A simple open-tray implant impression technique

Richard J. Windhorn, DMD,a and Thomas R. Gunnell, DDSb US Army Prosthodontic Residency Program, Ft. Gordon, Ga Obtaining an accurate impression of the implant position and surrounding hard and soft tissues is paramount to fabricating an esthetic and biologically functional denitive restoration. There are 2 primary techniques for registering the positions of dental implants, the closed-tray and open-tray impression techniques. Each of these impression techniques has variations.1-5 This article describes an open-tray technique for impressing implants that is inexpensive, clean, and easy to perform with materials commonly found in a restorative dental practice. The soft boxing wax is easy to apply to the impression tray and easily peels off. It connes the Blu-Mousse (Parkell, Inc, Edgewood, NY) used around the implant copings and allows the guide pins to protrude through the tray. Blu-Mousse is preferred around the impression copings because of its rigidity.6 The BluMousse is placed in the impression tray last because it polymerizes in 2 minutes, whereas most vinyl polysiloxane impression materials polymerize in approximately 5 to 6 minutes. Other open-tray impression protocols recommend wiping off the excess impression material that extrudes through the hole in the tray with a gloved nger or injecting impression plaster through the hole(s) in the tray to ll the remaining void.7,8 This may be messy to accomplish. Additionally, the powder on some gloves may inhibit the polymerization of vinyl polysiloxane (VPS) impression materials.9 Wax placed over the hole in the tray prevents contact of the impression material with the gloves.

Fig. 1. A, Implant impression copings placed intraorally. B, Boxing wax sealed to impression tray.

PROCEDURE
1. Fabricate a custom acrylic resin tray (Triad; Dentsply Intl, York, Pa) or select an appropriately sized stock tray from accurate dental casts and create an opening in the area where the implant is located. 2. Remove the healing abutment(s) (Replace Select; Nobel Biocare, Yorba Linda, Calif) and screw on the implant impression coping(s) (Replace Select; Nobel Biocare) (Fig. 1, A). 3. Evaluate the impression tray intraorally. Ensure that it is well adapted and that all the impression copings
The views and opinions expressed herein are those of the authors and do not reect those of the United States Army or the Department of Defense. a Assistant Director. b Third-year Resident. J Prosthet Dent 2006;96:220-1.

4.

5.

6.

7.

protrude through the opening(s) in the tray without contacting the acrylic resin tray. Remove the tray from the mouth and adapt a section of boxing wax (Dentsply Intl) over the opening(s) in the tray and seal the wax to the tray using a hot instrument. (Fig. 1, B) Paint tray adhesive (Kerr Corp, Orange, Calif) on the inside of the tray, except where the wax is located, and allow to dry. Inject light-bodied VPS impression material (Take 1; Kerr Corp) around the impression coping(s) near the gingival tissues and into the interproximal areas between teeth. Have an assistant ll the tray with either medium- or heavy-bodied VPS impression material (Take 1; Kerr Corp) in all areas, except where the wax is located. Place Blu-Mousse Classic (Parkell, Inc) in the entire area where the wax is located. Place the loaded tray intraorally and push on the wax until all impression coping guide pins have
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10. Disinfect the impression in accordance with the Centers for Disease Control and Prevention guidelines10 and connect the appropriate laboratory analog(s) (Fig. 2, B). Forward to the dental laboratory for appropriate handling and prosthesis fabrication.
REFERENCES
1. Carr AB. Comparison of impression techniques for a ve-implant mandibular model. Int J Oral Maxillofac Implants 1991;6:448-55. 2. Assif D, Marshak B, Schmidt A. Accuracy of implant impression techniques. Int J Oral Maxillofac Implants 1996;11:216-22. 3. Spector MR, Donovan TE, Nicholls JI. An evaluation of impression techniques for osseo-integrated implants. J Prosthet Dent 1990;63:444-7. 4. Daoudi MF, Setchell DJ, Searson LJ. An evaluation of three implant level impression techniques for single tooth implants. Eur J Prosthodont Restor Dent 2004;12:9-14. 5. Daoudi MF, Setchell DJ, Searson LJ. A laboratory investigation of the accuracy of two impression techniques for single tooth implants. Int J Prosthodont 2001;14:152-8. 6. Michalakis KX, Pissiotis A, Anastasiadou V, Kapari D. An experimental study on particular physical properties of several interocclusal recording media. Part III: resistance to compression after setting. J Prosthodont 2004; 13:233-7. 7. Phillips K, Goto Y. Alternative implant impression techniques. Compend Contin Educ Dent 2002;23:170-4. 8. Eid N. An implant impression technique using a plaster splinting index combined with a silicone impression. J Prosthet Dent 2004;92:575-7. 9. Peregrina A, Land MF, Feil P, Price C. Effect of two types of latex gloves and surfactants on polymerization inhibition of three polyvinylsiloxane impression materials. J Prosthet Dent 2003;90:289-92. 10. Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM, et al. Guidelines for infection control in dental health-care settings-2003. MMWR 2003;52(RR17):1-61. Reprint requests to: DR RICHARD WINDHORN 1412 ANDOVER CT EVANS, GA 30809 FAX: 706-787-7528 E-MAIL: richard.windhorn@amedd.army.mil 0022-3913/$32.00 Copyright 2006 by The Editorial Council of The Journal of Prosthetic Dentistry.

Fig. 2. A, Boxing wax cleared from guide pins on patients left side. B, Laboratory analogs connected to impression copings prior to casting.

been located and protrude through the wax a few millimeters. 8. Allow the impression to completely polymerize. 9. Remove any wax or impression material on the guide pin(s) to gain access for connection of the screwdriver (Nobel Biocare) (Fig. 2, A). Disengage all guide pins from the implants and remove the impression from the patients mouth.

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