impression making

requirements of tooth-supported crown restoration

• prepare tooth to achieve appropriate taper/retention

• prepare distinct margin/finish line

preparation of margin for tooth-supported crown restoration

• margin and preparation should be clean/dry and visible during impression making

• control for bleeding/fluid

what type of material and tray should you use for tooth-supported crown restoration

• use LB impression material to capture fine details and RB/HB tray material

• full arch/section/triple tray may be used

for an implant-supported restoration no ___________ is necessary comparing to a tooth-supported restoration

preparation

requirements of implant supported restoration impressioin

• well-defined margin- implant platform

• high precision prefabricated components conencted to the implant and use for impression making

• no tissue covering the platform

• may need x-ray to evaluate impresison coping fit

impression coping will capture implant position and depth/angulation/margin details, what do you do after this

transfer the information to the master cast

impression material and tray to use for implant-supported restoration

• ONLY RB/HB impression material

• always use full arch tray

when you remove the healing abutment to place the impression coping, why do you have to do this quickly

tissue will collapse if you wait more than 5 min

what cna you use on tissue if it is sensitive

topical

how to connect the impression coping

• hand tighten guide pin to secure coping to the implant

  • NEVER use hand wrench to tighten the guide pin

• make sure the impression coping is firmly connected w no mobility

always use a ________________ tray for implant impressions, even for single units

full arch tray

2 impression techniques

• open tray

• closed tray

a window is made in the impression tray in the area of the implants

open tray technique

impression tray is covering teeth and implants

closed tray impression technique

open tray impression

impression procedure set up for open tray technique

• connect impression coping to the implant using the guide pin and hand tighten

• check coping is engaged

• PA to verify if needed

• make window in impression tray to access guide pin and try in

• cover window w wax sheet/rope wax and reposition tray to identify position of guide pin

w the conical internal connection you don’t need to verify seating of impression coping w …

a PA

impression procedure for open tray technique

• apply RB/HB impression material in impression tray

• use mixing gun and inject RB/HB impression material around coping and adjacent teeth

for the open tray technique, no need to use ___ impression material

LB

when you seat the tray and allow the impression material to set, do you want to identify position of the guide pin and unscrew th eguide pin before or after removing the tray

BEFORE

inspecting the impression

• make sure the impression coping is fully embedded in the impression material

• no voids in the impression

• all important details must be included in the impression

for the open impression technique, the impression copings are ___________ in impression, ALWAYS

picked up

indications for open tray technique

anterior implants, multiunit restorations

disadvantage for open tray technique

difficult to use for impressions in the molar/bicuspid area bc lack of vertical space

advantage of open tray technique

low risk of displacement

vertical clearance required for open tray technique

35-40 mm

in the closed impression technique, what is removed w the impression and what stays in the implant

• coping/cap is removed w imression

• metal coping stays connected to the implant after impression is removed

• coping is then un-screwed from implant and repositioned into impression after tray is removed

impression material used for closed tray technique

same as open tray technique- RB/HB

the impression coping in the closed tray technique can either be ___ or ___ piece component

1 or 2

describe the two piece component in the closed tray technique

metal post w plastic cap

• cap is placed onto metal post and will come out in the impression while metal post stays in

• metal post is disconnected after the impression is removed

describe the one piece component in the closed tray technique

• connect the impression coping to the implant

• make a VPS impression of the coping

• unscrew and remove coping after impression is done

• re-position coping back into impression

in the close tray technique, the snap on/friction fit coping can be used _________ in the mouth

anywhere

in the close tray technique, the snap on/friction fit coping can be used for what type of restorations

single or multi-unit

disadvantage of metal impression coping in closed tray technique

difficult to reposition in impression, could compromise precision in multi-unit fixed prostheses

w the closed tray impression, you always want the lab to reposition the ________ before pouring the impression

impression coping (send copings separate w impression to lab)

vertical clearance needed for closed tray impression technique

10-12 mm

analog/implant replica

what to use for master cast fabrication: is a manufactured that has an internal geometry identical to that of the implant

will be embedded int he master cast and used for the fabrication of the restoration

what is the implant impression/transfer copping used for

transfer information from the pts mouth to the master model

in master cast fabrication, the analog is connected to the impression coping ______ (before/after) the impression is poured

before

is master cast fabrication usually done by the student or lab technician

lab technician

impression is poured in _________

type III yellow stone/die stone

preparation of pouring up closed tray impression

• impression coping is connected to the analog using guide pin

• impression coping w analog connected is repositioned back into impression

preparation of pouring up open tray impression

• impression coping is embedded int VPS material

• when connecting the analog to the impression, you MUST hold the analog w your fingers to prevent rotation of coping

• ONLY tighten guide pin gently w you fingers

the position of the analog on the cast must be identical to that of…

the implant in the mouth

master cast evaluation

lab will return master cast w full contour wax-up to determine cervical contours occlusion/design

• review position and angulation of implant on cast

• locate screw access channel

• select abutment- screw retained or cement retained

stone model contouring will create an approriate…

emergence profile for the restoration

goals of stone model contouring

• to create a natural tooth shape

• allow for adequate soft tissue support arounf restoration

• facilitate hygiene/improve esthetics

contouring of stone model shoudl allow for ~____ mm soft tissue between implant restoration and adjacent tooth

~1 mm

good emergence profile?

no- they just followed the opening provided by the healing abutment

good emergence profile?

proper emergence profile design

how to do stone model contouring

• use pencil to outline profile on model

• use carver to remove stone following outline

the lab will make a __________ groove to verify seating of restoration

buccal/lingual

should stone model contouring ALWAYS be done on tissue or bone level implant

bone level implants when fabricating metal abutments/PFM and FGC restorations

what is soft tissue moulage

made of resilient silicone material

when to use soft tissue moulage

ALWAYS needed when fabricating ceramic abutments

soft tissue moulage is removed when…

abutment is scanned for ceramic crown restoration

soft tissue moulage ressembles….

oral mucosa

goals of soft tissue moulage

• lab uses to design ideal emergence profile

• restoration is fabricated to ideal design/anatomy

• restoration will guide/create soft tissue profile after placement

steps of ceramic implant abutment

1. wax-up the abutment w ideal emergence profile

2. evaluate wax-up and remove soft tissue moulage

3. re-connect back onto cast without soft tissue moulage for scanning

impression making check-list closed tray

1. choose correct impression tray size

2. connect impression coping, make sure everything seated

3. verify w radiograph if needed

4. use RB/HB in tray and over impression coping before seating tray

5. remove impression, spray, and have QC check

6. remove impression coping from implant and send w impression to lab, re-connect healing abutment

7. impressions of opposing arch/occlusal record, and shade selection

8. ALWAYS send impression to lab with analog for return of master cast model w full contour wax-up/moulage

9. stone model contouring

10. return model to lab for completions of restoration

impression making check-list open tray

1. choose correct impression tray

2. prepare tray hole and cover w wax

3. connect impression coping, make sure everything seated

4. verify w radiograph if needed

5. use RB/HB in tray and over impression coping before seating tray

6. unscrew guide pin completely, remove impression, spray, have QC check

7. impressions of opposing arch/occlusal record, and shade selection

8. ALWAYS send impression to lab with analog for return of master cast model w full contour wax-up/moulage

9. stone model contouring

10. return model to lab for completions of restoration

digital workflow

• intraoral scanner

• sending electronic STL files to labs for fabrication of implant restorations

• emergence profile and design done by lab

• restoration sent to you for insertion

reasons for a provisional restoration

• protect underlying structures

• restore funx/esthetics

• oral comfort

• prevent tooth migration

• evaluate esthetics/function/speech

• soft tissue architecture/papilla

• ALWAYS required for implants in esthetic zone

steps to successfully fabricate a provisional implant restoration

1. impression and evaluation

2. diagnostic wax-up

3. stone model contouring

4. duplicate wax up

5. place and modify provisional abutment

6. fabrication of restoration

7. finish restoration

impression and evaluation step of fabricating a provisional implant restoration

• make implant level impression using VPS/HB/RB

• pour up in die stone or yellow stone

• evaluate angulation, position, depth if implant

diagnostic wax-up step in fabricating a provisional implant restoration

• send case to lab or i can do waxup

• use plastic/wooden stick that fits the inside of the implant analog

• modify height and do crown wax up

• check/evaluate on cast

stone model contouring step in fabricating a provisional implant restoration

• create adequate emergenc eprofile

• critical this is done right → will guide the fabrication of the restoration

duplicating wax-up step in fabricating a provisional implant restoration

• soak cast for 10-15 min BEFORE making impression

• make alginate impression of wax-up and pour yellow stone model

• make vacuum form or VPS putty/HB/cinch impression for mold

what type of abutment is used for the provisional crown

provisional abutment- made of titanium and comes w an abutment screw

placing and modifying provisional abutment step in fabricating a provisional implant restoration

secure abutment to cast and modify

fabricating the restoration step in making a provisional implant restoration

• secure provisional abutment to analog

• seal access channel w cotton pellet or short wodden stick to avoid crown material to cover screw, apply die lube on cast

• fill VPS mold/vacuum form w protemp/acrylic resin

clearance needed for abutment

1.5-2 mm

finishing the restoration step in fabricating a provisional implant restoration

• remove excess acrylic resin/protemp

• fill any voids and do dinal contouring

• make sure the restoration is in tight contact w the stone model- emergence profile

• check occlusion/proximal contacts

• polish to make sure the surface is smooth

provisional crown seat steps

1. remove healing abutment

2. apply local anesthetics around implant area

3. seat crown and hand tighten abutment screw

4. eval occlusion/proximal contacts, cervical adaptation, esthetics

5. seal access channel w cotton pellet and ocmposite resin

6. hygiene instructions

when you seat a provisional implant crown, when would you need to take a PA to eval interface

if you used a metal temporary cylindrical

follow-up apts after seating provisional

• bring back in 1-2 weeks to make adjustments is necessary and check occlusion/lateral excursion

• have pt back after 6-8 weeks for final restoration

for bone level design, you want to build the restoration from implant level to achieve ideal tooth anatomy and avoid…

avoid spacing between the restoration and the surrounding mucosa

concerns w tissue level design

• food impaction between crown and gum tissue

• reduced vertical clearance for the restoration

• esthetics

steps for final implant restoration- transferring from provisional to final restoration

1. impression procedure

2. remove provisional crown(s)

3. preserve soft tissue architecture

4. fabricate master cast

5. master cast

6. final restoration

impression procedure for transferring from provisional to final restoration

• use provisional restoration as impression coping

• make VPS HB/RB impression w the provisional crowns seated

removing provisional crown(s) when transferring from provisional to final restoration

• clean and disinfect provisional crowns and connect analogs

• tighten abutment screws

• apply thin layer of wax around the analog- restoration interface

  • will simplify removal from cast

preserving soft tissue architecture when transferring from provisional to final restoration

inject regisil after removal of provisional restoration(s) to prevent soft tissue from collapsing

fabricating master cast when transferring from provisional to final restoration

• re-position provisional restoration in VPS impression

• make sure it fits correctly

• pour impression using die stone/yellow stone

master cast when transferring from provisional to final restoration

• remove provisional crown from stone cast, clean/sterilize before re-seat in pt

• evaluate master cast

writing a lab slip for the final restoration must include

• implant system and diameter used

• clear information about the design of

  • abutment/restoration

  • taper

  • position of finish line

  • instruction to follow stone model exactly

• shade, characterizations