Bonded provisional restorations for esthetic soft tissue support in single-implant treatment

During the early phases of single-implant treatment, clinician needs and patient expectations can be challenging. This article describes a technique for making a simple bonded provisional restoration. In addition to minimizing patient discomfort without increasing laboratory costs, the technique enables soft tissue preservation through all treatment phases, from tooth loss to implant loading.     

暂时修复体的临床应用与材料选择

良好的暂时修复体有利于永久修复,但临床医生常因其使用时间短而忽略其制作。本文在回顾暂时修复体临床应用的基础上,总结其在口腔治疗中的临床意义及两种常用的暂时修复材料。     

Crowns and other extra-coronal restorations: provisional restorations

The important role of provisional restorations is often overlooked. This may be because they are left until the end of an appointment when time for construction is short or because they generally do not need to last for long. However, not only can good provisional restorations help produce better final restorations, they can also save a lot of time and expense at subsequent appointments. In fact time spent in their construction will be more than repaid in time saved doing additional procedures, adjustments and remakes later on.     

Abutment screw loosening in single-implant restorations: a systematic review

PURPOSE: The purpose of this study was to systematically review clinical studies on the incidence of abutment screw loosening in single-implant restorations with different implant-abutment connection geometries. MATERIALS AND METHODS: The literature search was conducted using several electronic databases. Specific terms were used for the database search, which spanned the years 1990 to 2006. The search was augmented by using the option of "related articles" as well as hand searching of references and relevant journals. Relevant studies were selected according to predetermined inclusion and exclusion criteria. Agreement between reviewers was determined by using Cohen's kappa coefficients. Three-year complication-free rates (survival proportions) were calculated with the aid of a survival function, assuming constant failure rates. Summary estimates per group for complication-free rate after 3 years (M-estimator) were calculated using Tukey's biweight estimator. RESULTS: The initial database search yielded 1,526 relevant titles. After the subsequent filtering process, 27 studies were finally selected. Interexaminer agreement ranged from good to perfect. The external-connection group comprised 12 studies following 586 single-implant restorations for a mean follow-up time that ranged from 3 to 5 years. The estimated percent of complication-free single-implant restorations after 3 years was 97.3% (95% CI: 95.6-98.3). The internal connection group comprised 15 studies following 1,113 single-implant restorations for a mean follow-up time that ranged from 3 to 10 years. The estimated percentage of complication-free single-implant restorations after 3 years was 97.6% (95% CI: 96.5-98.3). CONCLUSION: The results show that abutment screw loosening is a rare event in single-implant restorations regardless of the geometry of implant-abutment connection, provided that proper antirotational features and torque are employed.     

Color characterization of provisional restorations

Esthetics is required for some provisional restorations. Acrylic resin stains can be used to develop natural appearing restorations with external and internal techniques. The use of a custom-made shade guide aids the dentist in selecting the desired pigment, and determining the need for external or internal staining.     

Technique for cementation of provisional restorations

A technique for cementation of a provisional resin splint or crown has been presented. The splint is lubricated with silicone grease and cemented with a noneugenol cement mixed with antibiotic ointment. The grease aids in the complete removal of the cement. The use of a sterile composite resin syringe and preloaded disposable tip allows delivery of the grease to the splint with minimal chance of bacterial cross contamination to the patient.     

Fabrication of provisional acrylic resin restorations

A technique for transitional restoration fabrication has been described. It permits modifications of existing axial and occlusal tooth contours to be accurately reproduced in transitional restorations.     

一步一步做好美学临时修复

美学设计、美学表达和美学实现是口腔美学修复诊疗的3个阶段。临时修复体是美学表达的重要手段,是美学设计和美学实现的桥梁和纽带。临时修复体的功能包括美学诊断、功能诊断和软组织美学处理。本文重点讨论口腔美学修复中临时修复体的功能、类型和临床应用。     

Clinical outcome study of customized zirconia abutments for single-implant restorations

PURPOSE: This study evaluated the clinical performance of cemented customized zirconia abutments. Additionally, the marginal fit between the selected implant components was measured and the clinical gingival response was monitored. MATERIALS AND METHODS: Twenty-five patients were consecutively selected for a prospective study of 30 implant-supported single-tooth restorations. Customized titanium post and zirconia abutment complexes were prepared, and scanning electron microscopy (SEM) analysis was used to study bicomponent marginal gaps. The abutments were screwed onto the implants and restored with all-ceramic crowns. Plaque and gingival indices were recorded at 6 monthly intervals over a 36- to 44-month period. RESULTS: SEM analysis showed mean marginal gaps of 10.161 microm (SD: 0.7) horizontally and 4.783 microm (SD: 0.67) vertically. Abutment fractures and screw loosening were neither reported nor observed throughout the clinical observation period. Mean Plaque Index scores were 0.57 (SD: 0.32) on abutments and 0.74 (SD: 0.34) on teeth, while mean Gingival Index scores were 0.54 (SD: 0.2) on abutments and 0.72 (SD: 0.3) on teeth. CONCLUSIONS: These preliminary results suggest that metallic-zirconia abutments may be comparable to currently available esthetic implant abutments.     

Esthetic modification of cast dental-ceramic restorations

The advantages and disadvantages of conventional opaque substructures (eg, metal ceramic restorations) used for creating esthetic complete crown restorations are reviewed, and the esthetic advantages of veneering a translucent crown (Dicor) are considered. An appropriate aluminous veneering porcelain was identified (Vitadur Veneer). This veneer porcelain was chosen to match the thermal coefficient of expansion of the cast glass-ceramic substructure. A flexural strength study was then completed and it showed no difference in the strength of the veneered and nonveneered translucent cast glass-ceramic specimens. Scanning electron microscopy revealed that the interface between the porcelain veneer and cast glass-ceramic substructure had no visible porosity and resulted in a continuous-appearing structure. Potential coping designs, as well as the clinical applications and ramifications of this modified crown, are discussed.     

Esthetic outcomes with porcelain-fused-to-ceramic and all-ceramic single-implant crowns: a randomized clinical trial

Objectives: The aim of this randomized‐controlled clinical trial was to compare the objective and subjective esthetic outcomes of two types of screwed‐retained single‐implant crowns. Materials and methods: Participants were randomly assigned to the test (all‐ceramic) and control [porcelain‐fused‐to‐ceramic (PFM)] groups and were seen under investigation at baseline (B), crown insertion (CI), 1‐year follow‐up (1Y), and 2‐year follow‐up (2Y). Objective parameters were assessed by an intra‐oral digital photograph (1 : 1 ratio), a study cast, a standardized radiograph, periodontal/peri‐implant measurements, and questionnaires were obtained for the subjective parameters. In addition, pink esthetic score (PES) and white esthetic score (WES) were calculated for both groups. For the subjective evaluation, a visual analogue scale (VAS) questionnaire was used to assess the level of patient satisfaction regarding the esthetic outcome. Then, nine expert clinicians visually inspected and assessed subjective evaluation at the professional level. Statistical analysis was used to compare between groups and investigational appointments. Results: Twenty patients were included in the study, 10 allocated to the all‐ceramic group and 10 to the PFM group. No statistically significant differences were observed for the objective measurements comparing the test and control groups. Minor chipping of the ceramic veneering material was observed in the two patients of control group. The mean difference for all groups comparing objective parameters revealed an increase of papilla height between time points. A slight recession (0.26 mm) of the peri‐implant mucosal margin at the implant site was observed between 1Y and 2Y. Mean values for PES and WES were 13.9 and 13.1 for the PFM group and for the all‐ceramic group, respectively. These values were not statistically significant. Implant crown volume, outline, translucency, and characterization showed major discrepancies with the contra‐lateral natural teeth. As for subjective parameters, VAS patients' responses regarding their perceptions of the esthetic outcome showed no statistical differences betwen groups and clinicians' accuracy scores were 50% and 47% for PFM and all‐ceramic crowns, respectively. Conclusion: PFM and all‐ceramic single‐implant restorations may be indistinguishable from each other regarding the objective/subjective assessment of esthetic integration. The material chosen for fabricating an implant crown per se does not ensure an optimal esthetic outcome if other esthetic parameters are not present. To cite this article:
Gallucci GO, Grütter L, Nedir R, Bischof M, Belser UC. Esthetic outcomes with porcelain‐fused‐to‐ceramic and all‐ceramic single‐implant crowns: a randomized clinical trial.
Clin. Oral Impl. Res. 22 , 2011; 62–69.
doi: 10.1111/j.1600‐0501.2010.01997.x     

Biologic outcome of single-implant restorations as tooth replacements: a long-term follow-up study

Background: The replacement of a single tooth or several teeth by means of single‐implant restorations is an increasingly used method that needs long‐term validation. Purpose: The goal of this study was to evaluate the outcome of single‐implant restorations by means of fixed restorations and to define the prognosis through marginal bone level estimations. Materials and Methods: From November 1986 to June 1998, 270 Brånemark implants (215 in the upper jaw) were installed in 219 patients (106 males). Both anterior and posterior sites were involved. Of the 263 single restorations, 28 were placed in private dental offices. The patients were followed until June 1999. Results: Twelve implants failed before or at abutment connection or within 6 months afterward. Only four implants failed later. The cumulative success rates were 93% for the implants and 96.5% for the restorations over a period of 11 years. The marginal bone loss during the first 6 months after abutment connection reached 0.71 mm and then dropped to 0.036 mm annually over a period of 10 years. Conclusions: Single‐implant restorations (Brånemark System) are a reliable treatment with a good long‐term prognosis. Failures were concentrated during the healing period and early loading phase.     

In vitro color stability of provisional restorations

A provisional restoration must protect the prepared tooth, provide comfort and function and be esthetically acceptable and color stable. This study measured the degree of color change of provisional restorations. Five commercially available resins were evaluated: Trim, Tab, Kind, Snap and Duralay. Five cylindrical samples of each resin were fabricated by mixing the powder and the liquid to a predetermined ratio and pouring the mix into a mold. The Minolta Chroma Meter II Reflectance was used to establish the baseline color L* a* b*. The resins were then subjected to accelerated in vitro aging in a Weather-O-Meter and color readings were recorded. The color differentials on delta E* were computed for each sample (delta E*ab = [(delta L*)2+(delta b*)2]1/2). The difference is a quantitative measurement of color change. The National Bureau of Standards describes delta E* as units (NBS Unit = delta E*ab x 0.92). With this parameter only the allowable delta E*ab need be specified rather than the range of allowable L*, a*, b* values. This is important for color comparison and quality control functions. The results showed that Kind had a slight color change delta E* = -1.72, Trim demonstrated the most color change delta E* = -13.84, while the remaining resins demonstrated a noticeable change in color due to in vitro aging.