KEEP IT LOCAL
ALTERNATIVE OPTIONS FOR PROVISIONAL PROSTHESES
By: Michael Steffen, DMD; David Wong, DDS; Terry Philbin, DDS Immediate dental implants have become an attractive alternative to conventional implants. While there are many advantages of immediate implants, there are situations where the extraction site does not possess adequate bone or soft tissue thickness to support an implant immediately. In these situations repair of the volumetric defect is required for a more ideal implant placement. When immediate loading is not possible provisionalization of the implant area becomes very important and can be challenging (for example, when a patient is informed of the prospect of wearing a provisional removable prosthesis). It is important that the hard and soft tissues of the implant area drive the entire treatment process rather than just the provisional restoration.
not advisable, the soft and hard tissues are best supported by a provisional resin-bonded bridge. A custom-fabricated healing abutment may also be delivered once the implant is placed in order to help guide the soft tissue and assist in shaping the emergence profile of the prosthesis.
In cases, where significant ridge augmentation is required to place and support implants, it is imperative that the provisional restoration not impinge on the bone graft and compromise its stability. In such situations where immediate implantation is
The following cases illustrate the use of provisionalization when immediate implants are not advised:
When determining if an immediate provisional should be considered, the primary stability of the implant is often assessed with either a torque test or an implant stability quotient (ISQ). When primary stability is inadequate, a custom healing abutment may be placed instead of a provisional restoration until the implant has properly healed.
CASE #1: EXTRACTION AND RESTORATION OF COMPROMISED ANTERIOR LEFT CENTRAL AND LATERAL INCISORS (#9 AND #10). To allow the area to heal without immediate loading, provisionalization was achieved with a Maryland bridge. After an adequate period of healing, the Maryland bridge was removed, the implant and custom abutment were placed, and the Maryland bridge reattached until full stability of the implant was achieved.
Case 1: Figure 1 – Endodontically failing teeth #9-10
Case 1: Figure 2 – Maryland bridge placed after surgery
Case 1: Figure 3 – Maryland bridge reattached with custom healing abutment
CASE #2: REPLACEMENT OF MULTIPLE TEETH IN THE ANTERIOR ESTHETIC ZONE LOST DUE TO FAILING ENDODONTIC TREATMENT AND PERIODONTAL DISEASE. Planned final treatment involved an implant-supported six-unit fixed bridge spanning from #6 to #11. Because of the need for ridge augmentation, immediate implant placement was contraindicated. Provisionalization with a temporary fixed bridge provided somewhat pleasing and functional esthetics without unduly compressing the delicate post-surgical bone grafting sites. Since the space will shrink as the site heals, a second provisional bridge may be indicated following placement of the implants.
Case 2: Figure 1 – Teeth #7-10 have a
poor 2021 prognosis 44 journal | Nov/Dec
Case 2: Figure 2 – Fixed temporary bridge in place following surgery
Case 2: Figure 3 – Post-operative healing with shrinkage of grafted tissue
