Management of a Fractured Multiunit Maxillary Implant‐Supported Fixed Prosthesis with Stripped Abutment Screws Using a Hybrid Cement‐Retained and Screw‐Retained Design: A 5‐Year Follow‐Up Clinical Report

Fracture and loosening of implant‐supported prostheses (ISPs) are complications encountered in routine dental practice. In the present report, management of a fractured maxillary full‐arch cement‐retained (CR) fixed dental prosthesis supported by six implants is presented. Due to stripped screws, complications were encountered that prevented the retrieval of two of the six abutment screws, which was managed by using a hybrid retention approach, whereby a single full‐arch CR and screw‐retained (SR) ISP was used. The techniques used to successfully retrieve four of the abutment screws are described. The final retention design involved a combination of three CR and three SR restorations, which offers the advantages of both retention designs.     

An Alternative Design to Overcome the Problem of Unfavorable Implant Angulations for a Screw‐Retained,Implant‐Supported Fixed Prosthesis: Two Clinical Reports

Two clinical reports present an alternative design to address the problem of unfavorable implant angulations if a screw‐retained prosthesis is desired. The restorations were designed as screw‐retained prostheses, except in the area with the unfavorable implant screw emergence. The frameworks in these areas were customized to receive individual cement‐retained crowns. This design offers retrievability and helps to minimize complications associated with excess cement without compromising the functional or esthetic outcome.     

Two‐Piece Nasal Septum Prosthesis for a Large Nasal Septum Perforation: A Clinical Report

Nasal septum perforation presents with the symptoms of epistaxis and crusting. Obturation of the defect will decrease the symptoms and increase patient comfort. Prosthetic closure is more predictable and thus the treatment of choice in larger defects. This article describes a procedure for construction of a magnet‐retained, heat‐processed acrylic nasal septum prosthesis. The two‐piece nasal septum prosthesis was processed and joined together in situ by magnets. Each piece of the septum prosthesis conforms to the remaining medial wall of each nostril and forms the missing half of the nasal septum. The prosthesis not only alleviates symptoms, but also provides structural support to the saddle‐shaped nose and improves esthetics.     

Porcelain Fracture Resistance of Screw‐Retained,Cement‐Retained,and Screw‐Cement‐Retained Implant‐Supported Metal Ceramic Posterior Crowns

Purpose: The purpose of this in vitro study was to compare the porcelain fracture resistance between screw‐retained, cement‐retained, and combined screw‐ and cement‐retained metal–ceramic (MC) implant‐supported posterior single crowns; and to investigate the effect of offsetting the occlusal screw‐access opening on porcelain fracture resistance of screw‐retained and cement‐retained MC implant‐supported posterior single crowns. Materials and Methods: Forty standardized MC molar‐shaped restorations were fabricated. The 40 restorations were divided into four groups (SRC, SRO, CRP, and CSC) of 10 specimens each. Group SRC: screw‐retained, screw‐access hole placed in the center of the occlusal surface; Group SRO: screw‐retained, screw access hole placed 1 mm offset from the center of the occlusal surface toward the buccal cusp; Group CRP: cement‐retained, zinc phosphate cement was used; Group CSC: cement‐retained with a screw‐access hole in the center of the occlusal surface. The screw‐retained restorations and abutments were directly attached to 3i implant fixtures embedded in acrylic resin blocks. Subsequently, all test specimens were thermocycled and vertically loaded in a universal testing machine at a crosshead speed of 2 mm/min until fracture. Mean values of load at fracture (in N) were calculated in each group and compared with a one‐way ANOVA and Tukey's Studentized test (α= 0.05). Results: Mean values of loads required to fracture the restorations were as follows (N): Group SRC: 1721 ± 593; Group SRO: 1885 ± 491; Group CRP: 3707 ± 1086; Group CSC: 1700 ± 526. Groups SRC, SRO, and CSC required a significantly lower force to fracture the porcelain than did the CRP group (p < 0.05). Conclusion: The cement‐retained restorations showed significantly higher mean fracture loads than the restorations having screw‐access openings in their occlusal surface. The position of the screw‐access hole within the occlusal surface did not significantly affect the porcelain fracture resistance.     

A Luting Technique for Passive Fit of Implant‐Supported Fixed Dentures

Several factors contribute to distortion of implant prostheses during fabrication and could prevent passive, accurate adaptation between implants and implant frameworks. The misfit between implants and restorative components may be significant and possibly lead to biologic or mechanical complications. The aim of this article is to describe a laboratory luting technique used to lute implant cylinders to metal frameworks in implant prostheses. This technique provides accurate, passive fits. According to this technique, titanium implant cylinders provided with corresponding external castable cylinders are used. Implant cylinders are screwed into the analogs in the master cast while the castable cylinders on top are splinted together using castable resin to realize a castable resin pattern. After casting, the framework is adjusted and cemented to the titanium cylinders on the master cast. Due to its ease and quickness of use and clinical efficiencies, this technique is deemed particularly useful in immediate loading rehabilitations.     

A 30‐Year Follow‐Up of a Patient with Mandibular Complete‐Arch Fixed Implant‐Supported Prosthesis on 4 Implants: A Clinical Report

Mandibular complete‐arch fixed implant‐supported prostheses are recognized as one of the earliest and most popular prostheses in implant dentistry. This prosthesis was the main focus in the early era of osseointegration. Despite its widespread popularity, few clinical reports have described long‐term follow‐up greater than 10 years for this type of prosthesis. This report describes a 30‐year follow‐up of a patient who underwent treatment for a mandibular complete‐arch fixed implant‐supported prosthesis with 4 machined surfaced implants, opposing a maxillary complete denture. This report documents a variety of photographs and radiographs taken over a period of 30 years to compare bone levels at various stages of care and maintenance, including de novo bone formation underneath the distal cantilevers due to functional loading. The biologic and biomechanical response to this treatment protocol and long‐term clinical observations and prosthodontic outcome and maintenance needs are also addressed.     

Rehabilitation of a Bilateral Maxillectomy Patient with a Free Fibula Osteocutaneous Flap and with an Implant‐Retained Obturator: A Clinical Report

A 47‐year‐old man underwent surgical resection and reconstruction with a fibula osteocutaneous flap. After the surgery, a surgical obturator was placed and adjusted. After flap healing, a conventional obturator was fabricated with polymethyl methacrylate resin and retained by the anatomical undercuts around the reconstructed fibula bone flap and the posterior part of the defect. As the defect shape changed with time, a second conventional obturator was fabricated and fitted. No further recurrence of myoepithelioma was observed for 2 years, and the patient was satisfied with the obturator during mastication and speech; however, despite having no major complaints, the patient found it difficult to chew on the right side, and the obturator was displaced slightly downward when the mouth was opened wide and shifted when chewing hard and sticky food. Thus, an implant‐retained obturator was suggested to provide better retention and stability. Four dental implants were therefore placed into the fibula bone, although one did not osseointegrate because either primary stability was insufficient or overload was affected in the nonloaded implant environment and was replaced. After fitting custom abutments with a magnet, an implant‐retained obturator was placed, and the patient was satisfied with the outcome. During 3 years of follow‐up, no issues were noted with the implant bodies, abutments, obturator, or reconstructed site. The conventional obturator was displaced slightly downward when the patient opened his mouth wide, and it shifted when chewing hard and sticky food because there was limited fibula bone at the reconstruction site and more available posteriorly. For better retention and stability, the implant‐retained obturator was fabricated with a custom abutment and magnetic retention. The patient was satisfied with the results, as improved implant retention increased the stability of the prosthesis. This clinical report describes the rehabilitation of a bilateral maxillectomy patient with a free fibula osteocutaneous flap and an implant‐retained obturator. The patient's oral functions were improved when the prosthesis was stabilized by means of dental implants and custom abutments.     

Fabrication of an Orbital Prosthesis Using a Noncontact Three‐Dimensional Digitizer and Rapid‐Prototyping System

Conventionally, fabricating a facial prosthesis requires complicated steps and sophisticated skills. Particularly, the facial impression can be uncomfortable for the patient and can cause compression because of the weight of the material. The new approach presented in this report could simplify the fabrication of facial prostheses using a noncontact three‐dimensional digitizer and binder multinozzle inkjet printer, without computed tomography or making a conventional impression. Treatment time was reduced, and the patient expressed satisfaction after 6 months follow‐up.     

Rehabilitation of a missing ear with an implant retained auricular prosthesis

Burns can leave a patient with a severely debilitating disability even after treatment. The objectives of burn rehabilitation are to minimize the adverse effects caused by the injury while rehabilitating the patient''s physical and psychological well-being, maximizing social integration. Long-term success of maxillofacial prostheses mainly depends on the retention. Extra oral implant retained prostheses have proved to be a predictable treatment option for maxillofacial rehabilitation. Replacement of a severely deformed external ear with burned tissues may be satisfactorily accomplished by a cosmetic prosthesis anchored by implants integrated in the skull. The use of such implants is now a well-recognized method for creating a stable result in maxillofacial rehabilitation. This case report describes a safe, simple and economical method for the rehabilitation of a patient with missing right auricle using an implant supported silicone prosthesis. The implant was placed in the mastoid region of the temporal bone. Reconstruction of the ear was done with auricular silicone prosthesis, retained using magnets incorporated in an autopolymerizing resin shim to decrease the weight of the prosthesis on a single implant. This method eliminates the need of tedious laboratory procedures and exact casting and fitting requirements of a metal substructure while minimizing the overall weight and cost of the prosthesis while maintaining adequate support, esthetics and retention of the prosthesis.     

Three‐Dimensional Image Correlation Analyses for Strains Generated by Cement and Screw‐Retained Implant Prostheses

Purpose: This study aimed to measure and compare strains generated by splinted implant crowns retained by cement or screws for two implants with applied load. Materials and Methods: A stereolithic resin model was printed using computed tomography data from a patient missing all mandibular molar teeth. Two 4 × 6 mm implants were consecutively placed in the left side. One set of splinted cement and screw‐retained crowns were made to fit the two implants. Image correlation technique was used for full‐field measurement of strains using an image correlation software and two synchronized high‐resolution digital cameras. A random dot pattern was applied to the model surface. Cameras recorded changes in random dot patterns as prostheses were loaded up to 400 N in vertical and oblique directions using a universal testing machine. Testing was repeated three times for cement and screw‐retained prostheses. An image correlation algorithm used the dot pattern to define correlation areas or virtual strain gauge boxes. Three‐dimensional coordinates of gauge box centers were determined for each recorded photograph and used to calculate strains. Strain distribution data were compared for major, minor, and von Mises strains for each loading condition, as well as peak and average strains for the field of view using an analysis of variance (α = 0.05). Results: Patterns and magnitudes of strain for cement‐ and screw‐retained splinted crowns were similar under vertical loading. Neither peak nor mean strains were significantly different for the two retention methods. For oblique loading, peak strains were lower for the screw‐retained crowns; however, there were no statistically significant differences between the two groups when strains were averaged throughout the entire field of view. Conclusions: Cement retention did not improve the magnitude of transferred strains for splinted implant crowns using either loading condition.