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Journal of Prosthetic Dentistry

Orthodontic elastomeric chain as an alternative to dental floss for splinting implant impression copings for complete-arch implant impressions

Published:November 20, 2019DOI:https://doi.org/10.1016/j.prosdent.2019.09.017
      The most significant step in fabricating an accurate implant prosthesis is to transfer the precise 3D intraoral location of the implants to the definitive cast.
      • Alikhasi M.
      • Siadat H.
      • Nasirpour A.
      • Hasanzade M.
      Three-dimensional accuracy of digital impression versus conventional method: effect of implant angulation and connection type.
      Various impression techniques have been described to achieve the necessary accuracy.
      • Kim J.H.
      • Kim K.R.
      • Kim S.
      Critical appraisal of implant impression accuracies: a systematic review.
      The open tray impression
      • Kim K.R.
      • Seo K.Y.
      • Kim S.
      Conventional open-tray impression versus intraoral digital scan for implant-level complete-arch impression.
      has been widely used; however, translation and rotation of these transfer impression copings may occur when the copings are detached from the implant fixture and during placement of the implant analog.
      • Kim S.
      • Nicholls J.I.
      • Han C.H.
      • Lee K.W.
      Displacement of implant components from impressions to definitive casts.
      Lee et al
      • Lee H.
      • So J.S.
      • Hochstedler J.L.
      • Ercoli C.
      The accuracy of implant impressions: a systematic review.
      concluded in their systematic review that splinting transfer impression copings produced an accurate definitive cast and prevented micromovement of the impression copings. Various methods, including dental floss and pattern resin, have been used to splint the open tray impression coping.
      • Ivanhoe J.R.
      • Adrian E.D.
      • Krantz W.A.
      • Edge M.J.
      An impression technique for osseointegrated implants.
      However, dental floss may slip over the open tray impression coping and is tedious to handle when making a complete-arch impression. The purpose of this article was to present an alternative technique for splinting open tray impression copings by using orthodontic elastomeric chain and light-polymerizing composite resin for complete-arch implant impression making.

      Technique

      • 1.
        Remove the healing abutments (TS Fixture, Healing abutment; Osstem Implant Co, Ltd). Place the open tray impression copings (TS Fixture, Pick up impression coping; Osstem Implant Co, Ltd) and tighten to 10 Ncm. Make periapical radiographs to verify proper seating of the impression copings.
      • 2.
        Take a short continuous orthodontic elastomeric chain (Dental Power E Chain; Pyrax Polymars) and pass it over the head of the impression copings (Fig. 1). Do not stretch the elastomeric chain to prevent elastic tension.
        Figure thumbnail gr1
        Figure 1Orthodontic elastomeric chain passed around open tray impression copings.
      • 3.
        Apply bulk fill flowable light-polymerizing composite resin (Tetric N-Flow Bulk fill; Ivoclar Vivadent AG) over the elastomeric chain to stabilize the open tray impression copings (Fig. 2). Bulk fill flowable composite resin is preferred over a lower filler content composite resin to minimize polymerization shrinkage.
        Figure thumbnail gr2
        Figure 2Open tray impression copings stabilized with bulk fill flowable light-polymerizing composite resin.
      • 4.
        Apply additional composite resin and light polymerize in multiple small increments to minimize polymerization shrinkage. The application and polymerization of the composite resin should be initiated at the impression copings so that shrinkage will be in the direction of a rigid wall of the copings. If the composite resin is applied in bulk, it must be sectioned between 2 copings and rejoined by using an additional composite resin.
        • Majchrowicz M.
        Spongy floss impregnated with light-polymerizing gel to splint implant impression posts.
      • 5.
        Inject low viscosity impression material (Extreme Lite, Medicept) around impression copings. Fill the stock tray with a high viscosity impression material (Extreme putty, Medicept) and place intraorally (Fig. 3).
        Figure thumbnail gr3
        Figure 3Intaglio surface of definitive polyvinyl siloxane impression.

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        Three-dimensional accuracy of digital impression versus conventional method: effect of implant angulation and connection type.
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        Conventional open-tray impression versus intraoral digital scan for implant-level complete-arch impression.
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