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.

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