JCDA - Canadian Dental Association

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Clinical s h o w c a s E Provisional Restoration for an Osseointegrated Single Maxillary Anterior Implant Robert David, DDS “Clinical Showcase” is a series of pictorial essays that focus on the technical art of clinical dentistry. The section features stepby-step case demonstrations of clinical problems encountered in dental practice. If you would like to contribute to this section, contact editor-in-chief Dr. John O’Keefe at jokeefe@cda-adc.ca. Figure 1: Patient’s appearance before removal of tooth, grafting and placement of implant fixture. The preparation of esthetically appealing and anatomically correct implant-supported provisional restorations facilitates fabrication of the final implant-supported crown. The provisional restoration is used to mould and manipulate the soft tissue and acts as a blueprint or template for the final crown (Fig. 1). 1,2,3 This type of restoration should be placed several weeks before the final impression is taken, to allow for maturation of the peri-implant tissue. My preferred method involves chairside fabrication of a fixed provisional restoration using an acrylic denture tooth affixed to a screw-retained temporary cylinder. The acrylic denture tooth is attached to the temporary cylinder with autopolymerizing acrylic, which is then retained to the implant fixture with a screw. The following technique provides an esthetic, functional and stable provisional restoration. Figure 2: The temporary cylinder has been screwed to the implant fixture. Details of the Procedure 1) Remove the healing abutment and immediately replace it with a screwretained temporary cylinder (Fig. 2). Any delay may result in collapse of the gingival tissue over the fixture platform, which will make it difficult to seat the temporary cylinder. 2) Adjust the cylinder by reducing its length enough to allow the teeth to meet in centric occlusion. 3) Roughen the cylinder surface to enhance adhesion of the acrylic (Fig. 3), and then seal the lingual screw hole with boxing wax to protect the screw from the autopolymerizing acrylic that will be used (Fig. 4). 4) Select an appropriate acrylic denture tooth with matching shade, colour and form. Reduce the lingual surface of the acrylic denture tooth, keeping the labial veneer intact (Fig. 5). The lingual surface should be concave and should fit around the temporary cylinder with the labial Figure 3: The temporary cylinder has been adjusted into occlusion and the surface roughened to enhance adhesion of the acrylic. <strong>JCDA</strong> • www.cda-adc.ca/jcda • September 2008, Vol. 74, No. 7 • 609
Page 1 and 2: PM40064661 R09961 JOURNAL OF THE CA
Page 3 and 4: Publisher Canadian Dental Associati
Page 5 and 6: 605 c o n t E n t s JCDA Journal of
Page 7 and 8: 651 c o n t E n t s All matters per
Page 9 and 10: Dr. James Lund “Our students acqu
Page 11 and 12: Dr. Deborah Stymiest “While CDA
Page 13 and 14: l E t t E r s The Modern Realities
Page 15 and 16: By the time oral cancer is diagnose
Page 17 and 18: My Team Loves A-dec Workflow can ma
Page 19 and 20: News & u p d a t E s Seniors’ Ora
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Page 23 and 24: Mobile oral Cancer screening --- Ne
Page 25 and 26: --- News & Updates --- urban smiles
Page 27 and 28: • Issues in Brief • --- News &
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Page 31 and 32: --- News & Updates --- American Col
Page 33 and 34: CDA Patient Information Brochures E
Page 35 and 36: Build Patient Confidence and Trust
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Page 47: --- Dentistry Outreach --- Ms. Fion
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Page 57 and 58: Point of Care The “Point of Care
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Page 65 and 66: Figure 5: Moderate inclination of t
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Page 78 and 79: Duty of Care Dentists, like all cli
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JCDA - Canadian Dental Association

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