To our patients now, most discussions
with regards to Justin and Gina
evolved around the temporary crowns.
I think most of us agree that temporary implant crowns
would be necessary for these two patients.
By conditioning the soft tissues
with the help of the temporary crowns,
we can actually achieve the optimal emergence profile
and aesthetics for these two patients
and then follow up with permanent crowns.
Some debated whether the temporary crowns
would be best made at the chair side or at the dental lab.
I think it's important to realize
that the basic principles and the design of the temporaries
are the same, regardless if they are made
at the chair side or at the dental lab.
Individual factors such as time, costs,
and needs for aesthetics might influence our decision
to make them chair side or delegate this to the dental lab.
Finally, it was agreed that Mary, on the other hand,
wouldn't require any temporary restoration on her implants.
Instead, some discussion evolved around
whether to place single crowns everywhere
or splint the crowns where possible.
I think today splinting of implant crowns is not necessary,
apart maybe from few exceptional cases of compromised bone,
such as for example, implant crowns in the posterior maxilla
in case of excessive sinus elevation procedures.
Much of the osseointegration is taking place
in the regenerated bone, while implants
in the posterior maxilla are bearing significant load.
In such cases, one could consider splinting
the implant crowns, aiming for a better distribution
of the occlusal load to the bone.
In cases, however, like Mary,
where implants are placed in native bone,
splinting of the implant crowns
would not offer any advantage,
while on the contrary,
it could hinder efficient oral hygiene.