Custom impression coping to capture soft tissue emergence profile

If doing many units together check steps at bottom.

Indirect method of custom impression coping Spyropoulou 2009

1. Remove custom temp
2. Screw it on lab analog
3. Seat entire assembly in bite reg PVS
4. Remove custom temp
5. Place Impression coping (may need to alter to seat fully)
6. Place autopolymerized acrylic resin (Pattern Resin; GC America, Inc, Alsip, Ill) OR dual-polymerizing composite resin (Duo-Link; Bisco, Schaumburg, Ill)
7. Now have custom impression coping
8. VPS impression

Custom implant temporary

Custom temp on lab analog

Custom temporary and lab analog in PVS

This is unscrewed, stock impression coping placed, and flowable comp is placed and cured.  The result is a custom impression coping.

Custom impression coping in place with tissue blanching showing what would have been lost had a stock impression been used

REALLY NICE photos of large case using indirect method Mykhaylyuk 2013 JCD

Direct method – Really nice photos

Worry with direct method any tissue that falls in is immediately lost as a flowable material will not lift back out and up

Double impression technique for multiple units

This may be faster or easier than doing many units as shown above.  This method allows the temporaries to act as the custom abutment.  This works because the stone model is poured up and reused as the base for a new soft tissue model.  Could do this in one step instead of double impression but patient must then sit and wait for stone to set to get temporaries back, which might be better???  Major issue is that if hexed abutments are used on individual temporary crowns then full arch impression may not draw (especially if luted)  Hegyi JPD 2016

1. Take final impression of dental implant arch and pour a soft tissue/stone model.
2. Remove soft tissue to make room for definitive soft tissue.
3. Take impression again of arch using the temps (check for if units are hexed)
4. Seat that impression of stone model to fabricate new soft tissue.

Final definitive stone model with initial soft tissue removed.

Final impression to replicate the soft tissue. Temporaries used as custom impression copings.

Final definitive soft tissue being made on previously made stone model.