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Use of a provisional restoration as a radiographic guide prior to implant placement
Use of a provisional restoration as a radiographic guide prior to implant placement Ophir Rosner, DMD,a Martin Gross, BDS, LSD, MSc,b and Joseph Nissan, DMDc The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel Proper implant placement, according to both osseous limitations and prosthetic demands, is a key factor contributing to the success of implant-supported prostheses. Radiographic imaging using radiographic guides provides necessary data required for the clinician to accurately select implant dimensions, as well as to plan implant placement, position, and angulation in advance.1,2 The radiographic guide should reproduce the outline of the definitive restoration either by duplicating the diagnostic waxing, or more accurately, duplicating the provisional restoration.3-5 The duplication process may involve physical distortions that will require relines and adjustments. These procedures entail chair time, materials, patient discomfort, as well as compromised esthetics, pain, additional sessions for insertion of the surgical template, and at a later time, the provisional restoration. This article presents a novel approach in which the provisional restoration serves as the radiographic template, thus eliminating the disadvantages and difficulties involved in the duplication processes.
PROCEDURE
Fig. 1. A, Rectangular spaces prepared in palatal surface of provisional restoration. B, Rectangular spaces prepared in labial surface of provisional restoration.
1. After completing the provisional restoration, make rectangular recesses using an inverted cone bur (No. H16; Strauss & Co, Raanana, Israel) on the buccal and palatal/lingual aspects in each restorative unit, to be replaced later by an implant-supported prosthesis. Ensure that the spaces are 1 to 2 mm deep and are not closer than 1 mm to the planned contact points (Fig. 1). 2. Mix acrylic resin powder (Unifast Trad; GC Corp, Tokyo, Japan) with Barium powder6 (Barium Sulfate; E-Z-EM Inc, Lake Success, NY) at a ratio of 4:1. Add monomer to create uniform viscous dough. 3. Place the dough inside the rectangular spaces. When filling the palatal/lingual spaces, do not overdilute the barium with the mixed powder, because of the small amount of barium present. Fig. 2. Provisional restoration in place. Maxillary left segment to be restored with implants (green brackets). a
Instructor, Department of Oral Rehabilitation. Associate Professor, Director Graduate Prosthodontics, Department of Oral Rehabilitation. c Lecturer, Director Implant Prosthodontics, Department of Oral Rehabilitation. J Prosthet Dent 2006;96:303-4. b
OCTOBER 2006
4. Shape, finish, and smooth all filled areas (Figs. 2 and 3) using a flame-shaped bur (No. H25; Strauss & Co). THE JOURNAL OF PROSTHETIC DENTISTRY 303
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3. Petrungaro PS. Implant placement and provisionalization in extraction, edentulous, and sinus grafted sites: a clinical report on 1,500 sites. Compend Contin Educ Dent 2005;26:879-90. 4. Small BW. Surgical templates for function and esthetics in dental implants. Gen Dent 2001;49:30-4. 5. Naitoh M. Can implants be correctly angulated based on surgical templates used for osseointegrated dental implants? Clin Oral Implants Res 2000;11: 409-14. 6. Israelson H, Plemons JM, Watkins P, Sory C. Barium-coated surgical stents and computer-assisted tomography in the preoperative assessment of dental implant patients. Int J Periodontics Restorative Dent 1992;12:52-61.
Fig. 3. Barium markers are apparent in CT scan, both in transverse and serial sections. Chosen sites for implant placement are identified with red frame. REFERENCES 1. MeCall RA, Rosenfeld AL. The influence of residual ridge resorption patterns on implant fixture placement and tooth position. 2. Presurgical determination of prosthesis type and design. Int J Periodontics Restorative Dent 1992;12:33-51. 2. Williams MY, Mealey BL, Hallman WW. The role of computerized tomography in dental implantology. Int J Oral Maxillofac Implants 1992;7:373-80.
304
Reprint requests to: DR JOSEPH NISSAN DEPARTMENT OF ORAL REHABILITATION SCHOOL OF DENTAL MEDICINE TEL AVIV UNIVERSITY 4 KLATCHKIN ST TEL AVIV, ISRAEL FAX: 972-3-6409250 E-MAIL: [email protected] 0022-3913/$32.00 Copyright Ó 2006 by The Editorial Council of The Journal of Prosthetic Dentistry.
doi:10.1016/j.prosdent.2006.08.003
VOLUME 96 NUMBER 4
PROCEDURE
Fig. 1. A, Rectangular spaces prepared in palatal surface of provisional restoration. B, Rectangular spaces prepared in labial surface of provisional restoration.
1. After completing the provisional restoration, make rectangular recesses using an inverted cone bur (No. H16; Strauss & Co, Raanana, Israel) on the buccal and palatal/lingual aspects in each restorative unit, to be replaced later by an implant-supported prosthesis. Ensure that the spaces are 1 to 2 mm deep and are not closer than 1 mm to the planned contact points (Fig. 1). 2. Mix acrylic resin powder (Unifast Trad; GC Corp, Tokyo, Japan) with Barium powder6 (Barium Sulfate; E-Z-EM Inc, Lake Success, NY) at a ratio of 4:1. Add monomer to create uniform viscous dough. 3. Place the dough inside the rectangular spaces. When filling the palatal/lingual spaces, do not overdilute the barium with the mixed powder, because of the small amount of barium present. Fig. 2. Provisional restoration in place. Maxillary left segment to be restored with implants (green brackets). a
Instructor, Department of Oral Rehabilitation. Associate Professor, Director Graduate Prosthodontics, Department of Oral Rehabilitation. c Lecturer, Director Implant Prosthodontics, Department of Oral Rehabilitation. J Prosthet Dent 2006;96:303-4. b
OCTOBER 2006
4. Shape, finish, and smooth all filled areas (Figs. 2 and 3) using a flame-shaped bur (No. H25; Strauss & Co). THE JOURNAL OF PROSTHETIC DENTISTRY 303
THE JOURNAL OF PROSTHETIC DENTISTRY
ROSNER, GROSS, AND NISSAN
3. Petrungaro PS. Implant placement and provisionalization in extraction, edentulous, and sinus grafted sites: a clinical report on 1,500 sites. Compend Contin Educ Dent 2005;26:879-90. 4. Small BW. Surgical templates for function and esthetics in dental implants. Gen Dent 2001;49:30-4. 5. Naitoh M. Can implants be correctly angulated based on surgical templates used for osseointegrated dental implants? Clin Oral Implants Res 2000;11: 409-14. 6. Israelson H, Plemons JM, Watkins P, Sory C. Barium-coated surgical stents and computer-assisted tomography in the preoperative assessment of dental implant patients. Int J Periodontics Restorative Dent 1992;12:52-61.
Fig. 3. Barium markers are apparent in CT scan, both in transverse and serial sections. Chosen sites for implant placement are identified with red frame. REFERENCES 1. MeCall RA, Rosenfeld AL. The influence of residual ridge resorption patterns on implant fixture placement and tooth position. 2. Presurgical determination of prosthesis type and design. Int J Periodontics Restorative Dent 1992;12:33-51. 2. Williams MY, Mealey BL, Hallman WW. The role of computerized tomography in dental implantology. Int J Oral Maxillofac Implants 1992;7:373-80.
304
Reprint requests to: DR JOSEPH NISSAN DEPARTMENT OF ORAL REHABILITATION SCHOOL OF DENTAL MEDICINE TEL AVIV UNIVERSITY 4 KLATCHKIN ST TEL AVIV, ISRAEL FAX: 972-3-6409250 E-MAIL: [email protected] 0022-3913/$32.00 Copyright Ó 2006 by The Editorial Council of The Journal of Prosthetic Dentistry.
doi:10.1016/j.prosdent.2006.08.003
VOLUME 96 NUMBER 4