TechniqueTips

Technique Tips
Making an Open-tray Implant or Abutment-level Impression
Technique Easier

Abstract: Various methods exist for taking implant impressions. The open-tray or pick-up impression technique is one of the
conventional methods for transferring the impression coping from the implant to the impression. In this method, a window directly
above the implant is made in a stock or custom tray to allow access to the impression coping. Traditionally, the window is either
left open, or closed with melted wax or foil. This technique tip describes a modification to create a stable and secure seal over the
opening using rayon-based adhesive tapes. The benefits of this modification over the conventional open-tray technique are due to the
enhanced adhesive quality of the materials to metal or plastic. Because there is less chance of impression material leaking from the tray
window into the mouth, it is more comfortable for patients and less messy for clinicians. The benefit of this method over the closed-tray
technique is the ability to feel for the head of the impression coping at the same time as making sure the impression material is in good
contact with the underlying structures. It is easy to use, and efficient in terms of time and cost.
Dent Update 2021; 48: 592–593

The techniques for transferring uses a novel, yet simple, process of

information from the clinical scenario to
the laboratory are based on commonly
used conventional impressions and
digital impression techniques. These can
be grouped as follows:
 Open closed tray;
 Stock custom tray;
 Digital scanning;
The open-tray technique uses an
impression coping that is picked up
with the impression, whereas the
closed-tray technique relies on the
clinician or technician to re-insert
the impression coping back into the
impression after it has been removed
from the patient’s mouth.1 The
re-insertion of the coping, including
any angulation factors on pick up, can
produce errors in either the pick-up
stage or during reseating. The open-
tray impression technique has been
shown in a systematic review to be
more accurate than the closed-tray in
all except partially edentulous patients
(where there was no difference).2
The standard open-tray impression
technique involves sealing the tray
opening with wax or using sticky wax
Figure 1. Implant healing abutment.
Figure 2. Implant impression coping.
to seal foil over the opening. As wax
does not always adhere very well to tray
material, a common problem is the wax
coming away, causing extrusion of the
impression material into the mouth. This
new technique (Figures 1–9), however,
using a 100% non-woven rayon with
a layer of acrylic adhesive tape DAM-it
(Danville, California USA; Figure 10) or
3M medical tapes (3M, Minnesota, USA;
Figure 11), which are latex free and
hypoallergenic, to create a stable and
secure seal over the opening. In the
authors’ opinion, owing to its adhesive
quality on metal or plastic, it is simple
to place. The adhesion is improved
the firmer it is pressed against the
tray material.
Creating an effectively sealed
opening prevents impression material
being pushed out through the open
access into the patient’s mouth,
especially on the upper impressions,
making it much more comfortable
for them. It also maintains a positive
downward pressure against the soft
tissue, teeth and impression coping, so
creating a better impression. It reduces
the cost because less material is needed
and there are fewer glove changes. It
keeps the working environment clean
and tidy.
DAM-it is an adhesive tape that was
marketed for use in the post-dam area

Javed Ikram, BDS, FDSRCPS(Glas), FDSRCS(Eng) DipRestDentRCS(Eng) DipOMFS(Manc),PGD(Orthodontics), Clinical Director Aesthetic
Dental Solutions, Lytham St Annes, Lancashire. Nabeel Essa, BDS, GDP Aesthetic Dental Solutions, Lytham St. Annes, Lancashire.
email: javed.ikram@icloud.com

592 DentalUpdate July/August 2021


Figure 3. Medium stock tray market, ready
for adjustment.
Figure 4. Custom open tray created using acrylic
cutting bur.
Figure 5. DAM-it adhesive tape placement.
Figure 6. Putty and light-bodied silicone wash
impression. Finger to push down material and
locate head of impression coping.
Figure 7. Locating the head of impression
coping with a dental probe and removing set
impression material.
July/August 2021 DentalUpdate 593
Figure 8. Final impression showing good occlusal
and soft tissue detail.
Figure 9. Final open-tray impression using stock
plastic tray and pick up impression coping.
to stop impression material flowing
beyond the posterior aspect of the
impression tray (Figure 10). 3M medical
tapes produce comparable results.
The tapes have very good adhesive
qualities to metal, stock and custom
acrylic trays. The advantages are that
the tape rarely comes away during
impression taking; and if it does
displace or distort, due to pressure
from putty or heavy body impression
material, it can be easily repositioned
onto the impression coping, teeth and
soft tissue (Figure 6). In addition, the
head of the impression coping can be
easily felt for, and by pushing firmly,
the impression coping can be pushed
through the tape with a good seal
around it. Alternatively, a probe can be
used to make a tiny hole in the tape and
remove the set impression material that
would get lodged in the screw access
hole. Wax can be used to cover over the
screw access to the impression coping,
although the benefit is questionable,
and it is generally not needed.
Conclusion
This modified open-tray technique
has been used for several years in my
TechniqueTips
Figure 10. DAM-it tape dispenser.
Figure 11. 3M Micropore with dispenser.
practice, where it has proven to be
simple and efficient in terms of both
time and cost. Importantly, patients find
the technique more comfortable than
the conventional open-tray technique,
and clinicians find it helpful to be able
to feel the impression coping through
the closed window.
Compliance with Ethical Standards
Conflict of Interest: The authors declare
that they have no conflict of interest.
Informed Consent: Informed consent
was obtained from all individual
participants included in the article.
References
1. Lee H, So JS, Hochstedler JL,
Ercoli C. The accuracy of implant
impressions: a systematic review. J
Prosthet Dent 2008; 100: 285–291.
https://doi.org/10.1016/S0022-
3913(08)60208-5.
2. Papaspyridakos P, Chen CJ, Gallucci
GO et al. Accuracy of implant
impressions for partially and
completely edentulous patients:
a systematic review. Int J Oral
Maxillofac Implants 2014; 29:
836–845. https://doi.org/10.11607/
jomi.3625.