Dentaltown June 2018 - 91
post, it has with it an inherent-though
small-opportunity for error. The reinsertion
and exact approximation of the post into the
impression material requires close attention
to detail. Any error in this step will be
carried through the entire fabrication process
and ultimately lead to failure of the final
restoration.
So how do you decide when to use which
type of impression? In my office, when
restoring a single-tooth implant, I use an
open technique unless the clinical situation
makes it challenging or impossible to do so.
Such scenarios most commonly happen when
restoring a second molar. Often, a patient
cannot open wide enough to accommodate
the removal of the post from an open impression. There are also times when an open
technique cannot be performed with a first
molar on a patient with a limited opening.
It is important to confirm before taking the
open-tray impression that you will be able to
have access for removal of the impression post.
When doing impressions of multiple
implants, the decision becomes even more
critical. A contraindication for a closed technique is when you are taking an impression
of multiple implants and the implants are
not close to parallel (Fig. 1).
If you were to take a closed impression
of nonparallel implants there is a significant
risk of locking the impression in the mouth,
a situation we want to avoid. Depending on
the placement or angulation of the implants,
I've sometimes used a combined approach
of a closed impression post on one implants
and an open impression post(s) on another.
When doing multiple implants, the open
technique also provides the advantage of
allowing the clinician to splint implants
together to further improve impression
stability and accuracy.
Ultimately, there is almost universal
agreement in the laboratory community that
open tray is the preferred technique because
of the stability and inherent accuracy. Our
in-house implant technician, Jeremy Johnston,
said, "Accuracy is significantly improved with
an open-tray technique and the opportunity
for error is drastically decreased."
Fig. 1
Fig. 2
dentaltown.com \\ JUNE 2018
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