Evaluation of the accuracy of three techniques used for multiple implant abutment impressions.

STATEMENT OF PROBLEM Movement of pick-up type impression copings inside the impression material during clinical and laboratory phases may cause inaccuracy in transferring the spatial position of implants from the oral cavity to the master cast. As a consequence, the laboratory technician may fabricate a restoration that requires corrective procedures. PURPOSE This in vitro study evaluated the accuracy of 3 different impression techniques using polyether impression material to obtain a master cast for the fabrication of a prosthesis that would fit passively on multiple implants. MATERIAL AND METHODS A machined metal model with 6 implants and abutments and a corresponding, passively fitting, matching metal template were fabricated. A total of 45 medium-consistency polyether impressions (Impregum Penta) of this model were made with pick-up type square impression copings. Three groups of 15 each were made with different impression techniques: in group 1, nonmodified square impression copings were used; in group 2, square impression copings were used and joined together with autopolymerizing acrylic resin before the impression procedure; and in group 3, square impression copings previously airborne particle-abraded and coated with the manufacturer-recommended impression adhesive were used. The matching metal template, which had been passively fit to the metal model so that it encountered no visually perceptible resistance or rocking on the abutments, was used as the control for evaluation of the accuracy of passive fit. A single calibrated and blinded examiner visually evaluated each cast. Positional accuracy of the abutments was numerically assessed with an optical scanner at original magnification x 10, which provided measurements to within 2 microm of the variations of the casts with respect to the horizontal distances between the 2 most posterior abutments and the 2 most anterior abutments. Data were analyzed with a 1-way analysis of variance at alpha=.05, followed by the Student Newman-Keuls method (P=.05). RESULTS Visual examination of the casts from group 1 revealed discrepancies between 1 or more abutments and the metal template. Visual analysis of the master casts from groups 2 and 3 revealed close alignment of the metal template on all 6 abutments. One-way analysis of variance analyzed the numerical data obtained with the optical scanner and revealed significant differences among the 3 impression techniques (P<.001). The Newman-Keuls procedure disclosed significant differences between the groups, with group 2 and 3 casts being significantly more accurate than group 1 casts (P=.05). The distance between abutments 1 and 6 compared to the standard metal model was 33.83 microm (SD +/- 5.4) greater on group 2 casts, 31.72 microm (SD +/- 4.6) greater on group 3 casts, and 78.16 microm (SD +/- 22.14) greater on group 1 casts. Distances between the most anterior abutments were also greater than those recorded on the metal model. The distance was 31.42 microm (SD +/- 7.6) greater on group 2 casts, 30.34 microm (SD +/- 6.4) greater on group 3 casts, and 67.91 microm (SD +/- 15.34) greater on group 1 casts. CONCLUSION Within the limitations of this study, improved accuracy of the master cast was achieved when the impression technique involved square impression copings joined together with autopolymerizing acrylic resin or square impression copings that had been airborne particle-abraded and adhesive-coated.