Available Online through ISSN: 0975-766X CODEN: IJPTFI Research Article www.ijptonline.com SURVEY OF IMPRESSION PROCEDURES FOR COMPLETE DENTURES AMONG DENTAL PRACTITIONERS IN CHENNAI Preethi Mariona.R, Dr.Dhanraj, Dr.Preetham Prasad Department of Prosthodontics, Saveetha Dental College & Hospitals, Chennai, Tamilnadu, India. Email: preethi.1997@hotmail.com Received on: 01-03-2017 Accepted on: 02-04-2017 Abstract Background: Impression for complete dentures is a negative replica of the edentulous ridges and the adjacent supporting structures. The basic objectives of impression making involves retention, support, stability and esthetics. The selection of the materials and method are important contributing factors to achieve these objectives. Aim: The study aims at identifying the materials and methods used by general dental practitioners for recording impressions in completely edentulous patients. Methodology: A cross sectional study was carried out by preparing a questionnaire and was conducted amongst 100 practising dentists in Chennai city. Based on the responses given, the knowledge and practices of impression materials and techniques were elicited and analysed. Results: This study inferred that all the 100 respondents use irreversible colloids i.e, alginate for making a primary impression. 100% of the respondents made a custom tray while taking a final impression for an edentulous patient and cold cure was the only material used for fabrication of the tray. 72% of the respondents mentioned that a spacer in the tray was made mandatorily, most of them used a full spacer without tissue stop while 28% used spacer covering incisive papilla and mid palatine suture area only. Green stick compound which is a low fusing compound is the only material that is used by all the 100 respondents for carrying border mouldings. 92% of the respondents routinely used a wash material zinc oxide eugenol for making final impression while 8% still used alginate.with regard to the method used for making an impression, 14% used muco compression method while 8% rolled mucostatic and 78% IJPT April-2017 Vol. 9 Issue No.1 29247-29253 Page 29247
followed selective pressure technique. For disinfecting the impression material 46% used cold sterilisation, 5% sterilised it under UV and 59% used running water and other techniques. Conclusion: This study concluded the preference of irreversible hydro colloid as the primary impression of choice and zinc oxide eugenol as the most preferred material of choice and selective pressure technique as the most commonly used impression technique amongst the 100 dental practitioners who participated in the survey. However, the knowledge and awareness regarding disinfection of impression to prevent cross contamination, was observed to be inadequate among the respondents, thus more awareness needs to be imparted to address this phenomenon to improve the quality of dental health care. Keywords: Impression, alginate, selective pressure, disinfection. Introduction: Impressions is basically when the imprint of the teeth and adjacent structures of obtained using specialised materials and methods. 2 Various impression materials are available and they each have a particular technique by which they should be used on the patient. For a material to be used as an impression material it needs to satisfy certain characteristics. An impression material should provide the required retention, support, mechanical strength and aesthetics. Selecting the material and method following this criteria is considered appropriate. For eg, alginate being a impression material has its own setting time and requires proper mixing. Impression compounds where the oldest technique which was used to take impressions. It's use slowed faded away in clinics as it was a tedious process and there arose many chances for failures in the impression. The impression material which should provide retention is of great importance. Mechanical strength of a impression material can help determining the elasticity. Given the variety of recommendations from academics, the dental practitioner is faced with a choice of materials and techniques for impressions for complete dentures. The aim of this survey is to determine which material and which technique dental practitioners use to fabricate a clinically straightforward complete denture. Materials and Method: A questionnaire was prepared which contained 9 questions and sent to 100 practitioners. They where all from age group 22 to 40. The dental practitioners where from chennai. The participants responded to the all questions in the questionnaire and there were no dropouts in the study.the questionnaire included the following questions: IJPT April-2017 Vol. 9 Issue No.1 29247-29253 Page 29248
1) Material used for impressions a)alginate b)impression compound c) any other (specify if) 2) Is a custom tray made for final impression of edentulous patients a) Yes b) No 3) If yes, what material Is used to fabricate the tray a) Base plate b) Cold cure 4) Do you use a spacer in the tray. a) Yes. B) No 5) If yes, what design do you use? a) Full spacer with tissue stop b) Full spacer without tissue stop 6) Material used to carry border mouldings a) Green stick b) Putty 7) Materials used for making the final impression of edentulous patients a) Light body b) Zinc oxide eugenol 8) What technique is followed for impressions taking a) Mucocompressive b) Mucostatic c) selective pressure 9) How do you disinfect the impression material? a) Cold sterilisation b) UV sterilisation. C) others IJPT April-2017 Vol. 9 Issue No.1 29247-29253 Page 29249
Results: This study inferred that all the 100 respondents use irreversible colloids i.e, alginate for making a primary impression. 100% of the respondents made a custom tray while taking a final impression for an edentulous patient and cold cure was the only material used for fabrication of the tray. 72% of the respondents mentioned that a spacer in the tray was made mandatorily, most of them used a full spacer without tissue stop while 28% used spacer covering incisive papilla and mid palatine suture area only. Green stick compound which is a low fusing compound is the only material that is used by all the 100 respondents for carrying border mouldings. 92% of the respondents routinely used a wash material zinc oxide eugenol for making final impression while 8% still used alginate.with regard to the method used for making an impression, 14% used muco compression method while 8% rolled mucostatic and 78% followed selective pressure technique. For disinfecting the impression material 46% used cold sterilisation, 5% sterilised it under UV and 59% used running water and other techniques. Discussion: Impression making is a very important step in the construction of denture. 2 The preference among the dentists regarding the choice of impression materials has remained unclear. This study inferred that all the 100 respondents use irreversible colloids i.e, alginate for making a primary impression and they use a perforated stock metal tray. All the respondents agreed on their preference of non perforated stock metal tray when impressions compound was the material of choice. Similar results were obtained by Paul Hyde and Vinay R Kakatkar in their survey about impression materials. The results revealed that 100% of the respondents made a custom tray while taking a final impression for an edentulous patient and cold cure was the only material used for fabrication of the tray. In a survey conducted by Gauthier et al it was observed that 88 % dental graduates use alginate for making primary impressions IJPT April-2017 Vol. 9 Issue No.1 29247-29253 Page 29250
where as 99 % gave alginate preference as primary impression material in UK. 6 In a survey in North American Dental Schools by Arbree et al 74 % preferred alginate to make primary Impressions where as 15 % preferred impression compound. 7 In Northern India, a survey conducted by Singh et al found that 71 % use alginate for making primary impressions and 29 % use impression compound. 8 72% of the respondents mentioned that a spacer in the tray was made mandatorily, most of them used a full spacer without tissue stop while 28% used spacer covering incisive papilla and mid palatine suture area only.a spacer allows the tray to be properly positioned in thickness of the spacer for different impression materials and at the final stage distortion of the material is prevented. Green stick compound which is a low fusing compound is the only material that is used by all the 100 respondents for carrying border mouldings. Green stick compound is thermoplastic and it allows corrections and modification which was perceived to be a great advantage by the respondents. The survey conducted by Paul Hyde in United Kingdom matched the results obtained. In this study, 92% of the respondents routinely used a wash material zinc oxide eugenol for making final impression while 8% still used alginate. In a survey of dental graduates by Gauthier in U.K it was noted that ZOE paste was preferred by 29 % where 13 % preferred elastomers. 6 It was noted that 94 % preferred alginate for secondary impressions. Alginate was not preferred by most of them because it was considered to be a bulk impression material and they preferred a thickness of about 3 mm. In another study of US prosthodontists and dental schools by Petrie it was noted that 36 % prosthodontists and 64 % schools used elastomers for making final impressions. 8 In the present study none of the respondents used polyvinylsiloxane. Similar results where obtained by Vinay R Kakatkar in the survey conducted. With regard to the method used for making an impression, 14% used muco compression method while 8% rolled mucostatic and 78% followed selective pressure technique. Selective pressure was preferred by the majority of the respondents as the areas that require more attention can be clearly recorded. All the respondents expressed mucocompressive method, where there is pressure applied on the mucosa it may cause a lot of discomfort and ridge resorption. For disinfecting the impression material 46% used cold sterilisation, 5% sterilised it under UV and 59% used running water and other techniques. In the survey conducted by Blair et al It is recommended that all impressions should at least undergo a disinfecting procedure by immersion in 1% sodium hypochlorite for a minimum of 10 minutes. 13 Disinfection is required as it prevents the risk of disease transmission and cross contamination. Thus disinfection showed a diversity of options among practitioners. IJPT April-2017 Vol. 9 Issue No.1 29247-29253 Page 29251
Conclusion: This study concluded the preference of irreversible hydro colloid as the primary impression of choice and zinc oxide eugenol as the most preferred material of choice and selective pressure technique the most preferred impression technique amongst the 100 dental practitioners who participated in the survey. However, the knowledge and awareness regarding disinfection of impression to prevent cross contamination, was observed to be inadequate among the respondents, thus more awareness needs to be imparted to address this phenomenon to improve the quality of dental health care. References: 1. VinayRKakatar Indian Prosthodont Soc,Complete Denture Impression Techniques Practiced by Private Dental Practitioners: A Survey, J Indian Prosthodont 201313(3):233-235. 2. Anusavice KJ Phillip s science of dental materials, 11th edn. Anusavice,Elsevier saunders;2016 pp 243 250, 752. 3. O Brien WJ Dental materials and their selection, 3rd edn. Quintessence Books Chicago; 2002 pp 9, 92, 96 4. Von Noart R Introduction to dental materials, 3rd edn Mosby, New York; 2007p 188 192. 5. Levin B (ed) Impressions for complete dentures. Quin- tessence Books, Chicago;1984. 6. Felton D Complete dentures: DCNA, vol 40, no 1. W. B. Saunders company;1996, pp 39 51. 7.Hyde TP, McCord JF Survey of Prosthodortic impression procedures for complete dentures in general dental practice in UK. J Prosthet Dent;1999 81(3):295 299. 8. Petrie CS, Walker MP, Williams K A survey of US prosthodontists and dental Schools on the current materials and methods for final impression for complete denture prosthodontics. J Prosthodont ;2005 14(4):253 262. 9. Singh G, Kapoor V, Gambhir RS, Bansal V Application of prosthodontic techniques by private practitioners in Northern India a survey. Int J Epidemiol;2011 9 (2). 10. Gauthier G, Williams JE, Zwemer JD The practice of complete denture prosthodontic selected dental graduates. J Prosthet Dent;1992 68(3):308 313. 11. Arbree NS, Fleck S, Askinas SW The results of a brief survey of complete denture prosthodontic techniques in predoc- toral programs in North American dental schools. J Prosthodont 5(3):211 225. 12. Petrie CS, Walker MP, Williams K A survey of US prosthodontists and dental Schools on the current materials and methods for final impression for complete denture prosthodontics. J Prosthodont 2005 14(4):253 262. IJPT April-2017 Vol. 9 Issue No.1 29247-29253 Page 29252
13. Blair and Wassell,A survey of the methods of disinfection of dental impressions used in dental hospitals in the United Kingdom, 1996 May 25;180(10):369-75. 14. Felton D Complete dentures: DCNA, vol 40, no 1. W. B. Saunders company;1996 pp 39 51. 15. Massad J, Sagna D Vinyl polysiloxame impression material in removable prosthodontics. Part I: edentulous impressions. Compend Contin Educ Dent;2007 28(8):452 459. 16. Von Noart R Introduction to dental materials, 3rd edn. Mosby, New Yor;2007 p 188 192. IJPT April-2017 Vol. 9 Issue No.1 29247-29253 Page 29253