Pressure from a removable temporary can cause “dehiscence” which is the incision line opening in the bone graft becoming exposed…YIKES!! This is the worst thing that can happen to any type of bone graft whether it be a sinus lift bone graft, block bone graft, GBR with membrane, socket extraction preservation graft.
Types of fixed temporaries include:
- Temporary fixed bridge (example on this post)
- Temporary Maryland bridge
- Screw retained directly to implant (immediate tooth)
Removable temporaries include:
If you have a removable temporary over a dental implant bone graft, you must remove it nightly…and DONT CHEW ON IT!!
For this case I removed and existing fixed bridge which had problems and extracted 2 teeth. With my trios digital scanner I fabricated a virtual workup and milled/printed teeth to be used for several months while the implant/bone graft process is being done. These are made of PMMA which is strong and durable especially for a long span temporary like this. They can keep you looking good throughout the process.
I have noticed that many dental implant practitioners use the flipper/stayplate all the time. This is my at least favorite although sometimes I have to use it but it is definitely my at least used!
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
Hi doctor Amin,
Hopefully you are still responding to this blog post.
I am going to Harvard Dental School for my dental work because of finances. The doctor student seems very knowledgeable, he is going into his fourth year and he said he has done many many implants. (I believe he is a graduate student also)
I have a failed apico on (I believe it is number ten , a front tooth) and have had a few infections.
He wants to do an extraction and bone graft and then wait several months for it to heal before putting in the implant screw.
He also said I should wait about a month before putting in a flipper to allow the site to heal. Is this right? And also, should I get a flipper or an Esix for this situation?
Does this plan sound right? I can’t imagine walking around for over a month with no front tooth.
Is it possible to get the implant the same day as the bone graft? He said no, because I probably have some lingering infection that needs to clear.
I also read on your blog that you recommend cementing for front teeth instead of screws because they are unsightly. Should I ask for this?
I am so beside myself about this whole thing. I have good dental g hygiene, never smoked or drank, and I’m 39 years old. Losing a front tooth just makes me sick to my stomach.
Thanks very much. Your blog is very informative.
Lindsay
Hello and thank you for your kind words. If you have had a few infections on the tooth, a safer path is to remove it and grafted and not put the implant at the same time. Somebody with a lot more experience would be able to do this in a single stage for you depending on the preoperative situation but a dental student probably should take the safest path possible. Apicoectomys do not last forever so it is not uncommon that you are losing this tooth… So sorry. 😢 As for the type of temporary an Essex is going to be better so does not put pressure on the graft and you can make it right away but you just might need to make another 1 or adjust it after the gum heals up again. And asked for retention of the tooth screw retained is always better than cement and today’s day and age where we have computer fabrication and ability to make unbelievably awesome custom abutments. Cement is okay as long as the custom abutment is being used but screw retained is probably the way to go.
Thank you for your reply. I have actually reconsidered and decided to use my original private surgeon because my dentist wasn’t willing to do the abutment and prosthetics in cooperation with the school.
I asked my dentist about the Essix and he argued strongly in favor of the flipper, so I was persuaded by him although I am not sure it was the correct choice. He also said the flipper would go in right after the extraction. I just hope it doesn’t injure or interfere with the graft site. Maybe the surgeon will have something different to say.
I go for the extraction/graft next week. I had a scare where I thought I had developed another infection but it turned out to be a severe sinus infection that had radiated to my tooth.
You mentioned that a more experienced surgeon might be able to do the implant and graft on the same day. Now that I am going to my original practitioner I will ask him, but I guess the chances are still pretty slim.
I have an abscess on a lower front tooth. The dentist said I have bone loss and was not sure an implant would take. She recommends a flipper as permanent solution! What do you think?
LOL…a Flipper is NOT a long-term solution! Get another opinion!
I have an abscess on lower front tooth. I was told I had bone loss and was told an implant may not take and wants to do a flipper for permanent solution! What do you think?
a Flipper is NOT a long-term solution! Get another opinion!
I need 23-26 pulled and a bridge from 22-27 with a bone graft with membrane. Will i get a temp thay same day? And do bridges that big usually hold up well? I
Bridges do well in that area and you should get a temp the SAME day!
I had 3 of my upper back teeth front last tooth down so no one could see it. Done 2 months ago having the implant 7 months from the extraction is that ok? And do I need a retainer through this whole process like flex partial upper? All together I will be without teeth for 10 months. I also get prolia for my osteoporosis.have to work around that. Also do you advise the plasma using my blood for the implant healing process ?
No problem with having implants 7 months from the time of extraction. You do not need a retainer if you do not want one. It will heal better without anything there. Your dentist needs to know about your Prolia injections and other things associated with osteoporosis and dental implants. Yes I definitely advised the platelet rich fibrin/PRP plasma product. I do this all the time and it helps healing.
Another question . So I had my tooth extracted #9 and a bone graft I got my braces 3 days after extraction and bone graft , they placed a fake tooth on my braces wire . Is that bad ? Will it make my bone graft fail ? I just want to know what’s the worst case that can happen in my case
That are really great option! I have used this many times!
Dear Dr. Amin,
2 weeks ago I had an extraction of the upper front tooth (21) since the root was broken.
The intention is to put an implant there.
At the time of the extraction the doctor did a socket preservation. He said the area was not infected. Afterwards he sutured the extraction area with self-eliminating thread and placed a temporary bridge on teeth 22, 21 and 11. The bridge does not press on the preserved socket, since it sits on the neighbouring teeth.
2 weeks after, the sutures are still there, the outer gum hurts if slightly press the area, the inner gum near tooth 21 is reddish and a bit swollen, there is a pulling/throbbing sensation and when I swallow or press it with my tongue it feels very tender and a funny-tasting liquid comes out.
Is this normal?
Not normal. See your DDS ASAP.