Options for Provisional Restoration?

When you say all these temporary options failed- do you mean failed structurally or cosmetically? I am not sure how an Essex would fail other than esthetics. How did the indivual temorary crown fail? The only other option I can think of is a bonded pontic between 7-10. It could be lab manufactured or made of composite. I look forward to hearing you elaborate on the failures.

Hi.. The best solution is Maryland bridge.Acrylic or composite -8- have a wings which are fixed to palatal areas of 7 and 9. Second solution is a removable ,transparent splint / something like for bleaching/.Missing teeth is filed by acryl or composite. Kris

I agree with the Maryland bridge....but one thing to consider. Very popular in Japan. A one winged maryland bridge. They do not debond because the stress is not there when the teeth move. I have made many and they work great. Of course you need some room so you do not have a traumatic occlusion situation.

Yes,I agree with You. One wing....and good adhesive luting.

Dr. Hoos' single wing Maryland bridge works great. We make it from Triad material and either bond to natural teeth or glue to a crown

A very similar thing is to use a composite tooth, pre-made tooth, whatever your fancy is and secure it to the lingual side of the adjacent teeth with Ribbond. Quick and easy like maryland

I actually use a rochette modified, maryland type bridge(made in casted metal with acrilic o art glass covering), The rochette modification is a series of holes in the wings that allow for mechanical fixation of the luting agent.It has the advantage of being luted instead of cemented (i use rely x luting or unicem) and it can be removed and placed many times (acrilics or resin ones get destroyed after the first removal) for recontouring or other procedures cheers

please check the occlusion.. and then use the desired temporary prosthesis.

I use a acrylic tooth for #8 (for denture), matching the shade and use Ribbon adhesive tape to bond #7, 8, 9 on palatal aspects. You may adjust the #8 coronal portion, or even adjust (add) acrylic resin on #8's palatal or cervical area for shaping the gingival shape for future soft tissue preparation. Finally check the bite and make sure no functional interference. Hope this help. Kenyu

u can use ribbond for a resin retained provisional.or Maybe an all ceramic maryland brige with just one flap.

I still haven't seen a post as to what was meant by failure. Any of the 3 temporary prostheses you provided should have worked if properly made and adjusted for fit and occlusion. However any of them could easily fail for reasons of patient acceptance. Most temporary upper central incisors are less than ideal from the patient's perspective, but they have to realize that options are limited and its only temporary.

you could also bond the crown of the extracted tooth as a pontic. I too would like to hear how the essix retainer failed??

Hello Colleagues, beside the aesthetic considerations, occlusion is always the problem in these provisional cases. All techniques work if the occlusion allows, when it is collapsed or attrition has occured that's when all techniques fail. I have not read what the orignator meant by failure but I am assuming he meant cracked or dislodged. One of the common areas of mis-diagnosis is occlusion disease. We are careful to spot decay, marginal discrepencies and discolored teeth but we all miss the occlusion reality sometimes. This is the one that haunts us with every restoration. Sometimes restoring vertical dimension and dealing with occlusion wear and bruxism before we start the case could alleviate some other common problesm we face every day. When it comes to implant occlusion , I have yet to see a publication and or any text that addreses this. We are working on a classification for this because it is such a necessary area for education and yet there is no hard data to help us make sense of it. I'm as confused as anyone..but I keep looking for answers..hope this helps. Bonded bridge is our first choice as well.

all mentioned subjects are important , aesthetic , occlusion , inter arch space , smile line , .... but we should remember that in central incisor site , the most critical aspect is soft tissue esthetic , or pink esthetic , which is related to emrgence profile . so immediate loading is the best choice , not cause of stability or comfort of the provisional restoration , but for contouring the soft tissue . ( do not forget the implant primary stability )

A temporary cylinder fixated to the implant should be stable enough to hold. The problem you had was probably during the construction of the temporary crown. If you fabricate it with acrylic you must roughen up the cylinder so the acrylic can have the proper mechanical retention. Then you can contour the temporary for proper embrasure form to promote the papilla. This has worked well for me in my Montreal private practice. The occlusion is very critical and this is where most problems can occur. Make sure you tell the patient that this is just for show and not for excessive forces. Good Luck

It seems to me that immediate load is the problem here. First our definitions are fuzzy due to advertising hype. Immediate load is shown to promote bone deposition under very specific circumstances. Angular incisal centric is NOT one of them, the forces need to be along the long axis of the root, so the concept applies only to posterior occlusal table interfaces. Therefore the anterior temporary must be out of occlusion, NOT immediate load, (although a buccal facing incisal edge to edge force could work it is practically difficult to achieve with confidence especially since it might be different in function at home with a food bolus). I use the Sargon Implant, it is expandable at the root apex like a molly bolt. In between the cortical plates in the anterior maxillary esthetic region it performs predicably excellent, results in ideal "pink tissue" when the provisional is fabricated intentionally, supports a single tooth restoration without exception, does not require sacrificing the adjacent tooth enamel as in a maryland bridge, does not stress the soft tissue (especially the papilla) as in a removable partial denture does and which often is too thin to work with out breaking off the denture base. I have a modified abutment for the rare angulation change at 20 degrees off the root axis. I do ninety percent extraction and placement in the same surgery including same day provisionalization. Ten percent are edentulous sites, under an old bridge, for instance. The implant itself can be tightened at weekly intervals (the molly portion further expanded), early on if angular forces of occlusion compromise stability. I have even hollowed out a PJC off the extracted cental incisor relined it with composite and eventually used it as the permanent restoration because it made such a perfect temporary, and the elderly gent wanted to economize. That is about six years old now. Oral hygiene is optimized, the temporary does not cause irreversible implant destabilization, the soft tissues can be developed to complement the final crown, esthetics, phonetics and 'function' are restored, all in a one stage process. No second surgery and healing shrinkage, no healing caps to disguise... This is the elegant solution to anterior implant esthetics in a single stage.

To give credit where credit is due, A.L. Rochette was the inventor of the resin bonded bridge around 1971 and published in JPD 1973. The so-called Maryland Bridge is a modification of Rochette's invention. I think any of the above solutions to provisionalize site # 8 could work successfully. Each has its strong points and disadvantages. The questions are which advantages and disadvantages are important to the patient and practitioner and why did the "immediate temporary crown with immediate loading", the flipper and Essix appliances fail? It was stated that the "immediate temporary crown with immediate loading failed." What aspect failed since it was also stated that the implant is still in place and waiting for osseointegration to take place? Did the temporaries physically break? There must be enough restorative space for strength and retention for each of the various types of temporaries to be successful. Checking the occlusion is essential.

I just had implants placed in 7 and 9 and due to my tight close bite, surgeon elected not to immediately load. Valplast little partial worked ok but needed Fixodent to stay in place and placed alot of pressure on the surgical site. I just got fitted with my alternate solution choice to the partial and that solution happens to be a Snap on Smile. So far, so good!, Works great day to day once you get used to the appliance. You can eat with it, speak with it normally and best of all, no worries it will fly out if you eat which can wash out the fixodent or worst of all sneeze! For a short term restorative solution when all else fails I say it's a great option! SAB

Failure means that the temporary and implant had to be removed. If you have a cosmetic failure that is a different problem. Anterior teeth are the most difficult areas to work with. If you do not have an understanding or workable patient then you do not place an implant. Flippers make it difficult to maintain anterior aesthetics. The essix works the best in these cases for me. If the occlusion allows room you can place any type of bonded restoration. Why did you have to remove #8? If this tooth had RCT and fractured because of a post and core, then the occlusion is the problem. Don't just fill the space, solve the problem first then place the implant. JAV

I too have lost an implant following immediate provisionalization. In assessing the cause of failure, it was determined (an patient admitted) that she did not follow our post op instructions and bit into various foods. Following surgical implantation, the implant is provisionally restored and the provisional crown is removed from all occlusal contacts. The patient is cautioned not to bite into food and to elimninate biting until integration. When this policy is adhered to, our immediate provisionalization treatments have been successful.

Sometimes when such simple things fail, you could assess whether your skills require further training. Pushing the envelope of safe dentistry is not so bad when you have some clinical skill base to work from. Trying a CE course may prevent trouble. Sales reps with a cup of coffee are no substitute for sound accredited CE.