When a patient presents with a partially edentulous arch, fixed restoration of the arch supported by dental implants and natural teeth requires proper planning and provisionalization. First, information must be obtained to help plan the case for function and aesthetics. Study models must be articulated so that the present occlusal relationship can be analyzed. Diagnostic wax-ups and intraoral waxups or diagnostic appliances must be utilized to evaluate aesthetics and phonetics. A detailed periodontal evaluation should be performed to determine which teeth can be saved for fixed prosthetic support. Radiographs including periapicals, panographs, and CT scans must be taken to evaluate the osseous support for dental implants. Interactive CT scans with radiographic guides offer detailed information with regard to implant placement related to tooth position and aesthetics.
Once it is determined which teeth can be saved and an overall plan is made for fixed prosthetics, it then must be decided how the case will be provisionalized during the treatment period. Most patients prefer a fixed provisional over a removable one due to stability, aesthetics, and less interference of speech patterns. There are many advantages to a laboratory-processed fixed provisional versus a chairside-produced provisional prosthesis. These advantages include improved aesthetics, smoother surface areas, increased strength, and reduced chair time compared to a chairside produced provisional.
Patient feedback about the provisional is also an important step in helping guide the final prosthesis toward an ideal aesthetic and functional outcome.
When natural teeth cannot support a provisional restoration, either provisional dental implants or immediately loaded dental implants can offer support for a provisional during a healing period. The healing period for a full-arch reconstruction can be up to a year if, for instance, bone grafting and periodontal surgery are incorporated into a plan.
Multiple tooth replacement
The implants are placed in the bone below the gum tissue. Like single tooth replacement, temporary abutments may be placed on the implants until the healing phase is complete. After healing, the abutments are attached to the implants. They will hold a custom-made bridge that the dental laboratory will mold and match to your existing teeth.
Implant-supported prosthesis (removable)
If all your lower teeth are missing, three to five implants may be used to support a lower denture. If all your upper teeth are missing, four or more implants may be used to support an upper denture.
The implants are positioned just below the gum tissue and given time to fuse with the bone. Temporary abutments may be placed on the implants until the healing phase is complete. Your existing denture can be modified so that it may be worn without disturbing the implants during the healing process.
The new denture will have attachments which snap or clip it into place. Your new teeth are firmly supported by the jaw, stimulating it and halting bone loss. You will be able to remove the denture easily for cleaning.