DENTAL TECHNIQUE
Simplified custom impression post for implant-supported restorations Michael Patras, DDS, MSa and William Martin, DDS, MSb Despite the high success rates ABSTRACT of implant dentistry, dental The esthetic outcome of an implant-supported restoration is greatly influenced by the relationship professionals are often faced between the contours of the definitive prosthesis and the periimplant tissues. In this clinical with the increasing expectatechnique, an implant analog holder and autopolymerizing acrylic resin were used to accurately tions of patients with regard to register the soft-tissue transition zone created by the interim restoration and transfer it to the esthetic outcomes, especially impression post during the definitive impression. (J Prosthet Dent 2015;-:---) in the anterior region.1,2 The success of an implant restoration from an esthetic optimal transfer of the transition zone to the dental standpoint is dependent upon making both the surlaboratory have been suggested.4-7,9-14 Among them, the rounding dentition and soft-tissue architecture indistinuse of customized impression posts is a well-established guishable from the adjacent natural dentition.3 However, procedure that enables the duplication of the transition implant-supported restorations in the esthetic zone zone and restoration emergence profile in a highly often pose a significant challenge for the clinician.4 precise and predictable manner.5,7,9,10,12,13 However, The importance of using interim restorations to direct techniques7,11 are relatively inaccurate because of optimize the contours of the periimplant tissue anatomy soft tissue collapse and may also cause chemical irritation after second stage surgery has been reported.1,3-5 This because of the acrylic resin monomer. Similarly, most tissue contour has been referred to as the transition zone, indirect methods require additional preparation, armathat is the emergence profile created from the shoulder of mentarium, and laboratory steps.14 6 the implant to the mucosal margin. Interim abutments A simple, predictable, and time-effective technique should be developed as needed to condition and shape for capturing the transition zone with an analog holder the transition zone during healing, with periodical and autopolymerizing acrylic resin is presented. Addiadjustments and modifications.3-7 Once the transition tional advantages of this technique include stability of the zone has reached a favorable form, this information can analog in relation to the silicone index, ease of fabrication be transferred to the definitive cast through a precise of the custom impression post, no need to prepare any impression-making procedure.4-7 However, the standard vessels or medicine cups, and no damage to implant impression post has a circular shape rather than analogs. A disadvantage is the cost of the analog holder. dimensions and cross sections of the natural tooth.4,8 TECHNIQUE Furthermore, the 3-dimensional periimplant architecture cannot be captured by the elastomeric impression material, as the soft tissue quickly collapses and adapts to 1. Confirm the optimal contours of the interim restorathe impression post’s circular configuration.5,9 tion that will shape the implant transition zone (Fig. 1). Apart from an arbitrary modification of the working 2. Position and secure the appropriate implant analog cast,8 many direct or indirect techniques that facilitate the (RC implant analog; Institut Straumann AG) into
a
Private practice, Athens, Greece. Associate Professor, Department of Oral and Maxillofacial Surgery, Center for Implant Dentistry, University of Florida, Gainesville, Fla.
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Figure 1. Interim restoration on maxillary first premolar after soft tissue maturation.
Figure 3. Space created from interim restoration in silicone matrix.
Figure 5. Impression post removed and evaluated for voids or other irregularities.
the laboratory analog holder (Institut Straumann AG). 3. Remove the interim restoration from the mouth and connect it to the implant analog. THE JOURNAL OF PROSTHETIC DENTISTRY
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Figure 2. Interim restoration secured in analog holder. C-silicone laboratory putty is used for duplication of emergence profile.
Figure 4. Soft tissue contours captured with autopolymerizing acrylic resin.
Figure 6. Customized impression post viewed intraorally.
4. Apply polyvinyl siloxane putty (Zetalabor; Zhermack SpA) and create a matrix around the gingival third of the interim restoration (Fig. 2). Ensure the material is firmly adapted in the notches of the analog holder to prevent rotation and then press it Patras and Martin
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Figure 7. Accurate reproduction of transition zone in definitive cast.
Figure 9. Alternative use of transparent silicone to capture interim restoration’s emergence profile.
over the submucosal portion of the restoration extending to 1 mm below the proximal contacts. Once the material has polymerized, mark the facial midline of the restoration with a pen to ensure proper orientation. 5. Remove the interim restoration and evaluate the outline of the emergence profile created in the matrix; this should correspond with the transition zone seen intraorally (Fig. 3). 6. Seat the corresponding stock impression post (RC impression post for closed tray; Institut Straumann AG) and incrementally fill all the remaining space with fast-setting autopolymerizing acrylic resin (Qyk-Set Temporary Acrylic; Holmes Dental Co) so that it is flush with the matrix (Fig. 4). 7. Remove the impression post and evaluate for voids or other irregularities. Trim any excess material with a tungsten carbide bur and polish. An appropriate surface sealer (Fortify Plus; Bisco) should be applied to ensure a smooth surface of the custom impression post (Fig. 5). Patras and Martin
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Figure 8. Buccal view of definitive restoration on maxillary first premolar 2 weeks after insertion.
Figure 10. Layers of flowable resin applied in provided space.
Figure 11. Light polymerization of flowable resin through clear matrix.
8. Place the impression post onto the implant (Fig. 6) and proceed with the definitive impression (Aquasil Ultra LV and Aquasil Soft Putty; Dentsply DeTrey GmbH) and fabrication of the definitive cast in the normal manner. The definitive cast (Fig. 7) will be THE JOURNAL OF PROSTHETIC DENTISTRY
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during the provisional phase will be easily and predictably maintained. REFERENCES
Figure 12. Custom impression post matched with submucosal portion of interim restoration.
used by the dental laboratory technician to generate the definitive restoration’s emergence profile and transition zone contours (Fig. 8) that will support the tissue as the interim prosthesis. 9. Alternatively, a similar customized anatomic impression post may be fabricated with a clear silicone matrix (Blue-Bite Clear; Henry Schein, Inc) and a flowable composite resin (Synergy Flow; Coltène/ Whaledent AG). (Figs. 9-12). SUMMARY The clinical technique illustrated describes a simplified method for developing a customized impression post that captures the transition zone generated by the contours of the interim restoration. Definitive impression procedures using the customized impression post will transfer the architecture of the transition zone to the dental laboratory so that the contours of the interim restoration can be accurately duplicated in the definitive restoration. With this, the soft tissue morphology and corresponding esthetics created
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[email protected] Copyright © 2015 by the Editorial Council for The Journal of Prosthetic Dentistry.
Patras and Martin
