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.     

Full‐Arch Implant‐Supported Rehabilitation Guided by a Predicted Lateral Profile of Soft Tissue

In full‐arch implant‐supported rehabilitation of patients with severe periodontitis, prediction of lateral facial profile with modified dental position remains a challenge, especially for patients with protruded anterior teeth. This clinical report describes a digital workflow to predict lateral profiles and then guide the implant placement and restoration fabrication.     

A Single Visit Direct Technique to Provisionally Restore Occlusion for a Full‐Mouth Rehabilitation: A Clinical Report

Attrition of the dentition can negatively affect esthetics and function. When reconstructing patients with attrition who require restoration at increased occlusal vertical dimension (OVD), it is necessary to first evaluate the OVD using a removable interim prosthesis to ensure that the patient will tolerate the new position. The transition to fixed interim prostheses has to be carefully planned to achieve the desired OVD. One approach is to prepare all teeth in a single day and place full‐arch interim prostheses; however, this can be tiring for the patient and prosthodontist. An alternative approach is to prepare one arch and place interim prostheses, while using composite resin in the opposing arch to maintain the newly established OVD. A diagnostic wax‐up at the proposed OVD is completed and duplicated in stone. A vacuform matrix is loaded with composite resin and applied to the unprepared etched teeth of the opposing arch to restore form and occlusion until full contour interim prostheses are placed at a later visit.     

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 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.     

Flapless CAD/CAM-guided surgery for staged transition from failing dentition to complete arch implant rehabilitation: a 3-year clinical report

The transition of patients from failing dentition to complete arch implant rehabilitation often requires that the patient be rendered edentulous and has to wear a complete removable dental prosthesis for varying periods of time. This is objectionable to many patients. A staged treatment approach allows a fixed interim restoration, patient comfort, and prosthodontic control throughout the rehabilitation process. CAD/CAM-guided flapless implant surgery has the advantage of prosthetically driven implant placement and minimal postoperative sequelae. A patient with a failing dentition was treated with this combined protocol and was followed up for 3 years after loading. Implant and prosthesis survival rates were 100%, with no technical complications encountered up to the last recall. The purpose of this clinical report is to describe a combination of CAD/CAM-guided flapless surgery and a staged treatment approach, thereby giving the patient a tooth-supported or implant-supported fixed interim prosthesis during the entire rehabilitation process. The various surgical, laboratory, and prosthetic stages are illustrated for the complete arch prosthetic rehabilitation, and the 3-year follow-up outcome is reported.     

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.     

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.     

Individual Lithium Disilicate Crowns in a Full‐Arch,Implant‐Supported Rehabilitation: A Clinical Report

This clinical report presents the clinical outcome of a maxillary full‐arch implant‐supported fixed rehabilitation with lithium disilicate reinforced glass ceramic monolithic crowns opposing a mandibular metal‐acrylic implant‐supported fixed rehabilitation in a 62‐year‐old woman. Eight implants were successfully placed (four maxillary, four mandibular), and no complications occurred in the postoperative or maintenance periods. Six months after delivery, the maxillary and mandibular prostheses were found to be clinically, biologically, and mechanically stable, and the patient was satisfied with the esthetics and her ability to function. Although the present indications for the use of lithium disilicate are still restricted to tooth‐borne restorations, it is possible to successfully rehabilitate edentulous patients through implant‐supported fixed prostheses using lithium disilicate reinforced glass ceramic monolithic crowns.     

Use of Vacuum‐Formed Templates to Guide Tooth Preparation and Insertion of Interim Restorations

Ideal tooth preparation and interim prostheses are critical to a predictable esthetic and functional outcome in the treatment of full‐mouth‐fixed restorations. During the treatment stages, multiple procedures need to be considered for a successful and predictable outcome. These include the parallel preparation of multiple abutment teeth followed by the relining of the interim prostheses. The purpose of this article is to describe a technique to simplify tooth preparation and facilitate subsequent insertion of a complete‐arch‐fixed interim prosthesis using vacuum‐formed templates.     

Initial management and long‐term follow up after the rehabilitation of a patient with severe dentoalveolar trauma: A case report

Dental trauma is common and for patients who suffer significant oral injuries, rehabilitation can be challenging to the clinical team. This case report describes the successful prosthetic replacement of multiple missing teeth lost due to severe dentoalveolar trauma, using iliac crest bone grafting, an implant‐retained removable dental prosthesis and implant‐supported crowns. Good functionality and aesthetic outcome were achieved.     

Electromyographic analysis of masticatory and neck muscles in subjects with natural dentition, teeth-supported and implant-supported prostheses

Objectives: To compare the electromyographic (EMG) characteristics of masticatory and neck muscles in patients with natural dentition, teeth‐supported prostheses and implant‐supported prostheses. Materials and methods: Twenty‐five subjects aged 40–80 years were examined. Five patients had maxillary and mandibular implant‐supported fixed prostheses; five patients had mandibular implant‐supported fixed prosthesis and maxillary removable complete denture; seven patients had implant‐supported fixed prosthesis (one arch) and natural dentition or full‐arch tooth‐fixed prosthesis (one arch); and eight control subjects had natural dentition or single tooth‐fixed prostheses. Surface EMG of masseter, temporal and sternocleidomastoid muscles was performed during maximum teeth clenching and unilateral gum chewing. Interarch dental contacts were assessed with shim stocks. Results: All groups had similar interarch dental contacts (P>0.05). During clenching, patients with maxillary and mandibular implant‐supported fixed prostheses had unbalanced standardized masseter and temporalis anterior activities (74%), with significantly larger values found in the other patients and control subjects (all mean values larger than 86%, P=0.017). All patients chewed with significantly larger muscular potentials than control subjects (on average, 1434–2100 μV s vs. 980 μV s, P=0.04), and had altered muscular patterns (left side, P=0.021). The patients with one arch with natural dentition/tooth fixed prostheses had chewing muscular patterns similar to the control subjects. Conclusions: Clenching with the analyzed prostheses was performed with a relative increment of temporalis activity. Neuromuscular coordination during chewing was larger in patients who maintained their teeth or dental roots, independently from the number of dental contacts.     

A Novel Approach for Converting a Mandibular Complete Denture to a Fixed Interim,Screw‐Retained Implant Prostheses: A Case Report

For most of the last century, conventional complete dentures have been the standard of care and the most common treatment for edentulous patients. Technological advancements in fabrication techniques may significantly reduce the number of office visits required to fabricate complete dentures. Immediate occlusal loading with mandibular full arch prostheses has been extensively researched and is now one of the standards of care for edentulous patients. A clinical technique for converting a mandibular immediate complete denture to an interim full arch, screw‐retained fixed prosthesis with novel implant restorative components for immediate loading on four implants is described.     

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.     

Full Mouth Rehabilitation with Maxillary Tooth Supported and Mandibular Tooth and Implant Supported Combination Prostheses: A 4-Year Case Report

The primary objectives of successful prosthetic rehabilitation are to provide function, esthetics and comfort to the patient. Combination prosthesis is one which is supported by both natural teeth and implant. The periodontal ligament and osseointegrated interface distribute force differently to the supporting bone. Therefore problems can develop when tooth and implants are combined in the same prosthesis. However, clinicians can apply biomechanical principles, to negate the deleterious leverages exerted by the fixed prosthesis by using non rigid components and to equalize the stress applied by the prosthesis on implant and teeth. A case of partially edentulous situation was rehabilitated successfully with a combination of prostheses. Maxillary arch was restored to function with crowns, fixed dental prosthesis and with an extra coronal castable attachment prosthesis and the mandibular arch with a combination of tooth and implant supported attachment prosthesis. The clinical and laboratory steps for the fabrication of these prostheses are explained in this report.     

Full‐Arch Implant‐Supported Fixed Dental Prosthesis Retained by a Combination of Galvano‐Telescopic Copings and Screws: A Clinical Report

Full‐arch screw‐retained implant‐supported fixed dental prostheses have a high long‐term success rate and are considered the gold standard by many clinicians. However, accurate fabrication of a passive fit long‐span prosthesis can be challenging. A novel intraoral adhesion method using galvano‐telescopic copings was proposed as a way of improving prosthetic fit for edentulous patients. This report describes the treatment of a 74‐year‐old female with a full‐arch implant‐supported dental prosthesis, supported by a combination of galvano‐telescopic copings and screws to prevent retention loss. Four years have passed since this superstructure was placed, during this time she exhibited a good clinical course with no inflammation noted in surrounding tissues. Treatment with an implant‐supported fixed dental prosthesis, retained by a combination of galvano‐telescopic copings and screws, can be a useful alternative treatment for edentulous patients.     

Considerations for a staged approach in implant dentistry

Full-arch and partial reconstruction is demanding for the clinician and a challenge for the patient. Traditionally, teeth are extracted, and implants are placed; the patient wears a provisional removable prosthesis during implant osseointegration. The patient is left to deal with a difficult transition from a fixed dentition to a removable one, albeit temporarily. This drastic alteration can generate functional, emotional, and esthetic changes for the patient, thereby making a difficult time even more challenging. Reconstructing the dentition through a staged approach has been documented and involves strategic extractions along with the placement of several implants, but leaves select abutment teeth for a fixed provisional prosthesis. This allows for the provisional prosthesis to be tooth-supported during implant integration and later converted to an implant-supported prosthesis. In this manner, the patient will benefit from a fixed provisional prosthesis throughout the treatment process. A staged approach is contingent upon a thorough periodontal and prosthetic evaluation and work-up. Success requires proper communication between the periodontist, surgeon, restorative dentist, laboratory, and patient. A team approach is necessary for success. The protocol, advantages, and disadvantages for a staged approach to a full-arch implant-supported reconstruction are discussed. The authors also present a case to show how the staged approach can be used for sextant or quadrant rehabilitation.     

Six‐Year Survival of a Mini Dental Implant‐Retained Overdenture in a Child with Ectodermal Dysplasia

Patients with ectodermal dysplasia (ED) experience several problems caused by abnormal development and functioning of the head and neck region. In addition to developmental nasal cartilage abnormalities and absence of sweat glands, hair, and eyebrows, edentulism or developmental disorders of teeth (cone‐shaped teeth) are commonly observed in these types of patients. ED is also characterized by underdeveloped alveolar ridges, a decreased occlusal vertical dimension, reduced salivary secretion, and dry oral mucosa, which make prosthetic rehabilitation difficult. Few studies of intraosseous dental implant‐retained prostheses have described adverse effects on craniofacial growth and esthetic and functional disadvantages, while some researchers have described the advantages of this treatment option as an alternative option in these cases. Due to the associated alveolar bone deficiency, dental mini‐implant therapy may be a treatment option for these patients; however, there are isolated cases in the literature regarding the rehabilitation of ED patients with mini‐implant‐supported overdentures. This clinical report describes the rehabilitation of a 6‐year‐old child with ED using a maxillary removable partial prosthesis and a mini‐implant‐retained mandibular overdenture. The clinical and radiographic findings of this prosthetic rehabilitation during the 6‐year follow‐up are also presented.     

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.     

Fully Digital Workflow with Magnetically Connected Guides for Full‐Arch Implant Rehabilitation Following Guided Alveolar Ridge Reduction

This technique report describes a fully digital workflow in which two surgical guides (i.e. one for alveolar bone reduction and the other for implant placement) are magnetically connected to ensure stability during full‐arch implant surgery following guided bone reduction. Digital prosthesis design as well as virtual bone reduction and implant planning are developed from the superimposition of facial, intraoral and CBCT scans. With this technique, different surgical guides and interim poly(methylmethacrylate) (PMMA) fixed prosthesis are precisely connected with magnets after being digitally designed and 3D‐printed. As a result, such magnetic connection allows for satisfactory stability of the implant surgical guide, as well as of the interim fixed PMMA fixed prosthesis during capture of screw‐retained abutments.