Doctor L. 911! Anterior Immediate load post opt protocols. Implant course in Dallas, Austin, Houston,Texas

Dr. “White Belt” a graduate of our LIVE patient implant training in Dallas, Austin, Houston, Texas wrote:

“I have a question about post-op recall for implants placed on #7 and #8. In addition to the implants, bone grafting, GTR with L-PRF membrane and immediate load temporary screw retained prostheses were placed.

How often do I follow up with the patient? What are the steps I should be taking until the final delivery? Thank you”

Thank you Dr. “White Belt” for your great question, our Master Clinicians are on the case.

In cases were moderate to high initial primary stability is achieved when placing  anterior implants; immediate load screw retained provisionals such as those taught in our implant prosthetics course are a great advanced option. Specifically, the clinician is able to satisfy the patients aesthetic needs, as well as surgically capture the gingival contours and begin tissue shaping as the surgical site begins to heal.

Key considerations in addition to the initial stability, would be the patients occlusion and most importantly protrusive movements. Specifically, in any given patient, as taught in our implant prosthetics course  , the anterior screw retained temporary provisionals are loaded onto the implant however are not in function. Great care by the clinician must be taken to ensure that the provisionals are not in occlusion during protrusive, excursive, and MICP.

In regards to routine post opt appointments, it is our consensus that the following protocol should be considered:

  • 1 week POP from the time of implant surgery. Clinician is evaluating patient      comfort , medicinal/home care compliance, and occlusion on the provisionals.
  • 2 week POP from the time of implant surgery. Clinician is generally removing  sutures. Clinician is also checking stability of the provisionals. Due to grafting once tissue begins to heal, provisionals may require retightening/retorquing. Please note your implant manufacturers torque recommendations for temporary screws. For example, Hiossen Implant temporary screws are torqued to 20Ncm v.s 30Ncm for their permanent gold ebony screws.
  • 3 week POP from the time of implant surgery. Clinician is beginning to evaluate initial aesthetics and contours of the immediate load provisionals. Generally, implant provisionals are not removed at this time; as this marks the apex stability “dip”, and the implant is at its weakest aspect during bone osseointegration .
  • 1 month POP from the time of implant surgery, and each 1 month POP following. Clinician may need to open up gingival embrasures to allow for soft papillae formation/maturation, and or add to the volume of the provisionals to further “push” shape and support the tissue.

Generally, given initial primary stability, osseointegration of the anterior implant will occur within 3.5-5 months. Resonance frequency utilizing instruments as presented in our LIVE patient implant training course , can be utilized to give more accurate estimations on final implant osseointegration. In relation to soft tissue, time and healing will be the key factor to when the tissue has matured and is stable enough to commence with fabrication of the final prosthesis. As a general rule, the more hard and or soft tissue augmentation performed at the initial surgery; the more time is required. In most cases clinicians have patients, as they contour tissue, in the temporary provisionals anywhere from 6-12 months from the time of surgery before finalizing the case.

Learn more on how to fabricate immediate load screw retained provisionals and the key steps involved to finalizing the case; in our comprehensive “A to Z” 2-day Hands-On implant prosthetics course. Take your skills, practice, and revenue to new heights!

If you found this helpful to your clinical practice and implant training please leave your comments below.

2 Replies to “Doctor L. 911! Anterior Immediate load post opt protocols. Implant course in Dallas, Austin, Houston,Texas”

  1. Dr. “Whitebelt” it is our pleasure. Thank you for using our new case assistance service that is currently FREE to our graduates of our LIVE patient implant training programs, Intermediate, and 7-day Advanced implant course.
    The technique of anterior tissue shaping can be seen as a very predictable process. Essentially, tissue wound healing will generally begin to finalize 6-8 weeks from the time of surgery. Knowing this, generally at the 4 week post opt check (from the time of surgery) the only adjustments that are made is potentially opening up the embrasure spaces to allow for papillae regeneration. From there it is suggested to followup with the patient once per month until, the clinician aesthetically feels the tissue resembles the final contours of the adjacent teeth or your final overall aesthetic crown gingival zenith positions. Sometimes patients can be in these anterior provisionals 8-12 months before it is restored. Remember “tissue is the issue” and restoring to soon can lead to unfavorable tissue aesthetic outcomes. Therefore, if tissue shaping is needed after the initial 4 weeks from the time of surgery, “additional volume” is added to the gingival antaglio surface to apply mild pressure from the 6-8 week post opt check and beyond; to shape the tissue to its final contours, such as those represented on an initial pre-surgical diagnostic wax-up. Once the final shape has been achieved it is suggested to maintain that provisional for an additional 4-6 weeks to ensure full keratinization and maturation of the transition zone prior to final impression. These techniques are meticulously covered in lecture and hands-on in the 2 day Advanced Implant Prosthetics course. If you are planning to take our Advanced implant prosthetics implant course you should be just fine to see the patient at one month. Potentially open up embrasures at that time, re-seat, then take the program. We hope to see you there. Best regards

  2. Thank you for the thorough response! I had a couple questions. You stated, “1 month POP from the time of implant surgery, and each 1 month POP following. Clinician may need to open up gingival embrasures to allow for soft papillae formation/maturation, and or add to the volume of the provisionals to further “push” shape and support the tissue.”

    I will be attending your implant prosthesis CE but my patient is coming in for her 1 month before that. How much volume do I add to the provisional to shape and support the tissue? How many months do I need to do this? Is there a good video on this process that you know of?
    How many 1 month POP followups do I need to do?

    Thank you in advance!

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