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.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.Immediate versus early or conventional loading dental implants with fixed prostheses: A systematic review and meta-analysis of randomized controlled clinical trials
Immediate loading of dental implants has gained widespread popularity because of its advantages in shortening treatment duration and improving esthetics and patient acceptance. However, whether immediate loading can achieve clinical outcomes comparable with those of early or conventional delayed loading is still unclear.A facially driven complete-mouth rehabilitation with ultrathin CAD-CAM composite resin veneers for a patient with severe tooth wear: A minimally invasive approach
The development of technologies that include face scanning and dental software has improved workflows in dentistry. Digital files make it possible to create a 3-dimensional virtual image of the patient that helps the clinician plan treatment and make decisions, reducing uncertainty and improving communication. This report describes the complete-mouth rehabilitation of a patient with severe tooth wear. The treatment adopted a minimal intervention approach, applying adhesive veneers in areas where the tooth structure was affected and used a computer-aided design and computer-aided manufacturing (CAD-CAM) workflow to prepare nanoceramic composite resin materials with a high filler loading.A CAD-CAM approach for designing and fabricating a periodontal prosthesis: A clinical report
The periodontal prosthesis is a successful retrievable fixed restoration provided for patients with a periodontally involved dentition who lack alternative fixed options. However, its popularity has declined due to the introduction of dental implants, as well as the cost and complexity of fabrication. Nonetheless, this remains a viable option for patients who cannot undergo implant surgery. This clinical report describes the use of computer-aided design and computer-aided manufacturing (CAD-CAM) technology to streamline the fabrication of a periodontal prosthesis.Digital prosthodontic management of a young patient with Papillon-Lefèvre syndrome: A clinical report
Papillon-Lefèvre syndrome (PLS) is a rare disorder that leads to symptoms including the early progressive loss of deciduous and permanent teeth. Prosthodontic management of children and adolescents affected by PLS sometimes requires an immediate complete denture. Tooth mobility presents a challenge to the dentist, especially during impression-making. This clinical report describes the management of a 14-year-old boy with PLS by using an intraoral scanner to prevent conventional impressions and a fully digital workflow for the design and fabrication of immediate complete dentures.Fabricating a screw-retained, complete arch, fixed implant prosthesis using selective metal laser sintering: A clinical report
In contemporary prosthodontic practice, implant-supported therapy has consistently resulted in high success rates, with satisfactory and predictable outcomes for completely edentulous patients. Of the several options, complete-arch, fixed screw-retained solutions are generally considered to be the preferred treatment solution. Screw retention offers advantages such as predictable retrievability and potentially easy prosthodontic maintenance, as well as excess cement not being a concern. However, implant mispositioning and malalignment may often necessitate the use of cement-retained prostheses.A tooth whitening and chemical abrasive protocol for the treatment of developmental enamel defects
This clinical report describes a chemical abrasive protocol and whitening techniques to quantify modifications to the color and volume produced when eliminating white spots associated with developmental defects in enamel. Chemical (oxidative-erosive) abrasive treatment (whitening + 6.6% hydrochloric acid) resolves white spots up to a depth of 0.2 mm. At greater depths, infiltration with 16% hydrochloric acid followed by composite resin infiltration is recommended.Milled cobalt-chromium metal framework with veneered porcelain for a complete-arch fixed implant-supported prosthesis: A clinical report
Many materials have been introduced for the fabrication of complete-arch fixed implant-supported prostheses. This clinical report demonstrates the use of a computer numerically controlled (CNC), milled, 1-piece cobalt-chromium framework with veneered porcelain to treat a patient with dental implants placed with limited prosthetic space. This prosthodontic option combined the advantages of a digitally manufactured solution for a 1-piece metal framework and the excellent track record of metal-ceramic prostheses.Reshaping a retained deciduous canine with a semidirect composite resin veneer: A clinical report
The presence of a retained primary canine in an adult, although not frequent, affects esthetics. Choosing the optimal restorative treatment is a challenge. The present clinical report describes a treatment for tooth reshaping with a semidirect composite resin technique, achieving an excellent esthetic result. The treatment was successful at the 18-month follow-up.Conservative approach to the restoration of vital teeth affected by severe tissue wear
Dental wear is a multifactorial progressive condition of hard tissue loss, often decreasing the vertical dimension and leading to functional and esthetic consequences. Regaining space by using contemporary restorative materials has enabled less invasive treatment options. This clinical report describes a complete mouth restoration of a patient with severe generalized dental wear by progressively increasing the vertical dimension and using conservative prosthetic treatment options to maintain pulp vitality.Titanium implant wear from a zirconia custom abutment: A clinical report
This clinical report describes damage to a 1-piece zirconia abutment where both biological and mechanical complications developed, resulting in premature loss of the implant. Scanning electron microscopy showed significant damage to the internal connection of the implant. When using 1-piece zirconia abutments with a titanium internal connection, periodic recall and identification of wear is necessary, especially in patients with repeated screw loosening.Digital workflow for predictable immediate loading in the mandible by using a shape memory dental implant abutment system: A clinical report
Digital surgical planning for immediately loaded dental implants can be a predictable and accurate procedure, with the interim prosthesis also designed digitally. If the planning and execution are meticulous, chairside adjustments can be minimized because the outcome should be closely matched to the proposed digital plan. A novel dental implant abutment system made from a shape memory metal could be an answer to the cement versus screw controversy as it uses neither. This new system can provide patients with better esthetics and is biologically favorable.Implant overdentures retained by self-aligning stud-type attachments: A clinical report
The functionality of a new overdenture attachment (LOCATOR R-Tx) was described for different clinical situations: a conventional mandibular implant overdenture (IOD) retained by 2 implants, a straightforward chairside maintenance procedure for replacing a worn LOCATOR (Legacy) attachment with the new LOCATOR R-Tx, and a complex clinical situation with nonideal implant positions with compromised parallelism. The LOCATOR R-Tx is an advance on the existing LOCATOR Legacy attachment and has an improved abutment head design with a more durable surface coating to prevent attachment wear and thereby reduce frequency of maintenance.Ceramic implant fracture: A clinical report
This clinical report describes the presentation of a fractured ceramic dental implant. The fractured implant segment was examined by scanning electron microscopy and energy dispersive spectroscopy. Energy dispersive spectroscopy confirmed that the fractured implant was made of alumina. Although alumina implants were withdrawn from the market because of poor survival rates, clinical reports of their complications are rare.Guided-welded approach planning using a computer-aided designed prosthetic shell for immediately loaded complete-arch rehabilitations supported by conometric abutments
In guided surgery, implants can be planned from radiographic guide information according to a restoratively driven treatment plan. Unfortunately, the palatal or lingual surface of teeth cannot be easily identified. The present article describes the use of a digitally designed prosthetic shell to improve the accuracy of guided-welded approach planning for immediate restorations supported by conometric abutments. Importing the virtual shell into the planning software provides an effective protocol for using the definitive prosthetic space information to plan the framework shape and position predictably.Implant-supported fixed dental prosthesis with a microlocking implant prosthetic system: A clinical report
A microlocking implant prosthetic system has recently been developed to address the limitations of conventional screw- and cement-retained implant-supported fixed dental prostheses. This prosthesis system consists of a precision-machined abutment and an attachment that includes zirconia balls and a nickel-titanium spring, thus providing retrievability and constant retention of the prosthesis. In addition, screw-related complications are avoided because there is no retention screw. The occlusal access hole is of a smaller diameter than that of conventional screw-retained prostheses, which is beneficial for esthetics and occlusion.Treatment and esthetic management of traumatized maxillary central incisors with endodontic therapy and the inside/outside bleaching technique: A clinical report
Traumatic dental injuries most commonly occur to the maxillary central incisors, occasionally resulting in tooth discoloration and prompting affected patients to seek dental treatment. Other negative sequelae of trauma to teeth include root resorption that can complicate definitive treatment planning to manage discoloration. This article describes the conservative esthetic management of discolored traumatized teeth through the inside/outside bleaching technique after endodontic therapy for external inflammatory root resorption.Staged orthodontic treatment in preparation for immediate implant placement: A clinical report with a 5-year follow-up
Anterior implant restoration is one of the most challenging restorative procedures, especially for sites with vertical and/or horizontal hard and soft tissue deformities. Orthodontic extrusion before implant placement may be the best means of overcoming vertical deficiencies. This article describes a modification to the standard technique, involving staged orthodontic extrusion and buccal root torque. The main advantage of this modification is that it encourages bone and soft tissue development, thereby allowing the patient to receive immediate or early implant treatment.A multidisciplinary approach to the functional and esthetic rehabilitation of dentinogenesis imperfecta type II: A clinical report
A 20-year-old woman presented with an unesthetic appearance and severe wear of the anterior teeth. Definitive expected treatment was designed by multidisciplinary combination therapy. Meanwhile, gene sequencing was used diagnostically, and digital smile design (DSD) was used to design the esthetics of the anterior teeth. The 3-month follow-up showed an acceptable outcome. The whole-exon sequencing and direct sequencing of polymerized chain reaction products of dentin sialophosphoprotein were performed, but further sequencing was needed in the repeat region of dentin sialophosphoprotein exon 5 (the data were not shown).Accuracy of the evaluation of implant position using a completely digital registration method compared with a radiographic method
Conventional radiographic methods are widely used to evaluate the clinical accuracy of implant position. However, such methods require a second computerized tomography (CT) scan and manual registration between presurgical and postsurgical CT data. The alignment errors cannot be calculated.Chairside management of an open proximal contact on an implant-supported ceramic crown using direct composite resin
Chairside management of an open proximal contact with an implant-supported ceramic crown next to an adjacent natural tooth using direct composite resin is presented in this article. The open proximal contact negatively impacts the periodontium and the long-term success of the implant and restoration, as well as the adjacent tooth. A strong resin bond is achieved by airborne-particle abrading, etching with hydrofluoric acid, and by applying a silane coupling agent and an adhesive resin bonding agent.CAD-CAM–fabricated interim fixed complete-arch implant-supported restorations based on the existing dentition
An interim restoration is often used to assess the patient's functional and esthetic needs for implant-supported complete-arch fixed prostheses. A digital protocol for accurately transferring information from the existing dentition to the interim restoration is required. The purpose of this clinical report was to describe a digital workflow to fabricate an interim fixed restoration by using the vertical dimension of occlusion and occlusal relationship from the original dentition to provide an accurate, efficient, and predictable computer-aided design and computer-aided manufacturing (CAD-CAM) interim complete-arch implant-supported restoration.Comprehensive digital approach with the Digital Smile System: A clinical report
This clinical report describes a comprehensive digital approach with the Digital Smile System (DSS) and its clinical use in the prosthetic treatment of a patient for whom 6 anterior maxillary porcelain veneers were fabricated. Following this digital protocol, extraoral facial images and a diagnostic intraoral digital scan were obtained. Digital smile analysis, virtual diagnostic waxing, and milled trial restorations were made in the diagnostic phase. After tooth preparation, data from digital scans were used in the computer-aided design and computer-aided manufacturing (CAD-CAM) of the definitive restorations.Surgical extrusion with biologically oriented preparation: An alternative to extraction
Surgical extrusion should be considered as an alternative treatment in patients with structurally compromised teeth that retain coronal integrity and have favorable root anatomy. The procedure described is straightforward and can be performed quickly. A situation in which it was used to treat a maxillary premolar with substantial structural loss but well-preserved periodontal attachment is presented. The biologically oriented preparation technique is a conservative method of tooth restoration.Treatment of peri-implant recession with a screw-retained, interim implant restoration: A clinical report
This clinical report describes a patient with an osseointegrated implant and definitive restoration of the maxillary right lateral incisor who was seeking resolution of the recession of the peri-implant tissues which revealed the underlying zirconia abutment. The patient had previously received a connective tissue graft in an unsuccessful attempt to resolve the recession. An undercontoured interim restoration that allowed for soft tissue coronal migration resolved the soft tissue deficiency.Oral tuberculosis mimicking a traumatic denture ulcer
Tuberculosis (TB) of the oral cavity may be overlooked in the differential diagnosis of oral lesions and can be misdiagnosed and managed incorrectly. A 66-year-old man with complete dentures presented with a nonhealing mucosal ulcer in the upper lip. Despite the treatments performed by a local medical clinic, the ulcerative lesion on the denture-bearing area had not improved over 5 months. A partial excisional biopsy was performed to investigate further. Histopathologic examination revealed granulomatous inflammation caused by TB, and a chest radiograph showed consolidation and cavitation of the upper lobes.The facial flow concept: An organic orofacial analysis—the vertical component
Orofacial analysis has been used by dentists for many years. The process involves applying mathematical rules, geometric principles, and straight lines to create either parallel or perpendicular references based on the true horizon and/or natural head position. These reference lines guide treatment planning and smile design for restorative treatments to achieve harmony between the new smile and the face. The goal is to obtain harmony and not symmetry. Faces are asymmetrical entities and because of that cannot be analyzed using purely straight lines.Management of ectodermal dysplasia with tooth-supported computer-engineered complete overdentures: A clinical report
Ectodermal dysplasia (ED) is a genetic disorder affecting organs derived from the embryonic ectoderm. Symptoms manifest early in life, and dental anomalies, including partial or complete edentulism, affect most of these patients. Overdentures have been a popular and conservative treatment option for patients with ED with a few natural teeth. Advancements in digital technology have improved and positively influenced dentistry, including removable prosthodontics. This clinical report describes a positive treatment outcome using computer-engineered complete overdentures to rehabilitate a patient with dental manifestations of ectodermal dysplasia.Management of an edentulous patient with temporomandibular disorders by using CAD-CAM prostheses: A clinical report
This clinical report describes the application of computer-aided design and computer-aided manufacturing (CAD-CAM) complete dentures (CDs) in 4 visits and a 2-year follow-up period for a patient with temporomandibular disorders (TMDs), severe occlusal disturbances, and parafunctional habits. The use of a Gothic arch tracing for recording the maxillomandibular relationship and verifying muscular function was particularly helpful in such a symptomatic patient. A trial period was used to determine patient acceptance and adaptation to the new CDs.Digital tools and 3D printing technologies integrated into the workflow of restorative treatment: A clinical report
The development of technologies including intraoral scanners, dental software for digital restoration design, and additive manufacturing has improved the digital workflow of restorative treatment. The present article describes a digital workflow with intraoral scanning, computer-aided design (CAD) software, and subtractive and additive manufacturing procedures for a patient receiving lithium disilicate laminate veneers.Digital workflow to provide an immediate interim restoration after single-implant placement by using a surgical guide and a matrix-positioning device
This article describes a workflow based on a top-down approach to provide a fixed-type immediate interim restoration after placing a single implant using a digitally driven surgical guide and a matrix-positioning device. A characteristic of the technique is that both the surgical guide and the matrix-positioning device are fabricated from a single diagnostic virtual trial restoration designed on computer-aided design (CAD) software. This workflow may shorten the time required for chairside placement of an interim restoration and enhance esthetics when rehabilitating anterior teeth.Treatment with a CAD-CAM–fabricated, double-crown–retained, removable partial denture: A clinical report
This clinical report describes treatment with a double-crown–retained, removable partial denture with a 2-year follow up. Primary and secondary crowns and a removable partial denture metal-alloy framework were fabricated using computer aided design and computer aided manufacturing (CAD-CAM) and milled from cobalt-chromium (Co-Cr) alloy.Anterior composite resin crown in an adverse situation: A dental technique with a 3-year follow-up
Endodontically treated teeth often exhibit severe coronal structure loss. Given the reversibility and tissue conservation of adhesive procedures, a conservative approach using an indirect resin crown with an adhesively cemented custom fiber-reinforced composite resin post provided a predictable and esthetic solution. The 24-hour and 3-year follow-ups of this technique showed good function, marginal adaptation, and esthetics.Use of a surgical template for minimally invasive second-stage surgery: A dental technique
The introduction of new techniques and new technology has been directly related to successful outcomes in implant dentistry. Merging information from high-quality cone beam computed tomography images and detailed prosthetically driven digital planning translates into computer-guided surgery. A surgical template is a guide used to assist in the proper surgical placement and angulation of dental implants. However, a surgical guide not only facilitates implant placement but can also be used for other purposes, including diagnosis, treatment planning, and even second-stage surgery.Use of an esthetic overdenture as an alternative treatment in a patient with bilateral cleft lip and palate
Stable occlusion and a pleasing esthetic appearance are often difficult to achieve in patients with congenital defects and severe midfacial deficiencies. Conventional therapy, such as orthodontic treatment followed by orthognathic surgery, is often not sufficient to fully correct the dental and esthetic problems. An interdisciplinary approach for these patients should include prosthodontic treatment that will assist in establishing a harmonious occlusion and improve facial appearance. This clinical report describes the interdisciplinary approach for a young patient with a history of bilateral cleft lip and palate, spina bifida, hydrocephalus, and ventriculoperitoneal shunt.Esthetic management of fused incisors with ceramic veneers
This clinical report describes a patient for whom single veneers with pink staining were used on fused maxillary incisors to camouflage and improve dental appearance.Staged extractions and implant placement in a periodontally compromised patient: A clinical report
Staging the extraction of selected teeth in a periodontally compromised patient during complete mouth rehabilitation has advantages, including avoiding a transitional complete denture, keeping the patient with a fixed prosthesis throughout the treatment without the need to immediately load the implants, maintaining the interdental papillae, and providing comfort for the patient. The need for a multistep extended treatment and additional cost are the main disadvantage of this approach. This clinical report describes the clinical steps and follow-up of a staging approach and implant placement in a periodontally compromised patient with excessive gingival display to achieve a good functional and esthetic result.Implant placement for patients with cleft lip and palate: A clinical report and guidelines for treatment
The multidisciplinary teams involved in the treatment of individuals with cleft lip and palate are challenged when implants are indicated in the cleft area. Difficulties include obtaining a healthy peri-implant area and, especially, obtaining the natural-looking papilla essential for esthetic success. The area affected by the cleft has a bone deficiency, which is typically augmented with an alveolar bone graft at adolescence. Guidelines for the 3-dimensional placement of implants at the cleft area are presented based on clinical reports.3D-printed custom trays with a Gothic arch for centric relation recording and definitive impression making for complete dentures: A dental technique
An appliance was designed and fabricated by using computer-aided design and computer-aided manufacturing (CAD-CAM) and 3-dimensional (3D) printing to combine a custom tray with an intraoral Gothic arch. This helped simplify centric relation recording and combined definitive impression making and centric relation recording into a single step.A digital technique for fabricating an interim implant-supported fixed prosthesis immediately after implant placement in patients with complete edentulism
The conversion of a denture into an interim implant-supported, screw-retained restoration has become the standard method for immediate interim restoration in patients with complete edentulism. The most critical steps of the denture conversion process are the creation of appropriate denture access holes to prevent displacement of the denture by the interim cylinders and removal of the denture flanges to facilitate both good esthetics and accessibility for oral hygiene after the denture is connected to the interim cylinders.Replacement of maxillary incisor crowns over discolored substrates in a single visit with a CAD-CAM system and lithium silicate ceramic
Discolored substrates constitute a challenge to the esthetics of the definitive restoration. Because of technique sensitivity, the generally prolonged treatment time is a drawback to both the patient and the dentist. The technique described presents the replacement of ceramic maxillary incisors crowns over discolored substrates in a single visit by using a milling machine. Translucent blocks of a lithium silicate ceramic reinforced with zirconium dioxide particles were used. Intraoral scans of the trial restorations and of the tooth preparations were performed.Computer-guided implant removal: A clinical report
Occasionally, osseointegrated dental implants must be removed because of complications such as malpositioning or screw fracture. This is most often accomplished with a surgical handpiece and trephine. However, a flap is often required to access and visualize the implants. This paper presents a treatment in which computer planning and a 3-dimensional-printed, custom fabricated, surgical guide was used to assist in implant removal. This technique simplified the procedure, allowed conservative removal of peri-implant bone, and permitted subsequent immediate implant replacement.Interim restoration using dynamic abutments to re-treat a single-implant crown with a labial angulation: A clinical report
The cause of some peri-implant problems may be primarily attributable to the design of the prosthesis. A screw-retained interim implant may be advisable for reversibility and to avoid peri-implant cement, although screw retention may be difficult for maxillary anterior implants with a labial angulation. In the treatment described, a interim screw-retained crown was attached to a dynamic abutment with a lingual screw access hole to obtain a correctly fitting restoration.Impending total airway collapse involving a maxillary removable partial denture: A clinical report
This article presents a rare incident of a bilateral maxillary removable partial denture as an airway foreign body. The removable partial denture and the surrounding soft tissue irritation caused partial obstruction of the airway. Impending airway collapse was avoided after successful removal of the foreign body. Removing a removable dental prostheses at night, not only to prevent soft tissue pathology but also to avoid ingestion or aspiration of the prosthesis, must be emphasized.Minimally invasive esthetic improvement in a patient with dental fluorosis by using microabrasion and bleaching: A clinical report
Dental fluorosis is a condition that produces unesthetic coloration of enamel because of excessive fluoride ingestion during enamel formation. Its appearance can range in severity from mildly white and opaque to dark brown and can lead a patient to seek dental treatment. Historically, these lesions have been masked, either with direct or indirect restorations, but more conservative treatment options are now available, including the combination of microabrasion and bleaching. This clinical report describes the use of these treatment options to address a young patient’s dental fluorosis.Postmortem evaluation of mandibular implant-supported fixed complete denture after 30 years of service
A postmortem evaluation of a 5-implant–supported mandibular fixed complete denture that had successfully opposed a maxillary conventional complete denture for 30 years was undertaken. Before embalming, radiographs, implant stability measurements, push-in failure load tests, and histomorphometric analyses were performed on the implants and the mandible. Evaluation of this cadaver suggests that an edentulous mandible restored with an implant-supported fixed prosthesis can function successfully for over 30 years with few complications.Thermal cracks of implant-based zirconia four-unit restorations: A fractographic analysis of two restorations fractured during production
Two zirconia-based 4-unit restorations intended for the same patient fractured during the veneering process even though the prolonged cooling protocol recommended by the manufacturers was used. Fractographic analyses revealed that both restorations fractured as a result of thermal shock, but at different times during production. Further investigation is necessary to optimize the firing protocols for large zirconia-based restorations and avoid fracture due to thermal shock.An alternative digital workflow for fabricating a mandibular implant-supported complete fixed dental prosthesis with limited restorative space: A clinical report
This clinical report describes the prosthetic rehabilitation of a patient with a mandibular implant-supported complete fixed dental prosthesis with limited interocclusal restorative space. The problem was manifested by repeated fractures of the acrylic resin teeth and distortion of the supporting framework. The definitive restoration included a custom computer-aided design and computer-aided manufacturing (CAD-CAM) titanium framework with the lingual cusps and most of the occlusal table of the mandibular posterior teeth milled in titanium as part of the framework.Complete dentures for a patient after a stroke by means of orofacial myofunctional therapy: A clinical report
After a stroke, patients frequently show compromised swallowing, mastication, and speech, as well as unfavorable motion and deviation of the tongue and mandible. The dentist can improve the oral rehabilitation of a patient with deteriorated facial and oral muscles after a stroke by incorporating orofacial myofunctional therapy. This report describes a method for tongue exercises and correction of mandible deviation in an edentulous patient after a stroke by using a pearl on a wire in the anteriomedian palatal part of the maxillary denture.Fabrication of an implant-supported fixed complete denture using multiple digital technologies for a patient with a perioral burn: A clinical report
This clinical report describes the prosthetic and surgical management of a patient with a restricted oral orifice due to a perioral burn. Complete oral rehabilitation was achieved with maxillary and mandibular implant-supported fixed prostheses using a combination of digital and conventional impressions, design, and processing techniques.Diagnosis and treatment of orofacial pain in a patient with unserviceable complete dentures: A clinical report
An ill-fitting complete denture has the potential to create pain and discomfort as well as conceal or confound the diagnosis of other primary sources of orofacial pain such as trigeminal neuralgia. Guidelines of the American Academy of Orofacial Pain offer an evidence-based approach for the assessment, diagnosis, and management of orofacial pain. A complete and accurate differential diagnosis is paramount to the success of treatment as well as to the circumvention of unnecessary therapy. The purpose of this clinical report was to emphasize an evidence-based approach to the diagnosis and treatment of orofacial pain in a patient with edentulism and a history of prolonged denture wear.
