Title

Provisional Implants in Dental Implant Therapy

Authors

José Manuel Mendes¹, Marco Infante da Câmara², Filomena Salazar², Tomás Escuin Henar³

¹ DDS, Msc, Phd, Coordinator of the Oral Rehabilitation Specialty .High Institute of  Health Sciences North (ISCSN) - Portugal                

² DDS, Msc, Phd, Professor of the Oral Surgery  Department. High Institute of  Health Sciences North (ISCSN) - Portugal

³ DDS, Phd Coordinator of the Oral Rehabilitation Specialty Barcelona University Espanha

Abstract

Provisional implants are an indispensable tool to get adequate retention of fixed provisionals during osseointegration of primary implants. Provisionals implants have numerous applications and different surgical protocols related with the provisional implants brand. Provisional implants increase patient confort, function esthetics during osseointegration as well as prevent overload of the primary periimplant tissues.

Key-Words

Provisional implants, osseointegration, temporary prosthesis

Introduction

 Osseointegration is one of the Keystones in Oral Rehabilitation, which allowed deep changes in Treatment Plan. Success in Osseointegration  with endosseous implants was published in 1969 by Branemark and Cols.¹

Implant Dentistry changed Oral Rehabilitation treatments with several advances towards not only function but also esthetics². In the last four  decades implant dentistry is a common treatment in both fully as in partially edentulous treatments^3,4. Implants are a feasable treatment with high success rates ^5,6,7 . Insuccess cases usually happen in the first few weeks after first stage surgery ⁸.

Immediate  implants present several advantages over delayed implants with a considerable reduction of patient discomfort by decreasing surgical procedures ⁹.

Fully edentulous fixed rehabilitation with dental implants are nowadaysdone with four to six implants. A waiting period of 3 to 4 months of waiting period for osseointegration is a safe approach to achieve high success rates ¹⁰.

Immediate provisional implants allow immediate fxed function and esthetics with no load on the primary implants.

Indications

 - Immediate support for a fixed Prosthesis.

 - Immediate esthetics and stability of provisional prosthesis.

 - Soft tissues protection.

 - Protection of overload on the bone surrounding the primary implants.

Contraindications

•-              Inadequate bone volume.

•-              Incapacity of placement of enough provisional implants to sustain fixed

           Prosthesis.

•-              Inadequate space between primary implants.

•-              Lack of cortical bone for implant stabilization.

Provisional implants

Provisional implants are used  with the purpose of delivering a fixed prosthesis in immediate loading with no risk to the primary implants. The provisional implants are removed after the osseointegration period. The Provisional implants allow immediate esthetic and function. Provisional implants can be of some assistance in the retention of Surgical guides (Fig 1)¹¹.

Fig1 Surgical guide with barium sulfate stabilized by 6 provisional implants

Provisional implants are usually placed in the same surgical procedure as the primary titanium implants. Can also be used after dental extractions which allows delivering fixed provisional prosthesis (Fig.2)¹².

Provisional implants can be used as anchorage in orthodontic treatments^13,14.

Fig.2 6 Provisional implants placed after dental extractions

Oral Rehabilitation with provisional implants

Provisional implants are more commonly used in fully edentulous patients. Promotes protection the the primary implants.¹⁵

Several implant companies have different provisional implants.

Nobelbiocare, Gotemburg, Sweden developed a Provisional implant Kit with the following features:

•-              Single piece implant containing the abutment

•-              2.8mm diameter

•-              14mm of length

Provisional prostheses with this system are usually cimented.¹⁶

Provisional implants with attachments

Attachment system in provisional implants can be used in cases of extraction and immediate implant placement when provisional fixed prosthesis is required (Fig.3). During first stage surgery of the primary implants the provisional implants are placed. In this stage the attachments are placed inside the provisional prosthesis (Fig4) and secured in place with self curing resin. The fixed provisional prosthesisis cimented with provisional ciment (Fig5).

Provisional implants can function with just friction between male and female with no need for ciment.¹⁷

 The procedure is similar in partially and fully edentulous patients. The purpose is to provide a fixed provisional in order to obtain,stability, esthetics and comfort. ^18,19 Metal reinforced provisional (Fig 6) provides more stability.

Provisional implants with connecting bars (MTI - Monorail TM Transitional Implant System)

Provisional implants using connecting bars promotes stability and retention.

Dentatus provisional implant System has the following features:

•-       Gingival protective sleeves

•-       Connective bars

•-       Modular coppings

MTI should  be placed 1.5 to 2mm away from the primary implants. The system allows divergency and angulation between the provisional implants.Mti Kit has a special tool to correct and achieve paralelim between provisional implants.

MTI system allows a load free osseointegration period of the primary implants as shown in the clinical case presented (fig 7). ¹²

Discussion

Oral Rehabilitation with provisinal implants require mulidisciplinary treatment between surgery and prosthodontics. The treament plan requires precision in the placement of the primary implants, provisional implants and the fixed provisional. The treatment with provisional implants allows immediate esthetics and function and guides us to the definitive prosthesis and protects the primary implants.^15,20

Conclusion

Provisional implants don´t compromise the integration of the primary implants and provide a fixed oral provisional wich is an important tool in implant therapy specially in cases of guided bone regeneration.

Bibliografia

1. Branemark PI, Adell R, Brein U, Hansson BO, Lindstrom J, Ohlsson A. Intra-osseous anchorage of dental prostheses. I Experimental studies. Scand J Plast Reconstr Surg 1969; 3: 81-100.

2. Uludag B, Gozde G. Fabrication of a cement and screw-retained multiunit Implant restoration. JOI 2006; 32(5):248-50.

3. Mericske-Stern R. Overdentures with roots or implants for elderly patients: a comparison. J Prosthet Dent 1994; 72:543-50.

4. Heydecke G, Boudrias P, Awad MA, De Alburquerque RF, Lund JP, Feine JS. Within-subject comparison of maxillary fixed and removable implant protheses: Pacient satisfaction and choise of prothesis. Clin Oral Implants Res 2003; 14:125-30.

5. Wood MR, Vermilya SG. A review of selected dental literature on evidence-based treatment planning for dental implants: Report of the Committee on Research in Fixed Prosthodontics of the Academy of Fixed Prosthodontics. J Prosthet Dent 2004; 92:447-62.

6. Esposito M, Hirsch JM, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. Success criteria and epidemiology. Eur Oral Sci 1998; 106: 527-51.

7. Quirynen M, De Soete M Steenberghe D. Infectious risks for oral implants: a review of the literature. Clin Oral Implants Res 2002; 13:1-19.

8. Weyant RJ, Burt BA. An assessment of survival rates and within-patient clustering of failures forendosseous oral implants. J Dent Res 1993; 72:2-8.

9. Chen ST, Darby IB, Adams GG, Reynolds EC. A prespective clinical study of bone augmentation techniques at immediate implants. Clin Oral Impl Res 2005; 16: 176-84.

10. Thomas D, Agar JR. Twenty years of progress in implant prosthodontic. J Prosthet Dent 2002;88:89-95.

11. Yeh S,Monaco EA, Buhite RJ. Using transitional implants as fixation screws to stabilize a surgical template for accurate implant placement: A clinical report. J Prosthet Dent 2005;93:509-13.

12. Simon H. Use of transitional implants to support a surgical guide: Enhancing the accuracy of implant placement. J Prosthet Dent 2002;87:229-32.

13. Lee LS, Park HS, Kyung HM,. Micro-implant anchorage for lingual tratment of a skeletal class II malocclusion. J Clin Orthod 2001; 35;643-7.

15. Babbush CA. Provisional implants: surgical and prosthetic aspects. Implant Dent 2001;10:113-20.

16. Babbush CA. Provisional implants: surgical and prosthetic aspects. Implant Dent 2001;10:113-20.

17. Ohkubo C, Sato JI, Hosoi T, Kurtz KS. O-ring attachments for transitional implant-retained overdentures. J Prosthet Dent 2004;91:195-7.

18. Balshi TJ. Converting patients with periodontally hopeless teeth to osseointegrated prostheses. Int J Periodontics Restorative Dent 1988;8:8-33.

19. Binon PP. The paramount role of transitional prostheses within implant prosthodontics-Part I. Dent Implantol Update 1995;6:49-53.

20. Chaimattayompol N. Transforming an existing fixed provisional prosthesis into an implantsupported fixed provisional prosthesis with the use of healing abutments. J Prosthet Dent 2002;88:96-9.

21. Siddiqui AA, Sosovicka M, Goetz M. Use of mini implants for replacement and immediate loading of 2 single-tooth restorations: a clinical case report. J Oral Implant 2006; 32;2:82-6.