CLINICAL IMPLICATIONS
This in vitro study demonstrated that rigid custom trays produced significantly more accurate
implant fixture-level impressions, as measured by vertical fit discrepancy, than did the polycarbonate stock trays tested.
VOLUME 89 NUMBER 3
BURNS ET AL
Typodont construction
The study used 4 regular platform implant analogs
(DCA 711-0; Nobel Biocare) mounted in an aluminum
typodont. Two channels were milled into the typodont
to retain a flexible bed of silicone material (Gemini 2
part silicone model duplicating material; Bracon Ltd,
Etchingham, Sussex, United Kingdom) (Fig. 1).
The width between the channels corresponded to the
width between the tray walls of a polycarbonate mandibular stock impression tray (Size 12 Solo tray; Davis
Healthcare Services Ltd, Potters Bar, Hertfordshire, England). This allowed the seating of impression trays on a
displaceable bed that could potentially allow tray distortion under load.
Impression protocol
Three impressions were made from each of the 9
impression trays using implant transfer copings (DCA
099-0; Nobel Biocare AB). Polyether impression material (Impregum Penta; 3M Espe Dental AG) was used
and was dispensed using a delivery unit (Pentamix II;
3M Espe Dental AG). A stop clock was used to note the
time to load and level the tray, load the syringe, syringe
the impression material around the copings, seat the tray
on the displaceable bed, and allow for full setting, to
standardize the impression protocol. The material was
allowed to polymerize for twice the manufacturers recommended setting times to allow for room temperature
rather than mouth temperature. A circular piece of steel
weighing 430 gm was used to standardize the seating
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BURNS ET AL
Measurement protocol
The subsequent measurements performed on the
casts were without the previously described information;
the envelope was opened only after the measurements
and re-measurements had been completed. This allowed
for a single blind study design. All measurements were
made by one operator.
By virtue of the markings on the reference framework
and cast, it was a straightforward procedure to mount
the anterior or posterior reference bar on the appropriate cast in the correct orientation. One end of the bar
was then attached to the cast with the abutment screw
and tightened to 20 Ncm with the restorative torque
indicator (RTI2035; 3i Implant Innovations, Palm
VOLUME 89 NUMBER 3
BURNS ET AL
RESULTS
The results are presented in Tables I and II. The
results showed that the mean fit accuracy, as measured
by vertical fit discrepancy, of casts from the stock trays
(23 20 m) were statistically significantly less
(P.001) than the spaced custom trays (12 10 m) or
close-fit custom trays (11 10 m). A significant difference (P.001) between the stock and the custom
impression trays was found at both anterior and posteMARCH 2003
DISCUSSION
The study showed that custom trays produced more
accurate impressions than stock trays. This finding is in
agreement with a number of other studies with natural
teeth14,16,19,30; however, there are potentially major differences between the natural tooth studies and this
study. In the natural tooth studies, investigators used
closed impression trays that may have been more susceptible to flexion and distortion when seated with impression material. The impression protocol used for implant
fixture-level registration generally uses an open tray,
which may allow impression material subjected to hydrostatic pressure on seating to more readily escape. In
addition, the use of a fixture-level impression technique
(with machined components) only needs to record the
implant head position rather than both its position and
dimensions. Both of these factors would suggest that
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BURNS ET AL
Stock trays
Spaced custom trays
Close fit custom trays
10
20
30
40
50
6
27
30
39
48
46
32
21
24
7
10
7
8
2
60
70
80
90
100
110
120
Table II. Results showing vertical gap measurements in micrometers Mean, (standard deviation), median and interquartile
range
Tray Type
Stock
Spaced Custom
18
(17)
20
10-40
28
(21)
20
10-40
0.001
9
(8)
10
0-10
14
(11)
10
10-20
0.013
9
(11)
10
0-10
14
(8)
10
10-20
0.001
23
(20)
20
10-30
12
(10)
10
5-30
11
(10)
10
0-20
P value for
comparison of trays*
.001
.001
All Trays
12
(13)
10
10-20
19
16)
20
10-20
0.001
.001
*Kruskal-Wallis ANOVA. Stock trays significantly different from spaced and close fit custom trays at both anterior and posterior sites (P .001), spaced custom
and close fit custom trays not significantly different (P.5). Post-ANOVA contrasts with Mann-Whitney U test.
Mann-Whitney U test
BURNS ET AL
CONCLUSIONS
Within the limits of this in vitro study, it may be
concluded that, as measured by vertical fit discrepancy,
rigid custom close-fit trays and spaced custom trays produce significantly more accurate impressions than flexible polycarbonate stock trays (P.001). Also, for analogs with a 20-mm separation, there was a difference in
medians of 10 m in accuracy between the stock and
custom trays, as measured by vertical fit discrepancy.
REFERENCES
1. Jemt T, Lie A. Accuracy of implant-supported prostheses in the edentulous
jaw: analysis of precision of fit between cast gold-alloy frameworks and
master casts by means of a three-dimensional photogrammetric technique.
Clin Oral Implants Res 1995;6:172-80.
2. Millington ND, Leung T. Inaccurate fit of implant superstructures. Part 1:
Stresses generated on the superstructure relative to the size of fit discrepancy. Int J Prosthodont 1995;8:511-6.
3. Jemt T. In vivo measurements of precision of fit involving implant-supported prostheses in the edentulous jaw. Int J Oral Maxillofac Implants
1996;11:151-8.
4. Riedy SJ, Lang BR, Lang BE. Fit of implant frameworks fabricated by
different techniques. J Prosthet Dent 1997;78:596-604.
5. Jemt T, Lekholm U. Measurements of bone and frame-work deformations
induced by misfit of implant superstructures. A pilot study in rabbits. Clin
Oral Implants Res 1998;9:272-80.
6. Taylor TD, Agar JR, Vogiatzi T. Implant prosthodontics: current perspective and future directions. Int J Oral Maxillofac Implants 2000;15:66-75.
7. Jemt T, Book K. Prosthesis misfit and marginal bone loss in edentulous
implant patients. Int J Oral Maxillofac Implants 1996;11:620-5.
8. Smedberg JI, Nilner K, Rangert B, Svensson SA, Glantz SA. On the influence of superstructure connection on implant preload: a methodological
and clinical study. Clin Oral Implants Res 1996;7:55-63.
9. McLean JW, Frauenhoffer JA. The estimation of cement film thickness by
an in vivo technique. Br Dent J 1971;131:107.
10. Kohavi D. Complications in the tissue integrated prostheses components:
clinical and mechanical evaluation. J Oral Rehabil 1993;20:413-22.
11. Jemt T, Linden B, Lekholm U. Failures and complications in 127 consecutively placed fixed partial prostheses supported by Branemark implants:
MARCH 2003
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
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