Virtual Implant Planning and Surgical Guide for Single Implant Placement Fabricated from a Digital Diagnostic Cast, 2-dimensional Radiographic Imaging, and an Open-source Program: A Dental Technique

A technique for virtually planning single implant by combining an intraoral digital scan, an opensource computer-aided design software program, bone sounding, and 2-dimensional radiographic imaging is described. The surgical implant guide is fabricated by using additive manufacturing technologies. Furthermore, the surgical implant guide positioned in the patient's mouth is used to radiographically verify the estimated mesio-distal implant angulation before proceeding with the surgical intervention and modified, if necessary. When a cone bean computed tomography scan is not available, this technique eases implant planning procedures and minimize possible surgical complications.

Novel "All in 4-4-4" Hybrid Prosthesis: Bridging the Affordability Gap

A strong body of scientific evidence indicates that a four dental implant-supported prosthesis is well suited for a full-arch rehabilitation. Yet, countless edentulous patients who could benefit from this established concept are left untreated because of high costs. This article describes a novel workflow that enables the fabrication of a metal-resin fixed hybrid prosthesis supported on four implants, with a variable cost for parts and material of around $400 and a (laboratory) production time of approximately 4 hours. This approach allows for the possibility of delivering a final or long-term provisional restoration on the day of implant placement. Because of the relatively low cost and the feasibility of in-house production, this workflow can potentially allow more patients to access high-quality full-arch implant care.

ITI consensus report on zygomatic implants: indications, evaluation of surgical techniques and long-term treatment outcomes

OBJECTIVES

The aim of the ITI Consensus Workshop on zygomatic implants was to provide Consensus Statements and Clinical Recommendations for the use of zygomatic implants.

MATERIALS AND METHODS

Three systematic reviews and one narrative review were written to address focused questions on (1) the indications for the use of zygomatic implants; (2) the survival rates and complications associated with surgery in zygomatic implant placement; (3) long-term survival rates of zygomatic implants and (4) the biomechanical principles involved when zygoma implants are placed under functional loads. Based on the reviews, three working groups then developed Consensus Statements and Clinical Recommendations. These were discussed in a plenary and finalized in Delphi rounds.

RESULTS

A total of 21 Consensus Statements were developed from the systematic reviews. Additionally, the group developed 17 Clinical Recommendations based on the Consensus Statements and the combined expertise of the participants.

CONCLUSIONS

Zygomatic implants are mainly indicated in cases with maxillary bone atrophy or deficiency. Long-term mean zygomatic implant survival was 96.2% [95% CI 93.8; 97.7] over a mean follow-up of 75.4 months (6.3 years) with a follow-up range of 36-141.6 months (3-11.8 years). Immediate loading showed a statistically significant increase in survival over delayed loading. Sinusitis presented with a total prevalence of 14.2% [95% CI 8.8; 22.0] over a mean 65.4 months follow-up, representing the most common complication which may lead to zygomatic implant loss. The international experts suggested clinical recommendations regarding planning, surgery, restoration, outcomes, and the patient's perspective.

An Analog Intermezzo in a Digital Workflow

Digital dental technology has revolutionized the workflows in the dental laboratory and clinical environment. Although the novelty of digital dentistry can be alluring, clinicians should bear in mind that the overall outcome is what matters most rather than the path taken to achieve that outcome. Combining analog and digital pathways can serve to amplify each one and thus enhance the result. This article presents two case examples where an analog excursion in an otherwise digital workflow saved time and reduced cost compared to a dogmatic digital approach. In one case, an alternative workflow is presented to produce implant fixed complete dentures, and in the other case composite was used to generate the pink esthetic component for a complete denture, which could be fixed or removable.

An open-source multifunctional registration device for implant-supported complete dentures

A 3D printed registration device is described for implant-supported complete dentures that simultaneously register implant position, soft-tissue contour, anterior tooth position, occlusal vertical dimension, and centric relation. This information is captured clinically in 10 to 20 minutes and can then be transferred to the dental laboratory technician to continue the prosthetic workflow. The standard tessellation language (STL) file for the registration device is available for free download and use.

The Metal-Zirconia Implant Fixed Hybrid Full-Arch Prosthesis: An Alternative Technique for Fabrication

The metal-resin hybrid full-arch prosthesis has been a traditionally used type of restoration for full-arch implant fixed dentures. A newer development has centered around the use of monolithic zirconia or zirconia veneered with porcelain. Being a ceramic, zirconia has the potential for fracture. This article describes a technique that utilizes a metal substructure to support a chemically and mechanically resinbonded shell of zirconia. The workflow is discussed, ranging from in-office master cast fabrication to the CAD/ CAM production of the provisional and the definitive metal-zirconia prosthesis. The article also highlights the advantages and disadvantages of various materials used for hybrid prostheses.

A Customized Healing Abutment for Immediate and Delayed Implant Cases

Anatomically contoured healing abutments have been shown to contain and protect slow-resorbing substitution grafts, resulting in bone and soft-tissue volume augmentation. Even in healed sites customized healing abutments have demonstrated favorable outcomes compared to standard healing abutments. Through two separate cases, this article describes a technique that enables simple chairside fabrication of precisely contoured customized healing abutments and exact 3-dimensional intraoral positioning. With this technique, the soft tissues upon maturation closely resemble the natural root contour, which allows for the generation of esthetic and functional implant-supported restorations.

Development and capture of soft tissue contours at time of implant placement

A technique is described which will generate a customized healing abutment for a dental implant to allow the development of ideal soft tissue contours. With implant position and soft tissue contours defined at surgery, customized impression techniques can be used to capture those details and help generate the definitive implant-supported restoration. This workflow reduces the number of patient visits.

Flexible thermoplastic resin to add retention to tooth-supported stereolithographic surgical guides

Surgical guides produced by stereolithography use hard resin. The hard resin prevents seating beyond the height of contour, hence these guides are not intrinsically retentive. By covering the guide with a flexible thermoplastic material that extends into the undercuts, the resulting guide now has a retentive feature. This allows it to maintain its position during surgery yet it can easily be removed and repositioned.

An adjustable, cast based, fully restrictive surgical guide

The 3D Click Guide is a fully restrictive cast-based surgical guide for the placement of dental implants. This in-office system consists of prefabricated parts that are assembled onto a carrier. The 3-dimensional data are derived from a dental cast in combination with a periapical radiograph or cone-beam computed tomography data.

A simple, safe and affordable cast-based guided implant placement system

A fully restrictive surgical guide allows controlled execution of a preoperatively planned osteotomy and subsequent implant placement. There are two fabrication modes. One is a digital path, where these guides can be fabricated based on data from a cone beam CT source. Alternatively, 3-D data can be derived from a dental cast and periapical radiographs. The 3D Click Guide is a cast-based, fully restrictive surgical guide that can be generated in the dental office.

Cast-based guided implant placement: a novel technique

One of the most challenging aspects of implant placement is the correct spatial positioning of the dental implant in the bone. Surgical guides of various configurations have been proposed to aid implant placement. If a fully limiting surgical guide is used, the encoded information should be reliable, as deviations are not possible during surgery. This article describes a combination of analog techniques, including bone sounding and periapical radiographs used to study the available bone volume. A simplified casting protocol is proposed, and the implant platform position of the implant analog is transferred to a surgical guide composed of a stiff vinyl polysiloxane material. This surgical guide is used in a conventional flapless guided implant surgery protocol. This combination of techniques allows precise placement of a dental implant, abutment, and provisional restoration in a minimally invasive manner.

An indirect immediate-load prosthetic protocol using a novel-winged analog

Immediate loading of implants has increasingly become the preferred treatment modality for both patients and clinicians. While the concept has been accepted as the preferred method of treatment, there are various options in terms of completing the actual procedure. This article will discuss the utilization of a novel-winged analog in combination with polyvinylsiloxane-casting material. This correlation allows for the rapid chairside development of a high-precision cast. On this cast, a conversion denture is transformed into an interim fixed prosthesis. Both the conventional analog as well as the computer-guided protocols will be described herein.

LEARNING OBJECTIVES

This article discusses a simplified, indirect method for placing an interim fixed prosthesis utilizing a novel-winged analog and polyvinylsiloxane casting material. Upon reading this article, the reader should: Understand the benefits attributed to the immediate loading of dental implants. Become familiar with the differences between conventional open-flap surgery and treatment protocol utilizing CAD/CAM technology.

The natural tooth pontic; simplified

This paper's objective is to describe a simple, economical and fast method to replace a single tooth. Utilizing an indirectly fabricated composite resin framework reinforced with polyethylene fiber and the existing tooth as pontic. This tooth can be the natural tooth or the restorative crown. In addition, this particular design allows for exact repositioning of the coronal part of the extracted tooth in its original intra-oral 3-dimensional position. This chairside technique does not require laboratory involvement.

A predictable precision cast for multi-unit screw-retained implant prosthesis: rationale and technique

The aim of this article is to describe a technique derived from the premachined cylinder luting technique with the goal to predictably fabricate a highly precise master cast. An impression can be taken directly at implant level or, with some technique modification, at the abutment level. Concurrently, multiple techniques can be employed to fabricate the final framework with the assurance that a framework that fits the cast will fit in the mouth. This predictability improves the workflow of the restoring dentist and laboratory technician since multiple framework try-ins and adjustments are eliminated.

The all-ceramic cantilever bridge: a variation on a theme

All-ceramic crowns have become a dependable treatment modality. As a result, there is interest in expanding this modality to all-ceramic bridge-work. This article describes a modification of the CAD/CAM all-ceramic Procera technique, which allows the fabrication of a single-unit cantilever ceramic bridge using existing equipment and procedures. The stress-bearing areas of the bridge are made of densely sintered high-purity alumina without ceramic-fusing material. Although the indications for this bridge are limited, this technique adds to the dentist's armamentarium of esthetic restorations.

Customized abutments to shape and transfer peri-implant soft-tissue contours

With the functional successes of implant therapy being realized, the emphasis is shifting to the creation of tooth-like esthetics with implant therapy. Dental implants are placed after careful planning and site preparation, which may include bone and soft tissue grafting. The final soft tissue appearance is enhanced through the early use of provisional restorations. A combination technique is described to fabricate provisional healing abutments for cement-on prostheses and to transfer the individualized peri-implant soft-tissue contours to the dental laboratory. This technique will allow the practitioner to deliver highly customized implant care with familiar techniques and readily available materials.

Implant bar design, the next generation

The rationale for implant-supported overdenture therapy is discussed with emphasis on diagnosis (why) and consequential therapy (how). After the conventionally available bar designs are discussed, the newer CEKA bar is discussed. This design of the next generation enables individualization of the essential functions of an implant bar, namely occlusal support, lateral stability and retention.

The adhesive-corrected implant framework

To avoid stress between bone, implant and supra construction, the connection between implants must be passive. This is clinically difficult, if not impossible, to achieve with current procedures. Two techniques are presented in which pre-machined titanium abutment cylinders or discs are intra-orally luted to a cast supra structure. The objective is to create a stress-free implant frame-work connection. Possible advantages and disadvantages are discussed.

Adhesive abutment cylinder luting

The connection between dental implants must be passive so that stress is not introduced between bone, implant, and prosthesis. To achieve this passivity clinically is difficult if not impossible with current procedures. A technique is presented in which premachined titanium abutment cylinders are clinically luted to a cast framework to create a stress-free connection. Possible advantages and disadvantages are discussed.

The bonded porcelain margin in porcelain-fused-to-metal prosthetics

Progress in dentistry is often made when existing techniques and products are combined with new developments. For example, although porcelain has been used for decades and Buonocore reported on its use in 1955, only in early 1980 did bonded porcelain become popular. Today, we assume that porcelain facings and inlays are an integral part of dentistry.

[Structured communication between dentist and laboratory]

Dentist and dental laboratory technician are closely related partners in the dental team. To ensure quality care, communication and understanding of mutual capabilities and limitations is of the utmost importance. Ambitions and goals need to be assessed after which general specifications can be agreed on. Regarding the case communication, a division is made between subjective and objective information. A few means of case communication are discussed.

Use of a multifunctional precision attachment in a fixed partial denture with limited periodontal support. A clinical report

A multifunctional precision attachment used in a fixed partial denture with questionable prognosis enhances the serviceability of the reconstruction. In the treatment presented, future loss of the posterior abutments will not jeopardize the complete rehabilitation. Osseointegrated implants used in conjunction with a fixed prosthesis or a removable partial denture can restore the missing segments.

Cross-pin fixation for fixed partial dentures

A technique is described in which a standardized post system is used as a cross pin. The pin is partially embedded in the mesial or distal aspect of the abutment tooth and the remainder of the pin diameter is incorporated in the metallic substructure of the fixed partial denture. The cemented pin will add retention and resistance to the fixed partial denture. The differences between threaded and smooth cross pins are discussed.