DENTAL TECHNIQUE

Simplified custom impression post for

implant-supported restorations
Michael Patras, DDS, MSa and William Martin, DDS, MSb

Despite the high success rates ABSTRACT

of implant dentistry, dental
The esthetic outcome of an implant-supported restoration is greatly influenced by the relationship
professionals are often faced between the contours of the definitive prosthesis and the periimplant tissues. In this clinical
with the increasing expecta- technique, an implant analog holder and autopolymerizing acrylic resin were used to accurately
tions of patients with regard to register the soft-tissue transition zone created by the interim restoration and transfer it to the
esthetic outcomes, especially impression post during the definitive impression. (J Prosthet Dent 2015;-:---)
in the anterior region.1,2 The
success of an implant restoration from an esthetic optimal transfer of the transition zone to the dental
standpoint is dependent upon making both the sur- laboratory have been suggested.4-7,9-14 Among them, the
rounding dentition and soft-tissue architecture indistin- use of customized impression posts is a well-established
guishable from the adjacent natural dentition.3 However, procedure that enables the duplication of the transition
implant-supported restorations in the esthetic zone zone and restoration emergence profile in a highly
often pose a significant challenge for the clinician.4 precise and predictable manner.5,7,9,10,12,13 However,
The importance of using interim restorations to direct techniques7,11 are relatively inaccurate because of
optimize the contours of the periimplant tissue anatomy soft tissue collapse and may also cause chemical irritation
after second stage surgery has been reported.1,3-5 This because of the acrylic resin monomer. Similarly, most
tissue contour has been referred to as the transition zone, indirect methods require additional preparation, arma-
that is the emergence profile created from the shoulder of mentarium, and laboratory steps.14
6
the implant to the mucosal margin. Interim abutments A simple, predictable, and time-effective technique
should be developed as needed to condition and shape for capturing the transition zone with an analog holder
the transition zone during healing, with periodical and autopolymerizing acrylic resin is presented. Addi-
adjustments and modifications.3-7 Once the transition tional advantages of this technique include stability of the
zone has reached a favorable form, this information can analog in relation to the silicone index, ease of fabrication
be transferred to the definitive cast through a precise of the custom impression post, no need to prepare any
impression-making procedure.4-7 However, the standard vessels or medicine cups, and no damage to implant
impression post has a circular shape rather than analogs. A disadvantage is the cost of the analog holder.
dimensions and cross sections of the natural tooth.4,8
Furthermore, the 3-dimensional periimplant architec- TECHNIQUE
ture cannot be captured by the elastomeric impression
material, as the soft tissue quickly collapses and adapts to 1. Confirm the optimal contours of the interim restora-
the impression post’s circular configuration.5,9 tion that will shape the implant transition zone (Fig. 1).
Apart from an arbitrary modification of the working 2. Position and secure the appropriate implant analog
cast,8 many direct or indirect techniques that facilitate the (RC implant analog; Institut Straumann AG) into

a
Private practice, Athens, Greece.
b
Associate Professor, Department of Oral and Maxillofacial Surgery, Center for Implant Dentistry, University of Florida, Gainesville, Fla.

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Figure 2. Interim restoration secured in analog holder. C-silicone labo-

Figure 1. Interim restoration on maxillary first premolar after soft tissue ratory putty is used for duplication of emergence profile.
maturation.

Figure 4. Soft tissue contours captured with autopolymerizing acrylic

resin.
Figure 3. Space created from interim restoration in silicone matrix.

Figure 5. Impression post removed and evaluated for voids or other Figure 6. Customized impression post viewed intraorally.
irregularities.

4. Apply polyvinyl siloxane putty (Zetalabor; Zher-

the laboratory analog holder (Institut Straumann mack SpA) and create a matrix around the gingival
AG). third of the interim restoration (Fig. 2). Ensure the
3. Remove the interim restoration from the mouth and material is firmly adapted in the notches of the
connect it to the implant analog. analog holder to prevent rotation and then press it

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Figure 7. Accurate reproduction of transition zone in definitive cast. Figure 8. Buccal view of definitive restoration on maxillary first premolar
2 weeks after insertion.

Figure 9. Alternative use of transparent silicone to capture interim res-

toration’s emergence profile. Figure 10. Layers of flowable resin applied in provided space.

over the submucosal portion of the restoration

extending to 1 mm below the proximal contacts.
Once the material has polymerized, mark the facial
midline of the restoration with a pen to ensure
proper orientation.
5. Remove the interim restoration and evaluate the
outline of the emergence profile created in the
matrix; this should correspond with the transition
zone seen intraorally (Fig. 3).
6. Seat the corresponding stock impression post (RC
impression post for closed tray; Institut Straumann
AG) and incrementally fill all the remaining space
with fast-setting autopolymerizing acrylic resin
(Qyk-Set Temporary Acrylic; Holmes Dental Co) so
Figure 11. Light polymerization of flowable resin through clear matrix.
that it is flush with the matrix (Fig. 4).
7. Remove the impression post and evaluate for voids
or other irregularities. Trim any excess material with 8. Place the impression post onto the implant (Fig. 6)
a tungsten carbide bur and polish. An appropriate and proceed with the definitive impression (Aquasil
surface sealer (Fortify Plus; Bisco) should be applied Ultra LV and Aquasil Soft Putty; Dentsply DeTrey
to ensure a smooth surface of the custom impres- GmbH) and fabrication of the definitive cast in the
sion post (Fig. 5). normal manner. The definitive cast (Fig. 7) will be

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Figure 12. Custom impression post matched with submucosal portion of
interim restoration.
used by the dental laboratory technician to generate
the definitive restoration’s emergence profile and
transition zone contours (Fig. 8) that will support
the tissue as the interim prosthesis.
9. Alternatively, a similar customized anatomic
impression post may be fabricated with a clear sili-
cone matrix (Blue-Bite Clear; Henry Schein, Inc) and
a flowable composite resin (Synergy Flow; Coltène/
Whaledent AG). (Figs. 9-12).
SUMMARY
The clinical technique illustrated describes a simplified
method for developing a customized impression post
that captures the transition zone generated by
the contours of the interim restoration. Definitive
impression procedures using the customized impres-
sion post will transfer the architecture of the transition
zone to the dental laboratory so that the contours of
the interim restoration can be accurately duplicated in
the definitive restoration. With this, the soft tissue
morphology and corresponding esthetics created
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during the provisional phase will be easily and pre-
dictably maintained.
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Corresponding author:
Dr Michael Patras
3 Lachana St, Metamorfosis
Athens, 14451
GREECE
Email: michpatras@yahoo.gr
Copyright © 2015 by the Editorial Council for The Journal of Prosthetic Dentistry.
Patras and Martin