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!
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