Implant overdenture impressions using a dynamic impression concept
A male patient aged 57 years visited a clinic with the chief complaint of a common consultation on dentures. He showed a combination syndrome-like appearance with overall caries and a serious periodontal status of the remaining teeth at initial examination (). The panoramic view revealed severe bone resorption on the mandibular molar area and a combination syndrome-like appearance on the mandibular anterior area (). First, the teeth with a poor prognosis (#11, 14, 24, 31, 32, 41, 42) were extracted while a periodontal flap surgery was conducted on the maxilla. Subsequently, the Kennedy Class II RPD was planned for the maxilla, and a four-implant-tissue supported bar overdenture was planned for the mandible. Four implants (Osstem, Seoul, Korea) were placed in the interforamenal area (), in which alveoloplasty was performed first (). All implants were 4.1 mm in diameter and had an anodized surface. A non-submerged, single-stage placement technique was performed according to the standard surgical procedure. Three temporary implants (Osstem, Seoul, Korea) were placed between the primary implants and the areas onto which the temporary fixed partial prosthesis was placed for aesthetic problems and no loading on the primary implants (). One month later, a provisional denture was fabricated. Three months later, a tissue conditioner (Coe-Comfort; Coe Laboratories Inc., Chicago, USA) was used to take a dynamic impression with the provisional denture on the mandible (). The following day, the tissue surface of the provisional denture was poured with yellow stone (Hi-Koseton, Maruishi, Japan) and the stone cast was removed. The stone cast was in accordance with the dynamic impression surface of the provisional denture (). Multiple layers of baseplate wax (Modeling wax; Kim's International Inc, Seoul, Korea) were adapted on the abutments to maintain space for the elastomeric impression material (). The individual tray (Ostron 100; GC Corporation, Tokyo, Japan) was manufactured based on the cast to the full length of the border and trimmed with a denture bur to make the denture border 0.5 mm shorter and smooth the border. An individual tray adhesive was pasted with tray adhesive (Adhesive; GC Corporation, Tokyo, Japan) (). An implant impression was taken without border molding - wash impressions with polyvinyl siloxane impression material (Aquasil Ultra LF; Dentsply Caulk, Milford, USA) (). The bar overdenture was fabricated with a Haderbar (Sterngold, Attleboro, USA) and ERA attachment system (Sterngold, Attleboro, USA) (). The overdenture was delivered () and the 5 years follow up result was favorable ().