The Lip-Tooth-Ridge Classification: A Guidepost for Edentulous Maxillary Arches. Diagnosis, Risk Assessment, and Implant Treatment Indications.

Prosthetic rehabilitation of the edentulous maxilla is known to be challenging and requires meticulous planning. The purpose of this article is to describe a novel classification system, the Lip-Tooth-Ridge (LTR), that offers a guidepost for treatment planning the edentulous maxilla for fixed or removable prostheses. This tool will help clinicians identify the final prosthetic design and will provide a case-specific risk assessment guide regarding two different areas. A high (HER) or low (LER) esthetic risk will be determined based on lip dynamics, as well as a high or low structural risk according to the prosthetic space availability.

Contingency, priority, and risk (CPR) protocol: a roadmap for designing successful and long-lasting implant therapy.

Poorly planned implant-supported restorations not only cause discomfort for patients, but they can also seriously damage the intraoral cavity. Sometimes clinicians inherit cases with poorly planned implant-supported restorations, while other times they may create this problem by not addressing a patient's overall condition prior to treatment planning. Clinicians require a realistic approach for designing prostheses in a comprehensive way. The CPR--ie, contingency, priority, and risk treatment planning--technique aids in identifying potential problems and creating a practical treatment option. By addressing the treatment-planning process in this manner, clinicians are better equipped to design successful and long-lasting implant restorations.

Adjacent implant-supported restorations in the esthetic zone: understanding the biology.

UNLABELLED: Traditionally, whe n considering adjacent implants in the esthetic zone, clinicians have encountered problems associated with deficient interproximal soft tissues. These discrepancies were often solved either by fabricating restorations with long interproximal contacts or by adding pink ceramics, both of which represent an esthetic compromise in today's demanding standard of care for restorative dentistry. This challenge has led to the recent introduction of scalloped implants. An understanding of the biology of wound healing of bone and soft tissue around implants and the remodeling process with implant-supported restorations allows the dental team to offer patients an alternative restorative solution consisting of combining conventional flat prosthetic table implants and scalloped implants. CLINICAL SIGNIFICANCE: This article illustrates the biologic behavior of wound healing associated with dental implants and shows a step-by-step clinical case in which a patient received four adjacent implants in the esthetic zone. It also describes key elements in laboratory communication when dealing with the aforementioned restorations.

Fabrication of an implant-supported reconstruction utilizing CAD/CAM technology.

Recent scientific and technological developments have allowed the dental team to execute revolutionary restorative treatments that would have once been considered unfeasible. This article describes a restorative alternative for fixed implant-supported reconstructions, consisting of a CAD/CAM-generated framework and CAD/CAM-generated all-ceramic cement-retained restorations. Distinct advantages of this type of restoration include the passive fit of the framework, the ability of the ceramist to fabricate individual restorations independent from the framework, and the delivery of optimal aesthetics.

An implant-supported, screw-retained, provisional fixed partial denture for pontic site enhancement.

Due to remodeling of the edentulous ridge following tooth extraction, clinicians and dental technicians face a variety of challenges when attempting to deliver an aesthetic fixed partial denture for the anterior maxilla. An implant-supported, screw-retained fixed partial denture provisional restoration can be utilized in order to manipulate the pontic site with predictable success. This technique can create the illusion of pontics emerging from the soft tissue, creating a natural-looking effect for seating of the definitive restoration.

Posterior implants for distal extension removable prostheses: a retrospective study.

Common complaints associated with the Kennedy Class I (bilateral free end) and Class II (unilateral free end) removable partial denture situations are lack of stability, minimal retention, and unesthetic retentive clasping. Some of the same complaints have been reported for implant overdentures with only anterior implants. Starting in 1995, 10 of these patients were treated at the University of Washington with posterior osseointegrated implants to provide stability and/or retention of the removable prostheses, eliminating the need for clasps when possible. This article describes implant alternatives and prosthesis designs and presents a follow-up clinical evaluation of at least 1 year consisting of patient satisfaction, radiographic examination, and soft tissue health. Two groups were evaluated. Group 1 included patients whose implants were used as vertical stops for mandibular distal extension prostheses. Care was taken to ensure that the implants were not loaded laterally by creating a single-point contact at the center of a modified healing abutment. In these cases, sufficient retention was available from the anterior teeth and/or implant abutments. Group 2 included patients whose implants required retention because of lack of adequate tooth abutments. In those cases, a resilient type of attachment was used, which allowed for a small divergence from the path of insertion. Results indicated consistent increased satisfaction in all patients, minimal component wear, no radiographic evidence of excessive bone loss, and stable peri-implant soft tissues.

Prototype provisional restorations for implant-supported, full-mouth, metal-ceramic reconstructions: the hybrid technique.

The restoration of fully edentulous patients using fixed, metal-ceramic prostheses is one of the most challenging tasks in aesthetic dentistry. Provisional restorations provide the treatment team with a valuable means of addressing criteria that are required throughout the surgical, prosthetic, and technical stages. They also enable the clinician to place and evaluate a prototype of the definitive restoration in the patient's intraoral environment. This presentation describes a technique for the fabrication of provisional restorations for patients receiving fixed implant prostheses.