Technique: Fabricating and Indexing a Provisional Restoration

INTRODUCTION
Many patients are demanding placement of an implant-supported fixed complete denture at the time of tooth extraction in order to avoid using removable complete dentures during the healing period. This article will present a technique for fabricating and indexing an interim implant-supported fixed complete denture for the maxillary arch.


Loss of natural dentition, in the presence of active disease such as caries, periodontal disease, or periapical pathology, often requires a temporary phase of treatment that includes a removable prosthesis during the healing period. For some patients, the use of a removable complete denture is undesirable, related to their concerns of compromised comfort, function, aesthetics, and quality of life issues associated with a removable prosthesis. A potential solution for these patients includes extraction of the remaining hopeless teeth, placement of temporary implants, and placement of a provisional implant-supported fixed complete denture. 

 

Figure 1. Processed acrylic resin palatal index.

Figure 2. Palatal index and provisional acrylic resin restoration attached for placement on the edentulous maxilla.

Figure 3. Prosthesis and palatal index seated passively on the maxilla over temporary implants with adequate relief for addition of self-cure acrylic resin.

Figure 4. Adaptation of the provisional restoration to the temporary implant abutments.

Figure 5. Finished provisional fixed complete denture restoration of the edentulous maxilla.

Immediate loading of the edentulous maxilla has been presented in the literature. Success is reported when adequate bone is available to provide primary stability of strategically placed implants that allow support for an ideal prosthesis.1-3


Most reports discussing the fabrication of an interim implant-supported complete denture on immediately loaded implants involve retrofitting a previous complete denture or fabricating an acrylic resin or metal reinforced acrylic resin prosthesis.4-8 Relating a provisional complete denture restoration to a maxillary arch that has been modified by extraction, alveloplasty, implant placement, and suture material is often difficult. The aim of this article is to present a technique for fabricating and indexing a provisional acrylic resin, implant-supported fixed complete denture.

 

THE TECHNIQUE

  • Complete a diagnostic wax-up of the provisional complete denture to include desired anatomic form, aesthetics, and occlusion based on accepted aesthetic principles.9,10
  • Fabricate a laboratory-processed, indirect acrylic resin provisional fixed complete denture restoration, derived from the diagnostic wax-up. Fabricate to include hollowed crowns in the area of implant placement.11
  • Make a stone duplicate cast of the laboratory processed provisional restoration on the definitive cast by making an impression with irreversible hydrocolloid (Jeltrate Alginate [DENTSPLY Caulk]) and pouring the impression in type III gypsum (Laboratory Stone [Whip Mix]).
  • Complete the wax-up of a clear acrylic palatal index on the stone duplicate and process in clear heat-cured acrylic (Clear denture resin [Coltène Whaledent]) (Figure 1).
  • Ensure proper interlocking of the clear acrylic palatal index to the laboratory-processed acrylic provisional restoration by making necessary adjustments (Figure 2).
  • Accomplish all procedures for placement of implants and prosthetic abutments in the desired locations (ANEW Screw-Retained Implant System [Dentatus USA]).
  • Place adequate openings in the prefabricated acrylic resin fixed complete denture to allow protrusion of the prosthetic abutments through the prosthesis. The prostheses must fit passively with adequate space for autocure acrylic.
  • Test the prefabricated fixed partial denture with attached palatal index over the assembled implant components for passive fit (Figure 3).
  • Adapt the provisional restoration to the abutments by placing the appropriate tooth shade of autocure acrylic resin (Jet Acrylic Resin, [Lang Dental] or MACH 4 Fast Setting Provisional Acrylic Resin, [Lang Dental]) into the hollowed crowns and by guiding it to the correct position using the palatal index (Figure 4). Take care to avoid flow of excess acrylic to the palatal index for ease of removal.
  • Once the provisional restoration is properly adapted, remove it from the palatal index, adjust the occlusion as needed, then finish and polish the restoration (Figure 5).

DISCUSSION
The technique described above uses a palatal index to relate a prefabricated provisional fixed complete maxillary denture to the maxillary arch in a patient who had undergone extraction of the maxillary dentition and immediate placement of temporary implants. The result is a durable and aesthetic provisional restoration.


The procedure offers the advantage of immediate provisionalization of the maxillary dentition on the same day as the extraction of the natural dentition in a manner that reliably mimics the orientation, position, and occlusion of the natural dentition. The palatal index allows the prosthetic procedures at the time of provisional implant placement to be accomplished in a fairly rapid manner that is uncomplicated and precise. As with all dental procedures, however, the patient should be made aware of the advantages and disadvantages of treatment that involves restoration immediately after implant placement. Considerations regarding provisional restoration fabrication should be based on the patient’s unique situation and desires as well as the dentist’s capabilities and access to laboratory support.

 

SUMMARY
The sequence of fabricating and indexing an acrylic resin provisional restoration on immediately loaded temporary implants in the edentulous maxilla was described. The technique presented in this article offers a reliable means of indexing a prefabricated fixed complete denture to a maxillary arch immediately after the extraction of the natural dentition and placement of temporary implants; in a manner that is precise and uncomplicated.

Acknowledgment
The author would like to thank Dr. David Sarment for surgical support and Resista-temps, Inc, Dental Laboratory (Indianapolis, Ind) for laboratory assistance in completing this technique.


References

  1. Cooper L, De Kok IJ, Reside GJ, et al. Immediate fixed restoration of the edentulous maxilla after implant placement. J Oral Maxillofac Surg. 2005;63(9 suppl 2): 97-110.
  2. Lekholm U, Zarb GA. Patient selection and preparation. In: Bränemark P-I, Zarb GA, Albrektsson T, eds. Tissue-Integrated Prostheses: Osseointegration in Clinical Dentistry. Chicago, Ill: Quintessence Publishing; 1985:199-209.
  3. Minsk L. Interim implants for immediate loading of temporary restorations. Compend Cont Educ Dent. 2001;22:186-194.
  4. Cooper LF, Rahman A, Moriarty J, et al. Immediate mandibular rehabilitation with endosseous implants: simultaneous extraction, implant placement, and loading. Int J Oral Maxillofac Implants. 2002;17:517-525.
  5. Emtiaz S, Tarnow DP. Processed acrylic resin provisional restoration with lingual cast metal framework. J Prosthet Dent.1998;79:484-488.
  6. Ganeles J, Rosenberg MM, Holt RL, et al. Immediate loading of implants with fixed restorations in the completely edentulous mandible: report of 27 patients from a private practice. Int J Oral Maxillofac Implants. 2001;16:418-426.
  7. Rodrígues AH, Morgano SM, Guimarães M, et al. Laboratory-processed acrylic resin provisional restoration with cast metal substructure for immediately loaded implants. J Prosthet Dent. 2003;90:600-604.
  8. Tarnow DP, Emtiaz S, Classi A. Immediate loading of threaded implants at stage 1 surgery in edentulous arches: ten consecutive case reports with 1- to 5-year data. Int J Oral Maxillofac Implants. 1997;12:319-324.
  9. Small BW. Pretreatment wax-ups and provisionals for restorative dentistry. Gen Dent. 2005;53:98-100.
  10. Tarnow DP, Chu SJ, Kim J. Aesthetic Restorative Dentistry: Principles and Practice. Mahwah, NJ: Montage Media; 2008:27-63.
  11. Shillingburg HT Jr, Hobo S, Whitsett LD, et al, eds. Fundamentals of Fixed Prosthodontics. 3rd ed. Carol Stream, Ill: Quintessence Publishing; 1997:225-246.

Dr. Duff is an assistant professor in the Department of Biologic and Materials Sciences Division of Prosthodontics at The University of Michigan School of Dentistry in Ann Arbor. She can be reached at (734) 764-5527 or reduff@umich.edu

Disclosure: Dr. Duff reports no conflicts of interest.



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