3.

Impressions

Preliminary
Final
Preliminary Impressions
Preliminary Impressions
Uses
Diagnostic
Fabrication of custom tray
Records – preoperative
Materials
Most common material for preliminary impressions is
Irreversible Hydrocolloid – alginate
 The mixing of the alginate powder with water forms a gel via a
chemical reaction
 This physical change is irreversible
Precautions
The impression should not be immersed in liquid (water
or disinfectants)
 Imbibition will occur and inevitably result in accompanying
expansion
Impression should not be exposed to air
 Dehydration will inevitably occur and result in shrinkage
 The impression should be protected from dehydration by placing
it in a damp paper towel to avoid volume change
 This should be done within 15 minutes of removal from the
mouth
Armamentarium
 Alginate – fluff material in container
 Water – room temperature
 Alginate measuring scoop
 Water measure
 Rubber bowl
 Spatula
 Sterile impression trays
 Periphery wax
 Bib and daisy chain
 Mouth mirror
 PPE – gloves, mask goggles
 Paper towel – optional
Impression Procedures
Explain the procedure to the patient to ensure their
comfort
Let them know the material will feel cold
There is no unpleasant taste
The material will set quickly
They must breathe deeply through the nose
 This will help the patient relax and be more comfortable

Perform a quick oral exam

Check for tori on palate or lingual of lower arch
Check vestibule for clearance of abnormal features
Select a suitable sterilized, perforated, or rim-lock tray
Seat patient upright, head back on rest
Try tray in patients mouth
 large enough to provide a 4 – 5 mm thickness of the impression
material between the teeth/tissues and the tray
... To begin
Place periphery wax if needed (to extend borders)
The maxillary tray often has to be extended
 to include the tuberosity
 To include the vibrating line region of the palate
The mandibular tray extension may be needed
 by the retramolar pads
 to include the third molars
 In the retro mylohyoid area

Such extensions also aid in correctly

seating/orientating the tray in the patient’s mouth when
the impression is being made
 Place the patient in an upright position, with the arch to be
impressed nearly parallel to the floor
 Their head should be resting back on the headrest for better stability

 Mix the premeasured alginate powder into the premeasured, room

temperature water
For a thicker consistency, you may fill the water 2 mm below the line
on the vile (depending on the brand of alginate used)
 Spatulate rapidly against the side of the bowl for 30 – 60 seconds
(according to manufactures instructions)
 In the meantime, have the patient rinse their mouth with warm
water
To eliminate any saliva or any food debris
... Loading the Tray
 When placing material into the tray, avoid entrapping air
Loading the mandibular tray
 Gather half the alginate in the bowl onto the spatula
 Wipe alginate into one side of the tray, from the lingual side
 Gather the remaining half of the alginate, in the bowl, onto the
spatula
 Load the other side of the tray in the same manner
Loading the maxillary tray
 In one large increment, use a wiping motion to fill the tray from the
posterior end
 Move it toward the anterior, palatal area of the tray

Moisten fingertips with tap water, and smooth the surface of the
alginate for the impression
... Insert tray
Maxillary (right handed operator)
Stand behind the patient, to their right side
Use the loaded tray to enter the mouth on the side farthest
from you first (patient’s left)
 Use the tray to retract the left cheek/lip out of the way
 Using your left index finger (or a hand mirror), retract the
patient's right cheek out of the way
 Rotate the tray into the mouth
 Ensure tray is in far enough to cover the posterior landmarks while
beginning to seat tray on the side farthest from you,
 then seat the anterior portion while reflecting the lip with your
finger
 Then seat other side
Ensure the lip is draping naturally over the tray
Do not seat the tray too deeply. Ensure that there is proper
Mandibular
Stand in front of patient, to their right
Use the loaded tray to enter the mouth on the side
farthest from you first (patient’s left)
 Use the tray to retract the left cheek/lip out of the way
 Using your left index finger (or a hand mirror), retract the
patient's right cheek out of the way
 Rotate the tray into the mouth
 Ensure tray is in far enough to cover the posterior landmarks
while beginning to seat tray on the side farthest from you,
 then seat the anterior portion while reflecting the lip with your
finger
 Then seat other side
Have patient lift tongue

Setting
Hold the tray immobile for 3 minutes
Use light finger pressure
Over the left and right premolar areas
Muscle mould

DO NOT ALLOW THE TRAY TO MOVE

DURING GELATION
Other tips
Do not seat the tray too deeply. Ensure that there is
proper thickness of material over the incisal and
occlusal surface
Smear some alginate over the teeth before inserting the
tray
Use the hole in the handle of the tray as a guide to
center the tray in the patient’s mouth
Use a timer, you can tell the patient “20 more seconds”
Relax your arms and shoulders, keep your elbows at
your side to appear more relaxed to the patient
Removal
Remove the impression once the impression material
has completely set,
Release the surface tension
Remove the impression quickly
 In line with the long axis of the teeth to avoid tearing and
distortion
Rinse the impression of all traces of saliva and debris
Examine
Examine the impression critically
It should be centered
The peripheral roll must be complete, and include all
vestibular areas
The tray was not over-seated
 Would result in exposure of areas of the impression tray
Sharp anatomical detail of all teeth and soft tissue areas
In the mandibular – The retramolar area, lingual frenum,
tongue space, and mylohyoid ridge are reproduced
In the maxillary – The hard palette, tuberosity, and labial
and buccal frenums are reproduced
Disinfect
Spray impression with disinfectant
Follow protocol
Final Impressions
Polyether
Polyvinyl
Alginate
Review - Polyether
POLYETHERS
 Invented in the 1960’s only for dentistry
 Polymerization process called cationic polymerization
“ring opening”
No reaction by-product is produced
 Very stiff, slightly brittle, low flexibility, difficult to remove
without rocking
Custom tray should allow 4mm space to compensate
Works well with stock tray
 Only available in one viscosity (medium) – (Impregum)
 Clean
 Unpleasant taste
 Shorter working times than Polysulfides
30-45 seconds
 Sets quickly
3 minutes from beginning of mix
 Hydrophilic
DO NOT USE IN HUMID ENVIRONMENTS
Easy to pour with stone
 Superior accuracy – elastic recovery 98.8%
 Excellent dimensional stability
Stable after 1 week
Can be re-poured
 Slight allergy chance - 0.5%
POLYETHER
Review - Polyvinyl
Vinylpolysiloxanes & Polyvinylsiloxanes
Silicones (Addition)
Most popular impression material
(polyvinyl siloxane, PVS), sets by linking molecules
in long chains, but produces no by-product
Clean, no unpleasant taste or smell
The most accurate and stable
Most expensive
Available in 5 viscosities
Light body
Medium body
Heavy body
Monophase
Putty
Supplied in two tubes
Base and catalyst dispensed in equal lengths
On completion of reaction, no by-product is formed
 Addition silicone (vinylpolysiloxanes & polyvinylsiloxanes)
impression materials have a polymerization shrinkage lower than
condensation silicone impression materials
 It is similar in many respects to condensation silicone expect that
it has much greater dimensional stability (equivalent to polyether
polymer)
 Their great stability means that accurate dies can be poured for
up to a week after they have been removed from the mouth.
 The set material is less rigid than polyether (though stiffer than
polysulfide).
 They have moderately high hardness making them more difficult
than the Polysulfides or condensation silicones to remove from
the mouth.
Alginate
Alginate can also be use for final impressions
MUST USE CUSTOM TRAY
With suitable relief – 3-5 mm
Armamentarium
 Custom tray
 Adhesive
 Alginate
 Alginate measure scoop
 Water
 Water measure
 Rubber bowl
 Spatula
 Bib and daisy chain
 Mouth mirror
 PPE – mask, gloves, goggles
Steps for Final Impressions
Explain the procedure to the patient to ensure their
comfort
Let them know the material will feel cold
There is no unpleasant taste (there is for elastomeric
materials)
The material will set quickly
They must breathe deeply through the nose
 This will help the patient relax and be more comfortable

Check the fit of the custom tray

Use the mouth mirror to check that there is no
interference or over-extensions
Periphery wax should not be needed
 Place the patient in an upright position, with the arch to be impressed
nearly parallel to the floor
 Their head should be resting back on the headrest for better stability

 Mix the premeasured alginate powder into the premeasured, room

temperature water
 For a thicker consistency, you may fill the water 2 mm below the line on
the vile (depending on the brand of alginate used)
 Spatulate rapidly against the side of the bowl for 30 – 60 seconds
(according to manufactures instructions)
 In the meantime, have the patient rinse their mouth with warm water
 To eliminate any saliva or any food debris
... Loading the Tray
 When placing material into the tray, avoid entrapping air
Loading the mandibular tray
 Gather half the alginate in the bowl onto the spatula
 Wipe alginate into one side of the tray, from the lingual side
 Gather the remaining half of the alginate, in the bowl, onto the
spatula
 Load the other side of the tray in the same manner
Loading the maxillary tray
 In one large increment, use a wiping motion to fill the tray from the
posterior end
 Move it toward the anterior, palatal area of the tray

Moisten fingertips with tap water, and smooth the surface of the
alginate for the impression
... Insert tray
Maxillary (right handed operator)
Stand behind the patient, to their right side
Use the loaded tray to enter the mouth on the side farthest
from you first (patient’s left)
 Use the tray to retract the left cheek/lip out of the way
 Using your left index finger (or a hand mirror), retract the
patient's right cheek out of the way
 Rotate the tray into the mouth
 Ensure tray is in far enough to cover the posterior landmarks while
beginning to seat tray on the side farthest from you,
 then seat the anterior portion while reflecting the lip with your
finger
 Then seat other side
Ensure the lip is draping naturally over the tray
Do not seat the tray too deeply. Ensure that there is proper
Mandibular
Stand in front of patient, to their right
Use the loaded tray to enter the mouth on the side
farthest from you first (patient’s left)
 Use the tray to retract the left cheek/lip out of the way
 Using your left index finger (or a hand mirror), retract the
patient's right cheek out of the way
 Rotate the tray into the mouth
 Ensure tray is in far enough to cover the posterior landmarks
while beginning to seat tray on the side farthest from you,
 then seat the anterior portion while reflecting the lip with your
finger
 Then seat other side
Have patient lift tongue

Setting
Hold the tray immobile for 3 minutes
Use light finger pressure
Over the left and right premolar areas
Muscle mould
Move the cheek and lips in different directions to capture
the peripheral roll and frunums
 Up
 Down
 Side to side

DO NOT ALLOW THE TRAY TO MOVE

DURING GELATION
Removal
Remove the impression once the impression material
has completely set,
Release the surface tension
Remove the impression quickly
 In line with the long axis of the teeth to avoid tearing and
distortion
Rinse the impression of all traces of saliva and debris
Examine
Examine the impression critically
It should be centered
The peripheral roll must be complete, and include all
vestibular areas
The tray was not over-seated
 Would result in exposure of areas of the impression tray
Sharp anatomical detail of all teeth and soft tissue areas
In the mandibular – The retramolar area, lingual frenum,
tongue space, and mylohyoid ridge are reproduced
In the maxillary – The hard palette, tuberosity, and labial
and buccal frenums are reproduced
Disinfect
Spray impression with disinfectant
Follow protocol for disinfection proceedures

POUR IMPRESSION WITHIN HALF AN HOUR