DENTAL TECHNIQUE

The segmental impression technique: A straightforward

solution to a difficult problem
Islam Abd Alraheam, DDS, MSa and Terry Donovan, DDSb

Dentists often make impres- ABSTRACT

sions of multiple prepared
Trying to capture all the details of multiple teeth preparation in one impression is challenging.
teeth. A recent study evalu- Techniques have been suggested to extend the working time of an impression material. This
ating 1157 single-tooth im- article describes a segmental impression technique to accurately capture all the preparation
pressions sent to commercial margins while allowing additional impression-making time. (J Prosthet Dent 2019;-:---)
dental laboratories found that
55% of these impressions had not adequately captured impression material. Extend the wax 2 mm past the
the prepared gingival margins.1 The results of this study free gingival margin and cover it with aluminum or
are consistent with those of similar studies.2,3 The diffi- tin foil (Fig. 2A).
culty of making adequate impressions of prepared teeth
Fabricate a custom tray with no handle from auto-
increases exponentially when multiple teeth are prepared
polymerizing acrylic resin or a light-polymerizing tray
(Fig. 1). One of the techniques for extending the working
material (Triad Visible Light Cure System; Dentsply
time of the impression material is by using chilled
Sirona). Extend the border of the tray just past the wax
impression material. Low temperature delays the poly-
spacer (Fig. 2B).
merization of the material, which gives more working
time and hopefully a better impression. Another way is to 1. Section the tray into segments by using a separating
adjust the base catalyst ratio, but this is not possible with disk (Medium HyperFlex Double Sided Diamond
the automix systems.4 Disc; Brasseler) (Fig. 2C). The number of segments
Although digital scanning has become popular, doubt depends on the number of teeth to be impressed. It
still exists as to whether scanning is sufficiently accurate is suggested that 3 to 4 teeth be included in each
for complete arches.5-8 This article describes a straight- segment (Fig. 3A).
forward solution that can help with conventional 2. Paint the appropriate impression material adhesive
impression making. The technique is a modification of (VPS Tray Adhesive; Kerr Corp) in a thin film onto
that described by Gardner and Loft in 1981.9 the intaglio surface of the tray and tray margins and
let it dry for 7 to 15 minutes.10
TECHNIQUE 3. Pack 2 displacement cords soaked in an astringent
(Hemodent; Premier Dental) in the sulcus of the
1. Pour the diagnostic cast from an irreversible prepared teeth (Fig. 1C).
hydrocolloid impression in Type III gypsum. A 4. Remove the second cord from the sulcus of the
duplicate of the diagnostic waxing can also be used. prepared teeth to be impressed in the first segment.
2. Adapt 1 layer of baseplate wax over the teeth to be Inject the low-viscosity polyvinyl siloxane (Extrude
impressed to provide enough space for the Wash VPS; Kerr Corp) impression material into the

a
Clinical Instructor, Division of Operative Dentistry, Department of Restorative Sciences, University of North Carolina, Chapel Hill, NC; and Assistant Professor, Department of
Conservative Dentistry, University of Jordan, Amman, Jordan.
b
Professor, Department of Restorative Sciences, University of North Carolina, Chapel Hill, NC.

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Figure 1. A, Maxillary arch, preoperative. B, Diagnostic waxing. C,
Complete-arch teeth preparation. Two cords packed in each sulcus.
sulcus around the prepared teeth before the collapse
of the gingival tissue. Timing is critical because the
gingival crevicular width decreases dramatically 30
seconds after cord removal.11 Load the first
segmental tray with heavy-body impression mate-
rial (Extrude Medium VPS; Kerr Corp), place it over
THE JOURNAL OF PROSTHETIC DENTISTRY
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the prepared teeth, and hold it in position. Remove
all excess impression material before it polymerizes.
The tray must not be removed for inspection at this
time.
5. Remove the second cord on the teeth in the adja-
cent segment. Inject light-body PVS around the
teeth as in the previous segment. The PVS in the
second segment will adhere to the PVS of the first
segment, and there will be no line or space between
them.
6. Repeat the same procedure for the last segments
until all impression segments are in place (Fig. 3A).
7. Use a custom tray or a stock tray loaded with a
compatible heavy-body material (Extrude Medium
VPS; Kerr Corp) to pick up the segmental impres-
sions (Figs. 2D, 3B).
The advantage of the sectional tray impression
technique is mainly getting an accurate impression of
multiple teeth preparations. This is critical when the
margins of the preparations are equigingival or sub-
gingival. One of the disadvantages of this technique is
the extra time needed in the laboratory to fabricate the
sectional trays. However, such tasks can be performed
by the dental assistant or dental laboratory technician
in 10 minutes. The time to load the sectional trays and
pick them up with a stock tray is not significantly
longer than making a conventional impression. The
benefits of this technique can easily outweigh the
disadvantages.
This technique is more predictable than refrigerating
the impression material to extend the working time.
Low temperature will delay the polymerization of the
material, giving more time to capture all the preparation
margins. However, if the second cord is removed and
bleeding occurs, the time needed to control the bleeding
and continue injecting the light-body material to com-
plete the impression will be limited. With the sectional
tray technique, because the previous teeth are captured
in the first sectional tray, the clinician will have sufficient
time to control the bleeding and inject the light-body
material to complete the second sectional tray
impression.
One of the limitations of this technique is fitting stock
sectional trays in patients with limited mouth opening,
on account of the additional bulk.
SUMMARY
The segmental impression technique is a useful proced-
ure for simplifying the making of definitive impressions
involving multiple prepared teeth.
Alraheam and Donovan
- 2019 3

Figure 2. A, Tin foil adapted over cast made from duplicate of

diagnostic waxing (no wax spacer was used since waxing was
additive). B, Light-polymerized tray resin used to make sectional
tray. C, Sectional tray after polymerization. D, Definitive
impression. E, Lithium disilicate restorations.

Figure 3. A, Sectional trays used to make definitive impression. B, Definitive impression.

Alraheam and Donovan THE JOURNAL OF PROSTHETIC DENTISTRY

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Corresponding author:
complete-arch digital scans versus conventional impressions. J Prosthet Dent
2019;121:69-75. Dr Islam Abd Alraheam
Department of Conservative Dentistry
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Email: islam.raheam@gmail.com
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optical impressions: A clinical study using a reference appliance. J Prosthet Copyright © 2019 by the Editorial Council for The Journal of Prosthetic Dentistry.
Dent 2017;118:400-5. https://doi.org/10.1016/j.prosdent.2019.05.039

THE JOURNAL OF PROSTHETIC DENTISTRY Alraheam and Donovan