Treatment with dental implants is an advanced biomechanical solution for the replacement of missing teeth. It includes several distinct stages and number of steps.
In certain instances before production of the final restoration we also make temporary restorations. When indicated temporary restoration are an integral part of implant treatment. In the following article I will explain the most important information about implant temporary crown and bridge restorations.
What are the implant temporary crown and bridge restorations?
Temporary (also called provisional) restorations are type of restorations which are done for the short to medium duration of the implant treatment, typically several months to one year.
Implant temporary crown and bridge restorations are designed to act as a blueprint / prototype of the final restoration and also provide cosmetic and function replacement of the missing teeth for the duration of treatment.
For clarification purposes I would like to explain that there are several different types of temporary restorations such as removable dentures, crowns and bridges. Temporary restorations can be supported by the patient’s teeth, gums and dental implants. In the following article I will be describing implant supported temporary crowns and bridges, i.e. type of restorations which are attached to the dental implants.
It also would be important to mention that in some complex implant treatment, patient may require more than one set of temporary restorations. For example in the early stages patient may wear temporary removable denture and during the later stages patient may have implant supported temporary restoration. Once all requirements of the case are achieved we than proceed with the production of the final restorations.
Below is the list of most common indications for the implant supported temporary restorations.
What are the indications for implant temporary crown and bridge restorations?
Immediate temporaries (teeth on one day)
In a number of clinical situations, there may be a possibility of immediate replacement of missing tooth or teeth with a dental implant. Patient can also be a candidate for the placement of implant supported crown or bridge restoration immediately after placement of dental implants. In this manner patient can have an immediate cosmetic and functional replacement of the tooth or teeth.
Temporary restorations which are attached to the dental implant soon after implant placement are called immediate temporaries. In contrast delayed temporaries are type of restorations which are placed on the dental implant after completion of the healing process which occurs after installation of the dental implant.
In the below example fractured central incisor was replaced with immediate implant and immediate implant temporary crown.
Cosmetic and functional blueprint / prototype
Implant temporary restoration can act as a blueprint / prototype of the final restoration. In other words it allows us to test the implants and gain important information on how the final restoration may perform and look.
Implant supported provisional can be shaped and modified during the course of the treatment. This is an important feature of the implant supported temporaries since it is not as easy to make modifications to the final restorations.
We do not always make provisional prototype since it does increase treatment cost, treatment time and number of steps. However prototyping the final restorations is invaluable in complex cases such a large number of missing teeth, history of extensive bone grafts and cases where appearance is very critical.
In the below example, patient’s all teeth in the top jaw were replaced with dental implants. Implant supported temporary bridges act as a blueprint/prototype of the final restorations.
Gum tissue shaping
Implant temporary crown and bridge restorations play an essential role in the shaping of the gum tissues. Proper gum shaping is critical in situations where patient show gum tissues in the visible area of the mouth which we call esthetic zone. Typically after implant surgery, the patient’s gums are not primed the shape of the final teeth. Provisional restorations allow us to shape the gums properly and achieve more natural looking restorations.
In the below example, patient’s two top incisors were replaced with dental implants. Temporary implant supported crowns which you can see in the photo were used to form the gum tissues to the proper shape.
Implants with problems
In rare instances dental implants may show some signs of bone loss and poor healing, which may require observation over long term. In such situations we may prefer to have temporary restorations placed on the dental implants rather than making final restorations.
What materials are used in the production of temporary restorations?
Most common materials which are used in the fabrication of temporary restorations includes dental polymers/plastics. Special part of the provisional which mates directly with the dental implant is called temporary abutment and can be made from titanium metal alloy or plastic polymer. Just like in the final restoration, abutment is secured to the dental implant with the metallic alloy screw. Crown or bridge plastic restorations either fused to the temporary abutment by friction or via use of dental adhesives.
The photo below shows example of titanium abutments and temporary acrylic bridge restoration.
What are the disadvantages of implant temporary crown and bridge restorations?
The disadvantages of temporary restorations include increase in treatment cost, treatment time and number of treatment steps. Another disadvantage of the temporary restoration is a possibility of fracture since it is not as strong as a final restoration.
Implant temporary crown and bridge restorations are an essential part of implant therapy. Implant supported restoration are not necessary for all patients. However in a number of clinical situations there is no substitute for the implant supported temporaries and mentioned disadvantages are negligible in comparison to the benefits which are provided by the temporaries.
Thank you for reading.
Dr. Alexander Shor.