SECTIONEDITORS

one-step versus two-step

ression technique
Shirley H. Hung, DDS, MS,” John H. Purk, DDS, MS,b Daniel. E. Tira, PhD,C
and J. David. Eick, PhDd
University of Missouri-Kansas City, School of Dentistry, Kansas City, MO.

This study compared the accuracy of one-step putty wash with two-step putty
wash impression techniques. Five addition silicone impression materials-Mirror 3
(MR), Mirror 3 Extrude (ME), Express (E), Permagum (P), and Absolute(A)-were
tested. A stainless steel model containing two full-crown abutment preparations
was used as the positive control. Five replications for one-step and two-step putty
wash impressions of the master model were made for each test material. Accuracy
of the materials was assessed by measuring six dimensions on stone dies poured
from impressions of the master model. Accuracy of addition silicone impression
material is affected more by material than technique. Accuracy of the putty wash
one-step impression technique was not different from the putty wash two-step
impression technique except at one of the six dimensions where one-step was more
accurate than two-step. Mirror 3 putty wash two-step impression presented less
distortion tham Mirror 3 Extrude putty wash one-step or two-step impression. (J
PROSTHET DENT 1992;67:583-9.)

he putty wash (P/W) impression technique was
originally recommended to overcome the problems associ-
ated with polymerization shrinkage of the condensation
silicone impression materials. The P/W technique has been
recommended for addition silicone impression materials
even though these materials appear t.o be dimensionally
stable.? The P/W impression technique can be made as a
one-step2 or as a two’-step technique.
The working time of some addition silicone putty mate-
rials has been lengthened, so it is now possible to make P/W
impressions using a one-step technique. Advantages of the
P/W one-step technique include reduced chairside time
and savings of impression material. A disadvantage is that
there are occasional ledges at the junction of the putty and
wash material.
An advantage of the P/W two-step impression technique
is that the impression of the teeth can be captured with the
wash material. Disadvantages of the P/W two-step impres-
sion technique are distortions, extra chairside time, and
extra material needed. Ideally, wash material should cover
the entire preparation for both techniques. However, clin-
ically it is not always possible to accomplish this procedure.
Presented at the American Association for Dental Research/
International Association for Dental Research, Cincinnati, Ohio.
aAssociate Professor, Department of Fixed Prosthodontics.
bAssistant Professor, Department of Operative Dentistry.
cProfessor, Department of Behavioral Sciences.
dCurator’s Professor, Department of Oral Biology.
POllI
This study had two objectives. The first objective was to
compare the accuracy of the P/W one-step technique with
the P/W two-step impression technique for four different
addition silicone impression materials. The second objec-
tive was to compare the accuracy of all of the materials
tested (either one-step or two-step) with the accuracy of a
standard stainless steel model (positive control) and with
the accuracy of stone dies produced from impressions made
from Mirror 3 P/W two-step technique (negative control).
The null hypotheses to be tested were as follows:
1. There will be no significant difference in accuracy be-
tween the one-step putty wash impression technique
and the two-step putty wash impression technique.
2. There will be no significant difference in accuracy be-
tween the materials tested compared with the positive
control of the standard stainless steel model and be-
tween the materials tested compared with the nega-
tive control of Mirror 3PiW two-step impression tech-
nique at six different measurement locations.
METHODS AND MATERIAL
A stainless steel model containing two full-crown fixed
partial denture abutment preparations with six measure-
ment locations was made.3 One abutment had a V-shaped
undercut below the gingival margin and the other abut-
ment did not. For measuring purposes a post was built be-
tween the two abutment crown preparations as a reference
point (Figs. 1 and 2, Table I).
Five addition silicone impression materials were evalu-
ated. Table II lists the respective viscosities and manufac-

THE JOURNAL OFPROSTHETICDENTISTRY


Fig. 1. Diagram of stainless steel model with reference marks. Numbers
cations measured.
Fig. 2. Stainless steel model.
turing dates for each impression material tested. Each ma-
terial, except Mirror 3 (MR), was used with a PW one-step
technique and a PW two-step technique. Mirror 3 material
was used with only the PW two-step impression technique
because of its shorter working time. Mirror 3 material was
also used as one control for comparison with the longer
working-time putty materials presently available, includ-
ing Mirror 3 extrude. The stainless steel model was used as
the other control.
The same size of perforated metal tray (XL21, Coe Lab-
oratories, Inc., Chicago, Ill.) was used to make impressions
of the stainless steel model. The tray adhesive supplied by
each impression material manufacturer was applied evenly
over the surface of the tray. For the PW two-step impres-
sion technique, a plastic spacer supplied by the manufac-
turer was placed over the stainless steel model when the
preliminary putty impression was made. This procedure
was followed to sirnulate clinical practice.
The preliminary impression was allowed to set for 10
minutes. The light-body wash was then added. For PW
one-step impressions, the putty and wash impressions were
mixed simultaneously. All wash material was dispensed
584
m3
indicate six lo-
Fig. 3. Stainless steel model wit.h positioning device.
with an automatic-mixing syringe with the exception of
Mirror 3 wash material, which was m.ixed by hand. The fi-
nal impression was allowed to set on the stainless steel
model for 12 minutes from the start of mixing. The man-
ufacturer’s setting time was doubled to compensate for a
delayed polymerization reaction compared with one at
mouth temperature.
All impressions were stored at room temperature, 25” C,
for 1 hour before being poured in improved stone (Die
Keen, Columbus Dental, St. Louis, MO.). The improved
stone was first mixed by hand to incorporate the water and
then mechanically mixed under vacuum for 15 seconds. All
mixes were vibrated into the impressions and allowed to set
for 1 hour before separation from the impression.
A positioning device (Figs. 3 and 4) was made so that the
measurements made from the six locations on the stainless
steel model and the stone dies could be reproduced. Each
measurement of the stainless steel model at the six mea-
surement locations was taken 10 times. The mean and
standard deviation at each measurement location was used
as the standard measurement for comparison to test the
first null hypothesis. The test samples at each measure-
MAY1992 VOLUMEW NUMBERS
ACCURACY OF PUTTY WASH IMPRESSIONS

~abIe I. Description of locations measured and corresponding means and standard deviations ef meas~reme~t$ for
standard die
Mean SD Measurement
Location Description (mm) (mm) error (%)

ml Distance between preparations 28.934 0.009 0.03

m2 Mesiodistal dimension of nonundercut 10.069 0.016 0.16
preparation
m3 Mesiodistal dimension of undercut 9.762 0.010 0.10
preparation
m4 Diameter of undercut area 8.497 0.023 0.21
m5 Occlusogingival height of nonundercut 9.589 0.014 0.15
preparation
m6 Occlusogingival height of undercut 9.118 0.004 0.04
preparation

Table II. List of addition silicone impression materials evaluated

Batch
Product Symbol Manufacturer Viscosity date

Mirror 3 MR Kerr/Sybron putty 9-8-83

Romulus, Mich. Wash 3-26-86
Extrude ME Kerr/Sybron Putty 10-27-88
Wash 11-04-88
Express E 3M Dental Products Div. putty 4-20-86
St. Paul, Minn. Low l-10-86
Permagum P Premier/Premier ESPE Putty 8-8-88
Norristown, Pa. Low 8-8-63
Absolute A COE Laboratories, Inc. Putty 4-18-39
Chicago, Ill. Low 3-16-89

ment location were measured with a traveling microscope
(Unitron Instruments, Inc., Woodbury, N.Y.) capable of
measuring to 0.001 mm (Fig. 5). Each measurement of the
stone dies was repeated three times. The difference be-
tween the mean of the stone model (msm) and the mean of
the stainless steel model (mss) divided by the mean of the
stainless steel model multiplied by 100 was expressed as the
percent of deviation from the stainless steel model for each
impression material at each measurement location.
msm - mss
Percent of deviation =
mss
x 100
A pilot study to determine sample size was performed.
Fifteen Mirror 3 material P/W two-step impressions of the
stainless steel model were made and poured in die stone.
With the mean and standard deviation at each measure-
ment location, the experimental design parameters of
alpha = 0.05 and with a power of 0.8, a test sample size of
five for each group was calculated. Therefore, five replica-
tions of each material and impression technique were used
for all test conditions. The investigator’s coefficient of
variability ranged from 0.03 % to 0.27 % for this study (Ta-
ble I-measurement error). A two-factor ANOVA was used
to test the first null hypothesis. A one-factor ANOVA with
the stainless steel model as the positive control and the
Mirror 3 P/W material two-step impression technique as
the negative control were used to test the second null hy-
pothesis. If significant differences were found, a compari-
son of individual means was performed by the Student-
Newman-Keuls method.4 All hypotheses were tested at the
95% level of confidence 03 I 0.05).
RESULTS
The means and standard deviations for the stainless steel
model and the stone dies at each measurement location are
listed in Table III. Graphic results are presented in Figs. 6
and 7 as percent deviations of the stone dies from the stain-
less steel model for each material and measurement (ml to
m6). The graphs in Figs. 8 and 9 present percent deviations
of the stone dies from the Mirror 3 P/W material two-step
impression for measurements ml to m6. Means that were
shown to differ significantly (p 5 0.05) are indicated with
asterisks on Figs. 6 through 9. The interabutment distance
(ml) increased for all materials compared with the stain-
less steel model except for Permagum material P two-
step impression technique, which decreased 0.1%. The
measurements of all the stone dies at m2, m3, and m4 were
generally larger than the standard dies except for the stone

THE JOURNAL OF PROSTHETIC DENTISTRY 585


ig. 4. Stone dies with positioning device.
Fig. 5. Unitron microscope.
dies produced from the Mirror 3 material P-W two-step,
Permagum material P/W one-step, and Absolute material
P/W two-step impression techniques for m2. Most cases
were not statistically significant (p 10.05).
To test the first null hypothesis, a two-factor ANOVA
evaluating technique versus material was performed. A
statistically significant difference was found among all im-
pression materials tested at all measurements (ml to m6).
There was no significant difference between the P/w one-
step impression technique and the P/W two-step impres-
sion technique at ml, m3, m4, m5, and m6. At m2 there was
586
IIUNG ET AL
a significant difference; the one-step impression technique
was more accurate than the two-step impression technique
e, I 0.05).
To test the second null hypothesis, a one-factor ANOVA
revealed a statistically significant difference between
groups (p I 0.05) with the standard stainless steel model
used as the control. The error term generated from the
ANOVA was used with the Student Newman-Keuls se-
quential range test to compare group means. Only Mirror
3 Extrude P/W material (one and two step), Express P/W
material (one and two step) and Absolute P/W material
(two step) for ml and Mirror 3 Extrude P/W material (two
step) for m2 and m5 were found to be statistically different
from the standard stainless steel model 0, I 0.05). To test
against the negative control, a one-factor ANQVA using
Mirror 3 P/W material (two step) as the control found a
significant difference between the control and Mirror 3 Ex-
trude P/W material (one and two step) at ml and m2
(p 5 0.05). There was no significant difference at the other
measurements m3, m4, m5, and m6 for both materials.
DISCUSSION
Interabutment distance
The interabutment distance increased for all materials
except with Permagum P/W material two-step impres-
sions, which decreased 0.1% . This increase of ml was also
reported by Linke et a1.5The six types of impression ma-
terials studied by Linke et aL5 were polyvinyl siloxane, sil-
icone-irreversible hydrocolloid, light/regular silicone irre-
versible hydrocolloid, irreversible hydrocolloid, modified
reversible-irreversible hydrocolloid, and reversible hy-
drocolloid. Linke et a1.5reported that the perimeter of the
arch of the test cast was larger than the standard reference
model. However, Johnson and Craig3 and Craigs reported
that there were no significant differences for addition sil-
icones between techniques for measurements between
preparations. Gordon et aL7 reported that interabutment
distances were greater for all dies using polysulfide, poly-
ether, and addition silicone impression materials, espe-
cially when the stock tray was used; a linear change of 45
pm to 100 pm greater than the standard was observed.
Clinically, this change may result in fixed ps.rtial dentures
that are too long mesiodistally when constructed on casts
made from stock tray impressions. Similar results were
found in our study with Mirror 3 Extrude, Express, and
Absolute materials. Permagum material produced inter-
abutment distances with the most accuracy.
Individual abutment Horizontal measurements m2,
m3, and m4). The diameters of all the stone dies were gen-
erally larger than the standard model except the stone dies
produced from Mirror 3 P/W material two-step impres-
sions, Permagum P/W material one-step, and Absolute
P/w material one-step impressions for m2. These dies were
smaller and this decreasewould need to be compensated for
on a stone die by a die relief method. Permagum P/W ma-
terial one-step and two-step impressions produced dies
MAY 1992 VOLhiME 67 NUMBER 5
ACCURACY OF PUTTY WASH IMPRESSIONS

Table III. Die measurements, corresponding means, and standard deviations (mm)
ml m2 m3 m4 m5 m6
Technique
Product (putty wash) x SD ii SD ii SD : SD ;; SD ii SD

Stainless steel model 28.984 0.009 10.069 0.016 9.762 0.010 8.497 0.023 9.589 0.014 9.118 0.004
Mirror 3 Two-step 29.053 0.018 10.048 0.024 9.794 0.034 8.494 0.050 9.607 0.050 9.148 0.026
Extrude One-step 29.317 0.033 10.105 0.012 9.781 0.018 8.534 0.047 9.632 0.032 9.143 0.010
Extrude Two-step 29.316 0.029 10.128 0.013 9.803 0.019 8.540 0.029 9.650 0.019 9.146 0.011
Express One-step 29.289 0.027 10.100 0.022 9.785 0.027 8.479 0.026 9.616 0.009 9.106 0.027
Express Two-step 29.289 0.013 10.100 0.013 9.791 0.033 8.514 0.034 9.619 0.019 9.134 0.008
Permagum One-step 28.992 0.038 10.040 0.016 9.750 0.027 8.473 0.044 9.607 0.018 9.121 0.021
Permagum Two-side 28.983 0.016 10.079 0.010 9.761 0.023 8.473 0.055 9.598 0.007 9.101 0.004
Absolute One-step 29.090 0.149 10.047 0.047 9.789 0.033 8.501 0.031 9.615 0.022 9.139 0.023
Absolute Two-step 29.221 0.111 10.082 0.024 9.792 0.021 8.505 0.028 9.624 0.027 9.130 0.020

N = 5 for each group.

with a smaller m3 measurement. Express P/W material
one-step, Permagum P/W material one-step and two-step
impressions produced dies with smaller m4 measurements
(Fig. 6). A one-way AMOVA showed no statistically signif-
icant difference (p i 0.05). The only statistically signifi-
cant difference (p 2 0.05) was shown for m2 with Mirror 3
Extrude P/W material two-step impression. The deviation
was a 60 pm increase in diameter, which could adequately
provide the die space needed for the fabrication of crowns
without the need of applying die spacer.
No obvious effect of undercut on the horizontal mea-
surements (m3, m4) was found. The deviation related more
to the material than the technique used. Impressions with
Permagum material consistently yielded undersized dies
whether the P/W one-step or two-step technique was used
(Fig. 6). This finding is in agreement with the results of
Tjan et a1.8
Figs. 8 and 9 show the results using Mirror 3 P/W ma-
terial (two-step) as the negative control. Mirror 3 P/W
two-step material provided impressions that were statisti-
cally significantly better than Mirror 3 Extrude P/W ma-
terial one and two-step impressions at ml and m2. When
the working time of Mirror 3 Extrude putty material was
lengthened, the accuracy of the impression material might
have been affected, compared with the Mirror 3 P/W ma-
terial two-step.
Individual abutment Vertical measurements m5 and
m6). The changes in vertical height are listed under m5 and
m6. Our study showed an increase in vertical heights with
all impression materials tested. Impression technique and

THE JOURNAL OF PROSTHETIC DENTISTRY 587

 KUNG ET AL

Fig. 8. to m4).

undercut of the die showed no effect on the vertical height.
In the study by Gordon et al.,7 a slight increase of vertical
heights for addition silicone impression with stock tray was
reported. Craig,6 Linke et al. 5 and Johnson and Craig,g re-
ported shorter vertical heights in their studies. de AraujoiO
also reported that the increase in thickness of the impres-
sion material from 1 to 4 mm caused a greater distortion
than height increase of the undercut from 1 mm to 3 mm.
Valderhaug and Flgiystrandli reported that although an
ample amount of impression material (2 to 9 mm) was al-

588 MAY 1992 VOLUME 67 NUMBER 5

 Fig. 9. Percent deviation from Mirror 3 P/W material two-step stone dies (m5 and m6).
lowed, the linear dimensional stability of the impressions
made in stock trays was not inferior to the stability of im-
pressions made in custom-made trays.
During this experiment, the separation of impressions
from the standard stainless steel dies was much more dif-
ficult than in clinical practice. This separation might have
contributed to the greater incisal-gingival dimension of the
stone die, since PW impressions may not recover well. The
putty material will be displaced if the tray is not seated
passively and the putty material will show through after
the wash impression i.smade. It then may rebound to cause
deformation. The wash material may hydraulically dis-
place the putty during seating of the impression so that the
putty could then exhibit some elastic recovery on removal
of the impression.
Overall Mirror 3 P/w material two-step and Permagum
P/W material ane or twa-step produced the most accurate
dies at all six measurements compared with the stainless
steel model.
CONCLUSIONS
1. The accuracy of the addition silicone impression ma-
terials tested was affected more by the material than
by technique.
2. The accuracy of the putty wash one-step technique
was not different from that of the putty wash two-step
technique except at measurement 2; where the one-
step impression technique was more accurate than the
two-step impression technique.
3. Mirror 3 putty wash material two-step impressions
THE JOURNAL OF PROSTHETIC DENTISTRY
(using putty material with a shorter working time)
presented less distortion than Mirror 3 Extrude putty
wash material one-step or two-step impressions (us-
ing putty material with a longer working time).
REFERENCES
1. Craig RG. Review of dental impression materials. Adv Dent Res
1988;2:51-64.
2. Pameijer CH. A one-step putty-wash impression technique utilizing vi-
nyl polysiloxanes. Quintessence Intl 1983;8%1-3.
Johnson GH, Craig RG. Accuracy of addition silicones as a function of
technique. J PROSTHETDENT 1986;55:197-203.
Kirk RE. Experimental design: procedures for the behavorial sciences.
Belmont, Calif’z Brooks/Cole Pub1 Co, 1968:91-3.
Liuke BA, Nicholls JI, Faucher RR. Distortion analysis of stone casts
made from impression materials. J PROSTHETDENT 1985;54:794-802.
6. Craig RG. Evaluation of au automatic mixing system for an addition
silicone impression material. J Am Dent Assoc 1985;110:213-5.
I. Gordon GE, Johnson GH, Drennor DG. The effect of tray selection on
the accuracy of elastomeric impression materials. J PROSTHETDENT
1990;63:12-5.
8. Tjau AHL, Whang SB, Tjan AH, Sarissian R. Clinically oriented eval-
uation of the accuracy of commonly used impression mat.erisls. J PRO+
THET DENT 1986$%4-S.
9. Johnson GH, Craig RG. Accuracy of four types of rubber impression
materials compared with time of pour aud a repeat pour of models. J
PROSTHETDENT 1985;53:484-90.
10. de Araujo PA. Effect of material bulk and undercuts on the accuracy of
impression materials. J PROSTHETDENT 1985;54:791-4.
11. Valderhaug J, Fl$ystraud F. Dimensional &ability of elastomeric
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DENT 1984;52:514-7.
Reprint requests to:
DR. SHIRLEY H. HUNG
UNIV!ARSITY OF MISSOURI-KANSAS CITY
SCHOOL OF DENTISTRY
KANSAS CITY, MISSOURI 64108
589