Are you the patient who is scared of being without teeth after extracting teeth? You are not alone. The good news is there a plethora of options available for you to choose from. The recent advancements in dentistry have taken implant dentistry to the next level, with implants being a very successful and preferable option for both the dentist and the patient alike for replacing missing teeth. Dental implants help in providing fixed solutions to missing teeth without compromising the tooth structure of the adjacent teeth. However, there was always a window period between the time of implant placement and replacement of the crown structure, which was necessary to allow for the integration of the implant with the bone. This window period used to make patients skeptical about the treatment, as they had to remain without teeth during that period. Nevertheless, implant dentistry has evolved to that extent, that this window period has been reduced or even completely removed by the advent of newer techniques. This evolution of implant dentistry has even further increased patient acceptance and clinical success rates. So how did this happen? What are the modalities that helped bring on this evolution? Let us see…
Immediate implant placement with immediate loading gives you the room to fit the teeth within 48 hours. When there is an adequate bone of more than 10mm and when there is primary stability, immediate loading would be a great choice to get your teeth in place immediately. However, not all patients can be treated with immediate loading. An important criterion would be the primary stability of the implant that was placed. After evaluating the same with periotest or resonance frequency analysis, your dentist will decide whether to immediately load or not. A screw-retained provisional restoration is more preferred for such cases when compared to cement retained prosthesis. If cemented, the dentist will have to remove the provisional restoration during the 4-6 month healing period. Cantilevers cannot be restored with a provisional restoration. A diagnostic wax-up will be used for template and provisional restoration fabrication. With the high success rates, immediate loading has become a very popular choice of treatment.
Tooth supported provisional prosthesis
Your dentist can use your teeth to support the interim prosthesis. This may include the use of an attached pontic with orthodontic brackets just adjacent to the implant site. Another viable option would be the use of resin-bonded provisional pontic. This involves acid etching the adjacent teeth and hence provides tooth supported prosthesis. Maryland Bridge is nothing but resin bonded, cast metal framework prosthesis. They have been used successfully for long term provisionals, especially in young patients. However,the prognosis of the outcome for long-term use of this type of restoration is unpredictable. Usually, the teeth with poor prognosis act as temporary abutments and are extracted after the implants osseointegrate. The teeth supported provisional restoration is then converted into an implant-supported provisional restoration. Hence, the option of the provisional tooth-supported prosthesis has also been very much popular among the patient population as it helps meet the aesthetic and functional demands.
Removable partial acrylic dentures have commonly been used during post-extraction and post-implant therapy. They are very easy to construct, relatively inexpensive, and easy for your dentist to adjust and fit. However, they may reduce the effectiveness of any additional surgical bone and gingival augmentation procedure used to optimize the implant site. Soft tissue borne prosthesis used during healing may cause uncontrolled implant loading leading to implant exposure, marginal bone loss, and/or failed integration. Often your dentist will adjust the provisional dentures to minimize contact with the healing implants.
You also have alternatives to tissue borne provisional restorations. An Essix appliance is an appliance made with vaccuform material with teeth bonded in the missing area to replace the missing teeth. They act as a removable prosthesis are useful in cases of deep anterior overbite or limited interocclusal space. This prosthesis is made from an acrylic tooth bonded to a clear vacuform material on a cast of the diagnostic wax-up. The prosthesis provides protection to the underlying soft tissue and implant during the healing phase. However, care has to be taken to get accustomed to the appliance, as some new wearers might not find it very comfortable wearing them for the first few days. Nevertheless, it provides the necessary esthetic function for your missing teeth in the interim period.
‘Some pains are physical, and some pains are mental, but the one that’s both is dental.’- Ogden Nash. Dentists are the ones who help you overcome this phase. With effective implant therapy and prosthesis planning, the pains of missing your teeth and in turn losing your esthetics and confidence can be overcome. Choose wisely, live better!