A CAD-CAM approach for designing and fabricating a periodontal prosthesis: A clinical report.

The periodontal prosthesis is a successful retrievable fixed restoration provided for patients with a periodontally involved dentition who lack alternative fixed options. However, its popularity has declined due to the introduction of dental implants, as well as the cost and complexity of fabrication. Nonetheless, this remains a viable option for patients who cannot undergo implant surgery. This clinical report describes the use of computer-aided design and computer-aided manufacturing (CAD-CAM) technology to streamline the fabrication of a periodontal prosthesis.

Periodontal prosthesis in contemporary dentistry.

In the last 5 decades, the developments of osseointegrated titanium implants (since 1965) have led to the success of contemporary dentistry. Endosseous implant-supported restorations delivered in accordance with the traditional Branemark protocol have proven to be highly predictable. Today, implants are becoming increasingly common in dental care and provide more therapeutic options, but treatment planning and the sequencing of therapy are critical in implant-assisted and implant-supported cases. Implant prostheses give patients and dentists more options in treatment planning, but also present challenging decisions regarding implant surgery. In essence, the emerging thought is that teeth are expendable, as we now have implants to solve these problems. The fact that peri-implantitis is no simple problem to treat does not seem to affect many who hold that thought. In this article, the authors explain how to properly apply the periodontal prosthesis philosophy, concepts, principles, and techniques in contemporary dentistry. (This article is an update from the article was published in 2005) [1].

Evaluation of Four Different Restorative Materials for Restoration of the Periodontal Condition of Wedge-Shaped Defect: A Comparative Study.

BACKGROUND This study aimed to conduct a clinical evaluation of four restorative materials for restoration of dental wedge-shaped defect (WSD) and their impacts on periodontal tissues. MATERIAL AND METHODS A total of 280 maxillary premolars with dental WSD were selected from 106 patients; the patient cases were divided into eight groups according to different combinations of restorative materials (flowable resin composites, Dyract compomers, glass ionomer cement (GIC), light-curing composite resin), and WSD positions (approaching gingival and subgingival positions). Gingival crevicular fluid (GCF) volume, levels of aspartate aminotransferase (AST), alkaline phosphatase (ALP), and interleukin-1ß (IL-1ß) in GCF were analyzed, while probing depth (PD), plaque index (PLI), and sulcus bleeding index (SBI) were also measured. The periodontal conditions of all patients were followed prior to restoration, as well as six months and 12 months after restoration. RESULTS After six months of restoration, the overall clinical success rates of flowable resin composites, Dyract compomers, and light-curing composite resin were greater than those of GIC. GCF volume, GCF-AST, IL-1ß levels, PD, PLI, and SBI of cases restored by GIC were higher than those restored by the other three materials. After 12 months of restoration, the overall clinical success rates of flowable resin composites and Dyract compomers were greater than those of light-curing composite resin and GIC. GCF volume, GCF-AST, GCF-ALP, IL-1ß levels, PD, PLI, and SBI of cases restored by GIC were higher than those restored by the other three materials. CONCLUSIONS Our study provided evidence that the clinical efficacy of flowable resin composites, Dyract compomers, and light-curing composite resin was greater than that of GIC for restoration of dental WSD.

Encía artificial en prótesis implantoasistida: indicaciones y aplicaciones clínicas / Artificial gingiva in implant-supported prosthesis: indications and clinical applications

En la rehabilitación odontológica integral actual, hay que evaluar los parámetros clínicos para una restauración sobre implantes dentales. El tratamiento del sector anterior de ambos maxilares en situaciones clínicas complejas, hace que el éxito sea difícil de alcanzar, inclusocuando todos los objetivos establecidos de diagnóstico y de planificación del tratamiento, sean respetados y puedan realizarse. El objetivo es imitar la apariencia de los dientes contiguos para simular la dentición natural, con un enfoque en la estética de los tejidos gingivales adyacentes a las restauraciones sobre implantes. En los casos en que el tejido óseo y la pérdida mucogingivales marcada y procedimientos quirúrgicos adicionales no son viables, se requerirá de tratamientos alternativos. Uno de ellos podría ser el uso de encía artificial para reconstruir las deficiencias de tejidos duros y blandos. Este artículo describe diferentes indicaciones y aplicaciones clínicas de la encía artificial en prótesis implanto asistida.

In the current comprehensive dental rehabilitation, clinical parameters for success restoration on dental implants must be evaluated.Treatment of both anterior maxillary and mandibular jaws in complex clinical situations makes success difficult to achieve, even when allestablished goals in diagnosis and treatment planning, are respected and can be made.The goal is to mimic the appearance of the adjacent teeth to simulate natural dentition, with a focus on the aesthetics of the gingival tissuesnext to implant restorations. In cases where the bone and mucogingival tissues loss are marked and additional surgical procedures shouldnot be viable, it will require alternative treatment options. One of them could be the use of artificial gingiva to rebuild the deficiencies ofhard and soft tissues.This article describes different indications and clinical applications in artificial gum assisted implant prosthesis.

Interdisciplinary orthodontic treatment for a patient with generalized aggressive periodontitis: Assessment of IgG antibodies to identify type of periodontitis and correct timing of treatment.

Aggressive periodontitis is a great challenge to clinicians when providing orthodontic treatment because of the potential for progression of periodontal disease. In this article, we report the successful comprehensive orthodontic treatment of bimaxillary protrusion and severe crowding in an adult with generalized aggressive periodontitis. A woman, aged 22 years 7 months, with a chief complaint of incisal crowding was diagnosed with a skeletal Class I malocclusion associated with severe anterior crowding, possibly worsened by generalized aggressive periodontitis. In addition to a periodontal examination, a blood IgG antibody titer analysis and microbiologic examination for periodontal pathogens were used to diagnose the type of periodontal disease and determine the proper timing to initiate orthodontic treatment. The total active treatment period was 28 months, followed by periodontal prostheses and regeneration therapy. Consequently, satisfactory facial profile, occlusion, and periodontal health were maintained for at least 36 months. These results indicate that efficient screening is important for providing successful orthodontic treatment in patients with advanced periodontal disease. This report also demonstrates the diagnostic importance of blood IgG antibody titer assays and microbiologic examinations to detect periodontal pathogens.

Procedimentos básicos em periodontia: método lógico para estabilizar a doença periodontal avançada / Basic periodontal therapy: logical method to stabilize advanced periodontal disease – case report

Para tratar a doença periodontal, é essencial controlar todos os agentes etiológicos envolvidos que possam desencadear a doença. Os procedimentos básicos são um conjunto de métodos aplicados para eliminar e/ou estabelecer um controle em todos os fatores etiológicos envolvidos no desenvolvimento da doença periodontal. Neste trabalho, alguns detalhes para estabilizar a doença periodontal avançada através dos procedimentos básicos serão analisados e discutidos.

Attachment-retained gingival prosthesis for implant-supported fixed dental prosthesis in the maxilla: a clinical report.

The rehabilitation of edentulous maxillae is a complex procedure due to the involvement of esthetic and functional requirements. A trial maxillary denture can be used to identify the need for adequate upper lip support when replacing removable complete dentures by implant-fixed dental prostheses. This clinical report describes the outcome of the rehabilitation of an edentulous atrophic maxilla with unfavorable maxillomandibular relationship and deficient upper lip support. A trial denture was fabricated and used to diagnose the need for a prosthesis capable of restoring the upper lip support. The reduced upper lip support was also confirmed by a lateral cephalogram. The patient was rehabilitated by an implant-fixed dental prosthesis associated with an attachment-retained gingival prosthesis. The case presented shows that when loss of upper lip support is detected and the patient does not wish to undergo further surgical reconstruction procedure, the retention of a gingival prosthesis using a ball attachment is a satisfactory treatment option.

Periodontal prosthesis on medically compromised patient with few remaining teeth: hybrid telescopic double crown with friction pin method / 대한치과보철학회지

Successful results of treatments using double crown prostheses for the partially edentulous patients who have a few remaining teeth have been reported in several journals. A double crown removable partial denture can be an alternative treatment for the patients with a poor periodontal condition of remaining teeth. Since a double crown removable partial denture can be applied without the risk of surgical operation to the medically compromised patients with a poor periodontal condition which is inadequate for dental implants, it has psychological and economical advantages. In this case, there were sufficient remaining teeth to be restored with fixed prostheses in maxilla, while there were a few remaining teeth with a very poor periodontal condition so that it was almost impossible to restore with a clasp removable partial denture using these remaining teeth in mandible. In addition, the patient had the medical history of surgical operation due to osteomyelitis in the mandibular anterior areas a year ago, thus difficult to conduct an implant placement. The main objective of this report is to introduce our case because a double crown partial denture using a few mandibular remaining teeth showed satisfactory results in functional and esthetical aspects during more than two years follow-up period in this unfavorable condition.

Gengiva artificial com restauração da papila em próteses unitárias sobre implantes mal posicionados: uma alternativa estética e de fácil higienização / Artificial gingiva with papilla restoration in sigle prostheses over malpositioned implants: An aesthetic and easy to clean alternative

A reabilitação bucal com implantes tem se tornado uma ótima opção de tratamento; no entanto, implantes mal posicionados muitas vezes apresentam dificuldade em uma resolução estética favorável. O presente trabalho teve como objetivo relatar uma abordagem alternativa para uma condição clínica de posicionamento desfavorável de implantes, com um planejamento protético inicial também desfavorável. Por meio de uma caso clínico foi apresentada uma alternativa viável para essas situações, de coroas individuais sobre implante com gengiva artificial, trazendo de volta a região das papilas, demonstrando ser essa uma alternativa eficiente no que diz respeito à estética e de fácil higienização — fator importante na manutenção da saúde peri-implantar

Oral rehabilitation with implants has become a great treatment option, however, poorly positioned implants often present dificulty in a esthetically favorable resolution. This study aimed to describe an alternative approach to clinical conditions with unfavorable positioning of implants and also unfavorable initial prosthetic planning. By means of a clinical case report it was presented a viable alternative for these situations, using individual crowns over implant with artificial gingiva, giving back the poper papillae region, proving to be an effective alternative with aesthetic benefits and easy cleaning, an important factor in maintaining peri-implant health

The use of pink porcelain to manage a malposed anterior implant: case report.

Pink porcelain was used in a custom zirconia abutment with a zirconia implant-supported anterior crown to compensate for a malposed anterior implant with horizontal bone deficiency and lack of keratinized tissue. This clinical procedure was able to reduce abutment height, mask the horizontal defect and create a symmetrical and esthetic effect.

Optical effects of different colors of artificial gingiva on ceramic crowns.

OBJECTIVES: The interaction between gingival color and the shade of ceramic restorations has never been fully studied. The purpose of this study is to investigate the optical effects of altering artificial gingival color on the ceramic crown shade in the cervical area. METHODS: Thirty-one all-ceramic crowns of different shades were used in this study with six different artificial gingival colors. Using a spectrophotometer (Crystaleye(®) Olympus, Japan), we measured the shade of crowns in cervical areas with each of six different artificial gingiva. The crown color measured in the presence of pink artificial gingiva (control) was compared with the crown color with five other artificial gingiva. color difference values ΔE* were calculated and compared between the control group and test groups and the correlation of the artificial gingival color with the crown color was also assessed. RESULTS: Significant differences were found in the mean L* and a* values of all-ceramic crowns at the cervical regions in all six gingival color groups (p<0.001) and significant Pearson correlations were also found for the mean L* (r=0.987, p<0.001) and a* (r=0.856, p=0.03) values between the artificial gingiva and the ceramic crowns. The mean ΔE* values between the control group and each of the five other gingival groups were all significantly larger than the clinical perceptual threshold of ΔE* 1.6 (p<0.001). CONCLUSIONS: Different colors of artificial gingiva generated clinically detectable shade differences in the cervical region of ceramic crowns.

Gingival conditioning in an implant-supported prosthesis: a clinical report.

The loss of gingival volume is a major challenge for dental surgeons with implant-supported fixed prosthesis manufactures, particularly from an aesthetics perspective in patients with a high smile line. Gingival tissue remodeling can help in papillae formation to avoid soft tissue surgery by reestablishing the appropriate shape and gingival contour of the tissues. This improves not only the aesthetics, but also the phonetics of the patient. This paper describes a clinical case of gingival conditioning obtained with interim implant-supported fixed partial dentures via incremental addition and adjustment of acrylic resin. The purpose of the gingival conditioning was to obtain improved aesthetics. Gingival conditioning by gradual pressure application is presented as an easy, non-traumatic technique that improves gingival aesthetics.

Conservative management of gingival recession: the gingival veneer.

UNLABELLED: Gingival recession is apical migration of the gingival tissues resulting in exposure of the underlying root surface. This can cause significant esthetic concerns for the patient, especially when it affects the anterior teeth. The gingival veneer is a prosthesis indicated for challenging clinical situations where there are esthetic concerns because of gingival recession, particularly loss of interdental papillae. Replacement crowns, surgery, or extraction of teeth, and provision of a removable partial denture are other treatment options; however, these have a significant biologic and financial cost compared with gingival veneers. This article aims to revisit the gingival veneer: its uses, advantages, disadvantages, and its fabrication. The cases discussed here highlight two different clinical situations where the gingival veneer prosthesis helped in achieving optimum esthetics and patient satisfaction thus proving to be a feasible and simple treatment modality in certain clinical cases. This may offer a good interim solution for patients who may wish to have time to consider their options of more advanced and complex treatment. Some patients may choose to wear the veneer as a long-term solution when the burden/risk of further advanced treatment may outweigh the benefits, as perceived by the patients. CLINICAL SIGNIFICANCE: The gingival veneer is a viable treatment option for restoring anterior esthetics in clinical situations where there are esthetic concerns caused by significant gingival recession. Case selection is important for a predictable and successful outcome.

Forced eruption without orthodontic brackets using fiber reinforced composite prostheses: a case report.

Maintenance of periodontal health is one of the most important factors governing success of the restoration and longevity of teeth. For proper maintenance of periodontal health, the biologic width functions as a protective barrier against the entrance of microorganisms in to the internal medium of the periodontal ligament and osseous connective tissue. This clinical case describes a technique to reestablish the biologic width surrounding a fractured central incisor by forced eruption without orthodontic brackets, using fibre reinforced composite prostheses. Main advantages of using fibre reinforced composite prostheses are aesthetic maintenance during the treatment period, no need for occlusal adjustments, simplicity, low cost, and stability.