CAD-CAM approach to designing and fabricating a low-maintenance metal-acrylic resin implant-supported fixed complete dental prosthesis: A clinical report.

The metal-acrylic resin implant-supported fixed complete dental prosthesis (IFCDP) is a reliable restorative option. However, clinical complications and laboratory fabrication concerns are associated with these restorations. Maintenance and repair lead to increased chair time, but recently introduced computer-aided design and computer-aided manufacturing (CAD-CAM) materials and technology can improve efficiency and mitigate complications. In this clinical report, the existing design principles and CAD-CAM materials were combined to fabricate a metal-acrylic resin IFCDP that minimized individual tooth fracture and facilitated efficient resurfacing of worn surfaces.

Use of platelet-rich fibrin in regenerative dentistry: a systematic review.

OBJECTIVES: Research across many fields of medicine now points towards the clinical advantages of combining regenerative procedures with platelet-rich fibrin (PRF). This systematic review aimed to gather the extensive number of articles published to date on PRF in the dental field to better understand the clinical procedures where PRF may be utilized to enhance tissue/bone formation. MATERIALS AND METHODS: Manuscripts were searched systematically until May 2016 and separated into the following categories: intrabony and furcation defect regeneration, extraction socket management, sinus lifting procedures, gingival recession treatment, and guided bone regeneration (GBR) including horizontal/vertical bone augmentation procedures. Only human randomized clinical trials were included for assessment. RESULTS: In total, 35 articles were selected and divided accordingly (kappa = 0.94). Overall, the use of PRF has been most investigated in periodontology for the treatment of periodontal intrabony defects and gingival recessions where the majority of studies have demonstrated favorable results in soft tissue management and repair. Little to no randomized clinical trials were found for extraction socket management although PRF has been shown to significantly decrease by tenfold dry sockets of third molars. Very little to no data was available directly investigating the effects of PRF on new bone formation in GBR, horizontal/vertical bone augmentation procedures, treatment of peri-implantitis, and sinus lifting procedures. CONCLUSIONS: Much investigation now supports the use of PRF for periodontal and soft tissue repair. Despite this, there remains a lack of well-conducted studies demonstrating convincingly the role of PRF during hard tissue bone regeneration. Future human randomized clinical studies evaluating the use of PRF on bone formation thus remain necessary. CLINICAL RELEVANCE: PRF was shown to improve soft tissue generation and limit dimensional changes post-extraction, with little available data to date supporting its use in GBR.

A multidisciplinary approach for the rehabilitation of a patient with an excessively worn dentition: a clinical report.

This clinical report describes a multidisciplinary approach to the diagnosis and treatment of a patient with a severely worn dentition. The treatment included osteotomy and immediate implant placement and loading in the mandible. The definitive restorations were implant- and tooth-supported metal ceramic restorations. These restorations were fabricated with metal occlusal surfaces at an increased occlusal vertical dimension, which provided acceptable esthetics and function.

Full mouth rehabilitation of a young patient with partial expressions of ectodermal dysplasia: a clinical report.

Ectodermal dysplasia (ED) is a hereditary disorder characterized by the abnormal development of specific tissues and structures of ectodermal origin. This clinical report describes the multidisciplinary approach to the diagnosis and treatment of a 24-year-old patient with partial expression of ED. The treatment plan used dental implants to support fixed prostheses and ceramic restorations to establish acceptable esthetics and provide function.

The severely atrophic maxilla: Decision making with zygomatic and pterygoid dental implants.

The severely atrophic maxilla can present with some challenges during treatment planning with communication between those performing the surgical and prosthetic aspects of the treatment as well as communication with the patient as to what is being suggested for treatment. This article simplifies the communication and understanding of treating the severely atrophic maxilla and based on the Bedrossian classification gives a guideline for the surgical approach to be adapted based on the patient residual anatomy.

Case report: utilization of Z-Point fixture "Trans-nasal" implants.

Severe bone loss in the anterior maxilla poses challenges to implant placement, especially when treating the entire arch. Utilization of zygomatic implants may not allow positioning of the implant platform anterior enough to properly support the full arch prosthesis, leaving an anterior cantilever in some clinical cases. Importance: Placement of implants into the trans-nasal bone between the pneumatized maxillary sinus and nasal fossa allows utilization of an extralong implant in this residual bone to augment zygomatic implants placed distal to this for better support of a full arch prosthesis. Case presentation: A typical case is presented with insufficient alveolar height for traditional implant placement in the anterior maxilla following extraction of the dentition related to bone loss resulting from periodontal disease. Review of the anatomy and technique for placement of implants into the Z-point area for trans-nasal implants. Clinical discussion: This article discusses the utilization of trans-nasal implants into the Z-point and the technique for placement in this residual bone with a case example. Conclusions: The Z-point implant aids in the elimination of the anterior cantilever that may be present due to the most anterior the platform for the zygomatic implant can be placed. Trans-nasal implants should be considered as part of the treatment plan in severely resorbed maxillary arches to allow better implant to spread and load management during functioning.

Fabrication of the mandibular implant-supported fixed restoration using CAD/CAM technology: a clinical report.

The mandibular implant-supported fixed restoration is an appropriate treatment choice for patients with inadequate bone volume in the posterior mandible. Computer-aided design/computer-aided manufacturing (CAD/CAM) technology has broadened the scope and application for this treatment option. A milled titanium bar retaining individual all-ceramic zirconium oxide crowns, with composite resin replicating gingival tissues, is recommended as an acceptable variation for this type of prosthesis. An alternative method for fabricating a mandibular implant-supported fixed restoration using CAD/CAM technology is described.

Mandibular cortical bone graft part 2: surgical technique, applications, and morbidity.

The mandibular cortical grafts, including the ramus graft, are reliable donor sites for the reconstruction of the alveolar ridge deformities before dental implant placement. The highest concentrations of promoter proteins (e.g., bone morphogenetic proteins) are found in the mandibular cortical grafts. Part 1 of this article (April issue) reviewed the anatomical considerations of mandibular cortical grafts, the associated healing process, and the factors influencing graft incorporation. This article describes mandibular ramus graft before implant placement including the surgical technique, applications, and morbidity

Mandibular cortical bone grafts part 1: anatomy, healing process, and influencing factors.

Mandibular cortical grafts are the gold standard in the restoration of intraoral osseous volume. Mandibular cortical grafts do not produce immune reactions and are incorporated by osteoclastic resorption with a short healing period when compared with other methods of osseous repair. Intraoral donor sites include the mandibular ramus, angle of the mandible, mandibular symphysis, and mandibular exostoses. The mandibular ramus provides primarily a dense cortical graft. Other advantages of a mandibular ramus transplant are minimal resorption, maintenance of osseous density, intraoral access, and proximity to the recipient site. This article is Part 1 of a 2-part presentation. It reviews anatomical considerations of mandibular cortical grafts, the associated healing process, and the factors influencing graft incorporation. Part 2 will discuss surgical technique, applications, and morbidity.

A Novel Technique in Root-Coverage Procedures: The Fibrin-Assisted Soft-Tissue Promotion Concept.

The goal of periodontal plastic surgery is to correct the soft-tissue deformities associated with the loss of attached and keratinized tissue. A variety of flap manipulations related to the use of subepithelial connective tissue grafts are described with great success in the literature but are linked with morbidity and harvesting-quality issues, inclining clinicians and researchers to find alternatives to such techniques. Advanced platelet-rich fibrin, which is widely used in medicine and oral therapy, represents a newer generation of blood-derived growth factors. This article discusses a simple and reproducible root-coverage procedure utilizing the fibrin-assisted soft-tissue promotion concept.

Functional restoration of implants on the day of surgical placement in the fully edentulous mandible: a case series.

PURPOSE: The purpose of this article is to report the clinical experience and outcome of a study of the functional rehabilitation of 16 completely edentulous mandibles with immediately loaded cross-arch screw-retained hybrid prostheses at the University of Southern California. MATERIALS AND METHODS: After signing informed consent forms 16 patients (9 male, 7 female) aged 47 to 84 years (mean age, 62.6+/-11.6 years) received 90 Brånemark System Mk III dental implants (Nobel Biocare USA, Yorba Linda, CA, USA). Stability and radiographs of the dental implants were evaluated at the time of surgery, at 3 months, at 1 year, and at 3 years post loading. RESULTS: Three implants failed to meet the criteria of success, bringing the cumulative success rate to 96.6%, with a 100% prosthetic success rate at 3 years. Thirty-nine (43.3%) of the dental implants placed were 15 mm in length. Seventy-seven (85.5%) of the dental implants were placed in high-density bone. At 3 years post loading, the average bone loss was -1.2+/-0.1 mm. CONCLUSION: Within the limitations of this study, restoration of implants by unreinforced hybrid prostheses at the time of placement provided satisfactory results. The outcome was stable at 3 years post restoration. Mandibular rehabilitation by functional loading of the implants on the day of the insertion requires the comprehension and proper application of surgical and restorative principles.

Clinical evaluation of dental implants with surfaces roughened by anodic oxidation, dual acid-etched implants, and machined implants.

PURPOSE: The purpose of this study was the clinical and radiographic comparison of dental implants with surfaces roughened by anodic oxidation (TiUnite), dual acid-etched implants (Osseotite), and machined implants. MATERIALS AND METHODS: Seventy-four patients (mean age, 52.8 +/- 14.2 years; range, 23 to 80 years; 41 men and 33 women) received 198 dental implants-58 TiUnite implants (25 patients), 52 Osseotite implants (27 patients), and 88 machined implants (22 patients). Clinical measurements and radiographs were evaluated at the time of surgery, at the restorative phase, and 2 years postloading. To account for statistical correlation among multiple implants in the same subject, a "per patient" mode of analysis was conducted. A 1-way analysis of variance of bone loss was conducted by type of implant as well by area of the mouth. In addition, differences in mean bone loss were tested for bone density category, gender, and smoking status using Student t tests. RESULTS: Eighteen TiUnite implants (31.0%) were placed in the maxilla and 40 (69.0%) in the mandible. The Osseotite group included 29 maxillary implants (55.8%) and 23 mandibular implants (44.2%). The machined group included 49 maxillary implants (55.7%) and 39 mandibular implants (44.3%). All 198 implants were considered radiographically and clinically successful. No mobility, signs of infection, or inflammation were detected. DISCUSSION: Implant size, location, bone quality, gender, age, and smoking did not influence the comparative clinical outcomes of the 3 groups (P > .05). A trend toward greater coronal bone loss in the TiUnite group was detected. CONCLUSION: Within the limitations of the present study, TiUnite, Osseotite, and machined dental implants had similar short-term clinical outcomes. No statistically significant differences in bone loss could be detected among implant groups or among the different regions of the oral cavity. The present data underlined the significance of surgical and prosthetic treatment planning.

Surgical template stabilization with transitional implants in the treatment of the edentulous mandible: a technical note.

Proper placement and orientation of dental implants is a requirement for the optimum function and esthetics of the definitive restoration. Surgical template stability during the surgical phase is a key element in the success of proper implant placement. Therefore, any clinical tool that enhances the precision of reproduction is of value. This article describes a simple, noninvasive, cost-effective technique for surgical template stabilization utilizing 2 transitional implants placed the same day as the definitive implants.