The temporary prosthesis implant treatment

he rehabilitation of an edentulous implant-supported prosthesis is a well codified, allowing the patient to find anchors to support or stabilize a denture restoring function and aesthetics. Treatment includes surgical step of setting up artificial roots, preceded by a period longer or shorter healing cells extracted from natural roots and followed by a phase of osseointegration of the implant. The delay between the loss of natural teeth and the realization of the prosthesis can last 6 to 10 months or more in case of bone grafts or complications, and the restorative dentist is faced with the temporary restoration of edentulism according to the wishes of the patient during this period. In the early days of implant restorations, a temporary denture was planned in anticipation of the final restoration [1-4]. Most patients who want a fixed prosthesis is, of course, reluctant at the prospect of a removable restoration, even if limited in time. Therefore a fixed temporary prosthesis is the solution of choice for this type of treatment. It is not always feasible, especially in the distal edentulism or complete, and the use of removable prosthesis is then the only solution, even with the absence of a temporary prosthesis for the period under review.

We will consider the possibilities:

1. removable temporary prosthesis;
2. temporary prosthesis fixed;
3. no temporary prosthesis.

Temporary removable prosthesis

According to the edentulous and topography, the use of dentures can restore aesthetics and, in part, the function in all cases encountered. If this type of prosthesis appears to be a solution of choice yaws economic development of its low cost and timeliness, we must temper this decision by the monitoring required by the removable prosthesis during implant treatment (Fig. 1a to 1 h). Indeed, the denture will be developed very soon after the extraction, or better, before, according to the principles of the prosthesis immediately, so that the patient remains toothless as little time as possible. The average waiting time between extraction and the development of implants at around 2 to 4 months, the denture will require little intervention during this period. We conduct audits at the request of the patient in case of injury or functional impairment.
After the introduction of implants, it is prudent not to return to the patient's denture the day of surgery so that he can not wear it for 10 to 15 days. Indeed, after surgery, edentulous area where the artificial roots are placed has a relief and a volume completely changed, and the prosthesis loses a significant portion of its balance. It is necessary to consider a rehabilitation of the prosthesis using a resin delay (type of Detrey Viscogel ®-Dentsply) or a flexible material-based relining vinylpolysiloxane (type of Kettenbach Mucopren ® soft or Rebasil Dexter ®). The presence of the son of suture complicates the implementation of the resin and the delay could pull points or fuser to the material in the mucosa through the incisions requires the removal of the son to wait to put in place denture.
This is the first disadvantage of the creation of a temporary removable prosthesis implant therapy: the patient does not have a prosthesis for 10 to 15 days after installation of implants.
After removing the son of suture, we can consider that primary healing of the mucosa is sufficient to seal necessary for the protection of the bone and bone implants under integration. The removable denture is then largely emptied in the area of intervention to prevent support of the prosthesis on one or more implants, which would be an immediate loading of the implant detrimental to its stability and thus the bone integration. Sometimes one can observe the appearance of the cover screw [5], which requires control and possibly a touch of the denture. The desired spacing must be at least 2 mm. It can be verified by a fluid silicone impression material (type Xantopren ® VL over Heraeus Kulzer) deposited on the lower surface of the prosthesis without prior application of adhesive. After curing, removal of the material used to display the existing space and any alterations can be performed on the prosthesis in the areas of residual compression. These checks are, initially, the prosthesis is held in place by the practitioner, and by asking the patient to maintain a high occlusal pressure to ensure that the prosthesis when masticatory function will not hurt the mucosa.

Fig. 1b - ... and the underside of the temporary denture is largely hollow next to the location of the implants. The prosthesis is placed in the mouth to check the spacing achieved.	Fig. 1a - Ten days after surgery, the sutures are removed,,

Fig. 1c - A fluid silicone impression material (VL Xantopren9 more Heraeus Kulzer) is deposited in the lower surface of the prosthesis, which is carried in the mouth. The patient should bite the bullet to put the prosthesis in operative position.	Fig. 1d - After polymerization of the material, the prosthesis is removed and the thickness of the silicone is checked and possibly corrected.
Fig. 1st - A late resin (Viscoget) is made and controlled during the 8 weeks following the introduction of the prosthesis.	Fig. 7f - Four months after surgery, six pillars are connected to the implants, ...
Fig. 1 g -... and overcome by healing caps.	Fig. 7 pm - The prosthesis must be re-edited so as not to press the caps in the functional demands of the prosthesis.

When the spacing of the denture is correct, we apply the product selected and relining, after polymerization, an Edge control monitoring necessary adjustments allows the patient to regain function and aesthetics. In the 1980s, we only had to do this late resin relining and a consensus was established around the Viscogel ®, including the keeping qualities of a smooth surface over time are much higher than similar products. However, an important oversight of the material is required before replacing it, after 2 months, with a permanent acrylic resin. The large number of appointments (between 10 and 15) for monitoring of material and mucosal healing has a direct impact on the cost of treatment. Therefore the development of new products relining flexible vinyl polysiloxane material, signi cantly reduces the number of manipulations and thus the duration of the appointment of control, and remove the replacement, at the end of 8 weeks, the soft relining material for acrylic resin hard. The only disadvantage of these materials is their quick (about 5 minutes), which requires a perfect record of operative edges of the prosthesis in a very short time. This may be difficult during the implementation of the prosthesis 10 days after surgery, the patient limiting functional exercises because of the discomfort caused by scar tissue. The risk of overextension of the edges is so important. The balance of the prosthesis is compromised, which can be detrimental to the healing of tissues and subjected to excessive voltages. It is possible in these cases, to defer the introduction of the prosthesis in a week or so to set up the Viscogef initially (8-15 days) and then replaced by the soft resin, either by direct technique in the mouth, or by indirect technique in the laboratory. This is the second disadvantage of the creation of a temporary removable prosthesis implant treatment: moderate initial cost of the denture is increased surveillance and changes it requires after the installation of implants.
We will now see the signs of a temporary removable prosthesis according to the present as the edentulous patient.

complete tooth loss

Most patients undergo an edentulous significant functional disability and the provision of implant-supported prosthesis gives them a considerable profit.

Two types of permanent prostheses are possible:

1. a removable prosthesis implant supra;
2. an implant-supported fixed prosthesis.

In all cases, the temporary removable prosthesis seems to be the most rational solution.
In the case of a supra-implant denture, it can be considered using the denture patient's existing use as a temporary prosthesis. The patient used to his dentures will have no difficulty to support the transition from it to a supra-implant prosthesis, whose stability is greatly enhanced by the presence of implants. If the patient's existing denture can be stored in prosthesis use, modification treatment of the pressure side after surgery, described above, is performed on it. In the event that the prosthesis of the patient may be retained to make the final prosthesis must analyze the reasons for requiring the change.
Sometimes the patient, whose teeth are doomed hook support, comes with a removable partial denture with a metal frame. Be aware that this type of prosthesis should be avoided in the postoperative treatment because the presence of metal frame limits the possibilities for change by the lower surface and most of the time there is injury from the surgical site due to lack of space. It is therefore sometimes obliged to remove the metal frame in these areas and undermine the prosthesis, which fractured during the wearing of soft resin. Any denture with a metal frame must be replaced by an acrylic resin denture base before the introduction of implants.
In other situations, the patient presents with old dentures whose stability is not satisfactory. We must then consider whether a renewal of these prostheses to improve their stability, or the realization of new prosthetic use, which will be retained after the establishment of the implants. The choice between the two options will often be determined by the type selected to anchor the prosthesis implant supra. In the case of a bar anchorage on implants, rehabilitation of an existing prosthesis on this bar is almost impossible and financial considerations will lead to use the old prosthesis patient rehabilitated to achieve satisfactory stability for the duration of osseointegration of implants. By cons, if such unit includes attachments snap, it is possible to envisage the realization of the final prosthesis in place before the implants, the prosthesis is then modified during the healing phase and during the implementation place attachments in its lower surface.

Conservation of one or more "several residual roots is a great advantage in the treatment of edentulous implant sub total. The elements retained root of the time integration of bone implants provide some comfort to the patient and is of course necessary that these elements are not of infection and are not located, to the extent possible, in an implant potential. Depending on the decay of stored items, they will hook supports, or temporary supports attachments Dalbo-Rotex Type ® (Ash and Metals France). These attachments consist of a prefabricated post and core titanium alloy (Ti 6AI 4V), having a thread and marketed in two lengths (6.4 and 7.9 mm). The post is topped by a ball of 2.25 mm in diameter (same as the anchor of Dalbo ® Ash and Metals France) and the female is in special plastic (Galak). These elements are positioned in the roots kept and ensure the stability of the transitional prosthesis while ensuring its survival in the vertical plane during the entire period of treatment. In addition, these elements allow precise positioning of radiological and surgical guides, providing high reliability in the positioning of implants. At the end of treatment when the prosthesis is connected to the artificial roots by anchoring means definitive, the roots are extracted and the denture is rebased.

Posterior partially edentulous

The temporary denture is the simplest solution because it adapts to all clinical situations, regardless of the extent of the edentulous maxilla and concerned. Constraints are identical to those of complete tooth loss, inability to know the port of the prosthesis after surgery and replacement of existing partial dentures when they have metal frames, for the reasons mentioned earlier.

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