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The ABCs of Implant Prosthodontics: A Step by Step Idiot’s
                                                   Guide
                  For A Successful Restorative Outcome
Impressions
Closed Tray Impression Techniques


Advantages
  Easier,
     Impression coping for closed tray are usually shorter, making it easier
       for posterior areas and for patients with limited mouth opening
     Less time for impression preparation: cutting holes in the impression
       tray usually not needed
     Impression cap type techniques can be “idiot proof”
       Possible problems with: Snappy, EZ, and other similar systems
Closed Tray Impression Techniques

Disadvantages
   Less accurate with multiple units
   Some implant systems require more clearance than other implant
     systems, therefore may still necessitate cutting holes in the impression
     tray as with the open tray technique, and as a result, may be less
     accurate depending upon several factors
   Positional timing error, depending upon the impression coping design
Open Tray Impression Techniques

Indications
   Usually used for multiple units
   Use non hex (non engaging) impression copings if implants are not in
   alignment

Splint together
  Durelay
  Wire/Durelay

Alignment jig/pick-up impression

Advantages
  More accurate for multi units
Open Tray Impression Techniques

Disadvantages
   More impression preparation and impression time
     Test fitting impression copings and cutting holes for the impression
       copings
     Additional time to “unlock” the impression copings
   Adequate mouth opening required
   More possibility for gagging
Closed Tray Technique for Bridges?


As the distance between the impression copings increase, so do the inaccuracies

Do not use Putty, more accurate to use regular/light bodied PVS or monophase

Wait 30 minutes before pouring up the models to maximize the rebound effect of the
impression material
Hands On Open and Closed Impression Taking
                Exercise
Provisionals

Is a provisional needed?

Function
   Eating
   Speech
   Tissue forming
   Maintain tissue support
   Maintain VDO (edentulous cases)
   Etc.

Esthetics
   Lip support
   Smile
   Etc.
Provisionals

Is a provisional needed?

FD

RPD

FPD
     Existing FPD
     Maryland Bridge
     Acrylic stayplate
     Composite tooth
     Existing tooth
     Essix

“Island” tooth

Immediate load provisional
The ABCs of Implant Prosthodontics 2
The ABCs of Implant Prosthodontics 2
The ABCs of Implant Prosthodontics 2
The ABCs of Implant Prosthodontics 2
The ABCs of Implant Prosthodontics 2
The ABCs of Implant Prosthodontics 2
The ABCs of Implant Prosthodontics 2

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The ABCs of Implant Prosthodontics 2

  • 1. The ABCs of Implant Prosthodontics: A Step by Step Idiot’s Guide For A Successful Restorative Outcome
  • 3. Closed Tray Impression Techniques Advantages Easier, Impression coping for closed tray are usually shorter, making it easier for posterior areas and for patients with limited mouth opening Less time for impression preparation: cutting holes in the impression tray usually not needed Impression cap type techniques can be “idiot proof” Possible problems with: Snappy, EZ, and other similar systems
  • 4. Closed Tray Impression Techniques Disadvantages Less accurate with multiple units Some implant systems require more clearance than other implant systems, therefore may still necessitate cutting holes in the impression tray as with the open tray technique, and as a result, may be less accurate depending upon several factors Positional timing error, depending upon the impression coping design
  • 5.
  • 6.
  • 7.
  • 8.
  • 9.
  • 10.
  • 11.
  • 12. Open Tray Impression Techniques Indications Usually used for multiple units Use non hex (non engaging) impression copings if implants are not in alignment Splint together Durelay Wire/Durelay Alignment jig/pick-up impression Advantages More accurate for multi units
  • 13. Open Tray Impression Techniques Disadvantages More impression preparation and impression time Test fitting impression copings and cutting holes for the impression copings Additional time to “unlock” the impression copings Adequate mouth opening required More possibility for gagging
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23. Closed Tray Technique for Bridges? As the distance between the impression copings increase, so do the inaccuracies Do not use Putty, more accurate to use regular/light bodied PVS or monophase Wait 30 minutes before pouring up the models to maximize the rebound effect of the impression material
  • 24.
  • 25.
  • 26.
  • 27.
  • 28.
  • 29.
  • 30.
  • 31.
  • 32.
  • 33. Hands On Open and Closed Impression Taking Exercise
  • 34.
  • 35.
  • 36.
  • 37.
  • 38.
  • 39.
  • 40.
  • 41. Provisionals Is a provisional needed? Function Eating Speech Tissue forming Maintain tissue support Maintain VDO (edentulous cases) Etc. Esthetics Lip support Smile Etc.
  • 42. Provisionals Is a provisional needed? FD RPD FPD Existing FPD Maryland Bridge Acrylic stayplate Composite tooth Existing tooth Essix “Island” tooth Immediate load provisional

Editor's Notes

  1. Closed tray impression technique: no hole cut into trayOpen tray technique: hole cut into tray so that impression coping can poke throughUse PLASTIC trays!
  2. Hiossen recommends when it’s 22 degrees or more (11 degree each) then use non-hex…
  3. Have patient bite a cotton roll or 2X2 to seat prosthesis all the way down and to “stretch” the gums, especially cement-retained
  4. Unless it is a FM restoration, the majority of the occlusion should be on natural teeth. Implant occlusion should be out of occlusion by the thickness of articular paper, or the thickness of the PDL
  5. Be sure to use soft liner with FD or PD monthly with at least 3mm thickness of the soft liner
  6. Use opaque with Ti abutments