38 Volume 25, Number 1, 2010

T
he accuracy of an impression remains a critical
factor in achieving passive fit of an implant frame-
work.
13
Although the implant and bone can usually
tolerate a degree of misfit without adverse biome-
chanical problems,
4,5
it is appropriate to ensure accu-
rate reproduction of the interimplant relationship in
the working cast for the fabrication of a passively fit-
ting framework. The accuracy of the master cast is
dependent on the type of impression material, the
implant impression technique, and accuracy of the
die material.
1
Most research indicates that the indi-
rect impression technique produces greater mean
distortion than direct techniques.
610
Among the direct techniques, both splinting and
nonsplinting have been advocated
717
for accurate
impressions. Although splinting with resin or impres-
sion plaster has been recommended for maintaining
a more accurate interimplant relationship, the effi-
cacy of these techniques in yielding accurate casts is
controversial.
717
The use of bite registration addition
silicone during impression making to hold the
i mpressi on copi ngs together ri gi dl y has been
reported in the literature.
18
The rigidity and dimen-
sional stability of such interocclusal recording materi-
als
1924
might make them a good choice for splinting
the impression copings.
Evaluation of Accuracy of Multiple Dental Implant
Impressions Using Various Splinting Materials
Ramasubramanian Hariharan, MDS
1
/Chitra Shankar, MDS
2
/Manoj Rajan, MDS, DNB
3
/
Mirza Rustum Baig, MDS, MRD Pros RCS
4
/N. S. Azhagarasan, MDS
5
Purpose: The aim of the present study was to compare the accuracy of casts obtained from non-
splinted and splinted direct impression techniques employing various splinting materials for multiple
dental implants. Materials and Methods: A reference model with four Nobel Replace Select implant
replicas in the anterior mandible was fabricated with denture base heat-curing acrylic resin. Impres-
sions of the reference model were made using polyether impression material by direct nonsplinted and
splinted techniques. Impressions were divided into four groups: group A: nonsplinted technique; group
B: acrylic resinsplinted technique; group C: bite registration addition siliconesplinted technique; and
group D: bite registration polyethersplinted technique. Four impressions were made for each group
and casts were poured in type IV dental stone. Linear differences in interimplant distances in the x-, y-,
and z-axes and differences in interimplant angulations in the z-axis were measured on the casts using a
coordinate measuring machine. Results: The interimplant distance D1y showed significant variations in
all four test groups (P = .043), while D3x values varied significantly between the acrylic resinsplinted
and silicone-splinted groups. Casts obtained from the polyether-splinted group were the closest to the
reference model in the x- and y-axes. In the z-axis, D2z values varied significantly among the three test
groups (P = .009). Casts from the acrylic resinsplinted group were the closest to the reference model
in the z-axis. Also, one of the three angles measured (angle 2) showed significant differences within
three test groups (P = .009). Casts from the nonsplinted group exhibited the smallest angular differ-
ences. Conclusion: Casts obtained from all four impression techniques exhibited differences from the
reference model. Casts obtained using the bite registration polyethersplinted technique were the most
accurate versus the reference model, followed by those obtained via the acrylic resinsplinted, non-
splinted, and bite registration addition siliconesplinted techniques. INT J ORAL MAXILLOFAC IMPLANTS
2010;25:3844
Key words: accuracy, dental implants, impressions, splinting materials
1
Senior Lecturer, Department of Prosthodontics, Ragas Dental
College and Hospital, Chennai, Tamil Nadu, India.
2
Professor, Department of Prosthodontics, Ragas Dental College
and Hospital, Chennai, Tamil Nadu, India.
3
Associate Professor, Department of Prosthodontics, Ragas
Dental College and Hospital, Chennai, Tamil Nadu, India.
4
Assistant Professor, Department of Prosthodontics, Ragas
Dental College and Hospital, Chennai, Tamil Nadu, India.
5
Professor and Head, Department of Prosthodontics, Ragas
Dental College and Hospital, Chennai, Tamil Nadu, India.
Correspondence to: Dr Ramasubramanian Hariharan, No. 2A,
Sai Ayush Rameshaa, Lakshmi Appadurai Street, Somu Nagar,
Medavakkam, Chennai 600100, Tamilnadu, India.
Fax: +044-24530009. Email: rrhh81@yahoo.co.in
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MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
Rotation of impression copings in the impression
during fastening of the implant analog is one of the
drawbacks of the direct impression technique. There
is a need for research on the amount of rotational dis-
tortion of impression copings in the z-axis, which can
occur when multiple implant impressions are made
with polyether.
The reliability of the measuring system is also vital
to evaluate the accuracy of the impression. Because
distortion of an impression can occur in the x-, y-,
and-z axes, it is of paramount importance to analyze
the distortion in three dimensions. The purpose of
this study was to compare the three-dimensional
accuracy of casts obtained using a nonsplinted
impression technique with those created using a
splinted technique and to evaluate the efficacy of
bite registration addition silicone and bite registra-
tion polyether as splinting materials.
MATERIALS AND METHODS
A reference model with four implant analogs (Nobel
Replace Regular Platform, REF 29500, Nobel Biocare)
in the mandibular symphyseal region was fabricated
in a denture base of heat-curing acrylic resin (DPI
Heat Cure). The reference model resembl ed a
mandibular implant-supported overdenture situa-
tion. Three stops, one in the anterior and two in the
posterior, were made in the land area of the model for
accurate positioning of custom impression trays. An
indirect impression was made to allow fabrication of
a primary cast. An even spacer of 3 mm was adapted
onto the primary cast and another impression was
made to obtain a spaced primary cast. Sixteen cus-
tom trays (four per group) with windows in the ante-
rior region were made using light-curing acrylic resin
sheets (Plaque Photo, W+P Dental) of 2 mm in thick-
ness. The trays were left undisturbed for 24 hours
prior to impression making to ensure dimensional
stability. The samples were divided into four groups
based on impression technique.
In group A, the impression copings were not
splinted. Manufacturer-recommended polyether
adhesive (3M ESPE) was coated onto the impres-
sion copings (Nobel Replace Regular Platform, REF
33540, Nobel Biocare) and the custom tray. Both
were allowed to dry for 15 minutes. Medium-body
pol yether (I mpregum Penta, 3M ESPE) was
injected around the impression copings and
administered into the tray using an electronic
mixer (Pentamix 2, 3M ESPE); then the impression
was made.
In group B, the impression copings were first
splinted with acrylic resin (GC Pattern Resin) (Fig
1). A putty index was made to act as a scaffold for
the splinting material. The splint was allowed to
polymerize for 4 minutes and then sectioned and
reoriented using the same pattern resin in a brush
bead method. The impression was made in a simi-
lar manner after the application of the recom-
mended adhesive.
In group C, the impression copings were splinted
with bite registration addition silicone (Imprint
Bite, 3M ESPE) (Fig 2) after the application of the
recommended adhesive. After 5 minutes, the
splint, copings, and tray were coated with poly-
ether adhesive and the impression was made in a
similar manner.
In group D, the impression copings were splinted
with bite registration polyether (Ramitec, 3M ESPE)
(Fig 3) and the impressions were made with poly-
ether in the previously mentioned manner. The
impressions were allowed to set for 6 minutes in
the reference model and after removal were
allowed to polymerize for 30 minutes per the man-
ufacturers recommendation.
Implant replicas were then fastened on to the
impression copings and the impressions were poured
with type IV dental stone (Ultrarock, Kalabhai). All 16
casts were subjected to three-dimensional evaluation
of accuracy using a coordinate measuring machine
3,9
(Spectra series 5.6.4, Accurate) (Fig 4). Measurements
The International Journal of Oral & Maxillofacial Implants 39
Hariharan et al
Fig 1 Impression copings splinted with
acrylic resin.
Fig 2 Impression copings splinted with bite
registration addition silicone.
Fig 3 Impression copings splinted with bite
registration polyether.
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MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
were accomplished using a probe with a diameter of
2 mm (Renishaw TP2). The centers of the implant
replicas were first measured by touching four points
on the circumference of the implant replicas and
feeding the data into a computer with processing
software (Accusoft, Accurate). Implant replica 1 was
kept as the reference, and all measurements were
made with reference to this implant replica. The dis-
tances between the centers of implant replicas 1 and
2 (D1x/y), 1 and 3 (D2x/y), and 1 and 4 (D3x/y) were
measured in the x- and y-axes (Figs 5 and 6). The
planes formed by the platforms of the implant repli-
cas were then measured. The distances between the
planes formed by implant replicas 1 and 2, 1 and 3,
and 1 and 4 were measured to determine the interim-
plant distances in the z-axis (D1z, D2z, D3z) (Fig 7).
To determine the angular relationships between
the replicas, the open tray impression copings were
connected to the implant replicas and tightened to
10 Ncm torque. The plane formed by the flat surfaces
of the impression copings was measured. The angles
formed between implant replicas 1 and 2 (angle 1), 1
and 3 (angle 2), and 1 and 4 (angle 3) were measured
by calculating the angle formed by the flat surfaces
of the respective impression copings (Fig 8). Thus,
nine distances and three angles were measured for
the reference model and for each of the 16 casts. The
values obtained from the casts were compared with
those from the reference model, and the differences
were calculated (Figs 9 to 12). The values were statisti-
cally compared with one-way analysis of variance and
the Tukey post-hoc test at a significance level of .05
(SPSS 11.5 software).
RESULTS
The means and standard deviations of the differences
in interimplant distances measured in the x-, y-, and z-
axes and in the interimplant angulations in the z-axis
(D1/2/3/angle = D1/2/3/angle of the respective
group D1/2/3/angle of the reference group) are
shown in Tables 1 to 4.
X-Axis
The nonsplinted and pattern resinsplinted groups
showed reduced interimplant distances (D1x and
D2x) and showed an increase in the D3x values. The
silicone-splinted and polyether-splinted groups
exhibited an increase in all three interimplant dis-
tances measured. This change in interimplant dis-
tances was largest in the silicone-splinted group
(D3x = 49.4 m) and smallest for the nonsplinted
group (D2x = 1.23 m). The differences in distance
between implant replicas 1 and 4 (D3x) for the sili-
cone-splinted group varied significantly from the val-
ues for the pattern resinsplinted group (P = .02).
40 Volume 25, Number 1, 2010
Hariharan et al
Fig 4 Evaluation of casts using coordinate
measuring machine.
Fig 5 Schematic representation of interim-
plant distances in the x-axis.
Fig 6 Schematic representation of interim-
plant distances in the y-axis.
Fig 7 (Left) Schematic representation of
interimplant distances in the z-axis.
Fig 8 (Right) Schematic representation of
interimplant angulations in the z-axis.
1
2 3
4
D1x
D2x
D3x
D1y D2y D3y
)3
)2
)1
D3z
D2z D1z
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MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
The International Journal of Oral & Maxillofacial Implants 41
Hariharan et al
Fig 9 Differences in interimplant distances in the x-axis for the
four test groups. *Statistically significant difference between
groups (P < .05).
50
40
30
20
10
0
10
20
30
40
50
60
Group A
Group B
Group C
Group D
17
9.8
19.6
12.6
1.2
39.8
38.3
13.4
33.0
8.2
49.4
21.2
D
i
f
f
e
r
e
n
c
e

i
n
i
n
t
e
r
i
m
p
l
a
n
t

d
i
s
t
a
n
c
e

(

m
)
D1x D2x D3x
*
Fig 10 Differences in interimplant distances in the y-axis for the
four test groups.

120
100
80
60
40
20
0
20
D1y D2y D3y
Group A
Group B
Group C
Group D
D
i
f
f
e
r
e
n
c
e

i
n
i
n
t
e
r
i
m
p
l
a
n
t

d
i
s
t
a
n
c
e

(

m
)
80.7
103.4
112.6
70
51.3 51.2
77.4 77.7
3.2 3.9 4.3
0.6
Fig 11 Differences in interimplant distances in the z-axis for the
four test groups. *Statistically significant difference between
groups (P < .05).
-
40
30
20
10
0
10
20
30
D1z D2z D3z
4.3
7.5
12.3
6.8
28.6
5.4
24.2
15.1
14.6
5.5
20.9
7.6
Group A
Group B
Group C
Group D
D
i
f
f
e
r
e
n
c
e

i
n
i
n
t
e
r
i
m
p
l
a
n
t

d
i
s
t
a
n
c
e

(

m
)
*
*
Fig 12 Differences in interimplant angulations in the z-axis for
the four test groups. *Statistically significant difference between
groups (P < .05).
1.5
1.0
0.5
0
0.5
1.0
1.5
Angle 1 Angle 2 Angle 3
0.4
0.8
0.3
0.1
0.04
1.0
0.6
0.5
0.3
0.1
1.2
0.7
Group A
Group B
Group C
Group D
D
i
f
f
e
r
e
n
c
e

i
n
i
n
t
e
r
i
m
p
l
a
n
t

d
i
s
t
a
n
c
e

(

m
)
*
*
Table 1 Differences (m) in Interimplant Distances
in the X-Axis
D1x D2x D3x
Group Mean SD Mean SD Mean SD
A 16.95 24.5 1.23 24.2 33.03 20.8
B 9.8 65.4 39.83 54.3 8.25 6.1
C 19.6 8.3 38.3 38.3 49.4 13.4
D 12.55 17.3 13.38 22.4 21.23 20.6
Table 2 Differences (m) in Interimplant Distances
in the Y-Axis
D1y D2y D3y
Group Mean SD Mean SD Mean SD
A 80.7 24.0 51.325 21.9 3.15 7.5
B 103.45 14.1 77.425 17.7 3.925 1.4
C 112.575 21.7 77.725 6.3 0.60 2.6
D 70.0 21.0 51.175 26.9 4.325 10.2
Table 3 Differences (m) in Interimplant Distances
in the Z-Axis
D1z D2z D3z
Group Mean SD Mean SD Mean SD
A 4.3 5.5 28.6 22.2 14.575 61.2
B 7.5 8.4 5.425 2.5 5.5 13.5
C 12.3 11.6 24.225 25.7 20.95 48.9
D 6.825 13.2 15.1 6.3 7.65 13.1
Table 4 Differences (in Degrees) in Interimplant
Angulations in the Z-Axis
Angle 1 Angle 2 Angle 3
Group Mean SD Mean SD Mean SD
A 0.4 0.8 0.04 0.1 0.3 0.8
B 0.8 0.4 1.0 0.6 0.1 0.3
C 0.3 1.0 0.6 0.6 1.2 1.0
D 0.1 0.7 0.5 0.8 0.7 0.8
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Y-Axis
All groups exhibited an increase in the interimplant
distances D1y and D2y and a decrease in interimplant
distance D3y. The silicone-splinted group showed the
greatest increase in interimplant distance (D1y =
112.6 m and D2y = 77.7 m), whereas the poly-
ether-splinted group showed the smallest increase in
interimplant distance (D1y = 70 m and D2y =
51.2 m). One-way analysis of variance showed that
the values of D1y varied significantly for all the
groups (P = .043).
Z-Axis
The nonspl i nted and si l i cone-spl i nted groups
showed an increase in D1z and D2z values and a
decrease in D3z values. The pattern resinsplinted
group showed an increase in D1z and a decrease in
D2z and D3z. The polyether-splinted group showed a
decrease in all three measurements in the z-axis. The
largest differences were seen in the nonsplinted
group (D2z = 28.6 m), whereas the resin-splinted
group showed the smallest differences (D2z = 5.4
m). Statistically significant differences were present
within the nonsplinted and polyether-splinted
groups (P = .018) and between the silicone- and poly-
ether-splinted groups (P = .033) for D2z values.
Interimplant Angulations
All the groups showed a reduction in interimplant
angle 1 (maximum of 0.8 degrees for the resin-
splinted group and minimum of 0.1 degrees for the
polyether-splinted group). Angle 2 decreased in the
nonsplinted and resin-splinted groups but increased
in the silicone-splinted and the polyether-splinted
groups. Angle 3 increased in all the groups except for
the acrylic resinsplinted group. Angle 2 for the
pattern resin splinted group was significantly differ-
ent from that observed for the silicone-splinted group
(P = .011) and the polyether-splinted group (P = .018).
DISCUSSION
Passive fit of an implant prosthesis depends on the
accuracy of the impression made. The impression,
which allows replication, must be accurate so that the
resulting master cast precisely duplicates the clinical
situation.
25
Four direct impression techniques were evaluated
in this study: nonsplinted open tray impression cop-
ings, splinting with acrylic resin, splinting with bite
registration addition silicone, and splinting with bite
registration polyether. Only direct impression tech-
niques were evaluated since most research indicates
that direct techniques produce less distortion than
indirect techniques.
2,7,9,10,26
Because splinting with
acrylic resin has yielded conflicting results,
716,27,28
an
attempt was made to evaluate the reliability of bite
registration silicone and bite registration polyether as
splinting materials. Because polyether has been advo-
cated as an i mpressi on materi al for mul ti pl e
i mpl antsupported prostheses for edentul ous
patients,
1,2,69
medium-body polyether was used as
the impression material. The impression copings were
screwed to the implants at 10 Ncm of torque before
impressions were made.
8
The copings were coated
with polyether adhesive to reduce their movement in
the impression.
29
When the implant replicas were
tightened to the impression copings in the impres-
sion, the torque wrench was not used; this prevented
rotation of the copings in the impression.
8,30
The
casts were poured with type IV dental stone accord-
ing to the manufacturers instructions.
Dimensional changes can occur in any direction.
To study the magnitude of error occurring in three
dimensions, the interimplant distances and angula-
tions were measured in the x-, y-, and z-axes. All casts
were measured usi ng a coordi nate measuri ng
machine
3,9,31
that was accurate to within 5 m. Distor-
tion can be measured as either absolute or relative.
1
In absolute distortion analysis, an external reference
point is used, while in relative distortion analysis one
implant/abutment is used as a reference for measur-
ing distortion. Because the prosthesis connects all the
implants together, the amount of strain on the
implants is related to the relative positions of the
implants to one another.
1
Therefore, relative distor-
tion analysis was done in this study by measuring the
interimplant distances and angulations in reference
to replica no 1.
1
The range of difference in the x-axis for group D
(polyether splint) was the least when compared with
other groups, whereas group C (silicone splint)
showed the greatest differences in the x-axis. Irre-
spective of the impression technique, the errors were
more on the positive side, signifying an increase in
the dimension of the master cast. The differences in
the x-axis obtained in this study were within a range
similar to those obtained in previous studies
7,9,10,16,25
for all four test groups.
The di fferences observed i n the y-axi s were
greater in magnitude when compared to other axes
in all the four groups. Greater differences were seen
in D1y and D2y values for all four groups with respect
to the reference model. They were similar to the dif-
ferences reported in earlier studies.
7,9,10
The reason
for such increased dimensional changes in the y-axis
needs to be explored.
42 Volume 25, Number 1, 2010
Hariharan et al
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In the z-axis, the acrylic resinsplinted copings
showed the smallest error, followed by bite registra-
tion polyether, whereas nonsplinted copings and bite
registration silicone splinting showed greater devia-
tions. These differences could be attributed to the
rigidity of the splinting material that was used to pre-
vent the movement of copings in the vertical direc-
tion during connection of the implant replica to the
impression coping. The differences in this study were
similar to the findings of earlier studies.
6,9
A variability
of 20 m caused by repeated screw fastening has
been reported.
2
Also, a vertical gap of 50 to 100 m
has been published as acceptable, as it can be com-
pensated by an extra half turn of the screw that con-
nects the different implant components.
32
With regard to rotational distortion in the z-axis,
maximum differences were seen in the silicone-
splinted group (1.2 degrees), followed by the acrylic
resinsplinted and polyether-splinted groups; the
smallest differences were seen in the nonsplinted
group. The angular differences could be a result of
finger tightening of the implant replica to the impres-
sion coping.
2,8
The lower values for rotational error in
the nonsplinted group could be attributed to the fact
that polyether adhesive was coated over the impres-
sion copings.
29
The negative values seen in the pat-
tern resinsplinted group reflected the rigidity of the
resin in preventing rotation of the impression copings.
Reports of tolerance between implant and abut-
ment
31,33
and the existence of rotational freedom of
about 5.5 degrees between implant and abutment
33
suggest that tolerance between the machined com-
ponents might compensate for the errors to a certain
extent. The minimal rotational discrepancies (mini-
mum of 0.09 degrees to a maximum of 1.2 degrees
among all test groups) obtained in this study also
reinforce the need for a rigid impression material,
such as polyether, to prevent rotational distortions.
From these data, it appears probable that the applica-
tion of polyether adhesive, rigidity of polyether
impression material, rigidity of the splinting material,
tolerances between the implant components, and
torque employed during fastening of the implant
replica could determine, either individually or collec-
tively, the extent of distortion.
1,8,29,31,33
Although splinting might rigidly hold the impres-
sion copings together, the time consumed for impres-
sion making is considerably greater when compared
to the nonsplinted technique. The reason that sili-
cone splinting showed the largest differences could
be a result of the relatively lower rigidity of the mate-
rial when compared to bite registration polyether
and acrylic resin.
Measurements made in all three axes in the pre-
sent study showed that certain techniques resulted in
accurate reproduction of interimplant relationships
i n one or more axes, but not i n al l three axes.
Although significant differences might not be pre-
sent in individual axis measurements, the collective
error occurring because of dimensional changes in all
the axes might play a role in the fit (or misfit) of the
prosthesis. The lack of any reference value for defin-
ing misfit makes it difficult to recommend any partic-
ular impression technique. The encouraging results
obtained from the nonsplinted technique after the
application of adhesive kindles the authors interest
in further research on the effect of polyether adhe-
sive on impression copings. Also, research on the
dimensions of the splint and the dimensions of the
section of resin splint, along with in vivo studies on
the efficacy of bite registration polyether as a splint-
ing material, could shed light on the importance of
splinting impression copings.
CONCLUSION
Within the limitations of this study, the following con-
clusions were drawn:
1. When impressions made with nonsplinted and
splinted impression copings were compared, the
casts obtained from copings splinted with bite
registration polyether were the closest to the ref-
erence model, followed by those made via acrylic
resin splinting, nonsplinting, and addition silicone
splinting.
2. The differences between the test groups were sta-
tistically similar to each other and within the range
observed in previous studies.
3. Selection of impression technique can be based
on the clinical situation and the individual clini-
cians preference.
ACKNOWLEDGEMENTS
We thank Nobel Biocare, Sweden, and 3M ESPE, India, for their
generous support.
The International Journal of Oral & Maxillofacial Implants 43
Hariharan et al
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REFERENCES
1. Wee AG. Comparison of impression materials for direct multi-
implant impressions. J Prosthet Dent 2000;83:323331.
2. Carr AB. A Comparison of impression techniques for a five-
implant mandibular model. Int J Oral Maxillofac Implants
1991;6:448455.
3. Jemt T, Rubenstein JE, Carlsson L, Lang BR. Measuring fit at the
implant prosthodontic interface. J Prosthet Dent
1996;75:314325.
4. Jemt T, Book K. Prosthesis misfit and marginal bone loss in
edentulous implant patients. Int J Oral Maxillofac Implants
1996;11:620625.
5. Kan JYK, Rungcharassaeng K, Bohsali K, Goodacre CJ, Lang BR.
Clinical methods for evaluating implant framework fit. J Pros-
thet Dent 1999;81:713.
6. Carr AB. Comparison of impression techniques for a two-
implant 15-degree divergent model. Int J Oral Maxillofac
Implants 1992;7:468475.
7. Hsu CC, Millstein PL, Stein RS. A comparative analysis of the
accuracy of implant transfer techniques. J Prosthet Dent
1993;69:588593.
8. Inturregui JA, Aquilino SA, Ryther JS, Lund PS. Evaluation of
three impression techniques for osseointegrated oral
implants. J Prosthet Dent 1993;69:503509.
9. Phillips KM, Nicholls JI. The accuracy of three implant impres-
sion techniques: A three-dimensional analysis. Int J oral Max-
illofac Implants 1994;9:533540.
10. Spector MR, Donovan TE, Nicholls JI. An evaluation of impres-
sion techniques for osseointegrated implants. J Prosthet Dent
1990;63:444447.
11. Assif D, Marshak B, Nissan J. A modified impression technique
for implant supported restoration. J Prosthet Dent
1994;71:589591.
12. Assif D, Marshak B, Schmidt A. Accuracy of implant impression
techniques. Int J Oral Maxillofac Implants 1996;11:216222.
13. Assif D, Nissan J, Varsano I, Singer A. Accuracy of implant
impression splinted techniques: Effect of splinting material. Int
J Oral Maxillofac Implants 1999;14:885888.
14. Herbst D, Nel JC, Driessen CH, Becker PJ. Evaluation of impres-
sion accuracy for osseointegrated implant supported super-
structures. J Prosthet Dent 2000;83:555561.
15. Vigolo P, Fonzi F, Majzoub Z, Cordioli G. Evaluation of the accu-
racy of three techniques used for multiple implant abutment
impressions. J Prosthet Dent 2003;89:186192.
16. Vigolo P, Odont Dr, Fonzi F, Majzoub Z, Cordioli G. An evalua-
tion of impression techniques for multiple internal connection
implant prostheses. J Prosthet Dent 2004;92:470476.
17. Eid N. An implant impression technique using a plaster splint-
ing index combined with a silicone impression. J Prosthet
Dent 2004;92:575577.
18. Windhorn RJ, Gunnel TR. A simple open-tray implant impres-
sion technique. J Prosthet Dent 2006;96:220221.
19. Balthazar Hart Y, Sandrik JL, Malone WFP, Mazur B, Hart T. Accu-
racy and dimensional stability of four interocclusal recording
materials. J Prosthet Dent 1981;45:586591.
20. Lassila V. Comparison of five interocclusal recording materials.
J Prosthet Dent 1986;55:215218.
21. Lassila V, McCabe JF. Properties of interocclusal registration
materials. J Prosthet Dent 1985;53:100104.
22. Millstein PL, Clark RE. Differential accuracy of silicone-body
and self-curing resin interocclusal records and associated
weight loss. J Prosthet Dent 1981;46:380384.
23. Muller J, Gotz G, Bruckner G, Kraft E. An experimental study of
vertical deviations induced by different interocclusal record-
ing materials. J Prosthet Dent 1991;65:4350.
24. Muller J, Gotz G, Horz W, Kraft E. Study of the accuracy of differ-
ent recording materials. J Prosthet Dent 1990;63:4146.
25. Humphries RM, Yaman P, Bloem TJ. The accuracy of implant
master casts constructed from transfer impressions. Int J Oral
Maxillofac Implants 1990;5:331336.
26. Akca K, Cehreli MC. Accuracy of 2 impression techniques for ITI
implants. Int J Oral Maxillofac Implants 2004;19:517523.
27. Barrett MG, de Rijk WG, Burgess JO. The accuracy of six impres-
sion techniques for osseointegrated implants. J Prosthodont
1993;2:7582.
28. Burawi G, Houston F, Byrne D, Claffey N. A comparison of the
dimensional accuracy of splinted and unsplinted impression
techniques for the bone-lock implant system. J Prosthet Dent
1997;77:6875.
29. Vigolo P, Majzoub Z, Cordioli G. In vitro comparison of master
cast accuracy for single-tooth implant replacement. J Prosthet
Dent 2000;83:562566.
30. Goheen KL, Vermilyea SG, Vossoughi J, Agar JR. Torque gener-
ated by handheld screwdrivers and mechanical torquing
devices for osseointegrated implants. Int J Oral Maxillofac
Implants 1994;9:149155.
31. Ma T, Nicholls JI, Rubenstein JE. Tolerance measurements of
various implant components. Int J Oral Maxillofac Implants
1997;12:371375.
32. Jemt T, Back T, Petersson A. PhotogrammetryAn alternative
to conventional impressions in implant dentistry? A clinical
pilot study. Int J Prosthodont 1999;12:363368.
33. Carrilho GPB, Dias RP, Elias CN. Comparison of external and
internal hex implants rotational freedom: A pilot study. Int J
Prosthodont 2005;18:165166.
44 Volume 25, Number 1, 2010
Hariharan et al
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