The Right Impression Materials for Accurate Restorations
An 82-year-old man presented to the office with swelling and discomfort on the lower right side. A 4-unit PFM bridge was present, with tooth No. 29 a pontic and teeth Nos. 28, 30, and 31 as abutments. Digital periapical x-rays and examination of the patient revealed a large periapical abscess on teeth Nos. 30 and 31 with moderate mobility (Figure 1). The teeth were deemed unsalvageable, so options and sequelae were discussed with the patient, whose medical history was noncontributory.
Treatment Plan
Despite the patient’s age, he was in excellent health and did not want to consider a removable partial as an option. He thus chose an implant restoration to restore the missing teeth. A few months after extractions and bone augmentations with local anesthesia, 2 implants were placed by the oral surgeon. Tooth No. 28 received a 3.75-mm x 13-mm implant, and tooth No. 30 received a 5-mm x 10-mm implant. The PFM bridge on No. 28 was salvaged.
Impression-Taking
After the oral surgeon verified sufficient healing and integration of the implants, the case was ready to move forward. The positions of the transfer copings were verified with digital x-rays prior to impression-taking (Figure 2). Impressions were taken using Henry Schein’s new VP Mix HP Max Hydro as a 2-step process in a stock Henry Schein tray with the new Blu-Bite HP bite registration material, a VITA shade guide, and a counter impression using Henry Schein alginate (Figures 3, 4). The impressions were sent to the lab for fabrication.
These impression materials have excellent strength with no tearing or deformation and handle quite well. I prefer fast-setting material, as it allows me to get the impression in and out of the mouth as quickly as possible to prevent distortion or patient gagging.
Restorative Appointment
For each implant, the lab fabricated custom solid zirconia abutments and pontics as 1-piece units for added strength and to avoid the need for cementation (Figures 5, 6). The restoration was placed into the patient’s mouth, occlusion checked, and seating verified with digital x-rays (Figure 7) before being torqued to the manufacturer’s Restorative Appointment For each implant, the lab fabricated custom solid zirconia abutments and pontics as 1-piece units for added strength and to avoid the need for cementation (Figures 5, 6). The restoration was placed into the patient’s mouth, occlusion checked, and seating verified with digital x-rays (Figure 7) before being torqued to the manufacturer’s specifications. Note that the x-ray pictured here was captured before the final torquing and shows a slight gap between the implant on tooth No. 28 and the abutment head.
Cotton pellets and a temporary filling material were placed in the access opening as a provisional restoration and will be replaced with core material in the near future (Figure 8).
A Successful Outcome
The patient was very happy and satisfied with the function of the restoration, especially without the need for a removable partial. Home care instructions were provided, including brushing and flossing with the aid of floss threaders. The case will be reviewed and radiographs taken to verify complete seating at the patient’s recare appointment
VP MIX HP MAX HYDRO
Henry Schein Brand’s most hydrophilic impression material with a low contact angle for maximum accuracy and void-free setting, VP Mix HP Max Hydro offers high-contrast colors and saturation. Maximum tear strength and elasticity give the impressions integrity during removal. Available in Regular Set (4:30 total work/set time) and Fast Set (2:15 total work/set time) in a variety of viscosities
BLU-BITE HP
Blu-Bite HP is a mousse-like, fluffy, vinylpolysiloxane material used for bite registration, copying transfers, and primary impression with bite trays. The blue thixotropic material flows easily, yet will not sag or run. A high-performance cartridge allows for easier dispensing. New Blu-Bite HP is available in Fast Set Rigid Chocolate, Super Fast Set Rigid Vanilla, and Super Fast Set Max Rigid Mint.
Dr. Sinesi graduated from the Georgetown University School of Dentistry in 1983. He practices in Brooklyn, NY, and specializes in general dentistry.
