FIXED PROSTHODONTICS

DR. ERWAN SUGIATNO DR HARYO M.DIPOYONO

PUSAT PENGAJIAN SAINS PERGIGIAN UNIVERSITI SAINS MALAYSIA

IMPRESSIONS
An impression is an imprint or negative likeness. It is made by placing some soft, semi fluid material in the mouth and allowing the material to set. The impression must be handled properly until it is poured up in a gypsum product.

An impression for a cast restoration should meet the following requirements : 1. It should be an exact duplication of the prepared tooth

2. Other teeth and tissue adjacent to the prepared tooth must be accurately reproduced
3. It must be free of bubbles

Custom resin tray

Custom resin tray have been utilized in elastomeric impression techniques because these material are more accurate in uniform, thin layer of 2to 3 mm. The custom tray must be rigid, and it should have stops on the occlusal surfaces of the teeth to orient the tray properly when it is seated in the mouth.

Armamentarium :
1. 2. 3. 4. 5. 6. 7. Diagnostic casts Autopolimerizing acrylic resin Measuring vial for monomer Measuring scoop for polymer Waxed paper cup Spatula Baseplate wax

8. Aluminum foil 9. Laboratory knife with no. 25 blade 10. Bunsen burner 11. Matches 12. Arbor bands 13. Adhesive for impression material used

Construction of custom tray :

Heat a sheet of baseplate wax in a flame until it is softened Fold it in half and place it on the diagnostic cast of the arch to be restored. Adapt it to the cast and trim any excess that extends more than 2 to 3 mm beyond the necks of the teeth. Cut a 3 x 3 mm hole through the wax over posterior teeth on both sides of the arch and in the incisor area. The tray resin will touch the teeth in these areas, forming solid stops for the tray.

 On the side where the prepared tooth is situated, the stop should be distal to the preparation. Mix the resin in the waxed paper cup, using one measure of powder and one vial of liquid. As soon as it is pliable and will not stick to your fingers, form it into a rod that is approximately the length of the dental arch (molar to molar, around the incisor). Flatten it out to form an oblong shape about 2.5 cm wide and 5.0 cm thick. Leave some extra bulk in the middle.

Cutouts for stops (arrows) in the spacers for fabrication of a custom impression tray

Tray resin ready for adaption to the cast

 Make sure that the tray does not extend beyond the trimmed distal border of the cast in the retromolar area. The bulk left in the middle of the tray should be used to shape a horizontal handle in the middle and a narrow ledge or wing on either side of it. The wings can be used to get better leverage on the tray for removal from the mouth. Allow the resin to polymerize. Paint the inside of the tray with a thin, uniform coat of adhesive, using the one specified for the impression material being used.

To achieve maximum adhesion of the impression material to the tray, allow it to dry for a minimum of 15 minutes.
Finished custom impression tray with a handle in front and wings on the side to facilitate removal

Inside of the tray is painted with adhesive

Gingival retraction It is essential that gingival tissue be healthy and free of inflammation before cast restorations are begun. To start tooth preparations in the face of untreated gingivitis makes the task more difficult and seriously compromises the chances for succes. Because the marginal fit of a restoration is essential in preventing recurrent caries and gingival iritation, the finish line of the tooth preparation must be reproduced in the impression.

Armamentarium :
1. Evacuator (saliva ejector) 2. Scissors 3. Cotton pliers 4. Mouth mirror 5. Explorer 6. Fisher Ultrapak Packer (small) 7. DE plastic filling instrument IPPA

8. Cotton rolls 9. Retraction cord 10. Hemodent liquid 11. Dappen dish 12. Cotton pellets 13. 2 x 2 gauze sponges

Retraction procedure :
Form the cord into a U and loop it around the prepared tooth. Hold the cord between the thumb and forefinger, and apply slight tension in an apical direction. Gently slip the cord between the tooth and the gingiva in the mesial interproximal area with a Fisher packing instrument or a DE plastic instrument IPPA. Once the cord has been tucked in on the mesial, use the instrument to lightly secure it in the distal interproximal area.

A loop of retraction cord is formed around the tooth and held with the thumb and forefinger

Placement of the retraction cord is begun by pushing it into the sulcus on the mesial surface of the tooth (A). It should also be tacked lightly into the distal crevice (B) to hold the cord in position while it is being placed.

 The tip of the instrument should be inclined slightly toward the area where the cord has already been placed. If the tip of the instrument is inclined away from the area in which the cord has been placed, the cord may be displaced and pull out. Gently press apically on the cord with the instrument, directing the tip slightly toward the tooth. Slide the cord gingivally along the preparation until the finish lineis felt. Then push the cord into the crevice.

As the cord is being placed subgingivally, the instrument must be pushed slightly toward the area already tucked into place (A). If the force of the instrument is directed away from the area previously packed, the cord already packed will be pulled out (B)

The instrument must be angled slightly, toward the root to facilitate the subgingival placement of the cord.

 If the instrument is directed totally in an apical direction, the cord will rebound of the gingiva and roll out of the sulcus. If cord persists in rebounding from a particularly tight area of the sulcus, do not apply greater force. Instead, maintain gentle force for a longer time, if it still rebounds, change to a smaller or more pliable cord. Pack all but the last 2.0 or 3.0 mm of cord.

If the instrument is held parallel to the long axis of the tooth, the retraction cord will be pushed against the wall of the gingival crevice, and it will rebound.

Placement of the distal end of the cord is continued until it overlaps the mesial. The force of the instrument must be directed toward the cord previously packed.

 Tissue retraction should be done firmly but gently, so that the cord will rest at the finish line. Heavy-handed operators can traumatize the tissue, create gingival problem, and jeopardize the longevity oh the restoration that they place. Do not over pack.

Placement of the retraction cord in the sulcus : A, correct; B, incorrect.

Impression materials (polysulfide): Polysulfide is an elastomer that is known as mercaptan, thiokol, or simply as rubber base. The impression material is packaged in two tubes : a base and an accelerator. The base contains a liquid polysulfide polymer mixed with an inert filler. The accelerator, which is usually lead dioxide mixed with small amounts of sulfur and oil, acts as an oxidation initiator on terminal thiol groups on the polymer.

Armamentarium :

1. Polysulfide impression kit (regular base and accelerator) 2. Polysulfide impression kit (light base and accelerator) 3. Adhesive (butyl rubber cement) 4. Two disposable mixing pads 5. Two stiff spatulas 6. Syringe with disposable tip 7. Two 2 x 2 inch gauze sponges 8. Alcohol 9. Custom resin tray

Impression Making With Polysulfide :

Try the custom tray in the mouth to make sure it fits without impinging on the prepared tooth. Insert the retraction cord and place a large gauze pack in the mouth. The following steps require an assistant : On one disposable mixing pad squeeze aout 4.0 cm each of light (syringe) base and accelerator. On second pad place 12.5 cm strips of regular (tray) base and accelerator.

 The assistant should start mixing the tray material on one pad 30 seconds before the operator begins mixing the syringe material on the other. Pick up the dark accelerator on the spatula and incorporate it into the white base. Holding the spatula flat against the pad, mix with a back-and-forth motion, pressing hard against the pad. Change directions often to produce a smooth, homogenous mixture. Be careful not to incorporate bubbles. Do not take more than 1 monute to mix it.

The mixture should be free of streaks and bubbles. Mixing is started with the dark accelerator.

Fold a sheet previously removed from the mixing pad in half and then fold it to make a cone. Open it up and wipe the syringe material from the spatula onto the crease.

Fully extended mixing pad sheet.

The sheet is folded in half

The sheet is folded to form a cone

Impression material is wiped on the crease

 Fold the cone over. Squeeze the syringe material from the cone into the back end of the syringe. Insert the plunger and express all the air from the syringe. In a second method of loading the syringe, the back end of the syringe is brought in contact with the pad, and quick, closely spaced sweeps of the syrunge will fill it, with a minimum of material spilled.

The paper is refolded to form cone again.

The cone is inserted into the syringe

The plunger is placed into the syringe

Scraping the back end across the mixing pad to scoop up material.

 Remove the 2 x 2 gauze squares from the patients mouth. Be sure that the retraction cord is slightly damp before removing it from the sulcus. Immediately inject polysulfide syringe material into the sulcus. Use an air syringe to direct a stream of air against the material to spread it evenly over the surface of the preparation and drive it into small detail such as grooves and boxes. Impression material is also forced more completely into the gingival crevice.

Impression material is injected into the sulcus

An air syringe is used to drive the impression material into the sulcus and preparation detail.

 Seat the tray slowly until the stops hold the tray solidly in one position. The tray should be held with light pressure for 8 to 10 minutes without movement. The set of the material can be tested with a blunt instrument. After the material has polymerized, the impression is removed. The wings on the sides of the tray can be used for added leverage in this task.

Wings on either side of the tray (arrows) are grasped to remove the impression from the mouth.

Soal midterm
Pasien kehilangan 3 dan2 RA kanan . 1.buat design GTC porselein fused metal 2.gigi mana sebagai abutment 3.jenis preparasi gigi abutment 4.bagaimana hukum Ante diterapkan pd pemilihan gigi abutment tsb 5.jenis pendak yg sdr pakai