Introduction:
Provisional restorations offer patients to try out the look and feel of the final prosthetic and make any necessary changes before the final fabrication and fitting. For example, patients who get their teeth extracted for dental implants may complain of immediate social or aesthetic concerns. In that case, after atraumatic extractions of the teeth, immediate implant prosthesis is given with provisional restoration, that is temporary tooth or crown in place of the permanent one. The provisional prosthesis is placed until the osseointegration (bone-implant fusion), which takes around four to six months.
What Is Immediate Implant Placement (IIP)?
Immediate implant placement (IIP) is a dental implant procedure that requires less chair time and sittings. Dental implants have multiple benefits that help preserve alveolar bone and maintain buccal bone volume after tooth extraction. Following this, dental implants are placed in the same sitting in this procedure after the tooth extraction to ensure the implant success as the bone height and volume do not change as in case of tooth loss and with age.
Immediate implant placement combines bone grafting procedures and soft tissue augmentation to achieve both implant aesthetics and functionality.
What Are the Concepts of Provisional Restoration in Dental Implants?
According to Degidi in 2014, the chamber concept states that providing a provisional prosthesis to the patient post immediate implant placement plays a crucial role in favoring bone formation within a three-dimensional biologic space of this prosthesis.
Some essential concepts involved in the placement of an immediate implant include -
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In the anterior segment of the jaw, placing an implant is challenging as the soft, and hard tissue healing should be adequate for good aesthetic outcomes.
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The smile and esthetic expectations of the patients depend upon the outcome of the anterior dental implant prosthesis because it can be a socially influential factor.
Hence achieving satisfactory esthetic outcomes after immediate implants either in the posterior segment or the technique-sensitive anterior segment is of utmost importance. Therefore, specific prerequisites like correct implant positioning and pleasing prosthetic contour of the dental implants are required.
However, the greatest challenge for provisionalization after immediate implant placement is the subgingival contours and the implant stability, which directly impact the healing or osseointegration phase.
What Are the Steps for Provisional Restoration Fabrication?
The steps for the fabrication of provisional restoration include three-dimensional scanning, printing, and transfer coping. The CAD-CAM (computer-aided design and computer-aided manufacturing) technology, alongside three-dimensional printing of surgical and radiographic guides, has helped perform dental implantation with predictable outcomes by preoperative assessment and analysis. Consequently, the surgeon does these steps to achieve the provisional restorations, correct positioning, and ideal soft tissue contour.
The preoperative planning before dental implantation ensures that the patient does not face any esthetic difficulties post the immediate extraction of the tooth. Along with that, it helps to provide soft tissue contour accuracy and to prevent any potential complications in osseointegration.
The steps involved in this procedure are as follows -
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The patient photographs are taken, and the dentist can perform a digital smile design analysis to give the best possible esthetic outcomes.
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The relationship of the gingival zenith to the tooth surface and the gingival margin position should be considered for producing the ideal soft tissue contour around the implant prosthesis.
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After that, the intra-oral digital scans can be obtained by the intraoral scanner for the maxillary and mandibular arches, and the intercuspal position should be ideally recorded.
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The three-dimensional printing of the digital file and planning of the virtual post-extraction socket can give the ideal overview of the next step for implantation and provisional restoration.
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Minimally invasive or atraumatic extraction procedures should be performed. The ideal implant position, as preoperatively planned by the dentist, can be transferred using three-dimensional model transfer coping and implant analog.
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After dental implantation, the fabricated provisional crown can be placed in the area to re-establish the esthetic facial profile of the patient in the implanted region.
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After four to six months, when the osseointegration has occurred, the final prosthesis (ceramic or zirconia) can be placed instead of the provisional restoration.
In addition, the peri-implant soft tissue contour and emergence profile play a fundamental role in patient esthetics for the provisional and final restoration. It is also clinically challenging for the dentist to produce accurate esthetic and functional results owing to the continuous process of bone remodeling and implant bone contact.
Conclusion:
In conclusion, provisionalization, digital scanning, and three-dimensional planning for immediate implants is an advancement in implant dentistry that is of esthetic benefit to the patient. Provisional restoration not only fulfill the patient's esthetic desire, but also enhances the molding and healing of the soft tissues encircling the implant placement area. It also preserves the bone support and alveolar dimensions, which otherwise would have undergone functional as well as structural changes posing challenges to the proper adaptation of the final prosthesis.
