A multiple tray impression technique for implant retained orbital pro/ oral surgery courses sthesis

A multiple tray impressionA multiple tray impression
technique for implant retainedtechnique for implant retained
orbital prosthesis - A revieworbital prosthesis - A review
INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing Dental EducationLeader in continuing Dental Education
www.indiandentalacademy.comwww.indiandentalacademy.com

Introduction:Introduction:
• Current methods of retaining facialCurrent methods of retaining facial
prostheses use eitherprostheses use either
AdhesivesAdhesives
Anatomic undercutsAnatomic undercuts
Attachments to oral prostheses or Osseo-Attachments to oral prostheses or Osseo-
integrated implants.integrated implants.

• Many patients requiring orbital prosthesesMany patients requiring orbital prostheses
undergo radiation treatment and theundergo radiation treatment and the
tissues which support and retaintissues which support and retain
prosthesis may be irritated by adhesiveprosthesis may be irritated by adhesive
placement and removal.placement and removal.

• In addition , the tissue surface of siliconeIn addition , the tissue surface of silicone
prostheses fabricate on the stone cast isprostheses fabricate on the stone cast is
rough and may act as an irritant andrough and may act as an irritant and
produce tissue abrasion.produce tissue abrasion.

• Implants can support and retain an orbitalImplants can support and retain an orbital
prosthesis.prosthesis.
• A history of radiation to the anatomic siteA history of radiation to the anatomic site
generally contraindicates the use ofgenerally contraindicates the use of
implants.implants.

• The advent of hyper baric oxygen therapyThe advent of hyper baric oxygen therapy
has made possible the use of Osseohas made possible the use of Osseo
integrated implants for patients who haveintegrated implants for patients who have
had previous radiation therapy.had previous radiation therapy.

• Making impression of orbital area, withMaking impression of orbital area, with
accurate transfer of implants, can be aaccurate transfer of implants, can be a
difficult procedure.difficult procedure.

• The use of multiple acrylic resin customThe use of multiple acrylic resin custom
trays and polyvinyl siloxane impressiontrays and polyvinyl siloxane impression
material allows the proper reproduction ofmaterial allows the proper reproduction of
all soft and hard tissue detail and theall soft and hard tissue detail and the
position of the implants.position of the implants.

• In this manner, the superstructure can beIn this manner, the superstructure can be
fabricated on the master cast with thefabricated on the master cast with the
orbital prosthesis processed on the sameorbital prosthesis processed on the same
cast.cast.

• This technique provides for a vertical pathThis technique provides for a vertical path
of removal for the implant transfer copingsof removal for the implant transfer copings
in the superior and inferior borders of thein the superior and inferior borders of the
orbit.orbit.
• In different implant positions, threeIn different implant positions, three
component trays may suffice.component trays may suffice.

TechniqueTechnique
• After exposure ofAfter exposure of
implants andimplants and
placement of healingplacement of healing
cuffs, make ancuffs, make an
irreversibleirreversible
hydrocolloidhydrocolloid
impression of theimpression of the
defect.defect.

• Pour the impression in dental stone.Pour the impression in dental stone.

• On the primary cast, place approximatelyOn the primary cast, place approximately
5mm of relief wax over the duplicated5mm of relief wax over the duplicated
implant healing cuffs and allow adequateimplant healing cuffs and allow adequate
space for impression material.space for impression material.

• Paint the cast with a release agent.Paint the cast with a release agent.

• Fabricate the acrylicFabricate the acrylic
resin custom trays.resin custom trays.
• Make the traysMake the trays
triangular in shapetriangular in shape
and separated fromand separated from
each other toeach other to
separate the defectseparate the defect
into superior andinto superior and
inferior parts.inferior parts.

• Make a third middleMake a third middle
tray over the othertray over the other
trays in position ontrays in position on
the cast.the cast.

• Make the external matrixMake the external matrix
[fourth] tray by lubricating[fourth] tray by lubricating
the external surfaces ofthe external surfaces of
the three internal trays onthe three internal trays on
the preliminary cast andthe preliminary cast and
form the matrix over theform the matrix over the
internal trays.internal trays.

• When set, remove the external matrix trayWhen set, remove the external matrix tray
and perforate it with no 8 round bur toand perforate it with no 8 round bur to
enhance mechanical retention of theenhance mechanical retention of the
impression material.impression material.

• Remove and polish the trays.Remove and polish the trays.

• Place appropriatePlace appropriate
abutments on theabutments on the
implants.implants.
• Try the fit of the traysTry the fit of the trays
and access forand access for
adaptation to theadaptation to the
defect.defect.

• Lightly lubricate the hair in the region withLightly lubricate the hair in the region with
a petroleum based lubricant.a petroleum based lubricant.

• Place the implantPlace the implant
transfer componentstransfer components
in position.in position.
• Again assess theAgain assess the
trays for unobtrusivetrays for unobtrusive
fit over the implantfit over the implant
component.component.

• Paint the trays with proper adhesive andPaint the trays with proper adhesive and
allow to dry.allow to dry.

• Make the inferiorMake the inferior
impression by syringingimpression by syringing
impression materialimpression material
around the implantaround the implant
transfer parts, in thetransfer parts, in the
inferior part of the orbit,inferior part of the orbit,
and in the tray.and in the tray.
• Gently seat the tray intoGently seat the tray into
place and remove theplace and remove the
excess material.excess material.

• The material should be confined to theThe material should be confined to the
inferior part of the orbit and should captureinferior part of the orbit and should capture
the desired perimeter of the defect.the desired perimeter of the defect.

• Lightly lubricate theLightly lubricate the
external aspect of theexternal aspect of the
inferior impressioninferior impression
with petroleum jelly.with petroleum jelly.
• Make the superiorMake the superior
impression in theimpression in the
same manner.same manner.

• If a middle tray is used,If a middle tray is used,
check the clearance ofcheck the clearance of
the tray.the tray.
• Adjust the tray and makeAdjust the tray and make
an impression withan impression with
sufficient impressionsufficient impression
material to allow joining ofmaterial to allow joining of
all impressions withoutall impressions without
locking one tray to thelocking one tray to the
other.other.

• Adapt the external matrix tray over theAdapt the external matrix tray over the
impressions to assess fit; then paint withimpressions to assess fit; then paint with
adhesive and allow to dray.adhesive and allow to dray.

• With impressionWith impression
material at each end.,material at each end.,
gently seat thegently seat the
external matrix trayexternal matrix tray
over the impressionover the impression
trays and allowed totrays and allowed to
set.set.

• Disassemble theDisassemble the
impressions in theimpressions in the
reverse order.reverse order.

• Place the appropriatePlace the appropriate
implant transferimplant transfer
analogs in theanalogs in the
impressions.impressions.

• Reassemble theReassemble the
impressions and useimpressions and use
sticky wax to securesticky wax to secure
them together.them together.

• Box and pour the impression in type 4Box and pour the impression in type 4
dental stone.dental stone.

conclusionconclusion
• The advantages of this method are accuracyThe advantages of this method are accuracy
and removal of impressions on implants that areand removal of impressions on implants that are
placed in opposing positioned a limited space,placed in opposing positioned a limited space,
which precludes removal of a one-partwhich precludes removal of a one-part
impression.impression.
• This allows fabrication of the superstructureThis allows fabrication of the superstructure
required and the final orbital prostheses on therequired and the final orbital prostheses on the
samesame

Thank youThank you

A multiple tray impression technique for implant retained orbital pro/ oral surgery courses sthesis

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