Impression techniques in Implant

Dentistry

Introduction:
An accurate impression of the implant as well as the
surrounding hard and soft tissue structures is known to be
the backbone to deliver a desired implant prosthesis with an
accurate fit and in harmony with the marginal soft tissues.
Fabrication of implant restorations requires accurate
impression transfer, good laboratory support, and
effective communication between the dentist and the
laboratory technician.

Implant Impression:
A dental impression is a negative imprint of hard and soft
tissues in the mouth from which a positive reproduction (or
cast) can be formed.

Tools for Implant impression:

Impression posts or coping is the component that is used to
transfer the implant Hex position and orientation from the
mouth to the working cast.
Implant Analogue: Implant analogue screw into the apical
portions of implant impression copings via the impression
coping screws.

Prof. Dr. Wahib Moussa

 Abutment Analogue: Abutment analogues are exact replicas
of implant abutments.

Impression materials:

The impression of the implant should be made using rubber

based impression materials as dimensional accuracy is
required in the impression, to achieve predictable results in
the fit and for precision in the implant prosthesis.

Polyether
Being hydrophilic in nature, this is the material of choice for
the implant impression, to accurately record and transfer the
implant position and orientation from the patients mouth to
the working cast.

Polyvinylsiloxane (addition silicon)

This is a material which is widely used to make implant
impressions because of its dimensional accuracy, stability,
increased strength and tear resistance, repeated pourability
and long storage life without any distortion in dimensions.

Impression techniques:
A. Direct abutment impression technique
B. Indirect impression techniques
a. Closed tray (Transfer) technique
b. Open tray (pick up) technique

A. Direct abutment impression technique:

Prof. Dr. Wahib Moussa

 The final abutment is fixed on top of the implant in
the patients mouth and prepared with a normal crown
and bridge technique, using a diamond or carbide bur.
Once the abutment is finally prepared, an impression is
made and poured with a high-strength stone material.
The prosthesis is fabricated and cemented in the mouth
by following crown and bridge technique steps.

Indications:
Single-body/one-piece implant.
Implant in non-esthetic posterior region.
Cement-retained prosthesis where high precision is
not a concern.

B. Indirect impression techniques:

This is the most common impression technique, as it

precisely and accurately transfers the implant position
and orientation from the patients mouth to the working
cast.

This impression can be made using either a closed tray

technique or an open tray one.

a. Closed tray technique

Steps:

The gingival former is removed from the implant in

the patients mouth and a closed tray impression
transfer abutment is inserted onto the implant using
a connection screw.

The accurate and complete seating of the impression

abutment on the implant should be checked with a
radiograph.

Prof. Dr. Wahib Moussa

 An impression of this impression abutment using
polyether or addition silicon material is made.

The impression abutment is removed from the

implant and assembled with an appropriate implant
analogue.

The impression abutmentanalogue assembly is

reinserted at the corresponding location in the
impression with the same orientation as in the
mouth.

The impression is sent to the dental laboratory to

fabricate the working model.

It is recommended to pour a soft tissue replicating

material around the implant analogue as it:
Facilitates the removal of the impression abutment after the
stone die is poured.
Provides ease of working to the laboratory technician, to the
level of implant abutment connection.

Indications:
Limited inter arch space.
Tendency to gag.
Difficult access in the posterior region of the
mouth.

Advantages:
Easier.
Suitable for short inter arch distance.
Visual fastening of the analog to the coping is more
accurate.

Disadvantages
Inaccuracies with recovery and subsequent
deformation of impression material may be
encountered with nonparallel implants.
Not Suitable for deeply placed implants.

Prof. Dr. Wahib Moussa

b. Open tray technique

The open tray technique transfers the implant position

and orientation more precisely and accurately than the
closed technique and thus should be followed when a
higher level of accuracy is required.

This technique should also be followed in cases of

multiple implants inserted at different angulations, as
the closed tray technique may tear the impression in
such cases on removal from the mouth.

Steps:

The gingival former is removed from the implant.

An open tray impression post is inserted on top of the

implant.

The screw holes are blocked using wax.

Try-in, for complete and passive seating of the special

tray, is done.

The impression is made using polyether impression

material with the post screws emerging out and above
the impression.

All the connection screws should be unscrewed from

the implants before removing the impression from the
patients mouth.

On removing the impression from the patients mouth,

the open tray posts come out firmly engaged within
the impression.

Prof. Dr. Wahib Moussa

 The analogues are assembled with the posts and
connection screws are tightened.

A soft tissue replicating material should be poured

around the post analogue connections in the
impression followed by the pouring of the impression
using high strength stone material.

Again the post screws should be unscrewed from the

analogues before removing the impression from the
cast.

Indications:
Multiple number of implants which are not parallel to
each other.
Full arch implant supported fixed prosthesis.
Joint screw-retained prosthesis over multiple implants.
Deep seated implants.

Advantages
Reduces the effect of the implant angulation.
Reduces the deformation of the impression material.
Removes the concern for replacing the coping back
into its respective space in the impression.

Disadvantages
The movement of impression copings inside the
impression material during clinical and laboratory
phases may cause inaccuracy.

Recent Approaches:
Digital impression:
Digital dental impressions have potentially eliminated
the need for taking conventional impressions for
crowns and other fixed prostheses.
Intraoral digital impression systems have gained
acceptance due to high accuracy and ease of use.

Prof. Dr. Wahib Moussa

 The use of intraoral digital impressions enables the
clinician to produce accurate restorations without the
unpleasant aspects of traditional impression materials
and techniques.
Instead of a traditional implant transfer coping a
scannable coping is used.
Once the scannable coping is placed into the implant,
proper seating is confirmed with a radiograph.
Next, the scanning is performed and a 3-dimensional
(3-D) model of the region is visualized on the screen.

Advantages:
Elimination of the unpleasant taste and gagging
sensation that the patient experiences with a
traditional impression.
Digital impressions resulted in a more efficient
technique than conventional impressions.
Digital impression systems save time in the chair
during the impression stage, but, moreover, they also
reduce the number of retakes.
Digital data sharing with the lab saves additional time
and eliminates further sources of errors.

Prof. Dr. Wahib Moussa