Taking impressions on pediatric patients can prove to be clinically difficult. The patient tends to exhibit apprehension, poor cooperation, and rejection due to the unfamiliar task. In addition, the gag reflex and hyperactive tongue may cause the patient to be overcome with fear. The practitioner can become frustrated with the patient and materials, which often leads to avoidance or treatment referral.
Maintenance of space in the primary dentition is a vital part of preventive and interceptive orthodontics. Arch length maintenance ensures the normal development of occlusion, minimizes functional problems, maintains aesthetics, and eliminates psychological problems associated with premature tooth loss. The most common cause of space loss is the premature loss of the maxillary first molar, causing the first premolar to erupt mesially, and subsequently consume space and block out the permanent canine.
Prevention of space loss can be achieved with space maintainers. The band and loop space maintainer is associated with the least number of problems. Problems with other appliances hinder their use. For example, lingual arches prove to have the lowest survival rate,glass fiber-reinforced composite resins (GFRCR) are for short-term use, and removable appliances fail due to poor compliance. Band and loop space maintainers allow unhindered eruption of permanent teeth into proper alignment and occlusion.
BACKGROUND
Contemporary impression techniques consist of alginate and a combination of alginate and wax (green stick compound) for the fabrication of fixed appliances. Although alginate has widespread use due to its commonality and low cost, alginate impressions have several shortcomings,7 which include the following:
• difficulty establishing a proper liquid-to-powder ratio to create a consistency that flows minimally
• difficulty establishing proper water temperature to create proper consistency
• flow of material posteriorly down the patient’s airway, which can cause apprehension and/or rejection of the procedure
• suction of set material, which causes impression withdrawal to be difficult
• low tear strength
• easy distortion of the material
• less accuracy than polyvinyl siloxane impressions
• necessity to pour up impression immediately to minimize distortion
• poor ability to withdraw bands from tooth.
METHODS AND MATERIALS
TempTray (Clinician’s Choice) is a disposable aluminum quadrant tray for temporary prosthodontic impressions prior to tooth preparation. The TempTray is utilized to fabricate custom temporary restorations. Template (Clinician’s Choice) is a silicone-based material that has a working time of 30 seconds and a set time of 30 seconds. It is very thixotropic, does not slump, and has excellent dimensional stability. Clinician’s Choice has not indicated pediatric applications for TempTray or Template. The author has developed the pediatric application through clinical trials.
The technique is a modified impression technique using solely Template. For simple, unilateral, fixed space maintainers, the author suggests using a TempTray with Template.
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