3 to 7 days and its resilient period to one month. It has a shortened working time as compared to Hydrocast and is slightly less sticky.

Conclusion The choice of impression material is often a very personal choice base mainly on personal preference and experience. It is however important to remember the characteristics of the material. A skilled dentist will use a variety of impression materials depending on the purpose of the impression and the specific condition of the impression site.

EXAM
Impression Materials Used in Removable and Fixed Prosthodontics by Guy Deyton DDS Tallgrass Dental Seminars The Missouri Dental Association has expressed permission to publish this for the benefit of its members.

1. All of the following are positive characteristics of a crown and bridge impression material except: A. Hydrophilic B. High wetting angle C. High detail reproduction D. Moderate rigidity E. Low contact angle 2. It is absolutely essential that impression materials for removable prostheses have high detail reproduction. A. True B. False 3. Alginate is an excellent final impression material for complete dentures A. True B. False 4. Which of the following statements about functional impression materials are correct? A. Functional impressions are made by allowing the patient to wear a prosthesis lined with a functional impression material. B. Functional impressions may be used to impress framework and tissue surfaces for removable partial dentures. C. Functional impression materials have an extended flow period after set. D. If you understand the unique characteristics of the plasticizers, any of the methacrylate materials are good choices for functional impressions for removable prostheses. E. Functional impressions may be poured multiple times to enable remount procedures used for checking occlusion prior to delivery of the prosthesis. F. Methacrylate impression materials should be disinfected with Lysol for three minutes followed by thorough rinsing and bone drying. A. All of the above B. (A) and (C) only C. (A), (B), and (C) only D. (A), (C), and (D) only E. (A), (C), (D), and (F) only

5. Polysulfides are an excellent choice for subperiosteal implant impressions because of excellent detail reproduction, low wetting angle, and favorable rigidity characteristics when using heavy and light body dual viscosity technique A. True B. False 6. All of the following are positive characteristics of Hydrocolloids making them a good choice for crown and bridge impression materials except: A. Exceptional hydrophilic characteristic makes hydrocolloids more forgiving when slight amounts of moisture or blood is present. B. Low cost C. Good tear strength enables excellent subgingival impressions D. Excellent detail reproduction E. Neutral taste F. Good dimensional stability enables dies to be poured as time allows A. (A) B. (C), (D), and (E) C. (C), (D), (E), and (F) D. (C) and (F) E. All of the above are positive characteristics of hydrocolloids making them a good choice for crown and bridge impression materials. 7. The following impression material would be the best choice for final crown and bridge impressions on an active Hepatitis C patient: A. alginate B. hydrocolloid C. polysulfide D. polyether E. polyvinyl addition silicone F. polyethyl methacrylate 8. Which material is the safest choice for crown and bridge impressions using a triple tray (no rigid tray walls) ? A. alginate B. hydrocolloid C. polysulfide D. polyether E. polyvinyl addition silicone F. polyethyl methacrylate

9. Polyethers are more "forgiving" than polyvinyls when taking multiple unit, full arch crown and bridge impressions because: A. The material is more hydrophilic and will more readily capture margins in the presence of slight moisture or blood. B. Polyethers have a lower wetting angle than polyvinyls and will more readily flow into small crevices and subgingival areas. C. Polyethers have a higher tear strength than polyvinyls and will be less likely to tear a thin margin on removal of the impression. D. All of the above. E. None of the above. 10. In order to avoid clinically significant distortion, Alginate impressions should be poured within: A. One hour of the impression B. 30 minutes of the impression C. 10 minutes of the impression D. Immediately

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