Digital workflow for prosthetic management of malpositioned implant in an adolescent patient: A 20-year follow-up.

OBJECTIVE: Dental implants placed in adolescent patients pose a challenge to restore and maintain an esthetic outcome over longer period of follow-up. Maxillomandibular changes throughout adulthood may lead to complications such as implant infraocclusion and interproximal contact loss. This case report describes an alternate prosthetic treatment strategy for maxillary single implant placed in an adolescent patient in the esthetic zone with inappropriate implant axis and screw hole placement. CLINICAL CONSIDERATIONS: With temporary restorations, the gingiva and soft tissues were shaped to imitate the emerging profile of the contralateral side. A zirconia screw-retained abutment was customized as a copy-mirror from the contralateral prepared tooth to mimic the exact shape and to avoid labiolingual over contour by computer-aided design/computer-assisted manufacture (CAD/CAM). The porcelain laminate veneer was bonded to the zirconia abutment. Porcelain adhesive approach was used instead of traditional principles of retention and resistance form of the abutment. CONCLUSIONS: A functional and esthetic outcome was achieved and maintained, while a minimally invasive procedure was implemented to use the malplaced implant instead of explanting it. CLINICAL SIGNIFICANCE: The present report illustrates the prosthetic management of a malpositioned dental implant placed 20 years ago, utilizing a minimally invasive digital protocol.

Reverse scan body: Complete digital workflow for double full-arch zirconia prostheses.

During intraoral complete-arch digital implant scanning, one of the most technique-sensitive steps is the implant data acquisition and merging of different surface geometry data sets for prototype prosthesis fabrication due to the absence of fixed landmarks. Recently developed extraoral techniques have allowed for an alternative approach for the digital acquisition of implant position in completely edentulous patients. Specifically, extraoral digital scanning of the conversion prosthesis after connecting reverse scan bodies has been proposed as an efficient approach. The reverse scan body protocol digitally simulates the traditional back-pouring technique long utilized in analog workflows. The present article describes a technique for simplifying the digital workflow for the fabrication of passive-fitting definitive prostheses using the reverse scan body concept.

Reverse scan body: A complete digital workflow for prosthesis prototype fabrication.

PURPOSE: To assess the accuracy of fit of prosthesis prototypes fabricated via a complete digital workflow protocol with a reverse scan body skipping intraoral scanning for implant data acquisition. MATERIALS AND METHODS: A maxillary stone cast with four multiunit abutment implant analogs (Screw-Retained Abutments, Institut Straumann AG, Basel, Switzerland) with adequate anteroposterior spread simulated a common clinical patient situation. This stone cast served as the master cast and an interim screw-retained prosthesis was fabricated on it. Novel reverse scan bodies were connected to the interim prosthesis, and extraoral scanning was performed with a white light intraoral scanner. The produced standard tessellation language (STL) files were then imported to computer-assisted design software and after the digital design, the STL file was exported to a computer-assisted machining milling machine and a three-dimensional (3D) printer to produce a total of 50 milled and 50 printed fixed complete denture prototypes, respectively. Two clinicians assessed the accuracy of fit of each digitally fabricated prosthesis prototype on the master cast, utilizing the screw-resistance test and radiographic evaluation. Out of the 100 prototypes, 94% (94/100) were fitting accurately. Fisher's exact test was used to test the difference among the groups. The test revealed statistically significant results (p = 0.027). RESULTS: Out of the 50 digitally fabricated milled prosthesis prototypes, 50 (100%) presented with accurate fit under in vitro assessment. Out of the 50 digitally fabricated 3D printed prototypes, 44 (88%) presented with accurate fit under in vitro assessment. CONCLUSIONS: Accurately fitting digitally fabricated prosthesis prototypes can be milled after extraoral scanning with reverse scan bodies without intraoral implant data acquisition.

Reverse scan body: The scan pattern affects the fit of complete-arch prototype prostheses.

PURPOSE: To assess the effect of different scan patterns on the fit of implant-supported complete-arch prototype prostheses fabricated via a complete digital extraoral protocol with a reverse scan body. MATERIALS AND METHODS: A mandibular cast with four multi-unit abutment (MUA) implant analogs with adequate antero-posterior spread served as the reference cast, simulating a common clinical patient situation, and a polymethylmethacrylate interim screw-retained prosthesis was fabricated on it. Novel reverse scan bodies were connected to the interim prosthesis on the intaglio of the MUA abutments and extraoral scanning was performed with a white light intraoral scanner (TRIOS 4; 3 shape) and three different scan patterns: starting from the occlusal surface of the interim prosthesis (O-group), starting from the intaglio (I-group), and helix pattern (H-group).  The resulting STL files from the three groups were then imported to computer-aided design (CAD) software and after the digital design, the STL files were exported to a computer-aided manufacturing (CAM) milling machine which generated a total of 15 CAD-CAM milled prototype prostheses per group. Two clinicians assessed the fit of each digitally fabricated prototype prosthesis on the reference cast, utilizing the screw-resistance test and radiographic evaluation. Fisher's exact test was used to test the difference between the three groups, and Cohen's k-score was used to assess the inter-examiner agreement. RESULTS: Out of the three different groups, the O-group scan pattern led to 100% prosthesis fit, while the prototype prostheses generated from I- and H-groups had 80% and 53% fit, respectively. The results were statistically significant (p = 0.008). CONCLUSIONS: Occlusal scan pattern leads to fitting milled prototype prostheses after extraoral scanning with reverse scan bodies without intraoral implant data acquisition.

Complete digital workflow for prosthesis prototype fabrication with double digital scanning: A retrospective study with 45 edentulous jaws.

PURPOSE: To assess the accuracy of fit of complete-arch printed prosthesis prototypes generated with a digital workflow protocol for completely edentulous jaws. MATERIALS AND METHODS: Forty-five edentulous jaws (35 patients) underwent intraoral complete-arch digital scans with the double digital scanning (DDS) technique and the generated standard tessellation language (STL) files were superimposed and imported into computer-aided design software. After STL merging, each master STL file was used for printing a prosthesis prototype. The primary outcome was the accuracy of fit assessment of the printed prototypes on verified master stone casts. Two experienced clinicians tested the accuracy of fit with radiographs and screw-resistance tests. Secondary outcomes were the effect of the scan body shape and implant number on the accuracy of fit. RESULTS: Out of the 45 DDS-generated prosthesis prototypes, 39 presented with accurate fit on verified master stone casts, yielding an 86.70% accuracy of fit. Cylindrical scan bodies led to 100% accuracy of fit (25/25), whereas polygonal scan bodies presented with 70% accuracy of fit (14/20). Four implant-supported prostheses yielded 100% accuracy of fit (12/12), compared with 25/29 (86.30%) accuracy of fit for the six-implant-supported ones. Fisher's exact test was used to assess the effect of different scan body shapes (p = 0.005) and implant number on accuracy of fit. Chi-squared test was used to assess the association between the number of implants per arch and the accuracy of fit (p = 0.039). CONCLUSIONS: Thirty-nine out of 45 complete-arch prosthesis prototypes generated with a completely digital workflow presented with clinically acceptable fit. The effect of the scan body design and implant number was statistically significant, favoring cylindrical scan bodies and four-implant-supported prostheses.

Accuracy of Different Surgical Guide Designs for Static Computer-Assisted Implant Surgery: An In Vitro Study.

The aims of this study were to evaluate the effect of (1) the different surgical guide designs and (2) implant placement location on the accuracy of fully guided implant placement in single edentulous sites using an in vitro study model. Forty-five partially edentulous models were scanned and divided into 3 groups: group 1, tooth-supported full-arch surgical guide; group 2, 3 different tooth-supported shortened surgical guides (SSGs); and group 3, tooth-supported full-arch surgical guide with a crossbar. All surgical guides were printed and used for fully guided implant placement. A total of 180 implants (60 per group) were placed, and scan bodies were positioned on all models, and postoperative surface scan files (STL) files were obtained. Superimposition of preoperative and postoperative STL files was performed, and the accuracy of implant position was evaluated. The interaction between group and implant location was statistically significant for angle, 3D offset at the base, and at the tip (P < .001). The post-hoc tests showed a statistically significantly higher deviation for group 2 compared to group 3 for all outcomes for implants #4 (P < .05) and #7 (P < .05). There was also a statistically significant difference in all outcomes between groups 1 and 3 for implant #7 (P < .05). All surgical guide designs presented satisfactory performance with clinically acceptable levels of deviation. However, SSGs presented higher accuracy for guided implant placement in a single-edentulous site, whereas a full-arch surgical guide with a crossbar presented superior outcomes when 2 or more guided implants were placed simultaneously.

Screw-retained surgical guide for implant placement in terminal dentition patients with existing implants.

For patients with existing implants in need of additional implant placement, the use of the existing implants for guide fixation seems to be a logical alternative. Current options for the fabrication of surgical guides involve creating surgical guides that are mucosa-borne and/or retained by fixation pins. Since these existing techniques involve inherent inaccuracies, the fabrication of surgical guides that are screw-retained at the implant- or abutment-level would eliminate the introduction of those same fundamental inaccuracies. The purpose of the present technical report is to illustrate a step-by-step digitally planned guided implant placement protocol for terminal dentition patients with salvageable existing implants requiring full-arch implant rehabilitation. The advantages of this protocol include enhancing the accuracy of guided implant placement with screw-retention versus the traditional mucosa- or fixation pin support. Thus, this simplifies the transition from failing teeth to implants by ensuring that fixed provisionalization serves both functional and esthetic requirements. This protocol can also predictably reduce chairside time and adjustments at the surgical implant placement appointment.

Influence of zirconia crown artifacts on cone beam computed tomography scans and image superimposition of tomographic image and tooth surface scan: An in vitro study.

STATEMENT OF PROBLEM: Zirconia restorations create significant artifacts on 3D cone beam computed tomography (CBCT) imaging. Static computer-assisted implant surgery (s-CAIS) relies on the accuracy of superimposition between an intraoral surface scan and CBCT imaging. However, how the artifacts from zirconia on the tomographic image might affect the predictability of s-CAIS is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the effect of zirconia crown restorations on the superimposition process for s-CAIS. MATERIAL AND METHODS: Four stone casts generated 4 groups: a control group (CG) with no crowns and 3 experimental groups with 4 (TG4), 7 (TG7), and 13 (TG13) zirconia crowns. A total of 40 CBCT scans were made for the 4 groups (n=10). All CBCTs were imported into a computer planning software program, and the casts from all 4 groups were scanned by using a high-resolution laboratory scanner. The standard tessellation language (STL) files were imported, segmented, and the 3 files superimposed for all groups. The accuracy of the superimposition was assessed, in millimeters, in 3 planes corresponding to anterior-posterior, horizontal, and vertical, as well as the overall measurement, and the results were analyzed statistically (α=.05). RESULTS: The overall analysis demonstrated statistically significant differences between all groups (P<.001), except between CG and TG4. The anterior-posterior dimension demonstrated significant differences between CG and TG7 (P<.001), CG and TG13 (P<.001), TG4 and TG7 (P=.004), and TG4 and TG13 (P=.001). For the vertical dimension analysis, significant differences were found between CG and TG7 (P=.001), CG and TG13 (P<.001), and TG4 and TG13 (P<.001). For the horizontal variable, statistically significant differences were found between CG and TG7 (P=.049), CG and TG13 (P<.001), TG4 and TG13 (P<.001), and TG7 and TG13 (P=.003). CONCLUSIONS: The accuracy of the superimposition of the images was influenced by the number of zirconia crowns, with an increased number reducing the superimposition accuracy.

Digital Workflow for Implant Rehabilitation with Double Full-Arch Monolithic Zirconia Prostheses.

The purpose of the present report is to illustrate a proof-of-concept protocol with the double digital scanning (DDS) technique for complete digital workflow in double full-arch implant rehabilitation. Two patients (4 restored arches) presented with hopeless dentitions and they were treated with a 4-appointment prosthodontic protocol and monolithic zirconia prostheses implementing a complete digital workflow. The outcomes are presented after clinical and radiographic observation for 2 years.

Accuracy of printed casts generated from digital implant impressions versus stone casts from conventional implant impressions: A comparative in vitro study.

OBJECTIVES: The aim of this in vitro study was to compare the accuracy of printed implant casts from digital impressions with two intra-oral scanners (IOS) to stone casts from conventional impressions. The hypothesis was that printed casts would be more accurate than stone casts from conventional impressions. MATERIALS AND METHODS: A mandibular stone cast with Kennedy class II edentulism was fabricated using two internal connection tissue-level implants at 30 degrees to each other (Replace Select RP, Nobel Biocare) to serve as master. Digital impressions (n = 10) were made with the white light (WL) and Active Wavefront Sampling technology (AWST) IOS. The resultant standard tessellation language (STL) datasets were used to print implant casts through stereolithography (SLA) prototyping. The conventional casts (n = 10) were produced with splinted open tray impression technique and polyether material in type IV stone. The master cast and all groups were digitized with lab reference scanner. The test groups STL datasets were superimposed to master cast STL in inspection software (Geomagic control 2015) to calculate root-mean-square error. RESULTS: The conventional, WL IOS and AWST IOS groups had mean values of 53.49 µm (SD 9.47), 108.09 µm (SD 9.59) and 120.39 µm (SD 5.91), respectively. The Shapiro-Wilk test showed no evidence of nonnormality (p = 0.131) and Levene's test showed no evidence of heterogeneity of variance (p = 0.518). The one-way ANOVA demonstrated a statistically significant difference (p < 0.001). Tukey's honest significant difference (HSD) showed statistically significant differences between all groups: for the comparison of AWST IOS and WL IOS, the p-value was 0.009, and the p-values of the other post hoc tests were <0.001. CONCLUSION: Printed casts generated from digital impressions for partially edentulous posterior mandibular arches had inferior accuracy to conventional stone casts fabricated from splinted open tray impressions. The printed casts from WL IOS had better accuracy compared to AWST IOS.

Digital workflow in full-arch implant rehabilitation with segmented minimally veneered monolithic zirconia fixed dental prostheses: 2-year clinical follow-up.

OBJECTIVE: To illustrate a digital workflow in full-arch implant rehabilitation with minimally veneered monolithic zirconia and to report the outcomes including technical complications. CLINICAL CONSIDERATIONS: Three patients (5 edentulous arches) received full-arch fixed implant rehabilitation with monolithic zirconia and mild facial porcelain veneering involving a digital workflow. The incisal edges and occluding surface areas were milled out of monolithic zirconia to reduce the possibility of chipping. Porcelain veneering was applied on the facial aspect to improve the esthetic result. Outcomes and technical complications are reported after 2 years of clinical and radiographic follow-up. CONCLUSION: Implant and prosthesis survival rates were 100% after a short-term follow-up of 2 years. Technical complications were encountered in one patient. They did not adversely affect prosthesis survival or patient satisfaction and were easily addressed. A digital workflow for the design and fabrication of full-arch monolithic zirconia implant fixed implant prostheses has benefits, but caution is necessary during CAD planning of the prosthesis to ensure a successful outcome. Long-term clinical studies are needed to corroborate the findings discussed in this report. CLINICAL SIGNIFICANCE: This article presents an integrated digital workflow that was implemented for the implant-prosthodontic rehabilitation of three edentulous patients with monolithic zirconia prostheses. Monolithic zirconia has been successfully incorporated in implant prosthodontics in an effort to reduce the technical complications associated with bilayered ceramics. This workflow simplifies design and fabrication of the zirconia prostheses. However, caution should be taken during CAD planning of the prosthesis to make sure the zirconia cylinder is sufficiently thick at the interface with the titanium insert. Additionally, when cutback is planned for facial porcelain veneering, the functional occluding cusps and incisal edges should be fabricated in monolithic zirconia to avoid chipping.

Digital versus conventional implant impressions for partially edentulous arches: An evaluation of accuracy.

STATEMENT OF PROBLEM: To the authors' knowledge, while accuracy outcomes of the TRIOS scanner have been compared with conventional impressions, no available data are available regarding the accuracy of digital scans with the Omnicam and True Definition scanners versus conventional impressions for partially edentulous arches. PURPOSE: The purpose of this in vitro study was to compare the accuracy of digital implant scans using 2 different intraoral scanners (IOSs) with that of conventional impressions for partially edentulous arches. MATERIAL AND METHODS: Two partially edentulous mandibular casts with 2 implant analogs with a 30-degree angulation from 2 different implant systems (Replace Select RP; Nobel Biocare and Tissue level RN; Straumann) were used as controls. Sixty digital models were made from these 2 definitive casts in 6 different groups (n=10). Splinted implant-level impression procedures followed by digitization were used to produce the first 2 groups. The next 2 groups were produced by digital scanning with Omnicam. The last 2 groups were produced by digital scanning with the True Definition scanner. Accuracy was evaluated by superimposing the digital files of each test group onto the digital file of the controls with inspection software. RESULTS: The difference in 3-dimensional (3D) deviations (median ±interquartile range) among the 3 impression groups for Nobel Biocare was statistically significant among all groups (P<.001), except for the Omnicam (20 ±4 µm) and True Definition (15 ±6 µm) groups; the median ±interquartile range for the conventional group was 39 ±18 µm. The difference in 3D deviations among the 3 impression groups for Straumann was statistically significant among all groups (P=.003), except for the conventional impression (22 ±5 µm) and True Definition (17 ±5 µm) groups; the median ±interquartile range for the Omnicam group was 26 ±15 µm. The difference in 3D deviations between the 2 implant systems was significant for the Omnicam (P=.011) and conventional (P<.001) impression techniques but not for the True Definition technique (P=.247). CONCLUSIONS: Within the limitations of this study, both the impression technique and the implant system affected accuracy. The True Definition technique had the fewest 3D deviations compared with the other 2 techniques; however, the accuracy of all impression techniques was within clinically acceptable levels, and not all differences were statistically significant.

Digital vs. conventional full-arch implant impressions: a comparative study.

PURPOSE: To test whether or not digital full-arch implant impressions with two different intra-oral scanners (CEREC Omnicam and True Definition) have the same accuracy as conventional ones. The hypothesis was that the splinted open-tray impressions would be more accurate than digital full-arch impressions. MATERIAL AND METHODS: A stone master cast representing an edentulous mandible using five internal connection implant analogs (Straumann Bone Level RC, Basel, Switzerland) was fabricated. The three median implants were parallel to each other, the far left implant had 10°, and the far right had 15° distal angulation. A splinted open-tray technique was used for the conventional polyether impressions (n = 10) for Group 1. Digital impressions (n = 10) were taken with two intra-oral optical scanners (CEREC Omnicam and 3M True Definition) after connecting polymer scan bodies to the master cast for groups 2 and 3. Master cast and conventional impression test casts were digitized with a high-resolution reference scanner (Activity 880 scanner; Smart Optics, Bochum, Germany) to obtain digital files. Standard tessellation language (STL) datasets from the three test groups of digital and conventional impressions were superimposed with the STL dataset from the master cast to assess the 3D deviations. Deviations were recorded as root-mean-square error. To compare the master cast with conventional and digital impressions at the implant level, Welch's F-test was used together with Games-Howell post hoc test. RESULTS: Group I had a mean value of 167.93 µm (SD 50.37); Group II (Omnicam) had a mean value of 46.41 µm (SD 7.34); Group III (True Definition) had a mean value of 19.32 µm (SD 2.77). Welch's F-test was used together with the Games-Howell test for post hoc comparisons. Welch's F-test showed a significant difference between the groups (P < 0.001). The Games-Howell test showed statistically significant 3D deviations for all three groups (P < 0.001). CONCLUSION: Full-arch digital implant impressions using True Definition scanner and Omnicam were significantly more accurate than the conventional impressions with the splinted open-tray technique. Additionally, the digital impressions with the True Definition scanner had significantly less 3D deviations when compared with the Omnicam.

Digital Workflow for Fixed Implant Rehabilitation of an Extremely Atrophic Edentulous Mandible in Three Appointments.

OBJECTIVE: To present a rationale to reduce treatment complexity, number of surgeries, and overall treatment time for patients with extreme mandibular ridge deficiency. CLINICAL CONSIDERATIONS: A 67-year-old fully edentulous male presented with a chief complaint of poor retention and stability of the mandibular complete denture with consequent discomfort and inability to chew. A novel 3-appointment protocol from guided implant placement to definitive prosthesis delivery was implemented. At the first appointment, a guided surgery protocol with the All-on-4 concept was used in the mandible. Implant placement was followed by immediate loading with a fixed provisional prosthesis providing the patient with immediate function. Final impression, cast verification and articulation, determination of VDO, and interocclusal records were obtained in the same appointment. In the second appointment, the framework try-in was performed and a pick-up impression was taken after a new CR record. The third appointment included the delivery of the final screw-retained, one-piece, full-arch prosthesis opposed by a maxillary complete denture. CONCLUSION: This expedited protocol allows for implant placement with a surgical template generated from preoperative virtual planning of the implants and the CAD/CAM prosthodontic rehabilitation using a digital workflow. The patient was satisfied with the esthetic and functional outcome and was enrolled into a 6-month recall program. CLINICAL SIGNIFICANCE: This article describes an expedited protocol illustrating a digital workflow for full arch implant rehabilitation of the extremely atrophic mandible. Flapless implant placement with a surgical template generated from virtual planning was followed by immediate loading with a fixed prosthesis. Digital impression/digitization of the working cast and CAD/CAM technology were used to mill the definitive prosthesis. From guided surgery to the definitive rehabilitation only three appointments were necessary. This digital workflow can enhance patient acceptance and comfort and serve as an alternative treatment in the indicated clinical scenario. (J Esthet Restor Dent 29:178-188, 2017).

Marginal adaptation of four inlay casting waxes on stone, titanium, and zirconia dies.

STATEMENT OF PROBLEM: Different inlay casting waxes do not produce copings with satisfactory marginal accuracy when used on different die materials. PURPOSE: The purpose of this study was to evaluate the marginal accuracy of 4 inlay casting waxes on stone dies and titanium and zirconia abutments and to correlate the findings with the degree of wetting between the die specimens and the inlay casting waxes. MATERIAL AND METHODS: The inlay casting waxes tested were Starwax (Dentaurum), Unterziehwachs (Bredent), SU Esthetic wax (Schuler), and Sculpturing wax (Renfert). The marginal opening of the waxes was measured with a stereomicroscope on high-strength stone dies and on titanium and zirconia abutments. Photographic images were obtained, and the mean marginal opening for each specimen was calculated. A total of 1440 measurements were made. Wetting between die materials and waxes was determined after fabricating stone, titanium, and zirconia rectangular specimens. A calibrated pipette was used to place a drop of molten wax onto each specimen. The contact angle was calculated with software after an image of each specimen had been made with a digital camera. Collected data were subjected to a 2-way analysis of variance (α=.05). Any association between marginal accuracy and wetting of different materials was found by using the Pearson correlation. RESULTS: The wax factor had a statistically significant effect both on the marginal discrepancy (F=158.31, P<.001) and contact angle values (F=68.09, P<.001). A statistically significant effect of the die material factor both on the marginal adaptation (F=503.47, P<.001) and contact angle values (F=585.02, P<.001) was detected. A significant correlation between the marginal accuracy and the contact angle values (Pearson=0.881, P=.01) was also found. CONCLUSIONS: Stone dies provided wax copings with the best marginal integrity, followed by titanium and zirconia abutments. Unterziehwachs (Bredent), wax produced the best marginal adaptation on different die materials. A significant correlation was found between the marginal accuracy and the contact angle values. As the contact angle value became smaller, the marginal accuracy improved. All combinations of waxes and stone and titanium dies presented a high wettability.

Digital Workflow With a Triple Scanning Technique for Implant Rehabilitation in the Esthetic Zone.

This article describes the case of a partially edentulous patient who had undergone template-guided implant placement and was treated using a triple digital scanning protocol that allowed for CAD/CAM prosthodontic rehabilitation in a complete digital workflow. At the impression appointment, the provisional implant-supported screw-retained prosthesis was digitally scanned both intraorally (first scan) and, after removal, extraorally (second scan). After the second scan, scan bodies were placed intraorally and an implant-level digital impression was taken (third scan). The three standard tessellation language (STL) files derived from the three digital scans were imported in a CAD software and superimposed into one file that contained all of the information from the implant 3D position, prosthesis contours, and transmucosal part of the peri-implant soft tissues. The superimposition of the three STL files led to one master file to serve as a blueprint for the definitive prosthesis. The definitive monolithic zirconia prosthesis was CAM copy-milled, externally stained, and inserted. The patient was satisfied with both the esthetic and functional outcome and the minimally invasive, time-efficient, two-visit restorative protocol. In summary, this case report illustrates a technique for a complete digital workflow in an implant rehabilitation for the replacement of multiple missing teeth in the esthetic zone in two visits.

Management of Technical Complications During Full-Mouth Implant Rehabilitation With Hybrid Prostheses Over a 7-Year Period.

Monolithic ceramics have been introduced in dentistry to help reduce technical complications reported with implant-supported metal-resin hybrid prostheses. This clinical report describes the maintenance and technical complications that occurred during a full-mouth implant rehabilitation using different prosthetic materials over a 7-year period. During the course of 4 of those years, multiple technical complications were encountered with the metal-resin hybrid prostheses, prompting the need for increased maintenance.New prostheses were inserted with screw-retained titanium frameworks and individually cemented single crowns, and subsequently no technical complications were encountered after 2 years of follow-up.

Full-Mouth Implant Rehabilitation With Monolithic Zirconia: Benefits and Limitations.

As increased chipping rates have been reported with porcelain-fused-to-zirconia fixed dental prostheses, monolithic zirconia has been introduced in an effort to reduce the technical complications associated with bilayered ceramics. This clinical report illustrates the steps for achieving full-mouth implant rehabilitation with monolithic zirconia prostheses and minimal facial porcelain veneering. The benefits and limitations of this technique are also discussed. The incisal edges and occluding surface areas comprised monolithic zirconia to reduce the possibility of breakage and improve the esthetic outcome. Up to 1 year in function, no porcelain fracture was found.

Management of a Malpositioned Implant in the Anterior Maxilla.

The surgical and prosthodontic management of patients with multiple missing teeth in the anterior maxilla can be challenging. The purpose of this clinical report is to illustrate the 2-year outcome after immediate implant placement in unintentional close proximity with the adjacent root. Following uneventful healing, the definitive implant rehabilitation was done with a modified monolithic zirconia framework and porcelain veneers bonded to the framework. The patient's satisfaction with the functional and esthetic outcomes remained high throughout the observation time, with no symptoms or biologic and technical complications.