An evaluation of impression techniques for multiple internal connection implant prostheses

Evaluation of Dimensional Change in Different Elastomeric Impression Materials Used in Implants: An Original Research

Aim

The study's objective was to assess the dimensional accuracy of hybrid polyether and polyvinyl siloxane materials for implant impressions.

Materials and Methods

Nine groups were created from 45 samples of various building materials and construction techniques from the study. Five samples were tested, and 45 impressions were recorded.

Results

The hybrid non-splinted technique has improved implant site replication, accuracy, and low interimplant distance alterations.

Conclusion

The finest possible reproduction of implant sites on the master cast was made feasible by the use of an open, non-splinted method and a hybrid polyvinyl siloxane-polyether impression material.

Accuracy of digitally coded healing abutments: A systematic review

The aim of this systematic review was to evaluate the in vitro accuracy of dental implant impressions taken using digitally coded healing abutments (CHAs) compared with impressions taken with conventional techniques (CI) and/or within the CHA group at varying degrees of angulations for multiple implant units. Two independent reviewers conducted a systematic electronic search in the MedLine, PubMed, Google Scholar, Cochrane Library, Web of Science, and Scopus databases. Some of the employed key terms, combined with the help of Boolean operators, were: "digitally coded healing abutments", "encode healing abutment", "dental implants", "impression accuracy", "digital impression", and "conventional impression". Publication dates ranged from January 2010 to November 2022. A total of 7 articles fulfilled the inclusion criteria: 6 studies compared the accuracy of CHA with conventional pick-up impression techniques, and one study only used CHAs at different angulations and heights to compare accuracy within the group. The results were divided into Group A (elastomeric impression of CHA) and Group B (CHA + Intraoral scanner). According to the results of this systematic review, elastomeric impression of CHA performed poorly when compared to CI for multiple implants, although an intraoral scan of CHA appears to be more accurate. Within the CHA group, the angulation and visible height of CHA play a significant role in impression accuracy. However, more studies are needed before CHA can be recommended for all non-parallel multiple implant-supported restorations.

Accuracy of Selective Laser Melted Bar Retaining Mandibular Implant-Assisted Overdenture: An In Vitro Comparison of Different Impression Materials and Techniques

This study aimed to assess the accuracy of the marginal fit of 2 implant-supported overdenture bars fabricated with selective laser melting technology, using polyvinyl siloxane and vinyl siloxane ether impression materials and different impression techniques. Two implants with multi-unit abutments were inserted in a 3D-printed mandibular model and used as a reference model, then duplicated into a stone cast to fabricate custom trays for obtaining impressions with polyvinyl siloxane and vinyl siloxane ether impression materials, using both open and closed-tray techniques. This resulted in a total of 4 groups, each with 8 specimens. The impressions were poured and scanned, and 32 cobalt-chromium bars were fabricated using selective laser melting technology. Each bar was screwed onto one abutment of the reference model, and a standardized digital periapical radiograph of the opposite unscrewed side was taken; this process was repeated to the other abutment. The vertical misfit was measured at 3 predetermined positions on the unscrewed side, and 6 values per bar were recorded. The mean gap distance was measured, and the data were subjected to statistical analysis; the present study found that the open-tray technique with vinyl polyether siloxane impression material may offer improved accuracy for obtaining impressions for 2 implant-supported bars. The open-tray technique groups also showed better marginal fit than the closed-tray groups. However, further clinical research is required to confirm these findings.

A digital approach to create a virtual implant preliminary cast for the fabrication of a splinted framework and custom open tray for multiple implants impression making: A dental technique

A digital approach is described for fabricating a splinted framework and custom open tray for the impression of multiple implants based on a virtually created implant cast with the digital prediction of the future impression coping positions. In this technique, impression copings to be used in the definitive impression-making process were digitally scanned and aligned to a preliminary cast using installed protective caps of screw-retained abutments as references, which resulted in a virtual cast that offers information both about the impression coping positions and their surrounding tissues and could allow a splinted framework and custom open tray to be digitally designed and fabricated. Creation of a virtual cast through digital technologies eliminates the traditional manual splinted framework and custom tray fabrication procedures. Additionally, only one set of impression copings and analogs is needed in this technique, thereby reducing treatment time and cost. It also offers a splinted framework and custom open tray with consistent quality.

Optimal impression materials for implant-supported fixed complete dentures: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Although polyvinyl siloxane (PVS) materials and polyether (PE) materials have been the recommended materials for making impressions for implant-supported fixed complete dentures (IFCDs), a consensus regarding the optimal impression materials has yet to be established.

PURPOSE

The purpose of this systematic review and meta-analysis was to evaluate the effect of impression materials on the accuracy of conventional impressions for IFCDs and to provide guidance for selecting the optimal impression material.

MATERIAL AND METHODS

The PubMed, Web of Science, and Embase databases were searched and supplemented via hand searches. Studies comparing the accuracy of conventional impressions for IFCDs by using PVS and PE materials with either direct (open-tray) or indirect (closed-tray) techniques were included. Linear distance deviations and angular deviations between adjacent implants were evaluated. The mean difference (MD) with a 95% confidence interval (CI) was calculated for continuous data. A subgroup analysis was conducted to evaluate the impact of implant angulation (α=.05).

RESULTS

Among the 597 publications identified, 27 in vitro studies were included for qualitative analysis, and 12 were included for quantitative analysis. The general analysis revealed no significant differences in linear distance and angular deviations between the 2 impression materials with the direct or indirect technique. The subgroup analysis found that a statistically significant difference in linear distance deviations was found when implants were placed at an angle greater than 15 degrees, favoring PE materials when using the direct technique (P=.010, MD: 32.54 µm; 95% CI: 6.83 to 58.24) and indirect technique (P=.020, MD: 138.15 µm, 95% CI: 19.17 to 257.13). However, only 2 relevant studies assessed the indirect technique.

CONCLUSIONS

When providing IFCDs, conventional impressions obtained by using PVS and PE materials were found to have similar accuracy in most scenarios. PE materials yielded better outcomes when implants were placed at an angle greater than 15 degrees.

Evaluation of the dislodgement force of splinted restorations with engaging conical abutments over multiple nonparallel implants (in-vitro study)

BACKGROUND

Splinted multiunit cement-retained restorations with screw access channels over engaging abutments are viable implant prosthetic options. However, information regarding the maximum degree of divergence between multiple implants is lacking. The purpose of this in vitro study was to determine the maximum degree of divergence between 2 adjacent implants with conical connections that allows insertion and removal of splinted restorations with engaging preparable abutments or titanium base abutments.

METHODS

Two implants were aligned in a stone base, one straight and the other at an angle ranging from 0 to 20 degrees. The implants represented an implant system that had an internal conical connection and a hexed abutment engaging the base of the connection. Two straight preparable engaging cement retained abutments were screwed onto the implants and splinted together using acrylic resin. A total of 11 angles were tested, with 7 specimens for every angle. Evaluation of dislodging force was performed by pulling out the splinted abutments after unscrewing them. This was performed subjectively by 3 blinded investigators who applied a tactile pulling force. A scale of 0-10 was used to estimate the pulling force. Objectively the dislodging force was measured in Newtons using a universal testing machine. A statistical correlation was made between the subjective and objective dislodging force values using Spearman's rank correlation coefficient.

RESULTS

The mean subjective values increased gradually from 0 to 16 degrees. A sudden rise was noticed at 18 degrees (9.71 ± 0.23) and, at 20 degrees, the investigators were not able to remove the splinted abutments from the implants. The mean objective dislodgement force values increased gradually from 0 to16 degrees and abruptly from 16 degrees (13.57 ± 0.45 N) to 18 degrees (25.40 ± 0.66 N) and 20 degrees (35.22 ± 0.64). The correlation between the subjective and the objective evaluations assessed using the Spearman's rank correlation coefficient was 0.98 indicating a statistically significant correlation (P < .001). As the objective dislodging force increased, the subjective dislodgement difficulty increased.

CONCLUSIONS

Splinting cement retained restorations with screw access channels on engaging abutments is possible when multiple implants with conical connections having an internal flare angle of 8 degrees are used, with implant divergence of up to 16 degrees.

Predictability of intraoral scanner error for full-arch implant-supported rehabilitation

OBJECTIVES

The present study aimed to analyze the behaviors of three intraoral scanners (IOSs): evaluating the interdistance and axial inclination discrepancies in full-arch scans, predictable errors were searched.

MATERIALS AND METHODS

Six edentulous sample models with variable numbers of dental implants were used; reference data were obtained with a coordinate-measuring machine (CMM). Each IOS (i.e., Primescan, CS3600, and Trios3) performed 10 scans per model (180 total scans). The origin of each scan body was used as a reference point to measure interdistance lengths and axial inclinations. Precision and trueness of interdistance measurements and axial inclinations were evaluated to address error predictability. Bland-Altman analysis, followed by linear regression analysis and Friedman's test (plus Dunn's post hoc correction), was performed to evaluate the precision and trueness.

RESULTS

Regarding interdistance, Primescan showed the best precision (mean ± SD: 0.047 ± 0.020 mm), while Trios3 underestimated the reference value more than the others (p < 0.001) and had the worst performance (mean ± SD: -0.079 ± 0.048 mm). Concerning the inclination angle, Primescan and Trios3 tended to overestimate angle values, while CS3600 underestimated them. Primescan had fewer inclination angle outliers, but it tended to add 0.4-0.6° to the measurements.

CONCLUSIONS

IOSs showed predictable errors: they tended to overestimate or underestimate linear measurements and axial inclinations of scan bodies, one added 0.4-0.6° to the angle inclination values. In particular, they showed heteroscedasticity, a behavior probably related to the software or the device itself.

CLINICAL SIGNIFICANCE

IOSs showed predictable errors that could affect clinical success. When performing a scan or choosing a scanner, clinicians should clearly know their behaviors.

Comparison of accuracy of hexed and nonhexed pickup impression copings in a multiple variable impression setup for recording multiple straight and angulated implant positions: An in vitro study

Aim

The aim of this study was to evaluate and compare the accuracy of hexed and nonhexed pickup impression copings with and without splinting using polyether (PE) and polyvinyl siloxane (PVS) impression materials in open-tray technique in recording multiple straight and angulated implant positions.

Settings and Design

An accurate impression results in an accurate definitive cast, thus minimizing the incidence of prosthesis misfit. The critical aspect is to record the three-dimensional location of the implant in bone rather than reproducing fine surface details. Precise fit of a fixed implant-supported prosthesis depends on the accuracy of the implant analog location within the definitive cast. Factors which affect impression accuracy include implant angulation, impression material, impression copings, technique, and splinting.

Materials and Methods

A sample size of 80 study models fabricated from the impression of different groups was included. A reference master model based on All-on-4 implant concept with two parallel (implants 1 and 2) and two angulated (implant 3 at 17° and implant 4 at 30°) was fabricated using implant angulation guide. All impressions were recorded using open-tray impression technique. The groups were divided into two main groups of 40 samples each. Group A used hexed open-tray impression copings and Group B used nonhexed open-tray impression copings. Both the groups involved impression recording using splinted (Subgroup I) and nonsplinted impression copings (Subgroup II). Further, impressions in each subgroup were made using PE (Subsubgroups a) and PVS (Subsubgroup b). A total of eight subsubgroups with ten samples each were included. Impressions were recorded for each group and poured into Type IV die stone for fabrication of study models. After 24 h, the study models and reference master model were fitted with implant abutments for measurement with coordinate measuring machine.

Statistical Analysis Used

The mean differences of the interimplant distance R1 (1-2), R2 (1-3), R3 (2-4), and R4 (3-4) between the reference model and sample models in different subsubgroups were calculated and three-way analysis of variance test was applied with Tukey's post hoc tests.

Results

No significant difference was found in mean coronal deviations for distance R1, R2, and R3 (P > 0.05) between different study groups. P = 0.02 for R4 (distance between 17° and 30° implants) between impression materials subsubgroups suggested that significantly less distortion was created in location of highly angulated implants (>30°) using PVS impression material. Splinting and type of coping did not have a significant influence on impression accuracy. Increasing angulation decreased the accuracy.

Conclusion

PVS was found equivalent in accuracy to rigid PE for recording parallel or angulated implants. Impressions of implants with higher angulations were recorded more accurately with PVS. The study found no difference in accuracy with or without splinting. Furthermore, nonhexed impression copings facilitate easier and accurate recording of multiple angulated implant location in bone.

Digital Analysis of the Dimensional Change Of an Irreversible Hydrocolloid Impression Material (Alginate) with Varying Storage Times

AIM

The aim of this study was to digitally measure the dimensional changes in an irreversible hydrocolloid impression material (alginate) resulting from varying storage times under optimal storage conditions.

MATERIALS AND METHODS

A single type V dental stone control cast was used to make 25 alginate impressions using perforated stock trays. The impressions were randomly assigned into five groups of five samples each (n=5 per group) with varying storage times: Group 1, poured at 15 minutes; Group 2, poured at one hour; Group 3, poured at 24 hours (one day); Group 4, poured at 72 hours (three days); Group 5, poured at 168 hours (seven days). All impressions were stored in sealed Ziploc® plastic bags with a wet paper towel (100% relative humidity) at room temperature and stored according to the assigned group storage times. All impressions were poured in type V dental stone according to the manufacturer's instructions. The casts were scanned with a digital 3D desktop scanner and saved as electronic stereolithography (.stl) files. Each .stl file of the scanned casts were superimposed on the .stl file of the control cast using Geomagic® Control X™ software. Three preselected fixed comparison measuring points (CMP) on each cast were compared to the control cast. Point one (CMP1) was on the midfacial surface of central incisor. Point two (CMP2) and point three (CMP3) were on the mesiobuccal proximal marginal ridge areas of third molars. The discrepancies between the files at each point were analysed with colour maps, and quantified (Table 1). The tolerance was set at ±10μm. CMP scores were analysed using one-way analysis of variance (ANOVA) and Kruskal-Wallis (K-W) non-parametric H tests.

RESULTS

Average gap distances across groups ranged from 0.04mm (seven-day group) to 0.06mm (one hour and 24-hour groups). Colour maps indicated increased dimensional change with increased storage time up to one day. After three days, shrinkage up to 139μm was measured. ANOVA results for CMP1 (F[4,20] = 1.65, p = 0.020) and CMP3 (F[4,20] = 0.44, p = -0.78) were not statistically significant. Similarly, K-W results for CMP2 were not significant (χ²= 3.62, p = 0.46).

CONCLUSIONS

Under optimal storage conditions, there were no significant dimensional changes in casts poured from alginate up to seven days.

A Literature Review on Implant Abutment Types, Materials, and Fabrication Processes

Dental implantology has made great strides since Dr. Brånemark introduced it to the world of dentistry. In terms of materials and fabrication processes, a wide range of implants and their implant abutments are now widely available in the market. Such a wide range would undoubtedly put the clinician in a quandary when it comes to selecting an acceptable abutment, one that is scientifically based and also has a high clinical rate of success. As a result, this literature review is a straightforward attempt to shed light on the wide range of implant-abutment types, materials and fabrications that are now easily accessible on the market, as well as offer an overview of each specific type to avoid further dilemma for its clinical intent.

Accuracy of the Different Materials Used to Fabricate a Verification Jig of Implant-Supported Fixed Complete Dental Prostheses: An In Vitro Study

Introduction

The passive fit of a full arch implant-supported prosthesis is one of the elements influencing implant success. Achieving the passive fit of a prosthesis requires verification of the master cast before the fabrication of the framework. A verification jig is a common way to verify the implant master cast and ensure the accuracy of the implant impression and produced cast. Different materials can be used to fabricate verification jigs, and each material exhibits different dimensional changes. In this study, we compared the accuracies of verification jig materials by 3D assessment.

Materials and methods

A type IV stone cast with four implant analogs was constructed and used as a control. Verification jigs were constructed from five different materials, and test casts were made from these jigs and poured using low expansion stone (type IV), resulting in five groups (n=5). All test casts and the control cast were scanned using a lab scanner. The scans of test casts were superimposed on that of the control cast for 3D accuracy assessment. The distortion of the implant analogs was recorded using Geomagic Design X and Geomagic Control X software (3D Systems, Rock Hill, South Carolina, USA). Statistical differences in the 3D accuracies between the five groups were analyzed using the Kruskal-Wallis test.

Result

The photopolymerizable resin group had a mean value of 23.16 (± 0.88) µm; the composite group had a mean value of 46.72 (± 2.122) µm; the GC pattern group had a mean of 23.51 (± 0.736) µm; the type III stone group had a mean of 19.84 (± 1.017) µm; the type IV stone group had a mean of 18.72 (± 0.819) µm. The Kruskal-Wallis test indicated that there were statistically significant differences between groups 2 (composite), 4 (type III stone), and 5 (type IV stone). 

Conclusion

The most accurate cast was produced by type IV stone, followed by type III stone, photopolymerizable resin, GC pattern, and composite in order of decreasing accuracy. Within the limitations of the study, a material with low distortion and high accuracy is recommended when fabricating verification jigs of implant-supported complete dental prostheses.

The impact of impression coping geometrical design on accuracy of implant impressions: an experimental study

AIM

This in vitro study aimed to evaluate the effect of implant impression coping geometrical designs on the accuracy of open and closed impression techniques and in the parallel and nonparallel implant positions.

MATERIAL AND METHODS

Three custom-made acrylic resin models of three tested implant systems (Straumann®, SIC Invent®, and Osstem®) with diverse coping geometrical designs were evaluated in simulated cases of two parallel and two nonparallel implants. The horizontal and vertical discrepancies were measured and analyzed.

RESULTS

No statistically significant differences between the two impression techniques in either parallel or nonparallel implants were observed. The high retentive design of the Osstem system showed a statistically significant difference.

CONCLUSION

The geometrical design of the impression copings did not affect the accuracy for either the open and closed tray techniques. However, the high retentive coping design of the Osstem implant affected the accuracy in the open tray technique.

Comparison of the accuracy of different impression procedures in case of multiple and angulated implants : Accuracy of impressions in multiple and angulated implants

Background

There is no consensus in the literature regarding the impression procedures in the presence of multiple and angulated implants.

Methods

Three maxillary master models with 6 implants bilaterally positioned in anterior, premolar and molar regions were fabricated. In model 1, all implants were placed in parallel; in models 2 and 3, anterior implants were buccally inclined and posterior implants were distally inclined in 10- and 20-degrees, respectively. Three different impression copings (hexed, non-hex, multi-unit) and two different impression techniques (splinting and non-splinting) were tested. A total of 180 impressions (n = 10 per group) were made using mono-phase vinyl poly-siloxane. Master models and duplicate casts were scanned by a 5-axis laboratory scanner and data were transferred to a software program for the alignment of master and duplicate copings. Coronal and angular deviations were calculated, and data were statistically analyzed.

Results

For angulated models, the lowest deviation values were detected at the splinted non-hex coping group (P < 0.05).

Conclusions

Implant angulation, impression coping type, and splinting the impression copings had significant effects on the accuracy of impressions.

Trial registration

Not applicable.

Implant-supported fixed hybrid acrylic complete dentures opposing fully restored mandibular metal ceramic restorations

This report presents a full-mouth rehabilitation case. A patient came with a failing dentition in maxilla, and after the treatment, the patient had a shortened full-arch, implant-supported, screw-retained hybrid acrylic complete denture in the maxilla and full-arch metal ceramic restorations in the mandible. The report describes the steps involved in the prosthodontic rehabilitation; a cost-effective treatment plan, the restoration of vertical dimension, an immediate denture, an implant-level impression, a verified-master cast, the fabrication of definitive prosthesis, the occlusal scheme and multiple follow-ups in 6 months. We discussed the merits/demerits of screw-retained prosthesis, impression techniques and various types of fixed complete dentures. We learnt the difficulty in hygiene measures and dissatisfaction of the patient with the hygienic gaps under the acrylic fixed dentures.

Photogrammetric and Intraoral Digital Impression Technique for the Rehabilitation of Multiple Unfavorably Positioned Dental Implants: A Clinical Report

The aim of this clinical report is to describe the use of the photogrammetric system and intraoral scanning as a reliable technique to record the 3-dimensional implant positions of a full-arch maxillary implant–supported fixed rehabilitation in which the implants were unfavorably positioned. The stereo camera of the photogrammetric system was used to capture the 3-dimensional panoramic position of the implants. The information on soft tissues was obtained with an intraoral scanner. Then, the 2 digital files (standard tessellation language [STL] files) were subsequently superimposed using a best-fit alignment function to generate the definitive digital model with information on teeth, soft tissues, and implants.

The Influence of Impression Material on the Accuracy of the Master Cast in Implant Restorations

Aim:

The precise framework fit is important for the success of implant restorations. The purpose of the present study was to examine the effect of two different impression materials both of their medium viscosity on the master cast accuracy when parallel and inclined implants were used.

Materials and Methods:

An epoxy master cast with three implants was fabricated. The first two implants were parallel to each other and perpendicular to the horizontal plane and the third implant had a 250 inclination in reference to the other two. A passively fitting metal framework that was fabricated over this master cast was used to measure accuracy of fit. Five closed tray impressions for each medium viscosity material (polyether and polyvinyl-siloxane) tested were taken and the respective ten stone casts with three implant analogs were fabricated. The metal framework in the master cast, was fixed in the new specimens and the micro-gap between this prosthesis and the implant analogs was evaluated. The specimens were observed to an optical microscope and digital photography.

Results and Conclusion:

The data were statistically analysed using a computer software and t-test. Polyether exhibited higher micro-gap mean values (93,4 to 61,8 μm) compared to polyvynil siloxane (30,47 to 14,83μm). The differences were statistically significant only for implant B. The categorical regression analysis (p < 0.01) for all implants showed that the marginal micro-gap was affected by the impression material (94.1%) and significantly by the type of it. The micro-gap values were higher for polyether compared to polyvinyl-siloxane. The torqued implant did not exhibit any statistically significant effect.

Strain Gauge Evaluation of Transfer Impression Techniques of Multiple Implant-Supported Prosthesis

PURPOSE

This in vitro study assessed the accuracy of multiple implant-level impression techniques (open tray and closed tray) for the fabrication of 3-unit implant prostheses with strain gauge (SG) analysis.

MATERIALS AND METHODS

A polyurethane master model was designed to simulate a clinical situation. Two rigid custom trays were fabricated for the model. The impression material used was polysulfide. Transfer implant impressions were made using 2 techniques; ten tapered copings not splinted (custom closed tray) and ten square copings splinted with acrylic-resin (custom open tray). The improved stone models were allowed to set for 1 hour before being separated from the impression. The superstructures were sprued, invested, and cast with a cobalt-chromium alloy. Four SGs were bonded on the surface of each polyurethane block.

RESULTS

A statistically significant difference was found between the 2 impression techniques tested (P = 0.000). This study found a significant average difference of 144.68 ± 5.53 με for open custom tray and 253.3 ± 16.7 με for closed custom tray.

CONCLUSION

The custom open tray technique was the most accurate impression for multiple implants compared with closed custom tray.

Cast accuracy obtained from different impression techniques at different implant angulations (in vitro study)

Background

Angulated implants may result in inaccurate impressions, and the impression technique may affect the accuracy of the definitive cast. This study was designed to compare the dimensional accuracy of casts obtained from three impression techniques for three definitive lower casts with implants at different angulations.

Methods

Three Osseolink implants were placed in three reference models with different angles (parallel, 15° and 30°). Impressions of each model were made with three techniques (n = 10 per group): indirect, unsplinted direct, and acrylic resin-splinted direct technique. Impressions were poured with type IV dental stone. Inter-implant distances were measured for casts using a coordinate measuring machine, and the deviations from the reference models (Δr) were calculated. Data were analyzed using one-way ANOVA followed by post hoc tests to detect significance between groups (α = 0.05).

Results

This study showed that the deviations in micrometers from the reference model were the least for acrylic resin-splinted direct technique (Δr1 = 49.96, Δr2 = 50.36) versus indirect (Δr1 = 93.8, Δr2 = 90.9) and unsplinted direct techniques ((Δr1 = 67.07, Δr2 = 68.66) in 30° angulated implant situation (p value < 0.0001^* for both Δr1 and Δr2). In 15° angulated implants, both the acrylic resin-splinted direct (Δr1 = 44.64, Δr2 = 45.58) and unsplinted direct techniques (Δr1 = 47.39, Δr2 = 55.28) were more accurate than indirect technique (Δr1 = 64.8, Δr2 = 68.3) (p value < 0.0001^* for both Δr1 and Δr2). While in parallel condition, no difference was found between all three techniques (p value = 0.085, 0.056 for Δr1 and Δr2, respectively).

Conclusions

The impression technique affected the accuracy of definitive casts. The acrylic resin splinted direct technique produced the most accurate casts, followed by direct unsplinted and indirect techniques. Furthermore, implant angulation affected the impression accuracy. When implant angulation increased from parallel implants to 30°, the forces of deformation increased, which resulted in increased distortion.

A Clinical Comparative Study of 3-Dimensional Accuracy between Digital and Conventional Implant Impression Techniques

PURPOSE

To evaluate the accuracy of a digital implant impression technique using a TRIOS 3Shape intraoral scanner (IOS) compared to conventional implant impression techniques (pick-up and transfer) in clinical situations.

MATERIALS AND METHODS

Thirty-six patients who had two implants (Implantium, internal connection) ranging in diameter between 3.8 and 4.8 mm in posterior regions participated in this study after signing a consent form. Thirty-six reference models (RM) were fabricated by attaching two impression copings intraorally, splinted with autopolymerizing acrylic resin, verified by sectioning through the middle of the index, and rejoined again with freshly mixed autopolymerizing acrylic resin pattern (Pattern Resin) with the brush bead method. After that, the splinted assemblies were attached to implant analogs (DANSE) and impressed with type III dental stone (Gypsum Microstone) in standard plastic die lock trays. Thirty-six working casts were fabricated for each conventional impression technique (i.e., pick-up and transfer). Thirty-six digital impressions were made with a TRIOS 3Shape IOS. Eight of the digitally scanned files were damaged; 28 digital scan files were retrieved to STL format. A coordinate-measuring machine (CMM) was used to record linear displacement measurements (x, y, and z-coordinates), interimplant distances, and angular displacements for the RMs and conventionally fabricated working casts. CATIA 3D evaluation software was used to assess the digital STL files for the same variables as the CMM measurements. CMM measurements made on the RMs and conventionally fabricated working casts were compared with 3D software measurements made on the digitally scanned files. Data were statistically analyzed using the generalized estimating equation (GEE) with an exchangeable correlation matrix and linear method, followed by the Bonferroni method for pairwise comparisons (α = 0.05).

RESULTS

The results showed significant differences between the pick-up and digital groups in all of the measured variables (p < 0.001). Concerning the transfer and digital groups, the results were statistically significant in angular displacement (p < 0.001), distance measurements (p = 0.01), and linear displacement (p = 0.03); however, between the pick-up and transfer groups, there was no statistical significance in all of the measured variables (interimplant distance deviation, linear displacement, and angular displacement deviations).

CONCLUSIONS

According to the results of this study, the digital implant impression technique had the least accuracy. Based on the study outcomes, distance and angulation errors associated with the intraoral digital implant impressions were too large to fabricate well-fitting restorations for partially edentulous patients. The pick-up implant impression technique was the most accurate, and the transfer technique revealed comparable accuracy to it.

A Comparison of implant impression precision: Different materials and techniques

Background

Precision of implant impressions is a prerequisite for long-term success of implant supported prostheses. Impression materials and impression techniques are two important factors that impression precision relies on.

Material and Methods

A model of edentulous maxilla containing four implants inserted by All-on-4 guide was constructed. Seventy two impressions using polyether (PE), polyvinyl siloxane (PVS), and vinyl siloxanether (VSE) materials with direct and indirect techniques were made (n=12). Coordinates of implants in casts were measured using coordinate measuring machine (CMM). Data were analyzed with ANOVA; t-test and Tukey test were used for post hoc.

Results

With two-way ANOVA, mean values of linear displacements of implants were significantly different among materials and techniques. One-way ANOVA and Tukey showed significant difference between PE and VSE (P=0.019), PE and PVS (P=0.002) in direct technique, and between PVS and PE (P<0.001), PVS and VSE (P<0.001) in indirect technique. One-way ANOVA and t-test showed significant difference between the two techniques in PVS groups (P<0.001) and in PE groups (P=0.02). Two-way ANOVA showed mean values of rotational displacement of implants were significantly different among materials. One-way ANOVA and Tukey test showed significant difference between PVS and PE (P=0.001) and between PVS and VSE (P=0.012) in indirect groups.

Conclusions

On the basis of the results, when deciding on the material to make an impression of implants, PE is recommended for direct technique while PE and VSE are recommended for indirect technique. Recommended technique for VSE is either direct or indirect; and for PE and PVS is direct. Key words:Polyvinyl siloxane, polyether, vinyl siloxanether, direct technique, indirect technique, All-on-4, coordinate measuring machine.

Use of a CAD-CAM poly(methyl methacrylate) interim prosthesis for direct intraoral splinting

This article describes a technique where an interim computer-aided design and computer-aided manufacturing (CAD-CAM) prosthesis is milled from a poly(methyl methacrylate) blank to confirm esthetics, occlusion, function, phonetics, and accessibility for oral hygiene. The interim prosthesis is then sectioned and reconnected intraorally with autopolymerizing acrylic resin. This interim prosthesis is used to fabricate the definitive stone cast. The interim prosthesis is then scanned with a laboratory scanner. By applying this technique, the implant positioning can be related to the occlusal plane, the contours of the teeth, and the flange. The clinician can more effectively design the definitive prosthesis because the location of the implants and the exact contours of the teeth are all captured in a single digital file.

Comparison of the Accuracy of Different Transfer Impression Techniques for Osseointegrated Implants

The aim of this study was to evaluate 3 transfer techniques used to obtain working casts of implant-supported prostheses through the marginal misfit and strain induced to metallic framework. Thirty working casts were obtained from a metallic master cast, each one containing 2 implant analogs simulating a clinical situation of 3-unit implant-supported fixed prostheses according to the following transfer impression techniques: group A, squared transfers splinted with dental floss and acrylic resin, sectioned, and re-splinted; group B, squared transfers splinted with dental floss and bis-acrylic resin; and group N, squared transfers not splinted. A metallic framework was made for marginal misfit and strain measurements from the metallic master cast. The misfit between the metallic framework and working casts was evaluated with an optical microscope following the single-screw test protocol. In the same conditions, the strain was evaluated using strain gauges placed on the metallic framework. The data were submitted to one-way analysis of variance followed by the Tukey test (α = 5%). For both marginal misfit and strain, there were statistically significant differences between groups A and N (P &lt; .01) and groups B and N (P &lt; .01), with greater values for group N. According to the Pearson test, there was a positive correlation between the misfit and strain variables (r = 0.5642). The results of this study showed that the impression techniques with splinted transfers promoted better accuracy than the nonsplinted technique, regardless of the splinting material used.

Changes in views on digital intraoral scanners among dental hygienists after training in digital impression taking

BACKGROUNDS

Despite the rapid development of digital dentistry, the use of digital intraoral scanners remains limited. The aim of this study was to evaluate the changes in views on intraoral scanners among dental hygienists after training.

METHODS

Thirty-four dental hygienists with >3 years of clinical experience participated and were divided into 2 groups : iTero and Trios groups. Participants of each group practiced the usage of both intraoral scanners, for total 12 times over 4 sessions, Questionnaires were given to participants at two different times; prior to and after the completion of the training sessions. The parameters of questionnaires included on difficulty of use, patient discomfort, awareness, preference, and clinical usefulness of intraoral scanners and comparison of two types of scanners.

RESULTS

Upon the completion of the training, both iTero and Trios groups gave positive feedback on anticipated accuracy, efficiency, and clinical usefulness. More participants of the iTero group responded that the level of difficulty of use and patient discomfort was greater than Trios. Both groups preferred Trios for its clinical usefulness.

CONCLUSIONS

The perceptions of dental hygienists on usage of intraoral scanner and digital impression improved positively with the training. The participants favored Trios over iTero in terms of difficulty of use , patient comfort, and clinical usefulness. This study showed that appropriate training could change the views on the efficiency of intraoral scanners positively among dental hygienists.

Effect of Splinting on Dimensional Accuracy of Impressions Made of Implants with Different Subgingival Alignments

PURPOSE

Placement of implants at deeper levels of gingiva is sometimes inevitable because of issues like esthetics or bone availability. The accuracy of impressions may be affected in these situations. The aim of this in vitro study was to evaluate the effects of splinting and length of impression copings on the accuracy of impressions made of deeply placed implants.

MATERIALS AND METHODS

A metal model with two parallel implants (Implantium; Dentium) was fabricated. One hundred and twenty impressions were made using the direct impression technique with and without splinting the impression copings (using short and long impression copings). Impressions were made of implants at three subgingival levels (1, 3, and 6 mm) using regular viscosity poly(vinyl siloxane). The impressions were poured with type IV dental stone. Displacements in the x, y, and z axes, as well as rotational discrepancies and interimplant distances were measured with a coordinate measuring machine. Data were analyzed with Kruskal-Wallis, Mann-Whitney, and nonparametric adjusted rank transform tests.

RESULTS

There was less rotational displacement using longer impression copings at different subgingival positions of the implants, either with splinted or nonsplinted direct technique (p < 0.05). Also, the nonsplinted technique produced more accurate impressions at different apico-coronal levels of implants than the splinted technique using short impression copings (p < 0.05).

CONCLUSIONS

According to the findings of this study, longer impression copings yielded better results than shorter ones in both splinted and nonsplinted techniques. Also, nonsplinted short impression copings produced more accurate impressions than splinted short impression copings.

Accuracy of different impression materials in parallel and nonparallel implants

BACKGROUND

A precise impression is mandatory to obtain passive fit in implant-supported prostheses. The aim of this study was to compare the accuracy of three impression materials in both parallel and nonparallel implant positions.

MATERIALS AND METHODS

In this experimental study, two partial dentate maxillary acrylic models with four implant analogues in canines and lateral incisors areas were used. One model was simulating the parallel condition and the other nonparallel one, in which implants were tilted 30° bucally and 20° in either mesial or distal directions. Thirty stone casts were made from each model using polyether (Impregum), additional silicone (Monopren) and vinyl siloxanether (Identium), with open tray technique. The distortion values in three-dimensions (X, Y and Z-axis) were measured by coordinate measuring machine. Two-way analysis of variance (ANOVA), one-way ANOVA and Tukey tests were used for data analysis (α = 0.05).

RESULTS

Under parallel condition, all the materials showed comparable, accurate casts (P = 0.74). In the presence of angulated implants, while Monopren showed more accurate results compared to Impregum (P = 0.01), Identium yielded almost similar results to those produced by Impregum (P = 0.27) and Monopren (P = 0.26).

CONCLUSION

Within the limitations of this study, in parallel conditions, the type of impression material cannot affect the accuracy of the implant impressions; however, in nonparallel conditions, polyvinyl siloxane is shown to be a better choice, followed by vinyl siloxanether and polyether respectively.

Effect of implant angulation and impression technique on impressions of NobelActive implants

STATEMENT OF PROBLEM

How the configuration of the NobelActive internal conical connection affects implant impressions is uncertain.

PURPOSE

The purpose of this study was to measure the effect in vitro of closed and open tray impression techniques for NobelActive implants placed at various angulations.

MATERIAL AND METHODS

Six NobelActive implants were placed in a master maxillary cast as follows: 0 degrees of angulation to a line drawn perpendicular to the occlusal plane in the first molar area, 15 degrees of angulation to a line drawn perpendicular to the occlusal plane in the first premolar area, and 30 degrees of angulation to a line drawn perpendicular to the occlusal plane in the lateral incisor area. Twelve open tray and 12 closed tray impressions were made. Occlusal, lateral, and frontal view photographs of the resulting casts were used to measure the linear and angular displacement of implant analogs. Statistical analysis was performed with a factorial analysis of variance (ANOVA), followed by the Tukey HSD test (α=.05).

RESULTS

No significant difference was found in the impressions made of NobelActive implants with the open or closed tray technique (linear displacement: F=0.93, P=.34; angular displacement: F=2.09, P=.15). In addition, implant angulation (0, 15, or 30 degrees) had no effect on the linear or angular displacement of impressions (linear displacement: F=2.72, P=.07; angular displacement: F=0.86, P=.43). Finally, no significant interaction was found between impression technique and implant angulation on NobelActive implants (F=0.25, P=.77; F=1.60, P=.20).

CONCLUSIONS

Within the limitations of this study, impression technique (open vs closed tray) and implant angulation (0, 15, and 30 degrees) had no significant effect on in vitro impressions of NobelActive implants.

Digital evaluation of the accuracy of impression techniques and materials in angulated implants

OBJECTIVES

The aim of this study was to investigate the accuracy of 2 different impression techniques and 3 different impression materials in models simulating parallel and angulated implants.

METHODS

Three master models simulating partial edentulous mandible with 2 implants at the sites of second premolars (parallel) and second molars with different angulations (parallel, 10° or 20° angulated) were fabricated. Two different impression techniques [splinted direct (D), indirect (I)] and 3 different monophase impression materials [polyether (PE), vinyl polysiloxane (VPS), vinyl polyether silicone (VPES)] were used for each master model and a total of 180 impressions were made (n=10). Master model and casts were scanned by a modified laser scanner and data were transferred to VRMesh software. Master model and duplicate cast scans were digitally aligned observing the superposition of anatomic markers. Angular and coronal deviations between master and duplicated copings were calculated and data were statistically analyzed.

RESULTS

Mean angular and coronal deviations were in a range of 0.205-0.359° and 22.56-33.33μm, respectively. Statistical analysis revealed that the angulation of implant affected both coronal and angular deviations of the impression copings (P<0.05). According to statistical analyses, for parallel implants, the accuracy of impression materials and techniques were ranging as VPS-D=PE-D>VPS-I=PE-I>VPES-D>VPES-I from most accurate to the least. For 10° and 20° angulated implants the most accurate material and technique was VPS-D whereas the least accurate combination was VPES-I (P<0.05).

CONCLUSION

Angulation, impression technique and material were found to be effective on the accuracy of implant impressions.

CLINICAL SIGNIFICANCE

Clinicians may prefer VPS impression material and splinted direct technique for impressions of both parallel and up to 20° angulated implants.

Comparison of polymerization shrinkage of pattern resins

STATEMENT OF PROBLEMM

The dimensional stability, in particular polymerization shrinkage, of pattern resins affects the accuracy of implant prosthesis fabrication. Recently introduced photopolymerizing pattern resins are easy to use, but their shrinkage needs to be determined and compared with traditional autopolymerizing pattern resins.

PURPOSE

The purpose of the study was to compare the polymerization shrinkage of photopolymerizing pattern resins with autopolymerizing pattern resins.

MATERIAL AND METHODSS

Two autopolymerizing (DuraLay, GC Pattern resin) and 2 photopolymerizing (Primopattern LC Gel, Primopattern LC Paste) pattern resins were tested. The sample size was 10 for each group. Polymerization shrinkage was determined by measuring the change in area dimensions with image analysis. The percentage of volumetric shrinkage was calculated, and the results were statistically analyzed with ANOVA, followed by the Student-Newman-Keuls post hoc test (α=.05).

RESULTS

The volumetric shrinkage values (%; mean ±standard deviation) for GC Pattern Resin were 5.72 ±0.89; for DuraLay, 5.07 ±1.36; for Primopattern LC Gel, 5.42 ±1.83; and for Primopattern LC Paste, 7.43 ±0.62. The volumetric shrinkage of the Primopattern LC Paste was significantly higher than that of the other 3 materials.

CONCLUSIONS

The photopolymerizing pattern resin in gel form (Primopattern LC Gel) had a similar shrinkage value to the autopolymerizing pattern resins (DuraLay and GC Pattern Resin). However, the photopolymerizing pattern resin in paste form (Primopattern LC Paste) shrank significantly more than the other 3 materials tested.

A method for fabrication of implant-supported fixed partial dentures

When restoring a partially edentulous arch with an implant-supported fixed partial denture, the optimal fit and function of the final restoration depend on the fabrication of an accurate impression and the registration of the interocclusal relationship. The present case report presents a method for the fabrication of impressions and the registration of the interocclusal relationship for implant-supported partial dentures. The described method allows the accurate transfer of the implant position and the registration of the interocclusal relationship using transfer key and electroformed gold copings. The key and copings were used to transfer the intraoral implant position to the cast, to position the abutments intraorally, and to facilitate the fabrication of the final partial denture.

Effects of impression levels and trays on the accuracy of impressions taken from angulated implants

BACKGROUND AND PURPOSE

It is crucial to keep the misfit of the abutment-fixture unit at the lowest possible rate. There are a few controversial studies on the accuracy of impression making of angulated implants, and much fewer (and controversial) studies on the abutment-level impression technique, which is a convenient and clinically favorable method. Besides, there are no studies on comparison of sectional vs. full-arch trays. We aimed to assess these.

METHODS

A trapezoidal model with four angulated implants installed at 20° and 30° buccal tilts was fabricated. Forty impressions were taken from this model, with two groups of full-arch and sectional custom trays (n = 2 × 20), each divided into two subgroups of implant-level and abutment-level techniques (n = 2 × 2 × 10 in four subgroups). Absolute and non-absolute linear and angular impression errors were estimated by comparing the fabricated casts with the model, using a coordinate measuring machine. The effects of sectional/full-arch trays and abutment-level and fixture-level techniques on impression accuracies were analyzed using one- and two-way analyses of variance (ANOVA), Tukey, Mann-Whitney, and one-sample t-tests (α = 0.05, Mann-Whitney's α using the Bonferroni Bonferroni method).

RESULTS

No significant differences between the absolute linear errors of the two trays (P = 0.100 [ANOVA]) and the two levels (P = 0.400 [ANOVA]) were observed. The assessment of absolute angular errors showed no significant differences (all P values ≥ 0.4 [ANOVA]). The difference between the linear errors in the full-arch vs. sectional trays was not significant in the fixture-level group (P = 0.290). However, in the abutment-level group, the linear error was significantly greater in the sectional tray compared to full-arch tray (P = 0.013, α = 0.025 [Mann-Whitney]).

CONCLUSIONS

Using sectional trays might not be advantageous over full-arch trays. Sectional trays are not recommended for taking abutment-level impressions. The abutment-level impression technique is as accurate as the studied fixture-level technique. Increasing the angle of implants' divergence from 40° to 60° might not usually lead to a significant increase in the errors, particularly when using abutment-level impressions.

Evaluation of Accuracy of Casts of Multiple Internal Connection Implant Prosthesis Obtained From Different Impression Materials and Techniques: An In Vitro Study

Movement of impression copings inside the impression material using a direct (open tray) impression technique during clinical and laboratory phases may cause inaccuracy in transferring the 3-dimensional spatial orientation of implants intraorally to the cast. Consequently, the prosthesis may require corrective procedures. This in vitro study evaluated the accuracy of 3 different impression techniques using polyether and vinyl polysiloxane (VPS) impression material to obtain a precise cast for multiple internal connection implants. A reference acrylic resin model with 4 internal connection implants was fabricated. Impressions of the reference model were made using 3 different techniques and 2 different impression materials. The study consisted of 24 specimens divided into 6 groups of 4 each. Impressions were poured with ADA type IV stone (Kalrock, Kalabhai Karson Pvt Ltd, Mumbai, India). All casts were evaluated for the positional accuracy (mm) of the implant replica heads using a profile projector. These measurements were compared to the measurements calculated on the reference resin model, which served as a control. Data were analyzed with 2-way analysis of variance (ANOVA) followed by Bonferroni multiple comparison procedures to evaluate group means. The results revealed significant difference for anterior implant distance between the 2 impression materials (P &lt; .01) and also among the 3 different techniques (P &lt; .05). The lowest mean variation was found with the polyether impression material and the splinted technique. For posterior implants, the results suggested no significant difference between the 2 impression materials (P ≥ .05). Although results were not statistically significant, the polyether impression material showed the lowest mean variation as compared to the VPS impression material. However, there was a significant difference among the 3 different techniques (P &lt; .05). Among the 3 different techniques, the lowest mean variation between 2 posterior implants was found in the splinted technique. Casts obtained from impression techniques using square impression copings splinted together with autopolymerizing acrylic resin prior to the impression procedure were more accurate than casts obtained from impressions with nonmodified implant impression copings and with airborne particle–abraded, adhesive-coated copings. Casts obtained from polyether impression material were more accurate than casts obtained from vinyl polysiloxane impression material.

Comparison of digital and conventional impression techniques: evaluation of patients' perception, treatment comfort, effectiveness and clinical outcomes

BACKGROUND

The purpose of this study was to compare two impression techniques from the perspective of patient preferences and treatment comfort.

METHODS

Twenty-four (12 male, 12 female) subjects who had no previous experience with either conventional or digital impression participated in this study. Conventional impressions of maxillary and mandibular dental arches were taken with a polyether impression material (Impregum, 3 M ESPE), and bite registrations were made with polysiloxane bite registration material (Futar D, Kettenbach). Two weeks later, digital impressions and bite scans were performed using an intra-oral scanner (CEREC Omnicam, Sirona). Immediately after the impressions were made, the subjects' attitudes, preferences and perceptions towards impression techniques were evaluated using a standardized questionnaire. The perceived source of stress was evaluated using the State-Trait Anxiety Scale. Processing steps of the impression techniques (tray selection, working time etc.) were recorded in seconds. Statistical analyses were performed with the Wilcoxon Rank test, and p < 0.05 was considered significant.

RESULTS

There were significant differences among the groups (p < 0.05) in terms of total working time and processing steps. Patients stated that digital impressions were more comfortable than conventional techniques.

CONCLUSIONS

Digital impressions resulted in a more time-efficient technique than conventional impressions. Patients preferred the digital impression technique rather than conventional techniques.

A technique to splint and verify the accuracy of implant impression copings with light-polymerizing acrylic resin

Transferring the implant position from the mouth to the definitive cast is one of the most critical steps in implant prosthodontics. To achieve a passive fit of the prosthesis, an accurate implant impression is crucial because discrepancies can induce both biologic and technical complications. Analysis of available research data suggests that a direct (pick-up) impression technique with splinted copings is the technique of choice, particularly for multiple implants. However, the traditional method of splinting the copings with autopolymerizing acrylic resin is a technique-sensitive and time- consuming procedure. This report describes a straightforward method of splinting impression copings with light-polymerizing acrylic resin, with minimal amount of autopolymerizing acrylic resin. The method also can be used to verify splinting accuracy.

Passive Fit in Screw Retained Multi-unit Implant Prosthesis Understanding and Achieving: A Review of the Literature

One of the considerable challenges for screw-retained multi-unit implant prosthesis is achieving a passive fit of the prosthesis' superstructure to the implants. This passive fit is supposed to be one of the most vital requirements for the maintenance of the osseointegration. On the other hand, the misfit of the implant supported superstructure may lead to unfavourable complications, which can be mechanical or biological in nature. The manifestations of these complications may range from fracture of various components in the implant system, pain, marginal bone loss, and even loss of osseointegration. Thus, minimizing the misfit and optimizing the passive fit should be a prerequisite for implant survival and success. The purpose of this article is to present and summarize some aspects of the passive fit achieving and improving methods. The literature review was performed through Science Direct, Pubmed, and Google database. They were searched in English using the following combinations of keywords: passive fit, implant misfit and framework misfit. Articles were selected on the basis of whether they had sufficient information related to framework misfit's related factors, passive fit and its achievement techniques, marginal bone changes relation with the misfit, implant impression techniques and splinting concept. The related references were selected in order to emphasize the importance of the passive fit achievement and the misfit minimizing. Despite the fact that the literature presents considerable information regarding the framework's misfit, there was not consistency in literature on a specified number or even a range to be the acceptable level of misfit. On the other hand, a review of the literature revealed that the complete passive fit still remains a tricky goal to be achieved by the prosthodontist.

The Effect of Implant Angulation on the Transfer Accuracy of External-Connection Implants

BACKGROUND

Accurate recording of implant location is required in every implant-supported prostheses. Implant angulation, which is inevitable in various clinical situations, could affect the impression accuracy.

PURPOSE

The purpose of this in vitro study was to compare the transfer accuracy of straight and tilted implants of All-on-4 protocol with implant or abutment level impression making and different techniques of direct and indirect.

MATERIALS AND METHODS

One reference model of edentulous maxilla with four external connection implants (Brånemark) inserted according to All-on-4 protocol was made. Forty impressions of this model were made at implant (groups 1 and 2) or abutment (groups 3 and 4) levels with different techniques of direct or indirect, respectively. Impressions were poured with type IV dental stone. Coordinate measuring machine was used to record x, y, and z coordinates and also angular dislocation of implants. These measurements were compared with the equals calculated on the reference model. Data were analyzed with univariate analysis of variance and t-test at α = 0.05.

RESULTS

The results showed that abutment level impression making (groups 3 and 4), either with direct or indirect technique, produced the same results for straight and tilted implants of Δr variable (p > .05), though in implant level groups (groups 1 and 2), it was statistically significant (p < .05). However, only implant level impression making with direct technique (group 1) had the same results of angular accuracy for straight and tilted implants.

CONCLUSION

Impression technique (direct or indirect) had significant effect on the impression accuracy of tilted implants, and direct technique produced less inaccuracy. Also, abutment level impressions showed more accuracy than implant level impressions.

Impression Techniques for Multiple Implants: A Photoelastic Analysis. Part I: Comparison of Three Direct Methods

The purpose of this article was to compare through photoelastic analysis the stress distribution in 3 direct transfer techniques for implants with splinting. Three photoelastic resin blocks were made with 2 implants placed parallel to each other and 2 square transfer copings splinted. Both transfers were splinted with acrylic resin chemically activated in 3 different techniques: metallic sticks (T1), prefabricated acrylic bars (T2), or dental floss (T3). A circular polariscope was used, and the distortion energy (E) was calculated in 4 periods: 20 minutes and 3, 24, and 36 hours. Statistically significant differences were found among the 3 techniques (P &lt; .05). The dental floss presented the greatest distortion energy values (T3 = 0.469 Kgf/mm2) and the metallic sticks the lowest values (T1 = 0.0 Kgf/mm2). Thus, the metallic sticks technique (T1) appears to be the most accurate protocol to be used for implant-supported prosthesis with multiple abutments.

Impression Techniques for Multiple Implants: A Photoelastic Analysis. Part II: Comparison of Four Acrylic Resins

Four commercial brands of chemically activated acrylic resin were compared through photoelastic analysis. Photoelastic resin blocks were made with 2 implants placed parallel to each other and 2 square transfer copings splinted. Both transfers were splinted with chemically activated acrylic resin: Dencrilay, Duralay I, Duralay II, and GC. Data were analyzed by 2-way analysis of variance and Tukey test (P &lt; .05). Statistically significant differences were found among the 3 brands of chemically activated acrylic resin. Dencrilay showed greater dimensional alteration. Duralay I and GC are recommended for the transfer of the position of the multi-implants.