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The article describes the workflow of a patient treatment with ultra-thin zirconia veneers (Prettau® Skin®, Zirkonzahn company). The patient lost part of his tooth 21 at the age of eleven and was provided with a plastic filling. At the age of 24, he decided to have a new treatment. The veneers were designed using an intraoral scan and special software, and then milled from a blank material. After sintering, the veneers were characterized and minimally glazed before being adhesively attached to the prepared teeth. The article emphasizes the new possibilities that this technique opens up and highlights the successful implementation of zirconia restorations with a wall thickness of 0.2 mm. [Extracted from the article]

Purpose: To evaluate the current scientific evidence on estimating cumulative risk for biologic complications relating to dental implants and to develop a patient-centered risk assessment tool for establishing aggregate risk. Materials and Methods: A review of the scientific literature on risk indicators relating to dental implants was completed with the goal of identifying and weighting individual risk indicators so aggregate biologic risk could be estimated. Three authors completed independent reviews of the literature, identifying 31 systematic reviews on risk indicators for biologic complications with dental implants, from which 24 potential risk indicators were considered. Due to inconclusive scientific data on risk indicators, a Delphi process was used to gather structured expert opinion to supplement findings from the literature. Eleven Delphi participants with expertise in prosthodontics or periodontics participated in two email exchanges and one face-to-face meeting to comment and debate on the initial identification and weighting of risk indicators, propose the addition or removal of risk indicators, and provide recommended clinical management for each risk indicator. Results: After literature review, three rounds of debate, and additions and removals of various risk indicators, consensus (defined as 95% or more in agreement) was achieved on 20 risk indicators. The Delphi group concluded that the risk indicators of smoking, diabetes, periodontal disease, plaque levels, antiresorptive agents, and cemented restorations should include subcategories to more accurately identify and represent patient-specific risk. Clinical recommendations based on individual and aggregate risk were established by consensus. Conclusion: The literature on risk indicators for biologic complications was conflicting and inconclusive. The Delphi method was used to identify and establish the weighting of individual risk indicators, resulting in a risk assessment tool for estimating aggregate risk. [ABSTRACT FROM AUTHOR]

The article discusses Artificial intelligence (AI) in the Dentistry and dental technology, which includes Artificial Intelligence (AI) refers to the ability of machines or technologies, perform human tasks or human cognitive abilities to imitate. The machine another aspect of AI is learning the development of algorithms, the computer programs allow automatically through experience improve.

Treatment planning must be guided by the least invasive and least risky therapy, which simultaneously guarantees mid-to long-term stability and the potential for easy reintervention and reversibility. The finishing phase of orthodontic treatment for the space closure treatment option requires close communication/decision-making between the orthodontist and the prosthodontist so as to plan the best possible patient-oriented result. [Extracted from the article]

There is an empirical saying that if, as a prosthodontist, you have a good orthodontist at your side, every case will also be an orthodontic case. Today, based on a thorough diagnostic evaluation of a specific case, orthodontists are in most cases technically able to symmetrically or asymmetrically close gaps in the anterior region, thus eliminating the need for any tooth replacement. The other strategy, which is to place the teeth at their original position and to specifically replace the missing tooth locally by several prosthodontic options (2-unit cantilever resin-bonded FPD, implant-supported single-crown conventional 2-unit cantilever FPD, conventional 3-unit FPD, single veneer/crown on a autotransplanted tooth) sounds logical, reasonable, and desirable. [Extracted from the article]

The article presents comments on Peter Schärer, teacher, author and periodontologist, from the dentist fraternity and issues a dentist is confronted with. Tony Aherne said about Schärer, who died on December 22, 2004, that his academic brilliance helped the University of Zurich, Switzerland, to produce many brilliant clinicians and academicians. Lloyd Miller uses the imagery of an elephant in a room to highlight the towering presence Schärer had in the field of dentistry. The importance of symmetry and art is discussed that is important to a dentist to excel in the profession, in the quest for oral hygiene and esthetics.

Purpose: Edentulous patients with denture problems benefit from implant treatment with overdenture prostheses. The aim of this prospective study was to investigate a method of analyzing cost effectiveness in dentistry. As an example, overdenture treatment with two or four implants was compared to the conventional complete denture (CD). Materials and Methods: In a self-selected trial, 20 patients each were treated with implant-retained overdentures (two implants, IRET), implant-supported overdentures (four implants, ISUP), or CDs (control group) in the edentulous mandible. A cost-effectiveness analysis was performed from the patient's perspective, with a time horizon of 6 months. Direct health-care costs were calculated in Swiss Francs (in 2000), and effects were defined as improvements in perceived chewing ability compared with the baseline value before treatment (measured on a VAS). Point estimates for mean incremental cost-effectiveness ratios were complemented with cost-effectiveness acceptability curves to account for uncertainties associated with costs and effects. Results:Mean incremental costs were CHF 4,329 (IRET-CD), CHF 13,360 (ISUP-CD), and CHF 9,031 (ISUP-IRET); these cost differences were all statistically significant. The mean incremental effects at 6 months were 19% (IRETCD), 23% (ISUP-CD), and 4% (ISUP-IRET). Incremental cost-effectiveness ratios were CHF 228 (IRET-CD), CHF 581 (ISUP-CD), and CHF 2,258 (IRET-ISUP) per percentage increase in chewing ability. Conclusion: From an economic point of view, IRETs were more attractive than ISUPs. The latter were associated with a statistically significant improvement in perceived chewing ability compared to CDs, but at substantially higher costs. [ABSTRACT FROM AUTHOR]

The aim of the present study was to investigate the healing of alveolar ridge defects augmented with cancellous bovine bone mineral. In six partially edentulous patients, bone augmentation was necessary prior to implant placement because of severe alveolar ridge resorption. The defect sites, all located in the maxilla, were filled with Bio-Oss and covered with the resorbable collagen membrane Bio-Gide. Biopsies were obtained from the defect sites 6 to 7 months following grafting and were processed for ground sectioning. The histologic analysis revealed that the Bio-Oss particles occupied 31% of the total biopsy area. An intimate contact between woven bone and Bio-Oss was detected along 37% of the particle surfaces. A mixed type of bone was found; it contained woven bone and parallel-fibered bone, which demonstrates features of remodeling activity. Signs of resorption of the grafting material were observed in the histologic sections, which indicates that the material takes part in the remodeling process. It is suggested that Bio-Oss may be a very suitable material for staged localized ridge augmentation in humans. [ABSTRACT FROM AUTHOR]

The article focuses on a study regarding clinical experimentation of the advantages of using resin-bonded etched cast extracoronal attachments for removable partial dentures. Some of the advantages of etched cast retainers over traditional retainers include minimal tooth reduction, supragingival margins, and improved aesthetics. It describes the materials and methods used in the study. It discusses the results of the study which indicate that there is some evidence that the new technique of bonding extracoronal attachments may be a valuable addition in the field of esthetic removable partial prosthetics.

The increasing use of oral endoprostheses has offered new alternatives for fixed and removable prosthesis design. However, the use of implants also requires the complex understanding and use of sound prosthodontic principles. The establishment of proper maxillomandibular relationships (vertical dimension, occlusal plane, curve of Spee, tooth arrangement), esthetics, and function are essential precursors to success. Although the usefulness of rehabilitation with overdentures supported by osseointegrated fixtures is sometimes underestimated, overdentures provide an adequate treatment alternative in indicated cases. A case is presented in which previous preprosthetic surgery had failed and subsequently an overdenture supported by osseointegrated fixtures was constructed. [ABSTRACT FROM AUTHOR]

The aim of this prospective clinical study was to investigate the long-term survival of Procera AllCeram all-ceramic crowns in the anterior and posterior regions. Between 1997 and 2005, 155 Procera crowns with aluminum oxide cores were placed in 50 patients. Patients were recalled in 2005 for a clinical assessment. Thirty-nine patients with 135 crowns attended the recall examination. Of the 135 total crowns, 103 were located in the posterior region and 32 were located in the anterior region. The cumulative survival rate was 100% in the anterior region and 98.8% in the posterior region (1 crown fracture) after 5 and 7 years. Clinical success was achieved irrespective of the tooth position, cement used (resin composite or glass-ionomer cement), or the core design with reduced or conventional margins. Procera AllCeram seems to be a predictable technique for esthetic all-ceramic single crown restorations in the anterior and posterior regions. [ABSTRACT FROM AUTHOR]

A patient with an extremely poor dental situation, characterized mainly by missing molars, increased tooth mobility, and irregular tooth position/distribution, requested an esthetic and functional prosthetic rehabilitation with minimal surgical intervention. In the presented case, CAD/CAM technology using zirconia for fabricating a partially veneered fixed complete denture was planned for the upper jaw. A partially veneered removable complete denture on telescopic retainers was planned for the lower jaw. This article describes the fabrication of a fixed complete denture in the upper jaw as well as a removable complete denture in the lower jaw. The clinical and the technical laboratory steps are presented. [ABSTRACT FROM AUTHOR]

The combination of scanning technology and CAD/CAM procedures allows to significantly reduce working time clinically as well as for the dental laboratory. In comparison to conventional complete denture fabrication, the AvaDent® system provides specific trays and registration plates to complete all the required patient recordings and steps in the first appointment. By virtual modeling (CAD) and milling of the denture (CAM) out of a solid acrylic puck, time-consuming flasking and packing procedures are needless. Due to the abscence of any polymerisation shrinkage of the dentures, the precision of fit remains accurate. This system allows to efficiently deliver high-quality and cost-effective complete dentures for the edentulous patient in only two appointments. The clinical procedure is presented step-by-step and critically evaluated from the clinician’s point of view.

Ectodermal dysplasias (EDs) form a large clinically and genetically heterogeneous group of manifestations characterized by dystrophy or agenesis of embryologic ectodermal derivatives. Therefore skin, nails, hair, teeth and secretory organs are mainly affected. Hypohidrotic ectodermal dysplasia (HED) is the most common ED syndrom. It is characterized by atrichosis or hypotrichosis, anodontia or hypodontia and hypohidrosis. Missing teeth or retarded eruption of teeth often leads to the diagnosis of ED, which emphasizes the significance of an appropriate dental examination. Tooth agenesis and its effects on craniofacial structures are often the most signicificant clinical and therapeutical problem. It is a challenge to manage the functional, esthetic and psychosocial needs of these patients and therefore requires the involvement of different specialists, such as pediatrists, pedodontists, oral surgeons and prosthodontists.

Applications such as “prepCheck” allow objective and consistent judgments of tooth preparations. Hereby the respective preparation is matched with a standardized preparation. Whereas the learning curve in the beginning is time-consuming, after some time the faculty members will be relieved from additional mentoring time in the preclinical simulation laboratory. Students independently get an objective self-assessment by the software. Time and effort at the moment are in a misbalance since three scans (preparation, occlusion record, opposite jaw) are necessary. A simple one-scan procedure would be preferable. “prepCheck” is considered as a user-friendly software. It will play an essential role in the objective assessment of students tooth preparations in the future education.

In dentist's daily practice, intraoral scanning systems are increased. Besides scanning of prepared teeth, also implants could be scanned intraorally. This clinical report describes the step-by-step techniques to scan digitally intraoral implants with two intraoral scanners (Lava™ C.O.S., 3M Espe and the CEREC AC connected with inLab MC XL, Sirona) for generating implant suprastructures without the use of impression materials, dental stone or implant impression copings. Different workflows, possibilities and limits by scanning dental implants are demonstrated.

Objectives: Immediate loading of two unsplinted mandibular implants by means of an overdenture may be a viable and cost-effective treatment option to improve the patient's oral health-related quality of life. We therefore conducted a prospective observational study to estimate implant survival and patient satisfaction after an immediate loading protocol in edentulous patients., Materials and Methods: Twenty edentulous patients who received two interforaminal implants (Straumann Standard implant, length 12 mm) were included in our study. Immediately after implant placement, ball attachments with a diameter of 2.25 mm were placed on the implants and the respective matrices were directly incorporated in the existing complete denture. Clinical recalls were scheduled 1 week, 1, 3, 6 months, and 1 and 2 years after implant placement. The following clinical parameters were assessed: gingival bleeding index (GBI), visual plaque index (VPI), and soft tissue overgrowth. In addition, we also assessed radiological bone level change (RBLC) using panoramic radiographs, and patient satisfaction using a visual analogue scale at baseline, after 6 months and 2 years., Results: No implant failures occurred during the 2-year observation period, resulting in a survival rate of 100%. The mean RBLC was 0.67 mm (95% Confidence Interval [95% CI]: 0.47-0.86 mm) two years after surgery. The GBI and VPI after two years were 24 (95% CI: 9-38)% and 36 (95% CI: 19-53)%, respectively. Soft tissue overgrowth was 1.6 mm (95% CI: 1.1-2.1) on average after two years. In a multivariate regression model, patients with a GBI ≥50% on average showed an increased RBLC (-0.6 mm, p = 0.007). High patient ratings were recorded for overall satisfaction. Overall patient satisfaction measured on a scale between one and ten was 5.2 (95% CI: 2.1-8.5) before implant placement and 9.5 (95% CI: 9.1-10) after 2 years., Conclusion: Immediate loading of two unsplinted interforaminal implants in overdenture patients using ball attachments is a clinically viable treatment option that leads to a high survival rate and oral health-related quality of life.

Regardless of the success of preventive measures the replace¬ment of missing teeth in young patients with caries-free dentitions is a daily challenge for the clinician. The decision-making process concerning the different treatment options is difficult, based on several equivalent solutions. Thereby the significance of minimal invasive approaches is steadily increasing. In indicated cases, resin-bonded fixed partial dentures which were introduced in the last century still represent a well documented and minimally invasive procedure, even in the era of dental implants. In this article, clinical aspects of a conventional, metal-based resin-bonded fixed partial dentures are discussed according to the current literature and the clinical steps are presented in a clinical case.

Zirconia as a framework material is well established in fixed prosthodontics. However, for its application for removable dentures little experience exists. Zirkonzahn® has developed a copy-milling unit, that is a manually operated machine for the manufacture not only of frameworks but also of complete removable dentures. The aim of this case report is to show the step-by-step clinical and technical fabrication of a zirconia bar on implants and of a corresponding zirconia complete denture. The advantages and disadvantages of the system are presented and problems are critically discussed.

Various attachments are available to retain overdentures on natural roots or implants. Technical aspects, the clinical handling, the capability to adapt or repair and the costs are parameters to be considered when choosing the appropriate attachment. Ball attachments and bars are clinically established and well documented. Ball attachments as prefabricated, unsplinted units are easily replaceable and show hygienic advantages, while bars show favorable stability. The Locator is a newer, popular clinical alternative to these established attachments. The ball attachment and the Locator are compared from a technical and clinical point of view.

Different materials and methods can be used for edentulous maxillae rehabilitations. A precise fit between the implant and the framework is assumed. Hence, often implant suprastructures made by conventional lost wax techniques lack such a fit and a secondary modification is necessary. Alternatively the CNC-milling technique provides implant frameworks with a passive fit made of titanium and recently also of zirconia. This article describes the fabrication of a fixed complete dental prosthesis supported by seven implants in an edentulous maxilla. Two prostheses were fabricated, one made of a titanium framework veneered with resin and one made experimentally of a zirconia framework veneered with ceramics. The clinical and technical steps are documented and discussed.

Surgical navigation allows precise implant placement and minimizes the risk of interferences with anatomical structures. Computerized implant planning based on tomographic data can be clinically realized by surgical templates. These are normally produced by stereo lithographic rapid prototyping. Accurate placement of virtually planned dental implants depends on a precise fabrication and positioning of the surgical template. Bone-, tooth-, implant-, and/or soft tissue-supported surgical templates allow for different micromovements. This report documents the diagnostics and surgical procedures of implant placement in an edentulous patient. Implant fixed complete dentures in the maxilla and mandible were planned. In the maxilla implants were inserted with the aid of a conventional surgical template. In the mandible a bone supported CT-guided surgical template was used.