The use of provisionals would be indicated in all the cases if for anatomic reasons or history of bone atrophy and collapse, the original architecture has been reduced or lost due to different factors.
The main goal is to recreate the lost scalloped gingiva as well as to reproduce the topography for the best and stable result of our final restoration and the proper emergence profile as much expansive as possible to avoid retentive and potential food impaction areas.
The main benefits that provisionals can bring are described below:
1-. Lost tissue remodeling:
The provisionals will recreate the emergence profile, exerting pressure over the reduced tissues in order to stimulate the gingival migration and accommodation.
A very good way to achieve this is by provisionalize immediately at the time of implant placement, since it adapts to the initial situation activated by regenerative process of healing and by applying the proper forces, driving the tissues 3 dimensionally.
In order to avoid over exposure of the surgical site but also potential dehiscence, the provisionals need to contact the tissues without pressure. This might increase the chances of bacterial proliferation so more frequent post surgical visits, especially the first 20 days and special care of the surgical area is recommended.
2-. Minimize the postoperatory effect over areas of potential exposure.
In cases of early or late loading we can combine this technique with soft tissue volume augmentation procedures giving a fixed prosthetic support.
3-. Providing with provisionals, immediate or late loading will promote the proper soft tissue remodeling, creating a better surrounding tissues of our implant, with a better long term prognosis providing expansive and positive emergence profiles.
The soft tissue augmentation surgical procedures that are performed the same day of the bone augmentation would be limited to minimal trauma or not too extended surgery since the organism cannot over correct and regenerate multiple layers at the same time, especially at the same site.
Which is your technique to reproduce the emergence profile when you are not using digital workflow?
Find out in the Aesthetic Masterclass.
