Incorporating Stud Attachments in the Bar Design for an Implant-Supported Overdenture.

Bone resorption following tooth loss might compromise retention, stability, and support of conventional removable prostheses, and for this reason, implant-supported overdentures are suggested as a viable alternative for completely edentulous patients. Bars, telescopic attachments, or stud attachments have been used to provide retention through a different mechanism of action based on specific design characteristics. The purpose of this report is to thoroughly describe the applied protocol for the fabrication of an implant overdenture supported by two bars incorporating stud attachments. A 67-year-old male patient presented to the Postgraduate Clinic of the National and Kapodistrian University in Athens seeking dental rehabilitation. The remaining teeth were characterized with poor prognosis, mainly due to their periodontal status. The proposed treatment plan included the placement of four implants in the maxilla and two implants in the mandible and the fabrication of implant-supported overdentures. The diagnostic stages revealed adequate prosthetic space that would enable the fabrication of a bar substructure for the maxillary overdenture. To combine the benefits of bars and stud attachments, two bars with four attachments were fabricated. Evaluation of the delivered prosthesis revealed adequate retention, support, and stability achieved with minimal palatal coverage. Patient's reported satisfaction and quality of life were increased. Recall appointments at one, six, and twelve months did not reveal any adverse effects or patient's complaints. According to the present case report, different types of attachments may be used after careful study of each case. More studies are needed to report on different aspects of the chosen treatment plan.

Fabrication of complete dentures for an older patient with mobility impairment in three appointments: A dental technique.

OBJECTIVE: To describe the clinical procedures of complete denture set fabrication in three appointments. BACKGROUND: Simplified approaches have proven not to be inferior to conventional ones in terms of quality, patient satisfaction and masticatory ability. MATERIALS AND METHODS: The patient was a 77-year-old edentulous adult with mobility impairment seeking dental rehabilitation in a small number of appointments due to commuting difficulties. RESULTS: A set of complete dentures was delivered within three appointments. The second appointment was dedicated to set-up trial due to the patient's aesthetic demands. CONCLUSION: Under certain circumstances and after a thorough study of each case, dental clinicians may propose the fabrication of complete dentures in a three-appointment protocol incorporating a set-up trial session.

Incorporation of the Altered Cast Technique in the Fabrication Workflow of an Implant-Assisted Removable Partial Denture (IARPD) for an Elderly Patient.

Implants are currently used to serve as abutments for implant-assisted removable partial dentures (IARPDs) to facilitate retention and support of the prosthesis. Implants are proposed in cases of posterior edentulous areas to convert Kennedy Class I or II to Class III or when the preparation of existing teeth to serve as abutments is contraindicated. The purpose of this report is to describe the protocol applied to fabricate an IARPD to restore a Kennedy Class II mandible of an elderly patient by incorporating traditional methods, such as the altered cast technique. Each step of the clinical procedure is thoroughly illustrated to document the selected appointment sequence. The patient was satisfied with the delivered prosthesis that demanded no additional implants to be placed but exploitation of an existing one. IARPDs are a viable and cost-effective solution substantiated by numerous reports with positive effects on patient satisfaction.

Chairside transformation of a removable partial denture to a transitional complete denture to alleviate an impaired stroke patient: A case report.

BACKGROUND: The purpose of this clinical report is to present a technique for transformation of an existing removable partial denture (RPD) into a transitional complete denture (CD) for an impaired stroke patient. CASE PRESENTATION: A 67-year-old male who underwent an ischemic stroke 12 months ago presented in the Postgraduate Clinic of the National and Kapodistrian University of Athens, requiring treatment of his remaining teeth and repair of his existing RPD which lacked retention and stability. The treatment plan included placement of amalgam plugs on the remaining teeth which were decoronated due to poor prognosis and modification of the existing RPD to a transitional CD. The procedure included one alginate impression and chairside alteration of the prosthesis with simple means. The new prosthesis managed to improve patient's masticatory ability and reduce the risk for aspiration pneumonia. CONCLUSION: In the present case report a technique for modifying an existing RPD into a transitional CD for an impaired, stroke patient is described. Reduced treatment time, costs and patient's inconvenience while embracing the benefits provided by the utilization of an existing prosthesis regarding adaptation of the neuromuscular system are among the advantages of the described technique.

Impact of maxillofacial growth on implants placed in adults: A narrative review.

OBJECTIVE: To determine the effect of lifetime maxillofacial changes on dental implants placed in adults, analyze the clinical implications of these changes, identify prognostic factors, and offer possible solutions. OVERVIEW: The relationship between implant placement and maxillofacial changes, occurring during not only the active growth period but also the entire span of adulthood, has not been extensively examined. Vertical differences between implants and adjacent teeth due to the ankylotic behavior of the former might be observed at any age and endanger restoration biologically, functionally, and esthetically. Regarding interproximal contacts, firm contact loss may occur within a few months after restoration, resulting in food impaction. Many prognostic factors have been reported, but most do not exhibit a statistically significant association with implant infraocclusion and interproximal contact loss. Incorporation of alternative solutions, accurate treatment planning, strict recall protocols, and retrievability of implant-supported restorations can facilitate efficient management of complications. CONCLUSION: Maxillomandibular changes throughout adulthood may lead to complications such as implant infraocclusion and interproximal contact loss. Rehabilitation of edentulism should be characterized by well-designed and flexible treatment plans to resolve long-term complications efficiently. Further long-term clinical studies are needed to identify other risk factors. CLINICAL SIGNIFICANCE: Treatment plans for implant therapy should be reconsidered for adults. Careful patient monitoring and early intervention are essential for securing treatment outcomes.

Deep Margin Elevation: A Literature Review.

A conservative approach for restoring deep proximal lesions is to apply an increment of composite resin over the preexisting cervical margin to relocate it coronally, the so-called "deep margin elevation" (DME). A literature search for research articles referring to DME published from January 1998 until November 2021 was conducted using MEDLINE (PubMed), Ovid, Scopus, Cochrane Library and Semantic Scholar databases applying preset inclusion and exclusion criteria. Elevation material and adhesive system employed for luting seem to be significant factors concerning the marginal adaptation of the restoration. This technique does not affect bond strength, fatigue behavior, fracture resistance, failure pattern or repairability. DME and subgingival restorations are compatible with periodontal health, given that they are well-polished and refined. The available literature is limited mainly to in vitro studies. Therefore, randomized clinical trials with extended follow-up periods are necessary to clarify all aspects of the technique and ascertain its validity in clinical practice. For the time being, DME should be applied with caution respecting three criteria: capability of field isolation, the perfect seal of the cervical margin provided by the matrix, and no invasion of the connective compartment of biological width.

A Thorough Analysis of the Endocrown Restoration: A Literature Review.

AIM: The aim of this literature review is to determine whether endocrowns are a reliable alternative for endodontically treated teeth with extensive loss of tooth structure, the indications and contraindications of this restorative choice, the principles that should be followed for tooth preparation and which material is most appropriate for endocrown fabrication. BACKGROUND: Rehabilitation of endodontically treated teeth with severe coronal destruction has always been a challenge for the dental clinician. Until recently, the fabrication of a metal-ceramic or all-ceramic full-coverage crown along with a metal or glass fiber post has been the "gold standard" proving its efficacy via numerous clinical studies. With the development of CAD/CAM technology and the evolution of dental materials, new minimally invasive techniques have been introduced with less need for adjustments and less incorporation of structural defects. One of them, the "monoblock technique," proposed by Pissis in 1995, was the forerunner of endocrown restoration, a term used by Bindl and Mörmann to describe an all-ceramic crown anchored to the internal portion of the pulp chamber and on the cavity margins, thus obtaining macromechanical retention provided by the axial opposing pulpal walls and microretention attained with the use of adhesive cementation. REVIEW RESULTS: Endocrowns require a decay-oriented preparation taking advantage of both the adhesion and the retention from the pulp-chamber walls, they are strongly indicated in endodontically treated molars in cases where minimal interocclusal space and curved or narrow root canals are present and they should be manufactured from materials that can be bonded to the tooth structure. CONCLUSION: Endocrowns are a reliable alternative to traditional restorative choices, given that the clinicians respect the requirements and indications describing this technique. CLINICAL SIGNIFICANCE: Traditional restorative techniques demanding tooth substance removal and minimizing the opportunity for reinterventions should be reconsidered.

Immediate Dentin Sealing: A Literature Review.

PURPOSE: The immediate application of a dentin-bonding agent after tooth preparation and before impression-taking (immediate dentin sealing [IDS]) has been suggested to provide several advantages concerning bacterial microleakage, hypersensitivity, and bonding quality. We reviewed the literature and clarified certain aspects related to each step of IDS application. MATERIALS AND METHODS: The search strategy comprised an electronic research in MEDLINE, Cochrane, Ovid and Scopus for studies published from January 1990 to December 2020 regarding the IDS technique and including both in vitro and clinical studies. RESULTS: After exclusion of irrelevant or duplicate articles, 88 articles focusing on aspects of the IDS technique were assessed. IDS seems to be advantageous with regard to bond strength, gap formation, bacterial microleakage, and dentin hypersensitivity. However, issues arising from interaction with impression materials, the provisional phase, and conditioning methods before cementation require further investigation. CONCLUSION: There are no documented reasons preventing clinicians applying IDS in their everyday practice. On the contrary, the presented technique seems to be beneficial in certain aspects regarding indirect restorations.