ABSTRACT An immediate implant placement and provisionalization approach has been increasingly adopted by clinicians because the technique seems to predictably improve esthetic outcomes. This approach offers the advantages of decreased treatment time and morbidity, while exhibiting success rates similar to those of the traditional approach. In this case report immediate implants were placed with immediate provisionalization

Muthu Mani

Pradeep Christopher

R Balakrishnan

Vijay Ebenezer

CiteSeerX

ISSN: 0975-8585 
 
March–April  2015  RJPBCS 6(2)  Page No. 615 
Research Journal of Pharmaceutical, Biological and Chemical 
Sciences 
 
 
Immediate Provitionalization of Full Arch Implant Placement: A Case Report. 
 
 
Vijay Ebenezer1*, R Balakrishnan2, Pradeep Christopher1, and Muthu Mani1. 
 
 
1
Department of Oral and Maxillofacial Surgery, Sree Balaji Dental College & Hospital, Bharath University, Pallikaranai, 
Chennai, 600100
 
2
Department of Oral and Maxillofacial Surgery, Thaimoogambigai Dental College & Hospital, Mogappair (west) Anna Nagar, 
Chennai, 600017
 
 
ABSTRACT 
 
An immediate implant placement and provisionalization approach has been increasingly adopted by 
clinicians because the technique seems to predictably improve esthetic outcomes. This approach offers the 
advantages of decreased treatment time and morbidity, while exhibiting success rates similar to those of the 
traditional approach. In this case report immediate implants were placed with immediate provisionalization. 
Keywords: implant, esthetic, provitional restoration, mandible. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
*Corresponding author 
 
ISSN: 0975-8585 
 
March–April  2015  RJPBCS 6(2)  Page No. 616 
INTRODUCTION 
 
Restoration of missing teeth in the esthetic zone is a great challenge for dental practitioners. Implant-
supported fixed prostheses are usually attempted before other options such as conventional bridges or 
removable dentures to avoid damage to adjacent teeth and provide better chewing function. 
 
The immediate replacement of teeth with implants is no longer considered an experimental 
technique. The literature bears witness to numerous reports and clinical studies demonstrating that this 
technique has been mastered in cases where its indications are properly assessed and its execution is perfectly 
accomplished. Advantages of this technique include preservation of tissue and optimization of the soft tissue 
contour, simplification of treatment and reduction of sequences, improved psychological advantages, 
enhanced patient comfort and aesthetics. 
 
The remarkable success rates reported by longitudinal studies [1-4] involving one-stage implants (i.e., 
implantation accomplished via one surgical procedure) have eliminated one of the basic tenets of the original 
Brånemark technique: the covering of the implants, supposedly protecting them against early loads liable to 
ruin their osseo integration. Clinical studies [5, 6] have demonstrated that these same one-stage implants, 
when situated in the symphyseal sectors and covered by complete rebased dentures (i.e., exerting pressures), 
had success rates comparable to those of two-stage implants. It has been recognized that immediate implant 
loading when properly implemented in bone of good quality and sufficient implant stability was achieved, did 
not compromise osseointegration.  
 
A vivid understanding of the biological and mechanical principles underlying the immediate-loading 
concept is necessary for achieving clinical success. Immediately loaded dental implants must achieve adequate 
primary stability [7-10] and should be rigidly splinted around the curvature of the arch. The provisional 
prosthesis should be undisturbed for a minimum of 2 months during the post-placement healing period. 
 
CASE PRESENTATION 
 
A 55 years old woman was complaining of pain and excessive tooth mobility in her lower teeth. She 
was not willing for complete dentures. She was willing to have fixed implant –supported restorations. On 
clinical examination, it was advanced generalized peridontities along with grade 2 and grade 3 mobility on her 
lower arch teeth. Radiographic feature showed moderate bone loss (fig 1). 
 
 
 
Figure 1: Pre-operative OPG. 
 
In the mandible the bone volume was adequate for implant placement immediately after extraction 
followed by fixed provisional restoration was planned. 
 
ISSN: 0975-8585 
 
March–April  2015  RJPBCS 6(2)  Page No. 617 
Since immediate implant placement and provisionalization was recommended only in intact sockets, 
it essential that alveolar bone and gingiva be preserved with an atraumatic extraction technique. Instruments 
such as periotomes, small elevators, and root forceps were used to avoid damage to the labial plate. Following 
extraction, the site was thoroughly inspected to verify the integrity of the osseous crest. Implant of 13mm 
length was selected for placement with 3.75 diameter. After the placement of implant, abutments were 
placed. All abutment screws were torque to 20 Ncm with a torque-indicating device.  Impressions were made 
for fabrication of acrylic dentures for lower arch. Patient’s vertical dimention at centric relation was taken 
from her pre operative cast and in dental laboratory the same vertical dimension was maintained and denture 
was fabricated. 
 
The patient left the dental office with fixed mandible implant retained provisional prosthesis in place. 
The mandibular prosthesis was supported by four implants; each implant insertional torque was 45Ncm for 
primary stability. The vertical dimention of occlusion of the patient was not disturbed and it was the original 
(Fig 2). Patient was review after 10days for first postoperative care. 
 
 
 
Figure 2: Post operative OPG. 
 
DISCUSSION 
 
Immediate implant placement, in which the clinician places the implant immediately following 
extraction, can be chosen if the periodontium is intact. This approach offers the advantages of decreased 
treatment time and morbidity, while exhibiting success rates similar to those of the traditional approach [11]. 
Additionally, it also offers the option of immediate provisionalization and enhanced esthetic outcomes. 
 
An immediate implant placement and provisionalization approach has been increasingly adopted by 
clinicians because the technique seems to predictably improve esthetic outcomes. Favorable results were 
originally reported over a decade ago [12, 13]. However, subsequent publications reported recession and loss 
of labial crest height [14]. Although buccal implant placement was the main cause of recession in many 
instances, biotype and factors affecting crestal bone maintenance may also play a role. A more recent animal 
study demonstrated that the labial plate is maintained when implants are placed in a lingual position [15].
 
 
Immediate placement and provisionalization requires the choice of an implant that will provide 
adequate primary stability and crestal bone maintenance.
 
 
Tapered implants facilitate the achievement of high insertion torque, which may serve as an indicator 
of implant stability [16]. A minimum insertion torque of 45 Ncm is required for immediate placement and 
provisionalization of single-tooth implants [12, 13].
 
The use of an adequately contoured immediate provisional 
restoration is essential in preserving the peri-implant soft-tissue.
 
 
ISSN: 0975-8585 
 
March–April  2015  RJPBCS 6(2)  Page No. 618 
The main objectives of the immediate provisional are to satisfy the patient’s esthetic needs and 
provide support for the peri-implant soft tissues. The contours of the provisional be adequately designed so 
that the position of the gingival margin is preserved [17]. The immediate provisional must be designed  
avoiding occlusal contact. 
 
CONCLUSION 
 
Same-day implant placement and provisionalization should be a treatment option and may ultimately 
become the preferred treatment option for patients requiring implant rehabilitation.  
 
REFERENCES 
 
[1] Wöhrle PS. Pract Periodontics Aesthet Dent 1998;10:1107-1114. 
[2] Kan JY, Rungcharassaeng K, Lozada J. Int J Oral Maxillofac Implants 2003;18:31-39. 
[3] Proussaefs P, Kan J, Lozada J, et al. Int J Oral Maxillofac Implants. 2002;17:567-572. 
[4] Calandriello R, Tomatis M, Vallone R, et al. Clin Implant Dent Relat Res. 2003;5(suppl 1):74-80. 
[5] Mura P. Clin Implant Dent Relat Res 2012;14:565-74 
[6] Degidi M, Nardi D, Piatelli A. Clin Implant Dent Relat Res 2012 
[7] Szmuckler-Moncler S, Piatelli A, Favero GA, Dubruille JH. Clin Oral Impl Res 2000;11(1):12-25. 
[8] Soballe K. Act Orthop Scan Suppl 1993;255:1-58. 
[9] Vaillancourt H, Pilliar RM, McCammond D. J Appl Biomater 1995;6(4):267-282. 
[10] Brunski JB. Clin Mater 1992;10(3):153-201.  
[11] Esposito M, Grusovin MG, Polyzos IP, et al. Eur J Oral Implantol 2010;3(3):189-205.12 
[12] Wöhrle PS. Pract Periodontics Aesthet Dent 1998;10(9):1107–1114. 
[13] Kan JY, Rungcharassaeng K. Pract Periodontics Aesthet Dent 2000;12(9):817–8  
[14] Evans CD, Chen ST. Clin Oral Implants Res 2008;19(1):73-80. 
[15] Caneva M, Salata LA, de Souza SS, et al. Clin Oral Implants Res 2010;21(1):43-49. 
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[17] Su H, Gonzalez-Martin O, Weisgold A, Lee E. Int J Periodontics Restorative Dent 2010;30(4):335-343. 


Immediate Provitionalization of Full Arch Implant Placement: A Case Report

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Immediate Provitionalization of Full Arch Implant Placement: A Case Report

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