105
Presented at: IADR General Session &
Figure 5. Alginate substitute (COUNTER-FIT
[CLINICIAN’S CHOICE]) being injected into a
Borderlock (CLINICIAN’S CHOICE) tray lined
with a PVS (Affinity Tray Adhesive [CLINICIAN’S
CHOICE]) adhesive.
PVS materials that are used for final
impressioning in fixed prosthodontics.
Christensen22 describes these alginate
substitutes as accurate, clean to use
(no bowl to clean, no dust), with no
taste (some are flavored which increas-
es salivation and is not a good thing),
no unpleasant odor, and the ability to
delay pouring or to make additional
pours of the same impression (Figure
6).22 Multiple studies have demon-
strated that PVS is the most dimen-
sionally stable impression materi-
al23,24 and has a higher tear
strength than alginate. Unlike algi-
nates they are not affected by disin-
fection techniques.25
The ability to pour these alginate
substitutes at any time provides a
whole new window of opportunity4,
and now allows the clinician to send
these opposing impressions along with
the final crown and bridge impression
to the laboratory, totally eliminating
the need to pour these up, separate
them, and trim them in the dental
office. Not only is this a tremendous
time- and cost-savings in the office,
but now this process is a billable pro-
cedure as part of the laboratory fee for
lF
the crown and bridge case. Currently
most dentists absorb the cost of fab-
ricating the opposing model and do not
bill it as a separate procedure. Since
na
the PVS has better surface replica-
tion of the opposing dentition, and since
the variables around mixing the dental
so
stone are more closely monitored in the
laboratory, the opposing model will be
much more detailed and accurate.
One of the main driving forces in
er
a change in direction from opposing
models produced from alginate to
opposing models derived from algi-
rP
nate substitutes in fixed prosthodon-
tics, is the severe mismatch of accu-
racy between modern bite registration
materials and alginate driven stone
Fo
models. Boksman26 looked at PVS bite
registration materials and the need
for extensive occlusal adjustments on
crown and bridge prostheses, show-
ing the severe open-bite mounting
that can result when using a highly
accurate PVS bite registration with a
poorly detailed alginate driven stone
model (Figure 7). Using PVS for the
final impression, for the bite regis-
Figure 6. Internal detail of a COUNTER-FIT
impression that has been repoured 4 times. (An
alginate should never be poured a second time.)
Figure 8. Alginate driven stone models on
Quickbite (CLINICIAN’S CHOICE) PVS bite regis-
tration material showing inaccurate fit.
du
rE
Figure 10. COUNTER-FIT driven stone model
on Quickbite PVS bite registration material
O
shows good interdigitation of the 3 compo-
nents.
s
tration, and for the opposing models
ile
eliminates the dimensional mismatch
between materials, resulting in more
accurate mounting of the case and
less clinical necessity for occlusal
adjustments (Figures 8 to 11).
The surface replication of the
casts is also much smoother than mod-
els derived from alginate impressions.
Even though the cost of the PVS
alginate substitutes is higher than
the irreversible hydrocolloid alginate
materials, the impression is easier to
take due to the thixotropic nature of
these materials, the time and cost of
pouring up the opposing model can
be eliminated, the impression can be
repoured if the model is broken or
chipped, there is increased office effi-
ciency, the opposing model is more
accurate, the bite registration actually
fits, and the time and frustration of
adjusting the final prosthesis is min-
imized. These many benefits more than
compensate for the additional cost. In
addition, the clinician can now (in
some cases) bill this as part of the lab-
oratory procedure.!
REFERENCES
1. Pace SL. Polyvinyl impression materials vs algi-
nate impression materials. Contemp Dental
Assisting. Feb 2006:20-23.
Figure 7. Alginate derived stone models on a
PVS bite registration material showing an obvi-
ous open-bite relationship.
lU
na
tio
Figure 9. Mounted case from Figure 8 showing
mismounted open bite.
ca
Figure 11. Precise mounting of the opposing
casts is obvious when using matching accura-
cies in the impression and bite registration
materials. This creates clinical predictability.
2. Rubel BS. Impression materials: a comparative
review of impression materials most commonly
used in restorative dentistry. Dent Clin North Am.
2007;51:629-642.
3. Cohen BI, Pagnillo M, Deutsch AS, et al.
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4. Perry R. Using polyvinyl impressions for study
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ruary 23, 2009.
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effect of a range of disinfectants on the dimen-
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iadr/2006Brisb/techprogram/abstract_82984.ht
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loid and silicone impressions in European Union
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nl
Prosthodont. 2004;17:165-171.
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disinfection on dimension stability of impres-
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O
2004;13:290-292.
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Clinical Removable Partial Prosthodontics. 3rd
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se
16. Frey G, Lu H, Powers J. Effect of mixing methods
on mechanical properties of alginate impression
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Econ. March 2008;98:66.
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Dr. Boksman practices in London, Ontario,
Canada. He is adjunct clinical professor at the
Schulich School of Medicine and Dentistry,
University of Western Ontario. He is a Fellow
in the Academy of Dentistry International and
in the International College of Dentists. He has
published more than 100 articles and various
chapters in dental texts and lectures national-
ly and internationally on restorative dentistry.
He can be reached at (519) 641-3066 x 292
or via e-mail at lboksman@clinicalresearch
dental.com.
Disclosure: Dr. Boksman holds a paid part-
time consulting position with Clinicians
Choice and Clinical Research Dental, with the
title of director of clinical affairs.
Mr. Tousignant graduated dental technology
from George Brown College in 1992, certified
dental technician since 1994 from the
National Board for Certification in the United
States. He has worked for 12 years as a den-
tal technician, was certified as an instructor
for Heraeus Kulzer where he provided a num-
ber of hands-on programs for indirect com-
posites and denture injection systems. He
currently provides lectures and hands-on
courses for both the general/cosmetic dentist
as well as dental and hygiene schools across
Canada. His course topics include tooth whit-
ening, impressioning, temporization, and
direct veneer color change including the invis-
ible class IV restoration and the sensitivity
free direct posterior composite. He has also
been published in Oral Health and the
Journal of the Toronto Academy of Cosmetic
Dentistry. He can be reached via e-mail at
gtousignant@clinicalresearchdental.com.
Disclosure: Mr. Tousignant is currently serving
as technical support manager for Clinical
Research Dental where he provides technical
support and hands-on courses consistent
with the company’s philosophy, teaching bet-
ter dentistry.
APRIL 2009 • DENTISTRYTODAY.COM