Dental Implant Impressions: Steps to Easier and More Predictable Results

Dental Implant Impressions: Steps to Easier and More Predictable Results Program Support Provided by Hager Worldwide Gregori M. Kurtzman, DDS, MAGD, FACD, FPFA, DICOI, DADIA General Practitioner Silv er Spring, Mary land Impressions are an integral part of restoring implants, be it a fixed or removable prosthesis. Unlike prosthetics for natural teeth that have a PDL allowing micromovement, implants are rigidly fixated in the bone. An accurate impression not only determines how the prosthesis fits the implants intraorally, but can affect bone stability long-term. Passive fit starts with an accurate impression and Passive fit is critical to long-term survival of the implants 1

Closed Tray verses Open Tray Closed Tray Advantages: Easier technically Easier in restricted vertical of posteriors Disadvantage: Potential inaccuracies in positioning of implant fixtures Potential for indexing and orientation between implant and impression material Open Tray Advantages: Accurate indexing Accurate orientation between the impression head and the impression Accurate positioning between the fixtures Disadvantage: Difficult to use in restricted vertical of posterior in some patients A little more technical 2

Closed Tray vs Open Tray? Closed tray is used for; Preliminary study models Impressions for stud attachments to be lab fabricated Open tray is used for; Fixed prosthetics (single or multiple units) Bar-overdentures Anything where plateform orientation needs to be captured Impression coping Closed Tray Open Tray Impression coping Implant Closed Tray Open Tray 3

Impression coping Analog Closed Tray Open Tray Closed Tray Technique Closed Tray Which Impression Material 4

As the impression coping will be reinserted back into the impression material after the impression is removed intraorally and then the impression coping is removed from the implants an impression material is utilized in the tray that will allow the coping to be reinserted without damaging the impression Medium-body (monophase) VPS - when fixture level used Heavy-body or Tray VPS when abutment level snap cap used A light-body or medium-body (monophase) VPS is injected around the impression copings intraorally to capture the gingiva Types of Closed Tray Impressions 1. Fixture level closed tray impression head: Used if a custom abutment is to be used or prosthesis fabricated at fixture level. 2. Abutment level closed tray impression head: Used if a stock abutment is being used that will not require any modifications. 5

Fixed Level Closed Tray Technique 6

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Closed tray impression intraorally. Indexing matching the closed tray impression head in the impression. 8

Closed tray impression head with analog being positioned in the impression to match the indexing. Abutment Level Closed Tray Technique Snap on impression coping upon the abutment head intraorally. 9

Snap on impression coping embedded in the impression. Analog being positioned into the snap on impression coping embedded in the impression. Analog snapped into impression coping embedded in the impression. 10

Healing screw in implant ready for restoration. Implant ready for abutment placement. Implant abutment head placed on the implant. 11

Snap on impression head on the abutment head. Snap on impression head embedded in the impression. Analog snapped into the snap on impression head embedded in the impression. 12

Multiple units, snap on impression heads placed on each implant abutment head. Snap on impression heads imbedded in the impression. Open Tray Technique 13

Open Tray Which Impression Material As the impression coping will be locked into the impression material and removed with the impression intraorally a stiff setting material is utilized in the tray Heavy-body VPS Putty VPS Tray VPS Polyether (Impregum) Do Not Use a Bite Material VPS! A light-body or medium-body (monophase) VPS is injected around the impression copings intraorally to capture the gingiva and avoid any pulls or drags that may result from the stiffer material in the tray. 14

Open tray impression head affixed intraorally with long pin. 15

Modified Stock Tray Custom Tray Open tray impression with long pin protruding through the tray. 16

Analogs are attached to the embedded open tray impression copings Open tray impression head embedded in the impression after intraoral removal. Analog affixed to the open tray impression coping embedded in the impression. 17

An Easier Method for Open Tray Impressions Miratray Implant Advanced (Hager Worldwide) Available from most dental suppliers Clear cellophane cover 18

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Verification Stents Why Make a Verification Stent? Dental Materials Shrink Impression Material Model Stone Passive fit Frameworks need to be passively fitting to remove lateral loads on individual fixtures which can lead to bone loss over time 23

Closed Tray: Verification Stents Depending on Impression Method: Done extraorally by the DDS or Lab to verify the accuracy of the master model before proceeding to prosthetic fabrication Requires an extra appointment AFTER the implant impression is made Open Tray: Can be done intraorally with open tray impression copings then incorporated into the implant impression Shortens verification of the master model by 1 appointment Need to inform the lab that a verification stent is incorporated into the impression as they can not see it and may return a verification stent to check the master model Method 1: Tray and Gel Extraoral 24

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Method 2: Gel & Floss Extraoral or Intraoral 30

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Importance of Taking Radiographs to Verify Part Seating 33

How do we better communicate gingival position established by the implant temporary to the lab? 34

Anterior Implant Esthetics Esthetic gingival contour transfer in an anterior implant prosthetic case. Da v i d Ku rtz ma n, DDS; Greg o rim. Ku rt z ma n, DDS; L e e H. Si l ve rst e i n, DDS, MS; Pe t e r Shatz, DDS Inside Dentistry, January 2010, Vol. 6 Issue 1. Anterior Implant Esthetics Esthetic gingival contour transfer in an anterior implant prosthetic case. Da v i d Ku rtz ma n, DDS; Greg o rim. Ku rt z ma n, DDS; L e e H. Si l ve rst e i n, DDS, MS; Pe t e r Shatz, DDS Inside Dentistry, January 2010, Vol. 6 Issue 1. Anterior Implant Esthetics Esthetic gingival contour transfer in an anterior implant prosthetic case. Da v i d Ku rtz ma n, DDS; Greg o rim. Ku rt z ma n, DDS; L e e H. Si l ve rst e i n, DDS, MS; Pe t e r Shatz, DDS Inside Dentistry, January 2010, Vol. 6 Issue 1. 35

Anterior Implant Esthetics Esthetic gingival contour transfer in an anterior implant prosthetic case. Da v i d Ku rtz ma n, DDS; Greg o rim. Ku rt z ma n, DDS; L e e H. Si l ve rst e i n, DDS, MS; Pe t e r Shatz, DDS Inside Dentistry, January 2010, Vol. 6 Issue 1. Illustration: David Kurtzman, DDS Anterior Implant Esthetics Esthetic gingival contour transfer in an anterior implant prosthetic case. Da v i d Ku rtz ma n, DDS; Greg o rim. Ku rt z ma n, DDS; L e e H. Si l ve rst e i n, DDS, MS; Pe t e r Shatz, DDS Inside Dentistry, January 2010, Vol. 6 Issue 1. Anterior Implant Esthetics Esthetic gingival contour transfer in an anterior implant prosthetic case. Da v i d Ku rtz ma n, DDS; Greg o rim. Ku rt z ma n, DDS; L e e H. Si l ve rst e i n, DDS, MS; Pe t e r Shatz, DDS Inside Dentistry, January 2010, Vol. 6 Issue 1. 36

Anterior Implant Esthetics Esthetic gingival contour transfer in an anterior implant prosthetic case. Da v i d Ku rtz ma n, DDS; Greg o rim. Ku rt z ma n, DDS; L e e H. Si l ve rst e i n, DDS, MS; Pe t e r Shatz, DDS Inside Dentistry, January 2010, Vol. 6 Issue 1. Illustration: David Kurtzman, DDS Anterior Implant Esthetics Esthetic gingival contour transfer in an anterior implant prosthetic case. Da v i d Ku rtz ma n, DDS; Greg o rim. Ku rt z ma n, DDS; L e e H. Si l ve rst e i n, DDS, MS; Pe t e r Shatz, DDS Inside Dentistry, January 2010, Vol. 6 Issue 1. Anterior Implant Esthetics Esthetic gingival contour transfer in an anterior implant prosthetic case. Da v i d Ku rtz ma n, DDS; Greg o rim. Ku rt z ma n, DDS; L e e H. Si l ve rst e i n, DDS, MS; Pe t e r Shatz, DDS Inside Dentistry, January 2010, Vol. 6 Issue 1. 37

Anterior Implant Esthetics Esthetic gingival contour transfer in an anterior implant prosthetic case. Da v i d Ku rtz ma n, DDS; Greg o rim. Ku rt z ma n, DDS; L e e H. Si l ve rst e i n, DDS, MS; Pe t e r Shatz, DDS Inside Dentistry, January 2010, Vol. 6 Issue 1. Illustration: David Kurtzman, DDS Anterior Implant Esthetics Esthetic gingival contour transfer in an anterior implant prosthetic case. Da v i d Ku rtz ma n, DDS; Greg o rim. Ku rt z ma n, DDS; L e e H. Si l ve rst e i n, DDS, MS; Pe t e r Shatz, DDS Inside Dentistry, January 2010, Vol. 6 Issue 1. Anterior Implant Esthetics Esthetic gingival contour transfer in an anterior implant prosthetic case. Da v i d Ku rtz ma n, DDS; Greg o rim. Ku rt z ma n, DDS; L e e H. Si l ve rst e i n, DDS, MS; Pe t e r Shatz, DDS Inside Dentistry, January 2010, Vol. 6 Issue 1. 38

Anterior Implant Esthetics Esthetic gingival contour transfer in an anterior implant prosthetic case. Da v i d Ku rtz ma n, DDS; Greg o rim. Ku rt z ma n, DDS; L e e H. Si l ve rst e i n, DDS, MS; Pe t e r Shatz, DDS Inside Dentistry, January 2010, Vol. 6 Issue 1. Dental Implant Impressions: Steps to Easier and More Predictable Results Thank You! Gregori M. Kurtzman, DDS, MAGD, FACD, FPFA, DICOI, DADIA General Practitioner Silv er Spring, Mary land 39