Immediate Implant Placement and Provisionalization - Zimmer Dental

CE 1Figure 7E—Closure and left lateral centric occlusion view.Figure 7F—Case complete clinical view of the immediaterestored implants placed in conjunction with sinus elevationsurgery at 5½ months.Figure 7G—Case complete periapical radiograph.implant carriers, the preprepared HLA stockabutments are seated, and the provisionalrestoration is inserted to confirm implant placement,before retrofitting with a composite material(Figure 7D). After the conversion of the surgicalguide to the provisional restoration, cementationof the restoration is achieved with a strongtemporary cement. Application of PRP over thelateral aspect of the maxillae precedes additionalgrafting with the PRP/PepGen graft complex atthe osteotomy site in the lateral wall of the maxillae,and the peri-implant defect sites. Closureis accomplished with 4.0 Vicryl Rapide sutures(Figure 7E). Note that in centric occlusion,disclusion is present from Nos. 13 to 15. In thenormal chewing cycle, small amounts of loadwill undoubtedly be present, and the authorobserves that enhancement of the maturationphase of the graft occurs, based on earlierdefinitive load times.After careful observation for 4½ months, thepatient is referred for completion of implantprosthetics. The final implant-supported restorations(Figure 7F) are seated 5½ months after theinitial, and only, surgical procedure. The casecomplete periapical radiograph shows the sinusgraft well incorporated at the level of theimplants (Figure 7G).ConclusionImplant treatment has previously beenseparated into the surgical and restorativephases. Depending on the complexity of theplanned site, the surgical phase may requiretwo to four procedures in conventionalimplant treatment. The restorative phase,especially in the esthetic zone, may requiretissue sculpting and provisionalization toachieve the foundation not only for esthetics,but also for long-term restorative success. Overthe years, conventional implant treatment hasproven to be a highly successful treatmentoption for replacing the natural tooth system.Advancements in surgical techniques,bone grafting materials, and bioengineering ofthe surgical site, have allowed the implantsurgeon to decrease treatment times and possiblysurgical visits. However, without propercommunication among the surgeon, restorativedentist, and laboratory technician, poor orimproper treatment planning leads to complex,and/or compromised prosthetic procedures.Continued advancements in surgical stentdesigns and the incorporation of provisionalrestorations during implant placement haveallowed the implant team (ie, surgeon, reconstructivedentist, and laboratory technician) tobetter communicate the parameters for thefunctional, biological, and esthetic success inimplant restorations.The immediate restoration of dentalimplants is an exciting option the implantteam can offer patients seeking implant treatment.The incorporation of a provisionalrestoration during implant placement providesthe patient with a stable, esthetic temporaryrestoration. From a periodontal perspective,the author observes that the preservation of10 Compendium / February 2003 Vol. 24, No. 2