Restoration of a partially edentulous patient with combination partial dentures.

Flexible partial removable dental prostheses (PRDP) provide superior aesthetics, durability, improved patient comfort due to softer surface and low elastic modulus, and require less time and expense for fabrication. However, when a flexible PRDP is used to replace several missing teeth, especially when no occlusal rests or vertical stops are present, rotation and sinking of the denture base and resorption of the residual ridge tend to occur. This may result in the concentration of excessive force in the resin clasp, along with clasp deformation or fracture, and compression of the marginal gingiva. In such situations, it is advisable to incorporate a metal framework and occlusal rests in the design of the flexible PRDP to achieve the optimal rigidity and support. This article describes a case restored with such a 'combination' prosthesis.

A Demonstrative Tactile Method to Guide Mandibular Movements.

Dental practitioners often require patients to perform specific mandibular movements (protrusive, retrusive, and lateral) in order to make centric relation and eccentric records. Occasionally, patients are unable to comprehend and perform the desired movements, even after repeated instructions. This article describes a quick, simple, and easy-to-follow technique to help guide patients with their mandibular movements.

A Prosthesis Retention System for Full-Arch, Fixed, Implant-Supported Prosthesis.

Full-arch, fixed, implant-supported prostheses can be designed to be cement- or screw-retained. Both retention mechanisms have a few inherent disadvantages. A fixed attachment system has been introduced to circumvent the disadvantages of both screw and cement retention. This system eliminates the screw access holes and the use of cement. The number of intraoral procedures required is also reduced. The purpose of this article is to report a case using the Locator F-Tx Attachment System to facilitate fabrication of an esthetic, clinician-retrievable, full-arch implant-supported fixed dental prosthesis.

Subcrestal Implant Placement and Recontouring Soft Tissue Using the Erbium YAG Laser to Manage Restorative Space in Implant Overdentures.

Subcrestal implant placement helps gain vertical restorative space at the location of the implants; however, this leads to the development of a tall mucosal cuff, necessitating the use of tall abutments. This article describes the technique of gaining restorative space by decreasing the height of the mucosal cuff with an Erbium YAG laser.

Angulated Implants for Fabrication of Implant Supported Fixed Partial Denture in the Maxilla.

Until recently, angled abutments have been the only solution to correcting the trajectory of the emergence profile of labially inclined implants in the maxilla. However, the clinical implications of angled abutments reveal several shortcomings. Newly designed angulated implants with a 12-degree restorative platform angulation are an alternative to angled abutments. The purpose of this article was to report a case utilizing new angulated implants (Co-axis, Keystone dental, Burlington, MA, USA) in the premaxilla thereby facilitating fabrication of a multi-unit implant retained fixed dental prosthesis.

Fabrication of new restorations with a consideration of oral hygiene.

Maintenance of adequate and effective oral hygiene is crucial for the long-term success of any dental therapy. This article discusses a case that failed due to the poor oral hygiene of the patient. Fabrication of uncomplicated restorations, patient education, motivation, maintenance and recall are important factors to be considered when treatment planning patients with poor oral hygiene.

Combination PROP: A Case Report of a Hybrid Flexible and Traditional Partial Removable Dental Prosthesis.

The need for partial removable dental prostheses (PRDP) is increasing as the over-65 partially edentulous population grows. The use of flexible materials in the fabrication of these prostheses has captured a large portion of the market once occupied by traditional cast metal PRDPs. While there are some clinical advantages to the use of flexible PRDPs, there are also disadvantages and contraindications that must be considered. This paper describes a clinical case in which a patient's dentition is restored with a hybrid partial removable dental prosthesis consisting of a traditional metal framework and flexible denture base and clasps. This design can result in achieving the benefits of each type of prosthesis in an effort to satisfy the needs of the patient.

Accuracy and reliability of stitched cone-beam computed tomography images.

PURPOSE: This study was performed to evaluate the linear distance accuracy and reliability of stitched small field of view (FOV) cone-beam computed tomography (CBCT) reconstructed images for the fabrication of implant surgical guides. MATERIALS AND METHODS: Three gutta percha points were fixed on the inferior border of a cadaveric mandible to serve as control reference points. Ten additional gutta percha points, representing fiduciary markers, were scattered on the buccal and lingual cortices at the level of the proposed complete denture flange. A digital caliper was used to measure the distance between the reference points and fiduciary markers, which represented the anatomic linear dimension. The mandible was scanned using small FOV CBCT, and the images were then reconstructed and stitched using the manufacturer's imaging software. The same measurements were then taken with the CBCT software. RESULTS: The anatomic linear dimension measurements and stitched small FOV CBCT measurements were statistically evaluated for linear accuracy. The mean difference between the anatomic linear dimension measurements and the stitched small FOV CBCT measurements was found to be 0.34 mm with a 95% confidence interval of +0.24 - +0.44 mm and a mean standard deviation of 0.30 mm. The difference between the control and the stitched small FOV CBCT measurements was insignificant within the parameters defined by this study. CONCLUSION: The proven accuracy of stitched small FOV CBCT data sets may allow image-guided fabrication of implant surgical stents from such data sets.

Occlusal rehabilitation of pseudo-class III patient.

To treat a patient with anterior crossbite, the clinician should first assess if it is a genuine class III or a pseudo-class III malocclusion. Cephalometric analysis is important; however, registering a patient's centric relation (CR) is simple, quick, and costless and can play a decisive role in a differential diagnosis for this type of patient profile. This clinical report depicts a patient clinically diagnosed as class III. After mandible manipulation in CR, it was noted that the patient in question was a pseudo-class III. The treatment was based on the pseudo-class III diagnosis. Therefore, the patient was rehabilitated by occlusal adjustments and conventional and implant-supported prostheses and without the need for invasive orthognathic surgery.

Defining the posterior palatal seal on a definitive impression for a maxillary complete denture by using a nonfluid wax addition technique.

The posterior palatal seal area is defined as the soft tissue area at or beyond the junction of the hard and soft palates on which pressure within physiologic limits can be applied by a removable complete denture to aid in its retention. The retention of the maxillary denture is affected by the extent and the design of the posterior palatal seal. This article discusses a method of defining the posterior palatal seal on a definitive impression for a maxillary complete denture by using microabrasion and a nonfluid wax addition technique.

A systematic approach to definitive planning and designing single and multiple unit implant abutments.

With an increase in the availability of implant restorative components, the selection of an appropriate implant abutment for a given clinical situation has become more challenging. This article describes a systematic protocol to help the practitioner more thoughtfully select abutments for single and multiple unit fixed implant prostheses. The article examines the evaluation, planning, design, and fabrication processes for the definitive restoration. It includes an assessment of a variety of factors, namely restorative space, soft and hard tissues, the location of the implant platform, the type of platform connection, platform switching indications, tissue collar heights, emergence profile, implant angulation, and finally the design and esthetic options for the final implant abutment.

A simplified approach to implant restorations using innovative digital technology.

Digital impressions and CAM/CAD systems are currently burgeoning dental technologies. This article presents a case study describing the clinical protocol necessary to produce multiple crown restorations supported by dental implants.

A technique to create an interocclusal bite registration using in situ implant healing abutments.

Obtaining an accurate interocclusal record which relates the upper and lower jaws to one another is critical in the laboratory production of dental restorations. This may be particularly challenging when the configuration of missing teeth dictate that such records are dependent on the remaining mucosal tissues for support. This article presents a practical and time saving method of using implant healing abutments, located within an edentulous distal extension space, to serve as vertical stops for an interocclusal record.

Single tooth replacement utilizing implants in the esthetic zone: a case report.

Replacing a single tooth with an implant has become a common dental procedure; however, careful evaluation is necessary before placing one in the esthetic zone. Thorough diagnosis and planning - including the use of transposed diagnostic casts and cone beam computed tomography scans - can help dentists predict the final esthetic result prior to treatment, and help inform the patient of the potential result prior to performing any irreversible therapy. In the present case, the primary concern was the presurgical location of the facial free gingival margin (FGM) of the implant-supported crown, in relation to the adjacent teeth. Steps taken to correct the position of the facial FGM prior to implant placement led to a successful esthetic result.

Fabricating a mandibular implant supported overdenture with a suspended framework.

The introduction of implant-supported overdentures as a clinical alternative has improved the quality of life of the edentulous population. Implant-supported overdentures have diminished many of the problems associated with conventional dentures by providing improved retention, stability, function, esthetics and physical and emotional health. Greater support and stability of the implant borne prosthesis is associated with improved bite force and oral function for overdentures when compared to conventional complete dentures. An adequate amount of restorative space is required when fabricating implant-supported overdentures. This space must accommodate a denture base of sufficient dimensions, appropriately positioned denture teeth, and an implant attachment system. Insufficient space may lead to reduced structural integrity of the prosthesis and/or compromised oral function. Typically a mandibular removable prosthesis is more vulnerable to fracture due to its shape and overall dimensions. Incorporation of a metal framework, metal reinforcing mesh, or woven or fiberglass-impregnated mesh have been recommended to improve resistance to denture fracture during function. This article presents a method for fabricating a framework that is specifically and predictably suspended within the denture base in order to decrease fracture susceptibility of implant-supported overdentures.

A review of implant abutments--abutment classification to aid prosthetic selection.

With an increase in the availability of implant restorative components, the selection of an appropriate implant abutment for a given clinical situation has become more challenging. This article describes a classification system that will help the practitioner understand the different implant abutments available and therefore be able to understand the selection of abutments for single and multiple unit fixed implant prosthesis.