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A technique was presented that enables a dentist to characterize a temporary restoration and its duplicate with external surface stains. This adjusted duplicate and an accompanying zone-diagrammed laboratory work authorization order will provide the dental laboratory technician with accurate information for making a porcelain restoration with esthetic acceptability.
BACKGROUND: Recent literature has increased our understanding of how the osseous crest responds to implant placement. Proper pre-prosthetic conditioning of these tissues is required to achieve predictable esthetic results in the anterior region. CASE DESCRIPTION: The author presents a case of a 38-year-old male with traumatic loss of a central incisor replaced with an ITI implant. The case demonstrates the fabrication of a provisional temporary crown designed to optimize the development of ideal soft tissue form. CLINICAL IMPLICATIONS: The difference between implants and teeth in terms of sulcular makeup (osseointegration vs. periodontal ligaments and circumferential fibers vs. transverse ligamental fibers) requires modification of procedures for temporary crown fabrication.
The problems that arise from using traditional methyl methacrylate material to construct temporary restorations are discussed. The need for exceptional, esthetic and well-fitting temporaries in a contemporary dental practice is stressed. A practical method for constructing temporary restorations is described in detail. The advantages of the author's method are described.
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This article describes the treatment of a 10 year-old patient with complete root resorption of the maxillary permanent incisor following avulsion and replantation 4 years earlier. The remaining natural crown was used to immediately solve the esthetic problem created by its extraction. The crown was attached with an orthodontic wire and composite resin to adjacent teeth. This temporary treatment does not elicit any damage to adjacent teeth, and can be easily removed. Therefore, it does not affect any plans that might be considered in the future as the permanent treatment.
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BACKGROUND: The replacement of single teeth with implants in the anterior maxilla poses a significant challenge to the clinician because of its esthetic implications. PURPOSE: The purpose of this article is to report a protocol in which single teeth are replaced by implants and temporarily restored without load, immediately after extraction. MATERIALS AND METHODS: Between June 2001 and July 2002, 16 cases were followed up in which this protocol was used. Briefly, the teeth are extracted with a Periotome (Friadent, Mannheim, Germany), using a flapless technique, the sockets are evaluated and débrided, an osteotomy is performed following the direction of the socket, and a tapered implant is placed using the alveolar crest as the landmark. A temporary abutment is immediately custom made, and a temporary crown is placed without loading. The 16 cases are summarized, and 4 of them are presented to illustrate this approach. RESULTS: All four cases have provided excellent esthetic results maintaining an ideal implant-to-supporting-tissue relationship. Furthermore, the overall time needed to restore the cases was considerably reduced when compared with time needed for the conventional approach. CONCLUSION: The four cases presented support the use of the described protocol in the placement of single implants in areas of the maxillary anterior region where esthetics is a high priority.
While single tooth replacement can be predictably accomplished using implant therapy, this procedure is challenging in the esthetic zone where numerous criteria must be evaluated by the restorative team. If the gingival and osseous architecture of the failing tooth is acceptable, the therapeutic goal is to maintain the existing morphological condition. The optimal tridimensional implant is placed in the esthetic zone immediately after extraction or 8 to 12 weeks after extraction. The abutment connection and the nonfunctional temporary tooth restoration are prepared in advance and should respect the forms of contour of the contralateral tooth. In some specific clinical cases, not only can the patient's smile be returned after only a few hours of clinical work, but more importantly, initial capital of soft and hard tissues can be preserved. After healing, maturation, and stabilization during the 3 to 6 months of osseointegration, a compressive impression of the implant site can be taken and the implant restoration can be cemented. A multi-centric study performed by several dentists during the past 3 years have drawn interesting statistics on the rate of success, the different type of implants, and the variation of the peri-implant bone and gingival contour.
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Long-term functional and esthetic success with implant-supported single-tooth restorations requires a comprehensive and interdisciplinary treatment approach. Important parameters include the initial clinical situation, the surgical approach, the provisional phase, and the choice of abutment material and design as well as the definitive restoration. This article presents the main aspects of current treatment protocols and discusses material options and clinical techniques to achieve predictable outcomes.
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This article describes a technique for modification of metal interim cylinders and their use in the fabrication of cementable implant-supported provisional restorations. This chairside technique allows for direct provisionalization of single or multiple implants during or after second-stage surgery, especially when there is a high esthetic demand.
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The successful integration of periodontal and restorative dentistry for both natural teeth and implants requires knowledge and application of both mechanical and biological principles. In areas of aesthetic concern, an adequate band of attached gingiva can increase patient comfort, reduce the probability of gingival recession following tooth preparation and simplify restorative procedures. While some restorative margins need to be placed at or below the margin of the free gingiva, this should be considered to be a compromise, and margins should not be placed more than 0.5 mm into a healthy gingival sulcus. Approximately 2-3 mm of healthy, natural supra-alveolar tooth surface is needed for attachment of the gingival tissues to the tooth. This dimension is called the biological width. If adequate biological width does not exist, surgical or orthodontic procedures to expose healthy tooth structure are recommended before final restorations are placed. Retraction of soft tissues for impressions is best accomplished with mechanical methods rather than lasers or electrosurgery because of the potentially harmful effects of these devices to the cementum, bone and soft tissues surrounding the teeth. Implants function best and withstand occlusal forces optimally when loaded in a vertical direction. Therefore, planning implant placement is critical for success. Because of increased proprioception, it is suggested that natural teeth be used to guide the occlusion in partially edentulous patients. Cantilevers should be used with caution and with appropriate attention to occlusal forces. While occlusal trauma does not cause periodontal disease, it may contribute to bone loss around teeth and implants. In the opinion of the authors, provisional restorations are an integral part of dental and periodontal therapy. They can be used to establish aesthetic and physiological contours that can be easily cleaned by patients and they can also be used as a guide for any needed surgical tissue modification.
The important role of provisional restorations is often overlooked. This may be because they are left until the end of an appointment when time for construction is short or because they generally do not need to last for long. However, not only can good provisional restorations help produce better final restorations, they can also save a lot of time and expense at subsequent appointments. In fact time spent in their construction will be more than repaid in time saved doing additional procedures, adjustments and remakes later on.
A technique is presented for fabricating a provisional restoration for a buccally angulated implant. This technique describes the fabrication of a provisional restoration for a labially angulated implant. This technique helps the prosthodontists to achieve esthetics and soft-tissue health until the definitive restoration is available.