"Tissue Management & Impression

Techniques"
"For Fixed Prosthodontics"
Before we start:

1- this is an easy lecture so don’t start hitting your head by the walls of your
room saying: it`s a long lecture I will never finish it, or starting pouring streams
of tears on the lecture spoiling it, no, just read it and you will find it very easy.

2- I included the things mentioned in the slides not by Dr with small font
(font 12) as usual so you don’t need to go back to the slides.

Now let`s start:

Why the impression in fixed prosthodontics is different?

As you studied in this course(C&B), of coarse in tooth preparation the

situation is different, there is tooth, finish line, gum, it`s not like complete
denture or RPD just take an impression (actually it`s not just take an
impression) but the requirements are different here in (C&B) we
need some different details, also you took in tooth preparation that the
finish line could be supragingival or subingingival.

Indications for subgingival finish line:

Esthetics, mechanical retention we need 3mm minimum in the
anterior teeth and 4mm minimum height in posterior teeth plus tapering
within 10-20 degrees, so if you achieve that, your preparation will be
acceptable clinically and beyond that you need to think of other solutions,
so saying this we can go down subgingivally to increase the height, now if
you want to go subgingivally how would you take an impression is by
retraction cord which is a tissue management and we will talk about it
later in this lecture

Part l: Tissue management

This part the Dr said that he will pass it very fast because it`s not
recommended from him to give to us, it`s supposed to be covered later
and the Dr will just pass on most things that will make our understanding
to the video that was viewed in the lecture better.

• Tissue management
  Aims and principles: why would you retract off the gingiva, simply
because you want to create a vertical as well as horizontal
space to push the gum away so there will be access to the finish line
so that the material will be injected in.

 Techniques

Could be Mechanical, Chemo mechanical, Surgical or Combination of

them.
 Haemostatic agents discussed below

 New cordless techniques discussed below

The impression should provide a precise and clear model of

the prepared tooth and the surrounding tissues for the technician
to fabricate an accurate dies and to produce a biologically,
functionally and esthetically satisfactory fit restoration: So we
know that we need to take an impression (accurate impression), and
technician to create a model, accurate die (which is the single prepared
tooth), and why die? because its removable, you will see it when you start
working that this tooth can be put in and out on the same cast.

so you need an accurate impression and accurate die and the

technician will have the full information to make the wax up and the
laboratory procedures, but if you can`t pick up finish line or accurate
tooth this means that your work will not be accurate and if it`s not
accurate what will happen is all of this:

Tissue displacement: the proper definition for it is that it’s the

deflection of the marginal gingiva away from the tooth.
Tissue displacement purposes:

 Is to create sufficient lateral and vertical space

between the gingival finish line and the gingival tissue.
 Provide absolute control of the gingival fluid seepage
and hemorrhage: the most famous material that you use in fixed
prosthodontics work is the silicon which is hydrophobic
material (can`t work properly when there is blood or saliva) so

"Mun: don’t worry just only 17 pages and you will end this easy
lecture"

this is a another objective of retracting the gingiva, also when you

do the preparation the retraction cord will help you, when you go
subgingivally how would you go there and there is gum on the tooth
?, you will definitely injure the gingival margin, but you want to make
the finish line equegingival or subgingival (slightly subgingival) so
you will retract the gum using the retraction cord (usually the cord
will retract the gingiva about 0.5 mm) then you go down with your
finish line at the retraction cord, now when you remove the
retraction cord the gum will go back to its place, so at the end you
entered subgingivally without harming the gingiva.

So in order to produce that we need the ideal retraction

material characteristics:
1- Effective for its intended use

2- Should not cause significant and irreversible tissue

damage, the local damage happens, when you use the retraction
cord there will be reversible gingivitis (the gingival index GI
increase), and most of the studies that we will pass on said that
within 8 days the GI remains high but after that we will go back to
normal so the procedure after a while is harmless, but the
retraction cord can cause recession depending on the force as we
will see later also the effect on the gum affected by number of
retraction cords that you used, nature of the gingival tissues
for ex. If the gingiva was highly scalloped, thin, biotied (not sure) it will
be vulnerable to recession so you need to consider these things
when you want to choose the technique that you want to use.

3- Should not cause potentially harmful systemic effects

Techniques:
• Mechanical methods using a retraction cords:

Simply you push the gum away physically by the body of the cord,
and remember if you don’t want to use any chemical agent as the next
method you should not use it dry but you should immerse it in water
because if you use it alone you will injure the tissues so never
use it alone.
• Chemomechanical methods:

Is when you immerse the retraction cord in a haemostatic agent

to control bleeding, so here we use chemistry and mechanical
means to control the situation.

• Surgical methods:

 Electro surgery: fully filtered rectified current (those things supposed to be

covered later as the Dr understood from the coordinator).

 Rotary gingival curettage: using bur we cut some of the inner side of
the gum to create space but this will cause bleeding.

• Combination of these.

But the standard technique in tissue displacement is the

retraction cord as the Dr answered one of the students.
Retraction cords:
• Most of the dentists use it as a tool to retract the gum so it`s
traditionally the most popular method, and there is another
methods called cordless techniques we will talk about them later in
this lecture.

• Safe but to a certain degree, as we said it may cause

recession if you leave it long time (you should not leave it
beyond 10 minutes, and if you do that the injury on the tissues will
be beyond what we said (remember we said that the tissue will heal within
10 days or maximum 2 weeks))

• Easy, actually it`s not very easy and its time consuming you
need to put it around the tissue ..etc, that’s why they invented the
cordless techniques.
 • Quick

• Effective it`s very effective and long history behind it so we

know what we are doing and we know the effects of it

• Inexpensive this cord is very cheap.

-There are numbers in this slide (slide 11) but they are not clear for what they are so I didn’t
copy them.

 Gingival retraction cord may damage the

periodontal tissues.
 Tissue damage may occur, with friable thin
gingival tissue particularly susceptible and subject to
tearing, we talked about these two points previously.
Factors Affecting Damage:
 Force used in packing the cord
 Size or Number of retraction cords: the cord comes in sizes
00,0, 1, 2, 3… to give you options which to use

 Length of time the cord is left in place within the sulcus

 Chemical agent with which the cord has been impregnated.

And these are some studies which studied the effect of retraction cord on
the gingiva:

• If the gingiva is healthy initially, healing will occur rapidly

(yap&ong 1994)

• Took about 8 days to heal, but with average postoperative

gingival recession of about 0.2 - 0.1 mm (ruel et al.1980)

• Healing occurred histologically in 7 to 10 days (godacre 1990)

• The damage healed clinically within two weeks as was

indicated by the GI (feng et al.2006).

So after these results we can all agree that this technique cause
reversible damage to the tissues, there will be some inflammation but by
the time things go back to normal.
Haemostatic Agents: (Dr said they should be covered more than this)

 epinephrine (0.1%- 0.8%):

 creates local vasoconstriction so they can use it as a tool to

control bleeding

 a 1 inch of cord dipped (‫ )مغطس‬with 1.0mg of epi contains 2.5x

(‫ )ضعفين ونص‬the max recommended dose for healthy patients and
12x(12 ‫ )ضعف‬the dose recommended for cardiac patients, so you
should have another thought Before using it in cardiovascular
patients.
 contraindications for epi use in cord: hx of cardiovascular disease,
hyperthyroidism, allergy to epi

 signs of epi syndrome: tachycardia, increase in respirations, nervousness,

increase in B.P., post op. depression---these symptoms will appear after the cord
has been in place for a few minutes or shortly after it is removed

 potassium aluminum sulfate (ALUM):

 only slightly less effective than epi at shrinking tissues

 aluminum chloride (Hemodent) 5-10%:

 conc in excess of 10% will cause local tissue destruction

 there are no major contraindications and minimal systemic effects

 less effective in stopping the bleeding than the

astringent (below), but you use it to clean the area from
debris because if you used cotton you may cause injury again but if
you used cotton wet with hemodent it will clean the tissues without
bleeding.

 ferric sulfate (13.3%):

 astringent

 very good for hemostasis so it`s my choice if there is

problem from bleeding and I have to control the bleeding.
 does not noticeably traumatize tissues and heal more rapidly than
hemodent

 temporarily discolors tissues for 1-2 days

 provides tissue displacement for at least 30min

  zinc chloride (Bitartrate)8% & 40%:

 tissue displacement equal to epi

 * tissue necrosis is high

 NOT RECOMMENDED FOR USE because more than 10% of

it cause high injury to the tissues.

 tetrahydrozoline (visine, afrin, murine plus, neosynephrine):

 a sympathomimetic amine that produces vasoconstriction with

minimal side effects.

The Dr wants us to remember that tethydrozoline cause the same

effect as epinephrine in cardiac patients.

New cordless techniques:

Expasyl:

 Viscous paste acts as a chemo-mechanical haemostatic

and retraction agent so it’s a clay which deflects the gingival,
you syringe the finish line so instead of cord packing you just syringe
it in and it will push the gum away.

 Component

 Organic, clay material (kaolin): easy and quick tissue

displacement.

 Aluminum chloride (15%): haemostatic agent the Dr said

zinc chloride instead of aluminum chloride and continued
explanation according to this (and I searched on the and I found it aluminum
chloride also), saying that it may cause injury to the tissues with this
high concentration as a chemical effect in addition to the
mechanical effect from the clay so the clay cause
chemomechanical effect (look above zinc chloride is not
recommended because more than 10% of it can injure the tissues,
and again in the slides its aluminum chloride and he said zinc
chloride)

 Additional ingredients include colorants, water, and essential oil

of lemon.
 Cartridge Form Stainless Steel
Dispenser

Disposable Tips

Technique Principle:
• The strength of the epithelial attachment is 1 N/ mm2

• Injured by the application of a pressure of 2.5 N/ mm2

• Pressure of 0.1 N/mm2 enable sulcus opening of 1.5 mm & a delayed

recovery up to 2 minutes per 0.5 mm opening

Too low to damage , Sufficient to obtain sulcus opening.

Magic Foam Cord:

There is no haemostatic agent, its silicon and silicon is
expanding (‫ )بنفش‬so you syringe it around the tooth using the gun
and tip

The first expanding PVS material designed for easy and fast
retraction of the sulcus

 Cartridge similar to the regular impression materials

 Disposable tips

 Cotton cap (Comprecap) they are emptied from below

The patient bite on them to push the sillicon material in, and

After 5 minutes the silicon will enlarge

 Used with the same gun of the regular addition silicone impression
material

Principle of Work:

Silicone foam expands in the sulcus and its mass

becomes larger precisely to achieve the retraction we
require.

In cordless techniques (both expasyl and magic foam) you should

remove and rinse them exactly before taking the
impression, and the magic needs 5 minutes and expasyl
needs 2 minutes only.
Before you start reading the next part (efficacy of cordless techniques on
gingiva and in gingival retraction) Dr said it`s not required because its
new things and it was not studied yet.

The efficacy of them on gingival health and in gingival retraction is not

studied, but the Dr made a study on them(published in general clinical
periodontology, only the effect on gingival health), he compared the
cordless techniques with retraction cords, so after tooth preparation on
several teeth and before taking the impression he used on one of them
retraction cord and on another one expasyl and on other one magic foam,
and he followed the effect on the gum, and he found that expasyl has
clinically significant gingival Index more than others, and
the Dr explained that by saying that its expectable because it has 15%
zinc chloride.

These are the results as in the slides:

Principal findings: all retraction techniques caused a temporary inflammation,
measured through the gingival index.The recovery at 7 days was slower for Expasyl.
Bleeding during or after retraction was only encountered with the use of conventional
retraction cords.

Practical implications: This study showed that none of the techniques tested seems to
harm the tissues in the long term; however, clinicians should be aware that Expasyl
use is less friendly to the gingival tissues. Cordless techniques do not require
haemostatic agents to control bleeding.

So by now we ended the first part of the lecture (tissue management) with
all its divisions aims and principles….. tell new cordless techniques which you
can easily read and even if you don’t know the technique you can read it on the
brochure behind it.

Part ll: impression techniques

By the beginning of this part the Dr started playing a video about
preparation for a molar and the impression techniques and below
are the comments by the Dr on these videos (I hoped that I can insert the
videos in this lecture but unfortunately it`s not applicable, maybe in the future it will
applicable to see videos on papers).

Here (in the video) we decided to make a crown on tooth, so we

started preparation using a round end tapered diamond bur no
shoulder no chamber just only use this bur and you can prepare
everything even the proximal areas, the tip of this bur is 0.8 mm so if you
want to prepare a finish line just enter half of it when you are doing
preparation and it will make a finish line, and if your crown is metal
ceramic which needs 1mm shoulder finish line all the tip should be in and
by that you prepare what we call heavy chamfer which is the substitute to
shoulder (Dr said that he don’t use the shoulder bur at all, but we as students
should study all techniques then select what we like in the future).

As we saw on the video the operator started preparing axially, the Dr

said regarding the order that you may start occlusaly as he do, so as we
saw along the same path of insertion that you selected
you keep the bur all the way in, then he continued to go
proximally (here the Dr mentioned a mistake that the students always
make which is when they go up proximally they tilt the bur proximally) so
don’t tilt the bur proximally and be on the same path of
insertion.
and as we saw the skillful operator when he went proximally he kept
the tilt the same and he entered the proximal area without changing the
bur, unlike us (students) we are not skillful and we might change the bur
and go to a small thin diamond bur to open proximal contact so on…, but
here he just kept going on because he is very skillful until he opened the
contact.

The tooth that the operator was preparing has amulgum

restoration which extending to the gingival margin and its
one of the indications to go with the finish line
subgingival beneath the restoration to house the
restoration and as you know your finish line should be on
tooth structure.
One of the students asked about the operator who opened the
proximal contact without changing the bur, and the Dr answered that we
as students are not skillful as him and we should adhere to the same
principles that we read in the books and the things we don’t read we
should not memorize it from the clip (so there are different schools).

The Dr emphasized on an important point that the operator made an

alignment between the mesial path of insertion and the
distal path of insertion to make the same taper (remember
we took in the principles of tooth preparation that we need to keep the taper as
minimum as possible).

previously they said that you should make the taper 6 degrees (this
came from a study done in the fifties by preparing teeth and calculating
the force required to pull the crowns against the path of insertion) and it
remains the ideal degree, but recently they revised this degree and found
that we actually don’t achieve the six degrees at all even
the specialists can`t achieve it, so the average is 18, 16 if it’s
a good preparation, so they revised the study and said that the
study examined the resistant to pull upward but this is not what happen
clinically because clinically the tooth is subjected to
horizontal forces that’s why the resistance form is more
important than the retention form (remember both of them are
important), because there is nothing can pull the tooth upward or
downward (according to Dr), so here after they considered the previous
things they found that the height with the taper with the other
features is the important things in the preparation, so the
recommendations mentioned that 10-20 degrees tapered is
acceptable if you have 3mm minimum height anteriorly
or 4mm minimum height posteriorely because the diameter of
the crown is wide posteriorely, otherwise you should think of other
solutions like guiding grooves boxes crown lengthening posts building up
the tooth core so there are different ways to improve the resistance form.

The operator put guiding grooves then he started to prepare the

occlusal surface, and he followed the anatomy of the tooth so
you should be as him, and he used the tip of the bur (0.8mm)
as a tool to measure the amount of occlusal reduction also you
could use indexes to control that, then the second plane of reduction
buccally and palatally, then he came back to remove the sharp edges.

Now in order to assess the occlusal reduction you could use wax
by making the patient bite on it then you measure the wax by wax gauge
to know the amount that you removed or by the indexes that we talked
about previously.

In the video the tooth was 90% ready and the finish line was still on
the amulgum, so he needed to take it downward to house the amulgum
within the crown.

Always students think that if you do not take much tooth structure then
you are good but this is not true, taking minimal tooth
structure is as bad as taking excessive, because if you prepare
minimal preparation your technician will either make your crown very
big(to get the color as Dr said) to have the enough thickness of metal or
ceramic so the emergence profile will be distorted and it will be
aesthetically ugly also it will cause harmful effects on the
gingival margin, or he will make it as its normal size so the thickness
of the crown will not be enough (especially occlusally he can`t make the
crown big because the crown will be high) and the ceramic will not cover
it or there will be perforation so it will be a failed crown, also if you did
over preparation you will get as bad results, so you should do what is
needed. (here the Dr mentioned example with numbers (I (mun) think they are not accurate and
they are different from book numbers so I think it's better not to memorize them and just get the idea)
about the effect of minimal preparation for metal ceramic crown on
technician work, for you to cast a metal you need minimally 0.3-0.5mm
thickness to cast a metal and at least 1mm for ceramic if it was supported
by metal so you need 1.3-1.5mm (in lec 5 its 1.5-2mm occlusal reduction)preparation
and if you prepare below this, you will get the above results).

Now we reached our topic in the video, the operator dipped the
retraction cord in haemostatic agent (strengodent as Dr read it)
then he took the excessive by gauze and then he applied it,
and the ways to do that is many, you can use a probe or a plastic
instrument with flat end, also there is some instruments the tip of
it is irregular (‫ )مخرمة‬to catch the cord to push it or other things flat
like plastic instruments you could use either (‫ )كله بيمشي‬but you should be
experience in this process.

Make the cord as a loop, the Dr himself found that if you hold the two
ends and you give it a bit of stress (‫ )شديتو شوي‬then you push it, it will slip
all inside the tissues, when you push you keep pushing backward means
you started from a point you keep pushing toward the starting point with
the same direction don’t make like this (I don’t know what he meant by this but
the result of making this this is pulling out the cord from the tissues ), then you cut
the excess and you push what remains inside.

As we noticed in the video the operator had a space to prepare mesial

to the tooth structure beneath the amulgum and that’s what Dr told us
about, that without retraction cord we can`t prepare beneath the gingiva,
and regarding the astringent we may put it on

the retraction cord as above or it come in a form of tip and you

rub it against the tooth structure to control the bleeding, and as
we said before use the hemodent which is a less powerful haemostatic
agent than astringent to clean the remaining debris, also you control
the moisture using cotton roll lingually, then piece of cotton dipped
in a haemostatic agent (hemodent as we said) to clean the tooth and then
see how nice and clear tooth structure finish line beneath the amulgum
restoration.
 One asked about the ferule and the Dr answered that it will be covered
more in post crown course.

Now one of the advantages of tissue displacement is that it will enable

us to do another step which is margination, when the gum is away you
can see the finish line obviously so you can see the entire finish line to
make sure that the finish line is clear all around with the thickness that
you want, then you do the final step which is the finishing to remove all
the rough areas using either fine grid diamond bur or use a used bur (
‫ )مستخدمة كثيريعني ماحيه‬it will not take much from the tooth it`s something
like polishing, so you remove all sharp areas.

And you do roundation for the cusps because these sharp areas
can cause problems to you, any sharp area in the impression may
cause voids and when the technician cast it if we got the impression
maybe he will not pour it properly because it`s very thin, even if all these
things continued good (‫ )يعني حتى لو زبطت كل المور‬later on even on the
crown when he work on these sharp edges he might break them, even if
he continue (‫ )رد مشاها‬there will be another chance that in the future after
cementation it will be stress areas on the cement, so there is many
advantages to remove the sharp areas.

Finally the operator checked for any sharp edges by probe and by
howly (spelling not sure) instrument he did finishing for the finish line or you
can use tungsten carbide bur, then he cleaned the area and prepared
for the impression, so by now we finished the first step which is the tissue
management and the tooth was ready for impression, now as the finish
line was clear to the operator he had two choices either taking the
impression with the retraction cord in its place, or removing it and do
syringing directly.

Then the operator started with the impression (the Dr didn’t about
what he did but he explained what we use in our clinics) by gun we load
the light body of silicon on the finish line and on the tooth
because its flowable and the heavy body (putty) on the
tray so this is the technique the same concept with different material
(from the material that operator used).

The operator used a gauze to control the moisture because as you

know silicon is hydrophobic material (can`t work properly with saliva and
blood), so we use regular viscosity or heavy putty on the tray and why is
that means (why we don’t load the tray also with light body?) is because if
we load it with light body it will flow and there will be much excess
and it may enter in the patient`s mouth, so it will force against the
light body (remember it’s the same material with two viscosities, the
difference is only in the filler).

The Dr mentioned a clinical point that when you do syringing with the
gun always keep material in front of and behind the tip of the gun
which means don’t drag the material behind, so you start with bollous of
impression then you keep syringing where there is material in front and in
the back of the tip.

Then the operator continued syringing the light body for all the
occlusal surfaces for all teeth because its more accurate than the heavy
body, so we need the more accurate light body on all the
teeth because the die is not the only thing important, we need
our impression to be accurate on all teeth even those on the other side
because these teeth after pouring the impression will be articulated
against the opposing arch and if the other teeth were not accurate this
means that your mounting will be wrong and the occlusal
surface shape of the crown will be wrong, so don’t be as one
of the students who asked the Dr "I want to make a bridge, can I get
sectional impression?" and of course the answer is no, you should get
full arch impression.
Finally he removed the impression and he inspected the impression,
and here the Dr pointed in the video on the impression and pointed on
depression in it, and that depression is the finish line and the part of
the impression which is coming upward toward us and has
irregularities is the material that entered subgingivally beneath
the finish line.

I found the picture beside on the net I think it can help

you understand.

This is the finish line

That is the material

that entered beneath
the finish line
 One of the students asked about all the previous process and that it
will take long time to do it, and the Dr answered that it’s a step by step,
applying retraction cord will not take 10 minutes and finishing will not
take more than 2 minutes also drying doesn’t take time so it will not take
long time, but if your preparation was bad it will take long time.

The Dr showed us another video, we saw in it how the nurse was

removing the retraction cord and the operator following here directly
with the impression material and that is to prevent any leakage of
fluid or blood in the place of retraction cord, so you need someone to
help you with this.

Now one should ask why here the operator removed the
retraction cord while in the previous case he didn’t?
Will this depends on the case, for example if you put the
retraction cord and still the finish line is not clear you
should remove the retraction cord because when you
remove it there will be space so the impression will be better,
but if you put the retraction cord and the finish line
became clear and you are afraid that if you removed the
cord there will be bleeding and you are working on
posterior teeth it will be better to take the impression
without removing it.

There is also another technique which is the double retraction

cord where you use two retraction cords above each other, you put
first very small size cord (size 00) then you put (size 1) on top of
it so there will be two retraction cords beneath the finish line, then
before taking the impression you remove only the larger
size and you take the impression above the smaller size which prevent
bleeding or seepage of fluids, finally you should always check that
there no remnants of impression material.
By now we finished watching videos and the Dr started passing on the
remaining slides, saying that it’s a revision and you can read it by
yourself.

Remember in fixed prosthodontics we use only rubbers which

are below

"Mun: did you see how this lecture is easy, just 5 pages and you will finish"

Classifications:
According to elasticity:

According to viscosity:
Available materials:
Polysulphide:

 Base:

Short chain Thiokol polymer.

 Used extensively in building industry where it is supplied as a

one pack and setting takes place under atmospheric oxygen (weeks).
This is regarding using in building not in clinic

 In dentistry, setting is brought about by oxidizing agent (lead

dioxide)

 Molecule of water is produced for every link that is made. (condensation)

 Objectionable odor

 Long setting time (9 minutes) so it`s one of its problems

 High shrinkage because of its water byproduct so it will

cause dimensional changes

 High tear resistance so it go out from undercut without

tearing (maybe it’s the only advantage)

 High permanent deformation.

Actually the Dr didn’t ever use polysulfide because of its bad

properties (bad smell in addition to above bad properties)

Polyether:

 Base:

 Polyether polymer with imine group

 Plasticizer & Inert filler

 Activator:

 Aromatic Sulphonate

 Plasticizer & Inert filler

 Short working time

 Less permanent deformation than polysulfide but not as low as silicones.

  Stiff (very rigid) not while polymerizing but once it set
(polymerized), the Dr mentioned a story about this point, when he
was training he took an impression for an implant with polyether
because its rigid (the impression material for implant should be
rigid), so when pulled the impression he pulled the bridge on the
other side from its place because this material is very rigid, so if
there is a lot of undercuts bridges or whatever block it with wax then
take the impression

 The least dimensional change except the addition type silicone,

so it’s the best after addition silicon (regarding stability)
because it doesn't have byproducts.

 Absorb water (like alginate) so between the impression and

pouring make sure that it`s away from water.

 It`s hydrophilic so if your tissue management is not very

good you can use it, unlike silicone which is hydrophobic.

Silicone Rubber:
• Condensation Type
• Base:

 Hydroxyl terminated Dimethyl siloxane (reactive OH).

• Catalyst:

 Alkyl silicate.

• Different viscosities produced by different MW of Dimethyl siloxane and

the concentration of the filler.

• Condensation reaction producing alcohol. Resulting in

dimensional change occuring mainly during the first 24 h.(remember
its very good and accurate material but dimensionally not stable)

• Addition Type (Polyvinylsiloxane):

• Prepolymer of polydimethyl siloxane in which some of the methyl groups
are replaced by vinyl groups in one paste and with hydrogen in the other paste.

• Catalyst: Platinum containing compound (chloroplatinic acid).

• Addition reaction producing no by products.

• Increase in Temperature and Moisture increases the reaction.

 • Early when they first introduced it (1950’s), gaseous hydrogen
was produced as a result of the cross linking reaction. Mechanism is
unclear !(side reaction of the hydroxil group ? Or a reaction of the
catalyst with moisture??), but in the new products they got rid
of this problem.

Comparison of elastomers:

œ Setting time - Polysulfides (longest)> Silicones >

Polyethers

œ Tear strength - Polysulfides > Silicones > Polyethers

œ Stiffness - Polyethers > Silicones > Polysulfides

œ Dimensional Change - Cond Silicone (the worst)>

Polysulfides > Polyethers > Addition Silicone

The Dr pointed to main indications, if you want to do crown

and bridge work use the best material (addition sillicon), for
implant use polyether, for complete denture use either
addition silicon or use ZOE as you do in the clinic because we
don’t need it to be elastic or you may use polyether but the
technique is different (with one shot you do border molding), for
partial dentures use addition silicone or alginate (but take
care of its dimensional changes), so by now you are not excused
if you were asked about them in viva exams.
Packaging & Techniques:

The material may come as putty (‫)معجونة‬, or heavy body or light

body and the difference between them is in the filler and they differ in
the flowability, the heavy body on the tray and light body on the crown.

Trays:
Routinely we don’t use custom trays, we use stock trays and
the best tray is the one who covers the teeth and is rigid,
notice for example the silicone, the spacer in it is not that important (we
want spacer if we use heavy body but the light body don’t need much
spacer same as ZOE).

The more important thing is that the tray should be rigid, because if
you want to use heavy body or putty with the red tray which is flexible (look
to the lower picture right)the tray will deflect and the impression will be deflected

(because silicon is accurate if the impression deflected it will remain

deflected).

You could use custom tray if you have big mouth and you don’t
have stock tray that cover all teeth, but not for the purposes of
thicknesses because silicon is accurate in either thin or thick sections
and at the end there is no dimensional changes.

This was previously important when they were using the condensation
type, because as you lower the amount of material in the impression you
lower the amount of dimensional changes.

Stainless steel perforated trays(metal)(left)

Polytrays (Polycarbonate/Yellow) (middle)
Orthodontic impression trays(red) (right)

Disinfection:
DISINFECTANTS FOR IMPRESSION MATERIALS:

 Glutaraldehyde:
 œ - Indicated for all impression materials except
hydrocolloids
 Phenols:

œ - Indicated for polysulfide rubber base only (so you will never
use it because the Dr didn’t ever use polysulfide)

 Iodophors and NaOCl:

œ - Indicated for all impression materials.

The end
Normal thanks to saleh alqadi for hearing a one word in the record

Any feedback is partially welcomed

Good luck for everyone in the next uncountable

exams
Done by: muntaser ghassan toffaha.