The Importance of the Provisional Restoration in Michigan Dental Implants

The important role of provisional restorations is often underestimated. That may be because they are left until the end of an appointment when time is short or because they generally do not need to last long. However, not only can good provisional restorations help to produce better final restorations, they can also save a lot of time and expense at subsequent appointments. Time spent in their construction is more than repaid in time saved doing additional procedures, adjustments, and remakes later on.

As you know, provisional or temporary restorations may be used for dental implants Michigan, fixed bridges, partials, or even dentures. They may be fixed or removable and are made of a variety of materials including acrylic, nylon, other flexible materials, or cast metal. Commonly, provisional restorations may take the form of a removable temporary partial or "flipper" that provides interim aesthetics and prevents pressure on a ssurgical site. The decision to use a provisional restoration and which type to use depends on the patient's dental needs and preferences.

The use of provisional restorations in implant therapy is an important clinical step and should be carefully planned prior to the surgical phase. Well-conceived provisional restorations protect the surgical site from occlusal forces during the healing process and can be used to shape the soft tissue during the maturation phase. These advantages are particularly helpful in the management of the aesthetic zone. Indeed, the provisional restoration provides both the prototype and the blueprint for the final prosthesis.

Various techniques are available to achieve optimal function and aesthetics with provisional restorations. Working together, both the restorative dentist and the periodontist should determine the proper techniques that fulfills the specific requirement of each case. Proper management will contribute to satisfying patients' expectations and the success of osseointegration.

Provisional prostheses should:

• Restore and enhance aesthetics and phonetics.




• protect the underlying gingival tissues.




• not exert direct occlusal load on the underlying implants or bone-grafted sites.




• Determine the future position, support, shape, and shade of the final prosthesis.

A well-designed provisional restoration is predicated upon four factors: the ultimate restorative plan, the number and location of the implants, the bone quality, and the needs and desires of the patient. The most common forms of temporary restorations are fixed bridges supported by retained natural teeth, resin-bonded bridges, and removable interim prostheses.

The treatment objective is to protect the healing surgical site, to provide aesthetics and to prevent micro-movement of the implant and grafted site.

The objective of an implant-supported prosthesis is to provide a functional and cosmetically acceptable form of tooth replacement. An interim provisional restoration is critical during the integration phase of the implant.

A well-conceived appliance, produced by the restorative dentist and laboratory and designed in partnership with the periodontist, provides protection of the surgical site and continued function without compromising aesthetics.

The surgeons at Joseph R. Nemeth, DDS & Associates take special care when deciding which type of provisional restoration is appropriate for their patients. Using state-of-the-art treatment planning software, the implant doctor is able to communicate with the patient's general dentist and the dental laboratory at all phases of the implant process. The software enables the three professionals to work together to design the best provisional restoration available for the implant patient. If you'd like to know more about any phase of the dental implants Michigan process, visit Dr. Nemeth and Associates on the web at http://www.drnemeth.com/ or call (248) 357-3100 with questions. You can also submit your questions via email to jrn@drnemeth.com.

The Realities of Dental Implant Maintenance

Implant dentistry can effectively meet the restorative needs of both partially and fully edentulous patients. The five-year success rate is currrently in the 95 percent range for most implant cases. However, both the implants and the restorations they support can fail in response to local and systemic etiologic factors.

The ability to assess the reaction of the peri-implant tissues and to maintain their health is linked to improvements in the biology and mechanics that affect implant dentistry.

Implants are being fabricated from a variety of materials, and their surfaces are being modified to enhance integration . Furthermore, the restorative components are being revised to facilitate clinical procedures and to improve esthetics.

Traditional implant maintenance has in the past consisted of clinical assessment of placque control and radiographic evaluation of crestal bone levels. Additionally, it was important to determine the integrity of the connection of the prosthesis to the abutment to the implant body. However, the advent of single tooth and cemented restorations, early and immediate loading, the variety of abutment designs, and a shift in focus to more cosmetically-acceptable restorations has necessitated the development of changes in implant maintenance concepts.

To ensure the continued maintenance of optimum intraoral health, the dental team must understand how to assess the health of the peri-implant tissues, the alveolar bone housing, and the common restorative components associated with dental implants.

To learn more about dental implant maintenance, call 248.357.3100 or visit Dr. Joseph Nemeth & Associates on the web at http://www.drnemeth.com/.

Sinus Augmentation for Implant Planning in the Posterior Maxilla

Successful placement of implants in the posterior maxilla could potentially be compromised by the lack of vertical dimension between the alveolar crest and the floor of the maxillary sinus. Typically, 10 mm of vertical bone is required for predictable implant success (Misch, 1987) although success can be achieved with less than 10mm (Fugazzoto 2007). Moreover, bone density in the posterior maxilla is often poor, which could lead to complications during implant fixation. To address these problems, maxillary sinus elevation surgery was developed to increase the amount of bone available for implant placement.

Anatomy of the Maxillary Sinus

The maxillary sinus is pyramidal in shape and borders the nasal wall, floor of the orbit, and alveolar processes. The maxillary ostium, a non-physiologic drainage port, lies high on the medial wall and opens into the nasal cavity between the middle and lower nasal conchae. The average volume of a fully developed sinus is about 15ml, but the volume expands with age as the sinus pneumatizes. The sinus is lined with pseudostratified ciliated columnar epithelium that covers a loose, highly vascular, connective tissue. Beneath the connective tissue lies the periostium, which tightly approximates the bony wall. These structures - epithelium, connective tissue, and periosteum - are collectively referreced to as the Schneiderian membrane.

Indications and Contraindications for Sinus Augmentation

Prior to tooth loss, the sinus membrane maintains its position above the roots of the posterior maxillary teeth. Upon extraction, the sinus pneumatizes or expands unimpeded, reducing the over-all bone volume in the area. If less than 10mm of bone height remains after tooth loss, sinus augmentation should be considered to prevent implant placement from extending through the Schneiderian membrane. Contraindications may include uncontolled medical conditions, sinus pathology, acute or chronic sinusitis, heavy smoking, history of radiation therapy, and blood disorders. These patients may be at high risk of complication such as delayed wound healing or graft infection.

When used appropriately, sinus augmentation is an important tool for implant planning in the posterior maxilla. Predictable implant placement and restoration is possible for patients with minimal bone height, allowing for ideal treatment.

Interested in learning more about sinus augmentation? Contact the author of this article, Southfield Periodontist and Dental Implant Specialist, Dr. Amar Katranji at 248.357.3100 or visit Joseph R. Nemeth, DDS & Associates on the web at http://www.drnemeth.com/.

If you are a dentist and would like information about the Michigan Implant Study Club or any upcoming continuing education courses sponsored by Joseph R. Nemeth, DDS & Associates, visit the for dental professionals page of the website at http://www.drnemeth.com/forprofessionals.html.

Michigan Dental Implant Patient Seeks Guidance From Southfield Periodontist

Patient Question: I have been missing a tooth in the back upper right area for quite a while and would like to have it replaced. I would prefer not to have to cap the teeth on either side so an implant seems like the way to go. I was told I would need to "grow bone" in that area. How is that possible?

Anonymous, Farmington Hills, MI

Answer: It sounds like what your doctor is concerned about is getting enough bone in the area requiring the implant. Sometimes when an implant is needed in the posterior areas of the maxilla (upper jaw bone), the sinus cavities get in the way. The sinus is nothing more than a space for air, but if the sinus is very large, it minimizes the amount of bone available to secure an implant; therefore, we need to grow bone.

The procedure, called a sinus augmentation or sinus lift, involves raising a small amount of the membrane lining the sinus (like the membrane inside an egg shell) and filling the empty space with a bone grafting material. We then let this bone grow or mature for approximately six months. At that point the patient will most likely have grown enough bone to support the implant.

Have a similar question? Contact the Michigan Dental Implant Specialists at Joseph R. Nemeth, DDS & Associates at 248.357.3100. Our team of Doctors, Hygienists, Assistants and Business staff are all highly knowledgable in the fields of Periodontics and Dental Implants and will be pleased to answer any and all of your questions or address any concerns. Submit your question online at http://www.drnemeth.com/patientinfo_asktheperiodontist.html.

The Newest Key to Longevity is Good Oral Health

The Michigan periodontal practice of Joseph R. Nemeth, DDS & Associates is striving to make Michigan healthier one smile at a time. Click on the image on the left to view a short video about the link between oral health and systemic health which gives helpful tips on how to live a longer, healthier life by taking better care of your teeth and gums. This group of Southfield periodontists are working hard to educate not only their patients but the public as well about gum disease and other related diseases.

For more tips on maintaining good oral health and avoiding the dangers of gum disease, visit these Michigan periodontists on the web at www.drnemeth.com.

Ridge Augmentation

Ridge Augmentation procedures are used to correct concavities in the jawbone where natural teeth are missing. They can correct depressions in your gum line that are unnatural looking and sometimes make you appear older that you are. They can be used to prevent the jawbone from collapsing following tooth extraction. Ridge augmentation is also used to even out replacement teeth that may seem too long compared to adjacent teeth.

If you would like to learn more about ridge augmentation or any other Michigan dental implants topic, call the office of Dr. Joseph Nemeth & Associates at 248.357.3100 or submit your questions online by clicking on this link www.drnemeth.com/asktheperiodontist.

What are Dental Implant?

Dental implants are tiny titanium posts that fill the role played by a tooth’s roots. The implants are placed in the jawbone, and bone grows around them, providing a strong foundation for the replacement teeth. Dental implants provide significant long-term advantages: They help stop the bone loss that occurs over time after a tooth is lost, often creating a “sunken” facial appearance in people who have lost all of their teeth. They enable people to eat and chew whatever they like, avoiding compromises to health because of poor nutritional intake. They give patients the confidence that they had with their natural teeth, freeing them to smile, talk and chew without embarrassment.

Dental implants allow people who have lost teeth to enjoy the function, appearance and permanence that their natural teeth once provided. They can be used to replace a single tooth, a partial, a bridge, or full dentures.
What are Dental Implants?

To find out more or see case studies, visit www.drnemeth.com.