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JJOD-2375; No. of Pages 9
Digital evaluation of the accuracy of impressiontechniques and
materials in angulated implants
Sevcan Kurtulmus-Yilmaz a,*, Oguz Ozan a, Tuncer Burak Ozcelik
b,Ayberk Yagiz c
aDepartment of Prosthodontics, Faculty of Dentistry, Near East
University, Mersin 10, TurkeybDepartment of Prosthodontics, Faculty
of Dentistry, Baskent University, Adana, TurkeycAy Tasarim Ltd.,
Ankara, Turkey
j o u r n a l o f d e n t i s t r y x x x ( 2 0 1 4 ) x x x – x
x x
* Corresponding author at: Near East University, Faculty of
Dentistry, Department of Prosthodontics, Lefkosa, Mersin 10,
Turkey.Tel.: +90 392 6802030; fax: +90 392 6802025.
E-mail address: [email protected] (S.
Kurtulmus-Yilmaz).
a r t i c l e i n f o
Article history:
Received 4 August 2014
Received in revised form
11 October 2014
Accepted 14 October 2014
Available online xxx
Keywords:
Implant angulation
Splinted direct technique
Indirect technique
Vinyl polysiloxane
Polyether
Vinyl polyether silicone
a b s t r a c t
Objectives: The aim of this study was to investigate the
accuracy of 2 different impression
techniques and 3 different impression materials in models
simulating parallel and angu-
lated implants.
Methods: Three master models simulating partial edentulous
mandible with 2 implants at
the sites of second premolars (parallel) and second molars with
different angulations
(parallel, 108 or 208 angulated) were fabricated. Two different
impression techniques
[splinted direct (D), indirect (I)] and 3 different monophase
impression materials [polyether
(PE), vinyl polysiloxane (VPS), vinyl polyether silicone (VPES)]
were used for each master
model and a total of 180 impressions were made (n = 10). Master
model and casts were
scanned by a modified laser scanner and data were transferred to
VRMesh software. Master
model and duplicate cast scans were digitally aligned observing
the superposition of
anatomic markers. Angular and coronal deviations between master
and duplicated copings
were calculated and data were statistically analyzed.
Results: Mean angular and coronal deviations were in a range of
0.205–0.3598 and 22.56-
33.33 mm, respectively. Statistical analysis revealed that the
angulation of implant affected
both coronal and angular deviations of the impression copings (P
< 0.05). According to
statistical analyses, for parallel implants, the accuracy of
impression materials and tech-
niques were ranging as VPS-D = PE-D > VPS-I = PE-I >
VPES-D > VPES-I from most accurate
to the least. For 108 and 208 angulated implants the most
accurate material and technique
was VPS-D whereas the least accurate combination was VPES-I (P
< 0.05).
Conclusion: Angulation, impression technique and material were
found to be effective on the
accuracy of implant impressions.
Clinical significance: Clinicians may prefer VPS impression
material and splinted direct
technique for impressions of both parallel and up to 208
angulated implants.
# 2014 Elsevier Ltd. All rights reserved.
Available online at www.sciencedirect.com
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Please cite this article in press as: Kurtulmus-Yilmaz S, et al.
Digital evaluation of the accuracy of impression techniques and
materials inangulated implants. Journal of Dentistry (2014),
http://dx.doi.org/10.1016/j.jdent.2014.10.008
http://dx.doi.org/10.1016/j.jdent.2014.10.0080300-5712/# 2014
Elsevier Ltd. All rights reserved.
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JJOD-2375; No. of Pages 9
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1. Introduction
The passive fit of implant-supported prosthesis is critical
for
long term clinical success.1 Any misfit between the
prosthesis
and implant may lead to complications, such as screw
loosening, screw fracture, occlusal discrepancies, increased
plaque accumulation caused by misfit components and even
loss of osseointegration and implant fracture.1–4 Impression
is
one of the most important steps for a passive fit and transfer
of
the precise position of implant to definitive cast with an
accurate impression is essential.5 Impression technique,
type of impression material,6 splinting or non-splinting
impression copings, type of splinting material, number
and angulation of implants7 are the factors that affect the
accuracy of impression.
To date, several implant impression techniques have been
introduced and evaluated for accuracy. Two basic impression
techniques are commonly used in implant dentistry: the
indirect (transfer, closed tray) and the direct (pick-up,
open
tray) technique. In indirect technique, the copings are
connected to the implant and after the removal of the
impression they are retained on the implants. The copings
are then removed from implant, attached to the implant
analogues and reinserted in the impression. In direct
technique, an open tray that exposes coronal ends of the
impression coping screws is used. Screws of the copings are
loosened when the impression material is set and impression
is removed from the mouth with impression copings retained
in the impression. The implant analogues are connected to
the
copings using the same screw.5,8
The accuracy of direct and indirect techniques were
compared in many studies.9–24 However the results are still
contradictory. In a systematic review, Lee et al.5
investigated
the published researches regarding the accuracy of implant
impressions and concluded that there was no difference
between direct and indirect techniques if there were 3 or
fewer
implants.
Accuracy of various implant impression materials were
investigated in numerous studies and more accurate impres-
sions were obtained with polyether (PE) and vinyl
polysiloxane
(VPS) in comparison to condensation silicone, polysulfide,
reversible hydrocolloid, irreversible hydrocolloid and plas-
ter.6,13,25–27 Wetting behaviour is an important
physiochemical
property of elastomeric impression materials that affects
the
accuracy of the material. Hydrophilicity provides detailed
reproduction of wet oral surfaces and increased wettability
with gypsum slurry.28 Hydrophobic or hydrophilic character
of
materials can be attributed to their chemical structure. VPS
has hydrophobic aliphatic hydrocarbon groups which sur-
round the siloxane bond. However, PE contains functional
groups that attract and interact with water molecules,
making
this material hydrophilic.29 To improve the wettability of
VPS,
manufacturers added extrinsic surfactants and labelled these
as hydrophilic VPS materials. Recent studies reported that
hydrophilized VPS has similar hydrophilicity to PE.28,30
Many
studies showed that there was no difference in the accuracy
of
PE and VPS6,13,25,26,31–36 and both of the materials are
recommended for implant impressions. Vinyl polyether
silicone (VPES) (EXA’lence, GC America Inc., Alsip, IL,
USA),
Please cite this article in press as: Kurtulmus-Yilmaz S, et al.
Digital evangulated implants. Journal of Dentistry (2014),
http://dx.doi.org/10.1016
a combination of VPS and PE was introduced a few years ago.
According to the manufacturer, VPES has intrinsic hydrophi-
licity and high dimensional stability. However, the data
regarding the accuracy of VPES is very limited.37–39 In a
recent
study, Schaefer et al.39 evaluated the accuracy and repro-
ducibility of VPES, VPS and PE impression materials by a 3-D
analysis. They reported that there was no significant
difference among the materials in terms of spatial deviation
and all of the materials demonstrated high accuracy and
reproducibility.39
Parallel placement of implants is not always possible due to
the anatomical limitations and angulations may occur in
implant positions. The effect of angulation of implants on
the
accuracy of impression has been evaluated in previous
studies
and researches reported that angulated implants caused less
accurate impressions in comparison to parallel implants when
there were 4–6 implants.8,25,40,41 However, the studies that
used 2 or 3 implants did not report any difference between
angulated and parallel implants in terms of impression
accuracy.42–44 There is limited data regarding the accuracy
of impression materials in case of implant angulation. The
results of previous studies40,41,45 investigating the accuracy
of
impression materials for angulated implants showed incon-
sistency. Sorrentino et al.41 found VPS more accurate than
PE
whereas Akalın et al.40 obtained more accurate impressions
with PE. On the other hand, Reddy et al.45 reported that
there
was no significant difference in accuracy of VPS and PE for
angulated implants. To the best of authors’ knowledge, the
accuracy of VPES impression material with angulated
implants has not been investigated.
The aim of the present study was to investigate the
accuracy of 2 different impression techniques (splinted
direct
and indirect) and 3 different impression materials (PE, VPS,
VPES) in models simulating parallel and angulated (108, 208)
implants.
2. Materials and methods
2.1. Fabrication of master models
Three autopolymerizing transparent acrylic resin (Pegasus
Plus Repair Acrylic, Davis Schottlander & Davis Ltd.,
Hertford-
shire, England) master models simulating partial edentulous
mandible were fabricated. Two implants (T4 3810, NucleOSS,
Sanlilar Tibbi Cihazlar Medikal Kimya San Tic Ltd. Sti,
İzmir,
Turkey) were placed at the sites of the right second
premolar
(implant 1) and right second molar (implant 2) of each model
with different angulations (parallel, 108 or 208 angulated)
(Fig. 1).
Model 1: Implant 1 and implant 2 were positioned parallel to
each other and long axes of neighbouring teeth;
perpendicular
to the horizontal plane.
Model 2: Implant 1 was positioned parallel to the long axis
of
neighbouring tooth and perpendicular to the horizontal
plane;
implant 2 was placed with 108 mesial angulation with respect
to the long axis of implant 1.
Model 3: Implant 1 was positioned parallel to the long axis
of
neighbouring tooth and perpendicular to the horizontal
plane;
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Fig. 2 – The alignment of the master model and duplicate
cast scan by superpositioning of the anatomic markers.
Fig. 1 – Master models with parallel, 108 and 208 angulated
implants.
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JJOD-2375; No. of Pages 9
implant 2 was placed with 208 mesial angulation with respect
to the long axis of implant 1.
2.2. Fabrication of custom trays
Ninety custom trays with 3 mm relief and 2 guide stops on
the
occlusal surface of neighbouring teeth were made for each
impression technique (totally 180 trays) with light
polymeriz-
ing resin (Plaque Photo, W + P Dental, Hamburg, Germany) and
polymerized (Tray Lux, Ampac Dental, Rockdale, Australia).
For direct impression technique, a hole was made on the
trays
to access to the coronal ends of the impression copings.
2.3. Impression procedures
A total of 180 impressions were made with 2 different
impression techniques (splinted direct and indirect) and 3
different impression materials (PE, VPS, VPES) from each
master model (n = 10).
Indirect technique (I): Impression copings (T4 4040,
NucleOSS)
were screwed into the implants and tray with impression
material was placed on the model. After the impression
material set, the tray was removed from the model. The
copings were unscrewed from the model and screwed to the
implant analogues (T4 4020, NucleOSS) and they were
repositioned in the impression.
Splinted direct technique (D): Impression copings were
screwed on implants and the copings were splinted with
dental floss and autopolymerizing acrylic resin (Pattern
Resin
LS, GC America Inc., Alsip, IL, USA). Splint was sectioned
after
17 min of application and reconnected with an autopolymer-
izing acrylic resin. Open tray with impression material was
placed on the model and a syringe was used to inject the
impression material around the exposed surfaces of
the impression copings. After the impression material set,
the screws of the copings were loosened and the impression
was separated from the model. Implant analogues were
screwed to the impression copings that fixed in the
impression.
PE (Impregum Penta Soft, 3M ESPE AG, Seefeld, Germany),
VPS (Hydrorise Maxi Monophase, Zhermack, Badia Polesine,
Italy) and VPES (EXA’lence 370 Monophase, GC America Inc,
Alsip, IL, USA) impression materials were used for both
impression techniques. Before making the impression, cus-
tom trays were coated with tray adhesives recommended by
the manufacturer. All impression materials used in this
study
were monophase and prepared straight from the polyester bag
using the automated mixing device (Pentamix 2, 3M ESPE,
Seefeld, Germany). The mixed impression materials were both
Please cite this article in press as: Kurtulmus-Yilmaz S, et al.
Digital evangulated implants. Journal of Dentistry (2014),
http://dx.doi.org/10.1016
syringed around the impression copings and loaded in the
custom tray. The custom tray was seated over the guide stops
with finger pressure and tray was removed after the material
set. All the impressions were taken by a single operator.
All impressions were poured with a type IV dental stone
(Hinriplast N, Ernst Hinrichs GmbH, Goslar, Germany) follow-
ing the manufacturer’s instructions. The stone was left for 1
h
and then the casts were gently separated from the
impression.
2.4. Measurement procedures
After the impression procedure, impression copings were
screwed to the implants on the master models. Master models
and duplicate casts were scanned by an optical scanner
(Activity 880, Smart Optics Sensortechnik GmbH, Bochum,
Germany) within 10 mm accuracy ratio.46 To avoid glossy
surface reflections, a single layer of powder was applied on
the
surface of master models with handy pushbutton powder
brush pen (NextEngine Inc., CA, USA). Master model and
duplicate cast scans were aligned observing the
superposition
of anatomic markers using software (VRMesh Studio, Virtual-
Grid Inc., Bellevue City, WA, USA) (Figs. 2 and 3). Two
points
were located (x-, y-, z-coordinates) on the long axes of
each
master and duplicate impression copings of implant 2 and the
copings were converted into cylinders. The first point was
located at the centre of the bottom of impression coping
whereas the second point was located at the centre of the
top
of impression coping (Fig. 4). The linear differences
between
the centres of the master and duplicate copings for bottom
point (coronal deviation) and the angles occurred between
the
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Fig. 3 – The alignment of the impression copings of the master
model and duplicate cast.
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JJOD-2375; No. of Pages 9
long axes of master and duplicate copings in x-, y-, z-axes
(angular deviation) (Fig. 5) were measured by cartesian
multiplication of the analytical coordinates of the points
by
a single observer.47,48
2.5. Sample size calculation
A minimum significant difference in deviation of 0.05 mm was
determined from available literature on accuracy of implant
impressions.25 The power analysis was conducted based on
this minimum significant difference in deviation, using
alpha
Fig. 4 – Two points were located at the centre of the bottom
and top areas of the master and duplicate impression
copings and the copings were converted into cylinders.
Green colour indicates master cylinder and blue colour
indicates duplicate cylinder. (For interpretation of the
references to colour in this figure legend, the reader is
referred to the web version of this article.)
Please cite this article in press as: Kurtulmus-Yilmaz S, et al.
Digital evangulated implants. Journal of Dentistry (2014),
http://dx.doi.org/10.1016
at level 0.05, at 80% power and a s of 0.048 according to
our
preliminary study. On the basis of these data, the number of
samples required to be enrolled to conduct this study has
been
calculated as 10.
2.6. Statistical analysis
Shapiro–Wilks test was used to confirm that the data were
normally distributed. Data were analyzed by three-way
analysis of variance (ANOVA). The considered variables were
impression technique (splinted direct, indirect), impression
material (PE, VPS, VPES) and implant angulation (parallel,
108,
208). Post hoc comparisons were performed using the
Bonferroni test when significance was detected. Values of
P < 0.05 were accepted as statistically significant.
3. Results
Mean values and standard deviations of angular and coronal
deviations of the copings are shown in Tables 1 and 2,
respectively. Mean angular and coronal deviations were in a
range of 0.205–0.3598 and 22.56-33.33 mm, respectively.
Three-
way ANOVA revealed that impression technique, impression
material and the implant angulation had significant effects
on
both angular (Table 3) and coronal (Table 4) deviations
(P < 0.0001).
According to statistical analysis, direct splinted technique
showed higher accuracy in comparison to indirect technique
for all impression materials and angulations (P < 0.05).
Angular and coronal deviations increased with the increase
in angulation of implants for all impression techniques and
materials. For parallel positioned implants, significantly
lowest angular and coronal deviations were observed in
splinted direct group (P < 0.05) and there was no
statistically
significant difference between PE and VPS (P > 0.05). In 108
and
208 angulated implants, significantly low deviations were
detected in splinted direct technique with VPS impression
material. For all angulations, regardless of the impression
aluation of the accuracy of impression techniques and materials
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Fig. 5 – Matching procedure between master and duplicate
impression copings. ‘‘A’’ is the distance between master
and duplicate impression copings at the bottom that
represents coronal deviation. ‘‘B’’ represents the angular
deviation between master and duplicate impression
copings.
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JJOD-2375; No. of Pages 9
technique, VPES showed the highest deviations (P = 0.0001)
(Tables 1 and 2).
4. Discussion
An impression that precisely records the exact 3-dimensional
positions of implants is paramount in order to achieve a
passively fitting prosthesis.1,5 Therefore, in implant
dentistry,
Please cite this article in press as: Kurtulmus-Yilmaz S, et al.
Digital evangulated implants. Journal of Dentistry (2014),
http://dx.doi.org/10.1016
comparative accuracy of impression techniques and materials
becomes an important issue in consideration of passive
fit.49
In the present study, accuracy of 2 different impression
techniques and 3 different impression materials were com-
pared and the effect of implant angulation on the accuracy
of
impression was evaluated. Statistical analysis revealed that
impression technique, impression material and implant
angulation had a significant effect on the accuracy of
impressions. Among the evaluated parameters, for both
angular and coronal deviations, impression material was
found to be the most significant factor and it was followed
by
impression technique and implant angulation (Tables 3 and
4).
In most of the studies, direct technique was reported to be
more precise and predictable in comparison to indirect
technique using repositionable copings.9,12,50,51 However,
the studies evaluating non-splinted direct and indirect
techniques demonstrated none of the two procedures to be
superior.10,17,32,44,51 Splinting of impression copings has
been
suggested as an important factor for increasing the
precision
of the impressions.15,17,19,20,27,52–54 Therefore in the
present
study, accuracies of splinted direct and indirect techniques
were compared. In splinted direct technique, autopolymeriz-
ing acrylic resin was used and to reduce the effects of
polymerizing shrinkage it was separated and reconnected
after 17 min of application.55 According to the results of
this
study, regardless of the impression material, splinted
direct
technique had a greater accuracy than indirect technique for
both parallel and angulated implants.
Angulated implants are common clinical situation due to
the anatomic and aesthetic limitations. It has been reported
that the increased angulation of the implants tended to
increase the distortion of the impression material and
decrease the impression accuracy56 since higher strength is
needed for the removal of the impression.41 In the present
study, angular and coronal deviation of the both 108 and 208
angulated copings were significantly higher than the
parallel
copings. Contradictory, in previous studies, angulation was
not found to be effective on the accuracy of impressions for
3
or fewer nonparallel implants with up to 158 of
angulation.42–44
However, in these studies42–44 master models were block
shaped and had flat impression surfaces which may not
simulate the deformation of the impression material upon
removal. In this study, partial mandible models with an
anatomical shape and neighbouring teeth were used to better
simulate the clinical conditions. On the other hand, the
methodology for the assessment of the impression accuracy
showed differences among the studies. In aforementioned
studies, the positional changes of the analogues were
evaluated by measuring inter-implant distances either with
coordinate measuring machine44 or measuring microscope43;
or evaluating the stress in the metal framework with strain
gauges.42 In this study, a digital method was used for the
evaluation of deviations which may provide more precise
results.
PEs and VPSs have been suggested as the materials of
choice for implant impressions due to the superior chemical
and physical properties.6,8,12,13,15,33 For direct
impression
technique, impression material should show sufficient
rigidity
to hold the coping in its position and prevent any displace-
ment during the removal of the impression.41 Therefore, the
aluation of the accuracy of impression techniques and materials
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Table 1 – Mean and standard deviation (SD) values of angular
deviations of the copings. Same capital letters in the samecolumn
and same lower cases in the same row show no statistically
significance according to 3-way ANOVA.
Material–technique 08 108 208
Mean SD Sig. Mean SD Sig. Mean SD Sig.
PE-I 0.235 0.005 B,a 0.245 0.005 F,G,b 0.292 0.003 L,c
PE-D 0.204 0.007 A,d 0.233 0.007 F,e 0.252 0.006 K,f
VPS-I 0.229 0.005 B,g 0.247 0.006 G,H,h 0.254 0.004 K,i
VPS-D 0.205 0.009 A,j 0.216 0.016 E,k 0.227 0.018 J,l
VPES-I 0.266 0.007 D,m 0.276 0.008 I,n 0.359 0.046 M,o
VPES-D 0.250 0.006 C,p 0.259 0.005 H,r 0.305 0.005 L,s
Table 2 – Mean and standard deviation (SD) values of coronal
deviations of the copings. Same capital letters in the samecolumn
and same lower cases in the same row show no statistically
significance according to 3-way ANOVA.
Material–technique 08 108 208
Mean SD Sig. Mean SD Sig. Mean SD Sig.
PE-I 26.33 1.11 B,a 27.34 1.13 F,b 28.83 1.39 I,c
PE-D 22.56 0.67 A,d 25.66 1.83 E,F,f 28.53 1.62 I,g
VPS-I 25.88 1.36 B,h 27.19 1.65 F,i 28.69 1.34 I,j
VPS-D 22.74 1.74 A,k 23.54 0.68 E,l 25.18 1.43 H,m
VPES-I 30.24 1.17 D,n 31.86 1.75 G,o 33.33 1.71 J,p
VPES-D 28.28 1.44 C,r 29.67 1.29 F,s 31.74 1.81 J,t
Table 3 – Results of 3-way ANOVA for angular deviations.
Source Tests of between-subjects effects
Type III sum of squares df Mean square F Sig.
Corrected model 0.251a 17 0.015 85.755 0.000
Intercept 11.455 1 11.455 66,432.772 0.000
Technique 0.038 1 0.038 221.664 0.000
Material 0.108 2 0.054 311.851 0.000
Angulation 0.073 2 0.036 210.741 0.000
Technique � material 0.000 2 0.000 0.996 0.372Technique �
angulation 0.005 2 0.003 15.861 0.000Material � angulation 0.024 4
0.006 35.077 0.000Technique � material � angulation 0.003 4 0.001
4.239 0.003Error 0.028 162 0.000
Total 11.735 180
Corrected total 0.279 179
a R2 = 0.900 (adjusted R2 = 0.889).
Table 4 – Results of 3-way ANOVA for coronal deviations.
Source Tests of between-subjects effects
Type III sum of squares df Mean square F Sig.
Corrected model 1562.303a 17 91.900 39.759 0.000
Intercept 133,380.178 1 133,380.178 57,703.952 0.000
Technique 278.656 1 278.656 120.554 0.000
Material 1010.211 2 505.105 218.523 0.000
Angulation 172.624 2 86.312 37.341 0.000
Technique � material 19.233 2 9.617 4.160 0.017Technique �
angulation 8.768 2 4.381 1.895 0.154Material � angulation 57.458 4
14.365 6.215 0.000Technique � material � angulation 15.358 4 3.839
1.661 0.162Error 374.456 162 2.311
Total 135,356.937 180
Corrected total 1936.759 179
a R2 = 0.807 (adjusted R2 = 0.786).
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Please cite this article in press as: Kurtulmus-Yilmaz S, et al.
Digital evaluation of the accuracy of impression techniques and
materials inangulated implants. Journal of Dentistry (2014),
http://dx.doi.org/10.1016/j.jdent.2014.10.008
http://dx.doi.org/10.1016/j.jdent.2014.10.008
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use of PE is recommended for fully edentulous and multi-
implant cases.41 On the other hand, elastic recovery is a
significant factor in determining the accuracy of an impres-
sion material.57 The use of a more elastic material may
reduce
the permanent distortion caused by the stress between
copings and the implant impression material.19 Thus, VPS
could be considered as a feasible option especially when
nonparallel implants are present.41 In the present study,
accuracies of 3 monophase elastomeric impression materials
with medium-consistency were assessed. Regardless of the
impression technique, no significant difference was detected
between the accuracies of PE and VPS for parallel implants,
whereas VPS provided statistically the most accurate impres-
sions for 108 and 208 angulated implants. This may be
explained by the higher elastic recovery of VPS in
comparison
to PE. The highest angular and coronal deviations of the
copings were detected in the casts obtained with VPES. VPES
is
a relatively new material and there is limited data
regarding
the accuracy and rigidity of this material. Further studies
are
needed for evaluation of its chemical and physical
properties.
According to the results of the present study, the best
combination of impression material and technique for
angulated implants were VPS and splinted direct technique.
Although significant differences were detected among the
accuracies of the materials and techniques tested in this
study,
the mean deviations were in a range of 22.56-33.33 mm.
Assuncao et al.25 stated that in a good impression, a
discrepancy
of 50 mm may be found in any axis. The discrepancies are not
only caused by the accuracy of impression techniques and
materials but also by the machining tolerances between
implant and the impression coping, and abutments. Ma58
reported machining tolerances between implant components
ranging from 22 to 100 mm. When interpreting the results of
the
studies regarding the accuracy of implant impressions, ma-
chining tolerance should also be considered.5
This in vitro study has several limitations. The hardness,
structure and wettability of acrylic resin surface of the
master
models are different from oral tissues. Also all impressions
were taken under ideal conditions without the presence of
soft
tissues, blood, saliva and sulcular fluid which may affect
the
accuracy of the impressions. Another possible limitation of
the study was that the axial rotation of the implant
components caused by the impression technique and material
were not detected. Furthermore, the results are limited to
two
internal connection implants and may not be relevant with
higher number of implants and different connection geome-
tries. Further studies testing more implants, different
angula-
tions and connection geometry are needed to evaluate the
accuracy of implant impressions.
5. Conclusions
Within the limitations of this study, the following
conclusions
can be drawn:
1. Angulation, impression technique and impression material
were found to be effective on the accuracy of implant
impressions.
Please cite this article in press as: Kurtulmus-Yilmaz S, et al.
Digital evangulated implants. Journal of Dentistry (2014),
http://dx.doi.org/10.1016
2. For parallel implants, more accurate impressions were
obtained with splinted direct technique and there was no
significant difference between PE and VPS. However VPES
showed higher deviations.
3. In the presence of angulated implants the most accurate
impression material was VPS and the most accurate
technique was splinted direct technique.
Conflict of interest
The authors declare no potential conflicts of interest with
respect to the authorship and/or publication of this
article.
This study was self-funded by the authors.
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Digital evaluation of the accuracy of impression techniques and
materials in angulated implants1 Introduction2 Materials and
methods2.1 Fabrication of master models2.2 Fabrication of custom
trays2.3 Impression procedures2.4 Measurement procedures2.5 Sample
size calculation2.6 Statistical analysis
3 Results4 Discussion5 ConclusionsConflict of
interestReferences