After all of the time and effort that goes into developing the gingival tissues around an implant provisional, the challenge is how to capture that information for the laboratory technician. In an instant once the provisional has been unscrewed, and the pressure on the tissue relieved the tissue begins to deform. I have tried multiple techniques to capture an accurate soft tissue impression, and despite working quickly the technician always has to alter the gingival mask due to distortion. The only accurate way to capture the soft tissue contours is to duplicate the shape and dimension of the provisional where it was in contact with the gingiva.
With this in mind, I do all of my records on the day of the implant fixture final impression with the provisional still in place. these include taking an impression of the patient approved provisional, facebow, photos and sizing the tray.
Implant Provisional and analog in StatStone
Once my impression tray is ready to go, I have the light body material at the ready. As I am unscrewing the provisional, my assistant is ready with the impression coping and the light body. The instant I remove the provisional, I place the impression coping, and then inject light body around it to capture the soft tissue. Once the light body is set, we can take a radiograph to confirm seating of the impression coping. Once we know the coping was fully seated, we now load the tray with heavy body, inject any additional light body we need and pick up the original light body, which has been holding tissue form and the coping in a final impression.
Implant Soft Tissue Model
Even with this technique, there is some tissue slumping. In order to send the laboratory everything they need to be successful, I also create a soft tissue model using the provisional. I attach an analog to the provisional, then seat the analog into a medicine cup that I have filled with Statstone, so that the emergence profile is in the stone. Once the stone has fully set, I unscrew the provisional, leaving the analog and a perfect soft tissue impression behind to send to the laboratory.
Thanks, Lee. Do you ever take the impression with the impression coping altered with composite using the technique you suggest for the soft tissue model as a way of negating the slumping issue?
I haven’t done this and I would love to hear your technique. Sound slike you customize the impression coping, but how do you mimic the soft tissue profile????
It would be great to see a video of the method you have descrived.
Thank you for the article