Possible errors during impression making

Introduction
Impression making is the first and foremost step in diagnosis and treatment
planning. A good impression will produce a cast that will apprise the
practitioner of the need of patient and the prognosis of the proposed
treatment.It is to be agreed that time spent in making a good impression will
reduce the time required in adjusting the final prosthesis in the mouth as well as
make it more comfortable for the patient inaccepting the artificial
prosthesis.Ideal outcome of the impression must be borne in the mind of the
dentist before it is in his hand. He must literally make the impression rather than
take it.(1)
The most common dental impression errors include:

1-Poor Tray Selection (2)

The tray selected must capture the necessary information without distortion. It should
be large enough to cover all the teeth without contacting the soft tissues. Once the
impression is taken, the tray should not show through.
Full arch trays are available in several sizes. The arch shape of trays varies according
to the manufacturer as some are more square while others are more rounded. When
selecting your tray, make sure it is long enough to capture the entire arch and wide
enough to allow adequate seating of the tray. Metal trays are modifiable and may be
widened in the posterior regions, but modifications to the anterior portion of metal trays
are trickier. Plastic trays can be modified using an alcohol torch to heat the plastic,
adapting the flanges to fit the patient.
Dual-arch trays (triple trays) come in a variety of widths, and it’s best to keep a selection
in stock. When sizing a dual-arch tray, check the opposite side of the arch as the patient
bites down on the empty tray. This will provide you with a good idea as to how the
occlusion should look while taking the impression.

2-Inadequate Impression Material Mixing (3)

Once the impression material is combined, it should be uniform in color with no streaking.
Streaking is more com- mon with hand mixed putty materials than with cartridge materials .
When hand mixing putty, the material should be kneaded quickly to keep within the working
time and yield a uniform color when completed. But, may also occur if the automix cartridge
is not bled prior to attaching the mixing syringe, allowing one component to extrude out of
the cartridge first. Standard operating procedure should be to bleed the cartridge right
before a new automix tip is placed to ensure both base and catalyst are equally flowing to
avoid mixing issues. It is also recommended that the practitioner use the wash and tray
material from the same manufacturer to ensure that chemically the two materials are
designed to work together. Mixing materials from different companies may lead to
separation of the wash material from the tray VPS decreasing the impressions accuracy
when the lab pours the model.
3. Surface Contamination (2)
Surface contamination can cause a tacky unset layer of impression material. It may be
due to core build-up material, or composites or adhesives leaving a greasy coating on
the tooth preparation. Any of these can prevent the material from setting correctly.
Retraction cords and solutions containing aluminum chloride or ferric sulfate can
transfer sulfur to critical areas, inhibiting the setting reaction of the marginal VPS
material. Glove contact or rolling the retraction cord in gloved fingers or using a rubber
dam can have the same effect. Putty can become contaminated with latex when
mixing by hand.

4. Poor Margin Detail (2)

The margin is one of the most critical aspects of a dental impression. Without an accurate
marginal impression, problems such as overhanging or open margins, or an inadequately
fitting restoration are more likely. Usually, voids at the margin are because of insufficient
retraction or where fluid has accumulated, preventing the impression material from
flowing around the margin.
Using retraction cords with syringeable hemostatics is the best way to solve this problem.

5. Internal Bubbles (2)

If moisture, including blood, water, or saliva, is trapped in the impression material, it can
cause bubbles in the impression. These bubbles may be large enough to affect the luting
agent, increasing the space to be filled. When the luting material is thicker, the interface
between the restoration and tooth is weaker. Also, the prosthetic material could be
thinner, increasing the risk of failure;  this is especially critical when using all-ceramic
materials in which case a minimum thickness is critical. This problem can be solved by
achieving hemostasis.

6. Marginal Tears (2)

Marginal tears can occur when the wash material has insufficient tear strength. The
strength of materials varies between manufacturers, and lower viscosity material is more
likely to tear in the sulcus. When the sulcus is particularly deep, the wash material is
thinner, and there is an increased risk that it will tear when removed. Also, removing the
impression before the wash material is wholly set could cause marginal tearing. If you
need to retake an impression because of marginal tearing, make sure any remnants are
removed from the sulcus and consider additional tissue retraction to widen the sulcus.
7. Choosing the Right Impression Material (2)
Selecting the right impression material is crucial for achieving an accurate and predictable
impression. Usually, a sort setting time is preferable for your patient’s comfort; in any case
it is vital to know the working time for the material you have chosen. The impression must
be inserted within the working time. If it is already setting, it may not seat fully and will not
capture the required details. Choosing a material that is more hydrophilic will help it adapt
to the prepared tooth more easily, especially sub-gingivally and where fluid may be
present.

8. Trying to Rush the Impression (2)

It is crucial to take your time, making sure the details are correct (for example packing the
retraction cord). Ensure the cord is packed correctly and has retracted the tissue
sufficiently. If you rush, the cord may not have enough time to sit, and it will do little other
than traumatize the area around the sulcus.

9. Failing to Keep the Patient Still (2)

Dental impressions can distort if the patient moves or begins to gag. One way to help
keep the patient still is to chat with them; this will distract them so they are less likely to
notice any discomfort. Keep reminding the patient to breathe through their nose. If they
feel uncomfortable, wiggling their toes could help.

References
1- Nishant Gaba , Khurshid Ahmed Mattoo , Errors in Impression making , Lambert Academic
Publishing 2014.
2- Bill Warner , MOST COMMON DENTAL IMPRESSION ERRORS AND HOW TO AVOID THEM , Dental
Techniques , 2019
3- Gregori M. Kurtzman ,DDS , Identifying and Managing Dantal impression problems, Dantal Academy
of Continuing Education ,2018