Immediate loading of the anterior sector - From provisional to final restoration
Dr. Erick Mota González
PhD in Dentistry Magna Cum Laude of the Universidad Nacional Pedro Henrique Ureña (UNPHU) of Santo Domingo (Dominican Republic). Clinical Masters’ Degree in Oral Prosthetics and Implantology of the University of Barcelona. Clinical coordinator of the Rubydent Dental Clinic (Madrid).
Dra. Núria Creus Sarri
Graduate in Dentistry of the University of Barcelona. PhD in Endodontics of the Societat Catalana d'Odontologia i Estomatologia (Catalan Association of Dentistry and Stomatology). Clinical Masters’ Degree in Oral Prosthetics and Implantology of the University of Barcelona. Implantologist, General Odontologist and Endodontist of the Clinic Dental Office (Mollerussa)
Dra. Sara Sabría
Graduate in Dentistry of the Universitat Internacional de Catalunya (International University of Catalonia). PhD in Endodontics of the Societat Catalana d'Odontologia i Estomatologia (Catalan Association of Dentistry and Stomatology). Masters’ Degree in Prosthetics and Implantology of the University of Barcelona.
Dr. Daniel Capitán
Graduate in Dentistry of the University of Barcelona. Clinical PhD in Oral Prosthetics and Implantology of the University of Barcelona. Diploma in Implantology of the SEI (Spanish Implant Association). International Diploma in Dentistry of the AIOI (International Academy of Integrated Dentistry). Professor of the Masters’ Degree in Oral Prosthetics and Implantology of the Department of Odontostomatology of the University of Barcelona. Official Masters’ Degree in Dental Science Research of the University of Barcelona. Director and Professor of the Course on Advanced Dental Implant Surgery of the University of Vic.
Immediate loading has now become an increasingly commonplace surgical technique with high demand in our clinics, and can provide the patient with increased comfort, aesthetics and harmony on the very same day as the implant treatment. We can also manage the tissues from the very first moment with correct provisionalisation designed for us by the emergence profile required for the final restoration.
Patient aged 58 with no relevant prior medical background, visits the clinic to improve his appearance, with high treatment expectations. Atraumatic extractions of pieces 12, 11, 21, 22 and 23 due to presenting an unfavourable periodontal condition, presence of a cyst, mobility and bad position. No alveolar regeneration or preservation was carried out as he presented good integrity of the vestibular panels.
Initial situation of the patient | Initial OPG | Pre-surgery image
After a 3-month healing period, placement was planned of the Biomimetic Ocean Implants (Avinent implant System) with internal connection in positions 11, 21 and 23 plus an immediate loading of the missing teeth using the modified Pick Up technique.Positioning of the provisional dentures using the modified Pick Up technique | Placement of the Biomimetic Ocean IC implants | Verification of the three-dimensional position of the implantsPlacement of the transepithelial caps
The technique used is a modification of the one described by Dr. German Galucci, which uses a scan prosthesis and another surgical prosthesis for placement of the implants designed on the basis of the diagnostic wax-up that will then be the future provisional. The choice of this technique is due to its ease and speed provided in the moment to know the prosthetically correct position of our implants while at the same time avoiding intra-operation impressions and bite registrations when the implants are put in place having previously verified all functional and aesthetic parameters in the teeth try-in or diagnostic wax-up.
All implants remained stable with a torque of approximately 45Ncm. Straight transepithelial caps were placed of 1 mm in height (AVINENT) to provide, given that this was a rehabilitation with multiple implants, greater passivity and improved insertion of the dentures. Another advantage of these caps is that they move the dentures away from the connection of the implants, thereby achieving an improved biological sealing.
Provisional titanium caps were placed directly on the implants and a provisional ovoid denture was made of acrylic resin to guide the healing of the tissues.
Placement of the provisional titanium caps | Close-up of the provisional dentures finished and polishedPlacement in the mouth of the provisional dentures within 24h | X-ray of the implants in place and provisional dentures loaded
Following the healing period for the tissues, and after achieving the required emergence profile, the latter was copied conventionally on the basis of the provisional dentures screwed to the master model.
Close-up of the tissues during the healing periodClose-up of the soft tissues
The emergence profile obtained was taken to the mouth and a new accurate impression was taken from the patient for transfer to the laboratory of all of the provisional information and preparation of the definitive metal-ceramic dentures.
Copy of the emergence profileDefinitive dentures in the mouthX-ray of the denture in placeDefinitive dentures in the mouth
In this case, it is possible to appreciate the importance of handling the soft tissues through execution and placement of provisional dentures on the same day as the implant surgery. If carried out correctly, this will be our starting point for the definitive rehabilitation, achieving harmony in the aesthetic sector.
TagsDental prosthetics, Dentistry 4.0, Advanced esthetics