Fig.1
Initial situation with four element bridge based on two compromised abutments with chronical infections.

Fig.2
X-ray of the initial situation: you can see the periapical infections and fracture of the root on tooth 17.
It was decided to extract and place two implants for a three element bridge.

Fig.3
Teeth have been extracted and two V3 implants (MIS implant) (3,9/13 mm) are placed in position 14 and 16 with 30° angulated axis for tooth 16 in order to follow the sinus wall.
Two multi unit abutments (one standard and one 30° angulated) are placed directly on the implant in order to receive temporary cylinders for the immediate loading.

Fig.4
X-ray of the placed V3 (Mis implant) implants.

Fig.5
Two temporary cylinders for multi unit abutment are screwed manually.

Fig.6
View after the placement of the temporary cylinders which are too high for the bite.

Fig.7
Wax up of the 3 element bridge with the expected design.

Fig.8
A simple silicone index is produced according to the wax up with a simple putty soft silicone (DMG Honigum-Putty Soft)

Fig.9
The silicone index is filled with a bis-acryl chemical cure flowable resin with high mechnical properties able to have a good color stability. This material (DMG LuxaCrown) allows the clinician to make a semi-permanent restoration.

Fig.10
After a setting time of 5 minutes you can achieve a very precise surface texture with a very good physical stability (no sticky effect). Within 5 minutes the good conversion rate gives your temporary restoration the expected physical properties.

Fig.11
Two small holes are made in the restoration through the resin to access to the screw to unscrew and take the finishing steps outside the mouth.

Fig.12
The restoration is relined in the cervical area around the base of the cylinder with a flowable composite (DMG LuxaFlow Star) to give the ideal emergence profile which will drive the healing of the gum.

Fig.13
Restorations are polished with a silicone wheel (Komet) in order to get a shiny effect. This material is very easy to polish with a basic sequence.

Fig.14
External view after the polishing sequence. No glazing is needed. Manual polishing is the ideal way to treat this material.

Fig.15
Internal view of the restoration before the placement.

Fig.16
Final view after placement.

Fig.17
Global view of the restoration in place .

Fig.18
Xray after 2 months in the mouth.

Fig.19

Conclusions

This type of semi permanent restoration does not, of course, represent the state of the art in the implant supported restorations, but can be a simple way to fix the issue of the time in between surgery and final restoration.

The use of a silicone index made from the wax up is nowadays a very common step for every dentist and is basically used for temporaries or mock up.

Following the same workflow, and changing the nature of the material we have to inject in the silicone index we can achieve a very smart restoration esthetically and functionally with a very cheap cost, and let the dentist and the patient have enough time to think of the next step. This is the daily life in dentistry, but in a stylish way.

Bibliography

Maló P, de Araújo Nobre M. Partial rehabilitation of the posterior edentulous maxilla using axial and tilted implants in immediate function to avoid bone grafting. Compend Contin Educ Dent. 2011 Nov-Dec;32(9):E136-45.
Agliardi EL, Tetè S, Romeo D, Malchiodi L, Gherlone E. Immediate function of partial fixed rehabilitation with axial and tilted implants having intrasinus insertion. J Craniofac Surg. 2014 May;25(3):851-5.