How soon after implant placement can I replace the healing collar with a temporary abutment?
I placed Nobel Groovy implant fixtures in the maxillary premolar sites in two patients. Both sets of dental implants had good primary stability. I placed transmucosal healing collars at the time of implant placement so all I have to do is remove these and I can immediately place the temporary abutments.
Patient is anxious for temporary crowns. I would like to try this and if it works would like to make this part of my normal routine. Patients coming in for implants want teeth right away. Any thoughts?
Theoretically, if you have good soft tissue healing after the surgery, you can do it. With the provisionals you can also “sculpture” the soft tissues around the abutment to the level that you want. Keep in mind to screw the abutments with finger pressure, especially if you are around the second-third week after implant placement.
You- You should read Professors Branemark s comment on Teeth right now. He disagrees with that. The profession has made up that right now concept for a variety of motives. Do no Harm.
The length of time to load is very controversial and is changing. I personally wait three months before impressions. I know that this is a long time for many but here is my rational. Bone growth needs 17 weeks. Also, I can better gauge implant surgery success at this time to before going on to the prosthesis construction. There is no chance of implant twisting at this time. I also place my implants loosely in the bone, decreasing compression necrosis. Having said all this, there is a lot of pressure from the patient to restore the implant sooner. I inform the patient that we can progressively load the implant, using temps that are out of occlusion and smaller than the final result. But I charge extra for this and any failure due to this becomes the patients responsibility. When I inform them of this, they always wait, after all they have usually been edentulous for many years and three to four months is not much time.
RS, you are 100% correct
When I was at the AAID grafting course this year, Dr Craig Cooper said he tells patients “Im not in a hurry to make this thing work. Now we have to wait on your biology to do what it needs to do.” Great comment. In keeping with most prudent implant dentistry. Bill
Some of the implants available come with the temporary abutment already on the implant,nobel biocare snap-on, providing the opurtunity to put a temporary restoration (temp crown, temp bridge) on directly after placement. I make these temps out of occlusion, trying to emulate any excursive movements the patient may exhibit( looking at any wear facets that the patient may have) and making sure that there is no contact possible.
I some cases, rather than place a healing cap, I place the abutment preped out of the mouth for total clearance. I get the tissue to form to the ideal and can then temporize at any time down the line. I have found this to work out in the posterior mandible quite well. This is done when no flap is laid.
I still may have to prep for the final restoration, but the temporary is in position up until that time. Since I usually place Cerac restoration, there is no impression needed.