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A modified technique for making putty-wash two-step impression

Article · January 2017

DOI: 10.4103/bjhs.bjhs_4_17

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Sunil Kumar Mishra Hazari P.

Peoples University Peoples Dental Academy,Peoples University,Bhopal
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Ramesh Chowdhary Shail Kumari Mishra

RajaRajeswari Dental College and Hospital Rishiraj College of Dental Sciences & Research Centre,Bhopal
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A modified technique for making
putty‑wash two‑step impression
Sunil Kumar Mishra, Puja Hazari1, Ramesh Chowdhary2, Shail Kumari3

Website:
Abstract:
www.bldeujournalhs.in BACKGROUND: If the impression thickness is uniform, stock trays can also give a better result
when compared to custom trays.
DOI:
10.4103/bjhs.bjhs_4_17 PURPOSE: This study aimed to obtain a uniform thickness impression with a modified putty‑wash
two‑step technique.
MATERIALS AND METHODS: A chairside method of putty‑wash two‑step impression in a stock
tray was made utilizing a wax spacer.
RESULTS: A uniform thickness impression was obtained in stock tray in quick time.
CONCLUSION: The current article has given the options of using wax as spacer for making putty
wash two step impressions for the fabrication of tooth-supported fixed restorations. Further research
is required to find whether there is any dimensional inaccuracy caused in restorations due to usage
of wax as a spacer.
Department of Keywords:
Maxillofacial Custom tray, elastomers, impression, stock tray
Prosthodontics and
Implantology, Peoples
College of Dental
Sciences and Research
Centre, 1Department
of Maxillofacial
O ne of the most important steps in the
fabrication of fixed partial denture is
making of accurate impression.[1] Among
than by the technique, while Johnson
and Craig[4] stated that accuracy could be
better controlled with technique than by
Prosthodontics and
Implantology, Peoples all the impression materials available, the material itself. An accurate impression
Dental Academy, nonaqueous elastomeric impression which can register the entire details of oral
3
Department of materials are considered to be the most structures requires uniform thickness of
Orthodontics and
accurate in dimensional stability and impression material.[5] Many studies[4,5‑7] had
Dentofacial Orthopaedics,
Rishiraj College of Dental surface detail reproduction. There are reported that custom trays provide more
Sciences and Research different impression techniques available accurate dental casts than stock trays, but
Centre, Bhopal, for elastomeric impression materials such if stock trays are properly oriented and the
Madhya Pradesh,
as (a) putty‑wash, two‑step technique impression thickness is uniform, stock trays
2
Department
of Maxillofacial with polyethylene spacer, using a stock can give better result than custom trays.[2,8]
Prosthodontics tray; (b) putty‑wash, one‑step technique, This article describes a modified method
and Implantology, using a stock tray; (c) single‑mix technique, of impression making to obtain a uniform
Rajarajeshwari Dental
utilizing medium viscosity in a custom tray; thickness impression with putty‑wash
College, Bengaluru,
Karnataka, India and (d) multiple‑mix technique, utilizing a two‑step technique.
heavy‑ and low‑viscosity combination in
Address for a custom tray.[2] There is much discussion Materials and Methods
correspondence: in the dental literature regarding the effect
Dr. Sunil Kumar Mishra,
Department of of impression technique on the accurate fit Custom trays have been recommended
Maxillofacial of cast restorations. Hung et al.[3] reported to produce more accurate impressions,
Prosthodontics that the accuracy of addition silicone was but stock trays remain in popular use.[9]
and Implantology, affected more by the type of materials Mishra and Chowdhary[2] and Valderhaug
Peoples College of
Dental Sciences and and Fløystrand [10] in their study found
Research Centre, Bhopal, This is an open access article distributed under the terms of the that the linear dimensional stability of the
Madhya Pradesh, India. Creative Commons Attribution-NonCommercial-ShareAlike 3.0
E‑mail: sunilmsr200@ License, which allows others to remix, tweak, and build upon How to cite this article: Mishra SK, Hazari P,
yahoo.co.in the work non-commercially, as long as the author is credited Chowdhary R, Kumari S. A modified technique for
and the new creations are licensed under the identical terms. making putty-wash two-step impression. BLDE Univ
Submission: 15‑02‑2017 J Health Sci 2017;2:55-8.
Accepted: 11‑05‑2017 For reprints contact: reprints@medknow.com

© 2017 BLDE University Journal of Health Sciences | Published by Wolters Kluwer - Medknow 55
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Mishra, et al.: Putty‑wash two‑step impression

impression made in stock trays was not inferior to the

stability of impressions made in custom trays. The two
different putty‑wash techniques that are commonly used
in a stock tray are: (1) Putty‑wash one‑step technique (2)
putty‑wash two‑step technique.[1] This article describes a
quick and easy method of making putty‑wash two‑step
impression in a stock tray utilizing wax spacer to control a b
the bulk of the wash impression material.
Figure 1: (a) Wax sheet cut in the form of maxillary arch. (b) Wax sheet adapted
over the maxillary dentulous arch
Steps of modified impression technique in stock
tray
A modified technique was done in which first the
base plate wax sheet was cut in the maxillary arch
form [Figure 1a]. The wax sheet was gently softened in
warm water and care was taken that it should not melt
and stick on the tooth. The wax sheet was adapted over
the tooth region of the maxillary dentulous arch to create
space for the wash impression material [Figure 1b]. The
putty consistency of elastomeric impression material was
manipulated and loaded in a stock tray and placed over
the adapted wax sheet on the maxillary arch and allowed
to set. The tray was removed along with the wax spacer a b
in it [Figure 2a]. The wax spacer was removed from the
Figure 2: (a) Putty impression with wax spacer. (b) Putty impression after removal
putty impression and inspected so that any residual of wax spacer
wax   should not left in the impression [Figure 2b]. The
tooth surface was thoroughly cleaned to remove any
wax residues adhered to it. The light‑bodied elastomeric
impression material was manipulated and loaded in the
space created by the wax spacer in the stock tray and the
final wash impression was made with uniform thickness
of light body impression material [Figure 3].

This modified impression was cost‑effective as stock trays

are economical and very convenient to use. Stock trays
can be used in a single visit as they are easily selected
and adapted in patient’s mouth. Custom tray requires
proper planning, a study model, laboratory time, a curing
interval, and lot of finishing time, so they are costly and
used only once. In this technique, the amount of light
body impression material required was controlled with
the use of uniform thickness of wax sheet, so the amount
Figure 3: Final putty wash impression in stock tray
of light body material can be saved and the impression
will be cost‑effective.
thickness of wash material is not uniform. In two‑step,
Results and Discussion double‑mix, putty‑wash impression technique with
spacer, polyethylene spacer or vacuum‑formed resin
The modified impression technique provides putty sheets are used as spacers. When using polyethylene sheet,
impression along with a uniform thickness of light body there is a risk of getting it folded while making impression.
impression in a stock tray in quick time. Although with vacuum-formed resin sheets we can get a
uniform thickness of impression, but this technique needs
For making an accurate impression, a uniform wash special armamentarium, laboratory time, and extra cost.
impression is needed. Nissan et al.[11] recommended the
use of two‑step technique for accurate impression making Custom tray with elastomeric impression material
as there is uniform wash space for the light body material or a stock tray with a putty‑wash is used for making
to polymerize. In the two‑step, double‑mix, putty‑wash an impression of dental implants. Impressions for
impression technique using stock tray without spacer, the implant‑fixed restorations are usually made in one

56 BLDE University Journal of Health Sciences ‑ Volume 2, Issue 1, January‑June 2017

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Mishra, et al.: Putty‑wash two‑step impression
step.[12] Gregory‑Head and LaBarre described two‑step
pick‑up impression procedure for implant‑retained
overdentures.[13] Patil and Muley[12] described a modified
two‑step putty‑wash impression technique for implant
restorations where they had adapted a double‑thickness
modeling wax around the impression copings and made
the impression with a putty elastomeric impression
material followed by addition of the light body
impression material on the spacer and wax areas of
the putty impression and made the final impression.
Monzavi and Siadat[14] used wax spacers for putty‑wash
impression of implant snap‑on impression copings in
their article. Thongthammachat et  al. stated that the
clinical significance of any investigation is related to their
tooth‑to‑tooth relationship. If distortion occurs within the
limit of periodontal ligament space, the deviation should
be acceptable. The periodontal ligament space has been
reported to range from 90 to 240 μm. A change of 90 μm
should be clinically acceptable.[8]
The modified impression technique stated in this article
for making putty‑wash two‑step impressions in a stock
tray utilizing a wax spacer is economical and convenient.
Stock tray can be selected, adapted, and used in a single
visit. It does not require any study model and laboratory
procedure. Finally, wax spacer provides controlled bulk
of the wash impression material.
There may be issues regarding bond strength of putty
to wash impression material when a wax spacer is used.
Researchers[12,14] had previously used wax as spacer for
putty‑wash two‑step technique for implant restorations.
Sandrik and Vacco studied bond strength of different
putty‑wash elastomeric impression materials. In a study,
one manufacturer recommended placement of boxing
wax over the teeth as a spacer while the initial impression
was made to provide space for the wash material. The
bond strength found was 79 Psi which was even greater
than the bond strength (70.5 Psi) of other techniques
where impression was made without wax spacer.[15] The
study did not showed decrease in bond strength even
though the wax spacer was used.
The disadvantage of using vinyl polysiloxane (VPS)
impression materials was their hydrophobic
characteristics due to which moisture has been reported
to result in impressions with pitted surfaces. Surfactants
were added to improve the property of VPS and make
them hydrophilic in nature and thus they improve the
wettability of the polymerized impression.[16] The effect
of wax spacer on the property of elastomeric impression
material can still be a matter of debate. Wassell et  al.
stated that controlling the thickness of the wax spacer
is not easy, and the resultant impression may not
provide the desired accuracy.[17] Study by Sandrik and
BLDE University Journal of Health Sciences ‑ Volume 2, Issue 1, January‑June 2017 57
Vacco did not show decrease in bond strength although
the wax spacer was used, but it was an in vitro study
and the technique presented in this paper is an in vivo
technique.[15]
Conclusion
The present article has given the options of using wax
as spacer for making putty wash two step impressions
for fabrication of tooth-supported fixed restorations.
Further research is required to find whether there is
any dimensional inaccuracy caused due to usage of wax
spacer or its effect on bonding of putty to light body
consistency of the impression material. Precaution was
taken to eliminate any wax present on the tooth surface
to reduce the incorporation of any possible inaccuracy
in impression, but still in vitro and in vivo studies are
recommended to analyze the benefit and drawbacks to
follow it in the clinical practice.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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58 BLDE University Journal of Health Sciences ‑ Volume 2, Issue 1, January‑June 2017

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