Cairo University

Faculty of Oral and Dental Medicine

Fixed Prosthodontics Department

S1 Master’s program 2017/2018

Presented by:
o Eslam Mostafa Ismail
o Shaimaa Mohsen
Introduction
Dental impression is a three dimensional negative record of the tissues of the
mouth. It is used to reproduce the form of teeth and the surrounding tissues.
An ideal impression material should exhibit certain characteristics in the
clinical and laboratory environment. Clinically, it should produce a dimensionally
stable accurate impression with optimal mechanical properties (optimal Young’s
modulus, yield strength and thermal expansion coefficient) for adequate elastic
recovery and to resist tearing. It should also set within reasonable amount of time
and demonstrate biocompatibility. It should be hydrophilic for making a good
impression and for accurate pouring of multiple casts. It also shouldn’t be affected
with disinfectants and remain dimensionally accurate. Moreover, reasonable cost is
recommended.
It is difficult to obtain an ideal impression material in reality that fulfills all
the needed requirements. More detailed description of each property will help in
understanding how each material interacts.

Classification
There are several classifications of impression materials according to
different points:
1) Classification according to tissue displacement:

Either mucostatic or mucocompressive impression materials

 Mucostatic: materials which produce minimal displacement of tissues
For example: plaster, agar, light body

 Mucocompressive materials: materials have more viscosity than

mucostatic and displace tissue while recording them.
For examples: impression compound, high viscosity alginates, high
viscosity elastomers.

*Pseudo plastic (thixotropic): they are viscous (thick) impression materials under
static conditions and flow under pressure (becomes thin and less viscous).
2) Classification according to viscosity:

 Type 0: Putty: very heavy viscous material.

 Type 1: Heavy-body: tray consistency material.
 Type 2: Medium consistency: Regular bodied.
 Type 3: Low or light-body: Syringe consistency.

3) Classification according to mode of setting and behavior:

Mode of setting Rigid Elastic

Chemical reaction Impression plaster Alginate
(irreversible) Zinc oxide eugenol Polysulfide
Polyether
silicone
Physical change Compound Agar
(temperature/ reversible) Waxes

4) Classification according to interaction with water:

 Hydrophilic: This is the recommended property for impression material

to flow better in humid areas as subgingival areas. And has contact angle
<90 degrees.
For example: Polyether, alginate

 Hydrophobic: exhibits contact angle with water 90 degrees or greater.

For example: polysulfides, condensation silicone.
 Impression materials

Non Elastic Elastic

Aqueous Non-aqueous
Plaster Compound Wax ZnO Eugenol
Hydrocolloids Elastomers

Polysulfides
Reversible Irreversible
Agar Alginate Polyether
Silicones

Addition Condensatio
n

Rigid impression materials are rarely used in fixed prosthodontics field.

They have been old materials before the introduction of elastomeric materials.
Impression compound had been used in single tooth impression, in which a cavity
is prepared then impression compound is softened and carried in a copper band,
then the band is pressed over the prepared tooth. This was referred to as tube
impression. Also, zinc oxide eugenol and wax have been used for bite registration
widely before the invention of silicones.

General Properties

Dimensional Stability
The material ability to maintain the accuracy over time. It is time dependent
with elastomeric impression materials. It depends on the presence or absence of
by-product. Polyvinyl siloxane and polyether impression materials remain
dimensionally accurate for 1 to 2 weeks. Polysulfide and C-Silicone impression
material is dimensionally accurate if poured within 1 to 2 hours.
Accuracy
The viscosity of the impression material is the most important factor in producing
impressions and dies with maximum detail. The international standard for
elastomeric impression materials that they must reproduce a line 20 μm in width.

Elastic recovery
Return to its original dimensions without significant distortion upon removal.
Impression can be poured multiple times. Low permanent deformation.
Polyvinyl siloxane has the best elastic recovery, followed by polyether and
polysulfide.

Tear strength
How material resist tearing after setting. An
important criterion where subgingival margins
are concerned. Polyethers are considered to have
the highest tear strengths. Hydrocolloids have
relatively low tear strengths.

Wettability (flow characteristics)

The ability of the material to flow into small areas with little pressure. Impressions
that wet the teeth well displace moisture and result in fewer voids and flow easily
into small crevices. (Low wetting angle). Water is the ideal example of a material
with a low wetting angle. Result in fewer voids providing more accurate
impressions. Reproduce minute detail in the area of 20 to 70 μm.

Flexibility
Easier to remove from the mouth when set. Achieved through long cross-linking.
Polyethers tend to be the most rigid (least flexible). Alginate would be considered
the most flexible of the impression materials.
Contact angle (and ability to reproduce detail)
Low contact angle enable dental stone
to flow easily, and relatively bubble-
free casts are produced. High contact
angle require more careful pour
technique and attention to produce
accurate casts. Polyvinyl siloxane
materials may require surfactants to
lower the contact angle before pouring casts. Hydrocolloids, polyethers, and
polysulfides have relatively low contact angles.

Hydrophilic vs. Hydrophobic

Hydrocolloids would be considered the most hydrophilic. Polyvinyl siloxanes are
hydrophobic nature. Affects surface quality. Presence of moisture results in
impressions with voids (even with the new ‘‘hydrophilic’’ polyvinyl siloxane).
Polysulfides and polyethers are more hydrophilic.

Disinfection
Diluted sodium hypochlorite (bleach 5.25%, 1:10 dilution, 10 minutes at 20C)
accepted disinfection but not sterilization. Hydrophilic materials need strict
attention to disinfection guidelines is necessary to prevent swelling of the material.
(Spray with disinfectant for 10 minutes and rinse and dry immediately before
pouring casts).
Elastic Impression Materials

Aqueous Hydrocolloids

1) Reversible Agar

• Agar hydrocolloids were the first successful introduced impression material

to be used in dentistry. It is an organic hydrophilic colloid (polysaccharide)
extracted from a type of seaweed. It is a sulfuric ester of linear polymer of
galactose. Although it is an excellent material, it has been replaced widely
by alginate hydrocolloids and rubber impression materials.
• It is used mainly for cast duplication, full mouth impressions without deep
undercuts and as tissue conditioner.
• Gelation of setting of Agar: It changes from sol to gel by physical process.
• Its working time ranges from 7-15 minutes and the setting time is about 5
minutes.
• Manipulation:

The equipment and material required for an agar impression are

 Hydrocolloid conditioner.
 Water cooled rim lock trays.
 Impression syringes.
 Connecting water hose.
 Agar tray material in tubes.
 Agar syringe material.

• One of the techniques used combining alginate and agar together is

Laminate technique (agar alginate combination technique):

After injecting the syringe agar on the area to be recorded an impression

tray consisting of chilled alginate is positioned over it alginate gels by
chemical reaction whereas the agar gels through the contact with cool
alginate.

Advantages: better details than alginate alone, less air bubbles and faster
technique than regular agar technique.
• Disadvantages of Agar:

- Doesn’t flow well when compared to other materials.

- During gelation the patient may
- Patient experiences thermal discomfort.
- High tearing susceptibility.
- Only one model can be poured.
- Can’t be stored for time before pouring.
- Requires special and expensive equipment.

2) Irreversible Alginate

Alginate was produced as a substitute for agar after World War II. It came
more popular than agar as it is simpler to use. It come from alginic acid
which is mucous extract yielded by species of brown seaweed.

• There are two types: Type I: Fast setting.

Type II: Normal setting.
• Uses:

- For pouring study casts for treatment planning and provisional

restorations fabrication.

- Impression making if there are undercuts or excessive salivary flow.

- Duplicating models.

• Setting reaction:
When alginate powder is mixed with water a sol is formed which later sets
to a gel by chemical reaction.
The final gel: insoluble calcium alginate is produced when soluble sodium
alginate reacts with calcium sulphate (reactor). However, this reaction
proceeds too fast. There is no enough working time, so a retarder (trisodium
phosphate) is added by manfcturer ro prolong the working time.
 • Properties:

 Pleasant taste and odor.

 Hydrophilic material.
 No known chemical or allergic reaction have been identified for
alginate. Silica particles present in the dust and could be inhaled by
the operator can cause health hazard.

 Compressive strength: ranges from 0.5-0.9 MPa.

Both compressive and tear strength of alginate are time dependent.

Factors affecting strength are:
- Powder/water ratio. Too much or too little water reduces gel strength.
- Mixing time. Over or under mixing both reduces strength.
- Time of impression removal. Strength increases if the time of removal is
delayed for few minutes after setting.
 Highly elastic material (but less when compared to agar. (About
98.2% elastic recovery occurs).

Lower permanent deformation (high elastic recovery) occurs when:

- The compression percent is lower.
-The impression is under compression for shorter time.
- The recovery time is longer, up to about 8 minutes after the release of load.
These factors translate clinically to the following requirements:
- Reasonable bulk of alginate between the tray and the teeth.
- Appropriate retention of alginate in the tray.
- Rapid removal of the impression from the mouth.

 Alginate doesn’t adhere well to the tray. Retention is achieved by the

mechanical locking in the perforated trays or by applying adhesive to
the tray. Good adhesion is important for the accuracy of the
impression.
  Like agar-agar alginate also exhibits the properties of synersis and
imbibition. When placed in contact with water, alginates absorb water
and swell. Continued immersion in water results in total disintegration
of alginates.

 Dimensional stability:

Set alginate has poor dimensional stability due to evaporation, synersis

and imbibition. Therefore, cast should be poured immediately. If storage
is unavoidable, keeping alginate in relative 100% humidity results in the
least dimensional changes.
- Modern alginates, both regular and extended have shown better dimensional
stability for periods ranging from 1-5 days according to some studies (the
journal of American dental association 2010).

These types of alginate which widely marketed with manufactures are

called extended pour alginates. e.g Hydrogum 5
- According to another study introduced in journal of contemporary clinical
dentistry in 2013, it has been reported that all irreversible hydrocolloid
materials studied could be stored in a zip-lock plastic bag for upto 1 h
without any significant distortion.

 Working time:
- The mixing time of regular alginate is 1 minute. And 45 seconds for fast-set
alginate.
- The regular-set material has 3 to 4.5 minutes working time.
- Fast-set material has 1.25 to 2 minutes.

 Setting time: ranging from 1-5 minutes.

- Increasing the setting time is better accomplished by decreasing water
temperature. Because decreasing powder/liquid ratio will affect and decrease
the strength and accuracy. So control of setting by changing P/L ratio is not
recommended.
  Alginate should be left in the mouth for 2-3 minutes after initial
gelation because strength and elasticity of alginates continues to
increase for several minutes after first gelation.
 The set gypsum model should not remain in contact with alginate for
periods of several hours because it may result in rough and chalky
surface.

 Disinfection:

- By spraying or immersion.
- Recommended disinfectants: phenol, idophor or glutaraldehyde.
 Shelf life and storage
- Alginate material deteriorates rapidly at elevated temperatures and humid
environment.
- The material should be stored in a cool, dry environment  not above 37 C.
- The lid of bulk package must be replaced after every use.
- Stock only for one year.

• Advantages:
- Easy to mix and manipulate.
- Minimum requirement for equipments.
- Flexibility of set material.
- Accuracy if properly handled.
- Low cost.
- Comfortable to the patient.
- Hydrophilic, so it gives good surface details even in the presence of saliva.

• Disadvantages:
- Irreversible, so it can’t be corrected.
- Poor dimensional stability.
- Poor tear strength.
- Not recommended where high degree of accuracy is needed.
- Can’t be electroplated.
- Can be easily distorted if the material was not held steady during its setting.
Elastomerics = Rubber-base

POLYSULFIDE
• The base paste :
• mercaptan (-SH) polysulfide
polymer
• filler (titanium dioxide) provide
strength
• Plasticizer provide viscosity
• The catalyst (or accelerator)
• Lead dioxide
• Filler, and plasticizer as in the base paste
• Retarder to control the rate of the setting reaction
• The reaction yields water as a by-product … has an effect on the
dimensional stability of the impression. Lead dioxide is the component that
gives polysulfide impression material its characteristic brown color.
Properties
• Hydrophobic
• Low wetting angle can make a full arch impression easier than with
polyvinyl siloxanes or polyethers
• Dimensional stability is fair
• Does not adhere to itself
• Not affected by latex gloves
Disadvantages
• Unpleasant sulfide odor and bitter taste
• Long setting time in the mouth (about 10 minutes).
 • Contracts slightly during polymerization, but the effects can be minimized
with a custom impression tray to reduce the bulk of the material
• Extremely viscous and sticky. Mixing is difficult.
• Elastic recovery improves with time and so pouring of the model should be
delayed by half an hour. Further delay is avoided to minimize curing
shrinkage. Loss of the by-product (water) also causes shrinkage.

POLYETHERS
• The base paste :
• Polyether polymer 80–85%
• Colloidal silica( Filler)
• Glycolether or phthalate (Plasticizer)
• The catalyst (or accelerator) :
• Aromatic sulfonate ester (Crosslinking agent)
• Colloidal silica (Filler)
• Phthalate or glycolether (Plasticizer)

Properties
 Setting reaction Ring opening polymerization with no by-product formation.
 Hydrophilic, used in a moist environment
 Good wetting properties also allow gypsum casts to be made more easily
 Newer polyether are slightly more flexible than the older products, making
them easier to remove from the mouth
 The nature of the material absorbing water, the impression should not be
submerged in water for a period of time because it could lead to distortion.
  Snap-Set behavior

Rapid transition from the unset

to the set state. The material will
not start setting before the
working time ends. Setting starts
immediately.

Disadvantages
 It is extremely stiff (flexibility 3%) and increases with time. Removing it
from undercuts can be difficult, so additional spacing (4 mm) is
recommended. Care should also be taken while removing the cast from the
impression to avoid any breakage.
 Bitter taste

CONDENSATION SILICONE
• The base paste consists of hydroxyl-terminated polydimethyl siloxane
• The catalyst paste consists of Orthoethyl
silicate
• The ethyl alcohol formed as a by-product

Properties
• Excellent reproduction of surface details.
• It is hydrophobic. The field should be well-dried before making an
impression
Disadvantages
• Less dimensional stability due to high curing shrinkage (0.4–0.6%) and
shrinkage due to evaporation of the ethyl alcohol by-products.
• The cast should be poured immediately.
• The permanent deformation is also high (1–3%)

POLYVINYL SILOXANES (Addition silicone) PVS

• Base paste containing hydrosilane-

terminated molecules

• Accelerator paste containing siloxane

oligomers with vinyl end groups and a
platinum catalyst.

Properties
• No by-product
• Produce great detail reproduction
• Can be poured multiple times because of their high tear strength and high
elastic recovery
• May cause allergic reaction
• Can be used with most disinfection protocols (no reports of any disinfectants
that damage them)
• Greater tendency to trap air bubbles when pouring stone because of its
moderately high contact angle
• The setting time is also relative short (4–5 minutes)

Disadvantages
• Hydrogen out-gassing
Secondary reaction that can release hydrogen. If you pour casts too soon the
stone captures these bubbles and produces a cast with pitted areas (surface
porosity). Recommended to wait at least 30-60 minutes de-gassing period before
pouring a PVS impression (some say they can be poured immediately). Current
materials do not have this problem because of the addition of palladium.
• PVS contamination
Avoid contact of the material with latex rubber dams or latex gloves, which may
leave a sulfur or sulfur compound that inhibits polymerization of the material +
gingival retraction soaked cords containing sulfur. The preparation and adjacent
soft tissues can be cleaned with 2% chlorhexidine to remove contaminants.
Another source of contamination is the oxygen-inhibited layer on the surface of
resin materials that appears immediately after curing.

HYDROPHILIC POLYVINYL SILOXANE

• Traditionally, PVS is a hydrophobic material
• Contain intrinsic surfactants (have a hydrophilic part and a silicone-
compatible hydrophobic part) that improve their wettability and facilitate the
pouring process with gypsum materials
• When these surfactants come into contact with moisture, it has to migrate to
the surface, which prevents the hydrophilicity from fully developing during
working and setting times and can result in voids and inaccurate
impressions.
• However, hydrophilic PVS seems to remain hydrophobic when it is still in
the liquid, unpolymerized state and its wetting abilities are compromised in
the presence of moisture.
• Their surface detail reproduction is inconsistent when moisture control is
not maintained
• A dry field is critical for their use.
Comparison between Elastomerics
Recent advances and modifications in impression materials
Vinyl PolyEther Silicone (VPES)
• EXA’lence™ is a hybrid new elastomeric material combining between PVS
and polyether (introduced in 2009)

• Intrinsically hydrophilic without surfactants, so it can capture the finer

details of the tooth surface, even in a moist environment.

• Ability to flow subgingivaly which will minimize voids and bubbles.

• Superior flexibility and high tear strength to get you in and out of tight
places without tearing.

• Pleasant mint taste.

• Handling of VPS with the detail of Polyether.

• Long working time with short intraoral setting time (double-snap-effect)

• Ming Sun in 2011 compared an evaluated details production, contact angle

and tear strength of the 3 materials : Polyether, PVS and the new VPES

The following were found:

- VPES yielded the most accurate impression and cast in moisture
environement.
- Polyether had the highest tear strength followed by PVS and VPES.
- Wettability from highest to lowest was PVS  VPES  Polyether.

• The Journal Of Prosthetic Dentistry reported also in 2013 that: By

comparing the dimensional stability of VPES with VPS and polyether by
delaying pouring time up to 2 weeks.
The result was: Casts produced from VPES (EXA’lence™) showed
excellent dimensional stability at different pouring times than the tested VPS
and polyether.
Hydro C-silicon
• Superior Hydrophilic condensation silicon similar in accuracy to A-silicon.
 • Putty: soft, smooth initial consistency adapting very well during impression
taking.
• Has ideal final hardness
• Wash: light bodied, low consistency; highly elastic which is extremely
hydrophilic to guarantee optimum reproduction of fine details in moist
conditions.

Optosil® P Plus / Xantopren®

• It combines the advantages of C- & A-Silicones with those of polyether in
one perfectly matches system.
• Matched system of classical putty and low viscosity materials
• Precise reproduction of details because of Hydrocontrol.
• No sensitivity problems during use.
• Easy application using the 4:1 cartridge dispensing system
• Exceptional long term dimensional stability even after 7 days

Recent in Alginates
• Alginot

- Reliable alginate alternative material.

- Single impression can yield multiple stone pours.

- Faster setting time without compromising performance or working time.

- Improved thixotropic consistency reduces slumping and displacement from

the impression tray.

- Uses: Preliminary impressions, study model, provisional crown&bridge

impression and for opposing dentition impressions.

• Dustless Alginate
- Coating the traditional alginate powder with glycol or glycerine (Dedusting
agent).
• Siliconized Alginate
- Adding silicone polymers to alginate to enhance its strength.

• Alginate with biocidal agents

- Jeltrate® Plus™ Antimicrobial Dustless Alginate Impression
- Material contains an antimocrobial agent to reduce chances of cross
contamination.
But it may irritate the eyes and skin if direct contact occurred.
References :
1- Rubel, B. S. (2007). Impression Materials: A Comparative Review of
Impression Materials Most Commonly Used in Restorative Dentistry.
Dental Clinics of North America, 51(3), 629–642.
https://doi.org/10.1016/j.cden.2007.03.006
2- CRAIG’S, 2012, RESTORATIVE DENTAL MATERIALS 13th Ed, Mosby
El Sevier.
3- Impregum™ Soft Polyether Impression Material ,2011
(http://multimedia.3m.com/mws/media/129996O/impregumtm-soft-
polyether-impression-material.pdf)
4- Punj, A., Bompolaki, D., & Garaicoa, J. (2017). Dental Impression Materials
and Techniques. Dental Clinics of North America, 61(4), 779–796.
https://doi.org/10.1016/j.cden.2017.06.004
5- Re, D., De Angelis, F., Augusti, G., Augusti, D., Caputi, S., D’Amario, M.,
& D’Arcangelo, C. (2015). Mechanical Properties of Elastomeric Impression
Materials: An in Vitro Comparison. International Journal of Dentistry,
2015. https://doi.org/10.1155/2015/428286
6- Stephen F. Rosenstiel, 2016. CONTEMPORARY FIXED
PROSTHODONTICS, FIFTH EDITION
7- Klettke T, Ranftl, D, Kuppermann, B, 2006. Comparison of different types of
impression materials. J Dent Res; 82: 2465.
8- McCabe JF, Carrick TE, 2006. Recording surface detail on moist surfaces
with elastomeric impression materials. Eur J Prosthodont Restor Dent.; 14:42-
6.