Clinical Reports
Application of digital prosthodontics and connective tissue grafting in the management of peri-implant mucosal recession around a malpositioned 1-piece implant: A clinical report
This clinical report describes a conservative approach to improve an unesthetic implant-supported crown and peri-implant mucosal recession around a malpositioned, 1-piece implant in the maxillary right central incisor region by using digital technology. In such clinical situations, the implants are usually removed because of an unpredictable definitive esthetic outcome. However, this clinical report describes the preservation of such a compromised implant by improving the esthetic outcome with a connective-tissue graft, and a digital approach used a 1-step preformed zirconia coping technique with an appropriate emergence profile.Fabrication of an implant-retained overdenture with ceramic crowns cemented on a polyetherketoneketone framework: A clinical report
This clinical report describes the treatment of a complex intraoral situation by fabricating a maxillary implant-retained overdenture with a high-performance polymer (polyetherketoneketone) framework and lithium disilicate crowns and mandibular tooth- and implant-supported ceramic restorations. No complications were noted in 2 years, and the patient was satisfied with function and esthetics.Pleomorphic sarcoma of maxillary sinus: Clinical report of a patient initially diagnosed with denture-induced fibrous hyperplasia
Undifferentiated pleomorphic sarcoma is a high-grade soft-tissue malignant tumor that is rare in the head and neck region. A 74-year-old woman displayed a large nodular lesion in the maxillary alveolar mucosa, which was initially identified as denture-related fibrous hyperplasia. Although her prosthodontist has adjusted the maxillary complete denture to relieve pressure on the lesion, it increased in size over time. Computed tomography images of the maxillary sinus showed an extensive destructive lesion.Prosthetic rehabilitation of meth mouth with implant-supported fixed dental prostheses: A clinical report
This clinical report describes the prosthetic restoration of a failing dentition subsequent to methamphetamine abuse. The treatment involved the use of endosteal dental implants and milled cobalt-chromium, screw-retained, implant-supported fixed dental prostheses. At the 1-year follow-up, the prosthetic rehabilitation had markedly improved the patients’ health, esthetics, and function.Use of ceramic veneers for improving esthetics and extending the service life of an existing cement-retained implant-supported ceramic restoration: A clinical report with a 3-year follow-up
This clinical report describes an approach for improving the esthetics and extending the service life of a cement-retained implant-supported ceramic single crown by using a ceramic veneer bonded to the conservatively prepared facial surface. The restoration satisfied the patient without removing and replacing the unesthetic implant-supported ceramic crown.Challenging replacement of a maxillary canine with an implant-supported restoration: A surgical and prosthetic approach
This clinical report describes the replacement of a traumatized maxillary canine that was extracted after unsuccessful orthodontic extrusion with an implant-supported restoration. Guided bone regeneration surgery was performed, followed by a second surgery with implant placement plus simultaneous bone and tissue regeneration. Esthetics and function were achieved with the placement of a veneered zirconia implant-supported restoration.Endodontic guide for the conservative removal of a fiber-reinforced composite resin post
Prosthetic dentistry involves functional and esthetic restoration. Some situations require the use of fiber-reinforced composite resin posts that help preserve restorations. However, if the initial treatment fails, a new endodontic intervention may be required for fiber-reinforced composite resin post removal. This procedure can be complex and challenging but can be facilitated with guided endodontics. This clinical report describes the use of a prototyped guide created with virtual planning for fiber-reinforced composite resin post removal.Implant placement in the pterygoid region with dynamically navigated surgery: A clinical report
Implant placement in the pterygoid region is a reliable treatment for posterior maxillary tooth loss. However, the surgery is not widely applied because the implant placement region is hard to access and the direct visual access is limited. This clinical report describes the use of a dynamic navigation system to improve the pterygoid implant placement surgery. Real-time imaging of the surgery area and full-time guidance are provided by the system to alleviate the problem of lack of visibility and to reduce the complexity of placement.Management of a partially edentulous patient with idiopathic root resorption by using digital and conventional implant planning technologies
This clinical report describes the rehabilitation of the maxillary arch of a partially edentulous patient with idiopathic root resorption, limited interarch distance, and a high smile line. Four implants were placed to provide a screw-retained fixed partial denture. The esthetic and functional challenges of a high smile line and limited interarch distance were addressed by using a combination of conventional and digital implant treatment technologies.Reducing the need to maintain fixed complete dentures by providing gold occlusal surfaces: A clinical report
The excessive occlusal wear of complete-arch implant-supported prostheses made with metal and acrylic resin is a clinical complication that can require repeated maintenance in certain patients. A patient who presented with moderate occlusal wear of the prosthetic teeth and substantial fracture of the maxillary anterior acrylic resin base only 2 years after a previous replacement of the acrylic resin base and denture teeth is described. Because of the patient’s history and existing wear, both the maxillary and mandibular prostheses were repaired by replacing the acrylic resin bases and resin denture teeth but with the addition of cast gold occlusal surfaces on the posterior prosthetic teeth.A custom screw-retained implant-supported prosthesis for a patient with amelogenesis imperfecta: An 8-year clinical follow-up
This clinical report with an 8-year follow-up describes the multidisciplinary management of a patient diagnosed with amelogenesis imperfecta. The rehabilitation included horizontal-guided bone regeneration, implant placement, use of a fixed interim prosthesis to preview the correction of occlusal disharmonies, and placement of a custom screw-retained definitive implant-supported restoration with a design that was retrievable and minimized maintenance problems.Zygomatic implant-supported prosthodontic rehabilitation of edentulous patients with a history of cleft palate: A clinical report
Zygomatic implants are an established treatment option in the management of the atrophic maxilla and in oncology rehabilitation, but evidence for their use in patients with a history of cleft palate is sparse. Zygomatic implants were used to retain a maxillary prosthesis in 7 edentulous patients with an unrepaired or repaired cleft lip and palate. Patient records were reviewed retrospectively to assess the survival rates. The mean follow-up time was 5 years with an implant survival of 100%. Most complications were associated with the prosthetic superstructures.Interdisciplinary rehabilitation of a patient with ectodermal dysplasia utilizing digital tools: A clinical report
The present clinical report describes the rehabilitation of a patient diagnosed with ectodermal dysplasia performed by an interdisciplinary team in a comprehensive approach aided by digital technology. The complexity of the treatment was related to predictability regarding timing and the type of approach. The patient was referred for treatment because of congenitally missing and abnormally shaped permanent teeth. The need for an interdisciplinary team involving orthodontic, periodontic, and prosthodontic specialists was identified.Reversal of the intrusion of a natural tooth located between two implant-supported crowns: A 7-year follow-up report
In patients with implant-supported restorations, intrusion rarely occurs in nonconnected natural teeth. This clinical report describes the intrusion of a natural tooth located between 2 implant-supported crowns after 4 months of normal function. The second premolar was intruded by 3 mm. The intrusion was completely reversed after interproximal contact adjustments, and the tooth position was stable at the 7-year follow-up.Implant and prosthetic rehabilitation of a patient with mucous membrane pemphigoid
Mucous membrane pemphigoid (MMP) is an autoimmune condition characterized by subepithelial separation and deposition of autoantibodies and complement along the basement membrane zone. The disease results in the development of vesiculobullous lesions of the mucous membranes and skin. This report discusses the surgical treatment and management and the prosthetic implant rehabilitation of a patient with mucous membrane pemphigoid. The rationale for this treatment was to fabricate a prosthesis that was stable and did not rub against the gingival tissues and that was easily cleaned.A completely digital workflow for the transition from a failed dentition to interim complete-arch fixed implant-supported prostheses: A clinical report
This clinical report describes a completely digital workflow for the rehabilitation of the maxillary and mandibular arches with implant-supported fixed interim prostheses. Computer-assisted implant planning was used to fabricate a multifunctional surgical template for the guided placement of transitional and endosteal dental implants. Advantages of this technique include the integration of a completely digital workflow into the production of a virtual diagnostic tooth arrangement for edentulous patients, the planning of implant placement as per a restorative-driven approach, and the delivery of implant-supported fixed interim prostheses.Magnetic extrusion technique for restoring severely compromised teeth: A case report
An orthodontic magnetic extrusion technique is described for the management of an extensively damaged maxillary premolar. A cylindrical neodymium-iron-boron (Nd2Fe14B) magnet was attached to the remaining tooth structure, and a second magnet was placed on a resin-bonded partial denture. A 4.5-mm extrusion was obtained after 3 adjustments, and the tooth was prepared with a 3-mm buccal and 2-mm lingual ferrule by following a biologically oriented preparation technique and restored with a monolithic zirconia crown.Digital fixed complete-arch rehabilitation: From virtual articulator mounting to clinical delivery
The virtual articulator is a tool that reproduces the relationship between the jaws in a virtual environment. The purpose of this clinical report was to describe a completely digital protocol starting from the virtual articulator mounting to developing static and dynamic occlusion in a complex prosthetic rehabilitation.Three-dimensional facial esthetics-driven computer-assisted osteotomy and implant placement for immediate restoration of a failing dentition with a protruded maxilla
The rehabilitation of facial esthetics when transitioning from a failing dentition in a patient with maxillary protrusion is challenging. This clinical report described such a patient treated with an immediate cross-arch implant-supported fixed prosthesis. The ideal virtual upper lip position was used to predict the sagittal and vertical position of the restoration. A stackable device was fabricated to guide the osteotomy and implant placement.Composite resin CAD-CAM restorations for a midline diastema closure: A clinical report
A diastema between the maxillary central incisors affects an esthetic smile and has been treated in various ways. Precise diagnosis is essential to guide the choice of the most appropriate treatment. This clinical report describes closing a maxillary midline diastema with a computer-aided design and computer-aided manufacturing (CAD-CAM) composite resin.Management of unfavorable implant positions and angulations in edentulous maxillae with different complete-arch fixed prosthetic designs: A case series and clinical guidelines
Implant-supported fixed prostheses in the edentulous maxilla can be difficult because of anatomic limitations and high esthetic demand. The choice between cement and screw retention depends on factors such as esthetics, occlusion, retrievability, and passivity. The choice is also often governed by the ability to manage technical or biologic complications. In the edentulous maxilla, because of the bone trajectory and resorption pattern, unfavorable implant angulations may be encountered. In such situations, a conventional screw-retained prosthesis is difficult to design.Periodontal plastic surgery for the management of an ankylosed permanent maxillary lateral incisor: A clinical report with 5-year follow-up
Anterior maxillary tooth ankylosis disturbs the development of the alveolar bone process, leading to discrepancies between the cervical gingival margin and incisal edge position of the affected tooth, and therefore, the esthetics is compromised. Proposed treatments in adults and growing patients have been used successfully, but they have disadvantages and are contraindicated in some circumstances. This article proposes an alternative treatment for an ankylosed permanent maxillary anterior tooth with a slow replacement resorption rate in an adult patient, for whom a combination of a periodontal plastic surgery procedure and a fixed dental prosthesis was used to correct the esthetics.Premature failure of a screw-retained ceramic single crown: A clinical report and fractographic analysis
Screw-retained implant-supported ceramic restorations have shown increased rates of technical complications compared with their cemented counterparts, including fracture and chipping of the ceramic structures. The present clinical report identified the causes leading to the catastrophic failure of a screw-retained lithium disilicate veneered crown cemented to a zirconia abutment with a titanium base by using a systematic fractographic approach. A combination of occlusal overloading, a deficient design and inadequate material selection was identified as being responsible for the fracture.Inverted body-shift concept in macroimplant design to enhance biologic and esthetic outcomes: A clinical report
A new implant design to increase labial plate dimension and tooth-implant distance in maxillary anterior extraction sockets over traditional tapered implant designs is presented. Generally, tapered implants are divergent and wider at the coronal aspect of the implant adjacent to the lowest bone volume. Decreasing bone around implants over time can lead to ridge collapse, recession, and a graying effect of the gingival tissues that eventually impacts esthetic outcomes adversely. This implant design incorporates a body-shift in both diameter, shape, and thread pattern and reduces the coronal portion to allow greater circumferential bone thickness to be created where it is needed most for long-term stability.Surgical extrusion to provide a ferrule for restoring a tooth with a compromised prognosis: A clinical report
A surgical extrusion technique was used to provide a ferrule for a tooth with significant tooth structure loss and an oblique coronal fracture. The maxillary lateral incisor was surgically repositioned coronally to provide sufficient dentinal wall for a good prognosis of the restorative treatment. The procedure is conservative and relatively straightforward and can be performed rapidly with minimal patient discomfort.
