Remake Provisional Answers
Why do we have to make the provisional?
1. We make the provisional for patient’s esthetic demand, especially for anterior teeth.
2. The provisional will keep interdental papilla and gingiva in place. If we do not do it, the papilla and gingiva may collapse or shrink later.
3. After bone graft is done at implant site, it is good to place a temporary crown immediately, because the crown will close the wound, so the bone debris will stay in the hole and it also close an entry portal for bacteria.
4. Some patients wear denture before placing implant, once the implant is placed, if we could not adjust the denture well, it is better we do not let patient put denture back to the mouth, because denture may causes pressure on implant. Especially at bone graft area, the immature bone may not heal when pressure is on . So temporary crown is a better solution.
(It is important to know that when patient bites down, there should be no contact between temporary crown and opposite tooth (contact will create pressure). So when making the temmporary crown, we should always make it shorter than the adjacent teeth.)
2. What do you expect to see when he returns? (This is Suniti’s answer. I agree with it)
(a) We may expect to see that the papillae are not in place.
(b) also possible to see little drifting of adjacent tooth if any.
3. What do you prepare for the remake provisional (Suniti’s answer sounds good. But we do not need cord because there is no titanium alloy shavings. And we need acrylic powder and liquid, spatula, dental floss. I do not know why the temp is off, should we use Ketac cement)?
- Preparations as a whole for remaking:
- Temporary crown forms
- # 2 cord, is it necessary?
- acrylic resin, which one?
- acrylic bur
- articulating paper
- shade
- temporary cement
- cementing instruments
- 2/2 cotton ro
- cotton rolls. Anything missing? Why do you think that temp is off?
Answer to Jenny's questions: Suniti’s answer sounds good. But we do not need cord because there is no titanium alloy shavings. I do not know why the temp is off, should we use Ketac cement?
Since the socket should have healed by now, a thick cord,, such as #2, may be not required. But if the gingiva has covered implant margin, it may be difficult to make good retentive provisional. Re-preparation of the margin might be needed. A thinner cord may be requested.
In the early stage after implantation, temp bond is preferred. In case the patient puts pressure on the provisional, it may be dislodged. The pressure may not be transmitted to the implant. Three or four months after implantation, osteointegration may occur. If the provisional is still needed, Ketac cement may be chosen. Relining the temporary is the better option. It is difficult to remove Ketac cement left over the abutment/implant once the temporary is removed.
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Xin Wei, DDS, PhD, MS 1st edition 09/14/2013, last revision 09/14/2013