Efficacy of Splinted and Non-splinted Direct Impression Techniques for Completely Edentulous Patients Requiring Implant Supported Prostheses- A Systematic Review

Main Article Content

Varun Wadhwani
Deepak Nallasway
Vinay Sivaswamy
Khushali K Shah
Subhabrata Maiti

Keywords

Implant, Systematic, clinical, traditional

Abstract

Background: Implants are not as mobile as natural teeth due to the absence of the periodontal ligament, which means that they cannot adapt to distortions and misfit at the implant-abutment interface. The success of implant-supported prostheses largely depends on achieving a passive fit between the implant components. Failure to achieve a passive fit may result in a range of biological and mechanical complications. Therefore, the precision of fit and passivity of implant-supported fixed dental prostheses are heavily influenced by the choice of impression materials and techniques used.
Materials and Methods: The search was performed in electronic database (i.e. PubMed, ScienceDirect, Lilacs, Cochrane Database of Systematic Review, Google Scholar, Europe PMC, Wiley online library) using a combination of controlled vocabulary from January 1, 2010 to March 1, 2021. The combined data was analysed. Factors which affect the accuracy were pinned down and their impact on the outcome was accessed.
Results: The 21 studies which fulfilled the inclusion criteria included 3 clinical and 18 in vitro studies. Most in vitro (10/18) and all clinical studies demonstrated that the splinted technique was more accurate when compared to non- splinted technique. 7 in vitro studies compared various impression materials and showed no statistical difference between poly-ether and polyvinyl siloxane, but 2 studies reported occlusal registration material and impression plaster used for non- splinted impressions to be as accurate as splinted impressions. All of the studies reported open tray technique to be better than  closed tray. 9 in vitro studies reported on the use of different splinting methods as well as modifications for unsplinted impression copings with conflicting results. Although 2 out of 3 studies reported air-abraded, adhesive coated and unilateral extended unsplinted copings to give as accurate results and splinted copings in the accuracy of casts obtained. 9 invitro and 3 clinical studies demonstrated that with the increase in angulation of implants, the accuracy of impressions decreases and splinted copings are preferred while 2 among the in-vitro reported no change in accuracy from 0-15 degrees.
Conclusion: The current literature points towards splinted technique to have better impression accuracy as compared to non- splinted technique but the clinical studies included show serious risk of bias. Angulation of implants play a major factor in influencing the accuracy of impressions made. Angulated implants show less accurate impressions as compared to parallel implants. No difference was observed between traditional impression materials like PVS and PE for the impression technique. Unconventional implant materials like occlusal registration materials have shown promise. Better structured and randomized clinical trials are needed to formulate a definite protocol.

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