A COMPARISON OF THE ACCURACY OF IMPRESSION
MATERIALS WITH IMMEDIATE AND DELAYED POURING
FOR LONG SPAN IMPLANT SUPPORTED PROSTHESIS – AN
INVITRO STUDY
Dissertation submitted to
THE TAMILNADU Dr.M.G.R MEDICAL UNIVERSITY
In partial fulfillment for the degree of
MASTER OF DENTAL SURGERY
BRANCH - I
PROSTHODONTICS AND CROWN & BRIDGE
2017-2020 CERTIFICATE BY THE GUIDE
This is to certify that the dissertation titled “A COMPARISON OF THE
ACCURACY OF IMPRESSION MATERIALS WITH IMMEDIATE AND
DELAYED POURING FOR LONG SPAN IMPLANT SUPPORTED
PROSTHESIS – AN INVITRO STUDY” is the Bonafide work done by
DR.M.NAVIN BHARATHY, Post Graduate Student, during the course of the study for the degree of MASTER OF DENTAL SURGERY in the speciality of
DEPARTMENT OF PROSTHODONTICS AND CROWN & BRIDGE,
Vivekanandha Dental College for Women, Tiruchengode during the period of 2017-
2020.
Date: Place: Tiruchengode
Signature of HOD Signature of Guide
Dr.K.BALU MDS, PGDHM Dr. V.DEVAKI, MDS, Professor and Head, Professor and Guide, Department of Prosthodontics and Crown Department of Prosthodontics and Crown & Bridge, & Bridge,
ENDORSEMENT BY THE HEAD OF THE DEPARTMENT AND
HEAD OF THE INSTITUTION
This is to certify that Dr.M.Navin Bharathy, Post Graduate student (2017-
2020) in the DEPARTMENT OF PROSTHODONTICS AND CROWN &
BRIDGE, Vivekanandha Dental College for Women, has done this dissertation titled
“A COMPARISON OF THE ACCURACY OF IMPRESSION MATERIALS
WITH IMMEDIATE AND DELAYED POURING FOR LONG SPAN
IMPLANT SUPPORTED PROSTHESIS – AN INVITRO STUDY” under our guidance and supervision in partial fulfillment of the regulation laid down by
Tamilnadu Dr.M.G.R. Medical University, Chennai-600032 for M.D.S BRANCH- I
Seal & Signature of HOD Seal & Signature of Principal Dr.K.BALU, MDS, PGDHM Dr.N.BALAN, MDS, Professor and Head, Principal, Department of Prosthodontics and Crown Vivekanandha Dental College for & Bridge, Women. Vivekanandha Dental College for Women.
DECLARATION
A Comparison Of The Accuracy Of Impression TITLE OF DISSERTATION Materials With Immediate And Delayed Pouring For Long Span Implant Supported Prosthesis – An Invitro Study Vivekanandha Dental College for Women, PLACE OF STUDY Elayampalayam, Tiruchengode, Namakkal District. DURATION OF COURSE 3 Years (2017-2020) NAME OF GUIDE Dr.V.Devaki, M.D.S., HEAD OF DEPARTMENT Dr.K.Balu, M.D.S., PGDHM.,
I hereby declare that no part of the dissertation will be utilized for gaining financial assistance for research or other promotions without obtaining prior permission of the Principal, Vivekanandha Dental College for Women, Tiruchengode.
In addition, I declare that no part of this work will be published either in print or electric without the guide who has been actively involved in the dissertation. The author has the right to reserve publishing of work solely with prior permission of the
Principal, Vivekanandha Dental College for Women, Tiruchengode.
Head of the Department Guide Signature of the Candidate
Dr.K.Balu MDS, PGDHM Dr. V.Devaki, MDS, Dr.M.Navin bharathy
CERTIFICATE – II
This is to certify that this dissertation work “A COMPARISON OF THE
ACCURACY OF IMPRESSION MATERIALS WITH IMMEDIATE AND
DELAYED POURING FOR LONG SPAN IMPLANT SUPPORTED
PROSTHESIS – AN INVITRO STUDY” of the candidate,
DR.M.NAVINBHARATHY, with registration number for the award of degree
MASTER OF DENTAL SURGERY in the branch of PROSTHODONTICS AND
CROWN & BRIDGE. I personally verified the urkund.com website for the purpose of plagiarism check. I found that the uploaded thesis file contains from introduction to conclusion pages and the results shows 6% of plagiarism in the dissertation.
Guide & Supervisor sign with Seal
ACKNOWLEDGEMENT
I am much obliged and I would like to extend my heartfelt gratitude to
(Capt.).Dr.S.GOKULNATHAN B.Sc., M.D.S., Dean, Vivekanandha Dental College for Women, for his positive criticism and support.
My sincere thanks and deep sense of gratitude to Prof. Dr. BALAN, M.D.S.,
Principal, Vivekanandha Dental College for Women, for permitting me to pursue this study.
I would like to gratefully and sincerely thank Dr.K.Balu M.D.S.,PGDHM,
Professor and Head of the Department of Prosthodontics and Crown & Bridge, for his constant support and accessibility throughout the course of the study.
With submissive ambition, I aspire to register my gratitude to my respected
Mentor and Guide Dr. V.Devaki, M.D.S., Professor, Department of Prosthodontics and Crown & Bridge, Vivekanandha Dental College for Women, for her inspiring guidance, invaluable counsel and encouragement throughout the process.
I would like to mention a special thanks to Dr. Devi MDS, Reader, Dr. R.
Ajay MDS, Reader, Dr. P. Arun, MDS, Senior lecturer, Dr.Lalitha Manohari MDS, senior lecturer, Department of Prosthodontics and Crown & Bridge for their support and timely advices throughout my course of study.
I would also like to extend my sense of gratitude and appreciation to fellow
PG, senior PG’S, junior PG’S of my department for their friendly help and co- operation throughout my postgraduate life. I wish to express my heartfelt thanks to my family members and friends for their constant encouragement, support, help and prayers throughout my course. They have always supported my dreams and aspiration. I am eternally indebted to my beloved parents and my brother and sister for their evergreen love and support all through my academic career and helping me to achieve my goals.
Last but not the least I would like to thank the Almighty for having made this work possible through all such wonderful people around me.
With gratitude
Dr.M.NAVIN BHARATHY,
TABLE OF CONTENTS
SL.NO. TITLE PAGE NO.
1. INTRODUCTION 1
2. AIM AND OBJECTIVES 6
3. REVIEW OF LITERATURE 7
4. MATERIALS AND METHODS 13
5. TESTING VALUES 26
6. STATISTICAL ANALYSIS 30
7. RESULTS 32
7. DISCUSSION 52
8. SUMMARY 62
9. CONCLUSION 64
10. REFERENCES 65
LIST OF FIGURES
FIGURE NO. TITLE PAGE NO.
1. Master Model -With Four Implant Analogs. 13
2. Polyether (3M Espe Impregnumtm Soft) 13
Monophase Impression Material (Aquasil Ultra 14 3. Monophase)
4. Poly Vinyl Siloxane Addition (Flexeed ) 14
5. Condensation Silicone ( Zhermack- Zeta Plus). 15
Irreversible Hydrocolloid ( Zhermach 15 6. Tropicalgin)
7. Auto Polymerizing Resin 16
8. Modelling Wax – As Spacer. 16
9. Type IV Die Stone (Pearlstone) 16
10. Implant Analog Master Model 19
11. Wax Spacer Adapted To Preliminary Cast 19
Custom Tray Fabricated Using Auto- 19 12. Polymerizing Resin
13. Group A (Immediate pouring) 22
14. Group B (Delayed pouring) 23
Measurement Of Implant Analog Master Model 24 15. In CMM
16. Measurement Of Impression Cast In CMM 24
LIST OF TABLES
TABLE PAGE TABLE NO: NO
ANOVA – To compare immediate pouring of impression 1. 32 materials based on inter-implant distance
2. Post Hoc test for immediate pouring 33
ANOVA – To compare delayed pouring of impression 2. 38 materials based on inter-implant distance
3. Post Hoc test for delayed pouring 39
5. Paired T test for impression cast and master model 44
Paired T test for impression cast (immediate and delayed 6. 45 pouring)
LIST OF CHARTS
CHART NO. TITLE PAGE NO.
1. Schematic representation of the methodology 17
2. Grouping of specimens – immediate pouring 18 (GROUP A)
3. Grouping of specimens for testing –delayed pouring 18 after one hour ( GROUP B)
LIST OF GRAPHS
GRAPH NO. TITLE PAGE NO.
ANOVA - to compare immediate pouring impression 46 1. materials based on inter-implant distance (1-2)
ANOVA - to compare immediate pouring impression 46 2. materials based on inter-implant distance(1-3)
ANOVA - to compare immediate pouring impression 47 3. materials based on inter-implant distance(1-4)
ANOVA - to compare immediate pouring impression 47 4. materials based on inter-implant distance(2-3)
ANOVA - to compare immediate pouring impression 48 5. materials based on inter-implant distance(2-4)
ANOVA - to compare immediate pouring impression 48 6. materials based on inter-implant distance(3-4)
Paired sample test to compare immediate and delayed 49 7. pouring impression materials based on inter-implant distance (1-2)
Paired sample test to compare immediate and delayed 49 8. pouring impression materials based on inter-implant distance (1-3)
Paired sample test to compare immediate and delayed 50 9. pouring impression materials based on inter-implant distance (1-4)
Paired sample test to compare immediate and delayed 50 10. pouring impression materials based on inter-implant distance (2-3) Paired sample test to compare immediate and delayed 51 11. pouring impression materials based on inter-implant distance (2-4)
Paired sample test to compare immediate and delayed 51 12. pouring impression materials based on inter-implant distance (3-4)
LIST OF ABBREVIATIONS
PE Poly Ether
P Polysulphide
A Addition silicone
PVS Poly Vinly Siloxane
C-Silicone Condensation Silicone
PMMA Poly Methyl Metha Acrylate
CMM Co-ordinated calibrated Measuring Machine
3D Three Dimension
LASER Light Amplification Stimulated Emission of Radiation
CCD Cartesian Co-ordinate system
MS Micro Soft
ANOVA Analysis Of Variance
SD Standard Deviation
Introduction
INTRODUCTION
Dental Implant is a prosthetic device made of alloplastic material(s) implanted into the oral tissues beneath the mucosal and/or periosteal layer and on or within the bone to provide retention and support for a fixed or removable dental prosthesis1.
Dental implants and implant restorations are preferable alternatives to conventional dentures and bridges works2. Use of dental endosseous implants to replace missing teeth in partially dentate and edentulous patient is associated with a high success rate from esthetic, functional, and psychological point of view3.
However, biomechanical failure does occur in long-span prosthesis, which may be attributed to lack of a passive fit of the implant superstructure3. Various factors may prevent a passive fit despite accurate implant prosthodontics procedures mainly include impression of implant.
Dental Impression is a negative imprint or a positive digital image display of intraoral anatomy; used to cast or print a 3D replica of the anatomic structure that is to be used as a permanent record or in the production of a dental restoration or prosthesis1.
Before the middle of the 18th century, no method was available for producing an impression of the alveolar ridges. A widely used method at that time was the painting of the ridges with a dye, and the pressing of a block of ivory or bone against the dyed surfaces. Areas of contact were scraped away from the block until the best fit for the prosthesis was achieved4.
1 Introduction
Phillip Pfaff5, in 1756, of Berlin, made sectional wax impressions of half of an arch at a time. William Rae, in 1782, said that he “got the measurement of the jaws in a piece of wax pushed into the gums, afterward making a cast of it with plaster of
Paris”. Charles de Loude, in 1840 of London, made one of the earliest references to impression trays.
Montgomery in 1842, had discovered gutta-percha. It is obtained from various saponaceous trees in Malaysia. It was introduced as an impression material. In about
1844, plaster of Paris was firs t used as an impression material. Franklin in 1862 described the first corrected impression. He used wax for the preliminary impression followed by a plaster wash. Other impression materials used were zinc oxide eugenol impression paste and impression compound, their application was limited by their inability to surpass undercuts without distorting or fracturing4.
Alphous Poller6, of Vienna, in 1925, described his elastic material as an improved material for “molding articles of all kinds, more particularly parts of living bodies.” Poller was most likely the first to suggest the use of agar for dental impressions. Even though this material produces excellent detail, it is not ideal for the edentulous impression and has not been used to any great extent.
In the early 1940s, the first irreversible hydrocolloid (alginate) impression material was developed. Alginate is one of the most frequently used impression materials, and it is simple and cost effective. Alginate posses the qualities of good surface detail and faster reaction at higher temperature. Alginate materials are hydrophilic in nature and this property facilitates making of accurate impression.
They are easier to remove but the tear strength is low. They are good for only single
2 Introduction pour7,8. The disadvantage of the hydrocolloids is shrinkage caused by the loss of water, leading to inaccuracy.
In late 1960, polyether9 was proposed as an alternate polymer because of improved mechanical properties and low shrinkage. The setting reaction for these materials is via cationic polymerization by opening of the reactive ethylene imines terminal rings to unite molecules with no by-product formation. Polyether is hydrophilic, allowing them to be used in moist environment. Their good wetting properties also allow gypsum casts to be made easily. Newer polyether impression materials are slightly more flexible than the older products, making them easier to remove from the mouth. These materials are available in low, medium, and high viscosities and can be used as a single-phase material or with a syringe-and-tray technique. The most popular method of dispensing this material is via a motorized mixing unit.
The condensation silicone10 are supplied in viscosities as light, regular and medium. They are pleasant to use. Short setting time. The main disadvantage of silicone is its poor wet ability. The hydrophobic nature requires their use in dry, clean field. They have more shrinkage on setting than other rubber base material
In 1970s, polyvinyl siloxane11 appeared on the market and became very popular with high dimensional stability. Polyvinyl siloxane is one of the most favored impression materials in dentistry because of excellent properties and availability in different viscosities ranging from extra light body to putty. Impressions made from this material produce great detail reproduction and can be poured multiple times because of their high tear strength and high elastic recovery11. Caution should be
3 Introduction taken to avoid contact of the material with latex rubber dams or latex gloves, which may leave a sulfur compound that inhibits polymerization of the material.
Monophase impression materials captures details in moist oral environment, quick, easy blending, and excellent detail reproduction, high tear strength.
Since the accuracy of impression affects the accuracy of the definite cast, an accurate impression is essential to fabricate prosthesis with a good fit. An inaccurate impression may result in prosthesis misfit, which led to mechanical and biological complications. Screw loosening, screw fracture, implant fracture and occlusal inaccuracy are mechanical complications arising from prosthetic misfit12,13.
Biologically, marginal discrepancy from misfit may cause unfavourable soft and hard tissue reaction due to increased plaque accumulation14.
The objective of making an impression in implant dentistry is to accurately relate the position of the most coronal portion of the implant to the other structures within the oral cavity15. Making an accurate impression is affected by several factors such as impression material, impression tray and impression technique16. Using an appropriate impression materials and techniques guarantees accurate transfer of implant position and precise surface details of prepare teeth to the definitive cast.
Making an accurate impression is necessary as the first step for achieving passive fit in implant- supported restoration16. Therefore to obtain accurate impression of implant, accuracy and surface detail reproduction both should be taken into account16. The search for best impression material that is associated with least amount of error is an important first step toward achieving this goal.
4 Introduction
Impression pouring is another critical step in the process of producing successful dental prosthesis. One problem faced by clinicians is time of pouring of cast on the impression. Because it is not possible to pour the impression immediate in routine clinical practice17. Thus this study was undertaken to compare the accuracy of different implant impression material on immediate and delayed pouring.
This study will serve as an addition to the existing evidence provides by previous comparative analyses of dimensional accuracy of various impression materials. It is an invitro analysis to compare the accuracy of five impression material: a Polyether, a Poly Vinyl Siloxane, a Condensation Silicone, a Monophase and
Irreversible hydrocolloid.
The null hypothesis was that there would be no significant different in the three dimensional (3D) accuracy between the impression materials with immediate and delayed pouring, under investigation and the master model.
5
Aim and Objectives
AIM AND OBJECTIVES
AIM:
The purpose of this study is to compare the accuracy of different impression materials (Polyether, Monophase, Poly vinyl siloxane - Addition, Condensation silicone and Irreversible hydrocolloid) to accurately reproduce the position of implant analog in the master model.
Objectives:
To compare the accuracy of Polyether, Monophase, Polyvinyl-Siloxane,
Condensation Silicone and Irreversible Hydrocolloids Impression materials with immediate and delayed pouring by analyzing inter-implant distance on the cast with calibrated coordinate measuring machine.
To measure the implant position in the master model and the resultant cast.
To calculate the difference between each impression on Immediate and
Delayed pouring.
6
Review of Literature
REVIEW OF LITERATURE
Before the middle of the 18th century, no method was available for producing an impression of the alveolar ridges. A widely used method at that time was the painting of the ridges with a dye, and the pressing of a block of ivory or bone against the dyed surfaces. Areas of contact were scraped away from the block until the best fit for the prosthesis was achieved4.
Phillip Pfaff, in 1756, of Berlin, made sectional wax impressions of half of an arch at a time5. William Rae, in 1782, said that he “got the measurement of the jaws in a piece of wax pushed into the gums, afterward making a cast of it with plaster of
Paris”. Charles de Loude, in 1840 of London, made one of the earliest references to impression trays.
Montgomery in 1842 had discovered gutta-percha. It is obtained from various saponaceous trees in Malaysia. It was introduced as an impression material. In about
1844, plaster of Paris was firs t used as an impression material.
Franklin18 in 1862 described the first corrected impression. He used wax for the preliminary impression followed by a plaster wash. In 187019, Wescott described a similar plaster wash technique, using oversized wax trays made by scooping out primary impressions.
Impression compounds (modeling plastics) had been developed and introduced, one by Charles Stens of England in 1857 and the other by S.S. White in
1874, the use of these materials dates from the contributions of J.W.Greene,
P.T.Greene, and of Rupert Hall4.
7 Review of Literature
The Greene brothers, about 1900, introduced a modeling plastic, a method for manipulating it, and a technique that is said to have been the first to utilize all the surfaces of the mouth to advantage for denture retention. They were probably the first to teach the closed mouth all-modeling plastic technique in detail.4
Rupert Hall, in 1915, perfected the first moderate- heat modeling plastic for making individual impression trays and introduced the correctable modeling plastic- plaster technique that almost immediately became a standard method for making impressions.4
Alphous Poller of Vienna, in 1925, described his elastic material as an improved material for “molding articles o f all kinds, more particularly parts of living bodies.” Even as late as 1942, Pendleton20 suggested a liquid w ax technique using an
Asiatic or India paraffin for the final mandibular impression.
Trapozzano21 in 1939 described one of the early techniques using a ZOE paste. Compound preliminary impressions were made in stock trays and plaster of
Paris casts were poured.
Then, in the early 1940s, the first irreversible hydrocolloid7 (alginate) impression material was developed. These materials were actually developed as a substitute for the reversible hydrocolloids (agar) when they became unavailable by import from Japan during World War II.
In the middle 1950s the elastomeric impression materials were introduced.
They were of two chemical types- the polysulfide and the silicone base. In 1955,
Pearson reported on “a new elastic impression material” of a polysulfide base
(Thiokol), describing, most likely, a typical composition of these materials4.
8 Review of Literature
Inturregui22 et al in 1993 studied about polyether, polyether and impression plaster, or polyether and acrylic resin and concluded that the polyether alone resulted in the closest duplication of the master cast.
Wee23 et al in 2000 studied about medium viscosity polyether, a high viscosity addition silicone, and medium viscosity polysulfide-condensation silicones and concluded that the use of either polyether (medium) or addition silicone (high) impression is recommended for direct implant impressions.
In an in vitro study by Johnson24 et al in 2003 significant differences were found between polyether and PVS impression materials under moist conditions, and between single viscosity versus dual viscosity impression materials under wet and dry conditions. Under conditions where moisture is difficult to control, polyether was shown to be the better choice for an impression material. In terms of surface detail, polyether was better compared with PVS, as were the monophase materials compared with the dual phase materials.
Assuncao25 et al 2004 studied about four elastomers: "P"-polysulfide; "I"- polyether; "A"-addition silicone; and "Z"-condensation silicone and concluded that the best materials were material polyether and silicone.
Holst26 et al 2007 studied the impression materials along with open-tray technique on polyvinyl siloxane and polyether impression materials and concluded that time cannot be neglected as a factor affecting the accuracy of implant master casts.
In a study by Von Berg27 in 2007 investigated the accuracy of polyether versus plaster impressions. He demonstrated distortion between impressions and master casts
9 Review of Literature relative to master models and concluded that it was not possible to make an undistorted impression or cast. The dimensions of the impression and the resultant master cast were compared to a steel master model under dry conditions. Both impression materials showed expansive distortion and the horizontal dimensions between implant analogues tended to increase with both impression materials.
Walker28 et al 2008 studied the various consistency polyether impressions. He used medium-body or heavy-body polyether impression material. And concluded that impression material viscosity does not appear to be a critical factor for implant cast accuracy.
Aguilar29 et al 2010 mixed polyether and hydrophilic addition silicone impression materials. Hydrophilic addition silicone and polyether impression materials have similar distortion effects for transfer procedures when using the direct impression technique and machine mixing. Silicone demonstrated superiority for perpendicularity distortion, though of a magnitude unlikely to have clinical significance.
Stober30 et al 2010 in an in-vitro study examined the properties and performance of PVS, polyether and the hybrid product vinyl siloxanether (containing combined properties of hydrophilicity). Results obtained with respect to accuracy of these materials from their non-disinfected group studied showed comparable results, and the differences compared to the master model were small. Considering that the accuracy of the casts was high, differences between the impression materials were irrelevant.
10 Review of Literature
Ferreira31 et al 2012 studied impression materials like polyvinyl siloxane, condensation siloxane or irreversible hydrocolloid and concluded that Resin-splinted transfer copings with the impression materials condensation siloxane or irreversible hydrocolloid produced impressions as accurately as polyvinyl siloxane.
Reddy32 et al 2013 studied impression materials using polyvinyl siloxane and polyether impression materials. And concluded that no significant difference in dimensional accuracy of the resultant casts made from two different impression materials (polyvinyl siloxane and polyether) by closed tray impression technique in parallel and angulated implants.
Buzayan33 et al 2013 studied on splinted or non-splinted direct impression techniques with polyether(PE) and poly vinylsiloxane(PVS) impression materials and concluded that no significant differences were found between the various splinting groups for both PE and PVS impression materials in terms of linear and 3D distortions. However, small but significant differences were found between the two impression materials (PVS, 91 μm; PE, 103 μm) in terms of 3D discrepancies, irrespective of the splinting technique employed
Pujari34 et al 2014 studied polyether and vinyl polysiloxane (VPS) impression material. Casts obtained from polyether impression material were more accurate than casts obtained from vinyl polysiloxane impression material.
Hoods-Moonsammy3 et al 2014 impression plaster (Plastogum, HarryJ
Bosworth), a polyether (ImpregumPenta, 3M ESPE), and two polyvinylsiloxane
(PVS) materials (AquasilMonophase and Aquasil putty with light-body wash,
Dentsply. The PVS monophase material reproduced the master model most
11 Review of Literature accurately. Although there was no significant distortion between the impressions and the master model or between the impressions and their casts, there were distortions between the master model and the master casts, which highlighted the cumulative effects of the distortions. The polyether material proved to be the most reliable in terms of predictability.
RaviShankar35 et al (2016) compared polyether, polyvinyl siloxane, vinylpoly siloxoether with impression techniques and concluded that the lowest deviation was found in casts made with splinted technique. Among the materials, VSE yielded more accurate casts.
12
Materials and Methods
MATERIALS
1. MASTER MODEL -WITH FOUR IMPLANT ANALOGS.
Figure -1
2. IMPRESSION MATERIALS.
a. POLYETHER (3M ESPE IMPREGNUMTM SOFT)
Figure - 2
13 Materials and Methods
b. MONOPHASE IMPRESSION MATERIAL (AQUASIL ULTRA
MONOPHASE)
Figure -3
c. POLY VINYL SILOXANE ADDITION (FLEXEED )
Figure – 4
14 Materials and Methods
d. CONDENSATION SILICONE ( ZHERMACK- ZETA PLUS).
Figure – 5
e. IRREVERSIBLE HYDROCOLLOID ( ZHERMACH TROPICALGIN)
Figure - 6
15 Materials and Methods
3. AUTO POLYMERIZING RESIN
Figure - 7
4. MODELLING WAX – AS SPACER.
Figure - 8
5. TYPE IV DIE STONE (PEARLSTONE)
Figure - 9
16 Charts
Chart 1: Schematic representation of the methodology
STEP-1: Preparation of master model
STEP-2: Preparation of specimens.
Immediate pouring Pouring after one hour
Group A : (n=30)
Sub-group: A2 Sub-group: A3 Sub-group: A4 Sub-group: A1 Sub- group :A5 monophase poly vinyl condensation irreversible polyether (n=6) (n=6) siloxane (n=6) silicone (n=6) hydrocolliod (n=6)
Group B : (n=30)
Sub-group: B2 Sub-group: B3 Sub-group: B4 Sub- group :B5 Sub-group: B1 irreversible monophase poly vinyl condensation polyether (n=6) hydrocolliod (n=6) siloxane (n=6) silicone (n=6) (n=6)
STEP-3:
Testing of specimens.
Coordinate measuring machine
Inter implant distance
17 Charts
Chart 2: Grouping of specimens – immediate pouring (GROUP A)
Group A : (n=30)
Sub-group: A2 Sub-group: A3 Sub-group: A4 Sub-group: A1 Sub- group :A5 monophase poly vinyl siloxane condensation irreversible polyether (n=6) (n=6) (n=6) silicone (n=6) hydrocolliod (n=6)
Chart 3: Grouping of specimens for testing –delayed pouring after one hour ( GROUP B)
Group B : (n=30)
Sub-group: B2 Sub-group: B3 Sub-group: B4 Sub- group :B5 Sub-group: B1 irreversible monophase poly vinyl siloxane condensation polyether (n=6) hydrocolliod (n=6) (n=6) silicone (n=6) (n=6)
24 Charts
25 Charts
Chart 2: Grouping of specimens – immediate pouring (GROUP A)
Group A : (n=30)
Sub-group: A2 Sub-group: A3 Sub-group: A4 Sub-group: A1 Sub- group :A5 monophase poly vinyl siloxane condensation irreversible polyether (n=6) (n=6) (n=6) silicone (n=6) hydrocolliod (n=6)
Chart 3: Grouping of specimens for testing –delayed pouring after one hour ( GROUP B)
Group B : (n=30)
Sub-group: B2 Sub-group: B3 Sub-group: B4 Sub- group :B5 Sub-group: B1 irreversible monophase poly vinyl siloxane condensation polyether (n=6) hydrocolliod (n=6) (n=6) silicone (n=6) (n=6)
18 Charts
19 Materials and Methods
MATERIALS AND METHODS
Step-1: Preparation of master model:
A completely edentulous maxillary clear acrylic resin model was fabricated which was used to mimic a dental arch (Figure - 10). Four parallel holes, 3.8 mm in diameter and 10 mm in length according to the size of implants were created in the site of canine and molar region. Four implant (Implantum) was inserted and secured with autopolymering acryclic resin. The fixture adaptor was secured on the vertical rod of the surveyor (J.M.Ney) and was used to orient implants vertically on the surveyor while inserting them in the holes.
Figure - 10
Step-2: Preparation of custom tray for impression making:
60 custom trays were made with autopolymerizing Poly methyl Methacylic resin
(PMMA). For this purpose the master implant model was covered by two layer of wax sheet (Figure – 11). An irreversible hydrocolloid impression was made.
Figure – 11 Figure - 12
19 Materials and Methods
60 Casts was obtained over which the custom trays was fabricated. Relief holes were placed on the custom tray (Figure – 12).
STEP -3 : IMPRESSION MAKING:
1. With Polyether Impression material: (A1(6)- Immediate pouring , B1(6)-
Delayed pouring):
Twelve impression of Polyether impression material was obtained. Type IV die stone was used for cast preparation. Six impressions were poured immediately after making impression for cast with type IV die. Another six impressions was stored carefully for one hour and pouring of cast with type IV die stone was done after one hour of making impression. The casts were obtained and labelled as A11, A12, A13,
A14, A15, A16 for Immediate pouring and as B11, B12, B13, B14, B15, B16 for delayed pouring for testing. The testing was done using calibrated coordinate measuring machine to measure the inter-implant distance.
2. With Monophase impression material (A2(6)- Immediate pouring , B2(6)-
Delayed pouring):
Twelve impression of Monophase impression material was obtained. Type IV die stone was used for cast preparation. Six impressions were poured immediately after making impression for cast with type IV die. Another six impression was stored carefully for one hour and pouring of cast with type IV die stone was done after one hour of making impression. The casts were obtained and labelled as A21, A22, A23,
A24, A25, A26 for Immediate pouring and as B21, B22, B23, B24, B25, B26 for delayed pouring for testing for testing. The testing was done using calibrated coordinate measuring machine to measure the inter-implant distance.
20 Materials and Methods
3. With poly-vinyl siloxane impression material: (A3(6)- Immediate pouring , B3
(6)- Delayed pouring):
Twelve impression of poly-vinyl siloxae impression material was obtained.
Type IV die stone was used for cast preparation. Six impressions were poured immediately after making impression for cast with type IV die. Another six impressions was stored carefully for one hour and pouring of cast with type IV die stone was done after one hour of making impression. The casts were obtained and labelled as A31,
A32, A33, A34, A35, A36 for Immediate pouring and as B31, B32, B33, B34, B35,
B36 for delayed pouring for testing for testing. The testing was done using calibrated coordinate measuring machine to measure the inter-implant distance.
4. With Condensation Silicone impression material: (A4(6)- Immediate pouring ,
B4(6)- Delayed pouring):
Twelve impressions of Condensation Silicone impression material was obtained. Type IV die stone was used for cast preparation. Six impressions were poured immediately after making impression for cast with type IV die. Another six impressions was stored carefully for one hour and pouring of cast with type IV die stone was done after one hour of making impression. The casts were obtained and labelled as A41,
A42, A43, A44, A45, A46 for Immediate pouring and as B41, B42, B43, B44, B45,
B46 for delayed pouring for testing for testing. The testing was done using calibrated coordinate measuring machine to measure the inter-implant distance.
5. With alginate impression material: (A5(6)- Immediate pouring , B5(6)- Delayed
pouring):
21 Materials and Methods
Twelve impression of Alginate impression material was obtained. Type IV die stone was used for cast preparation. Six impressions were poured immediately after making impression for cast with type IV die. Another six impressions was stored carefully for one hour and pouring of cast with type IV die stone was done after one hour of making impression. The casts were obtained and labelled as A61, A62, A63,
A64, A65, A66 for Immediate pouring and as B61, B62, B63, B64, B65, B66 for delayed pouring for testing for testing. The testing was done using calibrated coordinate measuring machine to measure the inter-implant distance.
Fig 13:GROUP A (Immediate pouring)
Fig 14: GROUP B (Delayed pouring)
22 Materials and Methods
STEP 4: MEASUREMENT OF THE CAST:
The cast were poured in a type IV dental stone. Three dimensional measure of the four implant position was made on the master model and the each resulting cast.
The calibrated coordinate measuring machine was used to measure with in accuracy of
2 microns.
A coordinate measuring machine (CMM) is a device that measures the geometry of physical objects by sensing discrete points on the surface of the object with a probe. Various types of probes are used in CMMs, including mechanical, optical, laser, and white light. Depending on the machine, the probe position may be manually controlled by an operator or it may be computer controlled.
CMMs typically specify a probe's position in terms of its displacement from a reference position in a three-dimensional Cartesian coordinate system (i.e., with XYZ axes). In addition to moving the probe along the X, Y, and Z axes, many machines also allow the probe angle to be controlled to allow measurement of surfaces that would otherwise be unreachable.
The typical 3D "bridge" CMM allows probe movement along three axes, X, Y and Z, which are orthogonal to each other in a three-dimensional Cartesian coordinate system. Each axis has a sensor that monitors the position of the probe on that axis, typically with micrometer precision. When the probe contacts (or otherwise detects) a particular location on the object, the machine samples the three position sensors, thus measuring the location of one point on the object's surface. This process is repeated as necessary, moving the probe each time, to produce a "point cloud" which describes the surface areas of interest.
23 Materials and Methods
Optical probes are lens-CCD-systems, which are moved like the mechanical ones, and are aimed at the point of interest, instead of touching the material. The captured image of the surface will be enclosed in the borders of a measuring window, until the residue is adequate to contrast between black and white zones. The dividing curve can be calculated to a point, which is the wanted measuring point in space. The horizontal information on the CCD is 2D (XY) and the vertical position is the position of the complete probing system on the stand Z-drive
Positional stability and consistency of the master model and the implant analog were confirmed by measurement take before and after each impression made with each materials (Figure – 15). Six Inter-implant distance (1-2, 1-3, 1-4, 2-3, 2-4, 3-4) of the cast were calculated using calibrated portable coordinate measuring machine
(Figure – 16).
Figure -15 Figure - 16
The ball probe laser scanner, when placed over the implant, the implant coping, or the laboratory analogue, scanned the mid point of each implant to give 3D representation position. Measurement was documented on the computer via a direct link. The XYZ coordinates of each implant position were recorded and from this information the inter implant distance were calculated for each impression.
24 Materials and Methods
A sample size of twelve impression per impression material has been reported to be adequate to detect clinically relevant result. This was shown by a number of studies in the literature that act as pilot studies, there by providing a greater statistical power to the study.
The above data were captured in MS excel and the information was statistically analysed using ANOVA and followed by multiple comparison test using Post-hoc test.
Data will be presented as mean ± standard deviation.
Limitations of the Study:
This investigation did not simulate the oral conditions and must therefore be interpreted cautiously. Still, the outcomes of the study are relevant and prove useful. In vitro studies under dry conditions have been shown to provide predictable results, which is an environment which can be achieved clinically.
25
Testing Values
TESTING VALUES:
FOR IMPLANT ANALOG MODEL:
IMPLANT DISTANCE 1-2 1-3 1-4 2-3 2-4 3-4
MASTER IMPLANT ANALOG MODEL 14.751 24.111 31.606 14.591 24.085 14.495
FOR IMMEDIATED POURING: GROUP A (N=30)
1. GROUP A1 POLYETHER ( N=6)
IMPLANT DISTANCE 1-2 1-3 1-4 2-3 2-4 3-4
A2-1 14.735 24.097 31.599 14.580 24.082 14.490 A2-2 14.750 23.110 31.596 14.586 24.080 14.495 A2-3 14.749 24.101 31.594 14.584 24.079 14.493 A2-4 14.751 24.095 31.596 14.586 24.075 14.494 A2-5 14.734 24.113 31.598 14.581 24.087 14.493 A2-6 14.767 24.090 31.591 14.589 24.081 14.489
2. GROUP A2 MONOPHASE ( N=6)
IMPLANT DISTANCE 1-2 1-3 1-4 2-3 2-4 3-4
A1-1 14.740 24.108 31.601 14.544 24.582 14.490 A1-2 14.745 24.114 31.599 14.514 24.586 14.497 A1-3 14.742 24.111 31.606 14.594 24.587 14.495 A1-4 14.746 24.110 31.604 14.603 24.592 14.496 A1-5 14.749 24.113 31.602 14.582 24.589 14.492 A1-6 14.740 24.109 31.612 14.622 24.584 14.496
26 Testing Values
3. GROUP A3 POLYVINYL SILOXANE ( N=6)
IMPLANT DISTANCE 1-2 1-3 1-4 2-3 2-4 3-4
A3-1 14.722 24.120 31.591 14.580 24.077 14.485 A3-2 14.724 24.122 31.598 14.586 24.072 14.484 A3-3 14.727 24.129 31.589 14.597 24.077 14.484 A3-4 14.729 24.123 31.589 14.580 24.070 14.486 A3-5 14.724 24.127 31.582 14.581 24.087 14.481 A3-6 14.725 24.125 31.592 14.586 24.071 14.485
4. GROUP A4 CONDENSATION SILICONE ( N=6)
IMPLANT DISTANCE 1-2 1-3 1-4 2-3 2-4 3-4
A4-1 14.702 24.090 31.595 14.577 24.075 14.480 A4-2 14.705 23.093 31.598 14.579 24.073 14.485 A4-3 14.715 23.091 31.597 14.574 24.076 14.480 A4-4 14.702 23.094 31.596 14.571 24.077 14.481 A4-5 14.701 24.093 31.592 14.577 24.075 14.486 A4-6 14.704 24.096 31.595 14.575 24.074 14.481
5. GROUP A5 ALGINATE ( N=6)
IMPLANT DISTANCE 1-2 1-3 1-4 2-3 2-4 3-4
A5-1 14.700 24.085 31.593 14.573 24.067 14.475 A5-2 14.703 24.088 31.598 14.571 24.065 14.475 A5-3 14.699 23.083 31.595 14.573 24.066 14.469 A5-4 14.701 23.086 31.592 14.579 24.064 14.473 A5-5 14.706 24.084 31.598 14.572 23.061 14.465 A5-6 14.709 24.085 31.593 14.576 24.063 14.471
27 Testing Values
FOR DELAYED POURING: GROUP B (N=30)
1. GROUP B1 POLYETHER ( N=6)
IMPLANT DISTANCE 1-2 1-3 1-4 2-3 2-4 3-4
B2-1 14.724 24.097 31.599 14.580 24.082 14.492 B2-2 14.724 24.098 31.596 14.587 24.083 14.491 B2-3 14.726 24.099 31.591 14.583 24.084 14.491 B2-4 14.725 24.092 31.597 14.581 24.089 14.496 B2-5 14.723 23.096 31.599 14.584 24.087 14.495 B2-6 14.722 23.093 31.599 14.585 24.084 14.495
2. GROUP B2 MONOPHASE ( N=6)
IMPLANT DISTANCE 1-2 1-3 1-4 2-3 2-4 3-4
B1-1 14.735 24.101 31.611 14.582 24.080 14.489 B1-2 14.730 24.117 31.600 14.582 24.084 14.490 B1-3 14.734 24.110 31.603 14.586 23.080 14.490 B1-4 14.732 24.115 31.601 14.581 24.081 14.491 B1-5 14.735 24.111 31.607 14.582 24.087 14.492 B1-6 14.735 24.119 31.611 14.583 24.080 14.491
28 Testing Values
3. GROUP B3 POLY VINYL SILOXANE ( N=6)
IMPLANT DISTANCE 1-2 1-3 1-4 2-3 2-4 3-4
B3-1 14.720 24.099 31.595 14.580 24.075 14.483 B3-2 14.727 23.090 31.590 14.581 24.078 14.488 B3-3 14.729 24.091 31.595 14.589 24.079 14.489 B3-4 14.720 23.090 31.591 14.582 24.073 14.487 B3-5 14.721 23.093 31.598 14.580 24.072 14.485 B3-6 14.726 24.096 31.597 14.583 23.074 14.486
4. GROUP B4 CONDENSATION SILICONE ( N=6)
IMPLANT DISTANCE 1-2 1-3 1-4 2-3 2-4 3-4
B4-1 14.700 24.090 31.590 14.570 23.073 14.475 B4-2 14.702 23.092 31.591 14.579 23.076 14.479 B4-3 14.703 24.096 31.597 14.576 23.068 14.473 B4-4 14.704 24.097 31.596 14.578 23.073 14.472 B4-5 14.705 24.090 31.599 14.571 23.072 14.479 B4-6 14.700 24.095 31.590 14.577 24.100 14.475
5. GROUP B5 ALGINATE ( N=6)
IMPLANT DISTANCE 1-2 1-3 1-4 2-3 2-4 3-4
B5-1 14.695 23.080 30.585 14.570 23.060 14.460 B5-2 14.690 23.081 30.585 14.573 23.061 14.461 B5-3 14.697 23.081 30.586 14.574 23.063 14.465 B5-4 14.693 23.083 30.584 14.570 23.065 14.463 B5-5 14.696 23.082 30.581 14.570 23.067 14.466 B5-6 14.695 23.080 31.581 14.571 23.063 14.460
29
Statistical Analysis
STATISTICAL ANALYSIS
This present study compares the accuracy of the impression materials
(Polyether, Monophase, Polyvinyl-siloxane- Addition, Condensation silicone and
Irreversible hydrocolloids) with immediate and delayed pouring of the cast and analyzing inter-implant distance on the cast with Calibrated Coordinate Measuring machine .
A completely edentulous maxillary clear acrylic resin master model with four implants in site of the canine and molar was fabricated which was used to mimic a dental arch. The impression materials used were Polyether, Monophase, Poly vinyl siloxane- Addition , Condensation silicone and Irreversible hydrocolloid .
All laboratory procedures throughout this investigation was standardized and followed according to the manufacturer’s instructions. A single operator performed all the tasks.
Twelve impressions of each impression materials with close mouth technique was taken. Six impressions of each impression materials was poured immediately and another six impressions of each impression material was poured after one hour. The cast was poured with type IV Dental stone as per manufacturer instructions. Inter- implant distance (1-2, 1-3, 1-4, 2-3, 2-4, 3-4) was calculated using Calibrated portable
Coordinate Measuring Machine (CMM). A sample size of sixty impressions has been reported to be adequate to detect clinically relevant differences in inter-implant distances.
30 Statistical Analysis
Data were analyzed for descriptive using SPSS version 11.0. The results were analyzed using ANOVA and followed by multiple comparison test using Post-hoc test. Data was presented as mean ± standard deviation.
31 Table 1: ANOVA – to compare immediate pouring impression materials based on interimplant distance Interimplant Group Mean±SD F value p value distance (mm) Model 14.751 Poly ether 14.734±0.067 Mono phase 14.740±0.101 1-2 13.270 0.000* Addition silicone 14.722±0.079 Condensation silicone 14.702±0.057 Irreversible hydrocolloid 14.700±0.157 Model 24.111 Poly ether 24.105±0.228 Mono phase 24.110±0.109 1.006 0.431 1-3 Addition silicone 24.120±0.071 Condensation silicone 24.090±0.109 Irreversible hydrocolloid 24.085±0.185 Model 31.606 Poly ether 31.600±0.128
1-4 Mono phase 31.601±0.046 0.524 0.756 Addition silicone 31.598±0.044
Condensation silicone 31.595±0.144 Irreversible hydrocolloid 31.593±0.321 Model 14.591 Poly ether 14.582±0.036 Mono phase 14.587±0.040 7.395 0.000* 2-3 Addition silicone 14.580±0.014 Condensation silicone 14.577±0.087 Irreversible hydrocolloid 14.572±0.068 Model 24.085 Poly ether 24.080±0.154 2-4 Mono phase 24.084±0.022 Addition silicone 24.077±0.023 6.313 0.000* Condensation silicone 24.075±0.099 Irreversible hydrocolloid 24.067±0.180 Model 14.495 Poly ether 14.490±0.091 Mono phase 14.492±0.075 3-4 Addition silicone 14.485±0.0251 9.148 0.000* Condensation silicone 14.480±0.040 Irreversible hydrocolloid 14.475±0.185 *Significance at p<0.05
32
Table 2: Post-hoc Tests Tukey HSD Interimplant GROUP (1) GROUP (2) Mean Std. Sig. 95% Confidence distance Difference Error Interval (mm) (1-2) Lower Upper Bound Bound Mono phase 0.167667* 0.052075 0.033 0.00928 0.32606 Addition silicone -0.032500 0.052075 0.988 -0.19089 0.12589 Poly ether Condensation silicone 0.000333 0.052075 1.000 -0.15806 0.15872 Irreversible hydrocolloid 0.016667 0.052075 1.000 -0.14172 0.17506 Model -0.249167* 0.052075 0.001 -0.40756 -0.09078 Poly ether -0.167667* 0.052075 0.033 -0.32606 -0.00928 Addition silicone -0.200167* 0.052075 0.007 -0.35856 -0.04178 Mono phase Condensation silicone -0.167333* 0.052075 0.034 -0.32572 -0.00894 Irreversible hydrocolloid -0.151000 0.052075 0.069 -0.30939 0.00739 Model -0.416833* 0.052075 0.000 -0.57522 -0.25844 Poly ether 0.032500 0.052075 0.988 -0.12589 0.19089 Mono phase 0.200167* 0.052075 0.007 0.04178 0.35856 Addition Condensation silicone 0.032833 0.052075 0.988 -0.12556 0.19122 silicone Irreversible hydrocolloid 0.049167 0.052075 0.932 -0.10922 0.20756 1-2 Model -0.216667* 0.052075 0.003 -0.37506 -0.05828
Condensation Poly ether -0.000333 0.052075 1.000 -0.15872 0.15806 silicone Mono phase 0.167333* 0.052075 0.034 0.00894 0.32572 Addition silicone -0.032833 0.052075 0.988 -0.19122 0.12556 Irreversible hydrocolloid 0.016333 0.052075 1.000 -0.14206 0.17472 Model -0.249500* 0.052075 0.001 -0.40789 -0.09111 Irreversible Poly ether -0.016667 0.052075 1.000 -0.17506 0.14172 hydrocolloid Mono phase 0.151000 0.052075 0.069 -0.00739 0.30939 Addition silicone -0.049167 0.052075 0.932 -0.20756 0.10922 Condensation silicone -0.016333 0.052075 1.000 -0.17472 0.14206 Model -0.265833* 0.052075 0.000 -0.42422 -0.10744 Poly ether 0.249167* 0.052075 0.001 0.09078 0.40756 Mono phase 0.416833* 0.052075 0.000 0.25844 0.57522 Model Addition silicone 0.216667* 0.052075 0.003 0.05828 0.37506 Condensation silicone 0.249500* 0.052075 0.001 0.09111 0.40789 Irreversible hydrocolloid 0.265833* 0.052075 0.000 0.10744 0.42422 Mono phase 0.062000 0.079879 0.969 -0.18096 0.30496 Addition silicone 0.041833 0.079879 0.995 -0.20113 0.28479 1-3 Poly ether Condensation silicone 0.092167 0.079879 0.855 -0.15079 0.33513 Irreversible hydrocolloid 0.167167 0.079879 0.318 -0.07579 0.41013 Model 0.050833 0.079879 0.987 -0.19213 0.29379
33 Poly ether -0.062000 0.079879 0.969 -0.30496 0.18096 Addition silicone -0.020167 0.079879 1.000 -0.26313 0.22279 Mono phase Condensation silicone 0.030167 0.079879 0.999 -0.21279 0.27313 Irreversible hydrocolloid 0.105167 0.079879 0.774 -0.13779 0.34813 Model -0.011167 0.079879 1.000 -0.25413 0.23179 Poly ether -0.041833 0.079879 0.995 -0.28479 0.20113 Mono phase 0.020167 0.079879 1.000 -0.22279 0.26313 Addition Condensation silicone 0.050333 0.079879 0.988 -0.19263 0.29329 silicone Irreversible hydrocolloid 0.125333 0.079879 0.624 -0.11763 0.36829 Model 0.009000 0.079879 1.000 -0.23396 0.25196 Condensation Poly ether -0.092167 0.079879 0.855 -0.33513 0.15079 silicone Mono phase -0.030167 0.079879 0.999 -0.27313 0.21279 Addition silicone -0.050333 0.079879 0.988 -0.29329 0.19263 Irreversible hydrocolloid 0.075000 0.079879 0.933 -0.16796 0.31796 Model -0.041333 0.079879 0.995 -0.28429 0.20163 Irreversible Poly ether -0.167167 0.079879 0.318 -0.41013 0.07579 hydrocolloid Mono phase -0.105167 0.079879 0.774 -0.34813 0.13779 Addition silicone -0.125333 0.079879 0.624 -0.36829 0.11763 Condensation silicone -0.075000 0.079879 0.933 -0.31796 0.16796 Model -0.116333 0.079879 0.693 -0.35929 0.12663 Poly ether -0.050833 0.079879 0.987 -0.29379 0.19213 Mono phase 0.011167 0.079879 1.000 -0.23179 0.25413 Model Addition silicone -0.009000 0.079879 1.000 -0.25196 0.23396 Condensation silicone 0.041333 0.079879 0.995 -0.20163 0.28429 Irreversible hydrocolloid 0.116333 0.079879 0.693 -0.12663 0.35929 Mono phase -0.020167 0.089423 1.000 -0.29215 0.25182 Addition silicone -0.051833 0.089423 0.992 -0.32382 0.22015 Poly ether Condensation silicone 0.009333 0.089423 1.000 -0.26265 0.28132 Irreversible hydrocolloid 0.085500 0.089423 0.928 -0.18649 0.35749 Model 0.015167 0.089423 1.000 -0.25682 0.28715 Poly ether 0.020167 0.089423 1.000 -0.25182 0.29215 Addition silicone -0.031667 0.089423 0.999 -0.30365 0.24032 Mono phase Condensation silicone 0.029500 0.089423 0.999 -0.24249 0.30149 1-4 Irreversible hydrocolloid 0.105667 0.089423 0.842 -0.16632 0.37765
Model 0.035333 0.089423 0.999 -0.23665 0.30732 Poly ether 0.051833 0.089423 0.992 -0.22015 0.32382 Mono phase 0.031667 0.089423 0.999 -0.24032 0.30365 Addition Condensation silicone 0.061167 0.089423 0.982 -0.21082 0.33315 silicone Irreversible hydrocolloid 0.137333 0.089423 0.645 -0.13465 0.40932 Model 0.067000 0.089423 0.974 -0.20499 0.33899 Condensation Poly ether -0.009333 0.089423 1.000 -0.28132 0.26265 silicone Mono phase -0.029500 0.089423 0.999 -0.30149 0.24249
34 Addition silicone -0.061167 0.089423 0.982 -0.33315 0.21082 Irreversible hydrocolloid 0.076167 0.089423 0.955 -0.19582 0.34815 Model 0.005833 0.089423 1.000 -0.26615 0.27782 Irreversible Poly ether -0.085500 0.089423 0.928 -0.35749 0.18649 hydrocolloid Mono phase -0.105667 0.089423 0.842 -0.37765 0.16632 Addition silicone -0.137333 0.089423 0.645 -0.40932 0.13465 Condensation silicone -0.076167 0.089423 0.955 -0.34815 0.19582 Model -0.070333 0.089423 0.968 -0.34232 0.20165 Poly ether -0.015167 0.089423 1.000 -0.28715 0.25682 Mono phase -0.035333 0.089423 0.999 -0.30732 0.23665 Model Addition silicone -0.067000 0.089423 0.974 -0.33899 0.20499 Condensation silicone -0.005833 0.089423 1.000 -0.27782 0.26615 Irreversible hydrocolloid 0.070333 0.089423 0.968 -0.20165 0.34232 Mono phase -0.110333* 0.029167 0.008 -0.19905 -0.02162 Addition silicone -0.005667 0.029167 1.000 -0.09438 0.08305 Poly ether Condensation silicone -0.003500 0.029167 1.000 -0.09221 0.08521 Irreversible hydrocolloid 0.064167 0.029167 0.267 -0.02455 0.15288 Model -0.013500 0.029167 0.997 -0.10221 0.07521 Poly ether 0.110333* 0.029167 0.008 0.02162 0.19905 Addition silicone 0.104667* 0.029167 0.013 0.01595 0.19338 Mono phase Condensation silicone 0.106833* 0.029167 0.011 0.01812 0.19555 Irreversible hydrocolloid 0.174500* 0.029167 0.000 0.08579 0.26321 Model 0.096833* 0.029167 0.026 0.00812 0.18555 Poly ether 0.005667 0.029167 1.000 -0.08305 0.09438 Mono phase -0.104667* 0.029167 0.013 -0.19338 -0.01595 Addition Condensation silicone 0.002167 0.029167 1.000 -0.08655 0.09088 silicone Irreversible hydrocolloid 0.069833 0.029167 0.190 -0.01888 0.15855 2-3 Model -0.007833 0.029167 1.000 -0.09655 0.08088 Condensation Poly ether 0.003500 0.029167 1.000 -0.08521 0.09221 silicone Mono phase -0.106833* 0.029167 0.011 -0.19555 -0.01812 Addition silicone -0.002167 0.029167 1.000 -0.09088 0.08655 Irreversible hydrocolloid 0.067667 0.029167 0.218 -0.02105 0.15638 Model -0.010000 0.029167 0.999 -0.09871 0.07871 Irreversible Poly ether -0.064167 0.029167 0.267 -0.15288 0.02455 hydrocolloid Mono phase -0.174500* 0.029167 0.000 -0.26321 -0.08579 Addition silicone -0.069833 0.029167 0.190 -0.15855 0.01888 Condensation silicone -0.067667 0.029167 0.218 -0.15638 0.02105 Model -0.077667 0.029167 0.113 -0.16638 0.01105 Poly ether 0.013500 0.029167 0.997 -0.07521 0.10221 Mono phase -0.096833* 0.029167 0.026 -0.18555 -0.00812 Model Addition silicone 0.007833 0.029167 1.000 -0.08088 0.09655 Condensation silicone 0.010000 0.029167 0.999 -0.07871 0.09871
35 Irreversible hydrocolloid 0.077667 0.029167 0.113 -0.01105 0.16638 Mono phase -0.250333* 0.061034 0.004 -0.43598 -0.06469 Addition silicone -0.038667 0.061034 0.988 -0.22431 0.14698 Poly ether Condensation silicone -0.061000 0.061034 0.914 -0.24664 0.12464 Irreversible hydrocolloid 0.066667 0.061034 0.881 -0.11898 0.25231 Model -0.001667 0.061034 1.000 -0.18731 0.18398 Poly ether 0.250333* 0.061034 0.004 0.06469 0.43598 Addition silicone 0.211667* 0.061034 0.018 0.02602 0.39731 Mono phase Condensation silicone 0.189333* 0.061034 0.044 0.00369 0.37498 Irreversible hydrocolloid 0.317000* 0.061034 0.000 0.13136 0.50264 Model 0.248667* 0.061034 0.004 0.06302 0.43431 Poly ether 0.038667 0.061034 0.988 -0.14698 0.22431 Mono phase -0.211667* 0.061034 0.018 -0.39731 -0.02602 Addition Condensation silicone -0.022333 0.061034 0.999 -0.20798 0.16331 silicone Irreversible hydrocolloid 0.105333 0.061034 0.526 -0.08031 0.29098 Model 0.037000 0.061034 0.990 -0.14864 0.22264 2-4 Condensation Poly ether 0.061000 0.061034 0.914 -0.12464 0.24664 silicone Mono phase -0.189333* 0.061034 0.044 -0.37498 -0.00369 Addition silicone 0.022333 0.061034 0.999 -0.16331 0.20798 Irreversible hydrocolloid 0.127667 0.061034 0.318 -0.05798 0.31331 Model 0.059333 0.061034 0.923 -0.12631 0.24498 Irreversible Poly ether -0.066667 0.061034 0.881 -0.25231 0.11898 hydrocolloid Mono phase -0.317000* 0.061034 0.000 -0.50264 -0.13136 Addition silicone -0.105333 0.061034 0.526 -0.29098 0.08031 Condensation silicone -0.127667 0.061034 0.318 -0.31331 0.05798 Model -0.068333 0.061034 0.869 -0.25398 0.11731 Poly ether 0.001667 0.061034 1.000 -0.18398 0.18731 Mono phase -0.248667* 0.061034 0.004 -0.43431 -0.06302 Model Addition silicone -0.037000 0.061034 0.990 -0.22264 0.14864 Condensation silicone -0.059333 0.061034 0.923 -0.24498 0.12631 Irreversible hydrocolloid 0.068333 0.061034 0.869 -0.11731 0.25398 Mono phase -0.232167* 0.052976 0.002 -0.39330 -0.07103 Addition silicone -0.094500 0.052976 0.491 -0.25563 0.06663 Poly ether Condensation silicone -0.064667 0.052976 0.823 -0.22580 0.09647 Irreversible hydrocolloid 0.112667 0.052976 0.301 -0.04847 0.27380 Model -0.053167 0.052976 0.913 -0.21430 0.10797 3-4 Poly ether 0.232167* 0.052976 0.002 0.07103 0.39330 Addition silicone 0.137667 0.052976 0.129 -0.02347 0.29880 Mono phase Condensation silicone 0.167500* 0.052976 0.038 0.00637 0.32863 Irreversible hydrocolloid 0.344833* 0.052976 0.000 0.18370 0.50597 Model 0.179000* 0.052976 0.023 0.01787 0.34013 Addition Poly ether 0.094500 0.052976 0.491 -0.06663 0.25563
36 silicone Mono phase -0.137667 0.052976 0.129 -0.29880 0.02347 Condensation silicone 0.029833 0.052976 0.993 -0.13130 0.19097 Irreversible hydrocolloid 0.207167* 0.052976 0.006 0.04603 0.36830 Model 0.041333 0.052976 0.969 -0.11980 0.20247 Condensation Poly ether 0.064667 0.052976 0.823 -0.09647 0.22580 silicone Mono phase -0.167500* 0.052976 0.038 -0.32863 -0.00637 Addition silicone -0.029833 0.052976 0.993 -0.19097 0.13130 Irreversible hydrocolloid 0.177333* 0.052976 0.024 0.01620 0.33847 Model 0.011500 0.052976 1.000 -0.14963 0.17263 Irreversible Poly ether -0.112667 0.052976 0.301 -0.27380 0.04847 hydrocolloid Mono phase -0.344833* 0.052976 0.000 -0.50597 -0.18370 Addition silicone -0.207167* 0.052976 0.006 -0.36830 -0.04603 Condensation silicone -0.177333* 0.052976 0.024 -0.33847 -0.01620 Model -0.165833* 0.052976 0.041 -0.32697 -0.00470 Poly ether 0.053167 0.052976 0.913 -0.10797 0.21430 Mono phase -0.179000* 0.052976 0.023 -0.34013 -0.01787 Model Addition silicone -0.041333 0.052976 0.969 -0.20247 0.11980 Condensation silicone -0.011500 0.052976 1.000 -0.17263 0.14963 Irreversible hydrocolloid 0.165833* 0.052976 0.041 0.00470 0.32697 *The mean difference is significant at the 0.05 level.
37 Table 3: ANOVA – to compare delayed pouring impression materials based on interimplant distance Interimplant Group Mean±SD F value p value distance (mm) Model 14.751 Poly ether 14.724±0.050 Mono phase 14.735±0.067 1-2 33.862 0.000* Addition silicone 14.720±0.026 Condensation silicone 14.700±0.159 Irreversible hydrocolloid 14.695±0.113 Model 24.111 Poly ether 24.097±0.434 Mono phase 24.110±0.070 1-3 5.321 0.001* Addition silicone 24.090±0.075 Condensation silicone 24.090±0.203 Irreversible hydrocolloid 23.080±0.140 Model 31.606 Poly ether 31.599±0.061 1-4 Mono phase 31.600±0.015 Addition silicone 31.595±0.079 24.237 0.000* Condensation silicone 31.590±0.111 Irreversible hydrocolloid 30.585±0.318 Model 14.591 Poly ether 14.580±0.108 Mono phase 14.582±0.023 2-3 Addition silicone 14.580±0.066 20.765 0.000* Condensation silicone 14.570±0.082 Irreversible hydrocolloid 14.570±0.037 Model 24.085 Poly ether 24.082±0.461 2-4 Mono phase 24.080±0.301 Addition silicone 24.075±0.082 2.875 0.000* Condensation silicone 23.073±0.241 Irreversible hydrocolloid 23.060±0.208 Model 14.495 Poly ether 14.492±0.106 Mono phase 14.490±0.056 3-4 Addition silicone 14.483±0.009 4.896 0.002* Condensation silicone 14.475±0.042 Irreversible hydrocolloid 14.460±0.161 *Significance at p<0.05
38 Table 4: Post-hoc Tests Tukey HSD Interimplant GROUP (1) GROUP (2) Mean Std. Sig. 95% Confidence distance (mm) Difference Error Interval (1-2) Lower Upper Bound Bound Poly ether 0.132333 0.048117 0.094 -0.01402 0.27869 Mono phase 0.018500 0.048117 0.999 -0.12785 0.16485 Model Addition silicone -0.052333 0.048117 0.882 -0.19869 0.09402 Condensation silicone 0.373500* 0.048117 0.000 0.22715 0.51985 Irreversible hydrocolloid -0.216333* 0.048117 0.001 -0.36269 -0.06998 Model -0.132333 0.048117 0.094 -0.27869 0.01402 Mono phase -0.113833 0.048117 0.201 -0.26019 0.03252 Poly ether Addition silicone -0.184667* 0.048117 0.007 -0.33102 -0.03831 Condensation silicone 0.241167* 0.048117 0.000 0.09481 0.38752 Irreversible hydrocolloid -0.348667* 0.048117 0.000 -0.49502 -0.20231 Model -0.018500 0.048117 0.999 -0.16485 0.12785 Poly ether 0.113833 0.048117 0.201 -0.03252 0.26019 Mono phase Addition silicone -0.070833 0.048117 0.684 -0.21719 0.07552 Condensation silicone 0.355000* 0.048117 0.000 0.20865 0.50135 1-2 Irreversible hydrocolloid -0.234833* 0.048117 0.000 -0.38119 -0.08848 Model 0.052333 0.048117 0.882 -0.09402 0.19869 Poly ether 0.184667* 0.048117 0.007 0.03831 0.33102 Addition Mono phase 0.070833 0.048117 0.684 -0.07552 0.21719 silicone Condensation silicone 0.425833* 0.048117 0.000 0.27948 0.57219 Irreversible hydrocolloid -0.164000* 0.048117 0.021 -0.31035 -0.01765 Condensatio Model -0.373500* 0.048117 0.000 -0.51985 -0.22715 n silicone Poly ether -0.241167* 0.048117 0.000 -0.38752 -0.09481
Mono phase -0.355000* 0.048117 0.000 -0.50135 -0.20865 Addition silicone -0.425833* 0.048117 0.000 -0.57219 -0.27948 Irreversible hydrocolloid -0.589833* 0.048117 0.000 -0.73619 -0.44348 Model 0.216333* 0.048117 0.001 0.06998 0.36269 Poly ether 0.348667* 0.048117 0.000 0.20231 0.49502 Irreversible Mono phase 0.234833* 0.048117 0.000 0.08848 0.38119 hydrocolloid Addition silicone 0.164000* 0.048117 0.021 0.01765 0.31035 Condensation silicone 0.589833* 0.048117 0.000 0.44348 0.73619 Poly ether 0.137667 0.120066 0.858 -0.22753 0.50286 Mono phase 0.077833 0.120066 0.986 -0.28736 0.44303 Model Addition silicone 0.046667 0.120066 0.999 -0.31853 0.41186 1-3 Condensation silicone 0.505500* 0.120066 0.003 0.14031 0.87069 Irreversible hydrocolloid -0.026167 0.120066 1.000 -0.39136 0.33903 Poly ether Model -0.137667 0.120066 0.858 -0.50286 0.22753
39 Mono phase -0.059833 0.120066 0.996 -0.42503 0.30536 Addition silicone -0.091000 0.120066 0.972 -0.45619 0.27419 Condensation silicone 0.367833* 0.120066 0.048 0.00264 0.73303 Irreversible hydrocolloid -0.163833 0.120066 0.747 -0.52903 0.20136 Model -0.077833 0.120066 0.986 -0.44303 0.28736 Poly ether 0.059833 0.120066 0.996 -0.30536 0.42503 Mono phase Addition silicone -0.031167 0.120066 1.000 -0.39636 0.33403 Condensation silicone 0.427667* 0.120066 0.014 0.06247 0.79286 Irreversible hydrocolloid -0.104000 0.120066 0.952 -0.46919 0.26119 Model -0.046667 0.120066 0.999 -0.41186 0.31853 Poly ether 0.091000 0.120066 0.972 -0.27419 0.45619 Addition Mono phase 0.031167 0.120066 1.000 -0.33403 0.39636 silicone Condensation silicone 0.458833* 0.120066 0.007 0.09364 0.82403 Irreversible hydrocolloid -0.072833 0.120066 0.990 -0.43803 0.29236 Condensatio Model -0.505500* 0.120066 0.003 -0.87069 -0.14031 n silicone Poly ether -0.367833* 0.120066 0.048 -0.73303 -0.00264
Mono phase -0.427667* 0.120066 0.014 -0.79286 -0.06247 Addition silicone -0.458833* 0.120066 0.007 -0.82403 -0.09364 Irreversible hydrocolloid -0.531667* 0.120066 0.001 -0.89686 -0.16647 Model 0.026167 0.120066 1.000 -0.33903 0.39136 Poly ether 0.163833 0.120066 0.747 -0.20136 0.52903 Irreversible Mono phase 0.104000 0.120066 0.952 -0.26119 0.46919 hydrocolloid Addition silicone 0.072833 0.120066 0.990 -0.29236 0.43803 Condensation silicone 0.531667* 0.120066 0.001 0.16647 0.89686 Poly ether 0.054167 0.082929 0.986 -0.19807 0.30640 Mono phase 0.050000 0.082929 0.990 -0.20224 0.30224 Model Addition silicone -0.035667 0.082929 0.998 -0.28790 0.21657 Condensation silicone 0.713833* 0.082929 0.000 0.46160 0.96607 Irreversible hydrocolloid -0.009167 0.082929 1.000 -0.26140 0.24307 Model -0.054167 0.082929 0.986 -0.30640 0.19807 Mono phase -0.004167 0.082929 1.000 -0.25640 0.24807 Poly ether Addition silicone -0.089833 0.082929 0.884 -0.34207 0.16240 1-4 Condensation silicone 0.659667* 0.082929 0.000 0.40743 0.91190 Irreversible hydrocolloid -0.063333 0.082929 0.972 -0.31557 0.18890 Model -0.050000 0.082929 0.990 -0.30224 0.20224 Poly ether 0.004167 0.082929 1.000 -0.24807 0.25640 Mono phase Addition silicone -0.085667 0.082929 0.903 -0.33790 0.16657 Condensation silicone 0.663833* 0.082929 0.000 0.41160 0.91607 Irreversible hydrocolloid -0.059167 0.082929 0.979 -0.31140 0.19307 Model 0.035667 0.082929 0.998 -0.21657 0.28790 Addition Poly ether 0.089833 0.082929 0.884 -0.16240 0.34207 silicone Mono phase 0.085667 0.082929 0.903 -0.16657 0.33790
40 Condensation silicone 0.749500* 0.082929 0.000 0.49726 10.00174 Irreversible hydrocolloid 0.026500 0.082929 1.000 -0.22574 0.27874 Condensatio Model -0.713833* 0.082929 0.000 -0.96607 -0.46160 n silicone Poly ether -0.659667* 0.082929 0.000 -0.91190 -0.40743
Mono phase -0.663833* 0.082929 0.000 -0.91607 -0.41160 Addition silicone -0.749500* 0.082929 0.000 -10.00174 -0.49726 Irreversible hydrocolloid -0.723000* 0.082929 0.000 -0.97524 -0.47076 Model 0.009167 0.082929 1.000 -0.24307 0.26140 Poly ether 0.063333 0.082929 0.972 -0.18890 0.31557 Irreversible Mono phase 0.059167 0.082929 0.979 -0.19307 0.31140 hydrocolloid Addition silicone -0.026500 0.082929 1.000 -0.27874 0.22574 Condensation silicone 0.723000* 0.082929 0.000 0.47076 0.97524 Poly ether -0.141500* 0.036935 0.007 -0.25384 -0.02916 Mono phase 0.087333 0.036935 0.201 -0.02501 0.19967 Model Addition silicone 0.064500 0.036935 0.514 -0.04784 0.17684 Condensation silicone 0.219000* 0.036935 0.000 0.10666 0.33134 Irreversible hydrocolloid 0.002500 0.036935 1.000 -0.10984 0.11484 Model 0.141500* 0.036935 0.007 0.02916 0.25384 Mono phase 0.228833* 0.036935 0.000 0.11649 0.34117 Poly ether Addition silicone 0.206000* 0.036935 0.000 0.09366 0.31834 Condensation silicone 0.360500* 0.036935 0.000 0.24816 0.47284 Irreversible hydrocolloid 0.144000* 0.036935 0.006 0.03166 0.25634 Model -0.087333 0.036935 0.201 -0.19967 0.02501 Poly ether -0.228833* 0.036935 0.000 -0.34117 -0.11649 Mono phase Addition silicone -0.022833 0.036935 0.989 -0.13517 0.08951 Condensation silicone 0.131667* 0.036935 0.014 0.01933 0.24401 Irreversible hydrocolloid -0.084833 0.036935 0.227 -0.19717 0.02751 2-3 Model -0.064500 0.036935 0.514 -0.17684 0.04784 Poly ether -0.206000* 0.036935 0.000 -0.31834 -0.09366 Addition Mono phase 0.022833 0.036935 0.989 -0.08951 0.13517 silicone Condensation silicone 0.154500* 0.036935 0.003 0.04216 0.26684 Irreversible hydrocolloid -0.062000 0.036935 0.556 -0.17434 0.05034 Condensatio Model -0.219000* 0.036935 0.000 -0.33134 -0.10666 n silicone Poly ether -0.360500* 0.036935 0.000 -0.47284 -0.24816
Mono phase -0.131667* 0.036935 0.014 -0.24401 -0.01933 Addition silicone -0.154500* 0.036935 0.003 -0.26684 -0.04216 Irreversible hydrocolloid -0.216500* 0.036935 0.000 -0.32884 -0.10416 Model -0.002500 0.036935 1.000 -0.11484 0.10984 Poly ether -0.144000* 0.036935 0.006 -0.25634 -0.03166 Irreversible Mono phase 0.084833 0.036935 0.227 -0.02751 0.19717 hydrocolloid Addition silicone 0.062000 0.036935 0.556 -0.05034 0.17434 Condensation silicone 0.216500* 0.036935 0.000 0.10416 0.32884
41 Poly ether -0.109333 0.078459 0.730 -0.34797 0.12931 Mono phase -0.028667 0.078459 0.999 -0.26731 0.20997 Model Addition silicone 0.110000 0.078459 0.726 -0.12864 0.34864 Condensation silicone 0.122167 0.078459 0.632 -0.11647 0.36081 Irreversible hydrocolloid -0.067500 0.078459 0.953 -0.30614 0.17114 Model 0.109333 0.078459 0.730 -0.12931 0.34797 Mono phase 0.080667 0.078459 0.905 -0.15797 0.31931 Poly ether Addition silicone 0.219333 0.078459 0.086 -0.01931 0.45797 Condensation silicone 0.231500 0.078459 0.061 -0.00714 0.47014 Irreversible hydrocolloid 0.041833 0.078459 0.994 -0.19681 0.28047 Model 0.028667 0.078459 0.999 -0.20997 0.26731 Poly ether -0.080667 0.078459 0.905 -0.31931 0.15797 Mono phase Addition silicone 0.138667 0.078459 0.501 -0.09997 0.37731 Condensation silicone 0.150833 0.078459 0.409 -0.08781 0.38947 Irreversible hydrocolloid -0.038833 0.078459 0.996 -0.27747 0.19981 2-4 Model -0.110000 0.078459 0.726 -0.34864 0.12864 Poly ether -0.219333 0.078459 0.086 -0.45797 0.01931 Addition Mono phase -0.138667 0.078459 0.501 -0.37731 0.09997 silicone Condensation silicone 0.012167 0.078459 1.000 -0.22647 0.25081 Irreversible hydrocolloid -0.177500 0.078459 0.241 -0.41614 0.06114 Condensatio Model -0.122167 0.078459 0.632 -0.36081 0.11647 n silicone Poly ether -0.231500 0.078459 0.061 -0.47014 0.00714
Mono phase -0.150833 0.078459 0.409 -0.38947 0.08781 Addition silicone -0.012167 0.078459 1.000 -0.25081 0.22647 Irreversible hydrocolloid -0.189667 0.078459 0.182 -0.42831 0.04897 Model 0.067500 0.078459 0.953 -0.17114 0.30614 Poly ether -0.041833 0.078459 0.994 -0.28047 0.19681 Irreversible Mono phase 0.038833 0.078459 0.996 -0.19981 0.27747 hydrocolloid Addition silicone 0.177500 0.078459 0.241 -0.06114 0.41614 Condensation silicone 0.189667 0.078459 0.182 -0.04897 0.42831 Poly ether 0.030333 0.048381 0.988 -0.11682 0.17749 Mono phase -0.104167 0.048381 0.289 -0.25132 0.04299 Model Addition silicone -0.168333* 0.048381 0.018 -0.31549 -0.02118 Condensation silicone 0.002667 0.048381 1.000 -0.14449 0.14982 Irreversible hydrocolloid -0.050667 0.048381 0.898 -0.19782 0.09649 Model -0.030333 0.048381 0.988 -0.17749 0.11682 3-4 Mono phase -0.134500 0.048381 0.089 -0.28165 0.01265 Poly ether Addition silicone -0.198667* 0.048381 0.004 -0.34582 -0.05151 Condensation silicone -0.027667 0.048381 0.992 -0.17482 0.11949 Irreversible hydrocolloid -0.081000 0.048381 0.558 -0.22815 0.06615 Model 0.104167 0.048381 0.289 -0.04299 0.25132 Mono phase Poly ether 0.134500 0.048381 0.089 -0.01265 0.28165
42 Addition silicone -0.064167 0.048381 0.768 -0.21132 0.08299 Condensation silicone 0.106833 0.048381 0.264 -0.04032 0.25399 Irreversible hydrocolloid 0.053500 0.048381 0.875 -0.09365 0.20065 Model 0.168333* 0.048381 0.018 0.02118 0.31549 Poly ether 0.198667* 0.048381 0.004 0.05151 0.34582 Addition Mono phase 0.064167 0.048381 0.768 -0.08299 0.21132 silicone Condensation silicone 0.171000* 0.048381 0.015 0.02385 0.31815 Irreversible hydrocolloid 0.117667 0.048381 0.178 -0.02949 0.26482 Condensati Model -0.002667 0.048381 1.000 -0.14982 0.14449 on silicone Poly ether 0.027667 0.048381 0.992 -0.11949 0.17482
Mono phase -0.106833 0.048381 0.264 -0.25399 0.04032 Addition silicone -0.171000* 0.048381 0.015 -0.31815 -0.02385 Irreversible hydrocolloid -0.053333 0.048381 0.877 -0.20049 0.09382 Model 0.050667 0.048381 0.898 -0.09649 0.19782 Irreversible Poly ether 0.081000 0.048381 0.558 -0.06615 0.22815 hydrocolloi Mono phase -0.053500 0.048381 0.875 -0.20065 0.09365 d Addition silicone -0.117667 0.048381 0.178 -0.26482 0.02949 Condensation silicone 0.053333 0.048381 0.877 -0.09382 0.20049 * The mean difference is significant at the 0.05 level.
43
Table 5: Paired sample t-test
Paired Differences t df Sig. (2- Paired sample Mean Std. Std. Error 95% Confidence tailed) (immediate – delayed) Deviation Mean Interval of the Difference Lower Upper 1-2mm 0.026 0.185 0.031 -0.037 0.088 0.843 35 0.405 1-3mm 0.132 0.245 0.041 0.049 0.214 3.222 35 0.003* 1-4mm 0.147 0.282 0.047 0.051 0.242 3.124 35 0.004* 2-3mm 0.034 0.102 0.017 -0.000 0.069 2.011 35 0.052 2-4mm 0.118 0.160 0.027 0.063 0.172 4.426 35 0.000* 3-4mm 0.004 0.168 0.028 -0.052 0.061 0.159 35 0.875
44
Table 6: Paired sample t-test
Paired Differences t df Sig. (2- Paired sample Mean Std. Std. Error 95% Confidence tailed) (immediate – delayed) Deviation Mean Interval of the Difference Lower Upper Poly ether 0.100 0.133 0.054 -0.040 0.241 1.837 5 0.126 Mono phase 0.012 0.036 0.014 -0.026 0.050 0.819 5 0.450 Addition silicone 0.066 0.054 0.021 0.010 0.123 3.022 5 0.029* Condensation silicone -0.010 0.138 0.056 -0.155 0.135 -0.173 5 0.870 Irreversible 0.257 0.266 0.108 -0.023 0.536 2.359 5 0.065 hydrocolloid
45
Results
Graph - 1 : ANOVA - to compare immediate pouring impression materials based on interimplant distance (1-2).
14.8
14.7
14.6
14.5
14.4
14.3
14.2 (1,2) Model Polyether Monophase Addition silicone Condensation silicone Alginate
Graph - 2 : ANOVA - to compare immediate pouring impression materials based on interimplant distance(1-3)
24.115 24.11 24.105 24.1 24.095 24.09 24.085 24.08 24.075 24.07 (1,3) Model Polyether Monophase Addition silicone Condensation silicone Alginate
46 Results
Graph - 3 : ANOVA – to compare immediate pouring impression materials based on interimplant distance(1-4)
31.61
31.605
31.6
31.595
31.59
31.585 (1,4) Model Polyether Monophase Addition silicone Condensation silicone Alginate
Graph - 4 : ANOVA – to compare immediate pouring impression materials based on interimplant distance(2-3)
14.595
14.59
14.585
14.58
14.575
14.57
14.565
14.56 (2,3) Model Polyether Monophase Addition silicone Condensation silicone Alginate
47 Results
Graph - 5 : ANOVA – to compare immediate pouring impression materials based on interimplant distance(2-4)
24.09
24.085
24.08
24.075
24.07
24.065
24.06
24.055 (2,4) Model Polyether Monophase Addition silicone Condensation silicone Alginate
Graph - 6 : ANOVA – to compare immediate pouring impression materials based on interimplant distance(3-4)
14.5
14.495
14.49
14.485
14.48
14.475
14.47
14.465 (3,4) Model Polyether Monophase Addition silicone Condensation silicone Alginate
48 Results
Graph - 7 : Paired sample test to compare immediate and delayed pouring impression materials based on inter-implant distance (1-2)
14.75
14.74
14.73
14.72
14.71 immediate
14.7 delayed
14.69
14.68
14.67 polyether Monophase addition c-silicone alginate silicone
Graph - 8 : Paired sample test to compare immediate and delayed pouring impression materials based on inter-implant distance (1-3)
24.13
24.12
24.11
24.1 immediate 24.09 delayed
24.08
24.07
24.06 polyether Monophase addition c-silicone alginate silicone
49 Results
Graph - 9 : Paired sample test to compare immediate and delayed pouring impression materials based on inter-implant distance (1-4)
31.605
31.6
31.595
31.59 immediate delayed 31.585
31.58
31.575 polyether Monophase addition c-silicone alginate silicone
Graph - 10 : Paired sample test to compare immediate and delayed pouring impression materials based on inter-implant distance (2-3)
14.59
14.585
14.58
14.575 immediate delayed 14.57
14.565
14.56 polyether Monophase addition c-silicone alginate silicone
50 Results
Graph - 11 : Paired sample test to compare immediate and delayed pouring impression materials based on inter-implant distance (2-4)
24.09
24.085
24.08
24.075
24.07 immediate 24.065 delayed 24.06
24.055
24.05
24.045 polyether Monophase addition c-silicone alginate silicone
Graph - 12 : Paired sample test to compare immediate and delayed pouring impression materials based on inter-implant distance (3-5) 14.5
14.49
14.48
14.47 immediate delayed 14.46
14.45
14.44 polyether Monophase addition c-silicone alginate silicone
51
Discussion
DISCUSSION
Implant dentistry has grown into every aspect of tooth replacement, which may starts from replacing a single missing tooth, multiple teeth to rehabilitation of mouth. It is esteem important to have appropriate transfer of proper position and orientation implant to the working casts36. The aim of an eminent prosthodontist in implant dentistry is to fabricate a long span implant supported prosthesis with a passive fit of implant superstructure and emergence profile with good esthetics.
Patients treated with implant-supported prosthesis judge overall psychological health as improved by 80% compared with their previous state while wearing traditional, removable prosthodontics device. They perceived the implant supported prosthesis as an integral part of their body37. Raghoebar38 et al in 1990 evaluated 90 edentulous patients in a randomized multicenter study. Five years after treatment, a validated questionnaire targeted patient esthetic satisfaction, retention, comfort, and the ability to speak and eat. Geertman39 et al reported similar results comparing chewing ability of conventional complete denture with mandibular implant over denture.
The goal of modern dentistry is to return patient to oral health in a predictable fashion. The partial and complete edentulous patient may be unable to recover normal function, esthetics, comforts or speech with in a traditional removable prosthesis. The patients function when wearing denture may be reduced to one sixth of that level formerly experienced40.
Implant-supported fixed prostheses comprise essentially screw-retained and cement-retained superstructures41,42. The use of any retention technique necessitates a
52 Discussion profound evaluation of a number of significant premises and parameters. Among these, the clinical aspect of passive fit has not been demonstrated, and claims regarding the subject are largely anecdotal. Although the challenge to apply advanced technology for the improvement of framework fit is ongoing, the phenomenon still remains and exclusive goal that is to be attained by the discerning implant prosthodontist43.
Passive fit (synonymous with “ideal fit”) is assumed to be one of the most significant prerequisites for the maintenance of the bone-implant interface. To provide passive fit or a stain-free superstructure, a framework should, theoretically, induce absolute zero stain on the supporting implant components and the surrounding bone in the absence of an applied external load. This vital requirement may be provided by simultaneous and even mating of the complete inner surfaces of all retainers by all abutments. However, according to the current scientific evidence and with the efficacy of contemporary dental technology used for framework fabrication, it has been concluded that an absolute passive fit cannot be obtained44.
The prosthodontics complication such as gold (fixation) screw loosening or fracture, abutment screw fracture, gold cylinder, frameworks, and veneers have been documented and may be related to poor framework fit45. However, there is no longitudinal clinical study that reports implant failure specifically attributed to framework misfit.
The preciseness of impression depends on two factors that are impression techniques and impression materials. Traditionally both open and close tray technique have been used to make implant impression. In the open tray technique impression coping remain in the impression while it is removed from the mouth. Conversely, in
53 Discussion the close tray technique, coping remain in the mouth after the impression is removed and are transferred to the impression in the second step46. Many studies have compared the accuracy of open tray and close tray impression tray technique. Some studies found no difference between the two47-50.
Each step in the process introduces potential human and/ or material errors. A number of implant impression techniques has been introduced, like transfer, pickup techniques and splint technique51.
According to Carr AB52, the open tray impression technique is better as a greater inaccuracy was observed with the closed tray because of non parallel abutments and apparent deformation of the polyether impression material while reorienting the impression-analog assembly in the impression. According to a study done by Al Quran FA53 et al., a clinically acceptable passive fit in the prosthesis can be achieved with closed tray, open tray splinted or open tray non splinted technique.
However, a relatively better fit was achieved when the open tray impression copings were splinted with auto-polymerising acrylic resin, sectioned and rejoined. Even under ideal circumstances problems arising due to laboratory faults or inefficient technician skills cannot be overlooked.
The accuracy of the implant cast depends on the type of the impression material. The impression technique, the implant angulation, the connection type and the die materials. While unfavorable angulation can be corrected with the restoration, the lack of parallelism in implant and the presence of undercuts creates an undesirable path of placement that may distort the impression materials upon removal and may produce an inaccurate master cast, especially when multiple implant are used implant connection type is another factor that may affect impression accuracy54.
54 Discussion
According to the literature review done by Baig55 et al in 2010, both polyether and polyvinyl siloxane are the materials of choice for implant impressions and are equally good. A study done by Wee AG23 et al in 2014,demonstrated that study casts made using polyether and addition silicone were significantly more accurate than the casts made using polysulfide as the impression material. Assuncao WG25 et al in
2016, also concluded that polyether and addition silicone were the best materials for making implant impressions. Several studies have been done to verify the accuracy of the impression materials for taking impressions for implant supported prosthesis are evident but no clear cut conclusion is given which materials is more accurate and clinically evident.
So this study is taken to identify clinically accurate impression material used to test the implant supported prosthesis.
The impression material were tested in this study were 1. Polyether,
2.Monophase, 3. Poly Vinyl Siloxane, 4. Condensation Silicone and 5. Irreversible
Hydrocolloid- Alginate.
Polyether56 is one of the elastomeric impression material commonly used in long span fixed prosthesis. Its advantages are fast setting, easily seeing margins, good stability, delayed pouring and shelf life of 2 years. But even then is has certain disadvantages like high stiffness and high modulus, bitter taste and needs to block the undercuts.
Polyvinyl siloxane56 is an ideally used elastomeric impression material. Cast can be poured repeatedly. Can be used as putty for custom tray, clean and pleasant,
55 Discussion easily seem margins, stable, delayed pouring, commonly used for long span prosthesis.
Condensation silicone56 is an elastomeric impression material which can be used as a putty for custom tray, clean and pleasant, good working time, easily seen margins. Even though it has high polymerization shrinkage, volatile by product, low tear strength, hydrophobic and poured immediately.
Irreversible hydrocolloid56 is most popular in dental clinics because of its low cost and easy use. Alginate is an elastomeric, irreversible hydrocolloid impression material. Alginate posses good surface detail and faster reaction at higher temperature. They are elastic enough to be drawn from undercut. They are non toxic and non irritant. Alginate is hydrophilic in nature and this property facilitates making of accurate impression in the presence of saliva and blood. It also has low wetting angle and hence full arch impression can be carried out. The only disadvantage included dimensional instability on delayed pouring.
Dahl58 et al concluded that clinically acceptable working cast could be obtain from irreversible hydrocolloid impression poured even after 3h. Recently extended storage alginate impression which claims that the material exhibits dimensional stability same as that of elastomers and can be delayed poured even after hours.
Studies comparing the accuracy of implant impression with methods such as micrometers, vernier calipers, strain gauges or measuring microscopes could merely carry out two dimensional measurements. However, when the measurements are two dimensional, relevant information are lost. Therefore CMM was used as the measuring device in this study because it made three dimensional evaluation of
56 Discussion distortion possible. When points from different implant cast have common reference within a coordinate system, the 3D orientation of the analogs can be recorded.
A coordinate measuring machine58 (CMM) is a device that measures the geometry of physical objects by sensing discrete points on the surface of the object with a probe. Various types of probes are used in CMMs, including mechanical, optical, laser, and white light. Depending on the machine, the probe position may be manually controlled by an operator or it may be computer controlled.
CMMs typically specify a probe's position in terms of its displacement from a reference position in a three-dimensional Cartesian coordinate system (i.e., with XYZ axes). In addition to moving the probe along the X, Y, and Z axes, many machines also allow the probe angle to be controlled to allow measurement of surfaces that would otherwise be unreachable.
The typical 3D "bridge" CMM allows probe movement along three axes, X, Y and Z, which are orthogonal to each other in a three-dimensional Cartesian coordinate system. Each axis has a sensor that monitors the position of the probe on that axis, typically with micrometer precision. When the probe contacts (or otherwise detects) a particular location on the object, the machine samples the three position sensors, thus measuring the location of one point on the object's surface. This process is repeated as necessary, moving the probe each time, to produce a "point cloud" which describes the surface areas of interest.
Optical probes are lens-CCD-systems, which are moved like the mechanical ones, and are aimed at the point of interest, instead of touching the material. The captured image of the surface will be enclosed in the borders of a measuring window,
57 Discussion until the residue is adequate to contrast between black and white zones. The dividing curve can be calculated to a point, which is the wanted measuring point in space. The horizontal information on the CCD is 2D (XY) and the vertical position is the position of the complete probing system on the stand Z-drive.
Positional stability and consistency of the master model and the implant analog were confirmed by measurement take before and after each impression made with each material. The casts obtained from various impression materials were also measured and reading were obtained with was subjected to statistical analysis and various conclusion were drawn.
When comparing the results of polyether impression materials (A1) average inter-implant distance between (1-2, 1-3, 1-4, 2-3, 2-4, 3-4) in the master model was
14.7. 24.1, 31.6, 14.5, 24, 14.4. The P value is <0.05. Even though there is distortion, in light of the absolute values there was no significant different.
This is an agreement with the study done by Inturregui22 et al in 1993 studied about polyether, polyether and impression plaster, or polyether and acrylic resin and concluded that the polyether alone resulted in the closest duplication of the mastercast.
Another study conducted by Pujari34 et al 2014 studied polyether and vinyl polysiloxane (VPS) impression material. Casts obtained from polyether impression material were more accurate than casts obtained from vinyl polysiloxane impression material.
Based on the statistical result when comparing the results of polyether impression material on immediate pouring (A1) and delayed pouring (B1) for the inter
58 Discussion implant distance between (1-2, 1-3, 1-4, 2-3, 2-4, 3-4) was 0.4, 0, 0.3, 0, 0.1 and 0.3,
0.1, 0, 0.1, 0. The P value is <0.05. There was no statistical difference between immediate and delayed pouring.
When comparing the results of Monophase impression materials (A2) average inter-implant distance between (1-2, 1-3, 1-4, 2-3, 2-4, 3-4) in the master model was
(14.7. 24.1, 31.6, 14.5, 24, 14.4) and impression cast (14.5, 24.1, 31.6, 14.5, 24, 14.4) was 0, 0.3, 0.4, 0.4, 0.8, 0.1. The P value is <0.05. Even though there is distortion, in light of the absolute values there was no significant different.
This is an agreement with the study done by Hoods-Moonsammy3 et al 2014 impression plaster (Plastogum, HarryJ Bosworth), a polyether (ImpregumPenta, 3M
ESPE), and two polyvinylsiloxane (PVS) materials (AquasilMonophase and Aquasil putty with light-body wash, Dentsply. The PVS monophase material reproduced the master model most accurately. Although there was no significant distortion between the impressions and the master model or between the impressions and their casts, there were distortions between the master model and the master casts, which highlighted the cumulative effects of the distortions.
Based on the statistical result when comparing the results of Monophase impression material on immediate pouring (A2) and delayed pouring (B2) for the inter implant distance between (1-2, 1-3, 1-4, 2-3, 2-4, 3-4) in the master model was 0.4, 0,
0.3, 0, 0.1 and 0.3, 0.1, 0, 0.1, 0. The P value is <0.05. There was no statistical difference between immediate and delayed pouring.
When comparing the results of Polyvinyl siloxane impression materials (A3) average inter-implant distance between (1-2, 1-3, 1-4, 2-3, 2-4, 3-4) in the master model was (14.7. 24.1, 31.6, 14.5, 24, 14.4) and impression cast (14.5, 24.1, 31.6,
59 Discussion
14.5, 24, 14.4) was 0, 0.3, 0.4, 0.4, 0.8, 0.1. The P value is <0.05. Even though there is distortion, in light of the absolute values there was no significant different.
This is an agreement with the study done by Reddy32 et al 2013 studied impression materials using polyvinyl siloxane and polyether impression materials.
And concluded that no significant difference in dimensional accuracy of the resultant casts made from two different impression materials (polyvinyl siloxane and polyether) by closed tray impression technique in parallel and angulated implants.
Based on the statistical result when comparing the results of Polyvinyl siloxane impression material on immediate pouring (A3) and delayed pouring (B3) for the inter implant distance between (1-2, 1-3, 1-4, 2-3, 2-4, 3-4) in the master model was 0.4, 0, 0.3, 0, 0.1 and 0.3, 0.1, 0, 0.1, 0. The P value is <0.05. There was no statistical difference between immediate and delayed pouring.
When comparing the results of Condensation Silicone impression materials
(A4) average inter-implant distance between (1-2, 1-3, 1-4, 2-3, 2-4, 3-4) in the master model was (14.7. 24.1, 31.6, 14.5, 24, 14.4) and impression cast (14.5, 24.1,
31.6, 14.5, 24, 14.4) was 0, 0.3, 0.4, 0.4, 0.8, 0.1. The P value is <0.05. Even though there is distortion, in light of the absolute values there was no significant different.
This is an agreement with the study done by Ferreira31 et al 2012 studied impression materials like polyvinyl siloxane, condensation siloxane or irreversible hydrocolloid and concluded that Resin-splinted transfer copings with the impression materials condensation siloxane or irreversible hydrocolloid produced impressions as accurately as polyvinyl siloxane.
60 Discussion
Based on the statistical result when comparing the results of Condensation
Silicone impression material on immediate pouring (A3) and delayed pouring (B3) for the inter implant distance between (1-2, 1-3, 1-4, 2-3, 2-4, 3-4) in the master model was 0.4, 0, 0.3, 0, 0.1 and 0.3, 0.1, 0, 0.1, 0. The P value is <0.05. There was no statistical difference between immediate and delayed pouring.
When comparing the results of alginate impression materials (A5) average inter-implant distance between (1-2, 1-3, 1-4, 2-3, 2-4, 3-4) in the master model was
(14.7. 24.1, 31.6, 14.5, 24, 14.4) and impression cast (14.5, 24.1, 31.6, 14.5, 24, 14.4) was 0, 0.3, 0.4, 0.4, 0.8, 0.1. The P value is <0.05. Even though there is distortion, in light of the absolute values there was no significant different.
Based on the statistical result when comparing the results of Condensation
Silicone impression material on immediate pouring (A3) and delayed pouring (B3) for the inter implant distance between (1-2, 1-3, 1-4, 2-3, 2-4, 3-4) in the master model was 0.4, 0, 0.3, 0, 0.1 and 0.3, 0.1, 0, 0.1, 0. The P value is <0.05. There was no statistical difference between immediate and delayed pouring. With in the limitation of this study the following conclusions can be drawn.
Three dimensional distortions are inevitable. In this study, distortion occurred in all of the impression materials but it was inconsistent. All though there was no statistically significant distortion between the impressions cast and the master model, based on immediate the PVS monophase material reproduced the master model most accurately. With in the impression materials used accurate reproduction of the master model was followed by polyether, addition silicone, condensation silicone and alginate. Based on delayed pouring there was no significant different between the materials.
61
Summary
SUMMARY
The use of Dental Implants to replace missing teeth in partially dentate and edentulous patients is associated with a high success rate from esthetics, functional and psychological point of view. However, biomechanical failure does occur in long- span prosthesis, which may be attributed to lack of passive fit of the Implant superstructure.
Various Impression materials are used in Implant dentistry and various studies have been conducted to provide the information about accuracy of Impression materials.
The aim of this present study was to compare the accuracy of Polyether,
Monophase, Polyvinyl-siloxane- Addition, Condensation silicone and Irreversible hydrocolloids with immediate and delayed pouring by analyzing inter-implant distance on the cast with Calibrated Coordinate Measuring machine.
A completely edentulous maxillary clear acrylic resin model was fabricated which was used to mimic a dental arch. Four parallel holes, 3.8 mm in diameter and
10 mm in length according to the size of implants were created in site of the canine and molar. The impression materials used were Polyether, Monophase, Poly vinyl siloxane- Addition, Condensation silicone and Irreversible hydrocolloid .
All laboratory procedures throughout this investigation was standardized. All materials used was stored and strictly used according to the manufacturer’s instructions. A single operator performed all the tasks. The mixture of the materials was performed as per manufactures direction, keeping the consistency constant.
62 Summary
Twelve impressions of each impression materials with close mouth technique was taken. Six impressions of each impression materials was poured immediately and another six impressions of each impression material was poured after one hour. The cast was poured with type IV Dental stone as per manufacturer instructions. Inter- implant distance (1-2, 1-3, 1-4, 2-3, 2-4, 3-4) was calculated using Calibrated portable
Coordinate Measuring Machine (CMM). A sample size of sixty impressions has been reported to be adequate to detect clinically relevant differences in inter-implant distances.
The results were analyzed using ANOVA and followed by multiple comparison test using Post-hoc test. Data was presented as mean ± standard deviation.
Three-dimensional distortion is inevitable. In this study, distortion occurred in all of the impression materials but inconsistently. Although there was no statistically significant distortion between the impressions cast and master model. Based on immediate pouring: the Monophase impression material reproduced the master model most accurately. Impressions showed no significant distortion between the master model or casts. Within the impression materials used accurate reproduction of the master model, following Monophase impression material are Polyether, Addition silicone, Condensation silicone and Alginate. Based on delayed pouring, there was no significant different between the materials on the delayed pouring the cast.
The outcome of this study give us the knowledge about the Implant
Impression materials and its accuracy in long-span implant prosthesis thus giving us a better perception about choosing the impression material and also reduces chairside working time during prosthesis placement. Enhance patient’s satisfaction.
63
Conclusion
CONCLUSION
In this study five impression materials namely Poly Ether, Monophase, Poly
Vinyl Siloxane, Condensation Silicone and Irreversible Hydrocolloid were compared for dimensional accuracy.
Within the limitations of this study the following conclusions can be drawn:
Three-dimensional distortion is inevitable. Distortion occurred in all of the impression materials but it was inconsistent.
There was no statistically significant distortion between the impressions cast obtained from various impression materials and the master model.
On concluding from the results obtained from impression casts by immediate pouring, the Monophase impression material reproduced the master model most accurately and showed no significant distortion between the casts and the master model. Among the other impression materials used in this study, accurate reproduction of the master model following Monophase impression material are Poly
Ether, Addition Silicone, Condensation Silicone and Irreversible hydrocolloid respectively.
On concluding from the results obtained by delayed pouring of impression cast after one hour there was no significant difference within the impression materials used.
64
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