Replacing a missing tooth with a dental implant is a multi-stage process that requires a temporary solution for aesthetics and function. Patients frequently use a temporary removable appliance, commonly known as a flipper, during the initial healing period. The question of whether this device can be worn once the connecting piece, the abutment, is placed requires careful mechanical and biological consideration. Understanding the function of both the flipper and the abutment helps determine compatibility during the healing phase.
Defining the Temporary and Permanent Parts
A dental flipper is a temporary, removable partial denture typically made from lightweight acrylic resin that holds a prosthetic tooth. This appliance rests on the gum tissue and sometimes uses small clasps on adjacent teeth for stability. Flippers serve as an aesthetic placeholder immediately following tooth loss or extraction, assisting with speech and chewing until a permanent restoration is ready.
The abutment, in contrast, is a fixed, permanent component of the final implant restoration. It acts as a connector, screwing directly into the titanium implant post placed in the jawbone. The abutment rises above the gum line and supports the final prosthetic crown, bridge, or denture. Materials like titanium or zirconia are commonly used due to their strength and biocompatibility. During healing, a temporary version called a healing abutment may be placed to shape the gum tissue before the final abutment is installed.
Compatibility and Pressure Concerns
The short answer to wearing a flipper with an abutment is often yes, but only after specific modifications are made. The standard flipper is molded to fit the space before the abutment is placed; once the abutment is connected, the flipper will no longer fit correctly. This occurs because the abutment, especially a healing abutment, is significantly larger and protrudes higher than the initial cover screw used to cap the implant.
The crucial concern is avoiding any pressure on the implant site, especially during osseointegration, where the implant post fuses with the jawbone. Applying vertical force or lateral movement through an ill-fitting flipper can disrupt this bone fusion, leading to implant failure or damage to the gum tissue. The flipper must be professionally adjusted, or “relieved,” to create a precise channel that completely clears the abutment and the surrounding healing gum tissue.
The timing of abutment placement dictates the level of modification needed. If the flipper is worn over a healing abutment, the acrylic must be relieved significantly to prevent contact. This ensures chewing forces are distributed only to the adjacent teeth and gums, not to the implant component. If the flipper is placed immediately after implant surgery, before any abutment is attached, the risk is greater, and it must be meticulously checked for zero pressure on the surgical site. Any sign of tightness or discomfort means the flipper should be removed immediately and adjusted by the dentist.
Other Temporary Options During Healing
If a flipper presents too great a risk or is not preferred, several alternatives exist to maintain aesthetics and function during the implant healing phase. One popular option is the Essix retainer, a clear, vacuum-formed plastic tray similar to an orthodontic retainer, with a prosthetic tooth built in. The Essix retainer distributes forces more broadly across the existing teeth, often placing less direct pressure on the implant site than a traditional flipper.
A temporary Maryland bridge is another fixed option that avoids loading the implant site entirely. This device consists of a replacement tooth with small wings bonded to the back surfaces of the adjacent natural teeth. Because it is cemented in place and supported by neighboring teeth, it provides greater stability and function than a removable flipper.
Temporary Crown
For cases where the abutment is already in place, a custom-fabricated temporary crown can be secured directly to it. This provides the most natural-feeling temporary restoration while the final crown is being prepared.