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Elcio Yamamoto, DDS, MSc1/Juliana Marotti, DDS, MSc1/Tomie Toyota de Campos, DDS, MSc, PhD2/ Pedro Tortamano Neto, DDS, MSc, PhD2
Purpose: The aim of this study was to evaluate, using scanning electron microscopy (SEM), the accuracy of four impression techniques for osseointegrated implants (with or without acrylic resin splinting and with irreversible hydrocolloid or polyvinyl siloxane [PVS] impression material). Materials and Methods: A metal master model was made with three implant analogs and two prosthetic spaces. This model was used as the standard for all impressions. Two impression materials were used (irreversible hydrocolloid and PVS) and two transfer techniques were used (squared impression copings indexed by the impression material and squared impression copings splinted with acrylic resin). Four groups were therefore analyzed (n = 5): IH = irreversible hydrocolloid only, IHS = irreversible hydrocolloid + splint, P = PVS only, and PS = PVS + splint. A reference framework made with palladium-silver alloy over the UCLA abutment was created on the master model. The fit of this structure to the master model was used as a reference. SEM images of the front and side gaps between the abutments and the implant analogs were created and then measured using image analysis software. Results: IH presented the largest misfit. The splinted impression copings generated a smaller marginal gap than the indexed material technique, irrespective of the impression material used. There was no significant difference between IHS, P, PS, and the reference (multivariate test, Wilks criteria). However, PS presented a standard deviation that was three times lower than those of the other groups, and its mean was closer to the reference. Conclusions: The IH impression technique was the least accurate technique. There was no difference between IHS, P, and PS techniques with regard to the reference constant. The impression techniques that used splinted impression copings generated more accurate casts, irrespective of the impression material. INT J ORAL MAXILLOFAC IMPLANTS 2010;25:1115–1124 Key words: dental implants, impression, irreversible hydrocolloid, polyvinyl siloxane, splinting
he first step in achieving an accurate, passively fitting prosthesis is to reproduce the relationships of dental implants through impression procedures. It is critical to record the three-dimensional orientation of the implant as it occurs intraorally, since imprecise superstructure fit can result in mechanical and biologic consequences that disrupt the function of dental implants.1–4 Misalignment of prostheses with the
Student, Department of Prosthodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil. 2Professor, Department of Prosthodontics, School of Dentistry, University of São Paulo, São Paulo, Brazil. Correspondence to: Prof Dr Pedro Tortamano Neto, Faculdade de Odontologia da USP, Departamento de Prótese Dentária, Av. Prof. Lineu Prestes 2227, Cidade Universitária, 05508-000 São Paulo, SP, Brazil. Fax: +55-11-3091-7888. Email: email@example.com
osseointegrated implants that support them may result in internal stress in the prosthesis, implants, and bone matrix.5 Mechanical complications that might arise from prosthesis misfit include screw loosening, screw fracture, and occlusal inaccuracy.6–8 Several impression transfer techniques for dental implants have been suggested to increase the precision of casts, such as splinting impression copings, surface treatment of impression copings, direct or indirect impression techniques, different impression materials, and angulated implants.5,9–13 Because of the many steps involved in constructing an implant prosthesis, errors seem to be unavoidable, but as the first step in the fabrication of the implant superstructure, a dependably accurate impression transfer procedure is vital to avoid subsequent correction. 14 Several studies have reported on impression transfer techniques, especially with regard to the advantages
The International Journal of Oral & Maxillofacial Implants 1115
© 2010 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
so that they could be more easily removed later. were made (15 8 40 mm) with three perpendicular holes in the base (4 10 mm). Three implant analogs with an external hexagon 4 mm in diameter and a 0. For this reason. the authors chose to use abutments without antirotational devices for a passive setting and to simulate the clinical practice. increase the precision of casts. Therefore. one made of acrylic resin and the other of stainless steel. Because the dimensions of the analogs were similar to those of the holes. . This acrylic resin block with the implant analogs was designated the initial model. parallel to the base of the model (Figs 1a to 1c). so that the structure would not undergo wear or deformation during the evaluation procedures. The structure was then included and cast in a palladium-silver alloy. The analog platforms were 2 mm above the block surface. Reference Structure To evaluate the accuracy of the duplicated models. in accordance with the manufacturer’s recommendations. The purpose of this structure was to verify distortions generated in the duplicate casts obtained by the transfer techniques. the analogs were inserted into the acrylic resin under pressure and remained stable. (c) Waxing of the structure ready for casting.Yamamoto et al a b c d e f Fig 1 Preparation of the reference structure. (d and e) Structure cast in a palladium-silver alloy. with two handles on the top part. (b) Waxing of the handles for fixation over the positioner. 1116 Volume 25. the aim of this study was to evaluate the precision of four impression transfer techniques by scanning electron microscopic (SEM) analysis. no substance was used to set the analogs in the resin block. The only care taken at the time of fabrication was to obtain maximum rigidity and resistance. (a) Waxing of the structure. INC. but it can be observed in the literature that this step is usually not sufficient to guarantee a faithful reproduction of the implant interrelationships because of the capacity of acrylic resin to produce distortion. Three prefabricated UCLA abutments of palladium-silver alloy were connected to the analogs of the initial model. Number 6. the structure was finished.13–17 The rigid union of the transfers would. Because the intent was to make a partial fixed prosthesis. contact with the prefabricated cylinders was avoided to prevent damage to the platform. of either splinting transfers or not and with regard to the type of impression transfer (direct or indirect). NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. (f) Reference structure after finishing. with a distance of 15 mm maintained between the edges of the perforations. the structure was not MATERIALS AND METHODS Initial Model Two identical rectangular blocks. 2010 © 2010 BY QUINTESSENCE PUBLISHING CO. either with or without acrylic resin splinting and with different impression materials (irreversible hydrocolloid or polyvinyl siloxane [PVS]).18–20 Because of the lack of consensus in the literature regarding the advantage of splinting in impression transfer. a metal superstructure was constructed on the initial model. After the investment was deflasked.7-mm-high platform on the external hexagon (Conexão) were inserted in the acrylic resin block in the previously prepared holes. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. theoretically. These abutments were identified by number (1 to 3). On the UCLA abutments that connected the analogs of the initial model. the waxing of a structure for a fixed partial prosthesis was made.
and the option was a beam shape that enabled better mechanical behavior. and group PS = PVS with transfer splinting. determining a limit for this insertion so that the volume of impression material in the top side of the master model would be the same for all impressions (Fig 4). allowing access to the screws for loosening them. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. After the squared transfer copings were positioned on the master model.Yamamoto et al given the usual shape of a partial fixed prosthesis.21 The bars were identified with numbers 1 and 2. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. Standardization of Impressions All groups had the same volume of impression material. a small portion of low-contraction acrylic resin (DuraLay) was inserted between the extremity of the bar and the transfer with an incremental application technique to minimize polymerization shrinkage of © 2010 BY QUINTESSENCE PUBLISHING CO. the setting screws were loosened to remove the structure. Squared transfers were screwed to the implant analogs of the master model with a calibrated torque wrench (Institut Straumann) limited to 15 N. group IHS = irreversible hydrocolloid with transfer splinting. Four customized trays. After the epoxy resin had completely polymerized. 18 minutes transpired before making the impression (Fig 3i). four individual trays were made of acrylic resin. After complete polymerization. group P = PVS without transfer splinting. Clássico). three holes were left that corresponded to the guide pins of the transfers. whereas the transfer copings were numbered according to their corresponding analogs. This set was then impressed with irreversible hydrocolloid in a perforated partial stock tray. After 24 hours. the resin. Two supports were created to keep the acrylic resin bars at the height of the square-shaped part of the transfers. which served as a matrix for the impression transfer procedures. . INC. which were machined until the analogs could enter without interference. After this. were made with acrylic resin (Jet. Vigodent) was poured. Ciba) was placed inside the central hole to set the respective analogs in the metal block. and union of bar 2 with transfer 3. With the bars located on the supports. The acrylic resin bars were cut into 15-mm lengths and tested so that they could be stabilized between transfer copings with a distance of 1 mm left between the bar extremity and the transfer coping surface. 2 mm thick. After setting. Five minutes transpired before the next step (Figs 3a to 3d). an apparatus was made to position the master model and to guide insertion of the tray in the model through the two guide pins that penetrated the two holes in the individual tray. giving origin to the master model (Fig 2). Steps for Bar Union • Step 1: Union of bar 1 with the transfer of analog 2. the internal part of each hole (area of vacancy in the acrylic resin jig) and the external part of each analog were cleaned with cotton soaked in acetone to remove oil and debris. After step 3. a new portion of epoxy resin was inserted to set the analogs in the hole corresponding to cylinder 1. Some perforations were made in the acrylic resin to provide the impression material with additional retention. • Step 3: Union of bar 2 with transfer 2 (Figs 3g and 3h). The International Journal of Oral & Maxillofacial Implants 1117 Splinting Technique Low-contraction acrylic resin bars (DuraLay. and a model made of type III dental stone (Herodent. Five minutes were allowed to elapse before step 3 (Figs 3e and 3f). Master Model The analogs were removed from the initial model and fixed to the reference structure with hexagonal titanium screws. To prepare for fixation. a relief was made with three thicknesses of baseplate wax to leave a space that would correspond to the impression material. • Step 2: Union of bar 1 with transfer 1. without sectioning for welding (Figs 1d to 1f ). For the same reasons the structure was included and cast as a single block. Epoxy resin (Araldite. Reliance Dental) were inserted into a 3-mm-diameter straw and left to polymerize for at least 24 hours before use. On this model. analog 3 was fixed in its respective hole. Fig 2 Master model. In the side of the upper tray. Test Groups Four test groups were then formed according to the interactions of the variables (n = 5): group IH = irreversible hydrocolloid without transfer splinting. the analogs fixed to the structure were tested in the stainless steel block holes. Special care was taken to increase the stability of the transfer splinting.
1118 Volume 25. Number 6. by the single impression technique. Impression Transfers Five impressions were made for each group. (c) Union of bar 2 with transfer 3. Stone model after modeling and the master Fig 5 (Below) model. The casts were stored at 40°C for at least 48 hours before evaluation. while P and PS impressions were made with PVS (Elite H-D. Casts were separated from the impressions after the stone was allowed to set for 4 hours. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. (i) Splinted transfers after union. The impressions in IH and IHS were made with irreversible hydrocolloid (Hidrogum. 2010 © 2010 BY QUINTESSENCE PUBLISHING CO. Zhermack). The two materials were manipulated in accordance with the manufacturers’ instructions. Zhermack). PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. Type IV dental stone (Vel-Mix. The impressions were boxed and filled to form a base height of 2 to 3 cm. . and they were stored under vacuum until the time of SEM evaluation. (g and h) Union of bar 2 with transfer 2. (e and f) Union of bar 1 with transfer 1. (d) After union. 5 minutes were allowed to elapse before the next step. INC. Fig 4 (Left) Impression with the perforated stock tray. this was followed by trimming and labeling to prepare the models for measurements (Fig 5).Yamamoto et al a b c d e f g h i Fig 3 (a) Acrylic resin bars positioned. Kerr) was prepared in accordance with the manufacturer’s instructions. (b) Union of bar 1 with the transfer of analog 2.
Yamamoto et al a b Frontal Side A1R A1 Fig 6 (a) Front and (b) side SEM images. a pattern was obtained for evaluating possible wear or deformation of the reference structure. Leo Electron Microscopy) with standardized sizes so that the side gap could be visualized with the highest possible magnification (Fig 7). Leica Imaging Solutions) to measure the front and side gaps (Figs 8a and 8b). Fig 8 gap. . The SEMs were obtained with a microscope (Leo 440i. the software drew 60 equidistant lines on the image and filled them in with another color (Fig 8c). These measurements were also made to assess the precision of this method. The mean obtained between these two measures (front and side) was called the constant of reference. images of the structural misalignment were made on the master model. Furthermore. SEM image analysis of the front a b c d Evaluation of the Impression Technique The precision of impression techniques was evaluated by measuring the marginal gap at the abutment-implant interface on analog 3. After gap delimitation. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. group misalignment was compared with the marginal gap between the master model and the reference structure as the possible ideal adaptation for this method of evaluation. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. and after the conclusion of marginal gap measurements in the experimental casts (final). JASC) for digital storage. in addition to serving as an ideal pattern of the structure adjustment on the models. Thus. The images were then inserted into image analysis software (Leica QWIN Q550W. The measurements of these 60 lines were then analyzed by Excel software (Microsoft) (Fig 8d). The front and side images were made of the abutment–analog 1 and abutment–analog 3 interfaces (Fig 6).0 deg Fig 7 Side SEM image analysis. Before the impression transfer procedures (initial) were begun. but only the misalignments at the abutment–analog 3 interface were measured. Angular measurement A1 = 200. INC.0. The International Journal of Oral & Maxillofacial Implants 1119 © 2010 BY QUINTESSENCE PUBLISHING CO. The images were then analyzed with graphic software (Paint Shop Pro 2. The marginal gap was evaluated in analogs 1 and 3.
Yamamoto et al Fig 9 Structure fixed to the SEM positioner with the master model fixed by analog 1. This allowed precise reproduction of the positions. values that were around three times lower than those obtained for the other groups. and also presented the most homogenous behavior with regard to misalignment.3 Front Side Front Side 140 120 100 80 60 40 20 0 IH PS 50.2 30. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. IH or PVS (PS). IHS. and P presented standard deviations that were similar (ranging between ± 29. IH.3 16. RESULTS Figure 10 shows that IH presented the largest mean marginal gap.0 42. the setting screws were not placed. In analogs 2 and 3.28 ± 25. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. All movement was described as a function of coordinates with precision of 10 µm. 2010 © 2010 BY QUINTESSENCE PUBLISHING CO. one at a time.33 µm for the front and ± 8. the valuation location and the angle of marginal gap visualization were standardized. Standardization of Cast Positions by Microscopy To ensure repeatability of the comparison of marginal gaps between the reference structure and some models used in this study. INC.2 Group 1 Group 2 Group Group 3 4 Ref REF IH PS REF Fig 10 Mean marginal gap values (µm) for the front and side regions of experimental groups and the reference constants (REF).40 45. . PS presented the smallest mean marginal gap misalignment.10 ± 38.2 30.70 µm and ± 39. observing the relationship between the variables “front profile” and “side profile. by tightening the setting screw corresponding to analog 1. even after the set was removed from the platform.8 58. Marginal gap (µm) Marginal gap (µm) 140 120 100 80 60 40 20 0 59.3 11. The models were fixed to the standard structure. Fig 11 Mean marginal gap values with regard to the impression material used.93 26. A stainless steel positioner was created to fix the reference structure inside the SEM chamber (Fig 9). By means of a motorized platform it was possible to move the set inside the SEM on many axes. Figure 11 presents a descriptive data analysis of the marginal gap with regard to the impression material used (IH or PVS) for the front and side Statistical Analysis A multivariate statistical analysis was used to compare the data obtained in this study with the aim of 1120 Volume 25.90 µm). REF = reference constants.1 52.32 ± 30. PS presented a standard deviation of ± 10. the latter two presented similar means when compared with each other. Number 6.70 ± 32. for the front (F) and side (S) regions.3 16.63 71.80 28.7 39.1 63.” The data were submitted to multiple bivariate analysis and comparison to determine the differences between the groups. followed by IHS and P.48 µm for the side.
Yamamoto et al Fig 12 Mean marginal gap values (µm) for the front (F) and side (S) regions with regard to the transfer technique. The group without splinting presented higher misalignment means: 48. The International Journal of Oral & Maxillofacial Implants 1121 © 2010 BY QUINTESSENCE PUBLISHING CO. The group with splinting presented a mean gap of 26.2 Reference 30.95 ± 27. The marginal gap misalignment in the group without splinting was about twice as great versus the group with splinting.40 µm for the side) than those seen with PVS (26.63 µm for the front and 45.01 µm for the side.1).70 40.1 ± 39.8 ± 31. Front Side Marginal gap (µm) 140 120 100 80 60 40 20 0 Not With REF Not With REF 48.95 ± 27.9 µm PS 28. values were similar between the groups (P = .10 ± 38.1 ± 39.70 ± 32.62 ± 30. Mean marginal gap values are shown.20 ± 39.0 µm Fig 13 SEM side views of experimental groups and reference constant.1 µm IHS 52.70 µm for the side. With regard to the standard deviations.20 ± 39.56 ± 25. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.3 16.01 * 30. according to Wilks criteria (multivariate test). .48 76.48 µm for the front and 40. Figure 13 shows the most representative images of the experimental groups and reference constant in a side view.28 ± 25.80 µm for the side).16 µm IH 89.46 µm regions.56 ± 25. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.62 ± 30. Figure 12 presents a descriptive analysis of the marginal gap values for the front and side regions with regard to the transfer technique and use of splinting. P 63. The IH mean gaps were larger (50.32 ± 30.93 µm for the front and 71. INC. with (WITH) or without splinting (NOT).78 26.78 µm for the front and 76.3 ± 8.
although there was a clear trend toward a better performance with PVS (mean gaps of 26. 21 in which bars of acrylic resin are made with the aid of plastic straws with a cross section of approximately 3 mm. among these are impression making.21 providing the transfers with greater stability within the impression material because of the rigidity resulting from polymerization. This guide pin is projected through a window in the tray. forming a wax pattern. and after the impression material is polymerized.3 µm for the profile was present at the time of the initial marginal gap measurement. With all the components used in this study to obtain optimal adaptation between the master model and the reference structure. This result is in agreement with those of previous studies. a discrepancy of 16.5% to 7. and manufacturing tolerances between implant components. With this procedure.22 To achieve the necessary adaptation. In this study.19. among them the volume of acrylic resin. in which the acrylic resin splinting generated a significantly smaller discrepancy in comparison with the techniques in which it was not used. the existing sources of distortion in each clinical step must be eliminated.9% was found in acrylic resins for indexation. the great majority of the studies that have evaluated the influence of transfer splinting on the precision of the models did not observe any advantage with this 1122 Volume 25. The author mentioned the advantage of transfer splinting in creating a rigid unit between the splint and transfers inside a rigid impression material. impression technique.20 The technique used for making splints in this study was based on that of Dumbrigue et al. creating the master model. which does not occur in the indirect technique. in some cases. 2010 procedure.22. Number 6. Moreover. the splinting generated more inexact models in comparison with the unsplinted technique. and polymerization time that elapsed before making the impression.25 Indeed. uniting of the transfers with bars for the addition of acrylic resin provided the cast models obtained by this technique greater precision. method of manipulation. clinical and laboratory procedures contribute to distortion of the implant-supported prosthesis.28 ± 25. Several impression transfer techniques have been suggested.29–31 Despite the low rigidity of the IH in comparison with the PVS.70 ± 32. better control was obtained of the factors that influence polymerization shrinkage. Twenty-four hours after the bars are polymerized. the greater the shrinkage. The transfer coping splinting with acrylic resin during the impression procedures is done to transfer the spatial relationship of implants precisely onto the master model. or compensated. The impression is executed after 17 minutes—the time required for 80% of the acrylic resin shrinkage to occur. impression material.24 This open tray technique allows the transfers to be splinted.23 The misalignment values obtained in this study for the reference constants support this idea. this would help to keep the transfers in position inside the impression at the time when torque is applied to the screws to set the analogs. Volumetric shrinkage of 6. and inserting the prosthesis. These divergent results can be justified by some differences in methodology between this study and the aforementioned studies. which he would define as an extremely precise relationship of the transfers with the tissues and between them. such as mandibular flexure. finishing the definitive prosthesis. it is loosened and the tray is removed. The larger the volume of acrylic resin used to make the splint.80 µm) in comparison with IH (mean © 2010 BY QUINTESSENCE PUBLISHING CO. Moreover. During the impression transfer. since the transfers remain fixed to the implants after the impression is removed. reduced. and techniques to compensate for this distortion have become standard during the verification index stage in the fabrication of implant-supported prostheses. Special care was taken in this study to compensate for any acrylic resin shrinkage using an incremental application technique. The care taken with regard to polymerization shrinkage can be the great differential with regard to the good performance of the techniques in which splinting was performed. Many other factors affect the behavior of transfer splinting during an impression on implants. they are cut and adapted into position in the mouth to unite the squared transfer copings using the brush technique. in which a squared two-piece transfer is screwed onto the implant with a guide pin.26–28 in contrast with the results obtained in this study. . In 1986 Loos17 praised the use of orthodontic wire instead of dental floss to serve as a basis for adding acrylic resin and splint making. INC. several factors influence the final adaptation. so that the impression retains the transfer.16 However. The impression technique used in this study was the direct technique. it was not possible to detect a significant difference between these materials in this study. the sequence of uniting the bars to the transfers was designed so that the shrinkage could occur incrementally to prevent the sum of all the shrinkage from occurring at the end of splinting.16. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. fabricating the superstruc ture.Yamamoto et al DISCUSSION In the process of making an implant-supported prosthesis.63 µm and 45. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.11.2 µm for the front and 30. One of the main factors is polymerization shrinkage.
REFERENCES 1. J Prosthet Dent 2007.33 However. which can be noted by the low variance among the samples. in which PVS was used without splinting. The fact that the transfer splinting provided better precision masked the true effect of the impression materials. with the others being a little more distant. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. that is. Jemt T.11:151–158. Conrad HJ. IHS and P presented variance of around ± 30 µm. a trend toward the marginal gap diminishing as the rigidity of the set in the transfer impression increases is noted in the data. splinting the transfers promoted similar performance of the IH when compared with the PVS alone. it was verified that the mismatches obtained in this study. Accuracy of two impression techniques with angulated implants. CONCLUSIONS Among the studied techniques. Moreover. Probably as a result of the high variance of the data and particularly as a result of the positive influence of the transfer splinting on the impression techniques.10 ± 38. This rigid union formed between the acrylic resin and the transfer probably compensated for the greater flexibility of the IH. regardless of the impression material used. In vivo measurements of precision of fit involving implant-supported prostheses in the edentulous jaw. this trend did not result in significant differences. Although no significant difference could be verified between IHS. around 25 ± 30 µm. Figure 10 provides verification of the similarity of behavior of these two groups. ACKNOWLEDGMENTS The authors would like to thank Dr Ângela Toshie Araki and Prof Dr Isaac Jamil Sayeg for their contributions to this work.97:349–356. Thus. INC. In absolute values. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. and it was difficult to find an explanation for this. Transfer splinting produced casts with a significantly smaller marginal gap discrepancy than when no splinting was performed.40 µm). while IHS and P had few samples around the reference constant. Lorenzoni et al32 demonstrated unfavorable behavior of IH. in which splinting and IH were used. The high variance of the data would probably have been solved by the inclusion of a higher number of specimens. that is. the consistency of this degree of precision. 2. demonstrates the predictability of its application. when one observes the result of splinting for each impression material. Thus it can be affirmed that the PS group presented the best precision among all the groups and IH showed the worst. This was observed in the behavior of IHS. Castilio and Pinto27 found no significant difference between the use of alginate and polysulfide. P. The positive effect of the transfer splinting can also be observed when the groups IH IHS and P PS are compared. which was three times higher than the variance of ± 10 µm presented for group PS.Yamamoto et al gaps of 50. All the samples in PS were very close to the reference constant. IH was the group that presented samples with a fit that was furthest from the reference constant. Int J Oral Maxillofac Implants 1996. Groups IHS and P were very close to each other and had differences for the lower reference constants.29 in which transfer splinting produced a precision of the impression that was similar to that of IH and polyether and far superior to that of an unsplinted model. As previously discussed.93 µm and 71. PS. Similar results were found by Assif et al. . it can be noted that the acrylic resin splint diminished the marginal discrepancy within these materials. and P. There was no significant difference in the marginal discrepancy between irreversible hydrocolloid with a splint and polyvinyl siloxane with and without a splint with regard to the reference constant. the transfer technique that showed the worst results was irreversible hydrocolloid as the impression material without an acrylic resin splint. DeLong R. were all satisfactory. the use of a resin splint decreased the misalignment of the IH to a degree similar to that of the PVS alone. especially when it is considered that tightening the three screws would have diminished the marginal gaps observed. a result that does not agree with the theory that a more rigid material would provide a more precise transfer. Group PS showed mean gaps that were very similar to the reference constants. with no more than 5 µm of difference. When making an analysis as a function of the reference constants. the use of transfer splinting with acrylic resin and impression with PVS provided models with marginal mismatches that were very similar to those observed on the reference model. with the methodology used. it is observed that the means that were further from the ideal were seen in the IH group. and the constants of reference. Pesun IJ. but with differences of only 40 ± 50 µm. and the association of PVS (a more rigid material) with a splint made of acrylic resin produced a mismatch that was similar to that of the reference. The International Journal of Oral & Maxillofacial Implants 1123 © 2010 BY QUINTESSENCE PUBLISHING CO. the biggest discrepancy was verified for the IH alone.32 ± 30. splinting worsened the precision of the impression techniques. Again. with the poorest results seen in comparison with polyether and PVS in the impression transfer of molding caps. Hodges JS.
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