Purpose: To compare the accuracy of digital and conventional impression techniques for partially and completely edentulous patients and to determine the effect of different variables on the accuracy outcomes. Materials and Methods: An electronic and manual search was conducted to identify studies reporting on the accuracy of implant impressions. Pooled data were descriptively analyzed. Factors affecting the accuracy were identified, and their impact on accuracy outcomes was assessed. Results: The 76 studies that fulfilled the inclusion criteria featured 4 clinical studies and 72 in vitro studies. Studies were grouped according to edentulism; 41 reported on completely edentulous and 35 on partially edentulous patients. For completely edentulous patients, most in vitro studies and all three clinical studies demonstrated better accuracy with the splinted vs the nonsplinted technique (15 studies, splint; 1, nonsplint; 9, no difference). One clinical study and half of the in vitro studies reported better accuracy with the open-tray vs the closed-tray technique (10 studies, open-tray; 1, closed-tray; 10, no difference). For partially edentulous patients, one clinical study and most in vitro studies showed better accuracy with the splinted vs the nonsplinted technique (8 studies, splint; 2, nonsplint; 3, no difference). The majority of in vitro studies showed better accuracy with the open-tray vs the closed-tray technique (10 studies, open-tray; 1, closed-tray; 7, no difference), but the only clinical study reported no difference. Conclusion: The splinted impression technique is more accurate for both partially and completely edentulous patients. The open-tray technique is more accurate than the closed-tray for completely edentulous patients, but for partially edentulous patients there seems to be no difference. The impression material (polyether or polyvinylsiloxane) has no effect on the accuracy. The implant angulation affects the accuracy of implant impressions, while there are insufficient studies for the effect of implant connection type. Further accuracy studies are needed regarding digital implant impressions.

Accuracy of implant impressions for partially and completely edentulous patients: a systematic review.

Statement of problem. Given that meticulous implant prosthodontic procedures are recommended to obtain the best possible intraoral fit, impression materials that are suitable for use with a direct impression technique warrant further investigation. Purpose. This in vitro study compared the amount of torque required to rotate a square impression coping in an impression and evaluated the accuracy of solid implant casts fabricated from different impression materials. Material and methods. Two direct transfer implant impressions were made using 8 impression materials; the torque required to rotate an impression coping in the impressions was calculated. Ten direct transfer implant impressions were made from the master model and poured in a die stone (Resin Rock) for 3 of the 8 initial impression material groups. Linear distances between steel balls placed on each abutment replica were measured with a traveling microscope to determine distortion in the impression procedure for each group. Data were analyzed ( P =.05) with ANOVA and Ryan-Einot-Gabriel-Welsch multiple range test for post hoc. Results. With a 1-way ANOVA, average torque values among the material groups differed significantly ( P =.001). Polyether (medium consistency) was found to produce the highest overall torque values, followed by addition silicone (high consistency), and then polysulfide (medium consistency). Statistically significant difference was also found among the 3 material groups' mean absolute cast error using a 1-way ANOVA ( P =.0086). Implant casts made from polyether (medium) or addition silicone (high) impressions were significantly more accurate than casts made from polysulfide medium impressions. Conclusion. On the basis of the results of this study, the use of either polyether (medium) or addition silicone (high) impression is recommended for direct implant impressions. (J Prosthet Dent 2000;83:323-31.)

Comparison of impression materials for direct multi-implant impressions

Statement of problem Different assessment methods have been used to measure the accuracy of implant impression techniques; therefore, the readers should understand the benefits and limitations of each assessment method used. Purpose The purpose of this systematic review was to classify the implant impression studies by the assessment methods and techniques used and to understand the characteristics of each assessment method. The results of published studies were also analyzed to draw meaningful conclusions about the accuracy of the implant impressions. Material and methods An electronic search of the MEDLINE/PubMed database was performed in February 2013 using specific search terms and predetermined criteria to identify and assess laboratory studies of the accuracy of implant impression techniques. A final list of articles deemed to be of interest was comprehensively reviewed by 2 reviewers to ensure that these were suitable for the purpose of this review. The results of the current review were also compared with results from a previous systematic review. Results A total of 56 studies met the inclusion criteria for this review. Thirty-seven studies measured the amount of linear distortion, and 17 studies compared the angular change to assess the accuracy. Most linear or angular distortions were only measured in 2 dimensions, and 3-dimensional analysis was rare. More than 80% of the studies compared nonsplinting versus splinting, direct versus indirect techniques, and different impression materials. Conclusions In recent publications, the direct or splint technique showed more accurate results than the indirect or nonsplinted technique. In contrast to external connection implants, inconsistent results were reported for internal connection implants.

Critical appraisal of implant impression accuracies: A systematic review.

Statement of problem Implant-supported prostheses are mechanically connected to implants. When this connection is a screw joint, it is likely that the fit will be imperfect. Previous studies demonstrate that deformation can occur at the interface between the prosthesis and implant following cyclic loading. This deformation alters the fit of components. If implant connection components, abutments, were to be reoriented or replaced, it is likely that deformed surfaces would no longer approximate each other. Likewise, it is possible that the deformation may deleteriously alter the fit to replacement components. Purpose This study evaluated the changes in prosthesis–implant abutment fit when gold cylinders that have been cyclically loaded are mated to as-manufactured abutments. Material and methods Fifteen implant-supported frameworks were fabricated using conventional casting techniques and were cyclically loaded under 3 different loading conditions: anterior region, unilaterally on posterior cantilever, and bilaterally on posterior cantilever. A cyclical load of 200 N was applied to each framework for 200,000 cycles. The abutments and frameworks were returned to the definitive casts for measurements. Linear measurements (μm) of the gap between the prosthetic cylinder and the implant-supported abutment at 4 predetermined reference points were made. The cycled abutments were replaced with as-manufactured abutments, and the gaps were measured at the same reference points. The Mann-Whitney rank-sum test was applied to the 2 sets of data to determine whether significant changes in fit were observed following component replacement (α=.05). Results Although minor changes in component fit were seen, the data failed to show that gaps at the prosthetic-abutment interface of cycled abutments were significantly different from those of as-manufactured abutments. Conclusions Within the limitations of this study, differences in the fit between the implant-supported prosthesis and the abutments were not significantly different when abutments worn through loading were replaced with new as-manufactured abutments.

Cyclic loading of implant-supported prostheses: Comparison of gaps at the prosthetic-abutment interface when cycled abutments are replaced with as-manufactured abutments

This study evaluated the effect of fabrication techniques and cyclic loading on the vertical marginal fit of implant-supported fixed partial denture (FPD) frameworks. Thirty implant-supported 3-unit FPD frameworks were fabricated on a model system, divided into 3 equal groups (n = 10). The first group (control) was constructed from base metal alloy; the other 2 test groups were constructed from all-ceramic zirconia using a computer-aided design/computer-aided manufacturing (CAD/CAM) Cerec 3 system and a copy milling (Zirkonzahn) system. A cyclic load of 200 N was applied to each framework for up to 50,000 cycles. Linear measurements were made in micrometers of the vertical gap between the framework and the implant-supported abutment at 16 predetermined points before and after cyclic loading. The frameworks were viewed using scanning electron microscopy to inspect any fractographic features. One-way analysis of variance was performed to compare the marginal discrepancy values of the control and the 2 test groups and for each group; a t test was applied to determine whether significant changes in the fit were observed after cyclic loading (α = 0.05). The CAD/CAM group showed significantly higher marginal gap mean values (80.58 μm) than the Zirkonzahn and control groups (50.33 μm and 42.27 μm, respectively) with no significant difference. After cyclic loading, the CAD/CAM group recorded the highest marginal gap mean value (91.50 ± 4.260 μm) followed by control group (72.00 ± 2.795 μm); the Zirkonzahn group recorded the lowest marginal gap (65.37 ± 6.138 μm). Cyclic loading significantly increased the marginal gap mean values in the control group only. A marginal chip was observed in one of the CAD/CAM ceramic frameworks. Within the limitations of this study, the fabrication technique influenced the marginal fit of the implant-supported 3-unit FPD frameworks. Cyclic loading failed to change the fit of all-ceramic zirconia frameworks, whereas significant changes were found in the metal frameworks.

Marginal Fit of Implant-supported All-Ceramic Zirconia Frameworks.

Purpose Materials used to fabricate the most dimensionally accurate implant casts have not been identified experimentally. The purpose of this investigation was to examine the dimensional accuracy of implant casts fabricated with different materials. Measurements of linear horizontal dimensional change and strain produced on a master framework were evaluated and correlated.



Materials and Methods A master framework was fabricated to fit an aluminum five-implant model. Forty polyether implant impressions of the aluminum model were randomly grouped and poured in either Vel-mix, Die Keen, Resin Rock, or Low Fusing Alloy. A digital veneer caliper was used to measure linear distance between the most distal abutments on each of the experimental implant casts and the master model. In addition, strain values were recorded from strain gauges bonded in the mesiodistal axis of the framework, which was secured by prosthetic retaining screws torqued to 10 Ncm.



Results A one-way ANOVA showed a significant difference among the four die materials in dimensional change of the experimental casts (p= .0001). A post-hoc Duncan's multiple-range test (p < .05) showed that casts fabricated with Low Fusing Alloy had the least linear dimensional change from the master cast, but the material exhibited the greatest dimensional variability. A MANOVA (Wilks' Lambda) showed significant differences in strain on the framework based upon die material (p= .015). A post-hoc Duncan's multiple-range test (p < .05) showed that Resin Rock casts induced significantly less strain on the framework than the other materials. Negligible correlation was found between the linear horizontal dimensional change and the total absolute strain on the framework.



Conclusion Experimental implant casts made of Resin Rock minimized strain on the master framework and decreased the amount of framework distortion on casts of this material. Low Fusing Alloy yielded accurate casts, but highly variable linear dimensional changes in the horizontal dimension may preclude its clinical benefit.

Evaluation of the Accuracy of Solid Implant Casts

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Evaluation of the Accuracy of Solid Implant Casts