Indirect implant-supported fixed provisional restoration in the esthetic zone: fabrication technique and treatment workflow.

UNLABELLED: Treatment objectives of an implant-supported fixed provisional restoration include shaping/preservation of the gingival soft tissue contour, functional and esthetic substitution of the missing dentition during postsurgical healing, and definitive prosthesis fabrication stages. Fixed provisional restoration can also serve as an esthetic and functional blueprint in the fabrication of the definitive restoration. Despite its common use and important indications, limited information is available on the various aspects of the provisional fabrication and treatment. This article presents a production technique and treatment workflow of a laboratory-fabricated, screw-retained fixed provisional restoration. Provisional restoration is fabricated using layering technique and internal stain characterization. The soft tissue profile of the working cast is modified according to the coronal contour of the diagnostic wax-up. Upon delivery, the provisional contour is reevaluated and modified as necessary. The developed emergence profile of the provisional restoration is transferred to the master cast via customized impression copings. CLINICAL SIGNIFICANCE: Laboratory-fabricated implant-supported provisional restorations allow the esthetic and functional substitution of the missing dentition and the shaping of the soft tissue profile, and can act as a blueprint in the fabrication of definitive restorations.

An alternative technique for the fabrication of removable complete dentures.

UNLABELLED: The traditional approach for the fabrication of removable complete dentures has several principal limitations. It requires numerous clinical and laboratory steps, and is labor intensive and time consuming. It is obvious that the clinical practice would benefit from further technique optimization in denture fabrication. The authors present a technique in which a duplicate of the patient's existing maxillary denture is simultaneously used as an impression carrying tray, as a guide for placement of the denture teeth, and for maxillomandibular articulation. LEARNING OBJECTIVES: This article discusses an alternative approach for the fabrication of removable complete dentures. Upon reading this article, the reader should: Be able to identify disadvantages in the traditional approach. Become familiar with the steps required to Fabricate a duplicate denture. Understand the clinical applications for the proposed technique.

Mandibular two-implant-retained overdenture: prosthetic design and fabrication protocol.

Among different treatment options, an implant-retained overdenture is a simple, cost-effective solution in the rehabilitation of the edentulous mandible. Despite widespread acceptance of this treatment, some controversies still exist with regard to the design of the overdenture, selection of the appropriate attachment system, and the most optimal techniques for the overdenture fabrication. In this article, the authors describe a mandibular overdenture retained by 2 freestanding implants placed in the anterior region of the mandible. The overdenture design includes a metal-reinforcing framework and uses prefabricated stock abutments and hinge-type resilient attachments for its retention. The proposed fabrication technique requires a minimal number of clinical appointments, and resilient attachments are incorporated into the overdenture in the laboratory.

A survey of edentulous patient preference among different denture esthetic concepts.

STATEMENT OF PROBLEM: Despite the fact that solutions to functional problems are available, successfully restoring the appearance of an edentulous patient remains a challenge. PURPOSE: The aim of this survey was to determine if edentulous respondents could differentiate among three denture esthetic concepts and if there was an overall preference among the three. MATERIALS AND METHODS: Six edentulous test subjects were selected based on age and smile criteria. One wax tooth arrangement was completed according to each of the three esthetic concepts for a total of three wax tooth arrangements per test subject. The three esthetic concepts followed were natural, supernormal, and denture look. Standardized full-face digital photographs were made of each arrangement (three) during maximum smile for each subject (six). These 18 photographs were included in a questionnaire. Respondents were asked questions about their preference among the three randomly ordered concept photographs for each of the six subjects. A total of 147 completed questionnaires were analyzed. RESULTS: Ninety-six percent of respondents were able to differentiate among the three esthetic denture concepts. Natural tooth arrangements were preferred by 55% of the respondents, supernormal tooth arrangements were preferred by 19%, and the denture look arrangements were preferred by 26%. CONCLUSION: Within the limitations of this survey, the questionnaire respondents differentiated between the three esthetic denture concepts. The tooth arrangement most closely resembling the anatomical average was selected by 55% of the respondents. Preference for a particular concept changed when responses to each test subject set were considered individually. Demographic factors do not significantly affect patient preference. CLINICAL SIGNIFICANCE: Three esthetic concepts for complete denture construction have been differentiated. Questionnaire respondents preferred appearances that are far from the anatomical average 45% of the time.

Implant-retained overdenture design for the malpositioned mandibular implants.

In the rehabilitation of the edentulous mandible, implant-retained overdenture represents a viable and cost-effective treatment. Successful prosthetic integration of this treatment relies on the accurate 3-dimensional position and angulation of the implant fixtures. If these requirements are not fulfilled, implant malposition occurs and negative effects on the function, esthetics, and structural integrity of the prosthesis may follow. Implant malposition commonly results from poor planning, surgical error, inaccuracies in the radiographic/surgical template fabrication, and the instability of the template during surgery. Potential solutions for implant malposition include surgical re-treatment or prosthetic compensation in the form of an altered design of the final prosthesis. This article presents a prosthetic design of an overdenture for malpositioned implants in the anteroposterior plane. Prosthetic compensations included relocating the attachment mechanism into the bulk of the overdenture with the help of an interconnecting implant bar and a metal reinforcing framework for the overdenture.

Rehabilitation of failing dentition with immediate denture prostheses: technique for a predictable esthetic and functional outcome.

The goal of this article is to describe the clinical and laboratory procedures used in the fabrication of immediate complete and removable partial denture prostheses. In this type of treatment, achieving optimal esthetic and functional outcomes is complicated because of the absence of the try-in stage. To overcome this limitation, a technique that predictably transfers the information obtained during esthetic dentofacial analysis from the patient to the laboratory in the form of an incisal-occlusal plane guide is described. Stability, support, and retention of the immediate partial denture prosthesis can be improved with the incorporation of cast clasp assemblies, and its fabrication technique is presented in this article.

The edentulous patient and body image--achieving greater patient satisfaction.

UNLABELLED: Aesthetic outcomes in the rehabilitation of edentulous patients play an important role in regard to treatment satisfaction and its acceptance. While the dental literature is replete with techniques and treatment philosophies that allow the fabrication of aesthetic restorations, adhering to such mechanical practices alone does not necessarily guarantee patient satisfaction. Taking into consideration the patient's perspective can significantly enhance treatment success. This article outlines the relevant factors that influence the aesthetic result of complete denture treatment. LEARNING OBJECTIVES: This article describes factors that contribute to patients' satisfaction with denture aesthetics and provides guidelines for clinicians to follow in daily practice. Upon reading this article, the reader should be able to: Understand the role that a patient's body image plays in an aesthetic outcome. Recognize contemporary aesthetic trends that influence denture aesthetics.

The milled surface as a precision attachment.

The creation of paralleled, milled surfaces in natural or restored abutment teeth, coupled with removable partial denture castings that have optimal contact with these preparations, results in a path of insertion and removal that is controlled in a manner similar to one using conventional precision attachments. Because the milled surfaces are primarily extracoronal, little if any, additional tooth reduction is required for adequate mouth preparation. Avoiding additional tooth reduction minimizes later abutment fracture. The great increase in stability and resistance to rotational movements, when combined with conventional posterior clasping, provides a reasonable alternative to the precision attachment in providing maximal esthetics for the partially edentulous patients.

Rehabilitation of the edentulous mandible with a fixed implant-supported prosthesis.

UNLABELLED: Implant rehabilitation of an edentulous mandible presents significant improvements over conventional complete denture therapy with regard to patient satisfaction, and it can improve a patient's quality of life. Several implant prosthetic designs have been developed and successfully utilized in clinical practices. The goal of this article is to describe the prosthetic design and technical steps in the fabrication of a fixed implant-supported mandibular prosthesis. A technique is described in which the positioning of appropriately selected abutments is completed in a predictable manner. LEARNING OBJECTIVES: This article discusses the prosthetic designs and technical steps in fabricating a fixed implant-supported mandibular prosthesis. Upon reading this article, the reader should: Understand the prosthetic design for the treatment of an edentulous mandible. Recognize the significance of the technical steps in this rehabilitation process.

A denture tooth position index fabricated with light-polymerized acrylic resin.

A denture tooth position index transfers the position of the denture teeth to the master cast during metal framework and bar-substructure fabrication stage. This article describes the use of light-polymerizing acrylic resin to fabricate a tooth position index.

Fatigue load of teeth restored with bonded direct composite and indirect ceramic inlays in MOD class II cavity preparations.

PURPOSE: This study compared the fatigue life of human maxillary premolars restored with direct composites and indirect ceramic inlays in mesio-occlusodistal (MOD) cavities. MATERIALS AND METHODS: Ten human maxillary premolars were divided into two groups of five and restored with (1) direct composite restorations, or (2) pressed ceramic restorations. Standardized MOD cavities were prepared for both groups. Teeth in the direct composite group were restored with Z250 composite and Single Bond adhesive, and those in the ceramic group were restored with IPS Empress ceramic inlays. The ceramic inlays were luted with Single Bond and RelyX ARC cement. Under the applied test load of 11.17 kg, strain measurements were recorded from an electric resistance stain gauge bonded to the buccal surface. These strains were recorded for the (1) intact tooth, (2) cavity preparation, and (3) restored tooth. These strain measurements were used to calculate the relative tooth compliance values for each tooth. The fatigue loading was applied until reinforcement loss was registered by the strain gauge. RESULTS: A one-way ANOVA showed no significant compliance difference between the intact and restored tooth conditions, and no significant difference in fatigue cycles to failure between the two groups. CONCLUSION: There were both adhesive and cohesive failures in both restoration groups, indicating that the adhesive joint is not the only weak link in these restorations.

A light-polymerized resin support tray as an aid for recording centric relation.

For patients who require complex fixed prosthodontic oral rehabilitation, recording an accurate centric relation is often a difficult procedure. A minimal number of abutment teeth or implants may not offer adequate support for the occlusal registration material. In the described technique, Triad tray material is used as an occlusal registration supporting tray. This procedure is accurate and convenient for the restorative dentist.