Tissue management and

Impression making
 Impression requisites
 Exact record of all aspects of the prepared tooth
 Must include sufficient unprepared tooth structure
adjacent to the margins
 Full arch and soft tissues
 Lingual surfaces of the anterior teeth
 Free of imperfections
 Adequate moisture control
 Tissue displacement
 Interim restoration if healing of soft tissues needed
 Saliva Control
 Rubber dam
 In Mx arch – cotton roll adjacent to
preparation and saliva evacuator in opposing
lingual sulcus
 In Mn arch – cotton rolls in buccal and lingual
sulcus
 Two vertical rolls in between horizontal to maitain
them
 One long roll in horse shoe fashion
 Moisture absorbing cards with cotton rolls
 Saliva ejectors
 Svedopter or speejector
 Medications
 Local anesthesia
 Anticholinergics

 Antihypertensives
Placement of cotton rolls
 Moisture absorbing cards
 Pressed paper wafers
 With or without
reflective foil
 Paper side towards the
cheek
 Cotton rolls also used to
displace cheek laterally
Saliva ejectors
 Svedopter - speejector
 Flange type evacuator
 Also retracts tongue
with suction
 Careful placement with
cotton rolls between the
blades minmizing
trauma and discomfort
 Medications
 Local anesthesia
 Atropine – 0.4mg
 Contraindicated in glaucoma
 Clonidine – 0.2mg
 Used with caution in hypertensive patients
 Tissue Displacement

 Mechanical
 Chemical
 Surgical
 Mechanical
 Displacement cords
 Impregated
 Non impregnated

 Braided
 Knitted
 Wool like cords
 Metal filament
reinforcement
 Non impregnated
 Wool like cords
 Initial placement
 Can be flattened

 Braided or knitted
 Easy placement
 If too thick - traumatic
 Chemical - Impregnated
 Better sulcus enlargment
 Chemically impregnated
 Dipped in astringent
 MOA
 Causes transient ischemia
 Shrinkage of gingival tissues
 Retraction cord placement
 Isolation and moisture
control
 Cut appropriate length of
cord
 Dry the tooth
 Dip in astringent
 Squeeze out excess on
guaze
 Loop it around the tooth
 Start from interproximal
Retraction cord placement
Double cord technique
 Chemicals are……
 Aluminium chloride and sulphate
 Iron salts
 Epinephrine
 Racemic epinephrine hydrochloride
 Zinc phenosulphonate
 Amine containing eye wash or nasl
decongestant
 Displacement paste
 Infusor syringe??
 Control seepage of gingival fluid
 Al and Fe salts – minimal tissue damage
 Low ph
 Alter smear layer
 Surgical - Electrosurgery
 For minor gingival tissue removal
 Controls post surgical hemorrhage
 Potential for gingival tissue recession
 Contraindications
 Pts with electronic medical device
 Thin gingival tissue

 Metal instruments
 Surgical

 Rotary curettage
 Soft tissue lasers
 Impressions

 Stock trays
 Custom trays
 Triple trays
Custom trays
Fabrication
 Putty - light body silicone

 One step technique

Two step
Heavy body – light body wash
Single mix technique
Automix technique
Machine mix technique
Triple tray / dual arch impression
closed mouth technique
 Special considerations
 Pin holes – plastic pins for reinforcement
 Explorer
 Letulospiral

 Post and cores

 Reversible hydrocolloids – water cooled trays
 Irreversible hydrocolloids – no need for
custom tray