TUFTS UNIVERSITY SCHOOL OF

DENTAL MEDICINE

Tissue Management and

Impression Making

Ekaterini Antonellou D.D.S.

Division of Prosthodontics
Department of Prosthodontics and
Operative Dentistry
 After tooth preparation and temporization , we
should make a final impression in order to fabricate
a restoration

Impression= Negative likeness of the teeth

and the surrounding structures.

It is the link between the prepared teeth and

the cast on which we make the crown.
 GOALS FOR A FINAL IMPRESSION

ƒ Accurate
ƒ Detailed
ƒ No voids
 PROPERTIES OF IMPRESSION
MATERIALS
ƒ Elasticity/rigidity -³WKHUHODWLYHVWLIIQHVVRIWKH
PDWHULDODIWHUVHWWLQJ´
ƒ Flow- ´GHILQHGE\WKHPDWHULDOVGHVLUHWRVWLFNWR
LWVHOI´
ƒ Tear strength- ³DELOLW\RIDPDWHULDOWRUHVLVW
WHDULQJDIWHUVHWWLQJ´
ƒ Hydrophilic- ³UHODWLYHDELOLW\RIDQLPSUHVVLRQ
material to tolerate moisture in an impression site
ƒ Accuracy/Dimensional stability-
ƒ Working and setting time
ƒ Ease of manipulation
ƒ Cost effectiveness
 Irreversible hydrocolloid(alginate)
ƒ Used for diagnostic impressions and
removable dentures and partials
ƒ Advantages : - Rapid set
- Straightforward technique
- Low cost
Disadvantages:- Poor accuracy and surface
detail
Precautions: - Pour immediately
 Reversible hydrocolloid (agar)

ƒ Used for multiple preparations or with problems

with moisture
ƒ Advantages : - Rapid set
- Low cost of actual material
Disadvantages: - Low tear resistance
- Low stability
- Equipment needed
- Special trays needed
Precautions: - Pour immediately
- Use only with stone
 Polysulfide Polymer
ƒ Currently used mostly for removable dentures and partials
ƒ Advantages : - High tear strength
- Easier to pour than other
elastomers
- Low cost
Disadvantages: - Messy
- Unpleasant odor
- Long setting time
- Stability only fair
- Humidity and temperature reduce
working time
Precautions: - Pour within 1 hour
- Use of a custom tray to minimize
the contraction of polysulfide polymerization
 Condensation silicone

ƒ Used mostly for lab procedures

ƒ Advantages : - Relative short setting time
Disadvantages:- Poor wetting
- By products of polymerization
reaction are alcohol and water. As
a result , evaporation from the set
material causes dimensional
stability
Precautions: - Caution to avoid bubbles when
pouring
 Polyether (Impregum)
ƒ Used for most impressions ,except for very long and thin teeth
ƒ Advantages : - Dimensional stability (can be poured more
than once ,even the next day)
- Accuracy
- Low polymerization shrinkage
- Relatively short setting time
- Automix available(pentamix machine)
Disadvantages:- Set material very stiff
- Absorption of water (should be
stored dry)
Precautions: - Care not to break the teeth when
separating the cast
- Block undercuts
- Care for perio involved teeth
 Addition silicone(Poly-Vinyl-siloxane)
ƒ Used for most impressions
ƒ Advantages : - Great dimensional stability (can be poured
more than once ,even the next day)
- Accuracy
- Very short setting time
- Automix available
Disadvantages:- Hydrophobic
- Poor wetting
-Some materials release Hydrogen .
Newer materials contain scavengers to
prevent the release of gas
Precautions: - Care to avoid bubbles when pouring
- Setting inhibition for some putties by latex
gloves
 Tissue Health
ƒ Control of periodontal disease
ƒ Proper contour, margins and surface of
provisional restoration
ƒ Oral hygiene
ƒ Use of Chlorhexidine (Peridex or Periogard)
 Saliva control
ƒ Use of cotton rolls and dry-angles to cover
the salivary ducts
ƒ Use of saliva evacuators
ƒ Use of local anesthesia
ƒ Prescription of anticholinergics e.g. atropine
or pilocarpine
 Displacement of gingival tissues
µ'LVSODFHPHQWFRUGV¶
ƒ Mechanical displacement with non-impregnated
cord.It is better if it is braided (Gingibraid, Van R)
or knitted (Ultrapak ,Ultradent)
ƒ Chemically impregnated cord in an
astrigent(Hemodent) . They contain aluminum or
iron salts that cause ischemia. Aluminum chloride
and ferric sulfate are suitable because they cause
minimum tissue damage.
ƒ Preimpregnated cords with epinephrine should be
used with caution
 Displacement of gingival tissues
³(OHFWURVXUJHU\´
ƒ The inner epithelial lining of the gingival sulcus is
removed
ƒ Access for a subgingival crown margin
ƒ Control of postsurgical hemorrhage
ƒ Passage of a high-frequency current through the
tissue from a large electrode to a small one. At
the small electrode the current induces rapid
localized polarity changes that cause cell
EUHDNGRZQ³FXWWLQJ´
 Displacement of gingival tissues
Electrosurgery
ƒ Profound local anesthesia is needed
ƒ Not suitable on thin attached gingiva
ƒ It should not be used with metal instruments
ƒ The electrode should not touch any metallic
restoration (can cause pulp damage)
ƒ It should not be used on or near patients
with cardiac pacemaker or insulin pump
 Disinfection
ƒ Glutaraldehyde 2% 10 min soak (not for
polyether)
ƒ Iodophor (1:213 dilution)
ƒ Chlorine compounds (1:10 dilution of
commercial bleach)
 Final steps

ƒ Re-evaluation of the final impression

ƒ Interocclusal record
ƒ Shade selection