implant impression

1. Good Morning

2. Impression taking for implant
supported prosthesis
By:
Osama Tarek Ali
MSc Fixed Prosthodontics
Minya University

3. Introduction
• The success of implants depends on its
osseointegration, and the passive fit of the
prosthesis.
• 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 failure.

4. • The main goal of an impression in implant
restorations is to accurately relate an
analogue/abutment of the implant to the
other structures in the dental arch.

5. This
presentation
focuses on
the:
• Components
• Impression materials
• Impression techniques
• Recent advances in implant impressions

6. ACCURATE IMPRESSIONS PROVIDE A
FOUNDATION FOR SUCCESSFUL IMPLANT
PROSTHODONTICS

7. Benefits of
Impression
in implant
Position
Depth
Axis/Angulation
Rotation (Hex) position
Soft Tissue Contour (Emergence Profile)

8. Implants vs.
Crowns and
Bridges
•It is more critical to record 3D
position of the implants as they
occur intraoral.

9. What you need to take an impression

10. • Accurate transfer of the relationship of the implant
and /or any remaining dentition to the master cast is a
primary concern.
• If not it will affect the passive fit of the prosthesis.

11. • Material used should be resilient enough to spring out of the
undercuts and stiff enough to allow for accurate seating of the
components in to 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

12. Components

13. Implant Analogue or Replica
• Metal replica that duplicates the implant head or abutment
connected to the implant which are used in laboratory to construct
working model.

14. Impression coping Or Transfer
• They are various types of copings available which are selected based
on the impression techniques.

15. • Transfer type (Repositioning) is
retained in the mouth when
impression is removed. In closed tray
technique

16. • In pick up type the coping gets
incorporated in the impression and it is
removed from the mouth with
the set impression. In open tray technique

19. ABUTMENT LEVEL IMPRESSION TECHNIQUES
• In case of no need for abutment modification or optimal fixture
implantation
• Easy impression and bite reg.
• Easy to make temporary restorations

20. Types
• Direct techniques
-By intra oral preparation of the abutment
• Indirect techniques

21. Direct techniques
-By intra oral preparation of the abutment

22. Indirect techniques
• Using Plastic Cap, Abutment and Analog.

27. 2:35

28. IMPLANT LEVEL IMPRESSIONS
Open Tray
• Implants more than 3.
• In cases with implant/abutment angulations and different path of
insertion.
Closed Tray
• limited mouth opening or in accessible area
• Single implant

29. CLOSED TRAY
• Indirect technique. The copings are connected to the implant and
after the removal of impressions they are retained on the implants.
• Then removed from the implant, attached to the analogues and
reinserted in the impression

30. CLOSED TRAY
• Initial situation
• Removing cover
screw
Or gingival
former

31. • Putting transfer coping

32. • Taking the impression
• Review the impression

33. • Putting the transfer back in the impression
after fixing to the analogue
Make sure of the position to be the same
as intraoral

34. • Making the gingival replica

35. Final situation

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

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

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

42. OPEN TRAY IMPRESSION TECHNIQUE
• A custom or stock open tray with access to the impression coping
screws is required, which exposes the coronal ends of the impression
coping.
• This technique can be used for single tooth restorations, multi-unit
restorations and implant over dentures for either cement retained or
screw retained

43. Steps
• Initial situation

44. • Unscrew the cover screw
• or healing abutment

45. • Insert impression coping or transfer

46. • Fabrication of the open tray (stock or custom)

47. • Try-in impression tray

48. • Impression material is syringed around the impression
coping and filled tray is then inserted into the mouth,
ensuring that guide pin of the impression coping is
visible and protrudes through the hole in the tray.

49. • When the material is set ,Impression copings are unscrewed and
removed from the mouth together with the set impression.

50. • The implant analogues are connected to the copings using the same
screw.

53. • Some precautions to be taken are: radiographically confirmed seating
of impression coping to the implant

55. OPEN TRAY IMPRESSION TECHNIQUE
•Indications
• Multiple implants
• Nonparallel located implants.

56. 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.

57. 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
• Some rotational movement of the impression coping when securing the
implant analog may occur
• Blind attachment of the implant analog to the impression coping may
result in a misfit of components

58. SPLINTING FOR MULTIPLE IMPLANT
IMPRESSION
• joining the direct transfer copings with acrylic resin to
-Stabilize the copings against rotation during fixture or abutment
analog fastening
-Control the relationship between implants in a rigid fashion
Assif et al. and Naconecy et al. showed that splinting technique was
significantly more accurate than unsplinted techniques

59. STEPS IN SPLINTING MULTIPLE IMPLANTS FOR
IMPRESSION

69. LITERATURE REVIEW

71. Three-Dimensional Accuracy of Implant and Abutment Level
Impression Techniques: Effect on Marginal Discrepancy
• With comparison of different impression methods, including
abutment level and implant level (closed tray and open tray), no
significant difference was noted

73. CONCLUSION
• Precise impression methodology would decrease the failures related
to the supra structure fabrication
Ozkane, 2006
• Imprecise superstructure fit results in mechanical and biologic
consequences that disrupt the function of dental implants
Heather J. et al, 2007

74. DIGITAL IMPLANT IMPRESSION
• More recently, one of the major developments in implant prosthodontics
has been the adoption of engineering principles in the form of (CAD/CAM)
to construct implant prosthesis.
• The integration of digital impressions in implant dentistry has simplified
surgical and restorative treatment leading to more predictable outcomes.
• The digital implant impression technique has proven its possibilities as an
effective alternative for the analogue impression-taking technique Nissan J, Ghelfan
O. The press fit implant impression coping technique. J Prosthet Dent 2009; 101:413-4.

75. • The applications of digital impressions in implant dentistry include
computer-guided implantation, fabrication of prostheses based on
virtual implant planning, and integration of extra oral facial scanning
in the design process of a prosthesis.

76. Advantages
• Improved patient experience and comfort during impression taking
• Reduced distortion of impression materials
• Ability to inspect preparations and impressions three-dimensionally
• Virtual assessment of the implant prosthetic space
• Less time consuming
• The ability to capture peri-implant soft tissues and implant positions
in a non-invasive manner.

77. Requirements of a digital impression
• (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 (milling machine)

78. • The results from the studies have reported that the digital
impressions are comparable to the conventional impressions and
produced clinically acceptable prostheses with similar or even
superior marginal and internal fit values than ones from conventional
impression

79. Digital implant workflow
• In the workflow of CAD-/CAM-guided implant planning, the DICOM
data from a CBCT are merged with the STL data from the digital
impression scanning in a 3D computer-guided software program

80. Superimposed digital data from CT and STL

81. Digital implant workflow

82. Computer guided implant

83. Digital intraoral imaging
• After proper contouring of emergence profile of the implants, the 3D
surface topography of specially designed scannable impression
copings (scanbody; scanpost) is digitally captured by a digital
impression system along with the contoured soft tissue.

84. • The virtual conversion of the scanbody to a virtual analog in 3D
software relays the position and orientation of the implant. This
ensures the accuracy of subsequent prosthesis fabrication in
CAD/CAMstages.

85. • The prosthesis can be designed and fabricated directly on a 3D virtual
model, or a 3D virtual model can be physically printed or milled
whereupon the prosthesis is examined and adjusted prior to the
delivery.

86. Azento
• Each patient receives a precise, custom treatment plan
recommendation based on their CBCT and intraoral scanning images,
including:
• Surgical guide
• All necessary instruments
• Implant
• Custom healing abutment
• temporary restoration (optional)

88. Thank you