Rapid technological
development has been a hallmark of the last five to ten years of
restorative dental practice. AS a periodontal services practice our
role in supporting your practice has been, first, to retain sufficient
natural.
dentition for functional restorations and, second, to develop
adequate osseous tissue for tooth replacement systems. Increasingly
as a profession we are moving towards non-removable tooth
replacements. When implants first began we chose sites for them
based on the amount of available bone in a site. As we searched to
increase the application of implants the emphasis switched to developing
sites which had inadequate bone. Currently, this type of therapy is
an expensive combination of supporting bone development, implants and
fixed ceramometal restorations. This combination of treatments has
been readily embraced by patients who have experienced the loss of
alveolar ridges from long term wear of removable appliances. Now, as
periodontally involved dentulous patients perceive the benefits of
esthetics and function from implant borne restorations, it becomes
necessary to provide interim functional and esthetic replacements while
implant sites are being developed. In three specific situations we
would rely on your expertise to prepare provisionals for maximum
esthetics.
The first situation we often
encounter is multiple adjacent tooth periodontal involvement necessitating
extraction of several teeth. Usually loss of these teeth results in
less ridge height than desirable for implant placement. With the
presence of periodontal defects the remaining alveolar ridge almost always
experiences shrinkage from the loss of narrow interproximal and facial
bony plates. At the time of extractions there is seldom adequate
soft tissue to do immediate osseous ridge augmentation with full soft
tissue closure. What is required in this instance is a provisional
replacement which is esthetic, avoids ridge pressure and lasts the 6-7
months necessary for the original extraction sites to cover with soft
tissue and allow osseous ridge augmentation. One method which has
effective is the immediate bonding of extracted tooth crowns into the
edentulous space.
The second situation for
special provisional use is the immediate provisional placed on an implant
at the time of implant placement or on the integrated implant which is
ready to be restored. With both approaches the provisional crown
provides proximal contours to develop interproximal papillae prior to
placing the final crown. Current implant site development in the
esthetic zone (maxillary arch #4-#13) dictates the presence of adequate
soft tissue coronal to bone to develop interproximal papillary height by
continually widening the provisional restoration until normal papilla
height is achieved. As the provisional is contoured to normal
interproximal shape the papilla is reformed provided the depth of
the implant and the thickness of the soft tissue has been developed.
This method has produced high levels of esthetics.
The third area where your
provisionals aid the periodontal repair process is the protection of
interproximal healing. A prime example of this is the crown
lengthening case. When we adjust the biologic width to produce
adequate crown length and gingival protection for the tooth it often
follows Endodontic care necessitated by recurrent caries. Invasion
of the biologic width dictates an apical positioning of the gingival
complex and necessitates protection of the interproximal tissue during
healing. The presence of a provisional restoration post-surgically
maintains the proximal space and helps develop gingival contours.
This is particularly true in the anterior esthetic zone, but may also
reduce food impaction in the process.
We
appreciate working with you to develop long term solutions of fixed
restorative care for your patients. If we can assist further in the
planning and implementation of restorative solutions through the creation
of additional osseous support or proper tooth-borne relationships please
contact our office.
