First Immediate Provisionalization on an Anterior Implant: Recommendations?

Immediate provisional for the anterior implant can be very unforgiving. I would be heedful about the bone condition, the primary implant stability, and the occlusion before the first attempt. Dr. T

As a surgeon I feel the need and responsibility to place my own immed temps just as dr. T says it can be very unforgiving! No one knows the bone better than the placing doc!

what is the time lapse between placing the implant and making the provisional? The provisional should be placed within the first 48 hours after the implant surgery to avoid disturbing the initial healing process. depending on the system u r using , the easiest way is to use a temporary abutment and have the provisional made on it. It is much easier to fabricate a cement retained crown rather than a screw retained. Ask the surgeon to place a healing cap for u to prevent soft tissue closure.

Dear Dr. MT Actually you are doing the right things.The best thing to do after placement implants are do NOT place abtments on implants, let them rest in the bone, cover them with soft tissue for period of time until loading them of course you would have excellent osseointegration. If you have plan for a custom provisinal crown after placing an implant in static zone, it's would be much better to torque down an abutment by time of placing an implant to lock out supra-bone packets by forming soft tissue around an abutments(Which part of implants are out of the bone and plac in gingival tissue). Placing temporary crown by temporary cement on healing cap it has more safty for implant than screw at this time, but placing permanent crown by screw on implant it's much favorable than cement for some reason. 1-Follow up and scaling. 2-Not stroke to implant to take off crown(simply remove resin composite on screw,lose screw and take out crown from implant. 3- more simple to renew crown in later time. Good luck to you Dr.Vaziri....IRAN

It is very important that the process of crown provisionalization be as undisturbing to the immediate implant as possible (you don't want movement or forces on the implant). It should be done during the first days after placement (the earlier the better). If the OS placed a healing cap, remove it carefully and put on the healing abutment. Observe that there is enough space for the provisional crown and cut the abutment extraorally to create space if there isn't. You can cut grooves on the abutment to create a retentive surface at this point. Trim the margin of the provisional acrylic crown and use self curing acrylic or bonded resin to fill it up and seat it on the abutment. Remove excesses, and cure. I prefer light cured bonded resin because it is easier to work with, polishes better, is more esthetic, and more resistant than acrylic. Make a hole on the occlusal of the temporary restoration to access the fixation screw. Try the abutment and add material to fill any voids in the margin or add material as needed to shape the gum margin (creating a proper emergence profile). Polish the margins very well extraorally and screw it without too much torque. Check occlusion, so there are NO contacts on centric or excentric movements. Do not remove the provisional crown during at least 2 months. Instruct the patient to avoid biting hard foods and especially to avoid using the provisional tooth during the healing phase. Best wishes

The best results with immediate provisionalization are obtained by following the correct protocol. If your surgeon is placing the implant, both of you have to know the details in advance since this is a prosthetically driven procedure with a surgical component. The surgeon should place the implant with high enough stability and insertion torque to allow immediate provisionalization. He can also place the temporary abutment with lesser torque and send the patient over to you, but that means that you have to do the abutment preparation intraorally and I don't like to do that. Depending on the implant placement and the abutment screw trajectory is whether you will or will not be able to use a screw retained temporary, since the screw needs to come out through the cingulum. Acemented temporary is more common and simpler to do. If you do not prepare the abutment in the mouth, make small marks intraorally and transfer the abutment to an analog held by an analog holder. You will work easier with cleaner, polished margins and better results than if you do it all in the mouth. Djust out of occlussion in all jaw movements and while clenching. Make sure the patient understands how important is is to avoid contact and function with the temporary while it osseointegrates. Good Luck.

we have a simple process- take pre surgical impressions, create a suck down, send it to the lab, the lab can create a one piece screw retrievable crown/temporary abutment that is hollowed out in the center so when it is time to manage the tissue you can place the temp abutment and temp cement on the crown and then remove the crown as needed adding material or reducing the amount of the temporary crown material to manage the tissue and papilla