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The patient, a 72 year old male, arrived to our clinic with a failing maxillary restoration on implants (hybrid bar on 10 Zimmer implants). When the restoration was removed for evaluation the reason for the failure became apparent. The bar was not passive and there were stress cracks all over the metal structure (Figs. 1a, b). Two of the implants were no longer integrated and needed to be removed, however, the others were stable and deemed sufficient to support a new maxillary fixed prosthesis. After taking a history, it became clear that it was not the first time this restoration had failed. In the past 10 years the hybrid bar was redone twice and repaired numerous times. The patient is a bruxer and kept fracturing the denture teeth from the bar as well as cracking the metal structure itself.
Dental implant therapy for the edentulous mandible is highly successful when measured at the level of the dental implant. When component and prosthetic complications are considered, recent systematic reviews suggest that component and prosthesis complications occur frequently. Many of these complications are related to prosthesis design and have been attributed to the cantilever designs that impose significant bending moments and stress to the prostheses and components.
Fixed restorations supported by implants are now the trend, although they are not easy to maintain by elderly patients. In such cases, the desire for natural fixed teeth is often given priority. Dieter Grau describes the case of a
patient who, after several unsatisfactory total renovations, decided to opt for immediate upper and lower implantation.
The new CAD / CAM technology that has recently emerged positively influences the entire scope of dentistry and dental technology, providing many possibilities of performing dental prostheses, be they fixed, removable or movable.
There are prosthetic restorations which do not reflect just how much work and effort lies behind them. Such interventions are harmoniously and discreetly integrated in the intraoral environment. Especially for prosthetic restorations on implants, there is a need for an increased dental and dental technical effort until a satisfactory patient’s recovery is obtained. This article aims to present the way in which a discreet and harmonious total prosthetic restoration is achieved supported on telescopes and implants. The concept of conical crowns made using the plating-ceramic technique with complete ceramics patrix and pure gold matrix has many positive features that facilitate a longlasting restoration and high comfort for the patient even for the difficult cases.
I’m sure most of you have heard of the story about the truck that got jammed under an overpass because the driver felt he had enough clearance to pass through, but didn’t because the truck was too tall. It’s a story that’s about 25 years old but the way it went was something like this.
It is often not easy to balance aesthetics, tissue interaction, simple application methods and efficiency. The dental industry and some colleagues imply to dental technicians and dentists alike that it is impossible to fabricate a proper implant prosthetic restoration without the use of a CAD/CAM system or at least a copy milling device.
I cannot imagine our profession without computers now or in the future and I am always open to new ideas. On the other hand I believe that still today, solid and innovative craftsmanship delivers a superior result technically as well as being more financially affordable. A perfect example is the fabrication of metal supported, all-ceramic, individual abutments without zirconium dioxide, CAD/CAM or costly pre-fabricated elements. While I was working on the realization of my ideas, I experienced resistance particularly from the dental industry sector, which considers skilled craftsmanship a thing of the past. But in my case, persistency paid off and helped me reach my goal.
A removable full restoration on an implantsupporting lower jaw bar is an exciting challenge for almost any dental technician. This requires a high degree of precision and offers patients security when talking, eating and laughing.
Guido Kirchberg is a proponent of such restorations and particularly appreciates their advantages in terms of oral hygiene. His contribution below describes the procedure in his laboratory.
In the following article, the authors demonstrate how to create an implant supported bar structure. Step-by-step they guide you through the backward-planning stages. They discuss the materials used in detail and address advantages and disadvantages of different designs.
Sun Opaque and Sun Dentine are two new VITA ceramic materials that reproduce shades that are extremely life-like and true to nature, while offering superior manipulation of luminosity, chroma and hue.
Since premiering at the IDS 2011 in Cologne, Ulmax Dental began using these new materials on more of their patients, praising the products as tools that allow them to utilize their creative options.
Chief Complaint: The patient presented to my office in 2008 with the following chief complaint:
“I cannot keep my upper bridge in and I was told that I need all new bridgework. I sought a second opinion from Dr. Joseph Buzzanco and he referred me here for an evaluation.” History of present illness: The patient had extensive crown and bridge in the maxillary in addition to 6 implants elsewhere in the dentition that have been successful. Teeth numbers 3 and 14 have been replaced with implants as well as numbers 19, 20, 28 and 30. The existing maxillary crown and bridge is approximately 6 years old and the patient is happy with the appearance. However, he was told by his general dentist prior to seeing Dr. Buzzanco that there were extensive caries under the crowns and therefore the crown and bridge had to be remade. The teeth from number 6 to number 11 had root canals, and posts.
Edentulous patients have numerous options with respect to prosthetics. Traditionally, completely edentulous patients would receive upper and lower complete dentures without even being presented or thinking of other types of treatment alternatives. Well, with today’s technology and treatment options, complete removable dentures should be a second option, and are no long the standard of care. Dental implant technology has revolutionized dentistry and denturism. Therefore implant retained dental prostheses are now considered the standard of care. With such a standard of care, comes many types of treatment options and one very interesting and newer implant retained option is the Marius Bridge.