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牙齿美学修复是当今临床工作中的一个热点,作为修复流程中的基础,印模的制取将直接影响修复体的质量。要制取合乎标准的印模,必须了解美学修复印模的特点、印模前龈组织的处理、印模材料的特性及其操作要点,从院内感染控制的角度,还应重视对印模的消毒工作。     

Prosthetic solution for unfavorably inclined maxillary implants: a case report

Misaligned implants may affect the esthetic, phonetic, and functional results and challenge the restorative dentist. Proper attachment selection is important considering the patient-related circumstances. This article presents a case where a change in prosthetic attachments was required because implant inclination diminished overdenture retention and stability. The treatment involved an alternative implant and soft-tissue impression technique.     

Modified Complete‐Arch Impression Technique for Facilitating Esthetic and Biomechanical Precision in Complete‐Arch Rehabilitation

Treating complex cases is clinically and technically challenging, yet highly rewarding to both patient and clinician when successfully completed. Precision in the fit of the restorations, the definitive occlusal scheme, and the esthetic result are the key elements to long‐term success. Clinicians should aim to achieve the same level of precision when treating these cases as they do when treating simple cases; however, with the numerous stages and increased complexity involved comes the potential for errors to compound and magnify as treatment progresses. Areas particularly prone to difficulties are the making of a complete‐arch impression and the ability to maintain patient comfort and eliminate unwanted dental emergencies throughout the time‐consuming treatment. This report illustrates the techniques and concepts used to achieve esthetic and biomechanical precision when treating complex cases. Specific emphasis is placed on the importance of an accurate complete‐arch impression technique, the detail of which is described in the article.     

The method of esthetic crown restoration with composite resin jacket crown in primary molars

The term "esthetics" has recently been also used in the dental field, and a field called esthetic dentistry is increasingly being noted. The number of not only adult but also pediatric patients who visit for treatment aiming at esthetic recovery is being increased. Inpedodontics, composite resin of the coronal color is generally used in the restoration of deciduous incisors. However, the method using metal crowns for the deciduous teeth is used for the deciduous molars at present. We applied a composite resin jacket crown to the deciduous molar in a way similar to that of esthetic crown restoration for the anterior teeth. The surgical procedure before crown preparation varied slightly according to the presence or absence of pulpal treatment of vital teeth and with non-vital teeth, but the application was performed as follows: 1) Desensitization of pulp, pulpal treatment and core construction. 2) Preparation of crown. 3) Selection, trial set and occlusal equilibration of a metal crown for the deciduous tooth. 4) Precision impression with a silicone impression material. 5) Removal of the metal crown for the deciduous tooth from the impression material. 6) Making of an under-cut to the abutment tooth on the buccal lingual side. 7) Filling of the impression with chemical polymerization resin. 8) Application of pressure in the oral cavity. 9) Adjustment of edge and crown forms. Thus, the preparation method for the composite resin jacket crown was relatively simple. Since this surgery, the patient has been followed up for 1 year and 6 months, and no specifically troublesome points have been observed clinically. The patient and her parents are satisfied with the results.(ABSTRACT TRUNCATED AT 250 WORDS)     

Important factors for accurate impressions

A great preparation is only as good as the impression and die made of it. Attention to every detail is necessary for a successful clinical result. By observing the clinical results, each individual dentist's experience will show the observant operator which technique works best. By combining experience, attention to detail, and patience, it is possible to achieve great fitting, adjustment-free esthetic dentistry.     

Implant-supported titanium prostheses following augmentation procedures: a clinical report

BACKGROUND: This report describes a novel technique for fabricating retrievable implant-supported titanium (Ti) prostheses in patients requiring a comprehensive treatment plan involving the combined efforts of maxillofacial surgery and implant prosthodontics. METHODS: Following bone graft reconstructive surgery and implant placement prosthetic treatment was initiated by inserting ITI-Octa abutments. An impression was made, and a framework was fabricated by fusing Ti-cast frameworks to prefabricated titanium copings by laser-welding. This was followed by veneering or fabrication of a removable denture with Ti metal re-enforcement. RESULTS: Favourable clinical results have been achieved using these screw-retained Ti implant-supported restorations for patients treated with reconstructive bone graft-surgery, with clinical observation periods ranging from three to four years. CONCLUSIONS: The present observations suggest that these screw-retained implant-supported Ti prostheses may be a meaningful contribution to implant prosthodontics, facilitating retrievable restorations of optimum biocompatibility, good marginal precision and with a good esthetic result. However, controlled clinical studies are needed to establish the long-term serviceability of these Ti restorations.     

Macroesthetics: facial and dentofacial analysis

Successful esthetic and prosthodontic treatment are inseparable. In esthetic treatment, the goal is an enhanced but natural-looking appearance in which all prosthodontic principles have been taken into account. By the same token, prosthodontic treatment is as much about esthetics as mechanical and biologic requirements. Using all disciplines of dentistry to create a functional and pleasing esthetic impression creates the most successful outcomes. This article reviews pertinent literature and discusses esthetic analysis from a macroesthetic perspective; i.e., taking into consideration the interrelationships of the face, lips, gingiva, and teeth.     

A Technique to Simultaneously Fabricate Multiple Custom Impression Posts for Implant‐Supported Restorations in the Esthetic Zone

Peri‐implant transmucosal tissue, an essential element of peri‐implant esthetics, is critical to the success of prostheses in the esthetic zone. The optimal transmucosal tissue profile can be transferred to the master cast with the aid of custom impression posts. In this clinical technique, the initial cast used to fabricate provisional prostheses was conveniently used to aid in the time‐efficient fabrication of multiple custom impression posts simultaneously using self‐cured acrylic resin. This technique also applies to single restorations. In addition, the use of an initial cast as holder makes it easy to transfer custom impression posts to the mouth accurately and efficiently.     

Indirect implant-supported fixed provisional restoration in the esthetic zone: fabrication technique and treatment workflow

Treatment objectives of an implant-supported fixed provisional restoration include shaping/preservation of the gingival soft tissue contour, functional and esthetic substitution of the missing dentition during postsurgical healing, and definitive prosthesis fabrication stages. Fixed provisional restoration can also serve as an esthetic and functional blueprint in the fabrication of the definitive restoration. Despite its common use and important indications, limited information is available on the various aspects of the provisional fabrication and treatment. This article presents a production technique and treatment workflow of a laboratory-fabricated, screw-retained fixed provisional restoration. Provisional restoration is fabricated using layering technique and internal stain characterization. The soft tissue profile of the working cast is modified according to the coronal contour of the diagnostic wax-up. Upon delivery, the provisional contour is reevaluated and modified as necessary. The developed emergence profile of the provisional restoration is transferred to the master cast via customized impression copings. CLINICAL SIGNIFICANCE: Laboratory-fabricated implant-supported provisional restorations allow the esthetic and functional substitution of the missing dentition and the shaping of the soft tissue profile, and can act as a blueprint in the fabrication of definitive restorations.     

Functional Impressions in Complete Denture and Overdenture Treatment

Tooth loss can cause loss of occlusal, masticatory, esthetic, physiognomic, phonetic and psychosocial function of patients. The most frequently used treatment method of completely edentulous patients and patients with a small number of remaining teeth are complete dentures or overdentures. One of the most important clinical and laboratory procedures in their fabrication is functional impression taking. The aim of this paper was to present procedures of taking functional impressions in fabrication of complete dentures and overdentures, using standardized techniques and materials. An accurate functional impression together with other correctly performed clinical and laboratory procedures ensure good retention and stability of dentures, which is a precondition for restoring patients’ lost functions.Key words: complete denture, overdenture, functional impression     

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.     

Final impressions: a review of material properties and description of a current technique

Esthetic rehabilitations are characterized by a sequence of well-structured clinical and laboratory steps, during which different kinds of impressions are required. This review presents a survey of the most clinically relevant physical properties that characterize final impression materials and their interactions with the products they are commonly in contact with. The principal steps of an esthetic rehabilitation involving a diagnostic phase, together with a rational step-by-step approach to final impressions, are described. The one-step/double-mix impression using polyvinyl siloxane materials associated with a "double cord" gingival displacement is explained.     

The use of sectional impressions and a transfer index for extensive fixed prosthodontic treatment

The philosophy of positioning the margins of crowns supragingivally may not be applicable with the presence of caries, erosion, abfraction (noncarious cervical lesion), short clinical crown length, or esthetic concerns. In such situations, it is essential not only to record precise subgingival details of all of the prepared teeth but also to accurately transfer them to a working master cast. If a patient presents with oral and/or gingival conditions that compromise the clinician's ability to obtain a single full-arch impression for extensive fixed restorations, a technique using sectional impressions, an intraoral transfer index, and a transfer impression for transfer dies will play a vital role in the patient's treatment.     

Composite resin inlays: a single appointment technique

This article presents a time efficient technique for the fabrication and subsequent placement of a composite resin inlay. An inlay preparation is cut into a tooth and a polyvinylsiloxane impression is made. A polyether impression of the polyvinylsiloxane impression forms a die, then a composite resin inlay is fabricated on the die. The inlay is contoured and polished on the die and occlusion is evaluated clinically. The inlay has a final polymerization under intense light and vacuum pressure, then is cemented with a mixture of unfilled resin and hybrid composite. The technique allows an esthetic restoration to be placed in one appointment. The die provides easy access and rapid inlay fabrication. There is no need to place a separator on the prepared tooth, no chance of premature tooth bonding, and interproximal contact is easily achieved.     

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.     

Preservation of Existing Soft‐Tissue Contours in the Transition from a Tooth to an Implant Restoration in the Esthetic Zone Using a Flapless Approach: A Clinical Report

Two‐stage placement of a dental implant is a well‐established method for restoring a missing anterior tooth; however, replacement of an anterior tooth by using two‐stage implant surgery may result in changes in the interdental papilla height and loss of alveolar bone with compromised esthetic results. Alternatively, the use of a one‐stage minimally invasive surgical technique followed by immediate provisionalization may facilitate achievement of esthetic and functional success with minimal discomfort and clinical time. This article presents a clinical case with a single anterior tooth replacement, illustrating ridge preservation with healing, delayed implant placement with immediate provisionalization of the implant to support the soft tissue, and a method of recording the soft‐tissue contour in the final impression to achieve an optimal esthetic result.     

临时冠塑形对前牙种植美学的临床观察

目的 在前牙区通过利用临时冠对种植体周围软组织进行塑形,观察最终修复的美学效果及软组织的稳定性。方法 选取本院种植科21例上前牙需要种植病例,牙种植后即刻或延期行临时冠修复,对种植体周围软组织进行塑形,待软组织稳定后,行个性化转移杆取模,制作最终修复体,使用红色美学指数（PES）来评价种植体周围软组织的美学效果。结果 11例患者PES≥12,9例8≤PES≤11,获得较好的美学效果。1例患者前牙区种植体支持固定桥修复,由于牙槽骨水平吸收,牙龈退缩,后期通过牙龈瓷进行美学处理。21例患者最终修复后观察1年,通过PES再次评价,同样获得较好的美学效果。结论 前牙种植术后利用临时冠对软组织进行塑形,能够将软组织调整到较好的美观外形,并且形态较稳定。此方法在前牙区种植修复是必要的,值得在临床中广泛推广。     

Implant Digital Impression in the Esthetic Area

The aim of this report is to describe two standardized protocols for digital impression when implant support rehabilitation is used in the esthetic area. The two techniques were used to transfer all provisional crown parameters to definitive restorations in different clinical scenarios. In the direct technique, an impression (STL1) is made of the provisional restorations attached to the implants, with surrounding gingival tissue. The second scan (STL2) captures the sulcular aspect of the peri‐implant soft tissue immediately after removal of the provisional restoration. The last impression (STL3) of the complete arch is made with a standardized scanbody attached to the implant to capture the 3D location of the implant. The direct technique is indicated when the peri‐implant soft tissues are stable upon removal of the provisional restoration. The indirect technique is used when the gingival tissue collapses rapidly after the removal of the provisional crown. The impressions of the provisional restoration and the position of the implant are similar to those obtained with the direct technique, and the shape of the peri‐implant tissue is extrapolated from the negative shape obtained from making the digital impression when the provisional restoration is taken out of the mouth. Finally, in both techniques the 3 scans are superimposed to obtain a file, which contains the details of the peri‐implant soft tissue. The direct and indirect digital techniques allowed realization of a predictable definitive restoration in the esthetic zone in different clinical scenarios, reducing the duration of clinical procedures.     

A nontraditional technique for obtaining optimal esthetics for an immediate denture: A clinical report

Bimaxillary protrusion and severe labioversion of anterior teeth complicate impression procedures and increase the difficulty in making esthetic predictions for the immediate complete denture patient. The presented technique, performed in reverse order of traditional methods, is accomplished in stages in which the anterior and nonessential posterior teeth are extracted and interim removable partial dentures placed. An opportunity is thus created to evaluate esthetics, phonetics, and anterior tooth function before extraction of the remaining dentition and delivery of immediate complete dentures. This technique facilitated the determination of the need for alveoplasty of the anterior maxilla.     

The periodontal factor in esthetic smile design--altering gingival display

The periodontal soft and hard tissues are an important determinant of restorative smile esthetics. Management of the periodontal tissues that "frame" each tooth is crucial to esthetic smile design. This article describes a four-step technique that makes it possible to sculpt the position of the labial gingival margin to provide additional crown height or length, a process the author describes as smile sculpting. This periodontal smile sculpting can aid in determining the pre-restorative treatment profile for teeth and create a blueprint for the restorative dentist to enhance a patient's final esthetic treatment results. Crucial to understanding this process is an appreciation of the periodontal principles that govern smile design, especially the periodontal biologic width and the influence of the underlying hard tissue bony architecture in defining the periodontal envelope from which the teeth emerge.