Guided protocol for indirect fabrication of a custom provisional restoration prior to immediate implant surgery in the esthetic zone

Background

Delivery of a high-quality provisional restoration at a maxillary anterior immediate implant site enhances patient-centered outcomes and promotes development of favorable hard and soft tissue architecture. The purpose of this report is to present a protocol relying upon compatible guided surgery and laboratory systems for fabrication of a custom provisional crown prior to immediate implant surgery in the esthetic zone.

Methods and Results

A female patient, aged 33 years, presented to the Army Postgraduate Dental School, Fort Gordon, Georgia, with an unfavorable prognosis for tooth #9. The patient elected extraction with immediate implant placement. Prior to the surgery, we utilized a cone-beam computed tomography volume, stone models, implant planning software, and an implant indexing system to fabricate a custom provisional crown. Following extraction of tooth #9 and immediate implant placement, the provisional crown exhibited excellent fit and finish, requiring virtually no chairside adjustment. We noted minimal change in baseline mucosal contours throughout the healing phase.

Conclusion

The clinical/restorative protocol described in this report assured accurate three-dimensional implant positioning and permitted indirect fabrication of a high-quality custom provisional crown in advance of surgery. The laboratory workflow—which dental technicians/auxiliaries can master—has the potential to shorten surgery, enhance treatment outcomes, and increase patient satisfaction.

Key points

Why is this case new information?

• This report provides a stepwise workflow guiding indirect fabrication of a custom provisional crown prior to immediate implant placement.

What are the keys to successful management of this case?

• The described technique requires compatible laboratory and guided surgery systems to assure that the restoration accounts for the three-dimensional position and timing of the implant.

What are the primary limitations to success in this case?

• Dental technicians/auxiliaries can master this protocol and independently produce high-quality provisional implant restorations under supervision, potentially enhancing practice efficiency. However, practitioners should provide adequate staff training to optimize reliability and quality.