More Predictable Triple Tray Impression Technique using Light, Medium and Putty PVS

[@jonclee]

I'll be sold if you do another one on a real patient with subgingival margins

[@emaxdentistry8747]

I've done this several times on a patient now, although I haven't filmed it, but I've been really pleased with the results even on deep margins and I find I get a little more retraction as well with the stiff putty. The lab looks at my a little crossed eyes though, wondering what I'm sending them. It may not be applicable is every case, but it's becoming my go to technique.

[@SuperMasterTea]

Supragingival prep with deep margins you could of taken an alginate and it would look fine Try the same with deep subgingival margins, heavy bleeding, distal tooth Also in the mouth the pt is unlikely to bite in centric occlusion with such a thick viscous putty material

[@emaxdentistry8747]

You're absolutely right. Having deep margins and bleeding will complicate getting a good impression using any technique. Moisture should be controlled, and tissue management is critical prior to attempting any PVS impression. This video was made on an idealized prep (which unfortunately is a little rare in real life dentistry) on a manikin. However, I believe this will help in a real world scenario for a couple of reasons. 1. The putty hydraulically compresses the light body material forcing it into more intimate contact with the margin of the prep and the deeper areas of the prep. It may also displaced air entrapped at the margins as seen in the second attempt with this technique 2. The putty will form a protective shell around the tooth so the light body does not get disturbed by the tongue or cheek while the tray is loaded and placed. Getting a good bite with this technique is a concern due to the viscosity of the putty, However if the putty is thinned out on the occlusal, I think the jaw deviation can be mitigated. Anyway, may not work for every case, but if it helps, use it.

[@SuperMasterTea]

This is an interesting discussion, hope you don't mind but regarding a few of your points: 1. This can be done but putting putty on the tray itself 2. Can be easily avoided using cotton rolls/mirror retraction (one hand using mirror, the other hand with the impression gun) Practically also you would be expecting the assistant to mix the putty while you inject the light body, then as you adapt the putty she will load the tray, I also have concerns on the difference in setting time of the light and heavy/medium body tray material The way impression materials flow around a tooth is very interesting and not just based on hydraulics. Even when you do a 2 step impression with set/unset putty material in the tray and light body on the tooth and tray you will find that sometimes you will still get a drag even though with this technique you should have maximum hydraulics with a putty 'custom tray' and minimal spacer.

[@emaxdentistry8747]

Excellent points all around. I don't think this is a fix all for impression taking. I would like to experiment with the technique more and I have to confess that I have yet to submit a case using this method. However I intend to. May not be for everyone or for every case. Thanks for your input.

[@mmmohhh8567]

eMax Dentistry i have been pondering the hydraulics issue for some time and am concerned that having too viscous a material like putty may cause a rebound effect and not a displace into the gingiva effect when removed.2nd variable is how hard is the expected seating force?i usually get the nurse to manually mould the putty very fast to make it a tad soft so preventing too heavy a seating force.is that right?i dont know.presumably also the seating force varies inter operator.finally i am considering using heavy body in my trays and medium instead of light,the latter in attempt to prevent possible "flaky"unsupported feather edge type margins.any thoughts?

[@albertlopez5475]

Additional problems among others with this is when the lab has to pour the impression. These materials being not manufactured for this purpose will pull away from each other! Checkout Glidewell laboratory channel where this is precisely shown in a video.Labs detest these ideas!

[@عبدالرحمنباجابر-س6ش]

Great work

[@j.lmendez9796]

Nice technique

[@resom777]

terrible technique

[@albertlopez5475]

Additional problems among others with this is when the lab has to pour the impression. These materials being not manufactured for this purpose will pull away from each other! Checkout Glidewell laboratory channel where this is precisely shown in a video.Labs detest these ideas!