Ralf Schuler

Indirect implant-supported fixed provisional restoration in the esthetic zone: fabrication technique and treatment workflow.

UNLABELLED Treatment objectives of an implant-supported fixed provisional restoration include shaping/preservation of the gingival soft tissue contour, functional and esthetic substitution of the missing dentition during postsurgical healing, and definitive prosthesis fabrication stages. Fixed provisional restoration can also serve as an esthetic and functional blueprint in the fabrication of the definitive restoration. Despite its common use and important indications, limited information is available on the various aspects of the provisional fabrication and treatment. This article presents a production technique and treatment workflow of a laboratory-fabricated, screw-retained fixed provisional restoration. Provisional restoration is fabricated using layering technique and internal stain characterization. The soft tissue profile of the working cast is modified according to the coronal contour of the diagnostic wax-up. Upon delivery, the provisional contour is reevaluated and modified as necessary. The developed emergence profile of the provisional restoration is transferred to the master cast via customized impression copings. CLINICAL SIGNIFICANCE Laboratory-fabricated implant-supported provisional restorations allow the esthetic and functional substitution of the missing dentition and the shaping of the soft tissue profile, and can act as a blueprint in the fabrication of definitive restorations.

Treatment Options Related to Cement Contamination and Repair of Lesions

Periodic evaluation of the implant and restoration should be made to monitor overall health. The examination should include mobility (restoration as well as implant), probing (depth and especially bleeding on probing), plaque score, radiographic and visual tissue examination (color, texture, tissue dimension changes), recession, and suppuration. The ability for the patient to adequately clean and maintain the implant site is also vitally important, and this too should be assessed regularly. The level of therapy required to restore implant health will be determined by the severity of the issue, which can often be determined during these examinations. Sequential information and how this changes between examinations will also give an indication of progression, although it must be remembered that peri-implant disease may have a unique pattern of onset time and progression, very different from periodontal disease.