{"id":541,"date":"2012-04-30T23:17:11","date_gmt":"2012-05-01T04:17:11","guid":{"rendered":"http:\/\/allisonwatts.com\/blog\/?p=541"},"modified":"2020-12-23T13:58:17","modified_gmt":"2020-12-23T19:58:17","slug":"impression-techniques-full-mouth-rehabilitation","status":"publish","type":"post","link":"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/","title":{"rendered":"Impression Techniques – Full Mouth Rehabilitation"},"content":{"rendered":"
\"\"<\/a><\/div>\n
 <\/div>\n
Impression Techniques<\/span><\/span><\/strong><\/div>\n
by Allison Watts, DDS
\n\t<\/span><\/strong><\/em><\/span><\/div>\n

\n\t<\/span><\/span><\/div>\n

\n\t<\/span><\/span><\/div>\n
You should already have models on this patient that you took for bite records<\/strong> so you likely have the size of the arch to choose your tray size. If you don’t have them out, pick the one that’s not too big and not too small. You know how to pick the size.  Occasionally we have to alter the tray by cutting something away for tori or an open tray implant impression. We also may have to add wax somewhere to extend it (3rd<\/sup> molars are a common place we have to extend. The type of trays we use are the Teledyne-Master Getz plastic ones. They are nice and rigid, but almost always have to be heated up and flared on the buccal of the posteriors.<\/span><\/span><\/div>\n

\n\t<\/span><\/span><\/div>\n
Final impression materials for C&B are appropriate<\/strong>. There are many to choose from. We use PVS and my favorite is aquasil (green heavy body and orange extra light viscosity).<\/span><\/span><\/div>\n

\n\t<\/span><\/span><\/div>\n
In our office before we remove the temps to take final impressions<\/strong>, we take an impression of the temps just in case something happens during removal and as the model for the approved provisionals for the lab. Sometimes we’ve already done this at the approval appointment so they can be sedated for this appointment. You may also want to take a facebow of them at this time if you need it. We often cross mount it to the already mounted models from the bite records or waxup. <\/span><\/span><\/div>\n

\n\t<\/span><\/span><\/div>\n
Hopefully ahead of time when you decided what kind of restoration these would be,<\/strong> you also took into consideration how deep the margins needed to be based on the coloration of the tooth, the recommended prep design for the restoration and the emergence profile you are wanting (If you are closing dark triangles at the gingival embrasure, you may need to take the finish line higher, but be careful not to invade the biologic width).<\/span><\/span><\/div>\n

\n\t<\/span><\/span><\/div>\n
Know the type of crest your patient has and measure the sulcus to avoid biologic width impingement.<\/strong> To figure out the best place to place your margin from a health perspective, please see the following article by Bill Robbins and Jeff Rouse (in particular, the parts on crest classification and the dentoalveolar complex). Here’s the link: http:\/\/www.coredentistry.com\/downloads\/BeyondSmileDesign.pdf<\/span><\/span><\/div>\n

\n\t<\/span><\/span><\/div>\n
Generally if I want a subgingival margin,<\/strong> I take off the temps, prepare teeth to the gingival margin, pack 00 cord (soaked in styptin) to expose .5-1 mm more tooth subgingivally, depending on the type of crest. Drop the margin to the cord. Be careful not to prep too deep… Finish the preps however you do — fine diamonds, carbides or white stone and brownie. When the prep is done, pack a second cord (usually size 0 or 1) all the way around the finish line (although some use electrosurg or expasyl, I prefer cord and that is the only technique I will discuss here). When the second piece of cord is in, make sure that the tissue is fully retracted and the tissue is not coming over the cord anywhere.<\/span><\/span><\/div>\n

\n\t<\/span><\/span><\/div>\n
If there is a lot of inflammation and bleeding, we use superoxyl first<\/strong> (be careful, it burns if it gets somewhere and doesn’t get removed quickly) by dabbing it on the area with a cotton pellet or a syringe with an infuser tip. Another trick I love that I learned from Bill Strupp, is called a widget. A widget is a piece of cotton long enough to cover the bleeding area that has been soaked with styptin. It’s small and thin like a strand of cotton pulled from a cotton roll that is probably a few mm thick and long enough to sit on the area we want to stop bleeding. We place it on the area and wait about 10 minutes. When I come back and check it, we’ll remove the widget and rinse to see if the bleeding looks better. If it does, prepare to take the impression. If not, try again or remove both cords and repack bigger cord like a 1 or 2 with styptin. All cord sizes are ultradent. <\/span><\/span><\/div>\n

\n\t<\/span><\/span><\/div>\n
When you’re ready, the patient, their teeth and the assistants are ready,<\/strong> pull the second piece of cord and leave the first if you can. I will usually be taking an impression of prepped anteriors with posterior temps in place or prepped posteriors with anterior temps in place. But the impression is a full arch regardless. If I do not get all the prepped teeth perfect, I will try another full arch, but may at some point use a partial tray to pick up one or two teeth. Usually when we are taking full arch impressions, we place the impression materials in ice, which gives us more working time. If you do this, allow an extra 2 minutes or so for it to set up. <\/span><\/span><\/div>\n

\n\t<\/span><\/span><\/div>\n
In step by step detail:<\/span><\/span><\/strong><\/div>\n

\n\t<\/span><\/span><\/div>\n
    \n
  1. I pull the top cords on the teeth I’m final impressing, tuck them in if necessary.<\/li>\n
  2. Rinse and dry.<\/li>\n
  3. Syringe the light body material around each prepared tooth.<\/li>\n
  4. Blow light air to help the material go down into the sulcus.<\/li>\n
  5. Syringe another layer of light body on top of the first layer. <\/li>\n
  6. Lightly blow air if there were any gaps in the impression material the first time.<\/li>\n
  7. Syringe another layer on the tops of all the teeth.<\/li>\n
  8. Assistant has the tray full by now and will hand it to you to seat.<\/li>\n
  9. Seat the tray.<\/li>\n
  10. Set timer and remove when finished.<\/span><\/span><\/li>\n<\/ol>\n

    \n\t<\/span><\/span><\/div>\n
    This is one of the few times that I have 2 assistants in the op together. One is filling the tray, while the other is retracting and keeping things dry.<\/span><\/span><\/em><\/div>\n

    \n\t<\/span><\/span><\/div>\n
    When taking a full arch impression and bite records on an entire arch of prepped teeth, there are some tricks that I found difficult to explain in writing.<\/strong> Email me at insights@allisonwatts.com<\/a> if you’d like more info about that. <\/span><\/span><\/div>\n

    \n\t<\/span><\/span><\/div>\n
    After the impressions, we take our bite registration and opposing impression. Don’t forget to take a stump shade and a shade photo of the desired shade next to the stump or a shade photo of the shade tabs next to the already restored teeth that you want to match.<\/span><\/span><\/div>\n

    \n\t<\/span><\/span><\/div>\n
    After the patient leaves, we mount the opposing with the facebow or with one of the patients already mounted models before we send to the lab. Let the lab know if you have enclosed the model of the approved temps by labeling it.<\/span><\/span><\/div>\n

    \n\t<\/span><\/span><\/div>\n
    Impress the heck out of ‘em,<\/span><\/span><\/strong><\/div>\n

    \n\t<\/span><\/span><\/div>\n
    \"\"<\/a><\/div>\n
     <\/div>\n
     <\/div>\n
     <\/div>\n
    \n
    \n
     <\/div>\n<\/p><\/div>\n
    \n
    \n
    \n
    \"\"<\/a>Allison<\/span> Watts<\/span> is a dentist and dental practice owner for 16 years.  She focuses on relationship-based, complex restorative and esthetic dentistry.  She is a personal and professional life coach and clinical mentor.  She is a member of the visiting faculty at the Spear Institute and faculty-in-training at the Pankey Institute.<\/strong><\/span><\/span><\/div>\n

    \n\t\t\t\t\t<\/span><\/span><\/div>\n

    As the founder and owner of Transformational Practices, she has helped many dentists and team members improve the quality and enjoyment of their practice and life.  She has created many systems and tools for practice and life success, including her newest tool, The Practice Success Guide.  <\/em><\/strong>Request your free copy by visiting TransformationalPractices.com\/<\/a><\/strong><\/span><\/span><\/a><\/strong><\/font>blog<\/a> and begin experiencing the practice and life you dream of!
    \n\t\t\t\t\t<\/strong><\/span><\/span><\/p>\n

     <\/p>\n

     <\/p>\n

     <\/p>\n

     <\/p>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

      Impression Techniques by Allison Watts, DDS You should already have models on this patient that you took for bite records so you likely have the size of the arch to choose your tray size. If you don’t have them out, pick the one that’s not too big and not too small. You know how to pick […]<\/p>\n","protected":false},"author":1,"featured_media":542,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_cloudinary_featured_overwrite":false,"footnotes":""},"categories":[310,22,25,4,27],"tags":[12,19,58,140,179,115,113,116,56,211,212,213,185,199],"class_list":["post-541","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-articles","category-clinical-excellence","category-communication","category-empowerment","category-patients","tag-allison-watts-dds","tag-builiding-a-profitable-dental-practice","tag-clinical-excellence-2","tag-dental-coaching","tag-dental-consulting","tag-dental-mentoring","tag-dental-practice-success","tag-dental-training","tag-full-mouth-rehabilitation","tag-full-mouth-restoration","tag-impression-techniques-full-mouth-rehabilitation","tag-impression-techniques-full-mouth-restoration","tag-successful-dental-practices","tag-transformationalpractices-com"],"yoast_head":"\nImpression Techniques - Full Mouth Rehabilitation<\/title>\n<meta name=\"description\" content=\"These are the impression techniques that I personally use to achieve excellent results during a full mouth rehabilitation. More detail is available from me directly ...\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Allison Watts\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/\",\"url\":\"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/\",\"name\":\"Impression Techniques - Full Mouth Rehabilitation\",\"isPartOf\":{\"@id\":\"https:\/\/allisonwatts.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/res.cloudinary.com\/transformational-practices-llc\/images\/f_auto,q_auto\/v1608753497\/Allison_Watts_Impression_techniques_nwwtol\/Allison_Watts_Impression_techniques_nwwtol.png?_i=AA\",\"datePublished\":\"2012-05-01T04:17:11+00:00\",\"dateModified\":\"2020-12-23T19:58:17+00:00\",\"author\":{\"@id\":\"https:\/\/allisonwatts.com\/#\/schema\/person\/83062dfac15b33cd0e3cce96b4d9db3a\"},\"description\":\"These are the impression techniques that I personally use to achieve excellent results during a full mouth rehabilitation. More detail is available from me directly ...\",\"breadcrumb\":{\"@id\":\"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/#primaryimage\",\"url\":\"https:\/\/res.cloudinary.com\/transformational-practices-llc\/images\/f_auto,q_auto\/v1608753497\/Allison_Watts_Impression_techniques_nwwtol\/Allison_Watts_Impression_techniques_nwwtol.png?_i=AA\",\"contentUrl\":\"https:\/\/res.cloudinary.com\/transformational-practices-llc\/images\/f_auto,q_auto\/v1608753497\/Allison_Watts_Impression_techniques_nwwtol\/Allison_Watts_Impression_techniques_nwwtol.png?_i=AA\",\"width\":322,\"height\":237},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/allisonwatts.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Impression Techniques – Full Mouth Rehabilitation\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/allisonwatts.com\/#website\",\"url\":\"https:\/\/allisonwatts.com\/\",\"name\":\"Helping You Live Your Brightest Life From The Inside Out\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/allisonwatts.com\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/allisonwatts.com\/#\/schema\/person\/83062dfac15b33cd0e3cce96b4d9db3a\",\"name\":\"Allison Watts\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/allisonwatts.com\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/5e781eff0923bc735ed9ce0eeeeb21d3?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/5e781eff0923bc735ed9ce0eeeeb21d3?s=96&d=mm&r=g\",\"caption\":\"Allison Watts\"},\"sameAs\":[\"http:\/\/allisonwatts.com\"],\"url\":\"https:\/\/allisonwatts.com\/author\/admin\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Impression Techniques - Full Mouth Rehabilitation","description":"These are the impression techniques that I personally use to achieve excellent results during a full mouth rehabilitation. More detail is available from me directly ...","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/","twitter_misc":{"Written by":"Allison Watts","Est. reading time":"6 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/","url":"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/","name":"Impression Techniques - Full Mouth Rehabilitation","isPartOf":{"@id":"https:\/\/allisonwatts.com\/#website"},"primaryImageOfPage":{"@id":"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/#primaryimage"},"image":{"@id":"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/#primaryimage"},"thumbnailUrl":"https:\/\/res.cloudinary.com\/transformational-practices-llc\/images\/f_auto,q_auto\/v1608753497\/Allison_Watts_Impression_techniques_nwwtol\/Allison_Watts_Impression_techniques_nwwtol.png?_i=AA","datePublished":"2012-05-01T04:17:11+00:00","dateModified":"2020-12-23T19:58:17+00:00","author":{"@id":"https:\/\/allisonwatts.com\/#\/schema\/person\/83062dfac15b33cd0e3cce96b4d9db3a"},"description":"These are the impression techniques that I personally use to achieve excellent results during a full mouth rehabilitation. More detail is available from me directly ...","breadcrumb":{"@id":"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/#primaryimage","url":"https:\/\/res.cloudinary.com\/transformational-practices-llc\/images\/f_auto,q_auto\/v1608753497\/Allison_Watts_Impression_techniques_nwwtol\/Allison_Watts_Impression_techniques_nwwtol.png?_i=AA","contentUrl":"https:\/\/res.cloudinary.com\/transformational-practices-llc\/images\/f_auto,q_auto\/v1608753497\/Allison_Watts_Impression_techniques_nwwtol\/Allison_Watts_Impression_techniques_nwwtol.png?_i=AA","width":322,"height":237},{"@type":"BreadcrumbList","@id":"https:\/\/allisonwatts.com\/impression-techniques-full-mouth-rehabilitation\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/allisonwatts.com\/"},{"@type":"ListItem","position":2,"name":"Impression Techniques – Full Mouth Rehabilitation"}]},{"@type":"WebSite","@id":"https:\/\/allisonwatts.com\/#website","url":"https:\/\/allisonwatts.com\/","name":"Helping You Live Your Brightest Life From The Inside Out","description":"","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/allisonwatts.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/allisonwatts.com\/#\/schema\/person\/83062dfac15b33cd0e3cce96b4d9db3a","name":"Allison Watts","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/allisonwatts.com\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/5e781eff0923bc735ed9ce0eeeeb21d3?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/5e781eff0923bc735ed9ce0eeeeb21d3?s=96&d=mm&r=g","caption":"Allison Watts"},"sameAs":["http:\/\/allisonwatts.com"],"url":"https:\/\/allisonwatts.com\/author\/admin\/"}]}},"_links":{"self":[{"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/posts\/541","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/comments?post=541"}],"version-history":[{"count":0,"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/posts\/541\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/media\/542"}],"wp:attachment":[{"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/media?parent=541"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/categories?post=541"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/allisonwatts.com\/wp-json\/wp\/v2\/tags?post=541"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}