A Simple Technique for Fabrication of Immediate Interim Removable Prosthesis Supported by Transitional Implants

A Simple Technique for Fabrication of Immediate Interim Removable Prosthesis Supported by Transitional Implants
September 2003
Leshem, David MD*; Mazor, Ziv DMD**; Leshem, Roy DMD***; Rosen, Daren DDSÇƒÜ
*Chief Resident, Department of Plastic and Reconstructive Surgery, Sourasky Medical Center, Tel Aviv, Israel.
**Private Practice, Ra'anana, Israel.
***Private Practice, Herzlia, Israel.
ÇƒÜSenior Surgeon, Unit of Oral and Maxillofacial Surgery, Sapir Medical Center, Kfar Saba; Private Practice, Ra'Anana, Israel.
Reprint requests and correspondence to: Roy Leshem, DMD, P.O. Box 2022, Herzlia, Israel
Implant Dentistry: Volume 12(3) September 2003 pp 227-231
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Abstract
The healing period between implant insertion and exposure is often challenging for both the patient and the surgeon. The use of a removable dental prosthesis is not recommended for a period of several days to 2 weeks in an effort to avoid undue pressure being placed on the newly placed implants and on the surrounding soft tissues. However, patients are frequently uneasy without dentures, even for a short period of time, because their diet and appearance are compromised. A simple technique was developed to overcome these obstacles. This technique allows the surgeon to place an im- mediate implant-supported prosthesis, based on two transitional implants, in addition to the implants placed for final restoration. This technique is performed at the surgical stage simultaneously with the placement of the permanent implants. It requires minimal additional time, and makes use of the patient's original prosthesis as an interim removable restoration during the integration period.
Integration of implants into the jaw is dependent on the initial stability of the implants. Most surgeons prefer to wait several months for the healing process to take place before constructing the prosthesis for the implant(s). 1 Recently, as a result of clinical research, progressive shortening of the healing period is recommended and immediate implant loading is being performed in select cases. 2-5 However, it should be remembered that the success of immediate-loaded implants is highly dependent on the initial bone density at the implant site and the meticulous occlusal force equilibration, 6 and that even minor movement of implants during the osseointegration period can interfere with the healing process, causing fibrosis around the implant and accelerated crestal resorption. 7,8 In the unfortunate event that a single implant fails after immediate restoration of several fixtures, the entire prosthesis may have to be replaced. Therefore, loading of final implants is often delayed. 7,9-11
In an effort to eliminate the forces placed on the implants and the surgical site by the existing denture immediately after surgery, patients are often requested to refrain from wearing their dentures for at least 7 days after stage 1 surgery. Furthermore, trauma to the soft tissue over the fixtures should be avoided to decrease the possibility of incision dehiscence. However, most patients refuse to remain without dentures even for a short period. A transitional implant was developed to meet the patient's need to wear a denture during the healing period and to meet the surgeon's request to protect the implant site by avoiding any prosthetic trauma to the implant area.
The purpose of this article is to describe a technique for simultaneous placement of transitional implants that enables patients to wear their prostheses immediately following surgery. These implants are designed to carry the load of the existing denture, thus relieving pressure on the soft tissue and the newly placed final implants. The transitional implant raises the prosthesis from the surgical site, thus avoiding trauma to the denture and the implants, and reduces the possibility of dehiscence of the incision. Immediate loading of transitional implants does not entail any risk to the final restoration, and does not require fabricating a special interim restoration.
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