Implants continue to be a large part of the general dentists’ restorative requirements. While posterior implants are temporized infrequently, anterior implants are temporized in varying ways. Some of these temporary techniques include acrylic removable partials, Essex composite Pontic clear aligners, bonded composite bridges, or the use of a Titanium Base (Ti-Base) for a screw-retained temporary.
The purpose of this article is to demonstrate a simple way to fabricate a screw-retained temporary implant restoration chairside using a Ti-Base. PREAT Corporation offers a variety of Ti-Bases that can be used in a final restoration, but also with composite to temporize and help shape the tissue, achieving the initial verification of contours. Ti-Bases are available in various platforms to match the connection type of the implant, along with different cylinder heights, including 4.5 mm for this patient.
The patient presented from the oral surgeon requesting restoration of the implant and veneers to improve his smile (Figure 1). He wanted to get rid of the acrylic flipper as soon as possible, often complaining of having to remove the partial and about its poor fit and aesthetics.
To facilitate the patient’s desire, a screw-retained temporary restoration was to be delivered. After removing the healing abutment, the appropriate Ti-Base (PREAT Corporation) was selected (Straumann Regular CrossFit, 4.5 mm cylinder height) and seated to check the path of placement and approximate position of the access channel in relation to incisal edge position. It was determined that the access channel would be lingual to the incisal edge. It is possible to fabricate a composite, screw-retained temporary to evaluate tissue height and papilla size and shape.
|Figure 1. The patient presented from the oral surgeon requesting restoration of the implant and veneers to improve his smile.
|Figure 2. Slowly spin while syringing a composite opaquer (tetrapaque) on the chimney.
|Figure 3. To extend composite vertically, remove the prosthetic screw, and replace with a long guide pin.
|Figure 4. Seat the Ti-Base intraorally using the long guide pin.
|Figure 5. Add flowable composite to build the desired length of the restoration.
|Figure 6. Remove the restoration.
|Figure 7. Add composite to create the desired contour using landmarks of contacts, gingival cuff, and incisal edge position.
|Figure 8. The final screw-retained
temporary restoration prior to veneers.
The lack of papilla on the mesial and distal of the flipper required some temporary tissue contouring and treatment planning to improve optimal soft-tissue aesthetics. The initial plan was to widen the temporary to push tissue mesial and distal to achieve a better soft-tissue profile. Here’s the technique:
Holding the lab analog, slowly spin while syringing a composite opaquer (tetrapaque) on the chimney to eliminate potential gray metal shine through (Figure 2). Add flowable composite to achieve the desired subgingival implant emergence profile and shape.
To extend composite vertically, remove the prosthetic screw and replace it with a long guide pin (Figure 3). Rotate the lab analog while adding flowable composite to create a hollow composite cylinder of the desired height for the clinical situation. Remove the modified Ti-Base from the analog.
Seat the Ti-Base intraorally using the long guide pin and add flowable composite to build the desired length of the restoration (Figures 4 and 5). Cure for 2 seconds and repeat as necessary to quickly rough out the shape. Add composite to touch each contact and cure to hold position. The same technique is used to approximate incisal edge position and lingual and facial contours, but not to do so into any undercuts below the contact. Thoroughly cure composite prior to removing.
Remove the restoration (Figure 6). The gingival height is demonstrated by a composite ledge. Rinse and air dry. Add composite to create the desired contour using landmarks of contacts, gingival cuff, and incisal edge position (Figure 7). Use a high-speed handpiece to shape the temporary to the ideal contour.
Reposition the restoration intraorally, and continue to add flowable and/or make adjustments to shape. Remove the restoration for polishing.
Upon delivery of the restoration, tooth No. 8 had a high-arch gingival shape compared to tooth No. 9, which had flat, wide gingival arches. The gingival height of tooth No. 9 should be brought up and shaped better by adding flowable composite to the sub-gingival facial to provide better tissue shape. Note the tissue blanching indicating the location of tissue pressure. Adding flowable composite to mesial and distal subgingivally will better shape the papilla. The practitioner can easily add or remove composite to better facilitate soft-tissue management, as well as an aesthetic, easily retrievable temporary prosthesis (Figure 8).
For more information, visit PREAT Corporation’s website at preat.com.