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Digital Impression Techniques in Implant Dentistry

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Digital impression techniques are becoming popular methods for prosthetics in dental implants. Keep reading to know about digital impression techniques.

Medically reviewed by

Dr. Samarth Mishra

Published At September 20, 2022
Reviewed AtSeptember 20, 2022

What Is the Purpose of Digital Intraoral Impressions?

In the field of present-day implantology, the position of dental implants, either in partial or fully edentulous patients, can be optimized and ascertained to meet the functional as well as esthetic concerns of these patients. Dental implantation is also superior in terms of chewing efficiency and to avoid functional discrepancies that may occur due to bone volume affliction, as in the case of conventional bridges or removable dentures. The purpose of digital intraoral impressions is to transfer the implant position correctly without any angular deviations. This ensures that no biologic or prosthetic complications arise and the final customized fit of the implant denture or implant prosthesis remains predictable and meets the patient's functional needs, and provides esthetic satisfaction as well.

Why Is Digital Impression Technique Beneficial?

The digital techniques for impressions in implant dentistry utilizes intraoral scanners that adopt the use of a laser or light beam (structured light) directed towards the object to be digitized. In implantology, the coordinates are needed for correct implant positioning. The potential of intraoral impression systems or digital impression systems in the market is not only promising over conventional impression techniques but also allows rapid digital data transfer followed by fabrication of interim prosthesis. Digital impressions also avoid the hassle of delivering the impressions to the lab and pouring or scanning them. Additionally, digital impression techniques reduce the number of patient appointments to the dental clinic and also may result in a shorter treatment span. This also holds true when the patient needs to be scheduled for multiple appointments while planning, checking, and pre and post-implant prosthetic protocols for accuracy and correct fabrication.

What Are the Drawbacks of Digital Impression?

Despite the benefits, the only drawback currently observed in digital impression techniques is that in largely edentulous patients, the impression may get distorted owing to the vertical plane discrepancies in these individuals. This results in a lack of support during the drilling procedure, where the surgical template for the implants may get tilted, which may lead to distortion in the vertical plane. The treatment of completely or largely edentulous patients is challenging to the implantologist; hence techniques used in digital scanning and intraoral digital impression protocols need to be further studied and improvised.

What Are the Exclusion Criteria for Digital Impression Techniques or Guided Implant Surgical Procedures?

Patients with certain debilitating conditions are contraindicated for implant treatment like:

  • Patients who are generally contraindicated for oral surgical procedures owing to either systemic health issues.

  • Invasive cancers.

  • Irradiation of the head and neck.

  • History of drug abuse.

  • Alcohol abuse.

  • Pregnant and nursing patients.

  • Severe bruxism or clenching (parafunctional habits).

  • Psychiatric disorders.

  • Patients with poor oral hygiene or lack of oral hygiene awareness with poor motivation.

  • Patients with an inability to complete dental follow-ups.

  • Immunocompromised patients.

  • Untreated or severe periodontitis cases.

  • Patients with uncontrolled diabetes and hypertension.

What Is A Prosthetic Driven Workflow Plan?

In digital impression techniques of implant dentistry, the patient's initial screening and evaluation are completed by preoperative photographs and radiographs for dental reference. These references are to be used post the completion of dental implantation and for the purpose of accurate prosthetic fit. Panoramic radiography like OPG (orthopantomogram) and 3D imaging modalities like CBCT (cone beam computed tomography) also hold value for preliminary assessments of the area for dental implantation. CBCT, however, is mainly used in this protocol for prosthetic-driven plans and workflow in order to analyze or study the dental arches separately by using wax bite.

  1. The implantologist, first, takes the digital impression of the patient's dental arches, and then the digital data gets transferred in STL format, which is to be imported into 3D design software systems (examples such as DentalCAD, Exocad, etc.) for creating a virtual wax-up.

  2. This is a simpler procedure in comparison to the conventional in-clinic implant impression techniques, where an impression is taken manually by the dentist with a customized tray and polyether implant impression material (like impregum impression material), and then a dental wax-up is done.

  3. The processed data in DICOM data format (both in the case of digital or conventional impression technique) to generate the master cast.

  4. Digital impression processing also takes into consideration the location of the dental implant, the bone quality and quantity, the thickness of soft tissue in that region, and the anatomic landmarks. This planning helps the dental surgeon visualize the shape and volume of the final restorative unit.

  5. When this prosthetic-driven workflow is approved by the implantologist, the stereolithic surgical guide template is fabricated.

  6. Following the placement of dental implants, oral hygiene and maintenance instructions are given utmost importance, especially for creating patient awareness about the importance of oral hygiene in osseointegration or implant bone fusion.

  7. After three to six months of implant placement, customized open tray impressions are taken, and then cement or screw-retained restoration is delivered as an implant prosthesis.

  8. The occlusion of the patient is adjusted, and the patients are asked to follow up every six months.

Conclusion

Hence to conclude, the surgical template guide that is produced by CAM-CAD (computer-aided designing or computer-assisted manufacturing technology) or by a high-resolution 3D printer allows for proper stabilization and accurate fit of the implant prosthesis in the patient's mouth. Moreover, the introduction and advancement of 3D imaging technologies in digital impression techniques now have become popular over the last few years not only for the prosthetic success of dental implants but also for meeting the esthetic or functional demands and expectations of the patients.

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Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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