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.
