First Clinical Appointment
The healing abutments are removed and kept aside in labeled containers denoting their exact positions. Closed tray impression copings (preordered prior to the appointment for all the implants) are attached to the implants (Figure 3). Ease in the placement of the impression copings can be achieved by starting with the posterior-most implant and then proceeding anteriorly. Upon removal of the healing abutments, the impression coping should be immediately attached to the implants to prevent tissue rebound. Primary impressions may be made using alginate in stock trays (dentate trays, to accommodate the height of the impression copings) (Figure 4). Following the removal of the impression, the impression copings are removed from the mouth one by one, starting with the anterior-most first and then proceeding posteriorly. The healing abutments are replaced as soon as the impression copings are removed. The impression copings are attached to the implant replica/analog (preordered for all the implants) and placed in the impression coping indentations in the impression. The impression copings are placed in the same location as they were in the mouth. Once all the impression copings with the analogs are placed in the impression, the impressions are carefully poured using type III dental stone to generate an implant level cast.
Figure 3A. Closed tray impression copings attached to the maxillary implants.
Figure 3B. Closed tray impression copings attached to the mandibular implants.
Figure 4A. Maxillary primary impression.
Figure 4B. Mandibular primary impression.