H&H Technique for crown and bridge impressions

[KorgTuner]

---

Members don't see this ad.

Hey, everyone. I graduated dental school a year ago and am an associate in the tri-state area. Working is scary, tiring, and cool. Anyway, I'm trying out different techniques to get my rhythm going as a general dentist.

Have any of you tried the H&H (Hydraulic and Hydrophobic) technique for taking crown and bridge impressions? The allure of this technique is that you need no cord and no hemostasis. It was invented by Dr Jeffrey Hoos.
Here's an article describing the technique:
http://www.dentalexplorations.com/articles/11-1.html

and a quick video:

http://www.youtube.com/watch?v=zgOZiU9pPYI&feature=related

What do you guys think? Anyone use this method? I tried it twice and am waiting for 2 crowns to come back. the finish lines looked pretty good so we'll see. fingers crossed. 🙂

 

[mdsn]

what if you have sub g margins (didnt read the whole thing so excuse me if that was answered)?

 

[KorgTuner]

what if you have sub g margins (didnt read the whole thing so excuse me if that was answered)?

It's made specifically for sub gingival margins and works best if you have them.

 

[BFord23]

Interesting. Thanks for the post. I have never tried it but considering cord takes some time to "work" and expand the gingiva (both vertical and horizontal displacement) I can't imagine you would be getting the best impressions. Even if you capture the subgingival margin, you probably wouldn't be capturing the uncut tooth below it very much, and that is what the lab tech needs to give you a good contour. Why not just train your assistant to pack cord?

 

[OceanDMD]

Hey, everyone. I graduated dental school a year ago and am an associate in the tri-state area. Working is scary, tiring, and cool. Anyway, I'm trying out different techniques to get my rhythm going as a general dentist.

Have any of you tried the H&H (Hydraulic and Hydrophobic) technique for taking crown and bridge impressions? The allure of this technique is that you need no cord and no hemostasis. It was invented by Dr Jeffrey Hoos.
Here's an article describing the technique:
http://www.dentalexplorations.com/articles/11-1.html

and a quick video:

http://www.youtube.com/watch?v=zgOZiU9pPYI&feature=related

What do you guys think? Anyone use this method? I tried it twice and am waiting for 2 crowns to come back. the finish lines looked pretty good so we'll see. fingers crossed. 🙂

The video's margins were gingival or supragingival. Often there may be a margin 1-3 mm sub. I would not trust this technique. The blue mouse's accuracy is suspect(I use it for bite reg, not trying to record fine anatomy.) The wash was evident only on the ging 1/3 and margin. If you dont like cord, use expasyl. I have not used cord in 2 years. Expasyl for 3 minutes, aquasyl for 3 minutes, money. Maybe I'll change my mind when I see this method in CE or a publication.

 

[DrJeff]

The video's margins were gingival or supragingival. Often there may be a margin 1-3 mm sub. I would not trust this technique. The blue mouse's accuracy is suspect(I use it for bite reg, not trying to record fine anatomy.) The wash was evident only on the ging 1/3 and margin. If you dont like cord, use expasyl. I have not used cord in 2 years. Expasyl for 3 minutes, aquasyl for 3 minutes, money. Maybe I'll change my mind when I see this method in CE or a publication.

As Ocean said, EXPASYL is 1 awesome product👍 I seriously haven't packed a cord in over 5 years because of it, and I just don't get any calls from the lab about margins when I use it either👍👍

In the most "extreme" of cases if the margin is really that far sub-g, realistically you should be doing some crown lengthening in the first place, or atleast removing some of the soft tissue with a soft tissue laser or electrosurge.

 

[Squished Rat]

Can you guys elaborate more on what expasyl is? Maybe something I would want to incorporate into the practice I am workig at.

 

[KorgTuner]

Interesting. Thanks for the post. I have never tried it but considering cord takes some time to "work" and expand the gingiva (both vertical and horizontal displacement) I can't imagine you would be getting the best impressions. Even if you capture the subgingival margin, you probably wouldn't be capturing the uncut tooth below it very much, and that is what the lab tech needs to give you a good contour. Why not just train your assistant to pack cord?

unfortunately I have only one asst so she can't be tied up packing cord while I have another patient waiting, lol. The idea is that the hardened blue mousse pushes the wash into the subg areas, displacing the gingiva in the process. but I'll update this thread when I get those crowns back! wish me luck.

 

[KorgTuner]

Can you guys elaborate more on what expasyl is? Maybe something I would want to incorporate into the practice I am workig at.

I know we have it at our practice but I haven't tried it yet. basically it's a retraction cord in paste form.
http://www.kerrdental.com/index/kerrdental-gingivalretraction-expasyl-2

 

[KorgTuner]

As Ocean said, EXPASYL is 1 awesome product👍 I seriously haven't packed a cord in over 5 years because of it, and I just don't get any calls from the lab about margins when I use it either👍👍

In the most "extreme" of cases if the margin is really that far sub-g, realistically you should be doing some crown lengthening in the first place, or atleast removing some of the soft tissue with a soft tissue laser or electrosurge.

Thanks for the tip. I'm gonna try expasyl. I know we have it. By the way, I noticed you're a Uconn grad. Have you heard anything good about their pros program?

 

[DrJeff]

Can you guys elaborate more on what expasyl is? Maybe something I would want to incorporate into the practice I am workig at.

EXPASYL is a combination tissue retractor/hemostatic agent that comes in a thick paste which is dispensed from a carpule held in a dispensing gun. You "inject" the EXPASYL around the area where you need retraction/hemostasis, smooth it out a little with a damp cotton roll, then leave it alone for atleast 3 minutes. 3+ minutes later you just simply wash the paste away with your air/water syringe and you have perfectly retracted, blood free tissue around the margins. The great thing is that it's quick, easy, and you can even place it comfortably on unanesthetized patients if need be(nice for endo restored teeth that need some tissue retraction)👍

The one little trick that I've found over the past 5+ years of using it, is that when you start to prep the tooth, have your assistant put the carpule of EXPASYL into a cup of HOT water. It will make the EXPASYL flow out of the tube easier(it's real stiff if cold), and you still get all the great retraction and hemostasis.

 

[vasco]

I would like to try this Expasyl. Today I had a hard time with a final impression of six crowns. Packing the cord took a fair amount of time and then I had to do the impression twice! First one had some voids. I think I'll see if one of the preceptors uses it in their office.

 

[vasco]

Wow...I just looked it up on the internet and it is super expensive. Liquid Gold. I don't think I'll be using it in D-School.

 

[anamod]

My wife and I both use a version of this technique. It works awesome in most cases. It is an expensive impression but I very very rarely have a retake. I use Blu-Mouse super fast set and wash with Splash light body.

 

[DrJeff]

I would like to try this Expasyl. Today I had a hard time with a final impression of six crowns. Packing the cord took a fair amount of time and then I had to do the impression twice! First one had some voids. I think I'll see if one of the preceptors uses it in their office.

Wow...I just looked it up on the internet and it is super expensive. Liquid Gold. I don't think I'll be using it in D-School.

My wife and I both use a version of this technique. It works awesome in most cases. It is an expensive impression but I very very rarely have a retake. I use Blu-Mouse super fast set and wash with Splash light body.

Bottom line on the cost of Expa-syl - yup it costs a bunch more than retraction cord, a cord packer and some hemodent solution, BUT if you're prepping a crown, you're billing alot too. When you take the extra cost of EXPA-SYL vs. cord and the extra cost of a syringe dispensed Bis-GMA autopolymerizing temp material vs. traditonal powder/liquid self mix temporary acrylic, yup it's more expensive, BUT its also about 20 minutes quicker in terms of chairtime. Over the course of a day or a week, those extra 20 minutes start to add up in the form of extra available chairtime to see more patients and bill more $$

That's the key, finding a product that while it might be more expensive, will free up more chairtime so you can do more work.