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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 posi-tion and surrounding hard and soft tissues is paramountto fabricating an esthetic and biologically functionaldefinitive restoration. There are 2 primary techniquesfor registering the positions of dental implants, theclosed-tray and open-tray impression techniques. Eachof these impression techniques has variations.1-5

This article describes an open-tray technique forimpressing implants that is inexpensive, clean, and easy to perform with materials commonly found in a restor-ative dental practice. The soft boxing wax is easy to apply to the impression tray and easily peels off. It confines theBlu-Mousse (Parkell, Inc, Edgewood, NY) used aroundthe implant copings and allows the guide pins to pro-trude through the tray. Blu-Mousse is preferred aroundthe impression copings because of its rigidity.6 The Blu-Mousse is placed in the impression tray last because itpolymerizes in 2 minutes, whereas most vinyl polysilox-ane impression materials polymerize in approximately 5 to 6 minutes.

Other open-tray impression protocols recommend wiping off the excess impression material that extrudesthrough the hole in the tray with a gloved finger orinjecting impression plaster through the hole(s) in thetray to fill the remaining void.7,8 This may be messy to

accomplish. Additionally, the powder on some glovesmay inhibit the polymerization of vinyl polysiloxane(VPS) impression materials.9  Wax placed over the holein the tray prevents contact of the impression material with the gloves.

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 createan opening in the area where the implant is located.

2. Remove the healing abutment(s) (Replace Select;Nobel Biocare, Yorba Linda, Calif) and screw onthe implant impression coping(s) (Replace Select;Nobel Biocare) (Fig. 1, A ).

3. Evaluate the impression tray intraorally. Ensure thatit is well adapted and that all the impression copings

protrude through theopening(s) in thetray withoutcontacting the acrylic resin tray.

4. Remove the tray from the mouth and adapt a sec-tion of boxing wax (Dentsply Intl) over the open-ing(s) in the tray and seal the wax to the tray usinga hot instrument. (Fig. 1, B )

5. Paint tray adhesive (Kerr Corp, Orange, Calif) onthe inside of the tray, except where the wax islocated, and allow to dry.

6. Inject light-bodiedVPS impression material(Take 1;KerrCorp) around theimpression coping(s) near thegingival tissues and into the interproximal areas be-tween teeth. Have an assistant fill the tray with eithermedium- 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.

7. Place the loaded tray intraorally and push on the

 wax until all impression coping guide pins have

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

The views and opinions expressed herein are those of the authorsand do not reflect those of the United States Army or the Depart-ment of Defense.

aAssistant Director.bThird-year Resident.

 J Prosthet Dent 2006;96:220-1.

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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 thescrewdriver (Nobel Biocare) (Fig. 2,  A ). Disengageall guide pins from the implants and remove theimpression from the patient’s mouth.

10. Disinfect the impression in accordance with theCenters for Disease Control and Prevention guide-lines10 and connect the appropriate laboratory analog(s) (Fig. 2, B ). Forward to the dental labora-tory for appropriate handling and prosthesisfabrication.

REFERENCES

1. Carr AB. Comparison of impression techniques for a five-implant mandib-ular model. Int J Oral Maxillofac Implants 1991;6:448-55.

2. Assif D, Marshak B, Schmidt A. Accuracy of implant impression tech-

niques. Int J Oral Maxillofac Implants 1996;11:216-22.3. Spector MR, Donovan TE, Nicholls JI. An evaluation of impression tech-

niques 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 RestorDent 2004;12:9-14.

5. Daoudi MF, Setchell DJ, Searson LJ. A laboratory investigation of theaccuracy of two impression techniques for single tooth implants. Int JProsthodont 2001;14:152-8.

6. Michalakis KX, Pissiotis A, Anastasiadou V, Kapari D. An experimental

study on particular physical properties of several interocclusal recordingmedia. 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 polyvinylsiloxaneimpression 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 30809FAX: 706-787-7528

E-MAIL: richard.windhorn@amedd.army.mil

0022-3913/$32.00Copyright Ó 2006 by The Editorial Council of  The Journal of Prosthetic 

Dentistry .

doi:10.1016/j.prosdent.2006.07.009

Fig. 2. A, Boxing wax cleared from guide pins on patient’s leftside. B, Laboratory analogs connected to impression copingsprior to casting.

THE JOURNAL OF PROSTHETIC DENTISTRYWINDHORN AND GUNNELL

SEPTEMBER 2006 221