Provisionalization for Implant Dentistry

Michael Tischler, DDS
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These are the matters that a practitioner must consider, and then discuss with the patient, when deciding between the options available for provisionalization for dental implant treatment.

Provisionalization is, and should rightly be, a primary focus for all dental implant treatment plans. This month, I would like to address some of the main concepts in regard to dental implant provisionalization, and how it is vital to every aspect of implant treatment. How, and if, an implant treatment site is provisionalized, should be decided early in the treatment planning process. The different aspects of provisionalization can affect things such as treatment time and cost, as well as healing time for the patient. These considerations greatly affect a patient’s overall treatment and should be discussed with them beforehand.

When a tooth is, or teeth are, going to be replaced by a dental implant or implants, the first clinical treatment question the clinician should ask is, “Does a temporary replacement tooth have to be addressed?” There are situations where not only is a provisional tooth not needed for the dental implant treatment period, but a removable appliance could be detrimental to healing, such as in cases of concurrent hard- and soft-tissue grafting. If, for example, a patient is having a mandibular second molar replaced and the patient has sufficient teeth in his or her mouth to chew food properly, not placing a removable appliance there will save the patient money and put less pressure on the implant site. In a location, such as a lower molar, when a provisional is not necessary, a healing abutment can be placed, thus saving the patient a second uncovery surgery and allowing for simultaneous emergence profile formation.

If an implant treatment area is going to be provisionalized, then the different types of available provisionalization are the next area of discussion with the patient as part of the treatment planning and informed consent process. For example, when treatment planning a provisional for an anterior maxillary tooth for implant treatment, a flipper appliance, a bonded tooth, a non-functional immediate-load tooth, or an Essix-type appliance can all be possible options from which to choose. Each one of these options has certain advantages and disadvantages as well as applications that are dependent on the presenting clinical situation. While a bonded tooth has the advantage of being non-removable and is more stable when developing the emergence profile, it also has a high chance of debonding at an inopportune moment. These are the matters that a practitioner must consider, and then discuss with the patient, when deciding between the options available for provisionalization for dental implant treatment.

This month, Dr. Justin Moody, one of our distinguished Implants Today advisory board members, presents a case report on the reconstruction of a patient’s mouth using full-arch zirconia. This excellent article addresses the many aspects of the treatment planning, provisionalization, and overall clinical protocols for this complex procedure.

If you have any questions or comments about this topic, or any other subject presented in Implants Today, feel free to contact Dr. Tischler at mt@tischlerdental.com.

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