Implant verification cast--a predictable restorative system in implant prosthodontics.

An implant verification cast is designed to provide an accurate representation of dental implant positions extraorally. It can be used by the laboratory as a trusted cast to create a passively fitting framework and by the clinician to verify framework fit prior to intraoral trial. This article discusses the treatment philosophy behind this specific cast and reviews applications, fabrication techniques and benefits of the verification cast compared to the conventional technique.

Clinically based diagnostic wax-up for optimal esthetics: the diagnostic mock-up.

A diagnostic wax-up can enhance the predictability of treatment by modeling the desired result in wax prior to treatment. It is critical to correlate the wax-up to the patient to avoid a result that appears optimal on the casts but does not correspond to the patient's smile. This article reviews the applications and techniques for clinically based diagnostic wax-up, and focuses on the diagnostic mock-up philosophy as a means to obtain predictable esthetics and function.

Histologic evaluation of bone-implant contact of immediately loaded transitional implants after 6 to 27 months.

PURPOSE: Transitional implants (TIs) were developed as a method of providing fixed provisional restorations for the implant patient who wishes to avoid removable temporary restorations during implant healing. Success of TIs depends on achieving sufficient osseointegrated bone-to-implant contact (BIC) during the provisional prosthesis phase. To date, little data are available on the degree of BIC of these implants in function. The purpose of this study was to histologically evaluate the BIC of TIs following various periods of loading. MATERIALS AND METHODS: Histologic analysis of 33 immediately loaded implants from 21 patients was performed. All TIs had turned machined surfaces and were made of commercially pure titanium (grade 1). These transitional implants were in function for an average of 10.8 months (range: 6 to 27 months). Before the definitive restoration was provided, all of the TIs were removed with trephine drills and sent for hard tissue histomorphometric analysis. RESULTS: The average percentage of BIC was 52.9% +/- 13.81% (range 25.1% to 83%). DISCUSSION: Although TIs are traditionally removed when the definitive implants are restored, the BIC and clinical integration of the TIs in the present study may suggest a change in TI protocol. Studies are indicated to examine long-term use of TIs as sole support or in conjunction with definitive implants in definitive implant-supported restorations. CONCLUSION: The percentage of BIC achieved with TIs was similar to that documented in the literature for conventional turned, machine-surfaced implants.

A simplified approach to implant-supported metal-ceramic reconstruction.

Restoring the edentulous patient with an implant-supported fixed complete denture prosthesis is a challenging procedure. The patient's occlusal vertical dimension, centric relation position, esthetics, and phonetics should be maintained throughout the restorative process, while the patient is traditionally wearing a removable prosthesis. This article presents an alternative treatment philosophy that addresses these concerns and guides the restorative process using a fixed provisional restoration made from the patient's removable complete dentures.

Retrofitting implant overdenture attachments: a clinical report.

The remake of implant-overdenture prostheses on preexisting implants can present the clinician with a challenge, especially when the prosthetic components used initially cannot be replaced. The difficulty of remaking the prosthesis may be further increased by implant attachments designed to be cemented to the implant itself--a feature that complicates future replacement. This clinical report describes the restoration of worn implant attachments using retrofit components.

Terminology for implant prostheses.

The use of systematic terminology for implant prostheses can simplify communication within the scientific community. However, a review of the current literature demonstrates the lack of uniformity in this field. It is the purpose of this manuscript to suggest uniform terminology based on conventional prosthodontic terms that will simplify communication in the profession.

Use of transitional implants to support a surgical guide: enhancing the accuracy of implant placement.

Surgical guides for edentulous patients often lack the stability desired for accurate implant placement. The difficulty is emphasized in the edentulous mandible when implant-supported metal-ceramic restorations, which require precise placement of implants, are planned. A technique is presented for the fabrication of a surgical and radiographic template, supported by transitional implants, that guides the placement of conventional implants. This template can enhance placement accuracy in an efficient way to achieve predictable, esthetic results.

Removal torque of immediately loaded transitional endosseous implants in human subjects.

PURPOSE: Transitional implants were designed to support provisional restorations and to allow for load-free osseointegration of conventional implants while a patient was provided with immediate esthetics and function. The purpose of this study was to evaluate the removal torque values of immediately loaded transitional implants in human subjects. MATERIALS AND METHODS: Thirty-one 1.8-mm-diameter transitional implants were placed in 4 patients to support provisional restorations and were subjected to immediate loading. Removal torque values were recorded using a modified ITI torque driver, which was calibrated on an Instron test machine. Torque values were subjected to analysis of variance and post hoc comparisons of means (P < .05). RESULTS: Twenty-six implants were removed intact with torque values between 10.5 and 22.9 Ncm, while 5 fractured at the bone crest at values between 27.1 and 35.4 Ncm. Mean torque values increased with time in function. These values were significantly lower in the maxilla (16.1 +/- 4.8 Ncm) than in the mandible (24.0 +/- 7.3 Ncm). DISCUSSION: Results suggest that these transitional implants may be safely removed from the maxilla after 7 to 15 months, but there is a risk of implant fracture during removal from the mandible after 10 months. CONCLUSION: Removal torque levels for these implants indicate varying degrees of integration even though they were subjected to immediate loading.