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Impression tecnique for implant supported rehabilitation/ dental courses

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Impression technique
for implant
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rehabilitation
INDIAN DENTAL ACADEMY
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Impression tecnique for implant supported rehabilitation/ dental courses

The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit 
www.indiandentalacademy.com

The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit 
www.indiandentalacademy.com

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Impression tecnique for implant supported rehabilitation/ dental courses

  1. 1. Impression technique for implant supported rehabilitation INDIAN DENTAL ACADEMY Leader in continuing Dental Education www.indiandentalacademy.comwww.indiandentalacademy.com
  2. 2. CONTENTSCONTENTS IntroductionIntroduction Preparation and evaluation of patient forPreparation and evaluation of patient for prosthetic careprosthetic care Impression materials and componentsImpression materials and components Impression procedures for edentulous patientImpression procedures for edentulous patient Impression procedures for partially edentulousImpression procedures for partially edentulous Single tooth impressionsSingle tooth impressions Impressions during maintenance of removableImpressions during maintenance of removable superstructuresuperstructure Impressions for soldering the frameworksImpressions for soldering the frameworks Impressions for maxillofacial implantsImpressions for maxillofacial implants Summary and ConclusionSummary and Conclusion ReferencesReferences www.indiandentalacademy.comwww.indiandentalacademy.com
  3. 3. Ideal impression must be in the mind of theIdeal impression must be in the mind of the dentist before it is in his hand .He mustdentist before it is in his hand .He must literally make the impression rather thanliterally make the impression rather than take ittake it -- M M DEVANM M DEVAN www.indiandentalacademy.comwww.indiandentalacademy.com
  4. 4. Terminologies used in implantTerminologies used in implant prosthesisprosthesis www.indiandentalacademy.comwww.indiandentalacademy.com
  5. 5.  Cover screwCover screw is placed afteris placed after stage 1 surgery into the top ofstage 1 surgery into the top of the implant to prevent bone,the implant to prevent bone, soft tissue, and debris fromsoft tissue, and debris from invading the abutmentinvading the abutment connecting area duringconnecting area during healing.healing. www.indiandentalacademy.comwww.indiandentalacademy.com
  6. 6. Healing capHealing cap is placed to facilitateis placed to facilitate retention of the surgical dressing afterretention of the surgical dressing after suturingsuturing Abutment healing cap (2005): any temporary cover used to provide a seal over the superior portion of a dental implant; most such covers are metallic and are intended for interim usage following exposure of the dental implants superior surface www.indiandentalacademy.comwww.indiandentalacademy.com
  7. 7.  Permucosal extension or healingPermucosal extension or healing abutmentabutment Extends the implant above the softExtends the implant above the soft tissue and results in the developmenttissue and results in the development of permucosal seal around theof permucosal seal around the implant, placed after stage 2 surgeryimplant, placed after stage 2 surgery for soft tissue healing.for soft tissue healing. www.indiandentalacademy.comwww.indiandentalacademy.com
  8. 8.  Transfer copingTransfer coping  It is used to position an analog in anIt is used to position an analog in an impression and is defined by the portion ofimpression and is defined by the portion of the implant it transfers to the master cast,the implant it transfers to the master cast, either the implant body transfer coping oreither the implant body transfer coping or the abutment transfer coping.the abutment transfer coping.  Used to position a die in an impressionUsed to position a die in an impression www.indiandentalacademy.comwww.indiandentalacademy.com
  9. 9.  AbutmentAbutment is the portion of theis the portion of the implant that supports or retainsimplant that supports or retains prosthesis or the superstructureprosthesis or the superstructure  SuperstructureSuperstructure is defined as a metalis defined as a metal framework that fits the implantframework that fits the implant abutment and provides retention for aabutment and provides retention for a removable prosthesisremovable prosthesis www.indiandentalacademy.comwww.indiandentalacademy.com
  10. 10.  An indirect transfer copingAn indirect transfer coping uses anuses an impression material requiring elasticimpression material requiring elastic properties.properties.  It is screwed into the implant or theIt is screwed into the implant or the abutment body and remains in placeabutment body and remains in place when the set impression is removedwhen the set impression is removed from the mouth.from the mouth.  It is parallel sided or slightly tapered toIt is parallel sided or slightly tapered to allow ease in removal.allow ease in removal. www.indiandentalacademy.comwww.indiandentalacademy.com
  11. 11.  A direct transfer copingA direct transfer coping  usually consists of a hollow transferusually consists of a hollow transfer component often square, and a long centralcomponent often square, and a long central screw to secure it to the abutment orscrew to secure it to the abutment or implant body and may be used as the pickimplant body and may be used as the pick up impression coping.up impression coping.  It takes advantage of impression materialsIt takes advantage of impression materials having rigid properties and eliminate thehaving rigid properties and eliminate the error of permanent deformation becauseerror of permanent deformation because they remain within the impression until thethey remain within the impression until the master model is poured and separated.master model is poured and separated. www.indiandentalacademy.comwww.indiandentalacademy.com
  12. 12.  Analog (1826Analog (1826) something that is analogous in part or whole to) something that is analogous in part or whole to something else; i.e., a replica of a portion of an implantsomething else; i.e., a replica of a portion of an implant abutment made of brass, aluminum, steel, or plasticabutment made of brass, aluminum, steel, or plastic  Abutment Analog (2005Abutment Analog (2005): a replica of the superior portion of a): a replica of the superior portion of a dental implant. Usually used to provide an exact form of thedental implant. Usually used to provide an exact form of the dental implant abutment within the dental laboratory duringdental implant abutment within the dental laboratory during fabrication of a prosthesis supported in part or whole by thefabrication of a prosthesis supported in part or whole by the dental implantdental implant  Abutment Post (2005):Abutment Post (2005): that component of a dental implantthat component of a dental implant abutment which extends into the internal structure of a dentalabutment which extends into the internal structure of a dental implant and is used to provide retention and/or stability to theimplant and is used to provide retention and/or stability to the dental implant abutmentdental implant abutment www.indiandentalacademy.comwww.indiandentalacademy.com
  13. 13.  Prosthetic copingProsthetic coping is a thin covering usually designed to fit theis a thin covering usually designed to fit the abutment screw retention and serve as connection between theabutment screw retention and serve as connection between the abutment and prosthesis or superstructure.abutment and prosthesis or superstructure. www.indiandentalacademy.comwww.indiandentalacademy.com
  14. 14. Preparation and evaluationPreparation and evaluation of patient for prostheticof patient for prosthetic carecare www.indiandentalacademy.comwww.indiandentalacademy.com
  15. 15. 1. Remove the surgical pack.1. Remove the surgical pack. 2. Unscrew the healing caps.2. Unscrew the healing caps. 3. Remove any remaining sutures3. Remove any remaining sutures 4. Using radiographs, check if all abutments are correctly4. Using radiographs, check if all abutments are correctly placed.placed. www.indiandentalacademy.comwww.indiandentalacademy.com
  16. 16. 5.5. check that the correct abutment length has been usedcheck that the correct abutment length has been used taking into consideration such factors as oral hygiene,taking into consideration such factors as oral hygiene, phonetics and cosmetic effects.phonetics and cosmetic effects. 6. Use the hexagonal screw driver to tighten the abutment6. Use the hexagonal screw driver to tighten the abutment screws so that the abutments are firmly seatedscrews so that the abutments are firmly seated www.indiandentalacademy.comwww.indiandentalacademy.com
  17. 17. If the radiographs show a space betweenIf the radiographs show a space between the fixture and the abutment, it must bethe fixture and the abutment, it must be corrected before an impression can becorrected before an impression can be made.made. 1. Loosen the abutment screw using the1. Loosen the abutment screw using the special screwdriver and remove thespecial screwdriver and remove the abutment with abutment clamp,abutment with abutment clamp, 2. Inspect the coronal surface of the fixture2. Inspect the coronal surface of the fixture and remove any soft tissue with a curette.and remove any soft tissue with a curette. www.indiandentalacademy.comwww.indiandentalacademy.com
  18. 18. 3 Clean the abutment & abutment screw in3 Clean the abutment & abutment screw in saline solution.saline solution. Check the silicon ring on the abutmentCheck the silicon ring on the abutment screw & replace ,if damaged.screw & replace ,if damaged. 4 Tighten the abutment screw a few turns &4 Tighten the abutment screw a few turns & rotate the abutment until it can be feltrotate the abutment until it can be felt that it slides into positionthat it slides into position 5 Take new radiograph to verify that the5 Take new radiograph to verify that the abutment is correctly seatedabutment is correctly seated www.indiandentalacademy.comwww.indiandentalacademy.com
  19. 19. Impression materials andImpression materials and componentscomponents www.indiandentalacademy.comwww.indiandentalacademy.com
  20. 20.  Greatest accuracy occurs if impression is poured soon afterGreatest accuracy occurs if impression is poured soon after they are removed.they are removed.  Polyether absorbs water so should not be stored in thisPolyether absorbs water so should not be stored in this medium.medium.  Addition silicones are very stableAddition silicones are very stable  Greatest dimensional change is seen with condensationGreatest dimensional change is seen with condensation siliconessilicones  Polysulfides shrink drastically after 24 hoursPolysulfides shrink drastically after 24 hours  Least amount of dimension changes occurs in additionLeast amount of dimension changes occurs in addition silicones and polyethers, so these should be used for finalsilicones and polyethers, so these should be used for final impression.impression. materialsmaterials www.indiandentalacademy.comwww.indiandentalacademy.com
  21. 21.  Permanent deformation of impression material may bePermanent deformation of impression material may be concern when the impression distorts from the undercutconcern when the impression distorts from the undercut region of the indirect impression transfer coping duringregion of the indirect impression transfer coping during removal.removal.  60% of the deformation occurs when elastomeric60% of the deformation occurs when elastomeric impression is removed from 1mm undercut in height andimpression is removed from 1mm undercut in height and depth.depth.  Permanent deformation or inaccurate placement of thePermanent deformation or inaccurate placement of the indirect transfer coping in the impression may beindirect transfer coping in the impression may be eliminated by using aeliminated by using a direct impression transfer copingdirect impression transfer coping forfor final impression.final impression. materialsmaterials www.indiandentalacademy.comwww.indiandentalacademy.com
  22. 22. Materials and componentsMaterials and components  The standard abutments are identical inThe standard abutments are identical in diameter and form and thus interchangeablediameter and form and thus interchangeable both before and after the impression as long asboth before and after the impression as long as the same length is used.the same length is used.  When a squared transfer coping is used, theWhen a squared transfer coping is used, the impression should be taken in impressionimpression should be taken in impression plaster or polyether material. The coping areplaster or polyether material. The coping are mounted on the abutments with screws (guidemounted on the abutments with screws (guide pins).pins).  The coping remain in the impression after theThe coping remain in the impression after the guide pins have been disengaged and theguide pins have been disengaged and the impression is removed from the mouth after theimpression is removed from the mouth after the material is set.material is set. www.indiandentalacademy.comwww.indiandentalacademy.com
  23. 23. Materials and componentsMaterials and components  Tapered transfer copings act in the same manner as aTapered transfer copings act in the same manner as a prepared tooth.prepared tooth. Thus only resilient material can be used like siliconesThus only resilient material can be used like silicones polyetherpolyether They are used when available space is lessThey are used when available space is less  Impression materials must hold its form in a perfectlyImpression materials must hold its form in a perfectly stable, manner since the tolerances allowed in the finishedstable, manner since the tolerances allowed in the finished prosthesis is extremely small.prosthesis is extremely small. www.indiandentalacademy.comwww.indiandentalacademy.com
  24. 24. Materials and componentsMaterials and components  Primary reasons for making an impression is to transferPrimary reasons for making an impression is to transfer the internal relationship of the abutments to a plasterthe internal relationship of the abutments to a plaster model, the impression of the alveolar crest and its coveringmodel, the impression of the alveolar crest and its covering of mucosa is of lesser importance.of mucosa is of lesser importance. An exception is made in the case of moderate loss of hardAn exception is made in the case of moderate loss of hard tissue in both the mandible and the maxilla where fortissue in both the mandible and the maxilla where for cosmetic or phonetic reason; the prosthesis must becosmetic or phonetic reason; the prosthesis must be formed so as to be in direct contact with the underlyingformed so as to be in direct contact with the underlying mucosa.mucosa. www.indiandentalacademy.comwww.indiandentalacademy.com
  25. 25. Impression proceduresImpression procedures for edentulous patientfor edentulous patient www.indiandentalacademy.comwww.indiandentalacademy.com
  26. 26.  Remove the healing caps with theRemove the healing caps with the internal hexagon screw driver.internal hexagon screw driver.  Rinse off debris and clean the areaRinse off debris and clean the area around abutment.around abutment.  Place the tapered impression copingsPlace the tapered impression copings using the frictional fit screw driver.using the frictional fit screw driver. www.indiandentalacademy.comwww.indiandentalacademy.com
  27. 27.  Select the appropriate size stock tray normallySelect the appropriate size stock tray normally used for natural dentition .used for natural dentition .  The edentulous stock trays do not provide spaceThe edentulous stock trays do not provide space for impression copings.for impression copings.  Make alginate impressionMake alginate impression  Inspect the impression for accurate reproduction ofInspect the impression for accurate reproduction of impression copings and rinse saliva from theimpression copings and rinse saliva from the impressionimpression www.indiandentalacademy.comwww.indiandentalacademy.com
  28. 28.  Connect abutment replicas to eachConnect abutment replicas to each tapered impression copingstapered impression copings  Slip each replica coping unit into theSlip each replica coping unit into the impressionimpression  Use gentle vibration when pouring theUse gentle vibration when pouring the impression.impression. www.indiandentalacademy.comwww.indiandentalacademy.com
  29. 29.  Recover the cast and remove theRecover the cast and remove the impression copingsimpression copings  Completed diagnostic castCompleted diagnostic cast  Connect the square impression copingsConnect the square impression copings with the medium or long length guidewith the medium or long length guide pinspins www.indiandentalacademy.comwww.indiandentalacademy.com
  30. 30.  Block out the impression copings withBlock out the impression copings with two thickness of base plate wax.two thickness of base plate wax.  Be certain to leave the heads of theBe certain to leave the heads of the guide pins exposedguide pins exposed  Lubricate the cast and adapt tray resinLubricate the cast and adapt tray resin on the caston the cast www.indiandentalacademy.comwww.indiandentalacademy.com
  31. 31.  Make a full arch custom tray andMake a full arch custom tray and leave the heads of the guide pinsleave the heads of the guide pins exposedexposed  Enlarge the guide pin accessEnlarge the guide pin access holes to approximately 5.0mm inholes to approximately 5.0mm in diameter.diameter.  Finish the tray borders.Finish the tray borders. www.indiandentalacademy.comwww.indiandentalacademy.com
  32. 32.  Remove the healing caps and connectRemove the healing caps and connect the square impression coping withthe square impression coping with medium guide pins.medium guide pins.  Try in the tray to verify intraorally.Try in the tray to verify intraorally.  Inject impression material aroundInject impression material around each impression coping andeach impression coping and surrounding tissues.surrounding tissues. www.indiandentalacademy.comwww.indiandentalacademy.com
  33. 33.  Fill the impression tray with remainingFill the impression tray with remaining impression material.impression material.  Seat the tray intraorally and wipeSeat the tray intraorally and wipe excess impression material to exposeexcess impression material to expose the guide pins.the guide pins.  Inspect the impression for accuracyInspect the impression for accuracy and check for impression materialand check for impression material between impression copings andbetween impression copings and abutment cylinders.abutment cylinders. www.indiandentalacademy.comwww.indiandentalacademy.com
  34. 34.  Connect abutment replicas toConnect abutment replicas to each impression copingeach impression coping  Bead the impression and use aBead the impression and use a two pour techniquetwo pour technique  After completing the secondAfter completing the second pour and the stone has set,pour and the stone has set, unscrew the guide pins.unscrew the guide pins. www.indiandentalacademy.comwww.indiandentalacademy.com
  35. 35.  Separate the cast from the impressionSeparate the cast from the impression  Trim and complete the master cast.Trim and complete the master cast. www.indiandentalacademy.comwww.indiandentalacademy.com
  36. 36.  This provides simultaneous impressions of the implantsThis provides simultaneous impressions of the implants and the determination of intermaxillary relationships, freeand the determination of intermaxillary relationships, free of any interfering forces from the position of lips, cheeks,of any interfering forces from the position of lips, cheeks, or tongue.or tongue. Impression making with the patient’s mouth closed www.indiandentalacademy.comwww.indiandentalacademy.com
  37. 37.  During the first prosthetic appointment, theDuring the first prosthetic appointment, the implants are uncovered, and stock traysimplants are uncovered, and stock trays (ivotray) are used for the initial impressions(ivotray) are used for the initial impressions of both mandible and maxilla. During thisof both mandible and maxilla. During this procedure, the intermaxillary relationship isprocedure, the intermaxillary relationship is estimated preciselyestimated precisely www.indiandentalacademy.comwww.indiandentalacademy.com
  38. 38.  During the second appointment, using individualDuring the second appointment, using individual custom trays with wax rims, the final functionalcustom trays with wax rims, the final functional impressions of both the jaws can be made usingimpressions of both the jaws can be made using masticatory pressure, and the definitivemasticatory pressure, and the definitive intermaxillary relationship determined.intermaxillary relationship determined. www.indiandentalacademy.comwww.indiandentalacademy.com
  39. 39. Review of literatureReview of literature  Paolo vigolo et al in 2003Paolo vigolo et al in 2003 studied and evaluated the accuracy ofstudied and evaluated the accuracy of 3 different impression techniques using polyether impression3 different impression techniques using polyether impression material to obtain a master cast for the fabrication of a prosthesismaterial to obtain a master cast for the fabrication of a prosthesis that would fit passively on multiple implants.that would fit passively on multiple implants.  Group 1, non modified square impression copings ,Group 1, non modified square impression copings ,  Group 2 square impression copings were used and joinedGroup 2 square impression copings were used and joined together with autopolymerizing acrylic resin impressiontogether with autopolymerizing acrylic resin impression procedureprocedure  Group 3, square impression coping previously airborne particleGroup 3, square impression coping previously airborne particle abraded and coated with the manufacturer recommendedabraded and coated with the manufacturer recommended impression were used.impression were used.  Positional accuracy of the abutments was numerically assessedPositional accuracy of the abutments was numerically assessed with an optical scanner.with an optical scanner. www.indiandentalacademy.comwww.indiandentalacademy.com
  40. 40.  It was concluded that improved accuracy of theIt was concluded that improved accuracy of the master cast was achieved when the impressionmaster cast was achieved when the impression technique involved square impression coping joinedtechnique involved square impression coping joined together with autopolymerizing acrylic resin ortogether with autopolymerizing acrylic resin or square impression coping that had been airbornesquare impression coping that had been airborne particle abraded and adhesive coated.particle abraded and adhesive coated. www.indiandentalacademy.comwww.indiandentalacademy.com
  41. 41. FULLY BONE ANCHOREDFULLY BONE ANCHORED PROSTHESISPROSTHESIS www.indiandentalacademy.comwww.indiandentalacademy.com
  42. 42. www.indiandentalacademy.comwww.indiandentalacademy.com
  43. 43. www.indiandentalacademy.comwww.indiandentalacademy.com
  44. 44. www.indiandentalacademy.comwww.indiandentalacademy.com
  45. 45. www.indiandentalacademy.comwww.indiandentalacademy.com
  46. 46. Impression technique forImpression technique for implant supported overimplant supported over denturedenture www.indiandentalacademy.comwww.indiandentalacademy.com
  47. 47.  The material must be accurate to reproduce the exactThe material must be accurate to reproduce the exact location of the implants or abutments and be of a viscositylocation of the implants or abutments and be of a viscosity that does not distort the soft tissue one that is stiff enoughthat does not distort the soft tissue one that is stiff enough to retain the implant or abutment analog during the pouringto retain the implant or abutment analog during the pouring procedures.procedures.  The heavy putty like materials provide the necessaryThe heavy putty like materials provide the necessary stiffness and the light body material accurately reproducesstiffness and the light body material accurately reproduces the area around the transfer components and the softthe area around the transfer components and the soft tissues. The addition type polysiloxane material has thetissues. The addition type polysiloxane material has the quality required.quality required. www.indiandentalacademy.comwww.indiandentalacademy.com
  48. 48.  The base of the tissue borne over denture should be asThe base of the tissue borne over denture should be as large as possible within the functional and anatomicallarge as possible within the functional and anatomical limitations to optimize the distribution of the occlusallimitations to optimize the distribution of the occlusal forces.forces.  There are several methods for making impression to obtainThere are several methods for making impression to obtain a master cast for fabrication of the overdentures.a master cast for fabrication of the overdentures. www.indiandentalacademy.comwww.indiandentalacademy.com
  49. 49. Single impression techniqueSingle impression technique www.indiandentalacademy.comwww.indiandentalacademy.com
  50. 50.  kk www.indiandentalacademy.comwww.indiandentalacademy.com
  51. 51.  AdvantagesAdvantages  A single impression for the fabrication of the frameworkA single impression for the fabrication of the framework and the processing of the prosthesisand the processing of the prosthesis  Decreased patient visits.Decreased patient visits.  Use of wax up and index to enhance the estheticsUse of wax up and index to enhance the esthetics  Index to ensure proper fit of framework within theIndex to ensure proper fit of framework within the prosthesisprosthesis  Placements of attachments in laboratory instead of usingPlacements of attachments in laboratory instead of using valuable chair timevaluable chair time  DisadvantagesDisadvantages  Possible damage to attachment & framework duringPossible damage to attachment & framework during processing phase.processing phase.  More complex laboratory procedures during packing.More complex laboratory procedures during packing.  Possible movements of attachment during packingPossible movements of attachment during packing procedures.procedures. www.indiandentalacademy.comwww.indiandentalacademy.com
  52. 52. DoubleDouble impression techniqueimpression technique  The metal superstructure is firstThe metal superstructure is first constructed and then secured in positionconstructed and then secured in position intraorally and a final impression is made.intraorally and a final impression is made. The superstructure is reproduced in stoneThe superstructure is reproduced in stone in the master cast.in the master cast.  This requires two impressions;This requires two impressions;  One that transfers the position of either theOne that transfers the position of either the abutments or the implants to a working castabutments or the implants to a working cast and a final impression for the fabrication ofand a final impression for the fabrication of the prosthesis itselfthe prosthesis itself www.indiandentalacademy.comwww.indiandentalacademy.com
  53. 53. www.indiandentalacademy.comwww.indiandentalacademy.com
  54. 54.  AdvantagesAdvantages  Conventional & simplified processing of the final prosthesis.Conventional & simplified processing of the final prosthesis.  Eliminating the possibilities of damaging the framework duringEliminating the possibilities of damaging the framework during the processing of denture.the processing of denture.  DisadvantagesDisadvantages  1. Necessity for blocking out of framework before making final1. Necessity for blocking out of framework before making final impression & placing retentive portion of attachments.impression & placing retentive portion of attachments.  2. Inability to use index for the fabrication of the framework to2. Inability to use index for the fabrication of the framework to ensure its fit within the confines of dentureensure its fit within the confines of denture  3. Inability to recognize compromises in aesthetics caused by the3. Inability to recognize compromises in aesthetics caused by the position of implants in the wax up stage before the fabrication ofposition of implants in the wax up stage before the fabrication of the framework.the framework.  4. Extended chair side time at delivery to accomplish placement of4. Extended chair side time at delivery to accomplish placement of the attachment.the attachment. www.indiandentalacademy.comwww.indiandentalacademy.com
  55. 55. Impression procedures forImpression procedures for partially edentulouspartially edentulous www.indiandentalacademy.comwww.indiandentalacademy.com
  56. 56. Review of literatureReview of literature  Nicolas in 2004Nicolas in 2004 described a technique for making implantdescribed a technique for making implant impression designed to reduce framework misfitimpression designed to reduce framework misfit The two stage impression technique combines the use ofThe two stage impression technique combines the use of plaster and a silicone impression material. The method canplaster and a silicone impression material. The method can be used for either completely or partially edentulousbe used for either completely or partially edentulous patientspatients  He concluded that the technique combines- the flexibility ofHe concluded that the technique combines- the flexibility of an elastomeric impression material for capturing the underan elastomeric impression material for capturing the under cut intraoral topography with the splinting effect ofcut intraoral topography with the splinting effect of impression plaster to improve the accuracy of the fit of theimpression plaster to improve the accuracy of the fit of the prosthetic component.prosthetic component. www.indiandentalacademy.comwww.indiandentalacademy.com
  57. 57. Primary impressions www.indiandentalacademy.comwww.indiandentalacademy.com
  58. 58. www.indiandentalacademy.comwww.indiandentalacademy.com
  59. 59. www.indiandentalacademy.comwww.indiandentalacademy.com
  60. 60. Impression recorded at the level ofImpression recorded at the level of top of implanttop of implant  1. To delay the decision on the type and size of1. To delay the decision on the type and size of the abutment after the construction of the masterthe abutment after the construction of the master model.model.  2. To provide a master impression for construing2. To provide a master impression for construing a one piece prosthesis designed to fit directly ona one piece prosthesis designed to fit directly on the Implantsthe Implants  3. To construct a master cast for the use of3. To construct a master cast for the use of prepable abutments or custom made abutmentsprepable abutments or custom made abutments www.indiandentalacademy.comwww.indiandentalacademy.com
  61. 61. Abutment level impression Following confirmation from the radiograph of complete seating they are then definitively secured by tightening the retaining screws with a torque device. Incorrect seating may be due to Failure to ensure that the abutment correctly engages an anti rotation features. The presence of soft tissue or bone encroaching on the head of the implant. www.indiandentalacademy.comwww.indiandentalacademy.com
  62. 62.  There are two different method to available toThere are two different method to available to record abutment impressionrecord abutment impression  Pick up impression coping technique atPick up impression coping technique at abutment levelabutment level  Reseating technique.Reseating technique. www.indiandentalacademy.comwww.indiandentalacademy.com
  63. 63. Pick up impression coping technique at abutment level www.indiandentalacademy.comwww.indiandentalacademy.com
  64. 64. Reseating technique.Reseating technique.  Where lack of space makes access to the screw retained copingsWhere lack of space makes access to the screw retained copings impossible, a non retentive, usually aimpossible, a non retentive, usually a tapered copingstapered copings may bemay be employed.employed.  This utilizes a one piece machined impression coping, whichThis utilizes a one piece machined impression coping, which screws directly on the abutment and remains in the mouth whenscrews directly on the abutment and remains in the mouth when the impression is removed it is then unscrewed from thethe impression is removed it is then unscrewed from the abutment and reseated in the impression.abutment and reseated in the impression.  This must be done carefully, as it is a common source ofThis must be done carefully, as it is a common source of inaccuracy if care is not taken and the copings incorrectly seated.inaccuracy if care is not taken and the copings incorrectly seated. www.indiandentalacademy.comwww.indiandentalacademy.com
  65. 65. Careful inspection of the impression will confirm theCareful inspection of the impression will confirm the key features;key features;  1. Stability of the impression coping1. Stability of the impression coping can be tested with tweezers, if thecan be tested with tweezers, if the movement is present in themovement is present in the impression; it is recommended thatimpression; it is recommended that impression be retaken.impression be retaken.  2. An accurate record of all hard and2. An accurate record of all hard and soft tissue Including teeth.soft tissue Including teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  66. 66.  Master cast is constructed usuallyMaster cast is constructed usually beginning with the soft tissue maskbeginning with the soft tissue mask  A soft gingival mask has beenA soft gingival mask has been constructed to reproduce the mucosalconstructed to reproduce the mucosal cuffscuffs www.indiandentalacademy.comwww.indiandentalacademy.com
  67. 67. Single tooth impressionsSingle tooth impressions www.indiandentalacademy.comwww.indiandentalacademy.com
  68. 68.  Single tooth impression can be divided intoSingle tooth impression can be divided into  Implant headImplant head  Abutment level impressionAbutment level impression Impression of preformed machined abutmentImpression of preformed machined abutment Impression of prepable abutmentsImpression of prepable abutments www.indiandentalacademy.comwww.indiandentalacademy.com
  69. 69. ImpressionImpression of Implant headof Implant head  Most implant system provides aMost implant system provides a premachined impression coping forpremachined impression coping for recording an impression of the head of therecording an impression of the head of the implant.implant.  This is usually made up of two pieces; theThis is usually made up of two pieces; the impression coping and the guide pin. Theimpression coping and the guide pin. The impression coping seats directly on to theimpression coping seats directly on to the implant head and is retained with the guideimplant head and is retained with the guide pin.pin. www.indiandentalacademy.comwww.indiandentalacademy.com
  70. 70.  A polymeric standard stock trayA polymeric standard stock tray may be used and modified so thatmay be used and modified so that the guide pin projects beyond thethe guide pin projects beyond the adjacent teeth through headjacent teeth through he impression tray.impression tray.  when set, the guide screw iswhen set, the guide screw is loosened and the impression trayloosened and the impression tray is removed from the mouth withis removed from the mouth with the coping picked up in thethe coping picked up in the impression.impression. www.indiandentalacademy.comwww.indiandentalacademy.com
  71. 71. Impression of preformed machined abutmentImpression of preformed machined abutment www.indiandentalacademy.comwww.indiandentalacademy.com
  72. 72.  Following removal of healing abutment,Following removal of healing abutment, measurement from the head of the implant to themeasurement from the head of the implant to the margin of the mucosal cuff will help determinemargin of the mucosal cuff will help determine the height of the final abutment to be use in thethe height of the final abutment to be use in the restorationrestoration  The objective is to produce a submucosalThe objective is to produce a submucosal margin of 1.5 -2mm from the crest of the gingivalmargin of 1.5 -2mm from the crest of the gingival tissue and to provide sufficient interocclusaltissue and to provide sufficient interocclusal distance from the top of the abutment to thedistance from the top of the abutment to the opposing tooth.opposing tooth.  A long cone periapical radiograph may be takenA long cone periapical radiograph may be taken to ensure correct placement of the definitiveto ensure correct placement of the definitive abutmentabutment www.indiandentalacademy.comwww.indiandentalacademy.com
  73. 73. An impression is taken using a machined plastic or metal impression coping that is placed over the abutment. A stock tray is used & modified so that the impression coping projects beyond the adjacent teeth & through the impression tray. www.indiandentalacademy.comwww.indiandentalacademy.com
  74. 74.  A polyvinyl silicone or polyetherA polyvinyl silicone or polyether impression material can be usedimpression material can be used  After setting, the impression tray isAfter setting, the impression tray is removed ,the impression coping pickedremoved ,the impression coping picked up in the impressionup in the impression www.indiandentalacademy.comwww.indiandentalacademy.com
  75. 75. Impression of prepable abutmentsImpression of prepable abutments  Prepable abutments are usually supplied inPrepable abutments are usually supplied in various materials such as alumina,various materials such as alumina, zirconium and titanium.zirconium and titanium.  The manufacturer typically supplies theseThe manufacturer typically supplies these as stock shaped abutments, which can beas stock shaped abutments, which can be placed directly on the implants andplaced directly on the implants and modified by the clinician in the mouth.modified by the clinician in the mouth. www.indiandentalacademy.comwww.indiandentalacademy.com
  76. 76.  The technique of preparing them is similar to traditionalThe technique of preparing them is similar to traditional crown and bridge techniques.crown and bridge techniques.  Preparation can be carried out directly in the mouth.Preparation can be carried out directly in the mouth.  This will allow the margins of the abutment to follow theThis will allow the margins of the abutment to follow the gingival contour.gingival contour.  Utilizing standard crown and bridge principle, anUtilizing standard crown and bridge principle, an impression can be recorded of the prepared abutmentsimpression can be recorded of the prepared abutments directly in the mouth.directly in the mouth. www.indiandentalacademy.comwww.indiandentalacademy.com
  77. 77. Impressions duringImpressions during maintenance of removablemaintenance of removable superstructuresuperstructure www.indiandentalacademy.comwww.indiandentalacademy.com
  78. 78.  Maintenance of these is usually confined to rebasing theMaintenance of these is usually confined to rebasing the denture and or replacement of the teeth , and adjusting ordenture and or replacement of the teeth , and adjusting or replacing retainers.replacing retainers.  The basic principle of the procedure is to record anThe basic principle of the procedure is to record an impression of the underlying soft tissue, and theirimpression of the underlying soft tissue, and their relationship with implants and the denturerelationship with implants and the denture  It must be remembered that the impression will not onlyIt must be remembered that the impression will not only record the changes in the soft tissue contours since therecord the changes in the soft tissue contours since the denture was made, but also modify the relationshipdenture was made, but also modify the relationship between these and occlusal plane of the denture.between these and occlusal plane of the denture. www.indiandentalacademy.comwww.indiandentalacademy.com
  79. 79. www.indiandentalacademy.comwww.indiandentalacademy.com
  80. 80. Impressions for solderingImpressions for soldering the frameworksthe frameworks www.indiandentalacademy.comwww.indiandentalacademy.com
  81. 81.  It may be necessary to solder a framework in certain situation.It may be necessary to solder a framework in certain situation.  If the fit of the framework on the abutments is not exact or If anIf the fit of the framework on the abutments is not exact or If an abutment must be replaced by one of a different length.abutment must be replaced by one of a different length.  If the fit is poor, an impression of the separate sections of theIf the fit is poor, an impression of the separate sections of the framework must be made for solderingframework must be made for soldering.. www.indiandentalacademy.comwww.indiandentalacademy.com
  82. 82. www.indiandentalacademy.comwww.indiandentalacademy.com
  83. 83. Impressions forImpressions for maxillofacial implantsmaxillofacial implants www.indiandentalacademy.comwww.indiandentalacademy.com
  84. 84. www.indiandentalacademy.comwww.indiandentalacademy.com
  85. 85. www.indiandentalacademy.comwww.indiandentalacademy.com
  86. 86. www.indiandentalacademy.comwww.indiandentalacademy.com
  87. 87. www.indiandentalacademy.comwww.indiandentalacademy.com
  88. 88. www.indiandentalacademy.comwww.indiandentalacademy.com
  89. 89. www.indiandentalacademy.comwww.indiandentalacademy.com
  90. 90. www.indiandentalacademy.comwww.indiandentalacademy.com
  91. 91. www.indiandentalacademy.comwww.indiandentalacademy.com
  92. 92. www.indiandentalacademy.comwww.indiandentalacademy.com
  93. 93. ConclusionConclusion  Measurable distortion results from the transfer of implantMeasurable distortion results from the transfer of implant positions as recorded with various impression techniquespositions as recorded with various impression techniques  The magnitude of the distortion was similar with theThe magnitude of the distortion was similar with the techniques evaluated.techniques evaluated.  In addition to dimensional changes in the materials used,In addition to dimensional changes in the materials used, positional errors were also attributed to the mechanicalpositional errors were also attributed to the mechanical components used in the transfer process.components used in the transfer process.  The objective is to achieve a passively fitting prosthesis.The objective is to achieve a passively fitting prosthesis. Further work is indicated to isolate a technique that willFurther work is indicated to isolate a technique that will reliably and predictably reproduce the intraoral relationshipreliably and predictably reproduce the intraoral relationship of implant fixtures.of implant fixtures. www.indiandentalacademy.comwww.indiandentalacademy.com
  94. 94. ReferencesReferences Color atlas and text of – dental and maxillofacial implantologyColor atlas and text of – dental and maxillofacial implantology mosby-mosby- wolfewolfe John A Hobkrick, Roger M WatsonJohn A Hobkrick, Roger M Watson ““Color atlas of dental medicine implantologyColor atlas of dental medicine implantology” Theime Publishers” Theime Publishers.. Hubertus SpiekermannHubertus Spiekermann Color atlas the Branemark system of oral reconstructionColor atlas the Branemark system of oral reconstruction ishiyakuishiyaku euroamerica, inceuroamerica, inc. Richard A Rasmussen. Richard A Rasmussen Dental implant prostheticsDental implant prosthetics"" Mosby.Mosby. Carl E. MischCarl E. Misch ““Dental implants the art and scienceDental implants the art and science” W.B. Saunder” W.B. Saunder Charles BabbushCharles Babbush www.indiandentalacademy.comwww.indiandentalacademy.com
  95. 95. ““Implant dentistryImplant dentistry”” 22ndnd edition, Mosby.edition, Mosby. Carl E. MischCarl E. Misch Implants in dentistryImplants in dentistry.. SaundersSaunders Michael, John Kent ,LuisMichael, John Kent ,Luis Introducing dental implantsIntroducing dental implants Churchill LivingstoneChurchill Livingstone John A HobkrickJohn A Hobkrick Roger M WatsonRoger M Watson Osseointegration and occlusal rehabilitationOsseointegration and occlusal rehabilitation”” QuintessenceQuintessence Publishing.-Publishing.- Hobo, Ichida, GarciaHobo, Ichida, Garcia Restorative dentist manualRestorative dentist manual www.indiandentalacademy.comwww.indiandentalacademy.com
  96. 96. www.indiandentalacademy.comwww.indiandentalacademy.com

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