In the past, with recommendations from dental implant manufacturers, implants were left buried under the gum (soft tissue) until bone has healed tightly around the implant. But some implant manufacturers and researchers advocated leaving the implant open to the oral cavity right after the dental implant surgery. Now, many implant manufacturers recommend even putting load on the implant (meaning putting a crown and allowing the patient to chew on it) right after the surgery. Well, the crown is designed to take less load than the surrounding natural teeth.
There are some advantages to immediate restoration of the implant, at least providing a temporary crown on top of the implant right after placing the implant in the jaw bone. First of all, a second surgery to expose the implant is no longer required, saving the overall treatment time for the patient, and some anxiety. Second, by putting a temporary crown on the implant right after placing it in the bone helps the soft tissue to mold around the temporary crown so that when the final and permanent crown is placed, the soft tissue is ready to receive the permanent crown.
So… Do we really recommend patients to go back home and chew on the implant right after a dental implant surgery? The answer is no. But, a temporary crown can be placed a little out of occlusion, meaning that the temporary crown is not touching the opposing tooth or teeth until bone heals tightly around the implant. Placing a temporary crown immediately after placing a dental implant is especially advantageous when a front tooth is being replaced with a dental implant. Instead of wearing a stay-plate or a denture, the patient can go home with a temporary crown on the implant that looks much like the final and permanent crown that will be used later.
When a front tooth is missing, a bridg has been the traditional way to replace the tooth. With the advent of dental implants, teeth adjacent to the missing tooth are no longer cut down. Dental implants allow replacing a missing tooth without touching the adjacent teeth, whether it is a front tooth or a back tooth.
Here is an immediate restoration case, the patient’s old porcelain crown used as the temporary crown right after placing an implant in the upper right lateral incisor (tooth #7).
Let’s take a look at this immediate restoration case.
Broken tooth before extraction
One week after immediate restoration of dental implant
X-ray showing the implant with crown. Photos used with permission
The tooth had root canal treatment done and after many years of service, the tooth broke. Instead of trying to restore a tooth with a questionable prognosis, this patient wanted to have the remaining root of the tooth removed and replaced with a dental implant.
The root of the tooth was removed, a dental implant was placed and the old porcelain crown was reused as the temporary crown, all in one appointment. That saves a lot of future appointments, time and money. The temporary crown can be replaced with a permanent crown 5-6 months later.
The patient was happy to go home with a natural looking temporary crown.
