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Slide 1

2003 By Default!

Amprenta n protetica fix

Catedra de protetic dentar fix 2005 -Sef de lucrri Dr. Sergiu Drafta
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2003 By Default!

Cnd precizia conteaz

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2003 By Default!

Amprenta

Definiie: este o
reproducere n negativ
a unui relief
Scop : confecionarea
de modele de lucru, de
studiu, document,
duplicat

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Slide 4

2003 By Default!

Clasificarea amprentelor
Amprenta unitar
Amprenta sectorial
Amprenta global (unimaxilar)
Amprenta bimaxilar
nregistrarea de ocluzie

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Slide 5

2003 By Default!

Care sunt obiectivele unei


amprente?
S reproduc exact forma, detaliile i

dimensiunile dinilor preparai


S redea ct mai fidel limitele cervicale ale
preparaiilor
S redea cel puin 0,5 mm. de structur
dentar nelefuit dincolo de limita cervical
a preparaiei
S nregistreze exact rapoartele preparaiilor
cu dinii vecini
S reproduc precis ceilali dini de pe
arcad i crestele edentate

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Slide 6

2003 By Default!

Obiectivele cursului
Controlul fluidelor
Eviciunea gingival
Materiale de amprent
Portamprente
Tehnici de amprentare

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2003 By Default!

Controlul fluidelor bucale

Rulouri de vat i comprese


Aspiratorul de saliv, svedopterul, aspiratorul
chirurgical
Medicaia antisialogog

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2003 By Default!

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2003 By Default!

Medicaia antisialogog
Anticolinergice: Atropina, diciclomina,

bromura de metantelina (Banthine 50mg.)


sau bromura de propantelin (ProBanthine
15mg.)
Pruden la btrni i la persoanele cu
afeciuni cardiace sau glaucom
De elecie CLONIDINA (antihipertensiv) 0,2
mg.

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Slide 11

2003 By Default!

Eviciunea gingival
Metoda mecanic
Metoda mixt: chemo-mecanic
Metoda chiuretajului gingival rotativ
Metoda electrochirurgical
Metoda laserului

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2003 By Default!

Metoda chemomecanic

nururi
Substane astringente
Instrumente de
introdus nurul
Tehnici

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Slide 13

2003 By Default!

CONDIII

Sntatea esutului
moale

Nivelul pragului
Calitatea restaurrii
provizorii
Ajutor suplimentar =
0.12% clorhexidin apa
de gur cu 2 spt.
nainte de amprentare

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2003 By Default!

Eviciunea gingival
pentru a obine un bun acces al materialului
de amprent subgingival
Deplasarea lateral a esutului moale =
cantitate adecvat a materialului de amprent
Deplasarea vertical a esutului moale =
expune zona dentar nelefuit dincolo de
limita cervical a preparaiei

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2003 By Default!

nururi de eviciune
Rsucite

mpletite
Cu mijlocul plin
Cu mijlocul gol

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2003 By Default!

nururi de eviciune
esute
Au mijlocul gol
Mai compresive i
ies mai greu din
an
Se pot mbiba cu
de 2,5 ori mai
mult soluie
Sunt mai des
tiate dect
prinse de freze

Impregnate sau
neimpregnate

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2003 By Default!

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2003 By Default!

nururi de eviciune

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2003 By Default!

Substane astringente

Clorura de aluminiu
Sulfatul feric
Sulfatul dublu de
potasiu i aluminiu
Epinefrin racemic
8%

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2003 By Default!

Clorura de aluminiu

A se evita
concentraiile 10%
4min. aplicarea
Retracie gingival de
0,1 mm
fr C.I. & efecte
sistemice minime

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2003 By Default!

Clorura de aluminiu
Avantaje
Hemostaz
moderat
Deplasare tisular
moderat
Dezavantaje
Pierdere tisular
moderat
Distrucie local
tisular dac se
folosesc conc mai
mari de 10%
Gust extrem de
neplcut
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Slide 24

2003 By Default!

nurul impregnat trebuie lsat n


anul gingivo-dentar cel puin 4
minute pentru o lrgire de 0,2
mm. (timp de 20 sec.)
Baharav H, Laufer BZ, Langer Y, Cardash

HS The effect of displacement time on


gingival crevice width. Int J Prosthodont.
1997 may-june 10 : 248-53.

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Slide 25

2003 By Default!

Sulfatul feric
Sulfatul feric soluie15.5% ASTRIGEDENT
Sulfatul feric soluie 20% VISCOSTAT

Vindecarea este mai rapid dect n cazul AlCl3


Se folosete 1-3 min.
esuturile temporar colorate i vor reveni n 1-2
zile
Dup utilizare , esuturile trebuie bine splate

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2003 By Default!

Sulfatul feric
Soluie de sulfat feric 15.5%
ASTRIGEDENT Soluie de
sulfat feric 20% VISCOSTAT
Avantaje
Hemostaz excelent
Pierdere tisular minim
Deplasare tisular
moderat
Timp de aciune lung

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Sulfatul feric
Soluie de sulfat feric 15.5% ASTRIGEDENT
Soluie de sulfat feric 20% = VISCOSTAT

Dezavantaje
Colorarea esuturilor tranzitorie
Traum tisular moderat
Gust neplcut
Interfer cu priza unor materiale dac nu
este splat
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Slide 31

2003 By Default!

Epinefrina
Creterea ritmului cardiac
Creterea forei contraciilor cordului
Tahipnee
Cresterea TA
Anxietate

TOTAL CONTRAINDICAT LA PACIENII


CARDIACI
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2003 By Default!

Instrumente pentru introducerea


nurului de eviciune

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2003 By Default!

Armamentarium

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2003 By Default!

Tehnici
Introducerea nurului de eviciune
Benzile de retracie Merocel
Folosirea spumei Expasyl

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Slide 38

2003 By Default!

Procedura practic

Verificarea statusului
esutului moale
Dac sngereaz

hemostaz
Dac nu se poate face
hemostaz
Verificarea adaptrii
marginale a lucrrii
provizorii, finisare i
lustruire
Prescrierea de CH i
amnarea amprentei

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2003 By Default!

Slide 40

2003 By Default!

Procedura practic

izolare
Se msoar adncimea
anului gingivo-dentar
pentru alegerea grosimii
nurului
Se impregneaz nurul n
substana astringent
Se nfsoar nurul n jurul
dintelui i se introduce n
anul gingivo-dentar
Se ncepe din zona
proximal

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Slide 41

2003 By Default!

Plasarea nurului

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Slide 42

2003 By Default!

Plasarea snurului

Trebuie evitata presiunea i


inserarea exagerat
Lezarea inseriei epiteliale
Lezarea esutului gingival
Crete hemoragia

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Slide 43

2003 By Default!

Cu un nur sau cu dou nururi???

Tehnica cu un nur

Simpl & rapid


De elecie n 90% din cazuri
Adncimea anului
grosimea nurului.
#000 (negru) = 0.5mm
# 00 (galben) = 0.8mm
#0 ( mov) = 1.0mm
#1 (albastru) = 1.2 mm
# 2 (verde) = 1.4mm
# 3 (rou)

= 1.5mm

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Slide 44

2003 By Default!

Tehnica cu un nur

n special pentru dinii


anteriori

n sanurile adnci

esutul poate colaba


deasupra nurului =
accesul materialului de
amprent restricionat

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Slide 46

2003 By Default!

Tehnica cu un nur

Snurul trebuie s fie vizibil n an, (dac nu e


vizibil=prea subire)
Se menine n jur de 5 minute i se scoate
nainte de injectarea materialului de amprent

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Slide 56

2003 By Default!

Tehnica cu doua nururi

Tehnica cu doua
nururi
cronofag
Pentru anuri adnci
Dac sunt dificulti n
obinerea hemostazei

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Slide 57

2003 By Default!

Tehnica cu dou snururi

etape
Un snur subire (mrimea 000 - 00 ) se plaseaz
adnc n sanul gingival(n fundul anului) sub
marginile preparaiei pentru a controla umiditatea i
hemoragia
un snur mai gros se plaseaz deasupra (0-1) i se
lasa in jur de 5 min.
Snurul de deasupra este indeprtat inainte de
injectarea mat de amprent

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2003 By Default!

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2003 By Default!

Tehnica cu dou snururi selectiv

n anumite zone ,n
special interproximal

Se introduce o mic
bucat de nur n zona
repectiv iar apoi se
introduce n totalitate
(360) al doilea nur

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Slide 60

2003 By Default!

Tehnica cu dou nururi

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Slide 61

2003 By Default!

Sfaturi
Nu realizai pragul mai adnc de 0,5 mm

subgingival
Lucrrile provizorii trebuie s aib o
excelent adaptare marginal cervical i s
fie foarte bine lustruite
Succesul amprentei finale depinde n mare
msur de sntatea esutului moale

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Slide 62

2003 By Default!

Benzile de retracie Merocel


Hidroxilat polivinil acetat
Material sintetic absorbant hemostatic
Se menin cu ajutorul coroanelor provizorii

10-15 min.

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Slide 63

2003 By Default!

Folosirea spumei Expasyl

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Metoda chiuretaj gingival rotativ

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Metoda electro-chirurgical

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Materiale de amprent
Poggioli 1953 Bratu 1994
1. materiale rigide i semirigide ireversibile
(gips, acrilat, paste ZOE)
2. Materiale rigide reversibile (compounduri,
ceruri, materiale bucoplastice)
3. Materiale elastice reversibile ( hidrocoloizii
agar-agar)
4. Materiale elastice ireversibile (hidrocoloizii
ireversibili, elastomerii de sintez:
polisulfuri,siliconi, polieteri)
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2003 By Default!

Hidrocoloizii reversibili
Avantaje: hidrofili, timp de lucru mare, ieftini,

nu este necesar lingur individual


Dezavantaje: lipsa stabilitii dimensionale,
rezisten sczut la rupere, echipament
special necesar
Amprentele trebuie turnate imediat

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2003 By Default!

Polisulfide
Avantaje: rezisten la rupere mare,

radioopac, cel mai ieftin elastomer


Dezavantaje: miros neplcut, timp de priz
lung(12 min.), pteaz
Amprentele trebuie turnate n prima or

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2003 By Default!

Siliconii de condensare
avantaje: timp de priz scurt, inodor, poate

avea orice culoare


Dezavantaje: capacitate de umectare a
suprafeelor sczut, hidrofob, stabilitate
dimensional sczut
Modelul trebuie turnat n prima or dup
amprentare

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2003 By Default!

Siliconii de adiie
Avantaje: stabilitate dimensional, contracie

de priz minim, timp de priz scurt


Dezavantaje: hidrofobi, capacitate de
umectare sczut, priza este inhibat de
unele mrci de manui
Turnarea modelelor poate fi amnat

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Polieterii
Avantaje: stabilitate dimensional, precizie,

timp de priz scurt, hidrofil, dispozitiv


automat de malaxare disponibil
Dezavantaje: rigiditate foarte mare, imbibiie,
timp de lucru scurt
Pruden n timpul demulrii

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Slide 80

2003 By Default!

Proprietile materialelor de
amprent elastice
Capacitatea de umectare a materialelor
Tixotropismul
Vscozitatea

Rezistena mecanic
Deformarea permanent
Contracia de priz
Stabilitatea dimensional

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2003 By Default!

Capacitatea de umectare a
suprafeelor

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Capacitatea de umectare a
suprafeelor

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2003 By Default!

Tixotropism

Capacitatea unui
material de a curge
cnd este supus
presiunii

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2003 By Default!

Vscozitatea
Consisten chitoas PUTTY
Consisten crescut HEAVY BODY
Consisten medie MEDIUM BODY
Consisten fluid LIGHT BODY

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2003 By Default!

H R polisulf Silicon
c

Silicon
a

Deformare 1,2
permanenta

2,1

0,5

0,3

Variatii
>5
dimens
Dupa 24h

0,25

0,6

0,05

Contractie 0,15
priza
/0,5

0,2

0,3

0,05

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polieteri
1,1
0,3

0,2

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2003 By Default!

Malaxarea

Manual
n pistol
Automat

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Portamprente

Suporturi rigide n care se aplic materialele de


amprent
Standard : Metalice , din mase plastice
Individuale : Acrilat, compozit, poliesteri

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Linguri din plastic

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Lingur individual

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2003 By Default!

Lingura individual
-se traseaz cu creionul limitele lingurii individuale
Se aplic o folie de cear care se secioneaz la linia
creionului
Se fac trei stopuri ocluzale
Pe cuspizii nefuncionali ai dinilor nepreparai
Se adapteaz o folie de aluminiu deasupra cerii
mpiedic ceara s contamineze materialul din care se
confectioneaz lingura
Creaz macroretenii
Se adapteaz materialul fotopolimerizabil la model
Se realizeaz un mic mner si retenii
Se fotoplimerizeaz

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Accesorii pentru amprentare

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Tehnici de amprentare
Amprenta n dublu amestec
Amprenta de splare
Amprenta monofazic n lingur individual
Amprenta pentru RCR
Amprenta bimaxilar
Amprenta cu tub de cupru
nregistrarea ocluziei

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2003 By Default!

Etapele amprentrii
Alegerea portamprentei i a materialelor de

amprentare
Pregtirea pacientului n vederea amprentrii
Amprentarea propriu-zis
Controlul amprentei
Dezinfecia amprentei

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Amprenta n dublu amestec


Este o amprent ntr-un singur timp
Utilizeaz un singur material n consistene

diferite care fac priz n acelai timp


Tehnica se preteaz pentru siliconi, polieteri,
polisulfuri i hidrocoloizi reversibili
Vscozitatea celor dou materiale s fie
apropiat

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2003 By Default!

Etapele

Aplicarea adezivului pe lingur


ndeprtarea firelor de retracie
Prepararea materialului de consisten crescut i
ncrcarea portamprentei
Prepararea materialului fluid i aplicarea lui n
anul gingival i pe preparaie ct i pe materialul
de consisten crescut din portamprent
Aplicarea portamprentei pe cmpul protetic
ndeprtarea amprentei dup priz i controlul
acesteia

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Materialul de amprent se
contract spre centru

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Amprenta n dublu amestec


aplicaie practic
24-coroan mixt metalo-ceramic
25-onlay MOD
26-coroan parial 4/5

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Probleme

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Amprenta de splare (washtehnique)


Este o tehnic n doi timpi
Se folosesc materiale de consistene diferite

(chitoas i fluid)
n primul timp se ia amprent cu materialul
chitos
n al doilea timp se corecteaz prima
amprent cu material fluid

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2003 By Default!

Etapele

Se aplic adezivul pe interiorul portamprentei


Se inser firele de retracie
Se prepar materialul chitos , se inser n
portamprent i se ia amprenta
Dup priza materialului, se ndeprteaz amprenta
i se taie zonele retentive, zonele interdentare ale
marginilor gingivale ale preparaiilor i se creaz
canale de refluare
Se ndeprteaz firele de retracie
Se prepar materialul fluid i se aplic n anul
gingival i pe preparaie ct i pe materialul chitos
din portamprent
Se aplic portamprenta pe cmpul protetic
Se ndeprteaz amprenta dup priz i se face
controlul acesteia

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probleme

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Amprenta monofazic n lingur


individual

Stratul de material de
amprent este uniform
Portamprenta se poate
poziiona cu precizie
Portamprenta
individual este mai
uor de folosit datorit
volumului sczut

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Controlul amprentei
Lipsa de reproducere a detaliilor
Prezena golurilor la nivelul limitei cervicale a

preparaiilor
Desprinderea amprentei de portamprent

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Greeli

Eviciune gingival incorect (inadecvat, soluii de retracie


ndeprtate insuficient)
Alegerea incorect a portamprentei (dimensiune, retenii)
Lipsa deretentivizrii zonelor puternic retentive
Utilizarea mnuilor de latex n timpul malaxrii
Folosirea materialelor de amprent expirate
Omogenizarea incorect a materialului de amprent
Prezena salivei sau a sngelui n anturile gingivo-dentare
Poziionarea incorect a portamprentei
Cantitate insuficient de material n lingur
Depasirea timpului de lucru
ndeprtarea amprentei naintea prizei
ndeprtarea amprentei prin mai multe micri
Dezinfecia incorect ( soluie inadecvat, timp)

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Ruperea materialului de amprenta


subgingival

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Bule de aer

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Fuga materialului fluid

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Amprenta pentru RCR

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Amprenta bimaxilar
Indicaii
Ocluzie

stabil ( s existe stop ocluzal distal)

1-2 coroane solo

RCR
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contraindicaii
Mai mult de 2 coroane solo
Puni
Coroane elemente de agregare pentru

proteze
Pacientul nu poate s oclud n IM cu lingura
n cavitatea bucal
Ocluzie instabil

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Tehnica clasic
Amprenta laminar
Tehnica H & H

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Amprenta bimaxilar tehnica


laminar

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Tehnica H & H
hidraulica i hidrofobic

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Amprenta cu tub de cupru

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Dezinfecia

Soluie de
glutaraldehid 2%
Spray cu iodoform
Pot aprea
distorsionri ale
amprentelor la imersia
prelungit (HC rev i
irev sau polieteri)

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nainte de turnarea modelului

Debublizer

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nregistrarea ocluziei
ce poziie nregistrm?
Ocluzie stabil : pacieni cu contacte ocluzale

stabile n IM, DVO normal


-poziionarea manual a modelelor n IM
-nregistrarea poziiei de IM
Ocluzie instabil:pacieni cu contacte
ocluzale instabile, DVO incert
-nregistrarea poziiei RC
Fr ocluzie: pacieni fr contacte ocluzale
ntre dinii restani
-nregistrarea RC cu ajutorul abloanelor de
ocluzie
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nregistrarea de ocluzie
Reprezint o amprent a feelor ocluzale

(margini incizale) ale ambelor arcade aflate


n raportul dorit
Trebuie s cuprind ct mai muli dini
Nu trebuie s depeasc ecuatorul clinic
Nu trebuie s acopere sub nici o form
prile moi deoarece acestea reprezint zone
reziliente
Nu trebuie s fie perforat n cazul
nregistrrii RC
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Materiale
Cear de ocluzie (Beautypink)
Cear cu adaos de pulberi metalice

(cuprowax)
Cear armat cu folie de aluminiu (aluwax)
Pastele ZOE-colofoniu pe diferite suporturi
Polieteri speciali (Ramitec-ESPE)
Siliconi de adiie speciali ( Dimension BiteESPE, Regisil 2x- DeTrey, Kristall Omicron
dental, etc.)
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