Clinical Reports
Optimizing the esthetic outcome by using screw-retained implant abutment crowns: A 3-year clinical follow-up
This clinical report describes a ceramic complete-mouth rehabilitation with screw-retained implant abutment crowns, optimizing esthetics by combining the properties of ceramic materials. The abutments connected a titanium insert to a computer-aided design and computer-aided manufacturing (CAD-CAM) monolithic zirconia framework, offering improved esthetics and biologic response without negatively affecting the implant abutment interface. Lithium disilicate crowns were cemented extraorally on the abutments, resulting in a screw-retained restoration.Modification of denture teeth for improved occlusal stability of a maxillary removable complete denture opposed by a mandibular implant-supported fixed complete denture: A clinical report
Wear of artificial teeth is the most common complication associated with an implant-supported fixed complete denture (ISFCD). This wear alters the occlusal scheme, with loss of eccentric occlusal balance and vertical dimension of occlusion (VDO). This clinical report describes the fabrication of a new maxillary removable complete denture opposing an existing ISFCD with occlusal modifications. Both prostheses received splinted zirconia crowns cemented with composite resin cement.Esthetic management of white spot lesions by using minimal intervention techniques of bleaching and resin infiltration: A clinical report
Dental fluorosis and hypocalcification manifest as white spot lesions and/or brown discolorations. With dental fluorosis, mottled layers in enamel can also be present depending on severity. Treatment options have varied in such situations, depending on severity, and can range from conservative to more invasive. This clinical report focuses on a combination of bleaching and resin infiltration as one of the more conservative treatment options.Full arch monolithic zirconia prosthesis in a patient with bilateral cleft palate: A clinical report
Adult patients with bilateral cleft lip and palate present unique challenges for prosthodontic treatment because of mobility of the premaxillary segment, oral-nasal communication, multiple missing and malpositioned anterior teeth, unfavorable soft tissues, and scar tissue underneath the maxillary lip. This clinical report describes the prosthodontic treatment of an adult patient with a terminal maxillary dentition and bilateral cleft palate, by using 5 dental implants and a 1-piece complete-arch fixed implant-supported prosthesis made of monolithic zirconia.Weighted mandibular complete denture fabricated by using selective laser melting: A clinical report
The rehabilitation of patients with severely resorbed mandibular ridges can be a clinical challenge when rehabilitation with endosteal implants is not the elected treatment. Historically, weighted mandibular complete dentures have been used successfully to manage patients with severely resorbed ridges, and the weight of their cast metal has been calculated by using the weight of the wax and the density of the alloy. This clinical report presents the management of an 87-year-old woman with a severely resorbed mandibular ridge by using a weighted mandibular complete denture fabricated by using selective laser melting (SLM) technology in which the weight of the metal base was calculated by using the volume of the digital file used for manufacture.Combined use of splinted labial lithium disilicate veneers and a bonded nickel-chromium alloy palatal splint for tooth stabilization: A clinical report with 4-year follow-up
This clinical report describes the restoration of severely compromised maxillary teeth in a 20-year-old woman secondary to excessive root shortening and minimal bone support but surrounded by healthy and esthetic soft tissues. The maxillary bone volume precluded provision of an implant-supported fixed or removable dental prosthesis without extensive grafting procedures. Splinted labial lithium disilicate veneers and a bonded nickel-chromium alloy palatal splint were used to stabilize and retain the structurally compromised maxillary teeth.Mandibular implant-supported fixed complete dental prostheses on implants with ultrashort and standard length: A pilot treatment
The described treatment approach demonstrated the clinical feasibility of providing atrophied mandibles with IFCDPs supported by a combination of anterior regular and distal ultrashort tissue-level implants. This approach combined the advantages of a simplified prosthetic treatment concept: virtual prosthetic and surgical planning, s-CAIS, and novel CAD-CAMBiologically oriented preparation technique for surgically extruded teeth: A clinical report
Surgical extrusion allows a ferrule to be obtained without the use of orthodontic extrusion or the need to remove hard and soft tissues. However, after the healing period, the soft tissue of the extruded tooth might become thinner, creating an unesthetic gingival margin. Unlike other preparation techniques, the biologically oriented preparation technique provides increased long-term gingival thickness. This article describes the treatment of 3 patients with teeth with no ferrule that were surgically extruded and restored with the biologically oriented preparation technique .CAD-CAM approach to designing and fabricating a low-maintenance metal-acrylic resin implant-supported fixed complete dental prosthesis: A clinical report
The metal-acrylic resin implant-supported fixed complete dental prosthesis (IFCDP) is a reliable restorative option. However, clinical complications and laboratory fabrication concerns are associated with these restorations. Maintenance and repair lead to increased chair time, but recently introduced computer-aided design and computer-aided manufacturing (CAD-CAM) materials and technology can improve efficiency and mitigate complications. In this clinical report, the existing design principles and CAD-CAM materials were combined to fabricate a metal-acrylic resin IFCDP that minimized individual tooth fracture and facilitated efficient resurfacing of worn surfaces.Successful splint therapy for embouchure dystonia in a trumpet player
This clinical report describes a straightforward oral device technique that successfully allowed a patient with embouchure dystonia to regain his ability to play the trumpet.Direct composite resin restoration of a class IV fracture by using 3D printing technology: A clinical report
Mimicking the appearance of the adjacent natural tooth is challenging when restoring a fractured anterior tooth. This clinical report describes a modified index technique for restoring a class IV defect. A replica of the restored tooth was fabricated with computer-aided design and 3D printing technology, which precisely mimicked the contralateral incisor. Labial and lingual silicone indices were developed on the replica to transfer the designed contour to the tooth to achieve a highly esthetic and precise restoration.Interdisciplinary approach using composite resin and ceramic veneers to manage an esthetic challenge
This clinical report describes the management of an esthetic challenge in an interdisciplinary manner addressing both the soft tissue and the anterior dentition. Different restorative materials were used in an esthetic and conservative manner to provide a pleasing smile. A minimally invasive approach was adopted to manage the anterior esthetics problems, including a maxillary diastema and inadequate width-to-length tooth proportions.A completely digital workflow for an interim implant-supported crown: A clinical report
This article describes a completely digital workflow for the diagnostic phase, surgical and prosthetic planning, extraction, immediate single implant placement by guided surgery, and interim implant-supported crown. From a virtual impression, zirconia abutments and a polymethylmethacrylate (PMMA) interim crown was planned in a computer-aided design (CAD) software program. This workflow shortened the time required for chairside placement of an interim restoration with enhanced function and esthetics while restoring an anterior mandibular tooth lost after trauma.Alternative approach to salvaging an implant with a fractured screw fragment: A clinical report
Managing fractures of implant abutment screws is challenging because of the uncertainty associated with the removal of the fractured screw fragments. In case of unsuccessful retrieval of the fractured fragment with known techniques, removal and replacement of the implant becomes traumatic and financially burdensome to the patient. This clinical report describes a conservative solution for the management of nonretrievable fractured screws by reconnecting the prostheses to the existing implants by using cut screws.Cast-free digital workflow for implant-supported rehabilitation in a completely edentulous patient: A clinical report
Digitalization of edentulous areas restored with dental implants is still considered a demanding procedure, mainly because of the lack of fixed reference landmarks, together with an increased interimplant distance. To overcome such limitations, an auxiliary device is introduced with the 3-fold purpose of stretching the soft tissues with a fixed object connected to the scan bodies, creating areas with nonhomogeneous architectures between the implants, and shortening the interimplant distance with the interposition of solid geometric figures.Adhesion and optics: The challenges of esthetic oral rehabilitation on varied substrates—Reflections based on a clinical report
Patients with challenging prosthodontic conditions require rehabilitation with a biological, functional, and esthetic approach. When one or more teeth are badly discolored, their restoration is problematic because poor appearance affects not only the crown but also the periodontal tissues. This clinical report describes a complex esthetic rehabilitation with conservative tissue management and ceramic restorations. Subepithelial connective tissue graft surgery and the replacement of a cast metal post with a glass fiber post addressed the problem of a discolored maxillary central incisor.Minimally invasive prosthodontic correction of pseudo class III malocclusion by implementing a systematic digital workflow: A clinical report
This clinical report describes the digital workflow for implementing different virtual and digital aids for the restoration of tooth wear and loss of occlusal vertical dimension (OVD). This conservative approach was implemented in an adult with pseudo class III malocclusion by using computer-aided design and computer-aided manufacturing (CAD-CAM) monolithic lithium disilicate ceramic restorations.Guided residual root preparation for socket-shield procedures: A clinical report
Tooth extraction in the esthetic area is usually accompanied by hard- and soft-tissue changes. The socket-shield technique is an effective method for preventing these undesirable changes. However, difficulty in preparing the socket shield and controlling the implant position might increase the complication rate along with the time needed for the surgery, limiting its widespread use. This clinical report demonstrates a digital protocol for accurate and rapid socket-shield preparation and implant placement with surgical guides.The use of selective laser melting in the fabrication of maxillary and mandibular metal base complete dentures for a patient with Ehlers-Danlos syndrome: A clinical report
Ehlers-Danlos syndrome is a rare hereditary disorder of the connective tissue that can have oral manifestations that can complicate the prosthodontic rehabilitation of edentulous patients. Intraoral features such as fragile mucosa, impaired healing, limited intraoral space, and a deep palatal vault can compromise treatment with conventional complete dentures. This clinical report describes the management of a 30-year-old edentulous man with Ehlers-Danlos syndrome by using metal base complete dentures fabricated with selective laser melting (SLM) technology.Maxillary zirconia and mandibular composite resin-lithium disilicate–modified PEEK fixed implant-supported restorations for a completely edentulous patient with an atrophic maxilla and mandible: A clinical report
Bimaxillary implant-supported restorations for edentulous patients must include a comprehensive diagnosis, treatment plan, and careful selection of the restorative materials. The present clinical report described a completely edentulous patient rehabilitated with a zirconia framework with a facial ceramic veneer on the maxillary arch and a modified polyetheretherketone (PEEK) framework with gingival composite resin and cemented lithium disilicate crowns on the mandibular arch. The rationale for this combination of restorative materials is reviewed.A 3D printing replication technique for fabricating digital dentures
Digitally fabricated dentures allow clinicians to provide new prostheses for edentulous patients in an efficient manner. One approach uses a replication technique where a prosthesis in need of minor alterations is used as a basis for the definitive prosthesis. Compared with conventional duplication techniques, this method allows for the predictable fabrication of accurate dentures in less time and with increased quality. In this clinical report, interim treatment dentures were scanned and 3D printed to make a replication denture for fabrication of a digital prosthesis with the replication technique.Use of an attachment system with angulated abutments and polyetheretherketone inserts to retain a maxillary overdenture: A clinical report
This clinical report describes the rehabilitation of a maxillary edentulous arch with a current overdenture attachment system with angulated prefabricated abutments and polyetheretherketone (PEEK) inserts. Prefabricated angulated abutments were used on previously and recently placed diverging implants, which enabled a common path of insertion for the overdenture to be established during fabrication.Occlusal device with extraoral retention: An occlusal technique for patients with Down syndrome
Temporomandibular disorders associated with bruxism have a high prevalence rate in the overall population, including individuals with Down syndrome (DS). Occlusal devices have been prescribed for the treatment of temporomandibular disorders and prevention of tooth wear due to bruxism. Patients with DS have restrictions concerning treatment with occlusal devices, with an increased risk of swallowing and asphyxia, because of limitations with cognitive ability and motor deficiency. Therefore, an occlusal device with extraoral retention was developed to improve the safety for a patient with DS.Treating an edentulous mandible with an implant-supported prosthesis with a shape-memory alloy abutment system
This clinical report describes a treatment protocol for completely edentulous patients using digital implant planning for an all-on-4 treatment of both the maxilla and mandible as well as the use of a shape-memory alloy retention system to secure a complete-arch restoration to the mandible.Interdisciplinary treatment with implant-supported prostheses for an adolescent with ectodermal dysplasia: A clinical report
This clinical report describes interdisciplinary treatments for a 17-year-old girl with ectodermal dysplasia. The treatment was initiated with orthodontic therapy. After the remaining primary teeth had been extracted, 6 implants were placed in the maxilla with bilateral sinus floor elevations, and 6 implants were placed in the mandible. Immediate restorations were provided. Definitive restorations included screw-retained partial dental prostheses and ceramic crowns.
