implant provisionals


As I discussed in a previous article, custom healing abutments and implant provisionals can be a vital tool in influencing the soft tissue healing around implants.

In this article, I will cover some tips on fabricating both screw-retained implant provisionals and custom healing abutments.

For much of this article, I will focus the detail on making implant provisionals due to the fact that fabricating a custom healing abutment is very similar in many ways.

Steps to Fabricating Implant Provisionals and Custom Healing Abutments

The first step is to start with an implant temporary abutment. These are typically long narrow cylinders made of plastic or metal (Fig. 1) that you add material to achieve your desired form. Both the plastic versions and metal versions have their positives and negatives; I generally prefer the metal versions when available since they are thinner than the plastic versions give me more room to work. The big downside to the metal versions is the fact that their color can bleed into your provisional.

The second step when it comes to fabricating implant provisionals is to tack your provisional shell to the temporary abutment or abutments. It's worth noting that this shell can be made in many different things, including a hollowed-out denture tooth, a shell temporary or even by hollowing out the patient's old crown. Simply make a hole through the top of whatever you are using that will allow the temporary abutment to pass through it. Once you have the shell properly positioned, lute it in place with composite. I will typically do this by injecting flowable composite from the occlusal, being careful not to get any resin in the screw access hole. I usually will cover the screw with cotton just to be sure I keep it completely clean. Once you have it secured on the implant, or implants, it should look something like Figure 2.

implant provisionals

It is important to note that the only goal here is to fix the shell to the temporary abutment. We, in fact, are not worried about creating the emergence profile at this point and if we are doing this step in the mouth, it can also be done on a model; we do NOT want get even close to allowing material into the tissue area.

The next step is to establish the emergence profile of the implant provisional. This is done by simply adding composite (flowable and/or paste) until you have achieved your desired contours as pictured in Figure 3.

It’s important to note that this step should be done extra-orally to prevent getting any debris into the surgical site.

When it comes to the custom healing abutments, you can really skip right to the above step. Fabricating only the gingival portion of an implant provisional, just make sure to extend the composite slightly above the tissue level so you are supporting all of the tissue you need to influence.

If you are like me, when you read about doing something that you have never done before, you will want to actually do this hands-on prior to ever doing it on a patient. The good news is, Spear has workshops that offer hands-on experience. If that sounds like something you would like, contact one of our education advisors and they can direct you to the right class for you.

John R. Carson, DDS, PC, Spear Visiting Faculty and Contributing Author


Commenter's Profile Image RAMESH GUPTA
October 1st, 2014
Thanks John for nicely explaining the process of fabricating a implant provisional and customize healing abutment.for customizing the healing abutment can we use our regular or wide healing abutment,instead of using temp plastic or metal abutment,and then customizing it by adding flowable composite or acrylic. Another issue where I have found myself struggling is the control of oozing from implant site and fresh wound, while fixing the shell to temp abutment.Whats your take on this issue Thanks
Commenter's Profile Image John Carson
October 2nd, 2014
Glad you liked it Ramesh, I get around the issues with a fresh surgical site by fixing the shell as far away from the surgical site as possible as stated in the article my goal when working in the mouth for this stage it only to fix or tack the shell in place then all the other stuff is added extraorally to develop the final contours. My periodontist, Brien Harvey, does this same thing, in fact I did this case with him and these are his photos. That being said I have found that most oral surgeons and periodontists do not want to do this themselves and would rather the restorative dentist do it all themselves and I do it this same way, just all myself when that's the case.
Commenter's Profile Image Eric M.
February 17th, 2016
My response to John Carson’s 2/15/16 post about fabricating implant provisional crowns is: “I too prefer the metal temporary abutments as well and I’ve avoided any problems with bleed-through of the metal by first masking the metal with a layer of opaque composite liquid. The Kerr Kolor Plus kit has two shades of opaque liquid that can be a applied with a bend-a-brush and then light cured. I published a technique article related to this subject in the JPD (2014; 111:455-459). Thanks for your well written Digest!” Eric.
Commenter's Profile Image John C.
February 17th, 2016
Thanks for the nice words Eric! You can indeed use stuff like you talked about! In fact we teach that at the Implant Restorative Design Workshop at Spear Education as it can be very useful in some situations. Thanks for sharing! John
Commenter's Profile Image Edward R.
July 27th, 2018
John, Great technique but very cumbersome with regard to chair time. Our technique involves an intraoral scan or a physical transfer impression the day of implant placement. This data is sent to our lab for fabrication of a milled PMMA hybrid provisional and returned the next day for screw retained delivery. The clinician can even design it in conjunction with communication software such as Codiagnostix or Team Viewer with your lab. Total chair time is 15 minutes for each appointment. So now, if you need to develop emergence in the esthetic zone just have your lab dial up another PMMA hybrid with your proposed design, unscrew the old one and screw in the new one. You can continue to do this until you and the patient are satisfied with the result and easily convert it to your material of choice when integrated.
Commenter's Profile Image John C.
July 28th, 2018
Hi Ed, the way you described is for sure useful. Pro's and con's to both the way you describe. For me and my team I like the way I discussed ince we do a lot of immediate implant placement AND provisionalization we need ability to flex and modify on the fly if we need too. Big plusses in my mind for the way discussed here is the patient is done at surgery so they don't have to return AND we are influencing the tissue as soon as possible. The other thing worth mentioning is typically it's my surgeon actually putting the provisional on the implant immediately post surgery although there are cases where they come right over to me and I do it. The advantage of my surgeon doing it is it's streamlined for the patient and well it make my life super easy as once we have planned the case all he needs from me it shell he is going to attach the implants just like listed above. As reference a "long" provisional fabrication for us is 45min, while obviously longer than 15 it's typically a one and done, if not like yours modification is easy with either simple reduction with polishers or additions with composite.
Commenter's Profile Image Alex S.
December 18th, 2018
Hi Edward. Where are you getting PMMA hybrids in one day? I am getting them three days in lab plus one day each way for express overnight. Thank Alex