Medical
Communication
Biosci. Biotech. Res. Comm. 10(2): 319-323 (2017)
Making an implant level cast with the angled abutment
and acrylic resin cap : A clinical report
Hamid Neshandar Asli
1
and Bardia Vadiati Saberi
2
1
Associate Professor, Dental Sciences Research Center, Department of Prosthodontics, Faculty of Dentistry,
Guilan University of Medical Sciences, Rasht, Iran
2
Assistant Professor, Dental Sciences Research Center, Department of periodontology, Faculty of dentistry,
Guilan University of Medical sciences, Rasht, Iran
ABSTRACT
Accurate casting to achieve a passive prosthesis is very important. Also, fabrication of a restoration because of the
proximity implants remains a challenge. In this case report, one approach to this problem is discussed. Also, the
goal of this study is analyzing fabrication an implant level cast with the help of angled abutment and acrylic resin
cap. The advantage of the mentioned method is that rst putting abutments provide the possibility of casting from
a transferable component. Second, increase accuracy of casting by correction of path of improper implants through
angled abutment.
KEY WORDS: IMPLANT LEVEL CAST, ANGLED ABUTMENT, ACRYLIC RESIN
319
ARTICLE INFORMATION:
*Corresponding Author: dr.bardia_vad@yahoo.com
Received 1
st
March, 2017
Accepted after revision 19
th
June, 2017
BBRC Print ISSN: 0974-6455
Online ISSN: 2321-4007 CODEN: USA BBRCBA
Thomson Reuters ISI ESC and Crossref Indexed Journal
NAAS Journal Score 2017: 4.31 Cosmos IF : 4.006
© A Society of Science and Nature Publication, 2017. All rights
reserved.
Online Contents Available at: http//www.bbrc.in/
INTRODUCTION
Preferably, installation of implant xtures are important
in that should be parallel to each other and to adjacent
teeth and be aligned vertically with axial forces. But,
when xtures are improperly positioned and soft-tissue
defects are visible, conventional abutments cannot be
used; therefore the use of custom angled abutments is
helpful (Gualini and Berglundh, 2003). However, there
is controversy about using of angled abutment. Because,
some studies recommend that angled abutments result
in increased stress on supporting implants, adjacent
bone, and the prosthesis (Lin et al. 2008). Also, there
is a challenge in fabrication of restoration on implants
which have proximity together (Chaimattayompol et al.
2003, Baig et al. 2014; Papaspyridakos et al. 2015).
Proximity of implant scan cause problems, however
there are a number of methods to facilitate these prob-
lems (Assif et al. 1996; Selecman et al. 2009). One of
the methods is using altered metal impression coping.
But, sometimes this shape change is not possible because
severe proximity of the implants (Chaimattayompol
320 MAKING AN IMPLANT LEVEL CAST WITH THE ANGLED ABUTMENT AND ACRYLIC RESIN CAP BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS
Hamid Neshandar Asli and Bardia Vadiati Saberi
et al. 2003). Another method is using of plastic impres-
sion copings to make implant level casts (Choi et al.
2006) but not all implant systems do not have this fea-
ture. Also, deformation of these plastic impression cop-
ings can affect the accuracy and strength, and reduce
involvement them in impression. This case report reviews
other method to make an implant level cast by an angled
abutment and acrylic resin cap.
MATERIAL AND METHODS
Case presentation. Patient F.Z, aged 35 years with a
noncontributory medical history, came to the dental
of ce with two implant xtures in region of LT. Man-
dibular premolar teeth (teeth # 20, 21). At clinical and
radiographic examination, we found signi cant prox-
imity between them (Fig. 1, 2). Also, Radiographic and
clinical examination suggested that osseous integration
and healing were within normal limits.
Clinical & laboratory procedures. Design and fabrica-
tion method of the xed prosthesis determine the impres-
sion technique, especially when implants are 2 or more
(Kupeyan et al. 1995). The rst, each of SICmax implants
Ø 3.7 mm/9.5 mm(SIC invent AG) with a stock try and
use of C-Silicone Impression Material putty and Light
Body Wash (speedex-Coltene/Whaledent) were under
the impression. After the impression, gingival mask to
reconstruct soft tissue height and gingival reproduc-
tion (Gingifast Elastic Zhermack Spa) was used. (Type IV
dental stone (Elite Master; Zermack SpA) was used for
pouring the mold. Then according to implant position,
angulation, soft tissue height, and inter-occlusal space
suitable abutment was selected (Giglio et al. 1999). One
of them is angled abutment to correct signi cant prox-
imity of the implant (Fig. 3).
The screw opening hole of abutment was lled with
cork and wax. Acrylic cap on the abutment also are
made and then connected to cap of transfer coping with
auto-polymerizing acrylic resin (DuraLay Reliance Den-
tal MFG Company) (Fig. 4).
Finally, the connected pieces were under impression
with a closed-tray technique and also the use of mono-
phase additional silicone impression material (Monopren
transfer; Kettenbach). Sitting of the implant analogue
which has abutment analogue controlledon the impres-
sion with rotating of them to the right &left. In addition
before sitting of those components, the connected caps
is set on the nal impression. The nal cast will be sent
to a lab to ring of the porcelain.
DISCUSSION
The placement of multiple implant requires careful
diagnosis and treatment planning. When faced with a
signi cant proximity between them, use of an angled
abutment together with a straight abutment is a suitable
idea. In the past decade, impression techniques have
made signi cant progress. During the prosthetic phase
of implant treatment, there are various treatment options
facing clinicians in relation to various impression tech-
niques and available materials for making impression.
The passive placement of prosthesis on implant and the
correct location of implant placement are very impor-
tant. The mentioned method in this study, especially for
making the nal cast in implants that have been inserted
improperly, is suitable. In some implant systems such as
ANKYLOSE, straight and angled abutments possess snap
connection for impression. So, if there is proximity of
implants, we can use of them. While, in the mentioned
method of this study, the acrylic cap and transfer cap
can be splint easily with acrylic resin and become con-
veniently pick up. Also, inserting the abutment and ana-
logue set into the impression is done easily. On the other
hand, the precision of this method of impression must be
FIGURE 1. The LT. premolar region is visible in the panoramic view.
BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS MAKING AN IMPLANT LEVEL CAST WITH THE ANGLED ABUTMENT AND ACRYLIC RESIN CAP 321
Hamid Neshandar Asli and Bardia Vadiati Saberi
FIGURE 2. A) Intra-oral view of implant xtures. B) Impression coping
to show degree of proximity of implant xtures.
FIGURE 3. The suitable angled & straight abutment were chosen.
compared with other techniques when the implants are
very close (McCartney et al. 1994; Schneider et al. 2001).
The rst advantage of the method in this study is
the possibility of impression from a transferable com-
ponent due to putting the abutments. Second, reducing
differences between improper axes of the implants to
less than 8 degrees by angled abutments, will increase
precision of impression (Lundqvist et al. 1983; Spector
et al. 1990). Based on a recent systematic review accu-
racy of the splint technique compared with non-splint
322 MAKING AN IMPLANT LEVEL CAST WITH THE ANGLED ABUTMENT AND ACRYLIC RESIN CAP BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS
Hamid Neshandar Asli and Bardia Vadiati Saberi
FIGURE 4. A) Abutments with acrylic resin joined to each other. B) The
nal radiographic view.
is far high. When the number of implants was 3 or less
signi cant differences between the two methods, pick
up and transfer, has not been observed. However, for
more than 4 implants, the most studies have reported
higher accuracy for pick up method (Lee et al. 2008). In
addition, the polyether and vinyl poly siloxane (VPS)
are recommended as the most widely used impression
materials. However, there is no signi cant difference
between these two. Also, there is no consensus about
most accurate technique for casting of implants (splint
or non-splint and transfer or pick up) (Baig et al. 2014;
Papaspyridakos et al. 2015). Little research on other pos-
sible factors affecting the implant casting precision is
available. Need to be more clinical studies to support the
laboratory results.
CONCLUSION
In this study, a practical method for making the nal
implant level cast in implants that have been inserted
improperly has been proposed. The advantage of
the mentioned method in this study is that rst put-
ting abutments provide the possibility of casting from
a transferable component. Second, increase accuracy
of casting by correction of path of improper implants
through angled abutment.
REFERENCES
Assif D., Marshak B., Schmidt A., Accuracy of implant impres-
sion techniques. International Journal of Oral & Maxillofacial
Implants, 11, (1996), 216-22.
BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS MAKING AN IMPLANT LEVEL CAST WITH THE ANGLED ABUTMENT AND ACRYLIC RESIN CAP 323
Hamid Neshandar Asli and Bardia Vadiati Saberi
Chaima ttayompol N., Arbree N.S., Wong S.X., A simple method
of making an implant-level impression when presented with
limited space, unfavorable implant positions, or problematic
implant angulations. The Journal of prosthetic dentistry, 87,
(2002), 684-7.
Choi J .H., Lim Y.J., Yim S.H., Kim C.W., Evaluation of the accu-
racy of implant-level impression techniques for internal-con-
nection implant prostheses in parallel and divergent models.
The International journal of oral & maxillofacial implants, 22,
(2007), 761-8.
Giglio G.D., Abutment selection in implant-supported xed
prosthodontics. International Journal of Periodontics & Restor-
ative Dentistry, 19, (1999), 233-41.
Gualin i F., Berglundh T., Immunohistochemical characteristics
of in ammatory lesions at implants. Journal of clinical peri-
odontology, 30, (2003), 14-8.
Kupeya n H.K., Lang B.R., The role of the implant impression in
abutment selection: a technical note. International Journal of
Oral & Maxillofacial Implants, 10, (1995), 429-33.
Lee H. , So J.S., Hochstedler J., Ercoli C., The accuracy of
implant impressions: a systematic review. The Journal of pros-
thetic dentistry, 100, (2008), 285-91.
Lin C. L., Wang J.C., Ramp L.C., Liu P.R., Biomechanical
response of implant systems placed in the maxillary posterior
region under various conditions of angulation, bone density,
and loading. International Journal of Oral & Maxillofacial
Implants, 23, (2008), 57-64.
Lundqv ist S., Carlsson G.E., Maxillary xed prostheses on
osseointegrated dental implants. The Journal of prosthetic
dentistry, 50, (1983), 262-70.
McCart ney J.W., Pearson R., Segmental framework matrix:
master cast veri cation, corrected cast guide, and analog
transfer template for implant-supported prostheses. The Jour-
nal of prosthetic dentistry, 71, (1994), 197-200.
Schnei der A., Kurtzman G., Silverstein L., Improving implant
framework passive t and accuracy through the use of veri -
cation stents and casts. Journal of dental technology: the peer-
reviewed publication of the National Association of Dental
Laboratories, 18, (2001), 23-5.
Selecm an A.M., Wicks R.A., Making an implant-level impres-
sion using solid plastic, press- t, closed-tray impression cop-
ings: A clinical report. The Journal of prosthetic dentistry, 101,
(2009), 158-9.
Specto r M.R., Donovan T.E., Nicholls J.I., An evaluation of
impression techniques for osseointegrated implants. The Jour-
nal of prosthetic dentistry, 63, (1990), 444-7.
M.R. B aig, Accuracy of impressions of multiple implants in
the edentulous arch: A systematic review. The International
journal of oral & maxillofacial implants, 29, (2014), 869-80.
P. Pap aspyridakos, H. Hirayama, C.J. Chen, C.H. Ho, V. Chrono-
poulos, H.P. Weber, Full‐arch implant xed prostheses: a com-
parative study on the effect of connection type and impression
technique on accuracy of t. Clinical oral implants Research,
27, (2015), 1099-105.