Tips From Our Readers
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.
