The art of making good alginate impression

Before you start We took this topic before so doctor Layla thinks that we are suppose to know every thing about it by now ,,, and she'll only give us what she thinks is new , anyway there was were no slides for this lecture only two videos loaded on e-learning if you like to take a look on them Every single information in the videos will be here I also took what I saw important from 2009's slides which were given by doctor essam ,, and this will be enough hopefullySO let us start

 Alginate falls in the ELASTIC ACQUOES HYDROCOLLOID type of impression material. Most widely used impression material Composition
1- Sodium alginate salt of alginic acid : mucous extraction of seaweed (algae) 2- Calcium sulfate : reactor 3- Tri-sodium phosphate : retarder 4- Filler 5- Potassium fluoride : improves gypsum surface

Indications study models removable partial dentures

Examples Hydrogum (Zhermack) Jeltrate (Dentsply/Caulk) Coe Alginate (GC America)

Advantages Inexpensive Easy to use Hydrophilic : displace moisture, blood, fluids Stock trays Handling the Material: Disadvantages Tears easily Dimensionally unstable immediate pour single cast Lower detail reproduction than non-aqueous elastomeric impression materials unacceptable for fixed pros High permanent deformation Difficult to disinfect
1. Pre-measure material do not take containers to your operatory. Do not handle containers with contaminated gloves/hands. This makes infection control easier. 2. Do not leave containers open in a humid environment - humidity and high temperatures can cause deterioration of the powder.
3. Do not mix in a bowl contaminated with dental stone gypsum can cause acceleration of the alginate. Conversely alginate contamination of a bowl used to mix stone can

diminish the strength of the cast or model produced. Keep separate bowls and spatulas for alginate and stone.

Very popular choice Especially effective if there are lots of soft tissue undercuts and/or teeth with different axial alignments Cost effective and setting time is ideal

 More easily removed from the stone cast than nonaqueous elastomeric impression materials

Patient Preparations
Instructions to patient Relax lips, tongue, and cheeks Advise patient that you will ask them to lift their tongue Ask patient to concentrate on breathing through nose. Review the procedure with the patient. (practice with a dry run) Block out large embrasures and inter-proximal spaces to prevent tearing of the impression material on removal

PREPARING ALGINATES

( all the information that was

mentioned in the video about this topic are included here )

Remember always to wear a mask to filter all the dust particles

when using alginate powder since it is not healthy to breath any

(studies have found evidence of pulmonary hypersensitivity to seaweed dust in force, and evidence of precipitating antibody to sodium alginate and seaweed extracts in the serum of people dealing with alginate dust )

Alginate powder come in two sets : - Regular set : creamy in color , jells in 3-4 mins - Fast set : pink In color , jells in 1-2 mins Shake the container well before using the material to remix the heavier components with the lighter ones (homogenizing the material) resulting In a proper amount of the material in each scoop .

Preparations :
Measuring by weight is more accurate than by volume, but not practical in clinic Therefore, we used measurement by volume in the clinic Ratio is 1 scoop powder : 1 measure water For the maxilla : it needs 3 scoops of powder with 3 measures of water For the mandible : it needs 2 scoops of powder with 2 measures of water Water measures are taken in room temperature since : - Warm water will accelerate the set of alginate - Cold water will retard it

Prepare the materials you need with clean hands Temple the closed alginate container as mentioned before Fill a scoop and tap it firmly until the powder is condensed Put the maxillary 3 scoops in one bowel and the 2 scoops for the mandible in another one Add water to one of the bowels (which you like to take the impression with it first ) Gently start mixing powder with water until the powder is completely wet Now the mixing action become more aggressive . use the blade of the spatula to push alginate against the side of the bowel , this is called stropping . Mixture can be held in one place and stropped side to side or it can be moved around inside the bowel and the bowel is rotated with the other hand Aggressive spatulating continues until smooth creamy mixture is obtained , which takes about 30 seconds ( fast set alginate requires 45 second of mixing for a creamy consistency ) The mixture should not contain grains Gather alginate on the spatula and press into the maxillary tray from posterior , while mandibular tray must be loaded from both sides allowing the alginate to meat at the middle Try to avoid air bubbles while loading Smooth the alginate with your wet figure creating an indentation with your figure to help orient the tray when seating it into the pt's mouth . Now you are ready to take an impression

Selection of a Stock Tray

( all the information that was

mentioned in the video about this topic are included here ) - There are two tray types you can use when taking alginate compounds : Disposable plastic trays : - Must be coated with adhesives to prevent its separation from alginate especially when it contain no or few perforations . Metal trays : - metal trays have a rim locked edges and many perforations that prevent the separation of the alginate from the tray when removing from patient's mouth . - can be sterilized . - no need for adhesives to be used (adhesives cannot be cleaned) . - When estimating the size of the tray that : you'll use a barrier must be used on the deposable trays to insure that it will not be contaminated . metal trays can be sterilized so they do not need a barrier . Make sure that the space between the tissue and the tray is 3-6 mm .

- Impression trays come in small , medium and large sizes - If the tray needs to be extended distally you can use beading wax to build it up .

- How to check the fitness of the mandibular tray ?? ( these directions are for right handed clinicians left handed clinicians must reverse these directions ) : Stand at 8 o'clock position . Hold the handle of the tray with your right hand and turn it over. Retract the right check with the index finger of your left hand . Hold the tray sideways and insert it using the side of the tray to retract the left cheek. Rotate the tray in the mouth until it is centered. Left the front of the tray up and visually inspect that the alveolar ridges clear the tray .ask the patient if the tray feels comfortable .

- How to check the fitness of the maxillary tray ?? ( these directions are for right handed clinicians left handed clinicians must reverse these directions ) : Stand at 8 o'clock position . The insertion of the tray is the same as for the mandibular one . When the maxillary tray is in the mouth lower the front of the tray to make sure it clears the alveolar ridge . Ask the patient if it feels comfortable .

- After finishing checking the trays ask the patient to rinse with full strength antimicrobial wash for 30 seconds .

Taking mandibular impression

( all the information that

was mentioned in the video about this topic are included here )

- Before inserting the trays, wipe some excess alginate onto the occlusal surfaces of teeth, deep undercuts or areas which may trap bubbles (deep palatal vault or lower labial sulcus) - The right handed clinicians stand in the 8 o'clock position , left handed must reverse directions

Raise the chair so you won't have to bend. Set the patient upright . Hold the tray handle with your right hand then turn it over . Retract the right cheek and hold the tray sideways and insert it while rotating it into the mouth until it is centered . Seat the tray gently over the teeth and soft tissues from posterior to anterior . Immediately muscle trim from the impression by bringing the patient's lower lip up over the edge . Instruct the patient to left up their tongues upward and forward and relax it . Hold the tray into the patients mouth until the alginate feels rubbery and does not stick to your fingers The setting time of the alginate using room temperature water is 2 mins and 30 seconds from the start of the mixing . Once the material has set , break the seal with one figure in the left vestibule in the patients oral cavity . Snap tray quickly to minimize distortion . Remove the tray by rotating it out of the oral cavity . Ask the patient to rinse out excess alginate

Taking maxillary impression ( all the information that was

mentioned in the video about this topic are included here )

- The right handed clinician stands at 11 o'clock or 12 o'clock position . - The chair must be lowered slightly to have a better view over the patient's head . - Remind the patient to breath from his nose during the impression taking . - Retract patient's left cheek with your left index finger . - Hold the sideways using the edges of the tray to retract the patient's right cheek . Insert the tray and rotate it to center it into the mouth . Align the handle with the midline of the center anterior teeth . Seat the posterior of the tray first and left the handle to seat the anterior part . Muscle trim the patients upper lip around the tray rim It helps to hold the patient's head upright with your left arm behind .this prevent the patients from tipping their head back and helps with the gagging . - Hold the seated tray until the alginate feels rubbery . - To remove the impression stand at the position of 8 o'clock in front of the patient and rape the seal in one of the two ways : Tell the patient to close his lips and blow to puff their cheeks If this doesn't replace the seal bring your right index finger along the left edge of the tray and break the seal manually . - Snap the tray out quickly to minimize distortion - Use your left hand figure to create a "pushing" over the opposing teeth so the tray won't snap against the mandibular teeth . - Remove the tray by rotating its sideways . - Instruct the patient to rinse out excess alginate

- After removing both trays from the patient's mouth , give him a towel and a mirror to wipe out excess alginate from the skin . - Rinse the impression under running water and spray it with disinfectant ( it is important not to soak the impression in disinfectant liquid due to the likelihood of imbibitions . - After 10 mins of contacting with the disinfectant rinse the impression before pouring it with stone , it is recommended to pour the impression as soon as possible as distortion increases due to delay pouring and evaporation .
-

Wrap it in a paper towel that has been wetted and let set in a bag to maintain 100% humidity .

Problem solving
You are treating a patient and preparing him for a partial denture prosthesis.

He told you he has a bad gag reflex which had stopped him from finishing the treatment with another doctor. What are you going to do differently to take a successful impression.?

Exaggerated gag reflex can frustrate both the patient and the dentist. It can also compromise the treatment plan. Its effective management is based on experience with combinations of clinical techniques, prosthodontic management, medication, and psychologist referral, or a specialist referral. Some simple measures that usually works: Reassurance and kind handling. Upright position of the patient. Avoid overloading the tray. Spray some local anesthesia on the soft palate Distract patients mind talking, raising one foot etc.

=> Care of Alginate Impression Should not be exposed to air (dehydration). Should not be immersed in water for too long (imbibition). Should be stored in a humid atmosphere by placing in a 100% humidity humidor device or wrapping in a damp paper towel in a sealed (zip-lock) plastic bag Should be poured immediately, with delay not to exceed hour. Support impression by handle or tray until cast poured

What is the difference between the following terms ?? Imbibition : distortion by water absorbtion Syneresis : loss of water and shrinkage distortion. Detergent : is a surfactant or a mixture of surfactants with "cleaning properties
in dilute solutions , removes dirt,especially from the surface of things

Disinfectant : are substances that are applied to non-living objects to

destroy microorganisms that are living on the objects.[1] Disinfection does not necessarily kill all microorganisms, especially resistant bacterial spores; it is less effective than sterilisation, which is an extreme physical and/or chemical process that kills all types of life.[1]Disinfectants are different from other antimicrobial agents such as antibiotics, which destroy microorganisms within the body, and antiseptics, which destroy microorganisms on living tissue.

Sterilization :is a term referring to any process that eliminates (removes) or

kills all forms of microbial life, including transmissible agents (such as fungi, bacteria, viruses, spore forms, etc.) present on a surface, contained in a fluid, in medication, or in a compound such as biological culture media.[1][2] Sterilization can be achieved by applying heat, chemicals, irradiation, high pressure,

Asepsis : is the state of being free from disease-causing contaminants (such

as bacteria, viruses, fungi, and parasites) or, preventing contact with microorganisms. The term asepsis often refers to those practices used to promote or induce asepsis in an operative field in surgery or medicine to preventinfection. Ideally, a surgical field is "sterile," meaning it is free of all biological contaminants, not just those that can cause disease, putrefaction, or fermentation, but that is a situation that is difficult to attain, especially given the patient is often a source of infectious agents. Therefore, there is no current method to safely eliminate all of the patients' contaminants without causing

significant tissue damage. However, elimination of infection is the goal of asepsis, not sterility.

Mixing time : the time to achieve a predefined level of homogeneity of a flow

tracer in a mixing vessel

setting time : The length of time that a resin or adhesive must be

subjected to heat or pressure or chemical reaction to cause them to set, that is, harden, gel, or cure.

border molding : the shaping of an impression material by the manipulation or

action of the tissues to determine the denture border position.

border extension of tray : extend borders of the tray if needed.

Extension should be made only to provide coverage of critical anatomy, not for the purpose of displacing or distorting the vestibular tissues, which should be registered accurately to obtain a peripheral seal on a denture.

The Happy End

Am really sorry for any shortage , but there was nothing to refer to as a reference for this lecture 10 hours of continues working hope you like it ,,, Enjoy