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.

Embedded partially edentulous

The temporary prosthesis is fixed the solution of choice in this case of tooth loss and will be considered further. The indication of the temporary denture we think ought to be reserved for very extensive edentulous (four or more teeth) when a fixed solution compromises the future of teeth intact pillars used as transient (Fig. 2a-2 / 7).

Tooth Missing

The indication of a temporary prosthesis in this type of tooth loss is only aesthetic, and the use of temporary partial denture should be exceptional. The hindrance caused to the patient by the size of the prosthesis, the need not to wear the prosthesis after surgery and the cost of monitoring because it requires limiting the use of dentures for him to prefer a temporary fixed prosthesis .

Temporary fixed prosthesis

In most cases treated in prosthetic implant range, recently edentulous patients wish to return a set of teeth as complete as possible, through artificial roots partially or totally replacing natural teeth lost. The idea of the harbor, even temporarily, of a removable prosthesis is often experienced as trauma, accentuated by the fact that during the 10 to 15 days after surgery, the temporary prosthesis is removed. Thus, a large number of patients want a fixed temporary prosthesis while waiting for an implant bridge carried. According to restore the edentulous, the use of temporary prosthesis will be fixed more or less easy, and sometimes involve a change in treatment plan with a significant lengthening of the duration.

Fig. 2 - On the day of suture removal.	Fig. 2b -... the prosthesis is reported in the mouth after the recess bottom surface.

Fig. 2c - a silicone fluid (VL Xantopren9 above) is placed in the denture, which is carried in the mouth, keeping the patient's teeth until the taking of the material.	Fig. 2d - The prosthesis is removed and examined its underside. Areas of support are marked with a pencil ...
Fig. Second -... and silicon is removed easily since there is no adhesive in the denture. Areas of support identified in pencil are perfectly visible and can, by grinding, to even very precisely the desired spacing between the prosthesis and the ridge.	Fig. 2f - Several tests are usually needed to control the spacing. Verification of three prints for judging the effectiveness of the previous editor and regular spacing.
	Fig. 2g - Resin delay (Viscoget) is then applied to the underside and the prosthesis is reported in the mouth. The patient maintains pressure during curing of the product.

Fig. 2h - After half an hour, the prosthesis can be removed and the excess material is removed.	Fig. 2f - Three days later, it is necessary to control the prosthesis, ...
Fig. 2d -... the surface of the resin delay, which is satisfactory in this case ...
Fig. 2k-... and scarring of the ridge, which has a defect in the posterior part of the intervention area. In this case, it is necessary to monitor very carefully the patient (twice weekly), eliminating any intrusion of relining material in the absence of scarring and eliminating excessive support of the material in this fragile area.	Fig. 2l - It may be noted improved healing 4 weeks after surgery. Rigorous monitoring of the resin delay avoids problems operculisation of the mucosa over the implant.

Fig. 2m - Five months after implant placement, healing abutments are in place, ...	Fig. 2n -... and the prosthesis is again touched up to avoid contact with one of the pillars which would lead to uncontrolled loading of the implant in question.

total tooth loss

The realization of a temporary prosthesis fixed in the case of a complete tooth loss may seem unrealistic, but a number of patients present with teeth, or natural roots, the medium-term conservation can be considered, but extraction may be deferred. These elements can be used as dental temporary pillars of a temporary bridge if their number (ideally four) and their distribution in the arch provide stability. The bridge can consist of elements of acrylic resin, from a diagnostic wax, and supported by a metal beam that includes preparations partial dental copings. The disadvantage of the conservation of dental elements of the occupation is a possible implant necessary for the sustainability of the final implant-supported restoration. In this case, the first temporary bridge dentoporté allows the establishment of a first set of implants after bone integration, the second temporary bridge will support the implant increased. The latter will then allow the extraction of teeth and the recent introduction of the latest implants. After integration, they will be eventually put in charge by binding to implant temporary bridge brought before completion of the final bridge. It is clear that this approach greatly extending treatment. The establishment of the first series, followed by a second set of implants, double the time to multiply and osseointegration surgery. The cost is greatly increased by increasing the number of manipulations. For many, many years, however, have delayed extraction was the only way to proceed to allow a totally edentulous patient (or soon become) to benefit from a recovery set for the duration of treatment.
Another method is described in recent years [6-7], with the use of transitional implants (MTI-MP ® from Dentatus: Transitionnal Mini Implant and Prosthetic Modular Systems). These implants are in the form of self-tapping titanium screws, small diameter (1.8 mm) and lengths (14, 17 and 21 mm) with a square head topped by a conical slit. Well anchor implants transition is made with a drill 1.4 mm in diameter, between the permanent implants placed first in the same surgical stage. The transitional implant is screwed with a screw mounted on the specific angle against surgery, and the parallelism of the heads is optimized using a tool to slightly bend the heads of transitional implants. Finally, after suture of the flaps, plastic components are mounted on the heads of transitional implants and the temporary bridge is positioned and secured with resin on the plastic parts. After polymerization of the resin, the bridge is removed, retouched, polished and sealed with temporary cement. After integration of permanent implants, 4 to 6 months later the transitional implants are removed by unscrewing. This technique is very attractive because it allows to establish a fixed provisional prosthesis immediately after surgery, but it significantly increases the surgical time and requires some dexterity to position the temporary bridge. For now, this system is beyond the promising field of experimentation, and many more studies are needed to make a routine technique. It should be noted that a similar system, the TAR ® (Temporary Retention Element) from Nobel Biocare, is under clinical study.

Posterior partially edentulous

The transitional treatment of partial edentulism in the posterior fixed prosthesis uses the same techniques used to treat edentulous. The extraction deferred, when possible, is a simple method especially since the abutment tooth is often preserved after in an area where the presence of sinus limits the possibilities of establishing implant. It would not entail postponing the implementation of the implants. The use of transitional implants are also an indication in the edentulous. The establishment of the temporary bridge implant is easier than focused in one case of complete tooth loss, due to the timing of the occlusal vertical dimension provided by the remaining teeth.

Embedded partially edentulous

The temporary restoration of this type of edentulism is often performed by a bonded bridge without preparation of the abutment teeth. This technique, developed in the early 1980s [8-12], is an indication of choice for its low cost and its adaptation to different clinical situations. The bridge is glued on a model developed from a conventional footprint and design of the fins is by studying the space between the abutment teeth and their antagonists. Intermediaries are made of resin, and the bridge is stuck in the first place with a glue Bis GMA (Caulk Dentsply Comspan of). The day of surgery, it can be off by heating fins with polishers polishing (type of Identoflex Burrs AABA), the bonding resin, very sensitive to sudden changes in temperature, yields very quickly. The resin remaining on the abutment teeth is removed by grinding and can make the surgical phase of implant development. Meanwhile, the metal underside of the wings of the bridge is retired in the laboratory and the next day, we can proceed with the replacement of the bridge. Of course, depending on the clinical cases, we can associate a preparation device with an existing blade bonded to a natural tooth free of any preparation.
In some favorable cases (Fig. 3a-31), the production of intermediate elements removable [13, 14] may allow the development of implants without removing the bridge, but it is necessary to clearly identify the operative field for the surgeon's actions is not limited by the infrastructure support of the intermediary. This technique may seem more expensive than removable partial denture, is actually quite economical because it reduces post-surgical follow-up at a meeting of setting up the bridge. It is also highly effective and protects perfectly, as all the solutions set, the surgical site. The limit is indicated in the occlusion. It is necessary to find enough enamel surface free of occlusal involvement so as not to interfere with the patient's occlusal scheme and having to make reductions irreversible.

Fig. 3a - This patient has an edentulous anterior ...	Fig. 3b -... restored by a removable partial denture.

Fig. 3c - A temporary denture glued considered; infrastructure has three metal blades whose lower surface is etched, connected by metal plates, ...
Fig. 3d -... cosmetic removable media elements.	Fig. 3rd - tooth enamel is etched pillars.
Fig. 3f - The infrastructure of the bridge is glued.	Fig. 3g - After curing of the composite bonding, the dam is made and you can see the release of the ridge by the inclination of the blades, ...

Fig. 3h -... and the notch to not impede the surgeon's actions during the installation of implants.
Fig. 3i - The bridge, whose crowns are sealed with removable temporary cement (GC ),... Freegenof	Figure 3d -... can replace the aesthetic elements from the end of the surgical stage.
Fig. 3k - Removal of crowns keeps the bridge glued in place, when connecting the pillars of healing ...	Fig. 31 -... and immediately give the patient aesthetics and function.

Tooth Missing

The bonded bridge is the same type of temporary restoration appropriate for a single tooth loss (Fig. 4a-4h). The procedure is identical to that described above, with the same limits.

No temporary prosthesis

In this paper the delay in implant prosthetics, we think it necessary to point out that wearing a prosthesis during the osseointegration of implants does not contribute to healing. At the first consultation implant, a number of patients present without their prostheses restaurant edentulous, edentulous posterior often, and it is useful to consider with them whether this can be extended for a few months it's simpler, cheaper and the prognosis remains the same.

Conclusion

Restoring a tooth loss with a prosthesis on implants is a technique that requires a delay of about 4-8 months between the introduction of artificial roots and production of implant-supported prosthesis. The realization of a temporary prosthesis should be considered depending on the patient's desire, remembering that there is no absolute need to develop a prosthesis during this period. So if the patient presents without a prosthesis for edentulous posterior single or plural, it seems appropriate not to consider temporary prosthesis, with the advantage of saving time chair with associated financial savings due to the completion of the denture. If the patient wants compensation from his temporary tooth loss, regardless of the location and importance, the most rational solution will set a temporary restoration. Indeed, based on a bridge abutment teeth, or on temporary implants ensures optimal protection of the operative site and requires a reduced monitoring during the phase of osseointegration. As a result, the sessions are reduced to the chair and the cost of this type of prosthesis (bridge bonded) can be equivalent to one removable solution. Finally, the use of removable denture is a temporary solution that fits all types of tooth loss, regardless of their size and their situation. The low cost of its implementation should not lose sight of its true cost quite high, due to the monitoring post surgical and prosthetic procedures it requires. In addition, the temporary removable prosthesis has the disadvantage of not being able to be returned to the patient on the day of surgery, and within 10 to 15 days needed for primary healing, is often one of the constraints that hinder the most patients candidates for the restoration of their edentulous by implant-.

Fig. 4a - The bonded bridge often requires a temporary overhang vestibular fins to compensate for the lack of preparation of the palatal surfaces of the abutment teeth.	Fig. 4b - The fins are often temporary bridge of low surface area so as not to interfere with the existing occlusion.
Fig. 4c - Despite these limitations, the aesthetic remains acceptable for a period of 6 months and the function is not disturbed by the presence of the temporary restoration.	Fig. 4d - Every surgery (by stage 2), the bridge is off ...

Fig. 4th -... and the adhesive is removed by careful polishing with strawberries very fine-grained.	Fig. 4f - Access to the surgical field is excellent, ...
Fig. 4g-... and in this case, the final abutment (here CeraOne Branemark System ® from Nobel Biocare) is set up ...	Fig. 4 hours -... with implant-supported temporary crown.

bibliographie

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SUMMARY Provisional prosthesis in implant treatment
The implant treatment, whatever the chosen implant is, implies an important delay between the loss of the natural tooth and the installing of implant-borne prosthesis. In the meantime, the provisional rehabilitation of the tooth missing can be done through: - a partial denture, which is a conceivable solution in all cases but which necessitates an important post-surgical maintenance and numerous prosthetic operations; - a fixed prosthesis, on natural pillars or on provisional implants, which is the most rational solution for a patient wishing a fixed implant-borne prosthesis but it is not always possible. Lastly, we must not neglect cases where the patient can think about not restoring the missing teeth, which makes tremendously easier the post-surgery follow-up, without harming the prognosis of the treatment.
Keywords bonded provisional bridge, implants, provisional fixed prosthesis, provisional partial prosthesis, transitional implants.

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