Tips From Our Readers
Permanent double-sided tape to facilitate the cementation of indirect restorations
Different 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 impressions
When 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 camera
Prosthetic 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 prostheses
Monolithic 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 images
Tooth 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 prostheses
Screw 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 cast
An 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 mandible
The 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 prostheses
Fixed 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.4Using an existing digital surgical guide and used burs as aids for a complete-arch implant impression
The 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 implant
With 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 program
An 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 clearance
Adequate 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.3A cost-effective and straightforward technique to fabricate an intraoral photographic contraster
Dental 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 abutment
Titanium 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 prostheses
Implant-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 relationships
The 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 impressions
Conventional 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 restorations
Light-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 mesh
Long-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.1A technique for making maxillomandibular records for a distal extension removable partial denture by using a fast-setting polyvinyl siloxane material
Making 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 screwdriver
During 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 impression
Digital 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.A straightforward technique for avoiding the need for a prototype when fabricating monolithic prostheses
Intraoral scanners allow the digital scan to be sent immediately to the dental laboratory to manufacture cast-free monolithic prostheses.1 Making a prototype to minimize the risk of damaging the prosthesis during occlusal adjustment is advised when fabricating monolithic prostheses.2,3 This article shows a straightforward technique for avoiding the need for a prototype evaluation appointment by scanning the occlusion designed by the clinician for the interim prosthesis on the same day as tooth preparation.Fabricating an altered cast to facilitate intraoral processing of the LOCATOR attachment
The LOCATOR attachment (Zest Anchors LLC) has been widely used for implant-retained overdentures (IODs),1,2 with several techniques for incorporating the attachment into the IOD proposed.3-6 When the indirect method is used, a strong bond between the matrix and acrylic resin can be achieved, and staining or porosities on the intaglio surface of the IOD are prevented.3 However, the method requires additional laboratory procedures and expense, LOCATOR impression posts (Zest Anchors LLC) and the LOCATOR analog (Zest Anchors LLC) are needed, and distortion during denture processing may occur.Use of extra-fine crosscut bur to produce horizontal texture in composite resin restorations
Reproducing the developmental lobes and perikymata of the anterior teeth of young patients with composite resin restorations is a clinical challenge.1-3 Different finishing and polishing systems and techniques are available, although a standard protocol is lacking. The selection of the correct instruments will depend on the position of the tooth and the type of surface to be reproduced. Multibladed and diamond rotary instruments and abrasive rubber points are commonly used for this procedure.4A self-grinding occlusal plane template to help modify an uneven occlusal plane before providing definitive restorations
Uneven alignment of the natural teeth is a common clinical occurrence, which may be caused by eruption, wear, or drifting of teeth.1 A normal occlusal plane, such as with a curve of Monson,2,3 is a primary objective of restorative procedures and facilitates natural mandibular movements and mastication.1 Devices and techniques have been described to evaluate and correct the occlusal plane, including the Broderick occlusal plane analyzer,4 the Yurkstas metal occlusal template,5 and the custom made occlusal plane template (OPT).A straightforward approach to conservative screw access for implant-supported fixed complete dentures
For decades, implant-supported fixed complete dentures have been used successfully to restore the masticatory system of edentulous patients.1,2 Multiple combinations of materials are available for the fabrication of these prostheses, each with different clinical indications and physical properties.3 Fixed complete dentures have a long history of use1 and have been reported to protect the bone-to-implant interface because of the shock-absorbing properties of the acrylic resin covering the framework.Digital preparation-evaluation tool
Tooth preparation is a fundamental procedure in prosthetic dentistry,1 with improper tooth preparation leading to treatment failure.1-3 Conventionally, an elastomeric putty index has been used to evaluate the quality of preparation.1,4,5 An index is obtained before tooth preparation, after which it is cut cross-sectionally and seated on the prepared tooth. The amount and quality of tooth preparation are then evaluated. However, this method is limited in that only a small number of sections can be obtained, and sectioning is irreversible.Creating QR-coded identification cards using CardExchange for straightforward identification of implant systems
Detailed record-keeping is essential in implant dentistry. With more than 250 dental implant companies producing implant components, it is difficult to accurately ascertain each system. While online resources such as https://whatimplantisthat.com may assist in identification, accurate clinical and radiographical recognition is still the responsibility of the dentist. Misidentification of an implant system may lead to clinical mishaps and delays. Offering patients quick response (QR)–coded implant identification wallet cards (Fig. 1) is a straightforward, inexpensive, and universal solution to this problem.Orthodontic wire loop for engaging dental floss or orthodontic elastomeric chain in the open tray implant impression technique
An accurate implant impression is essential for a successful implant restoration, with various impression techniques being suggested.1 The open tray (pick-up) impression technique has been recommended over the closed tray impression technique for improved accuracy,2 although splinting the open tray impression copings is essential to prevent micromovement and for accurate 3D transfer of the implant locations to the definitive cast.3 Splinting can be achieved in various ways,3,4 including with dental floss and autopolymerizing resin or composite resin.Complete-arch implant impression technique for capturing the acquired soft-tissue profile
Implant impression techniques can be classified as either pick-up or transfer. Pick-up impression techniques, also known as open-tray impression techniques, can be subdivided into splinted and nonsplinted techniques.1 Splinting transfer copings with acrylic resin effectively resist translation and rotation of the transfer copings within a complete-arch implant impression.2 By modifying the contours of the interim restoration, the clinician can shape the peri-implant soft tissue for an esthetic result.Using an existing surgical template as an aid for a virtual interocclusal record
A satisfactory complete denture can be duplicated with acrylic resin to preserve the information on the patient’s occlusal vertical dimension, occlusal relationship, and tooth arrangement during preoperative planning for dental implant treatment.1 The duplicated denture can be used as a radiographic template, surgical template, and occlusally adapted custom tray.2 A dual scan protocol with the existing complete denture and additively manufactured surgical template (in the shape of a duplicated denture) is commonly used in contemporary static computer-aided implant surgery (s-CAIS).Using the screw shank as a retrieval tool: A straightforward approach to removing screws with diagonal fractures
Abutment screw fracture is a mechanical complication that has been related to the failure of dental implants.1 With the advent of new prosthetic designs, new materials, and more specialized torque controlling devices, the incidence of these types of complications has decreased significantly2 and has been reported to vary from 0.16% to 3.9%.3,4 Factors such as nonaxial loading of the screw joint,5 nonpassive frameworks, presence of cantilevers, and inadequate preload of the abutment screw have been associated with screw fracture.Transfer of posterior palatal seal area on maxillary cast: A modified technique
The posterior palatal seal (PPS) area plays a critical role in the retention of maxillary complete dentures and is often missed by the clinician.1,2 The PPS area is defined by the Glossary of Prosthodontic Terms3 as “the soft tissue area limited posteriorly by the distal demarcation of the movable and nonmovable tissues of the soft palate and anteriorly by the junction of the hard and soft palates on which pressure, within physiologic limits, can be placed; this seal can be applied by a removable complete denture to aid in its retention.” Various techniques have been proposed to record the PPS area.A technique for registering the peri-implant soft-tissue profile with an interim restoration
Creation of a pleasing peri-implant soft-tissue architecture in an esthetic zone is a challenging task. To develop a predictable gingival architecture during the healing process, the contours of the implant-supported fixed interim restoration requires careful modification.1 Once an appropriate gingival profile has been achieved, it must be recorded in the definitive impression. Different techniques have been proposed to replicate the peri-implant soft-tissue profile by using a custom impression coping,2 by inserting autopolymerizing acrylic resin into the sulcus,3,4 and by using an interim restoration transfer protocol.Orthodontic elastomeric chain as an alternative to dental floss for splinting implant impression copings for complete-arch implant impressions
The most significant step in fabricating an accurate implant prosthesis is to transfer the precise 3D intraoral location of the implants to the definitive cast.1 Various impression techniques have been described to achieve the necessary accuracy.2 The open tray impression3 has been widely used; however, translation and rotation of these transfer impression copings may occur when the copings are detached from the implant fixture and during placement of the implant analog.4 Lee et al5 concluded in their systematic review that splinting transfer impression copings produced an accurate definitive cast and prevented micromovement of the impression copings.Impression for an immediate denture with mobile teeth: A clinical approach
During the fabrication of an immediate complete denture, making the impressions may present difficulties,1,2 especially if the remaining teeth are mobile or painful. In addition, there may be deep undercuts from tilted teeth, root furcations, and spaces between pontics and the residual ridge. Removal of the impression could be difficult and painful, even resulting in extracting the mobile teeth.Spongy floss impregnated with light-polymerizing gel to splint implant impression posts
Multiple implant impression posts are often splinted together before making an impression to reduce the potential for movement when removing the impression from the mouth.1 In the dental laboratory, technicians may splint the laboratory analogs before pouring in stone to minimize the distortion from stone expansion.2 Dentists may want to splint the implant laboratory analogs before sending them to the dental laboratory to reduce the chance of displacement during shipping. This splinting has been performed with autopolymerizing acrylic resin.Injectable silicone-based gingival mask technique: Transferring the emergence profile of multiple implant restorations
Interim implant-supported restorations play an important role in achieving the desired esthetic outcome and long-term success of implant prostheses.1,2 The initial interim restoration is made from a conventional implant-level impression, which is then modified to sculpt the gingival contour. Additional material is added to mold the papillae and gingival margins and recreate the natural gingival architecture. An appropriate impression technique is essential for an accurate transfer of the peri-implant emergence profile to the definitive cast.A chair side cast with removable die for the fabrication of indirect composite resin restorations
The fabrication of indirect composite resin restorations (ICRRs) presents multiple advantages over direct techniques. While sharing the advantage of direct repair in the event of a fracture, when compared with direct composite resin restorations, ICRRs require less intraoral time and increase patient comfort. Facilitated manipulation and control of restorative materials improving marginal adaptation and control over polymerization shrinkage are also advantages of ICRRs.1 However, a disadvantage of ICRRs is the need to obtain a definitive cast with a removable die, typically preventing single-appointment procedures.Virtual smile design tip: From 2D to 3D design with free software
Starting with the use of photographs and more recently with the use of straightforward and accessible software programs, virtual or digital smile design has been used to analyze patient's smiles and design 2D images to provide a guide for planning and communication.1 A problem with the superimposition of 2D photographs is it relies on transferring the proposed design to a physical or digital dental cast.2-4 The most widely described method is the use of calipers.1 This leads to a loss of information between the 2D project and the wax pattern.A technique to retrieve a fractured implant abutment screw by using a screwdriver fashioned from a needle
Implant therapy is one of the most effective and reliable options for replacing missing teeth, but even with the high success and survival rates of dental implants,1 clinicians may still have to deal with a variety of complications,2 both biological and mechanical. Biological complications include the loss of osseointegration or peri-implantitis,3 and mechanical complications include crown fracture, ceramic chipping, framework fracture, and loosening or fracture of abutment screws.2,4 The reported rates of abutment screw fracture range between 2% and 3.9%.Fabricating a low-cost autoclavable throat screen from a steamer mat
The dental literature is full of reports of aspirated restorations and instruments.1-6 Not all instruments or restorations can be secured to prevent this. It is in this context that the use of a cotton gauze throat screen,4-6 a simple double square of cotton gauze, is advocated to block the throat, thus preventing aspiration or swallowing. Unfortunately, the main reason most practitioners do not use such a throat screen is that cotton gauze is flimsy and unwieldy especially once wet.Immediate occlusal loading of implants: A rapid chairside procedure for making an interim fixed prosthesis
This technique provides the patient with an interim fixed prosthesis at the time of implant placement.1-4 In the described treatment, the procedure lasted 5 hours from the start of surgery until the patient left the office. Six implants were placed in the maxilla by using the immediate complete denture as a surgical guide.Accurate repositioning of an implant interim restoration into the definitive impression to obtain an exact reproduction of tissue contours in the soft tissue cast
Detailed reproduction of the soft tissue surrounding the implant is essential to the passive fit of implant restorations, and even small discrepancies may result in complications during the fabrication and insertion of the definitive crown. A method is presented here for transferring precise tissue contours to the definitive cast by using the interim restoration as an impression coping, simultaneously helping to mold the peri-implant tissue.1,2 Soft tissue becomes modifiable after controlled and constant compression.Midline diastema closure using a vacuum-formed retainer
A midline diastema, especially in the maxillary arch, commonly compromises anterior esthetics. Etiologic factors include the location of the insertion of the labial frenum, supernumerary teeth, missing adjacent teeth, peg laterals, anterior tongue posture, excessive arch width, and relapse after orthodontics.1,2Functionally generated path technique to fabricate a crown in group function on a deciduous maxillary canine
The accurate fabrication of a restoration in group function is challenging because an articulator cannot accurately simulate the simultaneous dental contacts during all eccentric mandibular movements.1 However, group function was indicated for the restoration of a maxillary deciduous canine in a 45-year-old patient in which the lateral incisor and the first premolar provided mandibular guidance. Canine guidance alone was contraindicated because of the minimal support offered by the deciduous canine (Fig. 1).Contour correction for stock titanium healing abutments
Healing abutments (HAs) initiate the formation of optimal gingival contours after dental implant placement, which can be refined later by anatomic interim restorations. The restorative dentist should specify the ideal HA dimension to the surgeon. A wider HA than a definitive cementable abutment facilitates accurate impressions. A narrower HA than the definitive restoration creates increased gingival thickness for manipulation with the contours of the interim restoration.Combination of digital photographs for the identification of the screw-access hole of cement-retained implant restorations
The use of dental implants has been well documented as a successful treatment for complete or partial edentulism.1,2 Initially, screw-retained prostheses were used for the restoration of completely edentulous patients.3 However, as implants were gradually used for the restoration of partially edentulous patients, new restorative concepts evolved, leading to cement-retained prostheses.4,5 Nowadays, both screw- and cement-retained restorations are used, each having its advantages and disadvantages.A simplified technique to record implant positions when fabricating a conversion prosthesis for immediate loading
Immediately loaded complete-arch fixed implant-supported prostheses have become a popular approach to the treatment of patients with edentulism. In the past 10 years, popular treatment concepts such as All-on-Four (Nobel Biocare) have streamlined the rehabilitation of the edentulous maxilla and mandible, with high implant and prosthetic survival rates.1,2 Two recent studies have reported overall cumulative implant survival rates approaching 97% over a 5- to 7-year follow-up period.3,4 Immediate loading involves either the conversion of an existing complete denture to an interim complete-arch fixed implant-supported prosthesis5,6 or the insertion of a prefabricated prosthesis using computer-aided engineering and cone beam computed tomography.Orientation of digital casts according to facial lines
In ideal situations, the incisal and occlusal lines are parallel to the horizontal facial lines (that is, the bipupillary line or the commissural line),1-2 but in many patients, the occlusal plane is canted. This makes it difficult to correctly orient digital casts according to the facial lines in the virtual environment, because intraoral scans generally provide no references to extraoral structures.3An impression technique for patients with fixed orthodontic appliances
An irreversible hydrocolloid impression is difficult to obtain in patients with fixed orthodontic appliances because the material is trapped by the bands, brackets, and wires, all of which may dislodge the impression material from the tray and even debond the orthodontic brackets.1,2 Covering the orthodontic brackets and arch wire completely or only on the gingival side with wax2,3 has been proposed, but the cast will reproduce the wax used.A safe holder for adjusting indirect prostheses: The silicone cube technique
Small ceramic and interim restorations may be difficult to hold to adjust or polish, especially when wet. This technique uses polyvinyl siloxane to hold dental restorations securely during extraoral adjustments with rotary instruments.Using a secondary impression with a resin index to correct an RPD definitive cast
The definitive cast for the fabrication of a removable partial denture (RPD) should accurately replicate the surface detail of the teeth and edentulous ridges of a partially edentulous arch.1 The cast should also reproduce the functional and physiologic extensions of the facial and lingual vestibules, particularly the sublingual vestibule, for the placement of a lingual major connector.A technique for obtaining flawless cast-to-implant custom abutments
Cast-to-implant custom-made abutments are frequently used in restorative dentistry. Casting flaws can occur because of bubbles inside the cylinder and on the surface of the implant abutment. Imperfect castings can lead to the imprecise fit of the abutment to the implant and may contribute to screw loosening.1-4 A straightforward effective way was devised of eliminating bubbles from inside the cylinder to obtain flawless cast-to-implant custom-made abutments.An alternative topical anesthesia technique for prosthetic implant procedures
Time-dependent change of the peri-implant mucosal profile occurs after the removal of healing abutments.1 Nissan et al1 reported that the peri-implant mucosa shrinkage was 31% in 1 minute after the removal of healing abutments, regardless of the gingival biotype. Repeated connection of prosthetic implant components may be painful because of peri-implant mucosal shrinkage, especially when the implant-abutment connection is located apical to the free gingival margin.2Aluminum barrier laminate or plastic tube as a dispenser for modeling plastic impression compound for border molding
Modeling plastic impression compound (MPIC) is a thermoplastic dental impression material composed of wax, rosin, resins, and colorants.1 Conventionally, type 1 MPIC sticks are used for border molding by softening them directly over a flame, which is both messy and time consuming.2,3Modification of Makzoume vertical dimension recorder for individuals with a beard
A practical, convenient, and accurate method of measuring the physiologic rest position and occlusal vertical dimension by using a vertical dimension recorder (VDR) was described by Makzoume.1 The VDR consists of a plastic 20-cm ruler suspended from a rectangular plate and rod attached to the forehead and a square plate with a needle pointer attached to the chin. The plates are attached to the forehead and chin with double-sided foam adhesive tape. In individuals with a beard, it is impractical to attach the needle pointer to the square plate with adhesive tape.A technique for removing a fractured 1-piece titanium abutment
The fracture of the dental implant abutment may represent a serious problem as the fragment remaining inside the implant may compromise the performance of the prosthesis if not removed.1 An important consideration is to avoid damaging the internal threads of the implant,2 and different methods of fractured screw fragment retrieval have been described.2-6Prosthodontic safety checklist before delivery of screw-retained and cement-retained implant restorations
Dental implant therapy requires meticulous attention to detail at all stages, including treatment planning, surgical placement, and prosthodontic procedures involved in fabricating the restoration. Although knowledge, skill, and experience vary among clinicians, recognizing that the definitive insertion of an implant-supported restoration is distinct from the delivery of a tooth-supported restoration is important and should be regarded as an advanced dental procedure requiring meticulous attention to detail.3D-printed cone-beam computed tomography scans: A tool for patient education
Patient education is one of the many responsibilities of clinicians. Various authors have highlighted the importance of patient prosthodontic education at various phases of treatment and even attribute the success or failure of treatment to the education provided to patients regarding the services to be rendered.1 Patient education should take place before treatment (that is, after clinical examination and diagnosis, which includes presentation and explanation of possible treatment limitations), during treatment (that is, restating the original diagnosis and treatment prognosis), and after treatment (that is, providing home care instructions for long-term maintenance of the treatment).Do not let the Spanish “s” misguide you
The orthographic representation of the “s” in the Spanish language may have three phonetic variations and be associated with other phonological phenomena that add to its unpredictability when used to evaluate the closest speaking space. These are of clinical interest since each of these variations may represent a more or less pronounced difference from what is observed in the English language and patient population. The present article explains the previously mentioned variations and reviews the suggested Spanish terms for evaluation of the closest speaking space.A method of fabricating an accurate repositioning device for relocating multiple multiunit abutments
A screw-retained restoration may provide the most definitive and rigid splinting for multiple implants.1,2 Multiunit abutments (MUAs) allow great variability in the angles between splinted implants, which facilitates prosthetic reconstructions. The complete-arch, screw-retained, immediate-loading, implant-supported prosthesis using MUAs is easily retrievable for future maintenance.Surgical safety checklist for dental implant and related surgeries
Throughout the world, dental implant therapy continues as a highly successful modality for replacing missing teeth, and its popularity remains high among general dental practitioners and dental specialists. Nevertheless, as dental implant therapy includes a surgical component and is an elective procedure, clinicians must strive to provide a safe and high quality treatment for patients. With the increase in the number of clinicians performing implant surgeries, the number of complications and surgical errors is expected to increase.Quality assurance of ceramic dental restorations by photographic transillumination
Quality assurance of indirect restorations should be performed by the dental laboratory before delivering the prosthetic parts to the clinician. Ultimately, it is the clinician’s responsibility to inspect and ensure, within the limits of clinically available technical and technological means, the quality of the prosthesis prior to insertion. Transillumination techniques in dentistry have been described as an aid in diagnosis as well as during the execution of various clinical procedures, including those for interproximal caries detection,1 endodontic visualization of dentinal defects,2 surgical localization of retained roots,3 location of the maxillary sinus floor and septa during sinus augmentation procedures,4 diagnosis of occult submucous cleft palate,5 and as a facilitator during arthroscopic puncture.A method of facilitating the fabrication of access openings for implant-supported complete fixed dental prostheses
This report describes a method for fabricating access openings for implant-supported complete fixed dental prostheses (ICFP) by using a dental milling machine and silicone putty matrix. The method can help clinicians achieve the accurate and precise fabrication of access openings for ICFPs without excessive grinding.A modified open tray implant impression technique for limited mouth opening
The success of implant-supported restorations relies on how well the hard and soft tissue information is transferred to the laboratory. In implant dentistry, the 2 traditional ways of making an impression are the closed tray and the open tray technique. Both impression techniques have their advantages and disadvantages.1-5 A recent systematic review revealed that the open tray impression technique is more accurate than the closed tray impression technique.6,7A procedure for directly measuring the physiologic rest position and occlusal vertical dimension
The Glossary of Prosthodontic Terms defines the physiologic rest position (PRP) as “the mandibular position assumed when the head is in an upright position and the involved muscles, particularly the elevator and depressor groups, are in equilibrium in tonic contraction, and the condyles are in a neutral, unstrained position”1; the rest vertical dimension (RVD) as “the distance between two selected points (one of which is on the middle of the face or nose and the other of which is on the lower face or chin) measured when the mandible is in the physiologic rest position”1; the occlusal vertical dimension (OVD) as “the distance measured between two points when the occluding members are in contact”1; and the interocclusal distance as “the distance between the occluding surfaces of the maxillary and mandibular teeth when the mandible is in a specified position.”1 PRP may be helpful in determining OVD in prosthetic dentistry.A modified method for fabricating a radiographic stent with transparent occlusal registration material for implant placement
For successful implant placement, the evaluation of anatomic structures is important in deciding the diameter, length, position, and angulation of the implant. Various diagnostic methods such as radiographic stent and cone-beam computed tomography (CBCT) can be used to determine the appropriate position.1 A radiographic stent can stably position a radiopaque marker without inducing scatter. In addition, it can be comfortably retained in the mouth.2Improved digital impressions of edentulous areas
Intraoral scanners (IOSs) are widely used in the fabrication of fixed dental prostheses, in that their accuracy compares well with traditional impression making.1 Recently, IOSs have been successfully used in the fabrication of removable dental prostheses.2-5 Digital impressions are useful for patients with a gag reflex and sensitivity to impression materials.2-4 Moreover, IOSs can register excessively movable tissue in a passive state to achieve a mucostatic impression.2,3,6,7 However, scanning edentulous area with IOSs may be difficult and time-consuming, because edentulous sites are smooth and devoid of features.A technique for minimizing subgingival residual cement by using rubber dam for cement-retained implant crowns
Excellent esthetics and a passive fit are facilitated by using cement-retained prostheses. However, eliminating residual cement is difficult in the subgingival area. Residual cement may cause periimplantitis, gingival swelling, pain, bleeding on probing, and other complications.1 Generally, the margin of an anterior implant crown is placed in the subgingival area for esthetic reasons. Because removing residual cement in subgingival areas is difficult, techniques using abutment replicas or Teflon tape have been introduced to minimize the problem.A technique to improve the fit of a soft tissue replica on a definitive cast
The fabrication of a soft tissue replica on a definitive cast is important in prosthodontic implantation. The replica keeps the mating surface of an implant analog above the stone and provides the soft tissue profile to the laboratory technicians so that maximum esthetics can be achieved.1,2 It should be used when the implant is placed below the gingival level. A replica should be able to be easily removed and repositioned when the prosthesis is being fabricated. Typically, the replica is made of a silicone material and is difficult to fit back onto the cast when the surface is not smooth.A technique for improving the fit of a vacuum-formed matrix
The vacuum-formed matrix is recommended for the fabrication of interim restorations, occlusal appliances, and surgical guides for implant placement.1-5 This technique requires a cast seated on a vacuum machine grid to which a heated plastic sheet will be adapted to the cast with negative pressure to form a matrix or an appliance. The detail of the matrix depends on the plastic material and the efficacy of the vacuum. To facilitate the vacuum, many techniques have been proposed, including the creation of an opening on the cast1,5 or making a duplicated cast and breaking it into several segments.An interim solution for a fractured complete-arch fixed implant-supported prosthesis using an Essix retainer
Complete-arch fixed implant-supported prostheses are known to be an excellent solution for edentulism. Although new, stronger materials have evolved, the metal-resin prosthesis using a combination of cast or milled bar supporting acrylic resin and denture teeth continues to be popular because of its lower cost and simplicity. However, these prostheses have a high rate of mechanical complications, primarily related to the fracture of the acrylic resin and denture teeth.1 A prospective cohort study of 24 fixed metal-resin complete-arch implant-supported prostheses found that each prosthesis required resin maintenance 5 to 6 times over a 10-year period.An extended guide pin for a direct implant impression
A precise implant impression is essential for the passive fit of an implant superstructure.1-3 Although digital impressions are becoming more popular,4,5 conventional impression techniques are still frequently used. A direct (pick-up) open tray impression technique uses a guide pin.6 When an implant is deeply placed, the guide pin may not extend through the hole of the open tray.7 Therefore, wiping off excessive impression materials through the hole with a gloved finger may be necessary.8 However, this is messy, and the gloves may inhibit the polymerization of polyvinyl siloxane materials.Metal framework design for a partial removable dental prosthesis to enhance the addition of an artificial tooth or clasp
When designing with a metal framework, modifications after the loss of remaining teeth and their replacement can be difficult.1-4 This metal framework design makes it easier to add artificial teeth or clasps to a partial removable dental prosthesis.A technique for assessing the fit of a removable partial denture framework on the patient and on the definitive cast
The lack of fit of a removable partial denture has been reported as the most common problem in the treatment of patients with partial edentulism.1 The misfit could be a result of poor laboratory procedures, a distorted impression, or ridge remodeling after delivery. Evaluating the fit of a removable partial denture starts at the framework evaluation appointment. The evaluation consists of the fit on the definitive cast and the fit intraorally.2,3 Damage to the definitive cast by inserting and removing the framework must be avoided, and the components of the framework should fit well on the cast before it is placed intraorally.Rapid orthodontic extrusion of a subgingivally fractured incisor
A subgingivally fractured incisor presents a restorative challenge. Orthodontic eruption is a good alternative to crown lengthening for restoring the biological width, maintaining the alveolar bone, and restoring esthetics.1,2 The technique requires a hook to serve as the attachment system, fixed to the fractured tooth root, and an anchorage bar to allow movement of the root. The bar should not interfere with the occlusion, should be directly above the hook, and should ensure stabilization of the anchored teeth.Computer software-based method of analyzing and communicating the nuances of tooth surface texture with the dental laboratory
The demand for ceramic-based dental restorations has increased markedly as a result of patient demand for higher-level esthetic results.1 The key elements in ensuring a proper esthetic outcome are, in order of importance, tooth position, contour form, surface texture, and the 3 components of color: value, chroma, and hue.2,3 Of these variables, inaccurate tooth surface characterization most impacts the perceived color of artificial restorations.4 The ability of the dentist to adequately communicate the topographical details of tooth surface texture with the dental laboratory, however, remains elusive.Adaptation of an interim partial removable dental prosthesis as a radiographic template for implant placement
Historically, dental implant placement was driven by the amount of existing bony support and the implant fixture was positioned where bone was abundant. Compromised biomechanics, esthetics, cleansability, unusable implants, and biological failure have resulted from not envisioning the definitive restorative and functional outcome.1Completely digital approach to an ovate pontic
When a missing maxillary incisor is replaced with a fixed dental prosthesis (FDP), an ovate pontic can be applied for esthetics and less plaque accumulation.1-10 The established tissue beneath an interim ovate pontic may collapse when an interim FDP is removed and an impression is made.10,11 To ensure positive contact and support of the pseudopapillae with a definitive pontic, a stone cast is scraped in this area.10 However, reshaping or porcelain additions to a definitive pontic may be necessary at the evaluation phase, because the scraping is done arbitrarily.Combining digital photography with cylinder-type magnets to record the screw access hole in a cement-retained implant prosthesis
Cement-retained or screw-retained implant prostheses can be placed in the oral cavity as fixed-type implant restorations. The characteristics of each type of prosthesis have been widely discussed in the literature.1-4Chairside technique for expediting indirect interim restorations
The use of flexible casts and dies for the chairside fabrication of interim restorations has been reported to overcome the drawbacks of the direct technique and provide a safe and biocompatible fabrication process.1-5 Because of the elasticity of these casts, removing the interim restoration after complete setting is easy, and the integrity of the casts is maintained. Unlike stone casts, the flexible cast can be reused if a new interim restoration is needed later.1Impression boxing and cast pouring with polymer modeling clay and polystyrene plastic sheet
A technique to fabricate an accurate definitive cast with 2 reusable materials: polymer clay (Sculpey; Polyform Products Co) and thin polystyrene plastic sheet (Gallery Glass Leading Blanks, 10×18 in; Plaid Enterprise) is described. The technique is a development of that described by Mora and Boone1 with newer materials.Technique for removing the stud attachment metal housing from an acrylic resin denture base
Stud attachments have been used with tooth-supported and/or implant-supported overdentures for several decades. They are easy to use and provide retention and stability for implant overdentures.1,2 Such attachments include a metal housing for the retentive insert that engages the patrix attached to a tooth or implant.3 A metal housing with the retentive insert can be incorporated into a denture directly intraorally or indirectly from a stone cast.4-8 Accurate placement of the attachment into the overdenture is essential for patient comfort, function, and tissue preservation.Technique for preserving pupil size when photographing the iris for ocular prostheses
The artificial iris of an ocular prosthesis should closely reproduce the patient’s natural iris. The traditional methods used to fabricate artificial irises typically include oil paints and cardboard. These techniques are time-consuming procedures that require strong technical and artistic abilities. Reproducing the iris by printing high-quality digital images should be a straightforward and time-saving process that closely reproduces the patient’s iris and requires minimal adjustment. However, we noticed that the size of the pupil varies according to the light conditions.Modified interrupted suturing technique for preventing suture irritation
Even though a continuous suturing technique is less time consuming, the failure of any part of the suture may result in loosening along its whole length.1,2 Therefore, horizontal mattress and interrupted suturing techniques are recommended for a guided bone regeneration procedure.3-7 A polypropylene suture (PPS) is also used to avoid wound dehiscence, because a PPS can resist muscle pull with prolonged high tensile strength, knot security, expansion due to swollen soft tissue, and minimal tissue reaction.Controlling the depth of ceramic veneer preparations by using a color marker in the depth grooves
Ceramic veneers are an established conservative treatment option for the restoration of facial defects, fractures, malformation, or misalignment of teeth.1-3 Various clinical studies have determined successful treatments, and reviews have confirmed the clinically acceptable longevity of veneers.4-7Technique to provisionally maintain the periimplant soft tissue profile
To reproduce the periimplant soft tissue morphology in a definitive cast, an interim restoration is temporarily removed and used extraorally.1-10 If prosthodontic complications such as ceramic fracture occur during function, a definitive restoration is removed for repair or replacement.11-13A technique for recording the abutment screw angulation of cement-retained implant prostheses
Determining the abutment screw channel of a cement-retained implant restoration with 2 dimensional, photographic, or radiographic records is difficult because of limited information on the abutment screw angulation.1-10 This article describes a technique for registering the abutment screw angulation with 2 digital photographs.Maxillary definitive impression of excessively movable tissue with a single material
Achieving an accurate impression that prevents the distortion of excessively movable tissues and allows for a passive fit of the denture has been a challenge.1 This type of tissue, also known as flabby tissue, is most commonly found in the anterior maxilla as a result of combination syndrome 2 or an ill-fitting denture.3 Displacement of this tissue in denture wearers leads to the loss of retention and instability of the denture during function due to lack of passivity and uneven distribution of forces.Fabricating short-term interim restorations from edentulous tissue conditioner material
The fabrication of interim restorations is a critical step in fixed prosthodontic treatment.1,2 In an extensive treatment, creating proper margins and adequate emergence profiles requires time and precision.3,4 However, if a rehabilitation appointment needs to be shortened unexpectedly and the relined interim shell still needs to be refined, the use of a short-term interim restoration is convenient for both the patient and clinician. This article describes a technique for fabricating a rapid and esthetic short-term interim device from a tissue conditioner and a vacuum-formed matrix.Alternative technique for handling indirect restorations during evaluation and cementation
Inlays, onlays, and porcelain veneers are small, fragile, and prone to accidental swallowing by the patient during the evaluation or cementation procedure.1 Evaluation of restoration fit and restoration placement also are challenging tasks.2 Once these restorations are fitted into the cavity preparation, they may be difficult to remove, especially class I inlays. Some clinicians have advocated special carrying devices (Optrastick; Ivoclar Vivadent), sticky wax, or dental adhesive.3,4 An alternative technique for handling the restorations with the help of a microbrush tip and composite resin is proposed.Color-to-grayscale conversion using a smart phone camera for value comparison
Color has 3 different dimensions: hue, value, and chroma.1 Hue describes the dominant color of an object. Value is often referred to as lightness and is the measurement of the lightness or darkness of a color. Chroma refers to the degree of saturation of a particular hue. To select tooth shade, value should be chosen first and then chroma and hue are determined later.1 Among many different methods of evaluating tooth shade, comparison of a series of values with several shade tabs is the most common method,2 especially as value selection is less affected by color vision deficiency than hue or chroma.Using a thermoplastic sheet to add palatal rugae to a complete removable dental prosthesis
One of the common complaints of first-time complete removable dental prosthesis wearers is difficulty speaking.1,2 The severity of the speech problem depends on the reaction of the denture patient to speech sound distortion. Although most patients with dentures do not encounter any difficulties, some have mild to moderate problems with speech both socially and vocationally.3Alternative antireflection substance for a digital impression
Obtaining a complete scanned image of a cast metal crown is difficult because of reflection. Therefore, a nonreflecting scan spray is applied in a dental laboratory.1-3Customized occlusal reduction guide made from a thermoplastic sheet
Estimating linear distances is of great importance to dental practitioners. In several studies it has been shown that dental students and dentists underestimate and undersize linear measurements.1-8 Clinically, this results in excessive extensions of tooth preparations that can compromise restorations. Even though resources are available for measuring the depths and distances of tooth preparations, a keen visual perception of measurements can benefit a dentist or dental student.1,7Salvaging an implant with damaged internal threads
Implant prosthetic dentistry is not problem-free, and clinicians face complications including screw loosening, screw fracture, abutment fracture, damaged abutment threads, and damaged implant threads.1-6 Where the internal threads of an implant are damaged, they may become nonrestorable. Some techniques have been reported for salvaging the implant,2,6 including fabrication of a conventional dowel and core.2,3 However, this can cause extensive damage to the implant and may result in the need to remove it.An alternative technique for transferring denture-related soft tissue irritation to the denture
The most critical time in the success or failure of a denture is the adjustment period, and the most common complaint is pain caused by soft tissue irritation.1-3 The clinician is responsible for the care of the patient throughout this period; however, detecting and transferring the irritated area to the denture is difficult because the irritated soft tissue is frequently located in the posterior area.1,4 As Loney and Knechtel5 emphasized, pressure-indicating paste is useful for improving the diagnosis and correction of denture-related problems.
