An alternative impression technique for mobile teeth-JPD

1. AN ALTERNATIVE IMPRESSION TECHNIQUE
FOR MOBILE TEETH
Evangelia Lampraki, DDS, A Konstantinos M. Chochlidakis,
DDS, B Evangelos Rossopoulos, DDS, & Carlo Ercoli, DDS
Presented by:
Mujtaba Ashraf
MDS 2nd
Department of Prosthodontics
§ JPD § Vol. 116 § Issue 2 § August 2016 §
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Contents
Introduction
Materials used
Technique
Advantages
Disadvantages
Discussion
Conclusion
References
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3. Introduction
Patients presenting for immediate denture therapy might
have remaining teeth that are extremely mobile and/or
misaligned.
Challenges during immediate denture impression
procedures in such patients include preventing accidental
exfoliation of mobile teeth during the impression
procedure and capturing in detail the teeth and buccal
tissues adjacent to remaining teeth, which frequently have
very different long axes.
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4. Numerous immediate denture
impression techniques have
been described.
The sectional impression
technique involves the use of
custom sectional trays,
custom trays in combination
with stock trays, or custom
trays with open buccal areas
adjacent to the remaining
teeth.
Gardner LK, Parr GR, Rahn AO. Modification of immediate denture sectional impression technique
using vinyl polysiloxane. J Prosthet Dent 1990;64: 182-4.
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5. The custom trays are fabricated on casts obtained after a
preliminary impression has been made.
A combination of impression materials, including modeling
plastic impression compound, zinc oxide and eugenol paste,
plaster, baseplate wax, irreversible hydrocolloid, and
polyvinyl siloxane (PVS) have been used to make
impressions of all hard and soft tissues.
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6. The use of stock and custom trays with holes to fit an
amalgam condenser to prevent movement of mobile teeth
while removing the impression from the patient’s mouth
has been described.
Similar methods involve the use of copper bands placed
over the mobile teeth and blocking the undercuts with wax
before impression making.
Soni A. Use of loose fitting copper bands over extremely mobile teeth while making impressions for immediate
dentures. J Prosthet Dent 1999.
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7. Recently, an impression technique for mobile teeth has
been described, Irreversible hydrocolloid on a modified
plastic stock tray that leaves exposed the labial or buccal
surfaces of the mobile teeth was used.
Lee H, Park C. A method to make a preliminary impression of mobile teeth. J Prosthet Dent 2009;102:52-3.12/22/2016Mujtaba Ashraf
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8. With this technique, the irreversible hydrocolloid
material captures the nonmobile teeth, the lingual
surfaces of the mobile teeth, and the edentulous areas
while PVS recording material is used to capture the
labial surfaces of the teeth at risk.
Lee H, Park C. A method to make a preliminary impression of mobile teeth.J Prosthet Dent 2009;102:52-3.
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9. Materials Used
The impression is made with a stock tray and a
combination of
• Low viscosity Polyvinyl Siloxane (PVS) and
• Polyether(PE)
• Irreversible hydrocolloid impression materials.
These materials quickly polymerize and do not adhere to
each other intraorally.
The impression is then separated in 3 different directions to
prevent any movement of the mobile teeth and reassembled
extraorally before pouring.
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10. TECHNIQUE
1. Select a stock tray and evaluate for proper fit in the patient’s
mouth. Modify with utility wax if needed until appropriate
extensions are achieved.
2. Inject low viscosity PVS impression material (Imprint 3M
ESPE) on the buccal aspects of mobile teeth
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11. 3. Inject low viscosity PE impression material
(Impregum; 3M ESPE) on the lingual aspects of the
mobile teeth
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4. After the polymerization of the elastomeric materials,
mix irreversible hydrocolloid (Jeltrate; Dentsply Caulk)
and load it into the tray. Place the tray intraorally and
maintain it in position until the material sets.
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13. 5. Remove the tray from the mouth in a vertical direction.
After removing the tray, the 2 pieces of PVS and PE
materials will still be present intraorally, generally
engaged in the proximal areas and/or undercuts.
6. Remove the polymerized PE impression material in a
lingual direction.
7. Remove the polymerized PVS impression material in a
buccal direction.
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14. 8. Assemble these 2 pieces in an appropriate relationship
(buccal or lingual) in the tray with the irreversible
hydrocolloid.
9. Pour dental stone into the tray.
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15. 10. After the dental stone sets, separate the cast from the
tray. The 2 pieces of PVS and polyether materials will still
be engaged on the cast in the proximal areas and/or
undercuts.
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16. 11. Remove the polyether and PVS impression
materials in 2 different horizontal directions.
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17. The complete diagnostic cast
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18. DISCUSSION
This technique addresses some of the limitations of
previously described methods for obtaining an
accurate impression of mobile and/or misaligned
teeth.
Although the sectional tray technique described in the
literature captures the edentulous and dentate areas
accurately, its use is limited in patients with
hypermobile periodontally involved teeth where the
risk of extraction during separation of either the
preliminary or the secondary impression is significant.
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19. The techniques described by Goldstein and Soni
eliminate the risk of extraction of the mobile teeth
during the impression procedures. However,
inaccurate capturing of the teeth and anatomic
structures around the teeth and patient discomfort
are problems related to these methods.
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20. Lee and Park described a technique that was modified
by Çomut, in which the impression of mobile anterior
teeth can be easily, accurately, and comfortably made
for the patient. This technique, though, can become
challenging when capturing posterior hypermobile and
misaligned teeth or soft tissues under fixed dental
prostheses.
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21. 1. Minimal risk of accidental tooth extraction
during the impression procedure.
2. Patient discomfort due to gag reflex is
minimal.
3. After the production of the stone cast, the
stock tray can be easily separated without the
risk of fracturing the stone.
Advantages
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22. Disadvantages
This technique is the use of 3 different impression
materials and their total setting time. Thus the total
time of this impression procedure is more than when a
single impression material is used.
The potential error caused by reassembling the PE and
PVS pieces in the tray with the irreversible
hydrocolloid material or by dislodging those 2 pieces
while pouring stone using a vibrator.
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23. This article presents a technique for making an accurate
stone cast of mobile and/or misaligned teeth combining
elastomers and irreversible hydrocolloid impression
materials.
This technique provides an alternative, easy, accurate,
and safe way to make a preliminary impression of
mobile, periodontally involved teeth.
Conclusion
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24. 1. Lee H, Park C. A method to make a preliminary impression of mobile teeth. J
Prosthet Dent 2009;102:52-3.
2. Çomut AA. Tray modification for making impressions of mobile teeth. J
Prosthet Dent 2013;109:341-2.
3. Cupero HM. Impression technique for complete maxillary immediate denture.
J Prosthet Dent 1978;39:108-9.
4. Goldstein GR. An alternative immediate complete denture impression
technique. J Prosthet Dent 1992;67:892-3.
5. Gardner LK, Parr GR, Rahn AO. Modification of immediate denture sectional
impression technique using vinyl polysiloxane. J Prosthet Dent 1990;64:182-4.
6. Soni A. Use of loose fitting copper bands over extremely mobile teeth while
making impressions for immediate dentures. J Prosthet Dent 1999;81:638-9.
References
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