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
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.
Provisional implants, osseointegration, temporary prosthesis
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 treatments3,4. 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.
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.
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 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 treatments13,14.
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
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
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.
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