Tips From Our Readers
Radiographic template used to facilitate the alignment of digital scans to computed tomography scans with extensive beam hardening artifactsEndosteal dental implants have shown to be an excellent long-term resource for the treatment of edentulism.1 For decades, restorative-driven implant placement has been considered the norm for patient care,2,3 and careful presurgical planning by using accurate diagnostic elements is widely recognized as a requirement for predictable, esthetic, and functional implant placement.3
A cost-effective technique for fabricating a dentoform by using a complete digital workflowDirect posterior composite resin restorations are a routine procedure and represent a large part of the restorative work in daily practice1; surprisingly, their complexity may be underestimated by many clinicians. This highly skill-dependent treatment requires well-defined layering protocols and practice by the dentist to make it more predictable and time-efficient,2-5 but many dentists do not invest in perfecting the procedure.6
Permanent double-sided tape to facilitate the cementation of indirect restorationsDifferent carrying devices have been proposed to facilitate the handling of indirect restorations, including the Optrastick (Ivoclar AG) and flowable composite resin applied to a microbrush tip.1,2 Such devices prevent an indirect restoration being dropped during the cementation process, avoiding the risk of aspiration or ingestion.3-10 This article proposes an affordable and straightforward method using a permanent double-sided tape (VHB Tape size 12 mm×4.5 m; 3M), commonly used in automotive and construction applications.
Use of aluminum foil to facilitate open-tray implant impressionsWhen the conventional impression technique is selected over digital optical scanning for multiple implants, the open tray impression technique has been recommended over the closed tray or transfer technique in situations where 4 or more implants are present.1,2 The open tray technique incorporates a large opening in the impression tray that accommodates the complete-arch impression copings.3 While loading the impression material into the tray, preventing the material from escaping through the opening is often difficult.
Visual inspection of implant screw access hole with an endoscope cameraProsthetic complications may necessitate the removal of an implant-supported restoration.1-4 Retrieval of cement-retained implant prostheses without any preexisting index of the screw access hole is challenging as it requires precision from the clinician during attempts to locate the abutment screws.5,6 Implants placed in unfavorable positions make the visibility of the screw access hole difficult, and the retrieval attempts in such situations pose a threat to the implant components, the intaglio surface of the implant, or the abutment screw.
A straightforward technique for removing titanium bases from screw-retained monolithic implant-supported prosthesesMonolithic screw-retained computer-aided design and computer-aided manufacturer (CAD-CAM) ceramics are widely used for implant-supported prostheses because of their efficiency in terms of manufacturing time, cost, and predictability.1,2 In this prosthetic design, a complete-contour prosthesis is typically milled in translucent zirconia or lithium disilicate and adhesively cemented under optimal conditions extraorally onto a titanium base, resulting in a screw-retained prosthesis.3,4 This method has the advantage of using prefabricated machined titanium bases that will not be processed in a furnace as in conventional techniques for metal-ceramic restorations, ensuring their structural integrity, absence of oxidation, and optimum fit.
A technique for selecting complete denture teeth by attaching printed tooth mold imagesTooth selection for complete denture patients has been assisted by different anthropometric studies of individuals from various ethnicities.1-4 However, it may be difficult for the patient to evaluate the esthetic outcome until the tooth arrangement is completed. Although digital dentistry has enabled visualizing the outcome with a digital trial restoration, the expensive software program and complex workflow may make these procedures inaccessible for many practices, and it may be many years before it becomes routine for complete denture fabrication.
Straightforward tip for identifying the type of screwdriver needed for screw-retained implant-supported prosthesesScrew loosening is a common complication of screw-retained implant prostheses.1,2 If the prosthesis was made in another clinic, it is sometimes challenging for clinicians to know what type of screwdriver to use. Using magnification loops with light to visualize the screw's head, making a radiograph to identify the implant type, or trying various available screwdrivers may help select the needed screwdriver. However, in some situations, such as when nonoriginal screws have been used or there are very deep screw channels, identifying which screwdriver should be used is not possible.
A method for fabrication of extraoral verification template for implant master castAn accurate intraoral impression of the 3-dimensional position of dental implants and peri-implant tissues is essential when fabricating an implant-supported fixed dental prosthesis. It is equally important to transfer this information precisely to the definitive cast.1,2 Different impression transfer techniques for implant-supported restorations, including splinting impression copings, surface treatment of impression copings, direct or indirect impression techniques, and different impression materials, are available.
Custom tray modification to accurately capture the lingual sulcus of an edentulous mandibleThe lingual extension of a mandibular edentulous impression is the most challenging border to determine accurately. Appropriately extending the mandibular lingual flange to assist in stabilizing a removable denture can be obtained with correct understanding of anatomy and function of the floor of the mouth.1 The lingual flange rests in the alveololingual sulcus, which has an S-shaped curve that extends from the lingual frenum to the premylohyoid fossa and then curves medially from the body of the mandible to the retromylohyoid fossa.
A sectional precontoured metal matrix to improve the pontic contour and emergence profile for fiber-reinforced composite resin fixed dental prosthesesFixed dental prostheses made with fiber-reinforced composite resin are a conservative and cost-effective option for replacing a missing tooth.1 This type of prosthesis can be fabricated directly or indirectly,2,3 but the direct technique is challenging and susceptible to error; in addition, shaping the pontic is difficult.4
Using an existing digital surgical guide and used burs as aids for a complete-arch implant impressionThe accuracy of an implant impression is essential to the passive fit of implant abutments.1,2 The open tray impression technique with splinting impression copings is recommended for edentulous patients.3-5 This article presents an accurate, convenient, and cost-effective technique for splinting open tray impression copings by using an existing digital surgical guide and used burs for complete-arch implant impression.
Design concept to facilitate the positioning of a custom abutment on an implantWith the development of computer-aided design and computer-aided manufacturing (CAD-CAM) technology, implant abutments have been fabricated with nearly unlimited design options.1,2 When an implant indexing device has not been fabricated or is not available, additional chair time for placing a custom abutment on a hexagonal connection implant is needed, especially for multiple implant restorations, as the abutment can be positioned in 6 different orientations.3,4 This article describes a design concept for fabricating a custom abutment with a mark.
Straightforward procedure for fabricating a digital cast from a conventional impression with a dental scanner and a free software programAn intraoral scanner allows the recording of hard and soft tissues in a rapid and comfortable way for patients with teeth and attached gingiva.1 In edentulous patients with minimal keratinized gingiva and mobile lingual and buccal tissues, scanning can be problematic, leading to poor quality scans.2 In these situations, conventional impression making and subsequent scanning of the resulting cast may be useful for providing the advantages of the digital workflow, including instant delivery to the dental laboratory and the possibility of working cast-free.
Chairside fabrication of a tooth reduction guide to ensure adequate occlusal clearanceAdequate tooth preparation is essential for the long-term success of a crown.1,2 Occlusal reduction must be conservative of tooth structure but provide adequate space for the restorative material.1,2 Insufficient occlusal reduction, especially on the lingual surface of molars, may occur because of limited access and visibility.3
A cost-effective and straightforward technique to fabricate an intraoral photographic contrasterDental photography is a routine procedure in contemporary dental practice.1 A photographic black contraster is a tool for dental photography that provides a black background to isolate the teeth of interest. The black color neutralizes the background, making it easier to visualize color matches or mismatches.2 Digital photographs aid in transferring information about shade, enamel staining, characterization, and incisal edge translucency between the dentist and the dental laboratory technician.3 High-quality images can impress patients and can be used for professional instruction and publications.
A technique for separating a ceramic implant-supported restoration from a titanium base abutmentTitanium base abutments or titanium inserts provide a metal implant connection for computer-aided design and computer-aided manufacture (CAD-CAM) fabricated screw-retained implant-supported ceramic restorations.1 These ceramic superstructures are usually cemented to the titanium base abutment extraorally with definitive resin cements.
A straightforward technique to obtain a subgingival nonglazed polished zirconia area in monolithic implant-supported prosthesesImplant-supported prostheses or abutments made of zirconia have been reported to provide a favorable response in the peri-implant tissues,1,2 with lower plaque adhesion,1 lower tissue inflammation,1 and better esthetics2-5 than titanium. The improved gingival outcome may be related to zirconia’s chemical composition because bacterial adhesion was reduced when zirconia was compared with titanium specimens with the same roughness, wettability, and topography.6 In addition, an adhesive protective barrier might be formed between zirconia and the gingiva,7,8 helping to provide long-term stability of the peri-implant tissues.
Overlay occlusion rim technique to facilitate the recording of maxillomandibular relationshipsThe efficient and accurate recording of maxillomandibular relations is an important step in prosthodontic treatment,1 with the occlusion directly affected by the accuracy of these records.2 Different methods have been proposed to perform this step, each with its advantages and limitations.3 The methods most commonly used have been gothic arch tracing and the wax recording procedure.4 Originally, these were intended for complete dentures1,3,4 but more recently have been adapted for implant-supported fixed prostheses.
Cast metal sprue as an alternative to dental floss for splinting open tray impression copings for complete-arch implant impressionsConventional implant impressions can be made with an open tray (pick-up) or closed tray (transfer) technique,1,2 with the open tray technique recommended for complete-arch implant impression because of its greater accuracy.3 However, stabilization of the impression copings is essential to prevent micromovement when it is detached from the implant fixture or during placement of the implant laboratory analog.4 Rigid impression copings are essential for the accurate transfer of their 3D position to the definitive cast.
Modified clear silicone index for light-polymerizing direct composite resin restorationsLight-polymerizing composite resins have been commonly used to restore the esthetics and function of anterior and posterior teeth1,2 Creating an ideal tooth morphology with direct composite resin is challenging, time consuming, and requires artistic skill, especially when multiple teeth are being restored. The procedure is simplified with the use of an index.3 Conventionally, a putty elastomeric impression material is adapted to a waxed cast to fabricate an index.3 However, light cannot pass through the opaque material.
Reinforcement of an interim fixed prosthesis with a denture metal meshLong-term interim fixed prostheses play a critical role in the success of extensive prosthodontic rehabilitations. They allow assessment of esthetics, phonetics, masticatory function, newly established vertical dimension of occlusion, and proper occlusal scheme before fabrication of the definitive restorations. Furthermore, fixed interim restorations protect implants or tissue grafts during the osseointegration phase.1
A technique for making maxillomandibular records for a distal extension removable partial denture by using a fast-setting polyvinyl siloxane materialMaking maxillomandibular records is an important step in the fabrication of a removable prosthesis. Typically, this is accomplished by using a record base and occlusion rim to support the recording material with the patient in centric relation. The fabrication of a record base and occlusion rim takes laboratory time or requires a second chairside appointment.
Removal of damaged implant components with a custom-made screwdriverDuring implant treatment, technical complications related to the abutment, abutment screw, or prosthetic screw may develop.1,2 Removing a damaged part can be challenging.3 Various retrieval systems are available but most require drilling and are not easily applied to every implant design.1,2,4 This report describes an alternative method for removing a damaged 1-piece abutment by using a custom screwdriver.
A technique to facilitate the prosthetic rehabilitation of oropharyngeal defects by combining an intraoral scanner with a conventional impressionDigital techniques for fabricating obturators have been described.1-3 However, digital technology is difficult to integrate into their fabrication because of imperfections in the printed casts.4 In addition, the required equipment or even software-editing expertise may not be available for dentists worldwide. Londono et al4 recently published a step-by-step technique for fabricating obturator prostheses by using a chairside digital scanner and conventional impressions. However, the demarcation described between the printed cast and the bulb portion, from a conventional impression used to generate a definitive cast, raises some concerns about the complexity of the technique, specifically, whether definitive casts can be combined easily.