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This article describes a technique for making implant impressions designed to reduce framework misfit. The 2-stage impression technique combines the use of plaster and a silicone impression material. The method can be used for either completely or partially edentulous patients.
Implant concepts continue to evolve not only in terms of materials, surfaces, and designs but also in clinical experience and technical management. This article presents a clinical and laboratory procedure describing how to plan, ensure, and achieve proper spatial dimension in fabricating definitive implant-supported prostheses with the use of 3 different matrices. This will in turn aid in restoring the patient with a predictable outcome from the outset of the treatment.
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STATEMENT OF PROBLEM: Dual-arch trays are often used to generate impressions of prepared teeth and of the opposing arch simultaneously. There is concern that accuracy of the casts generated with this technique can be affected by the type of tray, viscosity of the impression material, and sequence of pouring the cast. PURPOSE: This study compared the accuracy of working dies made from impressions with metal and plastic dual-arch trays, for 2 different viscosities of impression tray material and by altering which side of the impression was poured first. MATERIALS AND METHODS: Impressions were made of a typodont mandibular arch containing a circular stainless steel crown preparation (standard). There were 3 variables: type of dual-arch tray, impression material viscosity, and order of pour of the impressioned arches. A balanced design with independent samples was used (n=10). Two types of dual-arch trays, plastic (Triple Tray) and metal (COE Impression Tray), and 2 viscosities of addition silicone for the tray were used (Aquasil Rigid and Aquasil Monophase). Type IV gypsum (Fuji-Rock) with a ratio of 20 mL of distilled water to 100 g of powder was hand-mixed for 10 seconds then mixed under vacuum for 40 seconds and poured into the trays while being vibrated. One side of the dual-arch impression was poured with 35 g of stone and allowed to set for 1 hour before the other side was poured with 35 g of stone. The order of pour was randomized, and all casts were allowed to set for 24 hours at room temperature before removal. The dies were measured in 3 dimensions (buccolingual, mesiodistal, and occlusogingival) with a measuring microscope. The gypsum working dies were placed into a custom jig fabricated to permit measurement at a fixed, reproducible position under the microscope. Each dimension of the working dies was measured 3 times, and the mean was used for the sample value. The same 3 aspects of the stainless steel standard were measured multiple times, before and then at the conclusion of measuring all working dies, to arrive at the 3 standard values to which all working die means were compared. The means for the standard used in the statistical analysis were those taken at the conclusion of the study. The intraexaminer variation for measuring the standard was 0.001 mm. A 3-factor analysis of variance was used for the statistical analysis with hypothesis testing at alpha=.05. RESULTS: Statistically significant differences were found with viscosity selection for the buccolingual and occlusogingival dimensions of the working die. The rigid material produced working dies slightly taller (1 microm) than the standard, and those from the monophase material were 4 microm shorter. Regarding tray selection, metal trays were slightly more accurate in the mesiodistal dimension, and when monophase was used in a plastic tray, gypsum dies were nearly 30 microm smaller in the mesiodistal dimension (P<.05). Differences were not detected for sequence of pouring impressions. CONCLUSION: Within the limitations of this study, the monophase material, when compared with the rigid impression material, was most accurate for the occlusogingival and mesiodistal dimensions, although not as accurate in the buccolingual. This buccolingual difference (0.002 mm-0.006 mm) would be clinically inconsequential with the application of die spacer. The rigid impression material was also unaffected by tray selection for the mesiodistal, whereas monophase was affected. When a monophase impression material was used, plastic dual-arch trays yielded gypsum dies which were significantly smaller (0.029 mm) than the ones generated from the metal trays (0.006 mm). Thus rigid impression materials can be recommended for use in dual-arch trays; however, the magnitude of the differences would generally not be clinically significant because they could be compensated for with several coats of die spacer.
STATEMENT OF PROBLEM: A major limitation of vinyl polysiloxane (VPS) impression materials is their hydrophobicity. There are 2 aspects to this problem, the wettability of the polymerized impression by dental gypsum materials and the ability of the unpolymerized material to wet intraoral tissues. To address this problem, manufacturers have added surfactants and labeled the new products as hydrophilic vinyl polysiloxane. PURPOSE: The purpose of this investigation was to compare dimensional accuracy and surface detail reproduction of 2 hydrophilic VPS impression materials, when used under dry, moist, and wet conditions. MATERIALS AND METHODS: A total of 102 impressions were made of stainless steel metal dies similar to those described in American Dental Association (ADA) specification 19. The dies had 2 vertical and 3 horizontal lines inscribed on their superior surfaces. Impressions were made under dry, moist, and wet conditions. Dimensional accuracy was measured by comparing the average length of the middle horizontal line in each impression to the same line on the metal die, by use of a measuring microscope with an accuracy of 0.001 mm. A 2-way analysis of variance and least significant difference post hoc test were used to compare mean dimensional changes (alpha=.05). Surface detail reproduction was evaluated in 2 ways: (1) by use of criteria similar to ADA specification 19 for detail reproduction, continuous replication of at least 2 of the 3 horizontal lines, and (2) by use of a method developed for this study that categorized the impressions as satisfactory or unsatisfactory based on their surface characteristics: presence of pits, voids, or roughness. Pearson chi(2) (alpha=.05) was used to compare detail reproduction results. RESULTS: Conditions (dry, moist, and wet) did not cause significant adverse effects on the dimensional accuracy of either material. The mean dimensional change and SD were 0.005% +/- 0.002% or less. With both surface detail analyses, dry, moist, and wet conditions had a significant effect on the detail reproduction of both materials (P<.05). Only under dry conditions did both impression materials continuously replicate at least 2 of the 3 horizontal lines 100% of the time. Under moist conditions, 82% of the Aquasil impressions and 100% of the Reprosil impressions were judged satisfactory, while under wet conditions, only 47% Aquasil and 11% Reprosil impressions were satisfactory. With the additional surface detail characterization, only under dry conditions were impressions produced with clinically acceptable surface quality (Aquasil 77% and Reprosil 100% satisfactory). CONCLUSIONS: Dimensional accuracy of both materials tested was well within ADA standards. Best surface detail results were obtained only under dry conditions for both materials.
Numerous factors are involved in making an accurate void-free dental artificial stone cast or die. The relationship of the wettability of an elastomeric impression material and its interaction with the gypsum slurry is an important factor. This study examined the relative "pourability" of several impression materials by counting the number of resultant voids in artificial stone casts containing 48 point angles. Those elastomers that exhibited the lowest contact angle with water produced artificial stone casts with the fewest voids. Surfactants applied to the impression material significantly reduced the number of voids in artificial stone casts, as did modified elastomers designated by the manufacturer as hydrophilic.
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The communication of soft tissue contours from the clinical situation to the laboratory technician through the laboratory phases of the dental implant restoration is enhanced with the use of soft tissue casts. Modern elastomeric impression materials can function well as both the master impression and soft tissue cast materials. The purpose of this study was to test the compatibility of a variety of elastomeric impression materials and commercially available soft tissue cast materials with various matrix impression materials. Chemical interaction between the materials may result in adhesion or inhibition of the set of the soft tissue cast material. The results of this study indicated that consideration must be given to material compatibility if predictably successful results are to be achieved in soft tissue cast fabrication.
Large cast frameworks rarely fit multiple implant abutments passively without time-consuming labor-intensive adjustment procedures. Intraoral luting of components has been suggested to achieve a passive fit and eliminate most adjustment procedures. When the intraoral luted framework is returned to the master cast, the implant analogs may not be properly aligned to framework abutments. To complete the restoration, master cast modification or replacement may be required. The procedure described in this article produces a corrected master cast that fits the final framework and preserves the tissue topography of the original master cast.
Silicone putty casts are useful for articulating existing dentures for evaluation and problem solving before relining procedures are performed or a new prosthesis is made. Tissue health may require significant modification of the existing dentures and treatment with tissue-conditioning material before final impressions are made. This practical procedure uses a functional impression that substitutes for a quality preliminary impression and combines tissue conditioning, a functional impression, silicone putty cast, custom final impression tray, and a final impression for a complete denture.
STATEMENT OF PROBLEM: Little information has been reported with regard to the dimensional accuracy of improved dental stone materials for reproduction of an entire arch form. PURPOSE: The purpose of this study was to evaluate the ability of an epoxy resin die material and a type IV dental stone to dimensionally reproduce an entire arch form. MATERIAL AND METHODS: Models were fabricated and measurements were made of reference marks to calculate dimensions from first molar to the midline bilaterally and between first molars. Each measurement was repeated three times and the mean measurement and percent relative change was calculated for each dimension. RESULTS: The results revealed that the difference in the relative change in two dimensions was statistically significant for the epoxy resin group (p < 0.05). CONCLUSIONS: The materials provided a similar degree of dimensional accuracy in reproducing a complete arch when used with addition silicone impression material.