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.
