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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 13  |  Issue : 3  |  Page : 201-204

Temporary implants and particulate dentin graft protecting traditional implants in severe periodontal patient: A case report


Department of Oral and Implant Surgery, Faculty of Health Sciences, Universidad Católica San Antonio de Murcia, Murcia, Spain

Date of Submission17-Feb-2021
Date of Acceptance10-Apr-2021
Date of Web Publication12-Jul-2021

Correspondence Address:
José Luis Calvo-Guirado
Department of Oral and Implant Surgery, Faculty of Health Sciences, Universidad Catolica San Antonio de Murcia, Murcia 30170
Spain
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijds.ijds_21_21

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  Abstract 


Provisional implants (PIs) can offer a total contribution to a patient's esthetic comfort and chew during the integration of standard implants. Although temporary implants are not intended for osseointegration and have to withdraw at there or 4 months, most of them begin to move during this process, and most of them had extracted before standard implants integration. Resin fixed prosthesis attached to temporary implant abutments gives the patient stability, gives esthetics, and gives protection to traditional implants, compared to removable prostheses, which more quickly leads to the loosening and loss of these temporary implants. Temporary implants could be used with cemented or screwed resin prosthesis or with titanium framework, depending on the patient's bite, bruxism, or clenching. All PIs are made in one piece, titanium grade 5, with V threads and a Bioetched surface (rough surface) to increase the insertion torque and bone to implant contact in soft and hard bone. Temporary upper fixed denture, relined with resin, is the easiest solution for protecting and reducing the risk of failure of some of the standard implants. The possible solution in such cases is the use of temporary implants as support for the fixed structure, acting as protection of traditional implants and bone grafts. Our clinical case was made with six temporary implants TR® 2.7 mm diameter by 13 mm length, grinding extracted teeth using smart dentin grinder, and fixed temporary denture for 3 months. At 4 months, a complete zirconium denture was screwed in standard implants.

Keywords: Dentin grafts, particulate dentin graft, particulate tooth graft, temporary implants, TR implants, transitional implants


How to cite this article:
Calvo-Guirado JL. Temporary implants and particulate dentin graft protecting traditional implants in severe periodontal patient: A case report. Indian J Dent Sci 2021;13:201-4

How to cite this URL:
Calvo-Guirado JL. Temporary implants and particulate dentin graft protecting traditional implants in severe periodontal patient: A case report. Indian J Dent Sci [serial online] 2021 [cited 2021 Oct 19];13:201-4. Available from: http://www.ijds.in/text.asp?2021/13/3/201/321178




  Introduction Top


Transitional implants were developed to support an implant-supported fixed prosthesis or overdenture to provide retention, stability, and support.

Placing the definitive implants submerged without doing an immediate load needs to go through a healing phase of 3–6 months depending on whether it is in the maxilla or mandible.[1],[2]

This load will depend essentially on the quality of the patient's bone and the patient's medical conditions. In the edentulous maxilla, hard tissue limitation appears to require a minimum of six implants to rehabilitate the patient's mouth.[3]

Although implant shape and implant surfaces have brought many positive changes to speed up the healing phase, it is hazardous in some cases to load the implants immediately.[4]

These complete dentures placed immediately can produce micromovements and increased loads on top of implants and within the bone with the risk of losing them.[5]

Provisional implants (PIs) have been developed for temporary restoration and immediate rehabilitation prostheses, avoiding the burden of traditional implants and can allow rapid rehabilitation by ensuring adequate stabilization of the overdenture. Krennmaier is one of the researchers who have used the most PIs in the maxilla and edentulous mandibles with a high long-term success rate of 6–10.

This clinical case evaluated how the PIs serve to maintain the temporary prosthesis's esthetics and function, allowing them to be loaded to obtain maximum comfort and patient satisfaction protecting definitive implants.


  Case Report Top


A clinical case of a 62-year-old woman is presented, with no significant medical history, which offers absence of some upper teeth in the maxilla with heavy periodontitis and a single implant without loading [Figure 1].
Figure 1: Panoramic radiograph showed heavy periodontitis on the upper jaw

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The intraoral cone-beam images showed severe periodontitis in the upper jaw with enough space to place implants in the upper posterior areas. The jaw presents mobility of Grade 1 in all front teeth and implants in rear regions [Figure 2].
Figure 2: Cone beam showing a bone loss in maxilla

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A diagnostic wax-up, study plaster models, and a plaster model of the diagnostic wax-up made a three-dimensional printing model and vacuum splint for immediate provisionals [Figure 3]a and [Figure 3]b. The intraoral image showed severe periodontal problems with some areas without papillae [Figure 4].
Figure 3: Three-dimensional printing model for temporary upper fixed teeth

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Figure 4: The intraoral image which shows periodontal problems

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The temporary TR implants (Bioner Sistemas Implantológicos, Barcelona, Spain) were used for the temporary denture. They have a polished neck of 2.3 mm, 2.7 mm diameter by 13 mm length [Figure 5]a and [Figure 5]b.
Figure 5: Temporary Implant TR® 2.7mm diameter by 13 mm length (Bioner Sistemas Implantológicos, Barcelona, Spain)

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The treatment plan was to extract all maxillary and the unloaded implants, and after that, eight immediate implants were placed [Figure 6]a.
Figure 6: (a) Intraoral view of upper maxilla af ter teeth extractions; (b) mucoperiosteal flap elevation; (c) eight Top DM® Bioner implants placed for fixed prostheses; six TR® (temporary implants) in place; (d) six TR® (temporary implants) placed between definitive implants

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A full-thickness flap and exposure of the maxillary alveolar bone were done, and eight Top DM® implants (Bioner Sistemas Implantológicos, Barcelona, Spain) were placed for fixed prostheses [Figure 6]b and [Figure 6]c.

Six temporary TR® were placed to protect definitive implants from harmful loads during the healing process [Figure 6]d.

The extracted teeth were polished, and the periodontal ligament was removed with a tungsten carbide bur to be later crushed. The teeth were placed in the Smart Dentin Grinder® (Kometabio NJ, USA, Distributor Bioner Sistemas Implantológicos, Barcelona, Spain) to be ground and used as a bone graft in the defects left by the extracted teeth [Figure 7]a, [Figure 7]b, [Figure 7]c.
Figure 7: (a) Smart dentin grinder® (Kometabio, NY, USA) used for grinding extracted teeth; (b) extracted roots into the grinding chamber; (c) particulate teeth prepare to use biomaterial covering bone defects

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Particulate dentin graft was used to fill bone defects and covering buccal and lingual plates, Silk stitches were used to close the wound (3.0, Lorca Marín, Murcia, Spain), a rubber dam is then placed and passed between the TR abutments to place the temporary vacuum splint in the upper maxilla with temporary resin Structure Premium® (Voco, Germany) used for an interim prosthesis [Figure 8]a, [Figure 8]b, [Figure 8]c, [Figure 8]d.
Figure 8: (a) Particulate dentin graft filling bone defects and covering buccal and lingual plates; (b) temporary vacuum splint placed in the upper maxilla; (c) quick resin used for interim prosthesis; (d) temporary teeth in place

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The orthopantomography was performed where eight traditional implants were observed in the upper jaw, protected by the six TR implants that support the provisional resin prosthesis, ensuring the postextraction implants' success [Figure 9].
Figure 9: Immediate radiograph after surgery showing submerged definitive Top DM® implants and temporary TR® protecting traditional implants from harmful loads during the healing process

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After 3 months, transitional implants were removed from the mouth, and impression techniques were used for the laboratory framework. An abutment checking process was done before the zirconia fixed screwed prosthesis be tight [Figure 10] and [Figure 11].
Figure 10: Zirconium complete screwed prosthesis

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Figure 11: (a) Panoramic radiograph of abutment checking process; (b) immediate postoperative radiograph after fixed denture tight

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Subsequently, panoramic control radiography was performed where the correct adjustment of the bar made by computer-aided design–computer-aided manufacturing (Classic Dental Workshop, Murcia Spain) is observed [Figure 11]b. Ceramic teeth are kept at the lower molars level so that the patient maintains the vertical dimension for time, thus avoiding prosthesis fracture and tooth breakage [Figure 12].
Figure 12: Fixed zirconia screwed denture in place

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The final radiograph after 1 year showed the perfect adjustment of the fixed prosthesis [Figure 13].
Figure 13: Final radiograph of fixed denture

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  Discussion Top


For cosmetic and psychosocial reasons, patients who must be without a prosthesis for long periods do not accept it. Still, the use of PIs improves comfort, chewing, esthetics, and phonetics of these patients, avoiding going through toothlessness periods. However, the literature on the use of temporary implants is scarce and limited to clinical case reports that describe treatment with a removable partial denture for partially and edentulous patients.[6],[7],[8],[9],[10] Simultaneously, the present study's temporary implants are mainly designed for provisional fixed prostheses, for agenesis of upper lateral incisors and mandibular incisors. They can also be used as temporary implants in children and adolescents who have not reached prosthetic age between 14 and 17. The use of temporary implants is necessary to avoid micromovements in the definitive implants postextraction and insertion of the screw-retained or removable hybrid prosthesis, which can cause premature loss.


  Concluions Top


The placement of temporary or temporary TR implants meets the requirements to place a cemented fixed immediate prosthesis, avoiding removable provisional prostheses. These implants serve to provide patient comfort and satisfaction during the traditional implants' healing, protecting them from avoiding their failure in early stages.

Ethical clearance

No ethical clearance was necessary because the patient give me the authorization signed in the informed consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Calvo-Guirado JL, Gómez-Moreno G, Aguilar-Salvatierra A, Guardia J, Delgado-Ruiz RA, Romanos GE. Marginal bone loss evaluation around immediate non-occlusal microthreaded implants placed in fresh extraction sockets in the maxilla: A 3-year study. Clin Oral Implants Res 2015;26:761-7.  Back to cited text no. 1
    
2.
Calvo-Guirado JL, López-López PJ, Maté Sánchez de Val JE, Mareque-Bueno J, Delgado-Ruiz RA, Romanos GE. Influence of collar design on peri-implant tissue healing around immediate implants: A pilot study in Foxhound dogs. Clin Oral Implants Res 2015;26:851-7.  Back to cited text no. 2
    
3.
Andersen E, Haanaes HR, Knutsen BM. Immediate loading of single-tooth ITI implants in the anterior maxilla: A prospective 5-year pilot study. Clin Oral Implants Res 2002;13:281-7.  Back to cited text no. 3
    
4.
Glauser R, Ruhstaller P, Windisch S, Zembic A, Lundgren A, Gottlow J, et al. Immediate occlusal loading of Brånemark System TiUnite implants placed predominantly in soft bone: 4-year results of a prospective clinical study. Clin Implant Dent Relat Res 2005;7:S52-9.  Back to cited text no. 4
    
5.
Ostman PO, Hellman M, Nilson H, Ericsson I. Provisional implants: A clinical prospective study in 45 patients, from implant placement to delivery of the final bridge. Clin Implant Dent Relat Res 2004;6:142-9.  Back to cited text no. 5
    
6.
Krennmair G, Weinländer M, Schmidinger S. Provisional implants for anchoring removable interim prostheses in edentulous jaws: A clinical study. Int J Oral Maxillofac Implants 2003;18:582-8.  Back to cited text no. 6
    
7.
Krennmair G, Weinländer M, Krainhöfner M, Piehslinger E. Implant-supported mandibular overdentures retained with ball or telescopic crown attachments: A 3-year prospective study. Int J Prosthodont 2006;19:164-70.  Back to cited text no. 7
    
8.
Krennmair G, Fürhauser R, Weinländer M, Piehslinger E. Maxillary interim overdentures retained by splinted or unsplinted provisional implants. Int J Prosthodont 2005;18:195-200.  Back to cited text no. 8
    
9.
Krennmair G, Krainhöfner M, Piehslinger E. Implant-supported mandibular overdentures retained with a milled bar: A retrospective study. Int J Oral Maxillofac Implants 2007;22:987-94.  Back to cited text no. 9
    
10.
Krennmair G, Krainhöfner M, Weinländer M, Piehslinger E. Provisional implants for immediate restoration of partially edentulous jaws: A clinical study. Int J Oral Maxillofac Implants 2008;23:717-25.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13]



 

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