hello welcome to chairside live I'm Megan strong and I'm will Schmitt registered dental assistant
here at gladwell dental we've got something pretty special for you today it's an exciting day wanna
know why Megan I'm always excited to be here with you but I do understand you have some very
important news yes so our first ever fellow in the Glidewell dental fellowship program her name's dr.
Taylor manna Lilly and she has got her first ever case that she's sharing with our viewers so she's
presented with a completely a dauntless patient and she's going to start with the preliminary
impression using open tre technique this is going to set the foundation for the eventual Brooks er
full arch implant prosthesis okay so let's get that PVS impression material flowing it's all
yours dr. mana Lilly today's case will demonstrate a full arch open Trey impression similar to many
patients that you will see in your own office this patient presents with implants already placed and
integrated prior to today's appointment I have identified several things the specific type of
implants which replaced the diameters and if there is a restorative platform shift involved
it is worth noting that with some systems the diameter of the implant body is different from
the restorative platform for today's video I'm going to demonstrate the very basics of
taking an open Tryon pression keep in mind that this is a preliminary impression using
individual transfer copings and a stock tray this impression will be utilized to provide our
lab with valuable foundational information once you have identified this information you will
have to order the desired components in this case a combination of both 3.5 millimeter and
four point five millimeter platform inclusive tapered implants were placed for this case we
ordered inclusive open try impression copings here you can see that this item comes with
several components a laboratory guide pin which has less threads and is longer making it easy
for the technician to utilize in the lab an impression guide pin which has more threads
and is shorter making it easier to utilize inter orally a plastic block out sleeve this is placed
over the guide pin to allow for clean and easy identification of the copings throughout the
impression the plastic component can easily be cut to the appropriate height a transfer coping this
coping has an engaging component that allows you to capture the timing of the internal connection
now that we have identified the components let's take our impression the first step is removing the
healing abutments and inserting our impression copings as we remove each healing abutment the
soft tissue will start to collapse which can be uncomfortable for the patient to avoid collapse
of the soft tissue as each healing abutment is removed I immediately replace it with an
impression coping I like to take radiographs for confirmation that the copings are fully seated
and not caught on the soft tissue radiographically you are looking to see that the impression coping
is flush with the implant platform once all the copings are confirmed I then make adjustments to
the stock tray I like to mark the trade directly in the mouth to identify the location of the
copings utilizing a coarse cut carbide burr I then perforate holes into the tray accordingly
there are trays on the market that have pop-out sections for your convenience if you do not want
to go through the trouble of cutting holes in one of your stock trays here you can see that
the plastic block out sleeves were each cut to the appropriate size and placed over the guide
pins I always try the tray in at this point to verify that the transfer copings are correctly
aligned with the holes in the tray I make sure that I know my path of insertion which I have
marked here with a black line the last thing you want is for one of your transfer copings
to not pop through the tray and get lost in the impression material once I verify that there is
enough room around each coping I like to place the soft wax on top of the holes I just created Here
I am using blue periphery wax this will keep my impression material in the tray making locating
the guide pins during the impression much easier at this point we are ready to take our impression
just like taking an impression on natural teeth we want to capture as much information as we can
I like to syringe a light body PV yes material around the transfer copings while my assistant
loads the tray with a heavy body PVS be sure to fully seat the tray so the guide pins poke through
the wax before the PBS fully sets be sure you can identify the top of each transfer coping once the
impression material fully sets you can easily remove any impression material in the plastic
sleeve allowing for easy access to the top of the guide pin unscrew and completely disengage each
guide pin before removing the impression from the patient's mouth as soon as the impression
is removed replace the healing abutments right away to avoid soft tissue collapse at this point
the guide pins will have to be inserted back into the impression or sent back to the lab where they
will be used to attach the analog component prior to the impression being poured this is an example
of how to attach an analog to the impression coping the analogues are ordered separately and
can be attached using either of the provided guide pins if you do not wish to attach the analogues
yourself make sure that you send the guide pins along with your impression to the lab thank you
for joining us back to you Meghan and well well thank you so much for that doctor manner Lily
you are a great addition to the global family and we are very excited to see the rest of this case
in action we are but for today that wraps it up for this episode so on behalf of everyone here at
global dental thank you so much for watching and we'll meet you right back here next time
so let's get that PBS impression material flowing