Anterior Implant Provisionals: Yes or No?

If your goal is to create optimal tooth and gingival esthetics, than the answer in my book is YES. Probably one of the most common questions i get is why the lab can’t simply go from a fixture level impression to the final restoration and create optimal gingival position and contours. The answer is simple, you are asking them to guess as to how the patients tissue will respond to the facial contour of the abutment and crown over time. Guessing inherently includes risk, the patients gingival health, tissue thickness, healing since fixture placement, and more. So asking your technician to sculpt a model and create the final contour from the fixture to the gingival margin is about your personal tolerance for risk assumption, and how you will deal with things when the result doesn’t meet your expectations or the patient’s expectations.

As someone who is fairly risk averse, loves predictability and loves to meet or exceed expectations anterior implant provisionals are routine in my office. The timing for placing an implant provisional is about the beliefs of the person placing the fixture and the person doing the restorative. Either way my clinical experience has cemented the importance of this stage of treatment int he esthetic zone. So what do implant provisionals do?

• Provide for complete an optimal tissue maturation and healing
• Provide interproximal and facial subgingival shape for development of papilla and free gingival margin placement
• Allow alteration of the shape of the abutment and crown as needed to optimize gingival esthetics
• Offer the patient a non-removable restoration during the healing phase
• Allow creation of a custom impression coping and soft tissue model

I fabricate most of my implant provisionals, but you can also partner with your lab and have them do this.  You are correct if you are thinking the shape of the provisional is a guess. The difference is you are guessing on plastic, and can evaluate the outcome and change the shape of the provisional easily to alter the tissue position. Making these same alterations on the final abutment and crown is laborious and sometimes costly, and send a very different message to the patient.