Impressions where the tray doesn't fit

I was thinking during a walk today about an impression I had to take a while back where the 18 was very buccally tilted and overerupted. The issue was that the largest impression tray wasn't large enough to get around this abnormally positioned tooth and the tray wasn't seating.

During my walk I asked myself what are the possible solutions to this problem. I cam up with a few:

1. Take a bad impression: Take an impression with a very overfilled tray and hope to get enough detail for what you want to achieve. The issue is the material around the 18 is unsupported and is likely to tear when you withdraw the impression, the differences in impression material thickness will result in inaccuracy and the tray seating onto a hard surface will cause rebound of the tray when you remove it resulting in further inaccuracy
2. Soften the tray in a flame and widen the tray around the tooth: This is what I did in the aforementioned situation. I used a bunsen burner to heat the tray in the area of the 18 until it was malleable and widened the tray until it fit around the 18. What I would suggest is that you have a bowl of water nearby and you wet your gloved fingers beforehand because the tray was very hot. It also smelled a lot like carcinogen so I would suggest you have the suction running, do it away from your patient or choose another method. Also be sure to cool the tray in the water before you try it back in for obvious reasons.
3. Take a bad impression and get the lab to make a special tray: This will somewhat account for the inaccuracies mentioned in point 1.
4. Cut the flange off at the 18: This will remove the interference to seating but it would be a good idea to replace the flange with stiff blue periphery wax/greenstick before you take the impression to allow some support of the impression material. For one tooth out of place within the arch e.g an ectopic 13 this is unlikely to make a difference because the surrounding material will provide some support but for a terminal tooth it may become more critical.
5. Cut the tray short and don't include the 18 in your impression: This is a fine strategy depending on what your treatment goals are
6. Find a bigger tray: There may be another larger tray in a drawer you haven't seen. Try and find one or order one in for next time
7. Extract the 18 and take your impression: Depending on what your plans are this may be a good or a bad idea.

The important thing to note here is not how it can be done but acknowledging that there is more than one way to solve a problem. The important leap of understanding is to recognise firstly WHAT the problem is, then WHY is it a problem, then you can work out HOW to solve it.

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