Achieving immediate function with provisional prostheses after implant placement: A clinical report

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Achieving immediate function with provisional prostheses after implant placement: A clinical report
June 2005
Kung-Rock Kwon, DDS, MSD, PhD, Amit Sachdeo, BDS, MS, Hans-Peter Weber, DMD
The Journal of Prosthetic Dentistry ǃ˘ Volume 93 ǃ˘ Number 6
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Abstract
When using a conventional implant treatment protocol in edentulous patients, reduced function and comfort for up to 6 months after implant surgery is inevitable until bone healing is complete and a prosthesis is securely attached to the implants. The following report highlights 2 treatment modalities that enable immediate function by inserting provisional prostheses immediately after implant placement.
Conventional implant treatment protocols involved the placement of implants followed by a healing period of 3 to 6 months in a submerged or nonsubmerged placement.1 This protocol resulted in relatively long treatment periods from surgery to prosthodontic completion. According to the original recommendations of Branemark and Schroeder,2 these periods were necessary to allow for complete osteogenesis and woven bone remodeling into load-bearing lamellar bone prior to any occlusal loading. Shortly thereafter, some clinicians proposed early or immediate loading, with implant placement and prosthetic loading for edentulous patients at the same clinical visit or separated by 2 to 4 weeks.3-6 This approach was primarily applied in the mandible, where excellent primary implant stability can be achieved in the interforaminal region.7 Bone formation has been shown to be enhanced by adequate mechanical stimulation.8-10 Initially, the attachment of the implant to the bone is purely mechanical (primary stability).10 Thus, primary stability depends on the implant (dimension, design) and the implant bed (bone density). Over the course of bone healing, both mechanical and biological factors are important in implant anchorage (secondary stability).10
Several authors have reported the successful use of transitional implants for restoring both partially and completely edentulous patients.11,12 These authors concluded that this approach was more economical and feasible for immediate patient restoration that allowed for osseointegration of unloaded, submerged implants to occur free from prosthetic loads. An implant-retained overdenture, using 4 implants, represents another attempt to restore edentulous patients immediately.13-16 A rigid cross-arch bar that rigidly connects the implants is recommended with this procedure.8,9,17 The purpose of this clinical report is to demonstrate 2 prosthetic treatment options for obtaining immediate function after implant surgery.
References
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