Simplified Provisional

When the patient returns for #31 implant placement, it is nearly 3 months postop for #21 placement without provisional.  Following changing to a smaller abutment (4.5x5(4) mm) and prep, a provisional is fabricated at #21 with light occlusal contact.

There are 2 challenges associated with #31 implant placement: indistinct Inferior Alveolar Canal (Fig.1-4) and difficulty in fabrication of a provisional (Fig.5).  After placing a 5.5x13 mm implant (Fig.3 supracrestal (<)), it is removed for apical resection for ~ 2 mm; when it is reseated, it is subcrestal (Fig.5 <).  A simplified temporary provisional (Fig.5 P) is fabricated around a 6.5x4(4) mm abutment (A) without adapting the lower RPD.  The patient is advised not to wear the latter.  When the socket heals, there will be 2 options: no provisional or a new one.  The latter should have good retention to the abutment and no contact with the lower RPD in and out.

Return to Lower Molar Immediate Implant, Prevent Molar Periimplantitis (Protocols, Table), IBS, #21, 23/25

Xin Wei, DDS, PhD, MS 1st edition 03/28/2017, last revision 07/04/2017