Fabrication of an Implant‐Supported Fixed Interim Prosthesis Using a Duplicate Denture: An Alternative Technique

The fabrication of an implant‐supported fixed complete denture prosthesis involves multiple clinical and laboratory steps. One of the main steps is to provide the patient with an interim fixed prosthesis to evaluate the patient's esthetic and functional needs as well as to enhance the patient's psychology before proceeding to the definitive prosthesis. Different techniques for fabricating interim prostheses have been described in the literature. This report describes an alternative technique that uses a duplicate denture made of self‐curing acrylic resin to fabricate an implant‐supported fixed interim prosthesis. The interim prosthesis was later used as a blueprint for the definitive implant‐supported hybrid prosthesis.     

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.     

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.     

A technique for immediately restoring single dental implants with a CAD-CAM implant-supported crown milled from a poly(methyl methacrylate) block

This technique is used when a single dental implant is placed. A stent made of autopolymerized acrylic resin was used to transfer the implant position to the laboratory. Once the implant position was transferred, the stone cast was scanned, and a computer-aided design and computer-aided manufacturing (CAD-CAM) interim implant-supported crown was milled from a poly(methyl methacrylate) (PMMA) block. A titanium insert, in contact with the implant platform and not the PMMA material, was used to support the crown. The interim prosthesis was then placed intraorally. The soft tissues were sutured, and the interim prosthesis was left for a period of at least 3 months to confirm osseointegration and allow the soft tissue to heal. A CAD-CAM titanium impression coping was made and used for the definitive impression. The contours of the impression coping were identical to the contours of the interim restoration. The data of the digital design of the interim prosthesis were saved, and the definitive prosthesis was fabricated with contours identical to those of the interim prosthesis.     

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.     

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.     

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.     

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.     

Implant stability and peri-implant parameters in free vascularized iliac graft transplantation patients: report of three ameloblastoma cases

Background: Ameloblastoma, a benign but locally aggressive tumor, accounts for 9% to 11% of all odontogenic tumors. Radical procedures, including resection, are performed. To restore functions after resection, free vascularized iliac grafts followed by a dental implant–supported prosthesis are used as a successful treatment option. The aim of this case report is to evaluate the peri‐implant clinical status and stability of dental implants placed in patients with advanced‐stage mandibular ameloblastomas. Methods: Examinations of three patients revealed extensive ameloblastomas, and hemimandibulectomies were performed. Six months after surgeries, two to four dental implants were placed. After 6 months of healing, one fixed prosthesis and two removable prostheses were delivered. The stability of implants was evaluated at the surgical baseline and 1, 3, 6, 9, and 12 months after surgery by resonance‐frequency (RF) analysis. Peri‐implant clinical parameters (i.e., plaque index [PI], gingival index [GI], gingival bleeding time index [GBTI], and peri‐implant probing depth [PD]) were recorded at the delivery of the prosthesis and at follow‐ups at 1, 3, and 6 months. Results: Nine implants that supported one removable prosthesis and two fixed prostheses were placed. RF analysis revealed no significant changes in implant stability during 12 months of follow‐up. Peri‐implant clinical parameters (PI, GI, and GBTI) showed slight improvements during follow‐up. Although advancements were observed in 6 months, PDs were found to be deeper than optimal measurements for the whole observation time. Conclusion: The implant‐supported prosthetic rehabilitation of patients with ameloblastomas reconstructed with free vascularized iliac crest grafts can be a predictive alternative for improving the quality of life of patients in which a high implant stability and acceptable peri‐implant health may be achieved.     

Freestanding and tooth-implant connected prostheses in the treatment of partially edentulous patients Part II: An up to 15-years radiographic evaluation

Abstract: A total of 123 patients were followed between January 1983 and July 1998 with 140 tooth‐implant connected prostheses. The age of the patients at prosthesis installation ranged from 20 to 79 years (mean 51.8). 339 (Brånemark^® system) implants were connected to 313 teeth. The loading time ranged from 1.5 to 15 years (mean: 6.5). 123 patients were randomly selected as a control group with freestanding implant‐supported prostheses only. The age of the patients at prosthesis installation ranged from 22 to 78 years (mean 52.3). The loading time for the 329 freestanding (Brånemark^® system) implants ranged from 1.3 to 14.5 years (mean: 6.2). Evolution of the marginal bone stability around the implant in the tooth‐implant connected as well as the freestanding group was studied with respect to the prognosis of the implants. Over the period from 0 to 15 years, there was significantly more marginal bone loss (0.7 mm) in tooth‐implant connected versus freestanding prostheses. No significant difference in marginal bone loss was found between the non‐rigid tooth‐implant connected prostheses versus freestanding prostheses. However, there was a significant difference in marginal bone loss for rigid and multi‐connected tooth‐implant connected prostheses versus freestanding ones. The results of this study indicate that more bone is lost around implants which are rigidly connected to teeth. This suggests that bending load, which is increased in tooth‐implant connected prostheses, might be responsible for this phenomenon. These observations favor the use of freestanding prostheses whenever possible. However, the clinical significance of greater bone loss in rigid versus non‐rigid connections might outweigh the annoying phenomenon of tooth intrusion in the case of non‐rigid tooth connection, when connection is considered.     

Evaluation of Primary Stability of Self‐Tapping and Non‐Self‐Tapping Dental Implants. A 12‐Week Clinical Study

Purpose: The aim of this study was to investigate the relationship between surgical techniques and implant macro‐design (self‐tapping/non‐self‐tapping) for the optimization of implant stability in the low‐density bone present in the posterior maxilla using resonance frequency analysis (RFA). Materials and Methods: A total of 102 implants were studied. Fifty‐six self‐tapping BlueSkyBredent® (Bredent GmbH&Co.Kg®, Senden, Germany) and 56 non‐self‐tapping Standard Plus Straumann® (Institut Straumann AG®, Waldenburg, Switzerland) were placed in the posterior segment of the maxilla. Implants of both types were placed in sites prepared with either lateral bone‐condensing or with bone‐drilling techniques. Implant stability measurements were performed using RFA immediately after implant placement and weekly during a 12‐week follow‐up period. Results: Both types of implants placed after bone condensing achieved significantly higher stability immediately after surgery, as well as during the entire 12‐week observation period compared with those placed following bone drilling. After bone condensation, there were no significant differences in primary stability or in implant stability after the first week between both implant types. From 2 to 12 postoperative weeks, significantly higher stability was shown by self‐tapping implants. After bone drilling, self‐tapping implants achieved significantly higher stability than non‐self‐tapping implants during the entire follow‐up period. Conclusions: The outcomes of the present study indicate that bone drilling is not an effective technique for improving implant stability and, following this technique, the use of self‐tapping implants is highly recommended. Implant stability optimization in the soft bone can be achieved by lateral bone‐condensing technique, regardless of implant macro‐design.     

Fabricating an Accurate Implant Master Cast: A Technique Report

The technique for fabricating an accurate implant master cast following the 12‐week healing period after Teeth in a Day® dental implant surgery is detailed. The clinical, functional, and esthetic details captured during the final master impression are vital to creating an accurate master cast. This technique uses the properties of the all‐acrylic resin interim prosthesis to capture these details. This impression captures the relationship between the remodeled soft tissue and the interim prosthesis. This provides the laboratory technician with an accurate orientation of the implant replicas in the master cast with which a passive fitting restoration can be fabricated.     

Immediate function in the edentulous mandible: replacement of a lost implant using prefabricated guides

This article describes a technique for replacement of a lost implant. The procedure involves the use of templates, drill guides, and drills of the system to replace a 4.5-mm-wide lost implant with a 5.0-mm-wide implant. The surgical procedure was simplified to optimize the healing process and to be more comfortable for the patient. The accuracy of the templates and guides allowed for ideal position of the implant and the immediate use of the original fixed implant-supported prosthesis.     

Immediate loading of implants in the edentulous maxilla

The overall aim of this thesis was to investigate different therapeutic strategies in treatment of the edentulous maxilla with dental implants and their importance for treatment outcome. The introduction of one-stage surgery, in place of two-stage surgery, was a paradigm shift in the area of implant treatment since submerged implant healing underneath the mucosa was considered a prerequisite for healing in the original concept. The advantages of a one-stage method are that a second surgery is unnecessary, costs are lower, and patients complain less about the surgical procedures. The development of implant treatment, regardless of whether it is performed in the mandible or the maxilla, strives to shorten the period from implant placement to implant loading. For the edentulous patient--due to esthetic, economical, or psychological reasons--shortening this time and thus avoiding a long period of wearing a transitional removable prosthesis is advantageous. Use of conventional one-stage surgery makes possible and is a prerequisite for immediate loading of implants. Successful treatment outcome has been demonstrated for immediate loading of implants in the mandible, but documentation of the method in the maxilla is still sparse. Two prospective clinical studies compared (i) one- and two-stage surgery and (ii) immediate and conventional loading in patients consecutively treated in the edentulous maxilla with implant-supported fixed prostheses. The first study found that the cumulative survival rate (CSR) after one-stage surgery performed according to a conventional protocol was consistent with two-stage protocol CSRs reported in previous studies. The second study evaluated an immediate loading protocol that provided patients with interim fixed prostheses within 24 hours after implant placement. A comparison of the studies found no significant difference in CSRs. But it was found that when a conventional protocol was used, transitional removable prostheses could traumatize the bone-implant interface during healing by adverse loading on the implants, which pierced the mucosa. Moreover, splinting the implants immediately after surgery with an interim fixed prosthesis might protect them from adverse loading. In a finite element analysis comparing uncoupled and splinted implants--imitations of the clinical situations in the two studies--splinted implants drastically reduced stresses in the bone tissue surrounding the implant, which might facilitate bone healing. Two factors considered important for a successful treatment outcome, especially when loading implants immediately, are (i) jawbone quality and (ii) primary implant stability at placement. In implant literature, bone quality is generally equivalent to bone density. Results of the third clinical study in this thesis indicate that use of computed tomography with calculations of bone mineral density can be a useful tool in bone tissue evaluation before implant placement. After 1 year of loading, changes in marginal bone level, compared to baseline, did not differ between implants that were stable and implants that were not stable at placement. The results of this thesis do not strengthen earlier recommendations that immediate and early loading is a treatment alternative that can be considered only in jaws with good bone quality. In conclusion, immediate loading with interim fixed prostheses in the edentulous maxilla is a viable treatment alternative. Splinting of implants seems to be important in immediate loading, especially when bone density is low.     

Outcome of Brånemark Novum implant treatment in edentulous mandibles: a retrospective 5-year follow-up study

Background: A gradual progression from a two‐stage surgical technique to a one‐stage and even immediate surgical protocol has occurred during the last decade with most oral implant systems. However, every new approach must obviously be reported individually, with long‐term results, in order to assess whether the changes have any real patient value. Purpose: The aim of the present report was to retrospectively review the 5‐year outcome of patients treated with the Brånemark Novum® (Nobel Biocare AB, Göteborg, Sweden) protocol. Methods: The first 15 patients treated according to the Novum procedure in a private specialist clinic in Lovere, Italy, were followed‐up with clinical, radiographic, and resonance frequency analyses. All the patients’ fixed constructions had been in function for an average of 5 years. Parameters recorded were implant survival, prosthesis success, oral hygiene and mucosal health, marginal bone remodeling, type and frequency of complications, and patient's opinion of the treatment outcome. Results: After 5 years, the cumulative survival rate for implants was 91%, and for inserted bridge constructions it was 87%. Very small changes in implant stability occurred during implant loading from 1 to 5 years. Oral health conditions were good; 87% of mucosal quadrants around the implants were free from signs of inflammation. Very small marginal bone height changes were observed at the implants during the examination period, and except for four implant losses reported, severe complications were few. All patients were satisfied with the functional outcome of their constructions, but two patients were not completely happy with the aesthetics of their bridgework as supplied. Conclusion: This report shows 5‐year evidence of acceptably good results with the Brånemark Novum implant technique in edentulous mandibles, when using only three implants to support the fixed bridge construction, and as long as inserted implants become and remain osseointegrated.     

Accuracy of Two Stereolithographic Surgical Templates: A Retrospective Study

Background: The use of computer software and stereolithography for dental implant therapy has significantly increased during the last few years. The aim of this study was to evaluate and compare the mean accuracy and maximum deviations values of dental implant placement using two stereolithographic (SLA) guide systems. Materials and Methods: Twenty patients were selected and 227 implants were inserted using bone‐, tooth‐ and mucosa‐supported SLA surgical guides. Thirty‐one guides, both single‐ and multiple‐type, were used. Some of the single‐type surgical guides were fixed with osteosynthesis screws. A postoperative computer tomography (CT) was performed and an iterative closest point algorithm was used to match the jaw of the CT preoperative with the jaw of the postoperative CT. Quantitative data of each group were described. The t‐test was used to determine the influence of the utilization of the different types of SLA on accuracy values. Results: t‐Test demonstrated a better accuracy of the multiple‐type guides in almost all deviation values when the mucosa‐supported guides were considered. Regarding the bone‐supported template, the single‐type fixed group showed a better accuracy while the highest values of deviation were registered by the multiple‐type guides. The single‐type group showed a better accuracy when the tooth support was considered. Conclusions: The results of the present study indicated best accuracy of the single‐type guide using a bone or tooth support. The multiple‐type guide recorded the best accuracy data when the mucosa support was considered comparing either a fixed and a not‐fixed single‐type guide.     

Adhesive residue on the CAD-CAM surgical guide sleeve: A technical report

Computer-aided design and computer-aided manufacturing (CAD-CAM) surgical guides can be used by the clinician and dental technician to create a definitive cast before surgery, thereby allowing an indirect interim restoration to be fabricated. However, the accurate transfer of the interim restoration from the laboratory to the surgical site requires a precise interface between components. This article reports the prosthetic significance of adhesive residue on the intaglio surface of the CAD-CAM surgical guide sleeve, which can create errors in the implant analog position of the definitive cast. A technique for identifying the presence of residue and its careful removal are also introduced.     

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.     

Intrasurgical Implant Position Transfer and Interim Restoration Placement

In the esthetic zone, the placement of an interim prosthesis is an important stage in implant treatment for gingival contouring. This article presents a simple procedure for making an intraoperative implant position transfer to construct an interim prosthesis with optimal shape and emergence profile. This prosthesis, inserted at stage II surgery, guides soft tissue healing and aids in the fabrication of a definitive prosthesis with optimal gingival contours.     

Prosthetically driven, computer-guided implant planning for the edentulous maxilla: a model study

Objectives: To analyze computer‐assisted diagnostics and virtual implant planning and to evaluate the indication for template‐guided flapless surgery and immediate loading in the rehabilitation of the edentulous maxilla. Materials and Methods: Forty patients with an edentulous maxilla were selected for this study. The three‐dimensional analysis and virtual implant planning was performed with the NobelGuide? software program (Nobel Biocare, Göteborg, Sweden). Prior to the computer tomography aesthetics and functional aspects were checked clinically. Either a well‐fitting denture or an optimized prosthetic setup was used and then converted to a radiographic template. This allowed for a computer‐guided analysis of the jaw together with the prosthesis. Accordingly, the best implant position was determined in relation to the bone structure and prospective tooth position. For all jaws, the hypothetical indication for (1) four implants with a bar overdenture and (2) six implants with a simple fixed prosthesis were planned. The planning of the optimized implant position was then analyzed as follows: the number of implants was calculated that could be placed in sufficient quantity of bone. Additional surgical procedures (guided bone regeneration, sinus floor elevation) that would be necessary due the reduced bone quality and quantity were identified. The indication of template‐guided, flapless surgery or an immediate loaded protocol was evaluated. Results: Model (a) – bar overdentures: for 28 patients (70%), all four implants could be placed in sufficient bone (total 112 implants). Thus, a full, flapless procedure could be suggested. For six patients (15%), sufficient bone was not available for any of their planned implants. The remaining six patients had exhibited a combination of sufficient or insufficient bone. Model (b) – simple fixed prosthesis: for 12 patients (30%), all six implants could be placed in sufficient bone (total 72 implants). Thus, a full, flapless procedure could be suggested. For seven patients (17%), sufficient bone was not available for any of their planned implants. The remaining 21 patients had exhibited a combination of sufficient or insufficient bone. Discussion: In the maxilla, advanced atrophy is often observed, and implant placement becomes difficult or impossible. Thus, flapless surgery or an immediate loading protocol can be performed just in a selected number of patients. Nevertheless, the use of a computer program for prosthetically driven implant planning is highly efficient and safe. The three‐dimensional view of the maxilla allows the determination of the best implant position, the optimization of the implant axis, and the definition of the best surgical and prosthetic solution for the patient. Thus, a protocol that combines a computer‐guided technique with conventional surgical procedures becomes a promising option, which needs to be further evaluated and improved.