implant-supported FDP

Making the best out of your analogical world. Provisional implant-supported FDPs.

The use of implant-supported FDPs, in everyday practice, has become more and more popular, as the protocols have been simplified in the last two decades.
Moreover, immediate-load protocols are today well established in clinical practice and in the literature.
These changes are of course happily welcomed by patients, for whom this kind of rehabilitation is now comfortable enough to be accepted, as the dentist can today extract the teeth, place the implant and also provisionalize in a very short time span.
The fabrication of nice-looking provisionals is still challenging for the dental team, both because of timing and aesthetic expectations of the patient.
Moreover, the mechanical properties of the material should withstand a minimum of 6 months inside the patient’s mouth. In the meantime digital technology allows clinicians to fabricate printed surgical guides, printed/milled temporaries, ready to be screwed or cemented onto the implant(s).
This technological reality is working very well, and will be more and more our daily future. Nevertheless, the financial reality of dental practice has changed significantly the last 5 years and it is easy to observe that the technological promise does not always match with the economic reality, because the digital workflow is more expensive, whatever experts can demonstrate.
The purpose of this article is to present a simple and affordable way to produce nice and elegant implant-supported temporaries to fit with the analogical reality.

implants and abutments from occlusal

Fig.1

This 56 years old female patient was affected by multiple, severe apical infections on FDP-supporting roots of teeth 22, 21 and 12. 5 implants 5 (V3 MIS NP) were placed after extraction. As you can see, we were not able to place the implant on 22 in the ideal position because of the severe lack of bone volume, and the impossibility to have an angulated multi unit abutment on a narrow platform implant.
The prosthetic treatment plan included an implant-supported FDP from 15 to 22, and natural tooth FDP from 23 to 27.

wax-up for implant supported fdp

Fig.2

The whole arch was first waxed-up in order to recreate a proper lip support, a nice smile line, and aesthetics. The patient explicitly asked for very white and aligned teeth, with not much customization.

prosthodontic wax up

Fig.3

In order to keep tooth proportion close to ideal, and compromising with the severe bone resorption, an artificial gum is used in the cervical area in the anterior zone.

putty and light silicone index

Fig.4

A silicone index was fabricated on the wax-up, with a putty silicone (Lab silicone, Henry Schein) relined with a light-bodied silicone (Honigum light, DMG) to get an accurate replica of the texture.

implant cylinders on cast model with prop gum

Fig.5

The temporary prosthetic cylinders were cut, in order to let the silicone index fit.

injecting resin in silicone index

Fig.6

The silicone index is first fit to check insertion, then a reinforced bis-acryl resin material (LuxaCrown, DMG) is injected in the silicone index . Injection has to start from the bottom of the incisal edge up to the cervical part.

resin provisional prosthesis with excess

Fig.7

After the setting time (5 minutes), the silicone index is removed. Some small bubbles can occur, especially in the incisal and buccal area. This depends on how smooth the index is fit, and how firmly it’s hold in position during setting. This small bubbles can be filled with a drop of flowable composite (LuxaFlow-Star, DMG) or can be relined as well with LuxaCrown again before starting the polishing sequence.

pink composite for provisional prosthesis

Fig.8

Pink composite (Gradia Pink GC) is added in the cervical area.

coarse grit silicone diamond wheel

Fig.9

A coarse-grit silicone disc is used for the primary polishing in order to finalize the shape.

rough implant prosthesis

Fig.10

After a couple of minutes both the white and pink are finished, and we can proceed to the actual polishing.

polishing paste on temporary prosthesis

Fig.11

A universal diamond paste is applied on the surface to get the gloss.

polishing prosthesis with brush

Fig.12

Polishing pastes, combined with miniature polishing brushes (HATHO) work impressively well on the LuxaCrown resin, thanks to its composition.

dental supported fdp bridge

Fig.13

The same brush is used without the diamond paste. Texture changes easily with this simple polishing technique.

implant bridge with fake gums

Fig.14

In 5 minutes total, the resin is glossy, and the value is improved, while texture is maintained.

provisional prosthesis with pink to fake gum

Fig.15

Intraoral integration of the temporaries for both implant and dental supported restorations.

provisional prosthesis with pink to fake gum

Fig.16

6-month follow-up picture shows the optical stability of this resin, making it ideal for long-term temporaries.

Final restoration with zirconia ceramic implant-supported fdp

Fig.17

Final restoration with zirconia ceramic implant supported fixed dental prostheses.

Conclusions

The aim of this article was to share simple tips and tricks for your everyday practice, while complying with a common financial reality.
This analogical approach is efficient on different sides:
– It’s easy to do
– It’s quick
– Durable for the scope
– Esthetic
Of course digital options work very nicely, but they do cost much more and can be longer too. The aim is not to compare the two very different workflows, but it’s to highlight the pros and cons of each.
The challenge for the dentist is not to use one technique instead of the other, but to try to make the best synthesis of the analogical and the digital workflows, and get the best out of each.

BIBLIOGRAPHY

1. Ostman PO, Hellman M, Sennerby L, Wennerberg A. Temporary implant-supported prosthesis for immediate loading according to a chair-side concept: technical note and results from 37 consecutive cases. Clin Implant Dent Relat Res. 2008 May;10(2):71-7.

2. Cooper L, De Kok IJ, Reside GJ, Pungpapong P, Rojas-Vizcaya F. Immediate fixed restoration of the edentulous maxilla after implant placement. J Oral Maxillofac Surg. 2005 Sep;63(9 Suppl 2):97-110.