An accurate chairside technique for fabricating a temporary restoration for ITI single-tooth implant

Current implant restoration techniques depend upon a well-fitting, anatomic provisional restoration--especially at the restoration margin--to promote healthy soft tissue contours, which are necessary for successful final restorations. The ITI implant system presents a particular challenge in this regard because of the configuration of the implant head and shoulder, especially when these are placed subgingivally. A chairside method for obtaining an accurate marginal fit and customized contours in the single-tooth provisional restoration is described and illustrated.     

Selecting treatment options and sequencing treatment in the replacement of 2 maxillary central incisors with implants: a case report

This article describes treatment provided to replace 2 maxillary central incisors with implant-supported restorations. The site of a missing maxillary central incisor was treated utilizing a bone expansion technique to augment the labial hard and soft-tissue profiles at the time of implant placement. The adjacent central incisor tooth, although destined to be extracted, was retained to serve as an abutment for a fixed provisional restoration until the first implant was deemed to have successfully integrated. At the appointment to uncover this implant, the fractured tooth was extracted and an implant was immediately placed into the socket. The first implant was then used to support the provisional restoration during the healing phase of the second implant. The techniques utilized resulted in optimum soft-tissue contours, allowed the patient to have a comfortable and esthetic provisional restoration, and minimized the number of surgical procedures.     

Use of an Immediate Provisional Implant to Support a Full-Arch Interim Restoration: A Clinical Report

The use of provisional implants as the sole or adjunct mean of stabilization for interim fixed partial dentures has gained popularity in implant prosthodontic treatment. These implants can be used between submerged implants during the healing phase to provide support for interim fixed or removable partial dentures. In this clinical report, a provisional implant used to provide support for a full-arch fixed interim restoration is described. Positioned between adjacent conventional implants, the provisional implant was placed during the same surgical procedure. As a result, an immediate acrylic fixed partial denture supported by natural teeth and the provisional implant provided a comfortable and esthetic interim restoration during the osseointegration period.     

An alternative method for restoring single-tooth implants

BACKGROUND: Having laboratory technicians prepare soft-tissue casts and implant abutments with or without concomitant removable temporary prostheses during the restorative phase of single-tooth replacement is an accepted practice. It can, however, result in functional and esthetic intraoral discrepancies. CASE DESCRIPTION: Single-tooth implants can be restored with crowns (like those for natural teeth) fabricated at a dental laboratory on casts obtained from final impressions of prepared implant abutments. In the case reported, the restorative dentist restored the patient's single-tooth implant after taking a transfer impression. He constructed a cast simulating the peri-implant soft tissue with final impression material and prepared the abutment on this model. His dental assistant then fabricated a fixed provisional restoration on the prepared abutment. At the patient's next visit, the dentist torqued the prepared abutment onto the implant, took a final impression and inserted the provisional restoration. A crown was made conventionally at the dental laboratory and cemented in place at the following visit. CLINICAL IMPLICATIONS: This alternative method for restoring single-tooth implants enhances esthetics by more accurately simulating marginal gingival architecture. It also improves function by preloading the implant through fixed temporization after the dentist, rather than the laboratory technician, prepares the abutment to the dentist's preferred contours.     

Provisionalization for a single cementable dental implant restoration

This article presents a procedure for refining margins of provisional implant crowns. This procedure uses an analog of the implant and abutment. This procedure allows functional and esthetic considerations such as emergence profiles, symmetry, diastemas, embrasures, size, contours, position, angulation, and relation to other teeth to be evaluated.     

Digital Custom Impression Technique to Record Emergence Profile and Fabrication of an Esthetic Implant Supported Restoration

One of the challenges in esthetic implant supported restorations is to replicate the emergence profile of soft tissue contours created by provisional restorations. Various analog techniques have been used to achieve the most esthetic and natural emergence profile in final restorations. The evolution of digital dentistry has made dentistry easier and efficient albeit with a learning curve. The technique described here uses digital technology to describe a complete digital workflow from the provisional stage to the final restoration.     

Guided tissue healing for single-tooth implants

The emergence profile of a single-tooth implant abutment has a significant effect on the esthetics of the final restoration. Most healing abutments are cylindrical, unlike the nonround contours of the natural teeth being replaced. The resulting peri-implant sulcus is round rather than having the correct anatomic cross-sectional shape. This disparity may compromise the ideal emergence profile of the final restoration. This article presents a technique in which a custom abutment and provisional crown or the definitive restoration can be placed at second-stage surgery to guide tissue healing to optimum form and esthetics.     

Customized provisional abutment and provisional restoration for an immediately-placed implant.

The use of immediate implant placement and immediate provisionalization techniques are paramount to the maintenance for aesthetic hard and soft tissue structures. This is particularly important when implant-supported restorations are utilized in the aesthetic zone. A purpose of the custom-fabricated provisional abutment and restoration is to guide the hard and soft tissue response during healing. This case presentation depicts the prosthetic technique used by the author to create the final tissue contours and emergence profile for the final restoration.     

Plastic temporary abutments with provisional restorations in immediate loading procedures: a clinical report

A provisional restoration in combination with an implant-retained restoration provides many of the same benefits as nonimplant-retained fixed restorations. Provisional restorations serve as a diagnostic tool to confirm esthetics, contours, accessibility for oral hygiene, and can be used to duplicate the definitive restoration. A provisional restoration allows for communication between the patient, dentist, and technician. The soft tissue around the implants can heal according to the contours of the provisional restoration. However, implant-retained treatment can require an extended period of osseointegration, and provisional treatment can be a challenge if a removable prosthesis is provided because adjustments of the denture may become necessary during healing. This article presents a case report that describes the simultaneous placement of implants with the connection of fixed provisional restorations to prefabricated plastic provisional abutments.     

Soft Tissue Modeling for the Esthetic Single-Tooth Implant Restoration

Abstract: The ability of the restorative dentist to understand and control the relation of the implant to its associated gingival tissues is extremely important in achieving the maximum esthetic result in the final restoration. The position of the gingival margin following stage-two surgery represents collapse of the gingival tissues until it finds support by the component against which it comes to rest. This component may be a healing abutment, final abutment, or provisional restoration, if placed at the same time of implant exposure. Generally, it will be a healing abutment. There is a complex relation between implant position, gingival management at stage-one and stage-two surgery, the position of the gingival margin over the buccal surface of the implant compared to the adjacent natural teeth, component selection, and lip line esthetics. The therapist who understands these relations will know how to mold the gingival tissue around implants to maximize the esthetic result. This article focuses on these relations and the technique of tissue modeling with subgingival contours to create a restoration with the illusion of reality.     

Long-term reinforced fixed provisional restorations

Extensive prosthodontic treatment often requires fabrication of long-term provisional restorations. Numerous materials and techniques have been described for prolonged insertion of interim restorations. This article describes a procedure for fabrication of long-term reinforced heat-processed provisional restorations based on a diagnostic wax-up. Reinforced heat-processed provisional restorations reduced flexure, which minimizes progressive loss of cement and diminished the possibility of recurrent decay. Occlusal stability and vertical dimension were maintained because of greater wear resistance. Occlusion, tooth contours, and pontic design developed in the provisional restoration were duplicated in the definitive restoration. The use of a matrix from a diagnostic wax-up facilitated fabrication of the prosthesis, and made the procedure less time-consuming and more predictable. (J Prosthet Dent 1998;79:698-701.)     

A system for the diagnosis, placement, and prosthetic restoration of root form implants (U.S. Patent #5,769,636)

It is difficult to achieve a high degree of reproducibility when using a diagnostic wax-up as the template for fabrication of a definitive implant restoration. Here a method for implant prosthesis treatment planning is described that allows fabrication of the provisional restoration before surgical placement of the implant. The method involves 6 steps: (1) determining the mesiodistal inclination of the implant, (2) determining the buccolingual dimension of the alveolar ridge, (3) determining the proper position of the implant, (4) fabricating the surgical guide, (5) fabricating the provisional restoration, and (6) performing surgical placement of the implant followed by immediate placement of the provisional restoration.     

A multifunctional, provisional, implant-retained fixed partial denture

This article describes the modification of a procedure for fabricating a laboratory-processed, metal-reinforced, acrylic resin provisional restoration that becomes an implant-retained fixed partial denture. The modification involves the incorporation of patrix and matrix components into a cast metal framework. The prosthesis can be used as an alternative to a removable radiologic stent and surgical guide. It can function as a surgical guide during implant placement and help retract the buccal mucogingival flap during implant placement. The prosthesis also can be used as an aid in locating the implant during stage II surgery. Finally, the pontics can be converted into an implant-supported provisional restoration immediately after the implant prosthetic components are attached to the uncovered implants.     

Fabricating a provisional restoration for a 2-stage, single-tooth implant with less than optimal angulation

A technique is presented for fabricating a provisional restoration for a buccally angulated implant. This technique describes the fabrication of a provisional restoration for a labially angulated implant. This technique helps the prosthodontists to achieve esthetics and soft-tissue health until the definitive restoration is available.     

Implant Digital Impression in the Esthetic Area

The aim of this report is to describe two standardized protocols for digital impression when implant support rehabilitation is used in the esthetic area. The two techniques were used to transfer all provisional crown parameters to definitive restorations in different clinical scenarios. In the direct technique, an impression (STL1) is made of the provisional restorations attached to the implants, with surrounding gingival tissue. The second scan (STL2) captures the sulcular aspect of the peri‐implant soft tissue immediately after removal of the provisional restoration. The last impression (STL3) of the complete arch is made with a standardized scanbody attached to the implant to capture the 3D location of the implant. The direct technique is indicated when the peri‐implant soft tissues are stable upon removal of the provisional restoration. The indirect technique is used when the gingival tissue collapses rapidly after the removal of the provisional crown. The impressions of the provisional restoration and the position of the implant are similar to those obtained with the direct technique, and the shape of the peri‐implant tissue is extrapolated from the negative shape obtained from making the digital impression when the provisional restoration is taken out of the mouth. Finally, in both techniques the 3 scans are superimposed to obtain a file, which contains the details of the peri‐implant soft tissue. The direct and indirect digital techniques allowed realization of a predictable definitive restoration in the esthetic zone in different clinical scenarios, reducing the duration of clinical procedures.     

Immediate placement and immediate provisional abutment modeling in anterior single-tooth implant restorations using a CAD/CAM application: a clinical report

A patient underwent immediate implant placement and immediate provisional restoration with nonocclusal loading in the right central incisor area. A provisional custom abutment and a cemented provisional restoration were fabricated. At the impression appointment, an implant level impression was made and the provisional abutment was scanned for fabrication of the definitive custom abutment. This clinical report describes how CAD/CAM technology can facilitate the definitive restoration of immediately placed and loaded implants by allowing the fabrication of the definitive abutment as an exact duplicate of the provisional abutment.     

个性化基台-冠一体式临时修复体在美学区种植修复中的应用

目的本文针对美学区种植修复中软组织塑形的难题,介绍了一种改良的个性化基台-冠一体式临时修复体的设计制作方法。方法牙种植体植入3个月后,通过数字化技术镜像缺失牙对侧同名牙的形态,设计制作个性化基台-冠一体式临时修复体,佩戴3个月后观察种植体周软组织塑形效果,制作、戴入永久修复体并随访1年。结果患者戴入永久修复体后随访一年,种植体周软组织塑形效果稳定,粉红色美学评分稳步上升达12分。X线根尖片显示种植体周边缘骨水平稳定。结论个性化基台-冠一体式临时修复体应用于美学区种植修复取得了良好的软组织塑形效果。     

Esthetic potential of single-implant provisional restorations: selection criteria of available alternatives

Provisional implant restorations are essential tools used to optimize the esthetic outcomes for single-tooth implant restorations. This article describes three groups of available alternatives and the specific options within each group including removable prostheses (interim removable partial denture, vacuum-formed appliance), tooth-supported prostheses (bonded extracted or denture teeth, cast metal or fiber-reinforced resin-bonded fixed partial denture [FPD], wire-retained resin-bonded FPD, acrylic resin provisional FPD), and implant-supported fixed prostheses (implant-retained provisional restoration). Advantages and disadvantages as well as fabrication guidelines for each option are provided. The author proposes that the restorative dentist consider eight criteria in selecting the most appropriate type of provisional prosthesis for a specific patient situation including the esthetic potential, patient comfort, treatment time, laboratory cost, occlusal clearance, ease of removal, durability, and ease of modification. The patient's esthetic expectations are critical in determining the most suitable type of provisional restoration. Esthetically pleasing provisional restorations are part of the evolving implant continuum, making implant dentistry more appealing to practicing dentists and potential patients. CLINICAL SIGNIFICANCE: Provisional restorations for single implants have evolved from temporary expedients during osseous and soft tissue integration to critical therapeutic tools used to assess patient expectations, communicate with the laboratory, and optimize definitive implant treatment. The selection of the type of provisional restoration may significantly influence esthetics during the period of implant integration and soft tissue healing. However, it is unlikely that there is a direct correlation between the type of provisional restoration used and the esthetic outcome of the definitive prosthesis.     

前牙美学区单颗牙种植后暂时性修复

随着口腔种植技术的成熟和发展,越来越多的患者首选种植义齿修复缺失牙.前牙缺失常需要形态美观、结构稳定的暂时修复体来恢复种植手术愈合期内前牙的美观和功能.暂时性修复体有助于牙龈的成型和维持,有助于医技沟通,有助于获得患者对医生的信任.同时,依据暂时修复体使用反馈的信息可指导永久义齿的设计制作.因此,暂时修复体在种植修复中起重要作用.临床医生应掌握各类暂时修复体的优缺点,依据患者个性化需求和临床适应症,选择最合适的暂时修复措施,以达到保护种植体,恢复美观及功能的目的.