Journal of Dental Implants
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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 9  |  Issue : 1  |  Page : 37-40

An impression technique to accurately register peri-implant soft tissue in single- and multi-unit implant restorations


1 Department of Prosthodontics and Crown and Bridge, School of Dental Sciences, Sharda University, Greater Noida, Uttar Pradesh, India
2 Oral Surgeon, Private Practice, Mumbai, Maharashtra, India
3 Prosthodontist, Private Practice, Mumbai, Maharashtra, India

Date of Web Publication17-Jun-2019

Correspondence Address:
Dr. Payal Rajender Kumar
D-2/248, Madhu Limaye Marg, Vinay Marg, Chanakyapuri, New Delhi - 110 021
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdi.jdi_20_18

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   Abstract 

Tooth replacement in the esthetic zone presents a challenging situation for the clinician. Contouring the soft-tissues around single- and multi-unit unit implant restoration is critical to achieving an esthetically pleasing final restoration. Duplicating the emergence profile is equally important for effective communication between the clinician and laboratory technician. This article presents a simple, quick, and convenient impression technique for easy and accurate transfer of the tissue contours to the working cast. This precludes the step of doing the jig trial resulting in a decrease in overall treatment time.

Keywords: Emergence profile, impression copings, ovate pontic, peri-implant soft tissue, sculpted soft-tissue contours


How to cite this article:
Kumar PR, Kher U, Tunkiwala A. An impression technique to accurately register peri-implant soft tissue in single- and multi-unit implant restorations. J Dent Implant 2019;9:37-40

How to cite this URL:
Kumar PR, Kher U, Tunkiwala A. An impression technique to accurately register peri-implant soft tissue in single- and multi-unit implant restorations. J Dent Implant [serial online] 2019 [cited 2019 Dec 12];9:37-40. Available from: http://www.jdionline.org/text.asp?2019/9/1/37/260455


   Introduction Top


To meet both esthetic and functional demands of implants in the esthetic zone, the peri-implant soft tissue is sculpted using a properly contoured highly polished provisional restoration.[1],[2] The resultant emergence profile then needs to be precisely reproduced into the impression to help duplication of soft tissues on a laboratory model.[3],[4] The impression copings have cylindrical shape which is not suitable to reproduce correctly the emerging profile of the natural teeth.[5] To capture the peri-implant tissue becomes even more critical in cases of malposed implant placement. Restoring multiple missing anterior teeth adjacent to each other is an esthetic challenge and often requires the combination of implants and ovate pontics to achieve an acceptable esthetic result.[6] The precise transfer of this sculpted tissue, beneath the pontics of the provisional restoration and around implants, is required so to provide the dental laboratory technician with the necessary information. This helps him to fabricate a definitive restoration with an appropriate and acceptable emergence profile.[7],[8]


   Case Report Top


A 23-year-old, healthy male patient presented with a chief complaint of fractured right central. Clinical examination of #11 revealed an endodontically treated non-restorable root stump. Immediate implant placement with socket shield technique and immediate temporarization was chosen as treatment modality. After proper planning and antibiotic coverage implant (Megagen AnyRidge) was placed. Straight titanium cylinder provided by the company was used for temporisation and chairside temporary was fabricated. Special attention was paid to the emergence profile (S-shape) of the provisional implant crown. Thereafter the patient was kept on regular follow-ups. The final restoration was planned 3 months post op. When the temporary crowns were removed, a very nice and healthy gingival emergence profile was seen. Precisely capturing this emergence profile and transferring it the final impression and the final cast is a challenging situation to the clinician. Since this step cannot be overlooked especially for the restorations in the esthetic zone; the following technique is suggested to duplicate the peri-implant soft tissue quickly and easily without any trauma to the soft tissue.

Procedure

  1. Unscrew the interim restoration in the patient's mouth, and observe the soft tissue conditioned around the implant [Figure 1] and [Figure 2]
  2. Screw the interim restoration using long guide pin of the pickup impression coping (used for the open tray impression technique) provided by the company (Megagen AnyRidge) [Figure 3]
  3. Apply bonding agent (Universal Bond, 3 M), and place the composite resin (Filtek Z250, 3M) on the labial surface of the interim restoration to form a small button to aid in mechanical retention. This button also helps to reorient the provisional restoration in impression if it does not come out with the impression. Polymerize using light cure gun [Figure 4]
  4. Apply tray adhesive (Caulk Tray Adhesive, Dentsply) on the customized impression tray
  5. Make an implant-level impression using polyvinyl siloxane impression material (Aquasil Ultra Heavy and Aquasil Ultra LV, Dentsply Sirona)
  6. Unscrew the guide pin and remove the impression. The interim restoration is picked up in the impression [Figure 5]. If it is not picked up, then it can be easily inserted into the impression using the orientation groove made by the composite button
  7. Apply the separator, add the gingival mask Multisil mask, Bredent) and pour the impression in Type 3 dental stone (Ultrastone, Kalabhai)
  8. Once the cast is made, clean and polish the interim restoration. Reinsert it in the patient's mouth
  9. Fabricate the definitive crown [Figure 6]. Perfect pink and white esthetics was achieved and gingival contours were well maintained.
Figure 1: Provisional restoration

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Figure 2: Sculpted peri-implant tissue

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Figure 3: Guide pin used to screw the provisional restoration

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Figure 4: Composite resin button added to provide mechanical interlocking

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Figure 5: Temporary restoration picked up in the impression

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Figure 6: Final restoration

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   Discussion Top


The described technique provides the laboratory technician with a definitive cast that is an exact replica of peri-implant soft tissue. It is an easy and reproducible technique. This technique does not require a jig trial because the interim restoration itself acts as jig. This impression technique can be used to accurately register peri-implant soft tissue not only in single- but also in multi-unit implant restorations. At times, we have to make impression when the implants are not placed in the correct three-dimensional position buccolingually or mesiodistally. A mesially tilted adjacent tooth can also hinder the proper seating of impression coping. The impression coping, in such clinical scenarios, comes so close to the tooth that there is not enough room for the impression material to flow [Figure 7] and [Figure 8]. In these cases, the direct pickup of the interim restoration is the only accurate way to make precise implant level impressions [Figure 9].
Figure 7: Impression coping touching adjacent tooth eliminating space for impression material to flow

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Figure 8: Guide pins used for open tray impression technique

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Figure 9: Polyvinyl siloxane implant level impression

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In cases with three- or more-unit bridge on multiple implants; there is need of recording the soft-tissue profile at the pontic site along with soft-tissue profile around the implant [Figure 10], [Figure 11], [Figure 12]. This technique, if used in cases of multiple implants, precludes the step of jig trial as the temporaries seating passively on the cast will act as jig trial itself; thus, decreasing the overall treatment time and a number of patient's visit. This also minimizes the number of times temporary restorations are removed from the implant; hence decreases the trauma to the peri-implant tissue.
Figure 10: Sculpted tissue beneath the pontic of the provisional restoration and around implants

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Figure 11: Guide pins attached

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Figure 12: Provisional bridge picked up directly into the open tray implant level impression

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The only disadvantage of this technique is an increase in chairside time at the time of impression making.


   Conclusion Top


The technique, of making implant level impressions, discussed is a straightforward and effective way of recording the peri-implant soft-tissue contours which are contoured by the interim restoration. It decreases overall treatment time and enables the fabrication of esthetically pleasing restorations.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Wittneben JG, Buser D, Belser UC, Brägger U. Peri-implant soft tissue conditioning with provisional restorations in the esthetic zone: The dynamic compression technique. Int J Periodontics Restorative Dent 2013;33:447-55.  Back to cited text no. 1
    
2.
Tsai BY. Use of provisional restorations as implant impression copings. J Prosthet Dent 2007;97:395-6.  Back to cited text no. 2
    
3.
Parpaiola A, Sbricoli L, Guazzo R, Bressan E, Lops D. Managing the peri-implant mucosa: A clinically reliable method for optimizing soft tissue contours and emergence profile. J Esthet Restor Dent 2013;25:317-23.  Back to cited text no. 3
    
4.
Spyropoulou PE, Razzoog M, Sierraalta M. Restoring implants in the esthetic zone after sculpting and capturing the periimplant tissues in rest position: A clinical report. J Prosthet Dent 2009;102:345-7.  Back to cited text no. 4
    
5.
Patras M, Martin W. Simplified custom impression post for implant-supported restorations. J Prosthet Dent 2016;115:556-9.  Back to cited text no. 5
    
6.
Ntounis A, Petropoulou A. A technique for managing and accurate registration of periimplant soft tissues. J Prosthet Dent 2010;104:276-9.  Back to cited text no. 6
    
7.
Chee WW, Cho GC, Ha S. Replicating soft tissue contours on working casts for implant restorations. J Prosthodont 1997;6:218-20.  Back to cited text no. 7
    
8.
Tsai BY. A method for obtaining peri-implant soft-tissue contours by using screw-retained provisional restorations as impression copings: A clinical report. J Oral Implantol 2011;37:605-9.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]



 

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