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: drgayathridevisk@gmail.com

Contributors:

1Assisstant Professor, Department

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

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

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

A primary concern when dealing with the

The success of implants depends on its
osseointegration and the passive fit of the
prosthesis. Osseointegrationis amultifactorial,
depending on precision of surgical and
restorative techniques, soft tissue management,
along with the general and oral health of the
patient. 3-5 As implants are functionally
ankylosed with direct contact to the bone they
lack the inherent mobility of the periodontal
ligament hence they cannot accommodate
distortion or misfit at the implantabutment
interface.6Long term clinical success of
implant supported prosthesis is depended on
passive fit. The discrepancies in the passive fit
of the prosthesis may lead to complications
such as screw loosening, screw facture,
occlusal discrepancies, increased plaque
accumulation, resulting in loss of
osseointegration and implant
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impression restorations is accurate transfer of
the relationship of the implant and /or any
remaining dentition to the master cast. Several
options exist when dealing with the impression
in implant prosthodontics. The implant analog
or the abutments analog may be transferred to
the master cast. An impression may be made
of the prepared implant abutments and these
are reproduced in the master cast each of these
options require careful consideration in the
choice of the impression material and the
technique used.14
If the transfer of the analog is not accurate it
will affect the passive fit of the prosthesis, for
this the impression material used should be
resilient enough to spring out of the undercuts
and stiff enough to allow for accurate seating
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Journal of Dental & Oro-facial Research Vol 12 Issue 02 Aug 2016
of the components in to the impression. It
should also prevent dislodging of the
components during the pouring of the
impression and avoid the fracture of the stone
when the prepared abutments are small. Thus
the impression material should be sufficiently
flexible and rigid. The most commonly used
impression materials in implant dentistry are
vinyl polysiloxanes and polyether rubber base
impression materials. In general the
impression material that use a putty like heavy
body component which gives rigidity to the
impression and less viscous wash impression
material are preferred to a avoid incorporation
of air bubbles around the abutment.14
Vinyl polysiloxane impression materials are
often used as they have excellent dimensional
stability, superior deformation recovery and
accurate reproduction of details. The
mechanical properties of the siloxane
impression material are adequate to withstand
various stresses upon removal and maintain
dimensional stability.15
There are numerous studies done to investigate
the accuracy of impression materials for
implant impression and it was found that
polyether and vinypolysiloxane impressions
provided superior reproduction in comparison
with other impression materials. The most
important property of an impression material is
its wettability which helps provide detail
reproduction in wet oral surfaces and also
reproduces the details accurately with gypsum
slurry. As vinyl siloxane is a hydrophobic
material manufactures have added extrinsic
surfactants to improve its wettability both
intraorally as well as with gypsum slurry,thus
making it hyrophilizedVinyl Polysilixone and
similar to Polyether.However many studies
show that there is no difference in accuracy of
impression made from polyether or vinyl
Polysiloxane.16-23
A newer impression material Vinyl polyether
silicon (VPES) which is a combination of
vinylpolysiloxane(VPS) and polyether(PE) has
been introduced which according to the
manufacturer has intrinsic hydrophilicity and
high dimensional stability. However the data
regarding its accuracy is very limited and
studies done using VPS,VPES and PE to
evaluate the accuracy and reproducibility by
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3D analysis does not show significant
difference in terms of spatial deviation5,24.
Components
The success, function and aesthetics of an
implant restoration are dependent on the
proper treatment planning and through
knowledge of components and
instrumentation. Some of the commonly used
components are drivers, healing abutments, lab
analogues, screws and impression copings.
Drivers are designed to carry different types of
components of implant to the mouth for easier
placement and removal. The driver head
design can be square, hexagonal and abutment
driver and contra-angle torque driver. Healing
abutments are available in varying heights and
diameters which are selected based on clinical
situations. Laboratory analogue are metal
replicas that duplicate the implant head or
abutment connected to the implant which are
used in laboratory to construct working model.
Impression copings have been designed for
making final impression after the soft tissue
has matured. These copings have the same
flare as the healing abutments and should fully
support the soft tissue around the head of the
implant. 2They are various types of copings
available which are selected based on the
impression techniques.(Fig:1)In transfer type
the coping is retained in the mouth when set
impression is removed. In pick up type the
coping gets incorporated in the impression and
it is removed from the mouth with the set
impression.25
Abutments are components that substitute for
missing coronal structure that attach directly to
the head of the implant and extend through the
gingival into the oral cavity. Abutment
selection depends on many clinical factors and
soft tissue maturation after second stage
surgery. The abutment must take a count of the
position and angulation of the implant, height
and thickness of the surrounding soft tissue,
the interocclusal space and the type of
restoration to be placed. Additional
considerations include the height of the lip line
the occlusal scheme and position of the tooth
in the arch. The abutment types are standard
abutment, angulated abutments, UCLA
abutment (preparable abutments), provisional
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Journal of Dental & Oro-facial Research Vol 12 Issue 02 Aug 2016
abutments, titanium abutments, ceramic
abutments, prefabricated conical abutments
Fig:1 Components used in Impression procedure.
Impression Techniques: Implant impression
techniques can be classified as either direct
(open, pick up) and indirect (closed tray,
transfer).5,7.
Direct Impression techniques (Open tray, Pick
Up): A custom or stock open tray with access
to the impression coping screws is required,
which exposes the coronal ends of the
impression coping.(fig:2) Impression material
is syringed around the impression coping and
filled tray is then inserted into the mouth,
ensuring that guidepin of the impression
coping is visible and protrudes through the
hole in the tray. Impression copings are
unscrewed and they are removed from the
mouth together with the set
impression.(fig:3)The implant analogues are
connected to the copings using the same
screw.(fig:4)3,5,6. Some precautions to be taken
are: radiographically confirmed seating of
impression coping to the implant and use vinyl
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and custom machined abutment.2,26
gloves when elastomeric impression material
is used.14,15.This technique can be used for
single tooth restorations, multi-unit
restorations and implant over dentures for
either cement retained or screw retained
prosthesis. .
An advantage of this technique is the dentist
can confirm the laboratory preparation and
contour of the provisional prosthesis to
achieve the desired healing and soft tissue
contour before final crown fabrication.26
The direct technique can be further subdivided
into splinted and non-splinted techniques. The
splinting procedure is recommended in case of
multiple implants to decrease the amount of
distortion and to improve impression accuracy
and implant stability.27-33Splinting of the
transfer copings prevents rotational movement
of impression copings in the impression
material during analog fastening, which
provides better results than not splinting.16
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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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 Journal of Dental & Oro-facial Research Vol 12 Issue 02 Aug 2016 JDOR

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