A fully digital approach to replicate functional and aesthetic parameters in implant-supported full-arch rehabilitation

Purpose

The aim of this technical procedure was to use a fully digital technique (FDT) for full-arch implant support rehabilitation. The FDT was used to transfer the provisional restoration parameters to definitive restorations using intraoral scanners.

Digital Custom Impression Technique to Record Emergence Profile and Fabrication of an Esthetic Implant Supported Restoration

One of the challenges in esthetic implant supported restorations is to replicate the emergence profile of soft tissue contours created by provisional restorations. Various analog techniques have been used to achieve the most esthetic and natural emergence profile in final restorations. The evolution of digital dentistry has made dentistry easier and efficient albeit with a learning curve. The technique described here uses digital technology to describe a complete digital workflow from the provisional stage to the final restoration.     

临时冠对美学区单颗种植修复体美学效果的影响

目的：观察在单颗上前牙的种植修复病例中使用临时冠与否对最终美学效果的影响。方法：收集70例上前牙种植修复病例,A组在二期术后使用临时冠（30例）,B组在二期术后使用愈合基台（40例）。采集所有病例戴入永久修复体后的口内临床数码照片,由一位种植科医生用红白美学指数对其评分。对评分结果进行非参数统计分析,比较2组病例的得分有无差异。结果：A组红色美学指数评分结果（均值8.03±1.38）高于B组（均值6.80±1.73）,差异有统计学意义。其中,A组近远中龈乳头2个参数得分高于B组,差异有统计学意义。结论：在美学区的种植修复病例中,使用临时冠有助于改善最终戴牙后的软组织美学效果,特别是对龈乳头的恢复非常有帮助。     

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.     

A Simplified Technique for Creating a Customized Gingival Emergence Profile for Implant‐Supported Crowns

A successful implant restoration is one that will allow adequate function and esthetics. Soft‐tissue management around implant‐supported restorations continues to present a considerable challenge for the restoring dentist as well as the laboratory technician while fabricating the final prosthesis. This article presents a simplified and economical technique to direct gingival tissue healing, as well as create a removable gingival replica of the customized gingival emergence profile. The created profile can then be used in the dental laboratory to achieve a superior and predictable esthetic outcome for implant‐supported fixed restorations.     

Esthetic potential of single-implant provisional restorations: selection criteria of available alternatives

Provisional implant restorations are essential tools used to optimize the esthetic outcomes for single-tooth implant restorations. This article describes three groups of available alternatives and the specific options within each group including removable prostheses (interim removable partial denture, vacuum-formed appliance), tooth-supported prostheses (bonded extracted or denture teeth, cast metal or fiber-reinforced resin-bonded fixed partial denture [FPD], wire-retained resin-bonded FPD, acrylic resin provisional FPD), and implant-supported fixed prostheses (implant-retained provisional restoration). Advantages and disadvantages as well as fabrication guidelines for each option are provided. The author proposes that the restorative dentist consider eight criteria in selecting the most appropriate type of provisional prosthesis for a specific patient situation including the esthetic potential, patient comfort, treatment time, laboratory cost, occlusal clearance, ease of removal, durability, and ease of modification. The patient's esthetic expectations are critical in determining the most suitable type of provisional restoration. Esthetically pleasing provisional restorations are part of the evolving implant continuum, making implant dentistry more appealing to practicing dentists and potential patients. CLINICAL SIGNIFICANCE: Provisional restorations for single implants have evolved from temporary expedients during osseous and soft tissue integration to critical therapeutic tools used to assess patient expectations, communicate with the laboratory, and optimize definitive implant treatment. The selection of the type of provisional restoration may significantly influence esthetics during the period of implant integration and soft tissue healing. However, it is unlikely that there is a direct correlation between the type of provisional restoration used and the esthetic outcome of the definitive prosthesis.     

Interim Prosthesis Options for Dental Implants

Dental implants have become a popular treatment modality for replacing missing teeth. In this regard, the importance of restoring patients with function during the implant healing period has grown in recent decades. Esthetic concerns, especially in the anterior region of the maxilla, should also be considered until the definitive restoration is delivered. Another indication for such restorations is maintenance of the space required for esthetic and functional definitive restorations in cases where the implant site is surrounded by natural teeth. Numerous articles have described different types of interim prostheses and their fabrication techniques. This article aims to briefly discuss all types of implant‐related interim prostheses by different classification including provisional timing (before implant placement, after implant placement in unloading and loading periods), materials, and techniques used for making the restorations, the type of interim prosthesis retention, and definitive restoration. Furthermore, the abutment torque for such restorations and methods for transferring the soft tissue from interim to definitive prostheses are addressed.     

个性化基台-冠一体式临时修复体在美学区种植修复中的应用

目的本文针对美学区种植修复中软组织塑形的难题,介绍了一种改良的个性化基台-冠一体式临时修复体的设计制作方法。方法牙种植体植入3个月后,通过数字化技术镜像缺失牙对侧同名牙的形态,设计制作个性化基台-冠一体式临时修复体,佩戴3个月后观察种植体周软组织塑形效果,制作、戴入永久修复体并随访1年。结果患者戴入永久修复体后随访一年,种植体周软组织塑形效果稳定,粉红色美学评分稳步上升达12分。X线根尖片显示种植体周边缘骨水平稳定。结论个性化基台-冠一体式临时修复体应用于美学区种植修复取得了良好的软组织塑形效果。     

前牙美学区单颗牙种植后暂时性修复

随着口腔种植技术的成熟和发展,越来越多的患者首选种植义齿修复缺失牙.前牙缺失常需要形态美观、结构稳定的暂时修复体来恢复种植手术愈合期内前牙的美观和功能.暂时性修复体有助于牙龈的成型和维持,有助于医技沟通,有助于获得患者对医生的信任.同时,依据暂时修复体使用反馈的信息可指导永久义齿的设计制作.因此,暂时修复体在种植修复中起重要作用.临床医生应掌握各类暂时修复体的优缺点,依据患者个性化需求和临床适应症,选择最合适的暂时修复措施,以达到保护种植体,恢复美观及功能的目的.     

A three-die cast technique for duplicating free gingival form in zirconia crowns: two case reports

This report describes a duplication technique of free gingival form from a provisional restoration to a zirconia crown. Three die casts were manufactured from a silicone impression with an acrylic resin ring tray. The first die cast was for the zirconia framework, the second for the provisionalized transfer coping, and the third for relining the provisional restoration. A free gingival impression was taken using a provisionalized transfer coping, and a soft gingival cast was manufactured. The depth of free gingival transparency was measured using a zirconia shade plate. Then, the zirconia framework was customized to allow for subgingival porcelain space. This technique seems to contribute to the clinical-laboratory interface in computer-aided design/computer-assisted manufacture restorations.     

Influence of abutment material on the gingival color of implant-supported all-ceramic restorations: a prospective multicenter study

Purpose: The aim of this clinical research on implant‐supported restorations is to analyze, through spectrophotometric digital technology, the influence of the abutment material on the color of the peri‐implant soft tissue. Material and methods: Twenty patients received an endosseous dental implant in the anterior maxilla. At the time of each definitive prosthesis delivery, an all‐ceramic crown has been tried on gold, titanium and zirconia abutment. After the insertion of each single abutment, the peri‐implant soft tissue color has been measured through a spectrophotometer. Also, the thickness of the facial peri‐implant soft tissue was measured at the level of the implant neck through a caliper. A specific software has been utilized to identify a specific tissue area and to collect the data before the statistical analysis in Lab^* color space. The normality of the quantitative variables was verified by means of the Shapiro–Wilk test. Simple linear correlation between quantitative variables was evaluated by using Pearson's coefficient. The results on the performance of the abutment materials with regard to the color measurements and the overall measurement ΔE were described by computing the least‐square means. The significance of differences among types of abutment was verified by means of the Scheffe test for multiple comparisons. Results: For all the abutments used, the color of the peri‐implant soft tissue appeared to be significantly different from the one of the contra‐lateral tooth (ΔE>8.5). Significantly higher (P<0.05) difference were present with the use of titanium abutments (11 ± 0.4) when compared with the results of gold (8.9 ± 0.4) and zirconia (8.5 ± 0.4) abutments. No correlation has been demonstrated between soft tissue thickness and degree of color difference (P>0.25). Conclusions: Within the limitation of the present study, the peri‐implant soft tissue color appears to be different from the soft tissue color around natural teeth, no matter which type of restorative material is selected. When titanium abutment was selected, significantly higher differences were present than those obtained with gold or zirconia abutments. The thickness of the peri‐implant soft tissue did not appear to be a crucial factor in the abutment impact on the soft tissue color. To cite this article:
Bressan E, Paniz G, Lops D, Corazza B, Romeo E, Favero G. Influence Of abutment material on the gingival color of implant supported all‐ceramic restorations: a prospective multicenter study
Clin. Oral Impl. Res. 22 , 2011; 631–637.
doi: 10.1111/j.1600‐0501.2010.02008.x     

种植暂时修复体在上颌前牙种植美学修复中软组织处理技术

目的:种植美学修复中对于种植体周围软组织的精确塑形并将最终塑形好的软组织轮廓精确的转移到模型上,这一中间环节对种植的最终美学修复效果至关重要。本研究目的旨在探讨种植美学修复中应用种植暂时修复体对种植体周围软组织进行诱导塑形的技术要点及其临床效果。方法:2005年10月至2009年2月共57例连续在北京大学口腔医院种植科就诊的上颌前牙缺失患者纳入本研究,所有患者均采用种植暂时修复体对种植体周围软组织进行诱导塑形,并对最终种植修复体进行修复效果的美学评估。美学评价指标包括牙龈乳头水平及种植体唇侧软组织丰满度。结果:57例患者共植入73枚种植体,平均追踪时间32.7个月(24-64个月),至最后一次复查未见种植体脱落。57例中单牙缺失43例,相邻2个牙位缺失7例,多牙缺失7例。修复后6个月与修复后2年相比牙间乳头由I度变为I I度2个牙位;牙龈唇侧丰满度由I I度变为I度2个牙位,I度变为0度4个牙位,但无统计学差异(P>0.05)。结论:尽最大可能保存软硬组织的形态结构并重建与重塑软组织是治疗过程中需要考虑的主要因素。而修复过程中应用种植暂时修复体对种植体周围软组织进行诱导塑形,精确确定基台及上部结构的的形态与大小,将对最终美学修复效果起到至关重要的影响。     

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。     

Direct custom implant impression copings for the preservation of the pontic receptor site architecture

The direct custom implant impression coping technique is designed to record the periimplant gingiva and pontic receptor site after the tissues have been shaped with a provisional restoration. The technique prevents inaccurate recording of the gingival architecture by using a dual polymerizing composite resin placed into the sulcus and pontic receptor sites and adapted to the open tray implant impression copings. This technique may improve soft tissue accuracy between the clinical condition and the laboratory cast.     

美学区单牙即刻种植即刻诱导牙龈成形的临床观察

目的观察美学区单牙即刻种植即刻采用临时冠进行牙龈诱导成形的临床效果。方法 2012年3月—2014年9月,选择满足适应证的上颌前牙单牙即刻种植修复患者共45例,随机平均分为A、B、C 3组,每组15例。A组术后即刻采用临时冠进行牙龈诱导成形;B组术后延期采用临时冠诱导牙龈成形;C组术后只安装愈合基台过渡,3个月后进行永久冠修复。修复完成后当天、6个月及12个月,以红色美学指数(PES)对种植体周围软组织进行美学评价;同时在永久修复一年后以视觉模拟评分法(VAS)对患者进行美观满意度调查。结果在追踪评估期间内,A、B、C 3组病例永久修复完成当天PES评分分别为(12.17±1.26)、(11.69±1.08)、(8.73±1.02),统计学分析可见A、B两组之间差异不明显(P>0.05),A、C和B、C两组差异显著,具有统计学意义(P<0.05)。另外,一年后随访调查发现A组患者的美观满意度(92.6%)也明显高于B、C组(87.3%、69.6%)。结论美学区单牙即刻种植即刻采用临时冠诱导牙龈成形技术,临床上具有可行性、短期美学效果可靠,患者满意度较高,但需要严格把握适应证。     

Maintaining and enhancing gingival architecture in fixed prosthodontics

The long-term success of fixed prosthodontic restorations is greatly dependent upon the health and stability of the surrounding periodontal structures. This article deals with the interrelationship between fixed prosthodontic procedures and the stability and health of the periodontium. The commonly encountered problem of alterations in gingival architecture is examined in relation to tooth preparation as well as soft tissue preparation. In addition, the ability of the provisional restoration to guide soft tissue form is discussed as well as the role of the final restoration in providing long-term tissue maintenance. Key factors such as margin placement, tissue damage during tooth preparation, the role of the provisional restoration, tissue injury during impression procedures, crown contour, pontic design, and embrasure design are covered in detail.     

Tissue alterations at implant-supported single-tooth replacements: a 1-year prospective clinical study

Objectives: The aim of this prospective study was to evaluate dimensional alterations of the peri‐implant tissues at single‐tooth restorations from the time of implant placement to 1‐year post‐loading. Material and methods: Eleven patients, aged 18–36 years, subjected to single‐tooth replacements with implant‐supported restorations (Brånemark implant^® system) in the maxillary anterior region were included in the analysis. The implant installation was performed as a two‐stage procedure with a 6‐month healing interval. Bone dimensions were determined by direct assessments immediately following implant placement and at abutment connection. The prosthetic restoration was placed approximately 1 month after abutment surgery. Radiographic and clinical examinations were performed at crown placement and at 1‐year post‐loading. Assessments of the soft tissues at the implant site and at the neighboring teeth were performed before and during implant placement, before abutment connection, after crown placement and at the 1‐year follow‐up examination. Mean values and standard deviations were calculated for each variable and interval, with the subject as the statistical unit. Results: At the time of abutment connection, a mean loss of bone height at the facial and lingual aspect of the implant amounting to 0.7–1.3 mm (P<0.05) was recorded, whereas no significant change was noted at proximal sites. A mean reduction of 0.4 mm of the labial bone thickness was observed between implant placement and the second‐stage surgery. The radiographic bone‐to‐implant level showed a mean loss of 0.9 mm between abutment connection and crown placement (P<0.05) and a further 0.7 mm loss at 1 year (P<0.05). The thickness of the labial mucosa was increased at crown placement followed by a slight remission at 1 year. During the corresponding interval, a mean apical displacement of the labial soft tissue margin of 0.6 mm had taken place (P<0.05). A papilla fill of ≥50% was observed at a frequency of 32% at crown placement and 86% at 1 year. Conclusions: The results demonstrated that following implant surgery remodeling takes place, which is manifested in diminished bone dimensions, both horizontally and vertically, at the facial aspect of the implant. The observed soft tissue alterations after the crown placement may affect the esthetic appeal of the restorative therapy.     

Immediate provisional restorations to aid in gingival healing and optimal contours for implant patients

A procedure for making an impression at stage I implant surgery is described, and the sequential laboratory procedures for fabricating a custom provisional restoration are presented. The provisional restoration is delivered at the uncovering of the implant, providing a template for the tissue healing with desired contours. This procedure facilitates the fabrication of implant restorations with optimal gingival contours and esthetics.     

Technique for fabricating a cement-retained single-unit implant-supported provisional restoration in the esthetic zone

The fabrication of provisional restorations is an important stage in implant treatment. In the esthetic zone, the potential for error without the use of provisional restorations in the selection of the abutments, framework design, appropriate vertical dimension of occlusion, occlusal profile, and the esthetic interpretation may be significant. Provisional restorations are indicated in esthetic zones, for the contouring of the gingiva, to achieve an acceptable emergence profile, to have custom-guided tissue healing, and to induce appropriate soft-tissue topography. This article describes the fabrication of a provisional restoration for a single-unit implant-supported crown.