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*Private practice limited to prosthodontics, Atlanta, GA, USA

Esthetic Potential of Single-Implant Provisional Restorations: Selection Criteria of Available Alternatives

GEORGE PRIEST, DMD*

ABSTRACTProvisional implant restorations are essential tools used to optimize the esthetic outcomes for sin-gle-tooth implant restorations. This article describes three groups of available alternatives andthe specific options within each group including removable prostheses (interim removable partialdenture, vacuum-formed appliance), tooth-supported prostheses (bonded extracted or dentureteeth, cast metal or fiber-reinforced resin-bonded fixed partial denture [FPD], wire-retainedresin-bonded FPD, acrylic resin provisional FPD), and implant-supported fixed prostheses(implant-retained provisional restoration). Advantages and disadvantages as well as fabricationguidelines for each option are provided. The author proposes that the restorative dentist considereight criteria in selecting the most appropriate type of provisional prosthesis for a specific patientsituation including the esthetic potential, patient comfort, treatment time, laboratory cost,occlusal clearance, ease of removal, durability, and ease of modification. The patient’s estheticexpectations are critical in determining the most suitable type of provisional restoration. Estheti-cally pleasing provisional restorations are part of the evolving implant continuum, makingimplant dentistry more appealing to practicing dentists and potential patients.

CLINICAL SIGNIFICANCEProvisional restorations for single implants have evolved from temporary expedients duringosseous and soft tissue integration to critical therapeutic tools used to assess patient expectations,communicate with the laboratory, and optimize definitive implant treatment. The selection of thetype of provisional restoration may significantly influence esthetics during the period of implantintegration and soft tissue healing. However, it is unlikely that there is a direct correlationbetween the type of provisional restoration used and the esthetic outcome of the definitive prosthesis.

(J Esthet Restor Dent 18:326–339, 2006)

DOI 10.1111/j.1708-8240.2006.00044.x

I N T R O D U C T I O N

Provisional implant restorationsare essential tools used by

restorative dentists to optimizeesthetic outcomes for single-toothimplant restorations. They are not

merely temporary expedients dur-ing implant integration, but a com-munication method used betweenthe dentist and the laboratory toassist in the development of toothcontours and soft tissue profiles.

They also serve as a means to cap-ture a patient’s confidence in theirdentist’s restorative capabilities.1

Even though the provisional phaseof treatment is often the longest induration and the most challenging

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aspect of implant therapy for therestorative dentist, there is minimalpublished information on the exist-ing types of provisional restora-tions, their indications, and theirclinical fabrication. The purpose ofthis article was to describe threegroups of available options of pro-visional restorations for singleimplants, from removable prosthe-ses to tooth-supported prostheses toimplant-supported fixed prostheses(Table 1). Their advantages and dis-advantages are compared by theauthor to aid restorative dentists intheir determination of the mostappropriate alternative for a givenpatient situation.

Removable Prostheses

1. Interim Removable Partial Denture (RPD) Interim RPDs, often referred to as“flippers,” are commonly used

options during single-implant ther-apy. Simplicity of fabrication andease of seating are this option’smost compelling advantages. Theability to modify an acrylic resininterim RPD easily presents anadditional benefit. For patients whomay require multiple procedures ofextraction, soft and hard tissue aug-mentation, and implant placement,interim removable prostheses maybe quickly removed and acrylicresin added or reduced to accom-modate changes in ridge anatomy.In younger patients who are stilldeveloping, yet not old enough forimplant placement, the adjustablenature of interim removable prostheses again facilitates modifications.

However, for many patients, bulkyremovable appliances are cumber-some, interfere with speech, initiatean inflammatory soft tissue

response from the acrylic base, andare frequently lost or destroyed.Implant or graft integrity may becompromised if passivity of fit can-not be maintained. It may be diffi-cult to prevent pressure from thepontic on a fresh surgical site.Patients with inordinately stronggag reflexes are often unable towear removable prostheses thatpartially cover the palate. For thosepatients with minimal distancebetween the implant platform andthe opposing dentition, the thinconnector area is prone to fracture,and repeated repairs during theinterim period can be frustratingfor both patients and dentists. Inpatients who have undergoneorthodontics, an RPD will maintaincoronal spacing, but a relapse mayoccur apically, resulting in conver-gence of the roots and ultimatelyinsufficient space for an implant.An adhesive fixed prosthesis, which

TABLE 1. AVAILABLE OPTIONS OF PROVISIONAL RESTORATIONS FOR SINGLE IMPLANTS.

Type Removable Fixed Tooth Supported Implant

Supported

Wire-

Metal or Retained

Vacuum- Fiber- Resin- Implant-

Interim Formed Bonded Reinforced Bonded Acrylic Retained

Criteria RPD Appliance Tooth FPD FPD Resin FPD Restoration

Esthetic potential Good Fair Poor Good Good Very Good Excellent

Patient comfort Poor Poor Good Good Good Excellent Excellent

Treatment time Minimal Minimal Moderate Lengthy Moderate Lengthy Lengthy

Laboratory cost Medium Low None High Low Low Medium

Occlusal clearance Substantial None Minimal Moderate Moderate Minimal Minimal

Ease of removal Easy Easy Moderate Difficult Easy Easy Easy

Durability Fair Fair Poor Good Good Fair Excellent

Modifications Easy Moderate Difficult Difficult Moderate Easy Easiest

RPD = removable partial denture; FPD = fixed partial denture.

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will maintain coronal and apicalspacing, may be more appropriatefor these patients.

Acceptable esthetics may be diffi-cult to master with interim remov-able appliances. The denture teethused in removable prostheses canbe modified to match the shape ofthe corresponding tooth, but thelimited shade selections may notclosely approximate the adjacentnatural dentition. During initialperiods of integration or after hardand soft tissue augmentation,removable appliances shouldremain passive over the implantsite, which may necessitate anunsightly gap between the ridge andneck of the denture tooth. After ini-tial soft tissue healing, the toothcan passively contact the ridge toimpart a more natural appearance.It is best to eliminate any flange inthe region of the pontic, thus givingthe patient and dentist a more

realistic approximation of theresult. Healing abutments on theimplants may be facially inclined ortoo long to be completely hidden bya removable appliance in theesthetic zone. A facially angledhealing abutment may be reducedon the facial aspect with a carbidebur and polished, allowing the pon-tic to contact the ridge slightlyfacial to the modified healing abut-ment. A long-healing abutment canbe replaced with one that is nearlysubgingival, allowing the pontic toseat directly over it and slightly intothe soft tissue of the ridge (Figures1 and 2).

Clasps, which are usually needed toretain interim RPDs, present twodisadvantages. First, they mayinterfere with occlusion if interoc-clusal space is limited. If there isinadequate space between opposingteeth even for thin clasp wires,patients must rely on undercuts in

the acrylic resin base or resort todenture adhesives. Second, visibleclasps can be unsightly. Ball claspsplaced between premolars andmolars are not objectionable tomost patients. If their estheticdemands require a more pleasingappearance, or if patients object toremovable appliances, fixed pros-thetic options should be explored.Another disadvantage of interimRPDs is their inability to facilitatesoft tissue development. Althoughimplant-site soft tissue developmenthas been reported with interimremovable appliances using ovatepontics,2 direct implant provisionalrestorations are significantly moreeffective.

2. Vacuum-Formed ApplianceVacuum-formed appliances aremade either in the laboratory or in-office from clear thermoplasticsheets that retain pontics for toothreplacement. Dentists using

Figure 1. Using an interim removable partial denture, adenture tooth, modified to mimic the contours of theadjacent central incisor, sat passively on the ridge justfacial to the subgingivally placed healing abutment.

Figure 2. Palatal undercuts on the surrounding teeth pro-vided retention for the claspless prosthesis.

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vacuum-formed matrices to retainprosthetic teeth as temporary appli-ances often refer to them as Essixretainers, although true Essixretainers (Raintree Products,Metairie, LA, USA) are made withspecific copolyester sheets that arereported to be stronger and moredurable than typical plastic sheets.Essix retainers, originally conceivedto overcome the disadvantages ofHawley appliances for orthodonticretention,3 were later suggested astemporary prostheses for missinganterior teeth,4 and most recentlyrecommended as interim prosthesesfor implant patients.5

The technique for making vacuum-formed prostheses is relatively quickand inexpensive and is thereforeconvenient prior to fabrication oflonger-lasting alternatives. A cast ismade of the arch that is missing thetooth and a denture tooth pontic isadapted to the site. A mesiodistal

trench 4-mm wide and 3-mm deepis then cut into the palatal or lingualsurface of the denture tooth to cre-ate a mechanical lock during thethermoformation process. The toothis fixed to the cast with acrylic resin.Wax is an unsuitable alternativebecause it will melt during heating.A plastic sheet, usually 0.030-inchthick, is thermoformed over the castand trimmed.

Esthetic results can be as good asthose of interim RPDs, primarilybecause unsightly clasps are unnec-essary (Figure 3). In contrast tointerim removable partial prosthe-ses, pressure on surgical sites is eas-ily avoided because vacuum-formedprostheses are tooth retained andsupported. Essix retainers or othervacuum-formed prostheses providetooth replacement while avoidingcompromise of the site followingtooth extraction, site development,or implant surgery.

Vacuum-formed prostheses may notbe appropriate for longer-termimplant therapy because they coverthe teeth, which may interfere witheffective mastication, and occlusalwear of the appliance may limittheir long-term durability. As withother removable appliances, vac-uum-formed prostheses are not ascomfortable as fixed alternatives.Essix retainers are reported to beexcellent tools for orthodonticretention.3 However, implant place-ment relies not only on coronalalignment, but also on retention ofadequate apical space. Particularlyin young patients who have com-pleted orthodontic treatment, fixedappliances are the best means oforthodontic retention while waitingfor skeletal maturity and implantplacement.

Tooth-Supported Fixed Prostheses

3. Bonded Extracted Natural Teeth,Denture Teeth, and Ceramic Pontics

Extracted natural teeth,6 dentureteeth or ceramic pontics,7 and resin-bonded fixed partial dentures(FPDs) (options 3 through 5) areexamples of adhesive prosthesesused for provisional implant pros-theses. Denture teeth or extractednatural teeth may be bonded toadjacent etched tooth surfaces andare usually indicated for short-termuse, particularly if there is insuffi-cient time to make or prescribeother options (Figures 4–6).

Figure 3. This vacuum-formed appliance for a maxillarylateral incisor remained passive on the ridge and unsightlyclasps were unnecessary.

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Figure 4. A composite resin restoration was used tomask a darkened endodontically treated maxillary central incisor, but compromised gingival color was still evident.

Figure 5. A denture tooth was bonded to the adjacent teethduring implant integration and soft tissue maturation.

Figure 6. Natural tooth and gingival color wasrestored with a single-implant restoration.

Because laboratory involvement isnot required, bonded teeth providean immediate solution. Estheticresults may be inferior due to thebulk of composite resin in proximalspaces needed to retain the pontic.If an extracted tooth is used, addi-tions to the gingival aspect are diffi-cult, which also compromisesesthetics.

4. Cast Metal or Fiber-ReinforcedResin-Bonded FPDCast-metal, resin-bonded FPDs,originally developed as conservative

options for definitive tooth replace-ment, are used frequently as provi-sional prostheses for implantpatients. In young patients withcongenitally missing teeth who havenot attained sufficient skeletalmaturity for implants, cast-metalresin-bonded FPDs are ideal interimprostheses. As mentioned previ-ously, following orthodontic treat-ment, a fixed appliance, such as anadhesive FPD, is more effectivethan an interim removable appli-ance for preventing orthodonticrelapse and root convergence

(Figures 7–9). Resin-bonded FPDsare retained and supported by adjacent teeth, and thus will remain passive over the implant site and not interfere with implantintegration or soft tissue healing.8,9

Because they are fixed appliances,they are unlikely to be misplaced or damaged.

Optimal esthetics can be problem-atic with cast-metal resin-bondedprostheses. Thin or translucent teethare unable to mask the palatal metalretainers, thus lowering the value ofthe adjacent teeth, and proximalmetal margins may be visible.

Cast-metal and fiber-reinforcedadhesive prostheses are not idealprovisional restorations duringactive implant treatment entailingmultiple procedures of placementand removal. The laboratory cost isrelatively high for a short-termappliance, retention and removalare unpredictable, and modificationof a ceramic pontic during ridge

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maturation is problematic. Fiber-reinforced adhesive prostheses pro-vide acceptable esthetics,10 but areusually destroyed upon removal.

5. Wire-Retained Resin-BondedFPDA wire-retained resin-bonded FPDincorporates a 30-gauge, 1/2 roundwire embedded in a customizedcomposite resin tooth. A full-archimpression is made of the unpre-

pared teeth, a shade is selected, andthe prosthesis is made in the labora-tory. The technician adapts the wireto the palatal surfaces of the teethon the cast adjacent to the edentu-lous space, and extends the wireacross the palatal or lingual toothsurfaces for maximum retention. Acomposite resin tooth is thenprocessed to the wire. Upon returnto the restorative dentist, thepalatal surfaces of adjacent teeth

are etched. Flowable compositeresin is injected onto the etched sur-faces, the wire is embedded into theresin, which is then polymerizedwith a curing light. Removal of theprosthesis is easy and predictable.Once the resin is detached from thewire, the prosthesis debonds andthe remaining composite resin ispolished from the tooth surfaces.

The author prefers to use this pros-thesis in lieu of other resin-bondedprovisional options (options 3 and4, mentioned earlier) because wire-retained prostheses incorporate theadvantages of cast-metal FPDs buteliminate the disadvantages of highlaboratory costs and unpredictableretention and removal. Clinicaltime is minimal and esthetics arepleasing to most patients (Figures10–14).

All resin-bonded prostheses used asimplant provisional restorationsrequire clearance with little or no

Figure 8. A cast metal resin-bonded prosthesis was fabri-cated on the adjacent, unprepared teeth.

Figure 9. Coronal and apical implant spacing were main-tained with the resin-bonded fixed partial denture, andesthetic continuity was achieved with a ceramic veneer onthe peg-shaped right lateral incisor.

Figure 7. Although implant spacing for the maxillary leftlateral incisor was ideal at the completion of orthodontictherapy, the patient had not reached skeletal maturity.

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removal of tooth structure. Thistechnique is readily applicable tomandibular anterior teeth whereocclusal interferences are not a con-sideration. In the maxillary arch,sufficient clearance on palatal sur-faces of incisors is usually obtain-able. However, in patients withsignificant vertical overlap, theremay be inadequate space for the wire retainers. Provisional

Figure 10. An implant was treatment planned to replace afailing and unaesthetic endodontically treated maxillarycentral incisor.

Figure 11. A 30-gauge, 1/2 round wire was embedded intothe customized composite resin tooth and retainers tosecure the provisional resin-bonded prosthesis intraorally.

Figure 12. The seated resin-bonded prosthesis met thepatient’s esthetic expectations.

Figure 13. On the palatal aspect, the retainers blended insmoothly with the supporting teeth.

Figure 14. Natural color and contours were restored to thecentral incisor with an implant and a metal ceramic crown.

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resin-bonded prostheses are particu-larly difficult to use on posteriorteeth because an occlusal rest is diffi-cult to obtain without tooth reduc-tion. If substantial tooth preparationis required, patients would be betterserved with RPDs, vacuum-formedretainers, or implant-level provi-sional restorations.

6. Acrylic Resin Provisional FPDAcrylic resin provisional prosthesesare used routinely to protect abut-ment teeth and provide temporaryreplacements when using conven-tional FPDs. In those cases in whichteeth adjacent to implant sitesrequire complete coverage restorations, provisional FPDs are

convenient and predictable optionsfor single-tooth implant restora-tions (Figures 15–18). They can beseated immediately after implantplacement without risk of compro-mising the implant site. For shorter-term use, chairside restorationsmade from self-curing materials,such as bis-acrylic resin, provide

Figure 15. Anterior crowns were esthetically unacceptableand the maxillary left lateral incisor was fractured subcrestally.

Figure 16. A laboratory-processed provisional fixed pros-thesis provided improved esthetics while replacing theextracted tooth.

Figure 17. Following implant placement, the pontic wasmodified to fit passively over the implant abutment.

Figure 18. Individual crowns on the single implant andprepared teeth restored esthetic continuity to the maxillaryarch.

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esthetically acceptable results at alow material cost. A limited num-ber of acrylic resin shades anddarkening over a period of weekslimit the esthetic potential of chair-side provisional restorations. How-ever, for protracted implanttherapy, laboratory-processed pros-theses are more durable and shadescan be customized for individualpatients, but the cost will be higher.On the other hand, if adjacent teethare to be prepared, the cost of theprovisional restoration is not neces-sarily related to implant treatment,but to the cost of the total recon-struction. Like other tooth-borneprovisional options, implant sitescan be maintained without pressureon gingival tissues. Minimal effortis required to remove the acrylicprostheses when alterations are nec-essary to follow the evolvinganatomy of the implant site. In sitesthat may require several proce-dures, a provisional FPD can beplaced on prepared teeth prior toextraction of the failing tooth,quickly removed and reseated at thetime of extraction, and easily modi-fied during continued site develop-ment and prosthetic therapy.

Implant-Supported Prostheses

7. Implant-Retained ProvisionalRestorationAn implant-retained provisionalrestoration supported by a tempo-rary implant cylinder can be madein the dental laboratory or by therestorative dentist. The author’s

preference is to make the provi-sional restoration from a vacuumor silicone matrix on a preoperativecast or on an ideally contouredwaxing of the replacementtooth.11,12 A prefabricated crown isalso an acceptable option.13,14

Immediately following implantplacement or upon second-stageuncovering, a temporary implantabutment is secured to the implant.A temporary abutment cylindermade of titanium or acrylic resin iseffective, easy to prepare, and lesscostly than a definitive abutment.Reduction and preparation of atemporary cylinder may be com-pleted intraorally on an integratedimplant. However, extraoral abut-ment preparation is necessary on animmediately placed implant toavoid disruption of initial implantstability and contamination of thesite with debris from the temporarycylinder. The cylinder is reseatedand the screw is gently hand-tightened. Depending on implantangulation, provisional crowns onanterior implants can be temporar-ily cemented or screw-retained. Fora screw-retained provisional crown,a hole must be placed in the matrix,

providing access for screw removalprior to complete setting of thetemporary resin. For a cement-retained provisional crown, thetemporary cylinder is tapered forremoval and subsequent cementa-tion of the restoration.

The vacuum-formed or siliconematrix is filled with a bis-acrylicresin, seated, and then removedbefore complete setting of the mate-rial. Because the soft tissue willquickly collapse around the tempo-rary abutment cylinder, a void willremain between the gingival crestand the subgingival implant mar-gin. After removal, flowable com-posite resin is injected and cured tofill the void, and the restoration iscontoured. The subgingival con-tours of the restoration are modi-fied by adding or subtracting resinuntil the soft tissue profile is opti-mal (Table 2).15–18 Increasing ordecreasing pressure on the fixedamount of soft tissue present withthe provisional restoration will subtly influence soft tissue levels.19

The limitation of this process is thatthe contours of the provisional anddefinitive restoration must still

TABLE 2. MODIFIATION OF CROWN CONTOURS TO OPTIMIZE THE SOFT TISSUE

PROFILE.

Soft Tissue Profile ➩ Crown Contours

To position facial margin apically ➩ Increase facial convexity

To position facial margin coronally ➩ Decrease facial convexity

To position papilla apically ➩ Decrease proximal contours

To position papilla coronally ➩ Increase proximal contours

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closely match those of the adjacentor contralateral teeth for estheticcontinuity. In addition to optimiz-ing soft tissue contours, the otherobjective of contouring the provi-sional restoration is to progressfrom the cylindrical form of theimplant to the three-dimensionalcontours of the tooth as the crownemerges from the sulcus (Figures 19and 20).20 After final polishing andaddition of a resin glaze, the provi-sional restoration is seated (Figure21). The laboratory can pattern thedefinitive prosthesis from the blue-print of the crown and soft tissueprofile provided by the provisionalrestoration.

An alternative to a chairsideimplant provisional restoration is alaboratory-processed restoration.An index of implant position ismade at the time of implant surgeryand is used to attach an implantanalog to a diagnostic cast.21,22 Aprovisional implant restoration isthen made on the cast by the dentistor the laboratory technician anddelivered at the time of implantexposure.

Because an implant-level provi-sional restoration actually emergesfrom the sulcus, it provides thehighest potential for optimal esthet-ics during the provisional stage ofimplant treatment. The ability ofthe dentist, patient, and laboratorytechnician to observe crown andsoft tissue profiles prior to placingthe final restoration may be the

Figure 19. Due to external root resorption, the crownedand endodontically treated maxillary right central incisorwas treatment planned for implant replacement.

Figure 20. The completed provisional restoration demon-strated a smooth transition from the cylindrical implant tothe three-dimensional form of the maxillary central incisor.

Figure 21. Sulcular levels matured around the provisionalrestoration over the ensuing weeks prior to seating of thedefinitive restoration.

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most significant benefit of thisoption. Provisional implant restora-tions for development of emergenceprofiles are indicated primarily inthe esthetic zone, from maxillarycanine to canine. Implant-retainedprovisional restorations have beendemonstrated to be an effectivemeans to temporarily restore singleimplants following integration anduncovering by facilitating the devel-opment of the soft tissue prior todefinitive restoration.23–27 The sul-cular profile may ultimately be thesame when using a provisional ordefinitive crown,28 but developingit in the provisional stage providesa guide to the soft tissue formbefore the definitive restoration ismade (Figures 22 and 23).29

An implant-supported provisionalrestoration may be the best way toestablish the optimal restorativedesign of the definitive restora-tion.30 Placement of a provisional

Figure 22. A sulcus developed with the provisional restora-tion provided easy and atraumatic seating of the definitiverestoration.

Figure 23. On the day of seating, the periimplant gingivacontributed to a natural continuity between the ceramiccrown and adjacent central incisor.

restoration at the time of implantplacement or second-stage uncover-ing accomplishes several goals: (1)the patient receives a restorationthat provides superior esthetics andmaximum comfort compared withother alternatives; (2) it eliminatesthe inconvenience of removable orfixed tooth-supported interimrestorations;31 (3) the implant-sup-ported provisional restorationallows the dentist to evaluate sulcu-lar depth and papilla heights priorto making the definitive restoration;(4) tissue maturation occurs at thesame time as integration, decreasingoverall treatment time; (5) thedefinitive restoration can be atrau-matically seated in a sulcus alreadyestablished by the provisionalrestoration, instead of attemptingto force the restoration into a smallcylindrical space developed by ahealing abutment; (6) the patientcan view the potential outcome andprovide the dentist with input and

approval; and (7) a direct implantrestoration requires few modifica-tions compared with other optionsand entails minimal additionalchair time once the provisionalrestoration is placed.

The only disadvantage of theimplant provisional restoration isits higher cost due to the expense ofa laboratory-made provisionalrestoration or the longer appoint-ment time for one made at chair-side. Therefore, this techniqueshould be reserved for estheticallycritical sites.

C O N C L U S I O N

The provisional phase of implanttreatment may be the longest andmost critical stage of restorativeimplant therapy. Available optionsfor provisional implant restorationsinclude various types of removableprostheses, tooth-supported fixedprostheses, and implant-retained

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provisional restorations. The cri-teria that the restorative dentistshould consider in selecting the typeof provisional prostheses includethe esthetic potential, patient com-fort, treatment time, laboratorycost, occlusal clearance, ease ofremoval, durability, and ease ofmodification. Selection of the mostappropriate provisional option forsingle-implant therapy significantlyaffects the esthetics during thisphase of treatment. However, theredoes not appear to be a direct cor-relation between the type of provi-sional restoration used and theesthetic result of the final restora-tion. Optimal esthetics of the defin-itive implant restoration can beachieved with all types of provi-sional restorations.

The alternatives for provisionalrestorations for single implantscarry varying degrees of estheticpotential. The more visually promi-nent the implant is, the more criti-cal the esthetic outcome becomes.The restorative dentist shouldchoose the type of provisionalrestoration that is most appropriatefor the specific patient and meetsthe patient’s esthetic expectations.Advancing surgical and restorativetechniques and components areproviding dentists with superiorand more consistent esthetic results with implant therapy.Esthetically pleasing provisionalrestorations are part of the evolvingimplant continuum, makingimplant dentistry more appealing to

practicing dentists and potentialpatients.

D I S C L O S U R E

The author does not mention anyproducts and therefore has nofinancial interest in any company orproduct.

R E F E R E N C E S

1. McLaren EA. Provisionalization and the3-D communication of shade and shape.Contemporary Esthet Restor Practice2000;4:48–60.

2. Kan JYK, Rungcharassaeng K, Kois JC.Removable ovate pontic for peri-implantarchitecture preservation during immedi-ate implant placement. Pract Proced Aesthet Dent 2001;13:711–5.

3. Sheridan JJ, Ledoux W, McMinn R. Essixretainers: fabrication and supervision forpermanent retention. J Clin Orthod1993;27:37–45.

4. Sheridan JJ, Ledoux W, McMinn R. Essixtechnology for the fabrication of tempo-rary anterior bridges. J Clin Orthod1994;28:482–6.

5. Moskowitz EM, Sheridan JJ, Celenza F, et al. Provisional anterior prosthesis forpre and post implant patients. N Y StateDent J 1997;63:32–5.

6. Misch CM. The extracted tooth pontic—Provisional replacement during bone graftand implant healing. Pract Periodont Aes-thet Dent 1996;10:711–8.

7. Heymann HO. The Carolina bridge: anovel interim all-porcelain bonded pros-thesis. J Esthet Restor Dent2006;18(2):81–92.

8. Dahlin C, Lekholm U, Becker W, et al.Treatment of fenestration and dehiscencebone defects around oral implants usingthe guided tissue regeneration technique: a prospective multicenter study. Int J Oral Maxillofac Implants 1995;10:312–8.

9. Kinzer G, Kokich VO. Managing congeni-tally missing lateral incisors. Part III. Sin-gle-tooth implants. J Esthet Restor Dent2005;17:202–10.

10. Smidt A. Esthetic provisional replacementof a single anterior tooth during the

implant healing phase: a clinical report. J Prosthet Dent 2002;87:598–602.

11. Wohrle PS. Single-tooth replacement inthe aesthetic zone with immediate provi-sionalization: fourteen consecutive casereports. Pract Periodont Aesthet Dent1998;10:1107–14.

12. Dieterich J. Implant crowns with a nat-ural emergence profile. Dent Dialogue2003;3:8–15.

13. Hui E, Chow J, Li D, et al. Immediateprovisional for single-tooth implantreplacement with Brånemark system: preliminary report. Clin Implant DentRelat Res 2001;3:79–86.

14. Kupeyan HK, May KB. Implant and pro-visional crown placement: a one stageprotocol. Implant Dent 1998;7:213–9.

15. Potashnick SR. Soft tissue modeling forthe esthetic single-tooth implant restora-tion. J Esthet Dent 1998;10:121–31.

16. Sadan A, Blatz MB, Salinas TJ, Block MS.Single-implant restorations: a contempo-rary approach for achieving a predictableoutcome. J Oral Maxillofac Surg2004;62(Suppl. 2):73–81.

17. Touati B. The double guidance concept.Pract Periodontics Aesthet Dent1997;9:1089–94.

18. Lorenzoni M, Pertl C, Zhang K, et al.Immediate loading of single-toothimplants in the anterior maxilla. Prelimi-nary results after one year. Clin OralImplants Res 2003;14:180–7.

19. Grunder U, Gracis S, Capellii M. Influ-ence of the 3-D bone-to-implant relation-ship on esthetics. Int J PeriodonticsRestorative Dent 2005;25:113–9.

20. Gallucci GO, Belser UC, Bernard JP,Magne P. Modeling and characterizationof the CEJ for optimization of estheticimplant design. Int J PeriodonticsRestorative Dent 2004;24:19–29.

21. Hochwald DA. Surgical template impres-sion during stage 1 surgery for fabricationof a provisional restoration to be placedat stage 2 surgery. J Prosthet Dent1991;66:796–8.

22. Resier G, Dornbush JR, Cohen R. Initiat-ing restorative procedures at first stagesurgery with a positional index: a casestudy. Int J Periodontics Restorative Dent1992;12:279–93.

338

E S T H E T I C P O T E N T I A L O F S I N G L E - I M P L A N T P R O V I S I O N A L R E S T O R A T I O N S

© 2 0 0 6 , C O P Y R I G H T T H E A U T H O RJ O U R N A L C O M P I L A T I O N © 2 0 0 6 , B L A C K W E L L M U N K S G A A R D

23. Touati B. Improving aesthetics ofimplant-supported restorations. PractProced Aesthet Dent 1995;7:81–93.

24. Biggs WF. Placement of a custom implantprovisional restoration at the second-stagesurgery for improved gingival manage-ment: a clinical report. J Prosthet Dent1996;75:231–3.

25. Tarnow DP, Eskow RN. Preservation ofimplant esthetics: soft tissue and restora-tive considerations. J Esthet Dent1996;8:12–9.

26. Jemt T. Restoring the gingival contour by means of provisional resin crowns after single-implant treatment. Int J Periodontics Restorative Dent1999;19:20–9.

27. Chee WWL, Donovan T. Use of provi-sional restorations to enhance soft-tissuecontours for implant restorations. Com-pend Contin Educ 1998;19:481–9.

28. Ryser MR, Block MS, Mercante DE. Cor-relation of papilla to crestal bone levelsaround single tooth implants in immedi-ate or delayed crown protocols. J OralMaxillofac Surg 2005;63:1184–95.

29. Touati B, Guez G, Saadoun A. Aestheticsoft tissue integration and optimizedemergence profile: provisionalization and customized impression coping. Pract Periodont Aesthet Dent1999;11:305–14.

30. Lewis S, Parel S, Faulkner R. Provisionalimplant-supported fixed restorations. Int J

Oral Maxillofac Implants 1995;10:319–25.

31. Locante WM. The nonfunctional immedi-ate provisional in immediate extractionsites: a technique to maximize esthetics.Implant Dent 2001;10:254–8.

Reprint requests: George Priest, DMD, 999Peachtree Street, NE, Suite 795, Atlanta, GA30309. Tel.: 404-872-3140; Fax: 404-872-3177; e-mail: georgepriest@mindspring.com.

Presented at the Annual Meeting of theAcademy of Osseointegration in Seattle,WA, on March 17, 2006.

©2006 Blackwell Publishing, Inc.