Perfectim Impression issues

[marmock]

Hi all,

Been a lurker for a long time but was hopping that someone could help me. I have a Dr. who uses the Perfectim impression material from J. Morita and everything we make using this impression material does not fit. I've tried talking with J. Morita's costumer service and they are no help at all. Looking around through Google I found some studies that this material makes smaller dies than the original prepped tooth, I then came across and old PDF online from J. Morita about using rubber sep as die spacers. So following this PDF we are now using 2 coats of die spacer and also using one coat of rubber sep taking both materials .5mm away from the margin. The crowns still are not fitting. The Dr took a new impression with a poly-either impression material (which he can not take without huge pulls) and we are finding that the crowns are binding around that .5mm area around the margins (of course). HELP!! I again called J. Morita and the reps knew nothing about using rubber sep and now say I should space all the way too the margin and slightly over the margins. WTF! Should I buy a stone that has a high expansion to solve this issue, and will this impression material even let the stone expand?

Any help would be great,

Mark Bonner CDT
Dental Design Studios inc.

 

[JSnyder85]

Id say thats the dr's problem not yours, suggest trying to use PVS material. If you are not having the same problems with other impressions, then i would not change die stones to compinsate for one drs incompetence.

 

[Mike2]

I would agree with snyder. I had an acct. that did this technique, very few Dr's are capable of reproducing it with any sort of consistency. The problem is not the technique, although very difficult, it works great. The true problem is that dr's think they are following all the steps, but like tech's they skip or compromise and that is where the failures start. By reading your explanation my money is on he is never fully seating the impression fully back onto the prep in the sam as the original position. He should be trimming all undercuts and interproximal material out of the first impression so that it can fully seat. the best chance for success with him is for you to fully understand what is happening. I don't care what the Morita company says, the material must seat fully to capture the margins and being polyvinyl, it's hydrophobic(ie dont like moisture and wont set in its presence) so my bet is you are not seeing the full extension of the prep cause that material did not set so all the crowns will be short! Only way to compensate is block the hell out of the occl. table(1mm of guttaperch) and die space twice over the margins and see what happens. if he likes the results let him know how you achieved and be a proactive consultant. My suggestion would be to get an impression rep(3m)to let him try some polyether, it's hydrophilic and seeks out and displaces moisture(unlike polyvinyl) Google impression tips and 3m HAS A NICE FLYER GUIDE YOU COUOLD USE t o help him with polyvinyl. Mty 2 cvents

 

[paulg100]

"Id say thats the dr's problem not yours"

Id say its very much YOUR problem as your probably remaking the work for free and the Dr will loose confidence in you! but im sure you know that, thats why your here looking for a solution.

"My suggestion would be to get an impression rep(3m)to let him try some polyether"

Beat me to it.. Impregum.. Impregum... IMPREGUM and must have the dispenser which they should give for free if he orders enough. get a loan one to start with. This and rigid trays. The most rock solid consistent stuff out there. And i promise if there are still variables then its a technique issue NOT the material.

Its really hard in this situation but i think if the doc wont take your advise (lets be honest many wont) then you really need to start charging for the remakes and/or except your gonna loose the account.

 

[JohnWilson]

If he is using the correct base and corresponding wash material and doing the H&H I am surprised he is getting bad results.

Where the problem lies is when they use non matched material and the base material doesn't have a shore hardness of 85 the base material will flex out when the wash is done, when the impression is taken out it flexes back in and you have a smaller die.

The number one thing drs do with this technique that is wrong is they try and reline and capture a margin that was deficient. Unless the client drills a vent in the impression to eliminate compression of the light bodied material he will deliver a distorted impression that LOOKS great.

Call him, ask him a few things things if you do not know the answers.

I start the convo out with Hi Dr, we have been noticing some odd anomalies with your cases. It appears our restorations are not going in as they should for you so I am trying to be proactive and help solve this annoying issue. If you don't mind I have a couple of questions that may help us solve our problem.

1) Is this a new material for you Dr,
2) Are you trying to do the H&H impression technique?
3) If you have used this material for some time Dr did you have similar issues with other labs ( this one will surprise you)
4) Can you describe your impression protocol are you using a timer?

Good luck

 

[JSnyder85]

I couldnt agree more, but its never the Drs fault, right? lol

 

[sidesh0wb0b]

JohnWilson hit the nail on the head. i did a year study on this exact technique and see it weekly from Drs that use the H&H technique but dont follow the instructions to a tee. and the "flex" he refers to is the #1 cause of all these poor/non-fitting crowns.

compression.

as he said, the tray/material flexes a bit (ESPECIALLY the cheap plastic triple trays that everyone loves to use) and once it is taken out of the mouth... BOING! pops back into position. shrinking or compressing the entire impression.
following instructions is important. i suggest doing what i did......have an expert on the technique teach you hands on, then go sit down with the Dr and watch him/her take an impression. using timers is also VERY important and highly overlooked in many practices.

these are all ideal solutions....im guessing your client will be open to your suggestions since he/she has made the attempt to work through it with you. good luck, keep us posted

PS: just had 3 remakes this week from a sloppy assistant who insisted that her compressed impressions were "perfect" (her own words). i warned the office, they refused to address it. she wouldnt call back when ALL THREE failed though. i bet they listen next time

 

[sidesh0wb0b]

also, Mark do you have pictures of these impressions you could post? there may be other factors at work as well