Comparison of impression materials for direct multi-implant impressions

Alvin G. Wee, BDS, MSa

College of Dentistry, The Ohio State University, Columbus, Ohio
Statement of problem. Given that meticulous implant prosthodontic procedures are recommended to
obtain the best possible intraoral fit, impression materials that are suitable for use with a direct impression
technique warrant further investigation.
Purpose. This in vitro study compared the amount of torque required to rotate a square impression cop-
ing in an impression and evaluated the accuracy of solid implant casts fabricated from different impression
materials.
Material and methods. Two direct transfer implant impressions were made using 8 impression materials;
the torque required to rotate an impression coping in the impressions was calculated. Ten direct transfer
implant impressions were made from the master model and poured in a die stone (Resin Rock) for 3 of the
8 initial impression material groups. Linear distances between steel balls placed on each abutment replica
were measured with a traveling microscope to determine distortion in the impression procedure for each
group. Data were analyzed (P=.05) with ANOVA and Ryan-Einot-Gabriel-Welsch multiple range test for
post hoc.
Results. With a 1-way ANOVA, average torque values among the material groups differed significantly
(P=.001). Polyether (medium consistency) was found to produce the highest overall torque values, followed
by addition silicone (high consistency), and then polysulfide (medium consistency). Statistically significant
difference was also found among the 3 material groups’ mean absolute cast error using a 1-way ANOVA
(P=.0086). Implant casts made from polyether (medium) or addition silicone (high) impressions were sig-
nificantly more accurate than casts made from polysulfide medium impressions.
Conclusion. On the basis of the results of this study, the use of either polyether (medium) or addition sili-
cone (high) impression is recommended for direct implant impressions. (J Prosthet Dent 2000;83:323-31.)

CLINICAL IMPLICATIONS
Use of medium consistency polyether and high consistency addition silicones is recom-
mended to make a direct implant impression, depending on the amount of hard tissue
undercuts present in the arch. In this study, polyether minimized the chance of acci-
dental displacement of the direct impression coping when the abutment replicas were
tightened. Addition silicone in a partial edentulous arch facilitates the removal of the
impression tray when hard tissue undercuts are present, although care must be taken
to avoid accidental rotation of the impression coping. A double impression technique
using a lower consistency addition silicone wash did not appear to present any advan-
tage for use in direct implant impressions.

A lthough true “passive fit” of multi-implant–sup-

ported prostheses to their intraoral implant abutments
does not seem attainable,1-6 it remains unclear what
degree of implant prosthesis misfit will lead to compli-
cations. For this reason, meticulous and accurate
implant prosthodontic procedures are recommended as
a means to attain the best possible fit.5 The implant cast
is the foundation on which the prosthesis is indirectly
This project was supported in part by funds from The Ohio State Uni-
versity College of Dentistry and presented in part at the 1999
International Association of Dental Research Annual Session as a
finalist for the 1999 Arthur R. Frechette Prosthodontic Research
Award competition.
aAssistant Professor, Section of Restorative Dentistry, Prosthodontics
and Endodontics.
fabricated. The use of the implant cast as a reference for
extraoral implant framework fit facilitates the clinician’s
evaluation of fit.
Strategies to achieve fit may be completed on the
master cast before the patient’s clinical appointment.
Several strategies have been suggested to reduce the
distortion of the implant framework, namely, laser
welding of titanium implant framework,7,8 or use of
electric discharge machining of the gold cylinders of
the implant framework to the abutment replicas.9-11
Many intraoral techniques used to improve framework
fit may also be used on the implant cast, given adequate
accuracy.5 Although absolute accuracy of the implant
cast does not appear to be attainable at this time,3,12-14
it has been suggested that the distortion of the implant

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THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 1. Aluminum implant master model milled out of alu-
minum block. Abutment replicas are labeled A to E from left
to right.
cast be minimized during its fabrication to improve fit.5
The accuracy of the implant cast depends on the type
of impression material,15 the implant impression tech-
nique,12,15-22 die material accuracy,14 and the implant
master cast technique.12,13
A number of implant impression techniques have
been described,23,24 but the more common include the
indirect, direct, and direct-splinted. The main purpose
of a multi-implant impression is to record and transfer
the relationship between implant abutments or
implants and to reproduce this relationship as accurate-
ly as possible. Implant impressions also serve a sec-
ondary but important purpose of recording soft tissue
morphology. Most research indicates that the indirect
impression technique produces a greater mean distor-
tion than the direct-splinted and the direct tech-
niques.12,17,18,20,21,25 When comparing the direct and
direct-splinted techniques, conflicting results have been
reported regarding their accuracy. However, most of
the studies found the direct technique to be more accu-
rate than the direct-splinted technique.17,21,25,26
When using the direct implant impression tech-
nique, the impression material must fulfill 2 require-
ments: (1) rigidity to hold the direct impression coping
and to prevent accidental displacement of the coping
when an abutment is connected, and (2) minimal posi-
tional distortion between abutment replicas as com-
pared with their intraoral implant abutments. Regard-
ing rigidity, the amount of torque required to rotate a
direct implant impression coping in different implant
impression materials has not been thoroughly investi-
gated to date and can be considered an important char-
acteristic of direct impression technique for implant
impressions. Liou et al27 reported that indirect impres-
sion copings did not return to their original position
when replaced in either polyether or addition silicones.
It is assumed that the same is true when direct impres-
324
WEE
sion copings are accidentally rotated. Therefore, the
practitioner may be less likely to accidentally displace
the impression coping by using a more rigid impression
material. This rigidity can be indirectly measured by
evaluating the amount of torque required to rotate the
impression coping in the impression. Regarding posi-
tional distortion, Barrett et al15 did not find any signif-
icant difference between the accuracy of direct implant
impressions that were made from polyether and those
made from addition silicones. In addition, the implant
impression technique groups, namely, direct, direct-
splinted, and indirect, did not vary significantly in accu-
racy, a finding that is contrary to the results of other
studies.16,20-22,25
Even though several impression materials are manu-
factured with a range of consistency, comprehensive
comparison has been made to document the rigidity
and accuracy of these materials/consistency types, as
required for the direct implant impression technique.
Because of a low strain in compression (flexibility) and
favorable Shore A hardness, polyether has been recom-
mended as an impression material for edentulous, mul-
tiple implant-retained restorations.12,18-22,25,28-31 The
use of addition silicones has also been recommended as
a material for direct implant impressions.15,16,32
Although polyether and addition silicones have
received more attention in research and practice, the
potential variance within and/or between impression
material groups warrants a complete evaluation.
The purposes of this study were to: (1) evaluate the
amount of torque required to rotate a direct implant
impression coping in various impression materials when
tightening the abutment replica, and (2) compare the
accuracy of solid implant casts produced from the
direct implant impression procedure with various
impression materials.
MATERIAL AND METHODS
This in vitro study compared the torque required to
rotate direct square impression copings in 8 impression
material groups. Those material groups that produced
torque values detectable by a torque-measuring unit
were then compared for implant cast accuracy. An
implant master model (Anderson Precision Machining,
Inc, Iowa City, Iowa) was milled from a solid alu-
minum block. Five stainless steel abutment replicas
(DCA 174, Nobel Biocare USA Inc, Chicago, Ill.)
were cemented symmetrically in an arch with an adhe-
sive resin cement (Panavia 21, Dental Adhesive,
Kuraray Dental J, Morita, Tustin, Calif.). Abutment
replicas were spaced 12 mm apart and labeled A to E
(Fig. 1).
Ten similar impression trays were fabricated from
light-polymerized resin (Triad, Dentsply, York, Pa.),
and 10 sets of 5 direct square impression copings (DCB
026, Nobel Biocare USA Inc) were distributed ran-
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WEE THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 2. Compudriver with attachment and slotted drive. Fig. 3. Slotted drive of Compudriver rotating square impres-
sion coping in implant impression.

Table I. Impression materials evaluated*

Batch Strain in Shore A Accuracy
Material Name and company Consistency number compression48 hardness48 (24 h)48

Polyethers Impregum F (Premier Dental Products Co, Medium 28621 2%-3% 35-60 –0.24%
Norristown, Pa.) High 28621 3% 40-50 –0.19%
Silicones Low 7-1062 3-6 35 –0.15%
Addition Extrude (Kerr Mfg Co, Romulus, Mich.) Medium 7-1140 2%-5% 30 –0.17%
High 7-1125 2%-3% 60 –0.15%
High/Medium 7-1125/7-1140
High/Low 7-1125/7-1062
Very high 1%-2% 50-75 –0.14%
Condensation Elasticon (Kerr Mfg Co, Romulus, Mich.) Very low 7-1160 4%-9% 15-30 –0.60%
Very high 7-1160 2%-5% 50-65 –0.38%
Polysulfide Permlastic (Kerr Mfg Co, Romulus, Mich.) Medium 7-1259 11%-15% 30 –0.45%
High 9%-12% 35 –0.44%
*Italicized areas highlight impression materials that were tested for rotational torque displacement only. Bold areas highlight impression materials that were tested
for rotational torque displacement and for solid cast accuracy.

domly. Direct impression copings were hand-tightened
to the master model by guide pins. Adhesive was paint-
ed on the impression trays 24 hours before impressions
were made.33 Impressions were made on the master
model and allowed to set for twice as long as the man-
ufacturers’ recommended setting times.34
Torque displacement
Sixteen impressions were made of the master model,
namely, 2 impressions for each of the 8 impression
materials/combinations evaluated (Table I, italicized
and bold-highlighted materials). Stainless steel abut-
ment replicas (DCA 174, Nobel Biocare USA Inc)
were secured carefully to the direct impression copings
with guide pins. Impressions were allowed to set for 30
minutes to simulate laboratory pouring time from
impression taking. A Compudriver device (Consolidat-
ed Device Inc, City of Industry, Calif.) was attached to
an adapter one-quarter drive (Craftsman, Hoffman
Estate, Ill.) and a 5-6 bit slotted 3⁄8-in. driver (Crafts-
man) (Fig. 2). The 5-6 bit slotted driver was placed on
the slotted guide pin of the impression coping to be
tested, then the driver was rotated clockwise until the
impression coping was displaced once in the impression
complex (Fig. 3). The Compudrive device recorded the
amount of torque required to rotate the coping in the
impression through the slotted guide pin–abutment
analog complex. Torque values for 5 impression cop-
ings for each of the 16 impressions were measured.
Statistical analyses of torque data were performed
with SAS software (version 6.12, SAS Institute Inc,
Cary, N.C.).35 Repeated measures analysis of variance
(ANOVA) (α=.05) was used to evaluate torque values
within and among impression material groups, as well

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THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 4. Microscope lens of measurescope directly over steel
ball on abutment replica.
as the interaction effect between torque value and
impression material. Thereafter, the 5 torque values for
each impression material group (N = 2) were averaged
and statistically compared among impression groups
with a 1-way ANOVA (α=.05). A post hoc Ryan-Einot-
Gabriel-Welsch multiple range test (REGWQ) was used
to compare the mean torque values of the impression
material groups.
Impression material accuracy
Thirty impressions were made of the master model,
10 each of the 3 impression materials that had
detectable torque values: medium polyether; high addi-
tion silicones; and medium polysulfide (Table I, bold-
highlighted materials). Polyether was dispensed in an
electric mixing and dispensing machine (Pentamix,
ESPE-Premier, Norristown, Pa.); addition silicone was
mixed and dispensed through an automixing system;
and polysulfide was hand mixed and dispensed with a
plastic syringe (Elastomer Syringe, ESPE-Premier).
Stainless steel abutment replicas (DCA 174, Nobel
Biocare USA Inc) were hand-tightened carefully with
15 mm guide pins to the 5 direct impression copings in
each impression. Impressions were poured 30 minutes
after removal from the master model to simulate a clin-
ical situation. As recommended in a previous study,14
impressions were poured in Resin Rock material (Whip
Mix Corp, Louisville, Ky.) that was vacuum mixed with
distilled water, in accordance with the manufacturer’s
instructions. Experimental implant casts were allowed
to set for 1 hour before the guide pins were unscrewed
and the impression was removed. One experimental
cast was poured from each impression producing 10
casts per group. Any debris remaining on the abutment
replicas was removed. All experimental implant casts
were numbered and stored in ambient conditions for at
least 24 hours.36
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Five 1.98-mm steel balls (McMaster-Carr, Aurora,
Oh.) were placed on the central screw access channel of
the abutments to provide a reliable central reflective
reference (Figs. 4 and 5). Linear distances between the
steel balls were measured with a traveling microscope
(model MM-11, Nikon Corp, Tokyo, Japan), which
was connected to an internal light source (Universal
Epi-Illuminator, Nikon Corp) and was capable of
recording the x-, y-, and z-axes to an accuracy of
±0.5 µm. The microscope was connected to a digital
readout counter (SC-111, Nikon Corp). Alignment of
the cross hairs with respect to the movable counter pro-
vided the x and y coordinates, while the focus of the
microscope lens provided the z coordinate (Fig. 5).
The middle abutment replica, C, was used as a ref-
erence on each cast for the distortion measurements of
the remaining steel balls/abutment replicas. Thus,
measurements were made of CA, CB, CD, and CE for
all experimental casts. The counter was moved mechan-
ically to align the steel ball on the abutment replica C
under the microscope lens (Fig. 4), thereby directing
the internal light source onto the steel ball and back
through the lens (magnification ×25). As magnification
was gradually increased to ×200, the focus on the steel
ball was standardized through the internal glass filter,
which appeared as pits within the steel ball. The inter-
nal light source aperture was reduced, and the cross
hairs were aligned on the center of this reduced light
source field of view. At this position, the digital readout
counter was set to 0 for x, y, and z coordinates.
The described procedure was repeated for each of
the remaining abutment replicas to be measured for
each cast. However, rather than zeroing the counter
after alignment of the cross hairs, measurements of the
x, y, and z coordinates were recorded on a personal
computer for CA, CB, CD, and CE. Each measure-
ment was taken on 3 separate occasions and then aver-
aged. A 45-minute time limit was observed for each
measurement session to prevent eye fatigue.37
Using the Pythagorean theorem for a 3-dimension-
al model [(x2 + y2 + z2) ⁄ ], the linear distances between
1
2
the steel balls and the reference ball C were calculated
(Fig. 6). The corresponding linear distance of the mas-
ter model, namely, CA, CB, and so forth, was then sub-
tracted from each mean linear distance of the experi-
mental cast, with the absolute value taken of the result.
The formula (CAexperimental – CAmaster = [A]) provides
an illustration for the derivation of an experimental
cast’s CA measurement to a measurement of [A], or
the absolute micron deviation of the experimental cast
abutment from the master model. The absolute micron
deviation for each cast’s 4 linear measurements, that is
[A], [B], [D], [E], were then averaged for each cast,
resulting in a cast’s mean absolute cast error. Absolute
micron deviations of all casts’ linear measurements
were compared statistically using a repeated measures
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WEE THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 5. Diagram of traveling microscope setup with implant cast and steel ball on abutment
replica.

ANOVA (α=.05) to evaluate within-group, between- Table II. Ryan-Einot-Gabriel-Welsch multiple range test
group differences, and the variables’ interaction effect. (REGWQ) groupings (P>.05) for torque measures
As illustrated, positive and negative linear distances Mean SD REGWQ
were used to calculate [A]; however, only absolute Material N (×10–3 mN) (×10–3 mN) groupings
(positive) values were compared for statistical analysis. Polyether 2 141.3 0.4 A
A 1-way ANOVA (α=.05) was then used to evaluate Addition silicone 2 71 6.4 B
the significance among the material groups’ mean Polysulfide 2 51.5 7 C
absolute cast errors. Finally, a post hoc using REGWQ
was used to rank the material groups’ mean absolute
cast errors.
A measurement error (SD) of 3 µm was computed groups’ torque values (P=.1866), and a significant
by measuring the distance between abutment replicas A interaction effect was not identified between impres-
and E on the master cast 10 times. The SAS statistical sion coping position and impression material
program35 was used to compute the statistical analyses. (P=.4574). Notably, mean torque values differed sig-
nificantly among impression material groups (P=.001),
RESULTS
with the highest overall torque values identified for
Of the impression materials tested (Table I), torque polyether (medium), followed by addition silicone
values were detected for only 3: polyether (medium), (high), and then polysulfide (medium) (Table II).
addition silicones (high), and polysulfides (medium) Similarly, regarding measures of accuracy within-
(Fig. 7). Impression coping position did not produce a group absolute micron deviations ([A], [B], [D], [E])
statistically significant difference within material did not reveal significant variation (P=.6881), and no

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Fig. 6. Calculation of linear distance between 2 steel balls.

Table III. Ryan-Einot-Gabriel-Welsch multiple range test

(REGWQ) groupings (P>.05) for mean absolute cast error
Tukey’s
Material N Mean (µm) SD (µm) groupings

Polyether 10 16.2 8.8 A

Addition silicone 10 15.2 8.2 A
Polysulfide 10 26.2 6.7 B

Industry, Calif.) was used arbitrarily as a selection crite-

Fig. 7. Comparison of tested direct implant impressions for
torque and group mean absolute cast error.
significant interaction effect was found (P=.7167).
One-way ANOVA (P=.0086) revealed a significant dif-
ference among material groups’ mean cast errors. On
the basis of further analysis, implant casts made from
polyether (medium) or addition silicone (high) impres-
sions presented significantly less cast error than casts
made from polysulfide impressions (Table III).
DISCUSSION
Methodologic and clinical considerations shed light
on the relevance of these findings. The sensitivity of the
Compudriver device (Consolidated Device Inc, City of
rion for differentiating between impression material
groups to be tested in the accuracy phase of this study.
Thereby, impression materials that lacked rigidity to
prevent possible rotation of the copings were eliminat-
ed from further consideration for viable accuracy. Sev-
eral impression materials were also removed from con-
sideration completely, as they were too difficult to
deliver with a plastic syringe, making them less clinical-
ly attractive, namely, polyether (high), polysulfide
(high), and addition silicones (very high). Although
additional information may have been gathered
through use of more sensitive torque detection instru-
ment, the significance of such information is limited.
A relative comparison of materials’ rigidity provides
the immediate, clinically applicable data, given that no
definitive standard exists regarding the amount of resis-
tance required to prevent accidental rotation of a

328 VOLUME 83 NUMBER 3

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square Nobel Biocare impression coping in an implant
impression. Results of our arbitrary selection criteria
coincide with impression materials that will most likely
be used for direct square implant impressions. For
instance, polyether is recommended repeatedly in the
dental literature.12,18-22,25,28-31 Addition silicones are
recommended as well,15,16,32 and are the preferred
fixed prosthodontic impression material as taught in
US dental schools (70% or 42/53 schools).38 Polysul-
fide, although not mentioned in the implant literature,
is the preferred removable prosthodontic impression
material as taught in US dental schools (48% or 47/54
schools).39
From a clinical standpoint, results of this study sup-
port the use of polyether for completely edentulous
multi-implant impressions. The rigidity of polyether
provides resistance to the accidental displacement of
the impression coping in the implant impression. How-
ever, use of polyether for an impression of a partially
edentulous arch also presents increased difficulty for
intraoral removal of the impression. High consistency
addition silicones and medium consistency polysulfides
are viable alternative materials of choice for experienced
practitioners. Addition silicone with its more favorable
modulus of elasticity (rigidity)40 allows easy removal of
the set impression.
Other suggested material combinations that were
not tested in this study include the use of very high
consistency or putty and low consistency wash, as test-
ed by Barrett et al,15 and the use of adhesive surround-
ing the impression copings. This concept of using a
high and low consistency impression material is bor-
rowed from techniques used in fixed prosthodontics.
The low consistency impression material is syringed
into the sulcus of the prepared tooth, whereas high
consistency material helps force the low consistency
material into the sulcus.41 The lack of detectable
torque when using high/medium or high/low consis-
tency impression material shows no advantage in using
it for direct implant impression. The design of the
implant impression coping may also be a relevant factor
to consider. However, the design of most implant
impression copings is not intricate enough to require
that a low consistency impression material be syringed
around them.
Addition silicones and polyether for direct multi-
implant impressions for edentulous arches produce
similarly accurate solid implant casts, results consistent
with those recorded previously for an indirect implant
impression technique by Barrett et al.15 The external
validity of this conclusion, although limited to these 2
studies, is noteworthy, given the significantly different
methods of distortion measurement and analysis
between the 2 studies.
To elaborate, distortion can be defined and mea-
sured as “absolute” or “relative,” depending on the
MARCH 2000
THE JOURNAL OF PROSTHETIC DENTISTRY
point of reference from which the distortion is mea-
sured.42 Barrett et al15 used absolute distortion analy-
sis, whereby the point of reference is an external refer-
ence point, namely, not include the impression copings.
In contrast, this study, and many other distortion stud-
ies, used relative distortion analysis, whereby one of the
abutment replicas/impression copings is used as the
reference to which the distortion of the other replicas/
impression copings are measured.16,17,21,43 It may be
argued that the use of relative distortion analysis
provides more clinically relevant data than absolute dis-
tortion analysis. The implant prosthesis connects all
abutments together. Therefore, the amount of strain in
the implant prosthetic–implant bone system is related
to the relative position of the implant abutments to one
another and not to an external reference point.
Another methodologic difference requires com-
ment. The study by Barrett et al15 evaluated the accu-
racy of the implant impression itself, as did Phillips et
al.21 Using this method requires that follow-up studies
be completed to determine the resultant accuracy of
the implant cast, with the appropriate die material, to
provide data from a clinically relevant end product,
such as the solid implant cast. Evaluating the accuracy
of the implant impression with reference to a resulting
solid implant cast, as completed in this study, eliminates
the need for follow-up studies and has become a stan-
dard method across the majority of implant impression
accuracy studies.12,16-20,25,43
This study also evaluated the accuracy of the relative
position between the implant abutments through the use
of steel balls on the abutment replicas, similar to Carr and
Master’s method.43 The purpose of this study was not to
evaluate the implant abutment-to-framework relation-
ship; this study only evaluated the resultant translational
distortion (x-, y-, and z-axes) of the abutment replicas to
one another, and not more complex rotational distortion
that occurs in implant prosthodontics.2-6,21,22,45-47 The
significant difference detected among impression materi-
al groups indicates that the method of this study was
appropriately sensitive.
To validate this study, a long-term prospective clinical
study would have to be performed with preliminary data
available from this study. Patients requiring a particular
type of implant retained prosthesis would be divided
into 2 groups. The patient’s definitive implant prosthe-
sis would be fabricated to fit their master cast accurately
using either “laser welding of titanium”7,8 or “electric
discharge machining”9-11 method. For 1 group, the
master cast would be made from a direct implant impres-
sion from addition silicone (high) or polyether (medi-
um), and for the other group, the impression would be
made from polysulfide (medium). The fit of the pros-
thesis would not be adjusted intraorally for every stage
of the prosthesis fabrication procedure. The 2 groups
would then be evaluated longitudinally.
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THE JOURNAL OF PROSTHETIC DENTISTRY
CONCLUSION
The properties of an impression material, including
rigidity and accuracy, can influence the accuracy of the
implant impression, the accuracy of the solid implant
cast, and ultimately, the accuracy of the cast implant
framework. Choosing an impression material for multi-
implant–retained prosthesis requires consideration of sev-
eral factors, including material accuracy, clinician’s expe-
rience with material, length of time before the impression
is poured, and amount of intraoral undercuts.
Within the limitations of this study, torque required
to rotate an impression coping in the impression was
significantly different (in descending order) from each
other: polyether (medium), addition silicone (high),
and polysulfide (medium). Implant cast made from
polyether (medium) or addition silicone (high) was sig-
nificantly different from cast made from polysulfide
(medium). New practitioners to the specialty of
prosthodontics may prefer using polyether (medium),
given its greater overall rigidity. The type of material
used for either the completely or partially edentulous
multi-implant impression will depend on which factors
are important to the practitioner.
I would like to thank Drs Steve Rosenstiel and Alan Carr for their
encouragement and review of the manuscript. Thanks also go to Dr
William Johnston for the statistical assistance and Dr Peter
Monaghan for his suggestions regarding the measuring technique.
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A retrospective study of 50 treatments using an appliance

Noteworthy Abstracts to produce localized occlusal space by relative axial tooth
of the movement
Current Literature Gough MB, Setchell DJ. Br Dent J 1999;187:134-9.

Purpose. This article describes the results of the treatment of 50 persons with a “Dahl”-type
appliance at the Eastman Dental Hospital, London, U.K., from 1981 to 1994. Studies by Dahl
have shown that the placement of a “partial bite raising appliance” on the maxillary anterior teeth
may be used to create localized occlusal space before restoration of teeth. The space being pro-
duced by the teeth in contact with the appliance being intruded and those out of contact extrud-
ing. The aim of this retrospective clinical audit was to assess the outcome of using similar appli-
ances placed in all regions of the mouth and the factors that may influence the outcome of treat-
ment.
Material and methods. Fifty appliances were used in 45 patients whose age ranged from 20 to
70 years (median 37 years of age); 54% of patients were women. Appliances were used in the fol-
lowing situations: attrition (19%-38%); erosion (11%-22%); total tooth wear (30%-60%); extrusion
(17%-34%); iatrogenic (2%-4%); and lack of space after adult orthodontic treatment (1%-2%). Sev-
enty-eight percent were cemented to teeth and 22% were removable. In addition, 64% were
placed in the anterior arch (32% in the posterior) and 76% were placed on the maxillary arch (24%
on the mandibular arch). Duration of treatment ranged from 1 month to 24 months, with a mean
treatment of 5.9 months. After treatment, teeth were restored with definitive restorations, includ-
ing conventional crown, fixed partial dentures, resin-retained fixed partial dentures, or hybrid
fixed prostheses.
Results. Success rate of treatment was high (96%), with only 1 appliance in place that produced
no useful tooth movement. All appliances produced enough space for restorations to be placed
conservatively when given enough time to act.
Conclusion. This type of treatment provided a conservative, predictable, and effective method to
general localized occlusal space before prosthetic restoration. 11 References. —RP Renner

MARCH 2000 331