Journal of Dental & Oro-facial Research Vol 12 Issue 02 Aug 2016 JDOR

Impression Techniques in Implants

Gayathridevi S.K1, Harshita Gowda2,
Vaishali K.3and Suma4
*Corresponding Author Email: [email protected]

Contributors:

1Assisstant Professor, Department

of Prosthodontics, Crown and Abstract
Bridge, FDS, RUAS The main goal of an impression implant restoration is to accurately relate an
2,3 Reader, Department of analogue/abutment of the implant to the other structures in the dental arch. This
Prosthodontics, Crown and review focuses on the components, impression materials and the various
Bridge, FDS, RUAS impression techniques that can be used in implant restorations with note on
4HOD & Professor, Department of recent advances in implant impressions
Prosthodontics, Crown and
Bridge, FDS, RUAS

Introduction: fracture.7,8Implant impression is one of the

most important steps in achieving passive fit
Implants are one of the successful options for by accurately relating an analogue of the
prosthodontic rehabilitations. Thus making the implant or implant abutment to the other
global statement Any edentulous space is a structures in the dental arch. Further the
potential implant site pertinent1.Implants in accuracy of impression is affected by the
dentistry requires a multidisciplinary team of selection of impression tray, impression
expertise that lead to an aesthetically pleasing technique and type of impression material,
and biologically acceptable final number and angulation of implants.9-13
restoration.2Prosthodontic planning plays a
pivotal role to achieve results that satisfies
both the patient and the clinician. Impression Materials:

A primary concern when dealing with the

The success of implants depends on its impression restorations is accurate transfer of
osseointegration and the passive fit of the the relationship of the implant and /or any
prosthesis. Osseointegrationis amultifactorial, remaining dentition to the master cast. Several
depending on precision of surgical and options exist when dealing with the impression
restorative techniques, soft tissue management, in implant prosthodontics. The implant analog
along with the general and oral health of the or the abutments analog may be transferred to
patient. 3-5 As implants are functionally the master cast. An impression may be made
ankylosed with direct contact to the bone they of the prepared implant abutments and these
lack the inherent mobility of the periodontal are reproduced in the master cast each of these
ligament hence they cannot accommodate options require careful consideration in the
distortion or misfit at the implantabutment choice of the impression material and the
interface.6Long term clinical success of technique used.14
implant supported prosthesis is depended on
passive fit. The discrepancies in the passive fit If the transfer of the analog is not accurate it
of the prosthesis may lead to complications will affect the passive fit of the prosthesis, for
such as screw loosening, screw facture, this the impression material used should be
occlusal discrepancies, increased plaque resilient enough to spring out of the undercuts
accumulation, resulting in loss of and stiff enough to allow for accurate seating
osseointegration and implant
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Journal of Dental & Oro-facial Research Vol 12 Issue 02 Aug 2016 JDOR

of the components in to the impression. It 3D analysis does not show significant

should also prevent dislodging of the difference in terms of spatial deviation5,24.
components during the pouring of the
impression and avoid the fracture of the stone
when the prepared abutments are small. Thus Components
the impression material should be sufficiently
flexible and rigid. The most commonly used The success, function and aesthetics of an
impression materials in implant dentistry are implant restoration are dependent on the
vinyl polysiloxanes and polyether rubber base proper treatment planning and through
impression materials. In general the knowledge of components and
impression material that use a putty like heavy instrumentation. Some of the commonly used
body component which gives rigidity to the components are drivers, healing abutments, lab
impression and less viscous wash impression analogues, screws and impression copings.
material are preferred to a avoid incorporation Drivers are designed to carry different types of
of air bubbles around the abutment.14 components of implant to the mouth for easier
placement and removal. The driver head
Vinyl polysiloxane impression materials are design can be square, hexagonal and abutment
often used as they have excellent dimensional driver and contra-angle torque driver. Healing
stability, superior deformation recovery and abutments are available in varying heights and
accurate reproduction of details. The diameters which are selected based on clinical
mechanical properties of the siloxane situations. Laboratory analogue are metal
impression material are adequate to withstand replicas that duplicate the implant head or
various stresses upon removal and maintain abutment connected to the implant which are
dimensional stability.15 used in laboratory to construct working model.
Impression copings have been designed for
There are numerous studies done to investigate making final impression after the soft tissue
the accuracy of impression materials for has matured. These copings have the same
implant impression and it was found that flare as the healing abutments and should fully
polyether and vinypolysiloxane impressions support the soft tissue around the head of the
provided superior reproduction in comparison implant. 2They are various types of copings
with other impression materials. The most available which are selected based on the
important property of an impression material is impression techniques.(Fig:1)In transfer type
its wettability which helps provide detail the coping is retained in the mouth when set
reproduction in wet oral surfaces and also impression is removed. In pick up type the
reproduces the details accurately with gypsum coping gets incorporated in the impression and
slurry. As vinyl siloxane is a hydrophobic it is removed from the mouth with the set
material manufactures have added extrinsic impression.25
surfactants to improve its wettability both
intraorally as well as with gypsum slurry,thus Abutments are components that substitute for
making it hyrophilizedVinyl Polysilixone and missing coronal structure that attach directly to
similar to Polyether.However many studies the head of the implant and extend through the
show that there is no difference in accuracy of gingival into the oral cavity. Abutment
impression made from polyether or vinyl selection depends on many clinical factors and
Polysiloxane.16-23 soft tissue maturation after second stage
surgery. The abutment must take a count of the
A newer impression material Vinyl polyether position and angulation of the implant, height
silicon (VPES) which is a combination of and thickness of the surrounding soft tissue,
vinylpolysiloxane(VPS) and polyether(PE) has the interocclusal space and the type of
been introduced which according to the restoration to be placed. Additional
manufacturer has intrinsic hydrophilicity and considerations include the height of the lip line
high dimensional stability. However the data the occlusal scheme and position of the tooth
regarding its accuracy is very limited and in the arch. The abutment types are standard
studies done using VPS,VPES and PE to abutment, angulated abutments, UCLA
evaluate the accuracy and reproducibility by abutment (preparable abutments), provisional
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Journal of Dental & Oro-facial Research Vol 12 Issue 02 Aug 2016 JDOR

abutments, titanium abutments, ceramic and custom machined abutment.2,26

abutments, prefabricated conical abutments

Fig:1 Components used in Impression procedure.

gloves when elastomeric impression material

is used.14,15.This technique can be used for
single tooth restorations, multi-unit
Impression Techniques: Implant impression restorations and implant over dentures for
techniques can be classified as either direct either cement retained or screw retained
(open, pick up) and indirect (closed tray, prosthesis. .
transfer).5,7.
An advantage of this technique is the dentist
Direct Impression techniques (Open tray, Pick can confirm the laboratory preparation and
Up): A custom or stock open tray with access contour of the provisional prosthesis to
to the impression coping screws is required, achieve the desired healing and soft tissue
which exposes the coronal ends of the contour before final crown fabrication.26
impression coping.(fig:2) Impression material
is syringed around the impression coping and The direct technique can be further subdivided
filled tray is then inserted into the mouth, into splinted and non-splinted techniques. The
ensuring that guidepin of the impression splinting procedure is recommended in case of
coping is visible and protrudes through the multiple implants to decrease the amount of
hole in the tray. Impression copings are distortion and to improve impression accuracy
unscrewed and they are removed from the and implant stability.27-33Splinting of the
mouth together with the set transfer copings prevents rotational movement
impression.(fig:3)The implant analogues are of impression copings in the impression
connected to the copings using the same material during analog fastening, which
screw.(fig:4)3,5,6. Some precautions to be taken provides better results than not splinting.16
are: radiographically confirmed seating of
impression coping to the implant and use vinyl
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Journal of Dental & Oro-facial Research Vol 12 Issue 02 Aug 2016 JDOR

Accuracy of a splinted impression technique up impression because it does not require an

depends upon its resistance to deformation open tray, but instead uses a closed tray. It is
under the forces of impression material; hence not a transfer impression, either, because the
the use of rigid splint material is essential for plastic impression copings are picked up in the
accurate master cast. impressions45.

Materials used to splint impression copings Advantages 44

include light-curing composite resin,
34
impression plaster 35, 36
, thermoforming 1. Helps to overcome the movement of
material, acrylic resin37, and autopolymerizing impression coping inside the impression
acrylic resin.38-43 material
2. Time saving
Indirect technique(closed tray): An indirect
technique is also known as closed tray 3. Has the advantage of both the open and
impression technique.The copings are closed tray implant impression techniques
connected to the implant (fig:5)and after the 4. More comfortable for both the clinician and
removal of impressions they are retained on the patient
the implants5,25. Thesecopings are then
removed from the implant, attached to the 5. Easy to manipulate
implant analogues and reinserted in the
impression. (fig 6&7).Clinical situations which
indicate the use of the closed tray technique,
The snap-fit technique may be a reliable
such as when the patient has limited interarch
impression making technique but regarding
space, a tendency to gag, or if it is too
accuracy of this technique none of the study is
difficultto access an implant in the posterior
available for investigation46.
region of the mouth.25,

Snap-fit (press fit) plastic impression coping:

This technique uses press-fit impression
coping which is connected to the implant by
pressing instead of screwing(fig:8) and the
plastic impression copings are picked up in the
impression.(fig:9)44This technique is not a pick

Fig: 2 Placement of Impression Coping. Fig:3 Unscrewing the Impression copings

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Fig: 4 Placementof Implant Analogs. Fig:5 Placing of impression coping on the implant.

Fig:6Impression making with closed tray Fig: 7 Orienting the impression coping with

copings in place lab analog into place.

Fig:8 Snap fit impression coping placed on Fig: 9 Implant analogue attached to the
implants picked snap fit impression coping
pickeimpression with

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Journal of Dental & Oro-facial Research Vol 12 Issue 02 Aug 2016 JDOR

DIGITAL IMPLANT IMPRESSION dimensional software that utilizes specific

alignment algorithms to allow for registration
More recently, one of the major developments of the object. Three of the common scanning
in implant prosthodontics has been the principles used today by intraoral dental
adoption of engineering principles in the form scanners on the market are triangulation,
of computer-aided design and computer aided active wave-front sampling, and parallel
manufacturing (CAD/CAM) to construct confocal laser scanning. Each of these
implant prosthesis. This technology utilizes 3- techniques utilize a combination of these
D intraoral scanners which has revolutionizing various imaging capturing methodologies to
the way we take impressions .The digital collect the surface data of the teeth and
implant impression technique has proven its mucosa so that the information can be
possibilities as an effective alternative for the registered and stitched together through an
analogue impression-taking technique44. alignment process in order to create the virtual
three-dimensional model49.
Advantages of the digital impression are as
follows: Disadvantages
1.Improved patient acceptance, (2) Reduced (1) Its More easy to carry out in the maxilla
distortion of impression materials, (3) Pre- due to direct view.(2) In case of multiple
visualization of the preparation three- implants difficult to identify the position of the
dimensionally (4) Virtual assessment of the abutments.(3) Inability to scan the proximal
implant prosthetic space(5) depth of area of the neighbouring tooth when situate
restorative interface (6) emergency prole too close to the abutment50.
conguration before proceeding with
laboratory steps and (7) potential cost and Digital Implant Dentistry will have an
time effectiveness 47 enormous impact on the dental implant market
in the near future because of the predictable
Requirements of a digital impression results, more predictable cost, save time for
both the patient and the dental team. Digital
The main requirements for the CAD/CAM are planning and processing will also make the
the (1) the digital scanner, which scans and dental implant treatment option much less
transforms the geometry into the digital data burdensome and easier to deliver for the dental
which can be processed by the computer (2) implant team and patient, thus improving
software that processes the data and creates a acceptability and utilization globally47.
CAD model (3) a production technology that
transforms the data set into the desired product
by means of CAM 48
Conclusion
Scanning principle
One of the critical factors which affect the
The intraoral scanning devices utilize a long term success of the implant is its passive
sophisticated optical surface scanning fit of the implant prosthesis. In order to
technology that works similarly to a camera, achieve this a clinician should have sound
but instead of simply capturing lights and knowledge regarding the components used
colors, the sensors measure light reflection during impression, the choice of impression
times from various surfaces through processes materials and the selection of suitable
to capture the object three-dimensionally. This impression techniques based on clinical
information is then captured by the three- situation.

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