Evaluation of defects in surface detail for

monophase, 2-phase, and 3-phase

impression techniques: An in vitro study
Giuseppe Varvara, DDS, PhD,a
Giovanna Murmura, MD, DMD, PhD,b Bruna Sinjari, DDS,c
Paolo Cardelli, DDS,d and Sergio Caputi, MD, DMDe
Dental School, ‘G. D’Annunzio’ University of Chieti-Pescara, Chieti-
Pescara, Italy
Statement of the problem. Polyvinyl siloxane materials of various consistencies have been tested to reduce defects commonly
associated with different definitive impression techniques.

Purpose. The purpose of this in vitro study was to compare the number of visible defects within the surface of a new 3-phase,
2-step impression injection technique with the number found in the monophase and in the conventional 2-phase, 1-step and
2-phase, 2-step impression techniques.

Material and methods. Two complete crown abutment preparations were impressed 10 times for each of these 4 techniques,
which gave 20 abutment impressions for each group. The 3-phase, 2-step impression–injection technique included extra-
light–body impression material added for the impression and injected after reinsertion. After the removal of all of these
impressions, an examiner counted the number of open voids and bubble-like enclosed voids visible to the naked eye at a
working distance of approximately 150 mm. Only the defects in the area of the prepared abutments were included in the
assessment.

Results. The frequency of defects ranged from 100% of the impressions in the monophase group to 5% with the new 3-phase,
2-step impression injection technique. No statistical differences were seen between the two 2-phase (1-step and 2-step)
impression techniques, although there were numerically fewer impressions with defects with 2 steps (45%) than with 1 step
(55%). The 3-phase, 2-step impression injection technique had the greatest accuracy, with fewer specimens with defects (5%)
than with either of the 2-phase techniques, although these differences did not reach statistical significance.

Conclusions. The 3-phase, 2-step impression injection technique provides improved defect-free reproduction of detail,
showing fewer defects than other impression techniques. (J Prosthet Dent 2014;-:---)

Clinical Implications
In fixed prosthodontics, a lower incidence of impression surface defects
can be obtained with the use of the 3-phase, 2-step impression injection
technique. This technique improves the overall accuracy of the
subsequent restoration, with improved performance and without
additional steps compared with the conventional 2-phase, 2-step
impression technique.

Impression materials are used to function of prosthetic restorations.1 The accurate cast of the prepared tooth and
provide an accurate record of hard and goal of an impression is to provide a the surrounding tissue when filled with
soft tissues. This step is the main deter- void-free negative representation of a the gypsum product.2 Several studies
minant of the definitive fit, form, and prepared tooth, which will produce an have evaluated the quality of the

a
Assistant Professor, Department of Medical, Oral and Biotechnological Sciences.
b
Aggregate Professor, Department of Medical, Oral and Biotechnological Sciences.
c
Research Fellow, Department of Medical, Oral and Biotechnological Sciences.
d
Research Fellow, Department of Medical, Oral and Biotechnological Sciences.
e
Professor and Head of Department of Medical, Oral and Biotechnological Sciences.

Varvara et al
2 Volume
reproduction of the surface detail of
partial fixed dental prosthesis impres-
sions sent to dental laboratories. In a
clinical study, Samet et al3 reported that
more than 89% of the impressions
investigated had 1 or more observable
errors; thus, they recommended that
dentists evaluate impressions more crit-
ically. Raigrodski et al4 reported that
92% to 96% of the control impression
preparation areas that were analyzed by
a clinician and a dental technician had
small defects, such as tears, voids, and
bubbles.
Various factors can influence the
quality and accuracy of impressions,
including the impression technique5-9
and the impression material.4,10 Re-
sults of some studies have indicated
that, as impression materials have
improved, the quality of the reproduc-
tion of the surface detail is influenced
more by the technique that is used
instead of by the material itself. Howev-
er, results of other studies have indicated
that the impression technique does not
affect the quality of the reproduction of
the surface detail of impressions.11,12
Thus, in spite of the number of previ-
ous studies on the quality and accuracy
of impressions as related to impression
materials and/or impression techniques,
controversies still remain. The types of
impression techniques and the different
protocols used to assess the quality and
accuracy of impressions might explain
the contradictory results that have been
reported in the literature.
Impression techniques have been
categorized according to the mono-
phase, 1-step technique, the 2-phase
(putty–light-body impression material)
techniques that can be accomplished in
1 or 2 steps (as the 1-step and 2-step
impression techniques), and the 3-
phase (putty–light-body impression
material plus extra-light-body impres-
sion material) 2-step technique (as the
2-step impression injection tech-
nique).13 The techniques that use
monophase materials are accomplished
in a single-step procedure that uses an
impression material with a medium
viscosity to record the finer details while
avoiding the slumping of the
The Journal of Prosthetic Dentistry
impression material in the tray. With
the techniques that use 2-phase mate-
rials, such as the putty–light-body
impression material techniques (both
the 1-step and 2-step approaches), the
light-body impression material should
cover the entire preparation, although
this cannot always be accomplished
clinically.8,10 The 2-phase, 2-step
impression technique has been re-
ported to be more accurate than the 2-
phase, 1-step impression technique.5,14
The 2-phase, 2-step impression tech-
nique allows mostly complete coverage
of the preparation area with the light-
body impression material; however, it
can be associated with the creation of
an occlusal step because some of the
light-body impression material can
spread along the occlusal surface dur-
ing the reseating of the putty.11
When considering the problems that
can be associated with these techniques,
although the 2-phase, 2-step impression
technique has a number of advantages,
further improvements in the reproduction
of dimensional accuracy and defect-free
surface detail can be achieved with a
novel 3-phase, 2-step impression injec-
tion technique. The principles of this 2-
step impression injection technique were
described in an in vitro study.13 In the
present study, the initial polymerization
of the putty and the light-body impres-
sion material was as for the traditional 1-
step impression technique, with this also
followed by injection of extra-light-body
impression material into the preparation
through a hole in the metal stock tray.
This new 2-step impression injection
technique allows the displacement of soft
tissues, for example, the tongue, during
the first seating with the putty–light-body
impression material, whereas, in the sec-
ond step, the extra-light-body impression
material can record all of the finer details
without being compressed.
The aim of the present in vitro study
was to evaluate the reproduction of the
surface detail of this new 2-step impres-
sion injection technique compared with
the monophase and conventional 1-step
and 2-step impression techniques by
analyzing the number of visible defects
on the surface of the resulting
- Issue -
impressions. The null hypothesis was
that no differences would be found in the
reproduction of defect-free surface
detail of the impressions with these
various techniques.
MATERIAL AND METHODS
To evaluate the reproduction of
defect-free surface detail, stainless-steel
abutments were impressed with different
materials and techniques by using stock
metal trays, and the numbers of open
voids and enclosed voids were deter-
mined. A stainless-steel die (the master
cast) that contained 2 complete-crown,
tapered-abutment preparations was
fabricated with a lathe according to the
American National Standards Institute–
American Dental Association specifica-
tions (no. 19; 8.015 mm in height,
6.330 mm and 8.450 mm at the base,
and 28.20 mm as the distance between
the centers of the abutments) (Fig. 1).
The device was used as the standardized
master cast to compare the defects
associated with each of the impression
techniques in this study (Fig. 1).
This master cast was manually
incorporated into an autopolymerizing
acrylic resin device (Lang Dental) and
fixed onto a base (Zeiser) (Fig. 2). The
autopolymerizing acrylic resin device
then was modeled to allow reproduc-
ible positioning of the tray on the
master cast (Fig. 2). All of the impres-
sions were made in stock perforated
metal trays (size 6; ASA Dental). The
study design required 20 experimental
impressions and 20 control impressions
for each group. Preexisting literature
data indicated that the probability
of impression defects in monophase
impressions is generally 100%. If the
true probability of exposure among the
experimental groups is 50%, with this
study design, then the null hypothesis
that the exposure rates for experimental
impressions and control impressions
are equal can be rejected with a power
of more than 80%. Therefore, the im-
pressions of the master cast were
made 10 times for each of the 4 tech-
niques: monophase, 2-phase, 1-step
and 2-step impressions, and 3-phase,
Varvara et al
- 2014
1 Stainless-steel die used as standardized master cast.
2-step impression injection. Thus, 20
abutment impressions were obtained
for each group.
The impressions were made by using
addition-reaction polyvinyl siloxane
impression materials (Aquasil; Dentsply
Intl), as detailed in Table I. The soft putty
material was mixed with the fingertips
for 30 seconds until the color was uni-
form, and all of the other materials were
dispensed by using an automatic mixing
device (AutoMix; Dentsply Intl). The
polymerization times used for each
impression material were double those
recommended by the manufacturer to
compensate for the impressions being
made at room temperature (20
C)
instead of at mouth temperature. Thus,
the setting time was increased to 12
minutes. No tray adhesive was used. The
monophase impressions were made with
the standard impression material, the 1-
step impressions were made with the
putty and light-body impression mate-
rial simultaneously, and the 2-step
impressions were made by using
Table I. Technical characteristics of addition reaction polyvinyl siloxane
impression materials used
Materiala Lot No.
Soft putty 0405000002, 2007.06
Regular body 0408001734, 2007.11
Light body 0408001289, 2007.9
Extra-light body 0405000010, 2007.07
ISO, International Organization for Standardization (http://www.iso.org/iso/home/store/catalogue_
tc/catalogue_detail.htm?csnumber=24125).
a
Materials were supplied by Dentsply Intl.
Varvara et al
2 Master cast in repositioning device.
prefabricated 2-mm-thick acrylic resin
copings (Duralay; Dental Mfg Co) that
were placed on each abutment to create
a uniform and optimal space for the
light-body impression material. The
acrylic resin copings were made by
removing material with a carbide bur
(187 023; Komet) until a uniform thick-
ness of 2 mm was obtained. The di-
mensions were standardized by using
calipers (no. 500-181-21; Roder Elec-
tronics). The preliminary putty impres-
sions were made first, and, before the
second step, the acrylic resin copings
were removed and the light-body
impression material was added. The
impressions were reinserted until firm
contact was made with the border of the
tray, and the light-body impression ma-
terial again was allowed to polymerize
on the master cast for 12 minutes. The 2-
step impression injection technique
initially used putty and light-body
impression material simultaneously (as
in the 1-step technique), and again,
these were left to polymerize on the
ISO 4823 Type Viscosity
1 Very high
3 Low
3 Low
3 Low
3
master cast for 12 minutes. The pre-
liminary impressions then were removed
from the master cast, and a hole was
made in the vicinity of the most occlusal
surface (edge) of each abutment by
drilling through the polymerized mate-
rial with a carbide bur (187 023; Komet).
This was designed to coincide with 1 of
the holes in the stock tray. The selected
hole on the stock tray of each abutment
was labeled with ink to facilitate its
identification during the following pro-
cedures. A thin section of interdental
material also was removed from the
impression with the same carbide bur.
Extra-light-body impression material
then was added to the preliminary
impression, which was immediately
reinserted onto the master cast. Further
extra-light-body impression material
was placed into a syringe (Elastomer;
ESPE Dental AG) and injected through
the holes marked on the abutments. The
trays were held down during this proce-
dure to prevent them from lifting off the
teeth. These impressions were again
allowed to polymerize for 12 minutes.
After removal, the impression sur-
faces of the abutments were observed
by an examiner trained in a standard-
ized technique for the recognition and
classification of surface defects. This
examiner counted the number of open
voids (approximately 2 to 4 mm) and
“bubble-like” enclosed voids (<2 mm)
visible to the naked eye at a working
distance of approximately 150 mm for
all of the surfaces of the abutments,
and each impression was
4 Volume - Issue -

3 Impression without open voids or 4 Impression that shows bubble-like 5 Impression showing open voids
bubble-like enclosed voids (specimen enclosed voids (specimen from 2-step (specimen from monophase impres-
from 2-step impression injection impression technique). sion technique).
technique).

photographed with a digital camera
(Fine Pix S2pro [Fuji]; AF Micro Nikkor,
105 mm, 1:2.8D [Nikon]). Only the
defects in the impression in the area of
the prepared abutments were counted.
The number of defects on each spec-
imen were ranked as follows: type 0, no
defects (Fig. 3); type 1, 1 or 2 enclosed
voids (Fig. 4); type 2, >2 enclosed
voids; and type 3, the presence of open
voids (Fig. 5). The differences in the
defect frequencies were investigated
according to c2 tests. An extension of
c2 tests according to Bonferroni was
used in a post hoc analysis. The me-
dians were obtained for each experi-
mental group, and these parameters
were analyzed for statistical significance
in the comparisons of the 4 impression
techniques with the Kruskal-Wallis tests
and Mann-Whitney tests after Bonfer-
roni correction (a¼.05).
worst results in comparison with
the other procedures, whereas the
3-phase, 2-step impression injection
technique had the best results. No sta-
tistically significant difference was seen
between the 2 dual-phase (1 step versus
2 step) techniques (Table II). The com-
parison of the defect distribution for
each of the 4 techniques gave similar
results: the monophasic technique gave
the worst results, whereas the 3-phase,
2-step impression injection technique
gave the best results (Table II).
DISCUSSION
Polyvinyl siloxane has been reported
to be the most accurate impression
material for dental impressions because
of its surface reproduction and dimen-
sional stability.15 In the present study,
the defect frequency of 4 different
impression techniques was investigated,
with significant differences seen be-
tween these different approaches. The
monophase technique is considered to
be the easiest to perform, although
many in vitro studies reported this to be
the worst technique in terms of
dimensional accuracy13 and surface
defects14 of the impressions thus
formed. These in vitro studies also have
been supported in a clinical study.16
The present investigation also has
confirmed these data, with the mono-
phase technique giving the highest
number of voids among the 4 experi-
mental groups. The monophase tech-
nique also resulted in statistically
significantly greater numbers of open
voids and enclosed voids, especially in
the finish line compared with the other

RESULTS Table II. Numbers and types of defects according to each impression technique
Defect
The frequency of defects ranged from Type
100% in the monophase group to 5% in
Impression No. Specimens Defect (No.)*
the 3-phase, 2-step impression injection
technique. A statistically significant dif- Technique With Defects Frequency (%) 1 2 3 Mediany
ference among the tested groups was
detected (P<.001). Thus, the data ob- Monophase 20 100a 0 0 20 3d
tained in this study supported the rejec- Two-phase, 1-step 11 55b 8 3 0 1e
tion of the null hypothesis. The presence Two-phase, 2-step 9 45b 7 2 0 0e,f
of the defects and the numbers and types Three-phase, 2-step 1 5 c
1 1 0 0f
of defects according to the 4 impression
Values with same superscript letters are not statistically different according to c2 tests with Bonferroni
techniques are listed in Table II. The
post hoc analysis (a-d), and Bonferroni-corrected Kruskal-Wallis tests and Mann-Whitney tests (d-f).
monophasic technique produced the *Type 1 (1-2 enclosed voids), type 2 (>2 enclosed voids), type 3 (presence of open voids).
y
Number of defect ranking.

The Journal of Prosthetic Dentistry Varvara et al

- 2014
procedures. This is due to the higher
viscosity and lower flow of this mono-
phase impression material. Indeed, in
the present study, the monophase
technique had defects in 100% of the
specimens.
The classic 2-phase, 2-step impres-
sion technique has been reported to be
more accurate than the 2-phase, 1-step
impression technique8,17; indeed, in the
2-phase, 2-step impression technique,
after the putty has polymerized, further
contraction of the light-body impression
material leads to only minimal dimen-
sional changes.7 The 2-phase, 1-step
impression technique, however, has
been criticized because of the uncon-
trolled bulk of the light-body impression
material, which can result in dimensional
changes that are proportional to the
thickness of the light-body impression
material during setting.18 The putty in the
2-phase, 1-step impression technique
also tends to push the light-body
impression material off the prepared
tooth, and critical areas, such as the finish
line, can be covered by the putty, which
cannot record details satisfactorily.10 A
further disadvantage has been reported
for the 2-phase, 2-step impression tech-
nique, whereby some light-body impres-
sion material can spread along the
occlusal surface during the reseating of
the putty, or it can displace the pre-
liminary putty impression during the
seating; this can generate distortions that
reduce dimensional accuracy.11
The data from the present study
confirmed the improved results of the 2-
phase, 2-step impression technique
compared with those with a 1-step pro-
cedure. For the 2-phase techniques (both
1-step and 2-step) and in agreement with
the literature, the present study shows a
lower incidence of open voids and
bubble-like enclosed voids; this result is
linked to the pressure applied by the
major viscosity impression material (the
putty) on the minor viscosity impression
material (the light-body impression ma-
terial), which increases its flow and aids in
the more-exact reproduction of the de-
tails. In the present study, however, in
terms of the number of defects, no sig-
nificant differences were found between
Varvara et al
these 2-phase, 1-step and 2-step impres-
sion techniques.
The best outcome in the present study
was instead obtained with the 3-phase,
2-step impression injection technique.
Here, only 5% of the specimens analyzed
had defects due to the use of the extra-
light-body impression material. This is
an extremely fluid material, which pro-
vides good reproduction of the prepara-
tion finish line and the subgingival
margins. Furthermore, this extra-light-
body impression material has a low sur-
face tension, which also improves the
“wettability” of the prepared teeth. The
application of this extra-light-body im-
pression material through the hole in the
metal stock tray also avoids its compres-
sion and dislocation, which are the main
disadvantages of the other 2-phase tech-
niques. Therefore, in this way, the whole
surface of the prepared tooth can be
covered by the extra-light-body impression
material. Analysis of the results of this
study indicates that improved defect-free
reproduction of detail can be attributed
to the 3-phase, 2-step impression injection
technique versus the other impression
techniques examined.
CONCLUSION
The 3-phase, 2-step impression in-
jection technique shows fewer defects in
the reproduction of detail, such as
open voids and enclosed, bubble-like,
voids than the monophase and con-
ventional 2-phase, 1-step and 2-step
impression techniques investigated.
REFERENCES
1. Donovan TE, Chee WW. A review of
contemporary impression materials and
techniques. Dent Clin North Am 2004;48:
445-70.
2. Guiraldo RD, Borsato TT, Berger SB,
Lopes MB, Gonini-Jr A, Sinhoreti MA. Sur-
face detail reproduction and dimensional
accuracy of stone models: influence of
disinfectant solutions and alginate impres-
sion materials. Braz Dent J 2012;23:417-21.
3. Samet N, Shohat M, Livny A, Weiss EI.
A clinical evaluation of fixed partial denture
impressions. J Prosthet Dent 2005;94:112-7.
4. Raigrodski AJ, Dogan S, Mancl LA, Heindl H.
A clinical comparison of two vinyl poly-
siloxane impression materials using the one-
step technique. J Prosthet Dent 2009;102:
179-86.
5
5. Hung SH, Purk JH, Tira DE, Eick JD. Accuracy
of one-step versus two-step putty wash
addition silicone impression technique.
J Prosthet Dent 1992;67:583-9.
6. Chen SY, Liang WM, Chen FN. Factors
affecting the accuracy of elastomeric
impression materials. J Dent 2004;32:603-9.
7. Nissan J, Laufer BZ, Brosh T, Assif D. Accu-
racy of three polyvinyl siloxane putty-wash
impression techniques. J Prosthet Dent
2000;83:161-5.
8. Morgano SM, Milot P, Ducharme P, Rose L.
Ability of various impression materials to
produce duplicate dies from successive im-
pressions. J Prosthet Dent 1995;73:333-40.
9. Craig RG. Review of dental impression ma-
terials. Adv Dent Res 1988;2:51-64.
10. Chee WW, Donovan TE. Fine detail repro-
duction of very high viscosity poly(vinyl
siloxane) impression materials. Int J Pros-
thodont 1989;2:368-70.
11. Idris B, Houston F, Claffey N. Comparison of
the dimensional accuracy of one- and two-
step techniques with the use of putty/wash
addition silicone impression materials.
J Prosthet Dent 1995;74:535-41.
12. Lee IK, DeLong R, Pintado MR, Malik R.
Evaluation of factors affecting the accuracy
of impressions using quantitative surface
analysis. Oper Dent 1995;20:246-52.
13. Caputi S, Varvara G. Dimensional accuracy
of resultant casts made by a monophase,
one-step and two-step, and a novel two-step
putty/light-body impression technique: an in-
vitro study. J Prosthet Dent 2008;99:274-81.
14. Millar BJ, Dunne SM, Robinson PB. In-vitro
study of the number of surface defects in
monophase and two-phase addition silicone
impressions. J Prosthet Dent 1998;80:32-5.
15. Ali KS, Shenoy VK, Rodrigues SJ. Compara-
tive evaluation of dimensional accuracy of
casts made by repeated pouring of addition
silicone impressions using 1) 2-step putty/
light-body technique using stock tray, and
2) 1-step simultaneous dual viscosity tech-
nique using custom tray: an in-vitro study.
J Nepal Dent Assoc 2010;11:32-9.
16. Luthardt RG, Walter MH, Quaas S, Koch R,
Rudolph H. Comparison of the three-
dimensional correctness of impression
techniques: a randomized controlled trial.
Quintessence Int 2010;41:845-53.
17. Franco EB, da Cunha LF, Herrera FS,
Benetti AR. Accuracy of single-step versus 2-
step double-mix impression technique. ISRN
Dent 2011;2011:341546.
18. 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.
Corresponding author:
Dr Giuseppe Varvara
University ‘G. D’Annunzio’ of ChietiePescara
Via dei Vestini, 31
66100 Chieti
ITALY
E-mail: gvarvara@unich.it
Copyright ª 2014 by the Editorial Council for
The Journal of Prosthetic Dentistry.