The logic of a dental implant for tooth replacement is obvious and makes converting patients away from a treatment plan of a fixed bridge one of the simpler consultations I conduct. That is, unless the tooth is in the esthetic zone.
Consent for a dental implant over a bridge . . . a three- to five-minute discussion. Whether the patient will have a removable temporary or be without a tooth during the 12- to 16-week osseointegration period is the real consultation challenge, and cases are won or lost on the issue of temporization.
In years past, I have made Essix-style retainers, used unreliable bonded temporary pontics, and had labs fabricate acrylic partials. None of the three offer patients the quality of life or confidence of a fixed, implant-supported provisional. I became convinced that the only path to success in consistently treatment planning dental implants in the esthetic zone was to master immediate temporization. It was only when I became willing to work with the implant on the day of surgery that my implant practice exploded.
Patients are not willing to “get along” with some old-fashioned prosthetic solution for temporization. Not one of my patients has ever displayed excitement over any of the three temporization modalities listed above. Besides that, we often compromise the architecture of the interdental papilla when it is allowed to collapse around a nonanatomical healing abutment or with two-stage “slept implant” protocols.
My surgeon and I realized that for our practices to succeed, we had to work together to provide the gold standard of tooth replacement.
A patient enters the practice with a compromised root and leaves the same day with a new, implant-supported tooth. Yes, there are situations where infection has destroyed the osseous structures that provide the primary stability that is the most basic requirement of this kind of case. Yes, there are functional situations (deep overbite with limited overjet) where immediate loading of a dental implant is risky or contraindicated, but a great majority of our cases allow this technique to be employed.
The result of incorporating this technique has been twofold. First, case acceptance is overwhelming when patients are not threatened by the idea that they will have to go toothless or wear a removable restoration. Second, we support their existing interdental papilla from extraction to final impression with a customized, full-contour, screw-retained temporary. In my mind, this is a perfect example of the proverbial win-win.