The Journal of the American Dental Association
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J Am Dent Assoc, Vol 136, No 8, 1138-1139.
© 2005 American Dental Association
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CLINICAL DIRECTIONS

Modification of a metal stock tray for a polyvinylsiloxane impression



JAMES E. HAUBENREICH, D.D.S. and PAUL B. OSBORNE, D.M.D.

Using custom resin trays for final impressions represents a dentist’s best effort to obtain an exact duplication of prepared teeth and adjacent tissues. They embody the twin pillars of rigidity and uniform impression thickness that several authors recommend.1–4 However, a majority of dentists use stock trays for final impressions.5

Research periodically shows that impression tray types do not affect the accuracy of final casts.6,7 In fact, dentists confidently take "check bite" or dual-arch impressions for single crowns and intracoronal inlays, assuming the small discrepancies in the final casts are insignificant and the advantages are obvious.8 Yet, researchers regularly demonstrate the importance of considering the flexure of dual-arch and plastic stock trays and the effect of variations in light-body wash bulk.5,9–12

Research periodically shows that impression tray types do not affect the accuracy of final casts. Yet, researchers regularly demonstrate the importance of considering the flexure of dual-arch and plastic stock trays and the effect of variations in light-body wash bulk.

The purpose of this article is to present another method of improving the accuracy of maxillary arch impressions without the use of a custom tray.

PROCEDURE
Select a perforated metal tray to fit the maxillary arch. While waiting for local anesthesia, mix polyvinylsiloxane (PVS) putty and place it in the palatal area of the tray. Seat the tray, ensuring there is as uniform a space as possible between the tray and the teeth (2–3 millimeters is ideal). Trim away putty that has extruded into undesired areas (Figure 1Go).



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  		Figure 1. Trimming the putty.

 
The modified tray now has a dam of putty, which makes taking the final impression more comfortable for the patient and which acts as a positive stop and index for reseating the tray (Figure 2Go). Follow the manufacturer’s recommendation regarding adhesive application to the putty, and then impress the arch using complementary light-body and heavy-body materials.



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  		Figure 2. Trimmed putty in metal stock tray.

 
CONCLUSION
Two-stage putty-wash techniques are considered reliably accurate.10 However, this technique does require inserting a stock tray into the patient’s mouth twice and waiting for the PVS material to set. Moreover, it does not generate exact wash thicknesses, which might be developed if provisional or polyethylene spacers were used, and it requires several seconds for trimming the excess material. However, it has the advantages of being relatively quick, accurate, practical and readily teachable to dental assistants.

FOOTNOTES

Dr. Haubenreich is an assistant professor, University of Kentucky College of Dentistry, D-638 Chandler Medical Center, 800 Rose St., Lexington, Ky. 40536-0297, e-mail "jhaub2{at}uky.edu". Address reprint requests to Dr. Haubenreich.


Dr. Osborne is an assistant professor, University of Kentucky College of Dentistry, Lexington.

REFERENCES

  1. Chiche GJ, Pinault A. Impressions for the anterior dentition. In: Chiche GJ, Pinault A, eds. Esthetics of anterior fixed prosthodontics. Carol Stream, Ill.: Quintessence; 1994:161–75.

  2. Shillingburg HT, Hobo S, Whitsett LD, Jacobi R, Brackett SE. Fundamentals of fixed prosthodontics. 3rd ed. Carol Stream, Ill.: Quintessence; 1997.

  3. Sturdevant JR, Sturdevant C. Class II cast metal restorations. In: Roberson TM, Heymann HO, Swift EJ, eds. Sturdevant’s art & science of operative dentistry. 4th ed. St. Louis: Mosby; 2002:799–869.

  4. Rosenstiel SF, Land MF, Fujimoto J. Contemporary fixed prosthodontics. 3rd ed. St. Louis: Mosby; 2001.

  5. Barghi N, Ontiveros JC. A predictable and accurate technique with elastomeric impression materials. Am J Dent 1999;12:161–3.[Medline]

  6. Brosky ME, Pesun IJ, Lowder PD, DeLong R, Hodges JS. Laser digitization of casts to determine the effect of tray selection and cast formation technique on accuracy. J Prosthet Dent 2002;87(2):204–9.[Medline]

  7. Brosky ME, Major RJ, DeLong R, Hodges JS. Evaluation of dental arch reproduction using three-dimensional optical digitization. J Prosthet Dent 2003;90:434–40.[Medline]

  8. Tucker RV, Miya DM. Conservative cast-gold restorations: The Tucker technique. In: Summitt JB, Robbins JW, Schwartz RS, dos Santos J, eds. Fundamentals of operative dentistry. 2nd ed. Carol Stream, Ill.: Quintessence; 2001:526–45.

  9. Larson TD, Nielsen MA, Brackett WW. The accuracy of dual-arch impressions: a pilot study. J Prosthet Dent 2002;87:625–7.[Medline]

  10. Nissan J, Laufer B-Z, Brosh T, Assif D. Accuracy of three polyvinyl siloxane putty-wash impression techniques. J Prosthet Dent 2000;83:161–5.[Medline]

  11. Nissan J, Gross M, Shifman A, Assif D. Effect of wash bulk on the accuracy of polyvinyl siloxane putty-wash impressions. J Oral Rehabil 2002;29:357–61.[Medline]

  12. Carrotte PV, Johnson A, Winstanley RB. The influence of the impression tray on the accuracy of impressions for crown and bridge work: an investigation and review. Br Dent J 1998;185(11–12):580–5.[Medline]





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