Simplifying Prosthetic Procedures while Converting an Interim Maxillary Removable Complete Denture to an Interim Implant‐Supported Fixed Complete Denture

This article describes a method of converting an interim maxillary removable complete denture to an interim implant‐supported fixed complete denture. The advantages of this method are that it provides the opportunity to evaluate the patient's function and esthetics, and helps the accurate transfer of the maxillomandibular relationship to the laboratory. Consequently, the fabrication of the definitive prostheses is accurate, and the final result is predictable.     

Stabilization of a Computer‐Aided Implant Surgical Guide Using Existing Dental Implants with Conversion of an Overdenture to a Fixed Prosthesis

This clinical report describes a technique to stabilize a computer‐aided dental implant surgical guide to existing implants. A patient requested conversion of her existing mandibular implant‐assisted overdenture into a fixed complete denture. The surgical procedure was planned virtually, and the two existing dental implants were integrated into the surgical plan as a means to fixate the surgical guide. The implants were placed, and the patient's prosthesis was converted into an interim fixed complete denture.     

An Alternative Approach in Fabrication of Fixed Complete Dentures Using a Duplicate Denture

The traditional prosthetic steps in the fabrication of a fixed complete denture after implant osseointegration include final impression, verification of implant positioning in the working cast, mounting of the working cast, and mock denture wax trial insertion prior to the laboratory fabrication of the metal substructure; however, in patient scenarios of immediate loading of implants, the interim conversion prosthesis can be used to advance from the final impression to the milling of the underlying framework in one appointment. Consistency in the initial wax trial insertion, radiographic guide, and intraoral positioning of the conversion prosthesis can result in a well‐designed definitive prosthesis in less time with the use of the existing duplicate complete denture.     

Alveolar Nerve Repositioning with Rescue Implants for Management of Previous Treatment. A Clinical Report

The goal of modern implant dentistry is to return patients to oral health in a rapid and predictable fashion, following a diagnostically driven treatment plan. If only a limited number of implants can be placed, or some fail and the prosthetic phase of implant dentistry is chosen to complete the patient's treatment, the final outcome may result in partial patient satisfaction and is commonly referred to as a “compromise.” Previous All‐on‐4 implant treatment for the patient presented here resulted in a compromise, with an inadequate support system for the mandibular prosthesis and a maxillary complete denture with poor esthetics. The patient was unable to function adequately and also was disappointed with the resulting appearance. Correction of the compromised treatment consisted of bilateral inferior alveolar nerve elevation and repositioning without bone removal for lateral transposition, to gain room for rescue implants for a totally implant‐supported and stabilized prosthesis. Treatment time to return the patient to satisfactory comfort, function, facial esthetics, and speech was approximately 2 weeks. The definitive mandibular prosthesis was designed for total implant support and stability with patient retrievability. Adequate space between the mandibular bar system and the soft tissue created a high water bridge effect for self‐cleansing. Following a short interim mandibular healing period, the maxillary sinuses were bilaterally grafted to compensate for bone inadequacies and deficiencies for future maxillary implant reconstruction.     

Transition from Failing Dentition to Full‐Arch Fixed Implant‐Supported Prosthesis with a Staged Approach Using Removable Partial Dentures: A Case Series

The present retrospective case series is aimed at evaluating a staged approach using a removable partial denture (RPD) as an interim prosthesis in treatment to correct a failing dentition until such time as a full‐arch fixed implant‐supported prosthesis may be inserted. Eight patients, who had undergone maxillary full‐arch rehabilitation with dental implants due to poor prognosis of their dentitions, were analyzed. All treatment included initial periodontal therapy and a strategic order of extraction of hopeless teeth. An RPD supported by selected teeth rehabilitated the compromised arch during implant osseointegration. These remaining teeth were extracted prior to definitive prosthesis delivery. Advantages and drawbacks of this technique were also recorded for the cases presented. Among the advantages provided by the staged approach are simplicity of fabrication, low cost, and ease of insertion. Additionally, RPD tooth support prevented contact between the interim prosthesis and healing abutments, promoting implant osseointegration. The main drawbacks were interference with speech and limited esthetic results. Implant survival rate was 100% within a follow‐up of at least 1 year. The use of RPDs as interim prostheses allowed for the accomplishment of the analyzed rehabilitation treatments. It is a simple treatment alternative for patients with a low smile line.     

An Alternative Technique for the Fabrication of a Metal‐Reinforced Interim Implant‐Supported Fixed Prosthesis: A Clinical Report

Despite advancements in restorative materials and techniques, complications with implant‐supported fixed prostheses such as veneer fracture and material wear are very common and present with varying frequencies. Following these complications, repair of this type of prosthesis can be time‐consuming and costly even in the hand of experience clinicians. Several techniques have proposed using the existing framework to minimize the cost of the repair for the patient; however, while the repairs are being performed, the patient will have to either wear an interim complete denture or no prosthesis, which might cause some inconvenience to the patient. This article will present a technique for the fabrication of a metal‐reinforced interim implant‐supported fixed prosthesis for patients to wear while the existing prosthesis is being repaired.     

Implant‐Supported Prosthetic Rehabilitation of a Patient with Localized Severe Attrition: A Clinical Report

Patients usually adapt to their existing occlusal vertical dimension (OVD). It is essential to resolve each of the problems associated with decreased vertical dimension as a result of attrition. This report describes the multidisciplinary dental treatment of a 40‐year‐old male patient who had severe tooth wear, resulting in reduced vertical dimension. After clinical evaluations, extraoral examination showed a reduction of the lower facial height, drooping, and overclosed commissures. Ten dental implants were placed into the maxillary and mandibular alveolar processes. During the osseointegration period, an interim removable partial denture was made at increased OVD to use in the first stage of rehabilitation. It was used for 3 months as a guide for preparing the definitive restorations. The patient's adaptation to the increased OVD was evaluated. During this period, he was asymptomatic. Following the evaluation period, the provisional fixed restoration was used for 3 months. Then, full‐mouth definitive prostheses supported by a combination of implants and teeth were fabricated to upper and lower jaws. Osseointegration of the implants, peri‐implant mucosa health, prosthesis function, and esthetics were assessed after 1 week and 1, 3, and 6 months. After 3 years of follow‐up, no functional or esthetic difficulties with the implants and restorations were noted.     

Fabricating an Interim Immediate Partial Denture in One Appointment (Modified Jiffy Denture). A Clinical Report

An immediate denture is fabricated before all the remaining teeth have been removed. Its advantages include maintenance of a patient's appearance, muscle tone, facial height, tongue size, and normal speech and reduction of postoperative pain. The purpose of this study is to describe the use of a patient's fixed prosthesis for fabricating an interim immediate partial denture in one appointment. Occlusion, occlusal vertical dimension, and facial support are maintained during the healing period in this procedure.     

A digital technique for fabricating an interim implant-supported fixed prosthesis immediately after implant placement in patients with complete edentulism

The conversion of a denture into an interim implant-supported, screw-retained restoration has become the standard method for immediate interim restoration in patients with complete edentulism. The most critical steps of the denture conversion process are the creation of appropriate denture access holes to prevent displacement of the denture by the interim cylinders and removal of the denture flanges to facilitate both good esthetics and accessibility for oral hygiene after the denture is connected to the interim cylinders. This article presents a digital technique for designing and fabricating an interim implant-supported, fixed prosthesis for edentulous patients. The interim prosthesis has cylinder access holes that are digitally prefabricated and a denture flange part that is designed to be easily sectioned. This technique facilitates more straightforward and efficient immediate restoration for edentulous patients after implant placement.     

Management of Biotechnical Complications Associated with a Full‐Arch Implant Restoration Using Digital and Conventional Workflows: A Clinical Report

Full‐arch implant‐supported restorations using a metal‐acrylic resin design have had a high success rate but are also associated with frequent technical complications including framework misfit due to casting errors, debonding of denture teeth, and fracture of the acrylic from the metal framework. This clinical report describes a case of maxillary and mandibular full‐arch implant‐supported rehabilitation associated with technical and biological complications and use of digital technology for fabricating monolithic restorations. The use of a bio‐functional try‐in and its subsequent use as a conversion prosthesis for fabricating a master cast is described. The use of the patient's existing metal bar to fabricate a retread type prosthesis is also described along with using digital technology for fabricating a new metal bar and a monolithic type of restoration. The integration of digital and conventional workflows to obtain an increased level of accuracy and simplicity is also discussed.     

Provisional implants for immediate restoration of partially edentulous jaws: a clinical study

PURPOSE: The aim of this study was to evaluate the use of provisional implants, which can provide patients with provisional fixed partial dentures during the healing time of augmentation procedures and/or during the osseointegration period of definitive implants until delivery of the definitive prosthesis. MATERIALS AND METHODS: Thirty-one patients were consecutively included in the study. Eighteen patients (group A, primary simultaneous group) were initially treated simultaneously with provisional and definitive implants and provided with 18 interim fixed partial dentures. Thirteen patients (group B) received provisional implants in a staggered procedure. In the first stage of group B patients (augmentation phase), provisional implants were placed to bridge the augmentation phase and for anchoring 13 interim fixed partial dentures. In the second stage (secondary simultaneous group), patients of group B received provisional implants to bridge the osseointegration phase for simultaneously placed definitive implants by further use of 13 interim fixed partial dentures. All patients were followed from provisional implant and definitive implant placement to delivery of the definitive prosthesis. Loss of provisional implants and interim fixed partial dentures was noted, and stability of provisional implants was evaluated using the Periotest device. The procedures of immediate rehabilitation with fixed partial dentures using provisional implants were subjectively rated by patients with regard to satisfaction, treatment period, and acceptance. RESULTS: In 31 patients, 44 provisional fixed partial dentures were supported by 98 provisional implants. No provisional implant loss in group A or group B-second stage was observed. Only 3 (3%) provisional implants were lost in group B-first stage during the augmentation phase. Incidence (90.8% versus 9.2%) and stability (Periotest values: 8.6 +/- 3.9 versus 4.8 +/- 2.7) of provisional implants differed significantly between maxilla and mandible (P < .01). All interim fixed partial dentures (n = 44) remained in place for the intended time period but in 3 cases with provisional implant loss they were shortened. No definitive implant loss (n = 94, survival: 100%) and especially no implant loss in cases of maxillary sinus augmentation was seen. The items rated showed high satisfaction and good acceptance of the intensive surgical and prosthodontic program. CONCLUSION: This clinical review showed that (1) provisional implants can successfully provide patients with a fixed partial denture for immediate rehabilitation to bridge the osseointegration or augmentation phase, even in cases with an initially compromised bone situation and (2) although treatment is elaborate, the selected patients decided on a fixed interim rehabilitation with provisional implants rather than on a removable solution.     

The Fixed/Detachable Implant Provisional Prosthesis

Interim modification and management of a complete denture following surgical uncovering of dental implants can be time-intensive and may fail to provide adequate patient benefit until the definitive prosthesis can be completed. Inadequate interim management can result in functional and tissue difficulties. Modification of the conventional complete denture to a fixed/detachable provisional prosthesis in a one-stage procedure provides the patient an opportunity to experience a fixed prosthesis. The incorporation of fixed, provisional cylinders to the existing denture base using autopolymerizing acrylic resin with a closed-mouth technique is described. The peripheral regions are reduced and the distal extension shortened to resemble a fixed/detachable prosthesis. This conversion technique can provide patient satisfaction and comfort until delivery of the definitive prosthesis. Esthetic concerns, home care problems, or patient difficulties with the provisional prosthesis can be rectified in the final prosthesis.     

Maxillary cement retained implant supported monolithic zirconia prosthesis in a full mouth rehabilitation: a clinical report

This clinical report presents the reconstruction of a maxillary arch with a cement retained implant supported fixed prosthesis using a monolithic zirconia generated by CAD/CAM system on eight osseointegrated implants. The prosthesis was copy milled from an interim prosthesis minimizing occlusal adjustments on the definitive prosthesis at the time of delivery. Monolithic zirconia provides high esthetics and reduces the number of metal alloys used in the oral cavity.     

Esthetic potential of single-implant provisional restorations: selection criteria of available alternatives

Provisional implant restorations are essential tools used to optimize the esthetic outcomes for single-tooth implant restorations. This article describes three groups of available alternatives and the specific options within each group including removable prostheses (interim removable partial denture, vacuum-formed appliance), tooth-supported prostheses (bonded extracted or denture teeth, cast metal or fiber-reinforced resin-bonded fixed partial denture [FPD], wire-retained resin-bonded FPD, acrylic resin provisional FPD), and implant-supported fixed prostheses (implant-retained provisional restoration). Advantages and disadvantages as well as fabrication guidelines for each option are provided. The author proposes that the restorative dentist consider eight criteria in selecting the most appropriate type of provisional prosthesis for a specific patient situation including the esthetic potential, patient comfort, treatment time, laboratory cost, occlusal clearance, ease of removal, durability, and ease of modification. The patient's esthetic expectations are critical in determining the most suitable type of provisional restoration. Esthetically pleasing provisional restorations are part of the evolving implant continuum, making implant dentistry more appealing to practicing dentists and potential patients. CLINICAL SIGNIFICANCE: Provisional restorations for single implants have evolved from temporary expedients during osseous and soft tissue integration to critical therapeutic tools used to assess patient expectations, communicate with the laboratory, and optimize definitive implant treatment. The selection of the type of provisional restoration may significantly influence esthetics during the period of implant integration and soft tissue healing. However, it is unlikely that there is a direct correlation between the type of provisional restoration used and the esthetic outcome of the definitive prosthesis.     

Use of Implant‐Supported Custom Milled Impression Copings to Capture Soft‐Tissue Contours and Incisal Guidance

A technique is presented where a custom milled impression coping is used to replicate the clinically established anterior incisal guidance to the definitive prosthesis when multiple implants are restored in the esthetic zone. A conventional impression is initially made, then the stone cast is scanned, and a digitally designed custom screw‐retained, implant‐supported interim prosthesis is milled from a polymethylmethacrylate (PMMA) billet. This is aimed to digitally design the pontic areas, contour the gingival soft tissue, and establish an anterior incisal guidance. A custom milled impression coping (CMIC) is then fabricated. The CMIC has contours similar to the contours of the interim prosthesis and is fabricated from a PMMA billet. Titanium inserts are placed in the interim prosthesis and the CMIC. The CMIC is inserted intraorally and used for the final impression by using a custom tray and by following the open tray impression protocol. With the proposed technique, the exact contours of the digitally designed and clinically verified interim prosthesis are used to fabricate the definitive restoration.     

Flapless implant placement: a technique to eliminate the need for a removable interim prosthesis

Computer-guided flapless surgery for implant placement using stereolithographic templates is gaining popularity. The advantages of this surgical protocol are its minimally invasive nature, accuracy of implant placement, predictability, and reduced time required for definitive rehabilitation. One of the disadvantages, however, pertains to complete arch implant rehabilitation. An existing protocol for complete arch flapless computer-guided implant surgery necessitates the patient to be rendered completely edentulous and to wear a removable complete denture for varying periods of time. This may be objectionable to the patient. This article illustrates a technique which uses a modified radiographic template to overcome this limitation. The patient may have a tooth-supported or implant-supported fixed interim prosthesis during the entire rehabilitation process.     

Use of an Immediate Provisional Implant to Support a Full-Arch Interim Restoration: A Clinical Report

The use of provisional implants as the sole or adjunct mean of stabilization for interim fixed partial dentures has gained popularity in implant prosthodontic treatment. These implants can be used between submerged implants during the healing phase to provide support for interim fixed or removable partial dentures. In this clinical report, a provisional implant used to provide support for a full-arch fixed interim restoration is described. Positioned between adjacent conventional implants, the provisional implant was placed during the same surgical procedure. As a result, an immediate acrylic fixed partial denture supported by natural teeth and the provisional implant provided a comfortable and esthetic interim restoration during the osseointegration period.     

Transforming an existing fixed provisional prosthesis into an implant-supported fixed provisional prosthesis with the use of healing abutments

Maintaining a fixed provisional prosthesis through all phases of complex implant prosthodontic therapy for a soon-to-be completely edentulous arch is a difficult task. This article focuses on the treatment phase in which teeth and/or transitional implants supporting a provisional fixed partial denture are removed. The described technique makes use of healing abutments to support a modified provisional fixed partial denture. This protocol ensures patient comfort and allows proper soft tissue healing before definitive implant abutment selection. It also eliminates the placement of interim implant abutments.     

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.     

Construction of a Custom-Shaded Interim Denture Using Visible-Light-Cured Resin

A patient treatment is presented to demonstrate a technique using visible-light-cured (VLC) resin to create a characterized denture base for an interim denture. This indication for characterization is routinely seen with African-Americans with dark-pigmented gingiva. Using a combination of blue VLC tray resin and pink VLC denture base resin, the mixture achieves a darker-colored denture base. This technique was used for the fabrication of an interim denture for a patient who required an immediate interim denture. The prosthesis was worn during the healing phase and allowed the patient to function while the definitive prosthesis was being fabricated.