The patient’s priorities on aesthetics and function during the implant healing process are subjective concerns that can help determine the appropriate provisionalization choice. Some patients have no problem missing a molar as the implant is healing, while others need a tooth…for aesthetic and/or functional reasons.
This month’s Implants Today topic is provisionalization for implant dentistry. The various options for provisionalizing a dental implant case should be a main focus when treatment planning. In Dentistry Today, we have included an article on the different aspects of full-arch provisionalization that also addresses how quadrant and single-tooth implant cases are provisionalized and why they command equal attention for successful outcomes.
The patient’s concerns for aesthetics and functional needs can be determined through the treatment planning discussion process. The patient’s priorities on aesthetics and function during the implant healing process are subjective concerns that can help determine the appropriate provisionalization choice. Some patients have no problem missing a molar as the implant is healing, while others need a tooth during the healing period for aesthetic and/or functional reasons. Through educating a patient and listening to his or her concerns, an appropriate course for provisionalization of patient’s edentulous area can be determined.
In a single- or multiple-tooth posterior area of the mouth with adjacent teeth, implants could be provisionalized with a nonfunctional tooth on the implants. Basically, the provisionals are kept out of occlusion, and the patient is asked not to eat in that area for 3 to 4 months. Another option in areas with adjacent teeth is a removable flipper appliance. However, many patients would rather be edentulous than wear a removable provisional appliance. A flipper can also have detrimental effects on areas that are being grafted by putting pressure on the surgical site, causing subsequent soft-tissue problems.
In the anterior areas of the mouth, the concept of using a provisional to shape the surrounding tissue and emergence profile becomes an important consideration. A flipper cannot create an ovate pontic form in the tissues as well as a bonded tooth or bridge can. The provisional plays an important role in the final aesthetics of implant-supported restorations in the aesthetic zone, especially in patients with a high lip-line. There are times when crowning adjacent teeth around implants makes sense from an aesthetic-outcome standpoint. When adjacent teeth are being crowned, a provisional bridge can be used to avoid a flipper and, at the same time, create the potential for ideal ovate pontic formation for implants and/or grafting. Another alternative to using a flipper is an Essix appliance that contains “teeth” in a matrix that fits into the empty space and over the existing teeth. The Essix appliance is another option in these anterior cases that allow for ovate pontic formation without being detrimental to the healing surgical site.
In addition to my article, Implants Today also provides an excellent piece by Dr. Randy Mitchmore on how to handle a broken implant, demonstrating the necessary steps to take when this happens.
If you have any questions or comments about this topic, or any other subject presented in Implants Today, feel free to contact Dr. Tischler at mt@tischlerdental.com.
Related Articles
Dental Implant Prosthetic Options
