Single Immediate Provisional Without Cement

As planned, the osteotomy at #3 is underprep (using 3 mm reamer), followed by taps until 5x11 mm (Fig.1).  When a 6x11 mm implant is being placed with high torque (Fig.2 (*: sinus lift)), bone mesiobuccal to the implant is starting to green-stick fracture.   After flap suturing, a 5x3 mm abutment is placed and adjusted for the height.  In fact the long vertical edentulous space is an artifact.  An immediate provisional is fabricated with clearance (Fig.3,4).  The adaptation of the provisional to the implant/abutment is so good that cement is not necessary for retention.  When the wound heals, the provisional is too short to be retentive.  It is not recemented.  A healing screw is placed until the implant is restored.

The patient returns for final restoration 5 months postop (Fig.5).  The crown is delivered 6 months postop.

Return to Upper Arch Reconstruction with Implants, Posterior Immediate Provisional

Xin Wei, DDS, PhD, MS 1st edition 10/26/2015, last revision 05/30/2016