Options To Consider For Interim Tooth Replacement And/Or Soft Tissue Management

Now that the implant is placed, we have several options to consider for interim tooth replacement and/or soft tissue management.

If the soft tissue form is favorable, then an attempt to maintain or support the supra-crestal gingival tissues during the period of osseointegration simplifies the restorative process. By simplifies, I mean that the emergence profile will not need to be developed with a provisional crown.

One way to achieve this is to fabricate a custom healing abutment with the proper shape to provide support for the gingival tissues.  To replace the tooth, an interim RPD or a bonded tooth pontic can be used.

Another technique I like to use is a chairside fabricated provisional crown.  If the implant is stable at placement, and the occlusal is favorable, then a crown can be attached on the day of surgery.

In this case, I utilized the patient’s tooth.  The tooth was trimmed to create a shell crown, and then relined on the temporary abutment in the mouth.  The provisional restoration is finished on an analog to ideal contours and then inserted with finger torque.

For this patient, I also added a small piece of connective tissue, that was harvested from the palate.  This helps to increase the thickness of the facial gingiva, to minimize the development of a flat or concave contour that so often happens after normal remodeling of the alveolar complex.

The restorative phase was completed with a porcelain veneer on tooth #8 (FDI #11) and a zirconium abutment/ porcelain crown on #9 (FDI #21).

In our next blog posting, I will talk about a patient that required a staged alveolar grafting and implant placement.