Welcome to the lecture

on implant supported provisional restorations.

In this series,

we will discuss about the significance of

placing provisional restorations in implant dentistry

in daily practice.

First of all, what is the definition?

We know from dental school that a provisional restoration

can be fabricated of composite or acrylic material.

The provisional restorations on implants can be supported

by a plastic or a metal abutment.

These restorations are serving as temporary solutions

until the implant has achieved osseointegration.

Why are provisional restorations important?

The ability to accomplish a successful implant placement

followed by an implant-supported restoration

in the aesthetic area

relies on the knowledge of critical surgical

and prosthetic parameters.

Creating a favourable aesthetic result

in the three-dimensional peri-implant

and soft tissue surroundings

is not only dependent on bone reconstruction techniques

and implant positioning,

but also highly dependent

on a well-performed tooth-like restoration.

In this context, fabricating a precise temporary crown,

also called provisional,

becomes an extremely important step

in the contemporary implant-restorative dentistry

where patients are demanding more and more aesthetic results

in all phases of their treatment.

And we're also trying to minimize

the number of surgical procedures performed.

When can we place them?

This moment relies on the implant placement.

Ideally, we would like to place them

simultaneously with the implant.

In this way, we minimize the number of surgical procedures

the patient will go through.

Sometimes if the implant doesn't have

appropriate primary stability,

we need to wait until the implant is osseointegrated

in order not to compromise this process.

Some authors prefer to condition the soft tissue

before the implant placement with the use of a pontic,

especially if that particular area

received a bone regeneration procedure.

There are different techniques and materials

that we have to take into consideration.

Choosing the appropriate combination

of materials and methods

for the fabrication of a provisional restoration

with high quality

is crucial to guide the tissue and predict

the final aesthetics.

A precise technique provides restoration

that fulfill the peri-implant tissue

and aesthetic requirements

needed to achieve an excellent final restoration.

We can have screw retained

or cement retained provisional restoration.

For the screw retained ones,

the type of abutment can be either plastic or metal.

For the crown, we can either use a prefabricated shell

that we can fill in with acrylic,

we can duplicate a wax up

and have an acrylic shell done in the lab,

or we can use a denture tooth

that we can adopt and reline with acrylic.

For this presentation, we will use the last technique,

the denture tooth technique,

as this provides higher aesthetic results.

There are some key principles

that we need to take into consideration.

Implant stability, measured by ISQ.

This is important because an implant that is spinning

and will receive a provisional restoration immediately

has high chances of failure.

Occlusion.

This can also affect the osseointegration of the implant

as if the forces are high

can produce micro-movements that later on

will jeopardize the osseointegration.

Ideally, we release the provisional restoration

and is out of any occlusion forces

in all lateral and protrusion movements.

Space maintenance.

For an area that will receive the implants later on,

we do know that there is a risk for malposition of the teeth

due to tooth migration or extrusion.

Provisional restoration can be a good solution

to help maintain the space

until the final restoration is in place.

Stability of the soft tissue.

Dr Chu and Dr Tarnow worked extensively

on providing more information

regarding the soft tissue stability

during various moments of connecting the implant

with the provisional restoration,

specifically, looking at the papilla preservation.

Healing time - soft tissue conditioning.

For tissue re-modeling,

provisional implant crowns should be used

for approximately three months

prior to the final restorative procedure.

This can vary based on the tissue biotype of the patients.

Interdisciplinary planning.

The planning of such a procedure

should be done interdisciplinary,

taking into account the position of the final prosthesis

and the location of the implant placement.

Don't hesitate to ask a prosthodontist colleague

for any questions.

Patient compliance.

I always tell my patient, "This is team-work.”

I will try my best to give you the best treatment,

but please take care of it at home

and follow all the post-operative instructions.

Let's review together a clinical case.

We can notice on this slide, the edentulous area -

maxillary central incisor” is missing

and is at the moment restored with a

removable partial denture, also called ‘the flipper”.

A CBCT was exposed,

and in order to evaluate the ridge morphology

and digitally plan the implant.

This slide identifies the need for bone augmentation

during the implant placement.

This slide identify basic steps of the procedure.

Flap elevation,

implant placement,

adding bone graft and membrane.

For this particular case,

we used a collagen membrane

because it will impede the invagination

of the epithelial cells

and also provide a better quality of the regenerated bone.

Primary closure, also as you can see, very important.

Since the patient needed a fixed restoration

on the adjacent tooth,

we used that as an asset to start soft tissue re-modeling

around the implant area.

You can see that we reinforced the provisional bridge

using a wire for the pontic side.

We made sure to create a convex profile

condition the inter-proximal papilla.

Implant uncovery -

minimal exposure,

and then replacing the cover screw with a healing abutment.

Starting to prepare the provisional,

we place the temporary abutment,

we expose a radiograph,

make sure it's seated completely.

We adjust the abutment based on the height available

and then we're starting to prepare the veneer

of the denture tooth.

We reline it with acrylic

and then we make sure we respect

critical and subcritical contours,

concepts that were presented by Dr. Su and Dr. Weisgold.

As mentioned earlier, polishing is very important,

and leave some space for soft tissue

to crawl and fill in the space left.

This is a direct comparison

between before and after treatment,

and you can appreciate

the amount of soft tissue conditioning obtained

with the use of provisional restorations.

This slide identifies a final implant-supported prosthesis.

There are some future thoughts

that we might want to consider.

The research has evolved in a manner

that more and more studies that take into consideration

patient experiences and expectations are now valued.

The topic of patient centred outcome research

will certainly look into ways

to evaluate the aesthetics achieved

with provisional restorations.

In order to facilitate an excellent aesthetic outcome,

interdisciplinary collaboration should be highly considered

as part of daily practice activities.

That's all we wanted to discuss

about the provisional restorations in implant dentistry.

Thank you for your attention.

种植体支持下的过渡义齿修复

口腔种植学（Implant Dentistry）

Rencontrer les enseignants

种植体支持下的过渡义齿修复

口腔种植学 （Implant Dentistry）

Rencontrer les enseignants

口腔种植学（Implant Dentistry）