Effect of subgingival depth of implant placement on the dimensional accuracy of the implant impression: an in vitro study

Evaluation of the Stability of Open-Tray Impression Coping Using Two Different Impression Materials at Three Different Subgingival Implant Placement Depths

Objective To evaluate and compare the stability of the open tray impression coping within the set impression while attaching the lab analog when polyether (PE) heavy body and polyvinyl siloxane (PVS) putty impression materials were used and the implant platform was placed sub-gingivally at three different depths. Methods Two impression materials, PE and PVS, and custom-made plexiglass models with embedded single implants to simulate implant positioning depths of 0 mm, 2 mm, and 4 mm, sub-gingivally, were used in the study. Open tray impressions were made after attaching impression coping to the implant embedded in the model. Implant lab analog was attached to the impression coping in the set impression, and its stability was measured using a universal testing machine. Forty-two open tray impressions were made in six groups, with seven impressions in each group. Descriptive statistics such as mean and standard deviation were calculated. A comparison of the mean stability between the two impression materials at each depth was done using an independent t-test. Comparison of the mean stability between the three different subgingival implant depths in each material was done by one-way ANOVA with the Scheffe multiple comparison test (post-hoc analysis). The level of significance was set at p<0.05. Results The stability of the impression coping was measured as the force in Newtons required for the displacement of the analog attached to the impression coping embedded in the set impression. PE with the embedded impression coping at a depth of 0 mm gave the highest mean stability value (4.37+/-0.41), and the least mean stability was offered by PVS with the embedded impression coping at 4 mm depth (1.88+/-0.37). When an independent t-test was done to compare the mean stability values of PE and PVS, there was a statistically significant difference at 0 mm, 2 mm, and 4 mm. On doing one-way ANOVA to compare the mean stability between the different depth groups, there was a statistically significant difference between the three depth groups in PE and PVS. Scheffe multiple comparison tests (post-hoc analysis) revealed a statistically significant difference between 0 mm, 2 mm, and 4 mm subgingival depths of the impression coping placement in both PE and PVS. Conclusion The accuracy of the master cast is an important determinant for the precise fit and long life of the final prosthesis. In the case of maxillary anterior implant placements where deep subgingival placement of the implant platform is needed for aesthetic and functional reasons, the impression material should be selected carefully to ensure the stability of the impression coping. Among the materials included in the present study, the PE impression material offered the maximum stability for impression coping compared to PVS.

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.

Effect of angulation on the 3D trueness of conventional and digital implant impressions for multi-unit restorations

PURPOSE

The study aimed to determine the influence of implant angulation on the trueness of multi-unit implant impressions taken through different techniques and strategies.

MATERIALS AND METHODS

As reference models, three partially edentulous mandibular models (Model 1: No angulation; Model 2: No angulation for #33, 15-degree distal angulation for #35 and #37; Model 3: No angulation for #33, 25-degree distal angulation for #35 and #37) were created by modifying the angulations of implant analogues. Using a lab scanner, these reference models were scanned. The obtained data were preserved and utilized as virtual references. Three intraoral scanning (IOS) strategies: IOS-Omnicam, ISO-Quadrant, and IOS-Consecutive, as well as two traaditional techniques: splinted open tray (OT) and closed tray (CT), were used to create impressions from each reference model. The best-fit alignment approach was used to sequentially superimpose the reference and test scan data. Computations and statistical analysis of angular (AD), linear (LD), and 3D deviations (RMS) were performed.

RESULTS

Model type, impression technique, as well as interaction factor, all demonstrated a significant influence on AD and LD values for all implant locations (P < .05). The Model 1 and SOT techniques displayed the lowest mean AD and LD values across all implant locations. When considering interaction factors, CT-Model 3 and SOT-Model 1 exhibited the highest and lowest mean AD and LD values, respectively. Model type, impression technique, and interaction factor all revealed significant effects on RMS values (P ≤ .001). CT-Model 3 and SOT-Model 1 presented the highest and lowest mean RMS values, respectively.

CONCLUSION

Splinted-OT and IOS-Omnicam are recommended for multi-unit implant impressions to enhance trueness, potentially benefiting subsequent manufacturing stages.

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.

Accuracy of Digital Impressions at Varying Implant Depths: An In Vitro Study

PURPOSE

Implants placed at variable depths may vary the amount of visible scannable surface of a scan body. Intraoral scanner technology uses advanced optical principles to record the surface of the scan body to accurately capture the implant position. The purpose of this study is to investigate the effect implant placement depth has on the accuracy of digital implant impressions using an intraoral scanner.

MATERIALS AND METHODS

A partially edentulous gypsum master model was fabricated to allow the positioning of a single implant analog at different depths. Four groups were created based on the planned implant depths of 7, 6, 3, and 0 mm and corresponding visibility of the scan body at 2, 3, 6, and 9 mm. The model was digitized with a laboratory scanner for the reference scan and with an intraoral scanner to generate 15 test scans per group, with a total of 60 scans. The test scans were superimposed onto the reference scan using the best fit algorithm to analyze and measure the positional (dXYZ) and angular deviation (d⍬) of the scan body using three-dimensional metrology software. Statistical analysis was performed using a one-way ANOVA and pairwise comparison was done with a Tukey-Kramer HSD test (α = 0.05).

RESULTS

The one-way ANOVA of the groups for the dXYZ and dθ parameters was statistically significant (F_3,56 = 11.45, p < 0.001, F_3,56 = 24.04, p < 0.001). Group D (9 mm) showed the least positional deviation at 38.41 μm (95% CI 30.26; 46.56) and the least angular deviation of 0.17° (95% CI 0.12; 0.21). Group A (2 mm) showed the greatest positional deviation of 77.17 μm (95% CI 65.23; 89.11) and greatest angular deviation of 0.84° (95% CI 0.65; 1.03). The positional and angular deviation increased with increased implant depth.

CONCLUSIONS

The accuracy of digital impressions is influenced by the implant depth and the amount of visibility of the scan body. The trueness and precision are highest when the implant is placed at 0 mm depth with complete visibility of the scan body and decreases with subgingival implant placement.

The effect of different implant impression splinting techniques and time on the dimensional accuracy: An in vitro study

Splinting of impression copings is generally recommended for more complex implant-supported restorations. It can also be used in the digital workflow when the control model is needed to improve the fit of the prosthesis. However, there is a lack of knowledge on how dimensional accuracy is affected by different splinting techniques and time factors.

OBJECTIVES

To evaluate the time factor on the dimensional stability of different implant impression splinting strategies used in the conventional and digital workflow.

MATERIALS AND METHODS

Ten pairs of implant analogs were fixed to a stainless steel bar. Modified impression copings were connected to the analogs and eight splinting strategies evaluated (n=10): 1) type I impression plaster (PLA), 2) autopolymerizing acrylic resin, cut and rejoin technique (PTR), 3) light-cured acrylic resin, cut and rejoin technique (ILC), 4) light-cured acrylic resin, no cutting and rejoining (ILN), 5) VPS bite registration material (SBR), 6) bis-acryl bite registration material (LXB), 7) bis-acryl composite resin (PTP), 8) 3D printed splint (3DP). In each group, the position of modified impression copings was scanned with an accurate laboratory scanner at different time points: 1) unsplinted impression copings (baseline), 2) 2 hours after splinting, 3) 24 hours after splinting. Modified impression coping design allowed using metrology software to measure and compare distance, vertical, angle and rotational deviations between impression copings.

RESULTS

All types of splints showed dimensional deviations. After 2 hours of splinting, the lowest distance deviation was recorded in PTR (15.4±6.15µm), vertical deviation - in ILC (19.2±27.37µm), angle deviation - in ILC (0.08±0.1°), rotation - in LXB (0.2±0.24°) groups. Comparing results 2 and 24 hours after connection of impression copings, statistically significant deviations in the distance were recorded in groups PLA (-5.6±5.95 µm), PTR (5.5±7.01µm), ILN (19.2±14.26µm), PTP (23.8±12.55µm).

CONCLUSION

The best dimensional accuracy was observed in the ILC group, followed by PTR and 3DP groups.

CLINICAL SIGNIFICANCE

Proper selection of splinting technique and polymerization time can increase the accuracy of conventional or digital impressions. Splinting techniques with rigid materials, proper polymerization and compensating for material shrinkage produce the best results.

Effect of implant angulation and depth on the accuracy of casts using the open tray splinted impression technique

The purpose of this study was to evaluate the accuracy of open tray dental implant impressions when the implants are placed with varying implant angulations and depths. Four partially edentulous models were fabricated using photopolymer resin, each having different angulation and depth of the implant analogs. A total of forty open tray elastomeric impressions were made which were poured in type IV die stone (n = 10). These casts were evaluated and compared for accurate reproduction of the spatial orientation of the implant analogs in the models using digitization in three dimensions. The results were analyzed using the independent T test. Statistically significant differences were observed when the casts were compared with their respective master models. These casts had the implant replicas placed deeper within the replicated soft tissue. Making accurate impressions in partially edentulous situations with dental implants placed with varying depth and angulation is critical and clinically demanding. There is a need for future in vivo research to identify methods and materials, exploring digital impression techniques as well, in order to make precise impressions.

Assessment of intraoral scanning technology for multiple implant impressions - A systematic review and meta-analysis

BACKGROUND

Intraoral scanner (IOS) is a medical device used for capturing direct optical impressions and composed of a handheld camera (hardware), a computer and software. Digital impressions by intraoral scanning have become an increasingly popular alternative to conventional impressions. The aim of this systematic review is to assess the studies regarding the various available technologies for IOS and evaluate the most accurate IOS system for cases with multiple implants and identify the factors that can influence its accuracy.

MATERIALS AND METHODS

A comprehensive electronic search was done in online databases, 'Pubmed', 'Google Scholar' and 'Cochrane' based on pre-determined eligibility criteria. In-vitro studies, In-vivo studies and Randomized controlled trials assessing the accuracy of intra-oral scanner technology were selected after thorough screening. The search strategy covered all studies published until February 2019 and yielded a total of 11 articles out of which 8 studies were determined to fulfil the inclusion criteria and were selected for this review. Data extraction from the included studies was conducted by the primary author and reviewed by the second author.

RESULTS

The information collected included sample size and population, study design, intervention, scanning methods, comparisons and outcome measures. 5 out of 8 included studies compared the distance deviation of the acquired scans from the true values while the remaining 3 studies gave trueness and precision values as the outcome variables. A forest plot on scanner precision displayed slightly higher precision levels in the TRIOS scanner compared to the other intraoral scanners.

CONCLUSION

Despite the limitations this study, it can be concluded that active wavefront sampling is more accurate than the other intraoral scanning technology employed by commercial scanners.

A modified protocol for restorative implant abutment selection by using computer-aided design and computer-aided manufacturing technology

STATEMENT OF PROBLEM

Implant abutment selection is complex because of the numerous factors involved. Computer-aided design (CAD) technology allows for the virtual selection and placement of abutments after all parameters have been precisely measured. The outcome of this new protocol should be validated.

PURPOSE

The purpose of this in vitro study was to validate a new digital protocol in which abutment selection is made through a CAD software program, the abutments are virtually placed, and the restoration is then designed based on the virtual abutments to fit the actual abutments when delivered to the implants intraorally.

MATERIAL AND METHODS

A cast with 2 parallel implants was scanned 10 times. Then, 2 abutments were placed and scanned 10 times. Twenty identical superstructures were designed and manufactured to simulate the clinical situation of a 3-unit fixed partial denture, screw-retained to 2 implants. These were divided into 2 groups-A, real abutment and B, virtual abutment-and then compared by means of digital and optical measurements.

RESULTS

No significant differences were detected for the measurements between the control and test groups in either the x-axis or y-axis; significant differences were found for the median value of the measurements obtained from both groups regarding the z-axis (P=.046). The mean gap in the virtual abutment group was 50 μm and 35 μm in the real abutment group.

CONCLUSIONS

Superstructures produced after the virtual selection and placement of intermediate restorative abutments compared favorably with those produced after the digitalization of actual abutments and placement in the implant model, thus validating the proposed digital protocol for virtual abutment selection and placement.

A prospective clinical study on implant impression accuracy

Background

An accurate impression is crucial to the long-term success of dental implants. This investigation evaluated the accuracy of the open and closed implant impression techniques in partially edentulous patients who received two adjacent implants.

Material and methods

Forty patients received Osstem Implants (Osstem Implant System, Seoul, Korea). Two impressions were made for each patient, one using an open tray and a second with a closed tray technique. The horizontal distances between two impression copings were measured and compared to similar measurements on the master casts. Also, under a stereomicroscope (AmScop14370, Myford Road, #150, Irvine, CA 92606 USA) at a 50-fold magnification, the presence or absence of the marginal discrepancies was evaluated.

Results

There were no statistically significant differences regarding horizontal measurements and in the marginal relationship for the two impression techniques, except between the anterior and posterior regions, for the closed tray technique. There were also no statistically significant differences in the impression accuracy between maxillary and the mandibular arches. In addition, there were no statistically significant differences for the intraoral horizontal distances, compared to similar horizontal measurements on master casts, between the open and closed tray techniques.

Conclusions

Within the limitations of the present study, there were generally no differences in the impression accuracy between the open and closed tray techniques in partially edentulous patients with two adjacent implants.

A clinical comparison of digital and conventional impression techniques regarding finish line locations and impression time

OBJECTIVE

This study compared digital and conventional impression techniques regarding impression time, frequency of adjustments, and adaptation of cobalt-chromium (Co-Cr) copings with supragingival and subgingival finish lines.

MATERIALS AND METHODS

Thirty premolars prepared for single-unit metal-ceramic restorations with supragingival and subgingival finish lines (n = 15). Conventional impression and digital scan of prepared teeth were made. Using computer aided design/computer aided manufacturing (CAD/CAM) system the copings were produced by a milling machine from Co-Cr blocks and internal and marginal discrepancies were measured using silicone replica technique. Data were analyzed using repeated measures ANOVA and Mann-Whitney test (alpha = .05).

RESULTS

The impression technique had a significant effect on the magnitude of gap (P < .001). The internal and marginal gaps in the digital technique (49.43 μ and 60.07 μ, respectively) were significantly lower than the values in the conventional method (91.88 μ and 96.96 μ, respectively-P < .001). Finish line positions had no significant effect on the fit and marginal gap of copings (P = .54 and .243, respectively). The mean impression time (19':27″ in conventional technique and 10':31″ in digital technique) was significantly shorter (P < .001) and the mean frequency of adjustments (2.2 times for conventional and 1.3 times for digital technique) was significantly lower in the digital technique (P < .001). The gingival biotype (thick or thin) had no significant effect on marginal and internal fit (P = .052 and .319, respectively).

CONCLUSION

The digital technique was superior in terms of fit, impression time, and frequency of adjustments. Finish line positions had no significant effect on the fit of copings.

CLINICAL SIGNIFICANCE

Using intraoral scanner promotes the fits of restorations in supragingival and subgingival finish lines.

Comparative in vitro study of the accuracy of impression techniques for dental implants: Direct technique with an elastomeric impression material versus intraoral scanner

Background

The aim of this study was to compare a conventional technique (elastomeric impression material - EIM) and a digital technique (scanner digital model – SDM) on a six-analog master model (MM) to determine which was the most exact.

Material and Methods

Twenty impressions were taken of a master model (EIM) and twenty scanned impressions (SDM) (True Definition). A coordinate measuring machine (CMM) was used to measure the distances between adjacent analogues (1-2, 2-3, 3-4, 4-5, 5-6), intermittently positioned analogues (1-4, 3-6) and the most distal (1-6). Reference values were established from the master model, which were compared with the two impression techniques. The significance level was established as 5% (p<0.05).

Results

The precision of each technique was compared with MM. For adjacent analogues (1-2), no significant differences were found between EIM-MM (p=0,146). For intermittently positioned analogues (1-4), SDM did not show significant differences with MM (p=0.255). For the distance between distal analogues (1-6), significant differences were found between both techniques and MM (p=0.001).

Conclusions

In a clinical situation with < three implants, EIM is more exact than SDM, but in cases of four implants SDM is more exact. For rehabilitations (> four implants), neither technique can be considered accurate although error falls within the tolerance limits established in the literature (30-150µm).

Key words:Digital workflow, full arch scan, intraoral scanner, CAD/CAM, polyether impression, accuracy.

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.

Knowledge, Attitude, and Practice toward Impression Technique and Materials for Recording Impression in Implant Placement among Dental Practitioners in Patna City, Bihar

Objectives:

The present study is conducted to explore the knowledge, attitude, and practice towards impression technique and materials for recording impression in implant placement among general dental practitioners.

Materials and Methods:

The present study is a cross-sectional questionnaire study. The study was conducted among general dental practitioners in Patna city in November–December 2017. Patna city was divided into five directions, which are north, south, east, west, and central. From each direction, 20 clinics were selected randomly, and dental practitioners from there clinics were interviewed. A closed-ended questionnaire consists of 19 items was prepared, the questionnaire was divided into four parts.

Results:

Majority of study participants (58 [34%]) were above the age of 40 years. 96 (56%) of study participants were male. Most of the study participants (89 [50%]) were having MDS degree. Knowledge, attitude, and behavior scores among study participants. About 43% of study participants have good knowledge scores regarding impression technique and material in implant placement while 50% of study participants had fair attitude score. About 58% of study participants had fair practice score. There was statistically significant correlation (P ≤ 0.05*) between knowledge and attitude of study participants.

Conclusion:

It was concluded that there was good knowledge, fair attitude, and practice among the dental professionals regarding the impression technique and materials for recording impression in implant placement. There was statistically significant correlation between knowledge and attitude of study participants. There was statistically significant correlation between some demographic variables and knowledge, attitude, and practice of study participants.

Comparative evaluation of the effect of impression materials and trays on the accuracy of angulated implants impressions

Background

Vinyl Polyether Siloxane is a newly introduced impression material and studies on that is scarce. Implant insertion in posterior mandible might be angulated due to anatomical considerations. The purpose of this study was to compare the dimensional and angular accuracy of impressions using full-arch versus sectional tray and Vinyl Polysiloxane versus Vinyl Polyether Siloxane in angulated implants.

Material and Methods

Four implants were placed in dental areas #19, #21, #28 and #30 of a Kennedy class I mandibular acrylic model with 30° lingual angulation. Twenty sectional and 20 full-arch open trays were made on the primary cast. Impressions were taken using Vinyl Polysiloxane and Vinyl Polyether Siloxane (n=10 in 4 groups); and were poured with type IV dental stone. The coordinate measuring machine was used to measure displacements in the X, Y and Z axes and rotational discrepancies of implants. The data were analyzed using SPSS 22 and two-way ANOVA.

Results

Type of tray had no significant effect on the dimensional and angular accuracy of impressions (p >0.05). Type of impression material significantly affected linear displacement (∆r) (P <0.05); but it did not significantly affect the rotational displacement (P >0.05).

Conclusions

Vinyl Polysiloxane yielded more accurate impressions of angulated implants.

Key words:Dental implant, impression material, impression tray, vinyl polysiloxane, vinyl polyether silicone, coordinate measuring machine.

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 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.

Effect of Implant Connection Type and Depth on the Seating Accuracy of Hand-Tightened Abutments

PURPOSE

Improper seating of abutment on the implant is a common problem. This study investigated the effect of the type of implant/abutment interface on the complete seating of the abutments on the head of implants placed at different gingival depths.

MATERIALS AND METHODS

Three implant systems with three different connections including straight external hexagon, butt-joint internal tri-lobed, and conical internal hexagon were used. Two gingival thicknesses (2 and 7 mm) were created using pink baseplate wax around the straight abutments seated on the implants. After placing the implants in acrylic blocks, the wax was replaced with the gingival mask material to simulate the gingival drape around the implant heads. Afterwards, 15 prosthodontists were asked to hand-tighten the straight abutments in the corresponding implant bodies relying only on their tactile sense. At the final stage, the gingival mask was removed, and the seating quality of the abutments on implant bodies was assessed visually. The effect of implant connection and depth on abutment seating accuracy was analyzed using Kruskal-Wallis and multiple-comparison tests.

RESULTS

No significant difference was found regarding the effect of either depth or connection design on the accuracy of the abutment seating (p > 0.05); however, pairwise comparison of the combined effect of the depth and connection design was significant (p = 0.009). Accuracy of abutment seating on the Nobel Active implants at both 2 and 7 mm depths were significantly better than Replace system with 7 mm depth (p = 0.027). The same results were obtained in comparison between Nobel Active system at both 2 and 7 mm depths with Branemark system with 7 mm depth (p = 0.006).

CONCLUSION

An increase in implant placement depth meant a decrease in accuracy of the abutment seating. The internal conical connection design showed the best result in abutment positioning in deep implants as compared with external and internal butt-joint connection designs.

In Vitro Comparative Evaluation of Different Types of Impression Trays and Impression Materials on the Accuracy of Open Tray Implant Impressions: A Pilot Study

Purpose. For a precise fit of multiple implant framework, having an accurate definitive cast is imperative. The present study evaluated dimensional accuracy of master casts obtained using different impression trays and materials with open tray impression technique. Materials and Methods. A machined aluminum reference model with four parallel implant analogues was fabricated. Forty implant level impressions were made. Eight groups (n = 5) were tested using impression materials (polyether and vinylsiloxanether) and four types of impression trays, two being custom (self-cure acrylic and light cure acrylic) and two being stock (plastic and metal). The interimplant distances were measured on master casts using a coordinate measuring machine. The collected data was compared with a standard reference model and was statistically analyzed using two-way ANOVA. Results. Statistically significant difference (p < 0.05) was found between the two impression materials. However, the difference seen was small (36 μm) irrespective of the tray type used. No significant difference (p > 0.05) was observed between varied stock and custom trays. Conclusions. The polyether impression material proved to be more accurate than vinylsiloxanether impression material. The rigid nonperforated stock trays, both plastic and metal, could be an alternative for custom trays for multi-implant impressions when used with medium viscosity impression materials.

An In Vitro Study of Factors Influencing the Performance of Digital Intraoral Impressions Operating on Active Wavefront Sampling Technology with Multiple Implants in the Edentulous Maxilla

PURPOSE

To evaluate the performance (accuracy and repeatability) and the factors affecting the clinical performance of a recently released intraoral scanner based on active wavefront sampling technology.

MATERIALS AND METHODS

A single resin model of an edentulous maxilla fitted with six implants inserted at various depths and angulations was measured with a coordinated measuring machine (CMM) at 3 to 5 μm, and this acted as the "true," or reference, values of the study. Six corresponding cylindrical PEEK scanbodies were then mounted onto the implants, and four calibrated observers independently repeated the digital intraoral scan five times with a True Definition (TrueDef) scanner. Using implant position #15 as a reference, five linear and angular measurements were compared with the reference values (CMM), and the data were analyzed via one-way ANOVA and two-sample t-test.

RESULTS

Mean linear and angular deviations for the TrueDef from CMM measurements were from 5.38 ± 12.61 μm to -26.97 ± 50.56 μm and from 0.16º ± 0.04º to -0.43º ± 0.1º, respectively. Experienced observers performed significantly better than inexperienced ones (p = 0.006), and scan distance (quadrant) significantly affected scanning accuracy (p = 0.003). Visible length of the scanbody affected measurement accuracy (p = 0.0001), while implant angulation did not (p = 0.757).

CONCLUSIONS

The TrueDef scanner provides measurements within clinically accepted limits. Yet scanbody visibility, observer experience, and scan length remain relevant factors affecting accuracy.

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.

Three-dimensional accuracy of different impression techniques for dental implants

Background:

Accurate impression making is an essential prerequisite for achieving a passive fit between the implant and the superstructure. The aim of this in vitro study was to compare the three-dimensional accuracy of open-tray and three closed-tray impression techniques.

Materials and Methods:

Three acrylic resin mandibular master models with four parallel implants were used: Biohorizons (BIO), Straumann tissue-level (STL), and Straumann bone-level (SBL). Forty-two putty/wash polyvinyl siloxane impressions of the models were made using open-tray and closed-tray techniques. Closed-tray impressions were made using snap-on (STL model), transfer coping (TC) (BIO model) and TC plus plastic cap (TC-Cap) (SBL model). The impressions were poured with type IV stone, and the positional accuracy of the implant analog heads in each dimension (x, y and z axes), and the linear displacement (ΔR) were evaluated using a coordinate measuring machine. Data were analyzed using ANOVA and post-hoc Tukey tests (α = 0.05).

Results:

The ΔR values of the snap-on technique were significantly lower than those of TC and TC-Cap techniques (P < 0.001). No significant differences were found between closed and open impression techniques for STL in Δx, Δy, Δz and ΔR values (P = 0.444, P = 0.181, P = 0.835 and P = 0.911, respectively).

Conclusion:

Considering the limitations of this study, the snap-on implant-level impression technique resulted in more three-dimensional accuracy than TC and TC-Cap, but it was similar to the open-tray technique.

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.

Comparative evaluation of the effects of implant position, impression material, and tray type on implant impression accuracy

PURPOSE

To evaluate the effect of implant position, impression, and tray material on the accuracy of implant impressions of edentulous arches with multiple implants.

MATERIALS AND METHODS

Four experimental groups were produced; medium-viscosity polyvinyl siloxane (PVS) was used in 3 groups and polyether was used in 1 group. In PVS groups, different tray types were used; metal stock trays, custom acrylic tray, and full-arch perforated plastic trays. In polyether group, custom acrylic trays were used. The discrepancies in 3 dimensions were measured.

RESULTS

The casts obtained exhibited small deviations (7.50-9.71 µm) from the master cast. There was no statistically significant difference between the polyether and PVS groups. Similarly, different tray materials did not produce any statistically significant discrepancies within the PVS groups. There was no significant difference among the groups when the accuracy of anterior implants were compared, but within-the-group comparisons showed that except group 1 (GR1), the posterior implants demonstrated more accuracy than anterior ones.

CONCLUSIONS

Polyether and PVS can safely be used for the impressions of the edentulous arches with multiple implants and different tray types produce similar accuracy results.

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.

In Vitro Implant Impression Accuracy Using a New Photopolymerizing SDR Splinting Material

PURPOSE

The study aims to evaluate three-dimensionally (3D) the accuracy of implant impressions using a new resin splinting material, "Smart Dentin Replacement" (SDR).

MATERIALS AND METHODS

A titanium model of an edentulous mandible with six implant analogues was used as a master model and its dimensions measured with a coordinate measuring machine. Before the total 60 impressions were taken (open tray, screw-retained abutments, vinyl polysiloxane), they were divided in four groups: A (test): copings pick-up splinted with dental floss and fotopolymerizing SDR; B (test): see A, additionally sectioned and splinted again with SDR; C (control): copings pick-up splinted with dental floss and autopolymerizing Duralay® (Reliance Dental Mfg. Co., Alsip, IL, USA) acrylic resin; and D (control): see C, additionally sectioned and splinted again with Duralay. The impressions were measured directly with an optomechanical coordinate measuring machine and analyzed with a computer-aided design (CAD) geometric modeling software. The Wilcoxon matched-pair signed-rank test was used to compare groups.

RESULTS

While there was no difference (p = .430) between the mean 3D deviations of the test groups A (17.5 μm) and B (17.4 μm), they both showed statistically significant differences (p < .003) compared with both control groups (C 25.0 μm, D 19.1 μm).

CONCLUSIONS

Conventional impression techniques for edentulous jaws with multiple implants are highly accurate using the new fotopolymerizing splinting material SDR. Sectioning and rejoining of the SDR splinting had no impact on the impression accuracy.

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.

Effect of Splinting in Accuracy of Two Implant Impression Techniques

Because there is no consensus in the literature about the need for a splint between copings, the aim of this study was to evaluate, in vitro, the accuracy of 2 impression techniques for implant-supported prostheses. A master cast was fabricated with four parallel implant abutment analogs and a passive framework. Two groups with 5 casts each were formed: Group 1 (squared impression copings with no splint: S) and Group 2 (splinted squared impression copings, using metal drill burs and Pattern resin: SS). The impression material used was polyvinyl siloxane with open trays for standard preparation of the casts. For each cast, the framework was positioned, and a titanium screw was tightened with 10 N·cm torque in analog A, after which measurements of the abutment-framework interface gaps were performed at analogs C and D. This process was repeated for analog D. These measurements were analyzed using software. A one-way analysis of variance (ANOVA) with a confidence interval of 95% was used to analyze the data. Significant differences were detected between S and SS in relation to the master cast (P ≤ 0.05). The median values of the abutment-framework interface gaps were as follows: master cast: 39.64 μm; squared impression copings with no splint: 205.86 μm; splinted squared impression copings: 99.19 μm. Under the limitations of this study, the technique presented for Group 2 produces better results compared with the technique used for Group 1.

A clinical protocol for intraoral digital impression of screw-retained CAD/CAM framework on multiple implants based on wavefront sampling technology

PURPOSE

To obtain an accurate CAD/CAM metal framework over 6 implants using a Chairside Intraoral Scanner based on the principle of active (optical) wavefront sampling.

MATERIAL AND METHODS

Six prototype cylindrical scan bodies screwed in the implants were used to obtain an intraoral digital impression. A conventional resin tooth try-in was fabricated and digitized with an extraoral scanner, and this dataset was merged to the digital data obtained from the intraoral impression to calculate the best framework design with advanced CAD software. The framework was fabricated with a 5-axis computer numerical control milling unit. Three clinical tests (saliva intrusion, Sheffield test, and screw resistance test) were performed to assess the fit of the framework.

RESULTS

Under 3 clinical tests, an accurate fit was observed.

CONCLUSION

The case presented in this report proposes a new clinical protocol for obtaining accurate digital impressions of multiple implants.

Accuracy of digital versus conventional implant impressions

OBJECTIVE

The accuracy of digital impressions greatly influences their clinical viability in implant restorations. The aim of this study was to compare the accuracy of gypsum models acquired from the conventional implant impression to digitally milled models created from direct digitalization by three-dimensional analysis.

MATERIALS AND METHODS

Thirty gypsum and 30 digitally milled models, impressed directly from a reference model, were prepared. The models and reference model were scanned by a laboratory scanner, and 30 surface tessellation language datasets from each group were imported to an inspection software program. The datasets were aligned to the reference dataset by a repeated best-fit algorithm, and 10 specified contact locations of interest were measured in mean volumetric deviations. The areas were pooled by cusps, fossae, interproximal contacts, horizontal and vertical axes of implant position and angulation. The pooled areas were statistically analysed by comparing each group to the reference model to investigate the mean volumetric deviations accounting for accuracy and standard deviations for precision.

RESULTS

Milled models from digital impressions had comparable accuracy to gypsum models from conventional impressions. However, differences in fossae and vertical displacement of the implant position from the gypsum and digitally milled models compared to the reference model exhibited statistical significance (P < 0.001, P = 0.020, respectively).

CONCLUSION

Milled models from digital impression are comparable to gypsum models from conventional impression.

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.

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.

Accuracy of a digital impression system based on active wavefront sampling technology for implants considering operator experience, implant angulation, and depth

BACKGROUND

There is a scarce knowledge on the accuracy of intraoral digital impression systems for dental implants.

PURPOSE

The purpose of this study is to evaluate the accuracy of a digital impression system considering clinical parameters.

MATERIALS AND METHODS

A master model with six implants (27, 25, 22, 12, 15, 17) was fitted with polyether ether ketone scan bodies. Implant no. 25 was placed with 30° mesial angulation in relation to the vertical plane (y axis), and implant no. 15 was positioned with 30° distal angulation. Implant no. 22 was placed 2 mm and no. 12, 4 mm below the gingiva. Experienced (n = 2) and inexperienced operators (n = 2) performed scanning (Lava Chairside Oral Scanner; 3 M ESPE, St Paul, MN, USA) at standard and high accuracy mode. Measurements involved five distances (27-25, 27-22, 27-12, 27-15, 27-17). Measurements with high accuracy three-dimensional coordinated measuring machine (CMM) of the master model acted as the true values. The data obtained were subtracted from those of the CMM values.

RESULTS

Experience of the operator significantly influenced the results (p = .000). Angulation (p = .195) and depth of implant (p = .399) did not show significant deviation from the true values. The mean difference between standard and high accuracy mode was 90 μm.

CONCLUSIONS

With the active wavefront sampling, technology-based digital impression system training seems to be compulsory. Impressions of angulated implants may diminish the accuracy of the impression, yet the results were not significant.

Fatigue performance of joints executed in pure titanium structures with several diameters

This study evaluated fatigue strength of CP-Ti laser-welded joints. Sixty (20/diameter) CP-Ti casted dumbbell rods with diameters of 1.5, 2.0, and 3.5 mm were sectioned and welded using two joint openings (0.0 (00) and 0.6 mm (06)). Six groups were formed, amounting to a total of 9 (n=10) with inclusion of intact groups. Welding was executed using 360 V/8 ms (1.5 and 2.0 mm) and 380 V/9 ms (3.5 mm). Joints were finished, polished, and submitted to radiographic examination to visually analyze presence of porosity (PP). Specimens were submitted to cyclic tests, and the number of cycles until failure (NC) was recorded. Fractured surfaces were examined by SEM. Kruskal-Wallis and Dunn (α=0.05) tests demonstrated that NC was lower for all diameters with 06, and for 3.5 mm/00. NC and PP were found to have a negative correlation (Spearman Coefficient). For CP-Ti frameworks with thin diameters, laser welding is better when structures are juxtaposed.