Immediate Temporary Crown for a Dental Implant

One of the most frequently cited requests by patients is that some type of crown can be put on a dental implant right after its placement.  This is especially the case with front teeth, or the esthetic zone, as we call it.  I can fully relate to such requests, because who really wants to leave a dental office with a tooth missing.  Want it or not, a nice set of teeth is a tremendous confidence builder for many people.  The human gaze is usually drawn to the teeth, right after eye contact is made.  A missing tooth will usually be the focus of attention for quite some time.  Our brain is occupied with this visual input, because it is for most of us here in the United States at least, it is a condition it considers out of the norm.  As you can imagine, this can lead to an embarrasing situation both for the “gazer” and the one being “gazed upon”.

Now, most of the time we are in luck and as dental professionals we can accomodate the patient in this quest.  Much of this decision will depend on two parameters:  How stable is the implant at the time of placement and, if the dental implant and the temporary crown is to be placed right after an extraction, how many roots did the original tooth have.

The stability at the time of placement is very important.  If the implant is torqued into the bone and we can not achieve a certain torque value during the placement, then the implant would be in too much jeopardy, if a temporary crown was immediately connected to the implant.  In this case, other temporization options need to be explored.  A lot of that has to do with the bone density of the patient.

In a scenario where a tooth is extracted and a dental implant is immediately placed, the root anatomy of the previous tooth is very important.

Molar vs Implant

Molar vs Implant

As you can appreciate in the image on the right, the geometry of a dental implant is quite different than that of a molar tooth.  If we were to place the implant in its proper position for this molar, we would ideally place it right into the middle of the tooth.  Just imagine overlaying this implant right down the center of this tooth.  The implant would end up partially in a root socket.  Well, this does not offer a whole lot of stability to the implant in the first place, and it certainly would not survive the load of a temporary. Premolar vs Implant

Premolar vs Imlant
Premolar vs Imlant

Now, in contrast, look at the second image to the right.  Here we see the socket of an extracted premolar, which is a single-rooted tooth (Well, ok …  this premolar has probably been extracted a long, long time ago…).  We can appreciate that the implant placement is a lot easier, since it would fit right into the socket.  If we were to select a larger-diameter implant, which has some taper to it, it would pretty much fill up the socket and probably also have enough torque to accommodate a temporary crown.

Now my sentiment is that immediate temporary crowns should be placed on dental implants whenever possible.  Not only do they look good (well, hopefully), but they also serve the important function of maintaining the gum architecture around the tooth/implant better.  That is important!  In terms of esthetics, I consider the tooth the “picture”, and the gums around it the “frame” – none of it works without the other very well.

I think the reason this is not being done so often is because Implant Dentistry is still a remarkably divided discipline of dentistry.  Because of its lucrativity to the practitioner, there is so much cross training amongst dental specialists, that you almost always have more than one doctor working on your implant case at any given time.  This, of course, makes it very difficult to coordinate the surgical placement of the implant by the surgeon with the manufacture of the temporary crown by the restorative dentist (hmmm, maybe this will be worth another blog in the near future).

Anyhow, the message is that it can be done and should be done whenever possible.  Just to show  you how easyly this can be accomplished, check out this series of slides showing the placement of a dental implant with a temporary crown made by a CAD/CAM device.  This is actually a PDF file of over 40 MB, so it might take some time to download.  It is also available to the right in the files link section under “Immediate CAD/CAM Temporary after Implant Placement”.

As always, feedback and questions are always welcome.

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3 Responses

  1. I have actually a request for a blog post. We are hearing a lot about “Cold Lasers” lately, especially in conjunction with dental implants.

    Do you have any information on those?

    Joanne

  2. Joanne,

    I will post on that topic shortly,

    Thanks for the interest.

    Robert

  3. Great Post !!!

    Exactly the info I was trying to find online.

    Thanks.

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