TAKING IMPRESSION WITH SILICONES

1. INTRODUCTION

The beginning of oral rehabilitation dates back a long time, where civilizations
made up of Phoenicians, Etruscans, Greeks and Romans, made the first
examples of dental prostheses in order to return function to the oral cavity. The
basic principles, on which current protocols for taking impressions and
constructing dental prostheses are based, were already known at the end of the
19th century.
From the beginning, there was a need to transfer the morphology of the
patient's oral cavity to the outside, in order to better observe and understand the
dental structure and the tissues that surround it, for which different types of
materials were used, such as for example plaster. As for trays or impression
holders, Delabarre, in 1820, introduced the first metal tray, used to transport the
impression material into the patient's mouth.
Nowadays, treatments linked to dental specialties such as oral rehabilitation,
orthodontics, orthopedics, among others, are frequently used in order to restore
the functions of the stomatognathic system and thus improve the patient's
quality of life. These specialties constantly resort to taking impressions with
materials specially designed to reproduce the details of the dental organs, in
order to obtain a plaster model that allows the dentist to carry out a study, reach
a diagnosis and provide the appropriate treatment in each case. patient
according to their needs.

2. GOALS

General Objective

 Prepare a simple virtual practical guide, with quick and easy access for
students of the Faculty of Dentistry of the Universidad Latinoamericana
CIMA, which indicates the protocol to follow for taking dental impressions,
based on the available impression materials.

Specific objectives

 Determine the protocols to follow for taking impressions with condensation

silicone, taking into account the handling instructions established by each
manufacturer.

 Identify the disinfection protocols that must be followed according to the

printing material used.

3. THEORETICAL FRAMEWORK
Silicones

Definition
They are materials that contain silicon atoms bonded together in their structure.
The size of its molecules and the composition of the reactors determine its
specific properties and characteristics. Silicones used in dentistry to make
impressions consist of a liquid (silicone oil) combined with silicon dioxide-based
filler powder. In addition, they require a reactor to polymerize and set once they
have been mixed. According to the chemical reaction generated between the
base and the reactor, two types of silicones have been classified: condensation
and addition. (Macchi, 2009, p. 255).
In a study carried out by Galarreta and Kobayashi (2007, p. 8), the
effectiveness of the use of adhesives for silicones by addition and condensation
was verified, since there was greater precision, in terms of the reproduction of
details, thanks to their application . The objective of using the adhesive is to
prevent separation between the impression material and the tray when removed
from the patient's mouth.
Silicone adhesives are composed of reactive silicone similar to its structure and
ethyl silicate, which allow bonding with the surface of the tray and with the
impression material. These adhesives must be used according to the
manufacturer of the silicone to be used and its instructions. (Bustamante, 2011,
p.35).

Condensation silicone

Composition
It is made up of dimethylsiloxane, which corresponds to a low molecular weight
silicone base, silica or copper carbonate as a filler, which prevents the material
from being extremely fluid and thus providing it with the firmness required to set
once it has been taken. the impression. (Hatrick; Eakle; Bird, 2012, p.185). The
reagent is a liquid of viscous consistency that contains ethyl silicate, which will
be activated by stannous octoate. When the base is mixed with the catalyst,
alcohol is eliminated as a by-product, causing the contraction of the silicone.
(Shillingburg, 2002,
p.297).

Properties
Condensation silicone has a polymerization time of 5 to 7 minutes. As already
mentioned, the reaction generates alcohol evaporation, which causes material
shrinkage and low dimensional stability. The more time passes, the greater the
contraction, especially in the first 24 hours after taking the impression, so it is of
great importance to empty it immediately, within a maximum period of one hour,
to obtain an accurate model. taking into account the manufacturer's instructions.
(Hatrick; Eakle; Bird, 2012, p.185).
Condensation silicone has different viscosities: light, medium, heavy or putty.
This impression material has been used in the manufacture of bridges and
crowns, but its properties have been surpassed by additive silicone. (Hatrick;
Eakle; Bird, 2012, p.185). Among the advantages of condensation silicone are
tear resistance, low cost compared to addition silicone, no odor or taste,
adjustable working time and polymerization according to the operator's needs.
While its disadvantages are short expiration time and shrinkage due to alcohol
evaporation. (Cárdenas, 2013, p.27).
In addition, silicone by condensation has a permanent deformation that varies
between 0.3-0.7%, which makes the impression better than that of alginate, but
at the same time, it is less precise compared to silicone by addition, the which
presents a deformation of 0.016-0.24%. (Cáceres, 2004, p. 23).

Features of Speedex (Coltene) condensation silicone

In the dental clinic of the University of the Americas (Quito-Ecuador), the
condensation silicone used is the Speedex brand, from the Coltene commercial
company, whose kit includes the putty (Putty), the light paste (Light body) and
the catalyst (Universal Activator).
The manufacturer indicates the possibility of accelerating or slowing down the
working time, increasing or decreasing the catalyst by 20% according to the
needs of the operator and the patient. It should be noted that the technical data
and handling protocol of this product have been taken from the Speedex:
Coltene instructions for use manual.

Speedex Condensation Silicone Handling Protocol (Coltene)

Materials:
 Ideal bucket. (rigid; perforated; posterior width: 10mm; anterior width:
8mm; upper bucket height: 25mm; lower bucket height: 21mm).
 Adhesive 4410 Coltene.
 Speedex – Coltene condensation silicone (Putty, Light Body and Universal
Activator).
 Specific Speedex – Coltene condensation Silicone dispensers.
 Mixing pad or tile.
 Spatula and syringe.
 Disinfectant solution (0.5% sodium hypochlorite or 2% glutaraldehyde).
 Silicone cutter or small plastic sleeve (separator).
4. MATERIALS
 Condensation silicone
 Pink type IV plaster
 Zocaleras
 glass plates
 Plaster spatulas
 Impression trays
 rubber cups
 Plaster Paris

5. PROCEDURE:

TO. Select the tray taking into account the size of the patient's arch; in addition,
it must be rigid and perforated, whose holes must have a considerable number
and size to allow the silicone to flow through them.

b. Spread a thin layer of Coltene 4410 adhesive into the tray and let it dry for
10-15 minutes. It is possible to speed up this process by applying heat.

c. Dispensing:

 One-step technique
a) Place a portion of Speedex Putty with the measuring spoon, pressing the
edge into the palm of your hand.
b) Measure a 4cm line of Universal Activator that covers the diameter of the
putty circle.

c) Mix these components vigorously, kneading them until they have a uniform
color, in a maximum time of 45 seconds and fill the bucket.
d) At the same time, the Light Body paste must be prepared, first placing a line
of Activator on the mixing pad and then a line of light silicone, in a 1:1 ratio.

e) Mix with the spatula for a maximum of 30 seconds and fill the syringe.
f) Inject the Light Body silicone first into the dental preparations and then into
the rest of the teeth.

g) Finally, insert the tray into the patient's mouth and wait 3 minutes until the
material polymerizes.

 Two-step technique
a) Place a portion of Speedex Putty with the measuring spoon, pressing the
edge into the palm of your hand.
b) Measure a 4cm line of Universal Activator that covers the diameter of the
putty circle.
c) Mix these components vigorously, kneading them until they have a uniform
color, in a maximum time of 45 seconds and load the bucket.

d) Insert the tray into the patient's mouth for 3 minutes and remove it once the
material has polymerized (cut the excess edges). It is necessary to make
channel cuts or, in turn, place a small plastic sleeve over the heavy silicone
impression, in order to provide the necessary space for the light silicone to flow.

e) Dispense the Light Body paste, first placing a line of

Activator on the mixing pad and then a line of light silicone in a 1:1 ratio.
f) Mix with the spatula for a maximum of 30 seconds and fill the syringe.
g) Distribute the Light Body silicone over the Putty silicone impression and over
the teeth, first on the dental preparations and then on the rest of the teeth.
h) Insert the tray into the patient's mouth and wait 2-3 minutes for the Light
Body silicone to polymerize.

d. Wash the print with plenty of water.

AND. Disinfect the impression by immersion in 0.5% sodium hypochlorite or 2%
glutaraldehyde for 5 minutes.
F. Rinse with plenty of water.
g. Cast the plaster model 30 minutes later.

Special considerations
 Check that the material has set before removing the impression, since excess
material requires more time to harden at room temperature.
 Factors that can accelerate the hardening process are: excess Universal
Activator, high temperature and intense mixing or kneading. On the contrary, a
low temperature lengthens the setting of condensation silicone.

EMPTYING OF MODELS
Once the impression has been obtained, which represents the negative
reproduction of the patient's oral cavity, it must be filled with fluid plaster
material, which will set and result in the positive reproduction of soft and hard
tissues of the patient's mouth. . (Hatrick; Eakle; Bird, 2012,
p.203).

Plaster classification
The American Dental Association (ADA) identifies 5 types of casts in its
specification #25:

TYPE I (Impression Plaster)

Plaster used to take impressions but is currently out of use, because there are
elastic products on the market intended for taking impressions that provide
greater comfort for the operator and the patient. (Farm, 2011, p. 21).

TYPE II (Plaster for models)

This type of plaster is mainly used for the articulation of type III plaster models.
It is characterized by being white in color, it is economical and requires a ratio of
45ml of water per 100g of powder, which makes it fragile compared to stone-
type plaster. (Hatrick; Eakle; Bird, 2012, p.205).
The plaster used in dentistry most frequently in the city of Quito is the Whip Mix
brand, which is why it has been taken as a reference in this study in terms of
technical data and specific requirements.
There are two types of type II plaster, the normal setting one has a working time
of 5-7 minutes and a setting time of 14 minutes; while quick setting plaster has
a working time of 2-4 minutes and a setting time of 9 minutes. The technical
data for each type of plaster has been taken from the Whip Mix catalogue.
TYPE III (Dental stone plaster)
It is characterized by having high hardness and resistance to abrasion, which is
why it is used for the preparation of partial, total and dental models.
orthodontics. (Hatrick; Eakle; Bird, 2012, p.205).
According to the Whip Mix brand, the most used type III plaster is Quickstone, it
can be light yellow or blue in color and requires a proportion of 28ml of water for
every 100g of powder. Mixing time is 60-90 seconds, working time is 3-5
minutes and setting takes 10 minutes.
For orthodontic models, the Orthodontic Stone (Whip Mix) plaster is used, it is
white and requires a proportion of 28ml of water for every 100g of powder, with
a mixing time of 60-90 seconds, working time of 5- 7 minutes and setting time of
10 minutes.

TYPE IV (High resistance dental stone plaster)

It is used for the production of dies due to its resistance and hardness, it is ideal
for the manufacture of wax patterns for modeling indirect restorations, as they
allow the carving of its structure. (Hatrick
Eakle; Bird, 2012, p.205).
The most used plaster is Silky-Rock (Whip Mix), it comes in different colors
(yellow, violet, white, ivory, light brown), the ratio is 23ml of water for every 100g
of powder. Mixing time is 60-90 seconds, working time 3-6 minutes and setting
time 10 minutes.

TYPE V (High hardness and high expansion dental stone plaster)

The high expansion property is necessary to compensate for the contraction of
metal bases in fixed prostheses. (Hatrick; Eakle; Bird, 2012, p.205). Jade Stone
(Whip Mix) is the most used type V plaster. The ratio is 22ml of water for every
100g of powder. It requires 60-90 seconds of mixing, with a working time of 5-7
minutes and a setting time of 10 minutes. Its presentation is green or blue.

Handling

Selection
The selection of the ideal type of plaster should be based on the hardness
needs required by the procedure that the operator will perform. It must be taken
into account whether a study model or a working model is to be developed,
which requires greater resistance and precision. (Hatrick; Eakle; Bird, 2012,
p.205).

Proportion
The properties that each type of plaster presents are directly related to the
proportion of water/powder that is placed at the time of its preparation (as can
be seen in Table 4). For this reason it is of great importance to know what type
of plaster and what amount of water and powder is required to have a favorable
result. (Hatrick; Eakle; Bird, 2012, p.205).

Mix
A rubber cup and a metal spatula are required to mix the ideal proportion of
water and powder. It is recommended to first place the water and then slowly
add the plaster, in this way all the dust particles are moistened. It should be
spatulated vigorously and firmly against the walls of the cup to obtain a
homogeneous, shiny and air-free mixture. (Hatrick; Eakle; Bird, 2012, p.205).
Mixing time depends on the manufacturer, it is generally 60-90 seconds, at a
speed of 2 revolutions per second. (Hatrick; Eakle; Bird, 2012,
p.206).
The use of a mechanical vibrator helps to incorporate dust particles, obtaining a
homogeneous mixture and avoiding the possible formation of bubbles that alter
the surface of the model.

Placement on print
Once the ideal consistency has been obtained, the working time begins, in
which we must place the plaster on the impression. The placement must be
carried out from one end of the impression, applying a small amount of plaster
and performing vibrating movements of the tray against a surface (work table),
in order to distribute it evenly on the replica of all the tooth surfaces located at
the bottom. of the print, avoiding the entry of air and the formation of bubbles in
this area. (Hatrick; Eakle; Bird, 2012, p.203).
Subsequently, the rest of the mixture is placed over the entire surface until
creating a base for the model. The loss of shine indicates the initial setting of
the plaster. Working and setting times vary according to the commercial brand.
(Hatrick; Eakle; Bird, 2012, p.203).

Model removal
Manufacturers recommend removing the model 45-60 minutes later. (Hatrick;
Eakle; Bird, 2012, p.203).

6. CONCLUSIONS
 Theoretical and practical knowledge is necessary to distinguish the
characteristics of different types of printing materials.
 The handling of each printing material depends directly on its technical
specifications, properties and handling times established by its
manufacturer.

 The selection of the tray is of great importance to correctly take impressions,

therefore, the use of an ideal tray is proposed, which is characterized by
being rigid, with sufficient size and number of holes for the material to flow,
with a posterior width of 10mm and an anterior width of 8mm; In addition, the
upper bucket must have a height of 25mm, while the height of the lower
bucket must be 21mm.

 The use of tray adhesives in the handling of silicone, both condensation and
addition, is of great importance, since it keeps the material inside the tray,
avoiding possible detachment when removing the tray from the patient's
mouth.

7. BIBLIOGRAPHY
 Coltene, (2012). Speedex silicone handling. Retrieved from:
www.coltene.com
 Díaz-Romeral, P.; López, E; Veny, T; Ears, J. (2007). Impression materials
and techniques in tooth-supported fixed prosthesis. Cient. Dent. Spain. 4(1),
p. 71-82.
 Macchi, R. (2009). Dental materials. 4th edition. Pan-American Medical
Publishing House: Argentina.
 Phillips, R. (2004). Science of dental materials. Eleventh edition.
 Elsevier: Spain.