Impression Techniques in Implant Dentistry

For a prosthesis

- an ideal impression is a foundation.

Learning Objectives
Understand purpose of an impression.
Understand difference of implant level and abutment
level impression.
Understand concept of an implant replica/analogue.
Understand closed tray and open tray impression
concepts and know the respective copings, understand
pick up impression with impression copings.

IMPRESSION

It is a negative replica of the structures of the oral cavity.

It helps to record the position of the implants or abutments (if

any), adjacent teeth and all surrounding structures in the mouth.

Purpose of Impression ?
To transfer information about one or more implants or
abutments to a working model.

Requirements of impression making.

Knowledge of the oral anatomy.
Knowledge of a basic & reliable technique.
Knowledge & understanding of materials.
Skill -- patient management.

Why accuracy of implant impressions so

critical...

A precise fit is of utmost important to an implant prosthesis.

Failure to record an accurate impression leads to multiple problems such

as :
1. Non-passive fit.
2. Incomplete seating.
3. Tight contact.
4. Improper retention.
5. Unharmonious prosthesis.

An implant differs from a natural tooth in not having

any periodontal ligament, thus a non-passive prosthesis
does not shift the implant from its position like in a
natural tooth to relieve stress, but the stress gets
transferred to crestal bone causing crestal bone
resorption.

History of Impression making

The concept of making impressions to make models,
from which prosthetic appliances could be constructed,
goes back to the early 18th century.
Philipp Pfaff (17131766), dentist to Frederick the Great
of Prussia, was the first to describe a technique of
making impressions with sealing wax, which had been
softened in hot water, and pouring plaster of Paris into
the impression to form a rigid cast.

In 1820, the French dentist C.F. Delabarre introduced

what is believed to be the first impression tray.

In 1844, Paul B. Goddard of Pennsylvania described a

similar method of making impressions and pouring
models. He preferred a clean yellow beeswax, which has
been immersed in warm water (100 F), for making
impressions.

Gutta percha was first used to make impressions in 1848.

It was soaked in boiling water, kneaded and placed
directly into a tray, which was then inserted in the mouth
until it hardened, at which time it was removed.

In 1857, Charles Stent of London tested a combination of

different waxes and invented a thermoplastic modeling
compound similar to those in use today.

Compounds were intended to replace plain wax and

plaster. But it was generally felt in the late 1870s that
plaster would be the most important impression material
for many years to come.

Modeling compound became popular when Peter and

Jacob Greene of Chillicothe, Mississippi, gave compound
technique courses around 1910.
In 1931, reversible hydrocolloids, with their fundamental
ingredient being agar-agar, which is a vegetable colloid
derived from seaweed were introduced. This jelly-like
substance softened when heated and set when cooled.
The dry alginate powder gels, when mixed with water,
form an irreversible hydrocolloid alginate.
Elastic impression materials were developed from
synthetic rubber by S.L. Pearson at the University of
Liverpool in 1955. The introduction of rubber-based,
polysulfide impression materials was followed by siliconebased materials and polyethers, which are still in use.

The most critical aspect of impression making

Material

Method

Mold
The 3 Ms of impression making

Material
Plaster
Plaster

Nonelastic
Nonelastic

Impression
Impression Compound
Compound
Zinc
Zinc oxide
oxide Eugenol
Eugenol
Impression
Impression waxes
waxes

Impression
Impression materials
materials
Hydrocolloids
Hydrocolloids

Elastic
Elastic
Non-aqueous
Non-aqueous
elastomers
elastomers

Agar
Agar
Reversible
Reversible

Polysulfides
Polysulfides

Alginate
Alginate
Irreversible
Irreversible

Polyethers
Condensation
silicone
Addition
silicone

Impression materials of choice for Implants

Polyether

- Being hydrophilic in nature, this is the

material of choice for implant impressions. The only
disadvantage is that it cannot be stored for a long time
because the dimensions of this material starts changing
after few days which may lead to inaccuracy.

PolyVinyl Siloxane This is widely used because

of its dimensional accuracy, stability and long
storage life without any distortion in dimensions.

Parts of a Dental Implant

1. Abutment screw
2. Abutment
3. Fixture-implant
4. Guide pin
5. Impression coping
6. Fixture replica
(implant analog)

Implant Fixture

Cover screw

Super structures

Method

Implant Impression Techniques

Direct / Transfer

Indirect / Pick-up
- Closed Tray
- Open Tray

Impression making options

Implant level

Abutment level

Method

Implant level impression

Method

In most implant cases implant level impressions are made where the
impression abutments are inserted into the implant, and after recording
open or closed tray pick-up impression, these impression abutments are
removed from the implant and assembled with the implant analogue.

Abutment level impression

Method

It is practised in cases of screw-retained multiple unit to full

arch joint implant prosthesis. In this technique, the gingival
formers/healing abutments are removed from the implants and
replaced with appropriate abutments.

Mold

IMPRESSION TECHNIQUES
CLOSED TRAY

OPEN TRAY

Open Tray
Versus

Closed tray
impression technique

Open Tray Versus Closed tray impression technique

Open tray

Closed tray

Open tray

Closed tray

The pick type requires that the tray be modified by placing a

hole for access to the screw.

Open tray
Closed tray

In both cases, impressions are similar, but for the open tray
type, it is important to locate the screw before the material
sets.

Open tray

Closed tray

With the pick up type, remove the long screw retaining the
coping before removing the impression.

Open tray

Closed tray

The open tray coping remains in the tray while the impression
is removed, and the closed tray type remains on the implant.

Open tray

Closed tray

For the closed tray technique, an analog must be attached to the

implant after removal of the transfer coping, but prior to
repositioning in the impression.

Open tray

Closed tray

For the closed tray type, the coping is secured in the

impression after attachment of the analog.

Open tray
Closed tray

For the open tray coping,

the screw is reinserted and
an analog is attached.

Open tray
Closed tray

Open tray

Closed tray

After setting in both cases, gingival mask is adapted and

trimmed if necessary so that no undercut is present.

Closed tray
Open tray

In both cases, the impression is poured. For the pick up

type, the screw is now removed.

Types of copings
SQUARE TAPERED COPING

The square tapered coping is

indicated in most of the
situations.
The copings are mounted on
the abutments with guide pins
and they remain in the
impression after the guide
pins have been disengaged
and
the
impression
is
removed from the mouth.
The impression should be
taken
using
polyether
material.

Tapered transfer coping

The coping uses a one piece
construction; the male thread is part
of the coping .it is screwed on to the
standard abutment before the
impression is taken and is removed
after the impression has been taken
out of the mouth.

Indications:
When difficult to unscrew a guide
pin.
In close-bite situations like posterior
regions.

Plastic Impression Coping

Impression coping is made of plastic
and fits precisely over all CERAONE
abutments.
Ceramic caps they are made from
densely-sintered semi-translucent
aluminium oxide providing optimum
esthetics.

Transfer Cap

CLOSED TRAY TECHNIQUE

CLOSED TRAY
Indications
Limited inter arch distance
Parallelism of implant is equal
In case of primary impression.

Impression copings

Impression tray

Steps
Tray selection.
Attaching impression post to
fixture.
Loading tray & injecting
material around post.
Seating the tray.

Removing the impression.

Removing the post.
Attaching post to implant
analogue.
Reinserting post with analogue in
impression.
Pouring the cast.

Impression making done at second stage.

With radiographic evidence of proper osseointegration.

Second stage

Exposing implant
and placing
gingival former.

Impression post

Impression post
attached to fixture

impression

Implant analogue

Attaching
implant analogue
to impression post

Reinserted impression
post along with
implant analogue

Cast with implant analogue

Abutment is attached

Impression post
attached to fixture

Impression post reinserted

into impression

Impression with
impression post &
implant analogue

Cast with implant analogue

OPEN TRAY TECHNIQUE

OPEN TRAY
INDICATIONS
During the lack of implant
parallelism.
In case greater than 25 divergent
of implant
Height of implant level impression
coping below the occlusal plane.
For making master or secondary
impression

Open Tray

STEPS
Custom tray or disposable tray.
Making vents on the tray at
implant sites.
Checking the tray for proper
seating.
Attaching impression post to
fixture.
Loading tray-injecting material
around post.
Seating the tray.

Loosen the post.

Removing the impression
along with post.
Attaching the implant
analogue to post.
Pouring cast.

Making vents in the

tray at implant sites

Checking in patients mouth

Impression posts connected

with floss & duralay

Making impression

Impression

Cast

Impression using Transfer cap

Courtesy: Nobel Biocare

Open Tray/ Pick-up impression

Impression material injected

over the impression copings.

Open tray seated and impression material

over the holes on transfer copings cleared off
before the material sets.

Cast poured and prosthesis is fabricated.

Closed Tray Technique

The closed tray impression

copings are connected to
the abutment replicas &
placed back in the
impression.

The lab then pours the master

cast which gives exact position
of the implant & abutment in
patients mouth.

Use of temporary
coping (plastic) multi
unit in lab.

The plastic copings are

trimmed to desired
height & wax up
framework is fabricated.

The wax up framework is

then invested and casted
to metallic framework.

Fabrication of Prosthesis

Ceramic build up is done on the metal framework. Final finishing

& glazing of the prosthesis is done and then delivered to the
patient.

Final Prosthesis

CONCLUSION
Whether in an implant restoration or any
other form of restoration, the ultimate esthetic and
functional success purely depends on the initial
negative replica of the intended restorative site.
Thus, making a good impression is not just
an art but a lot of science as well.

Thank yo