PATIENT WITH MULTIPLE IMPLANTS-CASE REPORT ... of fabrication of Implant supported provisional ... 1) Easy Abutments were selected as Prosthodontic ... However, the selection of ... retained fixed provisional prosthesis supported.
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J Indian Prosthodont Soc - Supplementary - 2 (2012)
CLINICAL REPORT INNOVATIVE TECHNIQUE FOR THE FABRICATION OF IMPLANT SUPPORTED PROVISIONAL RESTORATION, IN PROSTHETIC REHABILITATION OF PATIENT WITH MULTIPLE IMPLANTS-CASE REPORT Jay Vikram, Abhilasha Vikram
Abstract : Prosthetic rehabilitation of patients, requiring multiple implant restorations, demand placement of Provisional restoration, prior to placement of definitive final restoration. This article presents a method of fabrication of implants supported provisional restoration, using an innovative technique.
additional implant components and are time consuming. Moreover, provisional restoration built on temporary copings is cemented on the abutments & therefore cannot be easily removed and placed back time and again. This article presents a method of fabrication of provisional restoration over implants using an innovative technique.
Keyword : Provisional Restorations, Implants, Healing Caps
Case
Introduction In case of treatment requiring multi-unit Implant restorations, all the implants cannot be permanently restored at the same time .There is, also, some time required in fabrication and placement of permanent restorations. Therefore, in such cases, it is empirical to place provisional restoration and subsequently replace it with permanent restoration. The standard procedure of fabrication of Implant supported provisional restoration is by using either temporary abutments or copings [1]. However, both the techniques require Dr. Vikram Jay. M.D.S Associate Professor, Department of Prosthodontics, School of Dental Sciences, Sharda University, Greater Noida, U. P.
A patient came to our dental office with 11 implants, Branemark System (Nobelbiocare) placed in his mouth (Figure 1)-
Figure 1 Along with the above implants he had Transitional implants on which a temporary prosthesis was fabricated, which, unfortunately was broken (Figures 2).
Dr. Vikram Abhilasha B.D.S, C.C.O.I Private Dental Practioner
Figure 2
J Indian Prosthodont Soc - Supplementary - 2 (2012)
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Since the temporary prosthesis was beyond repair and the Transitional implants were not stable the following treatment plan was made. a)
Removal of the Transitional implants and the existing temporary restorations
b)
Fabrication of new provisional restoration.
c)
Extraction of 13,12 and further replacement with Replace - select Tiunite implant system (Nobelbiocare)
d)
Replacement of provisional restoration with permanent restoration. For this Easy-abutments were selected due to ease in fabrication of cast metal superstructure over the multiple Branemark Implants. Moreover, the Easyabutments were also the Prosthodontic option over the Replace- Select Tiunite implants, also a part of Nobelbiocare Implant System.
Once the transitional implants, along with the broken provisional restoration, were removed (Figure 3), Implant supported provisional restoration was fabricated in the following way.
Figure 4 3)
Plastic Healing caps, which were included in the abutment package, were fastened on the Easyabutments using the fastening screw. Retentive grooves were made on the plastic healing caps. (Figure4).
4)
Alginate impression was made and working cast was obtained, which was then articulated at established vertical &horizontal jaw-relation.
5)
Modeling-wax channels were attached to the screw slots of the replicas of the healing caps on the working cast, in such a way that the channels extend beyond the planned occlusal plane. Undercuts were blocked. (Figure 5). Figure 5
Technique 1)
2)
Figure 3
Easy Abutments were selected as Prosthodontic option for restoration over the Branemark Implants. Easy-Abutments were fastened on the implants using abutment screws. The abutment screws were tightened to 35 Ncm using the Manual Torque Wrench Prosthetic and Unigrip Machine Screwdriver.
6)
Separating media was applied over the cast.
7)
The provisional restorations were fabricated on the working cast over the replicas of the easy abutments with the healing caps fastened on it, using Autopolymerising Resin. The holes created by the Modeling-wax channels on the occlusal surfaces, formed the screw access channels for tightening of the fastening screw .These screw
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J Indian Prosthodont Soc - Supplementary - 2 (2012) fastened the provisional restoration over the Easy-abutments. (Figure 6&7).
abutments using the Unigrip Machine Screwdriver. The screw access channels were blocked with gutta percha. (Figure 8).
Figure 8 Figure 6 Figure 7
8)
The provisional restorations were filled with Autopolymerising resin and were seated over the plastic healing caps in the patient’s mouth so that, the screw access channels were not blocked. Once the Autopolymerising resin hardens, the screws, fastening the plastic healing caps to the easy abutments, were loosened using the Unigrip Machine Screwdriver and provisional restorations, with the attached plastic healing caps, were removed.
9)
The provisional restorations were washed with water. It was ensured that the healing caps were firmly attached to the tissue surface of the provisional restorations.
10) The excess acrylic was trimmed and the provisional restorations were polished. 11) The provisional restorations were screwed, with the corresponding fastening screw, on the easy
12) The provisional restorations were checked for function, occlusion & esthetics. Occlusion was established such thatA)
Minimum contact in centric occlusion,by reducing the occlusal table of the posterior teeth.
B)
Removal of all the interferences in centric as well as eccentric movements by spot grinding.
13) After establishing the occlusion with the provisional restorations, they were sequentially replaced with the permanent restoration thus reestablishing the same occlusion as established with the provisional earlier. (Figure 9)
Discussion
Figure 9
Provisional restoration provides the patient the first real glimpse of the treatment outcome The
J Indian Prosthodont Soc - Supplementary - 2 (2012) Dentists face the greatest challenge, while fabricating the provisional restoration. Unlike their use in conventional crown and bridge, provisional restorations during Implant therapy have been less understood. The techniques available today include removable, tooth-supported, and implant-retained provisional restorations [2-6]. Studies have suggested that implant retained provisional restorations are best tolerated by the patients. [7] However, the selection of the type of provisional prosthesis should be based on esthetic demands, functional requirements, duration, and ease of fabrication. Provisional restorations should be used to evaluate esthetics, phonetics and occlusal functions prior to delivery of the final implant restorations, while preserving and/or enhancing the condition of the peri-implant and gingival tissues. Provisional restorations are useful as a communication tool between members of the treatment team which, in most cases, consists of the restorative clinician, implant surgeons, laboratory technicians, and the patient. The standard procedure of fabrication of provisional restoration in patient having multiple implants is by using either temporary abutments or copings. But, both methods require use of additional components. The provisional restoration built on temporary abutments enables the operator to screw, in & out restoration at will. It becomes cumbersome for the operator to switch over from temporary to permanent abutments during trial stages of the final restoration. When temporary copings are used in fabrication of the provisional restoration, the restoration has to be cemented on the implant abutment, thus, making it difficult to repeatedly remove &place during the trials of the final restoration, without putting additional load on the implant/abutment. The above technique has a clear cut advantage over the two standard techniques in following ways: 1)
There is no additional component used in fabrication of the provisional restoration, other then the Plastic Healing Cap, which is provided along with the abutment in the package.
2)
The provisional restoration is screwed on the abutment, enabling the operator to remove and
169 place the restoration without putting extra load on the implant/abutment. 3)
The final position of the abutments is not disturbed on repeated removal & placement of the provisional restoration.
4)
The patient as well as the clinician can better visualize the shape, size & functions of the final restoration with this kind of provisional restoration in place, and thus the clinician can accordingly bring about the desired changes in the final restoration. However this technique is limited to the use of Easy-Abutments in Prosthodontic rehabilitation of multiple Implants of Nobelbiocare Implant System.
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2)
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