INTRODUCTION Nowadays million of people tend to lose their teeth It can be due to many causes such as decay gum disease wear and tear or trauma Lost of teeth can be quiet emotional experience since it may affect our ability to speak and masticate food Replacement of teeth will be more challenging as more number of teeth are missing In the past clinicians and patients had been struggling with options available to replace the missing teeth until dental implant treatment had been discovered Treatment options for replacement of missing teeth have been evolved from acrylic dentures to metal framework and removable partial dentures to fixed partial dentures Actually dental implants has been an optional treatment for dental prosthesis since late 1930 and the popularity of this treatment start to increase when the concept of osseointegration had been introduced in dentistry 1 5 This concept had been introduced by Toronto implant in 1980 s to the North American dental community 6 9
Based on statistic it was revealed that approximately 100 000 300 000 dental implants are placed per year 10 Sometimes failure still can occur even though predictable long term result can be obtained with implant treatment This maybe due to certain condition such as imprecise surgical or prosthodontics techniques Based on glossary prosthodontics term dental impression can be defined as the negative imprint of an oral structure used to produce a positive replica of the structure which is used either for permanent record or production of dental restoration 11 An accurate impression is compulsory to prevent prosthesis misfit Prosthesis misfit can lead to some mechanical problems like screw loosening screw fracture implant fracture and occlusal inaccuracy 12 14 Passive fit of the prosthesis and osseointegration are the factors responsible for the success of implants 15 17 The most important steps in achieving passive fit is during impression taking Selection of proper tray proper impression techniques type of impression material and angulation of impression may influenced the accuracy of dental implants 18 24 There are numerous impression techniques available for dental implants The techniques can be divided into two major group which are known as direct impression techniques and indirect impression techniques Direct impression techniques includes open tray or known as pick up techniques whereas indirect impression techniques involve closed tray and snap fit plastic impression coping
Open tray technique or known as pick up technique includes making an impression coping to the implant together with screw that projects above the height of the coping and customised impression tray which has an opening cut on it When the impression material has been set the screw will be loosened and the tray will be removed from patient's mouth together with the impression coping remained within the impression Later an implant analog is tightened to the impression coping with the same screw and working cast is poured 25 26 This technique enables the impression coping to retain in the impression Therefore it will prevent implant angulation deformation toward impression material upon recovery of the mouth and to eliminate the concern for the placement of the coping back to its specific space in the impression Some drawback of this technique are more parts need to be control during tightening some rotational movement of the impression coping will be presence when securing the implant analog and blind attachment of the implant analog to the impression coping may cause misfit problem Some clinical conditions or situations may required the use of closed tray technique instead of open tray technique For examples are when the patient has limited inter arch space probability to gag or when it is too challenging to access an implant located in the posterior area of the oral cavity 27 Close tray technique involves the use of single piece impression coping which attached intraorally toward the implant when the impression is removed from patients mouth Then this coping is removed from implant fixed to the implant analog and repositioned to the impression with correct orientation According to research done by Daoudi 28 he found that open tray technique at the implant level is more superior and more predictable when compared to closed tray technique which is at the abutment level for single tooth implants
Commonly closed tray technique will have discrepancies in term of axial rotation and inclination of the analogs Based on previous study by Rodney et al the results showed that a passive prosthesis could not be achieved either by pick up or transfer technique but the pick up technique will establish better and accurate impression rather than transfer technique In 1992 a two implant model with an anterior implant parallel to the adjacent natural tooth and a posterior implant exhibiting 15 degree lingual inclination The accuracy of pick up and transfer technique was investigated using polyether impression material The results suggested that the pick up technique showed comparable or better results than the transfer technique Based on previous study also distortion of abutment positions is very frequent with available impression techniques Method that is usually used to prevent this problem is by using splinting of implant transfer copings to gain stabilization against rotation during analogue tightening and control transfer coping relationships in the impression material According to study done by Branemark in 1985 he emphasised about the importance of impression copings splinted associated with dental floss scaffolding covered by autopolymerizing acrylic resin for close tray technique The reason behind this condition or scenario was that relate all the impression coping altogether using a rigid material to prevent individual coping movement during the impression making procedure Most of the previous studies suggest that implant impression with splint technique is more accurate compared to the non split technique alone 29 Some authors also suggested that some problems or issues will be arise when using splint techniques such as distortion of splint materials 30 and fracture of the connection between splint material and impress copings 31
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