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Slide 1
Amprenta n protetica fix
Catedra de protetic dentar fix 2005 -Sef de lucrri Dr. Sergiu Drafta
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Slide 2
Cnd precizia conteaz
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Slide 3
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
Clasificarea amprentelor
Amprenta unitar
Amprenta sectorial
Amprenta global (unimaxilar)
Amprenta bimaxilar
nregistrarea de ocluzie
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Slide 5
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
Obiectivele cursului
Controlul fluidelor
Eviciunea gingival
Materiale de amprent
Portamprente
Tehnici de amprentare
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Slide 7
Controlul fluidelor bucale
Rulouri de vat i comprese
Aspiratorul de saliv, svedopterul, aspiratorul
chirurgical
Medicaia antisialogog
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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
Eviciunea gingival
Metoda mecanic
Metoda mixt: chemo-mecanic
Metoda chiuretajului gingival rotativ
Metoda electrochirurgical
Metoda laserului
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Slide 12
Metoda chemomecanic
nururi
Substane astringente
Instrumente de
introdus nurul
Tehnici
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Slide 13
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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Slide 14
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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Slide 15
nururi de eviciune

Rsucite




mpletite
Cu mijlocul plin
Cu mijlocul gol
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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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nururi de eviciune
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Substane astringente
Clorura de aluminiu
Sulfatul feric
Sulfatul dublu de
potasiu i aluminiu
Epinefrin racemic
8%

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Slide 22
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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Slide 23
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
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
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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Slide 26
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


Sulfatul feric
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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
Sulfatul feric
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Slide 31
Epinefrina
Creterea ritmului cardiac
Creterea forei contraciilor cordului
Tahipnee
Cresterea TA
Anxietate


TOTAL CONTRAINDICAT LA PACIENII
CARDIACI

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Slide 32
Instrumente pentru introducerea
nurului de eviciune
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Armamentarium
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Tehnici
Introducerea nurului de eviciune
Benzile de retracie Merocel
Folosirea spumei Expasyl
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Slide 38
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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Slide 39
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Slide 40
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
Plasarea nurului


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Slide 42
Plasarea snurului
Trebuie evitata presiunea
i inserarea exagerat
Lezarea inseriei epiteliale
Lezarea esutului gingival
Crete hemoragia


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Slide 43
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
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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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
Tehnica cu doua nururi
Tehnica cu doua
nururi
cronofag
Pentru anuri adnci
Dac sunt dificulti n
obinerea hemostazei

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Slide 57
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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Slide 58
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Slide 59
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
Tehnica cu dou nururi
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Slide 61
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
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
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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Slide 74
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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Slide 75
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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Slide 76
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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Slide 77
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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Slide 78
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Slide 79
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
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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Slide 81
Capacitatea de umectare a
suprafeelor
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Capacitatea de umectare a
suprafeelor
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Tixotropism
Capacitatea unui
material de a curge
cnd este supus
presiunii
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Slide 84
Vscozitatea
Consisten chitoas PUTTY
Consisten crescut HEAVY BODY
Consisten medie MEDIUM BODY
Consisten fluid LIGHT BODY
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Slide 85
H R polisulf Silicon
c
Silicon
a
polieteri
Deformare
permanenta
1,2 2,1 0,5 0,3 1,1
Variatii
dimens
Dupa 24h
>5 0,25 0,6 0,05 0,3
Contractie
priza
0,15
/0,5
0,2 0,3 0,05 0,2
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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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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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Slide 109
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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Slide 118
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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Slide 119
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 (wash-
tehnique)
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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Slide 142
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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JPD 2005 , 94 112-7.
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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 Bite-
ESPE, Regisil 2x- DeTrey, Kristall Omicron
dental, etc.)
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