Implant provisionals.
An implant provisional does something a conventional provisional does not: it forms the soft tissue. The contour it establishes is what the definitive restoration should reproduce.
Shaping the tissue is the point
Around an implant, the emergence profile, the position of the gingival zenith and the fill of the papillae are all determined by the shape the tissue is held in while it heals and matures.
That makes the provisional's contour a clinical decision rather than an approximation. Where tissue needs supporting, the provisional supports it; where space is needed for tissue to grow into, the provisional creates it.
In the aesthetic zone this is the stage that determines the result, more than anything done to the definitive restoration afterwards.
Screw retention is strongly preferred
A provisional is removed and replaced repeatedly during shaping, and each removal of a cemented provisional risks leaving cement subgingivally in healing tissue.
A screw-retained provisional is removed cleanly, modified, and replaced, as many times as the shaping requires.
Where the angulation makes that impractical, an alternative is to cement onto a temporary abutment extraorally and deliver the assembly through the screw.
Immediate and delayed provisionalization
An immediate provisional placed at implant placement supports the tissue architecture from the outset, which in an anterior case can preserve papillae that would otherwise be lost. It requires adequate primary stability and it must be kept clear of occlusal contact.
A delayed provisional, placed after integration, is the more common route and gives more control because the tissue has settled and the case can be assessed properly.
Say which applies. An immediate provisional is designed differently — out of occlusion, and shaped to support rather than to function.
Record it before it comes out
This is the step most often missed. A provisional that has successfully shaped the tissue is a design document, and removing it and scanning the empty site records a sulcus that starts collapsing within minutes.
The options are to scan or impress the provisional itself, to use a customized impression coping that reproduces the emergence, or at minimum to photograph the tissue immediately on removal.
Send that record with the definitive case and state explicitly that the restoration should reproduce the provisional profile.
Materials and durability
Provisional materials on implants take load without a ligament to cushion it, and an anterior provisional may be in service for months while tissue matures.
Laboratory-processed provisionals in a tougher material hold form and contact considerably better over that period than a chairside restoration made for a fortnight.
Keep the surface highly polished. A rough provisional surface against healing tissue produces inflammation that undermines the shaping it was placed to achieve.
Communicating the shape you want
Where you are asking the laboratory to make a provisional that will shape tissue, describe the outcome rather than the object. Which papilla needs support, where the zenith should sit, whether the emergence should be fuller or flatter than the contralateral.
Photographs of the contralateral tooth and of the current site carry that far better than a written description.
On a case where the aesthetic result matters, a provisional adjusted over several visits and then recorded is a more reliable route to a good definitive restoration than any amount of design work on an unshaped site.
What to send
System, product line, platform and connection. Whether the provisional is immediate or delayed. Whether it should be in or out of occlusion. The emergence you want established, and any photographs of the site.
For the definitive case afterwards, send the provisional record and say what should be reproduced.
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Send a case
Digital scans and conventional impressions are both accepted. Cases move by UPS and Purolator, and Fairmont works with practices throughout British Columbia and across Canada.