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Figure 41: The bottom cord provides the
vertical retraction of the tissue, while the
top cord provides the lateral retraction that
creates the space for the impression material
to flow into. It is imperative that we get a nice
thickness to the marginal impression material,
or it has a tendency to tear when the impression
is removed. Keep in mind that the impression
material is in contact with the #00 cord in the
base of the sulcus, and the cord is preventing
bleeding by remaining in place against the
inflamed base of the sulcus.
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Figure 42: Removal of the top cord leaves
behind a wide-open sulcus in which to place
the impression material. It is not the type of
situation where you are racing against gingival
blood flowing into the sulcus. Take your time
and make sure to go around each tooth three
or four times to prevent any pulls or voids in the
material. These pulls and voids are especially
difficult when you get back to the point where
you started expressing the material. I have
watched slow-motion footage of moisture
being pushed around the sulcus in front of the
material and creating a pull when the syringe
tip gets back to the starting point, hence the
recommendation to go around each tooth three
or four times with the tip in the sulcus.
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Figure 43: Here I am using a custom impression
tray. I never used a custom tray for two single
anterior crowns in the past, so I admit this
is overkill — perhaps I am a little spoiled by
working within a lab — but I can confidently
say that if you got them for free and they were
always available, you would use them too! In a
case like this, it is perfectly acceptable to use
an anterior double-arch tray for this impression.
The biggest challenge when using anterior
double-arch trays is being able to see whether
the patient is in maximum intercuspation.
Always hold the impression up to the light to
verify that the un-prepped teeth are in contact.
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