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The functional and aesthetic needs of a 17-year-old patient afflicted with ectodermal dysplasia, chronic long-term immunosuppression, cleft palate, velopharyngeal insufficiency, hypernasality, maxillary hypoplasia, and oligodontia were met with a multidisciplinary team approach. Predictable functional and aesthetic outcomes were obtained with a combination of injection augmentation of the soft palate and nasopharynx and rigid fixation maxillary external distraction with immediate placement and immediate load protocols. No biological or prosthetic complications were noted after definitive rehabilitation with a mandibular implant-retained fixed prosthesis and a maxillary implant-retained detachable prosthesis., (Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

The dowel-and-core restoration is indicated when inadequate tooth structure remains to retain an extracoronal restoration. A modified technique for fabricating the dowel and core combines the direct technique of forming the dowel in the actual channel with the indirect technique of creating an ideal core contour in the laboratory. This technique allows the operator to create an accurate and passive fit of the dowel pattern in the canal preparation. The technique also introduces the option of retrieving the dowel portion by utilizing a polyvinyl siloxane cast or liner. Further advantages of the technique are reduced chairside time and the ability to capitalize on the preparation of multiple teeth. The technique focuses efforts on achieving an accurate and passive fit of the dowel clinically while delegating the formation of the core to the laboratory.

Detailed background information leading to the development of a silicoating technique is presented with its advantages and disadvantages and its role in implant dentistry. The rationale is shown for coining a new acronym "osseointegrated Implant-Bone Unison" with an interest in biomechanical considerations for a prosthodontic restorative scenario. Several clinical cases are presented that involve silicoating and composite restorations.

One primary objective for implant therapy is the achievement of an aesthetic result, and this is significantly dependent upon the condition of the peri-implant soft tissue and the implant emergence profile. The requisite for the configuration of the definitive crown is formulated by the provisional restoration, which transfers the position of the implant and the peri-implant soft tissue to the model utilized in the fabrication process. This article demonstrates the use of a provisionalization stage to precisely replicate the peri-implant tissue in the definitive restoration.

Advancements in implant therapy have expanded the prosthetic options available to treat edentulous patients. The dental professional must be able to accurately diagnose the status of the intraoral environmental in order to provide the patient with appropriate treatment and a suitable restorative result. Skeletal relationships, arch malalignment, implant angulation, and ridge morphology must be evaluated during initial treatment planning and incorporated into the definitive prosthetic result. This case report demonstrates the application of an implant-supported prosthesis to address the various complications presented in the treatment of edentulous patients.

The disparity in dimensions between implant fixtures and the exposed extraction sockets has resulted in the development of anatomically shaped abutments. Systems have been recently introduced that facilitate the fabrication of abutments to the configuration of natural teeth in the anterior maxilla. These systems permit development of an aesthetic emergence profile and contours for easy access in maintenance of oral hygiene of maxillary anterior single-tooth implant-supported restorations. The rationale for the development, indications, advantages, and clinical utilization of a recently introduced abutment system is discussed.

The utilization of surgical stents/templates for implant placement is of significant importance to the success of the definitive prosthesis. However, major conceptual differences exist between surgical stents designed for implant-supported crowns and bridges and those designed for implant overdentures. In addition, various types of surgical stents exist within each group. In either case, optimizing the prosthetic result by customization of the stent should be a major consideration in the fabrication process. The design of the stent must account for several treatment conditions, including position of the implant, the tissue present, and the anticipated prosthesis. The teaching objective of this article is to present the prosthetic considerations in the fabrication and customization of surgical stents. The article compares the two groups and offers specific guidelines for the fabrication of surgical stents for the various types of restorations within each group.

The advances in osseointegration have resulted in an increased utilization of implants for restoration of the edentulous jaw. The success of osseointegrated implants supporting full arch prostheses has become more predictable. All implant restorations require a thorough diagnosis and a definitive treatment plan. Following a diagnostic wax-up, an optimal surgical implant template must be fabricated; it serves as a guide or prescription for placement of implants in an optimal anatomic location. The slightest misangulation of an implant may create restorative limitations. In such circumstances, alteration of the restorative design or selection of alternate materials may be required. The learning objective of this article is to review the fabrication of a combined ceramometal and resin-metal fixed/removable implant-supported mandibular hybrid prosthesis. Diagnosis, surgical template fabrication, vertical dimensions, buccal/lingual space limitations, and aesthetics are discussed.

Maxillary obturators are prostheses used to replace maxillary tissues, missing congenitally or removed by trauma or tumor ablative surgery. These prostheses are used to restore function (speech, swallowing, and mastication) and aesthetics. A considerable number of edentulous patients have difficulty in retaining this type of prosthesis. Utilization of osseointegrated dental implants is a significant adjunct in treating these cases, but it must be undertaken with careful planning to ensure predictable aesthetic results. The learning objective of this article is to discuss the technique of designing aesthetic maxillary prostheses supported by osseointegrated dental implants. The discussion includes indications and contraindications, and a postcarcinoma surgery case is used to illustrate the clinical procedure.

Maxillary definitive obturators are usually fabricated for patients who have an acquired defect. The obturators help patients with speech, swallowing, mastication, esthetics and psychological well-being. The main goals in restoring a maxillary defect with a completely edentulous or partially dentate obturator are to provide adequate retention, increased stability and strong vertical support. This article addresses the step-by-step fabrication of a maxillary obturator that meets these goals.

This article describes a technique that uses polyvinlysiloxane (PVS) putty impression material to create adequate space between the tissue and inferior margin of a framework in pattern construction for implant supported hybrid dentures. This spacer is easily retrieved from the cast, so the dental technician can evaluate and adjust the spacer to a standardized thickness and shape it to form the framework's underside. Basic framework construction for implant hybrid dentures is also reviewed, including specific dimensions, acrylic retentive features and passive construction. PVS putty impression material is easy to obtain, maintains dimensions well and is easy to shape, making it an excellent choice for use as a spacer and a matrix to preserve the position of denture teeth during fabrication.

The use of implants in retaining orbital prostheses has gained favor in recent years. Not all patients may be candidates for use of medical adhesives or anatomic retention as advocated by some. Osseointegrated implants offer an alternative method for retaining an orbital prosthesis. Because of the confining nature of an orbital defect, it may be difficult to reproduce the spatial arrangement of implants accurately with one impression. The technique presented here accomplishes the objectives of minimal trauma to the tissues, accuracy, and elimination of consecutive impression technique.

This article deals with the topic of nicotine replacement drugs and their use in smoking cessation. Questions frequently arise as to their prescription by dentists. Provided patients are carefully selected on the basis of medical and psychological profiles, there is no ethical or legal contraindication to dentists prescribing these aids. This article reviews the current literature and answers commonly asked questions concerning these effective drugs.

Overdentures can be utilized effectively in treatment plans involving implants. Usually soft tissue support is necessary, which requires a conventional denture base. Implant-supported overdentures do not require conventional denture base extension unless necessitated by functional or esthetic considerations. With fixed-detachable hybrid dentures, flanges can often interfere with home care procedures. Spark erosion overdentures meet the requirements for esthetics, phonetics, retention, and support and also allow accessibility for proper patient oral hygiene. This article reviews the advantages and disadvantages of the spark erosion overdenture and provides guidelines for the fabrication of this type of prosthesis.