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    2003;134;729-730J Am Dent Assoc

    JEFFERY C. HOOS and GARY J. KAPLOWITZtraysProper placement of dual-arch impression

    jada.ada.org ( this information is current as of March 3, 2011 ):The following resources related to this article are available online at

    http://jada.ada.org/cgi/content/full/134/6/729

    found in the online version of this article at:including high-resolution figures, can beUpdated information and services

    http://jada.ada.org/cgi/collection/implantsImplants :subject collectionsThis article appears in the following

    http://www.ada.org/prof/resources/pubs/jada/permissions.asp

    reproduce this article in whole or in part can be found at:of this article or about permission toreprintsInformation about obtaining

    2011 American Dental Association. The sponsor and its products are not endorsed by the ADA.

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    JADA, Vol. 134, June 2003 729

    One of the most fre-quently encountered

    problems in makingdual-arch impres-

    sions is placing thetray in an improper position,

    where it impinges on ananatomical structure and is dis-

    torted. This kind of distortionmay affect the accuracy of the

    final impression and often canbe recognized when the side wall

    of the tray shows through theimpression material. This usu-

    ally indicates that the side wallof the tray has been deflected by

    an anatomical structure thathas pressed against the side of

    the tray, thereby displacing theimpression material. Impres-

    sions like these should berejected.

    We have developed a tech-nique for ensuring that the

    impression tray is placed in theproper position. We have used

    this technique in more than2,000 impressions, with few

    cases involving possible distor-tion caused by deflection by an

    anatomical structure. We pre-sent this technique for use in

    any dual-arch impressionprotocol.

    PROCEDURE

    The dentist should select a dual-

    arch impression tray that pas-sively fits the quadrant con-

    taining the prepared tooth anddoes not impinge on any

    anatomical structure. The trayis best fitted before the clinician

    administers local anesthetic sothat the patient can feel the tray

    in place. A metal or plastic dual-arch tray of any design will suf-

    fice, as long as it fits properly.With the tray in place, have

    the patient close down and askhim or her if closing down is

    comfortable and easy or if thereare any interferences. Retract

    the cheek and note the intercus-pation of the teeth. If the patient

    can comfortably close down allthe way and no interferences are

    noted, proceed with the impres-sion procedure.

    Insert the empty tray into thequadrant containing the pre-

    pared tooth. Hold the tray onthe maxillary arch and note the

    position of the posterior crossbarof the tray. It must be located

    posterior to the distal surface ofthe most posterior tooth in the

    arch and should not be in a posi-tion that will interfere with com-

    plete seating. Load themandibular side of the tray

    directly into the mouth using amixing tip on an impression car-

    tridge (Figure 1). Have thepatient close down and then

    Proper placement ofdual-arch impression trays

    JEFFERY C. HOOS, D.D.S., F.A.G.D.; GARY J. KAPLOWITZ,D.D.S., M.A., M.Ed.

    C L I N I C A L D I R E C T I O N S

    Do you have a time- or work-saving clinical technique to share with your colleagues? Submit it

    to JADAs Clinical Directions department. A Clinical Directions item should be a maximum of twodouble-spaced typed pages and should include no more than one figure or illustration. Submit five

    copies of your manuscript and of each illustration to Clinical Directions, JADA, 211 E. ChicagoAve., Chicago, Ill. 60611.

    Copyright 2003 American Dental Association. All rights reserved.

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    730 JADA, Vol. 134, June 2003

    open. The tray, loaded on themandibular side, will remain on

    the mandibular arch.The dentist should then load

    the maxillary side of the tray,

    again directly into the patientsmouth using the same mixing

    tip and cartridge. Have thepatient bite down all the way

    (Figure 2).

    CONCLUSION

    This technique has the advan-tage of allowing the dentist to

    visually inspect the position ofthe crossbar and the walls of the

    tray in their final position. Inother dual-arch impression pro-

    tocols, when both sides of thetray are loaded, the dentist

    cannot adequately visualize thecrossbar or the walls, because

    they are covered with impres-sion material. The dentist may

    not be able to determine if thetray has been placed into the

    proper position until the impres-sion protocol has been com-

    pleted. With the technique

    described above, however, thedentist can abort the impression

    procedure as soon as he or sherecognizes a problem in tray

    position.This technique is fast and

    simple and can be incorporatedinto any dual-arch impression

    technique. s

    Dr. Hoos is in private practice in Stratford,Conn.

    Dr. Kaplowitz is in private practice inHanover, Pa. Address reprint requests to Dr.Kaplowitz at 3109 Northbrook Road, Balti-more, Md. 21208, e-mail [email protected].

    1. Kaplowitz G. Trouble-shooting dual archimpressions. JADA 1996;127:234-40.

    2. Kaplowitz G. Trouble-shooting dual archimpressions II. JADA 1997;128:1277-81.

    C L I N I C A L D I R E C T I O N S

    Figure 1. Impression material is delivered intothe mandibular side of the tray.

    Figure 2. Impression material is delivered intothe maxillary side of the tray.

    Copyright 2003 American Dental Association. All rights reserved.

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