Efficacy of Splinted and Non-splinted Direct Impression Techniques for Completely Edentulous Patients Requiring Implant Supported Prostheses- A Systematic Review

Main Article Content

Varun Wadhwani
Deepak Nallasway
Vinay Sivaswamy
Khushali K Shah
Subhabrata Maiti


Implant, Systematic, clinical, traditional


Background: Implants are not as mobile as natural teeth due to the absence of the periodontal ligament, which means that they cannot adapt to distortions and misfit at the implant-abutment interface. The success of implant-supported prostheses largely depends on achieving a passive fit between the implant components. Failure to achieve a passive fit may result in a range of biological and mechanical complications. Therefore, the precision of fit and passivity of implant-supported fixed dental prostheses are heavily influenced by the choice of impression materials and techniques used.
Materials and Methods: The search was performed in electronic database (i.e. PubMed, ScienceDirect, Lilacs, Cochrane Database of Systematic Review, Google Scholar, Europe PMC, Wiley online library) using a combination of controlled vocabulary from January 1, 2010 to March 1, 2021. The combined data was analysed. Factors which affect the accuracy were pinned down and their impact on the outcome was accessed.
Results: The 21 studies which fulfilled the inclusion criteria included 3 clinical and 18 in vitro studies. Most in vitro (10/18) and all clinical studies demonstrated that the splinted technique was more accurate when compared to non- splinted technique. 7 in vitro studies compared various impression materials and showed no statistical difference between poly-ether and polyvinyl siloxane, but 2 studies reported occlusal registration material and impression plaster used for non- splinted impressions to be as accurate as splinted impressions. All of the studies reported open tray technique to be better than  closed tray. 9 in vitro studies reported on the use of different splinting methods as well as modifications for unsplinted impression copings with conflicting results. Although 2 out of 3 studies reported air-abraded, adhesive coated and unilateral extended unsplinted copings to give as accurate results and splinted copings in the accuracy of casts obtained. 9 invitro and 3 clinical studies demonstrated that with the increase in angulation of implants, the accuracy of impressions decreases and splinted copings are preferred while 2 among the in-vitro reported no change in accuracy from 0-15 degrees.
Conclusion: The current literature points towards splinted technique to have better impression accuracy as compared to non- splinted technique but the clinical studies included show serious risk of bias. Angulation of implants play a major factor in influencing the accuracy of impressions made. Angulated implants show less accurate impressions as compared to parallel implants. No difference was observed between traditional impression materials like PVS and PE for the impression technique. Unconventional implant materials like occlusal registration materials have shown promise. Better structured and randomized clinical trials are needed to formulate a definite protocol.

Abstract 251 | PDF Downloads 153


1. P TLA, S BG, A JP. Knowledge and Awareness of Dental Implant Treatment versus Fixed Partial Dentures. J Long Term Eff Med Implants. 2020;30(2):103–11.
2. Buser D, Janner SFM, Wittneben JG, Brägger U, Ramseier CA, Salvi GE. 10-year survival and success rates of 511 titanium implants with a sandblasted and acid-etched surface: a retrospective study in 303 partially edentulous patients. Clin Implant Dent Relat Res. 2012 Dec;14(6):839–51.
3. Ravald N, Dahlgren S, Teiwik A, Gröndahl K. Long-term evaluation of Astra Tech and Brånemark implants in patients treated with full-arch bridges. Results after 12-15 years [Internet]. Vol. 24, Clinical Oral Implants Research. 2013. p. 1144–51. Available from: http://dx.doi.org/10.1111/j.1600-0501.2012.02524.x
4. Jemt T, Hjalmarsson L. In Vitro Measurements of Precision of Fit of Implant-Supported Frameworks. A Comparison between “Virtual” and “Physical” Assessments of Fit Using Two Different Techniques of Measurements [Internet]. Vol. 14, Clinical Implant Dentistry and Related Research. 2012. p. e175–82. Available from: http://dx.doi.org/10.1111/j.1708-8208.2011.00416.x
5. Sahin S, Cehreli MC. The significance of passive framework fit in implant prosthodontics: current status. Implant Dent. 2001;10(2):85–92.
6. Lee H, So JS, Hochstedler JL, Ercoli C. The accuracy of implant impressions: a systematic review. J Prosthet Dent. 2008 Oct;100(4):285–91.
7. Shankar Y, Sahoo S, Krishna M, Kumar P, Kumar T, Narula S. Accuracy of implant impressions using various impression techniques and impression materials [Internet]. Vol. 6, Journal of Dental Implants. 2016. p. 29. Available from: http://dx.doi.org/10.4103/0974-6781.190384
8. Mostafa TMN, Elgendy MNM, Kashef NA, Halim MM. Evaluation of the precision of three implant transfer impression techniques using two elastomeric impression materials. Int J Prosthodont. 2010 Nov;23(6):525–8. 9. Martínez-Rus F, García C, Santamaría A, Özcan M, Pradíes G. Accuracy of Definitive Casts Using 4 Implant-Level Impression Techniques in a Scenario of Multi-Implant System With Different Implant Angulations and Subgingival Alignment Levels [Internet]. Vol. 22, Implant Dentistry. 2013. p. 268–76. Available from: http://dx.doi.org/10.1097/id.0b013e3182920dc5
10. Baig MR, Buzayan MM, Yunus N. Accuracy of a new elastomeric impression material for complete-arch dental implant impressions. J Investig Clin Dent. 2018 May;9(2):e12320.
11. Ribeiro P, Herrero-Climent M, Díaz-Castro C, Ríos-Santos JV, Padrós R, Mur JG, et al. Accuracy of Implant Casts Generated with Conventional and Digital Impressions—An In Vitro Study [Internet]. Vol. 15, International Journal of Environmental Research and Public Health. 2018. p. 1599. Available from: http://dx.doi.org/10.3390/ijerph15081599
12. Menini M, Setti P, Pera F, Pera P, Pesce P. Accuracy of multi-unit implant impression: traditional techniques versus a digital procedure. Clin Oral Investig. 2018 Apr;22(3):1253–62.
13. Moreira AHJ, Rodrigues NF, Pinho ACM, Fonseca JC, Vilaça JL. Accuracy Comparison of Implant Impression Techniques: A Systematic Review. Clin Implant Dent Relat Res. 2015 Oct;17 Suppl 2:e751–64.
14. Agarwal S, Ashok V, Maiti S. Open- or Closed-Tray Impression Technique in Implant Prosthesis: A Dentist’s Perspective. J Long Term Eff Med Implants. 2020;30(3):193–8.
15. Choi JH, Lim YJ, Yim SH, Kim CW. Evaluation of the accuracy of implant-level impression techniques for internal-connection implant prostheses in parallel and divergent models. Int J Oral Maxillofac Implants. 2007 Sep;22(5):761–8.
16. Assif D, Nissan J, Varsano I, Singer A. Accuracy of implant impression splinted techniques: effect of splinting material. Int J Oral Maxillofac Implants. 1999 Nov;14(6):885–8.
17. Hariharan R, Shankar C, Rajan M, Baig MR, Azhagarasan NS. Evaluation of accuracy of multiple dental implant impressions using various splinting materials. Int J Oral Maxillofac Implants. 2010 Jan;25(1):38–44.
18. Duraisamy R, Krishnan CS, Ramasubramanian H, Sampathkumar J, Mariappan S, Navarasampatti SA. Compatibility of Nonoriginal Abutments With Implants: Evaluation of Microgap at the Implant-Abutment Interface, With Original and Nonoriginal Abutments. Implant Dent
[Internet]. 2019 Jun [cited 2023 May 5];28(3). Available from: https://pubmed.ncbi.nlm.nih.gov/31124826/
19. Papaspyridakos P, Benic GI, Hogsett VL, White GS, Lal K, Gallucci GO. Accuracy of implant casts generated with splinted and non-splinted impression techniques for edentulous patients: an optical scanning study. Clin Oral Implants Res. 2012 Jun;23(6):676–81.
20. Papaspyridakos P, Gallucci GO, Chen CJ, Hanssen S, Naert I, Vandenberghe B. Digital versus conventional implant impressions for edentulous patients: accuracy outcomes. Clin Oral Implants Res. 2016 Apr;27(4):465–72.
21. Elshenawy EA, Alam-Eldein AM, Abd Elfatah FA. Cast accuracy obtained from different impression techniques at different implant angulations (in vitro study). Int J Implant Dent. 2018 Mar 20;4(1):9.
22. Burawi G, Houston F, Byrne D, Claffey N. A comparison of the dimensional accuracy of the splinted and unsplinted impression techniques for the Bone-Lock implant system [Internet]. Vol. 77, The Journal of Prosthetic Dentistry. 1997. p. 68–75. Available from: http://dx.doi.org/10.1016/s0022-3913(97)70209-9
23. Inturregui JA, Aquilino SA, Ryther JS, Lund PS. Evaluation of three impression techniques for osseointegrated oral implants [Internet]. Vol. 69, The Journal of Prosthetic Dentistry. 1993. p. 503–9. Available from: http://dx.doi.org/10.1016/0022-3913(93)90160-p
24. Castro RA, Moretti KP, Jóias RP, Da ANA PA, Jóias RM. Evaluation of the accuracy between splinting and non-splintingimpression techniques for multiple implants [Internet]. Vol. 3, Rio de Janeiro Dental Journal (Revista Científica do CRO-RJ). 2018. p. 37–42. Available from: http://dx.doi.org/10.29327/24816.3.3-7
25. Buzayan M, Baig MR, Yunus N. Evaluation of accuracy of complete-arch multiple-unit abutment-level dental implant impressions using different impression and splinting materials. Int J Oral Maxillofac Implants. 2013 Nov;28(6):1512–20.
26. Pera F, Pesce P, Bevilacqua M, Setti P, Menini M. Analysis of Different Impression Techniques and Materials on Multiple Implants Through 3-Dimensional Laser Scanner. Implant Dent. 2016 Apr;25(2):232–7.
27. Papaspyridakos P, Chen CJ, Gallucci GO, Doukoudakis A, Weber HP, Chronopoulos V. Accuracy of implant impressions for partially and completely edentulous patients: a systematic review. Int J Oral Maxillofac Implants. 2014 Jul;29(4):836–45.
28. Page MJ, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C d., et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews [Internet]. Available from: http://dx.doi.org/10.31222/osf.io/v7gm2
29. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016 Oct 12;355:i4919.
30. Russo LL, Lo Russo L, Caradonna G, Biancardino M, De Lillo A, Troiano G, et al. Digital versus conventional workflow for the fabrication of multiunit fixed prostheses: A systematic review and meta-analysis of vertical marginal fit in controlled in vitro studies [Internet]. Vol. 122, The Journal of Prosthetic Dentistry. 2019. p. 435–40. Available from: http://dx.doi.org/10.1016/j.prosdent.2018.12.001
31. Papazoglou E, Wee AG, Carr AB, Urban I, Margaritis V. Accuracy of complete-arch implant impression made with occlusal registration material. J Prosthet Dent. 2020 Jan;123(1):143–8.
32. Pujari M, Garg P, Prithviraj DR. Evaluation of accuracy of casts of multiple internal connection implant prosthesis obtained from different impression materials and techniques: an in vitro study. J Oral Implantol. 2014 Apr;40(2):137–45.
33. Tsagkalidis G, Tortopidis D, Mpikos P, Kaisarlis G, Koidis P. Accuracy of 3 different impression techniques for internal connection angulated implants. J Prosthet Dent. 2015 Oct;114(4):517–23.
34. Richi MW, Wafa Richi M, Kurtulmus-Yilmaz S, Ozan O. Comparison of the accuracy of different impression procedures in case of multiple and angulated implants [Internet]. Vol. 16, Head & Face Medicine. 2020. Available from: http://dx.doi.org/10.1186/s13005-020-00225-3
35. Ghanem RA, Nassani MZ, Baroudi K, Fattah AA. Dimensional accuracy of different techniques used for complete-arch multi-implant impressions [Internet]. Vol. 7, Journal of Investigative and Clinical Dentistry. 2016. p. 225–31. Available from: http://dx.doi.org/10.1111/jicd.12160
36. Shankar SD, Doddamani S. To evaluate and compare the accuracy of definitive casts using various splinting methods on implant level impressions in All-on-Four treatment: An study.J Indian Prosthodont Soc. 2020 Apr;20(2):193–201.
37. Papaspyridakos P, Lal K, White GS, Weber HP, Gallucci GO. Effect of splinted and nonsplinted impression techniques on the accuracy of fit of fixed implant prostheses in edentulous patients: a comparative study. Int J Oral Maxillofac Implants. 2011 Nov;26(6):1267–72.
38. Khorshid H. The Effect of two different impression techniques on the passivity of fit of implant supported prosthesis placed in completely edentulous maxillae [Internet]. Vol. 64, Egyptian Dental Journal. 2018. p. 2697–705. Available from: http://dx.doi.org/10.21608/edj.2018.77267
39. Buzayan MM, Yunus NB. Passive Fit in Screw Retained Multi-unit Implant Prosthesis Understanding and Achieving: A Review of the Literature [Internet]. Vol. 14, The Journal of Indian Prosthodontic Society. 2014. p. 16–23. Available from: http://dx.doi.org/10.1007/s13191-013-0343-x
40. Del’Acqua MA, Chávez AM, Amaral ALC, Compagnoni MA, Mollo F de A Jr. Comparison of impression techniques and materials for an implant-supported prosthesis. Int J Oral Maxillofac Implants. 2010 Jul;25(4):771–6.
41. Eid N. An implant impression technique using a plaster splinting index combined with a silicone impression. J Prosthet Dent. 2004 Dec;92(6):575–7.
42. Saini HS, Jain S, Kumar S, Aggarwal R, Choudhary S, Reddy NK. Evaluating the Effect of Different Impression Techniques and Splinting Methods on the Dimensional Accuracy of Multiple Implant Impressions: An in vitro Study. J Contemp Dent Pract. 2018 Aug 1;19(8):1005–12.
43. Kushali R, Maiti S, Girija SAS, Jessy P. Evaluation of Microbial Leakage at Implant Abutment Interfact for Different Implant Systems: An In Vitro Study. J Long Term Eff Med Implants [Internet]. 2022 [cited 2023 May 5];32(2). Available from: https://pubmed.ncbi.nlm.nih.gov/35695631/
44. Al Quran FA, Rashdan BA, Zomar AAA, Weiner S. Passive fit and accuracy of three dental implant impression techniques. Quintessence Int. 2012 Feb;43(2):119–25.
45. Del’acqua MA, de Avila ÉD, Amaral ÂLC, Pinelli LAP, de Assis Mollo F Jr. Comparison of the accuracy of plastic and metal stock trays for implant impressions. Int J Oral Maxillofac Implants. 2012 May;27(3):544–50.
46. Fernandez MA, de Mendoza CYP, Platt JA, Levon JA, Hovijitra ST, Nimmo A. A Comparative Study of the Accuracy between Plastic and Metal Impression Transfer Copings for Implant Restorations [Internet]. Vol. 22, Journal of Prosthodontics. 2013. p. 367–76. Available from: http://dx.doi.org/10.1111/jopr.12015
47. Mpikos P, Kafantaris N, Tortopidis D, Galanis C, Kaisarlis G, Koidis P. The effect of impression technique and implant angulation on the impression accuracy of external- and internal-connection implants. Int J Oral Maxillofac Implants. 2012 Nov;27(6):1422–8.
48. Cabral LM, Guedes CG. Comparative Analysis of 4 Impression Techniques for Implants [Internet]. Vol. 16, Implant Dentistry. 2007. p. 187–94. Available from: http://dx.doi.org/10.1097/id.0b013e3180587b3f
49. Naconecy MM, Teixeira ER, Shinkai RSA, Frasca LCF, Cervieri A. Evaluation of the accuracy of 3 transfer techniques for implant-supported prostheses with multiple abutments. Int J Oral Maxillofac Implants. 2004 Mar;19(2):192–8.
50. Vigolo P, Majzoub Z, Cordioli G. Evaluation of the accuracy of three techniques used for multiple implant abutment impressions. J Prosthet Dent. 2003 Feb;89(2):186–92.
51. Yuvashree CS, Venugopalan S, Nesappan T, Antony SDP. Comparing Closed Tray Implant Impression Techniques Using Snap-On and Impression Analogues on a Clinical Radiographic Scale. J Long Term Eff Med Implants. 2021;31(1):1–6.
52. Kachhara S, Nallaswamy D, Ganapathy DM, Sivaswamy V, Rajaraman V. Assessment of intraoral scanning technology for multiple implant impressions - A systematic review and meta-analysis. J Indian Prosthodont Soc. 2020 Apr 7;20(2):141–52.
53. Brosky ME, Major RJ, DeLong R, Hodges JS. Evaluation of dental arch reproduction using three-dimensional optical digitization. J Prosthet Dent. 2003 Nov;90(5):434–40.
54. Mojon P, Oberholzer JP, Meyer JM, Belser UC. Polymerization shrinkage of index and pattern acrylic resins. J Prosthet Dent. 1990 Dec;64(6):684–8.
55. Carr AB, Master J. The accuracy of implant verification casts compared with casts produced from a rigid transfer coping technique. J Prosthodont. 1996 Dec;5(4):248–52.
56. Herbst D, Nel JC, Driessen CH, Becker PJ. Evaluation of impression accuracy for osseointegrated implant supported superstructures. J Prosthet Dent. 2000 May;83(5):555–61.
57. Balaji GS. Evaluation Of Bond Strength Of Splinting Material To The Teeth After Thermocycling - An In Vitro Study. 2021 Sep 22 [cited 2023 May 5]; Available from: https://zenodo.org/record/5702251
58. Assuncao WG, Filho HG, Zaniquelli O. Evaluation of Transfer Impressions for Osseointegrated Implants at Various Angulations [Internet]. Vol. 13, Implant Dentistry. 2004. p. 358–66. Available from: http://dx.doi.org/10.1097/01.id.0000144509.58901.f7
59. Sorrentino R, Gherlone EF, Calesini G, Zarone F. Effect of Implant Angulation, Connection Length, and Impression Material on the Dimensional Accuracy of Implant Impressions: An In Vitro Comparative Study [Internet]. Vol. 12, Clinical Implant Dentistry and Related Research. 2009. p. e63–76. Available from: http://dx.doi.org/10.1111/j.1708-8208.2009.00167.x
60. Kim S, Nicholls JI, Han CH, Lee KW. Displacement of implant components from impressions to definitive casts. Int J Oral Maxillofac Implants. 2006 Sep;21(5):747–55.
61. Cheshire PD, Hobkirk JA. An in vivo quantitative analysis of the fit of Nobel Biocare implant superstructures [Internet]. Vol. 23, Journal of Oral Rehabilitation. 1996. p. 782–9. Available from: http://dx.doi.org/10.1046/j.1365-2842.1996.d01-193.x
62. Ma T, Nicholls JI, Rubenstein JE. Tolerance measurements of various implant components. Int J Oral Maxillofac Implants. 1997 May;12(3):371–5.

Most read articles by the same author(s)

1 2 > >>