DTUS1310

Making a good ‘first impression’ By Todd Snyder, DDS The ability to take a good impression is nothing short of amazing when considering the environment we work in: upside down, under water and in the dark. The impression tech- nique has evolved consider- ably from the days of plaster impressions, copper bands and hydrocolloid. You would think with all of the modern technology and science we would be captur- ing an amazing reproduction of the oral environment with- in the blink of an eye. Today there are many materials and devices on the market that can make the pro- cess easier for everyone and provide great results too. Current impression tech- nologies have many forms available to fit the needs of each practitioner. The digi- tal impression technique has created quite a lot of interest within the dental community. Systems such as the CEREC AC by Sirona, iTero by Cadent and the Lava COS by 3M ESPE all have a lot to offer den- tists when compared to the traditional cumbersome tech- nique. Avoiding a messy two-step, putty wash system makes it nice for patients in terms of not having a mouth full of impression material for many minutes. Additionally, the level of accuracy with digital impressions is nothing short of superb. All of the units have various proprietary software and cap- ture devices, but for the most part a large wand/capture device on it takes a digital image that can then be used to create a three-dimensional model. Minor points of contention Some minor grievances that have been discussed with the systems are that the quality of the models that are fabricated for some of the systems are not as nice as hand-poured models, and the turnaround time to get models from the fabricating companies can sometimes be lengthy. These are minor inconve- niences when compared to tissue and fluid management during impression taking. These are the biggest obsta- cles in capturing a quality dental impression, neither of which is addressed with these modern marvels unless your preparation margin is supra- gingival. In addition, the cur- rent price point may displace some users from investing in the technology. The next generation intra- oral scanners could quite pos- sibly have technology that can look through gingival tissues, crevicular fluid and blood to find the cavosurface mar- gin without having to jump through the same hoops of tissue and fluid management. These systems will become a better investment regardless of cost when that becomes a reality. Keeping tissues and liquids at bay Until the next level of technol- ogy evolves, we will all still have to contend with moisture and tissue retraction to expose the elusive cavosurface mar- gin. Fortunately, various com- batant solutions and devices can be used to hold tissues and liquids at bay. Hemostatic materials such as Viscostat (Ultradent) and Hemostasyl (Kerr Corpora- tion) are excellent in han- dling bleeding issues. Simply scrubbing either liquid into a bleeding capillary will typi- cally cause hemostasis. Rinse the area vigorously to allow for removal of any excess material and identify any additional or stubborn capillaries that need more attention. For displacement of gingi- val tissues, there is nothing better than the placement of the single or double retraction cord techniques. A single cord can work very well at displacing tissues, however, it will either need to be removed, which can cause bleeding, or if left in during the impression technique it will need to be pushed past the margin enough to leave the margin exposed along with additional root surface. Many dentists opt for the double cord technique with a small cord placed followed by a larger second cord to help with tissue displace- ment. When it is time for the impression, the second cord is removed leaving the smaller cord behind. Some interesting alterna- tives can be used instead of a second cord or, in some cases, in place of cords all together. Products such as Expa-syl (Kerr Corporation) and other soon-to-be-released products, are allowing for some decent tissue expansion and hemo- stasis at the same time. After placement, these materials can either be washed out of the gingival sulcus or lifted out with an instrument. Preparation technique Although oftentimes over- looked, the preparation tech- nique can provide substantial benefits to control bleeding issues. Preparing the tooth structure along the gingival tissues in a clockwise manner Clinical DENTAL TRIBUNE | May 201014 AD Invest in your practice with HSFS Henry Schein Financial Ser- vices (HSFS) business solutions portfolio offers a wide range of financing options that make it possible for you to invest in your practice for greater effi- ciency, increased productivity and enhanced patient services. HSFS helps health-care practitioners operate finan- cially successful practices by offering complete leasing and financing programs. HSFS can help obtain financing for equipment and technology purchases, practice acquisitions and practice start- ups. HSFS also offers value-add- ed services including credit card acceptance, demographic site analysis reports, patient collections, patient financing and the Henry Schein Credit Card with 2 percent cash back or 11 /2 points per dollar spent. For additional information, please call (800) 443-2756 or send an e-mail to hsfs@henry schein.com. DT