Swelling after provisional crown: Removal of temp crown best solution?

I placed a provisional crown in the lower 2nd molar position 4 days ago to develop the emergence profile for an implant placed 6 months ago. A lot of pressure is on the surrounding tissues as only soft tissue relief was provided with an incision. The patient is now in pain and reports feeling like there is a large cheek swelling, which I have not confirmed visually. Unfortunately circumstance means I can’t see the patient for some time. Is removing the temporary crown the only solution to reduce any potential swelling? The patient is only able to access over the counter medications.

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14 thoughts on “Swelling after provisional crown: Removal of temp crown best solution?

    1. Not totally sure of the problem but it looks like the emergence of the temp is too wide and either impinging on soft tiss or bone and soft tissue. Try to get a healing abutment that has a narrow emergence profile to develop the tissue and make the ultimate abutment with a narrower emergence profile than you used if this solution works.

  1. Hello. This happend to me on this type of implants that are called:bone level. Whether is an ASTRA or Straumann on placing this internal connection one looks after preventing initial bone loss thus there is a tendency to sink the implant about a mm or so. Therefore on your phase two there is an space conflict between the crestal bone and the provisional. The tissue is strangulated and it hurts a lot and swelling occurs. You need to open a flap and bevel the bone surrounding the implant with a bur giving more space for the prosthetic restoration. The tissue will heal very quickly. Welcome to the club

  2. Juan Remeu-
    That is not good advice.
    Do not raise a flap and remove bone around a nicely healed implant.
    Your provisional is impinging the bone.
    Your implant is platform switched and counter-sunk. Your provisional needs to match this bone profile.
    While I’m not answering your question on what to do- I had to say something about that recommendation.
    Provisional should be removed and redone with a better soft tissue profile. If the patient can’t come to see you, then someone else needs to take off the provisonal, reduce the sub- gingival flare on the crown and replace it.
    Do not flap and remove bone, just bad advice.

    Bone level implants usually come with an implant specific bone mill or profile. Use this to profile the bone if necessary.

    1. Whether reducing the bone with a regular #2 carbide bur or a special bur provided by the implant brand depends upon your ability. And yes indeed you can make a straight abutment but referral dentist don’t usually like this type of emerging profile. Cheers

  3. Thankyou everyone, your assumptions are all correct about tissue impingement. Pt has started taking taking diclofenac. I can’t see them due to the patient travelling.

    In the mean time I will try to arrange for a remote dentist to put a standard healing abutment again (previously asymptomatic) until they return. What adverse outcomes apart from the immediate swelling could eventuate if left alone.

    There are different degrees of removing bone, so on the one hand, removing bone down to expose the implant may be detrimental, but re contouring bone above the implant to allow a wider emergence apically would not affect the implant.

    I may just do what Juan rumeu has suggested when the patient returns in combination with re-contouring as sb oms has suggested. A wide emergence would be more ideal aesthetically.

  4. This is an Ankylos implant that is nicely placed submerged. The temporary abutment is too close to the bone. The material of the temporary abutment is not like titanium welcomed by hard tissue. All you need to do is to change the temporary abutment and choose one with longer neck.

  5. I have a follow-up question. The provisional crown is a lab made acrylic crown. The patient is very swollen now with limited opening (an appointment has been made to replace with a stock abutment).

    What are the chances it is an allergic reaction to the acrylic? I ask because there is an adjacent provisional crown on a bone level implant (so with much less impingement due to not being countersunk and wider platform) which I intend for the remote dentist to leave in place.

  6. Hello. First asap remove the provisional crown. Secon. Place a healing abutment. Third. If you can not control the swelling give some AB and some ibuprofen. Fourth. Once the swelling is under control do the surgery and bevel the bone.
    Note. Very little chances are that the patient is allergic to acrylic. Cheers.

  7. The temporary crown is too short. Remove temporary crown and replace it with a long narrow healing cap. Wide temporary crown will not affect the emergence profile. The emergence profile is affected by the position of the implant shoulder relative to neighbouring teeth or alveolar ridge. The effect of a wide temporary crown is to provide a support for keratinised gingivitis to build a papilla. There are no neighbouring teeth in this case and because of that you do not to fill the papillary space. Put the patient on a course of antibiotic. Hope it goes well and we all have been in similar difficult positions.

  8. The gingiva must be reflected enough to see the implant table so that the bone that covers it can be cleared and the abutment seated without impinging on the tissues. This should have been done at second stage surgery. There are some implants that are designed for bone to grow partly over the crestal area of the implant such as Bicon and Quantum. Review the protocol for this implant system. Bone over this part of the implant may be the problem.

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