- Email: [email protected]
A technique for indirect fabrication of a complete-arch, implant-supported, fixed provisional restoration from a radiographic template
A technique for indirect fabrication of a complete-arch, implant-supported, fixed provisional restoration from a radiographic template Panagiota-Eirini Spyropoulou, DDS,a Michael Razzoog, DDS, MS, MPH,b and Marianella Sierraalta, DDS, MSc School of Dentistry, The University of Michigan, Ann Arbor, Mich This article describes an alternative technique for the fabrication of a complete-arch, implant-supported, cementretained, fixed provisional restoration. The definitive cast is fabricated from the surgical guide and the provisional restoration is fabricated indirectly from the radiographic guide. This technique is an easy and time-saving procedure to fabricate an interim prosthesis for immediate or delayed loading of implants. (J Prosthet Dent 2010;104:199-203) Dental implants are an excepted treatment modality for restoration of partially and completely edentulous patients.1-3 While not necessary for every patient, the use of provisional restorations is advantageous for numerous reasons.4-6 They help confirm the design of the prosthesis (screw or cement retained), esthetics, contours, and phonetics, and guide the development of the definitive restoration. In addition, they facilitate clear communication between the patient, dentist, and dental technician. Provisional restorations permit monitoring of the patient’s oral hygiene and the healing response of the periimplant soft tissues, and enable healing of the soft tissue around the implants according to the contours of the provisional restoration.7 They also provide patients the opportunity to view and evaluate the proposed restorative result and to actively participate in decisions about modifications for the definitive restoration. Once the desired result has been achieved with the provisional restoration, the necessary information can be easily transferred to the laboratory with facial/buccal indexes and clinical photographs. Several techniques have been described in the literature for the fabrication of implant-supported provisional a
restorations. They can be fabricated intraorally, directly on the implant abutments, or indirectly in the laboratory. For partially edentulous patients, and when the implants have already been placed, a diagnostic waxing is fabricated; then, with the use of a clear matrix form, the acrylic resin is shaped into a provisional restoration.8-10 When fabrication is accomplished intraorally, a potential danger is that acrylic resin may flow into the screw-access channels and increase the difficulty of removing the provisional restoration. The indirect technique consists of fabricating the provisional restoration in the laboratory, where the acrylic resin may be either heat polymerized, which provides excellent fit, function, esthetics, and durability,11 or polymerized in a pressure pot, providing the restoration with increased transverse strength and less porosity.12 Along with the acrylic resin, denture teeth laminates may be used, thereby ensuring longterm color stability and esthetics of the provisional restoration.13 In all of the previously described techniques, the adjacent teeth assist in positioning the clear matrix correctly and aligning it with the remaining dentition. When the patient is edentulous, the clear matrix is seated on the soft tissue,14 and inaccuracies in
occlusal vertical dimension or midline alignment may result. An alternative indirect fabrication technique for an implant-supported, cement-retained, fixed provisional restoration, using a radiographic guide prior to implant placement, is described.
TECHNIQUE 1. Perform a thorough examination of the patient and evaluate the existing complete maxillary denture for esthetics and phonetics. 2. Fabricate a maxillary completearch radiographic template using autopolymerized acrylic resin (COE Tray Plastic; GC America, Inc, Alsip, Ill), ADA type I baseplate wax (Euro #4; Carmel Dental Waxes, Montreal, Canada), and denture teeth (SR Ortholingual DCL; Ivoclar Vivadent, Inc, Amherst, NY), following the steps in the fabrication of a complete maxillary denture. 3. Evaluate the esthetics, phonetics, and occlusion of the radiographic template (Fig. 1). Once those features are verified and approved by both the clinician and the patient, fabricate a duplicate of the radiographic guide in autopolymerized tooth-shaded acrylic resin (Jet Acrylic; Lang Dental Mfg Co, Wheeling, Ill), and allow the patient to function with it for approxi-
Resident, Department of Biologic and Materials Sciences, Division of Prosthodontics. Professor, Department of Biologic and Materials Sciences, Division of Prosthodontics. c Clinical Associate Professor, Department of Biologic and Materials Sciences, Division of Prosthodontics. b
Spyropoulou et al
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1 Intraoral evaluation of radiographic template.
2 CT image with radiographic template in place.
3 Surgical template with metal cylinders.
4 Fabrication of definitive cast using stereolithographic surgical template.
mately 5 to 7 days. 4. Once both the clinician and the patient are satisfied with the esthetics and phonetics, prescribe a double computerized tomography (CT) scan, one scan with the patient wearing the radiographic template, and one scan of the template itself.15-17 5. Use the reformatted data from the double CT scan and a commercially available 3-D implant planning software (Procera; Nobel Biocare USA, Yorba Linda, Calif ) to complete the virtual implant planning (Fig. 2). 6. Finalize the implant lengths and locations in relation to the bone and position of the teeth in the radiographic template. 7. Transfer the prosthodontically driven implant surgical planning data to a production facility (Procera; Nobel Biocare, Inc, Mahwah, NJ) to fabricate a CAD/CAM stereolithographic surgical
template with metal cylinders (Guided Sleeves; Nobel Biocare USA) corresponding to the previously planned implant positions (Fig. 3).13-15,18-20 8. Fabricate the definitive cast using the stereolithographic surgical template, guided cylinders with pins (Guided Cylinder with Pin, Unigrip Branemark System RP; Nobel Biocare USA), implant replicas (Implant Replica, Branemark System RP; Nobel Biocare USA), boxing wax (Boxing Wax; Carmel Dental Wax, Inc), soft tissue simulation material (Gingitech; Ivoclar Vivadent, Inc), and highstrength die stone (Jade Stone; Whip Mix Corp, Louisville, Ky) (Fig. 4). 9. Place the radiographic template on the definitive cast and make a facial matrix with laboratory vinyl polysiloxane putty material (Sil-Tech; Ivoclar Vivadent, Inc) (Fig. 5). 10. Use the facial matrix as a ref-
The Journal of Prosthetic Dentistry
erence to select the correct titanium temporary abutments (Nobel Biocare USA). 11. Make a vacuum-formed clear matrix on the radiographic template using a 2-mm polyethelene sheet (Clear Temporary Splint Sheets; Ultradent Products, Inc, South Jordan, Utah) (Fig. 6), and cut it at the borders of the radiographic template. Make a second facial matrix with laboratory vinyl polysiloxane putty material (Sil-Tech; Ivoclar Vivadent, Inc) on top of the vacuum-formed clear matrix (Fig. 7). 12. Remove the radiographic template from the definitive cast and attach the titanium temporary abutments (Nobel Biocare USA) to the definitive cast. 13. Cover the screw access openings with cotton, lubricate the abutments and the cast with a thin layer
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5 Radiographic template with facial matrix in place.
6 Vacuum-formed clear matrix on radiographic template.
7 Second facial matrix on top of vacuum-formed clear matrix.
of petroleum jelly (Petroleum Jelly; ViJon Laboratories, St. Louis, Mo), and mix the correct tooth-shaded autopolymerizing acrylic resin (Jet Acrylic; Lang Dental Mfg Co). 14. Place the acrylic resin in the vacuum-formed matrix and place it on the cast, stabilizing it with the fa-
Spyropoulou et al
cial matrix. 15. Place the definitive cast in a pressure pot (Acri-Dense VI Pneumatic Curing Unit; GC America, Inc) in warm water to increase the strength and reduce the porosity of the material.11 16. Once the acrylic resin polymerizes, remove it from the vacuum-
formed matrix and trim the excess material with laboratory rotary cutting instruments (Brasseler USA, Savannah, GA) up to the cemento-enamel junction, allowing space for soft tissue-shaded acrylic resin (Jet Denture Repair Acrylic; Lang Dental Mfg Co). 17. Place the provisional restoration again in the vacuum-formed clear matrix, and mix soft tissue-shaded autopolymerized acrylic resin (Jet Denture Repair Acrylic; Lang Dental Mfg Co). Wet the surface of the previously polymerized tooth-shaded acrylic resin with monomer prior to its application, and then place the soft-tissue shaded acrylic resin in the clear matrix. Place the clear matrix on the cast, stabilizing it with the facial matrix, and again place the definitive cast in the pressure pot (Acri-Dense VI Pneumatic Curing Unit; GC America, Inc) in warm water. 18. Once the acrylic resin polymerizes, remove the provisional restoration from the vacuum-formed matrix and trim excess material. 19. Evaluate the junctional integrity between the titanium abutments and the autopolymerized acrylic resin, and add additional autopolymerized acrylic resin in defective areas using the sprinkle-on method.21 Polish the polymerized provisional restoration with flour and pumice (Fig. 8). 20. Place the implants (NobelSpeedy Groovy; Nobel Biocare USA) using the surgical template. 21. Attach the titanium custom abutments (Nobel Biocare USA) on the implants and cement the provisional restoration with provisional cement (TempBond NE; Kerr Corp, Orange, Calif ). 22. Remove all excess cement and make a panoramic radiograph to evaluate the implant placement. Alternatively, if an insertion torque of 35 Ncm or higher was not achieved for all implants, proceed with delayed implant loading (Fig. 9).
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202
8 Provisional restoration on cast.
DISCUSSION Numerous direct and indirect provisional restoration techniques have been described in the literature. Using the direct technique, laboratory steps are eliminated and the procedure becomes more cost effective. The disadvantages are increased chair time and decreased strength of the provisional restoration. However, the use of the indirect technique requires an implant level impression to fabricate a working cast, if it cannot be fabricated from a surgical template. Additionally, mounted casts and a diagnostic waxing are required. The restoration can be fabricated either with heat- or autopolymerized acrylic resin. The use of a pressure pot enhances polymerization. The restoration is more color stable, less porous, and more wear resistant, enhancing the esthetics and serviceability of the fixed provisional prosthesis. The technique described is an alternative indirect method of fabricating an implant-supported, cement-retained, fixed complete provisional restoration. Cementretained provisional restorations eliminate the access holes, preventing them from showing on the incisal edge or the facial surface of teeth with malaligned dental implants, which would compromise esthetics and function. Furthermore, care should be taken during the cementation procedure to ensure no provisional cement remains in the periimplant tissue, as this can cause inflammation.
9 Provisional restoration in place.
SUMMARY An alternative for the fabrication of an implant-supported, cementretained, fixed complete provisional restoration has been described. This technique allows for an easy, time-saving, cost-effective laboratory procedure which provides an esthetic fixed complete provisional restoration, fabricated from a radiographic guide and ready for use in the immediate loading of dental implants.
REFERENCES 1. Jemt T, Lekholm U, Adell R. Osseointegrated implants in the treatment of partially edentulous patients: a preliminary study on 876 consecutively placed fixtures. Int J Oral Maxillofac Implants 1989;4:211-7. 2. Jemt T, Pettersson P. A 3-year follow-up study on single implant treatment. J Dent 1993;21:203-8. 3. Adell R, Lekholm U, Rockler B, Branemark PI. A 15 year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981;10:387-416. 4. Moscovitch MS, Saba S. The use of a provisional restoration in implant dentistry: a clinical report. Int J Oral Maxillofac Implants. 1996;11:395-9. 5. Santosa RE. Provisional restoration options in implant dentistry. Aust Dent J 2007;52:234-42. 6. Lewis S, Parel S, Faulkner R. Provisional implant-supported fixed restorations. Int J Oral Maxillofac Implants 1995;10:319-25. 7. Spyropoulou PE, Razzoog M, Sierraalta M. Restoring implants in the esthetic zone after sculpting and capturing the periimplant tissues in rest position: a clinical report. J Prosthet Dent 2009;102:345-7.
The Journal of Prosthetic Dentistry
8. Ganddini MR, Tallents RH, Ercoli C, Ganddini R. Technique for fabricating a cementretained single-unit implant-supported provisional restoration in the esthetic zone. J Prosthet Dent 2005;94:296-8. 9. Kökat AM, Akça K. Fabrication of a screwretained fixed provisional prosthesis supported by dental implants. J Prosthet Dent 2004;91:293-7. 10.Binon PP. Provisional fixed restorations supported by osseointegrated implants in partially edentulous patients. Int J Oral Maxillofac Implants 1987;2:173-8. 11.alZallal M, Morgano SM. The implant supported, heat-processed provisional fixed partial denture. Am J Dent 1991;4:260-4. 12.Donovan TE, Hurst RG, Campagni WV. Physical properties of acrylic resin polymerize d by four different techniques. J Prosthet Dent 1985;54:522-4. 13.Lin WS, Ercoli C. A technique for indirect fabrication of an implant-supported, screw-retained, fixed provisional restoration in the esthetic zone. J Prosthet Dent 2009;102:393-6. 14.Proussaefs P. The use of healing abutments for the fabrication of cement-retained, implant-supported provisional prostheses. J Prosthet Dent 2002;87:333-5. 15.van Steenberghe D, Naert I, Andersson M, Brajnovic I, Van Cleynenbreugel J, Suetens P. A custom template and definitive prosthesis allowing immediate implant loading in the maxilla: a clinical report. Int J Oral Maxillofac Implants 2002;17:663-70. 16.van Steenberghe D, Glauser R, Blombäck U, Andersson M, Schutyser F, Pettersson A, et al. A computed tomographic scanderived customized surgical template and fixed prosthesis for flapless surgery and immediate loading of implants in fully edentulous maxillae: a prospective multicenter study. Clin Implant Dent Relat Res 2005;7 Suppl 1:S111-20. 17.Marchack CB. An immediately loaded CAD/CAM-guided definitive prosthesis: a clinical report. J Prosthet Dent 2005;93:8-12.
Spyropoulou et al
September 2010 18.Sanna AM, Molly L, van Steenberghe D. Immediately loaded CAD-CAM manufactured fixed complete dentures using flapless implant placement procedures: a cohort study of consecutive patients. J Prosthet Dent 2007;97:331-9. 19.Marchack CB. CAD/CAM-guided implant surgery and fabrication of an immediately loaded prosthesis for a partially edentulous patient. J Prosthet Dent 2007;97:389-94.
20.Parel SM, Tripplet RG. Interactive imaging for implant planning, placement, and prosthesis construction. J Oral Maxillofac Surg 2004;62:41-7. 21.Moscovitch MS, Saba S. The use of a provisional restoration in implant dentistry: a clinical report. Int J Oral Maxillofac Implants 1996;11:395-9.
Corresponding author: Dr Panagiota-Eirini Spyropoulou The University of Michigan, School of Dentistry 1011 N University Ave, Rm 1378 Ann Arbor, MI 48109-1078 Fax: 734-764-1481 E-mail: [email protected] Copyright © 2010 by the Editorial Council for The Journal of Prosthetic Dentistry.
Noteworthy Abstracts of the Current Literature Digitization of simulated clinical dental impressions: Virtual three-dimensional analysis of exactness Persson AS, Odén A, Andersson M, Sandborgh-Englund G. Dent Mater 2009;25:929-36. Epub 2009 Mar 4. Objectives. To compare the exactness of simulated clinical impressions and stone replicas of crown preparations, using digitization and virtual three-dimensional analysis. Methods. Three master dies (mandibular incisor, canine and molar) were prepared for full crowns, mounted in full dental arches in a plane line articulator. Eight impressions were taken using an experimental monophase vinyl polysiloxane-based material. Stone replicas were poured in type IV stone (Vel-Mix Stone; Kerr). The master dies and the stone replicas were digitized in a touch-probe scanner (Procera® Forte; Nobel Biocare AB) and the impressions in a laser scanner (D250, 3Shape A/S), to create virtual models. The resulting point-clouds from the digitization of the master dies were used as CAD-Reference-Models (CRM). Discrepancies between the points in the point-clouds and the corresponding CRM were measured by a matching-software (CopyCAD 6.504 SP2; Delcam Plc). The distribution of the discrepancies was analyzed and depicted on color-difference maps. Results. The discrepancies of the digitized impressions and the stone replicas compared to the CRM were of similar size with a mean ± SD within 40 μm, with the exception of two of the digitized molar impressions. The precision of the digitized impressions and stone replicas did not differ significantly (F = 4.2; p = 0.053). However, the shape affected the digitization (F = 5.4; p = 0.013) and the interaction effect of shape and digitization source (impression or stone replica) was pronounced (F = 28; p < 0.0001). The reliability was high for both digitization methods, evaluated by repeated digitizations. Significance. The exactness of the digitized impressions varied with shape. Both impressions and stone replicas can be digitized repeatedly with a high reliability. Reprinted with permission of the Academy of Dental Materials.
Spyropoulou et al
restorations. They can be fabricated intraorally, directly on the implant abutments, or indirectly in the laboratory. For partially edentulous patients, and when the implants have already been placed, a diagnostic waxing is fabricated; then, with the use of a clear matrix form, the acrylic resin is shaped into a provisional restoration.8-10 When fabrication is accomplished intraorally, a potential danger is that acrylic resin may flow into the screw-access channels and increase the difficulty of removing the provisional restoration. The indirect technique consists of fabricating the provisional restoration in the laboratory, where the acrylic resin may be either heat polymerized, which provides excellent fit, function, esthetics, and durability,11 or polymerized in a pressure pot, providing the restoration with increased transverse strength and less porosity.12 Along with the acrylic resin, denture teeth laminates may be used, thereby ensuring longterm color stability and esthetics of the provisional restoration.13 In all of the previously described techniques, the adjacent teeth assist in positioning the clear matrix correctly and aligning it with the remaining dentition. When the patient is edentulous, the clear matrix is seated on the soft tissue,14 and inaccuracies in
occlusal vertical dimension or midline alignment may result. An alternative indirect fabrication technique for an implant-supported, cement-retained, fixed provisional restoration, using a radiographic guide prior to implant placement, is described.
TECHNIQUE 1. Perform a thorough examination of the patient and evaluate the existing complete maxillary denture for esthetics and phonetics. 2. Fabricate a maxillary completearch radiographic template using autopolymerized acrylic resin (COE Tray Plastic; GC America, Inc, Alsip, Ill), ADA type I baseplate wax (Euro #4; Carmel Dental Waxes, Montreal, Canada), and denture teeth (SR Ortholingual DCL; Ivoclar Vivadent, Inc, Amherst, NY), following the steps in the fabrication of a complete maxillary denture. 3. Evaluate the esthetics, phonetics, and occlusion of the radiographic template (Fig. 1). Once those features are verified and approved by both the clinician and the patient, fabricate a duplicate of the radiographic guide in autopolymerized tooth-shaded acrylic resin (Jet Acrylic; Lang Dental Mfg Co, Wheeling, Ill), and allow the patient to function with it for approxi-
Resident, Department of Biologic and Materials Sciences, Division of Prosthodontics. Professor, Department of Biologic and Materials Sciences, Division of Prosthodontics. c Clinical Associate Professor, Department of Biologic and Materials Sciences, Division of Prosthodontics. b
Spyropoulou et al
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1 Intraoral evaluation of radiographic template.
2 CT image with radiographic template in place.
3 Surgical template with metal cylinders.
4 Fabrication of definitive cast using stereolithographic surgical template.
mately 5 to 7 days. 4. Once both the clinician and the patient are satisfied with the esthetics and phonetics, prescribe a double computerized tomography (CT) scan, one scan with the patient wearing the radiographic template, and one scan of the template itself.15-17 5. Use the reformatted data from the double CT scan and a commercially available 3-D implant planning software (Procera; Nobel Biocare USA, Yorba Linda, Calif ) to complete the virtual implant planning (Fig. 2). 6. Finalize the implant lengths and locations in relation to the bone and position of the teeth in the radiographic template. 7. Transfer the prosthodontically driven implant surgical planning data to a production facility (Procera; Nobel Biocare, Inc, Mahwah, NJ) to fabricate a CAD/CAM stereolithographic surgical
template with metal cylinders (Guided Sleeves; Nobel Biocare USA) corresponding to the previously planned implant positions (Fig. 3).13-15,18-20 8. Fabricate the definitive cast using the stereolithographic surgical template, guided cylinders with pins (Guided Cylinder with Pin, Unigrip Branemark System RP; Nobel Biocare USA), implant replicas (Implant Replica, Branemark System RP; Nobel Biocare USA), boxing wax (Boxing Wax; Carmel Dental Wax, Inc), soft tissue simulation material (Gingitech; Ivoclar Vivadent, Inc), and highstrength die stone (Jade Stone; Whip Mix Corp, Louisville, Ky) (Fig. 4). 9. Place the radiographic template on the definitive cast and make a facial matrix with laboratory vinyl polysiloxane putty material (Sil-Tech; Ivoclar Vivadent, Inc) (Fig. 5). 10. Use the facial matrix as a ref-
The Journal of Prosthetic Dentistry
erence to select the correct titanium temporary abutments (Nobel Biocare USA). 11. Make a vacuum-formed clear matrix on the radiographic template using a 2-mm polyethelene sheet (Clear Temporary Splint Sheets; Ultradent Products, Inc, South Jordan, Utah) (Fig. 6), and cut it at the borders of the radiographic template. Make a second facial matrix with laboratory vinyl polysiloxane putty material (Sil-Tech; Ivoclar Vivadent, Inc) on top of the vacuum-formed clear matrix (Fig. 7). 12. Remove the radiographic template from the definitive cast and attach the titanium temporary abutments (Nobel Biocare USA) to the definitive cast. 13. Cover the screw access openings with cotton, lubricate the abutments and the cast with a thin layer
Spyropoulou et al
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September 2010
5 Radiographic template with facial matrix in place.
6 Vacuum-formed clear matrix on radiographic template.
7 Second facial matrix on top of vacuum-formed clear matrix.
of petroleum jelly (Petroleum Jelly; ViJon Laboratories, St. Louis, Mo), and mix the correct tooth-shaded autopolymerizing acrylic resin (Jet Acrylic; Lang Dental Mfg Co). 14. Place the acrylic resin in the vacuum-formed matrix and place it on the cast, stabilizing it with the fa-
Spyropoulou et al
cial matrix. 15. Place the definitive cast in a pressure pot (Acri-Dense VI Pneumatic Curing Unit; GC America, Inc) in warm water to increase the strength and reduce the porosity of the material.11 16. Once the acrylic resin polymerizes, remove it from the vacuum-
formed matrix and trim the excess material with laboratory rotary cutting instruments (Brasseler USA, Savannah, GA) up to the cemento-enamel junction, allowing space for soft tissue-shaded acrylic resin (Jet Denture Repair Acrylic; Lang Dental Mfg Co). 17. Place the provisional restoration again in the vacuum-formed clear matrix, and mix soft tissue-shaded autopolymerized acrylic resin (Jet Denture Repair Acrylic; Lang Dental Mfg Co). Wet the surface of the previously polymerized tooth-shaded acrylic resin with monomer prior to its application, and then place the soft-tissue shaded acrylic resin in the clear matrix. Place the clear matrix on the cast, stabilizing it with the facial matrix, and again place the definitive cast in the pressure pot (Acri-Dense VI Pneumatic Curing Unit; GC America, Inc) in warm water. 18. Once the acrylic resin polymerizes, remove the provisional restoration from the vacuum-formed matrix and trim excess material. 19. Evaluate the junctional integrity between the titanium abutments and the autopolymerized acrylic resin, and add additional autopolymerized acrylic resin in defective areas using the sprinkle-on method.21 Polish the polymerized provisional restoration with flour and pumice (Fig. 8). 20. Place the implants (NobelSpeedy Groovy; Nobel Biocare USA) using the surgical template. 21. Attach the titanium custom abutments (Nobel Biocare USA) on the implants and cement the provisional restoration with provisional cement (TempBond NE; Kerr Corp, Orange, Calif ). 22. Remove all excess cement and make a panoramic radiograph to evaluate the implant placement. Alternatively, if an insertion torque of 35 Ncm or higher was not achieved for all implants, proceed with delayed implant loading (Fig. 9).
7PMVNF*TTVF
202
8 Provisional restoration on cast.
DISCUSSION Numerous direct and indirect provisional restoration techniques have been described in the literature. Using the direct technique, laboratory steps are eliminated and the procedure becomes more cost effective. The disadvantages are increased chair time and decreased strength of the provisional restoration. However, the use of the indirect technique requires an implant level impression to fabricate a working cast, if it cannot be fabricated from a surgical template. Additionally, mounted casts and a diagnostic waxing are required. The restoration can be fabricated either with heat- or autopolymerized acrylic resin. The use of a pressure pot enhances polymerization. The restoration is more color stable, less porous, and more wear resistant, enhancing the esthetics and serviceability of the fixed provisional prosthesis. The technique described is an alternative indirect method of fabricating an implant-supported, cement-retained, fixed complete provisional restoration. Cementretained provisional restorations eliminate the access holes, preventing them from showing on the incisal edge or the facial surface of teeth with malaligned dental implants, which would compromise esthetics and function. Furthermore, care should be taken during the cementation procedure to ensure no provisional cement remains in the periimplant tissue, as this can cause inflammation.
9 Provisional restoration in place.
SUMMARY An alternative for the fabrication of an implant-supported, cementretained, fixed complete provisional restoration has been described. This technique allows for an easy, time-saving, cost-effective laboratory procedure which provides an esthetic fixed complete provisional restoration, fabricated from a radiographic guide and ready for use in the immediate loading of dental implants.
REFERENCES 1. Jemt T, Lekholm U, Adell R. Osseointegrated implants in the treatment of partially edentulous patients: a preliminary study on 876 consecutively placed fixtures. Int J Oral Maxillofac Implants 1989;4:211-7. 2. Jemt T, Pettersson P. A 3-year follow-up study on single implant treatment. J Dent 1993;21:203-8. 3. Adell R, Lekholm U, Rockler B, Branemark PI. A 15 year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981;10:387-416. 4. Moscovitch MS, Saba S. The use of a provisional restoration in implant dentistry: a clinical report. Int J Oral Maxillofac Implants. 1996;11:395-9. 5. Santosa RE. Provisional restoration options in implant dentistry. Aust Dent J 2007;52:234-42. 6. Lewis S, Parel S, Faulkner R. Provisional implant-supported fixed restorations. Int J Oral Maxillofac Implants 1995;10:319-25. 7. Spyropoulou PE, Razzoog M, Sierraalta M. Restoring implants in the esthetic zone after sculpting and capturing the periimplant tissues in rest position: a clinical report. J Prosthet Dent 2009;102:345-7.
The Journal of Prosthetic Dentistry
8. Ganddini MR, Tallents RH, Ercoli C, Ganddini R. Technique for fabricating a cementretained single-unit implant-supported provisional restoration in the esthetic zone. J Prosthet Dent 2005;94:296-8. 9. Kökat AM, Akça K. Fabrication of a screwretained fixed provisional prosthesis supported by dental implants. J Prosthet Dent 2004;91:293-7. 10.Binon PP. Provisional fixed restorations supported by osseointegrated implants in partially edentulous patients. Int J Oral Maxillofac Implants 1987;2:173-8. 11.alZallal M, Morgano SM. The implant supported, heat-processed provisional fixed partial denture. Am J Dent 1991;4:260-4. 12.Donovan TE, Hurst RG, Campagni WV. Physical properties of acrylic resin polymerize d by four different techniques. J Prosthet Dent 1985;54:522-4. 13.Lin WS, Ercoli C. A technique for indirect fabrication of an implant-supported, screw-retained, fixed provisional restoration in the esthetic zone. J Prosthet Dent 2009;102:393-6. 14.Proussaefs P. The use of healing abutments for the fabrication of cement-retained, implant-supported provisional prostheses. J Prosthet Dent 2002;87:333-5. 15.van Steenberghe D, Naert I, Andersson M, Brajnovic I, Van Cleynenbreugel J, Suetens P. A custom template and definitive prosthesis allowing immediate implant loading in the maxilla: a clinical report. Int J Oral Maxillofac Implants 2002;17:663-70. 16.van Steenberghe D, Glauser R, Blombäck U, Andersson M, Schutyser F, Pettersson A, et al. A computed tomographic scanderived customized surgical template and fixed prosthesis for flapless surgery and immediate loading of implants in fully edentulous maxillae: a prospective multicenter study. Clin Implant Dent Relat Res 2005;7 Suppl 1:S111-20. 17.Marchack CB. An immediately loaded CAD/CAM-guided definitive prosthesis: a clinical report. J Prosthet Dent 2005;93:8-12.
Spyropoulou et al
September 2010 18.Sanna AM, Molly L, van Steenberghe D. Immediately loaded CAD-CAM manufactured fixed complete dentures using flapless implant placement procedures: a cohort study of consecutive patients. J Prosthet Dent 2007;97:331-9. 19.Marchack CB. CAD/CAM-guided implant surgery and fabrication of an immediately loaded prosthesis for a partially edentulous patient. J Prosthet Dent 2007;97:389-94.
20.Parel SM, Tripplet RG. Interactive imaging for implant planning, placement, and prosthesis construction. J Oral Maxillofac Surg 2004;62:41-7. 21.Moscovitch MS, Saba S. The use of a provisional restoration in implant dentistry: a clinical report. Int J Oral Maxillofac Implants 1996;11:395-9.
Corresponding author: Dr Panagiota-Eirini Spyropoulou The University of Michigan, School of Dentistry 1011 N University Ave, Rm 1378 Ann Arbor, MI 48109-1078 Fax: 734-764-1481 E-mail: [email protected] Copyright © 2010 by the Editorial Council for The Journal of Prosthetic Dentistry.
Noteworthy Abstracts of the Current Literature Digitization of simulated clinical dental impressions: Virtual three-dimensional analysis of exactness Persson AS, Odén A, Andersson M, Sandborgh-Englund G. Dent Mater 2009;25:929-36. Epub 2009 Mar 4. Objectives. To compare the exactness of simulated clinical impressions and stone replicas of crown preparations, using digitization and virtual three-dimensional analysis. Methods. Three master dies (mandibular incisor, canine and molar) were prepared for full crowns, mounted in full dental arches in a plane line articulator. Eight impressions were taken using an experimental monophase vinyl polysiloxane-based material. Stone replicas were poured in type IV stone (Vel-Mix Stone; Kerr). The master dies and the stone replicas were digitized in a touch-probe scanner (Procera® Forte; Nobel Biocare AB) and the impressions in a laser scanner (D250, 3Shape A/S), to create virtual models. The resulting point-clouds from the digitization of the master dies were used as CAD-Reference-Models (CRM). Discrepancies between the points in the point-clouds and the corresponding CRM were measured by a matching-software (CopyCAD 6.504 SP2; Delcam Plc). The distribution of the discrepancies was analyzed and depicted on color-difference maps. Results. The discrepancies of the digitized impressions and the stone replicas compared to the CRM were of similar size with a mean ± SD within 40 μm, with the exception of two of the digitized molar impressions. The precision of the digitized impressions and stone replicas did not differ significantly (F = 4.2; p = 0.053). However, the shape affected the digitization (F = 5.4; p = 0.013) and the interaction effect of shape and digitization source (impression or stone replica) was pronounced (F = 28; p < 0.0001). The reliability was high for both digitization methods, evaluated by repeated digitizations. Significance. The exactness of the digitized impressions varied with shape. Both impressions and stone replicas can be digitized repeatedly with a high reliability. Reprinted with permission of the Academy of Dental Materials.
Spyropoulou et al