Predictable Outcomes with Porcelain Laminate Veneers: A Clinical Report

This clinical report describes how to achieve predictable outcomes for anterior teeth esthetic restorations with porcelain laminate veneers by associating the digital planning and design of the restoration with interim restorations. The previous digital smile design of the restoration eliminates the communication barrier with the patient and assists the clinician throughout patient treatment. Interim restorations (diagnostic mock‐ups) further enhance communication with the patient and prevent unnecessary tooth reduction for conservative tooth preparation. Adequate communication between patient and clinician contributes to successful definitive restorations and patient satisfaction with the final esthetic outcome.     

Orthodontically Assisted Vertical Augmentation in the Esthetic Zone

Severe periodontal disease leading to tooth loss causes multiple challenges when treatment planning replacement of these teeth with implant‐supported restorations. Provisionalization and transitioning the patient from natural dentition to implant‐supported restorations without use of removable prostheses can be difficult to achieve. A detailed evaluation and comprehensive treatment plan should precede extraction of the affected teeth. Forced eruption as a method of modifying the osseous and gingival topography has been established. This clinical report illustrates the use of nonmaintainable teeth to simultaneously develop the site for future implant placement, as well as support a fixed interim restoration during treatment. Patient was classified as an American College of Prosthodontists Prosthodontic Diagnostic Index (ACP PDI) class IV patient.     

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.     

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.     

Revisiting Tooth Preservation in Prosthodontic Therapy

Dental implants have been established as long‐term supports for tooth replacements, and they have profoundly altered treatment concepts of traditional prosthodontics. The use of teeth as prosthetic abutments is revisited relative to implants as predictable support mechanisms for fixed and removable prostheses. The purpose of this review is to appraise tooth preservation in a different manner while considering implants as additional and even preferred support mechanisms for dental prostheses. Data reviewed in this article include a comparison of implants and traditional prostheses and their effects on abutment teeth, the use of periodontally and endodontically compromised teeth as abutments, and prosthetic complications potentially created by healthy remaining teeth. The evidence presented suggests that the longstanding objective of tooth preservation during prosthetic treatment be appended to include the use of dental implants for fixed/removable prostheses, and to avoid or remove teeth presenting as liabilities that diminish the overall prognosis. Patients are not well served if they are faced with biologic, economic, and psychological burdens associated with ongoing revisions of dental rehabilitations using natural teeth. Dentists must use all means available to carefully evaluate remaining teeth to determine if they benefit or impair proposed prosthetic outcomes.     

The Use of 3D Printed Tooth Preparation to Assist in Teaching and Learning in Preclinical Fixed Prosthodontics Courses

Tooth preparation for fixed dental prostheses is not an easy procedure to understand spatially, especially for first‐year dental students. This technical report describes an innovative technique for assisting learning in preclinical fixed prosthodontics courses. Ideal full‐contour tooth preparations are digitally scanned and 3D printed to the exact specifications of the ideal preparation. Students and faculty use these printed tooth preparations as teaching and learning tools to facilitate in 3D visualization for fixed prosthodontics courses.     

CAD-CAM–fabricated interim fixed complete-arch implant-supported restorations based on the existing dentition

An interim restoration is often used to assess the patient's functional and esthetic needs for implant-supported complete-arch fixed prostheses. A digital protocol for accurately transferring information from the existing dentition to the interim restoration is required. The purpose of this clinical report was to describe a digital workflow to fabricate an interim fixed restoration by using the vertical dimension of occlusion and occlusal relationship from the original dentition to provide an accurate, efficient, and predictable computer-aided design and computer-aided manufacturing (CAD-CAM) interim complete-arch implant-supported restoration.     

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.     

牙列重度磨损咬合重建修复治疗方法的探讨

目的 探讨牙列重度磨耗患者行固定义齿咬合重建修复的可行性.方法 结合1例牙列重度磨耗患者,咬合垫佩戴3个月后,制作过渡性修复体,口内观察1年,然后行上下颌固定义齿最终修复,经过这一序列诊疗过程完成咬合重建.结果 患者使用最终修复体2年,美观满意,咀嚼效率良好,无咀嚼系统肌肉及颞下颌关节不适症状.结论 牙列重度磨耗的固定义齿咬合重建修复是一个复杂的序列治疗过程,治疗效果是满意的.     

Facially generated and cephalometric guided 3D digital design for complete mouth implant rehabilitation: A clinical report

Harmony among the teeth, lips, and facial components is the goal of prosthodontic treatment, whether performed by conventional or digital workflow methods. This clinical report describes a facial approach to planning computer-guided surgery and immediate computer-aided designed and computer-aided manufactured (CAD-CAM) interim complete-arch fixed dental prostheses on immediately placed dental implants with a digital workflow. A single clinical appointment for data collection included dentofacial documentation with photographs and videos. On these photographs, facial reference lines were drawn to create a smile frame. This digital smile design and sagittal cephalometric analysis were merged with 3-dimensional scanned casts and a cone beam computed tomographic file in virtual planning software, thus guiding virtual waxing and implant positioning. Computer-guided implant surgery and CAD-CAM interim dental prostheses allowed esthetic and functional rehabilitation in a predictable manner and integrated with the patient’s face.     

Esthetic Interim Acrylic Resin Prosthesis Reinforced with Metal Casting

Fabrication of an interim prosthesis is an important procedure in oral rehabilitation because it aids in determining the esthetics, phonetics, and occlusal relationship of the definitive restoration. The typical material (acrylic resin) used in interim prostheses commonly fails due to fractures. During extended oral rehabilitation with fixed partial prostheses, high strength interim prostheses are often required to protect hard and soft tissues, avoid dental mobility, and to allow the clinician and patient a chance to evaluate cosmetics and function before the placement of the definitive prosthesis. Furthermore, a satisfactory interim prosthesis can serve as a template for the construction of the definitive prosthesis. The maintenance of this prosthesis is important during treatment for protection of teeth and occlusal stability. Procedures to reinforce interim prostheses help to improve performance and esthetics in long-term treatment. Due to the low durability of acrylic resin in long-term use, the use of reinforcing materials, such as metal castings or spot-welded stainless steel matrix bands, is indicated in cases of extensive restoration and long-term treatment. This paper describes an easy technique for fabricating a fixed interim prosthesis using acrylic resin and a cast metallic reinforcement.     

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.     

Direct technique for the fabrication of acrylic provisional restorations

Provisional restorations are fabricated to protect the prepared tooth structure during the period between tooth preparation and insertion of the definitive restoration. These restorations are also referred to in the literature as interim, temporary, or provisional restorations (prostheses). Such restorations should be uncomplicated and inexpensive to fabricate in a short period of time. Several laboratory and clinical techniques for the fabrication of provisional restorations have been described in the literature, such as the indirect technique, direct technique, and indirect-direct techniques for both single and multiple unit restorations. This article describes a step by step clinical technique for the fabrication of a direct provisional restoration to satisfy the issues of esthetics, patient comfort, speech and function, maintenance of periodontal health, and maxillomandibular relationships while wearing the restoration.     

Removable Partial Denture in Combination with a Milled Fixed Partial Prosthesis as Interim Restorations in Long-Term Treatment

Interim restorations are frequently used in prosthodontic treatments. Many complex situations require the combination of fixed and removable partial prostheses. An appropriate interim restoration design that accurately implements the treatment plan is necessary to prepare the oral cavity for the prostheses, and to contribute to the preservation and health of remaining natural teeth, bone support, and gingival tissues. This report describes a modified technique for construction of interim restorations with a combination of fixed and removable partial prostheses. The technique consists of the construction of a milled fixed prosthesis and removable partial denture with metallic framework for use during extensive treatment, improving masticatory function and esthetics and preserving the periodontal health of supporting structures. This interim restoration can also serve as a template for the definitive restoration, allowing patient and dentist to evaluate appearance and function and helping to ensure the success of the definitive restoration.     

Splinting osseointegrated implants and natural teeth in partially edentulous patients: a systematic review of the literature

Dental implants in partially edentulous patients are a predictable therapeutic option. In patients with reduced bone volume, tooth-to-implant connected prostheses have been described as a treatment option. In this systematic review, the incidence of biologic and technical complications and the long-term survival rates of tooth-implant supported fixed partial dentures (FPDs) are analyzed. In cases where a natural tooth is connected with an implant to support a FPD, a rigid connection should be preferred.     

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.     

Guided tooth preparation device fabricated with a complete digital workflow: A dental technique

Guided tooth preparations allow clinicians to provide fixed dental prostheses for dentate patients in an efficient manner. One approach uses a digital preparation device technique where the preparation of a tooth needing a crown is guided by a device. Compared with conventional techniques, this method allows for accurate abutment preparation more efficiently and with improved quality. By controlling tooth preparation, this method preserves natural tooth structure and provides adequate clearance for the restorative material. To illustrate this technique, an adhesive minimally invasive fixed complete-mouth rehabilitation was provided by using a 3D-printed digital preparation device.