Appointment 2: Final Impressions


All right, for this all-in-four patient, last time we took the preliminary impression, we poured up this model, and now you can see these are three temporary cylinders. I didn't have an extra temporary cylinder, so I just used an open tray impression coping. And then I connected, or my assistant Melissa connected all of them with GC Pattern, and then she cut them really thin at each connection. We're going to put them in the patient's mouth, re-lute them with some fast set acrylic, and then take our final impression. She also made this tray with a little window, so it'll seat right over everything, and we can wipe that easily to take the impression.

I'm just pulling off this conversion prosthesis first. I'm just removing the plug at each site. Now I'm going to go ahead and put the jig on each implant. It actually helps if you have a little fine-tip sharpie marker, and you label each segment, so that way you don't get them all mixed up. So I have my assistant hand me them one at a time, and I put them just lightly on the implant site at first. I'm just putting them really lightly, so that way I can still rotate it so they match up with the adjacent one. So I make sure that it matches up, and that also that it's not touching the adjacent one. So if it's actually touching, it might be binding and not be seated all the way. And so now I have all of them seated all the way. You see that one of them in the back is an impression coping, and the three other ones are temporary abutments.

And so now what you want to do is go to each of those gaps, and I'm just using like a little salt and pepper technique, just dipping it in powder, and then just applying the GC pattern at the gaps. So I want to mention something about this that's pretty important. You want to keep that cut in between your GC pattern segments pretty thin, so that way you're only adding a little bit of acrylic and not causing too much shrinkage. And secondly, you want to add enough acrylic, though, that it's securely looting the two segments together, or all the segments together. The last thing you want is to not apply enough acrylic, or not apply enough pattern resin, and then your little GC pattern bridge is flexible, or it's not really secure to the adjacent one. Here you see that my assistant puts a little plastic barrier over the hole in that tray, so that way the impression material doesn't just like goop down and get all over the place. And while she's filling up the tray, I use light body, and I express it on the facial side around the jig, and also on the lingual side. You want to make sure you get the lingual too, because otherwise you'll get some gaps back there.

So before I did this, I dried, I used the air-water syringe to dry off around the implants first. Now I'll go ahead and take off this plastic barrier, and the patient's got a small mouth, so I just kind of maneuver it in there, and then I wipe off all this excess PVS. You see how some is stuck inside the access hole? That's okay, I actually just make sure I find each implant site, and then I let it set up, and then just pluck it out with the Explorer. It's super easy to pluck out. Sometimes, actually though, they do, you do get little pieces stuck in there, and then I'll use a peri-orb probe to kind of work it towards the surface, and then pluck it out too. So this is my final impression. This is with the verification jig all looted together, and that's ready to go.

All right guys, so we finished taking our final impression. So the next step is that I send that off to the lab, and they send me back a wax rim. It's going to be a poured up model with the implants in place, and a wax rim, so I can take occlusal records next time. For this procedure, you can use a stock tray, a custom tray, you can even use a tray called a mirror tray. A mirror tray is a little plastic tray that's got the little plastic barrier on top of it. It's already like built into it, and so that makes these impressions really convenient.

Lesson Summary

For a patient with an all-in-four dental implant procedure, the dentist and his assistant prepared temporary cylinders by connecting an open tray impression coping using GC Pattern. The cylinders were cut thin and placed in the patient's mouth. The dentist carefully seated each cylinder on the implant sites, ensuring they matched up with adjacent ones and were not touching. Gaps between the cylinders were filled with GC pattern resin using a salt and pepper technique. The dental tray, with a window to fit over the cylinders, was filled with light body material to take the final impression. Excess material was wiped off, and any material stuck inside the access hole was plucked out. The final impression, with the verification jig in place, was sent to the lab to receive a poured up model with implants and a wax rim for taking occlusal records in the next appointment.

This procedure can be done using a stock tray, custom tray, or a mirror tray, which has a built-in plastic barrier for convenience.

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