Management of bleeding during dental implant surgery using a novel implant with an abbreviated drilling protocol: A clinical report

Coagulopathy is a well-recognized complication in dental surgery in patients who use oral anticoagulants or some dietary supplements. Proper pre-operative diagnosis, medical consultation, timely management, and conservative treatment can decrease the incidence of such complications. Management of bleeding during dental implant surgery commonly involves conventional methods such as discontinuation of anticoagulant use, compression, styptics, and local anesthetic administration containing vasoconstrictors. This clinical report describes the successful management of a patient with a history of coagulopathy who was rehabilitated with complete arch fixed implant-supported prostheses with immediate loading. A novel implant design with a significantly abbreviated single drill protocol for osteotomy preparation was used in an outpatient setting. The novel protocol successfully decreased the overall bleeding and significantly reduced the intraoperative time for the surgical procedure. Additional considerations related to the novel implant design and osteotomy protocol, supplementary applications, and advantages of the protocol are presented in this article.

Comparison of electronic versus mechanical torque-limiting devices for dental implants: An in vitro study

PURPOSE

To determine the accuracy of new electronic torque-limiting devices (ET) when compared to new and used conventional-style beam-type (BT) mechanical torque-limiting devices and hand-piece style (HS) mechanical torque-limiting devices. The secondary purpose was to compare any difference in accuracy between new and used mechanical torque-limiting devices, and any difference in accuracy when used on a straight versus an angled screw channel abutment.

MATERIALS AND METHODS

A total of five torque-limiting devices were used to obtain 2000 readings under standardized conditions. An implant analog was fastened into a digital torque meter, to which an abutment was connected. Pre-determined torque values of 15 Ncm and 35 Ncm were applied, and actual torque values were recorded. A straight and an angled abutment were used to record 1000 readings each using the five torque-limiting devices. An overall Kruskal-Wallis test was applied to compare the median deviation among devices followed by a pairwise comparison ( = 0.05).

RESULTS

For a target torque value of 15 Ncm on a straight abutment, the electronic device (ET) was statistically more accurate than the beam type (BT) new (p < 0.001) and used (p < 0.048) devices but less accurate than the hand-piece style (HS) used device (p < 0.001). On an angled abutment for a target value of 15 Ncm, the electronic device (ET) was statistically more accurate than hand-piece style (HS) new and used devices (p < 0.001). For a target torque value of 35 Ncm on a straight abutment, the ET was statistically more accurate than the HS new device (p < 0.001) but less accurate than the BT new device (p < 0.001). On an angled abutment for a target value of 35 Ncm, the electronic device (ET) was statistically less accurate than the beam-type (BT) new device (p < 0.001), the beam-type (BT) used device (p = 0.001), and the hand-piece style (HS) used device (p < 0.001). The electronic device (ET) was the only device accurate within the ISO standard of accuracy of 6% for each of the target torque value/abutment design combinations. There was no statistically significant difference related to the type of abutment used (angled vs. straight).

CONCLUSIONS

Electronic torque limiting devices (ET) are an acceptable method for delivering torque for implant restorations for straight and angled abutments at 15 Ncm and 35 Ncm torque values. Conventional style beam-type (BT) mechanical torque-limiting devices are a simple, predictable, validated, and inexpensive tool for delivering accurate torque at 15 Ncm and 35 Ncm torque values. The hand-piece style (HS) mechanical torque-limiting devices are predictable to deliver 15 Ncm torque values.

A technique for improved gingival esthetics on complete arch implant-supported acrylic resin prototype prosthesis

An important step during the workflow of complete arch fixed implant-supported prostheses is the fabrication of an acrylic resin prototype prosthesis so that the patient can visualize the definitive treatment outcome or to be used as an interim prosthesis. The prototype prosthesis is typically designed digitally as a single file and is produced by milling from a solid block of white-colored prepolymerized acrylic resin. A common challenge in fabricating a resin-based prototype prosthesis is reproducing the natural appearance of the gingival architecture in gingiva-colored material. Current methods, including multicolored resin blocks, gingiva-colored stain, and layering with gingiva-colored composite resin, can be costly, time-consuming, and labor-intensive. This article describes a straightforward chairside technique that allows clinicians to fabricate an acrylic resin prototype prosthesis with appropriate gingival esthetics.

Clinical outcomes of implant-supported monolithic zirconia crowns and fixed partial dentures: A systematic review

PURPOSE

To determine the survival rates of implant-supported monolithic zirconia crowns and fixed partial dentures (FPD).

MATERIAL AND METHODS

An electronic search for articles in the English language literature published from January 1, 2001 to September 17, 2021 was performed using PubMed, Scopus, and CENTRAL search engines. After applying predetermined inclusion and exclusion criteria, the definitive list of selected articles was used for calculating the interval survival rate (ISR) and cumulative survival rate (CSR). Restoration failure in this study was defined as the fracture or compromise of any part of the ceramic restoration that required the removal or remake of the implant-supported restoration.

RESULTS

The electronic search resulted in 457 titles. The systematic application of inclusion and exclusion criteria resulted in 14 clinical studies that addressed the clinical outcomes of implant-supported monolithic zirconia crowns and fixed partial dentures. Of these, 3 were randomized controlled trials, 5 were prospective studies, and 6 were retrospective studies. Follow-up periods ranged from 1 to 5 years. Of the 644 implant-supported monolithic zirconia restorations computed in this systematic review, there was only 1 reported failure of the monolithic zirconia restorative material over a follow-up period of up to 5 years, for a cumulative survival rate of 99.84%. At the maximum follow-up interval of 5 years, the cumulative survival rate for monolithic zirconia single crowns was 100% and the cumulative survival rate for monolithic zirconia fixed partial dentures was 99.60%.

CONCLUSIONS

Implant-supported monolithic zirconia single crowns and fixed partial dentures have excellent short-term (<5 years) survival rates but the evidence for medium-term survival (>5 years) and beyond is lacking.

Implants in the pterygoid region: An updated systematic review of modern roughened surface implants

PURPOSE

To determine the survival rates of modern roughened surface dental implants in the pterygoid region.

MATERIAL AND METHODS

This systematic review was an update from a previously published systematic review in 2011, which largely reported data on older machined surface dental implants. An electronic search for articles in the English language literature published from January 1, 2010 to December 8, 2021 was performed using PubMed, Scopus, and CENTRAL search engines. After applying a systematic search process in 3 stages, the final list of selected articles on roughened surface pterygoid implants was obtained. Data from the selected articles were collated with data from pertinent articles on roughened implant surface from the previous systematic review. The combined data was then used for calculating the interval survival rate (ISR) and cumulative survival rate (CSR) of pterygoid implants.

RESULTS

The initial electronic search resulted in 1263 titles. The systematic search process eventually resulted in 10 clinical studies reporting on modern roughened surface pterygoid implants. These 10 studies reported on a total of 911 pterygoid implants with 39 reported failures over a 6-year period. The majority of failures (37) were reported during the first year time interval and a majority of them (30) occurred before loading of the pterygoid implants. Only 2 late failures were reported after loading, during the 6^th year time interval. The majority of implants were used for rehabilitation of full arch fixed implant supported prosthesis. At the maximum follow-up interval of 6 years, the cumulative survival rate of pterygoid implants with roughened surfaces was 95.5%, which was 5% higher than reported in the previous systematic review which combined machined and roughed surface pterygoid implants.

CONCLUSIONS

The survival rate of modern roughened surface dental implants in the pterygoid region is favorable at 95.5% over a 6 year period, and comparable to the existing evidence on survival of implants in other regions of the maxilla and mandible. This article is protected by copyright. All rights reserved.

A technique for digital alignment of cross-articulated casts in a computer-aided design software program for complete-mouth rehabilitation

With the advent of computer-aided design and computer-aided manufacturing (CAD-CAM), dental restorations are no longer fabricated in an entirely analog fashion. Successful execution of complete-mouth rehabilitations requires articulation of definitive maxillary and mandibular casts with tooth preparations, as well as cross-articulation with the patient's interim restorations. These cross-articulated records serve as a guide for the dental laboratory technician in fabricating the definitive restorations. In the CAD-CAM workflow, cross-articulation and overlaying of a patient's interim casts over the definitive casts of tooth preparations poses some challenges because of loss of common anatomic data points such as incisive papilla, rugae, and the palate. This article describes a straightforward technique to overcome this common challenge, where a dental laboratory technician can predictably overlay the digitized interim casts to allow for cross-articulation and proceed with designing and fabricating the definitive restorations.

Management of Fractured Zirconia Complete Arch Fixed Implant-Supported Prosthesis Caused by Misfit Due to Diverse Implant Components: A Case Report

Recently, monolithic zirconia complete-arch fixed implant-supported prosthesis (CAFIP) has been shown to be an effective means of managing patients with edentulism or terminal dentition. Prosthetic complications have been reported to be rare, as long as there is proper treatment planning, prosthetic space and careful attention during fabrication of the prosthesis. Few reports exist in the literature that have described the management of patients with fractured zirconia CAFIP. This case report describes the successful management of a female patient with a midline fracture of a monolithic zirconia CAFIP supported by 6 dental implants in the mandibular arch. The fractured prosthesis had adequate prosthesis thickness with no distal cantilever, and opposed a similar prosthesis in the maxilla. However, upon careful analysis, diverse implant components were identified as the primary contributory factor to prosthetic misfit, and subsequent fracture. This is a new factor that requires attention by clinicians and dental laboratory technicians due to the increased prevalence of patients with preexisting dental implants. This article describes the considerations related to diverse implant components and connections from different implant manufacturers, choice of favorable implant-abutment design, technique for mitigation, and importance of passive fit for zirconia CAFIP.

The Influence of Age and Facial Expression (Eye Open/Closed) On Maxillary Dental and Gingival Display

PURPOSE

To assess if there are any differences in maxillary dentogingival exposure between different facial expressions (maximum smile with eyes open and eyes closed), age groups and both sexes.

MATERIAL AND METHODS

Digital photographs of the lower third of the face of 120 subjects, belonging to 6 different age groups were taken. There were 20 subjects in each of the 6 age groups (20-30, 30-40, 40-50, 50-60, 60-70, and 70-80) which were comprised of 80 women and 40 men. Two standardized images of each subject were taken, one of maximum smile with eyes open, and the second of maximum smile with eyes closed. These 240 images were used to quantify a dentogingival exposure ratio (DER) for each tooth spanning the second bicuspids on either side, using standardized measurement techniques. Additionally, incidence of interdental papilla visibility was studied in a binary manner, and all data were studied with respect to various covariables of age, sex and type of facial expression using a generalized linear mixed effects model. A p-value < 0.05 was determined to be statistically significant.

RESULTS

There was a statistically significant difference between the dentogingival exposure ratio (DER) for all images with eyes open and eyes closed per tooth location studied, across all age groups (p ≤ 0.001) and both sexes, suggesting that subject images of smiles with eyes closed had significantly higher dentogingival exposure. There was a decreasing trend of DER with increasing age groups when eyes were open (p = 0.005) and when eyes were closed (p = 0.042), suggesting that older subjects had lower dentogingival exposure. With respect to sex, there was no statistically significant difference in mean DER between males and females, when eyes were open (p = 0.430) and closed (p = 0.351). The incidence of interdental papilla exposure also differed significantly between images with eyes open and eyes closed across all age groups (p ≤ 0.001). However, the incidence of interdental papilla exposure decreased with age, only in images with eyes open (p < 0.001) but was not statistically significant among images with eyes closed (p = 0.127). With respect to sex, there was a significant difference in incidence of interdental papilla exposure in images with eyes open (p = 0.029) but no significant difference when eyes were closed (p = 0.782).

CONCLUSIONS

Maxillary dentogingival exposure decreases with increasing age and is significantly higher when recording maximum smile with eyes closed, for all age groups and both sexes. As this is a simple and clinically reproducible facial expression, incorporating patient's maximum smiling images with eyes closed may be routinely necessary for complete and accurate data collection for prosthodontic treatment planning purposes.

Full arch monolithic zirconia prosthesis in a patient with bilateral cleft palate: A clinical report

Adult patients with bilateral cleft lip and palate present unique challenges for prosthodontic treatment because of mobility of the premaxillary segment, oral-nasal communication, multiple missing and malpositioned anterior teeth, unfavorable soft tissues, and scar tissue underneath the maxillary lip. This clinical report describes the prosthodontic treatment of an adult patient with a terminal maxillary dentition and bilateral cleft palate, by using 5 dental implants and a 1-piece complete-arch fixed implant-supported prosthesis made of monolithic zirconia. The zirconia prosthesis aided in rigidly splinting not only the implants but also in orthopedically splinting the mobile premaxillary segment to the maxilla. Additional surgical and prosthodontic considerations in splinting the mobile premaxilla as well as biomechanical principles involved in management of such patients are also presented in this article.

Comparison of In Vitro Inactivation of SARS CoV-2 with Hydrogen Peroxide and Povidone-Iodine Oral Antiseptic Rinses

Purpose

To evaluate the in vitro inactivation of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) with hydrogen peroxide (H₂O₂) and povidone‐iodine (PVP‐I) oral antiseptic rinses at clinically recommended concentrations and contact times.

Materials and Methods

SARS‐CoV‐2, USA‐WA1/2020 strain virus stock was prepared prior to testing by growing in Vero 76 cells. The culture media for prepared virus stock was minimum essential medium (MEM) with 2% fetal bovine serum (FBS) and 50 µg/mL gentamicin. Test compounds consisting of PVP‐I oral rinse solutions and H₂O₂ aqueous solutions were mixed directly with the virus solution so that the final concentration was 50% of the test compound and 50% of the virus solution. Thus PVP‐I was tested at concentrations of 0.5%, 1.25%, and 1.5%, and H₂O₂ was tested at 3% and 1.5% concentrations to represent clinically recommended concentrations. Ethanol and water were evaluated in parallel as standard positive and negative controls. All samples were tested at contact periods of 15 seconds and 30 seconds. Surviving virus from each sample was then quantified by standard end‐point dilution assay and the log reduction value of each compound compared to the negative control was calculated.

Results

After the 15‐second and 30‐second contact times, PVP‐I oral antiseptic rinse at all 3 concentrations of 0.5%, 1.25%, and 1.5% completely inactivated SARS‐CoV‐2. The H₂O₂ solutions at concentrations of 1.5% and 3.0% showed minimal viricidal activity after 15 seconds and 30 seconds of contact time.

Conclusions

SARS‐CoV‐2 virus was completely inactivated by PVP‐I oral antiseptic rinse in vitro, at the lowest concentration of 0.5 % and at the lowest contact time of 15 seconds. Hydrogen peroxide at the recommended oral rinse concentrations of 1.5% and 3.0% was minimally effective as a viricidal agent after contact times as long as 30 seconds. Therefore, preprocedural rinsing with diluted PVP‐I in the range of 0.5% to 1.5% may be preferred over hydrogen peroxide during the COVID‐19 pandemic.

Rapid In-Vitro Inactivation of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Using Povidone-Iodine Oral Antiseptic Rinse

PURPOSE

To investigate the optimal contact time and concentration for viricidal activity of oral preparation of povidone-iodine (PVP-I) against SARS-CoV-2 ('corona virus') to mitigate the risk and transmission of the virus in the dental practice.

MATERIALS AND METHODS

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) USA-WA1/2020 strain, virus stock was tested against oral antiseptic solutions consisting of aqueous povidone-iodine (PVP-I) as the sole active ingredient. The PVP-I was tested at diluted concentrations of 0.5%, 1%, and 1.5%. Test media without any virus was added to 2 tubes of the compounds to serve as toxicity and neutralization controls. Ethanol (70%) was tested in parallel as a positive control, and water only as a negative control. The test solutions and virus were incubated at room temperature (22 ± 2 °C) for time periods of 15 and 30 seconds. The solution was then neutralized by a 1/10 dilution in minimum essential medium (MEM) 2% fetal bovine serum (FBS), 50 µg/mL gentamicin. Surviving virus from each sample was quantified by standard end-point dilution assay and the log reduction value (LRV) of each compound compared to the negative (water) control was calculated.

RESULTS

PVP-I oral antiseptics at all tested concentrations of 0.5%, 1%, and 1.5%, completely inactivated SARS-CoV-2 within 15 seconds of contact. The 70% ethanol control group was unable to completely inactivate SARS-CoV-2 after 15 seconds of contact, but was able to inactivate the virus at 30 seconds of contact.

CONCLUSIONS

PVP-I oral antiseptic preparations rapidly inactivated SARS-CoV-2 virus in vitro. The viricidal activity was present at the lowest concentration of 0.5 % PVP-I and at the lowest contact time of 15 seconds. This important finding can justify the use of preprocedural oral rinsing with PVP-I (for patients and health care providers) may be useful as an adjunct to personal protective equipment, for dental and surgical specialties during the COVID-19 pandemic.

Management of Maxillary Cluster Implant Failures with Extra-Maxillary Implants: A Clinical Report

Late cluster implant failures can be one of the most devasting outcomes of implant therapy for patients. It can have anatomic, functional, psychological and financial consequences for patients, and sometimes the loss of residual bone can preclude subsequent implant placement. Fortunately, management of cluster implant failures in the maxilla can be mitigated by using implant anchorage from remote sites like zygomatic and pterygoid regions. Few reports exist in the literature that have described the management of cluster implant failure using extra-maxillary implants such as zygomatic and pterygoid implants. This case report describes the management of a female patient with bruxism who experienced late cluster implant failure in the maxilla after 9 years of function with an overdenture. Due to the loss of residual bone, subsequent implant therapy involved the use of bilateral zygomatic, pterygoid and anterior maxillary implants, which were immediately loaded and thereafter used to support a complete arch fixed implant-supported zirconia prosthesis.

Complete Arch Monolithic Zirconia Prosthesis Supported By Cobalt Chromium Metal Bar: A Clinical Report

Complete arch fixed implant supported prosthesis made of monolithic zirconia is a popular treatment option with minimal complications, as documented in the literature over a 5-year period. One of the limitations of this material is its inability to be used when the span between adjacent implants is excessively long. A potential solution to mitigate this problem is to support the zirconia prosthesis with a metal substructure, which intrinsically has higher tensile strength. This clinical report describes the successful use of this prosthetic design in a male patient with bruxism and history of multiple implant failures in the maxilla. This resulted in a large anterior-posterior span between the anterior implants in the maxillary lateral incisor region and the distal implants in the pterygoid region. This article also describes the use of a split file digital workflow to scan the prototype prosthesis and then digitally design and mill the screw-retained cobalt chromium bar, as well as the overlaying of zirconia prosthesis which was retained by separate screws. This novel approach offers promise for management of the atrophic maxilla where implants with remote anchorage are used resulting in broader distribution of implants.

Application of the palatogram technique to improve speech with complete-arch fixed implant-supported zirconia prostheses

While maxillary complete-arch fixed implant-supported prostheses are a popular treatment for patients with complete edentulism or with a terminal dentition, how speech is best optimized with this treatment is unclear. One popular method used in complete denture therapy for immediate improvement of speech, as well as to reduce the speech adaptation period for patients, is the use of a palatogram technique. Contemporary biomaterials such as zirconia used for complete-arch fixed implant-supported prosthesis are difficult to adjust and modify. Therefore, the purpose of this article was to describe the application of the palatogram technique during the evaluation stage of the maxillary screw-retained milled prototype prosthesis (interim acrylic resin prosthesis) to improve the palatal contours and optimize contact areas of the tongue with the palatal aspect of the prosthesis. The modified interim prosthesis can then be used for copy milling the definitive zirconia prosthesis. This technique is useful when other prosthodontic factors related to speech, such as the occlusal vertical dimension and tooth positions, have already been optimized.

Implant-Supported Immediately Loaded Complete Arch Rehabilitations with a Mean Follow-up of 10 Years: A Prospective Clinical Study

PURPOSE

To evaluate the complication-free and failure-free survival rates of porcelain fused to zirconia (PFZ) and all-resin complete arch fixed implant-supported prostheses over a mean follow-up of 10 years.

MATERIAL AND METHODS

Subjects with either all-resin or PFZ complete arch fixed implant-supported prostheses on 4 or 6 implants were followed prospectively for 10 years. Cumulative survival rates of prostheses without any catastrophic mechanical complications (resolved without replacing the prosthesis) and free of prosthesis failure (requiring the replacement or removal of the prosthesis) were calculated using life table analysis for up to 10-year period. Additional descriptive variables for various prosthesis events were recorded, such as sex, smoking and drinking status of subjects.

RESULTS

A total of 36 subjects with a total of 68 prostheses (53 all-resin and 15 PFZ) were available for evaluation with a mean follow-up of 10 years (SD 1.47; range: 8-13 years). The study registered an overall 90% prostheses survival rate-78% for males and 94% for females; 91% for PFZ and 87% for all-resin; and a 31% complication-free prosthesis survival rate-13% for males and 38% for females; 29% for PFZ and 31% for all-resin at 10 years. A slight decrease in survival rate was identified in the first 3 years since the initial treatment (from 100% to 93%). The number of complications increased with time, especially after the 6th year after the initial treatment.

CONCLUSION

Despite the number of reparable mechanical complications, the results confirmed the long-lasting features of both PFZ and all-resin complete arch fixed implant-supported prostheses over a 10-year period. There was however an increased number of mechanical complications after 6 years which may entail additional treatment cost for patients.

An analysis of anterior mandibular anatomy by using cone beam computed tomography: A study of 225 mandibular images

STATEMENT OF PROBLEM

The anterior mandible has conventionally been deemed as a safe zone for dental implants. However, with the evolution of cone beam computed tomography (CBCT), several anatomic challenges have been identified that, if violated, can lead to surgical complications, including life-threatening hemorrhage.

PURPOSE

The purpose of this observational clinical study was to obtain standardized average values for the location of the sublingual artery (SLA), submental artery (SMA), and mandibular incisive canal (MIC) and to determine whether differences exist between dentate and edentulous individuals. In addition, the prevalence of these anatomic landmarks on CBCT images was determined. An additional objective was to study the cross-sectional morphology of the anterior mandible.

MATERIAL AND METHODS

CBCT images of 125 edentulous and 100 dentate patients were studied at the anterior mandible for the prevalence of SLA, SMA, and MIC. Measurements of these 3 structures were then made from the inferior cortical border of the mandible to the superior border of each structure to obtain average anatomic measurements. The cross-sectional shapes of anterior mandibles were then categorized, and the prevalence of each shape in this sample was calculated.

RESULTS

The prevalence of SLA across all 225 CBCT images was 100% for edentulous patients and 98% for dentate patients. The SLA was located approximately 15 mm above the inferior border of the mandible. The prevalence of SMA was 94% for edentulous patients and 88% for dentate patients. The SMA was located approximately 5 mm above the inferior border of the mandible. The prevalence of MIC was 61% for edentulous patients and 59% for dentate patients. The MIC was located approximately 11 mm above the inferior border of the mandible in edentulous patients and approximately 14 mm above the inferior border of the mandible in dentate patients. Five distinct shapes were observed for the cross-sectional morphology of the anterior mandible: hourglass (1%), pear (53%), sickle (4%), ovoid (26%), and triangular (17%). The distance from the crest of the residual ridge to a minimum 6-mm width in the anterior mandible was approximately 4 mm.

CONCLUSIONS

The SLA and SMA vascular structures were consistently identified in the anterior mandible on CBCT images, both in dentate and edentulous patients, whereas the mandibular incisive canal was not consistently visualized. Average values from the inferior border of the mandible to the SLA, SMA, and MIC were computable. The cross-sectional morphology of the anterior mandible is diverse in dentate and edentulous mandibles, with pear shaped being the most common in both. These findings should be taken into consideration when dental implants are planned in the anterior mandible.

Management of peripheral giant cell granuloma around complete-arch fixed implant-supported prosthesis: A case series

Abnormal peri-implant tissue response in the form of benign reactive lesions, such as peripheral giant cell granuloma and pyogenic granuloma, is a less frequent biologic complication associated with dental implant therapy. However, these lesions can cause gingival pain, swelling, and discomfort, as well as peri-implant bone loss and possible implant failure. Few reports in the dental literature have described these lesions around complete-arch fixed implant-supported prostheses. The purpose of this clinical report was to describe 3 distinct scenarios in patients with complete-arch fixed implant-supported prostheses presenting with benign reactive lesions that were histologically diagnosed as peripheral giant cell granulomas. Each of these 3 patients had acrylic resin as one of the materials in their prosthesis. The distinctive management of each of these 3 patients encompassed surgical, prosthodontic, and pharmacologic means.

A 30-Year Follow-Up of a Patient with Mandibular Complete-Arch Fixed Implant-Supported Prosthesis on 4 Implants: A Clinical Report

Mandibular complete-arch fixed implant-supported prostheses are recognized as one of the earliest and most popular prostheses in implant dentistry. This prosthesis was the main focus in the early era of osseointegration. Despite its widespread popularity, few clinical reports have described long-term follow-up greater than 10 years for this type of prosthesis. This report describes a 30-year follow-up of a patient who underwent treatment for a mandibular complete-arch fixed implant-supported prosthesis with 4 machined surfaced implants, opposing a maxillary complete denture. This report documents a variety of photographs and radiographs taken over a period of 30 years to compare bone levels at various stages of care and maintenance, including de novo bone formation underneath the distal cantilevers due to functional loading. The biologic and biomechanical response to this treatment protocol and long-term clinical observations and prosthodontic outcome and maintenance needs are also addressed.

Internal Sinus Membrane Elevation in Patients With Less Than 5 mm Residual Bone Height

Sinus membrane elevation can be accomplished through use of either a direct or indirect technique. The indirect or internal elevation technique lifts the sinus membrane by elevating it superiorly using osteotomes, with or without the use of grafting material. The authors reference a revolutionary randomized clinical trial in which tissue-level implants with a coronally flared design were placed in residual bone height of ≤4 mm using an internal sinus membrane elevation technique and describe an adaptation of the procedure discussed in that study and its successful use in a prosthodontics residency program.

Rehabilitation of edentulous jaws with zirconia complete-arch fixed implant-supported prostheses: An up to 4-year retrospective clinical study

STATEMENT OF PROBLEM

Limited data are available on the clinical outcomes of patients with edentulism treated with zirconia complete-arch fixed implant-supported prostheses (CAFIPs).

PURPOSE

The primary purpose of this retrospective clinical study was to study the failure rate of dental implants as well as the fracture rate of zirconia CAFIPs. The secondary purpose was to study the survival outcomes of patients with edentulism treated with zirconia CAFIPs as well as the rate of technical complications.

MATERIAL AND METHODS

This retrospective clinical study from private practice included 128 patients rehabilitated between January 1, 2013, and December 31, 2016, with 1072 implants supporting 191 zirconia CAFIPs for single-jaw as well as double-jaw rehabilitations. All zirconia prostheses were of 1-piece design and were veneered with feldspathic porcelain only at the gingival region and therefore considered as predominantly monolithic. Additionally, all prostheses were bonded to implant manufacturer's titanium cylinders that provided an intimate contact with the implants. The primary outcome measures were implant failure rate and prosthesis fracture rate. The secondary outcome measures were prosthodontic treatment survival rate and the incidence of technical complications with respect to monolithic zirconia CAFIPs. Cumulative survival rate (CSR) for implants and prostheses was calculated after a life-table survival analysis.

RESULTS

Of the analyzed samples over a 4-year period, at least 288 implants and 49 prostheses had a minimum of 4 years of follow-up. A total of 18 implant failures were noted (13 in maxilla, 5 in mandible), yielding a CSR of 97.6% for implants. One fracture of the zirconia prosthesis was recorded, yielding a CSR of 99.4% for the prostheses over the 4-year period. Another 3 prostheses required remaking because the supporting implants failed, and 1 prosthesis was remade because the lack of passive fit resulted in a CSR of 96.8% for the prosthodontic treatment itself. During the 4-year period, 1 zirconia prosthesis had a technical complication related to the debonding of titanium cylinders, and 2 prostheses had fractured screws, which were resolved successfully. No zirconia prostheses had chipping of the veneered gingival porcelain.

CONCLUSIONS

Findings from this retrospective clinical study from private practice showed that prosthodontic treatment of edentulous patients with a 1-piece, complete-arch fixed implant-supported zirconia prosthesis with veneered porcelain restricted to the gingival region had high survival rates for implants and prostheses. Minimal technical complications related to this type of treatment for edentulous jaws and no chipping of the veneered gingival porcelain were encountered.

Differences in Lip Support with and without Labial Flanges in a Maxillary Edentulous Population. Part 2: Blinded Subjective Analysis

PURPOSE

To study the subjective differences in facial esthetics evaluations among lay people, general dentists, and prosthodontists, when evaluating images of patients wearing a maxillary denture with a labial flange in comparison to an experimental flangeless denture.

MATERIALS AND METHODS

A random sample of 20 maxillary edentulous patients from the original sample of 31 patients described in part 1 of the study was selected for this study. A total of 60 judges comprising 15 general dentists, 15 prosthodontists, and 30 lay people were recruited for subjective analysis. The judges were blinded about the objectives of the study and were asked to rate the facial esthetics of each image using a 100 mm visual analog scale (VAS) instrument. Four digital images per subject (total of 80 images) were evaluated in a random order, twice by all 60 judges. A repeated measures general linear mixed modeling method using restricted maximum likelihood estimation was performed using mixed procedure in a statistical software package to study the differences in evaluations.

RESULTS

The overall VAS ratings of facial esthetics for images with flangeless dentures were slightly lower compared to images with labial flanges, and this difference was statistically significant (p < 0.05). This was true for both profile and frontal images; however, the magnitude of the difference was too small (no greater than 4 mm on a 100 mm scale) to be clinically significant. There were no statistically significant differences in facial esthetics ratings irrespective of the background or gender of the judges.

CONCLUSIONS

Flangeless dentures resulted in slightly lower ratings of facial esthetics compared to images with a labial flange, but the differences were clinically insignificant. This was true for all judges comprising general dentists, prosthodontists, and lay people and for both frontal and profile images.

A Systematic Review of Recall Regimen and Maintenance Regimen of Patients with Dental Restorations. Part 1: Tooth-Borne Restorations

PURPOSE

To evaluate the current scientific evidence on patient recall and maintenance of dental restorations on natural teeth, standardize patient care regimens, and improve maintenance of oral health. An additional purpose was to examine areas of deficiency in the current scientific literature and provide recommendations for future studies.

MATERIALS AND METHODS

An electronic search for articles in the English language literature from the past 15 years was performed independently by multiple investigators using a systematic search process. After application of predetermined inclusion and exclusion criteria, the final list of articles was reviewed in depth to meet the objectives of this review.

RESULTS

The initial electronic search resulted in 2161 titles. The systematic application of inclusion and exclusion criteria resulted in 12 articles that met the objectives of the study. An additional 4 articles were added through a supplemental search process for a total of 16 studies. Out of these, 9 were randomized controlled clinical trials and 7 were observational studies. The majority of the studies (14 out of 16) were conducted in the past 5 years, and most of the studies were conducted in Europe (10). Results from the qualitative data, on a combined 3569 patients, indicated that outcome improvements in recall and maintenance regimen were related to (1) patient/treatment characteristics (adherence to recall appointments, type of restoration and type of restorative material); (2) agent (chlorhexidine, fluoride, triclosan); and (3) professional interventions (repeated oral hygiene instruction, regular oral hygiene intervention).

CONCLUSIONS

There is minimal evidence related to recall regimens in patients with removable and fixed tooth-borne restorations; however, there is considerable evidence indicating that patients with tooth-borne removable and fixed restorations require lifelong dental professional maintenance to provide repeated oral hygiene instruction and regular oral hygiene intervention customized to each patient's treatment. Current evidence also indicates that use of specific oral topical agents like chlorhexidine, fluoride, and triclosan can aid in reducing risk for gingival inflammation, dental caries, and candidiasis. Therefore, these agents may aid in improvement of professional and at-home maintenance of various tooth-borne dental restorations. Furthermore, due to the heterogeneity of patient populations, restorations, and treatment needs, the evidence compels forethought of creating clinical practice guidelines for recall and maintenance of patients with tooth-borne dental restorations.

Ability of General Dentists and Prosthodontists to Discern and Identify Incremental Increases in Occlusal Vertical Dimension in Dentate Subjects

PURPOSE

The aim of this study was to determine whether dentists are able to discern and identify increases in occlusal vertical dimension (OVD) in dentate subjects without apparent loss of OVD.

MATERIALS AND METHODS

A total of 10 dentate subjects had mandibular overlays fabricated at 2-, 3-, 4-, and 5-mm openings of the anterior guide pin (AGP) of a semiadjustable articulator. Standardized frontal and profile photographs with subjects wearing each of the overlays were made. Photographs were presented in random order to 40 judges comprising 20 prosthodontists and 20 general dentists who were informed about the purpose of the study. Judges first rated the degree of facial naturalness on a visual analog scale (VAS) and then took a discriminatory sensory analysis test (triangle test) where they were required to correctly identify the image with no increase in OVD from a set of three images.

RESULTS

Mean VAS ratings for facial naturalness were inversely correlated with incremental increases in OVD, irrespective of the judge's background. Though subjects were rated less natural with incremental increases in OVD, only a 5-mm increase from baseline was clinically significant (P < .05). For the triangle test, judges correctly identified the image with a 3-mm increase in OVD 57% of the time (P < .582), irrespective of the judge's profession, sex, race, and years in practice, which were clinically insignificant.

CONCLUSION

Increasing OVD by a 5-mm opening of the AGP of the articulator significantly decreased the judge's evaluation of facial naturalness. The ratings were more pronounced in female subjects than in male subjects. However, an increase in OVD of 3 mm was visually indistinguishable by the judges.

Differences in Lip Support with and without Labial Flanges in a Maxillary Edentulous Population. Part 4: Patient-Centered Analysis

PURPOSE

To study the subjective differences in facial esthetics evaluations and the ability to distinguish facial changes due to changes in lip support, when evaluated by patients themselves. An additional objective was to study the differences between patients' self-evaluation versus evaluation of other patients.

MATERIALS AND METHODS

A total of 22 maxillary edentulous patients from the original sample of 31 patients described in Part 1 of the study, returned to participate in this part of the study. The 22 patients acted as judges for all images in this study, and were therefore un-blinded to the objectives and details of the study. Patients first completed evaluation of facial esthetics on a visual analog scale (VAS). Four digital images per patient (total of 88 images) were evaluated in a random order, twice by all 22 patients. The mean scores from all judgments were used as the outcomes to be analyzed. All patients then took a discriminatory sensory analysis test (triangle test) where they were required to correctly identify the image with a flangeless denture out of a set of 3 images. Both the VAS and triangle test ratings were conducted twice in a random order, and mean ratings were used for all analyses.

RESULTS

For VAS analysis, there were no statistically significant or clinically significant differences in facial esthetics ratings between flange and flangeless dentures (p < 0.05). This was true for both profile and frontal images, irrespective of self-evaluation versus evaluation of other patients, years of patient edentulism, and judge (patient) gender. For the triangle test, frontal images had a correct identification rate of 50.2% and profile images of 50.4%, and the difference was not significant. There were no significant differences in triangle test results with respect to self-evaluation versus evaluation of other patients and judge (patient) gender. For all patients, the likelihood of correctly identifying images with flangeless dentures was significantly greater than 1/3, which was the minimum chance for correct identification (p < 0.0001).

CONCLUSIONS

Flangeless dentures resulted in no differences in facial esthetics ratings for frontal and profile images, when evaluated by patients. When patients were forced to look for differences, flangeless dentures were detected in half of the image sets. These findings were similar for self-evaluation versus evaluation of other patients and for both patient genders.

Differences in Lip Support with and without Labial Flanges in a Maxillary Edentulous Population. Part 1: Objective Analysis

PURPOSE

To study the objective differences in lip support using common facial soft tissue markers, when evaluating patients wearing a maxillary denture with a labial flange in comparison to an experimental flangeless denture.

MATERIALS AND METHODS

A total of 31 maxillary edentulous patients who were esthetically satisfied with their existing maxillary denture were recruited in this clinical study. The maxillary denture was then duplicated in clear acrylic resin. Two standardized full-face digital photographs (frontal and profile) were made with the duplicate denture in the mouth. The labial flange of the duplicate denture was then removed from first premolar to first premolar region, to create the experimental flangeless denture. It was returned to the oral cavity, and 2 additional full-face digital photographs were made. The differences between these images were studied using 5 facial anatomic markers (subnasale, labrale superior, stomion, nasolabial angle, lip thickness). A paired sample t-test was used to compare differences in measurements for various anatomic markers using an alpha value of 0.05.

RESULTS

For profile images, there were no statistically significant differences between photographs with and without a labial flange for anatomic markers- labrale superior and stomion (p < 0.05). There was a statistically significant difference for subnasale as well as the nasolabial angle but the magnitude of the difference was too small to be clinically significant (p < 0.05). For frontal images, there was no statistically significant difference in lip thickness between photographs with and without a labial flange. Additionally, there was no association between differences in measurements and patient-related factors such as gender and prior years of edentulism.

CONCLUSIONS

Removal of a labial flange in a maxillary denture resulted in minimal and clinically insignificant anatomic differences in lip support between flange and flangeless dentures, when analyzed in frontal and profile images.

Clinical outcomes of full arch fixed implant-supported zirconia prostheses: A systematic review

AIM

The primary aim of this systematic review was to study the clinical outcomes of one-piece fixed complete dentures (complete arch fixed implant-supported prostheses) made of zirconia for edentulous patients. The secondary aim was to compare the clinical outcomes of monolithic zirconia vs zirconia veneered with porcelain (conventional, minimal or gingival) for fixed complete dentures.

MATERIALS AND METHODS

Two investigators conducted an independent electronic search of the literature, using PubMed and Scopus search engines from January 1, 2000, to August 31, 2016. After application of pre-determined inclusion and exclusion criteria, the final list of articles was reviewed to meet the aims of this review.

RESULTS

A total of 12 observational studies were identified that satisfied the inclusion criteria of this systematic review. Short-term results from a combined 223 patients with 285 one-piece zirconia fixed complete dentures showed a mean failure rate of 1.4% due to the fracture of four prostheses. Prosthetic complications occurred in 46 prostheses (16.1%). Out of these, 42 prostheses (14.7%) had minor complications exclusive to fracture of veneered porcelain.

CONCLUSIONS

Current evidence indicates that zirconia fixed complete dentures have a very low failure rate in the short term, but have a substantial rate of minor complications related to chipping of veneered porcelain. Use of monolithic zirconia with only gingival stains, or zirconia that is veneered only at the gingiva may offer promising results, but will need to be validated by future long-term studies. Conflict-of-interest statement: All authors report no conflict of interest.

Technique for soft tissue closure in surgeries for fixed implant-supported prostheses in the edentulous maxilla

A technique is presented that can be used as a straightforward, quick, and minimally invasive solution to improve soft tissue closure for surgeries involving bone reduction for fixed implant-supported prostheses in the edentulous maxilla.

Clinical Practice Guidelines for Recall and Maintenance of Patients with Tooth-Borne and Implant-Borne Dental Restorations

PURPOSE

To provide guidelines for patient recall regimen, professional maintenance regimen, and at-home maintenance regimen for patients with tooth- and implant-borne removable and fixed restorations.

METHODS

The American College of Prosthodontists (ACP) convened a scientific panel of experts appointed by the ACP, American Dental Association (ADA), Academy of General Dentistry (AGD), and American Dental Hygienists Association (ADHA) who critically evaluated and debated recently published findings from 2 systematic reviews on this topic. The major outcomes and consequences considered during formulation of the clinical practice guidelines (CPGs) were risk for failure of tooth- and implant-borne restorations. The panel conducted a round table discussion of the proposed guidelines, which were debated in detail. Feedback was used to supplement and refine the proposed guidelines, and consensus was attained.

RESULTS

A set of CPGs was developed for tooth-borne restorations and implant-borne restorations. Each CPG comprised of 1) patient recall; 2) professional maintenance, and 3) at-home maintenance. For tooth-borne restorations, the professional maintenance and at-home maintenance CPGs were subdivided for removable and fixed restorations. For implant-borne restorations, the professional maintenance CPGs were subdivided for removable and fixed restorations and further divided into biological maintenance and mechanical maintenance for each type of restoration. The at-home maintenance CPGs were subdivided for removable and fixed restorations.

CONCLUSION

The clinical practice guidelines presented in this document were initially developed using the 2 systematic reviews. Additional guidelines were developed using expert opinion and consensus, which included discussion of the best clinical practices, clinical feasibility and risk-benefit ratio to the patient. To the authors' knowledge, these are the first CPGs addressing patient recall regimen, professional maintenance regimen, and at-home maintenance regimen for patients with tooth-borne and implant-borne restorations. This document serves as a baseline with the expectation of future modifications when additional evidence becomes available.

Clinical significance of immediate mandibular lateral translation: A systematic review

STATEMENT OF PROBLEM

Immediate mandibular lateral translation (IMLT) has been widely described in theory, but its clinical significance in prosthodontics and restorative dentistry is not clear.

PURPOSE

The purpose of this study was to systematically review the existing literature to identify the clinical significance of IMLT (immediate side shift).

MATERIAL AND METHODS

An electronic search for articles in the English language literature was performed independently by multiple investigators using a systematic search process with the PubMed search engine. After applying predetermined inclusion and exclusion criteria, the final list of studies was analyzed to identify the clinical significance of IMLT.

RESULTS

The initial electronic search yielded 858 titles. The systematic application of the inclusion and exclusion criteria eventually produced 23 studies addressing IMLT in 914 human participants. Eleven studies reported use of voluntary movements, 5 articles reported use of only induced movements, 2 studies reported use of both voluntary and induced movements, and 5 articles did not report the recording method. The amount of IMLT reported ranged from 0 to 3 mm with minimal clarity among authors on the exact description of IMLT. No studies reported on any clinical implication (harm or benefit to patients or clinicians) of incorporating IMLT in diagnosis and treatment planning.

CONCLUSIONS

This systematic review did not identify any scientific evidence on the clinical implications of IMLT. Furthermore, there is a lack of clear terminology related to IMLT and the timing of the side shift, occurrence of IMLT on the working versus nonworking condyle, and induced versus noninduced methods of recording and measuring. Current scientific evidence does not support the need to include IMLT as a factor when prosthodontic or restorative treatment is planned and executed.

Clinical practice guidelines for recall and maintenance of patients with tooth-borne and implant-borne dental restorations

The purpose of this article is to provide guidelines for patient recall regimen, professional maintenance regimen, and at-home maintenance regimen for patients with tooth-borne and implant-borne removable and fixed restorations. The American College of Prosthodontists (ACP) convened a scientific panel of experts appointed by the ACP, American Dental Association, Academy of General Dentistry, and American Dental Hygienists Association, who critically evaluated and debated recently published findings from 2 systematic reviews on this topic. The major outcomes and consequences considered during formulation of the clinical practice guidelines (CPGs) were risk for failure of tooth- and implant-borne restorations. The panel conducted a roundtable discussion of the proposed guidelines, which were debated in detail. Feedback was used to supplement and refine the proposed guidelines, and consensus was attained. A set of CPGs was developed for tooth-borne restorations and implant-borne restorations. Each CPG comprised (1) patient recall, (2) professional maintenance, and (3) at-home maintenance. For tooth-borne restorations, the professional maintenance and at-home maintenance CPGs were subdivided for removable and fixed restorations. For implant-borne restorations, the professional maintenance CPGs were subdivided for removable and fixed restorations and further divided into biological maintenance and mechanical maintenance for each type of restoration. The at-home maintenance CPGs were subdivided for removable and fixed restorations. The clinical practice guidelines presented in this document were initially developed using the 2 systematic reviews. Additional guidelines were developed using expert opinion and consensus, which included discussion of the best clinical practices, clinical feasibility, and risk-benefit ratio to the patient. To the authors' knowledge, these are the first CPGs addressing patient recall regimen, professional maintenance regimen, and at-home maintenance regimen for patients with tooth-borne and implant-borne restorations. This document serves as a baseline with the expectation of future modifications when additional evidence becomes available.

Technique for systematic bone reduction for fixed implant-supported prosthesis in the edentulous maxilla

Bone reduction for maxillary fixed implant-supported prosthodontic treatment is often necessary to either gain prosthetic space or to conceal the prosthesis-tissue junction in patients with excessive gingival display (gummy smile). Inadequate bone reduction is often a cause of prosthetic failure due to material fractures, poor esthetics, or inability to perform oral hygiene procedures due to unfavorable ridge lap prosthetic contours. Various instruments and techniques are available for bone reduction. It would be helpful to have an accurate and efficient method for bone reduction at the time of surgery and subsequently create a smooth bony platform. This article presents a straightforward technique for systematic bone reduction by transferring the patient's maximum smile line, recorded clinically, to a clear radiographic smile guide for treatment planning using cone beam computed tomography (CBCT). The patient's smile line and the amount of required bone reduction are transferred clinically by marking bone with a sterile stationery graphite wood pencil at the time of surgery. This technique can help clinicians to accurately achieve the desired bone reduction during surgery, and provide confidence that the diagnostic and treatment planning goals have been achieved.

Management of pain and sublingual hematoma caused by suture irritation after implant surgery: a clinical report

Hematoma in the sublingual region is an adverse consequence of implant surgery in the mandibular posterior region. Improved knowledge and understanding of the anatomy as well as the use of advanced radiographic imaging have all contributed to minimizing adverse surgical complications in this region. Delayed sublingual hematoma caused by suture irritation after implant surgery has not previously been reported. This article describes the management of a patient with a delayed sublingual hematoma after implant surgery in the posterior mandible had been performed. No evidence of encroachment of the vascular structures was noted at the time of implant surgery. However, at a 48-hour follow-up, the patient presented with severe pain and irritation of the sublingual mucosa, along with extravasation and a collection of blood in the sublingual region. Based on the patient's symptoms and clinical signs, the source of the problem was determined to be the stiff tags of polypropylene suture, which had been used to attain primary closure of the surgical flaps. The situation was conservatively and successfully managed by the use of a custom soft tissue guard to protect the patient's sublingual mucosa and the tongue from the stiff suture tags. Various suture materials and measures for preventing and managing similar situations are discussed in this article.

Clinical and histologic outcomes of socket grafting after flapless tooth extraction: a systematic review of randomized controlled clinical trials

STATEMENT OF PROBLEM

Several biomaterials and techniques have been reported for socket grafting and alveolar ridge preservation. However, the evidence for clinical and histologic outcomes for socket grafting with different types of materials in flapless extraction is not clear.

PURPOSE

The purpose of this systematic review was to analyze the outcomes of a socket grafting procedure performed with flapless extraction of teeth in order to determine which graft material results in the least loss of socket dimensions, the maximum amount of vital bone, the least remnant graft material, and the least amount of connective tissue after a minimum of 12 weeks of healing. Secondary outcomes, including the predictability of regenerating deficient buccal bone, necessity of barrier membranes, and coverage with autogenous soft tissue graft, were also evaluated.

MATERIAL AND METHODS

An electronic search for articles in the English-language literature was performed independently by multiple investigators using a systematic search process with the PubMed search engine. After applying predetermined inclusion and exclusion criteria, the final list of randomized controlled clinical trials (RCTs) for flapless extraction and socket grafting was analyzed to derive results for the various objectives of the study.

RESULTS

The initial electronic search resulted in 2898 titles. The systematic application of inclusion and exclusion criteria resulted in 32 RCTs studying 1354 sockets, which addressed the clinical and histologic outcomes of flapless extraction with socket grafting and provided dimensional and histologic information at or beyond the 12-week reentry period. From these RCTs, the mean loss of buccolingual width at the ridge crest was lowest for xenografts (1.3 mm), followed by allografts (1.63 mm), alloplasts (2.13 mm), and sockets without any socket grafting (2.79 mm). Only 3 studies reported on loss of width at 3 mm below the ridge crest. The mean loss of buccal wall height from the ridge crest was lowest for xenografts (0.57 mm) and allografts (0.58 mm), followed by alloplasts (0.77 mm) and sockets without any grafting (1.74 mm). The mean histologic outcomes at or beyond the 12-week reentry period revealed the highest vital bone content for sockets grafted with alloplasts (45.53%), followed by sockets with no graft material (41.07%), xenografts (35.72%), and allografts (29.93%). The amount of remnant graft material was highest for sockets grafted with allografts (21.75%), followed by xenografts (19.3%) and alloplasts (13.67%). The highest connective tissue content at the time of reentry was seen for sockets with no grafting (52.53%), followed by allografts (51.03%), xenografts (44.42%), and alloplast (38.39%). Data for new and emerging biomaterials such as cell therapy and tissue regenerative materials were not amenable to calculations because of biomaterial heterogeneity and small sample sizes.

CONCLUSIONS

After flapless extraction of teeth, and using a minimum healing period of 12 weeks as a temporal measure, xenografts and allografts resulted in the least loss of socket dimensions compared to alloplasts or sockets with no grafting. Histologic outcomes after a minimum of 12 weeks of healing showed that sockets grafted with alloplasts had the maximum amount of vital bone and the least amount of remnant graft material and remnant connective tissue. There is a limited but emerging body of evidence for the predictable regeneration of deficient buccal bone with socket grafting materials, need for barrier membranes, use of tissue engineering, and use of autogenous soft tissue grafts from the palate to cover the socket.

The 2-Visit CAD-CAM Implant-Retained Overdenture: A Clinical Report

Recently, computer-aided technology has become commercially available in the United States for fabrication of complete dentures. Manufacturers offering this technology require exclusive clinical and laboratory protocols that sharply contrast with the traditional paradigms of complete denture therapy. These protocols allow fabrication of complete dentures in only 2 clinical appointments. Currently, there are no clinical reports in the scientific literature describing the use of this technology for overdentures. This article describes the successful use of computer aided design-computer aided machining (CAD-CAM) technology for prosthodontic phase of fabrication of a mandibular implant-retained overdenture in only 2 clinical appointments. A discussion of the techniques, rationale, indications, advantages, and disadvantages of using CAD-CAM technology for complete dentures and overdentures are described in this article.

Clinical outcomes of lithium disilicate single crowns and partial fixed dental prostheses: a systematic review

STATEMENT OF PROBLEM

Lithium disilicate is a relatively new and popular restorative material for esthetic and functional rehabilitations, but the evidence for clinical outcomes is not clear.

PURPOSE

The purpose of this systematic review was to analyze the short-term (1- to 5-year) and medium-term (5- to 10-year) survival rates of lithium disilicate single crowns and partial fixed dental prostheses.

MATERIAL AND METHODS

An electronic search for articles in the English-language literature published between January 1998 and June 2013 was performed with the PubMed search engine. The specific search terms used were lithium disilicate, lithium silicate, IPS e max, IPS Empress, CAD CAM, pressed ceramic, monolithic, and bilayer. After applying predetermined inclusion and exclusion criteria, the definitive list of selected articles was suitable only for calculating the interval survival rate and cumulative survival rate.

RESULTS

The electronic search resulted in 2033 titles. The systematic application of inclusion and exclusion criteria resulted in 12 clinical studies that addressed the clinical outcomes of lithium disilicate restorations. Of these, 2 were randomized controlled trials, 5 were prospective studies, 1 was a retrospective study, and 4 studies were descriptive in nature. All 12 studies reported on tooth-retained lithium disilicate restorations. The 2-year cumulative survival rate for single crowns was 100%, and the 5-year cumulative survival rate was 97.8%. The 2-year cumulative survival rate for fixed dental prostheses was 83.3%, and the 5-year cumulative survival rate was 78.1%. The cumulative survival rate over a 10-year period, primarily owing to data from 1 study, was 96.7% for single crowns and 70.9% for fixed dental prostheses.

CONCLUSIONS

For lithium disilicate single crowns, the existing evidence indicates excellent short-term survival rates, but the evidence for medium-term survival is limited. For lithium disilicate fixed dental prostheses, the evidence for short-term survival is fair, although limited, but the evidence for medium-term survival is not promising. The majority of failures in both types of restorations were reported in the posterior region.